Pub Date : 2024-10-30DOI: 10.1016/S0146-2806(24)00537-1
{"title":"Guidelines for Authors","authors":"","doi":"10.1016/S0146-2806(24)00537-1","DOIUrl":"10.1016/S0146-2806(24)00537-1","url":null,"abstract":"","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"49 12","pages":"Article 102902"},"PeriodicalIF":3.0,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142540060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-30DOI: 10.1016/j.cpcardiol.2024.102912
John E. Madias MD, FACC, FAHA
It is increasingly apparent that takotsubo syndrome (TTS) and spontaneous coronary artery dissection (SCAD) are associated. While the pathophysiology of TTS and SCAD are still debated, there should not be much doubt that SCAD could trigger TTS, as the latter often emerges in the context of a great variety of physical and emotional stresses, and thus SCAD should not be excluded as a TTS precipitant. In regards to TTS precipitating SCAD, it has been proposed that the anatomic junction of vigorously contracting base of the heart and the abutting akinetic/dyskinetic mid-ventricular/apical myocardium, could form a "hinge pivoting point”, exerting a disrupting mechanical influence on the coronary vessels crossing these 2 planes, precipitating tearing of the coronary vessel wall, formation of an intramural hematoma, with resultant SCAD in susceptible individuals. This review also provides a detailed list of recommendations for exploring the plausible association of TTS and SCAD, irrespective of their temporal sequence of occurrence.
{"title":"Could “preclinical takotsubo syndrome” be the cause of spontaneous coronary artery dissection?","authors":"John E. Madias MD, FACC, FAHA","doi":"10.1016/j.cpcardiol.2024.102912","DOIUrl":"10.1016/j.cpcardiol.2024.102912","url":null,"abstract":"<div><div>It is increasingly apparent that takotsubo syndrome (TTS) and spontaneous coronary artery dissection (SCAD) are associated. While the pathophysiology of TTS and SCAD are still debated, there should not be much doubt that SCAD could trigger TTS, as the latter often emerges in the context of a great variety of physical and emotional stresses, and thus SCAD should not be excluded as a TTS precipitant. In regards to TTS precipitating SCAD, it has been proposed that the anatomic junction of vigorously contracting base of the heart and the abutting akinetic/dyskinetic mid-ventricular/apical myocardium, could form a \"hinge pivoting point”, exerting a disrupting mechanical influence on the coronary vessels crossing these 2 planes, precipitating tearing of the coronary vessel wall, formation of an intramural hematoma, with resultant SCAD in susceptible individuals. This review also provides a detailed list of recommendations for exploring the plausible association of TTS and SCAD, irrespective of their temporal sequence of occurrence.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"50 1","pages":"Article 102912"},"PeriodicalIF":3.0,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-30DOI: 10.1016/j.cpcardiol.2024.102886
Jorge Perea-Armijo MD , Guillermo Gutiérrez-Ballesteros MD , Francisco Mazuelos-Bellido MD, PhD , Rafael González-Manzanares MD, PhD , Jose María Huelva BsC , Jose López-Aguilera MD, PhD , Manuel Pan MD, PhD , José María Segura Saint-Gerons MD, PhD
Introduction
Left bundle branch area pacing (LBBAP) seems to be an alternative to coronary sinus pacing in patients with non-ischaemic dilated cardiomyopathy (NI-DCM) with left bundle branch block (LBBB) and in pacing-induced cardiomyopathy (PICM). The aim of the study was to compare the response of LBBAP in severe forms of both entities.
Material and methods
Prospective study of patients with severe forms of PICM and NI-DCM in NYHA II-IV who underwent LBBAP. Clinical, electrocardiographic, echocardiographic and electrical parameters were analysed and the medium-term prognostic impact was assessed.
