Clinical and echocardiographic predictors of mortality in acute pulmonary embolism

Purpose: The aim of this study was to evaluate the utility of adding quantitative assessments of cardiac function from echocardiography to clinical factors in predicting the outcome of patients with acute pulmonary embolism (PE). Methods: Patients with a diagnosis of acute PE, based on a positive ventilation perfusion scan or computed tomography (CT) chest angiogram, were identified using the Duke University Hospital Database. Of these, 69 had echocardiograms within 24–48 h of the diagnosis that were suitable for offline analysis. Clinical features that were analyzed included age, gender, body mass index, vital signs and comorbidities. Echocardiographic parameters that were analyzed included left ventricular (LV) ejection fraction (EF), regional, free wall and global RV speckle-tracking strain, RV fraction area change (RVFAC), Tricuspid Annular Plane Systolic Excursion (TAPSE), pulmonary artery acceleration time (PAAT) and RV myocardial performance (Tei) index. Univariable and multivariable regression statistical analysis models were used. Results: Out of 69 patients with acute PE, the median age was 55 and 48 % were female. The median body mass 2 index (BMI) was 27 kg/m . Twenty-nine percent of the cohort had a history of cancer, with a significant increase in cancer prevalence in non-survivors (57 % vs 29 %, p = 0.02). Clinical parameters including heart rate, respiratory rate, troponin T level, active malignancy, hypertension and COPD were higher among non-survivors when compared to survivors (p ≤ 0.05). Using univariable analysis, NYHA class III symptoms, hypoxemia on presentation, tachycardia, tachypnea, elevation in Troponin T, absence of hypertension, active malignancy and chronic obstructive pulmonary disease (COPD) were increased in non-survivors compared to survivors (p ≤ 0.05). In multivariable models, RV Tei Index, global and free (lateral) wall RVLS were found to be negatively associated with survival probability after adjusting for age, gender and systolic blood pressure (p ≤ 0.05). Conclusion: The addition of echocardiographic assessment of RV function to clinical parameters improved the prediction of outcomes for patients with acute PE. Larger studies are needed to validate these findings

Inhalation of rod-like carbon nanotubes causes unconventional allergic airway inflammation

Peer reviewe

Empatia : video reflection method for reflecting on empathic interactions between care worker and client

Purpose This paper aims to introduce the Empatia video reflection method, designed to enhance care workers’ awareness of empathic care. The method makes the quality of care visible, which is needed when digitalization efforts in elder care focus on the efficiency and adequacy of care work. Design/methodology/approach The Empatia method leans on previous studies of the interaction between care professionals and clients and elaborates further previous video reflection methods. In empathic care work, the care worker sees the client on their life continuum, rather than focusing on only medical treatments. Findings The empirical example demonstrates how a care worker gained awareness of their empathic interaction habits. Within the work community, the reflection process sparked discussions on values: the purpose of care work and how to conduct empathic care. Focusing on empathic relationships in care fosters both the client’s and the care worker’s well-being. Practical implications The strength of the Empatia method is that it makes empathy visible in interaction and something that is individually and collectively learnable. The Empatia includes an analytical tool for researchers to reveal empathy in client interaction. It can be developed further into a reflection tool for service work to learn how to be empathic in service encounters. Originality/value Compared to other video-stimulated recall methods, the Empatia involves contextual understanding of care work. Empowering positive interactions instead of detecting errors and solving problems is a novel concept and is scantily used in studies of organizational learning. The Empatia provides a detailed method description that allows for the replication of the method by anyone.peerReviewe

Dyssynchrony and Electromechanical delay are associated with focal fibrosis in the Systemic Right Ventricle - Insights from Echocardiography

© 2016 Elsevier Ireland LtdBackground Systemic right ventricular (RV) dysfunction and sudden cardiac death remain problematic late after Mustard operation for transposition of the great arteries. The exact mechanism for that relationship is likely to be multifactorial including myocardial fibrosis. Doppler echocardiography gives further insights into the role of fibrosis shown by late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) in late morbidity. Methods and results Twenty-two consecutive patients, mean age 28 ± 8 years, were studied with 2D echocardiography, and also assessed by LGE CMR. The presence of LGE in 13/22 patients (59%) was related to delayed septal shortening and lengthening (P = 0.002 & P = 0.049), prolonged systemic RV isovolumic contraction time (P = 0.024) and reduced systemic RV free wall and septal excursion (P = 0.027 & P = 0.005). The systemic RV total isovolumic time was prolonged but not related to extent of LGE. LGE extent was related to markers of electromechanical delay and dyssynchrony (delayed onset of RV free wall shortening and lengthening; r = 0.73 & P = 0.004 and r = 0.62 & P = 0.041, respectively, and QRS duration r = 0.68, P < 0.01) and was inversely related to systolic RV free wall shortening velocity (r = − 0.59 & P = 0.042). The presence of LGE was also related to lower exercise capacity, ≥ mild tricuspid regurgitation and more arrhythmia (P = 0.008, P = 0.014 and P = 0.040). RV free wall excursion and systolic tissue Doppler velocity were related to CMR derived RV ejection fraction (r = 0.51, P = 0.015, and r = 0.77, P = < 0.001, respectively). Conclusion Post Mustard repair, myocardial fibrosis is related to dyssynchrony, RV long axis dysfunction and tricuspid regurgitation. Echocardiographic measurements of systemic RV function can be confidently used in serial follow-up following Mustard operation