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Callum K, Graune C, Bowman E, Molden E, Leslie SJ. Remote monitoring of implantable defibrillators is associated with fewer inappropriate shocks and reduced time to medical assessment in a remote and rural area. World J Cardiol 2021; 13:46-54. [PMID: 33791078 PMCID: PMC7988594 DOI: 10.4330/wjc.v13.i3.46] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 01/13/2021] [Accepted: 03/09/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Implantable cardioverter defibrillators (ICDs) and cardiac resynchronisation therapy with defibrillators (CRT-D) reduce mortality in certain cardiac patient populations. However, inappropriate shocks pose a problem, having both adverse physical and psychological effects on the patient. The advances in device technology now allow remote monitoring (RM) of devices to replace clinic follow up appointments. This allows real time data to be analysed and actioned and this may improve patient care.
AIM To determine if RM in patients with an ICD is associated with fewer inappropriate shocks and reduced time to medical assessment.
METHODS This was a single centre, retrospective observational study, involving 156 patients implanted with an ICD or CRT-D, followed up for 2 years post implant. Both appropriate and inappropriate shocks were recorded along with cause for inappropriate shocks and time to medical assessment.
RESULTS RM was associated with fewer inappropriate shocks (13.6% clinic vs 3.9% RM; P = 0.030) and a reduced time to medical assessment (15.1 ± 6.8 vs 1.0 ± 0.0 d; P < 0.001).
CONCLUSION RM in patients with an ICD is associated with improved patient outcomes.
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Affiliation(s)
- Kara Callum
- Department of Cardiology, NHS Highland, Inverness IV2 3UJ, United Kingdom
| | - Claudia Graune
- Department of Cardiology, NHS Highland, Inverness IV2 3UJ, United Kingdom
| | - Elizabeth Bowman
- Department of Cardiology, NHS Highland, Inverness IV2 3UJ, United Kingdom
| | - Edward Molden
- Department of Cardiology, NHS Highland, Inverness IV2 3UJ, United Kingdom
| | - Stephen J Leslie
- Department of Cardiology, NHS Highland, Inverness IV2 3UJ, United Kingdom
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202
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Hein SJ, Knoll M, Aus dem Siepen F, Furkel J, Schoenland S, Hegenbart U, Katus HA, Kristen AV, Konstandin M. Elevated interleukin-6 levels are associated with impaired outcome in cardiac transthyretin amyloidosis. World J Cardiol 2021; 13:55-67. [PMID: 33791079 PMCID: PMC7988596 DOI: 10.4330/wjc.v13.i3.55] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/19/2021] [Accepted: 02/12/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Elevated interleukin (IL)-6-levels have been described in familial variant transthyretin amyloidosis (ATTRv) associated polyneuropathy and heart failure. However, IL-6 in cardiac ATTR amyloidosis (ATTR-CM) and its prognostic value have not been investigated yet.
AIM We aim to study the correlation between IL-6 levels with clinical presentation (Gillmore-class) and outcome [heart transplantation or death (htx/death)], or the combined endpoint of cardiac decompensation or htx/death in ATTR-CM.
METHODS IL-6 levels of 106 ATTR-CM patients [54 wild-type ATTRwt, 52 ATTRv-CM], 15 asymptomatic carriers of ATTR mutations (aATTRv-CM) and 27 healthy donors were quantified using Luminex technology. Statistical analysis was performed using parametric survival regression models.
RESULTS We found that IL-6 levels from wild-type ATTR patients were significantly elevated compared to healthy controls, while aATTRv-CM carriers and ATTRv-CM patients did not show a significant difference. IL-6 levels showed significantly higher values in increasing Gillmore classes. Univariate analyses revealed association of low IL-6 levels with cardiac decompensation and htx/death [odds ratio: 0.26 (0.09-0.72), P = 0.01] and htx/death [odds ratio: 0.15 (0.04-0.58), P = 0.006]. However, in the multivariate model, no significant improvement of risk prediction was seen for IL-6, while established prognostic factors were significantly associated with outcome.
CONCLUSION Raised IL-6 levels correlate with clinical presentation and are associated with worse outcome in ATTR-CM but do not improve stratification in addition to established risk factors.
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Affiliation(s)
- Selina J Hein
- Department of Cardiology, Pneumology and Angiology, University Hospital Heidelberg, Heidelberg, BW 69120, Germany
| | - Maximilian Knoll
- Department of Radiation Oncology, Heidelberg Ion-Beam Therapy Center, German Cancer Research Center, University Hospital Heidelberg, Heidelberg, BW 69120, Germany
| | - Fabian Aus dem Siepen
- Department of Cardiology, Pneumology and Angiology, University Hospital Heidelberg, Heidelberg, BW 69120, Germany
| | - Jennifer Furkel
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, BW 69120, Germany
| | - Stefan Schoenland
- Department of Hematology, Oncology and Rheumatology, Amyloidosis Center, Heidelberg University Hospital, Heidelberg, BW 69120, Germany
| | - Ute Hegenbart
- Department of Hematology, Amyloidosis Center, Heidelberg University Hospital, Heidelberg, BW 69120, Germany
| | - Hugo A Katus
- Department of Cardiology, Medical University Hospital Heidelberg, Heidelberg, BW 69120, Germany
| | - Arnt V Kristen
- Department of Cardiology, Amyloidosis Center, University of Heidelberg, Heidelberg, BW 69120, Germany
| | - Mathias Konstandin
- Department of Cardiology, Medical University Hospital Heidelberg, Heidelberg, BW 69120, Germany
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203
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Wendl E, Telles N, Wall GC. Survey concerning internal medicine physicians and prolonged QT interval: Knowledge and treatment practices. World J Cardiol 2021; 13:42-45. [PMID: 33791077 PMCID: PMC7988595 DOI: 10.4330/wjc.v13.i3.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/03/2020] [Accepted: 01/13/2021] [Indexed: 02/06/2023] Open
Abstract
Prolongation of the QT interval is associated with adverse cardiac events specifically Torsades de pointes (TdP). There are multiple mediations that have a known, possible, or conditional risk for prolonged QT interval, but general practitioners’ knowledge of these medications is unknown. We conducted a survey to assess internal medicine (IM) providers’ knowledge of risk factors and medications associated with prolonged QT as well as provider experience and comfort when treating patients with prolonged QT. A 17-question, anonymous survey was constructed in 2019 and distributed to IM providers and residents at a tertiary care center. Questions included demographic information, 6 Likert-scale questions gauging provider experience with prolonged QT, and 10 multiple choice clinical vignettes to assess clinical knowledge. Data was analyzed descriptively. Knowledge was assessed via clinical vignettes and compared by level of training. Forty-one responses were received out of a total of 87 possible respondents (47.1% response rate). About 70% of respondents see patients with acquired prolonged QT once monthly or more. 95% rarely see congenital prolonged QT. When presented with QTc drug issues, 73% of providers seldom or sometimes consulted pharmacy, but about half used online resources. The average correct score on the clinical vignettes was 5.59/10, with the highest scores seen in attending physicians in their first five years of practice (6.96/10). Our survey suggests that IM providers commonly encounter QT prolonging drugs. Educational efforts to improve knowledge of drug and patient risk factors for TdP may be needed.
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Affiliation(s)
- Elizabeth Wendl
- Department of Medical Education, Internal Medicine Residency Program, Iowa Methodist Medical Center, Des Moines, IA 50311, United States
| | - Nelson Telles
- Department of Cardiology, Internal Medicine Residency Program, Iowa Methodist Medical Center, Des Moines, IA 50311, United States
| | - Geoff C Wall
- Department of Pharmacy Practice, Drake University College of Pharmacy and Health Sciences, Des Moines, IA 50311, United States
- Internal Medicine Residency Program, Iowa Methodist Medical Center, Des Moines, IA 50311, United States
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204
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Ma YJ, Pai RG. New Year's greeting and overview of World Journal of Cardiology in 2021. World J Cardiol 2021; 13:38-41. [PMID: 33717410 PMCID: PMC7941670 DOI: 10.4330/wjc.v13.i2.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/06/2021] [Accepted: 02/19/2021] [Indexed: 02/06/2023] Open
Abstract
On behalf of the Editorial Office of World Journal of Cardiology (WJC), we extend our sincere gratitude to our authors, readers, Editorial Board members, and peer reviewers, thanking each and every one for their contributions to WJC in 2020 and with wishes for a Happy New Year. It was the collective support of all authors, Editorial Board members, peer reviewers and staff of the Editorial Office that allowed the Baishideng Publishing Group Inc. to carry out successfully the complete peer review, editing and publishing processes for WJC in 2020. We have now analyzed the metric data of WJC's manuscripts that were submitted and published in 2020, the peer review of manuscripts in 2020, the invited manuscripts for 2021 and the Editorial Board members’ composition and activities. As a global academic journal in cardiology, the findings from such will facilitate greater productivity and more efficient collaborative efforts to raise the academic rank of WJC in 2021. We enthusiastically anticipate WJC’s contributions to promote further cardiology research sharing and exchange in 2021.
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Affiliation(s)
- Ya-Juan Ma
- Editorial Office, Baishideng Publishing Group Inc, Pleasanton, CA 94566, United States
| | - Ramdas G Pai
- University of California Riverside School of Medicine, St Bernardines Medical Center, Riverside, CA 92507, United States
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205
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Abe T, Eyituoyo HO, De Allie G, Olanipekun T, Effoe VS, Olaosebikan K, Mather P. Clinical outcomes in patients with native valve infective endocarditis and diabetes mellitus. World J Cardiol 2021; 13:11-20. [PMID: 33552399 PMCID: PMC7821010 DOI: 10.4330/wjc.v13.i1.11] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/18/2020] [Accepted: 12/28/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There is a lack of data on the clinical outcomes in patients with native valve infective endocarditis (NVIE) and diabetes mellitus (DM).
AIM To investigate (1) trends in the prevalence of DM among patients with NVIE; and (2) the impact of DM on NVIE outcomes.
METHODS We identified 76385 with NVIE from the 2004 to 2014 National Inpatient Sample, of which 22284 (28%) had DM. We assessed trends in DM from 2004 to 2014 using the Cochrane Armitage test. We compared baseline comorbidities, microorganisms, and in-patients procedures between those with vs without DM. Propensity match analysis and multivariate logistic regression were used to investigate study outcomes in in-hospital mortality, stroke, acute heart failure, cardiogenic shock, septic shock, and atrioventricular block.
RESULTS Crude rates of DM increased from in 22% in 2004 to 30% in 2014. There were significant differences in demographics, comorbidities and NVIE risk factors between the two groups. Staphylococcus aureus was the most common organism identified with higher rates in patients with DM (33.1% vs 35.6%; P < 0.0001). After propensity matching, in-hospital mortality (11.1% vs 11.9%; P < 0.0001), stroke (2.3% vs 3.0%; P < 0.0001), acute heart failure (4.6% vs 6.5%; P = 0.001), cardiogenic shock (1.5% vs 1.9%; P < 0.0001), septic shock (7.2% vs 9.6%; P < 0.0001), and atrioventricular block (1.5% vs 2.4%; P < 0.0001), were significantly higher in patients with DM. Independent predictors of mortality in NVIE patients with DM include hemodialysis, congestive heart failure, atrial fibrillation, staphylococcus aureus, and older age.
CONCLUSION There is an increasing prevalence of DM in NVIE and it is associated with poorer outcomes. Further studies are crucial to identify the clinical, and sociodemographic contributors to this trend and develop strategies to mitigate its attendant risk.
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Affiliation(s)
- Temidayo Abe
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, GA 30310, United States
| | - Harry Onoriode Eyituoyo
- Department of Internal Medicine, Mercer University School of Medicine, Macon, GA 31207, United States
| | - Gabrielle De Allie
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, GA 30310, United States
| | - Titilope Olanipekun
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, GA 30310, United States
| | - Valery Sammah Effoe
- Department of Cardiovascular Disease, Morehouse School of Medicine, Atlanta, GA 30310, United States
| | - Kikelomo Olaosebikan
- Department of Medicine, University of Debrecen Medical and Health Science Center, Debrecen 4032, Hungary
| | - Paul Mather
- Department of Cardiovascular Disease, University of Pennsylvania, Pennsylvania, PA 19104, United States
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206
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Kuo Y, Ottens TH, van der Bilt I, Keunen RWM, Akin S. Myasthenic crisis-induced Takotsubo cardiomyopathy in an elderly man: A case report of an underestimated but deadly combination. World J Cardiol 2021; 13:21-27. [PMID: 33552400 PMCID: PMC7821008 DOI: 10.4330/wjc.v13.i1.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/30/2020] [Accepted: 12/14/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients with myasthenia gravis (MG) are at a higher risk of developing Takotsubo cardiomyopathy (TTC), particularly during a myasthenic crisis. Myasthenic crisis-associated TTC occurs predominantly in women. In this case report, we present a man with metastasized prostate carcinoma who developed TTC after new-onset MG.
CASE SUMMARY An 81-year-old man with non-insulin dependent diabetes mellitus and metastasized prostate carcinoma presented with dyspnea. During primary assessment examination at the emergency department, there was evident blepharoptosis of his right eye. His electrocardiograms were suggestive of an acute anterior wall myocardial infarction, for which he underwent emergency coronary angiography. No obstructive coronary artery disease was found. During the coronary angiography, the patient developed respiratory failure and was admitted to the Intensive Care Unit for non-invasive respiratory support. The following day, diagnostic neostigmine test revealed a myasthenic crisis. Bedside echocardiography revealed left ventricular apical ballooning with a typical appearance of TTC. Despite the potentially reversible character of both MG and TTC, the patient and family requested an end of support in the Intensive Care Unit due to age and chronic malignancy with reduced quality of life in recent months after non-chemo-responding prostate carcinoma. The patient died soon after treatment withdrawal.
CONCLUSION Elderly men should be carefully evaluated for TTC when new-onset MG is diagnosed.
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Affiliation(s)
- Yvonne Kuo
- Intensive Care Unit, Hagaziekenhuis, The Hague 2545, Netherlands
| | - Thomas H Ottens
- Intensive Care Unit, Hagaziekenhuis, The Hague 2545, Netherlands
| | - Ivo van der Bilt
- Department of Cardiology, Hagaziekenhuis, The Hague 2545, Netherlands
| | - Ruud WM Keunen
- Department of Neurology, Haga Teaching Hospital, The Hague 2545, Netherlands
| | - Sakir Akin
- Intensive Care Unit, Hagaziekenhuis, The Hague 2545, Netherlands
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207
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Chong EG, Lee EH, Sail R, Denham L, Nagaraj G, Hsueh CT. Anthracycline-induced cardiotoxicity: A case report and review of literature. World J Cardiol 2021; 13:28-37. [PMID: 33552401 PMCID: PMC7821007 DOI: 10.4330/wjc.v13.i1.28] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 11/07/2020] [Accepted: 12/23/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Doxorubicin and other anthracycline derivatives inhibit topoisomerase II and is an important class of cytotoxic chemotherapy in cancer treatment. The use of anthracycline is limited by dose-dependent cardiotoxicity, which may manifest initially as asymptomatic cardiac dysfunction with subsequent progression to congestive heart failure. Despite baseline assessment and periodic monitoring of cardiac function for patients receiving anthracycline agents, there are unmet needs in prediction and prevention of anthracycline-induced cardiotoxicity (AIC).
CASE SUMMARY A 35-year-old African American female was found to have a 9-cm high-grade osteosarcoma of right femur and normal baseline cardiac function with left ventricular ejection fraction of approximately 60%-70% determined by transthoracic and dobutamine stress echocardiogram. She underwent perioperative doxorubicin and cisplatin chemotherapy with 3 cycles before surgery and 3 cycles after surgery, and received a total of 450 mg/m2 doxorubicin at the end of her treatment course. She was evaluated regularly during chemotherapy without any cardiac or respiratory symptoms. Approximately two months after her last chemotherapy, the patient presented to the emergency department with dyspnea for one week and was intubated for acute hypoxic respiratory failure. Echocardiogram showed an ejection fraction of 5%-10% with severe biventricular failure. Despite attempts to optimize cardiac function, the patient’s hemodynamic status continued to decline, and resuscitation was not successful on the seventh day of hospitalization. The autopsy showed no evidence of osteosarcoma, and the likely cause of death was cardiac failure with the evidence of pulmonary congestion, liver congestion, and multiple body cavity effusions.
