Journal of the Saudi Heart Association最新文献

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.

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: 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.

Objective: To evaluate the feasibility, safety, and efficacy of transcatheter closure (TCC) of patent ductus arteriosus (PDA) using anatomo-haemodynamic landmark without any arteriography.

Method: In this prospective, non-randomized study, all consecutive patients with PDA undergoing transcatheter closure at LPS Institute of Cardiology, Kanpur, India between January 2019 and June 2024 were evaluated. TCC was performed using anatomical and haemodynamicl landmark without aortogram, and device was deployed through antegrade route only. Transthoracic echocardiography with colour-Doppler imaging was used to confirm position of the device before final deployment. Primary outcome was procedural and fluoroscopy time, and major complications (access site complications, device embolization, residual shunt ≥ grade 3, haemolysis, flow acceleration in left pulmonary artery and descending thoracic aorta, and death). Success was defined as complete closure of shunt without any major complications.

Result: TCC was successfully performed through antegrade route in 250 patients (age: 2.3 ± 1.2 years; weight: 10.3 ± 9.8 kg) while 16 patients were excluded for various reasons. Mean diameter of duct was 6.7 ± 4.5 mm. Male and female comprised 176 (70.4%) and 74 (29.6%) respectively. PDA were type A (n = 195; 78%), B (n = 27; 10.8%), C (n = 20; 8%), and (n = 8; 3.2%). TCC was successful in all patients although dislodgement was noted in 1 (0.04%). Lifetech duct occluder and Konar MFO were most commonly used devices in 156 (62.4%) and 33 (13.2%) patients respectively. Immediate closure was achieved in 233 (93.2%) patients while remaining 17 (7.8%) with grade I or II shunt on echocardiogram had complete closure in 2 days. Device embolization was observed in 1 (0.4%) patient while flow acceleration in DTA were observed in 5 (2%) patients. Procedure was successful in 99.6% using antegrade while TCC using isolated venous route was successful in 94%.

Conclusion: TCC of PDA using anatomo-haemodynamic landmark and avoiding arterial access is feasible, safe, and effective, with excellent results on short and medium-term follow-up.

Fungal endocarditis (FE) is a rare yet life-threatening condition, especially in hemodialysis (HD) patients with indwelling long-term catheters. Symptoms often overlap with non-fungal infective endocarditis, making diagnosis difficult. As FE incidence increases, healthcare providers face challenges in diagnosing and managing this severe condition. Early suspicion of FE is crucial for patients with long-term catheters. We reported a 23-year-old male with end-stage renal disease (ESRD) on HD that developed FE affecting the tricuspid valve, requiring valve replacement and anti-fungal medication. Despite these interventions, he had recurrent Candida prosthetic endocarditis (CPE). Currently, he is receiving anti-fungal medication, with plans for a third surgery.

Objectives: Zilebesiran is an investigational RNA interference therapeutic designed to lower blood pressure by targeting the hepatic production of angiotensinogen, the most upstream precursor of the renin-angiotensin-aldosterone system. This approach aims to offer long-lasting blood pressure control with potentially fewer doses compared to traditional antihypertensive medications. The objective of this systematic review and meta-analysis was to assess the antihypertensive efficacy of zilebesiran in patients with hypertension.

Methods: We conducted a search across PubMed, Cochrane Library, Ovid, EBSCO, up until July 2024. The eligible studies included randomized controlled trials that examined Zilebesiran versus placebo in hypertensive patients. These studies reported outcomes like reduction in 24-hour systolic blood pressure (SBP) from baseline, changes in plasma angiotensinogen (ATG) levels and office SBP at three months. Meta-analyses were carried out using RevMan.

Results: Our search identified 138 records, of which three randomized controlled trials (RCTs) with 1145 patients met inclusion criteria, focusing on Zilebesiran versus placebo for primary hypertension. Quality assessment revealed two high-quality and one moderate-quality study. Pooled analysis showed Zilebesiran significantly reduced 24-hour systolic blood pressure (SBP) compared to placebo across all doses (MD -12.84, 95% CI -16.00 to -9.68, P < 0.00001), though heterogeneity was high for doses above 500 mg. Zilebesiran also significantly lowered plasma angiotensinogen and office SBP. Sensitivity analysis resolved some heterogeneity issues. Publication bias could not be assessed.

Conclusion: Zilebesiran effectively reduces 24-hour and office systolic blood pressure and plasma angiotensinogen, demonstrating significant antihypertensive benefits. Optimal dosing appears between 250 and 500 mg. Further research should explore patient-specific responses to enhance therapeutic efficacy and minimize side effects.

Background: Cardiovascular disease (CVD) and diabetes mellitus are prominent public health concerns in Saudi Arabia owing to their increasingly high prevalence and burden. Based on this, the Saudi Heart Association (SHA) set out to develop an official position statement on CVD and diabetes mellitus, with a focus on the prevention and management of these conditions and relevant special populations in the context of Saudi Arabia.

