RESUMEN
Aortic stenosis (AS) is characterized by restricted motion and calcification of the aortic valve and is the deadliest valvular cardiac disease. Assessment of AS severity is typically done by expert cardiologists using Doppler measurements of valvular flow from echocardiography. However, this limits the assessment of AS to hospitals staffed with experts to provide comprehensive echocardiography service. As accurate Doppler acquisition requires significant clinical training, in this paper, we present a deep learning framework to determine the feasibility of AS detection and severity classification based only on two-dimensional echocardiographic data. We demonstrate that our proposed spatio-temporal architecture effectively and efficiently combines both anatomical features and motion of the aortic valve for AS severity classification. Our model can process cardiac echo cine series of varying length and can identify, without explicit supervision, the frames that are most informative towards the AS diagnosis. We present an empirical study on how the model learns phases of the heart cycle without any supervision and frame-level annotations. Our architecture outperforms state-of-the-art results on a private and a public dataset, achieving 95.2% and 91.5% in AS detection, and 78.1% and 83.8% in AS severity classification on the private and public datasets, respectively. Notably, due to the lack of a large public video dataset for AS, we made slight adjustments to our architecture for the public dataset. Furthermore, our method addresses common problems in training deep networks with clinical ultrasound data, such as a low signal-to-noise ratio and frequently uninformative frames. Our source code is available at: https://github.com/neda77aa/FTC.git.
Asunto(s)
Estenosis de la Válvula Aórtica , Enfermedades de las Válvulas Cardíacas , Humanos , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Enfermedades de las Válvulas Cardíacas/diagnóstico , Ecocardiografía/métodos , Válvula Aórtica/diagnóstico por imagenRESUMEN
The Canadian Cardiovascular Society (CCS) atrial fibrillation (AF) guidelines program was developed to aid clinicians in the management of these complex patients, as well as to provide direction to policy makers and health care systems regarding related issues. The most recent comprehensive CCS AF guidelines update was published in 2010. Since then, periodic updates were published dealing with rapidly changing areas. However, since 2010 a large number of developments had accumulated in a wide range of areas, motivating the committee to complete a thorough guideline review. The 2020 iteration of the CCS AF guidelines represents a comprehensive renewal that integrates, updates, and replaces the past decade of guidelines, recommendations, and practical tips. It is intended to be used by practicing clinicians across all disciplines who care for patients with AF. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system was used to evaluate recommendation strength and the quality of evidence. Areas of focus include: AF classification and definitions, epidemiology, pathophysiology, clinical evaluation, screening and opportunistic AF detection, detection and management of modifiable risk factors, integrated approach to AF management, stroke prevention, arrhythmia management, sex differences, and AF in special populations. Extensive use is made of tables and figures to synthesize important material and present key concepts. This document should be an important aid for knowledge translation and a tool to help improve clinical management of this important and challenging arrhythmia.
Le programme de lignes directrices de la Société canadienne de cardiologie (SCC) en matière de fibrillation auriculaire (FA) a été élaboré pour aider les cliniciens à prendre en charge ces patients complexes, ainsi que pour orienter les décideurs politiques et les systèmes de soins de santé sur des questions connexes. La dernière édition complète des lignes directrices de la SCC en matière de FA a été publiée en 2010. Depuis lors, des mises à jour périodiques ont été publiées, traitant de domaines en évolution rapide. Cependant, en 2020, un grand nombre de développements s'y étaient ajoutés, couvrant un large éventail de domaines, ce qui a motivé le comité à créer une refonte complète des lignes directrices. L'édition 2020 des lignes directrices de la SCC en matière de FA représente un renouvellement complet qui intègre, met à jour et remplace les lignes directrices, les recommandations et les conseils pratiques des dix dernières années. Elle est destinée à être utilisée par les cliniciens praticiens de toutes les disciplines qui s'occupent de patients souffrant de FA. L'approche GRADE (Gradation des Recommandations, de l'Appréciation, du Développement et des Évaluations) a été utilisée pour évaluer la pertinence des recommandations et la qualité des résultats. Les domaines d'intérêt incluent : la classification et les définitions de la FA, son épidémiologie, sa physiopathologie, l'évaluation clinique, le dépistage de la FA, la détection et la gestion des facteurs de risque modifiables, l'approche intégrée de la gestion de la FA, la prévention des accidents vasculaires cérébraux, la gestion de l'arythmie, les différences entre les sexes et la FA dans des populations particulières. Des tableaux et figures ont été largement utilisés pour synthétiser les éléments importants et présenter les concepts clés. Ce document devrait représenter une aide importante pour l'intégration des connaissances et un outil pour aider à améliorer la gestion clinique de cette arythmie importante et difficile à traiter.
