Ajay Kumar Mishra, Kannu Bansal, Ibragim Al-Seykal, Pradnya B Bhattad, Anu Anna George, Anil Jha, Nitish Sharma, Jennifer Sargent, Mark J Kranis
Background: Infective endocarditis (IE) is a life-threatening infection with an annual mortality of 40%. Embolic events reported in up to 80% of patients. Vegetations of > 10 mm size are associated with increased embolic events and poor prognosis. There is a paucity of literature on the association of multiple vegetations with outcome.
Aim: To study the echocardiographic (ECHO) features and outcomes associated with the presence of multiple vegetations.
Methods: In this retrospective, single-center, cohort study patients diagnosed with IE were recruited from June 2017 to June 2019. A total of 84 patients were diagnosed to have IE, of whom 67 with vegetation were identified. Baseline demographic, clinical, laboratory, and ECHO parameters were reviewed. Outcomes that were studied included recurrent admission, embolic phenomenon, and mortality.
Results: Twenty-three (34%) patients were noted to have multiple vegetations, 13 (56.5%) were male and 10 (43.5%) were female. The mean age of these patients was 50. Eight (35%) had a prior episode of IE. ECHO features of moderate to severe valvular regurgitation [odds ratio (OR) = 4], presence of pacemaker lead (OR = 4.8), impaired left ventricle (LV) relaxation (OR = 4), and elevated pulmonary artery systolic pressure (PASP) (OR = 2.2) are associated with higher odds of multiple vegetations. Of these moderate to severe valvular regurgitation (P = 0.028), pacemaker lead (P = 0.039) and impaired relaxation (P = 0.028) were statistically significant. These patients were noted to have an increased association of recurrent admissions (OR = 3.6), recurrent bacteremia (OR = 2.4), embolic phenomenon (OR = 2.5), intensive care unit stay (OR = 2.8), hypotension (OR = 2.1), surgical intervention (OR = 2.8) and device removal (OR = 4.8). Of this device removal (P = 0.039) and recurrent admissions (P = 0.017) were statistically significant.
Conclusion: This study highlights the associations of ECHO predictors and outcomes in patients with IE having multiple vegetations. ECHO features of moderate to severe regurgitation, presence of pacemaker lead, impaired LV relaxation, and elevated PASP and outcomes including recurrent admissions and device removal were found to be associated with multiple vegetations.
{"title":"Echocardiographic predictors and associated outcomes of multiple vegetations in infective endocarditis: A pilot study.","authors":"Ajay Kumar Mishra, Kannu Bansal, Ibragim Al-Seykal, Pradnya B Bhattad, Anu Anna George, Anil Jha, Nitish Sharma, Jennifer Sargent, Mark J Kranis","doi":"10.4330/wjc.v16.i6.318","DOIUrl":"10.4330/wjc.v16.i6.318","url":null,"abstract":"<p><strong>Background: </strong>Infective endocarditis (IE) is a life-threatening infection with an annual mortality of 40%. Embolic events reported in up to 80% of patients. Vegetations of > 10 mm size are associated with increased embolic events and poor prognosis. There is a paucity of literature on the association of multiple vegetations with outcome.</p><p><strong>Aim: </strong>To study the echocardiographic (ECHO) features and outcomes associated with the presence of multiple vegetations.</p><p><strong>Methods: </strong>In this retrospective, single-center, cohort study patients diagnosed with IE were recruited from June 2017 to June 2019. A total of 84 patients were diagnosed to have IE, of whom 67 with vegetation were identified. Baseline demographic, clinical, laboratory, and ECHO parameters were reviewed. Outcomes that were studied included recurrent admission, embolic phenomenon, and mortality.</p><p><strong>Results: </strong>Twenty-three (34%) patients were noted to have multiple vegetations, 13 (56.5%) were male and 10 (43.5%) were female. The mean age of these patients was 50. Eight (35%) had a prior episode of IE. ECHO features of moderate to severe valvular regurgitation [odds ratio (OR) = 4], presence of pacemaker lead (OR = 4.8), impaired left ventricle (LV) relaxation (OR = 4), and elevated pulmonary artery systolic pressure (PASP) (OR = 2.2) are associated with higher odds of multiple vegetations. Of these moderate to severe valvular regurgitation (<i>P</i> = 0.028), pacemaker lead (<i>P</i> = 0.039) and impaired relaxation (<i>P</i> = 0.028) were statistically significant. These patients were noted to have an increased association of recurrent admissions (OR = 3.6), recurrent bacteremia (OR = 2.4), embolic phenomenon (OR = 2.5), intensive care unit stay (OR = 2.8), hypotension (OR = 2.1), surgical intervention (OR = 2.8) and device removal (OR = 4.8). Of this device removal (<i>P</i> = 0.039) and recurrent admissions (<i>P</i> = 0.017) were statistically significant.