Pub Date : 2022-04-28DOI: 10.11909/j.issn.1671-5411.2022.04.006
Kang Li, F. Fan, Pengfei Sun, Jie Jiang, Jing Zhou, Ying Shi, Hai-bo Wang, Jianping Li, Yan Zhang, Y. Huo
BACKGROUND Catheter ablation for atrial fibrillation (AF) is commonly performed worldwide. However, the clinical characteristics of hospitalized patients with AF and national trends in catheter ablation at tertiary hospitals in China remain unreported. METHODS This study used the Chinese national database (Hospital Quality Monitoring System) from 2013 to 2016, which is a mandatory database that collects the front page of patients’ medical records for hospital accreditation, to describe the clinical characteristics of patients with AF as an overall cohort and as subgroups divided by catheter ablation and sex. RESULTS Of 597,919 AF patients first admitted, 57,983 patients underwent catheter ablation [56,384 cases (97.2%) of radiofrequency ablation and 1599 cases (2.8%) of cryoablation] at 746 tertiary hospitals. Nearly 10% of patients hospitalized with AF at tertiary hospitals in China underwent catheter ablation, and the percentage of patients undergoing catheter ablation was on the rise between 2013 and 2016, and the number of cases increased by 2.5 times. Compared with AF patients who did not undergo catheter ablation, those who did were younger, more frequently male, and had fewer baseline comorbidities. Although the overall CHA2DS2VASc score revealed over half of the patients were high-risk, patients who underwent catheter ablation were mostly low-risk (71.2% of males and 59.1% of females). Considering in-hospital adverse events, the overall pericardial tamponade and all-cause death incidences were 0.2% (0.6% in the ablation group) and 1.2% (0.1% in the ablation group), respectively; both of which were higher in females than males. CONCLUSIONS In this study, AF patients who underwent catheter ablation were relatively young, had a low thrombosis risk, and had few comorbidities and adverse events. Females were older and experienced more complications than males.
{"title":"Trends and sex differences in atrial fibrillation hospitalization and catheter ablation at tertiary hospitals in China from 2013 to 2016","authors":"Kang Li, F. Fan, Pengfei Sun, Jie Jiang, Jing Zhou, Ying Shi, Hai-bo Wang, Jianping Li, Yan Zhang, Y. Huo","doi":"10.11909/j.issn.1671-5411.2022.04.006","DOIUrl":"https://doi.org/10.11909/j.issn.1671-5411.2022.04.006","url":null,"abstract":"BACKGROUND Catheter ablation for atrial fibrillation (AF) is commonly performed worldwide. However, the clinical characteristics of hospitalized patients with AF and national trends in catheter ablation at tertiary hospitals in China remain unreported. METHODS This study used the Chinese national database (Hospital Quality Monitoring System) from 2013 to 2016, which is a mandatory database that collects the front page of patients’ medical records for hospital accreditation, to describe the clinical characteristics of patients with AF as an overall cohort and as subgroups divided by catheter ablation and sex. RESULTS Of 597,919 AF patients first admitted, 57,983 patients underwent catheter ablation [56,384 cases (97.2%) of radiofrequency ablation and 1599 cases (2.8%) of cryoablation] at 746 tertiary hospitals. Nearly 10% of patients hospitalized with AF at tertiary hospitals in China underwent catheter ablation, and the percentage of patients undergoing catheter ablation was on the rise between 2013 and 2016, and the number of cases increased by 2.5 times. Compared with AF patients who did not undergo catheter ablation, those who did were younger, more frequently male, and had fewer baseline comorbidities. Although the overall CHA2DS2VASc score revealed over half of the patients were high-risk, patients who underwent catheter ablation were mostly low-risk (71.2% of males and 59.1% of females). Considering in-hospital adverse events, the overall pericardial tamponade and all-cause death incidences were 0.2% (0.6% in the ablation group) and 1.2% (0.1% in the ablation group), respectively; both of which were higher in females than males. CONCLUSIONS In this study, AF patients who underwent catheter ablation were relatively young, had a low thrombosis risk, and had few comorbidities and adverse events. Females were older and experienced more complications than males.","PeriodicalId":285674,"journal":{"name":"Journal of geriatric cardiology : JGC","volume":"424 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122296488","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 : 2022-04-28DOI: 10.11909/j.issn.1671-5411.2022.04.002
Long Li, Zeping Jin, Yuesong Pan, J. Jing, X. Meng, Yong Jiang, Hao Li, Caixia Guo, Yong-Jun Wang
BACKGROUND The Essen risk score improves stratification of patients with acute ischemic stroke by early stroke recurrence. Recent study showed it could also predict myocardial infarction (MI). This study aimed to compare the Essen score’s ability to predict cerebrovascular events with compared cardiovascular events. METHODS We included patients with acute ischaemic stroke or transient ischaemic attack within seven days from the Third China National Stroke Registry. One-year cumulative event rates of combined vascular events (a composite of MI, stroke recurrence or vascular death) and cardiac events (a composite of MI, heart failure or cardiac death) was estimated using the Kaplan-Meier method. The predictive value of the Essen score was assessed with C-statistics. In multivariate Cox regression analyses, we assessed whether Essen score, etiological subtype and imaging parameters were associated with outcomes. RESULTS Of 13,012 patients were included, the cumulative one-year event rates were 10.03% for combined vascular events and 0.77% for cardiac events, respectively. Compared with those with an Essen score < 3, patients with an Essen score ≥ 3 were more likely to have a subsequent combined vascular event [hazard ratio (HR) = 1.39, 95% CI: 1.24−1.55] and cardiac events (HR = 2.30, 95% CI: 1.53−3.44). The score tended to be more predictive of the risk of MI (C-statistic = 0.63, 95% CI: 0.55−0.71) and cardiac events (C-statistic = 0.62, 95% CI: 0.56−0.67) than stroke recurrence (C-statistic = 0.55, 95% CI: 0.54−0.57) and combined vascular events (C-statistic = 0.56, 95% CI: 0.54−0.57). In multivariable analysis after adjusted Essen score, patients with multiple acute infarctions or single acute infarctions and large artery atherosclerosis subtype were independently associated with an increased risk of combined vascular events. While the cardioembolism subtype was associated with an increased risk of cardiac events. CONCLUSIONS The Essen score is potentially more suitable for risk stratification of cardiovascular events than cerebrovascular events. Moreover, future predictive tools should take brain imaging findings and cause of stroke into consideration.
