Global Cardiology Science & Practice最新文献

Background: Percutaneous pulmonary valve implantation (PPVI) has emerged as a promising treatment for congenital right ventricular outflow tract (RVOT) dysfunction and restoring conduit graft viability.

Methods: This is a single-centre retrospective study of 41 patients (18 men, 23 women; mean age 26.1 ± 10.2 years) who underwent PPVI between December 2007 and November 2014 and were evaluated for right ventricular pressures and exercise tolerance.

Results: PPVI significantly reduced mean baseline RVOT gradients across different pathologies: stenosis (45 vs 18.4 mmHg), regurgitation (19.2 vs 7.6 mmHg), and mixed disease (32.5 vs 12 mmHg). Furthermore, mean right ventricular (RV) systolic pressures decreased from 61.6 ± 2.3 to 41.9 ± 2 mmHg (p < 0.001), while RV diastolic pressures decreased by about 60% from 14.3 ± 1.1 to 8.6 ± 1.4 mmHg (p < 0.001). Echocardiography revealed significant improvements in pulmonary and tricuspid valve velocities (p for trend < 0.01). Additionally, there was a consistent reduction in the main pulmonary artery maximum pressure gradient measured pre-procedure. No significant changes were observed in PR, QRS, or QTc interval duration on follow-up electrocardiograms. Similarly, no changes were noted in cardiopulmonary exercise test performance during follow-up.

Conclusion: The study highlights the effectiveness of PPVI using Medtronic Melody and Edwards SAPIEN valves in patients with various pulmonary diseases. Immediate improvements in right ventricular pressures and functional outcomes suggest that PPVI is a valuable treatment option for individuals with RVOT dysfunction. Multi-centre collaborations are crucial for further elucidating the long-term effects of PPVI on cardiac function, exercise tolerance, and quality of life in RVOT dysfunction.

Background Stroke survivors can experience residual disability and are at risk for subsequent strokes that might cause further damage or even death. The objective of this study was to identify factors associated with recurrent stroke in Sikhio District, Nakhon Ratchasima Province, Thailand. Method: We used gender and age characteristics to match our study participants in a ratio of 1 case patient to 2 controls. The total sample size was 111 participants, 37 participants with recurrent stroke were considered as the case group and 74 participants without recurrent stroke were the control group. The case group was diagnosed by a physician along with a computerized tomography (CT) scan and received treatment at Sikhio Hospital in the period of 1 October 2021-30 September 2022. Face-to-face data were collected by a structured questionnaire and compared to the medical record. Results: The study revealed that risk factors associated with recurrent stroke in Sikhio District were comorbidities (AOR = 4.64, 95% CI = 1.35-15.86, p < 0.014) and systolic blood pressure (AOR = 2.41, 95% CI = 1.10-5.78, p < 0.049). Conclusion: Comorbidities and systolic blood pressure represented a risk to recurrent stroke among post-stroke patients. Therefore, hospitals should find effective methods to care for patients with co-morbidities and promote knowledge about blood pressure control.

Background: Treating irreversible cardiomyocyte loss following myocardial infarction presents several therapeutic challenges. While cell therapy shows promise as a regenerative treatment for infarcted cardiac tissue, different cell sources vary in their therapeutic potential. Adipose-derived stem cells (ADSCs) have emerged as an attractive option due to their accessibility, but their limited differentiation capacity remains a significant constraint. Recent evidence suggests that injectable platelet-rich fibrin may enhance this process by stimulating the differentiation of ADSCs into cardiomyocyte-like cells. Objective: Analyse the benefit of injectable platelet-rich fibrin to accelerate the differentiation of adipose-derived mesenchymal stem cells into cardiomyocyte-like cells. Methods: This study is a true experimental randomized pos t-test design study. Adipose-derived mesenchymal stem cells were isolated from adipose tissue and expanded in culture through four passages. The characteristics of adipose-derived mesenchymal stem cells were measured by the expression of CD 34-, CD 45-, and CD 105+ using flowcytometry. The samples were divided into 3 groups, i.e., negative control (α-MEM), positive control (differentiation medium) and treatment group (platelet-rich fibrin). The assessment of GATA-4 marker expression was conducted using flowcytometry on the fifth day and troponin was conducted using immunocytochemistry on the tenth day to determine the differentiation to cardiomyocyte. Statistical analysis was performed using Student's t-tests and one-way ANOVA for data that demonstrated normal distribution as verified by the Shapiro-Wilk test. Results: Flowcytometry on GATA-4 expression revealed significant difference on addition of platelet-rich fibrin compared with negative and positive controls (68.20 ± 6.82 vs 58.15 ± 1.23; p < 0.05; 68.20 ± 6.82 vs 52.96 ± 2.02; p < 0.05). This was supported by the results of immunocytochemistry on troponin expression which revealed significant difference between platelet-rich fibrin group compared with negative and positive controls (50.66 ± 7.2 vs 10.73 ± 2.39; p < 0.05; 50.66 ± 7.2 vs 26.00 ± 0.4; p < 0.05). Conclusion: Injectable platelet-rich fibrin accelerates differentiation of adipose-derived mesenchymal stem cells into cardiomyocyte-like cells.

