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e-publication ahead of print and offers authors the
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sooner for an international audience.
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The role of C-reactive protein:albumin ratio and neutrophil:lymphocyte ratio in predicting coronary artery disease
Murat Özmen
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DOI:
10.5830/CVJA-2024-004
Online Publication Date: 26
March 2024
Introduction:
Acute coronary syndrome
(ACS), one of the most
common causes of death
worldwide, is a condition
characterised by ischaemia
and/or infarction due to
reduced coronary blood flow.
The most prevalent cause of
ACS is coronary artery
disease. In this study, we
aimed to investigate the
relationship between blood
parameters that we commonly
use in the laboratory
[C-reactive protein (CRP),
albumin, neutrophils and
lymphocytes] and coronary
artery disease (CAD).
Methods:
This retrospective,
single-centre study included
100 patients who underwent
coronary angiography, with
the diagnosis of acute
coronary syndrome between
January and June 2023, and
106 patients with high
clinical suspicion and
normal coronary arteries as
a control group. The NLR was
obtained from the ratio of
neutrophils to lymphocytes
and the CAR was obtained
from the ratio of CRP to
albumin. We analysed the
relationship between CAD and
NLR and CAR according to
laboratory findings and
demographic characteristics
of the patients.
Results:
The average age of the study
group was 59 ± 10 years. NLR
and CAR values were higher
in the patient group than
the control group (5.2 ± 3.3
vs 2.27 ± 1.2, p = 0.004 and
0.5 ± 0.1 vs 0.097 ± 0.095,
respectively, p < 0.001).
Albumin ratios were found to
be statistically
significantly lower in the
patient group than the
patient group (42.4 ± 4 vs
44 ± 3.3, respectively, p =
0.01). In addition, CAR and
NLR showed a significant
diagnostic value for CAD in
receiver operating
characteristic curve
analysis (area under the
curve: 0.68 ± 0.07, p =
0.003; 0.66 ± 0.09 p ≤
0.001).
Conclusion:
NLR and CAR values, which
are important indicators of
inflammation, were found to
be higher in the patient
group. We believe it may be
important to monitor these
patients more frequently and
follow them closely in terms
of CAD, especially if the
rate is higher in
individuals without CAD who
come for out-patient clinic
check-ups.
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Evaluation of cardiac function in paediatric Wilson’s disease patients with advanced echocardiographic modalities (strain and strain rate echocardiography)
Kerem Ertaş, Özlem Gül, Fatma Demirbaş
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DOI:
10.5830/CVJA-2024-006
Online Publication Date: 26
March 2024
Objective:
In Wilson’s disease (WD),
copper accumulation in the
organs and/or damage caused
by oxygen free radicals
occurs due to disturbances
in copper excretion. In our
study, we aimed to evaluate
cardiac involvement with
advanced echocardiographic
modalities (tissue Doppler
echocardiography, strain and
strain-rate
echocardiography).
Methods:
Twenty WD patients and 20
healthy children from the
Pediatric Gastroenterology
Department of Diyarbakır
Children’s Hospital were
included in the study
between 2022 and 2023.
Results:
The mean age of the WD
patients was 12.89 ± 3.79
years. Left ventricular wall
thicknesses and diameters
(diastolic interventricular
septum thickness, diastolic
left ventricular posterior
wall thickness, left
ventricular end-diastolic
diameter), left ventricular
diastolic function
parameters (E, A, E/A,
deceleration time) and left
ventricular ejection
fraction and tricuspid
annular plane systolic
excursion were similar and
not statistically
significantly different in
the WD and control groups.
Mitral lateral e′, mitral
septal e′ and tricuspid
lateral e′ velocities were
lower in the WD patients and
statistically significantly
different from the controls
(p = 0.02, 0.04 and 0.005,
respectively), as assessed
by tissue Doppler
echocardiography. Global
longitudinal systolic strain
was similar in the WD and
control groups and no
statistically significant
difference was detected.
Longitudinal early diastolic
strain rate was lower in the
WD patients and
statistically significantly
different (p = 0.002).
Conclusion:
Subclinical early diastolic
dysfunction and segmental
systolic dysfunction were
detected in WD patients with
advanced echocardiographic
modalities, in addition to
normal cardiac function as
assessed by conventional
echocardiography. Advanced
echocardiographic modalities
can be used in the follow up
of WD patients.
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Comprehensive ABC (HbA1c, blood pressure, LDL-C) control and cardiovascular disease risk in patients with type 2 diabetes mellitus and major depressive disorder in a South African managed healthcare organisation
Lovina A Naidoo, Neil Butkow, Paula Barnard-Ashton, Elena Libhaber
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DOI:
10.5830/CVJA-2024-003
Online Publication Date: 25
March 2024
Aim:
Patients with type 2
diabetes mellitus (T2DM) who
have suboptimal control of
the triad of glucose (A),
blood pressure (B) and lipid
profile (C) have an
increased risk of
cardiovascular disease
(CVD). Additionally, the
presence of major depressive
disorder (MDD) can lead to
poor outcomes. Therefore,
the aim of this study was to
assess the role of MDD with
ABC control in patients with
T2DM in a South African
private healthcare setting.
Methods:
Healthcare medical claims
and electronic health
records of 1 211 adult
patients with T2DM and/or
MDD were analysed for 2019.
Results:
Only 24% of the T2DM +/– MDD
patients reached a
low-density lipoprotein
cholesterol (LDL-C) target <
1.8 mmol/l, and only 13% of
the T2DM + MDD and 7.1% of
T2DM – MDD patients achieved
simultaneous ABC targets.
The proportion of patients
admitted due to
macrovascular complications
was higher in the T2DM + MDD
group (22.8%) compared to
the T2DM – MDD (13.1%) and
MDD group (9.9%) (p =
0.012). Multivariate
logistic regression analysis
showed that older patients
with T2DM + MDD achieved
better glycated haemoglobin
and LDL-C control.
Significantly more patients
with T2DM + MDD (12%) had
repeat macrovascular
admissions in 2019 compared
to the T2DM – MDD patients
(2.9%) (p = 0.005).
Conclusion:
Despite a managed-care
environment, the
comprehensive ABC control
among patients with T2DM was
suboptimal, particularly in
those with MDD, placing them
at greater risk for CVD
events.
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The predictive value of triglyceride–glucose index for assessing the severity and MACE of premature coronary artery disease
Ling Yang, Yu Peng, Zheng Zhang
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DOI:
10.5830/CVJA-2023-060
Online Publication Date: 21
February 2024
Objective:
The aim of this study was to
investigate the predictive
value of the
triglyceride–glucose (TyG)
index to assess the severity
and major adverse
cardiovascular events (MACE)
of patients in hospital with
premature coronary artery
disease (PCAD).
Methods: A
total of 300 patients with
PCAD, diagnosed by coronary
angiography (CAG), were
enrolled in this study.
According to the tertiles of
TyG index, the 300 patients
were divided into a T1 (n =
100), T2 (n = 100) and T3
group (n = 100). According
to the presence or absence
of MACE, the 300 patients
were divided into a MACE (n
= 80) and a non-MACE group
(n = 220). The patients’
clinical data were compared
between the groups, the
relationship between TyG
index and the severity of
PCAD and MACE were analysed
through multivariable
logistic regression
analysis, and their
predictive value was
detected using receiver
operating characteristic
(ROC) curves.
Results:
Multivariable logistic
regression analysis showed
that the TyG index was an
independent risk factor for
the severity of PCAD and
MACE. The area under the ROC
curve was 0.833 and 0.807,
respectively (all p < 0.05).
Conclusion:
The TyG index was
independently associated
with the severity of PCAD
and MACE, and had a good
predictive value.
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Obesity is associated with long-term outcome of catheter ablation of atrial fibrillation in patients with dilated cardiomyopathy
Jiaqi Yang, Tienan Sun, Xunxun Feng, Yuchao Zhang, Biyang Zhang, Yang Liu, Qianyun Guo
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DOI:
10.5830/CVJA-2023-063
Online Publication Date: 20
February 2024
Background:
Patients with atrial
fibrillation (AF) and
dilated cardiomyopathy (DCM)
often exhibit cardiac
dysfunction and a poor
prognosis. However, the
specific reasons are
unclear. This study aimed to
describe the impact of
obesity in patients with AF
and DCM.
Methods:
Seventy-four consecutive
patients with AF and DCM
were enrolled and classified
by body mass index. We
measured primary endpoints,
including cardiac death,
recurrent AF, recurrent
atrial tachyarrhythmia and
stroke, as well as secondary
endpoints.
Results: In
multivariate analysis,
compared to the normalweight
group, the overweight and
obese groups had greater
incidences of recurrent AF
(0.0 vs 30.3 vs 40.0%,
respectively, log-rank p =
0.048) and rehospitalisation
(9.1 vs 36.4 vs 45.0%,
respectively, log-rank p =
0.035). Compared to the
normalweight group,
five-year outcomes for
primary endpoints were
inferior in the overweight
and obese groups (18.2 vs
30.3 vs 50.0%, respectively,
log-rank p = 0.042).
Overweight patients
exhibited more benefit in
recovery of left ventricular
ejection fraction after
ablation (from 39.1 to
50.0%, p = 0.005) than the
normal-weight group (from
43.1 to 52.3%, p = 0.199)
and obese group (from 44.9
to 51.2%, p = 0.216).
Conclusion:
Patients with AF and DCM
with overweight or obesity
exhibited worse long-term
outcomes in recurrent AF
than normal-weight patients.
However, overweight patients
showed the most benefit in
cardiac function after
ablation.
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Successful surgical treatment of left ventricular free wall rupture
Hakan Kara
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DOI:
10.5830/CVJA-2024-002
Online Publication Date: 19
February 2024
Abstract:
Left ventricular free wall
rupture (LVFWR) is a rare
mechanical complication of
acute myocardial infarction.
The clinical course of LVFWR
is very poor. Direct or
patch closure of the rupture
area and sutureless
procedures constitute the
treatment for LVFWR. We
present the surgical
treatment of a patient who
developed LVFWR after high
lateral myocardial
infarction, and its
successful outcome.
Successful salvage of LVFWR
remains relatively rare.
Transthoracic
echocardiography, myocardial
contrast echocardiography
and thoracic computed
tomography are important
diagnostic tools for LVFWR.
These patients usually
present with acute cardiac
tamponade symptoms requiring
immediate treatment.
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Correlation of osteopontin hormone with TIMI score and cardiac markers in patients with acute coronary syndrome presenting with chest pain
Ayşe Şule Akan, Ibrahim Özlü
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DOI:
10.5830/CVJA-2023-066
Online Publication Date: 16
February 2024
Aim: Rapid
evaluation of patients with
acute coronary syndrome
(ACS) attending the
emergency service under
emergency room conditions
and using appropriate risk
scoring would improve
treatment success. Calcium
levels accumulate in the
tissue in people with
coronary artery disease and
this has been found to
correlate with osteopontin
levels in some studies. It
is predicted that
osteopontin level could be
used as a biomarker to
detect coronary artery
calcification. In this
study, we aimed to evaluate
the use of osteopontin
levels in the differential
diagnosis of ACS in
conjunction with cardiac
troponin I (cTnI) levels,
and HEART (history, ECG,
age, risk factors, troponin)
and thrombolysis in
myocardial infarction (TIMI)
scores in patients with
chest pain who attended the
emergency service.
Methods:
This study was conducted as
a prospective observational
clinical study in the
Department of Emergency
Medicine, Faculty of
Medicine, Ataturk
University. There was a
total of 90 participants,
including 60 patients and 30
healthy individuals in the
control group. All
participants’ demographic
information,
electrocardiography (ECG)
findings, cTnI level, TIMI
and HEART score, and
osteopontin level were
evaluated.
Results:
The patients’ mean age was
51.61 ± 17.56 years and
63.3% (n = 57) were male.
The body mass index (BMI) of
the patients was 25.63 ±
4.67 kg/m2. Patients with
chest pain [CP(+)] and high
cardiac troponin I levels
[cTnl(+)] were found to be
older and to have higher
HEART and TIMI scores than
individuals with CP(+) and
normal cardiac troponin I
levels [cTnl(–)] and the
healthy control group (p <
0.001). While the HEART
score was zero in 22 (24.4%)
of the patients, the TIMI
score was zero in 42
(46.7%). In terms of gender
distribution, vital signs
and serum osteopontin
levels, there was no
significant difference
between the patient groups
(p > 0.05). It was found
that patients with CP(+) and
cTnl(+) had a higher rate of
ECG abnormalities than the
CP(+) and cTnl (–) group and
the healthy control group (p
= 0.13 and p < 0.001,
respectively). In 65 (72.2%)
of the patients, the ECG
results were normal.
ST-segment elevation was
detected in 13 (14.4%)
patients. In our study, cTnl
levels were found to be
positively correlated with
age (r = 0.624), BMI (r =
0.291), HEART score (r =
0.794) and TIMI score (r =
0.805) (p = 0.001, p =
0.005, p = 0.001 and p =
0.001, respectively). In our
study, we discovered that
osteopontin levels could not
reach the differential
diagnostic level for
ST-elevation myocardial
infarction or
non-ST-elevation myocardial
infarction. No statistically
significant difference was
found in osteopontin levels
between the groups (p >
0.05).
Conclusion:
While very positive results
were obtained in this
approach to the ACS
diagnosis using HEART and
TIMI scores in patients with
chest pain who attended the
emergency service and were
diagnosed with ACS, no
significant results could be
obtained regarding the use
of osteopontin levels as a
biomarker. More
comprehensive, multicentre
studies involving a large
number of appropriately
selected patients are
considered to be necessary.
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Delayed diagnosis of cardiac amyloidosis in a West African octogenarian
Dzifa Ahadzi, Abdul-Subulr Yakubu, Alfred Doku, Francis Agyekum, Cyril Ofori, Harold Ayetey
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DOI:
10.5830/CVJA-2024-001
Online Publication Date: 12
February 2024
Abstract:
Left ventricular hypertrophy
(LVH) is a common finding on
cardiac imaging. Although
there are multiple
aetiologies for LVH,
hypertension is frequently a
presumed cause due to its
high prevalence in the
African region. Establishing
a specific cause of LVH
however requires thorough
clinical evaluation with
multimodality cardiac
imaging playing a key role
in the diagnostic pathway.
We report on a case of a
West African octogenarian
who was treated
presumptively for heart
failure with preserved
ejection fraction from
hypertensive heart disease,
based on his initial
clinical presentation and
echocardiographic findings
three years earlier. By
adopting a stepwise approach
to his evaluation, including
revisiting the history, and
the application of
multimodality cardiac
imaging, the patient was
diagnosed with cardiac
amyloidosis.
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Impact of COVID-19 on cardiac surgery outcomes
Danica Mandić, Aleksandra Milovančev, Aleksandar Redžek, Milovan Petrović, Aleksandra Ilić, Milenko Čanković, Melisa Mironicki Pekarić, Vanja Dudaš, Bojana Šarošković
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DOI:
10.5830/CVJA-2023-065
Online Publication Date: 12
February 2024
Aim: This
study aimed to assess the
impact of COVID-19 infection
on cardiac surgery outcomes
in patients who contracted
COVID-19 peri-operatively or
had recently recovered from
COVID-19.
Methods:
The study prospectively
enrolled 95 patients
scheduled for cardiac
surgery who had recently
recovered from COVID-19.
This formed the
post-COVID-19 group. The
other group consisted of 25
patients who contracted
COVID-19 peri-operatively.
Patients were followed for
all-cause mortality as the
primary endpoint and
postoperative course
complications as the
secondary endpoint. Data
were compared to a
historical cohort of 280
non-COVID-19 patients.
