Background: Dyslipidemia and hypertension are independent cardiovascular risk factors that are linked by insulin resistance and they require follow-up and more aggressive therapeutic strategies. Hence, the present stu...Background: Dyslipidemia and hypertension are independent cardiovascular risk factors that are linked by insulin resistance and they require follow-up and more aggressive therapeutic strategies. Hence, the present study was done to study the prevalence of Diabetes and Dyslipidemia patterns in hypertensive patients. Methods: A cross-sectional observational study was done on patients with hypertension for duration of one year, i.e. from Feb 2022 to January 2023. A total of 726 hypertensive Patients were included. All calculations and statistical analyses were processed by SPSS 25.0. Results: A Total of 726 patients with a history of hypertension were included;the average age was 55, with 24.2% of patients belonging to the age group 51 - 60;55.8% were males and 44.2% were females. In the present study, the prevalence of diabetes was 29.06% and 35.5% of patients in the prediabetic stage. The most frequent dyslipidaemic form was reduced HDL, seen in 96.1% and 94% of new and old respectively;followed by elevated LDL, 86% and 48.2% in new and old respectively. It was followed by elevated TG level and Total cholesterol levels. Conclusion: There was a high prevalence of diabetes, pre-diabetes as well as dyslipidemia in hypertensive patients.展开更多
Myocardial infarction(MI) remains the most common cause of heart failure(HF) worldwide. For almost 50 years HF has been recognised as a determinant ofadverse prognosis after MI, but efforts to promote myocardial repai...Myocardial infarction(MI) remains the most common cause of heart failure(HF) worldwide. For almost 50 years HF has been recognised as a determinant ofadverse prognosis after MI, but efforts to promote myocardial repair have failed to translate into clinical therapies. Primary percutaneous coronary intervention(PPCI) has driven improved early survival after MI, but its impact on the incidence of downstream HF is debated. The effects of PPCI are confounded by the changing epidemiology of MI and HF, with an ageing patient demographic, an increasing proportion of non-STelevation myocardial infarction, and the recognition of HF with preserved ejection fraction. Herein we review the mechanisms of HF after MI and discuss contemporary data on its incidence and outcomes. We review current and emerging strategies for early detection of patients at risk of HF after MI, with a view to identification of patient cohorts for novel therapeutic agents.展开更多
Heart failure (HF) and atrial fibrillation (AF) frequently coexist and have emerged as major cardiovascular epidemics. There is growing evidence that AF is an independent prognostic marker in HF and affects patients w...Heart failure (HF) and atrial fibrillation (AF) frequently coexist and have emerged as major cardiovascular epidemics. There is growing evidence that AF is an independent prognostic marker in HF and affects patients with both reduced as well as preserved LV systolic function. There has been a general move in clinical practice from a rhythm control to a rate control strategy in HF patients with AF, although recent data suggests that rhythm control strategies may provide better outcomes in selected subgroups of HF patients. Furthermore, various therapeutic modalities including pace and ablate strategies with cardiac resynchronisation or radio-frequency ablation have become increasingly adopted, although their role in the management of AF in patients with HF remains uncertain. This article presents an overview of the multidimensional impact of AF in patients with HF. Relevant literature is highlighted and the effect of various therapeutic modalities on prognosis is discussed. Finally, while novel anticoagulants usher in a new era in thromboprophylaxis, research continues in avariety of new pathways including selective atrial anti-arrhythmic agents and genomic polymorphisms in AF with HF.展开更多
AIM To evaluate cardiac magnetic resonance imaging(CMR) as a non-invasive tool to detect acute cellular rejection(ACR) in children after heart transplant(HT).METHODS Thirty pediatric HT recipients underwent CMR at the...AIM To evaluate cardiac magnetic resonance imaging(CMR) as a non-invasive tool to detect acute cellular rejection(ACR) in children after heart transplant(HT).METHODS Thirty pediatric HT recipients underwent CMR at the time of surveillance endomyocardial biopsy(EMB) and results were compared to 14 non-transplant controls. Biventricular volumes, ejection fractions(EFs), T2-weighted signal intensities, native T1 times, extracellular volumes(ECVs) and presence of late gadolinium enhancement(LGE) were compared between patients and controls and betweenpatients with International Society of Heart and Lung Transplantation(ISHLT) grade ≥ 2R rejection and those with grade 0/1R. Heart rate(HR) and brain natriuretic peptide(BNP) were assessed as potential biomarkers.RESULTS Significant ACR(ISHLT grade ≥ 2R) was an infrequent event in our population(5/30, 17%). Ventricular volumes,EFs, LGE prevalence, ECVs, native T1 times, T2 signal intensity ratios, HR and BNP were not associated with the presence of ≥ 2R ACR.CONCLUSION In this pilot study CMR did not reliably identify ACRrelated changes in pediatric HT patients.展开更多