Asunto(s)
Humanos , Masculino , Femenino , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/terapia , Fibrilación Atrial/clasificación , Fibrilación Atrial/fisiopatología , Fibrilación Atrial/epidemiología , Grupos de Riesgo , Algoritmos , Factores Sexuales , Factores de Riesgo , Vías Clínicas , Accidente Cerebrovascular/prevención & controlAsunto(s)
Fibrilación Atrial/diagnóstico por imagen , Ecocardiografía , Anciano , Fibrilación Atrial/etiología , Fibrilación Atrial/fisiopatología , Femenino , Estudios de Seguimiento , Hemodinámica/fisiología , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de RiesgoRESUMEN
OBJECTIVE: To evaluate the contribution of left atrial (LA) volume in predicting atrial fibrillation (AF). PATIENTS AND METHODS: In this retrospective cohort study, a random sample of 2200 adults was identified from all Olmsted County, Minnesota, residents who had undergone transthoracic echocardiographic assessment between 1990 and 1998 and were 65 years of age or older at the time of examination, were in sinus rhythm, and had no history of AF or other atrial arrhythmias, stroke, pacemaker, congenital heart disease, or valve surgery. The LA volume was measured off-line by using a biplane area-length method. Clinical characteristics and the outcome event of incident AF were determined by retrospective review of medical records. Echocardiographic data were retrieved from the laboratory database. From this cohort, 1655 patients in whom LA size data were available were followed from baseline echocardiogram until development of AF or death. The clinical and echocardiographic associations of AF, especially with respect to the role of LA volume in predicting AF, were determined. RESULTS: A total of 666 men and 989 women, mean +/- SD age of 75.2 +/- 7.3 years (range, 65-105 years), were followed for a mean +/- SD of 3.97 +/- 2.75 years (range, < 1.00-10.78 years); 189 (11.4%) developed AF. Cox model 5-year cumulative risks of AF by quartiles of LA volume were 3%, 12%, 15%, and 26%, respectively. With Cox proportional hazards multivariate models, logarithmic LA volume was an independent predictor of AF, incremental to clinical risk factors. After adjusting for age, sex, valvular heart disease, and hypertension, a 30% larger LA volume was associated with a 43% greater risk of AF, incremental to history of congestive heart failure (hazard ratio [HR], 1.887; 95% confidence interval [CI], 1.230-2.895; P = .004), myocardial infarction (HR, 1.751; 95% CI, 1.189-2.577; P = .004), and diabetes (HR, 1.734; 95% CI, 1.066-2.819; P = .03). Left atrial volume remained incremental to combined clinical risk factors and M-mode LA dimension for prediction of AF (P < .001). CONCLUSION: This study showed that a larger LA volume was associated with a higher risk of AF in older patients. The predictive value of LA volume was incremental to that of clinical risk profile and conventional M-mode LA dimension.
