History Of Ischemic Heart Disease Research Articles

The Prescription Pattern of Heart Failure Medications in Reduced, Mildly Reduced, and Preserved Ejection Fractions.

A substantial proportion of patients with heart failure (HF) receive suboptimal guideline-recommended therapy. We aimed to identify the factors leading to suboptimal drug prescription in HF and according to HF phenotypes. This retrospective, single-centre observational cohort study included 702 patients admitted for worsening HF (HF with a reduced ejection fraction [HFrEF], n = 198; HF with a mildly reduced EF [HFmrEF], n = 122; and HF with a preserved EF [HFpEF], n = 382). A score based on the prescription and dose percentage of ACEi/ARBs, β-blockers, and MRAs at discharge was calculated (a total score ranging from zero to six). Approximately 70% of patients received ACEi/ARBs/ARNi, 80% of patients received β-blockers, and 20% received MRAs. The mean HF drug dose was approximately 50% of the recommended dose, irrespective of the HF phenotype. Ischaemic heart disease was associated with a higher prescription score (ranging from 0.4 to 1) compared to no history of ischaemic heart disease, irrespective of the left ventricular EF (LVEF) level. A lower prescription score was associated with older age and male sex in HFrEF and diabetes in HFmrEF. The overall ability of the models to predict the optimal drug dose, including key HF variables (including natriuretic peptides at admission), was poor (R2 < 0.25). A higher prescription score was associated with a lower risk of re-hospitalization and death (HR: 0.75 (0.57−0.97), p = 0.03), irrespective of phenotype (p-interaction = 0.41). Despite very different HF management guidelines according to LVEF, the prescription pattern of HF drugs is poorly related to LVEF and clinical characteristics, thus suggesting that physician-driven factors may be involved in the setting of therapeutic inertia. It may also be related to drug intolerance or clinical stability that is not predicted by the patients’ profiles.

Angiographic Characteristics of Young Yemeni Patients Undergoing Diagnostic Coronary Angiography: Data from A Major Cardiac Center In Yemen

Background: Coronary artery disease (CAD) accounts for the greatest proportion of CVDs and is one of the most common causes of death in the developed countries. It is one of the main etiologies of disease burden in developing countries. There is increase in the number of patients with coronary artery disease in Yemen. The number of patients undergoing elective diagnostic coronary angiography is increasing among different age groups. This study was aimed to identify and compare the prevalence of the risk factors, clinical presentation, management, and angiographic characteristics of CAD between young patients (age ≤ 40 years) and older patients (age ≥ 40 years) presented with ischemic heart disease (IHD). Methods: A total of 555 patients were were enrolled between January 2013 and June 2013. Patient admitted in ward as one-day admission and discharged 6 hours after the procedure. Demographic data, clinical findings, and details of electrocardiographic and echocardiographic findings were recorded. The traditional cardiovascular risk factors (smoking, hypertension, Khat chewing, family history and diabetes mellitus, dyslipidemia) were noted. The patient included were patients with sable angina, post myocardial infarction and pre-operative coronary angiography before valve replacement. Results: The older group accounts for 90.3% while younger group accounts for 9.7% of the patients. The majority of patients in both groups were male (81.5% in the young and 74.5% in the older group). Most of the patients in the study were diagnosed as post MI angina. High incidence of diabetes and hypertension among the older group in comparison to the younger group (24.4% diabetes and 43.1% hypertensive Vs. 11.1% diabetes and 29.6% hypertensive). 50% of the younger group were smokers in comparison to 23.8% in older group with statistically significant difference (p=0.0001). Family history of IHD was higher in the younger age group (24.1%) than that in the older age group (16%) (p = 0.129). Dyslipidemia was not common risk factor among both groups. The percentage of Khat chewing did not differ between the two groups (70.4% and 62.5% in younger and older group respectively). Significant left main disease was more than double in younger group (3.7%) when compared older group (1.9%). About one-third (31.5%) of patients of younger group had significant LAD lesion while small number of older patients had significant LAD lesion (1.6%) (p = 0.037). The involvement of right coronary artery (RCA) was significantly higher in older group than in younger group (27.7% and 7.5% respectively; with p = 0.001). Although the incidence of left circumflex artery (LCX) disease was higher in older group (28.8% and 16.7% respectively) it did not reach statistical significance. The left anterior descending artery (LAD) was commonly involved vessel in the young group (31.5%) in comparison to older group (1.6%) while left circumflex artery and right coronary artery was common in in the older group. Conclusion: Coronary angiography is a useful diagnostic and therapeutic tool for CAD. Smoking, male gender as well as family history of cardiovascular diseases showed high prevalence in the in younger patients ≤ 40 years, while hypertension and diabetes were common in the older patients. Khat chewing was highly prevalent among both groups.

