The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology最新文献

Background: Hyponatremia is one of the complicating findings in acute decompensated heart failure. Decrease in cardiac output and systemic blood pressure triggers activation of renin-angiotensin-aldosterone system, antidiuretic hormone, and norepinephrine due to the perceived hypovolemia. Fluid-overloaded heart failure patients are commonly treated with loop diuretics, acutely decompensated heart failure patients tend to be less responsive to conventional oral doses of a loop diuretic, while other different diuretics could work in different part of nephron circulation system. In this study, we aim to further examine the role of tolvaptan, a vasopressin receptor antagonist, in the treatment of hyponatremia secondary to acutely decompensated heart failure.

Results: A total of 71 patients with hyponatremia secondary to ADHF were included, and all patients were given tolvaptan. 37 patients were administered tolvaptan early (up until 5 th day of admission). 34 patients received tolvaptan after 5 th day of admission mean administration as 6.86 th day, and median administration was 5 th day. Analysis showed lower length of stay in patients receiving early administration of tolvaptan compared to late administration (8.86 ± 5.06 vs 18.5 ± 9.05 p0.001, respectively). Patients with early initiation of tolvaptan also achieved a larger net increase in sodium levels at discharge compared to admission (6.46 ± 6.69 vs 3.68 ± 4.70 p0.048, respectively).

Conclusions: Early administration of tolvaptan in treating hyponatremia in acutely decompensated heart failure patients is associated with a lower length of hospitalization and a higher increase in serum sodium of patients in hyponatremic ADHF patients.

Background: The rate at which atrial fibrillation (AF) patients experience a return of symptoms after catheter ablation is significant, and there are multiple risk factors involved. This research intends to perform a meta-analysis to explore the risk factors connected to the recurrence of AF in patients following catheter ablation.

Methods: The PubMed, Cochrane Library, WOS, Embase, SinoMed, CNKI, Wanfang, and VIP databases were explored for studies from January 1, 2000 to August 10, 2021, and research meeting the established inclusion requirements was chosen. Two authors separately gathered details regarding the study structure. The strength of the link between various risk factors and AF returning after CA was evaluated using odds ratios. All statistical evaluations were conducted with RevMan5.3 software.

Results: In total, 44 articles and 62,674 patients were included. The OR for AF recurrence in patients with diabetes was 2.04 compared with the reference group (95% CI 1.51-2.76, p < 0.00001); that of lower left ventricular ejection fraction was 1.38 (95% CI 1.25-1.52, p < 0.00001); that of female was 1.34 (95% CI 1.18-1.52, p < 0.00001); that of increased age was 1.03 (95% CI 1.02-1.04, p < 0.00001); that of persistent AF was 1.72 (95% CI 1.58-1.87, p < 0.00001); that of AF duration over 2 years was 1.17 (95% CI 1.08-1.26, p < 0.00001); that of increased left atrial diameter (LAD) was 1.12 (95% CI 1.08-1.17, p < 0.00001); that of larger left atrial volume index (LAVi) was 1.02 (95% CI 1.01-1.03, p < 0.00001); that of higher hs-CRP was 1.19 (95% CI 1.04-1.36, p = 0.04); that of early recurrence (ER) was 3.22 (95% CI 2.74-3.77, p < 0.00001); and that of long ablation duration was 1.00 (95% CI 0.98-1.02, p = 0.72). Heterogeneity and slight publication bias were observed for each factor.

Conclusions: Evidence indicates that diabetes, low left ventricular ejection fraction, being female, older age, longer duration of atrial fibrillation, elevated high-sensitivity C-reactive protein levels, large left atrial dimension, large left atrial volume index, persistent atrial fibrillation, and exercise rehabilitation are factors that increase the chances of getting atrial fibrillation again after catheter ablation. However, the length of the ablation procedure does not relate to the recurrence of AF.

Background: Precapillary pulmonary hypertension (PH) as complication in atrial septal defect (ASD) is closely related to right heart hemodynamics, such as right atrial pressure (RAP) and pulmonary vascular resistance (PVR). Right heart catheterization (RHC) as the gold standard for their measurement is invasive and not widely available in Indonesia. Electrocardiography (ECG) was proposed to be alternative in this matter.

Method: This is a retrospective observational study with cross-sectional design. We collected data and measured ECG parameters of secundum ASD patients who underwent elective RHC from May 2019 until November 2023. We compared several ECG parameters based on RAP (< 8 and ≥ 8 mmHg) and PVR (< 5 and ≥ 5 WU).

Result: Eighty-three patients were included. The R_V1 was the only ECG marker that showed significant difference based on RAP (AUC 0.639, sensitivity 61.7%, specificity 61.1%, p = 0.030) and PVR (AUC 0.801, sensitivity 73.2%, specificity 81%, p < 0.001). Several ECG parameters were found significantly different based on PVR value only, namely S_V5 (AUC 0.773, sensitivity 80.5%, specificity 71.4%, p < 0.001), S_V6 (AUC 0.823, sensitivity 80.5%, specificity 81%, p < 0.001), right ventricular Sokolow-Lyon index (RVSLI) (AUC 0.841, sensitivity 82.9%, specificity 83.3%, p < 0.001), R/S_V1 (sensitivity 97.6%, specificity 16.7%, p = 0.031) as well as right ventricular strain (sensitivity 87.8%, specificity 69%, p < 0.001). Multivariate regression analysis showed RVSLI (OR 15.66 (4.46-55.02), CI 95%) and right ventricular strain pattern (OR 9.23 (2.43-35.14), CI 95%) had the best predictive value for PVR ≥ 5 WU.

