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Gagnon LR, Huang Y, Kay R, Cujec B. Kounis Syndrome, a Case of Vancomycin Associated Coronary Artery Vasospasm Resulting in Myocardial Infarction. CJC Open 2021; 4:337-339. [PMID: 35386129 PMCID: PMC8978073 DOI: 10.1016/j.cjco.2021.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/03/2021] [Indexed: 11/28/2022] Open
Abstract
We describe a case of Kounis syndrome, an allergic reaction causing coronary artery vasospasm, triggered by a vancomycin infusion, in a healthy 32-year-old man. The patient initially presented with an inguinal abscess requiring intravenous vancomycin. During his third infusion, he developed typical chest pain that resolved with cessation of the infusion. Troponin was elevated, and electrocardiogram showed ST elevation, prompting emergent cardiac catheterization that demonstrated normal coronary arteries. The cause of the myocardial infarction was consistent with Kounis syndrome. Diagnosis of Kounis syndrome is important, as prompt cessation of the offending agent is a priority to reduce further cardiac injury.
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Cohen A, Donal E, Delgado V, Pepi M, Tsang T, Gerber B, Soulat-Dufour L, Habib G, Lancellotti P, Evangelista A, Cujec B, Fine N, Andrade MJ, Sprynger M, Dweck M, Edvardsen T, Popescu BA. EACVI recommendations on cardiovascular imaging for the detection of embolic sources: endorsed by the Canadian Society of Echocardiography. Eur Heart J Cardiovasc Imaging 2021; 22:e24-e57. [PMID: 33709114 DOI: 10.1093/ehjci/jeab008] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 01/07/2021] [Indexed: 12/28/2022] Open
Abstract
Cardioaortic embolism to the brain accounts for approximately 15-30% of ischaemic strokes and is often referred to as 'cardioembolic stroke'. One-quarter of patients have more than one cardiac source of embolism and 15% have significant cerebrovascular atherosclerosis. After a careful work-up, up to 30% of ischaemic strokes remain 'cryptogenic', recently redefined as 'embolic strokes of undetermined source'. The diagnosis of cardioembolic stroke remains difficult because a potential cardiac source of embolism does not establish the stroke mechanism. The role of cardiac imaging-transthoracic echocardiography (TTE), transoesophageal echocardiography (TOE), cardiac computed tomography (CT), and magnetic resonance imaging (MRI)-in the diagnosis of potential cardiac sources of embolism, and for therapeutic guidance, is reviewed in these recommendations. Contrast TTE/TOE is highly accurate for detecting left atrial appendage thrombosis in patients with atrial fibrillation, valvular and prosthesis vegetations and thrombosis, aortic arch atheroma, patent foramen ovale, atrial septal defect, and intracardiac tumours. Both CT and MRI are highly accurate for detecting cavity thrombosis, intracardiac tumours, and valvular prosthesis thrombosis. Thus, CT and cardiac magnetic resonance should be considered in addition to TTE and TOE in the detection of a cardiac source of embolism. We propose a diagnostic algorithm where vascular imaging and contrast TTE/TOE are considered the first-line tool in the search for a cardiac source of embolism. CT and MRI are considered as alternative and complementary tools, and their indications are described on a case-by-case approach.
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Affiliation(s)
- Ariel Cohen
- Assistance Publique-Hôpitaux de Paris, Saint-Antoine and Tenon Hospitals, Department of Cardiology, and Sorbonne University, Paris, France.,INSERM unit UMRS-ICAN 1166; Sorbonne-Université, Paris, France
| | - Erwan Donal
- University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Mauro Pepi
- Centro Cardiologico Monzino, IRCCS, Via Parea 4, 20141, Milan, Italy
| | - Teresa Tsang
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bernhard Gerber
- Service de Cardiologie, Département Cardiovasculaire, Cliniques Universitaires St. Luc, Division CARD, Institut de Recherche Expérimental et Clinique (IREC), UCLouvainAv Hippocrate 10/2803, B-1200 Brussels, Belgium
| | - Laurie Soulat-Dufour
- Assistance Publique-Hôpitaux de Paris, Saint-Antoine and Tenon Hospitals, Department of Cardiology, and Sorbonne University, Paris, France.,INSERM unit UMRS-ICAN 1166; Sorbonne-Université, Paris, France
| | - Gilbert Habib
- Aix Marseille Univ, IRD, MEPHI, IHU-Méditerranée Infection, APHM, La Timone Hospital, Cardiology Department, Marseille, France
| | - Patrizio Lancellotti
- University of Liège Hospital, GIGA Cardiovascular Sciences, Department of Cardiology, CHU SartTilman, Liège, Belgium.,Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, and Anthea Hospital, Bari, Italy
| | - Arturo Evangelista
- Servei de Cardiologia. Hospital Universitari Vall d'Hebron-VHIR. CIBER-CV. Pº Vall d'Hebron 119. 08035. Barcelona. Spain
| | - Bibiana Cujec
- Division of Cardiology, University of Alberta, 2C2.50 Walter Mackenzie Health Sciences Center, 8440 112 St NW, Edmonton, Alberta, Canada T6G 2B7
| | - Nowell Fine
- University of Calgary, Libin Cardiovascular Institute, South Health Campus, 4448 Front Street Southeast, Calgary, Alberta T3M 1M4, Canada
| | - Maria Joao Andrade
- Maria Joao Andrade Cardiology Department, Hospital de Santa Cruz-Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos 2790-134 Carnaxide, Portugal
| | - Muriel Sprynger
- Department of Cardiology-Angiology, University Hospital Liège, Liège, Belgium
| | - Marc Dweck
- British Heart Foundation, Centre for Cardiovascular Science, Edinburgh and Edinburgh Imaging Facility QMRI, University of Edinburgh, United Kingdom
| | - Thor Edvardsen
- Faculty of medicine, Oslo University, Oslo, Norway and Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Bogdan A Popescu
- Cardiology Department, University of Medicine and Pharmacy 'Carol Davila', Emergency Institute for Cardiovascular Diseases 'Prof. Dr. C. C. Iliescu', Sos. Fundeni 258, sector 2, 022328 Bucharest, Romania
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Nguyen Q, Wang K, Nikhanj A, Chen-Song D, DeKock I, Ezekowitz J, Mirhosseini M, Cujec B, Oudit GY. Screening and Initiating Supportive Care in Patients With Heart Failure. Front Cardiovasc Med 2019; 6:151. [PMID: 31696120 PMCID: PMC6817607 DOI: 10.3389/fcvm.2019.00151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 10/07/2019] [Indexed: 01/03/2023] Open
Abstract
Background: Patients with heart failure (HF) experience a major symptom burden and an overall reduction of quality of life. However, supportive care (SC) remains an under-utilized resource for these patients. Among the many existing barriers to integrating SC into routine care, identifying patients with SC needs remains challenging. The Kansas City Cardiomyopathy Questionnaire (KCCQ) is an important predictor of SC needs in patients with HF. Methods and Results: We used the shortened version KCCQ-12 as a screening tool for SC need in our ambulatory HF patient population using a KCCQ-12 summary score of <29 as the cut-off. Of the 456 patients who completed the KCCQ-12, 41 (9%) were predicted to have SC needs. Demographics, medical history, biochemical parameters, echocardiographic assessment and medical treatment were similar between the two groups of patients. However, patients with KCCQ-12 <29 were more symptomatic based on both New York Heart Association (NYHA) classification and American Heart Association (AHA) staging with a higher prevalence of depression. We established a multidisciplinary SC clinic and the profile and outcomes of patients with SC needs that were referred and followed at our SC clinic were also evaluated. Twenty-three patients were referred to our SC clinic: 2 died before being seen, 1 refused SC and 20 received SC. Of these 20 patients, 11 died and 9 are currently being followed. Median survival after starting the SC clinic is 3 months. In the original SC cohort of 23, 17 patients had available KCCQ-12 summary scores. However, only 6 out of 17 (35%) had KCCQ-12 scores <29, indicating the need for additional assessment tools in this patient population. Conclusions: The magnitude of unmet supportive care needs in patients with HF is significant. While the KCCQ-12 questionnaire is a useful tool to identify patients with SC, serial clinical evaluation, establishment of a SC clinic and prompt referral are essential for patients needing supportive care.
