Cardiac Hospital Research Articles

Predictors of Clinical Outcome after Percutaneous Coronary Intervention in Hemodialysis Patients with Acute Myocardial Ischemia Syndrome

Introduction: Acute myocardial ischemia syndrome (AMIS), encompassing conditions such as unstable angina and acute myocardial infarction, is a major global health concern due to its significant morbidity and mortality rates. Objective: The main objective of the study is to find the predictors of clinical outcomes after percutaneous coronary intervention in hemodialysis patients with acute myocardial ischemia syndrome. Methodology: This retrospective cohort study was conducted at Army Cardiac Hospital Lahore from June 2023 to June 2024. Data were collected from 178 patients. Data were extracted from electronic health records, capturing comprehensive patient information across multiple domains. Results: The study analyzed data from 178 hemodialysis patients with mean age of 58.91 ± 8.02 years, with a gender distribution of 60% males and 40% females. Comorbid conditions were prevalent, with 65% having diabetes mellitus and 85% hypertension. Smoking was reported by 25% of individuals, and 40% had a history of myocardial infarction (MI) or revascularization. Laboratory parameters indicated anemia (mean hemoglobin: 10.2 ± 1.5 g/dL), low albumin levels (3.2 ± 0.5 g/dL), and systemic inflammation, as 70% had elevated CRP levels. Conclusion: It is concluded that hemodialysis patients undergoing PCI for acute myocardial ischemia syndrome face significant risks influenced by nutritional status, systemic inflammation, and comorbidities such as diabetes and cardiogenic shock

The Role of Nursing Educational Program in Improving Nutritional Status among Patients with Heart Failure

Background: Heart failure (HF) is characterized by cardiac dysfunction, fluid retention, and subsequent exercise intolerance, significantly impacting patients’ quality of life. Nutrition plays a pivotal role in managing HF, as dietary modifications can alleviate symptoms and improve clinical outcomes. Foods are categorized based on their nutritional density, which is critical for optimizing health in HF patients. Nurses play a key role in healthcare by providing education, empowering patients to make informed decisions, and enhancing healthcare efficiency through structured interventions. Methods: From (August 2 to February 8, 2024), 200 patients with HF were treated in the Sulaimani Cardiac Hospital in Sulaimani City using a quasi-experimental technique. The participants were divided into two groups: Intervention (100) and control (100). They completed a detailed questionnaire that included demographics, medical data, and a variety of examinations. The interventional group had exclusive access to the nutrition education program. Data were collected through direct interviews and processed with the Statistical Package for the Social Sciences, version (26). Results: The average age of the respondents was (68.3 ± 11.2) years. At first, both groups comprised (100) patients, however, the intervention group dropped to (94) and the control group to (90) owing to fatalities. The nutrition education program resulted in significant differences between the groups in high-density lipoprotein and cholesterol levels, blood electrolytes, waist-hip ratios, and hospitalization rates. Conclusions and recommendations: The intervention group showed greater improvements in nutritional status than the control group. A 12-week educational program improved eating habits, reduced hypertension, diabetes, cholesterol levels, and body weight, and increased awareness of healthier food alternatives. This demonstrates that such programs can enhance quality of life, and dietary habits, and perhaps reduce death rates in the intervention group compared to the control group.

Pattern of Dyslipidemia in Patients with Acute Coronary Syndrome in a Cardiac hospital in Nepal

Background: Dyslipidemia is defined as an abnormal concentration of lipids in the blood and is a critical modifiable risk factor for the development of cardiovascular diseases, including acute coronary syndrome (ACS). The aim of the study was to determine the pattern of dyslipidemia among patients with Acute Coronary Syndrome admitted to a cardiac hospital. Methodology: This is a cross-sectional study including consequent 143 patients admitted to Chitwan Mutu Aspatal with a diagnosis of acute coronary syndrome. The study was conducted from July 2021 to Jan 2024 over a period of 2.5years. The patient’s lipid levels were taken within 24 hours from the onset of Acute Coronary Syndrome. Results: Out of total of 143 patients, dyslipidemia was found in majority of patients with low HDL in 92(64.30%) in our study. 53 (37.1%) were females and 90 (62.9%) were males. The mean age of the patients was 62.3013.03 SD (in years). Patients with STEMI had maximum elevation of LDL (52.9%) compared with those having NSTEMI in 44.4% and 31% in Unstable angina patients. Also, low HDL level was detected in the majority of the patients across all spectrum of ACS patients which was statistically significant (p<0.05). Conclusion: There is a higher prevalence of low HDL-C and high prevalence of LDL-C among the Nepalese population presenting with acute coronary syndrome (ACS) in the hospital

