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

Background: Hypertensive disease and obesity frequently coexist and synergistically increase the risk of cardiovascular morbidity and mortality in the USA. Despite this intersection, national trends and disparities in mortality attributable to both conditions remain underexplored.

Methods: We conducted a retrospective analysis using the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research Multiple Cause of Death database. Hypertensive disease-related deaths with co-listed obesity were extracted for US adults between 1999 and 2023. Age-adjusted mortality rates (AAMRs) were calculated, and Joinpoint regression was used to estimate annual percentage changes (APCs) and identify significant trends.

Results: A total of 412,767 deaths were attributed to hypertensive disease and coexisting obesity from 1999 and 2023. The AAMRs rose nearly tenfold, from 1.3 per 100,000 in 1999 to 13.23 in 2023. While mortality rates increased overtime for both sexes, men consistently exhibited higher rates than women (AAPC: 10.38 vs. 8.15). Older adults (AAMR: 32.63) had the highest mortality, followed by middle-aged (5.56) and young adults (0.71), though young adults saw the steepest relative rise (AAPC: 9.63). Non-Hispanic (NH) Black individuals had the highest mortality (AAPC: 7.78), followed by NH American Indian/Alaska Native (8.76), NH White (9.90), Hispanic (6.48) and NH Asian/Pacific Islander populations (6.51). Geographic disparities widened over time. The South and Midwest bore the heaviest regional burden, while urban-rural analyses showed a higher and quicker rise in mortality in non-metropolitan areas (AAPC: 12.13 vs. 10.73 in metro areas).

Conclusion: Mortality due to hypertensive disease with coexisting obesity has escalated sharply across USA over the past 2 decades. These results highlight the need for further investigation into the factors contributing to the observed disparities and trends.

Background: Ischemic heart disease (IHD) is the leading cause of death in adults and poses a substantial economic burden in the United States. Coronary artery bypass grafting (CABG) remains the standard surgical intervention for multivessel and left-main coronary disease. However, the combined impact of race and socioeconomic status on CABG outcomes has not been fully explored.

Methods: A total of 47,373 admissions of adults (18-85 y) who underwent CABG from 2016-2020 were analysed. Adults aged 18-85 years with a primary diagnosis of IHD who underwent CABG were identified using ICD-10 codes. Data on patient demographics, socioeconomic indicators (household income quartile, insurance type), comorbidities (Charlson Comorbidity Index), and hospital characteristics were collected. Multivariable logistic regression models adjusted for clinical and hospital factors were used to estimate adjusted odds ratios (aORs) for in-hospital mortality, nonhome discharge, prolonged length of stay (> 75th percentile), and postoperative complications. Linear regression assessed differences in hospital costs.

Results: Compared to White patients, Black individuals had significantly higher odds of nonhome discharge (aOR 1.37), prolonged hospitalization (aOR 1.54), and postoperative complications (aOR 1.35) (all p < 0.001). Hispanic and Asian/Pacific Islander patients also faced increased risks of prolonged stay (aORs 1.23-1.26) and complications (aORs 1.15-1.19) (all p < 0.001). Minority groups incurred significantly higher hospitalization costs, with adjusted increases ranging from $17,000 to $73,000 per admission (p < 0.001). Trends toward elevated in-hospital mortality in Native American and Black patients did not reach statistical significance.

Conclusions: Racial and socioeconomic disparities persist in CABG outcomes and hospital resource utilization, despite adjustments for clinical and institutional factors. These findings underscore the need for targeted strategies to improve equity in cardiovascular surgical care, including enhanced access to preventive services, perioperative support, and system-level quality improvements.

Highlights: Non-Hispanic Black and Hispanic patients experience higher postoperative complication rates and longer hospital stays after CABG. Native American and Black patients showed trends toward higher in-hospital mortality, though not statistically significant. Patients from socioeconomically disadvantaged backgrounds incur significantly higher hospital costs and are more likely to experience prolonged hospitalizations. Racial and socioeconomic disparities persist despite adjustment for comorbidities and hospital-level factors.

