Computed tomography (CT) used in cases of blunt abdominal trauma has been found sensitive in detection of bowel and mesenteric injuries and discrimination of operable from nonoperable candidates. In 51 patients with suspected bowel or mesenteric injury following blunt abdominal trauma, CT correctly depicted bowel hematoma or mesenteric injury in 17 of 19 nonoperable patients (89%) and severe injuries in one patient who died preoperatively. In 26 of 28 patients who underwent therapeutic laparotomy (93%), initial CT enabled identification of surgically confirmed injuries. In two cases, initial scan misinterpretation delayed diagnosis of serious bowel injuries. The correct interpretation was rendered preoperatively and at blind retrospective review. CT findings that correlated with bowel or mesenteric injury requiring surgery were free peritoneal fluid (27 of 28, 96%), mesenteric infiltration (24 of 28, 86%), thick-walled bowel (17 of 28, 61%), associated abdominal injuries (12 of 28, 43%), and free air (nine of 28, 32%). In nonoperable cases, CT scans demonstrated bowel thickening (84%) but less frequently peritoneal fluid (21%), mesenteric infiltration (26%), or associated injuries (5%). In three of four patients who underwent nontherapeutic laparotomy, preoperative CT correctly imaged the limited abdominal injuries.
Anemia and iron deficiency are often associated with heart failure, influencing the symptoms and prognosis. Correction of anemia and iron deficiency improves functional capacity and decreases hospitalizations. Many studies have analyzed echocardiographic parameters in iron deficiency and anemia and their evolution after iron treatment; however, the heterogeneity of the results makes it difficult to draw conclusions. The aim of this paper is to review the echocardiographic parameters during anemia and iron deficiency, and their evolution after treatment. Available data suggest that they lead to ventricular and atrial remodeling, a decrease in ventricular contractility, and an alteration of ventricular relaxation, although in heart failure with preserved ejection fraction these changes are not significant. Anemia and iron deficiency also increase systolic pulmonary artery pressure. There is consistent evidence that correction of these comorbidities leads to a reduction in preload and left ventricular cavity dimensions, an improvement in diastolic and load‐independent ventricular systolic function parameters, and a decrease in systolic pulmonary artery pressure. However, the evidence is less consistent about the changes produced in ventricular hypertrophy, load‐dependent systolic function parameters, and E‐wave. Generally, anemia and iron deficiency affect the echocardiographic findings, and correcting these conditions often results in improvement in the affected echocardiographic parameters.
Introduction: In patients with heart failure, global longitudinal strain (GLS) early detects decreased ventricular contractility, with prognostic value, but there is no evidence that GLS properly differentiates etiologies in patients with left ventricular ejection fraction <50%. Methods and aims: 147 patients with heart failure and left ventricular ejection fraction <50% were included retrospectively. The aims were to compare the GLS in patients with heart failure with reduced (<40%) to those with mildly reduced ejection fraction (40-49%) and, to compare GLS between the different etiologies in each of these two subpopulations. Results: 78 patients presented mildly reduced (53%) and 69 reduced ejection fraction (47%). The mean GLS was -13.4% ± 3.3% (mildly reduced -14.9% ± 2.9%, reduced -11.7% ± 3.0%, p <0.001). In mildly reduced ejection fraction, the etiologies were ischemic (47.4%), idiopathic (25.6%), tachycardiomyopathy (12.8%), valvular (11.6%), and toxic (2.6%), with similar mean GLS (p = ns among all etiologies). In reduced ejection fraction, the etiology of 50.7% patients was ischemic, 24.6% idiopathic, 10.1% valvular, 8.7% tachycardiomyopathy, and 5.8% toxic, with similar mean GLS (p = ns among all etiologies). Conclusions: There were no significant differences in GLS between the etiologies of heart failure in any subpopulation. The reduced ejection fraction patients presented worse GLS.
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