Biomedical subjects

J Launbjerg

Publications and source records attributed to J Launbjerg.

At least 37 records · Page 2Linked to original sources

PubMed1993

Long-term cardiac mortality in patients admitted with noncoronary chest pain under suspicion of acute myocardial infarction.

The long-term prognosis for cardiac death was prospectively evaluated in three subpopulations admitted to a coronary care unit with chest pain under suspicion of acute myocardial infarction (AMI) with (1) confirmed AMI (n = 275), (2) AMI ruled out, but suspicion of coronary artery disease (n = 257) and (3) AMI ruled out and an obvious noncoronary reason for chest pain (n = 63). The latter subgroup included patients with pericarditis, valvular disease, arrhythmia, pneumonia, pulmonary embolism, gastric ulcer and musculoskeletal disorders. The 7-year cardiac mortality rates of the three subpopulations were 34, 17 and 32%, respectively (p < 0.0001). Despite the 'benign' nature of the chest pain, the cardiac mortality was high in all diagnostic categories of noncoronary chest pain. In conclusion, patients admitted with chest pain of apparently noncoronary origin are at high risk for later cardiac death. This indicates the presence of severe coronary artery disease in some of the patients. Consequently, all patients with chest pain and AMI ruled out should be evaluated carefully regarding coronary artery disease at the time of discharge.

Adult↗

PubMed1992

Echocardiographic algorithms for admission and predischarge prediction of mortality in acute myocardial infarction.

To develop improved prognostic algorithms for routine bedside use in acute myocardial infarction (AMI), the prognostic value concerning 2- and 12-month mortality of an early (within 72 hours after AMI) resting echocardiogram was defined in 201 consecutive patients. The relation between (1) the clinical variables (age, sex, prior and repeat AMI, arrhythmias, cardiac arrest, early [less than 72 hours after AMI] and late heart failure, early and maximal in-hospital Killip class, and maximal creatine kinase-MB isoenzyme), (2) early myocardial performance by echocardiography, and (3) mortality was characterized by Kaplan-Meier survival curves and receiver-operating characteristic curves based on Cox regression model. Only age and clinical heart failure in terms of the maximal in-hospital Killip class had independent predictive value of death (p less than 0.05) when an early echocardiographic estimate of left ventricular ejection fraction (LVEF) was included in the multivariate statistical models. The following 2 optimized algorithms for admission and predischarge calculation of risk of mortality at 2 and 12 months were developed based on the Cox model, using combinations of age, maximal Killip class and early echocardiographic LVEF: mortality at 2 months = 1 - exp - [0.051 x exp [0.044 x (age -60) - (0.117 x (LVEF - 40)]]; and mortality at 1 year = 1 - exp - [0.101 x exp [0.408 x (maxKillip - 1) - (0.061 x (LVEF - 40)]]. Discriminative power for prediction of mortality of the predischarge algorithm in an independent population of 195 patients 5 days after AMI compared favorably with that obtained in the original population, confirming the validity of the proposed method of prognostication.

Adult↗

PubMed1992

[Early discharge after acute myocardial infarction. Cost-effectiveness of early echocardiographic risk evaluation].

A total of 195 consecutive patients with acute myocardial infarction were examined and risk classified (low or middle/high risk) on the fifth day by two physicians. These two physicians employed two different sets of criteria: conventional clinical examination compared with 2-D echocardiographic assessment of the wall motion of the left ventricle (wall motion index, WMI). Both physicians concluded their examination by determination of a theoretical time for discharge. By design this was on the 5th-7th days for low risk patients by echocardiography, while low risk patients by clinical criteria are normally discharged on the 7th to 8th days. The most sensitive method of identifying the low risk patients was achieved by combining the clinical examination with echocardiographic WMI determination. In this manner, a total of 104 (53%) low risk patients could be identified. A potential saving of 18% of the total duration of hospitalization could be calculated from the two theoretical times of discharge for the total population. All of the patients in this study could be assessed by echocardiography which provided valuable information and thus may be implemented in the routine treatment of acute myocardial infarction.

Adult↗

PubMed1992

[Relation between 1-year mortality after acute myocardial infarction and left ventricular ejection function estimated by echocardiography].