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Affiliation(s)
- Quynh Nguyen
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
| | - Kaiming Wang
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
| | - Anish Nikhanj
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
| | - Dale Chen-Song
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
| | - Ingrid DeKock
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, AB, Canada
| | - Justin Ezekowitz
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
| | - Mehrnoush Mirhosseini
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, AB, Canada
| | - Bibiana Cujec
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
| | - Gavin Y Oudit
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
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Nguyen Q, Wang B, Chen-Song D, Nikhanj A, Mirhosseini M, Cujec B, Ezekowitz J, DeKock I, Oudit G. SUPPORTIVE CARE IN HEART FAILURE: ESTABLISHING A NEW INTEGRATIVE CARE INITIATIVE. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Parent S, Cujec B. Subclinical Hypothyroidism and Heart Failure: Chicken or Egg? Can J Cardiol 2018; 34:11-12. [DOI: 10.1016/j.cjca.2017.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 11/21/2017] [Accepted: 11/21/2017] [Indexed: 11/28/2022] Open
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Sivakumaran S, Shanks M, Tsuyuki R, Irwin M, He W, Hassan I, Kimber S, Oudit G, Cujec B, Becher H. PATIENTS WITH MITRAL REGURGITATION ARE NOT MORE LIKELY TO RESPOND TO CARDIAC RESYNCHRONIZATION THERAPY. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Yogasundaram H, Putko BN, Tien J, Paterson DI, Cujec B, Ringrose J, Oudit GY. Hydroxychloroquine-Induced Cardiomyopathy: Case Report, Pathophysiology, Diagnosis, and Treatment. Can J Cardiol 2014; 30:1706-15. [DOI: 10.1016/j.cjca.2014.08.016] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Revised: 08/21/2014] [Accepted: 08/21/2014] [Indexed: 12/20/2022] Open
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Solez K, Karki A, Rana S, Bjerland H, Cujec B, Aaron S, Morrish D, Walker M, Gowrishankar M, Bamforth F, Satkunam L, Glick N, Stevenson T, Ross S, Dhakal S, Allain D, Konkin J, Zakus D, Nichols D. Multifaceted support for a new medical school in Nepal devoted to rural health by a Canadian Faculty of Medicine and Dentistry. Glob J Health Sci 2012; 4:109-18. [PMID: 23121747 PMCID: PMC4777003 DOI: 10.5539/gjhs.v4n6p109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 08/22/2012] [Indexed: 11/24/2022] Open
Abstract
Nepal and Alberta are literally a world apart. Yet they share a common problem of restricted access to health services in remote and rural areas. In Nepal, urban-rural disparities were one of the main issues in the recent civil war, which ended in 2006. In response to the need for improved health equity in Nepal a dedicated group of Nepali physicians began planning the Patan Academy of Health Sciences (PAHS), a new health sciences university dedicated to the education of rural health providers in the early 2000s. Beginning with a medical school the Patan Academy of Health Sciences uses international help to plan, deliver and assess its curriculum. PAHS developed an International Advisory Board (IAB) attracting international help using a model of broad, intentional recruitment and then on individuals’ natural attraction to a clear mission of peace-making through health equity. Such a model provides for flexible recruitment of globally diverse experts, though it risks a lack of coordination. Until recently, the PAHS IAB has not enjoyed significant or formal support from any single international institution. However, an increasing number of the international consultants recruited by PAHS to its International Advisory Board are from the University of Alberta in Edmonton, Alberta, Canada (UAlberta). The number of UAlberta Faculty of Medicine and Dentistry members involved in the project has risen to fifteen, providing a critical mass for a coordinated effort to leverage institutional support for this partnership. This paper describes the organic growth of the UAlberta group supporting PAHS, and the ways in which it supports a sister institution in a developing nation.
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Affiliation(s)
- Kim Solez
- University of Alberta, Alberta, Canada.
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Ezekowitz JA, Thai V, Hodnefield TS, Sanderson L, Cujec B. The correlation of standard heart failure assessment and palliative care questionnaires in a multidisciplinary heart failure clinic. J Pain Symptom Manage 2011; 42:379-87. [PMID: 21444186 DOI: 10.1016/j.jpainsymman.2010.11.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Revised: 11/27/2010] [Accepted: 12/03/2010] [Indexed: 11/20/2022]
Abstract
CONTEXT Heart failure (HF) is a leading cause of death and disability, and despite optimal care, patients may eventually require palliative care. Little is known about how palliative care questionnaires (the Edmonton Symptom Assessment Scale [ESAS] and the Palliative Performance Scale [PPS]) perform compared with HF assessment using the New York Heart Association (NYHA) functional class and the Kansas City Cardiomyopathy Questionnaire (KCCQ). OBJECTIVES To assess the utility of a palliative care questionnaire in patients with HF. METHODS One hundred and five patients (mean age=65 years, 76% male, mean ejection fraction=28%) followed in an HF clinic were surveyed with the NYHA, PPS, ESAS, and KCCQ. RESULTS The PPS and ESAS were each correlated to the NYHA class (P<0.0001 for both) and the KCCQ score (PPS: R(2)=0.57; ESAS: R(2)=-0.72; both P<0.0001). There were 33 patients who either died (10 deaths) or were hospitalized (26 patients) for more than one year. In addition to age and gender, a higher (worse) ESAS score trended toward significance (P=0.07) and a lower (worse) PPS was a significant (P=0.04) predictor of all-cause hospitalization or death. CONCLUSION In a cohort of HF patients, we found a modest correlation with NYHA class and KCCQ assessment with the PPS and ESAS, two standard palliative care questionnaires. Given the difficulty in identifying patients with HF eligible for palliative or hospice care, these tools may be of use in clinical practice.
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Affiliation(s)
- Justin A Ezekowitz
- Division of Cardiology and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta.
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Cujec B, Quan H, Jin Y, Johnson D. The Effect of Age upon Care and Outcomes in Patients Hospitalized for Congestive Heart Failure in Alberta, Canada. Can J Aging 2010. [DOI: 10.1353/cja.2004.0030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
ABSTRACTWe describe the age-specific outcomes for patients hospitalized with newly diagnosed congestive heart failure using administrative hospital abstracts from Alberta, Canada, from April 1, 1994, to March 31, 2000. Seniors (aged 65 years and older) constituted about 85 per cent of the 16,162 patients. Both co-morbidity and severity of illness tended to increase with age. The use of special care unit admissions, coronary artery diagnostic services (cardiac catheterization), and revascularization procedures (percutanenous transluminal coronary angioplasty/stenting, coronary artery bypass surgery) peaked in the 50-to 64-year age group and decreased with increasing age. Specialist/sub-specialist care, prescriptions of beta blockers and angiotensin-converting enzyme inhibitors / angiotensin receptor blockers decreased with age in seniors. Adjusted in-hospital, 1-year mortality and crude, age-specific 5-year mortality were significantly greater in those 75 years and older. Outcomes and process of care in patients with newly diagnosed congestive heart failure were not uniformly distributed with age. The elderly had greater mortality but received less therapy.
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McAlister FA, Quan H, Fong A, Jin Y, Cujec B, Johnson D. Effect of invasive coronary revascularization in acute myocardial infarction on subsequent death rate and frequency of chronic heart failure. Am J Cardiol 2008; 102:1-5. [PMID: 18572027 DOI: 10.1016/j.amjcard.2008.02.089] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2007] [Revised: 02/26/2008] [Accepted: 02/26/2008] [Indexed: 11/18/2022]
Abstract
There is debate about whether therapies that reduce mortality in acute myocardial infarction (AMI) will increase the risk for heart failure. In this study, an inception cohort of patients hospitalized with AMIs from April 1, 1994, to March 31, 1999 (without previous diagnoses of heart failure or myocardial infarction), were followed for a mean of 32 months to explore whether invasive coronary revascularization during the index AMI hospitalization was associated with a trade-off between reduced mortality in the short term and increased heart failure in the intermediate term. Of 13,472 patients (mean age 65 +/- 13 years, 70% men), 3,278 (24%) underwent invasive coronary revascularization during their index AMI hospitalizations. Patients who underwent invasive revascularization during their index AMI hospitalizations were less likely to die (171 of 3,278 [5%] vs 1,688 of 10,194 [17%], p <0.0001) and were less likely to develop heart failure, either during the AMI hospitalization (571 of 3,278 [17%] vs 2,422 of 10,194 [24%], p <0.0001) or after discharge (144 of 3,278 [4%] vs 754 of 10,194 [7%], p <0.0001). These associations persisted after covariate adjustment (for heart failure, hazard ratio 0.68, 95% confidence interval 0.56 to 0.81; for death or heart failure, hazard ratio 0.60, 95% confidence interval 0.51 to 0.70). In conclusion, invasive coronary revascularization during AMI hospitalization is associated with lower rates of death and subsequent heart failure; there is no trade-off of 1 outcome for the other.
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Affiliation(s)
- Finlay A McAlister
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Chan KL, Tam J, Dumesnil JG, Cujec B, Sanfilippo AJ, Jue J, Turek M, Robinson T, Williams K. Effect of Long-Term Aspirin Use on Embolic Events in Infective Endocarditis. Clin Infect Dis 2008; 46:37-41. [DOI: 10.1086/524021] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Toma M, McAlister FA, Ezekowitz J, Kimber S, Gulamhusein S, Pantano A, Sivakumaran S, Cujec B, Paterson I, Armstrong PW. Proportion of patients followed in a specialized heart failure clinic needing an implantable cardioverter defibrillator as determined by applying different trial eligibility criteria. Am J Cardiol 2006; 97:882-5. [PMID: 16516594 DOI: 10.1016/j.amjcard.2005.09.138] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2005] [Revised: 09/23/2005] [Accepted: 09/23/2005] [Indexed: 11/26/2022]
Abstract
Numerous trials have demonstrated survival benefits using implantable cardioverter defibrillators (ICDs) for primary prevention in selected patients with left ventricular (LV) systolic dysfunction. However, eligibility criteria differed across these trials. Without a risk stratification scheme that clearly identifies those who will benefit, there remains debate about which patients with heart failure (HF) should receive ICDs for primary prevention. To explore the implications of applying different eligibility criteria, this study evaluated all patients seen in a specialized HF clinic from August 2003 to January 2004. Of the 309 consecutive patients in the cohort, 46 were excluded because their HF complicated recent myocardial infarcts (n = 3); their LV ejection fractions were not measured (n = 9); or their HF was due to valvular disease, myocarditis, or peripartum cardiomyopathy (n = 34). The Multicenter Automatic Defibrillator Implantation Trial-II criteria were met by 85 patients (32%), and 134 patients (51%) met the Sudden Cardiac Death in Heart Failure Trial criteria. Even allocation decisions based on randomized trial evidence can have vastly different resource implications depending on which trial is chosen. Thus, the development and validation of a risk stratification scheme to identify those patients most likely to benefit from ICDs for primary prophylaxis should be a research priority.
