New York Heart Association Score Research Articles

Relationship between New York functional class and duke activity status index with the severity of mitral valve stenosis and echocardiographic parameters: is left atrial strain a better predictor?

Purpose This study aimed to investigate the relationship between symptoms of patients with severe mitral stenosis (MS), evaluated by the New York Heart Association (NYHA) functional class and Duke Activity Status Index (DASI) score, and echocardiographic parameters. We evaluated patients with severe rheumatic MS diagnosed as mitral valve area (MVA) less than 1.5 cm2. All patients underwent transthoracic echocardiography and the left atrium (LA) reservoir auto-strain (LASr) analysis. In addition, DASI and NYHA scores were determined to evaluate the functional capacity and symptoms of MS patients. We evaluated 60 patients with MS with a mean age of 50.13 ± 10.28 and a median DASI score of 26.95 (26.38). There were 6 (10%) and 28 (46.7%) patients with NYHA class I and II, and 25 (40.0%) and 2 (3.3%) patients with NYHA class III and IV, respectively. NYHA class was positively correlated with LA area (LAA, r = 0.638), LA volume (LAV, r = 0.652), LAV index (LAVI, r = 0.62), E (r = 0.45), A (r = 0.25), and pulmonary artery pressure (PAP, r = 0.34), while negatively correlated with LASr (r=-0.73) and MVA (r=-0.417). Furthermore, the DASI score was positively associated with LASr (r = 0.81) and MVA (r = 0.52) while negatively correlated with LAA (r=-0.62), LAV (r=-0.65), LAVI (r=-0.56), E (r=-0.46), A (r=-0.3), and PAP (r= -0.32). Our findings indicate that LAA, LAV, LAVI, E, A, PAP, MVA, and LASr are associated with NYHA and DASI scores in MS patients. Additionally, the LASr had the strongest correlation between all measured parameters in severe MS patients.

Long-Term Survival and Quality of Life Following Transcatheter Aortic Valve Replacement in Nonagenarians

Transcatheter aortic valve replacement (TAVR) has emerged as a successful treatment option for severe aortic stenosis. However, the long-term outcomes of TAVR in nonagenarians is lacking. We aimed to examine the long-term mortality and quality of life in nonagenarians after TAVR. This is a multicenter, retrospective analysis on patients with severe aortic stenosis who underwent TAVR. Patients were divided into 2 groups: nonagenarians (age ≥90years) and age <90years. The Kansas City cardiomyopathy questionnaire (KCCQ) and New York Heart Association (NYHA) scores were compared before and after TAVR. All-cause mortality was compared between both groups at 30days, 1 year, and 5 years after TAVR using the Cox proportional hazard model. A total of 6,896 patients were included, of whom 591 were nonagenarians. Nonagenarians had a higher Society of Thoracic Surgeons perioperative risk of mortality (8.1 ± 4.6% vs 5.4 ± 4.2%, p <0.001) before TAVR. Both groups were similar in KCCQ and NYHA scores at baseline. At 1year after TAVR, there was no significant difference in improvement in the KCCQ overall score between those aged <90 years and nonagenarians (-4.76, 95% confidence interval [CI] -11.4 to 1.9, p=0.161). Similarly, therewas no statistically significant difference in improvement in NYHA class between the 2 groupsat 1year (odds ratio 1.07, 95% CI 0.85 to 1.25), p=0.526). The unadjusted 30-day (3.2% vs 2.7%, hazard ratio 1.11, 95% CI 0.70 to 1.80, p=0.667) and 5-year (28.0% vs 26.6%, hazard ratio 1.05, 95% CI 0.89 to 1.24, p=0.60) all-cause mortality were similar between the 2 groups. In conclusion, this study demonstrates an excellent long-term mortality rate at 5years after TAVR in nonagenarians, comparable to patients younger than 90 years. There is a significant and enduring improvement in functional status in nonagenarians, observed up to 1year after TAVR.

Complexity analysis from EEG data in congestive heart failure: A study via approximate entropy.