</p><p><strong>Conclusion: </strong>This study highlights the associations of ECHO predictors and outcomes in patients with IE having multiple vegetations. ECHO features of moderate to severe regurgitation, presence of pacemaker lead, impaired LV relaxation, and elevated PASP and outcomes including recurrent admissions and device removal were found to be associated with multiple vegetations.</p>","PeriodicalId":23800,"journal":{"name":"World Journal of Cardiology","volume":"16 6","pages":"318-328"},"PeriodicalIF":1.9,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11235202/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141591535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Central venous pressure (CVP) serves as a direct approximation of right atrial pressure and is influenced by factors like total blood volume, venous compliance, cardiac output, and orthostasis. Normal CVP falls within 8-12 mmHg but varies with volume status and venous compliance. Monitoring and managing disturbances in CVP are vital in patients with circulatory shock or fluid disturbances. Elevated CVP can lead to fluid accumulation in the interstitial space, impairing venous return and reducing cardiac preload. While pulmonary artery catheterization and central venous catheter obtained measurements are considered to be more accurate, they carry risk of complications and their usage has not shown clinical improvement. Ultrasound-based assessment of the internal jugular vein (IJV) offers real-time, non-invasive measurement of static and dynamic parameters for estimating CVP. IJV parameters, including diameter and ratio, has demonstrated good correlation with CVP. Despite significant advancements in non-invasive CVP measurement, a reliable tool is yet to be found. Present methods can offer reasonable guidance in assessing CVP, provided their limitations are acknowledged.
{"title":"Ultrasound based estimate of central venous pressure: Are we any closer?","authors":"Atit A Gawalkar, Akash Batta","doi":"10.4330/wjc.v16.i6.310","DOIUrl":"10.4330/wjc.v16.i6.310","url":null,"abstract":"<p><p>Central venous pressure (CVP) serves as a direct approximation of right atrial pressure and is influenced by factors like total blood volume, venous compliance, cardiac output, and orthostasis. Normal CVP falls within 8-12 mmHg but varies with volume status and venous compliance. Monitoring and managing disturbances in CVP are vital in patients with circulatory shock or fluid disturbances. Elevated CVP can lead to fluid accumulation in the interstitial space, impairing venous return and reducing cardiac preload. While pulmonary artery catheterization and central venous catheter obtained measurements are considered to be more accurate, they carry risk of complications and their usage has not shown clinical improvement. Ultrasound-based assessment of the internal jugular vein (IJV) offers real-time, non-invasive measurement of static and dynamic parameters for estimating CVP. IJV parameters, including diameter and ratio, has demonstrated good correlation with CVP. Despite significant advancements in non-invasive CVP measurement, a reliable tool is yet to be found. Present methods can offer reasonable guidance in assessing CVP, provided their limitations are acknowledged.</p>","PeriodicalId":23800,"journal":{"name":"World Journal of Cardiology","volume":"16 6","pages":"310-313"},"PeriodicalIF":1.9,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11235208/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141591541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Coronavirus is an important pathogen causing disease in humans and animals. At the end of 2019, an investigation into an increase in pneumonia cases in Wuhan, Hubei Province, China, found that the cause was a new coronavirus. This disease, which spread rapidly across China and caused an outbreak worldwide, resulted in a pandemic. Although this virus has previously been referred to as 2019-nCoV, which causes coronavirus disease 2019 (COVID-19), later it was named severe acute respiratory syndrome coronavirus 2. Children were usually asymptomatic and rarely severely affected. In April 2020, reports from the United Kingdom indicated that children may have Kawasaki disease or a clinical condition similar to toxic shock syndrome. This clinical picture was later defined as multisystem inflammatory syndrome in children. Since then, similarly affected children as well as cases with other cardiac complications have been reported in other parts of the world. In this review, we aimed to evaluate COVID-19 in terms of cardiac involvement by reviewing the literature.
