Pub Date : 2021-07-27DOI: 10.5083/ejcm20424884.188
A. Sabharwal, V. Nayar, S. Salar
Introduction: The adverse prognosis of heart failure (HF) correlates with both N-terminal pro-B-type natriuretic peptide (NT-proBNP) and ferritin. The contribution of an underlying inflammatory process in the pathogenesis of HF is not only evidenced by increased ferritin (acute phase reactant), but also a reduced haemoglobin (Hb) due to cytokine-mediated bone marrow suppression. However, it remains unknown if there is a linear relationship between NT-pro BNP with ferritin and Hb levels. Objective: To determine an association between very elevated levels of NT-proBNP (>10,000pg/ ml) with Hb and ferritin in patients with HF. Methods: A retrospective, cross-sectional study to evaluate levels of ferritin and Hb among patients with very high NT-proBNP levels (>10,000pg/ml) treated at a district hospital serving a population of 500,000 people. Inclusion criteria: in-patient between October to December 2020, diagnosis of HF, NT-proBNP level >10,000 pg/ml, measured haemoglobin and ferritin level within 7 days of NT-proBNP measurement. Results: Forty-five patients met all of the inclusion criteria. Mean age 81 years ± 12 years. There was a positive correlation between NT- proBNP with ferritin and a negative correlation between NT-proBNP and Hb. With NT-proBNP on the x-axis and Hb on the y-axis, the trend line equated y = -0.0003x + 124.88. With NT-proBNP on the x-axis and ferritin on the y-axis, the trend line equated y = 0.0043x + 311.6. Conclusion: With rising levels of NT-proBNP, Hb levels decrease and ferritin levels increase in a linear manner, simultaneously. Larger studies are required to confirm this observation and to investigate the clinical implications of these findings.
{"title":"The Association of N-terminal Pro-B-Type Natriuretic Peptide with Haemoglobin and Ferritin in Heart Failure Patients","authors":"A. Sabharwal, V. Nayar, S. Salar","doi":"10.5083/ejcm20424884.188","DOIUrl":"https://doi.org/10.5083/ejcm20424884.188","url":null,"abstract":"Introduction: \u0000The adverse prognosis of heart failure (HF) correlates with both N-terminal pro-B-type natriuretic peptide (NT-proBNP) and ferritin. The contribution of an underlying inflammatory process in the pathogenesis of HF is not only evidenced by increased ferritin (acute phase reactant), but also a reduced haemoglobin (Hb) due to cytokine-mediated bone marrow suppression. However, it remains unknown if there is a linear relationship between NT-pro BNP with ferritin and Hb levels.\u0000\u0000Objective: To determine an association between very elevated levels of NT-proBNP (>10,000pg/ ml) with Hb and ferritin in patients with HF.\u0000Methods: A retrospective, cross-sectional study to evaluate levels of ferritin and Hb among patients with very high NT-proBNP levels (>10,000pg/ml) treated at a district hospital serving a population of 500,000 people. Inclusion criteria: in-patient between October to December 2020, diagnosis of HF, NT-proBNP level >10,000 pg/ml, measured haemoglobin and ferritin level within 7 days of NT-proBNP measurement.\u0000\u0000Results: Forty-five patients met all of the inclusion criteria. Mean age 81 years ± 12 years. There was a positive correlation between NT- proBNP with ferritin and a negative correlation between NT-proBNP and Hb. With NT-proBNP on the x-axis and Hb on the y-axis, the trend line equated y = -0.0003x + 124.88. With NT-proBNP on the x-axis and ferritin on the y-axis, the trend line equated y = 0.0043x + 311.6.\u0000\u0000Conclusion: With rising levels of NT-proBNP, Hb levels decrease and ferritin levels increase in a linear manner, simultaneously. Larger studies are required to confirm this observation and to investigate the clinical implications of these findings.","PeriodicalId":75000,"journal":{"name":"The European journal of cardiovascular medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48899264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-05-02DOI: 10.5083/EJCM20424884.187
Bhende Vishal, P MajmudarHardil, Amit Kumar, R PathanSohilkhan, H PatelShradha
ABSTRACT We report an extremely rare case of a Bronchogenic Cyst incidentally identified via contrast enhanced computed tomography in a one and half-month-old male infant, a known case of Ostium Secundum Atrial Septal Defect and mild pulmonary hypertension. The patient was evaluated in detail and cystic mass resembling a Bronchogenic Cyst was found over lower paratracheal mediastinal space. The patient was planned for excision of the posterior mediastinal lesion using a right limited postero-lateral thoracotomy incision and complete excision was done and the mass was pathologically confirmed to be a Bronchogenic Cyst. This case is one of the few rare cases of infants with acyanotic congenital heart defectd that were incidentally found to have a Bronchogenic Cyst. This case to our knowledge is one of the youngest patient yet and also highlights the importance of identifying rare causes like these amongst differentials of cough and wheeze responding poorly to regular treatment.
