Pub Date : 2024-09-16DOI: 10.1186/s43044-024-00559-2
Sudipta Mondal, Prabhu Selvaraj, Asish Vijayaraghavan, Viswanadh S. V. G. Kalaparti, Deepti Narasimhaiah
The occurrence of cerebral aneurysm in a case of cardiac myxoma is rare with less than 60 cases reported worldwide. The course of management is still debatable given its rarity. We present a case of multiple intracranial aneurysms secondary to atrial myxoma in a young lady with a brief review of the literature. Case presentation A young lady in her late 30s with a history of right middle cerebral artery territory stroke eight years ago presented with gradually progressive symptoms in the form of holocranial headache, inattention and forgetfulness for the last few years. On neuroimaging, she was found to have multi-territorial lacunar infarcts and multiple intracranial artery aneurysms which was confirmed with a digital subtraction angiogram. A cardiac evaluation revealed a left atrial myxoma. The aetiology of subcortical cognitive decline and intracranial aneurysms was attributed to the myxoma with secondary myxomatous embolism. Other secondary causes were ruled out. She is being followed up medically after resection of the myxoma. Intracranial aneurysms are rare complications of cardiac myxoma which may present before, concurrent or many years after diagnosis of the myxoma. Nonspecific neurological complaints occasionally are the ominous signs of intracranial aneurysms which mandate a low threshold for neuroimaging in a case of cardiac myxoma. Given the absence of definitive risk factors and unclear natural history, clinical and radiological follow-ups are critical. Learning Points
{"title":"Myxomatous cause of multiple intracranial aneurysms and cognitive decline: a case report","authors":"Sudipta Mondal, Prabhu Selvaraj, Asish Vijayaraghavan, Viswanadh S. V. G. Kalaparti, Deepti Narasimhaiah","doi":"10.1186/s43044-024-00559-2","DOIUrl":"https://doi.org/10.1186/s43044-024-00559-2","url":null,"abstract":"The occurrence of cerebral aneurysm in a case of cardiac myxoma is rare with less than 60 cases reported worldwide. The course of management is still debatable given its rarity. We present a case of multiple intracranial aneurysms secondary to atrial myxoma in a young lady with a brief review of the literature. Case presentation A young lady in her late 30s with a history of right middle cerebral artery territory stroke eight years ago presented with gradually progressive symptoms in the form of holocranial headache, inattention and forgetfulness for the last few years. On neuroimaging, she was found to have multi-territorial lacunar infarcts and multiple intracranial artery aneurysms which was confirmed with a digital subtraction angiogram. A cardiac evaluation revealed a left atrial myxoma. The aetiology of subcortical cognitive decline and intracranial aneurysms was attributed to the myxoma with secondary myxomatous embolism. Other secondary causes were ruled out. She is being followed up medically after resection of the myxoma. Intracranial aneurysms are rare complications of cardiac myxoma which may present before, concurrent or many years after diagnosis of the myxoma. Nonspecific neurological complaints occasionally are the ominous signs of intracranial aneurysms which mandate a low threshold for neuroimaging in a case of cardiac myxoma. Given the absence of definitive risk factors and unclear natural history, clinical and radiological follow-ups are critical. Learning Points ","PeriodicalId":22462,"journal":{"name":"The Egyptian Heart Journal","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142250348","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}
Pub Date : 2024-09-16DOI: 10.1186/s43044-024-00561-8
Gbolahan Olatunji, Emmanuel Kokori, John Aboje, Saad Mohammed, Olamide Asifat, David Timilehin Isarinade, Ismaila Ajayi Yusuf, David B. Olawade, Nicholas Aderinto
Excimer laser coronary angioplasty (ELCA) has evolved as a pivotal element in percutaneous coronary intervention (PCI), significantly influencing procedural efficacy and safety. This mini-narrative review explores ELCA's applications, focusing on its efficacy and clinical outcomes. A search of major databases identified studies from ELCA's inception. Inclusion criteria encompassed diverse study designs exploring ELCA in coronary interventions, with rigorous data extraction ensuring accuracy and completeness. A narrative synthesis presented key findings across studies. ELCA demonstrated promising outcomes compared to traditional PCI and stent placement. Reduced reperfusion time, enhanced microcirculation, and lower postoperative major adverse cardiac events (MACE) rates highlighted its efficacy. Improved vascular and lumen dynamics, plaque modification, and successful treatment of complex lesions showcased its versatility. Quality of life enhancements positively impacted long-term recovery, particularly in acute coronary syndrome (ACS) cases. ELCA's success in challenging scenarios and its role in refining in-stent restenosis (ISR) treatment indicated broader applications. Despite limitations in some studies, ELCA presented a favorable safety profile. The review underscores ELCA's dynamic role in coronary interventions, offering a promising tool for enhancing procedural outcomes. Clinical implications include improved reperfusion, adaptability in complex lesions, and potential long-term benefits for ACS patients. While integration into routine practice requires careful consideration, ELCA's positive outcomes encourage further exploration and innovation in interventional cardiology.
