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Lisa Mielniczuk

Publications and source records attributed to Lisa Mielniczuk.

8 recordsLinked to original sources
PubMed2006

Reasons for escalating pacemaker implants.

Surveys of pacing practice have shown a steady increase in pacemaker implantation rates in the past 15 years, despite no major changes in United States guidelines for permanent pacing. There are no data to explain why this is occurring. In this study, records were extracted from the National Hospital Discharge Survey to investigate this. There were 3 major findings. First, age-adjusted implantation rates increased progressively over the study period from 370 per million in 1990 to 612 per million in 2002. Second, it was found that the escalating implantation rate is attributable to increasing implantation for isolated sinus node dysfunction (SND). Implantation for SND increased significantly over the study period (by 102%), whereas implantation for all other indications did not. The increasing implantation for SND is due primarily to the increasing prevalence of SND, with a lesser increase in implantation rate relative to prevalence rate. The third major finding of this study is that there has been a progressive relative and absolute increase in the dual-chamber implantation rate. In 2002, 82.8% of all initial pacemaker implantations were dual-chamber devices. Furthermore, the National Hospital Discharge Survey data indicate that the major randomized pacing trials seem to have had no impact on pacing practice in the United States. In conclusion, age-adjusted implantation rates increased progressively over the study period. This escalating implantation rate is primarily attributable to increasing implantation for SND.

Age Factors↗
PubMed2005

Tricuspid valve chordal tissue in endomyocardial biopsy specimens of patients with significant tricuspid regurgitation.

OBJECTIVES: Tricuspid regurgitation is the most common valvular abnormality after orthotopic heart transplantation, with multiple etiologic factors implicated. The purpose of this study was to determine if the endomyocardial biopsy specimens of patients who developed significant tricuspid valve regurgitation (TVR) after cardiac transplantation had evidence of chordal tissue. METHODS: The echocardiograms of 98 patients who had cardiac transplantation between 1986 and 2002 were reviewed for evidence of significant TVR greater than mild. The biopsy specimens of all patients with significant TVR were then reviewed for histologic evidence of tricuspid chordal tissue and frequency and severity of rejection episodes. Clinical information collected included the presence of any systolic murmurs, significant dyspnea, and invasive hemodynamic measurements. RESULTS: The incidence of significant TVR was 19% (n = 19 patients). Histologic evidence of chordal tissue was present in 9 patients (47%) with significant TVR. Patients whose biopsy specimens evidenced chordal tissue tended to have a greater degree of TVR, but this was not statistically significant (odds ratio, 2.07; 95% confidence interval, 0.537-8.01, p = 0.32). There was no statistically significant difference in the number of biopsy specimens (p = 0.798), the number of rejection episodes (p = 0.73), or overall left or right ventricular systolic function between the patients with and without biopsy specimen evidence of chordal tissue disruption. Most of the patients with evidence of significant TVR after chordal tissue biopsy were clinically asymptomatic, with no significant change in their hemodynamics. CONCLUSION: Histologic evidence of chordal tissue in endomyocardial biopsy specimens was present in 47% of patients with significant TVR and did not relate to the number of biopsy procedures performed or the frequency of rejection episodes. This study provides histologic evidence that chordal tissue damage can occur after cardiac biopsy, resulting in significant TVR; however, it is clinically well tolerated by affected patients.

Adult↗
PubMed2005

Angiotensin-converting enzyme inhibitors and angiotensin II type I receptor blockers in the management of congestive heart failure patients: what have we learned from recent clinical trials?

PURPOSE OF REVIEW: Angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers and aldosterone antagonists have all been shown to decrease the morbidity and mortality related to heart failure. The population of patients with a diagnosis of heart failure represents a heterogeneous group, ranging from asymptomatic left ventricular dysfunction to chronic decompensation with advanced heart failure; and the clinical roles of these agents can vary within this diverse heart failure population. This article will review the recent developments pertaining to renin-angiotensin-aldosterone system modulation therapy and help to clarify some of the relevant issues surrounding the role and relevance of these drugs in the currently established multi-drug regimen of heart failure patients. RECENT FINDINGS: Clinical trials such as OPTIMAAL, VALIANT and EPHESUS have added insight into the role of angiotensin II receptor blockers and aldosterone in the post-myocardial infarct heart failure patient. The CHARM series has provided new information into the role of angiotensin II receptor blocker therapy in patients who are angiotensin-converting enzyme intolerant and those with heart failure and normal ejection fraction. In addition further data is now available about the benefits and risks when considering a strategy of either angiotensin-converting enzyme plus angiotensin II receptor blocker or angiotensin-converting enzyme plus aldactone in chronic heart failure patients. SUMMARY: Important recent clinical trials have helped to add insight on the role of renin-angiotensin-aldosterone system in heart failure. Choosing between a class of drug or particular strategy depends on knowledge of the patient populations studied in clinical trials as well as the inherent risks involved.

Angiotensin II Type 1 Receptor Blockers↗
PubMed2004

Patient selection for left ventricular assist devices.

The use of mechanical support as a bridge to cardiac transplant has become the standard of care in many cardiac transplant centers. This therapy has been shown to increase survival and improve morbidity in carefully selected patients waiting for heart transplantation. With approximately 30000 patients being listed worldwide for transplant every year and only 3500 transplantations performed annually, alternative strategies need to be developed to minimize morbidity and mortality in this high-risk population. Patient selection remains the primary determinant of success with left ventricular assist device (LVAD) therapy. This article will review both the cardiac and extracardiac considerations needed in the assessment of patient suitability for LVAD support as a bridge to transplantation.

Body Constitution↗
PubMedDate not supplied

Persistent orthopnea and the prognosis of patients in the heart failure clinic.

Heart failure (HF) is a public health problem with ever-growing costs. Signs such as jugular venous pressure and third heart sound have been associated with disease prognosis. Symptoms of heart failure are frequently subjective, and their real value is often overlooked. The authors aimed to assess the relationship between orthopnea and left ventricular ejection fraction (LVEF) and hospitalization rate in patients referred to the HF clinic. One hundred fifty-three new consecutive patients referred to the HF clinic from September 2001 to July 2002 were reviewed. Information about orthopnea was available at baseline and at a 6-month to 1-year follow-up. One hundred thirty-one patients had a baseline multigated radionuclide ventriculogram scan, and 68 patients had a follow-up multigated radionuclide ventriculogram scan available. The patients were divided into groups by presence of orthopnea and compared with respect to LVEF and hospitalization rate. Patients with or without orthopnea had similar LVEFs at baseline (32%+/-17% vs. 33%+/-15%, respectively; p=NS). However, patients who were orthopnea-free at the follow-up visit had a significant LVEF improvement whereas patients with ongoing orthopnea at follow-up had no LVEF improvement (11%+/-13% vs. -1%+/-6%; p<0.001). Patients who presented with persistent orthopnea had a significantly higher rate of hospitalization (64% vs. 15.3%; p=0.0001). Persistent orthopnea in HF patients is associated with a significantly higher rate of hospitalization and with worsening or no improvement in LVEF. Patients with persistent orthopnea may require a more aggressive approach to improve their outcome. This result may help centers with limited access to LVEF measurements to better stratify HF patients' risk.

Aged↗