Background: Reperfusion can be done through primary percutaneous coronary intervention (PPCI) and thrombolytic administration. Patients with myocardial infarction should receive antiplatelet drugs from the P2Y12 receptor inhibitor category (such as ticagrelor, prasugrel, and clopidogrel). Based on recent researches, effectiveness of ticagrelor versus clopidogrel is still debatable. Methods: A total of 128 patients who underwent PPCI, divided into two groups (Zyllt® group (600 mg received as a loading dose, maintenance with dose of 75 mg daily)) and Ticora® group (180 mg as a loading dose, maintenance with dose of 90 mg twice). Both the groups received aspirin 80 mg daily, too. They were followed up after 3 months. Results: In this study, 86.9% were men, and there was no significant difference in terms of gender and age in 2 groups. Risk factors, type of myocardial infraction (MI), number of involved and infarct-related arteries, and presence of complications and their type were not statistically different in groups (P > 0.05). Among all complications, only one person had dyspnea in the Ticora group, one patient in the Ticora group, and 3 patients in the Zyllt group had chest pain. The difference in “TIMI Score” during Time was significant (P = 0.037). Conclusion: Our study shows no difference between ticagrelor and clopidogrel after PPCI in patients with MI in terms of risk factors, type of MI, number of involved and infarct-related arteries, and presence of complications and their type, in two studied groups.
{"title":"Short-term clinical outcomes of ticagrelor versus clopidogrel after percutaneous coronary intervention in patients with myocardial infarction: A randomized clinical trial study","authors":"SeyyedAboozar Fakhr-Moosavi, Salman Nikfarjam, Yasaman Borghei, Arsalan Salari, SeyyedMehrad Miraftabi, Bahare Gholami-Chaboki","doi":"10.4103/rcm.rcm_24_23","DOIUrl":"https://doi.org/10.4103/rcm.rcm_24_23","url":null,"abstract":"Background: Reperfusion can be done through primary percutaneous coronary intervention (PPCI) and thrombolytic administration. Patients with myocardial infarction should receive antiplatelet drugs from the P2Y12 receptor inhibitor category (such as ticagrelor, prasugrel, and clopidogrel). Based on recent researches, effectiveness of ticagrelor versus clopidogrel is still debatable. Methods: A total of 128 patients who underwent PPCI, divided into two groups (Zyllt® group (600 mg received as a loading dose, maintenance with dose of 75 mg daily)) and Ticora® group (180 mg as a loading dose, maintenance with dose of 90 mg twice). Both the groups received aspirin 80 mg daily, too. They were followed up after 3 months. Results: In this study, 86.9% were men, and there was no significant difference in terms of gender and age in 2 groups. Risk factors, type of myocardial infraction (MI), number of involved and infarct-related arteries, and presence of complications and their type were not statistically different in groups (P > 0.05). Among all complications, only one person had dyspnea in the Ticora group, one patient in the Ticora group, and 3 patients in the Zyllt group had chest pain. The difference in “TIMI Score” during Time was significant (P = 0.037). Conclusion: Our study shows no difference between ticagrelor and clopidogrel after PPCI in patients with MI in terms of risk factors, type of MI, number of involved and infarct-related arteries, and presence of complications and their type, in two studied groups.","PeriodicalId":21031,"journal":{"name":"Research in Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136206883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dear Editor, Due to technological advancements, the quality of medical care has significantly increased over the past few decades, posing new challenges for the health-care industry. Health service delivery is now widely acknowledged as a team effort involving clinicians and nonclinicians and is not the sole responsibility of doctors and nurses. These professionals were historically referred to as paramedical staff, paraprofessionals, or health technicians.[1] As the Ministry of Health and Family Welfare states, Allied Healthcare Professionals (AHPs) provide health or health-care-related services, possessing the necessary qualifications, and skills to perform therapeutic, diagnostic, curative, preventive, and rehabilitative interventions. Professionals who can easily handle sophisticated tools and cutting-edge protocols are in high demand. Diagnosis has recently relied so heavily on technology that AHPs are crucial to delivering health-care services. They collaborate in multidisciplinary teams with doctors (physicians and specialists), nurses, and public health officials in various health-care settings to promote, protect, treat, and manage a person’s physical, mental, social, emotional, environmental, and holistic health.[2] The quality of education, training, and community health orientation received by all categories of health-care workers, as well as their ability to work as a cohesive team, are significant factors in the efficient delivery of health-care services. The Indian Government recognized the need to maintain education standards for AHPs and thus set up a National Health Policy in 2002.[3] Paramedical courses do not adhere to a uniform syllabus, unlike medical and dental programs in the country. As a result, some universities or colleges offer cardiac rehabilitation to Bachelor of Science in Cardiac Care Technology (B.Sc. CCT) students, whereas others do not. The World Health Organization defines cardiac rehabilitation as restoring a person to an optimal physical, psychological, social, emotional, and economic state.