{"title":"Excimer laser coronary angioplasty: a mini-narrative review of clinical outcomes","authors":"Gbolahan Olatunji, Emmanuel Kokori, John Aboje, Saad Mohammed, Olamide Asifat, David Timilehin Isarinade, Ismaila Ajayi Yusuf, David B. Olawade, Nicholas Aderinto","doi":"10.1186/s43044-024-00561-8","DOIUrl":"https://doi.org/10.1186/s43044-024-00561-8","url":null,"abstract":"Excimer laser coronary angioplasty (ELCA) has evolved as a pivotal element in percutaneous coronary intervention (PCI), significantly influencing procedural efficacy and safety. This mini-narrative review explores ELCA's applications, focusing on its efficacy and clinical outcomes. A search of major databases identified studies from ELCA's inception. Inclusion criteria encompassed diverse study designs exploring ELCA in coronary interventions, with rigorous data extraction ensuring accuracy and completeness. A narrative synthesis presented key findings across studies. ELCA demonstrated promising outcomes compared to traditional PCI and stent placement. Reduced reperfusion time, enhanced microcirculation, and lower postoperative major adverse cardiac events (MACE) rates highlighted its efficacy. Improved vascular and lumen dynamics, plaque modification, and successful treatment of complex lesions showcased its versatility. Quality of life enhancements positively impacted long-term recovery, particularly in acute coronary syndrome (ACS) cases. ELCA's success in challenging scenarios and its role in refining in-stent restenosis (ISR) treatment indicated broader applications. Despite limitations in some studies, ELCA presented a favorable safety profile. The review underscores ELCA's dynamic role in coronary interventions, offering a promising tool for enhancing procedural outcomes. Clinical implications include improved reperfusion, adaptability in complex lesions, and potential long-term benefits for ACS patients. While integration into routine practice requires careful consideration, ELCA's positive outcomes encourage further exploration and innovation in interventional cardiology.","PeriodicalId":22462,"journal":{"name":"The Egyptian Heart Journal","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142250347","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}
Pub Date : 2024-09-14DOI: 10.1186/s43044-024-00556-5
Abhimanyu Agarwal, Mohamed A. Mostafa, Muhammad Imtiaz Ahmad, Elsayed Z. Soliman
This systematic review aims to determine the impact of isolated diastolic hypertension (IDH) on cardiovascular outcomes. We searched only English language articles on PubMed and SCOPUS until July 31, 2023 to investigate the association between IDH and cardiovascular outcomes. This meta-analysis of 19 studies evaluated the impact of different hypertension diagnostic guidelines (ACC/AHA: American Heart Association/American College of Cardiology; JNC7: Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; NICE/ESC: National Institute for Health and Care Excellence/European Society of Cardiology) on hypertension-related outcomes. Studies had varying sample sizes (173 to 2,969,679 participants) and study designs. In cohort studies using JNC7 guidelines, IDH was linked to increased cardiovascular disease (CVD) risk (HR: 1.45, 95% CI 1.17, 1.74), CVD mortality (HR: 1.54, 95% CI 1.23, 1.84), and coronary heart disease (CHD) risk (HR: 1.65). In studies using ACC/AHA guidelines, associations with CVD risk and CVD mortality were weaker [HR: 1.16 (95% CI 1.06, 1.25) and 1.10 (95% CI 0.95, 1.25), respectively]. Subgroup analysis revealed differences in outcomes on the basis of age and sex. Cross-sectional studies did not show significant associations with JNC7 and ACC guidelines; NICE guidelines were not used in cross-sectional studies. IDH is associated with an increased risk of CVD. Higher diastolic blood pressure cutoffs were associated with higher cardiovascular risk. This association varied by study design and effect modification by sex and race influenced the association.
