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Bhandari M, Pradhan A, Vishwakarma P, Singh A, Sethi R. Sodium glucose cotransporter 2 inhibitors in the management of heart failure: Veni, Vidi, and Vici. World J Cardiol 2024; 16:550-563. [DOI: 10.4330/wjc.v16.i10.550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 08/25/2024] [Accepted: 09/06/2024] [Indexed: 10/17/2024] [Imported: 10/17/2024] Open
Abstract
Heart failure (HF) is a chronic disease associated with high morbidity and mortality rates. Renin-angiotensin-aldosterone system blockers (including angiotensin receptor/neprilysin inhibitors), beta-blockers, and mineralocorticoid receptor blockers remain the mainstay of pharmacotherapy for HF with reduced ejection fraction (HFrEF). However, despite the use of guideline-directed medical therapy, the mortality from HFrEF remains high. HF with preserved ejection fraction (HFpEF) comprises approximately half of the total incident HF cases; however, unlike HFrEF, there are no proven therapies for this condition. Sodium glucose cotransporter-2 inhibitors (SGLT-2is) represent a new class of pharmacological agents approved for diabetes mellitus (DM) that inhibit SGLT-2 receptors in the kidney. A serendipitous finding from seminal trials of SGLT-2is in DM was the significant improvement in renal and cardiovascular (CV) outcomes. More importantly, the improvement in HF hospitalization (HHF) in the CV outcomes trials of SGLT-2is was striking. Multiple mechanisms have been proposed for the pleiotropic effects of SGLT-2is beyond their glycemic control. However, as patients with HF were not included in any of these trials, it can be considered as a primary intervention. Subsequently, two landmark studies of SGLT-2is in patients with HFrEF, namely, an empagliflozin outcome trial in patients with chronic HF and a reduced ejection fraction (EMPEROR-Reduced) and dapagliflozin and prevention of adverse outcomes in HF (DAPA-HF), demonstrated significant improvement in HHF and CV mortality regardless of the presence of DM. These impressive results pitchforked these drugs as class I indications in patients with HFrEF across major guidelines. Thereafter, empagliflozin outcome trial in patients with chronic HF with preserved ejection fraction (EMPEROR-Preserved) and dapagliflozin evaluation to improve the lives of patients with preserved ejection fraction HF (DELIVER) trials successively confirmed that SGLT-2is also benefit patients with HFpEF with or without DM. These results represent a watershed as they constitute the first clinically meaningful therapy for HFpEF in the past three decades of evolution of HF management. Emerging positive data for the use of SGLT-2is in acute HF and post-myocardial infarction scenarios have strengthened the pivotal role of these agents in the realm of HF. In a short span of time, these classes of drugs have captivated the entire scenario of HF.
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Cernea S, Onișor D, Roiban AL, Benedek T, Rat N. Metabolic dysfunction-associated steatotic liver disease-associated fibrosis and cardiac dysfunction in patients with type 2 diabetes. World J Cardiol 2024; 16:580-594. [DOI: 10.4330/wjc.v16.i10.580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 08/28/2024] [Accepted: 09/19/2024] [Indexed: 10/17/2024] [Imported: 10/17/2024] Open
Abstract
BACKGROUND Metabolic dysfunction-associated steatotic liver disease (MASLD), particularly in the presence of liver fibrosis, increases the risk of cardiovascular morbidity and mortality, but the nature of the cardio-hepatic interaction in the context type 2 diabetes mellitus (T2DM) is not fully understood.
AIM To evaluate the changes in cardiac morphology and function in patients with T2DM and MASLD-associated liver fibrosis.
METHODS T2DM patients with MASLD underwent a medical evaluation that included an assessment of lifestyle, anthropometric measurements, vital signs, an extensive laboratory panel, and a standard echocardiography. Liver fibrosis was evaluated using two scores [Fibrosis-4 (FIB4) and Non-alcoholic fatty liver disease-Fibrosis Score (NFS)], and subjects were classified as having advanced fibrosis, no fibrosis, or an indeterminate risk. The correlations between structural and functional cardiac parameters and markers of liver fibrosis were evaluated through bivariate and multiple regression analyses. Statistical significance was set at P < 0.05.
RESULTS Data from 267 T2DM-MASLD subjects with complete assessment was analyzed. Patients with scores indicating advanced fibrosis exhibited higher interventricular septum and left ventricular (LV) posterior wall thickness, atrial diameters, LV end-systolic volume, LV mass index (LVMi), and epicardial adipose tissue thickness (EATT). Their mean ejection fraction (EF) was significantly lower (49.19% ± 5.62% vs 50.87% ± 5.14% vs 52.00% ± 3.25%; P = 0.003), and a smaller proportion had an EF ≥ 50% (49.40% vs 68.90% vs 84.21%; P = 0.0017). Their total and mid LV wall motion score indexes were higher (P < 0.05). Additionally, they had markers of diastolic dysfunction, with a higher E/e’ ratio [9.64 ± 4.10 vs 8.44 (2.43-26.33) vs 7.35 ± 2.62; P = 0.026], and over 70% had lateral e’ values < 10 cm/second, though without significant differences between groups. In multiple regression analyses, FIB4 correlated with left atrium diameter (LAD; β = 0.044; P < 0.05), and NFS with both LAD (β = 0.039; P < 0.05) and right atrium diameter (β = 0.041; P < 0.01), Moreover, LVMi correlated positively with age and EATT (β = 1.997; P = 0.0008), and negatively with serum sex-hormone binding protein (SHBP) concentrations (β = -0.280; P = 0.004). SHBP also correlated negatively with LAD (β = -0.036; P < 0.05).