{"title":"Essen score in the prediction of cerebrovascular events compared with cardiovascular events after ischaemic stroke or transient ischaemic attack: a nationwide registry analysis","authors":"Long Li, Zeping Jin, Yuesong Pan, J. Jing, X. Meng, Yong Jiang, Hao Li, Caixia Guo, Yong-Jun Wang","doi":"10.11909/j.issn.1671-5411.2022.04.002","DOIUrl":"https://doi.org/10.11909/j.issn.1671-5411.2022.04.002","url":null,"abstract":"BACKGROUND The Essen risk score improves stratification of patients with acute ischemic stroke by early stroke recurrence. Recent study showed it could also predict myocardial infarction (MI). This study aimed to compare the Essen score’s ability to predict cerebrovascular events with compared cardiovascular events. METHODS We included patients with acute ischaemic stroke or transient ischaemic attack within seven days from the Third China National Stroke Registry. One-year cumulative event rates of combined vascular events (a composite of MI, stroke recurrence or vascular death) and cardiac events (a composite of MI, heart failure or cardiac death) was estimated using the Kaplan-Meier method. The predictive value of the Essen score was assessed with C-statistics. In multivariate Cox regression analyses, we assessed whether Essen score, etiological subtype and imaging parameters were associated with outcomes. RESULTS Of 13,012 patients were included, the cumulative one-year event rates were 10.03% for combined vascular events and 0.77% for cardiac events, respectively. Compared with those with an Essen score < 3, patients with an Essen score ≥ 3 were more likely to have a subsequent combined vascular event [hazard ratio (HR) = 1.39, 95% CI: 1.24−1.55] and cardiac events (HR = 2.30, 95% CI: 1.53−3.44). The score tended to be more predictive of the risk of MI (C-statistic = 0.63, 95% CI: 0.55−0.71) and cardiac events (C-statistic = 0.62, 95% CI: 0.56−0.67) than stroke recurrence (C-statistic = 0.55, 95% CI: 0.54−0.57) and combined vascular events (C-statistic = 0.56, 95% CI: 0.54−0.57). In multivariable analysis after adjusted Essen score, patients with multiple acute infarctions or single acute infarctions and large artery atherosclerosis subtype were independently associated with an increased risk of combined vascular events. While the cardioembolism subtype was associated with an increased risk of cardiac events. CONCLUSIONS The Essen score is potentially more suitable for risk stratification of cardiovascular events than cerebrovascular events. Moreover, future predictive tools should take brain imaging findings and cause of stroke into consideration.","PeriodicalId":285674,"journal":{"name":"Journal of geriatric cardiology : JGC","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114992315","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 : 2022-04-28DOI: 10.11909/j.issn.1671-5411.2022.04.005
D. Hu, Y. Hao, Jun Liu, N. Yang, Yiqian Yang, Zhaokun Sun, Dong Zhao, Jing Liu
OBJECTIVE To describe the duration of the pre-hospital delay time and identify factors associated with prolonged pre-hospital delay in patients with acute myocardial infarction (AMI) in China. METHODS Data were collected from November 2014 to December 2019 as part of the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome (CCC-ACS) project. A total of 33,386 patients with AMI admitted to the index hospitals were included in this study. Two-level logistic regression was conducted to explore the factors associated with the pre-hospital delay and the associations between different pre-hospital delay and in-hospital outcomes. RESULTS Of the 33,386 patients with AMI, 70.7% of patients arrived at hospital ≥ 2 h after symptom onset. Old age, female, rural medical insurance, symptom onset at early dawn, and non-use of an ambulance predicted a prolonged pre-hospital delay (all P < 0.05). Hypertension and heart failure at admission were only significant in predicting a longer delay in patients with ST-segment elevation myocardial infarction (STEMI) (all P < 0.05). A pre-hospital delay of ≥ 2 h was associated with an increased risk of mortality [odds ratio (OR) = 1.36, 95% CI: 1.09–1.69, P = 0.006] and major adverse cardiovascular events (OR = 1.22, 95% CI: 1.02–1.47, P = 0.033) in patients with STEMI compared with a pre-hospital delay of < 2 h. CONCLUSIONS Prolonged pre-hospital delay is associated with adverse in-hospital outcomes in patients with STEMI in China. Our study identifies that patient characteristics, symptom onset time, and type of transportation are associated with pre-hospital delay time, and provides focuses for quality improvement.