Results:
The peri-operative COVID-19
group exhibited a
significantly higher
prevalence of primary
outcome all-cause mortality
(28%), compared with 4.3% in
the controls (p < 0.01), as
well as the secondary
composite endpoint (stroke,
peri-operative myocardial
infarction and pneumonia)
(52 vs 13.9%, p < 0.01). The
post-COVID-19 group had a
higher incidence of acute
pulmonary embolism (3.2 vs
0%, p < 0.01) and atrial
fibrillation (23.4 vs 11.4%,
p < 0.01).
Conclusion:
Patients who contracted
COVID-19 peri-operatively
had an increased rate of
mortality and postoperative
complications, while cardiac
surgery in the recently
recovered COVID-19 group was
associated with a higher
incidence of pulmonary
embolism and atrial
fibrillation.
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Percutaneous coronary intervention facilities in Nigeria
Olufemi T Olorunda, Kelechukwu Okoro, Basil Okoh, Tosin Majekodunmi
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DOI:
10.5830/CVJA-2022-041
Online Publication Date: 12
February 2024
Background:
In Nigeria, the incidence of
coronary artery disease has
doubled over the last three
decades. However, there
appears to be a lack of
adequate heart
catheterisation facilities.
Methods: A
list of percutaneous
coronary intervention (PCI)-
capable facilities was
compiled for each state in
Nigeria and the federal
capital territory.
Population estimates for
2019 were obtained from the
National Bureau of
Statistics and this was
utilised to calculate the
number of PCI facilities per
person in each state and the
country.
Results:
There are 12 operational PCI
facilities in Nigeria, 11 of
which are in the private
health sector. Overall,
there is one PCI facility
per 16 761 272 people in
Nigeria.
Conclusions:
There is a distinct lack of
PCI-capable facilities in
Nigeria. There needs to be
an investment from the
government and stakeholders
in Nigeria to increase the
access to PCI, given the
paradigm shift from
communicable to
noncommunicable diseases.
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Association of ratios of monocyte/high-density lipoprotein cholesterol and neutrophil/high-density lipoprotein cholesterol with atherosclerotic plaque type on coronary computed tomography
Taha Okan, Caner Topaloglu
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DOI:
10.5830/CVJA-2023-064
Online Publication Date: 26
January 2024
Objectives:
The monocyte/high-density
lipoprotein cholesterol
(HDL-C) ratio (MHR) and
neutrophil/HDL-C ratio (NHR)
are markers for inflammation
and dyslipidaemia, which are
important factors in
atherosclerosis. Studies
have linked MHR and NHR to
the prediction, severity and
prognosis of coronary artery
disease. However, no study
has explored their
connection to plaque
stability, specifically its
calcific or soft/mixed
content.
Methods:
Monocyte, neutrophil and
HDL-C levels were examined
in 99 patients who had
coronary computed
tomographic angiography
(CTA) between January and
August 2023. They were
divided into three groups: a
group of 42 healthy
individuals (group 0) with
no coronary artery plaque
and an Agatson score of 0,
an unstable plaque group
(group 1) with 31 patients
displaying mixed and/or soft
plaque on CTA, and a stable
plaque group (group 2) with
26 patients showing only
calcific plaque.
Results:
White blood cell (WBC),
monocyte and neutrophil
counts were significantly
higher in group 1 patients
compared to group 0 patients
(group 0: WBC = 6.31 ± 0.97
× 103 cells/μl, monocytes =
0.40 ± 0.09 × 10³ cells/μl,
neutrophils = 3.32 ± 0.81 ×
10³ cells/μl; and group 1:
WBC = 7.61 ± 1.95 × 10³
cells/μl, monocytes = 0.50 ±
0.11 × 10³ cells/μl,
neutrophils = 4.19 ± 1.36
10³ cells/μl; p < 0.05). MHR
and NHR were significantly
higher in group 1 patients
compared to group 0 patients
(group 0: MHR = 0.0079 ±
0.0029, NHR = 0.063 ± 0.023
and group 1: MHR = 0.0102 ±
0.003, NHR = 0.085 ± 0.036,
p < 0.05).
Conclusion:
The significant differences
in MHR and NHR between the
three groups were due to the
differences between groups 0
and 1. MHR and NHR were
significantly higher in
group 1 patients, although
there was no statistically
significant difference
between groups 1 and 2.
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Assessment of Tp–Te interval in patients with cardiac AL amyloidosis
Yavuz B Tor, Ismat Habibov, Mustafa Altinkaynak, Mehmet Aydogan, Derya Baykiz, Mehmet Tayfur, Mehmet G Gonenli, Imran Onur, Sevgi Kalayoglu-Besisik, Bulent Saka, Sebile N Erten, Timur S Akpinar
Full text:
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DOI:
10.5830/CVJA-2023-059
Online Publication Date: 15
January 2024
Background:
Prolonged Tp–Te interval is
strongly associated with
fatal ventricular
arrhythmias and mortality.
This association has been
demonstrated in various
diseases. However, the
current literature does not
give any information on
Tp–Te interval in cardiac
amyloid light-chain (AL)
amyloidosis.
Methods: We
retrospectively screened 116
cardiac AL amyloidosis
patients and 35 patients
were included in the study.
Demographic, laboratory,
12-lead electrocardiographic
(QTc, Tp–Te V1–V6) and
transthoracic
echocardiographic data of
the patients were analysed
and compared with 35 healthy
controls.
Results:
QTc and Tp–Te V2–V5 were
significantly prolonged in
the cardiac AL amyloidosis
group (p < 0.05). Also,
there was a positive and
statistically significant
correlation between the
parameters of QTc and Tp–Te
V3–V6, and also between the
parameters of
interventricular septum
thickness at enddiastole and
Tp–Te V2–V5.
Conclusion:
We present the first strong
evidence of prolonged Tp–Te
intervals in patients with
cardiac AL amyloidosis.
There may also be a
relationship between
prolonged Tp–Te interval and
the development of
arrhythmia in this patient
group, as in some other
groups. There is a need for
prospective studies
examining the relationship
of prolonged Tp–Te interval
with arrhythmias and its
prognostic significance in
cardiac AL amyloidosis.
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Association between Pfizer-BioNTech mRNA vaccine and myocardial infarction: clinical and angiographic insights
Fatih Aydin, Bektaş Murat, Selda Murat, Ayse Huseyinoglu Aydin
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DOI:
10.5830/CVJA-2023-062
Online Publication Date: 13
December 2023
Objective:
With the widespread
administration of the
BioNTech mRNA-based COVID-19
vaccine, there is a need to
evaluate its potential
effects on cardiovascular
health, particularly its
association with myocardial
infarction (MI). This study
aimed to investigate the
relationship between
BioNTech vaccination and MI,
as well as its impact on
clinical and angiographic
parameters.
Methods: A
retrospective analysis was
conducted at the Eskisehir
Osmangazi University,
Eskisehir City Hospital,
between April 2020 and May
2023 on a cohort of 1 151
patients hospitalised with
MI. The patients were
stratified into a BioNTech+
(vaccinated) and a BioNTech–
(unvaccinated) groups.
Medical records were
reviewed for demographic
information, clinical data
and angiographic findings.
Statistical analyses were
performed, including
logistic regression models
adjusting for potential
confounders.
Results:
The BioNTech– group had a
higher mean number of
percutaneous transluminal
coronary angioplasty
procedures and stents
compared to the BioNTech+
group. Haematological
parameters and lipid
profiles showed some
discrepancies between the
two groups. The BioNTech–
group had higher white blood
cell and platelet counts,
while also exhibiting a
higher mean low-density
lipoprotein cholesterol
level. The prevalence of
co-morbidities and
cardiovascular risk factors
differed between the groups.
Conclusion:
This study found
associations between the
BioNTech vaccination and
clinical and angiographic
parameters in patients with
MI.
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Investigation of the effects of ellagic, vanillic and rosmarinic acid on reperfusion-induced renal injury
Alper Gurmen, Orkut Guclu, Serhat Huseyin, Nuray Can, Eray Ozgun, Mursel Buyukadali, Adem Reyhancan, Suat Canbaz
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DOI:
10.5830/CVJA-2023-061
Online Publication Date: 29
November 2023
Introduction:
The aim of this study was to
investigate the effects of
ellagic, vanillic and
rosmarinic acid on
reperfusionrelated kidney
damage, developed in an
experimental lowerextremity
ischaemia/reperfusion (I/R)
model.
Methods:
Forty-eight female
Sprague-Dawley rats were
divided into six groups. A
median laparotomy and
dissection were performed.
In the I/R group, 60 minutes
of ischaemia followed by 120
minutes of reperfusion was
achieved. In addition one
group was given 100 mg/kg
ellagic acid, one group was
given 12 mg/kg vanillic
acid, one group was given 50
mg/kg rosmarinic acid and
one group was given all
three drugs 15 minutes
before clamp removal.
Bilateral kidney and blood
samples were taken in all
groups.
Results:
Tubular epithelial
degeneration, necrosis of
the tubule epithelium and
vessel wall thickening were
significantly higher in the
I/R group. Some parameters
in the groups that were
given drugs were found to be
lower than in the I/R group
and close to that of the
control group. Total oxidant
status (TOS) and oxidative
stress index (OSI) were
significantly higher and
total antioxidant status
(TAS) was significantly
lower in the I/R group.
Although not statistically
significant in the groups
given drugs, TAS was higher,
and TOS and OSI were lower
than in the I/R group.
Conclusion:
The antioxidant effect of
ellagic, vanillic and
rosmarinic acid
administration may have
beneficial effects on renal
damage after reperfusion in
acute lower-extremity
ischaemia. This study is
expected to provide
information for future
clinical trials.
-
A novel method that can be used in both the diagnosis and treatment of peripheral arterial disease in diabetics: vibration-mediated dilation
Mehmet Aydogan, Omer Kumet, Alp Ozcan, Ilke Ozcan, Ahmet Tas, Sabahattin Umman
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DOI:
10.5830/CVJA-2023-058
Online Publication Date: 29
November 2023
Objective:
The growing incidence of
diabetes and the increasing
life expectancy of the
diabetic population
worldwide has increased the
number of diabetic vascular
complications occurring in
cardiology practice. As
current treatment and
prevention methods are less
effective in this patient
group, there is a need for
new treatment methods in
this area. Exercise, which
reduces metabolic and
vascular problems associated
with diabetes, often becomes
impossible, especially in
advanced-stage patients who
need exercise the most.
Since exercise and
flow-mediated dilation (FMD)
are effective by stimulating
mechanotransduction
mechanisms on the
endothelium, it can be
expected that the same
mechanisms could also be
stimulated by direct
vibration.
Methods: In
order to test this
hypothesis, in this study, a
group of 20 type 2 diabetes
patients (11 males, age
56.80 ± 11.05 years and
diagnosed for 15.35 ± 8.61
years) were examined via the
application of FMD and
vibration-mediated dilation
(VMD). We performed
vibration for five minutes
with 20-Hz frequency and
3-mm vertical amplitude, to
the same side forearm, with
a 30-minute interval. Using
a 10-MHz linear echo probe,
brachial artery diameter and
flow velocities were
recorded for 10 minutes
before and at two-minute
intervals after the FMD and
VMD applications. Then
brachial artery flow and
resistance were calculated
at each stage.
Results: In
the first minute after FMD
and VMD applications,
brachial artery diameter and
flow velocities increased
significantly, and vascular
resistance decreased
significantly. None of the
corresponding FMD or VMD
parameters in the first
minute was different. The
artery diameters in the
first minute after FMD and
VMD were increased by 6.04 ±
5.29 and 5.49 ± 5.21%,
respectively. At the tenth
minute, these values
decreased to 1.73 ± 3.21 and
2.05 ± 3.31%. In the FMD
series, all parameters
except brachial artery
diameter returned to their
baseline values after the
fourth minute. After VMD,
all parameters also
decreased after the first
minute, but the recovery was
much slower. At each stage
after the first minute, the
VMD averages were higher
than the baseline value and
their corresponding FMD
values.
Conclusion:
The results of this study
indicated that vibration may
be a powerful, long-lasting
and feasible treatment
option in patients with
peripheral perfusion
failure, developed due to
diabetic macro- and
microvascular complications.
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Predictive values of stress hyperglycaemia and glycosylated haemoglobin on admission for long-term recovery of cardiac function in patients with acute myocardial infarction after primary percutaneous coronary intervention
Jinfeng Xiao, Chuanchao Luo, Lixin Yang
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DOI:
10.5830/CVJA-2023-056
Online Publication Date: 22
November 2023
Abstract:
We aimed to explore the
predictive values of stress
hyperglycaemia (SHG) and
glycosylated haemoglobin
(HbA1c) levels on admission
for long-term recovery of
cardiac function in patients
with acute myocardial
infarction (AMI) after
primary percutaneous
coronary intervention
(PPCI). A total of 210 AMI
patients were randomly
selected. The levels of SHG
and HbA1c were measured on
admission, and all patients
were treated with PPCI and
followed up for one year.
According to the recovery
status of cardiac function
during follow up, the
patients were divided into a
good recovery group and a
poor recovery group. At one
year after treatment, there
were statistically
significant differences in
the levels of SHG (6.75 ±
0.69 vs 7.81 ± 0.92 mmol/l)
and HbA1c (5.13 ± 0.25 vs
5.91 ± 0.39%) between the
good and poor recovery
groups (p < 0.05). The
levels of SHG and HbA1c were
associated with long-term
recovery of cardiac function
(p < 0.05). The receiver
operating characteristic
curves were plotted, and the
area under the curves of SHG
and HbA1c for predicting the
long-term recovery of
cardiac function were >
0.70. The levels of SHG and
HbA1c were closely
associated with longterm
recovery of cardiac function
after PPCI in AMI patients,
displaying high predictive
values.
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The relationship between epicardial adipose tissue and choroidal vascularity index in patients with hypertension
Güvenç Toprak, Muhammet Fatih Bayraktar
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DOI:
10.5830/CVJA-2023-057
Online Publication Date: 20
November 2023
Objective:
The choroidal vascularity
index (CVI) is a method that
measures the density of
blood vessels in the
choroidal layer and can be
used to evaluate the effects
of hypertension. In this
study we aimed to
investigate the relationship
between epicardial fat
thickness (EFT) and CVI in
patients with hypertension.
Methods:
This prospective study
included 112 patients
diagnosed with hypertension
and 120 healthy individuals.
Patients’ demographic data
such as age, gender, weight,
height, body mass index
(BMI), smoking status, and
presence of coronary artery
disease and diabetes
mellitus were recorded. BMI
was calculated by dividing a
patient’s weight in
kilograms by their height in
metres squared. EFT was
measured by echocardiography
and CVI was calculated using
the optical coherence
tomography method.
Results:
The mean CVI was found to be
66.57 ± 2.21 in the patient
group and 69.22 ± 2.39 in
the control group and the
difference was significant
(p < 0.001). The mean EFT
was found to be 5.23 ± 3.25
mm in the patients and 2.57
± 1.97 mm in the control
group and the difference was
statistically significant (p
= 0.003). According to
Spearman’s correlation
analysis, there was a
significant positive
correlation between BMI and
EFT (r = 0.379, p < 0.001)
and a significant negative
correlation between CVI and
EFT (r = –0.412, p < 0.001).
Conclusion:
The CVI value was
significantly lower and the
EFT value was significantly
higher in patients with
hypertensioncompared to
non-hypertensive patients.
There was a significant
positive correlation between
EFT and BMI and a
significant negative
correlation between EFT and
CVI.
