scholarly journals Preoperative cardiac function parameters as valuable predictors for nurses to recognise delirium after cardiac surgery: A prospective cohort study

2019 ◽  
Vol 19 (4) ◽  
pp. 310-319 ◽  
Author(s):  
Shining Cai ◽  
Jos M Latour ◽  
Ying Lin ◽  
Wenyan Pan ◽  
Jili Zheng ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
New York ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Cardiac Function ◽  
Heart Association ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Functional Classification ◽  
New York Heart Association

Background: Delirium is a common postoperative complication after cardiac surgery. The relationship between delirium and cardiac function has not been fully elucidated. Aims: The aim of this study was to identify the association between preoperative cardiac function and delirium among patients after cardiac surgery. Methods: We prospectively recruited 635 cardiac surgery patients with a planned cardiac intensive care unit admission. Postoperative delirium was diagnosed using the confusion assessment method for the intensive care unit. Preoperative cardiac function was assessed using N-terminal prohormone of brain natriuretic peptide (NT-proBNP), New York Heart Association functional classification and left ventricular ejection fraction. Results: Delirium developed in 73 patients (11.5%) during intensive care unit stay. NT-proBNP level (odds ratio (OR) 1.24, 95% confidence interval (CI) 1.01–1.52) and New York Heart Association functional classification (OR 2.34, 95% CI 1.27–4.31) were both independently associated with the occurrence of delirium after adjusting for various confounders. The OR of delirium increased with increasing NT-proBNP levels after the turning point of 7.8 (log-transformed pg/ml). The adjusted regression coefficients were 1.19 (95% CI 0.95–1.49, P=0.134) for NT-proBNP less than 7.8 (log-transformed pg/ml) and 2.78 (95% CI 1.09–7.12, P=0.033) for NT-proBNP greater than 7.8 (log-transformed pg/ml). No association was found between left ventricular ejection fraction and postoperative delirium. Conclusion: Preoperative cardiac function parameters including NT-proBNP and New York Heart Association functional classification can predict the incidence of delirium following cardiac surgery. We suggest incorporating an early determination of preoperative cardiac function as a readily available risk assessment for delirium prior to cardiac surgery.

scholarly journals Divine Love and Deep Connections: A Long-Term Followup of Patients Surviving Cardiac Surgery

2011 ◽  
Vol 2011 ◽  
pp. 1-8 ◽  
Author(s):  
Amy L. Ai ◽  
Daniel E. Hall
Keyword(s):  
New York ◽  
Cardiac Surgery ◽  
Spiritual Growth ◽  
Heart Association ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Spiritual Support ◽  
Divine Love ◽  
Ventricular Ejection Fraction ◽  
New York Heart Association

We examined experiencing divine love as an indicator of affective spiritual growth in a prospective cohort of 200 patients surviving cardiac surgery. These patients previously completed two-wave preoperative interviews when standardized cardiac surgery data were also collected. The information included left ventricular ejection fraction, New York Heart Association Classification, baseline health (physical and mental), optimism, hope, religiousness, prayer coping, religious/spiritual coping, and demographics. We then measured divine love at 900 days postoperatively. Hierarchical linear regression indicated the direct effect of positive religious coping on experiences of divine love, controlling for other key variables. Postoperatively perceived spiritual support was entered at the final step as an explanatory factor, which appeared to mediate the coping effect. None of the other faith factors predicted divine love. Further research regarding divine love and spiritual support may eventually guide clinical attempts to support patients' spiritual growth as an independently relevant outcome of cardiac surgery.

scholarly journals Patients with dilated cardiomyopathy show reduction of the somatotroph responsiveness to GHRH both alone and combined with arginine

2000 ◽  
pp. 157-163 ◽  
Author(s):  
F Broglio ◽  
A Benso ◽  
C Gottero ◽  
LD Vito ◽  
G Aimaretti ◽  
...  
Keyword(s):  
New York ◽  
Dilated Cardiomyopathy ◽  
Heart Association ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Female Age ◽  
Gh Secretion ◽  
Igf I ◽  
New York Heart Association

