TWO YEAR RESULTS FROM THE COMPARE-ACUTE TRIAL Smits, Pieter; Omerovic, Elmir; Abdel-Wahab, Mohamed ...
Journal of the American College of Cardiology,
03/2018, Letnik:
71, Številka:
11
Journal Article
The objective of the study was to evaluate the ability of established and new parameters of global systolic left ventricle function to estimate myocardial infarct size. Increasing infarct extent is ...associated with impaired prognosis in chronic ischemic heart disease. Systolic myocardial deformation is a complex 3D process that is mainly influenced by the amount and transmural distribution of viable myocardium. Speckle-tracking echocardiography (2D-STE) enables deformation assessment along the 3 main cardiac axes independent of insonation angle.
Global longitudinal, circumferential, and radial strain and left ventricle twist by 2D-STE, global longitudinal strain rate and strain by tissue Doppler imaging, and left ventricle ejection fraction and wall motion score index were assessed in 40 patients 8.5+/-5.4 months after a first myocardial infarct and compared with global myocardial infarct mass assessed by contrast-enhanced MRI. Longitudinal and circumferential strain by 2D-STE and longitudinal strain and strain rate by tissue Doppler imaging significantly separated medium-sized infarcts from small or large infarcts at the global level (P<0.05). All deformation indices correlated significantly with global infarct mass (P<0.01). Circumferential and longitudinal strains by 2D-STE demonstrated the best ability to identify medium-sized global myocardial infarcts.
Circumferential and longitudinal strains by 2D-STE correlate with myocardial infarct mass and significantly differentiate among large, medium, and small myocardial infarcts.
There is no consensus on how, when, and at what intensity exercise should be performed and organized after heart transplantation (HTx). Most rehabilitation programs are conducted in HTx centers, ...which might be impractical and costly. We have recently shown that high-intensity interval training (HIT) is safe, well tolerated, and efficacious in maintenance HTx recipients, but there are no studies among de novo patients, and whether HIT is feasible and superior to moderate training in HTx recipients is unclear.
A total of 120 clinically stable HTx recipients older than 18 years will be recruited from 3 Scandinavian HTx centers. Participants are randomized to HIT or moderate training, shortly after surgery. All exercises are supervised in the patients' local communities. Testing at baseline and follow-up includes the following: VO2peak (primary end point), muscle strength, body composition, quality of life, myocardial performance, endothelial function, biomarkers, and progression of cardiac allograft vasculopathy. A subgroup (n = 90) will also be tested at 3-year follow-up to assess long-term effects of exercise.
So far, the HIT intervention is well tolerated, without any serious adverse events. We aim to test whether decentralized HIT is feasible, safe, and superior to moderate training, and whether it will lead to significant improvement in exercise capacity and less long-term complications.
... three randomised trials that tested therapy with BMC were negative for the primary endpoint, improvement in left ventricular ejection-fraction (LVEF).3-5 REPAIR-AMI was a study in 204 patients ...with acute myocardial infarction who, after successful revascularisation with percutaneous coronary intervention, were randomised to receive an intracoronary infusion of BMC or placebo medium into the infarct artery.6 After 4 months' follow-up, mean LVEF increased from 47% to 50% in the placebo group, and from 48% to 54% in the group given BMC. Surprisingly, in view of the modest improvement in left ventricular function, there was also a significant reduction in clinical events after 12 months in the treatment group compared with the placebo group (hazard ratio 0.52,95% CI 0.32-0.86, for the combined endpoint of death, myocardial infarction, or revascularisation) (table).7 The investigators concluded that large-scale trials based on the methods in REPAIR-AMI are now warranted to study effects on morbidity and mortality.6,7 For two reasons, we are concerned about that conclusion.
