The concept of point-of-care, problem-oriented focus cardiac ultrasound examination (FoCUS) is increasingly applied in the settings of medical emergencies, including cardiac diseases. The European Association of Cardiovascular Imaging (EACVI) recognizes that cardiologists are not the only medical professionals dealing with cardiovascular emergencies. In reality, emergency cardiac diagnostics and treatment are also carried out by a wide range of specialists. For the benefit of the patients, the EACVI encourages any medical professional, sufficiently trained to obtain valuable information from FoCUS, to use it in emergency settings. These medical professionals need to have the necessary knowledge to understand the obtained information entirely, and to use it correctly, thoughtfully and with care. In this document, the EACVI underlines major differences between echocardiography and FoCUS, and underscores the need for specific education and training in order to fully utilize advantages and minimize drawbacks of this type of cardiac ultrasound examination in the critically ill patients.
BackgroundThe independent prognostic impact of diabetes mellitus (DM) and prediabetes mellitus (pre‐DM) on survival outcomes in patients with chronic heart failure has been investigated in observational registries and randomized, clinical trials, but the results have been often inconclusive or conflicting. We examined the independent prognostic impact of DM and pre‐DM on survival outcomes in the GISSI‐HF (Gruppo Italiano per lo Studio della Sopravvivenza nella Insufficienza Cardiaca‐Heart Failure) trial.Methods and ResultsWe assessed the risk of all‐cause death and the composite of all‐cause death or cardiovascular hospitalization over a median follow‐up period of 3.9 years among the 6935 chronic heart failure participants of the GISSI‐HF trial, who were stratified by presence of DM (n=2852), pre‐DM (n=2013), and non‐DM (n=2070) at baseline. Compared with non‐DM patients, those with DM had remarkably higher incidence rates of all‐cause death (34.5% versus 24.6%) and the composite end point (63.6% versus 54.7%). Conversely, both event rates were similar between non‐DM patients and those with pre‐DM. Cox regression analysis showed that DM, but not pre‐DM, was associated with an increased risk of all‐cause death (adjusted hazard ratio, 1.43; 95% CI, 1.28–1.60) and of the composite end point (adjusted hazard ratio, 1.23; 95% CI, 1.13–1.32), independently of established risk factors. In the DM subgroup, higher hemoglobin A1c was also independently associated with increased risk of both study outcomes (all‐cause death: adjusted hazard ratio, 1.21; 95% CI, 1.02–1.43; and composite end point: adjusted hazard ratio, 1.14; 95% CI, 1.01–1.29, respectively).ConclusionsPresence of DM was independently associated with poor long‐term survival outcomes in patients with chronic heart failure.Clinical Trial Registration
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00336336.
In relation to the percentile distribution of the values in the population analyzed, the normal range of m-IMT could be established just on the basis of the patient's age and sex. In this way, the ultrasound scan operator can rely on a simple reference scheme. This will help to refine the use of carotid ultrasound as an excellent tool for detecting asymptomatic carotid alterations and patients at high risk for cerebral and cardiovascular disease.
The metabolic syndrome (MetS) has previously been associated with an early marker of atherosclerosis, the carotid intima-media thickness (IMT). From the ISMIR (Ispessimento Medio Intimale e Rischio cardiovascolare [media-intima thickness and cardiovascular risk]) study population of 479 asymptomatic participants, we identified 80 participants with MetS. Carotid IMT and plaques were evaluated by ultrasonography. Blood samples were obtained from all participants. Participants with MetS had a significantly higher prevalence of a carotid IMT > 0.80 mm (P = .004) and of carotid plaques (P < .001) as compared with participants without MetS. Carotid IMT was significantly correlated with fasting triglycerides and fibrinogen levels both in participants with MetS and in those without MetS (all P < .01). In contrast, IMT correlated with fasting plasma glucose, serum creatinine, and uric acid levels only in participants without MetS. Our study confirms the association between MetS and carotid atherosclerosis. In MetS, a significant correlation between carotid IMT and triglycerides and fibrinogen levels was found.
Summary: Using subcostal echocardiography, 97 patients with diseases involving the right side of the heart and 15 nonnal subjects were examined in order to study the inferior vena cava (lVC) wall motion. All cases had a diagnostic cardiac catheterization and routine echocardiogram. The jugular pulse (JP) was recorded in 35 random cases contemporary to the IVC and tricuspid valve (TV) tracings. The aim of the study was to evaluate the variations of the IVC diameters in different cardiopathies and in relation to the right atrial mean pressure and the time-relationship of the IVC wall motion related to the cardiac rhythm and cycle, respiratory events, and IP and TV waves. The a, b, v, and y waves were identified on the IVC tracings and related to the respective waves of the IP and the points of closure and opening of the TV. The IVC a and v waves were coincident with the TV closure and opening, and therefore, considered as moments of maximal presystolic and systolic filling of the IVC. The IP a wave inscribed before, Whereas the v wave did so after the same IVC waves, respectively. The IVC a wave was due to the atrial contraction and influenced by the cardiac rhythm. The emptying index (EI) was calculated from the diameters in a and b as a -b/a x %, whereas the collapsability index
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.