Critical Pathways in Cardiology最新文献

Background: Data are lacking to guide standardized management of coronary artery aneurysms (CAA). We sought to analyze the available evidence in a quantitative manner.

Methods: Electronic search identified 431 case reports or case series on CAA, comprising 488 patients. Patient-level data were extracted. Subgroups with (CAAF) and without fistulous connections (CAAO) were analyzed separately.

Results: Fistulous connection was present in 24.0% (117/488) of patients with CAA. Angina was a presenting symptom in 64.7% (301/465), with higher preponderance in the CAAO group [CAAO: 71.1 % (249/350) vs CAAF: 45.2% (52/115), p<0.01). Median largest aneurysm diameter was higher in the CAAF group [CAAO: 3.0 [1.5-5.0] cm vs CAAF: 5.0 [3.0-7.0], p<0.01], and rupture was more frequently observed in the CAAF group [CAAO: 3.1% (11/353) vs CAAF: 13.8% (16/116), p<0.01]. For any given diameter, CAAF had a higher risk of rupture compared to CAAO. Surgery was the most common management strategy, particularly in patients with CAAF [CAAO: 50.9% (189/371) vs CAAF: 75.2% (88/117), p<0.01]. Kaplan-Meier analysis showed a trend toward more favorable survival in CAAF. Hazard of mortality was associated with aneurysm diameter in both subsets but was higher in the CAAO group independent of surgical vs interventional management.

Conclusion: CAAF appears to have a higher risk of rupture but may be associated with better survival than CAAO. Management for patients with CAA differs based on presence or absence of fistula, however, both surgical and interventional mode of management result in similar survival.

Background: To further analyze the impacts, findings, and modalities of multiple cardiac screenings to answer the question - are multiple screens necessary and useful in youth?

Methods: Over 20 years, the Anthony Bates Foundation (ABF) has offered free and low-cost cardiac screenings to youth and their families nationwide. The volunteer force has provided blood pressure, and ultrasound tests to participants throughout the 20 years. After year 7, electrocardiograms were added to the screening.

Results: Over the 20 years, ABF abnormal findings held steady between 10 - 13%, with Potential Life-Threatening (PLT) findings at 2.5%. The participants that have experienced multiple screening tests on average would repeat within 2.5 years, have abnormal findings at 31.84%, PLT at 11.43%, and total echocardiography-related abnormal findings at 16.82%. The variance between male and female attendance by age is also noted during the review of ABF repeat screened data. Male attendance was at 59.65% and female 40.35%. The abnormality rate of males for the first visit was 10.9% followed by the second visit of 18.80%. The abnormality rate of females for the first visit was 12.22% followed by the second visit of 17.09%. A detailed analysis of abnormal findings is presented in this manuscript.

Conclusions: Cardiac screening involving multiple repeated screenings appears to be effective in detecting increasing numbers of abnormal findings that can be lifesaving.

Introduction: Cardiovascular diseases (CVDs) are the principal cause of worldwide mortality, with 17.9 million deaths reported in 2019. In Saudi Arabia, CVDs account for 42% of all deaths, occurring on average 10 years earlier than in Western populations. Medical students are particularly susceptible to Cardiovascular disease CVD risk factors due to demanding academic schedules and lifestyle changes. This study aims to identify cardiovascular risk factors (CVRF) among medical students at King Faisal University, highlighting the need for preventive measures and curriculum modifications.

Methods: This prospective cross-sectional study was conducted from February to April 2024 at King Faisal University, focusing on undergraduate medical students. Participants not enrolled in the College of Medicine, those who declined to complete the survey, or those who submitted incomplete responses were excluded. A total of 313 students participated in the study. Data collection involved physical evaluations and a validated questionnaire covering demographics, medical history, lifestyle, and diet. Measurements included waist circumference, weight, height, blood pressure, and pulse. Data was analyzed using IBM SPSS Statistics version 19.

Results: Among participants, 52.4% had a normal body mass index BMI, while 19.5% were overweight and 11.2% obese. Blood pressure measurements showed 45.7% had normal BP, but 44.4% were prehypertensive. A family history of CVDs was reported by 55.6% of students, with hypertension (HTN) and diabetes being the most common. Smoking was infrequent, with only 5.1% reporting regular habits. Dietary analysis showed moderate consumption of unhealthy foods, with 80% maintaining a moderately healthy diet. Physical activity assessment indicated significant portions engaged in light or moderate activities, but only a minority met recommended levels for vigorous activities. Significant associations were found between physical activity levels and academic year, personal history of diseases, and smoking behavior.

Conclusion: Most students had normal body weight, but many were overweight or pre-hypertensive. Family histories of CVDs, particularly (HTN) and diabetes, were common. Smoking was rare, but diets included frequent unhealthy foods. These findings underscore the need for targeted health programs to reduce cardiovascular risks in this population.