{"title":"Bronchogenic Cyst Associated with an Ostium Secundum Atrial Septal Defect in a One and Half Month Infant: Is it the Youngest Patient Yet","authors":"Bhende Vishal, P MajmudarHardil, Amit Kumar, R PathanSohilkhan, H PatelShradha","doi":"10.5083/EJCM20424884.187","DOIUrl":"https://doi.org/10.5083/EJCM20424884.187","url":null,"abstract":"ABSTRACT\u0000\u0000We report an extremely rare case of a Bronchogenic Cyst incidentally identified via contrast enhanced computed tomography in a one and half-month-old male infant, a known case of Ostium Secundum Atrial Septal Defect and mild pulmonary hypertension. The patient was evaluated in detail and cystic mass resembling a Bronchogenic Cyst was found over lower paratracheal mediastinal space. The patient was planned for excision of the posterior mediastinal lesion using a right limited postero-lateral thoracotomy incision and complete excision was done and the mass was pathologically confirmed to be a Bronchogenic Cyst. This case is one of the few rare cases of infants with acyanotic congenital heart defectd that were incidentally found to have a Bronchogenic Cyst. This case to our knowledge is one of the youngest patient yet and also highlights the importance of identifying rare causes like these amongst differentials of cough and wheeze responding poorly to regular treatment.","PeriodicalId":75000,"journal":{"name":"The European journal of cardiovascular medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49023238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-04-13DOI: 10.5083//EJCM.20424884.186
B. Zwaenepoel, R. Roelandt, J. Backer, J. Pooter
ABSTRACT Atrial septal defects (ASD) are among the most common forms of congenital heart disease. Although surgical correction was the only available therapy for decades, its long-term complications remain unknown and many patients do not have structured medical follow-up in later life. However, increasing evidences suggest that late-onset cardiac problems, such as complete heart block (CHB), can arise after surgery and therefore, long-term follow-up should be advised in these patients. We hereby present an interesting case of CHB occurring in a 30-year-old patient who had undergone surgical secundum ASD closure approximately 21 years prior to this event and now presented with episodes of dizziness and pre-syncope. Seven-day Holter reported seven episodes of CHB, corresponding to the presenting complaints. The patient was successfully managed with conduction system pacing and he remained asymptomatic on further follow-up. The case description is followed by a brief overview of the available literature.
