Cardiology Hospital Research Articles

Simulator transesophageal echocardiography: the new horizon of training?

Abstract Background trans-esophageal echocardiography (TEE) plays a crucial role in the diagnosis of cardiovascular diseases. In recent years, the importance of theoretical-practical training based on advanced simulation systems in learning specific medical skills has emerged but evidence for the effectiveness for TEE are limited. Purpose evaluate the impact of a theoretical-practical course with simulator for TEE in the diagnostic interpretation of morpho-functional images and acquisition of projections according to standard protocol of the American Society of Echocardiography (ASE). Methods cardiologist specialists and resident cardiologists who participated in the TEE course at a center of simulation and advanced training center from 2018 to 2023, were retrospectively enrolled in the study. Before the course, participants underwent a question multiple-choice based test, aimed at assessing theoretical knowledge and clinical interpretation of morpho-functional images and clips recorded during interventional procedures. During the course, learners where divided into three groups: one utilizing the simulator to conduct exams with clinical cases and acquisition of clips according to ASE protocol, another one participating in interactive discussions of the first group's TEE hands-on activities, and the last one attending lectures with clinical cases. The activities were switched during the two days of the course. Following the course, the same test was administered to evaluate changes in results. Results 290 hospital cardiologists and resident cardiologists (95.2% and 4.8%, respectively) participated in the course. Among them, mean age was 45.2 ± 11 years old, 164 were male (57%). Before the course, the learners answered correctly the 77.6% of questions, while after the course this value increase to 89.5% (p value < 0.001). This improved result was driven by the group above 54 years (p = 0.026) and by the one with an age between 45 and 54 years (p = 0.042), as shown in Figure 1. 205 learners (71.9%) improved their test results after the course, while 41 (14.4%) lowered the score and 39 (13.7%) achieved the same result. In the learners that improved (205), 79% wronged ≥3 questions at the first evaluation and after the course this number decreased to 15% (p < 0.001); on the other hand, in the ones that not improved (80), 14% wronged ≥ 3 questions and this value grew to 45% after the course (p < 0.001), as shown in Figure 2. Moreover, at the end of the training, all the learners were able to complete the sequence of 28 projections of the standard protocol of trans-esophageal echocardiographic recommended by international society of echocardiography. Conclusions In our cohort of cardiologist specialists and fellows, a two-day theoretical-practical course with a TEE-based simulator improved competencies in interpretation of TEE clips and images. These findings should therefore encourage greater use of advanced training with simulation TEE training.

In elderly with cardiovascular disease over 65 years of age the relationship between frequency of frailty and quality of life

This study aim was designed as an analytical cross-sectional study to assess the prevalence of frailty in patients aged 65 years and older with cardiovascular disease and to investigate its relationship with quality of life. The population consisted of a State Hospital Cardiology patients, and the sample consisted of 255 patients, who were calculated according to the incidence of the event (frequency of frailty) (25%) at the 95% confidence interval. Data were collected face to face by interview method between 25.07.2019-01.04.2020. In this study, frailty was observed in 30.9% of cardiovascular patients aged 65 and older. Frailty is mostly seen in illiterate people, women, single people, those who state that their income does not meet their expenses, and those who live alone, and there is a statistically significant difference between them (p≤ 0.05). A statistically significant relationship was found between frailty and factors such as the number of comorbidities, fall history in the past year, frequency of hospitalizations, and the number of medications taken within the last year in patients with cardiovascular disease. This study identified a negative correlation between the total score of the quality of life scale, its sub-dimension scores, and frailty (r=-0.414:p=0.000). Additionally, it was observed that patients with cardiovascular frailty experience a lower quality of life. In our study the frequency of frailty due to sociocultural factors is high in elderly individuals living alone with cardiovascular disease.

Reprocessing of Single-Use Medical Devices: Viewpoints and Perceptions of Cardiologists and Hospital Pharmacists

A pilot initiative on the reprocessing of medical devices (MD), particularly in electrophysiology, is expected to be launched in France in November 2024. Reprocessing single-use medical devices (SUDs) presents potential benefits and challenges, with differing perspectives among healthcare professionals. This study aims to compare the knowledge and positions of hospital pharmacists (HP) and cardiologists (CA) regarding the use of reprocessed single-use devices (R-SUDs), in order to identify their concerns as well as points of convergence and divergence. A directive and mixed electronic questionnaire consisting of 27 questions was sent to HPs and CAs from the Assistance Publique-Hôpitaux de Paris (AP-HP). Responses from 32 HPs and 30 CAs were analyzed using statistical methods via R software. The results revealed that CAs overwhelmingly support reprocessing, while HPs show significantly more reservations (p<0.0001). Among HPs, 56% (n=18) favored an "open" supply chain model for reprocessing, compared to 28% (n=9) who preferred a "closed" one. CAs show a more balanced distribution of their preferences, with 30% (n=9) favoring the "open" chain and 40% (n=12) the "closed" model. Both groups raised concerns about the safety and quality of reprocessed devices, but the majority would accept R-SUDs if clinical trials validated their safety and effectiveness compared to original SUDs. Reprocessing is nevertheless seen as a means to reduce hospital costs and carbon footprint in hospitals.

