Journal of the Saudi Heart Association最新文献

Objectives: Anthracyclines used in the treatment of breast cancer are known for their cumulative cardiotoxic effect. Two-dimensional speckle tracking echocardiography is a promising technique in detection of subclinical cardiotoxicity. Cardio-oncology rehabilitation is a new field aiming to decrease the risk of cardiovascular diseases and improve cardiopulmonary fitness among cancer patients.

Methods: The study included 100 female patients with de novo breast cancer and treated with anthracycline-based chemotherapy. Patients were randomly assigned into two groups in a 1:1 ratio. Group (1) included patients who were allocated to cardiac rehabilitation program in addition to their regular chemotherapeutic drugs and group 2 included patients who received chemotherapy only. Standard 2-dimensional echocardiography and 2-dimensional speckle tracking echocardiography for assessment of left ventricle global longitudinal strain were performed to all patients before receiving the chemotherapy and at 3 and 6 months after.

Results: At 3 months, no significant difference was found between Group 1 and Group 2 as regards the left ventricular ejection fraction and left atrial volume Index. However, a significant difference was observed as regards E/E' (5.25 (4.5-5.5) in group 1 versus 7.5 (5-9.5) in group 2 with P value ≤ 0.01) and also in the average global longitudinal strain between the 2 groups; (-18.81 ± 1.39 in group 1 vs. -18.21 ± 1.43 in group 2, P = 0.092). At 6 months, Ejection fraction showed a significant difference between the 2 groups (64.10 ± 3.52 in group 1 vs. 59.46 ± 5.57 in group 2, P ≤ 0.01) which was also accompanied by a significant change in average global longitudinal strain (-18.91 ± 1.39 in group 1 vs. -17.89 ± 1.54 in group 2, P = 0.001). As regards cardiotoxicity (defined as ≥15 % change in average global longitudinal strain), there were no cases detected in group 1 despite the presence of 4 cases (8 %) in group 2 with a mean change of global longitudinal strain (16 %).

Conclusion: Cardiac rehabilitation program has a protective role against chemotherapy-induced cardiotoxicity in patients with breast cancer.

Objectives: Diagnosing hypertrophic cardiomyopathy (HCM) can be challenging due to its nonspecific clinical manifestations, variability in electrocardiographic (ECG) patterns, and limited access to echocardiography, the gold standard for diagnosis, often leading to delayed detection. Recent artificial intelligence (AI) advancements have enabled ECG-based algorithms to improve HCM detection. This systematic review and meta-analysis aim to assess the overall diagnostic performance of AI-enhanced ECG in identifying HCM.

Methods: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Articles were retrieved from PubMed, EBSCO, and Proquest. Inclusion criteria encompassed all studies evaluating AI algorithms for the detection of HCM from 12-lead ECGs. Meta-analysis was performed using R v4.4.1. Bivariate random-effects models were employed to derive pooled estimates of sensitivity, specificity, and the area under the curve (AUC) of the summary receiver operating characteristic (SROC).

Results: A total of five retrospective cohort studies involving 69,343 participants, were included. The pooled sensitivity of AI-enhanced ECG for detecting HCM was 0.84, and the specificity was 0.86. The AI-enhanced ECG demonstrated excellent diagnostic accuracy, with an SROC-AUC of 0.927 in detecting HCM.

Conclusion: AI-enhanced ECG shows promise as a novel screening tool for detecting hypertrophic cardiomyopathy. However, the considerable heterogeneity and the limited number of studies necessitate careful interpretation and highlight the need for additional research in the future.

Objectives: Breast cancer (BC) treatment often involves cardiotoxic chemotherapy, leading to potential cardiac dysfunction. Early detection of cardiotoxicity is crucial for timely intervention and improved patient outcomes. This study aims to compare the effectiveness of speckle-tracking echocardiography (STE) and cardiospecific markers in detecting early signs of cardiotoxicity in BC patients undergoing chemotherapy.

Methods: The study included 45 women (mean age, 55.8 ± 12 years) diagnosed with HER-2 positive BC. They were treated with doxorubicin and cyclophosphamide for the first four cycles (group-1), docetaxel and Trastuzumab for the second four cycles (group-2), and Trastuzumab for the third four cycles or more subsequent treatment (group-3). Using STE, we assessed the global longitudinal strain of the left ventricle (GLS LV), together with measuring the levels of troponin I and N-terminal pro b-type natriuretic peptide (NT-proBNP) before and after the chemotherapy courses.

