Journal of Cardiovascular and Thoracic Research最新文献

Introduction: The interplay between coronary disease and neurocognitive dysfunction remains unclear with several underlying factors likely contributing to this complex relationship. This study develops a predictive model using a machine learning approach to determine a predictive model of neurocognitive functioning in patients with acute coronary syndrome (ACS).

Methods: Sixty-three patients, enrolled in the phase III cardiac rehabilitation program, underwent a neurocognitive assessment. To predict neurocognitive functioning a cross validated random forest model was used (RF_cv) due to its robustness to non-linear relationships and overfitting, and its successful application in prior disease prediction studies.

Results: The RF_cv model showed an r-squared of 0.978, an RMSE of 0.6309 and a MAE value of 0.479. The top-ten predictors in the model were: HDL, Depression, Glucose, Glycated Hemoglobin, B-Type Natriuretic Peptide, BMI (Kg/m2), Waist-to-Hip Ratio, Cholesterol, Anxiety and Age.

Conclusion: The variance in neurocognitive functioning is explained by a combination of biochemical indicators and body composition, reflecting classical cardiovascular risk factors and depression. The obtained RF-cv predictive model supports early identification of patients for tailored interventions.

Introduction: Coronary artery bypass graft surgery (CABG) is the standard treatment for obstructive coronary artery disease, particularly in patients with multi-vessel involvement or diabetes. Blood transfusions are often necessary during CABG, with rates ranging from 40% to 90%. We studied the multifactorial analysis of transfusion practices and infection risks in open heart surgery in Golestan Province, Iran.

Methods: In the study we reviewed the medical records of 268 patients who underwent open heart surgery in 2022. Exclusion criteria included known immunodeficiency conditions, immunosuppressive drug use, and incomplete records. Data on risk factors (age, gender, diabetes, BMI, smoking) and laboratory results (CRP, WBC, blood cultures) were collected.

Results: Out of 268 patients, 210 were analyzed (125 men, 85 women). The average ages were 57.7±9.8 for men and 58.6±9.3 for women (P=0.515). Diabetic patients showed a higher incidence of positive blood cultures (P=0.047). PC transfusion occurred in 29.5% of patients, with no significant differences between diabetic and non-diabetic groups.

Conclusion: The prevalence of positive blood cultures, particularly among diabetic patients, emphasizes the importance of vigilant monitoring and management of this population to mitigate infection risks.

Introduction: To verify the long-term durability, freedom from reoperation and mortality of Biocor and Epic bioprosthesis in mitral position.

Methods: The use of biological prostheses in mitral valve replacement surgery is widespread. Advances in transcatheter techniques have increased the utilisation of these biological substitutes, rendering the study of their durability once again pertinent. Biocor and Epic are two stented tissue valves with porcine leaflets indicated for patients requiring replacement of a diseased mitral or aortic heart valve. Long-term follow-up data were collected and analysed by age group and by type of surgery. Between 2000 and 2010, 244 patients underwent mitral or double valve replacement with a Biocor or Epic bioprosthesis at our institution. The median follow-up was 9 years (IQR: 0.01- 17.9). Complete follow-up was achieved in 98.4%.

Results: The survival rates at 1, 5 and 10-years were 90, 73.7 and 43 %, respectively. Freedom from prothesis reintervention from any cause at 1, 5 and 10 years was 98.5, 92.8 and 90%. Freedom from structural valve deterioration by age group at 1, 5 and 10 years was as follows: age<60: 100, 84.6 and 47.6; age 60-69: 100, 94.1 and 94.1; and age≥70: 99.4, 98.7 and 96.5% respectively.

Conclusion: Our 10-year freedom from structural valve deterioration of 93.1% matches, and may even surpass those previously reported. The Epic porcine xenograft in mitral position has demonstrated to have excellent durability and long-term outcomes; representing an excellent option for patients in need for mitral valve replacement.

Introduction: Sevoflurane has little effect on hemodynamics and has been shown to have a hemodynamic stabilizing effect in the pre- and post-cardiopulmonary bypass (CPB) period in patients undergoing cardiac surgery. However, clinical data on the effect of sevoflurane on the hemodynamic response during CPB in patients undergoing cardiac surgery are lacking. This study investigated whether the hemodynamic stabilizing effect of sevoflurane is demonstrated during CPB time in cardiac surgery patients.

Methods: Fifty-five patients undergoing cardiac surgery under CPB were randomly assigned to anesthesia with sevoflurane (intervention group) or propofol (control group) during CPB. The primary outcomes were changes in hemodynamic parameters and the need for inotropes and vasopressors during CPB. Secondary outcomes were morbidity and mortality within 30 days after surgery.

Results: The mean arterial pressure (MAP) at 5 minutes after heartbeat recovery and the end of CPB as well as central venous oxygen saturation (ScvO₂) at 5 minutes after heartbeat recovery and cardiac index (CI) at the end of CPB of group S-CPB (intervention group) were higher than those of group P-CPB (control group). In addition, the proportion of patients using dobutamine and noradrenaline during CPB was also lower in group S-CPB.

Conclusion: In conclusion, in patients undergoing cardiac surgery under CPB, the use of sevoflurane for anesthesia during CPB results in hemodynamic stability with less need for inotropes and vasopressors during CPB but morbidity and mortality within 30 days after surgery were not significantly different when compared with the control group.

Introduction: Since there is a bidirectional interaction between heart failure (HF) and depression, we aimed to evaluate the effects of colchicine on depression scale scores in individuals with HF with reduced ejection fraction (HFrEF).