CONCLUSION T2DM patients with markers of MASLD-related liver fibrosis exhibit lower EF and present indicators of diastolic dysfunction and cardiac hypertrophy. Additionally, LVMi and LAD correlated negatively with serum SHBP concentrations.
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Eid N, Abdel Wahab M, Thanu AS. Bioresorbable stent unloading during percutaneous coronary intervention: Early detection and management. World J Cardiol 2024; 16:616-618. [DOI: 10.4330/wjc.v16.i10.616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2024] [Revised: 09/24/2024] [Accepted: 09/30/2024] [Indexed: 10/17/2024] [Imported: 10/17/2024] Open
Abstract
In this letter, we comment on a recent case report by Sun et al in the World Journal of Cardiology. The report describes the successful management of a rare complication: The unloading or detachment of a bioresorbable stent (BRS) during percutaneous coronary intervention (PCI) in a male patient. The unloading of BRS was detected via angiography and intravascular ultrasound (IVUS) imaging of the left coronary artery and left anterior descending artery. Although this case is interesting, the authors’ report lacked crucial details. Specifically, insufficient information about the type of BRS used, potential causes of BRS unloading, or whether optical coherence tomography (OCT) imaging for coronary arteries was performed before, during, or after PCI. The OCT imaging of coronary arteries before PCI can potentially prevent BRS unloading due to its higher resolution compared to IVUS. In addition, despite detecting myocardial bridging during the PCI, the authors did not provide any details regarding this variation. Here we discuss the various types of BRS, the importance of OCT in PCI, and the clinical relevance of myocardial bridging.
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Milioglou I, Qian A, Salerno PRVDO, Pereira GTR, Palma Dallan LA, Gray KE, Morrison M, Abu-Omar Y, Eldiasty M, Baeza C. Percutaneous decannulation of extracorporeal membrane oxygenation using MANTA device: A real-world single-center experience. World J Cardiol 2024; 16:574-579. [DOI: 10.4330/wjc.v16.i10.574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 08/12/2024] [Accepted: 09/11/2024] [Indexed: 10/17/2024] [Imported: 10/17/2024] Open
Abstract
BACKGROUND The MANTA vascular closure device (VCD) represents a novel approach to achieving hemostasis after large-bore femoral access procedures. Numerous clinical studies have evaluated the efficacy of the MANTA device across a range of patient populations undergoing different procedures. However, there is still a paucity of data available concerning the use of MANTA devices in aiding the decannulation of venoarterial extracorporeal membrane oxygenation (VA-ECMO).
AIM To present our single-center experience of utilizing the MANTA VCD in patients undergoing this procedure.
METHODS This single-center study included all patients undergoing percutaneous decannulation of femoral VA-ECMO using the MANTA plug-based VCD between January 2021 and October 2023 at University Hospitals Cleveland Medical Center. Inclusion criteria were adult patients who required prolonged (> 24 hours) hemodynamic support with VA-ECMO. Outcomes included all-cause mortality, hemostasis, bleeding, limb ischemia, and site infection.
RESULTS This is a retrospective cohort study of 19 patients with a mean age of 56.8 years. Twelve of them were males with a mean body mass index of 29. The most common extracorporeal membrane oxygenation indication was acute coronary syndrome complicated by cardiogenic shock at 36.8%. The mean length of intensive care unit stay for these patients was 18.8 ± 8.42 days. Seventeen out of 19 patients survived to discharge. The MANTA device was successfully deployed in 19 patients, with 10 procedures conducted at the bedside and 9 in an operating room setting. Complete hemostasis was achieved within 5 minutes of MANTA deployment in 17 out of 19 patients. In 2 patients manual compression after Manta deployment was required to achieve adequate hemostasis. Additionally, acute lower extremity ischemia was noted in two patients, necessitating endovascular interventions. No infections were reported at the site of MANTA deployment.
CONCLUSION Overall, based on our experience and that of other centers, the MANTA VCD has proven to be a simple, safe, and effective percutaneous technique for facilitating in the OR, but most of all it opens the opportunity for bedside VA-ECMO decannulation. Post-decannulation ischemic complications are higher in this series of sick patients when compared with elective procedures like transcatheter aortic valve replacement and endovascular aneurysm repair. Additionally, operators should be mindful of the incidence of ischemic complications. Distal Doppler pulse signals should always be checked, to indicate bailout options when this occurs.
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Kurian AL, Lucke-Wold B. Evaluating neuromuscular electrical stimulation for preventing and managing intensive care unit-acquired weakness: Current evidence and future directions. World J Cardiol 2024; 16:604-607. [DOI: 10.4330/wjc.v16.i10.604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 09/03/2024] [Accepted: 09/20/2024] [Indexed: 10/17/2024] [Imported: 10/17/2024] Open
Abstract
Intensive care unit-acquired weakness (ICU-AW) is a prevalent issue in critical care, leading to significant muscle atrophy and functional impairment. Aiming to address this, Neuromuscular Electrical Stimulation (NMES) has been explored as a therapy. This systematic review assesses NMES's safety and effectiveness in enhancing functional capacity and mobility in pre- and post-cardiac surgery patients. NMES was generally safe and feasible, with intervention sessions varying in frequency and duration. Improvements in muscle strength and 6-minute walking test distances were observed, particularly in preoperative settings, but postoperative benefits were inconsistent. NMES showed promise in preventing muscle loss and improving strength, although its impact on overall functional capacity remained uncertain. Challenges such as short ICU stays and body composition affecting NMES efficacy were noted. NMES also holds potential for other conditions like cerebral palsy and stroke. Further research is needed to optimize NMES protocols and better understand its full benefits in preventing ICU-AW and improving patient outcomes.
