Background. In our clinical practice, conventional radial access has been employed routinely for coronary procedures. The distal radial artery (DRA) access site has recently emerged as a novel technique in cardiac procedures. Objectives. This study compares distal radial access to standard forearm radial access (FRA) in terms of feasibility, outcomes, and complications. Method. This prospective, randomized trial was conducted at a single center. The patients were chosen from An-Najah National University Hospital’s catheterization laboratory between December 2019 and November 2020. A total of 209 patients were randomized into two groups: DRA group (n = 104) and FRA group (n = 105). Results. Access was successful in 98% of patients in both the groups. The DRA group had a longer puncture duration and a higher number of attempts (duration: 56.6 ± 61.1 s DRA vs. 20.0 ± 18.4 s FRA, p < 0.001 , attempts: 1.9 ± 1.3 DRA vs. 1.2 ± 0.60 FRA, p < 0.001 ). Puncture-associated pain was greater in the DRA group (4 ± 2.2 DRA vs. 3 ± 2.1 FRA, p = 0.001 ). There were two radial artery occlusions in the FRA group and none in the DRA group ( p = 0.139 ). Percutaneous coronary intervention (PCI) was performed in 26% of the DRA group and 37.1% of the FRA group. The DRA group had significantly shorter procedure times ( p = 0.006 ), fluoroscopy times ( p = 0.002 ), and hemostasis times ( p = 0.002 ). Over time, the learning curve demonstrated improved puncture duration and a decrease in the number of puncture attempts. Conclusions. DRA is a safe and practical alternative to FRA for coronary angiography and intervention. The overtime learning curve is expected to improve puncture-related outcomes.
Background. The standard electrocardiogram (ECG) is commonly performed in the supine posture. It may be difficult to report ECG in a supine posture for those who are unable to adopt the supine posture because of certain circumstances such as acute respiratory distress syndrome—patients who are placed in a prone position for long periods to improve oxygenation. Few data are available on the impact of the prone position on the ECG recording with electrodes on the posterior chest. Examining and analyzing the type and extent of changes observed in the prone ECG in healthy adults have become vitally valuable. Methods. A cross-sectional observational study enrolled forty healthy adults (24 males and 16 females) aged between 18 and 40 years. The ECG was performed in two different body positions, supine and prone. Influence of prone position on the heart rate, mean QRS axis, amplitude, morphology, duration, mean T wave axis and polarity, mean P wave axis, PR, and mean QTc duration was evaluated. Results. The mean heart rate was higher in the prone position (73.2 ± 12.4 bpm) compared with the supine position (69.5 ± 11.5 bpm, p = 0.03). The QRS duration decreased considerably from supine (92.8 ± 12.6 ms) to prone (84.9 ± 11.9 ms, p < 0.001 ). The mean QRS axis moved to the left in the prone posture (40.5° ± 32°) relative to the supine (49° ± 28°, p = 0.015 ). The QRS amplitude in the precordial leads was significantly decreased from supine (7.42 ± 3.1 mV) to prone (3.68 ± 1.7 mV, p < 0.001 ). In addition, changes in the QRS morphology in leads V1–V3 with the appearance of new Q waves were noted. A notable variation in the mean corrected QT (QTc) period with decrease in duration in prone posture ECG (385 ± 64.8) relative to supine (406 ± 18.8, p = 0.05 ). Conclusions. Prone position ECG resulted in significant changes in healthy adults that should be aware of this as this can affect diagnosis and management strategies. Further studies are needed to investigate the impact of prone position on ECG recording in patients with cardiovascular diseases.
Background Heart failure (HF) is considered one of the main causes of morbidity and death among chronic diseases worldwide. Patients have increasingly reported chronic pain in long-standing heart failure as a disturbing symptom. Its unknown etiology and mechanism, in addition to its insidious progressive nature, made both the doctor and the patient not notice it until it affects the quality of life (QoL) and general health status. The primary objective of this study is to find the prevalence of pain in chronic heart failure patients and its impact on their QoL. The secondary objective is to determine the predictors of QoL in HF patients. Methods A multicenter cross-sectional design was used. The European Quality of Life scale five dimensions scale and the Brief Pain Inventory were adopted to evaluate QoL and pain, respectively. The Statistical Package for the Social Sciences version 25 was applied to present the data. The Mann-Whitney U, Kruskal-Wallis, and Cronbach alpha tests were used. Results The final study had a total of 142 individuals. The prevalence of pain among HF patients was 84.5%. Knee pain was the main complaint among patients. Our patients' median pain severity score was 18 [5.00–25.00], while the median pain interference score was 39 [24.75–53.00]. They had a median EQ-5D score of 0.34 [0.0–0.6] and an EQ-VAS score of 50 [30–70]. Pain severity (p = 0.004 and p < 0.001, respectively) and pain interference (p < 0.001 and p = 0.001, respectively) were found to significantly associated with both QoL scores; the visual analogue scale (EQ-VAS) and EQ-5D-5L. In multivariate analysis, monthly income was the only variable significantly correlated with EQ-VAS and EQ-5D-5L, along with pain variables. Conclusions Pain is a common symptom among patients with HF and is significantly associated with their QoL. Low income is also highly associated with poor QoL. Definitive guidelines should be achieved to increase awareness and understanding of the importance of pain management, reaching a higher QoL level, less pain, and good adherence to HF medications.
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