Coronary Complications Research Articles

Influence of pre-hospital to post-hospital delay factors on MI complications: a prospective cohort study

Objective: To identify factors contributing to delays in in the initiation of treatment among ST elevation myocardial infarction patients. Method: The prospective cohort study was conducted at the National Institute of Cardiovascular Disease, Karachi, from December 2020 to June 2021, and comprised ST elevation myocardial infarction patients of either gender aged at least 18 years. Time delay categories were 1st and 2nd delays that were patient-related, and 3rd delay that was system-related), with thresholds of 90 minutes and 120 minutes. Those who experienced delays were placed in group A, while the rest were in group B. Socio-demographic factors, co-morbidities, reasons of delay and in-hospital complications were recorded. Data was analysed using SPSS (version 21). Results: Of the 348 patients, 174(50%) were in group A; 129(74.1%) males and 45(25.9%) females with overall mean age 57.52±10.59 years. The remaining 174(50%) were in group B; 148(85.1%) males and 26(14.9%) females with overall mean age 54.4±12.1 years. The delays were associated with male gender, education level and employment status (p<0.05). Factors contributing to 1st delay included lack of cardiac symptom awareness 77(77%), belief in symptom resolution 38(38%), attributing symptoms to gastric issues 30(30%), and dependency 14(14%). Transportation issues 4(66.7%), indirect commutation 3(50%) and distance 82(47.1%) caused the 2nd delay, while improper referrals 2(50%) and decision delays of more than an hour 1(25%) were common in the 3rd delay. Moreover, 150(86.2%) experienced in-hospital complications, and 88(50.6%) encountered both pre- and post-percutaneous coronary intervention complications (p=0.01). Conclusions: Pre-hospital and post-hospital delaying factors had an impact on ST elevation myocardial infarction complications, highlighting the need for improved patient education on recognising cardiac symptoms and seeking timely medical attention to reduce ST elevation myocardial infarction complications. Key Words: Delay factors, ST elevation myocardial infarction, STEMI, Percutaneous coronary intervention, PCI, three delay model, Myocardial infraction complications.

Comprehensive analysis of the impact of primary percutaneous coronary intervention on patients with ST-segment elevation myocardial infarction.

This comprehensive analysis by Saeed and Faeq investigates the impact of primary percutaneous coronary intervention (pPCI) on mortality among patients with ST-segment elevation myocardial infarction (STEMI) at the Erbil Cardiac Center. Analyzing data from 96 consecutive STEMI patients, the study identified significant predictors of in-hospital mortality, emphasizing the critical impact of time of hospital arrival post-symptom onset on overall prognosis. Findings indicate that factors such as atypical presentation, cardiogenic shock, chronic kidney disease, and specific coronary complications are associated with higher mortality rates. The study underscores the necessity of prompt medical intervention for improving survival outcomes in STEMI patients, especially in the high-risk subgroup. This research offers valuable insights into optimizing STEMI management and enhancing patient survival rates through effective and timely pPCI.

Urgent Coronary Angiography Following Cardiac Surgery: Insights from a High-Volume Cardiac Surgery Center.

Post-operative myocardial infarction is a possible complication following cardiac surgery. Data on the incidence, predictors and prognosis of urgent coronary angiography (UCA) after cardiac surgery are scarce. This study aims to report in hospital and 1-year follow-up outcomes of a recent large cohort of patients undergoing UCA after cardiac surgery. This study provides a retrospective analysis of an high volume cardiac center (Maria Cecilia Hospital, Italy), from 2016 to 2021 regarding patients treated with coronary artery bypass grafting (CABG), valve, or aortic root surgery, focusing on those who required UCA within the same hospitalization. Out of 6505 cardiac surgeries, 119 patients (1.83%) underwent UCA, with a median age of 69 years. The study found that UCA was more frequent post-CABG (2.62%) than non-CABG interventions (1.35%, p < 0.001). A graft failure was detected in 31.1% of the cases, while a native vessel complication in 36.1%. The leading reasons for UCA included ST/T abnormalities, ventricular arrhythmias, and hemodynamic instability, with 92% of UCAs performed within a week post-surgery. The in-hospital mortality rate was 32%, with no significant difference between CABG and non-CABG patients. Predictive factors for in-hospital mortality included Euroscore II, hemodynamic instability and late UCA. One-year follow-up showed a low mortality rate (2.5%) among discharged patients. UCA resulted to have a pivotal role in detecting coronary complications after cardiac surgery, guiding subsequent treatment decisions. Despite the high in-hospital mortality rate, survival showed an overall low mortality at the 1-year mark.