{"title":"Isolated diastolic hypertension and cardiovascular outcomes across different diagnostic guidelines: a systematic review and meta-analysis","authors":"Abhimanyu Agarwal, Mohamed A. Mostafa, Muhammad Imtiaz Ahmad, Elsayed Z. Soliman","doi":"10.1186/s43044-024-00556-5","DOIUrl":"https://doi.org/10.1186/s43044-024-00556-5","url":null,"abstract":"This systematic review aims to determine the impact of isolated diastolic hypertension (IDH) on cardiovascular outcomes. We searched only English language articles on PubMed and SCOPUS until July 31, 2023 to investigate the association between IDH and cardiovascular outcomes. This meta-analysis of 19 studies evaluated the impact of different hypertension diagnostic guidelines (ACC/AHA: American Heart Association/American College of Cardiology; JNC7: Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; NICE/ESC: National Institute for Health and Care Excellence/European Society of Cardiology) on hypertension-related outcomes. Studies had varying sample sizes (173 to 2,969,679 participants) and study designs. In cohort studies using JNC7 guidelines, IDH was linked to increased cardiovascular disease (CVD) risk (HR: 1.45, 95% CI 1.17, 1.74), CVD mortality (HR: 1.54, 95% CI 1.23, 1.84), and coronary heart disease (CHD) risk (HR: 1.65). In studies using ACC/AHA guidelines, associations with CVD risk and CVD mortality were weaker [HR: 1.16 (95% CI 1.06, 1.25) and 1.10 (95% CI 0.95, 1.25), respectively]. Subgroup analysis revealed differences in outcomes on the basis of age and sex. Cross-sectional studies did not show significant associations with JNC7 and ACC guidelines; NICE guidelines were not used in cross-sectional studies. IDH is associated with an increased risk of CVD. Higher diastolic blood pressure cutoffs were associated with higher cardiovascular risk. This association varied by study design and effect modification by sex and race influenced the association.","PeriodicalId":22462,"journal":{"name":"The Egyptian Heart Journal","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142250349","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}
Pub Date : 2024-09-14DOI: 10.1186/s43044-024-00553-8
Zarin S. Rangwala, Bineesh K. Radhakrishnan, Pruthvi S. Patel, Prasanta K. Dash, G. Gayathri, Vivek V. Pillai
Cardiac ochronosis, presenting as a rare manifestation of alkaptonuria, an autosomal recessive disorder, is characterised by black pigmentation of calcified cardiac valves and atherosclerotic plaques. We report an intraoperative dilemma on the discovery on the black aortic valve in a case of an old lady with degenerative calcific aortic stenosis. A 60-year-old lady was electively admitted for valve replacement with a bioprosthetic valve for severe aortic stenosis. She was symptomatic with complaints of headache and giddiness and had a pressure gradient of 113/17mmhg across the aortic valve. Intraoperatively, she was found to have cardiac ochronosis on the discovery of pigmented aortic intima extending to the valve leaflets and underwent valve replacement with a mechanical prosthetic valve. She was post-operatively evaluated for the same and diagnosed with alkaptonuria. Though the surgery went uneventful and the patient was discharged without any complication, she was advised to be on regular follow-up to assess valve gradients, paravalvular leaks and to monitor the disease progression. The presented case sheds light on the rare cardiac manifestation of alkaptonuria. In the absence of definitive pre-operative diagnosis, intraoperative findings played a pivotal role in guiding the surgical approach and choice of prosthetic valve. The decision to use a mechanical valve was influenced by the potential risks associated with bioprosthetic valves in the setting of ochronosis. Ongoing follow-up and monitoring are essential to assess the durability of the chosen prosthetic valve and to manage any long-term consequences of the underlying metabolic condition.
{"title":"A rare differential diagnosis of aortic stenosis with a black aortic valve: A case report","authors":"Zarin S. Rangwala, Bineesh K. Radhakrishnan, Pruthvi S. Patel, Prasanta K. Dash, G. Gayathri, Vivek V. Pillai","doi":"10.1186/s43044-024-00553-8","DOIUrl":"https://doi.org/10.1186/s43044-024-00553-8","url":null,"abstract":"Cardiac ochronosis, presenting as a rare manifestation of alkaptonuria, an autosomal recessive disorder, is characterised by black pigmentation of calcified cardiac valves and atherosclerotic plaques. We report an intraoperative dilemma on the discovery on the black aortic valve in a case of an old lady with degenerative calcific aortic stenosis. A 60-year-old lady was electively admitted for valve replacement with a bioprosthetic valve for severe aortic stenosis. She was symptomatic with complaints of headache and giddiness and had a pressure gradient of 113/17mmhg across the aortic valve. Intraoperatively, she was found to have cardiac ochronosis on the discovery of pigmented aortic intima extending to the valve leaflets and underwent valve replacement with a mechanical prosthetic valve. She was post-operatively evaluated for the same and diagnosed with alkaptonuria. Though the surgery went uneventful and the patient was discharged without any complication, she was advised to be on regular follow-up to assess valve gradients, paravalvular leaks and to monitor the disease progression. The presented case sheds light on the rare cardiac manifestation of alkaptonuria. In the absence of definitive pre-operative diagnosis, intraoperative findings played a pivotal role in guiding the surgical approach and choice of prosthetic valve. The decision to use a mechanical valve was influenced by the potential risks associated with bioprosthetic valves in the setting of ochronosis. Ongoing follow-up and monitoring are essential to assess the durability of the chosen prosthetic valve and to manage any long-term consequences of the underlying metabolic condition.","PeriodicalId":22462,"journal":{"name":"The Egyptian Heart Journal","volume":"105 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142268751","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}
Pub Date : 2024-09-13DOI: 10.1186/s43044-024-00558-3
Cyndiana Widia Dewi Sinardja, Gusti Ngurah Prana Jagannatha, Bryan Gervais de Liyis, Anastasya Maria Kosasih
The beta-blocker (BB) initiation in acute heart failure (AHF) patients is still controversial. Some show the benefit of BB employment in decreasing the mortality outcome. This study aims to assess the safety and efficacy of in-hospital and long-term outcomes of BB initiation in AHF hospitalized patients. We searched multiple databases examining the outcome of AHF patients who had administered BB as the therapy initiation. Primary outcomes were all-cause mortality, composite endpoint after BB initiation when hospitalized, and post-discharge all-cause mortality. The secondary outcomes were adverse events after in-hospital BB initiation, including hypotension and symptomatic bradycardia after BB initiation when hospitalization and rehospitalization. Eight cohort studies with 16,639 patients suffering from AHF and cardiogenic shock, with 9923 participants allocated to the early BB group and 6,713 patients in the control group. The follow-up durations ranged from 2 to 24 months. Early BB administration significantly reduced in-hospital composite endpoints (RR: 0.42; 95% CI (0.30–0.58); p < 0.001), in-hospital all-cause mortality (RR: 0.43; 95% CI (0.31–0.61); p < 0.001), discharge mortality (RR: 0.51; 95% CI (0.41–0.63); p < 0.001), and rehospitalization (RR: 0.57; 95% CI (0.44–0.74); p < 0.001). There were no discernible differences in in-hospital BB-related adverse events between the two groups (p = 0.13). Subgroup analyses conducted on AHF patients presenting with cardiogenic shock revealed no significant differences in in-hospital composite endpoint and in-hospital mortality, and similar results were shown in the naive BB population. The BB initiation in AHF patients shows advantages in efficacy and safety outcome.