Recently, Hartmann and Hartmann
(2014)
found that psychiatric outpatients, both with and without access to Internet-based information about the Rorschach Inkblot Method (RIM; Weiner,
2003
) and the ...MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer,
1989
), were unable to imitate healthy test performance on these tests. We replicated the study by administering the RIM and the MMPI-2 to 63 incarcerated violent offenders using similar testing conditions. As in the previous study, comparisons were made not only among the 3 subgroups of incarcerated offenders, but also between these offender groups and the group of nonpatients examined in the previous study. On the RIM, Internet-coached and uncoached "faking good" offenders produced records with significantly higher F% and X-% and significantly lower M, m, SumC, X+%, P, AG, and COP than nonoffenders under standard instructions (effect sizes between d = 0.24 and d = 2.39). For AgC, AgPot, AgPast, and TCI% there were no significant differences between the faking offenders and the nonoffenders under standard instructions. On the MMPI-2 clinical scales, there were no significant differences between the faking good groups and the nonoffenders under standard instructions, except on Hs, Pd, and Sc. Both faking groups were identifiable by their high L scale scores. Although both faking groups managed to avoid giving responses with aggressive and generally psychopathological content on the RIM, they were unable to produce test profiles demonstrating healthy test performance on any of the tests; nevertheless, Internet-based test information might weaken test validity.
Catheter-based left atrial appendage closure Lunde, Ketil; Al-Ani, Ahmed; Bjørnerheim, Reidar ...
Tidsskrift for den Norske Lægeforening,
04/2018, Letnik:
138, Številka:
7
Journal Article
Recenzirano
Atrieflimmer er en vanlig tilstand i befolkningen og gir økt risiko for hjerneslag. Antikoagulasjonsbehandling er effektivt for å forebygge tromboembolisme ved atrieflimmer, men av ulike grunner blir ...mange atrieflimmerpasienter med indikasjon for antikoagulasjonsbehandling ikke behandlet. Kateterbasert lukking av venstre atriums aurikkel er en ny metode for å forebygge hjerneslag ved atrieflimmer.
I perioden september 2014-april 2016 gjennomgikk 27 pasienter med atrieflimmer og høy risiko for hjerneslag forsøk på kateterbasert lukking av venstre atriums aurikkel ved Oslo universitetssykehus. Antikoagulasjonsbehandling var vurdert som kontraindisert hos 26 av pasientene. Vi presenterer resultater fra prosedyre, ekkokardiografikontroller og kliniske hendelser i oppfølgingsperioden på ett år.
Aurikkelplugg ble vellykket implantert hos 26 pasienter. To pasienter fikk komplikasjoner i forbindelse med prosedyren: En fikk hjerneslag og en fikk transfusjonskrevende lyskeblødning. En pasient fikk hjertetamponade fem måneder etter prosedyren. En pasient som grunnet anatomisk vanskelige forhold ikke fikk implantert aurikkelplugg, døde av hjerneslag i oppfølgingsperioden. Tre pasienter hadde klinisk transitorisk iskemisk anfall (TIA). Det var ingen forekomst av intrakranial eller gastrointestinal blødning.
Kateterbasert lukking av venstre atriums aurikkel er gjennomførbart, men innebærer risiko for komplikasjoner og bør forbeholdes pasienter med høy risiko for hjerneslag og kontraindikasjon mot antikoagulasjonsbehandling.
This paper presents multiview and multiframe active appearance models (AAMs) for left ventricular segmentation in triplane echocardiograms. We describe a general way of integrating local edge ...detector based segmentation algorithms into the AAM framework. The feasibility of this approach is evaluated by comparing an AAM constrained by a dynamic programming (DP) based snake with an unconstrained AAM, and an AAM constrained by manually defined landmarks. A leave-one-out validation scheme was used for training and testing of the methods. Evaluation was done in 36 patients suffering from various heart diseases, using manually determined volumes and ejection fractions (EF) as reference. The segmentation was initialized by manual selection of the mitral annulus and apex in three imaging planes. The differences, in volume, between manual segmentation and the best automatic method (DP-constrained AAM) were -3.1 plusmn 20 ml (meanplusmnSD) at end-diastole and 0.61 plusmn 13 ml at end-systole. The difference in EF was -1.3 plusmn 6.3%, comparable to the interobserver variability. We show that 1) constraining the model to manually defined landmarks improves volume and EF estimates compared to unconstrained AAMs, 2) further improvement is achieved using a DP-constrained AAM, and 3) segmentation in triplane echocardiograms gives higher accuracy than single plane data.
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