Cardiovascular Examination Research Articles

Body Packing: Hiding in Plain Sight.

A 31-year-old man was brought to the emergency department by airport customs officials for medical examination due to suspicion of concealed drugs in his body. He was conscious and oriented with a blood pressure of 124/80 mm Hg and a pulse rate of 80 beats/min. Respiratory and cardiovascular system examinations were normal. Abdomen was soft and nontender, but rectal examination revealed multiple pellet-like structures in the rectum. Blood and urine examinations for toxins were unremarkable.

Wolff-Parkinson-White syndrome type B

A 25-year-old female presented for a medical consultation complaining of sudden central chest pain, pleuritic in nature. She had never experienced such pain before. She denied experiencing coughing, shortness of breath or other respiratory or cardiac symptoms. Notably her grandparents, now in their 80s, were apparently being treated for ischemic heart disease attributed to their old age. She occasionally drank alcohol < 20 units per week. She was not using tobacco. On examination, her body mass index was 24.8 kg/m2, waist circumference 86 cm, pulse rate 59 beats per minute, blood pressure 103/68 mmHg, SpO2 97% and temperature 37 °C. Her general, cardiovascular and respiratory examinations were all normal. A resting electrocardiogram (ECG) showed a normal sinus rhythm, PR interval 126 ms, prolonged QRS duration 138 ms, and a delta wave (pictured - lead II). Leads I, II, and aVF had inverted T waves. Ventricular pre-excitation, Wolff-Parkinson-White syndrome type B was diagnosed. Echocardiography was unremarkable. The nature of her condition was explained to her. Advice to avoid medications like verapamil and digoxin was offered along with a recommendation to avoid over-strenuous activity. Screening ECGs were advised for her immediate family. As she had been asymptomatic up to this point, cardiology follow-up was recommended for consideration of a prophylactic ablation procedure. This case illustrates the benefit of a high index of suspicion and the utility of electrocardiography in diagnosing a rare condition.

Experience of 500 cardiovascular magnetic resonance imaging and systematic analysis of cases.

Cardiovascular magnetic resonance imaging (MRI) is a widely accepted reference imaging technique in routine cardiology clinics in many centers due to its advantages in providing preferable functional, morphologic information. However, there is little information about national experience in clinical application and findings of cardiovascular MRI. The objective of this study was to demonstrate the clinical and demographic characteristics of patients admitted to our cardiac imaging department. A total of 500 cardiovascular MRI examinations performed between 2016 and 2019 were enrolled in this retrospective study. Clinical indications, demographic, and cardiovascular MRI findings of the patients were retrospectively evaluated. Five hundred patients (M/F=301/199) were included in this retrospective, single center study. The majority of the examinations were performed for the assessment of congenital heart disease (n=254, 50.8%). The other indications were for myocardial disease (n=160, 32%), cardiac mass (n=44, 8.8%), valvular heart disease (n=20, 4%), magnetic resonance angiography (n=12, 2.4% for aorta and pulmonary artery [n=9, 1.8%] and for coronary arteries [n=3, 0.6%]), and vasculitis (n=7, 1.7%), pericardial disease (n=3, 0.6%). Minor complication was seen during the contrast agent injection in three patients (0.06%). Cardiovascular MRI is a reliable and accurate imaging tool in identifying the various cardiac pathology with widely accepted use in the clinical area. Our single-center experience of 500 cases demonstrates the varieties of clinical indications in daily practice that may contribute to the national data pool.

P3 mitral valve prolapse in a young patient, an uncommon case

 A 33-year-old patient with no cardiovascular risk factors and no history presented with shortness of breath, palpitations and fatigue. The cardiovascular examination showed an apex beat lateral and inferior displacement and a mitral systolic murmur. The electrocardiogram showed both left ventricular hypertrophy and left atrial hypertrophy. Inflammatory markers were within normal range and blood cultures were sterile. Transthoracic echocardiography showed a severe mitral regurgitation and posterior mitral leaflet prolapse and both left ventricular and auricular dilatation. The transoesophageal echocardiography showed a P3 prolapse with a mobile structure on the posterior mitral valve atrial side suggesting a chordal rupture. The patient had a surgical cure (posterior valve plasty) with good outcomes.