FACTOR INFLUENCING MIGRATION AND JOB SATISFACTION AMONGST PAKISTANI NURSES: A STUDY OF PUSHING AND PULLING FACTORS IN MULTAN INSTITUTE OF CARDIOLOGY AND NISHTAR HOSPITAL MULTAN

The nursing workforce plays a critical role in healthcare delivery; however, job dissatisfaction and migration intentions among nurses pose significant challenges, particularly in low- and middle-income countries like Pakistan. Factors such as low wages, poor working conditions, and lack of professional development contribute to dissatisfaction and workforce shortages. Objective: To explore factors influencing job satisfaction and migration intentions among nurses at Multan Institute of Cardiology (MIC) and Nishtar Hospital, Multan. Methods: A descriptive cross-sectional survey was conducted at MIC and Nishtar Hospital, involving 250 nurses using stratified random sampling. Data were collected using a validated structured questionnaire addressing demographic characteristics, job satisfaction, and migration intentions. Responses were analyzed using SPSS version 26, with descriptive and inferential statistics. A p-value ≤0.05 was considered statistically significant. Results: The study revealed that 50% of nurses reported dissatisfaction with their jobs, primarily due to low wages (60%), poor working conditions (65%), and excessive workloads (70%). Migration intentions were significantly driven by higher salaries (75%) and better working conditions (70%) in destination countries. Professional development opportunities were identified as a major pull factor by 65% of nurses. Adverse events such as burnout and dissatisfaction were more prevalent among nurses with high workloads and inadequate workplace support. The results align with global studies emphasizing economic and professional growth as key motivators for migration. Conclusion: Low wages, poor working conditions, and lack of professional development are critical factors contributing to job dissatisfaction and migration intentions among nurses in Pakistan. Addressing these challenges through improved salaries, better working conditions, and enhanced professional development opportunities could improve nurse retention and reduce migration.

Assessment of Simplified Surveillance for Congenital Rubella Syndrome in Sudan, 2014-2017.

Congenital rubella syndrome (CRS) is a constellation of serious multi-organ birth defects following rubella virus infection during early pregnancy. Countries in which rubella vaccination has not yet been introduced can have a high burden of this disease. Data on CRS burden and epidemiology are needed to guide the introduction of a rubella vaccine and monitor progress for rubella elimination, but the multi-system nature of CRS manifestations and required specialized testing creates a challenge for conducting CRS surveillance in developing settings such as Sudan. To enhance data quality, we designed and tested a simplified approach for CRS surveillance in Sudan. Seven CRS surveillance sentinel sites were set up at general pediatric, eye, and cardiology hospitals in Sudan, using standard definitions for reporting and classifying infants with CRS clinical manifestations. Between 2014 and 2017, we evaluated the system using WHO CRS surveillance monitoring indicators, comparing simplified approaches against a comprehensive one. The simplified approaches included (1) an ophthalmic-focused approach; (2) a heart-focused approach; and (3) a cataract-only approach. Surveillance identified 179 infants with suspected CRS via the comprehensive approach, with 25 infants classified as laboratory-confirmed and 6 as clinically compatible. Surveillance sensitivity was highest for the simplified ophthalmic approach, while cataract-based surveillance had the highest proportion of confirmed cases. Simplified CRS surveillance, particularly focusing on detecting cataracts, can significantly contribute to monitoring the impact of rubella vaccine introduction. It could serve as an initial step towards comprehensive CRS surveillance, providing robust evidence to support rubella and CRS elimination efforts.

Impact of the COVID-19 pandemic on acute cardiology and neurology services in a secondary peripheral hospital

The indirect impact of the COVID-19 pandemic on clinical services in peripheral hospitals has not been fully described. We compared the impact of COVID-19 on Cerebral Vascular Accident (CVA) and ST-elevation myocardial infarction (STEMI) management and outcome in an Israeli peripheral hospital. We included 1029 CVA and 495 STEMI patients. Patients who arrived during (15/3/2020–15/4/2022) and before (1/1/2018–14/3/2020) the pandemic, were demographically comparable. During the pandemic, median time for CVA patients from arrival to imaging was longer (23 vs. 19 min, p = 0.001); timing from arrival to tissue Plasminogen Activator administration was similar (49 vs. 45 min, p = 0.61); transfer to another hospital was more common (20.3% vs. 14.4% p = 0.01) and median length of stay (LOS) was shorter (3 vs. 4 days, p < 0.05). Among STEMI patients, median time from arrival to intervention intra- pandemic was shorter (45 vs. 50 min p = 0.02); Mean LOS shorter (3.86 vs. 4.48 p = 0.01), and unplanned re-admission less frequent (7.8% vs. 14.6% p = 0.01). Mortality did not change significantly. Our data shows no major negative impact of the COVID-19 pandemic on CVA outcomes, and improved care for STEMI patients. Interviews with the neurology and cardiology staff are performed to investigate how quality of care was maintained during the crises.

