Cardiology Department Research Articles

Prognosis of different hemodynamic classifications in patients with pulmonary hypertension due to left heart disease

Objective: To compare the prognostic values of different classification by using transpulmonary pressure gradient (TPG), diastolic pressure gradient (DPG) and pulmonary vascular resistance (PVR) in patients with pulmonary hypertension due to left heart disease (PH-LHD), and investigated hemodynamic and clinical factors associated with mortality in patients with PH-LHD. Methods: This was a single-center prospective cohort study. In-hospital patients diagnosed with PH-LHD via right heart catheterization at the Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, from September 2013 to December 2019 were enrolled. Patients were divided according to TPG (cutoff value 12 mmHg; 1 mmHg=0.133 kPa), DPG (cutoff value 7 mmHg), PVR (cutoff value 3 Wood Units), and the combination of TPG and PVR. Baseline characteristic was recorded. All patients were followed up until the occurrence of endpoint event, defined as all-cause death that occurred during the follow-up period, or until April 18, 2022. Receiver operating characteristic curves were used to compare the predictive value of 3 classification methods for all-cause death in PH-LHD patients. The optimal cutoff values were calculated using Jorden index. Survival analysis was performed using Kaplan-Meier analysis, and log-rank test was used to compare the predictive efficacy of classification methods based on optimal cutoff values or guidance-recommended thresholds for the survival of PH-LHD patients. Variables showing statistical significance in the univariate analysis were incorporated into multivariate Cox regression model to analyze the independent risk factors for all-cause mortality. Results: A total of 243 patients were enrolled, aged (54.9±12.7) years old, including 169 (69.5%) males. During a median follow-up of 57 months, there were 101 (41.6%) deaths occurred. Grouping results were as follows: (1) TPG: TPG≤12 mmHg group 115 patients, TPG>12 mmHg group 128 patients; (2) DPG: DPG<7 mmHg group 193 patients, DPG≥7 mmHg group 50 patients; (3) PVR: PVR≤3 Wood Units group 108 patients, PVR>3 Wood Units group 135 patients; (4) TPG and PVR: TPG≤12 mmHg and PVR≤3 Wood Units group 89 patients, TPG>12 mmHg and PVR>3 Wood Units group 109 patients. PVR (AUC=0. 698,95%CI:0.631-0.766) had better predictive value for all-cause mortality than TPG (AUC=0.596, 95%CI: 0.523-0.669) and DPG (AUC=0.526, 95%CI: 0.452-0.601) (all P<0.05). The optimal cutoff values for TPG, DPG, and PVR were13.9 mmHg, 2.8 mmHg, and 3.8 Wood Units, respectively. Kaplan-Meier analysis based on the optimal cutoff values or guidance-recommended thresholds showed that PVR and TPG were the predictors of survival (P<0.05), while DPG did not showed significance (P>0.05). Multivariate Cox regression analysis showed that age, PVR and log2N-terminal pro-B-type natriuretic peptide were independent risk factors for all-cause mortality in PH-LHD patients (all P<0.05). Conclusion: Classification according to PVR was most valuable in predicting all-cause death in PH-LHD patients, while TPG showed moderate predictive ability and DPG had no predictive value.

Initial response to the 2024 Noto earthquake by the university hospital closest to the disaster area

Major earthquakes have occurred frequently in Japan throughout history, and the 2024 Noto earthquake is no exception. However, such natural disasters differ in some respects, and specific problems related to these events have also become clear. Kanazawa Medical University Hospital, which was the closest university hospital to the disaster area of the 2024 Noto earthquake, played a crucial role in serving the local community in the wake of the earthquake. The first method used to identify disaster-related patients is to tag them when they are examined by a physician. After confirming that a patient was eligible at the disaster-related patient-determination meeting, patients’ medical information was extracted from the tag name. A total of 421 disaster-related patients were transported and hospitalized by day 31. Fifty-two (14.4%) and 48 (13.3%) patients were admitted for orthopedic surgery and respiratory medicine, respectively. Forty (11.1%) and 38 (10.5%) patients were admitted to cardiology and nephrology departments, respectively. These four departments account for 49.3% of the total. The number of hospitalized patients in the nephrology and orthopedic surgery departments was high immediately after the 2024 Noto Earthquake. We also describe new hospital-specific initiatives and recommendations to improve Kanazawa Medical University Hospital’s system while sharing another hospital experience.

Evaluating the role of pericoronary adipose tissue on coronary artery disease: insights from CCTA on risk assessment, vascular stenosis, and plaque characteristics.

