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

Background: The ideal treatment strategy for spontaneous coronary artery dissection (SCAD) remains unclear, with patients potentially treated with either conservative medical care or a revascularization approach.

Methods: We performed a systematic review and meta-analysis adhering to PRISMA 2020 guidelines. Inclusion criteria involved studies with confirmed SCAD diagnosis, reporting initial management strategies, and original research with ≥ 10 participants. Random-effect models were applied for insignificant heterogeneity with significance at p ≤ 0.05. Sensitivity analysis and funnel plots assessed potential publication bias.

Results: Our analysis found no significant differences in major adverse cardiac events (MACE) (OR = 0.61, p = 0.49), unstable angina pectoris (UAP) (OR = 1.04, p = 0.93), non-ST segment elevation myocardial infarction (NSTEMI) (OR = 1.16, p = 0.82), recurrent myocardial infarction (MI) (OR = 0.78, p = 0.56), stroke (OR = 0.35, p = 0.07), heart failure (OR = 0.41, p = 0.24), in-hospital mortality (OR = 0.35, p = 0.09), post-discharge mortality (OR = 1.66, p = 0.27), or ST segment elevation myocardial infarction (STEMI) (OR = 0.45, p = 0.23) between conservative management and revascularization procedures. However, sensitivity analysis reveals significant decreases in odds of inferior wall STEMI (OR = 0.41 [95% CI 0.17-0.97], p = 0.04) and heart failure (OR = 0.18 [95% CI 0.06-0.54], p = 0.002) in conservative treatment compared to revascularization group.

Conclusion: Conservative therapy significantly decreased inferior wall STEMI and heart failure as compared to revascularization in SCAD. Although no significant differences in cardiovascular outcomes, sensitivity analysis highlights potential benefits of conservative management.

Background: Myocardial deformation by speckle tracking echocardiography provides valuable information on the left ventricular function. The study aims to assess myocardial deformation in terms of left ventricular strain as an indicator of myocardial function in children after cardiac surgery at outpatient follow-up visits.

Methods: The study design was a prospective observational cross-sectional study that included pediatric patients after biventricular cardiac surgery during the postoperative follow-up visits in the outpatient department. In addition to conventional echocardiographic examination, two-dimensional speckle tracking echocardiography was done to evaluate myocardial deformation in terms of left ventricular strain. Echocardiographic measurements were done offline and were compared to published reference normal values for age. Study subjects were divided according to age at follow-up into four groups (1 month-1 year, 1-2 years, 2-5 years, and 5-11 years).

Results: Over ten months, 100 patients (64 males and 36 females) were included in the study. The median age was 30.8 months (IQR 12.8-65.3 months), the median weight was 11.7 kg (IQR 8-17 kg) and the median duration after surgery was 7.3 months (IQR 3.2-30.8 months). Longitudinal strain values were significantly (p < 0.001) lower than reference values for different age groups. Global circumferential strain showed no significant difference from the reference values. The duration after surgery had a statistically significant effect on longitudinal strain values, with improvement of the strain values with increasing intervals after surgery.

Conclusion: Using myocardial deformation method to evaluate cardiac function may detect underlying cardiac function abnormalities even with normal traditional functional parameters, which could have implications for patient management and follow-up.

Background: Mineralocorticoid receptor antagonists (MRAs) have been shown to improve outcomes in various populations of heart failure (HF) patients. However, the impact of concomitant diseases, such as diabetes mellitus (DM), on these outcomes remains unclear. This meta-analysis aimed to evaluate the efficacy and safety of MRAs in heart failure patients with and without diabetes mellitus.

Methods: A systematic search was conducted on PubMed, Scopus, and Google Scholar databases up to April 30, 2024. Data analysis was performed using a random-effects model to account for variability across studies, and statistical analysis was carried out using Review Manager 5.4. Efficacy and safety parameters were evaluated in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines.

Results: The meta-analysis included a total of 21,832 subjects from ten studies. The pooled results demonstrated that MRAs, compared to placebo, significantly reduced all-cause mortality in HF patients with and without DM (RR: 0.85; 95%CI 0.75-0.96; p = 0.009). A similar effect was observed in HF patients without DM (RR: 0.83; 95%CI 0.71-0.97; p = 0.02), while no significant effect was detected in the DM subgroup (RR: 0.87; 95%CI 0.69-1.11; p = 0.27). Both treatments had comparable effects on cardiovascular mortality in HF patients with and without DM (RR: 0.88; 95%CI 0.82-0.94; p = 0.0002), in HF patients with DM (RR: 0.90; 95%CI 0.81-1.01; p = 0.08), and in the non-DM subgroup (RR: 0.86; 95%CI 0.79-0.94; p = 0.0009). MRAs significantly reduced the risk of cardiovascular mortality in HF patients with and without DM (RR: 0.82; 95%CI 0.72-0.94; p = 0.005) and in HF patients with DM (RR: 0.79; 95%CI 0.63-0.98; p = 0.03), but no significant effect was observed in the non-DM subgroup (RR: 0.85; 95%CI 0.69-1.05; p = 0.13). Furthermore, compared to placebo, MRAs were associated with an increased risk of hyperkalemia (> 5.5 mEq/L) in HF patients with and without DM (RR: 1.63; 95%CI 1.18-2.24; p = 0.003), particularly in HF patients with DM (RR: 1.44; 95%CI 0.97-2.13; p = 0.07) and in the non-DM subgroup (RR: 1.87; 95%CI 1.34-2.61; p = 0.0002).

