Abstract Background: Inferior vena cava (IVC) ultrasound measurement is a reliable indicator used in the assessment of intravascular volume status. The aim of this study was to evaluate intravascular volume changes in pediatric patients by measuring the IVC diameter and collapsibility index (CI) in children whose oral feeding was restricted preoperatively. Material and Methods: From May 2018 to October 2018, a total of 55 pediatric patients who were scheduled for surgery were included in this prospective, observational, cohort study. Fasting and satiety IVC diameters and CIs of patients were determined by ultrasonographic evaluation twice: in the preoperative preliminary evaluation, when the patients were satiated, and before surgery, during a fasting period of 6–8 hours. Ultra-sonographic data were recorded and compared between fasting and satiety periods. Results: In the grey scale (B-mode), mean IVC diameter was significantly higher when the patients were satiated, compared to the measurements made just before surgery during the fasting period. In the M-mode, the mean IVC diameter was significantly higher only during the inspiratory phase when the patients were satiated, while during the expiratory phase it was detected to be statistically similar. Mean CI was significantly higher in the immediate preoperative period, compared to the assessment made when satiated. Conclusion: Preoperative ultrasound IVC diameter and CI measurement can be a practical and useful method for evaluating preoperative intravascular volume in children.
{"title":"Can Inferior Vena Cava Diameter and Collapsibility Index Be a Predictor in Detecting Preoperative Intravascular Volume Change in Pediatric Patients?","authors":"Zeliha Coşgun, E. Dagistan, M. Coşgun, H. Ozturk","doi":"10.2478/jce-2021-0008","DOIUrl":"https://doi.org/10.2478/jce-2021-0008","url":null,"abstract":"Abstract Background: Inferior vena cava (IVC) ultrasound measurement is a reliable indicator used in the assessment of intravascular volume status. The aim of this study was to evaluate intravascular volume changes in pediatric patients by measuring the IVC diameter and collapsibility index (CI) in children whose oral feeding was restricted preoperatively. Material and Methods: From May 2018 to October 2018, a total of 55 pediatric patients who were scheduled for surgery were included in this prospective, observational, cohort study. Fasting and satiety IVC diameters and CIs of patients were determined by ultrasonographic evaluation twice: in the preoperative preliminary evaluation, when the patients were satiated, and before surgery, during a fasting period of 6–8 hours. Ultra-sonographic data were recorded and compared between fasting and satiety periods. Results: In the grey scale (B-mode), mean IVC diameter was significantly higher when the patients were satiated, compared to the measurements made just before surgery during the fasting period. In the M-mode, the mean IVC diameter was significantly higher only during the inspiratory phase when the patients were satiated, while during the expiratory phase it was detected to be statistically similar. Mean CI was significantly higher in the immediate preoperative period, compared to the assessment made when satiated. Conclusion: Preoperative ultrasound IVC diameter and CI measurement can be a practical and useful method for evaluating preoperative intravascular volume in children.","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"864 ","pages":"47 - 51"},"PeriodicalIF":0.4,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72554697","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}
R. Lazar, A. Rus, C. Țolescu, R. Gerculy, D. Opincariu, I. Benedek
Abstract Introduction: Spontaneous coronary artery dissection (SCAD) represents a very rare and poorly understood condition that is gaining recognition as an important cause of myocardial infarction, especially among young women. The pathogenesis of SCAD is not well established yet, but several theories have been proposed. Case presentation: We report the case of a 25-year-old woman without any history of cardiovascular disease who presented with acute anterior ST-elevation myocardial infarction (STEMI) due to the luminal obstruction generated by an intramural hematoma from a SCAD of the left main coronary artery, which was successfully treated by coronary artery stenting. Additionally, the patient presented anomalies of coronary origins (ACO) with separate emergences of the left anterior descending (LAD) artery from the left coronary cusp and the left circumflex artery (LCX) from the right coronary cusp, with no apparent clinical significance. Conclusion: SCAD should always be included in the differential diagnosis of young patients presenting with STEMI. In case of prompt diagnosis, SCAD-STEMI patients are successfully treated with percutaneous coronary intervention (PCI). Moreover, it is of vital importance to identify variants of ACO, even without clinical relevance at the moment of the acute event, in order to initiate an appropriate management, since ACO increases the risk of routine PCI.