急性心力衰竭（AHF）患者开始使用β-受体阻滞剂（BB）仍存在争议。一些研究表明，使用β-受体阻滞剂有利于降低死亡率。本研究旨在评估急性心力衰竭住院患者使用β-受体阻滞剂的安全性和有效性以及长期疗效。我们检索了多个数据库，研究了使用 BB 作为初始疗法的 AHF 患者的疗效。主要结果是全因死亡率、住院期间开始使用 BB 后的综合终点以及出院后的全因死亡率。次要结果是住院时开始使用BB后的不良事件，包括住院时开始使用BB后出现的低血压和症状性心动过缓，以及再次住院时出现的低血压和症状性心动过缓。八项队列研究共涉及16639名AHF和心源性休克患者，其中9923名患者被分配到早期BB治疗组，6713名患者被分配到对照组。随访时间从2个月到24个月不等。早期BB治疗可明显降低院内复合终点（RR：0.42；95% CI (0.30-0.58)；P < 0.001）、院内全因死亡率（RR：0.43；95% CI (0.31-0.61)；P < 0.001）、出院死亡率（RR：0.51；95% CI (0.41-0.63)；P < 0.001）和再住院率（RR：0.57；95% CI (0.44-0.74)；P < 0.001）。两组患者在院内 BB 相关不良事件方面没有明显差异（P = 0.13）。对出现心源性休克的 AHF 患者进行的亚组分析显示，院内复合终点和院内死亡率无显著差异，在天真 BB 患者中也显示了类似的结果。AHF患者开始使用BB治疗在疗效和安全性方面均有优势。
{"title":"Safety and efficacy of early beta-blocker initiation in acute heart failure and cardiogenic shock: systematic review and meta-analysis","authors":"Cyndiana Widia Dewi Sinardja, Gusti Ngurah Prana Jagannatha, Bryan Gervais de Liyis, Anastasya Maria Kosasih","doi":"10.1186/s43044-024-00558-3","DOIUrl":"https://doi.org/10.1186/s43044-024-00558-3","url":null,"abstract":"The beta-blocker (BB) initiation in acute heart failure (AHF) patients is still controversial. Some show the benefit of BB employment in decreasing the mortality outcome. This study aims to assess the safety and efficacy of in-hospital and long-term outcomes of BB initiation in AHF hospitalized patients. We searched multiple databases examining the outcome of AHF patients who had administered BB as the therapy initiation. Primary outcomes were all-cause mortality, composite endpoint after BB initiation when hospitalized, and post-discharge all-cause mortality. The secondary outcomes were adverse events after in-hospital BB initiation, including hypotension and symptomatic bradycardia after BB initiation when hospitalization and rehospitalization. Eight cohort studies with 16,639 patients suffering from AHF and cardiogenic shock, with 9923 participants allocated to the early BB group and 6,713 patients in the control group. The follow-up durations ranged from 2 to 24 months. Early BB administration significantly reduced in-hospital composite endpoints (RR: 0.42; 95% CI (0.30–0.58); p < 0.001), in-hospital all-cause mortality (RR: 0.43; 95% CI (0.31–0.61); p < 0.001), discharge mortality (RR: 0.51; 95% CI (0.41–0.63); p < 0.001), and rehospitalization (RR: 0.57; 95% CI (0.44–0.74); p < 0.001). There were no discernible differences in in-hospital BB-related adverse events between the two groups (p = 0.13). Subgroup analyses conducted on AHF patients presenting with cardiogenic shock revealed no significant differences in in-hospital composite endpoint and in-hospital mortality, and similar results were shown in the naive BB population. The BB initiation in AHF patients shows advantages in efficacy and safety outcome.","PeriodicalId":22462,"journal":{"name":"The Egyptian Heart Journal","volume":"91 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142250350","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}
Globally, Ischemic heart disease (IHD) is considered a leading cause of mortality and morbidity affecting men than women. The more the population ages, the more the prevalence. There was a concern about improper referral of women to MPI testing. We aimed to study if there a gender effect on the results of MPI studies and if this could have an impact on future referral or investigation selection for diagnosis of IHD as a general or specially in women. Female gender represented 266 (60%) while male represented in 177 (40%). Males demonstrated significantly higher age (55 ± 10 vs. 49 ± 9, P < .0001), weight (85 ± 11 vs. 83 ± 13, P = 0.006), height (166 ± 4 vs. 165 ± 4, P = 0.02), and smoking (35% vs. 0%, P < 0.001) than females. Male gender was associated with ten times increased risk of positive MPI (OR = 10, 95% CI = 5.348–18.868, P < 0.001). Diabetes was associated with an increased risk of positive MPI (OR = 1.82, 95% CI = 1.052–3.148, P = 0.032). Positive MPI test are more common in males. Female patients with positive MPI were younger in age than male patients. Diabetes mellitus and age are traditional strong predictors for the presence of positive MPI test.
