Early Doppler echocardiographic dysfunction is associated with an increased mortality after orthotopic cardiac transplantation.

BACKGROUND: Doppler echocardiographic (DE) diastolic dysfunction has been correlated with rejection after orthotopic cardiac transplantation (Tx). However, the relationship of early diastolic dysfunction to late outcome is unknown. The purpose of this study was to assess the correlation between early DE diastolic dysfunction and outcome after heart Tx. METHODS AND RESULTS: Of 133 patients undergoing heart Tx between October 1990 and April 1994, 83 were identified with > or = 4 routine DE performed during the first 6 months. Assessment of diastolic function included measurement of isovolumic relaxation time (IVRT), pressure half-time (PHT), and peak early mitral inflow velocity (M1). Diastolic dysfunction was defined as a decrease of 15% from baseline (IVRT and PHT) or an increase of 20% (M1). A mean dysfunction score (MDS) was calculated for each patient (number of episodes of dysfunction by Doppler total number of echocardiograms performed). The population diastole MDS was determined and two groups established (group 1, MDS < mean; group 2, MDS > mean). Actuarial survival, rejection, and transplant coronary artery disease (TxCAD) were compared between groups. Actuarial survival was significantly reduced in patients with greater early diastolic dysfunction (P < .05). There were 17 deaths overall: 5 in group 1 (mean, 786 days) and 12 in group 2 (mean, 384 days). There were no significant differences in treated rejection episodes, actuarial freedom from rejection or TxCAD, immunosuppression, sex, donor age, donor ischemic time, or cytomegalovirus between the two groups. CONCLUSIONS: Diastolic dysfunction within 6 months of transplant was associated with an increased late mortality.

Description of the interview process in selecting students for admission to U.S. medical schools.

A survey was made of the medical schools in the United States to obtain a description of the interview process used in the selection of first-year medical students. The following questions were the basis for the study: What is the role of the interview in the selection of medical students? What is the nature of the interview process? How is the interview administered? An 87 percent response rate was obtained. The results indicated that 99 percent of the responding medical schools use interviews in evaluating students for medical school admission, and the interview ranks second only to the grade-point average in importance among four selection factors. The interview is usually in a one to one setting, with each applicant having two separate interviews. All schools use faculty and staff members in interviewing, and usually at least one admissions committee member interviews each applicant. Usually interviews are conducted on the campus of the school. Implications drawn from the results indicate a need for a quantification of methods to incorporate the interview into the selection process.