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Affiliation(s)
- Mustafa Toma
- Division of General Internal Medicine, University of Alberta, Edmonton, Canada
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McAlister FA, Tu JV, Newman A, Lee DS, Kimber S, Cujec B, Armstrong PW. How many patients with heart failure are eligible for cardiac resynchronization? Insights from two prospective cohorts. Eur Heart J 2005; 27:323-9. [PMID: 16105850 DOI: 10.1093/eurheartj/ehi446] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
AIMS To determine what proportion of patients with heart failure are eligible for cardiac resynchronization therapy (CRT). METHODS AND RESULTS Eligibility criteria from the trials establishing the efficacy of CRT were applied to two prospective cohorts: the first enrolled patients with newly diagnosed heart failure discharged from 103 hospitals between April 1999 and March 2001 ('the hospital discharge cohort'); the second enrolled patients seen in a specialized clinic between August 2003 and January 2004 ('the specialty clinic cohort'). In the hospital discharge cohort, 73 patients (3% of the 2640 patients with ischaemic or dilated cardiomyopathy and 1% of all 9096 patients with heart failure discharged alive) met trial eligibility criteria: LVEF< or =0.35, QRS > or =120 ms, sinus rhythm, and NYHA class III or IV symptoms despite the treatment with ACE-inhibitor/angiotensin receptor blocker and beta-blocker. In the specialty clinic cohort, 54 patients (21% of the 263 patients with ischaemic or dilated cardiomyopathy and 17% of all 309 patients with heart failure) met these criteria. If persistent symptoms despite taking spironolactone were required for CRT eligibility, then the proportions qualifying dropped to 1% in the hospital discharge cohort and 18% in the specialty clinic cohort. CONCLUSION Few heart failure patients meet trial eligibility criteria for CRT.
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Affiliation(s)
- Finlay A McAlister
- The Division of General Internal Medicine, 2E3.24 Walter Mackenzie Health Sciences Centre, University of Alberta, 8440 112 Street, Edmonton, Alberta T6G 2R7, Canada.
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Sanfilippo AJ, Bewick D, Chan KL, Cujec B, Dumesnil JG, Honos G, Munt B, Sasson Z, Tam J, Tomlinson C, Aboguddah A, Ahmed S, Ali M, Arsenault M, Ascah K, Ashton T, Baird M, Basmadjian A, Beique F, Blakeley M, Blais MJ, Burggraf G, Burwash I, Cochrane J, Fagan S, Giannoccaro P, Hughes W, Jones A, Jue J, Koilpillai C, Leblanc MH, Londry C, Morgan D, O'Reilly M, Sawchuk C, Siu S, Sochowski R, Tremblay G, Welikovitch L, Yu E. Guidelines for the provision of echocardiography in Canada: recommendations of a joint Canadian Cardiovascular Society/Canadian Society of Echocardiography Consensus Panel. Can J Cardiol 2005; 21:763-80. [PMID: 16082436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
Recognizing the central role of echocardiographic examinations in the assessment of most cardiac disorders and the need to ensure the provision of these services in a highly reliable, timely, economical and safe manner, the Canadian Cardiovascular Society and Canadian Society of Echocardiography undertook a comprehensive review of all aspects influencing the provision of echocardiographic services in Canada. Five regional panels were established to develop preliminary recommendations in the five component areas, which included the echocardiographic examination, the echocardiographic laboratory and report, the physician, the sonographer and indications for examinations. Membership in the panels was structured to recognize the regional professional diversity of individuals involved in the provision of echocardiography. In addition, a focus group of cardiac sonograhers was recruited to review aspects of the document impacting on sonographer responsibilities and qualification. The document is intended to be used as a comprehensive and practical reference for all of those involved in the provision of echocardiography in Canada.
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Cujec B, Quan H, Jin Y, Johnson D. Association between physician specialty and volumes of treated patients and mortality among patients hospitalized for newly diagnosed heart failure. Am J Med 2005; 118:35-44. [PMID: 15639208 DOI: 10.1016/j.amjmed.2004.08.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2002] [Accepted: 08/09/2004] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess the effects of hospital care by a specialist or nonspecialist physician, and by volume of treated patients, on mortality among hospitalized patients with newly diagnosed heart failure. METHODS Data describing heart failure patients in Alberta, Canada, from April 1, 1994, to March 31, 2000, were extracted from hospital abstracts and analyzed using hierarchical regression, with adjustment for patient demographic characteristics, comorbid conditions, physician volume, physician specialty, and hospital volume. RESULTS There were 16,162 hospital discharges for heart failure. Nonspecialist physicians were predominantly in the two lowest-volume quartiles (93%) and specialists were predominantly in the two highest-volume quartiles (68%). Considering the effects of volume alone and after adjustment for comorbidity, for each 10 additional hospital patients treated by a physician, the odds ratio for in-hospital mortality was 0.97 (95% confidence interval [CI]: 0.95 to 0.98), and the odds ratio for 1-year mortality was 0.99 (95% CI: 0.98 to 0.999). In analyses that considered both volume and specialty, the odds of in-hospital mortality decreased by 4% for each 10 additional in-hospital patients treated by a physician (odds ratio [OR] = 0.96; 95% CI: 0.95 to 0.98). In these same analyses, the odds ratio for in-hospital mortality was 1.32 (95% CI: 1.13 to 1.53) for general practitioners with specialist consultation and 1.32 (95% CI: 1.08 to 1.61) for specialists compared with general practitioners without specialist consultations. At 1 year, mortality was not associated significantly with the volume of in-hospital patients treated, or with the specialty of the treating physician. CONCLUSION Treatment by high-volume physicians during hospitalization for newly diagnosed heart failure was associated with a decrease in mortality, but these benefits did not persist at 1 year. The increased mortality noted in patients treated by specialists may be due to residual confounding or unmeasured comorbidity.
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Affiliation(s)
- Bibiana Cujec
- Department of Medicine, University of Alberta, Canada.
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Cujec B, Jin Y, Quan H, Johnson D. The province of Alberta, Canada avoids the hospitalization epidemic for congestive heart failure patients. Int J Cardiol 2004; 96:203-10. [PMID: 15262034 DOI: 10.1016/j.ijcard.2003.06.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2003] [Revised: 06/06/2003] [Accepted: 06/09/2003] [Indexed: 10/26/2022]
Abstract
BACKGROUND We assessed the incidence and prevalence of congestive heart failure (CHF) in patients diagnosed at the time of hospitalization and patients diagnosed in specialists offices without prior hospitalization in order to compare the trends in Canada with previously published trends in the USA and other industrialized countries. METHODS Administrative data for Alberta, Canada from 1 April 1994 to 31 March 2000. RESULTS There was a small but statistically significant decline in the age-sex incident and prevalent hospitalization rates for CHF between 1994/1995 (incidence per 1000 of 1.59; 99% CI 1.51, 1.66: prevalence per 1000 of 2.31; 99% CI 2.22, 2.40) and the year 1999/2000 (incidence per 1000 of 1.24; 99% CI 1.18, 1.30: prevalence per 1000 of 1.97; 99% CI 1.89, 2.05). Crude hospitalization rate per 1000 also demonstrated a small but statistically significant decline between 1994/1995 (2.98; 99% CI 2.88, 3.08) and 1999/2000 (2.55; 99% CI 2.46, 2.64). The age-sex incident rates of ambulatory diagnosis of CHF were similar throughout the 1994/1995-1999/2000 time period (0.88; 99% CI 0.82, 0.94 during 1994/1995 and 0.84; 99% CI 0.79, 0.89 during 1999/2000). The crude mortality percentage for incident hospitalization for CHF were similar throughout the 1994/1995-1999/2000 time period (31.0%; 99% CI 28.7, 33.3 during 1994/1995 and 28.6%; 99% CI 26.3, 30.9 during 1999/2000). CONCLUSIONS We noted a small decrease in the incident, prevalent, and total hospitalizations for CHF in the time period 1994/1995-1999/2000. The decrease was not the result of a substituted increase in ambulatory diagnosis for CHF.
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Affiliation(s)
- Bibiana Cujec
- Division of Cardiology, Department of Medicine, University of Alberta, 2C2.39 WMC, Edmonton, Alta., Canada T6G 2B7.
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Abstract
UNLABELLED Home care services are provided to about 10% of those admitted to hospital for acute myocardial infarction and about 20% of those discharged from hospital. The use of home care in patients with an acute myocardial infarction is growing in Alberta over the brief time span of this four year study. Those that received home care prior to a hospitalization for acute myocardial infarction were "old and frail" with a high mortality rate during and after hospitalization. The provision of home care after hospitalization selected those patients that stay in hospital longer and required more hospital care. BACKGROUND The use of home care before and after hospitalization for acute myocardial infarction is described. METHODS Hospital discharge abstracts were used to identify patients hospitalized in alberta, canada for acute myocardial infarction which were then linked to home care administrative data. RESULTS There were 12,648 patients with acute myocardial infarction from April 1, 1995 until March 31, 1999. Home care within 60 days prior to hospitalization was provided for 8.7% of patients with acute myocardial infarctions (n = 1097) which significantly (p = 0.023) increased from 7.6% in the fiscal year 1995/6 to 9.5% in the fiscal year 1998/9. Home care within 60 days after hospitalization was provided to 16.4% of patients with acute myocardial infarctions (n = 2076) which significantly (p < 0.000) increased from 14.1% in the fiscal year 1995/6 to 18.1% in fiscal year 1998/9. Recipients of home care were significantly older, had more comorbidities, and greater severity of illness, but were less likely to undergo coronary artery revascularization during hospitalization. After multivariate adjustment, length of hospital stay, 60 day re-admissions, and mortality were higher in those receiving home care post hospitalization. Nearly half of those receiving home care prior to hospitalization died within one year. 80% of those receiving home care prior to admission also received home care services after hospitalization. CONCLUSION Those patients who received home care prior to a hospitalization for acute myocardial infarction were "old and frail" with a high mortality rate during and after hospitalization. The provision of home care after hospitalization selected those patients that stay in hospital longer and required more hospital care.
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Affiliation(s)
- Hude Quan
- Department of Community Health Sciences, University of Calgary, AB.
