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

Background: Atrial fibrillation (AF) is the most common arrhythmias. Other than pharmacotherapy, catheter ablation is preferred especially for symptomatic paroxysmal AF or persistent AF. However, recurrence of atrial fibrillation following catheter ablation can occur due to several factors. Hyperthyroidism is known as a factor in atrial fibrillation pathogenesis but its role in AF recurrence following ablation is not known yet. Therefore, we aimed to assess the recurrence risk after catheter ablation in patients with a history of hyperthyroidism.

Methods: Systematic searching was performed through three databases: MEDLINE, EMBASE, and SCOPUS for studies reporting the recurrence of AF (hazard ratio) following catheter ablation in patients with a history of hyperthyroidism. The risk of bias assessment of included studies was performed using quality in prognosis studies (QUIPS). Meta-analysis (random effect model and inverse variance) was conducted using RevMan software version 5.4.

Results: Four studies involving 837 subjects were included. Pooled analysis shows a higher risk of recurrence of atrial fibrillation following catheter ablation in patients with history of hyperthyroidism (HR 1.86 [CI 95% 1.26-2.75]; I² 38%). Subgroup analysis showed patients with amiodarone-induced hyperthyroidism (AIH) had a higher risk of atrial fibrillation recurrence (HR 2.31; CI 95% 1.49-3.58; I² 0%) compared to non-AIH. However, two studies on AIH showed moderate risk of bias.

Conclusions: History of hyperthyroidism was found as the risk of recurrence of atrial fibrillation after a single ablation procedure. Patients with amiodarone-induced hyperthyroidism have a higher recurrence risk. Further studies with larger participants are needed for subgroup analysis on specific parameters of the ablation.

Background: Heart failure (HF) is a major cardiovascular disease (CVD) with high morbidity and mortality. Research on the effect of electroacupuncture (EA) on the quality of life (QoL) of HF patients with reduced ejection fraction (HFrEF) remains limited. This study aims to determine the role of combining EA with conventional treatment in improving QoL for patients with HFrEF.

Methods: This single-blind, randomized controlled trial employed a pre- and post-test design at the Heart Failure and Acupuncture Clinics of UNS Hospital, Indonesia. Thirty-four participants participated, with random assignment to either an intervention or a control group. While the intervention group received pharmacological therapy combined with electroacupuncture, the control group received only pharmacological therapy. All pharmacological treatments were administered according to cardiologists' prescriptions in alignment with the 2021 European Society of Cardiology guidelines. In the intervention group, participants underwent 32 EA sessions conducted by a medical acupuncture specialist, delivered twice weekly for 30 min per session. The primary outcomes were: (1) Change in Left Ventricular Ejection Fraction (LVEF); (2) Change in six-minute walk distance; and (3) Change in Kansas City Cardiomyopathy Questionnaire-23 (KCCQ-23) score, measured before and after the intervention period.

Results: The combination of pharmacological therapy and EA produced a significant increase in the mean of LVEF by 14.07 ± 5.67%, an improvement in mean 6MWD by 348.82 ± 61.23 m, and an increase in mean KCCQ-23 score to 34.94 ± 5.99. Statistically significant differences were observed between the intervention and control groups for all measured outcomes (p < 0.05).

Conclusions: The combination of conventional treatment and EA significantly improves quality of life in patients with HFrEF, representing a promising adjuvant therapy for heart failure.

Background: Acute limb ischemia (ALI) is a severe complication in patients with structural heart disease and recurrent arrhythmias that often leads to significant morbidity and potential lifelong disability. The combination of arrhythmia, recurrent electrical shocks in patients with incessant supraventricular tachycardia (SVT), and structural heart abnormalities may increase the risk of thrombus formation and migration, raising questions about the role of thromboprophylaxis in such high-risk scenarios.

Case presentation: We present a 54-year-old female with Wolff-Parkinson-White (WPW) Syndrome and structural heart disease who was admitted with incessant SVT, complicated by several episodes of ventricular tachycardia (VT) and ventricular fibrillation (VF). Despite multiple unsynchronized cardioversions, the patient remained hemodynamically unstable. Echocardiography revealed a dilated left ventricle with reduced systolic function and an intracardiac thrombus. During hospitalization, she underwent over ten direct current (DC) shocks, exacerbating her thromboembolic risk. On day three of hospitalization, she developed severe pain in her right leg, progressing to signs of ALI. Doppler ultrasound and CT angiography confirmed thrombi in the abdominal aorta and lower extremities, supporting the diagnose of ALI Rutherford III dextra and ALI Rutherford IIA sinistra. Surgical thrombectomy and anticoagulation were initiated, but ALI progressed, necessitating above-knee amputation in her right leg.

Discussion: Thromboprophylaxis in patients with structural heart disease and incessant arrhythmia must be carefully assessed. Incessant SVT alone does not justify early anticoagulation, but coexisting cardiomyopathy and repeated cardioversions increase thromboembolic risk. Identifying the underlying cause of structural abnormalities is essential to guide treatment and prevent severe complications. Delayed anticoagulation in the presence of undetected thrombus may result in irreversible events such as limb loss due to ALI.

