Biomedical subjects

Sandeep S Soman

Publications and source records attributed to Sandeep S Soman.

3 recordsLinked to original sources

PubMed2005

Bundle branch block patterns, age, renal dysfunction, and heart failure mortality.

BACKGROUND: The determinants of bundle block patterns and their relationship to mortality in heart failure patients is not completely understood. METHODS: We evaluated 2907 consecutive patients admitted to an intensive care unit with decompensated heart failure over 8 years. Clinical and echocardiographic factors were analyzed using multivariate techniques. All-cause mortality was available on greater than 99.0% of patients at a median of 23 months after discharge. RESULTS: Right and left bundle branch blocks occurred in 211 (7.3%) and 386 (13.2%), p<0.0001. Older age, decreased left ventricular ejection fraction, and renal dysfunction were all found to be independently associated with bundle branch block patterns. Mortality rates for the subgroups of QRS<120 ms, right bundle branch block and left bundle branch block, over a mean follow-up of 23.4+/-2.6 months were 46.1%, 56.8% and 57.7%, p<0.0001 for comparison of QRS<120 ms versus either bundle pattern. Cox proportional hazards model adjusting for age, sex, ejection fraction, and renal function demonstrated graded decrements in survival in those with QRS<120 ms, right bundle branch block and left bundle branch block, p=0.03. CONCLUSIONS: In patients hospitalized with severe heart failure, age, left ventricular dysfunction, and renal dysfunction are associated with bundle branch block patterns. When controlling for these factors, bundle branch block patterns are independently associated with slightly higher all cause mortality after discharge.

Age Factors↗

PubMed2005

Contrast-induced nephropathy.

Contrast-induced nephropathy (CIN) is a leading cause of in-hospital acute renal failure in critically ill patients who undergo radiographic procedures. Critical care patients are at particular risk, often because of baseline renal dysfunction, older age, and the presence of diabetes. In addition, there are superimposed risks, including volume depletion, sepsis, and use of nephrotoxic drugs. The rates of CIN (defined as an increase in serum creatinine by >25% or 0.5 mg/dL) can be predicted by using multivariate tools. Prevention measures include adequate hydration, use of N-acetylcysteine and iso-osmolar contrast, and for patients who are at the highest risk, prophylactic hemofiltration.

Acute Kidney Injury↗

PubMed2002

The independent association of renal dysfunction and arrhythmias in critically ill patients.

STUDY OBJECTIVES: The purpose of this study was to quantify the impact of baseline renal dysfunction on incidence and occurrence of cardiac arrhythmias in the coronary ICU. BACKGROUND: Renal dysfunction is an established predictor of all-cause mortality in the ICU setting. We set out to evaluate the independent contributory effect of renal dysfunction to arrhythmias and mortality in this population. DESIGN AND SETTING: We analyzed a prospective coronary care unit registry of 12,648 admissions by 9,557 patients over 8 years at a single, tertiary center. An admission serum creatinine level was available for 9,544 patients. Those patients not receiving long-term dialysis were classified into quartiles of corrected creatinine clearance with cutpoints of 46.2 mL/min/72 kg (group 1), 63.1 mL/min/72 kg, and 81.5 mL/min/72 kg. Dialysis patients (n = 527) were considered as a fifth comparison group (group 5). MEASUREMENTS AND RESULTS: Baseline characteristics including older age, African-American race, diabetes, hypertension, history of previous coronary disease, and heart failure were incrementally more common with increasing renal dysfunction strata. There were graded, independent increased risks for accelerated idioventricular rhythm (relative risk [RR], 2.43; 95% confidence interval [CI], 1.40 to 4.20; p = 0.002), sustained ventricular tachycardia (RR, 2.07; 95% CI, 1.02 to 4.22; p = 0.04), ventricular fibrillation (RR, 2.42; 95% CI, 1.13 to 5.15; p = 0.02), and complete heart block (RR, 3.64; 95% CI, 1.77 to 7.48; p = 0.0004, group 5 vs group 1). CONCLUSIONS: We conclude that baseline renal function is a powerful, independent predictor of cardiac arrhythmias in the coronary ICU population.

Arrhythmias, Cardiac↗