Serum vascular endothelial growth factor (VEGF) levels are increased in sepsis.
Purpose
To investigate the prognostic value of the serum VEGF level in critically ill septic patients regarding the clinical course and final outcome.
Methods
A total of 40 critically ill septic patients were included in a prospective, randomized, single center study. All patients were subjected to the measurement of VEGF levels on admission day (VEGF1) and 48 hours later (VEGF2). CRP levels and Microalbuminuria levels were also measured on admission. APACHE IV and SOFA scores were calculated. Clinical outcome (duration of stay in the ICU, need for MV, need for inotropic/vasopressor support, need for hemodialysis, and survival) was recorded.
Results
In relation to healthy subjects, the mean VEGF 1&2 levels were significantly higher in the septic patients (142 + 28.98 vs 750.5 + 380.34 and 802.07 + 292.65 ng/l; p = 0.001 and <0.001 respectively). Septic patients who required MV, inotropic/vasopressor support and hemodialysis, and also those who died had significantly higher VEGF1 levels compared to those who didn’t require them (p = 0.002, 0.006, 0.008 and 0.001 respectively). VEGF2 level was significantly higher only in those who required inotropic/vasopressor support (p = 0.024). VEGF1 and 2 levels were significantly positively correlated with CRP level, Albumin/Creatinine ratio and APACHE IV score. ROC analysis of the data indicated a sensitivity of 85.15% and a specificity of 92.3% when a VEGF 1 level of 410 ng/l was taken as a predictor of ICU mortality.
Conclusion
The admission VEGF is a useful marker for the evaluation of septic patients.
{"title":"Prognostic value of vascular endothelial growth factor in sepsis syndrome","authors":"Hazem El-Akabawy , Mohamed Abo Hamela , Ayman Gaber , Ahmed Abozekry","doi":"10.1016/j.ejccm.2016.10.002","DOIUrl":"10.1016/j.ejccm.2016.10.002","url":null,"abstract":"<div><h3>Background</h3><p>Serum vascular endothelial growth factor (VEGF) levels are increased in sepsis.</p></div><div><h3>Purpose</h3><p>To investigate the prognostic value of the serum VEGF level in critically ill septic patients regarding the clinical course and final outcome.</p></div><div><h3>Methods</h3><p>A total of 40 critically ill septic patients were included in a prospective, randomized, single center study. All patients were subjected to the measurement of VEGF levels on admission day (VEGF1) and 48 hours later (VEGF2). CRP levels and Microalbuminuria levels were also measured on admission. APACHE IV and SOFA scores were calculated. Clinical outcome (duration of stay in the ICU, need for MV, need for inotropic/vasopressor support, need for hemodialysis, and survival) was recorded.</p></div><div><h3>Results</h3><p>In relation to healthy subjects, the mean VEGF 1&2 levels were significantly higher in the septic patients (142<!--> <!-->+<!--> <!-->28.98 vs 750.5<!--> <!-->+<!--> <!-->380.34 and 802.07<!--> <!-->+<!--> <!-->292.65 ng/l; <em>p</em> <!-->=<!--> <!-->0.001 and <0.001 respectively). Septic patients who required MV, inotropic/vasopressor support and hemodialysis, and also those who died had significantly higher VEGF1 levels compared to those who didn’t require them (<em>p</em> <!-->=<!--> <!-->0.002, 0.006, 0.008 and 0.001 respectively). VEGF2 level was significantly higher only in those who required inotropic/vasopressor support (<em>p</em> <!-->=<!--> <!-->0.024). VEGF1 and 2 levels were significantly positively correlated with CRP level, Albumin/Creatinine ratio and APACHE IV score. ROC analysis of the data indicated a sensitivity of 85.15% and a specificity of 92.3% when a VEGF 1 level of 410 ng/l was taken as a predictor of ICU mortality.</p></div><div><h3>Conclusion</h3><p>The admission VEGF is a useful marker for the evaluation of septic patients.</p></div>","PeriodicalId":31233,"journal":{"name":"Egyptian Journal of Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ejccm.2016.10.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120992812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-12-01DOI: 10.1016/j.ejccm.2016.07.002
Ahmed Hassouna Bedier Shetaya, Khaled Ahmed Elkhashab, Gomaa Abdel Razek Ahmed
Background
Patients with inferior wall myocardial infarction (IWMI) associated with right ventricular (RV) infarction have much higher rates of adverse events.
Aim
Tissue Doppler (TDI) systolic annular velocity (S′) and myocardial performance index may be useful predictors of proximal right coronary artery (RCA) stenosis as a culprit lesion in inferior wall myocardial infarction.
Methods
In a prospective study, patients with first episode of acute IWMI underwent early conventional and tissue Doppler echocardiographic assessment (within 24 h) of symptom onset and RV indices; Tricuspid annular systolic plane excursion(TAPSE), myocardial performance index (MPI) and tissue Doppler velocities from RV free wall were measured. Patients underwent coronary angiogram within one month and were divided into two groups (A, B) according to angiographic findings based on the presence or absence of significant proximal RCA stenosis.
Results
There were 35 patients with first episode of IWMI, group A includes (n 14 patients) and group B includes (n 21patients), There was significant difference between groups in TAPSE (1.28 cm vs 1.98 p < 0.001), MPI–TDI (0.69 ± 0.12 vs 0.38 ± 0.05 p < 0.001), and in S′ velocity from RV free wall (0.09 m/s ± 0.02 vs 0.12 m/s ± 0.02 p < 0.001). It was found that S′ < 10 cm/s is a predictor of proximal RCA lesion with a sensitivity of 92.86% and a specificity of 85.71% ppv 81.25, npv 94.74, MPI–TDI > 0.55 with a sensitivity of 92.86% and a specificity of 100%, 100% ppv and 95.45% npv, and TAPSE < 16 mm (sensitivity 93%, specificity 100%).
Conclusion
RV indices (S′ velocity, MPI–TDI and TAPSE) are useful in predicting proximal RCA as infarct related artery in IWMI.
