Hospital Cardiology Department Research Articles

Original Article--Predictors of Persistent Functional Tricuspid Regurgitation After Transcatheter Closure of Atrial Septal Defect and its Relationship to Tricuspid Valve Remodeling.

ObjectivesThe aim of this study is assessment of persistent functional tricuspid regurgitation in patients with atrial septal defect before and after successful device closure and its relationship to tricuspid valve remodeling.MethodsThe current study was conducted on 60 patients referred to Tanta University Hospital Cardiology Department with the provisional diagnosis of atrial septal defect secundum type for transcatheter closure from December 2017 to December 2019. All patients were subjected to history taking, clinical examination, 12 lead electrocardiography, plain chest X-ray, full two dimension transthoracic echocardiography (for assessment of tricuspid regurgitation severity) before and at 3, 6 months after transcatheter closure.ResultsTricuspid regurgitation was decreased significantly after atrial septal defect closure due to remodeling in the right side. Age, estimated systolic pulmonary artery pressure, right atrium end systolic area, right ventricular end diastolic area, tricuspid valve tenting area and height, tricuspid septal leaflet angle and tricuspid annular diameter were predictors of persistent tricuspid regurgitation after 3 and 6 months of closure. Only estimated systolic pulmonary artery pressure, tricuspid septal leaflet angle and tricuspid annular diameter were independent predictors of persistent tricuspid regurgitation after 3, and 6 months of closure.ConclusionTricuspid regurgitation significantly improved after transcatheter atrial septal defect closure despite its significance at baseline due to remodeling in right side and tricuspid valve.

Clinical and Laboratory Predictors of No-reflow during Primary Percutaneous Coronary Intervention

Background: The phenomenon of no-reflow is defined as the occurrence of areas with very low tissue flow after the target vessel has reopened. Current knowledge suggests that the no-reflow phenomenon is caused by the damage to microvascular integrity established both during ischemia and during reperfusion. D-dimer is the end product of fibrin degradation by plasmin, as plasma concentrations increase in people with persistent or recent thrombosis. Its levels reflect the rate of fibrin turnover and give an indirect estimate of the size of the coagulant mass available for fibrinolysis and the severity of the hypercoagulable condition. Objective: To investigate the Clinical and laboratory predictors of no-reflowon admission afterprimary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) patients. Patients and methods: A prospective single group observational study.A total of 100 patients presented with STEMI and eligible for primary PCI to the cardiology department in Ain Shams University hospital. Results: Coronary angiography showed that (74%) had normal flow while (26%) showed no re-flow. Renal impairment, DM and delayed reperfusion (> 4 hr) were significantly associated with no reflow(P-values = 0.018,0.023,0.005) respectively. ROC curve showed that the best cut off point for D-dimer to predict cases with no reflow was found ≥ 560 with sensitivity of 96.15%, specificity of 79.73% and area under curve (AUC) of 86.5% where as the best cut off point for CRP was > 41 with sensitivity of 76.92%, specificity of 64.86% and area under curve (AUC) of 69.8. Conclusion: Assessment ofD-dimer and CRP levels on admission in STEMI patients might independently predicts no-reflow after primary PCI.

Designing and usability assessing an electronic personal health record for patients with chronic heart failure in a developing country

BackgroundChronic heart failure (CHF) is one of the serious chronic progressive conditions with the highest incidence, mortality, and disability so that its complications can be controlled and prevented through self-care behaviors. An electronic personal health record (e-PHR) can increase patients' understanding of their level of health to improve it. ObjectiveThis study aimed to design an e-PHR system and assess its usability for patients with CHF. MethodsThis applied developmental research was conducted in 2019. Based on the literature review, a questionnaire was designed to assess and determine the data elements required for the e-PHR system of patients with CHF by 14 cardiologists and 40 nurses employed at Cardiology departments of hospitals in Iran. Then the system was designed and developed using the PHP programing language and MySQL database server and implemented on a web server. The system's usability was assessed by three cardiologists and three patients using the System Usability Scale (SUS) questionnaire and five health information technology experts using Nielsen's usability heuristics. ResultsThe experts approved the system design elements, including 225 data elements, such as identity information, vital signs, diet and liquids, health records, symptoms, medications, vaccination, tests, social records, physical activities, sexual activities, and travel. The most important elements in this system were social records (98.52%) and physical activities (97.53%), whereas the least important element was vaccination (80%). Patients and cardiologists gave 83.33 and 85 SUS scores to the designed system, respectively. In other words, they evaluated the system usability at a "good" level. Based on Nielsen's usability heuristics, the system had 30 unique problems, with overall average severity of 2.39. ConclusionThe designed e-PHR system for CHF patients obtained good and satisfactory results in usability assessment. Therefore, this web-based system can be easily employed for the condition management of patients with CHF.