{"title":"Late Complete Heart Block after Surgical Repair of an Atrial Septal Defect","authors":"B. Zwaenepoel, R. Roelandt, J. Backer, J. Pooter","doi":"10.5083//EJCM.20424884.186","DOIUrl":"https://doi.org/10.5083//EJCM.20424884.186","url":null,"abstract":"ABSTRACT\u0000Atrial septal defects (ASD) are among the most common forms of congenital heart disease.\u0000Although surgical correction was the only available therapy for decades, its long-term\u0000complications remain unknown and many patients do not have structured medical follow-up in later life. \u0000\u0000However, increasing evidences suggest that late-onset cardiac problems, such\u0000as complete heart block (CHB), can arise after surgery and therefore, long-term follow-up should be advised in these patients. We hereby present an interesting case of CHB occurring in a 30-year-old patient who had undergone surgical secundum ASD closure approximately 21 years prior to this event and now presented with episodes of dizziness and pre-syncope. Seven-day Holter reported seven episodes of CHB, corresponding to the presenting complaints.\u0000\u0000The patient was successfully managed with conduction system pacing and he remained\u0000asymptomatic on further follow-up. The case description is followed by a brief overview of\u0000the available literature.","PeriodicalId":75000,"journal":{"name":"The European journal of cardiovascular medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43677672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-04-06DOI: 10.5083/EJCM20424884.185
Lisa Ferraza, P. Carvalhoa, D. Carvalhoa, Ana Faustinoa, R. Ferreiraa, Ana Briosaa
ABSTRACT Introduction: Myocarditis is often a diagnostic challenge given the heterogeneity of the clinical presentation. Cardiac magnetic resonance imaging is an important diagnostic tool required for the diagnosis as well as detecting the prognosis of the patient. Although rarely used, an endomyocardial biopsy is the gold standard diagnostic method. Clinical case: We present the case of a 29-year old man diagnosed with myocarditis who later developed severe depression of biventricular systolic function. An endomyocardial biopsy was performed, which revealed a parvovirus B19 infection. After treatment of the left ventricular dysfunction, the global systolic function was recovered.
{"title":"Myocarditis with Biventricular Dysfunction Caused by Parvovirus B19 – A case report","authors":"Lisa Ferraza, P. Carvalhoa, D. Carvalhoa, Ana Faustinoa, R. Ferreiraa, Ana Briosaa","doi":"10.5083/EJCM20424884.185","DOIUrl":"https://doi.org/10.5083/EJCM20424884.185","url":null,"abstract":"ABSTRACT\u0000\u0000Introduction: Myocarditis is often a diagnostic challenge given the heterogeneity of the clinical presentation. Cardiac magnetic resonance imaging is an important diagnostic tool required for the diagnosis as well as detecting the prognosis of the patient. Although rarely used, an endomyocardial biopsy is the gold standard diagnostic method.\u0000\u0000Clinical case: We present the case of a 29-year old man diagnosed with myocarditis who later developed severe depression of biventricular systolic function. An endomyocardial biopsy was performed, which revealed a parvovirus B19 infection. After treatment of the left ventricular dysfunction, the global systolic function was recovered.","PeriodicalId":75000,"journal":{"name":"The European journal of cardiovascular medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43431467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-03-01DOI: 10.5083/EJCM20424884.184
Savas Ozdemir, D. Roura, C. Klassen
ABSTRACT Background: Radiation dose is an important factor in performing a coronary Computed Tomography Angiography (CTA). Objective: To assess the correlation between Body Mass Index (BMI) and radiation dose in patients receiving a Coronary CTA. Methods: All retrospectively EKG gated coronary CTA studies using a 64 slice CT in patients above 18 years old, during a one-year time period were included in the study. The data was obtained by a query of the PACS system. Sixteen of the total 75 subjects were excluded due to lack of BMI or Dose length product (DLP) data or the CTA deviated from standard protocol. Seven of these patients were specifically excluded by using an x-ray tube voltage other than the standard 120 kVp. For the remaining 52 subjects, correlation and linear regression statistical analysis was used to analyze the relationship between BMI and DLP. Pearson correlation coefficient was calculated using Microsoft Excel. Results: There was a weak correlation between the BMI and DLP with a coefficient of determination value of 0.0217. Conclusion: When appropriate criteria exist for obtaining a coronary CTA, a high BMI should not deter ordering based only on high radiation dose concerns since correlation between BMI and DLP is weak.