Asunto(s)
Fibrilación Atrial/etiología , Volumen Cardíaco , Anciano , Anciano de 80 o más Años , Fibrilación Atrial/diagnóstico por imagen , Distribución de Chi-Cuadrado , Comorbilidad , Ecocardiografía , Electrocardiografía , Femenino , Humanos , Masculino , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Factores de RiesgoRESUMEN
The population of older individuals in the United States is growing rapidly. Because women generally live longer than men and make up the majority of this aging population, the elucidation of health issues related to older women is important. Cardiovascular disease is the leading cause of death and disability for women and claims the lives of more women than the next 14 causes combined. The majority of these deaths are due to atherosclerotic coronary heart disease, with nearly 250,000 women dying of myocardial infarction each year. There is evidence that women with suspected or established cardiovascular disease have not benefited fully from recent advances in the detection and management of coronary heart disease. Regardless of the mechanism and extent of the effect that sex differences have on approaches to cardiovascular disease, women appear to benefit from proven efficacious therapies, and the longer-term outcomes associated with these treatments are positive. The data regarding women and coronary heart disease are rapidly evolving and sometimes conflicting. The intent of this article is to summarize the most current understanding of coronary heart disease risks in women, highlighting the impact of prevention, and to discuss the latest novel findings that may become important in our armamentarium for prevention of coronary heart disease.
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Enfermedad Coronaria/prevención & control , Salud de la Mujer , Adulto , Factores de Edad , Anciano , Fármacos Cardiovasculares/uso terapéutico , Enfermedad Coronaria/epidemiología , Terapia de Reemplazo de Estrógeno , Femenino , Humanos , Estilo de Vida , Persona de Mediana Edad , Factores de Riesgo , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVE: To evaluate the treatment strategies for primary and secondary management of malignancy-related pericardial effusions. PATIENTS AND METHODS: Retrospective review of Mayo Clinic Rochester charts and external records of patients with pericardial effusion associated with malignant disease who required treatment between February 1979 and June 1998 was performed. Telephone interviews with patients, their families, or their physicians were conducted to determine the outcomes of treatment. Recurrence of pericardial effusion and survival were the main outcome measures. RESULTS: Of 1002 consecutive pericardiocenteses performed during the period under study, 341 were performed in 275 patients with confirmed malignant disease. Patients were followed up for a minimum of 190 days, unless death occurred first. Of 275 patients, recurrence of pericardial effusion or persistent drainage necessitated secondary management in 59 (43 of 118 simple pericardiocenteses, 16 of 139 pericardiocenteses with extended catheter drainage, and 0 of 18 pericardial surgery following temporizing pericardiocentesis). Recurrence was strongly and independently predicted by absence of pericardial catheter for extended drainage, large effusion size, and emergency procedures. Recurrence after secondary management occurred in 12 patients: 11 underwent successful pericardiocentesis with extended catheter drainage, and 1 had pericardial surgery. Median survival of the cohort was 135 days, and 26% survived the first year after diagnosis of pericardial effusion. Male sex, positive fluid cytology for malignant cells, lung cancer, and clinical presentation of tamponade or hemodynamic collapse were independently associated with poor survival. CONCLUSION: Echocardiographically guided pericardiocentesis with extended catheter drainage appears to be safe and effective for both primary and secondary management of pericardial effusion in patients with malignancy.
Asunto(s)
Neoplasias/complicaciones , Derrame Pericárdico/terapia , Adulto , Anciano , Catéteres de Permanencia , Factores de Confusión Epidemiológicos , Árboles de Decisión , Drenaje , Ecocardiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Derrame Pericárdico/etiología , Pericardiocentesis/métodos , Recurrencia , Estudios Retrospectivos , Escleroterapia , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
Cardiac tamponade is a life-threatening condition. Accurate diagnosis and prompt intervention are necessary to prevent adverse outcomes. Clinical features of tamponade such as pulsus paradoxus, tachycardia, elevated jugular venous pressure, and hypotension are important clues to the diagnosis, but are non-specific. Echocardiography allows rapid confirmation of the presence or absence of an effusion, and enables assessment of its hemodynamic impact. Decisions regarding treatment must take into account the clinical presentation and echocardiographic findings. Echocardiographically-guided pericardiocentesis with catheter drainage is the primary treatment strategy of choice for most large or hemodynamically significant effusions. In contemporary clinical practice, echocardiography is the gold standard for diagnosis of tamponade and is essential for directing treatment.