Sodium-glucose Co-transporter 2 Inhibitor use and Barriers to Prescription in a Tertiary Cardiology Department

Sodium-glucose co-transporter 2 inhibitors (SGLT2i) are emerging oral hypoglycaemic agents shown to reduce cardiovascular events and hospitalisation for heart failure. Current CSANZ guidelines recommend their use for patients with type 2 diabetes mellitus and high cardiovascular risk who have inadequate diabetic control despite metformin. We audited SGLT2i use in a tertiary hospital cardiology department and identified barriers to SGLT2i prescription.

Acute Coronary Syndrome Admissions and Mortality Rate During Covid-19 Pandemic in Gaza

Background: What is the nature and duration of changes to admissions for different types of acute coronary syndrome (ACS), among patients during coronavirus disease 2019 (COVID-19) pandemic in Gaza? Methods: The investigators analyzed data on hospital admissions in Gaza for types of ACS from August 25-2020, to October 1, 2020, that were recorded in the Alshifa Hospital Cardiology Department Service Admitted Patient Care database. Admissions were classified as ST-elevation myocardial infarction (STEMI) and non-STEACS and we calculate the diagnostic and percutaneous coronary intervention (PCI) rate. Results: Hospital admissions for ACS declined from rate of 99 admissions to 40 admission in 2020in this time, a reduction of 60%. During the period of declining admissions, there were reductions in the number of admissions for all types of ACS, including both STEMI and NONSTEACS, but relative and absolute reductions were larger for NSTEMI, (from 73 patients in 2019 to 26 patients in 2020) with a percent reduction of 64% In parallel, reductions were recorded in the STEMI ( from 26 patients in 2019 to 14 patients in 2020) percent reduction 46 %, the mortality rate for STEMI patient was 4% in 2019 and 21% in 2020, for non-STEMI patient was 0% in 2019 and 4% in 2020. The diagnostic coronary angiography decrease from 130 to 31 cases (76%) and PCI decrease from 35 to 18 cases (49%) during this period Conclusions: We found that significant reduction in the number of patients with ACS who were admitted to the hospital during the pandemic, but increase in mortality rate by 17% in STEMI and 4% in NON-STEACS in Gaza strip

Tetralogy of Fallot—A literature review

AbstractTetralogy of Fallot is a combination of four specific cardiac abnormalities. (a) A ventricular septal defect (VSD), (b) pulmonary valve stenosis/right ventricular outflow tract obstruction, (c) aorta overriding the VSD, and (d) right ventricular hypertrophy. This review attempts to outline the current literature regarding embryology, morphology, pathophysiology, ultrasound appearances and the current treatments/outcomes of infants with Tetralogy of Fallot. Tetralogy of Fallot is the most commonly occurring conotruncal anomaly. Here, the aim is to present the ultrasound features, with examples of Tetralogy of Fallot along with the story post birth in terms of surgical treatment. This information was gathered doing a literature search using PubMed and the University of South Australia library database, as well as through information provided by the Royal Children's Hospital Cardiology department, via fact sheets. With early diagnosis under ultrasound, preparations can be made and counseling provided to organize for intervention and further assessment after birth. With current surgical intervention, the survival rate past the age of 10 is now over 92%, when, 50 years ago, it was only 50%.

