2012 June 05 » Page 3

Left ventricular non-noncompaction: The mitral valve prolapse of the 21st century?

Jun 052012

Left ventricular non-noncompaction: The mitral valve prolapse of the 21st century?

Int J Cardiol. 2012 May 31;

Authors: Captur G, Flett AS, Jacoby DL, Moon JC

Abstract
A spongiform epidemic is upon us - myocardial trabeculae are everywhere as left ventricular noncompaction (LVNC) ingratiates itself into modern day cardiology. Current understanding of the condition is evolving but remains incomplete, and brings to mind the chronicles of another great cardiac story: mitral valve prolapse. Anecdote suggests that many individuals with prominent trabeculae may be being falsely labelled with a disease - LVNC - using poor echocardiographic and cardiovascular magnetic resonance criteria. Until we have robust diagnostic criteria, aetiology, clinicopathological significance and prognosis, the risk of casualties from ascertainment bias will remain. We should look to history and learn from past mistakes - specifically from the mitral valve prolapse story to show the way forward for LVNC. Meanwhile, clinicians (and patients) should be wary, bearing in mind the possibility that they might be seeing LVNNC - left ventricular non-noncompaction.

PMID: 22658573 [PubMed - as supplied by publisher]

Link to Article at PubMed

The Effect of Renin-Angiotensin-Aldosterone System Blockade on Contrast-Induced Acute Kidney Injury: A Propensity-Matched Study.

Am J Kidney Dis Start a Discussion »

Jun 052012

The Effect of Renin-Angiotensin-Aldosterone System Blockade on Contrast-Induced Acute Kidney Injury: A Propensity-Matched Study.

Am J Kidney Dis. 2012 May 30;

Authors: Rim MY, Ro H, Kang WC, Kim AJ, Park H, Chang JH, Lee HH, Chung W, Jung JY

Abstract
BACKGROUND: The role of the angiotensin-converting enzyme (ACE) inhibitor and angiotensin receptor blocker (ARB) in the pathophysiology of contrast-induced acute kidney injury (AKI) is controversial, and the available literature is contradictory. STUDY DESIGN: A retrospective propensity score-matched study to analyze the effect of ACE-inhibitor/ARB therapy on the development of contrast-induced AKI. SETTING & PARTICIPANTS: Using propensity score matching, 1,322 ACE-inhibitor/ARB recipients and nonrecipients were paired for analysis from 5,299 patients and fulfilled the inclusion criteria among 11,447 patients receiving coronary angiography (CAG) or percutaneous coronary intervention. PREDICTORS: ACE-inhibitor/ARB use based on prescription and risk factors for contrast-induced AKI. OUTCOMES: The incidence of contrast-induced AKI defined by AKI Network (AKIN) criteria: an absolute increase in serum creatinine levels ?0.3 mg/dL or a relative increase ?50% from baseline values within 48 hours after exposure to the contrast medium. MEASUREMENTS: Baseline serum creatinine, hemoglobin, and albumin levels; volume of contrast agents; preprocedural medication; and post-CAG serum creatinine levels. RESULTS: An ACE inhibitor/ARB was prescribed for 64.0% of patients receiving CAG. ACE-inhibitor/ARB users showed an increased incidence of contrast-induced AKI after propensity score matching (11.4% vs 6.3%; P < 0.001). In multivariable analysis, use of ACE inhibitors/ARBs remained an independent and significant predictor of contrast-induced AKI in an unmatched cohort (OR, 1.39; 95% CI, 1.10-1.76; P = 0.06). In the matched cohort, use of ACE inhibitors/ARBs also was associated with a higher adjusted OR of contrast-induced AKI (OR, 1.43; 95% CI, 1.06-1.94; P = 0.02). LIMITATIONS: A retrospective study at a single center. CONCLUSIONS: Use of ACE inhibitors/ARBs during CAG has a possible influence to increase the incidence of contrast-induced AKI. Further randomized clinical trials are warranted to confirm the effect of ACE-inhibitor/ARB therapy on the development of contrast-induced AKI.

