An echocardiographic method for selecting high risk patients shortly after acute myocardial infarction, for inclusion in multi-centre studies (as used in the TRACE study)

The aim of our study was to examine if echocardiography canreproducibly be used in a multicentre study to select high riskpatients with reduced left ventricular function early afteran acute myocardial infarction (MI). In the TRAndolapril Cardiac Evaluation Study (TRACE) patientswith reduced left ventricular systolic function were randomized3–7 days post MI to receive either the ACE inhibitor trandolapril,or placebo. Twenty-seven Danish centres participated and 7001consecutive MI patients were screened for entry. Local doctorsand technicians who had received a brief but thorough trainingcourse recorded a two-dimensional echocardiographic examinationon videotape 2–6 days after MI. Within 24 h, wall motionindex (WMI) was visually assessed by one of two cardiologists(examiners) with considerable experience in echocardiography.A WMl of l.2 (corresponding to a left ventricular ejection fraction(LVEF) 0.35) meant that the patient was eligible for randomizationin the TRACE study. Two other experienced cardiologists withsubstantial experience in echocardiography (controllers) performedblind reassessment of 155 randomly chosen videotapes. We showed that 93% of the 7001 screened Mis had an assessableechocardiogram. WMl was 1.2 in 37% of patients. The one-yearmortality was inversely related to WMl, being 60%, 30%, 14%and 11% in patients with a WMI<0.8, 0.8–1.2, 1.3–1.6and >l.6, respectively. In the random sample of 155 videorecordingsthat were reevaluated, 97% were found to be technically adequatefor analysis both by the examiners and the controllers. Comparingthe examiners with the controllers, the reproducibility analysisshowed 95% confidence limits for a single estimate of LVEF of± 0.13. Comparison between the two examiners showed correspondingconfidence limits of ±0.10. Using WMl of 12 (LVEF0.35)as a discriminative value the concordance between examinersand controllers was 80%. Thus, evaluation by experienced cardiologists of videotapedechocardiographic examinations recorded by briefly but thoroughlytrained investigators appears to be a reliable and reproduciblemethod for the selection of high risk patients shortly afterMI in multicentre studies.     

骨质疏松性骨折中西医协同诊疗专家共识

骨质疏松性骨折是骨质疏松症最严重并发症,发病隐匿、致死致残率高,发病率逐年上升,带来巨大社会经济负担。西医诊疗在诊断和手术方面存在优势,传统中医强调整体调理、恢复机体平衡,中西医协同诊疗是骨质疏松性骨折诊疗的有效策略。为推广中西医协同诊疗理念,促进骨质疏松性骨折中西医协同诊疗技术发展,建立规范化、标准化疾病预防、诊断和治疗方案,中国老年学和老年医学学会老年病学分会骨科专家委员会、中华医学会骨科学分会青年骨质疏松学组、中国医师协会骨科医师分会骨质疏松学组、上海中西医结合学会骨质疏松专业委员会牵头成立共识专家组,讨论并制订《骨质疏松性骨折中西医协同诊疗专家共识》,从预防、诊断和治疗三方面阐述中西医协同理念并提供推荐意见,期望改善骨质疏松性骨折预后,提高生活质量。