背景:下壁心肌梗死(IWMI)合并右心室(RV)梗死的患者有更高的不良事件发生率。目的组织多普勒(TDI)收缩期环速度(S’)和心肌功能指数可作为右近端冠状动脉(RCA)狭窄作为下壁心肌梗死罪魁祸首病变的有效预测指标。方法在一项前瞻性研究中,首次发作的急性IWMI患者在早期(24 h内)接受常规和组织多普勒超声心动图评估症状发作和RV指数;测量三尖瓣环形收缩平面偏移(TAPSE)、心肌性能指数(MPI)和左心室游离壁组织多普勒速度。患者在1个月内行冠状动脉造影,根据造影结果根据是否存在显著的近端RCA狭窄分为A、B两组。结果首发IWMI患者35例,A组14例,B组21例,两组间TAPSE差异有统计学意义(1.28 cm vs 1.98 p <0.001), MPI-TDI(0.69±0.12 vs 0.38±0.05 p & lt;0.001),从RV自由壁上的速度(0.09 m/ S±0.02 vs 0.12 m/ S±0.02 p <0.001)。发现S ' <10 cm/s是RCA近端病变的预测因子,敏感性为92.86%,特异性为85.71%,ppv 81.25, npv 94.74, MPI-TDI >0.55,灵敏度为92.86%,特异性为100%,ppv为100%,npv为95.45%;16mm(灵敏度93%,特异性100%)。结论rv指标(S’velocity、MPI-TDI、TAPSE)可用于预测近端RCA是否为IWMI梗死相关动脉。
{"title":"Tissue Doppler tricuspid annular motion in acute inferior wall myocardial infarction and infarction related artery","authors":"Ahmed Hassouna Bedier Shetaya, Khaled Ahmed Elkhashab, Gomaa Abdel Razek Ahmed","doi":"10.1016/j.ejccm.2016.07.002","DOIUrl":"10.1016/j.ejccm.2016.07.002","url":null,"abstract":"<div><h3>Background</h3><p>Patients with inferior wall myocardial infarction (IWMI) associated with right ventricular (RV) infarction have much higher rates of adverse events.</p></div><div><h3>Aim</h3><p>Tissue Doppler (TDI) systolic annular velocity (S′) and myocardial performance index may be useful predictors of proximal right coronary artery (RCA) stenosis as a culprit lesion in inferior wall myocardial infarction.</p></div><div><h3>Methods</h3><p>In a prospective study, patients with first episode of acute IWMI underwent early conventional and tissue Doppler echocardiographic assessment (within 24<!--> <!-->h) of symptom onset and RV indices; Tricuspid annular systolic plane excursion(TAPSE), myocardial performance index (MPI) and tissue Doppler velocities from RV free wall were measured. Patients underwent coronary angiogram within one month and were divided into two groups (A, B) according to angiographic findings based on the presence or absence of significant proximal RCA stenosis.</p></div><div><h3>Results</h3><p>There were 35 patients with first episode of IWMI, group A includes (<em>n</em> 14 patients) and group B includes (<em>n</em> 21patients), There was significant difference between groups in TAPSE (1.28<!--> <!-->cm vs 1.98 <em>p</em> <!--><<!--> <!-->0.001), MPI–TDI (0.69<!--> <!-->±<!--> <!-->0.12 vs 0.38<!--> <!-->±<!--> <!-->0.05 <em>p</em> <!--><<!--> <!-->0.001), and in S′ velocity from RV free wall (0.09<!--> <!-->m/s<!--> <!-->±<!--> <!-->0.02 vs 0.12<!--> <!-->m/s<!--> <!-->±<!--> <!-->0.02 <em>p</em> <!--><<!--> <!-->0.001). It was found that S′<!--> <!--><<!--> <!-->10<!--> <!-->cm/s is a predictor of proximal RCA lesion with a sensitivity of 92.86% and a specificity of 85.71%<!--> <!-->ppv 81.25, npv 94.74, MPI–TDI<!--> <!-->><!--> <!-->0.55 with a sensitivity of 92.86% and a specificity of 100%, 100%<!--> <!-->ppv and 95.45%<!--> <!-->npv, and TAPSE<!--> <!--><<!--> <!-->16<!--> <!-->mm (sensitivity 93%, specificity 100%).</p></div><div><h3>Conclusion</h3><p>RV indices (S′ velocity, MPI–TDI and TAPSE) are useful in predicting proximal RCA as infarct related artery in IWMI.</p></div>","PeriodicalId":31233,"journal":{"name":"Egyptian Journal of Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ejccm.2016.07.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121401438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-12-01DOI: 10.1016/j.ejccm.2016.10.003
Anjalee Chiwhane, Sanjay Diwan
Introduction
The information on patient characteristics and outcome in patients requiring invasive mechanical ventilation (IMV) is critical for better use of resources and clinical decision making in a rural ICU.
Objective
To understand characteristics and outcome of patients on IMV.
Design
This is a retrospective study in patients admitted in medical intensive care unit of a rural hospital who were on IMV during August 2013 to February 2015. Adult patients with failing respiratory drive and/or those who failed oxygen therapy or NIV (non invasive ventilation) were considered eligible for invasive ventilation. Patients exclusively on NIV were excluded (reason for exclusion was to study the outcome in an expensive intervention like IMV). Patients who were weaned and extubated and subsequently shifted to medicine ward were considered “good” outcome and “adverse” (not-extubated) if they died or sought discharge against medical advice.
Outcome measure
All-cause mortality during ICU stay.
Results
A total of 505 patients, of which 74.7% were male with mean age of 52 years (IQ range 38–65 years). Comorbidities were seen in 76.4% patients; significantly higher in not-extubated (94.85% vs 5.15%) (p = 0.008). The ICU stay, days on ventilation and total hospital stay were 5 (3–9) days, 2 (1–5) days and 5(3–9) days respectively. Primary cause for IMV was sepsis, neurological, cardiac, renal and respiratory and others like envenomation, drug overdose, organophosphate poisoning, etc. Hypertension and diabetes were the commonest co-morbidities.
Conclusion
The mortality in patients requiring invasive ventilation support from low-resource setting is high.
