Adherence to penicillin treatment is essential for effective secondary prevention of rheumatic heart disease: a systematic review and meta-analysis

Background

Penicillin is essential for secondary prevention of acute rheumatic fever (ARF) and rheumatic heart disease (RHD). However, the incidences of ARF recurrence and RHD progression remain high, particularly in endemic countries. This meta-analysis evaluated the effectiveness of penicillin adherence in secondary prevention of ARF recurrence and RHD progression.

Methods

The authors included original articles employing an observational study design in which the study population included patients with ARF or RHD and documented adherence to secondary prophylaxis with penicillin for secondary prevention. Systematic searches of the PubMed, Scopus, and Cochrane databases were performed. Moreover, the authors also conducted a snowballing literature search from Europe PMC to expand the included studies. The quality of each study was assessed using the National Institute of Health Quality Assessment Tool. The statistical analyses were conducted using Review Manager 5.4.1 software developed by Cochrane. In addition, the authors utilized pooled odds ratios (ORs) to compare the adherence techniques.

Results

A total of 310 studies were identified, of which 57 full-text articles were assessed for eligibility. The authors included six studies with 1364 patients for the qualitative synthesis and meta-analysis. Good adherence to penicillin for the secondary prophylaxis of ARF and RHD, significantly reduced the odds of ARF recurrence or RHD progression by up to 71% compared to that associated with poor adherence [pooled OR 0.29 (0.21-0.40); I²=0% (p=0.56); Z=7.64 (p <0.00001)].

Conclusion

Good adherence to penicillin for secondary prophylaxis in patients with ARF or RHD is essential for reducing the risk of ARF recurrence or RHD progression.

Proactive method for identification and handling of patient complaints with root cause analysis in Surabaya Islamic Hospital

Background

Errors or cases that occur in health care organizations are very fatal because they can reduce the quality of life of patients and the worst is cause the death of the patient. One of the appropriate tools to be applied in analyzing cases/problems that occur in Surabaya Islamic Hospitals is root cause analysis. The complaints were addressed to the medical services, medical support, general, administration and verification, information systems and management, and finance sections.

Design and methods

This research uses secondary data on hospital patient complaints in 2022 and is supported by the results of online interviews with the head of marketing public relations. Secondary data was processed through a six stages of root cause analysis and analyzed with the help of a fishbone diagram to determine the root cause of the problem in the health care sector.

Results

There were 261 complaints received by customer service addressed to the medical services, medical support, general, administration and verification, information systems and management, and finance departments. There are eight root causes found in Surabaya Islamic Hospital inpatient complaints. This proves that there must be improvements/ interventions made by the Surabaya Islamic Hospital to overcome inpatient complaints.

Conclusions

Inpatient complaints at Surabaya Islamic Hospital prove the need for a number of interventions/improvements, especially in the field of human resources, namely the level of discipline, skills, empathy, communication, limited medical, and financial staff.

Identification of Pacemaker Lead Position Using Fluoroscopy to Avoid Significant Tricuspid Regurgitation

Permanent pacemaker implantation improves survival but can cause tricuspid valve dysfunction in the form of tricuspid regurgitation (TR). The dominant mechanism of pacemaker-mediated TR is lead impingement. This study evaluated the association between the location of the pacemaker leads crossing the tricuspid valve and the incidence of worsening TR and lead impingement using fluoroscopy. Lead positions were evaluated using perpendicular right anterior oblique (RAO) and parallel left anterior oblique (LAO) fluoroscopic angulation views of the tricuspid annulus. A two-dimensional transthoracic echocardiogram (TTE) was performed to evaluate the maximum TR jet area-to-right atrium ratio and define regurgitation severity. A three-dimensional TTE was performed to evaluate lead impingement. A worsening of TR was observed in 23 of 82 subjects. Most leads had an inferior position in the RAO view and a septal position in the LAO view. The mid position in the RAO view and septal position in the LAO view were risk factors for lead impingement. Mid and septal positions were associated with higher risks of significant TR and lead impingement. Lead impingement was associated with a high risk of significant TR. Pacemaker-mediated TR remains a significant problem after lead implantation.