Incidence Rate of Post Coronary Artery Shunt Complications; Age Dependent!

Numerous complications, such as postoperative arrhythmia and stroke, have been observed following coronary artery bypass graft (CABG) surgery. This study sought to examine the impact of aging on the incidence of post-coronary artery shunt complications. Aging is a physiological process experienced by every living cell, beginning early in development. Age plays a crucial role in determining postoperative complications, including those related to CABG. A retrospective analysis was conducted on 290 patients who underwent CABG at the Mordovian Republic Hospital between 2017 and 2021. The sample was divided into two age-based groups: the first group comprised 126 patients (mean age range: 55.21-60.00), and the second group included 163 patients (mean age range: 66.11-80.00). Statistical analyses employed in this study encompassed descriptive statistics, Chi-square test, T-test, one-way ANOVA test, ROC analysis, and Pearson correlation using Statistica 12 software. Elderly patients in the second group demonstrated a higher incidence of post-CABG arrhythmia (p < 0.012528). Moreover, the second group experienced markedly longer ICU and total hospitalization days following CABG, with p-values of less than 0.000000 and 0.000072, respectively. Notably, elderly individuals in the second group faced an increased risk of developing psychosis after CABG surgery (p < 0.007379). Furthermore, psychosis was found to be significantly associated with longer ICU hospitalization (p < 0.000140). Postoperative stroke occurred more frequently among the elderly (second group) with a p-value of less than 0.037736. Consequently, postoperative stroke was associated with extended ICU hospitalization (p < 0.000747). The usage of internal thoracic arteries (ITAs) was lower among the elderly (second group), with a p-value of less than 0.016145. Regarding correlations, a direct association was observed between age and ICU days, total hospitalization days, and the number of complications, with correlation coefficients (r) of 0.189046, 0.141415, and 0.138565, respectively. Elderly individuals in the second group who undergo CABG face a greater risk of developing psychosis, arrhythmia, prolonged total and ICU hospitalization, and stroke. The presence of arrhythmia, which is commonly observed in patients aged 63 years and older, significantly affects total hospitalization days. The number of complications is influenced by age, cardiopulmonary bypass (CPB) time, aortic cross-clamp time, ICU hospitalization, and total hospitalization duration.

Urinary exosomal microRNA-200 family: diagnostic biomarkers for Kawasaki disease and their link to inflammatory markers.

The microRNA-200 family plays a key role in inflammatory and vascular processes, making it a relevant target for Kawasaki disease, a vasculitis with coronary complications. This study aimed to evaluate the diagnostic potential of urinary exosomal microRNA-200 family members in Kawasaki disease patients. Urine samples from 15 Kawasaki disease patients and 15 healthy controls underwent total exosome isolation and high-throughput sequencing. Differential expression of microRNA-200 family members was validated using quantitative real-time polymerase chain reaction. Diagnostic potential was assessed via receiver operating characteristic analysis, and correlations with clinical parameters were evaluated using Spearman correlation. High-throughput sequencing identified upregulation of microRNA-429, microRNA-200b-3p/5p, microRNA-141-3p, microRNA-200a-3p/5p, and microRNA-200c-3p in Kawasaki disease patients. We confirmed significant upregulation of microRNA-200a-3p/5p, microRNA-200b-3p/5p, and microRNA-429, with receiver operating characteristic analysis showing high diagnostic potential for these microRNAs (area under the curves of 0.844, 0.791, 0.942, 0.842, and 0.898, respectively) and a combined analysis yielding a perfect area under the curve of 1.000. MicroRNA-141 and microRNA-200c-3p/5p, however, showed no significant diagnostic value. MicroRNA-200a-3p and microRNA-200a-5p were positively correlated with white blood cells, platelet counts, and C-reactive protein, while microRNA-200b-3p and microRNA-429 were positively correlated with white blood cells, platelet counts, erythrocyte sedimentation rate, and C-reactive protein. microRNA-200b-5p showed moderate correlations with platelet counts and erythrocyte sedimentation rate. Urinary exosomal microRNA-200 family members, especially microRNA-200a-3p/5p, microRNA-200b-3p/5p, and microRNA-429, demonstrate strong diagnostic potential for Kawasaki disease, correlating with key inflammatory markers. MicroRNA-141 and microRNA-200c did not demonstrate significant diagnostic utility.