{"title":"Correlation between Body Mass Index and Radiation Dose in Patients Undergoing Coronary Computed Tomography Angiography","authors":"Savas Ozdemir, D. Roura, C. Klassen","doi":"10.5083/EJCM20424884.184","DOIUrl":"https://doi.org/10.5083/EJCM20424884.184","url":null,"abstract":"ABSTRACT\u0000Background: Radiation dose is an important factor in performing a coronary Computed Tomography Angiography (CTA).\u0000\u0000Objective: To assess the correlation between Body Mass Index (BMI) and radiation dose in patients receiving a Coronary CTA.\u0000\u0000Methods: All retrospectively EKG gated coronary CTA studies using a 64 slice CT in patients above 18 years old, during a one-year time period were included in the study. The data was obtained by a query of the PACS system. Sixteen of the total 75 subjects were excluded due to lack of BMI or Dose length product (DLP) data or the CTA deviated from standard protocol. Seven of these patients were specifically excluded by using an x-ray tube voltage other than the standard 120 kVp. For the remaining 52 subjects, correlation and linear regression statistical analysis was used to analyze the relationship between BMI and DLP. Pearson correlation coefficient was calculated using Microsoft Excel.\u0000Results: There was a weak correlation between the BMI and DLP with a coefficient of determination value of 0.0217.\u0000\u0000Conclusion: When appropriate criteria exist for obtaining a coronary CTA, a high BMI should not deter ordering based only on high radiation dose concerns since correlation between BMI and DLP is weak.","PeriodicalId":75000,"journal":{"name":"The European journal of cardiovascular medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41405836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-23DOI: 10.5083/ejcm20424884.180
K. Jadhav, P. Jariwala
ABSTRACT Various publications have increasingly reported the development of the prothrombotic state and its consequences associated with coronavirus disease 2019 (COVID-19). Although the exact etiology is uncertain, various factors collectively increase the risk of thrombus formation in COVID-19 patients. We present a case series of four patients with left ventricular (LV) thrombus formation along with simultaneous COVID-19 infection. All these patients had acute myocardial infarction with left ventricular ejection fraction (LVEF) between 35-45%. Among the series, two patients had favourable outcomes with complete resolution of LV thrombus, whereas the other two suffered cerebral embolization followed by mortality. This study looks in depth at all cases of intracardiac thrombi formation in patients with COVID-19 published worldwide. n addition to the increased predisposition for venous/ arterial thrombosis, even a few cases of intra- cardiac thrombus have been reported. Systemic thrombolysis is an initial treatment of choice for the management of right cardiac thrombi with pulmonary thromboembolism (PTE) and ST-elevation myocardial infarction (STEMI) in COVID-19. Right cardiac thrombi have better outcomes when compared to left cardiac thrombi.
{"title":"Intra-Cardiac Thrombus in COVID-19 pandemic – Case Series and Review","authors":"K. Jadhav, P. Jariwala","doi":"10.5083/ejcm20424884.180","DOIUrl":"https://doi.org/10.5083/ejcm20424884.180","url":null,"abstract":"ABSTRACT\u0000Various publications have increasingly reported the development of the prothrombotic state and its consequences associated with coronavirus disease 2019 (COVID-19). Although the exact etiology is uncertain, various factors collectively increase the risk of thrombus formation in COVID-19 patients. \u0000\u0000We present a case series of four patients with left ventricular (LV) thrombus formation along with simultaneous COVID-19 infection. All these patients had acute myocardial infarction with left ventricular ejection fraction (LVEF) between 35-45%. Among the series, two patients had favourable outcomes with complete resolution of LV thrombus, whereas the other two suffered cerebral embolization followed by mortality. This study looks in depth at all cases of intracardiac thrombi formation in patients with COVID-19 published worldwide. \u0000\u0000n addition to the increased predisposition for venous/ arterial thrombosis, even a few cases of intra- cardiac thrombus have been reported. Systemic thrombolysis is an initial treatment of choice for the management of right cardiac thrombi with pulmonary thromboembolism (PTE) and ST-elevation myocardial infarction (STEMI) in COVID-19. Right cardiac thrombi have better outcomes when compared to left cardiac thrombi.","PeriodicalId":75000,"journal":{"name":"The European journal of cardiovascular medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45402218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-03DOI: 10.5083/ejcm20424884.179
M. Khalifa, Emad Effat Fakhr
ABSTRACT Background: Vasovagal syncope is the most common cause of cardiac related syncope. Meticulous history taking and stepladder multi- investigatory tools are necessary to detect the underlying causes. However, in view of cardiologist’s busy day, a short protocol of Head up tilt table test could save effort and money. Objective: To evaluate the effectiveness of short timed protocol of Head Up Tilt (HUT) table test versus the traditional long protocol in assessment of neuro-cardiogenic syncope. Methods: The current study was conducted among 138 patients with history of syncope or pre-syncope, referred for HUT test during the study period from February 2019 to January 2020. A complete general and local examination and 12 leads baseline ECG was carried out. Patients were randomly divided into two groups- Conventional HUT test with 15 minutes long protocol group with 75 patients and modified short HUT test (10 minutes’ protocol) group with 63 patients. Results: No significant differences were observed in the test outcomes between both groups. However, a significant difference was observed in the mean patient recovery time in short protocol (2.64±1.35 minutes) as compared to the long protocol (4.05±1.19l minutes) (P <0.001). Conclusion: Applying the short timed protocol in tilt table testing is considered as effective as doing the traditional long protocol and would not affect the test results. The short protocol improved the patient wellbeing and helped in saving time and effort.