OBJECTIVE: Altered function of the GH/IGF-I axis in patients with dilated cardiomyopathy (DCM) has been reported. In fact, DCM patients show reduction of IGF-I levels, which could reflect slight peripheral GH resistance or, alternatively, reduced somatotroph secretion. Spontaneous GH secretion has been reported to be altered by some but not by other authors, whereas the GH response to GHRH, but not that to GH-releasing peptides, seems reduced in DCM patients. On the other hand, it is well known that the GH response to GHRH in humans is markedly potentiated by arginine (ARG), which probably acts via inhibition of hypothalamic somatostatin release; in fact the GHRH+ARG test is known as one of the most reliable to evaluate the maximal secretory capacity of somatotroph cells. METHODS: In order to further clarify the somatotroph function in DCM, in well-nourished patients with DCM (34 male, 4 female; age (mean+/-s.e. m.) 57.8+/-1.1 years; body mass index (BMI) 24.6+/-0.6kg/m(2); left ventricular ejection fraction 23.2+/-1.6%; New York Heart Association classification I/1, II/17, III/18, IV/2) we studied the GH response to GHRH (1.0 microgram/kg i.v.) alone or combined with ARG (0.5g/kg i.v.). The results in DCM patients were compared with those in age-matched control subjects (CS) (39 male, 7 female; age 58.9+/-1.0 years; BMI 23.2+/-0.3kg/m(2)). RESULTS: Mean IGF-I levels in DCM patients were lower than in CS (144.3+/-6.9 vs 175.1+/-8. 4 microgram/l, P<0.05) whereas basal GH levels were similar in both groups (1.7+/-0.3 vs 1.7+/-0.3 microgram/l). The GH response to GHRH in DCM patients was lower (P<0.05) than that in CS (GH peak 6.5+/-1.2 vs 10.7+/-2.1 microgram/l). In both groups the GH response to GHRH+ARG was higher (P<0.001) than that to GHRH alone. However, the GH response to GHRH+ARG in DCM patients remained clearly lower (P<0.01) than that in CS (18.3+/-3.2 vs 34.1+/-4.6 microgram/l). The GH response to GHRH alone and combined with ARG was not associated with the severity of the disease. CONCLUSION: DCM patients show blunted GH responses to GHRH both alone and combined with ARG. Evidence that ARG does not restore the GH response to GHRH in DCM patients makes it unlikely that the somatotroph hyporesponsiveness to the neurohormone reflects hyperactivity of hypothalamic somatostatinergic neurons.

scholarly journals CORRELATION BETWEEN CONCENTRATION OF PATHOLOGICAL CYTOKINES AND ERYTHROPOIETIN IN PATIENTS WITH CHRONIC HEART FAILURE WITH ANEMIC SYNDROME

2015 ◽  
Vol 69 (1-2) ◽  
pp. 32-37
Author(s):  
K. Kh. Zahidova
Keyword(s):  
Heart Failure ◽  
New York ◽  
Chronic Heart Failure ◽  
Nyha Class ◽  
Heart Association ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
New York Heart Association ◽  
Erythropoietin Treatment

Aim: to study correlation between concentration of pathological cytokines and erythropoietin in patients with chronic heart failure with anemic syndrome and also to prove importance of this communication for need of appointment erythropoietin excitants. Patients and methods: 94 patients with chronic heart failure of New York Heart Association (NYHA) class ІІІ–ІV a left ventricular ejection fraction of 40% or less with anemia w ere included in investigation (58 males, 36 females). Anemia was detected when hemoglobin (Hb) was less than 120 g/l in males and less than 110 g/l in females. 46 patients received traditional treatment of CHF (І group) and 48 patients were treated additionally with erythropoietin (EPO) (ІІ group). Percutaneous EPO 50 IU monthly to patients without iron deficiency for a period of 6 months. Echocardiography parameters, plasma NT and pro-BNP, cytokines, EPO, ferritin and 6-minute walking test were assessed at baseline and after treatment. Results: in patients with CHF and anemia in ІІ group erythropoietin treatment increased Hb levels by 22,4% (p IL 6 by 54,3% (p α by 48,3% (p increase of LVEF by 19,04% (p Conclusions: Correction of anemia in patients with chronic heart failure with percutaneous erythropoietin injections 50 IU monthly for 6 month period to improve erythropoietin deficit and cytokines aggression and associated anemia, symptoms and quality of life.