{"title":"COVID-19 and cardiac complications: Myocarditis and multisystem inflammatory syndrome in children","authors":"Muhammed Güneş, Öner Özdemir","doi":"10.4330/wjc.v16.i5.260","DOIUrl":"https://doi.org/10.4330/wjc.v16.i5.260","url":null,"abstract":"Coronavirus is an important pathogen causing disease in humans and animals. At the end of 2019, an investigation into an increase in pneumonia cases in Wuhan, Hubei Province, China, found that the cause was a new coronavirus. This disease, which spread rapidly across China and caused an outbreak worldwide, resulted in a pandemic. Although this virus has previously been referred to as 2019-nCoV, which causes coronavirus disease 2019 (COVID-19), later it was named severe acute respiratory syndrome coronavirus 2. Children were usually asymptomatic and rarely severely affected. In April 2020, reports from the United Kingdom indicated that children may have Kawasaki disease or a clinical condition similar to toxic shock syndrome. This clinical picture was later defined as multisystem inflammatory syndrome in children. Since then, similarly affected children as well as cases with other cardiac complications have been reported in other parts of the world. In this review, we aimed to evaluate COVID-19 in terms of cardiac involvement by reviewing the literature.","PeriodicalId":23800,"journal":{"name":"World Journal of Cardiology","volume":"30 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141098084","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}
Muhammad Ahmed Ali Fahim, Afia Salman, Hira Anas Khan, Syed Muhammad Hasan, Muskan Fatima Bhojani, Sarah Aslam, Amna Zia Ul Haq, Vishal Reddy Bejugam, Beena Muntaha Nasir, Wajiha Gul, Abdul Moeed, A. S. Abdalla, Muhammad Majid, Muhammad Sohaib Asghar, Md Al Hasibuzzaman
BACKGROUND In severe cases of coronary artery disease, percutaneous coronary intervention provide promising results. The stent used could be a drug-eluting stent (DES) or a titanium-nitride-oxide coated stent (TiNOS). AIM To compare the 5-year effectiveness and safety of the two stent types. METHODS The following systematic review and meta-analysis was conducted in accordance with the preferred reporting items for systematic reviews and meta-analysis guidelines, and PubMed/MEDLINE, Scopus, and Cochrane Central were searched from inception till August 2023. Primary outcomes were major adverse cardiac events (MACE), cardiac death, myocardial infarction (MI), cardiac death or MI, and ischemia-driven total lesion revascularization (ID-TLR). RESULTS Four randomized controlled trials (RCT), which analyzed a sum total of 3045 patients with acute coronary syndrome (ACS) after a median follow-up time of 5 years were included. Though statistically insignificant, an increase in the ID-TLR was observed in patients receiving TiNOSs vs DESs. In addition, MI, cardiac death and MI, and definite stent thrombosis (DST) were significantly decreased in the TiNOS arm. Baseline analysis revealed no significant results with meta-regression presenting non-ST elevated MI (NSTEMI) as a statistically significant covariate in the outcome of MACE. CONCLUSION TiNOS was found to be superior to DES in terms of MI, cardiac death or MI, and DST outcomes, however, the effect of the two stent types on ID-TLR and MACE was not significant. A greater number of studies are required to establish an accurate comparison of patient outcomes in TiNOS and DES.