Coronary artery complications in patients with Kawasaki disease who successfully responded to the standard initial IVIG treatment

ObjectivesTo identify clinical characteristics of patients with non-refractory Kawasaki disease (KD), which were defined as those who successfully responded to the standard initial intravenous immunoglobulin (IVIG) treatment (2 g/kg/day, single...

Update on the diagnosis and treatment of coronary complications of percutaneous coronary interventions.

Prevention, prompt diagnosis, and rapid treatment are crucial for improving outcomes of complications that occur during percutaneous coronary intervention (PCI). The authors summarize studies on PCI complications published between January 1, 2023, and May 1, 2024, including coronary dissection, no reflow, perforation, and equipment loss/entrapment.

A School-Goer’s Nightmare: Case Report of CABG in an 8 Year-Old with Kawasaki Disease

Introduction: Kawasaki disease (KD) is an acute vasculitis primarily affecting medium-sized arteries, particularly the coronary arteries (CA). Its impact varies, with some patients developing transient dilation while others experience severe coronary artery aneurysms (CAA), leading to complications such as thrombosis, stenosis, and myocardial ischemia. Male gender, delayed diagnosis, incomplete presentation of KD, and resistance to Intravenous Immunoglobulin (IVIG) therapy are risk factors for CAA. The Japanese Ministry of Health classifies CAAs by size, with giant aneurysms (&gt;8 mm) carrying significant long-term risks, including coronary thrombosis and acute coronary syndrome. Case Report: We report the case of an 8-year-old Malay boy with giant CAA secondary to KD. The patient presented with classical KD symptoms and inflammatory markers, with echocardiography revealing a giant aneurysm (8.7 mm) in the left anterior descending artery (LAD), alongside smaller aneurysms in the left circumflex and right coronary arteries (RCA). Initial management included IVIG, aspirin, and heparin, with warfarin and clopidogrel added subsequently. Coronary angiography indicated severe LAD stenosis (95%) with total occlusion and an aneurysmal segment distal to the occlusion. A multidisciplinary team determined that coronary artery bypass grafting (CABG) using bilateral internal mammary arteries was the optimal intervention. The patient had a favourable recovery and was stable at discharge. Discussion: CABG is recognized as a preferred treatment for severe or multivessel coronary involvement in KD, offering lower reintervention rates compared to percutaneous coronary intervention (PCI). Studies support CABG’s efficacy in managing coronary complications in KD, especially for complex or multivessel cases. Conclusion: This case illustrates the complexities of managing giant CAAs in paediatric KD and underscores the necessity of a multidisciplinary approach and long-term monitoring to

