Journal of the Saudi Heart Association最新文献

Background: After the surge of artificial intelligence in late 2022, researchers started exploring the idea of using artificial intelligence in the medical field. Considering the endless possibilities of artificial intelligence, there is still some hesitation toward its use in the medical field. This study aims to explore the attitudes of cardiac surgeons toward involving artificial intelligence in diagnosing cardiac conditions and planning cardiac operations.

Methodology: This study surveyed cardiac surgeons on AI integration in their field using a cross-sectional design and purposive sampling. Data were collected via a structured questionnaire and analyzed in IBM SPSS 29.0.

Results: Our study included 33 cardiac surgeons primarily male (n =26, 78.8 %) and Saudi nationals (n =26, 78.8 %), assessed attitudes towards AI in cardiac surgery. A significant majority supported AI for pre-operative (n =17, 51.5 %), intra-operative (n =11, 33.3 %), and post-operative tasks (n =13, 39.4 %). The overall positive attitude towards AI was 54.2 % and overall positive perception towards AI was 50 %. However, perceptions of AI's integration into healthcare varied, with the highest approval for Documentation AI Assistance (n =13, 39.40 %). No significant demographic differences were found affecting attitudes towards AI (p-values ranging from 0.576 to 1.000).

Conclusion: Our study reveals a positive yet cautious attitude towards AI in cardiac surgery, recognizing its potential to improve precision and efficiency but emphasizing the irreplaceable need for human judgment and expertise in managing patient-specific variables.

Background: Direct oral anticoagulants (DOACs) have emerged as non-inferior and effective alternatives to traditional anticoagulants in managing thromboembolic risks associated with various cardiovascular conditions. This position statement by the Saudi Heart Association (SHA) aims to provide guidance on the use of DOACs in the context of cardiovascular disease, particularly patients with arterial and venous thrombosis.

Methods: A multidisciplinary panel of experts reviewed current evidence and international guidelines on DOACs, considering the local healthcare context in Saudi Arabia. The statement addresses the initiation, maintenance, interruption, and re-initiation of DOAC therapy across different patient populations.

Results: DOACs are effective alternatives to traditional anticoagulants with a comparable or lower risk of bleeding and no requirement for frequent monitoring, making them more convenient for patients. It is important to regularly assess stroke risk (CHA2DS2-VASc score) and bleeding risk (HAS-BLED score) before initiating DOAC therapy and during the course of treatment, particularly in patients with changing clinical conditions. Specific factors warrant careful consideration for the use of DOACs in special patient populations. Recommendations are therefore provided for dosing adjustments in renal and hepatic impairment, alongside considerations for patients in different clinical scenarios such as those undergoing surgery or with malignancies.

Conclusion: DOACs represent a valuable option for clinicians owing to their efficacy, safety and convenience compared to traditional anticoagulants. DOACs should be used based on individualized patient assessment, particularly regarding bleeding risk, stroke risk, and other comorbidities and clinical factors that may affect clinical outcomes. Adherence to the recommendations and guidance provided in this SHA statement is needed to enhance patient care and outcomes in Saudi Arabia.

Hypertrophic cardiomyopathy (HCM) is often associated with conservative exercise recommendations due to the risk of sudden cardiac death (SCD). However, emerging evidence suggests that tailored exercise programs may provide significant benefits to HCM patients. This systematic review and meta-analysis evaluated the impact of different types and intensities of exercise on clinical outcomes and quality of life in HCM patients, assessed the role of exercise in preventing disease progression and arrhythmias, and determined the safety and efficacy of structured exercise programs tailored to individual risk profiles. A comprehensive literature search was conducted using PubMed, Embase, Cochrane Library, and relevant cardiology journals. Studies included were those that evaluated exercise interventions in HCM patients and reported clinical outcomes, quality of life measures, and safety data. Data were extracted and pooled to determine the overall impact of exercise on HCM. Meta-analysis results showed that moderate-intensity exercise improved VO₂ max by 3.5 mL/kg/min (95% CI 2.0-5.0, p < 0.001), reduced NYHA class by -0.5 (95% CI -0.7 to -0.3, p < 0.001), and enhanced quality of life measures across physical, emotional, and social domains (SMD +0.40, 95% CI 0.25-0.55, p < 0.001). No significant increase in arrhythmias (RR 0.95, 95% CI 0.75-1.20, p = 0.68) or mortality (RR 0.85, 95% CI 0.60-1.20, p = 0.35) was observed. Tailored exercise programs show promise in managing symptoms and preventing disease progression. This systematic review underscores the potential benefits of personalized exercise regimens for HCM patients. Further research is needed to establish standardized exercise protocols that optimize safety and efficacy.