Prevalence factors and strategies for handling health workers’ anxiety in providing health services for COVID-19 variants

Introduction: Analysis of health workers' anxiety in providing patient services towards the COVID-19 variant has never been done well. Therefore, this study analyzes factors that affect anxiety among health workers because it has the potential to interfere with health services. The purpose of the study is to analyze the factors that affect the prevalence of anxiety among health workers in providing patient services variant of COVID-19. Methods: Participants involves health workers who handle patient variant of COVID-19. The data collection was approved by the research ethics committee of Surabaya Islamic Hospital A.Yani. Data source taken in Surabaya and surrounding areas in June 2021 namely N= 300-400 data breeding techniques is purposive sampling, research instrument is in the form of questionnaires by sharing to social media using a google form, data in the univariate analysis is done descriptively to see the respondents' characteristics and bivariate analysis is used to analyze factors affecting anxiety in statistical tests used is regression ordinal. Results: The results of statistical analysis obtained factors that affect anxiety, namely: female sex obtained = 0.02), age 30 years obtained results= 0.00, working in public health center = 0.08, nursing profession= 0.25, unmarried= 0.00, works outside Surabaya= 0.00, has a child and 2-3 children= 0.00. Conclusions: The study was conducted to analyze the prevalence factors of health care workers' anxiety in providing care for patients with COVID-19 variants and how the anxiety management strategies that resulted in this greatly contributed to the condition of health workers with psychological problems, namely anxiety.

Efforts to increase interest in using company guaranteed patients by approaching customer relations management

Introduction: Customer relationship management (CRM) is a strategy hospitals can use to realize patient-centered care. The study was based on the low interest in inpatient visits by company guarantees, where only 11.4% of employees used inpatient facilities at Ciputra Mitra Hospital (CMH). This study aimed to develop an effort to increase inpatient visits by company guarantees at CMH Banjarmasin. Methods: This study was conducted on 95 respondents from company customers. Of the 95 customers, they are divided into actual customers, namely those who have used inpatient services, as many as 58 people and potential customers who have not utilized as many as 37 people. The data is processed by classifying some between actual and potential customers and processed descriptively from several variables, including Satisfaction, Interact and Loyalty. Results: This study informs that the low interest in visiting is strongly influenced by customer knowledge regarding the company's cooperation with hospitals and services following customer needs. The actual customer differentiation is mostly just first-timers and repeat customers, while the rest are prospects who have not taken advantage of the services at CMH. The interaction of the hospital with partner company customers at CMH influences satisfaction with a significance of <0.001, while the resulting patient satisfaction influences loyalty with a significance of <0.001, thereby increasing customer loyalty. Conclusion: Based on this study, most customers were prospective customers who had never used inpatient services. The service experience felt by customers is the same as other customers, while customer loyalty to CMH is higher than customer loyalty to other hospitals.

Incident analysis of patient safety in hospital: Based on feedback and supervision concept

Introduction: The concept of feedback and supervision is at the core of efforts to reduce hospital patient safety incidents. This study aimed to analyze the effect of feedback and supervision on the occurrence of patient safety incidents in hospitals. Methods: The population included 18 work units that provide services to patients with samples of the unit head or room head, the person in charge of work shifts and the person in charge of patient safety quality. Data in the form of respondents' perceptions were collected through a questionnaire using Google form and analyzed using cross-tabulation and the Pareto approach with a note that it is influential if a difference of >20% is found between the independent and the dependent variable. Results: The results showed that most of the feedback in the work unit was lacking (50.0%), and supervision in the work unit was good (55.6%). The number of patient safety incidents at the Surabaya Islamic Hospital was dominated by near-injury incidents (NII) with a green rating. The outpatient unit is the unit with the highest incidence. Feedback and supervision affect the number of patient safety incidents because they have a difference of 22.2% and 52.5%, respectively. This study has shown that hospital patient safety incidents are influenced by feedback and supervision. Conclusion: This study showed that feedback and supervision influence the incidence of patient safety incidents in hospitals. Therefore, there is a need for training on supervision at the head of the room, providing socialization and education about the importance of patient safety, and increasing the commitment of decision-makers and related stakeholders.

Relationship between demographics and patient infographics of company guarantees on utilization of inpatient services

Introduction: Based on the low interest in inpatient visits by company insurance, only 11.4% of employees utilize inpatient facilities at CMH. This study aimed to find the relationship between demographics and infographics of company insurance patients on the use of inpatient services. Methods: This study was conducted on 95 respondents from a customer's company. Ninety-five customers are divided into actual customers who have used inpatient services (58 people) and potential customers who have not utilized (37 people). The data is processed by grouping some between actual and potential customers and processed descriptively using a chi-square of several variables, including demographics and infographics. Results: This study informs that the distance from home and the length of time known to the hospital did not affect inpatient care. At the same time, knowledge of cooperation and socialization of HRD influences the utilization of inpatient services. Repeated socialization and the hospital's proximity to HRD can cause more patients to visit and take advantage of inpatient services Conclusion: In carrying out inpatient services, the company's role as a guarantor is very decisive in directing customers to CMH. Utilization of inpatient services is not influenced by distance from home and length of time with CMH but by customer knowledge regarding collaboration with CMH and socialization by HRD.

