Aim: The objective of this study was to analysis factors affecting arteriovenous fistula patency, to improve access outcome. Methods& Patients: Patients (n=290) were enrolled in our prospective observational study. Demographic, clinical, and operative variables were compared between those with and without NAVF function loss. In addition, we evaluated the distribution and complication of NAVF and its association with different factors. All statistical analyses were performed with the use of appropriate SPSS software package, version 24.0. Results: We found 96.5% (n=280) of patients had NAVFs, among them 67.9% (190/280) of patients had upper NAVFs, followed by lower NAVFs 32.1% 90/280), while 3.4% (10/290) of patients had depended on a cuff catheter. The most frequent complication post NAVF creation was thrombosis (11.4%), followed by noninfectious fluid collections (9.3%), infection (6.4%), Limp edema (4.3%), Aneurysmal degeneration (3.2%), arterial steal syndrome (2.5%) and venous hypertension (1.8%). History of dialysis catheter used AVF location and absent intraoperative thrill were independently associated with loss of NAVF primary patency. There was a statistically significant increase in the number of steal syndrome in patients who had diabetes mellitus (P value= 0.021) and in patients who had age >65 years (P value 0.002), while female gender was not (P value= 0.122). History of catheter used (P = 0.02), previous AVF procedure (P= 0.01), and present of non-infection fluid (P = 0.00) were found significantly increase the infection rate of NAVF. Conclusions: Identifying risk factors affecting AVF patency is crucial. Early and timely treating complications post AVF is essential for proper management and maturation.
{"title":"Prospective Evaluation of Factors Associated with Arteriovenous Fistula Primary Failure and Complications in Hemodialysis Patients: A Single Center-Study","authors":"Ismail Al-Shameri, Gamal KhudaBux, Abudar Al-Ganadi","doi":"10.33425/2639-8486.1103","DOIUrl":"https://doi.org/10.33425/2639-8486.1103","url":null,"abstract":"Aim: The objective of this study was to analysis factors affecting arteriovenous fistula patency, to improve access outcome. Methods& Patients: Patients (n=290) were enrolled in our prospective observational study. Demographic, clinical, and operative variables were compared between those with and without NAVF function loss. In addition, we evaluated the distribution and complication of NAVF and its association with different factors. All statistical analyses were performed with the use of appropriate SPSS software package, version 24.0. Results: We found 96.5% (n=280) of patients had NAVFs, among them 67.9% (190/280) of patients had upper NAVFs, followed by lower NAVFs 32.1% 90/280), while 3.4% (10/290) of patients had depended on a cuff catheter. The most frequent complication post NAVF creation was thrombosis (11.4%), followed by noninfectious fluid collections (9.3%), infection (6.4%), Limp edema (4.3%), Aneurysmal degeneration (3.2%), arterial steal syndrome (2.5%) and venous hypertension (1.8%). History of dialysis catheter used AVF location and absent intraoperative thrill were independently associated with loss of NAVF primary patency. There was a statistically significant increase in the number of steal syndrome in patients who had diabetes mellitus (P value= 0.021) and in patients who had age >65 years (P value 0.002), while female gender was not (P value= 0.122). History of catheter used (P = 0.02), previous AVF procedure (P= 0.01), and present of non-infection fluid (P = 0.00) were found significantly increase the infection rate of NAVF. Conclusions: Identifying risk factors affecting AVF patency is crucial. Early and timely treating complications post AVF is essential for proper management and maturation.","PeriodicalId":72522,"journal":{"name":"Cardiology & vascular research (Wilmington, Del.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49578882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
B. Md, Bah Mb, Balde Ey, B. M, C. A., Tamko C, Barry Is, Baldé Ma, K. A, Sylla Is, D. S, D. M., Conde M
Introduction: Peripheral arterial disease of the lower limbs (PAD) is a partial or total obliteration of one or more arteries intended for the lower limbs by atheroma. Its prevalence increases with age, but also with other major cardiovascular risk factors such as diabetes, smoking, high blood pressure and dyslipidemia. Its diagnosis is essentially based on arterial Doppler ultrasound, which studies the topography and extension of the lesions, thus constituting the essential tool for therapeutic decision-making. The objective was to describe the epidemiological and ultrasound profile of patients with atheromatous arterial stenosis of the lower limbs. Methodology: This was a cross-sectional descriptive study running from 1 January 2019 to 31 March 2020, we took a duration of 15 months. This study was carried out at the Conakry University Hospital (Donka and Ignace Deen Hospitals). Results: In our series, the average age was 64.7 ± 13 years, with a sex ratio of 1.04. The average age was 64.7 ± 13 years, with a sex ratio of 1.04. The average age of the women in our series was 64.7 ± 13 years. Risk factors were dominated by advanced age (78.67%), diabetes (58%), hypertension (57%) and physical inactivity (47.66%). Among the 300 patients, 145 were carriers of atheromatous arterial stenosis, or a frequency of 48.33%. The leg arteries were the most affected, followed by the common femoral arteries. Concerning the degree of stenosis, patients with stenosis greater than 70% were the most represented. Conclusion: Peripheral arterial disease of the lower limbs (AOMI) is a pathology not to be neglected in Guinea. Patients have several risk factors : stenosis is an important part of the ultrasound lesions of this disease.