Congestive heart failure (CHF) is a very complex clinical syndrome that may lead to ischemic cerebral hypoxia condition. The aim of the present study is to analyze the effects of CHF on brain activity through electroencephalographic (EEG) complexity measures, like approximate entropy (ApEn). Twenty patients with CHF and 18 healthy elderly people were recruited. ApEn values were evaluated in the total spectrum (0.2-47 Hz) and main EEG frequency bands: delta (2-4 Hz), theta (4-8 Hz), alpha 1 (8-11 Hz), alpha 2 (11-13 Hz), beta 1 (13-20 Hz), beta 2 (20-30 Hz), and gamma (30-45 Hz) to identify differences between CHF group and control. Moreover, a correlation analysis was performed between ApEn parameters and clinical data (i.e., B-type natriuretic peptides (BNP), New York Heart Association (NYHA), and systolic blood pressure (SBP)) within the CHF group. Statistical topographic maps showed statistically significant differences between the two groups in the total spectrum and theta frequency band. Within the CHF group, significant negative correlations were found between total ApEn and BNP in O2 channel and between theta ApEn and NYHA scores in Fp1, Fp2, and Fz channels; instead, a significant positive correlation was found between theta ApEn and SBP in C3 channel and a nearly significant positive correlation was obtained between theta ApEn and SBP in F4 channel. EEG abnormalities in CHF are very similar to those observed in cognitive-impaired patients, suggesting analogies between the effects of neurodegeneration and brain chronic hypovolaemia due to heart disorder and underlying high brain sensitivity to CHF.

Comparison of Coronary Artery Bypass Grafting Combined With Mitral Valve Repair Versus Coronary Artery Bypass Grafting Alone in Patients With Moderate Ischemic Mitral Regurgitation: A Meta-Analysis.

The aim of this meta-analysis was to compare clinical outcomes between those who underwent coronary artery bypass grafting (CABG) alone and CABG with mitral valve repair (MVR) in patients with moderate ischemic mitral regurgitation. The present study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two authors performed a comprehensive search of international databases, including PubMed, EMBASE, and the Cochrane Library, for relevant studies published from inception to March 1, 2023. The search was performed again before the submission of the manuscript on March 20, 2023. Primary outcomes assessed in the present meta-analysis included early mortality and long-term mortality. Secondary outcomes assessed in the present meta-analysis included change in New York Heart Association (NYHA) score from baseline, change in ejection fraction (EF) from baseline (%), and major cardiovascular events (MACE). A total of 13 studies were included in the present meta-analysis. Out of 13 included studies, four were randomized control trials (RCTs) and nine were retrospective cohort studies. The pooled analysis showed that early mortality was significantly lower in patients in the CABG group compared to the CABG+MVR group (risk ratio [RR]: 0.47, 95% confidence interval [CI]: 0.31, 0.70). Long-term mortality was also lower in patients who underwent CABG compared to patients in the CABG+MVR group. However, the difference was statistically insignificant (RR: 0.88, 95% CI: 0.77, 1.02). No significant differences were reported in the EF score between patients who underwent CABG and patients who underwent CABG plus MVR (mean difference [MD]: 0.40, 95% CI: -1.90, 2.69). NYHA score was significantly lower in patients in the CABG+repair group compared to the CABG alone group (MD: 0.39, 95% CI: 0.06, 0.72). In conclusion, our meta-analysis suggests that concomitant MVR during CABGmay not improve clinical outcomes in patients with moderate ischemic mitral regurgitation. Further clinical trials are needed to investigate this intervention in more detail.

