While some studies reported that an approximate estimation of LVEF can be performed clinically in 40% of patients after MI, the practical value of such scoring systems is limited. Indeed, stud-ies reported associations between several clinical indicators and abnormal LVEF, but these studies consisted of relatively small case series and the proposed prediction algorithms were…
After adjusting for comorbidities and for other determinants of LVEF testing (including age, sex, year, peak CK, history of heart failure and comorbidity, EF measurement prior to index MI, cardiologist involved as care provider, length of stay > 10 days and reperfusion), patients who did not have an assessment of LVEF within 30 days of…
Characteristics Associated With Testing To Measure LVEF Table 1 compares the characteristics of patients who underwent measurement of LVEF within 30 days after an incident MI between 1988 and 1998 to those who did not. Characteristics associated with greater likelihood of ejection fraction (EF) measurement included male sex, higher peak CK, cardiologist involved as a…
Time Trends of Testing To Measure LVEF After MI Between 1979 and 1998, 2,317 subjects in Olmsted County were hospitalized with an incident MI. The percentage of patients undergoing testing for LVEF within 30 days after MI over time is shown in Figure 1. The use of testing increased from 22% in 1979 to 85%…
The Mantel-Haenszel x2 test for trend was used to analyze the change in the proportion of patients tested for LVEF over time, and the Pearson x2 test was used to compare proportions. Logistic regression was used to examine the independent association between demographic and clinical variables, and testing for LVEF within 30 days after index…
The procedures used to assemble the MI incidence cohort have been reported in detail elsewhere. Briefly, all incident MIs between 1979 and 1998 were ascertained from indexes of medical diagnosis and hospital discharges using standardized epidemiologic criteria, relying on cardiac pain, creatine phos-phokinase enzyme values, and Minnesota coding of the ECG.
Study Setting This study was carried out within the boundaries of Olmsted County, MN. Epidemiologic research in the county is possible because it is relatively isolated from other urban centers, and nearly all medical care is delivered to local residents by few providers. With the exception of a higher proportion of the working population employed…
Knowledge of left ventricular ejection fraction (LVEF) after acute myocardial infarction (MI) helps stratify risk and guides the use of evidence-based treatment such as angiotensin-converting enzyme (ACE) inhibitors and (3-blockers and revascularization. Indeed, studies demonstrated positive associations between LVEF measurement and use of ACE inhibitor therapy after MI. Furthermore, data underscore the pivotal role of…
Once the decision to treat has been made, it is critical to define adequate therapy. Seven of our HIV-positive patients who received antituberculosis therapy survived, and none of those who died received antituberculosis therapy. Nevertheless, we cannot definitively prove that they died because of M gordonae disease, and not because of an additional infection (see…
Patient 12 had 1 positive sputum sample, but 5 blood cultures with centrifugation lysis, 12 sputa, the bronchoalveolar lavage, and the bone marrow aspiration and biopsy specimen did not reveal M gordonae. All these diagnostic procedures may expose the patient to potential complications. On the other hand, empirical treatment may induce unwanted side effects such…
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