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A 56-year-old man with no significant past medical history presented with exertional shortness of breath. Echocardiogram, cardiac magnetic resonance, and computed tomography showed mitral stenosis and a left atrial thrombus. Left atrial thrombus formation is a well-known complication of severe mitral stenosis that can lead to systemic thromboembolism. The patient underwent mitral valve replacement, left atrial thrombus resection, and left atrial appendage closure that resulted in significant improvement in breathing.
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Fibrilación Atrial , Estenosis de la Válvula Mitral , Tromboembolia , Trombosis , Masculino , Humanos , Persona de Mediana Edad , Estenosis de la Válvula Mitral/diagnóstico por imagen , Estenosis de la Válvula Mitral/cirugía , Corazón , Trombosis/diagnóstico por imagen , Trombosis/etiología , Trombosis/cirugíaRESUMEN
Membranous interventricular septal (MIVS) aneurysm is a rare often asymptomatic, accidentally discovered congenital anomaly, which might be complicated with right ventricular obstruction, rupture, thromboembolism, and conduction abnormalities.
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BACKGROUND: An increased heart rate (HR) is deleterious in patients with decompensated heart failure. Ivabradine, an HR lowering agent which acts by inhibiting the If current in the sinoatrial node, is indicated for chronic heart failure with reduced ejection fraction. However, data regarding the safety and efficacy of ivabradine in acute decompensated heart failure is limited. This retrospective observational study aimed to investigate the effects of ivabradine on morbidity and short-term mortality of hospitalized patients with acute decompensated heart failure. METHODS: A total of 998 patients with acute decompensated heart failure on top of a chronic status from 1/5/2014 to 1/5/2019 who were already on guideline-directed treatment including a beta-blocker were included. Patients were divided into two groups, the first group (No-ivabradine) where patients continued the same dose of beta-blocker alone while the second group (ivabradine group) ivabradine 5 mg BID was added in addition to the same dose of beta-blocker. Patients with hemodynamic instabilities were excluded from the study. Propensity matching was performed to exclude confounding factors. RESULTS: There was no significant difference between groups regarding baseline patient characteristics, laboratory, and echocardiographic data. There were significant differences between groups regarding average HR (87 ± 15 and 90 ± 12 bpm in ivabradine and control groups, consecutively, P = 0.0006*) and length of hospital stay (5.3 ± 2.3 and 7.7 ± 5.6 days in ivabradine and control groups, consecutively, P < 0.0001*). However, there were no differences in rehospitalization and mortality rates at 1 month and 6 months. CONCLUSION: In a retrospective cohort study aimed to investigate the effects of ivabradine on morbidity and short-term mortality of hospitalized patients with acute decompensated heart failure. Ivabradine was associated with significantly lower average HR and length of hospital stay. However, there was no benefit in the reduction of rehospitalization and mortality rates at 1- and 6-month follow-ups.
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BACKGROUND: A wide range of cardiac arrhythmias were reported in the setting of active infection or as a complication of COVID-19. The main pathophysiology can be attributed to dysautonomia or autonomic nervous system dysfunction. Postural orthostatic tachycardia syndrome (POTS) is a complex, multisystemic disorder affecting usually younger age with tachycardia at rest or with minimal effort being the main symptom. Data regarding the safety and efficacy of ivabradine in POTS treatment is limited to small studies and case reports. METHODS: This prospective observational study included a total of 55 COVID-19-associated POTS patients after the exclusion of other causes of tachycardia. Ivabradine 5 mg twice daily was initiated. Re-assessment of patients' symptoms, heart rate, and heart rate variability (HRV) parameters' changes after 3 days of ivabradine therapy was done. RESULTS: The mean age of the included patients was 30.5±6.9 years with 32 patients being males (58.2%). 43 of 55 (78%) of the included patients reported significant improvement of the symptoms within 7 days of ivabradine therapy. 24-hour heart rate (minimum, average, and maximum) was significantly lower (p-value < 0.0001*, = 0.001*, < 0.0001* consecutively) with a significant difference in HRV time-domain parameters (SDNN, rMSSD) (p-value < 0.0001*) after ivabradine therapy. CONCLUSION: In a prospective study that evaluated the effects of ivabradine in post-COVID-19 POTS, patients treated with ivabradine reported improvement of their symptoms within 7 days of ivabradine treatment with a significant reduction of 24-hour average, minimum, and maximum heart rate, and improvement of HRV time domains parameters. Ivabradine might be a useful option to relieve symptoms of tachycardia in COVID-19 POTS. Further research is required to confirm the safety and efficacy of ivabradine in POTS treatment.