有创机械通气(IMV)患者的特征和预后信息对农村ICU更好地利用资源和临床决策至关重要。目的了解IMV患者的特点及转归。本研究对2013年8月至2015年2月在某农村医院重症监护病房接受IMV治疗的患者进行回顾性研究。呼吸驱动衰竭和/或氧疗或无创通气失败的成年患者被认为符合有创通气的条件。排除单纯使用NIV的患者(排除的原因是为了研究像IMV这样昂贵的干预措施的结果)。断奶拔管后转到内科病房的患者如果死亡或不顾医嘱要求出院,则被认为是“良好”结果和“不良”结果(未拔管)。结果测量:ICU住院期间的全因死亡率。结果505例患者中男性占74.7%,平均年龄52岁(智商38 ~ 65岁)。76.4%的患者存在合并症;未拔管组明显高于对照组(94.85% vs 5.15%) (p = 0.008)。ICU住院时间5(3-9)天,通气时间2(1-5)天,总住院时间5(3-9)天。IMV的主要病因为败血症、神经系统、心脏、肾脏和呼吸系统以及中毒、药物过量、有机磷中毒等。高血压和糖尿病是最常见的合并症。结论低资源环境中需要有创通气支持的患者死亡率较高。
{"title":"Characteristics, outcome of patients on invasive mechanical ventilation: A single center experience from central India","authors":"Anjalee Chiwhane, Sanjay Diwan","doi":"10.1016/j.ejccm.2016.10.003","DOIUrl":"10.1016/j.ejccm.2016.10.003","url":null,"abstract":"<div><h3>Introduction</h3><p>The information on patient characteristics and outcome in patients requiring invasive mechanical ventilation (IMV) is critical for better use of resources and clinical decision making in a rural ICU.</p></div><div><h3>Objective</h3><p>To understand characteristics and outcome of patients on IMV.</p></div><div><h3>Design</h3><p>This is a retrospective study in patients admitted in medical intensive care unit of a rural hospital who were on IMV during August 2013 to February 2015. Adult patients with failing respiratory drive and/or those who failed oxygen therapy or NIV (non invasive ventilation) were considered eligible for invasive ventilation. Patients exclusively on NIV were excluded (reason for exclusion was to study the outcome in an expensive intervention like IMV). Patients who were weaned and extubated and subsequently shifted to medicine ward were considered “good” outcome and “adverse” (not-extubated) if they died or sought discharge against medical advice.</p></div><div><h3>Outcome measure</h3><p>All-cause mortality during ICU stay.</p></div><div><h3>Results</h3><p>A total of 505 patients, of which 74.7% were male with mean age of 52<!--> <!-->years (IQ range 38–65<!--> <!-->years). Comorbidities were seen in 76.4% patients; significantly higher in not-extubated (94.85% vs 5.15%) (<em>p</em> <!-->=<!--> <!-->0.008). The ICU stay, days on ventilation and total hospital stay were 5 (3–9)<!--> <!-->days, 2 (1–5)<!--> <!-->days and 5(3–9)<!--> <!-->days respectively. Primary cause for IMV was sepsis, neurological, cardiac, renal and respiratory and others like envenomation, drug overdose, organophosphate poisoning, etc. Hypertension and diabetes were the commonest co-morbidities.</p></div><div><h3>Conclusion</h3><p>The mortality in patients requiring invasive ventilation support from low-resource setting is high.</p></div>","PeriodicalId":31233,"journal":{"name":"Egyptian Journal of Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ejccm.2016.10.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116502672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-12-01DOI: 10.1016/j.ejccm.2016.08.001
Hatem Abdel Rahman Helmy Ali , Nady A. Razik Mohamad , Hanan Sharaf El-Deen Mohammad , Samir Kamal Abdul Hamid
Several studies have demonstrated that uremic patients who have preserved left ventricular (LV) systolic function could still have subtle systolic dysfunction. In our study, we assessed the right ventricular (RV) and LV myocardial functions measured by conventional echocardiography and two-dimensional (2D) longitudinal speckle-tracking in hemodialysis and non-dialysis recently diagnosed uremic patients. The study population consisted of 24 newly diagnosed uremic patients, 25 hemodialysis patients, and 20 healthy controls. The RV and LV longitudinal strains were significantly lower in patients than in controls (−9.6 vs. −15.3, P < 0.001 for RV and −11.3 vs. −14.8, p < 0.001 for LV). In the hemodialysis group, the RV longitudinal strain was significantly lower than in the non-dialysis group (p = 0.018). The RV longitudinal strain was correlated with hypertension and LV strain. The 2-D longitudinal speckle tracking can detect early ventricular (left and right) systolic dysfunction in patients with uremia in the presence of normal systolic function by conventional methods.
一些研究表明,保留左心室收缩功能的尿毒症患者仍可能有轻微的收缩功能障碍。在我们的研究中,我们评估了常规超声心动图和二维纵向斑点跟踪测量的血液透析和非透析新近诊断为尿毒症患者的右心室(RV)和左室心肌功能。研究人群包括24名新诊断的尿毒症患者,25名血液透析患者和20名健康对照。患者的RV和LV纵向菌株显著低于对照组(- 9.6 vs. - 15.3, P <RV为0.001,- 11.3对- 14.8,p <LV为0.001)。血液透析组RV纵向应变显著低于非透析组(p = 0.018)。左心室纵应变与高血压、左室应变相关。二维纵向斑点跟踪可以检测尿毒症患者在正常收缩功能的情况下早期心室(左、右)收缩功能障碍。
{"title":"2-D Speckle tracking in the assessment of left and right ventricular functions in hemodialysis versus recently diagnosed uremic patients with preserved systolic function","authors":"Hatem Abdel Rahman Helmy Ali , Nady A. Razik Mohamad , Hanan Sharaf El-Deen Mohammad , Samir Kamal Abdul Hamid","doi":"10.1016/j.ejccm.2016.08.001","DOIUrl":"10.1016/j.ejccm.2016.08.001","url":null,"abstract":"<div><p>Several studies have demonstrated that uremic patients who have preserved left ventricular (LV) systolic function could still have subtle systolic dysfunction. In our study, we assessed the right ventricular (RV) and LV myocardial functions measured by conventional echocardiography and two-dimensional (2D) longitudinal speckle-tracking in hemodialysis and non-dialysis recently diagnosed uremic patients. The study population consisted of 24 newly diagnosed uremic patients, 25 hemodialysis patients, and 20 healthy controls. The RV and LV longitudinal strains were significantly lower in patients than in controls (−9.6 vs. −15.3, <em>P</em> <!--><<!--> <!-->0.001 for RV and −11.3 vs. −14.8, <em>p</em> <!--><<!--> <!-->0.001 for LV). In the hemodialysis group, the RV longitudinal strain was significantly lower than in the non-dialysis group (<em>p</em> <!-->=<!--> <!-->0.018). The RV longitudinal strain was correlated with hypertension and LV strain. The 2-D longitudinal speckle tracking can detect early ventricular (left and right) systolic dysfunction in patients with uremia in the presence of normal systolic function by conventional methods.</p></div>","PeriodicalId":31233,"journal":{"name":"Egyptian Journal of Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ejccm.2016.08.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117260304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-12-01DOI: 10.1016/j.ejccm.2016.10.001
Walid Omar Ahmed , Amr Elmaadawy , Ahmed Yehia , Sameh Elmaraghi
Background
Acute myocardial infarction (AMI) is an acute stress state in which plasma copeptin rises. The combination of copeptin and troponin has been suggested to improve the diagnostic performance of acute MI in chest pain patients at time of presentation in the emergency department.