Pericoronary adipose tissue (PCAT) plays a significant role in the occurrence and progression of coronary artery disease (CAD). This study investigates the relationship between PCAT and CAD, focusing on the occurrence of the disease, the severity of vascular narrowing, and the characteristics of arterial plaques. We analyzed a cohort of 152 individuals with CAD and 55 individuals with non-coronary artery disease (N-CAD). Participants underwent both coronary computed tomography angiography (CCTA) and digital subtraction angiography (DSA). Utilizing United Imaging software for artificial intelligence delineation, we measured the fat attenuation index (FAI) and volume of PCAT in the left anterior descending (LAD), left circumflex (LCX), and right coronary arteries (RCA). Our findings demonstrate that while CCTA is effective in diagnosing CAD compared to DSA, its diagnostic power for individual coronary arteries remains limited. Further analysis revealed that the FAI of the RCA and the overall PCAT volume independently influenced CAD (OR: 1.057, 95% CI: 1.002 to 1.116; OR: 0.967, 95% CI: 0.936 to 0.999). FAI showed a significant independent effect on RCA stenosis (OR: 1.041, 95% CI: 1.003 to 1.081), while the fat volume of the LAD had a significant independent effect on LAD stenosis (OR: 0.884, 95% CI: 0.809 to 0.965). A higher FAI and a lower fat volume were significantly correlated with more severe vascular stenosis percentages in all three arteries (p < 0.05), except for the fat volume and stenosis of the LCX. Moreover, we found the significant differences in the fat volume of the LCX between different plaque types (H = 8.869, p = 0.012), with calcified plaques consistently exhibiting the lowest fat volume across all three arteries. Finally, the likelihood ratio test confirmed that incorporating the PCAT fat volume parameter of LAD significantly improved the diagnostic ability of CCTA for both CAD (p = 0.01543) and LAD stenosis (p = 0.001585). The quantification of PCAT has potential application value in the comprehensive assessment of CAD. It is recommended that cardiology and radiology departments consider incorporating PCAT into the assessment criteria for patients suspected of having CAD.

Reducing rehospitalization in cardiac patients: a randomized, controlled trial of a cardiac care management program (“Cardiolotse”) in Germany

BackgroundWe conducted a prospective, randomized, controlled, two-group parallel trial investigating the effectiveness of a care management program employing cardiac care navigators providing post-discharge support to patients compared to standard care.MethodsThe intervention commenced in 2019/2020 for 2862 patients hospitalized with heart failure, coronary heart disease, or cardiac arrhythmias in departments of cardiology across eight participating sites of a hospital group in Berlin, Germany. We analyzed the results using an intention-to-treat approach. The primary outcome was the all-cause rehospitalization rate after 12 months. Secondary outcomes included rehospitalizations due to one of the qualifying cardiac diagnoses, duration of rehospitalization, mortality, health-related quality of life, and several process indicators.Trial data were collected from a combination of face-to-face and phone interviews conducted by hospital staff throughout the 12-month follow-up period using standardized questionnaires. Administrative claims data were provided by a large statutory health insurer. Outcomes for the intervention and control groups were compared using logistic regression, generalized linear models (GLMs) with a negative binomial distribution, ordinary least squares, and Cox proportional hazards regression.ResultsCompared to the control group (N = 1294), the intervention group (N = 1256) had a lower rate of all-cause rehospitalizations (62.6% vs. 66.4%, p = 0.05) and shorter lengths of stay (14.49 vs. 16.89 days, p = 0.02) during the 12-month follow-up period. These differences were also present for rehospitalizations due to the cardiac diseases qualifying for study recruitment, with rehospitalization rates for the intervention and control groups being 58.0% vs. 61.4% (p = 0.08) and particularly pronounced for lengths of rehospitalization stay of 12.97 vs. 15.40 days (p = 0.01), respectively. Subgroup analyses indicated positive effects of the intervention for patients 70 years and older (p = 0.05), females (p = 0.06), and those with little or no German language proficiency (p = 0.03). Furthermore, we found positive effects on patients’ adherence to health-related behavioral recommendations (81.91% vs. 73.95%, p = 0.000).ConclusionsThis study adds to the body of evidence indicating that care management interventions supporting patients as they transition from the inpatient to the outpatient sector can lower rehospitalizations, decrease length of rehospitalization stays, and improve adherence to post-discharge recommendations.Trial registrationGerman Clinical Trial Register, DRKS00020424. Registered 2020-06-18. (retrospectively registered).

IN-HOSPITAL OUTCOMES AMONG PATIENTS PRESENTED WITH ST-ELEVATION MYOCARDIAL INFARCTION TREATED WITH PRIMARY PERCUTANEOUS CORONARY INTERVENTION