Characteristics of hypertension and its impact on cognitive functions in older adults: a cross-sectional study.

Hypertension is a potentially modifiable risk factor for cognitive decline. Understanding the variables of hypertension related to cognitive functions will help in mitigating the risk. The study aims to assess the characteristics of hypertension and its effect on cognitive functions in the older adults. The study involved 95 hypertensive participants aged 60 years and above from cardiology and medicine outpatient services of a tertiary care hospital from August to October 2022. The characteristics of hypertension and cognitive functions were assessed using semi-structured proforma and Adenbrooke's Cognitive Examination (ACE-III) Hindi version respectively. Further, individual cognitive functions were compared with duration of the hypertension and hypertensive status of the participants. The chi-square test and independent t-tests were used and p value < 0.05 was considered to be significant. The mean age of the study population was 68.2 years, the cognitive functions was comparable in terms of age, sex, locality, co-morbidity, and treatment characteristic. Although a significant difference in cognitive functions was present in relation to duration and status of hypertension. Among the individual cognitive domains, a significant difference was observed in attention and fluency domains of cognitive function based on HTN status (p > 0.05) but differential effect on cognitive domains was not seen with the duration of HTN. However, there was overall decline in cognitive domains with both hypertension status and the duration of hypertension. The study highlights association of status of hypertension and its characteristics with cognitive decline.

Effect of low-dose rivaroxaban on bleeding events in low-weight patients with nonvalvular atrial fibrillation: a retrospective propensity score-matched cohort study.

To investigate the effect of low-dose rivaroxaban on bleeding events in low-weight patients with nonvalvular atrial fibrillation. A retrospective study was conducted in patients with nonvalvular atrial fibrillation (weight ≤ 60 kg) who were admitted to the Department of Cardiology of Jiangxi Provincial People's Hospital from June 1, 2022, to December 12, 2022 and received anticoagulant therapy with rivaroxaban. The patients were divided into standard-dose group (15-20 mg) and low-dose group (10-15 mg). The patients were followed up for an average of 15 months by outpatient examination, telephone follow-up, or medical record inquiry of readmission patients. The bleeding events of the two groups were recorded during the follow-up period, and the two groups were balanced by propensity score weighting. A total of 198 patients with NVAF and body weight ≤60 kg receiving rivaroxaban anticoagulation therapy were enrolled, including 65 patients in the standard-dose group (15-20 mg) and 133 patients in the low-dose group (10-15 mg). In this study, only 24.1% (65/241) of the patients followed the standard dose of rivaroxaban. There was no significant difference in the incidence of bleeding events between the two groups after the balance of baseline characteristics (age) (P > 0.05). This was also consistent in patients weighing less than 50 kg. In the real world, in lower-weight patients with nonvalvular atrial fibrillation, a reduced dose of rivaroxaban did not reduce the risk of bleeding, and this was consistent in patients weighing less than 50 kg.

Simplification of a registry-based algorithm for ejection fraction prediction in heart failure patients: Applicability in cardiology centres of the Netherlands.

Left ventricular ejection fraction (EF) is used to categorize heart failure (HF) into phenotypes but this information is often missing in electronic health records or non-HF registries. We tested the applicability of a simplified version of a multivariable algorithm, that was developed on data of the Swedish Heart Failure Registry to predict EF in patients with HF. We used data from 4,868 patients with HF from the Cardiology Centers of the Netherlands database, an organization of 13 cardiac outpatient clinics that operate between the general practitioner and the hospital cardiologist. The algorithm included 17 demographical and clinical variables. We tested model discrimination, model performance and calculated model sensitivity, specificity, positive and negative predictive values for EF ≥ vs. <50% and EF ≥ vs. <40%. We additionally performed a multivariable multinomial analysis for all three separate HF phenotypes (with reduced, mildly reduced and preserved EF) HFrEF vs. HFmrEF vs. HFpEF. Finally, we internally validated the model by using temporal validation. Mean age was 66 ±12 years, 44% of patients were women, 68% had HFpEF, 17% had HFrEF, and 15% had HFmrEF. The C-statistic was of 0.71 for EF ≥/< 50% (95% CI: 0.69-0.72) and of 0.74 (95% CI: 0.73-0.75) for EF ≥/< 40%. The model had the highest sensitivities for EF ≥50% (0.72, 95% CI: 0.63-0.75) and for EF ≥40% (0.70, 95% CI: 0.65-0.71). Similar results were achieved by the multinomial model, but the C-statistics for predicting HFpEF vs HFrEF was lower (0.61, 95% CI 0.58-0.63). The internal validation confirmed good discriminative ability. A simple algorithm based on routine clinical characteristics can help discern HF phenotypes in non-cardiology datasets and research settings such as research on primary care data, where measurements of EF is often not available.