Methods: A randomized clinical trial was carried out on 50 patients with HFrEF. The intervention group (n=25) received colchicine 0.5 mg twice a day plus standard care for HFrEF, while the control group (n=25) received only standard care. The study's primary outcome was the changes in the 21-item Hamilton Depression Rating Scale (HDRS-21) over 12 weeks.

Results: During the study period, HDRS-21 significantly decreased in both groups (both P<0.05); however, there were no significant differences between the study groups at baseline (12.2±2.9 vs. 10.5±2.9; P=0.54), week 4 (6.6±2 vs. 5.8±4.7; P=0.21), and week 12 (2.1±2 vs. 4.2±4.5; P=0.11).

Conclusion: This study shows that colchicine had no significant effect on HDRS-21 in individuals with HFrEF. Further studies are warranted to confirm the study hypothesis.

Introduction: Mechanical valve thrombosis (MVT), along with its associated embolic or obstructive complications, can have significant clinical implications. Studies evaluating the relationship of inflammatory and albumin-based markers such as neutrophile-lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), C-reactive protein to albumin ratio, uric acid to albumin ratio and lactate dehydrogenase to albumin ratio (LAR) with thrombosis burden in patients with left sided mechanical valves are lacking. We aimed to examine the relationship between inflammatory and albumin-based markers, and left sided MVT with and without obstruction.

Methods: Eighty-eight patients (age 48.9±13.8, 72.7% female) with left-sided MVT were included in the study. Patients were divided into two groups as obstructive thrombosis (OT) and non-obstructive thrombosis (NOT).

Results: NLR, PLR and LAR levels were found to be significantly higher in OT group (P<0.001, P<0.001; P=0.032, respectively). There was a strong correlation between OT and both NLR and PLR (r=0.736 and r=0.645). Of those markers, NLR (odds ratio (OR) 5.68, 95% confidence interval (CI) 1.96 to 16.48, P=0.001) was found to be the independent predictor of OT. On receiver operating characteristic (ROC) analysis, a cut-off value 2.83 of NLR (area under the curve (AUC)=0.931; 95% CI:0.877-0.984; P<0.001) had 86.3% sensitivity and 86.5% specificity for prediction of OT.

Conclusion: Increased NLR, PLR, and LAR values were associated with OT in left-sided MVT. Of those, NLR was found to be the most sensitive and specific marker and represented as an independent predictor of OT.

Unilateral pulmonary vein atresia is an unusual congenital cardiovascular abnormality. It occurs due to failure of incorporation of pulmonary veins into the left atrium. It is usually diagnosed in childhood and diagnosis after adulthood is very rare. Herein we present a case of 21-year-old young adult with isolated unilateral pulmonary vein atresia who presented with unilateral interstitial lung disease.

Introduction: Removal of adherent intravascular catheters (hemodialysis catheters and venous ports) is still an unsolved clinical problem lying at the intersection of vascular surgery, anesthesiology, cardiac surgery and cardiology. Analysis of resistant removals of adherent catheters when simple traction was unsuccessful. Description of the technique and effectiveness of catheter removal using mechanical dilatation and dedicated tools.

Methods: Retrospective review of a prospectively maintained computerized database at the reference center. One hundred eleven transvenous catheter extractions (TCE), including 71 hemodialysis catheters and 40 venous ports.

Results: A procedure for removing adherent catheters using mechanical dilatation is described. All catheters were removed in their entirety, there was one major complication (embolization). It is difficult to identify predictors of the need for mechanical dilatation. The main indication for catheter removal is malfunction most frequently due to fibrous encapsulation at catheter tips or adherence of catheter tips to the cardiac structures. The second is catheter-related infection. Most dysfunctional and infected catheters are implanted with improper positioning of the catheter tip beyond the right atrium. Half of seemingly adherent catheters can be removed with simple traction, which is not predictable before the procedure. Moreover, 50% of catheters require dissection of fibrous tissue using additional specialized tools. The effects of mechanical dilatation are very good, if the procedure is performed with participation of operators experienced with transvenous lead extraction. TCE of adherent hemodialysis catheters and venous ports is a safe and effective procedure.

Conclusion: The final result of mechanical dilatation is very good if the procedure is performed with collaboration of operators experienced with transvenous lead extraction. Transvenous removal of adherent hemodialysis catheters and venous ports is safe and effective.

Aspirin is considered a cornerstone medication among patients with established coronary artery disease (CAD). There is a lack of evidence regarding aspirin reloading in CAD patients who are already receiving aspirin therapy. We performed this systematic review to address this gap of knowledge. A systematic review on PubMed, Embase, and the Cochrane Library was conducted from inception until July 15, 2024. Two authors independently performed study selection, data extraction, and risk of bias assessment. Means differences (MD) were used in a meta-analysis of related outcomes from the studies. Our review included four studies enrolling 1187 individuals with CAD and chronic aspirin use before admission. The results of this systematic review found that aspirin reloading is significantly associated with a reduction of thromboxane B₂ (MD, -17.46; 95% CI, -19.61 to -15.32; P<0.00001; I²=0%). Additionally, our findings revealed the beneficial effects of aspirin loading on thromboxane B₂ -related platelet reactivity and myocardial injury indexes. No significant adverse outcomes, such as bleeding and increased mortality, were observed among the study groups. In conclusion, aspirin reloading can improve cardiovascular outcomes with a good safety profile among CAD individuals. However, further randomized clinical trials (RCTs) are still needed to provide robust evidence.