Journal of Cardiology and Cardiovascular Medicine https://www.cardiologymedjournal.com/feed Introduction The term Cardiology is derived from the Greek words "cardia", which refers to the heart and "logy" meaning "study of." Cardiology is a branch of medicine that concerns diseases and disorders of the heart. Cardiovascular Medicine is concerned with the study of those medicines that help in prevention, detection, management and treatment of cardiovascular diseases. Journal of Cardiology and Cardiovascular Medicine is an independent, peer-reviewed journal of Heighten Science which publishes manuscripts written and refereed by researchers, scientists, doctors, specialists and other health professionals. The contents of Journal of Cardiology and Cardiovascular Medicine are clinically focused, practical, evidence-based and well-illustrated, designed to meet the needs of busy doctors. Reasons for Publishing The number of patients with chronic cardiovascular conditions is likely to increase as our population ages, accompanied by an increasing prevalence of obesity, diabetes and associated vascular complications. Improvements in acute care for patients encountering cardiac events are one of the main reasons for Heighten Science to come up with the Journal of Cardiology and cardiovascular medicine. The Journal of Cardiology and cardiovascular medicine is designed to provide valuable insights on cardiology and cardiovascular medicine to the world-wide healthcare professionals. The manuscripts published in the Journal of Cardiology and Cardiovascular Medicine are easy to read and have been carefully reviewed by an editorial board of cardiologists, as well as other specialists outside the editorial board, to ensure the tone and content meet the busy practitioners’ needs. Observational Study Causes of Coronary Angioplasty Denial in Patients Diagnosed with Significant Coronary Artery Disease in East Afghanistan Akmal Shams,Ikramullah Ibrahimi,Humayoun Chardiwal 2024-10-30 14:29:20 Coronary Artery Disease (CAD) is a leading cause of mortality worldwide, with coronary angioplasty being a crucial intervention for patients with significant disease. This study aimed to identify and analyze the causes of coronary angioplasty denial in patients with significant coronary artery disease in Afghanistan, focusing on demographic, socioeconomic, and clinical factors.A case-control study was conducted with a sample size of 213 patients diagnosed with significant CAD at tertiary care center in Afghanistan. The case group consisted of 106 patients who were denied angioplasty, and the control group included 107 patients who underwent the procedure. Data were collected on demographic characteristics, comorbidities, education, residence, functional status, income, and the reasons for angioplasty denial. Descriptive statistics and comparative analyses were performed to assess the factors associated with denial.The primary reasons for angioplasty denial were financial constraints (45.3%, p < 0.001), limited hospital facilities (15.1%, p = 0.045), patient refusal (23.6%, p < 0.001), and physician preference for conservative management (12.3%, p = 0.091). Denial rates were higher among patients who were older, had multiple comorbidities, were from rural areas, and had lower education and income levels. Illiteracy and cultural beliefs contributed significantly to patient refusal, while inadequate healthcare infrastructure disproportionately affected rural populations.Financial and infrastructural barriers are the leading causes of coronary angioplasty denial in Afghanistan, exacerbating disparities in healthcare access, particularly among low-income and rural patients. Addressing these issues through policy reforms, improved healthcare infrastructure, and targeted public health education is essential to reducing CAD-related morbidity and mortality in the country. https://www.cardiologymedjournal.com/articles/jccm-aid1197.pdf Research Article Association Between Electrocardiographic Abnormalities and In-Hospital Adverse Outcome in COVID-19 Patients Anjuman Begum*, Wadud Chowdhury, Suman KS, Arnab KC, Md. Akteruzzaman, Barua Sushanta 2024-10-10 16:45:11 Background: SARS-CoV-2 is increasingly recognized for its cardiovascular complications. To address the knowledge gap in our region, this study investigated the relationship between electrocardiographic (ECG) features and in-hospital mortality among COVID-19 patients.Methods: A prospective cohort study was conducted involving 140 RT-PCR-confirmed COVID-19 patients at Dhaka Medical College Hospital from August 2021 to July 2022. Patients were divided into two groups based on ECG findings: normal (Group A) and abnormal (Group B). Clinical data and ECG parameters were analyzed using SPSS 24.0.Results: Patients with abnormal ECGs were older, more likely male, and presented with higher rates of dyspnea and palpitations. They were also at increased risk of severe COVID-19 and had longer hospital stays. In-hospital mortality was significantly higher in Group B (21.4% vs.4.3%). ST-T changes and atrial fibrillation were associated with increased mortality. Independent predictors of in-hospital mortality included ECG abnormalities and admission SpO₂ < 90%.Conclusion: ECG abnormalities are significantly associated with adverse outcomes in COVID-19 patients. Further large-scale studies are warranted to strengthen these findings. https://www.cardiologymedjournal.com/articles/jccm-aid1196.pdf Observational Study Poor Diet Leading to the Increasing Risk of Atherosclerosis in the World Bijaya Bhusal* 2024-09-03 10:03:28 Atherosclerosis Ischemic Cardiovascular Disease (ASICD), one of the leading causes of global deaths, is mainly caused due to the development of plaque on the inner walls of arteries of the human heart. Ischemia refers to the lack of enough oxygen (O2), nutrient delivery, and improper waste removal in the cardiac cells. About 90% of cardiovascular diseases in the present world are due to the formation of lipid/cholesterol-based plaques that can form under the lining of the smooth epithelial blood cells. In the US, a study published in the Journal of the American College of Cardiology estimated that poor diet is responsible for about 45% of Cardiovascular Disease. Atherosclerosis doesn’t cause much effect until and unless the plaque becomes unstable due to the accumulation of thrombus that shows Acute Coronary Syndrome. Acute Coronary Syndrome is the result of blockage of blood vessels leading to Myocardial Infarction (Unstable Angina Pectoris). Cardiac Cells require a sufficient amount of Oxygen to function properly. Thus, the demand and supply of oxygen to the cardiac cells should be properly balanced. Atherosclerosis Ischemic Cardiovascular syndrome can worsen if the person is more involved in exercise or emotional stress because at that time their body requires higher oxygen but blood flow gets disrupted due to the formation of plague. Later in the paper, we will discuss the New York Heart Association classification, followed by the top 3 poor diets that are considered to be increasing the cases of cardiovascular disease around the world. https://www.cardiologymedjournal.com/articles/jccm-aid1195.pdf Observational Study Prescribing Inertia or Not? Quantitative Investigation of Loop Diuretics Prescribing after Palliative Care Consultation among Patients with Heart Failure Zidong Zhang*, William Frick, Leslie Hinyard, Divya S Subramaniam 2024-08-27 17:00:32 Purpose: Loop Diuretics (LD) are the first-line pharmacotherapy to address Heart Failure (HF)-associated edema and dyspnea. However, LD causes frequent urinary, resulting in inconvenience and possibly undermining the quality of life. While prescription adjustment is an essential part of Palliative Care Consultation (PCC), it remains unclear how PCC affects the deprescribing of diuretics for adults with HF. Methods: We conducted a pre-post analysis of the percentage of HF patients who were prescribed LD in a national Electronic Health Record (EHR) database 12 months before and after the first PCC. The difference in prescription rates between the periods was determined. Adjusted associations of post-PCC LD prescription with pre-PCC LD prescription and patient’s characteristics, insurance, provider type, and clinical factors were quantified.Results: From 2010 to 2018, 5,969 patients with newly diagnosed HF received at least one PCC, among whom 2,539 (42.5%) were prescribed LD before and 1,552 (26.0%) after their first PCC. Despite a decrease in LD prescription rate encompassing the date of PCC, post-PCC LD prescribing was strongly associated with pre-PCC prescribing (aOR[95%CI] 3.2[2.8,3.7]) and varied by age at first PCC, year of HF diagnosis (aOR[95%CI] 2.1[1.9,2.4]) and months from HF diagnosis to first PCC. While our finding demonstrates reduced polypharmacy associated with PCC, the strong association between pre- and post-PCC indicates reverse therapeutic inertia. Future research should investigate the benefits and costs of polypharmacy among specific patient groups to help develop personalized treatment for HF. https://www.cardiologymedjournal.com/articles/jccm-aid1194.pdf Research Article Awareness of Myocardial Infarction in Nangarhar Residents: A Community Based Study Akmal Shams, Ikramullah Ibrahimi*, Hayatullah Ahmadzai 2024-08-27 16:57:09 Myocardial infarction is the leading cause of morbidity and mortality worldwide. The overall aim of the study was to evaluate community awareness about myocardial infarction.It was a community-based cross-sectional study conducted during one month including both male and female participants aged 18 years and over in Nangarhar province of Afghanistan. The percentage of awareness for risk factors was as follows: Diabetes (56.4%), Hypertension (43.4%), Elderly (42.1%), Obesity (39.8%), Physical inactivity (38.5%), Hyperlipidemia (37.6%), and Family history (33.8%). Furthermore, knowledge about symptoms and signs was as the following: chest pain (67.4%), pain in neck and jaw (57.8%), Dyspnea (50.7%), pain in arms (46.1%), weakness/fainting (40.1%), cold sweats (38.2%), nausea and vomiting (34.5%), anxiety (29.6%), fever (22.7%), hypotension/shock (20.1%), and silent myocardial infarction (11.3%). Moreover, 24% of participants did not know about the prevention strategies for myocardial infarction. Regarding treatment, 80.3% of participants exactly knew to go to the emergency room, 11.9% of participants would intend to go to a general practitioner (GP), 5.6% of participants would ask others for advice on what to do, and 2.2% of participants would wait to see if the symptoms go away spontaneously or if the symptoms were due to other diseases. The current awareness level about myocardial infarction especially atypical symptoms, risk factors, prevention, and treatment strategies in Nangarhar residents was insufficient, especially in females and healthy individuals, and warrants designing and implementing immediate awareness programs in order to avoid delay of treatment-seeking, misbeliefs about the disease and subsequent morbidity and mortality. https://www.cardiologymedjournal.com/articles/jccm-aid1193.pdf Case Report Contrast Echocardiography for the Detection of a Giant Right Coronary Artery Aneurysm: A Useful Diagnostic Tool Fabrizio De Rosa*, Granit Rabia 2024-08-22 17:49:00 Coronary artery aneurysm is an uncommon condition defined as abnormal dilatation of the coronary artery.We report the case of a man admitted to the Emergency Department for suspected intestinal obstruction. At abdominal/thoracic Computed Tomography (CT) it was reported a suspected pericardial cyst. Contrast echocardiography showed a clear pattern of blood flow inside the mass with a probable origin at a very limited region where it was also possible to sample an ECG-synchronized system-diastolic Pulse-Wave (PW)-Doppler pattern, typical for a coronary artery flow. Our suspicion of a giant coronary artery aneurysm was then confirmed by coronary CT and coronary angiography. The patient was transferred to a Cardiac Surgery center where he underwent surgical treatment for the aneurysm.Most coronary aneurysms are clinically silent and are often incidentally detected. Coronary angiography is the ‘‘gold standard’’ for diagnosis and evaluation of coronary artery aneurysms. Among non-invasive diagnostic techniques, Computed Tomography Coronary Angiography is the best method for coronary artery anatomy and coronary abnormalities. However, echocardiography with the use of a contrast agent, a cost-effective non-radiation nature, and a widespread use method, maybe a reliable method to detect and characterize the masses, allowing a differential diagnosis.Learning objective1.    Recognition and evaluation of cardiac masses require first-line imaging methods such as echocardiography.2.    The use of additional non-invasive (cardiac CT or MRI) and/or invasive imaging methods are often required. 3.    Contrast echocardiography may be helpful, as second-line imaging methods, to better characterize the mass and approach the correct diagnosis. https://www.cardiologymedjournal.com/articles/jccm-aid1192.pdf Research Article Defibrillation of Atrial Fibrillation is not Associated with Increased Risk of Ventricular Fibrillation – The VCD-Trial (Clinical Trial of Electrical Therapy for Atrial Fibrillation using R-wave Guided Cardioversion Versus Defibrillation) Christian Keller*, Martina Gercken, Jens Hagemeister, Martin Hellmich, Uta Hoppe, Damian Franzen 2024-08-19 15:34:44 Background: Because of a possible risk of induction of Ventricular Fibrillation (VF) by defibrillation of atrial fibrillation (AF) postulated by LOWN and coworkers, synchronized cardioversion is used worldwide. This prospective, randomized study assessed the efficacy and safety between R-wave controlled cardioversion and defibrillation of AF at 2 study centers in Cologne, Germany. Hypothesis: Defibrillation is not significantly different from cardioversion primarily in the occurrence of VF or sustained Ventricular Tachycardia (VT) and secondarily in restoring sinus rhythm, inducing non-sustained VT, asystole, or bradycardia.Methods: 146 patients at an outpatient practice and 122 at the university hospital were randomized to cardioversion (n = 140) or defibrillation (n = 124).Results: Cardioversion was successful in 92.1% of cases and defibrillation in 87.1%. The difference in efficacy was not statistically significant. In n = 1 patients receiving defibrillation, VF occurred after the first shock (200J) and immediate defibrillation (200J) restored sinus rhythm. In the n = 1 case, asystole occurred during cardioversion which terminated spontaneously. In n = 1 patients cardioverted and n = 2 who were defibrillated, sinus bradycardia occurred requiring Atropine in two cases. There were no thromboembolic events within 10 days. N = 9 patients reverted to AF within two hours. No patients died. Conclusion: Electrical conversion of AF can be performed with similar results and low risk with both R-wave-triggered cardioversion and defibrillation. In particular, defibrillation with higher energies (> 100J) can be performed as effectively and safely without a statistically significant increased risk of VF or VT. There was no difference in efficacy and risk between electrotherapy performed in the outpatient and inpatient settings. https://www.cardiologymedjournal.com/articles/jccm-aid1191.pdf Case Presentation Single Coronary Artery Associated with an Arteriovenous Communication: An Incremental Diagnostic Value of Coronary CTA Rabih Touma*, Karan T Singh, Ramanjit Kaur, James F Mastromatteo, Aiden Abidov 2024-08-12 11:25:21 Single coronary artery and coronary arteriovenous communication are rare congenital cardiac anomalies with potentially harmful effects, making the diagnosis essential for the appropriate management. The coexistence of these two anomalies is exceptional. We present a case illustrating the diagnostic power of Coronary CTA in depicting this unusual combination. https://www.cardiologymedjournal.com/articles/jccm-aid1190.pdf Mini Review Required Elements for Next-generation Prognostic Index beyond Left Ventricular Ejection Fraction in Heart Failure Shiro Hoshida* 2024-08-12 11:21:29 Many reports are showing no differences in prognosis between patients with Heart Failure (HF) with preserved and reduced ejection fraction. All-in-one analysis with a multivariable model, including clinical characteristics, blood test, comorbidity, and echocardiographic indices, on clinical outcomes in patients with HF has not been performed rarely in previous studies. We have to accept the need to be more comprehensive in the outcome analysis of patients with HF and consider the intricate interplay of multiple variables in patient outcomes. https://www.cardiologymedjournal.com/articles/jccm-aid1189.pdf Case Report Imaging Challenge in Recurrent Spontaneous Coronary Artery Dissection (SCAD): A Case Report Giovanni Martino*, Mario Leporace*, Francesco Greco, Rossella Quarta, Letizia Romano, Antonio Curcio, Alberto Polimeni 2024-08-08 11:51:28 Spontaneous Coronary Artery Dissection (SCAD) represents a significant cause of acute coronary syndrome (ACS) in patient populations with low-risk cardiovascular profiles and, therefore can be sometimes underdiagnosed. On the other hand, it often preserves the typical clinical presentation of ACS which makes coronary artery angiography (CAG) execution mandatory. A 62-year-old woman with a history of recurrent SCAD presented to the emergency department for a new episode of acute chest pain with troponin elevation. CAG revealed an ambiguous angiography image suggesting a sub-occlusive type 2 SCAD involving the distal segment of the left circumflex artery. The patient was managed conservatively due to the absence of ongoing ischemia or hemodynamic instability. At the seven-day follow-up, a computed tomography coronary angiography (CTCA) was performed to better assess SCAD and detect concomitant associated arteriopathies. Optimized medical therapy was prescribed at the discharge and at one-month follow-up, no recurrence of symptoms was referred. https://www.cardiologymedjournal.com/articles/jccm-aid1188.pdf Research Article Improving Cardiac Rehabilitation Referral Rates in Patients with Coronary Heart Disease from Diverse Communities Using an Electronic Order System Alexandra Maloof*, David Torres Barba, Santiago Ramirez Nuño, Nainjot K Bains, Ignacio A Zepeda, Armando Gallegos, Hyeri You, Wesley Thompson, Jia Shen, Robert El-Kareh, Luis R Castellanos 2024-06-29 10:56:12 Introduction: Despite the benefits of Cardiac Rehabilitation (CR), local and national CR referral and participation rates remain low when compared to established cardiovascular therapies, especially amongst racial/ethnic groups. Objectives: This study investigated the effects of the implementation of a CR program and electronic order set (EOS) in a large health system on CR referral and participation rates among a diverse group of patients with Coronary Heart Disease (CHD). Methods: A total of 360 patients from UCSD Health who presented with ACS were prospectively evaluated during initial hospitalization and 6- and 12-weeks post-discharge. The multivariable logistic regression model assessed referral and participation rates by week 1 and -12 post-discharge, adjusting for gender, age, race, ethnicity, geography, and referring physician subspecialty. Results: UCSD CR program implementation led referral rates to increase at week 1 (Pre- 38.6% and Post-54.9%, p = 0.003) and week-12 (Pre- 54.1% and Post- 59.8%, p = 0.386). Post-CR referrals were more likely at week-1 (OR: 1.93, 95% CI 1.27-2.95) and week-12 (OR: 1.26, 95% CI 0.79-2.00). EOS implementation increased referral rates at week-1 (Pre- 40.3% and Post- 58.7%, p < 0.001) and week-12 (Pre- 54.9% and Post- 60.4%, p = 0.394) with referrals more likely at week-1 (OR: 2.1, 95% CI 1.35-3.29) and week-12 (OR: 1.25, 95% CI 0.795-1.98). Participation in CR following EOS was more likely at both week-1 and week-12. Multivariable analysis revealed disparities in referral based on race, geographic location, and referring physician subspecialty. Conclusion: A CR program and EOS implementation were shown to increase referral rates with long-term potential for increasing referral and participation rates. Condensed abstract: This prospective study investigated the implementation of a Cardiac Rehabilitation (CR) program and Electronic Order Set (EOS) within the same health system on CR referral and participation rates. 360 patients with ACS were evaluated over 12 weeks. UCSD CR program and EOS implementation led referral rates to increase at week-1 and -12. CR participation was more likely to increase at week-1 and -12 following EOS. Multivariable analysis revealed disparities in referrals disproportionally affecting racial and ethnic minority groups and rural communities. CR and EOS implementation may increase CR referral rates for diverse patients with CHD. https://www.cardiologymedjournal.com/articles/jccm-aid1187.pdf Research Article Descriptive Study of the Urinary Tract Infections in Patients Admitted in the Cardiology Ward of Afghan Momand Medical Complex Shams Akmal, Ibrahimi Ikramullah*, Agha Said Asif 2024-06-28 10:52:02 Urinary Tract Infection (UTI) is very common in our community most specifically in married females with numerous antecedent risk factors. The aim of the study was to find out about the current risk factors and clinical profile of urinary tract infections in patients admitted to the cardiology ward of Afghan Momand Medical Complex for various purposes.It was a cross-sectional descriptive hospital-based study including both male and female patients visiting the Afghan Momand Medical Complex from January 2022 to June 2022. Of all 960 patients, 202 (21%) patients had urinary tract infections with gender distribution as 69 (34.2%) males and 133 (65.8%) females. In fact, 33 (16.3%) patients with urinary tract infections were single while the rest 169 (83.7%) patients were married. In addition, regarding clinical profile, the following clinic was respectively more prevalent: Dysuria in 120 (59.4%) patients, flank pain in 73 (36.1%) patients, urine frequency in 67 (33.1%) patients, urgency in 36 (17.8%) patients, fever in 24 (11.8%) patients, and nausea and vomiting in 19 (9.4%) patients. Moreover, the following risk factors were respectively the most common ones: Diabetes mellitus 86 (42.5%), pregnancy 30 (14.9%), stones 15 (7.4%), 10 (4.9%) devices, 10 (4.9%) prostatic hyperplasia, and 4 (2%) anatomical anomalies.Urinary tract infection is a common disease in the admitted patients in Afghan Momand Medical Complex specifically being more common in females and early 20s of the age. In fact, diabetes, pregnancy, and kidney stones were the leading associated factors with UTI. Moreover, dysuria, bladder emptying irritative symptoms, and abdominal pain were the most prevalent clinical profile of the patients. Special attention should be paid to infectious diseases in cardiac patients since infection itself is a stress and a threat to such patients and authorities should design special measures to prevent UTI in the general population to avoid a sum of burden on the health system. https://www.cardiologymedjournal.com/articles/jccm-aid1186.pdf Case Report Utilizing Smartphone ECG for Early Detection and Management of Ischemic Heart Disease: A Case Report Yogendra Singh, CB Pandey, Nitin Chandola*, Deeksha Agarwal 2024-06-24 10:46:09 Ischemic Heart Disease (IHD) remains a significant cause of morbidity and mortality worldwide. We present a case report of a 54-year-old individual presenting with symptoms suggestive of IHD, including palpitations and chest heaviness. Utilizing a Spandan device at home, the patient detected anteroseptal and lateral wall ischemia, prompting consultation with a cardiologist. Subsequent diagnostic evaluations revealed Left Ventricular Hypertrophy (LVH), concentric LVH, regional wall motion abnormality, and Grade I diastolic dysfunction. Hypertension and dyslipidemia were identified as prominent risk factors, with additional findings of carotid artery disease. Management strategies included antihypertensive medications, lipid-lowering therapy, and lifestyle modifications. This case underscores the complexity of diagnosing and managing IHD, highlighting the importance of comprehensive assessment and multidisciplinary care in optimizing patient outcomes. https://www.cardiologymedjournal.com/articles/jccm-aid1185.pdf Research Article Percutaneous Closure of Post-myocardial Infarction Ventricular Septal Rupture-experience From a Resource-limited Setup From Eastern Part of India Siddhartha Saha* 2024-06-20 10:22:50 Background: Post-infarction ventricular septal rupture (VSR) is a rare but lethal mechanical complication of an acute myocardial infarction (AMI). It results in 90% - 95% mortality within two months of diagnosis without any kind of intervention. Given high surgical mortality, transcatheter closure has emerged as a potential strategy as an alternative to high-risk surgical closure. Indian data on percutaneous device closure of post-AMI-VSR is limited hence we report our resource-limited single-centre experience with different kinds of occluder devices for closure of post-AMI VSR.Methods and results: In this single-centre, retrospective, cohort study, patients who underwent transcatheter closure of post-MI VSR between 2018 and 2024 at Health World hospitals, in Durgapur, West Bengal, were included. The primary outcome was a mortality rate of 30 days. The study population was eleven primary cases of post-MI VSR. The mean age of the population was 61 years. The majority of the patients had anterior wall MI (54.5%) and the remaining had inferior wall MI.  Different kinds of devices (ASO, PostMI VSD device, Konar MFO) were used to close VSR. Successful closure was performed in 9 patients (81%) with minimal residual shunt in 2 patients. Out of 9 cases 3 patients expired, one was lost to follow up and the rest are doing well at 30 days follow-up. Conclusion: Transcatheter closure of PMIVSRs can be performed with different kinds of devices with high technical success, relatively low procedural complication rates, and 30 days survival even in a resource-limited setup as an alternative to high-risk surgical closure. https://www.cardiologymedjournal.com/articles/jccm-aid1184.pdf Prospective Outcome of Patients Presenting with Peripartum Cardiomyopathy in a Tertiary Care Center of Nepal Smriti Shakya*, Ratna Mani Gajurel, Chandra Mani Poudel, Hemant Shrestha, Surya Devkota, Sanjeev Thapa, Bhawani Manandhar, Rajaram Khanal, Suraj Shrestha, Manju Sharma 2024-05-29 14:11:35 Purpose: Peripartum cardiomyopathy is a rare life-threatening cardiomyopathy of unknown etiology with significant maternal morbidity and mortality. It causes heart failure due to left ventricular systolic dysfunction with or without left ventricular dilatation in the last month of pregnancy up to 5 months postpartum in previously healthy women. We aimed to determine short-term outcomes of peripartum cardiomyopathy clinically as well as in terms of left ventricular systolic function and to study the clinical profile and associated risk factors.Patients and methods: A prospective observational study was carried out in the Department of Cardiology of Manmohan Cardiothoracic Vascular and Transplant Center, Institute of Medicine, Kathmandu, Nepal, from July 2018 to January 2022. All the patients with peripartum cardiomyopathy who presented to the department of cardiology were enrolled in the study and re-evaluated with echocardiography at 6 months.Results: A total of 68 women met the inclusion criteria. The mean age was 28.38 ± 5.5 years (range 19 to 44 years). The most common clinical presentation was dyspnea followed by lower limb edema. Six (8.8%) patients presented during the last month of pregnancy whereas 62 (91.2%) patients presented in the postpartum period. The mean left ventricular ejection fraction on presentation was 30.01 ± 8.54. A full recovery was observed among 60.29% at 6 months. The mortality rate was 4.41%.Conclusion: Timely diagnosis and management of peripartum cardiomyopathy with standard therapy for heart failure leads to better recovery of left ventricular systolic function. https://www.cardiologymedjournal.com/articles/jccm-aid1183.pdf Case Series Non-surgical Techniques for Combined Rheumatic Severe Aortic and Mitral Stenosis – Case Series and Brief Review of Literature Uma Devi Karuru, Sadanand Reddy Tummala*, Naveen T, Kiran Kumar Kanjerla, Gautam PS, Sai Kumar Mysore 2024-05-13 15:36:15 Rheumatic heart disease persists as a significant concern in developing regions, often resulting in multivalvular heart conditions. Treatment options are limited, though percutaneous transvenous mitral commissurotomy effectively addresses rheumatic mitral stenosis. Non-surgical interventions for aortic stenosis include balloon aortic valvotomy and Transcatheter aortic valve replacement (TAVR), tailored to patient factors like age and comorbidities.We describe two cases of Rheumatic multivalvular disease which were managed non-surgical. The first case is a pioneering procedure performed on a young patient combined percutaneous transvenous mitral commissurotomy with balloon aortic valvotomy, guided by 4-dimensional transoesophageal echocardiography (4D TEE). This represents the first documented instance in medical literature, showcasing the potential of integrated interventions and advanced imaging techniques. In the second challenging case involving a heavily calcified, retrovirus, and Hepatitis B positive 55-year-old, a staged approach was adopted, involving percutaneous transvenous mitral commissurotomy followed by Transcatheter aortic valve replacement (TAVR). Despite complexities, this sequential strategy demonstrates the adaptability of transcatheter techniques in managing complex valvular pathologies. These cases highlight the evolving landscape of interventional cardiology and underscore the importance of tailored, multidisciplinary approaches in optimizing outcomes for patients with rheumatic heart disease and multivalvular involvement, especially in resource-limited settings. Further exploration and dissemination of such innovative strategies hold promise for enhancing cardiac care quality and expanding treatment options globally. https://www.cardiologymedjournal.com/articles/jccm-aid1182.pdf Research Article Chronic Ethanol Decreases the Left Ventricular Cardiac Performance Camargo VMB*, Damatto FC, Fioravante VC, Godoi AR, Stoppa EG, Okoshi MP, Okoshi K, Miranda JRA, Martinez FE 2024-04-15 11:08:03 Introduction: Spaced fiber bundles, less evident cell striations, deposition of collagen fiber bundles, and increased presence of fibroblasts in the cardiac tissue of rats that voluntarily and chronically ingested ethanol were observed by our research group. In addition, we observed increased proliferation and cell death of cardiomyocytes. To find out whether these changes lead to impaired heart functionality, some clinical tests were performed. Aim: to investigate whether chronic ethanol decreases the left ventricular performance assessed by exercise testing, electrocardiogram, and echocardiogram of male and female UChB strain rats. Material and methods: ten adult males and ten adult females, Wistar strain rats, named UChB (University of Chile), spontaneous high ethanol drinkers (consumption greater than 2 g ethanol / Kg body weight/day), and ten male UChB rats and ten adults female UChB rats, not exposed to ethanol, UChBC rats (controls) were used. Cardiac performance was evaluated by the stress test, electrocardiogram, and echocardiogram. Results: Exposed females showed ventricular morphological changes in the heart. The exposed females and males had the highest heart relative weight with females being larger than males. The exposed females showed altered electrocardiogram and echocardiogram. Conclusion: Chronic ethanol decreases the left ventricular cardiac performance in rats. Females are more sensitive to changes in cardiac electrical conduction. https://www.cardiologymedjournal.com/articles/jccm-aid1181.pdf Case Report A Complex Case with a Completely Percutaneous Solution: Treatment of a Severe Calcific Left Main in a Patient with Low-Flow Low-Gradient Aortic Stenosis Renatomaria Bianchi*, Giovanni Marco Esposito, Giovanni Ciccarelli, Donato Tartaglione, Paolo Golino 2024-04-02 11:45:14 Background: This case study explores an integrated approach to managing a complex cardiac condition, presenting a comprehensive single-session intervention. This includes balloon valvuloplasty using a Nucleus 18 mm balloon, complex angioplasty with rotational atherectomy (rotablator) targeting calcified lesions in the left main and left anterior descending artery, and Transcatheter Aortic Valve Implantation (TAVI) with a 23 mm Sapien 3 valve, all performed on an 81-year-old woman. Furthermore, this report underscores the strategic left atrial appendage closure conducted three months post-procedure due to the patient’s elevated hemorrhagic risk.Case presentation: Facing critical coronary and valvular pathologies, the patient underwent a meticulously planned, single-session intervention. The process began with a balloon valvuloplasty using a Nucleus 18 mm balloon to address the aortic stenosis. This was followed by a high-risk angioplasty, during which the Impella CP device provided hemodynamic support and rotational atherectomy was employed to address the calcified coronary artery disease effectively. The same session saw the successful execution of TAVI using a 23 mm Sapien 3 valve. The comprehensive approach notably diminished procedural complications, illustrating the benefits of an integrated treatment pathway in managing high-risk patients. Three months later, the patient underwent a left atrial appendage closure, a critical move considering her high risk of hemorrhage. This procedure also provided an opportunity to assess the favorable outcomes of the previous angioplasty.Conclusion: This case validates the feasibility and efficacy of performing multiple advanced percutaneous interventions in a single session for high-risk cardiac patients. It underscores the crucial role of innovative and personalized treatment strategies in improving patient outcomes, particularly in complex clinical scenarios. Moreover, the case exemplifies the essential relationship between immediate, comprehensive intervention and subsequent follow-up procedures in ensuring optimal long-term patient care. https://www.cardiologymedjournal.com/articles/jccm-aid1180.pdf Case Report Diagnosing Peripartum Cardiomyopathy in a Resource-Limited Setting, a Clinical Perspective: Case Report Tyfur Rahman*, Kazi Nazratun Nomany Tahia 2024-03-29 14:12:22 Peripartum cardiomyopathy is a rare case of heart failure with reduced ejection fraction and is considered a diagnosis of exclusion. The symptoms of heart failure in patients with peripartum cardiomyopathy can mimic the physiologic conditions of normal pregnancy. In an acute decompensated state, PPCM can present with acute severe upper abdominal or epigastric pain. We are presenting a 24-year-old female with no personal or family history of heart disease and no identifiable risk factor for PPCM. Based on her initial presentation in the emergency department, a diagnosis of acute severe pancreatitis was sought, and she was referred to the Intensive Care Unit. After further evaluation of the serological tests and imaging, she was eventually diagnosed as a case of PPCM. We emphasize the rare nature of the disease with a diverse presentation which poses a diagnostic challenge, especially in a resource-limited setting where advanced diagnostic tools may be restricted and socioeconomic condition poses a barrier to further patient evaluation. This case exemplifies the infrequent occurrence and atypical manifestation, presenting a learning opportunity for future clinicians. https://www.cardiologymedjournal.com/articles/jccm-aid1179.pdf Review Article The Ketogenic Diet: The Ke(y) - to Success? A Review of Weight Loss, Lipids, and Cardiovascular Risk Angela H Boal*, Christina Kanonidou 2024-03-06 12:55:02 Background: Obesity remains a global epidemic with over 2.8 million people dying due to complications of being overweight or obese every year. The low-carbohydrate and high-fat ketogenic diet has a rising popularity for its rapid weight loss potential. However, most studies have a maximal 2-year follow-up, and therefore long-term adverse events remain unclear including the risk of Atherosclerotic Cardiovascular Disease (ASCVD).Results: Based on current evidence on PubMed and Google Scholar, there is no strong indication ketogenic diet is advantageous for weight loss, lipid profile, and mortality. When comparing a hypocaloric ketogenic diet with a low-fat diet, there may be faster weight loss until 6 months, however, this then appears equivalent. Ketogenic diets have shown inconsistent Low-Density Lipoprotein (LDL) changes; perhaps from different saturated fat intake, dietary adherence, and genetics. Case reports have shown a 2-4-fold elevation in LDL in Familial hypercholesterolaemic patients which has mostly reversed upon dietary discontinuation. There is also concern about possible increased ASCVD and mortality: low (< 40%) carbohydrate intake has been associated with increased mortality, high LDL from saturated fats, high animal product consumption can increase trimethylamine N-oxide, and cardioprotective foods are likely minimally ingested.Conclusion: Ketogenic diets have been associated with short-term positive effects including larger weight reductions. However, by 2 years there appears no significant differences for most cardiometabolic risk markers. Therefore, this raises the question, excluding those who have a critical need to lose weight fast, is this diet worth the potentially higher risks of ASCVD and mortality while further long-term studies are awaited? https://www.cardiologymedjournal.com/articles/jccm-aid1178.pdf Research Article Rida Herbal Bitters Improve Cardiovascular Function in High-fat Diet/Streptozotocin-induced Diabetic Rats Folasade Omobolanle Ajao*, Damilola Ayodeji Balogun, Marcus Olaoy Iyedupe, Ayobami Olagunju, Esther Oparinde, Luqman Adeniji, Victor Abulude and Funmilayo Elizabeth Olaleye 2024-02-28 17:01:04 Background: Effective medication to manage diabetes mellitus-related organ complications with minimal adverse drug toxicity is still in pursuit by scientists worldwide. This study investigated the cardio-protective of Rida herbal bitter (RHB) in a high-fat diet/streptozotocin (STZ)-induced diabetic rats.Methods: Thirty-two matured male Wistar rats (250 ± 20g) were used. The animals were fed with high-fat diet (HFD) for 6 weeks before diabetes induction. A single dose of (35 mg/kgb.wt) freshly prepared STZ was injected intraperitoneally to induce diabetes. The animals were allocated into four groups, 8rats/group. Group I: control; Group II: HFD/STZ-induced diabetic rats; Groups III & IV: HFD/STZ-induced diabetic rats treated with 0.3 ml RHB & 200 mg/kgb.wt metformin respectively. At the end of the experiment, the animals were sacrificed, blood was sample collected via cardiac puncture and the heart was excised and homogenized. The blood samples and cardiac homogenates tissue were centrifuged to retrieve clear supernatant plasma for biochemical assay.Results: Diabetic rats exhibited significant (p < 0.05) elevated blood glucose, insulin, glycated hemoglobin (HbA1c), cardiac biomarkers, lipid profile, malondialdehyde (MDA), pro-inflammatory cytokines, food, and water intake levels with a reduction in body weight, cardiac antioxidant activity, and total protein. RHB administration significantly (p < 0.05) diminished the blood glucose, insulin, HbA1c, cardiac biomarkers, MDA, pro-inflammatory cytokines, lipid profile, food, and water intake, and improved the body weight cardiac antioxidant activity, and total protein.Conclusion: Rida herbal bitter possesses a cardio-protective effect from this study and could be a better alternative medication for managing diabetes and its related cardiovascular complications. https://www.cardiologymedjournal.com/articles/jccm-aid1177.pdf Research Article Calcium Scoring on CT Coronary Angiography in Hypertensive Patients as a Criterion for the Prediction of Coronary Artery Disease Eleni Tserioti, Harmeet Chana, Abdul-Majeed Salmasi* 2024-02-19 15:23:40 Introduction: Hypertension is the strongest independent predictor of Coronary Artery Disease (CAD) identified by Computed tomography of coronary arteries (CTCA). In this study, CTCA-assessed Coronary Calcium Scoring (CCS) was studied in hypertensive subjects referred for CTCA.Methods: After excluding TAVI and graft assessment patients, the individual electronic health records of 410 consecutive patients who underwent CTCA between July and November 2020, were reviewed with a mean age of 58.7 years. Risk factors were recorded including smoking (38%), hyperlipidaemia (33%), positive family history (22%), systemic hypertension (48%), diabetes mellitus (30%), and male gender (46%). Referral criteria, ethnicity, cardiac, and past medical history were recorded. Patients were stratified into four groups according to CAD severity: absent, mild, moderate, and severe disease, as seen on CTCA. The mean CCS for each CAD category was compared between hypertensive and non-hypertensive patients. Mean CCS were further compared according to the number of coronary arteries affected and the severity of CAD in each artery. Results: Out of all CTCA reports, 200 (48.8%) CCS were interpreted in the very low-risk category, 80 (19.5%) low risk, 58 (14.1%) moderate risk, 23 (5.6%) moderately high risk and 49 (12.0%) high risk. A significant difference in mean CCS and CAD severity was observed between mild, moderate, and severe CAD (p = 0.015 and p < 0.001). Comparison of CCS between hypertensives and non-hypertensives, across the four CAD severity categories, revealed a significant difference in mean CCS in the severe CAD category (p = 0.03). There was no significant difference in the CCS between hypertensives with chest pain and hypertensives without chest pain. A higher number of affected coronary arteries was associated with a higher mean CCS and a significant difference in CCS was observed between hypertensive and non-hypertensive subjects for the number of arteries affected. Similar results were observed when comparing mean CCS in moderate-severely affected coronary arteries.Conclusion: Hypertensive patients with a high CCS were associated with a higher incidence of severe CAD independent of the presence of chest pain. These results suggest that the incorporation of CCS in the investigation of CAD on CT angiography may pose a powerful adjunct in proposing an alternative paradigm for the assessment of patients with hypertension, in the progress of coronary artery disease.  https://www.cardiologymedjournal.com/articles/jccm-aid1176.pdf Retrospective Study Impact of Chronic Kidney Disease on Major Adverse Cardiac Events in Patients with Acute Myocardial Infarction: A Retrospective Cohort Study Abbas Andishmand, Ehsan Zolfeqari*, Mahdiah Sadat Namayandah, Hossein Montazer Ghaem 2024-02-05 11:57:17 Background: Acute Myocardial Infarction (AMI) results in a reduction in patients’ life expectancy. Different risk factors affect the risk of Major Adverse Cardiac Events (MACE). Although the role of kidney dysfunction in patients with Chronic Kidney Disease (CKD) in cardiac events has been identified, many patients with AMI are unaware of their underlying kidney disease. This study aimed to compare the incidence of adverse cardiovascular events and identify predictors of major adverse cardiovascular events in the medium term among patients with and without renal dysfunction following AMI. Methods: This retrospective cohort study was conducted on 1039 patients who were hospitalized for Acute Myocardial Infarction (AMI) between 2018 and 2019. The patient cohort comprised 314 women (mean age: 69.8 ± 13.2 years) and 725 men (mean age: 60.5 ± 13.8 years). Patient data were obtained from the registry of patients with acute myocardial infarction and the participants were followed up for a minimum of one year following hospital discharge to assess the incidence of MACE.Results: The study found that patients with a Glomerular Filtration Rate (GFR) level below 60 had a significantly higher mortality rate than those with a GFR level of 60 or above (15.7% vs. 3.5%,p < 0.0001). The multivariate analysis showed that Diabetes Mellitus (DM), GFR, and Non-ST Elevation Myocardial Infarction (NSTEMI) are significant risk factors for cardiovascular events. (p = 0.016, p = 0.015, p = 0.006 respectively), while variables such as sex, age, and Hypertension (HTN) were not significant risk factors. There was a negative correlation between GFR and death (0.241 - = r, p < 0.0001)Conclusion: This study highlights the importance of detecting kidney disease during an AMI and managing risk factors for cardiovascular disease to improve health outcomes and reduce the risk of mortality. https://www.cardiologymedjournal.com/articles/jccm-aid1175.pdf Case Report Persistent Bilateral Vocal Cord Paralysis Following Unilateral Basal Ganglia Hemorrhage Nikil Joseph John, John Thomas*, Martyn Bracewell 2024-01-18 14:35:35 Post-stroke vocal cord paralysis is a condition much less recognized compared to dysphagia. We describe bilateral vocal cord palsy in a thirty-six-year-old man following a stroke.  https://www.cardiologymedjournal.com/articles/jccm-aid1174.pdf Review Article Aspirin for Primary Prevention of Cardiovascular Disease: What We Now Know Steven M Weisman,Dominick J Angiolillo 2024-01-09 12:39:41 Cardiovascular disease (CVD), including coronary artery disease and stroke, is the leading cause of death worldwide. Advances in primary and secondary prevention of CVD have improved patient prognoses and outcomes, however, it is imperative that the clinician and patient engage in early risk factor screening and preventive management of modifiable risk factors for CVD. In addition to blood lipid and blood pressure lowering medications, aspirin has been a long-standing therapy targeted to the prevention of CVD based on its antiplatelet and anti-inflammatory activity. However, recent articles and reports on updates to clinical guidelines for the primary prevention of CVD have resulted in confusion about aspirin recommendations. This review aims to assess the latest guidance on aspirin in CVD prevention and how to identify appropriately at-risk patients who may benefit from low-dose aspirin therapy as part of their CVD preventive healthcare choices. Additionally, this review will provide practical application guidance about clinician-patient conversations to clearly explain the benefits and risks of aspirin use and ensure a patient-centric decision to initiate aspirin therapy. https://www.cardiologymedjournal.com/articles/jccm-aid1172.pdf Research Article The Fulcrum of the Human Heart (Cardiac fulcrum) Jorge Carlos Trainini*, Mario Wernicke, Mario Beraudo, Alejandro Trainini 2024-01-03 16:04:23 Introduction: The functional anatomy of the myocardium allows envisioning that it initiates and ends at the origin of the great vessels. In our research, we have always considered that it should have a point of attachment to allow its helical rotation to fulfill the fundamental movements of shortening-torsion (systole) and lengthening-detorsion (suction), which once found, was called the cardiac fulcrum. Materials and methods: A total of 31 hearts, arising from the morgue and slaughterhouse were used: 17 corresponded to bovids and 14 were human. Anatomical and histological studies were performed. The heart was fixed in 10% buffered formalin. Hematoxylin-eosin, Masson’s trichrome staining technique, and 4-micron sections were used for the histological study, and 10 % formalin was used as a buffer. Results: The anatomical investigations have revealed that all the hearts (bovids and humans) have myocardial support whose histological structure in the analyzed specimens presents with an osseous or chondroid-tendinous character. In this structure, which we have called the cardiac fulcrum, are inserted the myocardial fibers at the origin and end of the band, which correspond to the continuous myocardium coiled as a helix.Conclusion: This description of the fulcrum would end the problem of lack of support of the myocardium to fulfill its function of suction/ejection. https://www.cardiologymedjournal.com/articles/jccm-aid1171.pdf Research Article Value of Speckle Tracking Echocardiography in Prediction of Left Ventricular Reverse Remodeling in Patients with Chronic total Occlusion Undergoing Percutaneous Coronary Interventions Gehan Magdy*, Sahar Hamdy Azab, Yasmin Ali Esmail, Mohamed Khalid Elfaky 2023-12-28 16:39:31 Background: Revascularization procedures for chronic complete occlusion (CTO) are technically challenging but aim to improve left ventricular (LV) function. The aim of this study is to evaluate the value of global longitudinal strain (GLS) measured by 2D-speckle tracking echocardiography( 2D-STE) in the assessment of LV reverse remodeling in patients with CTO undergoing revascularization by percutaneous coronary intervention (PCI).Methods: Our study included 54 patients with CTO treated by PCI. We evaluate LV systolic function by measurement of left ventricular ejection fraction (LVEF), left ventricular end-systolic volume (LVESV), and the GLS within 24 hours before the PCI and after 3 months post-procedure. Results: The mean age of the patients was 56.65 ± 7.65 years; 74.1% were males. There was a significant improvement in the LVESV (p < 0.001), LVEF (p < 0.001), and GLS (p < 0.001) at 3 months post-PCI, and by multivariate regression analysis, the GLS was the single most significant predictor of LV reverse remodeling post revascularization (p < 0.001).Conclusion: Revascularization of coronary CTO lesions by PCI is associated with a significant improvement in regional and global LV function. The GLS measured by 2D-STE is a strong predictor of LV reverse remodeling post-CTO interventions. https://www.cardiologymedjournal.com/articles/jccm-aid1170.pdf Hypothesis Rats with Postinfarction Heart Failure: Effects of Propranolol Therapy on Intracellular Calcium Regulation and Left Ventricular Function Hari Prasad Sonwani* 2023-11-28 15:19:37 Patients with heart failure may live longer if they receive chronic treatment with beta-adrenergic blocking medications. Unresolved are the mechanisms underlying the beneficial effects and if they may be applied to ischemic heart failure. Rats (n = 28) underwent echocardiographic-Doppler exams one and six weeks following a simulated operation or myocardial infarction (MI). After the first echocardiography, rats were randomized to either no therapy or 500 mg/l of propranolol in their drinking water. The noninfected left ventricular (LV) papillary muscles were used to record isometric contractions and intracellular Ca transients simultaneously.Untreated MI rats had a restrictive LV diastolic filling pattern, decreased systolic function (13% ± 2%), and significant LV dilatation (10.6 ± 0.4 mm vs. 8.9 ± 0.3 mm, MI vs. control). The LV chamber diameters of the propranolol-treated MI rats were 10.6 ± 0.5 mm, and systolic performance (13% ± 2%). Higher LV end-diastolic pressures (27 ± 2 mmHg vs. 20 ± 3 mmHg) and a more constrained LV diastolic filling pattern (increased ratio of early to late filling velocities and faster E wave deceleration rate) were seen in the propranolol-treated animals. Papillary muscle contractility in untreated MI rats was lower (1.6 ± 0.3 g mm²). Furthermore, the inotropic response to isoproterenol was attenuated, and Ca transients were extended. During isoproterenol stimulation, beta-adrenergic blocking administration had no effect on force development (1.6 ± 0.3 g mm²) or the length of Ca transients.Rats with postinfarction heart failure receiving chronic propranolol treatment did not have improvements in systolic function or LV remodeling. Propranolol exacerbated LV diastolic pressures and filling patterns. Additionally, there was no discernible improvement in intracellular contractility following treatment, Calcium control, or beta-adrenergic sensitivity in the myocardium that is not infarcted). https://www.cardiologymedjournal.com/articles/jccm-aid1169.pdf Research Article Unmasking the Viral Veil: Exploring the Cardiovascular Intrigue of Pathogenic Infections Zahra Zahid Piracha, Syed Shayan Gilani, Muhammad Nouman Tariq, Umar Saeed, Azka Sohail, Umer Ali Abbasi, Abrisham Akbariansaravi, Muhammad Shahmeer Fida Rana, Ayesha Basra, Faizan Faisal, Madeeha Rasool, Misbah Ghazal, Mubeen Ur Rehman, Hussain Ghya 2023-11-23 12:19:58 The intricate interplay between viral infections and cardiovascular complications has garnered significant attention from 2018 to 2023. Extensive research during this period has unveiled substantial connections between various viruses and cardiovascular diseases. Notable examples include Cytomegalovirus (CMV), coxsackievirus, influenza, Human Immunodeficiency Virus (HIV), Epstein-Barr Virus (EBV), Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), as well as coxsackievirus A and B, enteroviruses, adenovirus, and parvovirus B19. These viruses exert diverse influences on cardiovascular health through various pathways, contributing to endothelial dysfunction, inflicting direct damage on cardiac tissue, and triggering inflammatory responses. The intricate interplay between viral infections and cardiovascular health underscores the importance of considering viral pathogens within the framework of cardiovascular disease development, clinical management practices, and future research initiatives. This systematic review comprehensively scrutinizes the cardiovascular impacts stemming from various viral infections, casting a revealing light on their underlying mechanisms and associated clinical implications. These valuable insights can guide clinical management strategies, preventive measures and further investigations into the complex connection between viral infections and cardiovascular diseases, emphasizing the necessity for ongoing research and vigilance in comprehending and managing these pathogen-induced cardiac manifestations. https://www.cardiologymedjournal.com/articles/jccm-aid1168.pdf Research Article Developing a Machine Learning Algorithm for Improved Management of Congestive Heart Failure Patients in the Emergency Department Karamo Bah*, Amadou Wurry Jallow, Adama Ns Bah, Musa Touray 2023-10-24 17:35:20 Background and aim: Congestive heart failure is a prevalent and serious condition that poses significant challenges in the emergency department setting. Prompt and accurate management of congestive heart failure patients is crucial for improving outcomes and optimizing resource utilization. This study aims to address these challenges by developing a machine learning algorithm and comparing it to a traditional logistic regression model that can assist in the triage, resource allocation, and long-term prognostication of congestive heart failure patients.Methods: In this investigation, we used the MIMIC-III database, a publicly accessible resource containing patient data from ICU settings. Traditional logistic regression, along with the robust XGBoost and random forest algorithms, was harnessed to construct predictive models. These models were built using a range of pretreatment clinical variables. To pinpoint the most pertinent features, we carried out a univariate analysis. Ensuring robust performance and broad applicability, we adopted a nested cross-validation approach. This method enhances the precision and validation of our models by implementing multiple cross-validation iterations.Results: The performance of machine learning algorithms was assessed using the area under the receiver operating characteristic curve (AUC). Notably, the random forest algorithm, despite having lower performance among the machine learning models still demonstrated significantly higher AUC than traditional logistic regression. The AUC for the XGBoost was 0.99, random forest 0.98, while traditional logistic regression was 0.57. The most important pretreatment variables associated with congestive heart failure include total bilirubin, creatine kinase, international normalized ratio (INR), sodium, age, creatinine, potassium, gender, alkaline phosphatase, and platelets.Conclusion: Machine learning techniques utilizing multiple pretreatment clinical variables outperform traditional logistic regression in aiding the triage, resource allocation, and long-term prognostication of congestive heart failure patients in the intensive care unit setting using MIMIC III data. https://www.cardiologymedjournal.com/articles/jccm-aid1167.pdf Research Article Association of Periprocedural Haemoglobin Reduction and Myocardial Injury in Patients with Unstable Angina Undergoing Percutaneous Coronary Intervention Sushil Kumar Bagchi*, Md Moniruzzaman, Sharifun Nahar, Md Khalequzzaman, Sanjib Chowdhury, Amal Kumar Choudhury 2023-10-23 00:00:00 Background: Patients undergoing percutaneous coronary intervention are at risk of different complications such as periprocedural bleeding and acute hemoglobin reduction that can lead to myocardial injury. Blood loss through the catheter during the procedure and through puncture site haematoma causes periprocedural acute haemoglobin drop.Objectives: To find out the association between acute haemoglobin reduction and myocardial injury after PCI in patients with unstable angina. Methods: This prospective observational study was conducted at the National Institute of Cardiovascular Diseases (NICVD) for one year of time. A total of 130 patients were enrolled based on inclusion and exclusion criteria during the study period. Haemoglobin and troponin-I were measured before and after PCI within 24 to 48 hours of the procedure. On the basis of post-procedural acute haemoglobin level, the study population was categorized into two groups: Group I patients with normal haemoglobin levels and Group II patients with significant acute haemoglobin reduction (≥ 1 gm/dl). Results: A total of 24 patients developed a periprocedural myocardial injury, among them 17 (70.8%) were in the reduced haemoglobin group and 7 (29.2%) in the normal haemoglobin group. Elevation of troponin I after PCI was higher in group II than in group I patients with a statistically significant difference. Multivariate logistic regression analysis showed that haemoglobin reduction was an independent predictor of PMI (OR 1.94; 95% CI, 1.241-8.684; p = 0.01). Conclusion: Periprocedural haemoglobin reduction in patients with unstable angina was associated with myocardial injury after percutaneous coronary intervention (PCI). https://www.cardiologymedjournal.com/articles/jccm-aid1166.pdf Case Report Preventing Coronary Occlusion in an Elderly Severe Aortic Stenosis Patient with Critically Low Coronary Heights – A Case Report Viveka Kumar* 2023-10-19 09:53:10 Background: Transcatheter Aortic Valve Replacement (TAVR) is an established treatment for severe, symptomatic Aortic Stenosis (AS). However, the presence of low coronary heights confers a high risk for coronary obstruction during or after TAVR. Case: In this case report, we present our experience with transfemoral-TAVR in an elderly, high-risk (STS score – 12.08%) female severe AS patient with low coronary heights (right: 7.4 mm, left: 8.7 mm). She had lower annulus area (287 mm2) and moderately low valve area (0.7 cm2) as well. Her mean and peak pressure gradients (PGs) were 38 mmHg and 61 mmHg, respectively. Upon the Heart Team’s evaluation, TAVR was recommended and a 20 mm Balloon Expandable (BE) Myval Transcatheter Heart Valve (THV) was selected. No peri-procedural or post-procedural complications were reported and the post-procedural hemodynamics, namely the mean and peak PGs improved to 16 mmHg and 30 mmHg after TAVR, respectively. The patient was discharged in a stable condition after four days of hospital stay.Conclusion: We report the successful implantation of a small-sized BE Myval THV (20 mm) in a patient with low coronary heights. Life-threatening complications including paravalvular leak, coronary obstruction, or annular rupture were well averted; hence, we ascertain that the Myval THV is a suitable device for treating severe AS in difficult anatomies. However, the viability of the novel valve needs to be reaffirmed in larger studies..  https://www.cardiologymedjournal.com/articles/jccm-aid1165.pdf Clinical Techniques Conduit quality control protocol in CABG Ignacio Juárez Del Río*, Enrique Villagrán Medinilla, Ali Ayaon Albarrán, Miguel Angel Rubio Alonso, Angel Aroca Peinado 2023-09-27 12:47:28 Cardiac revascularization surgery has a long history. Its results and safety are well known. Nonetheless, the long-term patency rate of certain grafts used in cardiac revascularization is non-optimal, and CABG is associated with a risk of cerebrovascular stroke due to aortic manipulation. We have developed a simple control quality protocol of the anastomosis performed in CABG, aiming to improve the long-term patency of certain grafts used in cardiac revascularization surgery and reduce the risk of cerebrovascular stroke in those patients.  https://www.cardiologymedjournal.com/articles/jccm-aid1164.pdf Research Article Correlation between the Values of Immature Platelet Fraction and Mean Platelet Volume with the Extent of Coronary Artery Disease in Patients with Non-ST-Segment Elevation Myocardial Infarction Shadab Rauf*, Tarun Kumar, Vijay Kumar, Ranjit Kumar Nath 2023-09-26 11:57:07 Introduction: The identification of new markers of thrombotic risk and early diagnosis of Non-ST-segment Elevation Myocardial Infarction (NSTEMI) could allow the optimization of the therapy and predict short and long-term prognosis. Aims and objective: We aimed to assess the impact of Immature Platelet Fraction (IPF) and Mean Platelet Volume (MPV) levels on the extent of Coronary Artery Disease (CAD) in patients with NSTEMI undergoing coronary angiography. Methods: This is a prospective observational study in which 100 subjects of Non-ST Elevation Myocardial Infarction were recruited. For the measurement of platelet count, IPF and MPV samples were analyzed by an automated hematology analyzer (Sysmex XN 1000). Patients were subjected to coronary angiography as per institutional protocol and the extent of coronary artery lesion was noted. Result: A cutoff of MPV (fL) ≥ 10.6 can predict the involvement of the left anterior descending artery (LAD) with a sensitivity of 84%, and a specificity of 50%. With the cutoff of IPF (%) ≥ 2.4, it can even predict the type of disease i.e., Double Vessel Disease (DVD), or Triple Vessel Disease (TVD) with a sensitivity of 97%, and a specificity of 19%. Mean IPF values and MPV levels were significantly higher in patients with LAD involvement i.e., 4.40 ± 1.72% (p = 0.003) and 12.45 ± 1.88 (p = 0.030) respectively than in patients without involvement of LAD i.e., 2.78 ± 1.50% and 11.08 ± 2.19 respectively. Conclusion: Immature platelet fraction and mean platelet volume were significantly associated with the involvement of the left anterior descending artery which was the most commonly involved vessel in patients with NSTEMI. Mean platelet volume was also associated with TVD which was statistically significant. MPV and IPF can be useful early independent hematologic markers to identify patients with a higher risk for significant CAD as they are readily available and inexpensive. https://www.cardiologymedjournal.com/articles/jccm-aid1163.pdf Review Article Faecal Transplant Therapy: A Promising Treatment Modality for Cardiovascular Diseases K Pushkala, Purshottam D Gupta* 2023-08-28 11:43:18 Cardiovascular diseases (CVD) are considered as “lifestyle” diseases and so far “No unified procedure” or medicines are effective in the management of this group of diseases. Researchers and clinicians have indicated that no safe therapeutic window is available in therapeutics at present. Recent research showed that gut microbiota are effective in managing lifestyle diseases therefore we introduced the influence of gut microbiota in the prognosis of the CVDs. Faecal transplant therapy(FMT) has been anticipated to treat many diseases similar to recurrent bacterial Clostridioides difficile infection which has been used worldwide. Recently, FMT was tried on an animal model to treat CVDs, and recent human trials that were tried to manage CVDs in humans by FMT showed encouraging results. The mechanism of action of transplanted bacteria to manage CVDs in the human population is also discussed. In-depth knowledge on the pros and cons of FMT will pave the way to standardize the procedure once the lacuna existing at present in treating CVDs, is paved, this technology will be useful for the masses. https://www.cardiologymedjournal.com/articles/jccm-aid1162.pdf Case Report Pneumopericardium: A Rare Complication of Antireflux Surgery Diquas Elisabeth, Druez Anne, Dili Alexandra* 2023-08-23 11:36:38 Pneumopericardium is a rare clinical entity, occurring in the setting of thoracic trauma, malignancies, or mechanical ventilation. Very few cases report pneumopericardium as a complication of gastrointestinal tract surgery. Signs and symptoms may be frustrating, ranging from asymptomatic to chest pain, sepsis, hemodynamic instability, pericarditis, or even cardiac tamponade. Clinical pathognomonic signs of pneumopericardium include pericardial metallic tinkling friction rub and mill wheel murmur. Diagnostic work-up includes electrocardiogram, chest radiography, and, computed tomography imaging. A gastro pericardial fistula should be considered a rare differential diagnosis for acute chest pain in patients with a history of gastroesophageal surgery. Rapid recognition and treatment avoid life-threatening complications. The successful outcome of gastro pericardial fistula treatment depends on both emergency and definitive surgical management. The survival rate with conservative management is poor.We present the case of a 78-year-old patient suffering from pneumopericardium and pericardial infusion, due to a fibrotic fistula between the Nissen’s valve, occurring 10 years after redo antireflux surgery. Treatment included broad-spectrum antibiotics, and emergency surgery for pericardial drainage, biopsy of the valve’s defect, suture, and omentoplasty. https://www.cardiologymedjournal.com/articles/jccm-aid1161.pdf Retrospective Study Evaluation of Preoperative Cardiology Consultations: Incidence, Characteristics and Implications for Perioperative Management Alioui Mohamed, Eljellouli Wiam, Houmed Houssein, Elghali Tanae, Choubhi Moncif, Abou Elalaa Khalil* 2023-08-14 10:23:25 Background: This retrospective study examines the importance of preoperative cardiology consultations in optimizing patient care and anesthesia surgical perioperative management.Methods: The study includes 7,756 patients from the Department of Anesthesiology at Mohammed V Military Teaching Hospital. Out of these, 122 patients were referred to cardiology consultations. Demographics, surgical specialties, reasons for referral, diagnostic tests, and interventions were analyzed.Results: Referred patients (average age 61.45 years) were mainly over 65 years old, with 59.01% being male. Common surgical specialties seeking consultations were abdominal surgery (30.327%), orthopedic surgery (26.230%), and urological surgery (19.672%). Hypertension, dyslipidemia, and diabetes were prevalent risk factors. Most patients were classified as ASA II (50%) or ASA III (27.04%), with NYHA I (61.5%) or NYHA II (31.2%) classifications. Referrals were due to ECG abnormalities (41.0%), routine evaluation (19.7%), and history of myocardial infarction or previous coronary angiography (39.3%).Discussion: Preoperative cardiology consultations accounted for 1.57% of all pre-anesthesia clinic patients. They were vital in assessing and managing cardiovascular risks, consistent with previous studies. The impact of these consultations was evident in optimizing patient management through treatment plan adjustments and interventions.Conclusion: Preoperative cardiology consultations play a crucial role in identifying and managing cardiovascular risks, contributing significantly to patient care and improving perioperative management. Further research should evaluate long-term outcomes and cost-effectiveness across different patient populations. https://www.cardiologymedjournal.com/articles/jccm-aid1160.pdf Case Report Transcatheter Aortic Valve Implantation in Two High-Risk Patients with Low Coronary Ostial Heights Using the Novel Balloon-Expandable Myval Valve Raja Ramesh N*, Ramesh Daggubati, Ramesh Babu P 2023-08-01 16:46:09 The treatment of severe aortic stenosis by transcatheter aortic valve implantation (TAVI) is challenging in patients with high-risk coronary anatomy that is predisposed to iatrogenic or delayed coronary obstruction. Hence, the evidence on performing TAVI with adequate coronary protection with or without deploying a stent needs to be accumulated. We report two cases of TAVI performed in patients with low coronary heights, wherein a “wire only” strategy was used to provide coronary protection along with the implantation of a novel balloon-expandable Myval THV. The first patient underwent a valve-in-valve TAVI, while the second patient underwent the replacement of a native bicuspid Type 1A valve. This case series presents two high-risk TAVI cases wherein a guide extension catheter and a supportive coronary guidewire provided sufficient coronary protection. None of the cases required any rescue revascularization and no incidences of a new pacemaker implantation were reported. https://www.cardiologymedjournal.com/articles/jccm-aid1159.pdf Case Report Sudden Cardiac Death in a Neonate Due to Bilateral Absence of Coronary Artery Ostium Nicole A Bailey, Khalifah A Aldawsari, Carlo M Zeidenweber, Danyal M Khan* 2023-07-24 14:09:05 Introduction: Congenital heart disease is a leading cause of neonatal mortality linked to birth defects. Despite the widespread availability of prenatal screenings, detection rates remain low. Accurate early detection of these lesions is pivotal to reducing neonatal morbidity and mortality.Methods: In this case, we present a neonate who experienced sudden cardiac death due to a rare, undiagnosed congenital cardiac anomaly - the bilateral absence of coronary artery ostium. Discussion: This case highlights the importance of prenatal detection of congenital cardiac anomalies. While fetal echocardiography is frequently utilized, it only identifies CHD in 36-50% of cases. This is attributed to inadequate imaging procedures, varied operator skills, and regional discrepancies. Early detection of severe CHD is essential for specialized treatment, thereby mitigating neonatal health risks and improving survival rates.Conclusion: Prenatal detection of CHD, especially coronary anomalies, continues to pose significant challenges. There is a pressing need to establish and enforce standardized protocols for fetal echocardiography aimed at these anomalies. To enhance care and improve outcomes, a joint effort between academic institutions and community centers is encouraged.Learning Objectives: •    Congenital coronary artery anomalies are a significant cause of sudden cardiac death in children.•    The absence of a coronary artery ostium is known to be associated with other congenital heart diseases, particularly pulmonary atresia with an intact ventricular septum. However, isolated coronary disease has also been reported in this case.