Renal Transplantation from a Deceased Donor with Large Bilateral Renal Cysts: A Case Report

We report a case of successfully transplanting a cadaveric donor kidney with three large cysts into a 54-year-old man. The donor was a 53‑year‑old male with a history of ischemic heart disease for two months and intracranial hemorrhage as the cause of death. Three 8-, 4-, and 2-cm cysts were identified in the upper and middle poles of the deceased donor’s kidney. Before transplantation, the large cysts were unroofed from the allograft. Postoperatively, the patient had a satisfactory urine output, and the serum creatinine level was 1.9 mg/mL at the time of hospital discharge, which fell further to 1.02 mg/dL three months after transplantation. Donor kidneys with large bilateral cysts can be effectively transplanted and should not be refused for use.

673 A CRACK AND A CLOT

Abstract A 74-year-old man with a history of ischaemic heart disease (multiple percutaneous coronary interventions (PCI)), broke his ankle. Therefore, he discontinued dual antiplatelet therapy (DAPT) -acetylsalicylic acid plus clopidogrel- and started enoxaparin sodium 4000 UI/day on medical advice. A few days later, he was admitted to the emergency department for refractory chest pain, vomit and syncope. Twelve-lead electrocardiogram (ECG) showed a sinus rhythm interrupted by frequent premature ventricular contractions in a pattern of trigeminy. The transthoracic echocardiogram revealed a mildly dilated LV with normal wall thickness and marked hypokinesis/ akinesis in apical, infero-lateral and antero-lateral walls, with a 33% ejection fraction. High sensitivity cardiac troponin was increased, and a second ECG showed a diffuse ST segment depression. The patient was loaded with aspirin and emergently taken to the cardiac catheterization lab. Coronary angiography showed a very late stent thrombosis of the left circumflex artery (LCx), with occlusion of the extreme distality of the second obtuse marginal artery and a 50-60% intrastent restenosis of the ostium-proximal tract of the left anterior descending artery (LAD). Given the non-obstructive nature of the thrombus, risk of peripheral embolization, TIMI flow grade 3 and improvement of symptoms, the decision was made to adopt a conservative strategy with loading dose of ticagrelor, heparin and tirofiban infusion. Besides, an optical coherence tomography (OCT) control was scheduled for the next day. OCT of the LCx revealed a well apposed and well expanded stent with a non-obstructive residual thrombus, nevertheless not visible on angiography. Thus, the tirofiban infusion was prolonged up to 48 hours. OCT of the LAD detected a fibro-calcific disease determining a significant restenosis of the distal left main (LM)-LAD ostium. OCT-guided provisional stenting with two drug eluting stents on LM-LAD-LCx was performed successfully. The patient was discharged home on acetylsalicylic acid (lifelong), ticagrelor (for 12 months) and enoxaparin sodium 4000 UI/day (according to specialist indication). DAPT is superior to anticoagulant therapy in preventing stent thrombosis in patients undergoing PCI, and a more informed inter-specialist communication is needed. Intracoronary imaging can help in the management of stent failure and in the guidance of complex PCI, allowing a patient-tailored treatment.