Background: The Austrian syndrome is a rare but malignant triad consisting of pneumonia, meningitis, and endocarditis caused by an invasive pneumococcal infection, with a mortality rate of approximately 32%, rising to over 60% if not diagnosed early. Most of the knowledge about this rare disease comes from case reports. The uniqueness of this case lies in the late presentation of endocarditis.

Case presentation: A 59-year-old woman with a medical history of hypertension, dyslipidemia, hypothyroidism, and mesangial proliferative glomerulonephritis was admitted to our hospital with meningitis and pneumonia with bacteremia caused by Streptococcus pneumoniae. After receiving antibiotic treatment, the patient improved, and an echocardiogram was performed, ruling out endocarditis. She was discharged and readmitted three weeks later due to endocarditis with an acute perforation of the aortic valve, which required urgent surgery. Fortunately, the patient survived.

Conclusion: In cases of invasive pneumococcal disease with involvement of more than one focus, the possibility of developing infective endocarditis should be considered, especially in cases of hemodynamic instability or heart failure. The Austrian syndrome is a triad that should not be overlooked due to its high mortality rate, especially the possibility of the late onset of endocarditis.

Background: Gender-based variations in the management and prognosis of ST-segment elevation myocardial infarction (STEMI) have been documented globally, with females often experiencing worse outcomes than males. However, limited data are available on these disparities in Egypt. This research aims to evaluate gender-based variations in the management and short-term findings of STEMI patients in Egypt.

Results: The study analyzed 1,356 STEMI patients, of whom 250 (18.44%) were female. Women were significantly older than men (61.7 ± 11.3 vs. 55.9 ± 11 years; p < 0.001) and had a greater prevalence of comorbidities, comprising diabetes (62.8% vs. 35.3%; p < 0.001), hypertension (55.2% vs. 33%; p < 0.001), and prior stroke/transient ischemic attack (7.2% vs. 3.3%; p < 0.01). Women experienced longer delays in seeking care (symptom onset to first medical contact time: 4.2 ± 6.1 vs. 3.1 ± 3.7 h; p < 0.001) and tended to show up with advanced heart failure (Killip class III/IV: 12.8 vs. 6.9%; p = 0.005). Despite similar rates of primary percutaneous coronary intervention utilization, women had greater rates of in-hospital mortality (7.6 vs. 4.0%; p = 0.01). Multivessel disease was less common in women, but they had a greater prevalence of right coronary artery involvement as the culprit lesion (32.9 vs. 21.7%; p = 0.002). Medication prescription rates at discharge revealed that women received high-intensity statins (93.2 vs. 96.1%; p = 0.04) and ticagrelor (3.6 vs. 7.8%; p = 0.01) less commonly.

Conclusions: Egyptian women with STEMI exhibit significant delays in presentation, a greater burden of comorbidities, and worse in-hospital outcomes compared to men.

Background: Left atrial (LA) localized voltage abnormality displayed by electro-anatomic mapping (EAM) has been established as a surrogate marker of atrial fibrosis (AF) which predicts post-ablation recurrence. This study investigates preoperative predictors of LA voltage abnormalities and assesses their impact on atrial fibrillation recurrence following catheter ablation in patients with paroxysmal atrial fibrillation (PAF).

Results: Forty-four (25.6%) patients had LA voltage abnormality which independently predicted post-ablation recurrence (HR 2.85, 95%CI 1.20-6.78, p = 0.02). Larger left atrial diameter (LAD) (OR 1.24 per 1 mm, 95%CI 1.02-1.50, p = 0.03) and higher atrial tachyarrhythmia (ATA) burden (OR 1.02 per 1%, 95%CI 1.00-1.04, p = 0.03) independently correlates with LA voltage abnormality with an ideal combined diagnostic efficiency (AUC 0.80, sensitivity 79.3%, specificity 70.7%, 95% CI 0.70-0.89, p < 0.01).

Conclusions: LA substrate abnormality, even moderate, is an independent risk factor for PAF post-ablation recurrence which can be predicted pre-procedure by LAD and ATA burden.

