Prognostic indicators in patients presenting with acute cardiogenic pulmonary edema treated with CPAP: it's not the acid that matters, it's back to basics

Several prognostic markers have been identified for patients admitted with acute cardiogenic pulmonary edema. Most of the markers are based on clinical risk scores. Unlike hypercapnic respiratory failure, acidosis is not an adverse predictor in these patients. Hemodynamic variables that assess pathophysiological mechanisms may be more helpful to guide appropriate management

The influence of the 1972 statewide extension clothing practice survey on amounts of staff time planned and expended and clientele contacts with selected audiences and teaching methods, fiscal years 1972 and 1974

Data from the Tennessee Extension Management Information System (i.e., Agent days planned and spent and clientele contacts made) for Fiscal Years 1972 and 1974 were related to information from the summary of the 1972 Tennessee Extension Clothing Survey to determine whether the latter had influenced time planned and spent with appropriate homemaker audiences and teaching methods. The relation between survey clothing practices and primary TEMIS clothing and textiles subjects was found to be satisfactory for study purposes. Recommended practices under the primary subjects Clothing Records and Clothing Management and Planning were found to be used the least by Tennessee homemakers suggesting need for program emphasis. Percents of total Agent days planned and expended on the weak clothing and textiles subjects between 1972 and 1974 showed no appreciable increases. Percents planned with non—club audiences tended to decrease and with Home Demonstration Club Members to increase; while percents expended were the reverse from 1972 to 1974. Regarding numbers of total Agent days planned for all clothing and textiles subjects, there was a marked decrease between 1972 and 1974. For total Agent days spent, a relatively small decrease in total time was noted. Also, a decrease of more than 10 percent was noted in total clientele contacts recorded in the clothing area from 1972 to 1974. Personal and Group methods were used the most in both years studied—mainly in Clothing Production and Construction. It was implied that factors other than the statewide survey had influenced Agent time planned and spent and contacts made for audiences and by methods studied. Recommendations were made for further study

Real-Time 3D Transesophageal Echocardiography for the Evaluation of Rheumatic Mitral Stenosis

ObjectivesThe aims of this study were: 1) to assess the feasibility and reliability of performing mitral valve area (MVA) measurements in patients with rheumatic mitral valve stenosis (RhMS) using real-time 3-dimensional transesophageal echocardiography (3DTEE) planimetry (MVA3D); 2) to compare MVA3D with conventional techniques: 2-dimensional (2D) planimetry (MVA2D), pressure half-time (MVAPHT), and continuity equation (MVACON); and 3) to evaluate the degree of mitral commissural fusion.Background3DTEE is a novel technique that provides excellent image quality of the mitral valve. Real-time 3DTEE is a relatively recent enhancement of this technique. To date, there have been no feasibility studies investigating the utility of real-time 3DTEE in the assessment of RhMS.MethodsForty-three consecutive patients referred for echocardiographic evaluation of RhMS and suitability for percutaneous mitral valvuloplasty were assessed using 2D transthoracic echocardiography and real-time 3DTEE. MVA3D, MVA2D, MVAPHT, MVACON, and the degree of commissural fusion were evaluated.ResultsMVA3D assessment was possible in 41 patients (95%). MVA3D measurements were significantly lower compared with MVA2D (mean difference: −0.16 ± 0.22; n = 25, p < 0.005) and MVAPHT (mean difference: −0.23 ± 0.28 cm2; n = 39, p < 0.0001) but marginally greater than MVACON (mean difference: 0.05 ± 0.22 cm2; n = 24, p = 0.82). MVA3D demonstrated best agreement with MVACON (intraclass correlation coefficient [ICC] 0.83), followed by MVA2D (ICC 0.79) and MVAPHT (ICC 0.58). Interobserver and intraobserver agreement was excellent for MVA3D, with ICCs of 0.93 and 0.96, respectively. Excellent commissural evaluation was possible in all patients using 3DTEE. Compared with 3DTEE, underestimation of the degree of commissural fusion using 2D transthoracic echocardiography was observed in 19%, with weak agreement between methods (κ < 0.4).ConclusionsMVA planimetry is feasible in the majority of patients with RhMS using 3DTEE, with excellent reproducibility, and compares favorably with established methods. Three-dimensional transesophageal echocardiography allows excellent assessment of commissural fusion