Results
Eighty patients were included, 25 with PICM and 55 with NI-DCM. PICM patients were older (PICM 75 [IQR 71-83.5] y.o vs NI-DCM 72 [IQR 60-78.5] y.o;p=0.01) and with longer baseline QRS duration (PICM 180 [IQR 167-194] ms vs NI-DCM 168 [IQR 153-178] ms;p<0.01), with no differences in left ventricular ejection fraction (LVEF) or medical treatment. QRS reduction occurred in both groups, being greater in PICM (PICM CI 95% 54±20 ms, p<0.01; NI-DCM CI 95% 40±15 ms;p<0.01). A NT-ProBNP levels reduction and LVEF improvement were observed without differences between groups. At follow-up, there were no differences in admissions for HF (PICM 4.2% vs NI-DCM 11%;p=0.413), cardiac mortality (PICM 14.9% vs NI-DCM 2.9%;p=0.13) and all-cause mortality (PICM 21.7% vs NI-DCM 10.9%;p=0.08).
Conclusion
LBBAP is an effective technique with a NT-ProBNP levels reduction and LVEF improvement in both groups without differences. At follow-up, both groups had a low rate of HF readmissions and there was a non-significant trend toward higher total mortality in PICM.
{"title":"Comparison of left bundle branch area pacing between patients with pacing-induced cardiomyopathy and non-ischemic dilated cardiomyopathy","authors":"Jorge Perea-Armijo MD , Guillermo Gutiérrez-Ballesteros MD , Francisco Mazuelos-Bellido MD, PhD , Rafael González-Manzanares MD, PhD , Jose María Huelva BsC , Jose López-Aguilera MD, PhD , Manuel Pan MD, PhD , José María Segura Saint-Gerons MD, PhD","doi":"10.1016/j.cpcardiol.2024.102886","DOIUrl":"10.1016/j.cpcardiol.2024.102886","url":null,"abstract":"<div><h3>Introduction</h3><div>Left bundle branch area pacing (LBBAP) seems to be an alternative to coronary sinus pacing in patients with non-ischaemic dilated cardiomyopathy (NI-DCM) with left bundle branch block (LBBB) and in pacing-induced cardiomyopathy (PICM). The aim of the study was to compare the response of LBBAP in severe forms of both entities.</div></div><div><h3>Material and methods</h3><div>Prospective study of patients with severe forms of PICM and NI-DCM in NYHA II-IV who underwent LBBAP. Clinical, electrocardiographic, echocardiographic and electrical parameters were analysed and the medium-term prognostic impact was assessed.</div></div><div><h3>Results</h3><div>Eighty patients were included, 25 with PICM and 55 with NI-DCM. PICM patients were older (PICM 75 [IQR 71-83.5] y.o vs NI-DCM 72 [IQR 60-78.5] y.o;p=0.01) and with longer baseline QRS duration (PICM 180 [IQR 167-194] ms vs NI-DCM 168 [IQR 153-178] ms;p<0.01), with no differences in left ventricular ejection fraction (LVEF) or medical treatment. QRS reduction occurred in both groups, being greater in PICM (PICM CI 95% 54±20 ms, p<0.01; NI-DCM CI 95% 40±15 ms;p<0.01). A NT-ProBNP levels reduction and LVEF improvement were observed without differences between groups. At follow-up, there were no differences in admissions for HF (PICM 4.2% vs NI-DCM 11%;p=0.413), cardiac mortality (PICM 14.9% vs NI-DCM 2.9%;p=0.13) and all-cause mortality (PICM 21.7% vs NI-DCM 10.9%;p=0.08).</div></div><div><h3>Conclusion</h3><div>LBBAP is an effective technique with a NT-ProBNP levels reduction and LVEF improvement in both groups without differences. At follow-up, both groups had a low rate of HF readmissions and there was a non-significant trend toward higher total mortality in PICM.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"50 1","pages":"Article 102886"},"PeriodicalIF":3.0,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-30DOI: 10.1016/S0146-2806(24)00539-5
{"title":"Information for Readers","authors":"","doi":"10.1016/S0146-2806(24)00539-5","DOIUrl":"10.1016/S0146-2806(24)00539-5","url":null,"abstract":"","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"49 12","pages":"Article 102904"},"PeriodicalIF":3.0,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142540137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-30DOI: 10.1016/j.cpcardiol.2024.102913
Gualtiero Palareti , Cristina Legnani , Sophie Testa , Oriana Paoletti , Michela Cini , Emilia Antonucci , Vittorio Pengo , Daniela Poli , Walter Ageno , Paolo Prandoni , Domenico Prisco , Alberto Tosetto , the MAS Working Group
Background
Frailty influences the effectiveness and safety of anticoagulant therapy in patients with atrial fibrillation (AF). The age-weighted Charlson comorbidity index may offer a valuable tool to assess the risk of adverse events in AF patients treated with direct oral anticoagulants (DOACs). This sub-analysis of MAS trial data aimed to assess whether using the Charlson index, instead of the standard criteria, would have led to different dosing and improved adverse event occurrence during treatment.