•    Prenatal echocardiography is a valuable tool for diagnosing congenital heart disease. However, certain limitations may be encountered when diagnosing coronary artery anomalies. https://www.cardiologymedjournal.com/articles/jccm-aid1158.pdf Short Communication Noninvasive Cuffless Blood Pressure Monitoring. How Mechanism-Driven and Data-Driven Models Can Help in Clinical Practice Mohamed Zaid*, Mihail Popescu, Laurel Despins, James Keller, Marjorie Skubic, Giovanna Guidoboni 2023-07-12 10:10:17 Continuous noninvasive cuffless blood pressure (BP) monitoring is essential for early detection and treatment of hypertension. In this paper, we provide an overview of the recent advancements in cuffless BP sensors. These include contact wearable sensors such as electrocardiography (ECG), photoplethysmography (PPG), contact non-wearable sensors such as ballistocardiography (BCG), and contactless sensors such as video plethysmography (VPG). These sensors employ different measuring mechanisms such as pulse arrival time (PAT), pulse transit time (PTT), and pulse wave analysis (PWA) to estimate BP. However, challenges exist in the effective use and interpretation of signal features to obtain clinically reliable BP measurements. The correlations between signal features and BP are obtained by mechanism-driven models which use physiological principles to identify mathematical correlations, and data-driven models which use machine learning algorithms to analyze observational data to identify multidimensional correlations. On the one hand, applying mechanism-driven models to non-linear scenarios and incomplete or noisy data is challenging On the other hand, data-driven models require a large amount of data in order to prevent physically inconsistent predictions, resulting in poor generalization. From this perspective, this paper proposes to combine the strengths of mechanism-driven and data-driven approaches to obtain a more comprehensive approach, the physiology-informed machine-learning approach, with the goal of enhancing the accuracy, interpretability, and scalability of continuous cuffless BP monitoring. This holds promise for personalized clinical applications and the advancement of hypertension management. https://www.cardiologymedjournal.com/articles/jccm-aid1157.pdf Research Article Early Outcomes of a Next-Generation Balloon-Expandable Transcatheter Heart Valve - The Myval System: A Single-Center Experience From Serbia Darko Boljevic*, Milovan Bojic, Mihajlo Farkic, Dragan Sagic, Sasa Hinic, Dragan Topic, Milan Dobric, Jovana Lakcevic, Marko Nikolic, Stefan Veljkovic, Matija Furtula, Jelena Kljajevic, Aleksandra Nikolic 2023-06-26 11:48:20 Transcatheter aortic valve implantation (TAVI) is one of the most effective treatments for severe aortic valve stenosis (AVS). Different genres and generations of transcatheter heart valves (THVs) are accessible, offering operators an opportunity to choose a patient-tailored device. In this single-center study, we present the outcomes of Serbian patients treated with next-generation Myval THV for severe symptomatic AVS. Myval THV was implanted in all consecutive patients who underwent TAVI at the Dedinje Cardiovascular Institute of Belgrade, Serbia between October 2020 and September 2021. The primary endpoint was device success on day 30. Secondary endpoints included 30-day all-cause mortality, cardiovascular death, stroke, moderate/severe paravalvular leak (PVL), and new permanent pacemaker implantation (PPI). TAVI was performed as per the European Society of Cardiology guidelines. The study comprised thirteen patients, aged 72±13 years with mean EuroSCORE (7.17%) and Society of Thoracic Surgeons (2.72%,) scores who underwent TAVI successfully with 92.3% using the percutaneous approach. Myval THV intermediate and extra-large sizes were implanted in 46% and 15% of patients, respectively. This acute procedure success rate was 100%. The primary composite endpoint of early device success was achieved in all patients. None of the patients had clinically significant aortic regurgitation or moderate/severe PVL. No patient experienced stroke, contrast-induced acute kidney injury, device-related vascular complications, or a new PPI. The all-cause mortality rate at 30 days was 0%. Myval THV system demonstrated a favorable safety/efficacy profile within 30 days post-procedure at a single center in Serbia. This is the first report of my experience with Myval THV from Serbia. https://www.cardiologymedjournal.com/articles/jccm-aid1156.pdf Mini Review The Role of Advanced Imaging in Paediatric Cardiology: Basic Principles and Indications Maria Kavga*, Tristan Ramcharan, Kyriaki Papadopoulou-Legbelou 2023-06-24 16:28:33 Tissue Doppler Imaging and Speckle Tracking Echocardiography are newer echo-cardiographic modalities, that assess myocardial and valvular function in congenital and acquired heart diseases in childhood. In addition, cross-sectional imaging including Cardiac Magnetic Resonance (CMR) and Cardiac Computed Tomography has been widely used over the last decade in paediatric cardiology, in order to evaluate intra-cardiac and extra-cardiac anatomy. Cardiac Magnetic Resonance particularly allows detailed analysis of myocardial function, and shunt quantification and has applications even in fetal life. This mini-review summarizes the basic principles of the above-advanced modalities and highlights their main indications and clinical applications in childhood. https://www.cardiologymedjournal.com/articles/jccm-aid1155.pdf Thesis Vitamin D Deficiency and its Correlation with the Severity of Heart Disease in Dilated Cardiomyopathy Patients Kuldeep Kumar Gaur*, LH Ghotekar, Shubha Laxmi Margekar, Tarun Kumar, Ritu Singh 2023-06-20 16:24:49 Background: Cardiomyopathy is primarily a disorder of the cardiac muscle that causes myocardial dysfunction and is not the result of disease or dysfunction of other cardiac structures, systemic arterial hypertension and valvular stenosis or regurgitation. Aim: The present study aimed to determine the prevalence of vitamin D deficiency and its correlation with the severity of heart disease in patients with dilated cardiomyopathy (DCMP). Method: 70 ECHO-proven DCMP cases were enrolled from the medicine/ cardiology department of LHMC & associated hospitals and ABVIMS & Dr. RML Hospital, New Delhi from November 2019 to October 2021. DCMP patients with ages more than 18 years who were willing to give consent and does not meet any of the exclusion criteria were enrolled in this study. Results: Mean age of idiopathic DCMP patients was 48.3 ± 15.2. There were more males 48 (69%) than females 22 (31%). The mean ejection fraction was 26.6 ± 7.3, while the mean fractional shortening was 17.6 ± 3.1. Vitamin D deficiency was observed in 90% of patients, among which 68.5% were having moderate vitamin D deficiency and 10% were having severe vitamin D deficiency. Conclusion: In our study, vitamin D levels were inversely correlated with the severity of heart disease in DCMP patients. https://www.cardiologymedjournal.com/articles/jccm-aid1154.pdf Observational Study Myocardial fibrosis in aortic stenosis: comparison between clinical data, laboratory, echocardiography, and cardiac magnetic resonance Giuseppe Tosto, Giulia Passaniti, Fortunata Alessandra Gibiino, Wanda Deste*, Antonino Indelicato, Tito Torrisi, Giuseppe Bottaro, Maria Teresa Cannizzaro, Corrado Tamburino 2023-05-16 14:25:55 Introduction: Patients with aortic stenosis often develop hypertrophy and fibrosis, regardless of symptoms. Cardiac Magnetic Resonance (CMR) represents the gold standard for the evaluation of fibrosis despite numerous limitations: cost, availability, atrial fibrillation, claustrophobia, kidney failure or inability to apnea.Purpose: The aim is to validate the role of echocardiographic parameters, such as Global Longitudinal Strain (GLS), as early markers of fibrosis. Clinical and laboratory data, particularly B-type Natriuretic Peptide (BNP), were also analyzed.Material and methods: In our study we recruited 33 patients with severe aortic stenosis, correlating echocardiographic values of GLS with the qualitative analysis of Late Gadolinium Enhancement (LGE) and the quantitative analysis of T1 mapping of CMR.Results: 70% of patients with an alteration of GLS had LGE+. Univariate logistic regression shows that the factors associated with the presence of LGE on CMR are hypertension (p = 0.043), GLS (p = 0.032), and elevated BNP values (p = 0.021); for GLS, Odds Ratio (OR) is 5 so the chance of finding fibrosis on CMR increases 5 times in presence of an altered GLS. The multivariate analysis confirms the association with impaired GLS values (p = 0.033) and hypertension (p = 0.025), but not with elevated Pro-BNP values.Conclusion: In patients with severe aortic stenosis, the association between GLS, LGE, and T1 mapping can help identify earlier those patients with structural changes caused by the disease, who could benefit from early intervention. It remains to be established how the presence of these alterations has a role in determining the intervention time and the outcome of these patients. https://www.cardiologymedjournal.com/articles/jccm-aid1153.pdf Research Article Security and performance of remote patient monitoring for chronic heart failure with Satelia® Cardio: First results from real-world use Patrick Jourdain*, F Picard, N Girerd, H Lemieux, F Barritault, MF Seronde, JP Labarre, N Pages, C Bedel, L Betito, S Nisse-Durgeat, B Diebold 2023-05-15 14:14:55 Background: Since 2019, remote patient monitoring (RPM) for patients with chronic heart failure (CHF) has been supported by the European Society of Cardiology. However, real-world data on the use of such solutions has been limited and not primarily based on patient-reported outcomes. The aim of this study was to describe the Satelia® Cardio solution in France within the French ETAPES funding program and assess the security and performance of its clinical algorithm.Methods: A retrospective observational study was conducted on CHF patients monitored by RPM through Satelia® Cardio. From September 1, 2018, to June 30, 2020, patients were included if they had completed over six months of follow-up. The risk of a possible CHF decompensation was categorized by the system in three levels: green, orange and red. The algorithm security and performance were assessed through the negative predictive value (NPV) of the prediction of hospitalization of a patient within seven days.Results: In total, 331 patients were included in this study with 36,682 patient self-administered questionnaires answered. Patients were mostly males (70.4%) and had a mean age of 68.1 years. The mean left ventricular ejection fraction (LVEF) was 35.4% (± 12.3) and 73.3% of patients had a LVEF ≤ 40%. The questionnaire response rate was 90.9%. A green status was generated for 95.3% of answers. There were 4.5% (n = 1,499) orange alerts and 0.2% (n = 74) red alerts. Overall, 92.1% of patients had at least one CHF related hospitalization and 31.7% (n = 105) of these cases were non-scheduled. The NPV at seven days was 99.43%.Conclusion: Satelia® Cardio is a feasible, relevant and reliable solution to safely monitor the cohorts of patients with CHF, reassuring cardiologists about patient stability. https://www.cardiologymedjournal.com/articles/jccm-aid1152.pdf Case Report A rare case of foreign body in coronary sinus. A novel endovascular method for retrieval Bhanu Maturi,Ashwini Sharma,Ashok Runkana,Rhoshini Rajasekaran,Varshitha Kondapaneni,Tilachan Parajuli 2023-03-30 16:06:53 Central venous catheter fracture and migration are rare complications in patients receiving long-term infusions or chemotherapy. We present a rare case of a chest port catheter fracture that migrated into the coronary sinus. This case is likely the fourth report of a port catheter fracture with migration to the coronary sinus. Because of the difficult-to-retrieve location, multiple attempts were unsuccessful with traditional techniques using a loop snare. Finally, the fractured portion was disengaged from the coronary sinus using a navigational electrophysiology catheter guided by intracardiac echocardiography; the dislodged end was snared and eventually removed by the femoral route. This case of a chest port catheter fracture is unique because of the unusual migration to the coronary sinus and the use of a navigational electrophysiology catheter as a novel retrieval technique. https://www.cardiologymedjournal.com/articles/jccm-aid1151.pdf Research Article A proposal of risk indicators for pathological development from hemodynamic simulation: application to aortic dissection Wenyang Pan,Pascale Kulisa,Benyebka Bou-Saïd,Mahmoud El Hajem,Serge Simoëns,Monica Sigovan 2023-03-28 16:00:29 Cardiovascular diseases are the leading cause of mortality in the industrialized world. Among these diseases, aortic dissection affects the aorta wall and is a surgical emergency with a low survival rate. This pathology occurs when an injury leads to a localized tear of the innermost layer of the aorta. It allows blood to flow between the layers of the aortic wall, forcing the layers apart and creating a false lumen. Endovascular treatment seeks to obliterate the entrances to the false lumen with a covered stent. There are very few studies on the postoperative demonstration of blood flow phenomena in the aortic dissection endovascular treatment. It is crucial to study the hemodynamics of blood in the aorta after an intervention because the new geometrical configuration of the aorta with a stent leads to modifications in blood flow. For the surgeons, the procedure can only be performed empirically, using MRI-4D images to view the postoperative flow of the patient’s blood in the aorta with the stent.This paper aims to present a numerical tool developed from the open-source software FOAM- Extend®, allowing for multiphysics numerical simulations. Using MRI data, a bio-faithful model of the patient-specific case was built. Numerical simulations were performed to predict preoperative and postoperative (endovascular treatment) hemodynamics. The modifications of the flow in the aorta were analyzed focusing on the postoperative perfusions. The results were compared with the corresponding MRI data and have a good qualitative agreement. Biomarkers are calculated to localize possible zones of post-operative pathological developments and recommendations may be suggested to the surgeons. https://www.cardiologymedjournal.com/articles/jccm-aid1150.pdf Review Article Soliton phenomena in the process of the functioning of the heart Adam Adamski 2023-03-14 11:19:15 The biochemical model explains the intricate mechanisms of psychobiological life. He still cannot explain what the transition from inanimate to living matter is all about. Where is the threshold and what is its essence, what role do biochemical processes play in the coherence of the soma with consciousness and its impact on the soma and vice versa? A similar problem is with other mental processes, their nature does not fit into the biochemical model of life and is inexplicable on the basis of biochemical interactions, again it is much easier to describe it in the light of quantum processes - including wave physics. It is similar to the functioning of the heart or other organs, where only the biochemical processes of the cell are considered, ignoring the bioelectronic processes. Man is not only a purely biological construct but also contains the basis of biochemical, bioelectronic, information, and cybernetic processes that are responsible for shaping the psychobiological processes of man. Contemporary biosystems in science are considered at the level of corpuscular structures, ignoring energy and information structures. By shifting the cognitive emphasis towards energy and information structures, the organism can be perceived as a quantum generator of information: electromagnetic, soliton, acoustic, spin and bioplasma. This bioelectronic construction creates homo electronics with his electronic personality. https://www.cardiologymedjournal.com/articles/jccm-aid1149.pdf Observational Study Left ventricular assessment in patients with significant mitral incompetence: a multi-modality imaging study Reham Mostafa Elgammal,Mona Adel Elsaiedy,Mahmoud Zki Alamrosy,Mohamed Elsaied Elsetiha,Magdy Mohamed Almasry 2023-03-09 17:13:41 Background: Detection of the deleterious effect of MR on LV is crucial in guiding the surgical decision. Aim of the study: Comprehensive assessment of LV with significant primary MR using (2D, 3D echo and CMR). Methods: 40 patients with significant MR have been recruited in a prospective study. Patients underwent 2D and 3D echo and CMR studies. LV volumes, function and GLS were calculated. Results: End diastolic and systolic volumes were significantly larger when measured by CMR (all p < 0.001). EDV measures were strongly correlated with CMR and 3D echocardiography. Conclusion: It’s important to identify early deleterious LV changes. https://www.cardiologymedjournal.com/articles/jccm-aid1148.pdf Review Article Outcomes of intervention treatment for concurrent cardio-cerebral infarction: a case series and meta-analysis Mohammed Habib,Somaya Elhout 2023-01-18 11:27:59 Background: The concurrent occurrence of acute ischemic stroke and acute myocardial infarction is an extremely rare emergency condition that can be lethal. The causes, prognosis and optimal treatment in these cases are still unclear.Methods: We conducted the literature review and 2 additional cases at Al-Shifa Hospital, we analyzed clinical presentations, risk factors, type of myocardial infarction, site of stroke, modified ranking scale and treatment options. We compare the mortality rate among patients with combination intervention treatment (both percutaneous coronary intervention for coronary arteries and mechanical thrombectomy for cerebral vessels) and medical treatment at the hospital and 90 days after stroke. Results: In addition to our cases, we identified 94 cases of concurrent cardio-cerebral infarction from case reports and series with a mean age of 62.5 ± 12.6 years. Female 36 patients (38.3%), male 58 patients (61.7%). Only 21 (22.3%) were treated with combination intervention treatment.The mortality rate at hospital discharge was (33.3%) and the mortality rate at 90 days was (49.2%). In patients with the combination intervention treatment group: the hospital mortality rate was 13.3% and the 90-day mortality rate was: 23.5% compared with the mortality rate in medical treatment (23.5% at the hospital and 59.5% at 90 days (p value 0.038 and 0.012 respectively) Conclusion: Concurrent cardio-cerebral infarction prognosis is very poor, about a third of patients died before discharge and half of the patients died 90 days after stroke. Despite only one-quarter of patients being treated by combination intervention treatment, this treatment modality significantly reduces the mortality rate compared to medical treatment. https://www.cardiologymedjournal.com/articles/jccm-aid1147.pdf Case Presentation Isolated multiple pericardial hydatid cysts in an asymptomatic patient: Role of the CMR Antonio Bisignani,Andrea Madeo,Silvana De Bonis,Riccardo Vico,Giovanni Bisignani 2023-01-06 10:58:02 Hydatid cysts primarily affect the liver and secondary involvement may be seen in almost any anatomic location. We describe the unusual pericardial location of the Echinococcus cysts in an asymptomatic patient with suggestive cardiac magnetic resonance imaging. https://www.cardiologymedjournal.com/articles/jccm-aid1146.pdf Case Report Double aortic dissection in a patient with Marfan disease. A case report Millogo Georges Rosa Christian,Kologo Jonas Koudougou,Seghda Taryètba André Arthur,Boro Théodore,Benon Laurence,Samadoulougou André K,Zabsonré Patrice 2022-12-27 16:29:48 Marfan syndrome is a dominant autosomal genetic disease of the connective tissue, leading to various complications. Cardiovascular complications are the main ones, with dilation of the aorta and aortic dissection which is the main cause of death. Double dissection with different sites of departure is scarcely reported by the literature. We reported the case of a 22-year’s-old young patient admitted for acute chest and abdominal pains, and cardiogenic shock. Investigations reported a double dissection of the aorta with a recent one of type A and an old one of type B. Ghent diagnostic criteria were used to allow the diagnosis of Marfan disease. Surgical management corrected successfully the type A dissection.Early diagnostic and adequate management of aortic complications can reduce the high mortality rate of patients with Marfan syndrome. https://www.cardiologymedjournal.com/articles/jccm-aid1145.pdf Research Article Correlation between chronic inflammation of rheumatoid arthritis and coronary lesions: “About a monocentric series of 202 cases” Nassime Zaoui,Amina Boukabous,Nabil Irid,Nadhir Bachir,Ali Terki 2022-12-06 11:30:40 Introduction: Cardiovascular diseases are the leading cause of death in the world, headed by coronary artery disease, which is secondary to atherosclerosis. The latter recognizes classic risk factors such as diabetes, high blood pressure, tobacco, and dyslipidemia and other less classic factors such as chronic inflammation of rheumatoid arthritis. Many studies have highlighted the correlation between this chronic inflammation and clinical coronary disease but very few have focused on the anatomical correlation. Objective: To describe the correlation between the chronic biological inflammation of rheumatoid arthritis and anatomical coronary lesions on angiography. Method: This observational, retrospective, single-center study, including over 10 years, of patients with rheumatoid arthritis, confirmed the EULAR 2010 criteria and presented with coronary artery disease requiring coronary angiography. Patients with missing data or in whom coronary angiography was not done were excluded (n = 14). We divided then the patients according to the existence or not of chronic inflammation to study the impact of the latter on the existence (Stenosis < 50% vs. stenosis ≥ 50%), the extent (single vs. multivessel disease), and the severity of the coronary lesions (syntax score < 32 vs. ≥ 32). Results: 202 patients (49♂/153♀) aged between 30-75 years with a history of rheumatoid arthritis have had a coronary event requiring coronary angiography, were included; The mean ejection fraction at baseline was 57.3% +/- 5.8 (37 vs.-65%). 75% of them were ≥ 65 years old. 55% were diabetics, 61% with hypertension, 38% with dyslipidemia, and 19% were smokers. Chronic inflammation was diagnosed in 70% of them on non-specific parameters (ESR, CRP, fibrinogen, anemia, and rheumatoid factor). All patients had coronary angiography, which made it possible to identify the coronary lesions according to their existence (Stenosis < 50%: 51 patients vs. stenosis ≥ 50%: 151 patients), the extent (single: 86 patients vs. multivessel disease: 116 patients) and the severity of the coronary lesions (syntax score < 32: 142 patients vs. ≥ 32: 60 patients). Chronic inflammation of rheumatoid arthritis was correlated in bivariate and multivariate analysis (after excluding the impact of other risk factors) with the existence and extent of coronary lesions (p < 0.05) but not with their severity (p > 0.05). Discussion: The two limitations of this work are the monocentric nature of the study and the absence of specific inflammatory parameters such as anti-CCP antibodies. Strengths are anatomical correlations and multivariate analysis. Chronic inflammation apart from any influence of the various risk factors predisposes to the existence and extent of coronary lesions (p < 0.05). The severity of coronary lesions assessed by Syntax Score was not correlated with chronic inflammation, although other studies suggest that this inflammation is the cause of complex lesions.Interpretation: Rheumatoid arthritis is associated with an increase in cardiac morbidity and mortality. Atheromatous lesions are more frequent in those patients than the existence of classic cardiovascular risk factors would suggest. Several explanations could account for this risk: the inflammatory syndrome and its impact on the cardiovascular risk factors and the vessel and the deleterious effect of the treatments. This requires stricter screening and management of risk factors in rheumatoid arthritis. https://www.cardiologymedjournal.com/articles/jccm-aid1144.pdf Case Report Percutaneous Atrial Septal Defect (ASD) closure technique in case of association with an azygos continuation of the inferior vena cava “case report” Nassime Zaoui,Amina Boukabous,Nadhir Bachir,Ali Terki,Nabil Irid 2022-12-02 11:24:59 Introduction: Atrial Septal Defect (ASD) is the most common congenital heart disease, accessible to percutaneous closure in 90% of cases. The closure procedure is performed usually under local anesthesia and TTE by femoral access. The association of OS-ASD with an azygos continuation of the inferior vena cava is very rare (< 0.1/1000 births) making femoral access impossible. Only a few cases are mentioned in the literature, here we describe the procedure as faithfully as possible. Important clinical finding: We present a case of a 32-years-old female candidate for percutaneous closure of OS-ASD with right cavity dilatation who present during her procedure an unusual guidewire path suspecting an azygos continuation of the inferior vena cava, confirmed by CT angiography, making impossible the closure via the femoral approach. Therapeutic intervention: After being confronted with the categorical patient refusal of the surgery, we performed successfully the procedure; one month later; under general sedation by internal jugular approach. We finished with manual compression before extubating the patient. Outcomes: The follow-up was favorable at the cost of a hematoma at the puncture site and brachial plexus compression, which regressed after 3 days. Conclusion: We opted for general anesthesia and intubation to guide the procedure by TEE. We placed it in the aorta, which gave us good stability to continue successfully the procedure. We underestimated the risk of complication at the puncture site, which could have been avoided by using a vascular suture device or more prolonged compression. Main takeaway lesson: Percutaneous closure is the reference treatment for OS-ASD. In case of is associated with an azygos continuation of the inferior vena cava, the right internal jugular vein remains a reasonable approach; it requires discussion and rigorous preparation by the whole team. The management of the puncture site in this situation remains delicate and requires great concentration.  https://www.cardiologymedjournal.com/articles/jccm-aid1143.pdf Case Report How to manage balloon entrapment during percutaneous coronary intervention of a calcified lesion “Case report” Nassime Zaoui,Amina Boukabous,Nadhir Bachir,Nabil Irid,Ali Terki 2022-12-02 10:20:08 Percutaneous coronary angioplasty is a minimally invasive procedure aimed at unclogging a coronary artery with a low complication rate (with a serious complication rate of 3% to 7% and a mortality rate of 1.2%). Device entrapment during PCI is a rare but life-threatening complication that occurs in < 1% of PCIs and balloon entrapment comes second after coronary guidewires. We present the case of 68-years-old man, smoker, hypertensive and type2 diabetic that presents angina with evidence of ischemia on myocardial tomoscintigraphy and in whom the radial coronary angiography reveals a tight calcified mid LAD stenosis. During his PCI and after dilatation with an NC balloon 2.5 × 12 the latter refuses to deflate and remains trapped in the lesion with the appearance of pain and ST-elevation despite several attempts to dilute the product in the inflator and to burst it by overexpansion. Traction on the balloon resulted in the deep intubation of the guiding-catheter, which comes in contact with the trapped balloon, and the rupture of the latter’s hypotube, which remains inflated at the site of the lesion and mounted on the 0.014 guidewire. We put a second 0.014 guidewire distally in the LAD and twisted with the distal part of the first guidewire, then we introduced a second balloon 2.0 × 20 over the second guidewire until the distal part of the guiding-catheter and inflated to trap the stucked balloon. We gradually removed this emergency assembly that allowed us to retrieve the trapped balloon. The control injection revealed a thrombotic occlusion of the LAD treated by thrombectomy and anti-GPIIbIIIa followed by a DES 2.75 × 28 placement. The patient was discharged 48 hours later with a good LVEF. The possible balloon entrapment mechanisms are an acute recoil of a highly calcified lesion with compression of the incompletely deflated balloon, which seems to be the case in our patient, strangulation of the proximal balloon end by the guiding-catheter if the balloon is removed before complete deflation and break or bend of the hypotube. The solutions in case of undeflatable balloon entrapment are to dilute the product in the inflator, to burst it by overexpansion, to pierce it through a stiff guidewire (or through its other end on a Microcatheter or OTW balloon), to cut its outer part and let it empty passively, to introduce a second guide-wire and perform a Buddy-Balloon or to transfer the patient to Surgery. Material entrapment remains a rare but life-threatening complication, its eviction requires the choice of material size and gentle manipulations (small balloons in the event of a calcified lesion) and its management uses different techniques, the choice of which depends on the clinical and anatomical situation.  https://www.cardiologymedjournal.com/articles/jccm-aid1142.pdf Mini Review Oncocardiology: Far beyond the cardiotoxicity Jing Wei,Wen-Jie Pan,Min Pan 2022-11-29 12:56:35 Approximately 73.4% of global deaths are caused by chronic non-communicable diseases, among them, cardiovascular and cerebrovascular diseases, tumors, and chronic respiratory diseases ranked in the top 3 respectively [1]. An accumulating body of evidence showed that the risk of all-cause mortality in cancer patients with cardiovascular disease (CVD) was 3.78 times higher than that of those without CVD and 8.8% of cancer survivors died of CVD [2]. Heart failure (HF) is a serious manifestation or terminal stage of various heart diseases. Although myocardial damage and dysfunction are the main causes of HF, the cardiovascular injury caused by the tumor itself and the detrimental effect of cancer treatment also play an important role. More recently, the data has suggested that up to 25% - 30% of patients with HF have histories of cancer for about 10 years; and cancer also determines the prognosis of heart HF [3].  https://www.cardiologymedjournal.com/articles/jccm-aid1141.pdf Research Article Acute ischemic stroke for alteplase or medical care alone or intervention with/without alteplase in Palestine (AIS-AMI Palestine) Mohammed Habib 2022-11-22 00:00:00 Background: Stroke is the most common cause of permanent disability and the third most common cause of death in Palestine. We aimed to examine patterns of stroke presentation, causes, management and outcomes at the largest public Mistry of health hospitals in Palestine.Methods: Comprehensive data from all patients with acute ischemic stroke who were admitted to al-Shifa hospital between November 2021 and July 2022 and treated with alteplase alone or endovascular intervention with or without alteplase were prospectively collected and compare with acute ischemic stroke patients who were treated with medical care alone at Palestine medical complex hospital at 2018. Acute ischemic stroke presentation patterns, in-hospital evaluation and management, mortality, and morbidity were evaluated. Results: Medical care alone group: 138 patients with acute ischemic stroke, mean age was 65 ± 14 years and 49% were women. Most of the patients received antiplatelet therapy (98%), although none received thrombolysis. Only 17% received physical therapy evaluation. In-hospital mortality was 13%, and a modified ranking score of 0 -2 was in 44 patients (32%). Endovascular intervention with/without alteplase group: 56 patients with acute ischemic stroke. The mean age was 61 ± 12 years and 41% were women. All patients received brain computed tomography scans, although few received other investigations such as carotid Doppler (13%). Most patients with ischemic stroke received antiplatelet therapy (99%), although 39 patients (70%) received thrombolysis. Only 61% received physical therapy evaluation. In-hospital mortality was 7%. The modified ranking score 0 - 2: 32 patients (57%).Conclusion: This study conducted in Palestine showed that among patients with acute ischemic stroke, functional outcomes according to modified ranking score 0 - 2 were better by endovascular therapy with/without alteplase than with medical care alone. https://www.cardiologymedjournal.com/articles/jccm-aid1140.pdf Literature Review Atrial fibrillation in elite athletes. What is missing? E Tsougos,E Giallafos, Paraskevaidis 2022-10-27 14:32:14 Although the beneficial effect of physical activity in the general population is well established, in elite athletes under vigorous physical activity, the effect on the electrical system of the heart is controversial. Indeed, several studies have shown an increased rate of atrial fibrillation among athletes, whereas others suggest that improved exercise capacity with training reduces atrial fibrillation recurrence. The pathophysiologic explanation of that discrepancy is missing, although several underlying mechanisms have been proposed. Taking into account the current knowledge, it seems that, although the beneficial effects of exercise are well recognized, there are conflicting data regarding the relation of the occurrence - the rate of atrial fibrillation to high-volume exercise and too long-term training. Its significance on the quality of life especially in highly trained athletes remains to be elucidated. Therefore, this short review will try to discuss this discrepancy and hopefully underlie the arising arguments.  https://www.cardiologymedjournal.com/articles/jccm-aid1139.pdf Case Presentation A patient with pulseless ST elevation myocardial infarction caused by a very late stent thrombosis Masahiko Satoda,Hiroaki Yusa 2022-09-24 14:44:55 Background: Persistent contrast staining is highly associated with stent thrombosis. Case summary: A 75-year-old woman presented with new-onset effort angina. A coronary angiogram revealed a 90% blockage of the distal left main trunk (LMT) and a 99% blockage of the ostial left anterior descending coronary artery (LAD). A 3.0 × 18-mm CYPHER™ the stent had previously been implanted into the dominant proximal circumflex artery (LCx) in 2009 because of unstable angina. The patient developed pulseless ST elevation myocardial infarction after the withdrawal of antiplatelet therapy before a scheduled CABG. The patient recovered with VA-ECMO and PCI using aspiration thrombectomy and urgent CABG.Discussion: This case highlighted that a preoperative patient may develop thrombosis at a previous stent site with peri-stent contrast staining and withdrawal of an antiplatelet regimen in certain settings poses an imminent risk for preoperative deterioration. A bridging strategy using intravenous PY12 inhibitor before CABG should be considered in this setting. The revascularization strategy should be selected based on coronary anatomy, hemodynamic status and baseline risk for CABG. A hybrid revascularization approach should be considered in this patient population. https://www.cardiologymedjournal.com/articles/jccm-aid1138.pdf Research Article Does global longitudinal strain improve stratification risk in heart failure with preserved ejection fraction? Assia Haddad,Mohamed Karim Guerchani,Nadia Ould Bessi,Dalila Djermane,Omar Ait Mokhtar,Hakim Himeur,Salim Benkhedda 2022-09-08 10:13:44 Background: Heart Failure with Preserved Ejection Fraction (HFPEF) accounts for more than half of the cases of heart failure.Long regarded as an abnormality of left ventricular diastolic function, recent studies using longitudinal strain (two-dimensional speckle tracking mode) have suggested that left ventricular longitudinal systolic function is altered in HFPEF.Despite these interesting pathophysiological perspectives, the data in the literature on the prognostic value of the alteration of longitudinal strain are controversial. Given these conflicting results, it is difficult to confirm the magnitude and prevalence of impaired LV longitudinal systolic function in patients with HFPEF and its prognostic relevance. Purposes: This work aims to study the prognostic value of Global the left ventricle’s Global Longitudinal Strain (GLS) Algerian cohort of patients with HFPEF. Patients and methods: We conducted a monocentric prospective observational study from April 2018 to April 2020, with a minimum follow-up of 1 year for each recruited patient. We included patients over the age of 18 referred to the echocardiography laboratory for chronic or acute HFpEF, defined according to the criteria of ESC 2016. 153 consecutive patients underwent clinical examination, biological tests, and echocardiography with measurement of GLS at rest, in addition to routine management by the attending physicians.Results: 153 patients were collected. The average age of our patients is 73 +/- 11 years ranging from 42 to 91 years old. The female population is predominant with a rate of 67%. Comorbidities are predominant mainly by arterial hypertension (86%) and diabetes (64%), with a history of atrial fibrillation (46%).63% of patients have impaired GLS (< 16%). Contrary to our hypothesis, GLS was not shown to be a powerful predictor of cardiovascular events in HFPEF patients either in dichotomous analysis (OR = 0.79; p = 0.64) or in continuous analysis (OR = 0.97; p = 0.69).We were able to identify that congestive venous signs, anemia, and pulmonary hypertension, are the main independent prognostic factors in our Algerian population study. Conclusion: We were unable to demonstrate the prognostic role of mpaired GLS in our population of patients with HFPEF. https://www.cardiologymedjournal.com/articles/jccm-aid1137.pdf Research Article An empirical study on factors responsible for Rheumatic Heart Disease (RHD) and its severity levels amongst the Bhutanese populace Karma Lhendup,Yeshey Penjore 2022-08-30 12:26:18 Background and objectives: This paper is aimed at excavating the factors responsible for RHD events and vis-à-vis establishing severity levels of RHD patients referred to Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) in Thimphu’s capital city of Bhutan. Methods: By taking notorious advantage of the data gathered over the past five years (2016-2020) from RHD patients across 20 districts of Bhutan, about 232 RHD patients are involved in this study recorded in JDWNRH by the Cardiology Department. Besides descriptive methods, multivariate linear regression models augmented by the multinomial logistic regression models had been applied to establish the causual links. Results: The findings revealed that RHD prevailed amongst the young populace of Bhutan, especially females. Variables like age, frequency of visits, number of diagnostics, levels of education and region had been found as predictors of RHD prevalence. Other socio-demographic factors like occupation and status of employment did not affect the RHD prevalence. The multinomial logistic regression results indicated that higher levels of education as an important factor for not making the patient fall into the category of ‘severe.’ Age has been constantly found to be a highly significant variable contributing to RHD events and a quadratic relationship is revealed between age and the severity of RHD. Conclusion and implications for translation: This study pigeonholed the significant factors responsible for RHD events and entailed severity levels by gender and age. The findings of this study also provide additional important insights into developing public health policies and programs.  https://www.cardiologymedjournal.com/articles/jccm-aid1136.pdf Review Article Clinical utility of intracardiac echocardiography in transvenous lead extraction Josef Kautzner,Tomas Skala,Marian Fedorco,Hanka Wunschova,Milos Taborsky 2022-08-04 11:50:03 The epidemics of heart failure and an aging population resulted in an exponential rise in the use of cardiac implantable devices (CIEDs) in developed countries. This is paralleled by the increased rate of complications such as system infection or malfunction. The higher number of complications, and longer patient life expectancies, are followed by an increase in the need for lead extractions.  https://www.cardiologymedjournal.com/articles/jccm-aid1135.pdf Research Article Single-center experience in sutureless aortic valve implantation using two aortic valve prostheses Laura Rings,Vasileios Ntinopoulos,Stak Dushaj,Gojart Hoti,Philine Fleckenstein,Omer Dzemali,Achim Häussler 2022-07-22 14:13:20 Background and aim of the study: Sutureless aortic valves are used to reduce operation time. However, the stent implantation might cause postoperative ECG alterations and a higher risk of paravalvular leakage. In literature, some cases of thrombocytopenia are described after implantation. We investigated the Sorin Perceval S Sutureless Valve and the Edwards Intuity Sutureless Valve.Material and methods: Seventy-nine patients underwent aortic valve replacement using a sutureless valve in a single center between 2015 - 2018. Thirty-seven patients received Sorin Perceval S (Group A) and 42 Edwards Intuity (Group B). Simultaneous bypass surgery was performed in 23 patients in Group A and 22 patients in Group B. We compared the groups regarding postoperative TTE and paravalvular leakage, postoperative ECG alterations, need for pacemaker implantation, postoperative platelet count, and 30-day mortalityResults: Only in Group B 2 patients had paravalvular leakage, and one was reoperated within the same hospital stay. In Group A, nine patients suffered from postoperative atrial fibrillation, and in Group B, 16 patients. Left bundle branch block (LBBB) was observed in 5 patients in Group A, and 13 patients in Group B. Two patients in Group A needed a definite pacemaker, and five patients in Group B. Tachy-Brady Syndrome and LBBB were observed more frequently in Group B as well as ECG alterations. One patient died within 30 days in Group A due to multiorgan failure. This patient was older and multimorbid compared to the average. Regarding platelet count, we saw a statistically significant decrease in both groups. There were no major bleeding complications or reoperations due to hemorrhage.Conclusion: Our data shows that sutureless aortic valve replacement is associated with new postoperative ECG alterations, which are self-limiting in most cases. Compared to the literature pacemaker implantation rate in Group B is higher. https://www.cardiologymedjournal.com/articles/jccm-aid1134.pdf Observational Study Posterior pericardiotomy in heart valve surgery; is it still performed or neglected? Yasser Mubarak 2022-07-04 15:46:05 Background: Posterior pericardiotomy (PP) is helpful to prevent arrhythmia; especially atrial fibrillation (AF), and cardiac tamponade postoperative cardiac valve surgery. The incidence of postoperative AF is increased due to postoperative pericardial effusion (PE). This study aimed to investigate the early outcome of PP after heart valve surgery. Methods: In this prospective study, 120 patients underwent elective valve heart surgery at our center from January 2020 until April 2022. Patients were followed up for AF and pericardial effusion, and reopening due to tamponade. Results: The mean age of patients was 35.26 years, 70.2% were female and 29.8% were male. Surgery was elective and all were valve surgery. The incidence of postoperative AF was 2%, and pericardial effusion was seen in 1% of patients. Tamponade was not seen in any case. Left PE needed intervention tube drainage of 2%. Conclusion: Posterior pericardiotomy is a simple and safe procedure during valve heart surgery, and it is effective in reducing the incidence of atrial fibrillation, pericardial effusion, and tamponade. https://www.cardiologymedjournal.com/articles/jccm-aid1133.pdf Literature Review A Wolff-Parkinson-White (WPW) Electrocardiographic Pattern in Asymptomatic Patient – State-of-the-Art-Review Vijay Yadav,Sanjeev Thapa,Ratna Mani Gajurel,Chandra Mani Poudel,Bhawani Manandhar,Manju Sharma,Suman Adhikari,Suraj Shrestha 2022-06-07 11:06:46 A comprehensive approach to asymptomatic adults with Wolff-Parkinson-White (WPW) pattern discovered incidentally on routine electrocardiography (ECG) is debatable. The objective of this review article is to update the most recent evidence on the management of young patients with asymptomatic WPW patterns. A substantial proportion of adults with WPW patterns on ECG may remain asymptomatic but the lifetime risk for fatal arrhythmias still exists. The inherent properties of the accessory pathway determine the risk of sudden cardiac death. A low-risk pathway is considered when the pre-excitation is intermittent on ambulatory monitoring or when it disappears completely or abruptly during exercise testing. On the other hand, a high-risk pathway in EP study is suggested by the presence of the shortest pre-excited RR interval (SPERRI) during atrial fibrillation of ≤ 250 ms or accessory pathway effective refractory period (APERP) ≤ 240 ms. The cardiac evaluation may thus be considered in asymptomatic patients with WPW to determine the individual risk for future symptomatic arrhythmia. A shared-decision making must be performed before offering catheter ablation whose procedural success rate is high. https://www.cardiologymedjournal.com/articles/jccm-aid1132.pdf Research Article Associations of arterial stiffness with left ventricular mass index and carotid intima-media thickness in the hypertensives Hoang P Le,Binh G Nguyen 2022-05-05 15:44:32 Background: Arterial stiffness has been considered an independent predictor of cardiovascular disease in addition to the traditionally known cardiovascular risk factors. Objectives: This study aimed to investigate the associations between arterial stiffness with left ventricular mass index and carotid intima-media thickness in the hypertensives. Methods: A descriptive cross-sectional study compared a control group in 210 study subjects (105 hypertensives and 105 normotensives). Measuring left ventricular mass index by echocardiography and carotid intima-media thickness by carotid doppler ultrasonography. Pulse wave velocity was measured using the Agedio B900 device and the Agedio K520 application. The manual method was measured by the ankle-brachial index.Results: There was a statistically significant positive correlation between pulse wave velocity and age (r = 0.922, p < 0.001). The ankle-brachial index had a statistically significant positive correlation at a weak level with left ventricular mass index and carotid intima-media thickness, in which the coefficient r was equal to 0.219 (p < 0.05) and 0.250 (p < 0,001), respectively. Pulse wave velocity also had a statistically significant positive correlation at a weak level with left ventricular mass index and carotid intima-media thickness, in which the coefficient r was equal to 0.188 (p < 0.05) and 0.289 (p < 0,001), respectively. Pulse wave velocity had a multivariable linear correlation with gender, pulse, mean blood pressure, and ankle-brachial index with statistical significance; and they were written in the form of the following equation: Pulse wave velocity (R2: 41.3%) = 0.641*(Gender) – 0.027*(Pulse) + 0.043*(Mean blood pressure) + 8.378*(Ankle-brachial index) – 3.254.Conclusion: Arterial stiffness was statistically correlated with left ventricular mass index and carotid intima-media thickness in the hypertensives. Through the above research results, we suggest that the hypertensives should be combined with the evaluation of hemodynamic parameters and arterial stiffness for contributing to the diagnosis and detection of cardiovascular complications, thereby improving the quality of monitoring and treatment in hypertensive patients. https://www.cardiologymedjournal.com/articles/jccm-aid1131.pdf Case Report FDG PET/CT of uncommon cardiac angiosarcoma with bone metastases: a case report Tatiana Moreno Monsalve,Laura Frutos-Esteban,Laroussi Mohamed-Salem,María Isabel Castellón-Sánchez,Ana Cristina Hernández-Martínez,Tomas Rodríguez-Locarno,Jose Fulgencio Contreras-Gutierrez 2022-04-26 15:39:02 Cardiac angiosarcomas are rare malignant neoplasms with an aggressive clinical course. These are characterized by the absence of specific clinical findings, rapid growth with frequent metastasis at the time of diagnosis, correlated with poor prognosis, and reduced response to treatment. But with early diagnosis, more possibilities for treatment and survival can be provided. We report the case of a young woman diagnosed with right atrial angiosarcoma locally advanced with bone metastases detected by 18F-FDG PET/CT, which revealed distant disease extent at diagnosis, consequently, chemotherapy was started. https://www.cardiologymedjournal.com/articles/jccm-aid1130.pdf Research Article Prevalence and pattern of congenital heart disease among children with Down syndrome seen in a Federal Medical Centre in the Niger Delta Region, Nigeria Ujuanbi Amenawon Susan,Onyeka Adaeze Chiemerie 2022-04-11 17:41:03 Background: Down syndrome (DS), or Trisomy 21, is the most common genetic disorder in the world and congenital heart disease (CHD) contributes significantly to morbidity and mortality in this population. Early diagnosis and prompt cardiac intervention improve their quality of life. This study was done to determine the prevalence and pattern of congenital heart disease among children with Down syndrome seen at the Paediatric Cardiology Unit of Federal Medical Centre (FMC), Bayelsa State.Method: A prospective study of children with Down syndrome referred for cardiac evaluation and echocardiography at the Paediatric Cardiology Unit of FMC, Bayelsa State over four years from 1st January 2016 to 30th December 2019. Data on socio-demographic information, echocardiographic diagnosis, and outcome were retrieved from the study proforma and analyzed.Results: A total of 24 children with Down syndrome were seen over the study period. Their age ranged from 0 to 16years. The majority, 20 (83.3%) of the children with Down syndrome were aged 5 years and below. There were 13 males and 11 females with a male to female ratio of 1.2:1. A total of 23 (95.8%) of the children with Down syndrome had CHD. The most common CHD was AVSD (including complete, partial, isolated, or in association with other defects) in 66.6% followed by TOF in 8.3%. Multiple CHDs were seen in 43.5% of the children. Only one child (4.2%) had a structurally normal heart on echocardiography. All the children with Down syndrome had pericardial effusion of varying severity while 33% had pulmonary artery hypertension (PAH). The fatality rate among the children seen with Down syndrome over the study period was 34.8% and only one child (4.2%) had open-heart surgery with the total repair of cardiac defect during the study period. Conclusion: Morbidity and mortality are high among children with Down syndrome due to the high prevalence of CHD. Early referral, diagnosis, and prompt intervention are encouraged. https://www.cardiologymedjournal.com/articles/jccm-aid1129.pdf Research Article Save the radial: go distally Rima Chaddad,Hussein Rabah,Batoul Awada,Malek Hmadeh 2022-04-07 16:18:54 Coronary artery disease is the leading cause of death worldwide.Percutaneous coronary intervention (PCI) is one of the most widely performed medical procedures used to save lives, currently over 3 million annually worldwide.The femoral artery has been the preferred vascular access site. However, radial access is gaining extensive popularity due to the benefits of earlier ambulation, fewer access site complications, and decreased rates of bleeding. Improvements in technology and understanding of the anatomic features of the vascular system have led to new insights into coronary angiography procedures.Distal radial access, which was first used in 2017, shows a higher success rate and fewer complications than previous sites; therefore, it might be the future for cardiovascular intervention.For this purpose, we conducted this prospective study at Beirut Cardiac Institute (BCI) comparing the two arms: radial vs. distal radial artery techniques through the anatomical snuffbox, in terms of patient’s length of stay, complication rate, and success rate of each procedure. https://www.cardiologymedjournal.com/articles/jccm-aid1128.pdf Case Report Fibromuscular dysplasia and aortic dissection Antonio M Puppo,Manuel Fernández Caro,Sara Martín Sastre,Francisco T Gómez,Jose Mariá López Sánchez 2022-03-30 15:36:33 Fibromuscular dysplasia is a rare, non-atherosclerotic, non-inflammatory vascular disease that typically affects women between the ages of 20 and 60 years.Although any artery can be affected fibromuscular dysplasia most commonly affects the renal and carotid arteries. Fibromuscular dysplasia of the renal arteries usually presents with hypertension, while carotid or vertebral artery disease causes transient ischemic attacks, strokes, or dissection. Aortic dissection is rare. We present the clinical case of a patient with fibromuscular dysplasia with type B aortic dissection. https://www.cardiologymedjournal.com/articles/jccm-aid1127.pdf Research Article Control of arterial hypertension and risk of new-onset of atrial fibrillation in patients with metabolic syndrome Ylber Jani,Kastriot Haxhirexha,Ferizat Haxhirexha,Bekim Pocesta,Atila Rexhepi,Fatmir Ferati,Ahmet Kamberi,Agim Zeqiri,Sotiraq Xhunga,Artur Serani,Lutfi Zylbeari 2022-03-10 14:20:58 Background: An association between Atrial Fibrillation (AF) and Metabolic Syndrome (MS) a constellation of abnormalities (high blood pressure, hyperglycemia, dyslipidemia, and abdominal obesity), has been demonstrated. There have been many studies that have shown that elevated blood pressure (BP), was significantly associated with an increased risk of AF. It is uncertain whether maintaining the optimal BP levels can prevent AF in the patients with MS categorized as ‘high-risk’ patients.Objective: The aim of this study was to evaluate the influence of control of BP on the occurrence of new-onset atrial fibrillation in patients with Metabolic Syndrome.Methods: Into this observational study, was enrolled 435 consecutive patients (210 males and 225 females) aged 45-79 years who fulfilled criteria for MS. Participants were selected among primary and secondary care patients, who were receiving ongoing care for arterial hypertension in the period from November 2018 till November 2021. The study was conducted at outpatients in 5 Health Care Clinics (3 Secondary Health Care Clinics and 2 Primary Health Clinics). Patient were categorized according to their BP levels as Group 1-patients with controlled BP, {(patients aged < 65 years Systolic Blood Pressure (SBP) of 120 - 130 mmHg, patients aged ≥ 65 years SBP of 130 - 139 mmHg)} and Diastolic Blood Pressure (DBP), {(patients aged < 65 years of < 80 mmHg. but not < 70 mmHg; patients aged ≥ 65 years of 85 - 89 mmHg)}, or Group 2-patients with uncontrolled BP(> 130/80 mmHg),and in patients aged ≥ 65 years BP (≥ 140/90 mmHg ). Results: New-onset of AF, was more frequent in participants with uncontrolled BP, respectively (34.7% vs. 19.5%, p = 0.009).Patients with uncontrolled BP have more frequent persistent AF (15.2% vs. 0.04%) and permanent AF (0.08% vs. 0.02%), whereas there was not significant changes between groups in relation to frequency of paroxysmal AF, respectively (12.8% vs. 10.9%, p = 0.29). There was observed significant association of uncontrolled BP with: increased frequency of AF (OR = 2.193; 95% CI 1.390 - 3.439), persistent AF (OR = 3.931; 95% CI 1.771 - 8.084), permanent AF (OR = 4.138; 95% CI 1.383-12.381), LA. Dimension ≥ 2.2 cm/m2 (OR = 2.089, 95% CI 1.330 - 3.252), BMI (OR = 5.226, 95% CI 3.155 - 8.659) and 5-risk factors for MS, respectively (OR = 2.998, 95% CI 1.833 - 4.901).Conclusion: Optimal BP levels, can reduce the frequency of new-onset AF in patients with MS categorized as ‘high-risk’ patients. Uncontrolled BP was associated with an increased risk of both subtypes of AF (persistent and permanent) in the patients with MS categorized as ‘high-risk’ patients. https://www.cardiologymedjournal.com/articles/jccm-aid1126.pdf Case Report Overview of glycemic control among admitted patients with diabetes in Tripoli University Hospital Haifa Elhadi Alshwikh,Faiza Hander 2022-02-18 10:51:56 Aim: To examine the relationship between the levels of HbA1c and hospital admission rates.Methods: We recorded HbA1c levels of all diabetic patients in Tripoli University Hospital over one year.Results: The mean HbA1c was 8.03%, with no difference between males and females. Over half of patients (56.5%) were admitted through their diabetes was well-controlled. Over half of the patients with type 1 diabetes (57/102, 55.9%) had a high HbA1c at admission compared to 42.1% of patients with type 2, who were mainly admitted with HbA1c level within the acceptable range set for this study. The HbA1c level was positively and significantly correlated with the length of hospital stay (R = 0.93, p = 0.000), and was significantly associated with hyperglycemia, diabetic ketoacidosis, coronary artery disease, limb ischemia, cataract, osteomyelitis, and non-alcoholic steatohepatitis.Conclusion: HbA1c is correlated significantly with hospitalization in type 1 diabetes but not in type 2. https://www.cardiologymedjournal.com/articles/jccm-aid1125.pdf Retrospective Study Lifestyle modification practice and associated factors among diagnosed hypertensive patients in selected Hospitals in West Arsi Zone, Oromia Regional State, Ethiopia Hika Wakjira,Tesfaye Gobena,Hirbo Shore 2022-02-01 14:44:18 Background: Globally 1.13 billion people were living with hypertension, Out of this two-thirds of them were living in low and middle-income countries. In Ethiopia, Non-Communicable Disease deaths are estimated at around 42%. However, it remains widely undetected and poorly controlled. To resolve these, lifestyle modification approaches that are often overlooked are the cornerstone of the prevention and management of hypertension. Objective: To assess lifestyle modification practice and associated factors among hypertensive patients in selected hospitals in West Arsi Zone, Oromia Regional, Ethiopia December 7 to 21, 2019. Method: Hospital-based cross-sectional study was conducted in the selected public hospital among 299 hypertensive patients. Systemic random sampling methods were used to select the study participants. Data were collected by face-to-face interviews using a structured questionnaire by trained data collectors. Data were analyzed using descriptive statistics and multivariate logistic regression method to identify predictors of the outcome (p < 0.05). Results: Of the total participants, only 25.2% (95% CI: 18.8-32.9) of the patients were practiced recommended lifestyle modifications. Patients Age older than 65 years (AOR = 2.9, 95% CI: 1.17 - 7.0), the patients with 2-5 years’ time since diagnosed hypertension (AOR = 0.26, 95% CI: 0.07 - 0.9), multiple co-morbidity (AOR = 2.7, 95% CI: 1.25 - 5.8,) and their knowledge on hypertension management (AOR = 14.6, 95% CI: 4.6 - 45.9) have an independently associated with recommended lifestyle modification. Conclusion: Lifestyle modification practices among hypertensive patients were low in this study. Age, comorbidity, time since diagnoses of hypertension, and knowledge of lifestyle were identified as predictors of the outcome. https://www.cardiologymedjournal.com/articles/jccm-aid1124.pdf Case Report Age, smoking, hypertension, and aortic aneurysm: Interactions and risks Seriki SA,Otoikhila OC 2022-01-06 17:46:31 Background/Aim: Aortic aneurysm is the bulging of a weakened portion of the aorta. The aorta is the major blood vessel that feeds blood (carrying oxygen, nutrients and water) to the tissues of the body. When a portion of the wall of the aorta becomes weak, blood pushing against the vessel wall can cause it to bulge like a balloon (aneurysm) leading to aortic dissection (a tear in the wall of the aorta that can cause life-threatening bleeding or sudden death). Blood pressure is the force arterial blood exerts on the wall of the artery. When this pressure is consistently high above 140/100 mmHg it is referred to as hypertension. As an individual gets older over time, physiological functions of the body depreciate leading to some abnormalities. Smoking is the consumption of tobacco mostly by inhalation of the smoke that is produced from burning the tobacco. This review article examines the close interactions between age, smoking, hypertension and aortic aneurysm, with a view to understanding mechanisms by which these factors predispose a patient to an aortic aneurism. It is also to observe if these factors interfere with treatment and recovery from aneurysms. Conclusion: After careful review, it is observed that age and smoking are risk factors for hypertension, and together with hypertension, the three factors predispose an individual to high risk for aortic aneurysm. https://www.cardiologymedjournal.com/articles/jccm-aid1123.pdf Case Report Stiff “Left Atrial” syndrome post-mustard procedure Joshua A Cowgill,Adrian M Moran 2021-12-01 20:36:09 Objectives: We describe the clinical course and management of two patients with post-capillary pulmonary hypertension due to diffuse pulmonary venous baffle calcification decades post-Mustard procedure.Background: From the late 1950s to the early 1990s, the definitive surgical repair for children with D-transposition of the great vessels (D-TGA) was an atrial switch procedure (either Senning or Mustard operation) which utilizes atrial-level baffles to shunt pulmonary venous blood to the morphologic right (systemic) ventricle and caval blood to the morphologic left (sub-pulmonary) ventricle. From a hemodynamic standpoint, baffle leaks and stenoses as well as precapillary pulmonary hypertension have all been described as both early and late complications [1]. Recently, delayed post-capillary pulmonary hypertension (in the absence of discrete baffle obstruction) decades post-atrial switch has also been described [2]. The underlying pathophysiology for this postcapillary pulmonary hypertension is unclear but is theorized to involve impaired diastology referable to the pulmonary venous baffle. Methods/Results: Using hemodynamic and imaging data, we describe two patients with extensive pulmonary venous baffle calcification and resultant pulmonary hypertension from the so-called “stiff left atrial (LA) syndrome.” This problem can be difficult to treat medically and is not amenable to catheter-based interventions. We hypothesize that this is an underlying mechanism for pulmonary hypertension in at least some post-Mustard and Senning patients. Conclusion: We describe the treatments and clinical course for each of these patients, and in particular describe how the surgical revision of the pulmonary venous baffle in one case led to the complete resolution of symptoms. https://www.cardiologymedjournal.com/articles/jccm-aid1122.pdf Research Article Mouth-to-mouth ventilation through cardiopulmonary resuscitation, is there any other way? Aini Maimaitiming,Xiaohai Wang,Jie Chen,Bing Zhang 2021-11-29 16:44:18 Objective: to provide and explore possibility of new idea that perform mouth-to-mouth ventilation through cardiopulmonary resuscitation. Methods: stage one was establishing the ventilation technique using cola bottles, stage two was measuring the tidal volume when different sized cola bottles were used. Result: the smallest sized cola bottle (500 ml) could also make obvious thorax rise in manikin CPR model. The tidal volume was 174.5 ± 9.1 ml, 220 ± 7.6 ml and 447 ± 15.9 ml respectively for 500 ml, 600 ml and 1.25 L cola bottles when using single hand performance. There were statistical differences (0.001) in tidal volume of different sized cola bottle by using one hand performance and two hands. Conclusion: Larger sized cola bottles (600 ml, 1.25 L) could be used as substitute ventilation technique for mouth-to-mouth ventilation in special circumnutates. https://www.cardiologymedjournal.com/articles/jccm-aid1121.pdf Research Article RV Function by cardiac magnetic resonance and its relationship to RV longitudinal strain and neutrophil/lymphocyte ratio in patients with acute inferior ST-segment elevation myocardial infarction undergoing primary percutaneous intervention Salma Taha,Shrouk Kelany Ali,Fabrizio D’Ascenzo,Hosam Hasan-Ali,Yousra Ghzally,Mohamed Abdel Ghany 2021-11-23 12:26:10 Background: Although acute inferior myocardial infarction (MI) is usually regarded as being lower risk compared with acute anterior MI, right ventricular (RV) myocardial involvement (RVMI) may show an increased risk of cardiovascular (CV) morbidity and mortality in patients with inferior MI. CMR is ideal for assessing the RV because it allows comprehensive evaluation of cardiovascular morphology and physiology without most limitations that hinder alternative imaging modalities. Objectives: To evaluate the sensitivity of strain and strain rate of the RV using 2D speckle tracking echo and the neutrophil/ lymphocyte ratio (NLR) compared to cardiac MRI (CMR) as the gold standard among patients with inferior STEMI undergoing primary percutaneous coronary intervention (PCI). Methodology: 40 Patients with inferior MI who had primary PCI were included in the study; they were divided into two groups according to the RVEF using CMR. NLR was done in comparison to RVEF.Results: out of the 40 patients, 18 (45%) patients had RV dysfunction. 2D echocardiography was done for all patients, where fractional area change (FAC) in the RV dysfunction group appeared to be significantly reduced compared to the group without RV dysfunction (p value = 0.03). In addition, RV longitudinal strain (LS) by speckle tracking echo was reduced with an average of 19.5 ± 3.9% in the RV dysfunction group.Both CMR- derived RV SV, and EF were lower among the RV dysfunction group, (26.8 ± 15.8) ml and (35.4 ± 6.9)% respectively, with large RV systolic volume, with a highly statistically significant difference in comparison to the other group (p value = 0.000). Complications, heart block was significantly higher in patients with RV dysfunction (p value = 0.008) as it occurred in 5 (27.8%) patients.N/L ratio for predicting RV dysfunction by CMR had a cut-off value of > 7.7 with low sensitivity (38.8%) and high specificity (77.3 %). In contrast, LS for predicting RV dysfunction by CMR had high sensitivity (83.3%) and high specificity (63.6%) with p value = 0.005.Conclusion: Our results showed that RV dysfunction in inferior MI is better detected using cardiac magnetic resonance imaging. In inferior STEMI patients who underwent primary PCI, NLR has low sensitivity but high specificity for predicting RVD when measured by cardiac MRI. https://www.cardiologymedjournal.com/articles/jccm-aid1120.pdf Case Report Percutaneous treatment of severe retroperitoneal hematoma after percutaneous coronary intervention Agarwal Rajendra Kumar,Agarwal Rajiv 2021-09-25 12:09:45 We describe a patient who developed severe retroperitoneal and intraperitoneal bleeding complicating femoral arterial catheterization for Percutaneous coronary intervention. Balloon tamponade of the actively bleeding femoral artery was effective in sealing off the leakage.This management strategy for this problem emphasizing an anatomical based interventional approach if the patient does not stabilize with volume resuscitation. https://www.cardiologymedjournal.com/articles/jccm-aid1119.pdf Research Article The complex interplay in the regulation of cardiac pathophysiologic functionalities by protein kinases and phosphatases Chrysanthus Chukwuma Sr 2021-08-26 00:00:00 Protein phosphorylation regulates several dimensions of cell fate and is substantially dysregulated in pathophysiological instances as evident spatiotemporally via intracellular localizations or compartmentalizations with discrete control by specific kinases and phosphatases. Cardiovascular disease manifests as an intricately complex entity presenting as a derangement of the cardiovascular system. Cardiac or heart failure connotes the pathophysiological state in which deficient cardiac output compromises the body burden and requirements. Protein kinases regulate several pathophysiological processes and are emerging targets for drug lead or discovery. The protein kinases are family members of the serine/threonine phosphatases. Protein kinases covalently modify proteins by attaching phosphate groups from ATP to residues of serine, threonine and/or tyrosine. Protein kinases and phosphatases are pivotal in the regulatory mechanisms in the reversible phosphorylation of diverse effectors whereby discrete signaling molecules regulate cardiac excitation and contraction. Protein phosphorylation is critical for the sustenance of cardiac functionalities. The two major contributory ingredients to progressive myocardium derangement are dysregulation of Ca2+ processes and contemporaneous elevated concentrations of reactive oxygen species, ROS. Certain cardiac abnormalities include cardiac myopathy or hypertrophy due to response in untoward haemodynamic demand with concomitant progressive heart failure. The homeostasis or equilibrium between protein kinases and phosphatases influence cardiac morphology and excitability during pathological and physiological processes of the cardiovascular system. Inasmuch as protein kinases regulate numerous dimensions of normal cellular functions, the pathophysiological dysfunctionality of protein kinase signaling pathways undergirds the molecular aspects of several cardiovascular diseases or disorders as related in this study. These have presented protein kinases as essential and potential targets for drug discovery and heart disease therapy. https://www.cardiologymedjournal.com/articles/jccm-aid1118.pdf Research Article Open heart surgery in Nigerian children the need for international and regional collaboration: The Bayelsa and Enugu experience Ujuanbi AS,Allagoa DO,Onwubere B,Chinawa JM,Ujunwa FA 2021-07-09 00:00:00 Background: Children with congenital heart diseases (CHD) often require palliative or definitive surgical heart interventions to restore cardiopulmonary function. Lack of early cardiac intervention contributes to large numbers of potentially preventable deaths and sufferings among children with such conditions. Objectives: The aim of this study was to highlight our experience and the importance of international and regional collaboration for open heart surgery in children with CHD and capacity building of local cardiac teams in Bayelsa and Enugu States. Methodology: In November 2016, a memorandum of understanding (MOU) was signed by the managements of FMC, Yenagoa, Bayelsa State, UNTH, Enugu and an Italian-based NGO- Pobic Open Heart International for collaboration in the area of free open heart surgery for children with CHDs and training of local cardiac teams from both institutions either in Nigeria or in Italy. Patients for the program were recruited from Bayelsa and Enugu States with referrals from all over the country with combined screening and selection done in UNTH. Selected patients were operated on and funded free of charge by the Italian NGO. Hands on training of the local cardiac teams and cardiac intervention was done twice yearly in Nigeria. Result: From inception of the program in November, 2016 to May, 2019 a total of 47 children (21 Males, 26 Females; age range 6 months to 14 years) with various types of congenital heart defects had free open heart surgery from the program with 41 surgeries done in UNTH & 6 in Italy (complex pathologies). Also, home cardiac teams from UNTH and FMC, Yenagoa gained from on-site capacity training & retraining from the Italian cardiac team both in Nigeria and in Italy. The Success rate was 95.7% (44) and Case Fatality rate was 4.3% (2). Conclusion: There is a great efficacy in early cardiac intervention. This is with respect to a high success rate and minimal Case Fatality seen in this study. This was achieved through Regional and international collaboration. https://www.cardiologymedjournal.com/articles/jccm-aid1117.pdf Case Report Unusual and severe peripartum cardiomyopathy: A case report Lamanna B,Vinciguerra M,Crupano FM,Cicinelli R,Cicinelli E,Vimercati A 2021-05-05 00:00:00 Peripartum cardiomyopathy (PPCM) is a relatively rare cardiac disease that manifests in the final stage of pregnancy and in the first months after delivery in women with no preexisting heart disease. Many etiological processes have been suggested: viral myocarditis, abnormal immune response to pregnancy, excessive prolactin excretion, prolonged tocolysis and a familiar predisposition to PPCM. Its diagnosis is often delayed because its symptoms, which include fatigue, dyspnea and palpitations are nonspecific. For this reason the diagnosis of PPCM is still made by exclusion of other etiologies. The long-term prognosis, once the acute phase is over, is a function of myocardial damage, this varies from complete functional recovery to chronic HF. The outcome of PPCM is highly variable with an alevated risk of fetomaternal morbidity and mortality. We report a serious case of a 40 years old female with biamniotic bicorionic twin pregnancy (PMA) who delivered by caesarean section and developed acute PPCM on post-operative. Symptoms occurred two hours after an intramuscular injection of two vials of methylergonovine the same day of cesarean delivery. These manifested in sudden tachypnoe, tachycardia and the appearance itchy maculopapular rash on her chest. On further evaluation, ECHO revealed cardiomegaly with reduced ejection fraction (< 15%). The case was successfully managed by a multidisciplinary team, using drugs like levosimendan and cabergoline, which rapresent emerging strategy in this clinical context. https://www.cardiologymedjournal.com/articles/jccm-aid1116.pdf Review Article Sildenafil citrate in healthy and diseased hearts Seriki Samuel Adinoyi 2021-04-23 00:00:00 Sildenafil citrate is one of the frontline drugs used to manage erectile dysfunction (ED). Chemically, it is described as 1-[[3-(6,7-dihydro-1-methyl-7-oxo-3-propyl-1H –pyrazolo [4,3-d]pyrimidin-5-yl)-4 ethoxyphenyl] sulfonyl]-4-methylpiperazine citrate (C22H30N6O4 S). It is a highly selective inhibitor of cyclic guanine monophosphate-specific phosphodiesterase type-5. There had been heightened concerns following reports that sildenafil citrate may increase the risk of cardiovascular events, particularly fatal arrhythmias, in patients with cardiovascular disease. So the cardiac electrophysiological effects of sildenafil citrate have been investigated extensively in both animal and clinical studies. This article ties up the various outcomes of the investigations with a view to guiding physicians and patients that use sildenafil citrate to manage erectile dysfunction, especially as it concerns its effect on their cardiovascular function in health and in disease. Sildenafil citrate could impact negatively on ailing hearts, but on a healthy heart, there may not be any such impact, rather, it improves on heart performance as it lowers the blood pressure. https://www.cardiologymedjournal.com/articles/jccm-aid1115.pdf Case Report pVAD-assisted left main DK-Crush Bifurcation PCI Post-ViV TAVR Steve Attanasio,Maria Isabel Camara Planek,Anshuman Das 2021-04-16 00:00:00 We describe successful percutaneous coronary intervention (PCI) of significantly diseased ostial left main (LM) and distal LM bifurcation (Medina 1,1,1) in a patient with a reduced left ventricular ejection fraction and a recent valve-in-valve balloon-expandable TAVR using the DK-Crush technique with the support of a percutaneous left ventricular assist device. https://www.cardiologymedjournal.com/articles/jccm-aid1114.pdf Research Article Abdominal obesity in predicting myocardial infarction risk. Waist-to-Hip Ratio: The metric that confused cardiology worldwide for a long time Angel Martin Castellanos 2021-03-24 00:00:00 Important differences has been found in assessing the effects of obesity on cardiovascular disease (CVD) risk [1]. Interestingly, accurate estimation of the body composition (BC) is highly relevant from a public health perspective [2], and it has the importance of being essential in establishing the impact of adiposity on increased myocardial infarction (MI) risk. However, in non-randomized studies, baseline differences of BC between groups to be compared may introduce bias in results. https://www.cardiologymedjournal.com/articles/jccm-aid1113.pdf Review Article Management of hypertension in Nigeria: The barriers and challenges Nelson I Oguanobi 2021-03-19 00:00:00 In recent years there has been increasing concern about the growing burden of cardiovascular disease (CVD) in developing countries. Systemic hypertension remains the commonest form of CVD and is identified as a key modifiable risk factor for cardiovascular morbidity and mortality. Primary and secondary prevention of cardiovascular adverse events are public health priorities. This review highlights the potential barriers and challenges to hypertension care in Africa’s most populous country, Nigeria, and proffers relevant recommendations. https://www.cardiologymedjournal.com/articles/jccm-aid1112.pdf Research Article Muscle growth and control of production of sarcomere components Gerry A Smith 2021-03-12 00:00:00 Here I contrast the skeletal and cardiac muscle in terms of the control muscle growth and of sarcomere component synthesis. The differences are major and reflect the long term needs of the two systems. With the skeletal system there is growth of both the number of myocytes and the sarcomere components within them dependent on demand made of the muscle. Unlike skeletal muscles the normal adult heart is greatly restricted in size, number of myocytes and their content of contractile proteins, i.e. there is little change on demand. Over time proteins get damaged or decay and for the normal heart this implies a strictly controlled maintenance synthesis of sarcomere components. From the studies of abnormal, mutated systems there is one thing inherent to and more pronounced in cardiac muscle, the FrankStarling Law of the Heart derived from the angiotensin ii type 1 receptor that my studies indicate is central to the control of sarcomere component synthesis. https://www.cardiologymedjournal.com/articles/jccm-aid1111.pdf Case Report An unusual presentation of atrioventricular nodal reentrant tachycardia Mihaela Grecu,Florina-Adriana Ghitun,Stefan Ailoaei,Dan Ursu,Raluca Chistol,Grigore Tinica,Cristian Statescu 2021-02-12 00:00:00 Introduction: Atrioventricular nodal reentrant tachycardia (AVNRT) is the most frequent supraventricular tachycardia, commonly manifesting as autolimited paroxysmal episodes of rapid regular palpitations that exceed 150 beats per minute (bpm), dizziness and pounding neck sensation. Case presentation: We present a case of a male patient, 70 years old, with ischemic heart disease and slow-fast AVNRT treated with radiofrequency catheter ablation (RFCA) in March 2019, with regular 6-months follow-ups. He was readmitted in our department in November 2020 for rest dyspnea and incessant fluttering sensation in the neck, without palpitations. The event electrocardiogram (ECG) was initially interpreted by general cardiologist as accelerated junctional rhythm, 75 bpm. Due to the persistence of symptoms and ECG findings, a differential diagnosis between reentry and focal automaticity was imposed. The response to vagal maneuvers and Holter ECG monitoring characteristics provided valuable information. We suspected recurrent slow ventricular rate typical AVNRT, which was confirmed by electrophysiological study and we successfully performed the RFCA of the slow intranodal pathway. Conclusion: AV nodal reentry tachycardia may have an unusual presentation, occurring in elder male patients with structural heart disease. Antiarrhythmic drugs can promote reentry in this kind of patients. In cases of slow ventricular rate, vagal maneuvers and Holter ECG monitoring can help with the differential diagnosis. The arrhythmia can be successfully treated with RFCA with special caution regarding the risk of AV block. https://www.cardiologymedjournal.com/articles/jccm-aid1110.pdf Review Article New insights from cardiac muscle applied to skeletal muscle Gerry A Smith 2021-01-15 00:00:00 I have recently described the origin of the second Ca2+ binding in the triggering of contractile activity in cardiac myofibrils that is the origin of the Ca2+ Hill coefficient of 2 for the ATPase. This site is not a simple protein binding site and cannot be measured by 45Ca2+ binding. The myofibril protein unit requirements are described by me and so are the consequences of disruption of the function of these units and the related medical outcomes. The purpose of this paper is to review the topic and extend the reasoning to the function of skeletal muscle and cite the literature that supports this. https://www.cardiologymedjournal.com/articles/jccm-aid1109.pdf Research Article Evidence of woven bone formation in carotid artery plaques Mirzaie Masoud,Zaur Guliyev,Michael Schultz,Peter Schwartz,Johann Philipp Addicks,Sheila Fatehpur 2021-01-05 00:00:00 Objective: Plaque morphology plays an important prognostic role in the occurrence of cerebrovascular events. Echolucent and heterogeneous plaques, in particular, carry an increased risk of subsequent stroke. Depending on the quality of the plaque echogenicity based on B-mode ultrasound examination, carotid plaques divide into a soft lipid-rich plaque and a hard plaque with calcification. The aim of this study was to investigate structural changes in the basement membrane of different carotid artery plaque types. Patients and methods: Biopsies were taken from 10 male patients (average age; 75 + 1 years) and 7 females (68 + 3 years). The study population included patients suffering from a filiform stenosis of the carotid artery, 8 patients with acute cerebrovascular events and 9 with asymptomatic stenosis. Scanning electron and polarised light microscopic investigations were carried out on explanted plaques to determine the morphology of calcified areas in vascular lesions. Results: By means of scanning electron microscopy, multiple foci of local calcification were identified. The endothelial layer was partially desquamated from the basement membrane and showed island-like formations. Polarised light microscopy allows us to distinguish between soft plaques with transparent structure and hard plaques with woven bone formation. Conclusion: The major finding of our study is the presence of woven bone tissue in hard plaques of carotid arteries, which may result from pathological strains or mechanical overloading of the collagen fibers. These data suggest a certain parallel with sclerosis of human aortic valves due to their similar morphological characteristics. https://www.cardiologymedjournal.com/articles/jccm-aid1108.pdf Case Report Acute ischemic stroke management in a patient with ventricular assist device Çisil İrem Özgenç Biçer,Işıl Kalyoncu Aslan,Irmak Salt,Eren Gözke 2020-12-23 00:00:00 Ventricular assist device is a portable machine which is also called an artificial heart for the patients who have terminal heart failure. The device maintains the heart’s vital functions until the suitable donor is found for the heart transplantation. It can be applied to either ventricles or both (biventricular). Although the device provides independence for the patient, it also has life-threatening complications. Such as infection, stroke secondary to thromboembolism, hemorrhage depending on anticoagulant use, right heart failure… and most of the time it is really hard to manage those complications. We will present a case, who had ischemic stroke as a complication of VAD even though he has been using aspirin, warfarin and had effective INR value. https://www.cardiologymedjournal.com/articles/jccm-aid1106.pdf Research Article Ivabradine versus carvedilol in the management of palpitation with sinus tachycardia among recovered COVID-19 patients Kartik Pandurang Jadhav,Pankaj V Jariwala 2020-12-23 00:00:00 Introduction: One of the major complications among COVID-19 patients include cardiac arrhythmias. Commonest arrhythmia is sinus tachycardia which is usually associated with palpitation causing discomfort to patients. In this study, we present a comparative study of use of Ivabradine vs. Carvedilol for sinus tachycardia in post-COVID-19 infected patients. Method: 50 consecutive recovered COVID-19 patients with sinus tachycardia were included in this open labelled RCT. 25 patients received Ivabradine and remaining 25 received Carvedilol. Single therapy non-responders were treated with Ivabradine with Atorvastatin. Results: The mean age of all patients is 48.8±7.66 years (Males 49.5 ± 7.21 years; Females 47.68 ± 8.23 years). The mean heart rate (MHR) of all patients is 125.52 ± 9.07/min (Males 125.67 ± 8.78/min; Females 125.26 ± 9.5/min). After five days of single drug therapy the mean drop in the heart rate was 35.04 ± 10.55/min (Males 34.41 ± 9.71/min; Females 36.05 ± 11.72/min), resulting in 27.88 ± 8.11% (Males 27.38 ± 7.56%; Females 28.69 ± 8.89%) reduction in MHR. Among the two groups, the Carvedilol group showed improvement of MHR in 14(56%) patients; whereas in Ivabradine group 18(72%) patients improved out of 25 patients each (p: 0.2385). In the Carvedilol group the MHR reduced from 128.6 ± 8.44 to 95.68 ± 10.63 (p < 0.001), which is statistically significant; similarly, the Ivabradine group showed a MHR from 122.44 ± 8.62 to 85.28 ± 10.52 (p < 0.001). The monotherapy therapy non-responders were treated with dual-therapy of (Ivabradine + Atorvastatin). Discussion: Ivabradine is more effective in controlling heart rate compared to Carvedilol. Also, Ivabradine group scores very well in ‘patient-satisfaction’ with regards to symptom (palpitation) relief. Conclusion: The COVID-19 sequelae of sinus tachycardia can be better controlled with Ivabradine when compared to Carvedilol. https://www.cardiologymedjournal.com/articles/jccm-aid1107.pdf Research Article Post-extrasystolic potentiation differentiates “true” from “pseudo” Low-flow, Low-gradient aortic stenosis Marc Vanderheyden,Sofie Verstreken,Marc Goethals 2020-12-16 00:00:00 Post-extrasystolic potentiation (PESP) is a marker of contractile reserve and refers to the augmentation of left ventricular contractility due to preload recruitment and rise in intracellular calcium following a premature beat. In this case report we show that PESP might be a safe and helpful aid to evaluate low flow, low gradient aortic stenosis and contractile reserve in the cathlab, thereby reducing the potential risk of complications associated with intravenous dobutamine evaluation and reducing unnecessary testing. https://www.cardiologymedjournal.com/articles/jccm-aid1105.pdf Research Article Antibiotic induced changes to mitochondria result in potential contributions to carcinogenesis, heart pathologies, other medical conditions and ecosystem risks Jorma Jyrkkanen 2020-10-02 00:00:00 With the discovery by Calghatgi (2013) that three common antibiotics (Abs) increased mitochondrial reactive oxygen (ROS) and lipid peroxide (LP) and depleted their natural absorbant glutathione led me to investigate further the potential impacts of these genotoxic substances on carcinogenesis. The range of impacts on mitochondria and cellular DNA varied by antibiotic to those consistent with known prior contributions to carcinogenesis. Specific cancers probably increased by these changes were HCC, RCC (KCC), CRC, cancer of the esophagus. Tumor suppressor gene mutations resulting from LP were noteworthy in this regard and mutations induced in CRC were consistent with those found in carcinogenesis of CRC. In addition depression of short chain fatty acids in microbiomes were found which depress the immune system increasing risk of all cancers. Many cancers were increased according to epidemiological studies linking Abs with elevated odds ratios, with one concern in particular, fatal breast cancer. The impact of loss of functionality of the mitochondria was also linked to depression of the citric acid cycle and therefore ATP which deflected metabolism to glycolysis, the Warburg mechanism also increasing risk of all cancers, favoured by cancer cells. In conclusion, some portion of many cancer types are probably increased in likelihood by number, type and frequency of Abs treatment and chronic residue exposure which varies from individual to individual. This led me to propose a three pronged carcinogenesis mechanism for Abs. 1. Cancer critical mutations 2. Immune depression 3. loss of mitochondrial functionality leading to Warburg effects. Damage to mitochondria were also noted by common pesticides tested in China and cancer associations were also found for many pesticides supporting a similar contributory etiology. Heart health concerns were raised by these findings because of the myriad mitochondria in the heart and because of long term reliability needs. Studies suggesting hearts were affected by Abs and pesticide exposure were presented. Because of their geographical ubiquitousness and the huge range of diseases associated with mitochondrial dysfunction, antibiotics and pesticides and bacteriocidal biocides are of concern for biodiversity and life in general. I propose research steps to evaluate Abs safety and suggest directions for further research and make suggestions on ways to ameliorate Abs toxicity. https://www.cardiologymedjournal.com/articles/jccm-aid1104.pdf Research Article Clinical profile and surgical outcomes of children presenting with teratology of Fallot Josephat M Chinawa,Agarwal Vijay,Sarang Gaikwad,Bhadra Trivedi4,Bartholomew Chukwu 2020-09-14 00:00:00 Background: Tetralogy of Fallot (TOF) is a very common cyanotic congenital heart disease presenting early at birth with various degrees of cyanosis. If left uncorrected surgically, can lead to death. Objectives: This study is aimed at determining pattern and surgical outcome of children with teratology of Fallot in a budding health facility in India over a year period. Result: A total of 51 children were diagnosed of TOF over the period, of which 66.7% were males with mean age of 48.14 ± 45.36 months. The surgical outcome showed only 3.9% mortality. The death was among children >1 to 5 years. The mean number of days in intensive care unit (ICU) was 5.8 ± 11.2 days. 82.4% of the patients were off-pump post-operatively, compared to 17.6% with re-pump. Among those who had re-pump, 77.8% were males and among those without re-pump, 64.3% were likewise males (χ2 = 0.6, p = 0.41). About 92.2% (47/51) of patients had pulmonary regurgitation post-op, ranging from mild to moderate regurgitation. 