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

Background: Artificial intelligence (AI) is a modern tool that increases the diagnostic precision of the classical electrocardiogram (ECG). The objective of this bibliometric analysis was to identify the 50 most cited articles in the domain of AI in ECG, emphasizing publication trends, citation metrics, prominent authors and journals, leading institutions, and significant contributing countries.

Results: The 50 most cited articles on AI in ECG were published between 2000 and 2020 across 25 journals. The mean citations per article were 488.0, with the highest citations count being 1870. 'IEEE Transactions on Biomedical Engineering' and 'Computers in Biology and Medicine' published the highest number of articles, while Rajendra Acharya U and RS Tan were the most contributing authors. The USA and China had a total of 14 publications, and Singapore was the country with most collaborations.

Conclusions: This bibliometric analysis provides clinicians and researchers with an overview of evolution and progression of AI in the domain of ECG. Improved collaborations among different countries and institutions are essential for achieving advancements in the utilization of AI in ECG.

Background: Among the various paediatric congenital heart disease pathologies, aneurysm of the right atrium represents a relatively uncommon condition and is characterised by a variety of progressive rhythm irregularities. While a number of cardiac surgical institutions advocate for medication in such cases, others persist in supporting radical surgical correction.

Case presentation: This paper presents a clinical case in which radical surgical correction was successfully performed on a rare large aneurysm of the right atrium, associated with supraventricular tachycardia, in an 8-year-old patient.

Conclusions: An aneurysm of the RA is an extremely rare cardiac anomaly with a variable clinical presentation. Despite the availability of a conservative treatment approach, surgical correction remains the preferred option at the majority of cardiac surgery centres. This is not only to prevent the development of complications but also to achieve successful correction of RA aneurysms.

Background: Kawasaki disease (KD) is a rare systemic inflammatory disease primarily affecting children under 5 years of age, with very few cases reported in adults. This condition is characterized by potential coronary involvement, including aneurysms and gastrointestinal manifestations, such as pancreatitis.

Case presentation: A 21-year-old man presented with a febrile rash, fever, conjunctivitis, and acute pancreatitis. Imaging revealed coronary artery aneurysms. Treatment with intravenous immunoglobulins, aspirin, and corticosteroids led to significant clinical improvement.

Conclusions: This case underscores the rare occurrence of Kawasaki disease in adults, particularly with both pancreatic and coronary artery involvement. The effective use of immunoglobulins and corticosteroids highlights the importance of early diagnosis and treatment in managing this rare condition in adults.

Background: Myocardial infarction (MI) continues to pose a significant global healthcare burden despite advances in treatment options and their effectiveness. The incidence, prevalence, and mortality rates associated with MI are rising, emphasizing the need for improved therapeutic strategies. Traditional invasive surgical methods, aimed at recanalizing blood flow to the coronary arteries, have proven insufficient in fully addressing the complexities of MI. This ongoing challenge necessitates the exploration of novel approaches to enhance treatment efficacy and outcomes for MI patients.

Main text: One promising approach is the use of nanoparticle delivery systems for targeted therapy to the infarct site. When conventional methods fail to achieve adequate permeability and retention, nanoparticle strategies offer a potential solution. Functionalizing nanoparticles is a particularly effective technique, allowing these particles to conjugate with specific ligands. These ligands possess the intrinsic ability to selectively bind to receptors that are overexpressed or uniquely present at the infarct site, thereby conferring "smartness" to the nanoparticle constructs. This review delves into the various strategies employed in nanoparticle-ligand functionalization, highlighting the versatility and potential of these approaches. It provides a detailed cross section of several ligand classes, each with unique properties and binding affinities that make them suitable for targeted delivery in the context of MI. The focus is on identifying ligands that are either unique to the infarcted myocardium or significantly upregulated during MI, ensuring precise and efficient targeting of therapeutic agents.

Conclusion: In summary, while traditional surgical methods for restoring blood flow in MI patients remain important, they are not sufficient on their own. By leveraging the specificity of these ligands, nanoparticles can be directed precisely to the infarct site, enhancing the delivery and efficacy of therapeutic agents. This review underscores the need for continued research into nanoparticle-ligand functionalization strategies, aiming to improve outcomes for MI patients and reduce the global burden of this condition.

Background: Heart valve diseases affect over 100 million people globally, with mitral regurgitation being the most common in developed countries. Bioprosthetic heart valves, frequently used for replacement, typically last 10-15 years before degeneration. Repeat open-heart surgery for valve replacement poses high risks, especially in older or high-risk patients. Following the success of transcatheter aortic valve replacement, transcatheter mitral valve-in-valve replacement has emerged as a less invasive alternative for patients deemed inoperable due to high surgical risks.