The performing of non-physician led exercise stress testing with and without echocardiography has shown similar diagnostic utility and safety as physician led models. While diagnostic accuracy and relative safety have been the focus of previous research, the current study aims to demonstrate efficiencies not previously reported such as reduction in wait times for testing and improved service attendance. A non-physician led exercise stress echocardiography (ESE) service was implemented on 01/01/2018, prior to this all tests were performed under a physician led model. Retrospective data was retrieved from both models (physician led model from 01/01/2015 to 31/12/2017 and the non-physician led model from 01/01/2018 to 31/12/2023). Comparisons were made between the models regarding the number of tests performed, the average wait time to access testing, and the did not attend (DNA) rates. On average 212 tests were performed in the physician led model per year, with average wait times to access testing of 11.3 weeks and a DNA rate of 15.3%. In contrast, the non-physician led model performed on average 501 tests per year (135% increase) (p<0.001) with average wait times of 6 weeks (47% decrease) (p<0.01) and DNA rate of 4.8% (69% decrease). Despite the physician led group displaying an overall higher cardiovascular (CV) disease risk, there were no adverse CV events at the time of testing in either model. Non-physician led ESE remains as safe as physician led models but demonstrates service improvements including significant reductions in wait times and lower DNA rates.

Among white rheumatoid arthritis (RA) cohorts, heart failure with preserved ejection fraction is the most prevalent type of heart failure (HF). We aimed to assess the type of HF affecting Black RA patients. A total of 64 patients with RA-HF were compared with age-, sex-, and race-matched RA patients without HF. Left ventricular ejection fraction, wall motion abnormalities, left ventricle (LV) mass, and wall thickness were reviewed. About 87.3% were Black and 84.4% were women, with a mean age of 69.6 ± 1.38 (± SEM) and body mass index (kg/m 2 ) of 29.6 ± 1.07. RA-HF patients had higher rates of hypertension (HTN), chronic kidney disease, and atrial fibrillation. However, 66.7% had ≥3 cardiovascular risk factors compared with RA patients without HF. 2D echocardiograms of RA-HF revealed that 62.3% had left ventricular ejection fraction ≥50%, 37% had diastolic dysfunction, and 43.1% had wall motion abnormalities. LV mass and relative wall thickness measurements indicated LV eccentric remodeling. The odds ratio for HF was 4.7 (CI, 1.5-14.53), P < 0.01, among the RA-HTN group and 3.5 (CI, 1.091-11.7) P < 0.01 among smokers. In our predominantly Black RA-HF patients, heart failure with preserved ejection fraction was the most common type of HF. HTN was associated with the highest OR for HF. Eccentric hypertrophic remodeling, a known poor prognostic indicator for cardiovascular events, was found. Further studies are required to confirm our findings.

Background: Atrioventricular node (AVN) radiofrequency (RF) ablation is a highly effective treatment of atrial tachyarrhythmias that are resistant to other management modalities. To date, there is limited research that compares the properties of different RF ablation catheters. The current study aims to compare the effectiveness of several types of RF catheters in AVN ablation.

Methods: A total of 66 patients, with a mean age of 73.27 years, underwent AVN RF ablation. The catheters used were categorized as unirrigated (UI), externally irrigated, and contact force sensing with 10 to 20 g of force. Externally-irrigated catheters were divided into 2 different settings: low-power long-duration (LPLD) (30 W, 45°C, and 60 seconds) and high-power short-duration (HPSD) (50 W, 43°C, and 12 seconds). We compared the success rate of the different RF catheters using logistic regression and lesion times using linear regression.

Results: The distribution of the types of catheters used is UI in 48%, LPLD in 16%, and HPSD in 36% of patients. All ablation procedures were successful, with no immediate postprocedure complications. HPSD had a significantly shorter lesion time than UI catheters by 403.42 seconds (-631.67 to -175.17).

Conclusions: UI catheters, LPLD, and HPSD were equally safe and effective in ablation procedures. The HPSD catheter had a significantly shorter lesion time and, thus, overall decreased procedure time.

Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) have become increasingly utilized in patients undergoing percutaneous coronary intervention (PCI). Despite these purported advantages, prior reports regarding the use of IVUS and OCT have indicated that contemporary use of intravascular imaging remains low with significant regional variation. Here, we present the findings of an updated contemporary analysis regarding the use of IVUS/OCT-guided PCI versus angiography-guided PCI in the United States. We also evaluated in-hospital mortality and clinical outcomes between IVUS/OCT-guided PCI versus angiography-guided PCI-only over million patients in the United States. There has been a significant decrease in the number of PCIs performed, while there has been increasing in the trend of IVUS/OCT-guided PCI over this period. Most importantly, we found that IVUS/OCT-guided PCI was associated with better clinical outcomes in terms of in-hospital mortality, compared with angiography-guided PCI.

