Cardiovascular Journal of Africa最新文献

Background: Ischaemic stroke is frequently associated with electrocardiographic (ECG) abnormalities, including repolarisation disturbances. These disturbances, often seen as prolonged QT intervals or altered T-wave morphology, reflect impaired ventricular repolarisation and have been linked to an increased risk of cardiovascular events. One specific marker, the frontal QRS-T angle (FQRS-T angle), which measures the relationship between the QRS complex and T wave, has gained attention as a potential prognostic indicator in cardiovascular diseases. However, its role in ischaemic stroke has been scarcely investigated. This study aimed to assess the prognostic value of the frontal QRS-T angle in predicting survival and cardiovascular events in patients with cryptogenic ischaemic stroke.

Methods: In this retrospective analysis, patients with confirmed cryptogenic ischaemic stroke were stratified into two groups based on a frontal QRS-T angle threshold of 90°. Clinical outcomes, including survival, cardiovascular events, recurrent stroke, and atrial fibrillation, were compared between the two groups.

Results: Patients with a frontal QRS-T angle >90° exhibited significantly higher mortality rates (26.3% vs. 6.3%, p < 0.05) and shorter survival durations (19.58 ± 1.72 months vs. 25.54 ± 0.63 months, p = 0.003). The >90° group also had a higher incidence of cardiovascular events (42.9% vs. 18.8%, p = 0.039). No significant association was found with recurrent stroke or atrial fibrillation.

Conclusion: The frontal QRS-T angle is a valuable prognostic marker for mortality and adverse events in cryptogenic ischaemic stroke patients. This simple parameter could be integrated into clinical practice to identify patients at higher risk for adverse outcomes, allowing for more targeted monitoring and management.

Background: This study was conducted to compare the procedure-related knowledge and anxiety levels among patients who underwent elective and emergency percutaneous transluminal coronary angioplasty (PTCA) in the coronary intensive care unit (CICU).

Methods: The study was descriptive and conducted in the Cardiology Clinic CICU of a training and research hospital in Ankara, Turkey, between January 2022 and June 2024. The study sample was completed with 95 volunteer participants who underwent PTCA. These were either elective (n = 47) or emergency admissions (n = 48) to the CICU.

Results: 37 (38.9%) of the patients were female, 58 (61.1%) were male, and the mean age was 61.1 ± 12.1 years. 23 (24.1%) were smokers, and 55 (57.89%) had chronic diseases. A statistically significant difference (p < 0.001)was found between the two groups in terms of their knowledge levels regarding the PTCA procedure. A significant difference (p < 0.05) was also found between the two groups in terms of the mean scores on Spielberger's State-Trait Anxiety Inventory (STAI).

Conclusion: The knowledge level of patients admitted to elective CICU was found to be higher than that of patients admitted to the emergency department. Patients admitted to emergency CICU were found to have more anxiety and fear of death than elective patients.

Background: Cardiac resynchronisation therapy (CRT) is a standard treatment for heart failure patients with ventricular conduction delay. While its benefits on left ventricular (LV) systolic function are well-established, the effects on LV diastolic mechanics remain controversial. This study aimed to investigate the interactions between CRT therapy, LV diastolic function, and LV chamber stiffness.

Methods: We evaluated 71 heart failure patients before and six months after CRT using two-dimensional echocardiography. LV volumes, ejection fractions (EF), and diastolic function parameters, including transmitral filling indices, tissue Doppler, and the E/e' ratio, were measured. The LV stiffness index (LV-SI) was calculated using the formula (E / e' lateral) / end-diastolic volume [EDV]). CRT response was defined as a > 15% reduction in LV end-systolic volume.

Results: Among CRT responders (67.6%), a mean reduction of 26.3% in LV end-systolic volume and a median EF improvement to 40% were observed. Diastolic function improved significantly (E-wave velocity ↓20.9%, E/A ratio ↓16.5%, and E/e' ratio ↓32.7% medial and ↓34.9% lateral; p < 0.001 for all values). The LV stiffness index decreased by 19.48% (p < 0.001). Non-responders showed no significant changes. Baseline parameters for both pulsed-wave and tissue Doppler measurements, as well as LV-SI, showed no significant differences between responders and non-responders.

Conclusion: This study demonstrates that CRT responders exhibited significant improvements in diastolic function, including measurements of LV filling pressure and active relaxation, as well as a reduction in LV stiffness. Additionally, LV stiffness and diastolic parameters do not appear to influence the response to CRT.

Background: Infective endocarditis (IE) is a complex and life-threatening condition in clinical practice. It is important for the clinical management of IE to make a timely and accurate diagnosis and to actively implement appropriate treatment plans.