HEART RATE RECOVERY TIME AFTER EXCERCISE STRESS TEST IN DIABETIC PATIENTS WITH SUSPECTED CORONARY ARTERY DISEASE

Background: Improving recovery after exercise is vital for decreasing cardiac mortality by dominance of parasympathetic nervous system control in recovery time. Objective: To determine the influence of coronary artery disease on heart rate recovery after exercise in patients with diabetes mellitus. Patients and Methods: The ethical approval was obtained from the hospital ethical research committee, in cardiology department in Al-Hussein university hospital from March 2019 to November 2019 and each patient signed an informed consent. Fifty patients were included in this study divided in 4 groups, all with no evident history of ischemic heart disease. Detailed history, physical examination, resting ECG, trans thoracic echocardiography, and finally treadmill exercise stress test was done. In this study we assessed heart rate recovery in 1st, 2nd& 3rd minute and also basal heart rate included. Results: Significant delay in heart rate recovery time was detected in diabetic patients with positive stress ECG test for myocardial included ischemia. Conclusion: Delayed recovery and reduced heart rate recovery after treadmill exercise stress test is an available and important index for detecting and revealing the extent of ischemic burden.

HEART RATE RECOVERY TIME AFTER EXCERCISE STRESS TEST IN DIABETIC PATIENTS WITH SUSPECTED CORONARY ARTERY DISEASE

Background: Improving recovery after exercise is vital for decreasing cardiac mortality by dominance of parasympathetic nervous system control in recovery time. Objective: To determine the influence of coronary artery disease on heart rate recovery after exercise in patients with diabetes mellitus. Patients and Methods: The ethical approval was obtained from the hospital ethical research committee, in cardiology department in Al-Hussein university hospital from March 2019 to November 2019 and each patient signed an informed consent. Fifty patients were included in this study divided in 4 groups, all with no evident history of ischemic heart disease. Detailed history, physical examination, resting ECG, trans thoracic echocardiography, and finally treadmill exercise stress test was done. In this study we assessed heart rate recovery in 1st, 2nd& 3rd minute and also basal heart rate included. Results: Significant delay in heart rate recovery time was detected in diabetic patients with positive stress ECG test for myocardial included ischemia. Conclusion: Delayed recovery and reduced heart rate recovery after treadmill exercise stress test is an available and important index for detecting and revealing the extent of ischemic burden.

Acute Coronary Syndrome Admissions and Mortality Rate During COVID-19 Pandemic in Gaza

Background: What is the nature and duration of changes to admissions for different types of acute coronary syndrome (ACS), among patients during coronavirus disease 2019 (COVID-19) pandemic in Gaza? Methods: The investigators analyzed data on hospital admissions in Gaza for types of ACS from August 25-2020, to October 1, 2020, that were recorded in the Alshifa Hospital Cardiology Department Service Admitted Patient Care database. Admissions were classified as ST-elevation myocardial infarction (STEMI) and non-STEACS and we calculate the diagnostic and percutaneous coronary intervention (PCI) rate. Results: Hospital admissions for ACS declined from rate of 99 admissions to 40 admission in 2020in this time, a reduction of 60%. During the period of declining admissions, there were reductions in the number of admissions for all types of ACS, including both STEMI and NON-STEACS, but relative and absolute reductions were larger for NSTEMI, (from 73 patients in 2019 to 26 patients in 2020) with a percent reduction of 64% In parallel, reductions were recorded in the STEMI ( from 26 patients in 2019 to 14 patients in 2020) percent reduction 46 %, the mortality rate for STEMI patient was 4% in 2019 and 21% in 2020, for non-STEMI patient was 0% in 2019 and 4% in 2020. The diagnostic coronary angiography decrease from 130 to 31 cases (76%) and PCI decrease from 35 to 18 cases (49%) during this period Conclusions: We found that significant reduction in the number of patients with ACS who were admitted to the hospital during the pandemic, but increase in mortality rate by 17% in STEMI and 4% in NON-STEACS in Gaza strip

Healthcare professionals’ knowledge on cardiopulmonary resuscitation correlated with return of spontaneous circulation rates after in-hospital cardiac arrests: A multicentric study between university hospitals in 12 European countries