{"title":"Head Up Tilt Table Test. Short versus Long Protocol","authors":"M. Khalifa, Emad Effat Fakhr","doi":"10.5083/ejcm20424884.179","DOIUrl":"https://doi.org/10.5083/ejcm20424884.179","url":null,"abstract":"ABSTRACT\u0000\u0000Background: Vasovagal syncope is the most common cause of cardiac related syncope. Meticulous history taking and stepladder multi- investigatory tools are necessary to detect the underlying causes. However, in view of cardiologist’s busy day, a short protocol of Head up tilt table test could save effort and money.\u0000\u0000Objective: To evaluate the effectiveness of short timed protocol of Head Up Tilt (HUT) table test versus the traditional long protocol in assessment of neuro-cardiogenic syncope.\u0000\u0000Methods: The current study was conducted among 138 patients with history of syncope or pre-syncope, referred for HUT test during the study period from February 2019 to January 2020. A complete general and local examination and 12 leads baseline ECG was carried out. Patients were randomly divided into two groups- Conventional HUT test with 15 minutes long protocol group with 75 patients and modified short HUT test (10 minutes’ protocol) group with 63 patients.\u0000\u0000Results: No significant differences were observed in the test outcomes between both groups. However, a significant difference was observed in the mean patient recovery time in short protocol (2.64±1.35 minutes) as compared to the long protocol (4.05±1.19l minutes) (P <0.001).\u0000\u0000Conclusion: Applying the short timed protocol in tilt table testing is considered as effective as doing the traditional long protocol and would not affect the test results. The short protocol improved the patient wellbeing and helped in saving time and effort.","PeriodicalId":75000,"journal":{"name":"The European journal of cardiovascular medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43826729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-09-10DOI: 10.5083/ejcm20424884.178
Wendy J Bottinor, Natalie A. Kelsey, E. Riley, John A Craycroft, M. Kong
ABSTRACT Background: Standard of care treatment for human epidermal growth factor receptor 2 (HER2) positive (HER2+) breast cancer often involves HER2 antagonism and anthracyclines. Anthracyclines and HER2 antagonists are associated with cardiotoxicity and cardiac screening is suggested. The optimal strategy for cardiac monitoring is not definitively established and the potential role of biomarkers to detect subclinical cardiotoxicity is an active area of interest within the field of cardio-oncology. Methods: This single center retrospective cohort analysis, examined the role of troponin I (Tp I) to detect subclinical cardiotoxicity and predict subsequent cardiovascular dysfunction in patients undergoing treatment for HER2+ breast cancer treated with combination trastuzumab and pertuzumab therapy. Subjects were identified by review of cardio-oncology and medical oncology clinical registries. Demographic and clinical data were obtained through chart review. Tp I absolute values and temporal trends, and subsequent decline in left ventricular ejection fraction or development of symptomatic heart failure were evaluated and compared for different chemotherapeutic regimens. Results: The incidence of Tp I elevation was significantly higher in patients treated with both anthracycline and HER2 antagonism when compared to patients treated with anthracycline or HER2 antagonism alone. In patients treated with both anthracycline and HER2 antagonism (either trastuzumab alone or in combination with pertuzumab), Tp I levels became positive (greater than 0.03 ng/mL) after the completion anthracycline therapy and 3.8 + 1.93 infusions of anti-HER2 therapy. The average peak Tp I was 0.104 + 0.05. Resolution of Tp I elevation occurred by infusion 14 + 1.94. Conclusions: Patients treated with a combination of anthracycline and HER2 antagonism, demonstrated elevated Tp I values with peak Tp I occurring after completion of anthracyclines and approximately 7 infusions of HER2 antagonist therapy.