Cycling to Regulate Random Blood Glucose Levels in Individuals with Diabetes

BACKGROUND: In Indonesia, the four pillars of diabetes management include health education, food planning, physical exercise, and drug adherence. However, the most common imprudence in those four pillars was ignoring physical activity. Cycling has become a new social activity and a lifestyle among the community during the COVID-19 pandemic. It is an aerobic exercise that increases insulin receptor sensitivity. AIM: This study aims to analyze the effect of cycling on Random Blood Glucose (RBG) levels in individuals with diabetes. METHODOLOGY: This paper used a quasi-experiment pre-post test design with the control group. It utilized total sampling with 60 respondents. The independent variable was cycling using a dynamic bicycle. Meanwhile, the dependent variable was RBG levels with a glucometer as the instrument. The procedure in the intervention group was cycling using a dynamic bicycle twice a week with a distance of 2–3 kilometers each session. The data analysis used a paired T-test and independent sample T-test. RESULTS: After cycling, the independent T-test result was p = 0.00 (p < 0.05). Thus, there was a difference in the mean RBG levels between the intervention and control groups after cycling. There was a decrease in mean RBG levels in the intervention group (206.67 ± 69.887 in pre-test and 114.60 ± 30.395 in post-test). In addition, the paired T-test resulted in p = 0.00 (p < 0.05). Thus, there was a difference in the intervention group’s mean RBG levels before and after cycling CONCLUSION: Cycling can lower RBG levels in individuals with diabetes.

Understanding Pacemaker-Induced Cardiomyopathy Incidence and Predictors in Patients with Right Ventricular Pacing: A Systematic Review

This study aimed to figure out the incidence and predictors of pacemaker-induced cardiomyopathy (PICM) in patients with right ventricular (RV) pacing. We systematically searched in PubMed on March 18, 2020, for English language abstract and full-article journals, using the following criteria: pacemaker induced cardiomyopathy AND right ventricular AND pacemaker AND patients AND human NOT implantable cardioverter defibrillator NOT ICD NOT animal. Four studies were included in this review after filtering 35 studies through year of publication and abstract selection. The average PICM incidence from 1,365 patients included from the four studies was 10.7 to 13.7%. One study stated that preimplantation left ventricular ejection fraction (LVEF) was the predictor for the development of PICM. Three studies mentioned that RV pacing burden was the predictor for the development of PICM. However, the percentage differ in three studies: ≥20, >40, and 60%. In addition, one of the studies also included interventricular dyssynchrony as another predictor. The incidence of PICM in patients with RV pacing ranged from 10.7 to 13.7%. Preimplantation LVEF, interventricular dyssynchrony, and burden of RV pacing are reported as the predictors for the development of PICM in patients with RV pacing.

Atrial Failure: What Do We Know About It?

Heart failure is the end of all pathological conditions in the heart. Most accepted paradigms in heart failure are always preceded by left ventricle disfunction. Currently, there are several clinical studies that show that heart failure may occur without prior left ventricular dysfunction. Left atrial dysfunction may play a more important role in heart failure than previously expected. Failure of the left atrium can exist independently of left ventricle dysfunction and mitral valve abnormalities. Atrial failure, just like left ventricular failure, can lead to global heart failure. Etiology, pathomechanism and clinical symptoms of atrial failure are complex and not well understood. This review will explain atrial failure.

Randomised controlled trial into the role of ramipril in fibrosis reduction in rheumatic heart disease: the RamiRHeD trial protocol

INTRODUCTION

Rheumatic heart disease (RHD) is a major burden in developing countries and accounts for 80% of all people living with the disease, where it causes most cardiovascular morbidity and mortality in children and young adults. Chronic inflammation and fibrosis of heart valve tissue due to chronic inflammation in RHD will cause calcification and thickening of the impacted heart valves, especially the mitral valve. This fibrogenesis is enhanced by the production of angiotensin II by increased transforming growth factor β expression and later by the binding of interleukin-33, which is known to have antihypertrophic and antifibrotic effects, to soluble sST2. sST2 binding to this non-natural ligand worsens fibrosis. Therefore, we hypothesise that ACE inhibitors (ACEIs) would improve rheumatic mitral valve stenosis.