Primary Percutaneous Coronary Intervention (PCI) is considered the gold standard treatment for patients with ST-elevation myocardial Infarction (STEMI). Prompt intervention, aimed at restoring blood flow, plays a critical role in improving survival and minimizing complications in these patients. Objective: The objective of this study was to evaluate in-hospital outcomes among patients diagnosed with STEMI and treated with Primary PCI. Methods: This cross-sectional study was conducted in the Cardiology Department over one year. The study included patients aged 50 years and older who were diagnosed with STEMI based on electrocardiographic criteria and presented within 12 hours of symptom onset. Demographic information, clinical characteristics, comorbidities, and in-hospital outcomes were recorded. Statistical analyses were performed using relevant descriptive measures. Results: A total of 150 patients were included in the study. The mean age of patients was 60.89 ± 5.65 years, with 64.4% being male. The average door-to-balloon time was 89.93 ± 18.12 minutes. Successful reperfusion, defined as achieving a TIMI grade 3 flow, was observed in 87.8% of the patients. In-hospital mortality was recorded at 4.4%, while 3.3% of patients developed infections during their hospital stay. Conclusion: The study demonstrated favourable in-hospital outcomes for STEMI patients treated with Primary PCI, with a high success rate in achieving TIMI grade 3 flow and a relatively low in-hospital mortality rate. These findings underscore the efficacy of timely PCI in improving survival and procedural outcomes in STEMI patients, particularly when door-to-balloon time is minimized.

Angiographic findings in patients with Non-ST-elevation myocardial infarction

Background &amp; Objective: Acute coronary syndrome (ACS) can be divided into subgroups of ST-segment elevation myocardial infarction (STEMI), Non-ST-segment elevation myocardial infarction (NSTEMI), and unstable angina (USA). Patients diagnosed with NSTEMI are either treated conservatively or early invasive strategy is adopted. In NSTEMI it is believed that either one or more vessel is transiently occluded or that the blood flow is critically reduced in a patent vessel i.e. subtotal occlusion. This study was conducted to find the angiographic characteristics of NSTEMI patients undergoing coronary angiography. Methods: This study was conducted in Department of Cardiology, Lady Reading Hospital Peshawar. It was Cross Sectional Study. Data was collected from 8th November 2022 to 8th May 2023. Consecutive non-probability sampling technique was used to collect data from the patients. Results: Total of 300 patients were studied. The mean age was 56.95 years ±1.176 standard deviation. Male patients were 201 (67%) and remaining were female. It was found that 51(17%) of total NSTEMI patients were having totally obstructed coronary artery (OCA) in one or more coronary arteries. In NSTEMI, non-obstructive CAD (&lt;50%) were found in 81 (27%) of patients whereas 219 (73%) were having significant CAD. It was found that 40% were having single vessel CAD, 32% were having double vessel CAD and 28% were having triple vessel CAD. TVCAD was present significantly higher in advance age, Diabetes mellitus, hyperlipidemia and family history of CAD. Conclusion: Patients having NSTEMI are usually having multiple risk factors and having usually severe and multivessel CAD. doi: https://doi.org/10.12669/pjms.40.10.9499 How to cite this: Ikramullah, Ahmad F, Haq A, Khan SW. Angiographic findings in patients with Non-ST-elevation myocardial infarction. Pak J Med Sci. 2024;40(10):2228-2232. doi: https://doi.org/10.12669/pjms.40.10.9499 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Incidence Pattern and Outcome of Diseases in Patients Admitted in Coronary Care Unit in a Tertiary Care Hospital in Dhaka - A 3 Year Retrospective Study

Background: Cardiovascular disease (CVD) is the leading causes of death globally. Like other countries, CVD prevalence is also rising among the adults in Bangladesh. Most of the cardiac emergencies and acute ailments are preferably managed in a specially designed place of a hospital called Coronary Care Unit, which has better facilities of monitoring, care and support. In every day-to-day practice a proportion of diabetic patients need to admit in CCU for different life threatening crisis. For better understanding of such CVD prevalence scenario, we conducted this retrospective observational study. Aim of the Study: Our objective was to assess the pattern and incidence of CVD admitted in CCU with their outcomes among the population using the data from the record book. Methodology: This is a retrospective observational study carried out in the Coronary Care Unit (CCU) of BIRDEM Hospital Dhaka Bangladesh from 2017-2019. Total 1069 patients (861 were Diabetic and rest were non diabetic) who were admitted to the CCU of this Institute from 2017-2019 were studied and evaluated to see the pattern of cardiac emergencies in diabetic population. Results: Among 1069 patients, 57.2% were male and 42.8% were female. Majority (80.54%) of them were diabetic. Most of the patients belonged to age 50 years and above. Seven hundred and one (65.57%) patients were admitted due to Ischemic Heart Disease (IHD) in different forms. Among the Acute Coronary Syndrome, most prevalent one was NSTEMI (354). Among NSTEMI group, where 50.37% were male and 50.67% were female, 102 patients had Unstable Angina and 73 had STEMI. Eighty nine patients were admitted after intervention (PCI or CABG) and 61 patients had Ischemic Dilated Cardiomyopathy (IDCM) due to some complications. Four hundred and twenty patients admitted due to Heart Failure and 137 patients were admitted due to different forms of Shock. Cardiac function was assessed (by Teichholz method and Biplane Simpson's method) among the admitted patients and 57.31% of patients had moderate LV dysfunction, 29.26% had severe systolic dysfunction and remainder 13.43% found to have mild LV systolic dysfunction. Mean hospital stay was assessed and it was found to be gradually declining from 13.33 in 2017 to 9.23 in 2019 (p=0.041*). Outcome of the study population shows that ~ 66% were transfer to general ward or cabin of the department of cardiology after initial stabilization, 17.3% were discharged directly from CCU, and 5.42% patients were transferred to other department after recovery. About 5.5% were become critically ill for which they need to transfer under care of ICU, 2.5% were transfer for intervention (to other institutes according to patient’s economical ability and preference for CABG, Pace maker implantation, PTCI etc.) and 3.3% patients were expired. Conclusion: In this study, incidence of IHD found higher than other cardiac diseases. NSTEMI is about three times more than Unstable Angina and about five times more prevalent than STEMI for the reason of admission in CCU. Diabetes Mellitus was found in majority of the admitted patients in CCU and the number of diabetic population is increasing which may also responsible for leading more coronary heart disease in our country in future. 88.7% of study population was shifted to general ward after initial stabilization after acute crisis, 2.5% required further cardiac intervention and 5.5% become critical and required ICU support. Only 3.3% of total population expired after all possible support. Bangladesh Crit Care J September 2024; 12 (2): 125-131

