Heart Views最新文献

Background: The study aimed to evaluate the clinical outcome and complications after thrombolysis in patients with left-sided prosthetic valve thrombosis (PVT) in relation to the time of onset of symptoms.

Materials and methods: This was a prospective, observational, single-center study carried out from January 2020 to June 2022 at a tertiary care center in India. A total of 50 patients with PVT were included in the study. Patients underwent thrombolysis either with streptokinase or tenecteplase as per their individual clinical status. Clinical profile and treatment outcomes were assessed.

Results: PVT was more in females (64%) as compared to males (36%). The majority of the patients were in the age group of 31-40 years (38%) with a mean age of presentation being 32.7 years. Majority of the patients (39 patients) had symptom onset between 0 and 7 days (78%) while 11 patients (22%) presented beyond 7 days. Streptokinase was used for thrombolysis in 37 patients while Tenecteplase was used in 13 patients. In our study, majority of the patients 30 (60%) had a complete response to thrombolysis while 10 (20%) patients had a partial response, and no response to thrombolysis was seen in 10 (20%) patients. Hemorrhagic stroke was seen in 4 (8%) patients. Among 6 deaths, 3 were due to hemorrhagic stroke and 3 were due to cardiogenic shock.

Conclusions: Early thrombolysis within 7 days of symptom onset provides a good response to thrombolysis after which the response to thrombolysis is more likely to be suboptimal.

Aim: The aim of this study was to describe the design and rationale of a registry of patients with acute coronary syndromes (ACSs) in Kuwait.

Methods: Kuwait Heart Foundation Registry of Acute Coronary Events (KHF RACEs) is a prospective, multicenter, observational, cohort-based registry of consecutive patients admitted to hospitals in Kuwait with a working diagnosis of ACSs. The trial is registered at "Clinical Trials.gov" number NCT05857735 and enrollment started on May 15, 2023. It involved 8 hospitals and 124 investigators. Data were collected prospectively and entered into an online system specifically created for this registry. This included demographic data, risk factors, past medical history, medications at admission and discharge, pertinent findings on physical examination at admission, inhospital investigations, and management including cardiac catheterization and subsequent percutaneous coronary interventions. The observed outcomes included inhospital and 30-day mortality and major adverse cardiac events.

Conclusion: KHF RACE is the largest contemporary ACS registry in the Middle East. It provides an example of how large multicenter registries can be carried out successfully in this part of the world. Results are expected to shed light on the adherence to guidelines in our daily practice and its influence on patients' outcomes. Several analyses of the data are planned, including the influence of age, gender, diabetes, and insurance status on outcomes. Other planned analyses will be relating to cardiac catheterization and its related outcomes.

Introduction: Hypertrophic cardiomyopathy (HCM), the most common inherited cardiomyopathy, has significant clinical presentation and outcome diversity. Early diagnosis and proper management are essential to improve the patient's quality of life and prevent sudden cardiac death. Collecting patient information in each country is the first step in finding the gaps in the proper diagnosis and management of these patients. We aimed to determine the general characteristics of HCM in the largest referral tertiary heart center in Iran.

Methods: In this cross-sectional study, between 2016 and 2020, clinical, imaging, and therapeutic data of patients diagnosed with HCM at Rajaie Cardiovascular Medical Research Center were reviewed and followed up to 48 months for Major adverse cardiovascular events (MACE), defined as composite endpoint of death, stroke (nonfatal), hospitalization due to decompensated heart failure (HF) and malignant ventricular arrhythmia defined as sustained ventricular tachycardia or ventricular fibrillation.

