Search PubMed⌕ Search

Biomedical subjects

E B Madsen

Publications and source records attributed to E B Madsen.

At least 37 records · Page 2Linked to original sources
PubMed1984

Usefulness of the chest x-ray for predicting abnormal left ventricular function after acute myocardial infarction.

We evaluated 229 patients discharged after a definite acute myocardial infarction. Pulmonary venous congestion determined from chest x-ray films during the hospitalization and at discharge and the cardiothoracic ratio at discharge were compared to the left ventricular ejection fraction measured at discharge by a gated radionuclide technique. During hospitalization, pulmonary venous congestion was found on at least one x-ray frame in 94 patients (41%). At discharge 134 patients (59%) had abnormal ejection fraction (less than 0.51) and 35 had pulmonary venous congestion (15%). The sensitivity of the x-ray for detecting an abnormal ejection fraction was 20% when pulmonary venous congestion was observed on the discharge x-ray film (specificity 92% and predictive value 77%), 52% if pulmonary venous congestion was present on any x-ray film during the hospitalization (specificity 74% and predictive value 73%), and 47% if the cardiothoracic ratio was abnormal (greater than or equal to 0.50) on the discharge x-ray film (specificity and predictive value 66%). We conclude that an abnormal x-ray film at discharge or during the hospitalization will identify approximately one-half of the abnormal ejection fractions at the time of hospital discharge. Therefore, to reliably assess left ventricular function, either for prognostic or therapeutic purposes in the individual patient, a more direct measure of left ventricular function such as radionuclide angiography must be obtained.

Adult↗
PubMed1984

Prognostic importance of digitalis after acute myocardial infarction.

Because previous reports have suggested that digitalis administration may lead to increased mortality after hospital discharge for acute myocardial infarction, the independent importance of digitalis therapy in long-term prognosis after acute myocardial infarction was investigated by analyzing 1,599 patients after definite myocardial infarction. After hospital discharge, mortality rate for the entire group at 4 months was 7.7% and after 1 year 14.2%. At discharge, 36.6% of the patients were taking digitalis. Compared with those not taking digitalis, those taking digitalis had more historical risk factors and a higher incidence of important clinical prognostic variables during the hospitalization. Their cardiac mortality rate after 4 months and 1 year (12.5 and 22.4%, respectively) was significantly higher than that of patients not taking digitalis (5.0 and 9.6%, respectively). Mortality was higher for patients taking digitalis whether or not they had congestive heart failure during hospitalization. However, in a multivariate Cox analysis for 1 year outcome, neither digitalis nor any other medication variable displaced the important clinical variables of age, congestive heart failure during the hospitalization, previous myocardial infarction, maximal heart rate during the hospitalization and previous angina. Quinidine and digitalis at discharge were selected sixth and seventh (not significant) by the analysis. It is concluded that digitalis therapy at discharge after myocardial infarction was not an independent predictor of late mortality in these patients.

Aged↗
PubMed1983

Periods of differing mortality distribution during the first year after acute myocardial infarction.

The mortality rate after acute myocardial infarction (AMI) has generally been modeled by a single exponential function. The present study was undertaken to determine, in 3 different populations, whether or not periods exist during the first year after AMI which have mortality distributions that differ from this pattern. The 3 patient populations included San Diego (346 patients, 71 deaths), Vancouver (704 patients, 146 deaths), and Copenhagen (1,140 patients, 262 deaths). Hospital admission was within 24 hours of the onset of symptoms, and patients dying within the first 24 hours after hospital admission or of noncardiac or unknown causes were not analyzed. The mortality between 2 and 21 days in the combined data base was 11.4% (range 10.9 to 11.7) and from 3 weeks to 1 year 10.5% (range 9.0 to 11.3). A high degree of similarity was noted among the shapes of the 3 survival curves. The hypothesis of an exponential mortality rate during the entire first year was rejected. Using a special statistic, changepoints at days 17, 23, and 24 in the 3 populations (21 days for the combined data base) were identified and used thereafter to divide the year into 2 separate periods of mortality within which exponentiality for the mortality rate was not rejected. The point by which exactly 50% of deaths had occurred was day 19, with 75% of deaths occurring by day 100. These data further define the natural history after AMI and indicate optimal follow-up periods for short- and longer-term management strategies based on risk assessment or trials of risk reduction after AMI.

Aged↗
PubMed1983

Dynamic evaluation of prognosis from time-dependent variables in acute myocardial infarction.

