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   Table of Contents - Current issue
July-December 2022
Volume 4 | Issue 2
Page Nos. 37-96

Online since Tuesday, April 18, 2023

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High heart failure rehospitalization and mortality: Call for a heart failure clinic- and team-based approach p. 37
Prashanth Panduranga, Mohammed El-Deeb, Kadhim Sulaiman
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Rare genetic mutations associated with long QT syndrome in Hong Kong chinese patients p. 41
Oscar Hou In Chou, Jeremy Man Ho Hui, Yan Hiu Athena Lee, Simon Siyuan Li, Keith Sai Kit Leung, Teddy Tai Loy Lee, Leonardo Roever, Yunlong Xia, Qiang Liu, Sharen Lee, Gary Tse, Khalid Bin Waleed
Congenital long QT syndrome (LQTS) is a type of cardiac ion channelopathy that increases the susceptibility of the affected individuals to spontaneous ventricular tachycardia/fibrillation or even sudden cardiac death. More than 17 subtypes have been identified. This was a systematic review of the published case series or reports on the clinical characteristics, genetic basis, and patient outcomes from Hong Kong with rare genetic variants of LQTS which fall outside the traditional LQTS classification system. PubMed and Zenodo were searched from the corresponding inception until January 15, 2022. Twenty-four studies were identified. Of these, one article met the inclusion criteria. The article included a case series of six patients from a cohort with 134 patients. They had either asymptomatic LQTS with HCN4 mutations (n = 1, c.1471G>A, QTc: 420 ms with prolonged QTc of 670 ms during the recovery phase of treadmill test), RYR2 (n = 1, c.7060G>A, QTc: 480 ms) or SCN10A (n = 2, c.3542C>T, QTc: 439 ms–480 ms), or LQTS with multiorgan syndromes with GATA3 mutations (n = 1, c. 815C>T, Barakat syndrome: Sensorineural deafness, hypoparathyroidism, and renal disease, QTc: 450–489 ms), or SLC6A8 (n = 1, c.691_693del; X-linked creatine transporter deficiency, with c.6065A>G mutation in AKAP9, known modifier of LQTS; QTc: 485 ms). In addition, rare genetic variants in non-LQTS causative genes were identified. Future studies should be conducted to compare the variants and investigate their functional consequences.
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Tricuspid regurgitation etiologies, current diagnostic methods, and management: A 2022 update and review of the literature p. 46
Retaj Al Haroun, Raja Dashti, Rajesh Rajan, Mohammed Al Jarallah, Khalid AI Mulla, Joud Al Balool, Zhanna Davidona Kobalava, Suprateeka Talukder, Endurance Osas Evbayekha, Gary Tse, Helen Huang
Tricuspid regurgitation (TR) is a common finding. Any changes to the components of the tricuspid valve (TV), such as the tricuspid annulus, valve leaflets, papillary muscles, and chordae tendinae can lead to TR. This valvular disease has recently sparked interest after it was long forgotten. This paper examines the anatomy of the TV, etiology of TR, and critically appraises the diagnostic methods used to assess the TV and the current medical treatment options for TR. This paper aims to give a detailed review of TR in hopes that more research will be conducted to help better assess patients with tricuspid regurgitation.
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Socioeconomic and clinical determinants of coronary artery disease in symptom-free type 2 diabetes mellitus patients p. 59
Chikezie Hart Onwukwe, Nkiru Ifeoma Chikezie, Kalu Kalu Okorie, Eric Okechukwu Umeh, Chukwunonso Celestine Odenigbo, Charles Ukachukwu Osuji, Augustine Efedaye Ohwovoriole
Background: There are global reports of rising cardiovascular burden in persons living with type 2 diabetes mellitus (T2DM) patients. The presence of coronary artery disease (CAD) increases mortality risk in T2DM patients. There are currently no data on the determinants of CAD in Nigerian T2DM patients. Objective: The objective was to determine the determinants of CAD in persons with T2DM. Methods: This was a cross-sectional study involving T2DM patients with and without CAD attending the diabetes clinic of Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria. The diagnosis of CAD was made based on personal information obtained using the Rose angina questionnaire and resting electrocardiogram findings. Medical history and other clinical evaluations were done to identify the socioeconomic and clinical variables in the study participants. Data obtained were analyzed using appropriate statistical software. Results: The study involved 400 asymptomatic T2DM patients with a median age of 60 years and a female-to-male ratio of 1.3:1. Sixty-four (16%) participants had CAD. The male: female ratio in CAD and non-CAD groups was 1.8:1 and 0.7:1 (χ2 = 1.7, P = 0.22). Formal education (χ2 = 4.1, P = 0.02), upper socioeconomic class (χ2 = 5.1, P = 0.02), hypertension (χ2 = 2.2, P = 0.03), dyslipidemia (χ2 = 4.7, P = 0.02), cerebrovascular disease (χ2 = 5.2, P = 0.01), smoking (χ2 = 9.1, P = 0.01), waist circumference (Mann–Whitney U = 358, P = 0.02), carotid intima-media thickness (Mann–Whitney U = 300, P = 0.01), and ankle brachial pressure index (Mann–Whitney U = 315, P = 0.01) were significantly associated with CAD in the study participants. Multivariate logistic regression analysis showed that formal education had the least odds of predicting CAD (odd ratio [OR] =2.1, 95% confidence interval [CI] =1.6–6.2; P = 0.02), while low-density lipoprotein cholesterol had the highest odds of predicting CAD (OR = 5.2, 95% CI = 2.1–9.5, P = 0.01) among the study participants. Conclusions: Early screening for comorbidities and lipid abnormalities in T2DM patients is required, especially in those with formal education and within the high socioeconomic class.
