Journal of the Saudi Heart Association最新文献

Background: Cardiovascular disease (CVD) remains the leading cause of death and disability globally. In Saudi Arabia, the burden of CVD is exceptionally high, with age-standardized mortality and prevalence rates that far exceed global averages. The current CVD risk prediction tools have several limitations, and those classified as low to intermediate risk still experience cardiovascular events, underscoring the urgent need to address CVD through effective screening and prevention strategies.

Methods: A panel of Saudi experts reviewed evidence on the use of high-sensitivity cardiac troponin (hs-cTn) to enhance cardiovascular risk assessment among seemingly healthy individuals. Consensus recommendations tailored to the Saudi context were formulated based on the literature and local clinical practice, taking into consideration the characteristics of the Saudi population, local healthcare system, available resources and medical expertise.

Results and conclusion: Cardiac troponins are biomarkers of myocardial injury that can be detected in most seemingly healthy individuals using high-sensitivity assays. Studies have shown that measuring hs-cTn is a reliable predictor of future cardiovascular events in the general population. Consequently, incorporating hs-cTn into cardiovascular risk assessments could significantly improve the accuracy and effectiveness of existing risk stratification models. The experts highlighted the additional benefits of this approach compared to current risk assessment methods. This document aims to guide the integration of hs-cTn into cardiovascular risk assessment and prevention strategies for seemingly healthy individuals.

Objectives: Left atrium (LA) remodeling, categorized by functional and structural variations, is predominant in heart failure with preserved ejection fraction (HFpEF) and atrial fibrillation (AF). Brain natriuretic peptide (BNP) levels, implying atrial strain, may lead management by indicating LA remodeling severity. This study was instructed to correlate BNP levels with LA volume index (LAVI) in HFpEF patients with nonvalvular AF against sinus rhythm (SR), to evaluate diagnostic implications.

Methods: This two-center, observational, cross-sectional study (April 2023-October 2024) registered 340 patients with de novo HFpEF (140 AF, 200 SR). Patients with left ventricular ejection fraction (LVEF) less than 50 %, valvular disease, or acute conditions were excluded. BNP was measured using enzyme-linked immunosorbent assay and categorized as low (≤200 pg/mL), moderate-high (>200-400 pg/mL), or high (≥400 pg/mL). LAVI was calculated via echocardiography per American Society of Echocardiography (ASE) guidelines, categorized as normal (16-34 mL/m²), mildly abnormal (35-41 mL/m²), moderately abnormal (42-48 mL/m²), or severely abnormal (more than or equal to 49 mL/m²). Spearman correlation, multivariate regression, and subgroup analyses by gender, age, and comorbidities were used to assess the associations.

Results: AF patients had higher BNP (470 ± 280 vs. 400 ± 211 pg/mL, P = 0.013) and LAVI (60.4 ± 19.0 vs. 54.8 ± 22.0 mL/m², P < 0.001). Paradoxically, AF patients with low BNP (≤200 pg/mL) showed higher LAVI (58 ± 22.0 vs. 54 ± 28.9 mL/m², P < 0.001) and worse New York Heart Association (NYHA) class IV symptoms (48.6 % vs. 35.4 % in SR). A negative correlation between BNP and severely abnormal LAVI (≥49 mL/m²) was observed in AF (r = -0.66, P < 0.0001), contrasting with a positive correlation in SR (r = 0.78, P = 0.001). BMI, eGFR, and severely abnormal LAVI were independent predictors (P = 0.004, 0.026, <0.001). Subgroup analyses showed no significant influence of age, gender, or comorbidities.

Conclusion: In HFpEF, low BNP levels in AF patients are paradoxically associated with severe LA remodeling and worse symptoms, unlike in SR. BNP interpretation should integrate clinical, echocardiographic, and strain data, particularly in AF, high BMI, or kidney disease, to optimize management.