51.1% of the regurgitations were mild while 25.5% and 23.4% were moderate and severe regurgitations respectively. Post-operative VSD was detected in 51% (26/51) of the patients. The post-op right ventricular pressure (RVOT) was significantly lower than that of pre-op pressure, 10.8 ± 1.5 mmHg vs. 31.7 ± 4.5 mmHg (pair t test = 8.7, p < 0.001). Conclusion: Timely surgical repair is crucial in alleviating several morbidity and mortality associated with teratology of fallot. Pulmonary regurgitation is a very common sequel after surgery and can result in death. https://www.cardiologymedjournal.com/articles/jccm-aid1103.pdf Research Article Incidence and outcome of no flow after primary percutaneous coronary intervention in acute myocardial infarction Goutam Datta 2020-08-31 00:00:00 Background: Primary percutaneous coronary intervention (PCI) of the infarct-related artery (IRA) is the most effective treatment modality in ST-segment elevation myocardial infarction (STEMI). Incidence of no flow is 8.8% - 10% in primary PCI of STEMI patients. Our aim was to study actual incidence and outcome of no flow patients. Methods: Five hundred and eighty primary PCI patients were enrolled and evaluated from 2016 January to 2017 December. We used drug eluting stents in all cases. Majority of our patients (> 90%) presented to emergency six hours after onset of symptoms. There were many patients where there was no flow even after mechanical thrombus aspiration and pharmacological vasodilator therapy. We have studied primary outcome (mortality) of no flow in those patients. Results: There were 44 cases of no flow in our series (7.75%). Involvement of Left anterior descending artery (LAD) was in eighteen patients. Right coronary artery (RCA) was culprit in twenty four cases. Only two cases were seen in LCX territory. One month mortality rate in no flow group was 50% and 6.25% in successful recanalization group. One year mortality was 12.5% in successful recanalization group and 66% in no flow group. Conclusion: Refractory no flow during STEMI intervention is associated with increased incidence of major adverse cardiovascular events (MACE). There is no established strategy to solve this phenomenon. https://www.cardiologymedjournal.com/articles/jccm-aid1102.pdf Review Article The mechanisms of cardiac myopathies, a kinetics approach: Leading review Gerry A Smith 2020-07-16 00:00:00 The normal adult heart is a well maintained machine that has a mechanism for growth replacement of the sarcomere that is lost by natural degeneration. This process ensures the heart has the strength of contraction to function correctly giving blood supply to the whole body. Some of the force of contraction of the sarcomere is transmitted to its major protein titin where its strength results in unfolding of a flexible section and release of a growth stimulant. The origin of all the cardiomyopathies can be traced to errors in this system resulting from mutations in a wide variety of the sarcomeric proteins. Too much or chronic tension transfer to titin giving increased growth resulting in hypertrophic cardiomyopathy (HCM) and too little leading to muscle wastage, dilated cardiomyopathy (DCM). HCM can ultimately lead to sudden cardiac death and DCM to heart failure. In this paper I show (1) a collection of the tension/ATPase calcium dependencies of cardiac myofibrils that define the mechanism of Ca2+ cooperativity. (2) I then reintroduce the stress/strain relationship to cardiomyopathies. (3) I then review the cardiomyopathy literature that contains similar Ca2+ dependency data to throw light on the mechanisms involved in generation of the types of myopathies from the mutations involved. In the review of cardiomyopathy there are two sections on mutations, the first dealing with those disrupting the Ca2+ cooperativity, i.e. the Hill coefficient of activation, leading to incomplete relaxation in diastole, chronic tension, and increased growth. Secondly dealing with those where the Ca2+ cooperativity is not affected giving either increased or decreased tension transfer to titin and changes in sarcomere growth.  https://www.cardiologymedjournal.com/articles/jccm-aid1101.pdf Research Article Femoral venous closure: A single-centre retrospective analysis in real world all comers with MynxGrip® vascular closure device Nadim Malik,Alexander Harvard,Shamin Thirunavukarasu,Afzal Hayat,Abid Ullah,Reza Aghamohammadzadeh,Cathy Mary Holt 2020-06-18 00:00:00 Background: Vascular closure devices (VCD) are routinely used to achieve haemostasis following percutaneous arterial procedures. The extravascular polyethylene-glycol based MynxGrip® device (Cardinal Health) received FDA approval for use in the closure of femoral veins, but so far limited data is available on its use, especially with concomitant use of anticoagulants. Method: This is a retrospective analysis of data from a single-centre on the effectiveness and complication rates following the use of the MynxGrip® device for femoral venous closure in patients undergoing diagnostic/interventional (temporary pacing during balloon aortic valvuloplasty, or electrophysiology) procedures utilising 5-7F sheaths. Results: 85 patients (mean age 74 years) underwent femoral venous closure with the MynxGrip® device. 51.8% were male. The rate of concomitant anticoagulant or antiplatelet use was 52.9%. Device deployment was 100% successful with full haemostasis in all cases. There were no major vascular complications (bleeding, thrombosis, or infections). There was one case of a minor small venous hematoma which did not require treatment. The mean length of stay was less than 1 day (67.1% patients discharged the same day) and overnight stay only indicated by interventional procedure. Conclusion: These data support safety and efficacy of the MynxGrip® device for femoral venous closure with same-day discharge, even with concomitant aggressive antiplatelet and anticoagulant use. It has the potential for use in other large bore venous access sites.  https://www.cardiologymedjournal.com/articles/jccm-aid1100.pdf Review Article Fibrinolytic therapy with tPA failed because it was based on a flawed concept Victor Gurewich 2020-06-16 00:00:00 Fibrinolytic therapy has become synonymous with tissue plasminogen activator (tPA) based on the belief that tPA alone was responsible for natural fibrinolysis. Although this assumption was belied from the outset by disappointing clinical results, it persisted, eventually causing fibrinolysis to be discredited and replaced by an endovascular procedure. Since time to reperfusion is the critical determinant of outcome, which in acute myocardial infarction (AMI) means within two hours, a time-consuming hospital procedure is ill-suited as first line treatment. For this purpose, fibrinolysis is more fitting. The assumption that tPA is responsible for fibrinolysis is contradicted by published findings. Instead, tPA ‘s function is limited to the initiation of fibrinolysis, which is continued by urokinase plasminogen activator (uPA) and that has the dominant effect. tPA and uPA gene deletion and clot lysis studies showed the activators have complementary functions, requiring both for a full effect at fibrin-specific doses. They are also synergistic in combination thereby requiring lower doses for efficacy. A clinical proof of concept study in 101 AMI patients who were treated with a 5 mg bolus of tPA followed by a 90 minute infusion of prouPA, the native form of uPA. A near doubling of the 24 h TIMI-3 infarct artery patency rate was obtained compared to that in the best of the tPA trials (GUSTO). In further contrast to tPA, there were no reocclusions and the mortality was only 1% [1]. A sequential combination of both activators, mimicking natural fibrinolysis, holds promise to significantly improve the efficacy and safety of therapeutic fibrinolysis. https://www.cardiologymedjournal.com/articles/jccm-aid1099.pdf Research Article Long-term results for post-interventional systemic heparinization following angioplasty of peripheral vessels Masoud Mirzaie,Zaur Guliyev,Mohammed Dakna 2020-06-15 00:00:00 Objective: The long-term outcome of percutaneous transluminal angioplasties is mainly determined by restenoses, either by progression of the underlying disease or by intimal hyperplasia. Pharmacological substances on the one hand and the implantation of stents on the other have been developed with the intention of preventing precisely this complication. While patients are treated after PTA of peripheral vessels with different low-molecular-weight heparins, the indication for stent implantation is determined individually rather by experience. The aim of this study was to determine gender-specific risk factors of long-term outcome after percutaneous transluminal angioplasty (PTA) of peripheral vessels with or without stentimplantation. Methods: In the present study, we examined the long-term results of percutaneous transluminal angioplasty (PTA) of peripheral vessels. Between 2007 and 2017, in total, 3,276 patients underwent PTA with or without stent implantation in our clinic. All patients were treated postinterventionally for 48 hours with 25,000 IU heparin (Unfractionated Heparin (UFH), heparinsodium-Braun, 25,000 I.E./5 ml, 2 ml/h) monitored by the partial thromboplastin time and subsequently underwent a control investigation every 6 months. The endpoint of the study was determination of symptomatic stenosis larger than 50% that required reintervention. Results: 239 (68.2% with mean age 68.02 years) male patients and 111 female patients (31.71% with mean age 62.92 years) were evaluated with complete follow-up. A total of 470 PTAs were performed on male patients and 213 on female patients in multiple interventions. The majority of patients at the time of treatment were in stage IIb according to the classification of Fontaine (81.6% of male patients and 68% of females). In our sample, peripheral arterial disease stage III and IV according to Fontaine classification occurred twice as frequently in female patients as in male patients (stage III in 12.6% in female versus 6.1% in male, and stage IV in 18% in female versus 8.9% in males). In both groups, the femoral superficialis artery was most frequently dilated (64 cases, 30% in female and 155 cases, 32.9% in male), followed by the iliacal communis artery (46 cases in female and 99 cases in male, both with 21.5%). A balloon angioplasty of the tibialis anterior and posterior arteries was performed twice as frequently in female patients as in male patients (28 cases with 13.1% of tibialis ant. artery in female versus 32 cases with 6.8% in male patients, and in 17 cases with 7.9% of tibialis post. artery in female versus 16 cases with 3.4% in male patients). In this study, without consideration of gender, patency rates of 79% after 2.5 years, 67% after 5 years, 49% after 7.5 years and 37% after 10 years were determined for PTA without stent implantation. Between the 7th and 10th year in follow-up, the cumulative patency rates for stent implantation was 49%, whereas it was 31% for PTA alone. The results of this study show that the stent assisted PTA`s of comm. artery and external iliacal artery are significantly independent of risk factors better than the femoral vessels, and these in female patients better than in male patients. Male patients do not benefit significantly from stent implantation in the long term. As the COXI and II regression analyses show, gender-linked results are most evident for renal insufficiency and diabetes mellitus, and less pronounced also for the number of open lower leg vessels. Conclusion: Under consideration of gender and risk factors, while male patients with diabetes mellitus, renal insufficiency and/or poor run-off did not benefit from stent implantation in the long-term, female patients with similar risk factors showed higher patency rates after stent therapy. In addition, the long-term results after PTA of femoral superficialis artery and poplitea artery are significantly worse than PTA of the pelvic vessels in both genders. https://www.cardiologymedjournal.com/articles/jccm-aid1098.pdf Research Article Assessment of cardiovascular and renal functions during treatment with Desmodium adscendens therapy Seriki Samuel Adinoyi 2020-06-09 00:00:00 Desmodium adscendens is a rain forest medicinal herb used in managing quite a number of medical conditions. Its efficacy in the treatment of several diseases has made it a first line herb for doctors, especially in managing all forms of spasm. It is however common knowledge that some of these medicinal herbs impact severely on the normal functioning of some vital organs of the body during their administration. The present study was carried out to assess the renal and cardiovascular performance in subjects undergoing treatment with Desmodium adscendens with a view to advising against its indiscriminate use. The parameters used for the assessment of renal functions were serum creatinine and urea concentrations and their clearance. Also, changes in electrolyte concentration of Sodium, Potassium and Chloride concentration were used to assess cardiovascular performance. The histology of the kidney and heart tissues was also done to determine if the extract has impact on the cyto-architecture of the organs. Twenty-four (24) wistar rats were used for the experiment. The rats were grouped randomly into four groups (n = 6). Group 1 served as control, and the rats in the group were given normal rat feeds and water. Group 2 served as low dose group, and rats in this group were administered with low dose of extract 300 mg/kg. Group 3 served as medium group, and rats in this group were treated with medium dose of extract, 450 mg/kg. Group 4 served as high dose group, and rats in this group were treated with high dose of extract 600 mg/kg. The extract was administered for 28 days. Result showed that the extract did not impact negatively on the normal function of the renal and cardiovascular system of the treated groups, rather it enhanced their performances. It can therefore be concluded that the extract is beneficial to renal and cardiovascular functions if used within the treatment dosage.  https://www.cardiologymedjournal.com/articles/jccm-aid1097.pdf Research Article Prognosis of peripartum cardiomyopathy in sub-Saharan Africa (Burkina Faso South-West PPCM register) Taryètba André Arthur Seghda,Théodore Boro,Jean Eudes Bambara,Kadari Cisse,Andrés Miguel Lopez,Patrice Zabsonre 2020-05-19 00:00:00 Peripartum cardiomyopathy is one of the curable cardiomyopathy. It’s a severe and frequent disease arising among women of childbearing age. Its evolution in the long-term among some patients leads to chronic heart failure. Our study aims to determine from a prospective cohort, the factors associated with the non-recovery of myocardial function upon 12 months of diagnosis. Sociodemographic, clinical and echocardiographic data were collected at the time of diagnosis and then in months 3, 6 and 12. The outcome was the non-recovery of myocardial function at one year, defined by a left ventricular ejection fraction (LVEF) below 50%. 60 patients were analyzed after 12 months of follow-up. Mortality was about 13.3% and recovery rate of myocardial function reached 42.3%. After logistic regression, delay diagnosis and observance were the factors related to non- recovery of myocardial function. https://www.cardiologymedjournal.com/articles/jccm-aid1096.pdf Review Article Our experience with single patch repair of complete atrioventricular septal defects Can Vuran,Uygar Yoruker,Oguz Omay,Bulent Saritas,Canan Ayabakan,Ozlem Sarisoy,Riza Turkoz 2020-05-02 00:00:00 Background: Various surgical methods have been utilized in the management of complete atrioventricular septal defects (CAVSD). Early intervention and achievement of a competent left atrioventricular valve are the key factors for successful treatment. Methods: A total of 66 patients with complete atrioventricular septal defect have been operated in a tertiary care center. Patient group consisted of 28 males and 38 females with an average age of 6.2 ± 3.3 months. Ventricular and atrial defects were repaired generally with single-patch technique using autogenous pericardium. Results: Preoperative catheterization and angiography was performed in 41 patients. Single patch and modified single patch techniques were preferred in 57 and 9 patients respectively. The average duration for respiratory support, intensive care unit stay and discharge from hospital were 36 ± 49.3 hours, 4.1 ± 1.9 days, and 10.1 ± 3.3 days respectively. In the left atrioventricular valve mild, moderate and severe regurgitation were detected in 44 (66.6%), 17 (25.7%) and 2 (3%) patients postoperatively. No regurgitation was determined in 3 patients (4.5%). Two cases ended up with mortality (3%). Conclusion: Single patch repair technique can provide satisfactory surgical outcomes in patients with complete atrioventricular septal defect. https://www.cardiologymedjournal.com/articles/jccm-aid1095.pdf Research Article Conservative treatment versus invasive approach in elderly patients with myocardial infarction without ST-segment elevation Alexandra Cozma,Adriana Ardelean,Katalin Babes,Mircea Ioachim Popescu 2020-04-30 00:00:00 Myocardial infarction without ST segment elevation is one of the most common causes of hospitalization of the elderly patient [1]. Coronarography followed by revascularization, is performed in the vast majority of cases of myocardial infarction without ST segment elevation, in the regions with a well-developed health system. The decision to perform the procedure, the type of approach (early/late) and the selection of the type of myocardial revascularization depend on numerous factors such as: associated comorbidities, clinical presentation, the risk group in which the patient is framed, fragility, cognitive status, life expectancy etc. [2,3]. Older patients often present with various comorbidities, having a higher risk of complications and an unfavorable evolution. Thus, it was observed that invasively treatment is less commonly used in elderly patients with comorbidities, even if, the current guideline recommends that the invasive strategy should be considered in all patients with NSTEMI, regardless of age. At the same time, this subgroup of patients is not so well represented in the studies performed so far, the type of treatment chosen, being most often at the discretion of the attending physician [1,2]. Objective The present study aims to analyze the evolution of a subgroup of patients ≥ 70 years of age, with different comorbidities, with the diagnosis of myocardial infarction without ST segment elevation, according to the type of treatment applied: conservative versus invasive strategy (diagnostic coronarography ± revascularization, if appropriate). https://www.cardiologymedjournal.com/articles/jccm-aid1094.pdf Research Article Effects of highest dose of sacubitril/valsartan association compared to lower doses on mortality and ventricular arrhythmias Paul Milliez,Florent Allain,Damien Legallois,Katrien Blanchart,Laure Champ-Rigot,Arnaud Pellissier,Pierre Ollitrault,Mathieu Chequel,Rémi Sabatier,Alain Lebon,Sophie Gomes,Olivier Citerne,Farzin Beygui 2020-04-24 00:00:00 Background: Sudden cardiac death is a major healthcare issue in reduced ejection fraction heart failure (HFrEF) patients. Recently, the new association of sacubitril/valsartan showed a reduction of both ventricular arrhythmias (VA) and mortality even at low dose compared to enalapril in HF patients. The purpose of our study was to assess whether the highest dose of sacubitril/valsartan compared to lower doses may improve the rate of death and VA in a population of patients with HFrEF and with an implantable cardiac defibrillator (ICD). Methods: 104 HF patients with reduced EF under sacubitril/valsartan with an ICD were divided in 2 groups: the first one with the lower doses of sacubitril/valsartan (24/26 mg or 49 mg/51 mg twice daily) and the second with the maximal dose (97mg/103mg twice daily). The primary outcome was a composite of death or appropriate ICD therapy for VA. Results: After a median follow-up of 14 months, 39 patients were treated with lower doses and 65 patients with the highest dose. Patients from the lower doses group were older (70 [60-80] vs. 66 [60-70]; p = 0,03), more symptomatic at initiation (NYHA 3: 44% vs. 19%; p < 0,01) and more often in atrial fibrillation (31% vs. 12%; p = 0,04). The primary composite endpoint occurred in 14 patients (36%) in the low doses group versus 7 patients (11%) in high dose group (p < 0,01). This difference was particularly observed in the subgroup of patients with ischemic cardiomyopathy. In a multivariable analysis, the higher dose was independently associated with the primary outcome with an HR = 2,934 [IC 95% 1,147 – 7,504]; p = 0,03. Kaplan-Meier curve showed an early effect of the highest dose of sacubitril/valsartan association. Conclusion: Patients with HFrEF under the highest dose of sacubitril/valsartan showed better clinical outcomes with a decrease of both mortality or appropriated ICD therapies related to ventricular arrhythmias. https://www.cardiologymedjournal.com/articles/jccm-aid1092.pdf Review Article Glycosaminoglycans as Novel Targets for in vivo Contrast-Enhanced Magnetic Resonance Imaging of Atherosclerosis Yavuz O Uca,Matthias Taupitz 2020-04-20 00:00:00 Atherosclerosis is an important promoter of cardiovascular disease potentiating myocardial infarction or stroke. Current demand in biomedical imaging necessitates noninvasive characterization of arterial changes responsible for transition of stable plaque into rupture-prone vulnerable plaque. in vivo contrast enhanced magnetic resonance (MR) imaging (MRI) allows quantitative and functional monitoring of pathomorphological changes through signal differences induced by the contrast agent uptake in the diseased vessel wall, therefore it is the ideal modality toward this goal. However, studies have so far focused on the cellular targets of persisting inflammation, leaving extracellular matrix (ECM) far behind. In this review, we portray ECM remodeling during atherosclerotic plaque progression by summarizing the state of the-art in MRI and current imaging targets. Finally, we aim to discuss glycosaminoglycans (GAGs) and their functional interactions, which might offer potential toward development of novel imaging probes for in vivo contrast-enhanced MRI of atherosclerosis. https://www.cardiologymedjournal.com/articles/jccm-aid1091.pdf Research Article Recurrence of atrial fibrillation after pulmonary vein isolation, should we change the energy and technique? Jorge Toquero Ramos,Alejandro Durante-López,Jesús González Mirelis,Víctor Castro Urda,Eusebio García Izquierdo,Diego Jiménez Sánchez,Ignacio Fernández-Lozano 2020-04-03 00:00:00 Background: Pulmonary vein isolation (PVI) is the accepted standard nowadays for atrial fibrillation (AF) ablation. The most widespread ablation techniques are cryoballoon (CB) and point-by-point radiofrequency (RF) ablation. Comparative studies between both techniques have shown their equivalence for the first ablation procedure, but no trial has explored the potential incremental benefit of crossing over the ablation technique after AF recurrence. Objective: To explore the potential incremental benefit of a crossover ablation strategy for AF recurrences, comparatively with repeating the same ablation energy used for the first procedure. Methods: Retrospective analysis of patients undergoing a second AF ablation procedure after documented AF recurrence. Patients were excluded if all 4 PV were isolated at the beginning of the second procedure or extra-PVI ablation was used for the second procedure. Crossover group (n = 16) included patients in which two different techniques were used for the first and second procedure (CB-RF or RF-CB). Control group (n = 23) for those with same ablation procedure (RF-RF of CB-CB). Acute procedure end-point was PVI of all four pulmonary veins. Patients were followed-up at 3, 6, and 12 months with an electrocardiogram and a 24 h-holter. Arrhythmia-free survival at 1 year after the second ablation procedure was studied, comparing efficiency and safety of the two approaches (crossover vs. same energy). Success was defined as freedom from AF or atrial tachycardia lasting > 30 s off antiarrhythmic drugs (AADs) Results: A cohort of 39 paroxysmal and persistent AF patients was analyzed. PVI after the second procedure was 100% in all patients in both groups. There were no baseline relevant differences between the two groups. No deaths or hospitalizations occurred during follow up (data censored at 24h moths). At 1 year, arrhythmia free-survival was significantly higher in the crossover group compared to control group [93,3% vs. 47,8%; HR 0.19 (0.06-0.66);p = 0,009]. Conclusion: Crossing the ablation technique (point-by-point radiofrequency or cryoballoon PVI) after AF recurrence significantly improved arrhythmia free-survival at one year, despite no difference in acute success (PVI isolation). Randomized controlled trials with a higher amount of patients are needed to confirm the results and widespread this approach. https://www.cardiologymedjournal.com/articles/jccm-aid1090.pdf Review Article Primary prevention of SCD with ICD in the elderly Fabio Maria Gemelli,Lucia Mancinelli,Olga Protic,Lorenzo Pimpini ,Roberto Antonicelli 2020-03-30 00:00:00 Implantable cardioverter defibrillators (ICDs) are electronic devices that can prevent sudden cardiac death (SCD) caused by arrhythmic events in patients. The latest ESC/EAS and ACC/AHA Guidelines deem the placement of an ICDs appropriate in patients with heart failure class NYHA II and III in the presence of an ejection fraction less than or equal to 35% [1,2]. ICDs are usually not indicated in either class I or IV patients. The Guidelines recommendations for primary prevention of SCD with ICD implantation do not take into account the age of the patients but only their life expectancy which must be at least 1 year. Our patients usually are over eighty years old with heart failure and severely reduced ejection fraction. We must consequently decide if it is right to implant these patients with an ICD. Is the use of ICD in the patients over 80, in particular over 90 years old, really make sense becomes particularly important considering demographic changes that await us in the coming decades. https://www.cardiologymedjournal.com/articles/jccm-aid1089.pdf Review Article Dapt Review KARACA Özkan,KARASU Mehdi,KOBAT Mehmet A,KIVRAK Tarık 2020-03-25 01:00:00 Dual antiplatelet therapy (DAPT) combining aspirin and a P2Y12 receptor inhibitor has been consistently shown to reduce recurrent major adverse cardiovascular events (MACE) in patients with acute coronary syndrome (ACS) or undergoing percutaneous coronary intervention (PCI) for stable coronary artery disease (CAD) compared with aspirin monotherapy but at the expense of an increased risk of significant bleeding. Among patients with stable CAD undergoing PCI with drug-eluting stents (DES), shorter duration of DAPT (3–6 months) were shown non-inferior to 12 or 24 months duration concerning MACE but reduced the rates of major bleeding? Contrariwise, prolonged DAPT durations (18–48 months) reduced the incidence of myocardial infarction and stent thrombosis, but at the cost of an increased risk of majör bleeding and all-cause mortality. Until more evidence becomes available, the choice of optimal DAPT regimen and duration for patients with CAD requires a tailored approach based on the patient clinical presentation, baseline risk profile and management strategy. Patients with acute coronary syndromes (ACS) and a history of atrial fibrillation (AF) have indications for both dual antiplatelet therapy (DAPT) and oral anticoagulation (OAC). Triple therapy (TT), the combination of DAPT and OAC, is recommended in guidelines. This article provides a contemporary state-of-the-art review of the current evidence on DAPT for secondary prevention of patients with CAD and its future perspectives. https://www.cardiologymedjournal.com/articles/jccm-aid1088.pdf Research Article A study on pacemaker pocket infection Goutam Datta 2020-03-25 00:00:00 Objective: Cardiac implantable electronic device (CIED) infections now constitute ∼ 10% of all endocarditis cases. The incidence of CIED infection is usually < 2%. Our objective was to study pacemaker pocket infection rate and different risk factors in our institution. Methods: This observational study was conducted over a period of five years from January 2011 to December 2016 and it included 1096 patients. Common risk factors like patients with diabetes, repeat procedure, chronic renal failure, chronic obstructive airway disease, immunosuppressive agents were studied in our patients. Results: Our study consisted of 1096 patients. Pacemaker pocket infection occurred in sixteen patients (1.5%). Chronic renal failure patients were one hundred thirty in our study (11.86%). There were three hundred fifty six diabetic patients (32.48%). Repeat procedure was done in ninety five patients (8.6%). Results: Our study consisted of 1096 patients. Pacemaker pocket infection occurred in sixteen patients (1.5%). Chronic renal failure patients were one hundred thirty in our study (11.86%). There were three hundred fifty six diabetic patients (32.48%). Repeat procedure was done in ninety five patients (8.6%) Eighty six patients were suffering from chronic obstructive airway (7.8%). Patients on immunosuppressive therapy were fourteen in our study (1.2%). Conclusion: Pacemaker pocket infections is a dreaded complication after pacemaker implantation. During implantation, there is a risk of device contamination with the patient’s own skin flora and it can be prevented by ideal surgical asepsis technique, pre and perioperative use of antibiotics. https://www.cardiologymedjournal.com/articles/jccm-aid1087.pdf Research Article Clinical relevance linked to echocardiography diagnosis in Bland, White and Garland syndrome Mariela Céspedes Almira,Adel Eladio González Morejón,Giselle Serrano Ricardo,Tania Rosa González Rodríguez 2020-03-06 00:00:00 Introduction: Bland, White and Garland syndrome is a coronary anomaly with high mortality without treatment. Its clinical presentation is varied which makes epidemiological documentation difficult. Echocardiography is a useful non-invasive tool for diagnosis. Objective: To determine the echocardiographic variables that lead to the diagnosis of Bland, White and Garland syndrome and their clinical relevance. Material: Observational, prospective and cross-sectional study in 31 patients of the “William Soler” Pediatric Cardiocenter, from 2005 to 2018. To check the association of echocardiographic variables with the diagnosis of Bland, White and Garland syndrome, an effectiveness study was carried out that included the analysis of the incidence of echocardiographic variables that lead to the diagnosis of this entity. The clinical relevance was estimated according to the minimum importance limit. The statistical validation of the research results adopted a significance level of less than 5% (p < 0.05). Results: The variables that facilitate the echocardiographic diagnosis of Bland, White and Garland syndrome were the echocardiographic visualization of the anomalous connection and the reversed flow in the anomalous left coronary artery. These echocardiographic measures have clinical relevance according to the quantification of risk estimators (incidence) the echocardiographic visualization of the anomalous connection, RR 39.00 and the reversed flow in the anomalous coronary artery, RR 26.31. LIM´s calculation value amounted to 6.31 and coincided with the risk estimators (incidence). Conclusion: The echocardiographic visualization of the anomalous origin of the left coronary artery from the pulmonary arterial trunk and the detection of the local intracoronary reversed flow instituted as factors to be considered for the effective diagnosis of the disease. The documentation of the diagnostic aspects of the syndrome through echocardiography contains high statistical value and clinical relevance. https://www.cardiologymedjournal.com/articles/jccm-aid1086.pdf Case Report Pathological left ventricular hypertrophy and outflow tract obstruction in an infant of a diabetic mother: A case report Ujuanbi AS,Onyeka CA,Yeibake WS, Oremodu T,Kunle-Olowu OE,Otaigbe BE 2020-03-03 01:00:00 Background: Infants of diabetic mothers (IDMs) are at increased risk of developing congenital anomalies including cardiac defects. Pathological left ventricular hypertrophy, asymmetrical septal hypertrophy and outflow tract obstruction is a rare but known cardiac comorbidity in infants of diabetic mothers. The severity of this condition in IDMs can vary from an incidental finding on echocardiography to an infant with severe symptoms of congestive heart failure and specific management of the condition varies. Aim: The aim of this article is to report this clinical entity in a Nigerian infant born to a mother with poor glycaemic control in pregnancy and highlight management. Case report: We report a term neonate who was diagnosed as a case of pathological left ventricular hypertrophy, asymmetrical septal hypertrophy and outflow tract obstruction delivered to a mother with gestational diabetics with poor glycaemic control in pregnancy. Child was treated successfully with β-adrenergic blocker and showed resolution of hypertrophy in follow-up echocardiography. Conclusion: Infants of diabetic mothers are very high risk infants. Pathological left ventricular hypertrophy in IDM have good prognosis. Early recognition and prompt intervention is advocated. https://www.cardiologymedjournal.com/articles/jccm-aid1085.pdf Review Article His bundle pacing in heart failure: A review of current literature Rahul Chaudhary,Jalaj Garg 2020-03-03 00:00:00 Biventricular (BiV) pacing revolutionized the heart failure management in patients with sinus rhythm and left bundle branch block; however, left ventricular-lead placement is not always technically possible. Also, BiV pacing does not fully normalize ventricular activation and, therefore, the ventricular resynchronization is imperfect. On the other hand, right ventricular pacing for bradycardia may cause or worsen heart failure in some patients by causing dyssynchronous ventricular activation. His bundle pacing comes as an alternative to current approaches as it activates the ventricles via the native His-Purkinje system, resulting in true physiological pacing, and, therefore, is a promising site for pacing in bradycardia and traditional CRT indications in cases where it can overcome left bundle branch block. Furthermore, it has the potential to open up new indications for pacing therapy in heart failure, such as targeting patients with PR prolongation, but a narrow QRS duration. In this article we explore the history, clinical evidence, proposed mechanisms, procedural characteristics, and the role in current therapy of His bundle pacing in the prevention and treatment of heart failure. https://www.cardiologymedjournal.com/articles/jccm-aid1084.pdf Review Article ECG interpretation and commentary Samir Rafla,Ahmed Mokhtar,Amr Kamal 2020-02-18 02:00:00 This is demonstration of selected ECGs for learning or for exams; guided by lessons from great teachers as Prof. Hein Wellens MD. Here we provide advanced examples with comment and analysis. https://www.cardiologymedjournal.com/articles/jccm-aid1084.pdf Review Article Localization of the occluded vessel in acute myocardial infarction Samir Rafla,Amr Kamal 2020-02-18 00:00:00 This is a review of features in ECG to diagnose the culprit artery responsible for the infarction. Localization of the occluded vessel in acute myocardial infarction is important for many reasons: to know which artery is to dilate and stent; to assess the severity of the lesion; to compare with the echocardiographic area with hypokinesia or akinesia and to differentiate the recent from the old occluded vessel. The ST-segment changes in 12-lead ECG form the basis of diagnosis, management, and prognosis. https://www.cardiologymedjournal.com/articles/jccm-aid1082.pdf Mini Review Angiotensin II type 1 receptor and the activation of Myosin Light-Chain Kinase and Protein Kinase C-βII: Mini Review Gerry A Smith 2020-02-17 00:00:00 The involvement of the angiotensin II type 1 receptor in the Frank-Starling Law of the Heart, where the various activations are very limited, allows simple analysis of the kinase systems involved and thence extrapolation of the mechanism to that of angiotensin control of activation of cardiac and skeletal muscle contraction. The involvement of phosphorylation of the myosin light chain in the control of contraction is accepted but not fully understood. The involvement of troponin-I phosphorylation is also indicated but of unknown mechanism. There is no known signal for activation of myosin light chain kinase or Protein Kinase C-βII other than Ca2+/calmodulin but the former is constitutively active and thus has to be under control of a regulated inhibitor, the latter kinase may also be the same. Ca2+/calmodulin is not activated in Frank-Starling, i.e. there are no diastolic or systolic [Ca2+] changes. I suggest here that the regulated inhibition is by myosin light chain phosphatase and/or β-arrestin. Angiotensin activation, not involving G proteins. is by translocation of the β-arrestin from the sarcoplasm to the plasma membrane thus reducing its kinase inhibition action in the sarcoplasm. This reduced inhibition has been wrongly attributed to a mythical downstream agonist property of β-arrestin. https://www.cardiologymedjournal.com/articles/jccm-aid1081.pdf Research Article Gender-specific associations of anthropometric measures of adiposity with blood pressure and hypertension in young Chinese Medical College Students Li-Hua Li,Navin Kumar Sah,Qing-Tao Zhang,Yong-Gang Li, Xue-Yan Yin 2020-01-31 00:00:00 Purpose: There are uncertainties about whether general or central obesity is the more important determinant for blood pressure and hypertension in young Chinese. We aim to investigate the association between adiposity measures and blood pressure and hypertension in young medical students. Methods: A total of 380 medical students were recruited from the 2012 batch in the Clinical College of Dali University. Anthropometric measures and office blood pressure were measured. Blood pressure status was defined by Chinese hypertension guidelines and ACC/AHA 2017 hypertension guidelines, respectively. We examined the associations of adiposity measures (body weight, body mass index [BMI], waist circumference, hip circumference, waist-to-hip ratio [WHR], waist-to-height ratio [WHtR], ponderal index [PI], body adiposity index (BAI) and conicity index [CI]) with blood pressure and hypertension by sex. Results: In 380 subjects (women 66.6%, mean age 21.5 years), the prevalence of obesity (BMI ≥ 28 kg/m2) was 2.1%, and the prevalence of hypertension was 2.6% (≥ 140/90 mmHg) and 24.5% (≥ 130/80 mmHg), respectively. In correlation analyses and multivariable-adjusted linear regression analyses, most adiposity measures of central obesity were significantly associated with blood pressure in men, while in women, either adiposity measures of central or general obesity were associated with blood pressure. The predictive power of adiposity measures for hypertension was generally low in men. However, adiposity measures of either general obesity or central obesity were predictive for hypertension defined by Chinese hypertension guidelines in women. Conclusion: There are gender-specific associations of central and general obesity with blood pressure and hypertension in young Chinese medical students. https://www.cardiologymedjournal.com/articles/jccm-aid1080.pdf Case Report Occluded superior vena cava and failed epicardial pacing: An unorthodox solution Ranjit K Nath,Satyam Rajvanshi 2020-01-13 01:00:00 Permanent pacemaker implantation is conventionally done via upper limb veins. But in 1% - 6% cases, usual sub clavicular approach is either not possible or contraindicated due to complete occlusion of superior vena cava (SVC) or bilateral subclavian vein and/or bilateral implant site infection or thin skin [1]. Alternative approaches are warranted, including leadless pacemaker or complex lead extraction techniques, before considering surgical epicardial lead placement as a last resort because it has own hazards. We report a patient with complete heart block, total SVC obstruction, and a previously implanted malfunctioning epicardial lead presenting with pacemaker end of life. In view of exhaustion of the surgical option and in a resource constrained situation for lead extraction or leadless pacemaker, transiliac endocardial pacemaker implantation was done and a repeat surgery was averted. Learning objective: Complete venous occlusion is not very often encountered after pacemaker/ICD implantation. Apart from the risk of general anesthesia and invasive surgery, epicardial leads increase battery drain, and have a shorter operating life compared to an endocardial lead. The sparingly utilized iliac venous approach for permanent pacemaker implantation is a valuable, safe and minimally invasive alternative, when the conventional percutaneous access is unavailable, and surgery is undesirable or not possible.  https://www.cardiologymedjournal.com/articles/jccm-aid1079.pdf Case Report Coronary-intercostal steal syndrome, a rare connection between the left circumflex coronary artery and intercostal arteries: A case report Khaled H Alkhodari,Mohammed H Habib 2020-01-13 00:00:00 A 60-year-old female patient presented with typical anginal pain on exertion and relieved by rest for about one month. Percutaneous coronary angiography was done and showed an abnormal left circumflex coronary artery connecting to intercostal artery. Embolization of that abnormal connection was done successfully and the patient discharged from hospital after 24 hours. This case shows a new form of coronary steal syndrome. This cause could be missed if not put under the differential diagnosis of typical anginal pain with normal coronary arteries. https://www.cardiologymedjournal.com/articles/jccm-aid1078.pdf Research Article Effect of hemodialysis session on acute changes in inflammatory and cardiovascular risk biomarkers Bernardo-Alio Lavín Gómez,María-Teresa García Unzueta,Armando-Raúl Guerra Ruiz,Sonia Pérez San-Martín,Ana Berja,Natalia Fañanás Rodríguez,Sara Díez Espejo,Domingo González-Lamuño Leguina 2020-01-09 00:00:00 Background: Inflammation is associated with enhanced cardiovascular risk profile and increased cardiovascular mortality in end-stage kidney disease patients undergoing hemodialysis. Mechanisms of activated acute phase reaction in patients on chronic hemodialysis remain to be identified. As successful treatment of the inflammatory condition in these patients may improve long-term survival, we studied potential changes in different inflammatory biomarkers of cardiovascular risk in end-stage kidney disease patients after a mid-week hemodialysis session. Methods: Inflammatory biomarkers of cardiovascular risk (cystatin-C, homocysteine, C-reactive protein, procalcitonin, pentraxin-3, serum amyloid-A) and atherogenic plasma lipoproteins (Lipoprotein(a), cholesterol low and high density lipoproteins) were studied in 21 end-stage kidney disease patients previously and after a mid-week hemodialysis session. Results: We found a significant reduction in serum levels of low molecular weight molecules: cystatin-C (5.56 to 1.85 mg/L, 66.73%, p < 0.001), homocysteine (22.85 to 13.25 µmol/L, 42.01%, p < 0.001) and procalcitonin (0.788 to 0.457 ng/mL, 42.01%, p < 0.001). Large molecules as C-reactive protein (9.70 to 9.90 mg/L, 2.06%, p = 0.022) and pentraxin-3 (1.67 to 4.28 ng/mL, 156%, p < 0.001) increased, but serum amyloid-A decreased (15.90 to 12.70 mg/L, 20.13%, p < 0.05). There was no change in Lipoprotein (a) levels. Conclusion: Pentraxin-3 was a more specific inflammatory vascular marker than C-reactive protein, and the best inflammatory marker associated with hemodialysis. Homocysteine, procalcitonin and the other small proteins could be released and removed during hemodialysis session. Further studies are needed to understand the behavior and significance of these markers after successive hemodialysis. https://www.cardiologymedjournal.com/articles/jccm-aid1077.pdf Review Article A proposed mechanism to explain increases in intracranial pressure: The concept of cerebral artery wedge pressure DR Hamilton,A Mitha,MG Hamilton,JV Tyberg 2020-01-08 00:00:00 We hypothesize that, with elevated cerebral spinal fluid (CSF) pressure, cerebral micro-vascular obstruction and congestion may occur despite (subdural) large-vein pressures being normal. Smaller veins emptying into these larger, dura-enveloped veins are not immune to the compressive effects of elevated CSF pressure and a “Starling Resistor” mechanism might explain why elevated CSF pressures collapse these smaller veins. This small cerebral venous starling resistor compression mechanism may be the final common pathway for many patients suffering from increased CSF pressures and might also be an important contributor to impaired focal venous drainage presenting as a headache with normal venous sinus pressures. https://www.cardiologymedjournal.com/articles/jccm-aid1076.pdf Research Article Evaluation of the effect of coronary artery bypass grafting on the right ventricular function using speckle tracking echocardiography Mahmoud Shawky Abdelmoneum,Neama Ali Elmeligy,Elsayed Abdelkhalek Eldarky,Mohamad Mahmoud Mohamad 2019-12-30 00:00:00 Purpose: This was a prospective study conducted at Benha University hospital and National Heart Institute on one hundred patients undwent coronary artery bypass grafting (CABG) to evaluate the effect of CABG on the right ventricular (RV) function using speckle tracking echocardiography (STE). Methods: All cases were subjected to detailed medical history, full physical examination, 12 leads electrocardiogram (ECG), routine laboratory tests including (complete blood picture, liver functions, renal functions and lipid profile) and echocardiography either conventional echocardiography or STE, all parameters obtained before and within 2 weeks after surgery. Results: By conventional echocardiography there was statistically significant decrease in peak right ventricle systolic velociy (RVS) from (12.76 ± 1.72) to (7.33 ± 1.71) and tricuspid annular plane systolic excursion (TAPSE) from (22.8 ± 3.99) to (13.77 ± 4.63) among the studied patients after CABG. While there was significant increase in right ventricle fractional area change (RVFAC) from (44.69 ± 3.25) to (49.01 ± 3.36). On the other hand, there was non-significant change in right ventricle end diastolic diameter (RVEDD) at mid-cavity from (26.37 ± 2.72) to (26.53 ± 2.72) and basal segment from (36.05 ± 2.98) to (36.29 ± 3.04), right ventricle stroke volume (RVSV) from (65.44 ± 7.02) to (65.85 ± 6.86) and right myocardial performance index (RMPI) from (0.491 ± 0.088) to (0.498 ± 0.086). By STE There was statistically significant decrease in right ventricle global longitudinal strain (RVGLS) from (-20.63 to -14.1) after CABG. There was statistically significant decrease in right ventricle free wall longitudinal strain [apical decreased from (-23.73 to -13.7), mid-cavity decreased from (-25.76 to -11.53), basal decreased from (-20.39 to -10.13) and lateral wall declined from (-23.01 to -9.13)]. There was statistically significant decrease in interventricular septum longitudinal strain [apical decreased from (-19.77 to -10.06), mid-cavity decreased from (-17.81 to -10.87) and basal decreased from (-15.89 to -11.13)]. There was statistically significant increase in RV circumferential strain of lateral free wall from (-12.04 to -16.21), while there was non-significant change in RV circumferential strain of septum from (-19.77 ± 4.86) to (-20.37 ± 5.14). Conclusion: Distorted RV geometry after CABG can lead to altered deformation parameters, in other words longitudinal functional parameters may underestimate RV function and the decrease in RVGLS was compensated by increase in circumferential strain of lateral free wall of RV without change in RVSV or RMPI. Therefor changes in deformation parameters should always be interpreted in relation to change in geometry. https://www.cardiologymedjournal.com/articles/jccm-aid1075.pdf Case Report Aortic dissection causing 2 myocardial infarctions Sebastian Szabo,Hans Martin Hoffmeister 2019-12-16 00:00:00 A 56-year-old man was admitted to our hospital because of sudden onset of right-sided thoracic pain. The ECG showed inferior ST segment elevations. He has been treated with aspirin, clopidogrel, unfractionated heparin and tenecteplase, and his symptoms resolved after 30 minutes. About half an hour later, the patient developed again left-sided thoracic pain and the signs of an anterior myocardial ST-segment elevation infarction. 90 minutes after receiving the initial medications, the performed coronary angiography revealed a long dissection of a large ramus circumflexus. Furthermore, the left anterior descending coronary artery was occluded at about the mid-level. The left ventriculography showed a reduced ventricular function and a Stanford type A aortic dissection. Immediate patient transfer for emergency surgical intervention was arranged. However, ventricular fibrillation occurred during transport and he required endotracheal intubation and prolonged cardiopulmonary resuscitation. Unfortunately, he died during further transport. In a patient with massive thoracic pain of initially uncommon localization in combination with fluctuation of ST-segment elevations, aortic dissection should be seriously taken into the differential diagnosis as well as into therapeutic management decisions (in particular antiplatelet and thrombolytic therapy). https://www.cardiologymedjournal.com/articles/jccm-aid1074.pdf Research Article Long-Term Impact of Coronary Artery Disease in Lung Transplantation William S Ragalie,Nilto C de Oliveira,Richard Cornwell,Keith Meyer,James D Maloney 2019-11-26 01:00:00 Background: Adoption of the Lung Allocation Score (LAS) has led to increased listing of older patients and those with idiopathic pulmonary fibrosis (IPF) for lung transplantation (LTX). Older patients and those with IPF have higher prevalence of coronary artery disease (CAD), a relative contraindication for LTX. The impact of the LAS on CAD prevalence and cardiovascular morbidity in LTX recipients is unknown. Methods: Retrospective review of single institution database from January 2000 to December 2010. Patients with and without CAD were compared by age, gender, LAS, single vs double LTX, and transplant indication. Survival was calculated by Kaplan-Meier method, and statistical significance determined by log-rank method. Survival analysis was performed on all patients and by 3:1 propensity matching. Differences in CAD, gender, and indication were determined by Chi-squared test. Differences in LAS and age were calculated with a two-tailed t - test. Results: In the pre-LAS era, 6.2% (9/145) recipients had CAD vs. 9.2% (17/184) in the post-LAS era (p = 0.411). Among all patients, recipients with CAD had a worse long term survival as estimated by Kaplan-Meier method (p = 0.001), although there was no statistically significant difference after propensity matching ((p = 0.14). Although more recipients in the post-LAS era had a diagnosis of IPF [15/145 vs. 71/184 patients, (p < 0.001)], there was no difference in the prevalence of CAD in the IPF cohort compared to others. There were no differences in cardiovascular deaths among recipients with CAD, with IPF, or in the post-LAS era. Patients with a pre-transplant diagnosis of CAD had an descreased risk of new onset postoperative atrial fibrillation (AF) (p = 0.007; HR:0.133; CI:0.030-0.583). Conclusion: Adoption of the LAS was not associated with a significant change in proportion of recipients with CAD who underwent LTX at our institution, despite an increase in recipients with IPF. Recipients with CAD had a higher risk of developing new postoperative AF and worse survival than patients without CAD. Differences in survival, however, could not be attributed directly to CAD based on propensity matched analysis https://www.cardiologymedjournal.com/articles/jccm-aid1073.pdf Research Article Readjustment of antithrombotic therapy in stroke-patients owing to transesophageal echocardiography findings Toralf Bruening,Mohamed Al-Khaled 2019-11-26 00:00:00 Objectives: Cardioembolic etiology is a frequent source of ischemic stroke. Echocardiogram is the mainstay of cardioembolic source detection with regard to plan secondary stroke management, however it remains unclear how often clinically actionable findings are provided hereby. In addition, it is uncertain whether echocardiography should be performed transthoracic or transesophageal (TEE). In a monocenter study, we evaluated the frequency of pathological findings from TEE evaluation in patients with ischemic stroke with suspected cardioembolic and cryptogenic source and determined whether there was an associated adjustment in the prescribed administration of antithrombotic therapy. Materials and Methods: Over a 21-month period (2012-2013), we enrolled 143 patients in a prospective monocenter study (mean age ± standard deviation, 70 ± 12 years; females, 44.1%) who were admitted to the Department of Neurology at the University of Lübeck due to ischemic stroke and who underwent TEE due to supposed cardiac embolism. We assessed the presence of atrial fibrillation; days from admission to TEE; and TEE findings, including atrial septal aneurysm, thrombogenic aortic arch, valve failure, presence of left atrial thrombus, and patent foramen ovale. Demografic information and medical history were drawn from patient records and the hospital information system. Results: On average, TEE was performed 4 days after admission to the hospital. Left atrial thrombus was detected in 3 patients (2.1%), patent foramen ovale (PFO) in 27 (18.9%), atrial septum aneurysm in 17 (11.9%), and thrombogenic aortic arch in 29 (20.3%). Findings from TEE were commonly associated with therapeutic adjustment; antiplatelet therapy increased from 30.1% to 80.4%, oral anticoagulation therapy increased from 2.8% to 27.3%. Conclusion: Findings from TEE for the evaluation of ischemic stroke lead to frequent adjustment of prior antithrombotic therapy, antiplatelet as well as anticoagulation. https://www.cardiologymedjournal.com/articles/jccm-aid1072.pdf Case Report Resolved complete atrioventricular block and left ventricular severe dysfunction in patient with Wegener’s granulomatis after cyclophosphamide and corticosteroid treatment Duc Dang,Lory Trevisan,Jérôme Bouet,Jérôme Taieb 2019-11-25 00:00:00 Wegener’s granulomatosis is a systemic granulomatous focus on small to medium sized vessels. It typically affects sinuses, lungs and kidneys due to necrotizing granulomatous vasculitis. Less commonly, cardiac involvement is reported up to 8%-44% of cases [1-3]. It often rises to supraventricular arrhythmia, left ventricular systolic dysfunction, pericarditis, myocarditis, and valvulitis [4,5]. Cardiac conducting tissue involvement is rare and associated with increased mortality. It was only reported in fourteen previous cases, some of them were reversible to medical treatment [6].  https://www.cardiologymedjournal.com/articles/jccm-aid1071.pdf Research Article The Renin-Angiotensin System: Alamandine is reduced in patients with Idiopathic Pulmonary Fibrosis Taís Salvi Sipriani,Robson Augusto Souza dos Santos,Katya Rigatto 2019-11-20 01:00:00 Idiopathic Pulmonary Fibrosis (IPF) is a chronic and progressive disease without treatment that leads to death. Therefore, to control its progression to pulmonary hypertension is still a challenge. Moreover, there is no study that has investigated the Renin-Angiotensin System in patients with IPF. Objective: Verify the plasma concentrations of Angiotensin I, Angiotensin II (AngII), Angiotensin-(1-7) [Ang- (1-7)] and Alamandine in patients with IPF. Methods: Ten IPF patients, with or without PH, were included, and ten controls matched by sex and age. Quantitative plasma peptide concentrations (PPC) were expressed as mean and standard deviation or median and interquartile range. The Student Newman-Keuls t test was used for parametric data, Mann-Whitney for nonparametric data and, to compare proportions, the Fisher exact test was performed. The associations between clinical variables and the PPC were evaluated by Pearson or Spearman correlation coefficients. A p ≤ 0.05 was considered statistically significant. Results: The Alamandine plasma concentration was significantly (365%) lower in the IPF group and positively associated (r = 0.876) with pulmonary artery pressure (PAP). In addition, only in control group, the forced expiratory volume (FEV1%) was positively associated (p = 0.758) with Ang-(1-7). Conclusion: This study showed, for the first time, that there is a decrease in Alamandine participation in patients with IPF. The ACE-AngII-AT1 axis may be more active in this disease. In addition, our results suggest that Alamandine might be compensating the increase in PAP, as well as the Ang-(1-7) is improving the forced expiratory volume. https://www.cardiologymedjournal.com/articles/jccm-aid1070.pdf Research Article Only low intensity of aerobic exercise improves respiratory compliance in pulmonary hypertensive rats Katya Rigatto,Denielli Da SG Bós,Renata Fernandes,Rodrigo B Jaenisch,Pedro Dal Lago 2019-11-20 00:00:00 Objective: To investigate in an animal model of Pulmonary Hypertension (PH) by monocrotaline whether a lower exercise intensity, which has lower potential to provoke dyspnea symptoms, could prevent the increase the right ventricle pressure and the decrease in respiratory compliance. Setting: A research laboratory. ANIMALS: twenty-one Wistar rats were randomized to the groups: Control (CO; saline solution); PH-sedentary; PH-low and PH-moderate intensity of exercise training (ET). Interventions: They received a single saline or monocrotaline subcutaneous injection (50 mg/kg). The exercise program was performed during 3-weeks. Main Outcome Measures: Rats were evaluated by their morphometric and hemodynamic changes and by the respiratory mechanic responses induced by the exercise protocols. Results: Both protocols of ET significantly (p < 0.05) attenuated the increase in the right ventricular systolic pressure. However, the lower intensity was more effective to prevent the impairment in the respiratory and quasi-static compliance. Conclusion: Collectively, our results showed for the first time the benefits of ET to the respiratory system mechanics. We also demonstrated that intensity is crucial in PH, probably due to the difficulty to match VO2 capacity and O2 demand during exercise. The improvement in quasi-static compliance not only might improve the ability to breathe, and capture oxygen, but also welfare. https://www.cardiologymedjournal.com/articles/jccm-aid1069.pdf Editorial Pulse Synchronized Contractions (PSCs) Katherine A Lothman,Allen W Mangel 2019-11-15 02:10:00 A key platform underpinning the traditional understanding of the cardiovascular system, with respect to the behavior of large arterial vessels, is Otto Frank’s Windkessel Hypothesis [1]. This hypothesis posits simply that the smooth muscle walls of large arteries do not undergo rhythmic contractions in synchrony with the heartbeat but, rather, behave as passive elastic tubes undergoing distension from pulsatile pressure waves. The Windkessel Hypothesis is elegant, well described for over a century, ingrained in the understanding of cardiovascular medicine and physiology, and simply wrong. Several groups have now shown that the arterial smooth muscle wall undergoes rhythmic activation in synchrony with the heartbeat in a variety of tissues, including human brachial artery; canine coronary, femoral, and carotid arteries; rabbit aorta; feline pulmonary artery and rodent aorta [2-8]. The phasing of these events is such that the upstroke of the contraction slightly precedes the upstroke of the pulse wave, suggesting nomenclature for the events as pulse synchronized contractions, or PSCs [3,6-8]. PSCs have been found to be of neurogenic origin, sensitive to the neural blocker tetrodotoxin [3,8]. Although the specific neural pathways regulating PSCs have not been elucidated, the alpha-adrenergic system is at least partially involved, as evidenced by reduction or blockade of PSCs by the alpha-adrenergic blocker phentolamine [8]. Further, PSCs have not been observed following vessel excision in in vitro studies, as an intact nervous system is not present. The pacemaker for the PSC resides in the right atrium, as suggested by two lines of evidence. First, pacing of the right atrial region to faster than spontaneous frequencies leads to a one-to-one correspondence of PSC frequency with the stimulation rate [3]. Additionally, excision of the right, but not the left, atrial appendage results in elimination of PSCs [3]. As the pacemaker region for PSCs and the heartbeat both lie in the right atrium, this may potentially allow for coordination between the heartbeat and pulse wave with PSCs [3,5,8]. Extensive evaluations also have been performed showing the PSC was not an artifact produced either by cardiac contractility or from the vessel distension from the pulse wave [3,5,6]. https://www.cardiologymedjournal.com/articles/jccm-aid1067.pdf Research Article Left ventricular ejection fraction and contrast induced acute kidney injury in patients undergoing cardiac catheterization: Results of retrospective chart review Firas Ajam,Obiora Maludum,Nene Ugoeke,Hetavi Mahida,Anas Alrefaee,Amy Quinlan DNP,Jennifer Heck-Kanellidis NP,Dawn Calderon DO,Mohammad A Hossain,Arif Asif 2019-11-15 02:00:00 Background: Contrast-induced acute kidney injury (CI-AKI) is an important cause of increasing the hospital stay and in-hospital mortality. By increasing intra-renal vasoconstriction, left ventricular ejection fraction (LVEF) can increase the risk of CI-AKI. We sought to investigate whether LVEF can impact the incidence of CI-AKI after cardiac catheterization and whether it can be used to predict CI-AKI. Methods: Patients underwent cardiac catheterization from December 2017 to February 2018 at Jersey Shore University Medical Center were enrolled in the study. Contrast-induced acute kidney injury (CI-AKI) was defined as an increase in serum creatinine of ≥ 0.5 mg/dL or an increase of ≥ 25% from the pre-procedure value within 72 hours post-procedure. The maximum allowable contrast dose was calculated using the following formula: (5* (weight (kg)/creatinine level (mg/dL)). A multivariable logistic regression analyses, controlling for potential confounders, were used to test associations between LVEF and CI-AKI. Results: 9.6% had post catheterization CI-AKI. A total of 18 out of 44 (44%) of patients who had CI-AKI also had ongoing congestive heart failure. No statistically significant association found neither with maximum allowable contrast (p = 0.009) nor ejection fraction (p = 0.099) with the development of CI-AKI. Conclusion: In spite of the fact that no statistically significant relationship found between the percentage maximum contrast dose and the ejection fraction with the post-procedure CI-AKI, we heighten the essential of employing Maximum Allowable Contrast Dose (MACD) and ejection fraction in patients undergoing PCI to be used as a clinical guide to predict CI-AKI. https://www.cardiologymedjournal.com/articles/jccm-aid1066.pdf Case Report Hemoptysis after subclavian vein puncture for pacemaker implantation: A case report Avishek Bagchi,Rajendra Kumar Agarwal,Kewa,Kishan Talwar 2019-11-15 00:00:00 Background: Subclavian venous access for pacemaker lead insertion is a common procedure and is normally considered safe in the hands of an expert. However, subclavian venepuncture is not without complications, starting from mild subcutaneous hematoma to pneumothorax. We here present a case of hemoptysis occurring after difficult subclavian vein puncture, which subsequently improved on conservative management only. Case Summary: A 65-year-old gentleman, post aortic valve replacement had persistent high-grade AV block and was taken up for a dual chamber pacemaker implantation. Immediately following venous access, he had a bout of hemoptysis, which recovered on its own. Post procedure chest x-ray was suggestive of alveolar hemorrhage which cleared gradually in next three-four days. Discussion: Post subclavian venepuncture hemoptysis is known; but it is a rare complication, arising either because of lung parenchyma injury or arterial injury. This is mostly benign and improves on conservative management only; however rarely it may be massive and life threatening where transcatheter arterial embolization may be required. https://www.cardiologymedjournal.com/articles/jccm-aid1065.pdf Research Article A Systematic review for sudden cardiac death in hypertrophic cardiomyopathy patients with Myocardial Fibrosis: A CMR LGE Study Sahadev T Reddy,Antonio T Paladino,Nackle J Silva,Mark Doyle,Diane A Vido,Robert WW Biederman 2019-11-04 06:00:00 Background: Hypertrophic cardiomyopathy (HCM) patients have a predisposition for malignant VT/VF and consequently, sudden cardiac death (SCD). In single center studies, late gadolinium enhancement (LGE) defined fibrosis has been linked to VT/VF. However, despite innumerable investigations, SCD has not been definitely attributable to LGE. Explanations for these are believed to be related to insufficient statistical power. Methods: We performed an electronic search of MEDLINE, PubMed: and CMR abstracts for original data published or presented between Jan 2001 to Mar 2011. Key search terms: HCM, LV fibrosis, SCD and LGE. Studies were screened for eligibility based on inclusion criteria: referral for CMR exam with LGE for HCM; and follow-up for incidence of VT/VF and SCD. Categorical variables were evaluated between patient groups via Chi-square test. Results: A total of 64 studies were initially identified. Of these, 4 (6.3%) were identified and included (n = 1063 patients). Three prospective and one retrospective study were included. LGE was detected in 59.6% of patients. As expected, the presence of myocardial fibrosis was associated with VT/VF (x2 = 6.5, p < 0.05; OR 9.0, (95% CI 1.2 to 68.7). Moreover, myocardial fibrosis strongly predicted SCD (x2 = 6.6, p < 0.05; OR 3.3 (95% CI 1.2 to 9.7). Conclusion: Despite single center CMR studies, LGE has consistently predicted VT/VF while prediction of SCD has remained paradoxically unlinked. Although the lack of studies meeting our criteria limited our ability to perform a comprehensive meta-analysis, we have been able to demonstrate for the first time that LGE-defined fibrosis is a predictor of SCD in patients with HCM0. https://www.cardiologymedjournal.com/articles/jccm-aid1064.pdf Review Article Do beta adrenoceptor blocking agents provide the same degree of clinically convincing morbidity and mortality benefits in patients with chronic heart failure? A literature review Martin Mumuni Danaah Malick 2019-11-04 03:00:00 Chronic heart failure has been extensively characterized as a disorder arising from a complex interaction between impaired ventricular performance and neurohormonal activation. Since beta adrenoceptor blocking agents are currently considered an integral component of therapy for the management of patients with severe chronic heart failure; several well designed clinical trials have been conducted to determine the morbidity and mortality benefits of these agents these studies, however did not yield the same results in terms of morbidity and mortality benefits. Currently only Bisoprolol, Carvedilol and sustained release metoprolol succinate have clinically proven and convincing morbidity and mortality benefits the current list of approved medicines of the National Health Insurance Scheme (NHIS) of the republic of Ghana does not provide coverage for these lifesaving therapeutic agents. The objective of this review was to collate the relevant scientific evidence that will convince the authorities at the National Health Insurance Authority (NHIA) of the Republic of Ghana to include at least one of the evidence based beta adrenoceptor blocking agents in the list of approved medicines. A thorough search on the internet was conducted using Google scholar to obtain only the clinically relevant studies associated with the benefits of beta adrenoceptor blocking agents in patients with chronic heart failure published in the English language. The phrases beta adrenoceptor blocking agents and chronic heart failure were used as search engines. The search engine yielded several studies that met the predefined inclusion criteria. However, only the Cardiac Insufficiency BIsoprolol Studies (CIBIS-I and CIBIS-II), Carvedilol Prospective Randomized Cumulative Survival Study (COPERNICUS) and Metoprolol CR/XL Randomized Intervention Trial (MERIF-HF) because of the clinical relevance of their findings Beta adrenoceptor blocking agents such as atenolol and propranolol have been used in the management of patients with chronic heart failure. However, their efficacy and optimal dose in reducing mortality have not been scientifically established not all beta adrenoceptor blocking agents scientifically studied provide the same degree of clinically meaningful and convincing morbidity and mortality benefits in patients with chronic heart failure. https://www.cardiologymedjournal.com/articles/jccm-aid1063.pdf Research Article Diagnosis of critical congenital heart defects in Iceland 2000-2014 Hallfríður Kristinsdóttir,Þórður Þórkelsson,Hildur Harðardóttir,Gylfi Óskarsson 2019-11-04 00:00:00 Critical congenital heart defects (CCHDs) are preferably diagnosed prenatally or soon after birth. Late diagnosis has been related to poorer prognosis. The aim of this study is to assess when CCHDs are diagnosed in Iceland and whether late diagnosis is a problem. All live born children in Iceland and foetuses diagnosed with CCHDs during the years 2000-2014 were included. CCHD was defined as a defect requiring intervention or causing death in the first year of life, or leading to abortion. The total number of pre- and postnatal diagnosis of CCHDs was 188. Prenatal diagnosis was made in 69 of 188 (36.7%). Of 69 diagnosed prenatally 33 were terminated due to CCHD. Of the 155 live born children with CCHD, 36 (23.2%) had a prenatal diagnosis and 100 (64.5%) were diagnosed shortly after birth, before discharge from birth facility. 19 children (12.3%) were diagnosed late, that is after discharge from birth facility. Coarctation of the aorta was the most common CCHD diagnosed late (6/19). Prenatal screening and newborn examination give good results in diagnosis of CCHDs in Iceland. Late diagnosis are relatively few, but both the number of prenatally diagnosed CCHDs and CCHDs diagnosed shortly after birth can be further improved. https://www.cardiologymedjournal.com/articles/jccm-aid1062.pdf Research Article Evaluation of the predictive value of CHA2DS2-VASc Score for no-reflow phenomenon in patients with ST-segment elevation myocardial infarction who underwent Primary Percutaneous Coronary Intervention Mahmoud Shawky Abd El-Moneum 2019-10-28 00:00:00 Objective: The aim of this study was to estimate the predictive clinical value of CHA2DS2-VASc score for no-reflow phenomena in patients having ST-segment elevation myocardial infarction (STEMI) who applied to primary percutaneous coronary intervention (PCI). Subjects and Methods: Three-hundred STEMI patients underwent primary PCI. They were classified into: group (1) included 27 patients with no-reflow and group (2) included 273 patients without no-reflow (control). CHA2DS2-VASc risk score was computed for each patient. Results: This study found statistically significant difference (p < 0.05) in multivariate analysis of the association between CHA2DS2-VASc score and no-reflow phenomenon. The predictive power of individual components in CHA2DS2-VASc score for no-reflow was statistically significant difference (p < 0.05). So, significantly higher CHA2DS2-VASc score is connected with higher risk of no-reflow and in-hospital mortality rate. Conclusion: Significantly higher CHA2DS2-VASc score is associated with higher risk of no- reflow phenomenon and in-hospital mortality rates in patients with STEMI who underwent primary PCI. https://www.cardiologymedjournal.com/articles/jccm-aid1061.pdf Research Article Impact of Pacemaker Implantation on 12-Month Resource Utilization Following TAVR Hospitalization Steven D Culler,Aaron D Kugelmass,David J Cohen,Matthew R Reynolds,Phillip P Brown,April W Simon,Marc R Katz 2019-10-21 00:00:00 Purpose: This study reports resource utilization during a Medicare Beneficiary’s (MBs) Transcatheter Aortic Valve Replacement (TAVR) index hospitalization and all subsequent encounters for 12 months and compares data between MBs who did or did not receive a pacemaker implantation (PPM) during their index hospitalization. Method: This retrospective study examined Medicare hospital claims from January 1, 2014 through June 30, 2015. 15,533 MBs who survived for 365 days were studied. Information from all encounters during the study period was combined to compare hospital resource utilization and outcomes. Results: 14.8% of MBs had a PPM during the index hospitalization. 46.0% of MBs had at least one readmission to a hospital during the 365-day follow-up period. 54.6% of MB’s first hospital readmission occurred within 90 days of their TAVR discharge date. Average total Medicare reimbursement for all hospitalizations was $60,638 ± $28,974 associated with average total hospital length of stay of 11.2 ± 11.7 days. After adjusting for demographics and 47 comorbid conditions, MBs receiving a PPM during the index TAVR had significantly higher estimated Medicare reimbursement ($5,132) and longer total length of stay (1.8 days) for the entire study period than MBs not receiving a PPM. Conclusion: Total Medicare reimbursement and hospital LOS were significantly higher among MBs that had a PPM implantation during their index admission; however, there were no significant differences in readmission rates, readmission length of stay, or days to first readmission during the follow-up period between the two study cohorts. https://www.cardiologymedjournal.com/articles/jccm-aid1060.pdf Research Article The effect of anemia on serum hepcidin levels in patients with heart failure Betul Borku Uysal,Feray Akbas,Esma Altunoglu,Gulhan Ipek Denız,Duygu Uysal,Harun Uysal,Hanife Usta Atmaca,Yasin Yuksel,Hale Aral,Guven Cetın,Cem Ar M,Fusun Erdenen 2019-10-17 00:00:00 Background: Anemia is an accelerating problem among patients with heart failure (HF) and its presence is associated with more symptoms. In this study, we investigated whether anemia in heart failure was related to hepcidin concentration. Methods: 50 patients with heart failure and 20 healthy subjects with no history of a chronic illness including heart failure as control group, were included in the study. Heart failure was verified by echocardiography in each subject and patients were defined as ones with reduced ejection fraction (HFrEF) if EF ≤ 40% and with preserved ejection fraction (HFpEF) if EF 40% - 50%. Blood samples were taken from all patients after 10-12 hours fasting. Anemia assessment was performed according to World Health Organization (WHO) criterias. Results: There was a positive correlation between hepcidin concentration and urea, ferritin, hemoglobin, hematocrite, C-reactive protein (p < 0,05). Hepcidin concentrations of anemic heart failure patients were significantly lower than the non-anemic heart failure patients (p < 0,05). Conclusion: We found that serum hepcidin concentration in anemic patients with heart failure was lower than in heart failure patients without anemia. We believe that iron defiency occurs as a result of inflammatory process in heart failure and therefore hepcidin concentrations decrease as a response. However, long-term follow up studies are needed. https://www.cardiologymedjournal.com/articles/jccm-aid1059.pdf Case Report Scintigraphic non-invasive diagnosis of amyloid cardiomyopathy Laroussi Mohamed-Salem,Tomás E Rodríguez-Locarno,Tatiana Moreno-Monsalve,Isabel Castellón-Sánchez,José F Contreras-Gutiérrez ,Antonia Claver-Valderas 2019-10-04 01:00:00 Amyloidosis encompasses a heterogeneous group of disorders, characterized by extracellular deposition of insoluble abnormal amyloid aggregates, due to a failure in protein quality control. Cardiac amyloidosis is a disorder in which proteins misfold and deposit as amyloid fibrils that infiltrate the myocardial extracellular space [1]. Transthyretin (ATTR) and light chain (AL) are the most frequent types of cardiac amyloidosis. Transthyretin is a protein mainly synthesized by the liver, it may be hereditary or acquired from either wild-type (ATTRwt) or mutant (ATTRm) amyloid [2]. Cardiomyopathy is a common manifestation of ATTR amyloidosis with a particularly poor life expectancy of 2 to 6 years after diagnosis [3]. Although considered rare, the prevalence of this serious disease is likely underestimated because symptoms can be non-specific, and diagnosis largely relies on amyloid detection in tissue biopsies. https://www.cardiologymedjournal.com/articles/jccm-aid1058.pdf Research Article Plaque morphology in diabetic vs. non diabetic patients assessed by Multi-Slice Computed Tomography coronary angiography Hesham Mohamed Aboul-Enein,Amr Elsayed El Naggar,Shereen Ibrahim Farag,Waleed Atef Ahmed Hassan 2019-10-04 00:00:00 Background and Objectives: Multi-slice computed tomography (MSCT) provides high accuracy for noninvasive assessment of coronary artery disease (CAD). The introduction of the latest computed tomography technology allows comprehensive evaluation of various aspects of CAD, including the coronary calcium score, coronary artery stenosis, bypass patency, and myocardial function. This study aimed to assess the effect of DM on coronary arteries evaluated by MSCT-CA Comparing Plaque Morphology in Diabetic patients with Non-Diabetic Whoever Controlled or not assessed by HbA1c. Methods: In this study we randomly assigned 150 adult patients were diagnosed with suspected coronary artery disease underwent MSCT-CA for evaluation their coronaries regarding luminal stenosis, Plaque analysis, Remodeling index, SSS, SIS and Ca score. Results: There was statistically significant difference between diabetics & non-diabetic groups in LM lesions with (P = 0.029). also, the results of multivariate logistic regression analysis after adjustment for age and sex, diabetics were shown a trend toward more mixed plaque with statistically significant {(OR): 3.422, 95% CI 1.66-7.023, P = 0.001}; whereas, after adjustment for age, sex, history of hypertension, smoking, and hypercholesterolemia, patients with diabetes also shown a trend toward more mixed plaque with statistically significant (OR: 3.456, 95% CI 1.668-7.160, P = 0.001). It means significant differences in coronary atherosclerotic plaque burden and composition between diabetic and non-diabetic patients, with a higher proportion of mixed plaques, a more vulnerable form of atherosclerotic plaque in diabetics (P < 0.001) otherwise No significant difference. Conclusion: MSCT angiography may be useful for the identification of CAD in diabetic and non-diabetic patients. There were statistically significant differences in coronary atherosclerotic plaque burden and composition, with a higher proportion of mixed plaques, between diabetic and nondiabetic patients. Furthermore, MSCT may give accurate information about plaque characteristics according to different coronary risk factors, thereby identifying high risk features warranting a more intensive anti-atherosclerotic treatment.    https://www.cardiologymedjournal.com/articles/jccm-aid1057.pdf Research Article Prevalence of congenital heart diseases among primary school children in the Niger Delta Region of Nigeria, West Africa Ujuanbi Amenawon Susan,Tabansi Petronilla Nnena,Otaigbe Barbara Edewele 2019-09-26 00:00:00 Introduction: Congenital heart diseases (CHD) are leading causes of childhood morbidity and mortality especially in developing countries. Community-based studies are important in ascertaining the burden of the disease. Objectives: The study was set out to determine the prevalence and types of CHD among primary school children in Port Harcourt Local Government Area (PHALGA) of Rivers State, Niger Delta, Nigeria. Methods: A total of 1,712 primary school pupils were selected by multistage sampling from twelve schools in PHALGA. A questionnaire was used to obtain information from pupil’s parents on their child’s biodata and symptoms suggestive of heart disease. General physical and cardiovascular system examinations were carried out on each selected pupil, following which those with symptoms and/or signs suggestive of heart disease had echocardiographic confirmation of their cardiac status. Results: The 1,712 subjects were aged 5-14 (mean 8.48 ± 2.30) years. 