In-hospital cardiac arrest is a major cause of death in European countries, and survival of patients remains low ranging from 20% to 25%. The purpose of this study was to assess healthcare professionals' knowledge on cardiopulmonary resuscitation among university hospitals in 12 European countries and correlate it with the return of spontaneous circulation rates of their patients after in-hospital cardiac arrest. A total of 570 healthcare professionals from cardiology, anaesthesiology and intensive care medicine departments of European university hospitals in Italy, Poland, Hungary, Belgium, Spain, Slovakia, Germany, Finland, The Netherlands, Switzerland, France and Greece completed a questionnaire. The questionnaire consisted of 12 questions based on epidemiology data and cardiopulmonary resuscitation training and 26 multiple choice questions on cardiopulmonary resuscitation knowledge. Hospitals in Switzerland scored highest on basic life support (P=0.005) while Belgium hospitals scored highest on advanced life support (P<0.001) and total score in cardiopulmonary resuscitation knowledge (P=0.01). The Swiss hospitals scored highest in cardiopulmonary resuscitation training (P<0.001). Correlation between cardiopulmonary resuscitation knowledge and return of spontaneous circulation rates of patients with in-hospital cardiac arrest demonstrated that each additional correct answer on the advanced life support score results in a further increase in return of spontaneous circulation rates (odds ratio 3.94; 95% confidence interval 2.78 to 5.57; P<0.001). Differences in knowledge about resuscitation and course attendance were found between university hospitals in 12 European countries. Education in cardiopulmonary resuscitation is considered to be vital for patients' return of spontaneous circulation rates after in-hospital cardiac arrest. A higher level of knowledge in advanced life support results in higher return of spontaneous circulation rates.

Clinical characteristics and related factors of somatization symptoms in outpatients with psychiatric disorders of the department of cardiology in general hospitals

Objective: To explore the clinical characteristics and related factors of somatization symptoms in outpatients with psychiatric disorders of the cardiology department in general hospital. Methods: Cross-sectional survey method was used in this study. From August 2017 to September 2018, 508 outpatients of our department with suspected mental disorders, who complained of physical discomfort and screened by the "Three Questions" method recommended by the Chinese Expert Consensus on Psychological Prescriptions of Cardiovascular Patients in 2014, were consecutively included. General Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire (PHQ-9), Patient Health Questionnaire-15 (PHQ-15) and self-made general demographic questionnaire (including age, sex, marital status, educational level, occupation, duration of disease, clinical diagnosis and the process of medical treatment for the main somatic symptoms in recent one year) were used to investigate these patients, under the assistance of unified training psychological consultants. The detection rate of anxiety and depression, the degree and distribution of somatization symptoms in outpatients with mental disorders were analyzed, and the related factors affecting the occurrence of somatization symptoms were screened by multivariate logistic regression. Results: The selected patients were (51.3±10.1) years old, of which 37.8% (192/508) were males and 62.2% (316/508) were females. The total detection rate of anxiety/depression was 86.8% (441/508), and the detection rate of somatization symptoms was 93.1% (473/508). The number of positive symptom items in PHQ-15 was 8.0±2.7, and the detection rate of anxiety/depression was 78.6% (372/473) in patients with somatization symptoms. There were significant differences in the proportion of women, the average number of outpatient visits and hospitalizations in the past one year, GAD-7 score and PHQ-9 score among the patients with mild, moderate and severe somatization symptoms (all P<0.05). PHQ-15 score was positively correlated with GAD-7 score (r=0.524 5, P<0.001) and PHQ-9 score (r=0.574 9, P<0.001) in patients with somatization symptoms. Stepwise logistic regression analysis showed that total scores of PHQ-9 (OR=8.020, 95%CI 3.470-18.930, P<0.001) and GAD-7 (OR=6.526, 95%CI 2.903-13.045, P<0.001) and female (OR=4.440, 95%CI 1.059-9.073, P=0.011) were related factors of somatizations. Conclusions: The incidence of somatization symptoms is high in patients with psychological disorders in outpatients of cardiology department in general hospital. Anxiety, depression and gender are the main related risk factors of somatization symptoms in this patient cohort. Degree of anxiety and depression increased in proportion to the severity of somatization symptoms. Anxiety, depression and female is related to somatization symptoms.

Mindfulness and Interoceptive Exposure Therapy for Anxiety Sensitivity in Atrial Fibrillation: A Pilot Study.