Predicting new-onset persistent conduction disturbance following transcatheter aortic valve replacement: the usefulness of FEOPS finite element analysis

BackgroundDespite the frequency of persistent new-onset conduction disturbances after transcatheter aortic valve replacement (TAVR), few preoperative methods of prediction exist.MethodsPatients who underwent TAVR in the Department of Cardiology of the Second Affiliated Hospital of the Army Medical University from December 2020 to September 2021 and postoperative aortic root modeling via the FEOPS finite element analysis were included in this single-center case–control study, divided into persistent conduction disturbances (PCD) and non-PCD groups according to their pre- and postoperative electrocardiograms in the first month. Risk factors affecting PCD were identified by comparing the baseline data of these two groups, including echocardiograms, computed tomography angiography of the aortic root, surgical decision-making, and FEOPS data. Independent risk factors were screened using logistic regression modeling, and the receiver operating characteristic (ROC) curve was used to test the predictive ability.ResultsA total of 56 patients were included in this study, 37 with bicuspid aortic valve (BAV) and 19 with trileaflet aortic valve (TAV), with 17 cases of PCD. The contact pressure index (CPI) of FEOPS, valve oversize ratio, differences between membranous interventricular septum length and implantation depth (ΔMSID) and valve implantation depth were statistically different (P < 0.05). CPI could be used as an independent risk factor for PCD (P < 0.05), and the ROC curve comparison showed that the CPI was more predictive (AUC = 0.806, 95% CI: 0.684–0.928, P = 0.001).ConclusionsThe CPI of FEOPS has better predictive value for new-onset conduction disturbance after TAVR compared to other known predictors.

Impact of COVID-19 on cardiology and neurology services in a peripheral hospital in Northern Israel

Abstract Background The indirect impact of COVID-19 pandemic on clinical services remains incompletely described in secondary care hospitals outside major urban centers. We compared clinical outcomes before and during the pandemic in a disrupted service (Neurology) and a non-disrupted one (Cardiology) in a peripheral hospital in Israel, using Cerebral Vascular Accident (CVA) and ST-elevation myocardial infarction (STEMI) as clinical indicators, respectively. Methods We compared demographics, treatment and outcomes from CVA and STEMI patients who attended Ziv Medical Center, Israel, during the pandemic (15/3/2020-15/4/2022) and before (1/1/2018-14/3/2020), Using chi-square, t-test and Wilcoxon-Mann-Whitney tests. Results 1029 CVA and 497 STEMI patients were included. Those who arrived during the pandemic were demographically comparable to those arriving before. Compared to pre-pandemic, intra-pandemic median time for CVA patients from arrival to imaging was longer (23 vs. 19 minutes, p = 0.001). However, timing from arrival to tissue Plasminogen Activator administration was similar (49 vs. 45 min, p = 0.61). The likelihood of transfer to another hospital was higher (20.3% vs. 14.4% p = 0.01) and median length of stay (LOS) was shorter (3 vs. 4 days, p &amp;lt; 0.05). Among STEMI patients, median time from arrival to percutaneous coronary intervention during the pandemic was shorter than before (45 vs. 50 minutes p = 0.02) and median ejection fraction at discharge was higher (50% vs. 45% p = 0.02). Mean LOS was shorter (3.86 vs. 4.48 p = 0.01), and unplanned re-admission to the ED was less frequent (7.8% vs. 14.6% p = 0.01). No significant changes in mortality were observed. Conclusions Our data shows no major negative impact of the COVID-19 pandemic on CVA and STEMI outcomes, and possibly improved care in the less disrupted department. Follow-up qualitative studies with neurology and cardiology staff already in action to comprehend how quality of care was maintained during the crises. Key messages • In peripheral setting, COVID-19 hadn’t negatively impact Neurology or Cardiology acute clinical outcomes. • The consequences of maintaining clinical performance when working under adverse conditions requires further research.

Prevalence and incidence of heart failure in patients with type 2 diabetes mellitus. Results of the prospective DIABET-IC study