874 (51.1%) were females while males were 838 (48.9%). The study revealed that 31 pupils had congenital heart diseases confirmed by echocardiography, giving a prevalence of 18.1 per 1,000 pupils. The commonest cardiac defects seen were acyanotic CHD in 30 (96.8%) pupils while cyanotic CHD was seen in only one (3.2%) pupil. Among the acyanotic CHD, atrial septal defects (83.9%) followed by ventricular septal defects (9.7%) were the commonest. CHD occurred with higher frequency among females (64.5%) and among the younger age group of 5-9 years (61.3%) though these were not statistically significant (p > 0.005). Conclusion: Cardiac examination as part of compulsory health screening at primary school entry will help detect children with CHD, reduce delay in diagnosis for intervention, avert debilitating morbidity and assure a better quality of life.  https://www.cardiologymedjournal.com/articles/jccm-aid1056.pdf Research Article Novel paclitaxel-coated balloon angioplasty via single retrograde popliteal access for challenging superficial femoral artery and iliac artery lesions? Erdem Cetin,Celal Selcuk Unal,Aydın Keskin,Hakan Kartal 2019-09-24 00:00:00 Objectives: We report our results regarding the use of BioPath™ paclitaxel-coated balloon catheters for superficial or distal external iliac artery revascularization via single retrograde popliteal access. Methods: We included 105 prospective consecutive patients. Single retrograde popliteal access was achieved under ultrasound guidance with the patients laid prone. An over-the-wire atherectomy system was used if risk of distal embolization was high due to plaque intensity of the target lesion. A 4 to 7 mm-diameter BioPath™ 035 balloon catheter was used for all lesions. Follow-up at 6th month included doppler ultrasound examination for patency. Results: Seventy-two patients (68.6%) had total SFA occlusion and 41 patients (39%) had concomitant external iliac artery involvement, out of whom 31 (29.5%) had total occlusion. Procedural success 90.5% for superficial femoral artery and 85.3% for external iliac artery. One-year patency rates in SFA and EIA were 84.8% and 80.4%, respectively Conclusion: Single retrograde popliteal access and drug-coated balloon angioplasty may offer a useful alternative to known modalities in treatment of challenging superficial femoral artery and concomitant iliac artery lesions https://www.cardiologymedjournal.com/articles/jccm-aid1055.pdf Research Article Arrhythmia of the heart - computer analysis VI Kaganov 2019-09-20 00:00:00 The problem of synchronization of oscillations of various physical nature is discussed. From the standpoint of the theory of synchronism, a model of the heart is considered as a system of four connected between self-oscillating links: two atria and two ventricles. The synchronous and asynchronous operating modes are considered at sinusoidal and relaxation oscillations. A computer program has been compiled that simulates the fluctuations in the heart using four differential equations. Four examples of calculation according to the program are given for asynchronous and synchronous operation modes. The possibility of evaluating the ablation procedure from the perspective of a computer model is discussed. https://www.cardiologymedjournal.com/articles/jccm-aid1053.pdf Review Article A mouse model of coronary microvacsular disease using a photochemical approach Xinlu Wang,Fang Liu,Zhen W. Zhuang 2019-09-18 00:00:00 The development of reproducible rodent models of coronary microvascular disease (MVD) is essential for the early detection, treatment, and mechanism study of the pathophysiology. We hypothesized that endothelial dysfunction and subsequent microthrombi in the coronary arterioles, two early events in clinical coronary MVD, could be reproduced by photochemical reaction (PCR) technology in mice hearts. After rose bengal (one of photosensitizers) was administrated systemically, a green light was locally used to activate the photosensitizer, inducing over-production of oxidative stress in the heart. Following PCR, animals demonstrated reproducible endothelial injury, occlusion in arterioles, focal ischemia, and infarct-let with preserved cardiac function. Our technique has proven to be a reliable and reproducible means of creating coronary MVD in mice. We believe that this is an ideal model for developing a novel molecular tracer for earlier detection of coronary MVD, for testing new anti-fibrinolytic drugs, and for investigating the complex pathophysiology of coronary MVD. The protocol for establishing this model takes about thirty to forty minutes. https://www.cardiologymedjournal.com/articles/jccm-aid1052.pdf Case Report Anomalies of coronary artery origin: About two cases Dioum M,Sarr EM,Manga S,Mingou JS,Diack A,Diop AD,Bindia D,Diagne PA,Sarr AN,Diop IB 2019-09-13 00:00:00 Anomalies of coronary artery origin are congenital malformations characterized by the abnormal birth of a coronary artery from the controlateral coronary aortic sinus (birth of the left coronary artery from the right sinus or birth of the right coronary artery from the left sinus). The artery concerned has an abnormal initial path between the aorta and the pulmonary artery; this segment is most often intramural, in the aortic wall. They are rare with a prevalence (0.1% to 0.3% of the population). They pose a high risk of sudden stress death related to exercise myocardial ischemia. The most common mode of discovery is aborted sudden death, but sometimes fortuitously. The contribution of multi-round CT is described for the positive diagnosis of these anatomical variations, sometimes delicate in coronary angiography, but also for the distinction between “benign” and “malignant” forms, potentially responsible for myocardial ischemia. Treatment is usually surgical in symptomatic forms. We report the cases of two patients with coronary connection abnormalities discovered in adulthood. https://www.cardiologymedjournal.com/articles/jccm-aid1051.pdf Research Article How often is Klippel-Feil Syndrome associated with congential heart disease presentation of five cases and a review of the literature Ramush Bejiqi,Ragip Retkoceri,Arlinda Maloku,Rinor Bejiqi,Aferdita Mustafa,Faruk Husremovic,Samir Bejic 2019-09-03 00:00:00 Introduction: Klippel-Feil syndrome (KFS), is a bone disorder characterized by the abnormal joining (fusion) of two or more spinal bones in the neck (cervical vertebrae), which is present from birth. Three major features result from this abnormality: a short neck, a limited range of motion in the neck, and a low hairline at the back of the head. In some individuals, KFS can be associated with a variety of additional symptoms and physical abnormalities which contribute in the deterioration and complication of the condition of the child. Aim of presentation: Here, we report five children from Kosovo with KFS associated with different heart abnormalities, clinical presentation, diagnosis, management, and outcomes of selected conditions in resources-limited settings. Methods: Retrospectively we analysed medical reports of five children, diagnosed at different age with congenital disease and clinical and lab signs of Klippel-Feil syndrome. Conclusion: Basing on our cases, all diagnosed in a small country as a Kosovo, we can conclude that KFS is not such a rare condition. In addition, such syndrome is not so rarely associated with different congenital heart disease. In four cases cardiac surgery was indicated and successfully was done abroad Kosovo in the lack of such services in Kosovo. https://www.cardiologymedjournal.com/articles/jccm-aid1051.pdf Research Article Role of novel cardiac biomarkers for the diagnosis, risk stratification, and prognostication among patients with heart failure Jennifer Miao,Joel Estis,Yan Ru Su,John A Todd,Daniel J Lenihan 2019-08-22 00:00:00 Background: Current guidelines for diagnosis and management of heart failure (HF) rely on clinical findings and natriuretic peptide values, but evidence suggests that recently identified cardiac biomarkers may aid in early detection of HF and improve risk stratification. The aim of this study was to assess the diagnostic and prognostic utility of multiple biomarkers in patients with HF and left ventricular systolic dysfunction (LVSD). Methods: High-sensitivity cardiac troponin I (cTnI), N-terminal pro b-type natriuretic peptide (NT-proBNP), interleukin-6 (IL-6), endothelin-1 (ET-1), pro-matrix metalloproteinase-9 (pMMP-9), and tumor necrosis factor-alpha (TNF-α) were measured using single-molecule counting technology in 200 patients with varying stages of HF. Plasma detection with cross-sectional associations of biomarkers across all HF stages, and advanced-therapy and transplant-free survival were assessed using multivariate analysis and Cox regression analyses, respectively. Results: NTproBNP, pMMP-9, IL-6 were elevated in early, asymptomatic stages of HF, and increased with HF severity. Higher circulating levels of combined IL-6, NTproBNP, and cTnI predicted significantly worse survival at 1500-day follow-up. Cox regression analysis adjusted for ACC/AHA HF stages demonstrated that a higher concentration of IL-6 and cTnI conferred greater risks in terms of time to death, implantation of left ventricular assist device (LVAD), or heart transplantation. Conclusion: Biomarkers of inflammation, LV remodeling, and myocardial injury were elevated in HF and increased with HF severity. Patients had a significantly higher risk of serious cardiac events if multiple biomarkers were elevated. These findings support measuring NTproBNP, cTnI and IL-6 among patients with HF and LVSD for diagnostic and prognostic purposes. https://www.cardiologymedjournal.com/articles/jccm-aid1049.pdf Case Report Late discover of a traumatic cardiac injury: Case report Benlafqih C,Bouhdadi H,Bakkali A,Rhissassi J,Sayah R,Laaroussi M 2019-08-19 00:00:00 Blunt chest trauma leads to a wide range of lesions, relatively minor parietal injuries to potentially fatal cardiac lesions, making diagnosis and management difficult. The diagnosis is currently facilitated by imaging, however, these lesions may go unnoticed and be discovered late through complications. We report the case of a neglected heart wound revealed by a heart failure. This case is notable due to a favourable outcome despite a delay in diagnosis due to a lack of pericardial effusion and the absence of cardiac symptoms, and a long delay from injury to appropriate treatment in the presence of a penetrating cardiac wound deep enough to cause a muscular ventricular septal defect and lacerate the anterior mitral leaflet. https://www.cardiologymedjournal.com/articles/jccm-aid1048.pdf Review Article Timing of cardiac surgery and other intervention among children with congenital heart disease: A review article Chinawa JM,Adiele KD,Ujunwa FA,Onukwuli VO,Arodiwe I,Chinawa AT,Obidike EO,Chukwu BF 2019-08-09 00:00:00 Background: Early diagnosis and improved facilities are necessary for determining the optimal timing of surgery and other interventions in children with congenital heart diseases in Nigeria. This is because late presentation, late diagnosis and delayed surgery can lead to mortality and affect the quality of life among these children. Objectives: This review article is aimed at enumerating the timing of cardiac surgeries and other interventions and to seek if there is any factor associated with the timing of cardiac surgery. Methods: A search on PubMed database, World Health Organization libraries, Google scholar, TRIP database, and reference lists of selected articles on timing of cardiac surgery in children was done. The Cochrane Database of Systematic Reviews was also searched. We noted few data from African setting. Key words such as timing of cardiac surgery; children, congenital heart defect were used. Conclusion: Appropriate timing for cardiac surgery in children with congenital heart disease is very important as late surgical intervention could result in several morbidities and mortality. https://www.cardiologymedjournal.com/articles/jccm-aid1047.pdf Research Article P wave dispersion in patients with premenstrual dysphoric disorder Seyda Yavuzkir,Suna Aydin,Melike Baspinar,Sevda Korkmaz,Murad Atmaca,Rulin Deniz,Yakup Baykus,Mustafa Yavuzkir 2019-07-31 01:00:00 Background: Growing evidence has revealed that fear and anxiety related situations could affect cardiac parameters. P wave dispersion (Pd) is an important index. In the present study, we aimed to evaluate Pd values in patients with premenstrual dysphoric disorder. Methods: The study was composed of twenty-five female patients with premenstrual dysphoric disorder and same number of healthy controls. Pd, Pmin and Pmax values were determined by electrocardiogram (ECG) in the subjects. Results: It was found that patients with premenstrual dysphoric disorder had considerably higher Pmax and Pmin values compared to those of healthy subjects. Pd was also significantly higher in patients with premenstrual dysphoric disorders than that of healthy subjects. Conclusion: Study suggests that patients with premenstrual dysphoric disorder seems to have increased Pd, as can be seen in anxiety and fear related clinical conditions, considering that this group of patients have an increased trend to cardiac abnormalities, particularly cardiac arrythmias. To access strong conclusion, it is required novel studies with larger samples. https://www.cardiologymedjournal.com/articles/jccm-aid1046.pdf Research Article Preclinical stiff heart is a marker of cardiovascular morbimortality in apparently healthy population Charles Fauvel,Michael Bubenheim,Olivier Raitière,Charlotte Vallet,Nassima Si Belkacem,Fabrice Bauer 2019-07-31 00:00:00 Background: The prognostic significance of impaired left ventricular (LV) relaxation and increased LV stiffness as precursor of heart failure with preserved ejection fraction and death is still largely unknown in apparently healthy subjects. Methods: We constituted a cohort of 353 patients with normal ejection fraction (>45%) and no significant heart disease, based on a total of 3,575 consecutive left-sided heart catheterizations performed. We measured peak negative first derivative of LV pressure (-dP/dt) and operating chamber stiffness (Κ) using a validated equation. Patients were categorized as having: 1) normal diastolic function, 2) isolated relaxation abnormalities (-dP/dt > 1860mm Hg/sec and K <0.025mm Hg/ml), or 3) predominant stiff heart (K ≥0.025mm Hg/ml). Results: During a follow-up of at least 5 years, the incidence of the primary composite endpoint (death, major arterial event, heart failure, and arrhythmia) was 23.2% (82 patients). Compared to isolated relaxation abnormalities, predominant stiff heart showed stronger prognostic significance for all events (p=0.002), namely heart failure (HR, 2.9; p=0.0499), cardiac death (HR, 5.8; p=0.03), and heart failure and cardiac death combined (HR, 3.7; p=0.003). Conclusion: In this apparently healthy population referred to our center for cardiac catheterization, the prevalence of diastolic dysfunction was very high. Moreover, predominant stiff heart was a better predictor of cardiovascular outcomes than isolated relaxation abnormalities. https://www.cardiologymedjournal.com/articles/jccm-aid1045.pdf Case Report Severe Infantile Coarctation and Mid Aortic Stenosis in Williams Syndrome Lousararian Marina,Troglia Ana,Cabrera María J,Alday Luis E 2019-07-30 00:00:00 We report a challenging patient with Williams syndrome and severe coarctation of the aorta. As in a few similar cases reported, several surgical and catheter interventions for recoarctation, intrastent intimal proliferation and stenosis of the left sub-clavian artery were required. Aortic patch angioplasty is planned for the future in a grower child. https://www.cardiologymedjournal.com/articles/jccm-aid1044.pdf Research Article Assessment of lipid and hematological profile among blood donors in European Gaza Hospital, Palestine Ahmad M Tabash,Wesam M Afana,Abdrabbou M Elregeb,Sameer Abu Eid,Ayman M Abu Mustafa 2019-07-16 01:00:00 Background: There is an important shortage of blood in the greatest blood banks worldwide to meet up with requirements for numerous medical interventions. Limited studies have associated regular blood donation to the lowering of lipid function parameters. Assessing the lipid function is a classical method of evaluating an individual’s risk for coronary heart disease. Objective: The general goal of the study is to determine lipid and hematological profile among blood donors in European Gaza Hospital, Palestine. Materials and Methods: This study was a case-control study that involved 120 male, 40 of whom were regular blood donors (study group), 40 first time donors and 40 non- donors (control group) aged between 18-60 years. A volume of 5ml venous blood was drawn from each fasting participant into a dry biochemistry screw-capped tube. This was allowed to clot and the serum was used to determine total cholesterol (TC), triglycerides, High-density lipoprotein cholesterol (HDL-C), Low-density lipoprotein cholesterol (HDL-C), while HDL-C/LDL-C and TC/LDL ratio were calculated by using the following formula. Anthropometric parameters (weight, height) of donors were measured using standard protocol. The height (in meter), weight (in kilogram) were used to calculate the body mass index (BMI) using the following formula. BMI= weight (kg)/ (height in meter)² and blood was collected from each participant in EDTA (for hematocrit, ESR). Three groups were matched for age and BMI. Data were analyzed using SPSS version 23. Chi-square (χ²) was used to compare the relationship between categorical variables, ANOVA was used to measure the difference between means. Data were summarized using tables, pie charts, histograms. A P-value < 0.05 was considered to be statistically significant for all tests conducted. Results: The mean total cholesterol (169±10.85 mg/dl), triglycerides (116±9.73 mg/dl), HDL (54±2.5 mg/dl ), LDL (92±11.4mg/dl), LDL/HDL ratio (1.73±0.25) and TC/HDL ratio (3.16±0.26) were lower in the regular blood donors than the first time donors(198±10.13, 179±5.82, 42.33±1.6, 120±11.2, 2.85±0.36, 4.7±0.40) and non- donors (202±10.19, 180±12.68, 41.75±1.4, 125±11.7, 2.99±0.33, 4.86±0.32) respectively and statistically significant (P < 0.05).The mean ESR (6.63±0.87mm/hr) was lower statistically significant in the regular blood donors than the first time donors (7.40±1.17) and non- donors (7.60±1.48) respectively (P < 0.05). The mean HCT (42.98±0.86%) was lower statistically significant in the regular blood donors than the first time donors (44.63±0.90) and non- donors (44.75±0.74, P < 0.05). Conclusion: Regular donors have reduced risk of developing coronary heart disease as reflected by the low total cholesterol, triglycerides, LDL-c, LDL-c/HDL-c ratio, TC/HDL-c ratio and HCT and high HDL. BMI in regular donor was less than the donor for the first time and did not donate, but did not reach the statistical significance. Also in our study regular donors have reduced risk of developing inflammation as reflected by low ESR. https://www.cardiologymedjournal.com/articles/jccm-aid1043.pdf Case Report Single Trans apical access for double aortic and mitral valves-in-valves procedures with high risk of thrombus embolism Julien Adjedj,Mathias Kirsch,Anna Nowacka ,Olivier Muller 2019-07-16 00:00:00 Background: Persistent left atrial thrombus remains a contra indication to transeptal valves in valves procedure. We aimed to perform a double valves in valves replacement through transapical access with cerebral angiography control during the procedure just after implantation. Our case shows the feasibility of this strategy and the management of right ventricle laceration successfully treated after extra corporeal membrane oxygenation implantation and local hemostasis. We reported a feasibility case report of successful double valves in valves implantation through transapical access with 6 months of clinical and computed tomography follow up. https://www.cardiologymedjournal.com/articles/jccm-aid1042.pdf Review Article Cardiomyopathies - The special entity of myocarditis and inflammatory cardiomyopathy Felicitas Escher,Uwe Kühl,Dirk Lassner,Heinz-Peter Schultheiss 2019-07-01 00:00:00 Cardiomyopathy is a heart muscle disease with structural and functional myocardial abnormalities in the absence of coronary artery disease, hypertension, valvular disease, and congenital heart disease. However, it has become clear that diverse etiologies and clinical manifestations (e.g. arrhythmogenic right-ventricular cardiomyopathy/dysplasia (ARVC/D), ARVD/C, left-ventricular non-compaction cardiomyopathy (LVNC)) are responsible for the clinical picture of dilated cardiomyopathy (DCM). The American Heart Association (AHA) classification grouped cardiomyopathies into genetic, mixed and acquired forms, while the European Society of Cardiology (ESC) classification proposed the subgrouping of each major type of cardiomyopathy into familial or genetic, and nonfamilial or nongenetic, forms [1-4]. Cardiomyopathies are clinically heterogeneous diseases, and there are differences in sex, age of onset, rate of progression, risk of development of overt heart failure and likelihood of sudden death within each cardiomyopathy subtype [5]. Because of the complex etiology and clinical presentation, the diagnostic spectrum in cardiomyopathies spans the entire range of non-invasive and invasive cardiological examination techniques including genetic analysis. The exact verification of certain cardiomyopathies necessitates additional investigations. So, histological, immunohistological and molecular biological/virological investigations of endomyocardial biopsies are the gold standard to confirm the diagnosis of an inflammatory cardiomyopathy (DCMi) [6-10]. This review focuses on myocarditis and inflammatory cardiomyopathies underlying an immune-mediated process or persistent viral infection. https://www.cardiologymedjournal.com/articles/jccm-aid1041.pdf Research Article C-reactive protein is associated with ventricular repolarization dispersion among patients with metabolic syndrome Ylber Jani,Atila Rexhepi,Bekim Pocesta,Ahmet Kamberi,Fatmir Ferati,Sotiraq Xhunga, Artur Serani,Dali Lala,Agim Zeqiri,Arben Mirto 2019-06-27 00:00:00 Background: An increasing body of evidence indicates that inflammatory activation profoundly impacts the electrophysiological properties of cardiomyocytes. A marker of systemic inflammation such as C-reactive protein(CRP), is associated with all parameters of the Mtabolic syndrome(MetS) and that may result in adverse cardiac events via multiple effects, ultimately resulting in a prolongation of Action Potential duration (APD), and thereby of the QTC (QT corrected) interval on ECG. Objective: We sought to investigate the influence of CRP levels on the prevalence of prolonged QT-dispersion and prolonged Tpeak-Tend –dispersion in the patients with MetS. Methods: We conducted a multicenter observational cross-sectional study. The study population consisted of 200 patients with MetS, stratified in two groups:103 participants (50 females and 53 males) with level of CRP>3mg/l, and 97 participants (47 females and 50 males) with level of CRP<3mg/l), who attended outpatient visits at general cardiology Health Care Clinics during 1 calendar year. For the analysis of the ECG, we performed a manual measurement of the values using a digital caliper with measuring range of 0-150 mm, 0.01 mm resolution, and 0-100 ± 0.02 mm accuracy. QT interval dispersion was obtained by the difference between the maximum and the minimum QT intervals found in the 12-lead electrocardiogram. The Tpeak-Tend interval was obtained from the difference between QT interval and QTpeak interval. Results: Prolonged QTC. dispersion, was found in 51.4% of participants with level of CRP>3mg/l and in 32.9% of with level of CRP<3mg/l, the differences were statistically significant. (p=0.004). The results showed that 51.4% participants with level of CRP>3mg/l had a prolonged Tpeak-Tend interval, and 32.9% of participants with level of CRP<3mg/l had prolonged Tpeak-Tend interval. Difference were statistically significant.( p=0.04). There were significant association of increased levels of CRP and QTC-dispersion (OR = 2.486, 95% CI 1.389-4.446).There were significant association of increased levels of CRP with Tpeak-Tend Dispersion (OR=2.239,95%CI 1.262-3.976). Prolonged QTC max. Interval OR=2.236,%CI 1.246-4.014),Prolonged Tp-Te-interval. (OR=2.367, 95%CI 1.327-4.222), also there were significant association of increased levels of CRP with BMI. (OR=1.154, 95%CI 1.095-1.227) and significant association of increased levels of CRP with presence of uncontrolled glicemia.(OR=1.779, 95%CI 1.014-3.12). Conclusion: We think we proved the hypothesis that patients with MetS and high level of CRP have higher prevalence of QT- dispersion and Tpeak-Tend dispersion than patients with MetS and lower level of CRP. These findings have both epidemiological and clinical relevance, also these findings might lend further insight into potential mechanisms by which MetS is associated with adverse cardiac events. https://www.cardiologymedjournal.com/articles/jccm-aid1040.pdf Case Report Acute viral myocarditis due to Influenza H3N2 infection resembling an acute coronary syndrome: A case report Carlos Jesus Rodriguez-Zuñiga,Leonel Martínez-Ramírez,Carlos Alberto Guizar-Sanchez,Mauricio Quetzal Trejo-Mondragon,Nilda Espinola-Zavaleta 2019-06-20 00:00:00 A 16-year-old man with history of two weeks-flu like symptoms with intermittent fever. He came to the emergency department with 2 hours-chest pain that radiates to the back and upper extremities. At the admission he was hemodynamically stable with normal blood pressure The ECG showed sinus rhythm and ST segment elevation of 0.5 mV in all leads (Figure 1A). The cardiac enzymes were elevated (Troponin 12.19 ng/mLland creatine kinase-MB fraction 63.25 U/L). He was admitted to the Intensive Care Unit and later transferred to our medical unit to continue with study protocol. The transthoracic echocardiogram (Figure 1B) reported normal left ventricular systolic function with left ventricular ejection fraction (LVEF) 68%, global longitudinal strain -18%, TAPSE 30 mm, and normal systolic pulmonary artery pressure (30 mmHg). https://www.cardiologymedjournal.com/articles/jccm-aid1039.pdf Short Communication Not-motorized Implantable Cardiac Assistance (NICA): Hemodynamic concepts and clinical perspectives Philippe Caimmi,Martinelli GL,Barbieri G 2019-06-13 00:00:00 The considerable improvements in cardiac support systems technologies have not solved until now the problem of connecting the cardiac assistance devices (CAD) to external energy sources, which makes these Patients at risk of lethal infections and dependent on external batteries with few hours of autonomy. Authors illustrate and discuss the hemodynamic concepts and clinical that underlie the mechanics of the first not-motorized implantable cardiac assistance device (NICA). https://www.cardiologymedjournal.com/articles/jccm-aid1038.pdf Research Article Impact of the Israeli attacks at 2014 on incidence of STEMI in Gaza Mohammed Habib,Belal Aldabbour 2019-06-07 00:00:00 For 51 days, Gaza was pummeled down by the Israeli military in a war known as Operation Protective Edge. During the 50 days (7-7-204 to 28-8-2014) of the Israeli campaign, 2104 Palestinians were killed, including 253 women (12%) and 495 children (24%). According to the UN, at least 69% of Palestinians killed were civilians. It is estimated that 10,224 Palestinians, including 3,106 children (30%) and 1,970 women (19%) were injured. Preliminary estimates indicate that up to 1,000 of the children injured will have a permanent disability and up to 1,500 orphaned children will need sustained support from the child protection and welfare sectors, 17,200 homes destroyed or severely damaged, 58 hospitals and clinics damaged [1]. Major stressful events are well documented to increase the incidence of acute cardiac events [2]. Cardiovascular complications more than doubled during the FIFA World Cup games of 2006 [3]. After the September 11 terrorist attacks, significantly more patients presented with acute myocardial infarction to the hospitals in Brooklyn [4] and New Jersey [5]. We were able to examine the effects of the Isreli attacks on acute STEMI presentations in Gaza city. https://www.cardiologymedjournal.com/articles/jccm-aid1037.pdf Research Article Single-centre real world experience of the Mynx Femoral closure device in patients undergoing percutaneous coronary intervention Thirunavukarasu S,Zaman M,Hayat A,Aghamohammadzadeh R,Malik N 2019-06-04 00:00:00 Background: Vascular closure devices are routinely used following femoral artery access to perform percutaneous coronary interventions (PCI). A number of devices are available on the market. We have reported previously on our experience of the Mynx device following diagnostic coronary angiography. Aims: To assess the success and complication rates of the Mynx device used in all-comers in the context of PCI within a single cardiac centre. Methods: Retrospective analysis of data available for patients who underwent PCI via the femoral route and received a Mynx device at a single tertiary centre. Results: The device was used to achieve haemostasis in 113 patients following PCI. In all cases weight-adjusted Heparin as well as dual antiplatelet therapy (Aspirin and Clopidogrel/ Ticagrelor) was administered as per PCI protocol. The device was successfully deployed in 111 cases (98.2%). The were 2 cases of device failure, one due to operator error and the other due to Mynx grip balloon bursting during device deployment. In 15 cases (13.2%; 9 male and 6 female) there were reports of small haematomas (<2cm) or oozing resulting in application of manual pressure or Femstop (St. Jude). A further patient required ultrasound-guided compression of the artery due to a large retroperitoneal bleed resulting from access complications. A larger proportion of the cases with complications were done as PPCI (44% vs 33%). The group with complications had higher systolic BP (140mmHg vs 128mmHg; P<0.05) and MABP (97mmHg vs 75mmHg; P<0.05) as compared with the group without any complications. Conclusion: The Mynx closure device is safe and easy to use in the context of PCI, in both the elective and emergency (PPCI) settings. Complication rates, predominately minor, can be minimised in experienced hands. https://www.cardiologymedjournal.com/articles/jccm-aid1036.pdf Research Article Is secondary prevention information before discharge adequate after percutaneous coronary intervention? Catrin Henriksson,Joep Perk 2019-05-08 00:00:00 Introduction: Implementation of prevention strategies for patients with coronary artery disease (CAD) is essential, but many fall short of reaching their goals. Patients often perceive themselves as healthy and are less motivated to change lifestyle. To obtain better results patients need repeated information, preferably with motivational and person-centered approaches. Aims: To investigate whether health care providers inform CAD patients about risk factors and lifestyle changes at a percutaneous coronary intervention unit. Also to investigate whether the information given at discharge included secondary prevention management and if motivational and person-centered approaches were used. Methods: This is a descriptive, observational study that includes both a qualitative and quantitative design. Physicians and nurses working at a percutaneous coronary intervention (PCI) unit and physicians at a coronary care unit (CCU) participated. A staff nurse observed and noted what information the patients received at the PCI unit. At the CCU, observations regarding secondary prevention strategies during the discharge counselling were performed. Results: There were 50 observations made at the PCI unit. The information mainly consisted of tobacco consumption, physical activity and diet. During the 31 discharge counselling sessions the diagnosis, interventional procedure and medical treatment were frequently included. Most patients received little or no person-centered or motivational counselling. Conclusion: Nearly all patients at the PCI unit received information about the consequence of tobacco consumption, and more than half about the beneficial effects of physical activity. In contrast, the counselling at discharge need to focus more on behavioral changes and a motivational and person-centered approach. https://www.cardiologymedjournal.com/articles/jccm-aid1034.pdf Research Article Are S-Klotho’s Maximal concentrations dependent on Exercise Intensity and Time in young adult males? Moran Sciamama Saghiv,David Ben-Sira,Ehud Goldhammer,Michael Sagiv 2019-03-08 00:00:00 The purpose of the present study was to define the period of time in which aerobic training does not increase further serum S-Klotho levels in untrained young adult males, and to examine the relation between plasma S-Klotho concentration and maximal oxygen uptake (VO2max). Methods: Sixty (60) untrained subjects (27.05±1.1 years) were divided into 2 groups, both exercised six months 4×wk-1 for the duration of 45 min×session. One group (LTI) exercised below the anaerobic threshold at 40-50% of VO2max, while the second group (HTI) worked above the anaerobic threshold at 65-70% of VO2max. Testing sessions were performed at 0, 2, 4, and 6 months. Blood samples were drawn after overnight fasting; S-Klotho was analyzed using an ELISA kit. Results: Following 2 and 4 months, significant (p≤0.05) increases were noted in the HTI group, at the fourth testing session, S-Klotho leveled off. In the LTI group, S-Klotho remained almost unchanged. Findings of the present study, support emerging evidence suggesting that a relation between plasma S-Klotho concentration and VO2max exists. Conclusion: Data suggest that increases in S-Klotho is tidally associated with VO2max levels. In addition, the S-Klotho increase levels-off following 4 months of aerobic training. Exercising below the anaerobic threshold does not increase VO2max and thus, does not increase S-Klotho.   https://www.cardiologymedjournal.com/articles/jccm-aid1033.pdf Research Article Diagnostic accuracy of TIMI versus GRACE score for prediction of death in patients presenting with Acute Non-ST Elevation Myocardial Infarction (NSTEMI) Syed Haseeb Raza Naqvi,Tariq Abbas,Han Naung Tun,Ali Ahmad Naqvi,Zubair Zaffar,Badar ul Ahad Gill,Nisar Ahmad 2019-02-22 00:00:00 Background: Acute Coronary Syndrome describes a spectrum of disease ranging from unstable angina through non-ST-Elevation Myocardial Infarction (NSTEMI) to ST-Elevation Myocardial Infarction (STEMI). Early death in NSTEMI is usually due to an arrhythmia. Patients should be admitted immediately to hospital, preferably to a cardiac care unit because there is a significant risk of death. Objective: To compare the diagnostic accuracy of TIMI versus GRACE for prediction of death in patients presenting with Acute Non-ST elevation Myocardial Infarction. Material & Methods: This present cross sectional study was conducted at Department of Cardiology, CPEIC, Multan. All patients assessed according to given scores in the two scoring system i.e. TIMI risk score and GRACE score. Then patients were labeled as high or low risk for death. Data was collected by using pre-designed proforma. 2x2 tables were generated to measure the sensitivity, specificity, positive predictive value, negative Predictive value and diagnostic accuracy of TMI Risk score and GRACE Score for prediction of death in NSTEMI patients. Results: In our study the mean age of the patients was 55.73±9.78 years. The male to female ratio of the patients was 1.6:1. The diabetes as risk factor was found in 145(39%) patients, smoking as risk factor was found in 53(14.2%) patients and hypertension as risk factor was found in 174(46.8%) patients. the sensitivity of TIMI risk was 97.7% with specificity of 92.93% and the diagnostic accuracy was 95.16%, similarly the sensitivity of GRACE risk was 100% with specificity of 95.96% and the diagnostic accuracy was 97.85%. Conclusion: Our study results concluded that both the TIMI risk and GRACE risk are good predictor of death in patients presenting with Acute Non-ST elevation Myocardial Infarction with higher sensitivity and diagnostic accuracy. However the GRACE risk showed more accurate results as compared to TIMI risk. https://www.cardiologymedjournal.com/articles/jccm-aid1032.pdf Commentary Is there an ideal blood pressure during cardiopulmonary bypass to prevent postoperative cerebral injury? – What does the recent evidence say? Ahmed Zaky 2018-11-21 00:00:00 Post cardiac surgery stroke is a devastating complication with an incidence as high as 50%1. The association between intra-operative mean arterial blood pressure (MAP- better called linear blood pressure) during cardiopulmonary bypass (CPB) and the development of postoperative stroke-as diagnosed by neuroimaging- and of cognitive dysfunction (POCD) is controversial. This is due to differences in the study populations, stroke assessment tools, operation and conduction of MAPs, variations in neurocognitive testing and duration of follow up. As a result there is a gap in the knowledge on an ideal MAP as a preventive measure of post CPB stroke and POCD. https://www.cardiologymedjournal.com/articles/jccm-aid1031.pdf Research Article Influence of Histidine on the contractility and adrenaline inotropic effect in the experiments with myocardium of right ventricular of Non pregnant and Pregnant Rats Victor Tsirkin,Alexander Nozdrachev,Julia Korotaeva,Grigorij Khodyrev 2018-11-19 00:00:00 It was investigated contractility and adrenoreactivity of intact myocardium strips of right ventricular in experiment with 60 rats. They were assessed by the force of induce contraction and its changes under the influence of adrenaline (10-9 or 10-5 g / ml). Found that these indicators do not depend on the phases of the estrous cycle and the presence of pregnancy. Histidine (10-10-10-4 g / ml) did not increase the response to adrenalin (10-9 g / ml), but increased the force of the contractions in rats in progesterone dominance (trend) and pregnancy (statistically significant). Against the background of propranolol (10-8 g / mL) or atenolol (10-8, 10-6 g / mL), adrenaline (10-5 g / mL) instead of increasing the force of contraction reduced it (probably due to activation of beta3-, alpha1 - and alpha1 a2- adrenergic receptors), and histidine (10-4 g / mL) prevented this reduction, but does not restore full ability of adrenaline to exert a positive inotropic effect. On the background of nicergoline (10-8 g / mL or nicergoline and propranolol (10-8 g / mL), adrenaline (10-5 g / mL) did not alter the force of contraction, and histidine (10-4 g/mL) restore ability of adrenaline to exert a positive inotropic effect but only in the experiments with nicergoline. Concluded that histidine increases the efficiency of the activation of all three (beta1-, beta2- and beta3-) populations of myocardial beta-adrenoceptoprs, including at lower by adrenergic blockers. Therefore, histidine proposed as an antagonist of beta-adrenergic blockers and as resensitizator of these receptors. Core Tip: In the experiments with strips of the right ventricle of 40 nonpregnant and 20 pregnant rats histidine (10-10-10-4 g /mL) did not increase the response to adrenaline (10-9 g / ml), but increased the force of contractions in pregnant rats. On the background of propranolol (10-8 g / mL) or atenolol (10-8, 10-6 g / mL), adrenaline (10-5g/mL) showed a negative inotropic effect, and histidine (10-4 g / mL) prevented it, but does not restore the ability of adrenaline to show positive inotropic effect,. i.e histidine exhibits the properties of the antagonist of beta-blockers and of resensitizator of beta-adrenoceptors https://www.cardiologymedjournal.com/articles/jccm-aid1030.pdf Case Report Hyperkalemia: An archenemy in emergency medicine. Description of two case reports C Naclerio,A Del Gatto,A Cavallera 2018-11-05 00:00:00 Potassium is an important ion capable to maintain intra-extracellular electric gradient. Variations in the intra-extracellular ionic flow may alter cells functions, skeletal and smooth muscle contractility and electric activity of myocardial cells. In this study we demonstrated that high level of serum potassium may be associated with cardiac and neurological life-threatening diseases. We describe two case reports in which one patient, chronic hemodialysed, presented with cardiogenic shock in setting of hyperkalemia; the other, with end-stage kidney disease, showed a flaccid paralysis associated to high level of serum potassium during potassium sparing diuretic therapy. Emergency haemodialysis was performed with a complete remission of the clinical manifestations. Indeed, the use of simply diagnostic instruments such as serum electrolyte assay and electrocardiographic study (ECG) are helpful in clinical practice solving in timely serious complications due to hyperkalemia. https://www.cardiologymedjournal.com/articles/jccm-aid1029.pdf Review Article Endogenous sensitizer of beta-adrenergic receptors (ESBAR) and its analogs (review) Victor Tsirkin,Alexander Nozdrachev,Elena Sizova,Tatyana Polezhaeva,Svetlana Khlybova,Marina Morozova,Andrew Trukhin,Julia Korotaeva,Grigory Khodyrev 2018-10-29 00:00:00 The results of the 20 years studies of the presence in blood serum and other body fluids of endogenous modulators of adrenergic and M-cholinergic impact as a component of humoral link of autonomic nervous system. The article is devoted to the endogenous sensitizer of beta-adrenergic receptor (ESBAR) - water-soluble low molecular weight substances, analogs of which are histidine, tryptophan, tyrosine, mildronat and preductal. It is shown, that separate dilutions of human serum and animal (as a source of ESBAR) and analogs of ESBAR ways to enhance the effectiveness of activation of beta-adrenoceptors (AR) of smooth muscle (uterus, coronary and renal arteries, trachea, stomach), myocardium, erythrocytes and platelets (respectively influenced of histidine and tryptophan). It is reported that content of ESBAR in human serum (according to the titers of its dilution) depends on the sex and the presence of somatic diseases, and at women are also on the stage of reproduction and obstetric complications It is discussed possible mechanisms of ESBAR action, its physiological role, including as a component of beta-adrenoceptor inhibitory mechanism for myometrium, as well as the prospect of the use of analogs of ESBAR, including for the prevention of preterm labor, and for the treatment of bronchial asthma, coronary heart disease, hypertension and heart failure. https://www.cardiologymedjournal.com/articles/jccm-aid1028.pdf Research Article An observational study of the occurrence of anxiety, depression and self-reported quality of life 2 years after myocardial infarction Catrin Henriksson,Mona-Lisa Wernroth,Christina Christersson 2018-10-17 00:00:00 Background: Patients with myocardial infarction (MI) often experience anxiety, depression and poor quality of life (QoL) compared with a normative population. Mood disturbances and QoL have been extensively investigated, but only a few studies have examined the long-term effects of MI on these complex phenomena. Aims: To examine the levels and associated predictors of anxiety, depression, and QoL in patients 2 years after MI. Methods: This was a single center, observational study of patients with MI (n=377, 22% women, median age 66 years). Two years after MI (2012-2014), the patients were asked to answer the Hospital Anxiety and Depression Scale (HADS) and EuroQol 5-dimension (EQ-5D-3L) questionnaires. Results: Most patients experienced neither anxiety (87%, 95% confidence interval [CI]: 83-90%) nor depression (94%, 95% CI: 92-97%) 2 years post-MI. Elderly patients experienced more depression than younger patients (p=0.003) and women had higher anxiety levels than men (p=0.009). Most patients had “no problems” with any of the EQ-5D-3L dimensions (72-98%), but 48% (95% CI: 43%-53%) self-reported at least “some problems” with pain/discomfort. In a multiple logistic regression model (EQ-5D-3L) higher age (p<0.001) and female sex (p<0.001) were associated with more pain/discomfort. Female sex (p=0.047) and prior MI (p=0.038) were associated with anxiety/depression. History of heart failure was associated with worse mobility (p=0.005) and problems with usual activities (p=0.006). The median total health status of the patients (EQ-VAS) was 78 (95% CI: 75-80) https://www.cardiologymedjournal.com/articles/jccm-aid1027.pdf Opinion Use of Rivaroxaban and Apixaban, Two Non-Vitamin K Antagonist Oral Anticoagulants (NOACs), in Renally Impaired Patients - the limits of our knowledge Kenneth T Moore,Maria Langas 2018-10-11 00:00:00 Patients with chronic kidney disease are at increased risk of thromboembolic complications and are therefore often managed with anticoagulation therapy [1]. While these patients are traditionally treated with Vitamin K antagonists (VKAs), the Non-Vitamin K antagonist oral anticoagulants (NOACs), such as rivaroxaban and apixaban are being used with increasing frequency. Relatively new to the anticoagulant treatment arsenal, both compounds are direct Factor Xa inhibitors and represent an alternative to traditional VKA treatments, such as warfarin. However, because these compounds are at least partially renally eliminated, achieving safe and effective anticoagulation in this vulnerable population has proven to be a challenge [2,3]. With limited published data, there is often uncertainty surrounding which of the NOACs can be safely used. https://www.cardiologymedjournal.com/articles/jccm-aid1026.pdf Research Article Cardiovascular damage during lupus in black African subjects Yaméogo NV,Tougouma SJ-B,Zabsonré J,Kologo KJ,Tiemtoré WS,Kagambèga LJ,Bagbila WPAH, Traoré A,Samadoulougou AK,Zabsonré P 2018-07-16 00:00:00 Introduction: Systemic lupus is a disseminated inflammation of the conjunctive tissue. Cardiovascular lesions are the first cause of morbidity and mortality in the course of that disease. These lesions are prevalent in 30 to 62% of cases, depending on whether the diagnostic tool is clinical, echocardiographic, or autopsic. Any part of the heart can be affected, yielding manifestations of pericarditis, endocarditis, coronary heart disease, conduction disorders, and rarely myocarditis. Objective: Describe cardiac manifestations during the follow up of patients diagnosed with systemic lupus. Patients and Methods: We conducted a transversal descriptive study over a period of 27 months, in the departments of Internal Medicine, Dermatology, and Cardiology of Yalgado Ouedraogo University Hospital of Ouagadougou. All patients diagnosed with systemic lupus according to the American College of Rheumatology criteria, and having done an EKG, a Holter EKG, or a transthoracic echocardiography, were included in the study. Data were collected from inpatient medical records, outpatient follow up registry and booklets. Results: Cardiovascular lesions were prevalent in 7 cases (43.75%) out of 16 patients diagnosed with systemic lupus. Mean age of patients was 36 years, with extremes of 23 and 51 years. Only female patients were affected in our study. Cardiac manifestations were mainly benign pericarditis, heart failure, and conduction disorders. Conclusions: Cardiovascular manifestations are frequent during the course of systemic lupus, and occur after few years of disease progression. Transthoracic echocardiography and EKG remain useful non-invasive explorations for the assessment of cardiovascular lesions, despite minor shortcomings. https://www.cardiologymedjournal.com/articles/jccm-aid1024.pdf Research Article Assessment of risk factors and MACE rate among occluded and non-occluded NSTEMI patients undergoing coronary artery angiography: A retrospective cross-sectional study in Multan, Pakistan Ibtasam Ahmad,Muhammad Haris,Amnah Javed,Muhammad Azhar 2018-05-30 00:00:00 Objectives: The prime focus of the present study was to evaluate the most occluded coronary artery (OCA) among non-ST elevated myocardial infarction (NSTEMI) patients, and risk factors associated with occluded and non-occluded NSTEMI. Also, major adverse cardiovascular event (MACE) were evaluated among patients during index hospitalization. Methods: A retrospective, cross-sectional study was conducted in Multan Institute of Cardiology, Pakistan between 1st February, 2017, and 31st September, 2017. The data were collected from medical records of the outpatients and inpatients who were index hospitalized. Data were analyzed by using Statistical Packages for Social Sciences (IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.) And Microsoft Excel (MS Office 2010). Results: Among 624 patients, angiographic findings revealed that 63.9% were suffering from non-occlusive NSTEMI while 36.1% of the patients had occluded NSTEMI. In occluded NSTEMI patients, 30.3% were having single vessel occlusion while 5.8% were having multi-vessel occlusion. Also, 49.8% were having occlusion of right coronary artery (CA) while 44% were having occluded left anterior descending (LAD) artery. Multivariate analysis revealed that age (p=0.001) and left ventricular ejection fraction (LVEF) (p=0.001) had a statistically significant association. The incidence of MACE was high among non-OCA patients as compared to OCA patients but no statistically significant association was found (p=0.44). Conclusions: Angiography confirmed that most of the NSTEMI patients had OCA. But the MACE rate was not significantly differ among OCA and non-OCA patients. The risk factors associated with OCA were low LVEF and age. https://www.cardiologymedjournal.com/articles/jccm-aid1023.pdf Research Article Design and validation of an Index to predict the development of Hypertensive Cardiopathy Alexis Álvarez-Aliaga,Andrés José Quesada-Vázquez,Alexis Suárez-Quesada,David de Llano Sosa 2018-02-16 00:00:00 Introduction: The high morbidity and mortality by hypertensive cardiopathy demand the construction and validation of tools to stratify the risk of developing this condition. Objective: To design and validate an index, based on risk factors, that permits to predict the development of hypertensive cardiopathy in patients with a diagnosis of essential arterial hypertension. Methods: A prospective cohort study was done in hypertensive patients assisted at the specialized arterial hypertension physicians’ office of the “Carlos Manuel de Céspedes” Specialty Policlinic attached to the General University Hospital, Bayamo Municipality, Granma Province, Cuba from January 1st, 2010 to December 31, 2016. Internal and external validity and the internal consistency of the index were determined. Results: The index sensitivity was of 97, 20 (IC: 93, 93-94.09) and specificity of 65, 38 (IC: 76, 25-76, 20). Both the index discriminative capacity (area under the ROC curve= 0,944; interval of confidence: 0.932-0.956; p<0.0005) and calibration (p=0.751) were adequate. Conclusions: The present study proposes an index to predict the risk of developing hypertensive cardiopathy, with adequate discriminative capacity and calibration (external validity). The index can be used as a tool of clinical and epidemiological surveillance since it permits to identify subjects with greater probability of developing the condition and to stratify the risk. https://www.cardiologymedjournal.com/articles/jccm-aid1022.pdf Research Article Electrocardiographic criteria in founder mutations related to Arrhythmogenic cardiomyopathy Stefan Peters 2018-02-02 00:00:00 Founder mutations are rare causes in arrhythmogenic cardiomyopathy including TMEM43 und phospholamban mutations. The incidence is approximately 1%. P.S358L TMEM43 mutations cause aggressive, in most cases biventricular arrhythmogenic cardiomyopathy [1], with the necessity of primary prophylactic ICD implantation in men and in women>30 years for sudden cardiac death prevention. https://www.cardiologymedjournal.com/articles/jccm-aid1021.pdf Short Communication Heart disease new hypothesis: under endogenous toxicological aspect luisetto M,Behzad Nili-Ahmadabadi,Ghulam Rasool Mashori 2018-01-22 00:00:00 In order to suggest new pathogenetic hypothesis in some heart disease we think is interesting to observe some biomedical literature: Can we think some endogenus toxicologic movens in some heart pathologies? https://www.cardiologymedjournal.com/articles/jccm-aid1020.pdf Research Article Numerical Simulation of Thrombotic Occlusion in Tortuous Arterioles Zhi-Gang Feng,Miguel Cortina,Jennifer KW Chesnutt,Hai-Chao Han 2017-12-06 00:00:00 Tortuous microvessels alter blood flow and stimulate thrombosis but the physical mechanisms are poorly understood. Both tortuous microvessels and abnormally large platelets are seen in diabetic patients. Thus, the objective of this study was to determine the physical effects of arteriole tortuosity and platelet size on the microscale processes of thrombotic occlusion in microvessels. A new lattice-Boltzmann method-based discrete element model was developed to simulate the fluid flow field with fluid-platelet coupling, platelet interactions, thrombus formation, and thrombotic occlusion in tortuous arterioles. Our results show that vessel tortuosity creates high shear stress zones that activate platelets and stimulate thrombus formation. The growth rate depends on the level of tortuosity and the pressure and flow boundary conditions. Once thrombi began to form, platelet collisions with thrombi and subsequent activations were more important than tortuosity level. Thrombus growth narrowed the channel and reduced the flow rate. Larger platelet size leads to quicker decrease of flow rate due to larger thrombi that occluded the arteriole. This study elucidated the important roles that tortuosity and platelet size play in thrombus formation and occlusion in arterioles.  https://www.cardiologymedjournal.com/articles/jccm-aid1019.pdf Mini Review Lipid-induced cardiovascular diseases Sumeet Manandhar,Sujin Ju,Dong-Hyun Choi,Heesang Song 2017-11-23 00:00:00 Cardiovascular diseases are the leading cause of death worldwide. There are many evidences that the dysfunctioning lipotoxicity is the one of major factors of cardiovascular diseases such as, atherosclerosis, hypertension, and coronary heart disease. Obesity and diabetes increase circulating lipids that are likely with more generation of toxic intermediates, which leading to the complications associated with cardiovascular diseases. Indeed, lipotoxicity is a metabolic syndrome caused by abnormal lipid accumulation, which leads to cellular dysfunction and necrosis. Here we review the factors that induced pathogenesis of cardiovascular diseases by lipid accumulation and the mechanisms underlying the lipotoxicity. https://www.cardiologymedjournal.com/articles/jccm-aid1018.pdf Research Article Non-hemodynamic factors associated to the risk of developing hypertensive cardiopathy Alexis Álvarez-Aliaga,Julio César González-Aguilera,Liliana del Rosario Maceo-Gómez,Lic David del Llano Sosa,Raúl Leyva-Castro,Rosa Ojeda-Vázquez 2017-09-20 00:00:00 Introduction: Hypertensive cardiopathy is the target organ lesion caused by arterial hypertension (HTN) that exhibits the highest morbidity and mortality rates. Although the importance of hemodynamic overload exerted by HTN on the onset of cardiopathy is well established, several non-hemodynamic factors may contribute significantly to its development. Objective: To evaluate the influence of different non-hemodynamic risk factors in the development of hypertensive cardiopathy. Methods: A prospective cohort study was carried out in hypertensive patients assisted at the specialized arterial hypertension physicians’ office of the “Carlos Manuel de Céspedes” Specialty Policlinic attached to the General University Hospital, Bayamo Municipality, Granma Province, Cuba from January 5, 2006 to December 31, 2015. The study included 18-to-55-year-old hypertensive patients with a stage 1 arterial hypertension diagnosis for less than a year1. Results: The multivariate analysis showed a significant and independent relation among the majority of the factors studied and the risk of developing cardiopathy. The major factor was C-reactive protein (HR: 5.020; IC 95%: 3.383-7,448; p<0.005) followed by microalbuminuria (HR: 2.649; IC 95%: 1.932-3.631; p<0.005). The area under the model ROC curve was 0.887 (p<0,005). Conclusions: The results showed that it is possible to estimate the risk of developing hypertensive cardiopathy with the application of the regression model to major risk factors. https://www.cardiologymedjournal.com/articles/jccm-aid1017.pdf Case Report A new heart: portraying the physiologic anatomo-functional reconstruction in ischemic cardiomyopathy Marco Cirillo,Marco Campana,Anna Bressanelli,Giovanni Troise 2017-09-15 00:00:00 Fiber-based model of the left ventricle is known since 1628 but the complex 3D structure of myocardial fibers has not taken into account in normalcy or in disease until the last decade. We here present the case of a 60-year-old female patient affected by ischemic cardiomyopathy and severe left ventricular dysfunction. Left ventricle was reconstructed according to a novel surgical technique aimed at rebuilding an elliptical ventricular chamber and redirecting myocardial bundles of fibers in a near-normal orientation, by means of an original suturing technique. Left ventricular torsion was restored, proving the reorientation of myocardial fibres’ bundles. The restored physiologic shape was maintained along the years, gradually improving global ejection fraction and diastolic indices, showing a positive remodeling induced by the optimised geometrical and functional parameters. The unexpected and never proven before renewal of ventricular torsion is an adjunctive element of ventricular efficiency, mainly in ventricles that work at a critical mechanics. A new fiber-based reading of heart function could improve clinical and functional outcomes and address some unsolved issues in the surgical treatment of ischemic cardiomyopathy as well as in medical approaches to the diseased myocardium. https://www.cardiologymedjournal.com/articles/jccm-aid1006.pdf Research Article Value of electrocardiographic T wave inversion in lead aVL in prediction of Mid Left Anterior Descending Stenosis in patients with stable Coronary Artery disease Gehan Magdy,Awad Yousef 2017-08-18 00:00:00 Background: The electrocardiogram (ECG) is a simple and noninvasive bedside diagnostic tool with a well-established role in the diagnosis of coronary artery disease (CAD). We aimed to study the diagnostic value of electrocardiographic ST-T wave changes in lead aVL in prediction of site of coronary artery stenosis in patients with chronic stable angina. Patients and Methods: study was conducted on 156 patients referred for invasive coronary angiography with history of stable CAD as proved by non- invasive tests, 12 lead ECG was recorded and fully interpreted with more focus on T wave direction in aVL lead. T waves in aVL were categorized into one of three groups: upright, flat or inverted. Results: regarding T wave in lead aVL, inverted T wave was reported in 71(45.5%) patients, 58 (37.2%) patients were with upright T wave in lead aVL and 27(17.3%) patients were with flat T wave in lead aVL, and we found that inverted T wave in lead aVL was most evident in 56(73.7%) patients with mid LAD with (highest κ value equal to 0.550[moderate agreement], and p value<0.001. Conclusions: This study confirmed the diagnostic value of T wave inversion in lead aVL in prediction of mid left anterior descending artery lesions in patients with stable coronary artery disease. https://www.cardiologymedjournal.com/articles/jccm-aid1015.pdf Case Report Subacute infectious endocarditis-associated membranoproliferative glomerular nephritis: A Case Report and Review Yi De Zhang,Ya Min Yu,Hou Yong Dai,Xiao Lan Chen,Li Yuan,Hui Shi 2017-08-17 00:00:00 We experienced a case of membranoproliferative glomerulonephritis (MPGN) caused by subacute infectious endocarditis (SIE). A 57-year-old male farmer complained of fatigue, lack of appetite and gross haematuria for a month; he had no cough, chest pain, or exertion dyspnea. After admission, lab tests showed mild proteinuria(1.04g/d) and heavy dysmorphic red blood cells(RBC) (543/HP), with serum creatinine(Scr) slightly elevated(1.46mg/dl) and anemia(hemoglobin Hb 85g/L). A renal biopsy revealed MPGN lesion with 16.6% cellular crescents. The echocardiogram test revealed mitra valve prolapse with perforation of the anterior lobe, vegetation, and severe regurgitation. He was diagnosed as SIE induced MPGN. Then he underwent mitral valve replacement after systemic antibiotic treatment without immunosuppressive agents. Follow-up showed that he dramatically regained normal kidney function in total 1 year after the operation. Thus, antibiotic administration and valve replacement may be efficient enough for some of SIE induced MPGN. We did a brief review of the literature on SIE induced MPGN, which was sometimes misdiagnosed due to its silent characteristics; some SIE patients may initially have other organs involved. https://www.cardiologymedjournal.com/articles/jccm-aid1014.pdf Research Article A rare Congenital Coronary Artery Anomaly: Woven Right Coronary Artery associated with Myocardial Infarction Tolga Doğan,Mucahit Yetim,Lütfü Bekar,Oğuzhan Çelik,Macit Kalçık,Yusuf Karavelioğlu 2017-07-07 01:00:00 Woven coronary artery (WCA) is an extremely rare and still not a clearly defined coronary anomaly. It is characterized by the division of epicardial coronary artery into thin channels which then reanastomose with the distal part of the abnormal coronary artery [1]. Since the angiographic imaging of WCA looks like an intracoronary thrombus and dissection; the differential diagnosis between atherothrombotic coronary arteries with recanalization of organized thrombi in coronary arteries and WCA may be very difficult for invasive cardiologists, especially in patients with single or two coronary artery involvements [2]. https://www.cardiologymedjournal.com/articles/jccm-aid1013.pdf Research Article Investigation of Retinal Microvascular Findings in patients with Coronary Artery Disease Tolga Doğan,Osman Akın Serdar,Naile Bolca Topal,Özgür Yalçınbayır 2017-07-07 00:00:00 Objectives: Retinal microvascular anomalies may be a marker for cardiovascular diseases. Our aim in this study was to investigate the utility of ocular fundoscopic examination as a noninvasive method in specifying the patients who carry a risk for coronary artery disease. Material and Method: Patients who were diagnosed with coronary artery disease by coronary angiography were included in our study. Bilateral fundoscopic examination was performed in these patients. Fundoscopic findings and risk factors for coronary artery disease were evaluated. Results: This study enrolled 100 patients (male: 72 (72%), mean age: 58.25±7.1) who were diagnosed with coronary artery disease by coronary angiography. Upon fundoscopic examination, 87% of the study population had atherosclerotic changes. Grade I atherosclerosis was found in 54% of the patients, grade II atherosclerosis was found in 32% of the patients and grade III atherosclerosis was found in 1% of the patients. Increased retinal tortuosity was present in 65% of the patients. Hollenhorst plaque was observed in 3 patients. Drusenoid bodies were observed with a statistically significantly higher rate in the patients who were not using clopidogrel compared to the patients who were using clopidogrel (p<0.001). Conclusions: Retinal findings are frequently found in patients with coronary artery disease. Therefore, fundoscopic examination is a noninvasive and feasible examination method which can be frequently used in the evaluation of cardiac functions. https://www.cardiologymedjournal.com/articles/jccm-aid1012.pdf Mini Review Incidence of symptom-driven Coronary Angiographic procedures post-drug-eluting Balloon treatment of Coronary Artery drug-eluting stent in-stent Restenosis-does it matter? Victor Voon,Dikshaini Gumani,Calvin Craig,Ciara Cahill,Khalid Mustafa,Terry Hennessy,Samer Arnous,Thomas Kiernan 2017-06-29 00:00:00 Objectives: The clinical impact of drug-eluting balloon (DEB) coronary intervention for drug-eluting in-stent restenosis (DES-ISR) is not fully known. To further evaluate this impact, we aimed to describe the incidence of symptom-driven coronary angiography (SDCA), an under-reported but potentially informative outcome metric in this cohort of patients. Methods: We retrospectively identified all patients (n=28) who had DEB-treated DES-ISR at University Hospital Limerick in between 2013-2015 and evaluated the incidence of subsequent SDCA as the primary endpoint. Data were expressed as mean ± SD and %. Results: Baseline demographics demonstrate a mean age 63±9 years with 61% of DEB-treated DES-ISR presenting with acute coronary syndrome. Mean number of ISR per patient and number of DEB per lesion was 1.2±0.6 lesions and 1.2±0.6 balloons, respectively. The incidence of SDCA was 54% after mean follow-up duration of 179±241 days. 67.8% of patients had follow-up data beyond 12 months. Within the first year of follow-up, the incidence of SDCA with and without target lesion revascularization (TLR) was 11% and 36% respectively. Among patients with SDCA without TLR, 30% had an acute coronary syndrome not requiring percutaneous coronary intervention. Conclusions: A high incidence of SDCA was observed, particularly within the first 12 months after DEB-treated DES-ISR. This under-reported metric may represent a cohort at higher cardiovascular risk but requires further confirmation in larger studies. https://www.cardiologymedjournal.com/articles/jccm-aid1011.pdf Mini Review Thrombolysis, the only Optimally Rapid Reperfusion Treatment Victor Gurewich 2017-06-23 00:00:00 Thrombolysis with tissue plasminogen activator (tPA) has been plagued by inadequate efficacy and a high risk of intracranial hemorrhage (ICH), which led to its replacement by procedures like percutaneous coronary intervention (PCI) whenever possible. Since this requires hospitalization, it is time-consuming, and compromising salvage of brain tissue and myocardium. Thrombolysis is the only first-line treatment that can provide sufficiently timely treatment for optimal recovery of organ function. However, for this potential to be realized, its efficacy and safety must be significantly improved over the current method. By adopting the sequential, synergistic fibrinolytic paradigm of the endogenous system, already verified by a clinical trial, this becomes possible. The endogenous system’s function is evidenced by the fibrinolytic product D-dimer that is invariably present in blood, and which increases >20-fold in the presence of thromboembolism. This system uses tPA to initiate lysis, which is then completed by the other fibrin-specific activator prourokinase (proUK). Since tPA and proUK in combination are synergistic in fibrinolysis, it helps explain their efficacy at their low endogenous concentrations. https://www.cardiologymedjournal.com/articles/jccm-aid1010.pdf Case Report Spontaneous rupture of a giant Coronary Artery Aneurysm after acute Myocardial Infarction Oğuzhan Çelik,Mucahit Yetim,Tolga Doğan,Lütfü Bekar,Macit Kalçık,Yusuf Karavelioğlu 2017-06-21 00:00:00 Coronary artery aneurysm is commonly defined as a localized dilatation exceeding the diameter of adjacent normal coronary segments by 50% [1]. Coronary artery aneurysms may be fusiform, involving the full circumference of the coronary artery, or saccular, involving only a portion of the circumference [2]. Causes of coronary artery aneurysms include atherosclerosis (accounting for 50% of cases), Kawasaki disease, polyarteritis nodosa, infection, trauma, coronary dissection, percutaneous coronary angioplasty, and congenital malformations [3]. The abnormal blood flow within the coronary artery aneurysm may lead to thrombus formation, embolization, rupture, myocardial ischemia or myocardial infarction [4]. Here we present a case of a giant fusiform coronary artery aneurysm who passed away due to coronary rupture after acute myocardial infarction. https://www.cardiologymedjournal.com/articles/jccm-aid1009.pdf Research Article Procedure utilization, latency and mortality: Weekend versus Weekday admission for Myocardial Infarction Nader Makki,David M Kline,Arun Kanmanthareddy,Hansie Mathelier,Satya Shreenivas,Scott M Lilly 2017-05-19 00:00:00 Background: Due to variations in hospital protocols and personnel availability, individuals with myocardial infarction admitted on the weekend may be less likely to receive invasive procedures, or may receive them with a greater latency than those admitted during the week. Whether or not this occurs, and translates into a difference in outcomes is not established. Method: Using the Nationwide Inpatient Sample (2008-2011) database, we identified all patients admitted with a principle diagnosis of acute myocardial infarction. They were stratified by weekend or weekday admission. Baseline clinical characteristics, procedure utilization and latency to procedure were compared, and logistic regression models were constructed to assess the relationship between these variables and in-hospital mortality. Results: Patient demographics and provider-related characteristics (hospital type, geography) were similar between weekend and weekday admission for myocardial infarction. Adjusted for covariates, we found that the odds of mortality for a weekend admission are 5% greater than for a weekday admission (OR: 1.05; 95% CI: 1.01, 1.09, p=0.009). For the utilization of an invasive procedure, we found that the odds of receiving a procedure for a weekend admission were 12% less than the odds for a weekday admission, adjusted for the other covariates (OR: 0.88; 95% CI: 0.86, 0.91, p<0.001). In addition, we found that the time to procedure was an average of 0.18 days (4.32 hours) longer for weekend admissions compared to weekday admissions (95% CI: 0.16, 0.20, p<0.001). However, we did not observe a significant difference in the overall length of stay for weekend and weekday admissions (0.004 days; 95% CI: -0.04, 0.05, p=0.87). Conclusion: In a large and diverse subset of patients admitted with myocardial infarction, weekend admission was associated with fewer procedures, increased latency to those procedures, and a non-significant trend towards greater in adjusted in-hospital mortality. https://www.cardiologymedjournal.com/articles/jccm-aid1008.pdf Case Report Indications and Results of Coronarography in Senegalese Diabetic Patients: About 45 Cases Ndao SCT,Gaye ND,Dioum M,Ngaide AA,Mingou JS,Ndiaye MB, Diao M,Ba SA 2017-02-20 01:00:00 Introduction: Coronary disease accounts for 75% of diabetic mortality. Coronary angiography reveals lesions that are often diffuse, staggered and multi-truncated. The objective of this study was to determine the indications and results of coronary angiography in diabetic patients. Method: This is a cross-sectional, descriptive and analytical study which took place from May 2013 to July 2015 at the cardiology clinic of the Aristide Le Dantec hospital. We have included all diabetics who have benefited from coronary angiography by studying clinical and paraclinical data, particularly coronary angiography ones. Results: During this period, 400 patients had coronary angiography, including 45 diabetics, a hospital prevalence of 11.25%. The average age of our patients was 62.27 y/o with extremes of 44 and 85 y/o. The sex ratio was 1.6 in favor of men. Diabete was revealed in 42 patients. Almost all patients were type II diabetics (44 patients) since 9.94 years in average. The associated cardiovascular risk factors were hypertension 66.7% and dyslipidemia 49.6%. Only 4 patients had typical chest pain. The electrocardiogram was abnormal in 84.4% of cases with 26 cases of SCA ST +. Coronary angiography was abnormal in 37 patients with significant stenosis in 30 patients. A single-truncular lesion was found in 14 cases, 8 had bi-truncular and other 8 had tri-truncular one. The anterior interventricular artery and the segment II of the right coronary were the most affected branches. Concerning the management, 14 patients had angioplasty with an active stent, 8 patients had medical treatment alone and 9 patients had coronary artery bypass surgery. Accidents occured for 4 patients, two of whom had arterial spasm, one of a vagal discomfort and another had an occlusion of the circumflex that led to the implantation of a stent. Conclusion: Diabetes is accompanied by progressive coronary atherosclerosis, which has an adverse effect on patients' prognosis. Tri-truncal affection and indications for coronary artery bypass surgery are common https://www.cardiologymedjournal.com/articles/jccm-aid1007.pdf Case Report Short and Medium-Term Evaluation of Patients in Coronary Post-Angioplasty: Préliminary results at the Cardiology Department of the Hospital University Aristide Le Dantec of Dakar (Senegal): Study on 38 Cases Dioum M,Aw F,Masmoudi K,Gaye ND,Sarr SA,Ndao SCT, Mingou J,Ngaidé AA,Diack B,Bodian M,Ndiaye MB,Diao M,Ba SA 2017-02-20 00:00:00 Introduction: Coronary angioplasty is a safe therapeutic method for coronary disease. However, its major obstacles remain the occurrence of stent thrombosis (ST) and in-stent restenosis (ISR). The aim of this study was to evaluate the short-term and medium-term results of coronary angioplasty patients in the cardiology department of Aristide Le Dantec hospital in Dakar. Methodology: It was a longitudinal, descriptive and analytical study over a period of 12 months (April 2014 to April 2015) with a follow-up at 6 months. Was included any patient who had a coronary angioplasty with stent placement. Results: Thirty-eight patients had been included with a male predominance and a sex ratio of 5.32. The average age was 57.94 years. Cardiovascular risk factors were mainly smoking (57.9%) and coronary heredity (42.1%), followed by hypertension (39.5%) and diabete (34.2%). The indications for angioplasty were acute coronary syndromes TS(+) and TS(-) respectively (50%) and (23.7%) and stable angina (26.3%). The right femoral approach was almost exclusive (97.4%). Coronary angiography revealed a predominance of anterior interventricular affection (84.2%). Type B lesions were the most frequent (68.4%). The single-truncal valve affection was predominant (76.3%). Direct stenting accounted for 63.2% of procedures. Twenty-one bare stents (55.3%) and 17 active stents (44.7%) were implanted. The results were excellent (94.7%). One case of acute stent thrombosis was noted. Echocardiography of dobutamine stress during follow-up was positive in 04 patients (12.5%). The control coronary angiography performed in two patients revealed an ISR. The predictive factors for restenosis were dominated by a deterioration in the segmental kinetics (p=0.009), in the diastolic function (p=0.002), the systolic function (p=0.003), a high post angioplasty troponin (p=0.004), the presence of calcifications (p=0.004) and a high SYNTAX score (p=0.021). Conclusion: According to these results, Angioplasty is an effective therapy for coronary disease. However, a correct intake of double platelet antiaggregants and clinical and non-invasive screening are required for follow-up to avoid stent thrombosis or restenosis. https://www.cardiologymedjournal.com/articles/jccm-aid1006.pdf Case Report Congenital Quadricuspid Aortic Valve, a Rare Cause of Aortic Insufficiency in Adults: Case Report Cyrus Kocherla,Kalgi Modi 2017-01-23 00:00:00 Quadricuspid aortic valve (QAV) is rare congenital malformation of the aortic valve with estimated prevalence of 0.013% to 0.043% [1-4]. QAV is most commonly associated with aortic insufficiency (AI), which is found in almost 75% of cases [5]. QAV can also be associated with other cardiac defects such as ventricular or atrial septal defects, patent ductus arteriosus, subaortic fibromuscular stenosis, malformation of the mitral valve, and coronary anomalies [3]. Up to 40% of all patients with QAV undergo aortic valve replacement surgery most commonly due to progressive AI in 88% of case [2,3,6]. Here we report a case from our institution of a woman with QAV with severe AI and anomalous origin of the right coronary artery. https://www.cardiologymedjournal.com/articles/jccm-aid1005.pdf Case Report Intermittent Left Bundle Branch Block: What is the Mechanism? Hussam Ali,Riccardo Cappato 2017-01-20 00:00:00 A 73-year-old male underwent cardiologic evaluation for an incidental electrocardiographic finding of left bundle branch block (LBBB). He was asymptomatic and had no relevant cardiac history. Physical examination and transthoracic echocardiogram revealed no abnormalities. https://www.cardiologymedjournal.com/articles/jccm-aid1004.pdf Research Article Concentration Polarization of Ox-LDL and Its Effect on Cell Proliferation and Apoptosis in Human Endothelial Cells Shijie Liu,Jawahar L Mehta,Yubo Fan,Xiaoyan Deng,Zufeng Ding 2016-12-30 03:00:00 Background: Flow-dependent concentration polarization of native LDL is important in the localization of atherogenesis. However, ox-LDL plays a more important role than n-LDL in atherogenesis by inducing cell proliferation and apoptosis. We hypothesized that concentration polarization of ox-LDL may adversely affect vascular beds due to its toxicity to endothelial cell (EC) lining. Methods: Using a parallel-plate flow chamber technique, we studied water filtration rate and wall concentration of ox-LDLs EC monolayers cultured on permeable or non-permeable membranes. ECs cultured on permeable and non-permeable membranes were examined in terms of cell viability, ox-LDL uptake, LOX-1 expression and cell apoptosis (Cytochrome c and Bcl-2 expression). We observed that the wall concentration of ox-LDL was about 16% higher in the permeable group than in the permeable group (P<0.05). Cell proliferation (MTT assay) increased in response to low concentration of ox-LDL (1-5 μg/ml), and fell drastically in response to higher concentration; all these changes were more pronounced in the permeable group than in the non-permeable group. The uptake of ox-LDL and LOX-1 expression by ECs were also significantly higher in the permeable group than in the non-permeable group of cultured cells. Conclusions: These observations suggest that concentration polarization of ox-LDL occurs in an artery that is permeable to water, and ox-LDL concentration polarization can enhance ox-LDL accumulation into the arterial wall and accelerate EC proliferation at low concentrations and apoptosis at high concentrations, possibly via LOX-1 expression. https://www.cardiologymedjournal.com/articles/jccm-aid1003.pdf Letter to Editor Mid-Ventricular Ballooning in Atherosclerotic and Non-Atherosclerotic Abnormalities of the Left Anterior Descending Coronary Artery Stefan Peters 2016-12-30 00:00:00 In a series of meanwhile 10 cases rigid straightening of the mid-portion of the left anterior descending coronary artery without lumen reduction mid-ventricular or basal ballooning was reported, or both basal and mid-ventricular ballooning in one case. In all these patients wrap-around (recurrent segment) phenomenon of the left anterior descending coronary artery was not present. The abnormalities of the left anterior descending coronary artery are due to myocardial bridging without lumen reduction of the LAD, only seen in computed tomography. When stress or in some cases happiness appears myocardial ballooning can appear, lasts 2-4 weeks and disappear with a recurrence rate of nearly 10% despite beta blocking agents. https://www.cardiologymedjournal.com/articles/jccm-aid1002.pdf Research Article Left Atrial Remodeling is Associated with Left Ventricular Remodeling in Patients with Reperfused Acute Myocardial Infarction Christodoulos E. Papadopoulos,Dimitrios G. Zioutas,Panagiotis Charalambidis,Aristi Boulbou,Konstantinos Triantafyllou,Konstantinos Baltoumas,Haralambos I. Karvounis,Vassilios Vassilikos 2016-12-07 00:00:00 Background: Left atrial volume (LAV) has been established as a sensitive marker of left ventricular (LV) diastolic function and as an independent predictor of mortality in patients with acute myocardial infarction (AMI). LA remodeling and its determinants in the setting of AMI have not been much studied. Methods: We studied 53 patients with anterior AMI and a relatively preserved LV systolic function, who underwent complete reperfusion and received guidelines guided antiremodeling drug management. LA and LV remodeling were assessed using 2D echocardiography at baseline and 6 months. LAV indexed for BSA (LAVi) was used as the index of LA size and further LA remodeling. Results: LAVi increased signifi cantly at 6 months compared to baseline [28.1 (23.0-34.5) vs 24.4 (19.5- 31.6) ml/m2, p=0.002] following LV end diastolic-volume index change [56.8 (47.6-63.9) vs 49.5 (42.0-58.4) ml/m2, p=0.0003]. Other standard LV diastolic function indices did not show any signifi cant change. Univariateanalysis showed a strong positive correlation of LAVi change with BNP levels at discharge, LV mass index and LV volumes indices change, throughout the follow up period. Multivariate regression analysis revealed that BNP plasma levels was the most important independent predictor of LA remodeling (b-coef.=0.630, p=0.001). Conclusions: Despite current antiremodeling strategies in patients with AMI, LA remodeling is frequently asssociated with LV remodeling. Additionally LAVi change in the mid-term reflects better than standard echocardiographic indices LV diastolic filling impairment. https://www.cardiologymedjournal.com/articles/jccm-aid1001.pdf
This XML file does not appear to have any style information associated with it. The document tree is shown below.
