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

Background: The supply of donor hearts has fallen short of the increasing demand. This widening gap has led to a crisis marked by long waiting times and high mortality rates among those on waiting lists. This study aimed to compare the echocardiographic data of individuals whose hearts were eligible for transplant.

Methods: This retrospective, cross-sectional study investigated all eligible brain-death cases conducted at Sina Hospital in Tehran, Iran. Based on echocardiographic data, patients were evaluated for heart donation (59 hearts that were deemed eligible vs. 39 hearts that were non-eligible for donation). The study used a custom checklist based on transthoracic echocardiography data. Data were analyzed using SPSS 18 software. A P < 0.05 was considered statistically significant.

Result: The average age of the cases was 29.28 ± 10.59 years. Gender was not significantly associated with transplant eligibility (P = 0.46). In contrast, the cause of brain death was a significant factor (P = 0.04). There were statistically significant differences between the cause of brain death and left ventricular ejection fraction (LVEF) (F = 3.14, η² = 0.094, P = 0.029). No significant relationship was found between the cause of brain death and regional wall motion abnormality (RWMA) or pulmonary artery systolic pressure (PASP).

Conclusion: Borderline cases should undergo reevaluation using repeat transthoracic echocardiogram or echocardiographic assessments of heart function with inotropic medications to increase the pool of potential heart donors due to limited organ donor options.

Background: Despite guideline recommendations for high-intensity statins in acute coronary syndrome (ACS) patients, real-world data show underutilization and suboptimal low-density lipoprotein cholesterol (LDL-C) target achievement. The statin-associated muscle symptoms (SAMS) is often a major limitation to drug compliance and hence to achieving LDL-C targets.

Methods: In this prospective, open label, randomized controlled trial, 502 ACS patients were randomized 1:1 to atorvastatin 80 mg monotherapy (Group A) versus atorvastatin 40 mg plus ezetimibe 10 mg (Group AE), aiming to compare the efficacy, safety, and tolerability of both treatment arms. Lipid profiles, safety, and clinical outcomes were assessed at baseline, 6 weeks, 6 months, and 12 months. The primary endpoints were LDL-C reduction, SAMS, and major adverse cardiovascular events (MACE).

Results: The mean age of participants was 56 ± 10 years, with 83% males, 55% diabetics, and 77% hypertensives. Baseline characteristics were comparable between groups. Group AE demonstrated superior LDL-C reduction at all timepoints (p < 0.01), with greater improvements in high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG). Group AE also showed significantly fewer events of treatment discontinuation (DC) or dose reduction (DR) (OR 0.50; 95% CI 0.31-0.81) and a 25.7% relative risk reduction (RRR) in the composite of MACE compared to Group A. SAMS and non-limiting muscle aches were significantly lower in Group AE (p < 0.05), with no cases of rhabdomyolysis reported. Subgroup analysis confirmed consistent benefits of Group AE in both diabetic and non-diabetic patients.

Conclusion: Atorvastatin 40 mg plus ezetimibe 10 mg demonstrated superior LDL-C reduction, improved tolerability, and fewer MACE compared to atorvastatin 80 mg monotherapy in ACS patients. These findings support the use of combination therapy as a viable starting alternative to atorvastatin 80 mg monotherapy following ACS, particularly in patients likely to have statin intolerance.

Background: Although the hemoglobin-to-creatinine ratio (HCR) has been recognized as a predictor for various diseases, its prognostic value in patients with coronary artery disease (CAD) remains unclear. This study aimed to examine the association between HCR and all-cause mortality in general CAD patients using data from the National Health and Nutrition Examination Survey (NHANES) database.

Methods: A total of 3701 adult patients with CAD, which was identified through self-report in questionnaires, were included and followed for a mean of 79 months. The association between HCR and all-cause mortality was evaluated using smooth curve fitting, threshold effect analysis, and a competing risk regression model.

Results: A nonlinear association was observed between HCR and all-cause mortality among CAD patients, characterized by an inflection point at 18.32. Below this threshold, each unit decrease in HCR was associated with a 6% reduction in all-cause mortality (HR = 0.94, 95%CI: 0.92-0.97, p < 0.001). Above the inflection point, each unit increase in HCR corresponded to a 7% increase in mortality risk (HR =1.07, 95%CI: 1.02-1.12, p = 0.005). The competing risk model revealed a similar association between HCR and cardiac mortality.

Conclusions: Utilizing data from the nationally representative NHANES database, this study identified a nonlinear correlation between HCR and all-cause mortality in a general population of patients with CAD. Specifically, mortality risk initially decreased and subsequently increased with rising HCR levels, highlighting the broad relevance of these findings to community-based CAD management.

Background: Ischaemic heart disease (IHD) is a leading cause of mortality and morbidity globally. Coronary angioplasty has a vital role in treating coronary artery disease. However, this is associated with a small risk of serious side effects, including contrast-induced nephropathy, vascular complications and arrhythmia. Contrast-induced nephropathy (CIN) is a serious and common complication of coronary angioplasty that can lead to renal failure and major adverse cardiac and renal outcomes.

Methods: We conducted a systematic review and meta-analysis by searching multiple databases, including PubMed, Scopus, Embase, Google Scholar, and ScienceDirect, as well as other sources. The inclusion and exclusion criteria are described in detail later in this article. Two independent reviewers performed the literature search in September 2024 and identified 282 articles. The study was conducted following the population, intervention, comparator, and outcome (PICO) framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 17 studies were included in the final analysis after applying the inclusion and exclusion criteria. The exclusion criteria were guidelines, case reports, qualitative research, and letters to the editor, commentaries, conference proceedings, gray literature, opinions, policy papers, and case series. Articles published after 2010 were included in this meta-analysis, and data analysis was performed using Rayyan statistical software.