Abstract Introduction Heart failure (HF) is one of the major health problems in our environment today. Type 2 diabetes mellitus (DM2) is an important cardiovascular risk factor and can increase the burden of HF through various mechanisms. The incidence of HF in DM2 has not been well studied. Purpose The aim of our study was to evaluate the prevalence and incidence of HF in patients with DM2 followed in hospital cardiology and endocrinology departments. Methods The DIABET-IC study is a longitudinal cohort, prospective, multicenter follow-up study that included 1,249 consecutive patients with DM2 in 2018-2019 in 30 Spanish centers in cardiology and endocrinology outpatient clinics. HF was diagnosed according to the clinical records and following the criteria of the European Society of Cardiology. The prevalence of HF at the inclusion visit was analyzed, as well as the incidence of HF (new diagnoses) during a 3-year follow-up. Results Mean age was 67.3±+9.9 years, with 31.7% of the patients being women. Cardiology clinics included 61.9% of patients and endocrinology clinics the remaining 38.1%. There was a previous history of coronary artery disease in 38.6%, hypertensive heart disease in 21% and atrial fibrillation in 31.9%. Cardiovascular and antidiabetic drugs prescribed at the baseline and 3-year visits are shown in figure 1. Figure 2 summarizes the results of the study. The prevalence of HF at the baseline visit was 39.2%, 490 cases (with reduced LVEF 17.3%, mildly reduced 8.1% and preserved 13.8%). After a follow-up of 1,935/100 persons-year of cases without baseline HF, 58 incident cases of HF were diagnosed, 7.6% (32 in the first year, 13 in the second and 13 in the third year of follow-up). The incidence rate was 3.01/100 person-years (95%CI: 2.30-3.92). Of these 58 cases, 23.7% were with reduced LVEF, 28.9% with slightly reduced LVEF and 47.4% preserved. The incidence was higher in patients followed by endocrinology (3.90 vs 2.90/100 persons-year; p=0.042). At the end of the 3-year follow-up, including baseline prevalence, 46.8% of all patients had HF. Conclusions The prevalence and incidence of HF in patients with DM2 are very high. The incidence of HF is around 3% per year, which is almost 8 times higher than the rate found in large studies in the general population. Approximately half of the new cases were HF with preserved LVEF, and the other half with LVEF &amp;lt; 50%. The use of new antidiabetic drugs, such as iSGLT2, which have been shown to reduce the incidence of HF, should be encouraged.

Guideline-directed medical therapy patterns in heart failure with reduced ejection fraction: the OPTIMA-HF registry

Abstract Background/Introduction European guidelines strongly recommend an optimized pharmacological treatment in patients with heart failure with reduced ejection fraction (HFrEF) with a fast introduction of the four-pillars. Purpose Aim of the Optimization of Therapy in the Italian Management of Heart Failure [OpTIMa-HF] Registry was to collect data on HF patients to describe the current Italian population of HF patients with a specific focus on HFrEF treatment adherence and prescription rates, according to the most recent European Guidelines. Methods OPTIMA-HF is an observational, cross-sectional, multicenter, real-life study conducted in two different clinical settings: HF outpatients’ clinics of Italian University Hospitals and territorial Italian Cardiology outpatients’ services, that enrolled patients with chronic HFrEF receiving at least 1 oral medication for management of HF. Patients were characterized by baseline use and dose of angiotensin-converting enzyme inhibitor (ACEI)/angiotensin II receptor blocker (ARB)/angiotensin receptor neprilysin inhibitor (ARNI), beta-blocker, mineralocorticoid receptor antagonist (MRA) and sodium glucose co-transporter II inhibitor (SGLT2i). Patient-level factors associated with medication use were examined. Results Overall, 1390 patients from 29 ambulatory cardiology practices and university hospitals were included. Mean age was 69.5 ± 11.9 years, 24% were female, and median EF was 33 (28-37). Among enrolled patients, 72.2% were prescribed ARNI, 17.1% ACEI/ARB, 95% beta-blocker, 75.5% MRA and 63% SGLT2i therapy (Figure 1). Despite high prescription rates for each single class, a still not sufficient number of patients was on treatment with all four pillars, in particular 40.4% considering the presence ARNI and 6.2%. When medications were prescribed, few patients were receiving target doses of ACEI/ARB (31.7%), ARNI (16%), and beta-blocker (33.3%), whereas a higher proportion were receiving target doses of MRA therapy (38%), and all were receiving target dose for SGLT2i. Among patients eligible for all classes of medication, only 1.1% were simultaneously receiving target doses of ACE/ARB/ARNI, beta-blocker, MRA and SGLT2i. Prescription rates did not significantly differ between the type of center (University Hospital vs. territorial Cardiology outpatients’ services). As regards patients not on treatment with any of the four pillars, a small but still present amount of patients had no contraindications to these drugs (Figure 1). Conclusions In this contemporary outpatient HFrEF Italian registry, significant high prescription rates of the four-pillars were observed, however therapy combination rate is still not sufficient and drugs' titration need to be implemented to receive the greatest benefits from an optimized treatment. Strategies to improve guideline-directed use of HFrEF medications remain urgently needed, and these findings may inform targeted approaches to optimize outpatient medical therapy.

