Journal of the Saudi Heart Association最新文献

Caffeine is a frequently consumed stimulant in different foods and beverages: coffee, tea, chocolate, sodas, and energy drinks. While its effects on the cardiovascular system have been extensively studied, there remains controversy surrounding its potential risks, particularly in patients with heart disease. This review provides a complete overview of caffeine's pharmacological properties, sources, and cardiovascular effects, particularly emphasizing its arrhythmogenic potential. The proarrhythmic potential of caffeine, particularly on atrial fibrillation and ventricular arrhythmias, is conducted. It explains the mechanism of action, including adenosine receptor antagonism, phosphodiesterase inhibition, calcium mobilization, and catecholamine release of caffeine. Epidemiological evidence and mechanistic insights are provided for both conditions, and caffeine consumption's incidence, triggers, and impact on premature ventricular contractions are explained. It emphasizes the need for more research to comprehend the complex relationship between caffeine consumption and cardiovascular health, specifically in high-risk populations.

Objectives: Mitral valve surgery is the reference treatment for severe symptomatic mitral regurgitation (MR). Percutaneous mitral valve interventions, such as the MitraClip procedure, offer an alternative, particularly for high-risk patients. The aim of this systematic review and meta-analysis was to analyze the safety and effectiveness of transcatheter mitral valve repair (TMVR) compared to surgical mitral valve repair or replacement (SMVR) in elderly patients with mitral regurgitation.

Methods: We searched PubMed, Scopus, Ovid, EBSCO, and ProQuest through July 2024. Eligible studies were randomized controlled trials and observational comparative studies of TMVR versus SMVR for patients with MR, reporting outcomes such as all-cause mortality, MR recurrence, stroke, myocardial infarction, and length of stay (LOS). Statistical analyses were performed using RevMan.

Results: Our search identified 3166 records, with 2756 screened and 21 studies included after review. The studies, comprising 20 retrospective cohorts and 1 randomized controlled trial with 20,900 patients, compared TMVR to SMVR. TMVR patients were significantly older than SMVR patients (MD 3.44 years; P < 0.00001). Mortality rates were similar at 30 days (relative risk (RR) 1.08; P = 0.79) and one year (RR 1.27; P = 0.18), but SMVR showed lower mortality at three years (RR 1.82; P = 0.006). SMVR also significantly reduced MR ≥ 3+ recurrence at 30 days (RR 6.95; P < 0.00001), one year (RR 3.31; P = 0.0001), and three years (RR 4.37; P < 0.00001). TMVR was associated with higher myocardial infarction rates (RR 1.58; P = 0.02) but reduced LOS (MD -4.88 days; P < 0.00001). Sensitivity analysis showed consistent results for recurrence of MR ≥ 3+ and variable outcomes for other metrics. Evidence of publication bias was noted for mortality at 30 days and LOS.

Conclusion: While TMVR with the MitraClip offers shorter hospital stays and is less invasive, SMVR provides better long-term survival and lower MR recurrence rates, emphasizing the need for a tailored approach based on patient risk profiles.

A 33-year-old female with recurrent syncope episodes showed normal ECG and Holter results, but had mitral valve prolapse (MVP) with moderate mitral regurgitation (MR) on an echocardiogram. Cardiovascular magnetic resonance (CMR) revealed mitral annulus disjunction (MAD) with fibrosis. She received an implantable loop recorder (ILR). Several months later, she experienced a syncope event, which correlated with self-terminating polymorphic ventricular tachycardia (PMVT) preceded by narrow complex tachycardia, which was proven to be atrioventricular nodal reentrant tachycardia (AVNRT) in an electrophysiology study. Post-ablation, she had no recurrences of syncope. This case highlights the importance of ILR in avoiding unnecessary ICDs in MVP patients with syncope.

Background: The search for the "Holy Grail" of surgical repair for aortic coarctation involves finding an access and correction method that successfully and consistently avoids aortic recoarctation and arterial hypertension. The controversy persists as there is still no consensus on the best surgical approach and technique to achieve these objectives.

