Unstable angina pectoris in a young male after first dose of COVID-19 MRNA- vaccine.

Some side effects regarding COVID-19 vaccination have been reported. The most common reports of cardiovascular issues were myocarditis and pericarditis. Although inflammation is the most common cause in this matter, there were only a few reports about ischaemic cases related to COVID-19 vaccines. These reports also commonly included older men who received a second dose of mRNA vaccination. We present a 25-year-old man with chest pain mimicking a heart attack after receiving the first dose of the mRNA COVID-19 vaccine. There were no known preceding cardiovascular risk factors. Workups were done, and the diagnosis made was unstable angina pectoris. This may remind physicians to increase awareness of cardiovascular side effects in this vaccination era, as it may be encountered even in younger patients. The patient was seen at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia, in August 2022.

Cardiologic scoring system as predictors of mortality in geriatric COVID-19 patients.

OBJECTIVE: To develop a cardiologic scoring system to predict mortality among geriatric coronavirus disease-2019 patients. METHODS: The retrospective cohort study was conducted after approval from the ethics review committee of the Dr Soetomo General Academic Hospital, Surabaya, Indonesia, and comprised data from March 1, 2020, to April 30, 2021, of geriatric patients of either gender confirmed for coronavirus disease-2019 from several referral hospitals in East Java, Indonesia. Data on comorbidities, electrocardiograph, and chest X-ray findings was examined to develop a comprehensive scoring system. Data was analysed using SPSS 26. RESULTS: Of the 3,893 cases reviewed, data of 322(8.27%) patients was analysed; 191(59.3%) males and 131(40.7%) females. The overall mean age was 66±4.1 years (range: 60-75 years). Of them, 267(82.9%) subjects were alive upon hospital discharge, while 55(17.1%) died during hospitalisation. Of the 24 variables analysed, 5(21%) were found to be significant: cardiomegaly, sinus tachycardia, ST-segment abnormalities, pathological T-wave inversions, and axis deviation (p<0.05). Receiver operating characteristic curve analysis showed an area under the curve 0.86, cut-off point ≤4 with sensitivity 89% and specificity 69%. CONCLUSIONS: The scoring system was found to have the potential to predict mortality in geriatric coronavirus disease-2019 patients based on cardiac findings during hospital admission.

Clinical findings and electrocardiography predicted mortality among COVID-19 patients with pre-existing hypertension: A cross-sectional study of East Java Province, Indonesia.

OBJECTIVE: To evaluate the factors associated with mortality among coronavirus disease-2019 patients with preexisting hypertension. METHODS: The retrospective, cross-sectional study was conducted from June 15 to July 7, 2021, after approval from Dr Soetomo General Province Hospital, Indonesia, and comprised data from the coronavirus disease-2019 registry in the East Java province of Indonesia from March 2020 to June 2021. Data was collected for adult patients infected by coronavirus disease-2019 with pre-existing hypertension Data was analysed using SPSS 23. RESULTS: Of the 2,732 patients in the registry, 425(15.6%) with median age 56.5 years (interquartile range: 50-64 years) had pre-existing hypertension. Of them, 251(59.06%) were males, and 110(25.9%) had died while in hospital. Mortality was associated with older age; higher white blood cell counts at admission and lower platelet count (p<0.05). In addition, electrocardiogram parameters associated with mortality were faster heart rate and ST abnormality (p<0.05). CONCLUSIONS: Older age, high white blood cell level, lower platelet count, faster heart rate, and ST abnormality at admission were found to be the predictors of mortality among hospitalised coronavirus disease-2019 patients with pre-existing hypertension.

Wellens Syndrome in a patient with a history of hypertension and chronic obstructive pulmonary disease: a case report.

Wellens syndrome, an ST Elevation Myocardial Infarction (STEMI) equivalent, is also known as T-wave left anterior descending (LAD) coronary artery disease. Wellens syndrome is characterized by a unique electrocardiogram (ECG) pattern that suggests a significant stenosis in the left anterior descending coronary artery that warrants immediate intervention. Hereby, we present a case report of Wellens syndrome in a patient with a history of hypertension and chronic obstructive pulmonary disease (COPD) that may be potentially mistaken for pseudo- Wellens syndrome because the ECG pattern mimics left ventricular strain pattern (LVSP) in left ventricular hypertrophy (LVH). Thus, cautious examination of recent chest pain and ECG is important to differentiate Wellens syndrome and LVSP in patients with hypertension and COPD to perform early detection and aggressive intervention since they may help to lessen the adverse results.

