Systemic lupus erythematosus (SLE) is an autoimmune, chronic, and heterogeneous disease. Antimalarial drugs, such as hydroxychloroquine (HCQ) is still an important immunomodulator medicine for the treatment of SLE. Rarely, HCQ toxicity can occur. We report a case of a patient who was admitted to our hospital with clinical symptoms of heart failure with a background of history of SLE and chronic HCQ use. Dilated cardiomyopathy in parallel with increased left ventricular apical trabeculation consistent with left ventricle non-compaction cardiomyopathy (LVNC) was diagnosed. We aim to pinpoint two rare manifestations presenting in the same patient, simultaneously a) the reversible dilated cardiomyopathy after modification of the dose of HCQ and b) the non-reversible left ventricle non compaction cardiomyopathy most likely associated with her underlying disease. HCQ cardiomyopathy is rare but occasionally correlated with undesirable side effects. It is crucial to consider it in any patient taking for prolonged time the medication, who presents with symptoms of heart failure.
{"title":"A unique combination of dilated cardiomyopathy and non- compaction cardiomyopathy in 75- year-old female with lupus erythematosus and hydroxychloroquine use","authors":"Foula Vassilara, Spyridon Kois, Ioannis Papadopoulos, Triantaphilli Nikolopoulou, Aikaterini Kouki, Georgakopoulos Nikolaos","doi":"10.15406/jccr.2024.17.00609","DOIUrl":"https://doi.org/10.15406/jccr.2024.17.00609","url":null,"abstract":"Systemic lupus erythematosus (SLE) is an autoimmune, chronic, and heterogeneous disease. Antimalarial drugs, such as hydroxychloroquine (HCQ) is still an important immunomodulator medicine for the treatment of SLE. Rarely, HCQ toxicity can occur. We report a case of a patient who was admitted to our hospital with clinical symptoms of heart failure with a background of history of SLE and chronic HCQ use. Dilated cardiomyopathy in parallel with increased left ventricular apical trabeculation consistent with left ventricle non-compaction cardiomyopathy (LVNC) was diagnosed. We aim to pinpoint two rare manifestations presenting in the same patient, simultaneously a) the reversible dilated cardiomyopathy after modification of the dose of HCQ and b) the non-reversible left ventricle non compaction cardiomyopathy most likely associated with her underlying disease. HCQ cardiomyopathy is rare but occasionally correlated with undesirable side effects. It is crucial to consider it in any patient taking for prolonged time the medication, who presents with symptoms of heart failure.","PeriodicalId":115064,"journal":{"name":"Journal of Cardiology & Current Research","volume":" 17","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141824433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-03DOI: 10.15406/jccr.2024.17.00605
Sameh Samir, Mohamed Sahsah, A. Kadry, Mohsen Mahdy, H. Khorshid
Background: Cardiovascular diseases are a leading cause of death worldwide. Multiple meta-analysis have demonstrated the benefit of exercise based cardiac rehabilitation. However, the effect of exercise training on left ventricular (LV) systolic function in patients with ischemic cardiomyopathy has been controversial in the literature. Objective: To study the effect of exercise-based cardiac rehabilitation (EBCR) on left ventricular (LV) systolic function and exercise stress parameters (METs achieved, HR recovery and HR reserve) in post anterior STEMI patients with ischemic cardiomyopathy (EF≤45%). Patients and methods: The study included 50 patients with ischemic cardiomyopathy (Post anterior STEMI successfully treated by 1ry PCI) referred for cardiac rehabilitation unit at Ain Shams University Hospitals. The patients were subjected to 3 months of formal exercise based cardiac rehabilitation. Before the CR program, they were subjected to a symptom-limited exercise test (modified Bruce protocol) to exclude any remaining ischemia and calculate enrolment HR reserve, baseline heart rate recovery in 1st minute and 2nd minute (HRR1 and HRR2). Another symptom-limited exercise test was done post CR program to assess the forementioned exercise parameters after completion of the program. Echocardiography was done at baseline and after completion of the CR program for assessment of LV systolic function by ejection fraction (assessed by 2D Simpson’s method) and peak longitudinal strain of the left ventricle (measured using speckle tracking echocardiography). Results: Exercise-based cardiac rehabilitation was associated with significant improvement in LV systolic function as reflected by significant improvement in Global longitudinal strain (GLS) (P-value = 0.0001) in patients with ischemic heart failure. CR was also associated with improvement in the functional capacity as reflected by the improvement in METs as well as in the HRR and HR reserve (P-value = 0.0001). However, there was no significant change regarding EF before and after cardiac rehabilitation (P-value= 0.4582).
