The American heart hospital journal最新文献

{"title":"Rectus hematoma- An under-recognized complication of transfemoral cardiac catheterization.","authors":"Habibollah Saadat,&nbsp;Maryam Taherkhani,&nbsp;Afsaneh Mohammadi,&nbsp;Abbas Arjmand Shabestari,&nbsp;Mohammad Reza Movahed","doi":"10.15420/ahhj.2009.7.2.128","DOIUrl":"https://doi.org/10.15420/ahhj.2009.7.2.128","url":null,"abstract":"<p><p>We present a case of rectus hematoma occurring in the setting of transfemoral cardiac catheterization. This is a potentially deadly complication that is under-reported and under-diagnosed. The goal of this article is to present a case of rectus hematoma alongside a comprehensive review of the literature.</p>","PeriodicalId":87149,"journal":{"name":"The American heart hospital journal","volume":"7 2","pages":"E128-9"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28890767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In vitro inhibition of platelet aggregation in response to increasing concentrations of tirofiban in patients with significant renal insufficiency.","authors":"Mahboob Alam,&nbsp;Rafael Gonzalez,&nbsp;Ariel Delarosa,&nbsp;Jaromir Bobek,&nbsp;Hisham Dokainish,&nbsp;Nasser Lakkis","doi":"10.15420/ahhj.2009.7.1.17","DOIUrl":"https://doi.org/10.15420/ahhj.2009.7.1.17","url":null,"abstract":"<p><strong>Background: </strong>Patients with impaired renal function are a growing subset at higher risk for cardiovascular complications due to vasculopathic state, inducing accelerated atherosclerosis and arteriosclerosis. These patients are at increased risk for complications after coronary interventions, especially major bleeding events. As a result, this at-risk population of patients has not been well studied in most of the major clinical trials evaluating coronary interventions. Of particular interest is the optimal dosing of glycoprotein IIb-IIIa inhibitors in the setting of acute myocardial infarction. In this study, we attempted to find the in vitro concentration of tirofiban required to inhibit platelet aggregation to <10% in patients with moderate to severe renal insufficiency.</p><p><strong>Methods: </strong>A total of 21 patients were divided into two groups based on estimated creatinine clearance (group 1 <46ml/min; group 2 >46ml/min). Platelet-rich plasma from each subject was then incubated in vitro with increasing concentrations of tirofiban (25, 37.5, and 50ng/ml), and light transmission aggregometry assay was used to assess the degree of platelet aggregation in response to adenosine diphosphate (ADP).</p><p><strong>Results: </strong>Patients in group 1 had a baseline platelet aggregation of 45%, which decreased to 10% at a 25.0ng/ml concentration of tirofiban; the effect was enhanced to a platelet aggregation of <5% at higher doses. In contrast, subjects in group 2 with creatinine clearance >or=46ml/min had an average platelet aggregation inhibition of 12% with 50ng/ml of tirofiban.We found a significant decrease in platelet aggregation in group 2 at 25, 37.5, and 50ng/ml of tirofiban (p<0.05) in comparison with group 1.</p><p><strong>Conclusions: </strong>Our data indicate that patients with moderate to severe renal dysfunction suppress their platelet aggregation to <10% with 25ng/ml of tirofiban, one-third of the standard effective dose for patients with normal renal function.We suggest further clinical trials to define an objective means to calculate proper renal dosing of glycoprotein IIb-IIIa inhibitors in these patients to prevent potentially fatal complication of major hemorrhagic events.</p>","PeriodicalId":87149,"journal":{"name":"The American heart hospital journal","volume":"7 1","pages":"17-20"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28469617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heart hospitals, medicare, and cross-subsidization.","authors":"Thomas R McLean,&nbsp;Valerie Lawson","doi":"10.15420/ahhj.2009.7.2.94","DOIUrl":"https://doi.org/10.15420/ahhj.2009.7.2.94","url":null,"abstract":"<p><strong>Background: </strong>Compared with heart hospitals (HHs), does Medicare provide better reimbursement to traditional hospitals (THs)?</p><p><strong>Methods: </strong>Diagnosis Related Group (DRG)-specific data from Hospital Compare (www.hospitalcompare.hhs.gov) were used to compare Medicare reimbursement to hospitals in nine HH markets, representing 10% of the national HH market.</p><p><strong>Results: </strong>On average, markets contained 1.2 HHs and 8.1 THs. Average market size for invasive cardiac services was $13+/-8.4 million, with HHs having 36.1% of the market share. Compared with HHs, THs received significantly better reimbursement for coronary artery bypass graft (CABG: $20,281+/-3,047 HH versus $23,958+/-4,562 TH; p=0.004), percutaneous coronary intervention (PCI: $11,230+/-742 HH versus $13,347+/-2,662 TH; p<0.001), heart valve replacement ($33,710+/-4,056 HH versus $39,819+/-6,356 TH; p=0.001), pacemaker implantation ($11,245+/-706 HH versus $13,212+/-2,043 TH; p<0.001), heart failure ($5,622+/-489 HH versus $6,482+/-1,010 TH; p<0.001), chronic obstructive pulmonary disease (COPD: $4,893+/-802 HH versus $5,641+/-841 TH; p=0.013), pneumonia ($5,708+/-763 HH versus $6,456+/-1,136 TH; p=0.012), and diabetes ($4,115+/-355 HH versus $4,963+/-812 TH; p<0.001).