Background: Rheumatic tricuspid stenosis (TS) is a rare and easily missed clinical finding until late stages. Two-dimensional echocardiography (2DE) can assess the leaflet thickening and transvalvular gradients, which may be misleading in the presence of significant TR. Moreover, it lacks en face views of the tricuspid valve (TV), making the diagnosis of TS challenging. Meanwhile, three-dimensional echocardiography (3DE) effectively visualizes commissural fusion and sub-valvular thickening, enabling accurate tracing of the orifice area.

Case presentation: The authors present a case series discussing rheumatic and non-rheumatic TV stenosis to emphasize the role of 3DE in identifying the key findings in rheumatic stenotic TV and distinguishing them from other non-rheumatic etiologies.

Conclusions: This case series demonstrated that 2DE has limitations in diagnosing TV stenosis, whereas 3DE provides a clear view of features such as commissural fusion and chordal thickening. Therefore, 3DE is essential in addition to 2DE for improved imaging of TV diseases, allowing accurate tracing of the orifice area, regardless of regurgitation.

Background: Aorto-left ventricular tunnel (ALVT) is a rare congenital anomaly. In this condition, the aorto-ventricular tunnel is a congenital extracardiac channel that connects the ascending aorta to the left ventricle above the sinotubular junction.

Case presentation: A 5-year-old boy presented with fatigue during physical activity, leading to visiting a pediatric specialist. Upon examination, a continuous murmur, predominantly diastolic, was detected. Suspecting aortic insufficiency, the patient was referred for further evaluation. Transthoracic echocardiography revealed a congenital ALVT.

Conclusion: Although congenital ALVT is a rare congenital heart disease, its clinical symptoms may overlap with other congenital heart diseases, such as tetralogy of Fallot without pulmonary stenosis and patent ductus arteriosus. Differential diagnosis, such as the absence of a wide pulse pressure, can be helpful in distinguishing between these conditions.

Background and aim: The use of thrombolytics in intermediate-high risk pulmonary embolism (PE) remains controversial. This study evaluated the efficacy and safety of half-dose alteplase compared to anticoagulation with LMWH in this group.

Material and methods: Patients treated with thrombolytics (50 mg alteplase) after the establishment of EGEPET (2.10.2018) formed the prospective group, while the retrospective group included patients treated with LMWH (enoxaparin) before EGEPET. Primary outcomes were one-month and one-year mortality. Secondary outcomes were vital sign changes after thrombolysis, hemorrhagic events, recurrence of embolism, chronic pulmonary thromboembolism (CPTE), and chronic thromboembolic pulmonary hypertension (CTEPH).

Results: Thrombolytic group (n = 59) and anticoagulation group (n = 38) were similar in age, comorbidities, and vital signs, except for higher pulse rates in the thrombolytic group. In the thrombolytic group, PaO₂/FiO₂ ratio significantly improved [330 (270-380) to 417 (351-447), p < 0.001], and pulse rate decreased [116 (105-127) to 91 (80-104), p < 0.001]. In the anticoagulation group, oxygenation showed no significant change, but pulse rate improved. No major bleeding occurred in either group. One-month mortality was 6.7% in the thrombolytic group and 15.8% in the anticoagulation group (p = 0.18). One-year mortality was 13.7% and 26.3%, respectively (p = 0.17). Advanced age (> 67) (OR: 8.82, %95 CI 1.54 - 50.53 p = 0.014) and elevated second-day pulse > 94/min (OR 7.61, 95% CI 1.33-43.49, p = 0.022) were independent predictors of one-month mortality in the multivariate analysis.

Conclusion: Thrombolytic therapy significantly improved oxygenation and clinical findings without major complications. Although mortality rates were lower in the thrombolytic group, the difference was not statistically significant. These results should be interpreted with caution, and larger prospective studies are needed to confirm the clinical efficacy and safety of thrombolytic therapy in this patient population.