Background: With increasing incidence of coronary artery disease (CAD) in Saudi Arabia and its fatal co-morbidity, this has resulted in a more complex pool of cases referred to cardiac surgeons. In selected cases, ach...Background: With increasing incidence of coronary artery disease (CAD) in Saudi Arabia and its fatal co-morbidity, this has resulted in a more complex pool of cases referred to cardiac surgeons. In selected cases, achieving optimal revascularization of diffuse CAD necessitates adjunctive techniques such as coronary endarterectomy (CE). The aim of our study is to evaluate the early mortality and post-operative morbidity related to CE. Method: Retrospective study from Jan 2009 to Dec 2010. Inclusion of 186 patients: 38 patients had CABG with CE and 148 patients had CABG alone. Results: Pre-operative percutaneous coronary intervention (PCI) was higher in the CE with CABG group (25.8%) compared with CABG alone (8.9%) (p = 0.009). Intra-operative data showed a higher mean cardiopulmonary bypass time (CBT) of 160 minutes and a mean cross-clamp time (XCT) of 109 minutes in the CE with CABG, compared to a mean CBT of 129 minutes and a mean XCT of 87 minutes in the CABG alone group (p = 0.001). The most common vessel endarterectomized was left anterior descending artery (LAD) (47%) followed by right coronary artery (RCA) (22%). Post-operatively, the mortality amongst the CE with CABG group (7.9%) was higher than CABG only group (1.4%), however it wasn’t statistically significant (p = 0.06). With regards to morbidity, hemodynamic instability requiring intra aortic balloon pump (HIR-IABP) was higher in the CE with CABG group (10.5%) compared to the CABG only group (1.4%) (p = 0.018). Conclusion: Our study showed that CE when combined with CABG wasn’t associated with a higher mortality rate when compared with CABG alone.展开更多
Background:Adults with obesity may display disturbed cardiac chronotropic responses during cardiopulmonary exercise testing,which relates to poor cardiometabolic health and an increased risk for adverse cardiovascular...Background:Adults with obesity may display disturbed cardiac chronotropic responses during cardiopulmonary exercise testing,which relates to poor cardiometabolic health and an increased risk for adverse cardiovascular events.It is unknown whether cardiac chronotropic incompetence(CI)during maximal exercise is already present in obese adolescents and,if so,how that relates to cardiometabolic health.Methods:Sixty-nine obese adolescents(body mass index standard deviation score=2.23±0.32,age=14.1±1.2 years;mean±SD)and 29lean adolescents(body mass index standard deviation score=-0.16±0.84,age=14.0±1.5 years)performed a maximal cardiopulmonary exercise testing from which indicators for peak performance were determined.The resting heart rate and peak heart rate were used to calculate the maximal chronotropic response index.Biochemistry(lipid profile,glycemic control,inflammation,and leptin)was studied in fasted blood samples and during an oral glucose tolerance test within obese adolescents.Regression analyses were applied to examine associations between the presence of CI and blood or exercise capacity parameters,respectively,within obese adolescents.Results:CI was prevalent in 32 out of 69 obese adolescents(46%)and 3 out of 29 lean adolescents(10%).C-reactive protein was significantly higher in obese adolescents with CI compared to obese adolescents without CI(p=0.012).Furthermore,peak oxygen uptake and peak cycling power output were significantly reduced(p<0.05)in obese adolescents with CI vs.obese adolescents without CI.The chronotropic index was independently related to blood total cholesterol(standardized coefficientβ=-0.332;p=0.012)and C-reactive protein concentration(standardized coefficientβ=-0.269;p=0.039).Conclusion:CI is more common in the current cohort of obese adolescents,and is related to systemic inflammation and exercise intolerance.展开更多
BACKGROUND Transfemoral aortic valve replacement(TAVR)is the standard treatment for elderly patients with aortic valve stenosis.Although safe and well-established,there is a risk of intraprocedural hemodynamic instabi...BACKGROUND Transfemoral aortic valve replacement(TAVR)is the standard treatment for elderly patients with aortic valve stenosis.Although safe and well-established,there is a risk of intraprocedural hemodynamic instability and silent cerebral embolism,which can lead to a decline in neurocognitive function and dementia.In clinical practice,comprehensive cognitive testing is difficult to perform.AI-assisted digital applications may help to optimize diagnosis and monitoring.METHODS Neurocognitive function was assessed by validated psychometric tests using“Δelta-App”,which uses artificial intelligence and computational linguistic methods for extraction and analysis.Memory function was assessed using the‘Consortium to Establish a Registry for Alzheimer’s Disease’(CERAD)word list and digit span task(DST)before TAVR and before hospital discharge.The study is registered in the German Register of Clinical Trials(https://drks.de/search/de/trial/DRKS00020813).RESULTS From October 2020 until March 2022,141 patients were enrolled at University Hospital Heart Centre Brandenburg.Mean age was 81±6 years,42.6%were women.Time between the pre-and post-interventional test was on average 6±3 days.Memory function before TAVR was found to be below average in relation to age and educational level.The pre-post TAVR comparison showed significant improvements in the wordlist repeat,P<0.001 and wordlist recall test of CERAD,P<0.001.There were no changes in the digital span test.CONCLUSIONS Despite impaired preoperative memory function before TAVR,no global negative effect on memory function after TVAR was detected.The improvements shown in the word list test should be interpreted as usual learning effects in this task.展开更多