EARLY MANIFESTATIONS OF HEART FAILURE AND ACTIVITY OF SYSTEMIC INFLAMMATION IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION DEPENDING ON RISK FACTORS

Acute myocardial infarction and heart failure (HF) resulting from this condition remain complex and not fully understood problems in cardiology. It is important to detect early manifestations of HF and optimize treatment to prevent pathological myocardial remodeling and the occurrence of adverse events. The increase in systemic inflammation activity (SIA) and the presence of comorbidities in patients contribute to the development of HF. The aim of the study- to investigate the impact of risk factors (RF) such as arterial hypertension (AH), diabetes mellitus (DM), history of COVID-19, and obesity on the occurrence of HF and SIA in patients with ST-elevation myocardial infarction (STEMI) who underwent percutaneous coronary intervention. Materials and Methods. The study involved 50 patients from the cardiology and reperfusion therapy department of St. Panteleimon Hospital in Lviv (66,00 (52,43-78,35) % men and 34,00 (21,65-47,57) % women), with an average age of 62,01±10,30 years. Blood levels of NT-proBNP (a biomarker of HF) and C-reactive protein (CRP) (a biomarker of SIA) were analyzed on the day of hospitalization for STEMI (the first day from the onset of clinical symptoms, stenting of the infarct-related coronary artery). Results were evaluated using descriptive statistical analysis methods (mean and standard deviation; median and percentile, fractions and their 95 % confidence intervals, calculated by the Wald and Fisher methods), unpaired Student's t-test, and Pearson correlation analysis. Results. The average NT-proBNP levels in the studied patients were 0,50 (0,30; 2,60) ng/ml, and CRP levels were 10,50 (6,00; 20,80) IU/ml (p&lt;0,05, compared to normal parameters). NT-proBNP levels significantly (p&lt;0,05) exceeded the upper reference limit in the presence of AH (0,50 (0,30; 3,30) ng/ml); DM (0,61 (0,30; 4,37) ng/ml); history of COVID-19 (0,61 (0,32; 3,36) ng/ml) (as well as without this RF – 0,49 (0,15; 1,37) ng/ml); obesity (0,31 (0,19; 380) ng/ml). The average NT-proBNP levels in patients with a history of COVID-19 were significantly (p&lt;0,05) higher compared to those in patients without it. CRP levels in blood were significantly (p&lt;0,05) higher than normal values in patients with AH (11,05 (5,60; 25,90) IU/ml); DM (15,20 (7,06; 25,20) IU/ml) (as well as without this RF – 9,50 (5,54; 18,20) IU/ml); history of COVID-19 (12,52 (8,20; 19,65) IU/ml) (as well as without it in history – 9,99 (5,60; 20,06) IU/ml); obesity (9,63 (6,52; 35,00) IU/ml) (as well as without this RF – 10,50 (5,81; 18,40) IU/ml). Average CRP levels in patients with DM and a history of COVID-19 were significantly (p&lt;0,05) higher compared to those without these RFs. The correlation between NT-proBNP and CRP levels was direct – strong in the presence of DM (r=0,78; p=0,012) and history of COVID-19 (r=0,70; p=0,001), medium strength in patients with AH (r=0,55; p=0,0004). Conclusions. In patients with STEMI who underwent myocardial revascularization, early manifestations of HF and a significant increase in SIA occur within the first day of the disease, promoted by such risk factors as AH, DM, history of COVID-19, and obesity. In the presence of DM and history of COVID-19, CRP should be considered an early marker of HF occurrence alongside NT-proBNP, as indicated by a strong direct correlation between these indicators in this category of individuals.