661 TWO CARDIOMYOPATHIES IN ONE HEART: LESSONS FROM CLINICAL CASE

Abstract Case description In November 2020, a 55-years-old female with no significant past medical history, was admitted to our Emergency Department for chest pain after acute stressful event. She had a significant family history of ischemic heart disease, and unclear comatose status of her sister. At admission, she was asymptomatic, blood pressure was 115/80 mmHg, and oxygen saturation was 96%. An electrocardiogram (ECG) showed biphasic T wave in anterolateral leads. Elevated levels of troponin I (hs-TnI of 900 ng/L) and B-type natriuretic peptide (BNP) of 864 pg/mL were detected. Transthoracic echocardiogram (TTE) revealed an ejection fraction (EF) of 30% with apical ballooning of mid and apical segments of the left ventricle (LV) along with a sizable apical thrombus. Aspirin, iv diuretics, iv nitrates and unfractioned heparin were started. After 13 hours, she suffered a sudden transient neurological sign of decreased level of consciousness. Cranial MRI revealed an ischemic lesion in the territory of the apex of basilar artery (thalamic region). After 7 days from stroke, the patients underwent coronary angiography demonstrating unobstructed coronaries. Thus, the diagnosis of takotsubo syndrome was confirmed. During hospitalization, ECG evolution showed T wave inversion in precordial and lateral leads. Hs-TnI declining within normal values. Of note, ventricular arrhythmias burden with polymorphic ventricular contraction (PVC) emerged on continuous ECG-monitoring. Despite resolution of apical balloning and apical thrombosis, there were persistent wall-motion abnormalities in infero-lateral walls and mild LV dysfunction. This was also confirmed by cardiac magnetic resonance (CMR). Further, CMR also showed an intense myocardial edema with elevated LV mass. The patients was discharged on Warfarin, Bisoprolol 2.5 mg/die, Ramipril 5 mg/die, Eplerenone 25 mg/die. A clinical documentation was required to further investigate history of her sister, and neurological sequelae after cardiac arrest at 28s related to ventricular fibrillation emerged. However, no deeply evaluation of underlining heart disease was available. Despite an early favorable follow-up of patient, after six months, she suffered from palpitations and heart failure requiring diuretic therapy. Persistent repolarization abnormalities in infero-lateral leads, and low-voltage in precordial leads were noted. An extensive wall-motion abnormalities and moderate LV dysfunction were detected. Importantly, significant arrhythmic burden with PVC (13%) at 24-hr ECG monitoring was recorded. CMR was requested to further investigate the possibility of underlining coexisting cardiomyopathy. Mild LV dilation, moderate dysfunction (LVEF 39%), wall motion abnormalities and thinning of the inferior wall middle segments were reported. Surprisingly, fibro-fatty replacement in infero-lateral of LV wall was detected, and unexpectedly, right ventricular (RV) fibro-fatty replacement and mild RV dysfunction were also described. Hence, diagnosis of arrhythmogenic cardiomyopathy was made. Since persistent arrhythmic burden despite optimized medical treatment, biventricular involvement, family history of SCD, an implantable cardioverter defibrillator in primary prevention was placed. Furthermore, genetic testing was required and extensive clinical family screening was suggested. Conclusion According to the clinical data collected, takotsubo and arrhytmogenic cardiomyopathy can coexist. A potential link between two myocardial heart disease may be identified in the future, especially among patients presenting takotsubo and long-term unfavorable outcome.

837 COMPLETE MAGNESIUM BIORESORBABLE SCAFFOLD ABSORPTION AT 1-YEAR OF INTRACORONARY IMAGING FOLLOW UP

Abstract Background the development of bioresorbable scaffolds (BRSs) has been conceived as revolution in interventional cardiology for the prospective improvements in the treatment of coronary artery disease. However, metallic drug eluting stent (DES) demonstrated greater safety and efficacy than bioresorbable vascular scaffold (BVS) Absorb in dedicated trials culminating in the commercial withdrawal of Absorb device in 2017. Nevertheless, the progressive absorption of the scaffold and the restoration of physiological coronary artery characteristics attracted attention, so currently research on BRSs is in progress. Case presentation a 58-year-old woman was admitted in our department after an episode of typical angina at rest without significant troponin elevation. The electrocardiogram showed T wave inversion in lateral leads. Hypokinesia of distal septum and anterior wall and mildly reduced left ventricular ejection fraction (LVEF 50%) were observed on echocardiography. Her cardiovascular risk factors included obesity, arterial hypertension, dyslipidaemia, family history of ischemic heart disease and former smoking. Her past medical history was remarkable for chronic kidney disease (CKD EPI eGFR 50 ml/min) and previous connective tissue disease. Coronary angiography highlighted a critical stenosis in the middle segment of left anterior descending artery (LAD). Optical coherence tomography (OCT) imaging showed recanalized and organized throumbus and calcific plaques. After adequate predilatation and stent sizing by OCT, a 3×25 mm Magnesium-based BVS (Magmaris, Biotronik AG, Buelach, Switzerland) was implanted. OCT confirmed good expansion and apposition of the stent after postdilatation. Patient was discharged on dual antiplatelet therapy (DAPT) for 12 months, anti-remodeling cardiac and lipid-lowering therapy. One year later, the patient underwent and elective coronary angiography and OCT control showing a complete reabsorption of the Magmaris BVS with positive remodelling and luminal enlargement of the vessel. The patient was asymptomatic throughout the year with a good performance status. Conclusion The present case illustrates an example of imaging-based revascularization with BVS Magmaris and optimal intracoronary imaging result at 1 year follow up in agreement with the last available evidence. The last European Society of Cardiology/European Association for Cardio-Thoracic Surgery Guidelines on myocardial revascularization recommends the use of BVS only in the context of clinical controlled studies. However, encouraging results obtained and what expected from the current studies with Magmaris scaffolds, might change indications considering the potential benefit about the restoration of natural vasomotion, the reduced risk of neoatherosclerosis and the positive vascular remodelling following the scaffold absorption.