{"title":"Spontaneous Coronary Artery Dissection and Anomalous Coronary Origin – Underlying Cause of Acute Coronary Syndrome in a Young Woman: A Case Report","authors":"R. Lazar, A. Rus, C. Țolescu, R. Gerculy, D. Opincariu, I. Benedek","doi":"10.2478/jce-2020-0017","DOIUrl":"https://doi.org/10.2478/jce-2020-0017","url":null,"abstract":"Abstract Introduction: Spontaneous coronary artery dissection (SCAD) represents a very rare and poorly understood condition that is gaining recognition as an important cause of myocardial infarction, especially among young women. The pathogenesis of SCAD is not well established yet, but several theories have been proposed. Case presentation: We report the case of a 25-year-old woman without any history of cardiovascular disease who presented with acute anterior ST-elevation myocardial infarction (STEMI) due to the luminal obstruction generated by an intramural hematoma from a SCAD of the left main coronary artery, which was successfully treated by coronary artery stenting. Additionally, the patient presented anomalies of coronary origins (ACO) with separate emergences of the left anterior descending (LAD) artery from the left coronary cusp and the left circumflex artery (LCX) from the right coronary cusp, with no apparent clinical significance. Conclusion: SCAD should always be included in the differential diagnosis of young patients presenting with STEMI. In case of prompt diagnosis, SCAD-STEMI patients are successfully treated with percutaneous coronary intervention (PCI). Moreover, it is of vital importance to identify variants of ACO, even without clinical relevance at the moment of the acute event, in order to initiate an appropriate management, since ACO increases the risk of routine PCI.","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"84 1","pages":"22 - 26"},"PeriodicalIF":0.4,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80566732","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}
Abstract Extracellular matrix (ECM) plays an important role in the development and progression of atherosclerotic lesions. Changes in the ECM are involved in the pathophysiology of many cardiovascular diseases, including atherosclerosis. Matrix metalloproteinases (MMPs) are a family of zinc-dependent proteases, also known as matrixins, with proteolytic activity in the ECM, being responsible for the process of tissue remodeling in various systemic pathologies, including cardiac and vascular diseases. MMPs play an important role in maintaining normal vascular structure, but also in secondary cardiovascular remodeling, in the formation of atherosclerotic plaques and in their vulnerabilization process. In addition to the assigned effect of MMPs in vulnerable plaques, they have a well-defined role in post-infarction ventricular remodeling and in various types of cardiomyopathies, followed by onset of congestive heart failure, with repeated hospitalizations and death. The aim of this manuscript was to provide a summary on the role of serum matrix metalloproteinases in the process of initiation, progression and complication of atherosclerotic lesions, from a molecular level to clinical applicability and risk prediction in patients with vulnerable coronary plaques.
{"title":"The Role of Matrix Metalloproteinases in the Progression and Vulnerabilization of Coronary Atherosclerotic Plaques","authors":"D. Opincariu, N. Raț, I. Benedek","doi":"10.2478/jce-2021-0001","DOIUrl":"https://doi.org/10.2478/jce-2021-0001","url":null,"abstract":"Abstract Extracellular matrix (ECM) plays an important role in the development and progression of atherosclerotic lesions. Changes in the ECM are involved in the pathophysiology of many cardiovascular diseases, including atherosclerosis. Matrix metalloproteinases (MMPs) are a family of zinc-dependent proteases, also known as matrixins, with proteolytic activity in the ECM, being responsible for the process of tissue remodeling in various systemic pathologies, including cardiac and vascular diseases. MMPs play an important role in maintaining normal vascular structure, but also in secondary cardiovascular remodeling, in the formation of atherosclerotic plaques and in their vulnerabilization process. In addition to the assigned effect of MMPs in vulnerable plaques, they have a well-defined role in post-infarction ventricular remodeling and in various types of cardiomyopathies, followed by onset of congestive heart failure, with repeated hospitalizations and death. The aim of this manuscript was to provide a summary on the role of serum matrix metalloproteinases in the process of initiation, progression and complication of atherosclerotic lesions, from a molecular level to clinical applicability and risk prediction in patients with vulnerable coronary plaques.","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"30 1","pages":"9 - 16"},"PeriodicalIF":0.4,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85054353","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}