Atrial fibrillation is the most common cardiac arrhythmia and symptoms overlap with physiological sensations of anxiety. Patients with atrial fibrillation can demonstrate anxiety sensitivity even in the absence of actual atrial fibrillation symptoms. Interoceptive exposure is effective in treating anxiety sensitivity, and recently, mindfulness has been proposed as an enhancement strategy to facilitating inhibitory learning in exposure therapy. This pragmatic study piloted a brief mindfulness and interoceptive exposure treatment for anxiety sensitivity in atrial fibrillation. Eight participants with atrial fibrillation and elevated anxiety sensitivity from a hospital cardiology department participated in the treatment. Anxiety sensitivity significantly decreased during the course of the intervention. These initial findings show proof of concept for this brief intervention in a cardiac-specific behavioral medicine setting.

Przywracanie rytmu zatokowego u pacjentów z migotaniem przedsionków leczonych doustnymi antykoagulantami niebędącymi antagonistami witaminy K jest bezpieczne bez przezprzełykowego badania echokardiograficznego — doniesienie wstępne

Introduction. Atrial fibrillation (AF) is the most common type of supraventricular arrhythmia. Electrical cardioversion is a non-pharmacological method of restoring sinus rhythm in AF patients. The role of transoesophageal echocardiography (TEE) in patients subjected to electrical cardioversion has not yet been fully established. The objective of this study was to assess the safety of electrical cardioversion procedures in AF patients who had received novel oral anticoagulants for at least 21 days prior to the procedure, and in whom electrical cardioversion was carried out without previous TEE examination. Material and methods. The study population consisted of 132 patients receiving non-vitamin K antagonist oral anticoagulants (NOACs) and subjected to electrical cardioversion procedures at a district hospital cardiology department. Patients with valvular AF and patients receiving NOACs in an irregular fashion were excluded from the study. The incidence of thromboembolic and haemorrhagic complications was assessed over a 30-day follow-up period. Results. In a group of 132 patients treated with NOACs, rivaroxaban was used in 65 (49.2%) patients, dabigatran was used in 62 (47.0%) patients, and apixaban was used in five (3.8%) patients. No thromboembolic or haemorrhagic complications were observed in the study group over the hospitalisation period or the 30-day follow-up period. Conclusions. NOACs are effective and safe in the premedication of AF patients prior to electrical cardioversion procedures. Electrical cardioversion without prior TEE is a safe method of managing patients receiving regular premedication with NOACs for at least 21 days before a sinus rhythm restoration procedure.

EFFECT OF PULMONARY HYPERTENSION SECONDARY TO CONGENITAL HEART DISEASE ON RIGHT VENTRICULAR VOLUMES AND FUNCTION: A COMPARATIVE STUDY BETWEEN TWO DIMENSIONAL, THREE DIMENSIONAL ECHOCARDIOGRAMS AND INVASIVE RV QUANTIFICATION

Background: Quantitative echo cardiographic assessment of right ventricular (RV) function is becoming of increasing interest in cardiac diseases that affect the right ventricle, such as congenital heart disease and acute or chronic pulmonary hypertension (PH),but is still challenging due to RV complex anatomy and structure. Aim of the Work: To study the effect of PH on the RV volumes and function using 2DE, 3DE and RV quantification by angiography in patients with PH secondary to congenital heart disease and to compare between 3D RV quantification by echocardiogram and invasive byangiography in patients with PH secondary to congenital heart disease. Patients and Methods: This cross sectional study included all patients with congenital heart diseases complicated by pulmonary hypertension referred to cardiology department in Ain shams university hospital for elective hemodynamic assessment. Results: The diagnostic accuracy of 3D RV and angiography (Ang.) RV parameters for detecting hemodynamic signs of pulmonary hypertension (a composite of PVR > 7) was shown by receiv‐er operating characteristic curves. The parameters with the largest areas under thecurve (AUC) were: 3D tenting volume (1.000) had the highest area under the curve followed by mean PAP and PASP, followed by 3D ‐ TV annulus area, Ang. RV EF,3D RV EF And lastly FAC. The best cut-off values of: 3D TV tenting volume >4.8 (Se: 100%, Sp: 100%), PASP >80(Se: 100%, Sp: 97.5%), mean PAP >50 (SE:100, SP: 97.5%), 3D TV annulus area >9.3 (SE: 100%, SP: 92.5), Ang. RV EF < =36% (SE=100%, SP= 80%), 3D RV EF <=42% (SE=100%, SP+77.5%)and RV FAC<=36 % (Se:100%, Sp: 67.5%). Conclusion: In PH patients, the quantitative assessment of globaland regional RV function by 3D provided a useful hemodynamic and prognostic information. Several indices can be obtained by 3D echocardiography non-invasively, to predict the PVR in congenital heart disease with PH.