[4] Due to the increasing number of heart disease survivors, more and more patients require rehabilitation from medical professionals with the necessary knowledge and skills to ensure their patients’ better quality of life. According to a prior study by Mohammed and Shabana on patients with chronic heart failure, cardiac rehabilitation activities positively impact mortality rates, physical health, sociopsychological function, blood lipid levels, hypertension, dyspnea, weight loss, smoking, and stress levels. It also revealed that cardiac rehabilitation significantly decreased cardiovascular risk factors, increased functional capacity, and improved health-related quality of life in these patients.[5] Further, this supports the assertion of the importance of educating medical professionals regarding cardiac rehabilitation with the necessary knowledge and skills. Cardiac rehabilitation is an integrated, multidisciplinary app
{"title":"Cardiac rehabilitation teaching for paramedical courses in India","authors":"E Thirumurugan","doi":"10.4103/rcm.rcm_25_23","DOIUrl":"https://doi.org/10.4103/rcm.rcm_25_23","url":null,"abstract":"Dear Editor, Due to technological advancements, the quality of medical care has significantly increased over the past few decades, posing new challenges for the health-care industry. Health service delivery is now widely acknowledged as a team effort involving clinicians and nonclinicians and is not the sole responsibility of doctors and nurses. These professionals were historically referred to as paramedical staff, paraprofessionals, or health technicians.[1] As the Ministry of Health and Family Welfare states, Allied Healthcare Professionals (AHPs) provide health or health-care-related services, possessing the necessary qualifications, and skills to perform therapeutic, diagnostic, curative, preventive, and rehabilitative interventions. Professionals who can easily handle sophisticated tools and cutting-edge protocols are in high demand. Diagnosis has recently relied so heavily on technology that AHPs are crucial to delivering health-care services. They collaborate in multidisciplinary teams with doctors (physicians and specialists), nurses, and public health officials in various health-care settings to promote, protect, treat, and manage a person’s physical, mental, social, emotional, environmental, and holistic health.[2] The quality of education, training, and community health orientation received by all categories of health-care workers, as well as their ability to work as a cohesive team, are significant factors in the efficient delivery of health-care services. The Indian Government recognized the need to maintain education standards for AHPs and thus set up a National Health Policy in 2002.[3] Paramedical courses do not adhere to a uniform syllabus, unlike medical and dental programs in the country. As a result, some universities or colleges offer cardiac rehabilitation to Bachelor of Science in Cardiac Care Technology (B.Sc. CCT) students, whereas others do not. The World Health Organization defines cardiac rehabilitation as restoring a person to an optimal physical, psychological, social, emotional, and economic state.[4] Due to the increasing number of heart disease survivors, more and more patients require rehabilitation from medical professionals with the necessary knowledge and skills to ensure their patients’ better quality of life. According to a prior study by Mohammed and Shabana on patients with chronic heart failure, cardiac rehabilitation activities positively impact mortality rates, physical health, sociopsychological function, blood lipid levels, hypertension, dyspnea, weight loss, smoking, and stress levels. It also revealed that cardiac rehabilitation significantly decreased cardiovascular risk factors, increased functional capacity, and improved health-related quality of life in these patients.[5] Further, this supports the assertion of the importance of educating medical professionals regarding cardiac rehabilitation with the necessary knowledge and skills. Cardiac rehabilitation is an integrated, multidisciplinary app","PeriodicalId":21031,"journal":{"name":"Research in Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136208183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Atrial septal defect (ASD) is one of the most common congenital heart defects (3.78/10,000 live births). For several decades, surgical closure has been considered the standard method of repairing an ostium secundum ASD. Surgical treatment is safe and effective, but the complications relate to bleeding, arrhythmia, and residual defects. However, over the years, percutaneous device closure using the Amplatzer ASD occluder (AGA Medical Corp., Golden Valley, Minnesota) has been widely used for the treatment of ASD and has proven to be effective and safe as traditional surgical repair. However, procedure- or device-related complications can occur; Complications commonly associated with ASD closure device includes residual shunt, device malposition or embolization, thrombosis in the vena cava or atrium and erosion of the surrounding tissue which may lead to perforation of the heart, which could be fatal. We report an unusual case of a 16-year-old female with embolization of the ASD occluder device into the right ventricle immediately after device deployment. We removed the device surgically and closed the ASD in a standard manner, with an autologous pericardial patch. The patient was discharged from the hospital without any complications.