Asunto(s)
Taponamiento Cardíaco/diagnóstico por imagen , Ecocardiografía , Taponamiento Cardíaco/etiología , Taponamiento Cardíaco/terapia , Ecocardiografía Doppler , Ecocardiografía Transesofágica , Hemodinámica/fisiología , Humanos , Derrame Pericárdico/diagnóstico por imagen , Derrame Pericárdico/etiología , Derrame Pericárdico/terapia , Pericardiocentesis , Valor Predictivo de las PruebasRESUMEN
We report a rare case of giant blood cyst originating from the anterior mitral valve leaflet and chordae tendineae, which was incidentally discovered during a 2-dimensional echocardiography examination performed for assessment of left ventricular function after an uncomplicated myocardial infarction in a 50-year-old man.
Asunto(s)
Quistes/diagnóstico por imagen , Enfermedades de las Válvulas Cardíacas/diagnóstico por imagen , Válvula Mitral/diagnóstico por imagen , Ecocardiografía , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Infarto del Miocardio/complicacionesRESUMEN
BACKGROUND: Benzodiazepines used for transesophageal echocardiography (TEE) sedation may be associated with postprocedural psychomotor effects that are undesirable. HYPOTHESIS: We hypothesize that flumazenil can reverse cognitive and motor effects from benzodiazepine, promoting earlier return to baseline function. METHODS: We prospectively evaluated the cognitive and motor function of patients who did or did not receive flumazenil following TEE. Patients' gait, level of drowsiness, and recall of items learned before and after benzodiazepine administration were evaluated before TEE, as well as immediately and 30 min after the procedure. RESULTS: Of 207 patients (123 men and 84 women), 93 (45%) were given flumazenil 0.2 or 0.4 mg intravenously, and 113 (55%) were not. The baseline characteristics of the patients who received flumazenil were not significantly different from those who did not receive flumazenil, with the exception of a higher mean dosage of midazolam administered to the flumazenil group. In addition, patients in the flumazenil group appeared more drowsy immediately following TEE. When adjusted for age and midazolam dosage, there were no differences, at any time, between the two groups in gait or recall of items learned prior to sedation. however, at 30 min following TEE, the flumazenil group was able to recall a larger number of new items learned immediately after the procedure (1.92/3 vs. 1.61/3, p = 0.02) than did patients in the group not receiving flumazenil. No adverse effects were encountered in any patient. CONCLUSION: Flumazenil appears safe and effective in reversing anterograde amnesic effects of benzodiazepine following TEE, but has no effects on retrograde amnesia and does not promote earlier return of motor function to baseline. It is useful in clinical situations where high dosages of benzodiazepine have been used and/or excessive drowsiness is evident following TEE. Routine use of the drug, however, is not necessary.
Asunto(s)
Ansiolíticos , Antídotos/farmacología , Ecocardiografía Transesofágica , Flumazenil/farmacología , Desempeño Psicomotor/efectos de los fármacos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Atención Ambulatoria , Ansiolíticos/efectos adversos , Ansiolíticos/antagonistas & inhibidores , Antídotos/uso terapéutico , Cognición/efectos de los fármacos , Femenino , Flumazenil/uso terapéutico , Humanos , Masculino , Persona de Mediana EdadRESUMEN
STUDY OBJECTIVES: This study assessed the clinical features, timing of presentation, and echocardiographic characteristics associated with clinically significant pericardial effusions after cardiothoracic surgery. The outcomes of echocardiographically (echo-) guided pericardiocentesis for the management of these effusions were evaluated. DESIGN: From the prospective Mayo Clinic Registry of Echo-guided Pericardiocentesis (February 1979 to June 1998), 245 procedures performed for clinically significant postoperative effusions were identified. Clinical features, effusion causes, echocardiographic findings, and management outcomes were studied and analyzed. Cross-referencing the registry with the Mayo Clinic surgical database provided an estimate of the incidence of significant postoperative effusions and the number of cases in which primary surgical management was chosen instead of pericardiocentesis. RESULTS: Use of anticoagulant therapy was considered a significant contributing factor in 86% and 65% of early effusions (< or =7 days after