American journal of cardiovascular disease最新文献

Nowadays, electrocardiogram (ECG) changes are one of the valuable diagnostic clues for recognizing abnormalities. Potassium is one of the essential electrolytes in cardiac cells, and its variations affect ECG. Potassium disorders, including hyperkalemia and hypokalemia in authoritarian states, may lead to heart dysfunctions and could be life-threatening, and urgent interventions are needed in this conditions. The current review summarizes studies to elucidate the correlation between potassium disorders and ECG demonstrations. In this review, we summarized ECG changes related to hyperkalemia and interventions. Moreover; animal studies on ECG changes related to hyper- and hypokalemia are provided. The studies showed peaked T wave, as well as expanded QRS complex and low P amplitude, are important changes that can guide us to immediate diagnosis. ECG Changes in severe hyperkalemia that can endanger patients' lives are noteworthy. Manifestations change in hyperkalemia, for correct diagnosis clinical history of the patients is essential.

Background: The multiple beneficial effects of sacubitril/valsartan in the treatment of heart failure with reduced ejection fraction are vastly known, but still no or few mentions have been made regarding its effects on endothelial dysfunction and arterial stiffness.

Patients and methods: To understand more deeply if sacubitril/valsartan may have a role on endothelial function and arterial stiffness, 15 patients with dilated cardiomyopathy with reduced left ventricular ejection fraction (LVEF) were evaluated through transthoracic echocardiography, peripheral arterial tonometry (EndoPAT^®) and applanation tonometry (SphygmoCor^® Px system). These noninvasive exams were performed at the beginning of the study and after 6 months of sacubitril/valsartan treatment.

Results: Aortic stiffness parameters didn't differ after 6 months of treatment. Augmentation pressure (P=0.889), augmentation index (P=0.906) and sphygmic wave velocity (P=0.263) increased slightly, but they weren't found to be statistically significant. Systolic, diastolic, and differential central arterial pressure didn't differ at the beginning and at the end of the study. RHI (reactive hyperemia index) increased significantly after 6 months (P=0.001) as well as augmentation index corrected for 75 bpm. Ejection fraction (32.21% ± 5.7 to 38.43% ± 8.4; P=0.010) and diastolic dysfunction degree (P=0.021) improved. There was an improvement in mitral regurgitation that wasn't statistically significant (P=0.116). TAPSE didn't change while pulmonary systolic arterial pressure increased, although not significantly (22.83 mmHg ± 4 to 27.33 mmHg ± 6; P=0.068) and within the normal range values.

Conclusions: Even though in a study with a limited number of patients, sacubitril/valsartan improved endothelial function, left ventricular function, MR, and diastolic function significantly in patients with dilated cardiomyopathy and reduced LVEF. It showed no effects on vascular stiffness.

Background: Current guidelines from American College of Cardiology (ACC) recommend ticagrelor over clopidogrel in patients with acute coronary syndrome. We have observed many patients being switched from ticagrelor to clopidogrel after percutaneous coronary intervention (PCI) in our hospital. Our goal is to evaluate the use rate of ticagrelor and categorize the reasons for non-use.

Methods: We performed a retrospective data analysis of all patients who underwent PCI at Unity Hospital of Rochester, New York, from January 2019 to January 2020. A total of 330 patients underwent PCI for ACS over the year. After exclusions, 277 patients were enrolled in the analysis.

Results: Of the 277 patients, 179 (65%) completed one year of ticagrelor therapy, and 98 (35%) stopped ticagrelor and transitioned to clopidogrel. The most common reason for switching from ticagrelor was dyspnea (42 patients), followed by cost concerns (41 patients).

Conclusion: At our community hospital, completion of one-year use of ticagrelor post-PCI occurred in 65% of patients. The most common reasons for discontinuation are dyspnea and medication cost.

Aims: In the latest years an emerging interest has risen towards the role of endothelial dysfunction (ED) in the pathogenesis of heart failure (HF) since the very first steps of the disease. Since the prevalent etiology of HF is ischemic cardiomyopathy (ICM), it is still not clear whether the connection with ED is linked to HF itself or to atherosclerosis. The aim is to determine the presence of ED in subjects with idiopathic dilated cardiomyopathy (IDCM) compared to ICM.

