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Pubblicazioni recenti - cardiac disease
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In-hospital outcomes in nonagenarian patients undergoing primary percutaneous coronary intervention.
Minerva Cardiol Angiol2022 Dec;():. doi: 10.23736/S2724-5683.22.06167-1.
Angelini Filippo, Franchin Luca, Bocchino Pier P, Morici Nuccia, Wa?ha Wojciech, Savonitto Stefano, Trabattoni Daniela, Cerrato Enrico, Barbieri Lucia, Fortuni Federico, DE Luca Leonardo, Greco Antonio, DE Filippo Ovidio, Montefusco Antonio, Montabone Andrea, Rubino Anna E, Gili Sebastiano, Quadri Giorgio, Somaschini Alberto, Cornara Stefano, Carugo Stefano, Capodanno Davide, Wojakowski Wojciech, Dusi Veronica, D'Ascenzo Fabrizio, DE Ferrari Gaetano M,
Abstract
BACKGROUND:
The aim of the present analysis was to evaluate the incidence and predictors of in-hospital adverse outcomes in nonagenarian patients undergoing primary percutaneous coronary intervention (pPCI) for ST-segment elevation myocardial infarction (STEMI).
METHODS:
Consecutive nonagenarian patients undergoing pPCI for STEMI from 2009 to 2019 were retrospectively included in an international multicenter registry. In-hospital all-cause death was the primary outcome.
RESULTS:
A total of 308 patients were included (mean age 92.5±2.5 years, 65.6% female). Mean systolic blood pressure (SBP) at hospital admission was 130.7±33.5 mmHg, 46 (17%) patients presented with a Killip class III-IV, mean left ventricle ejection fraction (LVEF) was 40.0±11.5% and 147 (58%) patients were independent in everyday activities. In-hospital death occurred in 99 patients (32%). After multivariate adjustment, lower LVEF (OR per unit reduction 1.08, 95% CI: 1.03-1.11, P value
CONCLUSIONS:
Nonagenarian patients presenting with STEMI and undergoing pPCI have high in-hospital mortality. Independency in everyday life is a strong independent predictor of survival to hospital discharge.
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Adipocytes control haematopoiesis and inflammation through CD40 signaling.
Haematologica2022 Dec;():. doi: 10.3324/haematol.2022.281482.
Reiche Myrthe E, Poels Kikkie, Bosmans Laura A, Vos Winnie G, Van Tiel Claudia M, Gijbels Marion J J, Aarts Suzanne A B M, Den Toom Myrthe, Beckers Linda, Weber Christian, Atzler Dorothee, Rensen Patrick C N, Kooijman Sander, Lutgens Esther,
Abstract
The co-stimulatory CD40-CD40L dyad plays an important role in chronic inflammatory diseases associated with ageing. Although CD40 is mainly expressed by immune cells, CD40 is also present on adipocytes. We aimed to delineate the role of adipocyte-CD40 in the aging haematopoietic system and evaluated the effects of adipocyte CD40 deficiency on cardiometabolic diseases. Adult adipocyte CD40-deficient mice (AdiCD40KO) mice had a decrease in bone marrow (BM) haematopoietic stem cells (Lin-Sca+cKit+, LSK) and common lymphoid progenitors, which was associated with increased BM adiposity and T-cell activation, along with elevated plasma corticosterone levels, a phenotype that became more pronounced with age. Atherosclerotic AdiCD40koApoE-/- (CD40AKO) mice also displayed changes in the LSK population, showing increased myeloid- and lymphoid multipotent progenitors, and augmented corticosterone levels. Increased T-cell activation could be observed in BM, spleen, and adipose tissue (AT), while B-cell numbers were decreased. Although atherosclerosis was reduced in CD40AKO mice, plaques contained more activated T-cells and larger necrotic cores. Analysis of peripheral AT in a diet-induced obesity model revealed that obese AdiCD40KO mice showed increased T-cell activation in AT and lymphoid organs, but exhibited decreased weight gain and improved insulin sensitivity, along with increased fat oxidation. In conclusion, adipocyte CD40 plays an important role in maintaining immune cell homeostasis in BM during ageing and chronic inflammatory diseases, particularly of the lymphoid populations. Although adipocyte CD40-deficiency reduces atherosclerosis burden and ameliorates diet-induced obesity, the accompanying T-cell activation may eventually aggravate cardiometabolic diseases.
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Incidentally discovered cold hemagglutinins within autologous blood bag and cardioplegia line in a patient with a recent history of COVID-19 undergoing coronary artery surgery.
Perfusion2022 Dec;():2676591221141323. doi: 10.1177/02676591221141323.
?im?ek Erdal, Karaca Okay G, Çetinkaya Ferit, Can Ferda, Günayd?n Serdar,
Abstract
INTRODUCTION:
Cold agglutinin disease (CAD) is a rare autoimmune disorder characterized by destruction (hemolysis) of erythrocytes. In CAD, autoantibodies that cause agglutination at temperature of optimum +3-+4 ? degree cause symptoms. It is known that CAD often occurs after viral infections. Also, it has been reported in case reports that COVID-19 disease can cause CAD.