{"title":"Long-term outcomes of titanium-nitride-oxide coated stents and drug-eluting stents in acute coronary syndrome: A systematic review and meta-analysis","authors":"Muhammad Ahmed Ali Fahim, Afia Salman, Hira Anas Khan, Syed Muhammad Hasan, Muskan Fatima Bhojani, Sarah Aslam, Amna Zia Ul Haq, Vishal Reddy Bejugam, Beena Muntaha Nasir, Wajiha Gul, Abdul Moeed, A. S. Abdalla, Muhammad Majid, Muhammad Sohaib Asghar, Md Al Hasibuzzaman","doi":"10.4330/wjc.v16.i5.293","DOIUrl":"https://doi.org/10.4330/wjc.v16.i5.293","url":null,"abstract":"BACKGROUND\u0000 In severe cases of coronary artery disease, percutaneous coronary intervention provide promising results. The stent used could be a drug-eluting stent (DES) or a titanium-nitride-oxide coated stent (TiNOS).\u0000 AIM\u0000 To compare the 5-year effectiveness and safety of the two stent types.\u0000 METHODS\u0000 The following systematic review and meta-analysis was conducted in accordance with the preferred reporting items for systematic reviews and meta-analysis guidelines, and PubMed/MEDLINE, Scopus, and Cochrane Central were searched from inception till August 2023. Primary outcomes were major adverse cardiac events (MACE), cardiac death, myocardial infarction (MI), cardiac death or MI, and ischemia-driven total lesion revascularization (ID-TLR).\u0000 RESULTS\u0000 Four randomized controlled trials (RCT), which analyzed a sum total of 3045 patients with acute coronary syndrome (ACS) after a median follow-up time of 5 years were included. Though statistically insignificant, an increase in the ID-TLR was observed in patients receiving TiNOSs vs DESs. In addition, MI, cardiac death and MI, and definite stent thrombosis (DST) were significantly decreased in the TiNOS arm. Baseline analysis revealed no significant results with meta-regression presenting non-ST elevated MI (NSTEMI) as a statistically significant covariate in the outcome of MACE.\u0000 CONCLUSION\u0000 TiNOS was found to be superior to DES in terms of MI, cardiac death or MI, and DST outcomes, however, the effect of the two stent types on ID-TLR and MACE was not significant. A greater number of studies are required to establish an accurate comparison of patient outcomes in TiNOS and DES.","PeriodicalId":23800,"journal":{"name":"World Journal of Cardiology","volume":"30 3","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141098159","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}
Sunetra Mondal, Subhodip Pramanik, Vibhu Ranjan Khare, Cornelius James Fernandez, Joseph M Pappachan
Sodium glucose cotransporter-2 inhibitors (SGLT-2i) are antidiabetic medications with remarkable cardiovascular (CV) benefits proven by multiple randomised controlled trials and real-world data. These drugs are also useful in the prevention of CV disease (CVD) in patients with diabetes mellitus (DM). Although DM as such is a huge risk factor for CVD, the CV benefits of SGLT-2i are not just because of antidiabetic effects. These molecules have proven beneficial roles in prevention and management of nondiabetic CVD and renal disease as well. There are various molecular mechanisms for the organ protective effects of SGLT-2i which are still being elucidated. Proper understanding of the role of SGLT-2i in prevention and management of CVD is important not only for the cardiologists but also for other specialists caring for various illnesses which can directly or indirectly impact care of heart diseases. This clinical review compiles the current evidence on the rational use of SGLT-2i in clinical practice.