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Improving cardiac function of angiotensin receptor/neprilysin inhibitor in patients with acute myocardial infarction: a systematic review and meta-analysis
Qiuli Niu, Changyuan Wang, Xiurong Xing
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DOI:
10.5830/CVJA-2023-028
Online Publication Date: 17
November 2023
Aim: As the
impact of angiotensin
receptor/neprilysin
inhibitor (ARNI) on cardiac
function in acute myocardial
infarction (AMI) patients is
unclear in clinical therapy,
we conducted this research
to investigate the actual
effects of improving cardiac
function with ARNI in AMI
patients.
Methods:
Publications were checked up
to June 2022. Standardised
mean differences (SMD) and
95% confidence intervals
(CI) were utilised for
assessing the size of the
effect of continuous
variables. To assess the
magnitude of the effect of
dichotomous variables, a
relative risk (RR) with 95%
CI was used.
Results:
ARNI could improve left
ventricular ejection
fraction (SMD = 0.40; 95%
CI: 0.23–0.58), while
lowering left ventricular
end-diastolic volume (SMD =
–0.43, 95% CI: –0.78 to
–0.08), left ventricular
end-systolic volume (SMD =
–0.39, 95% CI: –0.66 to
–0.11) and left ventricular
enddiastolic diameter (SMD =
–0.49; 95% CI: –0.65 to
–0.33). Besides, it could
decrease the rates of major
adverse cardiac events (RR =
0.55; 95% CI: 0.43–0.69) and
heart failure (RR = 0.42;
95% CI: 0.31–0.58).
Conclusion:
ARNI could greatly improve
cardiac function in AMI
patients.
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Ultrasonographic assessment and clinical outcomes after deployment of a suture-mediated femoral vascular closure device
Dimitrios Papoutsis, Konstantinos Mourouzis, Nikoleta Bozini, Konstantinos Aznaouridis, Evangelos Oikonomou, Katerina Chatzimichael, Elias Brountzos, Manolis Vavuranakis, Costas Tsioufis, John Lekakis, Gerasimos Siasos, Dimitris Tousoulis
Full text:
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DOI:
10.5830/CVJA-2023-054
Online Publication Date: 16
November 2023
Introduction:
Data regarding changes in
the arterial vascular wall
after the deployment of
suture-mediated vascular
closure devices (VCD) at the
femoral site in patients
undergoing percutaneous
coronary angiography (CAG)
or percutaneous coronary
intervention (PCI) are
sparse. This study
investigated the occurrence
of structural vascular
changes or adverse vascular
complications at the access
site in the short term after
the deployment of a
suture-mediated
intravascular VCD.
Methods:
Ninety-three patients (72%
males) with a mean age of 62
± 11 years were enrolled.
Duplex sonography was
conducted at the access site
at baseline, 24 hours and 30
days after femoral puncture
in patients with successful
VCD deployment. Vessel
diameter, flow velocities,
the severity of
atherosclerosis, and the
intravascular or
perivascular tissue
alterations in both the
right common femoral artery
(RCFA) and right external
iliac artery (REILA) were
assessed. Vascular
complications were
documented.
Results:
There were no significant
changes regarding the
diameter of the RCFA in the
transverse and longitudinal
view, peak systolic velocity
(PSV) of the RCFA, PSV ratio
of the RCFA to REILA, the
resistive index of the RFCA
and the severity of arterial
wall abnormalities before
femoral puncture, the day
following VCD deployment and
30 days after (p = NS for
all) in the general
population and in patients
with diabetes mellitus, on
oral anticoagulants or with
mild peripheral artery
disease (p = NS for all
markers). Device failure was
observed in four cases. Few
(4.4%) patients had vascular
complications, which
included exclusively major
or minor haematomas, most of
which did not persist at the
30-day follow up.
Conclusion:
The use of a suture-mediated
VCD was safe and was not
associated with adverse
vascular wall changes at the
femoral access site 30 days
after deployment in patients
undergoing CAG and/or PCI.
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Correlation between carotid intima–media thickness and patient outcomes in coronary artery disease in central South Africa
V Mokoena, L Botes, SC Brown, FE Smit
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DOI:
10.5830/CVJA-2023-055
Online Publication Date: 16
November 2023
Objectives:
Carotid intima–medial
thickness (CIMT) is a
non-invasive tool used to
detect atherosclerosis and
diagnose cardiovascular
disease. This study aimed to
determine whether
pre-operative CIMT
measurements correlated with
intraand postoperative
outcomes in patients with
acute coronary syndrome
(ACS) undergoing coronary
artery bypass graft (CABG)
surgery.
Methods:
This retrospective,
analytical cohort included
89 patients diagnosed with
ACS who received CABG
surgery. Patients were
divided into two cohorts:
group 1: normal CIMT < 0.07
cm and group 2: abnormal
CIMT ≥ 0.07 cm. B-mode
ultrasound was used to
measure the CIMT in all
patients. Pre-, intra- and
postoperative data and
complications were recorded
for each patient.
Results:
The study included 77
(86.5%) males and 12 (13.5%)
females. Pre-operative mean
body mass index was
significantly higher (p =
0.03) in group 2 than in
group 1. Group 2 had a
significantly increased
incidence of diabetes (p =
0.008) and hypertension (p =
0.009), and increased
NT-proBNP levels (p = 0.02).
Intra- and postoperative
outcomes between the groups
were comparable, with no
significant differences.
Conclusion:
The study showed no
correlation between abnormal
CIMT and increased adverse
intra- and postoperative
patient outcomes. Therefore,
the results of this study
show CIMT should not be
considered a tool to predict
adverse events in patients
undergoing CABG surgery.
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Contemporary risk factors associated with ischaemic heart disease in central South Africa: a single-centre study
Michelle Butler, Lezelle Botes, Stephen Brown, Francis Smit
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DOI:
10.5830/CVJA-2023-053
Online Publication Date: 06
November 2023
Background:
Deaths from non-communicable
diseases have increased in
sub-Saharan Africa over the
years, with limited data on
coronary artery disease
(CAD) and the risk factors
thereof. The objective of
this study was to
investigate modifiable and
non-modifiable risk factors
in central South Africa in
patients with CAD.
Methods:
Patients with
angiographically confirmed
CAD who were evaluated in
the catheterisation
laboratory for the first
time over a two-year period
(2016–2017) were included.
Data were
extracted from the patients’
medical records.
Results:
Four hundred and eighty-two
patients met the inclusion
criteria, presenting at a
mean age of 58.4 ± 10.8
years, and were
predominantly male (66%).
Females were significantly
older than the males (60.3 ±
9.6 vs 57.4 ± 11.1 years; p
< 0.05). The mean age at
presentation was comparable
between ethnic groups,
except Asian patients who
presented at a significantly
younger age compared to
Caucasians (49.8 ± 10.5 vs
59.1 ± 10.8 years; p <
0.05). Hypertension (91%)
was the most common risk
factor, followed by smoking
(67%) and obesity (41%).
Black Africans demonstrated
a higher incidence of
hypertension when compared
to Caucasians (96 vs 87%; p
< 0.05). Smoking was more
prevalent in Caucasians than
black Africans (68 vs 55%; p
< 0.05) and occurred more
commonly in males than
females (73 vs 55%; p <
0.05). Most patients
presented with acute
coronary syndrome (ACS)
(72%), mainly with
ST-elevation myocardial
infarction (STEMI) (36%).
The majority of patients
presenting with ACS were in
the age group 51–60 years.
The ACS risk-factor profile
was similar to that of the
total study group.
Conclusion:
CAD was present in all
ethnic groups, and
modifiable and
non-modifiable risk factors
were similar to the
classical risk factors
described worldwide. Minor
interracial differences were
observed and hypertension
was the most prevalent risk
factor recorded in central
South Africa. Most patients
with CAD presented with ACS,
particularly STEMI.
Recognition of the risk
factors associated with CAD
would contribute to improved
planning of healthcare
systems and increased
awareness of CAD.
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Comparison of early postoperative results in patients with and without diabetes with low ejection fraction and normal serum creatinine values who underwent coronary artery bypass operation
Cihan Yücel, İlhan Özgöl
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DOI:
10.5830/CVJA-2023-052
Online Publication Date: 27
October 2023
Background:
Low left ventricular
ejection fraction and renal
insufficiency are factors
that increase the risk of
coronary artery bypass graft
surgery in patients with
diabetes mellitus. The aim
of this study was to group
patients with low left
ventricular ejection
fraction undergoing coronary
artery bypass graft surgery
according to the presence or
absence of diabetes mellitus
and to evaluate
postoperative changes in
serum creatinine levels and
postoperative outcomes.
Methods: A
total of 93 patients
undergoing isolated coronary
artery bypass grafting were
included in this
single-centre,
retrospective, cohort study.
Patients with a
pre-operative low left
ventricular ejection
fraction of less than 35%
were included in the study.
Patients were divided into
diabetic and non-diabetic
groups and intra- and
intergroup values were
compared. Pre-operative, and
postoperative days 2 and 5
serum creatinine levels of
the patients were measured
and compared.
Results: Of
the 93 patients included in
the study, 60 were in the
diabetic group (group 1) and
33 were in the non-diabetic
group (group 2).
Postoperative 2- and 5-day
creatinine levels were
significantly higher in
group 1 than in group 2 (p =
0.033 and p = 0.005,
respectively). Postoperative
2- and 5-day creatinine
levels were significantly
higher than pre-operative
creatinine levels in group 1
(p = 0.008 and p = 0.001,
respectively). The intensive
care unit stay was
significantly longer in the
diabetes mellitus group than
in the group without
diabetes mellitus (p =
0.031).
Conclusion:
Following coronary artery
bypass graft surgery in
patients with low left
ventricular ejection
fraction, which is already a
risk factor, creatinine
levels were found to have
increased in the diabetes
mellitus group.
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Coronary artery bypass grafting in a patient with situs inversus totalis
Taha Okan, Caner Topaloglu, Orhan Kucuk, Selen Bayraktaroglu, Naim Ceylan
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DOI:
10.5830/CVJA-2023-051
Online Publication Date: 20
October 2023
Abstract:
Situs inversus totalis (SIT)
describes a complete mirror
image of the visceral organs
in the thoracic and
abdominal cavities.
Dextrocardia, in combination
with SIT, is a rare
congenital anomaly with a
frequency of 1:10 000, and
coronary heart disease may
occur with a similar
frequency and manifestation
as in the general
population. Coronary
computed tomography (CT)
angiography is useful for
accurately assessing the
coronary artery origin and
position for preprocedural
planning of difficult
coronary artery
catheterisation in SIT. In
this case, invasive coronary
angiography (ICA) was
performed from the same
angle but on the opposite
side compared to standard
angiography. With the use of
volume-rendered
three-dimensional and curved
reformatted images
reconstructed from coronary
CT angiography, the
advancement of guidewires
and catheters during ICA as
well as the planning of
surgical procedures can be
performed more safely.
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Correlation between maternally expressed gene 3 expression and heart rate variability in heart failure patients with ventricular arrhythmia
Ling Lin, Mei Hou, Ailing Yang, Yunfei Li, Rong Su, Li Li, Siyun Wu, Mingguo Zhang
Full text:
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DOI:
10.5830/CVJA-2023-044
Online Publication Date: 06
October 2023
Aim: The
aim of the study was to
analyse the correlation
between maternally expressed
gene 3 (MEG3) expression and
heart rate variability (HRV)
in heart failure patients
with ventricular arrhythmia
(VA).
Methods: A
total of 130 heart failure
patients, treated from July
2018 to March 2021, were
prospectively selected and
divided into a non-VA group
(n = 85) and a VA group (n =
45) according to the
presence or absence of VA.
The correlations of serum
MEG3 expression and HRV with
cardiac function indicators
were investigated by Pearson
correlation analysis.
Receiver operating
characteristic (ROC) curves
were plotted to assess the
predictive value of MEG3,
HRV and their combination
for the occurrence of heart
failure complicated with VA.
Results:
The VA group had a higher
left atrial diameter (LAD)
and left ventricular
end-diastolic diameter
(LVEDD) but lower left
ventricular ejection
fraction (LVEF) and ratio of
mitral early diastolic peak
velocity (E) to late peak
atrial filling velocity (A)
(E/A) than the non-VA group
(p < 0.05). The serum MEG3
expression was negatively
correlated with: standard
deviation of the average RR
intervals calculated over
five-minute segments in the
24-hour record (SDANN),
SDANN index, standard
deviation of
normal-to-normal RR interval
(SDNN) index, percentage of
differences between adjacent
normal RR intervals
exceeding 50 ms (PNN50),
root mean square of
successive difference
(RMSSD), low frequency (LF),
high frequency (HF), very
low frequency (VLF), LVEF
and E/A (r < 0, p < 0.05).
The serum MEG3 expression
was positively correlated
with LAD and LVEDD (r > 0, p
< 0.05). The areas under the
ROC curves of MEG3, SDANN,
SDANN index, SDNN index,
PNN50, RMSSD, LF, HF, VLF
and their combination for
the prediction of the
occurrence of heart failure
complicated with VA were
0.812, 0.731, 0.737, 0.689,
0.860, 0.783, 0.791, 0.856,
0.769 and 0.966,
respectively.
Conclusion:
MEG3 combined with HRV can
effectively predict the
occurrence of heart failure
complicated with VA.
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A novel U-shaped relationship between serum klotho and abdominal aortic calcification in the general population
Na Wei, Zuolei Shi, Yan Gong
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DOI:
10.5830/CVJA-2023-048
Online Publication Date: 05
October 2023
Background:
Abdominal aortic
calcification (AAC) is
considered an independent
predictor of cardiovascular
morbidity and mortality.
Klotho, an anti-aging gene,
has cardiovascular
protective effects. At
present, the association
between klotho and AAC in
the general population is
uncertain. We investigated
the relationship between
serum soluble α-klotho
(SSKL) and AAC in 2 327
participants from the
National Health and
Nutrition Examination
Survey.
Methods: To
estimate the association
between log-transformed SSKL
(lnSSKL) and AAC,
multivariate logistic
regression analyses were
conducted. Stratified
analyses were performed to
evaluated the potential
modifiers. Smoothed curve
fitting and generalised
additive models were also
performed.
Results: We
found lnSSKL correlated
negatively with AAC after
adjusting for other
confounders. The
relationship of lnSSKL with
AAC was a U-shaped curve
(inflection point: 7.01
pg/ml). On subgroup
analyses, stratified by age
and smoking habit, the
negative correlation of
lnSSKL with AAC remained in
men and in the population
who smoked.
Conclusion:
Our study revealed a
negative relationship
between lnSSKL and AAC in
the general population. This
relationship showed a
U-shaped curve and was
influenced by age and
smoking habit.
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Echocardiographic multiparameter assessment for patients with heart failure with preserved ejection fraction and atrial fibrillation
Lingling Qin, Junhua Yang, Fenglan Xu
Full text:
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DOI:
10.5830/CVJA-2023-047
Online Publication Date: 04
October 2023
Abstract:
We aimed to assess the
echocardiographic parameters
of cardiac structure and
function in patients with
heart failure with preserved
ejection fraction (HFpEF)
and atrial fibrillation
(AF). Thirty-seven HFpEF
patients with AF were
selected, while 38 patients
with simple HFpEF in the
same period were selected as
controls. Three-dimensional
speckletracking
echocardiography was
performed on both groups and
the parameters were
compared. The early
diastolic longitudinal peak
strain rates [early
diastolic longitudinal
strain rate (LSRE), early
diastolic circumferential
strain rate (CSRE), early
diastolic radial strain rate
(RSRE) and early diastolic
rotational strain rate
(RotRE)], late diastolic
longitudinal peak strain
rates (LSRA, CSRA, RSRA and
RotRA) and untwisting
parameters [untwisting rate
during isovolumic relaxation
time (UTRIVR) and early peak
untwisting rate (UTRE)] were
all negatively correlated
with the ratio of early
diastolic transmitral
velocity to early diastolic
mitral annular velocity
(E/E′) (p < 0.01). The
cardiac event-free survival
rate of the simple HFpEF
group (92.11%) was
significantly higher than
that of the HFpEF + AF group
(81.08%) (p < 0.0001).