Background: Recent studies have focused on treating cardiac sarcoidosis (CS) with corticosteroids primarily mitigating symptoms and reducing the risk of mortality and other cardiovascular complications. A promising new treatment approach involves tumor necrosis factor (TNF) alpha inhibitors.

Methodology: A systematic search was conducted on PubMed, the Cochrane Library, and Elsevier's Science Direct databases to identify studies comparing TNF alpha inhibitors with other drugs in CS patients who had heart failure. The analyses were conducted using the random-effects model.

Results: The study's primary outcome is an increase in ejection fraction (EF), secondary outcomes include a reduction in the dose of prednisone at 6 and 12 months, maximum standardized uptake value by cardiac tissue, and fluorodeoxyglucose uptake by cardiac myocytes on positron emission tomography scan. The total number of pooled participants was 154 out of which 140 met the Heart Rhythm Society criteria for CS. The pooled analysis showed that treatment with the TNF alpha inhibitors was associated with a significant increase in EF [weighted mean difference (WMD), 46.272; 95% confidence interval (CI), 40.60-51.94, P < 0.001; I2, 75.74%], reduction in the dose of prednisone at 6 months (WMD, 9.20; 95% CI, 7.65-10.75; P < 0.001; I2, 13.33%) and at 12 months (WMD, 6.40; 95% CI, 4.74-8.07; P < 0.001; I2, 9.37%); decrease in myocardial maximum standardized uptake value (WMD, 1.99; 95% CI, 0.91-3.06; P < 0.001; I2: 97%) and reduction in fluorodeoxyglucose uptake by cardiac myocytes (WMD, 1.55; 95% CI, 1.09-2.00; P < 0.001; I2, 32.29) on positron emission tomography scans.

Conclusions: The research findings suggest that TNF alpha inhibitors improve EF, reduce required steroid dosage, and improve clinical outcomes. Nonetheless, further high-quality randomized controlled trials with large sample sizes are needed to assess other impacts of this therapy on patients with CS.

Background: Ambulatory electrocardiogram (AECG) monitoring is an attractive method for objectively identifying atrial fibrillation (AF) symptoms by documenting simultaneous arrhythmia with symptomatic episodes. However, no study yet has evaluated this simultaneous symptom-rhythm correlation in patients with heart failure (HF). We aimed to measure the correlation between symptoms and atrial arrhythmia (ATAF) episodes among patients with HF and known AF using prolonged AECG monitoring.

Methods: We analyzed ATAF events and patient-triggered symptomatic events (PTSEs) on AECG monitors in adults with a history of AF and HF.

Results: Among 959 monitors, we identified a total of 26,634 events, including 15,787 ATAF events and 4950 PTSE. The mean age was 70 years, 48% were female, and 91% were Caucasian. Among 4950 PTSEs, only 1116 demonstrated ATAF (23%). PTSE showed a low correlation with ATAF, with a moderate inverse tetrachoric correlation of -0.62 (bootstrapped 95% confidence interval: -0.61 to -0.63). The mean heart rate (HR) of symptomatic ATAF events was 115 bpm (SD: 33), compared with asymptomatic ATAF (107 bpm, SD: 33, P < 0.001). The mean HR of all symptomatic events was 92 bpm (SD: 28) and of asymptomatic events was 99 bpm (SD: 30), P < 0.001.

Conclusions: Our study found that symptomatic events on AECG monitors poorly predict ATAF episodes, ATAF episodes are rarely noted as symptomatic, and poor HR control fails to fully explain AF symptoms in patients with known AF and HF. Our study encourages further research into other symptom assessments, such as patient-reported outcomes and a more comprehensive approach to AF treatment in HF rather than primarily symptom based.

Aortic dissection (AD) is a potentially fatal cardiovascular issue that needs to be diagnosed and treated very away. Although early detection is essential for bettering patient outcomes, there are substantial obstacles with the diagnostic techniques used today. Promising pathways for improving AD prognosis evaluation and early detection are presented by recent developments in serum biomarkers. The most recent research on serum biomarkers for AD is reviewed here, with an emphasis on the prognostic and diagnostic utility of these indicators. A number of biomarkers, including as matrix metalloproteinases, soluble elastin fragments, smooth muscle myosin heavy chain, and D-dimer, have been identified as putative markers of AD. These indicators are indicative of multiple pathophysiological mechanisms associated with AD, including inflammation, extracellular matrix remodeling, and vascular damage. Research has indicated that they are useful in differentiating AD from other acute cardiovascular diseases, facilitating prompt diagnosis and risk assessment.