Objective: The objective of this study is to compare sternotomy and left thoracotomy as surgical techniques for treating patients with aortic coarctation and hypoplasia of the distal aortic arch.

Methods: From January 2008 to December 2020, 103 surgical procedures were performed using an extended oblique anastomosis. The patients were divided into 2 groups: oblique, extended anastomosis from thoracotomy access (n-68; 66%) and oblique extended anastomosis from sternotomy access (n-35; 34%). After performing a propensity score analysis (1:1) for the entire sample, 25 patients from sternotomy access were matched with 25 patients from thoracotomy access.

Results: The mortality rate in the thoracotomy group was 4%, with 1 patient, while it was 8% with 2 patients in the sternotomy group, p > 0.99. There were no significant differences in early postoperative complications between the two groups. Recurrence of aortic coarctation was observed more frequently in the thoracotomy group (20.8% vs 0%). Low weight was identified as the only risk factor for aortic re-coarctation.

Conclusion: The mortality rates and early postoperative complications associated with the surgical repair of aortic coarctation were similar between the sternotomy and thoracotomy approaches. Nevertheless, sternotomy approach may be beneficial in reducing aortic recoarctation.

Objectives: The obesity pandemic is a major public health concern in Saudi Arabia, with significant impact on cardiovascular disease (CVD). This position statement aims to provide an overview of available evidence as well as the recommendations of the Saudi Heart Association on the management of obesity associated with CVD.

Methods: Under the auspices of the Saudi Heart Association, a multidisciplinary expert panel comprised of cardiologists and endocrinologists discussed available evidence and provided recommendations on the management of obesity in CVD. The expert panel discussions occurred between September of 2023 and May of 2024 and also took into consideration local expertise in addition to published data in the management of obesity and CVD in the Kingdom of Saudi Arabia.

Results and conclusions: The expert panel explored studies on obesity and its implication on CVD assessment modalities, while also examining the efficacy and cardiovascular safety of available interventions for weight reduction. The association between obesity and CVD is undeniable. The treatment of obesity, be it through lifestyle changes, pharmacological therapy or surgery, is an effective strategy for both weight loss as well as the primary and secondary prevention of CVD. The Saudi Heart Association position statement thus provides guidance and recommendations for the management of obesity/overweight and CVD in Saudi Arabia. This position statement is expected to contribute towards obesity and CVD prevention efforts in Saudi Arabia by promoting adequate and time-appropriate treatment of these conditions.

Objectives: This study aimed to evaluate adherence to secondary prevention measures and to identify barriers to cardiac rehabilitation enrolment among patients with coronary heart disease after percutaneous coronary intervention.

Methods: An observational cross-sectional survey was conducted through computer-assisted telephone interviews to assess recently treated percutaneous coronary intervention patients at the Prince Sultan Cardiac Center in Saudi Arabia.

Results: Out of 104 surveyed patients with coronary heart disease, 85 (82%) were male, with an average age of 59.5 years. The obesity rate was 28% (n = 29), with a high prevalence of comorbidities: 82 (79%), 63 (61%), and 62 (60%) patients had hyperlipidemia, diabetes, and hypertension, respectively. Despite high medication compliance (97%), adherence to secondary prevention measures was low (21%). Adherence to physical exercise and weight monitoring for fluid body build-up was notably poor at 35% and 9%, respectively. Only 11 (10.6%) patients were referred for cardiac rehabilitation, of whom only four (36.4%) attended. Significant barriers such as a lack of staff contact, insufficient physician support, and distance to cardiac rehabilitation facilities were particularly noted by 69% of rural patients.

Conclusions: This study underscores the significant cardiac risk factors and low adherence to secondary prevention measures among post revascularization patients with coronary heart disease in Saudi Arabia. Low referral and other organizational barriers, as well as the travel distance to hospital-based cardiac rehabilitation, hinder program enrolment. To improve cardiac rehabilitation accessibility, it is crucial to revise the discharge plans, implement automated referral systems, expand the services across all regions, and utilize alternative delivery models.

