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

Background: Epicardial adipose tissue (EAT) is a metabolically active visceral fat depot surrounding the myocardium and evidence suggests its potential role in the development of cardiovascular complications in type 1 diabetes mellitus (T1DM). This systematic review and meta-analysis aimed to: (1) quantify EAT measurements (thickness and volume) in patients with T1DM, and (2) compare EAT measurements between T1DM patients and healthy controls.

Methods: A comprehensive literature review was conducted using a systematic search strategy to identify studies that measured EAT thickness or volume in T1DM patients in PubMed, Embase, Cochrane Library, Web of Science, and CINAHL. Studies were included if they: (1) involved patients with T1DM, (2) reported EAT measurements using imaging techniques, and (3) were published in English. Case reports and reviews were excluded. Two independent reviewers performed study selection, data extraction, and quality assessment. Study quality was evaluated using the Newcastle-Ottawa Scale (NOS). Statistical heterogeneity was assessed using I² statistics. Meta-analysis was performed using a random effect model.

Results: A total of nine studies involving 285 and 233 participants measuring thickness and volume with T1DM were included. The pooled mean EAT thickness was 5.81 mm (95%CI: 4.30, 7.32 mm), and the pooled mean EAT volume was 56.84cm³ (95%CI: 34.05, 79.63cm³). Significant heterogeneity was observed between the volume and thickness of EAT among people with T1DM (I² = 99% for volume and 95% for thickness). Subgroup analysis revealed a mean difference of 2.12 mm (95%CI: 0.82, 3.43 mm) in EAT thickness between T1DM and control groups.

Conclusions: Our findings indicate increased EAT measurements in T1DM patients compared to healthy individuals, suggesting EAT's potential involvement in T1DM-related cardiovascular issues.

Background: Congenital heart diseases (CHDs) represent a significant healthcare challenge with incidence rates of 17.9 per 1000 live births. Extracorporeal membrane oxygenation (ECMO) has become an invaluable therapeutic option providing essential aid to support both cardiac as well as pulmonary failure.

Methods: A systematic search was performed using PubMed, Embase, and Scopus from 2000 till date. Observational studies involving pediatric patients with CHD undergoing cardiac surgery using ECMO were included. The main outcomes were to determine short-term mortality, weaning off ECMO, complications, hospital and ICU length of stay, and indications for ECMO. Assessment of the risk of bias of included studies was done by Newcastle-Ottawa scale.

Results: 24 retrospective observational studies, encompassing 1,658 patients, were ultimately included in our review. The overall incidence of mortality across these studies was 45.2%. Successful weaning from ECMO was achieved in 73.9% of patients. The most frequently reported complications included bleeding, which affected 42.9% of patients, renal failure in 42.5%, and sepsis in 27.5%. The mean duration of hospital stay was 47.8 ± 41.1 days, while the mean length of stay in the ICU was 33.4 ± 32.6 days.

Conclusions: ECMO benefits pediatric heart patients but comes with risks like bleeding and high mortality. Percutaneous techniques can reduce complications; more research on minimally invasive approaches is needed.

Background: Situs inversus with dextrocardia (SI-DC) is rarely associated with congenital heart defects. Traditionally, ventricular septal defect (VSD) in such patients has been managed surgically. Percutaneous VSD device closure in SI-DC, albeit a suitable alternative, has been seldom reported. The present report describes the unique challenges of mirror-image cardiac anatomy and suggests technical modifications for successful percutaneous closure. A 4-year-old boy, previously diagnosed with SI-DC and a moderate-size perimembranous VSD, presented with a history of poor weight gain and dyspnea. A 2D echocardiogram indicated that the septal defect was suitable for device closure. The procedure was adapted to account for the altered cardiac anatomy by adjusting the fluoroscopic angles and wire-torquing maneuvers. A Konar-multifunction occluder device MFO® 7-5mm was successfully deployed via retrograde approach without complications utilizing hemodynamic and echocardiographic guidance. No excess contrast volume or fluoroscopic radiation dose was used during the procedure due to meticulous pre-procedure planning.

Conclusion: VSD device closure in atypical scenarios like SI-DC is both safe and feasible with thorough pre-procedure planning tailored to the "mirror image" cardiac anatomy.

Background: TEER has revolutionized mitral regurgitation treatment, addressing clinical burden in aging patients. However, thrombotic complications may still occur.

Case presentation: An 83-year-old man with severe mitral regurgitation underwent a MitraClip procedure. A large molding thrombus was observed during the procedure, despite a targeted ACT. To prevent cerebral embolization, two carotid filters were placed. The procedure was successfully completed, and mitral regurgitation was reduced. The patient was stable during the procedure, with no evidence of pulmonary or cerebral embolism.