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Tandon P, McAlister FA, Tsuyuki RT, Hervas-Malo M, Dupuit R, Ezekowitz J, Cujec B, Armstrong PW. The use of beta-blockers in a tertiary care heart failure clinic: dosing, tolerance, and outcomes. ACTA ACUST UNITED AC 2004; 164:769-74. [PMID: 15078647 DOI: 10.1001/archinte.164.7.769] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Little is known about the dosing, tolerability, and impact of beta-blockers in nontrial participants. This study was conducted to evaluate the use and outcomes of beta-blockers in a tertiary care heart failure clinic. METHODS Analysis of prospectively collected data from a cohort of 1041 patients with heart failure seen at the University of Alberta Heart Function Clinic, Edmonton, from September 1, 1989, through July 1, 2001, with objective measurement of ejection fraction at baseline and prospective collection of data at all subsequent clinic visits. RESULTS Median age at baseline was 69 years; 65% were male; 75% had systolic dysfunction; mean ejection fraction was 33%; and 51% had New York Heart Association class III or IV symptoms. Median duration of follow-up was 32 months (interquartile range, 13-62 months). Overall, 46% of patients received beta-blockers, but only 18% of these were ultimately prescribed the dosages achieved in the trials (mean maximum dosages achieved, 27 mg/d for carvedilol and 81 mg/d for metoprolol tartrate). Of those patients prescribed beta-blockers, 74% continued to receive them during follow-up. Blood pressure, heart rate, and failure symptomatology did not change appreciably before and after beta-blockers were prescribed, or during the upward titration of the dosage. Although our patients were prescribed lower dosages than those used in trials, Cox multivariate regression revealed that beta-blockers were associated with improved survival, even after adjusting for potential confounders including New York Heart Association class, year of prescription, and concomitant medication use (relative risk, 0.63; 95% confidence interval, 0.50-0.81). CONCLUSIONS The benefits of beta-blockers seen in randomized trials extend to nontrial participants treated in a tertiary care clinic specializing in heart failure. In our cohort of elderly patients with multiple comorbidities, beta-blockers were well tolerated.
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Affiliation(s)
- Puneeta Tandon
- Division of General Internal Medicine, University of Alberta, Edmonton, Canada
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Chan KL, Dumesnil JG, Cujec B, Sanfilippo AJ, Jue J, Turek MA, Robinson TI, Moher D. Reply. J Am Coll Cardiol 2004. [DOI: 10.1016/j.jacc.2003.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Quan H, Cujec B, Jin Y, Johnson D. Acute myocardial infarction in Alberta: temporal changes in outcomes, 1994 to 1999. Can J Cardiol 2004; 20:213-9. [PMID: 15010746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND The current survival trends in patients with acute myocardial infarction (AMI) are not known. A population-based study using administrative data to examine the short and long term survival of patients after AMI in Alberta between 1994 and 1999 was conducted. METHODS AMI patients were identified from hospital discharge data. Temporal changes in the adjusted (age, sex, AMI anatomical location and comorbidities) fatality rate were analyzed in 19,928 AMI patients. RESULTS The age- and sex-adjusted incidence of hospitalization for AMI in Alberta significantly declined from 169.6 per 100,000 population in 1994 to 160.8 per 100,000 in 1999 (P=0.03). The risk-adjusted in-hospital case fatality rate from all causes was 11.4% (95% CI 10.6% to 12.3%) in 1994 versus 9.2% (8.4% to 10.1%) in 1999; the 30-day case fatality rate was 12.6% (11.7% to 13.6%) in 1994 versus 10.1% (9.1% to 11.0%) in 1999; and the one-year case fatality rate was 19.0% (17.8% to 20.1%) in 1994 versus 14.9% (13.8% to 16.0%) in 1999. The percentage of hospitalized AMI patients who underwent coronary angiography within one year after admission rose from 48.2% in 1994 to 52.4% in 1999; percutaneous transluminal coronary angioplasty increased from 25.5% to 35.0% and coronary artery bypass surgery increased from 9.7% to 12.6%. Prescriptions for pharmacological drugs at discharge increased from 1994 to 1999 among patients aged 65 and older: from 29.5% in 1994 to 41.0% in 1999 for beta-blockers, from 5.2% to 18.7% for lipid lowering agents and from 14.0% to 20.5% for angiotensin-converting enzyme inhibitors. INTERPRETATION There was a modest improvement in patient survival after AMI between 1994 and 1999. The improvements may be associated with increasing use of revascularization and pharmacological therapy provided in the management of AMI.
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Affiliation(s)
- Hude Quan
- Department of Community Health Sciences, Centre for Health and Policy Studies, University of Calgary, Quality Improvement and Health Information, Calgary Health Region, Alberta.
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Cujec B, Quan H, Jin Y, Johnson D. The effect of age upon care and outcomes in patients hospitalized for congestive heart failure in Alberta, Canada. Can J Aging 2004; 23:255-67. [PMID: 15660299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
We describe the age-specific outcomes for patients hospitalized with newly diagnosed congestive heart failure using administrative hospital abstracts from Alberta, Canada, from April 1, 1994, to March 31, 2000. Seniors (aged 65 years and older) constituted about 85 per cent of the 16,162 patients. Both co-morbidity and severity of illness tended to increase with age. The use of special care unit admissions, coronary artery diagnostic services (cardiac catheterization), and revascularization procedures (percutaneous transluminal coronary angioplasty/stenting, coronary artery bypass surgery) peaked in the 50-to 64-year age group and decreased with increasing age. Specialist/sub-specialist care, prescriptions of beta blockers and angiotensin-converting enzyme inhibitors / angiotensin receptor blockers decreased with age in seniors. Adjusted in-hospital, 1-year mortality and crude, age-specific 5-year mortality were significantly greater in those 75 years and older. Outcomes and process of care in patients with newly diagnosed congestive heart failure were not uniformly distributed with age. The elderly had greater mortality but received less therapy.
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Affiliation(s)
- Bibiana Cujec
- Department of Medicine, University of Alberta, Division of Cardiology, 2C2.39 WMC, Edmonton, Alberta T6G 2B7.
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Johnson D, Jin Y, Quan H, Cujec B. Beta-blockers and angiotensin-converting enzyme inhibitors/receptor blockers prescriptions after hospital discharge for heart failure are associated with decreased mortality in Alberta, Canada. J Am Coll Cardiol 2003; 42:1438-45. [PMID: 14563589 DOI: 10.1016/s0735-1097(03)01058-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES We sought to evaluate the common utilization of beta-blockers and angiotensin-converting enzyme (ACE) inhibitors or receptor blockers (RBs) in congestive heart failure (CHF). BACKGROUND We assessed the association between prescriptions of beta-blockers and ACE inhibitors or RBs within three months after hospitalization and mortality for newly diagnosed CHF in Alberta, Canada seniors (age 65 years and older). METHODS Administrative hospital discharge abstracts and drug data during October 1, 1994, to December 31, 1999, were analyzed. RESULTS There were 11854 hospitalizations for newly diagnosed CHF. The use of beta-blockers within three months after hospitalization increased from 7.3% in 1994-1995 to 20.9% in 1999-2000. The use of ACE inhibitor or RBs within three months after hospitalization increased from 31.0% in 1994-1995 to 44.3% in 1999-2000. Adjusted one-year mortality was lower in seniors with prescriptions for beta-blockers (18.2%; 95% confidence interval [CI] 14.2 to 22.2), ACE inhibitors/RBs (22.3%; 95% CI 20.9 to 23.7), or both (16.6%; 95% CI 13.3 to 20.0), compared with those with no prescriptions (29.9%; 95% CI 28.8 to 31.0). Absolute adjusted risk reduction comparing no prescription with prescription of both beta-blockers or ACE inhibitors/RBs was 13.3% for a relative adjusted risk reduction of 44%. CONCLUSIONS This study of incident CHF hospitalizations among seniors demonstrates an association between decreased mortality and the use of beta-blockers, ACE inhibitors/RBs, or combination of both. The effectiveness of beta-blockers and ACE inhibitors/RBs for CHF should be more broadly tested in clinical trials that recruit older patients and those with diastolic dysfunction.
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Affiliation(s)
- David Johnson
- Division of Critical Care Medicine, University of Alberta, Alberta, Canada
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Chan KL, Dumesnil JG, Cujec B, Sanfilippo AJ, Jue J, Turek MA, Robinson TI, Moher D. A randomized trial of aspirin on the risk of embolic events in patients with infective endocarditis. J Am Coll Cardiol 2003; 42:775-80. [PMID: 12957419 DOI: 10.1016/s0735-1097(03)00829-5] [Citation(s) in RCA: 143] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES This study examined the effect of aspirin on the risk of embolic events in infective endocarditis (IE). BACKGROUND Embolism is a major complication of IE, and studies in animal models have shown that platelet inhibition with aspirin can lead to more rapid vegetation resolution and a lower rate of embolic events. METHODS We conducted a randomized, double-blinded, placebo-controlled trial of aspirin treatment (325 mg/day) for four weeks in patients with IE to test the hypothesis that the addition of aspirin would reduce the incidence of clinical systemic embolic events. Patients with perivalvular abscess were excluded. Serial cerebral computed tomograms and transesophageal echocardiograms were obtained in a subset of patients. RESULTS During the four-year study period, 115 patients were enrolled: 60 assigned to aspirin and 55 assigned to placebo. Embolic events occurred in 17 patients (28.3%) on aspirin and 11 patients (20.0%) on placebo, with an odds ratio (OR) of 1.62 (95% confidence interval [CI] 0.68 to 3.86, p = 0.29). There was a trend toward a higher incidence of bleeding in the patients taking aspirin versus placebo (OR 1.92, 95% CI 0.76 to 4.86, p = 0.075). Development of new intracranial lesions was similar in both groups. Aspirin had no effect on vegetation resolution and valvular dysfunction. CONCLUSIONS In endocarditis patients already receiving antibiotic treatment, the addition of aspirin does not appear to reduce the risk of embolic events and is likely associated with an increased risk of bleeding. Aspirin is not indicated in the early management of patients with IE.
