RESUMO
BACKGROUND: Anxiety and depression are potentially harmful outcomes of permanent cardiac pacemakers. Dual-chamber P.P.M. is frequently used to treat life threatening bradycardia. The study aims to estimate the effect of the right ventricular PM lead position on recipients' anxiety and depression before, 6 months, and 1 year after implantation. RESULTS: A statistically significant correlation was discovered between the studied groups regarding HADS depression score after 6 months (p 0.013) and 1 year (p 0.013). A statistically non-significant difference was found among the studied groups at any point of time regarding baseline (p 0.063), after 6 months (p 0.054), or after 1 year (p 0.099). Significance was found between HADS anxiety score (p 0.015) or depression score after 1 year and the incidence of complications (p 0.001). CONCLUSIONS: A strong relationship was found between the level of depression and the R.V. site of implantation, as patients with the apical group had higher levels of depression post-implantation. The septal position has less stress and depression on the patient's well-being than the apical one.
RESUMO
Objectives: To assess patients with three-dimensional echocardiography before cardiac resynchronisation therapy device implantation to predict the responders, and to determine the response 3 months post-intervention. Method: The descriptive study was conducted at Kafrelsheikh University Hospital, Egypt, from January 2020 to March 2022, and comprised patients of either gender who underwent cardiac resynchronisation therapy device implantation. The patients were assessed clinically and with three-dimensional echocardiography using 16-segment systolic dyssynchrony index asthe main parameter compared at baseline and 3 months after implantation. The patients were classified as non-responders, clinical responders, and clinical and echocardiographic responders. Data was analysed using SPSS 23. RESULTS: Of the 40 patients, 23(57.5%) were males and 17(42.5%) were females. The overall mean age was 57.43±10.47 years, mean body weight was 81.30±11.33kg, mean height was 171.15±10.56cm), and mean body surface area was 1.93±0.17m2. Of the total, 14(35%) patients were hypertensive, 10(25%) diabetic, 15(37.5%) ischaemic and 2(5%) patients had atrial fibrillation. There were 8(20%) non-responders, 8(20%) clinical responders, and 24(60%) clinical and echocardiographic responders to therapy. Mean systolic dyssynchrony index at baseline was a positive highly significant predictor of post-therapy response (p<0.01). A positive highly significant correlation was also found between post-therapy response and end-systolic volume, three-dimensional ejection fraction, New York Heart Association class and QRS width (p<0.01). CONCLUSIONS: Three-dimensional 16-segmentsystolic dyssynchrony index wasfound to be a significantly effective tool to predict response to cardiac resynchronisation therapy device implantation.
Assuntos
Terapia de Ressincronização Cardíaca , Ecocardiografia Tridimensional , Insuficiência Cardíaca , Masculino , Feminino , Humanos , Pessoa de Meia-Idade , Idoso , Resultado do Tratamento , Seguimentos , Terapia de Ressincronização Cardíaca/métodos , Ecocardiografia Tridimensional/métodos , Ecocardiografia , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/terapiaRESUMO
Objectives: To assess heart failure patients by speckle tracking echocardiography before cardiac resynchronisation therapy implantation to predict the outcome. Method: The descriptive follow-up study was conducted at Kafrelsheikh and Mansoura University Hospitals, Egypt, from January 2020 to May 2022, and comprised heart failure patients of either gender who had ejection fraction ≤35%, QRS width ≥130msec and symptomatic even on optimal medical therapy. They were subjected to full clinical evaluation, electrocardiogram, basic and speckle tracking echocardiography with calculation of maximal septal to lateral delay at baseline and 3 months after cardiac resynchronisation therapy implantation. The patients were classified according to response into group I having non-responders, group II having patients who improved clinically only, and group III having responders both in clinical and echocardiographic terms. Data was analysed using SPSS 23. RESULTS: Of the 38 patients with mean age 55.24±11.23 years, 16(42%) were females and 22(57.9%) were males. There were 7(18.4%) patients in group I, 7(18.4%) in group II and 24(63.2%) in group III. There was a positive significant correlation between response to cardiac resynchronisation therapy CRT and increase in maximalseptal to lateral delay at baseline (p<0.01). There was an inverse significant correlation between response to cardiac resynchronisation therapy and decrease in maximal septal to lateral delay 3 months after the implantation (p=0.036). CONCLUSIONS: Maximal septal to lateral delay was found to be a good tool to predict the response to cardiac resynchronisation therapy before implantation.