Influence of myocardial scar on the response to frequent premature ventricular complex ablation

Heart ◽  
2018 ◽  
pp. heartjnl-2018-313452 ◽  
Author(s):  
Diego Penela ◽  
Mikel Martínez ◽  
Juan Fernández-Armenta ◽  
Luis Aguinaga ◽  
Luis Tercedor ◽  
...  
Keyword(s):  
New York ◽  
Heart Association ◽  
Left Ventricular ◽  
Myocardial Scar ◽  
Left Ventricular Ejection ◽  
Premature Ventricular Complex ◽  
Ventricular Ejection Fraction ◽  
Lv Dysfunction ◽  
New York Heart Association ◽  
Lge Cmr

ObjectiveThis study aims to evaluate the influence of myocardial scar after premature ventricular complexes (PVC) ablation in patients with left ventricular (LV) dysfunction.Methods70 consecutive patients (58±11 years, 58 (83%) men, 23% (18–32) mean PVC burden) with LV dysfunction and frequent PVCs submitted for ablation were included. A late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) was performed prior to the ablation and a quantitative and qualitative analysis of the scar was done.ResultsLeft ventricular ejection fraction progressively improved from 34.3%±9% at baseline to 44.4%±12% at 12 months (p<0.01) and 48 (69%) patients were echocardiographic responders. New York Heart Association class improved from 1.96±0.9 points at baseline to 1.36±0.6 at 12 months (p<0.001). Brain natriuretic peptide decreased from 120 (60–284) to 46 (23–81) pg/mL (p=0.04). Twenty-nine (41%) patients showed scar in the preprocedural LGE-CMR with a mean scar mass of 10.4 (5–20) g. Mean scar mass was significantly smaller in responders than in non-responders (0 (0–4.7) g vs 2 (0–14) g, respectively, p=0.017). PVC burden reduction (OR 1.09 (1.01–1.16), p=0.02) and scar mass (OR 0.9 (0.81–0.99), p=0.04) were independent predictors of response, but the former showed a higher accuracy.ConclusionsPresence of myocardial scar modulates, but does not preclude, the probability of response to PVC ablation in patients with LV dysfunction.

scholarly journals Severe mitral regurgitation from Libman–Sacks endocarditis treated with MitraClip: a case report

2021 ◽  
Vol 5 (10) ◽  
Author(s):  
Wong Ningyan ◽  
Ignasius Aditya Jappar ◽  
Ewe See Hooi ◽  
Yeo Khung Keong
Keyword(s):  
New York ◽  
Mitral Regurgitation ◽  
Heart Association ◽  
Class Ii ◽  
Left Ventricular ◽  
Functional Class ◽  
Left Ventricular Ejection ◽  
Severe Mitral Regurgitation ◽  
Nyha Functional Class ◽  
New York Heart Association

Abstract Background  Systemic lupus erythematosus (SLE) valvulopathy can manifest as a spectrum of pathologies and treatment of severe valvular dysfunction thus far has been surgical. However, surgery in patients with SLE is frequently associated with high morbidity and mortality due to the presence of significant co-morbidities. Case summary  We report the case of a 41-year-old woman with SLE and anti-phospholipid syndrome with extensive co-morbidities including lupus nephritis, pancytopaenia, cerebrovascular accident, and severe airway obstruction from ipsilateral lung collapse and bronchiectasis. She had severe mitral regurgitation (MR) from Libman–Sacks endocarditis and in recent months developed heart failure with progressive exertional dyspnoea from New York Heart Association (NYHA) functional Class from New York Heart Association (NYHA) functional class II to III. In addition, there was progressive left ventricular dilatation and reduction in left ventricular ejection fraction. In view of the high surgical risk, she underwent transcatheter edge-to-edge repair (TEER) of the mitral valve with the MitraClip system. At 1-month follow-up, she was back to NYHA functional Class II with mild MR. Discussion Our case demonstrates that in select patient with suitable anatomy, TEER is a potential treatment option for severe MR from SLE valvulopathy.

Cardiomyoplasty: First Clinical Case with New Cardiomyostimulator

2002 ◽  
Vol 10 (3) ◽  
pp. 264-266
Author(s):  
Valeri S Chekanov ◽  
Duane E Sands ◽  
Conville S Brown ◽  
Fernando Brum ◽  
Pedro Arzuaga ◽  
...  
Keyword(s):  
New York ◽  
Clinical Case ◽  
Heart Association ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
New York Heart Association ◽  
Stimulation Regimen ◽  
Class Iv ◽  
Dynamic Cardiomyoplasty

Dynamic cardiomyoplasty was performed in a patient using a new cardio-myostimulator (LD-PACE II) designed to enable a novel stimulation regimen that utilizes a new range of stimulation options, including cessation during sleep. After treatment, left ventricular ejection fraction improved in 24 months from 15% to 25% and New York Heart Association classification improved from class IV to II.