Use of chatgpt-4 to explain kawasaki disease to parents and paediatric trainees

Abstract Background Paediatric trainees and parents of Kawasaki disease (KD) patients may face challenges when managing the disease due to insufficient accessibility to KD information. Chat Generative Pre-Trained Transformer (ChatGPT) based on large language models may help explain KD information to paediatric trainees and patient parents. Purpose This study aims to determine the usefulness of Chat Generative Pre- Trained Transformer -4 (ChatGPT-4) in explaining Kawasaki Disease (KD) and its management to parents and paediatric trainees managing KD patients. Methods We created 2 sets of clinical scenarios. In the first set, ChatGPT-4 was instructed to respond to 10 questions based on enquiries from parents of KD patients. Responses were scored in terms of "factual accuracy", "coherence", "comprehensiveness", and "humaneness" by 3 paediatric cardiologists using Likert scale of 0-10. Readability were calculated using Flesch reading-ease test. In the second set, ChatGPT-4 was instructed to respond to 8 KD-related questions based on enquiries from paediatric trainees. Responses are graded based on "relevance", "reliability" and "comprehensiveness" using Likert scale of 0-10 by 3 paediatric cardiologists independently. Reviewers would determine whether major advice from chatGPT-4 would be adopted in clinical judgement. Results For parent-targeted responses, ChatGPT-4 achieved the highest scores in ‘humaneness’ (median 9.00, IQR 8.00 to 9.00) and ‘coherence’ (median 8.00, IQR 7.00 to 8.00). Inaccurate information regarding disease prognosis, actions as well as prescription of medications and surgery is found in 80% of scenarios. Missing information regarding long-term coronary complications, antiplatelet management and cardiac assessments is found in all 10 scenarios. Mean readability of parent-targeted responses is 71.70 ± 6.26, a readability level easily understood by 12-year-olds. For paediatrician-targeted responses, ChatGPT-4 achieved the highest scores in ‘relevance’ (median 9.50, IQR 7.25 to 9.0). Inaccurate information regarding coronary interventions, patient education and immunization recommendations is spotted in 37.5% of the scenarios. Missing information regarding patient education and stress imaging is found in 25% of the scenarios. All reviewers would adopt ChatGPT-4’s advice in 87.5% of the scenarios. Conclusions ChatGPT-4 has significant limitations in accuracy and lacks salient information when providing KD recommendations for parents and paediatric trainees.Performance in parent-targeted questionsPerformance in trainee-targeted question

Associations of the HMGB1 rs1412125 and rs2249825 polymorphisms with Kawasaki disease.

Kawasaki disease is an acute febrile disease causing systemic vasculitis that is common in infants and young children. This study was conducted to explore the relationships of the rs1412125, and rs2249825 single nucleotide polymorphisms of the high mobility group box 1 gene to Kawasaki disease and its complication of coronary artery injury. In total, 200 children with Kawasaki disease (49 with coronary artery injury) and 200 healthy controls were enrolled in this study. Polymerase chain reaction was used to amplify the target gene, and direct sequencing was performed to determine distributions at the rs1412125 T/C and rs2249825 C/G loci in the HMGB1 gene. The chi-squared test was used to compare data between groups. Linkage disequilibrium coefficients and single nucleotide polymorphism haplotype analysis were conducted, and a false-positive report probability analysis was used to assess significant associations. Expression quantitative trait loci analysis was performed to determine if single nucleotide polymorphisms affected mRNA levels via the GTEx portal. Significant differences in the genotype TT, TC, and CC distributions (χ2 = 7.918, P = 0.019) and allele T and C frequencies (χ2 = 6.125, P = 0.013) of rs1412125 T/C locus were found between the Kawasaki disease and healthy control groups. The genotype CC was associated with a greater Kawasaki disease risk [odds ratio = 3.205, 95% confidence interval = 1.352-7.595, χ2 = 7.560, P = 0.006]. C allele carriers had a higher Kawasaki disease risk than did T allele carriers (odds ratio = 1.469, 95% confidence interval = 1.083-1.993, χ2 = 6.125, P = 0.013). The rs1412125 genotype T/C distribution (χ2 = 10.906, P = 0.004) and allele frequencies (χ2 = 8.813, P = 0.003) differed significantly between patients with and without coronary artery injury. In the dominant model, the coronary artery injury risk was 3.006 times greater for patients with the TT genotype than for those with the other genotypes (odds ratio = 3.006, 95% confidence interval = 1.540-5.867, χ2 = 10.875, P = 0.001). No significant difference in the rs2249825 genotype C/G distribution or allele frequencies was found between the Kawasaki disease and control groups, or between the coronary artery injury and without coronary artery injury groups. The rs1412125 polymorphism of the HMGB1 gene is associated with Kawasaki disease and its coronary artery injury complication. The CC genotype may be a risk factor for Kawasaki disease onset, and the TT genotype may be a risk factor for coronary artery injury in Kawasaki disease.