{"title":"Effect of exercise based cardiac rehabilitation on LV systolic function & exercise stress parameters in patients with ischemic cardiomyopathy post anterior STEMI","authors":"Sameh Samir, Mohamed Sahsah, A. Kadry, Mohsen Mahdy, H. Khorshid","doi":"10.15406/jccr.2024.17.00605","DOIUrl":"https://doi.org/10.15406/jccr.2024.17.00605","url":null,"abstract":"Background: Cardiovascular diseases are a leading cause of death worldwide. Multiple meta-analysis have demonstrated the benefit of exercise based cardiac rehabilitation. However, the effect of exercise training on left ventricular (LV) systolic function in patients with ischemic cardiomyopathy has been controversial in the literature. Objective: To study the effect of exercise-based cardiac rehabilitation (EBCR) on left ventricular (LV) systolic function and exercise stress parameters (METs achieved, HR recovery and HR reserve) in post anterior STEMI patients with ischemic cardiomyopathy (EF≤45%). Patients and methods: The study included 50 patients with ischemic cardiomyopathy (Post anterior STEMI successfully treated by 1ry PCI) referred for cardiac rehabilitation unit at Ain Shams University Hospitals. The patients were subjected to 3 months of formal exercise based cardiac rehabilitation. Before the CR program, they were subjected to a symptom-limited exercise test (modified Bruce protocol) to exclude any remaining ischemia and calculate enrolment HR reserve, baseline heart rate recovery in 1st minute and 2nd minute (HRR1 and HRR2). Another symptom-limited exercise test was done post CR program to assess the forementioned exercise parameters after completion of the program. Echocardiography was done at baseline and after completion of the CR program for assessment of LV systolic function by ejection fraction (assessed by 2D Simpson’s method) and peak longitudinal strain of the left ventricle (measured using speckle tracking echocardiography). Results: Exercise-based cardiac rehabilitation was associated with significant improvement in LV systolic function as reflected by significant improvement in Global longitudinal strain (GLS) (P-value = 0.0001) in patients with ischemic heart failure. CR was also associated with improvement in the functional capacity as reflected by the improvement in METs as well as in the HRR and HR reserve (P-value = 0.0001). However, there was no significant change regarding EF before and after cardiac rehabilitation (P-value= 0.4582).","PeriodicalId":115064,"journal":{"name":"Journal of Cardiology & Current Research","volume":"56 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141388512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-05DOI: 10.15406/jccr.2023.16.00580
Ashish K Mohapatra MD, Cyril James MD, FESC
Heart Failure (HF) is a complicated, fatal medical condition that poses a severe threat to human life. It is a complex ailment that can lead to death and is associated with high healthcare costs, significant morbidity and mortality rates, and a reduction in functional capacity and quality of life. Recent data analysis reveals that approximately 64million people worldwide are affected by HF.1 Patients with HFrEF can benefit from cardiac contractility modulation (CCM), a revolutionary device-based treatment. In patients with HFrEF, CCM treatment has been associated with an improvement in exercise tolerance, an improvement in quality of life, a decrease in HF hospitalizations, and a reversal remodeling of the left ventricle. In this instance, we describe the therapeutic benefit of CCM in an elderly individual with advanced HFrEF triggered by ischemic dilated cardiomyopathy who frequently required hospitalization for heart failure-related issues and had a low quality of life despite receiving the best possible guideline-directed medical therapy (GDMT).
