Diagnostic value of chest X-ray and echocardiography for cardiac tamponade in post cardiac surgery patients

Objective: To investigate the effectiveness of X-ray and echocardiography (ECHO) as a diagnostic tool for cardiac tamponade in adult cardiac surgery patients.Methods: Thirty five coronary artery bypass and graft surgery patients who developed cardiac tamponade at Cleveland clinic foundation, were included in this study. Their diagnosis was confirmed at the time of re-exploration in the operating room. These patients were followed retrospectively for demographics, X-ray and echocardiography findings. Abnormal and enlarged cardiac silhouette which was different from first postoperative X-ray was used as radiological criteria for tamponade while echocardiographic diagnosis was left to the discretion of cardiologist.Results: Twenty four males (69%) and 11 (31%) females with an average age of 60.7 +/- 15.2 years were included in this study. Only 7 (20%) patients met our criteria for radiological diagnosis of tamponade. All 35 patients showed pericardial effusion on ECHO while cardiac tamponade was present in 30 (86%) patients. Tamponade developed on an average on 4th postoperative day.CONCLUSION: Radiological diagnosis of cardiac tamponade based on changes in cardiac silhouette provide limited information while ECHO is a reliable diagnostic tool when combined with clinical findings

Classificiation of Atrial Fibrillation Prone Patients Using Electrocardiographic Parameters in Neuro-Fuzzy Modeling,

Atrial Fibrillation (AF) is a significant clinical problem and the complications of cardiovascular postoperative AF often lead to longer hospital stays and higher heath care costs. The literature showed that AF may be preceded by changes in electrocardiogram (ECG) characteristics such as premature atrial activity, heart rate variability (HRV), and P-wave morphology. We hypothesize that the limitations of statistics-based attempts to predict AF occurrence may be overcome using a hybrid neuro-fuzzy prediction model that is better capable of uncovering complex, non-linear interactions between ECG parameters. We created a neuro-fuzzy network that was able to classify the patients into the control and AF groups with the performances: 99.42% sensitivity, 99.89% specificity, and 99.74% accuracy for 30 minutes just before AF onset

Prediction of Paroxysmal Atrial Fibrillation Onset in Postoperative Patients Using Neuro-Fuzzy Modeling

ATRIAL FIBRILLATION (AF) is the most common cardiac arrhythmia. In the United States alone, it affects more than 2.5 million people annually. The onset of AF is frequently associated with thoracic surgery and it is estimated to occur in 25% of patients that undergo cardiac surgery. The AF may be preceded by changes in electrocardiogram (ECG) characteristics such as premature atrial activity, heart rate variability (HRV), and P-wave morphology [3]. A valid question regarding the availability of a time lag that could be used to provide adequate treatment against AF onset was raised by Dr. Lombardi in his editorial [1]. We are using a hybrid neuro-fuzzy prediction model that exploits non-linear interactions between ECG parameters. The techniques are non-invasive and analyze 5-lead ECG waveforms. This will allow the model to be easily applied in a Cardio-Vascular Intensive Care Unit setting with very few modifications. http://ama-ieee.embs.org/2011conf/wp-content/uploads/2011/10/AMA_IEEE_2011_Ovreiu_AF_prediction.pd

Prediction of Paroxysmal Atrial Fibrillation Onset in Postoperative Patients Using Neuro-Fuzzy Modeling

ATRIAL FIBRILLATION (AF) is the most common cardiac arrhythmia. In the United States alone, it affects more than 2.5 million people annually. The onset of AF is frequently associated with thoracic surgery and it is estimated to occur in 25% of patients that undergo cardiac surgery. The AF may be preceded by changes in electrocardiogram (ECG) characteristics such as premature atrial activity, heart rate variability (HRV), and P-wave morphology [3]. A valid question regarding the availability of a time lag that could be used to provide adequate treatment against AF onset was raised by Dr. Lombardi in his editorial [1]. We are using a hybrid neuro-fuzzy prediction model that exploits non-linear interactions between ECG parameters. The techniques are non-invasive and analyze 5-lead ECG waveforms. This will allow the model to be easily applied in a Cardio-Vascular Intensive Care Unit setting with very few modifications. http://ama-ieee.embs.org/2011conf/wp-content/uploads/2011/10/AMA_IEEE_2011_Ovreiu_AF_prediction.pd

Operation Timing Does Not Affect Outcome after Coronary Artery Bypass Graft Surgery