Medical history summary: The patient was a 60-year-old man who was admitted to our hospital on 31 January 2016. On admission, he had a temperature of 38.9°C; the breath sounds in both lungs were coarse, and no obvious dry and wet rales were heard. Rapid rate atrial fibrillation, small amounts of aortic, mitral and tricuspid valve regurgitation and arrhythmia were observed. On 2 February 2016, cranial magnetic resonance imaging showedmultiple acute infarct foci in the right frontoparietal lobe, corpus callosum knee and both cerebellar hemispheres. The diagnostic results were cerebral infarction, atrial fibrillation and acute coronary syndrome. The patient was given 200 mg aspirin tablets to take orally once a day, 20 mg Atorvastatin calcium tablets to take orally once at night and a 30 mg Edaravone injection to administer twice daily. On 3 February 2016, blood culture was positive for Staphylococcus aureus. A vancomycin injection of 500 mg was administered twice a day for anti-infection treatment. On 7 February 2016, the patient went to another hospital. On 6 March 2016, he returned to our hospital due to recurrent chest tightness and shortness of breath, where he underwent an ultrasound examination of his heart on 14 March 2016 and was diagnosed with IE.

Conclusion: Attention should be paid to the recent appearance of or changes concerning atrial fibrillation or cardiac murmur in patients with a history of cardiac disease and a lack of risk factors for stroke. For patients with cerebral infarction and positive blood culture but where no vegetation was observed via cardiac ultrasound, follow-up procedures should be strengthened after discharge.

Background: There are few studies on the relationship between psychological disorders, sleep quality and coronary artery disease (CAD) severity in acute coronary syndrome (ACS).

Aim: Our aim was to clarify the relation between CAD severity, psychological symptoms, and sleep quality in patients with ACS.

Methods: This is a prospective, single-center, hospital-based study, and 151 patients with ACS between 1st March and 1st September 2021 were included in the study. Symptom Checklist-90-Revised (SCL-90-R) and Pittsburgh Sleep Quality Index (PSQI) tests were applied to the patients. The study population consisted of two groups; mild CAD group (SS ≤ 22) and severe CAD group (SS > 22) based on the SYNTAX score (SS), and their SCL-90-R and PSQI scores were compared.

Results: The median age of all patients was 60 (40-85) years. 83 patients (55%) were male. SCL-90-R anxiety score (p = 0.013), depression score (p = 0.024), hostility score (p = 0.028), additional scale score (p = 0.028), and PSQI score (p < 0.001) were statistically significantly higher in the severe CAD group. In binary logistic regression analyses of all psychological features and sleep status, the PSQI score (p < 0.001) was independently associated with severe CAD in ACS.

Conclusions: This study pointed out that anxiety, depression, hostility symptoms, and poor sleep quality were more common in the severe CAD group in patients with ACS when evaluated in terms of all psychological characteristics. Unlike all psychological disorders, poor sleep quality was observed to be independently associated with severe CAD in ACS.

Cardiac fibroblasts play a crucial role in the development and progression of cardiac fibrosis. The expression and function of CXCL17 has been unclear in cardiac fibrosis. In this study, we demonstrated CXCL17 was highly expressed in cardiac fibroblasts of cardiac fibrosis patient samples. In vitro, CXCL17 promotes cardiac fibroblasts proliferation by activating AKT signaling and up-regulating bFGF in a positive feedback loop. The synergistic effects of CXCL17 and bFGF on cardiac fibroblast proliferation can be attributed to their shared AKT signaling pathway. Additionally, in vivo CXCL17 increased cardiac fibrosis in isoprenaline induced mice cardiac fibrosis model and could be reversed by CXCL17 blocking antibody. Collectively, the identification and understanding of the CXCL17-bFGF loop in cardiac fibrosis have opened up new avenues for developing targeted therapies.

Aim: Infective endocarditis remains a serious condition with a high mortality rate. However, surgical treatment of infective endocarditis still raises some questions despite the researches. This study aimed to analyse the early- and mid-term outcomes of patients with infective endocarditis who required surgical treatment and to identify perioperative risk factors for mortality and morbidity.

Methods: Between April 2019 and January 2024, 70 patients who were diagnosed with infective endocarditis according to the Modified Duke criteria and underwent cardiac surgery in our clinic, retrospectively.

Results: The results showed that in the preoperative period, older age, previous surgery/intervention, and chronic renal failure were associated with higher mortality in the postoperative period. Long cross-clamp and cardiopulmonary bypass times increased the mortality as the complexity of the intraoperative case increased. Patients requiring postoperative mechanical and inotropic support had a worse prognosis (p<0.05).

Conclusion: Regardless of whether factors can be changed at each stage of the operation, the risk of complications increases as complexity increases. It is important that surgical as well as medical management of infective endocarditis is well protocolised. Choosing the simplest option as much as possible is the best decision for this patient group.

Glossary of abbreviations: IE: Infective Endocarditis, CT: Computed Tomography, CABG: Coronary Artery Bypass Grafting, AVR: Aortic Valve Replacement, MVR: Mitral Valve Replacement, TVR: Tricuspid Valve Replacement, PVR: Pulmonary Valve Replacement, MBVP: Mitral Balloon Valvuloplasty, ECMO: Extracorporeal Membrane Oxygenation, IABP: Intraaortic Balloon Pump, MAIF: Mitral-aortic intervalvular fibrosa, CPB: Cardiopulmonary Bypass, CPR: Cardiopulmonary Resuscitation.