Methods
The MAS study looked for a relationship between DOAC levels assessed at baseline and adverse events during follow-up. The study is described in detail elsewhere.
Results
Among the 1,657 patients studied, 832 (50.2 %) had a relatively low Charlson index (up to 6, general median class), of whom 132 (15.9 %) were treated with reduced doses. Conversely, among the 825 patients with a high Charlson index (≥7), 257 (31.1 %) received standard doses. A weak but statistically significant positive correlation (r = 0.1413, p < 0.0001 by ANOVA) was observed between increasing Charlson classes and DOAC levels standardized to allow comparability among drug results. However, no significant differences were found in the incidence or number of adverse events during follow-up, or in other parameters, between patients with low and high Charlson's scores.
Conclusions
Utilizing the Charlson index would have led to notable differences in DOAC dosing compared to standard criteria. However, we found no evidence that its use would have improved the prediction of adverse events in AF patients enrolled in the MAS study.
背景：虚弱会影响心房颤动（房颤）患者抗凝治疗的有效性和安全性。年龄加权的查尔森合并症指数可为评估接受直接口服抗凝剂（DOACs）治疗的房颤患者发生不良事件的风险提供有价值的工具。本研究对 MAS 试验数据进行了子分析，旨在评估使用 Charlson 指数而非标准标准是否会导致不同的用药剂量并改善治疗期间的不良事件发生率：MAS研究寻找基线评估的DOAC水平与随访期间不良事件之间的关系。该研究在其他地方有详细描述：在接受研究的 1,657 名患者中，832 人（50.2%）的查尔森指数相对较低（最高为 6，一般中位分级），其中 132 人（15.9%）接受了减量治疗。相反，在 825 名夏尔森指数较高（≥7）的患者中，有 257 人（31.1%）接受了标准剂量治疗。在夏尔森等级增加与 DOAC 水平标准化之间观察到微弱但有统计学意义的正相关（r = 0.1413，方差分析 p = 0.0001），以便在不同药物结果之间进行比较。然而，在随访期间不良事件的发生率或数量或其他参数方面，Charlson评分低和高的患者之间没有发现明显差异：结论：与标准标准相比，使用 Charlson 指数会导致 DOAC 剂量的显著差异。然而，我们没有发现任何证据表明使用该指数会改善对 MAS 研究中房颤患者不良事件的预测。
{"title":"Can the Charlson comorbidity index help to guide DOAC dosing in patients with atrial fibrillation and improve the efficacy and safety of treatment? A subanalysis of the MAS study","authors":"Gualtiero Palareti , Cristina Legnani , Sophie Testa , Oriana Paoletti , Michela Cini , Emilia Antonucci , Vittorio Pengo , Daniela Poli , Walter Ageno , Paolo Prandoni , Domenico Prisco , Alberto Tosetto , the MAS Working Group","doi":"10.1016/j.cpcardiol.2024.102913","DOIUrl":"10.1016/j.cpcardiol.2024.102913","url":null,"abstract":"<div><h3>Background</h3><div>Frailty influences the effectiveness and safety of anticoagulant therapy in patients with atrial fibrillation (AF). The age-weighted Charlson comorbidity index may offer a valuable tool to assess the risk of adverse events in AF patients treated with direct oral anticoagulants (DOACs). This sub-analysis of MAS trial data aimed to assess whether using the Charlson index, instead of the standard criteria, would have led to different dosing and improved adverse event occurrence during treatment.</div></div><div><h3>Methods</h3><div>The MAS study looked for a relationship between DOAC levels assessed at baseline and adverse events during follow-up. The study is described in detail elsewhere.</div></div><div><h3>Results</h3><div>Among the 1,657 patients studied, 832 (50.2 %) had a relatively low Charlson index (up to 6, general median class), of whom 132 (15.9 %) were treated with reduced doses. Conversely, among the 825 patients with a high Charlson index (≥7), 257 (31.1 %) received standard doses. A weak but statistically significant positive correlation (r = 0.1413, p < 0.0001 by ANOVA) was observed between increasing Charlson classes and DOAC levels standardized to allow comparability among drug results. However, no significant differences were found in the incidence or number of adverse events during follow-up, or in other parameters, between patients with low and high Charlson's scores.