462 Factors Associated with Longer Post-Operative Hospital Stay Following First Time Coronary-Artery-Bypass-Graft (CABG)

Abstract Prolonged post-operative hospital stay is associated with worse patient healthcare outcomes. Aim To identify parameters which correlate with longer post-operative hospital stay (POHS) following first time Coronary-Artery-Bypass-Graft (CABG) Method Data was collected retrospectively on 50 patients who underwent a first time CABG between 12/02/2020 – 21/09/2020 at the Golden Jubilee National Hospital (GJNH). Data included patient demographics, body-mass-index (BMI), presence of co-morbidities, peri-operative blood results, pre-operative renal dysfunction, left ventricular systolic dysfunction (LVSD), severity of left main stem disease, New York Heart Association (NYHA) Functional Classification score, number of grafts, cross-clamp time and bypass time. Results The mean POHS was 7.5 days. Patients with a POHS&amp;gt;7.5 days had a total mean POHS twice as long (12.07 vs 5.7 days, p &amp;lt; 0.001). They spent more time in intensive care unit (2.6 vs 0.97 days, P = 0.05), high dependency unit (2.5 vs 1.2 days, p = 0.005) and ward (7 vs 3.5 days, p = 0.001) compared to the shorter POHS group. They had a higher mean age (69 vs 65, p = 0.036), lower mean CrCl (80.32 vs 95.14, p = 0.141), higher mean renal dysfunction severity grades (0.8 vs 0.28, p = 0.014), higher mean LVSD severity grades (0.33 vs 0.17, p = 0.35) and higher mean NYHA scores (2.2 vs 1.88, p = 0.17). More of the patients had renal dysfunction (p = 0.01), were on ≥ 2 anticoagulants (p = 0.028), had sub-optimal pre-operative bloods (p = 0.075) and required blood transfusion post-operatively (p = 0.02). One patient in the longer POHS group died. Conclusions Longer POHS was associated with older age, worse renal function, presence of co-morbidities, sub-optimal peri-operative blood levels and requirement for post-operative blood transfusions.

Randomized, Double-Blinded, Multicenter, Placebo-Controlled Trial of Shenfu Injection for Treatment of Patients with Chronic Heart Failure during the Acute Phase of Symptom Aggravation (Yang and Qi Deficiency Syndrome).

Background Shenfu injection (SFI) has shown a remarkable therapeutic effect in patients with chronic heart failure (CHF) during the acute phase of symptom aggravation since it became commercially available in 1987. However, the therapeutic effect of SFI has not been validated in a standard clinical study. As a pilot clinical trial, this study aimed to evaluate the safety and efficacy of SFI for treatment of CHF patients during the acute phase. Methods A total of 160 patients experiencing acute phase CHF were enrolled in this study and randomly assigned to receive the placebo (placebo group, 150 ml glucose (GS)) or SFI (SFI group, 50 ml SFI + 100 ml GS) in addition to their standard medications for CHF treatment. The treatment lasted for 7 ± 1 days, and the follow-up continued for 28 ± 3 days after treatment. The primary endpoints were New York Heart Association (NYHA) classification and Traditional Chinese Medicine (TCM) syndrome scores. Results After 7±1 days of treatment, the efficacy of SFI according to improvements in NYHA and TCM syndrome scores in the SFI group (78.38% and 89.19%, respectively) was significantly higher than that in the placebo group (61.43% and 60.00%, respectively; P<0.05). The SFI group had a longer increase in amplitude than the placebo group (113.00 m versus 82.99 m, P<0.05). The incidence of adverse events and other safety indices showed no significant differences between the two groups. Conclusion SFI combined with conventional therapy for treatment of CHF during acute symptom aggravation ameliorated the cardiac dysfunction and clinical symptoms and improved the patients' quality of life without any significant AEs compared with the conventional therapy alone.

Utilidad de la Escala de Minnesota en el seguimiento de los pacientes con insuficiencia cardiaca crónica

IntroductionThe Minnesota Living with Heart Failure Questionnaire (MLHFQ) is a widely used scale to measure quality of life in patients with heart failure. The aim of the study was to analyse the usefulness of the MLHFQ in the follow-up of patients with chronic heart failure and establish the relationship with New York Heart Association (NYHA) functional class and ejection fraction. Materials and methodsWe reviewed 172 records, we presented general characteristics, assessed the internal validity and reliability and explored differences between the overall outcomes and by domain vs. ejection fraction and NYHA functional class. ResultsThe median age of the patients was 63 (57; 72) years, with a predominance of males (67.4%). Fifty-one point one percent had an ejection fraction<40%. The reliability coefficients in the 3 domains were>0.6; the physical domain was the most affected; significant differences were found in ejection fraction in the «Others» domain. Regarding the NYHA admission, significant differences were observed in 3 domains, we found lower quality of life in patients with a higher NYHA score. ConclusionsThe MLHFQ proved to be reliable and valid in measuring the quality of life in patients with heart failure by demonstrating lower quality of life in patients who had worse functional class; comparing the quality of life of patients with preserved versus reduced ejection fraction, only differences were found in one domain.