Conclusion: MRAs are effective in reducing all-cause mortality, cardiovascular death, and cardiovascular mortality in heart failure patients. However, the use of MRAs is associated with an increased risk of hyperkalemia, necessitating careful monitoring, particularly in patients with diabetes mellitus.

Background: Unrepaired tetralogy of Fallot (TOF) is uncommonly diagnosed in adulthood and only 3% of patients survive to reach the age of 40 without surgical repair. If unrepaired, these patients are at risk for infective endocarditis (IE).

Case presentation: In this report, we present a case of a middle-aged, previously healthy female whose only complaint was unexplained fever. Echocardiography led to the discovery of undiagnosed TOF complicated with IE with a vegetation on the right ventricular (RV) side of the ventricular septal defect (VSD) which was appropriately managed with antibiotics.

Conclusions: In rare cases of acyanotic TOF where there is a lesser degree of right ventricular outflow tract obstruction (RVOTO), patients may survive into adulthood and can be asymptomatic till becoming initially presented with complications such as infective endocarditis.

Background: Prediction of mortality in hospitalized patients is a crucial and important problem. Several severity scoring systems over the past few decades and machine learning models for mortality prediction have been developed to predict in-hospital mortality. Our aim in this study was to apply machine learning (ML) algorithms using QTc interval to predict in-hospital mortality in ACS patients and compare them to the validated conventional risk scores.

Results: This study was retrospective, using supervised learning, and data mining. Out of a cohort of 500 patients admitted to a tertiary care hospital from September 2018 to August 2020, who presented with ACS. Prediction models for in-hospital mortality in ACS patients were developed using 3 ML algorithms. We employed the ensemble learning random forest (RF) model, the Naive Bayes (NB) model and the rule-based projective adaptive resonance theory (PART) model. These models were compared to one another and to two conventional validated risk scores; the Global Registry of Acute Coronary Events (GRACE) risk score and Thrombolysis in Myocardial Infarction (TIMI) risk score. Out of the 500 patients included in our study, 164 (32.8%) patients presented with unstable angina, 148 (29.6%) patients with non-ST-elevation myocardial infarction (NSTEMI) and 188 (37.6%) patients were having ST-elevation myocardial infarction (STEMI). 64 (12.8%) patients died in-hospital and the rest survived. Performance of prediction models was measured in an area under the receiver operating characteristic curve (AUC) ranged from 0.83 to 0.93 using all available variables compared to the GRACE score (0.9 SD 0.05) and the TIMI score (0.75 SD 0.02). Using QTc as a stand-alone variable yielded (0.67 SD 0.02) with a cutoff value 450 using Bazett's formula, whereas using QTc in addition to other variables of personal and clinical data and other ECG variables, the result was 0.8 SD 0.04. Results of RF and NB models were almost the same, but PART model yielded the least results. There was no significant difference of AUC values after replacing the missing values and applying class balancer.

Conclusions: The proposed method can effectively predict patients at high risk of in-hospital mortality early in the setting of ACS using only clinical and ECG data. Prolonged QTc interval can be used as a risk predictor of in-hospital mortality in ACS patients.

Background: The perioperative use of the Impella 5.5 has been increasing recently; however, the left ventricular perforation by this device during surgery has not been reported to date.

Case presentation: Postinfarction ventricular septal rupture in a 75-year-old man was successfully repaired with support of a single Impella 5.5 device used for consecutive 28 days perioperatively. The patient underwent surgery after 16 days of Impella support. During surgery, the Impella was left in place expecting its use for left ventricular unloading after the operation. After aortic cross-clamp, when the apex was carefully lifted, the tip of the Impella almost protruded from the posterior wall, and could be seen through the epicardium. The aorta was unclamped briefly, the Impella was pulled out several centimeters, and the aorta was cross-clamped again. The ventricular septal rupture was repaired by the double-layer patch technique via the right ventricle. Immediately before the chest closure, the free wall of the LV ruptured and blood rapidly flowed out. It was where the Impella almost protruded during cardiac arrest, and was repaired with a pledgeted monofilament mattress suture.