{"title":"Sodium glucose cotransporter-2 inhibitors and heart disease: Current perspectives.","authors":"Sunetra Mondal, Subhodip Pramanik, Vibhu Ranjan Khare, Cornelius James Fernandez, Joseph M Pappachan","doi":"10.4330/wjc.v16.i5.240","DOIUrl":"10.4330/wjc.v16.i5.240","url":null,"abstract":"<p><p>Sodium glucose cotransporter-2 inhibitors (SGLT-2i) are antidiabetic medications with remarkable cardiovascular (CV) benefits proven by multiple randomised controlled trials and real-world data. These drugs are also useful in the prevention of CV disease (CVD) in patients with diabetes mellitus (DM). Although DM as such is a huge risk factor for CVD, the CV benefits of SGLT-2i are not just because of antidiabetic effects. These molecules have proven beneficial roles in prevention and management of nondiabetic CVD and renal disease as well. There are various molecular mechanisms for the organ protective effects of SGLT-2i which are still being elucidated. Proper understanding of the role of SGLT-2i in prevention and management of CVD is important not only for the cardiologists but also for other specialists caring for various illnesses which can directly or indirectly impact care of heart diseases. This clinical review compiles the current evidence on the rational use of SGLT-2i in clinical practice.</p>","PeriodicalId":23800,"journal":{"name":"World Journal of Cardiology","volume":"16 5","pages":"240-259"},"PeriodicalIF":1.9,"publicationDate":"2024-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11135334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141180885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In this editorial we comment on the article by Kuwahara et al , published in the recent issue of the World Journal of Cardiology . In this interesting paper, the authors showed a correlation between portal vein pulsatility ratio, examined by bedside ultrasonography, and prognosis of hospitalized patients with acute heart failure. Systemic congestion is being notoriously underdetected in the acutely ill population with conventional methods like clinical examination, biomarkers, central venous pressure estimation and X-rays. However, congestion should be a key therapeutic target due to its deleterious effects to end organ function and subsequently patient prognosis. Doppler flow assessment of the abdominal veins is gaining popularity worldwide, as a valuable tool in estimating comprehensively congestion and giving a further insight into hemodynamics and patient management.
在这篇社论中，我们对 Kuwahara 等人发表在最近一期《世界心脏病学杂志》上的文章进行了评论。在这篇有趣的论文中，作者通过床旁超声波检查显示了门静脉搏动率与急性心力衰竭住院患者预后之间的相关性。传统方法，如临床检查、生物标记物、中心静脉压估算和 X 射线，对急性病患者全身充血的检测不足，这是众所周知的。然而，由于充血会对终末器官功能产生有害影响，进而影响患者的预后，因此应将其作为重点治疗目标。腹腔静脉多普勒血流评估作为一种全面评估充血情况、进一步了解血液动力学和患者管理的重要工具，在全球范围内越来越受欢迎。
{"title":"Portal vein pulsatility: An important sonographic tool assessment of systemic congestion for critical ill patients","authors":"Stavros Dimopoulos, Michael Antonopoulos","doi":"10.4330/wjc.v16.i5.221","DOIUrl":"https://doi.org/10.4330/wjc.v16.i5.221","url":null,"abstract":"In this editorial we comment on the article by Kuwahara et al , published in the recent issue of the World Journal of Cardiology . In this interesting paper, the authors showed a correlation between portal vein pulsatility ratio, examined by bedside ultrasonography, and prognosis of hospitalized patients with acute heart failure. Systemic congestion is being notoriously underdetected in the acutely ill population with conventional methods like clinical examination, biomarkers, central venous pressure estimation and X-rays. However, congestion should be a key therapeutic target due to its deleterious effects to end organ function and subsequently patient prognosis. Doppler flow assessment of the abdominal veins is gaining popularity worldwide, as a valuable tool in estimating comprehensively congestion and giving a further insight into hemodynamics and patient management.","PeriodicalId":23800,"journal":{"name":"World Journal of Cardiology","volume":"31 11","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141098066","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}
A multiple hormonal imbalance that accompanies heart failure (HF) may have a significant impact on the clinical course in such patients. The non-thyroidal illness syndrome (NTIS), also referred to as euthyroid sick syndrome or low triiodothyronine syndrome, can be found in about 30% of patients with HF. NTIS represents a systemic adaptation to chronic illness that is associated with increased cardiac and overall mortality in patients with HF. While conclusions on thyroid-stimulating hormone, free triiodothyronine, total and free thyroxine are currently unresolved, serum total triiodothyronine levels and the ratio of free triiodothyronine to free thyroxine seem to provide the best correlates to the echocardiographic, laboratory and clinical parameters of disease severity. HF patients with either hyper- or hypothyroidism should be treated according to the appropriate guidelines, but the therapeutic approach to NTIS, with or without HF, is still a matter of debate. Possible treatment options include better individual titration of levothyroxine therapy, combined triiodothyronine plus thyroxine therapy and natural measures to increase triiodothyronine. Future research should further examine the cellular and tissue mechanisms of NTIS as well as new therapeutic avenues in patients with HF.