{"title":"Peripheral Arterial Disease of the Lower Limbs: Epidemiological and Ultrasound Profile of Patients with Stenosis at the Conakry University Hospital","authors":"B. Md, Bah Mb, Balde Ey, B. M, C. A., Tamko C, Barry Is, Baldé Ma, K. A, Sylla Is, D. S, D. M., Conde M","doi":"10.33425/2639-8486.1108","DOIUrl":"https://doi.org/10.33425/2639-8486.1108","url":null,"abstract":"Introduction: Peripheral arterial disease of the lower limbs (PAD) is a partial or total obliteration of one or more arteries intended for the lower limbs by atheroma. Its prevalence increases with age, but also with other major cardiovascular risk factors such as diabetes, smoking, high blood pressure and dyslipidemia. Its diagnosis is essentially based on arterial Doppler ultrasound, which studies the topography and extension of the lesions, thus constituting the essential tool for therapeutic decision-making. The objective was to describe the epidemiological and ultrasound profile of patients with atheromatous arterial stenosis of the lower limbs. Methodology: This was a cross-sectional descriptive study running from 1 January 2019 to 31 March 2020, we took a duration of 15 months. This study was carried out at the Conakry University Hospital (Donka and Ignace Deen Hospitals). Results: In our series, the average age was 64.7 ± 13 years, with a sex ratio of 1.04. The average age was 64.7 ± 13 years, with a sex ratio of 1.04. The average age of the women in our series was 64.7 ± 13 years. Risk factors were dominated by advanced age (78.67%), diabetes (58%), hypertension (57%) and physical inactivity (47.66%). Among the 300 patients, 145 were carriers of atheromatous arterial stenosis, or a frequency of 48.33%. The leg arteries were the most affected, followed by the common femoral arteries. Concerning the degree of stenosis, patients with stenosis greater than 70% were the most represented. Conclusion: Peripheral arterial disease of the lower limbs (AOMI) is a pathology not to be neglected in Guinea. Patients have several risk factors : stenosis is an important part of the ultrasound lesions of this disease.","PeriodicalId":72522,"journal":{"name":"Cardiology & vascular research (Wilmington, Del.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45017827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: While people with congestive heart failure (CHF) are living longer, they often have limited ability to engage in treatment plans and self-management at home, thus resulting in increased hospitalizations. The use of novel digital technologies for improving self-management has been recommended for reducing CHF related hospitalizations. Objective: This pilot study compared a patient-centered enhanced self-care (ESC) intervention using a mobile system called “HeartMapp (HM)” (ESC HM) with an active wait listed control (WLC) group who received CHF education in reducing hospitalization rate and improving CHF outcomes. A total of 18 participants who met the inclusion criteria were block randomized to ESC HM (n=9) and active WLC group (n=9), both using similar mobile platform. Participants were followed for 30-days to examine the number of hospitalization and secondary outcomes including self-care, quality of life, and CHF knowledge. Results: Results showed that none of the participants randomized to ESC HM (n=9) were hospitalized during the study period of 30-days compared to two participants, both men (11%) in the WLC group. Additionally, clinically meaningful improvement in self-care management (t=3.38; p=0.006) and self-care confidence (6.7 vs 1.8; t=2.53; p=0.028) were observed in ESC HM group. Knowledge significantly improved in the ESC HM group while declined in the WLC group (t=2.37; p=0.037). Quality of life score declined by 2 points in the ESC HM group, while the WLC group score declined by 8 points (p=.08). Conclusion: Preliminary results of the pilot study demonstrated feasibility and potential efficacy of reducing hospitalization and improving CHF self-care; thus, warranting further evaluation in a well-designed large clinical trial.