PMID: 22658321 [PubMed - as supplied by publisher]

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Comparison of Chronic Kidney Disease and Risk for Presenting With Painless Versus Nonpainless Acute Myocardial Infarction.

Am J Cardiol Start a Discussion »

Jun 052012

Comparison of Chronic Kidney Disease and Risk for Presenting With Painless Versus Nonpainless Acute Myocardial Infarction.

Am J Cardiol. 2012 May 30;

Authors: Lee MG, Jeong MH, Lee KH, Park KH, Sim DS, Yoon HJ, Yoon NS, Kim KH, Kim JH, Ahn Y, Cho JG, Park JC, Kang JC

Abstract
Chronic kidney disease increases the risk for developing ischemic heart disease, but it has not been well known whether it also affects the manifestation of painless acute myocardial infarction (AMI), which has important clinical implications. The aim of this study was to identify whether chronic kidney disease is associated with the presentation of painless AMI. A total of 2,656 consecutively hospitalized patients with AMI from January 2008 to February 2012 were enrolled. Estimated glomerular filtration rate (eGFR) was calculated using calibrated serum creatinine and the abbreviated Modification of Diet in Renal Disease (MDRD) equation. Patient clinical characteristics, angiographic findings, and the use of medications were reviewed. Multivariate logistic regression analysis was used to examine the association of reduced eGFR and presentation with painless AMI. A total of 2,176 adults with painful AMI and 480 adults with painless AMI were studied, and baseline eGFR was calculated. Mean eGFR was lower in subjects with painless AMI compared to those with painful AMI. Compared to an eGFR >90 ml/min/1.73 m(2), a strong, graded, independent association was observed between reduced eGFR and presentation with painless AMI, with adjusted odds ratios of 1.65 (95% confidence interval 1.16 to 2.36) for an eGFR of 60 to 89 ml/min/1.73 m(2), 2.92 (95% confidence interval 1.89 to 4.52) for an eGFR of 45 to 59 ml/min/1.73 m(2), and 3.44 (95% confidence interval 2.20 to 5.38) for an eGFR <45 ml/min/1.73 m(2). In conclusion, lower eGFR was a strong, independent predictor of presentation with painless AMI versus painful AMI.

PMID: 22657394 [PubMed - as supplied by publisher]

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Clinical negligence, litigation and healthcare-associated infections.

J Hosp Infect Start a Discussion »

Jun 052012

Clinical negligence, litigation and healthcare-associated infections.

J Hosp Infect. 2012 May 31;

Authors: Goldenberg SD, Volpé H, French GL

Abstract
BACKGROUND: Litigation costs resulting from clinical negligence claims involving healthcare-associated infections are a significant but underappreciated cost to healthcare organizations. In England these claims are handled on behalf of the National Health Service (NHS) organizations by the NHS Litigation Authority (NHSLA). The total number of claims and the amounts awarded have increased significantly in recent years. AIM: To determine whether the recent significant reductions in meticillin-resistant Staphylococcus aureus (MRSA) bloodstream infection (BSI) and Clostridium difficile infections in England have had an effect on the number and value of NHSLA claims relating to these infections. METHODS: Data obtained from the NHSLA relating to claims mentioning C. difficile or MRSA from 2003 to 2010 were correlated with mandatory surveillance data from the Health Protection Agency for these infections. FINDINGS: The rate of NHSLA claims for MRSA has decreased in line with reductions in BSI for this infection (0.007 per BSI between 2003/4-2006/7 to 0.0017 per BSI between 2007/8 and 2010/11), but there was no significant change in claims relating to C. difficile infection. Overall the amounts awarded for successful claims have decreased significantly from a total of £76,846 for the period 1997/8-2006/7 to £24,821 for the period 2007/8-2010/11. CONCLUSIONS: The number of litigation claims involving MRSA has recently decreased significantly in line with surveillance data. There was no observed effect on claims involving C. difficile. The amounts awarded for successful claims for both infections have also fallen, although the reasons for this are not clear.