Background:Ventricular septal defect(VSD)is the most common congenital heart disease.Transcatheter VSD closure is an effective treatment for patients with muscular and perimembranous VSD.However,there is a limit data ...Background:Ventricular septal defect(VSD)is the most common congenital heart disease.Transcatheter VSD closure is an effective treatment for patients with muscular and perimembranous VSD.However,there is a limit data for outlet VSD,especially impact to the aortic valve leaflet after transcatheter closure.This study aims to assess the outcomes of transcatheter closure of the outlet-type ventricular septal defect(OVSD)after 1 postoperative year.Methods:A retrospective study was performed including 50 patients who underwent transcatheter(n=25)and surgical(n=25)OVSD closure during the exact time frame at two medical centres.Results:The median age and body weight of patients in the transcatheter group were significantly higher than those of patients in the surgical group(7.0 vs.2.8 years;27.0 vs.11.4 kg;p<0.01).The defect size in the surgical group was significantly larger than that in the transcatheter group(5.0 vs.3.0 mm;p<0.01).All OVSD patients have successful transcatheter closure(100%)as effective as surgical closure.Less than small residual shunt was present 20%and 8%immediately after the procedure in the transcatheter and surgical groups(p=0.50),which decreased to 12%and 4%at the 1-year follow-up(p=0.61),respectively.No incidence of complete atrioventricular block and other complications was observed in both groups,and no significant differences were noted in the new onset or worsening of the aortic regurgitation in both groups(p=1.0).Conclusions:Transcatheter treatment could be effectively and safely achieved for OVSD closure at 1-year follow-up.展开更多
BACKGROUND As a result of improved and novel treatment strategies,the spectrum of patients with cardiovascular disease is consistently changing.Overall,those patients are typically older and characterized by increased...BACKGROUND As a result of improved and novel treatment strategies,the spectrum of patients with cardiovascular disease is consistently changing.Overall,those patients are typically older and characterized by increased burden with comorbidities.Limited data on the prognostic impact of age in cardiogenic shock(CS)is available.Therefore,this study investigates the prognostic impact of age in patients with CS.METHODS From 2019 to 2021,consecutive patients with CS of any cause were included.The prognostic value of age(i.e.,60-80 years and>80 years)was investigated for 30-day all-cause mortality.Spearman’s correlations,Kaplan-Meier analyses,as well as multivariable Cox proportional regression analyses were performed for statistics.Subsequent risk assessment was performed based on the presence or absence of CS related to acute myocardial infarction(AMI).RESULTS 223 CS patients were included with a median age of 77 years(interquartile range:69-82 years).No significant difference in 30-day all-cause mortality was observed for both age-groups(54.6%vs.63.4%,log-rank P=0.169;HR=1.273,95%CI:0.886-1.831,P=0.192).In contrast,when analyzing subgroups stratified by CS-etiology,AMI-related CS patients of the group>80 years showed an increased risk of 30-day all-cause mortality(78.1%vs.60.0%,log-rank P=0.032;HR=1.635,95%CI:1.000-2.673,P=0.050),which was still evident after multivariable adjustment(HR=2.072,95%CI:1.174-3.656,P=0.012).CONCLUSIONS Age was not associated with 30-day all-cause mortality in patients with CS of mixed etiology.However,increasing age was shown to be a significant predictor of increased mortality-risk in the subgroup of patients presenting with AMI-CS.展开更多
Background One potential modifiable factor to improve the mental health of healthcare professionals(HCPs)during the pandemic is lifestyle.Aims This study aimed to assess whether an improved lifestyle during the pandem...Background One potential modifiable factor to improve the mental health of healthcare professionals(HCPs)during the pandemic is lifestyle.Aims This study aimed to assess whether an improved lifestyle during the pandemic is associated with improved mental health symptoms and mental well-being in HCPs over time.Methods This was a cohort study involving an online survey distributed at two separate time points during the pandemic(baseline(July–September 2020)and follow-up(December 2020–March 2021))to HCPs working in primary or secondary care in the UK.Both surveys assessed for major depressive disorder(MDD)(Patient Health Questionnaire-9(PHQ-9)),generalised anxiety disorder(GAD)(Generalised Anxiety Disorder-7(GAD-7)),mental well-being(Short Warwick-Edinburgh Mental Well-being Score(SWEMWBS))and self-reported lifestyle change(compared with the start of the pandemic)on multiple domains.Cumulative scores were calculated to estimate overall lifestyle change compared with that before the pandemic(at both baseline and follow-up).At each time point,separate logistic regression models were constructed to relate the lifestyle change score with the presence of MDD,GAD and low mental well-being.Linear regression models were also developed relating the change in lifestyle scores from baseline to follow-up to changes in PHQ-9,GAD-7 and SWEMWBS scores.Results 613 HCPs completed both baseline assessment and follow-up