For predicting the 3 endpoints death, cardiac arrest, and cardiogenic shock within 44 days after admission for acute myocardial infarction (MI), a competing risk variant of the Cox multivariate model was developed. The population consisted of 1,140 patients with definite MI admitted within 24 hours of onset of symptoms. Prognostic variables from the entire hospitalization period were assessed. The time-dependent variables (occurrence of complications) were evaluated with occurrence up through the day before the actual prediction period started. The important prognostic variables for the endpoint death were ventricular fibrillation, age, congestive heart failure, and asystole. Variables for the endpoint cardiac arrest were congestive heart failure, ventricular premature beats, supraventricular tachycardia, extension of MI, and age. Variables for the endpoint cardiogenic shock were cardiac arrest, age, congestive heart failure, previous MI, and nodal rhythm. By using a hazard function for each endpoint and the coefficients for the variables entered, it is possible to estimate a total risk of death, cardiac arrest, or cardiogenic shock for the individual patient. This prediction can be updated during the course of hospitalization according to the occurrence of the new complications. The model can be directly utilized to assess risk.

Adult↗
PubMed1983

How much prognostic information do exercise test data add to clinical data after acute myocardial infarction?

We compared the prognostic significance of variables from a symptom-limited bicycle exercise test performed three weeks after acute myocardial infarction with clinical variables from the hospitalization utilizing discriminant function analysis for one year follow-up. Clinical exclusion criteria define a high-risk group of patients not eligible for exercise testing. Among 430 patients without test 28.4% died versus 6.6% among 456 patients with test (P less than 0.0001) and 21.4% versus 9.6% experienced a new infarction (P less than 0.001). The most important exercise test variables were duration of exercise and ventricular premature beats. The prediction of death was not significantly different when clinical variables, exercise test variables or the combined set were used for positive predictive value (66.7%, 60.0%, 63.3%) and negative predictive value (71.6%, 67.4%, 71.8%). For new infarction the positive predictive value was significantly higher for exercise test variables (56.8%, P less than 0.03) or the combined set (59.3%, P less than 0.02) compared to clinical variables (45.5%). The negative predictive value was significantly higher for clinical variables (79.6%) compared to exercise data (63.6%, P less than 0.0001) or the combined set (67.0%, P less than 0.001). We conclude that exercise data cannot improve prediction of death but provides higher positive predictive value for the prediction of new infarction.

Aged↗
PubMed1983

Limitations of electrocardiographic scoring systems for estimation of left ventricular function.

Four electrocardiographic scoring systems for the assessment of left ventricular function or presence of myocardial infarction were evaluated in 231 patients with coronary artery disease. Electrocardiographic scores were compared with radionuclide ejection fraction and thallium perfusion studies. The correlation between Wagner's modified QRS score and ejection fraction was only fair (r = -0.60). Askenazi's sum of R wave voltage score correlated poorly with ejection fraction (r = 0.44), as did Gottwik's sum of voltage score from the Frank lead electrocardiogram (r = 0.44). Rautaharju's Cardiac Infarction Injury Score did not reliably predict presence of infarction in the patient group, nor did it correlate well with ejection fraction (r = -0.49). None of the correlations were significantly improved when only patients with a history of a myocardial infarction, a thallium defect compatible with a scar or a diagnostic Q wave were considered. Although Wagner's QRS score correlated best with ejection fraction, all scoring systems had limited clinical usefulness for estimating ejection fraction.

Cardiac Output↗
PubMed1983

Evaluation of prognosis one year after myocardial infarction.

Three multivariate methods for predicting death within 1 year for patients discharged after acute myocardial infarction were evaluated: Cox model, discriminant function analysis and recursive partitioning. Discriminant function analysis was utilized to predict a new myocardial infarction (any new or nonfatal infarction). A Cox classification model developed in a population of 260 patients (group 1) discharged after myocardial infarction was tested in 886 patients from the same institution (group 2) and 582 patients from another institution (group 3). Discriminant function analysis and recursive partitioning were developed in group 2 and tested in group 3. Data gathered during the entire period of hospitalization were utilized. The important variables (ordered as selected by the analyses) for the end point death were: heart failure, ventricular tachycardia and atrioventricular block in the Cox model and heart failure, previous myocardial infarction, age and ventricular premature beats in the discriminant function analysis. For the end point new myocardial infarction, the important variables were: previous myocardial infarction, heart failure, extension of infarction during the acute phase and infarct site. For predicting death and survival within 1 year, each of the three schemes was comparable. For estimating the actual risk of death, the Cox model was best. Recursive partitioning had the advantage of using only one variable--heart failure. Total correct classification ranged from 65.4 (Cox model) to 71.6% (discriminant function analysis) for the original population (groups 1 and 2) and from 47.9 (discriminant function analysis) to 54.3% (recursive partioning) when the schemes were tested in patients in group 3. The Cox model and discriminant function analysis were able to correctly predict over half of the new infarctions within 1 year.

Analysis of Variance↗
PubMed1983

The length of hospitalization after acute myocardial infarction determined by risk calculation.