Optimisation du traitement de l’insuffisance cardiaque chronique par les médecins généralistes en sortie d’hospitalisation : les recommandations sont-elles appliquées ?

Heart failure is a common and serious disease, with constantly increasing incidence. General practitioners have an essential role in its management. Aim of the studyDescribe general practitioner's practice in optimizing heart failure treatment after hospital discharge. Patients and methodAll patients admitted for heart failure with altered ejection fraction in Nanterre's hospital cardiology department between February 2014 and January 2015 and having a general practitioner were included. Demographic, clinical, biological, ultrasound data and treatments were collected. A questionnaire was submitted to general practitioners two months after discharge. ResultsA total of 82 patients (age 76±12years, left ventricular ejection fraction 36±8%) were included. The target dose of angiotensin-converting-enzyme inhibitors and beta-blockers was reached for 18% of patients during hospitalization. Forty-two general practitioners answered the questionnaire, which concerned 60% of patients (n=49). None of them modified angiotensin-converting-enzyme inhibitors nor beta-blockers. The reasons were the lack of patient consultation (43%), the good tolerance (43%), the absence of habit (24%), and the attribution of this role to the cardiologist (41%). Possible improvements are: more precise hospitalization reports, alternating consultations and educational sessions. ConclusionPatients with heart failure are under-treated at discharge and general practitioners do not optimize the treatment after hospital discharge. The main axis of improvement is to establish a better defined care pathway.

Retrospective analysis of HF detection in city hospitals of Bishkek in three-year study (2016-2018)

In this article, we analyzed prevalence of heart failure in patients visited cardiology departments of secondary level hospitals of Bishkek city, Kyrgyz Republic.

Prevalencia de derrame pericárdico en enfermedades sistémicas.

The presence of 50 mL of fluid or more in the pericardial sac is known as pericardial effusion. To determine the prevalence of pericardial effusion in patients with systemic diseases. Echocardiographic studies performed at the National Medical Center Siglo XXI Specialty Hospital Cardiology Department between 2006 and 2016 were reviewed. According to Weitzman's criteria, pericardial effusion was classified as mild, < 10 mm, moderate, 10 to 20 mm and severe, > 20 mm. In total, 10,653 studies were reviewed; the prevalence of pericardial effusion was 3.5 % (380), in 209 women (55 %, 45.9 ± 19.0 years) and 171 men (45 %, 41.9 ± 18.5 years). Etiology was uremic in 227 (59.7 %), lymphatic drainage reduction in 73 (15.8 %), autoimmune diseases in 30 (7.9 %), neoplastic in 26 (6.8 %), infectious in 19 (5 %), idiopathic in 14 (3.7 %), hypothyroidism in two (0.5 %), iatrogenic in one (0.3 %) and post-infarction in one (0.3 %). Severity was mild in 87 (22.9 %), moderate in 147 (38.7 %) and severe in 146 (38.4 %). The prevalence of pericardial effusion was 3.5% in patients with systemic diseases.

The importance of characteristics of angina symptoms for the prediction of coronary artery disease in a cohort of stable patients in the modern era