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Zhang YX, Hu HS, Sun BQ. Effectiveness and mechanisms of sodium-dependent glucose transporter 2 inhibitors in type 2 diabetes and heart failure patients. World J Cardiol 2024; 16:611-615. [DOI: 10.4330/wjc.v16.i10.611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Revised: 09/29/2024] [Accepted: 10/11/2024] [Indexed: 10/17/2024] [Imported: 10/17/2024] Open
Abstract
We comment on an article by Grubić Rotkvić et al published in the recent issue of the World Journal of Cardiology. We specifically focused on possible factors affecting the therapeutic effectiveness of sodium-dependent glucose transporter inhibitors (SGLT2i) in patients with type 2 diabetes mellitus (T2DM) and their impact on comorbidities. SGLT2i inhibits SGLT2 in the proximal tubules of the kidneys, lowering blood glucose levels by inhibiting glucose reabsorption by the kidneys and causing excess glucose to be excreted in the urine. Previous studies have demonstrated a role of SGLT2i in cardiovascular function in patients with diabetes who take metformin but still have poor glycemic control. In addition, SGLT2i has been shown to be effective in anti-apoptosis, weight loss, and cardiovascular protection. Accordingly, it is feasible to treat patients with T2DM with cardiovascular or renal diseases using SGLT2i.
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Peters RM. Heart failure with preserved ejection fraction and the first law of thermodynamics. World J Cardiol 2024; 16:608-610. [DOI: 10.4330/wjc.v16.i10.608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 09/19/2024] [Accepted: 09/26/2024] [Indexed: 10/17/2024] [Imported: 10/17/2024] Open
Abstract
In heart failure with preserved ejection fraction, significant left ventricular diastolic abnormalities are present, despite a normal systolic ejection fraction. This article will consider whether this is consistent with the law of conservation of energy, also know as the first law of thermodynamics.
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Bitar F, Bulbul Z, Jassar Y, Zareef R, Abboud J, Arabi M, Bitar FF. Unroofed coronary sinus, left-sided superior vena cava and mitral insufficiency: A case report and review of the literature. World J Cardiol 2024; 16:595-603. [DOI: 10.4330/wjc.v16.i10.595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 08/21/2024] [Accepted: 09/11/2024] [Indexed: 10/17/2024] [Imported: 10/17/2024] Open
Abstract
BACKGROUND Unroofed coronary sinus (UCS) is a rare subtype of atrial septal defect. It is frequently associated with a persistent left superior vena cava and is often part of a more intricate cardiac malformation.
CASE SUMMARY This report describes a rare case of an adolescent patient with UCS featuring atrial situs solitus, absence of the right superior vena cava and a persistent left superior vena cava draining into the left atrium consistent with total unroofing of the coronary sinus. This was associated with concurrent severe mitral insufficiency secondary to redundant and prolapsing leaflets, and a substantial left-to-right shunt across the coronary sinus orifice. A comprehensive examination of the existing literature is included, shedding light on the diagnostic challenges of UCS and describing the available surgical options within the context of mitral valve surgery.
CONCLUSION UCS is a complex condition requiring careful consideration of associated anomalies and a tailored surgical approach.
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Jiang Q, Yu T, Huang KL, Liu K, Li X, Hu SS. Carotid versus axillary artery cannulation for descending aorta remodeling in type A acute aortic dissection. World J Cardiol 2024; 16:564-573. [DOI: 10.4330/wjc.v16.i10.564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 09/03/2024] [Accepted: 09/27/2024] [Indexed: 10/17/2024] [Imported: 10/17/2024] Open
Abstract
BACKGROUND Arterial cannulation sites for the surgical repair of type A aortic dissection (AAD) have evolved from right axillary artery (AA) cannulation to bilateral carotid artery (CA) based of femoral artery (FA) cannulation. Postoperative descending aorta remodeling is closely linked to the false lumen area ratio (FLAR), defined as false lumen area/aortic area, as well as to the incidence of renal replacement therapy (RRT).
AIM To investigate the effect of the updated arterial cannulation strategy on descending aortic remodeling.
METHODS A total of 443 AAD patients who received FA combined cannulation between March 2015 and March 2023 were included in the study. Of these, 209 received right AA cannulation and 234 received bilateral CA cannulation. The primary outcome was the change in FLAR, as calculated from computed tomography angiography in three segments of the descending aorta: Thoracic (S1), upper abdominal (S2), and lower abdominal (S3). Secondary outcomes were the incidence of RRT and the serum inflammation response, as observed by the levels of high sensitivity C reaction protein (hs-CRP) and Interleukin-6 (IL-6).
RESULTS The postoperative/preoperative ratio of FLAR in S2 and S3 was higher in the AA group compared to the CA group (S2: 0.80 � 0.08 vs 0.75 � 0.07, P < 0.001; S3: 0.57 � 0.12 vs 0.50 � 0.12, P < 0.001, respectively). The AA group also had a significantly higher incidence of RRT (19.1% vs 8.5%, P = 0.001; odds ratio: 2.533, 95%CI: 1.427-4.493) and higher levels of inflammation cytokines 24 h after the procedure [hr-CRP: 117 � 17 vs 104 � 15 mg/L; IL-6: 129 (103, 166) vs 83 (69, 101) pg/mL; both P < 0.001] compared to the CA group.
