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Biomedical subjects

Bernard Paelinck

Publications and source records attributed to Bernard Paelinck.

4 recordsLinked to original sources
PubMed2006

Should major vascular surgery be delayed because of preoperative cardiac testing in intermediate-risk patients receiving beta-blocker therapy with tight heart rate control?

OBJECTIVES: The purpose of this study was to assess the value of preoperative cardiac testing in intermediate-risk patients receiving beta-blocker therapy with tight heart rate (HR) control scheduled for major vascular surgery. BACKGROUND: Treatment guidelines of the American College of Cardiology/American Heart Association recommend cardiac testing in these patients to identify subjects at increased risk. This policy delays surgery, even though test results might be redundant and beta-blockers with tight HR control provide sufficient myocardial protection. Furthermore, the benefit of revascularization in high-risk patients is ill-defined. METHODS: All 1,476 screened patients were stratified into low-risk (0 risk factors), intermediate-risk (1 to 2 risk factors), and high-risk (> or =3 risk factors). All patients received beta-blockers. The 770 intermediate-risk patients were randomly assigned to cardiac stress-testing (n = 386) or no testing. Test results influenced management. In patients with ischemia, physicians aimed to control HR below the ischemic threshold. Those with extensive stress-induced ischemia were considered for revascularization. The primary end point was cardiac death or myocardial infarction at 30-days after surgery. RESULTS: Testing showed no ischemia in 287 patients (74%); limited ischemia in 65 patients (17%), and extensive ischemia in 34 patients (8.8%). Of 34 patients with extensive ischemia, revascularization before surgery was feasible in 12 patients (35%). Patients assigned to no testing had similar incidence of the primary end point as those assigned to testing (1.8% vs. 2.3%; odds ratio [OR] 0.78; 95% confidence interval [CI] 0.28 to 2.1; p = 0.62). The strategy of no testing brought surgery almost 3 weeks forward. Regardless of allocated strategy, patients with a HR <65 beats/min had lower risk than the remaining patients (1.3% vs. 5.2%; OR 0.24; 95% CI 0.09 to 0.66; p = 0.003). CONCLUSIONS: Cardiac testing can safely be omitted in intermediate-risk patients, provided that beta-blockers aiming at tight HR control are prescribed.

Adrenergic beta-Antagonists↗
PubMed2005

Prevalence of mechanical dyssynchrony in patients with heart failure and preserved left ventricular function (a report from the Belgian Multicenter Registry on dyssynchrony).

The present study evaluated the prevalence of mechanical inter- and intraventricular dyssynchrony in patients with heart failure and preserved left ventricular (LV) ejection fraction (LVEF). We studied 138 patients with heart failure (age 67+/-11 years; 76% men); 60 patients had preserved LVEF (>40%). Using conventional Doppler echocardiography, an interventricular mechanical delay>or=40 ms was defined as interventricular dyssynchrony. Using pulse-wave tissue Doppler imaging, the time from the beginning of the QRS complex to onset of systolic motion was measured in 4 basal LV segments. A dispersion of >or=60 ms was defined as intraventricular dyssynchrony. The prevalence of inter- and intraventricular dyssynchrony was lower in patients with preserved LVEF than in those with reduced LVEF (17% vs 41%, p<0.01 for interventricular dyssynchrony, 18% vs 36%, p<0.01 for intraventricular dyssynchrony). However, patients with preserved LVEF and a QRS width>or=120 ms had higher values for the parameters for inter- and intraventricular dyssynchrony than patients with a QRS width<120 ms (interventricular mechanical delay 33+/-20 vs 20+/-16 ms, p<0.05; tissue Doppler imaging dispersion 42+/-26 vs 33+/-22 ms, p<0.05). In patients with a QRS width>or=120 ms, the prevalence of inter- and intraventricular dyssynchrony was comparable for patients with preserved and reduced LVEF (42% vs 55%, p=NS for interventricular dyssynchrony and 45% vs 46%, p=NS for intraventricular dyssynchrony). In conclusion, the prevalence of inter- and intraventricular dyssynchrony was low (17% and 18%, respectively) in patients with heart failure and preserved LVEF. However, in the presence of a QRS width of >or=120 ms, this prevalence increased to almost 50%, comparable to that for patients with heart failure and reduced LVEF and a QRS width of >or=120 ms.

Aged↗
PubMed2004

Second harmonic transthoracic echocardiography: the new reference screening method for the detection of patent foramen ovale.

AIM: Transesophageal echocardiography (TEE) is still considered as the reference method for the non-invasive detection of right-to-left shunts. Echocardiographic laboratories are spending most of their time performing TEE studies to exclude a thromboembolic cardiac disease. In a considerable proportion of these patients the question can be simplified to exclude a PFO. Replacing these TEE studies by TTE would result in a considerable gain in time and money. We evaluated the value of transthoracic echocardiography with second harmonic imaging (TTE) (SH) and peripheral intravenous agitated saline solutions in the detection of patent foramen ovale (PFO) in a large cohort of patients. METHODS: In 256 consecutive patients, TEE and TTE (SH) with the consecutive administration of three intravenous contrast injections of agitated saline injections before the release phase of the Valsalva manoeuvre were performed. Semi-quantification and timing of contrast passage were assessed during both imaging modalities. A shunt was present if at least one imaging modality showed microbubbles appearing in the left atrium. PFO was defined when these bubbles appeared early and arteriovenous pulmonary malformations were suspected if bubbles appeared late after the opacification of the right atrium. Shunts were considered important when >20 bubbles were present in one frame in the left atrium or left ventricle. RESULTS: From the 256 patients, 60 presented a passage of contrast from the right to the left atrium in at least one imaging modality. PFO was detected by TEE in 53 patients and by TTE in 55 patients (sensitivity: 90.5% and specificity: 96.5% if TEE is accepted as the golden standard) (p>0.05). Considering only the important shunts TEE detected 39 important shunts and TTE 46 important shunts (sensitivity: 89.7% and specificity: 94.6%) (p>0.05). AV pulmonary malformations were detected by TEE in 7 patients and by TTE in 10 patients (sensitivity: 85.7% and specificity: 98.3%) (p>0.05). CONCLUSIONS: In this large cohort of patients TTE (SH) is as accurate as TEE for the detection of PFO and late right-to-left shunts. If the only purpose of TEE is the detection of PFO such as in young cryptogenic stroke patients and in divers, TEE can be replaced by TTE (SH).

Chi-Square Distribution↗