Influence of conduction disturbances on clinical outcome in patients with acute myocardial infarction receiving thrombolysis (results from the ARGAMI-2 study)

Right bundle branch block and complete atrioventricular (AV) block are conduction disorders (CDs) that have been observed in 14% of patients admitted with ST-elevation acute myocardial infarction. CDs carry a poor prognosis, with a threefold increase in the mortality rate, mainly due to cardiogenic shock and recurrent fatal myocardial infarction at 1-year follow-up. According to multivariable analysis, CD was the second strongest predictor of death, after high Killip class. Compared with patients without CD, the 1-year outcome of patients with CD was identically worse, irrespective of whether CD appeared during admission, disappeared, or remained constant. Similar adverse outcomes were seen in patients with complete AV block and right bundle branch block.     

生脉注射液盐酸曲美他嗪联用治疗缺血性心肌病的临床观察

目的观察生脉注射液盐酸曲美他嗪（万爽力）联用治疗缺血性心肌病的临床疗效。方法入选48例缺血性心肌病患者，全部为心功能不全Ⅳ级，超声心动左室射血分数（LVEF）〈55％。随机分为两组，治疗组26例，在强心利尿基础上给予生脉注射液盐酸曲美他嗪联用，对照组22例，给予强心利尿治疗，疗程14d。结果治疗组心功能不全分级提高明显改善（治疗组改善21例，对照组改善12例）。超声心动LVEF升高与对照组相比明显改善[治疗组治疗前（46．7±7．2）％，治疗后（60．6±5．3）％，对照组治疗前（47．1±6．6）％，治疗后（51．0±4．7）％，P〈0．05]。结论生脉注射液盐酸曲美他嗪联用治疗缺血性心肌病疗效确切，值得推广应用。     

成人心脏外科术后脑损伤诊治的中国专家共识

背景：脑损伤作为成人心脏外科术后一种严重的并发症,发病率依然较高,是除心功能不全以外导致心脏外科手术患者预后不良的最主要因素之一。 目的：为减少心脏外科手术后脑卒中并发症,建立相关方面的诊治规范。 方法：为了降低成人心脏外科术后脑损伤的发生率,减少神经系统并发症,中国研究型医院学会神经再生与修复专业委员会心脏重症脑保护学组联合神经重症护理与康复学组,组织国内心脏内外科、神经内外科、重症监护、体外循环、麻醉以及急诊等医学专家,参考国内外相关指南,结合中国的实际情况,从成人心脏外科术后脑损伤的表现形式、危险因素、非药物性保护策略、术中神经监测以及药物性保护策略等方面,旨在促进患者脑神经功能康复角度进行撰写,经多次讨论最终成稿,制定该专家共识,以期指导临床工作。 结果与结论：为了降低成人心脏手术后脑损伤的发生率,减少神经系统并发症,需要采用个性化、以患者为中心的方法来管理那些可改变的脑损伤危险因素,采用包括术中栓塞的预防,血压、血糖、体温的管理,以及针对术后神经炎性反应药物治疗等方法,达到改善手术效果、提高患者生活质量的目的。然而,目前仍需要进一步的研究,尤其是高质量的以结果为导向的随机对照试验,以进一步提高脑损伤处理策略的证据支持。 ORCID: 0000-0002-0850-5922(韩宏光) 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

New device indications: practice and cost implications in Europe

The potential clinical value of implantable devices, for both diagnostic and therapeutic uses in cardiology practice, has increased greatly with technical innovation. This coupled with an increased recipient population size (as the population ages) and increased referral rates (as that population and its healthcarers are educated), has increased the demand for such devices and the associated economic burden is impacting on healthcare resources. Although there is a commonality of approach to clinical practice in Europe, aided by the publication of European guidelines, the implementation of these is hindered by the need to overcome national obstacles, particularly for new indications for established therapies and for innovative therapies. Cost efficacy assessments and evidence-based medicine are blurred and used as rationing tools. National inequalities and disparate healthcare systems will become divisive in a European theatre that is otherwise seeing greater political and economic integration. There needs to be a mature and honest debate on how to bring the benefits of implantable device medical technology to the patient population which will benefit.     

Standard versus fiberoptic pulmonary artery catheterization for cardiac surgery in the Department of Veterans Affairs: a prospective, observational, multicenter analysis

BACKGROUND: Controversy exists regarding the utility of continuous monitoring of mixed venous oxygen saturation (STvo2) during cardiac surgery. During a multicenter, prospective, observational study in the Department of Veterans Affairs (Cooperative Study #5), frequency of use of standard pulmonary artery catheterization (PAC) and STvo2-PAC was recorded. Here the authors relate these data to clinical outcomes. METHODS: Logistic and Cox regression models evaluating the association of PAC type with mortality, one or more postoperative complications, cardiac complications, time to extubation, and intensive care unit length of stay were constructed. The number of thermodilution cardiac outputs and arterial blood gas analyses performed in the first 24 h postoperatively were compared. RESULTS: Data from 3,265 patients undergoing myocardial revascularization (81.7%) or valve replacement-repair (18.3%) were considered. STvo2-PAC was used in 49% and PAC in 51% of patients. In the 14 hospitals, STvo2-PAC was used in all patients in four, in some patients in four, and never in six. No association of STvo2-PAC use with outcome were observed aside from unexplained hospital level effects. A small but statistically significant reduction in the number of arterial blood gas analyses (8 +/- 3 vs. 10 +/- 4, P < 0.0001, STvo2-PAC vs. PAC, respectively) and thermodilution cardiac outputs (14 +/- 8 vs. 15 +/- 9, P < 0.0001, STvo2-PAC vs. PAC, respectively) was observed with use of STvo2-PAC. CONCLUSIONS: Despite higher cost, STvo2-PAC was commonly used in this cohort. Our analysis failed to detect associations with improved outcomes aside from a small reduction in resource utilization. The precise role of STvo2-PAC remains uncertain.