CASE REPORT:
46-year-old male patient with a history of diabetes mellitus and hypertension presented to outpatient clinic in our department to have CABG surgery. He recovered from COVID-19 disease 1.5 months ago. Cardiopulmonary bypass was initiated and the cross-clamp was placed and antegrade Delnido cardioplegia solution was started to be given at +4 ?. It was observed that the cardioplegia line was agglutinated. On the other hand, it was seen that the autologous blood taken by the anesthesiologist was also agglutinated and formed air bubbles and became unusable. X-clamp was removed and the heart rhythm recovered. The patient was consulted to hematology during postoperative intensive care follow-ups. The cold agglutinin test performed at of +4 ? was reported as positive. In this case, we associated the CAD with covid-19 for three main reasons. First one, the patient's complaints about CAD started after COVID-19 disease. Secondly, in the national health archive, the patient's pre-COVID-19 blood tests were completely normal but it was seen that LDH increased and RBC-HCT incompatibility started after COVID-19. As the third, when we search the literature, we have seen the COVID-19 related CAD in many case reports published by hematologists.
CONCLUSION:
With the rare cold agglutinin disease, it seems that we will encounter it more often after the COVID-19 pandemic. Except for deep hypothermia, the most important problem is seen during cardioplegia administration. Therefore, non-blood cardioplegia can be lifesaving.
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HDL cholesterol, triglycerides and characteristics of coronary atherosclerosis in patients with newly diagnosed significant coronary artery disease by CTCA.
Kardiol Pol2022 Dec;():. doi: 10.33963/KP.a2022.0279.
Oleksiak Anna, K?pka Cezary, K?pka Cezary, Ruci?ska Karolina, Ruci?ska Karolina, Marcinkiewicz Kamil, Marcinkiewicz Kamil, Demkow Marcin, Demkow Marcin, Kruk Mariusz, Kruk Mariusz,
Abstract
BACKGROUND:
Current European Society of Cardiology guidelines indicate specific target low-density lipoprotein cholesterol (LDL-C) levels for different cardiovascular risk categories in terms of prevention. However, the target for high-density lipoprotein cholesterol (HDL-C) and triglycerides have not been established.
AIM:
The study aim to investigate the associations betweenHDL-C,triglycerides andcoronary plaquescharacteristics.
METHODS:
This is a prospective single-center study with enrolled consecutive patients with newly diagnosed significant (?1stenosis ?50%) CAD on CTCA. Patients had lipids andCTCA analysis, including high-risk plaque (HRP) features: low-attenuation plaque (LAP), napkin-ring sign (NRS), positive remodeling (PR) and spotty calcium (SC), type of plaque (calcified, noncalcified, mixed), and their composition (calcified, fibrous, fibro-fatty, necrotic core).
RESULTS:
The study included 300 patients (191 men, 66 [8] years). 66% of them took lipid-lowering therapy. HRPwere found in 208 patients. There was no association between LDL-C, plaque composition and HRP presence. There was a negative correlation between HDL-Cand fibro-fatty and necrotic core plaque components (P = 0.0002, P = 0.0009). There was a positive correlation between triglycerides and necrotic core (P = 0.038). There were differences in HDL-C and triglycerides in patients with and without NRS (47 vs. 53 mg/dl, P = 0.0002 and 128 vs. 109 mg/dl, P = 0.02). In logistic regression, HDL-C (odds ratio [OR], 0.95;95% confidence interval [CI], 0.93-?0.98; P
CONCLUSION:
Lower HDL-C and higher triglycerides were associated with NRS presence and more necrotic core plaque component in coronary plaques in patients with newly diagnosed CAD.
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Radiofrequency catheter ablation of ventricular tachycardia using combined endocardial techniques in patients with structural heart disease improves procedural effectiveness and reduces arrhythmia episodes.
Kardiol Pol2022 Dec;():. doi: 10.33963/KP.a2022.0278.
Karkowski Grzegorz, Z?bek Andrzej, Szotek Micha?, Dru?bicki ?ukasz, Lelakowski Jacek, Legutko Jacek, Gosnell Marc, Kuniewicz Marcin,
Abstract
INTRODUCTION:
Radiofrequency catheter ablation (RFCA) of ventricular tachycardia (VT) in patients with structural heart disease (SHD) is by evidence, safe and effective. However, arrhythmia recurrence is still relatively high and the optimal procedural strategy is unclear. In clinical practice, several combinations of mapping and ablation techniques are used to improve VT ablation efficacy.
AIM:
The study aimed to evaluate and provide evidence of the efficiency and safety of a systematized combination of VT ablation (mapping) techniques in patients with SHD.
METHODS:
From 2016 to 2019, 47 patients (54 procedures) with SHD (89% heart failure, 94% ischemic heart disease, 37% VT storm) who underwent RFCA of VT were retrospectively analyzed from a group of 58 consecutive patients. During RFCA of VT, different combinations of three techniques, (activation mapping (AM), pace-mapping (PM), and substrate-based mapping (SbM), were used. The procedures were performed using the CARTO® 3 (Biosense Webster Inc., Diamond Bar, CA, US) electro-anatomical mapping system.