Dynamic Coronary Roadmap for Contrast, and Radiation Time Reduction during Coronary Intervention (DRM-COR)

Purpose: The regularly used contrast media in the angiography procedures and interventions are known to carry certain risks to the patient. This includes allergy, nephrotoxicity, and pulmonary edema. Additionally, radiation exposure is associated with high bone marrow depression, infertility, and other hazards. The purpose of the study was to compare the Dynamic Roadmap technology to the regular contrast used in coronary intervention regarding radiation exposure, fluoroscopy time, and incidence of Contrast Induced Nephropathy.&#x0D; Methodology: Observational prospective cohort with 2 arms where 40 patients were randomly divided into 2 arms a case and control groups. The case group had DRM technology used in their procedures where the control group received the standard contrast used in the National Heart Institute.&#x0D; Findings: Findings showed no statistically significant difference between the 2 groups in age, sex, and risk profile including status of Hypertension, Diabetes Mellitus, Smoking and history of Ischemic Heart Disease. There was no difference in echocardiographic findings of both groups. There was significant difference in creatinine level at the 5th day of intervention and volume of contrast used and fluoroscopy time. DRM reduced contrast volume, reduced radiation exposure despite not reducing fluoroscopy or procedure time. This resulted in reduction of elevation in serum creatinine levels with similar success rates.&#x0D; Recommendations: Using the least possible contrast volume and radiation doses should always be target of the operator. Dynamic roadmap technology is recommended in all coronary interventions specially those at high risk of CIN with CKD.

Assessment of right atrial function in inferior wall AMI

Background: Approximately 30–50% of patients with inferior infarction have some involvement of the right ventricle. The right ventricular (RV) infarction almost invariably develops in association with a large infarction of the adjacent septum and inferior 0 walls, but isolated infarction of the right ventricle is seen in just 3–5% of autopsy-proven cases of MI. This study is designed to assess the right atrial (RA) functions in inferior wall acute myocardial infarction (AMI) (IWMI) echocardiographically and to compare it with patients who do not have history of ischemic heart disease (IHD) but having risk factors for IHD. Aims and Objectives: The aims of this study were to study the patients presenting with Inferior wall MI IWMI for RA function. Materials and Methods: Patients admitted in the Cardiology ward of R G Kar Medical College and Hospital with IWMI from March 2020 to March 2022 were included in the study. Results: Average Measurement of RA volume index (RAVI) and RA Pressure (RAP) was highest among patients with IWMI+RV myocardial infarction (RVMI). Out of 100 IWMI patients, 33 had high RAVI and RAP and out of 100 non-IHD patients none had high RAVI. Conclusion: In our study, there was no statistically significant difference in average RAVI and RAP in patients presenting with IWMI and in patients with risk factors for myocardial infarction but without AMI. However, patients presented with IWMI+RVMI showed statistically significant increased RAVI and RAP as compared to inferior wall AMI only.

Kounis syndrome – a silent killer under the blanket

Allergy angina syndrome or allergic myocardial infarction is an immune-mediated coronary spasm which is also known as Kounis syndrome (KS). It's not uncommon, but it's often underdiagnosed. In a typical case of allergy, a skin reaction may be preceding symptoms and shock status may be a severe accompanying symptom. KS may cause devastating events namely cardiac arrest in some extreme cases. A 40-year-old obese gentleman with underlying intrapapillary mucinous neoplasm of uncinate process of pancreas was electively admitted for pancreaticoduodenectomy. He had a past medical history of hypertension and chronic gout arthritis with no previous history of ischemic heart disease. Intraoperatively was uneventful and he was monitored in the intensive care unit postoperatively. However, due to new onset obstructive jaundice postoperatively, he was subjected to contrast-enhanced computed tomography (CECT) of the abdomen for further evaluation. Following injection of contrast, he was developed generalized skin rashes followed by respiratory distress and cardiac arrest. Intravenous steroid and antihistamine were given immediately. He was resuscitated for 9 min, and ECG post-resuscitation showed new onset ST segment elevation V3-V6. Bedside echocardiography revealed preserved ejection function with no obvious hypokinetic segment. Repeated ECG two hours later noted resolution of the ST elevation with the absence of Q wave, T wave inversion, and return into sinus rhythm. Unfortunately, he was complicated prolonged hospital stay, seizure, hypoxic-ischemic encephalopathy (HIE), persistent abdominal sepsis subsequently succumbed after 27 days of admission. As per the above case, cardiac arrest following contrast agent administered should ring a bell about Kaonis syndrome. Diagnosis made needs the concurrent presence of acute coronary syndrome and an allergic event. Every contrast agent has the potential to cause KS. Therefore it is very crucial to detect and treat promptly as it may also lead to death.