METHODS AND ANALYSIS

This is a single-centre, double-blind, placebo-controlled, randomised clinical trial with a pre-post test design. Patients with rheumatic mitral stenosis and valve dysfunction will be planned for cardiac valve replacement operation and will be given ramipril 5 mg or placebo for a minimum of 12 weeks before the surgery. The expression of ST2 in the mitral valve is considered to be representative of cardiac fibrosis. Mitral valve tissue will be stained by immunohistochemistry to ST2. Plasma ST2 will be measured by ELISA. This study is conducted in the Department of Cardiology and Vascular Medicine, Universitas Indonesia, National Cardiac Center Harapan Kita Hospital, Jakarta, Indonesia, starting on 27 June 2019.

ETHICS AND DISSEMINATION

The performance and dissemination of this study were approved by the ethics committee of National Cardiovascular Center Harapan Kita with ethical code LB.02.01/VII/286/KEP.009/2018.

TRIAL REGISTRATION NUMBER

NCT03991910.

Determinants and Prediction Equations of Six-Minute Walk Test Distance Immediately After Cardiac Surgery

Background: To date, there is no reference for a 6-min walk test distance (6-MWD) immediately after cardiac surgery. Therefore, this study aimed to identify the determinants and to generate equations for prediction reference for 6-MWD in patients immediately after cardiac surgery.

Methods: This is a cross-sectional study of the 6-min walk test (6-MWT) prior to participation in the cardiac rehabilitation (CR) program of patients after coronary artery bypass surgery (CABG) or valve surgery. The 6-MWT were carried out in a gymnasium prior to the CR program immediately after the cardiac surgery. Available demographic and clinical data of patients were analyzed to identify the clinical determinants of 6-MWD.

Results: This study obtained and analyzed the data of 1,509 patients after CABG and 632 patients after valve surgery. The 6-MWD of all patients was 321.5 ± 73.2 m (60–577). The distance was longer in the valve surgery group than that of patients in the CABG group (327.75 ± 70.5 vs. 313.59 ± 75.8 m, p < 0.001). The determinants which significantly influence the 6-MWD in the CABG group were age, gender, diabetes, atrial fibrillation, and body height, whereas in the valve surgery group these were age, gender, and atrial fibrillation. The multivariable regression models generated two formulas using the identified clinical determinants for patients after CABG: 6-MWD (meter) = 212.57 + 30.47 (if male gender) − 1.62 (age in year) + 1.09 (body height in cm) − 12.68 (if with diabetes) − 28.36 (if with atrial fibrillation), and for patients after valve surgery with the formula: 6-MWD (meter) = 371.05 + 37.98 (if male gender) − 1.36 (age in years) − 10.61 (if atrial with fibrillation).

Conclusion: This study identified several determinants for the 6-MWD and successively generated two reference equations for predicting 6-MWD in patients after CABG and valve surgery.

Dietary Habits and Physical Activity Affect Random Blood Sugar Levels In Outpatients

Background: Diabetes is caused by several etiology resulting in the body not using glucose into the cells, so glucose accumulates in the blood. The pancreas cannot produce the particular hormone in type 1 diabetes. Meanwhile, type 2 diabetes is caused by the inefficient use or deficiency of certain hormones relative to blood glucose levels.  Purpose: This study analyzes the correlation between dietary regulation and physical activity and blood sugar levels in outpatients Methods: This paper was a cross-sectional analytic study. The population was all outpatients who checked their blood sugar levels at the Internal Medicine Specialist Clinic of Islamic Hospital Surabaya from January to February 2021. Meanwhile, there were 115 respondents with total random sampling. The independent variable was random blood sugar (RBS) levels, while the dependent variables were dietary habits and physical activity. Data collection used medical records at the Internal Medicine Specialist Clinic of Islamic Hospital Surabaya. Then, data analysis utilized Fisher's Exact Test with a significance of 0.05  Results: Most respondents had regular dietary habits (53%) and normal random blood sugar levels (54%). In addition, they had regular physical activity (80%), with frequency once a week (34.8%), and most types of physical activity were gymnastics (34.8%). The Fisher's Exact Test obtained p=0.000 in analyzing between dietary habits and RBG levels. In addition, p=0.000 in evaluating between physical activity and RBG levels. Conclusion: Dietary habits and physical exercise affect random blood sugar levels in outpatients. Further study should evaluate other factors associated with blood sugar levels.

