Relationship of left ventricular end-diastolic pressure with extent of myocardial ischemia, myocardial salvage and long-term outcome in patients with ST-segment elevation myocardial infarction.

OBJECTIVES: We aimed to assess the association of left ventricular end-diastolic pressure (LVEDP) with myocardial salvage and long-term mortality in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). BACKGROUND: The association of LVEDP with myocardial salvage or long-term mortality in patients with STEMI has not been investigated. METHODS: This study included 1,312 patients with STEMI undergoing primary PCI between 2002 and 2007. LVEDP was measured at the time of intervention. Patients were divided into three groups: a group with LVEDP in the 1st tertile (LVEDP, 4-19 mmHg; n = 496), a group with LVEDP in the 2nd tertile (LVEDP >19-24 mmHg; n = 410) and a group with LVEDP in the 3rd tertile (LVEDP >24-45 mmHg; n = 406). The primary outcome was 8-year cardiac mortality. RESULTS: The primary outcome (cardiac deaths) occurred in 114 patients. Deaths occurred in 26 (7.9%), 36 (11.5%), and 52 (16.4%) patients with LVEDP in the 1st to 3rd tertiles, respectively (adjusted hazard ratio = 1.18, 95% confidence interval 1.02-1.36, P = 0.022, for 5 mmHg increment in the LVEDP values). LVEDP correlated with the extent of myocardial ischemia (R = 0.351; P < 0.001). In patients with LVEDP in the 1st to 3rd tertiles, the salvage index (proportion of initial area at risk salvaged) was 0.53 [0.27-0.84], 0.53 [0.28-0.80], and 0.43 [0.18-0.75], respectively (P = 0.012). After adjustment, LVEDP correlated inversely with myocardial salvage (P < 0.001). CONCLUSIONS: In patients with STEMI, elevated LVEDP correlated with the extent of myocardial ischemia, reduced myocardial salvage and increased risk of 8-year cardiac mortality.

Imaging, Health Record, and Artificial Intelligence: Hype or Hope?

PURPOSE OF REVIEW: The review is focused on "digital health", which means advanced analytics based on multi-modal data. The "Health Care Internet of Things", which uses sensors, apps, and remote monitoring could provide continuous clinical information in the cloud that enables clinicians to access the information they need to care for patients everywhere. Greater standardization of acquisition protocols will be needed to maximize the potential gains from automation and machine learning. RECENT FINDINGS: Recent artificial intelligence applications on cardiac imaging will not be diagnosing patients and replacing doctors but will be augmenting their ability to find key relevant data they need to care for a patient and present it in a concise, easily digestible format. Risk stratification will transition from oversimplified population-based risk scores to machine learning-based metrics incorporating a large number of patient-specific clinical and imaging variables in real-time beyond the limits of human cognition. This will deliver highly accurate and individual personalized risk assessments and facilitate tailored management plans.

Differences Among Body Mass Index (BMI) Groups in Patients Undergoing First Elective Percutaneous Coronary Intervention.

BACKGROUND AND PURPOSE: Body Mass Index (BMI) is known to be an independent risk factor for hypertension, type 2 diabetes mellitus, dyslipidemia and various cardiovascular diseases. Our aim was to investigate the differences among BMI groups in patients undergoing first elective PCI. METHODS: 781 consecutive patients who underwent their first-time elective PCI from September 2011 to December 2013 in the Department of Cardiology were enrolled in the study. The patients with BMI < 18.5 kg/m(2) or > 50 kg/m(2) and those who had previously undergone revascularization were excluded from the study. Patients were categorized according to their BMI groups. BMI 18.5 - 24.9 kg/m(2) normal group, 25 - 29.9 kg/m(2) overweight group and > 30 kg/m(2) obese group. We studied the demographic, angiographic, and interventional differences between BMI groups. RESULTS: Compared with normal weight individuals, those obese were younger (61.9 ±10.34 vs. 58.41 ± 8.01 p = 0.0006), had higher prevalence of diabetes mellitus (46.4% vs. 26.6% p = 0.0001), dyslipidemia (77.5% vs. 65.4% p=0.0134) and hypertension (1.3% vs. 81.3% p=0.0067). There was a greater use of calcium channel blockers (CCBs) and Angiotensin Enzyme Inhibitors (ACEIs)/Angiotensin Receptor Blockers (ARBs) in obese individuals but it was not statistically significant. Obese individuals were associated with higher risk anatomy (3-Vessel CAD or LM) compared to normal individuals but not statistically significant (18.8% vs. 14.2% p=0.25). Obese patients were associated with a higher length of stents/person used (36.7 ± 22.02 vs. 31.7 ± 17.48 p=0.016) and also a larger diameter of stents/person used (3.14 ± 0.4 vs. 2.98 ± 0.33 p=0.0001) compared to normal individuals. CONCLUSIONS: Patients with a higher BMI are younger and have diabetes mellitus, hypertension and dyslipidemia more frequently. Patients with a higher BMI have a higher length and larger diameter of stents/person used, probably related to a more extensive coronary artery disease.