Abstract Background and Aim: Novel surgical approaches are gaining attention in an attempt to overcome possible adverse events following coronary artery bypass graft (CABG) surgery. This single-center study aimed to evaluate and compare the early postoperative outcomes of on-pump beating-heart (OPBH-CABG) versus off-pump CABG surgery in similar risk groups with a total number of 1–2 grafts. Methods: The records of a total of 229 patients who underwent non-emergency, primary, isolated, either OPBH-CABG (n = 32) or off-pump CABG (n = 197) surgery were retrospectively evaluated. Reported outcome measures included baseline data, the number of coronary artery grafts, prophylactic intra-aortic balloon pump, time of extubation from mechanical ventilation, duration of stay in the coronary ICU and hospital, as well as early postoperative complications, in-hospital and early postoperative mortality. Results: The groups were identical with regards to age and BMI. The patients in the off-pump group received a higher number of grafts (1.84 ± 0.36 vs. 1.18 ± 0.39, p <0.0001). The OPBH-CABG group had a higher Euroscore II score (2.514 ± 1.68 vs. 1.706 ± 1.93, p = 0.021). The time to extubation after the surgery, postoperative length of ICU stay, and total length of hospital stay were similar between the groups (p = 0.2228; p = 0.098; p = 0.717, respectively). The incidence of arrythmia and atrial fibrillation was higher in the on-pump group (12.5% vs. 2.53%, p <0.05). One patient in the on-pump, and four patients in the off-pump groups deceased due to postoperative complications. Conclusions: OPBH-CABG surgery is comparable to off-pump CABG in terms of early postoperative outcomes. In patients who underwent OPBH-CABG, the risk of arrythmia and atrial fibrillation should be of concern and solved with optimal strategies.
背景与目的:为了克服冠状动脉旁路移植术(CABG)术后可能出现的不良事件，新的手术入路正在引起人们的关注。这项单中心研究旨在评估和比较在相同风险组中，总移植物数量为1-2的有泵心脏搏动(ophb -CABG)与无泵心脏搭桥手术的早期术后结果。方法:回顾性分析229例接受非急诊、原发性、孤立性、OPBH-CABG (n = 32)或非泵送CABG (n = 197)手术的患者的记录。报告的结局指标包括基线数据、冠状动脉移植物数量、预防性主动脉内球囊泵、机械通气拔管时间、冠状动脉ICU和医院住院时间、术后早期并发症、院内和术后早期死亡率。结果:两组在年龄和体重指数方面基本一致。停泵组移植数量较多(1.84±0.36 vs 1.18±0.39,p <0.0001)。OPBH-CABG组Euroscore II评分较高(2.514±1.68比1.706±1.93,p = 0.021)。两组患者术后拔管时间、术后ICU住院时间、总住院时间差异无统计学意义(p = 0.2228;P = 0.098;P = 0.717)。非泵组心律失常和心房颤动发生率较高(12.5% vs. 2.53%， p <0.05)。有泵组1例，无泵组4例因术后并发症死亡。结论:OPBH-CABG手术在术后早期预后方面与非体外泵CABG相当。在接受OPBH-CABG的患者中，应该关注心律失常和房颤的风险，并采取最佳策略来解决。
{"title":"On-Pump Beating Heart versus Off-Pump Coronary Artery Bypass Graft Surgery: Short-Term Follow-up Outcomes of a Single Center","authors":"E. Ilkeli, A. Düzgün","doi":"10.2478/jce-2021-0003","DOIUrl":"https://doi.org/10.2478/jce-2021-0003","url":null,"abstract":"Abstract Background and Aim: Novel surgical approaches are gaining attention in an attempt to overcome possible adverse events following coronary artery bypass graft (CABG) surgery. This single-center study aimed to evaluate and compare the early postoperative outcomes of on-pump beating-heart (OPBH-CABG) versus off-pump CABG surgery in similar risk groups with a total number of 1–2 grafts. Methods: The records of a total of 229 patients who underwent non-emergency, primary, isolated, either OPBH-CABG (n = 32) or off-pump CABG (n = 197) surgery were retrospectively evaluated. Reported outcome measures included baseline data, the number of coronary artery grafts, prophylactic intra-aortic balloon pump, time of extubation from mechanical ventilation, duration of stay in the coronary ICU and hospital, as well as early postoperative complications, in-hospital and early postoperative mortality. Results: The groups were identical with regards to age and BMI. The patients in the off-pump group received a higher number of grafts (1.84 ± 0.36 vs. 1.18 ± 0.39, p <0.0001). The OPBH-CABG group had a higher Euroscore II score (2.514 ± 1.68 vs. 1.706 ± 1.93, p = 0.021). The time to extubation after the surgery, postoperative length of ICU stay, and total length of hospital stay were similar between the groups (p = 0.2228; p = 0.098; p = 0.717, respectively). The incidence of arrythmia and atrial fibrillation was higher in the on-pump group (12.5% vs. 2.53%, p <0.05). One patient in the on-pump, and four patients in the off-pump groups deceased due to postoperative complications. Conclusions: OPBH-CABG surgery is comparable to off-pump CABG in terms of early postoperative outcomes. In patients who underwent OPBH-CABG, the risk of arrythmia and atrial fibrillation should be of concern and solved with optimal strategies.","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"20 1","pages":"3 - 8"},"PeriodicalIF":0.4,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84135512","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}
{"title":"Pulmonary Embolism – a Thrombo-Inflammatory Complication of a Viral Infection. The Paradigm Shift in the COVID Era","authors":"T. Benedek","doi":"10.2478/jce-2021-0004","DOIUrl":"https://doi.org/10.2478/jce-2021-0004","url":null,"abstract":"","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"7 1","pages":"1 - 2"},"PeriodicalIF":0.4,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87390598","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}
C. Șuteu, I. Muntean, Cristina Blesneac, M. Pop, R. Togănel
Abstract Pulmonary arterial hypertension (PAH) is a rare but severe complication that should be investigated in patients diagnosed with transposition of the great arteries who have undergone neonatal arterial switch operation. Early diagnosis and aggressive combination therapy for PAH could help to improve survival in these patients. We report a favorable clinical response 6 months after the initiation of vasodilator therapy in a pediatric case with transposition of the great arteries, successfully repaired in the neonatal period, who developed pulmonary arterial hypertension at the age of 5 years.
{"title":"Critical Neonatal Congenital Heart Disease – a Rare Complication after Successful Surgical Correction","authors":"C. Șuteu, I. Muntean, Cristina Blesneac, M. Pop, R. Togănel","doi":"10.2478/jce-2020-0019","DOIUrl":"https://doi.org/10.2478/jce-2020-0019","url":null,"abstract":"Abstract Pulmonary arterial hypertension (PAH) is a rare but severe complication that should be investigated in patients diagnosed with transposition of the great arteries who have undergone neonatal arterial switch operation. Early diagnosis and aggressive combination therapy for PAH could help to improve survival in these patients. We report a favorable clinical response 6 months after the initiation of vasodilator therapy in a pediatric case with transposition of the great arteries, successfully repaired in the neonatal period, who developed pulmonary arterial hypertension at the age of 5 years.","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"10 1","pages":"104 - 108"},"PeriodicalIF":0.4,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75624210","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}
Abstract Background: In this study, we aimed to compare echocardiography, electrocardiography (ECG) abnormalities, Doppler ultrasonography (USG), and computed tomography pulmonary angiography (CTPA) results in predicting 3-month mortality in patients with acute pulmonary embolism (PE). Methods: This retrospective cohort study included 124 patients (72 females, 52 males) with acute PE. Demographics, symptoms, clinical signs, comorbidities, history of surgery, arterial blood gas, liver-renal functions, complete blood count, echocardiography, ECG, Doppler USG, and CTPA results, as well as 3-month mortality were recorded. Results: pH (z = –2.623; p <0.01), hemoglobin (z = –3.112; p <0.01), and oxygen saturation (z = –2.165; p <0. 01) were significantly higher in survivors. White blood cell (z = –2.703; p <0.01), blood urea nitrogen (z = –3.840; p <0.01), creatinine (z = –3.200; p <0.01), respiratory rate (z = –2.759; p <0.01), and heart rate (z = –2.313; p <0.01) were significantly higher in non-survivors. Nonspecific ST changes (AUC 0.52, 95% CI 0.43–0.61), p pulmonale (AUC 0.52, 95% CI 0.43–0.61), normal axis (AUC 0.61), right axis deviation (AUC 0.56), right ventricle strain pattern (AUC 0.59), and right pulmonary artery embolism (AUC 0.54) on CTPA showed the highest mortality prediction. Conclusions: Nonspecific ST changes, p pulmonale, normal axis and right axis deviation in ECG, RV strain in echocardiography, and right pulmonary artery embolism on CTPA are associated with a higher mortality in patients with PE.
