Heart Views最新文献

Introduction: Mitral stenosis (MS) remains a significant cardiovascular burden, particularly in developing nations, where rheumatic heart disease is a major contributor. Percutaneous mitral balloon commissurotomy (PMBC) is a widely used intervention to improve hemodynamic and alleviate symptoms in MS patients.

Methods: A prospective cohort study was carried out on 40 patients with mitral stenosis (MS) who underwent percutaneous mitral balloon commissurotomy (PMBC). Heart rate variability (HRV) was recorded before the procedure and two weeks after, using 5-minute short-term analysis. The assessment included time-domain measures [average heart rate (HR), standard deviation of normal-to-normal intervals (SDNN), root mean square of successive differences (RMSSD), and percentage of NN50 (pNN50)], frequency-domain measures [total power, low frequency (LF), high frequency (HF), and LF/HF ratio], and nonlinear indices [standard deviation 1 (SD1) and standard deviation 2 (SD2)]. Statistical analysis was performed to compare pre- and postprocedure values, with the objective of evaluating the effect of PMBC on sympathovagal balance.

Results: Post-PMBC, there was a significant reduction in HR (P = 0.004) and LF/HF ratio (P < 0.001), indicating a shift toward parasympathetic dominance. SDNN and RMSSD values improved significantly (P < 0.001), suggesting enhanced autonomic function. These autonomic improvements may contribute to enhanced cardiovascular regulation and reduced sympathetic drive.

Conclusion: PMBC significantly enhances autonomic function, as reflected by improved HRV parameters. These changes suggest better cardiovascular autonomic regulation, although direct cardiovascular risk was not assessed in this study. HRV analysis can serve as a valuable tool for assessing recovery and guiding postprocedural management in MS patients.

Background: A drug-coated balloon (DCB) allows treating the coronary artery lesions without permanent implantation of a metallic stent. International guidelines recommend DCB for the treatment of in-stent restenosis (ISR). Although DCB showed promising results in treating ISR, their role is still not well established in the broader clinical practice.

Objective: In this short report, we describe our institution's four-year initial experience in using DCB angioplasty, and compare the characteristics and outcomes of the patients treated with DCB with those treated with drug-eluting stent (DES) for ISR.

Methods: This is a single-center retrospective study of patients who underwent coronary angioplasty with either DCB or DES from January 1, 2018 to November 30, 2021 at the Heart Hospital in the State of Qatar.

Results: A total of 572 patients with ISR were recruited, 132 and 440 patients were in the DCB and DES group, respectively. In the DCB group, the median age was 57.9 years and there were 117 (88.6%). There was no significant difference between the DCB and DES groups in term demographics, comorbidities, coronary angiography indication or characteristics, and clinical outcomes. With regards the clinical outcomes, 13 patients (9.8%) underwent angioplasty for ACS and chest pain in the DCB group. The median time to the first event was a median of 480 days (16 months).

Conclusion: The use of DCB is increasing in Qatar. The initial experience was limited to its use in ISR. Patient characteristics, angiographic characteristics, and clinical outcomes in the DCB group did not significantly differ from those in the DES group. More studies are needed to evaluate the use of DCB in wider indications.

Introduction: The obesity paradox has been observed in patients with cardiovascular disease. The goal of this study was to evaluate if obesity has a protective effect in patients presenting with non-ST-elevation myocardial infarction (NSTEMI).

Methods: Using a large Nationwide Inpatient Sample (NIS) database, we evaluated mortality in patients with NSTEMI based on weight categories in adults.

Results: A total of 3,597,279 NSTEMI patients were found in the database over the age of 18 years. We found that overweight and obesity, followed by morbid obesity, had the lowest mortality using univariate (overweight mortality of 3.2% vs. obesity mortality of 3.78% vs. morbid obesity mortality of 5.69% vs. 7.8% of normal weights), whereas cachexia was associated with the highest mortality in univariate analysis (cachexia 21.82%). Using multivariate analysis adjusting for baseline characteristics and comorbidities, those relations remained unchanged (cachexia Multivariate Odds ratio (MVOR): 2.56, confidence interval [CI]: 2.41-2.73, P < 0.001; overweight MVOR: 0.49, CI: 041-0.59, P < 0.001; obesity MVOR: 0.6, CI: 0.58-0.63, P < 0.001; and morbid obesity MVOR: 0.94, CI: 0.9-0.98, P = 0.004).

