No abstract

ÖZETAmaç: Kronik kalp yetersizliği (KKY) hastalarında kardiyak mortalite ve tekrarlayan hastaneye yatışları öngören komorbidite durumları araştırmak. Yöntemler: Hafif, orta ve ciddi (NYHA sınıfı II-IV) KKY'li 580 hasta (ortalama yaş 63±13 yıl, 373 erkek, 207 kadın, ortalama ejeksiyon fraksiyon (EF) %26±9) bu prospektif gözlemsel çalışmaya dahil edildi. Çalışmamızda dekompanse kalp yetersizliği nedeniyle Ocak 2003 ve Temmuz 2009 tarihleri arasında Kocaeli Üniversitesi, Tıp Fakültesi hastanesine yatırılan KKY'li hastalarda mevcut olan tüm komorbidite durumları; iskemik inme, koroner arter hastalığı, periferik arter hastalığı, kronik obstrüktif akciğer hastalığı, hipertansiyon, diyabetes mellitus ve kronik böbrek yetersizliği öyküsünü değerlendirdik. İstenmeyen sonlanım olayların öngödürücüleri Cox regresyon ve Kaplan-Meier sağkalım analizleri ile belirlendi. Bulgular: Toplam 580 hastadan 207 (%36) hasta kardiyovasküler nedenlerden dolayı öldü. Çoklu Cox regresyon analizinde yaş ( HR-1.06, %95 GA %95 GA 1.04-1.08, p<0.001), NYHA fonksiyonel kapasite, (HR-3.20, %95 GA 1.90-5.41, p<0.001), iskemik inme öyküsü (HR-2.48,%95 GA 1.14-5.37, p=0.022), hs-CRP (HR-1.09, %95 GA 1.04-1.15, p=0.001), BNP (HR-1.00, %95 GA 1.00-1.00, p=0.01) ve hemoglobin (HR-0.90, %95 GA 0.81-0.99, p=0.038) kardiyak ölüm için bağımsız öngördürücü olarak saptandı. KKY'li hastalarda iskemik inme öyküsü diğer komorbidite durumlara göre ABSTRACT Objective: To investigate comorbidities that predict cardiac mortality and re-hospitalization in chronic heart failure (CHF) patients. Methods: Five hundred eighty patients (mean age 63±13 years, 373 male, 207 female, mean ejection fraction (EF) 26±9%) with mild, moderate or severe CHF [NYHA class II-IV] were included in this prospective observational study. We evaluated all comorbidities such as history of ischemic stroke, coronary artery disease, peripheral arterial disease, chronic obstructive lung disease, hypertension, diabetes mellitus and chronic kidney disease in CHF patients who were hospitalized due to decompensated heart failure in Kocaeli University, Faculty of Medicine's Hospital between January 2003 and July 2009. Cox regression and Kaplan-Meier survival analyses were used to establish predictors of unfavorable outcomes. Results: Of 580 patients 207 (36%) patients died due to cardiovascular reasons. In multivariable Cox regression analysis age (HR-1.06, 95% CI 1.04-1.08, p<0.001), NYHA functional class (HR-3.20 95% CI, 1.90-5.41, p<0.001), history of ischemic stroke (HR-2.48, 95% CI 1.14-5.37, p=0.022), high-sensitive C-reactive protein (HR-1.09, 95% CI, 1.04-1.15, p=0.001), brain natriuretic peptide (HR-1.00, 95% CI 1.00-1.00, p=0.01) and hemoglobin p=0.038) were independent predictors of cardiac death in the present study. History of ischemic stroke was demonstrated as an important comorbidity that predicts cardiovascular mortality beyond other co-morbidities in CHF patients. NYHA functional class (HR-2.85, 95% CI 1.80-4.65, p<0.001), left ventricular EF p=0.039) and ischemic stroke histor...

The benefits of taking of aspirin, clopidogrel, and warfarin in relation to cardiovascular mortality and re-hospitalization in chronic heart failure (HF) patients have been called into question. We examined the outcomes (cardiac mortality and/or HF re-hospitalization) in patients discharged from our hospital between January 2003 and July 2009 after hospitalization for chronic decompensated HF. Of 580 HF patients (mean age, 63 ± 13 years; mean ejection fraction, 26 ± 9%, 63% with coronary disease and 37% without coronary disease), 207 patients (36%) died due to cardiovascular reasons, and 313 (54%) required HF re-hospitalization for decompensated HF during a 39 ± 14 month follow-up period. 101 (17%) patients were taking clopidogrel during enrollment in the study. When comparing patients who were on clopidogrel treatment with those who were not, clopidogrel was found to have a beneficial effect on cardiac mortality (27 vs. 38%, P = 0.04). In conclusion, in this observational prospective study, patients who used clopidogrel showed decreased cardiac mortality [HR, 0.566 (95% CI 0.332-0.964), P = 0.036] compared to patients who did not take clopidogrel. Clopidogrel had a beneficial effect on the survival of chronic HF patients in the long term.

Introduction: The purpose of this study was to compare the results of physical examinations (PEs) performed by a cardiologist with the results of point-of-care echocardiography for the diagnosis and management of patients during cardiac consultation rounds. Patients and Methods:In all, 265 hospitalized consecutive patients from non-cardiac units (age, 62 ± 11; male, 56%) were included after complete cardiovascular (CV) examination by a consulting cardiologist. After the PE, the consulting cardiologist imaged each patient using a hand-carried cardiac ultrasound (HCU). All patients subsequently underwent a study with a standard echocardiographic device (SED) as the gold standard, performed on an upper-end platform. Defi nitive diagnosis, management change, and modifying diagnostic workup were also assessed.Results: There were 196 CV fi ndings detected with an SED in this patient population. Of these, PE failed to detect 41% of the overall CV fi ndings and HCU missed 23% of the overall CV pathology. Overall, HCU had an effect on patient treatment decisions in 149 patients (56%); 42% had a change in medical therapy and 21% had a change in their diagnostic workup (most with changes in both). Conclusion:HCU echocardiographic assessment during consultation rounds improved the detection of signifi cant CV pathology. Also, a direct assessment of cardiac function and anatomy at the bedside by an experienced cardiologist with HCU as a routine adjunct to PE results in an important change in clinical management and diagnostic workup during consultation.Key Words: Hand-carried cardiac ultrasound; point-of-care screening Kardiyak Konsültasyonlar Esnasında Tanı ve Tedavide Taşınabilir Ekokardiyografi Cihazları ile Birlikte Fizik Muayenenin Karşılaştırılması ÖZETGiriş: Bu çalışmanın amacı, kardiyak konsültasyon esnasında tanı ve tedavi üzerinde ekokardiyografi sonuç-ları ile kardiyolog tarafından gerçekleştirilen fi zik muayene sonuçlarını karşılaştırmaktır.

The impact of coronary revascularization methods (coronary artery bypass graft [CABG] surgery and stent implantation) on clinical outcome has not been determined yet in patients with systolic heart failure (SHF). We examined outcomes in patients discharged from our hospital after hospitalization for decompensated SHF. Of 637 patients with SHF (mean age, 64 ± 13 years; mean ejection fraction, 26.5% ± 9%), 402 patients (63%) had coronary artery disease (CAD) and 235 patients (37%) had no CAD; 223 patients (35%) died because of cardiovascular reasons during follow-up. Patients who had stenting alone and patients who had CABG surgery and stenting had better prognosis than patients with CAD but no revascularization procedure (P < .001 and P = .013, respectively). In the patients with SHF having CAD who had stenting and CABG surgery + stenting may have better prognosis compared with patients with CAD who had no revascularization procedure in their past.