Factors Affecting Successful Creation of Arterio-venous Fistula for Hemodialysis

The preferred vascular access method for efficient hemodialysis is the arterio-venous fistula (AVF). There is a rising trend in AVF establishment conducted by nephrologists, aiming to alleviate the workload of vascular surgeons and expedite the prompt care of individuals afflicted with end-stage renal disease (ESRD). This descriptive observational study was conducted at the Department of Vascular Surgery, Ibrahim Cardiac Hospital and Research Institute during the period of June 2017 to July 2022. During the data collection period 1700 patients sought care in the Department for arterio-venous fistula creation, among them complete data of 1103 patients were included in this study. Majority of chronic kidney disease (CKD) patients were referred from the Department of Nephrology, BIRDEM for AVF creation in the mentioned timeline. Data were collected pre-designed data collection sheet and data were analyzed using Statistical Package for Social Sciences (SPSS) version- 25. This study shows that most of the patients (80.8%) were in ages 30 - 59 years and more than two-third (67.6%) of them were male; male-female ratio was 2:1. Diabetes mellitus (DM) was detected in nearly half of the patients (47.2%) and more than two-third (67.2%) of them were suffering from hypertension (HTN). Higher failure rate (73.3%) of AVF creation among patients of age group 30-59 years was significant. Failure rate for male patients was 57% and female patients was 43%. The AVF creation failure rates were 100% for patients with hypertension and for diabetes patients was 60.5%. Complications were found in 15.2% of patients. Post-operative edema and hematoma formation were more common (3.2% and 3.5%, respectively) in comparison to other complications. Among the complicated cases, 7 patients (4.2%) required intervention to correct stealing syndrome and AVF salvage was attempted in 43 cases (25.6%); medical management was pursued in 32(19.0%) cases. Majority (51.2%) of cases who were experiencing complications required AVF ligation. This research demonstrates that several significant clinical factors influence the successful establishment of an arterio-venous fistula (AVF) for hemodialysis factors include advanced age, being male, having diabetes (DM) and hypertension (HTN), having a history of Maintenance Hemodialysis (MHD) prior to AVF creation, choosing the wrist or arm as the AVF site, utilizing specific veins (cephalic and basilic) and specific arteries (radial and brachial). Bangladesh Med J. 2023 Sept; 52(3): 1-7

The prognostic value of the Dandel's index in patients undergoing tricuspid transcatheter edge‐to‐edge repair

AimsConventional parameters of right ventricular (RV) function are load‐dependent and therefore do not accurately reflect contractility in patients with relevant tricuspid regurgitation (TR). RV adaptability to load has been characterized using the Dandel's index in patients with heart failure, but its prognostic value in patients undergoing tricuspid transcatheter edge‐to‐edge repair (T‐TEER) has not been investigated so far.Methods and resultsFrom the EuroTR registry (2019 to 2022), patients with complete datasets and a minimum of 2‐years of follow‐up were included. RV functional parameters (i.e. tricuspid annular plane systolic excursion [TAPSE], fractional area change [FAC], TAPSE/systolic pulmonary arterial pressure [sPAP]), as well as a echocardiographic RV load adaptation index (Dandel's index) were assessed and their predictive value in terms of all‐cause mortality evaluated using logistic multivariate logistic regression. The majority of the 364 patients had secondary TR (96%) and were severely symptomatic (New York Heart Association class ≥III; 92%). At 2‐year follow‐up, 36% of patients had died. Functional RV parameters (TAPSE: hazard ratio [HR] 0.72, 95% confidence interval [CI] 0.62–0.84; FAC: HR 0.73, 95% CI 0.59–0.91), coupling index (TAPSE/sPAP: HR 0.8, 95% CI 0.65–0.99) and Dandel's index (HR 0.67, 95% CI 0.53–0.85) were all associated with mortality at 2 years in univariable analyses. In a multivariate logistic regression model, the Dandel's index maintained its predictive value (p < 0.001), along with TAPSE and absence of signs of right heart failure, with an optimal threshold of 20.5 determined by the receiver‐operating characteristic analysis. This threshold also successfully predicted cardiac hospital readmission. A multivariate analysis was conducted to identify parameters linked to RV function and predicting clinical outcomes.ConclusionAssessment of the RV capacity to adjust for changes in loading conditions predicted mortality in patients with severe symptomatic TR undergoing T‐TEER. The use of a multiparametric approach including the Dandel's index to assess RV function had an incremental value for the stratification of patients into subgroups with different prognosis.

Multiparametric cardiovascular magnetic resonance is associated with outcomes in pediatric heart transplant recipients.