Conclusion: We observe an obesity paradox in patients with NSTEMI, showing that overweight, followed by obesity and morbid obesity, have the lowest mortality, with cachexia having the highest mortality.

Introduction: Risk factors for needing a pacemaker have not been well studied. The goal of this study was to evaluate predictors, complications, trends, and mortality rates of pacemakers in adults.

Methods: We utilized the International Classification of Diseases, Tenth Revision, and Clinical Modification coding for this study. We evaluated clinical predictors of pacemaker insertions, their complications, and mortality using the Nationwide Inpatient Sample database for the years 2016-2020 in adults.

Results: A total of 647,435 patients had a pacemaker insertion at an average age of 76 years old (±11.48 years). Significant independent clinical predictors for pacer insertion were non-ST-elevation myocardial infarction: 4.3% versus 2.4%, odds ratio (OR), 1.85; 95% confidence interval (CI), 1.80-1.91; P < 0.001, hypertension: 84.40% versus 55.95%, OR, 4.26; 95% CI, 4.19-4.34; P < 0.001, hyperlipidemia: 59.59% versus 2.85%, OR, 3.01; 95% CI, 2.97-3.05; P < 0.001, atrial fibrillation/flutter: 45.89% versus 15.35%, OR, 4.68 95% CI, 4.62-4.74; P < 0.001, diabetes: 35.76% versus 27.20%, OR, 1.49; 95% CI, 1.47-1.51; P < 0.001, chronic kidney disease: 30.00% versus 17.70%, OR, 1.99; 95% CI, 1.97-2.02; P < 0.001, smoking: 29.81% versus 23.10%, OR, 1.41; 95% CI, 1.31-1.43; P < 0.001, chronic obstructive pulmonary disease: 17.63% versus 16.17%, OR, 1.11; 95% CI, 1.09-1.13; P < 0.001, valvular heart disease: 17.19% versus 3.76%, OR, 5.31; 95% CI, 5.21-5.41; P < 0.001, systolic heart failure: 12.94% versus 6.99%, OR, 1.98; 95% CI, 1.94-2.02; P < 0.001, prior percutaneous intervention: 11.70% versus 5.45%, OR, 2.30; 95% CI, 2.26-2.34; P < 0.001, obesity: 10.05% versus 8.57%, 1.19; 95% CI, 1.17-1.22; P < 0.001, history of coronary artery bypass grafting: 10.05% versus 4.32%, OR, 2.48; 95% CI, 2.43-2.52; P < 0.001, STEMI: 1.45% versus 2.66%, 1.45% OR, 1.86; 95% CI, 1.79-1.93; P < 0.001, history of cardiomyopathy: 0.74% versus 0.39%, OR, 1.90; 95% CI, 1.78-2.03; P < 0.001, and endocarditis: 0.15% versus 0.09%, OR, 1.77; 95% CI, 1.53-2.04; P < 0.001. Pacemaker complication rates were around 2% with a mortality of 1.44%.

Conclusion: We found many predictors for the need for pacemaker insertion. Mortality and complications have remained low over recent years with higher prevalence in males and Caucasians.

Introduction: Left main coronary artery (LMCA) revascularization has been indicated when the mean luminal area (MLA) measured by intravascular ultrasound (IVUS) is <6 mm². Few studies showed that the cut point for revascularization is less than that in Asian population. In this study, we studied the relationship between the LMCA area measured by IVUS and height and weight measurements to approximate the correlation.

Methodology: A cross-sectional analysis study included all patients who underwent IVUS assessment in King Abdulaziz Cardiac Center, Riyadh, Saudi Arabia, between 2015 and 2021. Patients with significant LMCA disease (>50%), calcification prevent clear measurement of LM artery media layer or any LMCA previous stents, and poor IVUS acquisition were excluded. The LMCA area measured by IVUS at the mid-shaft of the artery was investigated for correlation with patients' height, weight, body mass index (BMI), and body surface area (BSA).