CONCLUSION We present a case of 35-year-old African American female developing cardiogenic shock shortly after receiving a cumulative dose of 450 mg/m2 doxorubicin over 9 mo. Cardiac monitoring and management of patients receiving anthracycline chemotherapy have been an area of intense research since introduction of these agents in clinical practice. We have reviewed literature and recent advances in the prediction and prevention of AIC. Although risk factors currently identified can help stratify patients who need closer monitoring, there are limitations to our current understanding and further research is needed in this field.
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Affiliation(s)
- Esther G Chong
- Department of Medicine, Loma Linda University, Loma Linda, CA 92350, United States
| | - Eric H Lee
- Department of Hematology/Oncology, Compassionate Cancer Care Medical Group, Fountain Valley, CA 92708, United States
| | - Reena Sail
- Department of Hematology/Oncology, Scripps MD Anderson Cancer Center, San Diego, CA 92121, United States
| | - Laura Denham
- Department of Pathology and Human Anatomy, Loma Linda University, Loma Linda, CA 92350, United States
| | - Gayathri Nagaraj
- Division of Medical Oncology and Hematology, Department of Medicine, Loma Linda University, Loma Linda, CA 92350, United States
| | - Chung-Tsen Hsueh
- Division of Medical Oncology and Hematology, Department of Medicine, Loma Linda University, Loma Linda, CA 92350, United States
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208
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Beltrami M, Fumagalli C, Milli M. Frailty, sarcopenia and cachexia in heart failure patients: Different clinical entities of the same painting. World J Cardiol 2021; 13:1-10. [PMID: 33552398 PMCID: PMC7821009 DOI: 10.4330/wjc.v13.i1.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/25/2020] [Accepted: 12/28/2020] [Indexed: 02/06/2023] Open
Abstract
Heart Failure (HF) in elderly patients is a systemic syndrome where advanced age, comorbidities with organ system deterioration, frailty and impaired cognition significantly impact outcome. Cardiac cachexia, sarcopenia and frailty despite overlap in definitions are different clinical entities that frequently coexist in HF patients. However, these co-factors often remain unaddressed, resulting in poor quality-of-life, prolonged physical disability and exercise intolerance and finally with higher rehospitalization rates and mortality. Strategy aim to increase muscle mass and muscle strength and delay the occurrence of frailty state appear essential in this regard. Common HF drugs therapy (b-blockers, angiotensin-converting enzyme inhibitors) and prescription of physical exercise program remain the cornerstone of therapeutic approach in HF patients with new promising data regarding nutritional supplementation. However, the treatment of all these conditions still remain debated and only a profound knowledge of the specific mechanisms and patterns of disease progression will allow to use the appropriate therapy in a given clinical setting. For all these reasons we briefly review current knowledge on frailty, sarcopenia and cachexia in HF patients with the attempt to define clinically significant degrees of multiorgan dysfunction, specific "red alert" thresholds in clinical practice and therapeutic approach.
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Affiliation(s)
- Matteo Beltrami
- Cardiology Unit, San Giovanni di Dio Hospital, Florence 50142, Italy
| | - Carlo Fumagalli
- Cardiomyopathy Unit, Careggi University Hospital, Florence 50139, Italy
| | - Massimo Milli
- Cardiology Unit, San Giovanni di Dio Hospital, Florence 50142, Italy
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209
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Wang J, Deng SB, She Q. Heparin-induced thrombocytopenia in renal insufficiency undergoing dialysis and percutaneous coronary intervention after acute myocardial infarction: A case report. World J Cardiol 2020; 12:634-641. [PMID: 33391616 PMCID: PMC7754382 DOI: 10.4330/wjc.v12.i12.634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/10/2020] [Accepted: 11/12/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Heparin-induced thrombocytopenia (HIT) is a rare complication of heparin therapy, and is characterized by arteriovenous thrombosis and bleeding events. The incidence of HIT after percutaneous coronary intervention (PCI) in patients with myocardial infarction complicated with renal failure is rarely reported.
CASE SUMMARY We report a 73-year-old man with acute myocardial infarction and renal failure who underwent hemodialysis and PCI, and developed a progressive decline in platelets and subcutaneous hemorrhage of both upper limbs after heparin treatment. In addition to a gradual decrease in platelets, the patient’s 4T's score was 7, and HIT antibody was positive, confirming the diagnosis of HIT.
CONCLUSION Patients receiving heparin combined with antiplatelet therapy should be monitored closely, especially for their platelet count. In the case of thrombo-cytopenia, HIT should be highly suspected. When the diagnosis of HIT is confirmed, timely individualized treatment should be delivered.
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Affiliation(s)
- Jing Wang
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Song-Bai Deng
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Qiang She
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
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210
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Trimukhe R, Vani P, Patel A, Salgotra V. Safety and performance of the EverPro TM everolimus-eluting coronary stent system with biodegradable polymer in a real-world scenario. World J Cardiol 2020; 12:615-625. [PMID: 33391614 PMCID: PMC7754385 DOI: 10.4330/wjc.v12.i12.615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/15/2020] [Accepted: 11/05/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The EverProTM (Sahajanand Laser Technology Ltd., India) everolimus-eluting coronary stent system (EES) is a second-generation drug-eluting stent with a biodegradable polymer.
AIM To determine the safety and performance of the EverProTM EES in patients with coronary artery disease (CAD) during a 1-year clinical follow-up.
METHODS This observational, retrospective, single-center study enrolled patients who had been implanted with the EverProTM stent between June 1, 2018 and January 31, 2019, and had completed a 1-year follow-up period after the index procedure. The primary clinical endpoint was major adverse cardiac events (MACE) at 6 mo defined as the composite of cardiac death, myocardial infarction (MI), and target lesion revascularization (TLR). Secondary endpoints were the incidence of TLR at 1, 6 and 12 mo follow-up, MACE at 1 and 12 mo follow-up, and stent thrombosis up to 1 year after the index procedure.
RESULTS The study population comprised 77 patients (98 lesions). A total of 37 (48.1%) patients had comorbid hypertension. In total, 26 (33.8%) patients presented with ST segment elevation MI and 10.4% patients with non-ST segment elevation MI. Treated lesions were located mainly in the left anterior descending artery (49%) followed by the right coronary artery (29.6%), left circumflex (12.2%) and obtuse marginal (9.2%) arteries. The majority of patients were with single-vessel disease (79%), 22.2% of lesions had a mild to severe thrombus load, and 94.9% were American College of Cardiology/American Heart Association type B or C. De novo stenting was performed in 96.9% of patients and 3% were treated for in-stent restenosis. Procedural success was attained in all patients. In-hospital or follow-up MACE and stent thrombosis were not reported during the 1-year follow-up period.
CONCLUSION These findings suggest that the EverProTM EES is a safe and effective treatment option with no MACE or stent thrombosis reported during the 1-year study period in patients with CAD.
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Affiliation(s)
- Rahul Trimukhe
- Department of Cardiology, Atma Malik Hospital, Ahmednagar 423601, Maharashtra, India
| | - Preeti Vani
- SLTL Medical Division, SLTL (Sahajanand Laser Technology Ltd.), Gandhinagar 382016, Gujarat, India
| | - Arvind Patel
- SLTL Group, SLTL (Sahajanand Laser Technology Ltd.), Gandhinagar 382016, Gujarat, India
| | - Vikas Salgotra
- SLTL Medical Division, SLTL (Sahajanand Laser Technology Ltd.), Gandhinagar 382016, Gujarat, India
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211
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Lin YP, Fan CH, Tsai KZ, Lin KH, Han CL, Lin GM. Psychological stress and long-term blood pressure variability of military young males: The cardiorespiratory fitness and hospitalization events in armed forces study. World J Cardiol 2020; 12:626-633. [PMID: 33391615 PMCID: PMC7754384 DOI: 10.4330/wjc.v12.i12.626] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/10/2020] [Accepted: 11/05/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Acute stress might increase short-term heart rate variability and blood pressure variability (BPV); however, chronic stress would not alter short-term BPV in animal models.
AIM To examine the association of psychological stress with long-term BPV in young male humans.
METHODS We prospectively examined the association of chronic psychological stress with long-term BPV in 1112 healthy military males, averaged 32.2 years from the cardiorespiratory fitness and hospitalization events in armed forces study in Taiwan. Psychological stress was quantitatively evaluated with the Brief Symptom Rating Scale (BSRS-5), from the least symptom of 0 to the most severe of 20, and the five components of anxiety, insomnia, depression, interpersonal sensitivity, and hostility (the severity score in each component from 0 to 4). Long-term BPV was assessed by standard deviation (SD) for systolic and diastolic blood pressure (SBP and DBP), and average real variability (ARV), defined as the average absolute difference between successive measurements of SBP or DBP, across four visits in the study period from 2012 to 2018 (2012-14, 2014-15, 2015-16, and 2016-18).
RESULTS The results of multivariable linear regressions showed that there were no correlations of the BSRS-5 score with SDSBP, SDDBP, ARVSBP, and ARVDBP after adjusting for all the covariates [β(SE): -0.022 (0.024), -0.023 (0.026), -0.001 (0.018), and 0.001 (0.020), respectively; P > 0.05 for all]. In addition, there were also no correlations between each component of the BSRS score and the long-term BPV indexes.
CONCLUSION Our findings suggest that chronic psychological stress might not be associated with long-term BPV in military young male humans.
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Affiliation(s)
- Yen-Po Lin
- Department of Critical Care Medicine, Yonghe Cardinal Tien Hospital, Yonghe 234, Taiwan
| | - Chia-Hao Fan
- Department of Nursing, Hualien Armed Forces General Hospital, Hualien 97144, Taiwan
| | - Kun-Zhe Tsai
- Department of Dentistry, Hualien Armed Forces General Hospital, Hualien 971, Taiwan
| | - Ko-Hwan Lin
- Department of Psychiatry, Hualien Armed Forces General Hospital, Hualien 97144, Taiwan
| | - Chih-Lu Han
- Department of Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Gen-Min Lin
- Department of Medicine, Hualien Armed Forces General Hospital, Hualien 970, Taiwan
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Vidal-Perez R, Vázquez-García R, Barge-Caballero G, Bouzas-Mosquera A, Soler-Fernandez R, Larrañaga-Moreira JM, Crespo-Leiro MG, Vazquez-Rodriguez JM. Diagnostic and prognostic value of cardiac imaging in amyloidosis. World J Cardiol 2020; 12:599-614. [PMID: 33391613 PMCID: PMC7754383 DOI: 10.4330/wjc.v12.i12.599] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/28/2020] [Accepted: 11/17/2020] [Indexed: 02/06/2023] Open
Abstract
Amyloidosis is an infiltrative disease caused by extracellular protein deposition that has accumulated a lot of scientific production in recent years. Different types of amyloidosis can affect the heart. Transthyretin amyloidosis and light chain amyloidosis are the two most common types of cardiac amyloidosis. These entities have a poor prognosis, so accurate diagnostic techniques are imperative for determining an early therapeutic approach. Recent advances in cardiac imaging and diagnostic strategies show that these tools are safe and can avoid the use of invasive diagnostic techniques to histological confirmation, such as endomyocardial biopsy. We performed a review on the diagnostic and prognostic implications of different cardiac imaging techniques in cardiac amyloidosis. We mainly focus on reviewing echocardiography, cardiac magnetic resonance, computed tomography and nuclear imaging techniques and the different safety measurements that can be done with each of them.
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Affiliation(s)
- Rafael Vidal-Perez
- Servicio de Cardiología, Unidad de Imagen y Función Cardíaca, Complexo Hospitalario Universitario A Coruña (CHUAC), Santiago de Compostela 15706, A Coruña, Spain
| | - Raquel Vázquez-García
- Servicio de Cardiología, Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña 15006, A Coruña, Spain
| | - Gonzalo Barge-Caballero
- Servicio de Cardiología, Complexo Hospitalario Universitario A Coruña, Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco, Instituto de Investigación Biomédica de A Coruña (INIBIC), Centro de Investigación Biomédica en Red (CIBERCV)-Instituto de Salud Carlos III, A Coruña 15006, A Coruña, Spain
| | - Alberto Bouzas-Mosquera
- Servicio de Cardiología, Unidad de Imagen y Función Cardíaca, Complexo Hospitalario Universitario A Coruña (CHUAC), Santiago de Compostela 15706, A Coruña, Spain
| | - Rafaela Soler-Fernandez
- Servicio de Cardiología, Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña 15006, A Coruña, Spain
| | | | - Maria Generosa Crespo-Leiro
- Servicio de Cardiología, Complexo Hospitalario Universitario A Coruña, Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco, Instituto de Investigación Biomédica de A Coruña (INIBIC), Centro de Investigación Biomédica en Red (CIBERCV)-Instituto de Salud Carlos III, A Coruña 15006, A Coruña, Spain
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213
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Mylonas KS, Ziogas IA, Mylona CS, Avgerinos DV, Bakoyiannis C, Mitropoulos F, Tzifa A. Rapid right ventricular pacing for balloon valvuloplasty in congenital aortic stenosis: A systematic review. World J Cardiol 2020; 12:540-549. [PMID: 33312439 PMCID: PMC7701905 DOI: 10.4330/wjc.v12.i11.540] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/22/2020] [Accepted: 10/11/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Balloon aortic valvuloplasty (BAV) is a well-established treatment modality for congenital aortic valve stenosis.
AIM To evaluate the role of rapid right ventricular pacing (RRVP) in balloon stabilization during BAV on aortic regurgitation (AR) in pediatric patients.
METHODS A systematic review of the MEDLINE, Cochrane Library, and Scopus databases was conducted according to the PRISMA guidelines (end-of-search date: July 8, 2020). The National Heart, Lung, and Blood Institute and Newcastle-Ottawa scales was utilized for quality assessment.
RESULTS Five studies reporting on 72 patients were included. The studies investigated the use of RRVP-assisted BAV in infants (> 1 mo) and older children, but not in neonates. Ten (13.9%) patients had a history of some type of aortic valve surgical or catheterization procedure. Before BAV, 58 (84.0%), 7 (10.1%), 4 (5.9%) patients had AR grade 0 (none), 1 (trivial), 2 (mild), respectively. After BAV, 34 (49.3%), 6 (8.7%), 26 (37.7%), 3 (4.3%), patients had AR grade 0, 1, 2, and 3 (moderate), respectively. No patient developed severe AR after RRVP. One (1.4%) developed ventricular fibrillation and was defibrillated successfully. No additional arrhythmias or complications occurred during RRVP.
CONCLUSION RRVP can be safely used to achieve balloon stability during pediatric BAV, which could potentially decrease AR rates.
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Affiliation(s)
- Konstantinos S Mylonas
- Department of Cardiothoracic Surgery, Yale New Haven Hospital, New Haven, CT 06510, United States
| | - Ioannis A Ziogas
- Medical School, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - Charitini S Mylona
- Department of Pediatrics, Trikala General Hospital, Trikala 42100, Greece
| | - Dimitrios V Avgerinos
- Department of Cardiothoracic Surgery, New York Presbyterian Hospital, New York, NY 10065, United States
| | - Christos Bakoyiannis
- Division of Vascular Surgery, First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens 11527, Greece
| | - Fotios Mitropoulos
- Department of Pediatric Cardiac Surgery, Mitera Children’s Hospital, Athens 15123, Greece
| | - Aphrodite Tzifa
- Department of Pediatric Cardiology and Adult Congenital Heart Disease, Mitera Children’s Hospital, Athens 15123, Greece
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214
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Rondano E, Bertolazzi M, Galluzzo A, Maltese L, Caccianotti P, Macciò S, Mazza S, Ruocco MVD, Favretto S, Occhetta E, Rametta F. Effectiveness and safety of antithrombotic strategies in elderly patients with acute myocardial infarction. World J Cardiol 2020; 12:513-525. [PMID: 33312437 PMCID: PMC7701903 DOI: 10.4330/wjc.v12.i11.513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/28/2020] [Accepted: 10/12/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Elderly patients represent a rapidly growing part of the population more susceptible to acute coronary syndromes and their complications. However, literature evidence is lacking in this clinical setting.
AIM To describe the clinical features, in-hospital management and outcomes of “elderly” patients with myocardial infarction treated with antiplatelet and/or anticoagulation therapy.