Objective
To investigate the correlation of plasma copeptin levels for early exclusion of acute myocardial infarction in combination with troponin-I.
Methods
This study was conducted in Cairo University hospitals on 40 patients presented to the critical care department with chest pain within 6 h of pain onset as a primary symptom of acute coronary syndrome. Baseline demographic characteristics and clinical data were collected prospectively. Plasma copeptin levels and cTnI were measured by ELISA technique. The primary outcome was diagnosis of AMI.
Results
A negative copeptin and cTnI at baseline ruled out AMI with a negative predictive value of 100%. AMIs not detected by the initial cTnI alone were picked up with copeptin >15.6 pg/ml in first 6 h from onset of chest pain which was confirmed by repeated troponin within 12 h from onset of chest pain.
Conclusion
Combined measurements of troponin and copeptin aid in early and safe rule-out of AMI.
{"title":"Combined measurements of plasma copeptin and troponin-I levels for early exclusion of acute myocardial infarction","authors":"Walid Omar Ahmed , Amr Elmaadawy , Ahmed Yehia , Sameh Elmaraghi","doi":"10.1016/j.ejccm.2016.10.001","DOIUrl":"10.1016/j.ejccm.2016.10.001","url":null,"abstract":"<div><h3>Background</h3><p>Acute myocardial infarction (AMI) is an acute stress state in which plasma copeptin rises. The combination of copeptin and troponin has been suggested to improve the diagnostic performance of acute MI in chest pain patients at time of presentation in the emergency department.</p></div><div><h3>Objective</h3><p>To investigate the correlation of plasma copeptin levels for early exclusion of acute myocardial infarction in combination with troponin-I.</p></div><div><h3>Methods</h3><p>This study was conducted in Cairo University hospitals on 40 patients presented to the critical care department with chest pain within 6<!--> <!-->h of pain onset as a primary symptom of acute coronary syndrome. Baseline demographic characteristics and clinical data were collected prospectively. Plasma copeptin levels and cTnI were measured by ELISA technique. The primary outcome was diagnosis of AMI.</p></div><div><h3>Results</h3><p>A negative copeptin and cTnI at baseline ruled out AMI with a negative predictive value of 100%. AMIs not detected by the initial cTnI alone were picked up with copeptin >15.6<!--> <!-->pg/ml in first 6<!--> <!-->h from onset of chest pain which was confirmed by repeated troponin within 12<!--> <!-->h from onset of chest pain.</p></div><div><h3>Conclusion</h3><p>Combined measurements of troponin and copeptin aid in early and safe rule-out of AMI.</p></div>","PeriodicalId":31233,"journal":{"name":"Egyptian Journal of Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ejccm.2016.10.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114418975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Electrocardiographic changes are known to occur in patients with acute neurological events but their significance remains uncertain. QT dispersion (QTD) reflects heterogeneity of myocardial repolarization, which is modulated by the central nervous system. QTD has been shown to predict adverse outcomes in various cardiac states.
Objective
To determine the degree of QTD and its relation to outcome in patients with acute neurological events.
Methods
We studied 40 patients admitted to our hospital with acute neurological events and without known cardiac disease. Simultaneous 12-lead ECG was done within 24 h of the onset. QTD was calculated manually as the difference between maximum and minimum QT intervals in at least 11 of 12 leads. Modified Rankin Scale (MRS) was used to assess functional status after 3 months from the onset.
Results
Increased QTD in the 24 h-ECG following the onset of acute neurological events (median = 60, range, 20–120 ms). QTD was higher in patients with intercerebral hemorrhage as compared to non hemorrhagic stroke (67 ± 16 versus 52 ± 26 ms; p = 0.04). The increase in QTD was associated with lower functional outcomes on Modified Rankin Scale ((r = 0.65 and p = 0.001) and with a higher mortality (p = 0.006) at 3 months follow-up. On multivariate analysis, the most independent predictors of mortality were QTD (odds ratio, 1.13; 95% confidence interval, 1.03–1.25) and GCS (odds ratio, 0.366; 95% confidence interval, 0.177–0.758).
Conclusion
Prolonged QTD in the first 24 h of acute neurological events is an independent predictor of short-term functional outcome and mortality following.