RESULTS:
During a median (interquartile range [IQR]) follow-up of 25.5 months (11.75?52.25), VT-free survival after ablation was 68.5% (n = 37/54 procedures). Acute procedural success was achieved in 85% (n = 46/54 procedures). The number of induced VT morphologies, induction of non-clinical or unsustained VT after ablation and less VT mapping techniques used during procedure were related to decreasing VT free-survival.
CONCLUSIONS:
VT ablation strategy based on combined systematized techniques is effective and safe in long-term follow-up patients with SHD.
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BioMatrix Versus Orsiro Stents for Coronary Artery Disease: A Multicenter, Randomized, Open-Label Study.
Circ Cardiovasc Interv2022 Dec;():e012307. doi: 10.1161/CIRCINTERVENTIONS.122.012307.
Yoon Chang-Hwan, Kwun Ju-Seung, Choi Young Jin, Park Jin Joo, Kang Si-Hyuck, Kim Sun-Hwa, Suh Jung-Won, Youn Tae-Jin, Kim Myeong-Kon, Cha Kwang Soo, Lee Seung-Hwan, Hong Bum-Kee, Rha Seung-Woon, Kang Woong Chol, Lee Jae-Hwan, Kim Sang-Hyun, Chae In-Ho,
Abstract
BACKGROUND:
Comparative studies of ultrathin-strut biodegradable polymer sirolimus-eluting stent (BP-SES) have reported promising results and validated its excellent outcomes in terms of safety and efficacy. However, there are limited studies comparing BP drug-eluting stents with struts of different thicknesses. We compared the long-term clinical outcomes of patients treated with an ultrathin-strut BP-SES or a thick-strut biodegradable polymer biolimus-eluting stent (BP-BES).
METHODS:
The BIODEGRADE trial (Biomatrix and Orsiro Drug-Eluting Stents in Angiographic Result in Patients With Coronary Artery Disease) is a multicenter prospective randomized study comparing coronary revascularization in patients with ultrathin-strut BP-SES and thick-strut BP-BES with the primary end point of target lesion failure at 18 months posttreatment. We performed the prespecified analysis of 3-year clinical outcomes.
RESULTS:
In total, 2341 patients were randomized to receive treatment with ultrathin-strut BP-SES (N=1175) or thick-strut BP-BES (N=1166). The 3-year incidence rate of target lesion failure was 3.2% for BP-SES and 5.1% for BP-BES (=0.023). The difference was primarily due to differences in ischemia-driven target lesion revascularization (BP-SES, 1.5%; BP-BES, 2.8%; =0.035) between groups. A landmark analysis of the late follow-up period showed significant differences in target lesion failure, with outcomes being better in BP-SES. Cardiac death and target lesion revascularization were significantly lower in the BP-SES group.
CONCLUSIONS:
In a large, randomized trial, the long-term clinical outcome of target lesion failure at 3 years was significantly better among patients treated with the ultrathin-strut BP-SES. The results indicate the superiority of the ultrathin-strut BP-SES compared with the thick-strut BP-BES.
REGISTRATION:
URL: https://clinicaltrials.gov; Unique identifier: NCT02299011.
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Cost-Effectiveness of the CNIC-Polypill Strategy Compared With Separate Monocomponents in Secondary Prevention of Cardiovascular and Cerebrovascular Disease in Portugal: The MERCURY Study.
J Health Econ Outcomes Res2022 ;9(2):134-146. doi: 10.36469/001c.39768.
Aguiar Carlos, Araujo Francisco, Rubio-Mercade Gabriel, Carcedo David, Paz Silvia, Castellano Jose María, Fuster Valentín,
Abstract
Cardiovascular (CV) diseases remain a leading and costly cause of death globally. Patients with previous CV events are at high risk of recurrence. Secondary prevention therapies improve CV risk factor control and reduce disease costs. To assess the cost-effectiveness of a CV polypill strategy (CNIC-Polypill) compared with the loose combination of monocomponents to improve the control of CV risk factors in patients with previous coronary heart disease or stroke. A Markov model cost-utility analysis was developed using 4 health states, SMART risk equation, and 3-month cycles for year 1 and annual cycles thereafter, over a lifetime horizon from the perspective of the National Health System in Portugal (base case). The NEPTUNO study, Portuguese registries, mortality tables, official reports, and the literature were consulted to define effectiveness, epidemiological costs, and utility data. Outcomes were costs (estimated in 2020 euros) per life-year (LY) and quality-adjusted LY (QALY) gained. A 4% discount rate was applied. Alternative scenarios and one-way and probabilistic sensitivity analyses tested the consistency and robustness of results. The CNIC-Polypill strategy in secondary prevention provides more LY and QALY, at a higher cost, than monocomponents. The incremental cost-utility ratio is ?1557/QALY gained. Assuming a willingness-to-pay threshold of ?30?000/QALY gained, there is a 79.7% and a 44.4% probability of the CNIC-Polypill being cost-effective and cost-saving, respectively, compared with the loose combination of monocomponents. Results remain consistent in the alternative scenarios and robust in the sensitivity analyses. The model reflects increments in the number of years patients would live and in quality of life with the CNIC-Polypill. The clinical effectiveness of the CNIC-Polypill strategy initially demonstrated in the NEPTUNO study has been recently corroborated in the SECURE trial. The incremental cost of the CNIC-Polypill strategy emerges slightly above the comparator, but willingness-to-pay estimates and sensitivity analyses indicate that the CNIC-Polypill strategy is consistently cost-effective compared with monocomponents and remains within acceptable affordability margins. The CNIC-Polypill is a cost-effective secondary prevention strategy. In patients with histories of coronary heart disease or stroke, the CNIC-Polypill more effectively controls CV risk factors compared with monocomponents.