Functional performance and quality of life in high-risk comorbid patients undergoing transcatheter aortic valve implantation for symptomatic aortic valve stenosis

We assessed the impact of transcatheter aortic valve implantation (TAVI) on functional performance and quality of life (QoL) in a high-risk patient population with multiple comorbidities. Between January 2009 and December 2014, 145 high-risk patients (EuroSCORE II 7.3% [4.9; 14.9]) with severe symptomatic aortic valve stenosis (AS) underwent TAVI in a single centre. We prospectively evaluated New York Heart Association (NYHA) functional class, 6-minute walking distance (6MWD), and QoL using the validated Dutch version of the EuroQol-5D (EQ-5D) descriptive assessment and a visual analogue scale (EQ-VAS) at baseline, 30 days, as well as 6, 12, and 24 months after TAVI. All patients were eligible for analysis. New York Heart Association functional class improved significantly at 30-day, 6-, 12-, and 24-month follow-up (P < 0.001 for all). The absolute 6MWD improved significantly at 30 days (+19.3 ± 8.2 m; P= 0.0499) and at 6 months (+23.3 ± 8.1 m; P = 0.0194). A favourable trend was maintained at 12 months (+17.1 ± 8.8 m; P = 0.1879), whereas at 24 months 6MWD was similar to baseline values. No significant change in the descriptive assessment of QoL (EQ5D) was observed, whereas the EQ-VAS showed a significant improvement in QoL up to 24 months (P < 0.0180 for all time-points). In high-risk comorbid patients with symptomatic AS, TAVI results in a significant but temporary improvement of functional performance when assessed with objective measures of 6MWD but not of EQ-5D. Moreover, TAVI has a significant and sustained impact on subjective well-being and exercise capacity assessed with the EQ-VAS and NYHA score.

0426: How to measure the functional status of obese heart failure patients?

Obesity is a high risk factor and has been described as an independent risk for heart failure (HF). Obese patients suffer dyspnea earlier than others. Our aim to explore the functional status of obese heart failure patients. This retrospective study including 685 patients (66 years, 436 were male) admitted in the therapeutic unit of heart failure, We divided the patients into 3 groups regarding their body mass index (the weight in kilograms divided by the square of the height in meters): normal weighted “18.5 to 24.9kg/m 2 ” (67 years, 72% were male); overweight “25.0 to 29.9kg/m 2 ” (65.3 years, 60% were male); and obese “30.0kg/m 2 or more” (65,6 years, 37% were male); We analyzed new York heart association (NYHA) status, the 6 minutes’ walk test a simple and reliable way to assess the exercise capacity of CHF patients. Baseline characteristics and ejection fraction was comparable in the 3 groups. Female sex, diabetes, hypertension, dyslipidemia were significantly associated in overweight and obese groups (p=0.0001). NYHA grade III/IV were significantly lower in the normal weighted patients (p=0.01); no difference in NYHA grade I/II was observed. There was significant correlation between groups in distance covered in the 6 minutes’ walk test (p=0.03). Patients incapable to walk were significantly obese (p=0.003). These results show that NYHA score and 6 minutes’ walk test are useful to discriminate functional status in obese patients compared to others but unsatisfying because can surestimates severity of obese heart failure patients, the VO2 max is more useful.

Utility of echocardiographic tissue synchronization imaging to redirect left ventricular epicardial lead placement for cardiac resynchronization therapy