Methods: A multidisciplinary panel of experts met under the auspices of the SHA in a series of meetings to review and discuss available evidence on the prevention and management of comorbid CVD and diabetes mellitus. Specialized subcommittees reviewed the data and offered context-specific recommendations (taking into account Saudi population characteristics, local healthcare system, available resources and medical expertise), which were later approved by the full expert panel.

Results and conclusions: The prevalence of diabetes mellitus and CVD is alarming in the Saudi Arabian population. Diabetes mellitus and CVD are interconnected on several levels, including cellular and molecular events as well as epigenetic and genetic mechanisms. Screening for CVD is a priority for patients with diabetes and concomitant risk factors. The expert panel also recommends aggressive management of high blood pressure and dyslipidemia in addition to lifestyle changes and achieving glycemic targets for the prevention of CVD in patients with diabetes. Some glucose-lowering drug classes, namely SGLT2-inhibitors and GLP-1 receptor agonists, offer significant benefits on the level of cardiovascular risk reduction and are thus a powerful addition to the clinical management armamentarium in CVD and diabetes. Special consideration is also advised for patient populations with distinct clinical presentation and needs, such as coronary artery disease, heart failure, and chronic kidney disease, among others.

Objectives: This study aimed to identify the barriers to and enablers of secondary prevention care and cardiac rehabilitation (CR) utilization by patients with coronary heart disease (CHD) following percutaneous coronary intervention (PCI) from the perspective of policymakers.

Methods: A qualitative study involving an interpretive descriptive design was conducted through recorded semistructured interviews with key decision-makers in cardiology care in Saudi Arabia. The analysis was guided by the updated Consolidated Framework for Implementation Research (CFIR), which informed the resulting themes.

Results: Interviews were conducted with nine key decision-makers: four directors of major cardiac centers, four heads of cardiac rehabilitation units, and one president of a specialized cardiac society. Data coding identified 16 CFIR constructs as barriers, with seven prioritized by the participants. The most frequently cited barriers included lack of CR facilities, shortage of trained staff, and insufficient knowledge of CR among cardiologists. Seventeen constructs emerged as enablers to aid in overcoming these challenges, with nine receiving high consensus among policymakers. Key enablers included implementing alternative models, such as home-based programs; enhancing cardiologists' understanding of CR benefits; and involving higher authorities for support.

Conclusions: This study highlights the significant barriers to CR utilization and proposes solutions to facilitate the implementation of these programs from the perspective of healthcare leaders. Successful implementation requires improved communication within institutions, collaboration with the broader healthcare system, and engagement with other stakeholders, such as the private sector, to expand access and ensure comprehensive service delivery.

Atrial septal defects are among the most prevalent congenital anomalies necessitating surgical intervention. Thrombus formation is a recognized complication that is typically characterized by an embolic event following patch-based repair. However, thromboembolic complications following primary repair of atrial septal defects are exceedingly uncommon. Minimally invasive surgery is a suitable alternative to redo sternotomy. We present a 46-year-old man who was diagnosed with a right atrial mass eight years following the patch repair of an atrial septal defect and underwent a successful minimally invasive redo surgery.

Objectives: This study aimed to determine the distribution of coronary collaterals (CC) as per the Rentrop Collateral Score (RCS) among patients with ST-segment elevation myocardial infarction (STEMI) and its impact on in-hospital and 30-day mortality after primary percutaneous coronary intervention (PCI).

Methods: In this study, a selected sample of consecutive STEMI patients was assessed for the development of CC as per the RCS classification. An RCS grade of 2 or 3 was taken as the presence of CC with either partial or complete filling of the infarct-related artery (IRA). Patients were followed during the hospital stay and up to 30 days, and the incidence of major adverse cardiovascular events (MACE) was recorded, which included mortality, re-infarction, stroke, and hospitalization due to heart failure.

Results: This study was conducted on a sample of 347 patients; 81.6% (283) were male, and the mean age was 56.2 ± 10.3 years. CC was not visible (RCS-0) in 206 (59.4%) patients, visible but without filling of the IRA (RCS-1) in 39 (11.2%) patients, and visible with partial (RCS-2) and complete (RCS-3) filling of the IRA in 72 (20.7%) and 30 (8.6%) patients, respectively. No significant differences were observed in the incidence of in-hospital mortality and short-term MACE between patients with and without CC, with an in-hospital mortality rate of 2% vs. 4.9% (p = 0.248) and a MACE rate of 7% vs. 6.4% (p = 0.850), respectively.

Conclusion: Good CC with either partial or complete filling of the IRA was observed in more than one-fourth of the patients with STEMI. However, no significant benefits of good CC were observed.