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Dilated Cardiomyopathy in Children: Early Detection and Treatment.
Cureus2022 Nov;14(11):e31111. doi: e31111.
Mallavarapu Amrita, Taksande Amar,
Abstract
Cardiomyopathy is segregated into primary and secondary categories, leading to different phenotypes, including dilated, hypertrophic, and restrictive patterns. Dilated cardiomyopathy (DCM) is a mixed bag of heart diseases with the unique features of cardiac dilatation and subnormal to poor myocardial contractility. Dilated cardiomyopathy in the pediatric age group is generally characterized by unobstructed, dilated, and contracting left ventricular chamber defects and is associated with heart failure. Other causes include genetic juvenile-onset cardiomyopathy, drug-induced cardiomyopathy, stress-induced cardiomyopathy, hemochromatosis, endocrine causes (thyroid disorder and pheochromocytoma), autoimmune diseases, and nutritional deficiencies (selenium and thiamine). It is characterized by thinning of the left ventricle, a dilated left ventricle or biventricular dilatation, left ventricular systolic dysfunction, left ventricular diastolic dysfunction, global hypokinesia, and cardiomegaly (seen on a chest X-ray). Decreased cardiac output leads to fatigue, cachexia, narrow pulse pressure, dicrotic pulse/hypokinetic pulse, dyspnea, cool extremities, decreased blood supply to the brain (cognitive dysfunction), and reduced blood supply to the kidney (renal failure). Left ventricular diastolic dysfunction can result in dyspnea, orthopnea, and paroxysmal nocturnal dyspnea. Cardiomyopathy can also occur with or without left ventricular dysfunction, as in left ventricular non-compaction cardiomyopathy (LVNC), which is a rare heart disease occurring due to two (likely) pathogenic nonsense mutations: DSG2-p.S363X and TBX20-p.D278X. The study of familial forms of LVNC is helpful for risk prediction and genetic counseling of relatives. Right ventricular chamber failure can be identified on the electrocardiogram as sinus tachycardia and non-specific ST/T changes. The complications include arrhythmia (atrial fibrillation) and thromboembolism (left ventricular mural thrombosis). It is of utmost importance in the field of heart transplantation as the definitive treatment of the disease. Heart transplantation is now an acceptable treatment option for patients with dilated cardiomyopathy. This short review highlights different methods for the detection and diagnosis of dilated cardiomyopathy and the treatment modalities available for the same.
Copyright © 2022, Mallavarapu et al.
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Late-Onset Fabry Disease Affecting the Kidneys and Liver While Sparing the Heart: A Case Report.
Cureus2022 Nov;14(11):e30989. doi: e30989.
Alitter Qusai,
Abstract
Fabry disease (FD), also known as Anderson-Fabry disease, is an X-linked inherited lysosomal storage disorder caused by the deficiency or reduced activity of alpha-galactosidase A enzyme, which results in the accumulation of globotriaosylceramide (Gb3) in the cells. Atypical (late-onset) FD is characterized by the preserved residual activity of alpha-galactosidase A enzyme resulting in a later presentation in life than classic FD. Patients with late-onset FD are usually present in their third to seventh decades of life with the heart being the most commonly affected organ. FD can also affect the renal and gastrointestinal (GI) systems, however, in the literature, FD limited to the kidneys is scarcely reported and there is no data to suggest disease involvement of the liver. We present a rare case of late-onset FD affecting the kidneys and liver without cardiac or other organ involvement in a patient without having a family history of FD.
Copyright © 2022, Alitter et al.
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A Rare Variant and Unusual Presentation of Holt Oram Syndrome in a Child.
Cureus2022 Nov;14(11):e31076. doi: e31076.
Reddy Rasagnya M, Lakra Mahaveer S, Meshram Revat J, Taksande Amar, Wanjari Mayur B,
Abstract
Holt Oram syndrome is a rare genetically inherited disorder characterized by various skeletal abnormalities of the upper limb with an underlying structural heart defect. Family history and conduction defects may or may not be there. The diagnosis is often clinical; if the criteria are not fulfilled, then genetic studies may be required. This syndrome can also occur with complex congenital heart defects, heart blocks, and arrhythmias. The correlation between the severity of cardiac and skeletal manifestations was not studied, and in severe conditions and acute presentation, the patient may have atrial, supraventricular, and ventricular fibrillation. The association of radius with hand deformity and the cardiac defect is well reported, but this disease's involvement of the humerus and Supraventricular tachycardia (SVT) is rare. Here, we are reporting a case of Holt Oram syndrome in a five-year male child with unusual skeletal hypoplastic humerus who presented with breathlessness, palpitations, and supraventricular tachycardia and suffered a total of three episodes which were managed with adenosine and cardioversion successfully. The involvement of the humerus, along with symmetrical bilateral radial defect with Atrial septal defect (ASD) and Supraventricular tachycardia (SVT), is a unique feature of Holt Oram syndrome seen in our case.
