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Comparison of the accuracy of four diagnostic prediction rules for pulmonary embolism in patients admitted to the emergency department 比较急诊科入院患者肺栓塞四种诊断预测规则的准确性。
IF 1.6 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-01 DOI: 10.1016/j.repc.2024.02.006

Introduction and Objectives

Ruling out pulmonary embolism (PE) through a combination of clinical assessment and D-dimer level can potentially avoid excessive use of computed tomography pulmonary angiography (CTPA). We aimed to compare the diagnostic accuracy of the standard approach based on the Wells and Geneva scores combined with a standard D-dimer cut-off (500 ng/ml), with three alternative strategies (age-adjusted and the YEARS and PEGeD algorithms) in patients admitted to the emergency department (ED) with suspected PE.

Methods

Consecutive outpatients admitted to the ED who underwent CTPA due to suspected PE were retrospectively assessed. Sensitivity, specificity, positive and negative predictive values, likelihood ratios and diagnostic odds ratios were calculated and compared between the different diagnostic prediction rules.

Results

We included 1402 patients (mean age 69±18 years, 54% female), and PE was confirmed in 25%. Compared to the standard approach (p<0.001), an age-adjusted strategy increased specificity with a non-significant decrease in sensitivity only in patients older than 70 years. Compared to the standard and age-adjusted approaches, the YEARS and PEGeD algorithms had the highest specificity across all ages, but were associated with a significant decrease in sensitivity (p<0.001), particularly in patients aged under 60 years (sensitivity of 81% in patients aged between 51 and 60 years).

Conclusion

Compared to the standard approach, all algorithms were associated with increased specificity. The age-adjusted strategy was the only one not associated with a significant decrease in sensitivity compared to the standard approach, enabling CTPA requests to be reduced safely.
简介和目的通过结合临床评估和 D-二聚体水平来排除肺栓塞(PE)可能会避免过度使用计算机断层扫描肺血管造影术(CTPA)。我们旨在对急诊科(ED)收治的疑似 PE 患者进行比较,以威尔斯和日内瓦评分为基础的标准方法结合标准 D-二聚体临界值(500 ng/ml)与三种替代策略(年龄调整算法、YEARS 算法和 PEGeD 算法)的诊断准确性。结果我们纳入了1402名患者(平均年龄69±18岁,54%为女性),其中25%确诊为 PE。与标准方法相比(p<0.001),年龄调整策略提高了特异性,但仅70岁以上患者的敏感性下降不明显。与标准方法和年龄调整方法相比,YEARS 和 PEGeD 算法在所有年龄段的特异性最高,但敏感性显著下降(p<0.001),尤其是在 60 岁以下的患者中(51 至 60 岁患者的敏感性为 81%)。与标准方法相比,年龄调整策略是唯一不会导致灵敏度显著下降的方法,因此可以安全地减少 CTPA 请求。
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引用次数: 0
Quality of life and performance status after cardiopulmonary resuscitation: A study in Cova da Beira University Hospital Center's intensive care unit 心肺复苏后的生活质量和表现状态:Cova da Beira大学医院中心重症监护室的一项研究。
IF 1.6 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-01 DOI: 10.1016/j.repc.2024.02.005

Introduction and Objectives

Cardiac arrest (CA) is associated with high morbidity and mortality. Many studies focus on survival, but few explore the outcomes. The aim of this study is to analyze the survival curve, independence, quality of life, and performance status after CA.

Methods

This retrospective study included adults admitted to the intensive care unit of Cova da Beira University Hospital Center after CA between 2015 and 2019. We analyzed patient records and applied a questionnaire including EuroQoL's EQ-5D-3L and ECOG performance status.

Results

Ninety-seven patients were included (mean age 75.74 years). Thirty-one patients (32.0%) survived to hospital discharge. There was a significant loss of independence for activities of daily living, with 50.0% of those previously independent becoming dependent and 47.5% of those previously at home being institutionalized. Diabetes, female gender, and length of hospital stay were especially impactful on these findings. One year after CA, only 20.6% were alive and only 13.4% (65% of the one-year survivors) were independent. Nine patients answered our questionnaire. Mean EQ-5D quality of life index (0.528±0.297) and the most affected domains (‘Pain/discomfort’ and ‘Anxiety/depression’) were similar to the Portuguese population aged >30 years. However, 66.6% reported a decline in their quality of life. Lastly, seven respondents had a good performance status (ECOG 0-1).

