Reply: When is the optimal time point for detecting malapposition in coronary bifurcation trials?

2021 ◽  
Vol 17 (7) ◽  
pp. 609-610
Author(s):  
Yusuke Watanabe ◽  
Yoshinobu Murasato ◽  
Nobuaki Suzuki ◽  
Ken Kozuma
2020 ◽  
Vol 47 (5) ◽  
pp. 361-369
Author(s):  
Tina Tomic Mahecic ◽  
Martin Dünser ◽  
Jens Meier

For many years, in daily clinical practice, the traditional 10/30 rule (hemoglobin 10 g/dL – hematocrit 30%) has been the most commonly used trigger for blood transfusions. Over the years, this approach is believed to have contributed to a countless number of unnecessary transfusions and an unknown number of overtransfusion-related deaths. Recent studies have shown that lower hemoglobin levels can safely be accepted, even in critically ill patients. However, even these new transfusion thresholds are far beyond the theoretical limits of individual anemia tolerance. For this reason, almost all publications addressing the limits of acute anemia recommend physiological transfusion triggers to indicate the transfusion of erythrocyte concentrates as an alternative. Although this concept appears intuitive at first glance, no solid scientific evidence supports the safety and benefit of physiological transfusion triggers to indicate the optimal time point for transfusion of allogeneic blood. It is therefore imperative to continue searching for the most sensitive and specific parameters that can guide the clinician when to transfuse in order to avoid anemia-induced organ dysfunction while avoiding overtransfusion-related adverse effects. This narrative review discusses the concept of anemia tolerance and critically compares hemoglobin-based triggers with physiological transfusion for various clinical indications.


2015 ◽  
Vol 7 (4) ◽  
pp. 20-35 ◽  
Author(s):  
Chun-Kit Ngan ◽  
Lin Li

The authors propose a Hypoglycemic Expert Query Parametric Estimation (H-EQPE) model and a Linear Checkpoint (L-Checkpoint) algorithm to detect hypoglycemia of diabetes patients. The proposed approach combines the strengths of both domain-knowledge-based and machine-learning-based approaches to learn the optimal decision parameter over time series for monitoring the symptoms, in which the objective function (i.e., the maximal number of detections of hypoglycemia) is dependent on the optimal time point from which the parameter is learned. To evaluate the approach, the authors conducted an experiment on a dataset from the Diabetes Research in Children Network group. The L-Checkpoint algorithm learned the optimal monitoring decision parameter, 99 mg/dL, and achieved the maximal number of detections of hypoglycemic symptoms. The experiment shows that the proposed approach produces the results that are superior to those of the domain-knowledge-based and the machine-learning-based approaches, resulting in a 99.2% accuracy, 100% sensitivity, and 98.8% specificity.


2012 ◽  
Vol 47 (2) ◽  
pp. 194-201 ◽  
Author(s):  
Sen Lin ◽  
Lei Xu ◽  
Shaonan Hu ◽  
Changqing Zhang ◽  
Yang Wang ◽  
...  

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
J C Reil ◽  
G-H Reil ◽  
J S Borer ◽  
N Hecker ◽  
A Aboud ◽  
...  

Abstract Background Current guidelines recommend surgery in patients with severe aortic regurgitation (AR) with clinical symptoms or subnormal ejection fraction (EF). Furthermore, surgery should be considered in patients with severe AR, preserved EF and increased left ventricular diameters (LVEDD >70mm, LVESD >50mm). The aim of the study was to investigate LV systolic function as well as mechanical energetics using non-invasive pressure-volume- and strain analysis in patients with severe AR and preserved EF as well as moderately dilated ventricles (LVEDD <70mm). Methods and Results Echocardiographic strain and single beat pressure-volume analyses were performed in patients with severe AR and moderately increased ventricular size (LVEDD < 70mm, EF >50% n = 39) as well as healthy, age-matched controls (n = 20) using echo-derived volume and arm-cuff blood pressure measurements. Load independent parameters of systolic contractile function like end-systolic elastance (Ees) and end-systolic volume at 100mmHg (ESV100) were calculated as well as stroke work ((SW) and total pressure volume area (PVA = SW + potential energy). Patients with AR demonstrated significant depression of systolic function beyond ejection fraction: global longitudinal strain was reduced compared to controls (-16 ±2.5% vs. -21.5 ±2%; p < 0.001). Accordingly load independent parameters of LV contractility like Ees (1.5mmHg/ml ±0.7 vs. 2.25mmHg/ml ±0.7; p < 0.001), ESV100 (65.7ml ±19.4 vs. 42.4ml ±19.8; p < 0.05) were reduced despite comparable ejection fractions (EF: 0.56% ±0.05 vs. 0.60% ±0.07 p = 0,10). End-diastolic volume of AR patients was markedly elevated (236ml ±90 vs. 136ml ±30; p < 0.001), while PVA (20470mmHg x ml ±10400 vs. 11907mmHg x ml ±2877; p < 0.01) and stroke work (13200mmHg x ml ±5700 vs. 7606 mmHG x ml ±2048; p< 0.01) were markedly elevated indicating waste of energy. Conclusion Patients with severe AR and moderately enhanced LV showed depressed values of contractility and waste of energy using more advanced parameters of LV systolic function although EF was preserved. The data may demonstrate that surgery is performed too late in many of those patients and may give clues for reconsidering guidelines to meet the optimal time point of surgery. .


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