Results: A total of 322 patients, with a mean age of 49.7 ± 1 years, including 129 women (40%), were studied. Women were significantly older than men (53.1 ± 9.1 vs. 47.2 ± 8.9, P < 0.0001). The most prevalent symptom was dyspnea on exertion, affecting 158 patients (49%). Nonobstructive HCM was present in 180 patients (55.9%), and atrial fibrillation was observed in 82 patients (25.46%). Major Adverse Cardiovascular Events were more frequent in patients with obstructive forms of the disease. Beta-receptor-blocking agents were the most used medication (85%). In addition, 29 patients (9% overall and 20.4% of those with obstructive forms) were treated with disopyramide, and 19 patients (5.9%) underwent surgical myectomy. Late gadolinium enhancement (LGE) was detected in 56 out of 122 patients (45.9%) who underwent cardiac magnetic resonance imaging. MACE incidence was notably higher in patients with positive LGE. Overall, MACE occurred in 110 patients (34.16%). Malignant ventricular arrhythmias were reported in 64 patients (19.87%), HF in 36 patients (11.18%), and HCM-related death in 4 patients (1.24%).

Conclusion: This study showed the general characteristics, clinical outcomes, and therapeutic approach of HCM patients in Iran. We found more MACE in obstructive versus nonobstructive forms and LGE ≥ 10%. Disopyramide and implantable cardioverter-defibrillator implantation are well-adapted therapeutic options, followed by surgical myectomy. However, genetic testing and alcohol septal ablation are uncommon procedures.

Context: Heart failure (HF) is a frequent complication following acute coronary syndrome (ACS), leading to higher mortality and rehospitalization rates. Measurement of brain natriuretic peptide (BNP) is well established to diagnose HF, and its levels during ACS have been associated with poor outcomes.

Aims: This review aims to assess the predictive value of baseline BNP in determining the risk of HF following ACS.

Methods: The search for relevant studies was conducted through Medline database, focusing on studies that reported baseline BNP values in ACS patients, the incidence of HF after follow-up, and their possible association. Statistical analysis was performed using Review Manager.

Results: Out of 647 studies, 10 met the inclusion criteria. Eight studies showed a positive association between baseline BNP and HF post-ACS. However, the meta-analysis revealed no significant difference in HF occurrence based on baseline BNP levels (odds ratio 1.83, 95% confidence interval [CI]: 0.11-29.07, P = 0.67). Although the development of HF was significantly correlated with higher baseline BNP (standard mean difference: 0.95, 95% CI: 0.54-1.37, P < 0.001).

Conclusions: Elevated baseline BNP levels were associated with an increased likelihood of HF following ACS. However, BNP alone may not be a reliable predictor. Serial measurements and integration with other risk factors may improve its predictive accuracy.

The first successful implantation of the HeartMate 3 LVAD in Iraq represents a transformative achievement in the nation's medical history. Conducted collaboratively by German and Iraqi teams in December 2023, the procedure addressed end-stage heart failure in a 60-year-old male. Despite significant healthcare challenges, the patient's functional status improved markedly, moving from New York Heart Association Class IV to Class I within a year. This groundbreaking case highlights the potential for Iraq to integrate advanced cardiac interventions into its healthcare system, paving the way for heart transplantation programs. Ongoing collaboration and investment in healthcare infrastructure will be pivotal for sustaining these innovations.

Arrhythmogenic cardiomyopathy (AC) is an inherited heart disease characterized by fibro-fatty changes of either ventricles in isolation or in combination. AC may present with ventricular tachycardia (VT), usually with a left bundle branch block (LBBB) morphology (although VT with right bundle branch block morphology may also be encountered). Diagnosis is multi-parametric and cardiovascular magnetic resonance (CMR) holds a key role in showing the typical tissue abnormalities of the ventricles. We report the case of a patient presenting with LBBB VT with multi-modality imaging findings consistent with AC with biventricular involvement and right ventricular (RV) thrombosis. The patient was treated with antiarrhythmics, heart failure therapy, and implantable cardioverter-defibrillator implantation. RV thrombus was treated with new oral anticoagulants.

Transcatheter aortic valve replacement (TAVR) using the valve-in-valve (ViV) approach presents a substantial risk of coronary artery obstruction, which adversely impacts patient outcomes. In this report, we describe the utilization of the simultaneous kissing balloon inflation technique during ViV TAVR, which resulted in significant improvement in the patient's condition.