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Clinical outcomes after transcatheter aortic valve replacement stratified by hemoglobin levels: A retrospective cohort pilot study p. 66
Retaj Al Haroun, Mohammed Al Jarallah, Rajesh Rajan, Raja Dashti, Nader Alasousi, Vladimir Kotevski, Ahmed Said Taha Mousa, Joud Al Balool, Gary Tse, Kobalava Davidovna Zhanna, Ahmad Al-Saber, Parul Setiya, Peter A Brady, Adham Hassan Ali Almowafy
Background: Anemia is a prevalent comorbidity in patients undergoing aortic valve replacement. Objectives: The objectives of this study were to define baseline parameters of patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) to determine procedural risk and mortality outcomes stratified by hemoglobin (Hb) levels. Methods: Retrospective study of a population of patients with severe AS undergoing TAVR with the Edwards SAPIEN 3 valve between 2018 and 2021 at Sabah Al-Ahmad Cardiac Centre, Al Amiri Hospital, Kuwait. Two cohorts were identified based on Hb level: Hb <13 and Hb ≥13 g/dl. Results: A total of 61 patients were included. The mean age was 73.5 ± 9.0 years, with a higher prevalence of females. The cohort with lower Hb had lower body surface area (2.0 ± 0.1 vs. 1.8 ± 0.2, P = 0.035) and bioprosthesis size (26.5 ± 1.8 vs. 24.4 ± 1.8, P = 0.001). Based on echocardiography, patients with higher Hb levels had a higher prevalence of aortic regurgitation in addition to stenosis (P = 0.029). Conclusions: Baseline anemia is a common comorbidity in patients with severe AS undergoing TAVR. However, in terms of procedural outcomes and mortality, Hb levels were not a predictor of post-TAVR complications or in-hospital death.
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Effect of herbal detoxification and reverse diet treatment on the mortality rate of CAD patients Highly accessed article p. 71
Rohit Sane, Rahul Mandole, Gurudatta Amin, Pravin Ghadigaonkar, Suhas Dawkhar
Background: Coronary Artery Disease (CAD) has metabolic disorders at its core etiology. Ayurvedic-based Panchkarma treatment has previously been reported to have reversed CAD-related conditions and improved the quality of life post-treatment. Objectives: The current study was designed to determine the effectiveness of Ayurvedic-based Panchkarma treatment as assessed by the mortality and rehospitalization rate. Methods: This was a multicenter cohort study carried out between August 2017 and August 2020 in India. The study enrolled known CAD patients (stable at rest). The study therapy included a three-step Panchkarma treatment and a low-calorie high-protein diet kit for 12 months and was monitored for up to 36 months. The hazard ratios for different risk factors including – age, body mass index (BMI), weight, diabetic status, and blood pressure were calculated using the Cox proportional hazards model and the actual number of deaths that occurred over the study period (24 months and 36 months) were recorded. Results: The study included 572 known CAD patients (78.67% of males and 21.33% of females) within the age group of 60.22 ± 10.89 years (mean ± standard deviation). Complete compliance to study therapy was recorded whereas ~15%–25% of patients were unable to follow the dietary modifications. The overall mortality rate was found to be 5.07%. BMI, weight, diabetes, and blood pressure were modified during the treatment which may have led low mortality rate. Statistically, age was the only risk factor that showed significance in determining overall survival. The total number of cases of rehospitalization during the study period was 52 (9.09%) patients. Conclusion: Our study concluded that the Panchakarma-based treatment is beneficial in reducing risk factors such as BMI, diabetes, and blood pressure in known CAD patients, thus lowering the mortality and rehospitalization rate posttreatment.
