Usefulness of transthoracic echocardiography as a tool for risk stratification of patients undergoing major noncardiac surgery.

Transthoracic echocardiography (TTE) is frequently ordered before noncardiac surgery, although its ability to predict perioperative cardiac complications is uncertain. To evaluate the incremental information provided by TTE after consideration of clinical data for prediction of cardiac complications after noncardiac surgery, 570 patients who underwent TTE before major noncardiac surgery at a university hospital were studied. Preoperative clinical data and clinical outcomes were collected prospectively according to a structured protocol.

Outcome following isolated tricuspid valve replacement.

Objectives: The clinical outcome of isolated tricuspid valve replacement is not well defined because this procedure is usually performed concomitantly with other valve surgery.

Methods: We retrospectively studied the short and long-term outcome of 15 consecutive patients (six men and nine women, aged 61+/-3 years) undergoing isolated tricuspid valve replacement from 1984 to 1996. The cause of valve dysfunction was rheumatic heart disease in 12 patients, healed endocarditis in two patients, and sarcoidosis in one patient.

Three-dimensional return map: a new tool for quantification of heart rate variability.

Background: Several methods are used to study heart rate variability, but they have limitations, which might be overcome by the use of a three-dimensional return map.

Objectives: To evaluate the performance of three-dimensional return map-derived indices to detect (1) sympathetic and parasympathetic modulation to the sinus node and (2) autonomic dysfunction in diabetic patients.

Methods: Six healthy subjects underwent partial and total pharmacological autonomic blockade in a protocol that incorporated vagal and sympathetic predominance.

Increased plasma levels of endothelin 1 and von Willebrand factor in patients with type 2 diabetes and dyslipidemia.

Objective: Endothelial markers endothelin 1 (ET-1) and von Willebrand factor (vWF) were assessed in patients with type 2 diabetes and dyslipidemia and in patients with hypercholesterolemia.

Research Design And Methods: In this case-control study, plasma ET-and vWF levels were measured by enzyme-linked immunosorbent assay in 35 normoalbuminuric type 2 diabetic patients with dyslipidemia (56+/-5 years), in 21 nondiabetic patients with hypercholesterolemia (52+/-7 years), and in 19 healthy control subjects (45+/-4 years). All of the individuals were normotensive and nonsmokers.

Ten-year trends in hospital care for congestive heart failure: improved outcomes and increased use of resources.

Background: Scarce data are available on long-term trends in hospital mortality, length of stay (LOS), and costs in congestive heart failure (CHF).

Objective: To assess 10-year trends in the outcomes of patients hospitalized with CHF.

Methods: We studied all 6676 patients with a primary discharge diagnosis of CHF hospitalized from January 1, 1986, through July 31, 1996, at an academic tertiary care center.

Emergency department triage strategies for acute chest pain using creatine kinase-MB and troponin I assays: a cost-effectiveness analysis.

Background: Evaluation of acute chest pain is highly variable.

Objective: To evaluate the cost-effectiveness of strategies using cardiac markers and noninvasive tests for myocardial ischemia.

Design: Cost-effectiveness analysis.

Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery.

Background: Cardiac complications are important causes of morbidity after noncardiac surgery. The purpose of this prospective cohort study was to develop and validate an index for risk of cardiac complications.

Methods And Results: We studied 4315 patients aged > or = 50 years undergoing elective major noncardiac procedures in a tertiary-care teaching hospital.

A proposed strategy for utilization of creatine kinase-MB and troponin I in the evaluation of acute chest pain.

In recent years, cardiac troponins have attracted great interest as a marker for myocardial injury. However, there are limited data on strategies for use of creatine kinase (CK)-MB and troponin I (cTnI) in clinical practice. We sought to develop a testing strategy using prospectively collected clinical data including serial CK-MB and cTnI levels from 1,051 patients aged > or = 30 years admitted to a teaching hospital for acute chest pain.

Management of patients with acute myocardial infarction at five academic medical centers: clinical characteristics, resource utilization, and outcome.