<rss xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:sy="http://purl.org/rss/1.0/modules/syndication/" xmlns:admin="http://webns.net/mvcb/" xmlns:rdf="http://www.w3.org/1999/02/22-rdf-syntax-ns#" xmlns:content="http://purl.org/rss/1.0/modules/content/" version="2.0">
<channel>
<title>Journal of Cardiology and Cardiovascular Medicine</title>
<link>https://www.cardiologymedjournal.com/feed</link>
<description>Introduction The term Cardiology is derived from the Greek words "cardia", which refers to the heart and "logy" meaning "study of." Cardiology is a branch of medicine that concerns diseases and disorders of the heart. Cardiovascular Medicine is concerned with the study of those medicines that help in prevention, detection, management and treatment of cardiovascular diseases. Journal of Cardiology and Cardiovascular Medicine is an independent, peer-reviewed journal of Heighten Science which publishes manuscripts written and refereed by researchers, scientists, doctors, specialists and other health professionals. The contents of Journal of Cardiology and Cardiovascular Medicine are clinically focused, practical, evidence-based and well-illustrated, designed to meet the needs of busy doctors. Reasons for Publishing The number of patients with chronic cardiovascular conditions is likely to increase as our population ages, accompanied by an increasing prevalence of obesity, diabetes and associated vascular complications. Improvements in acute care for patients encountering cardiac events are one of the main reasons for Heighten Science to come up with the Journal of Cardiology and cardiovascular medicine. The Journal of Cardiology and cardiovascular medicine is designed to provide valuable insights on cardiology and cardiovascular medicine to the world-wide healthcare professionals. The manuscripts published in the Journal of Cardiology and Cardiovascular Medicine are easy to read and have been carefully reviewed by an editorial board of cardiologists, as well as other specialists outside the editorial board, to ensure the tone and content meet the busy practitioners&rsquo; needs.</description>
<item>
<type>Observational Study</type>
<title>Causes of Coronary Angioplasty Denial in Patients Diagnosed with Significant Coronary Artery Disease in East Afghanistan</title>
<author>Akmal Shams,Ikramullah Ibrahimi,Humayoun Chardiwal</author>
<pubDate>2024-10-30 14:29:20</pubDate>
<description>Coronary Artery Disease (CAD) is a leading cause of mortality worldwide, with coronary angioplasty being a crucial intervention for patients with significant disease. This study aimed to identify and analyze the causes of coronary angioplasty denial in patients with significant coronary artery disease in Afghanistan, focusing on demographic, socioeconomic, and clinical factors.A case-control study was conducted with a sample size of 213 patients diagnosed with significant CAD at tertiary care center in Afghanistan. The case group consisted of 106 patients who were denied angioplasty, and the control group included 107 patients who underwent the procedure. Data were collected on demographic characteristics, comorbidities, education, residence, functional status, income, and the reasons for angioplasty denial. Descriptive statistics and comparative analyses were performed to assess the factors associated with denial.The primary reasons for angioplasty denial were financial constraints (45.3%, p &lt; 0.001), limited hospital facilities (15.1%, p = 0.045), patient refusal (23.6%, p &lt; 0.001), and physician preference for conservative management (12.3%, p = 0.091). Denial rates were higher among patients who were older, had multiple comorbidities, were from rural areas, and had lower education and income levels. Illiteracy and cultural beliefs contributed significantly to patient refusal, while inadequate healthcare infrastructure disproportionately affected rural populations.Financial and infrastructural barriers are the leading causes of coronary angioplasty denial in Afghanistan, exacerbating disparities in healthcare access, particularly among low-income and rural patients. Addressing these issues through policy reforms, improved healthcare infrastructure, and targeted public health education is essential to reducing CAD-related morbidity and mortality in the country.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1197.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Association Between Electrocardiographic Abnormalities and In-Hospital Adverse Outcome in COVID-19 Patients</title>
<author>Anjuman Begum*, Wadud Chowdhury, Suman KS, Arnab KC, Md. Akteruzzaman, Barua Sushanta</author>
<pubDate>2024-10-10 16:45:11</pubDate>
<description>Background: SARS-CoV-2 is increasingly recognized for its cardiovascular complications. To address the knowledge gap in our region, this study investigated the relationship between electrocardiographic (ECG) features and in-hospital mortality among COVID-19 patients.Methods: A prospective cohort study was conducted involving 140 RT-PCR-confirmed COVID-19 patients at Dhaka Medical College Hospital from August 2021 to July 2022. Patients were divided into two groups based on ECG findings: normal (Group A) and abnormal (Group B). Clinical data and ECG parameters were analyzed using SPSS 24.0.Results: Patients with abnormal ECGs were older, more likely male, and presented with higher rates of dyspnea and palpitations. They were also at increased risk of severe COVID-19 and had longer hospital stays. In-hospital mortality was significantly higher in Group B (21.4% vs.4.3%). ST-T changes and atrial fibrillation were associated with increased mortality. Independent predictors of in-hospital mortality included ECG abnormalities and admission SpO₂ &lt; 90%.Conclusion: ECG abnormalities are significantly associated with adverse outcomes in COVID-19 patients. Further large-scale studies are warranted to strengthen these findings.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1196.pdf</link>
</item>
<item>
<type>Observational Study</type>
<title>Poor Diet Leading to the Increasing Risk of Atherosclerosis in the World</title>
<author>Bijaya Bhusal*</author>
<pubDate>2024-09-03 10:03:28</pubDate>
<description>Atherosclerosis Ischemic Cardiovascular Disease (ASICD), one of the leading causes of global deaths, is mainly caused due to the development of plaque on the inner walls of arteries of the human heart. Ischemia refers to the lack of enough oxygen (O2), nutrient delivery, and improper waste removal in the cardiac cells. About 90% of cardiovascular diseases in the present world are due to the formation of lipid/cholesterol-based plaques that can form under the lining of the smooth epithelial blood cells. In the US, a study published in the Journal of the American College of Cardiology estimated that poor diet is responsible for about 45% of Cardiovascular Disease. Atherosclerosis doesn&rsquo;t cause much effect until and unless the plaque becomes unstable due to the accumulation of thrombus that shows Acute Coronary Syndrome. Acute Coronary Syndrome is the result of blockage of blood vessels leading to Myocardial Infarction (Unstable Angina Pectoris). Cardiac Cells require a sufficient amount of Oxygen to function properly. Thus, the demand and supply of oxygen to the cardiac cells should be properly balanced. Atherosclerosis Ischemic Cardiovascular syndrome can worsen if the person is more involved in exercise or emotional stress because at that time their body requires higher oxygen but blood flow gets disrupted due to the formation of plague. Later in the paper, we will discuss the New York Heart Association classification, followed by the top 3 poor diets that are considered to be increasing the cases of cardiovascular disease around the world.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1195.pdf</link>
</item>
<item>
<type>Observational Study</type>
<title>Prescribing Inertia or Not? Quantitative Investigation of Loop Diuretics Prescribing after Palliative Care Consultation among Patients with Heart Failure</title>
<author>Zidong Zhang*, William Frick, Leslie Hinyard, Divya S Subramaniam</author>
<pubDate>2024-08-27 17:00:32</pubDate>
<description>Purpose: Loop Diuretics (LD) are the first-line pharmacotherapy to address Heart Failure (HF)-associated edema and dyspnea. However, LD causes frequent urinary, resulting in inconvenience and possibly undermining the quality of life. While prescription adjustment is an essential part of Palliative Care Consultation (PCC), it remains unclear how PCC affects the deprescribing of diuretics for adults with HF.&nbsp;Methods: We conducted a pre-post analysis of the percentage of HF patients who were prescribed LD in a national Electronic Health Record (EHR) database 12 months before and after the first PCC. The difference in prescription rates between the periods was determined. Adjusted associations of post-PCC LD prescription with pre-PCC LD prescription and patient&rsquo;s characteristics, insurance, provider type, and clinical factors were quantified.Results: From 2010 to 2018, 5,969 patients with newly diagnosed HF received at least one PCC, among whom 2,539 (42.5%) were prescribed LD before and 1,552 (26.0%) after their first PCC. Despite a decrease in LD prescription rate encompassing the date of PCC, post-PCC LD prescribing was strongly associated with pre-PCC prescribing (aOR[95%CI] 3.2[2.8,3.7]) and varied by age at first PCC, year of HF diagnosis (aOR[95%CI] 2.1[1.9,2.4]) and months from HF diagnosis to first PCC. While our finding demonstrates reduced polypharmacy associated with PCC, the strong association between pre- and post-PCC indicates reverse therapeutic inertia. Future research should investigate the benefits and costs of polypharmacy among specific patient groups to help develop personalized treatment for HF.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1194.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Awareness of Myocardial Infarction in Nangarhar Residents: A Community Based Study</title>
<author>Akmal Shams, Ikramullah Ibrahimi*, Hayatullah Ahmadzai</author>
<pubDate>2024-08-27 16:57:09</pubDate>
<description>Myocardial infarction is the leading cause of morbidity and mortality worldwide. The overall aim of the study was to evaluate community awareness about myocardial infarction.It was a community-based cross-sectional study conducted during one month including both male and female participants aged 18 years and over in Nangarhar province of Afghanistan.&nbsp;The percentage of awareness for risk factors was as follows: Diabetes (56.4%), Hypertension (43.4%), Elderly (42.1%), Obesity (39.8%), Physical inactivity (38.5%), Hyperlipidemia (37.6%), and Family history (33.8%). Furthermore, knowledge about symptoms and signs was as the following: chest pain (67.4%), pain in neck and jaw (57.8%), Dyspnea (50.7%), pain in arms (46.1%), weakness/fainting (40.1%), cold sweats (38.2%), nausea and vomiting (34.5%), anxiety (29.6%), fever (22.7%), hypotension/shock (20.1%), and silent myocardial infarction (11.3%). Moreover, 24% of participants did not know about the prevention strategies for myocardial infarction. Regarding treatment, 80.3% of participants exactly knew to go to the emergency room, 11.9% of participants would intend to go to a general practitioner (GP), 5.6% of participants would ask others for advice on what to do, and 2.2% of participants would wait to see if the symptoms go away spontaneously or if the symptoms were due to other diseases.&nbsp;The current awareness level about myocardial infarction especially atypical symptoms, risk factors, prevention, and treatment strategies in Nangarhar residents was insufficient, especially in females and healthy individuals, and warrants designing and implementing immediate awareness programs in order to avoid delay of treatment-seeking, misbeliefs about the disease and subsequent morbidity and mortality.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1193.pdf</link>
</item>
<item>
<type>Case Report</type>
<title>Contrast Echocardiography for the Detection of a Giant Right Coronary Artery Aneurysm: A Useful Diagnostic Tool</title>
<author>Fabrizio De Rosa*, Granit Rabia</author>
<pubDate>2024-08-22 17:49:00</pubDate>
<description>Coronary artery aneurysm is an uncommon condition defined as abnormal dilatation of the coronary artery.We report the case of a man admitted to the Emergency Department for suspected intestinal obstruction. At abdominal/thoracic Computed Tomography (CT) it was reported a suspected pericardial cyst. Contrast echocardiography showed a clear pattern of blood flow inside the mass with a probable origin at a very limited region where it was also possible to sample an ECG-synchronized system-diastolic Pulse-Wave (PW)-Doppler pattern, typical for a coronary artery flow. Our suspicion of a giant coronary artery aneurysm was then confirmed by coronary CT and coronary angiography. The patient was transferred to a Cardiac Surgery center where he underwent surgical treatment for the aneurysm.Most coronary aneurysms are clinically silent and are often incidentally detected. Coronary angiography is the ‘‘gold standard’’ for diagnosis and evaluation of coronary artery aneurysms. Among non-invasive diagnostic techniques, Computed Tomography Coronary Angiography is the best method for coronary artery anatomy and coronary abnormalities. However, echocardiography with the use of a contrast agent, a cost-effective non-radiation nature, and a widespread use method, maybe a reliable method to detect and characterize the masses, allowing a differential diagnosis.Learning objective1.    Recognition and evaluation of cardiac masses require first-line imaging methods such as echocardiography.2.    The use of additional non-invasive (cardiac CT or MRI) and/or invasive imaging methods are often required. 3.    Contrast echocardiography may be helpful, as second-line imaging methods, to better characterize the mass and approach the correct diagnosis.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1192.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Defibrillation of Atrial Fibrillation is not Associated with Increased Risk of Ventricular Fibrillation – The VCD-Trial (Clinical Trial of Electrical Therapy for Atrial Fibrillation using R-wave Guided Cardioversion Versus Defibrillation)</title>
<author>Christian Keller*, Martina Gercken, Jens Hagemeister, Martin Hellmich, Uta Hoppe, Damian Franzen</author>
<pubDate>2024-08-19 15:34:44</pubDate>
<description>Background: Because of a possible risk of induction of Ventricular Fibrillation (VF) by defibrillation of atrial fibrillation (AF) postulated by LOWN and coworkers, synchronized cardioversion is used worldwide. This prospective, randomized study assessed the efficacy and safety between R-wave controlled cardioversion and defibrillation of AF at 2 study centers in Cologne, Germany.&nbsp;Hypothesis: Defibrillation is not significantly different from cardioversion primarily in the occurrence of VF or sustained Ventricular Tachycardia (VT) and secondarily in restoring sinus rhythm, inducing non-sustained VT, asystole, or bradycardia.Methods: 146 patients at an outpatient practice and 122 at the university hospital were randomized to cardioversion (n = 140) or defibrillation&nbsp;(n = 124).Results: Cardioversion was successful in 92.1% of cases and defibrillation in 87.1%. The difference in efficacy was not statistically significant. In n = 1 patients receiving defibrillation, VF occurred after the first shock (200J) and immediate defibrillation (200J) restored sinus rhythm. In the n = 1 case, asystole occurred during cardioversion which terminated spontaneously. In n = 1 patients cardioverted and n = 2 who were defibrillated, sinus bradycardia occurred requiring Atropine in two cases. There were no thromboembolic events within 10 days. N = 9 patients reverted to AF within two hours. No patients died.&nbsp;Conclusion: Electrical conversion of AF can be performed with similar results and low risk with both R-wave-triggered cardioversion and defibrillation. In particular, defibrillation with higher energies (&gt; 100J) can be performed as effectively and safely without a statistically significant increased risk of VF or VT. There was no difference in efficacy and risk between electrotherapy performed in the outpatient and inpatient settings.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1191.pdf</link>
</item>
<item>
<type>Case Presentation</type>
<title>Single Coronary Artery Associated with an Arteriovenous Communication: An Incremental Diagnostic Value of Coronary CTA</title>
<author>Rabih Touma*, Karan T Singh, Ramanjit Kaur, James F Mastromatteo, Aiden Abidov</author>
<pubDate>2024-08-12 11:25:21</pubDate>
<description>Single coronary artery and coronary arteriovenous communication are rare congenital cardiac anomalies with potentially harmful effects, making the diagnosis essential for the appropriate management. The coexistence of these two anomalies is exceptional. We present a case illustrating the diagnostic power of Coronary CTA in depicting this unusual combination.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1190.pdf</link>
</item>
<item>
<type>Mini Review</type>
<title>Required Elements for Next-generation Prognostic Index beyond Left Ventricular Ejection Fraction in Heart Failure</title>
<author>Shiro Hoshida*</author>
<pubDate>2024-08-12 11:21:29</pubDate>
<description>Many reports are showing no differences in prognosis between patients with Heart Failure (HF) with preserved and reduced ejection fraction. All-in-one analysis with a multivariable model, including clinical characteristics, blood test, comorbidity, and echocardiographic indices, on clinical outcomes in patients with HF has not been performed rarely in previous studies. We have to accept the need to be more comprehensive in the outcome analysis of patients with HF and consider the intricate interplay of multiple variables in patient outcomes.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1189.pdf</link>
</item>
<item>
<type>Case Report</type>
<title>Imaging Challenge in Recurrent Spontaneous Coronary Artery Dissection (SCAD): A Case Report</title>
<author>Giovanni Martino*, Mario Leporace*, Francesco Greco, Rossella Quarta, Letizia Romano, Antonio Curcio, Alberto Polimeni</author>
<pubDate>2024-08-08 11:51:28</pubDate>
<description>Spontaneous Coronary Artery Dissection (SCAD) represents a significant cause of acute coronary syndrome (ACS) in patient populations with low-risk cardiovascular profiles and, therefore can be sometimes underdiagnosed. On the other hand, it often preserves the typical clinical presentation of ACS which makes coronary artery angiography (CAG) execution mandatory. A 62-year-old woman with a history of recurrent SCAD presented to the emergency department for a new episode of acute chest pain with troponin elevation. CAG revealed an ambiguous angiography image suggesting a sub-occlusive type 2 SCAD involving the distal segment of the left circumflex artery. The patient was managed conservatively due to the absence of ongoing ischemia or hemodynamic instability. At the seven-day follow-up, a computed tomography coronary angiography (CTCA) was performed to better assess SCAD and detect concomitant associated arteriopathies. Optimized medical therapy was prescribed at the discharge and at one-month follow-up, no recurrence of symptoms was referred.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1188.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Improving Cardiac Rehabilitation Referral Rates in Patients with Coronary Heart Disease from Diverse Communities Using an Electronic Order System</title>
<author>Alexandra Maloof*, David Torres Barba, Santiago Ramirez Nuño, Nainjot K Bains, Ignacio A Zepeda, Armando Gallegos, Hyeri You, Wesley Thompson, Jia Shen, Robert El-Kareh, Luis R Castellanos</author>
<pubDate>2024-06-29 10:56:12</pubDate>
<description>Introduction: Despite the benefits of Cardiac Rehabilitation (CR), local and national CR referral and participation rates remain low when compared to established cardiovascular therapies, especially amongst racial/ethnic groups.&nbsp;Objectives: This study investigated the effects of the implementation of a CR program and electronic order set (EOS) in a large health system on CR referral and participation rates among a diverse group of patients with Coronary Heart Disease (CHD).&nbsp;Methods: A total of 360 patients from UCSD Health who presented with ACS were prospectively evaluated during initial hospitalization and 6- and 12-weeks post-discharge. The multivariable logistic regression model assessed referral and participation rates by week 1 and -12 post-discharge, adjusting for gender, age, race, ethnicity, geography, and referring physician subspecialty.&nbsp;Results: UCSD CR program implementation led referral rates to increase at week 1 (Pre- 38.6% and Post-54.9%, p = 0.003) and week-12 (Pre- 54.1% and Post- 59.8%, p = 0.386). Post-CR referrals were more likely at week-1 (OR: 1.93, 95% CI 1.27-2.95) and week-12 (OR: 1.26, 95% CI 0.79-2.00). EOS implementation increased referral rates at week-1 (Pre- 40.3% and Post- 58.7%, p &lt; 0.001) and week-12 (Pre- 54.9% and Post- 60.4%, p = 0.394) with referrals more likely at week-1 (OR: 2.1, 95% CI 1.35-3.29) and week-12 (OR: 1.25, 95% CI 0.795-1.98). Participation in CR following EOS was more likely at both week-1 and week-12. Multivariable analysis revealed disparities in referral based on race, geographic location, and referring physician subspecialty.&nbsp;Conclusion: A CR program and EOS implementation were shown to increase referral rates with long-term potential for increasing referral and participation rates.&nbsp;Condensed abstract: This prospective study investigated the implementation of a Cardiac Rehabilitation (CR) program and Electronic Order Set (EOS) within the same health system on CR referral and participation rates. 360 patients with ACS were evaluated over 12 weeks. UCSD CR program and EOS implementation led referral rates to increase at week-1 and -12. CR participation was more likely to increase at week-1 and -12 following EOS. Multivariable analysis revealed disparities in referrals disproportionally affecting racial and ethnic minority groups and rural communities. CR and EOS implementation may increase CR referral rates for diverse patients with CHD.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1187.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Descriptive Study of the Urinary Tract Infections in Patients Admitted in the Cardiology Ward of Afghan Momand Medical Complex</title>
<author>Shams Akmal, Ibrahimi Ikramullah*, Agha Said Asif</author>
<pubDate>2024-06-28 10:52:02</pubDate>
<description>Urinary Tract Infection (UTI) is very common in our community most specifically in married females with numerous antecedent risk factors. The aim of the study was to find out about the current risk factors and clinical profile of urinary tract infections in patients admitted to the cardiology ward of Afghan Momand Medical Complex for various purposes.It was a cross-sectional descriptive hospital-based study including both male and female patients visiting the Afghan Momand Medical Complex from January 2022 to June 2022.&nbsp;Of all 960 patients, 202 (21%) patients had urinary tract infections with gender distribution as 69 (34.2%) males and 133 (65.8%) females. In fact, 33 (16.3%) patients with urinary tract infections were single while the rest 169 (83.7%) patients were married. In addition, regarding clinical profile, the following clinic was respectively more prevalent: Dysuria in 120 (59.4%) patients, flank pain in 73 (36.1%) patients, urine frequency in 67 (33.1%) patients, urgency in 36 (17.8%) patients, fever in 24 (11.8%) patients, and nausea and vomiting in 19 (9.4%) patients. Moreover, the following risk factors were respectively the most common ones: Diabetes mellitus 86 (42.5%), pregnancy 30 (14.9%), stones 15 (7.4%), 10 (4.9%) devices, 10 (4.9%) prostatic hyperplasia, and 4 (2%) anatomical anomalies.Urinary tract infection is a common disease in the admitted patients in Afghan Momand Medical Complex specifically being more common in females and early 20s of the age. In fact, diabetes, pregnancy, and kidney stones were the leading associated factors with UTI. Moreover, dysuria, bladder emptying irritative symptoms, and abdominal pain were the most prevalent clinical profile of the patients. Special attention should be paid to infectious diseases in cardiac patients since infection itself is a stress and a threat to such patients and authorities should design special measures to prevent UTI in the general population to avoid a sum of burden on the health system.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1186.pdf</link>
</item>
<item>
<type>Case Report</type>
<title>Utilizing Smartphone ECG for Early Detection and Management of Ischemic Heart Disease: A Case Report</title>
<author>Yogendra Singh, CB Pandey, Nitin Chandola*, Deeksha Agarwal</author>
<pubDate>2024-06-24 10:46:09</pubDate>
<description>Ischemic Heart Disease (IHD) remains a significant cause of morbidity and mortality worldwide. We present a case report of a 54-year-old individual presenting with symptoms suggestive of IHD, including palpitations and chest heaviness. Utilizing a Spandan device at home, the patient detected anteroseptal and lateral wall ischemia, prompting consultation with a cardiologist. Subsequent diagnostic evaluations revealed Left Ventricular Hypertrophy (LVH), concentric LVH, regional wall motion abnormality, and Grade I diastolic dysfunction. Hypertension and dyslipidemia were identified as prominent risk factors, with additional findings of carotid artery disease. Management strategies included antihypertensive medications, lipid-lowering therapy, and lifestyle modifications. This case underscores the complexity of diagnosing and managing IHD, highlighting the importance of comprehensive assessment and multidisciplinary care in optimizing patient outcomes.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1185.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Percutaneous Closure of Post-myocardial Infarction Ventricular Septal Rupture-experience From a Resource-limited Setup From Eastern Part of India</title>
<author>Siddhartha Saha*</author>
<pubDate>2024-06-20 10:22:50</pubDate>
<description>Background: Post-infarction ventricular septal rupture (VSR) is a rare but lethal mechanical complication of an acute myocardial infarction (AMI). It results in 90% - 95% mortality within two months of diagnosis without any kind of intervention. Given high surgical mortality, transcatheter closure has emerged as a potential strategy as an alternative to high-risk surgical closure. Indian data on percutaneous device closure of post-AMI-VSR is limited hence we report our resource-limited single-centre experience with different kinds of occluder devices for closure of post-AMI VSR.Methods and results: In this single-centre, retrospective, cohort study, patients who underwent transcatheter closure of post-MI VSR between 2018 and 2024 at Health World hospitals, in Durgapur, West Bengal, were included. The primary outcome was a mortality rate of 30 days. The study population was eleven primary cases of post-MI VSR. The mean age of the population was 61 years. The majority of the patients had anterior wall MI (54.5%) and the remaining had inferior wall MI. &nbsp;Different kinds of devices (ASO, PostMI VSD device, Konar MFO) were used to close VSR. Successful closure was performed in 9 patients (81%) with minimal residual shunt in 2 patients. Out of 9 cases 3 patients expired, one was lost to follow up and the rest are doing well at 30 days follow-up.&nbsp;Conclusion: Transcatheter closure of PMIVSRs can be performed with different kinds of devices with high technical success, relatively low procedural complication rates, and 30 days survival even in a resource-limited setup as an alternative to high-risk surgical closure.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1184.pdf</link>
</item>
<item>
<type>Prospective</type>
<title>Outcome of Patients Presenting with Peripartum Cardiomyopathy in a Tertiary Care Center of Nepal</title>
<author>Smriti Shakya*, Ratna Mani Gajurel, Chandra Mani Poudel, Hemant Shrestha, Surya Devkota, Sanjeev Thapa, Bhawani Manandhar, Rajaram Khanal, Suraj Shrestha, Manju Sharma</author>
<pubDate>2024-05-29 14:11:35</pubDate>
<description>Purpose: Peripartum cardiomyopathy is a rare life-threatening cardiomyopathy of unknown etiology with significant maternal morbidity and mortality. It causes heart failure due to left ventricular systolic dysfunction with or without left ventricular dilatation in the last month of pregnancy up to 5 months postpartum in previously healthy women. We aimed to determine short-term outcomes of peripartum cardiomyopathy clinically as well as in terms of left ventricular systolic function and to study the clinical profile and associated risk factors.Patients and methods: A prospective observational study was carried out in the Department of Cardiology of Manmohan Cardiothoracic Vascular and Transplant Center, Institute of Medicine, Kathmandu, Nepal, from July 2018 to January 2022. All the patients with peripartum cardiomyopathy who presented to the department of cardiology were enrolled in the study and re-evaluated with echocardiography at 6 months.Results: A total of 68 women met the inclusion criteria. The mean age was 28.38 &plusmn; 5.5 years (range 19 to 44 years). The most common clinical presentation was dyspnea followed by lower limb edema. Six (8.8%) patients presented during the last month of pregnancy whereas 62 (91.2%) patients presented in the postpartum period. The mean left ventricular ejection fraction on presentation was 30.01 &plusmn; 8.54. A full recovery was observed among 60.29% at 6 months. The mortality rate was 4.41%.Conclusion: Timely diagnosis and management of peripartum cardiomyopathy with standard therapy for heart failure leads to better recovery of left ventricular systolic function.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1183.pdf</link>
</item>
<item>
<type>Case Series</type>
<title>Non-surgical Techniques for Combined Rheumatic Severe Aortic and Mitral Stenosis – Case Series and Brief Review of Literature</title>
<author>Uma Devi Karuru, Sadanand Reddy Tummala*, Naveen T, Kiran Kumar Kanjerla, Gautam PS, Sai Kumar Mysore</author>
<pubDate>2024-05-13 15:36:15</pubDate>
<description>Rheumatic heart disease persists as a significant concern in developing regions, often resulting in multivalvular heart conditions. Treatment options are limited, though percutaneous transvenous mitral commissurotomy effectively addresses rheumatic mitral stenosis. Non-surgical interventions for aortic stenosis include balloon aortic valvotomy and Transcatheter aortic valve replacement (TAVR), tailored to patient factors like age and comorbidities.We describe two cases of Rheumatic multivalvular disease which were managed non-surgical. The first case is a pioneering procedure performed on a young patient combined percutaneous transvenous mitral commissurotomy with balloon aortic valvotomy, guided by 4-dimensional transoesophageal echocardiography (4D TEE). This represents the first documented instance in medical literature, showcasing the potential of integrated interventions and advanced imaging techniques. In the second challenging case involving a heavily calcified, retrovirus, and Hepatitis B positive 55-year-old, a staged approach was adopted, involving percutaneous transvenous mitral commissurotomy followed by Transcatheter aortic valve replacement (TAVR). Despite complexities, this sequential strategy demonstrates the adaptability of transcatheter techniques in managing complex valvular pathologies. These cases highlight the evolving landscape of interventional cardiology and underscore the importance of tailored, multidisciplinary approaches in optimizing outcomes for patients with rheumatic heart disease and multivalvular involvement, especially in resource-limited settings. Further exploration and dissemination of such innovative strategies hold promise for enhancing cardiac care quality and expanding treatment options globally.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1182.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Chronic Ethanol Decreases the Left Ventricular Cardiac Performance</title>
<author>Camargo VMB*, Damatto FC, Fioravante VC, Godoi AR, Stoppa EG, Okoshi MP, Okoshi K, Miranda JRA, Martinez FE</author>
<pubDate>2024-04-15 11:08:03</pubDate>
<description>Introduction: Spaced fiber bundles, less evident cell striations, deposition of collagen fiber bundles, and increased presence of fibroblasts in the cardiac tissue of rats that voluntarily and chronically ingested ethanol were observed by our research group. In addition, we observed increased proliferation and cell death of cardiomyocytes. To find out whether these changes lead to impaired heart functionality, some clinical tests were performed.&nbsp;Aim: to investigate whether chronic ethanol decreases the left ventricular performance assessed by exercise testing, electrocardiogram, and echocardiogram of male and female UChB strain rats.&nbsp;Material and methods: ten adult males and ten adult females, Wistar strain rats, named UChB (University of Chile), spontaneous high ethanol drinkers (consumption greater than 2 g ethanol / Kg body weight/day), and ten male UChB rats and ten adults female UChB rats, not exposed to ethanol, UChBC rats (controls) were used. Cardiac performance was evaluated by the stress test, electrocardiogram, and echocardiogram.&nbsp;Results: Exposed females showed ventricular morphological changes in the heart. The exposed females and males had the highest heart relative weight with females being larger than males. The exposed females showed altered electrocardiogram and echocardiogram.&nbsp;Conclusion: Chronic ethanol decreases the left ventricular cardiac performance in rats. Females are more sensitive to changes in cardiac electrical conduction.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1181.pdf</link>
</item>
<item>
<type>Case Report</type>
<title>A Complex Case with a Completely Percutaneous Solution: Treatment of a Severe Calcific Left Main in a Patient with Low-Flow Low-Gradient Aortic Stenosis</title>
<author>Renatomaria Bianchi*, Giovanni Marco Esposito, Giovanni Ciccarelli, Donato Tartaglione, Paolo Golino</author>
<pubDate>2024-04-02 11:45:14</pubDate>
<description>Background: This case study explores an integrated approach to managing a complex cardiac condition, presenting a comprehensive single-session intervention. This includes balloon valvuloplasty using a Nucleus 18 mm balloon, complex angioplasty with rotational atherectomy (rotablator) targeting calcified lesions in the left main and left anterior descending artery, and Transcatheter Aortic Valve Implantation (TAVI) with a 23 mm Sapien 3 valve, all performed on an 81-year-old woman. Furthermore, this report underscores the strategic left atrial appendage closure conducted three months post-procedure due to the patient’s elevated hemorrhagic risk.Case presentation: Facing critical coronary and valvular pathologies, the patient underwent a meticulously planned, single-session intervention. The process began with a balloon valvuloplasty using a Nucleus 18 mm balloon to address the aortic stenosis. This was followed by a high-risk angioplasty, during which the Impella CP device provided hemodynamic support and rotational atherectomy was employed to address the calcified coronary artery disease effectively. The same session saw the successful execution of TAVI using a 23 mm Sapien 3 valve. The comprehensive approach notably diminished procedural complications, illustrating the benefits of an integrated treatment pathway in managing high-risk patients. Three months later, the patient underwent a left atrial appendage closure, a critical move considering her high risk of hemorrhage. This procedure also provided an opportunity to assess the favorable outcomes of the previous angioplasty.Conclusion: This case validates the feasibility and efficacy of performing multiple advanced percutaneous interventions in a single session for high-risk cardiac patients. It underscores the crucial role of innovative and personalized treatment strategies in improving patient outcomes, particularly in complex clinical scenarios. Moreover, the case exemplifies the essential relationship between immediate, comprehensive intervention and subsequent follow-up procedures in ensuring optimal long-term patient care.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1180.pdf</link>
</item>
<item>
<type>Case Report</type>
<title>Diagnosing Peripartum Cardiomyopathy in a Resource-Limited Setting, a Clinical Perspective: Case Report</title>
<author>Tyfur Rahman*, Kazi Nazratun Nomany Tahia</author>
<pubDate>2024-03-29 14:12:22</pubDate>
<description>Peripartum cardiomyopathy is a rare case of heart failure with reduced ejection fraction and is considered a diagnosis of exclusion. The symptoms of heart failure in patients with peripartum cardiomyopathy can mimic the physiologic conditions of normal pregnancy. In an acute decompensated state, PPCM can present with acute severe upper abdominal or epigastric pain. We are presenting a 24-year-old female with no personal or family history of heart disease and no identifiable risk factor for PPCM. Based on her initial presentation in the emergency department, a diagnosis of acute severe pancreatitis was sought, and she was referred to the Intensive Care Unit. After further evaluation of the serological tests and imaging, she was eventually diagnosed as a case of PPCM. We emphasize the rare nature of the disease with a diverse presentation which poses a diagnostic challenge, especially in a resource-limited setting where advanced diagnostic tools may be restricted and socioeconomic condition poses a barrier to further patient evaluation. This case exemplifies the infrequent occurrence and atypical manifestation, presenting a learning opportunity for future clinicians.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1179.pdf</link>
</item>
<item>
<type>Review Article</type>
<title>The Ketogenic Diet: The Ke(y) - to Success? A Review of Weight Loss, Lipids, and Cardiovascular Risk</title>
<author>Angela H Boal*, Christina Kanonidou</author>
<pubDate>2024-03-06 12:55:02</pubDate>
<description>Background: Obesity remains a global epidemic with over 2.8 million people dying due to complications of being overweight or obese every year. The low-carbohydrate and high-fat ketogenic diet has a rising popularity for its rapid weight loss potential. However, most studies have a maximal 2-year follow-up, and therefore long-term adverse events remain unclear including the risk of Atherosclerotic Cardiovascular Disease (ASCVD).Results: Based on current evidence on PubMed and Google Scholar, there is no strong indication ketogenic diet is advantageous for weight loss, lipid profile, and mortality. When comparing a hypocaloric ketogenic diet with a low-fat diet, there may be faster weight loss until 6 months, however, this then appears equivalent. Ketogenic diets have shown inconsistent Low-Density Lipoprotein (LDL) changes; perhaps from different saturated fat intake, dietary adherence, and genetics. Case reports have shown a 2-4-fold elevation in LDL in Familial hypercholesterolaemic patients which has mostly reversed upon dietary discontinuation. There is also concern about possible increased ASCVD and mortality: low (&lt; 40%) carbohydrate intake has been associated with increased mortality, high LDL from saturated fats, high animal product consumption can increase trimethylamine N-oxide, and cardioprotective foods are likely minimally ingested.Conclusion: Ketogenic diets have been associated with short-term positive effects including larger weight reductions. However, by 2 years there appears no significant differences for most cardiometabolic risk markers. Therefore, this raises the question, excluding those who have a critical need to lose weight fast, is this diet worth the potentially higher risks of ASCVD and mortality while further long-term studies are awaited?</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1178.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Rida Herbal Bitters Improve Cardiovascular Function in High-fat Diet/Streptozotocin-induced Diabetic Rats</title>
<author>Folasade Omobolanle Ajao*, Damilola Ayodeji Balogun, Marcus Olaoy Iyedupe, Ayobami Olagunju, Esther Oparinde, Luqman Adeniji, Victor Abulude and Funmilayo Elizabeth Olaleye</author>
<pubDate>2024-02-28 17:01:04</pubDate>
<description>Background: Effective medication to manage diabetes mellitus-related organ complications with minimal adverse drug toxicity is still in pursuit by scientists worldwide. This study investigated the cardio-protective of Rida herbal bitter (RHB) in a high-fat diet/streptozotocin (STZ)-induced diabetic rats.Methods: Thirty-two matured male Wistar rats (250 &plusmn; 20g) were used. The animals were fed with high-fat diet (HFD) for 6 weeks before diabetes induction. A single dose of (35 mg/kgb.wt) freshly prepared STZ was injected intraperitoneally to induce diabetes. The animals were allocated into four groups, 8rats/group. Group I: control; Group II: HFD/STZ-induced diabetic rats; Groups III &amp; IV: HFD/STZ-induced diabetic rats treated with 0.3 ml RHB &amp; 200 mg/kgb.wt metformin respectively. At the end of the experiment, the animals were sacrificed, blood was sample collected via cardiac puncture and the heart was excised and homogenized. The blood samples and cardiac homogenates tissue were centrifuged to retrieve clear supernatant plasma for biochemical assay.Results: Diabetic rats exhibited significant (p &lt; 0.05) elevated blood glucose, insulin, glycated hemoglobin (HbA1c), cardiac biomarkers, lipid profile, malondialdehyde (MDA), pro-inflammatory cytokines, food, and water intake levels with a reduction in body weight, cardiac antioxidant activity, and total protein. RHB administration significantly (p &lt; 0.05) diminished the blood glucose, insulin, HbA1c, cardiac biomarkers, MDA, pro-inflammatory cytokines, lipid profile, food, and water intake, and improved the body weight cardiac antioxidant activity, and total protein.Conclusion: Rida herbal bitter possesses a cardio-protective effect from this study and could be a better alternative medication for managing diabetes and its related cardiovascular complications.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1177.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Calcium Scoring on CT Coronary Angiography in Hypertensive Patients as a Criterion for the Prediction of Coronary Artery Disease</title>
<author>Eleni Tserioti, Harmeet Chana, Abdul-Majeed Salmasi*</author>
<pubDate>2024-02-19 15:23:40</pubDate>
<description>Introduction: Hypertension is the strongest independent predictor of Coronary Artery Disease (CAD) identified by Computed tomography of coronary arteries (CTCA). In this study, CTCA-assessed Coronary Calcium Scoring (CCS) was studied in hypertensive subjects referred for CTCA.Methods: After excluding TAVI and graft assessment patients, the individual electronic health records of 410 consecutive patients who underwent CTCA between July and November 2020, were reviewed with a mean age of 58.7 years. Risk factors were recorded including smoking (38%), hyperlipidaemia (33%), positive family history (22%), systemic hypertension (48%), diabetes mellitus (30%), and male gender (46%). Referral criteria, ethnicity, cardiac, and past medical history were recorded. Patients were stratified into four groups according to CAD severity: absent, mild, moderate, and severe disease, as seen on CTCA. The mean CCS for each CAD category was compared between hypertensive and non-hypertensive patients. Mean CCS were further compared according to the number of coronary arteries affected and the severity of CAD in each artery.&nbsp;Results: Out of all CTCA reports, 200 (48.8%) CCS were interpreted in the very low-risk category, 80 (19.5%) low risk, 58 (14.1%) moderate risk, 23 (5.6%) moderately high risk and 49 (12.0%) high risk. A significant difference in mean CCS and CAD severity was observed between mild, moderate, and severe CAD (p = 0.015 and p &lt; 0.001). Comparison of CCS between hypertensives and non-hypertensives, across the four CAD severity categories, revealed a significant difference in mean CCS in the severe CAD category (p = 0.03). There was no significant difference in the CCS between hypertensives with chest pain and hypertensives without chest pain. A higher number of affected coronary arteries was associated with a higher mean CCS and a significant difference in CCS was observed between hypertensive and non-hypertensive subjects for the number of arteries affected. Similar results were observed when comparing mean CCS in moderate-severely affected coronary arteries.Conclusion: Hypertensive patients with a high CCS were associated with a higher incidence of severe CAD independent of the presence of chest pain. These results suggest that the incorporation of CCS in the investigation of CAD on CT angiography may pose a powerful adjunct in proposing an alternative paradigm for the assessment of patients with hypertension, in the progress of coronary artery disease.&nbsp;</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1176.pdf</link>
</item>
<item>
<type>Retrospective Study</type>
<title>Impact of Chronic Kidney Disease on Major Adverse Cardiac Events in Patients with Acute Myocardial Infarction: A Retrospective Cohort Study</title>
<author>Abbas Andishmand, Ehsan Zolfeqari*, Mahdiah Sadat Namayandah, Hossein Montazer Ghaem</author>
<pubDate>2024-02-05 11:57:17</pubDate>
<description>Background: Acute Myocardial Infarction (AMI) results in a reduction in patients&rsquo; life expectancy. Different risk factors affect the risk of Major Adverse Cardiac Events (MACE). Although the role of kidney dysfunction in patients with Chronic Kidney Disease (CKD) in cardiac events has been identified, many patients with AMI are unaware of their underlying kidney disease. This study aimed to compare the incidence of adverse cardiovascular events and identify predictors of major adverse cardiovascular events in the medium term among patients with and without renal dysfunction following AMI.&nbsp;Methods: This retrospective cohort study was conducted on 1039 patients who were hospitalized for Acute Myocardial Infarction (AMI) between 2018 and 2019. The patient cohort comprised 314 women (mean age: 69.8 &plusmn; 13.2 years) and 725 men (mean age: 60.5 &plusmn; 13.8 years). Patient data were obtained from the registry of patients with acute myocardial infarction and the participants were followed up for a minimum of one year following hospital discharge to assess the incidence of MACE.Results: The study found that patients with a Glomerular Filtration Rate (GFR) level below 60 had a significantly higher mortality rate than those with a GFR level of 60 or above (15.7% vs. 3.5%,p &lt; 0.0001). The multivariate analysis showed that Diabetes Mellitus (DM), GFR, and Non-ST Elevation Myocardial Infarction (NSTEMI) are significant risk factors for cardiovascular events.&nbsp;(p = 0.016, p = 0.015, p = 0.006 respectively), while variables such as sex, age, and Hypertension (HTN) were not significant risk factors. There was a negative correlation between GFR and death (0.241 - = r, p &lt; 0.0001)Conclusion: This study highlights the importance of detecting kidney disease during an AMI and managing risk factors for cardiovascular disease to improve health outcomes and reduce the risk of mortality.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1175.pdf</link>
</item>
<item>
<type>Case Report</type>
<title>Persistent Bilateral Vocal Cord Paralysis Following Unilateral Basal Ganglia Hemorrhage</title>
<author>Nikil Joseph John, John Thomas*, Martyn Bracewell</author>
<pubDate>2024-01-18 14:35:35</pubDate>
<description>Post-stroke vocal cord paralysis is a condition much less recognized compared to dysphagia. We describe bilateral vocal cord palsy in a thirty-six-year-old man following a stroke.&nbsp;</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1174.pdf</link>
</item>
<item>
<type>Review Article</type>
<title>Aspirin for Primary Prevention of Cardiovascular Disease: What We Now Know</title>
<author>Steven M Weisman,Dominick J Angiolillo</author>
<pubDate>2024-01-09 12:39:41</pubDate>
<description>Cardiovascular disease (CVD), including coronary artery disease and stroke, is the leading cause of death worldwide. Advances in primary and secondary prevention of CVD have improved patient prognoses and outcomes, however, it is imperative that the clinician and patient engage in early risk factor screening and preventive management of modifiable risk factors for CVD. In addition to blood lipid and blood pressure lowering medications, aspirin has been a long-standing therapy targeted to the prevention of CVD based on its antiplatelet and anti-inflammatory activity. However, recent articles and reports on updates to clinical guidelines for the primary prevention of CVD have resulted in confusion about aspirin recommendations. This review aims to assess the latest guidance on aspirin in CVD prevention and how to identify appropriately at-risk patients who may benefit from low-dose aspirin therapy as part of their CVD preventive healthcare choices. Additionally, this review will provide practical application guidance about clinician-patient conversations to clearly explain the benefits and risks of aspirin use and ensure a patient-centric decision to initiate aspirin therapy.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1172.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>The Fulcrum of the Human Heart (Cardiac fulcrum)</title>
<author>Jorge Carlos Trainini*, Mario Wernicke, Mario Beraudo, Alejandro Trainini</author>
<pubDate>2024-01-03 16:04:23</pubDate>
<description>Introduction: The functional anatomy of the myocardium allows envisioning that it initiates and ends at the origin of the great vessels. In our research, we have always considered that it should have a point of attachment to allow its helical rotation to fulfill the fundamental movements of shortening-torsion (systole) and lengthening-detorsion (suction), which once found, was called the cardiac fulcrum.&nbsp;Materials and methods: A total of 31 hearts, arising from the morgue and slaughterhouse were used: 17 corresponded to bovids and 14 were human. Anatomical and histological studies were performed. The heart was fixed in 10% buffered formalin. Hematoxylin-eosin, Masson&rsquo;s trichrome staining technique, and 4-micron sections were used for the histological study, and 10 % formalin was used as a buffer.&nbsp;Results: The anatomical investigations have revealed that all the hearts (bovids and humans) have myocardial support whose histological structure in the analyzed specimens presents with an osseous or chondroid-tendinous character. In this structure, which we have called the cardiac fulcrum, are inserted the myocardial fibers at the origin and end of the band, which correspond to the continuous myocardium coiled as a helix.Conclusion: This description of the fulcrum would end the problem of lack of support of the myocardium to fulfill its function of suction/ejection.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1171.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Value of Speckle Tracking Echocardiography in Prediction of Left Ventricular Reverse Remodeling in Patients with Chronic total Occlusion Undergoing Percutaneous Coronary Interventions</title>
<author>Gehan Magdy*, Sahar Hamdy Azab, Yasmin Ali Esmail, Mohamed Khalid Elfaky</author>
<pubDate>2023-12-28 16:39:31</pubDate>
<description>Background: Revascularization procedures for chronic complete occlusion (CTO) are technically challenging but aim to improve left ventricular (LV) function. The aim of this study is to evaluate the value of global longitudinal strain (GLS) measured by 2D-speckle tracking echocardiography( 2D-STE) in the assessment of LV reverse remodeling in patients with CTO undergoing revascularization by percutaneous coronary intervention (PCI).Methods: Our study included 54 patients with CTO treated by PCI. We evaluate LV systolic function by measurement of left ventricular ejection fraction (LVEF), left ventricular end-systolic volume (LVESV), and the GLS within 24 hours before the PCI and after 3 months post-procedure.&nbsp;Results: The mean age of the patients was 56.65 &plusmn; 7.65 years; 74.1% were males. There was a significant improvement in the LVESV (p &lt; 0.001), LVEF (p &lt; 0.001), and GLS (p &lt; 0.001) at 3 months post-PCI, and by multivariate regression analysis, the GLS was the single most significant predictor of LV reverse remodeling post revascularization (p &lt; 0.001).Conclusion: Revascularization of coronary CTO lesions by PCI is associated with a significant improvement in regional and global LV function. The GLS measured by 2D-STE is a strong predictor of LV reverse remodeling post-CTO interventions.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1170.pdf</link>
</item>
<item>
<type>Hypothesis</type>
<title>Rats with Postinfarction Heart Failure: Effects of Propranolol Therapy on Intracellular Calcium Regulation and Left Ventricular Function</title>
<author>Hari Prasad Sonwani*</author>
<pubDate>2023-11-28 15:19:37</pubDate>
<description>Patients with heart failure may live longer if they receive chronic treatment with beta-adrenergic blocking medications. Unresolved are the mechanisms underlying the beneficial effects and if they may be applied to ischemic heart failure. Rats (n = 28) underwent echocardiographic-Doppler exams one and six weeks following a simulated operation or myocardial infarction (MI). After the first echocardiography, rats were randomized to either no therapy or 500 mg/l of propranolol in their drinking water. The noninfected left ventricular (LV) papillary muscles were used to record isometric contractions and intracellular Ca transients simultaneously.Untreated MI rats had a restrictive LV diastolic filling pattern, decreased systolic function (13% ± 2%), and significant LV dilatation (10.6 ± 0.4 mm vs. 8.9 ± 0.3 mm, MI vs. control). The LV chamber diameters of the propranolol-treated MI rats were 10.6 ± 0.5 mm, and systolic performance (13% ± 2%). Higher LV end-diastolic pressures (27 ± 2 mmHg vs. 20 ± 3 mmHg) and a more constrained LV diastolic filling pattern (increased ratio of early to late filling velocities and faster E wave deceleration rate) were seen in the propranolol-treated animals. Papillary muscle contractility in untreated MI rats was lower (1.6 ± 0.3 g mm²). Furthermore, the inotropic response to isoproterenol was attenuated, and Ca transients were extended. During isoproterenol stimulation, beta-adrenergic blocking administration had no effect on force development (1.6 ± 0.3 g mm²) or the length of Ca transients.Rats with postinfarction heart failure receiving chronic propranolol treatment did not have improvements in systolic function or LV remodeling. Propranolol exacerbated LV diastolic pressures and filling patterns. Additionally, there was no discernible improvement in intracellular contractility following treatment, Calcium control, or beta-adrenergic sensitivity in the myocardium that is not infarcted).</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1169.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Unmasking the Viral Veil: Exploring the Cardiovascular Intrigue of Pathogenic Infections</title>
<author>Zahra Zahid Piracha, Syed Shayan Gilani, Muhammad Nouman Tariq, Umar Saeed, Azka Sohail, Umer Ali Abbasi, Abrisham Akbariansaravi, Muhammad Shahmeer Fida Rana, Ayesha Basra, Faizan Faisal, Madeeha Rasool, Misbah Ghazal, Mubeen Ur Rehman, Hussain Ghya</author>
<pubDate>2023-11-23 12:19:58</pubDate>
<description>The intricate interplay between viral infections and cardiovascular complications has garnered significant attention from 2018 to 2023. Extensive research during this period has unveiled substantial connections between various viruses and cardiovascular diseases. Notable examples include Cytomegalovirus (CMV), coxsackievirus, influenza, Human Immunodeficiency Virus (HIV), Epstein-Barr Virus (EBV), Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), as well as coxsackievirus A and B, enteroviruses, adenovirus, and parvovirus B19. These viruses exert diverse influences on cardiovascular health through various pathways, contributing to endothelial dysfunction, inflicting direct damage on cardiac tissue, and triggering inflammatory responses. The intricate interplay between viral infections and cardiovascular health underscores the importance of considering viral pathogens within the framework of cardiovascular disease development, clinical management practices, and future research initiatives. This systematic review comprehensively scrutinizes the cardiovascular impacts stemming from various viral infections, casting a revealing light on their underlying mechanisms and associated clinical implications. These valuable insights can guide clinical management strategies, preventive measures and further investigations into the complex connection between viral infections and cardiovascular diseases, emphasizing the necessity for ongoing research and vigilance in comprehending and managing these pathogen-induced cardiac manifestations.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1168.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Developing a Machine Learning Algorithm for Improved Management of Congestive Heart Failure Patients in the Emergency Department</title>
<author>Karamo Bah*, Amadou Wurry Jallow, Adama Ns Bah, Musa Touray</author>
<pubDate>2023-10-24 17:35:20</pubDate>
<description>Background and aim: Congestive heart failure is a prevalent and serious condition that poses significant challenges in the emergency department setting. Prompt and accurate management of congestive heart failure patients is crucial for improving outcomes and optimizing resource utilization. This study aims to address these challenges by developing a machine learning algorithm and comparing it to a traditional logistic regression model that can assist in the triage, resource allocation, and long-term prognostication of congestive heart failure patients.Methods: In this investigation, we used the MIMIC-III database, a publicly accessible resource containing patient data from ICU settings. Traditional logistic regression, along with the robust XGBoost and random forest algorithms, was harnessed to construct predictive models. These models were built using a range of pretreatment clinical variables. To pinpoint the most pertinent features, we carried out a univariate analysis. Ensuring robust performance and broad applicability, we adopted a nested cross-validation approach. This method enhances the precision and validation of our models by implementing multiple cross-validation iterations.Results: The performance of machine learning algorithms was assessed using the area under the receiver operating characteristic curve (AUC). Notably, the random forest algorithm, despite having lower performance among the machine learning models still demonstrated significantly higher AUC than traditional logistic regression. The AUC for the XGBoost was 0.99, random forest 0.98, while traditional logistic regression was 0.57. The most important pretreatment variables associated with congestive heart failure include total bilirubin, creatine kinase, international normalized ratio (INR), sodium, age, creatinine, potassium, gender, alkaline phosphatase, and platelets.Conclusion: Machine learning techniques utilizing multiple pretreatment clinical variables outperform traditional logistic regression in aiding the triage, resource allocation, and long-term prognostication of congestive heart failure patients in the intensive care unit setting using MIMIC III data.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1167.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Association of Periprocedural Haemoglobin Reduction and Myocardial Injury in Patients with Unstable Angina Undergoing Percutaneous Coronary Intervention</title>
<author>Sushil Kumar Bagchi*, Md Moniruzzaman, Sharifun Nahar, Md Khalequzzaman, Sanjib Chowdhury, Amal Kumar Choudhury</author>
<pubDate>2023-10-23 00:00:00</pubDate>
<description>Background: Patients undergoing percutaneous coronary intervention are at risk of different complications such as periprocedural bleeding and acute hemoglobin reduction that can lead to myocardial injury. Blood loss through the catheter during the procedure and through puncture site haematoma causes periprocedural acute haemoglobin drop.Objectives: To find out the association between acute haemoglobin reduction and myocardial injury after PCI in patients with unstable angina.&nbsp;Methods: This prospective observational study was conducted at the National Institute of Cardiovascular Diseases (NICVD) for one year of time. A total of 130 patients were enrolled based on inclusion and exclusion criteria during the study period. Haemoglobin and troponin-I were measured before and after PCI within 24 to 48 hours of the procedure. On the basis of post-procedural acute haemoglobin level, the study population was categorized into two groups: Group I patients with normal haemoglobin levels and Group II patients with significant acute haemoglobin reduction (&ge; 1 gm/dl).&nbsp;Results: A total of 24 patients developed a periprocedural myocardial injury, among them 17 (70.8%) were in the reduced haemoglobin group and 7 (29.2%) in the normal haemoglobin group. Elevation of troponin I after PCI was higher in group II than in group I patients with a statistically significant difference. Multivariate logistic regression analysis showed that haemoglobin reduction was an independent predictor of PMI (OR 1.94; 95% CI, 1.241-8.684; p = 0.01).&nbsp;Conclusion: Periprocedural haemoglobin reduction in patients with unstable angina was associated with myocardial injury after percutaneous coronary intervention (PCI).</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1166.pdf</link>
</item>
<item>
<type>Case Report</type>
<title>Preventing Coronary Occlusion in an Elderly Severe Aortic Stenosis Patient with Critically Low Coronary Heights – A Case Report</title>
<author>Viveka Kumar*</author>
<pubDate>2023-10-19 09:53:10</pubDate>
<description>Background: Transcatheter Aortic Valve Replacement (TAVR) is an established treatment for severe, symptomatic Aortic Stenosis (AS). However, the presence of low coronary heights confers a high risk for coronary obstruction during or after TAVR.&nbsp;Case: In this case report, we present our experience with transfemoral-TAVR in an elderly, high-risk (STS score &ndash; 12.08%) female severe AS patient with low coronary heights (right: 7.4 mm, left: 8.7 mm). She had lower annulus area (287 mm2) and moderately low valve area (0.7 cm2) as well. Her mean and peak pressure gradients (PGs) were 38 mmHg and 61 mmHg, respectively. Upon the Heart Team&rsquo;s evaluation, TAVR was recommended and a 20 mm Balloon Expandable (BE) Myval Transcatheter Heart Valve (THV) was selected. No peri-procedural or post-procedural complications were reported and the post-procedural hemodynamics, namely the mean and peak PGs improved to 16 mmHg and 30 mmHg after TAVR, respectively. The patient was discharged in a stable condition after four days of hospital stay.Conclusion: We report the successful implantation of a small-sized BE Myval THV (20 mm) in a patient with low coronary heights. Life-threatening complications including paravalvular leak, coronary obstruction, or annular rupture were well averted; hence, we ascertain that the Myval THV is a suitable device for treating severe AS in difficult anatomies. However, the viability of the novel valve needs to be reaffirmed in larger studies..&nbsp;</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1165.pdf</link>
</item>
<item>
<type>Clinical Techniques</type>
<title>Conduit quality control protocol in CABG</title>
<author>Ignacio Juárez Del Río*, Enrique Villagrán Medinilla, Ali Ayaon Albarrán, Miguel Angel Rubio Alonso, Angel Aroca Peinado</author>
<pubDate>2023-09-27 12:47:28</pubDate>
<description>Cardiac revascularization surgery has a long history. Its results and safety are well known. Nonetheless, the long-term patency rate of certain grafts used in cardiac revascularization is non-optimal, and CABG is associated with a risk of cerebrovascular stroke due to aortic manipulation. We have developed a simple control quality protocol of the anastomosis performed in CABG, aiming to improve the long-term patency of certain grafts used in cardiac revascularization surgery and reduce the risk of cerebrovascular stroke in those patients.&nbsp;</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1164.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Correlation between the Values of Immature Platelet Fraction and Mean Platelet Volume with the Extent of Coronary Artery Disease in Patients with Non-ST-Segment Elevation Myocardial Infarction</title>
<author>Shadab Rauf*, Tarun Kumar, Vijay Kumar, Ranjit Kumar Nath</author>
<pubDate>2023-09-26 11:57:07</pubDate>
<description>Introduction: The identification of new markers of thrombotic risk and early diagnosis of Non-ST-segment Elevation Myocardial Infarction (NSTEMI) could allow the optimization of the therapy and predict short and long-term prognosis.&nbsp;Aims and objective: We aimed to assess the impact of Immature Platelet Fraction (IPF) and Mean Platelet Volume (MPV) levels on the extent of Coronary Artery Disease (CAD) in patients with NSTEMI undergoing coronary angiography.&nbsp;Methods: This is a prospective observational study in which 100 subjects of Non-ST Elevation Myocardial Infarction were recruited. For the measurement of platelet count, IPF and MPV samples were analyzed by an automated hematology analyzer (Sysmex XN 1000). Patients were subjected to coronary angiography as per institutional protocol and the extent of coronary artery lesion was noted.&nbsp;Result: A cutoff of MPV (fL) &ge; 10.6 can predict the involvement of the left anterior descending artery (LAD) with a sensitivity of 84%, and a specificity of 50%. With the cutoff of IPF (%) &ge; 2.4, it can even predict the type of disease i.e., Double Vessel Disease (DVD), or Triple Vessel Disease (TVD) with a sensitivity of 97%, and a specificity of 19%. Mean IPF values and MPV levels were significantly higher in patients with LAD involvement i.e., 4.40 &plusmn; 1.72% (p = 0.003) and 12.45 &plusmn; 1.88 (p = 0.030) respectively than in patients without involvement of LAD i.e., 2.78 &plusmn; 1.50% and 11.08 &plusmn; 2.19 respectively.&nbsp;Conclusion: Immature platelet fraction and mean platelet volume were significantly associated with the involvement of the left anterior descending artery which was the most commonly involved vessel in patients with NSTEMI. Mean platelet volume was also associated with TVD which was statistically significant. MPV and IPF can be useful early independent hematologic markers to identify patients with a higher risk for significant CAD as they are readily available and inexpensive.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1163.pdf</link>
</item>
<item>
<type>Review Article</type>
<title>Faecal Transplant Therapy: A Promising Treatment Modality for Cardiovascular Diseases</title>
<author>K Pushkala, Purshottam D Gupta*</author>
<pubDate>2023-08-28 11:43:18</pubDate>
<description>Cardiovascular diseases (CVD) are considered as &ldquo;lifestyle&rdquo; diseases and so far &ldquo;No unified procedure&rdquo; or medicines are effective in the management of this group of diseases. Researchers and clinicians have indicated that no safe therapeutic window is available in therapeutics at present. Recent research showed that gut microbiota are effective in managing lifestyle diseases therefore we introduced the influence of gut microbiota in the prognosis of the CVDs. Faecal transplant therapy(FMT) has been anticipated to treat many diseases similar to recurrent bacterial Clostridioides difficile infection which has been used worldwide. Recently, FMT was tried on an animal model to treat CVDs, and recent human trials that were tried to manage CVDs in humans by FMT showed encouraging results. The mechanism of action of transplanted bacteria to manage CVDs in the human population is also discussed. In-depth knowledge on the pros and cons of FMT will pave the way to standardize the procedure once the lacuna existing at present in treating CVDs, is paved, this technology will be useful for the masses.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1162.pdf</link>
</item>
<item>
<type>Case Report</type>
<title>Pneumopericardium: A Rare Complication of Antireflux Surgery</title>
<author>Diquas Elisabeth, Druez Anne, Dili Alexandra*</author>
<pubDate>2023-08-23 11:36:38</pubDate>
<description>Pneumopericardium is a rare clinical entity, occurring in the setting of thoracic trauma, malignancies, or mechanical ventilation. Very few cases report pneumopericardium as a complication of gastrointestinal tract surgery. Signs and symptoms may be frustrating, ranging from asymptomatic to chest pain, sepsis, hemodynamic instability, pericarditis, or even cardiac tamponade. Clinical pathognomonic signs of pneumopericardium include pericardial metallic tinkling friction rub and mill wheel murmur. Diagnostic work-up includes electrocardiogram, chest radiography, and, computed tomography imaging. A gastro pericardial fistula should be considered a rare differential diagnosis for acute chest pain in patients with a history of gastroesophageal surgery. Rapid recognition and treatment avoid life-threatening complications. The successful outcome of gastro pericardial fistula treatment depends on both emergency and definitive surgical management. The survival rate with conservative management is poor.We present the case of a 78-year-old patient suffering from pneumopericardium and pericardial infusion, due to a fibrotic fistula between the Nissen&rsquo;s valve, occurring 10 years after redo antireflux surgery. Treatment included broad-spectrum antibiotics, and emergency surgery for pericardial drainage, biopsy of the valve&rsquo;s defect, suture, and omentoplasty.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1161.pdf</link>
</item>
<item>
<type>Retrospective Study</type>
<title>Evaluation of Preoperative Cardiology Consultations: Incidence, Characteristics and Implications for Perioperative Management</title>
<author>Alioui Mohamed, Eljellouli Wiam, Houmed Houssein, Elghali Tanae, Choubhi Moncif, Abou Elalaa Khalil*</author>
<pubDate>2023-08-14 10:23:25</pubDate>
<description>Background: This retrospective study examines the importance of preoperative cardiology consultations in optimizing patient care and anesthesia surgical perioperative management.Methods: The study includes 7,756 patients from the Department of Anesthesiology at Mohammed V Military Teaching Hospital. Out of these, 122 patients were referred to cardiology consultations. Demographics, surgical specialties, reasons for referral, diagnostic tests, and interventions were analyzed.Results: Referred patients (average age 61.45 years) were mainly over 65 years old, with 59.01% being male. Common surgical specialties seeking consultations were abdominal surgery (30.327%), orthopedic surgery (26.230%), and urological surgery (19.672%). Hypertension, dyslipidemia, and diabetes were prevalent risk factors. Most patients were classified as ASA II (50%) or ASA III (27.04%), with NYHA I (61.5%) or NYHA II (31.2%) classifications. Referrals were due to ECG abnormalities (41.0%), routine evaluation (19.7%), and history of myocardial infarction or previous coronary angiography (39.3%).Discussion: Preoperative cardiology consultations accounted for 1.57% of all pre-anesthesia clinic patients. They were vital in assessing and managing cardiovascular risks, consistent with previous studies. The impact of these consultations was evident in optimizing patient management through treatment plan adjustments and interventions.Conclusion: Preoperative cardiology consultations play a crucial role in identifying and managing cardiovascular risks, contributing significantly to patient care and improving perioperative management. Further research should evaluate long-term outcomes and cost-effectiveness across different patient populations.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1160.pdf</link>
</item>
<item>
<type>Case Report</type>
<title>Transcatheter Aortic Valve Implantation in Two High-Risk Patients with Low Coronary Ostial Heights Using the Novel Balloon-Expandable Myval Valve</title>
<author>Raja Ramesh N*, Ramesh Daggubati, Ramesh Babu P</author>
<pubDate>2023-08-01 16:46:09</pubDate>
<description>The treatment of severe aortic stenosis by transcatheter aortic valve implantation (TAVI) is challenging in patients with high-risk coronary anatomy that is predisposed to iatrogenic or delayed coronary obstruction. Hence, the evidence on performing TAVI with adequate coronary protection with or without deploying a stent needs to be accumulated. We report two cases of TAVI performed in patients with low coronary heights, wherein a &ldquo;wire only&rdquo; strategy was used to provide coronary protection along with the implantation of a novel balloon-expandable Myval THV. The first patient underwent a valve-in-valve TAVI, while the second patient underwent the replacement of a native bicuspid Type 1A valve. This case series presents two high-risk TAVI cases wherein a guide extension catheter and a supportive coronary guidewire provided sufficient coronary protection. None of the cases required any rescue revascularization and no incidences of a new pacemaker implantation were reported.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1159.pdf</link>
</item>
<item>
<type>Case Report</type>
<title>Sudden Cardiac Death in a Neonate Due to Bilateral Absence of Coronary Artery Ostium</title>
<author>Nicole A Bailey, Khalifah A Aldawsari, Carlo M Zeidenweber, Danyal M Khan*</author>
<pubDate>2023-07-24 14:09:05</pubDate>
<description>Introduction: Congenital heart disease is a leading cause of neonatal mortality linked to birth defects. Despite the widespread availability of prenatal screenings, detection rates remain low. Accurate early detection of these lesions is pivotal to reducing neonatal morbidity and mortality.Methods: In this case, we present a neonate who experienced sudden cardiac death due to a rare, undiagnosed congenital cardiac anomaly - the bilateral absence of coronary artery ostium.&nbsp;Discussion: This case highlights the importance of prenatal detection of congenital cardiac anomalies. While fetal echocardiography is frequently utilized, it only identifies CHD in 36-50% of cases. This is attributed to inadequate imaging procedures, varied operator skills, and regional discrepancies. Early detection of severe CHD is essential for specialized treatment, thereby mitigating neonatal health risks and improving survival rates.Conclusion: Prenatal detection of CHD, especially coronary anomalies, continues to pose significant challenges. There is a pressing need to establish and enforce standardized protocols for fetal echocardiography aimed at these anomalies. To enhance care and improve outcomes, a joint effort between academic institutions and community centers is encouraged.Learning Objectives:&nbsp;&bull; &nbsp; &nbsp;Congenital coronary artery anomalies are a significant cause of sudden cardiac death in children.&bull; &nbsp; &nbsp;The absence of a coronary artery ostium is known to be associated with other congenital heart diseases, particularly pulmonary atresia with an intact ventricular septum. However, isolated coronary disease has also been reported in this case.&bull; &nbsp; &nbsp;Prenatal echocardiography is a valuable tool for diagnosing congenital heart disease. However, certain limitations may be encountered when diagnosing coronary artery anomalies.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1158.pdf</link>
</item>
<item>
<type>Short Communication</type>
<title>Noninvasive Cuffless Blood Pressure Monitoring. How Mechanism-Driven and Data-Driven Models Can Help in Clinical Practice</title>
<author>Mohamed Zaid*, Mihail Popescu, Laurel Despins, James Keller, Marjorie Skubic, Giovanna Guidoboni</author>
<pubDate>2023-07-12 10:10:17</pubDate>
<description>Continuous noninvasive cuffless blood pressure (BP) monitoring is essential for early detection and treatment of hypertension. In this paper, we provide an overview of the recent advancements in cuffless BP sensors. These include contact wearable sensors such as electrocardiography (ECG), photoplethysmography (PPG), contact non-wearable sensors such as ballistocardiography (BCG), and contactless sensors such as video plethysmography (VPG). These sensors employ different measuring mechanisms such as pulse arrival time (PAT), pulse transit time (PTT), and pulse wave analysis (PWA) to estimate BP. However, challenges exist in the effective use and interpretation of signal features to obtain clinically reliable BP measurements. The correlations between signal features and BP are obtained by mechanism-driven models which use physiological principles to identify mathematical correlations, and data-driven models which use machine learning algorithms to analyze observational data to identify multidimensional correlations. On the one hand, applying mechanism-driven models to non-linear scenarios and incomplete or noisy data is challenging On the other hand, data-driven models require a large amount of data in order to prevent physically inconsistent predictions, resulting in poor generalization. From this perspective, this paper proposes to combine the strengths of mechanism-driven and data-driven approaches to obtain a more comprehensive approach, the physiology-informed machine-learning approach, with the goal of enhancing the accuracy, interpretability, and scalability of continuous cuffless BP monitoring. This holds promise for personalized clinical applications and the advancement of hypertension management.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1157.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Early Outcomes of a Next-Generation Balloon-Expandable Transcatheter Heart Valve - The Myval System: A Single-Center Experience From Serbia</title>
<author>Darko Boljevic*, Milovan Bojic, Mihajlo Farkic, Dragan Sagic, Sasa Hinic, Dragan Topic, Milan Dobric, Jovana Lakcevic, Marko Nikolic, Stefan Veljkovic, Matija Furtula, Jelena Kljajevic, Aleksandra Nikolic</author>
<pubDate>2023-06-26 11:48:20</pubDate>
<description>Transcatheter aortic valve implantation (TAVI) is one of the most effective treatments for severe aortic valve stenosis (AVS). Different genres and generations of transcatheter heart valves (THVs) are accessible, offering operators an opportunity to choose a patient-tailored device. In this single-center study, we present the outcomes of Serbian patients treated with next-generation Myval THV for severe symptomatic AVS. Myval THV was implanted in all consecutive patients who underwent TAVI at the Dedinje Cardiovascular Institute of Belgrade, Serbia between October 2020 and September 2021. The primary endpoint was device success on day 30. Secondary endpoints included 30-day all-cause mortality, cardiovascular death, stroke, moderate/severe paravalvular leak (PVL), and new permanent pacemaker implantation (PPI). TAVI was performed as per the European Society of Cardiology guidelines. The study comprised thirteen patients, aged 72&plusmn;13 years with mean EuroSCORE (7.17%) and Society of Thoracic Surgeons (2.72%,) scores who underwent TAVI successfully with 92.3% using the percutaneous approach. Myval THV intermediate and extra-large sizes were implanted in 46% and 15% of patients, respectively. This acute procedure success rate was 100%. The primary composite endpoint of early device success was achieved in all patients. None of the patients had clinically significant aortic regurgitation or moderate/severe PVL. No patient experienced stroke, contrast-induced acute kidney injury, device-related vascular complications, or a new PPI. The all-cause mortality rate at 30 days was 0%. Myval THV system demonstrated a favorable safety/efficacy profile within 30 days post-procedure at a single center in Serbia. This is the first report of my experience with Myval THV from Serbia.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1156.pdf</link>
</item>
<item>
<type>Mini Review</type>
<title>The Role of Advanced Imaging in Paediatric Cardiology: Basic Principles and Indications</title>
<author>Maria Kavga*, Tristan Ramcharan, Kyriaki Papadopoulou-Legbelou</author>
<pubDate>2023-06-24 16:28:33</pubDate>
<description>Tissue Doppler Imaging and Speckle Tracking Echocardiography are newer echo-cardiographic modalities, that assess myocardial and valvular function in congenital and acquired heart diseases in childhood. In addition, cross-sectional imaging including Cardiac Magnetic Resonance (CMR) and Cardiac Computed Tomography has been widely used over the last decade in paediatric cardiology, in order to evaluate intra-cardiac and extra-cardiac anatomy. Cardiac Magnetic Resonance particularly allows detailed analysis of myocardial function, and shunt quantification and has applications even in fetal life. This mini-review summarizes the basic principles of the above-advanced modalities and highlights their main indications and clinical applications in childhood.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1155.pdf</link>
</item>
<item>
<type>Thesis</type>
<title>Vitamin D Deficiency and its Correlation with the Severity of Heart Disease in Dilated Cardiomyopathy Patients</title>
<author>Kuldeep Kumar Gaur*, LH Ghotekar, Shubha Laxmi Margekar, Tarun Kumar, Ritu Singh</author>
<pubDate>2023-06-20 16:24:49</pubDate>
<description>Background: Cardiomyopathy is primarily a disorder of the cardiac muscle that causes myocardial dysfunction and is not the result of disease or dysfunction of other cardiac structures, systemic arterial hypertension and valvular stenosis or regurgitation.&nbsp;Aim: The present study aimed to determine the prevalence of vitamin D deficiency and its correlation with the severity of heart disease in patients with dilated cardiomyopathy (DCMP).&nbsp;Method: 70 ECHO-proven DCMP cases were enrolled from the medicine/ cardiology department of LHMC &amp; associated hospitals and ABVIMS &amp; Dr. RML Hospital, New Delhi from November 2019 to October 2021. DCMP patients with ages more than 18 years who were willing to give consent and does not meet any of the exclusion criteria were enrolled in this study.&nbsp;Results: Mean age of idiopathic DCMP patients was 48.3 &plusmn; 15.2. There were more males 48 (69%) than females 22 (31%). The mean ejection fraction was 26.6 &plusmn; 7.3, while the mean fractional shortening was 17.6 &plusmn; 3.1. Vitamin D deficiency was observed in 90% of patients, among which 68.5% were having moderate vitamin D deficiency and 10% were having severe vitamin D deficiency.&nbsp;Conclusion: In our study, vitamin D levels were inversely correlated with the severity of heart disease in DCMP patients.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1154.pdf</link>
</item>
<item>
<type>Observational Study</type>
<title>Myocardial fibrosis in aortic stenosis: comparison between clinical data, laboratory, echocardiography, and cardiac magnetic resonance</title>
<author>Giuseppe Tosto, Giulia Passaniti, Fortunata Alessandra Gibiino, Wanda Deste*, Antonino Indelicato, Tito Torrisi, Giuseppe Bottaro, Maria Teresa Cannizzaro, Corrado Tamburino</author>
<pubDate>2023-05-16 14:25:55</pubDate>
<description>Introduction: Patients with aortic stenosis often develop hypertrophy and fibrosis, regardless of symptoms. Cardiac Magnetic Resonance (CMR) represents the gold standard for the evaluation of fibrosis despite numerous limitations: cost, availability, atrial fibrillation, claustrophobia, kidney failure or inability to apnea.Purpose: The aim is to validate the role of echocardiographic parameters, such as Global Longitudinal Strain (GLS), as early markers of fibrosis. Clinical and laboratory data, particularly B-type Natriuretic Peptide (BNP), were also analyzed.Material and methods: In our study we recruited 33 patients with severe aortic stenosis, correlating echocardiographic values of GLS with the qualitative analysis of Late Gadolinium Enhancement (LGE) and the quantitative analysis of T1 mapping of CMR.Results: 70% of patients with an alteration of GLS had LGE+. Univariate logistic regression shows that the factors associated with the presence of LGE on CMR are hypertension (p = 0.043), GLS (p = 0.032), and elevated BNP values (p = 0.021); for GLS, Odds Ratio (OR) is 5 so the chance of finding fibrosis on CMR increases 5 times in presence of an altered GLS. The multivariate analysis confirms the association with impaired GLS values (p = 0.033) and hypertension (p = 0.025), but not with elevated Pro-BNP values.Conclusion: In patients with severe aortic stenosis, the association between GLS, LGE, and T1 mapping can help identify earlier those patients with structural changes caused by the disease, who could benefit from early intervention. It remains to be established how the presence of these alterations has a role in determining the intervention time and the outcome of these patients.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1153.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Security and performance of remote patient monitoring for chronic heart failure with Satelia® Cardio: First results from real-world use</title>
<author>Patrick Jourdain*, F Picard, N Girerd, H Lemieux, F Barritault, MF Seronde, JP Labarre, N Pages, C Bedel, L Betito, S Nisse-Durgeat, B Diebold</author>
<pubDate>2023-05-15 14:14:55</pubDate>