UTRIVR had a more
significant correlation with
E/E′ ratio than the other
indicators and could serve
as a sensitive indicator for
evaluating the diastolic
function of patients with
HFpEF + AF.
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Relationship between adiponectin and copeptin levels with long-term cardiovascular mortality in ST-segment elevation myocardial infarction after percutaneous coronary intervention
Ayça Türer Cabbar, Ersin Yıldırım, Özge Güzelburç Çalbayram, Mustafa A Şimşek, Servet Altay, Kazım S Özcan, M Muzaffer Değertekin
Full text:
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DOI:
10.5830/CVJA-2023-046
Online Publication Date: 04
October 2023
Objective:
The aim of this study was to
determine adiponectin and
copeptin levels that might
be prognostic for
cardiovascular mortality
(CvsM) in ST-segment
elevation myocardial
infarction (STEMI) patients
who had percutaneous
coronary intervention (PCI).
Methods:
Patients who underwent PCI
between November 2010 and
April 2011 were enrolled and
followed for more than eight
years. The baseline,
demographic and angiographic
findings, in-hospital follow
up, laboratory results
including adiponectin and
copeptin levels, and
echocardiographic data of
the patients were evaluated.
Results:
There were 78 males and 20
females. The CvsM rate was
26.66% at 112 months of
follow up. Some factors were
significantly related to
CvsM and adiponectin level
was an independent predictor
of mortality. A cut-off
value of ≥ 8 950 ng/ml for
adiponectin and ≥ 7.41 ng/ml
for copeptin was related to
a 3.01- and 2.83-times
higher CvsM risk,
respectively.
Conclusion:
Adiponectin level was a
predictor for CvsM. Higher
levels of adiponectin and
copeptin could predict a
higher risk of CvsM in STEMI
patients.
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Six months of resistance training improves heart rate variability in the elderly
Matteus Dinis Oliveira, Perciliany Martins de Souza, Aparecida Patricia Guimarães, Lenice Kappes Becker, Daniel Barbosa Coelho, Emerson Cruz de Oliveira
Full text:
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DOI:
10.5830/CVJA-2023-050
Online Publication Date: 27
September 2023
Abstract:
Heart rate variability is a
non-invasive method of
assessing global health
through the analysis of the
autonomous central nervous
system, including both the
sympathetic and
parasympathetic systems. The
aim of this study was to
evaluate the effect of
resistance training on heart
rate variability at rest in
elderly individuals
undergoing six months of
resistance training with
progressive loads. Training
reduced the body fat
percentage of the volunteers
(pre: 39.39 ± 7.21 vs post:
34.97 ± 6.40%; p = 0.0069).
There was also a significant
reduction in the
low-frequency index (pre:
69621.50 ± 9817.28 vs post:
54210.50 ± 14903.94; p =
0.0322) and a significant
increase in the
high-frequency index (pre:
30308.00 ± 9857.86 vs post:
45627.10 ± 14838.80; p =
0.0326). We concluded that
six months of resistance
training with progressive
loads were beneficial for
heart rate variability and
reduced the body fat
percentage in the elderly.
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Association between serum α-klotho level and the prevalence of heart failure in the general population
Weimin Luo, Na Wei, Zhaoling Sun, Yan Gong
Full text:
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DOI:
10.5830/CVJA-2023-042
Online Publication Date: 27
September 2023
Background:
Heart failure is a major
cause of global morbidity
and mortality. Studies in
laboratory animals have
shown the direct protective
effects of α-klotho on the
cardiovascular system
although it has limited
expression in the heart. The
association between α-klotho
and cardiovascular disease
is still controversial in
different clinical studies.
We designed a
cross-sectional study in
order to investigate the
association between serum
α-klotho level and the
prevalence of heart failure
in the American general
population.
Methods:
The data were obtained from
the National Health and
Nutrition Examination Survey
(NHANES), which included 11
271 participants aged 40–80
years. Serum α-klotho level
was examined by
enzyme-linked immunosorbent
assay and divided into four
quartiles for further
analysis. Heart failure
status was obtained from
self-reported
questionnaires. To estimate
the association between
α-klotho level and
prevalence of heart failure,
multivariate logistic
regression analyses were
conducted. Interaction and
stratified analyses were
performed to evaluate the
potential modifiers.
Results:
After adjusting for multiple
covariates, a per-standard
deviation increase in serum
α-klotho level was
associated with a decrease
in prevalence of heart
failure [odds ratio (OR):
0.76, 95% confidence
interval (CI): 0.68–0.85).
The ORs for participants in
quartiles 2 to 4 were 0.77
(95% CI: 0.58–1.01), 0.70
(95% CI: 0.52–0.93) and 0.71
(95% CI: 0.53–0.95),
respectively, compared with
those in quartile 1.
Stratified analysis revealed
significant gender and
racial differences.
Conclusion:
We revealed an independent
association between serum
α-klotho level and the
prevalence of heart failure
in the American general
population. The association
was not always consistent
and varied according to
gender and race.
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The assessment of thoracal approaches in the treatment of aortic coarctation
Onur Işık, Gökmen Akkaya, Fatih Durak, Defne Engür, Meltem Çakmak, Ali Rahmi Bakiler, Muhammet Akyüz
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DOI:
10.5830/CVJA-2023-041
Online Publication Date: 15
September 2023
Objectives:
The optimal choice of
surgery in coarctation of
the aorta (CoA) remains
controversial but it needs
to be individualised.
However, in most conditions,
a surgical approach through
thoracotomy maintains
adequate exposure to create
aortic patency. This study
aimed to assess the
efficiency and reliability
of thoracal approaches in
the treatment of CoA by
examining the mid- and
late-term outcomes, and
determining the predictive
factors for re-intervention.
Methods:
Patients who underwent CoA
repair through thoracotomy
between September 2015 and
February 2023 were included
in the study, except for
those with complex cardiac
diseases. Medical records
were retrospectively
analysed and peri-operative
course, follow-up findings
on echocardiogram and
physical examinations were
obtained. The complication
rate, postoperative arch
gradient, need for
antihypertensive medication
use, and freedom from
re-intervention were
evaluated and then compared
in terms of age at surgery.
Results:
Overall, 98 patients
including 50 neonates were
reviewed. The most common
surgical method was extended
end-to-end anastomosis,
performed in 53 patients.
The median follow-up time
was 4.6 years. There was one
death in hospital and one
late mortality in the
cohort. Eight complications
were observed in the cohort
but all recovered well.
Overall, 13
re-interventions, six redo
surgeries and seven balloon
angioplasties were carried
out in 12 patients. Ten of
the re-interventions were
carried out within the first
year of the initial surgery.
One- and three-year freedom
from re-intervention rates
were 89.5 and 86.4%,
respectively. However, there
was no significant
predictive factor for
re-intervention. Comparisons
according to the age at
surgery did not differ,
except for intensive care
unit stay. The need for
hypertensive medication was
initially in 14 (14.2%)
patients and then reduced to
eight (8%) patients. The
mean peak residual gradient
on postoperative examination
was 9 mmHg.
Conclusion:
Thoracotomy provided
feasible surgical access
that led to satisfactory
results with a low
complication rate,
negligible residual
gradient, low incidence of
hypertension and excellent
rate for freedom from
re-intervention in the
treatment of CoA.
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Point-of-care testing compared to gold-standard laboratory methods in the measurement of serum lipids
Brett S Mansfield, Belinda Stevens, Frederick J Raal, Farzahna Mohamed
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DOI:
10.5830/CVJA-2023-039
Online Publication Date: 31
August 2023
Background:
Cardiovascular disease is
the leading cause of
mortality worldwide, with
dyslipidaemia being one of
the major risk factors.
Point-of-care testing (POCT)
allows for the rapid
measurement of serum lipids.
The aim of this study was to
assess the accuracy of serum
lipid measurement by the
Fujifilm™ NX700 POCT
compared to a gold-standard
clinical laboratory method
(Medpace, Leuven, Belgium).
Methods:
This was a prospective,
observational study
conducted at the Lipid
Clinic at Charlotte Maxeke
Johannesburg Academic
Hospital from July to
September 2022. Participants
were known to have a lipid
disorder, most commonly,
familial
hypercholesterolaemia.
Samples sent for lipid
measurement by standard
laboratory methods were
simultaneously measured by
the Fujifilm™ NX700 POCT.
Results:
Lipograms evaluating total
cholesterol (TC),
triglycerides (TG),
high-density lipoprotein
cholesterol (HDL-C) and
calculated low-density
lipoprotein cholesterol
(LDL-C) were obtained from
115 participants. No
statistically significant
difference was noted between
the parameters tested on the
different platforms. The
Fujifilm™ NX700 POCT
correctly identified > 91%
of serum lipid results as
normal or abnormal, as
defined by NCEP-ATP III
criteria, and exhibited good
sensitivity and specificity
for each parameter. Lin’s
concordance correlation
coefficient demonstrated a
strong correlation for all
parameters; TC (ρc =
0.9861), HDL-C (ρc =
0.95919), LDL-C (ρc =
0.98134) and TG (ρc =
0.92775). Bland–Altman plots
identified low bias and a
good level of agreement
between the two test
methods.
Conclusion:
The Fujifilm™ NX700 POCT
compared favourably with
gold-standard laboratory
methods in the determination
of serum lipid measurements,
allowing for rapid screening
at the primary healthcare
level.
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Outcomes of single-ventricle physiology in central South Africa
MJ van Jaarsveld, L Botes, FE Smit, SC Brown
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DOI:
10.5830/CVJA-2023-043
Online Publication Date: 25
August 2023
Introduction:
Single-ventricle physiology
is a critical cardiac
condition requiring early
diagnosis and intervention.
The objectives of this study
were to report on the
management and outcomes of
patients diagnosed with
single-ventricle physiology
in central South Africa.
Methods:
This study was a
retrospective, observational
analysis of patients
presenting with
single-ventricle physiology
at the Universitas Academic
Hospital in central South
Africa between November 1997
and June 2021.
Results:
Patients were referred from
the Free State (54%) and
Northern Cape (29%)
provinces and Lesotho. One
hundred and fifty-four
patients presented with
single-ventricle physiology:
114 received interventions
and 40 were not eligible for
intervention. Patients
presented for the first time
at a median age of 34.5
days, with patients from
nearby districts presenting
within a few days of birth.
However, patients from
outlying areas presented
much later. Eighty-seven
patients received
systemic-to-pulmonary artery
shunting or pulmonary artery
banding. Sixty-three
patients proceeded to
bidirectional Glenn
procedures, and 30 patients
(26%) had full palliation to
Fontan. Twenty-one patients
died after stage 1, six
after the Glenn procedure
and two after the Fontan
procedure. Overall, 34
(29.8%) patients were lost
to follow up.
Conclusion:
Patients in our study
presented late and follow up
of these patients was a
challenge. The highest
mortality rate occurs during
the first stage of
palliation. Outcomes from
this study are comparable to
other sub-Saharan studies.
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Comparison of serum lipoprotein(a) levels in young and middle-aged patients presenting for the first time with ST-elevation myocardial infarction: a single-centre stud
Songül Usalp, Emine Altuntaş, Bayram Bağırtan, Kanber Ö Karabay
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DOI:
10.5830/CVJA-2023-038
Online Publication Date: 25
August 2023
Background:
Lipoprotein(a) [Lp(a)] is
associated with coronary
artery disease due to its
atherogenic and thrombogenic
nature. In this study, we
aimed to compare the level
of Lp(a) in young and
middle-aged patients with
ST-elevation myocardial
infarction (STEMI).
Methods:
This retrospective study
included 287 patients aged
20–65 years who presented to
the emergency department for
the first time due to STEMI.
The patients were divided
into two groups: 20–45 years
(young group, n = 111) and
46–65 years (middle-aged
group, n = 176). The groups
were compared in terms of
demographic characteristics,
co-morbidities and
laboratory findings.
Results: In
the young group, smoking
(99, 89.2% vs 130, 73.9%; p
= 0.001), family history of
coronary artery disease (75,
67.6% vs 80, 45.5; p <
0.001), serum Lp(a) level
[38.1 ± 27.9 (93 ± 68) vs
23.5 ± 23.2 mg/dl (57 ± 56
nmol/l); p < 0.001],
triglyceride level [219.1 ±
231.9 (2.48 ± 2.62) vs 170.2
± 105.6 mg/dl (1.92 ± 1.19
mmol/l); p = 0.018),
ejection fraction (52.4 ±
6.1 vs 47.2 ± 7.7%; p =
0.004) and single-vessel
disease (83, 74.8% vs 110,
62.5%; p = 0.031) were
higher than in the
middle-aged group. In
multivariable logistic
regression analyses, family
history (OR: 2.073, 95% CI:
1.210–3.549; p = 0.008), low
high-density lipoprotin
cholesterol level (OR:
1.032, 95% CI: 1.003–1.062;
p = 0.029) and Lp(a)
elevation (OR: 1.981, 95%
CI: 1.871–3.991; p < 0.001)
were possible independent
risk factors for STEMI in
young patients.
Conclusion:
Lp(a) level was found to be
a higher and a possible
independent risk factor in
young patients who presented
with STEMI for the first
time, compared to the
middle-aged patient group.
Lp(a) is a highly
atherogenic molecule and it
has been associated with
stroke, heart failure,
aortic stenosis, as well as
coronary artery disease.
Measurement of Lp(a) levels
may be recommended in young
patients with high
cardiovascular risk.
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The value of measured partial oxygen pressure during pulmonary vein closure and the relationship with the diameter of the closed vein in patients with cryoablation
Enes Çon, Namık Kemal Eryol, Mehmet Tuğrul İnanç, Deniz Elçik
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DOI:
10.5830/CVJA-2023-040
Online Publication Date: 17
August 2023
Aim: The
aim of this study was to
investigate the value of
partial oxygen pressure
(PO2) changes measured in
the left atrium (LA) during
transient pulmonary vein
(PV) closure in patients
undergoing cryoablation and
its relationship with the
diameter of the closed PV.
Methods:
The study was carried out on
a total of 25 cases. The
grouping of PVs was made
separately as the left
superior, left inferior,
left common, right superior,
right inferior, right common
and total PVs. PV
measurement was made from
angiographic images obtained
after the cryoablation
balloon was inflated and
opaque. From the LA, the
difference between the PO2
values in the blood gases
obtained before and during
the temporary closure of
each PV was evaluated as the
PO2 change. The difference
of the lowest temperature
reached during the closing
of each PV from –36°C was
termed the heat difference.
The relationship of PO2
change with PV diameter and
the heat difference were
investigated.
Results:
There was no significant
relationship between any of
the PV diameters and PO2
changes (p > 0.05). There
was a significant
relationship between heat
differences and PO2 changes
in the left superior (p =
0.011), right superior (p =
0.049), right ‘common’ (p =
0.037) and total PVs (p =
0.001), but there was no
significant relationship
between heat differences and
PO2 changes in the left
inferior, left ‘common’ and
right inferior PVs (p >
0.05).
Conclusion:
In the light of these data,
PO2 change could demonstrate
the success of cryoablation,
and was related with the
cooling degree, but not with
the PV diameter.
