Real-time ultrasound-guided catheterisation of the internal jugular vein: a prospective comparison with the landmark technique in critical care patients

INTRODUCTION: Central venous cannulation is crucial in the management of the critical care patient. This study was designed to evaluate whether real-time ultrasound-guided cannulation of the internal jugular vein is superior to the standard landmark method. METHODS: In this randomised study, 450 critical care patients who underwent real-time ultrasound-guided cannulation of the internal jugular vein were prospectively compared with 450 critical care patients in whom the landmark technique was used. Randomisation was performed by means of a computer-generated random-numbers table, and patients were stratified with regard to age, gender, and body mass index. RESULTS: There were no significant differences in gender, age, body mass index, or side of cannulation (left or right) or in the presence of risk factors for difficult venous cannulation such as prior catheterisation, limited sites for access attempts, previous difficulties during catheterisation, previous mechanical complication, known vascular abnormality, untreated coagulopathy, skeletal deformity, and cannulation during cardiac arrest between the two groups of patients. Furthermore, the physicians who performed the procedures had comparable experience in the placement of central venous catheters (p = non-significant). Cannulation of the internal jugular vein was achieved in all patients by using ultrasound and in 425 of the patients (94.4%) by using the landmark technique (p < 0.001). Average access time (skin to vein) and number of attempts were significantly reduced in the ultrasound group of patients compared with the landmark group (p < 0.001). In the landmark group, puncture of the carotid artery occurred in 10.6% of patients, haematoma in 8.4%, haemothorax in 1.7%, pneumothorax in 2.4%, and central venous catheter-associated blood stream infection in 16%, which were all significantly increased compared with the ultrasound group (p < 0.001). CONCLUSION: The present data suggest that ultrasound-guided catheterisation of the internal jugular vein in critical care patients is superior to the landmark technique and therefore should be the method of choice in these patients

Asymptomatic papillary fibroelastoma of the Aortic valve in a young woman - a case report

Echocardiography represents an invaluable diagnostic tool for the detection of intracardiac masses while simultaneously provides information about their size, location, mobility and attachment site as well as the presence and extent of any consequent hemodynamic derangement

Selective versus non selective third generation b-blockers in patients with heart failure: a comparative study of the safety and efficasy of nebivolol versus carvedilol in the treatment of with diopathic dilated cardiomyopathy

Purpose. To compare the efficacy of nebivolol versus carvedilol on left ventricular (LV) function and exercise capacity in patients with nonischemic dilated cardiomyopathy (NIDC). Methods. After enrollment in this double-blind trial 72 patients aged 55±9.5 years with NIDC LV ejection fraction (LVEF) b45% New York Heart Association classes II to III were randomized to either nebivolol (34 patients) or carvedilol (38 patients) and were evaluated through echocardiography and exercise tests at baseline and 3 and 12 months after treatment. Results. During follow-up 4 patients discontinued nebivolol although 3 patients stopped carvedilol. Patients in both the nebivolol and carvedilol groups showed a steady improvement in New York Heart Association class (Ρ=002 and <0 001 at 12 months respectively) and LVEF (Ρ=001 and <0 001 at 12 months respectively) that became significant from 3-month follow-up on. Intergroup analysis showed that Carvedilol group had a greater increase in LVEF at 3 (Ρ=004) and 12 (Ρ=02) months follow-up compared with nebivolol group. Advanced diastolic dysfunction regressed to earlier stages in carvedilol patients after 3 (Ρ=02) and 12 (Ρ=01) months treatment whereas in the nebivolol group a significant improvement in diastolic dysfunction was found at the 12 months follow-up (Ρ=02). Exercise duration improved in both groups at 12 months follow-up (both Ρ=01) but in the nebivolol group there was an initial deterioration at 3 months (P=07). Conclusions. Both nebivolol and carvedilol appear relatively safe with beneficial effects on LV systolic and diastolic function as well as exercise capacity in patients with ΝIDC after 12 months treatment. However carvedilol exhibits more favorable effects on LV function than nebivolol.Σκοπός. Η συγκριτική αξιολόγηση της αποτελεσματικότητας της Νεμπιβολόλης έναντι της καρβεντιλόλης στην λειτουργικότητα της αριστερής κοιλίας και στην ικανότητα για άσκηση σε ασθενείς πάσχοντες από μη ισχαιμική διατατική μυοκαρδιοπάθεια (ΜΙΔΚ). Μέθοδος. Μετά από την εισαγωγή σε αυτήν την διπλή τυφλή μελέτη 72 ασθενών ηλικίας 55±9.5 έτη με ΜΙΔΚ κλάσμα εξωθήσεως της αριστερής κοιλίας (ΚΕΑΚ) <45% λειτουργικής ικανότητας κατά ΝΥΗΑ 11-111 οι ασθενείς τυχαιοποιήθηκαν να λάβουν είτε Νεμπιβολόλη (34 ασθενείς) είτε καρβεντιλόλη (38 ασθενείς ) και αξιολογήθηκαν υπερηχοκαρδιογραφικά και με δοκιμασία κόπωσης κατά την είσοδο τους στην μελέτη και μετά από 3 και 12 μήνες. Αποτελέσματα. Κατά την διάρκεια της μελέτης 4 ασθενείς σταμάτησαν τη θεραπεία με νεμπιβολόλη και 3 την καρβεντιλόλη. Οι ασθενείς και στην ομάδα της νεμπιβολόλης και στην ομάδα της καρβεντιλόλης παρουσίασαν μια συνεχή βελτίωση στην λειτουργική κατά ΝΥΗΑ ικανότητα (p=0.002 και p<0.001 στους 12 μήνες αντίστοιχα) καθώς και στο (p=0.001 και p<0.001 στους 12 μήνες αντίστοιχα) που άρχισε να παρατηρείται ήδη από τους πρώτους 3 μήνες. Ωστόσο η συγκριτική ανάλυση των ομάδων έδειξε ότι η ομάδα της καρβεντιλόλης παρουσίασε μια μεγαλύτερη αύξηση στο ΚΕΑΚ στους 3 (p=0.02) και 12 μήνες παρακολούθησης (p=0.03) συγκρινόμενη με την ομάδα της νεμπιβολόλης. Η διαστολική δυσλειτουργία της ΑΚ των ασθενών στην ομάδα της καρβεντιλόλης παρουσίασε βελτίωση με την υποστροφή του τύπου πλήρωσης της ΑΚ από προχωρημένα σε πρωϊμότερα στάδια διαστολικού τύπου πλήρωσης της ΑΚ μετά από 3 (p=0.02) και 12 μήνες θεραπείας (p=0.01) ενώ στην ομάδα της νεμπιβολόλης αντίστοιχη βελτίωση παρατηρήθηκε μονό στους 12 μήνες θεραπείας (p=0 02). Η διάρκεια της άσκησης βελτιώθηκε και στις 2 ομάδες θεραπείας στους 12 μήνες παρακολούθησης (αμφότερα p=0.01 ) άλλα στην ομάδα της νεμπιβολόλης παρατηρήθηκε μια πρόσκαιρη μείωση της ικανότητας για άσκηση στους πρώτους 3 μήνες θεραπείας (p=0.07). Συμπέρασμα. Αμφότερες οι θεραπείες με νεμπιβολόλη η καρβεντιλόλη είναι σχετικά ασφαλείς θεραπείες με ευεργετικά αποτελέσματα στην συστολική και διαστολική δυσλειτουργία της ΑΚ καθώς επίσης και στην ικανότητα για άσκηση σε ασθενείς με ΜΙΔΚ μετά από 12 μήνες θεραπείας. Ωστόσο φαίνεται ότι η καρβεντιλόλη συγκρινόμενη με την νεμπιβολόλη δείχνει μια συγκριτική υπέροχη στην βελτίωση της λειτουργικότητας της ΑΚ