Abstract 216: Left Ventricular Enlargement and Heart Failure Events: Is Bigger Better?

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Farbod Raiszadeh ◽  
Neeraja Yedlapati ◽  
Ileana L Piña ◽  
Daniel M Spevack
Keyword(s):  
Heart Failure ◽  
New York ◽  
Cox Regression ◽  
Systolic Heart Failure ◽  
Heart Association ◽  
Left Ventricular ◽  
Left Ventricular Volumes ◽  
End Diastolic Volume ◽  
New York Heart Association ◽  
The Individual

Background: Since stroke volume (SV) is a function of ejection fraction (EF) and end-diastolic volume (EDV) (SV = EF x EDV), we hypothesized that increased EDV may be advantageous in systolic heart failure (HF), allowing the left ventricle to supply increased cardiac output. Methods: Echocardiograms from 968 consecutive patients seen in our hospital’s HF clinic were reviewed. Left ventricular volumes were measured both at end systole and end diastole using the bi-plane Simpson’s method and were indexed to body surface area. EF was calculated using (EDV-ESV)/EDV. Dates of subsequent HF events (death or admission for HF exacerbation) were obtained from our database. Results: Systolic HF (EF < 50%) was found in 649 of the study subjects. Increased SV index was associated with increased EDV index. The strength of this association varied with EF, Figure. In a bivariate Cox regression model, lower SV index and higher EDV index were each independent predictors of HF events. Increase in EDV by 50 cc was associated with a 20% increase in HF events, p<0.001. Decrease in SVI by 5 cc was associated with 5% increase in HF events, p<0.001. These associations were limited to those with systolic HF. The associations between both EDVI and SVI and HF events were not confounded by patient age, sex and New York Heart Association Class. Conclusion: Increased EDV index was independently associated with increased HF events, indicating that LV enlargement in HF is not favorable. These findings underscore the individual contributions of the components of EF (SV and EDV) in predicting HF outcomes.

An Early Canadian Experience with the Correx Automated Coring and Apical Connector Device for Aortic Valve Bypass

2016 ◽  
Vol 11 (6) ◽  
pp. 434-438
Author(s):  
Hussein A. Al-Amodi ◽  
Christopher L. Tarola ◽  
Hamad F. Alhabib ◽  
Corey Adams ◽  
Linrui Ray Guo ◽  
...  
Keyword(s):  
New York ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Heart Association ◽  
Left Ventricular ◽  
Functional Class ◽  
New York Heart Association ◽  
Apical Connector ◽  
Aortic Valve Bypass

Objective Aortic valve replacement is the standard of care for severe, symptomatic aortic valve stenosis (AS); however, anatomy or preexisting comorbidities may preclude conventional or alternative transcatheter approaches. Aortic valve bypass (AVB) may be performed as a salvage procedure for the relief of symptomatic aortic stenosis in patients who are not suitable candidates for aortic valve replacement. Methods At our institution, seven patients underwent AVB using the Correx automated coring and apical connector system. All patients had severe AS with New York Heart Association functional class 3 symptoms and were not candidates for conventional or transcatheter approaches. Via a left anterolateral thoracotomy to access the descending aorta and left ventricular apex, we used the Correx system (Correx, Waltham, MA USA) to anastomose a valve conduit to the left ventricular apex proximally and the descending aorta distally. Three patients required cardiopulmonary bypass. Results In all seven patients, the automated coring and apical connector was successfully deployed. There were two in-hospital deaths in this series. Immediately postoperatively and at 3 months, there was a significant reduction in mean and peak valve gradients, and all surviving patients performed at New York Heart Association functional class 1. Conclusions Aortic valve bypass seems to be an acceptable alternative for the treatment of severe AS in high-risk patients who are not candidates for aortic valve replacement. The Correx automated system may improve the clinical applicability and surgical repro-ducibility of AVB in appropriately selected patients in which conventional or transcatheter aortic valve replacement is not a feasible options.

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