Multiparametric cardiovascular magnetic resonance (CMR) has an emerging role in non-invasive surveillance of pediatric heart transplant recipients (PHTR). Higher myocardial T2, higher extracellular volume fraction (ECV), and late gadolinium enhancement (LGE) have been associated with adverse clinical outcomes in adult heart transplant recipients. This study's purpose was to investigate the prognostic value of CMR-derived T1- and T2-mapping, ECV, and LGE for clinical outcomes in PHTR. We performed a single-center, retrospective chart review of consecutive, gadolinium-enhanced CMR studies in PHTR over a 7.5-year period, excluding follow-up studies. Standard CMR ventricular volume and function analysis, T1 mapping with ECV, T2 mapping, and LGE assessment were performed. The composite outcome included cardiac death, non-cardiac death, re-transplantation, and cardiac hospitalization. Among 113 PHTR, mean age was 13.0±5.1y, with 6.0±4.0y since transplant. The indication for CMR was surveillance in 79%. Mean native T1 was 1050±48ms; T2 49.2±3.9ms and ECV 29.7±4.5%. LV LGE was present in 37% (42/113) and RV LGE in 3.5% (4/113). The mean follow-up time was 2.3y, median 1.4y. Cardiac death occurred in 2% (2/113), re-transplantation in 4% (4/113), and cardiac hospitalization in 22% (25/113). Non-cardiac death did not occur. Using Kaplan-Meier analysis, high T1 (≥1061ms), T2 (≥50.0ms), and ECV (≥31.4%) were each associated with decreased freedom from the composite outcome in follow-up. In univariable Cox regression analyses, high T1 was associated with increased risk of the composite outcome (HR 4.0, 95% CI 1.7-9.2, p=0.001), as were high T2 (HR 2.8, 95% CI 1.1-7.1, p=0.026), and high ECV (HR 3.5, 95% CI 1.5-8.1, p=0.004). T1 and T2 mapping are associated with early differences in adverse cardiac events in PHTR. These data suggest a role for a multicenter study with longer follow-up duration.

A multivariate and retrospective analysis of the impact of intra-aortic balloon counterpulsation in Open-Heart surgery

Background The use of intraaortic balloon pump (IABP) effectively reduces left ventricular afterload and significantly increases coronary perfusion pressure by raising aortic diastolic pressure. This study examined the short and medium-term outcomes of 22,540 adult cardiac surgical patients requiring an IABP. Methods From 2009 to 2018, 1114 patients (4.94%) undergoing open-heart surgery at a single tertiary cardiac hospital received IABP support and were included in this retrospective study. They were categorized into pre-operative (Group A, n = 577), intra-operative (Group B, n = 475), and post-operative (Group C, n = 62) IABP insertion groups. Results Cardiogenic shock occurred in 11.2% of cases, mainly in Group A. Hemodynamic instability (38.8%) drove IABP use in Groups A and C, while difficulty weaning from CPB was the primary reason in Group C. The overall operative mortality rate was 10.9%, highest at 25.8% postoperatively. Multivariate analysis identified significant predictors of mortality: age (OR: 1.067, 95% CI: 1.041–1.094, p < 0.001), higher BMI (OR: 1.071, 95% CI: 1.017–1.128, p = 0.009), pulmonary hypertension (OR: 2.085, 95% CI: 1.302–3.341, p = 0.002), renal disease (OR: 2.780, 95% CI: 1.556–4.967, p < 0.001), and cardiogenic shock (OR: 3.684, 95% CI: 2.066–6.569, p < 0.001). Complications were more common in Group C, especially with renal disease. Average preoperative and postoperative stays were 4.0 ± 4.8 days and 15.2 ± 20.4 days, respectively, with no significant differences between groups. Conclusion IABP might offer safety for open-heart surgery, with longer hospital stays potentially associated with high-risk patients. Pre-operative IABP prophylaxis could be crucial in high-risk open-heart cases to reduce mortality.Clinical registration number: NHG DSRB Ref No# 2016/01070 and 2019/00397.

Potassium disorders at intensive care unit admission and functional outcomes after cardiac arrest

BackgroundAbnormal serum potassium levels are commonly found in the intensive care unit (ICU) population. We aimed to determine the prevalence of potassium disorders at ICU admission and its association with functional outcomes in comatose patients resuscitated from cardiac arrest. MethodsWe performed a post hoc analysis of pooled data from four randomised clinical trials involving comatose post-cardiac arrest patients admitted to ICU after return of spontaneous circulation (ROSC). Reference serum potassium levels were defined as between 3.0 and 4.9 mmol/L. An unfavourable functional outcome was defined as a cerebral performance category of 3 to 5 at 180 days. We compared potassium disturbances categorically in a mixed effects logistic regression model including initial rhythm, delay from collapse to return of spontaneous circulation, bystander cardiopulmonary resuscitation, lactate and urea at ICU admission, with normokalaemia set as the reference group. ResultsWe included 1133 patients (557 from the HYPERION, 346 from the TTH48, 120 from the COMACARE, and 110 from the Xe-HYPOTHECA trials) with a median age of 64 years (interquartile range 55–72) and a predominance of males (72 %); a total of 712 (64 %) patients had unfavourable functional outcomes. On admission, 221 patients (19.5 %) experienced hyperkalaemia and 35 (3.1 %) patients experienced hypokalaemia. Fewer patients in the normokalaemia group (513/877, 58.5 %) had an unfavourable functional outcome compared to the hypokalaemia (24/35, 68.6 %) and hyperkalaemia groups (180/221, 81.4 %; p < 0.001). Hyperkalaemia was associated with higher odds for an unfavourable functional outcome (adjusted odds ratio (OR) 1.85, 95 % confidence interval (CI) 1.10–3.12, p = 0.02), while hypokalaemia was not (OR 1.36 95 % CI 0.51–3.60, p = 0.53). The associations were not significant in a subgroup analysis adjusted for the modified cardiac arrest hospital prognosis score in 833 patients (OR 1.74, 95 % CI 0.91–3.34, p = 0.10 for hyperkalaemia and OR 1.48, 95 % CI 0.40–5.44, p = 0.55 for hypokalaemia). ConclusionsOf the comatose patients admitted to ICU after cardiac arrest, one in five experienced a potassium disorder on ICU admission. Hyperkalaemia was associated with unfavourable functional outcomes at 180 days, while hypokalaemia was not.