{"title":"Enhanced Self Care with Mobile Technology to Reduce Readmission in Congestive Heart Failure: A Pilot Study","authors":"P. Athilingam, M. Labrador, B. Redding","doi":"10.33425/2639-8486.1107","DOIUrl":"https://doi.org/10.33425/2639-8486.1107","url":null,"abstract":"Introduction: While people with congestive heart failure (CHF) are living longer, they often have limited ability to engage in treatment plans and self-management at home, thus resulting in increased hospitalizations. The use of novel digital technologies for improving self-management has been recommended for reducing CHF related hospitalizations. Objective: This pilot study compared a patient-centered enhanced self-care (ESC) intervention using a mobile system called “HeartMapp (HM)” (ESC HM) with an active wait listed control (WLC) group who received CHF education in reducing hospitalization rate and improving CHF outcomes. A total of 18 participants who met the inclusion criteria were block randomized to ESC HM (n=9) and active WLC group (n=9), both using similar mobile platform. Participants were followed for 30-days to examine the number of hospitalization and secondary outcomes including self-care, quality of life, and CHF knowledge. Results: Results showed that none of the participants randomized to ESC HM (n=9) were hospitalized during the study period of 30-days compared to two participants, both men (11%) in the WLC group. Additionally, clinically meaningful improvement in self-care management (t=3.38; p=0.006) and self-care confidence (6.7 vs 1.8; t=2.53; p=0.028) were observed in ESC HM group. Knowledge significantly improved in the ESC HM group while declined in the WLC group (t=2.37; p=0.037). Quality of life score declined by 2 points in the ESC HM group, while the WLC group score declined by 8 points (p=.08). Conclusion: Preliminary results of the pilot study demonstrated feasibility and potential efficacy of reducing hospitalization and improving CHF self-care; thus, warranting further evaluation in a well-designed large clinical trial.","PeriodicalId":72522,"journal":{"name":"Cardiology & vascular research (Wilmington, Del.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43183405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lubna Alruwaili, Khalid A Alnemer, F. Alamro, Mohammed Alshebebi
Coronavirus disease (COVID-19) is a serious illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), that continues to grow globally. Incidence of cardiovascular complications has increased during the COVID-19 (Coronavirus disease 2019) pandemic, in regards of population- wide and in patients diagnosed with the disease. Various cardiovascular manifestations have been linked to the viral insult, including among others acute coronary syndromes, myocarditis, acute heart failure, cardiac injury, arrhythmias spontaneous coronary artery dissection, and stress induced cardiomyopathy. Although, the mechanism of heart injury in COVID-19 is not clear yet, several hypothesis and theories to various cardiac manifestation have been described. We performed a narrative review for the current published literature on the different cardiovascular manifestation related to COVID-19 infection.