Conclusions

There was a significant loss of independence after CA. Moreover, despite the acceptable performance status and the quality of life results being similar to the general population, there was a perceived deterioration post-CA. Ultimately, we emphasize the need to improve care for these patients.
导言和目的心脏骤停(CA)与高发病率和高死亡率有关。许多研究关注存活率,但很少有研究探讨其结果。本研究旨在分析心脏骤停后的生存曲线、独立性、生活质量和表现状态。方法这项回顾性研究纳入了2015年至2019年期间因心脏骤停入住科瓦达贝拉大学医院中心重症监护室的成年人。我们分析了患者的病历,并采用了包括EuroQoL's EQ-5D-3L和ECOG表现状态在内的调查问卷。结果共纳入97名患者(平均年龄75.74岁)。31名患者(32.0%)存活至出院。患者的日常生活能力明显下降,50.0%的患者由独立生活变为依赖生活,47.5%的患者由居家生活变为住院生活。糖尿病、女性性别和住院时间对这些结果的影响尤为明显。CA 一年后,只有 20.6% 的患者存活,只有 13.4% 的患者(占一年存活患者的 65%)能够独立生活。九名患者回答了我们的调查问卷。平均 EQ-5D 生活质量指数(0.528±0.297)和最受影响的领域("疼痛/不适 "和 "焦虑/抑郁")与葡萄牙 30 岁人群相似。然而,66.6%的受访者表示他们的生活质量有所下降。最后,7 名受访者的表现状况良好(ECOG 0-1)。此外,尽管受访者的表现状态和生活质量与普通人相似,但他们认为 CA 术后生活质量有所下降。最终,我们强调有必要改善对这些患者的护理。
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引用次数: 0
Cardiovascular benefits of resistance exercise: It's time to prescribe 阻力运动对心血管的益处:是时候开处方了。
IF 1.6 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-01 DOI: 10.1016/j.repc.2024.02.009
Despite the well-known health benefits of regular physical activity, sedentary behavior and physical inactivity remain a real global pandemic. Exercise is associated with increased life expectancy, improved quality of life and prevention of multiple diseases. Although less implemented in practice compared to aerobic exercise, recent evidence shows that resistance exercise (RE) is also responsible for various benefits, including improvements in body composition, control of several cardiovascular (CV) risk factors, and reduction of CV outcomes. RE increases strength and muscle mass, is effective in controlling type 2 diabetes, and improves the management of obesity, lipids, and blood pressure profiles. In this setting, clinical guidelines recommend the inclusion of RE for primary and secondary CV risk prevention, particularly in combination with aerobic exercise, in which the benefits are most pronounced. Prescription of RE should follow a methodology that includes key variables such as frequency, intensity, type, time, and progression. Despite challenges, professionals in the CV field should be familiar with RE prescription in order to maximize its referral in clinical practice. This review aims to analyze the CV effects of RE and current recommendations regarding the prescription of this type of exercise.
尽管经常进行体育锻炼对健康的益处众所周知,但久坐不动和缺乏体育锻炼仍是全球的一个现实问题。运动与延长预期寿命、提高生活质量和预防多种疾病有关。虽然与有氧运动相比,阻力运动(RE)在实践中开展得较少,但最近的证据显示,阻力运动(RE)也能带来各种益处,包括改善身体成分、控制多种心血管(CV)风险因素和减少 CV 后果。阻力运动能增强力量和肌肉质量,有效控制 2 型糖尿病,改善肥胖、血脂和血压状况。在这种情况下,临床指南建议将 RE 纳入一级和二级心血管风险预防,尤其是与有氧运动相结合,因为有氧运动的益处最为明显。RE 的处方应遵循包括频率、强度、类型、时间和进展等关键变量的方法。尽管存在挑战,但心血管领域的专业人士仍应熟悉 RE 的处方,以便在临床实践中最大限度地推广它。本综述旨在分析 RE 对心血管疾病的影响,以及目前有关此类运动处方的建议。
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引用次数: 0
Cardio-oncology guidelines, structural heart disease and Kounis syndrome in the upcoming guidelines 对 "即将发布的指南中的心肿瘤指南、结构性心脏病和库尼斯综合征 "一信的回复。
IF 1.6 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-01 DOI: 10.1016/j.repc.2024.03.003
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引用次数: 0
The early and medium-term results of the Ross procedure in pediatric patients. 罗斯手术在儿童患者中的早期和中期效果。
IF 1.6 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-30 DOI: 10.1016/j.repc.2024.05.009
Shiraslan Bakhshaliyev, Ergin Arslanoğlu, Bahruz Aliyev, Görkem Çitoğlu, Kaan Altunyuva, Ibrahim Demir, Mohammed Skaik, Dogan Yetut, Murat Başaran, Emin Tireli

Introduction and objectives: The Ross procedure is the preferred surgical treatment for pediatric aortic valve diseases, and its long-term outcomes have been extensively documented. This article presents the results of the Ross and Ross-Konno procedures performed on pediatric patients in our center.