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Affiliation(s)
- Kwan-Leung Chan
- Department of Medicine, University of Ottawa and University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, Canada K1Y 4W7.
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Abstract
OBJECTIVES We compare the hospitalization rate, duration, cost, and mortality for newly diagnosed congestive heart failure in patients admitted to rural and metropolitan hospitals in one Canadian province. METHODS Administrative data for Alberta, Canada, from April 1, 1994, to March 31, 2000. RESULTS Hospitalizations (16,162) for newly diagnosed congestive heart failure constituted 50% of all hospitalizations for congestive heart failure. Hospitals were distributed as follows: rural with less than 200 cases (21% of hospitalizations), rural with 204 to 646 cases (21% of hospitalizations), regional (13% of hospitalizations), metropolitan with angiography capability (24% of hospitalizations), and metropolitan without angiography capability (21% of hospitalizations). The hospitalization rate per 1000 population was lower for residents of metropolitan regions (1.01; 95% confidence interval [CI] 0.97 to 1.05) compared with residents of rural (1.70; 95% CI 1.65 to 1.75) and regional (1.95; 95% CI 1.90 to 2.00) health regions. Patient comorbidity and severity scores were lower in rural hospitals. Special care unit admissions and cardiac catheterizations were more frequent in patients admitted to metropolitan hospitals. After adjustment, the length of stay and mortality were similar amongst all hospital types. Adjusted hospital total costs were about 23% (900 Canadian dollars) greater in metropolitan hospitals with angiography capability compared to rural hospitals. CONCLUSION Hospital admission rates for newly diagnosed congestive heart failure were lower for metropolitan residents compared to non-metropolitan residents. Cost per admission was greatest in metropolitan hospitals with angiography capability compared to other hospital types.
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Affiliation(s)
- Yan Jin
- Research and Evidence, Alberta Health and Wellness, Alberta, Canada
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Oancia T, Bohm C, Carry T, Cujec B, Johnson D. The influence of gender and specialty on reporting of abusive and discriminatory behaviour by medical students, residents and physician teachers. Med Educ 2000; 34:250-256. [PMID: 10733720 DOI: 10.1046/j.1365-2923.2000.00561.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
INTRODUCTION The perception of whether a given behaviour is abusive differs between students and teachers. We speculated that attitudes towards reporting abusive and discriminatory behaviour may vary by specialty as well as by gender. METHODS We report a cross-sectional survey of incoming medical students, medical students, residents, and teaching faculty at one Canadian medical school. The discrimination and abuse questions were in the following domains: (i) psychological abuse, (ii) sexual abuse, (iii) physical abuse, (iv) gender discrimination, (v) racial discrimination, (vi) disability discrimination, (vii) derogatory remarks regarding homosexuality. The frequency of self-reported witnessed or experienced abusive and discriminatory behaviour was compared by gender, specialty choice and stage of training. RESULTS The response rates varied by respondent group: 44/56 (79%) of incoming medical students, 177/218 (81%) of medical students, 134/206 (65%) of residents and 215/554 (38%) of physician teachers. The frequency of these behaviours was perceived to be low by both male and female respondents. Abusive and discriminatory behaviour by physician teachers was noted more frequently by residents (P < 0.001) and physician teachers themselves (P < 0.001) compared with incoming medical students. As well, in general, women noted more abusive and discriminatory behaviour by all teachers, compared with men (P < 0. 003). Each response to the abuse/discrimination questions was also modelled as the independent variable using stepwise multiple regression. The area of specialization (surgical versus non-surgical) altered the reporting of abusive and discriminatory behaviour by women. CONCLUSION We conclude that female surgical residents and medical students undergo a process of acclimatization to the patriarchal surgical culture. As female surgeons become physician teachers they revert to a culture more similar to that of their female non-surgical colleagues. Although a process of deidealization occurs in medical training, these attitudes are not necessarily retained throughout the practising lifetime of physicians as they regain autonomy and more personal control.
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Affiliation(s)
- T Oancia
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Cujec B, Oancia T, Bohm C, Johnson D. Career and parenting satisfaction among medical students, residents and physician teachers at a Canadian medical school. CMAJ 2000; 162:637-40. [PMID: 10738448 PMCID: PMC1231217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Studies of career and parenting satisfaction have focused separately on medical students, residents and practising physicians. The objective of this study was to compare satisfaction across a spectrum of stages of medical career. METHODS A survey of incoming medical students, current medical students, residents and physician teachers at the University of Saskatchewan was conducted in the spring of 1997. Response rates were 77% (43/56), 81% (177/218), 65% (134/206) and 39% (215/554) respectively. Factors assessed in the stepwise regression analysis were the effect of sex, parenting and level of training on the likelihood of recommending parenting to medical students or residents, and on parenting dissatisfaction, job dissatisfaction, career dissatisfaction and the importance of flexibility within the college program to accommodate family obligations. RESULTS More male than female physician teachers had partners (92% v. 81%, p < 0.01) and were parents (94% v. 72%, p < 0.01). Female physician teachers spent equal hours per week at work compared with their male counterparts (mean 52 and 58 hours respectively) and more than double the weekly time on family and household work (36 v. 14 hours, p < 0.01). Physician teachers were the most likely respondents to recommend parenting to residents and their peers. Residents were the most dissatisfied with their parenting time. At all career stages women were less likely than men to recommend parenting, were more dissatisfied with the amount of time spent as parents and were more likely to regard flexibility within the college program as beneficial. There were no sex-related differences in job dissatisfaction and career dissatisfaction. However, married women were more dissatisfied with their jobs than were married men. Job dissatisfaction was greatest among medical students, and career dissatisfaction was greatest among residents. INTERPRETATION The optimal timing of parenthood appears to be upon completion of medical training. Women were less likely to recommend parenting, less satisfied with the time available for parenting and more likely to value flexibility within the college program to accommodate family needs. These differences did not translate into women experiencing more job or career dissatisfaction.
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Affiliation(s)
- B Cujec
- Department of Medicine, University of Saskatchewan, Saskatoon.
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Cujec B, Mainra R, Johnson DH. Prevention of recurrent cerebral ischemic events in patients with patent foramen ovale and cryptogenic strokes or transient ischemic attacks. Can J Cardiol 1999; 15:57-64. [PMID: 10024860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Patent foramen ovale (PFO) is found in up to 50% of patients less than 55 years of age who have had a stroke. Therapeutic options include no therapy, antiplatelet therapy, warfarin and surgical closure of the PFO. OBJECTIVES To determine the relative and attributable risks of PFO for recurrent cerebral ischemic events in young patients with stroke or transient ischemic attacks. The predictors of recurrent cerebral ischemic events and the effects of different therapies on recurrence rates were sought. DESIGN Follow-up of a retrospective cohort of patients with cryptogenic stroke or transient ischemic attacks identified from an echocardiography database. SETTING University-based regional neurology referral centre. PATIENTS Consecutive group of 90 patients less than 60 years of age who underwent transesophageal echocardiography following a cryptogenic transient ischemic attack (TIA) or stroke (cerebrovascular accident [CVA]) between 1991 and 1997. INTERVENTIONS Structured telephone interviews and chart reviews. RESULTS Fifty-two patients had a PFO, and 38 patients did not have a PFO. During a mean follow-up of 46 months, 19 recurrent cerebral ischemic events (12 TIA and seven CVA) occurred in 14 patients with PFO, and eight recurrent events (three TIA and five CVA) occurred in six patients without PFO. The recurrence rates were 12% and 5%/patient/year in the PFO and control groups, respectively, for a crude recurrence rate ratio of 2.39 (95% CI 1.01 to 6.32, P < 0.03). The attributable risk of PFO in recurrent neurological events was 7%/patient/year. In a Cox regression model, predictors of recurrent neurological events were presence of PFO (hazard ratio 5.27, 95% CI 1.58 to 17.6, P < 0.007), history of migraine (hazard ratio 4.54, 95% CI 1.11 to 18.52, P < 0.035), hypertension requiring therapy (hazard ratio 3.5, 95% CI 1.33 to 9.01, P < 0.01), and antiplatelet or no therapy instead of warfarin therapy (hazard ratio 2.88, 95% CI 1.11 to 8.7, P < 0.04). Fourteen patients underwent surgical closure of PFO; there were no neurological recurrences during a mean follow-up of 43 months (crude incidence rate difference 12%/patient/year, 95% CI 6.6 to 17.9, P < 0.02). CONCLUSIONS Patients with PFO had a significantly higher rate of recurrent cerebral ischemic events than those without PFO. Surgical PFO closure prevented any recurrences during a mean follow-up of 43 months. Warfarin was better than antiplatelet therapy or no therapy in preventing recurrences.
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Affiliation(s)
- B Cujec
- Department of Medicine, University of Saskatchewan, Saskatoon.