Ischemic Stroke Revealing Infective Endocarditis in a Young Subject: About a Clinical Case

Introduction: Neurological complications are possible during infective endocarditis. They are often life-threatening and can be a source of sequelae. Case Presentation: We report the case of an 11-year-old patient admitted to the cardiology department of the CHU-ME “LUXEMBOURG” in Bamako for functional impotence of the left hemibody, accompanied by fever and NYHA stage II dyspnea. The clinical examination on admission shows the poor general condition, normal consciousness, and sensory-motor deficit of the pyramidal type of the left hemibody. The cardiovascular examination notes a systolic murmur at the mitral focus, hepato-jugular reflux, hepatomegaly, and slight edema in the lower limbs. Brain CT showed localized hypodensity in favor of an ischemic stroke. The electrocardiogram shows a sinus rhythm. Transthoracic Doppler echocardiography revealed mitral insufficiency with vegetation of 17 × 14 mm on the anterior mitral valve, with left ventricular ejection fraction estimated at 75%. Dual antibiotic therapy associated with conventional treatment for heart failure was initiated. The clinical evolution was marked by the persistence of the deficit of the left upper limb, the cardiac Doppler echography of control after 6 weeks of treatment found the same vegetation. A discussion with the heart team with a view to a surgical cure has been initiated for the rest of the treatment. Conclusion: A motor deficit associated with fever related to an ischemic vascular accident should lead to a search for infective endocarditis on cardiac Doppler ultrasound.

Кардиотоксичность при лечении онкологических пациентов (обзор литературы)

Thanks to modern diagnostics methods and high efficiency of chemoradiotherapy for cancer diseases, the survival rate of patients increased, and the cancer mortality dropped. However, complications of anti-tumor therapy often have a negative impact on the cardiovascular system. The direct effect of radiation therapy and chemoradiotherapy on the heart causes damage to cardiomyocytes, endocardium and valve structures. Furthermore, it can lead to the development of myocardial dysfunction and heart failure. This term is defined as cardiotoxicity. The preparation process for patients starting chemoradiotherapy should include a cardiovascular examination, pre-treatment identification of possible risk factors for the development of cardiotoxicity, as well as regular check-ups throughout the course of therapy thereafter. One of the most important aspects of the cancer treatment is the close interaction between the cardiologist and the oncologist. Finally, a long-term dynamic supervision and monitoring of patients receiving chemoradiotherapy is required. The purpose of this supervision is the timely diagnosis of cardiovascular complications and prescription of long-term prophylactic therapy for the period in the aftermath of the anti-tumor therapy.

Percussion in Cardiovascular Examination of a Tombstone

The growing abundance of technology in the medical field has led to doctors' sensory de-skilling. Technology is seen replacing the clinical diagnosis based on sensory perception. Percussion as a skill has been lost from clinical practice. Though percussion disappeared from wards, it is still taught in medical colleges. Percussion is a very vital component in the bedside examination of the patient. Auenbrugger first thought of tapping the chest of patients to determine the cardiac size, borders, and presence of pericardial fluid, its extent, and related pathologies. Percussion used to be a critical component of clinical heart disease evaluation. There was rapid advancement of technology in the last century. With the introduction of technology in the medical field, diagnosing and treating disorders and diseases have significantly improved. Percussion can be a valuable bedside aid in determining the cardiac size, borders and to find the presence and extent of pericardial fluid. Cardiac percussion is not just tapping the chest and hearing the sound produced, it is also feeling the touch and observing the vibrations produced noting the tone, thus percussion takes a considerable amount of time, practice and a mindset to master as a clinical skill. Thus teaching the correct way to percuss right from the initial years in the medical school is extremely necessary. With proper knowledge and experience cardiac percussion can prove to be a beneficial tool in specific cardiac pathologies.

Expanding Free Open-Access Medical Education.

During my medical school cardiology placement, I remember our clinical tutor printing us out the cardiovascular examination checklist from Geeky MedicsÓ as our learning tool for the term. When I would study later for my pre-clinical exams, AmbossÓ and UpToDateÓ were the first and most useful resources that I looked at, rather than my course lectures. When I would study for finals, the advice from seniors was to get through the core lectures from the university quickly, and then to move onto online question banks. My experience was not unique; I would rather confidently say it characterised the learning and revision approach of most of my peers. The growing use of FOAM resources by students and the concerns justify the need for academic institutes to take an active role in developing them. Faculties should consider investing in developing FOAM resources to empower their faculty in adopting a new era and dominant pedagogy in medical education. This will not only benefit their own students, who are increasingly turning to such resources for their education, but also help these faculties become more active members in the global community of medical educators.