METHODS This study was a retrospective analysis of all consecutive patients older than 80 years admitted to the Division of Cardiology of St. Andrea Hospital of Vercelli from January 2018 to December 2018 due to ST-elevation myocardial infarction (STEMI) or non-ST elevation myocardial infarction (NSTEMI). Clinical and laboratory data were collected for each patient, as well as the prevalence of previous or in-hospital atrial fibrillation (AF). In-hospital management, consisting of an invasive or conservative strategy, and the anti-thrombotic therapy used are described. Outcomes evaluated at 1 year follow-up included an efficacy ischemic endpoint and a safety bleeding endpoint.
RESULTS Of the 105 patients enrolled (mean age 83.9 ± 3.6 years, 52.3% males), 68 (64.8%) were admitted due to NSTEMI and 37 (35.2%) due to STEMI. Among the STEMI patients, 34 (91.9%) underwent coronary angiography and all of them were treated with percutaneous coronary intervention (PCI); among the NSTEMI patients, 42 (61.8%) were assigned to an invasive strategy and 16 (38.1%) of them underwent a PCI. No significant difference between the groups was found concerning the prevalence of previous or in-hospital de-novo AF. 10.5% of the whole population received triple antithrombotic therapy and 9.5% single antiplatelet therapy plus oral anticoagulation (OAC), with no significant difference between the subgroups, although a higher number of STEMI patients received dual antiplatelet therapy without OAC as compared with NSTEMI patients. A low rate of in-hospital death (5.7%) and 1-year cardiovascular death (3.3%) was registered. Seven (7.8%) patients experienced major adverse cardiovascular events, while the rate of minor and major bleeding at 1-year follow-up was 10% and 2.2%, respectively, with no difference between NSTEMI and STEMI patients.
CONCLUSION In this real-world study, a tailored evaluation of an invasive strategy and antithrombotic therapy resulted in a low rate of adverse events in elderly patients hospitalized with acute myocardial infarction.
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Affiliation(s)
- Elisa Rondano
- Cardiology Department, St. Andrea Hospital, Vercelli 13100, Italy
| | | | | | - Ludovica Maltese
- Cardiology Department, St. Andrea Hospital, Vercelli 13100, Italy
| | | | - Sergio Macciò
- Cardiology Department, St. Andrea Hospital, Vercelli 13100, Italy
| | - Stefano Mazza
- Cardiology Department, St. Andrea Hospital, Vercelli 13100, Italy
| | | | - Serena Favretto
- Cardiology Department, St. Andrea Hospital, Vercelli 13100, Italy
| | - Eraldo Occhetta
- Cardiology Department, St. Andrea Hospital, Vercelli 13100, Italy
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215
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Radhakrishnan SL, Ho KKL. Transradial vs transfemoral secondary access outcomes in transcatheter aortic valve implantation: A systematic review and meta-analysis. World J Cardiol 2020; 12:571-583. [PMID: 33312442 PMCID: PMC7701901 DOI: 10.4330/wjc.v12.i11.571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/21/2020] [Accepted: 10/30/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Complications of transcatheter aortic valve implantation (TAVI) procedures include bleeding, vascular complications, and strokes. These complications are often associated with the type of access used. The two types of access in TAVI procedures are primary and secondary. The main use of the primary access is for valve delivery, while secondary access is used for angiography and hemodynamic monitoring. While there are many options for primary access, those for secondary access are transfemoral and transradial.
AIM To compare outcomes between transradial vs transfemoral secondary access (TFSA).
METHODS A systematic search was conducted using major databases (EMBASE, PubMed, Cochrane Central, Google Scholar), which resulted in 5 studies that met the criteria for study selection. Outcomes of interest were 30-d rates each of major/life-threatening bleeding, vascular complications, strokes, and mortality. All 5 studies were observational. Only adjusted or matched data were used when available in this meta-analysis.
RESULTS A total of 5065 patients underwent TAVI, with 1453 patients (28.7%) having undergone transradial secondary access (TRSA) and 3612 patients (71.3%) TFSA. Irrespective of the site of primary access, the odds of having major or life-threatening bleeding were 60% lower in the TRSA group than the TFSA group (P < 0.00001). The odds of having major vascular complications were 52% lower in the TRSA group (P < 0.0001) with no difference in minor vascular complications between the 2 groups. Similarly, the odds of mortality in 30-d after the procedure were 41% lower (P = 0.006) and the odds of stroke were 54% lower (P = 0.001) in the TRSA group than the TFSA group.
CONCLUSION The transradial secondary approach appears to be a safer alternative to the transfemoral secondary approach in TAVI procedures.
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Affiliation(s)
- Shree Lata Radhakrishnan
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States
| | - Kalon KL Ho
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States
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Kourek C, Karatzanos E, Psarra K, Georgiopoulos G, Delis D, Linardatou V, Gavrielatos G, Papadopoulos C, Nanas S, Dimopoulos S. Endothelial progenitor cells mobilization after maximal exercise according to heart failure severity. World J Cardiol 2020; 12:526-539. [PMID: 33312438 PMCID: PMC7701904 DOI: 10.4330/wjc.v12.i11.526] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/28/2020] [Accepted: 10/05/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Vascular endothelial dysfunction is an underlying pathophysiological feature of chronic heart failure (CHF). Patients with CHF are characterized by impaired vasodilation and inflammation of the vascular endothelium. They also have low levels of endothelial progenitor cells (EPCs). EPCs are bone marrow derived cells involved in endothelium regeneration, homeostasis, and neovascularization. Exercise has been shown to improve vasodilation and stimulate the mobilization of EPCs in healthy people and patients with cardiovascular comorbidities. However, the effects of exercise on EPCs in different stages of CHF remain under investigation.
AIM To evaluate the effect of a symptom-limited maximal cardiopulmonary exercise testing (CPET) on EPCs in CHF patients of different severity.
METHODS Forty-nine consecutive patients (41 males) with stable CHF [mean age (years): 56 ± 10, ejection fraction (EF, %): 32 ± 8, peak oxygen uptake (VO2, mL/kg/min): 18.1 ± 4.4] underwent a CPET on a cycle ergometer. Venous blood was sampled before and after CPET. Five circulating endothelial populations were quantified by flow cytometry: Three subgroups of EPCs [CD34+/CD45-/CD133+, CD34+/CD45-/CD133+/VEGFR2 and CD34+/CD133+/vascular endothelial growth factor receptor 2 (VEGFR2)] and two subgroups of circulating endothelial cells (CD34+/CD45-/CD133- and CD34+/CD45-/CD133-/VEGFR2). Patients were divided in two groups of severity according to the median value of peak VO2 (18.0 mL/kg/min), predicted peak VO2 (65.5%), ventilation/carbon dioxide output slope (32.5) and EF (reduced and mid-ranged EF). EPCs values are expressed as median (25th-75th percentiles) in cells/106 enucleated cells.
RESULTS Patients with lower peak VO2 increased the mobilization of CD34+/CD45-/CD133+ [pre CPET: 60 (25-76) vs post CPET: 90 (70-103) cells/106 enucleated cells, P < 0.001], CD34+/CD45-/CD133+/VEGFR2 [pre CPET: 1 (1-4) vs post CPET: 5 (3-8) cells/106 enucleated cells, P < 0.001], CD34+/CD45-/CD133- [pre CPET: 186 (141-361) vs post CPET: 488 (247-658) cells/106 enucleated cells, P < 0.001] and CD34+/CD45-/CD133-/VEGFR2 [pre CPET: 2 (1-2) vs post CPET: 3 (2-5) cells/106 enucleated cells, P < 0.001], while patients with higher VO2 increased the mobilization of CD34+/CD45-/CD133+ [pre CPET: 42 (19-73) vs post CPET: 90 (39-118) cells/106 enucleated cells, P < 0.001], CD34+/CD45-/CD133+/VEGFR2 [pre CPET: 2 (1-3) vs post CPET: 6 (3-9) cells/106 enucleated cells, P < 0.001], CD34+/CD133+/VEGFR2 [pre CPET: 10 (7-18) vs post CPET: 14 (10-19) cells/106 enucleated cells, P < 0.01], CD34+/CD45-/CD133- [pre CPET: 218 (158-247) vs post CPET: 311 (254-569) cells/106 enucleated cells, P < 0.001] and CD34+/CD45-/CD133-/VEGFR2 [pre CPET: 1 (1-2) vs post CPET: 4 (2-6) cells/106 enucleated cells, P < 0.001]. A similar increase in the mobilization of at least four out of five cellular populations was observed after maximal exercise within each severity group regarding predicted peak, ventilation/carbon dioxide output slope and EF as well (P < 0.05). However, there were no statistically significant differences in the mobilization of endothelial cellular populations between severity groups in each comparison (P > 0.05).
CONCLUSION Our study has shown an increased EPCs and circulating endothelial cells mobilization after maximal exercise in CHF patients, but this increase was not associated with syndrome severity. Further investigation, however, is needed.
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Affiliation(s)
- Christos Kourek
- Department of Clinical Ergospirometry, Exercise & Rehabilitation Laboratory, Evaggelismos Hospital, Athens 10676, Greece
| | - Eleftherios Karatzanos
- Department of Clinical Ergospirometry, Exercise & Rehabilitation Laboratory, Evaggelismos Hospital, Athens 10676, Greece
| | - Katherina Psarra
- Immunology and Histocompatibility Department, Evaggelismos Hospital, Athens 10676, Greece
| | | | - Dimitrios Delis
- Department of Clinical Ergospirometry, Exercise & Rehabilitation Laboratory, Evaggelismos Hospital, Athens 10676, Greece
| | - Vasiliki Linardatou
- Department of Clinical Ergospirometry, Exercise & Rehabilitation Laboratory, Evaggelismos Hospital, Athens 10676, Greece
| | - Gerasimos Gavrielatos
- Department of Cardiology, Tzaneio General Hospital of Piraeus, Piraeus 18536, Greece
| | - Costas Papadopoulos
- 2nd Cardiology Department, Korgialenio-Benakio Red Cross Hospital, Athens 11526, Greece
| | - Serafim Nanas
- Department of Clinical Ergospirometry, Exercise & Rehabilitation Laboratory, Evaggelismos Hospital, Athens 10676, Greece
| | - Stavros Dimopoulos
- Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, Athens 17674, Greece
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Ullah W, Meizinger C, Ali Z, Panchal A, Saeed R, Haas DC, Rame E. Effects of left ventricular assist device on pulmonary functions and pulmonary hemodynamics: A meta-analysis. World J Cardiol 2020; 12:550-558. [PMID: 33312440 PMCID: PMC7701900 DOI: 10.4330/wjc.v12.i11.550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/18/2020] [Accepted: 10/30/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Given current evidence, the effect of left ventricular assist device (LVAD) implantation on pulmonary function tests remains controversial.
AIM To better understand the factors contributing to the changes seen on pulmonary function testing and the correlation with pulmonary hemodynamics after LVAD implantation.
METHODS Electronic databases were queried to identify relevant articles. The summary effect size was estimated as a difference of overall means and standard deviation on a random-effects model.
RESULTS A total of four studies comprising 219 patients were included. The overall mean forced expiratory volume in one second (FEV1), forced vital capacity (FVC) and diffusion lung capacity of carbon monoxide (DLCO) after LVAD implantation were significantly lower by 0.23 L (95%CI: 0.11-0.34, P = 00002), 0.18 L (95%CI: 0.03-0.34, P = 0.02), and 3.16 mmol/min (95%CI: 2.17-4.14, P < 0.00001), respectively. The net post-LVAD mean value of the cardiac index was significantly higher by 0.49 L/min/m2 (95%CI: 0.31-0.66, P < 0.00001) compared to pre-LVAD value. The pulmonary capillary wedge pressure and pulmonary vascular resistance were significantly reduced after LVAD implantation by 8.56 mmHg (95%CI: 3.78-13.35, P = 0.0004), and 0.83 Woods U (95%CI: 0.11-1.55, P = 0.02), respectively. There was no significant difference observed in the right atrial pressure after LVAD implantation (0.61 mmHg, 95%CI: -2.00 to 3.32, P = 0.65). Overall findings appear to be driven by studies using HeartMateII devices.
CONCLUSION LVAD implantation might be associated with a significant reduction of the spirometric measures, including FEV1, FVC, and DLCO, and an overall improvement of pulmonary hemodynamics.
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Affiliation(s)
- Waqas Ullah
- Department of Internal Medicine, Abington Jefferson Health, Abington, PA 19001, United States
| | - Casey Meizinger
- Department of Internal Medicine, Abington Jefferson Health, Abington, PA 19001, United States
| | - Zain Ali
- Department of Internal Medicine, Abington Jefferson Health, Abington, PA 19001, United States
| | - Ankur Panchal
- Department of Internal Medicine, University of Pittsburgh, Pittsburgh, PA 15213, United States
| | - Rehan Saeed
- Department of Internal Medicine, Abington Jefferson Health, Abington, PA 19001, United States
| | - Donald C Haas
- Department of Cardiology, Abington Jefferson Health, Abington, PA 19001, United States
| | - Eduardo Rame
- Department of Cardiology, Thomas Jefferson University, Abington, PA 19001, United States
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218
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Khan MS, Sami F, Singh H, Ullah W, Al-Dabbas M, Changal KH, Mir T, Ali Z, Kabour A. Medical therapy vs early revascularization in diabetics with chronic total occlusions: A meta-analysis and systematic review. World J Cardiol 2020; 12:559-570. [PMID: 33312441 PMCID: PMC7701902 DOI: 10.4330/wjc.v12.i11.559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/30/2020] [Accepted: 10/29/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Management of chronic total occlusions (CTO) in diabetics is challenging, with a recent trend towards early revascularization [ER: Percutaneous coronary intervention (PCI) and bypass grafting] instead of optimal medical therapy (OMT). We hypothesize that ER improves morbidity and mortality outcomes in diabetic patients with CTOs as compared to OMT. AIM To determine the long term clinical outcomes and to compare morbidity and mortality between OMT and ER in diabetic patients with CTOs. METHODS Potentially relevant published clinical trials were identified in Medline, Embase, chemical abstracts and Biosis (from start of the databases till date) and pooled hazard ratios (HR) computed using a random effects model, with significant P value < 0.05. Primary outcome of interest was all-cause death. Secondary outcomes included cardiac death, prompt revascularization (ER) or repeat myocardial infarction (MI). Due to scarcity of data, both Randomized control trials and observational studies were included. 4 eligible articles, containing 2248 patients were identified (1252 in OMT and 1196 in ER). Mean follow-up was 45-60 mo. RESULTS OMT was associated with a higher all-cause mortality [HR: 1.70, 95% confidence interval (CI): 0.80-3.26, P = 0.11] and cardiac mortality (HR: 1.68, 95%CI: 0.96-2.96, P = 0.07). Results were close to significance. The risk of repeat MI was almost the same in both groups (HR: 0.97, 95%CI: 0.61-1.54, P = 0.90). Similarly, patients assigned to OMT had a higher risk of repeat revascularization (HR: 1.62, 95%CI: 1.36-1.94, P < 0.00001). Sub-group analysis of OMT vs PCI demonstrated higher all-cause (HR: 1.98, 95%CI: 1.36-2.87, P = 0.0003) and cardiac mortality (HR: 1.87, 95%CI: 0.96-3.62, P = 0.06) in the OMT group. The risk of repeat MI was low in the OMT group vs PCI (HR: 0.53, 95%CI: 0.31-0.91, P = 0.02). Data on repeat revascularization revealed no difference between the two (HR: 1.00, 95%CI: 0.52-1.93, P = 1.00). CONCLUSION In diabetic patients with CTO, there was a trend for improved outcomes with ER regarding all-cause and cardiac death as compared to OMT. These findings were reinforced with statistical significance on subgroup analysis of OMT vs PCI.