房间隔缺损(Atrial septal缺损，ASD)是最常见的先天性心脏缺陷之一(3.78/10,000活产)。几十年来，手术闭合一直被认为是修复第二口ASD的标准方法。手术治疗是安全有效的，但并发症涉及出血、心律失常和残留缺陷。然而，多年来，使用Amplatzer ASD闭塞器(AGA Medical Corp.， Golden Valley, Minnesota)的经皮装置封闭已被广泛用于治疗ASD，并被证明与传统手术修复一样有效和安全。然而，手术或器械相关的并发症可能发生;与ASD关闭装置相关的常见并发症包括残留分流、装置错位或栓塞、腔静脉或心房血栓形成以及周围组织侵蚀，可能导致心脏穿孔，这可能是致命的。我们报告一个不寻常的情况下，16岁的女性与栓塞ASD闭塞装置进入右心室后立即装置部署。我们通过手术移除该装置，并使用自体心包贴片以标准方式关闭ASD。病人出院了，没有任何并发症。
{"title":"Emergent surgical retrieval of an embolized atrial septal occluder device from right ventricle – An unusual occurrence","authors":"SushilKumar Singh, Sarvesh Kumar, Kumar Rahul, Vivek Tewarson, Bhupendra Kumar, Karan Kaushik, Shobhit Kumar","doi":"10.4103/rcm.rcm_32_22","DOIUrl":"https://doi.org/10.4103/rcm.rcm_32_22","url":null,"abstract":"Atrial septal defect (ASD) is one of the most common congenital heart defects (3.78/10,000 live births). For several decades, surgical closure has been considered the standard method of repairing an ostium secundum ASD. Surgical treatment is safe and effective, but the complications relate to bleeding, arrhythmia, and residual defects. However, over the years, percutaneous device closure using the Amplatzer ASD occluder (AGA Medical Corp., Golden Valley, Minnesota) has been widely used for the treatment of ASD and has proven to be effective and safe as traditional surgical repair. However, procedure- or device-related complications can occur; Complications commonly associated with ASD closure device includes residual shunt, device malposition or embolization, thrombosis in the vena cava or atrium and erosion of the surrounding tissue which may lead to perforation of the heart, which could be fatal. We report an unusual case of a 16-year-old female with embolization of the ASD occluder device into the right ventricle immediately after device deployment. We removed the device surgically and closed the ASD in a standard manner, with an autologous pericardial patch. The patient was discharged from the hospital without any complications.","PeriodicalId":21031,"journal":{"name":"Research in Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136206887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dear Editor, Resistant hypertension (RH) is defined as the persistent blood pressure (BP) elevation above the target values utilizing three antihypertensive medications (a diuretic should be part of therapy) at the highest doses, and this BP elevation is not attributable to the whitecoat effect. If a patient with RH achieves BP control using ≥4 antihypertensive agents, the term describing this situation is “controlled RH.”[1] The advent of new therapies to manage RH is evolving, and some of the antihypertensive therapies that have shown significant benefits in randomized controlled trials are the mineralocorticoid receptor antagonists (MRA) such as spironolactone, eplerenone, and a new selective aldosterone inhibitor (AI), baxdrostat. The PATHWAY-2 and the BrigHTN studies are two of the most important randomized controlled trials demonstrating outstanding outcomes from the MRA and AI treatment in RH. In the PATHWAY-2 trial, patients with RH were randomized to receive spironolactone (25–50 mg), bisoprolol (5–10 mg), doxazosin (4–8 mg), or placebo for 12 weeks. Then, the dosage with each intervention was doubled after 6 weeks. Spironolactone showed the best reduction in home systolic BP compared to bisoprolol (−4.48 [−5.50 to −3.46]; P < 0.0001), doxazosin (−4.03 [−5.04 to −3.02]; P < 0.0001), and placebo (−8.70 mmHg [95% confidence interval (CI) −9.72 to −7.69]; P < 0.0001). However, serum potassium above 6·0 mmol/L was noted in 6 of the 285 patients that received spironolactone.[2] One of the most ambitious therapies for RH is baxdrostat, which acts by inhibiting aldosterone synthase selectively without altering cortisol levels.[3] The BrigHTN study, a phase 2 multicenter trial, compared the values of systolic BP at 12 weeks in patients with RH receiving either baxdrostat (0.5 mg, 1 mg, or 2 mg) or placebo. The median systolic BP decrease with baxdrostat was −20.3 mmHg (2 mg group), −17.5 mm Hg (1 mg group) and −12.1 mmHg (0.5 mg group). The reduction in systolic BP observed with the placebo group was −9.4 mmHg. The change in systolic BP showed a significant difference between the 2-mg group and the placebo group, with a decrease of 11.0 mmHg (95% CI, −16.4 to −5.5; P < 0.001). Similarly, the 1-mg group also exhibited a significant difference compared to the placebo group, with a decrease of 8.1 mmHg (95% CI, −13.5 to −2.8; P = 0.003). Even though the baxdrostat groups were associated with an increment in the potassium level above 6.0 mmol/L in two patients of the 248 individuals, there was no need for baxdrostat withdrawal or reinitiation. No deaths or serious adverse events (including adrenocortical insufficiency) were linked to baxdrostat.[4] In conclusion, patients with RH can achieve better BP control from MRA and baxdrostat therapies, particularly because of significant systolic BP reduction. However, potassium levels must be monitored in patients receiving these therapies since a few individuals might experience hyperkalemia. Financial sup