Inconsistencies in healthcare access, varying infrastructure, resource constraints and diverse local practices as well as practical and political issues restrict the global applicability of currently available guidelines. There is a need for universal recommendations that address the unique challenges faced by patients and healthcare providers worldwide. Our iCARDIO Alliance Global Implementation Guidelines emphasize the incorporation of novel therapies, while integrating standard of care with the most up-to-date evidence to enable clinicians to optimize patient care. This document is about heart failure (HF), including acute and chronic heart failure, heart failure with reduced ejection fraction and heart failure with preserved ejection fraction as well as cardiomyopathies. Context-specific recommendations tailored to individual patient needs are highlighted providing a thorough evaluation of the risks, benefits, and overall value of each therapy, aiming to establish a standard of care that improves patient outcomes and reduces the burden of hospitalization in this susceptible population. These guidelines provide evidence-based recommendations that represent a group consensus considering the many other published guidelines that have reviewed many of the issues discussed here, but they also make new recommendations where new evidence has recently emerged. Most importantly these guidelines also provide recommendations on a number of issues where resource limitations may put constraints on the care provided to HF patients. Such "economic adjustment" recommendations aim to provide guidance for situations when "Resources are somewhat limited" or when "Resources are severely limited". Hence, this document presents not only a comprehensive but also concise update to HF management guidelines thereby aiming to provide a unified strategy for the pharmacological, nonpharmacological, invasive and interventional management of this significant global health challenge that is applicable to the needs of healthcare around the globe.

Objective: The objective of this study was to investigate the association between the index of electrophysiological balance (iCEB) and ischaemic stroke (IS) and newly diagnosed atrial fibrillation (AF). AF is an independent risk factor for stroke. Study design: This is an observational study. Place and duration of the study: The study was conducted at the institution where the authors are employed (Şehit Prof Dr Ilhan Varank Training and Research Hospital, Istanbul, between 1 October 2021 and 1 April 2022).

Methodology: We included 452 patients in this study diagnosed with IS. The patients participating in the research were separated into two categories: patients with and without AF on rhythm holter. Both groups were balanced in point of clinical, demographic, and echocardiographic features. iCEB was described and evaluated as the proportion of QT to QRS (QT/QRS); and ciCEB (QTc/QRS). A p-value under 0.05 was noted as significant.

Results: The mean old of the participants in the AF group (n = 250) was 72.4 ± 9.5 years but the control group (n = 202) was 62.1 ± 12.6) years (p < 0.001). Both groups were similar in point of demographic and clinical features. CHA₂DS₂-VASc score (5.2 ± 1.5 vs 4.3 ± 1.3, p < 0.001), QT duration (412.3 ± 48.1 vs 404.5 ± 41.5 ms, p = 0.029), cQT duration (456.3 ± 35.4 vs 441.9 ± 33.2 ms, p = 0.017), iCEB (4.4 ± 0.7 vs 4.1 ± 0.6 ms, p = 0.007), ciCEB (4.9 ± 0.8 vs 4.6 ± 0.4 ms, p = 0.005) were higher in the AF group. Multivariable analyses confirmed that only age (OR:1.075, 95% CI [1.058-1.107], p < 0.001) and the iCEB (OR:1.781, 95% CI [1.128 - 2.812], p = 0.013) are potential independent risk factors for AF events with ischaemic stroke patients.

Conclusion: The study concluded with the finding that iCEB and ciCEB values were elevated in patients who presented with IS and AF events detected on rhythm Holter. Concurrently, these patients exhibited higher CHA₂DS₂-VASc scores and advanced age. Furthermore, the iCEB parameter was found to be a valuable predictor of AF in patients with ischaemic stroke and normal sinus rhythm.

Objectives: Hypoxia and high-fat diet are independent risk factors for pulmonary vascular endothelial dysfunction (VED); however, their interactive effects are poorly understood. This study aimed to elucidate the effect and mechanism of hypoxia combined with a high-fat diet on the pulmonary arterial endothelial structure and function in rats.

Methods: Forty rats were randomly assigned to a normal diet and normoxia, a normal diet and hypoxia, a high-fat diet and normoxia, and a high-fat diet and hypoxia. Pulmonary morphology, pulmonary VED, and nitric oxide synthase (NOS) were evaluated.

Results: Compared to single factor, high-fat diet and hypoxia showed impaired vascular structure, reduced endothelium-dependent vasodilation, increased tissue factor, pulmonary NOS mRNA, peroxynitrite, and plasma malondialdehyde in rats. Hypoxic exposure also increased endothelial NOS (eNOS) and phosphorylated eNOS at threonine 495 in rats fed with a high-fat diet.

Conclusions: Hypoxia combined with a high-fat diet aggravates pulmonary VED in rats, which may be associated with eNOS and nitric oxide (NO) dysfunction.