Comparison of Atorvastatin Alone and its Combination with Ezetimibe among Mixed Hyperlipidemic Patients

Background: Lowering the lipid levels remains the basis of recent medical therapy for preventing cardiovascular events. Statin treatment to attain target low-density lipoprotein cholesterol (LDL-C) levels is still associated with residual risk. Objective: To compare the efficacy of Atorvastatin and Atorvastatin combined with Ezetimibe among mixed hyperlipidemic patients. Methodology: This was a prospective interventional study among the 58 diagnosed mixed hyperlipidemic patients in the outpatient department (OPD) of the Department of Cardiology at the Sylhet MAG Osmani Medical College Hospital during February to November, 2023. Patients were divided into two groups. Group I had a combination of Atorvastatin 10mg and Ezetimibe 10mg, whereas Group II took Tab. Atorvastatin 20mg once daily at night for 12 weeks. Results: After 12 weeks of treatment, a comparison of lipid profile changes between the combination therapy group and the Atorvastatin group revealed a significant reduction (p&lt;0.05) in total cholesterol (35.7% vs. 30.1%), triglycerides (30.6% vs. 16%), and LDL-C (47.5% vs. 40.1%). In the combination therapy group, ALT levels increased by 4.6%, compared to a 3.8% increase with Atorvastatin treatment alone. Combination therapy led to a 2.07% elevation in CK levels, while the Atorvastatin treatment group showed a 1.9% increase in CK values. The differences in HDL-C, ALT, and CK levels between the two groups were not statistically significant (p&gt;0.05). Conclusion: The study revealed that combination therapy of Atorvastatin with Ezetimibe is more effective in reducing LDL-C, TG, and total cholesterol in patients with mixed hyperlipidemia compared to Atorvastatin alone. Journal of Monno Medical College June, 2024; 10 (1):23-29

Characteristics of intestinal microbiota in the acute phase of Kawasaki disease in infants and children

To study the composition, abundance, and functional profiles of the intestinal microbiota in infants and young children with Kawasaki disease (KD) during the acute phase, and to explore the potential role of intestinal microbiota in the pathogenesis of KD. Six children aged 0-3 years with acute KD admitted to the Department of Cardiology, Children's Hospital Affiliated to Capital Institute of Pediatrics from July to October 2021 were prospectively included as the KD group. Six age- and sex-matched healthy children who underwent physical examinations at the hospital during the same period were selected as the healthy control group. Metagenomics sequencing was used to detect and compare the differences in the microflora structure and functional profiles of fecal samples between the two groups. There were significant differences in the structural composition and diversity of intestinal microbiota between the two groups (P<0.05). Compared with the healthy control group, the abundance of Listeria_monocytogenes (family Listeriaceae and genus Listeria), Bifidobacterium_rousetti, Enterococcus_avium, and Enterococcus_hirae was significantly higher in the intestinal microbiota in the KD group (|LDA|>2.0, P<0.05). The steroid degradation and apoptosis pathways were significantly upregulated in the KD group compared with the healthy control group, while the Bacterial_secretion_system, Sulfur_metabolism, Butanoate_metabolism, Benzoate_degradation, β-alanine metabolism, and α-linolenic acid pathways were significantly downregulated (|LDA|>2, P<0.05). There are significant differences in the structure and diversity of intestinal microbiota between children aged 0-3 years with acute KD and healthy children, suggesting that disturbances in intestinal microbiota occur during the acute phase of KD. In particular, Listeria_monocytogenes, Enterococcus_avium, and Enterococcus_hirae may be involved in the pathogenesis of KD through steroid degradation and apoptosis pathways.

Magnetic Resonance Imaging of the Heart is a Robust Method for Diagnosing Myocardial Lesions with Low Availability in Emergency Cardiology Departments

This article discusses the problem of underuse, low availability of modern imaging techniques such as magnetic resonance imaging of the heart (MRI). This technique is characterized by high accuracy and uniqueness in the diagnosis of myocardial lesions of various genesis. The widespread introduction of this technique in emergency cardiology departments can improve the accuracy of diagnosis and the effectiveness of patient therapy. Despite the high costs of implementation and current use, modern diagnostic methods can save healthcare resources by reducing hospital stays and improving treatment outcomes.

Health Education Nursing Based on BCW Theory Improve Negative Psychology, Sleep and Quality of Life in Elderly Patients After Cardiac Interventional Surgery: A Retrospective Study