Refractory Kawasaki Disease With a Giant Aneurysm Successfully Treated With Infliximab and Enoxaparin: A Case Report

Kawasaki disease (KD) is the most common vasculitis in children, and can result in the development of coronary artery aneurysms (CAAs) if not properly managed. While intravenous immunoglobulin (IVIG) and aspirin are standard first-line treatments, refractory KD may develop, increasing the risk of coronary complications. Herein, we report the case of a young girl with KD who initially responded to IVIG, but later developed a giant CAA, despite additional treatments. Infliximab stabilized her condition, and one year later, the CAA remained stable without thrombus formation. This case demonstrates that clinical appearance, particularly fever, may not fully reflect the patient's condition, as fever can subside immediately after treatment, but may relapse days later, underscoring the need for vigilant monitoring.

A pilot study of diet lifestyle on complete blood picture, elements, and biological profile in females

Obesity, a prevalent global health issue, is characterized by elevated lipid levels, altered hematological parameters, inflammation, and other related symptoms. A biological profile and complete blood count (CBC) are essential tools for assessing overall health and detecting various dysfunctions, including anemia, infections, leukemia, and heart diseases. In obese patients of both sexes, a high white blood cell count is a reliable indicator of leukemia risk, coronary complications, and inflammation. Notably, dietary and lifestyle changes can significantly improve obesity-related conditions and hematological disorders. This study examines the effects of a six-month dietary program on anthropometric measurements, biological profiles, elemental composition, and complete blood counts in 43 obese females with white blood cell counts above the normal range. Participants underwent comprehensive hematological, biochemical, and anthropometric assessments at the beginning and end of the diet program. The findings revealed a significant weight loss and substantial improvements in laboratory parameters and blood profiles. These improvements are likely due to the nutrient composition of the diet program. The investigation confirmed that modifying dietary intake by reducing consumption of high-acidic foods, fast foods, animal-derived lipids, refined carbohydrates, red meats, and non-seasonal produce, in favor of a nutrient-dense regimen comprising fruits, vegetables (consumed raw or steamed), fish, poultry, and whole grains, resulted in significant enhancements in hematological indices and biological markers. These enhancements substantially surpassed baseline measurements for complete blood count and biological profiles. However, alterations in the elemental profile were not statistically significant. Further studies are being conducted to examine these outcomes with greater specificity. Ongoing research aims to further understand these effects according to personal medical history, age, and sex.

An outcome-driven threshold for pulse pressure amplification

Pulse pressure amplification (PPA) is the brachial-to-aortic pulse pressure ratio and decreases with age and cardiovascular risk factors. This individual-participant meta-analysis of population studies aimed to define an outcome-driven threshold for PPA. Incidence rates and standardized multivariable-adjusted hazard ratios (HRs) of cardiovascular and coronary endpoints associated with PPA, as assessed by the SphygmoCor software, were evaluated in the International Database of Central Arterial Properties for Risk Stratification (n = 5608). Model refinement was assessed by the integrated discrimination (IDI) and net reclassification (NRI) improvement. Age ranged from 30 to 96 years (median 53.6). Over 4.1 years (median), 255 and 109 participants experienced a cardiovascular or coronary endpoint. In a randomly defined discovery subset of 3945 individuals, the rounded risk-carrying PPA thresholds converged at 1.3. The HRs for cardiovascular and coronary endpoints contrasting PPA < 1.3 vs ≥1.3 were 1.54 (95% confidence interval [CI]: 1.00–2.36) and 2.45 (CI: 1.20–5.01), respectively. Models were well calibrated, findings were replicated in the remaining 1663 individuals analyzed as test dataset, and NRI was significant for both endpoints. The HRs associating cardiovascular and coronary endpoints per PPA threshold in individuals <60 vs ≥60 years were 3.86 vs 1.19 and 6.21 vs 1.77, respectively. The proportion of high-risk women (PPA < 1.3) was higher at younger age (<60 vs ≥60 years: 67.7% vs 61.5%; P < 0.001). In conclusion, over and beyond common risk factors, a brachial-to-central PP ratio of <1.3 is a forerunner of cardiovascular coronary complications and is an underestimated risk factor in women aged 30–60 years. Our study supports pulse wave analysis for risk stratification.

Chemotherapy Related Cardiotoxicity Evaluation-A Contemporary Review with a Focus on Cardiac Imaging.

