American journal of cardiovascular disease最新文献

Brugada Syndrome (BrS) is a hereditary cardiac condition associated with an elevated risk of lethal arrhythmias, making precise and prompt diagnosis vital to prevent life-threatening outcomes. The diagnosis of BrS is challenging due to the requirement of invasive drug challenge tests, limited human visual capacity to detect subtle electrocardiogram (ECG) patterns, and the transient nature of the disease. Artificial intelligence (AI) can detect almost all patterns of BrS in ECG, some of which are even beyond the capability of expert eyes. AI is subcategorized into several models, with deep learning being considered the most beneficial, boasting its highest accuracy among the other models. With the capability to discriminate subtle data and analyze extensive datasets, AI has achieved higher accuracy, sensitivity, and specificity compared to trained cardiologists. Meanwhile, AI proficiency in managing complex data enables us to discover unclassified genetic variants. AI can also analyze data extracted from induced pluripotent stem cell-derived cardiomyocytes to distinguish BrS from other inherited cardiac arrhythmias. The aim of this study is to present a synopsis of the evolution of various algorithms of artificial intelligence utilized in the diagnosis of BrS and compare their diagnostic abilities to trained cardiologists. In addition, the application of AI for classification of BrS gene variants is also briefly discussed.

Objectives: We tested whether management with metabolic cytoprotective and antiischemic agent trimetazidine may reduce readmissions in advanced heart failure (HF) patients through the possible improvement of left ventricular ejection fraction (LV EF) and filling pressure.

Methods: This was a single-center prospective open-label study. The study population included initially 40 patients with advanced HF and EF <30%, NYHA III-IV functional class, significant restriction of physical activity and at least 1 hospitalization during the last 12 months. After discharge patients were assigned to additional treatment with trimetazidine 80 mg/daily dose (20 patients) or standard guideline-based pharmacological therapy (20 patients). After enrollment patients underwent a total of four outpatient clinical and echocardiographic examinations (baseline before discharge, 2 weeks, 1, 3 and 6 months after the discharge). The echocardiographic assessment of EF and LV filling pressure by Tissue Doppler were performed blindly.

Results: At 6 months, trimetazidine-treated patients had an improvement of LV EF (from 23.7% to 25%) as compared to controls (from 22.5% to 22.6%). Tissue Doppler study showed a decrease of LV filling pressure in trimetazidine treated group from 15.1 at baseline to 13.7 after 6 months of treatment. In the control group, LV filling pressure remained unchanged (from 16.78 to 16.7) (P<0.001). The rate of hospitalizations for cardiovascular causes was reduced at 6 months (83.3% vs 70.0%).

Conclusions: Treatment with trimetazidine 80 mg/daily in addition to standard guideline-based therapy for 6-months decreased hospitalization, improved systolic function and LV filling pressure in advanced HF patients.

We report a case of a 57-year-old male with narrow QRS tachycardia exhibiting the alternance of the cycle length. Differential diagnoses include orthodromic atrioventricular reciprocating tachycardia with alternating antegrade atrioventricular (AV) nodal pathways, atrioventricular nodal re-entrant tachycardia (AVNRT) with alternating AV nodal pathways, and atrial tachycardia with alternating antegrade AV nodal pathways or with Wenckebach periodicity. In electrophysiological study the tachycardia showed alternance in the retrograde atrial conduction sequence and the cycle length. The alternation was caused by that of the HA intervals, between the shorter HA interval with the earliest atrial activation recorded in coronary sinus (CS), and the longer HA interval with that in His bundle region. The tachycardia was diagnosed with fast-slow form of AVNRT exhibiting the alternance of the earliest atrial activation sites. Electroanatomical 3D mapping further revealed that the exit site of retrograde slow pathway (SP) alternated between the left inferior extension (LIE) inside the CS, and the right inferior extension (RIE) in the posterior tricuspid annulus although among conventional electrode catheters the earliest site was the His bundle region. After ablation of the exit site of LIE, the alternation disappeared and fast-slow AVNRT showing a uniform retrograde atrial activation for which the earliest atrial activation site was the exit of RIE sustained. A single application of ablation at this point was insufficient, thereafter conventional SP ablation was added. Then, the ventriculoatrial conduction disappeared and no tachycardia was inducible even with isoproterenol administration. This case is followed by a review of the literature.

Introduction: Prevalence of different valvular pathologies has not been reported in female and male patients in large population-based studies. The goal of this study was to report the gender-specific prevalence of various valvular pathologies.

Methods: We retrospectively analyzed 24,265 echocardiograms performed between 1984 and 1998. The prevalence of mitral regurgitation (MR) aortic valve regurgitation (AR) and stenosis (AS), and tricuspid regurgitation (TR) were calculated in female and male patients.