Contrast-Induced Nephropathy in Interventional Cardiology: Incidence, Risk Factors, and Identification of High-Risk Patients.

AIM: This study aimed to study contrast-induced nephropathy (CIN) or more recent nomenclature contrast-associated acute kidney injury (CI-AKI) in patients undergoing percutaneous coronary procedures, evaluating CIN incidence, risk factors (RFs), and high-risk patients with CIN.  Methods: This is a prospective, observational, unicentric trial of patients who underwent coronary angiography and/or percutaneous coronary intervention (PCI) in the University Hospital Center (UHC) "Mother Teresa" in Tirana, Albania, during 2016-2018. CIN was defined as an increase of 25% and/or by 0.5 mg/dL of serum creatinine (SCr) and high-risk patients with CIN as an increase by 50% and/or by 2 mg/dL and/or need for dialysis compared to the basal pre-procedural values. We evaluated RFs for CIN: preexisting renal lesion (PRL), heart failure (HF), age, diabetes mellitus (DM), anemia, and contrast quantity.  Results: The incidence of CIN resulted in 14.4%. HF, PRL, and age ≥65 years resulted in independent RFs for CIN, whereas anemia, DM, and contrast quantity >100 mL did not. PRL proved to be the most important RF for CIN, whereas HF was the only independent RF for high-risk CIN patients. CONCLUSIONS: The incidence of CIN coincides with the results in the literature. PRL, HF, and age ≥65 years resulted in independent RFs for CIN; more and larger trials are needed to evaluate DM, anemia, and contrast quantity related to their impact on CIN. High-risk patients with CIN represent the most problematic patients of this pathology.

Sex differences in the outcome after percutaneous coronary intervention - A propensity matching analysis.

BACKGROUND: Whether there are sex differences in the outcome of patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) remains controversial. We undertook this study to assess whether there are sex-related differences in the long-term mortality in a large series of patients with CAD after PCI. METHODS: The study included 18,334 patients (4735 women and 13,599 men) with CAD treated with PCI. Propensity matching was performed to obtain a group of patients (3000 women and 3000 men) matched for all characteristics available in database. The primary outcome was a composite of cardiac mortality, myocardial infarction or stroke at 3 years of follow-up. RESULTS: The primary outcome occurred in 660 women and 1440 men (Kaplan-Meier [KM] estimates, 15.2% in women and 11.6% in men, unadjusted hazard ratio [HR] = 1.35, 95% confidence interval [CI] 1.24 to 1.49; P < 0.001). Women were at higher risk of all-cause mortality (15.4% vs. 12.3%; P < 0.001), cardiac mortality (10.2% vs. 7.6%; P < 0.001) and stroke (2.6% vs. 1.4%; P < 0.001) than men. In matched patients, the primary outcome occurred in 371 women and 322 men (KM estimates, 13.4% vs. 11.6%, HR = 1.18 [1.01-1.36], P = 0.033). Women were at higher risk of myocardial infarction (4.2% vs. 3.1%; P = 0.044) but not cardiac (8.7% vs. 8.2%; P = 0.306) or all-cause death (12.5% vs. 12.9%; P = 0.991) or stroke (1.9% vs. 1.6%; P = 0.550) than men. CONCLUSIONS: After propensity matching, women remained at a higher risk of a composite of cardiac mortality, myocardial infarction or stroke up to 3 years after PCI than men.

Localized constrictive pericarditis compressing and obstructing the right ventricular inflow tract due to a giant anterior calcified cardiac mass. A case report.