Assessment of Fall Risk in Elderly Rural Population

Background: Fall risk assessment is an essential component of a comprehensive fall reduction and prevention program. Fall risk assessment is done to identify patients' risk for falls and ultimately prevent falls from occurring. The aim of the study was to identify the risk factors for fall in the elderly population. Methods:This study included 250 elderly patients > 60 years (105 males, 145 females) attending Medicine OPD in a tertiary care hospital. Detailed history including the previous h/o falls, medication history elicited and divided study subjects into two groups: fallers and non-fallers. Cardiovascular, neurological, and musculoskeletal system examinations were done. Handgrip, 30 seconds chair standing test (CST), "timed up and go" test (TUG), and performance-oriented mobility assessment (POMA) were performed. Results:The prevalence of falls in our study was 27.6%. The mean age of fallers was 72.22±6.219 years (P 0.002). Females had significant falls compared to males (p < 0.001). In binary logistic regression, age >80 [OR-3.8, CI (1.8-8.1); p 0.016], female gender [OR-19.2, CI (3.03-122.2); p 0.002], visual impairment [OR-8.9, CI (1.4-55.4); p 0.019], postural hypotension [OR-59.8, CI (3.3-1.07); p 0.006] and presence of more than three risk factors [OR-9.6, CI (4.6-2.01); p 0.000] were significantly associated with fall in our study. Conclusion:Falls among older people were common, especially among individuals aged over 80. Females were more prone to fall. The number of risk factors, visual impairment, and postural hypotension increased the fall risk. Simple clinical assessment can identify high-risk patients.

Construction of a risk assessment model of cardiovascular disease in a rural Chinese hypertensive population based on lasso‐Cox analysis

Many assessments have been used to predict cardiovascular risks in the general population, but their applicability in patients with hypertension needs to be further evaluated. In the current study, a cardiovascular risk assessment model was constructed in a hypertensive population. This prospective cohort study was conducted with cardiovascular examinations in rural northeast China in 2012 and 2013, and followed up to collect cardiovascular events in 2015 and 2018. Data were derived from 4763 hypertensive patients who were free of cardiovascular disease (CVD) at baseline and completed follow‐up. After lasso regression was used to screen for risk factors of CVD at baseline, a multivariate Cox regression risk model was established and a nomogram was developed. The model was validated using an independent test set (one third of data not used for model building). Among 4763 patients, 354 (7.43%) had a cardiovascular event during a median follow‐up of 4.66 years. Nine risk factors were screened by lasso regression, including sex, age, current smoking, body mass index (BMI), history of transient ischemic attack (TIA), family history of hypertension, family history of stroke, physical labor intensity, and high low‐density lipoprotein cholesterol (LDL‐C). The c‐index of the CVD model was 0.707, and that of an updated model with baseline blood pressure was 0.732. In the validated cohort the respective c‐indexes were 0.665 and 0.714. An assessment model of CVD risk was established in a hypertensive population which may provide an original prevention strategy for hypertensive populations in rural China, and further reduce the CVD burden.

Chronic low‐grade inflammation predicts greater decline in verbal fluency and word‐list learning on 10 years' follow‐up