{"title":"Major Cardiovascular Manifestations during COVID-19 Infection","authors":"Lubna Alruwaili, Khalid A Alnemer, F. Alamro, Mohammed Alshebebi","doi":"10.33425/2639-8486.1104","DOIUrl":"https://doi.org/10.33425/2639-8486.1104","url":null,"abstract":"Coronavirus disease (COVID-19) is a serious illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), that continues to grow globally. Incidence of cardiovascular complications has increased during the COVID-19 (Coronavirus disease 2019) pandemic, in regards of population- wide and in patients diagnosed with the disease. Various cardiovascular manifestations have been linked to the viral insult, including among others acute coronary syndromes, myocarditis, acute heart failure, cardiac injury, arrhythmias spontaneous coronary artery dissection, and stress induced cardiomyopathy. Although, the mechanism of heart injury in COVID-19 is not clear yet, several hypothesis and theories to various cardiac manifestation have been described. We performed a narrative review for the current published literature on the different cardiovascular manifestation related to COVID-19 infection.","PeriodicalId":72522,"journal":{"name":"Cardiology & vascular research (Wilmington, Del.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44100340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bamigboye-Taiwo Olukemi T, Ojo Olugbenga O, O. Ao, Onakpoya Uvie U, Adeyefa Babajide S, Eyekpegha Joel O, Oguns Abayomi
Background: The coronavirus disease 2019 (COVID-19), a highly contagious infection first diagnosed in China has rapidly spread worldwide. The resultant pandemic has witnessed over one million deaths with unprecedented and severe disruption of socioeconomic activities and healthcare services globally. Hitherto, paediatric cardiac services in Nigeria were underdeveloped and the impact of this disease remains unexamined. Objectives: To evaluate the impact of COVID-19 pandemic on the paediatric cardiac services in Nigeria. Methods: Self-administered digital questionnaires were sent directly into the private accounts of Paediatric Cardiologists and Paediatric Cardiac Surgeons in Nigeria using the Nigerian Cardiac Society and the Association of Cardiovascular and Thoracic Surgeons of Nigeria Register. Thereafter, each person was contacted personally and requested to fill the questionnaires. Results: There were 31 (51.7%) respondents; 23 Paediatric Cardiologist and 8 Cardiac Surgeons, 28 (90.3%) practice in the public sector and the remaining practice privately. About a third reported temporary outpatient clinic closures. Others’ weekly clinic attendance dropped from an average of 17.55 ± 12.6 patients before to 3.90 ± 4.37 during the pandemic. Over 90% of respondents had instituted use of personal protective equipment in their centres. Over 70% of respondents reported suspension of procedures including echocardiography, pericardiocentesis, and partial exchange transfusion. Only one centre performed open-heart surgery during this period. Conclusions: Paediatric cardiac services in Nigeria are grossly inadequate and the COVID-19 pandemic has further worsened the plight of Nigerian children with heart disease.
{"title":"Evaluation of the Impact of COVID-19 Pandemic on Delivery of Paediatric Cardiac Services in Nigeria","authors":"Bamigboye-Taiwo Olukemi T, Ojo Olugbenga O, O. Ao, Onakpoya Uvie U, Adeyefa Babajide S, Eyekpegha Joel O, Oguns Abayomi","doi":"10.33425/2639-8486.1105","DOIUrl":"https://doi.org/10.33425/2639-8486.1105","url":null,"abstract":"Background: The coronavirus disease 2019 (COVID-19), a highly contagious infection first diagnosed in China has rapidly spread worldwide. The resultant pandemic has witnessed over one million deaths with unprecedented and severe disruption of socioeconomic activities and healthcare services globally. Hitherto, paediatric cardiac services in Nigeria were underdeveloped and the impact of this disease remains unexamined. Objectives: To evaluate the impact of COVID-19 pandemic on the paediatric cardiac services in Nigeria. Methods: Self-administered digital questionnaires were sent directly into the private accounts of Paediatric Cardiologists and Paediatric Cardiac Surgeons in Nigeria using the Nigerian Cardiac Society and the Association of Cardiovascular and Thoracic Surgeons of Nigeria Register. Thereafter, each person was contacted personally and requested to fill the questionnaires. Results: There were 31 (51.7%) respondents; 23 Paediatric Cardiologist and 8 Cardiac Surgeons, 28 (90.3%) practice in the public sector and the remaining practice privately. About a third reported temporary outpatient clinic closures. Others’ weekly clinic attendance dropped from an average of 17.55 ± 12.6 patients before to 3.90 ± 4.37 during the pandemic. Over 90% of respondents had instituted use of personal protective equipment in their centres. Over 70% of respondents reported suspension of procedures including echocardiography, pericardiocentesis, and partial exchange transfusion. Only one centre performed open-heart surgery during this period. Conclusions: Paediatric cardiac services in Nigeria are grossly inadequate and the COVID-19 pandemic has further worsened the plight of Nigerian children with heart disease.","PeriodicalId":72522,"journal":{"name":"Cardiology & vascular research (Wilmington, Del.