Texas Heart Institute Journal最新文献

Rhabdomyosarcoma represents almost 20% of all primary malignant neoplasms of the heart. In the majority of cases, the tumor arises from the ventricular wall, although these tumors can also arise from the atrial walls and mimic atrioventricular valve stenosis. This report presents a case of a patient diagnosed with an atrial mass that was detected by transthoracic echocardiography and confirmed by histopathology. The mass was successfully resected during an uneventful surgical intervention, but the patient died 6 months after the procedure.

Platypnea-orthodeoxia syndrome is a rare condition characterized by positional dyspnea and hypoxemia, with symptoms presenting in the upright position and improving when recumbent. Hypoxemia in platypnea-orthodeoxia syndrome is defined as a drop in Pao₂ of more than 4 mm Hg or oxygen saturation greater than 5% when moving from a supine to an upright position. Etiologic mechanisms include intracardiac or pulmonary shunts and ventilation perfusion ratio mismatch. Platypnea-orthodeoxia syndrome has been described as part of COVID-19 pneumonia sequelae, with differing physiologic mechanisms from cardiac pathologies. This report presents the case of a patient with platypnea-orthodeoxia syndrome of multifactorial etiology: intracardiac shunting secondary to a patent foramen ovale and ventilation perfusion ratio mismatch as a sequela of COVID-19 pneumonia.

Takotsubo cardiomyopathy (stress cardiomyopathy, or broken-heart syndrome), characterized by reversible left ventricular dysfunction without clinically significant coronary artery obstruction, is rare but has been more commonly reported recently. Esophagogastroduodenoscopy as a cause of takotsubo cardiomyopathy remains exceedingly rare. The case report of an 84-year-old female patient with a complex medical history who had acute stress cardiomyopathy following esophagogastroduodenoscopy, which required prolonged hospitalization and hemodynamic support, is presented. This case emphasizes the importance of recognizing and considering this uncommon pathology and its complications in differential diagnosis. Diagnostic modalities and treatment options for this condition are also discussed.

Background: Dilated cardiomyopathy (DCM) is one of the most common types of cardiomyopathies. The current study constructs a proposed genetic risk score and assesses its potential as a predictive tool for individual DCM susceptibility.

Methods: A total of 1,000 patients with idiopathic DCM and 828 control participants from the study institution were enrolled. The top 25 up-regulated and down-regulated genes from tandem mass spectrometry analysis of 6 hearts with DCM and 7 control hearts (from a study by Chen et al) were selected for logistic analysis using whole-exome sequencing data. Statistically significant variants were prepared for genetic risk score construction. The predictive power of the genetic risk score and a composite variable for DCM risk were evaluated using receiver operating characteristic curve analysis.

Results: A total of 5 variants associated with DCM susceptibility were identified to develop the genetic risk score. A score of at least 6.4 was more strongly associated with increased risk of DCM (odds ratio, 2.4; P < .001) than scores lower than 6.4. Statistical significance remained evident in multivariate analysis after adjusting for traditional risk factors, including age, sex, hypertension, diabetes, and smoking status (odds ratio, 2.54; P < .001). Individuals with a score of at least 6.4 exhibited a decrease in left ventricular ejection fraction and an increase in left ventricular end-diastolic diameter compared with individuals with a score lower than 6.4 (P < .001). Stratification by age, sex, history of hypertension, diabetes, and smoking status did not substantially affect the association between genetic risk score and the risk of DCM. The discriminant power of the genetic risk score is excellent, with a C statistic of 0.72.

Conclusion: The genetic risk score, which consists of 5 variants, could effectively identify individuals at high risk of DCM in the study population and aid in the implementation of early prevention strategies in clinical practice.

Background: Although Houston, Texas, is a diverse city with opportunities for economic prosperity, many Houston residents have low socioeconomic status and poor access to health care. Cardiovascular disease rates in Houston differ by ethnicity. It is therefore crucial to understand how the risk of cardiovascular disease differs among diverse ethnic and sexual minority populations.

Methods: This study assessed the recruitment methods and demographic composition of the Houston HeartReach Registry, a database repository of cardiovascular disease trends and risk factors in Houston's population. The self-reported demographics of the participants recruited to date were analyzed with descriptive statistics. The primary end point of this interim study was the number of women recruited from each location by year, ethnicity, socioeconomic status, health care status, and sexual orientation. The number of women of each ethnicity recruited from each location was also examined.

Results: Currently, 1,476 women are enrolled in the registry, including 996 (67.48%) Hispanic women, 233 (15.79%) non-Hispanic White women, 190 (12.87%) Black women, 24 (1.63%) Asian women, and 29 (1.97%) women from other races and ethnicities. Of these 1,476 women, 352 (23.85%) had an annual income of $10,000 to $24,000, 375 (25.41%) had private health insurance, and 342 (23.17%) were heterosexual. Most women enrolled in the registry (1,082 [73.31%]), including most of the Hispanic participants, were recruited at BakerRipley events.

Conclusion: To date, 1,476 of a planned 5,000 participants have been enrolled in the Houston HeartReach Registry. At present, Hispanic women make up the majority of participants, indicating an underrepresentation of other ethnic demographics. The enrollment of individuals from sexual minority groups, from varied socioeconomic backgrounds, and with diverse health care statuses aligns proportionally with the total count of recruited women to date. The application of deliberate, culturally nuanced, and demographic-specific recruitment strategies should facilitate the inclusion of desired participants in a comprehensive manner.

Acute type A aortic dissection is a catastrophic cardiovascular event characterized by severe pain and hemodynamic instability. The standard of care is emergency surgery, which, despite its benefits, carries substantial perioperative risks. Conservative management is an alternative approach reserved for older patients with clinically significant comorbidities or for whom surgical risk is prohibitive and perioperative mortality may outweigh potential benefits. The case is presented of a 75-year-old patient who opted for conservative management and has been followed up with favorable outcomes for 9 years since the index event.