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Publications (41) View all
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Article: Response of Cardiac Endocrine Function to Surgery Stress Is Age Dependent in Neonates and Children With Congenital Heart Defects: Consequences in Diagnostic and Prognostic Accuracy of Brain Natriuretic Peptide Measurement.
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ABSTRACT: OBJECTIVE:: The aim of this study was to evaluate the diagnostic and prognostic accuracy of brain natriuretic peptide assay in neonates and children undergoing surgery for congenital heart disease. DESIGN:: Prospective, observational study. SETTING:: Single center. PATIENTS:: We enrolled 336 consecutive children (median age, 6 mo [range, 0-37 mo]) undergoing cardiac surgery (87 neonates; age, 7 d [5-12]; median, 25-75th percentile; 24 infants and children; age, 11 mo [4-60]) and 436 healthy controls. INTERVENTIONS:: Brain natriuretic peptide was measured preoperatively, on every postoperative day in the ICU, and at discharge. Intubation time was the primary outcome. MEASUREMENTS AND MAIN RESULTS:: Preoperative brain natriuretic peptide values in patients with congenital heart disease were higher than those in controls (p < 0.01). Brain natriuretic peptide had a good diagnostic accuracy in discriminating between patients with congenital heart disease and healthy controls with an area under curve = 0.918 for neonates and area under curve = 0.894 for older children. The best cutoff values, calculated by receiver operating characteristic analysis, were different for the two age subgroups with cutoff values of 363.5 ng/L for neonates and 23.5 ng/L for older children. At 24 hours after surgery, although brain natriuretic peptide decreased in neonates (baseline 2723 vs 1290 ng/L, p < 0.001), it increased in children (60 vs 365 ng/L at 24 hours, p < 0.001). Multivariable analysis identified the preoperative level of brain natriuretic peptide in infant/children and the difference in brain natriuretic peptide value (baseline 24 hours) in neonates, as independent predictors of intubation time. Furthermore, body surface area, Aristotle score, and cardiopulmonary bypass time had an independent significant effect on the endpoint in either group. CONCLUSIONS:: Baseline cardiac endocrine function and its response to surgical stress are dependent on age in neonates and children, undergoing cardiac surgery for congenital heart disease. Brain natriuretic peptide shows a good diagnostic and prognostic accuracy in this setting, with different features in either neonates or infants/children subsets.Pediatric Critical Care Medicine 04/2013; · 3.13 Impact Factor -
Article: Real practice radiation dose and dosimetric impact of radiological staff training in body CT examinations.
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ABSTRACT: OBJECTIVES: To evaluate the radiation dose of the main body CT examinations performed routinely in four regional diagnostic centres, the specific contribution of radiologists and technologists in determining CT dose levels, and the role of radiological staff training in reducing radiation doses. METHODS: We retrospectively evaluated the radiation dose in terms of dose-length product (DLP) values of 2,016 adult CT examinations (chest, abdomen-pelvis, and whole body) collected in four different centres in our region. DLP values for contrast-unenhanced and contrast-enhanced CT examinations performed at each centre were compared for each anatomical area. DLP values for CT examinations performed before and after radiological staff training were also compared. RESULTS: DLP values for the same CT examinations varied among centres depending on radiologists' preferences, variable training of technologists, and diversified CT image acquisition protocols. A specific training programme designed for the radiological staff led to a significant overall reduction of DLP values, along with a significant reduction of DLP variability. CONCLUSIONS: Training of both radiologists and technologists plays a key role in optimising CT acquisition procedures and lowering the radiation dose delivered to patients. MAIN MESSAGES : • The effective dose for similar CT examinations varies significantly among radiological centres. • Staff training can significantly reduce and harmonise the radiation dose. • Training of radiologists and technologists is key to optimise CT acquisition protocols.Insights into imaging. 03/2013; -
Dataset: Comparative-JACC imaging 2012-2013
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Article: Comparative Prediction of Cardiac Events by Wall Motion, Wall Motion Plus Coronary Flow Reserve, or Myocardial Perfusion Analysis: A Multicenter Study of Contrast Stress Echocardiography.
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ABSTRACT: OBJECTIVES: This study sought to determine whether the increasing difficulty of assessing wall motion (WM), Doppler coronary flow reserve on the left anterior descending coronary artery (CFR-LAD), and myocardial perfusion (MP) during stress echocardiography (SE) was justified by increasing prognostic information in patients with known or suspected coronary artery disease. BACKGROUND: The use of echocardiographic contrast agents during SE permits the assessment of both CFR-LAD and MP, but their relative incremental prognostic value is undefined. METHODS: This study followed a multicenter cohort of 718 patients for 16 months after high-dose dipyridamole contrast SE for evaluation of known or suspected coronary artery disease. The ability of WM, CFR-LAD, and MP to predict cardiac events was studied by multivariable models and risk reclassification. RESULTS: Abnormal SE was detected as a reversible WM abnormality in 18%, reversible MP defect in 27%, and CFR-LAD <2 in 38% of subjects. Fifty cardiac events occurred (annualized event rate 6.0%). A normal MP stress test had a 1-year hard event rate of 1.2%. The C-index of outcomes prediction based on clinical data was improved with MP (p < 0.001) and WM/CFR-LAD (p = 0.037), and MP (p = 0.003) added to clinical and WM data. Net risk reclassification was improved by adding MP (p < 0.001) or CFR-LAD (net reclassification improvement p = 0.001) in addition to clinical and WM data. The model including clinical data, WM/CFR-LAD, and MP performed better than that without MP did (p = 0.012). CONCLUSIONS: The multiparametric assessment of WM, CFR-LAD and MP during stress testing in patients with known or suspected coronary artery disease is feasible. Contrast SE allowed better prognostication, irrespective of the use of CFR-LAD or MP. The addition of either CFR-LAD or MP assessment to standard WM analysis and clinical parameters yielded progressively higher values for the prediction of cardiac events and may be required in today's intensively treated patients undergoing SE, because their average low risk of future cardiac events requires methods with higher predictive sensitivity than that available with standalone WM assessment.JACC. Cardiovascular imaging 12/2012; · 14.29 Impact Factor -
Article: Measuring and Evaluating the Potential Addiction Risk of the Online Poker Game Texas Hold’em No Limit
Gaming Law Review and Economics 11/2012; 16.