The long-term survivorship of patients diagnosed with cancer has improved due to accelerated detection and rapidly evolving cancer treatment strategies. As such, the evaluation and management of cancer therapy related complications has become increasingly important, including cardiovascular complications. These have been captured under the umbrella term "cardiotoxicity" and include left ventricular dysfunction and heart failure, acute coronary syndromes, valvular abnormalities, pericardial disease, arrhythmia, myocarditis, and vascular complications. These complications add to the burden of cardiovascular disease (CVD) or are risk factors patients with cancer treatment are presenting with. Of note, both pre- and newly developing CVD is of prognostic significance, not only from a cardiovascular perspective but also overall, potentially impacting the level of cancer therapy that is possible. Currently, there are varying recommendations and practices regarding CVD risk assessment and mitigating strategies throughout the cancer continuum. This article provides an overview on this topic, in particular, the role of cardiac imaging in the care of the patient with cancer. Furthermore, it summarizes the current evidence on the spectrum, prevention, and management of chemotherapy-related adverse cardiac effects.

Approaches to therapy Amlodipine/Indapamide/Perindopril therapy of high arterial hypertension in ischemic heart disease patients with chronic kidney disease stage 1-3 after coronary stenting

Introduction: Acute coronary syndrome, chronic forms of ischemic heart disease (IHD) and postinfarction cardiosclerosis are the main causes of morbidity and mortality in the world, including Russia. In the XXI century, there is an increase in comorbid pathology, especially in the combination of IHD with arterial hypertension, diabetes, chronic obstructive pulmonary disease and chronic kidney disease. Patients with IHD and chronic kidney disease have a higher incidence of coronary events and complications. The frequency of coronary events and complications indicates the need to improve the diagnosis and treatment of this group of patients. diagnosis and treatment of this group of patients. The aim of the study was to analyze the dynamics of vascular stiffness, pulmonary hypertension (PH), diastolic heart dysfunction and endothelial dysfunction indices in patients with different variants of ischemic heart disease combined with chronic kidney disease (CKD) stage 1-3 using complex therapy of combined hypotensive drug Amlodipine/Indapamide/Perindopril three months after coronary stenting and to compare them with the group of patients on conservative therapy only. Materials and Methods: 85 patients with different forms of IHD, arterial hypertension (AH) on the background of CKD 1-3 stages, as well as data of 42 patients with IHD, AH without renal pathology were analyzed. The first group – IHD, postinfarction cardiosclerosis, CKD stage 1-3 (33 patients); the second group – acute coronary syndrome with ST-segment elevation, Myocardial infarction (MI) (30 patients); the third group – ACS without ST-segment elevation, Unstable angina (UA) (22 patients). Results: The highest indices of vascular stiffness (Pulse wave velocity (PWV), Augmentation index (AI), CAVI, Central Systolic Blood Pressure (SBPao), central arterial pulse pressure (PP)) were registered in combination of ACS with ST-segment elevation and CKD 1-3 stages. These indices are markers of IHD progression in these patients; they also have increased pulmonary hypertension and diastolic dysfunction of the heart, endothelial dysfunction with vasodilation insufficiency in 88% of cases, which even without hemodynamically significant coronary artery stenoses according to coronary CT angiography data leads to the development of ACS with ST-segment elevation and ACS without ST-segment elevation with MI. Amlodipine/Indapamide/Perindopril was prescribed to all patients due to high arterial hypertension on admission against the background of basic therapy of IHD and coronary stenting. Coronary CT angiography in patients with comorbid renal pathology does not lead to aggravation of chronic kidney disease after 3 months, on the contrary; in this group of patients the most pronounced decrease of arterial stiffness (AS), AI, SBPao, PP with elevation of glomerular filtration rate (GFR) and decrease of creatinine in blood occurs in comparison with the group of patients who did not undergo coronary stenting, they were only on conservative therapy. Conclusion: Prescription of three component drug Amlodipine/Indapamide/Perindopril on the background of baseline therapy especially in combination with surgical vascularization of the heart is justified.