Percutaneous transcatheter embolization in large tortuous coronary artery fistula patient: a case report.

Coronary artery fistula is a rare anomaly involving the coronary artery and a heart chamber or vessel. Percutaneous intervention has been shown to be effective and safe in fistulas that are small and nontortuous; however, it is not an absolute contraindication in fistulas that are large and tortuous. We report a delayed diagnosis of a single, large-diameter, tortuous coronary artery fistula that manifested as myocardial ischaemia due to the steal phenomenon in a 49 year old male. The undesirable connection was successfully obliterated by percutaneous embolisation, followed by an improvement in symptoms and daily activities. Steal phenomenon is the fundamental mechanism of myocardial ischaemia in coronary artery fistula, as confirmed by improvement in symptoms and coronary artery perfusion following occlusion of the fistula. Percutaneous catheterization is safe and effective for coronary artery fistula closure, and the occlusion site should be precise to achieve complete occlusion and prevent complications.

Economic Evaluation of COVID-19 Screening Tests and Surveillance Strategies in Low-Income, Middle-Income, and High-Income Countries: A Systematic Review.

BACKGROUND Economic evaluation of the testing strategies to control transmission and monitor the severity of COVID-19 after the pandemic is essential. This study aimed to review the economic evaluation of COVID-19 tests and to construct a model with outcomes in terms of cost and test acceptability for surveillance in the post-pandemic period in low-income, middle-income, and high-income countries. MATERIAL AND METHODS We performed the systematic review following PRISMA guidelines through MEDLINE and EMBASE databases. We included the relevant studies that reported the economic evaluation of COVID-19 tests for surveillance. Also, we input current probability, sensitivity, and specificity for COVID-19 surveillance in the post-pandemic period. RESULTS A total of 104 articles met the eligibility criteria, and 8 articles were reviewed and assessed for quality. The specificity and sensitivity of COVID-19 screening tests were reported as 80% to 90% and 40% to 90%, respectively. The target population presented a mortality rate between 0.2% and 19.2% in the post-pandemic period. The implementation model of COVID-19 screening tests for surveillance with a cost mean for molecular and antigen tests was US$ 46.64 (min-max US $0.25-$105.39) and US $6.15 (min-max US $2-$10), respectively. CONCLUSIONS For the allocation budget for the COVID-19 surveillance test, it is essential to consider the incidence and mortality of the post-pandemic period in low-income, middle-income, and high-income countries. A robust method to evaluate outcomes is needed to prevent increasing COVID-19 incidents earlier.

Quantification of hs-Troponin Levels and Global Longitudinal Strain among Critical COVID-19 Patients with Myocardial Involvement.

Background. Myocardial involvement among critically ill patients with coronavirus disease 2019 (COVID-19) often has worse outcomes. An imbalance in the oxygen supply causes the excessive release of pro-inflammatory cytokines, which results in increased ventilation requirements and the risk of death in COVID-19 patients. Purpose. We evaluated the association between the hs-troponin I levels and global longitudinal strain (GLS) as evidence of myocardial involvement among critical COVID-19 patients. Methods. We conducted a prospective cohort study from 1 February to 31 July 2021 at RSUD Dr. Soetomo, Surabaya, as a COVID-19 referral center. Of the 65 critical COVID-19 patients included, 41 (63.1%) were men, with a median age (interquartile range) of 51.0 years (20.0-75.0). Subjects were recruited based on WHO criteria for severe COVID-19, and myocardial involvement in the form of myocarditis was assessed using CDC criteria. Subjects were examined using echocardiography to measure the GLS, and blood samples were taken to measure the hs-troponin. Subjects were then followed for their need for mechanical ventilation and in-hospital mortality. Results. Severe COVID-19 patients with cardiac injury were associated with an increased need for intubation (78.5%) and an increased incidence of myocarditis (50.8%). There was a relationship between the use of intubation and the risk of death in patients (66.7% vs. 33.3%, p-value < 0.001). Decreased GLS and increased hs-troponin were associated with increased myocarditis (p values < 0.001 and 0.004, respectively). Decreased GLS was associated with a higher need for mechanical ventilation (12.17 + 4.79 vs. 15.65 + 4.90, p-value = 0.02) and higher mortality (11.36 + 4.64 vs. 14.74 + 4.82; p-value = 0.005). Elevated hs-troponin was associated with a higher need for mechanical ventilation (25.33% vs. 3.56%, p-value = 0.002) and higher mortality (34.57% vs. 5.76%, p-value = 0.002). Conclusions. Critically ill COVID-19 patients with myocardial involvement and elevated cardiac troponin levels are associated with a higher need for mechanical ventilation and higher mortality.