PMID: 22658237 [PubMed - as supplied by publisher]

Link to Article at PubMed

Infrared Pupillometry to Detect the Light Reflex During Cardiopulmonary Resuscitation: A Case Series.

Resuscitation Start a Discussion »

Jun 052012

Infrared Pupillometry to Detect the Light Reflex During Cardiopulmonary Resuscitation: A Case Series.

Resuscitation. 2012 May 30;

Authors: Behrends M, Niemann CU, Larson MD

Abstract
BACKGROUND: : The presence or absence of the pupillary light reflex following cardiopulmonary resuscitation has been shown to have prognostic value. We asked whether the light reflex could be objectively measured during cardiopulmonary resuscitation in humans and whether the quality of the reflex was associated with outcome. METHODS: : Sixty-seven in-hospital code blue alerts were attended of which 30 met our inclusion criteria. Portable infrared pupillometry was used to measure the light reflex during each code. The reliability of the presence of the light reflex during each code as a predictor of survival and neurological outcome was analyzed statistically using the Barnard's Exact test. RESULTS: : In 25 patients (83%) the pupillary light reflex was detectable throughout or during a part of the resuscitation. Continuous presence of the light reflex or absence for less than 5minutes during resuscitation was associated with early survival of the code and a good neurological outcome. In contrast, no patients without a light reflex or with a gradually deteriorating light reflex survived the code and absence of a pupillary light reflex for more than 5minutes was associated with an unfavorable outcome. CONCLUSION: : Portable infrared pupillary measurements can reliably demonstrate the presence and quality of the pupillary light reflex after cardiac arrest and during resuscitation. In our limited case series, the presence of the pupillary light reflexes obtained in serial measurements during resuscitation was associated with early survival and a favorable neurological status in the recovery period.

PMID: 22659054 [PubMed - as supplied by publisher]

Link to Article at PubMed

Proadrenomedullin improves REA-ICU score for predicting Early Severe Community-Acquired Pneumonia.

Chest Start a Discussion »

Jun 052012

Proadrenomedullin improves REA-ICU score for predicting Early Severe Community-Acquired Pneumonia.

Chest. 2012 May 31;

Authors: Renaud B, Schuetz P, Claessens YE, Labarère J, Albrich W, Mueller B

Abstract
Abstract BACKGROUND:Whether proadrenomedullin (ProADM) improves the performance of the Risk of Early Admission to ICU score (REA-ICU score) in predicting early severe Community Acquired Pneumonia (CAP) has never been demonstrated. METHODS:Secondary analysis of the original data from 877 consecutive patients with CAP enrolled in the ProHosp study, a multicenter trial in emergency departments of six tertiary care hospitals in Switzerland. Early severe CAP was defined by either the requirement for mechanical ventilation or vasopressive drugs or occurrence of death within 3 days of emergency department (ED) presentation. RESULTS:Eighty (9.1%) patients developed early severe CAP (47 required mechanical ventilation, 19 vasopressive drugs, and 16 died) within 3 days of ED presentation. They had a higher median ProADM value (2.18 nmol/L vs 1.15 nmol/L, P <0.001). Combining ProADM testing with the REA-ICU score improved the AUC (0.81) compared with either parameter (ProADM [0.73] or REA-ICU score [0.76], P <0.001) and resulted in a net reclassification improvement of 0.20 (P <0.001). A ProADM value ?1.8 nmol/L or assignment to REA-ICU risk classes III-IV predicted early severe CAP with a sensitivity of 76.3% and a negative predictive value of 96.7%. Excluding 21 patients with major criteria of severe CAP on presentation showed similar results. CONCLUSION:These study findings demonstrate that addition of ProADM to the REA-ICU score improves the classification of a substantial proportion of ED patients at intermediate or high risk for early severe CAP, which may translate into better triage decisions.

PMID: 22661450 [PubMed - as supplied by publisher]

Link to Article at PubMed

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