{"title":"Effect of gender on spect myocardial perfusion imaging results in Egypt","authors":"Taghreed Abdel-Rahman Ahmed, Ahmed Al-Habbaa, Mona Naiem, Naglaa Mokhtar, Fatma Elhady","doi":"10.1186/s43044-024-00560-9","DOIUrl":"https://doi.org/10.1186/s43044-024-00560-9","url":null,"abstract":"Globally, Ischemic heart disease (IHD) is considered a leading cause of mortality and morbidity affecting men than women. The more the population ages, the more the prevalence. There was a concern about improper referral of women to MPI testing. We aimed to study if there a gender effect on the results of MPI studies and if this could have an impact on future referral or investigation selection for diagnosis of IHD as a general or specially in women. Female gender represented 266 (60%) while male represented in 177 (40%). Males demonstrated significantly higher age (55 ± 10 vs. 49 ± 9, P < .0001), weight (85 ± 11 vs. 83 ± 13, P = 0.006), height (166 ± 4 vs. 165 ± 4, P = 0.02), and smoking (35% vs. 0%, P < 0.001) than females. Male gender was associated with ten times increased risk of positive MPI (OR = 10, 95% CI = 5.348–18.868, P < 0.001). Diabetes was associated with an increased risk of positive MPI (OR = 1.82, 95% CI = 1.052–3.148, P = 0.032). Positive MPI test are more common in males. Female patients with positive MPI were younger in age than male patients. Diabetes mellitus and age are traditional strong predictors for the presence of positive MPI test.","PeriodicalId":22462,"journal":{"name":"The Egyptian Heart Journal","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142193530","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}
Pub Date : 2024-09-12DOI: 10.1186/s43044-024-00550-x
Mehrdad Rabiee Rad, Ghazal Ghasempour Dabaghi, Bahar Darouei, Reza Amani-Beni, Mohammad Mehdi Zare, Fatemeh Shirin, Marjan Jamalian
The presence of cardiac myxoma in the right atrium (RA) is rare. There is limited knowledge regarding the clinical symptoms and diagnosis of RA myxoma. This systematic review aimed to provide a summary of the clinical and laboratory characteristics, electrocardiogram (ECG) findings, and outcome previous cases with RA myxoma. A comprehensive search was conducted in PubMed, Web of Science, and Scopus to identify relevant studies. Inclusion criteria were case reports and case series written in English that provided sufficient data on the manifestation of RA myxoma. Descriptive statistics were used for quantitative analysis. The search identified 619 patients from 480 eligible studies. The patient’s mean age was 45.7 ± 17.6 years, and 55.4% of cases were female. The most common clinical manifestations of RA myxoma were cardiac, systemic, and neurologic manifestations which reported in 77.0%, 34.8%, and 21.1% of cases, respectively. Besides, 11.7% of RA myxoma were asymptomatic. ECG findings revealed normal in 39.4% reported cases. The ECG abnormalities included tall or peaked P-wave, RA and LA enlargement (19.2%), abnormal T-wave (14.0%), sinus tachycardia (11.8%), and incomplete or complete RBBB (11.2%). Echocardiography remained the diagnostic method in a majority of the cases. The mortality rate of RA myxoma was low (9.2%) during the follow-up. This systematic review provides a comprehensive summary of the clinical and laboratory manifestations and outcomes of RA myxoma, contributing to the existing knowledge on this rare cardiac tumor.