Background: Although variability in management of cardiovascular syndromes has been demonstrated among regions, the extent to which variability exists among academic medical centers in different countries in uncertain.

Methods: This retrospective cohort study includes data on consecutive patients (n = 694) with acute myocardial infarction who were admitted to five teaching hospitals from different countries (84, Brigham and Women's Hospital, USA; 97, Iizuka Hospital, Japan; 64, Hospital de Clinicas de Porto Alegre, Brazil; 62, Universitätsklinikum Charité, Germany; and 387, Hôpital Cantonal Universitaire de Genève, Switzerland) during a one-year period. Data were collected via chart review on clinical characteristics, rates of diagnostic and therapeutic interventions, complications and mortality, length of stay, and one-year follow-up outcomes.

Value of additional two-hour myoglobin for the diagnosis of myocardial infarction in the emergency department.

Myoglobin has been described as an early marker of myocardial injury. It increases within 1 to 3 hours of myocardial injury, and falls back to normal early after the event. Few data suggest that myoglobin can be used to triage patients with chest pain.

Sympathetic nervous system representation in time and frequency domain indices of heart rate variability.

This study evaluated the contributions of sympathetic and parasympathetic modulation to heart rate variability during situations in which vagal and sympathetic tone predominated. In a placebo-controlled, randomized, double blind blockade study, six young healthy male individuals received propranolol (0.2 mg x kg(-1)), atropine (0.

Weekend and holiday exercise testing in patients with chest pain.

Objective: To determine the outcome, safety, and possible cost savings of patients undergoing weekend or holiday exercise treadmill testing.

Design: Medical records of all 195 patients scheduled for weekend and holiday exercise testing were reviewed, and 77.9% of patients were contacted by telephone to ascertain medical outcomes and need for further emergency department or inpatient care.

Effect of diabetes mellitus on the presentation and triage of patients with acute chest pain without known coronary artery disease.

Purpose: Patients with diabetes and acute chest pain may be admitted to hospitals more frequently than patients without diabetes because physicians suspect atypical presentations for ischemic heart disease. This study aimed to determine whether the presentation of acute myocardial infarction and risk for major cardiac complications differs among patients without known coronary artery disease who do or do not have diabetes.

Patients And Methods: Data from an emergency department of an urban teaching hospital on the medical histories, physical examinations, and electrocardiograms of 2,694 subjects with acute chest pain and without known coronary artery disease were prospectively recorded.

A new casemix adjustment index for hospital mortality among patients with congestive heart failure.

Objectives: Comparative analysis of hospital outcomes requires reliable adjustment for casemix. Although congestive heart failure is one of the most common indications for hospitalization, congestive heart failure casemix adjustment has not been widely studied. The purposes of this study were (1) to describe and validate a new congestive heart failure-specific casemix adjustment index to predict in-hospital mortality and (2) to compare its performance to the Charlson comorbidity index.

Supraventricular arrhythmia in patients having noncardiac surgery: clinical correlates and effect on length of stay.

Background: Few recent data are available on risk factors for perioperative supraventricular arrhythmia (SVA) after noncardiac surgery or on the effect of SVA on clinical outcomes.

Objective: To determine the incidence, clinical correlates, and effect on length of stay of perioperative SVA in patients having major noncardiac surgery.

Design: Prospective cohort study.

Cardiac troponin I as a predictor of major cardiac events in emergency department patients with acute chest pain.

Objectives: We sought to evaluate the diagnostic and prognostic value of cardiac troponin I (cTnI) in emergency department (ED) patients with chest pain.

Background: Although cTnI has been shown to correlate with an increased risk for complications in patients with unstable angina, the prognostic significance of this assay in the heterogeneous population of patients who present to the ED with chest pain is unclear.

Methods: cTnI and creatine kinase-MB fraction (CK-MB) mass concentration were collected serially during the first 48 h from onset of symptoms in 1,047 patients > or =30 years old admitted for acute chest pain.