Myocardial inotropic reserve: An old twist that constitutes a reliable index in the modern era of heart failure

Current national and international guidelines, including those of the European Society of Cardiology, recognize that the assessment of prognosis should be a part of the standard management for patients with chronic heart failure (CHF). However, these same guidelines recognize the inherent difficulty of this process. A variety of factors contribute to this difficulty, including the varying etiology, frequent co-morbidity and, perhaps most importantly, huge inter-individual variability in the disease progression and outcome. Although CHF is chronic, it is also a condition in which significant proportions of patients experience apparently ‘sudden’ death, which almost certainly contributes to our difficulty in assessing individual patient prognosis. A useful tool for the risk stratification of heart failure patients is dobutamine stress echocardiography (DSE), which determines the myocardial viability in ischemic cardiomyopathy and myocardial contractile reserve in idiopathic cardiomyopathy

Detection of abnormal left ventricular geometry in patients without cardiovascular disease through machine learning: An ECG‐based approach

Cardiac remodeling is recognized as an important aspect of cardiovascular disease (CVD) progression. Machine learning (ML) techniques were applied to basic clinical parameters and electrocardiographic features, in order to detect abnormal left ventricular geometry (LVG) even before the onset of left ventricular hypertrophy (LVH), in a population without established CVD. The authors enrolled 528 patients with and without essential hypertension, but no other indications of CVD. All patients underwent a full echocardiographic evaluation and were classified into 3 groups; normal geometry (NG), concentric remodeling without LVH (CR), and LVH. Abnormal LVG was identified as increased relative wall thickness (RWT) and/or left ventricular mass index (LVMi). The authors trained supervised ML models to classify patients with abnormal LVG and calculated SHAP values to perform feature importance and interaction analysis. Hypertension, age, body mass index over the Sokolow‐Lyon voltage, QRS‐T angle, and QTc duration were some of the most important features. Our model was able to distinguish NG from CR+LVH combined, with 87% accuracy on an unseen test set, 75% specificity, 97% sensitivity, and area under the receiver operating curve (AUC/ROC) equal to 0.91. The authors also trained our model to classify NG and CR (NG + CR) against those with LVH, with 89% test set accuracy, 93% specificity, 67% sensitivity, and an AUC/ROC value of 0.89, for a 0.4 decision threshold. Our ML algorithm effectively detects abnormal LVG even at early stages. Innovative solutions are needed to improve risk stratification of patients without established CVD, and ML may enable progress in this direction

Peripheral Blood MicroRNAs as Potential Biomarkers of Myocardial Damage in Acute Viral Myocarditis

Background: microRNAs (miRs) have emerged as important modulators of cardiovascular development and disease. Our aim was to determine whether cardiac-related miRs such as miR-21-5p and miR-1-3p were differentially expressed in acute viral myocarditis and whether any of them was related with the extent of myocardial damage and left ventricular dysfunction. Methods: We enrolled 40 patients with acute viral myocarditis. Blood samples were taken on admission and miRs expression levels in peripheral blood mononuclear cells were quantified by real-time reverse transcription polymerase chain reaction. Results: miR-21-5p, miR-1-3p were significantly elevated in acute myocarditis. miR-21-5p levels showed a strong correlation with global longitudinal strain (r = 0.71, p &lt; 0.01), while miR-1-3p had significant correlations with troponin I (r = 0.79, p &lt; 0.01). Conclusions: The expression of miR-21-5p and miR-1-3p in peripheral blood is increased in acute viral myocarditis, and this increase is correlated with myocardial damage and indicative of left ventricular systolic dysfunction in these patients