American journal of cardiovascular disease最新文献

WPW (Wolff-Parkinson-White) syndrome is a congenital heart condition characterized by an abnormal accessory electrical pathway in the heart that can cause rapid heartbeat (supraventricular tachycardia). Radiofrequency ablation is considered the first-line treatment, it can be curative in almost 95% of patients. Sometimes ablation therapy can fail when the pathway is close to the epicardium. We hereby report a case of a patient with a left lateral accessory pathway. Several attempts of ablation from the endocardium targeting a clear pathway potential failed. Subsequently, the pathway was safely and successfully ablated from within the distal coronary sinus.

Objective: To assess the safety and effectiveness of a novel pathway of deferrred invasive angiography in low-risk NSTEMI patients with concurrent COVID-19 infections; contrary to current UK guidelines recommending invasive coronary angiography in NSTEMI patients within 72 hours.

Methods: This was a single-centre, observational study of all NSTEMI patients referred for inpatient coronary angiography at Barts Heart Centre, between March 2020 and June 2022. Demographic, procedural and outcome data were collected as part of a national cardiac audit.

Results: 201 COVID positive NSTEMI patients were referred for angiography at Barts Heart Centre. 10 patients died from COVID related respiratory complications prior to angiography. Therefore, 191 patients underwent deferred angiography (median time 16 days from COVID diagnosis). The median GRACE score was 128 (IQR 86-153). Troponin levels were significantly elevated on initial COVID diagnosis compared to time of their procedure. 73% patients had a culprit lesion identified. 61.2% receiving PCI. Patients were followed-up for a median of 363 days (IQR 120-485 days) with MACE rates of 7.3%. This is comparable to the MACE event for NSTEMI patients (n=4529) without COVID at our institution treated during the same time-period (8.1%).

Conclusion: This study demonstrates the safety and effectiveness of deferred coronary angiography on a COVID-Recovered pathway after a period of medical management for patients presenting with NSTEMI and concurrent COVID-19 infection. There was no adverse signal associated with the wait for angiography with similar MACE rates to the non-deferred NSTEMI cohort without COVID-19.

Background: Cardiac conditions are a significant cause of maternal morbidity and mortality, significantly exacerbated during the hemodynamic demands of pregnancy. Mitral stenosis in pregnancy (MSp) is rare in the USA however, it has a high risk for maternal complications.

Methods: We aim to outline the burden of MSp hospitalizations nationally. A retrospective review of HCUP/NIS data from 2002-2014 was conducted.

Results: There were 2014 weighted discharges for both pregnancy and mitral stenosis (MS). Patients diagnosed with MS had a more considerable mean cost per discharge than the comparison group. Pulmonary Hypertension (PH), Atrial Arrhythmias (AA), Stroke, and Heart Failure (HF) were respectively reported in 25.71%, 7.14%, 0.95%, and 19.28% of the discharges. Our study identified a low incidence of MS in the US over the 12-year period; no deaths were identified.

Conclusion: Our results substantiate MSp as a risk factor for PH, AA, HF, and stroke in pregnancy. Even though the mortality is low, it is essential that clinicians be aware of this diagnosis due to higher associated morbidity and costs.

Fusobacteria is anaerobic gram-negative rods, which frequently colonize the oral cavity and can rarely cause deadly diseases in humans. The two most commonly found in this group of bacteria are fusobacterium necrophorum and fusobacterium nucleatum. Only a handful of cases of endocarditis due to fusobacterium have been reported. We describe an 86-year-old male who had a recent tooth extraction presenting to the emergency department with weakness lightheadedness, and pain in his right elbow. He had a low-grade fever of 100.8°. The patient was discharged home but came back less than 24 hours with a fever of 102° and chills and again after the second discharge with sepsis of unknown origin. A week after initial blood cultures were drawn, fusobacterium nucleatum grew in one of two sets and his transesophageal echocardiogram revealed vegetation on his mitral valve. The patient was then successfully treated with a six weeks course of ampicillin-sulbactam. This case is followed by a review of the literature.