Background Cardiac resynchronization therapy (CRT) with biventricular pacing has demonstrated cardiac function improvement for treating congestive heart failure (HF). It has been documented that the placement of the left ventricular lead at the longest contraction delay segment has the optimal CRT benefit. This study described follow-up to surgical techniques for CRT as a viable alternative for patients with heart failure. Methods Between April 2007 and June 2012, a total of 14 consecutive heart failure patients with New York Heart Association (NYHA) Class III-IV underwent left ventricular epicardial lead placements via surgical approach. There were eight males and six females, aged 36 to 79 years ((59.6±9.2) years). The mean left ventricular ejection fraction (LVEF) was (33.6±7.4)%. All patients were treated with left ventricular systolic dyssynchrony and underwent left ventricular epicardial lead placements via a surgical approach. Tissue Doppler imaging (TDI) and intraoperative transesophageal echocardiography were used to assess changes in left heart function and dyssynchronic parameters. Also, echo was used to select the best site for left ventricular epicardial lead placement. Results Left ventricular epicardial leads were successfully implanted in the posterior or lateral epicardial wall without serious complications in all patients. All patients had reduction in NYHA score from III-IV preoperatively to II-III postoperatively. The left ventricular end-diastolic diameter (LVEDD) decreased from (67.9±12.7) mm to (61.2±7.1) mm (P&lt;0.05), and LVEF increased from (33.6±7.4)% to (42.2±8.8)% (P&lt;0.05). Left ventricular intraventricular dyssynchrony index decreased from (148.4±31.6) ms to (57.3±23.8) ms (P&lt;0.05). Conclusions Minimally invasive surgical placement of the left ventricular epicardial lead is feasible, safe, and efficient. TDI can guide the epicardial lead placement to the ideal target location.

Long-term Results of Autologous Stem Cell Transplantation in the Treatment of Patients With Congestive Heart Failure

Background The aim of this study was to assess the long-term efficacy of stem cell transplantation with revascularization for patients with ischemic cardiomyopathy. Methods We enrolled 17 patients with ischemic cardiomyopathy who had undergone autologous stem cell treatment. To assess myocardial ischemia and viability they underwent coronary angiography, stress tests with dobutamine, echocardiography, and positron emission tomography. Peripheral stem cells mobilized using granulocyte colony-stimulating factor (G-CSF) were collected by aphseresis for transplantation transmyocardially into the areas of injury during coronary artery bypass surgery to increase blood flow to the engrafted areas. Results Three patients died in the early follow-up period and 4 patients with cardiac failure died during mid-term follow-up; they all underwent stem cell transplantation at 6 months after acute myocardial infarction. The mean follow-up period of the remaining 10 patients was 85.8 ± 9.2 months (range, 70–100). Mean left ventricular ejection fraction improved to 30.0 ± 6.7, whereas the preoperative mean left ventricular ejection fraction of the surviving patients was 25.6 ± 4.5 ( P = .035). Mean New York Heart Association (NYHA) functional class decreased from 3.2 to 1.5 ( P = .006). When the study population was divided into 2 subgroups according to the interval between acute myocardial infraction and surgery, the patients who underwent autologous stem cell transplantation within the first 6 months after myocardial infraction (Group 1) showed significantly lower NYHA scores at the last follow-up ( P = .024 in Group 1 and P = .102 in Group 2). No side effects were observed to be due to the stem cell or G-CSF injections. Conclusion Treatment of ischemic cardiomyopathy with autologous stem cell transplantation is easy and safe, opening a new window in the treatment of “no hope” patients.

High prevalence of vitamin D deficiency and its association with left ventricular dilation: An echocardiography study in elderly patients with chronic heart failure

Background and aims Vitamin D deficiency has been associated with chronic heart failure (CHF). We evaluated vitamin D levels in relationship with New York Heart Association (NYHA) classes, N-terminal pro-brain natriuretic peptide (NT-proBNP) values and left ventricular (LV) measures in ≥60 year old patients with stable CHF. Differently from previous investigations, LV function was assessed by transthoracic echocardiography, to provide easily reproducible results. Methods and results The study was performed at geographic latitude 44° N, from March to May and from September to November 2008. Acute HF and diseases or drugs altering vitamin D status were exclusion criteria. NYHA scores and 25-hydroxyvitamin D [25(OH)D], 1,25-dihydroxyvitamin D and NT-proBNP concentrations were assessed in 90 (45 F, 45 M) Caucasian patients with CHF secondary to hypertension and/or coronary artery disease. Vitamin D levels were also measured in 31 subjects without heart disease (controls). LV echocardiography was performed in 52 (26 F, 26 M) representative patients. Vitamin D concentrations were significantly lower in CHF cases than in controls. Among subject with CHF, 97.8% presented vitamin D deficiency (25(OH)D < 75 nmol/L), being severe (<25 nmol/L) in 66.7%. LV end-diastolic and end-systolic diameters were significantly longer, LV end-diastolic and end-systolic volumes bigger and fractional shortening lower in CHF patients with 25(OH)D < 25 nmol/L than with 25(OH)D ≥ 25 nmol/L ( p < 0.05). Log-values of 25(OH)D were negatively correlated with LV end-systolic diameter and volume ( r = −0.28; p < 0.05). On subgroup analysis, these results persisted only in male patients. Conclusions In elderly CHF patients, vitamin D deficiency was highly prevalent and often severe. This first addressed echocardiography study showed a sex-specific association between vitamin D deficiency and LV dilation. Since further echocardiography data are easily obtainable, larger investigations are demanded.