Methods: Ross and Ross-Konno procedures were performed on 20 patients in our center between January 2015 and January 2019.

Results: The patients' mean age was 10.6 years (range: 23 days to 18 years) and mean weight was 37.6 kg (range: 3-63 kg). Thirteen had aortic valve stenosis, four had aortic valve insufficiency, and three had a mixed disease. The Ross-Konno procedure was used for four patients. The mean cardiopulmonary bypass time was 184.68±60.1 min and the mean cross time was 149±67.8 min. One neonatal patient died in the early postoperative phase due to low cardiac output. The mean follow-up time was 60.15±24.45 months. One patient later underwent reoperation due to conduit stenosis. One patient is being monitored for moderately serious conduit stenosis. At present, of those who underwent the procedure, one has moderate aortic regurgitation, two have mild or moderate aortic regurgitation, and others have minimal aortic regurgitation. No patients required intervention for left ventricular outflow tract obstruction and mortality was not observed in the long term.

Conclusion(s): The reintervention rates for autograft and conduit-related cases were low in early and medium-term follow-up, and no significant autograft insufficiency was observed. Ross or Ross-Konno surgery is preferred for aortic diseases in pediatric patients due to its low mortality and satisfactory long-term results.

简介和目的:Ross 法是治疗小儿主动脉瓣疾病的首选手术方法,其长期疗效已被广泛记录。本文介绍了本中心为儿科患者实施的 Ross 和 Ross-Konno 手术的结果:2015年1月至2019年1月期间,本中心为20名患者实施了Ross和Ross-Konno手术:患者的平均年龄为10.6岁(范围:23天至18岁),平均体重为37.6公斤(范围:3-63公斤)。13人患有主动脉瓣狭窄,4人患有主动脉瓣功能不全,3人患有混合性疾病。4 名患者采用了 Ross-Konno 手术。平均心肺旁路时间为(184.68±60.1)分钟,平均交叉时间为(149±67.8)分钟。一名新生儿患者由于心输出量低而在术后早期死亡。平均随访时间为(60.15±24.45)个月。一名患者后来因导管狭窄而接受了再次手术。一名患者因导管中度狭窄而接受监测。目前,在接受手术的患者中,一人有中度主动脉瓣反流,两人有轻度或中度主动脉瓣反流,其他人有轻微主动脉瓣反流。没有患者因左心室流出道梗阻而需要介入治疗,长期观察也未发现死亡率:结论:在早期和中期随访中,自体移植和导管相关病例的再介入率较低,未发现明显的自体移植不足。Ross或Ross-Konno手术因其低死亡率和令人满意的长期效果而成为治疗儿童主动脉疾病的首选。
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引用次数: 0
Superdominant circumflex as culprit of inferior myocardial infarction. 下心肌梗死的罪魁祸首是超优势环状静脉。
IF 1.6 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-19 DOI: 10.1016/j.repc.2024.07.009
Joana Lima Lopes, Luís Brízida, João Bicho Augusto
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引用次数: 0
Asymptomatic ruptured sinus of Valsalva aneurysm. 无症状的瓦尔萨尔瓦窦动脉瘤破裂。
IF 1.6 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-19 DOI: 10.1016/j.repc.2024.07.007
Mónica Dias, Sofia Fernandes, Nuno Salomé, Catarina Vieira, Juliana Martins
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引用次数: 0
Knowledge and perception among adults of their congenital heart disease: A single center cross-sectional study. 成年人对先天性心脏病的了解和认知:单中心横断面研究。
IF 1.6 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-14 DOI: 10.1016/j.repc.2024.06.006
Francisco Barbas de Albuquerque, Inês Neves, Rita Teixeira, Tânia Mano, Tiago Rito, Pedro O Costa, Rui Ferreira, Lídia de Sousa, Fátima Pinto

Introduction and objective: Congenital heart disease (CHD) is a complex condition requiring a multidisciplinary approach. It is crucial that adults with CHD (CHD) have adequate knowledge of their condition, enabling them to engage in their healthcare decisions and self-management. We aimed to investigate knowledge and perception among adults of their CHD.

Methods: Single-center, observational, cross-sectional study. A 25-item adapted survey of Leuven Questionnaire for CHD was used to assess four main domains: (1) disease and treatment, (2) endocarditis and preventive measures, (3) physical activity and (4) reproductive issues.

Results: One hundred forty-eight patients participated in the study. Patients had a significant lack of knowledge localizing their heart defect, recognizing drug side effects, acting in case of experiencing drug side effects, recognizing at least two symptoms of clinical deterioration, to adequately define endocarditis and most typical signs and risk factors, to acknowledge the hereditary nature of their CHD and risk of clinical deterioration during pregnancies. Patients with an education level ≥12th grade have higher knowledge in various items and, overall, the complexity of CHD was not associated with a better performance.