Methods: In this observational study 107 patients were enrolled, 65 of them suffering from IDCM and 42 from ICM. ED was assessed as peripheral arterial tonometry by means of EndoPAT device. The Reactive Hyperaemia Index (RHI) was calculated, ED being established with RHI values ≤1.67 and normal endothelial function >2.00 (grey area between 1.67 and 2.00).

Results: ED, expressed both as RHI ≤1.67 and RHI ≤2.00, showed a similar prevalence in the two groups. However, they differed as regards sex, dyslipidemia and statin use.

Conclusion: Endothelial function, evaluated through peripheral artery tonometry, seems equally compromised in patients with IDCM and ICM.

Background: Heart failure with preserved ejection fraction is a complex clinical syndrome marked by different phenotypes and related comorbidities. Transthyretin amyloidosis is an underestimated phenotype. We aim to evaluate the prevalence of transthyretin amyloidosis in heart failure with preserved ejection fraction.

Methods: This meta-analysis was conducted according to PRISMA guidelines. A search strategy was designed to utilize PubMed/Medline, EMBASE, and Google scholar to locate studies whose primary objective was to analyze the prevalence of transthyretin amyloidosis in heart failure preserved ejection fraction.

Results: Of 271 studies initially identified, 5 studies comprising 670 patients were included in the final analysis. The prevalence of transthyretin amyloidosis was 11%. Patients with transthyretin amyloid cardiomyopathy were more likely to be males (RR 1.38; 95% CI 1.09 to 1.75; P<0.01; I²=37%), and more likely to have low voltage criteria on ECG (RR 2.98; 95% CI 1.03 to 8.58; P=0.04; I²=75%) compared with transthyretin negative group. They also have higher SMD of age (SMD 0.73; 95% CI 0.48 to 0.97; P<0.01; I²=0%), and NT-proBNP (SMD 0.48; 95% CI 0.02 to 0.93; P=0.04; I²=36%) compared with transthyretin negative group. On reported echocardiogram, they have higher SMD of mass index (SMD 0.77; 95% CI 0.27 to 1.27; P<0.01; I²=65%), posterior wall thickness (SMD 0.92; 95% CI 0.62 to 1.21; P<0.01; I²=0%), and septal wall thickness (SMD 1.49; 95% CI 0.65 to 2.32; P<0.01; I²=87%) compared with transthyretin negative group.

Conclusion: Transthyretin amyloidosis affects 11% of HFpEF patients. Therefore, screening HFpEF patients at risk of cardiac amyloidosis is warranted.

The COVID-19, actual pandemic due to SARS COV 2 is associated with numerous thromboembolic complications. Although venous thrombosis including pulmonary embolisms have been widely described, arterial localization seems rarely reported. Acute limb ischemia and myocardial infarction are two major consequences of arterial thrombosis and their concomitant occurrence among COVID-19 patients is extremely rare. It is an evident aspect of hypercoagulability and a real challenge to physicians. We herein describe the management of a 77 years old COVID-19 patient presenting an acute lower limb ischemia with concomitant myocardial infarction. He underwent coronary angiography with subsequent stent placement then was transferred to the operating room where a thrombectomy was performed. The outcome was poor as the cardiogenic shock persisted in addition to a reperfusion syndrome with multiorgan failure.

Background: Diabetes mellitus causes ischemic heart disease (IHD) through macrovascular or microvascular involvement. Diabetes-associated hypertension, dyslipidemia, and obesity further increase coronary artery disease risk and can cause left ventricular hypertrophy leading to heart failure with preserved ejection fraction independent of IHD. This study was undertaken to evaluate the differences in demographics, clinical characteristics, Echocardiographic parameters, management, and outcomes between non-ischemic cardiomyopathy (NICM) and ischemic cardiomyopathy (ICM) patients in cohort of diabetes patients.