The pump function of the left ventricle was characterized by means of early echocardiographic determination of the motion of the ventricular walls (wall motion index, WMI) in a consecutive unselected series of 195 patients with acute myocardial infarction. The pump function, WMI, was related to one-year mortality after infarction. The patients were subdivided prospectively into three risk groups (low, middle and high) depending on WMI. One-year mortality in the three groups were 2%, 34% and 37%, respectively (p less than 0.0001). Patients with previous infarcts had significantly lower WMI and greater one-year mortality than patients with first infarct (p less than 0.001 and less than 0.05, respectively). Among patients with first infarct with inferior localization, significantly higher WMI and lower one-year mortality were found than with anterior localization (p less than 0.001 and = 0.15, respectively, (NS)). Women had significantly higher one-year mortality than men (30.2% compared with 16.9% (p less than 0.04)) although this was reflected by a corresponding difference in WMI. Regardless of sex, age, localization of the infarct and signs of residual ischaemia, patients who were allocated to the low risk group solely on the basis of WMI, had particularly good prognoses. Among patients with more extensive myocardial damage, WMI less than or equal to 1.3, other risk factors probably played a greater role.

Adult↗

PubMed1992

[Acute recurrent chest pain originating in the esophagus. A review].

In half of the patients admitted for observation for acute myocardial infarction, this diagnosis is disproved. Gastro-oesophageal reflux and/or disturbances of oesophageal motility are the cause of the thoracic pain resulting in hospitalization in 16-34% of these patients. In 13-59% of the patients with chronic recurrent thoracic pain without demonstrable ischaemic cardiac disease (IHD), oesophageal disease is, similarly, considered to be the cause of the pain. It is not possible to distinguish whether the pain is caused by oesophageal disease or IHD on the basis of the history, but the differential diagnosis is important as patients with pain on account of oesophageal disease have a good prognosis as regards mortality. The physical and mental conditions of the patients may be improved if the correct diagnosis is established and treatment instituted. Methods of examination to demonstrate oesophageal disease are described. On account of the frequency of the condition and the extent of the methods of examination, a programme of investigation is proposed for patients suspected of having thoracic pain due to oesophageal disease.

Chest Pain↗

PubMed1992

[Differential diagnosis in acute chest pain and suspected myocardial infarction. A pilot study].

In half of the patients admitted with chest pain on suspicion of an acute myocardial infarction (AMI), this diagnosis is not confirmed (non-AMI). Both AMI and non-AMI patients have a mortality which exceeds the mortality of the background population in the years following discharge based on a high incidence of cardiac death. As a pilot investigation, a comprehensive investigation programme was tested in 32 consecutive non-AMI patients. The possible organic causes of acute chest pain were thus illustrated systematically in each individual patient. In ten of the patients, a definitive diagnosis was established within the first 24 hours of admission and no further investigation was thus performed. The remaining 22 patients participated in the planned investigation programme. In 30 of the patients (94%) a probable organic cause for the chest pain was found. This investigation demonstrates that the investigation programme is employable and it suggests that the cause of chest pain in non-AMI patients usually can be placed in one of the three main groups: 1) IHS, 2) oesophageal disease and 3) physiurgic conditions.

Adult↗

PubMed1992

Sensitivity and specificity of echocardiographic identification of patients eligible for safe early discharge after acute myocardial infarction.

In a prospective clinical trial of 195 consecutive unselected patients with acute myocardial infarction (AMI), systematic blinded clinical and echocardiographic examinations were performed by two observers on day 5. The purpose was to define low-risk patients with regard to in-hospital and 2-month mortality and predict the potential costs (lost patient lives) and benefits (saved in-patient days) if as a routine procedure these low-risk patients were discharged earlier. By design, low-risk patients as defined by clinical criteria were allocated to discharge on days 7 to 10 and by echocardiographic criteria on days 5 to 7 after AMI. The sensitivity of the echocardiographic low-risk identification procedure was more than twofold higher than the sensitivity of clinical low-risk identification (49% vs 24%). Both procedures were safe with a specificity of 100% for cardiac mortality. Optimal identification of low-risk patients was provided by combining data from echocardiographic and clinical evaluations (sensitivity 59%). Results of the study suggest that a bedside echocardiographic approach to estimation of global left ventricular function is more sensitive and equally specific and therefore more efficient for risk stratification on post-AMI day 5 than clinical examination alone. Thus echocardiographic examination allows identification of a larger subset of patients with AMI (greater than 40% of the population alive on day 5) who can be discharged earlier and safely, with a potential saving of in-patient days of 436 days in 87 low-risk patients minus the cost of echocardiographic studies in 195 patients. However, the best prediction was obtained by combining clinical and echocardiographic examination.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1992

Rapid estimation of left ventricular ejection fraction in acute myocardial infarction by echocardiographic wall motion analysis.

