Heart Views最新文献

Background: Emerging evidence from various countries suggests that ST-segment elevation myocardial infarction (STEMI) patients with differing health-care insurance types experience discrepancies in clinical management and outcomes. Kuwait government provides free essential treatments and medications to noninsured patients with certain emergency conditions. We aimed to compare differences in clinical management and in-hospital and 30-day outcomes in STEMI patients with different insurance types in Kuwait.

Methods: Data were derived from Kuwait Catheterization Laboratory Project (Kuwait CLAP) registry. Adult patients (≥18 years) diagnosed with STEMI were enrolled in Kuwait CLAP registry between February 2020 and February 2021. Patients were categorized into insured and noninsured. The coprimary outcomes were the in-hospital and 30-day mortality in insured versus noninsured patients with STEMI. In-hospital and 30-day adverse cardiac outcomes were also compared.

Results: Of 668 patients with STEMI, 116 (17%) were insured and 552 (83%) were not insured. Three (2.6%) of the insured and 9 (1.6%) of the noninsured patients suffered in-hospital mortality, while no patients in the insured group and four patients (0.7%) patients in the noninsured group suffered 30-day mortality, with no significant difference between the two groups (P = 0.447 and P = 1, respectively). The rates of in-hospital complications and 30-day adverse events were similar between the two groups.

Conclusions: Our findings suggest no differences in acute or short-term outcomes among patients with different insurance status in Kuwait. These findings are reassuring knowing that the free essential services provided by Kuwait government for STEMI patients did not compromise the outcomes of noninsured compared to insured patients.

3-Methylcrotonyl-CoA carboxylase (3-MCC) deficiency is a rare autosomal recessive disease of leucine catabolism. 3-MCC deficiency may lead to metabolic decompensation under stress; however, outcomes of elective surgery requiring cardiopulmonary bypass (CPB) are unknown. We report a 4-year-old girl with asymptomatic 3-MCC deficiency and atrial septal defect (ASD) who's undergone surgical ASD repair under CPB. She was otherwise normal developmentally and medically. Although patients with 3-MCC may face metabolic crises, the ASD repair under CPB was uneventful.

We report a case of cardiac arrest in a 38-year-old male with no past medical history who presented as a case of ST-segment elevation myocardial infarction, and coronary angiography showed triple coronary artery thrombosis complicated with cardiogenic shock (CS) that warrants starting on inotropic support and insertion of intra-aortic balloon pump. CS diagnosis with a high likelihood of deterioration was established based on hemodynamics assessment; hence, an early prompt decision for escalation of mechanical circulatory support to Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) was made, which helped to prevent the patient's further deterioration and organ damage. The patient had uneventful VA-ECMO decannulation and was transferred to the ward and discharged after 28 days in stable condition on oral medical therapy and was following up regularly in the cardiology clinic. Therefore, early hemodynamics assessment in acute myocardial infarction CS cases will help predict rapid worsening, which may require prompt escalation of mechanical circulatory support and perhaps improve the outcome.

Cardiac rehabilitation (CR) is recommended for all patients with stable angina (SA) as an effective treatment. Hemoglobin (Hgb) levels predict exercise performance and may affect symptom threshold in SA patients. A multidisciplinary CR intervention was individually tailored for a 72-year-old patient with a diagnosis of SA, low Hgb (<10 g/dL), and typical chest pain at light-to-moderate exercise (<5 metabolic equivalent task), who was stratified as at high risk for cardiac events during exercise. Two symptom-limited exercise tests were performed before and after 36 sessions of supervised exercise training producing near-optimal accumulated total volume load and chronic training load. In this case report, we show that an individually tailored CR intervention in a patient with SA and low Hgb is feasible, effective, and safe at reducing the burden of symptoms while increasing peak exercise capacity, health-related quality of life, and physical activity engagement.

Spontaneous coronary artery dissection (SCAD) is a well-recognized cause of acute coronary syndrome (ACS) which can lead to myocardial infarction and sudden death. Unlike typical atherosclerosis, SCAD operates through distinct pathophysiology, affecting both individuals with and without conventional cardiovascular risk factors. We present a case of a young female presented with retrosternal chest pain radiating to the left arm, mimicking ACS symptoms with mildly elevated troponin levels, and slightly reduced left ventricular ejection fraction (45%). Subsequent evaluation using coronary angiography unveiled a Type 2A SCAD. A comprehensive computed tomography angiography (CTA) of her entire body revealed findings suggestive of fibromuscular dysplasia (FMD) affecting multiple arteries in different sites. Our case entailed the successful management of a young female patient with SCAD stemming from FMD.

A 40-year-old patient confirmed on computed tomography of the pulmonary arteries (CT/PAs) a large saddle pulmonary embolus in the main PA extending in both branches. He was managed by ultrasound-supported catheter-directed (EkoSonic, Boston Scientific) intrapulmonary thrombolytic therapy using a recombinant tissue plasminogen activator prolonged infusion over 16 h with a total dose of 50 mg divided in both PAs simultaneously with intravenous unfractionated heparin. He showed clinical improvement with improved arterial oxygen (PaO2) with reduced oxygen therapy with a nasal cannula. Follow-up right heart catheterization showed a significant reduction of PA pressure from 96/32 (mean 64) to 47/27 (mean 39) mmHg. Repeat pulmonary angiography showed significant improvement in PA branch opacification, suggesting increased flow and successful therapy. The patient received oral anticoagulants for months. He had followed with CT/PA and echocardiogram after 4 weeks, both were normalized. He resumed his regular physical activities, including exercises in the gymnasium.

Background: Computed Tomography coronary angiography and fractional flow reserve (CTCA and CT-FFR) are noninvasive diagnostic tools for the detection of flow-limiting coronary artery stenoses. Although their negative predictive values are well established, there is a concern that the high sensitivity of these tests may lead to overestimation of coronary artery disease (CAD) and unnecessary invasive coronary angiography (ICA). We compared the positive predictive value (PPV) of CT-FFR with computerized tomography coronary angiography (CTCA) against the gold standard of ICA in different real-world patient groups.

Methods: A retrospective analysis of 477 patients referred for CTCA or CT-FFR for investigation of possible coronary ischemia. Patients were excluded if the image quality was poor or inconclusive. Patient-based PPV was calculated to detect or rule out significant CAD, defined as more than 70% stenosis on ICA. A sub-analysis of PPV by indication for the scan was also performed. Patients who underwent invasive nonhyperemic pressure wire measurements had their instant wave-free ratio or resting full-cycle ratio compared with their CT-FFR values.

Results: In a patient-based analysis, the overall PPV was 59.3% for CTCA and 76.2% for CT-FFR. This increased to 81.0% and 86.7%, respectively, for patients with stable angina symptoms. In patients with atypical angina symptoms, CT-FFR considerably outperformed CTCA with a PPV of 61.3% vs. 37.5%. There was not a linear relationship between invasive pressure wire measurement and CT-FFR value (r = 0.23, P = 0.265).

Conclusion: The PPV of CTCA and CT-FFR is lower in the real world than in previously published trials, partly due to the heterogeneity of indication for the scan. However, in patients with typical angina symptoms, both are reliable diagnostic tools to determine the presence of clinically significant coronary stenoses. CT-FFR significantly outperforms CTCA in patients with more atypical symptoms and the targeted use of CT-FFR in this group may help to avoid unnecessary invasive procedures.