{"title":"Cardiovascular mechanisms of thyroid hormones and heart failure: Current knowledge and perspectives","authors":"Viktor Čulić","doi":"10.4330/wjc.v16.i5.226","DOIUrl":"https://doi.org/10.4330/wjc.v16.i5.226","url":null,"abstract":"A multiple hormonal imbalance that accompanies heart failure (HF) may have a significant impact on the clinical course in such patients. The non-thyroidal illness syndrome (NTIS), also referred to as euthyroid sick syndrome or low triiodothyronine syndrome, can be found in about 30% of patients with HF. NTIS represents a systemic adaptation to chronic illness that is associated with increased cardiac and overall mortality in patients with HF. While conclusions on thyroid-stimulating hormone, free triiodothyronine, total and free thyroxine are currently unresolved, serum total triiodothyronine levels and the ratio of free triiodothyronine to free thyroxine seem to provide the best correlates to the echocardiographic, laboratory and clinical parameters of disease severity. HF patients with either hyper- or hypothyroidism should be treated according to the appropriate guidelines, but the therapeutic approach to NTIS, with or without HF, is still a matter of debate. Possible treatment options include better individual titration of levothyroxine therapy, combined triiodothyronine plus thyroxine therapy and natural measures to increase triiodothyronine. Future research should further examine the cellular and tissue mechanisms of NTIS as well as new therapeutic avenues in patients with HF.","PeriodicalId":23800,"journal":{"name":"World Journal of Cardiology","volume":"27 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141098175","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}
Ibrutinib, a targeted therapy for B-cell malignancies, has shown remarkable efficacy in treating various hematologic cancers. However, its clinical use has raised concerns regarding cardiovascular complications, notably atrial fibrillation (AF). This comprehensive review critically evaluates the association between ibrutinib and AF by examining incidence, risk factors, mechanistic links, and management strategies. Through an extensive analysis of original research articles, this review elucidates the complex interplay between ibrutinib’s therapeutic benefits and cardiovascular risks. Moreover, it highlights the need for personalized treatment approaches, vigilant monitoring, and interdisciplinary collaboration to optimize patient outcomes and safety in the context of ibrutinib therapy. The review provides a valuable resource for healthcare professionals aiming to navigate the intricacies of ibrutinib’s therapeutic landscape while prioritizing patient well-being.