Results: Both STE and NT-proBNP were effective in detecting early signs of cardiotoxicity (p < 001). However, STE showed higher sensitivity in detecting subtle changes in cardiac function compared to cardiospecific markers. STE provided valuable information on myocardial deformation, particularly Global Longitudinal Strain (GLS), enabling early intervention by quantifying myocardial deformation along the longitudinal axis.

Conclusions: STE shows promise for early cardiotoxicity detection in BC patients undergoing chemotherapy due to its sensitivity and ability to assess myocardial mechanics. Integrating STE into cardiac monitoring can improve early detection and management. Increases in NT-proBNP correlate with GLS LV changes after CTx, serving as a useful biomarker where STE isn't feasible. Further research is needed to validate findings and standardize protocols.

Introduction: Myocardial infarction (MI) is one of the leading causes of mortality in Saudi Arabia, with individuals sharing genetic, lifestyle, and environmental risk factors. The present investigation aimed to review the literature on genetic susceptibility to MI among Saudi individuals, with a specific emphasis on genome-wide association studies (GWAS) for coronary artery disease (CAD) and MI. Studies have revealed the relationship between polymorphisms in genes such as proprotein convertase subtilisin/kexin type 9 (PCSK9), cholesteryl ester transfer protein (CETP), and cyclin-dependent kinase inhibitor 2B antisense RNA 1 (CDKN2B-AS1), which are involved in lipid metabolism, inflammation, and endothelial function.

Methods: This PROSPERO-registered systematic review and meta-analysis (CRD42024603752) evaluates genetic determinants of myocardial infarction among Saudi adults. Five databases were searched (1989-Oct 2024) according to PRISMA guidelines. Case-control and cohort studies that met the inclusion criteria were analyzed using random-effects models.

Results: Findings suggest that several polymorphic genes are highly associated with MI in Saudi citizens. There is strong evidence indicating that PCSK9, CETP, and CDKN2B-AS1 contribute to susceptibility to MI, though the effect of these polymorphic genes varies. The meta-analysis confirmed that MI is a polygenic disease, and genetic predisposition, in combination with individual lifestyle factors, determines disease progression.

Conclusions: This study establishes that genetic factors significantly contribute to MI in Saudi Arabia. Integrating genetic screening with traditional cardiovascular risk assessments can enhance early intervention strategies. The findings highlight the need for MI prevention programs tailored to specific genotypes in the Saudi population.

Aim: To evaluate the relationship between the location of chest pain (topography) and the site of coronary artery involvement in patients with acute coronary syndromes (ACS) undergoing percutaneous transluminal coronary angioplasty (PTCA).

Materials and methods: This prospective, observational study included 411 consecutive ACS patients admitted to a tertiary care center between January 2017 and December 2019. A total of 589 angina topographic sites were analyzed. The site and characteristics of chest pain, along with electrocardiogram and coronary angiography findings, were documented and assessed for correlation with the involved coronary artery.

Results: Among the 411 patients, 337 (82.0 %) were male and 74 (18.0 %) were female. The mean age was 57.03 ± 11.28 years. In both ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI), the left anterior descending (LAD) artery was the most commonly affected vessel-201 cases (63.4 %) in STEMI and 49 (53.3 %) in NSTEMI. LAD occlusion correlated with retrosternal pain (r = 0.298, p = 0.001). The left circumflex artery showed a correlation with jaw and neck pain (r = 0.647, p = 0.001) and backache with shoulder pain (r = 0.585, p = 0.001). The right coronary artery correlated with retrosternal plus jaw and neck pain (r = 0.713, p = 0.001), and with retrosternal plus back pain (r = 0.719, p = 0.001).

Conclusion: There is a significant correlation between the topography of chest pain and the involved coronary artery. These findings may aid in early recognition of the culprit vessel in ACS and serve as a foundation for future diagnostic tools, especially in resource-limited settings.

Background: Transcatheter aortic valve implantation (TAVI) is an alternative treatment for surgically high-risk patients with severe aortic stenosis (AS). This study aimed to assess the echocardiographic outcomes of TAVI in patients with severe AS, focusing on left ventricular mass, volume, and pressure.