Background: Human factors such as fatigue, circadian rhythms, scheduling, and staffing may have an impact on patient care over the course of a day across all medical specialties. Research by the transportation industry concludes that human performance is degraded by shift work, circadian rhythm disturbances, and prolonged duty. This study investigated whether the timing of coronary artery bypass graft surgery affects outcomes. Methods: The outcomes of coronary artery bypass graft surgery patients were analyzed according to the hour of the day, day of the workweek, month, and moon phase in which the surgery started. All patients who underwent isolated coronary artery bypass graft surgery between January 1, 1993 and July 1, 2006 were considered for the study. The primary outcome measurement was a compound morbidity outcome of six variables defined by the Society of Thoracic Surgeons. These outcomes included (1) in-hospital death, (2) acute postoperative myocardial infarction, (3) neurologic morbidity, including focal or global neurologic deficits or death without awakening, (4) serious infection morbidity consisting of sepsis syndrome or septic shock, (5) new-onset renal failure requiring dialysis, and (6) postoperative ventilatory support exceeding 72 h. Results: The composite morbidity and in-hospital mortality rates were 4.8% and 1.4%, respectively. The number of cases each weekday, each month of the year, and during each phase of the moon were consistent. None of the time factors significantly affected the composite morbidity outcome. Conclusions: Elective coronary artery bypass graft surgery can be scheduled throughout the workday, any day of the work week and in any month of the year without compromising outcome

Low Vitamin D Concentration Is Not Associated with Increased Mortality and Morbidity after Cardiac Surgery

<div><p>Objective</p><p>To determine the effect of vitamin D on postoperative outcomes in cardiac surgical patients.</p><p>Design</p><p>Retrospective study.</p><p>Setting</p><p>Single institution-teaching hospital.</p><p>Participants</p><p>Adult cardiac surgical patients with perioperative 25-hydroxyvitamin D measurements.</p><p>Interventions</p><p>None. We gathered information from the Cardiac Anesthesiology Registry that was obtained at the time of the patients’ visit/hospitalization.</p><p>Measurements and Main Results</p><p>We used data of 18,064 patients from the Cardiac Anesthesiology Registry; 426 patients with 25-hydroxyvitamin D measurements met our inclusion criteria. Association with Vitamin D concentration and composite of 11 cardiac morbidities was done by multivariate (i.e., multiple outcomes per subject) analysis. For other outcomes separate multivariable logistic regressions and adjusting for the potential confounders was used. The observed median vitamin D concentration was 19 [Q1-Q3∶12, 30] ng/mL. Vitamin D concentration was not associated with our primary composite of serious cardiac morbidities (odds ratio [OR], 0.96; 95% CI, 0.86–1.07). Vitamin D concentration was also not associated with any of the secondary outcomes: neurologic morbidity (P = 0.27), surgical (P = 0.26) or systemic infections (P = 0.58), 30-day mortality (P = 0.55), or length of initial intensive care unit (ICU) stay (P = 0.04).</p><p>Conclusions</p><p>Our analysis suggests that perioperative vitamin D concentration is not associated with clinically important outcomes, likely because the outcomes are overwhelmingly determined by other baseline and surgical factors.</p></div

Severity-adjusted^* average relative effect of vitamin D concentration across 11 cardiac morbidities among 426 cardiac surgical patients.

*<p>Weights were determined as the median score for that morbidity (from 1 to 100, 100 being most severe) scored by nine independent anesthesiologists who were otherwise not involved in this study (<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0063831#pone.0063831.s002" target="_blank">appendix S2</a>).</p>¶<p>Potential confounders: age, gender, race, body mass index, smoking status, dialysis, and ethanol alcohol (ETOH).</p>§<p>Mediator variables: congestive heart failure, hypertension, vascular surgery dilatations, vascular heart disease, carotid surgery, carotid disease, stroke, atrial fibrillation, atrial flutter, ventricular tachycardia, ventricular fibrillation, junctional, and myocardial infarction.</p>#<p>Odds ratio for a 5-unit increase in vitamin D concentration.</p

The associations between serum vitamin D concentration and individual cardiac morbidities among 426 cardiac surgical patients.

<p>IABP = Intra-aortic balloon pump, ECMO = Extra corporeal membrane oxygenator, VT/VF = Ventricular tachycardia/Ventricular fibrillation.</p>*<p>Odds ratio for a 5-unit increase in vitamin D concentration, after adjusting for potential confounders: age, gender, race, body mass index, smoking status, dialysis, and ethanol alcohol (ETOH).</p>†<p>A Bonferroni correction was used to adjust for multiple testing. Thus, the 99.55% CIs are presented, and the significance criterion for each individual outcome is P<0.0045 (i.e., 0.05/11). None of the individual cardiac morbidities thus met our <i>a priori</i> criteria for statistical significance.</p