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Biomedical subjects

N Kucher

Publications and source records attributed to N Kucher.

8 recordsLinked to original sources
PubMed2003

Novel management strategy for patients with suspected pulmonary embolism.

AIMS: A simple management strategy is required for patients with acute pulmonary embolism which allows a rapid and reliable diagnosis in order to start timely and appropriate treatment. METHODS AND RESULTS: Two hundred and four consecutive patients with suspected pulmonary embolism were managed according to a standardized protocol based on the clinical pretest probability and the initial haemodynamic presentation (shock index=heart rate divided by systolic blood pressure). Patients with a high pretest probability and a positive shock index (> or =1) (n=21) underwent urgent transthoracic echocardiography. Based on the presence or absence of right ventricular dysfunction, reperfusion treatment was initiated immediately. Patients with a negative shock index (<1) (n=183) underwent diagnostic evaluation including pretest probability, D-dimer, and spiral computed tomography (CT) as first-line tests. Echocardiography was performed only when a central pulmonary embolism was found in the spiral CT(n=33). According to our strategy, 98 patients met the diagnostic criteria of pulmonary embolism: 75 patients (all shock index <1) were treated with heparin alone, 16 (seven had a shock index > or =1) with thrombolysis, four (all shock index > or =1) with catheter fragmentation, and three (all shock index > or =1) with surgical embolectomy. The all-cause mortality rate at 30 days was 5%, and at 6 months 11%. Right ventricular dysfunction on baseline echocardiography was not associated with a higher mortality rate at 6 months (logrank 2.4, P=0.12). CONCLUSIONS: The novel management strategy for patients with suspected pulmonary embolism resulted in a rapid diagnosis and treatment with a low 30-day mortality. In patients with pulmonary embolism and a positive shock index, time-consuming imaging tests can be avoided to reduce the risk of sudden death and not to delay reperfusion therapy.

Acute Disease↗
PubMed2003

Accuracy of D-dimer/fibrinogen ratio to predict pulmonary embolism: a prospective diagnostic study.

D-Dimer and fibrinogen are elevated in many diseases presenting signs and symptoms similar to those seen in patients with pulmonary embolism (PE). We tested the hypothesis that patients with PE have lower fibrinogen and higher d-dimer values than patients in whom the diagnosis is suspected but safely excluded. One hundred and ninety-one consecutive patients with suspected acute PE (85 positive, 106 negative) were investigated with a diagnostic strategy including d-dimer, pretest probability, and helical computed tomography as first-line tests. In 38 of 40 patients with suspected PE and d-dimer <500 microg L(-1), PE was excluded without further testing. During a 3-month follow-up, there was no clinical PE among these 38 and the 68 patients with a negative helical CT. In 151 patients with d-dimer >500 microg L(-1), d-dimer, fibrinogen, and d-dimer/fibrinogen ratio (D/F ratio) were different in PE-positive compared with PE-negative patients [medians (and ranges) for d-dimer: 3793 (780 - 42 195) vs. 992 (621-6957) microg L(-1), fibrinogen: 3.8 (0.4-6.2) vs. 4.7 (2.2-8.4) g L(-1), and D/F ratio: 1.22 (0.15-85.45) 103 vs. 0.25 (0.09-1.03) x 103; P < 0.0001, respectively). The true positive rate was almost twice as high using D/F ratio >1.04 x 103 (49 of 85 patients; 57.6%) compared with d-dimer >7000 micro g L(-1) (25 of 85 patients; 29.4%). Patients with acute PE have lower fibrinogen values than patients with suspected but excluded PE. D/F ratio >103 is highly specific for the presence of acute PE, and causes a doubling of the diagnostic rate compared with d-dimer testing alone.

Adult↗
PubMed2001

Gender differences in coronary artery size per 100 g of left ventricular mass in a population without cardiac disease.