{"title":"Aldosterone pathway blockade therapies for resistant hypertension: An update","authors":"Johao Escobar","doi":"10.4103/rcm.rcm_30_23","DOIUrl":"https://doi.org/10.4103/rcm.rcm_30_23","url":null,"abstract":"Dear Editor, Resistant hypertension (RH) is defined as the persistent blood pressure (BP) elevation above the target values utilizing three antihypertensive medications (a diuretic should be part of therapy) at the highest doses, and this BP elevation is not attributable to the whitecoat effect. If a patient with RH achieves BP control using ≥4 antihypertensive agents, the term describing this situation is “controlled RH.”[1] The advent of new therapies to manage RH is evolving, and some of the antihypertensive therapies that have shown significant benefits in randomized controlled trials are the mineralocorticoid receptor antagonists (MRA) such as spironolactone, eplerenone, and a new selective aldosterone inhibitor (AI), baxdrostat. The PATHWAY-2 and the BrigHTN studies are two of the most important randomized controlled trials demonstrating outstanding outcomes from the MRA and AI treatment in RH. In the PATHWAY-2 trial, patients with RH were randomized to receive spironolactone (25–50 mg), bisoprolol (5–10 mg), doxazosin (4–8 mg), or placebo for 12 weeks. Then, the dosage with each intervention was doubled after 6 weeks. Spironolactone showed the best reduction in home systolic BP compared to bisoprolol (−4.48 [−5.50 to −3.46]; P < 0.0001), doxazosin (−4.03 [−5.04 to −3.02]; P < 0.0001), and placebo (−8.70 mmHg [95% confidence interval (CI) −9.72 to −7.69]; P < 0.0001). However, serum potassium above 6·0 mmol/L was noted in 6 of the 285 patients that received spironolactone.[2] One of the most ambitious therapies for RH is baxdrostat, which acts by inhibiting aldosterone synthase selectively without altering cortisol levels.[3] The BrigHTN study, a phase 2 multicenter trial, compared the values of systolic BP at 12 weeks in patients with RH receiving either baxdrostat (0.5 mg, 1 mg, or 2 mg) or placebo. The median systolic BP decrease with baxdrostat was −20.3 mmHg (2 mg group), −17.5 mm Hg (1 mg group) and −12.1 mmHg (0.5 mg group). The reduction in systolic BP observed with the placebo group was −9.4 mmHg. The change in systolic BP showed a significant difference between the 2-mg group and the placebo group, with a decrease of 11.0 mmHg (95% CI, −16.4 to −5.5; P < 0.001). Similarly, the 1-mg group also exhibited a significant difference compared to the placebo group, with a decrease of 8.1 mmHg (95% CI, −13.5 to −2.8; P = 0.003). Even though the baxdrostat groups were associated with an increment in the potassium level above 6.0 mmol/L in two patients of the 248 individuals, there was no need for baxdrostat withdrawal or reinitiation. No deaths or serious adverse events (including adrenocortical insufficiency) were linked to baxdrostat.[4] In conclusion, patients with RH can achieve better BP control from MRA and baxdrostat therapies, particularly because of significant systolic BP reduction. However, potassium levels must be monitored in patients receiving these therapies since a few individuals might experience hyperkalemia. Financial sup","PeriodicalId":21031,"journal":{"name":"Research in Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136207953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Context: Angiotensin receptor-neprilysin inhibitor (ARNi) has been established as the standard medication for heart failure. However, the blood pressure (BP)-lowering effect circumvented its administration and titration in patients with borderline hypotension. Aim: This study aimed to determine the correlation between ARNi dosage and hemodynamic impacts. Subjects and Methods: A network meta-analysis was conducted to interrogate the BP impact of ARNi (sacubitril/valsartan 100 mg/d, 200 mg/d, 400 mg/d) and angiotensin receptor blocker (ARB) counterparts. Individuals with mild-to-moderate systolic hypertension were enrolled in respective studies. The outcomes were set as the change from baseline systolic and diastolic BP. Statistical Analysis Used: Network meta-analysis, node-splitting, and inconsistency model methods in Bayesian approach were employed. Results: A total of 14 manuscripts with 7705 subjects were included for pooled analysis. Compared with ARB, sacubitril/valsartan 400 mg/d and 200 mg/d, but not 100 mg/d, were associated with significantly greater reduction effect of systolic and diastolic BP, either by office documentation or 24-h ambulatory monitoring. The BP-lowering effect of sacubitril/valsartan 400 mg/d and 200 mg/d was nevertheless equivalent. Conclusions: ARNi exerts a dose-dependent effect on BP reduction. Such hemodynamic impact exceeds ARB at higher doses.