Aims: No data is available about the significance of cardiovascular magnetic resonance (CMR) derived vascular distensibility (VD) and vessel wall ratio (VWR) for risk stratification in patients with type 2 diabetes mellitus (T2DM). Therefore, this study aimed to investigate the effects of T2DM on VD and VWR using CMR in both central and peripheral territories.

Methods: Thirty-one T2DM-patients and nine controls underwent CMR. Angulation of the aorta, the common carotid, and the coronary arteries was performed to obtain cross-sectional vessel areas.

Results: In T2DM the Carotid-VWR and the Aortic-VWR correlated significantly. Mean values of Carotid-VWR and Aortic-VWR were significantly higher in T2DM than in controls. Coronary-VD was significantly lower in T2DM than in controls. No significant difference in Carotid-VD or Aortic-VD in T2DM vs. controls, respectively, could be observed. In a subgroup of thirteen T2DM patients with coronary artery disease (CAD), Coronary-VD was significantly lower and Aortic-VWR was significantly higher compared to T2DM patients without CAD.

Conclusion: CMR allows a simultaneous evaluation of the structure and function of three important vascular territories to detect vascular remodeling in T2DM.

Background: A wide range of cardiac arrhythmias were reported in the setting of active infection or as a complication of COVID-19. The main pathophysiology can be attributed to dysautonomia or autonomic nervous system dysfunction. Postural orthostatic tachycardia syndrome (POTS) is a complex, multisystemic disorder affecting usually younger age with tachycardia at rest or with minimal effort being the main symptom. Data regarding the safety and efficacy of ivabradine in POTS treatment is limited to small studies and case reports.

Methods: This prospective observational study included a total of 55 COVID-19-associated POTS patients after the exclusion of other causes of tachycardia. Ivabradine 5 mg twice daily was initiated. Re-assessment of patients' symptoms, heart rate, and heart rate variability (HRV) parameters' changes after 3 days of ivabradine therapy was done.

Results: The mean age of the included patients was 30.5±6.9 years with 32 patients being males (58.2%). 43 of 55 (78%) of the included patients reported significant improvement of the symptoms within 7 days of ivabradine therapy. 24-hour heart rate (minimum, average, and maximum) was significantly lower (p-value < 0.0001*, = 0.001*, < 0.0001* consecutively) with a significant difference in HRV time-domain parameters (SDNN, rMSSD) (p-value < 0.0001*) after ivabradine therapy.

Conclusion: In a prospective study that evaluated the effects of ivabradine in post-COVID-19 POTS, patients treated with ivabradine reported improvement of their symptoms within 7 days of ivabradine treatment with a significant reduction of 24-hour average, minimum, and maximum heart rate, and improvement of HRV time domains parameters. Ivabradine might be a useful option to relieve symptoms of tachycardia in COVID-19 POTS. Further research is required to confirm the safety and efficacy of ivabradine in POTS treatment.

Congenitally corrected transposition of the great arteries (ccTGA) compromises less than 1% of all congenital heart diseases, where the RV is the systemic ventricle. It can be associated with heart block, twin AV nodes and accessory pathway connections. Idiopathic Ventricular tachycardia (VT) is not common, with only few reported cases, and they were scar related. Previously reported cases of VT ablation from coronary venous sinus (CVS) are in structurally normal hearts. We performed a VT ablation in ccTGA patient from the CVS, resulting in symptomatic improvement and a decrease in PVC burden from 35% to less than 1%. CVS should be considered as a potential site in ccTGA patients especially when PVCs have RBBB morphology and superior axis.

Background: Abdominal aortic aneurysm (AAA) is a life-threatening condition. Open surgery and endovascular repair are the options for treating AAA. This study aimed to compare the frequencies of in-hospital complications and outcomes in two groups of patients who underwent AAA repair surgery using either an open or an endovascular repair method.

Methods: This retrospective study was conducted on the records of 60 patients with AAA undergoing elective surgery repair using endovascular approaches or open surgery at Razi Hospital from 2010 to 2019. Patients' related information, including age, sex, changes in blood pressure, respiratory complications, renal complications, myocardial infarction, paraplegia, cloneischemia, lower limb ischemia, duration of hospital stay in intensive care unit and hospital, the dose of packed RBC, the dose of injectable narcotic analgesics, the need for vasopressor medication, duration of surgery, duration of postoperative oral feeding, and death during hospitalization were assessed.

