Circulation. 2006;114:2199
(Circulation. 2006;114:2199.)
© 2006 American Heart Association, Inc.
Issue Highlights
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BEDSIDE TOOL FOR PREDICTING THE RISK OF POSTOPERATIVE DIALYSIS IN PATIENTS UNDERGOING CARDIAC SURGERY, by Mehta et al.
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The use of a large clinical database allows unique opportunities
for clinical research. The Society of Thoracic Surgeons’
National Cardiac Database is the largest cardiac surgery database
in the world, providing a rich source of information. Using
this database, Mehta et al studied renal failure after cardiac
surgery requiring dialysis. Based on multiple preoperative clinical
factors, a means of estimating a patient’s individual
risk for postoperative dialysis was developed using a bedside
additive risk tool. Renal failure requiring the initiation of
dialysis is a serious postoperative complication associated
with higher mortality, poor quality of life, and increased hospital
length of stay and resource utilization. The use of this clinical
tool was developed to facilitate informed clinical decision
making and patient counseling prior to surgery. See p
2208.
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LONG-TERM SURVIVAL IN PATIENTS PRESENTING WITH TYPE B ACUTE AORTIC DISSECTION: INSIGHTS FROM THE INTERNATIONAL REGISTRY OF ACUTE AORTIC DISSECTION, by Tsai et al.
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Survival in patients presenting with uncomplicated acute type
B aortic dissection is generally good, and hospital discharge
is approximately 90%. In patients with a more complex presentation,
morbidity and mortality may be significantly higher. Long-term
follow-up of patients with type B aortic dissection has been
limited and confined to a few small series. In the current edition
of
Circulation, the International Registry of Aortic Dissection
(IRAD) provides useful long-term follow-up of a contemporary
series of patients with type B dissection. The present study
reports on a cohort of patients from centers with good postdischarge
surveillance. At a median follow-up of 2.3 years, survival for
patients treated medically, surgically, or with endovascular
therapy was 77.6±6.6%, 82.8±18.9%, and 76.2±25.2%
respectively. Independent predictors of follow-up mortality
included female gender, history of prior aortic aneurysm, history
of atherosclerosis, in-hospital renal failure, and pleural effusion
on chest x-ray and in-hospital hypotension/shock. Even with
contemporary approaches to treatment of type B aortic dissection,
the 3-year mortality rate approaches 1 in every 4 patients.
Strategies to improve long-term outcome in patients with type
B dissection need to be developed. See p
2226.
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CORONARY MULTIDETECTOR COMPUTED TOMOGRAPHY IN THE ASSESSMENT OF PATIENTS WITH ACUTE CHEST PAIN, by Hoffmann et al.
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Assessment of Emergency Department (ED) patients with suspected
acute coronary syndromes (ACS) who have no obvious ischemic
ECG changes and negative initial biomarker studies remains challenging.
Rapid evaluation is important, as ruling in an ACS could lead
to earlier treatment, while ruling out an ACS could lead to
more rapid ED discharge. In this issue of
Circulation, Hoffmann
and colleagues present the initial report on the performance
characteristics of multidetector computed tomographic angiography
(CTA) in such patients. They report that the absence of stenosis
or plaque on CTA has 100% negative predictive value for ruling
out an ACS. Moreover, the extent of coronary plaque on CTA,
when present, adds significant information to the probability
of an ACS being present. Although requiring confirmation, these
data usher in a potential new noninvasive paradigm for the evaluation
of patients with suspected ischemic chest pain in the ED. See
p
2251.
Visit http://circ.ahajournals.org:
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Images in Cardiovascular Medicine
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Echocardiographic History of an Asymptomatic Congenital Cardiac
Tumor: No Changes in Mass Dimensions During a 14-Year Follow-Up.
See p
e591.
Intraamniotic Fetal Echocardiography: A New Fetal Cardiovascular Monitoring Approach During Human Fetoscopic Surgery. See p e594.
Esophageal Diverticulum Illustrated by Barium Swallow During Left Atrial Catheter Ablation for Atrial Fibrillation. See p e597.
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Correspondence
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See p
e598.
Related Articles:
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Echocardiographic History of an Asymptomatic Congenital Cardiac Tumor: No Changes in Mass Dimensions During a 14-Year Follow-Up
- Andrea Motto, Piercarlo Ballo, Arianna Bocelli, Silvana Gramenzi, and Maurizio de Martino
Circulation 2006 114: e591-e593.
[Extract]
[Full Text]
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Intraamniotic Fetal Echocardiography: A New Fetal Cardiovascular Monitoring Approach During Human Fetoscopic Surgery
- Thomas Kohl, Kristina Tchatcheva, Patricia Van de Vondel, and Ulrich Gembruch
Circulation 2006 114: e594-e596.
[Extract]
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Esophageal Diverticulum Illustrated by Barium Swallow During Left Atrial Catheter Ablation for Atrial Fibrillation
- Sujoya Dey, Eric Good, Fred Morady, and Hakan Oral
Circulation 2006 114: e597.
[Extract]
[Full Text]
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Letter by Karapanayiotides Regarding Article, "Histological Assessment of 526 Symptomatic Carotid Plaques in Relation to the Nature and Timing of Ischemic Symptoms: the Oxford Plaque Study"
- Theodoros Karapanayiotides
Circulation 2006 114: e598.
[Extract]
[Full Text]
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Long-Term Survival in Patients Presenting With Type B Acute Aortic Dissection: Insights From the International Registry of Acute Aortic Dissection
- Thomas T. Tsai, Rossella Fattori, Santi Trimarchi, Eric Isselbacher, Truls Myrmel, Arturo Evangelista, Stuart Hutchison, Udo Sechtem, Jeanna V. Cooper, Dean E. Smith, Linda Pape, James Froehlich, Arun Raghupathy, James L. Januzzi, Kim A. Eagle, Christoph A. Nienaber on behalf of the International Registry of Acute Aortic Dissection (IRAD)
Circulation 2006 114: 2226-2231.
[Abstract]
[Full Text]
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Coronary Multidetector Computed Tomography in the Assessment of Patients With Acute Chest Pain
- Udo Hoffmann, John T. Nagurney, Fabian Moselewski, Antonio Pena, Maros Ferencik, Claudia U. Chae, Ricardo C. Cury, Javed Butler, Suhny Abbara, David F. Brown, Alex Manini, John H. Nichols, Stephan Achenbach, and Thomas J. Brady
Circulation 2006 114: 2251-2260.
[Abstract]
[Full Text]
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Bedside Tool for Predicting the Risk of Postoperative Dialysis in Patients Undergoing Cardiac Surgery
- Rajendra H. Mehta, Joshua D. Grab, Sean M. O’Brien, Charles R. Bridges, James S. Gammie, Constance K. Haan, T. Bruce Ferguson, Eric D. Peterson for the Society of Thoracic Surgeons National Cardiac Surgery Database Investigators
Circulation 2006 114: 2208-2216.
[Abstract]
[Full Text]
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LONG-TERM SURVIVAL IN PATIENTS...