伊布替尼是一种治疗 B 细胞恶性肿瘤的靶向疗法，在治疗各种血液肿瘤方面疗效显著。然而，其临床应用也引发了对心血管并发症的担忧，尤其是心房颤动（AF）。这篇综合综述通过研究伊布替尼的发病率、风险因素、机理联系和管理策略，对伊布替尼和房颤之间的关联进行了批判性评估。通过对原始研究文章的广泛分析，本综述阐明了伊布替尼的治疗益处与心血管风险之间复杂的相互作用。此外，它还强调了个性化治疗方法、警惕性监测和跨学科合作的必要性，以优化伊布替尼治疗的患者预后和安全性。这篇综述为医疗保健专业人士提供了宝贵的资源，帮助他们了解伊布替尼错综复杂的治疗方案，同时优先考虑患者的健康。
{"title":"Ibrutinib and atrial fibrillation: An in-depth review of clinical implications and management strategies","authors":"Moiud Mohyeldin, Shitij Shrivastava, S. Allu","doi":"10.4330/wjc.v16.i5.269","DOIUrl":"https://doi.org/10.4330/wjc.v16.i5.269","url":null,"abstract":"Ibrutinib, a targeted therapy for B-cell malignancies, has shown remarkable efficacy in treating various hematologic cancers. However, its clinical use has raised concerns regarding cardiovascular complications, notably atrial fibrillation (AF). This comprehensive review critically evaluates the association between ibrutinib and AF by examining incidence, risk factors, mechanistic links, and management strategies. Through an extensive analysis of original research articles, this review elucidates the complex interplay between ibrutinib’s therapeutic benefits and cardiovascular risks. Moreover, it highlights the need for personalized treatment approaches, vigilant monitoring, and interdisciplinary collaboration to optimize patient outcomes and safety in the context of ibrutinib therapy. The review provides a valuable resource for healthcare professionals aiming to navigate the intricacies of ibrutinib’s therapeutic landscape while prioritizing patient well-being.","PeriodicalId":23800,"journal":{"name":"World Journal of Cardiology","volume":"29 10","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141098163","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}
Maria Drakopoulou, Panayotis K Vlachakis, C. Tsioufis, Dimitris Tousoulis
In this editorial, we comment on the article by Kong et al published in the recent issue of the World Journal of Cardiology . In this interesting case, the authors present the challenges faced in managing a 13-year-old patient with Down syndrome (DS) and congenital heart disease (CHD) associated with pulmonary arterial hypertension. In this distinct population, the Authors underscore the need for early diagnosis and management as well as the need of a multidisciplinary approach for decision making. It seems that the occurrence of CHD in patients with DS adds layers of complexity to their clinical management. This editorial aims to provide a comprehensive overview of the intricate interplay between DS and congenital heart disorders, offering insights into the nuanced diagnostic and therapeutic considerations for physicians.
在这篇社论中，我们对 Kong 等人发表在最近一期《世界心脏病学杂志》上的文章进行了评论。在这个有趣的病例中，作者介绍了在管理一名患有唐氏综合征（DS）和先天性心脏病（CHD）并伴有肺动脉高压的 13 岁患者时所面临的挑战。在这一特殊人群中，作者强调了早期诊断和管理的必要性以及多学科决策方法的必要性。看来，DS 患者发生冠心病增加了临床管理的复杂性。这篇社论旨在全面概述 DS 与先天性心脏病之间错综复杂的相互作用，为医生在诊断和治疗方面的细微考量提供见解。
{"title":"Congenital heart “Challenges” in Down syndrome","authors":"Maria Drakopoulou, Panayotis K Vlachakis, C. Tsioufis, Dimitris Tousoulis","doi":"10.4330/wjc.v16.i5.217","DOIUrl":"https://doi.org/10.4330/wjc.v16.i5.217","url":null,"abstract":"In this editorial, we comment on the article by Kong et al published in the recent issue of the World Journal of Cardiology . In this interesting case, the authors present the challenges faced in managing a 13-year-old patient with Down syndrome (DS) and congenital heart disease (CHD) associated with pulmonary arterial hypertension. In this distinct population, the Authors underscore the need for early diagnosis and management as well as the need of a multidisciplinary approach for decision making. It seems that the occurrence of CHD in patients with DS adds layers of complexity to their clinical management. This editorial aims to provide a comprehensive overview of the intricate interplay between DS and congenital heart disorders, offering insights into the nuanced diagnostic and therapeutic considerations for physicians.","PeriodicalId":23800,"journal":{"name":"World Journal of Cardiology","volume":"24 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141098182","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}
Rubina Rauf, Muhammad Ismail Soomro, Muhamman Nauman Khan, Mukesh Kumar, N. Soomro, K. Kazmi
