Publications (2)2.26 Total impact
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ABSTRACT: Routine use of an invasive strategy (IS) has been shown to exceed a conservative strategy in reducing myocardial infarction (MI), angina and re-hospitalization rate in patients with non-ST elevation acute coronary syndrome (NSTEACS). The present study aimed to analyse, by use of randomized trials data, whether the risk profile of patients with NSTEACS influences the survival benefit of the IS over a conservative strategy from randomization to end of follow-up (range 6-24 months). Eight studies were identified from 1970 to 2005. A fixed effect-meta-regression analysis for: (i) the log-odds ratio on death and (ii) the log-odds ratio on death/MI against the odds of death/MI in the control group was made. IS was associated with a significant reduction in death/MI [12% versus 13.7%, odds ratio (OR) = 0.86, P = 0.009], but not in mortality (5.1% versus 5.5%, OR = 0.92, P = 0.34). There was evidence of heterogeneity in the outcome mortality (P = 0.06 for heterogeneity) and the composite of death/MI (P = 0.01 for heterogeneity). Sensitivity analysis demonstrated that the source of heterogeneity was significantly related to the outlier VANQWISH trial. When the latter was removed from the analysis, IS was related to a significant reduction of both death (3.9% versus 4.9%, OR = 0.81, P = 0.04, P heterogeneity = 0.35) and death/MI (10% versus 12.1%, OR = 0.81, P = 0.001, P heterogeneity = 0.07). The main finding of this meta-analysis is that, compared to a conservative strategy, the benefits of IS for the management of NSTEACS in terms of death/MI reduction are related to the patient's risk profile.
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ABSTRACT: BACKGROUND AND AIM of the study: Wide discrepancies are often observed between catheter- and Doppler-derived gradients and valve areas. The study aim was to verify if these measurements could be attenuated in a clinical setting by taking into account pressure recovery. METHODS: Between 1st January 2000 and 31st March 2005, a total of 259 patients with an aortic valve area (AVA) < or =2 cm(2) was prospectively collected. During a standard diagnostic catheterization, the aortic valve gradient was taken as: [peak left ventricular pressure-- peak aortic pressure]. The AVA was calculated using the Gorlin formula (AG). Echocardiography was performed within 30 days of this procedure. Transvalvular gradients were measured using the Doppler technique, and the AVA was computed using the continuity equation (ACE). The diameter of the ascending aorta was monitored in the parasternal long-axis view, and the values averaged. The ascending aorta sectional area (AA) was then computed according to geometric formulae. In order to correct for pressure recovery, an energy loss coefficient (ELCO) equation was used [ELCO = (AA x ACE)/(AA -ACE)]. Correlations between AG, ACE and ELCO were evaluated by linear regression analysis. As cardiac output affects the estimates of valve areas, the correlation was calculated separately for patients with a median cardiac index (CI) above and below 2.7 1/min/m(2). RESULTS: A good linear correlation was found between AG and ACE with regression coefficient 0.88, independent of cardiac output. A similar correlation was present between AG and ELCO, with correlation coefficient 0.99 in patients with CI >2.7 1/min/m(2), and
University of Padova
Padua, Veneto, Italy
- Department of Cardiac, Thoracic and Vascular Sciences