{"title":"Dose-dependent reduction of blood pressure by angiotensin receptor-neprilysin inhibitor: A network meta-analysis","authors":"Yi-Chih Lee, Ting-Wei Kao","doi":"10.4103/rcm.rcm_33_22","DOIUrl":"https://doi.org/10.4103/rcm.rcm_33_22","url":null,"abstract":"Context: Angiotensin receptor-neprilysin inhibitor (ARNi) has been established as the standard medication for heart failure. However, the blood pressure (BP)-lowering effect circumvented its administration and titration in patients with borderline hypotension. Aim: This study aimed to determine the correlation between ARNi dosage and hemodynamic impacts. Subjects and Methods: A network meta-analysis was conducted to interrogate the BP impact of ARNi (sacubitril/valsartan 100 mg/d, 200 mg/d, 400 mg/d) and angiotensin receptor blocker (ARB) counterparts. Individuals with mild-to-moderate systolic hypertension were enrolled in respective studies. The outcomes were set as the change from baseline systolic and diastolic BP. Statistical Analysis Used: Network meta-analysis, node-splitting, and inconsistency model methods in Bayesian approach were employed. Results: A total of 14 manuscripts with 7705 subjects were included for pooled analysis. Compared with ARB, sacubitril/valsartan 400 mg/d and 200 mg/d, but not 100 mg/d, were associated with significantly greater reduction effect of systolic and diastolic BP, either by office documentation or 24-h ambulatory monitoring. The BP-lowering effect of sacubitril/valsartan 400 mg/d and 200 mg/d was nevertheless equivalent. Conclusions: ARNi exerts a dose-dependent effect on BP reduction. Such hemodynamic impact exceeds ARB at higher doses.","PeriodicalId":21031,"journal":{"name":"Research in Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136208387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Neurological complications (NCs) (stroke) remain a devastating complication after cardiovascular surgical procedures despite advances in perioperative monitoring and management. The incidence of NC related to cardiovascular surgeries (CS) is comparatively very high and associated with high morbidity and mortality. The aim of this study is to evaluate the overall incidence of neurological complications in adult as well as pediatric patients and various pattern of neurological injury on noncontrast computed tomography head (NCCT) associated with various types of CS. Materials and Methods: We retrospectively analyzed all the NCCT heads of the postoperative cardiovascular surgery patients done in the immediate and early postoperative period (<7 days) who developed postoperative neurological deficits between April 2016 and February 2020. The medical records of all these cardiac surgery patients were analyzed for various variants such as the total number of patients who underwent CS, various types of cardiac surgery done during the study period, demographic information, associated comorbidities, various types of NC, postoperative data and various spectrum of computed tomography (CT) findings in the brain. Results: A total of 12,896 adult and pediatric cardiac surgeries were performed at our institute. Out of these, 1115 patients (8.6%) underwent CT brain for suspected neurological injury. A total of 215 patients (1.6%) had a positive finding on their NCCT head. Out of 215 patients, 148 (68.9%) were adult patients, whereas 67 (31.1%) were pediatric patients. A total of 156 (72.5%) patients had ischemic infarction (stroke), whereas hemorrhagic lesions were present in 59 patients (27.4%). The various types of positive CT scan findings were-156 ischemic infarcts (72.5%), 20 intraparenchymal hemorrhages (9.3%), 16 subdural hemorrhage (7.4%), 15 subarachnoid hemorrhage (6.9%), 01 cerebrovascular thrombosis (0.4%), and 07 intraventricular hemorrhage (3.2%). In an adult patient, pattern of ischemic infarct comprised middle cerebral artery (MCA) territory in 42 patients (41.5%), posterior territory in 34 patients (33.6%), anterior cerebral territory in seven patients (7.0%), multi-territory infracts in 11 patients (11.0%) and global ischemia in six patients (6.0%). Intraparenchymal hemorrhage was present in 17 patients (11.4%). In a pediatric subset of patient, the pattern of ischemic infarct included global hypoxic injury (GHI) in 30 patients (54.5%), posterior cerebral artery territory in nine patients (16.3%), MCA territory in eight patients (14.5%), multi-territory involvement in five patients (9.0%), and anterior cerebral artery territory in three patients (5.4%). In the hemorrhage group, five patients (7.4%) developed subarachnoid hemorrhage (SAH). Conclusion: In an adult patient, subset MCA territory infarcts were common in the infract group, whereas intra parenchymal haemorrhage (IPH) in the hemorrhage group. In the pediatric patient subset,
{"title":"Incidence and distribution of various arterial territories involved in postoperative neurological complications in patients undergoing cardiovascular surgery: A single centre retrospective analysis","authors":"Kumar Rahul, Pankaj Garg, Suresh Kumar, Satish Kumar, Bhupendra Kumar, Sarvesh Kumar, Vivek Tewarson","doi":"10.4103/rcm.rcm_6_23","DOIUrl":"https://doi.org/10.4103/rcm.rcm_6_23","url":null,"abstract":"Background: Neurological complications (NCs) (stroke) remain a devastating complication after cardiovascular surgical procedures despite advances in perioperative monitoring and management. The incidence of NC related to cardiovascular surgeries (CS) is comparatively very high and associated with high morbidity and mortality. The aim of this study is to evaluate the overall incidence of neurological complications in adult as well as pediatric patients and various pattern of neurological injury on noncontrast computed tomography head (NCCT) associated with various types of CS. Materials and Methods: We retrospectively analyzed all the NCCT heads of the postoperative cardiovascular surgery patients done in the immediate and early postoperative period (<7 days) who developed postoperative neurological deficits between April 2016 and February 2020. The medical