CONCLUSION The CA cannulation strategy was associated with better abdominal aorta remodeling after AAD repair compared to AA cannulation, as observed by a greater change in FLAR and lower incidence of RRT.
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She LQ, Gao DK, Hong L, Tian Y, Wang HZ, Huang S. Intracoronary thrombolysis combined with drug balloon angioplasty in a young ST-segment elevation myocardial infarction patient: A case report. World J Cardiol 2024; 16:531-541. [PMID: 39351340 PMCID: PMC11439105 DOI: 10.4330/wjc.v16.i9.531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 08/28/2024] [Accepted: 09/10/2024] [Indexed: 09/19/2024] [Imported: 09/19/2024] Open
Abstract
BACKGROUND The combination of acute ST-segment elevation myocardial infarction (STEMI) and gastric ulcers poses a challenge to primary percutaneous coronary intervention (PPCI), particularly for young patients. The role of drug-coated balloons (DCBs) in the treatment of de novo coronary artery lesions in large vessels remains unclear, especially for patients with STEMI. Our strategy is to implement drug balloon angioplasty following the intracoronary administration of low-dose prourokinase and adequate pre-expansion. CASE SUMMARY A 54-year-old male patient presented to the emergency department due to chest pain on June 24, 2019. Within the first 3 minutes of the initial assessment in the emergency room, the electrocardiogram (ECG) showed significant changes. There was atrial fibrillation with ST-segment elevation. Subsequently, atrial fibrillation terminated spontaneously and reverted to sinus rhythm. Soon after, the patient experienced syncope. The ECG revealed torsades de pointes ventricular tachycardia. A few seconds later, it returned to sinus rhythm. High-sensitivity tropon in I was normal. The diagnosis was acute STEMI. Emergency coronary angiography revealed subtotal occlusion with thrombus formation in the proximal segment of the left anterior descending artery. Considering the patient's age and history of peptic ulcer disease, after the intracoronary injection of prourokinase, percutaneous transluminal coronary angioplasty and cutting balloon angioplasty were conducted for thorough preconditioning, and paclitaxel drug-eluting balloon angioplasty was performed without any stents, achieving favorable outcomes. CONCLUSION A PPCI without stents may be a viable treatment strategy for select patients with STEMI, and further research is warranted.
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Caruzzo CA, Rigamonti E, Scopigni FR. Left bundle branch area pacing: A new era of cardiac resynchronization therapy? World J Cardiol 2024; 16:542-545. [PMID: 39351338 PMCID: PMC11439098 DOI: 10.4330/wjc.v16.i9.542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Revised: 07/30/2024] [Accepted: 08/26/2024] [Indexed: 09/19/2024] [Imported: 09/19/2024] Open
Abstract
The recent systematic review and meta-analysis provided a comprehensive focus on the current state of cardiac resynchronization therapy (CRT). The authors determined the feasibility of physiological left bundle branch area pacing (LBBAP) in patients indicated for CRT through a careful analysis of trials. They found that LBBAP was associated with significant reductions in QRS duration, New York Heart Association functional class, B-type natriuretic peptide levels, and pacing thresholds as well as improvements in echocardiographic parameters compared to biventricular pacing.
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Jin D, Wang YW, Lin ZM, Li C, Li M. Medical dilemma: Programmed death 1 blockade (sintilimab) therapy in patients suffering from tumours combined with psoriasis. World J Cardiol 2024; 16:546-549. [PMID: 39351336 PMCID: PMC11439104 DOI: 10.4330/wjc.v16.i9.546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Revised: 08/16/2024] [Accepted: 09/10/2024] [Indexed: 09/19/2024] [Imported: 09/19/2024] Open
Abstract
Tumour immunotherapy represented by immune checkpoint inhibitors (ICIs) has greatly improved the overall prognosis of patients with malignant tumours, and is regarded as an important breakthrough in the field of medicine in recent years. ICIs have gradually become the core of tumour therapy and are increasingly used in the clinic. In order to achieve early clinical prediction and management of immune-related adverse events (irAEs), it is still necessary to perform further research on the mechanisms, risk factors, and predictors of irAE occurrence in the future. Zhou et al describe the consultation of a patient with advanced gastric cancer combined with chronic plaque psoriasis. This case provides an important reference for the use of programmed cell death protein-1 (PD-1) inhibitors in patients of tumours combined with chronic plaque psoriasis. This case also highlights that screening of high-risk groups for irAEs is critical before applying PD-1 inhibitors to patients with chronic psoriasis combined with tumours. PD-1 inhibitors are new and potent antineoplastic agents that can cause serious immune-related adverse events such as toxic epidermal necrolysis release and psoriasis. Glucocorticosteroids are the first-line agents for irAEs. The incidence of rheumatic irAEs may be higher in reality, which will inevitably become a new challenge for rheumatologists and dermatologists.