Results: Echocardiograms were performed on 12,926 (53%) female and 11,339 (47%) male patients. Gender-specific echocardiographic prevalence of different valvular abnormalities was as follows: Prevalence of mitral regurgitations was similar in women and men (25% vs 24.7%). Aortic regurgitation was higher in males (5.5 vs 14.9%, P < 0.001). Aortic stenosis prevalence was similar between both genders (2.1 vs 2.3%). Tricuspid valve regurgitations were slightly higher in females (18.5 vs 16.7%, P < 0.001).

Conclusion: In this study, we found a significantly higher prevalence of tricuspid valve regurgitation in women. Aortic regurgitation was more prevalent in men. Aortic stenosis and mitral regurgitation had similar prevalence in both genders.

Chylothorax development following blunt abdominal trauma is a rare event. While low volume chylothoraxes usually improve with conservative treatment, invasive interventions are required in high-volume chylothoraxes with daily drainage exceeding 1000 ml. We report a case of a 14-year-old boy who developed high-volume (>3 L/d) chylothorax on the left side following blunt abdominal trauma. The patient did not respond to conservative treatments. He underwent thoracic duct ligation three times, with percutaneous lymphatic interventions, and percutaneous Lipiodol-glue mixture injections under computed tomography (CT) guidance, but all treatments were unsuccessful. We describe the four-month multidisciplinary challenge in this case that was ultimately successfully treated by surgical ligation of aberrant and/or collateral lymphatics draining from the left abdomen to the left pleural cavity, with the help of the novel cone-beam computed tomography (CBCT) lymphangiography (LAG) technique.

Introduction: Percutaneous coronary intervention (PCI) is a critical procedure for improving blood flow by alleviating arterial blockage. However, its availability in Ethiopia is limited because of insufficient resources, staff, and infrastructure.

Objective: To evaluate the clinical characteristics and outcomes of patients who underwent percutaneous coronary intervention at Gesund Cardiac and Medical Center in Addis Ababa, Ethiopia, in 2024.

Methods: This retrospective observational chart review included 224 patients who underwent percutaneous coronary intervention. Data were collected using a standardized checklist, imported into EPI information v7, and analyzed using SPSS v26. A binary logistic regression model was used to identify factors associated with percutaneous coronary intervention.

Results: The study found that most participants (n = 186, 83%) were male, with a mean age of 57.82 ± 11.5 years. Diabetes mellitus was prevalent among participants (n = 135, 60.3%), followed by hypertension (n = 127, 56.7%). A notable portion (n = 31, 13.8%) had previously undergone percutaneous coronary intervention. Most patients presented with typical chest pain, with ST-Elevation Myocardial Infarction (STEMI) being the primary indication for percutaneous coronary intervention. Post-procedure complications includes significant bleeding (n = 6, 2.6%), myocardial infarction (n = 20, 8.9%), death (n = 2, 0.9%), transfer to another hospital (n = 12, 5.4%), and acute kidney injury (n = 16, 7.14%). The use of bare metal stents was significantly associated with transfer to other hospitals (AOR = 5; 95% CI = 1.69-10.29). Male gender (AOR = 0.09; 95% CI = 0.03-0.34) and a history of myocardial infarction (AOR = 10; 95% CI = 2.31-13.31) were linked to an increased risk of post-percutaneous coronary intervention death.

Conclusion and recommendations: Our findings suggest that coronary artery stenosis (CAS) is more prevalent in older individuals and men. Chronic illnesses often coexist with coronary artery stenosis, thereby complicating the prognosis. Interestingly, men exhibited a lower risk of unfavorable outcomes compared to women. Adherence to procedural guidelines and effective management techniques are essential for improving patient outcomes following percutaneous coronary intervention.

Objectives: Postoperative pulmonary complications (POPC) are common after cardiac surgeries such as coronary artery bypass grafting (CABG) and are influenced by factors including anesthesia and surgical trauma. Inspiratory muscle training (IMT) with visual biofeedback may mitigate these complications. This study investigates the impact of threshold loading inspiratory muscle training (TL-IMT) combined with respiratory biofeedback on the dynamic strength of inspiratory muscles (S-index) in patients undergoing CABG surgery during their hospitalization phase.

Methods: A single-blind study was conducted with 38 CABG candidates at Shahid Modares Hospital, Tehran. Participants were randomized into two groups: the TL-IMT with biofeedback group and the placebo IMT group. TL-IMT exercises were performed at 30% of maximum dynamic inspiratory strength using the Power Breath K5 device, with visual biofeedback displayed on the screen. The placebo group performed the same exercises at minimal load without biofeedback. Both groups received standard respiratory physiotherapy. Measurements of S-index, peak inspiratory flow (PIF), and vital capacity (VC) were taken before surgery (T1), one day after surgery (T2), and at discharge (T3).