The clinical effectiveness of exercise training for patients with chronic heart failure

Aims: The efficacy of a supervised exercise-training programme, for patients with chronic heart failure, was assessed by comparing programme results with recommendations from current national ser vice frameworks and key systematic reviews. Methods: Retrospective data, on 22 Caucasian patients (18 male) aged 47 to 81 years were collected before and following a 12-week course of supervised exercise training, including: step test performance, New York Heart Association (NYHA) functional classification and brain natriuretic peptide (BNP). Results: For the same heart rate (~60% heart rate reserve), mean (SD) step test levels increased from 4.5 (0.2) to 5.1 (0.3) metabolic equivalents (P=0.0001) and NYHA scores improved from 2.1 (0.4) to 1.8 (0.5) (P=0.004). Mean BNP levels were 1563 (664) nanograms/ litre before the exercise programe and 1351 (536) nanograms/litre, after it (P=00.075). Conclusions: This audit clearly reflects the recommendations of national guidelines and systematic reviews, that exercise is not detrimental to the health and wellbeing of CHF patients and enhances physical functioning. The trend of improved BNP levels appears favourable and demonstrated to be of clinical significance in spite of not reaching statistical significance. This area requires further study on a greater number and wider variety of patients, where it is hypothesized that exercise will be both clinically and statistically significant.

Prospective Evaluation of Right Ventricular Function and Functional Status 6 Months After Acute Submassive Pulmonary Embolism: Frequency of Persistent or Subsequent Elevation in Estimated Pulmonary Artery Pressure

No published data have systematically documented pulmonary artery pressure over an intermediate time period after submassive pulmonary embolism (PE). The aim of this work was to document the rate of pulmonary hypertension, as assessed noninvasively by estimated right ventricular systolic pressure (RVSP) of >or= 40 mm Hg 6 months after the diagnosis of submassive PE. We enrolled 200 normotensive patients with CT angiography-proven PE and a baseline echocardiogram to estimate RVSP. All patients received therapy with unfractionated heparin initially, but 21 patients later received alteplase in response to circulatory shock or respiratory failure. Patients returned at 6 months for repeat RVSP measurement, and assessments of the New York Heart Association (NYHA) score and 6-min walk distance (6MWD). Six months after receiving a diagnosis, 162 of 180 survivors (90%) returned for follow-up, including 144 patients who had been treated with heparin (heparin-only group) and 18 patients who had been treated with heparin plus alteplase (heparin-plus-alteplase group). Among the heparin-only patients, the RVSP at diagnosis was >or= 40 mm Hg in 50 of 144 patients (35%; 95% CI, 27% to 43%), compared with 10 of 144 patients at follow-up (7%; 95% CI, 3% to 12%). However, the RVSP at follow-up was higher than the baseline RVSP in 39 of 144 patients (27%; 95% CI, 9% to 35%), and 18 of these 39 patients had a NYHA score of >or= 3 or exercise intolerance (6MWD, < 330 m). Among heparin-plus-alteplase patients, the RVSP was >or= 40 mm Hg in 11 of 18 patients at diagnosis (61%; 95% CI, 36% to 83%), compared with 2 of 18 patients at follow-up (11%; 95% CI, 1% to 35%). The RVSP at follow-up was not higher than at the time of diagnosis in any of the heparin-plus-alteplase patients (95% CI, 0% to 18%). Six months after experiencing submassive PE, a significant proportion of patients had echocardiographic and functional evidence of pulmonary hypertension.