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Latsios G, Koliastasis L, Toutouzas K, Tsioufis K. Recognizing and preventing complications regarding bioresorbable scaffolds during coronary interventions. World J Cardiol 2024; 16:508-511. [PMID: 39351339 PMCID: PMC11439101 DOI: 10.4330/wjc.v16.i9.508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Revised: 08/30/2024] [Accepted: 09/06/2024] [Indexed: 09/19/2024] [Imported: 09/19/2024] Open
Abstract
The evolution of coronary intervention techniques and equipment has led to more sophisticated procedures for the treatment of highly complex lesions. However, as a result, the risk of complications has increased, which are mostly iatrogenic and often include equipment failure. Stent dislodgement warrants vigilance for the early diagnosis and a stepwise management approach is required to either expand or retrieve the lost stent. In the era of bioresorbable scaffolds that are not radiopaque, increased caution is required. Intravascular imaging may assist in detecting the lost scaffold in cases of no visibility fluoroscopically. Adequate lesion preparation is the key to minimizing the possibility of equipment loss; however, in the case that it occurs, commercially available and improvised devices and techniques may be applied.
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Hao WR, Cheng CH, Cheng TH. Addressing the alarming link between nonalcoholic fatty liver disease and cardiovascular mortality in men. World J Cardiol 2024; 16:502-507. [PMID: 39351337 PMCID: PMC11439102 DOI: 10.4330/wjc.v16.i9.502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 08/21/2024] [Accepted: 09/05/2024] [Indexed: 09/19/2024] [Imported: 09/19/2024] Open
Abstract
This editorial discusses the key findings presented in Batta and Hatwal's recent paper titled "Excess cardiovascular mortality in men with non-alcoholic fatty liver disease: A cause for concern!", which was published in the World Journal of Cardiology. Their original article highlights a notable correlation between nonalcoholic fatty liver disease (NAFLD) and increased cardiovascular mortality risk in men. The present commentary explores the implications of their findings, discussing potential mechanisms, risk factors, and the urgent need for integrated clinical approaches to mitigate the dual burden of these diseases. Emphasis should be placed on the importance of early detection, lifestyle modifications, and interdisciplinary collaboration for improving patient outcomes. This editorial aims to highlight the broad implications of NAFLD for cardiovascular health and to advocate for increased awareness and proactive management strategies within the medical community.
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Zeng J, Zhao Y, Gao D, Lu X, Dong JJ, Liu YB, Shen B. Medical appraisal of Chinese military aircrew with abnormal results of coronary computed tomographic angiography. World J Cardiol 2024; 16:522-530. [PMID: 39351334 PMCID: PMC11439103 DOI: 10.4330/wjc.v16.i9.522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 08/18/2024] [Accepted: 08/28/2024] [Indexed: 09/19/2024] [Imported: 09/19/2024] Open
Abstract
BACKGROUND Coronary artery diseases can cause myocardial ischemia and hypoxia, angina pectoris, myocardial infarction, arrhythmia, and even sudden death led to inflight incapacitation of aircrew. As the main cause of grounding due to illness, they severe threats to the health and fighting strength of military aircrew. Early warning in an early and accurate manner and early intervention of diseases possibly resulting in inflight incapacitation are key emphases of aeromedical support in clinic. AIM To figure out the flight factors and clinical characteristics of military aircrew with abnormal results of coronary artery computed tomographic angiography (CTA), thereby rendering theoretical references for clinical aeromedical support of military flying personnel. METHODS The clinical data of 15 flying personnel who received physical examinations in a military medical center from December 2020 to June 2023 and were diagnosed with coronary artery diseases by coronary artery CTA were collected and retrospectively analyzed, and a descriptive statistical analysis was conducted on their onset age, aircraft type and clinical data. RESULTS The 15 military flying personnel diagnosed with coronary artery diseases by coronary artery CTA were composed of 9 pilots, 1 navigator and 5 air combat service workers. Multi-vessel disease was detected in 9 flying personnel, among which 8 (88.9%) were pilots. Flying personnel with multi-vessel disease had higher content of cholesterol, low-density lipoprotein cholesterol and apolipoprotein B than those with single-vessel disease. CONCLUSION Coronary artery diseases are the major heart disease for the grounding of flying personnel due to illness, which can lead to inflight incapacitation. Coronary artery CTA is conducive to early detection and early intervention treatment of such diseases in clinic.
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Desai R, Gurram P, Mohammed AS, Salian RB, Lingamsetty SSP, Guntuku S, Medarametla RVSK, Jahan R, Muslehuddin Z, Ghantasala P. Contemporary nationwide trends in major adverse cardiovascular events in young cannabis users without concomitant tobacco, alcohol, cocaine use. World J Cardiol 2024; 16:512-521. [PMID: 39351335 PMCID: PMC11439100 DOI: 10.4330/wjc.v16.i9.512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 07/26/2024] [Accepted: 08/07/2024] [Indexed: 09/19/2024] [Imported: 09/19/2024] Open
Abstract
BACKGROUND Cannabis use has increased among young individuals in recent years. Although dependent cannabis use disorder (CUD) has been associated with various cardiac events, its effects on young adults without concurrent substance use remain understudied. AIM To examine trends in hospitalizations for major adverse cardiac and cerebrovascular events (MACCE) in this cohort. METHODS We used the National Inpatient Sample (2016-2019) to identify hospitalized young individuals (18-44 years), excluding those with concurrent substance usage (tobacco, alcohol, and cocaine). They were divided into CUD+ and CUD-. Using International Classification of Diseases-10 codes, we examined the trends in MACCE hospitalizations, including all-cause mortality (ACM), acute myocardial infarction (AMI), cardiac arrest (CA), and acute ischemic stroke (AIS). RESULTS Of 27.4 million hospitalizations among young adults without concurrent substance abuse, 4.2% (1.1 million) had co-existent CUD. In CUD+ group, hospitalization rates for MACCE (1.71% vs 1.35%), AMI (0.86% vs 0.54%), CA (0.27% vs 0.24%), and AIS (0.49% vs 0.35%) were higher than in CUD- group (P < 0.001). However, rate of ACM hospitalizations was lower in CUD+ group (0.30% vs 0.44%). From 2016 to 2019, CUD+ group experienced a relative rise of 5% in MACCE and 20% in AMI hospitalizations, compared to 22% and 36% increases in CUD- group (P < 0.05). The CUD+ group had a 13% relative decrease in ACM hospitalizations, compared to a 10% relative rise in CUD- group (P < 0.05). However, when adjusted for confounders, MACCE odds among CUD+ cohort remain comparable between 2016 and 2019. CONCLUSION The CUD+ group had higher rates of MACCE, but the rising trends were more apparent in the CUD- group over time. Interestingly, the CUD+ group had lower ACM rates than the CUD- group.