{"title":"Using Biomarkers to Detect the Temporal Trend of Subclinical Cardiotoxicity in Patients with Breast Cancer Treated with Anthracyclines and Her2+ Antagonists","authors":"Wendy J Bottinor, Natalie A. Kelsey, E. Riley, John A Craycroft, M. Kong","doi":"10.5083/ejcm20424884.178","DOIUrl":"https://doi.org/10.5083/ejcm20424884.178","url":null,"abstract":"ABSTRACT\u0000\u0000Background: Standard of care treatment for human epidermal growth factor receptor 2 (HER2) positive (HER2+) breast cancer often involves HER2 antagonism and anthracyclines. Anthracyclines and HER2 antagonists are associated with cardiotoxicity and cardiac screening is suggested. The optimal strategy for cardiac monitoring is not definitively established and the potential role of biomarkers to detect subclinical cardiotoxicity is an active area of interest within the field of cardio-oncology.\u0000\u0000Methods: This single center retrospective cohort analysis, examined the role of troponin I (Tp I) to detect subclinical cardiotoxicity and predict subsequent cardiovascular dysfunction in patients undergoing treatment for HER2+ breast cancer treated with combination trastuzumab and pertuzumab therapy. Subjects were identified by review of cardio-oncology and medical oncology clinical registries. Demographic and clinical data were obtained through chart review. Tp I absolute values and temporal trends, and subsequent decline in left ventricular ejection fraction or development of symptomatic heart failure were evaluated and compared for different chemotherapeutic regimens.\u0000\u0000Results: The incidence of Tp I elevation was significantly higher in patients treated with both anthracycline and HER2 antagonism when compared to patients treated with anthracycline or HER2 antagonism alone. In patients treated with both anthracycline and HER2 antagonism (either trastuzumab alone or in combination with pertuzumab), Tp I levels became positive (greater than 0.03 ng/mL) after the completion anthracycline therapy and 3.8 + 1.93 infusions of anti-HER2 therapy. The average peak Tp I was 0.104 + 0.05. Resolution of Tp I elevation occurred by infusion 14 + 1.94.\u0000\u0000Conclusions: Patients treated with a combination of anthracycline and HER2 antagonism, demonstrated elevated Tp I values with peak Tp I occurring after completion of anthracyclines and approximately 7 infusions of HER2 antagonist therapy.","PeriodicalId":75000,"journal":{"name":"The European journal of cardiovascular medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45595726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-09-10DOI: 10.5083/ejcm20424884.177
M. Açıkel, Evren Işçi, Nihatcan Divarci
ABSTRACT Background: Venous vessel removal during coronary artery bypass grafting may cause undesired problems such as pain and skin infection in the surgical site. Objective: To investigate the usefulness of professional foot and wound care on the healing of saphenectomy surgical site in patients undergoing coronary artery bypass grafting (CABG). Methods: The present prospective study was conducted among 574 patients (>18 years) undergoing CABG with great saphenous vein harvesting, between May 2017 and May 2018. The patients were randomly divided into two groups based on the foot care into professional foot care group (PFCG) and the standard foot care group (SFCG) with 287 patients each. Postoperative surgical site complications were assessed on the first, second, third, fourth day, 1 week and 1 month interval. Results: The Mean age of patients in PFCG and SFCG groups was 59.71 ±9.9 and 60.34 ±11.22, respectively. Rate of Postoperative complications decreased on the follow up examinations in PFCG group as compared to SFCG group. A significant difference in the incidence of complications was observed on the fourth day (p=0.004) and after 1 month (p=0.029) of surgery between 2 groups. No significant correlation was determined between the length of the removed saphenous vein, number of arteries anastomosed and the post-saphenectomy complication rate at the first, second, third, and fourth days, at the first week, and first month in both groups except in PFCG where significant association was noted on the third postoperative day. Conclusion: Postoperative limb care by professional foot specialist decreases the postoperative complications in the surgical site.