Results: This study demonstrated that nicorandil was associated with protective effects against CIN. The total number of patients in the Nicorandil and placebo groups were 3836 and 3858 respectively. The occurrence of CIN was 5.14% in the nicorandil group, compared with 13.15% in the control group. This study also confirmed the dose-dependent effect of nicorandil on CIN. Among 662 patients enrolled in three studies, 3,9% in the double dose (DD) group presented with CIN, compared with 8,4% in the standard dose (SD) group. The occurrence of MACE was 5.7% in the Nicorandil group and 8.2% in the control group. However, there was no statistically significant protective effect against major adverse cardiovascular events (MACE) or major adverse kidney events (MAKE). Only a few studies measured the impact on MAKE, and the findings may not be truly representative of its effects.

Conclusion: This study demonstrated the renoprotective effects of nicorandil in preventing CIN in patients undergoing coronary angioplasty, and this relationship was also evident from the double-dose response. Further larger size randomised controlled trials are recommended to assess the efficacy of nicorandil in preventing CIN in patients undergoing coronary angioplasty.

Background: Peripartum aortic dissection (AD) is an uncommon yet significant complication during pregnancy and delivery, characterized by a tear in the aortic intima that can lead to severe maternal morbidity and mortality. This case report describes a rare instance of Stanford Type B aortic dissection occurring in a pregnant woman, emphasizing that acute, severe labor pain can obscure the diagnosis of AD, often leading to misattribution of symptoms to more common obstetric complications.

Case presentation: This report highlights the case of a 36-year-old primigravida who presented with acute chest pain during labor, initially misdiagnosed until imaging revealed the dissection post-delivery. The critical interplay between labor-induced hemodynamic stress and pre-existing vascular weaknesses, such as those found in connective tissue disorders, raises concerns about the cardiovascular risks faced by pregnant individuals. The importance of a multidisciplinary approach, involving obstetricians, cardiologists, and anesthesiologists, is underscored, as effective management strategies are essential to ensure maternal and fetal safety.

Conclusion: This case underscores the necessity for healthcare providers to maintain a high index of suspicion for atypical thoracic pain in pregnant patients and advocates for enhanced screening protocols for aortic disease. The findings advocate for regular cardiovascular assessments in women of childbearing age with known risk factors to improve early diagnosis and intervention, thereby potentially reducing the associated morbidity and mortality from this rare but critical condition. Further research is needed to develop evidence-based guidelines for managing AD in the peripartum setting, aiming to refine clinical protocols and optimize patient outcomes.

Background: Infective endocarditis (IE) is a potentially fatal condition with high morbidity and mortality. This single center study was designed to assess the clinical presentation, causative organisms, antibiotic resistance, and clinical outcomes of IE in patients treated at a tertiary care cardiac center in Pakistan.

Methods: A retrospective observational study was conducted at a large tertiary care cardiology center in Peshawar, Pakistan from July 2021 to July 2023. Data was collected from hospital records, including demographic, clinical, and laboratory parameters. Statistical analysis was performed using Stata version 14.2.

Results: Among 84 patients, 41.7% were male with a mean population age of 49.17 ± 18.55 years, and an average BMI of 27.72 ± 4.37 kg/m². Hypertension was the most common comorbidity, found in 47.6% patients, followed by diabetes in 36.9% patients. Streptococcus Viridans (25%) was the most common organism isolated, followed closely by Staphylococcus aureus at 22.6%. Surprisingly, 32.1% of the patients had negative cultures. Antibiotic resistance was observed in 25/57 (43.9%) of culture positive cases, and Major Adverse Cardiovascular Events (MACE) occurred in 56%. Acute kidney injury was observed in 48.8% of the patients.

Conclusion: IE presents diverse etiologies and outcomes, necessitating targeted management strategies to reduce antibiotic resistance and improve outcomes in such a challenging subsets of patients.

Background: The incompetence of the tricuspid valve (TV) may predispose to unfavorable results of Fontan palliation in patients with single right ventricle (RV). This study aims to reveal the effect of TV intervention in patients with single RV on long-term outcomes after Fontan completion.

Methods: A single-center retrospective cohort study was conducted with patients who underwent Fontan completion from 1985 to 2017. There was a total of 678 patients with single RV. A total of 128 patients (18.8%) underwent TV intervention at any stage (TVI group); 30 of them (23.4%) underwent repeat TV surgery (repeat TVI subgroup). The control group comprises 550 patients (81.2%) who had no TV surgery regardless of the degree of TR (non TVI group).

Results: The median follow-up was 8.8 (± 7.6) years. Overall transplant- and Fontan takedown-free survival was 62.5% (95% CI 59.2%-64.9%) at 20 years. The repeat TVI group had significantly lower transplant and takedown-free survival rates (Non TVI 76.5% vs. Single TVI 75.3% vs. repeat TVI 56.0% at 15 years, P = 0.02). The younger age at Fontan (1.12 [95% CI 1.02-1.22], p = 0.019), repeat TVI (3.33 [95% CI 1.57-7.04], p = 0.002), TV intervention after Fontan (6.14 [95% CI 2.60-14.50], p < 0.001), significant ventricular dysfunction before Fontan (3.12 [95% CI 1.12-8.30], p = 0.028) and any concomitant procedure at Fontan (1.98 [95% CI 1.16-3.37], p = 0.013) were the significant risk factors for transplant and takedown free- survival.

Conclusions: Repeat TV intervention during the Fontan was associated with inferior outcomesin patients with morphologic systemic RV. Successful TV intervention could provide comparable long-term survival outcomes to non-TV intervention patients.