Case presentation: We report the case of a 69-year-old male with a history of mitral bioprosthetic valve replacement and thoracic radiotherapy who presented with shortness of breath and NYHA class 3 functional capacity. Echocardiography revealed bioprosthetic valve dysfunction with a mean gradient of 13 mmHg and pulmonary artery pressure of 70 mmHg. Given his high surgical risk (The Society of Thoracic Surgeons score 10.9%, EuroScore2 9.8%) and prior thoracic radiotherapy, a transcatheter valve-in-valve procedure was planned. A 29 mm MyVal valve was successfully implanted via a transseptal approach, resulting in complete resolution of mitral regurgitation and a mean gradient of 3 mmHg post-procedure. The patient was discharged without complications and reported improved functional capacity (NYHA class 1) at follow-up.

Conclusion: This case highlights the successful application of transcatheter valve-in-valve replacement for a patient with bioprosthetic mitral valve dysfunction who was at high surgical risk. The procedure, performed using a transseptal approach with a 29 mm MyVal valve, resulted in significant symptomatic and hemodynamic improvement with no complications. The patient's functional capacity improved dramatically, and follow-up imaging confirmed the effective functioning of the new valve. This case supports the viability of transcatheter techniques as a preferred alternative for inoperable patients with mitral valve dysfunction, contributing valuable insights to the growing field of minimally invasive cardiac interventions. As technology advances, transcatheter solutions are expected to offer safer and more effective treatments for bioprosthetic valve failures.

Background: Cancer breast is the most common malignancy worldwide in females and is commonly treated using regimens based on anthracycline therapy. Cardiac complications related to breast cancer treatment using chemotherapy can manifest as either acute, subacute, or chronic dysfunction of the heart. Most of the signs of cardiotoxicity are subclinical. Our study aimed to evaluate left atrial strain (LAS) changes before and after anthracycline-based therapy in patients with breast cancer. One hundred and twenty patients with invasive breast cancer stages I-III eligible to receive anthracycline-based chemotherapy were enrolled in the study. We used doxorubicin 60 mg/m² plus cyclophosphamide 600 mg/m² every three weeks for 3-4 cycles. Every patient completed at least two echocardiograms: baseline and after each chemotherapy cycle.

Results: We initially enrolled 120 patients in this observational cohort prospective study. Twenty-six patients were excluded. All LAS measures were significantly reduced at follow-up with a significant positive correlation with left ventricular global longitudinal strain. 56.4% of our patients were hypertensive, and 81% of hypertensive patients received angiotensin-converting enzyme inhibitors (ACEI). The subgroup of patients who received ACEI for treatment of HTN had a lower rate of left atrial strain changes following anthracycline therapy compared with non-ACEI-treated patients, either hypertensive or not.

Conclusion: We concluded that LAS deteriorated usually after anthracycline treatment, and it predicted early chemotherapy-induced cardiotoxicity.

Hypertrophic cardiomyopathy (HCM) is a common inherited cardiac disorder associated with significant morbidity. The role of high-intensity exercise in HCM remains controversial due to concerns about potential adverse effects. This study aims to conduct a systematic review of experimental and observational studies to evaluate the effects of high-intensity training (HIT) on patients diagnosed with HCM. This systematic review was conducted according to the Preferred Reporting Items in the Systematic Review and Meta-analysis Guidelines 2020. A comprehensive search was performed using Proquest, Pubmed, Scopus, and JSTOR databases to identify relevant studies published up to March 2024. Both experimental and observational studies written in English were included in the study. No restrictions were placed on the year, country of publication, or duration of follow-up. Study quality was evaluated using the Effective Public Health Practice Project (EPHPP) tool. A narrative synthesis was also conducted to summarize the findings. A total of 1418 references were identified through the search strategy. After removing 151 duplicates, 1267 records were screened based on title and abstract, resulting in the exclusion of 1253 studies. The full text of 14 articles was assessed for eligibility, of which ten were excluded. Four papers with a total of 2008 sample sizes were included. Significant differences were observed in several echocardiographic parameters. HCM athletes exhibited higher left ventricular end-diastolic volume (96 ± 33 vs. 76 ± 27 mL; p = 0.001, effect size = 0.682) and stroke volume (58 ± 21 vs. 47 ± 17 mL; p = 0.004, effect size = 0.593) compared to non-athletes. Additionally, significant differences were found in left ventricular outflow tract (LVOT) gradients: both resting (p < 0.001, effect size = - 0.192) and provoked (p < 0.001, effect size = - 0.258) LVOT gradients were significantly lower in the vigorous exercise group compared to the non-vigorous exercise group. In contrast, no significant differences were found between HIT and the comparator group in vital signs and functional aerobic capacity. Moreover, no significant differences were observed in arrhythmias, cardiac arrest, or mortality, suggesting that HIT did not increase the risk of arrhythmias or other adverse events compared to the comparator group. HIT improves cardiac function and exercise capacity in patients with HCM without increasing the risk of severe adverse events. These findings support reconsidering the guidelines on physical activity restrictions for individuals with HCM.