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Abstract
OBJECTIVE Compare resident evaluations by self, nurses, and attending physicians. DESIGN Prospective cohort. SETTING University intensive care unit. SUBJECTS Sixty residents. INTERVENTIONS End-rotational evaluation using a standardized, multiple-choice examination and one of two subjective instruments, Global Rating Scale and Behaviorally Anchored Rating Scale. MEASUREMENTS AND MAIN RESULTS Means for overall competence, using both the Behaviorally Anchored Rating Scale and the Global Rating Scale clustered between 3 to 4 on a 5-point scale. Physicians' evaluations correlated with the multiple-choice test scores (Spearman's rho 0.3082, p = .005, n = 82), whereas neither self-evaluation (Spearman's rho 0.1124, p = .65, n = 42) nor nurses' evaluations (Spearman's rho 0.2060, p = .069, n = 79) had a significant correlation with test scores. Spearman's correlations were not significant for either overall competence or specific medical knowledge by any category of evaluator using the Global Rating Scale. Spearman's rho correlations and kappa statistic between the three types of evaluators (physicians, nurses, and self) for each criterion of the Behaviorally Anchored Rating Scale demonstrated significant correlations between the ratings of physicians and nurses, except for the assessment of humanistic qualities. Pooled clinical skills-history taking (b = 0.277, p <.009), humanistic qualities (b = 0.607, p <.000), and professional attitudes and behavior (b = 0.488, p < .000) systematically differed in ratings comparing self with nurse and physician (by analysis of variance). The explanatory power of the model of ratings (independent variables of year of residency, category of evaluator, evaluation criteria, and interaction terms) was 47.3% (r2adj). CONCLUSIONS Self-rating by residents did not correlate to multiple-choice test scores and differed in some criteria with physicians' or nurses' evaluations. We found many similarities and some differences between physicians' and nurses' evaluations of residents. We speculate that different categories of evaluators assess different aspects of performance. Assessment by a varied group of evaluators should be used when attempts to predict future practice are made.
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Affiliation(s)
- D Johnson
- Department of Critical Care, Royal University Hospital, Saskatoon, SK, Canada
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Cujec B. Surgical Closure of Patent Foramen Ovale is the Preferred Treatment to Prevent Recurrent Cerebral Ischemic Events in Young Patients. J Am Coll Cardiol 1998. [DOI: 10.1016/s0735-1097(97)83884-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cujec B, Mainra R, Johnson D, Voll C. Surgical closure of patent foramen ovale is the preferred treatment to prevent recurrent cerebral ischemic events in young patients. J Am Coll Cardiol 1998. [DOI: 10.1016/s0735-1097(98)80823-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Cujec B, Hurst T, McCuaig R, Antecol D, Mayers I, Johnson D. Inhaled nitric oxide reduction in systolic pulmonary artery pressure is less in patients with decreased left ventricular ejection fraction. Can J Cardiol 1997; 13:816-24. [PMID: 9343030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To assess whether inhaled nitric oxide decreases pulmonary artery pressure in patients with depressed left ventricular ejection fraction. DESIGN Randomized, blinded, crossover clinical trial. SETTING Tertiary care university referral hospital. PATIENTS Thirty-three patients with pulmonary hypertension and left ventricular dysfunction or valvular heart disease were recruited by convenience. INTERVENTIONS Systolic pulmonary artery pressure was measured by Doppler echocardiography during randomized inhalation of either 20 ppm or 40 ppm nitric oxide in 30% oxygen as well as during control periods without nitric oxide. MAIN RESULTS Systolic pulmonary artery pressure was significantly (P < 0.05) decreased with 20 ppm nitric oxide (53.4 +/- 13.9 mmHg) and 40 ppm nitric oxide (53.1 +/- 14.4 mmHg) compared with either initial control (55.8 +/- 15.3 mmHg) or terminal control (56.3 +/- 15.2 mmHg) values. The regression equation for the change in systolic pulmonary artery pressure (y) as predicted by the left ventricular ejection fraction (x) alone for 20 ppm nitric oxide was y = 13.8x-2.9; R2adj = 0.30, P < 0.0001. For 40 ppm nitric oxide alone, the regression equation was y = 16.3x-3.3; R2adj = 0.25, P < 0.0001. Left ventricular ejection fraction was the most explanatory independent variable in the multivariate equation for nitric oxide-induced change in systolic pulmonary artery pressure (R2 = 0.61, P = 0.0000). The change in systolic pulmonary artery pressure was -5.1 +/- 5.2 versus 0.8 +/- 4.9 mmHg (P < 0.0000) in patients with left ventricular ejection fractions greater than 0.25, and 0.25 or less, respectively. CONCLUSIONS These data imply that in patients with left ventricular ejection fraction of 0.25 or less, nitric oxide may not decrease systolic pulmonary artery pressure. Nitric oxide inhalation may result in a paradoxical increase in systolic pulmonary artery pressure in patients with severely depressed left ventricular ejection fraction. This effect would significantly limit the therapeutic role of nitric oxide in patients with severe heart failure.
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Affiliation(s)
- B Cujec
- College of Medicine, Department of Medicine, University of Saskatchewan, Saskatoon.
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Hurst T, Johnson D, Cujec B, Thomson D, Mycyk T, Burbridge B, Mayers I. Depletion of activated neutrophils by a filter during cardiac valve surgery. Can J Anaesth 1997; 44:131-9. [PMID: 9043724 DOI: 10.1007/bf03013000] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To determine whether inclusion of a neutrophil-specific filter into the extracorporeal circuit during open heart valve surgery alters postoperative outcomes. METHODS Convenience sampling of 24 patients undergoing elective open heart valve surgery between July 1993 and June 1994. Patients were randomized to a neutrophil-specific filter (n = 11) or to a standard blood filter (n = 13) during cardiopulmonary bypass. RESULTS Neutrophil-specific filter diminished (P < 0.02) the expression of CD18, a neutrophil surface adhesion molecule, at I (84.5 +/- 4.2 vs 94.8 +/- 3.8%), 4 (80.0 +/- 4.2 vs 95.1 +/- 3.9%) and 24 hr (75.2 +/- 4.2 vs 98.2 +/- 3.9%) post-operatively compared with standard filter. Total white blood cell count, neutrophil count, and pro-inflammatory cytokines (IL-6, IL-8) were similar between groups at all times. Measured outcomes including: PaO2 cardiac index, ejection fraction, haemodynamic variables, use of inotropes, spirometry (FEV1, FVC), and hospitalization duration were similar between groups. CONCLUSIONS Inclusion of the neutrophil filter during open heart valve surgery selectively depletes activated neutrophils. There were no other detectable differences between the two groups and the use of a neutrophil-specific filter in routine clinical practice for patients undergoing open heart valve surgery is not supported.
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Affiliation(s)
- T Hurst
- Department of Anaesthesia, University of Saskatchewan, Saskatoon, Canada
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Mayers I, Hurst T, Johnson D, Cujec B, Ang LC, Thomson D, Fox JA, Blank GS, Saxena A, Richardson JS. Anti-CD18 antibodies improve cardiac function following cardiopulmonary bypass in dogs. J Crit Care 1996; 11:189-96. [PMID: 8977995 DOI: 10.1016/s0883-9441(96)90030-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE Cardiopulmonary bypass is associated with activation of neutrophils, which may adhere to vascular endothelium causing lung, heart, and brain injury. We tested whether blocking neutrophil adherence would improve organ function following cardiopulmonary bypass in dogs. MATERIALS AND METHODS All dogs received a standard anesthetic, and then one group (n = 6) received 2 hours of cardiopulmonary bypass followed by 4 hours of observation. A second group (n = 6) received a monoclonal antibody (6 mg/kg) to CD18, a neutrophil adherence factor, immediately before cardiopulmonary bypass. A third group (n = 6) did not receive cardiopulmonary bypass or antibody. RESULTS Using flow cytometry we found that the antibody bound essentially all neutrophil CD18 sites. All three groups had similar gas exchange and hemodynamics. Lung and heart histology results were similar between groups. By echocardiography, five animals receiving cardiopulmonary bypass alone showed regional wall abnormalities, whereas only one receiving antibody showed wall motion abnormality (P < .05). Following cardiopulmonary bypass, intracellular myocardial pH was higher (P < .05) in the antibody-treated group compared with the group that had cardiopulmonary bypass alone (7.23 +/- 0.05 v 7.07 +/- 0.07 respectively). CONCLUSION Monoclonal antibodies to CD18 can prevent the deterioration in cardiac function routinely observed following cardiopulmonary bypass.
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Affiliation(s)
- I Mayers
- Department of Medicine, University of Saskatchewan, Saskatoon, Canada
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Cujec B, Johnson D. Determining ejection fraction by Doppler echocardiography. Can J Cardiol 1996; 12:1210. [PMID: 9191514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Sharif MN, Schwarz D, Cujec B, Radhi J, Thomson D. Right ventricular nerve sheath tumour and patent foramen ovale presenting with transient ischemic attack. Can J Cardiol 1996; 12:789-91. [PMID: 8842130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
A 66-year-old man presented with dyspnea and a transient ischemic attack. Echocardiography revealed a right ventricular mass and patent foramen ovale. During surgery the mass was found to be a malignant nerve sheath tumour. Several weeks later, the patient developed small bowel obstruction, and laparotomy disclosed multiple metastases involving the small and large bowel. The paper describes the clinical course and management of this patient and reviews the pertinent literature.