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Affiliation(s)
- Muhammad Shayan Khan
- Internal Medicine, Mercy Saint Vincent Medical Centre, Toledo, OH 43608, United States.
| | - Farhad Sami
- Internal Medicine, University of Kansas School of Medicine, Kansas City, Kansas, 66202, United States
| | - Hemindermeet Singh
- Department of Cardiovascular Fellowship, Mercy St Vincent Medical Center and Hospital, Toledo, OH 43608, United States
| | - Waqas Ullah
- Internal Medicine, Abington Jefferson Health, Abington, Abington Township, Montgomery County, PA 19001, United States
| | - Ma'en Al-Dabbas
- Department of Cardiovascular Fellowship, Mercy St Vincent Medical Center and Hospital, Toledo, OH 43608, United States
| | - Khalid Hamid Changal
- Department of Cardiovascular Medicine, University of Toledo, Toledo, OH 43606, United States
| | - Tanveer Mir
- Internal Medicine, Detroit Medical Center, Detroit, MI 48201, United States
| | - Zain Ali
- Internal Medicine, Abington Jefferson Health, Philadelphia, PA 19001, United States
| | - Ameer Kabour
- Department of Cardiovascular Fellowship, Mercy St Vincent Medical Center and Hospital, Toledo, OH 43608, United States
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Nso N, Antwi-Amoabeng D, Beutler BD, Ulanja MB, Ghuman J, Hanfy A, Nimo-Boampong J, Atanga S, Doshi R, Enoru S, Gullapalli N. Cardiac adverse events of immune checkpoint inhibitors in oncology patients: A systematic review and meta-analysis. World J Cardiol 2020; 12:584-598. [PMID: 33312443 PMCID: PMC7701899 DOI: 10.4330/wjc.v12.i11.584] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/12/2020] [Accepted: 11/10/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs) are novel therapeutic agents used for various types of cancer. ICIs have revolutionized cancer treatment and improved clinical outcomes among cancer patients. However, immune-related adverse effects of ICI therapy are common. Cardiovascular immune-related adverse events (irAEs) are rare but potentially life-threatening complications.
AIM To estimate the incidence of cardiovascular irAEs among patients undergoing ICI therapy for various malignancies.
METHODS We conducted this systematic review and meta-analysis by searching PubMed, Cochrane CENTRAL, Web of Science, and SCOPUS databases for relevant interventional trials reporting cardiovascular irAEs. We performed a single-arm meta-analysis using OpenMeta [Analyst] software of the following outcomes: Myocarditis, pericardial effusion, heart failure, cardiomyopathy, atrial fibrillation, myocardial infarction, and cardiac arrest. We assessed the heterogeneity using the I2 test and managed to solve it with Cochrane’s leave-one-out method. The risk of bias was performed with the Cochrane’s risk of bias tool.
RESULTS A total of 26 studies were included. The incidence of irAEs follows: Myocarditis: 0.5% [95% confidence interval (CI): 0.1%-0.9%]; Pericardial effusion: 0.5% (95%CI: 0.1%-1.0%); Heart failure: 0.3% (95%CI: 0.0%-0.5%); Cardiomyopathy: 0.3% (95%CI: -0.1%-0.6%); atrial fibrillation: 4.6% (95%CI: 1.0%-14.1%); Myocardial infarction: 0.4% (95%CI: 0.0%-0.7%); and Cardiac arrest: 0.4% (95%CI: 0.1%-0.8%).
CONCLUSION The most common cardiovascular irAEs were atrial fibrillation, myocarditis, and pericardial effusion. Although rare, data from post market surveillance will provide estimates of the long-term prevalence and prognosis in patients with ICI-associated cardiovascular complications.
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Affiliation(s)
- Nso Nso
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Queens, NY 10029, United States
| | - Daniel Antwi-Amoabeng
- Department of Internal Medicine, University of Nevada, Reno School of Medicine, Reno, NV 89502, United States
| | - Bryce D Beutler
- Department of Radiology, University of Southern California, Keck School of Medicine, Los Angeles, CA 90033, United States
| | - Mark B Ulanja
- Department of Internal Medicine, University of Nevada, Reno School of Medicine, Reno, NV 89502, United States
| | - Jasmine Ghuman
- Department of Internal Medicine, University of Nevada, Reno School of Medicine, Reno, NV 89502, United States
| | - Ahmed Hanfy
- Department of Internal Medicine, University of Nevada, Reno School of Medicine, Reno, NV 89502, United States
| | - Joyce Nimo-Boampong
- Department of Internal Medicine, Warren Alpert Medical School of Brown University, Providence, RI 02903, United States
| | - Sirri Atanga
- Department of Medicine, United Health Services Wilson Medical Center, Johnson City, NY 13790, United States
| | - Rajkumar Doshi
- Department of Internal Medicine, University of Nevada, Reno School of Medicine, Reno, NV 89502, United States
| | - Sostanie Enoru
- Department of Cardiovascular Disease, SUNY Downstate Health Science University, Brooklyn, NY 11203, United States
| | - Nageshwara Gullapalli
- Department of Internal Medicine, University of Nevada, Reno School of Medicine, Reno, NV 89502, United States
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Vajdi B, Tuktamyshov R. Electronic cigarettes — myocardial infarction, hemodynamic compromise during pregnancy, and systolic and diastolic dysfunction: Minireview. World J Cardiol 2020; 12:475-483. [PMID: 33173566 PMCID: PMC7596422 DOI: 10.4330/wjc.v12.i10.475] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 08/12/2020] [Accepted: 10/05/2020] [Indexed: 02/06/2023] Open
Abstract
The aim of this study was to review the most recent literature on the safety of electronic cigarettes (ECs) in the context of cardiovascular disease and in the context as a tool for smoking cessation and recreational purposes. The format of this review begins with relevant research from the basic sciences and follows through with a pertinent review of clinical trials. Daily use of ECs has implications in myocardial infarction (MI) with an odds ratio of 1.70 compared to healthy, nonsmokers and even worse risk for MI with dual use of combustible cigarettes together with EC with an odds ratio of 4.62. Studies measuring cardiac function with echocardiography reported both systolic and diastolic dysfunction along with reduced ejection fractions. Platelet aggregation, endothelial function, and hemodynamics during pregnancy were all but some of the pernicious cardiovascular implications of EC exposure. Though more studies need to be done on the topic of EC use and cardiovascular disease, the majority of studies considered in this review concluded some level of harm albeit in some instances less than that of traditional combustible cigarettes. ECs are toxic to human beings and their harmful effects cannot be overlooked. There is some favorable evidence of efficacy in smoking cessation though mixed with concern of chronic EC use. It will take decades to collect data for chronic EC use on long term sequelae, such as lung cancer. Though more and more reports of acute lung injury and hospitalizations related to EC use have been reported. Due to undergoing investigations of possible harm and life threatening complications of EC use, we cannot recommend ECs as safer or a more efficacious method of smoking cessation to traditional nicotine replacement therapies. A notable consideration for much of the literature reviewed are that standardization of EC use is difficult as device generation and battery voltage, frequency of use, and contents of EC liquid are just some of the vast complicating factors that limit the ability to effectively compare data.
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Affiliation(s)
- Borna Vajdi
- Department of Neurology, University of Southern California Keck School of Medicine, Los Angeles, CA 90033, United States
| | - Rasikh Tuktamyshov
- Department of Internal Medicine, Yale University, New Haven, CT 06511, United States
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Ullah W, Mukhtar M, Al-Mukhtar A, Saeed R, Boigon M, Haas D, Rame E. Safety and efficacy of soluble guanylate cyclase stimulators in patients with heart failure: A systematic review and meta-analysis. World J Cardiol 2020; 12:501-512. [PMID: 33173569 PMCID: PMC7596421 DOI: 10.4330/wjc.v12.i10.501] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/31/2020] [Accepted: 09/11/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The utility of novel oral soluble guanylate cyclase (sGC) stimulators (vericiguat and riociguat), in patients with reduced or preserved ejection fraction heart failure (HFrEF/HFpEF) is currently unclear.
AIM To determine the efficacy and safety of sGC stimulators in HF patients.
METHODS Multiple databases were searched to identify relevant randomized controlled trials (RCTs). Data on the safety and efficacy of sGC stimulators were compared using relative risk ratio (RR) on a random effect model.
RESULTS Six RCTs, comprising 5604 patients (2801 in sGC stimulator group and 2803 placebo group) were included. The primary endpoint (a composite of cardiovascular mortality and first HF-related hospitalization) was significantly reduced in patients receiving sGC stimulators compared to placebo [RR 0.92, 95% confidence interval (CI): 0.85-0.99, P = 0.02]. The incidence of total HF-related hospitalizations were also lower in sGC group (RR 0.91, 95%CI: 0.86-0.96, P = 0.0009), however, sGC stimulators had no impact on all-cause mortality (RR 0.96, 95%CI: 0.86-1.07, P = 0.45) or cardiovascular mortality (RR 0.94, 95%CI: 0.83-1.06, P = 0.29). The overall safety endpoint (a composite of hypotension and syncope) was also similar between the two groups (RR 1.50, 95%CI: 0.93-2.42, P = 0.10). By contrast, a stratified subgroup analysis adjusted by type of sGC stimulator and HF (vericiguat vs riociguat and HFrEF vs HFpEF) showed near identical rates for all safety and efficacy endpoints between the two groups at a mean follow-up of 19 wk. For the primary composite endpoint, the number needed to treat was 35, the number needed to harm was 44.
CONCLUSION The use of vericiguat and riociguat in conjunction with standard HF therapy, shows no benefit in terms of decreasing HF-related hospitalizations or mortality.
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Affiliation(s)
- Waqas Ullah
- Department of Internal Medicine, Abington Jefferson Health, Abington, PA 19001, United States
| | - Maryam Mukhtar
- Department of Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi 44000, Punjab, Pakistan
| | - Aws Al-Mukhtar
- Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, United Kingdom
| | - Rehan Saeed
- Department of Internal Medicine, Abington Jefferson Health, Abington, PA 19001, United States
| | - Margot Boigon
- Department of Internal Medicine, Abington Jefferson Health, Abington, PA 19001, United States
| | - Donald Haas
- Department of Internal Medicine, Abington Jefferson Health, Abington, PA 19001, United States
| | - Eduardo Rame
- Department of Cardiology, Thomas Jefferson University, Philadelphia, PA 19001, United States
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Kaipa S, Mastropietro CW, Bhai H, Lutfi R, Friedman ML, Yabrodi M. Upper body peripherally inserted central catheter in pediatric single ventricle patients. World J Cardiol 2020; 12:484-491. [PMID: 33173567 PMCID: PMC7596420 DOI: 10.4330/wjc.v12.i10.484] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 07/19/2020] [Accepted: 08/16/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There is risk of stenosis and thrombosis of the superior vena cava after upper extremity central catheter replacement. This complication is more serious among patients with single ventricle physiology, as it might preclude them from undergoing further life-sustaining palliative surgery.
AIM To describe complications associated with the use of upper extremity percutaneous intravenous central catheters (PICCs) in children with single ventricle physiology.
METHODS A single institution retrospective review of univentricular patients who underwent superior cavopulmonary anastomoses as their stage 2 palliation procedure from January 2014 until December 2018 and had upper body PICCs placed at any point prior to this procedure. Clinical data including ultrasonography, cardiac catheterization, echocardiogram reports and patient notes were used to determine the presence of thrombus or stenosis of the upper extremity and cervical vessels. Data regarding the presence and duration of upper extremity PICCs and upper extremity central venous catheter (CVC), and use of anticoagulation were recorded.
RESULTS Seventy-six patients underwent superior cavopulmonary anastomoses, of which 56 (73%) had an upper extremity PICC at some point prior to this procedure. Median duration of PICC usage was 24 d (25%, 75%: 12, 39). Seventeen patients (30%) with PICCs also had internal jugular or subclavian central venous catheters (CVCs) in place at some point prior to their superior cavopulmonary anastomoses, median duration 10 d (25%, 75%: 8, 14). Thrombus was detected in association with 2 of the 56 PICCs (4%) and 3 of the 17 CVCs (18%). All five patients were placed on therapeutic dose of low molecular weight heparin at the time of thrombus detection and subsequent cardiac catheterization demonstrated resolution in three of the five patients. No patients developed clinically significant venous stenosis.
CONCLUSION Use of upper extremity PICCs in patients with single ventricle physiology prior to super cavopulmonary anastomosis is associated with a low rate of catheter-associated thrombosis.
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Affiliation(s)
- Santosh Kaipa
- Department of Pediatrics, Division of Pediatric Critical Care, Indiana University, Riley Hospital for Children, Indianapolis, IN 46303, United States
| | - Christopher W Mastropietro
- Department of Pediatrics, Division of Pediatric Critical Care, Indiana University, Riley Hospital for Children, Indianapolis, IN 46303, United States
| | - Hamza Bhai
- Department of Pediatrics, Division of Pediatric Critical Care, Indiana University, Riley Hospital for Children, Indianapolis, IN 46303, United States
| | - Riad Lutfi
- Department of Pediatrics, Division of Pediatric Critical Care, Indiana University, Riley Hospital for Children, Indianapolis, IN 46303, United States
| | - Matthew L Friedman
- Department of Pediatrics, Division of Pediatric Critical Care, Indiana University, Riley Hospital for Children, Indianapolis, IN 46303, United States
| | - Mouhammad Yabrodi
- Department of Pediatrics, Division of Pediatric Critical Care, Indiana University, Riley Hospital for Children, Indianapolis, IN 46303, United States
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Belov DV, Garbuzenko DV, Abramovskikh KA, Arefyev NO. Risk score for predicting abdominal complications after coronary artery bypass grafting. World J Cardiol 2020; 12:492-500. [PMID: 33173568 PMCID: PMC7596419 DOI: 10.4330/wjc.v12.i10.492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 06/08/2020] [Accepted: 08/26/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although early abdominal complications after coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) are rare, the associated mortality remains high.
AIM To develop a risk score for the prediction of early abdominal complications after CABG with CPB.
METHODS This retrospective study was performed in the Federal State Budgetary Establishment “Federal Center of Cardiovascular Surgery” of the Ministry of Health of Russia (the city of Chelyabinsk) and included data of 6586 patients who underwent CABG with CPB during 2011-2017. The risk factors taken for evaluation were compared between patients with early abdominal complications (n = 73) and without them (n = 6513). We identified the most important risk factors and their influence on the development of early abdominal complications after CABG with CPB.
RESULTS Gender and the presence of postinfarction cardiosclerosis, chronic kidney disease, or diabetes in the anamnesis did not affect the occurrence of abdominal complications. The leading risk factors of the early abdominal complications after CABG with CPB were multifocal atherosclerosis, extracorporeal membrane oxygenation, intra-aortic balloon pump, atrial fibrillation, perioperative myocardial infarction, and the need for resternotomy in the postoperative period. The average value of the predicted probability was 0.087 ± 0.015 in patients with early abdominal complications after CABG with CPB and 0.0094 ± 0.0003 in patients without these complications. The percentage of correct classification turned out to be 98.9%. After calculating a score for each of the leading risk factors, we counted a total score for each particular patient. The highest risk was noted in patients with a total score of 7 or more.
CONCLUSION The developed score predicts the risk of early abdominal complications after CABG with CPB and makes it possible to stratify patients by risk groups.
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Affiliation(s)
- Dmitry Vladimirovich Belov
- Department of Hospital Surgery, Federal Center of Cardiovascular Surgery of the Ministry of Health of Russia (the city of Chelyabinsk), Chelyabinsk 454003, Russia
| | | | | | - Nikolay Olegovich Arefyev
- Department of Pathological Anatomy and Forensic Medicine, South Ural State Medical University, Chelyabinsk 454092, Russia
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Alam L, Lasam G, Fishberg R. Pericardial effusion with tamponade – an uncommon presentation leading to the diagnosis of eosinophilic granulomatosis polyangiitis: A case report. World J Cardiol 2020; 12:460-467. [PMID: 33014293 PMCID: PMC7509990 DOI: 10.4330/wjc.v12.i9.460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/02/2020] [Accepted: 09/01/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Eosinophilic granulomatosis polyangiitis (EGPA) is a small vessel necrotizing vasculitis that commonly presents as peripheral eosinophilia and asthma; however, it can rarely manifest with cardiac involvement such as pericarditis and cardiac tamponade. Isolated pericardial tamponade presenting as the initial symptom of EGPA is exceedingly rare. Early diagnosis and appropriate treatment are crucial to prevent life-threatening outcomes.
CASE SUMMARY 52-year-old woman with no past medical history presented with progressive dyspnea and dry cough. On physical exam she had a pericardial friction rub and bilateral rales. Vital signs were notable for tachycardia at 119 beats per minute and hypoxia with 89% oxygen saturation. On laboratory exam, she had 45% peripheral eosinophilia, troponin elevation of 1.1 ng/mL and N-terminal prohormone of brain natriuretic peptide of 2101 pg/mL. TTE confirmed a large pericardial effusion and tamponade physiology. She underwent urgent pericardial window procedure. Pericardial and lung biopsy demonstrated eosinophilic infiltration. Based on the American College of Radiology guidelines, the patient was diagnosed with EGPA which manifested in its rare form of cardiac tamponade. She was treated with steroid taper and mepolizumab.