The Impact of Classical Cardiovascular Risk Factors on Hospitalization and Mortality among Hajj Pilgrims.

Background: Cardiovascular disease (CVD) is the leading cause of morbidity and mortality during Hajj. The objective of the present study was to examine the effect of classical cardiovascular disease risk factors on mortality and hospitalization among Hajj pilgrims from East Java, Indonesia, during 2017, 2018, and 2019. Methods: This study was a retrospective cohort of Hajj pilgrims from East Java, Indonesia, from 2017 to 2019. The data on risk factors were obtained from the pre-embarkation Hajj screening records. The diagnosis of hospitalization and cause of death during the Hajj period were obtained from the medical report and hospital/flight doctor death certificate. Results: A total of 72078 eligible subjects were included in this study. 33807 (46.9%) were men, and 38271 (53.1%) were women, and the majority (35%) were aged between 50 and 59 years. A total of 42446 pilgrims (58.9%) were classified as high risk due to underlying health conditions such as hypertension, diabetes, or if they were aged 60 years or older. The overall hospitalization rate is 971 per 100,000 pilgrims and the overall death rate is 240 deaths per 100,000 pilgrims. Multivariate analysis using logistic regression showed that male gender, age > 50 years, hypertension grade II-III, diabetes, overweight, and obesity were associated with a higher risk of hospitalization. Moreover, male gender, diabetes, and overweight were associated with a higher risk of mortality. Of all hospitalized patients, 92 patients (13.1%) had an initial diagnosis of CVD, and CVD is the main cause of mortality (38.2%) of pilgrims. Conclusion: Pilgrims with classical cardiovascular risk factors were associated with increased hospitalization and mortality.

Clinical characteristics, management, and outcomes of pulmonary valve myxoma: systematic review of published case reports.

BACKGROUND: Cardiac myxoma is the most common type of primary cardiac tumor, with the majority located in the atrial wall. The tumor is attached to valvular structures in a few cases, of which the pulmonary valve is the least affected. Pulmonary valve myxoma may have different clinical manifestations from the more common cardiac myxomas because of its vital position. A misdiagnosis of these types of cardiac myxoma may be detrimental to the care and well-being of patients. Therefore, this systematic review aims to define the clinical characteristics of pulmonary valve myxoma and how this differs from a more common cardiac myxoma. METHODS: Employed literature was obtained from PubMed, ScienceDirect, Scopus, Springer, and ProQuest without a publication year limit on August 23, 2022. The keyword was "pulmonary valve myxoma." Inclusion criteria were as follows: (1) case report or series, (2) available individual patient data, and (3) myxoma that is attached to pulmonary valve structures with no evidence of metastasis. Non-English language or nonhuman subject studies were excluded. Johanna Briggs Institute checklists were used for the risk of bias assessment. Data are presented descriptively. RESULTS: This review included 9 case reports from 2237 articles. All cases show a low risk of bias. Pulmonary valve myxoma is dominated by males (5:4), and the patient's median age is 57 years with a bimodal distribution in pediatric and geriatric populations. The clinical manifestation of pulmonary valve myxoma is often unspecified or asymptomatic. However, systolic murmur in the pulmonary valve area is heard in 67% of cases. Echocardiography remains the diagnostic modality of choice in the majority of cases. Tumor attached to the pulmonary cusps or annulus and extended to adjacent tissues in all cases. Therefore, valve replacement or adjacent tissue reconstructions are required in 77% of cases. The recurrence and mortality are considerably high, with 33% and 22% cases, respectively. CONCLUSIONS: Pulmonary valve myxoma is more common in males with a bimodal age distribution, and its outcomes seem worse than usual cardiac myxomas. Increasing awareness of its clinical symptoms, early diagnosis, and complete myxoma resection before the presence of congestive heart failure symptoms are important in achieving excellent outcomes. A firm embolization blockade is needed to prevent myxoma recurrence.

Efficacy of Ranolazine to Improve Diastolic Performance in Heart Failure with Preserved Ejection Fraction: A Systematic Review and Meta-analysis.