背景:已知急性神经系统事件患者会发生心电图改变,但其意义尚不确定。QT离散度(QTD)反映心肌复极的异质性,并受中枢神经系统调节。QTD已被证明可预测各种心脏状态的不良后果。目的探讨急性神经系统事件患者QTD程度及其与预后的关系。方法对我院收治的40例无已知心脏疾病的急性神经系统事件患者进行研究。发病24小时内同时行12导联心电图。QTD是手动计算12个导联中至少11个导联中最大和最小QT间期的差值。采用改良Rankin量表(MRS)评估发病后3个月的功能状态。结果急性神经事件发生后24 h心电图QTD增加(中位数= 60,范围20-120 ms)。脑出血患者的QTD高于非出血性卒中患者(67±16 vs 52±26 ms;p = 0.04)。QTD的增加与修正兰金量表的功能结局较低(r = 0.65, p = 0.001)以及随访3个月时较高的死亡率(p = 0.006)相关。在多变量分析中,最独立的死亡率预测因子是QTD(优势比,1.13;95%可信区间为1.03-1.25)和GCS(优势比0.366;95%置信区间0.177-0.758)。结论急性神经系统事件前24 h QTD延长是预测急性神经系统事件后短期功能结局和死亡率的独立指标。
{"title":"The prognostic value of QT dispersion in patients with acute neurological events without known cardiac disease","authors":"Abdelmonaem Ibrahim, Wael Samy, Mohamed Khaled, Nael Samir","doi":"10.1016/j.ejccm.2016.03.001","DOIUrl":"10.1016/j.ejccm.2016.03.001","url":null,"abstract":"<div><h3>Background</h3><p>Electrocardiographic changes are known to occur in patients with acute neurological events but their significance remains uncertain. QT dispersion (QTD) reflects heterogeneity of myocardial repolarization, which is modulated by the central nervous system. QTD has been shown to predict adverse outcomes in various cardiac states.</p></div><div><h3>Objective</h3><p>To determine the degree of QTD and its relation to outcome in patients with acute neurological events.</p></div><div><h3>Methods</h3><p>We studied 40 patients admitted to our hospital with acute neurological events and without known cardiac disease. Simultaneous 12-lead ECG was done within 24<!--> <!-->h of the onset. QTD was calculated manually as the difference between maximum and minimum QT intervals in at least 11 of 12 leads. Modified Rankin Scale (MRS) was used to assess functional status after 3<!--> <!-->months from the onset.</p></div><div><h3>Results</h3><p>Increased QTD in the 24<!--> <!-->h-ECG following the onset of acute neurological events (median<!--> <!-->=<!--> <!-->60, range, 20–120<!--> <!-->ms). QTD was higher in patients with intercerebral hemorrhage as compared to non hemorrhagic stroke (67<!--> <!-->±<!--> <!-->16 versus 52<!--> <!-->±<!--> <!-->26<!--> <!-->ms; <em>p</em> <!-->=<!--> <!-->0.04). The increase in QTD was associated with lower functional outcomes on Modified Rankin Scale ((<em>r</em> <!-->=<!--> <!-->0.65 and <em>p</em> <!-->=<!--> <!-->0.001) and with a higher mortality (<em>p</em> <!-->=<!--> <!-->0.006) at 3<!--> <!-->months follow-up. On multivariate analysis, the most independent predictors of mortality were QTD (odds ratio, 1.13; 95% confidence interval, 1.03–1.25) and GCS (odds ratio, 0.366; 95% confidence interval, 0.177–0.758).</p></div><div><h3>Conclusion</h3><p>Prolonged QTD in the first 24<!--> <!-->h of acute neurological events is an independent predictor of short-term functional outcome and mortality following.</p></div>","PeriodicalId":31233,"journal":{"name":"Egyptian Journal of Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ejccm.2016.03.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133383561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The resulting left ventricular (LV) dysfunction in acute STEMI is definitely secondary to loss of myocardial muscle mass (Krumholz et al., 2009; Guerchicoff et al., 2014) but may have an additional component of LV dyssynchrony.
Aim
Detection of LV dyssynchrony in acute STEMI patients and its relation to LV dysfunction in these patients.
Patients and methods
60 patients presenting with acute STEMI were injected with 25 mCi of Tc99m SestaMIBI prior to primary PCI. Acquisition was deferred after the procedure within 6 h of injection. Images were analyzed using QGS Cedars Sinai software to measure the histogram bandwidth, standard deviation and entropy using GSPECT phase analysis. The results were compared to 60 patients with negative perfusion scans upon maximal exercise imaged using the same protocol during rest.
Results
Our study included a total number of 60 acute STEMI patients, 54 males, mean age 54.8 ± 10.38 years, Compared to 60 controls mean age 50.7 + 20.3 years. Risk factors for CAD were smoking in 41 patients, hypertension in 17, dyslipidemia in 7, diabetes in 15, and positive family history of CAD in 21. 30 patients had acute anterior STEMI and 30 had inferior. LVEDV and LVESV were larger compared to controls; 133.0 ± 88.7 vs. 62.0 ± 19.2 ml and 89.7 ± 82.1 vs. 19.9 ± 12.3 ml respectively, p < 0.001, and lower LVEF 39.0 ± 16.8 vs. 71.1 ± 10.4%, p < 0.001. Histogram bandwidth (BW), standard deviation (SD) and entropy (E) values were significantly higher in patients when compared to controls; 76.2 ± 54.7 vs. 17.8 ± 5.3, 20.7 ± 15.2 vs. 4.1 ± 2.0 and 51.1 ± 18.6 vs. 21.8 ± 7.1 degrees respectively, p < 0.001. BW, SD and E significantly negatively correlated with LVEF in acute STEMI cases; r = −.733, p < 0.001, r = −.75, p < 0.001, and r = −.858, p < 0.001 respectively.
Conclusion
LV dyssynchrony may be acquired acutely very early in STEMI and may have a negative impact on LV ejection fraction.
急性STEMI导致的左心室功能障碍肯定是继发于心肌质量的损失(Krumholz等,2009;Guerchicoff et al., 2014),但可能有左室不同步的额外成分。目的检测急性STEMI患者左室非同步化及其与左室功能障碍的关系。患者和方法60例急性STEMI患者在首次PCI前注射25mci Tc99m SestaMIBI。注射后6小时内延迟采集。采用QGS Cedars Sinai软件对图像进行分析,采用GSPECT相位分析测量直方图带宽、标准差和熵。将结果与60例在最大运动时使用相同方案进行负灌注扫描的患者在休息时进行成像的结果进行比较。结果本研究共纳入急性STEMI患者60例,男性54例,平均年龄54.8±10.38岁,对照组60例,平均年龄50.7±20.3岁。冠心病的危险因素有吸烟41例,高血压17例,血脂异常7例,糖尿病15例,冠心病家族史21例。急性前路STEMI 30例,下路STEMI 30例。与对照组相比,LVEDV和LVESV更大;133.0±88.7和62.0±19.2毫升和89.7±82.1和19.9±12.3毫升分别p & lt;0.001,低LVEF 39.0±16.8和71.1±10.4%,p & lt;0.001. 直方图带宽(BW)、标准差(SD)和熵(E)值显著高于对照组;76.2±54.7和17.8±5.3,20.7±15.2和4.1±2.0,51.1±18.6和21.8±7.1度分别p & lt;0.001. 急性STEMI患者BW、SD、E与LVEF呈显著负相关;r =−。733, p <0.001, r =−。75、p <0.001, r =−。858, p <分别为0.001。结论左室非同步化可能在STEMI患者早期就出现,并可能对左室射血分数产生负面影响。
