1,721,001 research outputs found
Surgical ventricular restoration : is there any difference in outcome between anterior and posterior remodeling?
No full textThe purpose of this study was to compare the early and long-term outcomes in a consecutive population who underwent surgical ventricular reconstruction (SVR) for either anterior or posterior remodeling.
METHODS:
Among 501 consecutive patients who underwent SVR at our institution between July 2001 and December 2011, 56 patients presented with posterior remodeling (group A; mean age, 65 ± 10 years), whereas anterior remodeling was evident in 445 patients (group B; mean age, 65 ± 9 years). The 2 groups were comparable regarding cardiac risk factors and comorbidities. Patients in group A presented with larger left ventricles, higher left ventricular (LV) cardiac mass, and higher ejection (EF) and stroke volume (p = 0.01) compared with patients in group B. Moderate to severe mitral regurgitation was present in 50% and 25% of patients in groups A and B, respectively (p = 0.01).
RESULTS:
Thirty-day mortality was not significantly different between the 2 groups (5.4% versus 8.3% in groups A and B, respectively; p = 0.32). At logistic regression analysis, only preoperative age, creatinine, and ejection fraction (ACEF) score was an independent predictor of early mortality. Sixteen patients (29%) in group A and 92 patients (21%) in group B died during follow-up (p = 0.12). Kaplan-Meier cumulative survival was comparable between the 2 groups (log-rank p = 0.27). At multivariate Cox regression analysis, preoperative age, advanced New York Heart Association (NYHA) class, preoperative severe mitral regurgitation (MR), and preoperative tricuspid annular plane systolic excursion (TAPSE) score less than 16 were independent predictors of late mortality.
CONCLUSIONS:
Patients presenting with posterior remodeling showed worse clinical signs of angina and congestive heart failure (CHF) and a higher proportion of moderate to severe MR; however in the present experience early and long-term outcomes after SVR seemed to be unaffected by remodeling location
Right Ventricular Pulmonary Hypertension
No full textIn heart failure (HF) syndrome, the development of pulmonary hypertension (PH), right ventricular (RV) dysfunction and failure are ominous prognostic signs. Pathophysiology, clinical interest and targeted therapeutic approaches for left-sided PH and its consequences on RV function have been traditionally confined to advanced HF stages. Community- and population-based studies have clearly indicated that PH is frequent even in HF patients with preserved ejection fraction, and may carry important prognostic implications in normal ageing as well. HF guidelines are inconclusive on both preventive and curative strategies for left-sided PH and its consequences on RV function. The search for new therapeutic opportunities targeted on pulmonary vascular and right heart remodeling are an important challenge for the future
Functional mitral regurgitation in patients with ischemic cardiomyophaty undergoing surgical ventricular restoration for anterior aneurysm: echocardiographic findings and clinical impact.
No full textFunctional mitral regurgitation in patients with ischemic cardiomyopathy undergoing surgical ventricular restoration for anterior aneurysm: echocardiographic findings and clinical impact
No full textObjective: to evaluate clinical impact of severe functional mitral regurgitation(MR) in patients with dilatative post-ischemic CMP submitted to Surgical Ventricular Restoration(SVR).
Methods: Among 445 consecutive patients operated of SVR for anterior aneurysm at our Institution between July 2001 and December 2011, 337(76%) patients presented with MR<2+(Group A,mean age 65±10yrs) while moderate to severe MR(3-4+) was evident in 108(24%) patients(Group B,mean age 64±9yrs;). LV volumes(p=.019), LV sfericity index(p=.004) and mitral tenting area(p=.005) resulted independent predictor of severe MR at presentation(Figure 1).
Results: All patients underwent standard SVR with exclusion of antero-septal akinetic area. CABG was concomitantly performed in 414 patients(93%; mean number of graft=2.7±1.5). All patients in Group B underwent mitral annuloplasty; on the opposite, mitral repair was performed in 18 patients(5%) of GroupA, who presented with annular enlargement > 40mm.
Thirty-days mortality was significantly higher in Group B(15%vs6%; p=.006). Seventy-five patients(22%) in Group A and 46 patients(43%) in Group B died at follow-up(p=.001). Kaplan-Meyer 5 and 10 years cumulative survival were significantly higher in group A(p=.008). Despite identical early mitral repair success rate, 15(7%) and 22(35%) patients in group A and B respectively(p=.001) showed long-term recurrence of severe MR. At Cox regression analysis preoperative mitral annulus dimension and postoperative systolic conicity index were the only independent predictors of late MR recurrence. Long-term 5 and 10 years survival(p=.037) as well as 5 and 10 years freedom from HF readmission(p=.001) were significantly affected by MR recurrence at FU.
Conclusion: Severe preoperative MR significantly impacts surgical risk of SVR as early and long-term mortality. Furthermore, despite early succesfull surgical repair, severe MR recurrs in nearly a third of the discharged patients
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
Impact of right ventricular dysfunction on the outcome of heart failure patients undergoing surgical ventricular reconstruction
No full textOBJECTIVES: The aim was to assess the impact of right ventricular dysfunction (RVD) on the outcome of heart failure (HF) patients undergoing surgical ventricular reconstruction (SVR).
METHODS: A total of 324 patients (65 +/- 9 years) with previous myocardial infarction had an echocardiographic assessment of right ventricular (RV) function before and after SVR. RV function was assessed measuring the tricuspid annular plane systolic excursion (TAPSE) and RV dysfunction was defined by a TAPSE < 16 mm.
RESULTS: RV dysfunction was detected in 69 patients (Group A, mean age 64 +/- 11 years), while 255 patients (Group B, mean age 65 +/- 9 years) had a preserved RV function. Patients in Group A showed a higher New York Heart Association (NYHA) class (P = 0.01), larger left ventricular (LV) end-diastolic and end-systolic volumes (P = 0.01), a lower EF (P = 0.01), a higher percentage of moderate-to-severe mitral regurgitation (P = 0.01) and a higher systolic pulmonary artery pressure (PAPs; P = 0.01). Propensity score matching was applied in order to adjust for baseline differences. In the fully matched population, low-output syndrome (P = 0.01), inotropic support (P = 0.01) and intra-aortic balloon pump insertion (P = 0.03) were significantly more frequent in Group A compared with Group B. However, 30-day mortality was not significantly different between the two groups (P = 0.18). Kaplan-Meier 5- and 8-year survival rate (log-rank: P = 0.01) as well as freedom from cardiac events (log-rank: P = 0.02) were significantly lower in patients with RV dysfunction. At Cox regression analysis, preoperative RVD (P = 0.01) and NYHA class at admission > II (P = 0.02) resulted in independent predictor of late mortality.
CONCLUSIONS: RV dysfunction correlates with LV dysfunction and it is an important predictor of long-term outcome in HF patients undergoing SVR
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
- …