Objectives: Atrial fibrillation (AF) is a prevalent arrhythmia with significant morbidity. Despite advancements in rhythm control strategies and ablation procedures, approximately 30 % of patients with paroxysmal AF experience recurrence, necessitating predictive tools for better patient stratification. This study evaluates the role of left atrial strain (LAS) and left atrial appendage emptying velocity (LAAeV) as predictors of recurrence, aiming to improve procedural outcomes and patient selection.

Methods: A prospective cohort of 32 patients with paroxysmal AF and structurally normal hearts, underwent either cryo- or radiofrequency ablation at a single tertiary center. Pre-ablation evaluations included LAS analysis via transthoracic echocardiography and LAAeV measurement via transesophageal echocardiography. Patients were followed for up to one year post-ablation, with recurrence defined as AF episodes lasting >30 seconds beyond a three-month blanking period. Statistical analyses assessed the predictive value of LAS and LAAeV, individually and in combination.

Results: AF recurrence occurred in 21.9 % of the cohort. Pre-ablation left atrial strain (LAS) values (global LAS ≥33.56 %, sensitivity 85.7 %, specificity 70 %, AUC = 81.4 %, P < 0.05) and left atrial appendage emptying velocity (LAAeV) (≥42.7 cm/s, sensitivity: 100 %, specificity: 87 %, AUC = 94 %, P < 0.001) were significantly associated with freedom from recurrence. The combination of LAS and LAAeV improved predictive accuracy to 100 % sensitivity and 94 % specificity (P value < 0.001). Post-ablation LAS showed inconsistent predictive value, with only apical-2 chamber global LAS achieving statistical significance (P = 0.002). Functional recovery of the left atrium post-ablation was minimal, suggesting limited reversibility of atrial remodeling.

Conclusion: Pre-ablation assessment of LAS and LAAeV provides robust predictors of recurrence in patients undergoing AF ablation. Incorporating these metrics into standard pre-procedural evaluation could optimize patient selection and improve ablation outcomes. Further studies are required to validate age-specific cutoff values and evaluate long-term implications.

We report a case of a male patient with an acute inferior myocardial infarction who underwent successful primary coronary intervention during prolonged cardiac arrest (220 minutes) and continuous resuscitation using a mechanical chest compression device. He achieved full neurological recovery. Mechanical compression devices may help maintain perfusion and improve outcomes in such scenarios.

Objectives: Inherited arrhythmia syndromes (IAS) are a group of rare disorders that result from genetic mutations in several genes including congenital long QT syndrome, Brugada syndrome (BrS), short QT syndrome, and Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT). Affected individuals may have various symptoms including sudden cardiac death (SCD). Few reports have highlighted long QT syndrome from the Arbian Gulf region. The current study aims to describe demographics of children and adults with inherited arrhythmia syndromes; report the presenting clinical features, genetic mutations and management strategies.

Material and method: This is a descriptive retrospective study that included Omani children and adults with inherited arrhythmia syndromes who were diagnosed and treated at the National Heart Centre (NHC) of the Royal Hospital, between 2006 and 2022. Data collected include patient demographics, geographical distribution, clinical features, genetic reports and management strategies.

Result: A total of one hundred and six Omani patients were included. Sixty-six (62.3 %) were males, and 71 (67 %) were adults at diagnosis and 35 (33 %) were children. Three inherited arrhythmia syndromes were found including Long QT, Brugada and catecholaminergic polymorphic ventricular tachycardia (CPVT) and these accounted for 58 (54.7 %), 39 (36.8 %) and 9 (8.5 %), respectively. Seventy-six (71.7 %) of the patients were from consanguineous families. The clinical features varied based on the type of arrhythmia. The treatment modalities constituted of beta blockers and antiarrhythmics, implantable cardioverter defibrillators (ICDs), pacemakers, and left sympathetic ganglionectomy (LSGs). Seventy-one individuals (66.9 %) underwent genetic testing. It is important to highlight that 36 (50.7 %) individuals were with pathogenic or likely pathogenic variants and 13 (18.3 %) individuals were with variants of uncertain significance (VUS) in different IAS related genes.