右心房（RA）出现心脏肌瘤的情况十分罕见。人们对右心房心肌瘤的临床症状和诊断了解有限。本系统性综述旨在总结RA肌瘤的临床和实验室特征、心电图（ECG）结果以及既往病例的预后。我们在PubMed、Web of Science和Scopus上进行了全面搜索，以确定相关研究。纳入标准是以英语撰写的病例报告和系列病例，这些报告和系列病例提供了有关RA肌瘤表现的充足数据。描述性统计用于定量分析。搜索结果从480项符合条件的研究中发现了619名患者。患者的平均年龄为（45.7 ± 17.6）岁，55.4%的病例为女性。RA肌瘤最常见的临床表现是心脏、全身和神经系统表现，分别占77.0%、34.8%和21.1%。此外，11.7%的 RA 肌瘤无症状。39.4%的报告病例心电图结果显示正常。心电图异常包括高或峰值 P 波、RA 和 LA 扩大（19.2%）、T 波异常（14.0%）、窦性心动过速（11.8%）、不完全或完全 RBBB（11.2%）。超声心动图仍是大多数病例的诊断方法。随访期间，RA肌瘤的死亡率较低（9.2%）。这篇系统性综述全面总结了RA肌瘤的临床和实验室表现及预后，丰富了现有关于这种罕见心脏肿瘤的知识。
{"title":"Clinical and laboratory manifestations, ECG findings, and outcomes of right atrial myxoma: a systematic review of cases reported worldwide","authors":"Mehrdad Rabiee Rad, Ghazal Ghasempour Dabaghi, Bahar Darouei, Reza Amani-Beni, Mohammad Mehdi Zare, Fatemeh Shirin, Marjan Jamalian","doi":"10.1186/s43044-024-00550-x","DOIUrl":"https://doi.org/10.1186/s43044-024-00550-x","url":null,"abstract":"The presence of cardiac myxoma in the right atrium (RA) is rare. There is limited knowledge regarding the clinical symptoms and diagnosis of RA myxoma. This systematic review aimed to provide a summary of the clinical and laboratory characteristics, electrocardiogram (ECG) findings, and outcome previous cases with RA myxoma. A comprehensive search was conducted in PubMed, Web of Science, and Scopus to identify relevant studies. Inclusion criteria were case reports and case series written in English that provided sufficient data on the manifestation of RA myxoma. Descriptive statistics were used for quantitative analysis. The search identified 619 patients from 480 eligible studies. The patient’s mean age was 45.7 ± 17.6 years, and 55.4% of cases were female. The most common clinical manifestations of RA myxoma were cardiac, systemic, and neurologic manifestations which reported in 77.0%, 34.8%, and 21.1% of cases, respectively. Besides, 11.7% of RA myxoma were asymptomatic. ECG findings revealed normal in 39.4% reported cases. The ECG abnormalities included tall or peaked P-wave, RA and LA enlargement (19.2%), abnormal T-wave (14.0%), sinus tachycardia (11.8%), and incomplete or complete RBBB (11.2%). Echocardiography remained the diagnostic method in a majority of the cases. The mortality rate of RA myxoma was low (9.2%) during the follow-up. This systematic review provides a comprehensive summary of the clinical and laboratory manifestations and outcomes of RA myxoma, contributing to the existing knowledge on this rare cardiac tumor.","PeriodicalId":22462,"journal":{"name":"The Egyptian Heart Journal","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142193529","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}
Acute kidney injury (AKI) occurs frequently in ST-elevation myocardial infarction with cardiogenic shock (CS-STEMI) and is a strong independent prognostic marker for short and intermediate-term outcomes. Owing to the delayed presentation and limited facilities for primary percutaneous coronary intervention in low- and middle-income countries, the incidence, predictors, and outcome of AKI are likely to be different compared to the developed countries. We performed a post hoc analysis of patients presenting with CS-STEMI over 7 years (2016–2022) at a tertiary referral center in North India. The primary outcome assessed was AKI and the secondary outcome was in-hospital mortality. Of the 426 patients, 194 (45.5%) patients developed AKI, as defined by the Kidney Disease Improving Global Outcomes criteria. Left ventricular (LV) pump failure with pulmonary edema [Odds ratio (OR) 1.67; 95% confidence interval (CI) 1.04–2.67], LV ejection fraction (OR 1.35 per 10% decrease in ejection fraction; CI 1.04–1.73), complete heart block (OR 2.06; CI 1.2–3.53), right ventricular infarction (OR 2.76; CI 1.39–5.49), mechanical complications (OR 3.89; CI 1.85–8.21), ventricular tachycardia (OR 2.80; CI 1.57–4.99), and non-revascularization (OR 2.2; CI 1.33–3.67) were independent predictors of AKI in multivariate logistic regression analysis. Additionally, AKI was a strong predictor of in-hospital mortality (univariate OR 30.61, CI 17.37–53.95). There is a higher incidence of AKI in CS-STEMI in resource-limited settings and is associated with adverse short-term outcomes. Additional studies are needed to address the optimal strategies for the prevention and management of AKI in such settings.