<description>Background: Since 2019, remote patient monitoring (RPM) for patients with chronic heart failure (CHF) has been supported by the European Society of Cardiology. However, real-world data on the use of such solutions has been limited and not primarily based on patient-reported outcomes. The aim of this study was to describe the Satelia&reg; Cardio solution in France within the French ETAPES funding program and assess the security and performance of its clinical algorithm.Methods: A retrospective observational study was conducted on CHF patients monitored by RPM through Satelia&reg; Cardio. From September 1, 2018, to June 30, 2020, patients were included if they had completed over six months of follow-up. The risk of a possible CHF decompensation was categorized by the system in three levels: green, orange and red. The algorithm security and performance were assessed through the negative predictive value (NPV) of the prediction of hospitalization of a patient within seven days.Results: In total, 331 patients were included in this study with 36,682 patient self-administered questionnaires answered. Patients were mostly males (70.4%) and had a mean age of 68.1 years. The mean left ventricular ejection fraction (LVEF) was 35.4% (&plusmn; 12.3) and 73.3% of patients had a LVEF &le; 40%. The questionnaire response rate was 90.9%. A green status was generated for 95.3% of answers. There were 4.5% (n = 1,499) orange alerts and 0.2% (n = 74) red alerts. Overall, 92.1% of patients had at least one CHF related hospitalization and 31.7% (n = 105) of these cases were non-scheduled. The NPV at seven days was 99.43%.Conclusion: Satelia&reg; Cardio is a feasible, relevant and reliable solution to safely monitor the cohorts of patients with CHF, reassuring cardiologists about patient stability.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1152.pdf</link>
</item>
<item>
<type>Case Report</type>
<title>A rare case of foreign body in coronary sinus. A novel endovascular method for retrieval</title>
<author>Bhanu Maturi,Ashwini Sharma,Ashok Runkana,Rhoshini Rajasekaran,Varshitha Kondapaneni,Tilachan Parajuli</author>
<pubDate>2023-03-30 16:06:53</pubDate>
<description>Central venous catheter fracture and migration are rare complications in patients receiving long-term infusions or chemotherapy. We present a rare case of a chest port catheter fracture that migrated into the coronary sinus. This case is likely the fourth report of a port catheter fracture with migration to the coronary sinus. Because of the difficult-to-retrieve location, multiple attempts were unsuccessful with traditional techniques using a loop snare. Finally, the fractured portion was disengaged from the coronary sinus using a navigational electrophysiology catheter guided by intracardiac echocardiography; the dislodged end was snared and eventually removed by the femoral route. This case of a chest port catheter fracture is unique because of the unusual migration to the coronary sinus and the use of a navigational electrophysiology catheter as a novel retrieval technique.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1151.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>A proposal of risk indicators for pathological development from hemodynamic simulation: application to aortic dissection</title>
<author>Wenyang Pan,Pascale Kulisa,Benyebka Bou-Saïd,Mahmoud El Hajem,Serge Simoëns,Monica Sigovan</author>
<pubDate>2023-03-28 16:00:29</pubDate>
<description>Cardiovascular diseases are the leading cause of mortality in the industrialized world. Among these diseases, aortic dissection affects the aorta wall and is a surgical emergency with a low survival rate. This pathology occurs when an injury leads to a localized tear of the innermost layer of the aorta. It allows blood to flow between the layers of the aortic wall, forcing the layers apart and creating a false lumen. Endovascular treatment seeks to obliterate the entrances to the false lumen with a covered stent. There are very few studies on the postoperative demonstration of blood flow phenomena in the aortic dissection endovascular treatment. It is crucial to study the hemodynamics of blood in the aorta after an intervention because the new geometrical configuration of the aorta with a stent leads to modifications in blood flow. For the surgeons, the procedure can only be performed empirically, using MRI-4D images to view the postoperative flow of the patient&rsquo;s blood in the aorta with the stent.This paper aims to present a numerical tool developed from the open-source software FOAM- Extend&reg;, allowing for multiphysics numerical simulations. Using MRI data, a bio-faithful model of the patient-specific case was built. Numerical simulations were performed to predict preoperative and postoperative (endovascular treatment) hemodynamics. The modifications of the flow in the aorta were analyzed focusing on the postoperative perfusions. The results were compared with the corresponding MRI data and have a good qualitative agreement. Biomarkers are calculated to localize possible zones of post-operative pathological developments and recommendations may be suggested to the surgeons.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1150.pdf</link>
</item>
<item>
<type>Review Article</type>
<title>Soliton phenomena in the process of the functioning of the heart</title>
<author>Adam Adamski</author>
<pubDate>2023-03-14 11:19:15</pubDate>
<description>The biochemical model explains the intricate mechanisms of psychobiological life. He still cannot explain what the transition from inanimate to living matter is all about. Where is the threshold and what is its essence, what role do biochemical processes play in the coherence of the soma with consciousness and its impact on the soma and vice versa? A similar problem is with other mental processes, their nature does not fit into the biochemical model of life and is inexplicable on the basis of biochemical interactions, again it is much easier to describe it in the light of quantum processes - including wave physics. It is similar to the functioning of the heart or other organs, where only the biochemical processes of the cell are considered, ignoring the bioelectronic processes. Man is not only a purely biological construct but also contains the basis of biochemical, bioelectronic, information, and cybernetic processes that are responsible for shaping the psychobiological processes of man. Contemporary biosystems in science are considered at the level of corpuscular structures, ignoring energy and information structures. By shifting the cognitive emphasis towards energy and information structures, the organism can be perceived as a quantum generator of information: electromagnetic, soliton, acoustic, spin and bioplasma. This bioelectronic construction creates homo electronics with his electronic personality.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1149.pdf</link>
</item>
<item>
<type>Observational Study</type>
<title>Left ventricular assessment in patients with significant mitral incompetence: a multi-modality imaging study</title>
<author>Reham Mostafa Elgammal,Mona Adel Elsaiedy,Mahmoud Zki Alamrosy,Mohamed Elsaied Elsetiha,Magdy Mohamed Almasry</author>
<pubDate>2023-03-09 17:13:41</pubDate>
<description>Background: Detection of the deleterious effect of MR on LV is crucial in guiding the surgical decision.&nbsp;Aim of the study: Comprehensive assessment of LV with significant primary MR using (2D, 3D echo and CMR).&nbsp;Methods: 40 patients with significant MR have been recruited in a prospective study. Patients underwent 2D and 3D echo and CMR studies. LV volumes, function and GLS were calculated.&nbsp;Results: End diastolic and systolic volumes were significantly larger when measured by CMR (all p &lt; 0.001). EDV measures were strongly correlated with CMR and 3D echocardiography.&nbsp;Conclusion: It&rsquo;s important to identify early deleterious LV changes.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1148.pdf</link>
</item>
<item>
<type>Review Article</type>
<title>Outcomes of intervention treatment for concurrent cardio-cerebral infarction: a case series and meta-analysis</title>
<author>Mohammed Habib,Somaya Elhout</author>
<pubDate>2023-01-18 11:27:59</pubDate>
<description>Background: The concurrent occurrence of acute ischemic stroke and acute myocardial infarction is an extremely rare emergency condition that can be lethal. The causes, prognosis and optimal treatment in these cases are still unclear.Methods: We conducted the literature review and 2 additional cases at Al-Shifa Hospital, we analyzed clinical presentations, risk factors, type of myocardial infarction, site of stroke, modified ranking scale and treatment options. We compare the mortality rate among patients with combination intervention treatment (both percutaneous coronary intervention for coronary arteries and mechanical thrombectomy for cerebral vessels) and medical treatment at the hospital and 90 days after stroke.&nbsp;Results: In addition to our cases, we identified 94 cases of concurrent cardio-cerebral infarction from case reports and series with a mean age of 62.5 &plusmn; 12.6 years. Female 36 patients (38.3%), male 58 patients (61.7%). Only 21 (22.3%) were treated with combination intervention treatment.The mortality rate at hospital discharge was (33.3%) and the mortality rate at 90 days was (49.2%). In patients with the combination intervention treatment group: the hospital mortality rate was 13.3% and the 90-day mortality rate was: 23.5% compared with the mortality rate in medical treatment (23.5% at the hospital and 59.5% at 90 days (p value 0.038 and 0.012 respectively)&nbsp;Conclusion: Concurrent cardio-cerebral infarction prognosis is very poor, about a third of patients died before discharge and half of the patients died 90 days after stroke. Despite only one-quarter of patients being treated by combination intervention treatment, this treatment modality significantly reduces the mortality rate compared to medical treatment.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1147.pdf</link>
</item>
<item>
<type>Case Presentation</type>
<title>Isolated multiple pericardial hydatid cysts in an asymptomatic patient: Role of the CMR</title>
<author>Antonio Bisignani,Andrea Madeo,Silvana De Bonis,Riccardo Vico,Giovanni Bisignani</author>
<pubDate>2023-01-06 10:58:02</pubDate>
<description>Hydatid cysts primarily affect the liver and secondary involvement may be seen in almost any anatomic location.&nbsp;We describe the unusual pericardial location of the Echinococcus cysts in an asymptomatic patient with suggestive cardiac magnetic resonance imaging.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1146.pdf</link>
</item>
<item>
<type>Case Report</type>
<title>Double aortic dissection in a patient with Marfan disease. A case report</title>
<author>Millogo Georges Rosa Christian,Kologo Jonas Koudougou,Seghda Taryètba André Arthur,Boro Théodore,Benon Laurence,Samadoulougou André K,Zabsonré Patrice</author>
<pubDate>2022-12-27 16:29:48</pubDate>
<description>Marfan syndrome is a dominant autosomal genetic disease of the connective tissue, leading to various complications. Cardiovascular complications are the main ones, with dilation of the aorta and aortic dissection which is the main cause of death. Double dissection with different sites of departure is scarcely reported by the literature. We reported the case of a 22-year&rsquo;s-old young patient admitted for acute chest and abdominal pains, and cardiogenic shock. Investigations reported a double dissection of the aorta with a recent one of type A and an old one of type B. Ghent diagnostic criteria were used to allow the diagnosis of Marfan disease. Surgical management corrected successfully the type A dissection.Early diagnostic and adequate management of aortic complications can reduce the high mortality rate of patients with Marfan syndrome.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1145.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Correlation between chronic inflammation of rheumatoid arthritis and coronary lesions: “About a monocentric series of 202 cases”</title>
<author>Nassime Zaoui,Amina Boukabous,Nabil Irid,Nadhir Bachir,Ali Terki</author>
<pubDate>2022-12-06 11:30:40</pubDate>
<description>Introduction: Cardiovascular diseases are the leading cause of death in the world, headed by coronary artery disease, which is secondary to atherosclerosis. The latter recognizes classic risk factors such as diabetes, high blood pressure, tobacco, and dyslipidemia and other less classic factors such as chronic inflammation of rheumatoid arthritis. Many studies have highlighted the correlation between this chronic inflammation and clinical coronary disease but very few have focused on the anatomical correlation.&nbsp;Objective: To describe the correlation between the chronic biological inflammation of rheumatoid arthritis and anatomical coronary lesions on angiography.&nbsp;Method: This observational, retrospective, single-center study, including over 10 years, of patients with rheumatoid arthritis, confirmed the EULAR 2010 criteria and presented with coronary artery disease requiring coronary angiography. Patients with missing data or in whom coronary angiography was not done were excluded (n = 14). We divided then the patients according to the existence or not of chronic inflammation to study the impact of the latter on the existence (Stenosis &lt; 50% vs. stenosis &ge; 50%), the extent (single vs. multivessel disease), and the severity of the coronary lesions (syntax score &lt; 32 vs. &ge; 32).&nbsp;Results: 202 patients (49♂/153♀) aged between 30-75 years with a history of rheumatoid arthritis have had a coronary event requiring coronary angiography, were included; The mean ejection fraction at baseline was 57.3% +/- 5.8 (37 vs.-65%). 75% of them were &ge; 65 years old. 55% were diabetics, 61% with hypertension, 38% with dyslipidemia, and 19% were smokers. Chronic inflammation was diagnosed in 70% of them on non-specific parameters (ESR, CRP, fibrinogen, anemia, and rheumatoid factor). All patients had coronary angiography, which made it possible to identify the coronary lesions according to their existence (Stenosis &lt; 50%: 51 patients vs. stenosis &ge; 50%: 151 patients), the extent (single: 86 patients vs. multivessel disease: 116 patients) and the severity of the coronary lesions (syntax score &lt; 32: 142 patients vs. &ge; 32: 60 patients). Chronic inflammation of rheumatoid arthritis was correlated in bivariate and multivariate analysis (after excluding the impact of other risk factors) with the existence and extent of coronary lesions (p &lt; 0.05) but not with their severity (p &gt; 0.05).&nbsp;Discussion: The two limitations of this work are the monocentric nature of the study and the absence of specific inflammatory parameters such as anti-CCP antibodies. Strengths are anatomical correlations and multivariate analysis. Chronic inflammation apart from any influence of the various risk factors predisposes to the existence and extent of coronary lesions (p &lt; 0.05). The severity of coronary lesions assessed by Syntax Score was not correlated with chronic inflammation, although other studies suggest that this inflammation is the cause of complex lesions.Interpretation: Rheumatoid arthritis is associated with an increase in cardiac morbidity and mortality. Atheromatous lesions are more frequent in those patients than the existence of classic cardiovascular risk factors would suggest. Several explanations could account for this risk: the inflammatory syndrome and its impact on the cardiovascular risk factors and the vessel and the deleterious effect of the treatments. This requires stricter screening and management of risk factors in rheumatoid arthritis.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1144.pdf</link>
</item>
<item>
<type>Case Report</type>
<title>Percutaneous Atrial Septal Defect (ASD) closure technique in case of association with an azygos continuation of the inferior vena cava “case report”</title>
<author>Nassime Zaoui,Amina Boukabous,Nadhir Bachir,Ali Terki,Nabil Irid</author>
<pubDate>2022-12-02 11:24:59</pubDate>
<description>Introduction: Atrial Septal Defect (ASD) is the most common congenital heart disease, accessible to percutaneous closure in 90% of cases. The closure procedure is performed usually under local anesthesia and TTE by femoral access. The association of OS-ASD with an azygos continuation of the inferior vena cava is very rare (&lt; 0.1/1000 births) making femoral access impossible. Only a few cases are mentioned in the literature, here we describe the procedure as faithfully as possible.&nbsp;Important clinical finding: We present a case of a 32-years-old female candidate for percutaneous closure of OS-ASD with right cavity dilatation who present during her procedure an unusual guidewire path suspecting an azygos continuation of the inferior vena cava, confirmed by CT angiography, making impossible the closure via the femoral approach.&nbsp;Therapeutic intervention: After being confronted with the categorical patient refusal of the surgery, we performed successfully the procedure; one month later; under general sedation by internal jugular approach. We finished with manual compression before extubating the patient.&nbsp;Outcomes: The follow-up was favorable at the cost of a hematoma at the puncture site and brachial plexus compression, which regressed after 3 days.&nbsp;Conclusion: We opted for general anesthesia and intubation to guide the procedure by TEE. We placed it in the aorta, which gave us good stability to continue successfully the procedure. We underestimated the risk of complication at the puncture site, which could have been avoided by using a vascular suture device or more prolonged compression.&nbsp;Main takeaway lesson: Percutaneous closure is the reference treatment for OS-ASD. In case of is associated with an azygos continuation of the inferior vena cava, the right internal jugular vein remains a reasonable approach; it requires discussion and rigorous preparation by the whole team. The management of the puncture site in this situation remains delicate and requires great concentration.&nbsp;</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1143.pdf</link>
</item>
<item>
<type>Case Report</type>
<title>How to manage balloon entrapment during percutaneous coronary intervention of a calcified lesion “Case report”</title>
<author>Nassime Zaoui,Amina Boukabous,Nadhir Bachir,Nabil Irid,Ali Terki</author>
<pubDate>2022-12-02 10:20:08</pubDate>
<description>Percutaneous coronary angioplasty is a minimally invasive procedure aimed at unclogging a coronary artery with a low complication rate (with a serious complication rate of 3% to 7% and a mortality rate of 1.2%). Device entrapment during PCI is a rare but life-threatening complication that occurs in &lt; 1% of PCIs and balloon entrapment comes second after coronary guidewires. We present the case of 68-years-old man, smoker, hypertensive and type2 diabetic that presents angina with evidence of ischemia on myocardial tomoscintigraphy and in whom the radial coronary angiography reveals a tight calcified mid LAD stenosis. During his PCI and after dilatation with an NC balloon 2.5 &times; 12 the latter refuses to deflate and remains trapped in the lesion with the appearance of pain and ST-elevation despite several attempts to dilute the product in the inflator and to burst it by overexpansion. Traction on the balloon resulted in the deep intubation of the guiding-catheter, which comes in contact with the trapped balloon, and the rupture of the latter&rsquo;s hypotube, which remains inflated at the site of the lesion and mounted on the 0.014 guidewire. We put a second 0.014 guidewire distally in the LAD and twisted with the distal part of the first guidewire, then we introduced a second balloon 2.0 &times; 20 over the second guidewire until the distal part of the guiding-catheter and inflated to trap the stucked balloon. We gradually removed this emergency assembly that allowed us to retrieve the trapped balloon. The control injection revealed a thrombotic occlusion of the LAD treated by thrombectomy and anti-GPIIbIIIa followed by a DES 2.75 &times; 28 placement. The patient was discharged 48 hours later with a good LVEF. The possible balloon entrapment mechanisms are an acute recoil of a highly calcified lesion with compression of the incompletely deflated balloon, which seems to be the case in our patient, strangulation of the proximal balloon end by the guiding-catheter if the balloon is removed before complete deflation and break or bend of the hypotube. The solutions in case of undeflatable balloon entrapment are to dilute the product in the inflator, to burst it by overexpansion, to pierce it through a stiff guidewire (or through its other end on a Microcatheter or OTW balloon), to cut its outer part and let it empty passively, to introduce a second guide-wire and perform a Buddy-Balloon or to transfer the patient to Surgery. Material entrapment remains a rare but life-threatening complication, its eviction requires the choice of material size and gentle manipulations (small balloons in the event of a calcified lesion) and its management uses different techniques, the choice of which depends on the clinical and anatomical situation.&nbsp;</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1142.pdf</link>
</item>
<item>
<type>Mini Review</type>
<title>Oncocardiology: Far beyond the cardiotoxicity</title>
<author>Jing Wei,Wen-Jie Pan,Min Pan</author>
<pubDate>2022-11-29 12:56:35</pubDate>
<description>Approximately 73.4% of global deaths are caused by chronic non-communicable diseases, among them, cardiovascular and cerebrovascular diseases, tumors, and chronic respiratory diseases ranked in the top 3 respectively [1]. An accumulating body of evidence showed that the risk of all-cause mortality in cancer patients with cardiovascular disease (CVD) was 3.78 times higher than that of those without CVD and 8.8% of cancer survivors died of CVD [2]. Heart failure (HF) is a serious manifestation or terminal stage of various heart diseases. Although myocardial damage and dysfunction are the main causes of HF, the cardiovascular injury caused by the tumor itself and the detrimental effect of cancer treatment also play an important role. More recently, the data has suggested that up to 25% - 30% of patients with HF have histories of cancer for about 10 years; and cancer also determines the prognosis of heart HF [3].&nbsp;</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1141.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Acute ischemic stroke for alteplase or medical care alone or intervention with/without alteplase in Palestine (AIS-AMI Palestine)</title>
<author>Mohammed Habib</author>
<pubDate>2022-11-22 00:00:00</pubDate>
<description>Background: Stroke is the most common cause of permanent disability and the third most common cause of death in Palestine. We aimed to examine patterns of stroke presentation, causes, management and outcomes at the largest public Mistry of health hospitals in Palestine.Methods: Comprehensive data from all patients with acute ischemic stroke who were admitted to al-Shifa hospital between November 2021 and July 2022 and treated with alteplase alone or endovascular intervention with or without alteplase were prospectively collected and compare with acute ischemic stroke patients who were treated with medical care alone at Palestine medical complex hospital at 2018. Acute ischemic stroke presentation patterns, in-hospital evaluation and management, mortality, and morbidity were evaluated.&nbsp;Results: Medical care alone group: 138 patients with acute ischemic stroke, mean age was 65 &plusmn; 14 years and 49% were women. Most of the patients received antiplatelet therapy (98%), although none received thrombolysis. Only 17% received physical therapy evaluation. In-hospital mortality was 13%, and a modified ranking score of 0 -2 was in 44 patients (32%). Endovascular intervention with/without alteplase group: 56 patients with acute ischemic stroke. The mean age was 61 &plusmn; 12 years and 41% were women. All patients received brain computed tomography scans, although few received other investigations such as carotid Doppler (13%). Most patients with ischemic stroke received antiplatelet therapy (99%), although 39 patients (70%) received thrombolysis. Only 61% received physical therapy evaluation. In-hospital mortality was 7%. The modified ranking score 0 - 2: 32 patients (57%).Conclusion: This study conducted in Palestine showed that among patients with acute ischemic stroke, functional outcomes according to modified ranking score 0 - 2 were better by endovascular therapy with/without alteplase than with medical care alone.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1140.pdf</link>
</item>
<item>
<type>Literature Review</type>
<title>Atrial fibrillation in elite athletes. What is missing?</title>
<author>E Tsougos,E Giallafos, Paraskevaidis</author>
<pubDate>2022-10-27 14:32:14</pubDate>
<description>Although the beneficial effect of physical activity in the general population is well established, in elite athletes under vigorous physical activity, the effect on the electrical system of the heart is controversial. Indeed, several studies have shown an increased rate of atrial fibrillation among athletes, whereas others suggest that improved exercise capacity with training reduces atrial fibrillation recurrence. The pathophysiologic explanation of that discrepancy is missing, although several underlying mechanisms have been proposed. Taking into account the current knowledge, it seems that, although the beneficial effects of exercise are well recognized, there are conflicting data regarding the relation of the occurrence - the rate of atrial fibrillation to high-volume exercise and too long-term training. Its significance on the quality of life especially in highly trained athletes remains to be elucidated. Therefore, this short review will try to discuss this discrepancy and hopefully underlie the arising arguments.&nbsp;</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1139.pdf</link>
</item>
<item>
<type>Case Presentation</type>
<title>A patient with pulseless ST elevation myocardial infarction caused by a very late stent thrombosis</title>
<author>Masahiko Satoda,Hiroaki Yusa</author>
<pubDate>2022-09-24 14:44:55</pubDate>
<description>Background: Persistent contrast staining is highly associated with stent thrombosis.&nbsp;Case summary: A 75-year-old woman presented with new-onset effort angina. A coronary angiogram revealed a 90% blockage of the distal left main trunk (LMT) and a 99% blockage of the ostial left anterior descending coronary artery (LAD). A 3.0 &times; 18-mm CYPHER&trade; the stent had previously been implanted into the dominant proximal circumflex artery (LCx) in 2009 because of unstable angina. The patient developed pulseless ST elevation myocardial infarction after the withdrawal of antiplatelet therapy before a scheduled CABG. The patient recovered with&nbsp;VA-ECMO and PCI using aspiration thrombectomy and urgent CABG.Discussion: This case highlighted that a preoperative patient may develop thrombosis at a previous stent site with peri-stent contrast staining and withdrawal of an antiplatelet regimen in certain settings poses an imminent risk for preoperative deterioration. A bridging strategy using intravenous PY12 inhibitor before CABG should be considered in this setting. The revascularization strategy should be selected based on coronary anatomy, hemodynamic status and baseline risk for CABG. A hybrid revascularization approach should be considered in this patient population.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1138.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Does global longitudinal strain improve stratification risk in heart failure with preserved ejection fraction?</title>
<author>Assia Haddad,Mohamed Karim Guerchani,Nadia Ould Bessi,Dalila Djermane,Omar Ait Mokhtar,Hakim Himeur,Salim Benkhedda</author>
<pubDate>2022-09-08 10:13:44</pubDate>
<description>Background: Heart Failure with Preserved Ejection Fraction (HFPEF) accounts for more than half of the cases of heart failure.Long regarded as an abnormality of left ventricular diastolic function, recent studies using longitudinal strain (two-dimensional speckle tracking mode) have suggested that left ventricular longitudinal systolic function is altered in HFPEF.Despite these interesting pathophysiological perspectives, the data in the literature on the prognostic value of the alteration of longitudinal strain are controversial. Given these conflicting results, it is difficult to confirm the magnitude and prevalence of impaired LV longitudinal systolic function in patients with HFPEF and its prognostic relevance.&nbsp;Purposes: This work aims to study the prognostic value of Global the left ventricle&rsquo;s Global Longitudinal Strain (GLS) Algerian cohort of patients with HFPEF.&nbsp;Patients and methods: We conducted a monocentric prospective observational study from April 2018 to April 2020, with a minimum follow-up of 1 year for each recruited patient. We included patients over the age of 18 referred to the echocardiography laboratory for chronic or acute HFpEF, defined according to the criteria of ESC 2016. 153 consecutive patients underwent clinical examination, biological tests, and echocardiography with measurement of GLS at rest, in addition to routine management by the attending physicians.Results: 153 patients were collected. The average age of our patients is 73 +/- 11 years ranging from 42 to 91 years old. The female population is predominant with a rate of 67%. Comorbidities are predominant mainly by arterial hypertension (86%) and diabetes (64%), with a history of atrial fibrillation (46%).63% of patients have impaired GLS (&lt; 16%). Contrary to our hypothesis, GLS was not shown to be a powerful predictor of cardiovascular events in HFPEF patients either in dichotomous analysis (OR = 0.79; p = 0.64) or in continuous analysis (OR = 0.97; p = 0.69).We were able to identify that congestive venous signs, anemia, and pulmonary hypertension, are the main independent prognostic factors in our Algerian population study.&nbsp;Conclusion: We were unable to demonstrate the prognostic role of mpaired GLS in our population of patients with HFPEF.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1137.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>An empirical study on factors responsible for Rheumatic Heart Disease (RHD) and its severity levels amongst the Bhutanese populace</title>
<author>Karma Lhendup,Yeshey Penjore</author>
<pubDate>2022-08-30 12:26:18</pubDate>
<description>Background and objectives: This paper is aimed at excavating the factors responsible for RHD events and vis-&agrave;-vis establishing severity levels of RHD patients referred to Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) in Thimphu&rsquo;s capital city of Bhutan.&nbsp;Methods: By taking notorious advantage of the data gathered over the past five years (2016-2020) from RHD patients across 20 districts of Bhutan, about 232 RHD patients are involved in this study recorded in JDWNRH by the Cardiology Department. Besides descriptive methods, multivariate linear regression models augmented by the multinomial logistic regression models had been applied to establish the causual links.&nbsp;Results: The findings revealed that RHD prevailed amongst the young populace of Bhutan, especially females. Variables like age, frequency of visits, number of diagnostics, levels of education and region had been found as predictors of RHD prevalence. Other socio-demographic factors like occupation and status of employment did not affect the RHD prevalence. The multinomial logistic regression results indicated that higher levels of education as an important factor for not making the patient fall into the category of &lsquo;severe.&rsquo; Age has been constantly found to be a highly significant variable contributing to RHD events and a quadratic relationship is revealed between age and the severity of RHD.&nbsp;Conclusion and implications for translation: This study pigeonholed the significant factors responsible for RHD events and entailed severity levels by gender and age. The findings of this study also provide additional important insights into developing public health policies and programs.&nbsp;</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1136.pdf</link>
</item>
<item>
<type>Review Article</type>
<title>Clinical utility of intracardiac echocardiography in transvenous lead extraction</title>
<author>Josef Kautzner,Tomas Skala,Marian Fedorco,Hanka Wunschova,Milos Taborsky</author>
<pubDate>2022-08-04 11:50:03</pubDate>
<description>The epidemics of heart failure and an aging population resulted in an exponential rise in the use of cardiac implantable devices (CIEDs) in developed countries. This is paralleled by the increased rate of complications such as system infection or malfunction. The higher number of complications, and longer patient life expectancies, are followed by an increase in the need for lead extractions.&nbsp;</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1135.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Single-center experience in sutureless aortic valve implantation using two aortic valve prostheses</title>
<author>Laura Rings,Vasileios Ntinopoulos,Stak Dushaj,Gojart Hoti,Philine Fleckenstein,Omer Dzemali,Achim Häussler</author>
<pubDate>2022-07-22 14:13:20</pubDate>
<description>Background and aim of the study: Sutureless aortic valves are used to reduce operation time. However, the stent implantation might cause postoperative ECG alterations and a higher risk of paravalvular leakage. In literature, some cases of thrombocytopenia are described after implantation. We investigated the Sorin Perceval S Sutureless Valve and the Edwards Intuity Sutureless Valve.Material and methods: Seventy-nine patients underwent aortic valve replacement using a sutureless valve in a single center between 2015 - 2018. Thirty-seven patients received Sorin Perceval S (Group A) and 42 Edwards Intuity (Group B). Simultaneous bypass surgery was performed in 23 patients in Group A and 22 patients in Group B. We compared the groups regarding postoperative TTE and paravalvular leakage, postoperative ECG alterations, need for pacemaker implantation, postoperative platelet count, and 30-day mortalityResults: Only in Group B 2 patients had paravalvular leakage, and one was reoperated within the same hospital stay. In Group A, nine patients suffered from postoperative atrial fibrillation, and in Group B, 16 patients. Left bundle branch block (LBBB) was observed in 5 patients in Group A, and 13 patients in Group B. Two patients in Group A needed a definite pacemaker, and five patients in Group B. Tachy-Brady Syndrome and LBBB were observed more frequently in Group B as well as ECG alterations. One patient died within 30 days in Group A due to multiorgan failure. This patient was older and multimorbid compared to the average. Regarding platelet count, we saw a statistically significant decrease in both groups. There were no major bleeding complications or reoperations due to hemorrhage.Conclusion: Our data shows that sutureless aortic valve replacement is associated with new postoperative ECG alterations, which are self-limiting in most cases. Compared to the literature pacemaker implantation rate in Group B is higher.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1134.pdf</link>
</item>
<item>
<type>Observational Study</type>
<title>Posterior pericardiotomy in heart valve surgery; is it still performed or neglected?</title>
<author>Yasser Mubarak</author>
<pubDate>2022-07-04 15:46:05</pubDate>
<description>Background: Posterior pericardiotomy (PP) is helpful to prevent arrhythmia; especially atrial fibrillation (AF), and cardiac tamponade postoperative cardiac valve surgery. The incidence of postoperative AF is increased due to postoperative pericardial effusion (PE). This study aimed to investigate the early outcome of PP after heart valve surgery.&nbsp;Methods: In this prospective study, 120 patients underwent elective valve heart surgery at our center from January 2020 until April 2022. Patients were followed up for AF and pericardial effusion, and reopening due to tamponade.&nbsp;Results: The mean age of patients was 35.26 years, 70.2% were female and 29.8% were male. Surgery was elective and all were valve surgery. The incidence of postoperative AF was 2%, and pericardial effusion was seen in 1% of patients. Tamponade was not seen in any case. Left PE needed intervention tube drainage of 2%.&nbsp;Conclusion: Posterior pericardiotomy is a simple and safe procedure during valve heart surgery, and it is effective in reducing the incidence of atrial fibrillation, pericardial effusion, and tamponade.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1133.pdf</link>
</item>
<item>
<type>Literature Review</type>
<title>A Wolff-Parkinson-White (WPW) Electrocardiographic Pattern in Asymptomatic Patient – State-of-the-Art-Review</title>
<author>Vijay Yadav,Sanjeev Thapa,Ratna Mani Gajurel,Chandra Mani Poudel,Bhawani Manandhar,Manju Sharma,Suman Adhikari,Suraj Shrestha</author>
<pubDate>2022-06-07 11:06:46</pubDate>
<description>A comprehensive approach to asymptomatic adults with Wolff-Parkinson-White (WPW) pattern discovered incidentally on routine electrocardiography (ECG) is debatable. The objective of this review article is to update the most recent evidence on the management of young patients with asymptomatic WPW patterns. A substantial proportion of adults with WPW patterns on ECG may remain asymptomatic but the lifetime risk for fatal arrhythmias still exists. The inherent properties of the accessory pathway determine the risk of sudden cardiac death. A low-risk pathway is considered when the pre-excitation is intermittent on ambulatory monitoring or when it disappears completely or abruptly during exercise testing. On the other hand, a high-risk pathway in EP study is suggested by the presence of the shortest pre-excited RR interval (SPERRI) during atrial fibrillation of &le; 250 ms or accessory pathway effective refractory period (APERP) &le; 240 ms. The cardiac evaluation may thus be considered in asymptomatic patients with WPW to determine the individual risk for future symptomatic arrhythmia. A shared-decision making must be performed before offering catheter ablation whose procedural success rate is high.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1132.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Associations of arterial stiffness with left ventricular mass index and carotid intima-media thickness in the hypertensives</title>
<author>Hoang P Le,Binh G Nguyen</author>
<pubDate>2022-05-05 15:44:32</pubDate>
<description>Background: Arterial stiffness has been considered an independent predictor of cardiovascular disease in addition to the traditionally known cardiovascular risk factors.&nbsp;Objectives: This study aimed to investigate the associations between arterial stiffness with left ventricular mass index and carotid intima-media thickness in the hypertensives.&nbsp;Methods: A descriptive cross-sectional study compared a control group in 210 study subjects (105 hypertensives and 105 normotensives). Measuring left ventricular mass index by echocardiography and carotid intima-media thickness by carotid doppler ultrasonography. Pulse wave velocity was measured using the Agedio B900 device and the Agedio K520 application. The manual method was measured by the ankle-brachial index.Results: There was a statistically significant positive correlation between pulse wave velocity and age (r = 0.922, p &lt; 0.001). The ankle-brachial index had a statistically significant positive correlation at a weak level with left ventricular mass index and carotid intima-media thickness, in which the coefficient r was equal to 0.219 (p &lt; 0.05) and 0.250 (p &lt; 0,001), respectively. Pulse wave velocity also had a statistically significant positive correlation at a weak level with left ventricular mass index and carotid intima-media thickness, in which the coefficient r was equal to 0.188 (p &lt; 0.05) and 0.289 (p &lt; 0,001), respectively. Pulse wave velocity had a multivariable linear correlation with gender, pulse, mean blood pressure, and ankle-brachial index with statistical significance; and they were written in the form of the following equation: Pulse wave velocity (R2: 41.3%) = 0.641*(Gender) &ndash; 0.027*(Pulse) + 0.043*(Mean blood pressure) + 8.378*(Ankle-brachial index) &ndash; 3.254.Conclusion: Arterial stiffness was statistically correlated with left ventricular mass index and carotid intima-media thickness in the hypertensives. Through the above research results, we suggest that the hypertensives should be combined with the evaluation of hemodynamic parameters and arterial stiffness for contributing to the diagnosis and detection of cardiovascular complications, thereby improving the quality of monitoring and treatment in hypertensive patients.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1131.pdf</link>
</item>
<item>
<type>Case Report</type>
<title>FDG PET/CT of uncommon cardiac angiosarcoma with bone metastases: a case report</title>
<author>Tatiana Moreno Monsalve,Laura Frutos-Esteban,Laroussi Mohamed-Salem,María Isabel Castellón-Sánchez,Ana Cristina Hernández-Martínez,Tomas Rodríguez-Locarno,Jose Fulgencio Contreras-Gutierrez</author>
<pubDate>2022-04-26 15:39:02</pubDate>
<description>Cardiac angiosarcomas are rare malignant neoplasms with an aggressive clinical course. These are characterized by the absence of specific clinical findings, rapid growth with frequent metastasis at the time of diagnosis, correlated with poor prognosis, and reduced response to treatment. But with early diagnosis, more possibilities for treatment and survival can be provided. We report the case of a young woman diagnosed with right atrial angiosarcoma locally advanced with bone metastases detected by 18F-FDG PET/CT, which revealed distant disease extent at diagnosis, consequently, chemotherapy was started.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1130.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Prevalence and pattern of congenital heart disease among children with Down syndrome seen in a Federal Medical Centre in the Niger Delta Region, Nigeria</title>
<author>Ujuanbi Amenawon Susan,Onyeka Adaeze Chiemerie</author>
<pubDate>2022-04-11 17:41:03</pubDate>
<description>Background: Down syndrome (DS), or Trisomy 21, is the most common genetic disorder in the world and congenital heart disease (CHD) contributes significantly to morbidity and mortality in this population. Early diagnosis and prompt cardiac intervention improve their quality of life. This study was done to determine the prevalence and pattern of congenital heart disease among children with Down syndrome seen at the Paediatric Cardiology Unit of Federal Medical Centre (FMC), Bayelsa State.Method: A prospective study of children with Down syndrome referred for cardiac evaluation and echocardiography at the Paediatric Cardiology Unit of FMC, Bayelsa State over four years from 1st January 2016 to 30th December 2019. Data on socio-demographic information, echocardiographic diagnosis, and outcome were retrieved from the study proforma and analyzed.Results: A total of 24 children with Down syndrome were seen over the study period. Their age ranged from 0 to 16years. The majority, 20 (83.3%) of the children with Down syndrome were aged 5 years and below. There were 13 males and 11 females with a male to female ratio of 1.2:1. A total of 23 (95.8%) of the children with Down syndrome had CHD. The most common CHD was AVSD (including complete, partial, isolated, or in association with other defects) in 66.6% followed by TOF in 8.3%. Multiple CHDs were seen in 43.5% of the children. Only one child (4.2%) had a structurally normal heart on echocardiography. All the children with Down syndrome had pericardial effusion of varying severity while 33% had pulmonary artery hypertension (PAH). The fatality rate among the children seen with Down syndrome over the study period was 34.8% and only one child (4.2%) had open-heart surgery with the total repair of cardiac defect during the study period.&nbsp;Conclusion: Morbidity and mortality are high among children with Down syndrome due to the high prevalence of CHD. Early referral, diagnosis, and prompt intervention are encouraged.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1129.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Save the radial: go distally</title>
<author>Rima Chaddad,Hussein Rabah,Batoul Awada,Malek Hmadeh</author>
<pubDate>2022-04-07 16:18:54</pubDate>
<description>Coronary artery disease is the leading cause of death worldwide.Percutaneous coronary intervention (PCI) is one of the most widely performed medical procedures used to save lives, currently over 3 million annually worldwide.The femoral artery has been the preferred vascular access site.&nbsp;However, radial access is gaining extensive popularity due to the benefits of earlier ambulation, fewer access site complications, and decreased rates of bleeding.&nbsp;Improvements in technology and understanding of the anatomic features of the vascular system have led to new insights into coronary angiography procedures.Distal radial access, which was first used in 2017, shows a higher success rate and fewer complications than previous sites; therefore, it might be the future for cardiovascular intervention.For this purpose, we conducted this prospective study at Beirut Cardiac Institute (BCI) comparing the two arms: radial vs. distal radial artery techniques through the anatomical snuffbox, in terms of patient&rsquo;s length of stay, complication rate, and success rate of each procedure.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1128.pdf</link>
</item>
<item>
<type>Case Report</type>
<title>Fibromuscular dysplasia and aortic dissection</title>
<author>Antonio M Puppo,Manuel Fernández Caro,Sara Martín Sastre,Francisco T Gómez,Jose Mariá López Sánchez</author>
<pubDate>2022-03-30 15:36:33</pubDate>
<description>Fibromuscular dysplasia is a rare, non-atherosclerotic, non-inflammatory vascular disease that typically affects women between the ages of 20 and 60 years.Although any artery can be affected fibromuscular dysplasia most commonly affects the renal and carotid arteries. Fibromuscular dysplasia of the renal arteries usually presents with hypertension, while carotid or vertebral artery disease causes transient ischemic attacks, strokes, or dissection. Aortic dissection is rare. We present the clinical case of a patient with fibromuscular dysplasia with type B aortic dissection.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1127.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Control of arterial hypertension and risk of new-onset of atrial fibrillation in patients with metabolic syndrome</title>
<author>Ylber Jani,Kastriot Haxhirexha,Ferizat Haxhirexha,Bekim Pocesta,Atila Rexhepi,Fatmir Ferati,Ahmet Kamberi,Agim Zeqiri,Sotiraq Xhunga,Artur Serani,Lutfi Zylbeari</author>
<pubDate>2022-03-10 14:20:58</pubDate>
<description>Background: An association between Atrial Fibrillation (AF) and Metabolic Syndrome (MS) a constellation of abnormalities (high blood pressure, hyperglycemia, dyslipidemia, and abdominal obesity), has been demonstrated. There have been many studies that have shown that elevated blood pressure (BP), was significantly associated with an increased risk of AF. It is uncertain whether maintaining the optimal BP levels can prevent AF in the patients with MS categorized as &lsquo;high-risk&rsquo; patients.Objective: The aim of this study was to evaluate the influence of control of BP on the occurrence of new-onset atrial fibrillation in patients with Metabolic Syndrome.Methods: Into this observational study, was enrolled 435 consecutive patients (210 males and 225 females) aged 45-79 years who fulfilled criteria for MS. Participants were selected among primary and secondary care patients, who were receiving ongoing care for arterial hypertension in the period from November 2018 till November 2021. The study was conducted at outpatients in 5 Health Care Clinics (3 Secondary Health Care Clinics and 2 Primary Health Clinics). Patient were categorized according to their BP levels as Group 1-patients with controlled BP, {(patients aged &lt; 65 years Systolic Blood Pressure (SBP) of 120 - 130 mmHg, patients aged &ge; 65 years SBP of 130 - 139 mmHg)} and Diastolic Blood Pressure (DBP), {(patients aged &lt; 65 years of &lt; 80 mmHg. but not &lt; 70 mmHg; patients aged &ge; 65 years of 85 - 89 mmHg)}, or Group 2-patients with uncontrolled BP(&gt; 130/80 mmHg),and in patients aged &ge; 65 years BP (&ge; 140/90 mmHg ).&nbsp;Results: New-onset of AF, was more frequent in participants with uncontrolled BP, respectively (34.7% vs. 19.5%, p = 0.009).Patients with uncontrolled BP have more frequent persistent AF (15.2% vs. 0.04%) and permanent AF (0.08% vs. 0.02%), whereas there was not significant changes between groups in relation to frequency of paroxysmal AF, respectively (12.8% vs. 10.9%, p = 0.29). There was observed significant association of uncontrolled BP with: increased frequency of AF (OR = 2.193; 95% CI 1.390 - 3.439), persistent AF (OR = 3.931; 95% CI 1.771 - 8.084), permanent AF (OR = 4.138; 95% CI 1.383-12.381), LA. Dimension &ge; 2.2 cm/m2 (OR = 2.089, 95% CI 1.330 - 3.252), BMI (OR = 5.226, 95% CI 3.155 - 8.659) and 5-risk factors for MS, respectively (OR = 2.998, 95% CI 1.833 - 4.901).Conclusion: Optimal BP levels, can reduce the frequency of new-onset AF in patients with MS categorized as &lsquo;high-risk&rsquo; patients. Uncontrolled BP was associated with an increased risk of both subtypes of AF (persistent and permanent) in the patients with MS categorized as &lsquo;high-risk&rsquo; patients.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1126.pdf</link>
</item>
<item>
<type>Case Report</type>
<title>Overview of glycemic control among admitted patients with diabetes in Tripoli University Hospital</title>
<author>Haifa Elhadi Alshwikh,Faiza Hander</author>
<pubDate>2022-02-18 10:51:56</pubDate>
<description>Aim: To examine the relationship between the levels of HbA1c and hospital admission rates.Methods: We recorded HbA1c levels of all diabetic patients in Tripoli University Hospital over one year.Results: The mean HbA1c was 8.03%, with no difference between males and females. Over half of patients (56.5%) were admitted through their diabetes was well-controlled. Over half of the patients with type 1 diabetes (57/102, 55.9%) had a high HbA1c at admission compared to 42.1% of patients with type 2, who were mainly admitted with HbA1c level within the acceptable range set for this study. The HbA1c level was positively and significantly correlated with the length of hospital stay (R = 0.93, p = 0.000), and was significantly associated with hyperglycemia, diabetic ketoacidosis, coronary artery disease, limb ischemia, cataract, osteomyelitis, and non-alcoholic steatohepatitis.Conclusion: HbA1c is correlated significantly with hospitalization in type 1 diabetes but not in type 2.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1125.pdf</link>
</item>
<item>
<type>Retrospective Study</type>
<title>Lifestyle modification practice and associated factors among diagnosed hypertensive patients in selected Hospitals in West Arsi Zone, Oromia Regional State, Ethiopia</title>
<author>Hika Wakjira,Tesfaye Gobena,Hirbo Shore</author>
<pubDate>2022-02-01 14:44:18</pubDate>
<description>Background: Globally 1.13 billion people were living with hypertension, Out of this two-thirds of them were living in low and middle-income countries. In Ethiopia, Non-Communicable Disease deaths are estimated at around 42%. However, it remains widely undetected and poorly controlled. To resolve these, lifestyle modification approaches that are often overlooked are the cornerstone of the prevention and management of hypertension.&nbsp;Objective: To assess lifestyle modification practice and associated factors among hypertensive patients in selected hospitals in West Arsi Zone, Oromia Regional, Ethiopia December 7 to 21, 2019.&nbsp;Method: Hospital-based cross-sectional study was conducted in the selected public hospital among 299 hypertensive patients. Systemic random sampling methods were used to select the study participants. Data were collected by face-to-face interviews using a structured questionnaire by trained data collectors. Data were analyzed using descriptive statistics and multivariate logistic regression method to identify predictors of the outcome (p &lt; 0.05).&nbsp;Results: Of the total participants, only 25.2% (95% CI: 18.8-32.9) of the patients were practiced recommended lifestyle modifications. Patients Age older than 65 years (AOR = 2.9, 95% CI: 1.17 - 7.0), the patients with 2-5 years&rsquo; time since diagnosed hypertension (AOR = 0.26, 95% CI: 0.07 - 0.9), multiple co-morbidity (AOR = 2.7, 95% CI: 1.25 - 5.8,) and their knowledge on hypertension management (AOR = 14.6, 95% CI: 4.6 - 45.9) have an independently associated with recommended lifestyle modification.&nbsp;Conclusion: Lifestyle modification practices among hypertensive patients were low in this study. Age, comorbidity, time since diagnoses of hypertension, and knowledge of lifestyle were identified as predictors of the outcome.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1124.pdf</link>
</item>
<item>
<type>Case Report</type>
<title>Age, smoking, hypertension, and aortic aneurysm: Interactions and risks</title>
<author>Seriki SA,Otoikhila OC</author>
<pubDate>2022-01-06 17:46:31</pubDate>
<description>Background/Aim: Aortic aneurysm is the bulging of a weakened portion of the aorta. The aorta is the major blood vessel that feeds blood (carrying oxygen, nutrients and water) to the tissues of the body. When a portion of the wall of the aorta becomes weak, blood pushing against the vessel wall can cause it to bulge like a balloon (aneurysm) leading to aortic dissection (a tear in the wall of the aorta that can cause life-threatening bleeding or sudden death). Blood pressure is the force arterial blood exerts on the wall of the artery. When this pressure is consistently high above 140/100 mmHg it is referred to as hypertension. As an individual gets older over time, physiological functions of the body depreciate leading to some abnormalities. Smoking is the consumption of tobacco mostly by inhalation of the smoke that is produced from burning the tobacco. This review article examines the close interactions between age, smoking, hypertension and aortic aneurysm, with a view to understanding mechanisms by which these factors predispose a patient to an aortic aneurism. It is also to observe if these factors interfere with treatment and recovery from aneurysms.&nbsp;Conclusion: After careful review, it is observed that age and smoking are risk factors for hypertension, and together with hypertension, the three factors predispose an individual to high risk for aortic aneurysm.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1123.pdf</link>
</item>
<item>
<type>Case Report</type>
<title>Stiff “Left Atrial” syndrome post-mustard procedure</title>
<author>Joshua A Cowgill,Adrian M Moran</author>
<pubDate>2021-12-01 20:36:09</pubDate>
<description>Objectives: We describe the clinical course and management of two patients with post-capillary pulmonary hypertension due to diffuse pulmonary venous baffle calcification decades post-Mustard procedure.Background: From the late 1950s to the early 1990s, the definitive surgical repair for children with D-transposition of the great vessels (D-TGA) was an atrial switch procedure (either Senning or Mustard operation) which utilizes atrial-level baffles to shunt pulmonary venous blood to the morphologic right (systemic) ventricle and caval blood to the morphologic left (sub-pulmonary) ventricle. From a hemodynamic standpoint, baffle leaks and stenoses as well as precapillary pulmonary hypertension have all been described as both early and late complications [1]. Recently, delayed post-capillary pulmonary hypertension (in the absence of discrete baffle obstruction) decades post-atrial switch has also been described [2]. The underlying pathophysiology for this postcapillary pulmonary hypertension is unclear but is theorized to involve impaired diastology referable to the pulmonary venous baffle.&nbsp;Methods/Results: Using hemodynamic and imaging data, we describe two patients with extensive pulmonary venous baffle calcification and resultant pulmonary hypertension from the so-called &ldquo;stiff left atrial (LA) syndrome.&rdquo; This problem can be difficult to treat medically and is not amenable to catheter-based interventions. We hypothesize that this is an underlying mechanism for pulmonary hypertension in at least some post-Mustard and Senning patients.&nbsp;Conclusion: We describe the treatments and clinical course for each of these patients, and in particular describe how the surgical revision of the pulmonary venous baffle in one case led to the complete resolution of symptoms.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1122.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Mouth-to-mouth ventilation through cardiopulmonary resuscitation, is there any other way?</title>
<author>Aini Maimaitiming,Xiaohai Wang,Jie Chen,Bing Zhang</author>
<pubDate>2021-11-29 16:44:18</pubDate>
<description>Objective: to provide and explore possibility of new idea that perform mouth-to-mouth ventilation through cardiopulmonary resuscitation.&nbsp;Methods: stage one was establishing the ventilation technique using cola bottles, stage two was measuring the tidal volume when different sized cola bottles were used.&nbsp;Result: the smallest sized cola bottle (500 ml) could also make obvious thorax rise in manikin CPR model. The tidal volume was 174.5 &plusmn; 9.1 ml, 220 &plusmn; 7.6 ml and 447 &plusmn; 15.9 ml respectively for 500 ml, 600 ml and 1.25 L cola bottles when using single hand performance. There were statistical differences (0.001) in tidal volume of different sized cola bottle by using one hand performance and two hands.&nbsp;Conclusion: Larger sized cola bottles (600 ml, 1.25 L) could be used as substitute ventilation technique for mouth-to-mouth ventilation in special circumnutates.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1121.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>RV Function by cardiac magnetic resonance and its relationship to RV longitudinal strain and neutrophil/lymphocyte ratio in patients with acute inferior ST-segment elevation myocardial infarction undergoing primary percutaneous intervention</title>
<author>Salma Taha,Shrouk Kelany Ali,Fabrizio D’Ascenzo,Hosam Hasan-Ali,Yousra Ghzally,Mohamed Abdel Ghany</author>
<pubDate>2021-11-23 12:26:10</pubDate>
<description>Background: Although acute inferior myocardial infarction (MI) is usually regarded as being lower risk compared with acute anterior MI, right ventricular (RV) myocardial involvement (RVMI) may show an increased risk of cardiovascular (CV) morbidity and mortality in patients with inferior MI. CMR is ideal for assessing the RV because it allows comprehensive evaluation of cardiovascular morphology and physiology without most limitations that hinder alternative imaging modalities.&nbsp;Objectives: To evaluate the sensitivity of strain and strain rate of the RV using 2D speckle tracking echo and the neutrophil/ lymphocyte ratio (NLR) compared to cardiac MRI (CMR) as the gold standard among patients with inferior STEMI undergoing primary percutaneous coronary intervention (PCI).&nbsp;Methodology: 40 Patients with inferior MI who had primary PCI were included in the study; they were divided into two groups according to the RVEF using CMR. NLR was done in comparison to RVEF.Results: out of the 40 patients, 18 (45%) patients had RV dysfunction. 2D echocardiography was done for all patients, where fractional area change (FAC) in the RV dysfunction group appeared to be significantly reduced compared to the group without RV dysfunction (p value = 0.03). In addition, RV longitudinal strain (LS) by speckle tracking echo was reduced with an average of 19.5 &plusmn; 3.9% in the RV dysfunction group.Both CMR- derived RV SV, and EF were lower among the RV dysfunction group, (26.8 &plusmn; 15.8) ml and (35.4 &plusmn; 6.9)% respectively, with large RV systolic volume, with a highly statistically significant difference in comparison to the other group (p value = 0.000). Complications, heart block was significantly higher in patients with RV dysfunction (p value = 0.008) as it occurred in 5 (27.8%) patients.N/L ratio for predicting RV dysfunction by CMR had a cut-off value of &gt; 7.7 with low sensitivity (38.8%) and high specificity (77.3 %). In contrast, LS for predicting RV dysfunction by CMR had high sensitivity (83.3%) and high specificity (63.6%) with p value = 0.005.Conclusion: Our results showed that RV dysfunction in inferior MI is better detected using cardiac magnetic resonance imaging. In inferior STEMI patients who underwent primary PCI, NLR has low sensitivity but high specificity for predicting RVD when measured by cardiac MRI.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1120.pdf</link>
</item>
<item>
<type>Case Report</type>
<title>Percutaneous treatment of severe retroperitoneal hematoma after percutaneous coronary intervention</title>
<author>Agarwal Rajendra Kumar,Agarwal Rajiv</author>
<pubDate>2021-09-25 12:09:45</pubDate>
<description>We describe a patient who developed severe retroperitoneal and intraperitoneal bleeding complicating femoral arterial catheterization for Percutaneous coronary intervention. Balloon tamponade of the actively bleeding femoral artery was effective in sealing off the leakage.This management strategy for this problem emphasizing an anatomical based interventional approach if the patient does not stabilize with volume resuscitation.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1119.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>The complex interplay in the regulation of cardiac pathophysiologic functionalities by protein kinases and phosphatases</title>
<author>Chrysanthus Chukwuma Sr</author>
<pubDate>2021-08-26 00:00:00</pubDate>
<description>Protein phosphorylation regulates several dimensions of cell fate and is substantially dysregulated in pathophysiological instances as evident spatiotemporally via intracellular localizations or compartmentalizations with discrete control by specific kinases and phosphatases. Cardiovascular disease manifests as an intricately complex entity presenting as a derangement of the cardiovascular system. Cardiac or heart failure connotes the pathophysiological state in which deficient cardiac output compromises the body burden and requirements. Protein kinases regulate several pathophysiological processes and are emerging targets for drug lead or discovery. The protein kinases are family members of the serine/threonine phosphatases. Protein kinases covalently modify proteins by attaching phosphate groups from ATP to residues of serine, threonine and/or tyrosine. Protein kinases and phosphatases are pivotal in the regulatory mechanisms in the reversible phosphorylation of diverse effectors whereby discrete signaling molecules regulate cardiac excitation and contraction. Protein phosphorylation is critical for the sustenance of cardiac functionalities. The two major contributory ingredients to progressive myocardium derangement are dysregulation of Ca2+ processes and contemporaneous elevated concentrations of reactive oxygen species, ROS. Certain cardiac abnormalities include cardiac myopathy or hypertrophy due to response in untoward haemodynamic demand with concomitant progressive heart failure. The homeostasis or equilibrium between protein kinases and phosphatases influence cardiac morphology and excitability during pathological and physiological processes of the cardiovascular system. Inasmuch as protein kinases regulate numerous dimensions of normal cellular functions, the pathophysiological dysfunctionality of protein kinase signaling pathways undergirds the molecular aspects of several cardiovascular diseases or disorders as related in this study. These have presented protein kinases as essential and potential targets for drug discovery and heart disease therapy.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1118.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Open heart surgery in Nigerian children the need for international and regional collaboration: The Bayelsa and Enugu experience</title>
<author>Ujuanbi AS,Allagoa DO,Onwubere B,Chinawa JM,Ujunwa FA</author>
<pubDate>2021-07-09 00:00:00</pubDate>
<description>Background: Children with congenital heart diseases (CHD) often require palliative or definitive surgical heart interventions to restore cardiopulmonary function. Lack of early cardiac intervention contributes to large numbers of potentially preventable deaths and sufferings among children with such conditions. Objectives: The aim of this study was to highlight our experience and the importance of international and regional collaboration for open heart surgery in children with CHD and capacity building of local cardiac teams in Bayelsa and Enugu States. Methodology: In November 2016, a memorandum of understanding (MOU) was signed by the managements of FMC, Yenagoa, Bayelsa State, UNTH, Enugu and an Italian-based NGO- Pobic Open Heart International for collaboration in the area of free open heart surgery for children with CHDs and training of local cardiac teams from both institutions either in Nigeria or in Italy. Patients for the program were recruited from Bayelsa and Enugu States with referrals from all over the country with combined screening and selection done in UNTH. Selected patients were operated on and funded free of charge by the Italian NGO. Hands on training of the local cardiac teams and cardiac intervention was done twice yearly in Nigeria. Result: From inception of the program in November, 2016 to May, 2019 a total of 47 children (21 Males, 26 Females; age range 6 months to 14 years) with various types of congenital heart defects had free open heart surgery from the program with 41 surgeries done in UNTH &amp; 6 in Italy (complex pathologies). Also, home cardiac teams from UNTH and FMC, Yenagoa gained from on-site capacity training &amp; retraining from the Italian cardiac team both in Nigeria and in Italy. The Success rate was 95.7% (44) and Case Fatality rate was 4.3% (2). Conclusion: There is a great efficacy in early cardiac intervention. This is with respect to a high success rate and minimal Case Fatality seen in this study. This was achieved through Regional and international collaboration.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1117.pdf</link>
</item>
<item>
<type>Case Report</type>
<title>Unusual and severe peripartum cardiomyopathy: A case report</title>
<author>Lamanna B,Vinciguerra M,Crupano FM,Cicinelli R,Cicinelli E,Vimercati A</author>
<pubDate>2021-05-05 00:00:00</pubDate>
<description>Peripartum cardiomyopathy (PPCM) is a relatively rare cardiac disease that manifests in the final stage of pregnancy and in the first months after delivery in women with no preexisting heart disease. Many etiological processes have been suggested: viral myocarditis, abnormal immune response to pregnancy, excessive prolactin excretion, prolonged tocolysis and a familiar predisposition to PPCM. Its diagnosis is often delayed because its symptoms, which include fatigue, dyspnea and palpitations are nonspecific. For this reason the diagnosis of PPCM is still made by exclusion of other etiologies. The long-term prognosis, once the acute phase is over, is a function of myocardial damage, this varies from complete functional recovery to chronic HF. The outcome of PPCM is highly variable with an alevated risk of fetomaternal morbidity and mortality. We report a serious case of a 40 years old female with biamniotic bicorionic twin pregnancy (PMA) who delivered by caesarean section and developed acute PPCM on post-operative. Symptoms occurred two hours after an intramuscular injection of two vials of methylergonovine the same day of cesarean delivery. These manifested in sudden tachypnoe, tachycardia and the appearance itchy maculopapular rash on her chest. On further evaluation, ECHO revealed cardiomegaly with reduced ejection fraction (&lt; 15%). The case was successfully managed by a multidisciplinary team, using drugs like levosimendan and cabergoline, which rapresent emerging strategy in this clinical context.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1116.pdf</link>
</item>
<item>
<type>Review Article</type>
<title>Sildenafil citrate in healthy and diseased hearts</title>
<author>Seriki Samuel Adinoyi</author>
<pubDate>2021-04-23 00:00:00</pubDate>
<description>Sildenafil citrate is one of the frontline drugs used to manage erectile dysfunction (ED). Chemically, it is described as 1-[[3-(6,7-dihydro-1-methyl-7-oxo-3-propyl-1H &ndash;pyrazolo [4,3-d]pyrimidin-5-yl)-4 ethoxyphenyl] sulfonyl]-4-methylpiperazine citrate (C22H30N6O4 S). It is a highly selective inhibitor of cyclic guanine monophosphate-specific phosphodiesterase type-5. There had been heightened concerns following reports that sildenafil citrate may increase the risk of cardiovascular events, particularly fatal arrhythmias, in patients with cardiovascular disease. So the cardiac electrophysiological effects of sildenafil citrate have been investigated extensively in both animal and clinical studies. This article ties up the various outcomes of the investigations with a view to guiding physicians and patients that use sildenafil citrate to manage erectile dysfunction, especially as it concerns its effect on their cardiovascular function in health and in disease. Sildenafil citrate could impact negatively on ailing hearts, but on a healthy heart, there may not be any such impact, rather, it improves on heart performance as it lowers the blood pressure.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1115.pdf</link>
</item>
<item>
<type>Case Report</type>
<title>pVAD-assisted left main DK-Crush Bifurcation PCI Post-ViV TAVR</title>
<author>Steve Attanasio,Maria Isabel Camara Planek,Anshuman Das</author>
<pubDate>2021-04-16 00:00:00</pubDate>
<description>We describe successful percutaneous coronary intervention (PCI) of significantly diseased ostial left main (LM) and distal LM bifurcation (Medina 1,1,1) in a patient with a reduced left ventricular ejection fraction and a recent valve-in-valve balloon-expandable TAVR using the DK-Crush technique with the support of a percutaneous left ventricular assist device.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1114.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Abdominal obesity in predicting myocardial infarction risk. Waist-to-Hip Ratio: The metric that confused cardiology worldwide for a long time</title>
<author>Angel Martin Castellanos</author>
<pubDate>2021-03-24 00:00:00</pubDate>
<description>Important differences has been found in assessing the effects of obesity on cardiovascular disease (CVD) risk [1]. Interestingly, accurate estimation of the body composition (BC) is highly relevant from a public health perspective [2], and it has the importance of being essential in establishing the impact of adiposity on increased myocardial infarction (MI) risk. However, in non-randomized studies, baseline differences of BC between groups to be compared may introduce bias in results.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1113.pdf</link>
</item>
<item>
<type>Review Article</type>
<title>Management of hypertension in Nigeria: The barriers and challenges</title>
<author>Nelson I Oguanobi</author>
<pubDate>2021-03-19 00:00:00</pubDate>
<description>In recent years there has been increasing concern about the growing burden of cardiovascular disease (CVD) in developing countries. Systemic hypertension remains the commonest form of CVD and is identified as a key modifiable risk factor for cardiovascular morbidity and mortality. Primary and secondary prevention of cardiovascular adverse events are public health priorities. This review highlights the potential barriers and challenges to hypertension care in Africa&rsquo;s most populous country, Nigeria, and proffers relevant recommendations.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1112.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Muscle growth and control of production of sarcomere components</title>
<author>Gerry A Smith</author>
<pubDate>2021-03-12 00:00:00</pubDate>
<description>Here I contrast the skeletal and cardiac muscle in terms of the control muscle growth and of sarcomere component synthesis. The differences are major and reflect the long term needs of the two systems. With the skeletal system there is growth of both the number of myocytes and the sarcomere components within them dependent on demand made of the muscle. Unlike skeletal muscles the normal adult heart is greatly restricted in size, number of myocytes and their content of contractile proteins, i.e. there is little change on demand. Over time proteins get damaged or decay and for the normal heart this implies a strictly controlled maintenance synthesis of sarcomere components. From the studies of abnormal, mutated systems there is one thing inherent to and more pronounced in cardiac muscle, the FrankStarling Law of the Heart derived from the angiotensin ii type 1 receptor that my studies indicate is central to the control of sarcomere component synthesis.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1111.pdf</link>
</item>
<item>
<type>Case Report</type>
<title>An unusual presentation of atrioventricular nodal reentrant tachycardia</title>
<author>Mihaela Grecu,Florina-Adriana Ghitun,Stefan Ailoaei,Dan Ursu,Raluca Chistol,Grigore Tinica,Cristian Statescu</author>
<pubDate>2021-02-12 00:00:00</pubDate>
<description>Introduction: Atrioventricular nodal reentrant tachycardia (AVNRT) is the most frequent supraventricular tachycardia, commonly manifesting as autolimited paroxysmal episodes of rapid regular palpitations that exceed 150 beats per minute (bpm), dizziness and pounding neck sensation. Case presentation: We present a case of a male patient, 70 years old, with ischemic heart disease and slow-fast AVNRT treated with radiofrequency catheter ablation (RFCA) in March 2019, with regular 6-months follow-ups. He was readmitted in our department in November 2020 for rest dyspnea and incessant fluttering sensation in the neck, without palpitations. The event electrocardiogram (ECG) was initially interpreted by general cardiologist as accelerated junctional rhythm, 75 bpm. Due to the persistence of symptoms and ECG findings, a differential diagnosis between reentry and focal automaticity was imposed. The response to vagal maneuvers and Holter ECG monitoring characteristics provided valuable information. We suspected recurrent slow ventricular rate typical AVNRT, which was confirmed by electrophysiological study and we successfully performed the RFCA of the slow intranodal pathway. Conclusion: AV nodal reentry tachycardia may have an unusual presentation, occurring in elder male patients with structural heart disease. Antiarrhythmic drugs can promote reentry in this kind of patients. In cases of slow ventricular rate, vagal maneuvers and Holter ECG monitoring can help with the differential diagnosis. The arrhythmia can be successfully treated with RFCA with special caution regarding the risk of AV block.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1110.pdf</link>
</item>
<item>
<type>Review Article</type>
<title>New insights from cardiac muscle applied to skeletal muscle</title>
<author>Gerry A Smith</author>
<pubDate>2021-01-15 00:00:00</pubDate>
<description>I have recently described the origin of the second Ca2+ binding in the triggering of contractile activity in cardiac myofibrils that is the origin of the Ca2+ Hill coefficient of 2 for the ATPase. This site is not a simple protein binding site and cannot be measured by 45Ca2+ binding. The myofibril protein unit requirements are described by me and so are the consequences of disruption of the function of these units and the related medical outcomes. The purpose of this paper is to review the topic and extend the reasoning to the function of skeletal muscle and cite the literature that supports this.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1109.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Evidence of woven bone formation in carotid artery plaques</title>
<author>Mirzaie Masoud,Zaur Guliyev,Michael Schultz,Peter Schwartz,Johann Philipp Addicks,Sheila Fatehpur</author>
<pubDate>2021-01-05 00:00:00</pubDate>
<description>Objective: Plaque morphology plays an important prognostic role in the occurrence of cerebrovascular events. Echolucent and heterogeneous plaques, in particular, carry an increased risk of subsequent stroke. Depending on the quality of the plaque echogenicity based on B-mode ultrasound examination, carotid plaques divide into a soft lipid-rich plaque and a hard plaque with calcification. The aim of this study was to investigate structural changes in the basement membrane of different carotid artery plaque types. Patients and methods: Biopsies were taken from 10 male patients (average age; 75 + 1 years) and 7 females (68 + 3 years). The study population included patients suffering from a filiform stenosis of the carotid artery, 8 patients with acute cerebrovascular events and 9 with asymptomatic stenosis. Scanning electron and polarised light microscopic investigations were carried out on explanted plaques to determine the morphology of calcified areas in vascular lesions. Results: By means of scanning electron microscopy, multiple foci of local calcification were identified. The endothelial layer was partially desquamated from the basement membrane and showed island-like formations. Polarised light microscopy allows us to distinguish between soft plaques with transparent structure and hard plaques with woven bone formation. Conclusion: The major finding of our study is the presence of woven bone tissue in hard plaques of carotid arteries, which may result from pathological strains or mechanical overloading of the collagen fibers. These data suggest a certain parallel with sclerosis of human aortic valves due to their similar morphological characteristics.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1108.pdf</link>
</item>
<item>
<type>Case Report</type>
<title>Acute ischemic stroke management in a patient with ventricular assist device</title>
<author>Çisil İrem Özgenç Biçer,Işıl Kalyoncu Aslan,Irmak Salt,Eren Gözke</author>
<pubDate>2020-12-23 00:00:00</pubDate>
<description>Ventricular assist device is a portable machine which is also called an artificial heart for the patients who have terminal heart failure. The device maintains the heart&rsquo;s vital functions until the suitable donor is found for the heart transplantation. It can be applied to either ventricles or both (biventricular). Although the device provides independence for the patient, it also has life-threatening complications. Such as infection, stroke secondary to thromboembolism, hemorrhage depending on anticoagulant use, right heart failure&hellip; and most of the time it is really hard to manage those complications. We will present a case, who had ischemic stroke as a complication of VAD even though he has been using aspirin, warfarin and had effective INR value.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1106.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Ivabradine versus carvedilol in the management of palpitation with sinus tachycardia among recovered COVID-19 patients</title>
<author>Kartik Pandurang Jadhav,Pankaj V Jariwala</author>
<pubDate>2020-12-23 00:00:00</pubDate>
<description>Introduction: One of the major complications among COVID-19 patients include cardiac arrhythmias. Commonest arrhythmia is sinus tachycardia which is usually associated with palpitation causing discomfort to patients. In this study, we present a comparative study of use of Ivabradine vs. Carvedilol for sinus tachycardia in post-COVID-19 infected patients. Method: 50 consecutive recovered COVID-19 patients with sinus tachycardia were included in this open labelled RCT. 25 patients received Ivabradine and remaining 25 received Carvedilol. Single therapy non-responders were treated with Ivabradine with Atorvastatin. Results: The mean age of all patients is 48.8&plusmn;7.66 years (Males 49.5 &plusmn; 7.21 years; Females 47.68 &plusmn; 8.23 years). The mean heart rate (MHR) of all patients is 125.52 &plusmn; 9.07/min (Males 125.67 &plusmn; 8.78/min; Females 125.26 &plusmn; 9.5/min). After five days of single drug therapy the mean drop in the heart rate was 35.04 &plusmn; 10.55/min (Males 34.41 &plusmn; 9.71/min; Females 36.05 &plusmn; 11.72/min), resulting in 27.88 &plusmn; 8.11% (Males 27.38 &plusmn; 7.56%; Females 28.69 &plusmn; 8.89%) reduction in MHR. Among the two groups, the Carvedilol group showed improvement of MHR in 14(56%) patients; whereas in Ivabradine group 18(72%) patients improved out of 25 patients each (p: 0.2385). In the Carvedilol group the MHR reduced from 128.6 &plusmn; 8.44 to 95.68 &plusmn; 10.63 (p &lt; 0.001), which is statistically significant; similarly, the Ivabradine group showed a MHR from 122.44 &plusmn; 8.62 to 85.28 &plusmn; 10.52 (p &lt; 0.001). The monotherapy therapy non-responders were treated with dual-therapy of (Ivabradine + Atorvastatin). Discussion: Ivabradine is more effective in controlling heart rate compared to Carvedilol. Also, Ivabradine group scores very well in &lsquo;patient-satisfaction&rsquo; with regards to symptom (palpitation) relief. Conclusion: The COVID-19 sequelae of sinus tachycardia can be better controlled with Ivabradine when compared to Carvedilol.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1107.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Post-extrasystolic potentiation differentiates “true” from “pseudo” Low-flow, Low-gradient aortic stenosis</title>
<author>Marc Vanderheyden,Sofie Verstreken,Marc Goethals</author>
<pubDate>2020-12-16 00:00:00</pubDate>
<description>Post-extrasystolic potentiation (PESP) is a marker of contractile reserve and refers to the augmentation of left ventricular contractility due to preload recruitment and rise in intracellular calcium following a premature beat. In this case report we show that PESP might be a safe and helpful aid to evaluate low flow, low gradient aortic stenosis and contractile reserve in the cathlab, thereby reducing the potential risk of complications associated with intravenous dobutamine evaluation and reducing unnecessary testing.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1105.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Antibiotic induced changes to mitochondria result in potential contributions to carcinogenesis, heart pathologies, other medical conditions and ecosystem risks</title>
<author>Jorma Jyrkkanen</author>
<pubDate>2020-10-02 00:00:00</pubDate>
<description>With the discovery by Calghatgi (2013) that three common antibiotics (Abs) increased mitochondrial reactive oxygen (ROS) and lipid peroxide (LP) and depleted their natural absorbant glutathione led me to investigate further the potential impacts of these genotoxic substances on carcinogenesis. The range of impacts on mitochondria and cellular DNA varied by antibiotic to those consistent with known prior contributions to carcinogenesis. Specific cancers probably increased by these changes were HCC, RCC (KCC), CRC, cancer of the esophagus. Tumor suppressor gene mutations resulting from LP were noteworthy in this regard and mutations induced in CRC were consistent with those found in carcinogenesis of CRC. In addition depression of short chain fatty acids in microbiomes were found which depress the immune system increasing risk of all cancers. Many cancers were increased according to epidemiological studies linking Abs with elevated odds ratios, with one concern in particular, fatal breast cancer. The impact of loss of functionality of the mitochondria was also linked to depression of the citric acid cycle and therefore ATP which deflected metabolism to glycolysis, the Warburg mechanism also increasing risk of all cancers, favoured by cancer cells. In conclusion, some portion of many cancer types are probably increased in likelihood by number, type and frequency of Abs treatment and chronic residue exposure which varies from individual to individual. This led me to propose a three pronged carcinogenesis mechanism for Abs. 1. Cancer critical mutations 2. Immune depression 3. loss of mitochondrial functionality leading to Warburg effects. Damage to mitochondria were also noted by common pesticides tested in China and cancer associations were also found for many pesticides supporting a similar contributory etiology. Heart health concerns were raised by these findings because of the myriad mitochondria in the heart and because of long term reliability needs. Studies suggesting hearts were affected by Abs and pesticide exposure were presented. Because of their geographical ubiquitousness and the huge range of diseases associated with mitochondrial dysfunction, antibiotics and pesticides and bacteriocidal biocides are of concern for biodiversity and life in general. I propose research steps to evaluate Abs safety and suggest directions for further research and make suggestions on ways to ameliorate Abs toxicity.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1104.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Clinical profile and surgical outcomes of children presenting with teratology of Fallot</title>
<author>Josephat M Chinawa,Agarwal Vijay,Sarang Gaikwad,Bhadra Trivedi4,Bartholomew Chukwu</author>
<pubDate>2020-09-14 00:00:00</pubDate>
