Outcomes of heart transplantation in cardiac amyloidosis: an updated systematic review.

Cardiac amyloidosis is one of the most common infiltrative cardiomyopathies that is characterized by the extracellular deposition of misfolded fibrillar protein. Several studies have previously found that patients with amyloid in the past have performed poorly after heart transplantation. Recent advancements in treatments have been made that have significantly improved outcomes in these patients. The study aimed to evaluate the outcomes of heart transplantation in cardiac amyloidosis. We systematically searched EMBASE, PubMed/MEDLINE, and Cochrane Library databases on 30 December 2021 following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. We identified 22 studies that examined 42,951 patients with cardiac amyloidosis of which only 1,329 patients underwent isolated heart transplantation. Seven studies reported individual patient data. The results of 123 patients have been pooled for analysis. There were 70 male patients, 45 female patients, and eight patients who did not report their gender. Among the types of amyloids, 63 (51%) patients were found to have light chain amyloidosis (AL) and 33 (27%) patients had transthyretin amyloidosis (ATTR). Only 41 patients (33.3%) reported a monoclonal component. There were 30 patients with AL that underwent autologous hematopoietic stem cell transplant (ASCT). The mean survival of 24 out of 30 patients was 4.33 years. In addition, the reported data include 13 patients requiring intra-aortic balloon pump (IABP), six with cardiac resynchronization therapy (CRT), and four with implantable cardioverter defibrillator (ICD). With the current advancements in treatments in combination with a multidisciplinary approach and careful patient selection, patients undergoing heart transplantation for amyloidosis may have encouraging results in the current era. Further studies will be needed to evaluate the outcomes of heart transplantation in amyloidosis patients now that several advances have been made in the field.

Congenital Long QT Syndrome, Coinciding With Cavitary Mycobacterium avium Lung Infection, Led to Cardiac Arrest.

Congenital long QT syndrome is a cardiac disorder leading to arrhythmias and sudden cardiac death. We present a case of a 55-year-old woman with altered mental status experiencing cardiac arrest caused by congenital long QT syndrome, coincidentally found with Mycobacterium avium complex lung infection. Genetic testing identified a pathogenic mutation in the KCNH2 gene. (Level of Difficulty: Intermediate.).

Efficacy of Cognitive Behavioral Therapy in Heart Failure Patients: A Systematic Review and Meta-Analysis.

BACKGROUND: Heart failure (HF) is a global disorder affecting around 6.2 million Americans aged 20 years and above. Neurovegetative disorders are common among such patients, and depression is a major problem that affects 20% to 40% of them. Cognitive behavioral therapy (CBT) is a type of treatment that produces the most favorable results compared to other psychotherapies, especially among patients with depression and anxiety. We aim to summarize and synthesize evidence regarding the efficacy of CBT for patients with HF. METHODS: We conducted this study by searching PubMed, Scopus, and Web of Science for relevant studies about CBT use in patients with HF. The outcomes were pooled as mean difference (MD) or standard MD with a 95% CI. The analysis was performed using the RevMan software. RESULTS: Combined data from 9 randomized controlled trials (1070 patients) revealed that CBT can alleviate both depression symptoms in HF patients when measured using different scales after 3 months of follow-up (standard MD, -0.18 [95% CI, -0.33 to -0.02]; P = 0.03) and the quality of life after 3 and 6 months of follow-up (MD, 4.92 [95% CI, 1.14-8.71]; P = 0.01 and MD, 7.72 [95% CI, 0.77-14.68]; P = 0.03, respectively). CONCLUSION: CBT is an effective type of psychotherapy for dealing with depression, mediocre quality of life, and defective physical functioning; therefore, it should be considered in HF patients' care.

Incidence and risk factors of cardiovascular mortality in patients with gastrointestinal adenocarcinoma.

BACKGROUND: Gastrointestinal (GI) cancers are common and fatal. Improved cancer-directed therapies, with thier substantial role in improving cancer-specific survival, may increase non-cancer mortality-including cardiovascular mortality-in these patients. AIM: To identify the risk factors of cardiovascular mortality in GI adenocarcinoma patients. METHODS: Data of GI adenocarcinoma patients were gathered from the Surveillance, Epidemiology, and End Results database. We used Pearson's chi-square test to assess the relationships between categorical variables. We used the Kaplan-Meyer test in the univariate analysis and Cox regression test for the multivariate analysis. RESULTS: Among 556,350 included patients, 275,118 (49.6%) died due to adenocarcinoma, 64,079 (11.5%) died due to cardiovascular causes, and 83,161 (14.9%) died due to other causes. Higher rates of cardiovascular mortality were found in patients ≥ 50 years (HR, 8.476; 95% CI, 7.91-9.083), separated (HR, 1.27; 95% CI, 1.184-1.361) and widowed (HR, 1.867; 95% CI, 1.812-1.924), patients with gastric (HR, 1.18; 95% CI, 1.1-1.265) or colorectal AC (HR, 1.123; 95% CI, 1.053-1.198), and patients not undergone surgery (HR, 2.04; 95% CI, 1.958-2.126). Lower risk patients include females (HR, 0.729; 95% CI, 0.717-0.742), blacks (HR, 0.95; 95% CI, 0.924-0.978), married (HR, 0.77; 95% CI, 0.749-0.792), divorced (HR, 0.841; 95% CI, 0.807-0.877), patients with pancreatic AC (HR, 0.83; 95% CI, 0.757-0.91), and patients treated with chemotherapy (HR, 0.416; 95% CI, 0.406-0.427). CONCLUSIONS: Risk factors for cardiovascular mortality in GI adenocarcinoma include advanced age, males, whites, separated and widowed, gastric or colorectal adenocarcinoma, advanced grade or advanced stage of the disease, no chemotherapy, and no surgery. Married and divorced, and patients with pancreatic adenocarcinoma have a lower risk.