{"title":"Pre-hospital delay in patients with acute myocardial infarction in China: findings from the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome (CCC-ACS) project","authors":"D. Hu, Y. Hao, Jun Liu, N. Yang, Yiqian Yang, Zhaokun Sun, Dong Zhao, Jing Liu","doi":"10.11909/j.issn.1671-5411.2022.04.005","DOIUrl":"https://doi.org/10.11909/j.issn.1671-5411.2022.04.005","url":null,"abstract":"OBJECTIVE To describe the duration of the pre-hospital delay time and identify factors associated with prolonged pre-hospital delay in patients with acute myocardial infarction (AMI) in China. METHODS Data were collected from November 2014 to December 2019 as part of the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome (CCC-ACS) project. A total of 33,386 patients with AMI admitted to the index hospitals were included in this study. Two-level logistic regression was conducted to explore the factors associated with the pre-hospital delay and the associations between different pre-hospital delay and in-hospital outcomes. RESULTS Of the 33,386 patients with AMI, 70.7% of patients arrived at hospital ≥ 2 h after symptom onset. Old age, female, rural medical insurance, symptom onset at early dawn, and non-use of an ambulance predicted a prolonged pre-hospital delay (all P < 0.05). Hypertension and heart failure at admission were only significant in predicting a longer delay in patients with ST-segment elevation myocardial infarction (STEMI) (all P < 0.05). A pre-hospital delay of ≥ 2 h was associated with an increased risk of mortality [odds ratio (OR) = 1.36, 95% CI: 1.09–1.69, P = 0.006] and major adverse cardiovascular events (OR = 1.22, 95% CI: 1.02–1.47, P = 0.033) in patients with STEMI compared with a pre-hospital delay of < 2 h. CONCLUSIONS Prolonged pre-hospital delay is associated with adverse in-hospital outcomes in patients with STEMI in China. Our study identifies that patient characteristics, symptom onset time, and type of transportation are associated with pre-hospital delay time, and provides focuses for quality improvement.","PeriodicalId":285674,"journal":{"name":"Journal of geriatric cardiology : JGC","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129400635","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 : 2022-04-28DOI: 10.11909/j.issn.1671-5411.2022.04.004
F. Kandah, P. Dhruva, Raj Shukla, M. Ganji, C. Palacio, E. Missov, J. Ruíz-Morales
A cute decompensated heart failure (HF) is the most common cause of hospital admission in patients older than 65 years. Mean length of hospital stay is about 5–6 days and with a frequent number of hospital readmission rates of 25% to 50% at 30 days and 6–12 months, respectively. Treatment options are vast and depend on certain patient characteristics, including hemodynamics, which drive the acute management. A popular modality to assess hemodynamics in acute HF is the right heart catheterization (RHC). While invasive, the use of RHC gives providers the opportunity to evaluate values that directly contribute to the management of the patient. These numbers can calculate the cardiac output as well as help establish the underlying etiology of the patient’s symptoms and guide therapy. Per Doshi, the use of right artery catheterization increased from 2010−2014 per 1000 hospitalizations compared to 2005−2010. The ESCAPE trial was a large trial that evaluated the use of RHC to guide therapy, however, results were shown to increase adverse events without affecting overall mortality and hospitalization. It was not until its use was studied in patients with cardiogenic shock (CS) in which RHC was shown to be associated with lower mortality and in-hospital cardiac arrest. Furthermore, another study compared RHC with N-terminal pro-B-type natriuretic peptide (NT-proBNP) measurements in the prognosis of chronic HF patients. It concluded that NT-proBNP was a better predictor of all-cause mortality with the benefit of being non-invasive. The role of RHC is still not clearly defined and its necessity in guiding therapy of HF patients is controversial. It is also not wellknown which patient’s populations benefit most from it. A retrospective study was conducted at a safetynet hospital in Jacksonville, Florida, USA. Through electronic medical record review, data was collected on HF admissions, procedures, medications, and medical history between January 2020 and December 2020. Inclusion criteria involved those patients over the age of 18 years who were admitted to the cardiac care unit. A total of 176 patients fitting this criteria were reviewed and stratified by age, gender, race, comorbidities, length of stay, ejection fraction (reduced vs. preserved), etiology of cardiomyopathy (ischemic vs. nonischemic), NT-proBNP and creatinine levels. Statistical analysis was performed using SPSS 22.0 (SPSS Inc., IBM, Chicago, IL, USA). Categorical variables are presented as counts (percentages). Continuous variables are presented as mean ± SD or median (interquartile range) as appropriate. Differences were assessed using the Pearson’s chi-squared test and Mann-Whitney U test as appropriate. The study was approved by the regional Institutional Review Board. All authors were involved in data collection and interpretation of results. This study resulted in 176 total patients. As shown in Table 1, out of these 176 patients, 95 patients were Caucasian and 81 patients were African
{"title":"Invasive versus non-invasive hemodynamic monitoring of heart failure patients and their outcomes","authors":"F. Kandah, P. Dhruva, Raj Shukla, M. Ganji, C. Palacio, E. Missov, J. Ruíz-Morales","doi":"10.11909/j.issn.1671-5411.2022.04.004","DOIUrl":"https://doi.org/10.11909/j.issn.1671-5411.2022.04.004","url":null,"abstract":"A cute decompensated heart failure (HF) is the most common cause of hospital admission in patients older than 65 years. Mean length of hospital stay is about 5–6 days and with a frequent number of hospital readmission rates of 25% to 50% at 30 days and 6–12 months, respectively. Treatment options are vast and depend on certain patient characteristics, including hemodynamics, which drive the acute management. A popular modality to assess hemodynamics in acute HF is the right heart catheterization (RHC). While invasive, the use of RHC gives providers the opportunity to evaluate values that directly contribute to the management of the patient. These numbers can calculate the cardiac output as well as help establish the underlying etiology of the patient’s symptoms and guide therapy. Per Doshi, the use of right artery catheterization increased from 2010−2014 per 1000 hospitalizations compared to 2005−2010. The ESCAPE trial was a large trial that evaluated the use of RHC to guide therapy, however, results were shown to increase adverse events without