Objectives: Brugada syndrome (BrS) is a hereditary channelopathy that affects cardiac electrical signal transmission, with SCN5A gene mutation being the most common cause. Current BrS therapy primarily relies on Implantable Cardioverter Defibrillators, which are limited to arrhythmia prevention. Recent research has explored gene therapy as an alternative approach for managing BrS. Resveratrol, a non-ketone polyphenol compound, exhibits cardioprotective effects due to its antioxidant properties, which can influence gene expression through cellular signaling pathways, thereby modulating adeno-associated virus (AAV). This study aims to evaluate the effectiveness of resveratrol in enhancing the induction of AAV-based viral vectors as a potential definitive therapy for SCN5A mutations in BrS patients.

Methods: A comprehensive literature search was conducted across multiple databases, including PubMed, Google Scholar, ScienceDirect, and PLOS ONE. The final stage involved assessing the eligibility of 47 studies, followed by a full-text review, which included seven studies for further analysis.

Results: The findings indicate that this therapeutic approach highlights resveratrol's crucial role as an activator of deacetylase proteins, influencing DNA repair processes, cell cycle regulation, and energy metabolism. Resveratrol facilitates the modulation of Voltage-Gated Calcium Channels, enabling calcium ion (Ca²⁺) influx into cardiomyocytes, thereby maintaining normal cardiac rhythm. Resveratrol enhances AAV-mediated gene delivery and expression through p53 pathway activation.

Conclusion: Experimental studies have demonstrated that AAV-MOG1 gene therapy can restore sodium channel function, improve cardiac electrophysiological abnormalities, and ameliorate the clinical manifestations of BrS. Thus, resveratrol is potentially an inducer of AAV-mediated gene therapy for BrS.

Background: This systematic review investigates the effect of small interfering RNA (siRNA) therapies on lipoprotein(a) [Lp(a)] levels. The purpose is to evaluate the outcomes of recent randomized controlled trials (RCTs) involving siRNA treatments aimed at lowering Lp(a) levels, a known cardiovascular risk factor.

Methods: A comprehensive search across multiple databases was conducted, identifying 20 published and ongoing RCTs that examined the effects of siRNA therapies such as inclisiran, olpasiran, and SLN360 on Lp(a) levels. The included studies were analyzed to assess Lp(a) reductions and other lipid-related outcomes.

Results: The RCTs demonstrated significant reductions in Lp(a) levels following siRNA therapy. Additional reductions were noted in LDL-c and apolipoprotein B levels. Side effects were typically mild, including injection site reactions.

Conclusions: siRNA therapies show promise in effectively lowering Lp(a) levels, with minimal adverse effects. However, further research is required to establish their long-term safety and efficacy.

Background: Ventricular septal rupture (VSR) is a rare but life-threatening complication following myocardial infarction (MI). While traditional management typically involves surgical repair, percutaneous closure techniques are increasingly being considered, particularly in cases where surgery is challenging or patients are high risk.

Case presentation: We present the case of a 62-year-old male with anterior ST-segment elevation MI, complicated by a large VSR. Transthoracic echocardiography (TTE) revealed an 11.8-mm VSR, hypokinetic anteroseptal and anterior walls, and an ejection fraction of 52%. Surgical repair was considered high risk due to the patient's advanced age, hypertension, anterior MI and apical VSR. Consequently, the heart team opted for a transjugular percutaneous closure approach. A 20-mm ASD occluder device was successfully deployed across the defect, as confirmed by cineangiography. Post-procedure, the patient showed clinical improvement, with resolution of the murmur and stabilization of hemodynamics. Follow-up TTE demonstrated proper occluder placement with minimal residual shunt.

Conclusions: This case highlights the feasibility and effectiveness of transjugular percutaneous closure for managing complex VSR post-MI, especially in patients unsuitable for surgical repair.