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44699073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Nammour, Metwally Hassan El-amry, A. Attia, Ahmed Abdel Mohsen Alsaghir Hegab, Y. A. Rahman
Background: The first trimester of pregnancy is where the mother's hemodynamic adaptation starts. A raise in preload, a drop in afterload, improved conduit vessel enforcement, ventricular remodeling, and a change in the renin system cause cardiac production to increase and diastolic activity to change. -the renin-angiotensinaldosterone axis. Aim: To assess maternal left ventricular dysfunction and remodeling in gestational hypertension. Methods: Our study was conducted on 50 patients divided on two groups as patients and control groups each of them 25. All subjects were evaluated by history taking, clinical examination, routine laboratory investigations, 12-lead ECG and echocardiography. Results: There was a statistically highly significant correlation between patients and control groups in age and parity with p values (0.027) and (0.023) respectively and significant correlation in left ventricular remodeling with p value for normal geometry and concentric LVH (<0.001) and (0.05) respectively. There was a significant correlation between patients and control groups with as regard left ventricular diastolic function in E/A ratio and septal E with P values <0.001 for both of them. There was a significant correlation between patients and control groups in using GLS with P value 0.001. Conclusion: As compared to normotensive deliveries, gestational hypertension is correlated with retained left ventricular systolic activity, subclinical diastolic dysfunction, and left ventricular remodeling in the context of increased mass and wall thickness, as well as a higher prevalence of concentric remodeling. Speckle monitoring echocardiography is important in the early identification of systolic dysfunction.
{"title":"Assessment of Maternal Left Ventricular Dysfunction and Remodeling in Gestational Hypertension","authors":"A. Nammour, Metwally Hassan El-amry, A. Attia, Ahmed Abdel Mohsen Alsaghir Hegab, Y. A. Rahman","doi":"10.33425/2639-8486.1106","DOIUrl":"https://doi.org/10.33425/2639-8486.1106","url":null,"abstract":"Background: The first trimester of pregnancy is where the mother's hemodynamic adaptation starts. A raise in preload, a drop in afterload, improved conduit vessel enforcement, ventricular remodeling, and a change in the renin system cause cardiac production to increase and diastolic activity to change. -the renin-angiotensinaldosterone axis. Aim: To assess maternal left ventricular dysfunction and remodeling in gestational hypertension. Methods: Our study was conducted on 50 patients divided on two groups as patients and control groups each of them 25. All subjects were evaluated by history taking, clinical examination, routine laboratory investigations, 12-lead ECG and echocardiography. Results: There was a statistically highly significant correlation between patients and control groups in age and parity with p values (0.027) and (0.023) respectively and significant correlation in left ventricular remodeling with p value for normal geometry and concentric LVH (<0.001) and (0.05) respectively. There was a significant correlation between patients and control groups with as regard left ventricular diastolic function in E/A ratio and septal E with P values <0.001 for both of them. There was a significant correlation between patients and control groups in using GLS with P value 0.001. Conclusion: As compared to normotensive deliveries, gestational hypertension is correlated with retained left ventricular systolic activity, subclinical diastolic dysfunction, and left ventricular remodeling in the context of increased mass and wall thickness, as well as a higher prevalence of concentric remodeling. Speckle monitoring echocardiography is important in the early identification of systolic dysfunction.","PeriodicalId":72522,"journal":{"name":"Cardiology & vascular research (Wilmington, Del.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47870897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mody Rohit, Dash Debabrata, M. Bhavya, Saholi Aditya, Khullar Akshit