A 30-Year-Old Man With Primary Cardiac Angiosarcoma

A previously fit and well 30-year-old man presented with palpitations, fever, and pleuritic chest pain. Multimodality imaging and histopathology confirmed the diagnosis of primary cardiac angiosarcoma. We present the details of the presentation, diagnostic process using multimodality imaging, and clinical management. (Level of Difficulty: Beginner.

Cardiac reverse remodeling in primary mitral regurgitation: mitral valve replacement vs. mitral valve repair

Background When feasible, guidelines recommend mitral valve repair (MVr) over mitral valve replacement (MVR) to treat primary mitral regurgitation (MR), based upon historic outcome studies and transthoracic echocardiography (TTE) reverse remodeling studies. Cardiovascular magnetic resonance (CMR) offers reference standard biventricular assessment with superior MR quantification compared to TTE. Using serial CMR in primary MR patients, we aimed to investigate cardiac reverse remodeling and residual MR post-MVr vs MVR with chordal preservation. Methods 83 patients with ≥ moderate-severe MR on TTE were prospectively recruited. 6-min walk tests (6MWT) and CMR imaging including cine imaging, aortic/pulmonary through-plane phase contrast imaging, T1 maps and late-gadolinium-enhanced (LGE) imaging were performed at baseline and 6 months after mitral surgery or watchful waiting (control group). Results 72 patients completed follow-up (Controls = 20, MVr = 30 and MVR = 22). Surgical groups demonstrated comparable baseline cardiac indices and co-morbidities. At 6-months, MVr and MVR groups demonstrated comparable improvements in 6MWT distances (+ 57 ± 54 m vs + 64 ± 76 m respectively, p = 1), reduced indexed left ventricular end-diastolic volumes (LVEDVi; − 29 ± 21 ml/m2 vs − 37 ± 22 ml/m2 respectively, p = 0.584) and left atrial volumes (− 23 ± 30 ml/m2 and − 39 ± 26 ml/m2 respectively, p = 0.545). At 6-months, compared with controls, right ventricular ejection fraction was poorer post-MVr (47 ± 6.1% vs 53 ± 8.0% respectively, p = 0.01) compared to post-MVR (50 ± 5.7% vs 53 ± 8.0% respectively, p = 0.698). MVR resulted in lower residual MR-regurgitant fraction (RF) than MVr (12 ± 8.0% vs 21 ± 11% respectively, p = 0.022). Baseline and follow-up indices of diffuse and focal myocardial fibrosis (Native T1 relaxation times, extra-cellular volume and quantified LGE respectively) were comparable between groups. Stepwise multiple linear regression of indexed variables in the surgical groups demonstrated baseline indexed mitral regurgitant volume as the sole multivariate predictor of left ventricular (LV) end-diastolic reverse remodelling, baseline LVEDVi as the most significant independent multivariate predictor of follow-up LVEDVi, baseline indexed LV end-systolic volume as the sole multivariate predictor of follow-up LV ejection fraction and undergoing MVR (vs MVr) as the most significant (p < 0.001) baseline multivariate predictor of lower residual MR. Conclusion In primary MR, MVR with chordal preservation may offer comparable cardiac reverse remodeling and functional benefits at 6-months when compared to MVr. Larger, multicenter CMR studies are required, which if the findings are confirmed could impact future surgical practice

The evaluation of the effect of two non-pharmacological treatment modalities - non-invasive ventilation and biventricular pacing - on indices of cardiac function and exercise capacity in patients with chronic heart failure

EThOS - Electronic Theses Online ServiceGBUnited Kingdo