Methods: This retrospective study included diabetes patients with reduced ejection fraction (≤40) who were hospitalized with heart failure between January 2014 and February 2020. Patients were divided into two groups: group 1; ICM and group 2; NICM. Data obtained on above mentioned features including mortality and heart failure readmissions were compared between the two groups.

Results: A total of 612 diabetes patients admitted with acute heart failure were screened of which 442 were included. Group 1 (ICM) had 361 patients (81.7%) and group 2 (NICM) had 81 patients (18.3%). Patients in group 1 were older, predominantly males and with higher prevalence of hypertension, smoking and insulin dependent Diabetes while group 2 patients had higher BMI and higher prevalence of cardiac rhythm problems. No significant difference was detected in 5-year-mortality between the two groups (P=0.165). However, heart failure associated hospitalizations were higher in group 2 though it was not statistically significant (P=0.062).

Conclusion: There was no difference in 5-years mortality between ICM and NICM in diabetes patients. However, NICM patients had higher prevalence of obesity and rhythm problems.

Introduction: Ischemic heart disease is the leading cause of death in Brazil and worldwide. The term acute coronary syndrome (ACS) generically represents the acute myocardial ischemic events. These events are clinically divided into three types: acute myocardial infarction (AMI) with ST-segment elevation, AMI without ST-segment elevation, and unstable angina. Although cardiovascular ischemic events occur acutely, studies describe cyclic patterns of ACS, mainly on circadian and weekly variation.

Objective: The aim of this study was to analyze the circadian and weekly variation of hospitalizations for ACS in a hospital in southern Brazil in 2019.

Methods: Observational, cross-sectional type study. The population was the patients hospitalized at the Nossa Senhora da Conceição Hospital (NSCH) in Tubarão (SC, Brazil) with the international classification of diseases (ICD) code referring to ACS in the year 2019, corresponding to 579 patients.

Results: After applying the exclusion criteria, 512 patients hospitalized for ACS were analyzed, 55.1% were male with a median (p25-p75) age of 62.0 (56.0-69.0) years. The main ICDs of hospitalization were: I20.0 (76.2%), I21.9 (16.6%), I21.3 (3.1%) and the most prevalent comorbidities were high blood pressure (82.6%), diabetes (30.1%) and previous AMI (23.6%). The median (p25-p75) time of admission was 14 h (10-18) h and length of stay was 5 (3-9) days. Death occurred in 18 hospitalizations (3.5%) of cases.

Conclusion: We conclude that in the present study there was a peak of hospitalizations for ACS on Mondays, proportionally reducing throughout the week and with a significant decrease on the weekend.

Background: Ostial left anterior descending (LAD) artery lesions are a critical area for coronary stenting, given that the location subtends a large area of the myocardium and can also be more technically challenging. It remains controversial whether crossover stenting of ostial LAD back into the left-main (LM) is advantageous over stenting the ostium alone.

Methods: To evaluate the long-term clinical outcomes of stenting ostial LAD lesions, we retrospectively reviewed all ostial LAD lesions cases at QEII Health Science Centre between 2008 and 2018. Specifically, we compared the outcomes in those patients that had left main stent crossover vs. ostial stenting (OS) alone.

Results: The total number of patients included in the study was 175, with 25 patients (14%) having a crossover to the LM and 150 (86%) having OS. There were more patients with previous CABG (24%) in the crossover group compared to the OS group (9.2%) (P = 0.042). The one-year MACE was not significantly different between CO vs. OS (13.3% (10.5-16.1) vs. 12% (5.5-18.5)). The five-year MACE was numerically higher, although statistically not significant, in CO vs. OS (19.3 (15.9-22.7) vs. 25.9 (16.6-35.2)).

Conclusion: This study shows that percutaneous intervention provides reasonable long-term outcomes and low rates of repeat revascularization for isolated ostial LAD lesions, with no noticeable difference in outcomes with crossover stenting into the LM vs. OS alone. A larger, prospective study may be required to determine the optimal strategy for treating ostial LAD lesions.