Methods: This retrospective, registry-based, single-center study was conducted at King Salman Heart Center, Riyadh, Saudi Arabia. We included 200 adult patients who underwent the TAVI procedure and completed at least one year of clinical and echocardiographic follow-up. Baseline demographic, clinical, and echocardiographic data were collected and paired pre- and post-procedure echocardiographic measurements were analyzed.

Result: Paired analysis in comparison of pre and post-transcatheter aortic valve implantation (TAVI) shows significant improvement in left ventricular (LV) mass, volume, and pressure.

Conclusion: This study demonstrates that transcatheter aortic valve implantation (TAVI) leads to significant improvement in key echocardiographic parameters such as left ventricular (LV) size, functions, mass, and ejection fractions (EF).

Objectives: The optimal management approach for patients with cryptogenic stroke and patent foramen ovale (PFO) remains uncertain. Whether medical therapy-using antiplatelet agents or anticoagulants-or transcatheter device closure offers superior protection against stroke recurrence has been a topic of considerable debate. This systematic review aims to assess and compare the effectiveness of these two treatment strategies, incorporating recent studies to provide updated insights on the most effective approach to preventing recurrent cryptogenic stroke.

Methodology: We systematically searched PubMed, Scopus, and Ovid database through December 2024. Eligible studies were randomized controlled clinical trials (RCTs) comparing PFO closure versus medical therapy among patients with cryptogenic stroke.

Results: This systematic review analyzed 7 RCTs encompassing 4539 patients with a mean age of 43.6 years, 53.38 % of whom were male. Patient characteristics, including comorbidities such as hypertension, hyperlipidemia, and diabetes mellitus, were well-balanced across groups receiving PFO closure or medical therapy. The primary analysis revealed a significant reduction in stroke incidence with PFO closure compared to medical therapy, with no stroke events in the PFO closure groups of the CLOSE and DEFENSE-PFO trials. Similarly, transient ischemic attack (TIA) incidence was consistently lower in PFO closure groups. All-cause mortality was comparable between groups, underscoring the safety profile of PFO closure. However, PFO closure was associated with a higher incidence of atrial fibrillation. Major bleeding risks varied, reflecting the need for tailored risk assessment.

Conclusion: PFO closure offers a significant advantage over medical therapy in preventing recurrent cryptogenic stroke and TIA. Nevertheless, the observed increase in atrial fibrillation postclosure highlights the need for additional research to elucidate its long-term implications and to determine whether anticoagulation could benefit specific subsets of patients with PFO and a history of stroke.

Objectives: Atrial fibrillation (AF) is a common comorbidity in patients undergoing mitral valve surgery (MVS), significantly increasing the risk of thromboembolism, heart failure, and mortality. Surgical ablation has recently been given a Class IA recommendation for concomitant MVS, reinforcing its role in restoring sinus rhythm and improving outcomes in this population. However, concerns about procedural complexity, extended operative time, and postoperative risks have limited its widespread adoption. This systematic review aims to synthesize evidence from recent randomized controlled trials to evaluate the safety and efficacy of surgical ablation for AF in patients undergoing MVS, addressing critical gaps in current clinical practice.

Methodology: We systematically searched Scopus, PubMed, and Ovid up to December of 2024 for randomized controlled trials (RCTs) that investigated surgical ablation concomitant to mitral valve repair or replacement (MVR) as the intervention, compared to isolated MVR.

Results: This review included 15 RCTs with 1219 patients (681 in the MVR + ablation group and 538 in the MVR-only group). Sinus rhythm restoration was significantly higher in the MVR + ablation group at discharge (64.7% vs. 18.8%), 6 months (62.5% vs. 22.4%), and 1 year (66.0% vs. 25.7%), indicating both immediate and sustained benefits. Short-term mortality rates were similar between groups (2.2% vs. 1.97%), while 1-year mortality was lower in the MVR + ablation group (5.43% vs. 5.91%). Pacemaker implantation rates were slightly higher in the MVR + ablation group, while stroke and thromboembolic events were rare and comparable between groups.

Conclusion: Surgical ablation combined with mitral valve surgery significantly improves sinus rhythm outcomes. While stroke and short-term mortality remain comparable between groups, one-year mortality was lower in the ablation group, warranting further investigation. Additionally, the increased pacemaker implantation rate in specific populations warrants tailored approaches.