The Correlation Between Patient Satisfaction Regarding Nutrition Service And Hospital Length Of Stay With Food Waste In Covid–19 Patients

Patient satisfaction is one indicator of the success of food delivery in the hospital. In the condition of the Covid-19 patient, there are several symptoms which will affect the length of stay in the hospital so that the patient’s nutrition greatly affects the patient’s improvement. This study aims to determine the relationship between food serving satisfaction and length of stay on leftover food in Covid-19 patients. This study used a quantitative method with observational and cross-sectional research method in the isolation room of RSI Surabaya in July-September. The data were processed using chi square test. The results showed that there was a relationship between the satisfaction of serving food and leftovers (P= 0,000), while the length of stay in Covid-19 patients had no relationship with food waste (P= 0,517). There is a relationship between the satisfaction of the patient’s food presentation and the food waste, this shows that the better the patient’s assessment of the assessment of the food presentation, the are no food waste. Meanwhile, the length of stay of patient in the Covid-19 isolation room did not have a relationship with food waste so that the length of stay did not affect the food waste.

Role of Matrix Metalloproteinase in the Progression of Heart Failure: A Narrative Review

Heart failure (HF) is a cardiovascular disease with a complex pathological pathway and influenced by many factors. Such a complex pathological mechanism would impair cardiac function and structural stability. One that plays a role in maintaining the function and structure of the heart is the extracellular matrix (ECM), and disruption in the extracellular matrix has a role in causing cardiac dysfunction. ECM regulation is associated with matrix metalloproteinase (MMP). Overexpression of matrix metalloproteinases can lead to ECM degradation process which leads to cardiac remodelling. The role of MMP in heart failure is also related to the increased inflammatory response, which is one of the pathways for progression of heart failure. The close association of MMP with the development of heart failure makes MMP a potential biological marker. This article aims was to understand the role of MMP and its mechanisms in cardiac remodelling pathways leading to heart failure. This narrative review suggests that overexpression of MMP can lead to heart failure. Inflammation is one of the factors triggering the expression of MMP. Inflammation will increase the release of pro-inflammatory cytokines, thereby triggering MMP expression. MMP expression imbalance can damage collagen tissue through ECM degradation and damage the structure and function of the heart. MMP can also be used as a biological marker in heart failure cases. The application of MMP as a biological marker can be used to assess the degree of disease severity as well as a predictor of heart failure. In conclusion, MMP has an important role in the development process of heart failure and can be a biological marker in cases of heart failure.

Highlighting Exosomes' Function in Cardiovascular Diseases

Exosomes as one of the extracellular vesicles' subgroups played an important role in the cell to cell communication. The cargos and surface protein of exosomes have been known to affect the cardiovascular system both positively and negatively in chronic heart failure, ischemic heart disease, and atherosclerosis. There have been several exosomes that emerged as a potential diagnostic and prognostic marker in cardiovascular patients. However, the conditions affecting the patients and the method of isolation should be considered to create a standardized normal value of the exosomes and the components. CPC-derived exosomes, ADSCs-derived exosomes, and telocyte-derived exosomes have been proven to be capable ofacting as a therapeutic agent in myocardial infarction models. Exosomes have the potential to become a diagnostic marker, prognostic marker, and therapeutic agent in cardiovascular diseases.

Drug-eluting balloon: is it useful?

Background

Coronary artery disease is one of the major issues in the medical world around the globe. The prevalence tends to increase. The use of coronary intervention is one of the ways often used in the management of coronary artery disease due to its satisfying result from earlier studies. Nowadays, there are several different techniques in coronary intervention: balloon vs stent.

Main body

The stent-based vascular interventions are increasingly being used over balloon-based coronary intervention. However, revascularization intervention using stent often have undesirable long-term effects compared to balloon. Besides, stent-based interventions are also considered more expensive, use more complicated techniques, and use more drug regimens. On the other hand, percutaneous coronary intervention techniques using balloons coated by anti-proliferation drugs have begun to be glimpsed by many interventionists. Studies have found many benefits that cannot be given by stent-based intervention therapy.