Copyright © 2022, Reddy et al.
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Pregnancy After Cardiac Surgery.
Cureus2022 Nov;14(11):e31133. doi: e31133.
Makhija Nidhi, Tayade Surekha, Tilva Hard, Chadha Arzoo, Thatere Utkarsh,
Abstract
Women with native heart valve disease who are considering getting pregnant should have a complete risk estimation to determine whether an intervention is required prior to becoming pregnant and, if so, to determine when it should be performed and what kind of surgical therapy will be used. Pregnancy is linked to early and late structural valve degeneration in women who have bioprostheses, suggesting a high reoperation rate. A mechanical valve during pregnancy increases the risk of maternal complications such as valve thrombosis and mortality. The claim that women with defective hearts should not become pregnant was driven by the high maternal death rate among cardiac patients who became pregnant. A preoperative anticoagulation therapy trial helped women scheduled for valve replacement to acquire complete information as to the choice of the prosthetic device. Integrated risk stratification scheme for pregnant patients with valvular heart disease, with WHO classification and an algorithmic approach to both preconception counseling and anticoagulation strategy as outlined here, as well as early referral to a cardiologist with expertise in the management of cardiac disease and pregnancy for these complex patients is recommended. However, in reality, some women present while pregnant and valve disease needs to be managed, balancing maternal outcome and fetal risk. In general, optimizing the hemodynamic situation of the mother is also beneficial to the fetus. However, cardiac surgery carries a high risk for the fetus. No anticoagulant regimen can be said to be entirely safe for use during pregnancy, as there is a degree of risk with each regimen. Therefore, this review has been done to find appropriate management for women dealing with such conditions.
Copyright © 2022, Makhija et al.
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COVID-19 Exposure Unmasking Systemic Amyloidosis With Hepatic Predominance.
Cureus2022 Nov;14(11):e31092. doi: e31092.
Russe-Russe Jose R, Abramowitz Chiya, Pellegrini James R, Alvarez Betancourt Alejandro, Cohen Ricky, Baldino Michael, Crandall Ronald, Kagolanu Deepthi, Mejia Jose, Rizvon Kaleem,
Abstract
Amyloidosis is characterized by depositing insoluble fibrillar proteins that misfold into beta-pleated sheets. This phenomenon occurs on a systemic or local level and may interfere with the function of various organs, including the heart, kidneys, and liver. Among those presenting with amyloidosis, hepatic, gastrointestinal, renal, cardiac, vitreous, and immunological involvement may occur. These manifestations are linked to several clinical presentations, varying from abdominal pain and hepatomegaly to restrictive cardiomyopathy and chronic renal failure. The two most common types of amyloid proteins are amyloid light chain (AL) and serum amyloid A (AA) proteins. AL produced by immunoglobulin light chains kappa and lambda (?, ?) circulate systemically and accumulate in organs. At the same time, serum AA proteins are acute-phase reactants seen in infectious, chronic inflammatory states. In an immune-mediated infection such as COVID-19, serum AA levels may be a predictive factor of disease severity and a valuable biomarker to monitor the clinical course of COVID-19 patients. This report highlights a case in which infection with COVID-19 provoked an effective immune response that may have contributed to the accelerated progression of systemic amyloidosis with hepatic involvement. The study further investigates the involvement of AL and AA proteins in COVID-19 infections, including their role in synergistically exacerbating an already grueling clinical course.
Copyright © 2022, Russe-Russe et al.
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COVID-19, cardiac involvement and cardiac rehabilitation: Insights from a rehabilitation perspective - State of the Art.
Turk J Phys Med Rehabil2022 Sep;68(3):317-335. doi: 10.5606/tftrd.2022.11435.
Sonel Tur Birkan, Köseo?lu Belma Füsun, Kutay Ordu Gökkaya Nilüfer, Kurtai? Aytür Ye?im, Özyemi?ci Ta?k?ran Özden, Demirba? Kabayel Derya, Kesikta? Nur, T?k?z Canan, Özdemir Hande, Alemdaro?lu Ebru, Bilir Kaya Ba?ak, Genç Aysun, Tomruk Sütbeyaz Serap,
Abstract
Since the beginning of the pandemic, many novel coronavirus disease 2019 (COVID-19) patients have experienced multisystem involvement or become critically ill and treated in intensive care units, and even died. Among these systemic effects, cardiac involvement may have very important consequences for the patient's prognosis and later life. Patients with COVID-19 may develop cardiac complications such as heart failure, myocarditis, pericarditis, vasculitis, acute coronary syndrome, and cardiac arrhythmias or trigger an accompanying cardiac disease. The ratio of COVID-19 cardiac involvement ranges between 7 and 28% in hospitalized patients with worse outcomes, longer stay in the intensive care unit, and a higher risk of death. Furthermore, deconditioning due to immobility and muscle involvement can be seen in post-COVID-19 patients and significant physical, cognitive and psychosocial impairments may be observed in some cases. Considering that the definition of health is "a state of complete physical, mental and social well-being", individuals with heart involvement due to COVID-19 should be rehabilitated by evaluating all these aspects of the disease effect. In the light of the rehabilitation perspective and given the increasing number of patients with cardiac manifestations of COVID-19, in this review, we discuss the rehabilitation principles in this group of patients.