Abstract 4117414: Risk Factors Associated with Cardiac Hospital Admissions in Cancer Patients Treated with Immune Checkpoint Inhibitors

Background: Immune checkpoint inhibitors (ICIs) are highly effective anti-cancer treatments for several cancers. However, treatment with ICIs is associated with metabolic perturbations, accelerated atherosclerosis, and increased risks of adverse cardiovascular events. In this study, we aimed to determine risk factors associated with cardiac hospital admissions in patients treated with ICIs for their cancer. Methods: Retrospective data was collected for all patients treated with ICIs between 1 January 2010 and 1 January 2020 through the Hunter New England Local Health District (HNELHD), Australia. Patient medical history and demographics were collected through electronic medical records. Outcome data was obtained from the HNELHD Institutional Cardiac and Stroke Outcomes Unit database. Cardiac admission was defined as cardiac disease based on hospital administration ICD-10 codes. Binary logistic regression was used for multivariate analysis and performed through SPSS version 28. Results: A total of 1,080 patients were included in the final analysis. Mean age of patients was 66.9 ± 11.7 years, with the majority male sex ( n =685; 63.4%). Primary cancer diagnosis of patients treated with ICIs included melanoma ( n =417; 38.7%), and cancer of the lung ( n =327; 30.3%). Nivolumab monotherapy was the most used first-line ICI treatment ( n =475; 44.0%) followed by pembrolizumab monotherapy ( n =428; 39.6%). A total of 266 (24.6%) patients had at least one cardiac hospital admission. On univariate analysis, pre-existing cardiovascular disease (CVD) ( p &lt;0.001), diabetes mellitus ( p &lt;0.001), chronic kidney disease ( p &lt;0.001), and prior CVD medications ( p &lt;0.001) were associated with cardiac hospitalisation. On multivariate analysis, prior history of heart failure ( p &lt;0.001), hypertension ( p =0.003), ischaemia, and peripheral vascular disease ( p =0.049) were independently associated with an increased risk of cardiac hospital admission. Conclusions: In cancer patients treated with ICIs, pre-existing CVD risk factors increases the risk of cardiac-associated hospitalisations. Adequate CVD risk modification and monitoring during treatment with ICIs may be necessary to reduce cardiac hospitalisations.

Abstract 4135708: Obesity and the risk of cardiac death in coronary artery disease

Background: The prevalence of obesity is increasing worldwide reaching epidemic proportions. Obesity increases the risk of coronary artery disease (CAD), but there is little prospective evidence about the effect of obesity on the risk of cardiac death in CAD patients. Aim: We aimed to investigate the effect of obesity and the risk of cardiac death in a prospective cohort of CAD patients. Methods: We have prospectively enrolled 1,946 patients with CAD (mean age 66.9±8.6, 68% male), with a mean follow-up of 8.7±2.2 years. BMI was measured at baseline and was categorized into 4 groups: 1) BMI 18.5-24.9 kg/m 2 (normal weight, reference group), 2) BMI 25-29.9 kg/m 2 (overweight), 3) BMI 30-34.9 kg/m 2 (class 1 obesity), and 4) BMI &gt;35 kg/m 2 (class 2 obesity). The primary endpoint was cardiac death and secondary endpoints were sudden cardiac death/arrest (SCD/SCA), non-sudden cardiac death, non-cardiac death, and heart failure (HF) hospitalization. Statistical analysis was performed with Cox regression and was adjusted for age, sex, type 2 diabetes, CCS class, kidney function (eGFR), systolic and diastolic blood pressure, LDL, smoking, SYNTAX score, and left ventricle ejection fraction. Results: The prevalence of BMI 18.5-24.9 kg/m 2 was 18.5% (n=359), BMI 25-29.9 kg/m 2 was 47.8% (n=929), BMI 30-34.9 kg/m 2 was 24.0% (n=466), and BMI&gt;35 kg/m 2 was 9.7% (n=189). During the follow-up, cardiac death occurred in 156 subjects, SCD/SCA in 75 subjects, non-sudden cardiac death in 81 subjects, and non-cardiac death in 197 subjects. BMI &gt;35 kg/m 2 was associated with an increased trend of cardiac death (adjusted HR 1.92, 95% CI 0.92-4.01; p=0.08) and an increased risk of non-sudden cardiac death (adjusted HR 4.11, 95% CI 1.58-10.68; p=0.004) and HF hospitalization (adjusted HR 2.83, 95% CI 1.06-7-54; p=0.04), but not with SCD/SCA (adjusted HR 0.79, 95% CI 0.24-2.56; p=0.69) or noncardiac death (adjusted HR 0.85, 95% CI 0.43-1.69; p=0.64). The risk of cardiac death or secondary endpoints was not increased in patients with overweight or class 1 obesity. Conclusions: Class 2 obesity was associated with an increased risk of non-sudden cardiac death and heart failure hospitalization among CAD patients. Obesity may have adverse long-term effects on cardiac function and prognosis among CAD patients, supporting the benefit of optimal weight control therapy.

