Heart Views最新文献

Background: Despite robust evidence and strong recommendations supporting the incremental and dose-related benefit of combined neurohormonal blockers (guideline-directed medical therapy [GDMT]) in heart failure with reduced ejection fraction (HFrEF), real-world data shows significant gaps in uses and/or dosing of these therapies.

Rationale: As heart failure (HF) hospitalization is viewed as an opportunity for the initiation and optimization of HF life-saving medications and the paucity of data exploring this important issue in Yemen, the current study aims to fill this gap.

Objective: The objective of this study was to evaluate the use, number, and dose optimization of the GDMT in a cohort of hospitalized patients with HFrEF in Yemen.

Materials and methods: We included 1408 Yemeni patients with available ejection fraction (EF) enrolled in the Gulf CARE registry from February to November 2012. In this analysis, we included only four classes of GDMT, renin-angiotensin system inhibitors (RASi), evidence-based beta-blockers, and mineralocorticoid receptor antagonist (MRA). Each drug dose was converted to the equivalent daily dose of a selected representative drug. We explored the prescription of these drugs either separately or in combination and the target dose (TD) achievement for each drug at admission and discharge.

Results: Among the1408 patients recruited, 916 patients (65%) were males and mean age was 53.5 ± 15.4 years, 53% (n = 748) presented with HFrEF (EF < 40%), 21% (n = 299) with HFpEF (EF ≥ 50%), and 26% (n = 361) with HFmrEF (Heart failure with mildly reduced ejection fraction) (EF 40-49%). Beta-blockers, renin-angiotensin system inhibitors, and MRA were prescribed to 28% (n = 400), 51% (n = 716), and 10% (n = 143) at baseline and 69.5% (n = 978), 82% (n = 1157), and 59% (n = 831) on discharge, respectively. The rate of TD achievement was (0.0% vs. 3.6% (n = 35]) for beta-blockers and (0.279% [n = 2] vs. 1.5% [n = 17]) for renin-angiotensin system inhibitors on baseline and discharge, respectively. Among 748 patients with HFrEF, 36% (n = 270) were not receiving any GDMT at baseline, while triple therapy was prescribed to 10% (n = 74) at baseline and 61.5% (n = 460) on discharge.

Conclusions: A substantial gap in GDMT implementations with both underutilization and low TD achievement in patients with HFrEF in Yemen.

Background: Microalbuminuria has been established as a marker for increased cardiovascular risk in diabetic patients. Nonetheless, its correlation with ischemic heart disease (IHD) among individuals without diabetes has received limited attention. The current study was performed to explore the potential link between microalbuminuria and IHD in nondiabetic subjects.

Methodology: During 2 years, a case-control study was executed, encompassing 100 individuals without diabetes who had IHD as cases, and an equal number of 100 non-IHD controls. Microalbuminuria levels were evaluated alongside diverse cardiovascular risk factors in both sets. IBM-SPSS version 25.0 was used for statistical analysis.

Results: The mean age, gender distribution, and body mass index were similar between the cases and controls. There was a higher prevalence of smokers and alcohol users among the cases compared to controls. In addition, a positive family history of IHD was more prevalent in the case group. In the case group, the mean values of systolic blood pressure, diastolic blood pressure, mean arterial pressure, fasting blood glucose, cholesterol, low-density lipoprotein (LDL), serum creatinine, and urine albumin levels were notably elevated compared to the control group. A significant increase in microalbuminuria levels in the case group was observed.

Conclusion: The results reveal a substantial link between microalbuminuria and IHD in individuals without diabetes. Microalbuminuria was independently correlated with major cardiovascular risk factors, including alcohol and cigarette use, and higher levels of cholesterol, LDL, and serum creatinine. These findings suggest that urine albumin measurements could serve as an early marker for identifying cardiovascular disease risk factors and potentially aid in preventive interventions in the general population.

Infective endocarditis (IE) of the native aortic valve (AV) secondary to Streptococcus infantarius is subacute, a highly destructive pathology leading to aortic regurgitation (AR) and severe cardiac complications such as progressively deteriorating heart failure. In these cases, valvular correction with surgery may not be the optimal option because of multiple chronic illnesses and the use of medications. Although transcatheter AV implantation (TAVI) is a well-known, established alternative method to surgical replacement in patients with severe aortic stenosis, it can be a good alternative in patients with severe AR in whom valvular surgery is not an option due to comorbidities. Here, we presented a case of TAVI in a patient with cirrhosis, hepatocellular cancer, and symptomatic severe AR due to S. infantarius IE.

Paragangliomas are catecholamine-secreting tumors arising from the sympathetic and parasympathetic ganglia. Here, we describe a case in which a young man who had visited the emergency room complaining of headache and shortness of breath was later found to have acute coronary syndrome with accompanying cardio-pulmonary complications necessitating immediate cardiac intervention. Later on, during further management, he was diagnosed with a retroperitoneal paraganglioma. Thus, we try to emphasize the need for a high clinical index of suspicion and urgent radio-imaging for diagnosing this relatively rare clinical entity to prevent fatal outcomes or any long-term morbidity.

