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At least 73 records · Page 4Linked to original sources
PubMed2006

The prognostic value of anemia, right-heart catheterization and neurohormones in chronic heart failure.

Chronic heart failure is increasing in incidence and prevalence. Recent advances in medical therapy have improved prognosis such that, even in patients with chronic heart failure who are New York Heart Association Classes III and IV, annual mortality can be as low as 11.4%. Nevertheless, some patients remain at risk, despite optimal disease-modifying medical therapy, and it would seem appropriate that these patients are considered first for appropriate device therapy or for the scarce resource of cardiac transplantation. Many parameters have been assessed for their prognostic potential in patients with chronic heart failure. In this review, pertinent studies investigating anemia, right-heart hemodynamics and neurohormones as prognostic markers are discussed.

Anemia↗
PubMed1975

A new catheter for percutaneous transfemoral right heart catheterization.

A new catheter for percutaneous transfemoral right heart catheterization is described. The catheter can also be used for pulmonary angiography and pulmonary wedgepressure recording. Because of the speed and efficiency with which this catheter may be used, we suggested a trial by physicians involved in right heart catheterization pulmonary angiography.

Cardiac Catheterization↗
PubMed1985

Right heart catheterization in the pre-operative evaluation of patients with lung cancer.

The right heart catheterization and lung function data of 637 consecutive patients with lung cancer evaluated preoperatively were analysed retrospectively, in order to review our past experience, and to examine, whether a subgroup of patients could be identified, in whom invasive haemodynamic measurements were dispensable due to a predictable normal result. 95 patients (14.9%) had precapillary pulmonary hypertension, 44 (6.9%) already at rest, 51 (8.0%) on exercise only. In contrast, 276 patients (43.3%) had pulmonary hypertension secondary to abnormal left ventricular function, 67 (10.6%) at rest, 209 (32.8%) on exercise only. In order to characterize a subgroup of patients, in whom precapillary pulmonary hypertension is very unlikely to be present, and in whom, therefore, right heart catheterization could be regarded as dispensable, a discriminant analysis was performed. By these means a discriminant function using FEV1, PaO2, DLCO - both on exercise - and RV/TLC as discriminant variables was obtained which can provide a qualitative prediction of precapillary pulmonary hypertension with a high sensitivity (at least 95%) and an acceptable specificity (approximately 50%). The usefulness of such a prediction was verified in a subsequent group of 71 patients. Precapillary pulmonary hypertension was correctly predicted in all cases; the specificity was 55%. It is concluded, that right heart catheterization has its value in the pre-operative evaluation of candidates for pulmonary resection due to a high prevalence of compromised haemodynamics, and that patients with a negligible risk of having precapillary pulmonary hypertension can be identified by means of non-invasive functional measurements.

Adult↗
PubMed1992

Significance of coronary angiography, left heart catheterization, and endomyocardial biopsy for the diagnosis of idiopathic dilated cardiomyopathy.

Many physicians assume that a reliable diagnosis of idiopathic dilated cardiomyopathy can be made by noninvasive methods, mainly echocardiography. On the other hand, use of endomyocardial biopsy in those patients who have undergone left heart catheterization and who demonstrate left ventricular dysfunction of unknown origin is increasing. Therefore the purpose of this study was to investigate the yield of that diagnostic strategy in patients with the tentative diagnosis of idiopathic dilated cardiomyopathy. Between 1980 and 1988, 3.2% of our 15,442 patients were diagnosed as having idiopathic dilated cardiomyopathy on the basis of left heart catheterizations and coronary angiograms. Idiopathic dilated cardiomyopathy was diagnosed in 444 patients on the basis of clinical data and results of noninvasive tests before catheterization, but in only 295 of these cases was the diagnosis confirmed by means of coronary angiography and left heart catheterization (predictive value of noninvasive tests is 66%). The remaining 34% of patients demonstrated extensive coronary artery disease (13%), significant valvular heart disease (11%), and other or no heart disease (10%). The diagnostic sensitivity of noninvasive tools (patient history, ECG, stress test, echocardiography) was only 59%. Left heart catheterization can easily be combined with endomyocardial biopsy. With the use of histologic techniques, specific heart muscle diseases were detectable in 3.5% of 209 patients, but in only 1% could therapeutic consequences be determined. Thus coronary angiography and left heart catheterization are mandatory for the correct diagnosis of idiopathic dilated cardiomyopathy.(ABSTRACT TRUNCATED AT 250 WORDS)

Biopsy↗
PubMed1999

Heart catheterization in the patient with valvular heart disease.

Despite impressive advances in non-invasive technology, cardiac catheterization remains the gold standard for the evaluation of patients considered for valve surgery. Diagnostic information should be combined with non-invasive measurements, particularly serial non-invasive echocardiographic assessments, to allow for optimal management decisions. For adult patients with risk factors for coronary artery disease, we do not believe there is any substitute for selective coronary angiography. The availability of non-ionic contrast agents, pre-assessment by thorough physical examination and non-invasive techniques, allows safe cardiac catheterization even in patients who are severely compromised by congestive heart failure and/or coronary artery disease.

Adult↗
PubMed1998

Impact of an educational program on bilateral heart catheterization practice patterns.

The value and necessity of performing right heart catheterizations for coronary artery disease have been increasingly questioned. Preliminary analyses of the procedure among Medicare and Medicaid patients in New York State revealed significant inter-hospital variations in the frequencies with which such catheterizations were performed. These data suggested that right heart catheterizations (RHC) were being performed routinely. Medicare and Medicaid claims data for bilateral catheterizations were analyzed before and after an educational intervention program involving the state's 53 catheterization laboratories. The educational intervention was multifaceted and consisted of disseminating suggested guidelines established with the assistance of the New York State Chapter of the American College of Cardiology, the Committee on Cardiovascular Disease of the Medical Society of the State of New York, and the Cardiac Advisory Council of the New York State Department of Health. Posteducational intervention assessments were made over a 4-year period. The baseline data for 1992 demonstrated that 10 (18.4%) laboratories had performed RHC routinely (70-100%) on Medicare and Medicaid patients undergoing catheterization. In contrast, 34 (64.2%) laboratories performed RHC in less than 20% of their Medicare cases, whereas 39 (73.5%) did so among Medicaid cases. Eighteen (34%) laboratories performed RHC in less than 10% of Medicare cases. These data indicated that there was significant inter-hospital variation in the frequency with which RHC was performed. Beginning in 1993, ongoing educational meetings and conferences were held with all laboratories, but especially with the 10 that were at the high end of the RHC performance level. As a result of this ongoing intervention, the rate of RHC among Medicare patients fell from 89/100,000 in 1992 to 65/100,000 beneficiaries in 1996. From another perspective, the percentage of catheterized Medicare patients undergoing RHC fell from 30.5% in 1992 to 17.4% in 1996. The decline among the 10 laboratories was even more dramatic; the percentage of catheterized Medicare patients undergoing RHC fell from 89.1% in 1992 to 31.6% in 1996. The parallel drop for Medicaid patients over the same time period was from 92.8 to 32.7%. The results of the study indicate that many previously performed RHC in patients with coronary artery disease were routine and not medically indicated. The dramatic decreases in RHC documented in this study over a 4-year period demonstrate the success of quality improvement efforts jointly undertaken by providers and a peer review organization.

Age Distribution↗