{"title":"Rejuvenating a failing heart: A Case report","authors":"Ashish K Mohapatra MD, Cyril James MD, FESC","doi":"10.15406/jccr.2023.16.00580","DOIUrl":"https://doi.org/10.15406/jccr.2023.16.00580","url":null,"abstract":"Heart Failure (HF) is a complicated, fatal medical condition that poses a severe threat to human life. It is a complex ailment that can lead to death and is associated with high healthcare costs, significant morbidity and mortality rates, and a reduction in functional capacity and quality of life. Recent data analysis reveals that approximately 64million people worldwide are affected by HF.1 Patients with HFrEF can benefit from cardiac contractility modulation (CCM), a revolutionary device-based treatment. In patients with HFrEF, CCM treatment has been associated with an improvement in exercise tolerance, an improvement in quality of life, a decrease in HF hospitalizations, and a reversal remodeling of the left ventricle. In this instance, we describe the therapeutic benefit of CCM in an elderly individual with advanced HFrEF triggered by ischemic dilated cardiomyopathy who frequently required hospitalization for heart failure-related issues and had a low quality of life despite receiving the best possible guideline-directed medical therapy (GDMT).","PeriodicalId":115064,"journal":{"name":"Journal of Cardiology & Current Research","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133761782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-12DOI: 10.15406/jccr.2023.16.00575
F. Cacciapuoti
Hyperhomocysteinemia (HHcy) is an independent risk factor for atherosclerosis responsible for chronic and acute cardiovascular events, such as myocardial infarction, stroke, and peripheral vascular disease. The aim of this review is to evaluate the mechanisms through which increased homocysteine (Hcy) levels cause atherosclerotic events. It is knonw that the amino-acid Hcy, through the trans-methylation pathway, results in S-adenosyl-methionine (SAM). In turn, SAM transfers a methyl group (-CH3) to some substrates, such as DNA, turning in S-Adenosyl-Homocysteine (SAH). But, this compound is able to inhibit DNA methyltransferase (DNT), that is the enzyme responsible for DNA methylation. The consequent DNA hypomethylation favors the Cyclin A inhibition, responsible for the atherosclerotic findings. Thus, DNA hypomethylation is a risk factor for atherosclerosis rather than HHcy, that is a simple indicator of this complication. Concordantly, several reports and large trials indicate that folate (vit. B-9) and B-6-12 vitamins supplementation, even lowers HHcy levels, did not reduce the incidence of atherosclerosis. But, that can be antagonized by the product of Hcy-transsulfuration, as H2S. Conclusively, the contemporary administration of H2S + folic acid (that antagonizes HHcy) should reduce both high Hcy serum levels and cardiovascular acute events.
{"title":"Hyperhomocysteinemia acts via DNA-hypomethylation to induce atherosclerosis","authors":"F. Cacciapuoti","doi":"10.15406/jccr.2023.16.00575","DOIUrl":"https://doi.org/10.15406/jccr.2023.16.00575","url":null,"abstract":"Hyperhomocysteinemia (HHcy) is an independent risk factor for atherosclerosis responsible for chronic and acute cardiovascular events, such as myocardial infarction, stroke, and peripheral vascular disease. The aim of this review is to evaluate the mechanisms through which increased homocysteine (Hcy) levels cause atherosclerotic events. It is knonw that the amino-acid Hcy, through the trans-methylation pathway, results in S-adenosyl-methionine (SAM). In turn, SAM transfers a methyl group (-CH3) to some substrates, such as DNA, turning in S-Adenosyl-Homocysteine (SAH). But, this compound is able to inhibit DNA methyltransferase (DNT), that is the enzyme responsible for DNA methylation. The consequent DNA hypomethylation favors the Cyclin A inhibition, responsible for the atherosclerotic findings. Thus, DNA hypomethylation is a risk factor for atherosclerosis rather than HHcy, that is a simple indicator of this complication. Concordantly, several reports and large trials indicate that folate (vit. B-9) and B-6-12 vitamins supplementation, even lowers HHcy levels, did not reduce the incidence of atherosclerosis. But, that can be antagonized by the product of Hcy-transsulfuration, as H2S. Conclusively, the contemporary administration of H2S + folic acid (that antagonizes HHcy) should reduce both high Hcy serum levels and cardiovascular acute events.","PeriodicalId":115064,"journal":{"name":"Journal of Cardiology & Current Research","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121292085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-29DOI: 10.15406/jccr.2023.16.00573
Marco Machado Marco Machado
This essay aims to show the state of the art in the use of creatine supplementation and precursors in the physiology and pathophysiology of the cardiovascular system. Also, show the prospects and plausibility of using the aforementioned supplements to prevent and improve the prognosis of heart disease patients.