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Paying more attention to arterial hypertension, dyslipidaemia, women and the rural environment in our ongoing fight against cardiovascular diseases and their risk factors
Pêngd-Wendé Habib Boussé Traore, Jean Augustin Diégane Tine, Oumar Bassoum, Abdoul Kane, Adama Faye
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DOI:
10.5830/CVJA-2023-033
Online Publication Date: 17
August 2023
Background:
The diagnostic and
therapeutic efforts
instituted by the state of
Senegal since the results of
the STEPwise survey in 2015
could and should be
reinforced with an effective
and targeted preventative
approach against
cardiovascular accidents.
This study aimed to (1)
identify the pathological
population that contains the
most incidents of stroke in
Senegal, (2) identify the
prevalence, and geographical
and gender distribution of
biological co-morbidities
with hypertension, stroke
and advice for a change in
behaviour, and (3) research
the factors associated with
the occurrence of
cardiovascular accidents
specific to the Senegalese
context.
Methods:
This was a secondary
analysis of the STEPwise WHO
Senegal 2015 survey: a
descriptive quantitative
epidemiological study with
an analytical aim.
Results:
Biological co-morbidities
with arterial hypertension
as well as cardiovascular
accidents affected more
women than men. Biological
co-morbidities with arterial
hypertension predominated in
urban areas, while
cardiovascular accidents
were more common in rural
areas. The population with
arterial hypertension and
total hypercholesterolaemia
simultaneously was at the
top of a list of 25
pathological populations in
terms of the proportion of
cardiovascular accidents
within them. In addition,
total hypercholesterolaemia
was found in the first three
populations with the most
cardiovascular accidents.
Regarding advice for
behavioural change, advice
for smoking cessation was
the most widespread. All
advice was given mostly to
the gender most affected by
the health problem, but some
advice was mostly addressed
to the environment least
affected by the problem.
Therefore, despite being the
most affected, the rural
environment received the
least advice for a change in
behaviour with regard to the
practice of any of the forms
of the physical activities
described, the consumption
of oil of palm, the
consumption of cubed sugar
or sugary drinks, smoked and
non-smoked tobacco and
attempted smoking cessation.
In multivariate analysis, it
was found that arterial
hypertension produced a 2.74
times greater risk of having
a cardiovascular accident
(adjusted odds ratio = 2.74;
95% confidence interval =
1.88–3.99; p < 0.001).
Conclusion:
In Senegal, we need to pay
more attention to arterial
hypertension, dyslipidaemia,
women and the rural
environment in our ongoing
fight against cardiovascular
diseases and their risk
factors.
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The relationship between serum osteoprotegerin levels and right atrial and ventricular speckle-tracking measurements in essential hypertension patients with normal left ventricular systolic function
Ender Emre, Ezgi Kalaycıoğlu, Ahmet Özderya, Murat Gökhan Yerlikaya, Turhan Turan, Kaan Hancı, Tayyar Gökdeniz, Mustafa Çetin
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DOI:
10.5830/CVJA-2023-036
Online Publication Date: 27
July 2023
Objective:
We planned to reveal the
relationship between OPG
(osteoprotegerin) level and
right heart function in
hypertensive patients with
normal ejection fraction,
using strain analysis, which
is a sensitive method in
demonstrating subclinical
dysfunction.
Methods:
Between February and June
2018, 625 consecutive
patients with a diagnosis of
hypertension who applied to
the cardiology out-patient
clinic of our hospital were
evaluated for our study and
175 eligible patients were
included. The patients were
divided into two groups
according to their OPG
level. Strain analysis was
performed in the
echocardiographic
evaluation.
Results:
The mean OPG value was 6.33
± 1.87 pg/l. There were 93
patients (age 51.1 ± 8.5
years) in the low OPG group
and 82 patients (age 54.6 ±
10.4 years) in the high OPG
group. A significant
difference was found between
the two groups with regard
to age (p = 0.016), statin
use (p = 0.026), C-reactive
protein level (p = 0.048),
office systolic blood
pressure (SBP) (p = 0.001)
and office diastolic blood
pressure (DBP) (p = 0.001).
A significant difference was
found between values of
strain during reservoir
phase (RASr) (p = 0.01),
strain during conduit phase
(RAScd) (p < 0.001) and peak
strain rate during reservoir
phase (pRASRcd) (p = 0.044).
In multivariate regression
analysis, age (OR: 1.162,
95% CI: 1.064–1.269, p =
0.001), office DBP (OR:
1.089, 95% CI: 1.020–1.161,
p = 0.011) and RAScd (OR:
0.890, 95% CI: 0.815–0.972,
p < 0.010) were found to be
independent predictors of
high OPG.
Conclusion:
In our study, we found high
OPG level was inversely
correlated with right atrial
strain values and linearly
associated with high blood
pressure. In order to take
advantage of the negative
indicators of high OPG,
positive results can be
obtained in strain values of
the right heart by
indirectly reducing the
afterload of the right
heart. This can be done by
reducing high systemic blood
pressure and providing tight
blood pressure control.
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The association between CHA2DS2-VASc score and aortic valve sclerosis
Funda Başyiğit, Havva Tuğba Gürsoy, Özlem Özcan Çelebi, Kevser Gülcihan Balcı, Özgül Uçar Elalmış, Kerem Özbek, Özge Çakmak Karaaslan, Mehmet İleri, Telat Keleş, Sinan Aydoğdu
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DOI:
10.5830/CVJA-2023-022
Online Publication Date: 26
July 2023
Background:
Antithrombotic therapy in
atrial fibrillation is
generally managed with the
CHA2DS2-VASc score. Aortic
valve sclerosis (AVS) is a
focal thickening of the
aortic valve without a
restriction of motion. AVS
is related to several
cardiovascular risk factors.
Our study was performed to
evaluate whether the
presence of AVS was
associated with the
CHA2DS2-VASc score.
Methods:
This cross-sectional,
observational study
comprised 411 patients with
AVS grades 1–3 [AVS (+)] and
102 patients with AVS grade
0 [AVS (–)]. We compared
CHA2DS2-VASc scores between
the AVS (+) and AVS (–)
groups.
Results: We
determined that the AVS (+)
group had a higher
CHA2DS2-VASc score than the
AVS (–) group [3 (0–8) vs 1
(0–4), p < 0.001)].
Conclusion:
In our study, the
CHA2DS2-VASc score was found
to be higher in patients
with AVS than in those
without AVS. AVS may predict
cardiovascular risk in the
general population.
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Oxidative metabolism of neutrophils in acute coronary syndrome
Elena Proskurnina, Tatiana Danilova, Madina Sozarukova, Artem Snitsar, Anatoly Baranov
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DOI:
10.5830/CVJA-2023-032
Online Publication Date: 25
July 2023
Background:
Inflammation in acute
coronary syndrome (ACS)
involves neutrophil
activation and oxidative
stress. Here, we studied the
production of reactive
oxygen species (ROS) by
neutrophils in ACS.
Methods:
The study included 42
patients, men and women aged
46–91 years with ischaemic
heart disease (IHD),
non-ST-segment elevation ACS
and ST-segment elevation
ACS. Neutrophil-derived ROS
were quantified with
double-step stimulated
luminol-enhanced
chemiluminometry.
Results:
The specific indices of
spontaneous and double-step
stimulated chemiluminescence
did not differ in the
subgroups of IHD,
non-ST-segment elevation ACS
and ST-segment elevation
ACS. The total double-step
stimulated ROS production by
neutrophils was
significantly higher in
ST-segment elevation ACS
than in non-ST-segment
elevation ACS and IHD.
Conclusions:
In ACS, special activation
mechanisms of peripherical
neutrophils were not
triggered in our study. The
significant increase in free
radical production by
neutrophils in acute
myocardial infarction was
presumably a consequence of
an increase in their number.
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Yield of family screening in dilated cardiomyopathy within low-income setting: Tanzanian experience
LS Fundikira, J Julius, P Chillo, H Mayala, E Kifai, LW van Laake, A Kamuhabwa, G Kwesigabo, FW Asselbergs
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DOI:
10.5830/CVJA-2023-037
Online Publication Date: 25
July 2023
Background:
Dilated cardiomyopathy (DCM)
is often familial and
screening of relatives is
recommended. However,
studies on the yield of
screening are scarce in
developing countries.
Aim: The
aim of the study was to
identify and characterise
first-degree relatives of
patients with DCM in
Tanzania. Methods: We
recruited first-degree
relatives of 57 DCM
patients. DCM in the
relatives was diagnosed
using the 2016 revised
definition by the European
Society of Cardiology
working group on myocardial
and pericardial diseases.
Results: We
screened 120 first-degree
relatives. All were
asymptomatic (100%) with a
median age of 39.0 years
(29.5– 49.0), slightly over
a half (53.3%) were females
and 17 (14.1%) were found to
have previously unknown DCM.
The mean (± SD) indexed left
ventricular end-diastolic
volume was significantly
higher in relatives with DCM
(71 ± 11.5 ml) compared to
relatives without DCM (50 ±
11.5) (p = 0.001).
Conclusion:
First-degree relatives of
patients with DCM are at
risk of developing
asymptomatic DCM at a young
age.
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Study of the mechanism of Shexiang Baoxin pill-mediated angiogenesis in acute myocardial infarction
Jingxun Wei, Binchang Dong, Xin Du, Huipu Xu
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DOI:
10.5830/CVJA-2023-030
Online Publication Date: 04
July 2023
Aim: The
Shexiang Baoxin pill (SBP)
is a commonly used drug for
the treatment of coronary
artery disease in China.
More recently, some studies
have found that it improved
coronary microvascular
function. This study aimed
to explore the possible
mechanism by which the SBP
promotes angiogenesis after
acute myocardial infarction
(AMI).
Methods: A
rabbit model of acute
myocardial infarction was
established by ligating the
left anterior descending
coronary artery with silk
thread, and the limb lead
electrocardiogram was
recorded to determine the
success of the model. The
rabbits were divided into a
control group (SBP + normal
rabbit group), a sham
operation group, a saline +
AMI group and an SBP + AMI
group. There were 10 rabbits
in each group. The animals
were sacrificed and
myocardial tissue was
collected seven days after
the operation.
Haematoxylin–eosin staining
was used to observe the
histological changes in the
rabbit myocardium in each
group. The degree of acute
myocardial infarction was
observed with picric acid
staining, which was used to
detect the expression of
vascular endothelial growth
factor (VEGF), silent
information regulator 1
(SIRT1), Beclin1 and mTOR
protein in the myocardial
tissue of each group.
Immunofluorescence
CD31-labelled microvascular
density (MVD) was used to
observe the vascular
regeneration of the rabbits
in each group.
Results:
Compared with the normal
saline + AMI group, the
myocardial infarction area
of the SBP + AMI group
decreased and CD31
immunofluorescence-labelled
MVD increased. Compared with
the control and sham
operation groups, the
expression of VEGF, Beclin1
and mTOR in the normal
saline + AMI group and the
SBP + AMI group increased,
while the expression of
SIRT1 decreased. Compared
with the normal saline + AMI
group and the SBP + AMI
group, the positive
expression of VEGF, Beclin1,
mTOR and SIRT1 in the SBP +
AMI group was significantly
increased.
Conclusion:
Autophagy was enhanced after
acute myocardial infarction.
SBP may affect angiogenesis
through the SIRT1/mTOR
signalling pathway after
acute myocardial infarction
to inhibit ventricular
remodelling and a decline in
cardiac function.
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Effects of intravenous sodium thiosulfate on vascular calcification in dialysis patients with end-stage renal disease: a systematic review and meta-analysis
Yu-Huan Song, AiBing Ning, Na Guo, Ying Yang, Fei Tang, Na Zhao, Jun Hu, Hong Wu, Ting Peng, Yue-fei Xiao, Guang-Yan Cai
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DOI:
10.5830/CVJA-2023-020
Online Publication Date: 03
July 2023
Background:
In dialysis patients,
vascular calcification is a
common complication and is
closely related to the
morbidity and mortality of
cardiovascular disease. We
performed a systematic
review to determine the
efficacy and safety of
sodium thiosulfate (STS) in
the progression of vascular
calcification in dialysis
patients with end-stage
renal disease.
Methods:
The PubMed, Web of Science,
Embase, Cochrane Library,
Wanfang, CNKI, China Biology
Medicine disc and Weipu
databases were searched up
to 9 March 2022 for clinical
trials to synthesise
findings on the efficacy and
safety of STS in the
progression of vascular
calcification in dialysis
patients. The primary
outcome was coronary artery
calcification scores (CACS)
or abdominal aortic
calcification scores (AACS)
or Kauppila index. The
secondary outcome was
pulse-wave velocity (PWV).
Laboratory data were shown
in safety data. A
random-effect model was used
to provide the summary
measures of effect
[standardised mean
difference (SMD) and 95%
confidence interval (CI)].
Results:
Seven randomised, controlled
trials and one
nonrandomised, controlled
trial involving 370 patients
were included. Six studies
reported that the
progression of CACS or AACS
was slower in the
intravenous STS group
compared with the control
group (SMD –3.24, 95% CI:
–5.29, –1.18, p = 0.002).
Two studies showed the
increase in PWV was less in
the STS group compared with
the control group (SMD
–0.52, 95% CI: –0.92, –0.13,
p = 0.009). During the trial
period, a lower
high-sensitivity C-reactive
protein level (SMD 1.61, 95%
CI: 0.19, 3.04, p = 0.03), a
decrease in serum
bicarbonate level (SMD 0.67,
95% CI: 0.22, 1.11, p =
0.003) and an increase in
serum phosphate level (SMD
–0.32, 95% CI: –0.62, –0.03,
p = 0.03) were noted in the
intravenous STS group
compared with the control
group. However, serum
calcium and parathyroid
hormone levels showed no
difference between the two
groups after the trials. The
most common adverse events
were temporary nausea and
vomiting, which occurred in
12.5 to 75% of patients.
Conclusions:
Intravenous STS may slow
down the progression of
vascular calcification and
ameliorate arterial
stiffness in dialysis
patients. Reliably defining
the efficacy and safety of
intravenous STS in
attenuating the progression
of vascular calcification
requires a high-quality
trial with a large sample
size.
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Right ventricular function in treatment-naïve human immunodeficiency virus-infected patients
Bassey Effiong, Victor Ansa, Joseph Andy, Idongesit Odudu-Umoh, Taiwo Shogade, Aquaowo Udosen, Udeme Ekripko
Full text:
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DOI:
10.5830/CVJA-2023-031
Online Publication Date: 03
July 2023
Background:
Right ventricular
dysfunction carries a poorer
prognosis in human
immunodeficiency virus
(HIV)-positive patients. The
objectives of this study
were to ascertain the
prevalence of right
ventricular systolic and
diastolic dysfunction, as
well as its predictors, in
antiretroviral therapy-naïve
HIV-positive patients.
Methods:
Participants in this
cross-sectional, descriptive
study comprised 60
HIV-positive patients and 60
HIV-negative controls. All
participants had
transthoracic
echocardiography done to
assess right ventricular
systolic and diastolic
function. The HIV-positive
patients had their CD4
counts measured.
Results:
The mean age of the study
population was 34.63 ± 8.7
years versus that of the
controls (34.45 ± 9.40
years) (p = 1.000). Right
ventricular systolic
dysfunction was found in
11.6% of the HIV-positive
patients versus the controls
(3.33%, p = 0.166) while
right ventricular diastolic
dysfunction was found in
15.0% of HIV-positive
patients versus the controls
(1.7%, p = 0.021). The CD4
count did not contribute to
the frequency and degree of
right ventricular systolic
or diastolic dysfunction.