Conclusions: The case highlights the importance of close observation and multidisciplinary decision-making in managing acute thrombus during TEER. Further research is needed to establish the potential role of cerebral protection devices and the effect of anticoagulation procedures on thrombus formation.

Background: Statins remain foundational in the prevention and treatment of atherosclerotic cardiovascular disease (ASCVD). However, despite optimal statin therapy, a significant residual risk of ASCVD persists, highlighting the need for novel lipid-lowering strategies targeting both low-density lipoprotein cholesterol (LDL-C) and other atherogenic lipoproteins. Over the last decade, a new generation of pharmacological agents has been developed to enhance dyslipidemia management beyond traditional statins.

Main body: Bempedoic acid, a prodrug activated in the liver, inhibits ATP-citrate lyase (ACLY), an enzyme upstream of HMG-CoA reductase in the cholesterol synthesis pathway. This action reduces hepatic cholesterol synthesis and simultaneously upregulates LDL receptor expression, promoting enhanced LDL-C clearance. These dual actions provide a statin-independent approach to LDL-C reduction, particularly beneficial for patients with statin intolerance. In addition, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, including monoclonal antibodies and siRNA-based therapies, have shown robust LDL-C-lowering effects by preventing LDL receptor degradation, leading to a significant reduction in cardiovascular risk. Other innovative lipid-modifying approaches include antisense oligonucleotides targeting apolipoprotein C3, angiopoietin-like protein 3, and lipoprotein(a) [Lp(a)]-such as pelacarsen and olpasiran-which demonstrate promising results in addressing genetically driven dyslipidemias. Additionally, strategies aimed at enhancing apolipoprotein A1 and promoting high-density lipoprotein functionality are under investigation, although clinical validation remains ongoing.

Conclusion: This review underscores the evolving landscape of lipid-lowering therapies, with emphasis on agents acting through novel mechanisms beyond statin pathways. Bempedoic acid, by inhibiting ACLY and increasing LDL receptor expression, represents a safe and effective option for reducing LDL-C, especially in statin-intolerant individuals. PCSK9 inhibitors further expand therapeutic options by augmenting LDL receptor recycling and clearance. The integration of these agents into clinical practice may help mitigate residual cardiovascular risk and personalize treatment strategies in dyslipidemia management.

Background: Dextro-transposition of the great arteries with intact ventricular septum (d-TGA/IVS) requires early arterial switch operation (ASO) to preserve left ventricular function, but delayed presentations complicate outcomes due to LV regression and hypoxemia. Alternative bridging strategies are essential for late-presenting patients to improve surgical feasibility.

Case report: We present a six-month-old male patient with dextrocardia, situs inversus, d-TGA/IVS who experienced persistent cyanosis despite prior balloon atrial septostomy (BAS). On admission, the patient exhibited severe hypoxemia (SpO₂ 33%), metabolic acidosis, and LV regression (LV mass index: 36-41 g/m2). Echocardiography confirmed a restrictive atrial septal defect (3.5 mm) and the absence of a patent ductus arteriosus (PDA). Given the prohibitive risk of immediate ASO, an emergency transcatheter intervention was performed. PDA recanalization was attempted. Following successful wire passage, balloon angioplasty and stent deployment restored systemic-to-pulmonary shunting, improving oxygen saturation to 56%. To further augment intercirculatory mixing, a 10.0 mm × 29 mm Omnilink Elite stent was implanted across the interatrial septum, increasing oxygen saturation to 85%. The patient demonstrated stable post-procedural hemodynamics and was subsequently bridged to elective ASO, which was performed successfully after two months.

Conclusion: Transcatheter PDA recanalization and interatrial septal stenting represent a viable bridge to ASO in late-presenting d-TGA/IVS patients. This minimally invasive approach expands treatment options in resource-limited settings where early surgical intervention is not always feasible.

Introduction: The study aimed to evaluate the effects of a cardiac rehabilitation program based on physical exercise and the promotion of healthy habits on anxiety, depression, and health-related quality of life in patients with cardiovascular conditions. Additionally, it sought to analyze the influence of baseline anxiety and depression levels on post-treatment health-related quality of life outcomes.

Methods: A longitudinal study was conducted with 189 patients who completed a structured cardiac rehabilitation program. Anxiety and depression were assessed using the Goldberg Anxiety and Depression Scale, while health-related quality of life was measured with the RAND-36 survey. Data were collected pre- and post-intervention. Statistical analyses included paired t tests for pre/post-comparisons and ANCOVA to evaluate the impact of initial anxiety and depression on health-related quality of life improvements.