AbstractBackgroundProcesses leading to the clinical presentation of Alzheimer´s disease (AD) start to develop years or even decades beforehand. Chronic low‐grade inflammation is suggested to play a role in the pathogenesis of many aging‐related chronic illnesses, including AD. The aim of this study was to evaluate whether low‐grade inflammation, commonly associated with obesity and the metabolic syndrome, is associated in cognitive decline after 10 years. We hypothesized that low‐grade inflammation at midlife, estimated by tumor necrosis factor alpha (TNF‐α), Interleukin‐6 (IL‐6) and high‐sensitivity CRP (hs‐CRP), predicts cognitive decline.Method915 subjects aged 45 to 74 years (median age 54, 55% women) participated a Finnish nationwide, population‐based Health 2000 Examination Survey, its supplemental cardiovascular and metabolic examinations in 2000‐2001 and the follow‐up Health 2011 Survey. Associations between baseline low‐grade chronic inflammation and cognitive performance at follow‐up in 2011 and the change in cognition from baseline to follow‐up were evaluated. TNF‐α, IL‐6 and hs‐CRP were measured in 2001. Categorical verbal fluency (VF), word‐list learning (WLL) and word‐list delayed recall (WLDR) were used as measures of cognitive performance at baseline and at follow‐up. Statistical analyses were performed with multivariable linear models adjusted for age, sex, education, APOEε4 genotype, type 2 diabetes, hypertension, hypercholesterolemia, body mass index, depressive symptoms and smoking, and for the change in cognition also baseline cognition.ResultHigher TNF‐α and IL‐6 at baseline individually predicted poorer performance in all three cognitive tests at follow‐up (VF: TNF‐α slope:‐2.29, p=0.003, IL‐6 slope:‐1.71, p&lt;0.0001; WLL: TNF‐α slope:‐1.02, p=0.02, IL‐6 slope:‐0.80, p=0.002; WLDR: IL‐6: slope:‐0.30, p=0.02). TNF‐α and IL‐6 predicted also a greater decline in VF (TNF‐α slope:‐1.69, p=0.009, IL‐6 slope:‐1.34, P=0.0009) from baseline to follow‐up. IL‐6, but not TNF‐α predicted greater decline in WLL (IL‐6 slope:‐0.71, p=0.02) and WLDR (IL‐6: slope:‐0.30, p=0.01). Baseline hs‐CRP was not associated with cognitive performance or decline after 10 years.ConclusionIn this middle‐aged population, low grade inflammation measured with TNF‐α and IL‐6 predicts worse cognitive performance and IL‐6 predicts greater decline in cognitive function over a 10‐year follow‐up. Potentially, developing interventions that target these inflammatory processes could help reduce cognitive decline in the future.

Italian Society of Cardiology (SIC) Position paper: Technical, instrumental and standards of interpretation for electrocardiography, ambulatory electrocardiographic and blood pressure monitoring in telemedicine

The current COVID-19 pandemic has renewed interest in providing healthcare services based on the implementation of innovative technologies. Such strategy capillarizes the therapeutic opportunities for larger urban areas, mostly when people are living under extraordinarily difficult circumstances. Improving care delivery in cardiovascular diseases appears particularly feasible when telemedicine is pursued, especially with regard to baseline standard 12-lead electrocardiography, ambulatory electrocardiographic monitoring, and 24-hour ambulatory blood pressure monitoring. Nowadays, these first-line cardiovascular examinations are also available in health centers and pharmacies, and in recent months, there has been an increasing demand of such local services in the absence of specific rules and regulations regarding technical requirements and standards of interpretation that ensure a high quality clinical consultation.The purpose of this position paper is to provide critical requirements for the type/model of devices to be used, training dedicated to healthcare personnel, ensuring security of sensitive data, highlighting type of platforms to be used, as well as for maintaining high reporting quality and standards.

Exome Sequencing Identifies a Novel FBN1 Variant in a Pakistani Family with Marfan Syndrome That Includes Left Ventricle Diastolic Dysfunction.

Introduction: Cardiomyopathies are diseases of the heart muscle and are important causes of heart failure. Dilated cardiomyopathy (DCM) is a common form of cardiomyopathy that can be acquired, syndromic or non-syndromic. The current study was conducted to explore the genetic defects in a Pakistani family with cardiac disease and features of Marfan’s syndrome (MFS). Methods: A family with left ventricle (LV) diastolic dysfunction and MFS phenotype was assessed in Pakistan. The clinical information and blood samples from the patients were collected after physical, cardiovascular, and ophthalmologic examinations. An affected individual (proband) was subjected to whole-exome sequencing (WES). The findings were further validated through Sanger sequencing in the family. Results: Through WES and sanger validation, we identified a novel variant NM_000138.4; c.1402A>G in the Fibrillin-1 (FBN1) gene that segregates with LV diastolic dysfunction and MFS. Furthermore, bioinformatic evaluation suggested that the novel variant is deleterious and disease-causing. Conclusions: This study identified for the first time a novel FBN1 variant in a family with LV diastolic dysfunction and MFS in Pakistan.