records of all these cardiac surgery patients were analyzed for various variants such as the total number of patients who underwent CS, various types of cardiac surgery done during the study period, demographic information, associated comorbidities, various types of NC, postoperative data and various spectrum of computed tomography (CT) findings in the brain. Results: A total of 12,896 adult and pediatric cardiac surgeries were performed at our institute. Out of these, 1115 patients (8.6%) underwent CT brain for suspected neurological injury. A total of 215 patients (1.6%) had a positive finding on their NCCT head. Out of 215 patients, 148 (68.9%) were adult patients, whereas 67 (31.1%) were pediatric patients. A total of 156 (72.5%) patients had ischemic infarction (stroke), whereas hemorrhagic lesions were present in 59 patients (27.4%). The various types of positive CT scan findings were-156 ischemic infarcts (72.5%), 20 intraparenchymal hemorrhages (9.3%), 16 subdural hemorrhage (7.4%), 15 subarachnoid hemorrhage (6.9%), 01 cerebrovascular thrombosis (0.4%), and 07 intraventricular hemorrhage (3.2%). In an adult patient, pattern of ischemic infarct comprised middle cerebral artery (MCA) territory in 42 patients (41.5%), posterior territory in 34 patients (33.6%), anterior cerebral territory in seven patients (7.0%), multi-territory infracts in 11 patients (11.0%) and global ischemia in six patients (6.0%). Intraparenchymal hemorrhage was present in 17 patients (11.4%). In a pediatric subset of patient, the pattern of ischemic infarct included global hypoxic injury (GHI) in 30 patients (54.5%), posterior cerebral artery territory in nine patients (16.3%), MCA territory in eight patients (14.5%), multi-territory involvement in five patients (9.0%), and anterior cerebral artery territory in three patients (5.4%). In the hemorrhage group, five patients (7.4%) developed subarachnoid hemorrhage (SAH). Conclusion: In an adult patient, subset MCA territory infarcts were common in the infract group, whereas intra parenchymal haemorrhage (IPH) in the hemorrhage group. In the pediatric patient subset,","PeriodicalId":21031,"journal":{"name":"Research in Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136208392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aim and Objectives: Recent randomized controlled trials have demonstrated the benefit of patent foramen ovale (PFO) device closure over medical therapy alone for secondary prevention of cryptogenic stroke in carefully selected patients. In the current study, we sought to investigate the outcomes and complications of PFO device closure in our referral tertiary cardiovascular center. Materials and Methods: In this retrospective study, 155 adult patients who underwent PFO device closure between 2006 and 2021 were included. Patient characteristics, recurrent neurologic events, and procedure-related complications were evaluated. Results: The follow-up period was 2.3 ± 1.2 years. The average age of the participants was 41.3 ± 10 years, and 59.4% were male. Six patients (3.9%) suffered recurrent cerebrovascular events in the follow-up. No procedure-related complications were reported in our study population. Two patients (1.3%) with recurrent stroke had developed newly diagnosed atrial fibrillation (AF). Conclusion: PFO device closure is a safe and effective method for the prevention of recurrent ischemic stroke in patients with no other detectable etiology. Patients, particularly those with cardiovascular risk factors, should be meticulously investigated for the asymptomatic episodes of AF as the contributing factor with prolonged Holter monitoring or use of loop recorders.
{"title":"Safety and efficacy of patent foramen ovale device closure: Evaluation of outcomes in a tertiary referral center","authors":"Sedigheh Saedi, Maryam Favaedi, Maryam Danesh-Moghadam, Zahra Khajali, Ata Firouzi, Mozhgan Parsaee","doi":"10.4103/rcm.rcm_16_23","DOIUrl":"https://doi.org/10.4103/rcm.rcm_16_23","url":null,"abstract":"Aim and Objectives: Recent randomized controlled trials have demonstrated the benefit of patent foramen ovale (PFO) device closure over medical therapy alone for secondary prevention of cryptogenic stroke in carefully selected patients. In the current study, we sought to investigate the outcomes and complications of PFO device closure in our referral tertiary cardiovascular center. Materials and Methods: In this retrospective study, 155 adult patients who underwent PFO device closure between 2006 and 2021 were included. Patient characteristics, recurrent neurologic events, and procedure-related complications were evaluated. Results: The follow-up period was 2.3 ± 1.2 years. The average age of the participants was 41.3 ± 10 years, and 59.4% were male. Six patients (3.9%) suffered recurrent cerebrovascular events in the follow-up. No procedure-related complications were reported in our study population. Two patients (1.3%) with recurrent stroke had developed newly diagnosed atrial fibrillation (AF). Conclusion: PFO device closure is a safe and effective method for the prevention of recurrent ischemic stroke in patients with no other detectable etiology. Patients, particularly those with cardiovascular risk factors, should be meticulously investigated for the asymptomatic episodes of AF as the contributing factor with prolonged Holter monitoring or use of loop recorders.","PeriodicalId":21031,"journal":{"name":"Research in Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136206885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The anomalous origin of the left coronary artery (LCA) from the pulmonary artery (PA) is a very uncommon congenital anomalous that can be fatal. The adult type of this coronary abnormality can be the presence of varied from asymptomatic to sudden cardiac death. In this study, we present a 35-year-old female with a diagnosis of LCA from the PA that present with exertional dyspnea due to systolic dysfunction after myocardial ischemia secondary to this anomaly. She underwent successful Takeuchi repair without any complications.