This article evaluates the efficacy of using ranolazine to improve diastolic performance and exercise capacity in heart failure with preserved ejection fraction. A comprehensive literature review found eight trials where there are no significant difference in peak O2 (p=0.09) and exercise duration (p=0.18) between ranolazine and placebo. The ranolazine group had significantly higher and better diastolic parameters compared to placebo, with a mean difference of 0.45 (95% CI [27.18-39.50]). There were no significant differences for haemodynamic parameters (blood pressure and heart rate) and electrocardiography (QT interval) between ranolazine and placebo. The review found that ranolazine has good wefficacy to improve diastolic performance among heart failure with preserved ejection fraction patients and it does not affect blood pressure, heart rate and rate of ventricular repolarisation (shortening of the QT interval).

Association of stigma with mental health and quality of life among Indonesian COVID-19 survivors.

BACKGROUND AND OBJECTIVE: Coronavirus disease 2019 (COVID-19) survivors face societal stigma. The study aims to analyze the association of this stigma with the mental health and quality of life of COVID-19 survivors. METHODS: In this cross-sectional study, we observed 547 adults who were previously documented as severe acute respiratory syndrome coronavirus (SARS-CoV-2) positive by a polymerase chain reaction (PCR) test, treated in a hospital or an emergency hospital and proven to be SARS-CoV-2 negative by their latest PCR test. We adopted the Berger HIV Stigma Scale to measure stigma; the World Health Organization Quality of Life Brief Form to measure quality of life; and the Mental Health Inventory-38 to measure mental health. The chi-square and binary logistic regression tests were used to find the correlation between the variables. RESULTS: The multivariate analysis revealed that medium stigma was more likely related to quality of life and mental health than low stigma. Females were less likely to experience stigma related to mental health than men, and respondents who worked as laborers and entrepreneurs were less likely to experience stigma related to mental health than those who worked as civil workers/army personnel/teachers/lecturers. COVID-19 survivors experienced medium stigma in society and lower quality of life and mental health status. We found that quality of life and mental health were affected by stigma, sex, and occupation. CONCLUSION: COVID-19 survivors are a vulnerable group that is most at risk when they return to their communities. Creating a safe environment and providing respectful care, including addressing complex stigma factors, is vital for developing appropriate interventions.

Enhancement of EPC migration by high-dose lisinopril is superior compared to captopril and ramipril.

Background: Angiotensin-converting enzyme (ACE) inhibitors have been shown to promote endothelial progenitor cell (EPC) function. However, the efficacies of different ACE inhibitors in improving the migratory capabilities of ECPs in coronary artery disease (CAD) patients is unclear. This study compared the effectiveness of captopril, lisinopril, and ramipril toward the migration capability of impaired EPCs from CAD patients. Methods: We isolated peripheral blood mononuclear cells (PBMCs), separated EPCs from PBMCs, and divided them into an untreated group (control) and treated groups of captopril, lisinopril, and ramipril at doses of 1mM, 10mM, and 100mM. EPC migration was evaluated using the Boyden chamber assay. Analysis of variance (ANOVA) was performed using SPSS 25.0. Results: This study showed that treatment with captopril, lisinopril, and ramipril starting at the lowest dose (1 mM) increased EPC migration (65,250 ± 6,750 cells; 60,750± 5,030 cells; and 49,500 ± 8,400 cells, respectively) compared to control (43,714 ± 7,216 cells). Increased migration of EPCs was observed by increasing the treatment dose to 10 mM with captopril, lisinopril, and ramipril (90,000 ± 16,837 cells; 79,071 ± 2,043 cells; and 64,285 ± 11,824 cells, respectively). The highest EPC migration was shown for lisinopril 100 mM (150,750 ± 16,380 cells), compared to captopril and ramipril at the same dose (105,750 ± 8112 cells and 86,625 ± 5,845 cells, respectively). Conclusions: Captopril, ramipril, and lisinopril were shown to increase EPC migration in a dose-dependent manner. Low-dose (1 mM) and medium-dose (10 mM) captopril had a larger effect on ECP migration than lisinopril and ramipril. Meanwhile, high-dose lisinopril (100mM) had the highest migration effect, suggesting it may be preferable for promoting EPC migration in CAD patients.

Electrocardiography on admission is associated with poor outcomes in coronavirus disease 2019 (COVID-19) patients: A systematic review and meta-analysis.