Assuntos
Terapia de Ressincronização Cardíaca , Insuficiência Cardíaca , Masculino , Feminino , Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Seguimentos , Resultado do Tratamento , Ecocardiografia , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/terapiaRESUMO
Objectives: To investigate the possible advantage of topical lidocaine and intravenous midazolam in preventing spasm and pain related to the radial artery. Method: The prospective, comparative study was conducted at the catheterization laboratory of the cardiology department Kafrelsheikh University Hospital, Egypt, from January 2021 to January 2022, and comprised adult patients of either gender who were due to undergo coronary angiography and/or percutaneous coronary intervention for different indications. The patients were randomised control group I which was administered a cocktail of nitroglycerine, verapamil and heparin, intervention group II which was administered the control cocktail plustopical lidocaine, group III which was administered the control cocktail plus midazolam intravenously, and group IV which was administered the control cocktail plus topical lidocaine and intravenous midazolam. The groups were compared for frequency of radial artery spasm, accesssite cross-over and the difference in occurrence as well as procedure events, including the puncture number, time and complications. Data was analysed using SPSS 25. RESULTS: Of the 120 patients, there were 30(25%) in each of the 4 groups. Overall, there were 72(60%) males and 48(40%) females. Gender and mean age were not significantly different among the groups (p>0.05). Spasm of the radial artery occurred in 22(18.3%) patients, with higher incidence in the group I 12(40%). The median visual analogue scale score was higher in patients with radial artery spasm patients (p<0.001). The groups showed no significant differences in terms of frequency related to ad hoc percutaneous coronary intervention, contrast volume and fluoroscopy time (p>0.05), while they showed a significant difference in puncture time (p<0.05). Significant differences were noted among the groups in the incidence of radial artery spasm, visual analogue scale scores, requirement of multiple punctures, and the number of indicated punctures (p<0.05). Access site cross-over was more in the group I, while age, complication rates, visual analogue scale score, incidence of multiple punctures, and puncture time were significantly higher in patients with radial artery spasm (p<0.05). CONCLUSIONS: Cutaneous analgesia and procedural sedation before transradial access for coronary interventions were found to be associated with a substantial reduction in radial artery spasm and procedure-related discomfort.
Assuntos
Midazolam , Intervenção Coronária Percutânea , Masculino , Feminino , Humanos , Angiografia Coronária/efeitos adversos , Angiografia Coronária/métodos , Midazolam/uso terapêutico , Artéria Radial , Estudos Prospectivos , Espasmo/prevenção & controle , Espasmo/etiologia , Dor/prevenção & controle , Lidocaína/uso terapêutico , Intervenção Coronária Percutânea/efeitos adversos , Cateterismo Cardíaco/efeitos adversosRESUMO
Objectives: To assess left ventricular functions by echocardiography after 12 weeks of sofosbuvir-daclatasvir combination therapy. Method: The prospective cohort study was conducted from December 2019 to December 2021 at Kafrelsheikh University Hospital, Egypt, and comprised adult patients of either gender who had been referred to the Cardiovascular Department for cardiac evaluation and were found to be eligible forsofosbuvir-daclatasvir combination therapy. The patients were classified into five groups according to cardiovascular risk factors. Group 1 had no risk factors; Group 2 had many risk factors; Group 3 had only hypertension; Group 4 had diabetes only; and Group 5 had smoking as the only risk. All patients were assessed at baseline and at the end of the 12-week of antiviral combination therapy sofosbuvir 400 mg once daily dose and daclatasvir 60 mg once daily dose. Parameters checked were left ventricular ejection fraction, global longitudinalstrain, wall motion abnormalities and diastolic function. Data was analysed using SPSS 23. RESULTS: Of the 200 patients, 104(52%) were females and 96(48%) were males. The age range was 34-81 years, and 18(9%) patients were aged >70 years. There were 78(39%) patientsin Group 1, 60(30%) in Group 2, 25(12.5%) in Group 3, Group 4 had 13(6.5%) and Group 5 had 24(12%) patients. There were no significant changes in mean ejection fraction, global longitudinal strain and wall motion abnormalities (p>0.05). Diastolic function had some significant parameters in each of the 5 groups (p<0.05). CONCLUSIONS: Sofosbuvir-daclatasvir combination therapy did not affect or impair left ventricular systolic or diastolic functions.