{"title":"Role of creatine and creatine precursors supplementation on cardiovascular system physiology and pathophysiology","authors":"Marco Machado Marco Machado","doi":"10.15406/jccr.2023.16.00573","DOIUrl":"https://doi.org/10.15406/jccr.2023.16.00573","url":null,"abstract":"This essay aims to show the state of the art in the use of creatine supplementation and precursors in the physiology and pathophysiology of the cardiovascular system. Also, show the prospects and plausibility of using the aforementioned supplements to prevent and improve the prognosis of heart disease patients.","PeriodicalId":115064,"journal":{"name":"Journal of Cardiology & Current Research","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126807440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-28DOI: 10.15406/jccr.2023.16.00574
Herman Ngadjole Chelo, T. B. Kabesha, P. Mishika, Amos Kahima Kamundu, Guillaume Gislain Bahati, Héritier Chelo Dz’bo Héritier Chelo Dz’bo, B. Mave, Elia Badjo, Fabrice Ombeni Bishenge, Zacharie Kibendelwa Tsongo, S. Wembonyama
Introduction: The aim of this study was to determine the in-hospital mortality rate related to complications of hypertension in Goma. Material and methods: We conducted a retrospective and analytical study during the study period from 1st January 2020 to 31st December 2021. We assessed in-hospital mortality among patients admitted for hypertension-related complications in 8 hospitals in Goma, the Democratic Republic of the Congo. We modeled the probability of death using stepwise logistic regression. Results: Of 485 hypertensive patients (mean age: 60.57 years; 221 women), 67 (13.8%) were unaware that they had hypertension. Among 418 conscious patients (86.2%), 25 (6.0%) were not taking antihypertensive medication. During the 15 days (median) of hospitalization, 181 deaths (37.2%) occurred. The multivariate adjusted probability of death increased with comorbidities: heart failure (adjusted OR=4.1; 95% CI: 1.76-10.8), chronic renal failure (adjusted OR= 5.43; 95% CI: 1.97-17.8), and cerebrovascular complications of hypertension (adjusted OR=2.14; 95% CI: 1.28-3.61). Conclusion: In-hospital mortality of African patients hospitalized for hypertension-related disorders in Goma is above 30%. These results highlight that screening and treatment of hypertension and prevention of cardiovascular disease should be much higher on the political agenda in sub-Saharan Africa.