affecting overall mortality and hospitalization. It was not until its use was studied in patients with cardiogenic shock (CS) in which RHC was shown to be associated with lower mortality and in-hospital cardiac arrest. Furthermore, another study compared RHC with N-terminal pro-B-type natriuretic peptide (NT-proBNP) measurements in the prognosis of chronic HF patients. It concluded that NT-proBNP was a better predictor of all-cause mortality with the benefit of being non-invasive. The role of RHC is still not clearly defined and its necessity in guiding therapy of HF patients is controversial. It is also not wellknown which patient’s populations benefit most from it. A retrospective study was conducted at a safetynet hospital in Jacksonville, Florida, USA. Through electronic medical record review, data was collected on HF admissions, procedures, medications, and medical history between January 2020 and December 2020. Inclusion criteria involved those patients over the age of 18 years who were admitted to the cardiac care unit. A total of 176 patients fitting this criteria were reviewed and stratified by age, gender, race, comorbidities, length of stay, ejection fraction (reduced vs. preserved), etiology of cardiomyopathy (ischemic vs. nonischemic), NT-proBNP and creatinine levels. Statistical analysis was performed using SPSS 22.0 (SPSS Inc., IBM, Chicago, IL, USA). Categorical variables are presented as counts (percentages). Continuous variables are presented as mean ± SD or median (interquartile range) as appropriate. Differences were assessed using the Pearson’s chi-squared test and Mann-Whitney U test as appropriate. The study was approved by the regional Institutional Review Board. All authors were involved in data collection and interpretation of results. This study resulted in 176 total patients. As shown in Table 1, out of these 176 patients, 95 patients were Caucasian and 81 patients were African","PeriodicalId":285674,"journal":{"name":"Journal of geriatric cardiology : JGC","volume":"55 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124898488","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 : 2022-04-28DOI: 10.11909/j.issn.1671-5411.2022.04.001
Xueqi Dong, Di Zhang, Yi Qu, Yuelin Hu, Chun Yang, T. Tian, Nan Xu, Hailun Jiang, L. Zeng, Pengyan Xia, Ya-xin Liu, R. Liu, Xianliang Zhou
BACKGROUND Mutation in the titin gene (TTN) in left ventricular noncompaction (LVNC) has been reported with a highly heterogeneous prevalence, and the molecular mechanisms underlying the pathogenesis of TTN gene mutation are uncharacterized. In the present study, we identified a novel TTN mutation in a pedigree with LVNC and investigated the potential pathogenic mechanism by functional studies. METHODS The whole-genome sequencing with linkage analysis was performed in a 3-generation family affected by autosomal dominant LVNC cardiomyopathy. The clustered regularly interspaced short palindromic repeats associated protein 9 (CRISPR/Cas9) technology was used to establish novel truncating mutation in TTN in a rat cardiomyoblast H9C2 cell line in vitro, in which functional studies were carried out and characterized in comparison to its wild-type counterpart. RESULTS A novel truncating mutation TTN p. R2021X was identified as the only plausible disease-causing variant that segregated with disease among the five surviving affected individuals, with an interrogation of the entire genome excluding other potential causes. Quantitative reverse transcription-polymerase chain reaction and cellular immunofluorescence supported a haploinsufficient disease mechanism in titin truncation mutation cardiomyocytes. Further functional studies suggested mitochondrial abnormities in the presence of mutation, including decreased oxygen consumption rate, reduced adenosine triphosphate production, impaired activity of electron translation chain, and abnormal mitochondrial structure on electron microscopy. Impaired autophagy under electron microscopy accompanied with activation of the Akt-mTORC1 signaling pathway was observed in TTN p. R2021X truncation mutation cardiomyocytes. CONCLUSIONS The TTN p. R2021X mutation has a function in the cause of a highly penetrant familial LVNC. These findings expand the spectrum of titin’s roles in cardiomyopathies and provide novel insight into the molecular basis of titin-truncating variants-associated LVNC.
研究背景:据报道，左心室非压实(LVNC)中titin基因(TTN)的突变具有高度异质性，但TTN基因突变的分子机制尚不清楚。在本研究中，我们在LVNC家系中发现了一个新的TTN突变，并通过功能研究探讨了潜在的致病机制。方法对常染色体显性LVNC心肌病家族3代患者进行全基因组测序和连锁分析。利用聚类规则间隔短回文重复相关蛋白9 (CRISPR/Cas9)技术在体外大鼠成心肌细胞H9C2细胞系中建立新的TTN截断突变，并进行功能研究，并与野生型TTN进行比较。一种新的截断突变TTN p. R2021X被确定为唯一可能的致病变异，在5个存活的受影响个体中与疾病分离，并对整个基因组进行了调查，排除了其他潜在原因。定量逆转录-聚合酶链反应和细胞免疫荧光支持在titin截断突变心肌细胞中单倍体不足的疾病机制。进一步的功能研究表明，突变存在线粒体异常，包括氧气消耗速率降低，三磷酸腺苷产生减少，电子翻译链活性受损，电镜下线粒体结构异常。电镜下观察到TTN p. R2021X截断突变心肌细胞自噬受损，并伴有Akt-mTORC1信号通路的激活。结论TTN p. R2021X突变在高渗透性家族性LVNC发病中起一定作用。这些发现扩大了titin在心肌病中的作用范围，并为titin截断变异相关LVNC的分子基础提供了新的见解。
{"title":"Implication of a novel truncating mutation in titin as a cause of autosomal dominant left ventricular noncompaction","authors":"Xueqi Dong, Di Zhang, Yi Qu, Yuelin Hu, Chun Yang, T. Tian, Nan Xu, Hailun Jiang, L. Zeng, Pengyan Xia, Ya-xin Liu, R. Liu, Xianliang Zhou","doi":"10.11909/j.issn.1671-5411.2022.04.001","DOIUrl":"https://doi.org/10.11909/j.issn.1671-5411.2022.04.001","url":null,"abstract":"BACKGROUND Mutation in the titin gene (TTN) in left ventricular noncompaction (LVNC) has been reported with a highly heterogeneous prevalence, and the molecular mechanisms underlying the pathogenesis of TTN gene mutation are uncharacterized. In the present study, we identified a novel TTN mutation in a pedigree with LVNC and investigated the potential pathogenic mechanism by functional studies. METHODS The whole-genome sequencing with linkage analysis was performed in a 3-generation family affected by autosomal dominant LVNC cardiomyopathy. The clustered regularly interspaced short palindromic repeats associated protein 9 (CRISPR/Cas9) technology was used to establish novel truncating mutation in TTN in a rat cardiomyoblast H9C2 cell line in vitro, in which functional studies were carried out and characterized in comparison to its wild-type counterpart. RESULTS A novel truncating mutation TTN p. R2021X was identified as the only plausible disease-causing variant that segregated with disease among the five surviving affected individuals, with an interrogation of the entire genome excluding other potential causes. Quantitative reverse transcription-polymerase chain reaction and cellular immunofluorescence supported a haploinsufficient disease mechanism in titin truncation mutation cardiomyocytes. Further functional studies suggested mitochondrial abnormities in the presence of mutation, including decreased oxygen consumption rate, reduced adenosine triphosphate production, impaired activity of electron translation chain, and abnormal mitochondrial structure on electron microscopy. Impaired autophagy under electron microscopy accompanied with activation of the Akt-mTORC1 signaling pathway was observed in TTN p. R2021X truncation mutation cardiomyocytes. CONCLUSIONS The TTN p. R2021X mutation has a function in the cause of a highly penetrant familial LVNC. These findings expand the spectrum of titin’s roles in cardiomyopathies and provide novel insight into the molecular basis of titin-truncating variants-associated LVNC.","PeriodicalId":285674,"journal":{"name":"Journal of geriatric cardiology : JGC","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129980527","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 : 2022-04-28DOI: 10.11909/j.issn.1671-5411.2022.04.010
