心血管疾病与诊断

Background: Reduced ejection fraction may increase the complications after transcatheter aortic valve implantation (TAVI). We investigated the impact of low flow (LF) and low gradient (LG) on long term mortality after TAVI in addition to other predictors.

Methods: We included retrospectively 450 patients with EF <40%, whom underwent TAVI in central hospital Bad Berka, Germany between 2012 and 2018. Patients were divided in to 4 groups according to the aortic mean pressure gradient and stroke volume. All demographic parameters and clinical outcomes were compared among the groups. Binary logistic regression was used to identify the predictors of 1-year mortality.

Results: Overall 1-year mortality was 16.3%, the 30-days mortality was 11.9%, 8.6%, 14.3% and 5%, and the 1- year mortality was 19.9%, 13.7%, 24.5% and 6.7% in LFLG, LFHG, NFLG and NFHG respectively. Univariable predictors for 12-month mortality were: age, male gender, diabetes mellitus, dementia, peripheral vascular disease, atrial fibrillation, ejection fraction <25%, TAPSE <16 mm, pulmonary hypertension and LG. Multivariable analysis showed that pulmonary hypertension (OR 3.4; 95% CI: 1,7-6.7, p value 0.0001), diabetes (OR 3; 95% CI: 1.5-5.8, p value 0.001) and dementia (OR 28; 95% CI: 5.6-144, p value 0.0001) remained as independent predictors. Significant improvement in NYHA class was shown in 81.7%, 83.4%, 93.5% and 80%, in LFLG, LFHG, NFLG and NFHG respectively.

Conclusions: TAVI improved the quality of life in all subgroups. LG has an impact on the 1-year mortality. Diabetes, dementia and pulmonary hypertension are independent predictors of 1-year mortality.

Being a very common condition among the whole population of the world, often leading a life-threatening illness and having high risk and mortality rate, chronic heart failure (CHF) is also a major public health problem for the world. Our goal is to investigate what has been achieved in the treatment of CHF patients with a left ventricular ejection fraction (LVEF) <40% recent years. In recent years, it is revealed that BNP has been crucial in the pathogenesis of heart disease. Due to this reason, we tried to investigate the results of the complex medical treatment method performed with the combination of sacubitril/alsartan which angiotensin is receptor neprilysin inhibitor in CHF patients. We also investigated the device treatment methods used in the treatment of these patients, particularly the cardiac resynchronization therapy. Finally, we investigated the results of the complex medical treatment method performed with the combination of sacubitril/valsartan which is angiotensin receptor neprilysin inhibitor in comparison with the those of the cardiac resynchronization therapy.

Background: Pediatric cardiac catheterization now has a major role in management of structural and congenital heart disease (SACHD) with progressive increase in interventional procedures over time.

Objectives: This study aimed to describe the frequency, level of severity, and cause of complications in a tertiary center and point out patient and procedural predictors related to these complications.

Materials and Methods: This was a retrospective observational study which included a total of 1129 cases admitted to the cardiology department congenital and structural heart disease unit Ain Shams university hospitals over a 1-year period.

Results: The overall complication, major complication, and mortality rate was 10.5%, 2.2%, and 0.5%, respectively. The predictors that increased the risk of overall complications included weight (p-value<0.0001), age at the time of the procedure (p-value<0.0001), age group (<0.0001), category of CHD (p-value<0.0001), invasive haemodynamic as mean pulmonary artery pressure(PAP) (p-value=0.0016), oxygen systemic saturation (p=0.0030) and dose of heparin given during the procedure (p<0.0001), number of catheterizations before the procedure (p=0.0345), anesthesia type (p<0.0001), procedure type risk category (p=0.0001), access type (p<0.0001) and number of sheaths used during the procedure (p=0.0313).

Conclusion: The complications risk in congenital and structural heart disease catheterization was independently increased if the patient was <2 year of age, use of local anesthesia, arterial access, more than one sheath used and procedure risk category 4.

Background: Conduction defects including various types of atrioventricular blocks and bundle branch blocks, may occur as complications of acute ST elevation myocardial infarction, and are associated with increased shortand long-term mortality rates.

Objectives: To determine the prevalence of conduction defects in patients with STEMI during hospital stay.

Materials and Methods: This prospective study included 100 consecutive cases (72 males, 28 females) of STEMI at Slemani cardiac center, with mean age of (60.06±12.86 years). The initial ECG was done immediately after the patient's admission, observation of patients performed in CCU and daily ECGs were done. Conduction defects whither transient or present on discharge were recorded.