assessment.Consistent significant cross-sectional associations between increased lifestyle change scores and a reduced risk of MDD,GAD and low mental well-being were observed at both baseline and follow-up.Over the study period,a whole unit increase in the change in novel scores(ie,improved overall lifestyle)over 4 months was inversely associated with changes in PHQ-9(adjusted coefficient:−0.51,95%confidence interval(CI):−0.73 to−0.30,p<0.001)and GAD-7 scores(adjusted coefficient:−0.32,95%CI:−0.53 to−0.10,p=0.004)and positively associated with the change in SWEMWBS scores(adjusted coefficient:0.37,95%CI:0.18 to 0.55,p<0.001).Conclusions Improved lifestyle over time is associated with improved mental health and mental well-being in HCPs during the pandemic.Improving lifestyle could be a recommended intervention for HCPs to help mitigate the mental health impact during the current and future pandemics.展开更多
Introduction: In comparison to anterior wall myocardial infarction, inferior wall myocardial infarction is generally regarded as a low risk event. The aim of this study was to evaluate the prognostic impact of right v...Introduction: In comparison to anterior wall myocardial infarction, inferior wall myocardial infarction is generally regarded as a low risk event. The aim of this study was to evaluate the prognostic impact of right ventricular (RV) myocardial involvement in patients with inferior wall myocardial infarction (IWMI). Methods: This is an observational study of 82 consecutive IWMI patients admitted and treated in Manmohan Cardiothoracic, Vascular and Transplant Center (MCVTC) from May 15 2018 to June 15 2019. The clinical characteristics, risk factors profile, electrocardiographic, echocardiographic, including RV function and angiographic characteristics, complications and in-hospital deaths were analyzed. Results: The mean age of patients presenting with IMWI was 64.8 ± 13.8 years with predominance of male (67%). Right ventricular myocardial infarction was present in 34.1% of patient with RV dysfunction in 25.6% patients. Mean Tricuspid Annular Plane Systolic Excursion (TAPSE), RV tricuspid annulus (S') and RV Fractional area change (FAC) in patients with RV dysfunction vs patients without RV dysfunction were 12.2 ± 3.3 mm vs 22.5 ± 3.5 mm (p < 0.001), 7.54 ± 0.91 cm/s vs. 12.79 ± 2.16 cm/s respectively (p Conclusion: In inferior wall myocardial infarction, RV involvement with RV dysfunction is an independent risk factor for in-hospital mortality along with advanced age, complete atrioventricular block, higher Killip class, delayed hospital presentation, left ventricular ejection fraction < 40% and angiographic evidence of triple vessel disease.展开更多
Background:Congenital absence of pericardium(CAP),also known as pericardial agenesis,represents an uncommon cardiac abnormality and mostly incidental finding.It can be subdivided into complete and partial(left or righ...Background:Congenital absence of pericardium(CAP),also known as pericardial agenesis,represents an uncommon cardiac abnormality and mostly incidental finding.It can be subdivided into complete and partial(left or right-sided)forms.Because of its infrequency,just case reports and a few case series have been released so far.This paper represents the largest systematic review in the field.Nine features(age at diagnosis,type,gender,clinical presentation,electrocardiography,imaging(ultrasounds,CT/MRI),concomitant cardiac defects,and outcome)were analysed.Methods:The electronic database PubMed was investigated from its establishment up to July 15th,2023.Just case reports and case series were included.Animal studies,papers that were not in English,Spanish,and Italian,and those manuscripts not reporting at least seven of the nine analysed features.were ruled out.The analysed data were reported mostly in terms of percentage.Results:One hundred eighty studies were included encompassing 247 patients.More than half of reviewed CAP cases were in males(63.2%).The mean age at diagnosis was 31.8±19.3 years;a range of 32 weeks of gestation-81 years).23.5%of the patients did not report any symptoms.The most common clinical presentations were chest pain(35.2%)and dyspnoea(29.2%).The most commonly seen ECG changes were right axis deviation(28.7%)and right bundle branch block(23.9%).CAP was suspected or diagnosed by echocardiography in 20.1%of cases.The diagnosis was made by CT and/or MRI in 61.9%of cases.CAP was left-sided in 71.2%,complete in 23.1%,and right-sided in 5.7%.A concomitant congenital heart defect was found in 22.7%,especially in the form of atrial septal defect(6.5%)and patency of ductus arteriosus(2.8%).The pericardial repair was required in 12.9% of the incomplete forms of the disease.Never did the complete form require surgical correction.The outcome appeared favourable in the vast majority of cases,with just 18 deaths(7.3%).Discussion:The main limitation of this systematic review is that it is based just on case reports and case series,due to the lack of large studies on CAP.However,it represents the largest analysis in the field.Due to the rarity of CAP establishing an International Registry is recommended.展开更多