Coronary Artery Calcium Score directed risk stratification of patients with Type-2 diabetes mellitus.

BACKGROUND AND AIMS: This study aimed to review the available data on the role of coronary artery calcium (CAC) scoring as the preferred adjunct modality to improve risk prediction and reduce the incidence of major adverse cardiac events and mortality in T2DM patients. METHODS: We reviewed the findings of 21 studies. RESULTS: This study revealed that the CAC scoring system could enhance cardiovascular disease (CVD) risk stratification and positively affect the medical management of patients with T2DM. CONCLUSION: A CAC scoring approach is necessary to reduce the incidence and prevalence of preventable CVD events in patients with type 2 diabetes.

New onset hypertension after transplantation.

It has been reported that up to 90% of organ transplant recipients have suboptimal blood pressure control. Uncontrolled hypertension is a well-known culprit of cardiovascular and overall morbidity and mortality. In addition, rigorous control of hypertension after organ transplantation is a crucial factor in prolonging graft survival. Nevertheless, hypertension after organ transplantation encompasses a broader range of causes than those identified in non-organ transplant patients. Hence, specific management awareness of those factors is mandated. An in-depth understanding of hypertension after organ transplantation remains a debatable issue that necessitates further clarification. This article provides a comprehensive review of the prevalence, risk factors, etiology, complications, prevention, and management of hypertension after organ transplantation.

Invasive Management of Vertebrobasilar Artery Stenosis and Occlusion: A Meta-Analysis on Efficacy and Safety Endpoints.

Vertebrobasilar angioplasty and stenting or mechanical thrombectomy (MT) using a stent retriever or suction thrombectomy are effective interventions in managing acute ischemic stroke caused by vertebrobasilar artery occlusion (VBAO). This study aims to investigate the safety and efficacy of self-expanding stents and balloon angioplasty in managing ischemic stroke. We reviewed the literature for relevant clinical trials and included those reporting the following primary outcomes: successful recanalization, favorable clinical outcome, and stenosis degree change. We included 24 studies (858 patients). In the subgroup analysis, participants were divided into three main subgroups based on the type of intervention: mechanical thrombectomy (MT), percutaneous transluminal angioplasty and stenting (PTAS), and MT+PTAS. Regarding overall mortality, the incidence was 34.5%, 9.9%, and 28.9% in the MT, PTAS, and MT+PTAS groups, respectively. The incidence of arterial dissection was 3.6% in the MT group, 3.1% in the PTAS group, and 16.7% in the MT+PTAS group. Incidence of distal embolization, MT, PTAS, and MT+PTAS groups had 3.4%, 5.8%, and 9.5% incidence rates, respectively. Favorable clinical outcomes were reported in 42.8% of subjects in the MT+PTAS group, 64.7% in the PTAS group, and 39.2% in the MT group. The incidence of intracranial hemorrhage was 5.2%, 4.5%, and 15.3% in the MT, PTAS, MT + PTAS groups, respectively. The incidence of successful recanalization was 85.3% in the MT group, 99.4% in the PTAS group, and 92.7% in the MT+PTAS group. Our analysis concludes that PTAS is the most effective intervention for VBAO and is associated with a lower rate of mortality compared to mechanical thrombectomy alone.

The Appearance of an Underrecognized Congenital Heart Disease in a Patient With COVID-19 Pneumonia.

A 60-year-old woman presented to the emergency department with worsening shortness of breath and non-productive cough for 1 week, which was preceding a recent COVID-19 infection. At the time the patient thought this was part of the constellation of symptoms of COVID-19, so she stayed home until her symptoms worsened to the point of needing hospitalization. The patient was found to have a rare and complex congenital heart disease that led her to develop acute heart failure precipitated by COVID-19 pneumonia. Medical management and surgical repair were essential in this patient given the late presentation.

Coronavirus Disease 2019 (COVID-19)-Induced Takotsubo Cardiomyopathy Prognosis in Geriatric Setting.

An 86-year-old female with a past medical history of hypertension, vertebral fractures with chronic lumbar pain, hip fracture, osteoporosis, deafness, and microcytic anemia underwent hospital admission for emergency medical management of her respiratory distress. The (overall) diagnostic workup confirmed COVID-19, the patient presented with 50% SPO2 (oxygen saturation), sinus tachycardia, diffuse bilateral pulmonary crackles, mild jugular venous distention (JVD), minimal bilateral pitting edema, elevated cardiac enzymes, bilateral pulmonary opacities, and ST-segment elevation. The cardiovascular assessment indicated stress-induced cardiomyopathy/Takotsubo cardiomyopathy (TCM) determined by 35%-40% LVEF (left ventricular ejection fraction), mid to apical left ventricular (LV) akinesia with preserved function in the proximal segment, aortic valve sclerosis, reduced excursion of Trileaflet valve (without stenosis), and mild-to-moderate tricuspid regurgitation with moderate pulmonary artery systolic pressure (PASP). The treatment protocol relied on 81 mg aspirin, 75 mg plavix, 20 mg lipitor, remdesivir, dexamethasone, ceftriaxone, azithromycin, red blood cells transfusion (pRBCs), endotracheal intubation for respiratory support, and systemic hemodynamic support. The patient's condition did not improve despite all treatment, and she passed away after seven days following her hospital admission.