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Affiliation(s)
- M N Sharif
- Department of Pathology, Royal University Hospital, University of Saskatchewan, Saskatoon
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Chan KL, Alvarez N, Cujec B, Dumesnil J, Koilpillai C, Patton N, Pollick C. [Standards for performing echocardiography in adults. Subcommittee on Echocardiography. Committee on Standards of the Canadian Society of Cardiology]. Can J Cardiol 1996; 12:722-6. [PMID: 8925470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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Chan KL, Alvarez N, Cujec B, Dumesnil J, Koilpillai C, Patton N, Pollick C. Standards for adult echocardiography training. Canadian Cardiovascular Society Committee. Can J Cardiol 1996; 12:473-6. [PMID: 8640591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Botero CA, Smith CE, Holbrook C, Pinchak AC, Johnson D, Thomson D, Mycyk T, Burbridge M, Mayers I, Wahba NRWM, Belque F, Kleiman SJ, Parker S, Cox P, Holtby H, Roy L, St-Amand MA, Murkin JM, Baird D, Downey DB, Menkis AH, Yang F, Troncy É, Francœur M, Charbonneau M, Vinay P, Blaise G, Splinter WM, Roberts DJ, Rhine EJ, MacNeill HB, Reid CW, McKay WPS, Erjavec M, McKay BWS, Gregson PH, Blanchet T, Kember G, Lavoie J, Vischoff D, Cyrenne L, Villeneuve E, Williot P, Raghupathy AK, Haug R, Punjabi B, Ditzig F, Melnik H, Tessler MJ, Krasner LJ, Corda DM, Solanki K, Layon AJ, Gallagher TJ, Stoltzfus DP, Rabuka SL, Moote CA, Chen RJB, Yee DA, Harrington E, Orser BA, Giffin DM, Gow KW, Phang PT, Walley KR, Warriner CB, Cohen MH, Klahsen AJ, O’Reilly D, McBride J, Ballantyne M, Goranson BD, Lang S, Dust WN, McKerrell J, Martin G, Martin R, Martin D, Valet P, Tétrault JP, Dagenais C, Pirlet M, Dansereau D, D’Orléans-Justes P, Jankowska A, Veillette Y, Mathieson AL, Intrater H, Cruickshank L, Duke PC, Ong BY, Woo V, Schimnowski D, Trosky S, Dalton L, Zabani I, Chilvers CR, Vaghadia H, Merrick PM, Kashkari I, Al-Oufi H, Jolly D, Finucane BT, Weyland W, Fritz U, Landmann H, Schumacher I, English M, Kettler D, Duffy CM, Manninen PH, Chung F, Sundar S, Lobato EB, Florete O, Paige GB, Daloze T, Chartrand DA, St-Laurent D, Fox GS, Rice ML, Doyle DJ, Volgyesi GA, Fisher JA, Slutsky A, Salazkin I, Brown KA, Kulkarni P, Johnson D, Cujec B, McCuaig R, Hurst T, Antecol D, Bellemare F, Couture J, Marchand M, McNeil P, Hung O, Ho-Tai LM, Devitt JH, Noel AG, O’Donnell MP, Greenhow RJ, Cervenko FW, Milne B, Peterson MD, Thomson IR, Hudson RJ, Rosenbloom M, Moon M, Sareen J, Bingham HL, Backman SB, Stein RD, Fox GS, Polosa C, Tessler M, Spadafora SM, Fuller JG, Kim L, Karkouti K, Rose DK, Ferris LE, Rose DK, Cohen MM, Ralley FE, DeVarennes B, Robitaille M, Searle N, Martineau R, Conzen P, Al-Hasani A, Ebert T, Muzi M, Hardy JF, Bélisle S, Couturier A, Robitaille D, Roy M, Gagnon L, Avraamides EJ, Murkin JM, Dryden PJ, O’Connor JP, Jamieson WRE, Reid I, Ansley D, Sadeghi H, Burr LH, Munro AI, Merrick PM, Benaroia M, Baker A, Mazer CD, Errett L, Frenette L, Cox J, Kerns D, Pearce S, Mark D, McDonagh P, DeLlma L, Nathan H, Dupuls JY, Wynands J, Moudgil GC, Johnson JG, Moudgil GM, Hall RI, MacLaren C, Ali MJ, Ballantyne M, Norris D, Beed SD, Menard EA, Noel LP, Bonn GG, Clarke W, Gould HM, Hall LE, Bernard P, Bass J, Reid CW, Kearney RA, Mack CA, Entwistle LM, Bevan JC, Macnab AJ, Veall G, Marsland C, Ries CR, Hamid SK, Selby IR, Sikich N, Splinter WM, Hsu E, McCarthy P, Yang CY, Wu WC, Huang JJ, Chen SY, Luk HN, Chai CY, Lafreniere GK, Brunet DG, Parlow JL, El-Beheiry H, Ouanounou A, Morris M, Carlen P, Morgan PJ, Chapados R, Gauthier M, Knox JWD, LeLorier J, Lin R, Rose K, Garvey B, McBrobm R, McAdam LC, MacDonald JF, Orser BA, koutsoukos G, Belo S, Chin CA, O’Hare B, Lerman J, Endo J, Schwartz AE, Minanov O, Stone JG, Adams DC, Sandhu AA, Pearson ME, Young WL, Michler RE, Cutz E, Kurrek MM, Cohen MM, Fish K, Fish P, Murphy P, Fung D, Noel A, Szalai JP, Robicsek A, Rucker J, Kruger J, Slutsky M, Sommer L, Silverman J, Dickstein J, Naik V, Hemphill DJ, Kurian R, Jeejeebhoy KN, Alahdal OA, Badner NH, Komar WE, Bhandari R, Craen R, Cuillerier D, Dobkowski WB, Smith MH, Vannelli AN, Bourne RB, Rorabeck CH, Doyle JA, Corvo A, Wahba RM, Scheffer N, Tsang JYC, Brush BA, N’Guyen NQ, Orain C, Tougui S, Lavenac G, Milon D, Ritchie ED, Tong D, Norris A, Miniaci A, Vairavanathan SD, FitzPatrick T, Stafford-Smith M, Kardash K, Trihas T, Kleiman SJ, Rossignol M, Bérard D, Martel B, Tétrault JP, Lunt PG, Coombs DW, Halpern S, Peter EA, Janssen P, Mahy J, Douglas MJ, Grange CS, Adams TJ, Wadsworth L, Muir H, Shukla R, Writer D, McLaren R, Liston R, Paetkau D, Ong BY, Segstro R, Littleford J, Hurtado C, Krishnathas A, Lannes M, Fortier J, Su J, Jeganathan R, Vaillancourt S. Abstracts. Can J Anaesth 1996. [DOI: 10.1007/bf03011678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Bree T, Cujec B, Goranson B, Lang S, Stockwell M. Comparison of two methods of local anaesthesia for transesophageal echocardiography. J Am Soc Echocardiogr 1995. [DOI: 10.1016/s0894-7317(05)80165-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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McParland C, Resch EF, Krishnan B, Wang Y, Cujec B, Gallagher CG. Inspiratory muscle weakness in chronic heart failure: role of nutrition and electrolyte status and systemic myopathy. Am J Respir Crit Care Med 1995. [DOI: 10.1164/ajrccm.151.4.7697238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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McParland C, Resch EF, Krishnan B, Wang Y, Cujec B, Gallagher CG. Inspiratory muscle weakness in chronic heart failure: role of nutrition and electrolyte status and systemic myopathy. Am J Respir Crit Care Med 1995; 151:1101-7. [PMID: 7697238 DOI: 10.1164/ajrccm/151.4.1101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Inspiratory muscle weakness has been demonstrated in ambulatory, stable chronic heart failure (CHF) and may contribute to dyspnea during daily living. However, the mechanisms underlying this weakness are unknown. Malnutrition and electrolyte depletion are recognized complications of CHF that may impair skeletal muscle function, and limb muscle weakness and myopathic changes have also been demonstrated in CHF. We examined whether nutrition and electrolyte status contribute to the reduced skeletal muscle strength and whether inspiratory muscle weakness in CHF is part of general skeletal muscle weakness. We measured maximum inspiratory and expiratory mouth pressures as indices of respiratory muscle strength, maximum hand-grip strength as an index of limb muscle strength, anthropometric indices, serum albumin, and total lymphocyte count as indices of nutritional status, and serum electrolytes in 15 stable patients with chronic cardiac pump failure who had no evidence of primary lung disease, and in 15 age-and-sex-matched healthy controls. As compared with the matched controls, the CHF patients had reduced inspiratory muscle strength (p < 0.0025), but their expiratory and limb muscle strength were not significantly reduced. CHF patients were not malnourished; they were heavier than matched controls because of increased body fat (p < 0.05). Serum sodium was significantly lower in the CHF patients than in the controls (p < 0.01), but was within the normal range in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- C McParland
- Division of Respiratory Medicine, University of Saskatchewan, Saskatoon, Canada
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Affiliation(s)
- C Wells
- Department of Medicine, Royal University Hospital, University of Saskatchewan, Saskatoon, Canada