Echocardiographic estimates of left ventricular ejection fraction (ECHO-LVEF) in acute myocardial infarction (AMI) were obtained by a new approach, using visual analysis of left ventricular wall motion in a nine-segment model. The method was validated in 41 patients using radionuclide ventriculography (RNV) and contrast ventriculography measurements of LVEF for comparison. ECHO-LVEF from the 41 patients correlated well with the reference methods (y = 1.5x - 14.7, r = 0.93; linear regression analysis; 95% confidence limit for a single determination of ECHO-LVEF was 17.2). Interobserver variability by linear regression was r = 0.89, SEE = 7.1 with a mean difference between paired observations of -1.5 +/- 6.9 (SD). In a random sample of 18 patients (45 observations), ECHO-LVEF allowed separation between RNV-LVEF values greater than or equal to 40 and less than 40, representing low and high risk groups following AMI. Thus, the results showed that simple, readily available wall motion-derived estimates of LVEF were as closely associated with LVEF measured by standard reference methods as were previously published, more cumbersome, planimetric echocardiographic methods. Reporting on global LVEF function in LVEF units rather than in nonstandardized wall motion scores of index values may facilitate intra- and interhospital communication and the use of optimized echocardiographic risk stratification after AMI.

Echocardiography↗

PubMed1992

Risk factors related to the 7-year prognosis for patients suspected of myocardial infarction with and without confirmed diagnosis.

This study prospectively evaluates the long-term prognosis of patients admitted with chest pain under suspicion of acute myocardial infarction (AMI) with and without confirmed diagnosis. All patients below 76 years of age, free of other severe diseases and alive at discharge, who were admitted to a coronary care unit of a well-defined region during 1 year, constituted the study population. In all, 275 patients with and 257 patients without confirmed AMI (non-AMI) were included. During 7 years of follow-up, 122 cardiac events (96 cardiac deaths and 26 nonfatal AMI) occurred in the AMI patients, and 69 (44 cardiac deaths and 25 nonfatal AMI) were observed in the non-AMI patients. Using univariate analysis, the following risk variables were significantly related to an impaired prognosis of non-AMI patients: age, a history of previous AMI, angina pectoris, clinical heart failure, diabetes and ST or T changes in the electrocardiogram (ECG) on admission. By multivariate analysis, the following risk factors contained independent prognostic information for non-AMI patients: (1) a history of angina pectoris and (2) ST and T changes on the ECG on admission. We conclude that a subset of non-AMI patients at high risk for cardiac events even in the long term can be identified from the medical history and the ECG on admission. These patients should be carefully evaluated prior to discharge, whereas patients without signs of ischemic heart disease have an excellent prognosis.

Aged↗

PubMed1992

Risk stratification after acute myocardial infarction by means of echocardiographic wall motion scoring and Killip classification.

In order to perform risk stratification, 195 consecutive, unselected patients with acute myocardial infarction (AMI) underwent independent echocardiographic and clinical evaluation of their left ventricular function by means of the wall motion index (WMI) and Killip classification 5 days after AMI. The patients were prospectively allocated to a low, medium or high risk class depending on WMI alone, and the 1-year mortality in these classes was 2, 34 and 37%, respectively (p < 0.0001). The 1-year mortality of the patients in Killip class I, II, or III and IV was 6, 26 and 48%, respectively (p < 0.00001). The number of patients allocated to the low risk group by means of WMI was 87, and the number of patients in Killip class I was 86. Since these groups were not identical, a total of 103 patients, i.e. 53% of the study population, could be identified as low risk patients regarding 1-year mortality 5 days after AMI, when WMI and Killip classification were used in combination. We conclude that the combination of echocardiographic and clinical evaluation of left ventricular function after AMI provides a strong and yet very simple procedure to identify low risk patients, which could be easily implemented in the routine work of coronary care units.