{"title":"Prediction of Mortality Associated with Cardiac and Radiological Findings in Patients with Pulmonary Embolism","authors":"S. Avci, Gökhan Perinçek, M. Karakayalı","doi":"10.2478/jce-2020-0020","DOIUrl":"https://doi.org/10.2478/jce-2020-0020","url":null,"abstract":"Abstract Background: In this study, we aimed to compare echocardiography, electrocardiography (ECG) abnormalities, Doppler ultrasonography (USG), and computed tomography pulmonary angiography (CTPA) results in predicting 3-month mortality in patients with acute pulmonary embolism (PE). Methods: This retrospective cohort study included 124 patients (72 females, 52 males) with acute PE. Demographics, symptoms, clinical signs, comorbidities, history of surgery, arterial blood gas, liver-renal functions, complete blood count, echocardiography, ECG, Doppler USG, and CTPA results, as well as 3-month mortality were recorded. Results: pH (z = –2.623; p <0.01), hemoglobin (z = –3.112; p <0.01), and oxygen saturation (z = –2.165; p <0. 01) were significantly higher in survivors. White blood cell (z = –2.703; p <0.01), blood urea nitrogen (z = –3.840; p <0.01), creatinine (z = –3.200; p <0.01), respiratory rate (z = –2.759; p <0.01), and heart rate (z = –2.313; p <0.01) were significantly higher in non-survivors. Nonspecific ST changes (AUC 0.52, 95% CI 0.43–0.61), p pulmonale (AUC 0.52, 95% CI 0.43–0.61), normal axis (AUC 0.61), right axis deviation (AUC 0.56), right ventricle strain pattern (AUC 0.59), and right pulmonary artery embolism (AUC 0.54) on CTPA showed the highest mortality prediction. Conclusions: Nonspecific ST changes, p pulmonale, normal axis and right axis deviation in ECG, RV strain in echocardiography, and right pulmonary artery embolism on CTPA are associated with a higher mortality in patients with PE.","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"1 1","pages":"84 - 90"},"PeriodicalIF":0.4,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73650960","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}
C. Țolescu, R. Gerculy, Camelia Libenciuc, I. Kovács
Abstract COVID-19 is a disease caused by the new coronavirus discovered in 2019, which may lead to a severe acute respiratory syndrome and has a major impact on public health worldwide, being declared a pandemic by World Health Organization. In Italy, and especially in the region of Lombardia, the healthcare system has faced a huge overload, which led to significant consequences on cardiology resources. The accessibility to cardiology care units has been drastically reduced, and scheduled interventions, such as elective primary percutaneous coronary interventions, have been significantly delayed. During this time, there was a global concern regarding the management of the SARS-CoV-2 pandemic, but also the management of main cardiovascular emergencies. Under usual circumstances, the differential diagnosis of myocardial injury does not confront many difficulties. Unfortunately, there are several limitations in the management of patients with SARS-CoV-2 infection in the current pandemic state. The aim of the present manuscript is to provide an overview on the main causes of myocardial injury during the COVID-19 pandemic.
