EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology, Jan 22, 2014
The relationship between the predictive performance of the TIMI risk score for STEMI and gender h... more The relationship between the predictive performance of the TIMI risk score for STEMI and gender has not been evaluated in the setting of primary PCI (pPCI). Here, we compared in-hospital mortality and predictive performance of the TIMI risk score between Belgian women and men undergoing pPCI. In-hospital mortality was analysed in 8,073 (1,920 [23.8%] female and 6,153 [76.2%] male patients) consecutive pPCI-treated STEMI patients, included in the prospective, observational Belgian STEMI registry (January 2007 to February 2011). A multivariable logistic regression model, including TIMI risk score variables and gender, evaluated differences in in-hospital mortality between men and women. The predictive performance of the TIMI risk score according to gender was evaluated in terms of discrimination and calibration. Mortality rates for TIMI scores in women and men were compared. Female patients were older, had more comorbidities and longer ischaemic times. Crude in-hospital mortality was ...
The hemodynamic effects of prazosin, a post-synaptic alpha blocker, were studied in 10 patients w... more The hemodynamic effects of prazosin, a post-synaptic alpha blocker, were studied in 10 patients with chronic stable cardiac failure, in Classes III and IV of the NYHA classification, resistant to digitalis and diuretic therapy. The measurements of pressure and cardiac output were carried out by right heart catheterisation and thermodilution. The administration of the first dose (1 to 3 mg) led to a 38% reduction in mean right atrial pressure, a 22% reduction in mean pulmonary artery pressure, a 22 ù reduction of wedge pulmonary artery pressure and a 15% reduction of systemic vascular resistance. The systolic index rose by 20%, systemic blood pressure and heart rate remained unchanged. After 7 days, treatment with 3 to 12 ng/day of prazosin mean right atrial pressure had fallen by 54%, mean pulmonary artery pressure by 37%, and wedge pulmonary artery pressure by 48%. The systolic index increased by 27%. The blood pressure was unchanged, but the heart rate decreased by 10%. The patients lost an average of 2,7 Kg in weight. These results show that in the short term, prazosin had a mixed vasodilator effect on both arteries and veins. In the medium term the arterial vasodilator action appears to be significantly smaller but remains detectable with doses greater than 8 mg/day, whilst the venous vasodilator effect persists, unchanged.
The anaphylactic shock of the rabbit is characterized by an acute right ventricular overload, acc... more The anaphylactic shock of the rabbit is characterized by an acute right ventricular overload, accompanied by severe alterations of cardiac electrogenesis. During shock, the mean QRS vector, as measured from the algebraic sum of the Q, R, and S deflections on the three leads, shifts to the right, inferiorly and anteriorly. An injury current quickly appears. The TQ vector points away from the right ventricle. A progressive depolarization on the right ventricular wall is displayed by suction electrodes and the suppression of right ventricular hypertension by a cross circulation produces an almost immediate disappearance of the injury current. The geneses of these electrical alterations are briefly discussed. The possibility of an anaphylactic reaction at the level of the coronary arterial wall, previously mentioned in the literature, seems unlikely. The role of the haemodynamic changes and of the increased right ventricular blood pool is thought to be predominant.
Fistula formation between a coronary artery bypass graft and a cardiac cavity is an uncommon find... more Fistula formation between a coronary artery bypass graft and a cardiac cavity is an uncommon finding. We describe a case of transcatheter occlusion of a coronary artery bypass graft to right ventricle fistula in a patient presenting with a subacute inferior myocardial infarction.
In an era of early and invasive therapeutic approaches, myocardial rupture has become an uncommon... more In an era of early and invasive therapeutic approaches, myocardial rupture has become an uncommon complication of myocardial infarction. While septal wall rupture most often leads to devastating haemodynamic consequences, free wall rupture is usually fatal. We report a case of a 48-year-old man in whom an incomplete myocardial rupture located in the inferior part of the interventricular septum was promptly detected during the acute phase of an inferior myocardial infarction treated by early percutaneous coronary angioplasty. A conservative rather than a surgical approach was decided with a favourable short-term outcome.
EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology, Jan 22, 2014
The relationship between the predictive performance of the TIMI risk score for STEMI and gender h... more The relationship between the predictive performance of the TIMI risk score for STEMI and gender has not been evaluated in the setting of primary PCI (pPCI). Here, we compared in-hospital mortality and predictive performance of the TIMI risk score between Belgian women and men undergoing pPCI. In-hospital mortality was analysed in 8,073 (1,920 [23.8%] female and 6,153 [76.2%] male patients) consecutive pPCI-treated STEMI patients, included in the prospective, observational Belgian STEMI registry (January 2007 to February 2011). A multivariable logistic regression model, including TIMI risk score variables and gender, evaluated differences in in-hospital mortality between men and women. The predictive performance of the TIMI risk score according to gender was evaluated in terms of discrimination and calibration. Mortality rates for TIMI scores in women and men were compared. Female patients were older, had more comorbidities and longer ischaemic times. Crude in-hospital mortality was ...
The hemodynamic effects of prazosin, a post-synaptic alpha blocker, were studied in 10 patients w... more The hemodynamic effects of prazosin, a post-synaptic alpha blocker, were studied in 10 patients with chronic stable cardiac failure, in Classes III and IV of the NYHA classification, resistant to digitalis and diuretic therapy. The measurements of pressure and cardiac output were carried out by right heart catheterisation and thermodilution. The administration of the first dose (1 to 3 mg) led to a 38% reduction in mean right atrial pressure, a 22% reduction in mean pulmonary artery pressure, a 22 ù reduction of wedge pulmonary artery pressure and a 15% reduction of systemic vascular resistance. The systolic index rose by 20%, systemic blood pressure and heart rate remained unchanged. After 7 days, treatment with 3 to 12 ng/day of prazosin mean right atrial pressure had fallen by 54%, mean pulmonary artery pressure by 37%, and wedge pulmonary artery pressure by 48%. The systolic index increased by 27%. The blood pressure was unchanged, but the heart rate decreased by 10%. The patients lost an average of 2,7 Kg in weight. These results show that in the short term, prazosin had a mixed vasodilator effect on both arteries and veins. In the medium term the arterial vasodilator action appears to be significantly smaller but remains detectable with doses greater than 8 mg/day, whilst the venous vasodilator effect persists, unchanged.
The anaphylactic shock of the rabbit is characterized by an acute right ventricular overload, acc... more The anaphylactic shock of the rabbit is characterized by an acute right ventricular overload, accompanied by severe alterations of cardiac electrogenesis. During shock, the mean QRS vector, as measured from the algebraic sum of the Q, R, and S deflections on the three leads, shifts to the right, inferiorly and anteriorly. An injury current quickly appears. The TQ vector points away from the right ventricle. A progressive depolarization on the right ventricular wall is displayed by suction electrodes and the suppression of right ventricular hypertension by a cross circulation produces an almost immediate disappearance of the injury current. The geneses of these electrical alterations are briefly discussed. The possibility of an anaphylactic reaction at the level of the coronary arterial wall, previously mentioned in the literature, seems unlikely. The role of the haemodynamic changes and of the increased right ventricular blood pool is thought to be predominant.
Fistula formation between a coronary artery bypass graft and a cardiac cavity is an uncommon find... more Fistula formation between a coronary artery bypass graft and a cardiac cavity is an uncommon finding. We describe a case of transcatheter occlusion of a coronary artery bypass graft to right ventricle fistula in a patient presenting with a subacute inferior myocardial infarction.
In an era of early and invasive therapeutic approaches, myocardial rupture has become an uncommon... more In an era of early and invasive therapeutic approaches, myocardial rupture has become an uncommon complication of myocardial infarction. While septal wall rupture most often leads to devastating haemodynamic consequences, free wall rupture is usually fatal. We report a case of a 48-year-old man in whom an incomplete myocardial rupture located in the inferior part of the interventricular septum was promptly detected during the acute phase of an inferior myocardial infarction treated by early percutaneous coronary angioplasty. A conservative rather than a surgical approach was decided with a favourable short-term outcome.
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