surgery) and late effusions (>7 days after surgery), respectively. Postpericardiotomy syndrome was an important factor in the development of late effusions (34%). Common presenting symptoms included malaise (90%), dyspnea (65%), and chest pain (33%). Tachycardia, fever, elevated jugular venous pressure, hypotension, and pulsus paradoxus were found in 53%, 40%, 39%, 27%, and 17% of cases, respectively. Transthoracic echocardiography permitted rapid diagnosis and hemodynamic assessment of all effusions except for three cases that required transesophageal echocardiography for confirmation. Echo-guided pericardiocentesis was successful in 97% of all cases and in 96% of all loculated effusions. Major complications (2%), including chamber lacerations (n = 2) and pneumothoraces (n = 3), were successfully treated by surgical repair and chest tube reexpansion, respectively. Median follow-up duration for the study population was 3.8 years (range, 190 days to 16.4 years). The use of extended catheter drainage was associated with reduction in recurrence for early and late postoperative effusions by 46% and 50%, respectively. CONCLUSIONS: The symptoms and physical findings of clinically significant postoperative pericardial effusions are frequently nonspecific and may be inadequate for a decision regarding intervention. Echocardiography can quickly confirm the presence of an effusion, and pericardiocentesis under echocardiographic guidance is safe and effective. The use of a pericardial catheter for extended drainage is associated with lower recurrence rates, and the majority of patients so treated do not require further intervention.
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Procedimientos Quirúrgicos Cardíacos , Drenaje , Derrame Pericárdico/diagnóstico por imagen , Derrame Pericárdico/terapia , Procedimientos Quirúrgicos Torácicos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Drenaje/métodos , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Recurrencia , Resultado del Tratamiento , UltrasonografíaRESUMEN
Cardiac tamponade is a life-threatening condition. Accurate diagnosis and prompt intervention are necessary. Classically, clinical features of tamponade include pulsus paradoxus, tachycardia, increased jugular venous pressure, and hypotension. With the advent of echocardiography, confirmation of an effusion and accurate assessment of its hemodynamic impact can be achieved, frequently in the absence of overt clinical manifestations. The decision regarding treatment and timing of intervention must take into account the clinical presentation and echocardiographic findings, along with careful weighing of risks and benefits to the individual patient. Echocardiographically guided pericardiocentesis is the best available therapy for initial management of cardiac tamponade. It is simple, safe, and effective for removing pericardial fluid and reversing hemodynamic instability, and the use of a pericardial catheter for extended drainage has been associated with significant reduction in recurrence of fluid accumulation.
Asunto(s)
Taponamiento Cardíaco/diagnóstico por imagen , Taponamiento Cardíaco/fisiopatología , Taponamiento Cardíaco/terapia , Drenaje , Ecocardiografía Doppler , Ecocardiografía Transesofágica , Hemodinámica , Humanos , Derrame Pericárdico/diagnóstico por imagen , Derrame Pericárdico/fisiopatología , Derrame Pericárdico/terapiaAsunto(s)
Paracentesis , Derrame Pericárdico/terapia , Humanos , Paracentesis/métodos , ToracoscopíaRESUMEN
The purpose of this study was to evaluate the safety and efficacy of echocardiographically (echo) guided pericardiocentesis in pediatric patients. Echo-guided pericardiocenteses performed in pediatric patients (age >/=16 years) at the Mayo Clinic between 1980 and 1997 were identified. Presentation, cause and characteristics of the effusion, details of the pericardiocentesis procedure, and outcome were determined by comprehensive chart review supplemented by telephone interviews when necessary. Seventy-three pediatric patients, median age 6.7 years (range 1 day to 16 years), underwent 94 consecutive echo-guided pericardiocenteses for effusions of various causes. Twenty-one (22%) procedures were performed in children younger than 2 years. All but 1 procedure were successful (99%). A mean fluid volume of 237 mL (range 4 to 970 mL) was withdrawn. Only a single attempt was needed for entry into the pericardial space in 87 (93%) procedures. No deaths