CONCLUSION This case highlights that when isolated pericardial involvement occurs in EGPA, diagnosis is recognized by performing pericardial biopsy demonstrating histopathologic evidence of eosinophilic infiltration.
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Affiliation(s)
- Loba Alam
- Department of Medicine, Atlantic Health System-Overlook Medical Center, Summit, NJ 07901, United States
| | - Glenmore Lasam
- Department of Cardiology, Icahn School of Medicine, Mount Sinai Heart at Mount Sinai Morningside, New York, NY 10025, United States
| | - Robert Fishberg
- Department of Cardiology, Atlantic Health System Overlook, Summit, NJ 07901, United States
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225
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Grewal D, Mohammad A, Swamy P, Abudayyeh I, Mamas MA, Parwani P. Diffuse coronary artery vasospasm in a patient with subarachnoid hemorrhage: A case report. World J Cardiol 2020; 12:468-474. [PMID: 33014294 PMCID: PMC7509992 DOI: 10.4330/wjc.v12.i9.468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/03/2020] [Accepted: 09/15/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Coronary artery vasospasm (CAV) is a reversible, transient form of vasoconstriction with clinical manifestations ranging from stable angina to acute coronary syndromes (ACS). Vasospasm of epicardial coronary arteries or associated micro-vasculature can lead to total or subtotal occlusion and has been demonstrated in nearly 50% of patients undergoing angiography for suspected ACS. The mechanism for CAV has been described in literature, but in a subgroup of patients presenting with intracranial hemorrhage, it appears to be multifactorial. These patients tend to have electrocardiographic changes, elevation of cardiac biomarkers of injury and neurogenic stress cardiomyopathy.
CASE SUMMARY A 44-year-old woman presented with severe headaches and tonic-clonic seizures. She was found to have diffuse subarachnoid hemorrhage (SAH) requiring ventricular drain placement, coil embolization and induced hypertension. She subsequently developed chest pain with ST elevations in anterior precordial leads, elevated cardiac enzymes and apical ballooning with left ventricular ejection fraction of 35% on transthoracic echocardiogram. Coronary angiogram revealed severe diffuse triple vessel stenoses secondary to CAV seen distally. Subsequent cardiac MRI notable for apical non-viability and scar formation.
CONCLUSION This case highlights a unique etiology of acute myocardial infarction in a patient with SAH leading to ST elevations, diffuse triple vessel CAV and apical scar.
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Affiliation(s)
- Dennis Grewal
- Division of Cardiology, Department of Cardiology, Loma Linda University Medical Center, Loma Linda, CA 92354, United States
| | - Adeba Mohammad
- Division of Cardiology, Department of Cardiology, Loma Linda University Medical Center, Loma Linda, CA 92354, United States
| | - Pooja Swamy
- Division of Cardiology, Department of Cardiology, Loma Linda University Medical Center, Loma Linda, CA 92354, United States
| | - Islam Abudayyeh
- Division of Cardiology, Department of Cardiology, Loma Linda University Medical Center, Loma Linda, CA 92354, United States
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institutes of Applied Clinical Science and Primary Care and Health Sciences, Keele University, Stoke on Trent, Manchester M139PT, United Kingdom
| | - Purvi Parwani
- Division of Cardiology, Department of Cardiology, Loma Linda University Medical Center, Loma Linda, CA 92354, United States
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Abstract
Repolarization heterogeneity (RH) is an intrinsic property of ventricular myocardium and the reason for T-wave formation on electrocardiogram (ECG). Exceeding the physiologically based RH level is associated with appearance of life-threatening ventricular arrhythmias and sudden cardiac death. In this regard, an accurate and comprehensive evaluation of the degree of RH parameters is of importance for assessment of heart state and arrhythmic risk. This review is devoted to comprehensive consideration of RH phenomena in terms of electrophysiological processes underlying RH, cardiac electric field formation during ventricular repolarization, as well as clinical significance of RH and its reflection on ECG parameters. The formation of transmural, apicobasal, left-to-right and anterior-posterior gradients of action potential durations and end of repolarization times resulting from the heterogenous distribution of repolarizing ion currents and action potential morphology throughout the heart ventricles, and the different sensitivity of myocardial cells in different ventricular regions to the action of pharmacological agents, temperature, frequency of stimulation, etc., are being discussed. The review is focused on the fact that RH has different aspects – temporal and spatial, global and local; ECG reflection of various RH aspects and their clinical significance are being discussed. Strategies for comprehensive assessment of ventricular RH using different ECG indices reflecting various RH aspects are presented.
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Affiliation(s)
- Natalia V Arteyeva
- Laboratory of Cardiac Physiology, Institute of Physiology of Komi Science Centre of the Ural Branch of the Russian Academy of Sciences, Syktyvkar 167982, Russia
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227
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Teragawa H, Oshita C, Orita Y. Clinical significance of prolonged chest pain in vasospastic angina. World J Cardiol 2020; 12:450-459. [PMID: 33014292 PMCID: PMC7509991 DOI: 10.4330/wjc.v12.i9.450] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/28/2020] [Accepted: 09/15/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Patients with vasospastic angina (VSA) sometimes experience prolonged chest symptoms. The clinical characteristics of these patients have not been clarified.
AIM To investigate the clinical characteristics of prolonged VSA patients.
METHODS This study included 167 patients with VSA diagnosed by spasm provocation tests (SPTs) using acetylcholine, which recorded the frequencies of positive reactions to a low dose of acetylcholine (L-ACh), total occlusion due to spasm (TOC), focal spasm, and the unavoidable use of nitroglycerin (unavoidable-NTG) during SPTs. The patients underwent a medical interview that investigated the maximum duration and frequency of chest symptoms as well as the frequencies of variant angina and other serious symptoms. The patients were divided into two groups based on the maximal duration: The short-duration group (< 15 min; n = 114) and the long-duration group (≥ 15 min; n = 53). They were also divided into two groups based on the frequency of chest symptoms: The low-frequency group (< 4/mo; n = 88) and the high-frequency group (≥ 4/mo; n = 79).
RESULTS The long-duration group showed higher frequencies of other serious symptoms (P < 0.001) and variant angina (P < 0.05) as well as higher frequencies of spasm induction by L-ACh (P < 0.05), TOC (P < 0.05), focal spasm (P < 0.01), and unavoidable-NTG (P < 0.01) than the short-duration group. These parameters did not differ significantly between the low-frequency and high-frequency groups.
CONCLUSION These findings suggest that patients with VSA who experience prolonged chest symptoms may have more severe characteristics of VSA.
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Affiliation(s)
- Hiroki Teragawa
- Department of Cardiovascular Medicine, JR Hiroshima Hospital, Hiroshima 732-0057, Japan
| | - Chikage Oshita
- Department of Cardiovascular Medicine, JR Hiroshima Hospital, Hiroshima 732-0057, Japan
| | - Yuichi Orita
- Department of Cardiovascular Medicine, JR Hiroshima Hospital, Hiroshima 732-0057, Japan
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228
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Chatterjee A, Miller NJ, Cribbs MG, Mukherjee A, Law MA. Systematic review and meta-analysis of outcomes of anatomic repair in congenitally corrected transposition of great arteries. World J Cardiol 2020; 12:427-436. [PMID: 32879705 PMCID: PMC7439449 DOI: 10.4330/wjc.v12.i8.427] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/08/2020] [Accepted: 07/19/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Treatment of congenitally corrected transposition of great arteries (cc-TGA) with anatomic repair strategy has been considered superior due to restoration of the morphologic left ventricle in the systemic circulation. However, data on long term outcomes are limited to single center reports and include small sample sizes.
AIM To perform a systematic review and meta-analysis for observational studies reporting outcomes on anatomic repair for cc-TGA.
METHODS MEDLINE and Scopus databases were queried using predefined criteria for reports published till December 31, 2017. Studies reporting anatomic repair of minimum 5 cc-TGA patients with at least a 2 year follow up were included. Meta-analysis was performed using Comprehensive meta-analysis v3.0 software.
RESULTS Eight hundred and ninety-five patients underwent anatomic repair with a pooled follow-up of 5457.2 patient-years (PY). Pooled estimate for operative mortality was 8.3% [95% confidence interval (CI): 6.0%-11.4%]. 0.2% (CI: 0.1%-0.4%) patients required mechanical circulatory support postoperatively and 1.7% (CI: 1.1%-2.4%) developed post-operative atrioventricular block requiring a pacemaker. Patients surviving initial surgery had a transplant free survival of 92.5% (CI: 89.5%-95.4%) per 100 PY and a low rate of need for pacemaker (0.3/100 PY; CI: 0.1-0.4). 84.7% patients (CI: 79.6%-89.9%) were found to be in New York Heart Association (NYHA) functional class I or II after 100 PY follow up. Total re-intervention rate was 5.3 per 100 PY (CI: 3.8-6.8).
CONCLUSION Operative mortality with anatomic repair strategy for cc-TGA is high. Despite that, transplant free survival after anatomic repair for cc-TGA patients is highly favorable. Majority of patients maintain NYHA I/II functional class. However, monitoring for burden of re-interventions specific for operation type is very essential.
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Affiliation(s)
- Arka Chatterjee
- Division of Cardiovascular Diseases, University of Alabama at Birmingham, Birmingham, AL 35294, United States
| | - Neal J Miller
- Division of Cardiovascular Diseases, University of Alabama at Birmingham, Birmingham, AL 35294, United States
| | - Marc G Cribbs
- Division of Cardiovascular Diseases, University of Alabama at Birmingham, Birmingham, AL 35294, United States
- Department of Pediatric Cardiology, University of Alabama at Birmingham, Birmingham, AL 35294, United States
| | - Amrita Mukherjee
- Department of Epidemiology, University of Alabama at Birmingham School of Public health, Birmingham, AL 35233, United States
| | - Mark A Law
- Department of Pediatric Cardiology, University of Alabama at Birmingham, Birmingham, AL 35294, United States
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Thomas MC, Iyngkaran P. Forensic interrogation of diabetic endothelitis in cardiovascular diseases and clinical translation in heart failure. World J Cardiol 2020; 12:409-418. [PMID: 32879703 PMCID: PMC7439453 DOI: 10.4330/wjc.v12.i8.409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/05/2020] [Accepted: 07/19/2020] [Indexed: 02/06/2023] Open
Abstract
Diabetic heart disease (DHD) can be classified as a primary consequence from several pathophysiological manifestation of diabetes mellitus (DM) on cardiac tissues or secondarily in extracardiac tissues and is encountered as either primary or secondary complications of DM. Endothelitis is inflammation of the vascular endothelium and is likely to be seen in the majority of patients who start to manifest an end organ complication of DM in this case DHD. Diabetes is a leading cause for many cardiovascular syndromes and diseases including congestive heart failure (CHF) however much remains unknown about the transition from diagnosed DM to clinical state and the contribution of the various mechanical and counterregulatory systems in the manifested complaint. Diastolic heart failure or heart failure with preserved ejection fraction (DHF/HFpEF), accounts for half of all CHF presentations, has DM as a major contributor, however, there remain large gaps in clinical and pathophysiological understanding. This review aims to explore the microscopic aspects in diabetic endothelitis and provide a clinical link to with context to HFpEF.
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Affiliation(s)
- Merlin C Thomas
- Department of Diabetes, Monash University, Melbourne 3004, Victoria, Australia
| | - Pupalan Iyngkaran
- Werribee Mercy Sub School, School of Medicine Sydney, University of Notre Dame, Northcote 3070, Victoria, Australia
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Cassagnol M, Hai O, Sherali SA, D’Angelo K, Bass D, Zeltser R, Makaryus AN. Impact of cardiologist intervention on guideline-directed use of statin therapy. World J Cardiol 2020; 12:419-426. [PMID: 32879704 PMCID: PMC7439448 DOI: 10.4330/wjc.v12.i8.419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 05/13/2020] [Accepted: 08/01/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Statins have an important and well-established role in the prevention of atherosclerotic cardiovascular disease (ASCVD). However, several studies have reported widespread underuse of statins in various practice settings and populations. Review of relevant literature reveals opportunities for improvement in the implementation of guideline-directed statin therapy (GDST).
AIM To examine the impact of cardiologist intervention on the use of GDST in the ambulatory setting.
METHODS Patients with at least one encounter at the adult Internal Medicine Clinic (IMC) and/or Cardiology Clinic (CC), who had an available serum cholesterol test performed, were evaluated. The 2 comparison groups were defined as: (1) Patients only seen by IMC; and (2) Patients seen by both IMC and CC. Patients were excluded if variables needed for calculation of ASCVD risk scores were lacking, and if demographic information lacked guideline-directed treatment recommendations. Data were analyzed using student t-tests or χ2, as appropriate. Analysis of Variance was used to compare rates of adherence to GDST.
RESULTS A total of 268 patients met the inclusion criteria for this study; 211 in the IMC group and 57 in the IMC-CC group. Overall, 56% of patients were female, mean age 56 years (± 10.65, SD), 22% Black or African American, 56% Hispanic/Latino, 14% had clinical ASCVD, 13% current smokers, 66% diabetic and 63% hypertensive. Statin use was observed in 55% (n = 147/268) of the entire patient cohort. In the IMC-CC group, 73.6% (n = 42/57) of patients were prescribed statin therapy compared to 50.7% (n = 107/211) of patients in the IMC group (P = 0.002). In terms of appropriate statin use based on guidelines, there was no statistical difference between groups [IMC-CC group 61.4% (n = 35/57) vs IMC group, 55.5% (n = 117/211), P = 0.421]. Patients in the IMC-CC group were older, had more cardiac risk factors and had higher proportions of non-white patients compared to the IMC group (P < 0.02, all).
CONCLUSION Although overall use of GDST was suboptimal, there was no statistical difference in appropriate statin use based on guidelines between groups managed by general internists alone or co-managed with a cardiologist. These findings highlight the need to design and implement strategies to improve adherence rates to GDST across all specialties.
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Affiliation(s)
- Manouchkathe Cassagnol
- Department of Cardiology, NuHealth/Nassau University Medical Center, East Meadow, NY 11554, United States
- Department of Clinical Health Professions, College of Pharmacy and Health Sciences, St. John’s University, Queens, NY 11430, United States
| | - Ofek Hai
- Department of Cardiology, NuHealth/Nassau University Medical Center, East Meadow, NY 11554, United States
| | - Shaqeel A Sherali
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, United States
| | - Kyla D’Angelo
- Department of Cardiology, NuHealth/Nassau University Medical Center, East Meadow, NY 11554, United States
| | - David Bass
- St. Lawrence Health System, Potsdam, NY 13676, United States
| | - Roman Zeltser
- Department of Cardiology, NuHealth/Nassau University Medical Center, East Meadow, NY 11554, United States
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, United States
| | - Amgad N Makaryus
- Department of Cardiology, NuHealth/Nassau University Medical Center, East Meadow, NY 11554, United States
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, United States
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231
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Butler MG. Classic Ehlers-Danlos syndrome and cardiac transplantation - Is there a connection? World J Cardiol 2020; 12:368-372. [PMID: 32879701 PMCID: PMC7439450 DOI: 10.4330/wjc.v12.i8.368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 06/02/2020] [Accepted: 07/19/2020] [Indexed: 02/06/2023] Open
Abstract
Ehlers-Danlos syndrome (EDS) is a heterogeneous group of connective tissue disorders comprised of several types. Classic EDS is an autosomal dominant disorder with stretchable skin, delayed wound healing with poor scarring, joint hypermobility with subluxations or dislocations, easy bruisability, hernias, aneurysms and cardiac abnormalities. Advances in genomics technology using next-generation sequencing has led to the discovery of causative genes for connective tissue disorders, hereditary cardiomyopathies and cardiovascular diseases including several genes for connective tissue disorders. A 55 year-old male exhibited thin stretchable skin, atrophic scars, easy bruising, joint pain and dislocations requiring multiple knee surgeries and a Beighton hyperflexibility score of 6 out of 7. He was found to have a heterozygous missense COL5A1 gene variant involving exon 3 at nucleotide c:305T>A with an amino acid position change at p.lle102Asn consistent with classic EDS. He had a heart transplant at 43 years of age due to cardiac failure of unknown cause. This patient with classic EDS is brought to medical attention and should be of interest to cardiologists, heart transplant specialists and surgeons, particularly in individuals with unexplained cardiac failure and then diagnosed prior to surgical intervention to avoid poor wound healing, scarring and other tissue involvement (e.g., vascular anomalies, blood pressure instability, aneurysms) as components of EDS.