The feasibility of the use of a Cox model for risk assessment of individualized hospital discharge after myocardial infarction was evaluated. First, a previously developed prognostic index computed at the fifth day after admission was tested on a new population of 1140 patients. It was confirmed that after 5 days half of the patients (52%) could be discharged with low risk. Second, a new competing risk variant of the Cox model that updates prognosis according to the occurrence of complications was developed that describes the risk of death, cardiac arrest, and cardiogenic shock within 44 days after hospital admission. With a risk of one of these events being below 2% during a 14 day period after proposed discharge, 453 patients of 966 survivors (47%) could be discharged after only 5 days. A longer stay (of up to 30 days) was proposed for 338 patients (35%) to achieve the same level of risk. The savings in hospitalization days would be 15%. These results were confirmed in a new sample of 197 patients from the same institution who were discharged according to the proposed system. Of the 169 day 5 survivors, 67% were discharged on days 6 through 15 and this resulted in only two unexpected deaths and a 20% savings in hospitalization days. We conclude that individually determined discharge time is feasible without increased risk of death of severe complications after early discharge.

Age Factors↗
PubMed1982

Cumulative dose-response study comparing terbutaline pressurized aerosol administered via a pearshaped spacer and terbutaline in a nebulized solution.

The bronchodilator effects of cumulative doses of terbutaline 0.125 mg, 0.125 mg and 0.250 mg administered as a pressurized aerosol via a pear shaped spacer were compared with those of terbutaline 1.25 mg, 1.25 mg and 2.50 mg administered as a nebulized solution via a PARI-inhaler Boy. FEV1.0 and flow-volume curves in 13 patients were measured. Initial placebo treatment of both groups resulted in a significant increase in FEV1.0, especially when it was given in nebulized form. The increase after active drug was significant after 15 min, with only minor changes during the rest of the trial. The log-dose/increase in FEV1.0 showed that equipotent doses of pressurized and nebulized terbutaline were in the ratio 1 to 4. Administration by nebulization offered no clear advantage over use of a pressurized aerosol with a pearshaped spacer.

Adult↗
PubMed1982

Pulmonary function in patients with rheumatoid arthritis.

106 women and 38 men suffering from definite or classical rheumatoid arthritis underwent a pulmonary function test. The results were correlated to the duration and various clinical activity parameters of the disease. Pulmonary diffusion capacity was found to be reduced compared with the predicted values (p less than 0.05), irrespective of the duration or activity of the disease. The findings suggest that inflammatory vascular changes in the lungs usually occur in rheumatoid arthritis even in cases where other extraarticular manifestations can usually not be demonstrated.

Adolescent↗
PubMed1980

Multivariate prognostic index in acute myocardial infarction for individual duration of hospitalization.

To estimate the feasibility of an early and individualized discharge of acute myocardial infarction patients, a new prognostic index was constructed from Cox's regression model for survival analysis. From the first 5 d in the coronary care unit the significant prognostic variables in the index were heart failure (definite objective signs of congestive heart failure and/or definite cardiomegaly and/or pulmonary vascular enlargement on chest x ray in upright position), cardiogenic shock, atrioventricular block, and age. From the index the individual patient's probability of survival up to day 36 after admission could be directly predicted. The more positive the index, the higher was the probability of death. The prognostic efficacy was good, with two unexpected deaths from 149 patients in the lowest risk group. With a selected mortality risk of 5% from the day of discharge until day 30 after admission, 134 patients (52%) could be discharged on day 6. To have the risk of less than or equal to 5% after discharge another 54 patients (21%) would have to stay in the hospital for 24 d. Following this system of early and individualized discharge there were few serious post-discharge complications (one cardiac arrest and one ventricular tachycardia). Reinfarctions could not be predicted. This model could save around 2000 hospitalization days per year in this hospital.

Adult↗
PubMed1980

Multivariate long-term prognostic index from exercise ECG after acute myocardial infarction.

From a symptom-limited bicycle exercise test 3 wk after acute myocardial infarction is 205 patients the prognostic significance for the 1-yr prognosis of the following variables was examined by a multivariate analysis (Cox's model): reasons for stopping, duration of work, maximal heart rate, maximal product heart rate x systolic blood pressure, maximal ST-deviation, time to maximal ST-deviation and ventricular ectopic beats (type and frequency). The reason for stopping was fatigue in 59% and angina pectoris in 15%. 48% exercised up to 6 min and 14% beyond 12 min with median duration of 7 min. The maximal heart rate was over 140/min in 30%. ST-deviations were found in 77%; in most patients below 3 mm. 44% had ventricular ectopic beats during the exercise. The only significant variable was the duration of of work with prognostic index for the 1-yr prognosis SE: SE = 1.21-0.16 x (duration of work). A probability of survival of over 0.95 after 1 yr required a duration of work over 13 min. The observed deaths were in good accordance with the expected with a little overestimation. 75% died from a definite cardial cause. There is a good predictive value for the 1-yr prognosis of the duration of work from an exercise test 3 wk after AMI.

Aged↗