Aim: The goal of this systematic review is to determine the effectiveness of empagliflozin in managing patients with heart failure with preserved ejection fraction (HFpEF) as compared with a placebo.

Methods: Web of Science, Cochrane, PubMed, and Scopus databases were searched for articles from 2000 to 2023. Reference lists of articles were manually screened. Trials that recruited patients with HFpEF and reported the effects of empagliflozin were included. Endnote X9 software was used for the study screening process.

Results: 1029 non-duplicate articles were identified from the literature and 9 were selected for inclusion in this review. The included papers were all randomized controlled trials (RCTs). According to the findings, empagliflozin reduces the risk of cardiovascular mortality, hospitalization for heart failure, and urgent heart failure visit to the hospital, as compared to placebo treatment. Empagliflozin was also associated with improved quality of life and lower occurrence of severe adverse events. Additionally, there were no significant differences between the treated and placebo groups, regarding the occurrence of adverse events or ability to exercise. The effect of empagliflozin was found to be better in Mineralocorticoid Receptor Antagonists (MRA) non-users and non-diabetic HFpEF patients. The effectiveness of empagliflozin was unaffected by age or gender.

Conclusion: Empagliflozin treatment for HFpEF patients appears to be both safe and efficient when compared to a placebo, according to data of moderate quality.

The totality of evidence suggests that there remains a significant disparity in the use of left ventricular assist devices (LVADs) and heart transplantation (HT) in women. This disparity persists even after accounting for differences in baseline characteristics, comorbidities, and cardiovascular risk factors between men and women undergoing LVAD implantation as a bridge to HT. Generally, women are less likely to undergo HT, leading to a higher mortality rate in women on the HT waiting list. The differences in risk profiles and device-related complications may account for the sexrelated disparities in the assignment of device therapies. These findings warrant an urgent need to conduct prospective studies to better define this conundrum and establish guidelines to narrow the current gaps in care.

The new 2024 European guideline on chronic coronary syndromes (CCS) is a pivotal document for clinical practice, updating the evidence and indications after five years, incorporating insights from the paradigm-shifting ISCHEMIA trial. This article explores the evolving role of functional and anatomical testing in assessing coronary artery disease (CAD), highlighting the introduction of a new risk probability score based on clinical and risk factors. Additionally, it provides a detailed comparison between these European recommendations and those from the most influential American guidelines, emphasizing key differences in the approach to risk stratification and diagnostic strategies. This comprehensive analysis provides valuable insights for optimizing the management of a syndrome that, in light of new evidence, has proven to be clinically complex and, in many aspects, counterintuitive.

Objectives: Even though Islam excludes the sick from Ramadan Fasting (RF), countless Muslims choose to fast throughout this holy month. So, it is of paramount importance to review how RF influences patients with chronic Heart Failure with reduced Ejection Fraction (HFrEF). Our study intended to check the safety of RF in these patients.

Methods: We selected patients under 75 years old with compensated chronic HFrEF. After applying all the exclusion conditions, those who insisted on fasting during the coming Ramadan were enrolled in fasting Group I (90 patients). Those who decided not to fast were listed as control Group II (68 patients) to ensure a comprehensive model.