Abstract 4115684: Outcomes Associated with Remote Monitoring without In-person Evaluations for Patients with Cardiovascular Implantable Electronic Devices

Introduction: Traditionally, patients with cardiovascular implantable electronic devices (CIEDs: pacemakers and implantable cardioverter-defibrillators) attend in-person visits at least annually, paired with remote monitoring (RM). Because similar data are obtained through RM and in-person visits, it is unclear whether routine in-person visits are necessary. Two small trials conducted outside the U.S. found no difference in clinical outcomes without routine in-person visits for patients engaged in RM, but their generalizability is uncertain. Research Aim: To determine whether routine visits for CIED care are associated with major adverse cardiac events (MACE) among patients in the U.S.’ largest public integrated health system, the Veterans Health Administration (VHA). Methods: We classified Veterans who received their CIED care within VHA and sent ≥1 RM transmission between 7/1/20-6/30/21 into one of three groups based on type of clinical encounters for CIED care: (1) any in-person, (2) virtual-only (telephone and/or videoconference), or (3) no in-person or virtual visits. Data were obtained from the VHA National Cardiac Device Surveillance Program and Corporate Data Warehouse. The primary outcome was MACE, a composite of all-cause mortality, stroke, and cardiac hospitalization, between 7/1/21-6/30/22. We performed multivariable logistic regression, adjusting for patient and device characteristics. Results: Of 40,366 patients, 27,298 (68%) had at least one in-person visit, 9,268 (23%) had only virtual visits, and 3,800 (9%) had neither. Mean age was 73 years, 97% were male, and 37% lived in rural areas. There were 6522 (23.9%) MACE events among patients who had in-person visits, 2116 (22.8%) among those who had only virtual visits, and 947 (24.9%) among those who had no visits. After multivariable adjustment, there was no significant association between encounter type and MACE [odds ratio 0.93 (95% CI: 0.85-1.01) for patients who had any in-person or virtual visits compared to those without]. Conclusion: Among patients engaged in RM, the odds of MACE was similar regardless of whether patients had in-person or virtual visits versus no visits. Although there could be unmeasured confounding, these results suggest routine in-person or virtual visits may no longer be necessary for CIED care with RM. Patients, clinicians, and healthcare systems could benefit by reducing low-value visits and re-focusing resources on visits that yield actionable interventions.

Abstract 4135335: A randomized trial of expedited intra-arrest transfer versus more extended on-scene resuscitation for refractory out of hospital cardiac arrest: the EVIDENCE Study

Background: Refractory out-of-hospital cardiac arrest (OHCA) has poor outcomes. The benefit of expedited intra-arrest transport with ongoing resuscitation versus more extended on-scene resuscitation for refractory OHCA is not clear. Methods: In this Phase III, multi-center (15 hospitals), randomized, controlled trial conducted in Sydney, Australia, we assigned patients with refractory out-of-hospital cardiac arrest to receive either expedited intra-arrest transport, with mechanical cardiopulmonary resuscitation, to a cardiac catherization-capable hospital for coronary angiography and, where available, extracorporeal membrane oxygenation (ECMO) cardiopulmonary resuscitation (ECPR) or more extended on-scene conventional CPR (advanced cardiac life support). Eligible patients were between 18 and 70 years of age, had received bystander CPR, initial rhythm VT/VF/PEA, and did not have a return of spontaneous circulation after 15 minutes of CPR, or three rounds of resuscitation. The primary outcome was survival with a favorable neurologic outcome, defined as a Cerebral Performance Category score of 1 or 2 at hospital discharge. Analyses were performed on an intention-to-treat basis. Results: One hundred and ninety-seven (197) eligible patients were randomized (median age, 57.0 years; 77 [81%] men), 149 VT/VF (76%). Ninety-five were assigned to receive expedited transfer and 102 to receive conventional CPR. Ten patients in the expedited arms and 6 patients in the conventional arm received ECPR at hospital. At hospital discharge, 15 patients (14.7%) in the expedited transfer group (median on scene time 26 mins) were alive with a favorable neurologic outcome, as compared with 15 patients (15.8%) (median on-scene time 36 minutes). This treatment difference was small and statistically insignificant (risk difference -1.1% [95% CI: -12.2% to 10.0%]), adjusted relative risk 0.95 [p=0.87, 95% CI: 0.50 to 1.8]. Conclusions: Among patients with refractory out-of-hospital cardiac arrest, expedited intra-arrest transport did not significantly improve survival with neurologically favorable outcome at discharge compared with more extended on-scene resuscitation. However, clinically relevant differences could still be consistent with our results.