BACKGROUND: Electrocardiogram (ECG) is a widely accessible diagnostic tool that can easily be obtained on admission and can reduce excessive contact with coronavirus disease 2019 (COVID-19) patients. A systematic review and meta-analysis were performed to evaluate the latest evidence on the association of ECG on admission and the poor outcomes in COVID-19. METHODS: A literature search was conducted on online databases for observational studies evaluating ECG parameters and composite poor outcomes comprising ICU admission, severe illness, and mortality in COVID-19 patients. RESULTS: A total of 2,539 patients from seven studies were included in this analysis. Pooled analysis showed that a longer corrected QT (QTc) interval and more frequent prolonged QTc interval were associated with composite poor outcome ([WMD 6.04 [2.62-9.45], P = .001; I 2:0%] and [RR 1.89 [1.52-2.36], P < .001; I 2:17%], respectively). Patients with poor outcome had a longer QRS duration and a faster heart rate compared with patients with good outcome ([WMD 2.03 [0.20-3.87], P = .030; I 2:46.1%] and [WMD 5.96 [0.96-10.95], P = .019; I 2:55.9%], respectively). The incidence of left bundle branch block (LBBB), premature atrial contraction (PAC), and premature ventricular contraction (PVC) were higher in patients with poor outcome ([RR 2.55 [1.19-5.47], P = .016; I 2:65.9%]; [RR 1.94 [1.32-2.86], P = .001; I 2:62.8%]; and [RR 1.84 [1.075-3.17], P = .026; I 2:70.6%], respectively). T-wave inversion and ST-depression were more frequent in patients with poor outcome ([RR 1.68 [1.31-2.15], P < .001; I 2:14.3%] and [RR 1.61 [1.31-2.00], P < .001; I 2:49.5%], respectively). CONCLUSION: Most ECG abnormalities on admission are significantly associated with an increased composite poor outcome in patients with COVID-19.

Biomarkers of endothelial dysfunction and outcomes in coronavirus disease 2019 (COVID-19) patients: A systematic review and meta-analysis.

BACKGROUND: Several studies have reported that the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can directly infect endothelial cells, and endothelial dysfunction is often found in severe cases of coronavirus disease 2019 (COVID-19). To better understand the prognostic values of endothelial dysfunction in COVID-19-associated coagulopathy, we conducted a systematic review and meta-analysis to assess biomarkers of endothelial cells in patients with COVID-19. METHODS: A literature search was conducted on online databases for observational studies evaluating biomarkers of endothelial dysfunction and composite poor outcomes in COVID-19 patients. RESULTS: A total of 1187 patients from 17 studies were included in this analysis. The estimated pooled means for von Willebrand Factor (VWF) antigen levels in COVID-19 patients was higher compared to healthy control (306.42 [95% confidence interval (CI) 291.37-321.48], p < 0.001; I2:86%), with the highest VWF antigen levels was found in deceased COVID-19 patients (448.57 [95% CI 407.20-489.93], p < 0.001; I2:0%). Meta-analysis showed that higher plasma levels of VWF antigen, tissue-type plasminogen activator (t-PA), plasminogen activator inhibitor-1 antigen (PAI-1) antigen, and soluble thrombomodulin (sTM) were associated with composite poor outcome in COVID-19 patients ([standardized mean difference (SMD) 0.74 [0.33-1.16], p < 0.001; I2:80.4%], [SMD 0.55 [0.19-0.92], p = 0.003; I2:6.4%], [SMD 0.33 [0.04-0.62], p = 0.025; I2:7.9%], and [SMD 0.55 [0.10-0.99], p = 0.015; I2:23.6%], respectively). CONCLUSION: The estimated pooled means show increased levels of VWF antigen in COVID-19 patients. Several biomarkers of endothelial dysfunction, including VFW antigen, t-PA, PAI-1, and sTM, are significantly associated with increased composite poor outcomes in patients with COVID-19. PROSPERO REGISTRATION NUMBER: CRD42021228821.

Cardiac injury is associated with mortality and critically ill pneumonia in COVID-19: A meta-analysis.

