1,721,186 research outputs found
Identification and quantification of congestion in heart failure: a work in progress
Full text linkNo abstract available
Takotsubo syndrome in the paediatric population
No full textWe describe the case of a takotsubo syndrome in a 12-year-old male patient following an acute intracranial haemorrhage, which had a favourable outcome. We also performed a systematic review of published case reports in patients younger than 18 years. Although takotsubo syndrome is common in postmenopausal women, in the paediatric population it equally affects both sexes. Compared with adults, paediatric patients more commonly present with heart failure symptoms or loss of consciousness. A higher proportion of paediatric patients have ST segment depression on ECG. Moreover, in younger patients, a high proportion has nonapical anatomical variants and more severe left ventricular impairment. The increase in troponin and the decrease in left ventricular ejection fraction, the prevalence of neurological or psychological disorders, and in-hospital outcome are similar between adults and children
Intravenous iron in patients with heart failure and iron deficiency: an updated meta-analysis
Full text linkBackground
For patients with heart failure (HF) and iron deficiency (ID), randomised trials suggest that intravenous (IV) iron reduces heart failure hospitalisations, but uncertainty exists about the effects in subgroups and the impact on mortality. We conducted a meta-analysis of randomised trials investigating the effect of IV iron on clinical outcomes in patients with HF.
Methods
We identified randomised trials published between January 1st 2000 and November 5th 2022 investigating the effect of IV iron vs standard care/placebo in patients with HF and ID in any clinical setting, regardless of HF phenotype. Trials of oral iron or not in English were not included. The main outcomes of interest were a composite of hospitalisations for heart failure (HHF) and cardiovascular death (CVD), on HHF alone and on cardiovascular and all-cause mortality.
Results
Ten trials were identified with 3,373 participants, of whom 1,759 were assigned to IV iron. IV iron reduced the composite of recurrent HHF and CVD [RR 0.75 (0.61-0.93), p<0.01] and first HHF or CVD [OR 0.72 (0.53-0.99), p=0.04]. Effects on cardiovascular [OR 0.86 (0.70-1.05), p=0.14] and all-cause mortality [OR 0.93 (0.78-1.12), p=0.47] were inconclusive. Results were similar in analyses confined to the first year of follow-up, which was less disrupted by the COVID-19 pandemic. Subgroup analyses found little evidence of heterogeneity for the effect on the primary endpoint, although patients with transferrin saturation <20% [OR 0.67 (0.49-0.92)] may have benefited more than those with values ≥20% [OR 0.99 (0.74-1.30)] (heterogeneity p = 0.07).
Conclusion
In patients with HF and ID, this meta-analysis suggests that IV iron reduces the risk of HHF but whether this is associated with a reduction in cardiovascular or all-cause mortality remains inconclusive
Newer imaging modalities to identify high-risk ambulatory patients with heart failure
Full text linkThe lack of widely accepted objective measures of cardiac dysfunction other than left ventricular ejection fraction (LVEF) has hampered, and continues to hamper, clinical research in patients with heart failure (HF). Identifying patients at higher risk of adverse outcome would allow better targeting of therapy to those with most to gain.The thesis is divided in three parts.In the first part, I report the results of studies of the association between echocardiographic measures of right atrial pressure (by measuring the inferior vena cava (IVC) diameter) and outcome in ambulatory patients with HF. I also studied the associations with prognosis of a newer echocardiographic method (global longitudinal strain, GLS) to assess left ventricular systolic function in patients with normal LVEF on conventional imaging. In the second part, I report the results of studies of the associations of