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Affiliation(s)
- Merlin G Butler
- Departments of Psychiatry and Behavioral Sciences, University of Kansas Medical Center, Kansas City, KS 66160, United States
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232
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Cohen SI. Oliver Wendell Holmes’ 1836 doctorate dissertation and his journey in medicine. World J Cardiol 2020; 12:362-367. [PMID: 32879700 PMCID: PMC7439451 DOI: 10.4330/wjc.v12.i8.362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/07/2020] [Accepted: 07/19/2020] [Indexed: 02/06/2023] Open
Abstract
Oliver Wendell Holmes’ 1836 hand written doctorate dissertation on acute pericarditis was discovered in the archives of the Boston Medical Library 101 years after it was successfully defended. It was then printed as an unabridged monograph with an explanation of its provenance. The dissertation has received little scrutiny since then. Holmes gathered materials for the scholarly work while he was a third and fourth year student at Ecole de Medecine in Paris. His mentor, Pierre-Charles-Alexandre- Louis insisted on the meticulous gathering and recording of every patient’s history and findings. Each category of data was given a weighted numerical value of diagnostic importance and the information was placed in a registry. Holmes became a disciple of Louis in gathering data by direct observation and measuring outcomes in a “statistical” fashion. Holmes dissertation on acute pericarditis describes the state of knowledge about the illness in the 1830s. When Holmes and other students who had studied in Paris returned to the United States, they helped turn American Medicine from opinion and strong personal bias toward scientific objectivity. Oliver Wendell Holmes eventually became both a professor of anatomy/physiology and a dean at Harvard Medical School. He is recognized as a leader in medicine and a popular author in America and beyond. In his late and infirmed years, Holmes questioned the wisdom of his unswerving advocacy for the scientific underpinnings of medicine. In retrospect he had overlooked the importance of also advocating that each patient be approached with comforting compassion.
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Affiliation(s)
- Stafford I Cohen
- Division of Cardiology, Beth Israel Deaconess Medical Center and Harvard Medical School, MA 02215, United States
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233
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Borovac JA, D'Amario D, Bozic J, Glavas D. Sympathetic nervous system activation and heart failure: Current state of evidence and the pathophysiology in the light of novel biomarkers. World J Cardiol 2020; 12:373-408. [PMID: 32879702 PMCID: PMC7439452 DOI: 10.4330/wjc.v12.i8.373] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 05/19/2020] [Accepted: 07/19/2020] [Indexed: 02/06/2023] Open
Abstract
Heart failure (HF) is a complex clinical syndrome characterized by the activation of at least several neurohumoral pathways that have a common role in maintaining cardiac output and adequate perfusion pressure of target organs and tissues. The sympathetic nervous system (SNS) is upregulated in HF as evident in dysfunctional baroreceptor and chemoreceptor reflexes, circulating and neuronal catecholamine spillover, attenuated parasympathetic response, and augmented sympathetic outflow to the heart, kidneys and skeletal muscles. When these sympathoexcitatory effects on the cardiovascular system are sustained chronically they initiate the vicious circle of HF progression and become associated with cardiomyocyte apoptosis, maladaptive ventricular and vascular remodeling, arrhythmogenesis, and poor prognosis in patients with HF. These detrimental effects of SNS activity on outcomes in HF warrant adequate diagnostic and treatment modalities. Therefore, this review summarizes basic physiological concepts about the interaction of SNS with the cardiovascular system and highlights key pathophysiological mechanisms of SNS derangement in HF. Finally, special emphasis in this review is placed on the integrative and up-to-date overview of diagnostic modalities such as SNS imaging methods and novel laboratory biomarkers that could aid in the assessment of the degree of SNS activation and provide reliable prognostic information among patients with HF.
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Affiliation(s)
- Josip Anđelo Borovac
- Department of Pathophysiology, University of Split School of Medicine, Split 21000, Croatia
- Working Group on Heart Failure of Croatian Cardiac Society, Zagreb 10000, Croatia
| | - Domenico D'Amario
- Department of Cardiovascular and Thoracic Sciences, IRCCS Fondazione Policlinico A. Gemelli, Universita Cattolica Sacro Cuore, Rome 00168, Italy
| | - Josko Bozic
- Department of Pathophysiology, University of Split School of Medicine, Split 21000, Croatia
| | - Duska Glavas
- Working Group on Heart Failure of Croatian Cardiac Society, Zagreb 10000, Croatia
- Clinic for Cardiovascular Diseases, University Hospital of Split, Split 21000, Croatia
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234
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Papanastasiou CA, Kyriakoulis KG, Theochari CA, Kokkinidis DG, Karamitsos TD, Palaiodimos L. Comprehensive review of hemolysis in ventricular assist devices. World J Cardiol 2020; 12:334-341. [PMID: 32843935 PMCID: PMC7415236 DOI: 10.4330/wjc.v12.i7.334] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/02/2020] [Accepted: 05/27/2020] [Indexed: 02/07/2023] Open
Abstract
Ventricular assist devices (VADs) have played an important role in altering the natural history of end-stage heart failure. Low-grade hemolysis has been traditionally described in patients with VADs, indicating effective device functionality. However, clinically significant hemolysis could be crucial in terms of prognosis, calling for prompt therapeutic actions. The absence of solid and widely approved diagnostic criteria for clinically significant hemolysis, render the utilization of hemolysis laboratory markers challenging. Hemolysis incidence varies (5%-18%) depending on definition and among different VAD generations, being slightly higher in continuous-flow devices than in pulsatile devices. Increased shear stress of red blood cells and underlying device thrombosis appear to be the main pathogenetic pathways. No certain algorithm is available for the management of hemolysis in patients with VADs, while close clinical and laboratory monitoring remains the cornerstone of management. Imaging examinations such as echocardiography ramp test or computed tomography scan could play a role in revealing the underlying cause. Treatment should be strictly personalized, including either pharmacological (antithrombotic treatment) or surgical interventions.
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Affiliation(s)
- Christos A Papanastasiou
- 1st Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki 54621, Greece
| | - Konstantinos G Kyriakoulis
- 3rd Department of Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Athens 11527, Greece
| | | | - Damianos G Kokkinidis
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, United States
| | - Theodoros D Karamitsos
- 1st Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki 54621, Greece
| | - Leonidas Palaiodimos
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, United States
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235
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Lightbody RJ, Taylor JMW, Dempsie Y, Graham A. MicroRNA sequences modulating inflammation and lipid accumulation in macrophage “foam” cells: Implications for atherosclerosis. World J Cardiol 2020; 12:303-333. [PMID: 32843934 PMCID: PMC7415235 DOI: 10.4330/wjc.v12.i7.303] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 06/03/2020] [Accepted: 06/10/2020] [Indexed: 02/06/2023] Open
Abstract
Accumulation of macrophage “foam” cells, laden with cholesterol and cholesteryl ester, within the intima of large arteries, is a hallmark of early “fatty streak” lesions which can progress to complex, multicellular atheromatous plaques, involving lipoproteins from the bloodstream and cells of the innate and adaptive immune response. Sterol accumulation triggers induction of genes encoding proteins mediating the atheroprotective cholesterol efflux pathway. Within the arterial intima, however, this mechanism is overwhelmed, leading to distinct changes in macrophage phenotype and inflammatory status. Over the last decade marked gains have been made in understanding of the epigenetic landscape which influence macrophage function, and in particular the importance of small non-coding micro-RNA (miRNA) sequences in this context. This review identifies some of the miRNA sequences which play a key role in regulating “foam” cell formation and atherogenesis, highlighting sequences involved in cholesterol accumulation, those influencing inflammation in sterol-loaded cells, and novel sequences and pathways which may offer new strategies to influence macrophage function within atherosclerotic lesions.
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Affiliation(s)
- Richard James Lightbody
- Department of Biological and Biomedical Sciences, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow G4 0BA, United Kingdom
| | - Janice Marie Walsh Taylor
- Department of Biological and Biomedical Sciences, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow G4 0BA, United Kingdom
| | - Yvonne Dempsie
- Department of Biological and Biomedical Sciences, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow G4 0BA, United Kingdom
| | - Annette Graham
- Department of Biological and Biomedical Sciences, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow G4 0BA, United Kingdom
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236
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Dimopoulos S, Raidou V, Elaiopoulos D, Chatzivasiloglou F, Markantonaki D, Lyberopoulou E, Vasileiadis I, Marathias K, Nanas S, Karabinis A. Sonographic muscle mass assessment in patients after cardiac surgery. World J Cardiol 2020; 12:351-361. [PMID: 32843937 PMCID: PMC7415234 DOI: 10.4330/wjc.v12.i7.351] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 05/11/2020] [Accepted: 06/17/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients undergoing cardiac surgery particularly those with comorbidities and frailty, experience frequently higher rates of post-operative morbidity, mortality and prolonged hospital length of stay. Muscle mass wasting seems to play important role in prolonged mechanical ventilation (MV) and consequently in intensive care unit (ICU) and hospital stay.
AIM To investigate the clinical value of skeletal muscle mass assessed by ultrasound early after cardiac surgery in terms of duration of MV and ICU length of stay.
METHODS In this observational study, we enrolled consecutively all patients, following their admission in the Cardiac Surgery ICU within 24 h of cardiac surgery. Bedside ultrasound scans, for the assessment of quadriceps muscle thickness, were performed at baseline and every 48 h for seven days or until ICU discharge. Muscle strength was also evaluated in parallel, using the Medical Research Council (MRC) scale.
RESULTS Of the total 221 patients enrolled, ultrasound scans and muscle strength assessment were finally performed in 165 patients (patients excluded if ICU stay < 24 h). The muscle thickness of rectus femoris (RF), was slightly decreased by 2.2% [(95% confidence interval (CI): - 0.21 to 0.15), n = 9; P = 0.729] and the combined muscle thickness of the vastus intermedius (VI) and RF decreased by 3.5% [(95%CI: - 0.4 to 0.22), n = 9; P = 0.530]. Patients whose combined VI and RF muscle thickness was below the recorded median values (2.5 cm) on day 1 (n = 80), stayed longer in the ICU (47 ± 74 h vs 28 ± 45 h, P = 0.02) and remained mechanically ventilated more (17 ± 9 h vs 14 ± 9 h, P = 0.05). Moreover, patients with MRC score ≤ 48 on day 3 (n = 7), required prolonged MV support compared to patients with MRC score ≥ 49 (n = 33), (44 ± 14 h vs 19 ± 9 h, P = 0.006) and had a longer duration of extracorporeal circulation was (159 ± 91 min vs 112 ± 71 min, P = 0.025).
CONCLUSION Skeletal quadriceps muscle thickness assessed by ultrasound shows a trend to a decrease in patients after cardiac surgery post-ICU admission and is associated with prolonged duration of MV and ICU length of stay.
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Affiliation(s)
- Stavros Dimopoulos
- Department of Cardiac Surgery ICU, Onassis Cardiac Surgery Center, Athens 17674, Greece
- Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, National and Kapodistrian University of Athens, Athens 10676, Greece
| | - Vasiliki Raidou
- Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, National and Kapodistrian University of Athens, Athens 10676, Greece
| | - Dimitrios Elaiopoulos
- Department of Cardiac Surgery ICU, Onassis Cardiac Surgery Center, Athens 17674, Greece
| | - Foteini Chatzivasiloglou
- Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, National and Kapodistrian University of Athens, Athens 10676, Greece
| | - Despoina Markantonaki
- Department of Cardiac Surgery ICU, Onassis Cardiac Surgery Center, Athens 17674, Greece
| | - Efterpi Lyberopoulou
- Department of Cardiac Surgery ICU, Onassis Cardiac Surgery Center, Athens 17674, Greece
| | - Ioannis Vasileiadis
- Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, National and Kapodistrian University of Athens, Athens 10676, Greece
| | - Katerina Marathias
- Department of Cardiac Surgery ICU, Onassis Cardiac Surgery Center, Athens 17674, Greece
| | - Serafeim Nanas
- Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, National and Kapodistrian University of Athens, Athens 10676, Greece
| | - Andreas Karabinis
- Department of Cardiac Surgery ICU, Onassis Cardiac Surgery Center, Athens 17674, Greece
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237
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Darrat YH, Smer A, Elayi CS, Morales GX, Alqahtani F, Alkhouli M, Catanzaro J, Shah J, Salih M. Mortality and morbidity in patients with atrial fibrillation and liver cirrhosis. World J Cardiol 2020; 12:342-350. [PMID: 32843936 PMCID: PMC7415237 DOI: 10.4330/wjc.v12.i7.342] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/10/2020] [Accepted: 05/30/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common cardiac arrhythmia encountered in clinical practice. However, the outcomes associated with AF in hospitalized patients with liver cirrhosis are unknown.
AIM To determine the outcomes of hospitalized patients with liver cirrhosis and AF.
METHODS In this study, we examined morbidity and mortality of patients with concomitant AF and liver cirrhosis from the National Inpatient Sample database, the largest publicly available inpatient healthcare database in the United States.
RESULTS A total of 696937 patients with liver cirrhosis were included, 45745 of whom had concomitant AF (6.6%). Liver cirrhosis patients with AF had higher rates of in-hospital mortality (12.6% vs 10.3%, P < 0.001), clinical stroke (1.6% vs 1.1%, P < 0.001), and acute kidney injury (28.2% vs 25.1%, P < 0.001), and less gastrointestinal bleeding (4.4% vs 5.1%, P < 0.001) and blood transfusion (22.5% vs 23.8%, P < 0.001) compared with those who did not have the arrhythmia. In addition, they had a longer length of stay (8 ± 10 d vs 7 ± 8 d, P < 0.001) and higher hospitalization costs (20720 ± 33210 $ vs 16272 ± 24166 $, P < 0.001).
CONCLUSION In subjects with liver cirrhosis, AF is associated with higher rates of inpatient mortality, stroke, and acute kidney injury compared to those who do not have the cardiac arrhythmia.
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Affiliation(s)
- Yousef H Darrat
- Department of Internal Medicine, Veterans Affairs Medical Center, Lexington, KY 40515, United States
| | - Aiman Smer
- Department of Internal Medicine, Creighton University, Omaha, NE 68178, United States
| | - Claude-Samy Elayi
- Department of Internal Medicine, University of Florida, Jacksonville, FL 32211, United States
| | - Gustavo X Morales
- Cardiac Electrophysiology, Grandview Medical Center, Birmingham, AL 35243, United States
| | - Fahad Alqahtani
- Department of Internal Medicine, University of Kentucky, Lexington, KY 40536, United States
| | - Mohamad Alkhouli
- Department of Internal Medicine, West Virginia University, Morgantown, WV 26506, United States
| | - John Catanzaro
- Department of Internal Medicine, University of Florida, Jacksonville, FL 32211, United States
| | - Jignesh Shah
- Cardiac Electrophysiology, Boulder Heart, Boulder, CO 80303, United States
| | - Mohsin Salih
- Department of Internal Medicine, University of Southern Illinois, Springfield, IL 62702, United States
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238
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Gatti M, Carisio A, D'Angelo T, Darvizeh F, Dell'Aversana S, Tore D, Centonze M, Faletti R. Cardiovascular magnetic resonance in myocardial infarction with non-obstructive coronary arteries patients: A review. World J Cardiol 2020; 12:248-261. [PMID: 32774777 PMCID: PMC7383353 DOI: 10.4330/wjc.v12.i6.248] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/13/2020] [Accepted: 05/30/2020] [Indexed: 02/06/2023] Open
Abstract
The diagnosis of myocardial infarction with non-obstructive coronary arteries (MINOCA) necessitates documentation of an acute myocardial infarction (AMI), non-obstructive coronary arteries, using invasive coronary angiography or coronary computed tomography angiography and no clinically overt cause for AMI. Historically patients with MINOCA represent a clinical dilemma with subsequent uncertain clinical management. Differential diagnosis is crucial to choose the best therapeutic option for ischemic and non-ischemic MINOCA patients. Cardiovascular magnetic resonance (CMR) is able to analyze cardiac structure and function simultaneously and provides tissue characterization. Moreover, CMR could identify the cause of MINOCA in nearly two-third of patients providing valuable information for clinical decision making. Finally, it allows stratification of patients with worse outcomes which resulted in therapeutic changes in almost half of the patients. In this review we discuss the features of CMR in MINOCA; from exam protocols to imaging findings.
