Association of gut microbiome dysbiosis with the progression of atrial fibrillation: A systematic review.

OBJECTIVE: Many clinical and preclinical studies have implicated an association between atrial fibrillation (AF) and its progression to imbalances in the gut microbiome composition. The gut microbiome is a diverse and complex ecosystem containing billions of microorganisms that produce biologically active metabolites influencing the host disease development. METHODS: For this review, a literature search was conducted using digital databases to systematically identify the studies reporting the association of gut microbiota with AF progression. RESULTS: In a total of 14 studies, 2479 patients were recruited for the final analysis. More than half (n = 8) of the studies reported alterations in alpha diversity in atrial fibrillation. As for the beta diversity, 10 studies showed significant alterations. Almost all studies that assessed gut microbiota alterations reported major taxa associated with atrial fibrillation. Most studies focused on short-chain fatty acids (SCFAs), whereas three studies evaluated TMAO levels in the blood, which is the breakdown product of dietary l-carnitine, choline, and lecithin. Moreover, an independent cohort study assessed the relationship between phenylacetylglutamine (PAGIn) and AF. CONCLUSION: Intestinal dysbiosis is a modifiable risk factor that might provide newer treatment strategies for AF prevention. Well-designed research and prospective randomized interventional studies are required to target the gut dysbiotic mechanisms and determine the gut dysbiotic-AF relationship.

Association of Depression With Myocardial Infarction With Non-obstructive Coronary Arteries: A Systematic Review.

This systematic review examined the association between depression and myocardial infarction with non-obstructive coronary arteries (MINOCA). A comprehensive literature search was conducted using electronic databases, resulting in the inclusion of six small case-control and cohort studies reported from Spain, Australia, China, and Pakistan. The studies included various study designs, such as cohort studies, case-control studies, and prospective cohort studies. The results of the systematic review indicate a significant association between depression and MINOCA. Several studies reported a higher prevalence of depression among MINOCA patients compared to those with obstructive coronary artery disease. Additionally, depression was found to be associated with worse outcomes in MINOCA patients, including increased cardiovascular events, all-cause mortality, and reduced quality of life. Some studies suggest that psychological factors, such as chronic stress, inflammation, and altered sympathetic nervous system activity, may play a role in the development and progression of MINOCA in individuals with depression. The findings highlight the importance of considering depression as a potential risk factor and prognostic marker in MINOCA patients. Early identification and management of depression in these individuals may improve outcomes and quality of life. A multi-center randomized controlled trial is needed to better understand the underlying mechanisms and to develop targeted interventions for individuals with depression and MINOCA.

Association of Deja vu With Cardiovascular Diseases.

Recent studies have suggested a link between déjà vu and cardiovascular diseases (CVDs). While the mechanism for this association is not fully understood, 1 theory suggests that déjà vu may be a result of a disruption in the temporal lobe, which is also responsible for regulating blood pressure and heart rate. Another theory suggests that there may be a shared genetic factor between the 2 conditions, with certain individuals being predisposed to experiencing both. The Apolipoprotein E (APOE) gene, in particular, has been associated with memory processing, Alzheimer's disease, and an increased risk of CVD. The protein encoded by this gene is involved in the metabolism of lipoproteins, including cholesterol and triglycerides, and is also involved in the development of atherosclerosis, which is a key risk factor for CVD. Several hypotheses have been proposed to explain how the APOE4 isoform contributes to CVD, including impairing the clearance of lipoproteins, promoting inflammation, and causing endothelial dysfunction. Psychological factors such as stress may also contribute to the development of CVD, and déjà vu may be associated with emotional arousal and stress. Further research is needed to fully understand the link between déjà vu and CVDs and to explore potential treatment options for individuals who experience both conditions.

Bullying in Cardiology: Pakistan's Perspective.

This survey aimed to investigate the extent of bullying among junior physicians in cardiology departments, by way of an anonymous web-based questionnaire in Pakistan. A survey of Pakistan cardiology trainees was piloted as a cross-sectional qualitative survey of junior cardiologists (including resident physicians and senior registrars) from teaching institutes all over Pakistan. Negative Acts Questionnaire-Revised was used as the tool for monitoring and reporting bullying nationwide. Of 1852 trainees, bullying was reported by 10.2% of males and 13.4% of females. Women had higher odds of reporting being bullied (odds ratio [OR] {95% confidence interval [CI]}: 1.42 [1.07-2.36]; P-value = 0.018), and the religious minority group (Hindu) reported more bullying (OR [95% CI]: 3.27 [2.16-4.73]; P-value < 0.001). Women were more likely than men to report sexist language (24.1% vs 7.5%; P-value < 0.001) while men reported more racist language (4.2% vs 16.5%; P-value < 0.001). Consultants in cardiology (75.4%) and other specialties (68.3%) commonly perpetrated bullying on cardiology trainees. Bullying in cardiology is a common finding and proportionally affects both males and females, religious minorities, and trainees working in tertiary care hospitals. In addition, females are reporting more sexist language being used by consultants as the majority.

