RESUMEN
Diastolic dysfunction is common in coronary artery disease (CAD). Exercise-based cardiac rehabilitation (CR) improves survival and quality of life but its effect on diastolic function is unclear. We sought to determine the impact of CR on diastolic function. We conducted a prospective study of CAD patients referred for 3-month outpatient CR, with pre-CR and post-CR echocardiograms. Twenty-five outpatients (age [mean ± SD], 66 ± 11 ! years; 7 [28 %] women; 22 [88 %] with recent acute coronary syndrome) were recruited upon beginning CR; one patient lacking follow-up was excluded from analysis. Before CR, patients' mean ejection fraction was 61 ± 7 %; regional wall motion score index was 1.18 ± 0.28; and left ventricular diastolic dysfunction existed in 21 (88 %). Of the 24 (96 %) patients with post-CR follow-up, 12 (50 %) had improved diastolic function, 2 of the 24 (8 %) had normal diastolic function throughout, nine (38 %) remained at the same grade, and one (4 %) had worsened diastolic function. The E/e' ratio improved significantly after CR (11.9 ± 4.5 vs. 10.7 ± 4.5; P = .048). Fourteen patients with normal or improved diastolic function had a greater decrease in left atrial volume index (-4.2 ± 6.3 vs. 1.6 ± 6.3 mL/m(2); P = .04) and a greater increase in peak untwisting rate (20 ± 36 vs. -42 ± 45 °/s; P = .003) than did patients with no diastolic improvement. Three-month, exercise-based CR was associated with improved left ventricular diastolic function in half of our patients. Further large studies are needed to clarify the effect of CR on diastolic dysfunction in patients with CAD.
Asunto(s)
Enfermedad de la Arteria Coronaria/rehabilitación , Diástole , Terapia por Ejercicio , Anomalía Torsional/rehabilitación , Disfunción Ventricular Izquierda/rehabilitación , Función Ventricular Izquierda , Anciano , Atención Ambulatoria , Enfermedad de la Arteria Coronaria/diagnóstico , Enfermedad de la Arteria Coronaria/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Estudios Prospectivos , Recuperación de la Función , Volumen Sistólico , Factores de Tiempo , Anomalía Torsional/diagnóstico , Anomalía Torsional/fisiopatología , Resultado del Tratamiento , Disfunción Ventricular Izquierda/diagnóstico , Disfunción Ventricular Izquierda/fisiopatologíaRESUMEN
BACKGROUND: The aim of this study was to investigate the incidence and predictors of neuropsychiatric (NP) symptoms during 24 hours after dobutamine-atropine stress testing (DST). METHODS: Consecutive outpatients undergoing DST were asked to return a questionnaire regarding symptoms during the following 24 hours. Trained registered nurses administered the Delirium Observation Screening Scale before and after DST. To assess baseline symptoms in a control group, consecutive patients referred for DST completed the questionnaire regarding their symptoms during the 24 hours before DST. RESULTS: A total of 1,006 patients were included (mean age, 67 ± 12 years; 462 [46%] women). Of the 750 patients who returned questionnaires, 53 patients (7.1%) reported NP symptoms. Among the 199 controls, three patients (1.5%) reported NP symptoms. Symptoms were usually mild and resolved spontaneously. Independent predictors of NP symptoms were atropine dose ≥ 1 mg (odds ratio [OR], 7.69; 95% confidence interval [CI], 4.13-14.81), prior NP disorder (OR, 2.11; 95% CI, 1.11-4.02), positive Delirium Observation Screening Scale result (OR, 4.89; 95% CI, 1.21-18.09), and body mass index < 24 kg/m(2) (OR, 2.37; 95% CI, 1.10-4.90). CONCLUSIONS: Although usually mild, NP symptoms were nearly fivefold more common after DST (P < .001). Patients who had received ≥ 1 mg atropine and those with underlying NP disease, positive Delirium Observation Screening Scale results, or lower body mass indexes are at increased risk.
Asunto(s)
Cardiotónicos/efectos adversos , Delirio/etiología , Dobutamina/efectos adversos , Ecocardiografía de Estrés/efectos adversos , Anciano , Atropina/efectos adversos , Distribución de Chi-Cuadrado , Femenino , Humanos , Incidencia , Modelos Logísticos , Masculino , Valor Predictivo de las Pruebas , Estudios Prospectivos , Factores de Riesgo , Encuestas y CuestionariosRESUMEN
BACKGROUND: The authors examined the feasibility of application of the American College of Cardiology Foundation's appropriateness criteria for transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE) at a large tertiary care practice. METHODS: Indications for consecutive TTE and TEE were determined by chart review and classified according to the guidelines as appropriate, inappropriate, or uncertain or, for situations not addressed in the document, nonclassifiable. RESULTS: Of the 529 studies reviewed, 469 were appropriate, 23 inappropriate, 1 uncertain, and 36 nonclassifiable. Inappropriate and nonclassifiable studies were more commonly TTE than TEE (P<.001). Inappropriate studies were more common in outpatients than inpatients (P<.001). Nonclassifiable cases included assessment after radiofrequency ablation (33.3%) and preoperative evaluation (8.3%). Disagreement between observers in selection of the criterion was present in 30.8%. CONCLUSIONS: Although the study was conducted retrospectively, only 4.7% of classifiable studies were inappropriate. The reproducibility of classification was moderate, and 6.8% of studies were not classifiable. Areas for improvement of the criteria were identified.
Asunto(s)
Centros Médicos Académicos/estadística & datos numéricos , Enfermedades Cardiovasculares/diagnóstico por imagen , Enfermedades Cardiovasculares/epidemiología , Ecocardiografía/estadística & datos numéricos , Ecocardiografía/normas , Revisión de Utilización de Recursos , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Minnesota/epidemiología , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
OBJECTIVE: To compare between adult patients with heart failure after hospital discharge in a heart failure clinic and daily practice in terms of survival, readmission rate, and quality of life. MATERIAL AND METHOD: The authors followed 100 patients who received care in the heart failure clinic (n = 50) or the usual care (n = 50) for twelve months. RESULTS: During follow-up, patients in the heart failure clinic group had fewer readmissions (12 vs. 23; p = 0.04). There were eight deaths in the control group and seven deaths in the heart failure clinic group (p = 0.45). At the end of the present study mean left ventricular ejection fraction, mean distance of 6-minute walk test, and mean quality of life scores in the treatment group improved more than in the control group (p = 0.038; 0.032; 0.048, respectively). CONCLUSION: The heart failure clinic reduces hospital readmission and improves cardiac function and quality of life for heart failure patients.