Conclusion:
Right ventricular systolic
and diastolic dysfunction
was common in
treatment-naïve HIV-infected
individuals but the
frequency and degree were
not associated with the CD4
count or other measured
parameters.
-
Changes in blood pressure after catheter-based renal denervation in South Africa
Iftikhar O Ebrahim, Mpiko Ntsekhe, Brian Rayner, Martin Fahy, Giuseppe Mancia, Michael Böhm; on behalf of the Global SYMPLICITY Registry investigators
Full text:
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DOI:
10.5830/CVJA-2023-021
Online Publication Date: 28
June 2023
Background:
Renal denervation (RDN) is
an interventional treatment
for patients with
uncontrolled hypertension.
The Global SYMPLICITY
Registry (GSR) is a
prospective, all-comer,
world-wide registry designed
to assess the safety and
efficacy of RDN. We
evaluated the outcomes in
South African patients in
the GSR over 12 months.
Methods:
Eligible patients with
hypertension had a daytime
mean blood pressure (BP) >
135/85 mmHg or night-time
mean BP > 120/70 mmHg.
Office and 24-hour
ambulatory systolic BP
reduction and adverse events
over 12 months were
evaluated.
Results:
South African patients (n =
36) in the GSR had a mean
age of 54.4 ± 9.9 years with
a median of four prescribed
antihypertensive medication
classes. At 12 months, mean
changes in office and
24-hour ambulatory systolic
BP were –16.9 ± 24.2 and
–15.3 ± 18.5 mmHg,
respectively, with only one
adverse event recorded.
Conclusion:
RDN safety and efficacy in
South African patients were
consistent with world-wide
GSR results.
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Effect of insulin resistance on left ventricular remodelling in essential hypertensives: a cross-sectional study
Bernard Kianu Phanzu, Aliocha Nkodila Natuhoyila, Eleuthère Kintoki Vita, Benjamin Longo-Mbenza, Jean-René M’Buyamba Kabangu
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DOI:
10.5830/CVJA-2023-024
Online Publication Date: 21
June 2023
Background:
In clinical practice, left
ventricular hypertrophy
(LVH) is defined by physical
findings and
electrocardiographic
criteria, which are useful
but imperfect tools,
echocardiographic criteria
and cardiac magnetic
resonance imaging. In
echocardiography, LVH is
defined not by left
ventricular wall thicknesses
but by left ventricular
mass. The latter is
calculated according to
Devereux’s formula, and is
increased by insulin
resistance/hyperinsulinaemia.
It is however unclear
whether insulin resistance,
hyperinsulinaemia, or both,
is actually causative and
what their collective or
individual influence is on
the components of Devereux’s
formula and parameters of
left ventricular diastolic
function. This study
evaluated the associations
of the homeostatic model
assessment for insulin
resistance (HOMAIR) and
fasting plasma insulin
levels with components of
Devereux’s formula and
parameters of left
ventricular diastolic
function.
Methods:
Relevant clinical data were
collected from 220
hypertensive patients
recruited between January
and December 2019. The
associations of components
of Devereux’s formula and
parameters of diastolic
function with insulin
resistance were tested using
binary ordinal, conditional
and classical logistic
regression models.
Results:
Thirty-two (14.5%) patients
(43.9 ± 9.1 years), 99 (45%)
patients (52.4 ± 8.7 years)
and 89 (40.5%) patients
(53.1 ± 9.8 years) had
normal left ventricular
geometry, concentric left
ventricular remodelling and
concentric left ventricular
hypertrophy, respectively.
In multivariable adjusted
analysis, 46.8% of variation
in interventricular septum
diameter (R² = 0.468;
overall p = 0.001) and 30.9%
of E-wave deceleration time
(R² = 0.309; overall p =
0.003) were explained by
insulin level and HOMAIR,
30.1% of variation in left
ventricular end-diastolic
diameter (R² = 0.301; p =
0.013) by HOMAIR alone, and
46.3% of posterior wall
thickness (R² = 0.463; p =
0.002) and 29.4% of relative
wall thickness (R² = 0.294;
p = 0.007) by insulin level
alone.
Conclusions:
Insulin resistance and
hyperinsulinaemia did not
have the same influence on
the components of Devereux’s
formula. Insulin resistance
appeared to act on left
ventricular end-diastolic
diameter, while
hyperinsulinaemia affected
the posterior wall
thickness. Both
abnormalities acted on the
interventricular septum and
contributed to diastolic
dysfunction via the E-wave
deceleration time.
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Impact of the COVID-19 pandemic on cardiology fellowship training in a sub-Saharan African training centre: an African perspective
E Amendezo, M Ngunga, AH Ahmed, MH Varwani, B Karau, R Kimeu, M Jeilan
Full text:
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DOI:
10.5830/CVJA-2023-023
Online Publication Date: 19
June 2023
Aim: The
impact of the COVID-19
pandemic on cardiology
fellowship training in
sub-Saharan Africa (SSA) is
not known. This study aimed
to determine the impact of
the COVID-19 pandemic on
fellowship training, and
reviewed the adaptiveness of
the existing training
systems.
Methods: We
conducted a three-month data
survey related to the
cardiology fellows’ clinical
exposure at the Aga Khan
University Hospital, Kenya,
before the COVID-19 pandemic
and compared it with a
three-month period during
the pandemic. Hospital data
volumes for patients’
contacts, ambulatory and
catheterisation laboratory
procedures recorded during
the periods of March to May
2019 (three months
pre-COVID-19) and March to
May 2020 (three months
during the COVID-19
pandemic) were analysed. A
comparative fellows’ logbook
evaluation of recorded cases
was also conducted for the
two study time periods. In
addition, fellows answered a
survey questionnaire related
to their roles and
responsibilities in the
hospital, their views on
cardiology training during
the COVID-19 pandemic and
the pandemic’s impact on
their training.
Results:
There was a significant
reduction in the volume of
patients and cardiac
procedures during the
COVID-19 period compared to
the pre-COVID-19 period. In
the same line, the number of
fellows’ training episodes
reduced significantly during
the COVID-19 pandemic
compared to their
performances before the
pandemic. Fellows felt that
the COVID-19 crisis has had
a moderate to severe impact
on their fellowship
training. They however noted
an increase in the provision
of virtual local and
international meetings and
conferences, which supported
the training positively.
Conclusions:
This study showed that the
COVID-19 crisis resulted in
a significant reduction in
the total volume of patients
and cardiac procedures and,
in turn, the number of
training episodes. This may
have limited the fellows
from achieving a great
amount of skills base in
highly technical skills by
the end of their training.
Opportunities for
postfellowship training in
the form of continued
mentorship and proctorship
would be a valuable option
for the trainees if there is
a similar pandemic in the
future.
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The effects on clinical outcomes of administering medications together or separately in prolonged dual antiplatelet therapy after peripheral revascularisation
Ozgur Akkaya, Oguz Karahan
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DOI:
10.5830/CVJA-2023-013
Online Publication Date: 19
June 2023
Background:
In the current guidelines,
dual antiplatelet therapy
[acetylsalicylic acid (ASA)
+ clopidogrel] is
recommended for at least
three months after
peripheral iliac stenting.
In this study, we
investigated the effect on
clinical outcomes of adding
ASA in different doses and
at different times after
peripheral
revascularisation.
Methods:
Seventy-one patients were
administered dual
antiplatelet therapy after
successful iliac stenting.
Group 1, consisting of 40
patients, was given 75 mg of
clopidogrel plus 75 mg of
ASA in a single dose in the
morning. In group 2,
separate doses of 75 mg of
clopidogrel (in the morning)
and 81 mg of 1 × 1 ASA (in
the evening) were started in
31 patients. The demographic
data and bleeding rates of
the patients after the
procedure were recorded.
Results:
The groups were found to be
similar in terms of age,
gender and accompanying
co-morbid factors (p >
0.05). The patency rate was
100% in the first month in
both groups, and it was
above 90% at the sixth
month. When one-year patency
rates were compared,
although the first group had
higher rates (85.3%), no
significant difference was
found (p < 0.05). However,
there were 10 (24.4%)
bleeding events in group 1,
and five (12.2%) of these
were in the gastrointestinal
system, resulting in reduced
haemoglobin levels (p =
0.038).
Conclusion:
ASA doses of 75 mg or 81 mg
did not affect one-year
patency rates. However,
higher bleeding rates were
observed in the group that
received both clopidogrel
and ASA treatment
simultaneously (in the
morning) despite the lower
dose of ASA.
-
Empagliflozin significantly prevents QTc prolongation due to amitriptyline intoxication
Veysel Özgür Barış, Esra Gedikli, Adnan Berk Dinçsoy, Ayşen Erdem
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DOI:
10.5830/CVJA-2023-017
Online Publication Date: 07
June 2023
Aim:
Empagliflozin (EMPA) is a
sodium-glucose transporter-2
inhibitor used in the
treatment of type 2 diabetes
and has positive effects on
cardiovascular outcomes.
Amitriptyline (AMT) can be
used in many clinical
indications but leads to
cardiotoxicity by causing QT
prolongation. Our aim in
this study was to determine
how the effects of the
concomitant use of
empagliflozin and
amitriptyline, which have
been shown to have effects
on sodium and calcium
metabolism in
cardiomyocytes, would cause
an effect on QT and QTc
intervals in clinical
practice.
Methods:
Twenty-four male Wistar
albino rats were randomised
into four groups. The
control group received only
physiological serum (1 ml)
via orogastric gavage (OG).
The EMPA group received
empagliflozin (10 mg/kg) via
OG. The AMT group received
amitriptyline (100 mg/kg)
via OG. The AMT+EMPA group
(n = 6) received
amitriptyline (100 mg/kg)
and empagliflozin (10
mg/kg). Under anaesthesia,
QT and QTc intervals were
measured at baseline, and in
the first and second hours.
Results: In
the AMT group, QT intervals
and QTc values were found to
be statistically longer than
in the control group (p ≤
0.001). Empagliflozin
significantly ameliorated
amitriptyline-induced QT and
QTc prolongation. In the
AMT+EMPA group, QT and QTc
intervals were significantly
lower compared to that in
the AMT group (p < 0.01)
Conclusion:
In this study, we determined
that empagliflozin
significantly ameliorated
amitriptyline-induced QT and
QTc prolongation. This
effect was probably due to
the opposite effects of
these two agents in the
intracellular calcium
balance. With more clinical
trials, the routine use of
empagliflozin may be
suggested to prevent QT and
QTc prolongation in diabetic
patients receiving
amitriptyline.
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Is the transradial approach associated with decreased acute kidney injury following percutaneous coronary intervention in patients not complicated by major bleeding and haemodynamic disturbance?
Tolga Dasli, Burak Turan
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DOI:
10.5830/CVJA-2023-025
Online Publication Date: 05
June 2023
Background:
The impact of the
transradial approach (TRA)
on the development of acute
kidney injury (AKI) after
percutaneous coronary
interventions (PCI) has been
controversial.
Methods: We
retrospectively analysed 463
patients undergoing PCI for
either acute or chronic
coronary syndrome. Excluded
patients were those with
missing laboratory or
procedural data,
acute/decompensated heart
failure, major bleeding,
haemodynamic instability,
long-term dialysis and
mortality. The primary
endpoint of the study was
the incidence of AKI after
PCI, which was defined as an
increase in serum creatinine
(SCr) level of 0.5 mg/dl or
25% from the baseline.
Secondary endpoints were
change in SCr level,
increase in SCr of ≥ 0.3 and
≥ 0.5 mg/dl, and increase in
SCr of ≥ 25 and ≥ 50%. We
compared the incidence of
AKI between the TRA and the
transfemoral approach (TFA)
in the overall and a
propensity score
(PS)-matched study
population.
Results:
The study population
included 339 patients. After
PS matching, we obtained a
well-balanced population of
182 patients. The
differences between the
incidence of AKI in the TRA
and TFA were not significant
in both the overall (9.0 vs
11.2%, p = 0.503) and
PS-matched (9.9 vs 7.7%, p =
0.601) study population. TRA
resulted in a significantly
lower incidence of SCr
increase of ≥ 50% in
unmatched patients. However,
after PS matching, there was
no difference between the
TRA and TFA in any variable
of secondary post-PCI renal
outcomes. Age, female
gender, baseline SCr level,
baseline estimated
glomerular filtration rate
and contrast volume were
independent predictors of
AKI.
Conclusion:
Compared to the conventional
TFA, TRA was not associated
with a reduced incidence of
AKI after PCI in patients
not complicated by major
bleeding, acute heart
failure and haemodynamic
disturbances.
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Effect of lactate levels on extubation time in coronary artery bypass grafting surgery
Selen Öztürk
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DOI:
10.5830/CVJA-2023-027
Online Publication Date: 05
June 2023
Aim: In
current practice, fast-track
protocols are gaining
importance in patients
undergoing cardiac surgery.
For this purpose, besides
different application
techniques, biomarkers are
frequently examined in the
peri-operative period. We
aimed to examine whether
serum lactate levels at
different peri-operative
intervals had an effect on
the extubation time.
Methods:
The patients were analysed
in two groups according to
the extubation time (early <
6 hours, and late extubation
> 6 hours). Individual
characteristics, co-existing
diseases, blood transfusion,
inotropic support,
intra-aortic balloon pump,
cardiopulmonary bypass time,
aortic cross-clamp time, and
the serial measurements of
serum lactate levels were
recorded. Correlations of
serial measurements of
lactate levels and the
peri-operative variables
with extubation times were
analysed.
Results: No
significant differences were
observed between the groups
in terms of co-existing
diseases and individual
characteristics. However,
cardiopulmonary bypass,
aortic cross-clamp times and
all lactate levels after
aortic crossclamping were
found to be significantly
different (p = 0.001). A
statistically significant
correlation was found
between the cut-off value of
1.7 for serum lactate levels
after aortic-cross clamping
(L2); 1.9 for levels after
aortic cross-clamp removal
(L3); 2.2 for levels after
cardiopumonary bypass (L4);
2.1 for levels after
intensive care admission
(L5); 1.7 for levels after
first postoperative hour in
the intensive care unit
(L6), and 1.8 for the
difference between
pre-operative levels (L0)
and the peak level of
lactate in the
peri-operative period (ΔL)
in predicting extubation
time (p < 0.01).
Conclusion:
We concluded that
cardiopulmonary bypass and
aortic cross-clamp times,
and intra-operative serum
lactate levels were
important in predicting
early extubation after
isolated coronary
arterybypass graft surgery.
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Evaluation of clinical results of esmarch bandage application in giant saphenous vein closure during endovenous glue ablation
Oğuz Karahan, Ozgur Akkaya, Eyup Aydogan
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DOI:
10.5830/CVJA-2023-026
Online Publication Date: 03
June 2023
Background:
In recent years, the
endovenous technique has
been presented as a good
alternative to surgery in
the treatment of patients
with lower extremity
varicose veins. However, its
effectiveness in very
advanced saphenous vein
diameters is controversial.
In this study, we
investigated the results of
an endovenous glue ablation
closure system applied with
an esmarch bandage in
saphenous veins with very
large diameters.
Methods:
Eighty-nine patients who
were operated on for
varicose veins were divided
into three groups according
to their saphenous vein
diameters: less than 10 mm
(group 1), between 10 and 15
mm (group 2), and larger
than 15 mm (group 3).
Endovenous closure was
performed with n-butyl
cyanoacrylate in all
patients. An esmarch bandage
was applied during the
procedure to all patients,
except for the group with a
diameter of less than 10 mm.
This group underwent the
standard procedure. All
patients were followed up
for six months after the
procedure and postoperative
symptoms, complications and
closure rates were recorded.
