Background The ability of left ventricular ejection fraction (LVEF) and late gadolinium enhancement (LGE) by cardiac magnetic resonance for risk stratification in suspected heart failure is limited. We aimed to evaluate the incremental prognostic value of cardiac magnetic resonance‐assessed extracellular volume fraction (ECV) and global longitudinal strain (GLS) in patients with signs and symptoms suspecting heart failure and no clinical evidence of coronary artery disease. Methods and Results A total of 474 consecutive patients (57±21 years of age, 56% men) with heart failure‐related symptoms and absence of coronary artery disease underwent cardiac magnetic resonance. After median follow‐up of 18 months, 59 (12%) experienced the outcome of all‐cause death or heart failure hospitalization (DeathCHF). In univariate analysis, cardiac magnetic resonance‐assessed LVEF, LGE, GLS, and ECV were all significantly associated with DeathCHF. Adjusted for a multivariable baseline model including age, sex, LVEF and LGE, ECV, and GLS separately maintained a significant association with DeathCHF (ECV, hazard ratio [HR], 1.44 per 1 SD increase; 95% CI 1.13–1.84; P =0.003, and GLS, HR, 1.78 per 1 SD increase; 95% CI, 1.06–2.96; P =0.028 respectively). Adding both GLS and ECV to the baseline model significantly improved model discrimination (C statistic from 0.749 to 0.782, P =0.017) and risk reclassification (integrated discrimination improvement 0.046 [0.015–0.076], P =0.003; continuous net reclassification improvement 0.378 [0.065–0.752], P <0.001) for DeathCHF, beyond LVEF and LGE. Conclusions In patients with signs and symptoms suspecting heart failure and no clinical evidence of coronary artery disease, joint assessment of GLS and ECV provides incremental prognostic value for DeathCHF, independent of LVEF and LGE.
Studies on the side effects of diazepam on the particularly vulnerable brain of preterm infants have not been done so far. We studied changes of blood flow velocity in the anterior, basilar and internal carotid artery by Doppler technique in 11 preterm infants < 1,500 g who were given 0.5 mg/kg i.v. diazepam. The flow velocities in the internal carotid and basilar artery did not change significantly and values for carbon dioxide tension, mean arterial blood pressure and HF remained stable. There was a marked increase of flow velocity in the anterior cerebral artery. We conclude that diazepam in this dosage does not cause dangerous haemodynamic changes in the premature brain.
Aim of the study was the assessment of possible side effects of analgesia with pethidine on the intracerebral circulation of very immature preterm infants. For this purpose the blood flow velocity in the internal carotid artery, basilar cerebral artery and the anterior cerebral artery was measured by pulsed Dopplersonography before and 5-10 min after i.v. injection of 1.0 mg/kg pethioine on 10 preterm infants with a gestational age of 24-30 weeks. Furthermore values for the parameter mean arterial blood pressure, heart frequency and tcpCO2 were obtained. None of the measured parameters showed a significant difference with the i.v. bolus injection of pethidine. As even very immature preterm infants do feel pain and can show potential dangerous physiological pain reactions and as this study proves the tolerance of the drug, analgesia with morphine derivates is recommended.
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