Subclinical late cardiac toxicity in childhood cancer survivors

The authors analyzed how self-reported health and self-reported modified New York Heart Association (NYHA) cardiac function scores were related to cardiac systolic function, cardiac risk factors, and cancer treatment history in childhood cancer survivors who reported no symptoms of cardiac disease. Long-term survivors of pediatric cancer who were treated between 1971 and 1995 (current ages, 16-39.7 years) underwent noninvasive clinical and laboratory cardiac risk evaluation and responded to selected subscales of the Medical Outcomes Study 36-item Short Form Health Survey. Results were compared with survivor history of anthracycline therapy alone or with radiotherapy (n=127 patients; mean, 10 years after diagnosis) versus no anthracycline therapy (n=32 patients; mean, 11 years after diagnosis). Sex, current age, highest school grade completed, race, age at diagnosis, diagnostic group, years off therapy, fractional shortening (FS), heart rate, and smoking status were found to be independently predictive of self-reported health. Interaction between female sex and higher low-density lipoprotein values and between diagnosis and abnormal FS variably predicted low reported vitality and low reported modified New York Heart Association (NYHA) scores. Echocardiographic findings, cardiac risk factors, and treatment history explained 13% to 28% of the variance in perceived health and self-reported modified NYHA scores. Systolic function and cardiac risk factors were linked to lower self-reported health and NYHA scores even in the absence of clinically evident cardiotoxicity.

Pressure ulcer risk factors in patients undergoing surgery

This paper reports a study to identify risk factors associated with pressure ulcer development among a mixed group of adult patients undergoing surgery. Few studies have been carried out with patients undergoing surgery to assess the risk of pressure ulcer development, and so there is a little knowledge of the risk factors for this group. However, studies among non-surgical patients have shown that nutritional predictors such as low serum albumin level and low body mass index (BMI) are of great importance. An additional predictive factor may be low blood pressure. It is important to study these predictors further among patients undergoing surgery, using techniques such as multiple regression techniques, designed to identify the most important predictors for pressure ulcer development. A prospective comparative study was carried out in 1996-1998 with 286 adult patients undergoing surgical treatment. The data were collected from patient records by Registered Nurses preoperatively, for seven days postoperatively and thereafter once a week for up to 12 weeks. Perioperative data were also collected. The Risk Assessment Pressure Sore Scale was used, and data were collected on general physical condition, activity, mobility, moisture, food intake, fluid intake, sensory perception, friction and shear, body temperature and serum albumin. Forty-one (14.3%) patients developed pressure ulcers during the observation period. The most common type was non-blanchable erythema. Those who developed pressure ulcers were significantly older, weighed less, and had a lower BMI and serum albumin. More women than men developed pressure ulcers. Risk factors identified in multiple stepwise regression analyses were female gender, American Society of Anaesthesiologists (ASA) status or New York Heart Association (NYHA) status and food-intake. Special attention, with regard to risk of pressure ulcer development, should be paid to patients undergoing surgery who have low ASA or NYHA scores, low food intake and/or are women.

Predictive Factors for Usefulness of Fiberoptic Pulmonary Artery Catheter for Continuous Oxygen Saturation in Mixed Venous Blood Monitoring in Cardiac Surgery