Results:
There was complete closure
of all veins in the first
month postoperatively. While
no thrombophlebitis was
observed in group 3,
thrombophlebitis was
detected in two patients in
groups 1 and 2. In the third
month, minimal
saphenofemoral reflux was
observed in two (4.2%)
patients in group 1 and in
one (4.3%) in group 2. In
the sixth month, minimal
saphenofemoral reflux was
detected in three (6.3%)
patients in group 1 and in
one (4.3%) in group 2. No
residual leakage was
observed in group 3 (p =
0.001). In all groups, the
severity score regressed
significantly in the
postoperative sixth month.
However, the most
significant symptomatic
regression was observed in
group 3, which had the
largest saphenous diameters
and we used an esmarch
bandage during closure (p =
0.000).
Conclusion:
Our findings support the
idea that the application of
an esmarch bandage during
endovenous closure improves
clinical outcomes,
especially in saphenous
veins with larger diameters.
-
Right atrial strain in a normal adult African population according to age
Nyange Mushitu, Ruchika Meel
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DOI:
10.5830/CVJA-2023-004
Online Publication Date: 02
June 2023
Background:
Right atrial longitudinal
strain (RALS) is a useful
parameter to define right
atrial (RA) subclinical
dysfunction prior to changes
in RA dimension and volume.
We sought to establish
normal values for RALS in a
sub-Saharan African
population.
Methods:
This was a retrospective,
cross-sectional study from
2017 to 2019 of 100 normal
individuals. All
echocardiographic
measurements were done as
per the standard guidelines.
Results:
Mean RALS was 32.7 ± 10.5%.
The mean RA volume indexed
to body surface area was
19.5 ± 5.7 ml/m2. There was
a negative correlation
between RALS and age but it
was not statistically
significant (r = –0.15, p =
0.129). Males had a tendency
towards higher RA volume
indexed and RALS
measurements compared to
females (20.8 ± 6.3 and 18.7
± 5.2 ml/m2, p = 0.07; 34.6
± 9.6 and 31.4 ± 10.9%, p =
0.141, respectively). Body
mass index was an
independent predictor of
RALS (r = –0.43, p = 0.003).
Conclusion:
We have provided normative
data for RALS in an African
population. This study
provides a platform for
future larger studies on
RALS.
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Long-term experience of the modified David V re-implantation technique for valve-sparing aortic root replacement
Sabit Sarikaya, Kaan Kirali
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DOI:
10.5830/CVJA-2023-018
Online Publication Date: 01
June 2023
Objective:
The modified David V
technique is one of the
valve-sparing aortic root
replacement (V-SARR)
techniques, which is an
alternative to traditional
composite valve graft root
replacement techniques. We
aimed to analyse our
longterm experience with the
modified David V
re-implantation technique
for the treatment of aortic
root aneurysm and
significant aortic valve
insufficiency.
Methods:
From March 2009 to November
2021 the modified David V
re-implantation technique,
one of the V-SARR
techniques, was performed on
48 patients in our centre.
The results were analysed
retrospectively. Two
different-sized grafts were
used in all patients. The
grafts used in the proximal
position were larger than
the distal grafts. We
performed both
intra-operative and
post-procedural
transoesophageal
echocardiography on each
patient. All patients were
followed by means of
transthoracic
echocardiography. The mean
follow-up period was 5.7 ±
3.1 years.
Results:
The mean age of this cohort
was 56.3 ± 14.3 years
(24–79) and the majority
were men (75%). The mean
aortic root diameter was 5.1
± 0.6 cm. The mean diameter
for the assending aorta was
5.4 ± 2.1 cm. The
in-hospital mortality rate
was 4.2% (n = 2). One
patient needed aortic valve
replacement in the early
postoperative period. Two
(4.2%) patients died in the
early postoperative period
and four (8.3%) died in the
late postoperative period.
Overall survival was 91 ± 4
and 86 ± 5% at one and five
years, respectively. Aortic
valve insufficiancy was at
moderate levels
postoperatively. Freedom
from moderate to severe
residual aortic
insufficiency was 89.6% at
10 years. None of the
patients needed late
re-operation of the aortic
valve postoperatively.
Freedom from valve
re-operation was 100% at the
end of the follow up.
Conclusions:
Our study shows that the
David V technique is
associated with excellent
long-term durability, a
remarkably low rate of
valve-related complications,
and it protects the
re-implanted native aortic
valve from a second
operation. Additionally this
technique could be safely
implemented in patients with
a bicuspid aortic valve and
acute type A aortic
dissection without leaflet
deformity.
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Pre-eclampsia: does cardiac function differ in HIV-positive and -negative women?
Raeesa Bhorat, Ismail Bhorat, Olive P Khaliq, Jagidesa Moodley
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DOI:
10.5830/CVJA-2023-005
Online Publication Date: 11
May 2023
Abstract:
This review aimed to
establish the impact of
pre-eclampsia and HIV
infection on cardiac
function. Cardiovascular
diseases have been reported
to affect pregnancies
complicated by both HIV and
pre-eclampsia. Pre-eclampsia
has been found to be
associated with both
systolic and diastolic
dysfunction. Currently it
has been found that there
may be a dual, bidirectional
pathophysiology, where
placenta-mediated factors
can influence cardiac
function, or pre-existing
cardiovascular disease can
predispose to pre-eclampsia.
Cardiovascular disease, HIV
and pre-eclampsia are major
health challenges
individually and are
interrelated with regard to
pathophysiology. It has been
found that both
pre-eclampsia and HIV
contribute to cardiac
dysfunction as does the
impact of antiretroviral
therapy. Further research is
needed to investigate the
link between these diseases
for the development of novel
therapeutic interventions.
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Systemic immune–inflammation index, and neutrophilto-lymphocyte and platelet-to-lymphocyte ratios can predict clinical outcomes in patients with acute coronary syndrome
Fatma Özpamuk Karadeniz, Yusuf Karadeniz, Emine Altuntaş
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DOI:
10.5830/CVJA-2023-011
Online Publication Date: 05
May 2023
Objective:
Inflammatory mechanisms play
an important role in the
pathogenesis of
atherosclerosis and
myocardial infarction. The
clinical and prognostic
importance of inflammatory
parameters, such as
neutrophil–lymphocyte (NLR)
and platelet–lymphocyte
ratios (PLR) in complete
blood counts in acute
myocardial infarction and
other cardiovascular
diseases has been
demonstrated. However,
systemic immune–inflammation
index (SII) calculated from
neutrophils, lymphocytes and
platelets in the complete
blood cell count has not
been studied sufficiently
and is thought to provide a
better prediction. This
study investigated whether
haematological parameters
such as SII, NLR and PLR
were associated with
clinical outcomes in acute
coronary syndrome (ACS)
patients.
Methods: We
included 1 103 patients who
underwent coronary
angiography for ACS between
January 2017 and December
2021. The association
between major adverse
cardiac events (MACE) that
developed in hospital and at
50 months of follow up and
SII, NLR and PLR was
compared. Long-term MACE
were defined as mortality,
re-infarction and
targetvessel
revascularisation. SII was
calculated using the
formula: NLR × total
platelet count in the
peripheral blood (per mm3).
Results: Of
the 1 103 patients, 403 were
diagnosed with ST-elevation
myocardial infarction and
700 with non-STelevation
myocardial infarction. The
patients were divided into a
MACE and a non-MACE group.
In hospital and during the
50-month follow up, 195 MACE
were observed. SII, PLR and
NLR were found to be
statistically significantly
higher in the MACE group (p
< 0.001). SII, C-reactive
protein level, age and white
blood cell count were
independent predictors of
MACE in ACS patients.
Conclusion:
SII was found to be a strong
independent predictor of
poor outcomes in ACS
patients. This predictive
power was greater than that
of PLR and NLR.
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A strategy to improve adherence to guidelinedirected medical therapy (GDMT) and the role of the multidisciplinary team in a heart-failure programme
Waleed AlHabeeb, Fakhr Alayoubi, Ahmed Hayajneh, Anhar Ullah, Fayez Elshaer
Full text:
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DOI:
10.5830/CVJA-2022-067
Online Publication Date: 05
May 2023
Background:
Heart failure (HF) patients
place a heavy burden on the
healthcare system because of
their frequent need for
in-patient treatment,
emergency room visits and
subsequent hospital stays.
To provide proper care and
effective therapy,
practitioners have
streamlined delivery
techniques such as clinical
pathways, checklists and
pocket manuals. However, a
description of the
establishment of a
disease-management
programme, including a
multidisciplinary team of
physicians, clinical
pharmacists and nurse
specialists is required. The
aim of this study was to
highlight the role of the
multidisciplinary team in a
heart-failure programme by
assessing the improvement in
adherence to
guideline-directed medical
therapy.
Methods: A
retrospective, observational
research was undertaken on
patients with HF at a
cardiac centre in Riyadh, to
observe the HF patients’
management before (January
to December 2014) and after
(January to December 2015)
the establishment of a
programme.
Results:
The use of angiotensin
converting enzyme inhibitors
and angiotensin receptor
blockers was 75.59% in 2014
at discharge and 81.17% in
2015 (p = 0.249).
Beta-blockers use at release
increased from 87.83% in
2014 to 94.53% in 2015 (p =
0.021). The flu vaccine was
given to 48.24% of patients
in 2014 and 75.13% of the
patients in 2015 (p <
0.001). The pneumococcal
vaccine was administered to
44.22% of patients in 2014
and 75.13% of patients in
2015 (p < 0.001). The
ejection fraction improved
from 30.21% in the first
month to 39.56% in the 12th
month (p = 0.001) in
patients managed in 2015.
Conclusion:
The multidisciplinary
heart-failure programme
resulted in a positive
effect, in the form of
improved patient care after
including the clinical
pharmacist and nurse
specialist.
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Association between apelin-12 and creatine kinase-MB, depending on success of reperfusion in STEMI patients
Xhevdet Krasniqi, Josip Vincelj, Masar Gashi, Blerim Berisha, Dardan Kocinaj
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DOI:
10.5830/CVJA-2023-002
Online Publication Date: 05
May 2023
Background:
Acute myocardial infarction
is characterised by an
imbalance in the supply and
demand of oxygen in the
heart. It requires urgent
reperfusion, and poor
outcomes are attributed to
myocardial
ischaemia–reperfusion
injury. We aimed to evaluate
the association between
apelin-12 levels and
creatine kinase-MB activity
in predicting the
effectiveness of reperfusion
therapy in ST-segment
elevation myocardial
infarction (STEMI) patients.
Methods: In
this study we included 72
patients with the following
criteria: chest pain
suggestive of myocardial
ischaemia for at least 30
minutes, an
electrocardiogram with
ST-segment elevation
(measured at the J-point) ≥
2 mm in leads V2–V3 and/or ≥
1 mm in the other leads,
rise of specific biomarkers
such as cardiac troponin and
the MB fraction of creatine
kinase (CK-MB), and those
who underwent reperfusion
therapy. Blood samples for
the measurement of apelin-12
and creatine kinase-MB were
collected 12 hours after the
reperfusion therapy.
Results: In
patients with thrombolysis
in myocardial infarction
(TIMI) flow grade ≤ 2, the
median of the apelin-12
level was 1.80 ng/ml
(0.46–9.20), and with TIMI
flow 3, it was 5.76 ng/ml
(1.14–15.2). Variability was
observed in the apelin
values (Mann–Whitney test)
based on TIMI flow grade (p
< 0.001), while no
variability was observed for
creatine kinase- MB (p <
0.18). The degree of
association between
apelin-12 and creatine
kinase-MB levels was
analysed with Pearson’s
correlation, enabling us to
determine patients with
successful reperfusion
(determined as TIMI flow 3)
(p < 0.004), and those with
unsuccessful reperfusion
(with TIMI flow ≤ 2) (p =
0.86).
Conclusion:
In STEMI patients undergoing
reperfusion therapy,
apelin-12 level was
associated with creatine
kinase-MB activity according
to the success of the
reperfusion.
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Investigation of left ventricular changes according to valve type in patients with surgical replacement due to isolated aortic stenosis
Abdullah Güner, Mehmet Işık, Ömer Tanyeli, Serkan Yıldırım, Erdal Ege, Volkan Burak Taban
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DOI:
10.5830/CVJA-2023-012
Online Publication Date: 05
May 2023
Objective:
The aim of this study was to
investigate postoperative
left ventricular changes
[left ventricular mass
(LVM), left ventricular mass
index (LVMI), left
ventricular end-diastolic
diameter (LVEDD), left
ventricular end-systolic
diameter (LVESD),
patient–prosthesis mismatch
(PPM), pulmonary artery
pressure (PAP), gradients,
and ejection fraction (EF)]
according to the valve type
used in patients undergoing
aortic valve replacement
(AVR) due to isolated aortic
stenosis.
Methods: A
total of 199 patients with
isolated AVR due to aortic
stenosis between 2010 and
2020 was retrospectively
investigated. Four groups
were identified according to
the valve type used
(mechanical, bovine
pericardium, porcine and
sutureless). Pre-operative
and first year postoperative
transthoracic
echocardiography findings
for the patients were
compared.
Results:
Mean age was 64.4 ± 13.0
years, while the gender
distribution was 41.7% women
and 58.3% men. Of the valves
used in patients, 39.2% were
mechanical, 18.1% were
porcine, 8.5% were bovine
pericardial and 34.2% were
sutureless valves. Analysis
independent of the valve
groups observed LVEDD,
LVESD, maximum gradient,
mean gradient, PAP, LVM and
LVMI values reduced
significantly
postoperatively (p < 0.001).
EF was observed to increase
by 2.1% (p = 0.008).
Comparisons of the four
valve groups revealed that
LVEDD, LVESD, maximum
gradient, mean gradient, LVM
and LVMI significantly
decreased in all groups. EF
significantly increased only
in the sutureless valve
group (p = 0.006). Analysis
of PPM groups showed that
LVESD, maximum gradient,
mean gradient, PAP, LVM and
LVMI were significantly
reduced in all groups. In
the normal PPM group, there
was an improvement in EF,
which was significantly
different to the other
groups (p = 0.001), while in
the severe PPM group, EF
appeared to be reduced (p =
0.19).
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Assessment value of the modified early warning score for long-term prognosis of older patients with chronic heart failure
Yin Yin, Jie Chen, Shijiu Jiang
Full text:
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DOI:
10.5830/CVJA-2023-003
Online Publication Date: 28
April 2023
Aim: The
aim of the study was to
explore the assessment value
of the modified early
warning score (MEWS) for the
long-term prognosis of older
patients with chronic heart
failure (CHF).
Methods: A
total of 180 CHF patients,
treated from January 2016 to
January 2018, were divided
into a grade I group (n =
28), a grade II group (n =
37), a grade III group (n =
68) and a grade IV group (n
= 47) according to the New
York Heart Association
(NYHA) functional
classification. The MEWS was
compared on admission and
discharge. Based on the
clinical outcomes during
follow up, the patients were
divided into a non-survival
group (n = 48) and a
survival group (n = 132).
Their general clinical data
and the MEWS were compared.
The predictive values of the
MEWS, troponin I (cTnI) and
B-type natriuretic (BNP)
peptide for long-term
prognosis were assessed
using receiver operator
characteristic (ROC) curves.
Results:
The MEWS on patient
discharge was significantly
lower than that on
admission, and it increased
with increasing NYHA grade
(p < 0.05). The MEWS in the
non-survival group was
significantly higher than
that in the survival group.