</p><p><strong>Conclusions: </strong>The excessive reimbursement granted to THs for non-cardiac services is likely to reflect a policy decision to assist these hospitals with their cross-subsidization of other services. If Medicare is to cut reimbursement to TH for CABG, PCI, or other services, Medicare should be asked to pay more for the services (e.g. emergency room care) that it currently reimburses only indirectly through the process of cross-subsidization.</p>","PeriodicalId":87149,"journal":{"name":"The American heart hospital journal","volume":"7 2","pages":"E94-8"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28890228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Osborne (J) waves in hypothermia.","authors":"David H Spodick","doi":"10.15420/ahhj.2009.7.2.109","DOIUrl":"https://doi.org/10.15420/ahhj.2009.7.2.109","url":null,"abstract":"","PeriodicalId":87149,"journal":{"name":"The American heart hospital journal","volume":"7 2","pages":"E109"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28890761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antiplatelet resistance--fact or myth?","authors":"Paul A Gurbel,&nbsp;Udaya S Tantry","doi":"10.15420/ahhj.2009.7.1.50","DOIUrl":"https://doi.org/10.15420/ahhj.2009.7.1.50","url":null,"abstract":"","PeriodicalId":87149,"journal":{"name":"The American heart hospital journal","volume":"7 1","pages":"50-7"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28391043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-invasive risk stratification for implantable cardioverter-defibrillator placement--heart rate variability.","authors":"Yi Gang,&nbsp;Marek Malik","doi":"10.15420/ahhj.2009.7.1.39","DOIUrl":"https://doi.org/10.15420/ahhj.2009.7.1.39","url":null,"abstract":"<p><p>Heart rate variability (HRV) is a beat-to-beat variation in cardiac cycle length resulting from autonomic influence on the sinus node of patients in sinus rhythm. The importance of HRV as a risk stratifier has been well accepted, particularly in survivors of myocardial infarction. Large clinical trials are still needed to clarify the role of HRV in patients with non-ischemic cardiomyopathy. Given the significant association between HRV and the development of fatal arrhythmias/sudden cardiac death, HRV has been used in some clinical trials as one of the screening tests to select optimal candidates for implantable cardioverter-defibrillator placement, although its role in this area has not been fully established. Additional large prospective clinical trials are needed to further clarify the predictive value of existing or novel HRV parameters, on their own or in combination with other risk stratifiers, for assessing the risk of sudden cardiac death in a variety of clinical settings.</p>","PeriodicalId":87149,"journal":{"name":"The American heart hospital journal","volume":"7 1","pages":"39-44"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28391041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Technology assessment is the key to healthcare reform.","authors":"Daniel J Ullyot","doi":"10.15420/ahhj.2009.7.2.82","DOIUrl":"https://doi.org/10.15420/ahhj.2009.7.2.82","url":null,"abstract":"","PeriodicalId":87149,"journal":{"name":"The American heart hospital journal","volume":"7 2","pages":"E82-6"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28890225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The perils of government-controlled comparative effectiveness.","authors":"Sylvan Lee Weinberg","doi":"10.15420/ahhj.2009.7.2.78","DOIUrl":"https://doi.org/10.15420/ahhj.2009.7.2.78","url":null,"abstract":"","PeriodicalId":87149,"journal":{"name":"The American heart hospital journal","volume":"7 2","pages":"E78-80"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28890769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contrast-induced nephropathy-choice of contrast agents to reduce renal risk.","authors":"Richard E Katholi","doi":"10.15420/ahhj.2009.7.1.45","DOIUrl":"https://doi.org/10.15420/ahhj.2009.7.1.45","url":null,"abstract":"<p><p>Contrast-induced nephropathy (CIN) represents an increasing healthcare burden and challenge as the frequency of diagnostic imaging and interventional procedures increases, particularly among patients at risk for developing CIN. Universally accepted strategies to reduce the risk for CIN include careful patient screening and selection, adequate patient hydration, limiting the volume of contrast medium administered, and choosing a safe, non-ionic, low-osmolar contrast agent. For both intra-arterial and intravenous use, all ionic and non-ionic iodinated contrast agents may further impair renal function in high-risk patients. Based on comparisons of contrast media in proximal renal tubular cell culture and in recent robust head-to-head prospective clinical trials in high-risk patients, however, iso-osmolar iodixanol and low-osmolar iopamidol are comparable and appear to be the contrast agents of choice to reduce renal risk for CIN.</p>","PeriodicalId":87149,"journal":{"name":"The American heart hospital journal","volume":"7 1","pages":"45-9"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28391042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-calcified coronary plaque in an asymptomatic physician.","authors":"Samuel Wann","doi":"10.15420/ahhj.2009.7.1.62","DOIUrl":"https://doi.org/10.15420/ahhj.2009.7.1.62","url":null,"abstract":"","PeriodicalId":87149,"journal":{"name":"The American heart hospital journal","volume":"7 1","pages":"62"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28391045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}