BACKGROUND Lipid treatment practices and levels in post-acute myocardial infarction (AMI) patients, which are crucial for secondary prevention. AIM To evaluate the lipid treatment practices and lipid levels in post-myocardial infarction (MI) patients at a tertiary care hospital in Pakistan. METHODS In this cross-sectional study, we analyzed patients who had experienced their first AMI event in the past 3 years. We assessed fasting and non-fasting lipid profiles, reviewed statin therapy prescriptions, and examined patient compliance. The recommended dose was defined as rosuvastatin ≥ 20 mg or atorvastatin ≥ 40 mg, with target total cholesterol levels set at < 160 mg/dL and target low-density lipoprotein cholesterol (LDL-C) at < 55 mg/dL. RESULTS Among 195 patients, 71.3% were male, and the mean age was 57.1 ± 10.2 years. The median duration since AMI was 36 (interquartile range: 10-48) months and 60% were diagnosed with ST-segment elevation MI. Only 13.8% of patients were advised to undergo lipid profile testing after AMI, 88.7% of patients were on the recommended statin therapy, and 91.8% of patients were compliant with statin therapy. Only 11.5% had LDL-C within the target range and 71.7% had total cholesterol within the target range. Hospital admission in the past 12 months was reported by 14.4%, and the re-admission rate was significantly higher among non-compliant patients (37.5% vs 5.6%). Subsequent AMI event rate was also significantly higher among non-compliant patients (43.8% vs 11.7%). CONCLUSION Our study highlights that while most post-AMI patients received the recommended minimum statin therapy dose, the inadequate practice of lipid assessment may compromise therapy optimization and raise the risk of subsequent events.
{"title":"Assessment of post-myocardial infarction lipid levels and management: Results from a tertiary care hospital of Pakistan","authors":"Rubina Rauf, Muhammad Ismail Soomro, Muhamman Nauman Khan, Mukesh Kumar, N. Soomro, K. Kazmi","doi":"10.4330/wjc.v16.i5.282","DOIUrl":"https://doi.org/10.4330/wjc.v16.i5.282","url":null,"abstract":"BACKGROUND\u0000 Lipid treatment practices and levels in post-acute myocardial infarction (AMI) patients, which are crucial for secondary prevention.\u0000 AIM\u0000 To evaluate the lipid treatment practices and lipid levels in post-myocardial infarction (MI) patients at a tertiary care hospital in Pakistan.\u0000 METHODS\u0000 In this cross-sectional study, we analyzed patients who had experienced their first AMI event in the past 3 years. We assessed fasting and non-fasting lipid profiles, reviewed statin therapy prescriptions, and examined patient compliance. The recommended dose was defined as rosuvastatin ≥ 20 mg or atorvastatin ≥ 40 mg, with target total cholesterol levels set at < 160 mg/dL and target low-density lipoprotein cholesterol (LDL-C) at < 55 mg/dL.\u0000 RESULTS\u0000 Among 195 patients, 71.3% were male, and the mean age was 57.1 ± 10.2 years. The median duration since AMI was 36 (interquartile range: 10-48) months and 60% were diagnosed with ST-segment elevation MI. Only 13.8% of patients were advised to undergo lipid profile testing after AMI, 88.7% of patients were on the recommended statin therapy, and 91.8% of patients were compliant with statin therapy. Only 11.5% had LDL-C within the target range and 71.7% had total cholesterol within the target range. Hospital admission in the past 12 months was reported by 14.4%, and the re-admission rate was significantly higher among non-compliant patients (37.5% vs 5.6%). Subsequent AMI event rate was also significantly higher among non-compliant patients (43.8% vs 11.7%).\u0000 CONCLUSION\u0000 Our study highlights that while most post-AMI patients received the recommended minimum statin therapy dose, the inadequate practice of lipid assessment may compromise therapy optimization and raise the risk of subsequent events.","PeriodicalId":23800,"journal":{"name":"World Journal of Cardiology","volume":"25 3","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141098318","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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