{"title":"Optical Coherence Tomography Analysis of Des In-Stent Restenosis Presenting As Stable and Unstable Angina: A Comparison – A Case Series","authors":"Mody Rohit, Dash Debabrata, M. Bhavya, Saholi Aditya, Khullar Akshit","doi":"10.33425/2639-8486.1101","DOIUrl":"https://doi.org/10.33425/2639-8486.1101","url":null,"abstract":"","PeriodicalId":72522,"journal":{"name":"Cardiology & vascular research (Wilmington, Del.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48277885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fibrinolysis has used tissue plasminogen activator (tPA) alone ever since it replaced Streptokinase (SK) in therapeutic fibrinolysis. This was based on the belief that tPA was responsible for natural fibrinolysis. When prourokinase plasminogen activator was discovered (prouPA) in 1980, it was believed to be an extravascular plasminogen activator. This has turned out to be a mistaken concept. Out of the three fibrin-bound plasminogens responsible for fibrinolysis, only the first one, the one which initiates fibrinolysis, is activated by tPA. The other two are activated by prouPA and two chain uPA (urokinase) respectively. Therefore, the functions of tPA and prouPA are analogous to those of the starter and the fuel in a car. By mimicking this natural model for therapy, fibrinolysis can be made much safer because high dose infusions of tPA, that can cause bleeding at vascular repair sites, are eliminated. *Correspondence: Victor Gurewich, MD, Vascular Research Laboratory, Mount Auburn Hospital, Cambridge, MA, USA, Professor of Medicine, Harvard Medical School. Received: 03 March 2021; Accepted: 26 April 2021
{"title":"Using tPA Alone for Fibrinolysis has been A Longstanding Mistake","authors":"V. Gurewich","doi":"10.33425/2639-8486.1102","DOIUrl":"https://doi.org/10.33425/2639-8486.1102","url":null,"abstract":"Fibrinolysis has used tissue plasminogen activator (tPA) alone ever since it replaced Streptokinase (SK) in therapeutic fibrinolysis. This was based on the belief that tPA was responsible for natural fibrinolysis. When prourokinase plasminogen activator was discovered (prouPA) in 1980, it was believed to be an extravascular plasminogen activator. This has turned out to be a mistaken concept. Out of the three fibrin-bound plasminogens responsible for fibrinolysis, only the first one, the one which initiates fibrinolysis, is activated by tPA. The other two are activated by prouPA and two chain uPA (urokinase) respectively. Therefore, the functions of tPA and prouPA are analogous to those of the starter and the fuel in a car. By mimicking this natural model for therapy, fibrinolysis can be made much safer because high dose infusions of tPA, that can cause bleeding at vascular repair sites, are eliminated. *Correspondence: Victor Gurewich, MD, Vascular Research Laboratory, Mount Auburn Hospital, Cambridge, MA, USA, Professor of Medicine, Harvard Medical School. Received: 03 March 2021; Accepted: 26 April 2021","PeriodicalId":72522,"journal":{"name":"Cardiology & vascular research (Wilmington, Del.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49178696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Toure Ai, S. K, Boncano A, Dodo B, Haggar M, M. S, Z. À, Djonyabo S, Akakpo E, Gonda I, Moustapha O, Yahaya I
Introduction: Coronary artery disease is the leader in cardiovascular disease. An estimated 7.5 million deaths from cardiovascular disease are due to coronary heart disease. WHO estimates that by 2030, nearly 23.6 million people will die from cardiovascular disease? Over 80% of deaths attributed to cardiovascular disease occur in low- and middle-income developing countries. The CORONAFRIC survey done in 1991 and which gathered 13 West African countries with 16 centers found a prevalence of coronary heart disease of 3, 17%. In Niger an over survey done in 2013 shows a prevalence of coronary heart disease at 5.60%. The main cause of coronary pathologies is atherosclerosis or atheroma and its sudden complication thrombosis. This review aims to study the local specificities of ACS through its epidemiological, clinical, Para clinical and therapeutic aspects at the level of the LAMORDE National Teaching Hospital (LNTH), in the absence of a cardiology technical platform intervention and in the absence of pre-hospital care, in order to formulate recommendations for the prevention of coronary artery diseases in low income countries. Patients and Methods: This is a retro and prospective study over a period (July 01, 