{"title":"In-hospital mortality among patients admitted for hypertension-related complications in Goma, in the Democratic Republic of the Congo","authors":"Herman Ngadjole Chelo, T. B. Kabesha, P. Mishika, Amos Kahima Kamundu, Guillaume Gislain Bahati, Héritier Chelo Dz’bo Héritier Chelo Dz’bo, B. Mave, Elia Badjo, Fabrice Ombeni Bishenge, Zacharie Kibendelwa Tsongo, S. Wembonyama","doi":"10.15406/jccr.2023.16.00574","DOIUrl":"https://doi.org/10.15406/jccr.2023.16.00574","url":null,"abstract":"Introduction: The aim of this study was to determine the in-hospital mortality rate related to complications of hypertension in Goma. Material and methods: We conducted a retrospective and analytical study during the study period from 1st January 2020 to 31st December 2021. We assessed in-hospital mortality among patients admitted for hypertension-related complications in 8 hospitals in Goma, the Democratic Republic of the Congo. We modeled the probability of death using stepwise logistic regression. Results: Of 485 hypertensive patients (mean age: 60.57 years; 221 women), 67 (13.8%) were unaware that they had hypertension. Among 418 conscious patients (86.2%), 25 (6.0%) were not taking antihypertensive medication. During the 15 days (median) of hospitalization, 181 deaths (37.2%) occurred. The multivariate adjusted probability of death increased with comorbidities: heart failure (adjusted OR=4.1; 95% CI: 1.76-10.8), chronic renal failure (adjusted OR= 5.43; 95% CI: 1.97-17.8), and cerebrovascular complications of hypertension (adjusted OR=2.14; 95% CI: 1.28-3.61). Conclusion: In-hospital mortality of African patients hospitalized for hypertension-related disorders in Goma is above 30%. These results highlight that screening and treatment of hypertension and prevention of cardiovascular disease should be much higher on the political agenda in sub-Saharan Africa.","PeriodicalId":115064,"journal":{"name":"Journal of Cardiology & Current Research","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128605032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-10DOI: 10.15406/jccr.2023.16.00571
D. Mathew, Jay Kim D.O, A. Sherif
Background: Marijuana or Cannabis is the most commonly used illicit drug in the United States. An estimated 2 million adults who reported marijuana use also have cardiovascular disease. Marijuana use has been associated with acute myocardial infarction, heart failure and arrhythmias. However, the implications of marijuana use on sudden cardiac arrest outcomes is unknown. Methods: Using the National Inpatient Sample of the years 2018 & 2019, patient characteristics and in-hospital outcomes were compared between marijuana users and non-marijuana users admitted with sudden cardiac arrest. Results: The median age of marijuana users was lower at 46.8years. They had significantly lower prevalence of congestive heart failure, coronary artery disease, valvular heart disease, pulmonary circulation disorders, atrial fibrillation, hypertension, and diabetes and a significantly higher prevalence of chronic liver disease, depression, alcohol use, tobacco use, amphetamine/psychostimulant use, opioid use, cocaine use, and sedative use. Multivariable logistic regression analysis showed significantly higher odds for ventricular fibrillation (OR: 1.24; 95% CI: 1.09- 1.41; p- 0.001) but lower odds for mortality (OR: 0.86; 95% CI: 0.78- 0.96; p-0.011), need for mechanical ventilation (OR: 0.76; 95% CI: 0.67- 0.86; p- 0.000), and tracheostomy (OR: 0.46; 95% CI: 0.34- 0.62; p- 0.000). Marijuana users were also more likely to be discharged home with self-care (25.25% vs 11.53%). Conclusion: Among patients admitted with sudden cardiac arrest, marijuana users were found to have significantly higher odds for ventricular fibrillation. They were found to have lower odds for in-hospital mortality, mechanical ventilation, and tracheostomy and were more likely to be discharged home with selfcare, but this is mostly because marijuana users who are admitted with sudden cardiac arrest were younger and had considerably fewer chronic medical conditions. Large prospective cohort studies are needed to ascertain the health risks associated with marijuana use.