</div></div><div><h3>Conclusions</h3><div>Utilizing the Charlson index would have led to notable differences in DOAC dosing compared to standard criteria. However, we found no evidence that its use would have improved the prediction of adverse events in AF patients enrolled in the MAS study.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"50 1","pages":"Article 102913"},"PeriodicalIF":3.0,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-29DOI: 10.1016/j.cpcardiol.2024.102914
Ruth Eshikotse Pius MB, BS , Janet Ngozi Ajuluchukwu MB , BS, MMED, FNCS, FESC, FMCP , Alero Ann Roberts BSc, MB, BS, MPH, FMCPH
Background
Physicians spearhead the prevention and management of cardiovascular diseases, however, there is a paucity of studies that have assessed the cardiovascular risk profiles of physicians in Africa. We aimed to determine the cardiovascular health indices of a cross-section of physicians in Nigeria.
Methodology
A cross-sectional study was conducted among medical doctors in a tertiary hospital in Nigeria, with different specialties being proportionally represented. Sociodemographic, work-associated, and cardiovascular factors, together with anthropometry and Fuster-BEWAT score (FBS): blood pressure, exercise, weight (BMI), alimentation and tobacco were used to assess cardiovascular health indices.
Results
The number of doctors enrolled in this study was 251 with a median age of 34; 51.4 % were males. While the mean FBS was 7.8 (±2.1), 1.6 % of physicians had ideal FBS, as 59.4 % and 39.0 % had intermediate and poor FBS respectively. A small proportion of doctors had adequate fruit or vegetable intake (1.2 %), or exercise (10.4 %). The percentages of doctors who had ideal blood pressure and BMI were 46.6 % and 27.9 % respectively. Almost all doctors were non-smokers (98.4 %). Medical officers and residents had better cardiovascular health compared to consultants. There was no statistically significant association between cardiovascular health score and other work-associated factors.
Conclusion
The composite cardiovascular health index of physicians was assessed as intermediate (7.8 on a maximum scale of 15). Positive metrics were normotensive blood pressure (46.6 %) and tobacco use (98.4 %). We recommend that Nigerian physicians need to improve weight, exercise, and alimentation cardiovascular health practices.
{"title":"Determinants of cardiovascular health indices among physicians in a tertiary centre","authors":"Ruth Eshikotse Pius MB, BS , Janet Ngozi Ajuluchukwu MB , BS, MMED, FNCS, FESC, FMCP , Alero Ann Roberts BSc, MB, BS, MPH, FMCPH","doi":"10.1016/j.cpcardiol.2024.102914","DOIUrl":"10.1016/j.cpcardiol.2024.102914","url":null,"abstract":"<div><h3>Background</h3><div>Physicians spearhead the prevention and management of cardiovascular diseases, however, there is a paucity of studies that have assessed the cardiovascular risk profiles of physicians in Africa. We aimed to determine the cardiovascular health indices of a cross-section of physicians in Nigeria.</div></div><div><h3>Methodology</h3><div>A cross-sectional study was conducted among medical doctors in a tertiary hospital in Nigeria, with different specialties being proportionally represented. Sociodemographic, work-associated, and cardiovascular factors, together with anthropometry and Fuster-BEWAT score (FBS): <u>b</u>lood pressure, <u>e</u>xercise, <u>w</u>eight (BMI), <u>a</u>limentation and <u>t</u>obacco were used to assess cardiovascular health indices.