Copyright © 2022, Turkish Society of Physical Medicine and Rehabilitation.
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Does the Mode of Anaesthesia (General or Regional) Affect Survival and Complications Following Femoropopliteal and Femorodistal Bypass?
Cureus2022 Dec;14(12):e32104. doi: e32104.
Gunawardena Malin, Salami Mohammad, Howard Adam, Awupetu Ayoola,
Abstract
INTRODUCTION:
Femoropopliteal and femorodistal bypasses are indicated in the management of severe claudication or critical limb ischaemia. The choice of type of anaesthesia between general anaesthesia (GA) and regional anaesthesia (RA; epidural/spinal) has remained controversial. The study aimed to compare the rates of graft failure, perioperative mortality, and other major complications (including graft failure) associated with GA versus RA for lower limb bypass revascularisation in patients presenting with significant peripheral arterial disease.
METHODS:
All patients who had femoropopliteal and femorodistal bypass at the vascular unit of Colchester Hospital between January 2016 and September 2018 were included. The primary outcome measure was survival, and secondary outcome measures were respiratory, wound, cardiac, and graft failure complications. Technical success was defined as a successful operation with demonstrated graft patency at discharge and up to 30 days of follow-up. Secondary outcome measures included respiratory, wound, and cardiac complications. Statistical analysis included descriptive statistics and tests of association using chi-square for graft failure outcomes and the Mann-Whitney U test for the length of stay. All analyses were done at a 5% level of significance.
RESULTS:
There were 139 patients identified during the study period who fulfilled the inclusion criteria, of which 127 had complete records. The overall mortality and morbidity in this study were 1.6% and 14.229%, respectively. The proportion of patients who had ischaemic heart disease is almost threefold amongst those who had failed bypass compared to the successful bypass group (33.3% versus 11.9%, p = 0.018). A total of 65 patients received GA and 62 patients underwent RA; there were no significant differences in baseline preoperative comorbidities, postoperative mortality and complications, and length of stay. The majority (84%) of the patients who had RA had combined spinal and epidural (CSE) anaesthesia. The overall mortality and morbidity in this study were 1.6% and 14.2%, respectively. The proportion of patients with graft failure was 14.5% for GA versus 13.8% for RA (p = 0.914); there was no significant difference for conduit type, quality of vein conduit, the prevalence of heart failure and postoperative hypotensive episodes, redo-surgery, and major amputation, and length of stay (GA: 5.0, RA: 6.0, p = 0.854) did not differ significantly between the two groups. The proportion of patients who had ischaemic heart disease is almost threefold amongst those who had failed bypass compared to the successful bypass group (33.3% versus 11.9%, p = 0.018).
CONCLUSION:
The mode of anaesthesia, GA or the use of CSE RA in approximately half of the patients, did not influence survival, respiratory, cardiac, wound, graft failure, or length of stay in this study. There was a relationship between the presence of cardiac comorbidity and bypass failure, indicating a need for a standard care protocol to further optimise cardiac perioperative care to improve outcomes.
Copyright © 2022, Gunawardena et al.
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Safety assessment of the gall hydroalcoholic extract: Single and repeated oral dose toxicity studies.
Iran J Basic Med Sci2022 Nov;25(11):1389-1395. doi: 10.22038/IJBMS.2022.65488.14418.
Shourmij Mohamad, Khalili Fard Javad, Najafizadeh Parvaneh, Mousavi Zahra,
Abstract
OBJECTIVES:
galls (QBGs) are well-known in Iranian traditional medicine for treating various diseases. The aim of study was to assess the acute and repeated oral toxicity of the hydroalcoholic extract of QBG in female rats.
MATERIALS AND METHODS:
The ethanolic extract of QBG was administered in rats by gavage in both acute and repeated dose models. In the acute section of the study, a single oral dose of 2000 mg/kg was administered to female rat which were observed for physical symptoms and behavioral changes for 14 days. In the repeated dose toxicity study, the QBG extract (50, 500, and 1000 mg/kg/day) was administered for a period of 28 days to rats. On 28 day of experiment, blood sampling of animals was done for hematological and biochemical analysis and then sacrificed for histopathological examination of the harvested tissues (liver, heart, kidney, lung, spleen, stomach, ovary and uterus).
RESULTS:
A single oral administration of the QBG extract (2000 mg/kg) did not produce mortality or significant behavioral changes during 14 days of observation. In repeated oral toxicity models, the extract significantly increased (
CONCLUSION:
The results indicate that the oral acute toxicity of QBG extract was of a low order with LD50 being more than 2000 mg/kg in rats. In addition, slight tissue damage was observed in some tissues in the 500 and 1000 mg/kg groups. It was found that prolonged use at higher doses i.e. 500 mg/kg/day of QBG extract should be avoided.