Background: Cardiovascular diseases remain one of the leading causes of mortality worldwide, with atrial fibrillation emerging as a clinically significant arrhythmia. The increasing prevalence of atrial fibrillation calls for advanced diagnostic tools for accurate detection to reduce adverse consequences, such as stroke and heart failure. Cardiovascular advancements in artificial intelligence have improved the detection and management of atrial fibrillation.

Objective: This review examines recent advancements in atrial fibrillation detection using artificial intelligence-driven tools-such as wearables, neural networks, and machine learning-and highlights their clinical relevance, limitations, and potential to transform cardiovascular care.

Methodology: A systematic review was conducted using PubMed, IEEE Xplore, and ScienceDirect to identify peer-reviewed studies between 2020 and 2024. Original clinical studies using artificial intelligence were included for the diagnosis of atrial fibrillation. Studies on conditions other than atrial fibrillation or incomplete data were excluded. Factors analyzed across all studies included diagnostic application, key findings, clinical implications, and limitations of artificial intelligence approaches.

Results: This review evaluated 11 studies on artificial intelligence-enhanced tools for atrial fibrillation diagnostics. Neural networks showed the highest diagnostic accuracy, outperforming clinicians in retrospective electrocardiogram analyses (80% vs. 75%). Wearable artificial intelligence-integrated devices, such as electrocardiogram wristbands, offer the highest accessibility and real-time monitoring, with sensitivities exceeding 94%, although they are limited by single-lead input and patient compliance. Machine learning models, including random forest and XGBoost, showed moderate performance (AUROC 0.74-0.89) with strengths in risk prediction and stratification. Key challenges included limited generalizability, small-sample sizes, and varying model accuracy.

Conclusions: This review highlights the potential of artificial intelligence to improve atrial fibrillation diagnostics through wearable technologies, neural networks, and machine learning. While these tools often outperform traditional methods, real-world use is limited by small, retrospective studies and a lack of validation. Future work should focus on equity, transparency, and expanding artificial intelligence use beyond atrial fibrillation diagnosis, with collaboration needed to ensure safe, effective clinical integration.

Background: A main concern during cardiac surgery is the protection of the heart. Myocardial ischemia tends to increase the generation of reactive oxygen species. Based on its oxidation-reduction potentials, vitamin C is the most powerful antioxidant to counteract the effects of free radicals. This reason made the researcher to perform this study with the goal to determine and evaluate the effect of on perioperative clinical outcomes and laboratory criteria of coronary artery bypass grafting (CABG) cases.

Methods: This randomized clinical trial (RCT) was done in 2022 at Rajaie Cardiovascular Medical and Research Center. Following obtaining permission from the ethics committee, 62 CABG patients were randomly allocated to two groups and were included in the study. The control group received routine Del Nido cardioplegia solution while vitamin C group received Del Nido cardioplegia solution containing 3gr of vitamin C. In this study, demographic information and variants like hemodynamic, blood, and FFP transfusion were evaluated and compared. Data were analyzed by two-way repeated measures ANOVA.

Results: According to the findings, diastolic blood pressure (DBP) in the vitamin C group was lower, which was significant across both groups (P < 0.05); however, these alterations were in the normal range. The groups showed no significant difference in other parameters like fresh frozen plasma (FFP) transfusion in the intensive care unit (ICU) and return to baseline heart rate (P > 0.05). Also, the average cardiac arrest time (average time to cardiac arrest from the time of cardioplegia injection) in the controls was significantly higher compared to the intervention group (P = 0.028).The data indicate that for CK-MB, the group effect is not statistically significant, while the effect of time and the interaction effect of group and time are significant. For troponin, the group effect and the interaction effect are not significant, although the effect of time is significant. Therefore, adding vitamin C to the cardioplegia solution does not significantly affect troponin.

Conclusion: One of the factors that contribute to myocardial protection is the reduction in the time to achieve cardiac arrest. In the group that received vitamin C, this time was reduced; therefore, it can be concluded that in this group, the risk of damage due to lack of blood flow and oxygen to the cardiac tissue is lower.

Clinical trial number: This study is a randomized clinical trial (RCT).

Irctid: IRCT20220716055477N1.