{"title":"Late adult anomalous origin of the left coronary artery from the pulmonary artery presentation by heart failure, underwent takeuchi repair – A case report","authors":"Soheila Salari, Zahra Khajali, Yaser Toloueitabar, Mahnaz Farajollahi, Atefe Shafiee, Sahar Molseghi","doi":"10.4103/rcm.rcm_38_22","DOIUrl":"https://doi.org/10.4103/rcm.rcm_38_22","url":null,"abstract":"The anomalous origin of the left coronary artery (LCA) from the pulmonary artery (PA) is a very uncommon congenital anomalous that can be fatal. The adult type of this coronary abnormality can be the presence of varied from asymptomatic to sudden cardiac death. In this study, we present a 35-year-old female with a diagnosis of LCA from the PA that present with exertional dyspnea due to systolic dysfunction after myocardial ischemia secondary to this anomaly. She underwent successful Takeuchi repair without any complications.","PeriodicalId":21031,"journal":{"name":"Research in Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136207120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The objective of this study was to identify the level of treatment adherence and also sought to explore several demographic, clinical, comorbidities, and self-care behavior factors that may affect adherence among patients with heart failure (HF). Materials and Methods: This single-center cross-sectional, questionnaire-based study was conducted on 500 adult HF patients referred to the clinic of Rajaie Cardiovascular, Medical, and Research Center, in Tehran, Iran, from February to July 2022. The level of treatment adherence was assessment through Modanloo’s questionnaire. An unadjusted and adjusted binary logistic regression model was used to check the effect of different factors on the patients’ adherence level. Results: Among 474 responders, 51.7% had “good” adherence to treatment. According to the results, age >54 years (odds ratio [OR]: 0.967, 95% confidence interval [CI]: 0.946–0.988, P = 0.002), mitral valve regurgitation (OR: 0.597, 95% CI: 0.362–0.982, P = 0.042) and HF duration (OR: 0.486, 95% CI: 0.274–0.862, P = 0.014) were found as independent variables associated with “poor” treatment adherence. However, higher educational level (OR: 3.313, 95% CI: 2.632–4.067, P < 0.001), New York Heart Association class I (OR: 3.231, 95% CI: 1.587–4.661, P = 0.002), ejection fraction (EF) >40% (OR: 1.023, 95% CI: 1.005–1.041, P = 0.013), HF with preserved EF (OR: 2.728, 95% CI: 1.387–5.365, P = 0.004), familiar with social media (OR: 3.792, 95% CI: 1.777–4.268, P < 0.001) and high awareness of HF (OR: 2.385, 95% CI: 1.072–3.044, P = 0.006) were significant positive predictors for good adherence to treatment. Conclusion: Adherence to the treatment regimen has improved compared to previous studies, but is still suboptimal, particularly with respect to awareness of HF. Therefore, improving the awareness of patients as well as encouraging and supporting them for self-care behaviors can have a positive effect on treatment adherence.
背景:本研究的目的是确定治疗依从性水平，并试图探索可能影响心力衰竭(HF)患者依从性的几种人口统计学、临床、合并症和自我保健行为因素。材料与方法:这项单中心横断面、基于问卷的研究于2022年2月至7月在伊朗德黑兰Rajaie心血管、医学和研究中心门诊就诊的500名成年HF患者中进行。通过Modanloo问卷评估治疗依从性水平。采用未调整和调整的二元logistic回归模型检验不同因素对患者依从性水平的影响。结果:在474名应答者中，51.7%的人治疗依从性“良好”。结果显示，年龄>54岁(比值比[OR]: 0.967, 95%可信区间[CI]: 0.946 ~ 0.988, P = 0.002)、二尖瓣返流(OR: 0.597, 95% CI: 0.362 ~ 0.982, P = 0.042)和心绞痛持续时间(OR: 0.486, 95% CI: 0.274 ~ 0.862, P = 0.014)是与“不良”治疗依从性相关的独立变量。然而，较高的教育水平(OR: 3.313, 95% CI: 2.632-4.067, P < 0.001)，纽约心脏协会I级(OR: 3.231, 95% CI: 1.587-4.661, P = 0.002)，射血分数(EF) >40% (OR: 1.023, 95% CI: 1.005-1.041, P = 0.013)，保留EF的HF (OR: 2.728, 95% CI: 1.387-5.365, P = 0.004)，熟悉社交媒体(OR: 3.792, 95% CI: 1.77 - 4.268, P < 0.001)，以及对HF的高度认识(OR: 2.385, 95% CI: P < 0.001)。1.072-3.044, P = 0.006)为治疗依从性良好的显著阳性预测因子。结论:与以前的研究相比，治疗方案的依从性有所改善，但仍然不够理想，特别是在心衰意识方面。因此，提高患者的自我护理意识，鼓励和支持患者的自我护理行为，可以对治疗依从性产生积极的影响。
{"title":"Predictions of adherence to treatment in patients referred to the heart failure clinic of shahid rajaee hospital in Tehran","authors":"Fakhrudin Faizi, Asma Shojaee, AmirVahedian Azimi, Nasim Naderi, MohammadMehdi Salaree","doi":"10.4103/rcm.rcm_36_22","DOIUrl":"https://doi.org/10.4103/rcm.rcm_36_22","url":null,"abstract":"Background: The objective of this study was to identify the level of treatment adherence and also sought to explore several demographic, clinical, comorbidities, and self-care behavior factors that may affect adherence among patients with heart failure (HF). Materials and Methods: This single-center cross-sectional, questionnaire-based study was conducted on 500 adult HF patients referred to the clinic of Rajaie Cardiovascular, Medical, and Research Center, in Tehran, Iran, from February to July 2022. The level of treatment adherence was assessment through Modanloo’s questionnaire. An unadjusted and adjusted binary logistic regression model was used to check the effect of different factors on the patients’ adherence level. Results: Among 474 responders, 51.7% had “good” adherence to treatment. According to the results, age >54 years (odds ratio [OR]: 0.967, 95% confidence interval [CI]: 0.946–0.988, P = 0.002), mitral valve regurgitation (OR: 0.597, 95% CI: 0.362–0.982, P = 0.042) and HF duration (OR: 0.486, 95% CI: 0.274–0.862, P = 0.014) were found as independent variables associated