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Fetal intelligent navigation echocardiography (FINE) has superior performance compared to manual navigation of the fetal heart by non-expert sonologists.
J Perinat Med2022 Dec;():. doi: 10.1515/jpm-2022-0387.
Swor Katie, Yeo Lami, Tarca Adi L, Jung Eunjung, Romero Roberto,
Abstract
OBJECTIVES:
Manual and intelligent navigation (i.e. fetal intelligent navigation echocardiography or FINE) by the operator are two methods to obtain standard fetal cardiac views from spatiotemporal image correlation (STIC) volumes. The objective was to compare the performance between manual and intelligent navigation (FINE) of the fetal heart by non-expert sonologists.
METHODS:
In this prospective observational study, ten sonologists underwent formal training on both navigational methods. Subsequently, they were tested on their ability to obtain nine cardiac views from five STIC volumes of normal fetal hearts (19-28 gestational weeks) using such methods. The following parameters were determined for both methods: (1) success rate of obtaining nine cardiac views; (2) mean time to obtain nine cardiac views per sonologist; and (3) maximum number of cardiac views successfully obtained for each STIC volume.
RESULTS:
All fetal cardiac images obtained from 100 STIC volumes (50 for each navigational method) were reviewed by an expert in fetal echocardiography. Compared to manual navigation, FINE was associated with a significantly: (1) higher success rate of obtaining eight (excluding the abdomen view) appropriate cardiac views (92-100% vs. 56-88%; all p
CONCLUSIONS:
When performed by non-expert sonologists, intelligent navigation (FINE) had a superior performance compared to manual navigation of the normal fetal heart. Specifically, FINE obtained appropriate fetal cardiac views in 92-100% of cases.
© 2022 Walter de Gruyter GmbH, Berlin/Boston.
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Smooth muscle cell fate decisions decipher a high-resolution heterogeneity within atherosclerosis molecular subtypes.
J Transl Med2022 Dec;20(1):568. doi: 10.1186/s12967-022-03795-9.
Zhang Ge, Liu Zaoqu, Deng Jinhai, Liu Long, Li Yu, Weng Siyuan, Guo Chunguang, Zhou Zhaokai, Zhang Li, Wang Xiaofang, Liu Gangqiong, Guo Jiacheng, Bai Jing, Wang Yunzhe, Du Youyou, Li Tao-Sheng, Tang Junnan, Zhang Jinying,
Abstract
BACKGROUND:
Mounting evidence has revealed the dynamic variations in the cellular status and phenotype of the smooth muscle cell (SMC) are vital for shaping the atherosclerotic plaque microenvironment and ultimately mapping onto heterogeneous clinical outcomes in coronary artery disease. Currently, the underlying clinical significance of SMC evolutions remains unexplored in atherosclerosis.
METHODS:
The dissociated cells from diseased segments within the right coronary artery of four cardiac transplant recipients and 1070 bulk samples with atherosclerosis from six bulk cohorts were retrieved. Following the SMC fate trajectory reconstruction, the MOVICS algorithm integrating the nearest template prediction was used to develop a stable and robust molecular classification. Subsequently, multi-dimensional potential biological implications, molecular features, and cell landscape heterogeneity among distinct clusters were decoded.
RESULTS:
We proposed an SMC cell fate decision signature (SCFDS)-based atherosclerosis stratification system and identified three SCFDS subtypes (C1-C3) with distinguishing features: (i) C1 (DNA-damage repair type), elevated base excision repair (BER), DNA replication, as well as oxidative phosphorylation status. (ii) C2 (immune-activated type), stronger immune activation, hyper-inflammatory state, the complex as well as varied lesion microenvironment, advanced stage, the most severe degree of coronary stenosis severity. (iii) C3 (stromal-rich type), abundant fibrous content, stronger ECM metabolism, immune-suppressed microenvironment.
CONCLUSIONS:
This study uncovered atherosclerosis complex cellular heterogeneity and a differentiated hierarchy of cell populations underlying SMC. The novel high-resolution stratification system could improve clinical outcomes and facilitate individualized management.
© 2022. The Author(s).
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Cardiac imaging findings in anomalous origin of the coronary arteries from the pulmonary artery; narrative review of the literature.
Echo Res Pract2022 Dec;9(1):12. doi: 10.1186/s44156-022-00012-7.
Ajam Ali, Rahnamoun Zahra, Sahebjam Mohammad, Sattartabar Babak, Razminia Yasaman, Ahmadi Tafti Seyed Hossein, Hosseini Kaveh,
Abstract
INTRODUCTION:
Anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is a rare coronary artery malformation with an incidence of 0.002% in patients undergoing coronary angiography. It can lead to an increased risk of myocardial infarction (MI) and sudden cardiac death, even in asymptomatic patients.
METHODS:
We conducted a review of published cases of ARCAPA using PubMed and Scopus databases and included patients over 18 years old with adequate echocardiographic data.
RESULTS:
We evaluated 28 patients with ARCAPA with a mean age of 42.8 from 1979 to 2021. Patients were diagnosed mostly by angiography and echocardiography, the most performed treatment was reimplantation (15, 53.6%) and the main echocardiographic findings were dilated coronary arteries (9, 32.1%), coronary collaterals (8, 28.6%), and retrograde flow from right coronary arteries to main pulmonary trunk (7, 25%).