Advanced glycation end products(AGEs) are produced through the non enzymatic glycation and oxidation of proteins,lipids and nucleic acids.Enhanced formation of AGEs occurs particularly in conditions associated with hy...Advanced glycation end products(AGEs) are produced through the non enzymatic glycation and oxidation of proteins,lipids and nucleic acids.Enhanced formation of AGEs occurs particularly in conditions associated with hyperglycaemia such as diabetes mellitus(DM).AGEs are believed to have a key role in the development and progression of cardiovascular disease in patients with DM through the modif ication of the structure,function and mechanical properties of tissues through crosslinking intracellular as well as extracellular matrix proteins and through modulating cellular processes through binding to cell surface receptors [receptor for AGEs(RAGE)].A number of studies have shown a correlation between serum AGE levels and the development and severity of heart failure(HF).Moreover,some studies have suggested that therapies targeted against AGEs may have therapeutic potential in patients with HF.The purpose of this review is to discuss the role of AGEs in cardiovascular disease and in particular in heart failure,focussing on both cellular mechanisms of action as well as highlighting how targeting AGEs may represent a novel therapeutic strategy in the treatment of HF.展开更多
文摘Background: Dyslipidemia and hypertension are independent cardiovascular risk factors that are linked by insulin resistance and they require follow-up and more aggressive therapeutic strategies. Hence, the present study was done to study the prevalence of Diabetes and Dyslipidemia patterns in hypertensive patients. Methods: A cross-sectional observational study was done on patients with hypertension for duration of one year, i.e. from Feb 2022 to January 2023. A total of 726 hypertensive Patients were included. All calculations and statistical analyses were processed by SPSS 25.0. Results: A Total of 726 patients with a history of hypertension were included;the average age was 55, with 24.2% of patients belonging to the age group 51 - 60;55.8% were males and 44.2% were females. In the present study, the prevalence of diabetes was 29.06% and 35.5% of patients in the prediabetic stage. The most frequent dyslipidaemic form was reduced HDL, seen in 96.1% and 94% of new and old respectively;followed by elevated LDL, 86% and 48.2% in new and old respectively. It was followed by elevated TG level and Total cholesterol levels. Conclusion: There was a high prevalence of diabetes, pre-diabetes as well as dyslipidemia in hypertensive patients.
文摘Myocardial infarction(MI) remains the most common cause of heart failure(HF) worldwide. For almost 50 years HF has been recognised as a determinant ofadverse prognosis after MI, but efforts to promote myocardial repair have failed to translate into clinical therapies. Primary percutaneous coronary intervention(PPCI) has driven improved early survival after MI, but its impact on the incidence of downstream HF is debated. The effects of PPCI are confounded by the changing epidemiology of MI and HF, with an ageing patient demographic, an increasing proportion of non-STelevation myocardial infarction, and the recognition of HF with preserved ejection fraction. Herein we review the mechanisms of HF after MI and discuss contemporary data on its incidence and outcomes. We review current and emerging strategies for early detection of patients at risk of HF after MI, with a view to identification of patient cohorts for novel therapeutic agents.
文摘Heart failure (HF) and atrial fibrillation (AF) frequently coexist and have emerged as major cardiovascular epidemics. There is growing evidence that AF is an independent prognostic marker in HF and affects patients with both reduced as well as preserved LV systolic function. There has been a general move in clinical practice from a rhythm control to a rate control strategy in HF patients with AF, although recent data suggests that rhythm control strategies may provide better outcomes in selected subgroups of HF patients. Furthermore, various therapeutic modalities including pace and ablate strategies with cardiac resynchronisation or radio-frequency ablation have become increasingly adopted, although their role in the management of AF in patients with HF remains uncertain. This article presents an overview of the multidimensional impact of AF in patients with HF. Relevant literature is highlighted and the effect of various therapeutic modalities on prognosis is discussed. Finally, while novel anticoagulants usher in a new era in thromboprophylaxis, research continues in avariety of new pathways including selective atrial anti-arrhythmic agents and genomic polymorphisms in AF with HF.
文摘AIM To evaluate cardiac magnetic resonance imaging(CMR) as a non-invasive tool to detect acute cellular rejection(ACR) in children after heart transplant(HT).METHODS Thirty pediatric HT recipients underwent CMR at the time of surveillance endomyocardial biopsy(EMB) and results were compared to 14 non-transplant controls. Biventricular volumes, ejection fractions(EFs), T2-weighted signal intensities, native T1 times, extracellular volumes(ECVs) and presence of late gadolinium enhancement(LGE) were compared between patients and controls and betweenpatients with International Society of Heart and Lung Transplantation(ISHLT) grade ≥ 2R rejection and those with grade 0/1R. Heart rate(HR) and brain natriuretic peptide(BNP) were assessed as potential biomarkers.RESULTS Significant ACR(ISHLT grade ≥ 2R) was an infrequent event in our population(5/30, 17%). Ventricular volumes,EFs, LGE prevalence, ECVs, native T1 times, T2 signal intensity ratios, HR and BNP were not associated with the presence of ≥ 2R ACR.CONCLUSION In this pilot study CMR did not reliably identify ACRrelated changes in pediatric HT patients.