INTRODUCTION: Localized pericardial constriction is a rare form of constrictive pericarditis CP. Depending on the CP location, clinical presentation may be variable, including compression and obstruction of right ventricular inflow tract(RVIT), coronary obstruction, or pulmonary stenosis. CASE PRESENTATION: A 72-year-old man presented a 2-year history of dyspnea and atrial fibrillation. A contrast enhanced angio computerized tomography clearly demonstrated a large spherical mass about 11×9×4cm in the anterior pericardium, presenting as a mediastinal tumor causing compression and obstruction of the RVIT. The patient underwent surgical procedure. The outer calcified layer of the pericardial mass was a thick layer of calcification surrounding an inner amorphous low density material. The inferior calcified layer of the pericardial mass which was extremely adherent with the epicardium, was carefully excised, without employment of cardiopulmonary bypass, from the aorta and pulmonary artery origin to the diaphragm and all areas between the right and left phrenic nerves. The final diagnosis was idiopathic CP. DISCUSSION: The clinical presentation was due to right ventricular free wall compression and obstruction of the RVIT by a giant calcified anterior cardiac mass. The differential diagnosis with other calcified masses in the anterior mediastinum such as teratoma, hemopericardium after blunt trauma and idiopathic or tuberculous CP should be considered. CONCLUSION: Herein we report a very rare case with localized CP causing compression and obstruction of RVIT due to a giant anterior calcified cardiac mass, treated successfully with pericardectomy. Careful dissection is mandatory for a successful procedure.

Surgical Treatment of Anomalous Origin of Right Coronary Artery in a Patient with Mitral Stenosis.

BACKGROUND: An anomalous origin of the right coronary artery is rarely observed, with a reported incidence between 0.026% and 0.25%. This condition is often completely asymptomatic and is found incidentally during angiographic evaluation for other cardiac diseases. However some patients present with exertion angina or sudden death. Surgical treatment in patients with anomalous RCA is still controversial. Treatment can be conservative, angioplasty or surgery. CASE PRESENTATION: A 59-year-old man was admitted with severe mitral stenosis. He complained exertion and rest dyspnea, NYHA III class. He had sequels of embolic stroke, results of left atrial thrombus. Echocardiography showed calcified severe mitral stenosis with mitral orifice area of 1.1 square centimeters with PSPAP 60 mmHg and normal LV function. Routine coronary angiography before surgery showed aberrant origin of RCA from the left sinus of Valsalva with 90% stenosis at his origin. Multi-slice computed tomography proved the diagnosis of anomalous RCA arising from the left sinus of Valsalva and taking an inter-arterial course between the aorta and pulmonary artery. The patient underwent mitral valve replacement with mechanical St. Jude prosthesis No 29 and saphenous vein graft to RCA. We chose by-pass grafting techniques because after aortotomy, RCA was too close to LMCA, intramural course was too short and stenosis of RCA was outside of aortic wall. The patient's perioperative course was without complications and patient was discharged on the seventh postoperative day. CONCLUSION: Correction of anomalous of the origin of right coronary artery is mandatory in cases where patient has to be operated for other cardiac causes.

The role of computed tomography in detecting splenic arteriovenous fistula and concomitant atrial myxoma.

PATIENT: Female, 45 FINAL DIAGNOSIS: Arterio-venous fistula of the splean Symptoms: Lef-side abdominal pain Medication: - Clinical Procedure: - Specialty: Surgery. OBJECTIVE: Rare disease. BACKGROUND: Splenic arterial-venous fistula and atrial myxoma are not rare cases but the co-existence of both lesions in the same patient is unpublished so far. CASE REPORT: A 45- year-old woman presented with vague left flank pain. She was initially scanned by B-dimensional echography, which revealed multiple enlarged hypo-echoic lesions in the splenic hilum. To further characterize the lesion, we performed computed tomography angiography (CTA). CTA showed dilatation of the splenic artery, and aneurismal dilatation of the splenic vein, associated with early opacification of the portal system. CTA showed also an intrasplenic venous aneurism, which was presumed to be the site of fistulous communication. Celiac arteriography confirmed the CTA findings. A left atrial mass was detected by cardiac echography, which was evaluated better by CTA, and was consistent with atrial myxoma. The patient underwent open surgery in different stage with resection of the atrial mass and spleen. The postoperative period was uneventful. CONCLUSIONS: This is a unique case in the literature, showing the coexistence of a dual-pathology splenic arterial venous fistula and atrial myxoma.