Objectives: Aortic stenosis is the most common valvular heart disease globally; while transcatheter aortic valve replacement (TAVR) has proven to be a competitive alternative to surgical aortic valve replacement (SAVR) and revolutionized treatment, its safety and efficacy has yet to be comprehensively assessed against SAVR for certain subsets of aortic stenosis patients; therefore, this study aims to systematically analyze all the available clinical evidence from randomized clinical trials on TAVR versus SAVR among intermediate and low-risk patients with severe symptomatic aortic stenosis.

Methodology: We performed a systematic review of the randomized controlled trials (RCT), studies comparing TAVR and SAVR in low- and intermediate-risk patients were identified by a comprehensive search of the major databases. Mortality, stroke, length of stay, and other perioperative outcomes were assessed.

Results: A comprehensive screening of 14,384 records identified 9 studies, encompassing 8884 patients with a mean age of 77.76 years and 49.47% male. TAVR demonstrated a significantly lower all-cause mortality at both 30 days and 1 year compared to SAVR, with comparable outcomes at 2 years, underscoring its potential for enhanced survival. Stroke incidence was markedly lower with TAVR at both 30 days and 1 year, highlighting its favorable neurological safety profile. Additionally, TAVR showed a reduced rate of myocardial infarction within the initial 30 days post-procedure. Prosthetic valve endocarditis rates remained low and comparable between the two approaches at both 30 days and 1 year. Notably, TAVR was associated with a significantly shorter hospital stay, suggesting a faster recovery trajectory and improved patient throughput. These findings collectively emphasize the superior efficacy and safety profile of TAVR over SAVR.

Conclusion: TAVR may serve as a viable therapeutic option for intermediate and low-risk patients with severe symptomatic aortic stenosis. Future research should focus on long-term outcomes and TAVR device durability, especially in younger, lower-risk populations.

Background: Papillary fibroelastoma (PFE) is an uncommon benign cardiac tumor, typically arising from valvular structures. Nonvalvular PFEs are exceedingly rare and may present with diverse symptoms.

Case presentation: We present a case of a 46-year-old woman with positional vertigo and exertional dyspnea. Transthoracic echocardiography revealed a mobile oval-shaped mass in the left ventricle. Cardiac magnetic resonance imaging suggested a large papillary fibroelastoma. The tumor was successfully resected, and histopathological examination confirmed the diagnosis.

Conclusion: This case highlights the importance of thorough imaging and surgical intervention in managing large, nonvalvular PFEs, which, although rare, can lead to significant complications.

Objectives: Studies show that intracoronary imaging (ICI)-guided PCI is associated with a significantly lower risk of stroke, Q-wave myocardial infarction, and death compared to angiography-guided PCI in the management of acute coronary syndromes, complex coronary lesions and left-main interventions. Despite these well-established clinical benefits, the utilization of ICI-guided PCI in Saudi Arabia remains suboptimal.

Methods: The National Heart Center (NHC) and the Saudi Arabian Cardiac Interventional Society (SACIS) gathered national experts to develop a consensus document on how to integrate ICI-guided PCI in routine clinical practice in Saudi Arabia. The consensus was based on the nominal group technique, whereby a committee of interventional cardiologists affiliated with the NHS and SACIS developed and discussed a number of statements on the clinical use of intracoronary imaging based on a systematic review of the literature.

Results: A total of 17 statements were discussed in light of scientific evidence and agreed upon. Initiatives to improve operator skills when it comes to image acquisition and interpretation are crucial in the incorporation of ICI-imaging guided PCI in Saudi Arabia. Local data on reference diameters and measurements and epidemiological data on Saudi patients being treated in catheterization laboratories are necessary.

Conclusions: Herein, we provide the first national consensus on the use of ICI-guided PCI in Saudi Arabia. We anticipate that this document contributes to a more optimal and integrative use of ICI-guided PCI in the Kingdom.