Percutaneous revascularization in late-presenting STEMI with absence of viability: effects on left ventricular remodeling and scar

Abstract Introduction In patients with ST-elevation myocardial infarction (STEMI), percutaneous coronary intervention (PCI) should be conducted within 12 hours of symptom onset. The potential benefits attributable to late reperfusion in STEMI fall under the "open artery hypothesis" where the stunned peri-infarction zone after revascularization would restore blood supply and contractility. Purpose To estimate the differences on the LV ejection fraction (LVEF), indexed LV end-systolic volume (iLVESV) and scar in patients with STEMI without viabilitity randomized to optimal medical therapy (OMT) alone or OMT and a late percutaneous coronary intervention (PCI) performed between 24 hours and 30 days after the event. Methods Patients with non-reperfused STEMI were evaluated from September 2021 to June 2022 at a tertiary cardiology hospital. The patients underwent Cardiac Magnetic Resonance (CMR) to assess myocardial viability and were classified as non-viable if they had only 1 wall segment with less than fifty percent thickness of the affected wall with late gadolinium enhancement. The patients were randomized to PCI or OMT alone. CMR was repeated at 6 months to evaluate LVEF, iLVESV and fibrosis. This summary presents a planned partial analysis of the 6-month results (N=51). Descriptive statistics analysis included central and dispersion estimators, or absolute and relative frequencies. To explore the differences between groups and time, Mann-Whitney and Wilcoxon tests were run, and results were given as point-estimates and confidence intervals at 95% (95% CI). A significance level of 5% was adopted for inferential analysis. Results 51 patients (60±11 years, 71% male) were included in the analysis. Of this total, 24 were randomized to PCI + OMT, and 27 to isolated OMT. The groups showed balanced distribution regarding clinical characteristics and initial CMR parameters (LVEF, iLVESV, and fibrosis). The difference in LVEF at the end of 6 months between the OMT and PCI groups was 2.07%, favoring the OMT group; however, this difference was not significant (p= 0.677, 95% CI: -5 to 10). Between the groups, the difference at the end of 6 months in iLVESV was -6.82 ml/m², also without statistical significance (p= 0.858, 95% CI: -19 to 11). There was a significant reduction in the amount of fibrosis in both PCI group with -14.68g (p= 0.011) and in the OMT group with -12.57g (p= 0.009). Detailed results are presented in Table 1. Conclusion Despite a significant reduction in fibrosis in both groups, there was no superiority observed in late PCI compared to isolated OMT in reducing reverse remodeling and fibrosis in patients with non-viable STEMI when compared to isolated OMT.Remodeling changes.

Telemedicine through social media to enhance guideline-directed revascularization in STEMI: a five-year analysis in a developing nation

Abstract Background Timely reperfusion reduces mortality in ST segment Elevation Myocardial infarction (STEMI). Telemedicine and social media have been variably used to improve STEMI care in community settings. We established a new care system for STEMI in a public health setting serving a population of over 80 million, in a state with from a developing nation. Purpose To enhance guideline directed revascularisation (GDR) in STEMI by networking non-percutaneous coronary intervention (PCI) capable hospitals to PCI capable hospitals in a hub-and-spoke model and implementing telemedicine via social media platforms (Whatsapp) over five years(2019-2023). Methods Eighteen Government medical college hospitals were identified as hubs and were provided with cardiac catheterisation laboratories and empowered to provide either round the clock (Phase I hubs) or office hour primary PCI (Phase II hubs). They were linked to 188 Taluk or District-level, non-PCI capable Government hospitals identified as spokes to form 18 STEMI clusters. Separate social media groups on WhatsApp were created for each of the clusters, facilitating the sharing of de-identified ECGs and clinical data from spokes for guidance on diagnosis and management by hub hospital cardiologists. Transfer to hub hospitals for catheter based therapies were coordinated through prior intimation in the cluster WhatsApp group to ensure timely arrival and treatment. A customised uniform protocol for STEMI management was developed and health care personnel were trained accordingly. Human resource support was provided to collect and submit cumulative daily data on the number of STEMIs, the revascularisation provided and mortality through online free web forms. Annual cumulative data on STEMI volumes and GDR were analysed. Results 71,907 STEMI patients were treated from 2019 to 2023. We observed a 67% increase in STEMIs treated per year from over five years (11,363 in 2019 to 18565 in 2023). Use of pharmaco-invasive therapy increased from 7.9% to 31.7% (Figure-1). There was a marginal increase in use of primary PCI. The count of patients without GDR decreased by 20%. There was a 6.7 fold (672 in 2019 to 4,535 in 2023) rise in patients referred from spoke to hub hospitals for catheter-based revascularization. Over five years, there was an increase in the proportion of patients receiving GDR. This increase was more evident in Phase II hubs (52% in 2019 to 87.1% in 2023). Commensurate with the increase in GDR, phase II hubs demonstrated a tangible decrease in mortality (Figure-2). Conclusion We have shown that networking of non-PCI-capable hospitals with PCI-capable hospitals in a hub and spoke model using social media groups, facilitates telemedicine, leading to improved GDR in STEMI. This innovative approach not only enhances connectivity but also contributes to more efficient and timely cardiac care in resource-constrained settings.Figure 1. Revascularisation in STEMIFigure 2.Mortality Trends in STEMI (hubs)

Relativity, Rank, and the US News Health's Cardiology, Heart, and Vascular Surgery Best Hospitals.