Background: In this systematic review and meta-analysis, we aimed to explore the association between cardiac injury and mortality, the need for intensive care unit (ICU) care, acute respiratory distress syndrome (ARDS), and severe coronavirus disease 2019 (COVID-19) in patients with COVID-19 pneumonia. Methods: We performed a comprehensive literature search from several databases. Definition of cardiac injury follows that of the included studies, which includes highly sensitive cardiac troponin I (hs-cTnl) >99th percentile.The primary outcome was mortality, and the secondary outcomes were ARDS, the need for ICU care, and severe COVID-19. ARDS and severe COVID-19 were defined per the World Health Organization (WHO) interim guidance of severe acute respiratory infection (SARI) of COVID-19. Results: There were a total of 2389 patients from 13 studies. This meta-analysis showed that cardiac injury was associated with higher mortality (RR 7.95 [5.12, 12.34], p < 0.001; I2: 65%). Cardiac injury was associated with higher need for ICU care (RR 7.94 [1.51, 41.78], p = 0.01; I2: 79%), and severe COVID-19 (RR 13.81 [5.52, 34.52], p < 0.001; I2: 0%). The cardiac injury was not significant for increased risk of ARDS (RR 2.57 [0.96, 6.85], p = 0.06; I2: 84%). The level of hs-cTnI was higher in patients with primary + secondary outcome (mean difference 10.38 pg/mL [4.44, 16.32], p = 0.002; I2: 0%). Conclusion: Cardiac injury is associated with mortality, need for ICU care, and severity of disease in patients with COVID-19.

Factor Xa inhibitor for venous thromboembolism management in patient with cancer: a systematic review and meta-analysis.

Background: An earlier systematic review reported no differences in the incidence of recurrent venous thromboembolism and major bleeding between factor Xa inhibitors and standard anticoagulation. The present meta-analysis aimed to assess the effectiveness of factor Xa inhibitors for the management of venous thromboembolism (VTE), specifically in patients with cancer, as there were more randomized clinical trials (RCTs) available. Methods: The PubMed and Cochrane Library databases were systematically screened for all RCTs assessing factor Xa inhibitor efficacy for VTE management in cancer patients. Using RevMan 5.3, we performed a Mantel-Haenszel fixed-effects meta-analysis of the following outcomes: recurrent VTE, VTE events, and major bleeding rates. Results: We identified 11 studies involving 7,965 patients. Factor Xa inhibitors were superior in preventing VTE recurrence, compared to low-molecular-weight heparin (LMWH) (OR 0.60; 95% CI 0.45-0.80; P < 0.01) and vitamin K antagonists (VKA) (OR 0.51; 95% CI 0.33-0.78; P < 0.01). As prophylaxis, factor Xa inhibitors had a similar rate of VTE compared to VKAs (OR 1.08 [95% CI 0.31-3.77]; P = 0.90) and a lower rate compared to placebo (OR 0.54 [95% CI 0.35-0.81]; P < 0.01). Major bleeding rates were higher with factor Xa inhibitors than with LMWHs (OR 1.34 [95% CI 0.83-2.18]; P = 0.23), but significantly lower than VKAs (OR 0.71 [95% CI 0.55-0.92]; P < 0.01). Conclusions: Factor Xa inhibitors are effective for VTE management in patients with cancer; however, they are also associated with an increased bleeding risk compared to LMWH, but decreased when compared to VKA.

Case Report: Transient cortical blindness following coronary angiography.

Temporary blindness, also known as transient cortical blindness, is an uncommon impediment of contrast agent usage during angiography procedures. The occurrence of blindness after a cardiac catheterization procedure is rare and its pathophysiology remains largely speculative. The most probable mechanism seems to be contrast agent-related disruption of the blood-brain barrier, possibly initiated by several predisposing factors. This case reports a 52-year-old man with transient vision loss that occurred following coronary angiography. Brain magnetic resonance imaging (MRI) showed no acute pathology and his vision spontaneously returned within approximately 15 hours post-procedure without any requirement of specific therapy. Suggesting that transient cortical blindness may have occurred following coronary angiography which subsequently self-resolved.

Coronary Angiography Characteristics as Predictor of Successful Chronic Total Occlusion Recanalization.