Background and Aim: In its 2022 revision of self-care guidelines, the World Health Organization underlines the irreplaceable function of high-quality self-care and emphasises that not only research into self-care, but also the development of self-care-specific research methods have to be intensified. Accordingly, improvement of translational cardiological self-care is a key challenge faced by the Austrian Heart Association (Österreichischer Herzverband = ÖHV), which has been dedicated to life-long/long-term rehabilitation and health promotion of heart patients for more than 40 years. In line with the WHO call for self-care specific research, a study to identify related characteristics and desiderates was carried out with 30 regional managers at the ÖHV federal state conference [ÖHV Bundesländertagung] in 2023. Methods: Through Mayring's method of qualitative content analysis, raw data were regrouped into categories and frequencies/weights identified. Results: Well-known benefits such as social inclusion, empathetic communication, mutual support, health sports and information were distinguished in a future-oriented manner, e.g., with regard to expansion of sports disciplines alongside more transparent adjustment to individual cardiorespiratory conditions. Conclusion: Health policymakers are called to recognise the benefits of cardiac self-care and -  according to WHO suggestions - improve its integration within national health systems, standardised financial support included.

Background: Prosthetic valve thrombosis (PVT) is a severe complication following prosthetic heart valve replacement, particularly in inadequately anticoagulated patients. Primary treatment options include intensive anticoagulation therapy, thrombolytic treatment (TT), and emergency surgery. This study aims to evaluate the clinical profile, management strategies, and short-term outcomes of patients with PVT. Methodology: Consecutive patients with PVT presenting to the emergency department of a tertiary care cardiac center were included in this study. Responses to treatment, hospital outcomes, and 30-day outcomes post-treatment were observed. Results: A total of 75 patients were analyzed, with a male predominance (50.7%) and a mean age of 39.5 ± 12.3 years. Bi-leaflet prosthetic valves were most common (96.0%), 54 (72.0%) had prosthetic mitral valve and 10 (13.3%) had prosthetic both mitral and aortic valves. Atrial fibrillation was present in 25.3% of cases. Treatment predominantly involved streptokinase (74.7%), followed by heparin (37.3%) and VKA (9.3%). Clinical success was achieved in 84.0% of cases, while 12.0% experienced clinical failure, including severe complications such as irreversible neurologic damage (1.3%) and bleeding (2.8%). The 30-day mortality rate was 12.0%, with recurring PVT and bleeding/embolic complications each in 1.5% of cases. Conclusion: Treatment of PVT with streptokinase, heparin, and VKA demonstrates efficacy, with a substantial proportion of patients achieving complete clinical success. However, the study highlights concerning outcomes, including clinical failure and severe complications. These findings underscore the importance of carefully balancing thrombolytic and anticoagulant therapies to mitigate potential adverse events.

Background: The sinus of Valsalva aneurysm (SVA) is an uncommon cardiac abnormality that may be either congenital or acquired. Case: In this case we describe a 73-year-old man who complained of acute shortness of breath. Echocardiography showed rupturing of a sinus Valsalva aneurysm into the right ventricle with ventricular septal defect/rupture diagnoses in a peripheral hospital far from a reference hospital. Conclusion: Echocardiography can aid in distinguishing between different diagnoses and serve as a catalyst for more exploration into the underlying cause. This can enhance the likelihood of early detection of an SVA and enable the implementation of an effective management strategy.