文摘Background: With increasing incidence of coronary artery disease (CAD) in Saudi Arabia and its fatal co-morbidity, this has resulted in a more complex pool of cases referred to cardiac surgeons. In selected cases, achieving optimal revascularization of diffuse CAD necessitates adjunctive techniques such as coronary endarterectomy (CE). The aim of our study is to evaluate the early mortality and post-operative morbidity related to CE. Method: Retrospective study from Jan 2009 to Dec 2010. Inclusion of 186 patients: 38 patients had CABG with CE and 148 patients had CABG alone. Results: Pre-operative percutaneous coronary intervention (PCI) was higher in the CE with CABG group (25.8%) compared with CABG alone (8.9%) (p = 0.009). Intra-operative data showed a higher mean cardiopulmonary bypass time (CBT) of 160 minutes and a mean cross-clamp time (XCT) of 109 minutes in the CE with CABG, compared to a mean CBT of 129 minutes and a mean XCT of 87 minutes in the CABG alone group (p = 0.001). The most common vessel endarterectomized was left anterior descending artery (LAD) (47%) followed by right coronary artery (RCA) (22%). Post-operatively, the mortality amongst the CE with CABG group (7.9%) was higher than CABG only group (1.4%), however it wasn’t statistically significant (p = 0.06). With regards to morbidity, hemodynamic instability requiring intra aortic balloon pump (HIR-IABP) was higher in the CE with CABG group (10.5%) compared to the CABG only group (1.4%) (p = 0.018). Conclusion: Our study showed that CE when combined with CABG wasn’t associated with a higher mortality rate when compared with CABG alone.
文摘Background:Adults with obesity may display disturbed cardiac chronotropic responses during cardiopulmonary exercise testing,which relates to poor cardiometabolic health and an increased risk for adverse cardiovascular events.It is unknown whether cardiac chronotropic incompetence(CI)during maximal exercise is already present in obese adolescents and,if so,how that relates to cardiometabolic health.Methods:Sixty-nine obese adolescents(body mass index standard deviation score=2.23±0.32,age=14.1±1.2 years;mean±SD)and 29lean adolescents(body mass index standard deviation score=-0.16±0.84,age=14.0±1.5 years)performed a maximal cardiopulmonary exercise testing from which indicators for peak performance were determined.The resting heart rate and peak heart rate were used to calculate the maximal chronotropic response index.Biochemistry(lipid profile,glycemic control,inflammation,and leptin)was studied in fasted blood samples and during an oral glucose tolerance test within obese adolescents.Regression analyses were applied to examine associations between the presence of CI and blood or exercise capacity parameters,respectively,within obese adolescents.Results:CI was prevalent in 32 out of 69 obese adolescents(46%)and 3 out of 29 lean adolescents(10%).C-reactive protein was significantly higher in obese adolescents with CI compared to obese adolescents without CI(p=0.012).Furthermore,peak oxygen uptake and peak cycling power output were significantly reduced(p<0.05)in obese adolescents with CI vs.obese adolescents without CI.The chronotropic index was independently related to blood total cholesterol(standardized coefficientβ=-0.332;p=0.012)and C-reactive protein concentration(standardized coefficientβ=-0.269;p=0.039).Conclusion:CI is more common in the current cohort of obese adolescents,and is related to systemic inflammation and exercise intolerance.
基金the Ministry of Science,Research and Cultural Affairs of the State of Brandenburg and the MHB publication fund supported by DFG.Jonathan Nübel declares that this work is supported by a research grant of the German Cardiac Society(DGK)the Ethics committee of the Brandenburg Medical School(MHB)E-01-20191006.
文摘BACKGROUND Transfemoral aortic valve replacement(TAVR)is the standard treatment for elderly patients with aortic valve stenosis.Although safe and well-established,there is a risk of intraprocedural hemodynamic instability and silent cerebral embolism,which can lead to a decline in neurocognitive function and dementia.In clinical practice,comprehensive cognitive testing is difficult to perform.AI-assisted digital applications may help to optimize diagnosis and monitoring.METHODS Neurocognitive function was assessed by validated psychometric tests using“Δelta-App”,which uses artificial intelligence and computational linguistic methods for extraction and analysis.Memory function was assessed using the‘Consortium to Establish a Registry for Alzheimer’s Disease’(CERAD)word list and digit span task(DST)before TAVR and before hospital discharge.The study is registered in the German Register of Clinical Trials(https://drks.de/search/de/trial/DRKS00020813).RESULTS From October 2020 until March 2022,141 patients were enrolled at University Hospital Heart Centre Brandenburg.Mean age was 81±6 years,42.6%were women.Time between the pre-and post-interventional test was on average 6±3 days.Memory function before TAVR was found to be below average in relation to age and educational level.The pre-post TAVR comparison showed significant improvements in the wordlist repeat,P<0.001 and wordlist recall test of CERAD,P<0.001.There were no changes in the digital span test.CONCLUSIONS Despite impaired preoperative memory function before TAVR,no global negative effect on memory function after TVAR was detected.The improvements shown in the word list test should be interpreted as usual learning effects in this task.