with “poor” treatment adherence. However, higher educational level (OR: 3.313, 95% CI: 2.632–4.067, P < 0.001), New York Heart Association class I (OR: 3.231, 95% CI: 1.587–4.661, P = 0.002), ejection fraction (EF) >40% (OR: 1.023, 95% CI: 1.005–1.041, P = 0.013), HF with preserved EF (OR: 2.728, 95% CI: 1.387–5.365, P = 0.004), familiar with social media (OR: 3.792, 95% CI: 1.777–4.268, P < 0.001) and high awareness of HF (OR: 2.385, 95% CI: 1.072–3.044, P = 0.006) were significant positive predictors for good adherence to treatment. Conclusion: Adherence to the treatment regimen has improved compared to previous studies, but is still suboptimal, particularly with respect to awareness of HF. Therefore, improving the awareness of patients as well as encouraging and supporting them for self-care behaviors can have a positive effect on treatment adherence.","PeriodicalId":21031,"journal":{"name":"Research in Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136206881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Prosthetic valve thrombosis is of the serious long-term complications of heart valve replacement that its treatment particularly in left-sided valves is controversial. Both surgery and thrombolysis are associated with their own merits and drawbacks. Hence, the aim of the present study is the evaluation of response to surgery and thrombolytic therapy in patients with aortic prosthetic valve thrombosis in a tertiary heart center in Tehran, Iran, during 2007–2019. Materials and Methods: In this retrospective study, 85 patients with aortic prosthetic valve thrombosis (including 63 case of surgery and 22 case of thrombolytic therapy) were evaluated. Response to clinical and hemodynamic treatment and frequency of complications and mortality were determined in each group. Results: Clinical complete response in surgery group (84.13%) was significantly more than patients with thrombolytic therapy (64.63%). The frequency of complications in surgery and the thrombolytic group was 12.7% and 9.09%, respectively, which show no significant difference. Mortality was seen in 1.58% and 4.53% of patients with surgery and thrombolytic therapy respectively that was not statistically significant. Complete failure of treatment was seen in 18.18% of patients with thrombolytic therapy and re-surgery was done for them. The surgery success rate was significantly more than thrombolytic success rate in patients with a therapeutic range of international normalized ratio (INR) level. Conclusion: Surgery versus thrombolytic therapy has more efficacy and similar safety in patients with aortic prosthetic valve thrombosis and may be preferable treatment for these patients. However, thrombolytic therapy also can be used as a suitable alternative, particularly in patients with a high risk of surgery.
{"title":"Evaluation of response to thrombolytic therapy versus surgery in patients with aortic prosthetic valve thrombosis in a tertiary heart center in Tehran, Iran, during 2007–2019","authors":"SeyedEhsan Parhizgar, Maryam Shojaeifard, Iman Koochari, Keyvan Zarei, HosseinDehghani Mohammadabadi, Sajad Erami, Vadood Khoshtinat, MohammadJavad Bahadori, Parisa Rezazadeh","doi":"10.4103/rcm.rcm_9_23","DOIUrl":"https://doi.org/10.4103/rcm.rcm_9_23","url":null,"abstract":"Background: Prosthetic valve thrombosis is of the serious long-term complications of heart valve replacement that its treatment particularly in left-sided valves is controversial. Both surgery and thrombolysis are associated with their own merits and drawbacks. Hence, the aim of the present study is the evaluation of response to surgery and thrombolytic therapy in patients with aortic prosthetic valve thrombosis in a tertiary heart center in Tehran, Iran, during 2007–2019. Materials and Methods: In this retrospective study, 85 patients with aortic prosthetic valve thrombosis (including 63 case of surgery and 22 case of thrombolytic therapy) were evaluated. Response to clinical and hemodynamic treatment and frequency of complications and mortality were determined in each group. Results: Clinical complete response in surgery group (84.13%) was significantly more than patients with thrombolytic therapy (64.63%). The frequency of complications in surgery and the thrombolytic group was 12.7% and 9.09%, respectively, which show no significant difference. Mortality was seen in 1.58% and 4.53% of patients with surgery and thrombolytic therapy respectively that was not statistically significant. Complete failure of treatment was seen in 18.18% of patients with thrombolytic therapy and re-surgery was done for them. The surgery success rate was significantly more than thrombolytic success rate in patients with a therapeutic range of international normalized ratio (INR) level. Conclusion: Surgery versus thrombolytic therapy has more efficacy and similar safety in patients with aortic prosthetic valve thrombosis and may be preferable treatment for these patients. However, thrombolytic therapy also can be used as a suitable alternative, particularly in patients with a high risk of surgery.","PeriodicalId":21031,"journal":{"name":"Research in Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136208181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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