Hemodynamic Effects of Different Combinations of Midazolam and Opioids in Healthy Dogs

The purpose of this study was to compare the hemodynamic effects of four different combinations of midazolam and opioids in healthy dogs. Twenty-four healthy dogs were divided in four groups (n = 6) using intramuscular midazolam 0.3 mg/kg and morphine 0.3 mg/kg (GMOR), methadone 0.3 mg/kg (GMET), butorphanol 0.2 mg/kg (GBUT) or fentanyl 5 ug/kg (GFEN). Cardiovascular variables were recorded before (TB) and 20 minutes following drug administration (T20) and comprised arterial blood pressure, heart rate and cardiac index. Subsequently, left ventricular work index and total peripheral resistance index were calculated using the previous variables. At the end of the study, data were compared using analysis of variance followed by Tukey test and Friedman followed by Dunn test, all under 5% significance. No differences were found on cardiovascular variables at all times among the groups, which indicates that all combinations provide hemodynamic stability for clinical sedation of healthy dogs. However, a few animals showed paradoxical excitation in GBUT. In conclusion, the association of midazolam with morphine, methadone, butorphanol or fentanyl provides cardiovascular stability and can be used to sedate dogs undergoing cardiovascular examination, although caution is warranted with the use of midazolam with butorphanol due to possible paradoxical excitation.

Chronic kidney disease and subclinical abnormalities of left heart mechanics in the community.

AimsCardiovascular disease is the leading cause of death in chronic kidney disease (CKD) patients, although the pathophysiological mechanisms are not fully studied. This study aimed to determine whether CKD could adversely affect subclinical left heart function in a sample of the general population without cardiac disease.Methods and resultsWe examined 1158 participants who voluntarily underwent extensive cardiovascular examination including laboratory test and two-dimensional speckle-tracking echocardiography to assess left ventricular global longitudinal strain (LVGLS) and left atrial (LA) reservoir, conduit, and pump strain. According to the estimated glomerular filtration rate (eGFR), participants were classified into four groups; Stage 1 (n = 112; eGFR ≥90 mL/min/1.73 m2), Stage 2 (n = 818; 60–89 mL/min/1.73 m2), Stage 3a (n = 191; 45–59 mL/min/1.73 m2), and Stage 3b–5 (n = 37; eGFR <45 mL/min/1.73 m2). Progressive declines of LVGLS, LA reservoir, and conduit strain were observed according to the severity of CKD (P < 0.001), while LA pump strain did not differ between the groups. In multivariable analyses, eGFR was associated with LVGLS (standardized β = −0.068, P = 0.019) as well as LA reservoir (standardized β = 0.117, P < 0.001) and conduit strain (standardized β = 0.130, P < 0.001), independent of traditional cardiovascular risk factors, pertinent biomarkers, and LV geometry and diastolic function. The independent association between eGFR and LA strain persisted even after adjustment for LVGLS.ConclusionWorsening renal function was independently associated with impaired LV/LA strain in an unselected community-based cohort. The assessment of LV and LA strain may allow better risk stratification in CKD patients.

P088 Prolonged fever in a boy revealing Takayasu disease: a case report

Abstract Background Takayasu's arteritis (TA) is a chronic inflammatory vasculitis of unknown origin. It affects the large vessels, especially the aorta, its main branches, and the pulmonary arteries. It begins acutely in children with severe general manifestations. The diagnosis of TA remains a challenge to clinicians due to many reasons such as its rarity, its great clinical polymorphism, and the lack of specific biological criteria. Case report A 13-years old boy with no pathological history, was admitted for prolonged fever with intermittent abdominal pain. The clinical examination has found a conscious boy, febrile with a BP of 130/90mmhg, a normal heart rate, and stable respiratory function. The cardiovascular examination noted a decrease in pedal pulses, without signs of ischaemia or necrosis, and the cardiac auscultation was normal. Examination of the lymph node areas has shown upper and left later cervical adenopathy measuring 1.7 cm in long axis, mobile, and painless. All joints were free. The complementary biological workups revealed an inflammatory syndrome (ESR: 120 mm, fibrinogen: 5 g/l, microcytic hypochromic anaemia at 9 g/dl, ferritin: 1051, low serum iron: 11µg/dl and thrombocytosis: 692 000 elements/l). Chest X-ray showed a dilated aortic button. A thoracic angioscan revealed a peri-aortitis more evident at the level of the emergence of the mesenteric artery with a pseudo-aneurysmal aspect and arteritis of the right primary carotid artery. Echocardiography was performed and showed a dilated aspect of the aorta with irregular wall. Renal ultrasound was normal. The diagnosis of Takayasu disease was made on the basis of clinical biological and essentially radiological arguments according to the diagnostic criteria of the American College of Rheumatology. The patient was treated with corticosteroid (prednisone: 2 mg/kg/d) for one month then then gradually reduced doses The disease course was marked by several relapses and the patient was then treated with mycophenolate mofetil (cellcept). Conclusion Takaysu's disease is a chronic inflammatory vasculitis of unknown origin, which affects the large- vessels, mainly the aorta, its main branches, and the pulmonary arteries; but it remains rare in children and its treatment is not well codified.