Residual Syntax Score as a Predictor of 30-Day Mortality after Primary Percutaneous Coronary Intervention for Acute ST-Elevation Myocardial Infarction

Objective: To evaluate residual SYNTEX score as a predictor of 30-day mortality after primarypercutaneous coronary intervention (P-PCI) in ST-elevation myocardial infarction (STEMI) patients. Methodology: It was a quasi-experimental study conducted in the Emergency department of Rawalpindi Institute of Cardiology from September 2019 to September 2020. After the study approval from the ethics committee and informed consent, 200 patients presenting with acute STEMI were included by convenient sampling. Primary PCI was done in all patients by theconsultant cardiologists, and then the residual SYNTEX score (rSS) was calculated for each patient. Patients were allocated the case or control group based on rSS: patients with complete revascularization were included in controls and those with incomplete revascularization were labeled as cases. All patients were followed after primary PCI for 30-day mortality. The analysis of data was carried out by the Statistical Package for Social Sciences (SPSS) version 25. Results: The 30-day mortality occurred in 11(5.5%) patients. Mortality occurred in 9(4.5%) patients in the case group and 2(1%) patients in the control group with a significant p-value of 0.03There was a significant association between diabetes mellitus &amp; 30-day mortality (0.032) and a family history of ischemic heart disease &amp; 30-day mortality (0.026). This shows that rSS can be used as a reliable predictor of 30-day mortality after P-PCI in STEMI patients. The patients with high rSS score and risk factors of diabetes mellitus and history of ischemic heart disease are at higher risk of 30-day mortality. Conclusion: The residual Syntax score is a simple, reliable and significant marker of 30-day mortality after P-PCI in STEMI patients. It provides an accurate assessment of the extent of revascularization needed to prevent coronary artery disease and enhance the prognosis following P-PCI. It may also serve as a guide for additional PCI decisions. Keywords: Residual Syntax score; rSS; Primary percutaneous coronary intervention;Acute ST-elevation myocardial infarction; STEMI; P-PCI

Coping in Mid- to Late Life and Risk of Mild Cognitive Impairment Subtypes and Dementia: A JPHC Saku Mental Health Study.

The relationship between coping in mid- to late life and cognitive functions remains unclear. To investigate the relationship between habitual coping behaviors of a large Japanese population in their mid- to late-lives and their risk of cognitive decline 15 years later. Overall 1,299 participants were assessed for coping behaviors (in 2000) and cognition (2014-2015). We used the Stress and Coping Inventory to assess the frequency of six coping behaviors (i.e., consulting, planning, positive reappraisal, avoidance, fantasizing, and self-blame). Logistic regression analyses were conducted to examine odds ratios (ORs) for the diagnosis of mild cognitive impairment (MCI), MCI subtypes (single- and multiple-domain MCI), and dementia for coping behaviors. Among the eligible 1,015 participants (72.6 [SD = 5.5] years old in 2014-2015), the numbers for cognitively normal, single-domain MCI, multiple-domain MCI, and dementia were 650 (64.0%), 116 (11.4%), 213 (21.0%), and 36 (3.5%), respectively. Among the six coping behaviors, avoidant coping was significantly associated with noticeable cognitive decline (multiple-domain MCI and dementia). This association remained significant after adjusting for sex, age, education, diagnosis of current major depressive disorder, past history of ischemic heart disease, diabetes, regular alcohol consumption, and smoking (OR = 2.52, 95% CI = 1.23 to 5.15). No significant association with other coping behaviors was found. Avoidant coping in mid- and late life is associated with cognitive decline among older people.

Increasing cardiac troponin-I level as a cardiac injury index correlates with in-hospital mortality and biofactors in severe hospitalised COVID-19 patients

BackgroundSevere acute respiratory syndrome coronavirus-2 raised in 2019 (COVID-19) affects the lung tissue and other organs, specifically the heart. MethodsThe current study evaluated 120 hospitalised patients with severe COVID-19 between March 2021 and February 2022. Patients' demographics, vital signs, electrocardiogram abnormalities, clinical laboratory tests, including troponin I (TPI), mortality, and discharge type, were recorded. ResultsAmong the 120 hospitalised patients with severe COVID-19, 54 (45.0%) patients were male, with an average age of 63.2 ± 1.4. Many patients have chronic comorbidities, including hypertension (51.6%), diabetes mellitus (34.1%), and ischemic heart disease (17.5%). The in-hospital and six months after the discharge mortality were 45.8% and 21.5%, respectively. Cardiac injury was observed in 14 (11.7%) patients with a mean TPI level of 8.386 ± 17.89 μg/L, and patients with cardiac injury had higher mortality than those without cardiac injury (P < 0.001). Furthermore, the cardiac injury was meaningfully correlated with age (ρ = 0.182, P = 0.019), history of ischemic heart disease (ρ = 0.176, P = 0.05), hospitalisation result and mortality (ρ = 0.261, P = 0.004), inpatient in ICU (ρ = 0.219, P = 0.016), and serum levels of urea (ρ = 0.244, P = 0.008) and creatinine (ρ = 0.197, P = 0.033). Additionally, the discharge results were significantly correlated with oxygen saturation with (ρ = −0.23, P = 0.02) and without (ρ = −0.3, P = 0.001) oxygen therapy, D-dimer (ρ = 0.328, P = 0.019), LDH (ρ = 0.308, P = 0.003), urea (ρ = 0.2, P = 0.03), and creatinine (ρ = 0.17, P = 0.06) levels. ConclusionElevated TPI levels are associated with increased mortality in severe COVID-19 patients. Therefore, TPI may be a beneficial biofactor for early diagnosis of cardiac injury and preventing a high mortality rate.