left atrial function by cardiac magnetic resonance (cMRI) with outcome in ambulatory patients with HF. I also studied the relationship between QRS morphology on ECG with cardiac structure and function measured by cMRI in ambulatory patients with HF.In the third part, I report the results of developing and prospectively evaluating an ultrasound method to measure the internal jugular vein diameter (as an objective estimate of the right atrial pressure) and its changes with respiratory manoeuvres.I studied the association between the jugular vein diameter, clinical and echocardiographic variables, and its relations with outcome in ambulatory patients with HF and controls.My results showed that upstream consequences of a dysfunctional left ventricle, such as impaired left atrial function measured by cMRI, a distended IVC or internal jugular vein by ultrasound, provide powerful prognostic information, similar to that obtained by measuring N-terminal pro-B-type natriuretic peptide plasma levels, in individuals with HF regardless of whether they have a reduced or normal LVEF.As residual congestion (dilated IVC or jugular vein) and impaired left atrial function appear strongly related to an adverse outcome, tailoring treatment to minimise congestion or improving left atrial function is an attractive concept worth testing.Published articles:1) Pellicori P, Carubelli V, Zhang J, Castiello T, Sherwi N, Clark AL, Cleland JG. IVC diameter in patients with chronic heart failure: relationships and prognostic significance. JACC Cardiovasc Imaging. 2013;6:16-28.http://doi.org/10.1016/j.jcmg.2012.08.012http://www.sciencedirect.com/science/article/pii/S1936878X120087902) Pellicori P, Kallvikbacka-Bennett A, Khaleva O, Carubelli V, Costanzo P, Castiello T, Wong K, Zhang J, Cleland JG, Clark AL. Global longitudinal strain in patients with suspected heart failure and a normal ejection fraction: does it improve diagnosis and risk stratification? Int J Cardiovasc Imaging. 2014;30:69-79.http://doi.org/10.1007/s10554-013-0310-yhttps://link.springer.com/article/10.1007/s10554-013-0310-y3) Pellicori P, Zhang J, Lukaschuk E, Joseph AC, Bourantas CV, Loh H, Bragadeesh T, Clark AL, Cleland JG. Left atrial function measured by cardiac magnetic resonance imaging in patients with heart failure: clinical associations and prognostic value. Eur Heart J. 2015;36:733-42.https://doi.org/10.1093/eurheartj/ehu405https://academic.oup.com/eurheartj/article/36/12/733/2293211/Left-atrial-function-measured-by-cardiac-magnetic?searchresult=14) Pellicori P, Joseph AC, Zhang J, Lukaschuk E, Sherwi N, Bourantas CV, Loh H, Clark AL, Cleland JG. The relationship of QRS morphology with cardiac structure and function in patients with heart failure. Clin Res Cardiol. 2015;104:935-45.http://doi.org/10.1007/s00392-015-0861-0https://link.springer.com/article/10.1007/s00392-015-0861-05) Pellicori P, Kallvikbacka-Bennett A, Zhang J, Khaleva O, Warden J, Clark AL, Cleland JG. Revisiting a classical clinical sign: jugular venous ultrasound. Int J Cardiol. 2014;170:364-70.http://doi.org/10.1016/j.ijcard.2013.11.015http://www.sciencedirect.com/science/article/pii/S01675273130198766) Pellicori P, Kallvikbacka-Bennett A, Dierckx R, Zhang J, Putzu P, Cuthbert J, Boyalla V, Shoaib A, Clark AL, Cleland JG. Prognostic significance of ultrasound-assessed jugular vein distensibility in heart failure. Heart. 2015;101:1149-58.http://dx.doi.org/10.1136/heartjnl-2015-307558http://heart.bmj.com/content/101/14/114
Newer imaging modalities to identify high-risk ambulatory patients with heart failure