Clip It or Let It: The Efficacy of Mitral Valve Transcatheter Edge-to-Edge Repair Versus Conservative Treatment in Reducing Mortality Among Patients With Ischemic Mitral Regurgitation

BACKGROUND: Despite revascularization and optimal medial therapy (OMT) residual ischemic mitral regurgitation (IMR) continues in a self-aggravating vicious cycle to affect prognosis and survival adversely. Mitral valve surgery in combination with coronary artery bypass graft remains a subject of debate due to the absence of a net overall benefit. Mitral valve transcatheter edge-to-edge repair (M-TEER) has been gaining grounds as a viable option from observational studies, but results from randomized controlled trials (RCTs) have yielded mixed results. Thus, this study was conducted to determine whether the current collective data support the efficacy of M-TEER with OMT versus OMT alone in patients with clinically significant IMR. METHODS: A literature search from PubMed/MEDLINE, Cochrane Review Central, Clinical Trials Registry, ResearchGate, Mendeley, and Google Scholar for relevant RCTs and observational studies was conducted and reviewed independently by three reviewers. Published and unpublished studies indexed from inception until 2023 were included. The pooled estimates for the primary outcome of all-cause mortality and secondary outcomes of cardiac mortality and heart failure hospitalizations were measured using R Studio statistical software (R Foundation forStatistical Computing, Vienna, Austria). RESULTS: Seven eligible studies (five observational and two RCTs) allocated 1610 IMR patients to M-TEER + OMT (n = 942) or OMT alone (n = 668). The effect estimate using random-effects model demonstrated M-TEER with OMT to significantly reduce 1-year (odds ratio [OR], 0.67; 95% confidence interval [CI], 0.52–0.86; P = 0.002) and 2-year (OR, 0.50; 95% CI, 0.38–0.67; P &lt; 0.00001) all-cause mortality. Cardiac mortality (OR, 0.58; 95% CI, 0.27–1.23; P = 0.15) and heart failure hospitalization (OR, 0.45; 95% CI, 0.18–1.13; P = 0.09) did not reach statistical significance between the treatment arms. CONCLUSION: In patients with IMR, M-TEER on top of OMT was able to afford a 2-year allcause mortality advantage. KEYWORDS: ischemic mitral regurgitation, mitral valve transcatheter edge-to-edge repair, optimal medical therapy

Practical experience in developing and implementing standard operating procedures for preventing patient falls in the hospital in the activities of medical staff

Today, the quality of nursing care directly depends on the level of training and competence of the staff, new forms of care, practical experience and skills in working with modern technologies. Target. To study the experience of improving innovations in the work of nurses-anesthesiologists of the anesthesiology and resuscitation department in connection with high-tech open-heart surgeries, in particular, during the implantation of mechanical left ventricular bypasses and orthotopic heart transplantation. Results. Nurses-anesthesiologists play a key role in providing high-quality care to patients in a cardiac surgery hospital. Innovations help the nurse improve monotonous and routine tasks, speed up and facilitate patient care, ensure safety during manipulations, increase the speed and quality of the treatment and diagnostic process, reduce staff labor costs, save the nurse’s time. Much attention in the center is paid to training, continuous professional development of highly qualified personnel. Conclusion. Improvements in the work of mid-level medical personnel, in particular, nurse anesthetists, are a key area for improving the quality and safety of medical care in a cardiac surgery hospital. Further development of competencies, training, implementation of new technologies and strengthening of teamwork will optimize the work of the entire treatment process.

The effect of BCG vaccination in the elderly on infectious and non-infectious immune-mediated diseases