Chang-Hao Xu, X. Liu
A trial fibrillation (AF) is the most prevalent arrhythmia in the aging population, with people over 75 years accounting for 70% of the AF population. Over the past twenty years, despite tremendous progress has been made in catheter ablation for rhythm control of AF, we still cannot establish a reliable ablative target for nonparoxysmal AF. Part of the reason is an incomplete understanding of the mechanism underlying the progressive nature of AF. In the time chain of AF, AF burden increases, and the success rate of catheter ablation decreases as AF progresses from paroxysmal AF (PAF) to persistent AF (PerAF) and long-standing persistent AF (LS-PerAF) form. Recently, with the advance in mapping technologies combined with biophysical insight, a new concept of AF maintenance has been introduced--the rotor (spiral waves). Meanwhile, the concept of complete electrical left atrial (LA) isolation has been introduced for AF with extensive atrial fibrosis. These innovative ideas enriched our armamentarium to combat different AF subtypes. This article proposes a rotor hypothesis to illustrate the mechanism underlying AF progress and discuss the application of new strategies in different AF subtypes.
{"title":"Rotor hypothesis in the time chain of atrial fibrillation","authors":"Chang-Hao Xu, X. Liu","doi":"10.11909/j.issn.1671-5411.2022.04.010","DOIUrl":"https://doi.org/10.11909/j.issn.1671-5411.2022.04.010","url":null,"abstract":"A trial fibrillation (AF) is the most prevalent arrhythmia in the aging population, with people over 75 years accounting for 70% of the AF population. Over the past twenty years, despite tremendous progress has been made in catheter ablation for rhythm control of AF, we still cannot establish a reliable ablative target for nonparoxysmal AF. Part of the reason is an incomplete understanding of the mechanism underlying the progressive nature of AF. In the time chain of AF, AF burden increases, and the success rate of catheter ablation decreases as AF progresses from paroxysmal AF (PAF) to persistent AF (PerAF) and long-standing persistent AF (LS-PerAF) form. Recently, with the advance in mapping technologies combined with biophysical insight, a new concept of AF maintenance has been introduced--the rotor (spiral waves). Meanwhile, the concept of complete electrical left atrial (LA) isolation has been introduced for AF with extensive atrial fibrosis. These innovative ideas enriched our armamentarium to combat different AF subtypes. This article proposes a rotor hypothesis to illustrate the mechanism underlying AF progress and discuss the application of new strategies in different AF subtypes.","PeriodicalId":285674,"journal":{"name":"Journal of geriatric cardiology : JGC","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131182277","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}
{"title":"3D vena contracta area in degenerative mitral regurgitation: cross-platform comparison in a single patient","authors":"S. Ching, C. Yue","doi":"10.11909/j.issn.1671-5411.2022.04.007","DOIUrl":"https://doi.org/10.11909/j.issn.1671-5411.2022.04.007","url":null,"abstract":"uantification of degenerative mitral reg-urgitation (MR) by two-dimensional (2D) transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) is challen-ging. Eccentric, obliquely oriented regurgitant jets limit inter-observer and intra-observer consistency.","PeriodicalId":285674,"journal":{"name":"Journal of geriatric cardiology : JGC","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129093373","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 : 2022-03-28DOI: 10.11909/j.issn.1671-5411.2022.03.010
J. Abramik, A. Dastidar, N. Kontogiannis, V. North, G. Patri, N. Weight, T. Raina, G. Kassimis
OBJECTIVE To examine the trends in patient characteristics and clinical outcomes over a ten-year period and to analyse the predictors of mortality in octogenarians undergoing percutaneous coronary intervention (PCI) in our centre. METHODS A total of 782 consecutive octogenarians (aged 80 and above) were identified from a prospectively collected PCI database within our non-surgical, medium volume centre between 1st January 2007 and 31st December 2016. This represented 10.9% of all PCI procedures performed in our centre during this period. We evaluated the demographic and procedural characteristics of the cohort with respect to clinical outcomes (all-cause in-hospital and 1-year mortality, in-hospital complication rates, duration of hospital admission, coronary disease angiographic complexity and major co-morbidities). The cohort was further stratified into three chronological tertiles (January 2007 to July 2012, 261 cases; August 2012 to May 2015, 261 cases; June 2015 to December 2016, 260 cases) to assess for differences over time. Predictors of mortality were identified through a multivariate regression analysis. RESULTS The number of octogenarians undergoing PCI increased nearly ten-fold over the studied period. Despite this, there were no significant differences in clinical outcomes or patient characteristics, except for the increased use of trans-radial vascular access [11.9% in first tertile vs. 73.2% in third tertile (P < 0.0001)]. The all-cause in-hospital (5.8% vs. 4.6% vs. 3.8%, P = 0.578) and 1-year mortality (12.4% vs. 12.5% vs. 14.4%, P = 0.746) remained constant in all three tertiles respectively. Six independent predictors of mortality were identified - increasing age [HR = 1.12 (1.03−1.22), P = 0.008], cardiogenic shock [HR = 16.40 (4.04–66.65), P < 0.0001], severe left ventricular impairment [HR = 3.52 (1.69−7.33), P = 0.001], peripheral vascular disease [HR = 2.73 (1.22−6.13), P = 0.015], diabetes [HR = 2.59 (1.30−5.17), P = 0.007] and low creatinine clearance [HR = 0.98 (0.96−1.00), P = 0.031]. CONCLUSION This contemporary observational study provides a useful insight into the real-world practice of PCI in octogenarians.