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Przytuła N, Dziewięcka E, Winiarczyk M, Graczyk K, Stępień A, Rubiś P. Hypertrophic cardiomyopathy and left ventricular non-compaction: Distinct diseases or variant phenotypes of a single condition? World J Cardiol 2024; 16:496-501. [PMID: 39351333 PMCID: PMC11439099 DOI: 10.4330/wjc.v16.i9.496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 08/02/2024] [Accepted: 08/21/2024] [Indexed: 09/19/2024] [Imported: 09/19/2024] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is a genetically determined myocardial disease characterized by an increased thickness of the left ventricle (LV) wall that cannot be solely attributed to abnormal loading conditions. HCM may present with an intraventricular or LV outflow tract obstruction, diastolic dysfunction, myocardial fibrosis and/or ventricular arrhythmias. Differentiating HCM from other diseases associated with LV hypertrophy, such as hypertension, aortic stenosis, or LV non-compaction (LVNC), can at times be challenging. LVNC is defined by excessive LV trabeculation and deep recesses between trabeculae, often accompanied by increased LV myocardial mass. Previous studies indicate that the LVNC phenotype may be observed in up to 5% of the general population; however, in most cases, it is a benign finding with no impact on clinical outcomes. Nevertheless, LVNC can occasionally lead to LV systolic dysfunction, manifesting as a phenotype of dilated or non-dilated left ventricular cardiomyopathy, with an increased risk of thrombus formation and arterial embolism. In extreme cases, where LVNC is associated with a very thickened LV wall, it can even mimic HCM. There is growing evidence of an overlap between HCM and LVNC, including similar genetic mutations and clinical presentations. This raises the question of whether HCM and LVNC represent different phenotypes of the same disease or are, in fact, two distinct entities.
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Raidou V, Mitete K, Kourek C, Antonopoulos M, Soulele T, Kolovou K, Vlahodimitris I, Vasileiadis I, Dimopoulos S. Quality of life and functional capacity in patients after cardiac surgery intensive care unit. World J Cardiol 2024; 16:436-447. [PMID: 39221189 PMCID: PMC11362807 DOI: 10.4330/wjc.v16.i8.436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 06/24/2024] [Accepted: 07/22/2024] [Indexed: 08/26/2024] [Imported: 08/26/2024] Open
Abstract
Coronary heart disease and aortic stenosis are prevalent cardiovascular diseases worldwide, leading to morbidity and mortality. Coronary artery bypass grafting (CABG) and surgical aortic valve replacement (SAVR) have therapeutic benefits, including improved postoperative quality of life (QoL) and enhanced patient functional capacity which are key indicators of cardiac surgery outcome. In this article, we review the latest studies of QoL outcomes and functional capacity in patients who underwent cardiac surgery. Many standardized instruments are used to evaluate QoL and functional conditions. Preoperative health status, age, length of intensive care unit stay, operative risk, type of procedure, and other pre-, intra-, and postoperative factors affect postoperative QoL. Elderly patients experience impaired physical status soon after cardiac surgery, but it improves in the following period. CABG and SAVR are associated with increases of physical and mental health and functional capacity in the immediate postoperative and the long long-term. Cardiac rehabilitation improves patient functional capacity, QoL, and frailty following cardiac surgery.
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Tan JY, Shen SH. Nomogram predicting the cardiovascular disease mortality for older patients with colorectal cancer: A real-world population-based study. World J Cardiol 2024; 16:458-468. [PMID: 39221191 PMCID: PMC11362806 DOI: 10.4330/wjc.v16.i8.458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 07/24/2024] [Accepted: 08/06/2024] [Indexed: 08/26/2024] [Imported: 08/26/2024] Open
Abstract
BACKGROUND Cardio-oncology has received increasing attention especially among older patients with colorectal cancer (CRC). Cardiovascular disease (CVD)-specific mortality is the second-most frequent cause of death. The risk factors for CVD-specific mortality among older patients with CRC are still poorly understood.
AIM To identify the prognostic factors and construct a nomogram-based model to predict the CVD-specific mortality among older patients with CRC.
METHODS The data on older patients diagnosed with CRC were retrieved from The Surveillance, Epidemiology, and End Results database from 2004 to 2015. The prognostic factors and a nomogram-based model predicting the CVD-specific mortality were assessed using least absolute shrinkage and selection operator and Cox regression.
RESULTS A total of 141251 eligible patients with CRC were enrolled, of which 41459 patients died of CRC and 12651 patients died of CVD. The age at diagnosis, sex, marital status, year of diagnosis, surgery, and chemotherapy were independent prognostic factors associated with CVD-specific mortality among older patients with CRC. We used these variables to develop a model to predict CVD-specific mortality. The calibration curves for CVD-specific mortality probabilities showed that the model was in good agreement with actual observations. The C-index value of the model in the training cohort and testing cohort for predicting CVD-specific mortality was 0.728 and 0.734, respectively.