Adult↗

PubMed1991

Three-year mortality in patients suspected of acute myocardial infarction with and without confirmed diagnosis. The Danish Study Group on Verapamil in Myocardial Infarction.

The 3-year mortality from day 15 after admission was evaluated prospectively in 11,345 consecutive patients with chest pain suspected of myocardial infarction--4,265 patients with confirmed diagnosis (AMI) and 7,080 patients without confirmed diagnosis (non-AMI), respectively. The mortality rates per year in the first 3 years in the patients with AMI were 14.2%, 6.9%, and 7.6%, and in the non-AMI patients were 8.8%, 5.8%, and 5.5%. The standardized mortality ratio (SMR) correcting for age and sex differences was calculated. SMR is the ratio between the observed mortality in the study population and the expected mortality in an age- and sex-matched subgroup of the general background population. SMR in the first year was 6.7 (95% confidence limits: 6.2 to 7.2) in AMI and 4.7 (4.4 to 5.1) in non-AMI patients. In the second and third years of follow-up, SMR was 3.0 (2.6 to 3.4) and 2.9 (2.5 to 3.4) in AMI and 2.8 (2.5 to 3.1) and 2.4 (2.1 to 2.8) in the non-AMI patients. It is concluded that in the first 3 years the mortality of non-AMI patients is approximately three times higher than in the general population and very close to the late mortality of AMI patients, suggesting that the majority of non-AMI patients are suffering from ischemic heart disease also. Non-AMI patients should consequently be evaluated carefully prior to discharge.

Age Factors↗

PubMed1991

Bleeding complications to oral anticoagulant therapy: multivariate analysis of 1010 treatment years in 551 outpatients.

One thousand and ten patient years of oral anticoagulant therapy with vitamin-K-antagonists were reviewed with regard to major bleeding complications. The incidence of bleeding that necessitated hospital admission was 2.7% per year (95% confidence limits, 1.7-3.7%). The major source of bleeding was the alimentary tract, whereas no cases of intracranial bleeding were found. Various factors with potential effects on the bleeding risk were evaluated by multivariate statistical analysis, and the following independent risk factors were identified: age greater than 75 years and hypertension increased the bleeding risk by 10.5% and 4.5%, respectively. Each recorded prothrombin value significantly below the therapeutic range increased the bleeding risk by 3.9%, and each year of treatment increased the risk by 2.0%. These figures may be used to estimate the risk of major bleeding in an individual patient. Current treatment with thiazide diuretics was found to increase the bleeding risk by 5.2%. However, this observation requires further documentation and analysis. Although no lethal episodes of bleeding occurred, the developing field of indications for oral anticoagulant therapy should be considered on the basis of a continuous substantial risk of major bleeding.

Adolescent↗

PubMed1990

Prognosis and diagnostic work-up in patients admitted for, but without, myocardial infarction--the value of nuclear medicine examinations.

Patients admitted for acute myocardial infarction that is not confirmed (non-AMI) have a prognosis only slightly better than that of patients with confirmed infarction. In a prospective, prognostic study of 158 patients with non-AMI the combination of exercise ECG and transient defects demonstrated at 201thallium scintigraphy identified low- and high-risk groups better than either examination alone. The purpose of a new, still ongoing study of non-AMI patients is to establish a relevant, cost-effective examination programme in order to arrive at a positive diagnosis in each non-AMI patient. Preliminary results of lung perfusion/ventilation scintigraphy suggest a rather low frequency of pulmonary embolism. Preliminary data of oesophageal scintigraphy suggest that about 25% of the non-AMI patients have abnormal mean transit times. The clinical significance of these data are discussed.

Coronary Disease↗

PubMed1989

[Pulmonary embolism as a complication of sclerosing treatment of esophageal varices].

In several investigations, sclerosing of oesophageal varices has proved effective as emergency treatment in cases of bleeding varices and also as prophylactic treatment after haemorrhage. Serious complications are extremely rare but brief episodes of slight pyrexia and tachycardia accompanied by dyspnoea and sensation of pressure in the thorax are not unusual observations. A patient, who experienced symptoms of this type after two successive sclerosing treatments, was investigated and pulmonary emboli were demonstrated probably resulting from passage of the sclerosing agent to the pulmonary circulation via the vena azygos and right side of the heart.

Esophageal and Gastric Varices↗

PubMed1988