{"title":"Early left ventricular dyssynchrony in acute ST elevation myocardial infarction: A gated single photon emission computed tomography study","authors":"Akram Abdelbary , Alaa Abdelhay , M.H. Khedr , M. Emam , Khayri Tohamy","doi":"10.1016/j.ejccm.2016.05.002","DOIUrl":"10.1016/j.ejccm.2016.05.002","url":null,"abstract":"<div><h3>Introduction</h3><p>The resulting left ventricular (LV) dysfunction in acute STEMI is definitely secondary to loss of myocardial muscle mass (Krumholz et al., 2009; Guerchicoff et al., 2014) but may have an additional component of LV dyssynchrony.</p></div><div><h3>Aim</h3><p>Detection of LV dyssynchrony in acute STEMI patients and its relation to LV dysfunction in these patients.</p></div><div><h3>Patients and methods</h3><p>60 patients presenting with acute STEMI were injected with 25<!--> <!-->mCi of Tc<sup>99m</sup> SestaMIBI prior to primary PCI. Acquisition was deferred after the procedure within 6<!--> <!-->h of injection. Images were analyzed using QGS Cedars Sinai software to measure the histogram bandwidth, standard deviation and entropy using GSPECT phase analysis. The results were compared to 60 patients with negative perfusion scans upon maximal exercise imaged using the same protocol during rest.</p></div><div><h3>Results</h3><p>Our study included a total number of 60 acute STEMI patients, 54 males, mean age 54.8<!--> <!-->±<!--> <!-->10.38<!--> <!-->years, Compared to 60 controls mean age 50.7<!--> <!-->+<!--> <!-->20.3<!--> <!-->years. Risk factors for CAD were smoking in 41 patients, hypertension in 17, dyslipidemia in 7, diabetes in 15, and positive family history of CAD in 21. 30 patients had acute anterior STEMI and 30 had inferior. LVEDV and LVESV were larger compared to controls; 133.0<!--> <!-->±<!--> <!-->88.7 vs. 62.0<!--> <!-->±<!--> <!-->19.2<!--> <!-->ml and 89.7<!--> <!-->±<!--> <!-->82.1 vs. 19.9<!--> <!-->±<!--> <!-->12.3<!--> <!-->ml respectively, <em>p</em> <!--><<!--> <!-->0.001, and lower LVEF 39.0<!--> <!-->±<!--> <!-->16.8 vs. 71.1<!--> <!-->±<!--> <!-->10.4%, <em>p</em> <!--><<!--> <!-->0.001. Histogram bandwidth (BW), standard deviation (SD) and entropy (E) values were significantly higher in patients when compared to controls; 76.2<!--> <!-->±<!--> <!-->54.7 vs. 17.8<!--> <!-->±<!--> <!-->5.3, 20.7<!--> <!-->±<!--> <!-->15.2 vs. 4.1<!--> <!-->±<!--> <!-->2.0 and 51.1<!--> <!-->±<!--> <!-->18.6 vs. 21.8<!--> <!-->±<!--> <!-->7.1 degrees respectively, <em>p</em> <!--><<!--> <!-->0.001. BW, SD and E significantly negatively correlated with LVEF in acute STEMI cases; <em>r</em> <!-->=<!--> <!-->−.733, <em>p</em> <!--><<!--> <!-->0.001, <em>r</em> <!-->=<!--> <!-->−.75, <em>p</em> <!--><<!--> <!-->0.001, and <em>r</em> <!-->=<!--> <!-->−.858, <em>p</em> <!--><<!--> <!-->0.001 respectively.</p></div><div><h3>Conclusion</h3><p>LV dyssynchrony may be acquired acutely very early in STEMI and may have a negative impact on LV ejection fraction.</p></div>","PeriodicalId":31233,"journal":{"name":"Egyptian Journal of Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2016-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ejccm.2016.05.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130845169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-08-01DOI: 10.1016/j.ejccm.2016.03.002
Osama Tayeh , Khaled M. Taema , Mohamed I. Eldesouky , Adel A. Omara
Several cumbersome scoring systems were developed for prognosis and outcome prediction in sepsis. We intended in this study to evaluate the urinary albumin/creatinine ratio (ACR) as a prognostic predictor in sepsis.
We included 40 adult septic patients in a prospective observational study. We excluded patients with preexisting chronic kidney disease or diabetes mellitus.
After clinical evaluation, urine spot samples were collected on admission and 24 h later for ACR1 and ACR2. Admission APACHE IV score and the highest recorded SOFA score of their daily estimation were considered. We also evaluated the need for mechanical ventilation, inotropic and/or vasoactive support, renal replacement therapy (RRT), and in-hospital mortality.
In a population with 63 (55–71) year old with 29 (72.5%) males, we found that the ACR2 is correlated with the SOFA score (r = 0.4, P = 0.03). SOFA was higher in patients with increasing ACR [14(4.8–16.8) vs 5(3–8), P = 0.01]. None of the ACR measures was correlated with APACHE IV score. ACR2 was higher in patients who needed mechanical ventilation and inotropic and/or vasoactive support [140(125–207) and 151(127–218) mg/g respectively] compared to [65(47–174) and 74(54–162) mg/g], P = 0.01 and 0.009. None of the measured parameters was related to the need of RRT. ACR1, ACR2, APACHE IV and increasing ACR were predictors of mortality. The AUC for mortality prediction was largest for APACHE IV (0.90) then ACR2 (0.88). ACR2 of 110.5 mg/g was 100% sensitive and 86% specific to predict mortality.
We concluded that the urinary ACR may be used as a simple test for prognosis and mortality prediction in sepsis.