THE “SANDWICH” TECHNIQUE IN MITRAL ANNULAR CALCIFICATION

Abstract Objective To assess the feasibility and safety of the “Sandwich” technique in case of massive mitral annular calcification (MAC). MAC is a multifactorial chronic disease and a challenging clinical entity to the surgeon: both respecting and resecting techniques have been developed, in order to prevent eventual annular ruptures. Methods Twelve patients underwent mitral valve replacement (MVR) between January and September 2023, mainly because of steno–insufficiency of the mitral valve, in presence of MAC. Their mean age was 76 ± 4.5, their BMI was 27.2 ± 2.8 and their surgery was mostly elective, except for one urgent active endocarditis; their mean EUROscore II was 8.2 ± 2.9. Results We performed 12 MVR with biological valve, through full sternotomy approach. The cardiopulmonary bypass and aortic cross–clamp time were 195 ± 57 and 155 ± 42 minutes respectively. We perform a double line suture respectful of the annular calcium, in order to reinforce the mitral annulus, before fixing the prosthesis. Surgical stiches on the anterior annulus were ordinarily put; on the posterior annulus, which is usually the most calcified part, a teflon band underneath the calcium was fixed as first, through separate prolene 2–0 U–stitches. Then the usual 2–0 ticron stitches with pledget were put between the posterior annulus and the atrial wall. Both 2–0 prolene and ticron were passed through the prosthesis sewing ring: prolene was placed more externally than ticron. No leakages were found, both intraoperative and postoperative. There were no in–hospital deaths. No strokes, thromboembolic or coronary complications were observed. Conclusions The “Sandwich” technique is reproducible, feasible and safe and it does not imply a long surgical learning curve. It is not a disruptive approach, avoiding annulus failure and it is respectful of the cardiac structures.

Angiographic Characteristics and Clinical Outcomes in Patients With Chronic Kidney Disease Undergoing Impella-Supported High-Risk Percutaneous Coronary Intervention: Insights From the cVAD PROTECT III Study.

Prior studies have found that patients with chronic kidney disease (CKD) have worse outcomes following percutaneous coronary intervention (PCI). There are no data about patients with advanced CKD undergoing Impella-supported high-risk PCI. We, therefore, aimed to evaluate angiographic characteristics and clinical outcomes in patients with CKD who received Impella-supported high-risk PCI as part of the catheter-based ventricular assist device PROTECT III study (A Prospective, Multi-Center, Randomized Controlled Trial of the IMPELLA RECOVER LP 2.5 System Versus Intra Aortic Balloon Pump [IABP] in Patients Undergoing Non Emergent High Risk PCI). Patients enrolled in the PROTECT III study were analyzed according to their baseline estimated glomerular filtration rate (eGFR). The primary outcome was 90-day major adverse cardiovascular and cerebrovascular events (the composite of all-cause death, myocardial infarction, stroke/transient ischemic attack, and repeat revascularization). Of 1237 enrolled patients, 1052 patients with complete eGFR baseline assessment were evaluated: 586 with eGFR ≥60 mL/min per 1.73 m2, 190 with eGFR ≥45 to <60, 105 with eGFR ≥30 to <45, and 171 with eGFR <30 or on dialysis. Patients with lower eGFR (all groups with eGFR <60) were more frequently females and had a higher prevalence of hypertension, diabetes, anemia, and peripheral artery disease. The baseline Synergy Between PCI With Taxus and Cardiac Surgery score was similar between groups (28.2±12.6 for all groups). Patients with lower eGFR were more likely to have severe coronary calcifications and higher usage of atherectomy. There were no differences in individual PCI-related coronary complications between groups, but the rates of overall PCI complications were less frequent among patients with lower eGFR. Major adverse cardiovascular and cerebrovascular events at 90 days and 1-year mortality were significantly higher among patients with eGFR <30 mL/min per 1.73 m2 or on dialysis. Patients with advanced CKD undergoing Impella-assisted high-risk PCI tend to have higher baseline comorbidities, severe coronary calcification, and higher atherectomy usage, yet CKD was not associated with a higher rate of immediate PCI-related complications. However, 90-day major adverse cardiovascular and cerebrovascular events and 1-year mortality were significantly higher among patients with eGFR<30 mL/min per 1.73 m2 or on dialysis. Future studies of strategies to improve intermediate and long-term outcomes of these high-risk patients are warranted. URL: https://www.clinicaltrials.gov; Unique identifier: NCT04136392.

