Atrial Fibrillation after Rheumatic Heart Valve Surgery: Incidence, Predictors, and Outcomes.

BACKGROUND: Atrial fibrillation after cardiac surgery (AFACS) impacts 10 to 65% of patients. AFACS is associated with stroke and other systemic embolic manifestations. METHODS: Patients at our hospital who underwent rheumatic valve surgery procedures including aortic valve replacement (AVR), mitral valve replacement (MVR), AVR with coronary artery bypass grafting (CABG), MVR with CABG, or AVR and MVR with/without CABG were included in this study in the period from 2002 to 2017. RESULTS: In total, 346 patients were included in the current analysis, with a mean age of 51.6 ± 16.1 years, and 51% were males. AFACS was documented in 102 patients (29.9%) .: Univariate predictors of AFACS included age, gender, body mass index (BMI), operation type, left ventricular ejection fraction (EF), left atrial (LA) diameter, previous history of AF, use of aldosterone antagonists more than a month before surgery, use of diuretics more than a month before surgery, length of ICU stay, total length of stay, cross-clamp time more than 90 minutes, pump time more than 120 minutes, postoperative acute kidney injury, left ventricular dimensions.By multivariate analysis, only age (p = 0.028, AOR = 10.6), male gender (p = 0.021, AOR = 3.4), type of surgery (p = 0.034, AOR = 7.12), history of AF (p = 0.018, AOR = : 2.32), BMI (p < 0.001, AOR = 3.91), EF before surgery (p ≤ 0.001, AOR = 3.91), and LA diameter (p = 0.0051, AOR = 18.23) were independent predictors of AFACS. CONCLUSION: This study identifies risk factors associated with the development of atrial fibrillation after rheumatic valve heart surgery. Older patients, male gender, type of surgery, preoperative AF, BMI, EF before surgery, and LA diameter are independent predictors of AF after cardiac valve surgery.

Predictors of mortality among patients with type 2 diabetes in Jordan.

BACKGROUND: Diabetes Mellitus (DM) is a common metabolic disease associated with increased risk of mortality. OBJECTIVE: The aim of this study was to examine predictors of mortality among patients with type 2 diabetes in the north of Jordan. METHODS: Electronic data files for diabetes patients admitted between the period of 2014-2018 at a tertiary center in the north of Jordan were reviewed. Patient's characteristics, clinical and laboratory data, use of medications and mortality rate were collected. RESULTS: Mean age of patients (n = 957) was 60.99 ± 0.37 (mean ± sem). Most of patients had multiple risk factors and underlying cardiovascular diseases (CVDs). Mortality rate was 10.1%. Univariate predictors of mortality included age, chronic kidney disease (CKD), acute kidney injury, hypertension, heart failure (HF), coronary artery disease, venous thromboembolism (VTE), stroke, atrial fibrillation (AF), and chronic obstructive pulmonary disease (COPD). As the number of CVDs increases, mortality rate also increases (Odd ratio 2.0, p < 0.0001). Use of insulin, aspirin, ACEi/ARBS, beta blockers, and diuretics were also associated with mortality. Fasting glucose and percentage of glycated hemoglobin were not associated with mortality. By multivariable logistic regression analysis adjusting for confounders and collinearity; age, HF, AF, COPD, VTE, and CKD were associated with mortality. CONCLUSION: Key risk factors of mortality are CVDs and CKD indicating that the primary step of management should focus on optimizing risk factors to prevent diabetes complications and death.

A comparative study of photoplethysmogram and piezoelectric plethysmogram signals.

The Photoplethysmogram (PPG) signal is one of the most important vital signals in biomedical applications. The non-invasive property and the convenience in the acquisition of both PPG and Piezoelectric Plethysmogram (PZPG) signals are considered as powerful and accurate tools for biomedical diagnosing applications, such as oxygen saturation in blood, blood flow, and blood pressure measurements. In this paper, a number of features for PPG and PZPG signals (ex. first derivative, second derivative, area under the curve and the ratio of systolic area to the diastolic area) are acquired and compared. The results show that both systems are able to extract the pulse rate (PR) and pulse rate variability (PRV), accurately with an estimation error of less than 10%. The averaged standard deviation of the ratio of the systolic area to the diastolic area for the first derivative of PPG and PZPG signals was small with less than 0.49 and 0.69 for the PPG and PZPG, respectively. Statistical analysis techniques (such as cross-correlation, P-value test, and Bland Altman method) are performed to address the relation between the PPG and PZPG signals. All of these methods showed a strong relationship between the features of the two signals (i.e. PPG and PZPG). The correlation value is found to be 0.954 with a p-value of < 0.05. This opens possibilities for combining both the PPG and PZPG systems to extract more features that can be used in diagnosing cardiovascular diseases. Such a system can provide a possibility to reduce the number of devices connected to patients (especially in emergencies) by means of measuring simultaneously both signals (PZPG and PPG).

Sinus of valsalva aneurysm with fistula to the right atrium presented as acute heart failure in a young man.

PATIENT: Male, 23 FINAL DIAGNOSIS: Sinus of valsalva aneurysm (SVA) Symptoms: Chest pain • low O2 saturation • short of breath MEDICATION: - Clinical Procedure: - Specialty: Cardiology. OBJECTIVE: Rare disease. BACKGROUND: Sinus of valsalva aneurysm (SVA) is a rare cardiac anomaly. It may be congenital or acquired; a coexisting cardiac lesion might be present. Rupture of the aneurysm, where it usually occurs in the right atrium, can cause acute symptoms of heart failure. Echocardiography (particularly TEE) can provide all necessary diagnostic data for safe surgical treatment. Treatment of choice is surgery. CASE REPORT: A 23-year-old male, previously healthy, presented to the emergency room (ER) with shortness of breath for the last 10 hours after lifting a heavy object. The patient had central chest pain. His O2 sat was 88%. ECG showed ischemic changes. Diagnosis of AMI was made, but auscultation revealed a murmur followed by a TTE and TEE, which revealed a ruptured sinus of valsalva aneurysm. CONCLUSIONS: This case report highlights the superiority of TEE over TTE in diagnosis and in planning adequate surgical treatment for patients with ruptured SVA, as well as the importance of ultrasonographer experience in the diagnosis. The optimal management for a ruptured SVA is surgical repair, with an acceptably low operative risk and good long-term outcome.