CONCLUSION The proposed nomogram-based model for CVD-specific mortality can be used for accurate prognostic prediction among older patients with CRC. This model is a potentially useful tool for clinicians to identify high-risk patients and develop personalized treatment plans.
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Safwan M, Bourgleh MS, Aldoush M, Haider KH. Tissue-source effect on mesenchymal stem cells as living biodrugs for heart failure: Systematic review and meta-analysis. World J Cardiol 2024; 16:469-483. [PMID: 39221190 PMCID: PMC11362808 DOI: 10.4330/wjc.v16.i8.469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 06/24/2024] [Accepted: 07/23/2024] [Indexed: 08/26/2024] [Imported: 08/26/2024] Open
Abstract
BACKGROUND Mesenchymal stem cells (MSCs), as living biodrugs, have entered advanced phases of clinical assessment for cardiac function restoration in patients with myocardial infarction and heart failure. While MSCs are available from diverse tissue sources, bone-marrow-derived MSCs (BM-MSCs) remain the most well-studied cell type, besides umbilical-cord-derived MSCs (UC-MSCs). The latter offers advantages, including noninvasive availability without ethical considerations.
AIM To compare the safety and efficacy of BM-MSCs and UC-MSCs in terms of left ventricular ejection fraction (LVEF), 6-min walking distance (6MWD), and major adverse cardiac events (MACEs).
METHODS Five databases were systematically searched to identify randomized controlled trials (RCTs). Thirteen RCTs (693 patients) were included using predefined eligibility criteria. Weighted mean differences and odds ratio (OR) for the changes in the estimated treatment effects.
RESULTS UC-MSCs significantly improved LVEF vs controls by 5.08% [95% confidence interval (CI): 2.20%-7.95%] at 6 mo and 2.78% (95%CI: 0.86%-4.70%) at 12 mo. However, no significant effect was observed for BM-MSCs vs controls. No significant changes were observed in the 6MWD with either of the two cell types. Also, no differences were observed for MACEs, except rehospitalization rates, which were lower only with BM-MSCs (odds ratio 0.48, 95%CI: 0.24-0.97) vs controls.
CONCLUSION UC-MSCs significantly improved LVEF compared with BM-MSCs. Their advantageous characteristics position them as a promising alternative to MSC-based therapy.
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Sun T, Zhang MX, Zeng Y, Ruan LH, Zhang Y, Yang CL, Qin Z, Wang J, Zhu HM, Long Y. Unloading and successful treatment with bioresorbable stents during percutaneous coronary intervention: A case report. World J Cardiol 2024; 16:484-490. [PMID: 39221188 PMCID: PMC11362809 DOI: 10.4330/wjc.v16.i8.484] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 07/04/2024] [Accepted: 07/19/2024] [Indexed: 08/26/2024] [Imported: 08/26/2024] Open
Abstract
BACKGROUND With the development of percutaneous coronary intervention (PCI), the number of interventional procedures without implantation, such as bioresorbable stents (BRS) and drug-coated balloons, has increased annually. Metal drug-eluting stent unloading is one of the most common clinical complications. Comparatively, BRS detachment is more concealed and harmful, but has yet to be reported in clinical research. In this study, we report a case of BRS unloading and successful rescue.
CASE SUMMARY This is a case of a 59-year-old male with the following medical history: “Type 2 diabetes mellitus” for 2 years, maintained with metformin extended-release tablets, 1 g PO BID; “hypertension” for 20 years, with long-term use of metoprolol sustained-release tablets, 47.5 mg PO QD; “hyperlipidemia” for 20 years, without regular medication. He was admitted to the emergency department of our hospital due to intermittent chest pain lasting 18 hours, on February 20, 2022 at 15: 35. Electrocardiogram results showed sinus rhythm, ST-segment elevation in leads I and avL, and poor R-wave progression in leads V1–3. High-sensitivity troponin I level was 4.59 ng/mL, indicating an acute high lateral wall myocardial infarction. The patient’s family requested treatment with BRS, without implantation. During PCI, the BRS became unloaded but was successfully rescued. The patient was followed up for 2 years; he had no episodes of angina pectoris and was in generally good condition.
CONCLUSION We describe a case of a 59-year-old male experienced BRS unloading and successful rescue. By analyzing images, the causes of BRS unloading and the treatment plan are discussed to provide insights for BRS release operations. We discuss preventive measures for BRS unloading.
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Grubić Rotkvić P, Rotkvić L, Đuzel Čokljat A, Cigrovski Berković M. Sodium-dependent glucose transporter 2 inhibitors effects on myocardial function in patients with type 2 diabetes and asymptomatic heart failure. World J Cardiol 2024; 16:448-457. [PMID: 39221192 PMCID: PMC11362810 DOI: 10.4330/wjc.v16.i8.448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 07/17/2024] [Accepted: 07/23/2024] [Indexed: 08/26/2024] [Imported: 08/26/2024] Open
Abstract
BACKGROUND Sodium-dependent glucose transporter 2 inhibitors (SGLT2i) have shown efficacy in reducing heart failure (HF) burden in a very heterogeneous groups of patients, raising doubts about some contemporary assumptions of their mechanism of action. We previously published a prospective observational study that evaluated mechanisms of action of SGLT2i in patients with type 2 diabetes who were in HF stages A and B on dual hypoglycemic therapy. Two groups of patients were included in the study: the ones receiving SGLT2i as an add-on agent to metformin and the others on dipeptidyl peptidase-4 inhibitors as an add-on to metformin due to suboptimal glycemic control.