{"title":"The Usefulness of Professional Foot and Wound Care on Post-Saphenectomy Surgical Site Complications in Patients Undergoing Coronary Artery Bypass Grafting","authors":"M. Açıkel, Evren Işçi, Nihatcan Divarci","doi":"10.5083/ejcm20424884.177","DOIUrl":"https://doi.org/10.5083/ejcm20424884.177","url":null,"abstract":"ABSTRACT\u0000\u0000Background: Venous vessel removal during coronary artery bypass grafting may cause undesired problems such as pain and skin infection in the surgical site.\u0000Objective: To investigate the usefulness of professional foot and wound care on the healing of saphenectomy surgical site in patients undergoing coronary artery bypass grafting (CABG).\u0000\u0000Methods: The present prospective study was conducted among 574 patients (>18 years) undergoing CABG with great saphenous vein harvesting, between May 2017 and May 2018. The patients were randomly divided into two groups based on the foot care into professional foot care group (PFCG) and the standard foot care group (SFCG) with 287 patients each. Postoperative surgical site complications were assessed on the first, second, third, fourth day, 1 week and 1 month interval.\u0000\u0000Results: The Mean age of patients in PFCG and SFCG groups was 59.71 ±9.9 and 60.34 ±11.22, respectively. Rate of Postoperative complications decreased on the follow up examinations in PFCG group as compared to SFCG group. A significant difference in the incidence of complications was observed on the fourth day (p=0.004) and after 1 month (p=0.029) of surgery between 2 groups. No significant correlation was determined between the length of the removed saphenous vein, number of arteries anastomosed and the post-saphenectomy complication rate at the first, second, third, and fourth days, at the first week, and first month in both groups except in PFCG where significant association was noted on the third postoperative day.\u0000\u0000Conclusion: Postoperative limb care by professional foot specialist decreases the postoperative complications in the surgical site.","PeriodicalId":75000,"journal":{"name":"The European journal of cardiovascular medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45423689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-08-11DOI: 10.5083/ejcm20424884.176
Ismail Alsuz, Mahdi Al-Zaidi
ABSTRACT Background: Etiology of severe cardiac conduction disturbances is frequently uncertain. The risk factors of both coronary artery disease and conduction defects often overlap. Considering this, the present study aimed to find the relationship between complete heart block and specific pathological coronary anatomy. Material and Methods: Seventy-eight patients, (39 patients with a permanent pacemaker and 39 matched control patients who underwent coronary angiography procedure) were studied. The lesions were classified into four types, according to the anatomy of blood supply to the different segments of the conduction system. Results: Type IV lesion was common in study group compared to matched control group where type III lesion was common. Lesions that compromise blood flow to septal branches (types II and IV) were common in study group and the lesion types that do not compromise blood flow (types I and III) were common in control group (p<0.001). Type 1 lesion were common in females (p<0.001). Type IV lesions were common in hypertensive, whereas, non- hypertensive and non-diabetic patients had type 1 lesions (p<0.001). Similarly, patients with LV dysfunction had type 4 lesion compared to the patients without LV dysfunction who had type 1 lesions (p<0.001) Conclusions: Patients with permanent pacemakers having coronary artery disease are more likely to have specific coronary angiographic findings. Therefore, the site of lesions and not the severity or extent of atherosclerosis is responsible for the conduction disturbances.
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