</div></div><div><h3>Results</h3><div>The number of doctors enrolled in this study was 251 with a median age of 34; 51.4 % were males. While the mean FBS was 7.8 (±2.1), 1.6 % of physicians had ideal FBS, as 59.4 % and 39.0 % had intermediate and poor FBS respectively. A small proportion of doctors had adequate fruit or vegetable intake (1.2 %), or exercise (10.4 %). The percentages of doctors who had ideal blood pressure and BMI were 46.6 % and 27.9 % respectively. Almost all doctors were non-smokers (98.4 %). Medical officers and residents had better cardiovascular health compared to consultants. There was no statistically significant association between cardiovascular health score and other work-associated factors.</div></div><div><h3>Conclusion</h3><div>The composite cardiovascular health index of physicians was assessed as intermediate (7.8 on a maximum scale of 15). Positive metrics were normotensive blood pressure (46.6 %) and tobacco use (98.4 %). We recommend that Nigerian physicians need to improve weight, exercise, and alimentation cardiovascular health practices.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"50 1","pages":"Article 102914"},"PeriodicalIF":3.0,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-29DOI: 10.1016/j.cpcardiol.2024.102915
Rinad Akhtar, Aabish Aftab
{"title":"Response to “Five-year risk of all-cause death and cardiovascular events in women with gestational diabetes and hypertensive disorders of pregnancy”","authors":"Rinad Akhtar, Aabish Aftab","doi":"10.1016/j.cpcardiol.2024.102915","DOIUrl":"10.1016/j.cpcardiol.2024.102915","url":null,"abstract":"","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"50 1","pages":"Article 102915"},"PeriodicalIF":3.0,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
One of the most prevalent causes of emergency room visits is acute dyspnea. Several etiologies, including cardiac, pulmonary, metabolic, psychogenic etc… may be involved. Acute heart failure (AHF) is among the most common causes. This study aims to evaluate, in patients presenting with acute dyspnea to the emergency departement (ED), the accuracy of a diagnostic approach combining Lung ultrasonography (LUS) and clinical assessment as compared to the traditional AHF diagnostic work-up.
Methods
This is a bi-centric cross-sectional observational study, conducted at the Emergency and Cardiology Department of both the Hedi Chaker Hospital in Sfax and the Habib Thameur Hospital in Tunis for the period extending from 01/07/2022 to 30/09/2023. The diagnostic performance of pulmonary ultrasonography was studied and the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were compared with those of clinical examination, chest X-Ray, NT-pro -BNP and the Transthoracic echocardiography (TTE) which was the reference exam.
Results
The most common cause of acute dyspnea is acute heart failure (79.3 %). LUS had a sensitivity of 94,2 % in diagnosing AHF and a specificity of 77,5 %. Its PPV and NPV were respectively 92 % and 81 %. The area under curbe (AUC) of B-Lines required for the diagnosis of interstitial pulmonary syndrome was excellent (92 %). There was a moderate significant positive correlation between the number of B-Lines and NT-Pro-BNP levels r = 0.51, P < 0.001. Also, there was a very strong significant positive relationship between the pulmonary congestion assessed by LUS and Left atrium - pressure r = 0.788, P < 0.001
Conclusion
LUS is an excellent test both to confirm and exclude the diagnosis of AHF in patients consulting the emergency room for acute dyspnea and therefore deserves to be performed systematically.