Results: Both groups showed significant changes, with a decrease from T1 to T2 and an increase from T2 to T3. In the study group, T3 values remained the same as at T1, while the placebo IMT group experienced a significant decrease. After surgery, both groups had a drop in the S-index. However, the study group saw more pronounced changes between T3-T2 and T3-T1 compared to the control group, although no significant difference was found between T2-T1. By the time of discharge, the TL-IMT group had higher S-index values than the placebo group, returning to preoperative levels. Additionally, the TL-IMT group showed improvements in PIF and VC.

Conclusion: TL-IMT with visual biofeedback effectively maintains dynamic inspiratory muscle strength and improves key pulmonary parameters in cardiac surgery patients. These findings suggest that integrating TL-IMT with biofeedback can enhance postoperative recovery and reduce the incidence of POPC.

Background and aims: Depression is a prevalent comorbidity among patients with coronary heart disease (CHD). While recent studies have hinted at a possible association between CHD and antidepressant medications like sertraline, the existing evidence remains inconclusive. To investigate this potential link, we conducted a comprehensive systematic review.

Methods: We systematically searched PubMed, Google Scholar, and Scopus for relevant articles published up to March 2023. After a thorough screening of titles and abstracts, 12 studies were included in our review.

Results: The included studies, spanning from 1999 to 2021, comprised 11 randomized controlled trials (RCTs) and one pilot study. A total of 2767 participants with major depressive disorder and a history of cardiovascular disease or at risk for such events were included. The majority of these studies demonstrated improvements in mood status among patients treated with serotonin-targeting antidepressants and a reduced risk of cardiovascular events, as measured by various outcomes. While some cardiac adverse effects were observed with serotonin treatment, these did not reach statistical significance.

Conclusion: Our findings provide evidence supporting the beneficial effects of serotonin-targeting antidepressants for both depressive symptoms and the prevention of coronary adverse outcomes. These results highlight the potential value of serotonin-based treatments for depression in high-risk populations.

Patients presenting with severe acute cardiogenic pulmonary edema with hypoxia commonly require intubation until heart failure treatments take effect. A new term describing similar condition is called sympathetic crashing acute pulmonary edema (SCAPE). It is also called Flash pulmonary edema. Immediate pre- and afterload reduction can abort intubation. Using rapid repeated buccal administrations of nitroglycerin ointments can prevent intubation by rapidly reducing pre- and afterload as long as systolic blood pressure remains adequate without cardiogenic shock. A case series of 6 patients who needed intubation due to severe cardiogenic pulmonary edema and hypoxia despite 100% O2 administration without the presence of cardiogenic shock were successfully treated with repeated buccal administration of nitroglycerin ointments. Approximately half of an inch of nitroglycerin ointment (nitropaste) was buccally administrated every 60 seconds as long as repeated blood pressure measurements every minute before each repeated administration remained above 120 mmHg. Complete response with resolution of dyspnea with minimal oxygen requirement achieved in less than 30 minutes in all patients. Intubation was prevented in all 6 patients. No adverse events occurred in any of the patients. A treatment protocol and algorithm are developed based on these patients and reported cases in the literature for prevention of intubation in these patients. Rapid repeated buccal administration of nitroglycerin ointment is highly effective in preventing intubation and mechanical ventilation in patients with any acute pulmonary edema or SCAPE and hypoxia without cardiogenic shock.

Objectives: This systematic review aimed to review existing evidence to evaluate the effects of physical cardiac rehabilitation on cardio-pulmonary outcomes in the patients with hypertrophic cardiomyopathy (HCM).

Methods: We conducted a systematic search of the databases PubMed, Web of Science, Embase, Scopus, and Google Scholar. The initial search led to 1222 citations after removing duplicate results. We included only English-written studies published since 2013 (2013-2023). Ultimately, we retrieved five studies, involving 235 participants. We used the Cochrane Risk of Bias Tool for randomized trials (RoB2) and risk of bias in non-randomized studies of intervention (ROBINS-I) for evaluating the risk of bias in randomized and non-randomized studies, respectively.

Results: Results showed that four training programs improved participants' functional capacity by up to 46%. Improvements in weight, BMI, echocardiography, and remodeling parameters (left atrium volume index, premature ventricular contraction burden, pulmonary artery systolic pressure), exercise test results (minute ventilation/carbon dioxide production, peak workload, heart rate reserve, exercise duration, peak heart rate, peak systolic pressure, and blood pressure response to exercise normalization), and a decrease in N- Terminal Pro-Brain Natriuretic Peptide (NT-pro BNP) were reported in these studies. No major adverse events, including sustained tachyarrhythmia, implantable cardioverter-defibrillator discharge, and sudden cardiac death were reported.

Conclusion: Supervised exercise training is safe and helpful for patients diagnosed with HCM. It can improve exercise capacity and is considered an adjunctive therapeutic option.