Previous research has suggested beneficial heterologous effects of the Bacillus Calmette-Guérin (BCG) vaccine on non-mycobacterial infections and other immune-mediated diseases. During the COVID-19 pandemic, randomized controlled trials BCG-PRIME (n=5349) and BCG-CORONA-ELDERLY (n=1907) investigated the impact of BCG on SARS-CoV-2 infections in older individuals. We extended the follow-up in these studies by one year (BCG-Long Term study), to assess the overall effects of BCG vaccination on infectious and immune-mediated diseases in individuals aged over 60. Prior participants were invited to complete a one-year follow-up survey after their completion of the original trial. Data on vaccinations, hospital admissions, infectious episodes, and new medical diagnoses were collected and compared between BCG- and placebo-vaccinated participants. Variables of interest were combined with the previous trial databases and analyzed using relative risks (RR) and an adjusted Cox regression model accounting for participation probability. The response in the follow-up survey was 60%, including 4238 individuals in the final analysis (2317 had received BCG and 1921 placebo). Incidence and severity of infectious diseases and other diagnoses, including cardiovascular diseases and cancer, did not differ between the groups. The proportion of individuals hospitalized for cardiac arrhythmias after BCG was two-fold higher than reported after placebo (1.6% versus 0.8%, RR 2.0 (95% confidence interval 1.1-3.6)). Cardiac arrhythmia-related hospitalizations were primarily due to exacerbation of pre-existing arrhythmias. The results of the present study confirm that BCG has no relevant effect on non-mycobacterial infectious diseases and other immune-mediated diseases in a population of generally mycobacteria-naïve older Dutch individuals in the two years following vaccination. However, our study suggests that BCG may aggravate pre-existing cardiac arrhythmia, which warrants further investigation.

Safety, efficacy, and side effects of sodium fluorescein-aided resection of glioblastoma: a quasi-experimental study.

The use of fluorescein sodium (FS) as a surgical adjunct in glioblastoma resection has shown promise in improving tumor visualization and resection outcomes. This study aimed to evaluate the safety, efficacy, and side effects of FS-aided resection in patients with glioblastoma. This is a prospective, single-center cohort study conducted at Ibrahim Cardiac Hospital and Research Institute from September 2021 to November 2023. Twelve patients with histologically confirmed glioblastoma underwent FS-guided resection. All participants received an intravenous dose of FS (5mg/kg body weight) ~30min before surgery. The study follows a quasi-experimental design, focusing on the outcomes of FS-aided surgery without a control group. Patients were selected based on specific inclusion and exclusion criteria, and all surgeries were performed by a single experienced neurosurgeon. The extent of tumor resection was classified as gross total resection (GTR), near-total resection (NTR), or partial resection (PR). Gross total resection (GTR) was achieved in 66.6% of patients, near total resection (NTR) in 16.6%, and subtotal resection (STR) in 16.6%. No significant adverse effects were observed except for a single case of postoperative seizure, which was managed without long-term consequences. All patients showed normal liver and kidney function tests postoperatively. The low-dose FS protocol demonstrated both a high rate of GTR and a favorable safety profile, with only minor, transient side effects such as temporary yellow discoloration of the skin, sclera, and urine. No severe or long-term complications related to FS were observed during the follow-up period, which had a median duration of 13.4 months. FS appears to be a safe and effective aid in glioblastoma resection, achieving high rates of GTR with minimal side effects. The findings suggest that FS, particularly at a low dose, is a viable, cost-effective alternative to other fluorescent markers, especially in settings where resource constraints may limit the use of more expensive options like 5-ALA.

Diagnosis and Prognosis of Isolated Cardiac Sarcoidosis: Multidisciplinary Diagnosis vs Japanese Circulation Society Criteria.

The prognosis of isolated cardiac sarcoidosis (ICS) has not been fully elucidated. The only diagnostic criteria available for ICS, the Japanese Circulation Society (JCS) criteria, have not been validated. Our objective was to study the prognosis of ICS, according to 2 different diagnostic strategies. We prospectively included patients with high suspicion for cardiac sarcoidosis (CS) by a multidisciplinary sarcoidosis team from November 2016 to June 2021. We included only incident cases. We applied the JCS ICS criteria and our multidisciplinary diagnosis (MDD) ICS criteria. We included 198 incident patients who had a final diagnosis of cardiac sarcoidosis. Median follow up time was 2.4 years (p25-p75 1.2-3.7). The prevalence of ICS was 7% (14/198) per the JCS criteria, and 29% (57/198) per our MDD criteria. Compared to non-isolated CS, patients with ICS per either criteria had similar rates of major cardiovascular outcomes (progression of atrioventricular block, worsening EF ≥ 10%, appropriate implantable cardioverter defibrillator [ICD] therapies, heart transplant, and death). Kaplan-Meier analyses showed similar prognosis for ICS and non-isolated CS in all outcomes, except for an association between ICS by MDD criteria and a shorter time to cardiac hospitalization. Multivariable Cox regression analyses showed that ICS was not an independent predictor of death, heart transplant, or clinical worsening. In conclusion, our MDD ICS criteria were more inclusive than the JCS ICS criteria. The prognosis was similar between ICS and non-isolated CS patients, regardless of which criteria were used.

Primary prevention of cardiovascular diseases among women in a South Asian population: a descriptive study of modifiable risk factors

ObjectiveThe aim of this study was the assessment of modifiable risk factors of cardiovascular diseases (CVD) among women versus men at a newly developed preventive cardiology clinic of a large...