2014 to December 31, 2019) of 66 months and concerns cases of ACS hospitalized in the internal medicine and cardiology department of LNTH. Were included in our study patients with angina pain, and electrocardiographic signs (ischemia, lesion or necrosis) with or without a confirmed past history of MI but admitted with biological signs. Results: At the end of our study, the prevalence of ACS is 10.67% compared to cardiovascular disease, CI 51.24%, stroke 26.24% and thromboembolic disease 2.84%. ACS is predominantly male in 63.77% of cases. The sex ratio is 1.76 -the age ≥50 years represents 86.98% of the subjects, with an average age of 60.98 years; -The months of November, December, January and February represent the favorable period for the onset of acute coronary syndromes with 23.20% of cases. - Retro sternal chest pain is by far the most common symptom with 67.63% of cases. Troponin was measured in 75 of our patients, ie 36.23% of which 35.27% had a high level.- ECG, troponin allowed us to identify forms of ACS with 70.05% of ACS ST +; 21.74% unstable angina and 8.21% Q- wave of MI. - The most affected territory was anterior with 153 cases (73.91%) followed by the lower territory 46 cases (22.22%) then the lateral territory 16 cases (7.73%) associated. In our study, hypertension was encountered in 34.48% of cases, diabetes (11.11%), hypercholesterolemia 4.35%), smoking (with 4.83%), obesity (with 2.90%), menopause (with 84.93%) were recognized as risk factors favoring the occurrence of ACS. In 96.14% of the cases, the patients were put on aspirin and clopidogrel followed by the ICE in 93.24% of the cases; Beta blocking in 92.75% of cases; statin in 89.86% of cases; of diuretics in 55.56% of cases and heparin in 52.17% of cases. In our study
{"title":"Acute Coronary Syndromes in Niger: (West Africa): Epidemiological, Clinical, Para clinical and Therapeutic Aspects","authors":"Toure Ai, S. K, Boncano A, Dodo B, Haggar M, M. S, Z. À, Djonyabo S, Akakpo E, Gonda I, Moustapha O, Yahaya I","doi":"10.33425/2639-8486.1092","DOIUrl":"https://doi.org/10.33425/2639-8486.1092","url":null,"abstract":"Introduction: Coronary artery disease is the leader in cardiovascular disease. An estimated 7.5 million deaths from cardiovascular disease are due to coronary heart disease. WHO estimates that by 2030, nearly 23.6 million people will die from cardiovascular disease? Over 80% of deaths attributed to cardiovascular disease occur in low- and middle-income developing countries. The CORONAFRIC survey done in 1991 and which gathered 13 West African countries with 16 centers found a prevalence of coronary heart disease of 3, 17%. In Niger an over survey done in 2013 shows a prevalence of coronary heart disease at 5.60%. The main cause of coronary pathologies is atherosclerosis or atheroma and its sudden complication thrombosis. This review aims to study the local specificities of ACS through its epidemiological, clinical, Para clinical and therapeutic aspects at the level of the LAMORDE National Teaching Hospital (LNTH), in the absence of a cardiology technical platform intervention and in the absence of pre-hospital care, in order to formulate recommendations for the prevention of coronary artery diseases in low income countries. Patients and Methods: This is a retro and prospective study over a period (July 01, 2014 to December 31, 2019) of 66 months and concerns cases of ACS hospitalized in the internal medicine and cardiology department of LNTH. Were included in our study patients with angina pain, and electrocardiographic signs (ischemia, lesion or necrosis) with or without a confirmed past history of MI but admitted with biological signs. Results: At the end of our study, the prevalence of ACS is 10.67% compared to cardiovascular disease, CI 51.24%, stroke 26.24% and thromboembolic disease 2.84%. ACS is predominantly male in 63.77% of cases. The sex ratio is 1.76 -the age ≥50 years represents 86.98% of the subjects, with an average age of 60.98 years; -The months of November, December, January and February represent the favorable period for the onset of acute coronary syndromes with 23.20% of cases. - Retro sternal chest pain is by far the most common symptom with 67.63% of cases. Troponin was measured in 75 of our patients, ie 36.23% of which 35.27% had a high level.