目的探讨近十年来我院接受经皮冠状动脉介入治疗(PCI)的80多岁老人的临床特点和预后趋势，并分析其死亡率的预测因素。方法在2007年1月1日至2016年12月31日期间，从我们的非手术中容积中心前瞻性收集的PCI数据库中确定了782名连续的80岁以上老人(80岁及以上)。这占本中心在此期间进行的所有PCI手术的10.9%。我们根据临床结果(全因住院和1年死亡率、院内并发症发生率、住院时间、冠心病血管造影复杂性和主要合并症)评估了该队列的人口学和程序特征。该队列进一步按时间顺序分为三组(2007年1月至2012年7月，261例;2012年8月至2015年5月，261例;2015年6月至2016年12月，260例)评估不同时间的差异。通过多变量回归分析确定死亡率的预测因素。结果在研究期间，接受PCI治疗的80多岁老人增加了近10倍。尽管如此，除了经桡动脉血管通路的使用增加外，临床结果或患者特征没有显著差异[第一组为11.9%，第三组为73.2% (P < 0.0001)]。全因住院死亡率(5.8% vs. 4.6% vs. 3.8%， P = 0.578)和1年死亡率(12.4% vs. 12.5% vs. 14.4%， P = 0.746)在所有三分位数中分别保持不变。确定了6个独立的死亡率预测因素:年龄增加[HR = 1.12 (1.03 ~ 1.22)， P = 0.008]、心源性休克[HR = 16.40 (4.04 ~ 66.65)， P < 0.0001]、严重左心室损伤[HR = 3.52 (1.69 ~ 7.33)， P = 0.001]、周围血管疾病[HR = 2.73 (1.22 ~ 6.13)， P = 0.015]、糖尿病[HR = 2.59 (1.30 ~ 5.17)， P = 0.007]和低肌酐清除率[HR = 0.98 (0.96 ~ 1.00)， P = 0.031]。结论:这项当代观察性研究为80多岁老人PCI的实际应用提供了有用的见解。
{"title":"Percutaneous coronary intervention in octogenarians: 10-year experience from a primary percutaneous coronary intervention centre with off-site cardiothoracic support","authors":"J. Abramik, A. Dastidar, N. Kontogiannis, V. North, G. Patri, N. Weight, T. Raina, G. Kassimis","doi":"10.11909/j.issn.1671-5411.2022.03.010","DOIUrl":"https://doi.org/10.11909/j.issn.1671-5411.2022.03.010","url":null,"abstract":"OBJECTIVE To examine the trends in patient characteristics and clinical outcomes over a ten-year period and to analyse the predictors of mortality in octogenarians undergoing percutaneous coronary intervention (PCI) in our centre. METHODS A total of 782 consecutive octogenarians (aged 80 and above) were identified from a prospectively collected PCI database within our non-surgical, medium volume centre between 1st January 2007 and 31st December 2016. This represented 10.9% of all PCI procedures performed in our centre during this period. We evaluated the demographic and procedural characteristics of the cohort with respect to clinical outcomes (all-cause in-hospital and 1-year mortality, in-hospital complication rates, duration of hospital admission, coronary disease angiographic complexity and major co-morbidities). The cohort was further stratified into three chronological tertiles (January 2007 to July 2012, 261 cases; August 2012 to May 2015, 261 cases; June 2015 to December 2016, 260 cases) to assess for differences over time. Predictors of mortality were identified through a multivariate regression analysis. RESULTS The number of octogenarians undergoing PCI increased nearly ten-fold over the studied period. Despite this, there were no significant differences in clinical outcomes or patient characteristics, except for the increased use of trans-radial vascular access [11.9% in first tertile vs. 73.2% in third tertile (P < 0.0001)]. The all-cause in-hospital (5.8% vs. 4.6% vs. 3.8%, P = 0.578) and 1-year mortality (12.4% vs. 12.5% vs. 14.4%, P = 0.746) remained constant in all three tertiles respectively. Six independent predictors of mortality were identified - increasing age [HR = 1.12 (1.03−1.22), P = 0.008], cardiogenic shock [HR = 16.40 (4.04–66.65), P < 0.0001], severe left ventricular impairment [HR = 3.52 (1.69−7.33), P = 0.001], peripheral vascular disease [HR = 2.73 (1.22−6.13), P = 0.015], diabetes [HR = 2.59 (1.30−5.17), P = 0.007] and low creatinine clearance [HR = 0.98 (0.96−1.00), P = 0.031]. CONCLUSION This contemporary observational study provides a useful insight into the real-world practice of PCI in octogenarians.","PeriodicalId":285674,"journal":{"name":"Journal of geriatric cardiology : JGC","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121239064","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 : 2022-03-28DOI: 10.11909/j.issn.1671-5411.2022.03.004
F. Pollari, F. Vogt, I. Grossmann, J. Marianowicz, Marie Claes, S. Pfeiffer, J. Schwab, T. Fischlein
OBJECTIVES To assess the impact of prosthesis choice and aortic valve calcifications on the occurrence of conduction disturbances after transcatheter aortic valve implantation (TAVI). METHODS We retrospectively analyzed the preoperative clinical characteristics, electrocardiograms, contrast-enhanced multidetector computed tomography scans and procedural strategies of patients who underwent TAVI in our center between January 2012 and June 2017. Quantification of calcium volume was performed for each aortic cusp above (aortic valve) and below (left ventricular outflow tract, LVOT) the basal plane. Multivariate analysis was performed to evaluate risk factors for the onset of new bundle branch block (BBB), transient and permanent atrioventricular block (tAVB, pAVB). RESULTS A total of 569 patients were included in the study. Six different prostheses were implanted (Edwards Sapien XT, n = 162; Edwards Sapien 3, n = 240; Medtronic CoreValve, n = 27; Medtronic CoreValve Evolut R, n = 21; Symetis Acurate, n = 56; Symetis Acurate neo, n = 63). The logistic regression analysis for BBB showed association with baseline left anterior hemiblock. The logistic regression for tAVB, found the prior valvuloplasty and the balloon post-dilatation associated with the outcome. Baseline left and right BBB, degree of oversizing, and LVOT calcification beneath the non-coronary cusp were associated with pAVB. Neither the prosthesis model, nor the use of a self-expandable prosthesis showed statistical significance with the above-mentioned outcomes on univariate analysis. CONCLUSIONS LVOT calcification beneath the non-coronary cusp, baseline left anterior hemiblock, right BBB, balloon post-dilatation, prior valvuloplasty and oversizing are independently associated with postprocedural conduction disturbances after TAVI. Use of a self-expandable prosthesis may show a lower incidence of AVB, if applied in lower calcified aortic valves.