Conclusions: A single device can be used throughout perioperative periods; however, if used during surgery, possible risk of left ventricular perforation should be well recognized since the device has no soft pigtail part at its end, and its stiff tip can directly contact the decompressed, flaccid ventricular wall during cardiac arrest.

Background: Emergency percutaneous coronary intervention (PCI) is a common treatment for ST-elevated myocardial infarction (STEMI) patients. However, the coronary slow flow/no reflow phenomenon (CSF/NRP) can occur as a complication during or after the procedure. Identifying predictors of CSF/NRP after emergency PCI in STEMI patients can help clinicians anticipate and prevent this complication. In this study, we aimed to investigate clinical, laboratory, and procedural factors that may contribute to the development of CSF/NRP in STEMI patients undergoing PCI.

Results: A total of 460 patients were included in this study, with a mean (± SD) age of 60 ± 12.5 years. The incidence of CSF/NRP was 30.2% (n = 139) among the study population. The univariate analysis showed that older age, lower left ventricular ejection fraction (LVEF), initial thrombolysis in myocardial infarction (TIMI)flow grade 0-2, increased creatinine level, lower estimated glomerular filtration rate (eGFR), diffuse target lesion length, and longer length of stent were significantly associated with the occurrence of CSF/NRP (p < 0.05). However, in the multivariate logistic regression model, only eGFR (OR = 0.98, 95% CI: 0.96-0.99, p = 0.005), diffuse target lesion length (OR = 2.15, 95% CI: 1.20-3.83, p = 0.009) and LVEF (OR = 0.96, 95% CI: 0.94-0.98, p = 0.004) remained significant predictors of CSF/NRP.

Conclusions: The present study demonstrated that diffuse lesion length, lower LVEF, and lower eGFR can be considered as independent predictors of CSF/NRP in STEMI patients.

Background: Developmental abnormalities of aortic valve cusps are relatively common with the bicuspid valve being the most frequently encountered congenital heart disease. However, the quadricuspid aortic valve (QAV) is an exceedingly rare abnormality.

Case presentation: We report a case involving a young, otherwise healthy male who presented with non-exertional syncope and was subsequently diagnosed with complete heart block (CHB). Further evaluation revealed the coexistence of a rare quadricuspid aortic valve and CHB. This combination, in the absence of surgery or infective endocarditis, has only been reported once before in the literature.The patient underwent successful permanent pacemaker implantation and continues to be monitored for aortic regurgitation.

Conclusions: The coexistence of a QAV with CHB, in the absence of infective endocarditis or aortic valve surgery, is extremely rare and necessitates careful evaluation and follow-up.

Background: The purpose of this study is to compare the clinical results of Left Atrial Appendage Closure (LAAC) and oral anticoagulation (OAC) in individuals with AF.

Methods: For randomized controlled trials (RCTs) comparing the clinical results of OAC to LAAC in patients with atrial fibrillation (AF), we searched PubMed, ScienceDirect, and Cochrane. The included publications were subjected to meta-analyses using Review Manager v5.4.

Results: In comparison to OAC, LAAC was linked with a decreased incidence of all stroke (OR 0.68; 95% CI 0.55-0.84; p = 0.0004). LAAC was also linked to a decreased risk of hemorrhagic stroke (OR 0.20, 95% CI 0.07-0.55; p = 0.002). There is no statistically significant difference between the two groups in terms of ischemic stroke (OR 1.05; 95% CI 0.59-1.84; p = 0.88) or systemic embolization (OR 1.02; 95% CI 0.42-2.46; p = 0.97).

Conclusions: According to our meta-analysis, the LAAC was less likely than the OAC to have a complete or hemorrhagic stroke. For the two groups, however, there was no difference in the risk of ischemic stroke or systemic embolization.

Background: Brugada syndrome (BrS) is associated with an increased risk of sudden death caused by ventricular arrhythmias. The characteristic electrocardiographic appearance of ST-segment elevation of more than 2 mm with coved-type morphology in more than 1 right precordial lead is seen. Hypokalemia is known to unmask the Brugada type-1 pattern, but its exact role and mechanisms in this context are not well understood.

Case presentation: We report a case of first-time diagnosis of BrS in a 51-year-old man with hypokalemia 2.8 mmol/L. Despite the normalization of potassium levels with potassium chloride (KCL), the Brugada type-1 pattern persisted on ECG. Interestingly, the corrected QT interval was shorter during hypokalemia (QTc 390 ms) compared to when potassium levels were normal (QTc 432 ms).

Conclusions: This case highlights that hypokalemia can unmask the Brugada type-1 electrocardiographic pattern, but does not alter it once unmasked. The observed shorter QT interval during hypokalemia challenges the assumption that QT prolongation is the sole mechanism by which hypokalemia influences Brugada syndrome. This underscores the need for further research into additional mechanisms by which hypokalemia might trigger ventricular arrhythmias in Brugada syndrome.