Prognostic implications of myocardial perfusion imaging by 82-rubidium positron emission tomography in male and female patients with angina and no perfusion defects.

Myocardial perfusion imaging with 82-rubidium positron emission tomography (82Rb-PET) is increasingly used to assess stable coronary artery disease (CAD). We aimed to evaluate the prognostic value of 82Rb-PET-derived parameters in patients with symptoms suggestive of CAD but no significant reversible or irreversible perfusion defects. Among 3726 consecutive patients suspected of stable CAD who underwent 82Rb-PET between January 2018 and August 2020, 2175 had no regional perfusion defects. Among these patients, we studied the association of 82Rb-PET-derived parameters with a composite endpoint of all-cause mortality, hospitalization for unstable angina pectoris, acute myocardial infarction, heart failure, or ischaemic stroke. During a median follow up of 1.7 years (interquartile range 1.1-2.5 years), there were 148 endpoints. Myocardial blood flow (MBF) reserve (MFR), MBF during stress, left ventricular ejection fraction (LVEF), LVEF-reserve, heart rate reserve, and Ca score were associated with adverse outcomes. In multivariable Cox model adjusted for patient and 82Rb-PET characteristics, MFR < 2 (hazard ratio (HR) 1.75, 95% confidence interval (CI) 1.24-2.48), LVEF (HR 1.38 per 10% decrease, 95% CI 1.24-1.54), and LVEF-reserve (HR 1.19 per 5% decrease, 95% CI 1.07-1.31) were significant predictors of endpoints. Results were consistent in subgroups defined by gender, history of ischaemic heart disease, low LVEF, and atrial fibrillation. MFR, LVEF, and LVEF-reserve derived from 82Rb-PET provide prognostic information on cardiovascular outcomes in patients with no perfusion defects. This may aid in identifying patients at risk and might provide an opportunity for preventive interventions.

CORONARY ARTERY DISEASE IN YOUNG PAKISTANIS: RISK FACTORS AND PATTERN OF DISEASE

Objectives: To determine the distribution of risk factors and pattern of coronary artery disease among young Pakistanis presenting with acute coronary artery syndrome. A cross sectional study conducted from August 2018 to October 2019 at Department of Cardiology Jinnah Hospital Lahore.&#x0D; Methodology: Total of 150 young patients up to 40 years of age with acute coronary syndrome (ACS) was included in this study. Risk factors were evaluated on patient’s current medication history for diabetes mellitus, hypertension, lipid lowering drugs and recent reports HbA1c, total body lipids. Data was entered and analyzed in SPSS version 21.0. Socio-demographic, clinical profile and risk factors were evaluated and presented as frequency and percentages. Cross tabulation was for ACS and risk factors. Statistical significance was assessed using Chi-square test with significant value of p &lt; 0.05.&#x0D; Results: Among 150 subjects mean age was 34.20 + 4.246 with minimum age of 23 years and maximum age of 39 years. 92.0 % were male and 56.0% were having acute anterior wall STEMI, 36.0% had acute inferior Wall STEMI, 2.0% suffered from acute lateral wall STEMI, 2.7% had acute inferoposterior wall STEMI and 3.3% had NSTE-ACS. Risk factor analysis shows that 22.0% had diabetes mellitus, 20.7% had hypertension, 33.7% had a positive history of IHD in family, 71.3% were smokers, 44.0% had obesity, 66.0% had reduced HDL and 44.0 % had elevated LDL levels. Regarding pattern of coronary artery disease, 70.7% patients were having one vessel CAD, 28.0% two vessels CAD and 1.3% had three vessels CAD.&#x0D; Conclusion: Mean age of acute coronary syndrome is low amongst young Pakistani population with male predominance and acute anterior and inferior wall STEMI being most frequent diagnosis. Smoking, dyslipidemia particularly low HDL, positive family history of ischemic heart disease, hypertension, diabetes mellitus, obesity, was identified as important risk factors. Most of the patients had one vessel CAD.

The Association Between Inflammatory Biomarkers and Vitamin D Level With the Evolution and Severity of Stroke.