AIM To evaluate the outcomes regarding natriuretic peptide, oxidative stress, inflammation, blood pressure, heart rate, cardiac function, and body weight.
METHODS The study outcomes were examined by dividing each treatment arm into two subgroups according to baseline parameters of global longitudinal strain (GLS), N-terminal pro-brain natriuretic peptide, myeloperoxidase (MPO), high-sensitivity C-reactive protein (hsCRP), and systolic and diastolic blood pressure. To evaluate the possible predictors of observed changes in the SGLT2i arm during follow-up, a rise in stroke volume index, body mass index (BMI) decrease, and lack of heart rate increase, linear regression analysis was performed.
RESULTS There was a greater reduction of MPO, hsCRP, GLS, and blood pressure in the groups with higher baseline values of mentioned parameters irrespective of the therapeutic arm after 6 months of follow-up. Significant independent predictors of heart rate decrease were a reduction in early mitral inflow velocity to early diastolic mitral annular velocity at the interventricular septal annulus ratio and BMI, while the predictor of stroke volume index increase was SGLT2i therapy itself.
CONCLUSION SGLT2i affect body composition, reduce cardiac load, improve diastolic/systolic function, and attenuate the sympathetic response. Glycemic control contributes to the improvement of heart function, blood pressure control, oxidative stress, and reduction in inflammation.
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Liu XC, Wang W, Wang LY. Antiphospholipid syndrome presenting as recurrent coronary thrombosis: A case report. World J Cardiol 2024; 16:491-495. [PMID: 39221193 PMCID: PMC11362805 DOI: 10.4330/wjc.v16.i8.491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Revised: 07/30/2024] [Accepted: 08/08/2024] [Indexed: 08/26/2024] [Imported: 08/26/2024] Open
Abstract
BACKGROUND Antiphospholipid syndrome (APS) is a chronic autoimmune disease characterized by venous or arterial thrombosis, pregnancy morbidity and a variety of other autoimmune and inflammatory complications. Here, we report a case of APS associated with multiple coronary thromboses.
CASE SUMMARY The patient, a 28-year-old male, suffered from recurrent coronary thromboses over a period of 31 months. Despite undergoing interventional coronary procedures, thrombolytic therapy, and anticoagulation treatment, the condition persisted intermittently. An extensive search for underlying thrombogenic factors revealed a diagnosis of APS. Accurate adjustment of the medication regimen led to the absence of further acute coronary syndrome (ACS) episodes during the subsequent 20-month follow-up. Although the patient occasionally experiences chest tightness, no further symptoms of distress have been reported.
CONCLUSION APS can manifest as ACS. Screening for rheumatologic and immunological conditions is essential when encountering patients with multiple coronary thromboses. Treatment strategy should include symptomatic relief and a targeted and aggressive approach to address the underlying pathophysiology.
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Teaima T, Carlini GB, Gajjar RA, Aziz I, Shoura SJ, Shilbayeh AR, Battikh N, Alyousef T. Rates, predictors, and causes of readmission after transcatheter aortic valve replacement in patients with chronic kidney disease. World J Cardiol 2024; 16:402-411. [PMID: 39086887 PMCID: PMC11287458 DOI: 10.4330/wjc.v16.i7.402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 05/09/2024] [Accepted: 06/06/2024] [Indexed: 07/23/2024] [Imported: 07/23/2024] Open
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is a revolutionary procedure for severe aortic stenosis. The coexistence of chronic kidney disease (CKD) and TAVR introduces a challenge that significantly impacts patient outcomes. AIM To define readmission rates, predictors, and causes after TAVR procedure in CKD stage 1-4 patients. METHODS We used the national readmission database 2018 and 2020 to look into readmission rates, causes and predictors after TAVR procedure in patients with CKD stage 1-4. RESULTS Out of 24758 who underwent TAVR and had CKD, 7892 (32.4%) patients were readmitted within 90 days, and had higher adjusted odds of being females (adjusted odds ratio: 1.17, 95%CI: 1.02-1.31, P = 0.02) with longer length of hospital stay > 6 days, and more comorbidities including but not limited to diabetes mellitus, anemia, and congestive heart failure (CHF). CONCLUSION Most common causes of readmission included CHF (18.0%), sepsis, and complete atrioventricular block. Controlling readmission predictors with very close follow-up is warranted to prevent such high rate of readmission.
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Barold SS. Misinterpretation of sleep-induced second-degree atrioventricular block. World J Cardiol 2024; 16:385-388. [PMID: 39086891 PMCID: PMC11287455 DOI: 10.4330/wjc.v16.i7.385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 06/26/2024] [Accepted: 07/09/2024] [Indexed: 07/23/2024] [Imported: 07/23/2024] Open
Abstract
A number of publications have claimed that Mobitz type II atrioventricular block (AVB) may occur during sleep. None of the reports defined type II AVB and representative electrocardiograms were either misinterpreted or missing. Relatively benign Wenckebach type I AVB is often misdiagnosed as Mobitz type II which is an indication for a pacemaker. Review of the published reports indicates that Mobitz type II AVB does not occur during sleep when it is absent in the awake state. Conclusion: There is no proof that sleep is associated with Mobitz type II AVB.
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