Conclusion: The current study is the first comprehensive study on the inherited arrhythmia syndromes in Oman and the Arabian Gulf countries. It provides insight about the demographic, clinical and genetic profile of the most common IAS in the region, hence helping in early detection of different types of IAS types and prevention of sudden cardiac death in patients and their relatives. Continuous research efforts in the genetic and cellular mechanisms underlying these disorders will help to identify potential targets for improved disease-specific treatments.

Objective: Dextrocardia refers to the right-sided positioning of the heart during embryonic development and may occur in isolation or in association with visceral malposition or other malformations. However, few studies have investigated this condition. This study aimed to determine the incidence of cardiac and non-cardiac malformations, as well as to analyze long-term follow-up and survival outcomes in patients with dextrocardia.

Methods: This was a retrospective chart review of dextrocardia cases at King Faisal Specialist Hospital & Research Centre in Riyadh, Saudi Arabia from April 22, 1975, to December 31, 2016. A total of 259,246 transthoracic echocardiograms from that period were reviewed, and 357 patients were included in the analysis.

Results: The incidence of dextrocardia was approximately 1 in 28,571 pregnancies (0.35 per 10,000 pregnancies). Most patients with dextrocardia were between 2 and 18 years old (n = 252, 70.6 %). The most common type was isolated dextrocardia (situs solitus), followed by situs inversus totalis, and situs ambiguous. The most common congenital cyanotic heart diseases were double outlet right ventricle (n = 55, 15.5 %) and pulmonary atresia (n = 35, 9.8 %). The most common acyanotic congenital abnormalities were ventricular (n = 152, 42.7 %) and atrial (n = 121, 34.2 %) septal defects. Overall survival in the study population was approximately 83 %. Survival rates varied by situs type, with the highest rates observed in patients with situs inversus (96 %), followed by those with situs solitus (91 %), and situs ambiguous (55 %). Moderate to severe pulmonary hypertension was significantly associated with a reduction in overall survival. The most common non-cardiac anomalies observed were gastrointestinal and urogenital abnormalities.

Conclusion: This study describes the largest regional cohort of patients with dextrocardia, providing important insights into dextrocardia and outcomes of different intracardiac defects in our community. Our findings confirm that complex congenital cardiac disease is more common in patients with situs solitus and isomerism group. Patients in the isomerism group (12.6 %) had significantly higher mortality rates compared to those in the situs solitus (7.6 %) and situs inversus (3.7 %) groups.

Background: The Rapid Access Chest Pain Assessment Clinic (RACPAC) streamlines the evaluation of low to intermediate-risk chest pain patients, reducing hospitalisation and healthcare costs. However, there is limited data on the virtual model of care for RACPAC.

Aim: We sought to evaluate the structure, cost-effectiveness, and imaging modalities performance of face-to-face and virtual RACPAC in an Australian setting.

Methods: A retrospective analysis of patients attending the RACPAC within a large Australian quaternary hospital between 2012 and 2021. We described the clinic parameters and imaging modality utilisation with parametric and non-parametric descriptive statics. Patterns of diagnostic modality utilisation were assessed with logistic regression. A p-value<0.05 was considered statistically significant.

Results: 3976 consecutive patients attended RACPAC, with a mean age of 55.2 years (±11.6), and 48.7 % were females. RACPAC transitioned to Virtual service during the COVID-19 pandemic, witnessing the highest attendance rate at 95 %, despite increased patient load by 10.7 %, with a lower re-presentation rate of 1.5 % compared to 2.8 % pre-pandemic (p < 0.01). The revascularisation rates were 34.6 % after positive CT coronary angiogram, 26.7 % for Treadmill Stress Echocardiogram, 20 % for Myocardial Perfusion Scan, and 33.3 % for Invasive Angiogram. The cost-effective analysis of virtual care reduced evaluation costs to one-fourth, with 460 days of in-hospital stays and AUD 283,663 of cost saved annually.

Conclusion: This study highlights the feasibility, cost-effectiveness and acceptability of virtual RACPAC, emphasising its potential to extend RACPAC services to remote areas or limited-resource countries. It underscores CTCA's utility as a diagnostic tool in the RACPAC setting.