Conclusions

Angioplasty using percutaneous coronary intervention techniques reveals satisfying result compared to conservative medical treatment. The indication and technique of percutaneous coronary intervention is still evolving until now. Currently, percutaneous coronary intervention using stent, either bare-metal stent or drug-eluting stent, is preferred by interventionist. Nevertheless, recent clinical trial favors the using of drug-eluting balloon for percutaneous coronary intervention in terms of both clinical outcome and complication in several scenarios.

Angiotensin Converting Enzyme Inhibitors (ACEIs) Decrease the Progression of Cardiac Fibrosis in Rheumatic Heart Disease Through the Inhibition of IL-33/sST2

Rheumatic heart disease (RHD) is common in developing countries and poses a big medical challenge and burden. The pathogenesis of RHD is influenced by the triad of host, agent, and environment. Autoantigens generated from Group A Streptococcus (GAS) infection are captured by the resident dendritic cells (DCs) in the heart's valvular endothelium. DCs differentiate into antigen presenting cells (APC) in the valve interstices. APC induces activation of autoreactive T cells, which triggers inflammation and tissue fibrosis. Cardiac fibrosis is promoted through the activation of Mitogen activated protein kinases (MAPKs) and its downstream signaling, including its interaction with transforming growth factor-β (TGF-β) and Smad proteins. TGF-β-induced phosphorylation of Smad2 complexes with Smad3 and Smad4, and translocates into the nucleus. Angiotensin II enhances the migration, maturation, and presentation of DC. In RHD, Angiotensin II induces fibrosis via the stimulation of TGF-β, which further increases the binding of IL-33 to sST2 but not ST2L, resulting in the upregulation of Angiotensin II and progression of cardiac fibrosis. This cascade of inflammation and valvular fibrosis causes calcification and stiffening of the heart valves in RHD. Angiotensin converting enzyme inhibitors (ACEIs) inhibit Angiotensin II production, which in turn decreases TGF-β expression and the onset of overt inflammatory response. This condition leads to a reduction in the sST2 as the decoy receptor to "steal" IL-33, and IL-33 binds to ST2L and results in cardioprotection against cardiac fibrosis in the pathogenesis of RHD.

A time-to-event analysis on air pollutants with the risk of cardiovascular disease and mortality: A systematic review and meta-analysis of 84 cohort studies

OBJECTIVE

Air pollution is one of the most substantial problems globally. Aerodynamic toxic of particulate matter with <10 mm in diameter (PM₁₀ ), or <2.5 mm (PM_2.5 ), as well as nitric dioxide (NO₂ ), have been linked with health issues. We aimed to perform a comprehensive analysis of the time-to-event for different types of air pollutants on cardiovascular disease (CVD) events based on cohort studies.

METHODS

A comprehensive search on topics that assesses air pollution and cardiovascular disease with keywords up until July 2019 was performed.

RESULTS

There were a total of 28 215 394 subjects from 84 cohorts. Increased PM_2.5 was associated with composite CVD [HR 1.10 (1.02, 1.19)], acute coronary events [HR 1.15 (1.12, 1.17)], stroke [HR 1.13 (1.06, 1.19)], and hypertension [HR 1.07 (1.01, 1.14)], all-cause mortality [HR 1.07 (1.04, 1.09)], CVD mortality [HR 1.10 (1.07, 1.12)], and ischemic heart disease (IHD) mortality [HR 1.11 (1.07, 1.16)]. Association with AF became significant after removal of a study. Increased PM₁₀ was associated with heart failure [HR 1.25 (1.04, 1.50)], all-cause mortality [HR 1.16 (1.06, 1.27)], CVD mortality [HR 1.17 (1.04, 1.30)], and IHD mortality [HR 1.03 (1.01, 1.05)]. Increased of NO₂ was associated with increased composite CVD [HR 1.15 (1.02, 1.29)], atrial fibrillation [HR 1.01 (1.01, 1.02)], acute coronary events [HR 1.08 (1.02, 1.13)], all-cause mortality [HR 1.23 (1.14, 1.32)], CVD mortality [HR 1.17 (1.10, 1.25)], and IHD mortality [HR 1.05 (1.03, 1.08)].

CONCLUSION

Air pollutants are associated with an increased incidence of cardiovascular diseases, all-cause mortality, and CVD mortality.