Social determinants of pacemaker reuse among patients and family members in Pakistan.

OBJECTIVES: This survey aimed to quantify the opinions of CIED reuse among patients and family members in Pakistan and to identify the social determinants which may predict these views. METHODS: A questionnaire formulating attitudes toward PPM reuse was administered to patients and family members at cardiology institutes in Pakistan from 1 July 2022 to 30 September 2022. The eligibility criteria (age > 18 years; inline for PPM placement) were taken into account and incomplete responses were excluded from the final analysis. RESULTS: A total of 9,246 participants recorded their responses, of which 7,152 (78.16%) accepted pre-used PPMs. The lower social class had more PPM reuse acceptance rate than the middle and upper class (92.72% vs. 60.52% vs. 35.38%), respectively. Age ≥ 65 (OR(95%CI): 0.68 (0.41-0.99); P-value = 0.023), male gender (OR(95%CI): 0.55 (0.35-0.72), P-value = 0.016), unemployment (OR(95%CI): 0.47 (0.25-0.64); P-value = 0.007), poor health status (OR(95%CI): 0.72 (0.53-0.92); P-value = 0.041), and lower social class (OR(95%CI): 0.36 (0.28-0.53); P-value = 0.003) were social determinants of PPM reuse acceptance. CONCLUSION: Patients and their family members endorse the concept of PPM reuse in Pakistan who cannot afford new devices.

Anxiety and Depression in Heart Failure: An Updated Review.

Anxiety and depression are commonly experienced by individuals with heart conditions, significantly impacting their overall well-being and prognosis. This review aims to provide an updated examination of the relationship between anxiety, depression, and heart disease. The review begins by exploring the prevalence of anxiety and depression in heart patients, highlighting the substantial rates at which these mental health disorders co-occur in this population. It further elucidates the risk factors that contribute to the development and exacerbation of anxiety and depression in individuals with heart conditions, including biological, psychological, and social factors. The impact of anxiety and depression on cardiac outcomes is a central focus of this review. It explores the intricate bi-directional relationship between mental health and cardiovascular health, discussing the mechanisms through which anxiety and depression can lead to adverse cardiac events and worsen existing heart conditions. Additionally, it examines the potential impact of anxiety and depression on treatment adherence, lifestyle modifications, and overall quality of life in heart patients. The review also investigates the diagnostic and assessment methods for anxiety and depression in heart patients, emphasizing the importance of implementing comprehensive screening protocols in clinical settings. In conclusion, this updated review provides valuable insights into the prevalence, impact, assessment, and management of anxiety and depression in heart patients. It underscores the importance of recognizing and addressing these mental health disorders within the context of cardiac care, ultimately aiming to enhance the overall well-being and prognosis of individuals living with heart conditions.

Gender Disparity in Work Distribution Among Cardiology Trainees: Pakistan's Perspective.

Gender disparity in work distribution among cardiology trainees is a crucial issue that can impact career development and the overall representation of women in the field. This cross-sectional survey aimed to examine the gender disparity in work distribution among cardiology trainees in Pakistan. A total of 1156 trainees from various medical institutions across the country participated in the study, with 687 male trainees (59.4%) and 469 female trainees (40.5%). Demographic characteristics, baseline characteristics, work distribution patterns, perceptions of gender disparity, and career aspirations were assessed. The findings revealed that male trainees reported being assigned more complex procedures compared to female trainees (75% vs 47%, P < 0.001), while female trainees reported a higher frequency of being assigned administrative tasks compared to male trainees (61% vs 35%, P = 0.001). Both genders reported similar perceptions of the overall workload. However, female trainees experienced significantly higher rates of perceived bias and discrimination compared to male trainees (70% vs 25%, P < 0.001). Moreover, female trainees expressed a higher perception of unequal opportunities for career advancement due to gender disparities (80% vs 67%, P < 0.001). While male and female trainees showed similar aspirations for pursuing advanced subspecialties within cardiology, male trainees expressed a higher intention to pursue leadership positions within the field (60% vs 30%, P = 0.003). These findings shed light on the existing gender disparities in work distribution and perceptions within cardiology training programs in Pakistan.