文摘Background:Ventricular septal defect(VSD)is the most common congenital heart disease.Transcatheter VSD closure is an effective treatment for patients with muscular and perimembranous VSD.However,there is a limit data for outlet VSD,especially impact to the aortic valve leaflet after transcatheter closure.This study aims to assess the outcomes of transcatheter closure of the outlet-type ventricular septal defect(OVSD)after 1 postoperative year.Methods:A retrospective study was performed including 50 patients who underwent transcatheter(n=25)and surgical(n=25)OVSD closure during the exact time frame at two medical centres.Results:The median age and body weight of patients in the transcatheter group were significantly higher than those of patients in the surgical group(7.0 vs.2.8 years;27.0 vs.11.4 kg;p<0.01).The defect size in the surgical group was significantly larger than that in the transcatheter group(5.0 vs.3.0 mm;p<0.01).All OVSD patients have successful transcatheter closure(100%)as effective as surgical closure.Less than small residual shunt was present 20%and 8%immediately after the procedure in the transcatheter and surgical groups(p=0.50),which decreased to 12%and 4%at the 1-year follow-up(p=0.61),respectively.No incidence of complete atrioventricular block and other complications was observed in both groups,and no significant differences were noted in the new onset or worsening of the aortic regurgitation in both groups(p=1.0).Conclusions:Transcatheter treatment could be effectively and safely achieved for OVSD closure at 1-year follow-up.
文摘BACKGROUND As a result of improved and novel treatment strategies,the spectrum of patients with cardiovascular disease is consistently changing.Overall,those patients are typically older and characterized by increased burden with comorbidities.Limited data on the prognostic impact of age in cardiogenic shock(CS)is available.Therefore,this study investigates the prognostic impact of age in patients with CS.METHODS From 2019 to 2021,consecutive patients with CS of any cause were included.The prognostic value of age(i.e.,60-80 years and>80 years)was investigated for 30-day all-cause mortality.Spearman’s correlations,Kaplan-Meier analyses,as well as multivariable Cox proportional regression analyses were performed for statistics.Subsequent risk assessment was performed based on the presence or absence of CS related to acute myocardial infarction(AMI).RESULTS 223 CS patients were included with a median age of 77 years(interquartile range:69-82 years).No significant difference in 30-day all-cause mortality was observed for both age-groups(54.6%vs.63.4%,log-rank P=0.169;HR=1.273,95%CI:0.886-1.831,P=0.192).In contrast,when analyzing subgroups stratified by CS-etiology,AMI-related CS patients of the group>80 years showed an increased risk of 30-day all-cause mortality(78.1%vs.60.0%,log-rank P=0.032;HR=1.635,95%CI:1.000-2.673,P=0.050),which was still evident after multivariable adjustment(HR=2.072,95%CI:1.174-3.656,P=0.012).CONCLUSIONS Age was not associated with 30-day all-cause mortality in patients with CS of mixed etiology.However,increasing age was shown to be a significant predictor of increased mortality-risk in the subgroup of patients presenting with AMI-CS.
基金This work was supported by a Barts Charity project grant(MGU0586).
文摘Background One potential modifiable factor to improve the mental health of healthcare professionals(HCPs)during the pandemic is lifestyle.Aims This study aimed to assess whether an improved lifestyle during the pandemic is associated with improved mental health symptoms and mental well-being in HCPs over time.Methods This was a cohort study involving an online survey distributed at two separate time points during the pandemic(baseline(July–September 2020)and follow-up(December 2020–March 2021))to HCPs working in primary or secondary care in the UK.Both surveys assessed for major depressive disorder(MDD)(Patient Health Questionnaire-9(PHQ-9)),generalised anxiety disorder(GAD)(Generalised Anxiety Disorder-7(GAD-7)),mental well-being(Short Warwick-Edinburgh Mental Well-being Score(SWEMWBS))and self-reported lifestyle change(compared with the start of the pandemic)on multiple domains.Cumulative scores were calculated to estimate overall lifestyle change compared with that before the pandemic(at both baseline and follow-up).At each time point,separate logistic regression models were constructed to relate the lifestyle change score with the presence of MDD,GAD and low mental well-being.Linear regression models were also developed relating the change in lifestyle scores from baseline to follow-up to changes in PHQ-9,GAD-7 and SWEMWBS scores.Results 613 HCPs completed both baseline assessment and follow-up assessment.Consistent significant cross-sectional associations between increased lifestyle change scores and a reduced risk of MDD,GAD and low mental well-being were observed at both baseline and follow-up.Over the study period,a whole unit increase in the change in novel scores(ie,improved overall lifestyle)over 4 months was inversely associated with changes in PHQ-9(adjusted coefficient:−0.51,95%confidence interval(CI):−0.73 to−0.30,p<0.001)and GAD-7 scores(adjusted coefficient:−0.32,95%CI:−0.53 to−0.10,p=0.004)and positively associated with the change in SWEMWBS scores(adjusted coefficient:0.37,95%CI:0.18 to 0.55,p<0.001).Conclusions Improved lifestyle over time is associated with improved mental health and mental well-being in HCPs during the pandemic.Improving lifestyle could be a recommended intervention for HCPs to help mitigate the mental health impact during the current and future pandemics.