ROLE OF CARDIOVASCULAR IMAGING IN CARDIO-ONCOLOGY: A LITERATURE REVIEW

Antitumor drugs are toxic to the cardiovascular system and directly affect cardiac function and anatomy. During the treatment of oncology, patients may experience complications in the form of asymptomatic myocardial dysfunction, severe heart failure, exacerbation of symptoms of coronary heart disease, thromboembolic complications, arterial and pulmonary hypertension, pericardial complications, valve defects and arrhythmias. A number of diagnostic tools are currently available to cardio-oncologists to detect cardiotoxicity, and the choice of imaging method depends on the availability of the specific diagnostic modality and its resolution. The main method for assessing the condition of the heart in cancer patients is echocardiography - a widely available method that enables to assess the structure of the heart and hemodynamics without exposing the patient to an additional dose of ionizing radiation. If imaging is insufficient, the recommended method for assessing cardiac structure and function is magnetic resonance imaging. Computed tomography of the chest, heart and coronary arteries is also used to diagnose complications of cancer treatment. In addition, nuclear medicine techniques, including gated radionuclide ventriculography, are also used to diagnose cardiotoxicity. Electroanatomical mapping systems combined with remote navigation are promising. Early detection of subclinical left ventricular myocardial dysfunction in cancer patients receiving potentially cardiotoxic drugs is advisable and aimed at secondary prophylaxis and prevention of mortality from cardiovascular diseases.

Risk Factors for Coronary Artery Complications After Prosthetic Pulmonary Valve Implantation in Patients With Congenital Heart Disease.

Coronary artery complications (CACs) in patients who undergoing prosthetic pulmonary valve implantation for congenital heart disease can lead to fetal outcomes. However, the incidence of and risk factors for CACs in these patients remain unknown. A retrospective cohort study was conducted on patients who underwent cardiac computed tomography or invasive coronary angiography after prosthetic pulmonary valve implantation at Seoul National University Hospital from June 1986 to May 2021. Among 341 patients, 25 (7.3%) were identified with CACs, and 2 of them died. Among the patients with CACs, congenital coronary anomalies and an interarterial course of the coronary artery were identified in 11 (44%) and 18 (72%) patients, respectively. Interarterial and intramural courses of the coronary artery were associated with a 4.4- and 10.6-fold increased risk of CACs, respectively. Among patients with tetralogy of Fallot and pulmonary atresia, the aortic root was rotated further clockwise in patients with coronary artery compression compared to those without it (mean [±SD] 128.0±19.9° vs. 113.5±23.7°; P=0.024). The cut-off rotation angle of the aorta for predicting the occurrence of coronary artery compression was 133°. Perioperative coronary artery evaluation and prevention of CACs are required in patients undergoing prosthetic pulmonary valve implantation, particularly in those with coronary artery anomalies or severe clockwise rotation of the aortic root.

Alcohol, health loss, and mortality: can wine really save the good name of moderate alcohol consumption?

It is estimated that one‑third of the world's population consumes alcohol. At the same time, it is well‑known that excessive alcohol consumption in one of the leading causes of premature mortality. The history of production of alcoholic beverages, especially wine, dates back as long as 8000 years. However, people soon realized adverse effects of alcohol abuse and tried to limit its consumption. Higher alcohol consumption is associated with health loss and increased risk of all‑cause mortality. It is linearly associated with a greater risk of many types of cancers, liver disease, incidence of atrial fibrillation, hemorrhagic stroke, or heart failure. Although many scientific societies recommend reduction of alcohol intake and specify the recommended limits of consumption, there is no proven safe amount of alcohol for the general population. There are conflicting data on the effect of low‑to‑moderate alcohol consumption on mortality, with most of the studies indicating a J‑shaped curve related mostly to a reduction of coronary artery disease complications, including cardiovascular death. Among different types of alcohol, red wine consumption may have different health effects, due to its high content of antioxidative polyphenols. Wine, together with abundance of plant‑based foods, olive oil, and fish, is an important part of the Mediterranean diet. There are both observational and randomized studies documenting a wide spectrum of health‑promoting effects of such a diet, especially a reduction in major adverse cardiovascular events. People who want to drink alcohol should be advised to limit their consumption to a minimum, and should consider choosing red wine.