were associated with the pericardiocentesis procedure. Only 1 major complication occurred (1%), a pneumothorax requiring chest tube reexpansion. Three (3%) minor complications-2 instances of right ventricular puncture and a small pneumothorax-did not require treatment. Extended catheter drainage for a mean of 5.2 +/- 4.5 days (range 1 to 19 days) was used with 30 (32%) of the 94 procedures. For the 52 patients who underwent pericardiocentesis without catheter drainage as the initial management strategy, 18 required 21 repeat pericardiocenteses for recurrence of effusion. In contrast, for the 21 patients who had pericardial catheterization as the initial management strategy, none had recurrences necessitating a repeat procedure (P <.001). Increased utilization of a pericardial catheter was associated with a concomitant decrease in the number of surgical pericardial procedures over the study period. Echo-guided pericardiocentesis was the only therapeutic modality for the management of effusion in 73% of all patients. Echo-guided pericardiocentesis is safe and effective in pediatric patients, including children younger than 2 years. The increasing use of pericardial catheterization in conjunction with this technique was associated with significant reduction of recurrence and decreased frequency of surgical interventions for treatment of pericardial effusion. Echo-guided pericardiocentesis with extended catheter drainage should be considered as primary management strategy for clinically significant pericardial effusions in pediatric patients.
Asunto(s)
Ecocardiografía , Paracentesis , Derrame Pericárdico/terapia , Adolescente , Niño , Preescolar , Drenaje , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Paracentesis/efectos adversos , Paracentesis/métodos , Derrame Pericárdico/diagnóstico por imagen , Estudios Prospectivos , RecurrenciaRESUMEN
OBJECTIVES: The purpose of this study was to determine the safety and efficacy of rescue echocardiographically guided pericardiocentesis as a primary strategy for the management of acute cardiac perforation and tamponade complicating catheter-based procedures. BACKGROUND: In this era of interventional catheterization, acute tamponade from cardiac perforation as a complication is encountered more frequently. The safety and efficacy of echocardiographically guided pericardiocentesis in this life-threatening situation and outcomes of patients managed by this technique are unknown. METHODS: Of the 960 consecutive echocardiographically guided pericardiocenteses performed at the Mayo Clinic (1979 to 1997), 92 (9.6%) were undertaken in 88 patients with acute tamponade that developed in association with a diagnostic or interventional catheter-based procedure. Most of the patients were hemodynamically unstable at the time of pericardiocentesis, with clinically overt tamponade in 40% and frank hemodynamic collapse (systolic blood pressure <60 mm Hg) in 57%. Clinical end points of interest were the success and complication rates of rescue pericardiocentesis and patient outcomes, including the need for other interventions, clinical and echocardiographic follow-up findings and survival. RESULTS: Rescue pericardiocentesis was successful in relieving tamponade in 91 cases (99%) and was the only and definitive therapy in 82% of the cases. Major complications (3%) included pneumothorax (n=1), right ventricular laceration (n=1) and intercostal vessel injury with right ventricular laceration (n=1); all were treated successfully. Minor complications (2%) included a small pneumothorax and an instance of transient nonsustained ventricular tachycardia; all were resolved spontaneously. Further surgical intervention was performed in 16 patients (18%). No deaths resulted from the rescue pericardiocentesis procedure itself. Early death (<30 days) in this series was due to injuries from cardiac catheter-based procedures (n=3), perioperative complications (n=2) and underlying cardiac diseases (n=2). Clinical or echocardiographic follow-up for a minimum of 3 months or until death (if <3 months) for recurrent effusion or development of pericardial constriction was achieved in 87 (99%) of the patients. CONCLUSIONS: Echocardiographically guided pericardiocentesis was safe and effective for rescuing patients from tamponade and reversing hemodynamic instability complicating invasive cardiac catheter-based procedures. For most patients, this was the definitive and only therapy necessary.