几个繁琐的评分系统被开发用于败血症的预后和预后预测。在这项研究中,我们旨在评估尿白蛋白/肌酐比值(ACR)作为脓毒症的预后预测因子。我们在一项前瞻性观察研究中纳入了40名成年脓毒症患者。我们排除了既往存在慢性肾脏疾病或糖尿病的患者。经临床评估,于患者入院时及入院24 h后采集尿斑标本进行ACR1和ACR2的检测。考虑入院APACHE IV评分和每日估计的最高记录SOFA评分。我们还评估了机械通气、肌力和/或血管活性支持、肾脏替代治疗(RRT)和住院死亡率的需求。在63(55-71)岁人群中,男性29人(72.5%),我们发现ACR2与SOFA评分相关(r = 0.4, P = 0.03)。ACR越高,SOFA越高[14(4.8 ~ 16.8)vs 5(3 ~ 8), P = 0.01]。所有ACR指标与APACHE IV评分均无相关性。需要机械通气和肌力和/或血管活性支持的患者的ACR2分别为140(125-207)和151(127-218)mg/g,高于65(47-174)和74(54-162)mg/g, P = 0.01和0.009。测量的参数均与RRT的需要无关。ACR1、ACR2、APACHE IV和ACR升高是死亡率的预测因子。APACHE IV的AUC(0.90)最大,ACR2(0.88)次之。预测死亡率的ACR2为110.5 mg/g,敏感性为100%,特异性为86%。我们认为尿ACR可作为脓毒症患者预后和死亡率预测的简单测试。
{"title":"Urinary albumin/creatinine ratio as an early predictor of outcome in critically-ill septic patients","authors":"Osama Tayeh , Khaled M. Taema , Mohamed I. Eldesouky , Adel A. Omara","doi":"10.1016/j.ejccm.2016.03.002","DOIUrl":"10.1016/j.ejccm.2016.03.002","url":null,"abstract":"<div><p>Several cumbersome scoring systems were developed for prognosis and outcome prediction in sepsis. We intended in this study to evaluate the urinary albumin/creatinine ratio (ACR) as a prognostic predictor in sepsis.</p><p>We included 40 adult septic patients in a prospective observational study. We excluded patients with preexisting chronic kidney disease or diabetes mellitus.</p><p>After clinical evaluation, urine spot samples were collected on admission and 24<!--> <!-->h later for ACR1 and ACR2. Admission APACHE IV score and the highest recorded SOFA score of their daily estimation were considered. We also evaluated the need for mechanical ventilation, inotropic and/or vasoactive support, renal replacement therapy (RRT), and in-hospital mortality.</p><p>In a population with 63 (55–71) year old with 29 (72.5%) males, we found that the ACR2 is correlated with the SOFA score (<em>r</em> <!-->=<!--> <!-->0.4, <em>P</em> <!-->=<!--> <!-->0.03). SOFA was higher in patients with increasing ACR [14(4.8–16.8) vs 5(3–8), <em>P</em> <!-->=<!--> <!-->0.01]. None of the ACR measures was correlated with APACHE IV score. ACR2 was higher in patients who needed mechanical ventilation and inotropic and/or vasoactive support [140(125–207) and 151(127–218)<!--> <!-->mg/g respectively] compared to [65(47–174) and 74(54–162)<!--> <!-->mg/g], <em>P</em> <!-->=<!--> <!-->0.01 and 0.009. None of the measured parameters was related to the need of RRT. ACR1, ACR2, APACHE IV and increasing ACR were predictors of mortality. The AUC for mortality prediction was largest for APACHE IV (0.90) then ACR2 (0.88). ACR2 of 110.5<!--> <!-->mg/g was 100% sensitive and 86% specific to predict mortality.</p><p>We concluded that the urinary ACR may be used as a simple test for prognosis and mortality prediction in sepsis.</p></div>","PeriodicalId":31233,"journal":{"name":"Egyptian Journal of Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2016-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ejccm.2016.03.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123520844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-08-01DOI: 10.1016/j.ejccm.2016.03.003
Sameh Samir, Mohamed Naseem
Background and aim
Glycosylated hemoglobin (HbA1c) is a more stable and accurate parameter of the glycometabolic state than fasting glycemia. However, its role in predicting the prognosis in acute myocardial infarction patients remains unclear with conflicting results from the available data. This study evaluates the effect of admission HbA1c as a parameter of the glycometabolic state on the clinical outcome in non diabetic acute st segment elevation myocardial infarction (STEMI) patients.
Method
Between June 2012 and December 2014, 208 consecutive STEMI non diabetic patients who underwent primary percutaneous coronary intervention (PPCI) were enrolled. Patients were divided according to the HbA1c level into 2 groups 112 patients in group I (HbA1c ⩽ 5.6%) and 96 patients in group II (HbA1c 5.7–6.4%). In hospital and at 6 months major adverse cardiac outcome (MACE) was calculated.
Results
Mean age was 55.9 ± 7.12 years, 149 were men and there was no significant difference regarding baseline characteristics. Post PPCI TIMI III flow was higher in group I (p = 0.016), angiographic no reflow was higher in group 2 (p = 0.003). No significant difference regarding in hospital MACE (p = 0.44). At 6 month follow up MACE was significantly higher in group 2 (p < 0.001) and this mainly due to higher incidence of target lesion revascularization (TLR) in group 2 (p < 0.001). Multivariate analysis showed that HbA1c is significantly associated with 6 months MACE (hazard ratio 1.9; p = 0.022).
Conclusion
Abnormal glycometabolic state assessed by HbA1c at admission in non diabetic STEMI patients was associated with higher MACE incidence at 6 months follow up.
{"title":"Effect of admission glycometabolic state on clinical outcome in non diabetic subjects with acute st segment elevation myocardial infarction","authors":"Sameh Samir, Mohamed Naseem","doi":"10.1016/j.ejccm.2016.03.003","DOIUrl":"10.1016/j.ejccm.2016.03.003","url":null,"abstract":"<div><h3>Background and aim</h3><p>Glycosylated hemoglobin (HbA1c) is a more stable and accurate parameter of the glycometabolic state than fasting glycemia. However, its role in predicting the prognosis in acute myocardial infarction patients remains unclear with conflicting results from the available data. This study evaluates the effect of admission HbA1c as a parameter of the glycometabolic state on the clinical outcome in non diabetic acute st segment elevation myocardial infarction (STEMI) patients.</p></div><div><h3>Method</h3><p>Between June 2012 and December 2014, 208 consecutive STEMI non diabetic patients who underwent primary percutaneous coronary intervention (PPCI) were enrolled. Patients were divided according to the HbA1c level into 2 groups 112 patients in group I (HbA1c<!--> <!-->⩽<!--> <!-->5.6%) and 96 patients in group II (HbA1c 5.7–6.4%). In hospital and at 6<!--> <!-->months major adverse cardiac outcome (MACE) was calculated.</p></div><div><h3>Results</h3><p>Mean age was 55.9<!--> <!-->±<!--> <!-->7.12<!--> <!-->years, 149 were men and there was no significant difference regarding baseline characteristics. Post PPCI TIMI III flow was higher in group I (<em>p</em> <!-->=<!--> <!-->0.016), angiographic no reflow was higher in group 2 (<em>p</em> <!-->=<!--> <!-->0.003). No significant difference regarding in hospital MACE (<em>p</em> <!-->=<!--> <!-->0.44). At 6<!--> <!-->month follow up MACE was significantly higher in group 2 (<em>p</em> <!--><<!--> <!-->0.001) and this mainly due to higher incidence of target lesion revascularization (TLR) in group 2 (<em>p</em> <!--><<!--> <!-->0.001). Multivariate analysis showed that HbA1c is significantly associated with 6<!--> <!-->months MACE (hazard ratio 1.9; <em>p</em> <!-->=<!--> <!-->0.022).</p></div><div><h3>Conclusion</h3><p>Abnormal glycometabolic state assessed by HbA1c at admission in non diabetic STEMI patients was associated with higher MACE incidence at 6<!--> <!-->months follow up.</p></div>","PeriodicalId":31233,"journal":{"name":"Egyptian Journal of Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2016-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ejccm.2016.03.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134484883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-08-01DOI: 10.1016/j.ejccm.2016.05.001
Hany Tawfeek, Mahmoud K. Nour, Akram A. Bary, Alia A. Fattah
Background
Cardiovascular disease is the leading cause of death in Egypt and worldwide, placing great strain on the world’s health systems. This is one of the few Egyptian registries dealing with patients with acute coronary syndrome admitted in critical care department, Cairo University.