文摘Introduction: In comparison to anterior wall myocardial infarction, inferior wall myocardial infarction is generally regarded as a low risk event. The aim of this study was to evaluate the prognostic impact of right ventricular (RV) myocardial involvement in patients with inferior wall myocardial infarction (IWMI). Methods: This is an observational study of 82 consecutive IWMI patients admitted and treated in Manmohan Cardiothoracic, Vascular and Transplant Center (MCVTC) from May 15 2018 to June 15 2019. The clinical characteristics, risk factors profile, electrocardiographic, echocardiographic, including RV function and angiographic characteristics, complications and in-hospital deaths were analyzed. Results: The mean age of patients presenting with IMWI was 64.8 ± 13.8 years with predominance of male (67%). Right ventricular myocardial infarction was present in 34.1% of patient with RV dysfunction in 25.6% patients. Mean Tricuspid Annular Plane Systolic Excursion (TAPSE), RV tricuspid annulus (S') and RV Fractional area change (FAC) in patients with RV dysfunction vs patients without RV dysfunction were 12.2 ± 3.3 mm vs 22.5 ± 3.5 mm (p < 0.001), 7.54 ± 0.91 cm/s vs. 12.79 ± 2.16 cm/s respectively (p Conclusion: In inferior wall myocardial infarction, RV involvement with RV dysfunction is an independent risk factor for in-hospital mortality along with advanced age, complete atrioventricular block, higher Killip class, delayed hospital presentation, left ventricular ejection fraction < 40% and angiographic evidence of triple vessel disease.
文摘Background:Congenital absence of pericardium(CAP),also known as pericardial agenesis,represents an uncommon cardiac abnormality and mostly incidental finding.It can be subdivided into complete and partial(left or right-sided)forms.Because of its infrequency,just case reports and a few case series have been released so far.This paper represents the largest systematic review in the field.Nine features(age at diagnosis,type,gender,clinical presentation,electrocardiography,imaging(ultrasounds,CT/MRI),concomitant cardiac defects,and outcome)were analysed.Methods:The electronic database PubMed was investigated from its establishment up to July 15th,2023.Just case reports and case series were included.Animal studies,papers that were not in English,Spanish,and Italian,and those manuscripts not reporting at least seven of the nine analysed features.were ruled out.The analysed data were reported mostly in terms of percentage.Results:One hundred eighty studies were included encompassing 247 patients.More than half of reviewed CAP cases were in males(63.2%).The mean age at diagnosis was 31.8±19.3 years;a range of 32 weeks of gestation-81 years).23.5%of the patients did not report any symptoms.The most common clinical presentations were chest pain(35.2%)and dyspnoea(29.2%).The most commonly seen ECG changes were right axis deviation(28.7%)and right bundle branch block(23.9%).CAP was suspected or diagnosed by echocardiography in 20.1%of cases.The diagnosis was made by CT and/or MRI in 61.9%of cases.CAP was left-sided in 71.2%,complete in 23.1%,and right-sided in 5.7%.A concomitant congenital heart defect was found in 22.7%,especially in the form of atrial septal defect(6.5%)and patency of ductus arteriosus(2.8%).The pericardial repair was required in 12.9% of the incomplete forms of the disease.Never did the complete form require surgical correction.The outcome appeared favourable in the vast majority of cases,with just 18 deaths(7.3%).Discussion:The main limitation of this systematic review is that it is based just on case reports and case series,due to the lack of large studies on CAP.However,it represents the largest analysis in the field.Due to the rarity of CAP establishing an International Registry is recommended.
文摘Advanced glycation end products(AGEs) are produced through the non enzymatic glycation and oxidation of proteins,lipids and nucleic acids.Enhanced formation of AGEs occurs particularly in conditions associated with hyperglycaemia such as diabetes mellitus(DM).AGEs are believed to have a key role in the development and progression of cardiovascular disease in patients with DM through the modif ication of the structure,function and mechanical properties of tissues through crosslinking intracellular as well as extracellular matrix proteins and through modulating cellular processes through binding to cell surface receptors [receptor for AGEs(RAGE)].A number of studies have shown a correlation between serum AGE levels and the development and severity of heart failure(HF).Moreover,some studies have suggested that therapies targeted against AGEs may have therapeutic potential in patients with HF.The purpose of this review is to discuss the role of AGEs in cardiovascular disease and in particular in heart failure,focussing on both cellular mechanisms of action as well as highlighting how targeting AGEs may represent a novel therapeutic strategy in the treatment of HF.