- ECG, troponin allowed us to identify forms of ACS with 70.05% of ACS ST +; 21.74% unstable angina and 8.21% Q- wave of MI. - The most affected territory was anterior with 153 cases (73.91%) followed by the lower territory 46 cases (22.22%) then the lateral territory 16 cases (7.73%) associated. In our study, hypertension was encountered in 34.48% of cases, diabetes (11.11%), hypercholesterolemia 4.35%), smoking (with 4.83%), obesity (with 2.90%), menopause (with 84.93%) were recognized as risk factors favoring the occurrence of ACS. In 96.14% of the cases, the patients were put on aspirin and clopidogrel followed by the ICE in 93.24% of the cases; Beta blocking in 92.75% of cases; statin in 89.86% of cases; of diuretics in 55.56% of cases and heparin in 52.17% of cases. In our study","PeriodicalId":72522,"journal":{"name":"Cardiology & vascular research (Wilmington, Del.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43341582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abdulaziz Aboushahba, R. Solomon, Ahmed H Dawood, Ibrahim Altaj, Gamal Abdel Hady, Mohamed Elbordy, Aida Elrefay
Background: Previous trials remained inconsistent regarding benefits and possible risks associated with intracoronary (IC) administration compared with intravenous (IV) are still questionable. We aimed at evaluation safety and effectiveness of IC versus IV tirofiban administration during primary percutaneous coronary intervention (PCI) for diabetic patients (DM) presented with acute ST segment elevation myocardial infarction. Methods: This trial included 100 patients who were randomized either IV high bolus plus maintenance or IC high bolus plus maintenance of tirofiban. Both groups were compared for pre and post intervention for myocardial perfusion, cardiac marker and Major composite adverse cardiac event incidence at 30 days were recorded. Results: Incidence of major adverse cardiac events was not different between groups, but Post procedure TIMI flow III and MBG III were significant in IC group with p = 0.45, and 0.21 respectively favoring intracoronary strategy. Peak CK-MB values were lower in IC tirofiban group than IV group, 155.68 ± 121, 192.4 ± 86 respectively with significant (p=0.021). Peak hs-TnT value was significantly were lower in IC tirofiban group [4291 ± 334 ng/dL vs 5342 ± 286 ng/dL in IV group; (p=0.035). ST segment resolution and 30 days LVEF in IC group were significantly higher in IC group than in IV group (p= 0.023) respectively. Conclusion: IC GpIIb/IIIa inhibitors is more effective in improving coronary blood flow and myocardial tissue perfusion in DM after STEMI 30 days post PCI despite the bleeding event and MACE rates showed no significant difference,IC tirofiban group, showed better improvement in LVEF.
{"title":"Intracoronary Versus Intravenous Administration of Glycoprotein IIb/IIIa inhibitors in Diabetic Patients Undergoing Primary Percutaneous Coronary Intervention","authors":"Abdulaziz Aboushahba, R. Solomon, Ahmed H Dawood, Ibrahim Altaj, Gamal Abdel Hady, Mohamed Elbordy, Aida Elrefay","doi":"10.33425/2639-8486.1091","DOIUrl":"https://doi.org/10.33425/2639-8486.1091","url":null,"abstract":"Background: Previous trials remained inconsistent regarding benefits and possible risks associated with intracoronary (IC) administration compared with intravenous (IV) are still questionable. We aimed at evaluation safety and effectiveness of IC versus IV tirofiban administration during primary percutaneous coronary intervention (PCI) for diabetic patients (DM) presented with acute ST segment elevation myocardial infarction. Methods: This trial included 100 patients who were randomized either IV high bolus plus maintenance or IC high bolus plus maintenance of tirofiban. Both groups were compared for pre and post intervention for myocardial perfusion, cardiac marker and Major composite adverse cardiac event incidence at 30 days were recorded. Results: Incidence of major adverse cardiac events was not different between groups, but Post procedure TIMI flow III and MBG III were significant in IC group with p = 0.45, and 0.21 respectively favoring intracoronary strategy. Peak CK-MB values were lower in IC tirofiban group than IV group, 155.68 ± 121, 192.4 ± 86 respectively with significant (p=0.021). Peak hs-TnT value was significantly were lower in IC tirofiban group [4291 ± 334 ng/dL vs 5342 ± 286 ng/dL in IV group; (p=0.035). ST segment resolution and 30 days LVEF in IC group were significantly higher in IC group than in IV group (p= 0.023) respectively. Conclusion: IC GpIIb/IIIa inhibitors is more effective in improving coronary blood flow and myocardial tissue perfusion in DM after STEMI 30 days post PCI despite the bleeding event and MACE rates showed no significant difference,IC tirofiban group, showed better improvement in LVEF.","PeriodicalId":72522,"journal":{"name":"Cardiology & vascular research (Wilmington, Del.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48143942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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