The main goal of this prospective study was to identify among cardiac surgery patients, usually monitored through a standard pulmonary artery catheter (PAC), those in whom a fiberoptic catheter oximeter to measure oxygen saturation in mixed venous blood (SVO2 PAC) would be most useful.Data from 286 patients who underwent coronary artery bypass graft (50%) or valvular surgery were recorded, including ASA physical status, New York Heart Association (NYHA) classification, and Parsonnet score (PS). Hemodynamic events and SVO2 changes were collected intra- and postoperatively until weaning from mechanical ventilation. The anesthesiologist in charge graded the usefulness of SVO2 PAC, and another anesthesiologist carried out a blindly controlled overall evaluation. Usefulness was defined as the presence of a change in therapeutic maneuver triggered solely by continuous SVO2 data that would not have occurred based on other routine parameters. SVO2 was also considered useful if earlier recognition of significant adverse events occurred. SVO2 PAC was useful in 57% of the patients. Independent predictive factors (multivariate analysis) for the perioperative usefulness of SVO2 in the whole population consisted of ASA class >or=to4 (P < 10-5; relative risk [RR] 1.78, 1.51-2.07), mitral surgery (P < 10-4; RR 1.72, 1.4-2.02), and NYHA score >or=to3 (P < 0.01; RR 1.66, 1.35-2.05). Independent predictive factors for the perioperative usefulness of SVO2 in the coronary artery bypass graft population were NYHA score >or=to 3 (P < 10-5; RR 1.90, 1.42-2.55) and ASA class >or=to 4 (P < 0.01; RR 1.99, 1.51-2.63). The presence of three stenosed coronary arteries showed borderline significance (P < 0.06), Independent predictive factors for perioperative usefulness of SVO2 in the valvular population were mitral pathology (P < 10-5) and ASA class >or=to 4 (P < 0.01). The receiver operator characteristic curve assessed the predictivity of the PS. SVO2 PAC was more useful in the group of patients with the greatest severity of illness (PS in useful group 17.0 +/- 10.3; in nonuseful group 8.7 +/- 6.6; P < 10-4). Intensive care unit duration and hospital stay in the useful group was prolonged compared with the nonuseful group. Similarly, morbidity was frequent in the useful group, although it was not always significantly different from the nonuseful group according to the type of complications. Mortality was comparable in the groups despite their different degree of illness and was reduced when taking into account the predictive and observed mortality provided by the PS. This study defined independent preoperative factors associated with SVO2 PAC monitoring and proposed a cutoff point above which SVO2 may be useful. (Anesth Analg 1997;85:2-10)

Predictive factors for usefulness of fiberoptic pulmonary artery catheter for continuous oxygen saturation in mixed venous blood monitoring in cardiac surgery.

The main goal of this prospective study was to identify among cardiac surgery patients, usually monitored through a standard pulmonary artery catheter (PAC), those in whom a fiberoptic catheter oximeter to measure oxygen saturation in mixed venous blood (SVO2 PAC) would be most useful. Data from 286 patients who underwent coronary artery bypass graft (50%) or valvular surgery were recorded, including ASA physical status, New York Heart Association (NYHA) classification, and Parsonnet score (PS). Hemodynamic events and SVO2 changes were collected intra- and postoperatively until weaning from mechanical ventilation. The anesthesiologist in charge graded the usefulness of SVO2 PAC, and another anesthesiologist carried out a blindly controlled overall evaluation. Usefulness was defined as the presence of a change in therapeutic maneuver triggered solely by continuous SVO2 data that would not have occurred based on other routine parameters. SVO2 was also considered useful if earlier recognition of significant adverse events occurred. SVO2 PAC was useful in 57% of the patients. Independent predictive factors (multivariate analysis) for the perioperative usefulness of SVO2 in the whole population consisted of ASA class > or = 4 (P < 10(-5); relative risk [RR] 1.78, 1.51-2.07), mitral surgery (P < 10(-4); RR 1.72, 1.4-2.02), and NYHA score > or = 3 (P < 0.01; RR 1.66, 1.35-2.05). Independent predictive factors for the perioperative usefulness of SVO2 in the coronary artery bypass graft population were NYHA score > or = 3 (P < 10(-5); RR 1.90, 1.42-2.55) and ASA class > or = 4 (P < 0.01; RR 1.99, 1.51-2.63). The presence of three stenosed coronary arteries showed borderline significance (P < 0.06). Independent predictive factors for perioperative usefulness of SVO2 in the valvular population were mitral pathology (P < 10(-5)) and ASA class > or = 4 (P < 0.01). The receiver operator characteristic curve assessed the predictivity of the PS. SVO2 PAC was more useful in the group of patients with the greatest severity of illness (PS in useful group 17.0 +/- 10.3; in nonuseful group 8.7 +/- 6.6; P < 10(-4)). Intensive care unit duration and hospital stay in the useful group was prolonged compared with the nonuseful group. Similarly, morbidity was frequent in the useful group, although it was not always significantly different from the nonuseful group according to the type of complications. Mortality was comparable in the groups despite their different degree of illness and was reduced when taking into account the predictive and observed mortality provided by the PS. This study defined independent preoperative factors associated with SVO2 PAC monitoring and proposed a cutoff point above which SVO2 may be useful.