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Prognostic value of integral assessment of congestion in patients hospitalized with acute decompensated chronic heart failure: A single center study p. 77
Zhanna Davidovna Kobalava, Veronica Vladimirovna Tolkacheva, Flora Elisa Cabello Montoya, Bekbolot Kanatbekovich Sarlykov, Mohammed Al-Jarallah, Peter A Brady, Rajesh Rajan
Background: Systemic congestion is the leading pathophysiological mechanism of decompensated heart failure (HF), and hospitalization and poor prognosis. Unfortunately, patients are discharged with residual congestion, possibly due to the lack of a clear strategy for its assessment. The existing criteria for discharge of patients from the hospital are more often based on a subjective assessment and poorly correlate with the state of hemodynamic stabilization, and the search for methods for detecting congestion remains relevant. Objective: The objective is to determine the prognostic value of an integrated assessment of congestion based on novel diagnostic methods in patients hospitalized with acute decompensated chronic HF (ADCHF). Methods: Single-center prospective study in 171 patients hospitalized with ADCHF. All patients underwent physical examination, paraclinical (laboratory and instrumental) investigations-N-terminal pro-brain natriuretic peptide (NT-proBNP) level, lung ultrasound, transient elastography (TE), bioimpedance vector analysis (BIVA) on admission and discharge. Clinical congestion was assessed in accordance with the HF Association consensus document. Clinical outcomes were assessed by structured telephone survey 1, 3, 6, 12 months after discharge. Combined rates of all-cause mortality and re-admissions were used as the study endpoint. Results: Patients hospitalized with ADCHF had the following congestion status at discharge as assessed by individual methods (TE, lung ultrasound, BIVA and NT-proBNP): The incidence of clinical residual Congestion I ranged 33%–39%, the incidence of subclinical congestion was 12%–24%, and patients with euvolemia accounted for 19%–32%. According to the integral assessment of hydration status, the incidences of clinical residual Congestion I, subclinical congestion, and euvolemia were 57%, 31% and 12%, respectively. The study has demonstrated a significant worsening of all congestion parameters with increasing number of methods (1–4) that had detected congestion. Patients with congestion detected at discharge by 2, 3, or 4 methods were at a significantly higher risk of all-cause mortality or readmission. TE + NT-proBNP had a higher prognostic value in regard to the risk of endpoint event, while the combination of all four methods was the most predictive. Conclusions: Patients hospitalized with ADCHF should undergo an integral assessment of residual and subclinical congestion at discharge. The introduction of integral congestion assessment into the routine practice will help identify patients with less favorable prognosis in terms of the risk of death and re-admission, as well as to enhance pharmacologic therapy and follow-up.
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Coronary artery ectasia and giant coronary aneurysms presenting with recurrent acute coronary syndrome and heart failure p. 85
Sunil Roy Narayanan, Rashid Khan, Muhammad Adnan Raufi
Coronary artery ectasia (CAE) or aneurysm (CAA) is characterized by inappropriate dilatation of the coronary vasculature. While our understanding of CAAs has developed over the last few years, the exact mechanism of Kawasaki disease (KD) and coronary artery complications is unknown. There is a scarcity of data addressing the management and prognosis of patients with CAE. KD is the most common cause of coronary aneurysms in children, whereas atherosclerosis is the most common cause in adulthood, and may present as missed KD. While infection, trauma, vasculitis, KD, cocaine use, and iatrogenic causes form the other etiologies of CAE. Here, we report a young patient who presented with recurrent acute coronary syndromes and heart failure in whom angiography showed severely ectatic coronary arteries with giant CAAs containing a heavy burden of thrombus, diagnosed as probable missed KD, especially with morphological findings from the coronary angiogram.
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Is remdesivir-induced symptomatic bradycardia persistent? A two case report of COVID-19 infection p. 89
Rime Mehannek, Krunal Truvedi, Kinjal Patel, Ahsan Khan
As of May 2022, a total of over 528 million cases of coronavirus 19 disease (COVID-19) worldwide with over 6 million deaths. Remdesivir is a broad-spectrum antiviral medication approved worldwide; it acts by inhibiting the RNA-dependent RNA polymerase, used for moderate-to-severe COVID-19 which requires supplemental oxygen but not intubation. Not shown to improve mortality but shorten the recovery time, especially if given within the first 10 days of symptom initiation. Despite its worldwide use, its cardiovascular safety profile has not been determined as yet. Herein, we report two cases of COVID-19 infection who develop symptomatic bradycardia on a 5-day course of remdesivir.
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Large fenestrated atrial septal occluder to treat an elderly female in her seventh decade p. 92
Anil Kumar Singhi, Arindam Pande, Soumya Kanti Mohapatra, Nandini Biswas, Arnab De
Atrial septal defect (ASD) is one of the common congenital heart anomalies presenting in the geriatric group. It presents with symptoms such as progressive effort intolerance, arrhythmias, and palpitations. Sometimes, associated obstructive and restrictive respiratory diseases can contribute significantly to the symptoms masked by cardiac disease. A female in her seventh decade, presenting with dyspnea, had a large ASD with diastolic dysfunction and moderate pulmonary hypertension. She had persistence of symptoms after initial treatment for cardiac elements. On detailed evaluation, she was found to have mixed obstructive and restrictive respiratory disease. She was treated for respiratory elements under expert pulmonology guidance with significant improvement. The ASD was occluded with a custom-made fenestrated 40 mm LifeTech atrial septal occluder in view of diastolic dysfunction and initial pulmonary arterial hypertension. She remained symptomatically better on her short-term follow-up. The index case highlights the importance of detailed evaluation of elderly patients with large ASDs and individualized care to treat.
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