Quantifying left ventricular function in heart failure: What makes a clinically valuable parameter?

In heart failure (HF) management, noninvasive quantification of left ventricular (LV) function is rapidly evolving. Deformation parameters, such as strain, continue to challenge the central role of ejection fraction (EF) in diagnosis and prognostication of LV dysfunction in HF. The increasing recognition and use of deformation parameters motivates a conceptual discussion about what makes a parameter clinically valuable. To do this, we introduce a framework for parameter evaluation. The framework considers three aspects that are important for parameter value; 1) how these parameters couple with underlying myocardial function; 2) the evidence base of the parameters; and 3) the technical feasibility of their measurement. In particular, we emphasize that the coupling of each parameter to the underlying myocardial function (aspect 1) is crucial for parameter value. While EF offers information about cardiac dysfunction trough measuring changes in LV volume, deformation parameters more closely reflect underlying myocardial processes that contribute to cardiac pumping function. This is a fundamental advantage of deformation parameters that could explain why a growing number of studies supports their use. A close coupling to underlying function is, however, not sufficient for high clinical value by itself. A parameter also needs a strong evidence base (aspect 2) and a high degree of technical feasibility (aspect 3). By considering these three aspects, this review discusses the present and potential clinical value of EF and deformation parameters in HF management

DVT og D-Dimer ved Nordre Follo legevakt

Spørsmål om DVT er en vanlig problemstilling i legevakt. Oppgaven viser at pasientnær måling av D-dimer er gunstig og legger en plan for hvordan innføring av dette kunne vært gjennomført i en legevakt. Mulige hindringer for innføringen problematiseres