CONCLUSION:
Although ARCAPA is rare and not as deadly as the anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) still there is a chance of serious outcomes, therefore surgical treatment should be performed upon diagnosis. Angiography is the gold standard for diagnosis, but echocardiography can be a convenient, non-invasive, and most reliable method as the primary step whenever ARCAPA is suspected.
© 2022. The Author(s).
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Organ damage evaluation in a temperature-controlled circulatory arrest rat model.
BMC Cardiovasc Disord2022 Dec;22(1):527. doi: 10.1186/s12872-022-02955-5.
Xiong Yaoyao, Zheng Quan, Wang Chunle, Yan Wei, He Wei,
Abstract
BACKGROUND:
Deep hypothermic circulatory arrest (DHCA) is commonly used in adult aortic surgery and pediatric complex congenital heart disease, and is associated with pathophysiological changes and postoperative complications. Here, a temperature-controlled circulatory arrest model in rats was established to study the suitable temperature of circulatory arrest by investigating the damage to body organs under different temperatures.
METHODS:
Thirty Sprague?Dawley rats were randomly divided into 5 equal groups for DHCA experiments: I (15-20 °C), II (20-25 °C), III (25-30 °C), IV (normothermic cardiopulmonary bypass), and V (sham operation group). Blood gas analysis, homodynamic parameters, and intervals of cardiac recovery were measured at different time points in all groups. Morphological changes in intestinal tissue were observed under light and electron microscopes. Oxidative stress was measured by MPO activity, MDA, and SOD content. Tissue damage was confirmed by serum detection of ALT, AST, BUN, Cr, and LDH. To examine the inflammatory response, cytokines, including IL-1, IL-4, IL-10, IFN-?, and TNF-?, were detected.
RESULTS:
The extracorporeal circulation technique caused damage to the body; the degree of the damage caused by the circulatory arrest technique may be related to circulating temperature, with the least amount of damage occurring at 20-25 °C compared to 15-20 °C and 25-30 °C. Ischemia and hypoxia can cause intestinal tissue damage, which manifests primarily as a loss of the intestinal mucosal barrier. Ischemic intestinal damage caused by DHCA was not associated with inflammation.
CONCLUSION:
The study provides new insights into the pathophysiologic mechanisms of DHCA.
© 2022. The Author(s).
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Prognostic value of cardiac magnetic resonance imaging parameters in left ventricular noncompaction with left ventricular dysfunction.
BMC Cardiovasc Disord2022 Dec;22(1):526. doi: 10.1186/s12872-022-02963-5.
Bai Wei, Xu Rong, Li Xiao, Xu Huayan, Fu Hang, Hou Ruilai, Zhou Ziqi, Huang Wei, Wang Yining, Guo Yingkun,
Abstract
BACKGROUND:
Cardiac magnetic resonance (CMR) has been used to diagnose and risk-stratify patients with left ventricular noncompaction (LVNC). The prognostic value of CMR parameters for LVNC, especially feature tracking (CMR-FT), is not well known in LVNC patients with left ventricular dysfunction. The present study aimed to investigate whether the combination of CMR-FT with traditional CMR parameters can increase the prognostic value of CMR for LVNC patients with reduced left ventricular ejection fraction (LVEF).
METHODS:
A total of 123 candidates were retrospectively included in this multicenter study and 55 LVNC patients (mean age, 45.7?±?16.2 years; 61.8% men) remained after applying the exclusion criteria. Clinical features, left ventricular (LV) function parameters, global and segment myocardial strain, and late gadolinium enhancement (LGE) were evaluated. The outcomes include the composite events of cardiovascular death, heart transplantation, hospitalization for heart failure, thromboembolic events, and ventricular arrhythmias.
RESULTS:
After a median follow-up of 5.17 years (interquartile range: 0.17 to 10.58 years), 24 (36.8%) patients experienced at least one major adverse cardiovascular event (MACE). The myocardial strain parameters of patients with events were lower than those of patients without events. In the univariable Cox analysis, LVEF, the presence of LGE, global longitudinal strain (GLS) and segmental strains, including longitudinal strain at the apical level and radial and circumferential strain at the basal level, were significantly associated with MACEs. In the multivariate analysis, LGE (hazard ratio (HR) 3.452, 95% CI 1.133 to 10.518, p?=?0.029) was a strong predictor of MACEs and significantly improved the predictive value (chi-square of the model after adding LGE: 7.51 vs. 13.47, p?=?0.009). However, myocardial strain parameters were not statistically significant for the prediction of MACEs after adjusting for age, body mass index, LVEF and the presence of LGE and did not increase the prognostic value (chi-square of the model after adding GLS: 13.47 vs. 14.14, p?=?0.411) in the multivariate model.
CONCLUSIONS:
The combination of CMR-FT with traditional CMR parameters may not increase the prognostic value of CMR in LVNC patients with reduced LVEF, while the presence of LGE was a strong independent predictor of MACEs and significantly improved the predictive value.
© 2022. The Author(s).
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