Objective: Guided by Behavior Change Wheel (BCW) theory, a rehabilitation nursing intervention program for patients after percutaneous coronary intervention (PCI) was constructed. This study aimed to explore the impact of this intervention program on the negative emotions, sleep quality, and quality of life of patients after PCI. Methods: Patients with coronary heart disease after PCI who visited the cardiology department in our hospital from September 2022 to February 2024 were selected as the research subjects. The patients were divided into two groups according to the order of the operation time: 57 cases in the conventional group and 56 in the BCW group. The systolic blood pressure, diastolic blood pressure, and resting heart rate (RHR) of the two groups before the administration (T1) and at the end of 3 month administration (T2) were evaluated. The Self-Rating Anxiety Scale (SAS), self-rating depression scale, Pittsburgh sleep quality index, and quality of life scale were used in measuring the anxiety, depression, sleep quality, and quality of life levels of the two groups of patients at two-time points. Results: A total of 113 cases were included: 57 cases in the conventional group and 56 in the BCW group. The BCW group had larger improvements in RHR and blood pressure than the conventional group (p &lt; 0.05). The SAS and Self-rating Depression Scale (SDS) scores of the BCW group were significantly lower than those in the conventional group (p &lt; 0.05). After nursing based on the BCW model was implemented, the Pittsburgh Sleep Quality Index (PSQI) scores of the patients in the BCW group were lower than those in the conventional group (p &lt; 0.001). After 3 months of administration, the SF-36 total score and other dimensional scores in the BCW group were higher than those in the conventional group (p &lt; 0.05), and no significant difference was observed between the groups before administration (p &gt; 0.05). Conclusion: Intervention programs based on BCW theory may help to reduce patients' depression and anxiety levels, potentially exerting positive effects that improve RHR and cardiac function in patients after coronary intervention and improving patients' sleep and life quality.

Prognostic Value of Triglyceride Glucose Index in ST-Elevation Myocardial Infarction: A Key Predictor of Mortality and Thrombus Burden.

We aimed to investigate the association between the triglyceride glucose index (TGI) and mortality in patients with ST-elevation myocardial infarction (STEMI). This retrospective study utilized data from the records of patients diagnosed with STEMI who underwent primary percutaneous coronary intervention (PCI) at the Cardiology Department of Private Aktif International Hospital between 2020 and 2023. Demographic data, medical history, laboratory results, and treatment processes of the patients were obtained from retrospective records. Patients were divided into low (TGI ≤ 8.6)-, medium (TGI = 8.6-9.2)-, and high (TGI ≥ 9.2)-TGI groups according to their TGI levels. The average age of the patients was 62 ± 10 years, and 65% were men. The intracoronary thrombus burden of patients in the high-TGI group was found to be significantly higher compared to the low- and medium-TGI groups (p = 0.01). While the rate of patients with a thrombolysis in myocardial infarction (TIMI) thrombosis score of 3 or above was 45% in the high-TGI group, this rate was observed to be 20% in the low-TGI group. The short-term (30-day) mortality rate was found to be 15% in the high-TGI group, 8% in the medium-TGI group, and 5% in the low-TGI group (p = 0.02). Long-term (after 30 days) mortality rates were determined as 25% in the high-TGI group, 15% in the medium-TGI group, and 10% in the low-TGI group (p = 0.01). TGI was an independent risk factor for both short-term and long-term mortality. The hazard ratio (HR) of high TGI levels for short-term mortality was found to be 2.5 (95% CI: 1.5-4.1, p = 0.01), and the HR for long-term mortality was 2.0 (95% CI: 1.3-3.2, p < 0.02). Our results show that high TGI levels are associated with increased thrombus burden and high mortality rates in STEMI. TGI can be used not only in predicting STEMI but also in early risk stratification and treatment planning for STEMI patients.

Echocardiographic abnormalities in chronic hemodialysis patients

Introduction: Cardiovascular abnormalities are prevalent and often insidious in individuals with renal insufficiency, significantly contributing to mortality and morbidity among hemodialysis patients. Echocardiography plays a crucial role in detecting these abnormalities early, allowing for tailored interventions. This study aimed to assess the prevalence of echocardiographic findings in chronic hemodialysis patients. Methods: This descriptive study was conducted at the cardiology department of Ibn Rochd University Hospital from July 2022 to December 2023. Forty-two chronic hemodialysis patients were included, selected from ambulatory echocardiography consultations or cardiac hospitalizations. Transthoracic echocardiography examinations were performed. Results: Forty-two participants (25 women, 17 men) with an average age of 45.34 ± 13.4 years were enrolled. Left ventricular hypertrophy (LVH) was the most common abnormality, affecting 54.7% of the cohort. Valvulopathy was identified in 41% of cases, with 10% showing valve calcifications. Left ventricular dilatation was present in 29.8% of participants. Pulmonary arterial hypertension was detected in 9% of cases, and pericarditis in 3.2%. The mean systolic ejection fraction (EF) was 51.52 ± 6.02%, with 10.4% displaying systolic dysfunction of the left ventricle. Discussion: Our findings corroborate global research, underscoring LVH as the predominant anomaly. Echocardiography emerges as indispensable in identifying these abnormalities, guiding tailored interventions to mitigate cardiovascular risk in hemodialysis patients. Conclusion: Echocardiography proves invaluable in diagnosing cardiac anomalies non-invasively, offering precision and reproducibility. Given the high prevalence of cardiac-related mortality in hemodialysis patients, its integration into clinical management protocols is imperative for improved patient outcomes.

Contemporary Management and Prognostic Factors of Arrhythmia Recurrence in Patients with High-Energy Discharge of Cardiac Implantable Electronic Devices.

