RESUMEN
BACKGROUND: Heart failure (HF) poses a major health problem, where frequent HF rehospitalizations (HFH) heavily burden national health systems. HFH are predominantly linked to inadequate decongestion before discharge. It is uncertain if systematic implementation of cardio-pulmonary ultra-sound imaging (CPUSI) to standard HF management can improve outcomes and reduce HFH. RESULTS: This study recruited 50 patients admitted with acute decompensated heart failure (ADHF). Besides the conventional daily assessment, CPUSI was systematically performed to guide treatment decisions, focusing on ventricular filling pressure and 8-zone lung ultrasound (LUS) score. On-admission and predischarge LUS scores were correlated to clinical outcomes. The mean age of the study group was 55.7 ± 10.59 years, with predominance of male gender. Supplementing clinical judgment, CPUSI modified therapeutic strategy in 57 out of 241 assessments (24%), improving patients' care. Besides its value in guiding therapeutic decisions, the LUS score on admission had a significant positive correlation to the length of ICU stay and the total hospitalization length. Also, LUS score > 12 at discharge predicted 90-day HFH with sensitivity and specificity of 100% and 98%, respectively. CONCLUSIONS: Systematic CPUSI can improve HF management by complementing the often challenging judgment of pulmonary congestion. Adding periodic evaluation of ventricular filling pressures and LUS scores to clinical assessment can optimize treatment decisions and improve patient care. LUS score was a significant predictor for in-hospital and post-discharge clinical outcomes.
RESUMEN
An 11-year-old boy presented with easy fatigability, multiple xanthomas, and absent pedal pulsations. Laboratory workup showed severe hypercholesterolaemia and non-invasive imaging revealed 'normally functioning' bicuspid aortic valve and tight aortic coarctation. Coronary angiography showed severe right coronary artery (RCA) stenosis. Medical treatment resulted in significant improvement of dyslipidaemia. We successfully performed balloon dilation and stenting of his coarctation, as well as percutaneous coronary intervention for RCA lesion.
Asunto(s)
Coartación Aórtica/complicaciones , Estenosis Coronaria/etiología , Hiperlipoproteinemia Tipo II/complicaciones , Coartación Aórtica/terapia , Niño , Angiografía Coronaria , Estenosis Coronaria/terapia , Humanos , Masculino , Intervención Coronaria PercutáneaRESUMEN
BACKGROUND: Management of acute limb ischemia (ALI) is largely based on the etiology of arterial occlusion (embolic vs. thrombotic). To our knowledge, the ability of duplex scanning to differentiate embolic from thrombotic occlusion has not been previously reported. PURPOSE: To determine the ability of duplex scanning to differentiate embolic from thrombotic acute arterial occlusion. METHODS: We prospectively recruited 97 patients (50.3 ± 19.7 years; 55% males) with 107 nontraumatic ALI in native arteries. All patients underwent surgical revascularization. Preoperative duplex scan detected arterial occlusion in the following arteries: iliac (11), femoral (38), popliteal (38), infrapopliteal (3), subclavian (3), axillary (1), brachial (9), and forearm arteries (4). We measured the arterial diameters at the site of occlusion (d(occl)) and at the corresponding contralateral healthy side (d(CONTRA)). The difference (Δ) between the two diameters was calculated as d(OCCL)-d(CONTRA). Duplex scan was also used to assess the state of the arterial wall whether healthy or atherosclerotic and the presence of calcification or collaterals. According to surgical findings, limbs were classified into embolic (E group=55 limbs) and thrombotic (T group=52 limbs) groups. RESULTS: Both groups were comparable regarding age, diabetes, hypertension, smoking, atrial fibrillation, and time of presentation. The status of arterial wall at the site of occlusion and presence of calcification or collaterals were all similar in both groups. Δ in the E group was 0.95 ± 0.92 mm vs. -0.13 ± 1.02 mm in the T group (P<.001). A value of ≥ 0.5 mm for Δ had 85% sensitivity and 76% specificity for the diagnosis of embolic occlusion (CI 0.72-0.90, P<.001), whereas a value of less than -0.5 mm for Δ had 85% sensitivity and 76% specificity for thrombotic occlusion (CI 0.72-0.90, P<.001). CONCLUSION: In acute arterial occlusion, ≥ 0.5 mm dilatation or diminution in the occluded artery diameter is a useful duplex sign for diagnosing embolic or thrombotic occlusion, respectively.