Comparative analysis of the 2016 diastolic guidelines and left atrial stiffness in predicting exercise tolerance and cardiac events

Abstract Background While the 2016 ASE/EACVI guideline for diastolic dysfunction is a robust tool for prognostication, their complexity and 20% rate of indeterminate limit their routine clinical practice. Purpose Left atrial (LA) stiffness, calculated as the E/e' ratio divided by LA strain, provides a simpler measure that indirectly reflects LA pressure. This study aims to evaluate whether LA stiffness can be better than the 2016 guidelines in predicting poor exercise tolerance and cardiac events (cardiac death or heart failure hospitalization) in patients with dyspnea. Methods In this retrospective single-center cohort study, 404 patients who underwent echocardiography and cardiopulmonary exercise test simultaneously were reviewed. Poor exercise tolerance was defined by a peak oxygen uptake (VO2) of &amp;lt;14 ml/kg/min or a minute ventilation-carbon dioxide production (VE/VCO2) slope of ≥ 40. The predictive abilities of LA stiffness for peak VO2, VE/VCO2 slope, and cardiac outcomes (cardiac death or heart failure hospitalization) were compared to those of the 2016 guidelines using ROC curve analysis. Results The mean left ventricular ejection fraction was 50% (IQR 58.58-66.70). Of the 404 patients (mean age 58.51, male 50.74%), peak VO2 &amp;lt; 14 and VE/VCO2 ≥ 40 were observed in 38 and 24 patients, and cardiac events occurred in 37 patients during median follow up of 85.45 months. ROC analysis showed that LA stiffness had AUC values of 0.697 (95% CI: 0.604-0.789) for peak VO2 &amp;lt; 14, 0.645 (95% CI: 0.529-0.760) for VE/VCO2 slope ≥ 40, and 0.628 (95% CI: 0.541-0.715) for cardiac events. The 2016 guidelines achieved AUCs of 0.685 (95% CI: 0.604-0.766), 0.586 (95% CI: 0.481-0.690), and 0.589 (95% CI: 0.505-0.674). Statistical comparison revealed no significant difference between the predictive capabilities of LA stiffness and the 2016 guidelines (p-values: 0.735, 0.165, and 0.439, respectively). (Figure) Conclusion LA stiffness offers comparable diagnostic accuracy to the 2016 ASE/EACVI guidelines in assessing poor exercise tolerance and cardiac events in patients with dyspnea. Given its simplicity and ease of measurement, LA stiffness represents a viable alternative for evaluating diastolic dysfunction.ROC curve

Risk and causes of hospital admission in patients with atrial fibrillation on treatment with oral anticoagulants

Abstract Background Atrial fibrillation (AF) is associated with an increased risk of hospitalisation, although the main reasons for hospital admission and the role of antiarrhythmic drugs are not clarified. Objective The aim of our study was to assess the incidence rate and the factors associated with all-cause, cardiovascular and AF-related causes of hospitalisation in patients suffering from AF. Methods This is a prospective single-centre ongoing study (ATHERO-AF cohort) which included 2782 patients affected by non-valvular AF on oral anticoagulants. The primary endpoints were all-cause, cardiovascular and AF-related hospitalisation. Cardiac hospitalizations were defined as (non-AF) arrhythmias, acute coronary syndromes, heart failure (HF), systemic embolism, hypertensive urgency, vascular/cardiac surgery. The AF-related hospitalisation was defined as a recurrence of AF in paroxysmal pattern or as a high-rate symptomatic AF episode in persistent/permanent patterns. Multivariable Cox proportional hazards regression analysis was used to calculate the hazard ratio (HR) with 95% Confidence interval (95%CI) for each factor in relation to risk of hospitalisation. Results Overall, 43.5% of patients were women with a mean age of 74.6±9.1year. Patients were followed for a mean of 31±26.8 months. We registered 1205 (12.1%/year) hospitalisations for any reason, 533 (5.7%/year) for cardiovascular causes and 180 (2.0%/year) were AF-related hospitalisations (Central illustration). Among the anti-arrhythmic drug use, we highlighted that flecainide and propafenone were associated with AF-related hospitalisations in paroxysmal and in persistent/permanent patterns (HR 1.861, 95%CI 1.116-3.101 and HR 1.947, 95%CI 1.069-3.548, respectively). Amiodarone (HR 3.012, 95%CI 1.835-4.943) and verapamil or diltiazem (HR 2.067, 95%CI 1.117-3.825) were associated with an increased risk of AF-related hospitalisations in persistent/permanent AF pattern. Furthermore, cancer was associated (HR 1.802, 95%CI 1.057-3.070) with increased risk of hospitalisation due to AF-related causes. Conversely, beta-blockers and digoxin were not associated with increased risk of hospital admission. Conclusions Hospitalisations of patients with AF are frequent for both cardiovascular and non-cardiovascular causes. Among the AF-related ones, the use of antiarrhythmic drugs emerged as associated with increased risk of hospitalisations, hypothesizing their poor effect in preventing AF episodes. For these reasons, we suggest carefully considering their use, reserving them for symptomatic patients with frequent AF recurrences.Central Illustration