Conclusion: In adults with secundum ASD, several ECG markers have potential role in predicting PVR ≥ 5 WU with satisfying sensitivity and specificity, but not in predicting RAP.

Background: The incidence of mortality in patients with cardiogenic shock due to ST elevation myocardial infarction (STEMI) remains high even with prompt reperfusion therapy. Ventricular systolic dysfunction is the primary condition causing cardiogenic shock in STEMI. Studies have been widely conducted on the left ventricle (LV) and right ventricle (RV) systolic dysfunction related to mortality events. However, the parameters of biventricular systolic dysfunction predicting mortality as a stronger predictor of mortality are still unclear. Accordingly, we evaluated the predictor mortality value of biventricular systolic dysfunction in STEMI patients with cardiogenic shocks. Based on The Society for Cardiovascular Angiography and Intervention classification, we analyzed data from November 2021 to September 2023 at Dr. Sardjito General Hospital in Yogyakarta, Indonesia, using the Sardjito Cardiovascular Intensive Care (SCIENCE) registry with a retrospective cohort design. Multivariate logistic regression analysis was used to assess predictors of in-hospital mortality.

Results: There were 1,059 subjects with a mean ± SD age of 59 ± 11 years, dominated by men (80.5%) who met the inclusion and exclusion criteria. Based on multivariate analysis, biventricular dysfunction (BVD) is a factor that significantly increases the risk of in-hospital mortality (Odds ratio [OR], 1.771: 95% confidence interval [CI] 1.113-2.819; p = 0.016). Other significant factors affecting mortality were renal failure (OR, 5.122; 95% CI 3.233-8.116; p < 0.001), percutaneous coronary intervention (PCI) (OR, 0.493; 95% CI 0.248-0.981; p = 0.044), and inotropic/vasopressor (OR, 6.876; 95% CI 4.583-10.315; p < 0.001).

Conclusions: Biventricular dysfunction significantly increases the risk of in-hospital mortality in STEMI patients with cardiogenic shock. Renal failure, PCI, and the requirement for inotropic or vasopressor drugs are also factors that influence in-hospital mortality.

Background: Post-infarct ventricular septal rupture (PI-VSR) is a rare complication of acute myocardial infarction (AMI) but has very serious implications. Managing PI-VSR using transcatheter closure (TCC) presents varying challenges depending on the patient's condition. The aim of this study is to present a highly challenging case of multiple VSRs as a complication of AMI.

Case presentation: A 59-year-old male was admitted with symptoms of shortness of breath, dyspnea on exertion, orthopnea, and swelling of the lower extremities. He had typical chest pain related to infarction 2 weeks before his admission. On electrocardiogram (ECG) examination, evidence of an old myocardial infarction in the infero-antero-lateral regions was seen. Echocardiography showed mild mitral and tricuspid regularities. The left ventricular (LV) systolic function was mildly compromised, with a global ejection fraction of 44%. There was also a left-to-right VSR shunt in the apical region of the LV. Multiple defects as outlined by 3D transthoracic echocardiography (TTE)-the largest measuring 17 mm. Given the high risks of open-heart surgery, a percutaneous closure of the VSR was carried out using a 21 mm atrial septal defect (ASD) occluder. The device was satisfactorily placed, and there was an improvement in the clinical condition of the patient. He was discharged after his 8-day stay in the hospital.

Conclusion: Our study emphasizes that echocardiography with 3D imaging provides a more detailed view of the size and shape of the rupture and serves as a valuable modality for guiding the percutaneous transcatheter VSR closure procedure.

Background: Hypertrophic cardiomyopathy (HCM) is a frequently encountered cardiac condition worldwide, often inherited, and characterized by intricate phenotypic and genetic manifestations. The natural progression of HCM is diverse, largely due to mutations in the contractile and relaxation proteins of the heart. These mutations disrupt the normal structure and functioning of the heart muscle, particularly affecting genes that encode proteins involved in the contraction and relaxation of cardiac muscle.

Main body: This review focused on understanding the role of contractile and relaxation proteins in the pathogenesis of hypertrophic cardiomyopathy. Mutations in contractile proteins such as myosin, actin, tropomyosin, and troponin are associated with hypercontractility and increased sensitivity of the heart muscle, leading to HCM. Additionally, impaired relaxation of the heart muscle, linked to abnormalities in proteins like phospholamban, sarcolipin, titin, myosin binding protein-C, and calsequestrin, contributes significantly to the disease. The review also explored the impact of targeted therapeutic approaches aimed at modulating these proteins to improve patient outcomes. Recent advances in therapeutic strategies, including novel pharmacological agents like mavacamten and aficamten, were examined for their potential to help patients manage the disease and lead more accommodating lifestyles.