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Mutch WAC, White IWC, Donen N, Thomson IR, Rosenbloom M, Cheang M, West M, Bryson G, Mundi C, Dupuis JY, Bourke M, McDonagh P, Curran M, Kitts J, Wynands JE, Carr AS, Hartley EJ, Holtby HM, Cox P, Macpherson BA, Baker JE, Baker AJ, Mazer CD, Peniston C, David T, Cheng DCH, Karski J, Asokumar B, Carroll J, Nierenberg H, Roger S, Sandier AN, Tong J, Feindel CM, Boylan JF, Teasdale SJ, Boylan J, Harley P, Froelich JE, Archer DP, Ewen A, Samanani N, Roth SH, Hall RI, Neumeister M, Dawe G, Cody C, O’Brien R, Shields-Thomson J, LeDez KM, Penney C, Snedden W, Tucker J, Fauvel N, Glavinovic M, Donati F, Backman SB, Stein RD, Polosa C, Abdallah C, Gal S, Clark AJ, Doig GA, Gondocz T, Peter EA, Lopez A, Mathieu A, Couture P, Boudreault D, Derouin M, Allard M, Blaise G, Girard D, Knill RL, Novick T, Vandervoort MK, Chung F, Paramanathar S, Parikh S, Cruise C, Michaloliakou C, Dusek B, Rose DK, Cohen MM, DeBoer D, Shorten G, Cutz E, Lerman J, Dolovich M, Crosby ET, Cirone R, Reid D, Lind J, Armstrong M, Doyle W, Halpern S, Glanc P, Myhr T, Ryan ML, Fong K, Amankwah K, Ohlsson A, Preston R, Petras A, Jacka MJ, Milne B, Nakatsu K, Pancham S, Smith G, Duggal KN, Douglas MJ, Merrick PM, Blew P, Miller D, Martineau R, Hull K, Baron CM, Kowalskl S, Greengrass R, Horan T, Unruh H, Baron CL, Cruchley PM, Nakajima K, Sugiura Y, Goto Y, Takakura K, Harada J, Lee RMKW, Fargas-Babjak AM, Ni J, Werstiuk ES, Woo J, Morison DH, McHugh MD, Pappius HM, Ishihara H, Shimodate Y, Koh H, Matsuki A, Mclntyre JWR, Bergeron P, DeLima LGR, Dupuls JY, Enns J, Murkin JM, McKenzie FN, White S, Shannon NA, Dobkowski WB, Kutt JL, Mezon BJ, Grant DR, Wall WJ, Doblar DD, Lim YC, Frenette L, Ronderos JR, Poplawski S, Ranjan D, Dubé L, Obbergh LV, Francoeur M, Blouin C, Carrier R, Doblar D, Ronderos J, Singer D, Cox J, Gosdin B, Boatwright M, Smith CE, Rovner A, Botero C, Holbrook C, Patel N, Pinchak A, Pinchak AC, Kao YJ, Thio A, Barker SJ, Sullivan P, Posner M, Cole CW, Lindsay P, Langevin PB, Gulig PA, Gravenstein N, Wong DT, Gomez M, McGuire GP, Byrick RJ, Sharma SK, Carmicheal FJ, Montanera WJ, Sharma S, Yee DA, Naser BI, Bryson GL, Kitts JB, Miller DR, Martineau RJ, Curran MJ, Bragg PR, Karski JM, Cheng D, Bailey K, Levytam S, Arellano R, Katz J, Doyle J, Sosis MB, Blazek W, Plourde G, Malik A, Peddle T, Au J, Sloan J, Cleland M, Hancock DE, Patel N, Costello F, Patterson L, Yamashita M, Kondo T, Graham MR, Thiessen D, Vener DF, Long T, Marion S, Steward DJ, Braverman B, Levine M, Yentis S, Bachman CR, Kopelow M, McNeill A, Graham R, Froese N, Patel L, Reimer H, Swartz J, Ullyot S, Wong H, Markakis MA, Siklch N, Goranson BD, Lang SA, Stockwell MJ, Cujec B, Yip RW, Southeriand LC, Vet TDB, Gollagher JM, Crone LA, Ferguson JG, Litwin D, Bertlik M, Orser BA, Yang LW, MacDonald JF, Morris GF, Gore-Hickman WL, Zamora JE, Rosaeg OP, Lindsay MP, Crossan ML, Pattee C, Adams M, Koller JP, Lavoie GJ, Rigal WM, Taylor DA, Grace MG, Flnegan BA, Hawkes C, Hopkins H, Tierney M, Drover DR, Whatley G, Knox JWD, Rausa J, El-Beheiry H, Seegobin R, Hirst GC, Dust WN, Cassidy JD, Boisvert D, Braden H, Halperin ML, Cheema-Dhadli S, McKnight DJ, Singer W, Elwood T, Huchcroft S, MacAdams C, Farran RP, Goresky G, LaLande P, Lacroix G, Lessard M, Trépanier C, van Vlymen JM, Parlow JL, Ibebunjo C, Morscher AH, Gordon GJ, Grocott HP, Belo SE, Koutsoukos G, Belo S, Smith D, Henderson S, Gelb A, Kantor G, Badner NH, Komar WE, Bhandari R, Cuillerier D, Dobkowski W, Smith MH, Vannelli AN, Wharton S, Tierney M, Redmond E, Reddy E, Gray A, Flynn J, Bourne RB, Rorabeck CH, MacDonald SJ, Doyle JA, Newton PT, Moote CA, Joiner R, Glynn MFX, Zulys V, Hennessy M, Winton T, Demajo W, McKay WPS, Gregson PH, McKay BWS, Militzer J, Hollebone E, Yee R, Klein G, Garnett RL, Conway J, Ralley FE, Robbins GR, Brown JE, Frei JV, Podufal E, Snow NJ, Chavez AM, Kramer RP, Mickle D, Tweed WA, Shrestha BM, Basnyat NB, Lekhak BD, O’Leary SD, Maryniak JK, Tucker JH, Guest CB, Mullen JB, Kay JC, Wigglesworth DF, Goodarzi M, Shier NH, Ogden JA, Hung OR, Pytka S, Murphy MF, Martin B, Stewart RD. Abstracts. Can J Anaesth 1994. [DOI: 10.1007/bf03009969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Cujec B, Polasek P, Mayers I, Johnson D. Positive end-expiratory pressure increases the right-to-left shunt in mechanically ventilated patients with patent foramen ovale. Ann Intern Med 1993; 119:887-94. [PMID: 8215000 DOI: 10.7326/0003-4819-119-9-199311010-00004] [Citation(s) in RCA: 76] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE To determine the effect of the presence of a patent foramen ovale on the right-to-left shunt in patients with respiratory failure who receive positive end-expiratory pressure (PEEP). DESIGN Convenience sample with randomized application of PEEP. SETTING General intensive care unit of a university teaching hospital. PATIENTS A total of 46 mechanically ventilated patients with respiratory failure requiring an inspired oxygen concentration of at least 50% and a PEEP of at least 5 cm of H2O. INTERVENTION Randomized application of PEEP (0 and 10 cm of H2O). MEASUREMENTS A patent foramen ovale was detected by saline contrast transesophageal echocardiography. The alveolar-to-arterial oxygen difference and the right-to-left shunt were calculated from arterial and venous blood gas sampling. RESULTS In patients without a patent foramen ovale (n = 39), the alveolar-to-arterial oxygen difference and the shunt fraction decreased (-50 mm Hg [95% CI, -21 to -67] and -0.05 [CI, -0.03 to -0.07], respectively) after adding PEEP (10 cm of H2O). In patients with a patent foramen ovale (n = 7), minimal changes were noted in the alveolar-to-arterial oxygen difference (4 mm Hg, P > 0.2), but the shunt fraction increased (0.05, CI, 0 to 0.09). Adding PEEP (10 cm of H2O) increased the shunt fraction in 6 of 7 (86%) patients with a patent foramen ovale, whereas the shunt increased in only 7 of 39 (18%) patients without a patent foramen ovale (P < 0.007). CONCLUSIONS A patent foramen ovale was found in 7 of 46 patients (15%; CI, 6% to 29%) with acute respiratory failure. This condition is a common cause of lack of improvement in oxygenation with the addition of PEEP in the mechanically ventilated patient. In patients with a patent foramen ovale, the right-to-left shunt is usually increased by using PEEP.
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Affiliation(s)
- B Cujec
- Royal University Hospital, University of Saskatchewan, Saskatoon, Canada
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Mosewich R, Shuaib A, Cujec B, Polasek P. Impact of transesophageal echocardiogram on the management of acute stroke. J Stroke Cerebrovasc Dis 1993; 3:57-60. [DOI: 10.1016/s1052-3057(10)80132-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Cujec B, Welsh R, Aboguddah A, Reeder B. Comparison of Doppler echocardiography and cardiac catheterization in patients requiring valve surgery: search for a 'gold standard'. Can J Cardiol 1992; 8:829-38. [PMID: 1423004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To compare the sensitivities of Doppler echocardiography and cardiac catheterization in the diagnosis of severe valvular heart disease in patients requiring valve surgery. DESIGN Retrospective analysis of Doppler echocardiograms and cardiac catheterizations. SETTING Tertiary referral cardiovascular centre in a university setting. PATIENTS Sixty-nine patients undergoing valve surgery between July 1988 and July 1990. RESULTS The sensitivities of echocardiography and cardiac catheterization were 84 and 87%, respectively (P = 1.0) in 32 patients who underwent aortic valve surgery primarily for severe aortic stenosis; 83 and 67%, respectively (P = 1.0) in six patients with severe aortic regurgitation, and 100 and 85%, respectively (P = 1.0) in seven patients with combined severe aortic stenosis and regurgitation. The sensitivities of echocardiography and cardiac catheterization in 11 patients who underwent mitral valve surgery for severe mitral stenosis were 73 and 91%, respectively (P = 0.6) and 69 and 92%, respectively (P = 0.3) in 13 patients with severe mitral regurgitation. Sensitivities of echocardiography and cardiac catheterization in the diagnosis of severe tricuspid regurgitation in five patients who had tricuspid valve repair were 100 and 80%, respectively (P = 1.0). Two patients with severe aortic stenosis by echocardiography, but not by catheterization, did not undergo aortic valve replacement during valvular surgery; both required aortic valve replacement within two years of initial surgery because of heart failure. Four patients with severe tricuspid regurgitation identified by echocardiography did not have tricuspid repair; three had pulmonary hypertension and these patients had resolution of tricuspid regurgitation on follow-up. One patient with severe tricuspid regurgitation and absence of pulmonary hypertension required reoperation for tricuspid valve repair 10 months after initial operation. CONCLUSIONS The sensitivity of echocardiography and cardiac catheterization in the detection of severe valvular lesions requiring surgery is similar. Discordant results should be reviewed carefully with knowledge of the inherent pitfalls of both techniques in order to ensure optimal patient outcome.
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Affiliation(s)
- B Cujec
- Department of Medicine, Royal University Hospital, University of Saskatchewan, Saskatoon
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Abstract
A prominent Chiari's network may be difficult to distinguish from pathologic right atrial masses on transthoracic echocardiography. We report a 38-year-old woman who had a cerebrovascular accident. Transthoracic echocardiogram revealed an atrial septal aneurysm and a mobile right atrial mass. This mass was correctly identified as Chiari's network on the basis of the transesophageal echocardiographic findings of a broad base of attachment in the right atrium and filamentous nature of the mass. These findings were confirmed at surgery.
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Affiliation(s)
- B Cujec
- Department of Medicine, Royal University Hospital, Saskatoon, SK, Canada
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