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Cardiomiopatías , Complicaciones Cardiovasculares del Embarazo , Trastornos Puerperales , Femenino , Humanos , Embarazo , Periodo Periparto , Disparidades Socioeconómicas en Salud , Cardiomiopatías/epidemiología , Trastornos Puerperales/epidemiología , Complicaciones Cardiovasculares del Embarazo/epidemiología , Complicaciones Cardiovasculares del Embarazo/terapiaRESUMEN
Repeated implantation failure refer to failure to conceive after three or more embryo transfer attempts. Several interventions were offered to improve maternal and fetal outcomes. Our objective was to investigate the impact of platelet-rich plasma (PRP) as a promising intervention to improve both pregnancy and birth outcomes. We searched PubMed, Scopus, Web of Science, and Cochrane Central, in addition to other relevant resources of grey literature. Only clinical trials were eligible to be included. We performed the meta-analysis using a random effects model. Eight randomized clinical trials, enrolling 1038 women with more than 3 implantation failure attempts, were included. We found a significant increase regarding all our prespecified primary outcomes. Chemical pregnancy rate [relative ratio (RR): 1.96, 95% confidence interval (CI): 1.61, 2.39; p<0.001], clinical pregnancy rate (RR: 4.35, 95% CI: 1.92, 2.88; p<0.001), and live birth rate (RR: 4.03, 95% CI: 1.29, 12.63; p=0.02) were found to be statistically significant and increased in patients who received PRP compared with the control group. Implantation rate (RR: 1.98, 95% CI: 1.34, 2.75; p<0.001), miscarriage rate (RR: 0.44, 95% CI: 0.23, 0.83, p=0.01), and multiple pregnancy rate (RR: 2.56, 95% CI: 1.02, 6.42, p=0.04) were also found to be significantly increased in the PRP group. We provide strong evidence on how intrauterine PRP can improve implantation, pregnancy, and birth outcomes in RIF women, which should direct clinicians to consider this intervention as a very effective tool in assisted reproductive techniques.
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Estenosis de la Válvula Aórtica , Dispositivos de Protección Embólica , Embolia Intracraneal , Accidente Cerebrovascular , Reemplazo de la Válvula Aórtica Transcatéter , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Embolia Intracraneal/etiología , Embolia Intracraneal/prevención & control , Estenosis de la Válvula Aórtica/cirugía , Resultado del Tratamiento , Válvula Aórtica/cirugía , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/prevención & control , Factores de RiesgoRESUMEN
Tricuspid regurgitation (TR) is being increasingly recognized in patient population. We aimed to investigate the long-term mortality due to TR in the United States (US) and demographic disparities in TR-related mortality using "Multiple Cause of Death data" via the Centers for Disease Control and Prevention Wide-Ranging On-line Data for Epidemiologic Research datasets, 1999 to 2019. The results from present analysis suggest that TR related deaths in the US may have increased over the last 20 years. This trend may justify greater focus on timely diagnosis and management of TR.
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Insuficiencia de la Válvula Tricúspide , Humanos , Estados Unidos/epidemiología , Insuficiencia de la Válvula Tricúspide/epidemiología , Insuficiencia de la Válvula Tricúspide/diagnóstico , Insuficiencia de la Válvula Tricúspide/etiología , Resultado del Tratamiento , Estudios RetrospectivosRESUMEN
Background: Transcatheter mitral valve-in-valve (MViV) replacement has emerged as an alternative to redo surgical mitral valve replacement (redo-SMVR) in patients with failed mitral bioprostheses deemed to be at a high surgical risk. The aim of this analysis was to compare the outcomes of MViV replacement with those of redo-SMVR in patients with a failed bioprosthetic mitral valve. Methods: We performed a study-level meta-analysis that compared MViV replacement with redo-SMVR in patients with failed mitral bioprostheses. Seven observational studies, with a total of 5083 patients, were included (1138 patients [22.4%] in the MViV replacement arm). The primary focus was all-cause mortality. Additional outcomes included major bleeding, stroke, vascular complications, and mean mitral valve gradient at follow-up. Results: The in-hospital mortality was lower in patients who underwent MViV replacement than in those who underwent redo-SMVR (odds ratio [OR], 0.64; 95% CI, 0.53-0.78; P = .0023). The short-term mortality (<1 year) was numerically lower in the MViV replacement group (OR, 0.45; 95% CI, 0.18-1.13; P = .069). At 1 year, the risk of mortality was similar in the 2 groups (OR, 0.99; 95% CI, 0.69-1.40; P = .906), and at midterm follow-up (≥1 year), there was a numerically higher risk of mortality in the MViV replacement group (OR, 1.51; 95% CI, 1.00-2.29; P = .051). The risk of major bleeding was significantly lower in the MViV replacement group (OR, 0.23; 95% CI, 0.10-0.56; P = .01). Additionally, stroke and vascular complications were similar between the 2 groups. Conclusions: The in-hospital mortality was lower in the MViV replacement group than in the redo-SMVR group. There were no differences in mortality at short-term (<1 year), 1-year, or midterm (≥1 year) follow-ups.