Background: Atrial fibrillation and flutter (AFF) are two of the most common cardiac tachyarrhythmias. The burden of AFF is increasing globally, with a particularly rapid increase in the Eastern Mediterranean region (EMR) due to economic and lifestyle changes. Despite extensive research on AFF, regional variations remain understudied.

Aims: To analyze the burden and risk factors for AFF in the EMR using the Global Burden of Disease (GBD).

Study design: Systematic analysis.

Methods: Data from the GBD 2021 were used to evaluate the incidence, prevalence, disability-adjusted life years (DALYs), and deaths associated with AFF stratified by age, sex, and sociodemographic index (SDI) from 1990 to 2021. In addition, deaths and DALYs of AFF attributable to risk factors were estimated. Accompanying 95% uncertainty intervals (UIs) were provided to reflect the combination of data and estimates, and findings were presented as absolute counts and age-standardized rates.

Results: From 1990 to 2021, the absolute number of incidence and prevalence of AFF in the EMR increased by 161.9% (from 64362.4 [48684.7-85763.7] in 1990 to 168555.0 [129706.9-220844.2] in 2021) and 162.4% (from 617721.6 [482076.0-807810.5] in 1990 to 1620763.1 [1270893.6-2108347.5] in 2021), respectively. From 1990 to 2021, the EMR revealed significant increases in the age-standardized incidence (3.0%, 95% UI 1.1-4.8) and prevalence (4.6%, 2.9-6.3) of AFF, with women experiencing greater increases than men did. The burden of AFF increased across all ages, with the incidence increasing by 161.9% and the prevalence increasing by 162.4%. From 2019 to 2021, the age-standardized rates of incidence, prevalence, DALYs, and deaths remained stable, with no significant changes. High systolic blood pressure was the leading risk factor, contributing to 25.5 age-standardized DALYs per 100,000 in 2021, whereas a high body mass index showed the largest increase in the attributable burden. Compared with low-SDI nations, high-SDI countries presented higher prevalence and incidence rates but lower death rates. Age-specific analysis revealed a sharp increase in the AFF burden with age, particularly among women aged 95+ years.

Conclusion: The burden of AFF in the EMR increased from 1990 to 2021, with increasing incidence, DALY, and death rates. High systolic blood pressure and high body mass index are key contributors to these conditions. These findings underscore the need for public health interventions, including improved hypertension and obesity management, lifestyle modifications, and early detection strategies.

Background: The electrocardiogram (ECG) is widely used in clinical practice, but accurate interpretation requires significant expertise. Variability in training leads to inconsistent diagnostic accuracy amongst healthcare professionals. Artificial intelligence (AI) applications, such as PMCardio (Powerful Medical, Samorin, Slovakia), can digitise and interpret ECGs. While validated in selected populations, its performance compared to clinicians in UK practice has not been assessed.

Methods: Seventy-six healthcare professionals interpreted eight ECG traces (seven abnormal, one normal). Their performance was compared with the PMCardio application. Accuracy and time were recorded.

Results: Healthcare professionals achieved a mean accuracy rate of 67.1% (SD 24.0%), improving with seniority (junior 60%, mid-level 67.5%, senior 80%). PMCardio achieved perfect accuracy on the tested ECGs. Clinicians interpreted faster (median 23.7 s, range 9.1 s) compared to PMCardio (39.0 s, range 8.0 s), noting that the application's timing included operational steps such as loading and capturing ECG images.

Conclusions: PMCardio demonstrated higher diagnostic accuracy than healthcare professionals but required longer interpretation times. Given the small dataset (8 ECGs) and lack of patient context, results should be interpreted cautiously. While AI tools may support clinicians and enhance consistency, they may also introduce uncertainty for less experienced users. Further studies with larger, real-world datasets are needed before widespread adoption.

Introduction: Ischemic heart disease (IHD) continues to be the primary cause of death among older adults in the United States (U.S.), while colorectal cancer (CRC), being the 3rd most common cancer, contributes to increased mortality when co-occurs with IHD. This study examines national trends in IHD mortality from 1999 to 2023 among older adults with co-existing CRC.

Methods: The study retrospectively analyzed death certificates from the CDC's Wide-ranging ONline Data for Epidemiologic Research (WONDER) database, including older adults (aged ≥ 65 years) who listed IHD as the underlying cause of death while CRC was a contributing cause. Crude and age-adjusted mortality rates (AAMRs) per 100,000 individuals, as well as the annual percent change (APC) in AAMRs with a 95% confidence interval, were obtained.

Results: A total of 43,417 deaths were attributed to IHD among patients with coexisting CRC. AAMR declined significantly throughout the study, being more prominent from 2003 to 2016 (APC - 8.65; p < 0.05). Males (6.3) had doubled the AAMR that of females (3.1). Non-Hispanic (NH) African Americans represented the highest AAMR (4.5), followed by other races/ethnicities. Regionally, peak AAMR was observed in the northeast (5.7) and non-metropolitan areas (4.7).