Different clinical outcomes
were positively correlated
with NYHA grade, MEWS,
six-minute walking distance
and left ventricular
ejection fraction (r =
0.368, r = 0.471, r = 0.387,
r = 0.423, p < 0.05), and
negatively correlated with
cTnI and BNP (r = –0.411, r
= –0.425). The area under
the ROC curve of the MEWS
was 0.852, indicating higher
accuracy. The optimal
cut-off value, sensitivity
and specificity of the MEWS
for determining prognosis
were 5.6, 0.854 and 0.797
points, respectively.
Conclusion:
The MEWS rose with
increasing NYHA grade and
reflected the severity of
CHF in older patients, which
has higher predictive value
for long-term prognosis.
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IA cross-sectional study of the spectrum, aetiology and clinical characteristics of adult mitral valve disease at Chris Hani Baragwanath Academic Hospital
Ebrahim Banderker, Geert Roozen, Merika Tsitsi, Ruchika Meel
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DOI:
10.5830/CVJA-2023-009
Online Publication Date: 26
April 2023
Background:
Valvular heart disease
constitutes a considerable
amount of cardiovascular
morbidity and mortality
worldwide. There is a
scarcity of data from
Africa.
Methods: In
this descriptive,
cross-sectional study, we
documented the demographic,
clinical and
echocardiographic features
of current patients with
adult mitral valve disease
(MVD) at Chris Hani
Baragwanath Academic
Hospital from December 2018
to March 2019.
Results:
The study included 134
patients (mean age 50 ± 13.3
years) and 77% were female.
The majority were of African
ethnicity (96%). Mitral
regurgitation (39%),
followed by mixed MVD (38%)
were the dominant lesions.
Mitral stenosis was found in
23% of the patients. The
main aetiologies were
rheumatic heart disease
(80%), mitral valve prolapse
(11%), myxomatous
degeneration (6%) and
infective endocarditis (3%).
Hypertension (30%) and HIV
(12%) were the main
co-morbidities. Heart
failure was present in 78%
of the patients at index
hospitalisation. The main
complications were pulmonary
hypertension (28%) and
atrial fibrillation (14%).
Conclusion:
The patients with MVD tended
to be older African females
with co-morbidities who had
predominant rheumatic mitral
regurgitation.
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Identification and treatment of asymptomatic central venous catheter thrombosis after TAVI
Xin Huang
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DOI:
10.5830/CVJA-2023-015
Online Publication Date: 24
April 2023
Abstract:
One of the most serious
complications of central
venous catheterisation is
thrombus, particularly
asymptomatic thrombus. If
not recognised and promptly
treated, it can result in
pulmonary emboli. Here, we
describe transcatheter
aortic valve implantation
performed in a 77-year-old
female patient with the
insertion of a central
venous catheter into the
right internal jugular vein
as part of the procedure.
The patient experienced no
associated discomfort and
received standard
antiplatelet and antibiotic
treatment. Given that the
catheterisation procedure
was unsuccessful on the
first attempt, an
ultrasonographic examination
of the blood vessel was
performed in order to
prepare for extubation of
the patient. A thrombus was
identified, which was
resolved with
low-molecular-weight heparin
anticoagulation therapy. The
patient experienced no
complications with removal
of the central venous
catheter.
-
Surgical experience in adults with Ebstein’s anomaly: long-term results
Ozge Altas, Sabit Sarikaya
Full text:
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DOI:
10.5830/CVJA-2023-008
Online Publication Date: 24
March 2023
Objective:
The aim of this study was to
review late results of the
surgical treatment of
Ebstein’s anomaly with
reconstruction and
replacement in adults.
Methods:
Medical records of 28
consecutive patients
operated on between 1991 and
2014 were reviewed
retrospectively. Surgical
repair was performed in 19
(67.9%) patients (Hardy:
two, Danielson: three,
modified Danielson: six,
Carpentier: three, Kay
annuloplasty reinforced with
ring: two), whereas
tricuspid valve replacement
was performed in nine
patients (32.1%). Primary
long-term outcomes consisted
of right ventricular
function, survival and
freedom from re-operation.
We evaluated the additional
impacts of residual
tricuspid insufficiency and
type of surgery on survival.
Results:
In-hospital mortality rate
was 7.1% (n = 2) due to low
cardiac output status and
sepsis. Patients showed a
significant postoperative
decrease in tricuspid
regurgitation (p < 0.001),
right atrial size (p <
0.001) and pulmonary
hypertension (p = 0.002).
The mean follow-up time was
140 ± 71.4 months, with a
median of 126 months
(105–192). Late mortality
occurred in two patients and
there was no significant
difference in terms of
survival based on residual
tricuspid insufficiency (p =
0.57) and type of surgery (p
= 0.094). Overall survival
rates were 89.3, 85.4, 85.4
and 68.3% at five, 10, 15
and 20 years, respectively.
Conclusion:
Although complex leaflet
reconstruction techniques
have evolved to achieve a
more physiological and
durable repair, both
approaches can be performed
safely on specific patients
and can be alternated, with
acceptable rates of survival
and re-operation.
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Effect of different priming fluids on extravascular lung water, cell integrity and oxidative stress in cardiopulmonary bypass surgery
Halim Ulugöl, Meltem Güner Can, Uğur Aksu, Kübra Vardar, Murat Ökten, Fevzi Toraman
Full text:
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DOI:
10.5830/CVJA-2023-006
Online Publication Date: 06
March 2023
Background:
Discussions continue on the
ideal priming fluid in adult
cardiac surgery. The purpose
of this prospective study
was to evaluate the effects
of different types of
priming fluids on
extravascular lung water,
cell integrity and oxidative
stress status.
Methods:
Thirty elective coronary
artery bypass surgery
patients were randomised
prospectively into two
groups. The first group
received colloid priming
fluid, while the second
group received crystalloid
priming fluid. Extravascular
lung water index, advanced
oxidative protein products,
total thiol, free
haemoglobin, ischaemic
modified albumin and sialic
acid levels were measured.
Moreover, intra-operative
and postoperative outcomes
were reviewed.
Results:
There were no significant
differences between the
groups with regard to
extravascular lung water
index, oxidative stress
parameters or cell integrity
(p > 0.05). Similarly, no
significant differences were
observed between the
patients with regard to
intra-operative and
postoperative outcomes (p >
0.05).
Conclusions:
The presumed superiority of
colloidal priming for
cardiopulmonary bypass could
not be confirmed in our
study.
-
Calcified right ventricular fibroma in an adult
Huanhuan Gao, Shuai Yuan, Zhiqiang Hu, Zhelan Zheng, Yanli Wang, Shengjun Wu
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DOI:
10.5830/CVJA-2023-007
Online Publication Date: 03
March 2023
Objectives:
We aimed to evaluate and
compare papillary muscle
free strain in hypertrophic
cardiomyopathy (HCMP) and
hypertensive (HT) patients.
Methods:
Global longitudinal strain
(GLS), and longitudinal
myocardial strain of the
anterolateral (ALPM) and
posteromedial papillary
muscles (PMPM) were obtained
in 46 HCMP and 50 HT
patients.
Results:
Interventricular septum
(IVS)/posterior wall (PW)
thickness ratio, left
ventricular mass index
(LVMI), left atrial
anteroposterior diameter
(LAAP) and mitral E/E′ were
found to be increased in
patients with HCMP compared
to HT patients. Left
ventricular cavity
dimensions were smaller in
HCMP patients. GLS of HCMP
and HT patients were –14.52
± 3.01 and –16.85 ± 1.36%,
respectively (p < 0.001).
Likewise, ALPM and PMPM free
strain values were
significantly reduced in
HCMP patients over HT
patients [–14.00% (–22 to
–11%) and –15.5% (–24.02 to
–10.16%) vs –23.00% (–24.99
to –19.01%) and –22.30%
(–26.48 to –15.95%) (p =
0.016 and p = 0.010)],
respectively. ALPM free
strain showed a
statistically significant
correlation with GLS,
maximal wall thickness, IVS
thickness and LVMI. PMPM
free strain showed a
significant correlation with
GLS, IVS thickness and LAAP.
The GLS value of –13.05 had
a sensitivity of 61.9% and a
specificity of 97.4% for
predicting HCMP. ALPM and
PMPM free strain values of
–15.31 and –17.17% had 63
and 76.9% sensitivity and
85.7 and 76.9% specificity
for prediction of HCMP.
Conclusions:
Besides other
echocardiographic variables,
which were investigated in
earlier studies, papillary
muscle free strain also
could be used in HCMP to
distinguish HCMP- from
HT-associated hypertrophy.
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Arterial stiffness assessment in obese black South African patients
TL Rasakanya, E Osuch
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DOI:
10.5830/CVJA-2022-064
Online Publication Date: 13
February 2023
Introduction:
Increased arterial stiffness
is a determinant of
cardiovascular mortality and
an independent marker of
cardiovascular disease. The
objective of this study was
to asses arterial elasticity
by determination of
pulse-wave velocity (PWV)
and augmentation index (Aix)
in obese black patients.
Methods:
PWV and Aix were assessed
non-invasively using the
AtCor SphygmoCor® system
(AtCor Medical, Inc, Sydney,
Australia). The study
participants were divided
into four groups; healthy
volunteers (HV) (n = 29),
patients with concomitant
diseases but normal body
mass index (Nd) (n = 23),
obese patients without
concomitant diseases (OB) (n
= 29) and obese patients
with concomitant diseases
(OBd) (n = 29).
Results:
The difference in the mean
levels of PWV was
statistically significant in
the obese group with and
without concomitant disease.
The PWV in the OB group (7.9
± 2.9 m/s) and in the OBd
group (9.2 ± 4.4 m/s) was,
respectively, 19.7 and 33.3%
higher than in the HV group
(6.6 ± 2.1 m/s). PWV was
directly correlated with
age, glycated haemoglobin
level, aortic systolic blood
pressure and heart rate. The
risk of cardiovascular
diseases in the obese
patient without additional
diseases was increased by
50.7%. The presence of
concomitant diseases (type 2
diabetes mellitus and
hypertension) in addition to
obesity increased arterial
stiffness by a further 11.4%
and therefore also increased
the risk of cardiovascular
diseases by a further 35.1%.
Aix was increased in the OBd
and Nd groups by 8.2 and
16.5%, respectively, however
the increase was not
statistically significant.
Aix was directly correlated
with age, heart rate and
aortic systolic blood
pressure.
Conclusion:
The obese black patients had
a higher PWV, indicating
increase in arterial
stiffness and therefore a
higher risk for
cardiovascular disease. In
addition, aging, increased
blood pressure and type 2
diabetes mellitus
contributed further to
arterial stiffening in these
obese patients.
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Clinical characteristics, diagnostic methods and results of surgically treated histologically benign cardiac myxomas
Durmuş Alper Görür, Hüseyin Şaşkin
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DOI:
10.5830/CVJA-2022-069
Online Publication Date: 07
February 2023
Background:
Myxomas are primary cardiac
tumours that may be detected
incidentally due to embolic
events, intracardiac
obstructive features or
non-specific structural
symptoms. The aim of this
study was to share our
experience of clinical
features, diagnostic
methods, surgical procedures
and postoperative follow up
of surgically treated
cardiac myxomas.
Methods:
Data of 34 patients who
underwent surgery for a
cardiac myxoma between
January 2006 and June 2022
were retrospectively
analysed. Group 1 (n = 19)
consisted of patients who
were symptomatic and group 2
(n = 15) patients were
asymptomatic. The medical
records of the patients,
their clinical status,
diagnostic methods,
operation information and
postoperative course data
were collected and recorded.
Results: A
total of 34 patients (16
female; mean age 54.5 ± 8.8
years) underwent cardiac
myxoma resection with
cardiopulmonary bypass.
Fifteen (44.1%) patients
were diagnosed incidentally
with asymptomatic myxoma. An
additional cardiac surgical
procedure was performed in
six patients (17.7%). The 34
cardiac myxomas that were
surgically resected were
localised in the left atrium
in 25 patients (73.5%) and
in the right atrium in nine
patients (26.5%). Patients’
most common symptoms were
dyspnoea (42.1%),
palpitations (21.1%),
ischaemic stroke (15.8%) and
syncope (10.5%). There was
no incident of 30-day
mortality and no recurrence
was observed in any patient
during the follow-up period.
The duration of surgical
intervention in symptomatic
patients was significantly
shorter than in asymptomatic
patients (p = 0.0001), but
there was no statistical
difference in terms of
characteristics.
Conclusion:
Myxomas are benign tumours,
but they are serious
pathologies that require
early treatment because of
signs of obstruction,
embolic complications and
confusion, with left atrial
thrombus in the differential
diagnosis.
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Characteristics and immediate outcomes of patients who underwent percutaneous balloon mitral valvuloplasty at the Jakaya Kikwete Cardiac Institute, Tanzania
Reuben K Mutagaywa, Maarten J Cramer, Pilly Chillo, Aileen Barongo, Engerasiya Kifai, Steven Chamuleau, Chete Eze-Nliam, Nelson B Vera, Deogratias Nkya, Alex Loth, Ben Alencherry, Stella Mongella, Henry Mayala, Peter Kisenge, Salehe Mwinchete, Alex B Joseph, Gideon Kwesigabo, Appolinary Kamuhabwa, Mazen Albaghdadi, Joanna Ghobrial, Mohamed Janabi
Full text:
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DOI:
10.5830/CVJA-2022-068
Online Publication Date: 06
February 2023
Background:
For rheumatic mitral
stenosis (MS), a
multidisciplinary evaluation
is mandatory to determine
the optimal treatment:
medical, percutaneous
balloon mitral valvuloplasty
(PBMV) or valve surgery.
Clinical and imaging
evaluations are essential
for procedural risk
assessment and outcomes.
PBMV interventions are
increasingly available in
Africa and are feasible
options for selected
candidates. Enhancing PBMV
training/skills transfer
across most of African
countries is possible.
Objectives:
The aim of this study was to
provide insight into the
clinical practice of
patients with rheumatic MS
evaluated for PBMV in a
Tanzanian teaching hospital
and to define the role of
imaging, and evaluate the
heart team and
training/skills transfer in
PBMV interventions.
Methods:
From August 2019 to May
2022, 290 patients with
rheumatic MS were recruited
consecutively in the
Tanzania Mitral Stenosis
study. In total, 43 (14.8%)
patients were initially
evaluated for eligibility
for PBMV by a heart team. We
carried out the clinical
assessment, laboratory
investigations,
transthoracic/oesophageal
echocardiography (TTE/TEE)
and electrocardiography.
Results:
The median age was 31 years
(range 11–68), and twothirds
of the patients were female
(four diagnosed during
pregnancy). Two patients had
symptomatic MS at six and
eight years. Nine patients
had atrial fibrillation with
left atrial thrombus in
three, and two were detected
by TEE. Nine patients in
normal sinus rhythm had
spontaneous echo contrast.
The mean Wilkins score was
8.6 (range 8–12). With
re-evaluation by the local
and visiting team, 17
patients were found to have
unfavourable
characteristics:
bi-commissural calcification
(four), ≥ grade 2/4 mitral
regurgitation (six), high
scores and left atrial
thrombus (three), left
atrial thrombus (two), and
severe pulmonary
hypertension (two). Three
patients died before the
planned PBMV. Eleven
patients were on a waiting
list. We performed PBMV in
12 patients, with success in
10 of these, and good
short-term outcomes [mean
pre- PBMV (16.03 ± 5.52
mmHg) and post-PBMV
gradients (3.08 ± 0.44 mmHg,
p < 0.001)]. There were no
complications.
Conclusions:
PBMV had good outcomes for
selected candidates. TEE is
mandatory in pre-PBMV
screening and for procedural
guidance. In our cohort,
patients with Wilkins score
of up to 11 underwent
successful PBMV. We
encourage PBMV skills
expansion in low- and
middle-income countries,
concentrating on expertise
centres.