Conclusions: The review underscored the significance of early diagnosis and personalized treatment approaches in managing HCM. Future research should prioritize the development of robust biomarkers for early detection and risk stratification, particularly in diverse populations, to enhance clinical outcomes. Furthermore, it is imperative to delve deeper into the genetic mutations and molecular mechanisms associated with HCM, with a focus on exploring the roles of less-studied myocardial relaxation proteins and their interactions with sarcomere constituents.

Background: Conduction disturbances are a frequent occurrence after tricuspid valve surgeries, and their management is challenging.

Case presentation: We present a case of 16-year-old male patient who presented with episodes of presyncope. At the age of 7 years, he underwent tricuspid valve replacement surgery with a biological prosthesis for infective endocarditis sourced from a gluteal abscess. Post-operatively, he had complete atrioventricular block and underwent epicardial pacing. Epicardial lead impedance increased at follow-up and led to failure of pacing. At the time of presentation he had prosthetic tricuspid valve dysfunction with increased gradients. We did tricuspid valve balloon valvotomy but the gradients did not improve and patient developed tricuspid regurgitation. In view of difficulty in placing the lead through degenerated tricuspid valve, we have decided to place the lead in coronary sinus. He underwent successful lead placement in posterolateral tributary of coronary sinus with acceptable parameters. He had an uneventful follow-up at 1 year.

Conclusion: TV surgeries create a unique problem for pacing. Coronary sinus pacing offers an effective alternative to conventional RV pacing in such cases.

Background: To investigate the optimization of leadless pacemaker placement and to assess its impact on heart synchronization and tricuspid regurgitation.

Results: A clinical trial was conducted involving 53 patients who underwent leadless pacemaker implantation at the Second Affiliated Hospital of Zhejiang University School of Medicine and Hangzhou First People's Hospital between March 2022 and February 2023. Implantation site localization was determined using the 18-segment method under RAO 30° imaging. Intraoperative and 1-month post-operative echocardiography was performed to assess cardiac electromechanical synchronization and tricuspid regurgitation; parameters of interest included interventricular mechanical delay (IVMD), pre-ejection period of the aorta (L-PEI), and septal-to-posterior wall motion delay (SPWMD). Pacing thresholds, sensing, and impedance exhibited no significant differences between the 8/9 zone and other sites (P > 0.05). In contrast, the 8/9 zone group manifested a significant reduction in L-PEI (128.24 ± 12.27 vs. 146.50 ± 18.17 ms, P < 0.001), IVMD (17.92 ± 8.47 vs. 28.56 ± 15.16 ms, P < 0.001), and SPWMD (72.84 ± 19.57 vs. 156.56 ± 81.54 ms, P < 0.001), compared to the non-8/9 group. Post-pacing QRS duration showed no significant difference between the two groups (139.21 ± 11.36 vs. 143.83 ± 16.35 ms P = 0.310). Notably, for patients with atrial fibrillation, the 8/9 zone placement significantly reduced tricuspid regurgitation. During the 1-month follow-up, neither group reported major complications such as bleeding, cardiac tamponade, pacemaker detachment, or malignant arrhythmias.

Conclusion: Implantation of the leadless pacemaker in the right ventricular 8/9 zone provides superior electromechanical synchronization compared to other sites.

Background: Heart failure is a critical cardiovascular condition, necessitating comprehensive treatment approaches and contributing to elevated mortality rates. This study aimed to evaluate the effect of the prognostic nutritional index (PNI) on the prognosis of geriatric patients diagnosed with acute heart failure.

Results: A total of 104 patients were included and evaluated retrospectively in this study; 57.7% of them were females, and 19.24% of the patients died. A statistically significant difference was identified between high (≥ 35.6) and low PNI (< 35.6) groups in terms of lymphocyte count, neutrophil-lymphocyte ratio, C-reactive protein, and albumin (p values: < 0.001, < 0.001, 0.011, and < 0.001, respectively). The area under the curve (AUC) value for albumin was 0.53 (95% CI: 0.30-0.83) with a cutoff value of 3.1 g/dL; for lymphocyte count, it was 0.61 (95% CI: 0.57-0.84) with a cutoff value of 0.34 × 10³/µL; and for PNI, it was 0.58 (95% CI: 41.18-85.06) with a cutoff value of 34.6.

Conclusion: The low PNI group exhibited a significantly higher mortality rate; nonetheless, PNI alone does not hold clinical significance as a prognostic marker. However, when combined with other clinical parameters, it can contribute to a more comprehensive assessment of patients.

Background: Coronary air embolism is a rare but severe complication of coronary interventions.

Case presentation: We present a case of a massive air embolism in the right coronary artery during percutaneous coronary intervention, resulting in ventricular fibrillation. The patient was successfully resuscitated with electric defibrillation, leading to full recovery and TIMI 3 coronary flow. The final fractional flow reserve showed no residual coronary microvascular dysfunction.

Conclusion: Our finding suggests that inducing strong myocardial contractions with a cardioverter defibrillator may effectively disperse large air emboli and restore coronary circulation.