Virtually anything can be ranked; the US News and World Report (USNWR or US News) ranks the top 50 hospitals specializing in cardiology, heart, and vascular surgery. Here the authors propose validating the effectiveness of rankings by comparing differences among the USNWR metrics across the top 50 hospitals. The ranking system for the top 50 hospitals specializing in cardiology, heart, and vascular surgery was derived from 16 variant scores. Each hospital's scores were collected from the USNWR. Hospitals were categorized into quintiles consisting of 10 institutions (1-10, 11-20, etc). An analysis of variance/χ2 comprehensive statistical analysis was run alongside a Wilcoxon/Kruskal-Wallis test to compare statistical outcomes. A significant threshold was deemed to be P < 0.05. Significant differences were noted between quintiles for advanced technologies (P = 0.05), US News specialty score (P < 0.001), number of patient referrals (P = 0.004), and expert opinion (P < 0.001). Non-statistically significant differences were found among patient experience, public transparency, Society of Thoracic Surgery transparency, American College of Cardiology transparency, recognition as a magnet hospital, and nursing staffing. Interestingly, a large variance was noted in the average number of referrals between the first quintile (13,371) and the last (6690). Expert opinion plays a critical role in the reputation of the USNWR's top 10 hospitals in cardiology, heart, and vascular surgery. Although many have argued about the merits of USNWR hospital rankings, taken together, rankings fill a strong customer demand and are sticky.

Correlation between Glycosylated Hemoglobin level with Angiographic findings of Coronary Artery Disease in different ages.

Objective: Coronary Artery Disease (CAD) is one of major macro vascular complication of Diabetes Mellitus (DM). The object of study is to analyze the correlation of angiographic findings of CAD with changes of glycosylated Hemoglobin (HbA1c) levels in CAD Patients, T2DM Patients and Patients having both CAD and T2DM as compared to normal in different age groups.Methodology: This cross-sectional descriptive study was conducted at Rawalpindi Institute of Cardiology (RIC) during 1st December 2020 to 28th February 2021. The study included 1540 (385 subjects in each group) from Rawalpindi Institute of Cardiology hospital presenting with symptoms of CAD. A Complete demographic data was taken. They were assessed according to HbA1c level and type of CAD based on angiographic findings. Patients were divided into 4 groups according to HBA1C ranging from &lt;5 % to &gt; 8.0% and 4 age groups ranging from 40 to 79 years.Result: A statistical positive correlation between HBA1c with advancing age. Most vulnerable age group was 50-59 years in all groups of altered HBA1c. A statistical correlation between Angiography findings of CAD with HBA1c was significantly positive. (p&lt;0.001).Conclusion: HbA1c can be used as a predictor of severity of coronary artery disease measured by Angiographic findings as patients with a higher level of HbA1c had significant severe lesions on Angiography. Keywords: Coronary heart disease, type 2 Diabetes Mellitus, HbA1c, Angiographic findings in CAD.

Evaluation of Inflammatory Markers in Predicting Coronary Complexity: Insights from the SYNTAX II Score in NSTEMI Patients.

Objectives: Non-ST-elevation myocardial infarction (NSTEMI) is characterized by the absence of pathological ST segment elevation but an increase in biological markers. The SYNTAX II score (SS-II) is calculated to evaluate the complexity of coronary artery disease and to guide treatment decisions between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). The aim of this study is to evaluate the relationship of socio-demographic data and biochemical markers with SS-II in NSTEMI patients. Materials and Methods: Six hundred patients who were admitted to the private Aktif International Hospital cardiology clinic between January 2020 and January 2024 and were diagnosed with NSTEMI were included in the study. Severity, extent, and clinical evaluation of atherosclerosis were determined using risk factors, laboratory tests, and coronary angiography. Patients were divided into two groups according to their SS-II score: low (≤ 22) and high SS-II (> 32). Socio-demographic data, neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and monocyte-to-HDL-C ratio (MHR) were compared between the two groups. Results: Group 1 (SS-II ≤ 22) included 380 patients, and group 2 (SS-II > 32) included 220 patients. There was a statistically significant difference in HDL, creatine value, white blood cell, troponin I, hs-TnT, and monocyte values in group 2 compared with group 1 (p = 0.001, p = 0.018, p = 0.031, and p = 0.001, respectively). NLR, MLR, MHR, and SS values were statistically significantly higher in group 2 compared with group 1 (p = 0.015, p = 0.002, p = 0.001, and p = 0.001, respectively). The risk factors were found to be significantly associated with high-risk NSTEMI (SS-II > 32) in a logistic regression analysis and included peripheral artery disease (PAD) (OR: 3.028, p = 0.040), troponin I (OR: 3.575, p = 0.015), hs-TnT (OR: 4.221, p = 0.010), NLR (OR: 1.528, p = 0.024). MLR (OR: 5.248, p = 0.012), and MHR (OR: 7.122, p = 0.010). ROC analysis revealed that NLR (AUC: 0.691, p = 0.016), MLR (AUC: 0.731, p = 0.004), and MHR (AUC: 0.824, p = 0.003) had higher predictive power than other parameters in patients with high-risk NSTEMI (SS-II > 32). Conclusions: We found that NLR, MLR, and MHR levels are associated with the severity of coronary artery disease. We think that adding these easily and quickly measurable parameters to routine laboratory results may support the clinician in evaluating the complexity of coronary artery disease and guiding treatment decisions in NSTEMI patients.

