Inappropriate PPI therapy is still a problem in hospitals, though it appears to be at a lower level compared with previous studies. Awareness of evidence-based guidelines and targeted medicine reconciliation strategies are essential for cost-effective and safe use of these medications.
Systolic RV base/apex ratio is a simple 2D index of RV shape that powerfully predicts a PVR > 3 WU and provides powerful discriminating ability between PVH and PH .
right atrium/ventricle to left atrium bypass with extracorporeal membrane oxygenation circuit in 2, percutaneous support in 1. The mean duration of RVAD support was 15 ± 16 days. Of the 20 patients, 15 (75%) were weaned from the RVAD (weaning group), whereas 5 (25%) required continued biventricular support (failure group). Failure group had significantly higher preoperative central venous pressure compared to weaning group (12±1.2mmHg vs. 8.1±2.4 mmHg, p= 0.003). In the failure group, 4 died (80%) and 1 (20%) was successfully bridged to transplant after 73 days of biventricular support. In the weaning group, during 275±211 days of LVAD support, 6 (40%) underwent bridge to transplant, 7 (47%) died, and 1 (6.7%) underwent LVAD explant after myocardial recovery. Two required repeated readmission due to recurrent RV failure during isolated LVAD support. Kaplan Meier analysis showed overall survival at 6 month and 1-year in RVAD cohort was 68% and 62%, which was significantly worse compared to non-RVAD cohort (p< 0.01). Conclusion: Among patients who required RVAD support early after LVAD insertion in the current era, majority could be weaned from the RVAD support. However, overall outcome remains unsatisfactory.
and without TCM. EAT was defined as the hypoechoic area from the outer wall of the myocardium to the visceral layer of the pericardium, determined from the parasternal long-axis view. EAT was measured perpendicularly from the free wall of the right ventricle during systole. EAT thickness from three cardiac cycles were measured. Results: Twenty-five patients with TCM and a control group of 25 patients without TCM, matched for similar baseline characteristics were enrolled. EAT thickness was 5.3mm § 1.3 mm in TCM patients and 4.5 § 1.4 mm in the non-TCM group (p<0.05). Correlation was also found between EAT thickness and BMI (r=0.52, p<0.05). Conclusions: Our study demonstrates patients with TCM have increased EAT thickness, which we hypothesize may play a role in the pathogenesis of TCM.Background: Mineralocorticoid receptor antagonists (MRA) have been shown to improve mortality in patients with heart failure (HF) with reduced ejection fraction (EF) and morbidity in those with preserved EF. It is unknown if cardiac anatomy changes over time in patients prescribed MRAs compared to those without a prescription. Hypothesis: Patients prescribed MRAs have improved echocardiographic measurements compared to controls. Methods: The electronic medical record was queried to find patients with heart failure who were prescribed MRA along with agematched controls. Each subject had been prescribed a beta blocker (BB), renin-angiotensin-aldosterone blockade (RAAS), had creatinine clearance greater than 30 mL/min and serum potassium less than 5 mmol/L. For each subject, two transthoracic echocardiograms (TTE) in the hospital image archive were quantitated and compared in a blinded fashion by three echocardiologists. Baseline TTEs were at least 3 months after initiating BB and RAAS therapy. Follow-up TTEs were at least 3 months after MRA prescription. For controls, follow-up TTEs were selected using the mean datedifference in MRA TTEs. Subgroup analyses were performed based on age and gender due to aldosterone-mediated effects associated with these factors. Continuous variables were analyzed with linear regression and categorical variables with logistic regression. All analyses controlled for the time difference between the two TTEs. Results: Seventy-two subjects were identified: 29 MRA-treated (40%) and 43 controls (60%). Twenty-two (78%) MRA subjects and 29 (67%) controls had a baseline EF below 45% (p = 0.44). For the entire population, there were no significant echocardiographic changes between the MRA and control patients. For subjects over the age of 65 years, the mean change in left ventricular mass index (LVMI) was -13.3 g/m 2 for MRA subjects and 17.4 g/m 2 for control subjects (p=0.035). For the same population, left atrial volume index increased (+4.5 ml/m 2 ) for MRA subjects and decreased (-3.9 ml/m 2 ) for control subjects (p=0.06). The ejection fraction (EF) increased by 8.3% for the MRA subjects and did not change for control subjects (p=0.53). There were no differences in the gender subgroup. Conclusions: LVMI dec...
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