Methods
This is a retrospective non-controlled cohort study of patients with acute coronary syndrome admitted from January 2010 to December 2012. Retrospective analysis of these patients data were retrieved through reviewing written paper and electronic database.
Results
A total number of 503 patients were enrolled in our study. The mean age was 57.2 ± 10.4 years. Their pain duration was 14 ± 24.4 h. Average length of stay was (7 ± 4.4 days). Primary percutaneous coronary intervention (PCI) was done to 154 patients (30.6%), while we had 105 elective PCI procedures (20.9%). Major adverse cardiac events (MACE) were higher in patients with higher age (60 years vs 56.7 years P value 0.021), STEMI (25.7% vs. 18% in UA/NSTEMI P value 0.002), higher CKMB levels (157iu/l vs 89iu/l P value0.019), and higher Killip class upon presentation (class III-IV 64.9% vs 2.2% class I-II p < 0.001). Patients with UA/NSTEMI who were treated conservatively developed statistically significant higher incidence of MACE as compared to those treated interventionally (23.4% vs. 13.5% P value 0.031). Patients with STEMI who were treated without intervention have significant higher incidence of MACE than those who were treated interventionally (15.4% vs. 5.5% p= 0.46).
Conclusion
1. Higher incidence of MACE was observed in the higher age group, higher levels of cardiac biomarkers, and higher Killip class. 2. Outcome was affected by early interventional treatment in all patient groups.
背景心血管疾病是埃及和全世界的主要死亡原因,给世界卫生系统带来了巨大压力。这是埃及为数不多的登记中心之一,处理在开罗大学重症监护室收治的急性冠状动脉综合征患者。方法对2010年1月至2012年12月收治的急性冠状动脉综合征患者进行回顾性非对照队列研究。回顾性分析这些患者的资料通过查阅书面论文和电子数据库进行检索。结果共纳入503例患者。平均年龄57.2±10.4岁。疼痛持续时间(14±24.4 h),平均住院时间(7±4.4 d)。初步经皮冠状动脉介入治疗(PCI) 154例(30.6%),而我们有105例选择性PCI手术(20.9%)。年龄越大(60岁vs 56.7岁P值0.021)、STEMI (25.7% vs 18% UA/NSTEMI P值0.002)、CKMB水平越高(157iu/l vs 89iu/l P值0.019)、就诊时Killip等级越高(III-IV级64.9% vs 2.2% I-II级P <0.001)。保守治疗的UA/NSTEMI患者MACE发生率高于介入治疗的患者(23.4%比13.5%,P值为0.031)。STEMI患者不进行干预治疗的MACE发生率显著高于介入治疗组(15.4% vs 5.5% p = 0.46)。年龄越大,心脏生物标志物水平越高,Killip分级越高,MACE的发生率越高。2. 所有患者组的预后均受早期介入治疗的影响。
{"title":"Contemporary retrospective analysis of acute coronary syndrome. An Egyptian study","authors":"Hany Tawfeek, Mahmoud K. Nour, Akram A. Bary, Alia A. Fattah","doi":"10.1016/j.ejccm.2016.05.001","DOIUrl":"10.1016/j.ejccm.2016.05.001","url":null,"abstract":"<div><h3>Background</h3><p>Cardiovascular disease is the leading cause of death in Egypt and worldwide, placing great strain on the world’s health systems. This is one of the few Egyptian registries dealing with patients with acute coronary syndrome admitted in critical care department, Cairo University.</p></div><div><h3>Methods</h3><p>This is a retrospective non-controlled cohort study of patients with acute coronary syndrome admitted from January 2010 to December 2012. Retrospective analysis of these patients data were retrieved through reviewing written paper and electronic database.</p></div><div><h3>Results</h3><p>A total number of 503 patients were enrolled in our study. The mean age was 57.2<!--> <!-->±<!--> <!-->10.4<!--> <!-->years. Their pain duration was 14<!--> <!-->±<!--> <!-->24.4<!--> <!-->h. Average length of stay was (7<!--> <!-->±<!--> <!-->4.4<!--> <!-->days). Primary percutaneous coronary intervention (PCI) was done to 154 patients (30.6%), while we had 105 elective PCI procedures (20.9%). Major adverse cardiac events (MACE) were higher in patients with higher age (60<!--> <!-->years vs 56.7<!--> <!-->years <em>P</em> value 0.021), STEMI (25.7% vs. 18% in UA/NSTEMI <em>P</em> value 0.002), higher CKMB levels (157iu/l vs 89iu/l <em>P</em> value0.019), and higher Killip class upon presentation (class III-IV 64.9% vs 2.2% class I-II <em>p</em> <!--><<!--> <!-->0.001). Patients with UA/NSTEMI who were treated conservatively developed statistically significant higher incidence of MACE as compared to those treated interventionally (23.4% vs. 13.5% <em>P</em> value 0.031). Patients with STEMI who were treated without intervention have significant higher incidence of MACE than those who were treated interventionally (15.4% vs. 5.5% <em>p</em> <em>=</em> <!-->0.46).</p></div><div><h3>Conclusion</h3><p>1. Higher incidence of MACE was observed in the higher age group, higher levels of cardiac biomarkers, and higher Killip class. 2. Outcome was affected by early interventional treatment in all patient groups.</p></div>","PeriodicalId":31233,"journal":{"name":"Egyptian Journal of Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2016-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ejccm.2016.05.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125087290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}