Combined transepicardial and transseptal implantation of autologous CD 133+ bone marrow cells during bypass grafting improves cardiac function in patients with low ejection fraction

OBJECTIVES

Autologous CD133+ bone marrow stem cells may improve cardiac function. This randomized, single-blind clinical trial inquired whether a combined transepicardial and transseptal implantation of CD133+ stem cells during coronary artery bypass grafting (CABG) improve cardiac function with ejection fraction (EF) changes as a primary endpoint in patients with low EF.

METHODS

Thirty patients with coronary heart disease and EF <35% were randomized to undergo CABG alone or CABG with transseptal and transepicardial implantation of CD133+. Cardiac function was evaluated using cardiac magnetic resonance imaging (MRI) before and 6 months after CABG.

RESULTS

Preoperative EF was lower in the intervention group (25.88% ± 5.66%) than in the control group (30.18% ± 3.85%; P = .04). The adverse event incidence was similar between both groups. At 6 months, EF changes were significantly higher (8.69% ± 9.49; P = .04) in the CD133+ group than in the CABG-only group. Compared to the control group, significant improvements were seen in the wall motion score index (P = .003) and scar size proportion (P = .047) in the CD133+ group. The quality of life (QOL), assessed by a 6-minute walking test, showed considerable improvement in the CD133+ group compared to that in the control group (P = .03). The Minnesota Living with Heart Failure Questionnaire (MLHFQ) scale did not show improvement in the intervention group (P = .09, vs control).

CONCLUSION

Combined transepicardial and transseptal autologous CD133+ BMC implantation during bypass grafting improved cardiac function in low EF coronary artery disease patients.

Electrocardiographic early repolarization is associated with future ventricular arrhythmia after acute myocardial infarction-Systematic Review and Meta-Analysis

BACKGROUND

Early repolarization (ER) has been linked to ventricular arrhythmia (VA) and sudden cardiac death in patients without structural heart disease. We aimed to assess the latest evidence on whether ER is associated with future VA after acute myocardial infarction (AMI).

METHODS

We performed a comprehensive search on the topic that assesses ER and VA/adverse cardiovascular events in AMI. We included studies with sufficient details on ER and VA, we also performed a meta-analysis on their morphology.

RESULTS

A total of 3350 subjects from 9 studies were included. Five hundred and twenty-one (15.55%) had ER and 2829 (84.45%) did not. On meta-analysis, ER (+) in AMI was associated with VA with a pooled odds ratio (OR) of 3.58 (2.70-4.73), P < 0.001; heterogeneity I 2 34%. Subgroup analysis of patients with ST-segment elevation myocardial infarction (STEMI) showed an OR of 2.79 [1.98-3.93], P < 0.001; heterogeneity I 2 0%. Inferior location of ER (+) was associated with VA OR 3.98 [1.86-8.53], P = 0.008; I 2 67%. Notching had a 5.41 [3.52-8.32], P < 0.001; low heterogeneity I 2 0% of having VA. Pooled OR for J-point elevation was 4.72 [2.63-8.46], P < 0.001; I 2 25%. Horizontal ST-segment was associated with VA with an OR of 4.30 [1.89-975], P < 0.001; I 2 59%. Lateral location and slurred morphology were not associated with VA. Upon sensitivity analysis for inferior location and horizontal ST-segment, removal of a study reduces heterogeneity significantly.

CONCLUSION

Early repolarization especially those with the inferior location, notching morphology, an elevated J-point and horizontal ST-segment had a higher likelihood of VA in AMI including STEMI patients.

Survival analysis of patients with rheumatic MS after PBMV compared with MVS in a low-to-middle-income country

Introduction

Rheumatic mitral stenosis continues to be prevalent in developing countries, notably in endemic areas. Over the last few decades, percutaneous balloon mitral valvuloplasty (PBMV) has been established as a lower-cost alternative treatment for mitral stenosis (MS) in low-to-middle-income countries. PBMV has also been suggested to be an effective and safe alternative treatment modality. This study aims to analyse the survival of rheumatic MS patients treated with PBMV compared with those treated with mitral valve surgery (MVS).

Methods

This study was a national, single-centre, longitudinal study using a survival analysis method in 329 consecutive patients suffering from rheumatic heart disease with severe MS who underwent PBMV compared with 142 consecutive patients with similar characteristics who underwent MVS between January 2011 and December 2016. Survival analysis and event-free duration were determined over a median follow-up of 24 months in the PBMV group and 27 months in the MVS group.