OBJECTIVES: To determine whether there is a gender difference in coronary artery size normalised for left ventricular (LV) mass. BACKGROUND: Small coronary artery caliber may play a role as a risk factor for coronary artery disease in women. However, the existence of a gender difference in coronary artery size is controversial. Furthermore, coronary artery size ought to be normalised for LV mass, since there is a theoretical relation of coronary artery size to LV mass according to the law of minimum viscous energy loss for the transport of blood in the coronary circulation. METHODS: In 200 individuals (100 women) without cardiac disease and with normal Doppler echocardiography, left main (LCA) and right coronary artery (RCA) size were determined using transoesophageal echocardiography. LV mass was assessed by transgastric M-mode echocardiography. RESULTS: Age (44 +/- 15 years in women; 41 +/- 16 years in men), the presence of non-cardiac diseases, cardiovascular risk factors and medication were similar in women and men. LV mass in women was lower than in men (148 +/- 36 g, 189 +/- 45 g; p < 0.0001). LCA and RCA cross-sectional areas in women were smaller than those in men (LCA: 10 +/- 3 and 16 +/- 5 mm2, p < 0.0001; RCA: 4 +/- 2 and 7 +/- 3 mm2, p < 0.0001, respectively). LCA and RCA cross-sectional areas of women were smaller even after normalisation for LV mass (LCA: 7 +/- 3 and 9 +/- 3 mm2/100 g LV mass, p < 0.0001; RCA: 3 +/- 1 and 4 +/- 1 mm2/100 g LV mass, p = 0.002, respectively). LCA caliber of women ranged below the theoretically expected size according to the law of minimum viscous energy loss for the transport of blood in the coronary circulation, whereas those of men tended to be above it. CONCLUSIONS: In a population without cardiac disease, women have smaller coronary artery size even after normalisation for left ventricular mass.

Adult↗
PubMed2001

Relation between directly detected patent foramen ovale and ischemic brain lesions in sport divers.

BACKGROUND: In divers, the significance of a patent foramen ovale and its potential relation to paradoxical gas emboli remain uncertain. OBJECTIVE: To assess the prevalence of symptoms of decompression illness and ischemic brain lesions in divers with regard to the presence of a patent foramen ovale. DESIGN: Retrospective cohort study. SETTING: University hospital and three diving clubs in Switzerland. PARTICIPANTS: 52 sport divers and 52 nondiving controls. MEASUREMENTS: Prevalence of self-reported decompression events, patent foramen ovale on contrast transesophageal echocardiography, and ischemic brain lesions on magnetic resonance imaging. RESULTS: The risk for decompression illness events was 4.5-fold greater in divers with patent foramen ovale than in divers without patent foramen ovale (risk ratio, 4.5 [95% CI, 1.2 to 18.0]; P = 0.03). Among divers, 1.23 +/- 2.0 and 0.64 +/- 1.22 ischemic brain lesions per person (mean +/- SD) were detected in those with and those without patent foramen ovale, respectively. Among controls, 0.22 +/- 0.44 and 0.12 +/- 0.63 lesion per person were detected (P < 0.001 for all groups). CONCLUSIONS: Regardless of whether a diver has a patent foramen ovale, diving is associated with ischemic brain lesions.

Adult↗
PubMed2001

Doppler tissue imaging for assessing left ventricular diastolic dysfunction in heart transplant rejection.

OBJECTIVE: To test the hypothesis that diastolic mitral annular motion velocity, as determined by Doppler tissue imaging and left ventricular diastolic flow propagation velocity, is related to the histological degree of heart transplant rejection according to the International Society of Heart and Lung Transplantation (ISHLT). METHODS: In 41 heart transplant recipients undergoing 151 myocardial biopsies, the following Doppler echocardiographic measurements were performed within one hour of biopsy: transmitral and pulmonary vein flow indices; mitral annular motion velocity indices; left ventricular diastolic flow propagation velocity. RESULTS: Late diastolic mitral annular motion velocity (A(DTI)) and mitral annular systolic contraction velocity (SC(DTI)) were higher in patients with ISHLT < IIIA than in those with ISHLT >/= IIIA (A(DTI), 8.8 cm/s v 7.7 cm/s (p = 0.03); SC(DTI), 19.3 cm/s v 9.3 cm/s (p < 0.05)). Sensitivity and specificity of A(DTI) < 8.7 cm/s (the best cut off value) in predicting significant heart transplant rejection were 82% and 53%, respectively. Early diastolic mitral annular motion velocity (E(DTI)) and flow propagation velocity were not related to the histological degree of heart transplant rejection. CONCLUSIONS: Doppler tissue imaging of the mitral annulus is useful in diagnosing heart transplant rejection because a high late diastolic mitral annular motion velocity can reliably exclude severe rejection. However, a reduced late diastolic mitral annular motion velocity cannot predict severe rejection reliably because it is not specific enough.

Blood Flow Velocity↗