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Affiliation(s)
- Marco Gatti
- Faletti Riccardo, Department of Surgical Sciences, University of Turin, Turin 10126, Italy.
| | - Andrea Carisio
- Faletti Riccardo, Department of Surgical Sciences, University of Turin, Turin 10126, Italy
| | - Tommaso D'Angelo
- Department of Biomedical Sciences and Morphological and Functional Imaging, "G. Martino" University Hospital Messina, Messina 98100, Italy
| | - Fatemeh Darvizeh
- Faletti Riccardo, Department of Surgical Sciences, University of Turin, Turin 10126, Italy
| | - Serena Dell'Aversana
- Department of advanced biomedical sciences, University of Naples Federico II, Naples 80138, Italy
| | - Davide Tore
- Faletti Riccardo, Department of Surgical Sciences, University of Turin, Turin 10126, Italy
| | - Maurizio Centonze
- Department of Diagnostic Imaging, APSS di Trento, Trento 38123, Italy
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239
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Shaik FA, Slotwiner DJ, Gustafson GM, Dai X. Intra-procedural arrhythmia during cardiac catheterization: A systematic review of literature. World J Cardiol 2020; 12:269-284. [PMID: 32774779 PMCID: PMC7383354 DOI: 10.4330/wjc.v12.i6.269] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/10/2020] [Accepted: 05/26/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Cardiac catheterization is among the most performed medical procedures in the modern era. There were sporadic reports indicating that cardiac arrhythmias are common during cardiac catheterization, and there are risks of developing serious and potentially life-threatening arrhythmias, such as sustained ventricular tachycardia (VT), ventricular fibrillation (VF) and high-grade conduction disturbances such as complete heart block (CHB), requiring immediate interventions. However, there is lack of systematic overview of these conditions.
AIM To systematically review existing literature and gain better understanding of the incidence of cardiac arrhythmias during cardiac catheterization, and their impact on outcomes, as well as potential approaches to minimize this risk.
METHODS We applied a combination of terms potentially used in reports describing various cardiac arrhythmias during common cardiac catheterization procedures to systematically search PubMed, EMBASE and Cochrane databases, as well as references of full-length articles.
RESULTS During right heart catheterization (RHC), the incidence of atrial arrhythmias (premature atrial complexes, atrial fibrillation and flutter) was low (< 1%); these arrhythmias were usually transient and self-limited. RHC associated with the development of a new RBBB at a rate of 0.1%-0.3% in individuals with normal conduction system but up to 6.3% in individuals with pre-existing left bundle branch block. These patients may require temporary pacing due to transient CHB. Isolated premature ventricular complexes or non-sustained VT are common during RHC (up to 20% of cases). Sustained ventricular arrhythmias (VT and/or VF) requiring either withdrawal of catheter or cardioversion occurred infrequently (1%-1.3%). During left heart catheterizations (LHC), the incidence of ventricular arrhythmias has declined significantly over the last few decades, from 1.1% historically to 0.1% currently. The overall reported rate of VT/VF in diagnostic LHC and coronary angiography is 0.8%. The risk of VT/VF was higher during percutaneous coronary interventions for stable coronary artery disease (1.1%) and even higher for patients with acute myocardial infarctions (4.1%-4.3%). Intravenous adenosine and papaverine bolus for fractional flow reserve measurement, as well as intracoronary imaging using optical coherence tomography have been reported to induce VF. Although uncommon, LHC and coronary angiography were also reported to induce conduction disturbances including CHB.
CONCLUSION Cardiac arrhythmias are common and potentially serious complications of cardiac catheterization procedures, and it demands constant vigilance and readiness to intervene during procedures.
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Affiliation(s)
- Fatima A Shaik
- Division of Cardiology, New York Presbyterian Queens Hospital, Flushing, NY 11355, United States
| | - David J Slotwiner
- Division of Cardiology, New York Presbyterian Queens Hospital, Flushing, NY 11355, United States
| | - Gregory M Gustafson
- Division of Cardiology, New York Presbyterian Queens Hospital, Flushing, NY 11355, United States
| | - Xuming Dai
- Division of Cardiology, New York Presbyterian Queens Hospital, Flushing, NY 11355, United States
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240
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Y-Hassan S. Autonomic neurocardiogenic syndrome is stonewalled by the universal definition of myocardial infarction. World J Cardiol 2020; 12:231-247. [PMID: 32774776 PMCID: PMC7383352 DOI: 10.4330/wjc.v12.i6.231] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 04/27/2020] [Accepted: 05/14/2020] [Indexed: 02/06/2023] Open
Abstract
Myocardial infarction (MI) is defined as myocardial cell death due to prolonged myocardial ischemia. Clinically, troponin rise and/or fall have become the “defining feature of MI” according to the universal definition of MI (UD-MI). Takotsubo syndrome (TS) and TS-related disease conditions also cause troponin elevation with typical rise and/or fall pattern but through a mechanism other than coronary ischemia. By strict application of the clinical diagnostic criteria for type-1 MI, type-2 MI, type-3 MI, and MI with non-obstructive coronary arteries according to the UD-MI including the fourth one published recently, TS and most of the 26 other causes of troponin elevation mentioned in the fourth UD-MI may erroneously be classified as MI. The existing evidence argues for the case that TS by itself is not a MI. Hyper-activation of the autonomic-sympathetic nervous system including local cardiac sympathetic hyper-activation and disruption with nor-epinephrine churn and spillover is the most probable cause of TS. This autonomic neuro-cardiogenic (ANCA) mechanism results in myocardial “cramp” (stunning), the severity and duration of which depend on the degree of the sympathetic-hyperactivation and nor-epinephrine spillover. The myocardial cramp may squeeze the cytosolic free troponin pools causing mild to moderate troponin elevation in TS and TS-related disease conditions. This ANCA syndrome, which has hitherto been enveloped by the UD-MI over more than one decade, may occur in acute, recurrent, and chronic forms. In this critical review, the controversies of UD-MI, evidence for ANCA syndrome, and a hypothetical mechanism for the troponin elevation in ANCA syndrome are provided.
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Affiliation(s)
- Shams Y-Hassan
- Coronary Artery Disease Area, Heart and Vascular Theme, Karolinska Institutet and Karolinska University Hospital, Stockholm S-141 86, Sweden
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241
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Khalili A, Drummond J, Ramjattan N, Zeltser R, Makaryus AN. Diagnostic and treatment utility of echocardiography in the management of the cardiac patient. World J Cardiol 2020; 12:262-268. [PMID: 32774778 PMCID: PMC7383355 DOI: 10.4330/wjc.v12.i6.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Echocardiograms are an incredibly useful diagnostic tool due to their lack of harmful radiation, the relative ease and speed with which they can be performed, and their almost ubiquitous availability. Unfortunately, the advantages that support the use of echocardiography can also lead to the overuse of this technology. We sought to evaluate the physician perceived impact echocardiography has on patient management.
AIM To evaluate the physician perceived impact echocardiography has on patient management.
METHODS Surveys were distributed to the ordering physician for echocardiograms performed at our institution over a 10-wk period. Only transthoracic echocardiograms performed on the inpatient service were included. Surveys were distributed to either the attending physician or the resident physician listed on the echocardiogram order. The information requested in the survey focused on the indication for the study and the perceived importance and effect of the study. Observational statistical analysis was performed on all of the answers from the collected surveys.
RESULTS A total of 103 surveys were obtained and analyzed. The internal medicine (57%) and cardiology (37%) specialties ordered the most echocardiograms. The most common reason for ordering an echocardiogram was to rule out a diagnosis (38.2%). Only 27.5% of physicians reported that the echocardiogram significantly affected patient care, with 18.6% reporting a moderate effect, and 30.4% reporting a mild effect. A total of 19.6% of physicians stated that there was no effect on patient management. Additionally, 43.1% of physicians reported that they made changes in patient management due to no change having occurred in the disease, 11.8% reported that changes in management were based on the recommendation of a specialist, and only 9.8% reported that further imaging was ordered due to the results of the echocardiogram. The majority of physicians (67.6%) considered an echocardiogram to be “somewhat essential” in the management of adult inpatients, with only 15.7% considering it “essential”.
CONCLUSION The majority of physicians surveyed report the echocardiogram had only a mild effect on management with only 27.5% reporting a significant effect. However, the majority of physicians (83.3%) perceived an echocardiogram to be somewhat or entirely essential for management. Only 9.8% reported the echo led to further imaging. These insights into ordering physician reasoning should help guide better definition of the optimal and ideal use of echocardiography.
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Affiliation(s)
- Ariella Khalili
- North Shore Hebrew Academy, Great Neck, NY 11020, United States
| | - Jennifer Drummond
- Department of Internal Medicine, Tufts Medical Center, Boston, MA 10211, United States
| | - Neiman Ramjattan
- Department of Cardiology, Nassau University Medical Center, East Meadow, NY 11554, United States
| | - Roman Zeltser
- Department of Cardiology, Nassau University Medical Center, East Meadow, NY 11554, United States
- Department of Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, United States
| | - Amgad N Makaryus
- Department of Cardiology, Nassau University Medical Center, East Meadow, NY 11554, United States
- Department of Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, United States
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Nalluru SS, Nadadur S, Trivedi N, Trivedi S, Goyal S. Tale of fat and fib — cardiac lipoma managed with radiofrequency ablation: A case report. World J Cardiol 2020; 12:285-290. [PMID: 32774780 PMCID: PMC7383356 DOI: 10.4330/wjc.v12.i6.285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cardiac lipoma and lipomatous hypertrophy of interatrial septum (LHIS) are very rare disorders with distinct pathological features. While cardiac lipoma is a well-circumscribed encapsulated tumor of mature adipocytes, LHIS is due to entrapment of fat cells in the interatrial septum during embryogenesis. Although a biopsy is the definitive diagnostic test, these disorders can be differentiated by a cardiac magnetic resonance imaging (MRI). Treatment of LHIS is not warranted in asymptomatic patients. In symptomatic patients, surgical resection is the only recommended treatment, which has shown to improve good long-term prognosis.
CASE SUMMARY A 63-year-old Caucasian woman with past medical history significant for hypertension, hypothyroidism, right breast ductal cell carcinoma treated with mastectomy and breast implant, platelet granule disorder, asthma requiring chronic intermittent prednisone use, presented to the outpatient cardiology office with recent onset exertional dyspnea, palpitations, weight gain and weakness. Initial workup with electrocardiogram and holter monitor did not reveal significant findings. During the subsequent hospitalization for community acquired pneumonia, the patient developed symptomatic paroxysmal atrial fibrillation. Transthoracic echocardiogram showed a right ventricular mass. A biopsy was not pursued given the high risk of bleeding due to platelet granule disorder. Cardiac MRI showed characteristic features consistent with cardiac lipoma and LHIS. Prednisone was discontinued. Genetic testing for arrhythmogenic right ventricular dysplasia and 24-h urine cortisol test was negative. As multiple attempts at rhythm control failed with sotalol and flecainide, pulmonary vein isolation and right atrial isthmus radiofrequency ablation were done. She is in follow-up with symptomatic relief and no recurrence of atrial fibrillation for 10 mo.
CONCLUSION Benign fatty lesions in heart include solitary lipoma, lipomatous infiltration and lipomatous hypertrophy of interatrial septum. Although transvenous biopsy provides a definitive diagnosis, Cardiac MRI is superior to computed tomography and aids in differentiating benign from malignant lesions. Surgical excision of cardiac lipoma along with capsule and pedicle removal generally prevents recurrence, but with our patient’s unusual tumor features and comorbidities proscribed a surgical approach. Symptom management with antiarrhythmics and ablation techniques were successfully utilized.
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Affiliation(s)
- Swarna Sri Nalluru
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01604, United States
| | - Srinivas Nadadur
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01604, United States
| | - Nitin Trivedi
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01604, United States
| | - Sunita Trivedi
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01604, United States
| | - Sanjeev Goyal
- Department of Cardiology, Saint Vincent Hospital, Worcester, MA 01604, United States
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Ghafari C, Vandergheynst F, Parent E, Tanaka K, Carlier S. Exercise-induced torsades de pointes as an unusual presentation of cardiac sarcoidosis: A case report and review of literature. World J Cardiol 2020; 12:291-302. [PMID: 32774781 PMCID: PMC7383351 DOI: 10.4330/wjc.v12.i6.291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/26/2020] [Accepted: 05/17/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Sarcoidosis is a rare multisystem disease characterized histologically by non-caseating granuloma formation in the affected organ. While cardiac sarcoidosis is found on autopsy in up to 25% of sarcoidosis cases, it is still underdiagnosed and is associated with a poor prognosis. Although the etiology of sarcoidosis remains unclear, an antigen triggered exaggerated immune response has been hypothesized. Early detection and prompt management of cardiac sarcoidosis remains pivotal.
CASE SUMMARY A 60-year-old female, with pulmonary sarcoidosis in remission, presented to the cardiology outpatient clinic for evaluation of weeks-long dyspnea on moderate exertion (New York Heart Association class II) that was relieved by rest. Submaximal exercise stress test showed multifocal ventricular extrasystoles, followed by a self-limiting torsades de pointes. Cardiac magnetic resonance imaging showed nondilated and normotrophic left ventricle with basoseptal and mid-septal dyskinesis. The magnetic resonance imaging-derived left ventricular ejection fraction was 45%. Delayed enhancement showed patchy transmural fibrosis of the septum and hyperenhancement of the papillary muscles, all in favor of extensive cardiac involvement of sarcoidosis. A double-chamber implantable cardiac defibrillator was implanted, and methylprednisolone (12 mg/d) and methotrexate (12.5 mg/wk) treatment was initiated. Follow-up and implantable cardiac defibrillator interrogation showed episodes of asymptomatic nonsustained ventricular tachycardia and an asymptomatic episode of nonsustained ventricular tachycardia ending by the first antitachycardia pacing run.
CONCLUSION Along an extensive review of the literature, this unusual case report highlights the importance of early detection of cardiac involvement of sarcoidosis, in order to avoid potential complications and increase survival.
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Affiliation(s)
- Chadi Ghafari
- Department of Cardiology, Centre Hospitalier Universitaire Ambroise Paré, Mons 7000, Belgium
- Department of Cardiology, Université de Mons, Mons 7000, Belgium
| | - Frédéric Vandergheynst
- Department of Internal Medicine, Cliniques Universitaires de Bruxelles - Erasme, Bruxelles 1070, Belgium
| | - Emmanuel Parent
- Department of Cardiology, Centre Hospitalier Universitaire Ambroise Paré, Mons 7000, Belgium
| | - Kaoru Tanaka
- Department of Cardiology, Universitair Ziekenhuis Brussels, Jette 1090, Belgium
| | - Stéphane Carlier
- Department of Cardiology, Centre Hospitalier Universitaire Ambroise Paré, Mons 7000, Belgium
- Department of Cardiology, Université de Mons, Mons 7000, Belgium
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Makaryus AN, Makaryus JN, Diamond JA. Preoperative nuclear stress testing in the very old patient population. World J Cardiol 2020; 12:210-219. [PMID: 32547715 PMCID: PMC7283996 DOI: 10.4330/wjc.v12.i5.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 04/21/2020] [Accepted: 05/13/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Elderly patients awaiting moderate to high-risk surgery may undergo nuclear stress testing (NST) in order to evaluate their cardiovascular risk. The prognostic utility of such testing in the very elderly (≥ 85 years) has yet to be fully evaluated. Octogenarians and nonogenarians frequently have a number of concurrent conditions including a high rate of coronary disease, and therefore the prognostic value of NST for their preoperative risk assessment has been questioned. Our evaluation assesses the ability of nuclear stress testing to predict peri-operative cardiac outcomes in this patient population.
AIM To investigate the ability of NST to predict peri-operative cardiac outcomes in elderly patients awaiting moderate to high-risk surgery.
METHODS Patients ≥ 85 years undergoing pre-operative NST were retrospectively evaluated. Patients undergoing low-risk surgery were excluded. Major adverse cardiac events (MACE) were considered any adverse event that occurred prior to discharge and included acute heart failure, arrhythmia, acute myocardial infarction, unstable angina, or death. Associations between patient risk factors, MACE, and the obtained results of the pre-operative stress testing, ejection fraction (< 40% or ≥ 40%), summed stress score (≤ 8, ≥ 9), and the summed difference score (≤ 0, > 0) were analyzed.