目的探讨假体选择和主动脉瓣钙化对经导管主动脉瓣植入术(TAVI)后传导障碍发生的影响。方法回顾性分析2012年1月至2017年6月在本中心接受TAVI的患者的术前临床特征、心电图、增强多探测器计算机断层扫描和手术策略。定量测定基底面上方(主动脉瓣)和下方(左心室流出道，LVOT)的每个主动脉尖钙量。通过多因素分析来评估发生新束支传导阻滞(BBB)、短暂性房室传导阻滞(tAVB)和永久性房室传导阻滞(pAVB)的危险因素。结果共纳入569例患者。植入6种不同的假体(Edwards Sapien XT, n = 162;Edwards Sapien 3, n = 240;美敦力CoreValve, n = 27;美敦力CoreValve Evolut R, n = 21;Symetis accurate, n = 56;Symetis precision neo, n = 63)。logistic回归分析显示血脑屏障与基线左前半部分有关。对tAVB进行logistic回归，发现先前的瓣膜成形术和球囊扩张后的结果相关。基线左、右血脑屏障、过大程度和非冠状动脉尖下LVOT钙化与pAVB相关。假体模型和自膨胀假体的使用与上述单变量分析结果均无统计学意义。结论:非冠状动脉尖下LVOT钙化、基线左前半块、右侧血脑屏障、球囊扩张、先前的瓣膜成形术和过大与TAVI术后传导障碍独立相关。如果应用于钙化的主动脉瓣下部，使用自膨胀假体可能显示AVB的发生率较低。
{"title":"Risk of conduction disturbances following different transcatheter aortic valve prostheses: the role of aortic valve calcifications","authors":"F. Pollari, F. Vogt, I. Grossmann, J. Marianowicz, Marie Claes, S. Pfeiffer, J. Schwab, T. Fischlein","doi":"10.11909/j.issn.1671-5411.2022.03.004","DOIUrl":"https://doi.org/10.11909/j.issn.1671-5411.2022.03.004","url":null,"abstract":"OBJECTIVES To assess the impact of prosthesis choice and aortic valve calcifications on the occurrence of conduction disturbances after transcatheter aortic valve implantation (TAVI). METHODS We retrospectively analyzed the preoperative clinical characteristics, electrocardiograms, contrast-enhanced multidetector computed tomography scans and procedural strategies of patients who underwent TAVI in our center between January 2012 and June 2017. Quantification of calcium volume was performed for each aortic cusp above (aortic valve) and below (left ventricular outflow tract, LVOT) the basal plane. Multivariate analysis was performed to evaluate risk factors for the onset of new bundle branch block (BBB), transient and permanent atrioventricular block (tAVB, pAVB). RESULTS A total of 569 patients were included in the study. Six different prostheses were implanted (Edwards Sapien XT, n = 162; Edwards Sapien 3, n = 240; Medtronic CoreValve, n = 27; Medtronic CoreValve Evolut R, n = 21; Symetis Acurate, n = 56; Symetis Acurate neo, n = 63). The logistic regression analysis for BBB showed association with baseline left anterior hemiblock. The logistic regression for tAVB, found the prior valvuloplasty and the balloon post-dilatation associated with the outcome. Baseline left and right BBB, degree of oversizing, and LVOT calcification beneath the non-coronary cusp were associated with pAVB. Neither the prosthesis model, nor the use of a self-expandable prosthesis showed statistical significance with the above-mentioned outcomes on univariate analysis. CONCLUSIONS LVOT calcification beneath the non-coronary cusp, baseline left anterior hemiblock, right BBB, balloon post-dilatation, prior valvuloplasty and oversizing are independently associated with postprocedural conduction disturbances after TAVI. Use of a self-expandable prosthesis may show a lower incidence of AVB, if applied in lower calcified aortic valves.","PeriodicalId":285674,"journal":{"name":"Journal of geriatric cardiology : JGC","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127848520","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 : 2022-03-28DOI: 10.11909/j.issn.1671-5411.2022.03.008
M. R. Sonsoz, Selin Berk, H. Pusuroğlu, A. Guler, F. Uzun
S evere valvular aortic stenosis is a commonly encountered disorder in the elderly, and the intervention is indicated when the patient is symptomatic. Transcatheter aortic valve implantation (TAVI) is a safer therapeutic option in symptomatic patients who cannot undergo surgery or who have high, intermediate, or even low surgical risk. Idiopathic thrombocytopenic purpura (ITP) is acquired thrombocytopenia caused by autoantibodies against platelet antigens. Herein, we report an 81-year-old patient, who was diagnosed with primary ITP two years ago, was admitted to the hospital for heart failure with acute coronary syndrome and severe aortic stenosis. We describe our experience in the peri-operative management of the case of coronary and structural intervention in a patient with ITP. An 81-year-old lady presented with shortness of breath and chest pain to the emergency room. Her medical history included hypothyroidism and primary ITP, which was diagnosed two years ago, and she wasn’t taking any medication for it. She had a temperature of 36.5 °C, a pulse rate of 105 beats/min, a respiratory rate of 30 breaths/min, and a blood pressure of 110/60 mmHg. Physical examination revealed pretibial edema with godet leaving on both legs, 3/6 systolic murmur on all cardiac auscultation sites, left-sided S4, tachypnea and bibasilar crackles. Electrocardiogram was consistent with sinus tachycardia and anterior negative T waves. Chest X-ray demonstrated increased cardio-thoracic index and interstitial pulmonary edema with bilateral pleural effusions. Complete blood count demonstrated mild anaemia with a haemoglobin level of 12.2 g/dL. The white blood cell