John Blair

Comparison of hand-carried ultrasound assessment of the inferior vena cava and N-terminal pro-brain natriuretic peptide for predicting readmission after hospitalization for acute decompensated heart failure.

OBJECTIVES We sought to compare the value of serial assessment with hand-carried ultrasound (HCU) of the inferior vena cava (IVC) with brain natriuretic peptide (BNP) to identify patients with acute decompensated heart failure (ADHF) who will be readmitted or seek emergency department treatment after hospital discharge. BACKGROUND Congestive heart failure (CHF) is a leading cause for hospitalization and, once hospitalized, patients with CHF frequently are readmitted. To date, no reliable index exists that can be used to predict whether patients with ADHF can be discharged with low readmission likelihood. METHODS A total of 75 patients who were admitted with a primary diagnosis of ADHF were followed. All patients were assessed at admission and discharge with the use of routine clinical evaluation, BNP measurement, and HCU evaluation of the IVC by physicians with limited training in ultrasound. RESULTS During the 30-day follow-up, 31 patients were rehospitalized or presented to the emergency department. Patients who were subsequently readmitted could not be differentiated from those who were not readmitted by their demographics, comorbidities, vital signs, presence of symptoms/signs suggestive of persistent congestion, hospital length of stay, or net volume removal. Routine laboratory tests, including assessment of renal function, also failed to predict readmission with the exception of serum sodium. Although admission BNP was similar in patients readmitted and not readmitted, pre-discharge log-transformed BNP was greater in patients who subsequently were readmitted. Patients who required repeat hospitalization had a larger IVC size on admission as well as at discharge. In addition, patients who were readmitted had persistently plethoric IVCs with lower IVC collapsibility indexes. At discharge, only serum sodium, log-transformed BNP, IVC size, and collapsibility were statistically significant predictors of readmission. CONCLUSIONS This study confirms that, once hospitalized, patients with CHF frequently are readmitted. Bedside evaluation of the IVC with a HCU device at the time of admission and discharge, as well as pre-discharge BNP, identified patients admitted with ADHF who were more likely to be readmitted to the hospital.

Percutaneous transluminal angioplasty versus surgery for limb-threatening ischemia

This retrospective study compared the results of percutaneous transluminal angioplasty (PTA) with those of infrainguinal bypass procedures in patients with critical arterial ischemia to determine which procedure had superior patency, limb salvage, and durability. The records of 54 patients who underwent 54 PTAs and 56 patients who underwent 63 infrainguinal bypasses (29 femoropopliteal and 34 femorodistal) from 1981 to 1987 were reviewed. In each patient PTA or bypass was the initial vascular procedure. Patients in both groups were comparable with respect to age, sex, and the presence of diabetes, hypertension, obesity, hypercholesterolemia, and smoking. Mean follow-up was 40 months (4 to 88 months) for the PTA group and 28 months (6 to 78 months) for the surgery group. Thirty-nine of the 54 patients (72%) were initially improved after PTA, whereas 15 patients (28%) showed no improvement. During follow-up, 20 initially successful PTAs reoccluded. Thirty-two of 54 patients (59%) underwent subsequent procedures, which included repeat PTA (10) and distal bypass (14). Patency determined by noninvasive Doppler studies was 18% at 2 years. Limb salvage, which included such secondary procedures, was 78%. Two-year patency for femoropopliteal bypasses was 68% with a limb salvage of 90%. Femorodistal bypasses had a 2-year patency of 47% and a limb salvage of 74%. No perioperative deaths occurred. Twenty-one of the 63 patients (33%) had subsequent procedures, which included thrombectomy (5) and bypass revision (9). In patients treated for limb-threatening ischemia the 2-year patency after femoropopliteal bypass (68%) or femorodistal bypass (47%) is significantly better than that from PTA (18%, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Mechanical chest compressions improve rate of return of spontaneous circulation and allow for initiation of percutaneous circulatory support during cardiac arrest in the cardiac catheterization laboratory