{"title":"Differential Diagnosis of Myocardial Injury in the SARS-CoV-2 Era – Myocarditis Versus Acute Coronary Syndrome","authors":"C. Țolescu, R. Gerculy, Camelia Libenciuc, I. Kovács","doi":"10.2478/jce-2020-0013","DOIUrl":"https://doi.org/10.2478/jce-2020-0013","url":null,"abstract":"Abstract COVID-19 is a disease caused by the new coronavirus discovered in 2019, which may lead to a severe acute respiratory syndrome and has a major impact on public health worldwide, being declared a pandemic by World Health Organization. In Italy, and especially in the region of Lombardia, the healthcare system has faced a huge overload, which led to significant consequences on cardiology resources. The accessibility to cardiology care units has been drastically reduced, and scheduled interventions, such as elective primary percutaneous coronary interventions, have been significantly delayed. During this time, there was a global concern regarding the management of the SARS-CoV-2 pandemic, but also the management of main cardiovascular emergencies. Under usual circumstances, the differential diagnosis of myocardial injury does not confront many difficulties. Unfortunately, there are several limitations in the management of patients with SARS-CoV-2 infection in the current pandemic state. The aim of the present manuscript is to provide an overview on the main causes of myocardial injury during the COVID-19 pandemic.","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"34 1","pages":"98 - 103"},"PeriodicalIF":0.4,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78937104","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}
Güney Erdoğan, M. Yenerçağ, G. Durmuş, D. Koprulu, U. Arslan
Abstract Introduction: The predictive role of serum bilirubin levels on the alteration of total ischemic burden expressed via frontal QRS-T angle change has never been studied in patients with acute coronary syndrome (ACS). In this study, we aimed to investigate the relationship between serum bilirubin levels and frontal QRS-T angle change after percutaneous coronary intervention (PCI) in ACS patients. Methods: Frontal QRS-T angle change was accepted as positive or negative according to whether the value of the baseline frontal QRS-T angle minus the post PCI frontal QRS-T angle is positive or negative. A total of 314 consecutive patients with ACS who underwent PCI were divided into two groups based on their negative frontal QRS-T angle change (n = 152 patients) and positive frontal QRS-T angle change (n = 162 patients). Results: Multivariate logistic regression analysis showed that the C-reactive protein (CRP) to albumin ratio (CAR) (Odds ratio [OR]: 0.519, 95% CI: 0.373–0.724, p <0.001), total bilirubin (OR: 3.687, 95% CI: 1.151–8.095, p = 0.03), and low-density lipoprotein (LDL) (OR: 0.985, 95% CI: 0.970–1.000, p = 0.04) were independent predictors of positive QRS-T angle change. In receiver operating characteristics curve analysis, a cut-off value of 0.59 total bilirubin had a 69% sensitivity and a 65% specificity (area under curve: 0.739, p <0.001) for the prediction of positive QRS-T angle change. Conclusion: In ACS patients, serum total bilirubin has been found to be a useful decision-making tool to predict positive frontal QRS-T angle change as a sign of reduced total ischemic burden, to assess early invasive strategy independently from other study parameters.
{"title":"Serum Bilirubin Level Predicts Frontal QRS-T Angle Change in Patients with Acute Coronary Syndrome","authors":"Güney Erdoğan, M. Yenerçağ, G. Durmuş, D. Koprulu, U. Arslan","doi":"10.2478/jce-2020-0016","DOIUrl":"https://doi.org/10.2478/jce-2020-0016","url":null,"abstract":"Abstract Introduction: The predictive role of serum bilirubin levels on the alteration of total ischemic burden expressed via frontal QRS-T angle change has never been studied in patients with acute coronary syndrome (ACS). In this study, we aimed to investigate the relationship between serum bilirubin levels and frontal QRS-T angle change after percutaneous coronary intervention (PCI) in ACS patients. Methods: Frontal QRS-T angle change was accepted as positive or negative according to whether the value of the baseline frontal QRS-T angle minus the post PCI frontal QRS-T angle is positive or negative. A total of 314 consecutive patients with ACS who underwent PCI were divided into two groups based on their negative frontal QRS-T angle change (n = 152 patients) and positive frontal QRS-T angle change (n = 162 patients). Results: Multivariate logistic regression analysis showed that the C-reactive protein (CRP) to albumin ratio (CAR) (Odds ratio [OR]: 0.519, 95% CI: 0.373–0.724, p <0.001), total bilirubin (OR: 3.687, 95% CI: 1.151–8.095, p = 0.03), and low-density lipoprotein (LDL) (OR: 0.985, 95% CI: 0.970–1.000, p = 0.04) were independent predictors of positive QRS-T angle change. In receiver operating characteristics curve analysis, a cut-off value of 0.59 total bilirubin had a 69% sensitivity and a 65% specificity (area under curve: 0.739, p <0.001) for the prediction of positive QRS-T angle change. Conclusion: In ACS patients, serum total bilirubin has been found to be a useful decision-making tool to predict positive frontal QRS-T angle change as a sign of reduced total ischemic burden, to assess early invasive strategy independently from other study parameters.","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"84 1","pages":"75 - 83"},"PeriodicalIF":0.4,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83867923","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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