Blood transfusion decisions cannot be based on percutaneous haemoglobin measurements.

INTRODUCTION: Percutaneous measurement of haemoglobin (SpHb) has been an emerging technique in the past decades. It has been suggested that SpHb measurement could be used as a trend monitor and as a supportive tool for easier and faster transfusion decision-making. The aim of this study was to investigate whether SpHb monitoring is a useful instrument in transfusion decision-making. MATERIAL AND METHODS: Patients scheduled for surgery with expected blood loss over 800 mL were included in the study. SpHb was measured using a Masimo Rainbow probe. Blood samples were drawn before and after surgery and, if clinically indicated, during surgery. Moreover, perfusion parameters were analysed, as well as transfusion triggers. RESULTS: Based on transfusion triggers 27.1% of patients would not have been transfused according to National Guidelines (14.5% transfused in error, 12.5% not transfused when indicated). Invasive haemoglobin (invasive Hb) and SpHb were obtained 266 times in 75 patients. The mean invasive Hb was 7.37 ± 1.34 mmol L-1 and SpHb was 6.47 ± 0.81 mmol L-1 (P < 0.001). Bland-Altman analysis corrected for multiple measurements revealed proportional bias of -4.05 + 0.72 Hb (least bias at Hb 5.62). CONCLUSIONS: The precision of the SpHb measurement exceeded the acceptable range of error. We concluded that SpHb measurement using the Rainbow device is too unreliable to be an acceptable alternative to invasive Hb measurement, or even as a trend monitor or decision support tool.

Short- and Longer-Term Association Between Body Mass Index and Health Status in Cardiac Rehabilitation Patients.

PURPOSE: The association between body mass index (BMI) and subjective health status before and after cardiac rehabilitation (CR) and 1 year later was compared in patients undergoing primary percutaneous coronary intervention (pPCI) who did (CR group) and did not receive CR (no-CR group). The aim was to investigate the association between BMI and subjective health status based on the Short Form-12 questionnaire. METHODS: Between 2009 and 2011, 242 patients with pPCI with an acute myocardial infarction completed a CR program and were compared with 115 patients in the no-CR group. All patients completed the Short Form-12 questionnaire at baseline, at 12 weeks, and at 1-year followup. The CR program consisted of a 2 sessions per week for 1.5 hours each for 12 weeks. Patients were categorized into 3 groups based on BMI: normal weight, overweight, and obese. RESULTS: Compared with patients in the no-CR group, CR group patients in the overweight group significantly improved their subjective health status after CR and these improvements were sustained at 1-year followup. CR patients in the normal weight and obese groups did not significantly improve subjective health status. The overweight patients had the highest improvement in subjective health status (OR = 3.4 post-CR and 5.1 at 1 year of followup). CONCLUSIONS: After CR, overweight patients showed the best improvement in subjective health status. CR did not significantly improve subjective health status in normal-weight and obese patients.

Prognostic Value of Coronary Computed Tomography Imaging in Patients at High Risk Without Symptoms of Coronary Artery Disease.

At present, traditional risk factors are used to guide cardiovascular management of asymptomatic subjects. Intensified surveillance may be warranted in those identified as high risk of developing cardiovascular disease (CVD). This study aims to determine the prognostic value of coronary computed tomography (CT) angiography (CCTA) next to the coronary artery calcium score (CACS) in patients at high CVD risk without symptoms suspect for coronary artery disease (CAD). A total of 665 patients at high risk (mean age 56 ± 9 years, 417 men), having at least one important CVD risk factor (diabetes mellitus, familial hypercholesterolemia, peripheral artery disease, or severe hypertension) or a calculated European systematic coronary risk evaluation of >10% were included from outpatient clinics at 2 academic centers. Follow-up was performed for the occurrence of adverse events including all-cause mortality, nonfatal myocardial infarction, unstable angina, or coronary revascularization. During a median follow-up of 3.0 (interquartile range 1.3 to 4.1) years, adverse events occurred in 40 subjects (6.0%). By multivariate analysis, adjusted for age, gender, and CACS, obstructive CAD on CCTA (≥50% luminal stenosis) was a significant predictor of adverse events (hazard ratio 5.9 [CI 1.3 to 26.1]). Addition of CCTA to age, gender, plus CACS, increased the C statistic from 0.81 to 0.84 and resulted in a total net reclassification index of 0.19 (p <0.01). In conclusion, CCTA has incremental prognostic value and risk reclassification benefit beyond CACS in patients without CAD symptoms but with high risk of developing CVD.