Journal of the Saudi Heart Association最新文献

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.

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.

Acute heart failure (AHF) is a critical condition with significant morbidity and mortality, necessitating timely and accurate diagnosis for effective management. The Venous Excess Ultrasound (VExUS) score has emerged as a non-invasive diagnostic tool, aimed at evaluating venous congestion through ultrasound. This scoring system integrates assessments of the inferior vena cava, hepatic veins, portal veins, and renal venous flow to quantify congestion severity. By providing a real-time assessment of venous pressure, the VExUS score has shown potential in optimizing early diagnosis of AHF and predicting outcomes and overall prognosis. Recent studies suggest that incorporating the VExUS score into clinical practice can enhance patient stratification and guide tailored therapeutic interventions, reducing the need for invasive procedures like right heart catheterization. However, further large-scale studies are required to fully validate its role in predicting long-term outcomes and establishing its place in standard heart failure protocols. We aimed to review the current evidence on the utility of the VExUS score in improving AHF diagnosis and its potential as a prognostic marker, highlighting its technical aspects, clinical implications and future research directions.

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.