BACKGROUND Performing advanced cardiac life support (ACLS) in the cardiac catheterization laboratory (CCL) is challenging. Mechanical chest compression (MCC) devices deliver compressions in a small space, allowing for simultaneous percutaneous coronary intervention and reduced radiation exposure to rescuers. In refractory cases, MCC devices allow rescuers to initiate percutaneous mechanical circulatory support (MCS) and extracorporeal life support (ECLS) during resuscitation. This study sought to assess the efficacy and safety of MCC when compared to manual compressions in the CCL. METHODS We performed a retrospective analysis of patients who received ACLS in the CCL at our institution between May 2011 and February 2016. Baseline characteristics, resuscitation details, and outcomes were compared between patients who received manual and mechanical compressions. RESULTS Forty-three patients (67% male, mean age 58 years) required chest compressions for cardiac arrest while in the CCL (12 manual and 31 MCC). Patients receiving MCC were more likely to achieve return of spontaneous circulation (ROSC) (74% vs. 42%, p=0.05). Of those receiving MCC, twenty-two patients (71%) were treated with MCS. Patients receiving percutaneous ECLS were more likely to achieve ROSC (100% vs. 53%, p=0.003) and suffered no episodes of limb loss or TIMI major bleeding. There were no significant differences in 30-day survival or survival to hospital discharge between groups. CONCLUSIONS Use of MCC during resuscitation of cardiac arrest in the CCL increases the rate of ROSC. Simultaneous implantation of MCS, including percutaneous ECLS, is feasible and safe during MCC-assisted resuscitation in the CCL.

Clinical determinants of radial artery caliber assessed at the time of Transradial cardiac catheterization using routine prospective Radiobrachial angiography

BACKGROUND Transradial coronary angiography/intervention (TRA/TRI) is associated with reduced rates of bleeding, vascular complications, and major adverse cardiovascular events as compared to the transfemoral approach, but remains underutilized in the United States (U.S.). Small radial caliber is often cited as a technical impediment, however radial artery diameter (RAD) has not yet been systematically studied in the U.S. population using routine, prospective radiobrachial angiography. METHODS Consecutive patients (pts) with radiobrachial angiography acquired during TRA/TRI from September 2015 to August 2016 were retrospectively analyzed. Quantitative angiography (QA) was performed on digital subtraction angiograms. RAD measurements at distal (dRAD), mid (mRAD), and proximal (pRAD) segments, as well as minimum (minRAD) and maximum (maxRAD) diameters were indexed to radial arterial sheath size and tabulated. RAD measurements were adjudicated by 2 expert operators. Descriptive statistics and regression analyses were performed using STATA (College Station, TX). RESULTS Of 175 radiobrachial angiograms, 2 were excluded due to uninterpretable QA. Woman had smaller RAD versus men: pRAD (3.11 vs 3.33 mm, p = 0.021), minRAD (2.36 vs 2.59 mm, p = 0.006), and maxRAD (3.32 vs 3.53 mm, p = 0.0195). Univariate analysis showed correlation between minRAD and gender (p = 0.012), age (p = 0.019), and weight (p = 0.008). However, after multivariate analysis, only gender was associated with minRAD (p = 0.05). CONCLUSION This is the first study to describe the clinical determinants of RAD using prospective post-vasodilator, radiobrachial angiography in a U.S. POPULATION Women had significantly smaller RAD across proximal, minimum, and maximum segments. Sex was the only multivariate predictor of minRAD.

TCT-125 Use of a Mechanical Compression Device Increases Return of Spontaneous Circulation in Patients with Cardiac Arrest in the Cardiac Catheterization Laboratory .

Recent studies suggest that therapies offered in the cardiac catheterization laboratory (CCL) can increase survival in patients who have suffered a cardiac arrest. Performing advanced cardiac life support (ACLS) in the CCL is challenging due to the presence of imaging equipment and rescuer fatigue.

TCT-134 Mechanical Chest Compressions as a Bridge to Percutaneous Extracorporeal Life Support Increase Return of Spontaneous Circulation in Patients with Cardiac Arrest

Recent studies have reported that patients with cardiac arrest refractory to advanced cardiac life support (ACLS) may benefit from initiation of percutaneous extracorporeal life support (ECLS) during resuscitation. In order to preserve critical organ function, chest compressions must be performed

TCT-790 Cardiac Arrest Triage score best predicts mortality after intervention in patients with massive and submassive pulmonary embolism

Medical Centers, AMAGASAKI, Japan; Kansai Rosai Hospital, Cardiovascular Center, Amagasaki city, Japan; Kokura Memorial Hospital; Morinomiya Hospital, Osaka, Japan; Minneapolis Heart Institute Foundation; Saiseikai Central Hospital, Kyoto, Japan; Saiseikai Yokohama-city Eastern Hospital; AstraZeneca; Nagoya Kyoritsu Hospital, Nagoya, Japan; Kyoto university Hospital, Kyoto, Japan; University of North Carolina Hospital; Fukuoka, Japan; Sant’Eugenio Hospital, Rome, Italy; Juntendo University Nerima Hp., Tokyo, Japan; Hospital of León; Kanazawa Cardiovascular Hospital, Ishikawa, Japan; shinshu university hospital, Matsumoto, Japan; Tokai University, Isehara, Japan; Sant’Eugenio Hospital, Rome, Italy; Hofstra Northwell School of Medicine