Background and Objectives: Understanding the underlying causes of implantable cardioverter-defibrillator (ICD) discharges is vital for effective management. This study aimed to evaluate the characteristics of patients admitted following ICD discharge, focusing on myocardial ischemia as a potential exacerbating factor and potential risk factors for VT recurrence. Materials and Methods: This retrospective, single-center study included 81 patients with high energy discharge from cardiac implantable electronic device admitted urgently to the cardiology department from 2015 to 2022. The exclusion criterion was ST-segment elevation acute coronary syndrome. Data were collected anonymously from electronic medical records. Patients were categorized based on coronary angiography, percutaneous angioplasty, presence of significant stenosis, recurrent ventricular tachycardia (VT), and catheter ablation. Clinical variables, including demographic data, echocardiographic parameters, and pharmacotherapy, were analyzed. The primary endpoint was the recurrence of VT during in-hospital stay. Results: Among 81 patients, predominantly male (86.4%), with a mean age of 63.6 years, 55 (67.9%) had coronary artery disease (CAD) as the primary etiology for ICD implantation. Coronary angiography was performed in 34 patients (42.0%) and showed significant stenosis (>50%) in 18 (41.8%) patients, while 8 (26.0%) individuals underwent percutaneous coronary intervention (PCI). Recurrent VT occurred in 21 subjects (26.3%), while ventricular catheter ablation was performed in 36 patients (44.0%). Referral for urgent coronary angiography was associated with presence of diabetes (p = 0.028) and hyperlipidemia (p = 0.022). Logistic regression analysis confirmed NYHA symptomatic class (OR 4.63, p = 0.04) and LVH (OR 10.59, p = 0.049) were independently associated with relapse of VT. CAD patients underwent catheter ablation more frequently (p = 0.001) than those with dilated cardiomyopathy. Conclusions: The study showed a low referral rate for coronary angiography among patients with ICD discharge. Presence of LVH and preexisting symptomatic class influence arrhythmia recurrence. Understanding these associations can guide personalized management strategies for ICD recipients.

Prevention of radial artery occlusion after transradial angiography and intervention: a best practice implementation project.

Among the complications associated with transradial artery access, radial artery occlusion (RAO) is the most frequent and serious, limiting the reuse of the same radial artery for subsequent procedures and as a graft for coronary artery bypass grafting. The objective of this project was to implement best practices to reduce the incidence of RAO, thereby enhancing the quality of patient care after transradial coronary angiography or intervention. The project was conducted in cardiology department of the Huadong Hospital, Shanghai, China. The seven-phase JBI Evidence Implementation Framework was used to guide the project. Eight audit criteria were developed and a baseline audit was conducted to compare current practice with best practices for RAO prevention. Following the implementation of improvement strategies, a follow-up audit was conducted to evaluate the success of the strategies. The implementation of best practices led to significant improvements in reducing the sheath/catheter size and systematically assessing radial artery patency before discharge, with both criteria reaching 100% compliance. The use of prophylactic ulnar compression increased from 0% to 90%, and the adoption of a minimal pressure strategy improved from 0% to 70%. The use of pre-puncture and post-procedural pre-hemostasis nitrates also increased from 23% to 93%. Barriers to implementation included the lack of dedicated devices for prophylactic ulnar artery compression, the possibility of bleeding after removal of the compression device, absence of an evidence-based care workflow, and absence of nursing assessment record forms for RAO prevention. This project promoted evidence-based practices among nurses for the care of RAO patients following transradial angiography and intervention. Efforts should be made to sustain the best practices in the future. http://links.lww.com/IJEBH/A261.

Severity Stratification of Coronary Artery Disease Using Novel Inner Ellipse-Based Foveal Avascular Zone Biomarkers.

Given the similarities between the retinal and coronary microvasculature, the retina holds promising potential to serve as a non-invasive screening tool for coronary artery disease (CAD). We aimed to develop novel inner ellipse-based metrics and discern whether foveal avascular zone (FAZ) alterations can serve as indicators for CAD presence and severity. Patients admitted to the Department of Cardiology who underwent coronary angiography were included. This resulted in an inclusion of 212 patients, of which 73 had no CAD. During the same visit, 6 × 6-mm (nominal size) fovea-centered optical coherence tomography angiography images of both eyes were acquired. The Gensini score (GS) was utilized to quantify CAD severity. Six known FAZ shape metrics were assessed and three novel biomarkers based on the inner ellipse were defined: absolute inner ellipse difference, Hausdorff distance, and Chamfer distance. Eight out of nine metrics showed significant associations with the GS in the left eye. However, significant differences across three CAD severity groups were only demonstrated by the novel metrics. Utilizing the Chamfer distance, age, and sex, patients with and without CAD could be distinguished with an average area under the curve (AUC) of 0.89 (95% confidence interval [CI], 0.84-0.95). Moreover, three CAD severity groups could be discerned with a macro average AUC of 0.77 (95% CI, 0.72-0.84). A comprehensive assessment of FAZ shape descriptors was performed, and a strong association with CAD was found. The inner ellipse-based biomarkers especially demonstrated high predictive abilities for CAD presence and severity.