Results: Patients with prior revascularization, AF, lower e-GFR, and poor functional capacity (higher NYHA class) had higher AEs after RF with P values (0.013, 0.027, 0.001, and 0.038), respectively. The low e-GFR and prior revascularization were independent predictors of AEs with P-values (0.005 & 0.031), respectively. The e-GFR (50 ml/min/1.73 m²) was cut off at which the incidence of AEs increased, with a specificity and sensitivity of 65 % and 81 %, respectively.

Conclusions: RF may be harmless in low-risk patients with chronic HFrEF under the supervision of a medical professional. However, HFrEF patients with prior coronary revascularization or CKD may have a higher incidence of AEs.

Objectives: Supraventricular tachycardia (SVT) is a significant cause of morbidity in patients visiting cardiology clinics with a chief complaint of palpitations and notable signs of distress worldwide. SVTs and panic attacks have overlapping clinical presentations, beginning with rapid palpitations of the heart that start abruptly and can be accompanied by shortness of breath, chest pain or discomfort, and a feeling of lightheadedness. The diagnosis could be straightforward if an ECG is recorded precisely during the attack. The chances of misdiagnosing patients with panic attacks increase because of the self-terminating nature of SVTs. Given the diagnostic dilemma caused by these conditions and lack of corresponding literature, we aimed to determine the true incidence of patients who were misdiagnosed with anxiety disorder and were later appropriately diagnosed with SVT in a large tertiary care center.

Methods: We retrospectively reviewed the records of 105 patients, both male and female aged ≥18 years, from King Abdulaziz University Hospital Jeddah, Saudi Arabia. Patients who were diagnosed with SVT between January 2015 and January 2023 and had data regarding SVT subtype, date of SVT diagnosis, and comorbidities were included. Patients with a confirmed diagnosis of a psychiatric condition were excluded. Ninety patients were contacted to participate in a prospective phone survey involving a subjective assessment of SVT symptomatology. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, panic disorder criteria under the classification of anxiety disorders were applied.

Results: Forty-seven patients responded, while 43 were lost to contact for reasons, such as out-of-service or switched off phones. In the final group, 20 patients (42.6%) were misdiagnosed with anxiety/panic attacks before being correctly diagnosed with SVT. The most prominent subtype was AVNRT (57.4%). The clinical presentations of both panic attacks and arrhythmia coincided; differentiation was performed based on the ECG results during the episode and appropriate further workup. SVT can be easily misdiagnosed as anxiety due to several factors, including lack of ECG and overlapping symptomatology.

Conclusions: Further research is needed to better assess the relationship between the overlapping clinical presentations of SVTs and panic attacks. Overall, physician awareness must be increased to avoid misdiagnosis, which can delay appropriate management of the underlying medical arrhythmia.

Objectives: The objective of this review is to evaluate the effectiveness of three-dimensional (3D) heart models as teaching tools for congenital heart disease (CHD), addressing the limitations of traditional medical education methods.

Methods: A thorough literature review was conducted using PubMed, Google Scholar, Scientific Direct and Scopus databases. Relevant articles were screened and selected based on their discussion of the application of 3D models in CHD education.

Results: The comprehensive review of 19 studies revealed that 3D heart models provide students, healthcare professionals, and patients with meaningful experiences that significantly enhance understanding and learning outcomes. These models improve objective knowledge, structural conceptualization, and personal satisfaction in medical education, especially in complex CHD compared to traditional methods such as books and 2D images ( p< 0.001). Additionally, they enhance spatial orientation, surgical planning, simulation training, clinical reasoning, and critical thinking of healthcare providers. Patients and parents showed better comprehension and confidence in explaining their condition to others. Despite the cost and technical limitations, 3D models of CHD show promising potential.

Conclusion: Integrating 3D heart models into CHD education has positively impacted knowledge acquisition, satisfaction, and confidence across various learner populations. The interactive and tangible nature of 3D models offers advantages over traditional teaching methods, fostering a deeper understanding of complex cardiac structures and pathology. However, further research is necessary to investigate long-term benefits and develop effective integration strategies in medical curricula and practice.