Asunto(s)
Cateterismo Cardíaco/efectos adversos , Ecocardiografía , Tratamiento de Urgencia/métodos , Lesiones Cardíacas/cirugía , Paracentesis/métodos , Pericardio/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Taponamiento Cardíaco/epidemiología , Taponamiento Cardíaco/etiología , Taponamiento Cardíaco/cirugía , Niño , Preescolar , Femenino , Estudios de Seguimiento , Lesiones Cardíacas/epidemiología , Lesiones Cardíacas/etiología , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Derrame Pericárdico/complicaciones , Derrame Pericárdico/epidemiología , Derrame Pericárdico/cirugía , Pericardio/diagnóstico por imagen , Estudios Prospectivos , Seguridad , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
The coefficient of variation is commonly used in medical and biological sciences. In this paper, several parametric and non-parametric tests for the equality of coefficients of variation in kappa populations are reviewed. Simulation studies are conducted to compare the sizes and power of these tests. It is found that the parametric tests perform well if the data are normally distributed, but perform poorly if otherwise. The non-parametric test, however, is rather robust against the underlying distribution. An example using data of the Quality Assurance Program from the Hong Kong Medical Technology Association in Haematology and Serology is provided. The insensitivity of the non-parametric test to outliers is demonstrated.
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Análisis de Varianza , Valor Predictivo de las Pruebas , Hong Kong , Humanos , Funciones de Verosimilitud , Garantía de la Calidad de Atención de Salud/estadística & datos numéricos , Valores de ReferenciaRESUMEN
Percutaneous pericardiocentesis was introduced during the 19th century and became a preferred technique for the management of pericardial effusion by the early 20th century. Until the era of two-dimensional echocardiographically guided pericardiocentesis, however, the procedure was essentially "blind," and serious complications were comparatively common, an outcome that resulted in an increased preference for surgical solutions. Because two-dimensional echocardiography facilitates direct visualization of cardiac structures and adjacent vital organs, percutaneous pericardiocentesis can be performed with minimal risk. Since its inception in 1979 (19 years ago), the echocardiographically guided pericardiocentesis technique has continued to evolve. Important procedural adaptations and modifications that optimize safety, simplicity, and patient comfort and minimize the recurrence of effusion have been defined and incorporated. This technique has been proved to be safe and effective. A detailed step-by-step description of the procedure and the necessary precautions to optimize success and safety is presented herein.
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Ecocardiografía , Paracentesis/métodos , Derrame Pericárdico/diagnóstico por imagen , Derrame Pericárdico/terapia , Humanos , ToracoscopíaRESUMEN
Two-dimensional echocardiography-guided pericardiocentesis is an accepted, safe, and cost-effective procedure. Carefully selected patients can be treated with this technique in an outpatient setting. A consecutive series of outpatient echocardiography-directed pericardiocentesis performed for diagnostic or therapeutic indications is described. Appropriate technique and precautions are discussed.
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Atención Ambulatoria , Drenaje/métodos , Ecocardiografía , Derrame Pericárdico/diagnóstico por imagen , Derrame Pericárdico/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Derrame Pericárdico/diagnóstico , Punciones/métodosRESUMEN
Cardiac herniation through an acquired pericardial defect is potentially fatal. Typically, symptoms manifest within days of a surgical procedure. We describe a patient with late ventricular herniation after surgical formation of an apical pericardial window.
Asunto(s)
Ecocardiografía , Cardiopatías/diagnóstico por imagen , Adulto , Femenino , Cardiopatías/etiología , Hernia/diagnóstico por imagen , Hernia/etiología , Humanos , Técnicas de Ventana Pericárdica/efectos adversosRESUMEN
We evaluated allergic reactions in 20,201 patients randomized to the streptokinase arms of The Global Utilization of Streptokinase and t-PA (Tissue Plasminogen Activator) in Occluded Coronary Arteries (GUSTO-I) trial, and tested the hypothesis that patients with streptokinase allergy would exhibit higher mortality. After adjusting for baseline variables and time of death, we found comparable coronary patency, left ventricular function, mortality, and bleeding complications between patients with versus those without streptokinase allergy.