<description>Background: Tetralogy of Fallot (TOF) is a very common cyanotic congenital heart disease presenting early at birth with various degrees of cyanosis. If left uncorrected surgically, can lead to death. Objectives: This study is aimed at determining pattern and surgical outcome of children with teratology of Fallot in a budding health facility in India over a year period. Result: A total of 51 children were diagnosed of TOF over the period, of which 66.7% were males with mean age of 48.14 &plusmn; 45.36 months. The surgical outcome showed only 3.9% mortality. The death was among children &gt;1 to 5 years. The mean number of days in intensive care unit (ICU) was 5.8 &plusmn; 11.2 days. 82.4% of the patients were off-pump post-operatively, compared to 17.6% with re-pump. Among those who had re-pump, 77.8% were males and among those without re-pump, 64.3% were likewise males (&chi;2 = 0.6, p = 0.41). About 92.2% (47/51) of patients had pulmonary regurgitation post-op, ranging from mild to moderate regurgitation. 51.1% of the regurgitations were mild while 25.5% and 23.4% were moderate and severe regurgitations respectively. Post-operative VSD was detected in 51% (26/51) of the patients. The post-op right ventricular pressure (RVOT) was significantly lower than that of pre-op pressure, 10.8 &plusmn; 1.5 mmHg vs. 31.7 &plusmn; 4.5 mmHg (pair t test = 8.7, p &lt; 0.001). Conclusion: Timely surgical repair is crucial in alleviating several morbidity and mortality associated with teratology of fallot. Pulmonary regurgitation is a very common sequel after surgery and can result in death.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1103.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Incidence and outcome of no flow after primary percutaneous coronary intervention in acute myocardial infarction</title>
<author>Goutam Datta</author>
<pubDate>2020-08-31 00:00:00</pubDate>
<description>Background: Primary percutaneous coronary intervention (PCI) of the infarct-related artery (IRA) is the most effective treatment modality in ST-segment elevation myocardial infarction (STEMI). Incidence of no flow is 8.8% - 10% in primary PCI of STEMI patients. Our aim was to study actual incidence and outcome of no flow patients. Methods: Five hundred and eighty primary PCI patients were enrolled and evaluated from 2016 January to 2017 December. We used drug eluting stents in all cases. Majority of our patients (&gt; 90%) presented to emergency six hours after onset of symptoms. There were many patients where there was no flow even after mechanical thrombus aspiration and pharmacological vasodilator therapy. We have studied primary outcome (mortality) of no flow in those patients. Results: There were 44 cases of no flow in our series (7.75%). Involvement of Left anterior descending artery (LAD) was in eighteen patients. Right coronary artery (RCA) was culprit in twenty four cases. Only two cases were seen in LCX territory. One month mortality rate in no flow group was 50% and 6.25% in successful recanalization group. One year mortality was 12.5% in successful recanalization group and 66% in no flow group. Conclusion: Refractory no flow during STEMI intervention is associated with increased incidence of major adverse cardiovascular events (MACE). There is no established strategy to solve this phenomenon.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1102.pdf</link>
</item>
<item>
<type>Review Article</type>
<title>The mechanisms of cardiac myopathies, a kinetics approach: Leading review</title>
<author>Gerry A Smith</author>
<pubDate>2020-07-16 00:00:00</pubDate>
<description>The normal adult heart is a well maintained machine that has a mechanism for growth replacement of the sarcomere that is lost by natural degeneration. This process ensures the heart has the strength of contraction to function correctly giving blood supply to the whole body. Some of the force of contraction of the sarcomere is transmitted to its major protein titin where its strength results in unfolding of a flexible section and release of a growth stimulant. The origin of all the cardiomyopathies can be traced to errors in this system resulting from mutations in a wide variety of the sarcomeric proteins. Too much or chronic tension transfer to titin giving increased growth resulting in hypertrophic cardiomyopathy (HCM) and too little leading to muscle wastage, dilated cardiomyopathy (DCM). HCM can ultimately lead to sudden cardiac death and DCM to heart failure. In this paper I show (1) a collection of the tension/ATPase calcium dependencies of cardiac myofibrils that define the mechanism of Ca2+ cooperativity. (2) I then reintroduce the stress/strain relationship to cardiomyopathies. (3) I then review the cardiomyopathy literature that contains similar Ca2+ dependency data to throw light on the mechanisms involved in generation of the types of myopathies from the mutations involved. In the review of cardiomyopathy there are two sections on mutations, the first dealing with those disrupting the Ca2+ cooperativity, i.e. the Hill coefficient of activation, leading to incomplete relaxation in diastole, chronic tension, and increased growth. Secondly dealing with those where the Ca2+ cooperativity is not affected giving either increased or decreased tension transfer to titin and changes in sarcomere growth.&nbsp;</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1101.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Femoral venous closure: A single-centre retrospective analysis in real world all comers with MynxGrip® vascular closure device</title>
<author>Nadim Malik,Alexander Harvard,Shamin Thirunavukarasu,Afzal Hayat,Abid Ullah,Reza Aghamohammadzadeh,Cathy Mary Holt</author>
<pubDate>2020-06-18 00:00:00</pubDate>
<description>Background: Vascular closure devices (VCD) are routinely used to achieve haemostasis following percutaneous arterial procedures. The extravascular polyethylene-glycol based MynxGrip&reg; device (Cardinal Health) received FDA approval for use in the closure of femoral veins, but so far limited data is available on its use, especially with concomitant use of anticoagulants. Method: This is a retrospective analysis of data from a single-centre on the effectiveness and complication rates following the use of the MynxGrip&reg; device for femoral venous closure in patients undergoing diagnostic/interventional (temporary pacing during balloon aortic valvuloplasty, or electrophysiology) procedures utilising 5-7F sheaths. Results: 85 patients (mean age 74 years) underwent femoral venous closure with the MynxGrip&reg; device. 51.8% were male. The rate of concomitant anticoagulant or antiplatelet use was 52.9%. Device deployment was 100% successful with full haemostasis in all cases. There were no major vascular complications (bleeding, thrombosis, or infections). There was one case of a minor small venous hematoma which did not require treatment. The mean length of stay was less than 1 day (67.1% patients discharged the same day) and overnight stay only indicated by interventional procedure. Conclusion: These data support safety and efficacy of the MynxGrip&reg; device for femoral venous closure with same-day discharge, even with concomitant aggressive antiplatelet and anticoagulant use. It has the potential for use in other large bore venous access sites.&nbsp;</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1100.pdf</link>
</item>
<item>
<type>Review Article</type>
<title>Fibrinolytic therapy with tPA failed because it was based on a flawed concept</title>
<author>Victor Gurewich</author>
<pubDate>2020-06-16 00:00:00</pubDate>
<description>Fibrinolytic therapy has become synonymous with tissue plasminogen activator (tPA) based on the belief that tPA alone was responsible for natural fibrinolysis. Although this assumption was belied from the outset by disappointing clinical results, it persisted, eventually causing fibrinolysis to be discredited and replaced by an endovascular procedure. Since time to reperfusion is the critical determinant of outcome, which in acute myocardial infarction (AMI) means within two hours, a time-consuming hospital procedure is ill-suited as first line treatment. For this purpose, fibrinolysis is more fitting. The assumption that tPA is responsible for fibrinolysis is contradicted by published findings. Instead, tPA &lsquo;s function is limited to the initiation of fibrinolysis, which is continued by urokinase plasminogen activator (uPA) and that has the dominant effect. tPA and uPA gene deletion and clot lysis studies showed the activators have complementary functions, requiring both for a full effect at fibrin-specific doses. They are also synergistic in combination thereby requiring lower doses for efficacy. A clinical proof of concept study in 101 AMI patients who were treated with a 5 mg bolus of tPA followed by a 90 minute infusion of prouPA, the native form of uPA. A near doubling of the 24 h TIMI-3 infarct artery patency rate was obtained compared to that in the best of the tPA trials (GUSTO). In further contrast to tPA, there were no reocclusions and the mortality was only 1% [1]. A sequential combination of both activators, mimicking natural fibrinolysis, holds promise to significantly improve the efficacy and safety of therapeutic fibrinolysis.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1099.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Long-term results for post-interventional systemic heparinization following angioplasty of peripheral vessels</title>
<author>Masoud Mirzaie,Zaur Guliyev,Mohammed Dakna</author>
<pubDate>2020-06-15 00:00:00</pubDate>
<description>Objective: The long-term outcome of percutaneous transluminal angioplasties is mainly determined by restenoses, either by progression of the underlying disease or by intimal hyperplasia. Pharmacological substances on the one hand and the implantation of stents on the other have been developed with the intention of preventing precisely this complication. While patients are treated after PTA of peripheral vessels with different low-molecular-weight heparins, the indication for stent implantation is determined individually rather by experience. The aim of this study was to determine gender-specific risk factors of long-term outcome after percutaneous transluminal angioplasty (PTA) of peripheral vessels with or without stentimplantation. Methods: In the present study, we examined the long-term results of percutaneous transluminal angioplasty (PTA) of peripheral vessels. Between 2007 and 2017, in total, 3,276 patients underwent PTA with or without stent implantation in our clinic. All patients were treated postinterventionally for 48 hours with 25,000 IU heparin (Unfractionated Heparin (UFH), heparinsodium-Braun, 25,000 I.E./5 ml, 2 ml/h) monitored by the partial thromboplastin time and subsequently underwent a control investigation every 6 months. The endpoint of the study was determination of symptomatic stenosis larger than 50% that required reintervention. Results: 239 (68.2% with mean age 68.02 years) male patients and 111 female patients (31.71% with mean age 62.92 years) were evaluated with complete follow-up. A total of 470 PTAs were performed on male patients and 213 on female patients in multiple interventions. The majority of patients at the time of treatment were in stage IIb according to the classification of Fontaine (81.6% of male patients and 68% of females). In our sample, peripheral arterial disease stage III and IV according to Fontaine classification occurred twice as frequently in female patients as in male patients (stage III in 12.6% in female versus 6.1% in male, and stage IV in 18% in female versus 8.9% in males). In both groups, the femoral superficialis artery was most frequently dilated (64 cases, 30% in female and 155 cases, 32.9% in male), followed by the iliacal communis artery (46 cases in female and 99 cases in male, both with 21.5%). A balloon angioplasty of the tibialis anterior and posterior arteries was performed twice as frequently in female patients as in male patients (28 cases with 13.1% of tibialis ant. artery in female versus 32 cases with 6.8% in male patients, and in 17 cases with 7.9% of tibialis post. artery in female versus 16 cases with 3.4% in male patients). In this study, without consideration of gender, patency rates of 79% after 2.5 years, 67% after 5 years, 49% after 7.5 years and 37% after 10 years were determined for PTA without stent implantation. Between the 7th and 10th year in follow-up, the cumulative patency rates for stent implantation was 49%, whereas it was 31% for PTA alone. The results of this study show that the stent assisted PTA`s of comm. artery and external iliacal artery are significantly independent of risk factors better than the femoral vessels, and these in female patients better than in male patients. Male patients do not benefit significantly from stent implantation in the long term. As the COXI and II regression analyses show, gender-linked results are most evident for renal insufficiency and diabetes mellitus, and less pronounced also for the number of open lower leg vessels. Conclusion: Under consideration of gender and risk factors, while male patients with diabetes mellitus, renal insufficiency and/or poor run-off did not benefit from stent implantation in the long-term, female patients with similar risk factors showed higher patency rates after stent therapy. In addition, the long-term results after PTA of femoral superficialis artery and poplitea artery are significantly worse than PTA of the pelvic vessels in both genders.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1098.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Assessment of cardiovascular and renal functions during treatment with Desmodium adscendens therapy</title>
<author>Seriki Samuel Adinoyi</author>
<pubDate>2020-06-09 00:00:00</pubDate>
<description>Desmodium adscendens is a rain forest medicinal herb used in managing quite a number of medical conditions. Its efficacy in the treatment of several diseases has made it a first line herb for doctors, especially in managing all forms of spasm. It is however common knowledge that some of these medicinal herbs impact severely on the normal functioning of some vital organs of the body during their administration. The present study was carried out to assess the renal and cardiovascular performance in subjects undergoing treatment with Desmodium adscendens with a view to advising against its indiscriminate use. The parameters used for the assessment of renal functions were serum creatinine and urea concentrations and their clearance. Also, changes in electrolyte concentration of Sodium, Potassium and Chloride concentration were used to assess cardiovascular performance. The histology of the kidney and heart tissues was also done to determine if the extract has impact on the cyto-architecture of the organs. Twenty-four (24) wistar rats were used for the experiment. The rats were grouped randomly into four groups (n = 6). Group 1 served as control, and the rats in the group were given normal rat feeds and water. Group 2 served as low dose group, and rats in this group were administered with low dose of extract 300 mg/kg. Group 3 served as medium group, and rats in this group were treated with medium dose of extract, 450 mg/kg. Group 4 served as high dose group, and rats in this group were treated with high dose of extract 600 mg/kg. The extract was administered for 28 days. Result showed that the extract did not impact negatively on the normal function of the renal and cardiovascular system of the treated groups, rather it enhanced their performances. It can therefore be concluded that the extract is beneficial to renal and cardiovascular functions if used within the treatment dosage.&nbsp;</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1097.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Prognosis of peripartum cardiomyopathy in sub-Saharan Africa (Burkina Faso South-West PPCM register)</title>
<author>Taryètba André Arthur Seghda,Théodore Boro,Jean Eudes Bambara,Kadari Cisse,Andrés Miguel Lopez,Patrice Zabsonre</author>
<pubDate>2020-05-19 00:00:00</pubDate>
<description>Peripartum cardiomyopathy is one of the curable cardiomyopathy. It&rsquo;s a severe and frequent disease arising among women of childbearing age. Its evolution in the long-term among some patients leads to chronic heart failure. Our study aims to determine from a prospective cohort, the factors associated with the non-recovery of myocardial function upon 12 months of diagnosis. Sociodemographic, clinical and echocardiographic data were collected at the time of diagnosis and then in months 3, 6 and 12. The outcome was the non-recovery of myocardial function at one year, defined by a left ventricular ejection fraction (LVEF) below 50%. 60 patients were analyzed after 12 months of follow-up. Mortality was about 13.3% and recovery rate of myocardial function reached 42.3%. After logistic regression, delay diagnosis and observance were the factors related to non- recovery of myocardial function.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1096.pdf</link>
</item>
<item>
<type>Review Article</type>
<title>Our experience with single patch repair of complete atrioventricular septal defects</title>
<author>Can Vuran,Uygar Yoruker,Oguz Omay,Bulent Saritas,Canan Ayabakan,Ozlem Sarisoy,Riza Turkoz</author>
<pubDate>2020-05-02 00:00:00</pubDate>
<description>Background: Various surgical methods have been utilized in the management of complete atrioventricular septal defects (CAVSD). Early intervention and achievement of a competent left atrioventricular valve are the key factors for successful treatment. Methods: A total of 66 patients with complete atrioventricular septal defect have been operated in a tertiary care center. Patient group consisted of 28 males and 38 females with an average age of 6.2 &plusmn; 3.3 months. Ventricular and atrial defects were repaired generally with single-patch technique using autogenous pericardium. Results: Preoperative catheterization and angiography was performed in 41 patients. Single patch and modified single patch techniques were preferred in 57 and 9 patients respectively. The average duration for respiratory support, intensive care unit stay and discharge from hospital were 36 &plusmn; 49.3 hours, 4.1 &plusmn; 1.9 days, and 10.1 &plusmn; 3.3 days respectively. In the left atrioventricular valve mild, moderate and severe regurgitation were detected in 44 (66.6%), 17 (25.7%) and 2 (3%) patients postoperatively. No regurgitation was determined in 3 patients (4.5%). Two cases ended up with mortality (3%). Conclusion: Single patch repair technique can provide satisfactory surgical outcomes in patients with complete atrioventricular septal defect.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1095.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Conservative treatment versus invasive approach in elderly patients with myocardial infarction without ST-segment elevation</title>
<author>Alexandra Cozma,Adriana Ardelean,Katalin Babes,Mircea Ioachim Popescu</author>
<pubDate>2020-04-30 00:00:00</pubDate>
<description>Myocardial infarction without ST segment elevation is one of the most common causes of hospitalization of the elderly patient [1]. Coronarography followed by revascularization, is performed in the vast majority of cases of myocardial infarction without ST segment elevation, in the regions with a well-developed health system. The decision to perform the procedure, the type of approach (early/late) and the selection of the type of myocardial revascularization depend on numerous factors such as: associated comorbidities, clinical presentation, the risk group in which the patient is framed, fragility, cognitive status, life expectancy etc. [2,3]. Older patients often present with various comorbidities, having a higher risk of complications and an unfavorable evolution. Thus, it was observed that invasively treatment is less commonly used in elderly patients with comorbidities, even if, the current guideline recommends that the invasive strategy should be considered in all patients with NSTEMI, regardless of age. At the same time, this subgroup of patients is not so well represented in the studies performed so far, the type of treatment chosen, being most often at the discretion of the attending physician [1,2]. Objective The present study aims to analyze the evolution of a subgroup of patients &ge; 70 years of age, with different comorbidities, with the diagnosis of myocardial infarction without ST segment elevation, according to the type of treatment applied: conservative versus invasive strategy (diagnostic coronarography &plusmn; revascularization, if appropriate).</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1094.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Effects of highest dose of sacubitril/valsartan association compared to lower doses on mortality and ventricular arrhythmias</title>
<author>Paul Milliez,Florent Allain,Damien Legallois,Katrien Blanchart,Laure Champ-Rigot,Arnaud Pellissier,Pierre Ollitrault,Mathieu Chequel,Rémi Sabatier,Alain Lebon,Sophie Gomes,Olivier Citerne,Farzin Beygui</author>
<pubDate>2020-04-24 00:00:00</pubDate>
<description>Background: Sudden cardiac death is a major healthcare issue in reduced ejection fraction heart failure (HFrEF) patients. Recently, the new association of sacubitril/valsartan showed a reduction of both ventricular arrhythmias (VA) and mortality even at low dose compared to enalapril in HF patients. The purpose of our study was to assess whether the highest dose of sacubitril/valsartan compared to lower doses may improve the rate of death and VA in a population of patients with HFrEF and with an implantable cardiac defibrillator (ICD). Methods: 104 HF patients with reduced EF under sacubitril/valsartan with an ICD were divided in 2 groups: the first one with the lower doses of sacubitril/valsartan (24/26 mg or 49 mg/51 mg twice daily) and the second with the maximal dose (97mg/103mg twice daily). The primary outcome was a composite of death or appropriate ICD therapy for VA. Results: After a median follow-up of 14 months, 39 patients were treated with lower doses and 65 patients with the highest dose. Patients from the lower doses group were older (70 [60-80] vs. 66 [60-70]; p = 0,03), more symptomatic at initiation (NYHA 3: 44% vs. 19%; p &lt; 0,01) and more often in atrial fibrillation (31% vs. 12%; p = 0,04). The primary composite endpoint occurred in 14 patients (36%) in the low doses group versus 7 patients (11%) in high dose group (p &lt; 0,01). This difference was particularly observed in the subgroup of patients with ischemic cardiomyopathy. In a multivariable analysis, the higher dose was independently associated with the primary outcome with an HR = 2,934 [IC 95% 1,147 &ndash; 7,504]; p = 0,03. Kaplan-Meier curve showed an early effect of the highest dose of sacubitril/valsartan association. Conclusion: Patients with HFrEF under the highest dose of sacubitril/valsartan showed better clinical outcomes with a decrease of both mortality or appropriated ICD therapies related to ventricular arrhythmias.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1092.pdf</link>
</item>
<item>
<type>Review Article</type>
<title>Glycosaminoglycans as Novel Targets for in vivo Contrast-Enhanced Magnetic Resonance Imaging of Atherosclerosis</title>
<author>Yavuz O Uca,Matthias Taupitz</author>
<pubDate>2020-04-20 00:00:00</pubDate>
<description>Atherosclerosis is an important promoter of cardiovascular disease potentiating myocardial infarction or stroke. Current demand in biomedical imaging necessitates noninvasive characterization of arterial changes responsible for transition of stable plaque into rupture-prone vulnerable plaque. in vivo contrast enhanced magnetic resonance (MR) imaging (MRI) allows quantitative and functional monitoring of pathomorphological changes through signal differences induced by the contrast agent uptake in the diseased vessel wall, therefore it is the ideal modality toward this goal. However, studies have so far focused on the cellular targets of persisting inflammation, leaving extracellular matrix (ECM) far behind. In this review, we portray ECM remodeling during atherosclerotic plaque progression by summarizing the state of the-art in MRI and current imaging targets. Finally, we aim to discuss glycosaminoglycans (GAGs) and their functional interactions, which might offer potential toward development of novel imaging probes for in vivo contrast-enhanced MRI of atherosclerosis.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1091.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Recurrence of atrial fibrillation after pulmonary vein isolation, should we change the energy and technique?</title>
<author>Jorge Toquero Ramos,Alejandro Durante-López,Jesús González Mirelis,Víctor Castro Urda,Eusebio García Izquierdo,Diego Jiménez Sánchez,Ignacio Fernández-Lozano</author>
<pubDate>2020-04-03 00:00:00</pubDate>
<description>Background: Pulmonary vein isolation (PVI) is the accepted standard nowadays for atrial fibrillation (AF) ablation. The most widespread ablation techniques are cryoballoon (CB) and point-by-point radiofrequency (RF) ablation. Comparative studies between both techniques have shown their equivalence for the first ablation procedure, but no trial has explored the potential incremental benefit of crossing over the ablation technique after AF recurrence. Objective: To explore the potential incremental benefit of a crossover ablation strategy for AF recurrences, comparatively with repeating the same ablation energy used for the first procedure. Methods: Retrospective analysis of patients undergoing a second AF ablation procedure after documented AF recurrence. Patients were excluded if all 4 PV were isolated at the beginning of the second procedure or extra-PVI ablation was used for the second procedure. Crossover group (n = 16) included patients in which two different techniques were used for the first and second procedure (CB-RF or RF-CB). Control group (n = 23) for those with same ablation procedure (RF-RF of CB-CB). Acute procedure end-point was PVI of all four pulmonary veins. Patients were followed-up at 3, 6, and 12 months with an electrocardiogram and a 24 h-holter. Arrhythmia-free survival at 1&thinsp;year after the second ablation procedure was studied, comparing efficiency and safety of the two approaches (crossover vs. same energy). Success was defined as freedom from AF or atrial tachycardia lasting &gt; 30 s off antiarrhythmic drugs (AADs) Results: A cohort of 39 paroxysmal and persistent AF patients was analyzed. PVI after the second procedure was 100% in all patients in both groups. There were no baseline relevant differences between the two groups. No deaths or hospitalizations occurred during follow up (data censored at 24h moths). At 1 year, arrhythmia free-survival was significantly higher in the crossover group compared to control group [93,3% vs. 47,8%; HR 0.19 (0.06-0.66);p = 0,009]. Conclusion: Crossing the ablation technique (point-by-point radiofrequency or cryoballoon PVI) after AF recurrence significantly improved arrhythmia free-survival at one year, despite no difference in acute success (PVI isolation). Randomized controlled trials with a higher amount of patients are needed to confirm the results and widespread this approach.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1090.pdf</link>
</item>
<item>
<type>Review Article</type>
<title>Primary prevention of SCD with ICD in the elderly</title>
<author>Fabio Maria Gemelli,Lucia Mancinelli,Olga Protic,Lorenzo Pimpini ,Roberto Antonicelli</author>
<pubDate>2020-03-30 00:00:00</pubDate>
<description>Implantable cardioverter defibrillators (ICDs) are electronic devices that can prevent sudden cardiac death (SCD) caused by arrhythmic events in patients. The latest ESC/EAS and ACC/AHA Guidelines deem the placement of an ICDs appropriate in patients with heart failure class NYHA II and III in the presence of an ejection fraction less than or equal to 35% [1,2]. ICDs are usually not indicated in either class I or IV patients. The Guidelines recommendations for primary prevention of SCD with ICD implantation do not take into account the age of the patients but only their life expectancy which must be at least 1 year. Our patients usually are over eighty years old with heart failure and severely reduced ejection fraction. We must consequently decide if it is right to implant these patients with an ICD. Is the use of ICD in the patients over 80, in particular over 90 years old, really make sense becomes particularly important considering demographic changes that await us in the coming decades.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1089.pdf</link>
</item>
<item>
<type>Review Article</type>
<title>Dapt Review</title>
<author>KARACA Özkan,KARASU Mehdi,KOBAT Mehmet A,KIVRAK Tarık</author>
<pubDate>2020-03-25 01:00:00</pubDate>
<description>Dual antiplatelet therapy (DAPT) combining aspirin and a P2Y12 receptor inhibitor has been consistently shown to reduce recurrent major adverse cardiovascular events (MACE) in patients with acute coronary syndrome (ACS) or undergoing percutaneous coronary intervention (PCI) for stable coronary artery disease (CAD) compared with aspirin monotherapy but at the expense of an increased risk of significant bleeding. Among patients with stable CAD undergoing PCI with drug-eluting stents (DES), shorter duration of DAPT (3–6 months) were shown non-inferior to 12 or 24 months duration concerning MACE but reduced the rates of major bleeding? Contrariwise, prolonged DAPT durations (18–48 months) reduced the incidence of myocardial infarction and stent thrombosis, but at the cost of an increased risk of majör bleeding and all-cause mortality. Until more evidence becomes available, the choice of optimal DAPT regimen and duration for patients with CAD requires a tailored approach based on the patient clinical presentation, baseline risk profile and management strategy. Patients with acute coronary syndromes (ACS) and a history of atrial fibrillation (AF) have indications for both dual antiplatelet therapy (DAPT) and oral anticoagulation (OAC). Triple therapy (TT), the combination of DAPT and OAC, is recommended in guidelines. This article provides a contemporary state-of-the-art review of the current evidence on DAPT for secondary prevention of patients with CAD and its future perspectives.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1088.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>A study on pacemaker pocket infection</title>
<author>Goutam Datta</author>
<pubDate>2020-03-25 00:00:00</pubDate>
<description>Objective: Cardiac implantable electronic device (CIED) infections now constitute &sim; 10% of all endocarditis cases. The incidence of CIED infection is usually &lt; 2%. Our objective was to study pacemaker pocket infection rate and different risk factors in our institution. Methods: This observational study was conducted over a period of five years from January 2011 to December 2016 and it included 1096 patients. Common risk factors like patients with diabetes, repeat procedure, chronic renal failure, chronic obstructive airway disease, immunosuppressive agents were studied in our patients. Results: Our study consisted of 1096 patients. Pacemaker pocket infection occurred in sixteen patients (1.5%). Chronic renal failure patients were one hundred thirty in our study (11.86%). There were three hundred fifty six diabetic patients (32.48%). Repeat procedure was done in ninety five patients (8.6%). Results: Our study consisted of 1096 patients. Pacemaker pocket infection occurred in sixteen patients (1.5%). Chronic renal failure patients were one hundred thirty in our study (11.86%). There were three hundred fifty six diabetic patients (32.48%). Repeat procedure was done in ninety five patients (8.6%) Eighty six patients were suffering from chronic obstructive airway (7.8%). Patients on immunosuppressive therapy were fourteen in our study (1.2%). Conclusion: Pacemaker pocket infections is a dreaded complication after pacemaker implantation. During implantation, there is a risk of device contamination with the patient&rsquo;s own skin flora and it can be prevented by ideal surgical asepsis technique, pre and perioperative use of antibiotics.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1087.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Clinical relevance linked to echocardiography diagnosis in Bland, White and Garland syndrome</title>
<author>Mariela Céspedes Almira,Adel Eladio González Morejón,Giselle Serrano Ricardo,Tania Rosa González Rodríguez</author>
<pubDate>2020-03-06 00:00:00</pubDate>
<description>Introduction: Bland, White and Garland syndrome is a coronary anomaly with high mortality without treatment. Its clinical presentation is varied which makes epidemiological documentation difficult. Echocardiography is a useful non-invasive tool for diagnosis. Objective: To determine the echocardiographic variables that lead to the diagnosis of Bland, White and Garland syndrome and their clinical relevance. Material: Observational, prospective and cross-sectional study in 31 patients of the &ldquo;William Soler&rdquo; Pediatric Cardiocenter, from 2005 to 2018. To check the association of echocardiographic variables with the diagnosis of Bland, White and Garland syndrome, an effectiveness study was carried out that included the analysis of the incidence of echocardiographic variables that lead to the diagnosis of this entity. The clinical relevance was estimated according to the minimum importance limit. The statistical validation of the research results adopted a significance level of less than 5% (p &lt; 0.05). Results: The variables that facilitate the echocardiographic diagnosis of Bland, White and Garland syndrome were the echocardiographic visualization of the anomalous connection and the reversed flow in the anomalous left coronary artery. These echocardiographic measures have clinical relevance according to the quantification of risk estimators (incidence) the echocardiographic visualization of the anomalous connection, RR 39.00 and the reversed flow in the anomalous coronary artery, RR 26.31. LIM&acute;s calculation value amounted to 6.31 and coincided with the risk estimators (incidence). Conclusion: The echocardiographic visualization of the anomalous origin of the left coronary artery from the pulmonary arterial trunk and the detection of the local intracoronary reversed flow instituted as factors to be considered for the effective diagnosis of the disease. The documentation of the diagnostic aspects of the syndrome through echocardiography contains high statistical value and clinical relevance.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1086.pdf</link>
</item>
<item>
<type>Case Report</type>
<title>Pathological left ventricular hypertrophy and outflow tract obstruction in an infant of a diabetic mother: A case report</title>
<author>Ujuanbi AS,Onyeka CA,Yeibake WS, Oremodu T,Kunle-Olowu OE,Otaigbe BE</author>
<pubDate>2020-03-03 01:00:00</pubDate>
<description>Background: Infants of diabetic mothers (IDMs) are at increased risk of developing congenital anomalies including cardiac defects. Pathological left ventricular hypertrophy, asymmetrical septal hypertrophy and outflow tract obstruction is a rare but known cardiac comorbidity in infants of diabetic mothers. The severity of this condition in IDMs can vary from an incidental finding on echocardiography to an infant with severe symptoms of congestive heart failure and specific management of the condition varies. Aim: The aim of this article is to report this clinical entity in a Nigerian infant born to a mother with poor glycaemic control in pregnancy and highlight management. Case report: We report a term neonate who was diagnosed as a case of pathological left ventricular hypertrophy, asymmetrical septal hypertrophy and outflow tract obstruction delivered to a mother with gestational diabetics with poor glycaemic control in pregnancy. Child was treated successfully with β-adrenergic blocker and showed resolution of hypertrophy in follow-up echocardiography. Conclusion: Infants of diabetic mothers are very high risk infants. Pathological left ventricular hypertrophy in IDM have good prognosis. Early recognition and prompt intervention is advocated.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1085.pdf</link>
</item>
<item>
<type>Review Article</type>
<title>His bundle pacing in heart failure: A review of current literature</title>
<author>Rahul Chaudhary,Jalaj Garg</author>
<pubDate>2020-03-03 00:00:00</pubDate>
<description>Biventricular (BiV) pacing revolutionized the heart failure management in patients with sinus rhythm and left bundle branch block; however, left ventricular-lead placement is not always technically possible. Also, BiV pacing does not fully normalize ventricular activation and, therefore, the ventricular resynchronization is imperfect. On the other hand, right ventricular pacing for bradycardia may cause or worsen heart failure in some patients by causing dyssynchronous ventricular activation. His bundle pacing comes as an alternative to current approaches as it activates the ventricles via the native His-Purkinje system, resulting in true physiological pacing, and, therefore, is a promising site for pacing in bradycardia and traditional CRT indications in cases where it can overcome left bundle branch block. Furthermore, it has the potential to open up new indications for pacing therapy in heart failure, such as targeting patients with PR prolongation, but a narrow QRS duration. In this article we explore the history, clinical evidence, proposed mechanisms, procedural characteristics, and the role in current therapy of His bundle pacing in the prevention and treatment of heart failure.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1084.pdf</link>
</item>
<item>
<type>Review Article</type>
<title>ECG interpretation and commentary</title>
<author>Samir Rafla,Ahmed Mokhtar,Amr Kamal</author>
<pubDate>2020-02-18 02:00:00</pubDate>
<description>This is demonstration of selected ECGs for learning or for exams; guided by lessons from great teachers as Prof. Hein Wellens MD. Here we provide advanced examples with comment and analysis.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1084.pdf</link>
</item>
<item>
<type>Review Article</type>
<title>Localization of the occluded vessel in acute myocardial infarction</title>
<author>Samir Rafla,Amr Kamal</author>
<pubDate>2020-02-18 00:00:00</pubDate>
<description>This is a review of features in ECG to diagnose the culprit artery responsible for the infarction. Localization of the occluded vessel in acute myocardial infarction is important for many reasons: to know which artery is to dilate and stent; to assess the severity of the lesion; to compare with the echocardiographic area with hypokinesia or akinesia and to differentiate the recent from the old occluded vessel. The ST-segment changes in 12-lead ECG form the basis of diagnosis, management, and prognosis.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1082.pdf</link>
</item>
<item>
<type>Mini Review</type>
<title>Angiotensin II type 1 receptor and the activation of Myosin Light-Chain Kinase and Protein Kinase C-βII: Mini Review</title>
<author>Gerry A Smith</author>
<pubDate>2020-02-17 00:00:00</pubDate>
<description>The involvement of the angiotensin II type 1 receptor in the Frank-Starling Law of the Heart, where the various activations are very limited, allows simple analysis of the kinase systems involved and thence extrapolation of the mechanism to that of angiotensin control of activation of cardiac and skeletal muscle contraction. The involvement of phosphorylation of the myosin light chain in the control of contraction is accepted but not fully understood. The involvement of troponin-I phosphorylation is also indicated but of unknown mechanism. There is no known signal for activation of myosin light chain kinase or Protein Kinase C-&beta;II other than Ca2+/calmodulin but the former is constitutively active and thus has to be under control of a regulated inhibitor, the latter kinase may also be the same. Ca2+/calmodulin is not activated in Frank-Starling, i.e. there are no diastolic or systolic [Ca2+] changes. I suggest here that the regulated inhibition is by myosin light chain phosphatase and/or &beta;-arrestin. Angiotensin activation, not involving G proteins. is by translocation of the &beta;-arrestin from the sarcoplasm to the plasma membrane thus reducing its kinase inhibition action in the sarcoplasm. This reduced inhibition has been wrongly attributed to a mythical downstream agonist property of &beta;-arrestin.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1081.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Gender-specific associations of anthropometric measures of adiposity with blood pressure and hypertension in young Chinese Medical College Students</title>
<author>Li-Hua Li,Navin Kumar Sah,Qing-Tao Zhang,Yong-Gang Li, Xue-Yan Yin</author>
<pubDate>2020-01-31 00:00:00</pubDate>
<description>Purpose: There are uncertainties about whether general or central obesity is the more important determinant for blood pressure and hypertension in young Chinese. We aim to investigate the association between adiposity measures and blood pressure and hypertension in young medical students. Methods: A total of 380 medical students were recruited from the 2012 batch in the Clinical College of Dali University. Anthropometric measures and office blood pressure were measured. Blood pressure status was defined by Chinese hypertension guidelines and ACC/AHA 2017 hypertension guidelines, respectively. We examined the associations of adiposity measures (body weight, body mass index [BMI], waist circumference, hip circumference, waist-to-hip ratio [WHR], waist-to-height ratio [WHtR], ponderal index [PI], body adiposity index (BAI) and conicity index [CI]) with blood pressure and hypertension by sex. Results: In 380 subjects (women 66.6%, mean age 21.5 years), the prevalence of obesity (BMI &ge; 28 kg/m2) was 2.1%, and the prevalence of hypertension was 2.6% (&ge; 140/90 mmHg) and 24.5% (&ge; 130/80 mmHg), respectively. In correlation analyses and multivariable-adjusted linear regression analyses, most adiposity measures of central obesity were significantly associated with blood pressure in men, while in women, either adiposity measures of central or general obesity were associated with blood pressure. The predictive power of adiposity measures for hypertension was generally low in men. However, adiposity measures of either general obesity or central obesity were predictive for hypertension defined by Chinese hypertension guidelines in women. Conclusion: There are gender-specific associations of central and general obesity with blood pressure and hypertension in young Chinese medical students.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1080.pdf</link>
</item>
<item>
<type>Case Report</type>
<title>Occluded superior vena cava and failed epicardial pacing: An unorthodox solution</title>
<author>Ranjit K Nath,Satyam Rajvanshi</author>
<pubDate>2020-01-13 01:00:00</pubDate>
<description>Permanent pacemaker implantation is conventionally done via upper limb veins. But in 1% - 6% cases, usual sub clavicular approach is either not possible or contraindicated due to complete occlusion of superior vena cava (SVC) or bilateral subclavian vein and/or bilateral implant site infection or thin skin [1]. Alternative approaches are warranted, including leadless pacemaker or complex lead extraction techniques, before considering surgical epicardial lead placement as a last resort because it has own hazards. We report a patient with complete heart block, total SVC obstruction, and a previously implanted malfunctioning epicardial lead presenting with pacemaker end of life. In view of exhaustion of the surgical option and in a resource constrained situation for lead extraction or leadless pacemaker, transiliac endocardial pacemaker implantation was done and a repeat surgery was averted. Learning objective: Complete venous occlusion is not very often encountered after pacemaker/ICD implantation. Apart from the risk of general anesthesia and invasive surgery, epicardial leads increase battery drain, and have a shorter operating life compared to an endocardial lead. The sparingly utilized iliac venous approach for permanent pacemaker implantation is a valuable, safe and minimally invasive alternative, when the conventional percutaneous access is unavailable, and surgery is undesirable or not possible. </description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1079.pdf</link>
</item>
<item>
<type>Case Report</type>
<title>Coronary-intercostal steal syndrome, a rare connection between the left circumflex coronary artery and intercostal arteries: A case report</title>
<author>Khaled H Alkhodari,Mohammed H Habib</author>
<pubDate>2020-01-13 00:00:00</pubDate>
<description>A 60-year-old female patient presented with typical anginal pain on exertion and relieved by rest for about one month. Percutaneous coronary angiography was done and showed an abnormal left circumflex coronary artery connecting to intercostal artery. Embolization of that abnormal connection was done successfully and the patient discharged from hospital after 24 hours. This case shows a new form of coronary steal syndrome. This cause could be missed if not put under the differential diagnosis of typical anginal pain with normal coronary arteries.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1078.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Effect of hemodialysis session on acute changes in inflammatory and cardiovascular risk biomarkers</title>
<author>Bernardo-Alio Lavín Gómez,María-Teresa García Unzueta,Armando-Raúl Guerra Ruiz,Sonia Pérez San-Martín,Ana Berja,Natalia Fañanás Rodríguez,Sara Díez Espejo,Domingo González-Lamuño Leguina</author>
<pubDate>2020-01-09 00:00:00</pubDate>
<description>Background: Inflammation is associated with enhanced cardiovascular risk profile and increased cardiovascular mortality in end-stage kidney disease patients undergoing hemodialysis. Mechanisms of activated acute phase reaction in patients on chronic hemodialysis remain to be identified. As successful treatment of the inflammatory condition in these patients may improve long-term survival, we studied potential changes in different inflammatory biomarkers of cardiovascular risk in end-stage kidney disease patients after a mid-week hemodialysis session. Methods: Inflammatory biomarkers of cardiovascular risk (cystatin-C, homocysteine, C-reactive protein, procalcitonin, pentraxin-3, serum amyloid-A) and atherogenic plasma lipoproteins (Lipoprotein(a), cholesterol low and high density lipoproteins) were studied in 21 end-stage kidney disease patients previously and after a mid-week hemodialysis session. Results: We found a significant reduction in serum levels of low molecular weight molecules: cystatin-C (5.56 to 1.85 mg/L, 66.73%, p &lt; 0.001), homocysteine (22.85 to 13.25 &micro;mol/L, 42.01%, p &lt; 0.001) and procalcitonin (0.788 to 0.457 ng/mL, 42.01%, p &lt; 0.001). Large molecules as C-reactive protein (9.70 to 9.90 mg/L, 2.06%, p = 0.022) and pentraxin-3 (1.67 to 4.28 ng/mL, 156%, p &lt; 0.001) increased, but serum amyloid-A decreased (15.90 to 12.70 mg/L, 20.13%, p &lt; 0.05). There was no change in Lipoprotein (a) levels. Conclusion: Pentraxin-3 was a more specific inflammatory vascular marker than C-reactive protein, and the best inflammatory marker associated with hemodialysis. Homocysteine, procalcitonin and the other small proteins could be released and removed during hemodialysis session. Further studies are needed to understand the behavior and significance of these markers after successive hemodialysis.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1077.pdf</link>
</item>
<item>
<type>Review Article</type>
<title>A proposed mechanism to explain increases in intracranial pressure: The concept of cerebral artery wedge pressure</title>
<author>DR Hamilton,A Mitha,MG Hamilton,JV Tyberg</author>
<pubDate>2020-01-08 00:00:00</pubDate>
<description>We hypothesize that, with elevated cerebral spinal fluid (CSF) pressure, cerebral micro-vascular obstruction and congestion may occur despite (subdural) large-vein pressures being normal. Smaller veins emptying into these larger, dura-enveloped veins are not immune to the compressive effects of elevated CSF pressure and a &ldquo;Starling Resistor&rdquo; mechanism might explain why elevated CSF pressures collapse these smaller veins. This small cerebral venous starling resistor compression mechanism may be the final common pathway for many patients suffering from increased CSF pressures and might also be an important contributor to impaired focal venous drainage presenting as a headache with normal venous sinus pressures.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1076.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Evaluation of the effect of coronary artery bypass grafting on the right ventricular function using speckle tracking echocardiography</title>
<author>Mahmoud Shawky Abdelmoneum,Neama Ali Elmeligy,Elsayed Abdelkhalek Eldarky,Mohamad Mahmoud Mohamad</author>
<pubDate>2019-12-30 00:00:00</pubDate>
<description>Purpose: This was a prospective study conducted at Benha University hospital and National Heart Institute on one hundred patients undwent coronary artery bypass grafting (CABG) to evaluate the effect of CABG on the right ventricular (RV) function using speckle tracking echocardiography (STE). Methods: All cases were subjected to detailed medical history, full physical examination, 12 leads electrocardiogram (ECG), routine laboratory tests including (complete blood picture, liver functions, renal functions and lipid profile) and echocardiography either conventional echocardiography or STE, all parameters obtained before and within 2 weeks after surgery. Results: By conventional echocardiography there was statistically significant decrease in peak right ventricle systolic velociy (RVS) from (12.76 &plusmn; 1.72) to (7.33 &plusmn; 1.71) and tricuspid annular plane systolic excursion (TAPSE) from (22.8 &plusmn; 3.99) to (13.77 &plusmn; 4.63) among the studied patients after CABG. While there was significant increase in right ventricle fractional area change (RVFAC) from (44.69 &plusmn; 3.25) to (49.01 &plusmn; 3.36). On the other hand, there was non-significant change in right ventricle end diastolic diameter (RVEDD) at mid-cavity from (26.37 &plusmn; 2.72) to (26.53 &plusmn; 2.72) and basal segment from (36.05 &plusmn; 2.98) to (36.29 &plusmn; 3.04), right ventricle stroke volume (RVSV) from (65.44 &plusmn; 7.02) to (65.85 &plusmn; 6.86) and right myocardial performance index (RMPI) from (0.491 &plusmn; 0.088) to (0.498 &plusmn; 0.086). By STE There was statistically significant decrease in right ventricle global longitudinal strain (RVGLS) from (-20.63 to -14.1) after CABG. There was statistically significant decrease in right ventricle free wall longitudinal strain [apical decreased from (-23.73 to -13.7), mid-cavity decreased from (-25.76 to -11.53), basal decreased from (-20.39 to -10.13) and lateral wall declined from (-23.01 to -9.13)]. There was statistically significant decrease in interventricular septum longitudinal strain [apical decreased from (-19.77 to -10.06), mid-cavity decreased from (-17.81 to -10.87) and basal decreased from (-15.89 to -11.13)]. There was statistically significant increase in RV circumferential strain of lateral free wall from (-12.04 to -16.21), while there was non-significant change in RV circumferential strain of septum from (-19.77 &plusmn; 4.86) to (-20.37 &plusmn; 5.14). Conclusion: Distorted RV geometry after CABG can lead to altered deformation parameters, in other words longitudinal functional parameters may underestimate RV function and the decrease in RVGLS was compensated by increase in circumferential strain of lateral free wall of RV without change in RVSV or RMPI. Therefor changes in deformation parameters should always be interpreted in relation to change in geometry.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1075.pdf</link>
</item>
<item>
<type>Case Report</type>
<title>Aortic dissection causing 2 myocardial infarctions</title>
<author>Sebastian Szabo,Hans Martin Hoffmeister</author>
<pubDate>2019-12-16 00:00:00</pubDate>
<description>A 56-year-old man was admitted to our hospital because of sudden onset of right-sided thoracic pain. The ECG showed inferior ST segment elevations. He has been treated with aspirin, clopidogrel, unfractionated heparin and tenecteplase, and his symptoms resolved after 30 minutes. About half an hour later, the patient developed again left-sided thoracic pain and the signs of an anterior myocardial ST-segment elevation infarction. 90 minutes after receiving the initial medications, the performed coronary angiography revealed a long dissection of a large ramus circumflexus. Furthermore, the left anterior descending coronary artery was occluded at about the mid-level. The left ventriculography showed a reduced ventricular function and a Stanford type A aortic dissection. Immediate patient transfer for emergency surgical intervention was arranged. However, ventricular fibrillation occurred during transport and he required endotracheal intubation and prolonged cardiopulmonary resuscitation. Unfortunately, he died during further transport. In a patient with massive thoracic pain of initially uncommon localization in combination with fluctuation of ST-segment elevations, aortic dissection should be seriously taken into the differential diagnosis as well as into therapeutic management decisions (in particular antiplatelet and thrombolytic therapy).</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1074.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Long-Term Impact of Coronary Artery Disease in Lung Transplantation</title>
<author>William S Ragalie,Nilto C de Oliveira,Richard Cornwell,Keith Meyer,James D Maloney</author>
<pubDate>2019-11-26 01:00:00</pubDate>
<description>Background: Adoption of the Lung Allocation Score (LAS) has led to increased listing of older patients and those with idiopathic pulmonary fibrosis (IPF) for lung transplantation (LTX). Older patients and those with IPF have higher prevalence of coronary artery disease (CAD), a relative contraindication for LTX. The impact of the LAS on CAD prevalence and cardiovascular morbidity in LTX recipients is unknown. Methods: Retrospective review of single institution database from January 2000 to December 2010. Patients with and without CAD were compared by age, gender, LAS, single vs double LTX, and transplant indication. Survival was calculated by Kaplan-Meier method, and statistical significance determined by log-rank method. Survival analysis was performed on all patients and by 3:1 propensity matching. Differences in CAD, gender, and indication were determined by Chi-squared test. Differences in LAS and age were calculated with a two-tailed t - test. Results: In the pre-LAS era, 6.2% (9/145) recipients had CAD vs. 9.2% (17/184) in the post-LAS era (p = 0.411). Among all patients, recipients with CAD had a worse long term survival as estimated by Kaplan-Meier method (p = 0.001), although there was no statistically significant difference after propensity matching ((p = 0.14). Although more recipients in the post-LAS era had a diagnosis of IPF [15/145 vs. 71/184 patients, (p &lt; 0.001)], there was no difference in the prevalence of CAD in the IPF cohort compared to others. There were no differences in cardiovascular deaths among recipients with CAD, with IPF, or in the post-LAS era. Patients with a pre-transplant diagnosis of CAD had an descreased risk of new onset postoperative atrial fibrillation (AF) (p = 0.007; HR:0.133; CI:0.030-0.583). Conclusion: Adoption of the LAS was not associated with a significant change in proportion of recipients with CAD who underwent LTX at our institution, despite an increase in recipients with IPF. Recipients with CAD had a higher risk of developing new postoperative AF and worse survival than patients without CAD. Differences in survival, however, could not be attributed directly to CAD based on propensity matched analysis</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1073.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Readjustment of antithrombotic therapy in stroke-patients owing to transesophageal echocardiography findings</title>
<author>Toralf Bruening,Mohamed Al-Khaled</author>
<pubDate>2019-11-26 00:00:00</pubDate>
<description>Objectives: Cardioembolic etiology is a frequent source of ischemic stroke. Echocardiogram is the mainstay of cardioembolic source detection with regard to plan secondary stroke management, however it remains unclear how often clinically actionable findings are provided hereby. In addition, it is uncertain whether echocardiography should be performed transthoracic or transesophageal (TEE). In a monocenter study, we evaluated the frequency of pathological findings from TEE evaluation in patients with ischemic stroke with suspected cardioembolic and cryptogenic source and determined whether there was an associated adjustment in the prescribed administration of antithrombotic therapy. Materials and Methods: Over a 21-month period (2012-2013), we enrolled 143 patients in a prospective monocenter study (mean age &plusmn; standard deviation, 70 &plusmn; 12 years; females, 44.1%) who were admitted to the Department of Neurology at the University of L&uuml;beck due to ischemic stroke and who underwent TEE due to supposed cardiac embolism. We assessed the presence of atrial fibrillation; days from admission to TEE; and TEE findings, including atrial septal aneurysm, thrombogenic aortic arch, valve failure, presence of left atrial thrombus, and patent foramen ovale. Demografic information and medical history were drawn from patient records and the hospital information system. Results: On average, TEE was performed 4 days after admission to the hospital. Left atrial thrombus was detected in 3 patients (2.1%), patent foramen ovale (PFO) in 27 (18.9%), atrial septum aneurysm in 17 (11.9%), and thrombogenic aortic arch in 29 (20.3%). Findings from TEE were commonly associated with therapeutic adjustment; antiplatelet therapy increased from 30.1% to 80.4%, oral anticoagulation therapy increased from 2.8% to 27.3%. Conclusion: Findings from TEE for the evaluation of ischemic stroke lead to frequent adjustment of prior antithrombotic therapy, antiplatelet as well as anticoagulation.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1072.pdf</link>
</item>
<item>
<type>Case Report</type>
<title>Resolved complete atrioventricular block and left ventricular severe dysfunction in patient with Wegener’s granulomatis after cyclophosphamide and corticosteroid treatment</title>
<author>Duc Dang,Lory Trevisan,Jérôme Bouet,Jérôme Taieb</author>
<pubDate>2019-11-25 00:00:00</pubDate>
<description>Wegener&rsquo;s granulomatosis is a systemic granulomatous focus on small to medium sized vessels. It typically affects sinuses, lungs and kidneys due to necrotizing granulomatous vasculitis. Less commonly, cardiac involvement is reported up to 8%-44% of cases [1-3]. It often rises to supraventricular arrhythmia, left ventricular systolic dysfunction, pericarditis, myocarditis, and valvulitis [4,5]. Cardiac conducting tissue involvement is rare and associated with increased mortality. It was only reported in fourteen previous cases, some of them were reversible to medical treatment [6].&nbsp;</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1071.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>The Renin-Angiotensin System: Alamandine is reduced in patients with Idiopathic Pulmonary Fibrosis</title>
<author>Taís Salvi Sipriani,Robson Augusto Souza dos Santos,Katya Rigatto</author>
<pubDate>2019-11-20 01:00:00</pubDate>
<description>Idiopathic Pulmonary Fibrosis (IPF) is a chronic and progressive disease without treatment that leads to death. Therefore, to control its progression to pulmonary hypertension is still a challenge. Moreover, there is no study that has investigated the Renin-Angiotensin System in patients with IPF. Objective: Verify the plasma concentrations of Angiotensin I, Angiotensin II (AngII), Angiotensin-(1-7) [Ang- (1-7)] and Alamandine in patients with IPF. Methods: Ten IPF patients, with or without PH, were included, and ten controls matched by sex and age. Quantitative plasma peptide concentrations (PPC) were expressed as mean and standard deviation or median and interquartile range. The Student Newman-Keuls t test was used for parametric data, Mann-Whitney for nonparametric data and, to compare proportions, the Fisher exact test was performed. The associations between clinical variables and the PPC were evaluated by Pearson or Spearman correlation coefficients. A p &le; 0.05 was considered statistically significant. Results: The Alamandine plasma concentration was significantly (365%) lower in the IPF group and positively associated (r = 0.876) with pulmonary artery pressure (PAP). In addition, only in control group, the forced expiratory volume (FEV1%) was positively associated (p = 0.758) with Ang-(1-7). Conclusion: This study showed, for the first time, that there is a decrease in Alamandine participation in patients with IPF. The ACE-AngII-AT1 axis may be more active in this disease. In addition, our results suggest that Alamandine might be compensating the increase in PAP, as well as the Ang-(1-7) is improving the forced expiratory volume.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1070.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Only low intensity of aerobic exercise improves respiratory compliance in pulmonary hypertensive rats</title>
<author>Katya Rigatto,Denielli Da SG Bós,Renata Fernandes,Rodrigo B Jaenisch,Pedro Dal Lago</author>
<pubDate>2019-11-20 00:00:00</pubDate>
<description>Objective: To investigate in an animal model of Pulmonary Hypertension (PH) by monocrotaline whether a lower exercise intensity, which has lower potential to provoke dyspnea symptoms, could prevent the increase the right ventricle pressure and the decrease in respiratory compliance. Setting: A research laboratory. ANIMALS: twenty-one Wistar rats were randomized to the groups: Control (CO; saline solution); PH-sedentary; PH-low and PH-moderate intensity of exercise training (ET). Interventions: They received a single saline or monocrotaline subcutaneous injection (50 mg/kg). The exercise program was performed during 3-weeks. Main Outcome Measures: Rats were evaluated by their morphometric and hemodynamic changes and by the respiratory mechanic responses induced by the exercise protocols. Results: Both protocols of ET significantly (p &lt; 0.05) attenuated the increase in the right ventricular systolic pressure. However, the lower intensity was more effective to prevent the impairment in the respiratory and quasi-static compliance. Conclusion: Collectively, our results showed for the first time the benefits of ET to the respiratory system mechanics. We also demonstrated that intensity is crucial in PH, probably due to the difficulty to match VO2 capacity and O2 demand during exercise. The improvement in quasi-static compliance not only might improve the ability to breathe, and capture oxygen, but also welfare.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1069.pdf</link>
</item>
<item>
<type>Editorial</type>
<title>Pulse Synchronized Contractions (PSCs)</title>
<author>Katherine A Lothman,Allen W Mangel</author>
<pubDate>2019-11-15 02:10:00</pubDate>
<description>A key platform underpinning the traditional understanding of the cardiovascular system, with respect to the behavior of large arterial vessels, is Otto Frank&rsquo;s Windkessel Hypothesis [1]. This hypothesis posits simply that the smooth muscle walls of large arteries do not undergo rhythmic contractions in synchrony with the heartbeat but, rather, behave as passive elastic tubes undergoing distension from pulsatile pressure waves. The Windkessel Hypothesis is elegant, well described for over a century, ingrained in the understanding of cardiovascular medicine and physiology, and simply wrong. Several groups have now shown that the arterial smooth muscle wall undergoes rhythmic activation in synchrony with the heartbeat in a variety of tissues, including human brachial artery; canine coronary, femoral, and carotid arteries; rabbit aorta; feline pulmonary artery and rodent aorta [2-8]. The phasing of these events is such that the upstroke of the contraction slightly precedes the upstroke of the pulse wave, suggesting nomenclature for the events as pulse synchronized contractions, or PSCs [3,6-8]. PSCs have been found to be of neurogenic origin, sensitive to the neural blocker tetrodotoxin [3,8]. Although the specific neural pathways regulating PSCs have not been elucidated, the alpha-adrenergic system is at least partially involved, as evidenced by reduction or blockade of PSCs by the alpha-adrenergic blocker phentolamine [8]. Further, PSCs have not been observed following vessel excision in in vitro studies, as an intact nervous system is not present. The pacemaker for the PSC resides in the right atrium, as suggested by two lines of evidence. First, pacing of the right atrial region to faster than spontaneous frequencies leads to a one-to-one correspondence of PSC frequency with the stimulation rate [3]. Additionally, excision of the right, but not the left, atrial appendage results in elimination of PSCs [3]. As the pacemaker region for PSCs and the heartbeat both lie in the right atrium, this may potentially allow for coordination between the heartbeat and pulse wave with PSCs [3,5,8]. Extensive evaluations also have been performed showing the PSC was not an artifact produced either by cardiac contractility or from the vessel distension from the pulse wave [3,5,6].</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1067.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Left ventricular ejection fraction and contrast induced acute kidney injury in patients undergoing cardiac catheterization: Results of retrospective chart review</title>
<author>Firas Ajam,Obiora Maludum,Nene Ugoeke,Hetavi Mahida,Anas Alrefaee,Amy Quinlan DNP,Jennifer Heck-Kanellidis NP,Dawn Calderon DO,Mohammad A Hossain,Arif Asif</author>
<pubDate>2019-11-15 02:00:00</pubDate>
<description>Background: Contrast-induced acute kidney injury (CI-AKI) is an important cause of increasing the hospital stay and in-hospital mortality. By increasing intra-renal vasoconstriction, left ventricular ejection fraction (LVEF) can increase the risk of CI-AKI. We sought to investigate whether LVEF can impact the incidence of CI-AKI after cardiac catheterization and whether it can be used to predict CI-AKI. Methods: Patients underwent cardiac catheterization from December 2017 to February 2018 at Jersey Shore University Medical Center were enrolled in the study. Contrast-induced acute kidney injury (CI-AKI) was defined as an increase in serum creatinine of &ge; 0.5 mg/dL or an increase of &ge; 25% from the pre-procedure value within 72 hours post-procedure. The maximum allowable contrast dose was calculated using the following formula: (5* (weight (kg)/creatinine level (mg/dL)). A multivariable logistic regression analyses, controlling for potential confounders, were used to test associations between LVEF and CI-AKI. Results: 9.6% had post catheterization CI-AKI. A total of 18 out of 44 (44%) of patients who had CI-AKI also had ongoing congestive heart failure. No statistically significant association found neither with maximum allowable contrast (p = 0.009) nor ejection fraction (p = 0.099) with the development of CI-AKI. Conclusion: In spite of the fact that no statistically significant relationship found between the percentage maximum contrast dose and the ejection fraction with the post-procedure CI-AKI, we heighten the essential of employing Maximum Allowable Contrast Dose (MACD) and ejection fraction in patients undergoing PCI to be used as a clinical guide to predict CI-AKI.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1066.pdf</link>
</item>
<item>
<type>Case Report</type>
<title>Hemoptysis after subclavian vein puncture for pacemaker implantation: A case report</title>
<author>Avishek Bagchi,Rajendra Kumar Agarwal,Kewa,Kishan Talwar</author>
<pubDate>2019-11-15 00:00:00</pubDate>
<description>Background: Subclavian venous access for pacemaker lead insertion is a common procedure and is normally considered safe in the hands of an expert. However, subclavian venepuncture is not without complications, starting from mild subcutaneous hematoma to pneumothorax. We here present a case of hemoptysis occurring after difficult subclavian vein puncture, which subsequently improved on conservative management only. Case Summary: A 65-year-old gentleman, post aortic valve replacement had persistent high-grade AV block and was taken up for a dual chamber pacemaker implantation. Immediately following venous access, he had a bout of hemoptysis, which recovered on its own. Post procedure chest x-ray was suggestive of alveolar hemorrhage which cleared gradually in next three-four days. Discussion: Post subclavian venepuncture hemoptysis is known; but it is a rare complication, arising either because of lung parenchyma injury or arterial injury. This is mostly benign and improves on conservative management only; however rarely it may be massive and life threatening where transcatheter arterial embolization may be required.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1065.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>A Systematic review for sudden cardiac death in hypertrophic cardiomyopathy patients with Myocardial Fibrosis: A CMR LGE Study</title>
<author>Sahadev T Reddy,Antonio T Paladino,Nackle J Silva,Mark Doyle,Diane A Vido,Robert WW Biederman</author>
<pubDate>2019-11-04 06:00:00</pubDate>
<description>Background: Hypertrophic cardiomyopathy (HCM) patients have a predisposition for malignant VT/VF and consequently, sudden cardiac death (SCD). In single center studies, late gadolinium enhancement (LGE) defined fibrosis has been linked to VT/VF. However, despite innumerable investigations, SCD has not been definitely attributable to LGE. Explanations for these are believed to be related to insufficient statistical power. Methods: We performed an electronic search of MEDLINE, PubMed: and CMR abstracts for original data published or presented between Jan 2001 to Mar 2011. Key search terms: HCM, LV fibrosis, SCD and LGE. Studies were screened for eligibility based on inclusion criteria: referral for CMR exam with LGE for HCM; and follow-up for incidence of VT/VF and SCD. Categorical variables were evaluated between patient groups via Chi-square test. Results: A total of 64 studies were initially identified. Of these, 4 (6.3%) were identified and included (n = 1063 patients). Three prospective and one retrospective study were included. LGE was detected in 59.6% of patients. As expected, the presence of myocardial fibrosis was associated with VT/VF (x2 = 6.5, p &lt; 0.05; OR 9.0, (95% CI 1.2 to 68.7). Moreover, myocardial fibrosis strongly predicted SCD (x2 = 6.6, p &lt; 0.05; OR 3.3 (95% CI 1.2 to 9.7). Conclusion: Despite single center CMR studies, LGE has consistently predicted VT/VF while prediction of SCD has remained paradoxically unlinked. Although the lack of studies meeting our criteria limited our ability to perform a comprehensive meta-analysis, we have been able to demonstrate for the first time that LGE-defined fibrosis is a predictor of SCD in patients with HCM0.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1064.pdf</link>
</item>
<item>
<type>Review Article</type>
<title>Do beta adrenoceptor blocking agents provide the same degree of clinically convincing morbidity and mortality benefits in patients with chronic heart failure? A literature review</title>
<author>Martin Mumuni Danaah Malick</author>
<pubDate>2019-11-04 03:00:00</pubDate>
<description>Chronic heart failure has been extensively characterized as a disorder arising from a complex interaction between impaired ventricular performance and neurohormonal activation. Since beta adrenoceptor blocking agents are currently considered an integral component of therapy for the management of patients with severe chronic heart failure; several well designed clinical trials have been conducted to determine the morbidity and mortality benefits of these agents these studies, however did not yield the same results in terms of morbidity and mortality benefits. Currently only Bisoprolol, Carvedilol and sustained release metoprolol succinate have clinically proven and convincing morbidity and mortality benefits the current list of approved medicines of the National Health Insurance Scheme (NHIS) of the republic of Ghana does not provide coverage for these lifesaving therapeutic agents. The objective of this review was to collate the relevant scientific evidence that will convince the authorities at the National Health Insurance Authority (NHIA) of the Republic of Ghana to include at least one of the evidence based beta adrenoceptor blocking agents in the list of approved medicines. A thorough search on the internet was conducted using Google scholar to obtain only the clinically relevant studies associated with the benefits of beta adrenoceptor blocking agents in patients with chronic heart failure published in the English language. The phrases beta adrenoceptor blocking agents and chronic heart failure were used as search engines. The search engine yielded several studies that met the predefined inclusion criteria. However, only the Cardiac Insufficiency BIsoprolol Studies (CIBIS-I and CIBIS-II), Carvedilol Prospective Randomized Cumulative Survival Study (COPERNICUS) and Metoprolol CR/XL Randomized Intervention Trial (MERIF-HF) because of the clinical relevance of their findings Beta adrenoceptor blocking agents such as atenolol and propranolol have been used in the management of patients with chronic heart failure. However, their efficacy and optimal dose in reducing mortality have not been scientifically established not all beta adrenoceptor blocking agents scientifically studied provide the same degree of clinically meaningful and convincing morbidity and mortality benefits in patients with chronic heart failure.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1063.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Diagnosis of critical congenital heart defects in Iceland 2000-2014</title>
<author>Hallfríður Kristinsdóttir,Þórður Þórkelsson,Hildur Harðardóttir,Gylfi Óskarsson</author>
<pubDate>2019-11-04 00:00:00</pubDate>
<description>Critical congenital heart defects (CCHDs) are preferably diagnosed prenatally or soon after birth. Late diagnosis has been related to poorer prognosis. The aim of this study is to assess when CCHDs are diagnosed in Iceland and whether late diagnosis is a problem. All live born children in Iceland and foetuses diagnosed with CCHDs during the years 2000-2014 were included. CCHD was defined as a defect requiring intervention or causing death in the first year of life, or leading to abortion. The total number of pre- and postnatal diagnosis of CCHDs was 188. Prenatal diagnosis was made in 69 of 188 (36.7%). Of 69 diagnosed prenatally 33 were terminated due to CCHD. Of the 155 live born children with CCHD, 36 (23.2%) had a prenatal diagnosis and 100 (64.5%) were diagnosed shortly after birth, before discharge from birth facility. 19 children (12.3%) were diagnosed late, that is after discharge from birth facility. Coarctation of the aorta was the most common CCHD diagnosed late (6/19). Prenatal screening and newborn examination give good results in diagnosis of CCHDs in Iceland. Late diagnosis are relatively few, but both the number of prenatally diagnosed CCHDs and CCHDs diagnosed shortly after birth can be further improved.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1062.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Evaluation of the predictive value of CHA2DS2-VASc Score for no-reflow phenomenon in patients with ST-segment elevation myocardial infarction who underwent Primary Percutaneous Coronary Intervention</title>
<author>Mahmoud Shawky Abd El-Moneum</author>
<pubDate>2019-10-28 00:00:00</pubDate>
<description>Objective: The aim of this study was to estimate the predictive clinical value of CHA2DS2-VASc score for no-reflow phenomena in patients having ST-segment elevation myocardial infarction (STEMI) who applied to primary percutaneous coronary intervention (PCI). Subjects and Methods: Three-hundred STEMI patients underwent primary PCI. They were classified into: group (1) included 27 patients with no-reflow and group (2) included 273 patients without no-reflow (control). CHA2DS2-VASc risk score was computed for each patient. Results: This study found statistically significant difference (p &lt; 0.05) in multivariate analysis of the association between CHA2DS2-VASc score and no-reflow phenomenon. The predictive power of individual components in CHA2DS2-VASc score for no-reflow was statistically significant difference (p &lt; 0.05). So, significantly higher CHA2DS2-VASc score is connected with higher risk of no-reflow and in-hospital mortality rate. Conclusion: Significantly higher CHA2DS2-VASc score is associated with higher risk of no- reflow phenomenon and in-hospital mortality rates in patients with STEMI who underwent primary PCI.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1061.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Impact of Pacemaker Implantation on 12-Month Resource Utilization Following TAVR Hospitalization</title>
<author>Steven D Culler,Aaron D Kugelmass,David J Cohen,Matthew R Reynolds,Phillip P Brown,April W Simon,Marc R Katz</author>
<pubDate>2019-10-21 00:00:00</pubDate>
<description>Purpose: This study reports resource utilization during a Medicare Beneficiary&rsquo;s (MBs) Transcatheter Aortic Valve Replacement (TAVR) index hospitalization and all subsequent encounters for 12 months and compares data between MBs who did or did not receive a pacemaker implantation (PPM) during their index hospitalization. Method: This retrospective study examined Medicare hospital claims from January 1, 2014 through June 30, 2015. 15,533 MBs who survived for 365 days were studied. Information from all encounters during the study period was combined to compare hospital resource utilization and outcomes. Results: 14.8% of MBs had a PPM during the index hospitalization. 46.0% of MBs had at least one readmission to a hospital during the 365-day follow-up period. 54.6% of MB&rsquo;s first hospital readmission occurred within 90 days of their TAVR discharge date. Average total Medicare reimbursement for all hospitalizations was $60,638 &plusmn; $28,974 associated with average total hospital length of stay of 11.2 &plusmn; 11.7 days. After adjusting for demographics and 47 comorbid conditions, MBs receiving a PPM during the index TAVR had significantly higher estimated Medicare reimbursement ($5,132) and longer total length of stay (1.8 days) for the entire study period than MBs not receiving a PPM. Conclusion: Total Medicare reimbursement and hospital LOS were significantly higher among MBs that had a PPM implantation during their index admission; however, there were no significant differences in readmission rates, readmission length of stay, or days to first readmission during the follow-up period between the two study cohorts.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1060.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>The effect of anemia on serum hepcidin levels in patients with heart failure</title>
<author>Betul Borku Uysal,Feray Akbas,Esma Altunoglu,Gulhan Ipek Denız,Duygu Uysal,Harun Uysal,Hanife Usta Atmaca,Yasin Yuksel,Hale Aral,Guven Cetın,Cem Ar M,Fusun Erdenen</author>
<pubDate>2019-10-17 00:00:00</pubDate>
<description>Background: Anemia is an accelerating problem among patients with heart failure (HF) and its presence is associated with more symptoms. In this study, we investigated whether anemia in heart failure was related to hepcidin concentration. Methods: 50 patients with heart failure and 20 healthy subjects with no history of a chronic illness including heart failure as control group, were included in the study. Heart failure was verified by echocardiography in each subject and patients were defined as ones with reduced ejection fraction (HFrEF) if EF &le; 40% and with preserved ejection fraction (HFpEF) if EF 40% - 50%. Blood samples were taken from all patients after 10-12 hours fasting. Anemia assessment was performed according to World Health Organization (WHO) criterias. Results: There was a positive correlation between hepcidin concentration and urea, ferritin, hemoglobin, hematocrite, C-reactive protein (p &lt; 0,05). Hepcidin concentrations of anemic heart failure patients were significantly lower than the non-anemic heart failure patients (p &lt; 0,05). Conclusion: We found that serum hepcidin concentration in anemic patients with heart failure was lower than in heart failure patients without anemia. We believe that iron defiency occurs as a result of inflammatory process in heart failure and therefore hepcidin concentrations decrease as a response. However, long-term follow up studies are needed.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1059.pdf</link>
</item>
<item>
<type>Case Report</type>
<title>Scintigraphic non-invasive diagnosis of amyloid cardiomyopathy</title>
<author>Laroussi Mohamed-Salem,Tomás E Rodríguez-Locarno,Tatiana Moreno-Monsalve,Isabel Castellón-Sánchez,José F Contreras-Gutiérrez ,Antonia Claver-Valderas</author>
<pubDate>2019-10-04 01:00:00</pubDate>
<description>Amyloidosis encompasses a heterogeneous group of disorders, characterized by extracellular deposition of insoluble abnormal amyloid aggregates, due to a failure in protein quality control. Cardiac amyloidosis is a disorder in which proteins misfold and deposit as amyloid fibrils that infiltrate the myocardial extracellular space [1]. Transthyretin (ATTR) and light chain (AL) are the most frequent types of cardiac amyloidosis. Transthyretin is a protein mainly synthesized by the liver, it may be hereditary or acquired from either wild-type (ATTRwt) or mutant (ATTRm) amyloid [2]. Cardiomyopathy is a common manifestation of ATTR amyloidosis with a particularly poor life expectancy of 2 to 6 years after diagnosis [3]. Although considered rare, the prevalence of this serious disease is likely underestimated because symptoms can be non-specific, and diagnosis largely relies on amyloid detection in tissue biopsies.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1058.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Plaque morphology in diabetic vs. non diabetic patients assessed by Multi-Slice Computed Tomography coronary angiography</title>
<author>Hesham Mohamed Aboul-Enein,Amr Elsayed El Naggar,Shereen Ibrahim Farag,Waleed Atef Ahmed Hassan</author>
<pubDate>2019-10-04 00:00:00</pubDate>
<description>Background and Objectives: Multi-slice computed tomography (MSCT) provides high accuracy for noninvasive assessment of coronary artery disease (CAD). The introduction of the latest computed tomography technology allows comprehensive evaluation of various aspects of CAD, including the coronary calcium score, coronary artery stenosis, bypass patency, and myocardial function. This study aimed to assess the effect of DM on coronary arteries evaluated by MSCT-CA Comparing Plaque Morphology in Diabetic patients with Non-Diabetic Whoever Controlled or not assessed by HbA1c. Methods: In this study we randomly assigned 150 adult patients were diagnosed with suspected coronary artery disease underwent MSCT-CA for evaluation their coronaries regarding luminal stenosis, Plaque analysis, Remodeling index, SSS, SIS and Ca score. Results: There was statistically significant difference between diabetics &amp; non-diabetic groups in LM lesions with (P = 0.029). also, the results of multivariate logistic regression analysis after adjustment for age and sex, diabetics were shown a trend toward more mixed plaque with statistically significant {(OR): 3.422, 95% CI 1.66-7.023, P = 0.001}; whereas, after adjustment for age, sex, history of hypertension, smoking, and hypercholesterolemia, patients with diabetes also shown a trend toward more mixed plaque with statistically significant (OR: 3.456, 95% CI 1.668-7.160, P = 0.001). It means significant differences in coronary atherosclerotic plaque burden and composition between diabetic and non-diabetic patients, with a higher proportion of mixed plaques, a more vulnerable form of atherosclerotic plaque in diabetics (P &lt; 0.001) otherwise No significant difference. Conclusion: MSCT angiography may be useful for the identification of CAD in diabetic and non-diabetic patients. There were statistically significant differences in coronary atherosclerotic plaque burden and composition, with a higher proportion of mixed plaques, between diabetic and nondiabetic patients. Furthermore, MSCT may give accurate information about plaque characteristics according to different coronary risk factors, thereby identifying high risk features warranting a more intensive anti-atherosclerotic treatment.&nbsp; &nbsp;</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1057.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Prevalence of congenital heart diseases among primary school children in the Niger Delta Region of Nigeria, West Africa</title>
<author>Ujuanbi Amenawon Susan,Tabansi Petronilla Nnena,Otaigbe Barbara Edewele</author>
<pubDate>2019-09-26 00:00:00</pubDate>
<description>Introduction: Congenital heart diseases (CHD) are leading causes of childhood morbidity and mortality especially in developing countries. Community-based studies are important in ascertaining the burden of the disease. Objectives: The study was set out to determine the prevalence and types of CHD among primary school children in Port Harcourt Local Government Area (PHALGA) of Rivers State, Niger Delta, Nigeria. Methods: A total of 1,712 primary school pupils were selected by multistage sampling from twelve schools in PHALGA. A questionnaire was used to obtain information from pupil&rsquo;s parents on their child&rsquo;s biodata and symptoms suggestive of heart disease. General physical and cardiovascular system examinations were carried out on each selected pupil, following which those with symptoms and/or signs suggestive of heart disease had echocardiographic confirmation of their cardiac status. Results: The 1,712 subjects were aged 5-14 (mean 8.48 &plusmn; 2.30) years. 874 (51.1%) were females while males were 838 (48.9%). The study revealed that 31 pupils had congenital heart diseases confirmed by echocardiography, giving a prevalence of 18.1 per 1,000 pupils. The commonest cardiac defects seen were acyanotic CHD in 30 (96.8%) pupils while cyanotic CHD was seen in only one (3.2%) pupil. Among the acyanotic CHD, atrial septal defects (83.9%) followed by ventricular septal defects (9.7%) were the commonest. CHD occurred with higher frequency among females (64.5%) and among the younger age group of 5-9 years (61.3%) though these were not statistically significant (p &gt; 0.005). Conclusion: Cardiac examination as part of compulsory health screening at primary school entry will help detect children with CHD, reduce delay in diagnosis for intervention, avert debilitating morbidity and assure a better quality of life.&nbsp;</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1056.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Novel paclitaxel-coated balloon angioplasty via single retrograde popliteal access for challenging superficial femoral artery and iliac artery lesions?</title>