Results: A total of 242 patients were included (20.2% of females with a mean age of 59.3 ± 12.1 years). The mean LMCA minimum luminal area (MLA) is 22.2 ± 5.51 mm². There is no significant difference between gender (female MLA 21.2041 mm² vs. male MLA 22.4021 mm² (P = 0.174). There is a significant correlation between LMCA area and height, with a correlation coefficient of 0.21 and P = 0.0008; by simple linear regression, there is a 1.38 mm² increase in LMCA area for every 10 cm increase in height. There is also a significant correlation between LMCA area and weight with a correlation coefficient of 0.19 and P = 0.0025; by simple linear regression, there is a 0.7 mm² increase in LMCA area for every 10 kg increase in weight.

Conclusion: The diameter values of the LM in our population sample aligned with those of other populations. There was no statistically significant correlation to age, gender, BMI, or BSA. However, we discovered a weak but statistically significant correlation between height and weight. The clinical importance of the correlation needs to be further investigated in a larger population-based study.

Background: Cardiovascular risk in nephrotic syndrome (NS) is attributed to persistent proteinuria, systemic inflammatory activation, and hyperlipidemia. Due to the limitations of conventional echocardiography, the Tei index is useful to detect subclinical cardiac dysfunction.

Objectives: To determine the cardiac dysfunction in children diagnosed with NS.

Materials and methods: This case-control study was conducted at Government Medical College, Nagpur, for 1 year in 36 children with NS of age group 1-12 years as cases and 36 age- and sex-matched children without kidney/cardiac diseases or illness which influences kidney/cardiac function selected by simple random method as a control. Demographic, clinical, and anthropometric data were collected. Hematological, biochemical investigations, and electrocardiography (ECG) were performed. Conventional two-dimensional echocardiography and tissue Doppler imaging (TDI) were performed by a cardiologist using ALPINION 5 color Doppler ultrasound machine. Conventional M-mode, B-mode, and Doppler parameters were measured as per the American Society of Echocardiography guidelines. Chi-square test and Student's t-test were used to compare between cases and controls. Pearson correlation coefficient was used to correlate between the variables of TDI findings. P <0.05 was considered statistically significant.

Results: Demographic and clinical variables were comparable in cases and controls except body mass index and diastolic blood pressure, which were significantly higher in cases. Serum albumin was significantly low (P < 0.0001), while the total mean cholesterol (P = 0.0005), triglycerides (P = 0.0001), and low-density lipoprotein (P = 0.01) were significantly higher in cases compared to controls. ECG and conventional echocardiographic findings were nonsignificant between cases and controls. Both left and right ventricular Tei indices were statistically significantly high in cases compared to control (P < 0.0001). Serum albumin was inversely correlated with a high Tei index of both ventricles.

Conclusion: Subclinical cardiac dysfunction is early evident by TDI compared to conventional echocardiography, and the Tei index is inversely associated with serum albumin. This implies timely recognition of cardiac subclinical dysfunction and to prevent the progression of cardiovascular disease to heart failure.

Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease presenting beyond the neonatal period. Since its first comprehensive description by Étienne-Louis Fallot in 1888, the management of TOF has evolved remarkably - from a universally fatal condition to one with high survival and long-term quality of life. The introduction of the Blalock-Taussig shunt in 1944 provided the first effective surgical palliation by increasing pulmonary blood flow. In the 1950s, the development of cardiopulmonary bypass enabled complete intracardiac repair, which soon became the definitive treatment. Subsequent decades saw refinements in surgical technique, including the adoption of the transatrial-transpulmonary approach and pulmonary valve-sparing strategies, aimed at preserving right ventricular (RV) function. Early primary repair, now typically performed in infancy, has become the standard of care in most centers. Despite these advances, late complications such as pulmonary regurgitation, RV dilation, arrhythmias, and reinterventions remain common, necessitating lifelong follow-up. Contemporary management includes the use of multimodality imaging, transcatheter pulmonary valve replacement (TPVR), and tailored surgical planning. Emerging technologies such as artificial intelligence and computational modeling hold promise for further improving individualized care. This review outlines the historical milestones, current best practices, and future directions in the surgical treatment of TOF, highlighting its transformation from a fatal diagnosis to a survivable chronic condition requiring multidisciplinary, lifelong care.