{"title":"Characteristics and outcomes of Marijuana users admitted with sudden cardiac arrest","authors":"D. Mathew, Jay Kim D.O, A. Sherif","doi":"10.15406/jccr.2023.16.00571","DOIUrl":"https://doi.org/10.15406/jccr.2023.16.00571","url":null,"abstract":"Background: Marijuana or Cannabis is the most commonly used illicit drug in the United States. An estimated 2 million adults who reported marijuana use also have cardiovascular disease. Marijuana use has been associated with acute myocardial infarction, heart failure and arrhythmias. However, the implications of marijuana use on sudden cardiac arrest outcomes is unknown. Methods: Using the National Inpatient Sample of the years 2018 & 2019, patient characteristics and in-hospital outcomes were compared between marijuana users and non-marijuana users admitted with sudden cardiac arrest. Results: The median age of marijuana users was lower at 46.8years. They had significantly lower prevalence of congestive heart failure, coronary artery disease, valvular heart disease, pulmonary circulation disorders, atrial fibrillation, hypertension, and diabetes and a significantly higher prevalence of chronic liver disease, depression, alcohol use, tobacco use, amphetamine/psychostimulant use, opioid use, cocaine use, and sedative use. Multivariable logistic regression analysis showed significantly higher odds for ventricular fibrillation (OR: 1.24; 95% CI: 1.09- 1.41; p- 0.001) but lower odds for mortality (OR: 0.86; 95% CI: 0.78- 0.96; p-0.011), need for mechanical ventilation (OR: 0.76; 95% CI: 0.67- 0.86; p- 0.000), and tracheostomy (OR: 0.46; 95% CI: 0.34- 0.62; p- 0.000). Marijuana users were also more likely to be discharged home with self-care (25.25% vs 11.53%). Conclusion: Among patients admitted with sudden cardiac arrest, marijuana users were found to have significantly higher odds for ventricular fibrillation. They were found to have lower odds for in-hospital mortality, mechanical ventilation, and tracheostomy and were more likely to be discharged home with selfcare, but this is mostly because marijuana users who are admitted with sudden cardiac arrest were younger and had considerably fewer chronic medical conditions. Large prospective cohort studies are needed to ascertain the health risks associated with marijuana use.","PeriodicalId":115064,"journal":{"name":"Journal of Cardiology & Current Research","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121488485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-23DOI: 10.15406/jccr.2023.16.00570
José A Citalán-Jiménez, Carlos A GuizarSanchez, Eduardo Lara-Vazquez, Leonel Martínez-Ramírez, Porfirio Visoso Palacios, Fernando Pérez-Villatoro
Introduction: Currently, there is a trend towards non-invasive hemodynamic monitoring guided by echocardiography, however, in our center, in patients undergoing coronary revascularization surgery, invasive hemodynamic monitoring with Swan-Ganz catheter placement continues. Given that hemodynamic monitoring using non-invasive methods has been shown to be feasible, it is therefore expected that the hemodynamic variables obtained by echocardiography are consistent with the variables obtained by Swan-Ganz catheterization in this type of patient. The objective of the study is to evaluate the concordance that exists between the different hemodynamic variables obtained by Swan-Ganz catheterization, with the variables obtained by echocardiography. Methods: Observational, non-interventional, retrospective, cross-sectional and analytical study, non-randomized. Patients admitted to the Coronary Unit after coronary revascularization surgery were selected, who had a Swan-Ganz catheter on admission, all patients underwent measurement of the hemodynamic variables CO, RAP, PASP, PWP and later TTE was performed to obtain the same variables. Finally, the Concordance Correlation Coefficient described by Lin CCC= (A2+B2-C2) ÷(A2+B2+D2) and by the Bland-Altman method was used as a statistical tool. Results: 26 patients were included, with a mean age of 63.8 ± 6.2 years, 69.2% male. For the CO variable, an average absolute difference of 0.77 L/min and a CCC of 0.7334 were obtained; in the analysis of (B-A), an average difference is -0.4149 L/min. For the RAP an average difference of 2.11 mmHg, with a CCC = 0.8595 and in the analysis of B-A an average difference of -1.11 mmHg. For the PASP an average absolute difference of 5.11 mmHg was obtained with a CCC = 0.5444 and in the B-A analysis an average difference of 0.2944 mmHg. For PWP an average absolute difference of 2.78 mmHg with a CCC = 0.3842, in the analysis of B-A an average difference of 2.13 mmHg. When carrying out the analysis of the average differences obtained from each of the variables, with which a P value of 0.293 was obtained for the CO, 0.129 for the RAP, 0.308 for the PASP, and 0.017 for the PWP. Conclusions: A poor strength of agreement was observed for the CCC for each of the variables, however, these are not clinically significant, so they can be considered as interchangeable methods. It is important to mention that the TTE provides other relevant parameters in the management of these patients.