Vitamin D deficiency has been linked to the evolution of ischemic stroke, but the data regarding the association between stroke severity and vitamin D level is scarce. Patients with first-ever ischemic stroke in the middle cerebral artery territory, within seven days after the stroke, were recruited. The control group included age- and gender-matched individuals. We compared 25-OH vitamin D (vitamin D), high sensitive C-reactive protein (hsCRP), serum amyloid A (SAA), and osteopontin levels between stroke patients and the control group. The association between stroke severity according to the National Institutes of Health Stroke Scale (NIHSS) and the Alberta stroke program early CT score (ASPECTS) and levels of vitamin D and inflammatory biomarkers were also studied. There was an association between hypertension (P=0.035), diabetes mellitus (P=0.043), smoking (P=0.016), history of ischemic heart disease (P=0.002), higher SAA (P<0.001), higher hsCRP (P<0.001), and lower vitamin D levels (P=0.002) and stroke evolution in a case-control study. Meanwhile, in stroke patients, its severity was associated with higher SAA (P=0.04) and hsCRP (P=0.001), and lower vitamin D levels (P=0.043) according to clinical scale (higher admission NIHSS). According to the ASPECT score, higher SAA (P=0.017) and hsCRP (P=0.007), but not lower vitamin D levels, were associated with more infarct areas (P=0.149). Vitamin D may play a role in both the evolution and severity of stroke.

Prognostic Assessment of Early Repolarization/J Wave Electrocardiographic Pattern in Patients With Stable Ischemic Heart Disease

Recent studies suggested that early repolarization (ER)/J wave at the electrocardiogram (ECG) is associated with increased risk of sudden death and ventricular arrhythmias in patients with acute myocardial infarction. In this study, we prospectively assessed whether ER/J wave has any long-term prognostic implications in patients with stable ischemic heart disease (IHD). We enrolled consecutive clinically stable patients with documented IHD, referred to undergo a routine ECG. ER (typical concave ST-segment elevation) and J wave were diagnosed according to prospectively defined criteria. The final population included 617 patients with documented IHD (455 men; age 68.1 ± 11years). ER/J wave was found in 138 patients (22.4%), 13 of whom (2.1%) showed ER and 133 (21.6%) a J wave. At a follow-up of 8.1±2.9years, 160 deaths occurred (25.9%), 60 (9.7%) attributed to cardiovascular causes. Total mortality was lower in patients with versus those without ER/J wave (18.8% vs 28.0%; hazard ratio [HR] 0.61, 95% confidence interval [CI] 0.40 to 0.93, p=0.02). The difference, however, was not significant after adjustment for confounding clinical variables (HR 0.78, 95% CI 0.51 to 1.19, p=0.25). No significant difference was found in cardiovascular death between patients with (7.2%) and those without (10.4%) ER/J wave (adjusted HR 0.78, 95% CI 0.40 to 1.55, p=0.48). Similar results were obtained for ER and J wave separately, and for ECG location of ER/J wave (inferior or lateral/precordial) and type of J wave (notched or slurred). The ER/J wave pattern at the ECG is not associated with increased risk of long-term mortality in clinically stable patients with a documented history of IHD.

Oxygen Saturation During Dental Surgery with Local Anesthesia Alone and in Combination with Sedation in Medically Compromised Patients

Objective. The aim of this study was to determine which specific operative events are associated with change in SaO2 and blood pressure and heart rate in patients undergoing exodontia or minor oral surgery with local anaesthetic Medically compromised patients with Local anaesthesia alone or in combination with sedation. Methods. Arterial oxygen saturation (SaO2) with Heart rate and blood pressure was measured in 60 patients divided into two equal groups. Group I consisted of 30 patients receiving LA alone and undergoing simple extraction minor oral surgery, group II 30 patients receiving LA with oral midazolam and undergoing simple extraction or minor oral surgery. Results. There was a decrease in SaO2 from the baseline in 10% of group I patients, represented in 3 patients, 2 of them asthmatic and one anxious patient who the BP and HR raised slightly during LA admiration. There was a fall in SaO2 from the baseline in 53% of patients in group II, represented in 16 patients, the majority of them asthmatic and anxious patients, 6 patients with history of ischemic heart disease. The majority of these decreases in SaO2 or raining in BP or HR were associated with breath holding, in response to fear or emotional stress, during administration of LA due to vasoconstrictor effect or during elevation of teeth. The patients in group II showed a significantly (P&lt;0. 001) greater maximum decrease in SaO2 from the baseline value compared to group I. The length of the operating time was longer in group II than that in group I, and the patients of group II were more anxious than the patients in group I. Conclusion. It was concluded that during simple extraction and minor oral surgery under LA alone or in combination with sedation procedures such as elevation of the tooth or administration of the LA may as a result of Breath holding cause reduction in SaO2 or raising in BP or HR. In fit patients this may be of little consequence, however patients with existing airway disease or Medically compromised patients may suffer significant falls in SaO2 or alter the Blood Pressure and Heart Rate. Therefor Monitoring of vital signs and oxygen saturation recommended during simple extraction dental surgery procedure and sedation as premedication for cardiac patients would be recommended.