RESULTS A total of 69 patients (mean age 88 ± 2.6 years, 31 males) underwent nuclear stress testing prior to surgery. There were 41 (60%) patients found to have an abnormal NST. Sixteen (23%) patients were noted to experience post-operative MACE. No significant associations between risk factors and MACE were noted. Patients with an abnormal NST and/or a summed stress score ≥ 9 were significantly (P < 0.01) more likely to develop peri-operative MACE.
CONCLUSION Indicated preoperative NST is useful to assess pre-operative risk in elderly patients ≥ 85 years undergoing moderate to high-risk surgery.
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Affiliation(s)
- Amgad N Makaryus
- Department of Cardiology, Northwell Health, New Hyde Park, NY, 11042, United States
- Department of Cardiology, Nassau University Medical Center, East Meadow, NY 11554, United States
| | - John N Makaryus
- Department of Cardiology, Northwell Health, New Hyde Park, NY, 11042, United States
| | - Joseph A Diamond
- Department of Cardiology, Northwell Health, New Hyde Park, NY, 11042, United States
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245
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Saadi A, Kanmanthareddy A, Anantha-Narayanan M, Hardy K, Williams M, Alla VM. Access to smart devices and utilization of online health resources among older cardiac rehabilitation participants. World J Cardiol 2020; 12:203-209. [PMID: 32547714 PMCID: PMC7283998 DOI: 10.4330/wjc.v12.i5.203] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 03/29/2020] [Accepted: 04/25/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Newer models of cardiac rehabilitation (CR) delivery are promising but depend upon patient participation and ability to use technological media including Internet and smart devices.
AIM To explore the availability of smart devices, current utilization and proficiency of use among older CR program attendees.
METHODS Study participants were enrolled from four CR programs in Omaha, Nebraska United States and completed a questionnaire of 28 items.
RESULTS Of 376 participants approached, 169 responded (45%). Mean age was 71.1 (SD ± 10) years. Demographics were 73.5% males, 89.7% Caucasians, 52% with college degree and 56.9%, with income of 40K$ or more. Smart device ownership was 84.5%; desktop computer was the most preferred device. Average Internet use was 1.9 h/d (SD ± 1.7); 54.3% of participants indicating for general usage but only 18.4% pursued health-related purposes. Utilization of other health information modalities was low, 29.8% used mobile health applications and 12.5% used wearable devices. Of all participants, 72% reported no barriers to using Internet. Education and income were associated positively with measures of utilization and with less perceived barriers.
CONCLUSION Among an older group of subjects attending CR, most have access to smart devices and do not perceive significant barriers to Internet use. Nonetheless, there was low utilization of health-related resources suggesting a need for targeted education in this patient population.
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Affiliation(s)
- Abdulghani Saadi
- Division of Cardiology, Creighton University School of Medicine, Omaha, NE 68124, United States
- CHI, Creighton University Medical Center, Omaha, NE 68124, United States
| | - Arun Kanmanthareddy
- Division of Cardiology, Creighton University School of Medicine, Omaha, NE 68124, United States
- CHI, Creighton University Medical Center, Omaha, NE 68124, United States
| | | | - Karen Hardy
- CHI, Creighton University Medical Center, Omaha, NE 68124, United States
| | - Mark Williams
- Division of Cardiology, Creighton University School of Medicine, Omaha, NE 68124, United States
| | - Venkata M Alla
- Division of Cardiology, Creighton University School of Medicine, Omaha, NE 68124, United States
- CHI, Creighton University Medical Center, Omaha, NE 68124, United States
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246
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Agasthi P, Pujari SH, Tseng A, Graziano JN, Marcotte F, Majdalany D, Mookadam F, Hagler DJ, Arsanjani R. Management of adults with coarctation of aorta. World J Cardiol 2020; 12:167-191. [PMID: 32547712 PMCID: PMC7284000 DOI: 10.4330/wjc.v12.i5.167] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 03/21/2020] [Accepted: 03/26/2020] [Indexed: 02/06/2023] Open
Abstract
Coarctation of the aorta (CoA) is a relatively common congenital cardiac defect often causing few symptoms and therefore can be challenging to diagnose. The hallmark finding on physical examination is upper extremity hypertension, and for this reason, CoA should be considered in any young hypertensive patient, justifying measurement of lower extremity blood pressure at least once in these individuals. The presence of a significant pressure gradient between the arms and legs is highly suggestive of the diagnosis. Early diagnosis and treatment are important as long-term data consistently demonstrate that patients with CoA have a reduced life expectancy and increased risk of cardiovascular complications. Surgical repair has traditionally been the mainstay of therapy for correction, although advances in endovascular technology with covered stents or stent grafts permit nonsurgical approaches for the management of older children and adults with native CoA and complications. Persistent hypertension and vascular dysfunction can lead to an increased risk of coronary disease, which, remains the greatest cause of long-term mortality. Thus, blood pressure control and periodic reassessment with transthoracic echocardiography and three-dimensional imaging (computed tomography or cardiac magnetic resonance) for should be performed regularly as cardiovascular complications may occur decades after the intervention.
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Affiliation(s)
- Pradyumna Agasthi
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Sai Harika Pujari
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Andrew Tseng
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, United States
| | - Joseph N Graziano
- Division of Cardiology, Phoenix Children's Hospital, Children's Heart Center, Phoenix, AZ 85016, United States
| | - Francois Marcotte
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - David Majdalany
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Farouk Mookadam
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Donald J Hagler
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, United States
| | - Reza Arsanjani
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
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Cora N, Ghandour J, Pollard CM, Desimine VL, Ferraino KE, Pereyra JM, Valiente R, Lymperopoulos A. Nicotine-induced adrenal beta-arrestin1 upregulation mediates tobacco-related hyperaldosteronism leading to cardiac dysfunction. World J Cardiol 2020; 12:192-202. [PMID: 32547713 PMCID: PMC7283997 DOI: 10.4330/wjc.v12.i5.192] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 03/27/2020] [Accepted: 05/13/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Tobacco-related products, containing the highly addictive nicotine together with numerous other harmful toxicants and carcinogens, have been clearly associated with coronary artery disease, heart failure, stroke, and other heart diseases. Among the mechanisms by which nicotine contributes to heart disease is elevation of the renin-angiotensin-aldosterone system (RAAS) activity. Nicotine, and its major metabolite in humans cotinine, have been reported to induce RAAS activation, resulting in aldosterone elevation in smokers. Aldosterone has various direct and indirect adverse cardiac effects. It is produced by the adrenal cortex in response to angiotensin II (AngII) activating AngII type 1 receptors. RAAS activity increases in chronic smokers, causing raised aldosterone levels (nicotine exposure causes the same in rats). AngII receptors exert their cellular effects via either G proteins or the two βarrestins (βarrestin1 and-2).
AIM Since adrenal ßarrestin1 is essential for adrenal aldosterone production and nicotine/cotinine elevate circulating aldosterone levels in humans, we hypothesized that nicotine activates adrenal ßarrestin1, which contributes to RAAS activation and heart disease development.
METHODS We studied human adrenocortical zona glomerulosa H295R cells and found that nicotine and cotinine upregulate βarrestin1 mRNA and protein levels, thereby enhancing AngII-dependent aldosterone synthesis and secretion.
RESULTS In contrast, siRNA-mediated βarrestin1 knockdown reversed the effects of nicotine on AngII-induced aldosterone production in H295R cells. Importantly, nicotine promotes hyperaldosteronism via adrenal βarrestin1, thereby precipitating cardiac dysfunction, also in vivo, since nicotine-exposed experimental rats with adrenal-specific βarrestin1 knockdown display lower circulating aldosterone levels and better cardiac function than nicotine-exposed control animals with normal adrenal βarrestin1 expression.
CONCLUSION Adrenal βarrestin1 upregulation is one of the mechanisms by which tobacco compounds, like nicotine, promote cardio-toxic hyperaldosteronism in vitro and in vivo. Thus, adrenal βarrestin1 represents a novel therapeutic target for tobacco-related heart disease prevention or mitigation.
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Affiliation(s)
- Natalie Cora
- Laboratory for the Study of Neurohormonal Control of the Circulation, Department of Pharmaceutical Sciences (Pharmacology), College of Pharmacy, Nova Southeastern University, Fort Lauderdale, FL 33328-2018, United States
| | - Jennifer Ghandour
- Laboratory for the Study of Neurohormonal Control of the Circulation, Department of Pharmaceutical Sciences (Pharmacology), College of Pharmacy, Nova Southeastern University, Fort Lauderdale, FL 33328-2018, United States
| | - Celina Marie Pollard
- Laboratory for the Study of Neurohormonal Control of the Circulation, Department of Pharmaceutical Sciences (Pharmacology), College of Pharmacy, Nova Southeastern University, Fort Lauderdale, FL 33328-2018, United States
| | - Victoria Lynn Desimine
- Laboratory for the Study of Neurohormonal Control of the Circulation, Department of Pharmaceutical Sciences (Pharmacology), College of Pharmacy, Nova Southeastern University, Fort Lauderdale, FL 33328-2018, United States
| | - Krysten Elaine Ferraino
- Laboratory for the Study of Neurohormonal Control of the Circulation, Department of Pharmaceutical Sciences (Pharmacology), College of Pharmacy, Nova Southeastern University, Fort Lauderdale, FL 33328-2018, United States
| | - Janelle Marie Pereyra
- Laboratory for the Study of Neurohormonal Control of the Circulation, Department of Pharmaceutical Sciences (Pharmacology), College of Pharmacy, Nova Southeastern University, Fort Lauderdale, FL 33328-2018, United States
| | - Rachel Valiente
- Laboratory for the Study of Neurohormonal Control of the Circulation, Department of Pharmaceutical Sciences (Pharmacology), College of Pharmacy, Nova Southeastern University, Fort Lauderdale, FL 33328-2018, United States
| | - Anastasios Lymperopoulos
- Laboratory for the Study of Neurohormonal Control of the Circulation, Department of Pharmaceutical Sciences (Pharmacology), College of Pharmacy, Nova Southeastern University, Fort Lauderdale, FL 33328-2018, United States
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248
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Elenizi K, Matta A, Alharthi R, Campelo-Parada F, Lhermusier T, Bouisset F, Elbaz M, Carrié D, Roncalli J. Incidental discovery of right ventricular lipoma in a young female associated with ventricular hyperexcitability: An imaging multimodality approach. World J Cardiol 2020; 12:220-227. [PMID: 32547716 PMCID: PMC7284002 DOI: 10.4330/wjc.v12.i5.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/08/2020] [Accepted: 05/05/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cardiac lipomas are rare benign tumors commonly found in the right atrium or left ventricle. Patients are usually asymptomatic, and clinical presentation depends on location and adjacent structures impairment. Right ventricle lipomas are scarce in the literature. Moreover, the previous published cases were reported in over 18-year-old patients.
CASE SUMMARY We report a giant right ventricle lipoma discovered incidentally in a 17-year-old female while performing preoperative work-up. The diagnosis was confirmed by histopathological examination, and a conservative approach was performed.
CONCLUSION Multimodal cardiac imaging and histopathological examination are required for a definitive diagnosis. The therapeutic approach depends on clinical presentation.
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Affiliation(s)
- Khaled Elenizi
- Department of Internal Medicine, College of Medicine, Prince Sattam bin Abdulaziz University, Alkharj 11942, Saudi Arabia
- Cardiovascular Department, Institute CARDIOMET, Rangueil University Hospital, Toulouse 31400, France
| | - Anthony Matta
- Cardiovascular Department, Institute CARDIOMET, Rangueil University Hospital, Toulouse 31400, France
- Faculty of Medicine, Holy Spirit University of Kaslik, Kaslik 1103, Lebanon
| | - Rasha Alharthi
- Cardiovascular Department, Institute CARDIOMET, Rangueil University Hospital, Toulouse 31400, France
| | - Francisco Campelo-Parada
- Cardiovascular Department, Institute CARDIOMET, Rangueil University Hospital, Toulouse 31400, France
| | - Thibault Lhermusier
- Cardiovascular Department, Institute CARDIOMET, Rangueil University Hospital, Toulouse 31400, France
| | - Frederic Bouisset
- Cardiovascular Department, Institute CARDIOMET, Rangueil University Hospital, Toulouse 31400, France
| | - Meyer Elbaz
- Cardiovascular Department, Institute CARDIOMET, Rangueil University Hospital, Toulouse 31400, France
| | - Didier Carrié
- Cardiovascular Department, Institute CARDIOMET, Rangueil University Hospital, Toulouse 31400, France
| | - Jerome Roncalli
- Cardiovascular Department, Institute CARDIOMET, Rangueil University Hospital, Toulouse 31400, France
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249
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Erythropoulou-Kaltsidou A, Alkagiet S, Tziomalos K. New guidelines for the diagnosis and management of pulmonary embolism: Key changes. World J Cardiol 2020; 12:161-166. [PMID: 32547711 PMCID: PMC7284001 DOI: 10.4330/wjc.v12.i5.161] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/29/2020] [Accepted: 05/05/2020] [Indexed: 02/06/2023] Open
Abstract
Pulmonary embolism (PE) is an important public health problem. In August 2019, the European Society of Cardiology in collaboration with the European Respiratory Society released new guidelines for the diagnosis and management of PE. We discuss the basic changes between these recent guidelines and the previous guidelines that were published in 2014. Regarding diagnosis, the new guidelines propose the use of an age-adjusted cut-off level of D-dimers instead of a fixed cut-off value. A D-dimer test adapted to clinical possibility should also be considered instead of fixed cut-off level of D-dimer. Detailed recommendations for the diagnosis of PE during pregnancy are also provided. Regarding risk stratification, assessment of PE-related early mortality risk is recommended. Moreover, the importance of right ventricular dysfunction is emphasized in low-risk patients. For further risk stratification of the severity of PE in patients without hemodynamic instability, use of validated scores that combine clinical, imaging and laboratory PE-related prognostic factors might also be considered. Regarding treatment, the possibility of early discharge is mentioned in patients without severe comorbidities, who are not of high risk for sudden death and in whom proper medical management at home and proper medical follow up can be ensured. The new guidelines also suggest that pro-brain natriuretic peptide levels, right ventricular function and the presence of thrombus in the right heart could be useful for guiding the decision of early discharge. Overall, these new guidelines introduce several key changes and knowledge and adherence to them will improve the outcome of patients with PE.
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Affiliation(s)
- Anastasia Erythropoulou-Kaltsidou
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki 54636, Greece
| | - Stelina Alkagiet
- Department of Cardiology, Georgios Papanikolaou Hospital, Thessaloniki 57010, Greece
| | - Konstantinos Tziomalos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki 54636, Greece
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250
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Antwi-Amoabeng D, Beutler BD, Moody AE, Kanji Z, Gullapalli N, Rowan CJ. Management of hypertension in COVID-19. World J Cardiol 2020; 12:228-230. [PMID: 32547717 PMCID: PMC7283999 DOI: 10.4330/wjc.v12.i5.228] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 05/05/2020] [Accepted: 05/12/2020] [Indexed: 02/06/2023] Open
Abstract
The ACE2 receptor plays a central role in severe acute respiratory syndrome coronavirus 2 host cell entry and propagation. It has therefore been postulated that angiotensin converting enzyme inhibitors and angiotensin receptor blockers may upregulate ACE2 expression and thus increase susceptibility to infection. We suggest that alternative anti-hypertensive agents should be preferred among individuals who may be exposed to this increasingly common and potentially lethal virus.
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Affiliation(s)
- Daniel Antwi-Amoabeng
- Department of Internal Medicine, Reno School of Medicine, University of Nevada, Reno, NV 89052, United States
| | - Bryce D Beutler
- Department of Internal Medicine, Reno School of Medicine, University of Nevada, Reno, NV 89052, United States
| | - Alastair E Moody
- Department of Anesthesiology, University of Utah, Salt Lake City, UT 84132, United States
| | - Zahara Kanji
- Department of Internal Medicine, Reno School of Medicine, University of Nevada, Reno, NV 89052, United States
| | - Nageshwara Gullapalli
- Department of Internal Medicine, Reno School of Medicine, University of Nevada, Reno, NV 89052, United States
| | - Christopher J Rowan
- Department of Internal Medicine, Reno School of Medicine, University of Nevada, Reno, NV 89052, United States
- Renown Institute for Heart and Vascular Health, Reno, NV 89512, United States
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