Olezarsen emerged as a novel promising Apo-C3 inhibitor for dyslipidemia. However, its dose-response relationship remains uncertain. This review aims to evaluate the lipid-lowering effect of olezarsen, safety measures, and dose-response effects to determine the optimal dose. A systematic search was conducted across Scopus, PubMed, Science-Direct, and CENTRAL on January 2, 2025. Randomized controlled trial (RCT) comparing olezarsen with placebo in dyslipidemia was included. The Rob 2.0 tool was implemented to assess quality. R-studio and STATA were used to conduct statistical analysis. From a total of 194 documents at initial search, four RCTs involving 361 patients were included in the present analysis. Olezarsen significantly reduces plasma Apo-C3 across all dosage cohorts, including a 50 mg dose (MD: -70.31 %; 95 % CI: -83.89 to -56.74; p < 0.01) and an 80 mg dose administered every four weeks. It also significantly lowered triglycerides at any dose level, with reductions observed at 50 mg (MD: -49.84 %; 95 % CI = -70.42 to -22.37; p = 0) and 80 mg (MD: -52.32 %; 95 % CI: -58.25 to -46.40; p < 0.01). Olezarsen has minimal effect on low-density lipoprotein (LDL) but significantly increases high-density lipoprotein (HDL). Dose-response meta-analysis modeling suggests that 50 mg administered every four weeks may represent the optimal dose, beyond which added benefits diminish. Safety analysis revealed tolerability in liver, renal, and hematological parameters. In conclusion, olezarsen is an effective Apo-C3 inhibitor that improves lipid profiles with a favorable safety profile. This modeling-based insight refines previous findings by delineating a clearer therapeutic window.

Myocardial bridging (MB) is a congenital coronary anomaly in which a segment of a coronary artery runs intramyocardially. We present the case of a 38-year-old male with myocardial bridging in the mid-left anterior descending artery who developed exercise-induced angina. This case underscores the importance of recognizing MB as a cause of ischemia that should not be overlooked in the diagnostic workup of patients with angina, especially in younger individuals. A comprehensive diagnostic approach, including multimodality imaging, is essential to uncover the pathology. A tailored pharmacological strategy is recommended. Long-term clinical follow-up is crucial for optimizing symptom management and reducing complications.

Introduction: Cardiovascular events are the most common cause of mortality worldwide. Various studies have shown the relationship between serum 25-hydroxyvitamin D [25(OH)Vit D] levels and cardiovascular events. The purpose of this study is to investigate the meta-analysis of the relationship between serum 25(OH)Vit D levels and the risk of cardiovascular diseases (CVD), including stroke, coronary heart disease, peripheral arterial disease, and aortic disease in the population.

Method: Using valid keywords and searching the Medline, Science Direct, Scopus, and Web of Science databases, 22 papers were compiled. Data analysis was performed in the group of people with low serum 25(OH)Vit D levels (<75 nmol/L). The data were analyzed using a random-effects meta-analysis model with R and Stata Version 17.0 software.

Results: In this study, 22 papers were included. This meta-analysis of 12 cohort studies (n = 39,396) found that lower serum vitamin D levels were significantly associated with increased risk of cardiovascular disease (HR = 1.38, 95 % CI: 1.24-1.53) and all-cause mortality (HR = 1.64, 95 % CI: 1.33-2.03). Dose-response analysis showed that each 10 nmol/L increase in vitamin D reduced CVD risk by 8.2 % (HR = 0.992, 95 % CI: 0.990-0.993). A non-linear inverse association was observed for all-cause mortality, with stronger protective effects at lower vitamin D levels. These results, in addition to most of the studies included in the systematic review, support a potential protective role of higher vitamin D concentrations.

Conclusion: The results of this study showed a relationship between serum 25(OH)Vit D levels and cardiovascular outcomes; the lower the serum 25(OH)Vit D level, the higher the risk of cardiovascular disease.