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Several studies have shown that elevated serum ferritin level is associated with a higher risk of coronary artery disease. Recently, it has been shown that high serum ferritin levels in men are independently correlated with an increased risk of cardiovascular mortality. This study aimed to investigate the possible correlation between the initial serum ferritin level and in-hospital mortality in patients presenting with ST-elevation myocardial infarction (STEMI). This retrospective cohort study included 890 patients who presented with acute STEMI and underwent successful primary percutaneous coronary intervention (PPCI) according to the standard techniques during the period from 1 May 2020 to 1 May 2021. At the time of admission, an initial serum ferritin level was measured in all patients. Comparison between initial ferritin levels was made between two groups: died and survived. Propensity matching was performed to exclude confounding factors effect. Forty-one patients had in-hospital mortality. There was no significant difference between both groups regarding baseline clinical characteristics. Initial serum ferritin levels were higher in deceased patients, even after propensity matching. In conclusion, even after propensity matching, initial ferritin levels were significantly higher in patients who died after being admitted for STEMI.
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OBJECTIVE: We sought to compare the clinical outcomes with provisional versus double-stenting strategy for left main (LM) bifurcation percutaneous coronary intervention (PCI). BACKGROUND: Despite two recent randomized controlled trials (RCTs) and several observational reports, the optimal LM bifurcation PCI technique remains controversial. METHODS: PubMed, Cochrane Central Register of Controlled-Trials (CENTRAL), Clinicaltrials.gov, International Clinical Trial Registry Platform were leveraged for studies comparing PCI bifurcation techniques for LM coronary lesions using second-generation drug eluting stents (DES). The primary outcome was major adverse cardiovascular events (MACE). Secondary outcomes of interest were all-cause mortality, cardiovascular mortality, myocardial infarction (MI), target vessel or lesion revascularization, and stent thrombosis. RESULTS: Two RCTs and 10 observational studies with 7105 patients were included. Median follow-up duration was 42 months (IQR: 25.7). Double stenting was associated with a trend towards higher incidence of MACE (odds ratio [OR] 1.20; 95 % confidence interval [CI] 0.94 to 1.53) compared with provisional stenting. This was mainly driven by higher rates of target lesion revascularization (TLR) (OR 1.50; 95 % CI 1.07 to 2.11). There were no statistically significant differences in the incidence of all-cause mortality, cardiovascular mortality, MI, or stent thrombosis. On subgroup analysis according to the study type, provisional stenting was associated with lower MACE and TLR in observational studies, but not in RCTs. CONCLUSION: For LM bifurcation PCI using second-generation DES, a provisional stenting strategy was associated with a trend towards lower incidence of MACE driven by statistically significant lower rates of TLR, compared with systematic double stenting. These differences were primarily driven by observational studies. Further RCTs are warranted to confirm these findings.
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Enfermedades Cardiovasculares , Proyectos de Investigación , HumanosRESUMEN
Cardiac arrest (CA) among young adults (<45 y) with ischemic heart disease (IHD) remained understudied. We evaluated the trends in clinical profile, in-hospital mortality, and health care resource utilization in CA-related hospitalizations among young adults with IHD. National Inpatient Sample (2004-2018) was used to identify adults aged 18-45 years. Of 77,359 weighted CA-related hospitalizations (mean age: 39 [0.05] y; 34.3% women), 65% had a myocardial infarction (MI), and 58% had a shockable rhythm. Between 2004 and 2018, CA-related hospitalizations among young adults with IHD increased from 1.8% to 2.4%. Overall, in-hospital mortality was 36.4%, which was higher for women vs men (40.4% vs 34.2%; P < 0.001) and Black vs White adults (43.9% vs 33.3%; P < 0.001). In-hospital mortality increased from 33.5% to 38.1%, with a consistent upward trend in men, White adults, and both MI and non-MI cases. However, in STEMI (40%), in-hospital mortality decreased from 34.6% to 20.2% (p-trend <0.001), while it increased in NSTEMI (14.8%) from 34.3% to 47.5% (p-trend <0.001). Overall mean length of stay (LOS) (7-9 days) and mean inflation-adjusted care cost ($34,431-$44,646) increased over the study duration. CA-related hospitalizations and associated LOS and inflation-adjusted care costs have increased in the last 15 years. In-hospital mortality increased by â¼5% during the study period with a higher mortality in women and among black adults. While increased CA-related hospitalizations may reflect improved pre-hospital care, greater efforts are needed to address improve in-hospital survival in CA among young adults with IHD.