{"title":"Role of pulmonary ultrasonography in diagnosis of acute heart failure","authors":"Hela Bouzidi , Selim hammami , Ihsen zairi , Sofien kammoun , Sondos kraiem , Mariem jabeur , Rania gargouri , Leila Abid","doi":"10.1016/j.cpcardiol.2024.102910","DOIUrl":"10.1016/j.cpcardiol.2024.102910","url":null,"abstract":"<div><h3>Background</h3><div>One of the most prevalent causes of emergency room visits is acute dyspnea. Several etiologies, including cardiac, pulmonary, metabolic, psychogenic etc… may be involved. Acute heart failure (AHF) is among the most common causes. This study aims to evaluate, in patients presenting with acute dyspnea to the emergency departement (ED), the accuracy of a diagnostic approach combining Lung ultrasonography (LUS) and clinical assessment as compared to the traditional AHF diagnostic work-up.</div></div><div><h3>Methods</h3><div>This is a bi-centric cross-sectional observational study, conducted at the Emergency and Cardiology Department of both the Hedi Chaker Hospital in Sfax and the Habib Thameur Hospital in Tunis for the period extending from 01/07/2022 to 30/09/2023. The diagnostic performance of pulmonary ultrasonography was studied and the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were compared with those of clinical examination, chest X-Ray, NT-pro -BNP and the Transthoracic echocardiography (TTE) which was the reference exam.</div></div><div><h3>Results</h3><div>The most common cause of acute dyspnea is acute heart failure (79.3 %). LUS had a sensitivity of 94,2 % in diagnosing AHF and a specificity of 77,5 %. Its PPV and NPV were respectively 92 % and 81 %. The area under curbe (AUC) of B-Lines required for the diagnosis of interstitial pulmonary syndrome was excellent (92 %). There was a moderate significant positive correlation between the number of B-Lines and NT-Pro-BNP levels <em>r</em> = 0.51, <em>P <</em> 0.001. Also, there was a very strong significant positive relationship between the pulmonary congestion assessed by LUS and Left atrium - pressure <em>r</em> = 0.788, <em>P <</em> 0.001</div></div><div><h3>Conclusion</h3><div>LUS is an excellent test both to confirm and exclude the diagnosis of AHF in patients consulting the emergency room for acute dyspnea and therefore deserves to be performed systematically.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"50 1","pages":"Article 102910"},"PeriodicalIF":3.0,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-28DOI: 10.1016/j.cpcardiol.2024.102883
Arif Albulushi , Jehad Al Buraiki , Gamal Aly , Yahya Al-Wahshi , Alireza Jahangirifard
Background
Cardiac amyloidosis is characterized by amyloid fibril deposition in the heart, leading to restrictive cardiomyopathy and heart failure. Early diagnosis and monitoring are crucial for effective management. This systematic review and meta-analysis evaluates the utility of various biomarkers in the early detection, disease progression, and prognosis of cardiac amyloidosis.
Methods
We conducted a comprehensive search of PubMed, Scopus, and Web of Science databases for studies published between 2000 and 2024 that assessed the diagnostic and prognostic value of biomarkers in cardiac amyloidosis. Data were extracted and analyzed to determine the sensitivity, specificity, and prognostic significance of each biomarker. The correlation between biomarker levels and imaging findings was also explored.
Results
A total of 45 studies were included in the meta-analysis. NT-proBNP and troponins had high sensitivity and specificity for early diagnosis of cardiac amyloidosis. Novel biomarkers, such as serum amyloid P component and light-chain assays, showed promise in distinguishing between amyloidosis subtypes and predicting disease progression. However, significant variability existed in the correlation between biomarkers and imaging findings.
Conclusions
Biomarkers are crucial for early diagnosis and prognosis of cardiac amyloidosis. NT-proBNP and troponins are well-established markers, while novel biomarkers offer additional insights into disease progression and subtype differentiation.
背景：心脏淀粉样变性的特点是淀粉样纤维沉积在心脏中，导致局限性心肌病和心力衰竭。早期诊断和监测对有效治疗至关重要。本系统综述和荟萃分析评估了各种生物标志物在心脏淀粉样变性的早期检测、疾病进展和预后方面的作用：我们在PubMed、Scopus和Web of Science数据库中全面检索了2000年至2024年间发表的评估心脏淀粉样变性生物标志物诊断和预后价值的研究。通过提取和分析数据，确定了每种生物标志物的敏感性、特异性和预后意义。此外，还探讨了生物标志物水平与影像学检查结果之间的相关性：荟萃分析共纳入了 45 项研究。NT-proBNP和肌钙蛋白对早期诊断心脏淀粉样变性具有较高的敏感性和特异性。新型生物标志物，如血清淀粉样蛋白P成分和轻链测定，在区分淀粉样变性亚型和预测疾病进展方面显示出前景。然而，生物标志物与成像结果之间的相关性存在很大差异：结论：生物标志物对心脏淀粉样变性的早期诊断和预后至关重要。结论：生物标记物对早期诊断和预后至关重要。NT-proBNP 和肌钙蛋白是公认的标记物，而新型生物标记物则为疾病进展和亚型分化提供了更多的见解。
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