{"title":"Evaluation of the concordance between hemodynamic variables obtained by Swan-Ganz catheterization and transthoracic echocardiography in patients after coronary revascularization surgery","authors":"José A Citalán-Jiménez, Carlos A GuizarSanchez, Eduardo Lara-Vazquez, Leonel Martínez-Ramírez, Porfirio Visoso Palacios, Fernando Pérez-Villatoro","doi":"10.15406/jccr.2023.16.00570","DOIUrl":"https://doi.org/10.15406/jccr.2023.16.00570","url":null,"abstract":"Introduction: Currently, there is a trend towards non-invasive hemodynamic monitoring guided by echocardiography, however, in our center, in patients undergoing coronary revascularization surgery, invasive hemodynamic monitoring with Swan-Ganz catheter placement continues. Given that hemodynamic monitoring using non-invasive methods has been shown to be feasible, it is therefore expected that the hemodynamic variables obtained by echocardiography are consistent with the variables obtained by Swan-Ganz catheterization in this type of patient. The objective of the study is to evaluate the concordance that exists between the different hemodynamic variables obtained by Swan-Ganz catheterization, with the variables obtained by echocardiography. Methods: Observational, non-interventional, retrospective, cross-sectional and analytical study, non-randomized. Patients admitted to the Coronary Unit after coronary revascularization surgery were selected, who had a Swan-Ganz catheter on admission, all patients underwent measurement of the hemodynamic variables CO, RAP, PASP, PWP and later TTE was performed to obtain the same variables. Finally, the Concordance Correlation Coefficient described by Lin CCC= (A2+B2-C2) ÷(A2+B2+D2) and by the Bland-Altman method was used as a statistical tool. Results: 26 patients were included, with a mean age of 63.8 ± 6.2 years, 69.2% male. For the CO variable, an average absolute difference of 0.77 L/min and a CCC of 0.7334 were obtained; in the analysis of (B-A), an average difference is -0.4149 L/min. For the RAP an average difference of 2.11 mmHg, with a CCC = 0.8595 and in the analysis of B-A an average difference of -1.11 mmHg. For the PASP an average absolute difference of 5.11 mmHg was obtained with a CCC = 0.5444 and in the B-A analysis an average difference of 0.2944 mmHg. For PWP an average absolute difference of 2.78 mmHg with a CCC = 0.3842, in the analysis of B-A an average difference of 2.13 mmHg. When carrying out the analysis of the average differences obtained from each of the variables, with which a P value of 0.293 was obtained for the CO, 0.129 for the RAP, 0.308 for the PASP, and 0.017 for the PWP. Conclusions: A poor strength of agreement was observed for the CCC for each of the variables, however, these are not clinically significant, so they can be considered as interchangeable methods. It is important to mention that the TTE provides other relevant parameters in the management of these patients.","PeriodicalId":115064,"journal":{"name":"Journal of Cardiology & Current Research","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127750357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-30DOI: 10.15406/jccr.2022.15.00569
Mittal Sr, Govind Mittal
The term ‘walk through angina’ is used when angina is relieved inspite of continued exertion. Objective documentation of ‘walk-through angina’ is rare. Two cases of ‘walk - through angina’ phenomenon with objective electrocardiographic documentation during treadmill stress test are reported. In both cases relief in angina was associated with reduction in electrocardiographic signs of ischemia. In one case, relief of angina was associated with reduction in rate - pressure product. In the second case angina reduced even when the rate pressure product was higher than at the onset of angina. Several factors could reduce angina inspite of increase in work load. Relief in anxiety, reduction in stress of exercise testing, coronary vasodilation, increased flow through collaterals or some adaptive process, alone or in combination, could contribute to relief in angina. Treatment is similar to chronic stable angina.