Intake of dietary flavonoids and incidence of ischemic heart disease in the Danish Diet, Cancer, and Health cohort

Background/ObjectivesFew studies have investigated the association between dietary flavonoid intake, including all major subclasses, and the long-term risk of ischemic heart disease (IHD). We examined whether dietary flavonoid intake associated with IHD incidence, assessing the possible modifying role of sex and smoking, in participants from the Danish Diet, Cancer, and Health study.Subjects/MethodsIn a cohort study design, 54,496 adults (46.8% male), aged 50–64 years, without a history of IHD, were followed for up to 23 years. Habitual dietary flavonoid intake was estimated from food frequency questionnaires using Phenol-Explorer. Incident cases of IHD were identified within Danish nationwide health registries. Restricted cubic splines in Cox proportional hazards models were used to examine associations between flavonoid intake and IHD risk.ResultsDuring follow-up, 5560 IHD events were recorded. No overall association was seen between total flavonoid intake, nor any subclass, and IHD, following adjustment for demographics, lifestyle, and dietary confounders. Stratified by sex and smoking status, higher intakes of specific subclasses associated with lower IHD risk among ever-smokers [Q5 vs. Q1 flavonols HR (95% CI): 0.90 (0.82, 0.99); flavanol oligo+polymers: 0.88 (0.80, 0.97)], but not among never-smokers, nor either sex specifically.ConclusionsWhile we did not find clear evidence that higher habitual dietary flavonoid intake was associated with lower IHD risk, these results do not exclude the possibility that certain subclasses may have a protective role in prevention of IHD among population sub-groups; this was evident among smokers, who are at a higher risk of atherosclerosis.

Impacto pronóstico de los factores de riesgo cardiovascular en pacientes ingresados por síndrome coronario agudo

Introduction and objectivesCardiovascular prevention measures place the emphasis on controlling cardiovascular risk factors (CVRF). However, the most recent studies provide disappointing data, the impact of which remains to be determined. The objective of this study was to analyse the impact that the different CVRFs, and their degree of control, have on the prognosis of patients after acute coronary syndrome. Patients and methodsEpidemiological, pharmacological, and CVRF control data were collected from 1,689 consecutive patients admitted from 2018 to 2020 for acute coronary syndrome to a tertiary hospital. Finally, the rate of major adverse cardiovascular events was calculated. ResultsThe patients admitted for acute coronary syndrome were predominantly men, with body mass index>25Kg/m2, smokers (or former smokers) and with poor CVRF control (50% for hypertension and diabetes and 35% for dyslipidaemia), especially those patients with a personal history of ischaemic heart disease. An underutilisation of useful drugs for CVRF control was found. A directly proportional relationship was observed between the number of CVRFs (or their poor control) and the incidence of major adverse cardiovascular events at 2 years, hypertension being the factor with the greatest cardiovascular impact. The SARS-CoV-2 lockdown worsened the degree of CVRF control and cardiovascular prognosis. ConclusionThere is still room for improvement in the control of CVRF, which would translate into a prognostic benefit for patients with ischaemic heart disease. The implementation of cardiovascular prevention campaigns seems essential.

Clinical Predictors of Successful Anti-tachycardia Pacing for Ventricular Arrhythmia Termination

Background: Anti-tachycardia pacing (ATP) is a fast and safe method for terminating ventricular tachycardia (VT). Implantable cardioverter defibrillator (ICD) shocks are unpleasant, stressful experiences that have been associated with higher mortality rates than ATP. Determining the factors enhancing the efficacy of ATP therapies can minimize the appropriate ICD shocks. Objectives: In this study, we investigated the factors anticipating the success rate of ATP. Methods: This descriptive cross-sectional study was carried out among 60 patients referring to our center for regular ICD device analysis. These patients had at least one episode of appropriate ATP therapy in their analysis. The VT morphologic characteristics were obtained from stored far-field intracardiac electrogram (EGM). The VT episodes and native QRS were classified into non-Q or Q categories based on their EGM morphologies. Results: ATP was successful in 38 (63.3%) cases. Age, sex, history of ischemic heart disease and diabetes, type of device and cardiomyopathy (ischemic or dilated), antiarrhythmic drugs, left ventricular ejection fraction, and EGM characteristics did not predict ATP success. Conclusions: It seems that neither the demographic factors nor the morphologic characteristics of VT EGMs can predict the efficacy of ATP therapy.