Results

The results showed that of the 329 consecutive patients in the PBMV group, 61 patients (18.5) had an event (6 patients died and 55 patients were hospitalised), and of the 142 consecutive patients in the MVS group, 19 patients (13.4%) had an event (5 patients died, and 14 patients were hospitalised). The hazard ratio was 0.631 (95% confidence interval, 0.376–1.058; P = 0.081). Longer short-term survival was found in the MVS group but was not statistically significant. Event-free survival was significantly longer in the MVS group (P = 0.002), by 5 months.

Conclusions

In this study, the efficacy and safety of PBMV was reconfirmed, as PBMV proved to be non-inferior to MVS in survival prognosis, but sustained event-free duration was significantly better in the MVS group than in the PBMV group.

Cardiac Performance by Echocardiography, Cardiovascular Biomarker, Kidney Function, and Venous Oxygen Saturation as Mortality Predictors of Septic Shock

BACKGROUND

cardiac function in patients with septic shock at the cellular level can be assessed by measuring troponin I and NT Pro BNP levels. Venous oxygen saturation is measured to evaluate oxygen delivery and uptake by organ tissue. Our study may provide greater knowledge and understanding on pathophysiology of cardiovascular disorder in patients with septic shock. This study aimed to evaluate the roles of echocardiography, cardiovascular biomarkers, venous oxygen saturation and renal function as predictors of mortality rate in patients with septic shock.

METHODS

this is a prospective cohort study in patients with infections, hypotension (MAP < 65 mmHg) and serum lactate level of > 2 mmol/L. On the first and fifth days, septic patients underwent echocardiography and blood tests. Statistical analysis used in our study included t-test or Mann-Whitney test for numeric data and chi-square test for nominal data of two-variable groups; while for multivariate analysis, we used Cox Regression model.

RESULTS

on 10 days of observation, we found 64 (58%) patients died and 47 (42%) patients survived. The mean age of patients was 48 (SD 18) years. Patients with abnormal left ventricular ejection fraction (LVEF) had 1.6 times greater risk of mortality than those with normal LVEF (RR 1.6; p = 0.034). Patients with abnormal troponin I level showed higher risk of mortality as many as 1.6 times (RR: 1.6; p = 0.004). Patients with impaired renal function had 1.5 times risk of mortality (RR 1.5; p = 0.024). Patients with abnormal troponin I level and/or impaired renal function showed increased mortality risk; however, those with normal troponin I level and impaired renal function also showed increased mortality risk. Multivariate analysis revealed that left ventricular ejection fraction and troponin I level may serve as predictors of mortality in patients with septic shock. (HR 1.99; 95% CI: 1.099  ̶  3.956 ; p = 0.047 and HR: 1.83 ; 95%CI: 1.049  ̶ 3,215 ; p = 0.043).

CONCLUSION

left ventricular ejection fraction and biomarkers such as troponin I level are predictors of mortality in septic shock patients.

Endothelial dysfunction in the young adult: a retrospective cohort study on the effect of low birth weight

AIM

to investigate the effect of low birth weight (LBW) on endothelial function, and to determine the role of plasma adiponectin in endothelial dysfunction by conducting flow mediated brachial artery (FMBA) test or vasodilation response (VR) and by measuring plasma asymmetrical dimethylarginine (ADMA) of young adults born with LBW.

METHODS

in a retrospective cohort study, subjects were randomly selected from the growth study cohort of Tanjungsari Sumedang district West Java. They consisted of 67 LBW and 67 NBW (Normal Birth Weight) young adults. Dependent variables were plasma adiponectin, plasma ADMA, and VR. The correlation between plasma adiponectin and ADMA level was examined using Pearson's correlation.

RESULTS

the relative risk for LBW to have low brachialis artery vasodilation response was 2.94, (95% CI:1.91-4.53), and to have low of plasma adiponectin concentration 1.53, (95% CI: 1.07-2.18). There was a statistically significant difference for all variables studied (FMBA, plasma ADMA, and plasma Adiponectin concentrations), while simultaneous confidence interval measurements indicated that the value of FMBA and the concentration of plasma adiponectin were significantly lower, respectively p<0.001, 95% CI: -4.409-(-2.114), and p=0.015, 95% CI: -1.083-(-0.082) in LBW compared to NBW subjects. The correlation between plasma adiponectin concentration and plasma ADMA concentration in LBW subjects was not significant.

CONCLUSION

there is an effect of LBW on endothelial function. LBW compared to NBW subjects have lower VR and plasma adiponectin concentration. There may be a small role of plasma adiponectin in endothelial dysfunction of young adults with LBW.