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Hepatite C Crônica , Sofosbuvir , Adulto , Masculino , Feminino , Humanos , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Sofosbuvir/uso terapêutico , Hepatite C Crônica/tratamento farmacológico , Estudos Prospectivos , Função Ventricular Esquerda , Volume Sistólico , Hepacivirus , Quimioterapia Combinada , Antivirais/efeitos adversos , Pirrolidinas/uso terapêutico , Resultado do TratamentoRESUMO
Objectives: To assess cardiovascular risk after sofosbuvir and daclatasvir antiviral combination therapy in chronic hepatitis C virus patients. Method: The prospective cohortstudy was conducted at the Kafrelsheikh University Hospital, Egypt, from December 2019 to December 2021, and comprised adult patients of either gender with chronic hepatitis C virus and with minimum ejection fraction 40%. They were classified into groups according to their cardiovascular risk. Group 1 had individuals with no risk factors, Group 2 had patients with many risk factors, Group 3 had patients with only hypertension, Group 4 had those with diabetes alone, and Group 5 comprised smokers. All the patients were evaluated for the risk of major cardiovascular events at baseline and at the end of 12-week of antiviral combination therapy of sofosbuvir 400 mg once daily dose and daclatasvir 60 mg once daily dose. Data was analysed with SPSS version 23. RESULTS: Of the 200 patients, there were 96(48%) males and 104(52%) females. The age ranged 34-81 years. There were 78(39%) patients in Group 1; 20(25.6%) males and 58(74.4%) females with mean age 54.4±10.45 years. Group 2 had 60(30%) patients; 40(66.6%) males and 20(33.3%) females with mean age 59.57±9.1 years. Group 3 had 25(12.5%) patients; 3(12%) males and 22(88%) females with mean age 61.4±7.8 years. Group 4 had 13(6.5%) patients; 10(77%) males and 3(23%) females with mean age 55.4±10.4 years. Group 5 had 24(12%) patients who were all (100%) males with mean age 60.7±5.7 years. There were non-significant changes in the incidence of angina, arrhythmias or progression of dyspnoea (p>0.05). Echocardiography follow-up results showed non-significant changes in mean ejection fraction, global longitudinal strain and pulmonary artery pressure (p>0.05). CONCLUSIONS: Sofosbuvir and daclatasvir combination therapy wasfound to be safe in chronic hepatitis C virus patients regarding cardiac risks.
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Doenças Cardiovasculares , Hepatite C Crônica , Adulto , Masculino , Feminino , Humanos , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Sofosbuvir/uso terapêutico , Hepatite C Crônica/tratamento farmacológico , Estudos Prospectivos , Doenças Cardiovasculares/induzido quimicamente , Doenças Cardiovasculares/epidemiologia , Resultado do Tratamento , Fatores de Risco , Antivirais/efeitos adversos , Pirrolidinas/uso terapêutico , Quimioterapia Combinada , Fatores de Risco de Doenças Cardíacas , Hepacivirus , GenótipoRESUMO
Objectives: To compare the left atrial function utilising speckle tracking echocardiography in patients with low-risk and high-risk non-valvular atrial fibrillation. Method: The descriptive, cross-sectional study was conducted at the cardiology department of Kafrelsheikh University Hospital, Egypt, from January 2021 to January 2022, and comprised low-risk atrial fibrillatin participants in group I, high-risk atrial fibrillatin patients in group II, and healthy controls in group III. After detailed medical history, the subjects underwent 12-lead electrocardigram, and echocardiographic assessment, including two dimensional, M-mode, tissue doppler, and speckle tracking of the left atrium. The association of left atrial strain with Congestive heart failure, hypertension, age ≥75 (doubled), diabetes,stroke (doubled), vascular disease sex category (female)score was explored. Data was analysed using SPSS 28. RESULTS: Of the 90 subjects, there were 30(33.3%) in each of the 3 groups. The mean age among the groups was significantly different among the groups (p=0.014). Left atrial ejection fraction and left atrial strain had an overall significant difference among the groups(p<0.001). Congestive heart failure, hypertension, age ≥75 (doubled), diabetes, stroke (doubled), vascular disease sex category (female)score was negatively correlated with Left atrial ejection fraction and (p<0.001) and left atrial strain (p<0.001). CONCLUSIONS: In individuals with atrial fibrillatin, there was a significant decrease in left atrial strain and left atrial function. The use of speckle tracking echocardiography allowed for a more detailed analysis of left atrial mechanics. The correlation of left atrialstrain and left atrial ejection fraction with Congestive heart failure, hypertension, age ≥75 (doubled), diabetes, stroke (doubled), vascular disease sex category (female) score was significantly negative.