Background: Atrial fibrillation (AF) increases morbidity and mortality. Traditional catheter ablation techniques have limitations. Pulsed-field ablation (PFA) is a new nonthermal ablation method aiming to eliminate arrhythmogenic tissue while minimizing collateral damage. The study reported the initial experience of the prince sultan cardiac center with PFA and the learning curve.

Patients and methods: This retrospective study included 33 patients with paroxysmal or persistent AF who underwent ablation with the PFA technique from 2022 to 2023. The study outcomes included short-term and follow-up complications and AF recurrence.

Results: The mean age was 48.52 ± 13.97 years, and 24 patients were males (72.73%). Hypertension was the most common comorbidity encountered in 11 patients (33.33%). Thirteen patients (39.39%) were on antiarrhythmic medications, and 26 (78.79%) were on nonvitamin K-dependent oral anticoagulation. The most common indication was symptomatic paroxysmal AF (n = 28; 84.85%). The preprocedural left atrial diameter was 41.82 ± 14.78 mm, and the ejection fraction was 51.36% ±8.41%. The left atrial ablation time was 45.38 ± 17.96 min, the fluoroscopy time was 33.45 ± 15.60 min, and the procedure time was 77.55 ± 19.73 min. No complications were reported postprocedurally or at 3 or 6 months. One patient had recurrent AF; one developed atrial flutter after 9 months and underwent ablation.

Conclusions: Pulmonary vein isolation using PFA for paroxysmal and persistent AF might be a safe and effective procedure. Future long-term studies comparing PFA with other ablation techniques are recommended.

Regular physical exercise is undoubtedly associated with cardiovascular health benefit, increased longevity, and improved endurance performance. Competitive endurance athletes exceed the recommended exercise dose, which lead to pathologic cardiac remodeling such as myocardial fibrosis. This review examines the impact of myocardial fibrosis on atrial and ventricular structures and functions in endurance athletes. A systematic literature search identified eight trials that enrolled 470 athletes. The prevalence of myocardial fibrosis ranged from 13% to 48%, which was commonly of a focal nonischemic pattern. The included studies did not find consistent results on the impact of myocardial fibrosis on ventricular function and volume parameters. Moreover, the prognostic implications of myocardial fibrosis on patient clinical outcomes, such as arrhythmias and mortality, were not reported as there was no long-term follow-up. There is a clear unmet need to encourage larger studies on myocardial fibrosis phenotypes to shed more light on the underlying mechanism, clinical consequences, and prognosis.

Ebstein's anomaly (EA) is a rare congenital cardiac defect that occurs when the tricuspid valve leaflets fail to delaminate from the ventricular myocardium, they adhere to the underlying myocardium. Multiple etiologies such as genetic mutation in NKX2-5, family history of congenital cardiac anomalies, and exposure to teratogen such as lithium are associated with this rare cardiac anomaly. In our case, we present an undiagnosed adolescent male with EA who was exposed to lithium during organogenesis.

Ruptured descending thoracic aortic aneurysm (DTAA) is a rare event and remains asymptomatic in over 95% of cases, often leading to the under-detection of most thoracic aortic aneurysms (TAAs) unless incidentally discovered during routine imaging, medical examinations, or autopsy following sudden death. This case report presents a 56-year-old male with a history of hypertension and diabetes mellitus who was managed with regular medication, collapsed suddenly, and was found unconscious. Emergency medical services declared him dead on arrival. An autopsy examination disclosed 2750 g of blood in the left pleural cavity and a 2.5 cm transverse tear in a saccular aneurysm on the descending thoracic aorta with aortic dissection (AD). Histopathological analysis confirmed necrosis, fibrosis, and a mixed inflammatory infiltrate at the rupture site, with features consistent with healed myocardial infarction and grade VII atherosclerosis. This case underscores the importance of recognizing the silent yet fatal nature of saccular aneurysms in the descending thoracic aorta.

Methadone is considered relatively safe when compared to other opioids. Methadone, however, can cause respiratory depression and QT prolongation. Among patients on methadone maintenance therapy, the rate of cannabis use is high. Multiple hypotheses, including the 'exit hypothesis' or 'the cannabis association with reduced opioid use,' need validation and further research. In this article, we present an interesting case of a 29-year-old female on methadone maintenance therapy for fifteen years who presented with methadone toxicity likely induced by systemic infection and cannabis co-ingestion. The patient had multiple cardiotoxic effects, including prolonged QT interval managed by antiarrhythmic medications, ST-segment elevation, and stress-induced cardiomyopathy managed conservatively. In this case report, the authors want to highlight the possible effects of methadone and cannabis co-injection, methadone toxicity induced by systemic infections, and increased awareness of these potentially catastrophic cardiotoxic effects in patients on high-dose methadone maintenance therapy.