Assessment of parasympathetic cardiovascular activity in primary open-angle glaucoma.

To describe the pattern of quantitative parasympathetic cardiovascular autonomic function among patients with normal-tension glaucoma (NTG) and high-tension primary open-angle glaucoma (HTG) patients. This was cross-sectional study of ninety-two subjects enrolled into three groups: HTG (31 patients), NTG (31 patients) and Control (30 patients). All the participants had anthropometric assessment, ophthalmic examination, baseline cardiovascular examination and the three parasympathetic components of Ewing's battery of autonomic cardiovascular function tests namely heart rate (HR) response to deep breathing, HR response to Valsalva manoeuvre and HR response to standing. The baseline PR intervals were significantly prolonged in HTG (0.18 ± 0.03s) and NTG (0.18 ± 0.04s) groups compared with control (0.15 ± 0.03s) (p = 0.008). The HTG group had a significantly longer mean RR interval (1.09 ± 0.17s) than the NTG group (1.03 ± 0.20s) and control (0.97 ± 0.17s) during the expiratory phase of the HR response to deep breathing test (p = 0.037). The HTG group also had significantly longer mean RR intervals around the 15th beat (p = 0.033) and 30th beats (p = 0.202) post-standing during the HR response to standing test. The HR response to Valsalva manoeuvre test showed a significantly higher mean Valsalva ratio in the NTG group (1.65 ± 0.48) compared to the HTG group (1.45 ± 0.31) and control (1.43 ± 0.25) (p = 0.034). This study demonstrated that normal-tension and high-tension primary open-angle glaucoma have higher parasympathetic cardiovascular activity than normal individuals.

Segmentation-free Heart Pathology Detection Using Deep Learning.

Cardiovascular (CV) diseases are the leading cause of death in the world, and auscultation is typically an essential part of a cardiovascular examination. The ability to diagnose a patient based on their heart sounds is a rather difficult skill to master. Thus, many approaches for automated heart auscultation have been explored. However, most of the previously proposed methods involve a segmentation step, the performance of which drops significantly for high pulse rates or noisy signals. In this work, we propose a novel segmentation-free heart sound classification method. Specifically, we apply discrete wavelet transform to denoise the signal, followed by feature extraction and feature reduction. Then, Support Vector Machines and Deep Neural Networks are utilised for classification. On the PASCAL heart sound dataset our approach showed superior performance compared to others, achieving 81% and 96% precision on normal and murmur classes, respectively. In addition, for the first time, the data were further explored under a user-independent setting, where the proposed method achieved 92% and 86% precision on normal and murmur, demonstrating the potential of enabling automatic murmur detection for practical use.

Profile of adult patients presenting for rheumatic mitral valve surgery at a tertiary academic hospital.