Results: A total of 60 patients in two groups were studied. The mean age of patients was 72.4 ± 6.28 years, and most were male (86.7%). The incidence of renal complications (3.3%) and respiratory complications (0%), rate of decrease in arterial blood oxygen saturation, length of stay in ICU (median 2 vs. 4) and hospital (median 4.5 vs. 7), the need for vasopressor injection and the dose of packed RBC (median 0.4 vs. 3.33), the dose of narcotic analgesic injection (53.3%), duration of surgery (median 2.5 vs. 3), duration of postoperative oral feeding (median 23 vs. 54), and the incidence of death were significantly lower in the endoscopic surgery group.

Conclusion: Endovascular surgery repairing the rupture of an AAA is associated with fewer postoperative complications and in-hospital death than open surgery.

Objectives: There is increasing evidence that particularly in patients with severe SARS-CoV-2 infection (COVID-19) the heart can be primarily or secondarily compromised. Neurological disease as a complication of SARS-CoV-2 associated cardiac disease is conceivable. This review aims at summarising and discussing previous and recent advances in the clinical presentation, pathophysiology, diagnosis, treatment, and outcome of cardiac complications and its implications on the brain of SARS-CoV-2 infected patients.

Method: Literature review using appropriate search terms and applying inclusion and exclusion criteria.

Results: Cardiac complications in SARS-CoV-2 infected patients not only include myocardial injury, myocarditis, Takotsubo cardiomyopathy (TTS), coagulation abnormalities, heart failure, cardiac arrest, arrhythmias, acute myocardial infarction, or cardiogenic shock, but a number of other more rarely occurring cardiac abnormalities. Additionally considered should be endocarditis due to superinfection, viral or bacterial pericarditis, aortic dissection, pulmonary embolism from the right atrium, ventricle or outflow tract, and cardiac autonomic denervation. Cardiac damage due to side effects from the anti-COVID medication should not be neglected. Several of these conditions may be complicated by ischemic stroke, intracerebral bleeding, or dissection of cerebral arteries.

Conclusion: The heart can be definitively affected in severe SARS-CoV-2 infection. Heart disease in COVID-19 may be complicated by stroke, intracerebral bleeding, or dissection of cerebral arteries. Treatment of SARS-CoV-2 associated cardiac disease is not at variance from that of cardiac disease without this infection.

Background: An increased heart rate (HR) is deleterious in patients with decompensated heart failure. Ivabradine, an HR lowering agent which acts by inhibiting the I_f current in the sinoatrial node, is indicated for chronic heart failure with reduced ejection fraction. However, data regarding the safety and efficacy of ivabradine in acute decompensated heart failure is limited. This retrospective observational study aimed to investigate the effects of ivabradine on morbidity and short-term mortality of hospitalized patients with acute decompensated heart failure.

Methods: A total of 998 patients with acute decompensated heart failure on top of a chronic status from 1/5/2014 to 1/5/2019 who were already on guideline-directed treatment including a beta-blocker were included. Patients were divided into two groups, the first group (No-ivabradine) where patients continued the same dose of beta-blocker alone while the second group (ivabradine group) ivabradine 5 mg BID was added in addition to the same dose of beta-blocker. Patients with hemodynamic instabilities were excluded from the study. Propensity matching was performed to exclude confounding factors.

Results: There was no significant difference between groups regarding baseline patient characteristics, laboratory, and echocardiographic data. There were significant differences between groups regarding average HR (87 ± 15 and 90 ± 12 bpm in ivabradine and control groups, consecutively, P = 0.0006*) and length of hospital stay (5.3 ± 2.3 and 7.7 ± 5.6 days in ivabradine and control groups, consecutively, P < 0.0001*). However, there were no differences in rehospitalization and mortality rates at 1 month and 6 months.

Conclusion: In a retrospective cohort study aimed to investigate the effects of ivabradine on morbidity and short-term mortality of hospitalized patients with acute decompensated heart failure. Ivabradine was associated with significantly lower average HR and length of hospital stay. However, there was no benefit in the reduction of rehospitalization and mortality rates at 1- and 6-month follow-ups.