Impact of Kidney Function on Physiological Assessment of Coronary Circulation.

Diagnosing myocardial ischemia in chronic kidney disease (CKD) patients is crucial since coronary artery disease (CAD) forms the predominant cause of mortality in these patients. Thus, this study aimed to assess the impact of kidney function on the results of coronary circulation physiological assessment. Data were collected from 279 consecutive patients admitted to the Clinical Department of Cardiology and Cardiovascular Interventions at the University Hospital in Krakow. A total of 417 vessels were assessed for fractional flow reserve (FFR) and non-hyperemic resting pressure ratios, such as instantaneous wave-free ratio (iFR) and resting full-cycle ratio (RFR). Patients were categorized into two groups: glomerular filtration rate (GFR)-L (estimated GFR (eGFR) <70 mL/min/1.73 m2) and GFR-H (eGFR ≥70 mL/min/1.73 m2). A total of 118 patients (42.3%) were included in the GFR-L group, while 161 patients (57.7%) were in the GFR-H group. The left anterior descending branch of the left coronary artery (LAD) was the assessed vessel in approximately 60% of procedures, the frequency of which was very similar in both study groups. Focusing solely on LAD assessments, both FFR metrics (continuous and binary) were comparable between the groups. In contrast, for non-LAD vessels, the GFR-H group revealed substantially reduced FFR values, with more vessels displaying significant constriction. Patients in the GFR-H group showed higher instances of FFR+ iFR/RFR- discrepancies than their lower eGFR counterparts. An eGFR of 70 mL/min/1.73 m2 was the optimal cut-off to differentiate patients concerning the mentioned discrepancies. Kidney function influenced the coronary circulation physiological assessment results. Patients with reduced eGFR tended to have negative hyperemic assessments, especially in non-LAD vessels.

Acute coronary syndrome or cardiac involvement due to leptospirosis: A case report

Leptospirosis is a globally prevalent zoonotic infection. Cardiac involvement in leptospirosis, including myocarditis, can be easily missed due to non-specific symptoms and concurrent multiorgan dysfunction. A 46-year-old male presented to the emergency department with weakness, fever, palpitations, and widespread joint and muscle pain. His temperature was 40&amp;deg;C, and his blood pressure dropped to 50/30 mm Hg. The patient, with elevated high-sensitivity troponin levels in laboratory findings, was referred to the cardiology department. Anti-ischemic treatment was started for a preliminary diagnosis of acute coronary syndrome. The leptospirosis polymerase chain reaction (PCR) test in serum was positive, whereas the urine Leptospira PCR test was negative. The patient presented with septic shock and elevated cardiac biomarkers and was re-evaluated based on electrocardiogram and echocardiogram findings. Considering these clinical and laboratory results, acute coronary syndrome was ruled out, and myocardial involvement due to leptospirosis was considered. This case highlights the importance of recognizing cardiac involvement in leptospirosis.

Successful Coronary Interventions with the Ingenious Vector\(\circledR\) Balloon in Chronic Total Occlusion (CTO): A Preliminary Study

Aims: To assess the safety and plausibility of successful coronary interventions in Chronic Total Occlusion (CTO) with the innovative Vector\(\circledR\) balloon through balloon-assisted crossing technique. Study Design: Observational, prospective study. Place and Duration of Study: Department of Cardiology, King Edward Memorial Hospital and Seth G. S. Medical College, Mumbai. The study was carried out between the months of March and June, 2024. Methodology: A total of 20 patients were included in the study. All patients with chronic coronary syndrome were being planned for Percutaneous Coronary Intervention (PCI) for CTO. During PCI, the standard protocol of intervening CTO lesions was followed. When the operator was not able to cross the lesion with standard CTO guidewires, Vector\(\circledR\) balloon-assisted crossing was planned. This technique was used in a total of seven (35%) patents. Success was defined as the possibility of advancing the guidewire further to the target lesion and being able to deploy a drug eluting stent. Safety was assessed as reporting complications like kinking or rupture of the balloon shaft, loss of balloon inside the guide or the coronary artery and the balloon burst rate after inflation exceeding the Rated Burst Pressure (RBP) according to the manufacturer’s reference table. Results: The mean age of the patients was 58.1 ± 3.6 years. The balloon-assisted crossing was successful in all seven patients. The most commonly used diameter of the balloon was 1.25 mm (42.85%). Conclusion: The novel Vector\(\circledR\) balloon catheter showed excellent result when deployed to treat the CTO after the usual strategy of guidewire escalation had failed. The proximal shaft with polytetrafluoroethylene (PTFE) coating brings the flexibility to navigate complex and tortuous vascular pathways with ease due to its laser welded core-wire. A study with a larger sample size and a comparator arm would rather clarify if such a balloon-assisted crossing technique in CTO would decrease the need of costly devices like double lumen microcatheters.