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Paro Cardíaco , Infarto del Miocardio , Isquemia Miocárdica , Adulto , Femenino , Paro Cardíaco/epidemiología , Paro Cardíaco/terapia , Mortalidad Hospitalaria , Hospitalización , Humanos , Tiempo de Internación , Masculino , Infarto del Miocardio/epidemiología , Infarto del Miocardio/terapia , Isquemia Miocárdica/epidemiología , Isquemia Miocárdica/terapia , Estados Unidos/epidemiología , Adulto JovenRESUMEN
CME CREDIT Earn free AMA PRA Category 1 CreditTM by reading this case and reviewing the video quizzes embedded. Then follow the link to obtain CME credit.
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Imagen Multimodal , Tomografía de Emisión de Positrones , Humanos , Imagen Multimodal/métodos , RadiofármacosAsunto(s)
Apéndice Atrial , Fibrilación Atrial , Procedimientos Quirúrgicos Cardíacos , Accidente Cerebrovascular , Anticoagulantes , Apéndice Atrial/diagnóstico por imagen , Apéndice Atrial/cirugía , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/cirugía , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Humanos , Resultado del TratamientoAsunto(s)
Diabetes Mellitus , Aneurisma Cardíaco , Infarto del Miocardio , Rotura Septal Ventricular , Anciano , Aneurisma Cardíaco/complicaciones , Aneurisma Cardíaco/diagnóstico por imagen , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Infarto del Miocardio/complicaciones , Infarto del Miocardio/diagnóstico por imagenRESUMEN
Endothelial dysfunction with subsequent thrombosis and, less commonly, vasculitis has been implicated during the active phase of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) infection. However, less has been described during the recovery phase or as late sequelae. Here, we report a case of acute anterior wall ST-elevation myocardial infarction in a female patient with no medical history of cardiovascular risk factors as a post-infectious complication of coronavirus disease 2019 (COVID-19). Coronary angiography revealed total occlusion of her left anterior descending, right coronary arteries, and tight stenosis in the left circumflex artery. Successful revascularization with a staged percutaneous coronary intervention was achieved. To date, there is not much data regarding the late cardiovascular sequelae of COVID-19 and its possible mechanisms. Prolonged follow-up, even for mild cases of COVID-19, is advised for early diagnosis and treatment of long-term complications of COVID-19.
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Oral vitamin K antagonists (VKAs), warfarin, have been in routine clinical use for almost 70 years for various cardiovascular conditions. Direct-Acting Oral Anticoagulants (DOACs) have emerged as competitive alternatives for VKAs to prevent stroke in patients with non-valvular atrial fibrillation (AF) and have become the preferred choice in several clinical indications for anticoagulation. Recent guidelines have limited the use of DOACs to patients with non-valvular AF to reduce the risk of cardioembolic complications and to treat venous thromboembolism (VTE). Although emerging evidence is suggestive of its high efficacy, there was a lack of data to support DOACs safety profile in patients with mechanical valve prosthesis, intracardiac thrombi, or other conditions such as cardiac device implantation or catheter ablation. Therefore, several clinical trials have been conducted to assess the beneficial effects of using DOACs, instead of VKAs, for various non-guideline-approved indications. This review aimed to discuss the current guideline-approved indications for DOACs, advantages, and limitations of DOACs use in various clinical indications highlighting the potential emerging indications and remaining challenges for DOACs use. Several considerations are in favour of switching from warfarin to DOACs including superior efficacy, better adverse effect profile, fewer drug-drug interactions, and they do not require frequent international normalized ratio (INR) monitoring. Large randomized controlled trials are required to determine the safety and efficacy of their use in various clinical indications.