Conclusions: A substantial (75%) reduction in AAMR was observed from 1999 to 2023. However, disparities across different demographical and geographical highlight the need for targeted interventions to lower IHD burned among patients with co-existing CRC.

Background: Device therapy for various cardiac rhythm disturbances has seen a tremendous increase in recent times, and so have the various complications associated with this therapy. Pacemaker lead perforation is one of the most feared complications associated with these device implantations. This prospective observational study was conducted to evaluate the clinical features, diagnosis, and outcome of pacemaker lead perforation in our setting.

Results: A total of 5493 patients were included in the study. It included 3438 temporary pacemaker (TPM) lead placements and 2055 patients who had undergone CIED implantation. The comorbidities of the study population include hypertension in 3582(65.21%), Diabetes in 2089(38%), dyslipidemia in 2293(41.74%) and hypothyroidism in 1527(42.6%). The indication of TPM lead implantation include complete heart block (CHB) in 1323(38.48%), TPM during CIED implantation in Sick sinus syndrome (SSS)/trifascicular block and high-grade AV block 766(22.28%), permanent pacemaker generator replacement 330(9.95%), EP study250(7.27%), drug induced heart block 13(0.38%). Indications of CIED implantation include CHB in 1103(53.67%), SSS in 221(10.75%), DCM in 132(6.42%) and ICD in 38(1.85%). There were 23 lead-induced RV perforations, with an incidence of 0.42%. There were 18(78.2%) perforations due to TPM Lead and 5(21.8%) due to CIED leads. Bradycardia was seen in 18(78.3%), hypotension in 8(34.8%), capture loss in 14(60.87%), pain abdomen in 4(17.4%). Pericardial effusion developed in 19(82.6%), tamponade needing pericardiocentesis was seen in 8(34.78%). Surgical intervention was required in 1(4.34%) case. With one death mortality in the study was 4.34%.

Conclusion: Careful monitoring and nonsurgical management of lead perforation has favourable outcomes.

Background: This study investigated the impact of right heart volume overload on renal perfusion in patients with heart failure (HF). We retrospectively analyzed 304 ambulatory HF patients enrolled between October 2017 and August 2022. Echocardiographic parameters-including left atrial diameter (LAD), left ventricular end-diastolic diameter (LVEDD), right atrial diameter (RAD), right ventricular diameter (RVD), and left ventricular ejection fraction (LVEF)-were measured and adjusted for body surface area (BSA). Renal perfusion was assessed via time-to-peak of renal blood flow (TTPr) using renal scintigraphy. Relationships between echocardiographic measures and TTPr were evaluated using Spearman correlation and multivariable ordinal logistic regression analyses.

Results: In the overall cohort, RAD/BSA showed the strongest correlation with TTPr (rs = 0.608, P < 0.001), which remained significant after multivariable adjustment. LVEDD/BSA and LVEF showed weak or no associations. Subgroup analyses demonstrated that RAD/BSA had the strongest correlation in HF with reduced ejection fraction (rs = 0.602, P < 0.001) and HF with preserved ejection fraction (rs = 0.496, P < 0.001), while LAD/BSA was most strongly correlated in HF with mildly reduced ejection fraction (rs = 0.586, P < 0.001), all remaining significant after adjustment.

Conclusions: Echocardiographic parameters of the right heart volume overload were associated with TTPr, suggesting a connection between right heart overload and renal perfusion in cardiorenal syndrome. This points to potential therapeutic targets to improve renal perfusion and outcomes in CHF patients.

Background: ST-elevation myocardial infarction (STEMI) is a critical condition requiring rapid diagnosis and treatment. Smartphone-based Electrocardiogram (ECG) devices, like Spandan Pro, offer the potential for timely Percutaneous Coronary Intervention (PCI) in STEMI patients, particularly in resource-limited environments.

Objective: To assess the agreement between ST-segment elevation measurements obtained from the Spandan Pro ECG device and those from a Gold standard ECG (BPL Cardiart), using Bland-Altman (BA) analysis, in the context of decision-making for PCI.

Methods: A cross-sectional, observational study was conducted on 200 patients who presented to the local Hospital with complaints of chest pain. After strict application of exclusion criteria, a total of 184 patients were assessed in the study. BA analysis has been used to estimate the agreement between ST-segment elevation measurements obtained from the Spandan Pro ECG device with the Gold standard ECG. The ECG reports assist the cardiologist in making decisions regarding PCI.

Results: Of the 184 patients, 55 met the criteria for PCI, 33 of whom presented within 120 h of symptom onset. BA analysis revealed that the mean differences between the two methods were clinically insignificant, with agreement limits falling within acceptable ranges across all leads, confirming the reliability of the Spandan Pro.

Conclusion: The Spandan Pro ECG device shows good agreement in diagnosing ST elevation with the Gold standard ECG, making it a valuable tool in decision-making regarding PCI by the cardiologist. It also improves patient outcomes by enabling rapid diagnosis and treatment, especially in resource-limited or prehospital environments.