Results: Out of 100 patients, 78% of patients had no significant conduction defects, 22% of patients developed various types of conduction defects, of which 10 patients (45.45%) had transient conduction defects, and 12 patients (54.5%) had permanent conduction defects. 50% of conduction defects were atrioventricular blocks all with inferior MI, the other 50% were intraventricular blocks. patients with conduction defects had significant higher mortality rates. the mean age of patients with conduction defects (mean=65.1year) was higher than those without conduction defects (mean=58.6 year).

Conclusion: Conduction defects are frequent complications of myocardial infarction in Slemani, even with reperfusion therapy, associated with high mortality, and their prevalence is increased with increasing age. All atrioventricular blocks had occurred with inferior STEMI while intraventricular blocks had occurred with variable types of STEMI.

Objective: Investigate the association of diagonal earlobe crease (DELC) and coronary artery disease (CAD) in men under 60.

Design: A prospective case-control study.

Setting: Male patients aged 60 and under, admitted to cardiology wards at Cork University Hospital.

Participants: 94 male patients were recruited from January 2018 to January 2019. 45 patients acutely presenting at the cardiology wards with an acute coronary syndrome event were included in the study. 49 patients without a history of CAD on the same wards were used as controls. Patients with visible trauma to the earlobe were excluded from the study.

Interventions: Subjects’ earlobes were inspected for the presence or absence of DELC and images were captured to be reviewed by two blinded observers.

Primary and secondary outcome measures: Primary goal was to establish the prevalence of DELC among male cardiac patients under 60. Secondary goal was to investigate the association of DELC with the traditional risk factors: smoking, hypertension, dyslipidaemia, diabetes.

Results: Mean age (in years) of patients with DELC was 51.9 ± 7.33 (p<0.015). The prevalence of DELC among cardiac patients was 80% compared to 51% in the control group (p<0.003). Sensitivity and specificity of DELC to detect CAD was 80% and 49.0% and an odds ratio of 3.84 (95% confidence interval of 1.53-9.64, p<0.001). DELC was independently associated with CAD (p<0.001). Smoking history was associated with DELC (p<0.046). Hypertension, dyslipidaemia and diabetes were not associated with DELC (p<0.241, p<0.478, p=1.000 respectively).

Conclusion: DELC was independently associated CAD and smoking history. DELC could be used as a simple clinical tool to risk-stratify patients for CAD.

Background: Acute coronary syndrome has been introduced as a major cause of mortality particularly in the elderly. ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction are two common types of acute coronary syndromes, which have been reported to be associated with some risk factors including age, obesity, hypertension and diabetes that can be utilized to predict and diagnose such disease.

Objectives: The present study was carried out in order to examine the effect of age on risk factors and clinical symptoms of acute coronary syndromes.

Materials and Methods: The present prospective study was carried out on 125 patients with acute coronary syndromes who were admitted at Coronary Care Unit in Sulaimani, the Kurdistan Region of Iraq. Their acute coronary syndromes were diagnosed through clinical presentations, electrocardiography (ECG), and troponin test. Required data were collected from the patients at their admission using a researcher-based checklist, face-to-face interviews, and reference to their medical records. The collected data were analyzed using descriptive statistics and Chi-square test through Statistical Package for the Social Sciences version 20.

Results: The results indicated that the males were the dominant group. Moreover, the age group 45-65 had the highest rate of prevalence of acute coronary syndromes. It was also observed that the most frequent risk factors for acute coronary syndromes were respectively hypertension (54.4%), dyslipidemia (52%), smoking (42.4%), and diabetes mellitus (38.4%). Typical chest pain was found to be the most frequent clinical presentation (88%). The results also demonstrated that there was a significant difference between the age groups in terms of the effect of age on typical and atypical symptoms. However, age had no significant effect on types of acute coronary syndromes. Also, age and typical/atypical symptoms had no significant effect on types of acute coronary syndromes. Finally, family history, hypertension, diabetes mellitus, obesity, smoking, physical inactivity, and dyslipidemia had no effect on types of acute coronary syndromes in the studied age groups.

Conclusion: Age can be a predictive factor for acute coronary syndromes, but the studied risk factors (i.e., family history, hypertension, diabetes mellitus, obesity, smoking, physical inactivity, and dyslipidemia) cannot be used as factors to predict acute coronary syndromes.