American journal of cardiovascular disease最新文献

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.

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.

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.

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.

Background and aim: Sodium-glucose cotransporter two inhibitors can reduce cardiovascular events by modulating lipid profiles in patients with heart failure, irrespective of diabetes status. In this study, we aimed to assess the effects of SGLT-2 inhibitors on the lipid profiles of patients with heart failure via a meta-analysis.

Methods: The PubMed, Scopus, Web of Science, and Google Scholar databases were searched up to 2023 to retrieve relevant article titles, abstracts, and full texts. STATA software was used to conduct the meta-analysis.

Result: The Forest plot of fasting blood sugar levels in patients receiving SGLT-2 inhibitors differed significantly from those the in control group (mean difference = -0.08, 95% CI [-0.13, -0.02], P < 0.05). Analysis of lipid profile parameters, including total cholesterol, triglyceride, HDL, and LDL in patients with HF receiving SGLT-2 inhibitors, did not show a notable difference from the control group (P > 0.005). However, the mean difference was towards the reduction of LDL, cholesterol, and triglycerides and showed an increase in HDL levels. Egger's test for publication bias revealed some publication bias (P < 0.05).

Conclusion: Our topic analysis did not reveal any notable alterations in the lipid profile. To arrive at a more definite agreement, further research on subjects with heart failure is necessary because there is currently insufficient evidence.

Objectives: To our knowledge, there is no clear consensus on a definitive cardiac rehabilitation method for patients undergoing Coronary Artery Bypass Graft (CABG). We conducted this systematic review to compare and evaluate the effects of two of the most frequent cardiac rehabilitation modalities, high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT), on cardiopulmonary variables.

Methods: We carried out a systematic search of the databases PubMed, Web of Science, Embase, Scopus, and Google Scholar. Following the removal of duplicate results, the original search yielded 385 citations. We identified four randomized clinical trials after reviewing titles, abstracts, and potential full-text studies. We utilized the Cochrane Risk of Bias Tool (RoB2) to assess the risk of bias.

Results: We included four randomized clinical trials involving 143 people. All trials included individuals who had CABG and completed HIIT or MICT sessions for at least four weeks. The findings indicated that HIIT programs may improve functional capacity, heart rate variability indices, and blood pressure management while lowering brain natriuretic peptide (BNP_1-32) and N-terminal pro-b-type natriuretic peptide (NT-proBNP_1-76) levels.

Conclusion: Given the findings, it appeared that supervised high-intensity exercise regimens could be more useful to patients. Following the surgery, HIIT therapy improves exercise capacity, the autonomic nervous system, volume overload, and blood pressure regulation.

Objectives: Cardiogenic shock is a significant economic burden on healthcare facilities and patients. The prevalence and outcome of cardiogenic shock in the South Bronx are unknown. The aim of the study was to examine the burden of non-AMI CS in Hispanic and Black population in South Bronx and characterize their in-hospital outcomes.

Methods: We reviewed patient charts between 1/1/2022 and 1/1/2023 to identify patients with a primary diagnosis of cardiogenic shock (ICD codes R57.0, R57, R57.8, R57.9) residing in the following zip codes: 10451-59 and 10463. Student's T-test was used to assess differences for continuous variables; chi-square statistic was used for categorical variables. A logistic regression analysis model was used to assess independent predictors of mortality. A P-value of < 0.05 was considered significant.

Results: 87 patients were admitted with cardiogenic shock (60% African American, 67% male, mean age =62±15 years) of which 54 patients (62%) died. Those who died were older, had > 1 pressor, out-of-hospital arrest, arrested within 24 hours of admission, and had higher SCAI class, lactate, and ALT levels than those who were discharged. The logistic regression analysis model showed that older age ((RR=3.4 [95% CI: 3.3-3.45]), > 1 pressor (RR=3.4 [95% CI: 2.6-4.2]) and higher SCAI class (2.1 [95% CI: 1.5-2.1], all P < 0.05)) were independent predictors of mortality in patients with cardiogenic shock. Additionally, most of the patients had either Medicare or Medicaid insurance in predominantly African American study population.

Conclusions: Cardiogenic shock carries a significant risk of death. Factors such as advanced age, the administration of more than one vasopressor, and a higher SCAI classification have been identified as independent predictors of mortality among inpatients with cardiogenic shock. Additionally, the progression and outcomes of the condition are influenced by variables like race (e.g., African American individuals in this study) and economic challenges, including the type of insurance coverage (e.g., Medicaid or Medicare). Further research is essential to explore strategies that could enhance survival rates in cardiogenic shock patients, with a particular focus on addressing economic and racial disparities.

Background: We compared long-term clinical outcomes between patients with cardiac sarcoidosis (CS) who received no treatment (NT), steroid treatment (ST), disease-modifying anti-rheumatic drugs (DMARDs), or tumor necrosis factor alpha inhibitors (TNF).

Methods: Patients from SSM healthcare system's data warehouse were identified using ICD codes. Inclusion criteria included at least 6 months of follow-up. Outcomes studied were heart failure (HF) admissions, ventricular tachyarrhythmias (VTA), and pacemaker/defibrillator placement. Statistical analysis included multivariate logistic regression and Kaplan-Meier curves.

Results: We identified 198, 174, 66, and 19 patients in NT, ST, DMARDs, and TNF groups respectively. Mean age was 62.4, 60.2, 56, and 54.4 respectively. There was no significant difference in the rate of medical comorbidities including pulmonary sarcoidosis between the groups. Mean follow up was 92.3 months. Percent incidences of VTA were 17.5, 16.3, 12.5, and 5.6 (P 0.57) in the NT, ST, DMARDs and TNF groups respectively. DMARDs and TNF groups had a lower incidence of HF admission (43.9% and 36.8%) compared to NT and ST (59.1% and 59.2%). In the multivariate model, compared to NT group, the odds ratio for HF admission was 1.08 (CI: 0.70-1.65), 0.64 (0.36-1.14) and 0.45 (0.17-1.20) in the ST, DMARDs and TNF groups respectively. There was no significant difference in the rate of pacemaker/defibrillator placement between the groups.

Conclusion: In this retrospective study from a large healthcare system, CS patients treated with DMARDs or TNF had a trend for lower incidence of HF admission than those on NT or ST.