Background: Constrictive pericarditis (CP) is a chronic inflammatory condition often necessitating surgical intervention. Radical pericardiectomy is the standard treatment, but the use of cardiopulmonary bypass (CPB) varies based on intraoperative hemodynamics. This study aims to evaluate the effectiveness of radical pericardiectomy combined with CPB and the apical suction device in treating CP.

Methods: We conducted a single-center retrospective analysis of 10 patients undergoing radical pericardiectomy for CP. Clinical data, surgical details, and postoperative outcomes were collected. Follow-up assessments included echocardiographic and clinical evaluations at 3 months, with a mean survival follow-up duration of 30.9 ± 21.3 months.

Results: Among the included patients, 60% underwent CPB during surgery. Despite longer recovery times and hospital stays, CPB usage did not increase postoperative complications. Echocardiographic and clinical assessments at 3-month follow-up revealed significant improvements in cardiac function and symptom relief. No cases of CP recurrence were observed during the follow-up period.

Conclusion: Radical pericardiectomy combined with CPB and the apical suction device demonstrates effectiveness in treating CP, with favorable short-term outcomes and low recurrence rates. Further studies with larger sample sizes and longer follow-up durations are warranted to validate these findings.

Pericarditis frequently occurs as a complication following pulmonary vein isolation (PVI) for atrial fibrillation (AF), yet it seldom progresses to constrictive pericarditis (CP). The diagnosis of constrictive pericarditis is often challenging owing to nonspecific signs and symptoms. Nevertheless, a high level of suspicion and prompt diagnosis offer an ultimate cure. We present a case of a 65-year-old patient who developed chronic pericarditis following PVI. This instance underscores the importance of promptly identifying this complication within this particular group of patients.

Propafenone is a class 1C antiarrhythmic and is one of the first-line drugs used in the management of atrial fibrillation. Its toxicity is rare, yet potentially life-threatening. Common clinical findings could range from hypotension, dysrhythmias, and conduction disturbances to cardiac arrest. We present a case of an 80-year-old male who presented with generalized weakness and polyuria secondary to over-diuresis leading to dehydration. Electrocardiogram on admission showed a first-degree atrioventricular block, QRS complex widening, and QTC interval prolongation. These findings were attributed to propafenone toxicity in the setting of dehydration and increased serum propafenone concentration. In the case described the optimization of fluid status and holding propafenone temporarily led to rapid reversal of the electrocardiogram changes. Multiple treatment modalities have been attempted, but standard recommendations for propafenone toxicity management have yet to be established. This case stresses the importance of taking into consideration volume status and other reversible risk factors possibly contributing to propafenone toxicity.

The selective serotonin reuptake inhibitors (SSRIs) citalopram and escitalopram are extensively prescribed for various psychopathies. Despite their reputation for safety compared to older antidepressants, concerns have arisen regarding their cardiotoxic potential, notably in prolonging the QTc interval. In this comprehensive review, we investigate the intricate mechanisms of cardiotoxicity induction by citalopram/escitalopram, with a special focus on their interactions with ion channels like Kv11.1, Nav1.5, and Cav1.2 which may contribute to QTc-prolongation, increasing the risk of life-threatening arrhythmias such as Torsades de Pointes (TdP). Moreover, we explore the predisposing factors to their associated cardiotoxicity along with an investigation of the QRS/QTc ratio as a potential biomarker for identifying patients at risk of ventricular arrhythmias, taking into consideration the impact of genetic variations and drug interactions, especially those involving the liver CYP2C19 metabolism. Our review extends to the geriatric population's use of citalopram and escitalopram, emphasizing the significance of assessing a patient's medical history and cumulative drug use to evaluate their susceptibility to cardiac adverse events. Finally, we scrutinize the compound relationship between QTc-prolongation, proton pump inhibitors (PPIs) and serum-to-dialysate potassium gradients in influencing the proarrhythmic potential of citalopram/escitalopram in hemodialysis patients.