Background Estimations of right ventricular (RV) and left ventricular (LV) size and function based on 1D and 2D measures are commonly used. However, their correlation with volumetric analysis methods ...is not well documented. Methods We analysed a series of subjects undergoing CMR ( n = 30). Contiguous short axis cine imaging was obtained to assess RV and LV volumes and function. Standard short and long axis cine imaging were performed to evaluate linear and planimetric dimensions as well as functional analysis. Results Linear and planimetric measurements of the RV in standard long and short axis views correlated weakly with standard volumetric measurements ( r = 0.34–0.73). RV ejection fraction (EF), when calculated from single plane functional analysis correlated only moderately with the volumetric EF ( r = 0.75, p < 0.001). In contrast, estimation of LV volumes, mass and EF by biplane area–length method demonstrated excellent correlation with volumetric data ( r = 0.89, 0.92 and 0.91, p < 0.001 for all). Conclusion Two-dimensional estimations of volume and function correlate well with LV volumetric analysis, but not with RV volumetric analysis. Estimation of RV size and function based on linear or planimetric assumption models should be performed and interpreted with caution.
Abstract Iron deficiency (ID) has been identified as an important comorbidity in patients with heart failure (HF). Intravenous iron therapy reduced symptoms and rehospitalisations of iron-deficient ...HF-patients in randomised trials. The present multicenter study investigated the “real-world” management of iron status in patients with HF. Consecutive patients with HF and ejection fraction < 40% were recruited and analyzed from 12/2010 to 10/2015 by 11 centres in Germany and Switzerland. Out of 1484 patients with HF, iron status was determined in only 923 patients (62.2%), despite participation of the centres in a registry focusing on ID and despite guideline recommendation to determine iron status. In patients with determined iron status, a prevalence of 54.7% (505 patients) for ID was observed. Iron therapy was performed in only 8.5% of the iron-deficient HF-patients; 2.6% were treated with intravenous iron therapy. The patients with iron therapy were characterised by a high rate of symptomatic HF and anemia. In conclusion despite strong evidence of beneficial effects of iron therapy on symptoms and rehospitalisations, diagnostic and therapeutic efforts on ID in HF are low in the actual clinical practice, and the awareness to diagnose and treat ID in HF should be strongly enforced.
Hyperkalemia is a concern in heart failure (HF), especially in older patients with co-morbidities. Previous studies addressing this issue have focused mainly on younger patients. This study was aimed ...at determining the frequency and predictors of hyperkalemia in older patients with HF undergoing intense medical therapy. Frequency and predictors of hyperkalemia were defined in patients (n = 566) participating in the Trial of Intensified versus Standard Medical Therapy in Elderly Patients with Congestive Heart Failure, in which patients ≥60 years of age were randomized to a standard versus an intensified N-terminal brain natriuretic peptide-guided HF therapy. During an 18-month follow-up 76 patients (13.4%) had hyperkalemia (≥5.5 mmol/L) and 28 (4.9%) had severe hyperkalemia (≥6.0 mmol/L). Higher baseline serum potassium (odds ratio OR 2.92 per mmol/L), baseline creatinine (OR 1.11 per 10 μmol/L), gout (OR 2.56), New York Heart Association (NYHA) class (compared to NYHA class II, IV OR 3.08), higher dosage of spironolactone at baseline (OR 1.20 per 12.5 mg/day), and higher dose changes of spironolactone (compared to no dose change: 12.5 mg, OR 1.45; 25 mg, OR 2.52; >25 mg, OR 3.24) were independent predictors for development of hyperkalemia (p <0.05 for all comparisons). In conclusion, hyperkalemia is common in patients ≥60 years of age with HF undergoing intense medical therapy. Risk is increased in patients treated with spironolactone, in addition to patient-specific risk factors such as chronic kidney disease, higher serum potassium, advanced NYHA class, and gout. Careful surveillance of serum potassium and cautious use of spironolactone in patients at risk may help to decrease the incidence of potentially hazardous complications caused by hyperkalemia.
Giant right coronary artery aneurysm Blank, Robert; Haager, Philipp K; Maeder, Micha ...
The Annals of thoracic surgery,
11/2007, Letnik:
84, Številka:
5
Journal Article
Recenzirano
We report the case of a 59-year-old man with a giant atherosclerotic thrombus-filled aneurysm of the right coronary artery presenting as an ambiguous spherical mass adjacent to the right atrium at ...the transthoracic echocardiography study. The diagnosis was established by transesophageal echocardiography, computed tomography, and coronary angiography. Due to extent of the aneurysm, the patient underwent placement of a vein graft to the posterior descending artery and subsequent exclusion of the aneurysm by proximal and distal ligation.
Background: Cardiogenic embolism accounts for 15% to 30% of ischemic strokes. Echocardiography is frequently being used as a screening test for sources of cardiac embolism in patients with stroke. ...However, the value of routine use of echocardiography for this task remains controversial. We evaluated the diagnostic yield of echocardiography in unselected patients with acute ischemic stroke. Methods: Consecutive patients with ischemic stroke or a transient ischemic attack were included in the study. Transthoracic echocardiography was performed in all patients, complemented by transesophageal echocardiography in selected patients. Results: In all, 807 echocardiographic examinations (743 transthoracic and 64 transesophageal) were performed in 775 consecutive patients. A potential cardiac source of embolism (CSE) was found in 144 (18%) of the patients. The most frequent potential causes of cardiac embolism included atrial fibrillation (7%) and patent foramen ovale (6%). Results were more likely to have impact on therapeutic decisions in younger patients. Numbers needed to test for detection of CSE increased 10-fold from 6 in patients younger than 50 years to 62 in patients aged 70 years and older. Conclusion: Echocardiography may provide important information on the cause of ischemic stroke. However, echocardiographic screening for a CSE is not warranted in all patients. In patients with younger than 50 years with stroke, echocardiography has a higher diagnostic yield and should routinely be performed. In older patients routine echocardiography results in a high rate of unspecific findings, and should be applied selectively, targeted at specific clinical questions.
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