Results: The cardiac rehabilitation program significantly reduced anxiety (mean difference =  - 0.93, CI: - 1.42 to - 0.44, p < 0.001; Cohen's d = 0.35) and depression (mean difference =  - 0.62, CI: - 0.99 to - 0.25, p < 0.001; Cohen's d = 0.32), with improvements observed across several health-related quality of life dimensions, including emotional well-being (p = 0.005) and energy/fatigue (p < 0.001). Baseline anxiety and depression levels influenced changes in specific health-related quality of life dimensions, such as social functioning and role limitations due to physical health (p < 0.05). Causal interpretations are limited by the observational design and absence of a control group.

Discussion: The results show an association between participation in cardiac rehabilitation programs and a reduction in anxiety and depression, as well as improved health-related quality of life in patients with cardiovascular disease. Baseline psychological status plays a key role in determining the magnitude of health-related quality of life improvements, highlighting the need for tailored interventions.

Background: Airway closure occurs in small airways and disconnects distal airways from proximal airways. This pathology may lead to acute pulmonary edema, worsening gas exchange and creating challenges in ventilator management.

Case presentation: We report the case of a 68-year-old woman who was admitted to the hospital because of non-ST elevation acute myocardial infarction and was subsequently intubated because of refractory pulmonary edema. The low-flow inflation procedure revealed airway closure, and the positive end-expiratory pressure was titrated according to the airway opening pressure.

Conclusions: Acute pulmonary edema may be accompanied by airway closure. A simple bedside procedure can indicate the presence of this complication and guide positive end-expiratory pressure setting.

Background: Restrictive cardiomyopathy (RCM) is characterized by increased myocardial stiffness, impaired diastolic filling, and preserved systolic function until advanced stages. Cardiac magnetic resonance imaging (CMR) provides precise strain analysis and tissue characterization, yet its prognostic value in idiopathic RCM remains underexplored. This study aims to evaluate the prognostic significance of CMR parameters, particularly myocardial strain and late gadolinium enhancement (LGE), in predicting outcomes in patients with idiopathic RCM.

Results: Patients demonstrated moderately impaired strain values, with global longitudinal strain (GLS) measured at -10.59 ± 4.64% and global circumferential strain (GCS) at -14.50 ± 4.98%, while maintaining preserved biventricular ejection fractions. LGE was present in 40% of patients. A GLS value greater than -9.5% independently predicted mortality (odds ratio [OR]: 1.195, p = 0.044) and heart failure (HF) hospitalization (OR: 1.152, p = 0.013). Additionally, LGE emerged as a strong independent predictor of both mortality (OR: 6.340, p = 0.004) and HF hospitalization (OR: 4.654, p = 0.001).

Conclusions: CMR is a valuable tool for prognostication in idiopathic RCM. GLS and LGE are independent predictors of adverse outcomes.

Background: Ascending aortic pseudoaneurysm is a rare but potentially fatal complication following cardiac surgery. Its management is particularly challenging in elderly or frail patients due to the high risk associated with repeat sternotomy. This case is notable for the successful use of a transcatheter approach to treat a pseudoaneurysm arising just above a sutureless aortic valve bioprosthesis-an unusual anatomical location that poses unique technical challenges.

Case presentation: An 83-year-old man with a history of hypertension underwent surgical aortic valve replacement with a large-size sutureless bioprosthetic valve. Five months later, he presented with chest heaviness. Imaging with computed tomography angiography and aortography revealed an ascending aortic pseudoaneurysm located 1.5 cm above the upper edge of the prosthetic valve frame. Due to his advanced age and stable clinical condition, a percutaneous approach was selected. Access was obtained via the right femoral artery, and angiography was performed using a pigtail catheter. An initial attempt to close the defect with a 22 mm atrial septal defect occluder failed due to inadequate anchoring. A 32 mm device was then successfully deployed, sealing the pseudoaneurysm without interfering with valve function. The patient remained hemodynamically stable throughout the procedure and had an uneventful recovery. Follow-up imaging at six months confirmed stable device positioning, complete exclusion of the pseudoaneurysm from systemic circulation, and no thrombus formation. The patient remained asymptomatic.

Conclusions: This case demonstrates that transcatheter closure of ascending aortic pseudoaneurysms is a viable and safe alternative to surgical repair in selected high-risk patients. The successful use of an atrial septal defect occluder above a sutureless aortic valve prosthesis highlights the adaptability of percutaneous closure devices and the importance of individualized procedural planning. This approach may expand treatment options for patients otherwise considered inoperable.