<author>Erdem Cetin,Celal Selcuk Unal,Aydın Keskin,Hakan Kartal</author>
<pubDate>2019-09-24 00:00:00</pubDate>
<description>Objectives: We report our results regarding the use of BioPath&trade; paclitaxel-coated balloon catheters for superficial or distal external iliac artery revascularization via single retrograde popliteal access. Methods: We included 105 prospective consecutive patients. Single retrograde popliteal access was achieved under ultrasound guidance with the patients laid prone. An over-the-wire atherectomy system was used if risk of distal embolization was high due to plaque intensity of the target lesion. A 4 to 7 mm-diameter BioPath&trade; 035 balloon catheter was used for all lesions. Follow-up at 6th month included doppler ultrasound examination for patency. Results: Seventy-two patients (68.6%) had total SFA occlusion and 41 patients (39%) had concomitant external iliac artery involvement, out of whom 31 (29.5%) had total occlusion. Procedural success 90.5% for superficial femoral artery and 85.3% for external iliac artery. One-year patency rates in SFA and EIA were 84.8% and 80.4%, respectively Conclusion: Single retrograde popliteal access and drug-coated balloon angioplasty may offer a useful alternative to known modalities in treatment of challenging superficial femoral artery and concomitant iliac artery lesions</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1055.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Arrhythmia of the heart - computer analysis</title>
<author>VI Kaganov</author>
<pubDate>2019-09-20 00:00:00</pubDate>
<description>The problem of synchronization of oscillations of various physical nature is discussed. From the standpoint of the theory of synchronism, a model of the heart is considered as a system of four connected between self-oscillating links: two atria and two ventricles. The synchronous and asynchronous operating modes are considered at sinusoidal and relaxation oscillations. A computer program has been compiled that simulates the fluctuations in the heart using four differential equations. Four examples of calculation according to the program are given for asynchronous and synchronous operation modes. The possibility of evaluating the ablation procedure from the perspective of a computer model is discussed.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1053.pdf</link>
</item>
<item>
<type>Review Article</type>
<title>A mouse model of coronary microvacsular disease using a photochemical approach</title>
<author>Xinlu Wang,Fang Liu,Zhen W. Zhuang</author>
<pubDate>2019-09-18 00:00:00</pubDate>
<description>The development of reproducible rodent models of coronary microvascular disease (MVD) is essential for the early detection, treatment, and mechanism study of the pathophysiology. We hypothesized that endothelial dysfunction and subsequent microthrombi in the coronary arterioles, two early events in clinical coronary MVD, could be reproduced by photochemical reaction (PCR) technology in mice hearts. After rose bengal (one of photosensitizers) was administrated systemically, a green light was locally used to activate the photosensitizer, inducing over-production of oxidative stress in the heart. Following PCR, animals demonstrated reproducible endothelial injury, occlusion in arterioles, focal ischemia, and infarct-let with preserved cardiac function. Our technique has proven to be a reliable and reproducible means of creating coronary MVD in mice. We believe that this is an ideal model for developing a novel molecular tracer for earlier detection of coronary MVD, for testing new anti-fibrinolytic drugs, and for investigating the complex pathophysiology of coronary MVD. The protocol for establishing this model takes about thirty to forty minutes.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1052.pdf</link>
</item>
<item>
<type>Case Report</type>
<title>Anomalies of coronary artery origin: About two cases</title>
<author>Dioum M,Sarr EM,Manga S,Mingou JS,Diack A,Diop AD,Bindia D,Diagne PA,Sarr AN,Diop IB</author>
<pubDate>2019-09-13 00:00:00</pubDate>
<description>Anomalies of coronary artery origin are congenital malformations characterized by the abnormal birth of a coronary artery from the controlateral coronary aortic sinus (birth of the left coronary artery from the right sinus or birth of the right coronary artery from the left sinus). The artery concerned has an abnormal initial path between the aorta and the pulmonary artery; this segment is most often intramural, in the aortic wall. They are rare with a prevalence (0.1% to 0.3% of the population). They pose a high risk of sudden stress death related to exercise myocardial ischemia. The most common mode of discovery is aborted sudden death, but sometimes fortuitously. The contribution of multi-round CT is described for the positive diagnosis of these anatomical variations, sometimes delicate in coronary angiography, but also for the distinction between &ldquo;benign&rdquo; and &ldquo;malignant&rdquo; forms, potentially responsible for myocardial ischemia. Treatment is usually surgical in symptomatic forms. We report the cases of two patients with coronary connection abnormalities discovered in adulthood.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1051.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>How often is Klippel-Feil Syndrome associated with congential heart disease presentation of five cases and a review of the literature</title>
<author>Ramush Bejiqi,Ragip Retkoceri,Arlinda Maloku,Rinor Bejiqi,Aferdita Mustafa,Faruk Husremovic,Samir Bejic</author>
<pubDate>2019-09-03 00:00:00</pubDate>
<description>Introduction: Klippel-Feil syndrome (KFS), is a bone disorder characterized by the abnormal joining (fusion) of two or more spinal bones in the neck (cervical vertebrae), which is present from birth. Three major features result from this abnormality: a short neck, a limited range of motion in the neck, and a low hairline at the back of the head. In some individuals, KFS can be associated with a variety of additional symptoms and physical abnormalities which contribute in the deterioration and complication of the condition of the child. Aim of presentation: Here, we report five children from Kosovo with KFS associated with different heart abnormalities, clinical presentation, diagnosis, management, and outcomes of selected conditions in resources-limited settings. Methods: Retrospectively we analysed medical reports of five children, diagnosed at different age with congenital disease and clinical and lab signs of Klippel-Feil syndrome. Conclusion: Basing on our cases, all diagnosed in a small country as a Kosovo, we can conclude that KFS is not such a rare condition. In addition, such syndrome is not so rarely associated with different congenital heart disease. In four cases cardiac surgery was indicated and successfully was done abroad Kosovo in the lack of such services in Kosovo.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1051.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Role of novel cardiac biomarkers for the diagnosis, risk stratification, and prognostication among patients with heart failure</title>
<author>Jennifer Miao,Joel Estis,Yan Ru Su,John A Todd,Daniel J Lenihan</author>
<pubDate>2019-08-22 00:00:00</pubDate>
<description>Background: Current guidelines for diagnosis and management of heart failure (HF) rely on clinical findings and natriuretic peptide values, but evidence suggests that recently identified cardiac biomarkers may aid in early detection of HF and improve risk stratification. The aim of this study was to assess the diagnostic and prognostic utility of multiple biomarkers in patients with HF and left ventricular systolic dysfunction (LVSD). Methods: High-sensitivity cardiac troponin I (cTnI), N-terminal pro b-type natriuretic peptide (NT-proBNP), interleukin-6 (IL-6), endothelin-1 (ET-1), pro-matrix metalloproteinase-9 (pMMP-9), and tumor necrosis factor-alpha (TNF-&alpha;) were measured using single-molecule counting technology in 200 patients with varying stages of HF. Plasma detection with cross-sectional associations of biomarkers across all HF stages, and advanced-therapy and transplant-free survival were assessed using multivariate analysis and Cox regression analyses, respectively. Results: NTproBNP, pMMP-9, IL-6 were elevated in early, asymptomatic stages of HF, and increased with HF severity. Higher circulating levels of combined IL-6, NTproBNP, and cTnI predicted significantly worse survival at 1500-day follow-up. Cox regression analysis adjusted for ACC/AHA HF stages demonstrated that a higher concentration of IL-6 and cTnI conferred greater risks in terms of time to death, implantation of left ventricular assist device (LVAD), or heart transplantation. Conclusion: Biomarkers of inflammation, LV remodeling, and myocardial injury were elevated in HF and increased with HF severity. Patients had a significantly higher risk of serious cardiac events if multiple biomarkers were elevated. These findings support measuring NTproBNP, cTnI and IL-6 among patients with HF and LVSD for diagnostic and prognostic purposes.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1049.pdf</link>
</item>
<item>
<type>Case Report</type>
<title>Late discover of a traumatic cardiac injury: Case report</title>
<author>Benlafqih C,Bouhdadi H,Bakkali A,Rhissassi J,Sayah R,Laaroussi M</author>
<pubDate>2019-08-19 00:00:00</pubDate>
<description>Blunt chest trauma leads to a wide range of lesions, relatively minor parietal injuries to potentially fatal cardiac lesions, making diagnosis and management difficult. The diagnosis is currently facilitated by imaging, however, these lesions may go unnoticed and be discovered late through complications. We report the case of a neglected heart wound revealed by a heart failure. This case is notable due to a favourable outcome despite a delay in diagnosis due to a lack of pericardial effusion and the absence of cardiac symptoms, and a long delay from injury to appropriate treatment in the presence of a penetrating cardiac wound deep enough to cause a muscular ventricular septal defect and lacerate the anterior mitral leaflet.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1048.pdf</link>
</item>
<item>
<type>Review Article</type>
<title>Timing of cardiac surgery and other intervention among children with congenital heart disease: A review article</title>
<author>Chinawa JM,Adiele KD,Ujunwa FA,Onukwuli VO,Arodiwe I,Chinawa AT,Obidike EO,Chukwu BF</author>
<pubDate>2019-08-09 00:00:00</pubDate>
<description>Background: Early diagnosis and improved facilities are necessary for determining the optimal timing of surgery and other interventions in children with congenital heart diseases in Nigeria. This is because late presentation, late diagnosis and delayed surgery can lead to mortality and affect the quality of life among these children. Objectives: This review article is aimed at enumerating the timing of cardiac surgeries and other interventions and to seek if there is any factor associated with the timing of cardiac surgery. Methods: A search on PubMed database, World Health Organization libraries, Google scholar, TRIP database, and reference lists of selected articles on timing of cardiac surgery in children was done. The Cochrane Database of Systematic Reviews was also searched. We noted few data from African setting. Key words such as timing of cardiac surgery; children, congenital heart defect were used. Conclusion: Appropriate timing for cardiac surgery in children with congenital heart disease is very important as late surgical intervention could result in several morbidities and mortality.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1047.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>P wave dispersion in patients with premenstrual dysphoric disorder</title>
<author>Seyda Yavuzkir,Suna Aydin,Melike Baspinar,Sevda Korkmaz,Murad Atmaca,Rulin Deniz,Yakup Baykus,Mustafa Yavuzkir</author>
<pubDate>2019-07-31 01:00:00</pubDate>
<description>Background: Growing evidence has revealed that fear and anxiety related situations could affect cardiac parameters. P wave dispersion (Pd) is an important index. In the present study, we aimed to evaluate Pd values in patients with premenstrual dysphoric disorder. Methods: The study was composed of twenty-five female patients with premenstrual dysphoric disorder and same number of healthy controls. Pd, Pmin and Pmax values were determined by electrocardiogram (ECG) in the subjects. Results: It was found that patients with premenstrual dysphoric disorder had considerably higher Pmax and Pmin values compared to those of healthy subjects. Pd was also significantly higher in patients with premenstrual dysphoric disorders than that of healthy subjects. Conclusion: Study suggests that patients with premenstrual dysphoric disorder seems to have increased Pd, as can be seen in anxiety and fear related clinical conditions, considering that this group of patients have an increased trend to cardiac abnormalities, particularly cardiac arrythmias. To access strong conclusion, it is required novel studies with larger samples.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1046.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Preclinical stiff heart is a marker of cardiovascular morbimortality in apparently healthy population</title>
<author>Charles Fauvel,Michael Bubenheim,Olivier Raitière,Charlotte Vallet,Nassima Si Belkacem,Fabrice Bauer</author>
<pubDate>2019-07-31 00:00:00</pubDate>
<description>Background: The prognostic significance of impaired left ventricular (LV) relaxation and increased LV stiffness as precursor of heart failure with preserved ejection fraction and death is still largely unknown in apparently healthy subjects. Methods: We constituted a cohort of 353 patients with normal ejection fraction (&gt;45%) and no significant heart disease, based on a total of 3,575 consecutive left-sided heart catheterizations performed. We measured peak negative first derivative of LV pressure (-dP/dt) and operating chamber stiffness (&Kappa;) using a validated equation. Patients were categorized as having: 1) normal diastolic function, 2) isolated relaxation abnormalities (-dP/dt &gt; 1860mm Hg/sec and K &lt;0.025mm Hg/ml), or 3) predominant stiff heart (K &ge;0.025mm Hg/ml). Results: During a follow-up of at least 5 years, the incidence of the primary composite endpoint (death, major arterial event, heart failure, and arrhythmia) was 23.2% (82 patients). Compared to isolated relaxation abnormalities, predominant stiff heart showed stronger prognostic significance for all events (p=0.002), namely heart failure (HR, 2.9; p=0.0499), cardiac death (HR, 5.8; p=0.03), and heart failure and cardiac death combined (HR, 3.7; p=0.003). Conclusion: In this apparently healthy population referred to our center for cardiac catheterization, the prevalence of diastolic dysfunction was very high. Moreover, predominant stiff heart was a better predictor of cardiovascular outcomes than isolated relaxation abnormalities.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1045.pdf</link>
</item>
<item>
<type>Case Report</type>
<title>Severe Infantile Coarctation and Mid Aortic Stenosis in Williams Syndrome</title>
<author>Lousararian Marina,Troglia Ana,Cabrera María J,Alday Luis E</author>
<pubDate>2019-07-30 00:00:00</pubDate>
<description>We report a challenging patient with Williams syndrome and severe coarctation of the aorta. As in a few similar cases reported, several surgical and catheter interventions for recoarctation, intrastent intimal proliferation and stenosis of the left sub-clavian artery were required. Aortic patch angioplasty is planned for the future in a grower child.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1044.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Assessment of lipid and hematological profile among blood donors in European Gaza Hospital, Palestine</title>
<author>Ahmad M Tabash,Wesam M Afana,Abdrabbou M Elregeb,Sameer Abu Eid,Ayman M Abu Mustafa</author>
<pubDate>2019-07-16 01:00:00</pubDate>
<description>Background: There is an important shortage of blood in the greatest blood banks worldwide to meet up with requirements for numerous medical interventions. Limited studies have associated regular blood donation to the lowering of lipid function parameters. Assessing the lipid function is a classical method of evaluating an individual&rsquo;s risk for coronary heart disease. Objective: The general goal of the study is to determine lipid and hematological profile among blood donors in European Gaza Hospital, Palestine. Materials and Methods: This study was a case-control study that involved 120 male, 40 of whom were regular blood donors (study group), 40 first time donors and 40 non- donors (control group) aged between 18-60 years. A volume of 5ml venous blood was drawn from each fasting participant into a dry biochemistry screw-capped tube. This was allowed to clot and the serum was used to determine total cholesterol (TC), triglycerides, High-density lipoprotein cholesterol (HDL-C), Low-density lipoprotein cholesterol (HDL-C), while HDL-C/LDL-C and TC/LDL ratio were calculated by using the following formula. Anthropometric parameters (weight, height) of donors were measured using standard protocol. The height (in meter), weight (in kilogram) were used to calculate the body mass index (BMI) using the following formula. BMI= weight (kg)/ (height in meter)&sup2; and blood was collected from each participant in EDTA (for hematocrit, ESR). Three groups were matched for age and BMI. Data were analyzed using SPSS version 23. Chi-square (&chi;&sup2;) was used to compare the relationship between categorical variables, ANOVA was used to measure the difference between means. Data were summarized using tables, pie charts, histograms. A P-value &lt; 0.05 was considered to be statistically significant for all tests conducted. Results: The mean total cholesterol (169&plusmn;10.85 mg/dl), triglycerides (116&plusmn;9.73 mg/dl), HDL (54&plusmn;2.5 mg/dl ), LDL (92&plusmn;11.4mg/dl), LDL/HDL ratio (1.73&plusmn;0.25) and TC/HDL ratio (3.16&plusmn;0.26) were lower in the regular blood donors than the first time donors(198&plusmn;10.13, 179&plusmn;5.82, 42.33&plusmn;1.6, 120&plusmn;11.2, 2.85&plusmn;0.36, 4.7&plusmn;0.40) and non- donors (202&plusmn;10.19, 180&plusmn;12.68, 41.75&plusmn;1.4, 125&plusmn;11.7, 2.99&plusmn;0.33, 4.86&plusmn;0.32) respectively and statistically significant (P &lt; 0.05).The mean ESR (6.63&plusmn;0.87mm/hr) was lower statistically significant in the regular blood donors than the first time donors (7.40&plusmn;1.17) and non- donors (7.60&plusmn;1.48) respectively (P &lt; 0.05). The mean HCT (42.98&plusmn;0.86%) was lower statistically significant in the regular blood donors than the first time donors (44.63&plusmn;0.90) and non- donors (44.75&plusmn;0.74, P &lt; 0.05). Conclusion: Regular donors have reduced risk of developing coronary heart disease as reflected by the low total cholesterol, triglycerides, LDL-c, LDL-c/HDL-c ratio, TC/HDL-c ratio and HCT and high HDL. BMI in regular donor was less than the donor for the first time and did not donate, but did not reach the statistical significance. Also in our study regular donors have reduced risk of developing inflammation as reflected by low ESR.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1043.pdf</link>
</item>
<item>
<type>Case Report</type>
<title>Single Trans apical access for double aortic and mitral valves-in-valves procedures with high risk of thrombus embolism</title>
<author>Julien Adjedj,Mathias Kirsch,Anna Nowacka ,Olivier Muller</author>
<pubDate>2019-07-16 00:00:00</pubDate>
<description>Background: Persistent left atrial thrombus remains a contra indication to transeptal valves in valves procedure. We aimed to perform a double valves in valves replacement through transapical access with cerebral angiography control during the procedure just after implantation. Our case shows the feasibility of this strategy and the management of right ventricle laceration successfully treated after extra corporeal membrane oxygenation implantation and local hemostasis. We reported a feasibility case report of successful double valves in valves implantation through transapical access with 6 months of clinical and computed tomography follow up.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1042.pdf</link>
</item>
<item>
<type>Review Article</type>
<title>Cardiomyopathies - The special entity of myocarditis and inflammatory cardiomyopathy</title>
<author>Felicitas Escher,Uwe Kühl,Dirk Lassner,Heinz-Peter Schultheiss</author>
<pubDate>2019-07-01 00:00:00</pubDate>
<description>Cardiomyopathy is a heart muscle disease with structural and functional myocardial abnormalities in the absence of coronary artery disease, hypertension, valvular disease, and congenital heart disease. However, it has become clear that diverse etiologies and clinical manifestations (e.g. arrhythmogenic right-ventricular cardiomyopathy/dysplasia (ARVC/D), ARVD/C, left-ventricular non-compaction cardiomyopathy (LVNC)) are responsible for the clinical picture of dilated cardiomyopathy (DCM). The American Heart Association (AHA) classification grouped cardiomyopathies into genetic, mixed and acquired forms, while the European Society of Cardiology (ESC) classification proposed the subgrouping of each major type of cardiomyopathy into familial or genetic, and nonfamilial or nongenetic, forms [1-4]. Cardiomyopathies are clinically heterogeneous diseases, and there are differences in sex, age of onset, rate of progression, risk of development of overt heart failure and likelihood of sudden death within each cardiomyopathy subtype [5]. Because of the complex etiology and clinical presentation, the diagnostic spectrum in cardiomyopathies spans the entire range of non-invasive and invasive cardiological examination techniques including genetic analysis. The exact verification of certain cardiomyopathies necessitates additional investigations. So, histological, immunohistological and molecular biological/virological investigations of endomyocardial biopsies are the gold standard to confirm the diagnosis of an inflammatory cardiomyopathy (DCMi) [6-10]. This review focuses on myocarditis and inflammatory cardiomyopathies underlying an immune-mediated process or persistent viral infection.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1041.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>C-reactive protein is associated with ventricular repolarization dispersion among patients with metabolic syndrome</title>
<author>Ylber Jani,Atila Rexhepi,Bekim Pocesta,Ahmet Kamberi,Fatmir Ferati,Sotiraq Xhunga, Artur Serani,Dali Lala,Agim Zeqiri,Arben Mirto</author>
<pubDate>2019-06-27 00:00:00</pubDate>
<description>Background: An increasing body of evidence indicates that inflammatory activation profoundly impacts the electrophysiological properties of cardiomyocytes. A marker of systemic inflammation such as C-reactive protein(CRP), is associated with all parameters of the Mtabolic syndrome(MetS) and that may result in adverse cardiac events via multiple effects, ultimately resulting in a prolongation of Action Potential duration (APD), and thereby of the QTC (QT corrected) interval on ECG. Objective: We sought to investigate the influence of CRP levels on the prevalence of prolonged QT-dispersion and prolonged Tpeak-Tend &ndash;dispersion in the patients with MetS. Methods: We conducted a multicenter observational cross-sectional study. The study population consisted of 200 patients with MetS, stratified in two groups:103 participants (50 females and 53 males) with level of CRP&gt;3mg/l, and 97 participants (47 females and 50 males) with level of CRP&lt;3mg/l), who attended outpatient visits at general cardiology Health Care Clinics during 1 calendar year. For the analysis of the ECG, we performed a manual measurement of the values using a digital caliper with measuring range of 0-150 mm, 0.01 mm resolution, and 0-100 &plusmn; 0.02 mm accuracy. QT interval dispersion was obtained by the difference between the maximum and the minimum QT intervals found in the 12-lead electrocardiogram. The Tpeak-Tend interval was obtained from the difference between QT interval and QTpeak interval. Results: Prolonged QTC. dispersion, was found in 51.4% of participants with level of CRP&gt;3mg/l and in 32.9% of with level of CRP&lt;3mg/l, the differences were statistically significant. (p=0.004). The results showed that 51.4% participants with level of CRP&gt;3mg/l had a prolonged Tpeak-Tend interval, and 32.9% of participants with level of CRP&lt;3mg/l had prolonged Tpeak-Tend interval. Difference were statistically significant.( p=0.04). There were significant association of increased levels of CRP and QTC-dispersion (OR = 2.486, 95% CI 1.389-4.446).There were significant association of increased levels of CRP with Tpeak-Tend Dispersion (OR=2.239,95%CI 1.262-3.976). Prolonged QTC max. Interval OR=2.236,%CI 1.246-4.014),Prolonged Tp-Te-interval. (OR=2.367, 95%CI 1.327-4.222), also there were significant association of increased levels of CRP with BMI. (OR=1.154, 95%CI 1.095-1.227) and significant association of increased levels of CRP with presence of uncontrolled glicemia.(OR=1.779, 95%CI 1.014-3.12). Conclusion: We think we proved the hypothesis that patients with MetS and high level of CRP have higher prevalence of QT- dispersion and Tpeak-Tend dispersion than patients with MetS and lower level of CRP. These findings have both epidemiological and clinical relevance, also these findings might lend further insight into potential mechanisms by which MetS is associated with adverse cardiac events.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1040.pdf</link>
</item>
<item>
<type>Case Report</type>
<title>Acute viral myocarditis due to Influenza H3N2 infection resembling an acute coronary syndrome: A case report</title>
<author>Carlos Jesus Rodriguez-Zuñiga,Leonel Martínez-Ramírez,Carlos Alberto Guizar-Sanchez,Mauricio Quetzal Trejo-Mondragon,Nilda Espinola-Zavaleta</author>
<pubDate>2019-06-20 00:00:00</pubDate>
<description>A 16-year-old man with history of two weeks-flu like symptoms with intermittent fever. He came to the emergency department with 2 hours-chest pain that radiates to the back and upper extremities. At the admission he was hemodynamically stable with normal blood pressure The ECG showed sinus rhythm and ST segment elevation of 0.5 mV in all leads (Figure 1A). The cardiac enzymes were elevated (Troponin 12.19 ng/mLland creatine kinase-MB fraction 63.25 U/L). He was admitted to the Intensive Care Unit and later transferred to our medical unit to continue with study protocol. The transthoracic echocardiogram (Figure 1B) reported normal left ventricular systolic function with left ventricular ejection fraction (LVEF) 68%, global longitudinal strain -18%, TAPSE 30 mm, and normal systolic pulmonary artery pressure (30 mmHg).</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1039.pdf</link>
</item>
<item>
<type>Short Communication</type>
<title>Not-motorized Implantable Cardiac Assistance (NICA): Hemodynamic concepts and clinical perspectives</title>
<author>Philippe Caimmi,Martinelli GL,Barbieri G</author>
<pubDate>2019-06-13 00:00:00</pubDate>
<description>The considerable improvements in cardiac support systems technologies have not solved until now the problem of connecting the cardiac assistance devices (CAD) to external energy sources, which makes these Patients at risk of lethal infections and dependent on external batteries with few hours of autonomy. Authors illustrate and discuss the hemodynamic concepts and clinical that underlie the mechanics of the first not-motorized implantable cardiac assistance device (NICA).</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1038.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Impact of the Israeli attacks at 2014 on incidence of STEMI in Gaza</title>
<author>Mohammed Habib,Belal Aldabbour</author>
<pubDate>2019-06-07 00:00:00</pubDate>
<description>For 51 days, Gaza was pummeled down by the Israeli military in a war known as Operation Protective Edge. During the 50 days (7-7-204 to 28-8-2014) of the Israeli campaign, 2104 Palestinians were killed, including 253 women (12%) and 495 children (24%). According to the UN, at least 69% of Palestinians killed were civilians. It is estimated that 10,224 Palestinians, including 3,106 children (30%) and 1,970 women (19%) were injured. Preliminary estimates indicate that up to 1,000 of the children injured will have a permanent disability and up to 1,500 orphaned children will need sustained support from the child protection and welfare sectors, 17,200 homes destroyed or severely damaged, 58 hospitals and clinics damaged [1]. Major stressful events are well documented to increase the incidence of acute cardiac events [2]. Cardiovascular complications more than doubled during the FIFA World Cup games of 2006 [3]. After the September 11 terrorist attacks, significantly more patients presented with acute myocardial infarction to the hospitals in Brooklyn [4] and New Jersey [5]. We were able to examine the effects of the Isreli attacks on acute STEMI presentations in Gaza city.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1037.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Single-centre real world experience of the Mynx Femoral closure device in patients undergoing percutaneous coronary intervention</title>
<author>Thirunavukarasu S,Zaman M,Hayat A,Aghamohammadzadeh R,Malik N</author>
<pubDate>2019-06-04 00:00:00</pubDate>
<description>Background: Vascular closure devices are routinely used following femoral artery access to perform percutaneous coronary interventions (PCI). A number of devices are available on the market. We have reported previously on our experience of the Mynx device following diagnostic coronary angiography. Aims: To assess the success and complication rates of the Mynx device used in all-comers in the context of PCI within a single cardiac centre. Methods: Retrospective analysis of data available for patients who underwent PCI via the femoral route and received a Mynx device at a single tertiary centre. Results: The device was used to achieve haemostasis in 113 patients following PCI. In all cases weight-adjusted Heparin as well as dual antiplatelet therapy (Aspirin and Clopidogrel/ Ticagrelor) was administered as per PCI protocol. The device was successfully deployed in 111 cases (98.2%). The were 2 cases of device failure, one due to operator error and the other due to Mynx grip balloon bursting during device deployment. In 15 cases (13.2%; 9 male and 6 female) there were reports of small haematomas (&lt;2cm) or oozing resulting in application of manual pressure or Femstop (St. Jude). A further patient required ultrasound-guided compression of the artery due to a large retroperitoneal bleed resulting from access complications. A larger proportion of the cases with complications were done as PPCI (44% vs 33%). The group with complications had higher systolic BP (140mmHg vs 128mmHg; P&lt;0.05) and MABP (97mmHg vs 75mmHg; P&lt;0.05) as compared with the group without any complications. Conclusion: The Mynx closure device is safe and easy to use in the context of PCI, in both the elective and emergency (PPCI) settings. Complication rates, predominately minor, can be minimised in experienced hands.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1036.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Is secondary prevention information before discharge adequate after percutaneous coronary intervention?</title>
<author>Catrin Henriksson,Joep Perk</author>
<pubDate>2019-05-08 00:00:00</pubDate>
<description>Introduction: Implementation of prevention strategies for patients with coronary artery disease (CAD) is essential, but many fall short of reaching their goals. Patients often perceive themselves as healthy and are less motivated to change lifestyle. To obtain better results patients need repeated information, preferably with motivational and person-centered approaches. Aims: To investigate whether health care providers inform CAD patients about risk factors and lifestyle changes at a percutaneous coronary intervention unit. Also to investigate whether the information given at discharge included secondary prevention management and if motivational and person-centered approaches were used. Methods: This is a descriptive, observational study that includes both a qualitative and quantitative design. Physicians and nurses working at a percutaneous coronary intervention (PCI) unit and physicians at a coronary care unit (CCU) participated. A staff nurse observed and noted what information the patients received at the PCI unit. At the CCU, observations regarding secondary prevention strategies during the discharge counselling were performed. Results: There were 50 observations made at the PCI unit. The information mainly consisted of tobacco consumption, physical activity and diet. During the 31 discharge counselling sessions the diagnosis, interventional procedure and medical treatment were frequently included. Most patients received little or no person-centered or motivational counselling. Conclusion: Nearly all patients at the PCI unit received information about the consequence of tobacco consumption, and more than half about the beneficial effects of physical activity. In contrast, the counselling at discharge need to focus more on behavioral changes and a motivational and person-centered approach.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1034.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Are S-Klotho’s Maximal concentrations dependent on Exercise Intensity and Time in young adult males?</title>
<author>Moran Sciamama Saghiv,David Ben-Sira,Ehud Goldhammer,Michael Sagiv</author>
<pubDate>2019-03-08 00:00:00</pubDate>
<description>The purpose of the present study was to define the period of time in which aerobic training does not increase further serum S-Klotho levels in untrained young adult males, and to examine the relation between plasma S-Klotho concentration and maximal oxygen uptake (VO2max). Methods: Sixty (60) untrained subjects (27.05&plusmn;1.1 years) were divided into 2 groups, both exercised six months 4&times;wk-1 for the duration of 45 min&times;session. One group (LTI) exercised below the anaerobic threshold at 40-50% of VO2max, while the second group (HTI) worked above the anaerobic threshold at 65-70% of VO2max. Testing sessions were performed at 0, 2, 4, and 6 months. Blood samples were drawn after overnight fasting; S-Klotho was analyzed using an ELISA kit. Results: Following 2 and 4 months, significant (p&le;0.05) increases were noted in the HTI group, at the fourth testing session, S-Klotho leveled off. In the LTI group, S-Klotho remained almost unchanged. Findings of the present study, support emerging evidence suggesting that a relation between plasma S-Klotho concentration and VO2max exists. Conclusion: Data suggest that increases in S-Klotho is tidally associated with VO2max levels. In addition, the S-Klotho increase levels-off following 4 months of aerobic training. Exercising below the anaerobic threshold does not increase VO2max and thus, does not increase S-Klotho. &nbsp;</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1033.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Diagnostic accuracy of TIMI versus GRACE score for prediction of death in patients presenting with Acute Non-ST Elevation Myocardial Infarction (NSTEMI)</title>
<author>Syed Haseeb Raza Naqvi,Tariq Abbas,Han Naung Tun,Ali Ahmad Naqvi,Zubair Zaffar,Badar ul Ahad Gill,Nisar Ahmad</author>
<pubDate>2019-02-22 00:00:00</pubDate>
<description>Background: Acute Coronary Syndrome describes a spectrum of disease ranging from unstable angina through non-ST-Elevation Myocardial Infarction (NSTEMI) to ST-Elevation Myocardial Infarction (STEMI). Early death in NSTEMI is usually due to an arrhythmia. Patients should be admitted immediately to hospital, preferably to a cardiac care unit because there is a significant risk of death. Objective: To compare the diagnostic accuracy of TIMI versus GRACE for prediction of death in patients presenting with Acute Non-ST elevation Myocardial Infarction. Material &amp; Methods: This present cross sectional study was conducted at Department of Cardiology, CPEIC, Multan. All patients assessed according to given scores in the two scoring system i.e. TIMI risk score and GRACE score. Then patients were labeled as high or low risk for death. Data was collected by using pre-designed proforma. 2x2 tables were generated to measure the sensitivity, specificity, positive predictive value, negative Predictive value and diagnostic accuracy of TMI Risk score and GRACE Score for prediction of death in NSTEMI patients. Results: In our study the mean age of the patients was 55.73&plusmn;9.78 years. The male to female ratio of the patients was 1.6:1. The diabetes as risk factor was found in 145(39%) patients, smoking as risk factor was found in 53(14.2%) patients and hypertension as risk factor was found in 174(46.8%) patients. the sensitivity of TIMI risk was 97.7% with specificity of 92.93% and the diagnostic accuracy was 95.16%, similarly the sensitivity of GRACE risk was 100% with specificity of 95.96% and the diagnostic accuracy was 97.85%. Conclusion: Our study results concluded that both the TIMI risk and GRACE risk are good predictor of death in patients presenting with Acute Non-ST elevation Myocardial Infarction with higher sensitivity and diagnostic accuracy. However the GRACE risk showed more accurate results as compared to TIMI risk.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1032.pdf</link>
</item>
<item>
<type>Commentary</type>
<title> Is there an ideal blood pressure during cardiopulmonary bypass to prevent postoperative cerebral injury? – What does the recent evidence say?</title>
<author>Ahmed Zaky</author>
<pubDate>2018-11-21 00:00:00</pubDate>
<description>Post cardiac surgery stroke is a devastating complication with an incidence as high as 50%1. The association between intra-operative mean arterial blood pressure (MAP- better called linear blood pressure) during cardiopulmonary bypass (CPB) and the development of postoperative stroke-as diagnosed by neuroimaging- and of cognitive dysfunction (POCD) is controversial. This is due to differences in the study populations, stroke assessment tools, operation and conduction of MAPs, variations in neurocognitive testing and duration of follow up. As a result there is a gap in the knowledge on an ideal MAP as a preventive measure of post CPB stroke and POCD.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1031.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Influence of Histidine on the contractility and adrenaline inotropic effect in the experiments with myocardium of right ventricular of Non pregnant and Pregnant Rats </title>
<author>Victor Tsirkin,Alexander Nozdrachev,Julia Korotaeva,Grigorij Khodyrev</author>
<pubDate>2018-11-19 00:00:00</pubDate>
<description>It was investigated contractility and adrenoreactivity of intact myocardium strips of right ventricular in experiment with 60 rats. They were assessed by the force of induce contraction and its changes under the influence of adrenaline (10-9 or 10-5 g / ml). Found that these indicators do not depend on the phases of the estrous cycle and the presence of pregnancy. Histidine (10-10-10-4 g / ml) did not increase the response to adrenalin (10-9 g / ml), but increased the force of the contractions in rats in progesterone dominance (trend) and pregnancy (statistically significant). Against the background of propranolol (10-8 g / mL) or atenolol (10-8, 10-6 g / mL), adrenaline (10-5 g / mL) instead of increasing the force of contraction reduced it (probably due to activation of beta3-, alpha1 - and alpha1 a2- adrenergic receptors), and histidine (10-4 g / mL) prevented this reduction, but does not restore full ability of adrenaline to exert a positive inotropic effect. On the background of nicergoline (10-8 g / mL or nicergoline and propranolol (10-8 g / mL), adrenaline (10-5 g / mL) did not alter the force of contraction, and histidine (10-4 g/mL) restore ability of adrenaline to exert a positive inotropic effect but only in the experiments with nicergoline. Concluded that histidine increases the efficiency of the activation of all three (beta1-, beta2- and beta3-) populations of myocardial beta-adrenoceptoprs, including at lower by adrenergic blockers. Therefore, histidine proposed as an antagonist of beta-adrenergic blockers and as resensitizator of these receptors. Core Tip: In the experiments with strips of the right ventricle of 40 nonpregnant and 20 pregnant rats histidine (10-10-10-4 g /mL) did not increase the response to adrenaline (10-9 g / ml), but increased the force of contractions in pregnant rats. On the background of propranolol (10-8 g / mL) or atenolol (10-8, 10-6 g / mL), adrenaline (10-5g/mL) showed a negative inotropic effect, and histidine (10-4 g / mL) prevented it, but does not restore the ability of adrenaline to show positive inotropic effect,. i.e histidine exhibits the properties of the antagonist of beta-blockers and of resensitizator of beta-adrenoceptors</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1030.pdf</link>
</item>
<item>
<type>Case Report</type>
<title>Hyperkalemia: An archenemy in emergency medicine. Description of two case reports</title>
<author>C Naclerio,A Del Gatto,A Cavallera</author>
<pubDate>2018-11-05 00:00:00</pubDate>
<description>Potassium is an important ion capable to maintain intra-extracellular electric gradient. Variations in the intra-extracellular ionic flow may alter cells functions, skeletal and smooth muscle contractility and electric activity of myocardial cells. In this study we demonstrated that high level of serum potassium may be associated with cardiac and neurological life-threatening diseases. We describe two case reports in which one patient, chronic hemodialysed, presented with cardiogenic shock in setting of hyperkalemia; the other, with end-stage kidney disease, showed a flaccid paralysis associated to high level of serum potassium during potassium sparing diuretic therapy. Emergency haemodialysis was performed with a complete remission of the clinical manifestations. Indeed, the use of simply diagnostic instruments such as serum electrolyte assay and electrocardiographic study (ECG) are helpful in clinical practice solving in timely serious complications due to hyperkalemia.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1029.pdf</link>
</item>
<item>
<type>Review Article</type>
<title>Endogenous sensitizer of beta-adrenergic receptors (ESBAR) and its analogs (review)</title>
<author>Victor Tsirkin,Alexander Nozdrachev,Elena Sizova,Tatyana Polezhaeva,Svetlana Khlybova,Marina Morozova,Andrew Trukhin,Julia Korotaeva,Grigory Khodyrev</author>
<pubDate>2018-10-29 00:00:00</pubDate>
<description>The results of the 20 years studies of the presence in blood serum and other body fluids of endogenous modulators of adrenergic and M-cholinergic impact as a component of humoral link of autonomic nervous system. The article is devoted to the endogenous sensitizer of beta-adrenergic receptor (ESBAR) - water-soluble low molecular weight substances, analogs of which are histidine, tryptophan, tyrosine, mildronat and preductal. It is shown, that separate dilutions of human serum and animal (as a source of ESBAR) and analogs of ESBAR ways to enhance the effectiveness of activation of beta-adrenoceptors (AR) of smooth muscle (uterus, coronary and renal arteries, trachea, stomach), myocardium, erythrocytes and platelets (respectively influenced of histidine and tryptophan). It is reported that content of ESBAR in human serum (according to the titers of its dilution) depends on the sex and the presence of somatic diseases, and at women are also on the stage of reproduction and obstetric complications It is discussed possible mechanisms of ESBAR action, its physiological role, including as a component of beta-adrenoceptor inhibitory mechanism for myometrium, as well as the prospect of the use of analogs of ESBAR, including for the prevention of preterm labor, and for the treatment of bronchial asthma, coronary heart disease, hypertension and heart failure.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1028.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>An observational study of the occurrence of anxiety, depression and self-reported quality of life 2 years after myocardial infarction</title>
<author>Catrin Henriksson,Mona-Lisa Wernroth,Christina Christersson</author>
<pubDate>2018-10-17 00:00:00</pubDate>
<description>Background: Patients with myocardial infarction (MI) often experience anxiety, depression and poor quality of life (QoL) compared with a normative population. Mood disturbances and QoL have been extensively investigated, but only a few studies have examined the long-term effects of MI on these complex phenomena. Aims: To examine the levels and associated predictors of anxiety, depression, and QoL in patients 2 years after MI. Methods: This was a single center, observational study of patients with MI (n=377, 22% women, median age 66 years). Two years after MI (2012-2014), the patients were asked to answer the Hospital Anxiety and Depression Scale (HADS) and EuroQol 5-dimension (EQ-5D-3L) questionnaires. Results: Most patients experienced neither anxiety (87%, 95% confidence interval [CI]: 83-90%) nor depression (94%, 95% CI: 92-97%) 2 years post-MI. Elderly patients experienced more depression than younger patients (p=0.003) and women had higher anxiety levels than men (p=0.009). Most patients had &ldquo;no problems&rdquo; with any of the EQ-5D-3L dimensions (72-98%), but 48% (95% CI: 43%-53%) self-reported at least &ldquo;some problems&rdquo; with pain/discomfort. In a multiple logistic regression model (EQ-5D-3L) higher age (p&lt;0.001) and female sex (p&lt;0.001) were associated with more pain/discomfort. Female sex (p=0.047) and prior MI (p=0.038) were associated with anxiety/depression. History of heart failure was associated with worse mobility (p=0.005) and problems with usual activities (p=0.006). The median total health status of the patients (EQ-VAS) was 78 (95% CI: 75-80)</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1027.pdf</link>
</item>
<item>
<type>Opinion</type>
<title>Use of Rivaroxaban and Apixaban, Two Non-Vitamin K Antagonist Oral Anticoagulants (NOACs), in Renally Impaired Patients - the limits of our knowledge</title>
<author>Kenneth T Moore,Maria Langas</author>
<pubDate>2018-10-11 00:00:00</pubDate>
<description>Patients with chronic kidney disease are at increased risk of thromboembolic complications and are therefore often managed with anticoagulation therapy [1]. While these patients are traditionally treated with Vitamin K antagonists (VKAs), the Non-Vitamin K antagonist oral anticoagulants (NOACs), such as rivaroxaban and apixaban are being used with increasing frequency. Relatively new to the anticoagulant treatment arsenal, both compounds are direct Factor Xa inhibitors and represent an alternative to traditional VKA treatments, such as warfarin.&nbsp;However, because these compounds are at least partially renally eliminated, achieving safe and effective anticoagulation in this vulnerable population has proven to be a challenge [2,3]. With limited published data, there is often uncertainty surrounding which of the NOACs can be safely used.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1026.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Cardiovascular damage during lupus in black African subjects</title>
<author>Yaméogo NV,Tougouma SJ-B,Zabsonré J,Kologo KJ,Tiemtoré WS,Kagambèga LJ,Bagbila WPAH, Traoré A,Samadoulougou AK,Zabsonré P</author>
<pubDate>2018-07-16 00:00:00</pubDate>
<description>Introduction: Systemic lupus is a disseminated inflammation of the conjunctive tissue. Cardiovascular lesions are the first cause of morbidity and mortality in the course of that disease. These lesions are prevalent in 30 to 62% of cases, depending on whether the diagnostic tool is clinical, echocardiographic, or autopsic. Any part of the heart can be affected, yielding manifestations of pericarditis, endocarditis, coronary heart disease, conduction disorders, and rarely myocarditis. Objective: Describe cardiac manifestations during the follow up of patients diagnosed with systemic lupus. Patients and Methods: We conducted a transversal descriptive study over a period of 27 months, in the departments of Internal Medicine, Dermatology, and Cardiology of Yalgado Ouedraogo University Hospital of Ouagadougou. All patients diagnosed with systemic lupus according to the American College of Rheumatology criteria, and having done an EKG, a Holter EKG, or a transthoracic echocardiography, were included in the study. Data were collected from inpatient medical records, outpatient follow up registry and booklets. Results: Cardiovascular lesions were prevalent in 7 cases (43.75%) out of 16 patients diagnosed with systemic lupus. Mean age of patients was 36 years, with extremes of 23 and 51 years. Only female patients were affected in our study. Cardiac manifestations were mainly benign pericarditis, heart failure, and conduction disorders. Conclusions: Cardiovascular manifestations are frequent during the course of systemic lupus, and occur after few years of disease progression. Transthoracic echocardiography and EKG remain useful non-invasive explorations for the assessment of cardiovascular lesions, despite minor shortcomings.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1024.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Assessment of risk factors and MACE rate among occluded and non-occluded NSTEMI patients undergoing coronary artery angiography: A retrospective cross-sectional study in Multan, Pakistan</title>
<author>Ibtasam Ahmad,Muhammad Haris,Amnah Javed,Muhammad Azhar</author>
<pubDate>2018-05-30 00:00:00</pubDate>
<description>Objectives: The prime focus of the present study was to evaluate the most occluded coronary artery (OCA) among non-ST elevated myocardial infarction (NSTEMI) patients, and risk factors associated with occluded and non-occluded NSTEMI. Also, major adverse cardiovascular event (MACE) were evaluated among patients during index hospitalization. Methods: A retrospective, cross-sectional study was conducted in Multan Institute of Cardiology, Pakistan between 1st February, 2017, and 31st September, 2017. The data were collected from medical records of the outpatients and inpatients who were index hospitalized. Data were analyzed by using Statistical Packages for Social Sciences (IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.) And Microsoft Excel (MS Office 2010). Results: Among 624 patients, angiographic findings revealed that 63.9% were suffering from non-occlusive NSTEMI while 36.1% of the patients had occluded NSTEMI. In occluded NSTEMI patients, 30.3% were having single vessel occlusion while 5.8% were having multi-vessel occlusion. Also, 49.8% were having occlusion of right coronary artery (CA) while 44% were having occluded left anterior descending (LAD) artery. Multivariate analysis revealed that age (p=0.001) and left ventricular ejection fraction (LVEF) (p=0.001) had a statistically significant association. The incidence of MACE was high among non-OCA patients as compared to OCA patients but no statistically significant association was found (p=0.44). Conclusions: Angiography confirmed that most of the NSTEMI patients had OCA. But the MACE rate was not significantly differ among OCA and non-OCA patients. The risk factors associated with OCA were low LVEF and age.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1023.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Design and validation of an Index to predict the development of Hypertensive Cardiopathy</title>
<author>Alexis Álvarez-Aliaga,Andrés José Quesada-Vázquez,Alexis Suárez-Quesada,David de Llano Sosa</author>
<pubDate>2018-02-16 00:00:00</pubDate>
<description>Introduction: The high morbidity and mortality by hypertensive cardiopathy demand the construction and validation of tools to stratify the risk of developing this condition. Objective: To design and validate an index, based on risk factors, that permits to predict the development of hypertensive cardiopathy in patients with a diagnosis of essential arterial hypertension. Methods: A prospective cohort study was done in hypertensive patients assisted at the specialized arterial hypertension physicians&rsquo; office of the &ldquo;Carlos Manuel de C&eacute;spedes&rdquo; Specialty Policlinic attached to the General University Hospital, Bayamo Municipality, Granma Province, Cuba from January 1st, 2010 to December 31, 2016. Internal and external validity and the internal consistency of the index were determined. Results: The index sensitivity was of 97, 20 (IC: 93, 93-94.09) and specificity of 65, 38 (IC: 76, 25-76, 20). Both the index discriminative capacity (area under the ROC curve= 0,944; interval of confidence: 0.932-0.956; p&lt;0.0005) and calibration (p=0.751) were adequate. Conclusions: The present study proposes an index to predict the risk of developing hypertensive cardiopathy, with adequate discriminative capacity and calibration (external validity). The index can be used as a tool of clinical and epidemiological surveillance since it permits to identify subjects with greater probability of developing the condition and to stratify the risk.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1022.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Electrocardiographic criteria in founder mutations related to Arrhythmogenic cardiomyopathy</title>
<author>Stefan Peters</author>
<pubDate>2018-02-02 00:00:00</pubDate>
<description>Founder mutations are rare causes in arrhythmogenic cardiomyopathy including TMEM43 und phospholamban mutations. The incidence is approximately 1%. P.S358L TMEM43 mutations cause aggressive, in most cases biventricular arrhythmogenic cardiomyopathy [1], with the necessity of primary prophylactic ICD implantation in men and in women&gt;30 years for sudden cardiac death prevention.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1021.pdf</link>
</item>
<item>
<type>Short Communication</type>
<title>Heart disease new hypothesis: under endogenous toxicological aspect</title>
<author>luisetto M,Behzad Nili-Ahmadabadi,Ghulam Rasool Mashori</author>
<pubDate>2018-01-22 00:00:00</pubDate>
<description>In order to suggest new pathogenetic hypothesis in some heart disease we think is interesting to observe some biomedical literature: Can we think some endogenus toxicologic movens in some heart pathologies?</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1020.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Numerical Simulation of Thrombotic Occlusion in Tortuous Arterioles</title>
<author>Zhi-Gang Feng,Miguel Cortina,Jennifer KW Chesnutt,Hai-Chao Han</author>
<pubDate>2017-12-06 00:00:00</pubDate>
<description>Tortuous microvessels alter blood flow and stimulate thrombosis but the physical mechanisms are poorly understood. Both tortuous microvessels and abnormally large platelets are seen in diabetic patients. Thus, the objective of this study was to determine the physical effects of arteriole tortuosity and platelet size on the microscale processes of thrombotic occlusion in microvessels. A new lattice-Boltzmann method-based discrete element model was developed to simulate the fluid flow field with fluid-platelet coupling, platelet interactions, thrombus formation, and thrombotic occlusion in tortuous arterioles. Our results show that vessel tortuosity creates high shear stress zones that activate platelets and stimulate thrombus formation. The growth rate depends on the level of tortuosity and the pressure and flow boundary conditions. Once thrombi began to form, platelet collisions with thrombi and subsequent activations were more important than tortuosity level. Thrombus growth narrowed the channel and reduced the flow rate. Larger platelet size leads to quicker decrease of flow rate due to larger thrombi that occluded the arteriole. This study elucidated the important roles that tortuosity and platelet size play in thrombus formation and occlusion in arterioles.&nbsp;</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1019.pdf</link>
</item>
<item>
<type>Mini Review</type>
<title>Lipid-induced cardiovascular diseases</title>
<author>Sumeet Manandhar,Sujin Ju,Dong-Hyun Choi,Heesang Song</author>
<pubDate>2017-11-23 00:00:00</pubDate>
<description>Cardiovascular diseases are the leading cause of death worldwide. There are many evidences that the dysfunctioning lipotoxicity is the one of major factors of cardiovascular diseases such as, atherosclerosis, hypertension, and coronary heart disease. Obesity and diabetes increase circulating lipids that are likely with more generation of toxic intermediates, which leading to the complications associated with cardiovascular diseases. Indeed, lipotoxicity is a metabolic syndrome caused by abnormal lipid accumulation, which leads to cellular dysfunction and necrosis. Here we review the factors that induced pathogenesis of cardiovascular diseases by lipid accumulation and the mechanisms underlying the lipotoxicity.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1018.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Non-hemodynamic factors associated to the risk of developing hypertensive cardiopathy</title>
<author>Alexis Álvarez-Aliaga,Julio César González-Aguilera,Liliana del Rosario Maceo-Gómez,Lic David del Llano Sosa,Raúl Leyva-Castro,Rosa Ojeda-Vázquez</author>
<pubDate>2017-09-20 00:00:00</pubDate>
<description>Introduction: Hypertensive cardiopathy is the target organ lesion caused by arterial hypertension (HTN) that exhibits the highest morbidity and mortality rates. Although the importance of hemodynamic overload exerted by HTN on the onset of cardiopathy is well established, several non-hemodynamic factors may contribute significantly to its development. Objective: To evaluate the influence of different non-hemodynamic risk factors in the development of hypertensive cardiopathy. Methods: A prospective cohort study was carried out in hypertensive patients assisted at the specialized arterial hypertension physicians&rsquo; office of the &ldquo;Carlos Manuel de C&eacute;spedes&rdquo; Specialty Policlinic attached to the General University Hospital, Bayamo Municipality, Granma Province, Cuba from January 5, 2006 to December 31, 2015. The study included 18-to-55-year-old hypertensive patients with a stage 1 arterial hypertension diagnosis for less than a year1. Results: The multivariate analysis showed a significant and independent relation among the majority of the factors studied and the risk of developing cardiopathy. The major factor was C-reactive protein (HR: 5.020; IC 95%: 3.383-7,448; p&lt;0.005) followed by microalbuminuria (HR: 2.649; IC 95%: 1.932-3.631; p&lt;0.005). The area under the model ROC curve was 0.887 (p&lt;0,005). Conclusions: The results showed that it is possible to estimate the risk of developing hypertensive cardiopathy with the application of the regression model to major risk factors.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1017.pdf</link>
</item>
<item>
<type>Case Report</type>
<title>A new heart: portraying the physiologic anatomo-functional reconstruction in ischemic cardiomyopathy</title>
<author>Marco Cirillo,Marco Campana,Anna Bressanelli,Giovanni Troise</author>
<pubDate>2017-09-15 00:00:00</pubDate>
<description>Fiber-based model of the left ventricle is known since 1628 but the complex 3D structure of myocardial fibers has not taken into account in normalcy or in disease until the last decade. We here present the case of a 60-year-old female patient affected by ischemic cardiomyopathy and severe left ventricular dysfunction. Left ventricle was reconstructed according to a novel surgical technique aimed at rebuilding an elliptical ventricular chamber and redirecting myocardial bundles of fibers in a near-normal orientation, by means of an original suturing technique. Left ventricular torsion was restored, proving the reorientation of myocardial fibres&rsquo; bundles. The restored physiologic shape was maintained along the years, gradually improving global ejection fraction and diastolic indices, showing a positive remodeling induced by the optimised geometrical and functional parameters. The unexpected and never proven before renewal of ventricular torsion is an adjunctive element of ventricular efficiency, mainly in ventricles that work at a critical mechanics. A new fiber-based reading of heart function could improve clinical and functional outcomes and address some unsolved issues in the surgical treatment of ischemic cardiomyopathy as well as in medical approaches to the diseased myocardium.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1006.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Value of electrocardiographic T wave inversion in lead aVL in prediction of Mid Left Anterior Descending Stenosis in patients with stable Coronary Artery disease</title>
<author>Gehan Magdy,Awad Yousef</author>
<pubDate>2017-08-18 00:00:00</pubDate>
<description>Background: The electrocardiogram (ECG) is a simple and noninvasive bedside diagnostic tool with a well-established role in the diagnosis of coronary artery disease (CAD). We aimed to study the diagnostic value of electrocardiographic ST-T wave changes in lead aVL in prediction of site of coronary artery stenosis in patients with chronic stable angina. Patients and Methods: study was conducted on 156 patients referred for invasive coronary angiography with history of stable CAD as proved by non- invasive tests, 12 lead ECG was recorded and fully interpreted with more focus on T wave direction in aVL lead. T waves in aVL were categorized into one of three groups: upright, flat or inverted. Results: regarding T wave in lead aVL, inverted T wave was reported in 71(45.5%) patients, 58 (37.2%) patients were with upright T wave in lead aVL and 27(17.3%) patients were with flat T wave in lead aVL, and we found that inverted T wave in lead aVL was most evident in 56(73.7%) patients with mid LAD with (highest &kappa; value equal to 0.550[moderate agreement], and p value&lt;0.001. Conclusions: This study confirmed the diagnostic value of T wave inversion in lead aVL in prediction of mid left anterior descending artery lesions in patients with stable coronary artery disease.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1015.pdf</link>
</item>
<item>
<type>Case Report</type>
<title>Subacute infectious endocarditis-associated membranoproliferative glomerular nephritis: A Case Report and Review</title>
<author>Yi De Zhang,Ya Min Yu,Hou Yong Dai,Xiao Lan Chen,Li Yuan,Hui Shi</author>
<pubDate>2017-08-17 00:00:00</pubDate>
<description>We experienced a case of membranoproliferative glomerulonephritis (MPGN) caused by subacute infectious endocarditis (SIE). A 57-year-old male farmer complained of fatigue, lack of appetite and gross haematuria for a month; he had no cough, chest pain, or exertion dyspnea. After admission, lab tests showed mild proteinuria(1.04g/d) and heavy dysmorphic red blood cells(RBC) (543/HP), with serum creatinine(Scr) slightly elevated(1.46mg/dl) and anemia(hemoglobin Hb 85g/L). A renal biopsy revealed MPGN lesion with 16.6% cellular crescents. The echocardiogram test revealed mitra valve prolapse with perforation of the anterior lobe, vegetation, and severe regurgitation. He was diagnosed as SIE induced MPGN. Then he underwent mitral valve replacement after systemic antibiotic treatment without immunosuppressive agents. Follow-up showed that he dramatically regained normal kidney function in total 1 year after the operation. Thus, antibiotic administration and valve replacement may be efficient enough for some of SIE induced MPGN. We did a brief review of the literature on SIE induced MPGN, which was sometimes misdiagnosed due to its silent characteristics; some SIE patients may initially have other organs involved.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1014.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>A rare Congenital Coronary Artery Anomaly: Woven Right Coronary Artery associated with Myocardial Infarction</title>
<author>Tolga Doğan,Mucahit Yetim,Lütfü Bekar,Oğuzhan Çelik,Macit Kalçık,Yusuf Karavelioğlu</author>
<pubDate>2017-07-07 01:00:00</pubDate>
<description>Woven coronary artery (WCA) is an extremely rare and still not a clearly defined coronary anomaly. It is characterized by the division of epicardial coronary artery into thin channels which then reanastomose with the distal part of the abnormal coronary artery [1]. Since the angiographic imaging of WCA looks like an intracoronary thrombus and dissection; the differential diagnosis between atherothrombotic coronary arteries with recanalization of organized thrombi in coronary arteries and WCA may be very difficult for invasive cardiologists, especially in patients with single or two coronary artery involvements [2].</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1013.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Investigation of Retinal Microvascular Findings in patients with Coronary Artery Disease</title>
<author>Tolga Doğan,Osman Akın Serdar,Naile Bolca Topal,Özgür Yalçınbayır</author>
<pubDate>2017-07-07 00:00:00</pubDate>
<description>Objectives: Retinal microvascular anomalies may be a marker for cardiovascular diseases. Our aim in this study was to investigate the utility of ocular fundoscopic examination as a noninvasive method in specifying the patients who carry a risk for coronary artery disease. Material and Method: Patients who were diagnosed with coronary artery disease by coronary angiography were included in our study. Bilateral fundoscopic examination was performed in these patients. Fundoscopic findings and risk factors for coronary artery disease were evaluated. Results: This study enrolled 100 patients (male: 72 (72%), mean age: 58.25&plusmn;7.1) who were diagnosed with coronary artery disease by coronary angiography. Upon fundoscopic examination, 87% of the study population had atherosclerotic changes. Grade I atherosclerosis was found in 54% of the patients, grade II atherosclerosis was found in 32% of the patients and grade III atherosclerosis was found in 1% of the patients. Increased retinal tortuosity was present in 65% of the patients. Hollenhorst plaque was observed in 3 patients. Drusenoid bodies were observed with a statistically significantly higher rate in the patients who were not using clopidogrel compared to the patients who were using clopidogrel (p&lt;0.001). Conclusions: Retinal findings are frequently found in patients with coronary artery disease. Therefore, fundoscopic examination is a noninvasive and feasible examination method which can be frequently used in the evaluation of cardiac functions.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1012.pdf</link>
</item>
<item>
<type>Mini Review</type>
<title>Incidence of symptom-driven Coronary Angiographic procedures post-drug-eluting Balloon treatment of Coronary Artery drug-eluting stent in-stent Restenosis-does it matter?</title>
<author>Victor Voon,Dikshaini Gumani,Calvin Craig,Ciara Cahill,Khalid Mustafa,Terry Hennessy,Samer Arnous,Thomas Kiernan</author>
<pubDate>2017-06-29 00:00:00</pubDate>
<description>Objectives: The clinical impact of drug-eluting balloon (DEB) coronary intervention for drug-eluting in-stent restenosis (DES-ISR) is not fully known. To further evaluate this impact, we aimed to describe the incidence of symptom-driven coronary angiography (SDCA), an under-reported but potentially informative outcome metric in this cohort of patients. Methods: We retrospectively identified all patients (n=28) who had DEB-treated DES-ISR at University Hospital Limerick in between 2013-2015 and evaluated the incidence of subsequent SDCA as the primary endpoint. Data were expressed as mean &plusmn; SD and %. Results: Baseline demographics demonstrate a mean age 63&plusmn;9 years with 61% of DEB-treated DES-ISR presenting with acute coronary syndrome. Mean number of ISR per patient and number of DEB per lesion was 1.2&plusmn;0.6 lesions and 1.2&plusmn;0.6 balloons, respectively. The incidence of SDCA was 54% after mean follow-up duration of 179&plusmn;241 days. 67.8% of patients had follow-up data beyond 12 months. Within the first year of follow-up, the incidence of SDCA with and without target lesion revascularization (TLR) was 11% and 36% respectively. Among patients with SDCA without TLR, 30% had an acute coronary syndrome not requiring percutaneous coronary intervention. Conclusions: A high incidence of SDCA was observed, particularly within the first 12 months after DEB-treated DES-ISR. This under-reported metric may represent a cohort at higher cardiovascular risk but requires further confirmation in larger studies.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1011.pdf</link>
</item>
<item>
<type>Mini Review</type>
<title>Thrombolysis, the only Optimally Rapid Reperfusion Treatment</title>
<author>Victor Gurewich</author>
<pubDate>2017-06-23 00:00:00</pubDate>
<description>Thrombolysis with tissue plasminogen activator (tPA) has been plagued by inadequate efficacy and a high risk of intracranial hemorrhage (ICH), which led to its replacement by procedures like percutaneous coronary intervention (PCI) whenever possible. Since this requires hospitalization, it is time-consuming, and compromising salvage of brain tissue and myocardium. Thrombolysis is the only first-line treatment that can provide sufficiently timely treatment for optimal recovery of organ function. However, for this potential to be realized, its efficacy and safety must be significantly improved over the current method. By adopting the sequential, synergistic fibrinolytic paradigm of the endogenous system, already verified by a clinical trial, this becomes possible. The endogenous system&rsquo;s function is evidenced by the fibrinolytic product D-dimer that is invariably present in blood, and which increases &gt;20-fold in the presence of thromboembolism. This system uses tPA to initiate lysis, which is then completed by the other fibrin-specific activator prourokinase (proUK). Since tPA and proUK in combination are synergistic in fibrinolysis, it helps explain their efficacy at their low endogenous concentrations.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1010.pdf</link>
</item>
<item>
<type>Case Report</type>
<title>Spontaneous rupture of a giant Coronary Artery Aneurysm after acute Myocardial Infarction</title>
<author>Oğuzhan Çelik,Mucahit Yetim,Tolga Doğan,Lütfü Bekar,Macit Kalçık,Yusuf Karavelioğlu</author>
<pubDate>2017-06-21 00:00:00</pubDate>
<description>Coronary artery aneurysm is commonly defined as a localized dilatation exceeding the diameter of adjacent normal coronary segments by 50% [1]. Coronary artery aneurysms may be fusiform, involving the full circumference of the coronary artery, or saccular, involving only a portion of the circumference [2]. Causes of coronary artery aneurysms include atherosclerosis (accounting for 50% of cases), Kawasaki disease, polyarteritis nodosa, infection, trauma, coronary dissection, percutaneous coronary angioplasty, and congenital malformations [3]. The abnormal blood flow within the coronary artery aneurysm may lead to thrombus formation, embolization, rupture, myocardial ischemia or myocardial infarction [4]. Here we present a case of a giant fusiform coronary artery aneurysm who passed away due to coronary rupture after acute myocardial infarction.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1009.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Procedure utilization, latency and mortality: Weekend versus Weekday admission for Myocardial Infarction</title>
<author>Nader Makki,David M Kline,Arun Kanmanthareddy,Hansie Mathelier,Satya Shreenivas,Scott M Lilly</author>
<pubDate>2017-05-19 00:00:00</pubDate>
<description>Background: Due to variations in hospital protocols and personnel availability, individuals with myocardial infarction admitted on the weekend may be less likely to receive invasive procedures, or may receive them with a greater latency than those admitted during the week. Whether or not this occurs, and translates into a difference in outcomes is not established. Method: Using the Nationwide Inpatient Sample (2008-2011) database, we identified all patients admitted with a principle diagnosis of acute myocardial infarction. They were stratified by weekend or weekday admission. Baseline clinical characteristics, procedure utilization and latency to procedure were compared, and logistic regression models were constructed to assess the relationship between these variables and in-hospital mortality. Results: Patient demographics and provider-related characteristics (hospital type, geography) were similar between weekend and weekday admission for myocardial infarction. Adjusted for covariates, we found that the odds of mortality for a weekend admission are 5% greater than for a weekday admission (OR: 1.05; 95% CI: 1.01, 1.09, p=0.009). For the utilization of an invasive procedure, we found that the odds of receiving a procedure for a weekend admission were 12% less than the odds for a weekday admission, adjusted for the other covariates (OR: 0.88; 95% CI: 0.86, 0.91, p&lt;0.001). In addition, we found that the time to procedure was an average of 0.18 days (4.32 hours) longer for weekend admissions compared to weekday admissions (95% CI: 0.16, 0.20, p&lt;0.001). However, we did not observe a significant difference in the overall length of stay for weekend and weekday admissions (0.004 days; 95% CI: -0.04, 0.05, p=0.87). Conclusion: In a large and diverse subset of patients admitted with myocardial infarction, weekend admission was associated with fewer procedures, increased latency to those procedures, and a non-significant trend towards greater in adjusted in-hospital mortality.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1008.pdf</link>
</item>
<item>
<type>Case Report</type>
<title>Indications and Results of Coronarography in Senegalese Diabetic Patients: About 45 Cases</title>
<author>Ndao SCT,Gaye ND,Dioum M,Ngaide AA,Mingou JS,Ndiaye MB, Diao M,Ba SA</author>
<pubDate>2017-02-20 01:00:00</pubDate>
<description>Introduction: Coronary disease accounts for 75% of diabetic mortality. Coronary angiography reveals lesions that are often diffuse, staggered and multi-truncated. The objective of this study was to determine the indications and results of coronary angiography in diabetic patients. Method: This is a cross-sectional, descriptive and analytical study which took place from May 2013 to July 2015 at the cardiology clinic of the Aristide Le Dantec hospital. We have included all diabetics who have benefited from coronary angiography by studying clinical and paraclinical data, particularly coronary angiography ones. Results: During this period, 400 patients had coronary angiography, including 45 diabetics, a hospital prevalence of 11.25%. The average age of our patients was 62.27 y/o with extremes of 44 and 85 y/o. The sex ratio was 1.6 in favor of men. Diabete was revealed in 42 patients. Almost all patients were type II diabetics (44 patients) since 9.94 years in average. The associated cardiovascular risk factors were hypertension 66.7% and dyslipidemia 49.6%. Only 4 patients had typical chest pain. The electrocardiogram was abnormal in 84.4% of cases with 26 cases of SCA ST +. Coronary angiography was abnormal in 37 patients with significant stenosis in 30 patients. A single-truncular lesion was found in 14 cases, 8 had bi-truncular and other 8 had tri-truncular one. The anterior interventricular artery and the segment II of the right coronary were the most affected branches. Concerning the management, 14 patients had angioplasty with an active stent, 8 patients had medical treatment alone and 9 patients had coronary artery bypass surgery. Accidents occured for 4 patients, two of whom had arterial spasm, one of a vagal discomfort and another had an occlusion of the circumflex that led to the implantation of a stent. Conclusion: Diabetes is accompanied by progressive coronary atherosclerosis, which has an adverse effect on patients' prognosis. Tri-truncal affection and indications for coronary artery bypass surgery are common</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1007.pdf</link>
</item>
<item>
<type>Case Report</type>
<title>Short and Medium-Term Evaluation of Patients in Coronary Post-Angioplasty: Préliminary results at the Cardiology Department of the Hospital University Aristide Le Dantec of Dakar (Senegal): Study on 38 Cases</title>
<author>Dioum M,Aw F,Masmoudi K,Gaye ND,Sarr SA,Ndao SCT, Mingou J,Ngaidé AA,Diack B,Bodian M,Ndiaye MB,Diao M,Ba SA</author>
<pubDate>2017-02-20 00:00:00</pubDate>
<description>Introduction: Coronary angioplasty is a safe therapeutic method for coronary disease. However, its major obstacles remain the occurrence of stent thrombosis (ST) and in-stent restenosis (ISR). The aim of this study was to evaluate the short-term and medium-term results of coronary angioplasty patients in the cardiology department of Aristide Le Dantec hospital in Dakar. Methodology: It was a longitudinal, descriptive and analytical study over a period of 12 months (April 2014 to April 2015) with a follow-up at 6 months. Was included any patient who had a coronary angioplasty with stent placement. Results: Thirty-eight patients had been included with a male predominance and a sex ratio of 5.32. The average age was 57.94 years. Cardiovascular risk factors were mainly smoking (57.9%) and coronary heredity (42.1%), followed by hypertension (39.5%) and diabete (34.2%). The indications for angioplasty were acute coronary syndromes TS(+) and TS(-) respectively (50%) and (23.7%) and stable angina (26.3%). The right femoral approach was almost exclusive (97.4%). Coronary angiography revealed a predominance of anterior interventricular affection (84.2%). Type B lesions were the most frequent (68.4%). The single-truncal valve affection was predominant (76.3%). Direct stenting accounted for 63.2% of procedures. Twenty-one bare stents (55.3%) and 17 active stents (44.7%) were implanted. The results were excellent (94.7%). One case of acute stent thrombosis was noted. Echocardiography of dobutamine stress during follow-up was positive in 04 patients (12.5%). The control coronary angiography performed in two patients revealed an ISR. The predictive factors for restenosis were dominated by a deterioration in the segmental kinetics (p=0.009), in the diastolic function (p=0.002), the systolic function (p=0.003), a high post angioplasty troponin (p=0.004), the presence of calcifications (p=0.004) and a high SYNTAX score (p=0.021). Conclusion: According to these results, Angioplasty is an effective therapy for coronary disease. However, a correct intake of double platelet antiaggregants and clinical and non-invasive screening are required for follow-up to avoid stent thrombosis or restenosis.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1006.pdf</link>
</item>
<item>
<type>Case Report</type>
<title>Congenital Quadricuspid Aortic Valve, a Rare Cause of Aortic Insufficiency in Adults: Case Report</title>
<author>Cyrus Kocherla,Kalgi Modi</author>
<pubDate>2017-01-23 00:00:00</pubDate>
<description>Quadricuspid aortic valve (QAV) is rare congenital malformation of the aortic valve with estimated prevalence of 0.013% to 0.043% [1-4]. QAV is most commonly associated with aortic insufficiency (AI), which is found in almost 75% of cases [5]. QAV can also be associated with other cardiac defects such as ventricular or atrial septal defects, patent ductus arteriosus, subaortic fibromuscular stenosis, malformation of the mitral valve, and coronary anomalies [3]. Up to 40% of all patients with QAV undergo aortic valve replacement surgery most commonly due to progressive AI in 88% of case [2,3,6]. Here we report a case from our institution of a woman with QAV with severe AI and anomalous origin of the right coronary artery.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1005.pdf</link>
</item>
<item>
<type>Case Report</type>
<title>Intermittent Left Bundle Branch Block: What is the Mechanism?</title>
<author>Hussam Ali,Riccardo Cappato</author>
<pubDate>2017-01-20 00:00:00</pubDate>
<description>A 73-year-old male underwent cardiologic evaluation for an incidental electrocardiographic finding of left bundle branch block (LBBB). He was asymptomatic and had no relevant cardiac history. Physical examination and transthoracic echocardiogram revealed no abnormalities.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1004.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Concentration Polarization of Ox-LDL and Its Effect on Cell Proliferation and Apoptosis in Human Endothelial Cells</title>
<author>Shijie Liu,Jawahar L Mehta,Yubo Fan,Xiaoyan Deng,Zufeng Ding</author>
<pubDate>2016-12-30 03:00:00</pubDate>
<description>Background: Flow-dependent concentration polarization of native LDL is important in the localization of atherogenesis. However, ox-LDL plays a more important role than n-LDL in atherogenesis by inducing cell proliferation and apoptosis. We hypothesized that concentration polarization of ox-LDL may adversely affect vascular beds due to its toxicity to endothelial cell (EC) lining. Methods: Using a parallel-plate flow chamber technique, we studied water filtration rate and wall concentration of ox-LDLs EC monolayers cultured on permeable or non-permeable membranes. ECs cultured on permeable and non-permeable membranes were examined in terms of cell viability, ox-LDL uptake, LOX-1 expression and cell apoptosis (Cytochrome c and Bcl-2 expression). We observed that the wall concentration of ox-LDL was about 16% higher in the permeable group than in the permeable group (P&lt;0.05). Cell proliferation (MTT assay) increased in response to low concentration of ox-LDL (1-5 &mu;g/ml), and fell drastically in response to higher concentration; all these changes were more pronounced in the permeable group than in the non-permeable group. The uptake of ox-LDL and LOX-1 expression by ECs were also significantly higher in the permeable group than in the non-permeable group of cultured cells. Conclusions: These observations suggest that concentration polarization of ox-LDL occurs in an artery that is permeable to water, and ox-LDL concentration polarization can enhance ox-LDL accumulation into the arterial wall and accelerate EC proliferation at low concentrations and apoptosis at high concentrations, possibly via LOX-1 expression.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1003.pdf</link>
</item>
<item>
<type>Letter to Editor</type>
<title>Mid-Ventricular Ballooning in Atherosclerotic and Non-Atherosclerotic Abnormalities of the Left Anterior Descending Coronary Artery</title>
<author>Stefan Peters</author>
<pubDate>2016-12-30 00:00:00</pubDate>
<description>In a series of meanwhile 10 cases rigid straightening of the mid-portion of the left anterior descending coronary artery without lumen reduction mid-ventricular or basal ballooning was reported, or both basal and mid-ventricular ballooning in one case. In all these patients wrap-around (recurrent segment) phenomenon of the left anterior descending coronary artery was not present. The abnormalities of the left anterior descending coronary artery are due to myocardial bridging without lumen reduction of the LAD, only seen in computed tomography. When stress or in some cases happiness appears myocardial ballooning can appear, lasts 2-4 weeks and disappear with a recurrence rate of nearly 10% despite beta blocking agents.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1002.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Left Atrial Remodeling is Associated with Left Ventricular Remodeling in Patients with Reperfused Acute Myocardial Infarction</title>
<author>Christodoulos E. Papadopoulos,Dimitrios G. Zioutas,Panagiotis Charalambidis,Aristi Boulbou,Konstantinos Triantafyllou,Konstantinos Baltoumas,Haralambos I. Karvounis,Vassilios Vassilikos</author>
<pubDate>2016-12-07 00:00:00</pubDate>
<description>Background: Left atrial volume (LAV) has been established as a sensitive marker of left ventricular (LV) diastolic function and as an independent predictor of mortality in patients with acute myocardial infarction (AMI). LA remodeling and its determinants in the setting of AMI have not been much studied. Methods: We studied 53 patients with anterior AMI and a relatively preserved LV systolic function, who underwent complete reperfusion and received guidelines guided antiremodeling drug management. LA and LV remodeling were assessed using 2D echocardiography at baseline and 6 months. LAV indexed for BSA (LAVi) was used as the index of LA size and further LA remodeling. Results: LAVi increased signifi cantly at 6 months compared to baseline [28.1 (23.0-34.5) vs 24.4 (19.5- 31.6) ml/m2, p=0.002] following LV end diastolic-volume index change [56.8 (47.6-63.9) vs 49.5 (42.0-58.4) ml/m2, p=0.0003]. Other standard LV diastolic function indices did not show any signifi cant change. Univariateanalysis showed a strong positive correlation of LAVi change with BNP levels at discharge, LV mass index and LV volumes indices change, throughout the follow up period. Multivariate regression analysis revealed that BNP plasma levels was the most important independent predictor of LA remodeling (b-coef.=0.630, p=0.001). Conclusions: Despite current antiremodeling strategies in patients with AMI, LA remodeling is frequently asssociated with LV remodeling. Additionally LAVi change in the mid-term reflects better than standard echocardiographic indices LV diastolic filling impairment.</description>
<link>https://www.cardiologymedjournal.com/articles/jccm-aid1001.pdf</link>
</item>
<!-- end item Block -->
</channel>
</rss>