count was normal. Platelet count was 122 × 10/μL. Liver function tests demonstrated elevated levels of aminotransferase (AST) 44 U/L, alanine transaminase (ALT) 62 U/L, and alkaline phosphatase 117 U/L, with slightly elevated levels of total bilirubin at 1.7 mg/dL and direct bilirubin at 0.7 mg/dL. Kidney function tests demonstrated elevated levels of creatinine 1.35 mg/dL. Additional test results included pro-BNP 25 770 pg/mL and high sensitivity troponin T 105 pg/mL. Her transthoracic echocardiogram disclosed severely reduced left ventricular systolic function (ejection fraction (EF) measured as 30%), left ventricular hypertrophy, akinesia in anterior wall and severe aortic stenosis with a mean gradient of 41 mmHg, transaortic velocity of 3.95 m/s and valve area of 0.82 cm (Figure 1). She was treated with intravenous furosemide. Within days, her signs and symptoms of congestion resolved. Acetylsalicylic acid 100 mg and clopidogrel 75 mg were initiated orally. A blood smear showed decreased platelets. She underwent invasive coronary angiography while having a platelet count of 40 × 10/ μL (Figure 2 and 3). There was stenosis of 90% in the proximal left anterior descending artery. We implanted a sirolimus eluting stent into the lesion (Biomime 30 × 16 mm) on 20 May. The patient was continued on steroids for four
{"title":"Severe aortic stenosis and acute coronary syndrome in an elderly patient with idiopathic thrombocytopenic purpura: a therapeutic challenge","authors":"M. R. Sonsoz, Selin Berk, H. Pusuroğlu, A. Guler, F. Uzun","doi":"10.11909/j.issn.1671-5411.2022.03.008","DOIUrl":"https://doi.org/10.11909/j.issn.1671-5411.2022.03.008","url":null,"abstract":"S evere valvular aortic stenosis is a commonly encountered disorder in the elderly, and the intervention is indicated when the patient is symptomatic. Transcatheter aortic valve implantation (TAVI) is a safer therapeutic option in symptomatic patients who cannot undergo surgery or who have high, intermediate, or even low surgical risk. Idiopathic thrombocytopenic purpura (ITP) is acquired thrombocytopenia caused by autoantibodies against platelet antigens. Herein, we report an 81-year-old patient, who was diagnosed with primary ITP two years ago, was admitted to the hospital for heart failure with acute coronary syndrome and severe aortic stenosis. We describe our experience in the peri-operative management of the case of coronary and structural intervention in a patient with ITP. An 81-year-old lady presented with shortness of breath and chest pain to the emergency room. Her medical history included hypothyroidism and primary ITP, which was diagnosed two years ago, and she wasn’t taking any medication for it. She had a temperature of 36.5 °C, a pulse rate of 105 beats/min, a respiratory rate of 30 breaths/min, and a blood pressure of 110/60 mmHg. Physical examination revealed pretibial edema with godet leaving on both legs, 3/6 systolic murmur on all cardiac auscultation sites, left-sided S4, tachypnea and bibasilar crackles. Electrocardiogram was consistent with sinus tachycardia and anterior negative T waves. Chest X-ray demonstrated increased cardio-thoracic index and interstitial pulmonary edema with bilateral pleural effusions. Complete blood count demonstrated mild anaemia with a haemoglobin level of 12.2 g/dL. The white blood cell count was normal. Platelet count was 122 × 10/μL. Liver function tests demonstrated elevated levels of aminotransferase (AST) 44 U/L, alanine transaminase (ALT) 62 U/L, and alkaline phosphatase 117 U/L, with slightly elevated levels of total bilirubin at 1.7 mg/dL and direct bilirubin at 0.7 mg/dL. Kidney function tests demonstrated elevated levels of creatinine 1.35 mg/dL. Additional test results included pro-BNP 25 770 pg/mL and high sensitivity troponin T 105 pg/mL. Her transthoracic echocardiogram disclosed severely reduced left ventricular systolic function (ejection fraction (EF) measured as 30%), left ventricular hypertrophy, akinesia in anterior wall and severe aortic stenosis with a mean gradient of 41 mmHg, transaortic velocity of 3.95 m/s and valve area of 0.82 cm (Figure 1). She was treated with intravenous furosemide. Within days, her signs and symptoms of congestion resolved. Acetylsalicylic acid 100 mg and clopidogrel 75 mg were initiated orally. A blood smear showed decreased platelets. She underwent invasive coronary angiography while having a platelet count of 40 × 10/ μL (Figure 2 and 3). There was stenosis of 90% in the proximal left anterior descending artery. We implanted a sirolimus eluting stent into the lesion (Biomime 30 × 16 mm) on 20 May. The patient was continued on steroids for four","PeriodicalId":285674,"journal":{"name":"Journal of geriatric cardiology : JGC","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121254787","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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