Full text linkThe lack of widely accepted objective measures of cardiac dysfunction other than left ventricular ejection fraction (LVEF) has hampered, and continues to hamper, clinical research in patients with heart failure (HF). Identifying patients at higher risk of adverse outcome would allow better targeting of therapy to those with most to gain.The thesis is divided in three parts.In the first part, I report the results of studies of the association between echocardiographic measures of right atrial pressure (by measuring the inferior vena cava (IVC) diameter) and outcome in ambulatory patients with HF. I also studied the associations with prognosis of a newer echocardiographic method (global longitudinal strain, GLS) to assess left ventricular systolic function in patients with normal LVEF on conventional imaging. In the second part, I report the results of studies of the associations of left atrial function by cardiac magnetic resonance (cMRI) with outcome in ambulatory patients with HF. I also studied the relationship between QRS morphology on ECG with cardiac structure and function measured by cMRI in ambulatory patients with HF.In the third part, I report the results of developing and prospectively evaluating an ultrasound method to measure the internal jugular vein diameter (as an objective estimate of the right atrial pressure) and its changes with respiratory manoeuvres.I studied the association between the jugular vein diameter, clinical and echocardiographic variables, and its relations with outcome in ambulatory patients with HF and controls.My results showed that upstream consequences of a dysfunctional left ventricle, such as impaired left atrial function measured by cMRI, a distended IVC or internal jugular vein by ultrasound, provide powerful prognostic information, similar to that obtained by measuring N-terminal pro-B-type natriuretic peptide plasma levels, in individuals with HF regardless of whether they have a reduced or normal LVEF.As residual congestion (dilated IVC or jugular vein) and impaired left atrial function appear strongly related to an adverse outcome, tailoring treatment to minimise congestion or improving left atrial function is an attractive concept worth testing.Published articles:1) Pellicori P, Carubelli V, Zhang J, Castiello T, Sherwi N, Clark AL, Cleland JG. IVC diameter in patients with chronic heart failure: relationships and prognostic significance. JACC Cardiovasc Imaging. 2013;6:16-28.http://doi.org/10.1016/j.jcmg.2012.08.012http://www.sciencedirect.com/science/article/pii/S1936878X120087902) Pellicori P, Kallvikbacka-Bennett A, Khaleva O, Carubelli V, Costanzo P, Castiello T, Wong K, Zhang J, Cleland JG, Clark AL. Global longitudinal strain in patients with suspected heart failure and a normal ejection fraction: does it improve diagnosis and risk stratification? Int J Cardiovasc Imaging. 2014;30:69-79.http://doi.org/10.1007/s10554-013-0310-yhttps://link.springer.com/article/10.1007/s10554-013-0310-y3) Pellicori P, Zhang J, Lukaschuk E, Joseph AC, Bourantas CV, Loh H, Bragadeesh T, Clark AL, Cleland JG. Left atrial function measured by cardiac magnetic resonance imaging in patients with heart failure: clinical associations and prognostic value. Eur Heart J. 2015;36:733-42.https://doi.org/10.1093/eurheartj/ehu405https://academic.oup.com/eurheartj/article/36/12/733/2293211/Left-atrial-function-measured-by-cardiac-magnetic?searchresult=14) Pellicori P, Joseph AC, Zhang J, Lukaschuk E, Sherwi N, Bourantas CV, Loh H, Clark AL, Cleland JG. The relationship of QRS morphology with cardiac structure and function in patients with heart failure. Clin Res Cardiol. 2015;104:935-45.http://doi.org/10.1007/s00392-015-0861-0https://link.springer.com/article/10.1007/s00392-015-0861-05) Pellicori P, Kallvikbacka-Bennett A, Zhang J, Khaleva O, Warden J, Clark AL, Cleland JG. Revisiting a classical clinical sign: jugular venous ultrasound. Int J Cardiol. 2014;170:364-70.http://doi.org/10.1016/j.ijcard.2013.11.015http://www.sciencedirect.com/science/article/pii/S01675273130198766) Pellicori P, Kallvikbacka-Bennett A, Dierckx R, Zhang J, Putzu P, Cuthbert J, Boyalla V, Shoaib A, Clark AL, Cleland JG. Prognostic significance of ultrasound-assessed jugular vein distensibility in heart failure. Heart. 2015;101:1149-58.http://dx.doi.org/10.1136/heartjnl-2015-307558http://heart.bmj.com/content/101/14/114
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
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