急性肾损伤（AKI）经常发生在ST段抬高型心肌梗死伴心源性休克（CS-STEMI）中，是影响短期和中期预后的一个强有力的独立指标。由于中低收入国家的患者发病延迟，经皮冠状动脉介入治疗设施有限，因此 AKI 的发生率、预测因素和预后可能与发达国家不同。我们对北印度一家三级转诊中心 7 年内（2016-2022 年）的 CS-STEMI 患者进行了事后分析。评估的主要结果是 AKI，次要结果是院内死亡率。在426名患者中，194名（45.5%）患者出现了肾脏病改善全球结局标准定义的AKI。左心室泵衰竭伴肺水肿[比值比 (OR) 1.67；95% 置信区间 (CI)1.04-2.67]、左心室射血分数（射血分数每下降 10% OR 1.35；CI 1.04-1.73）、完全性心脏传导阻滞（OR 2.06；CI 1.2-3.53）、右心室梗死（OR 2.76；CI 1.39-5.49）、机械并发症（OR 3.89；CI 1.85-8.21）、室性心动过速（OR 2.80；CI 1.57-4.99）和无血管形成（OR 2.2；CI 1.33-3.67）是多变量逻辑回归分析中 AKI 的独立预测因素。此外，AKI 还是院内死亡率的有力预测因素（单变量 OR 30.61，CI 17.37-53.95）。在资源有限的环境中，CS-STEMI 患者的 AKI 发生率较高，并且与不良的短期预后有关。需要开展更多研究，以确定在这种情况下预防和管理 AKI 的最佳策略。
{"title":"A study of the predictive role of multiple variables for the incidence of acute kidney injury and its outcomes in Indian patients with ST-elevation myocardial infarction and cardiogenic shock","authors":"Kewal Kanabar, Yash Paul Sharma, Darshan Krishnappa, Krishna Santosh, Miren Dhudasia","doi":"10.1186/s43044-024-00557-4","DOIUrl":"https://doi.org/10.1186/s43044-024-00557-4","url":null,"abstract":"Acute kidney injury (AKI) occurs frequently in ST-elevation myocardial infarction with cardiogenic shock (CS-STEMI) and is a strong independent prognostic marker for short and intermediate-term outcomes. Owing to the delayed presentation and limited facilities for primary percutaneous coronary intervention in low- and middle-income countries, the incidence, predictors, and outcome of AKI are likely to be different compared to the developed countries. We performed a post hoc analysis of patients presenting with CS-STEMI over 7 years (2016–2022) at a tertiary referral center in North India. The primary outcome assessed was AKI and the secondary outcome was in-hospital mortality. Of the 426 patients, 194 (45.5%) patients developed AKI, as defined by the Kidney Disease Improving Global Outcomes criteria. Left ventricular (LV) pump failure with pulmonary edema [Odds ratio (OR) 1.67; 95% confidence interval (CI) 1.04–2.67], LV ejection fraction (OR 1.35 per 10% decrease in ejection fraction; CI 1.04–1.73), complete heart block (OR 2.06; CI 1.2–3.53), right ventricular infarction (OR 2.76; CI 1.39–5.49), mechanical complications (OR 3.89; CI 1.85–8.21), ventricular tachycardia (OR 2.80; CI 1.57–4.99), and non-revascularization (OR 2.2; CI 1.33–3.67) were independent predictors of AKI in multivariate logistic regression analysis. Additionally, AKI was a strong predictor of in-hospital mortality (univariate OR 30.61, CI 17.37–53.95). There is a higher incidence of AKI in CS-STEMI in resource-limited settings and is associated with adverse short-term outcomes. Additional studies are needed to address the optimal strategies for the prevention and management of AKI in such settings.","PeriodicalId":22462,"journal":{"name":"The Egyptian Heart Journal","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142193608","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}
Four-dimensional flow magnetic resonance imaging (MRI) enables blood flow visualization. The absence of left atrial vortex flow (LAVF) has been implicated in the development of thrombus formation and arrhythmias. However, the clinical relevance of this phenomenon in patients with congenital heart disease (CHD) remains unclear. This study aimed to unravel the relationship of LAVF with left atrial functions in patients with CHD. Twenty-five participants who underwent cardiac MRI examinations were included (8 postoperative patients with CHD aged 17–41 years and 17 volunteers aged 21–31 years). All participants were in sinus rhythm. Four-dimensional flow MRI (velocity encoding 100 cm/s) assessed the presence of LAVF, and its relationship with left atrial function determined by transthoracic echocardiography was explored. LAVF was detected in 16 patients. Upon classification of the participants based on the presence or absence of LAVF, 94% of participants in the LAVF group were volunteers, while 78% of those in the without LAVF group were postoperative patients. Participants without LAVF had a significantly lower left atrial ejection fraction (61% vs. 70%, p = 0.019), reservoir (32% vs. 47%, p = 0.006), and conduit (22% vs. 36%, p = 0.002) function than those with LAVF. LAVF occurred during the late phase of ventricular systole, and left atrial reservoir function may have contributed to its occurrence. Many postoperative patients with CHD experienced a loss of LAVF. LAVF may indicate early left atrial dysfunction resulting from left atrial remodeling.