Peri-operative morbidity and mortality are increased in patients with rheumatic heart disease. Pre-operative risk stratification is imperative for optimisation and a better outcome. This was a descriptive, retrospective, contextual study. A consecutive convenience sampling method was used. Eighty-nine patients who underwent mitral valve surgery at Charlotte Maxeke Johannesburg Academic Hospital between January 2014 and December 2015 were enrolled. The objectives of the study were to describe the demographic profile of the patients presenting for rheumatic mitral valve surgery, describe their peri-operative cardiovascular and echocardiographic parameters, and risk stratify according to their clinical and echocardiographic parameters. Demographic, echocardiographic and laboratory data as well as the cardiovascular examination were analysed. Descriptive statistics using proportions (percentages), means (standard deviations) or medians (interquartile ranges) were used where appropriate. A total of 102 patients were reviewed. Thirteen were excluded due to significant missing data. Of the 89 analysed, all had demographic data, 81 had cardiovascular clinical examination data, 82 had echocardiographic data and 52 had laboratory data. Forty-seven patients presented with mitral regurgitation (MR) and 35 had mitral stenosis (MS). Data included two mixed mitral valve disease patients with predominant regurgitation who were classified under the MR group. In total, 45% (39 patients) had arrhythmias and 49% (42 patients) had congestive cardiac failure at presentation for surgery. The overall mean (SD) pulmonary artery systolic pressure was 57 (20) mmHg and mean (SD) left atrial size was 53 (11) mm. Those with MS presented with mean (SD) mitral valve area of 0.9 (0.2) cm2. Of the analysed MR patients, 51% presented with left ventricular ejection fraction < 60% and 55% with left ventricular end-systolic diameter > 40 mm. Among the analysed MS patients, 59% had mitral valve area < 1 cm2. A substantial number (49% MR and 54% MS) of collected records were not eligible for analysis and stratification using the American Heart Association/American College of Cardiology (ACC/AHA) guidelines for valvular heart disease due to missing vital information. Of the 24 MR patients analysed utilising the 2014/2017 AHA/ACC guidelines, 13 had asymptomatic severe MR (stage C) and 11 had symptomatic severe MR (stage D). One patient had progressive MS (stage B), eight had asymptomatic severe MS (stage C) and seven had symptomatic severe MS (stage D). The majority of those who could be stratified presented in stages C and D of disease progression; however, they also presented with concomitant clinical and echocardiographic features that placed them at high risk of perioperative morbidity.

Associations of Walking Activity With Hypertensive Mediated Organ Damage in Community-Dwelling Elderly Chinese: The Northern Shanghai Study.

Background: Walking, as the most common campaign in older people, is recommended to improve their cardiovascular health. However, the direct association between weekly walking activity and asymptomatic hypertensive mediated organ damage (HMOD) remains unclear.Methods: 2,830 community-dwelling elderly subjects (over 65 years) in northern Shanghai were recruited from 2014 to 2018. Weekly walking activity was assessed by International Physical Activity Questionnaires (IPAQ). Within the framework of comprehensive cardiovascular examinations, HMOD, including left ventricular mass index, peak transmitral pulsed Doppler velocity/early diastolic tissue Doppler velocity, creatinine clearance rate, urinary albumin–creatinine ratio, carotid-femoral pulse wave velocity (cf-PWV), carotid intima–media thickness (CIMT), arterial plaque, and ankle-brachial index (ABI), were all evaluated.Results: 1,862 (65.8%) participants with weekly walking activity showed lower CIMT, lower cf-PWV, fewer abnormal ABI, and lower prevalence of hypertension and coronary heart disease (p < 0.05). Walking activity was negatively correlated with age and smokers (correlation coefficient: −0.066, −0.042; both p < 0.05). After adjusting for cardiovascular risk factors and concomitant diseases, walking activity was significantly associated with better indicator of most vascular HMOD in multivariate logistic regressions, including arterial stiffness [odds ratio (OR) = 0.75, p = 0.01], increased CIMT (OR = 0.70, p = 0.03), and peripheral artery disease (OR = 0.72, p = 0.005), but not cardiac or renal HMOD. Subgroup analysis further showed that walking duration ≥1 h/day was significantly associated with decreased risk of most vascular HMOD after adjustment for confounders and moderate-to-vigorous physical activity based on IPAQ (all p < 0.05).Conclusions: In the community-dwelling elderly Chinese, there was a significant negative association of weekly walking activity with vascular HMOD, but not cardiac or renal HMOD. Increased daily walking duration, but not walking frequency, was significantly associated with improved vascular HMOD. Hence, increasing daily walking duration seems to encourage a healthy lifestyle in terms of vascular protection.Clinical Trial Registration: ClinicalTrials.gov, identifier: NCT02368938.