Effect of partial arrhythmia suppression with amiodarone on heart rate variability of patients with congestive heart failure.

Background: Some antiarrythmic agents that may increase mortality rates have been shown to reduce heart rate variability in patients with heart failure. Amiodarone is a potent antiarrhythmic agent that may reduce mortality rates in heart failure, but little is known about its effects on heart rate variability.

Methods And Results: The purpose of this study was to evaluate the effect of partial arrhythmia suppression by amiodarone on indexes of heart rate variability in patients with heart failure.

Clinical correlates and prognostic significance of early negative exercise tolerance test in patients with acute chest pain seen in the hospital emergency department.

An exercise tolerance test (ETT) is often performed to identify patients for early discharge after observation for acute chest pain, but the safety of this strategy is unproven. We prospectively studied 276 low-risk patients who underwent an ETT within 48 hours after presentation to the emergency department with acute chest pain. The ETT was considered negative if subjects achieved at least stage I of the Bruce protocol and the electrocardiogram showed no evidence of ischemia.

Frontiers in Internal Medicine.

Clinical research in Internal Medicine has provided many scientific advances during the past few years. However, the newly generated information overrides the time available to read all of the medical literature regarding advances in Internal Medicine. The goal of this review is to summarize some of the most relevant improvements in clinical practice published over the last few years.

[Maternal knowledge on breastfeeding and related factors].

The influence of maternal knowledge about breastfeeding on the initiation and duration of lactation has been described. The present study evaluated the maternal knowledge about breastfeeding and its relationship with prenatal and postnatal orientation and prevalence of breastfeeding at 3 months. A cross-sectional study was designed involving 100 mothers of first-born babies between 6 and 12 months old receiving medical care in the Hospital de Clínicas de Porto Alegre.

Validity of self-reported weight--a study of urban Brazilian adults.

In order to evaluate the validity of self-reported weight for use in obesity prevalence surveys, self-reported weight was compared to measured weight for 659 adults living in the Porto Alegre county, RS Brazil in 1986-87, both weights being obtained by a technician in the individual's home on the same visit. The mean difference between self-reported and measured weight was small (-0.06 +/- 3.

[Acute myocardial infarction in the thrombolytic era: high mortality in elderly patients].

Unlabelled: Patients with acute myocardial infarction (AMI) admitted to a general hospital are very different from those reported in large multicenter trials.

Purpose: To evaluate the in-hospital mortality in patients with AMI admitted to a general hospital in the thrombolytic era, and to identify factors associated with poor prognosis.

Methods: 113 consecutive patients admitted with AMI in one year at the Hospital de Clínicas of Porto Alegre were studied.

[Risk factors for non-communicable diseases in a metropolitan area in the south of Brazil. Prevalence and simultaneity].

Three-quarters of deaths in Rio Grande do Sul State, Brazil, are due to non-communicable diseases-cardiovascular diseases, alone, being responsible for 35% of them. To evaluate the prevalence of risk factors for these diseases, a household survey of 1,157 randomly sampled individuals between 15 and 64 years of age was undertaken in 1986 and 1987 in census tracts of 4 areas of the city of Porto Alegre. The age- and sex-adjusted prevalence of smoking was 40%, hypertension 14%, obesity 18%, overall sedentary life-style 47%, and excessive alcohol consumption 7%.

Socioeconomic distribution of noncommunicable disease risk factors in urban Brazil: the case of Pôrto Alegre.

The study reported here sought to assess the degree to which the prevalences of five risk factors for noncommunicable diseases--hypertension, smoking, obesity, sedentary lifestyle, and excessive alcohol consumption--varied individually and in combination for urban Brazilians with differing socioeconomic status in terms of educational achievement, income, and social class. For this purpose, 1986-1987 data from a cross-sectional household survey of 1,157 randomly selected adults 15-64 years of age residing in the major Brazilian city of Pôrto Alegre were analyzed. In general, it was found that less privileged socioeconomic situations tended to be associated with higher risk factor prevalences.