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Pub Date : 2022-12-30DOI: 10.15406/jccr.2022.15.00568
Wilson Salgado Filho, A. Saldanha, A. L. Valera Gasparoto, Ana Paula Pantoja Margeotto, Elisa Rinaldi Nunes, Renato Cesar da Silva de Oliveira, Gustavo Costa Pontes, Luiza Ferrari de Castro Melo, Tania Leme da Rocha Martinez
The involvement of inflammation is described in all stages of atherosclerosis as well as in dyslipidemias, particularly in lipoproteins (especially oxidized LDL), coronary syndromes, hypertension, diabetes, infections, obesity, and also in the use of sexual replacement hormones. From the first steps of leukocyte recruitment in the nascent atheromatic lesion to the development of atheroma plaque, culminating in its rupture and thrombosis in the acute coronary event, we found a constant release of inflammatory mediators, soluble in plasma, from macrophages, T lymphocytes, endothelial cells and smooth muscle vessels of the vessels, hepatocytes, and adipocytes. The greatest evidence relating inflammation to the future development of cardiovascular events has been verified in large-scale population studies. High concentrations of inflammatory markers such as TNF-α, IL-6, ICAM-1, P-selectin, E-selectin, C Reactive Protein, fibrinogen, and amyloid serum A, in apparently healthy individuals, have shown predictive value for future vascular events. Considering the multifactorial etiology of coronary artery disease and its inflammatory nature, it was possible to find an association between the presence of risk factors and the increase in the concentration of biomarkers of inflammation. TNF-α is a multifunctional cytokine derived from smooth endothelial and muscle cells, as well as macrophages present in the coronary atheroma. It is involved in a number of cardiovascular processes, being increased in congestive heart failure.
{"title":"Inflammatory mediators and their special roles in diverse clinical circumstance","authors":"Wilson Salgado Filho, A. Saldanha, A. L. Valera Gasparoto, Ana Paula Pantoja Margeotto, Elisa Rinaldi Nunes, Renato Cesar da Silva de Oliveira, Gustavo Costa Pontes, Luiza Ferrari de Castro Melo, Tania Leme da Rocha Martinez","doi":"10.15406/jccr.2022.15.00568","DOIUrl":"https://doi.org/10.15406/jccr.2022.15.00568","url":null,"abstract":"The involvement of inflammation is described in all stages of atherosclerosis as well as in dyslipidemias, particularly in lipoproteins (especially oxidized LDL), coronary syndromes, hypertension, diabetes, infections, obesity, and also in the use of sexual replacement hormones. From the first steps of leukocyte recruitment in the nascent atheromatic lesion to the development of atheroma plaque, culminating in its rupture and thrombosis in the acute coronary event, we found a constant release of inflammatory mediators, soluble in plasma, from macrophages, T lymphocytes, endothelial cells and smooth muscle vessels of the vessels, hepatocytes, and adipocytes. The greatest evidence relating inflammation to the future development of cardiovascular events has been verified in large-scale population studies. High concentrations of inflammatory markers such as TNF-α, IL-6, ICAM-1, P-selectin, E-selectin, C Reactive Protein, fibrinogen, and amyloid serum A, in apparently healthy individuals, have shown predictive value for future vascular events. Considering the multifactorial etiology of coronary artery disease and its inflammatory nature, it was possible to find an association between the presence of risk factors and the increase in the concentration of biomarkers of inflammation. TNF-α is a multifunctional cytokine derived from smooth endothelial and muscle cells, as well as macrophages present in the coronary atheroma. It is involved in a number of cardiovascular processes, being increased in congestive heart failure.","PeriodicalId":115064,"journal":{"name":"Journal of Cardiology & Current Research","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121730818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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