{"title":"Left atrial vortex flow and its relationship with left atrial functions in patients with congenital heart disease","authors":"Keita Ito, Hideharu Oka, Yuki Shibagaki, Yuki Sasaki, Rina Imanishi, Sorachi Shimada, Yuki Akiho, Kazunori Fukao, Sadahiro Nakagawa, Kunihiro Iwata, Kouichi Nakau, Satoru Takahashi","doi":"10.1186/s43044-024-00486-2","DOIUrl":"https://doi.org/10.1186/s43044-024-00486-2","url":null,"abstract":"Four-dimensional flow magnetic resonance imaging (MRI) enables blood flow visualization. The absence of left atrial vortex flow (LAVF) has been implicated in the development of thrombus formation and arrhythmias. However, the clinical relevance of this phenomenon in patients with congenital heart disease (CHD) remains unclear. This study aimed to unravel the relationship of LAVF with left atrial functions in patients with CHD. Twenty-five participants who underwent cardiac MRI examinations were included (8 postoperative patients with CHD aged 17–41 years and 17 volunteers aged 21–31 years). All participants were in sinus rhythm. Four-dimensional flow MRI (velocity encoding 100 cm/s) assessed the presence of LAVF, and its relationship with left atrial function determined by transthoracic echocardiography was explored. LAVF was detected in 16 patients. Upon classification of the participants based on the presence or absence of LAVF, 94% of participants in the LAVF group were volunteers, while 78% of those in the without LAVF group were postoperative patients. Participants without LAVF had a significantly lower left atrial ejection fraction (61% vs. 70%, p = 0.019), reservoir (32% vs. 47%, p = 0.006), and conduit (22% vs. 36%, p = 0.002) function than those with LAVF. LAVF occurred during the late phase of ventricular systole, and left atrial reservoir function may have contributed to its occurrence. Many postoperative patients with CHD experienced a loss of LAVF. LAVF may indicate early left atrial dysfunction resulting from left atrial remodeling.","PeriodicalId":22462,"journal":{"name":"The Egyptian Heart Journal","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140830395","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}
Heart failure (HF) prevalence increases with age, and sarcopenia is a poor prognostic factor in patients with HF. We aimed to evaluate the characteristics and prognostic factors in patients with HF and sarcopenia. We retrospectively reviewed 256 consecutive patients admitted to our hospital for HF between May 2018 and May 2021, underwent dual-energy X-ray absorptiometry, and were diagnosed with sarcopenia. The primary endpoint was all-cause mortality. The prognoses and characteristics were evaluated and compared between patients with left ventricular ejection fraction (LVEF) < 50% (reduced LVEF, HF with reduced ejection fraction [HFrEF]) and those with LVEF ≥ 50% (preserved LVEF, HF with preserved ejection fraction [HFpEF]). 83 (32%) and 173 (68%) patients had HFrEF and HFpEF, respectively. The HFrEF group had fewer women, lower hypertension rates, higher ischemic heart disease rates, and brain natriuretic peptide (BNP) levels than did the HFpEF group. Kaplan–Meier analysis for all-cause death showed that the HFrEF group had a significantly worse prognosis than the HFpEF group [log-rank p = 0.002]. In patients with HF and sarcopenia, older age, higher New York Heart Association (NYHA) class, BNP levels, and reduced LVEF were independent predictors of death after evaluation. During the treatment of patients with HF and sarcopenia, it is necessary to manage treatment with close attention to BNP and LVEF.
{"title":"Prognostic factors in patients with heart failure and sarcopenia: an observational retrospective study","authors":"Yasutaka Imamura, Atsushi Suzuki, Kazuho Kamishima, Kazuhito Suzuki, Junichi Yamaguchi","doi":"10.1186/s43044-024-00484-4","DOIUrl":"https://doi.org/10.1186/s43044-024-00484-4","url":null,"abstract":"Heart failure (HF) prevalence increases with age, and sarcopenia is a poor prognostic factor in patients with HF. We aimed to evaluate the characteristics and prognostic factors in patients with HF and sarcopenia. We retrospectively reviewed 256 consecutive patients admitted to our hospital for HF between May 2018 and May 2021, underwent dual-energy X-ray absorptiometry, and were diagnosed with sarcopenia. The primary endpoint was all-cause mortality. The prognoses and characteristics were evaluated and compared between patients with left ventricular ejection fraction (LVEF) < 50% (reduced LVEF, HF with reduced ejection fraction [HFrEF]) and those with LVEF ≥ 50% (preserved LVEF, HF with preserved ejection fraction [HFpEF]). 83 (32%) and 173 (68%) patients had HFrEF and HFpEF, respectively. The HFrEF group had fewer women, lower hypertension rates, higher ischemic heart disease rates, and brain natriuretic peptide (BNP) levels than did the HFpEF group. Kaplan–Meier analysis for all-cause death showed that the HFrEF group had a significantly worse prognosis than the HFpEF group [log-rank p = 0.002]. In patients with HF and sarcopenia, older age, higher New York Heart Association (NYHA) class, BNP levels, and reduced LVEF were independent predictors of death after evaluation. During the treatment of patients with HF and sarcopenia, it is necessary to manage treatment with close attention to BNP and LVEF.","PeriodicalId":22462,"journal":{"name":"The Egyptian Heart Journal","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140809546","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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