Although remarkable progress in percutaneous coronary intervention (PCI) has been achieved over the last decade, the success rate of chronic total occlusion (CTO) recanalization varies greatly. Coronary angiography characteristics may affect the success rate of CTO recanalization. This study sought to establish a scoring model to predict successful CTO recanalization based on coronary angiography characteristics. We analyze 287 angiography data from patients who underwent elective PCI. Angiography characteristics being measured were lesion location, blunt stump, calcification, ostial lesion, bridging collateral, bending, side branch, tortuosity, previous stent attempt, and lesion length of >20 mm. Data were analyzed using SPSS 25.0. Multivariate analysis shows that side branch lesion ( p = 0.000), proximal vessels tortuosity ( p = 0.015), calcified lesion ( p = 0.000), lesion length of >20 mm ( p = 0.000), and blunt stump ( p = 0.000) can predict the successful PCI in the CTO. ROC curve analysis of the score ability to predict successful PCI in the CTO showed area under curve of 0.89 (confidence interval 95%), the cutoff point of ≤2 with a sensitivity of 93.33%, and specificity of 88.23%. We concluded that the five angiography characteristics that strongly associate with successful PCI in the CTO are calcified lesion, blunt stump, lesion length >20 mm, proximal vessel tortuosity, and side branch lesion. This score may help cardiologists to predict the success probability of PCI in the CTO.

Diagnostic test accuracy of Xpert MTB/RIF for tuberculous pericarditis: a systematic review and meta-analysis.

Introduction: Xpert MTB/RIF is a rapid diagnostic instrument for pulmonary tuberculosis (TB). However, studies reported varied accuracy of Xpert MTB/RIF in detecting Mycobacterium tuberculosis in pericardial effusion. Methods: We performed a systematic review of literature in PubMed, published up to February 1, 2020, according to PRISMA guidelines. We screened cross-sectional studies, observational cohort studies, and randomized control trials that evaluated the accuracy of Xpert MTB/RIF in diagnosing TB pericarditis. Papers with noninterpretable results of sensitivity and specificity, non-English articles, and unpublished studies were excluded. The primary outcomes were the sensitivity and specificity of Xpert MTB/RIF. We conducted a quality assessment using QUADAS-2 to evaluate the quality of the studies. A bivariate model pooled the overall sensitivity, specificity, positive likelihood ratios (PLRs), and negative likelihood ratios (NLRs) of included studies. Results: In total, 581 subjects from nine studies were analyzed in this meta-analysis. Our pooled analysis showed that the overall sensitivity, specificity, PLRs and NLRs of included studies were 0.676 (95% CI: 0.580-0.759), 0.994 (95% CI: 0.919-1.000), 110.11 (95% CI: 7.65-1584.57) and 0.326 (95% CI: 0.246-0.433), respectively. Conclusions: Xpert MTB/RIF had a robust specificity but unsatisfactory sensitivity in diagnosing TB pericarditis. These findings indicated that although positive Xpert MTB/RIF test results might be valuable in swiftly distinguishing the diagnosis of TB pericarditis, negative test results might not be able to rule out TB pericarditis. Registration: PROSPERO CRD42020167480 28/04/2020.

No-reflow phenomenon during percutaneous coronary intervention in a patient with polycythemia vera: A case report.

RATIONALE: Acute myocardial infarction is the leading cause of mortality and morbidity in a patient with polycythemia vera (PV). However, the benefit of various percutaneous coronary intervention (PCI) technique on the patient with PV is relatively unexplored. PATIENT CONCERN: A 46-year-old woman presented to the primary hospital complained about new-onset typical chest pain. Echocardiography examination showed inferior ST-elevation myocardial infarction (STEMIs) and increased cardiac markers. Complete blood count showed elevated hemoglobin, white blood cell, and platelet. DIAGNOSIS: Coronary angiography revealed simultaneous total occlusion at proximal right coronary artery (RCA) and also at proximal left anterior descending (LAD) artery. Elevated hemoglobin and hematocrit with JAK2 mutation establish the diagnosis of PV. INTERVENTIONS: We performed multi-vessel primary PCI by using direct stenting in RCA and aspiration thrombectomy in LAD after failed with balloon dilatation and direct stenting method. This procedure resulted in thrombolysis in myocardial infarction (TIMI)-3 flow in both coronary arteries. However, the no-reflow phenomenon occurred in the LAD, followed by ventricular fibrillation. After several attempts of resuscitation, thrombus aspiration, and low-dose intracoronary thrombolysis, the patient was returned to spontaneous circulation. The patient then received dual antiplatelet and cytoreductive therapy. OUTCOMES: The patient clinical condition and laboratory finding were improved, and the patient was discharged on the 7th day after PCI. LESSONS: Cardiologist should be aware of the no-reflow phenomenon risk in the patient with PV and STEMI. Direct stenting, intracoronary thrombectomy, and thrombolysis are preferable instead of balloon dilatation for PCI technique in this patient.