How did coronavirus disease 2019 affect autonomic balance in young individuals? Analysis by heart rate variability.

The aim of this study was to demonstrate the effect of coronavirus disease 2019 on the cardiovascular autonomic system using heart rate variability in young individuals. The study was designed retrospectively by scanning the 24-h Holter electrocardiography records of patients who applied to the Ankara Abdurrahman Yurtaslan Oncology Education and Research Hospital Cardiology outpatient clinic. The study group consisted of 492 patients under the age of 40 years, who did not have additional comorbidities or medication use and had prolonged symptoms after coronavirus disease 2019 during the pandemic. The control group, including 401 patients, was determined during the pre-pandemic period (before December 2019). Heart rate variability parameters were evaluated by scanning the 24-h Holter electrocardiography records of the patients and compared with the non-coronavirus disease 2019 group. The median age of participants was 30 years. Standard deviation of normal RR intervals (SDNN) ≤100 ms was more prevalent in the study group (27 (6.7%) vs 73 (14.8%), p<0.001). In univariate logistic regression analysis, the presence of coronavirus disease 2019 [(OR 2.41, 95%CI 1.52-3.83), p<0.001] and age [(OR 1.04, 95%CI 1.01-1.07), p=0.016] had a significant effect on the probability of SDNN≤100. In multivariate logistic regression analysis, the presence of coronavirus disease 2019 [(OR 2.42, 95%CI 1.52-3.85), p<0.001] and age [(OR 2.42, 95%CI 1.52-3.85), p=0.016] had a significant effect on the probability of SDNN≤100. Frequency domain measures such as, high-frequency values were significantly higher in the study group (p=0.029). The study group's low-frequency/high frequency ratio was significantly lower (p=0.019). The low-frequency/high-frequency ratio's cut-off value was ≤2.77. for determining the differentiation between coronavirus disease 2019 positive and negative cases in the receiver operating characteristic analysis. The sensitivity rate was 80.7%. The area under the curve value is 0.546 (p=0.019). This study showed that coronavirus disease 2019 causes reduced heart rate variability and increased parasympathetic activity in young patients. This may explain the prolonged symptoms after coronavirus disease 2019 infection.

Association of Physical Activity Levels with Coronary Artery Disease Risk Factors in Middle aged (40-55) Bangladeshi Women

Background: A sedentary lifestyle is associated with increased risk of Coronary Artery Disease (CAD) in women. At least 150min/wk of moderate activity or 75min/wk of vigorous activity or combination is recommended by American Heart Association (AHA) for primary prevention of CAD. The purpose of this study was to assess the physical activity levels of middle aged women and to find out the association of CAD risk factors with physical activity level. Methods: This cross-sectional analytical study was conducted in Dhaka Medical College Hospital (DMCH) cardiology OPD from May 2019 to April 2020. We interviewed 249 middle aged women (40-55) who attended our OPD during the study period and fulfilled the exclusion and inclusion criteria. Global Physical Activity Questionnaire (GPAQ) was used to assess physical activity level. Blood pressure and BMI was measured. OGTT and fasting lipid profile was done. Subjects with low physical activity was assigned in Group I (n=152), moderate activity in group II (n= 93) and high activity in group III (n= 4). Association between the physical activity levels and presence of CAD risk factors like DM, HTN, dyslipidemia and obesity was evaluated. Results: In this study we found that most of the study subjects (61.0%) were in low active group. Overall 70.2% women were menopausal and premature menopause (≤50 years) was found in 47.8% of subjects. Mean age of menopause was 47±3.8; (44-53) years and mean duration of menopause was 3.1±0.5 years. Overall prevalence of DM, HTN, obesity and dyslipidemia was 62.2%, 50.6%, 39.8% and 53.4% accordingly. Women in low active group were having significant higher proportion of DM (52.6%), HTN (65.8%), obesity (57.9%) and dyslipidemia (75.7%) in comparison to moderate active group. Only 4 women were in highly active group and none of the CAD risk factors was present among them. Bangladesh Heart Journal 2024; 39(2): 127-137