ObjectiveAngina is an important clinical symptom indicating underlying coronary artery disease (CAD). Its characteristics are important for the diagnosis and risk stratification of patients with CAD. Currently, we aimed to investigate the association of chest pain characteristics with the presence of obstructive CAD in a contemporary cohort of patients undergoing coronary angiography for suspected stable CAD. MethodsConsecutive patients undergoing coronary angiography for suspected stable CAD (n = 686) in a single university hospital cardiology department were enrolled. Chest pain was classified as typical angina, atypical angina, nonangina chest pain, and lack of symptoms. The presence of significant angiographic CAD was diagnosed by standard coronary angiography. ResultsTypical angina symptoms were associated with a higher prevalence of CAD (odds ratio [OR], 3.47, p < 0.001), whereas atypical angina symptoms were associated with a lower prevalence of CAD (OR, 0.49, p = 0.003) than the nonangina symptoms/or asymptomatic status. In multivariate analysis, typical angina symptoms remained an independent predictor of CAD (OR, 2.54, p < 0.001), with a greater predictive accuracy than other clinical risk factors (area under the curve [AUC], 0.715, p < 0.001) and similar to the accuracy of the high-sensitivity C-reactive protein (AUC, 0.712, p < 0.001). In a multivariate model, the combination of all studied factors further improved the predictive accuracy (AUC, 0.81, p < 0.001). ConclusionIn a contemporary cohort of patients referred for coronary angiography for stable CAD, the presence of typical angina symptoms was the most important independent predictor of obstructive CAD. The association of atypical angina symptoms with low CAD prevalence compared to nonangina chest pain or absence of significant symptoms probably reflects different management and referral strategies in these groups of patients.

Occupational Exposure to Ionizing Radiation in Interventional Cardiology Practices in Bangladesh during 2010-2014

Objective: The objective of this study is to assess, analyze and discuss the occupational exposure to ionizing radiation in interventional cardiology practices in Bangladesh for the last 5-year periods.&#x0D; Method: Each year, about 100 workers working in interventional cardiology departments of big hospitals in Dhaka City were monitored using Harshaw Thermoluminescent Dosimeters (TLDs) for quarterly basis. The effective dose of the occupational workers were measured using Two Harshaw TLD Readers (one is manual TLD reader, model-4500, and another is automatic TLD reader, model 6600 plus).&#x0D; Finding: The average annual effective dose (about 80 % workers) in interventional cardiology practices were &lt;2mSv in 2010-2014 and no monitored workers were found to have received an occupational exposure &gt;50 mSv in a single year or &gt;100 mSv in a 5 year period. The status and trends in occupational exposure demonstrate that radiation protection conditions at the majority of the workplace were adequate. Despite that, further optimization is necessary due to large variations observed in the maximum individual doses over the 5-year periods.&#x0D;

Early Endocarditis and Delayed Left Ventricular Pseudoaneurysm Complicating a Transapical Transcatheter Mitral Valve-in-Valve Implantation: Percutaneous Closure Under Local Anesthesia and Echocardiographic Guidance.

A 72-year-old man was referred because of suspected infective endocarditis. Fifteen years earlier, he had undergone mitral valve replacement with a 33-mm Hancock valve for severe mitral regurgitation. Three months ago, he presented with a first episode of congestive heart failure caused by severe mitral regurgitation reflecting degeneration of the bioprosthetic valve without sign of endocarditis. Because of a high surgical risk based on an estimated Euroscore I of 42.96% and The Society of Thoracic Surgeons (STS) score of 29% (main comorbidity is an advanced Parkinson disease), valve-in-valve implantation was planned. A 29-mm Edwards Sapien 3 (S3) balloon-expandable valve was successfully implanted through transapical puncture of the left ventricle (LV) after direct surgical exposure by mini thoracotomy. Patient was discharged 10 days after the procedure without complications. On his admission, the patient was febrile and examination revealed a purulent discharge at the site of thoracotomy. Transthoracic echocardiography (TTE) and transesophageal echocardiography showed a 15-mm mobile vegetation on the leaflet of the S3 (Movie I in the Data Supplement) and a pseudoaneurysm at the apex of the left ventricle (LVPA) flowing by a large apical defect (Figure 1; Movie II in the Data Supplement). Computed tomographic (CT) scanning confirmed the LVPA free from any thrombus and identified the surgical suture tip in its deep (Figures 1 and 2; Movie III in the Data Supplement). 18F positron-emission tomography demonstrated an uptake on the S3 and LVPA (Figure 2). Blood cultures were positive for Staphylococcus aureus . Antibiotherapy with co-trimoxazole for 6 weeks and clindamycin for 1 week was started, and a quick clinical and biological …