Assuntos
Reanimação Cardiopulmonar/métodos , Hidratação/métodos , Parada Cardíaca/mortalidade , Parada Cardíaca/terapia , Mortalidade Hospitalar/tendências , Pressão Sanguínea/fisiologia , Reanimação Cardiopulmonar/mortalidade , Pressão Venosa Central/fisiologia , Ecocardiografia Transesofagiana , Feminino , Parada Cardíaca/diagnóstico por imagem , Hemodinâmica/fisiologia , Humanos , Masculino , Monitorização Fisiológica/métodos , Valor Preditivo dos Testes , Medição de Risco , Volume Sistólico/fisiologia , Análise de Sobrevida , Equilíbrio Hidroeletrolítico/fisiologiaRESUMO
BACKGROUND: We hypothesized a patient selection score (PSS) may improve patient selection for cardiac resynchronization therapy (CRT). METHODS: Of 136 patients who received CRT, group A included 100 study patients and group B 36 patients for validation. A positive response to CRT was a left ventricular (LV) end-systolic volume decrease of ≥15% and survival from heart failure at end of follow-up. RESULTS: Of 100 group A patients, 37 (37%) were CRT responders during 14-month follow-up. A 7-point PSS was generated based on six variables. The cutoff point for PSS to predict a positive response to CRT was >4 by receiver operating characteristic (ROC) analysis. The area under the ROC curve (AUC) for PSS to predict CRT response was 0.94 (P = 0.0001). CRT responders in patients with a PSS > 4 and ≤4 were 33/40 (83%), and 4/60 (7%), respectively (P < 0.001). Multivariate Cox proportional regression analysis showed that PSS was related to CRT response (hazard ratio = 10.3, P < 0.0001). The CRT response rate in patients with a PSS > 4 in Group B was also significantly higher compared to a PSS ≤ 4 (88% vs. 16%, P < 0.001). The AUC for PSS to predict a CRT response in Group B was 0.91 (P = 0.0001). CONCLUSIONS: Patients with a PSS >4 are the most likely to respond to CRT. Using this score system, a PSS score >4 can predict the probability of a CRT response up to 88% in patients with heart failure and a wide QRS duration.
Assuntos
Terapia de Ressincronização Cardíaca/mortalidade , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/prevenção & controle , Avaliação de Resultados em Cuidados de Saúde/métodos , Seleção de Pacientes , Ultrassonografia/estatística & dados numéricos , Idoso , Comorbidade , Feminino , Insuficiência Cardíaca/diagnóstico por imagem , Humanos , Masculino , New York/epidemiologia , Prevalência , Medição de Risco , Fatores de Risco , Análise de Sobrevida , Taxa de Sobrevida , Resultado do TratamentoRESUMO
Acute cardiac tamponade requires urgent diagnosis and treatment. Spontaneous hemopericardium leading to cardiac tamponade as an initial manifestation of essential thrombocythemia (ET) has never been reported in the literature. We report a case of a 72-year-old Caucasian female who presented with spontaneous hemopericardium and tamponade requiring emergent pericardiocentesis. The patient was subsequently diagnosed to have ET. ET is characterized by elevated platelet counts that can lead to thrombosis but paradoxically it can also lead to a bleeding diathesis. Physicians should be aware of this complication so that timely life-saving measures can be taken if this complication arises.