Conclusion: This study highlights the existing knowledge gaps among adults with CHD. It underscores the need for tailored information and structured educational programs to improve management. By addressing these challenges, healthcare providers can enhance patient outcomes, improve quality of life, and promote long-term well-being for individuals with CHD.

导言和目的:先天性心脏病(CHD)是一种复杂的疾病,需要采用多学科方法治疗。患有先天性心脏病(CHD)的成年人必须充分了解自己的病情,使他们能够参与医疗决策和自我管理。我们的目的是调查成年人对其心脏病的了解和看法:单中心、观察性、横断面研究。研究使用了一份由 25 个项目组成的鲁汶心脏病调查问卷,主要评估四个方面:(1) 疾病和治疗;(2) 心内膜炎和预防措施;(3) 体力活动;(4) 生殖问题:148名患者参与了研究。患者严重缺乏以下方面的知识:定位其心脏缺陷、认识药物副作用、在出现药物副作用时采取行动、认识至少两种临床恶化症状、充分定义心内膜炎和最典型的体征及风险因素、认识其先天性心脏病的遗传性和怀孕期间临床恶化的风险。受教育程度≥12年级的患者对各个项目的了解程度较高,总体而言,心脏病的复杂程度与患者的表现无关:本研究强调了成人冠心病患者现有的知识差距。结论:本研究强调了患有冠心病的成年人中存在的知识差距,并强调了需要有针对性的信息和结构化教育计划来改善管理。通过应对这些挑战,医疗服务提供者可以提高患者的治疗效果、改善生活质量并促进冠心病患者的长期福祉。
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引用次数: 0
Of mice and man 老鼠与人类
IF 1.6 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-10 DOI: 10.1016/j.repc.2024.09.001
Manuela Fiuza
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引用次数: 0
Training and attitudes concerning cardiac rehabilitation in Portugal: A national survey of physician members of the Portuguese Society of Cardiology 葡萄牙有关心脏康复的培训和态度:对葡萄牙心脏病学会医生成员的全国调查。
IF 1.6 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-01 DOI: 10.1016/j.repc.2023.12.009

Introduction and Objectives

Cardiac rehabilitation (CR) is a central component in the management of cardiovascular disease. While its potential benefits have been extensively explored and confirmed, its implementation is still suboptimal, due to various possible barriers. This study aimed to assess training and attitudes concerning CR among physicians in a Portuguese setting.

Methods

An online questionnaire structured in three parts (participant characteristics, training and attitudes concerning CR, and a brief general knowledge assessment) was developed and sent to members of the Portuguese Society of Cardiology. The study population encompassed physicians with a medical specialty or residents from the third year onward of a specialty program.

Results

A total of 97 individuals (57.7% male, 61.9% aged ≤50 years) presented valid answers. CR was available at the workplace of 54.6% of participants. Most of them considered that the time allocated to CR training during residency was inadequate, and thought that more time was needed for this purpose. Most had not dedicated (or intended to dedicate) time for CR training, with lack of time being the most frequently attributed reason. In terms of referral, a substantial proportion of subjects did not refer patients, with lack of CR centers and human resources being the most frequent reasons.

Conclusions

This survey provides contemporary data on CR training and attitudes, highlighting areas of potential improvement, such as time allocated to training in this area. These results could provide a useful pragmatic framework for optimization of training and awareness in this pivotal field of cardiovascular medicine.

导言和目标:心脏康复(CR)是心血管疾病治疗的核心组成部分。虽然其潜在益处已得到广泛探讨和证实,但由于各种可能的障碍,其实施情况仍不理想。本研究旨在评估葡萄牙医生对 CR 的培训情况和态度:研究开发了一份在线调查问卷,分为三个部分(参与者特征、关于 CR 的培训和态度以及简短的常识评估),并发送给葡萄牙心脏病学会的成员。研究对象包括医学专业医生或专业课程三年级以上的住院医师:共有 97 人(57.7% 为男性,61.9% 年龄在 50 岁以下)提供了有效答案。54.6%的参与者在工作场所有 CR。他们中的大多数人认为,在住院实习期间分配给 CR 培训的时间不够,并认为需要为此投入更多的时间。大多数人没有(或不打算)专门拨出时间进行 CR 培训,最常见的原因是缺乏时间。在转诊方面,相当一部分受试者没有转诊病人,缺乏 CR 中心和人力资源是最常见的原因:这项调查提供了有关 CR 培训和态度的最新数据,突出了可能需要改进的领域,例如分配给该领域培训的时间。这些结果可为优化心血管医学这一关键领域的培训和认识提供一个有用的实用框架。
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引用次数: 0
期刊
Revista Portuguesa De Cardiologia
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