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BMC Women's Health Aug 2023Rheumatic heart disease (RHD) remains prevalent in the developing world and reproductive-age women are disproportionately affected. It is among the common est cardiac...
Pregnancy risk and contraception among reproductive-age women with rheumatic heart disease attending care at a tertiary cardiac center in Tanzania: a hospital-based cross-sectional study.
BACKGROUND
Rheumatic heart disease (RHD) remains prevalent in the developing world and reproductive-age women are disproportionately affected. It is among the common est cardiac diseases during pregnancy and is associated with poor pregnancy outcomes. Despite its importance among reproductive-age women, there are no local studies that characterize the clinical characteristics, risk of poor pregnancy outcomes and contraception which represents one effective way to prevent unplanned pregnancies in this population.
METHODS
This was a hospital-based descriptive cross-sectional study. Non-pregnant reproductive-age women with echocardiographically diagnosed RHD were consecutively recruited from in- and out-patients units of the Jakaya Kikwete Cardiac Institute (JKCI). A clinical research form was used to gather socio-demographic, clinical characteristics, contraception status and echocardiographic information. The maternal/pregnancy risk class was determined using the modified World Health Organization (WHO) classification of maternal risk.
RESULTS
Two hundred thirty-eight women of reproductive age with RHD were recruited. The median age (range) was 36 years (15-49). Two-thirds were dyspneic on moderate exertion and 17.2% had New York Heart Association class IV heart failure. A quarter had atrial fibrillation/flutter. On echocardiography, mitral regurgitation was the most common valvular lesion (68.1%), followed by mitral stenosis (66.8%), and 12.2% of participants had reduced left ventricular ejection fraction. Two-thirds (66%) had a high pregnancy risk (class IV) based on the modified WHO classification system. The proportion of participants using contraception was 7.1% and common methods were: bilateral tubal ligation 5 of 17 (29.4%) and hormonal implant (4 of 17). The most common reason for the choice of a method was safety, 10 out of 17 (58.8%).
CONCLUSION
The majority of women of reproductive age with RHD in our hospital cohort are at the highest pregnancy risk based on the modified WHO classification and a very small proportion of them are on contraception. These results call for action among clinicians to offer counselling to these patients, educating them on their risk and offering appropriate contraception advice while waiting for definitive interventions.
Topics: Pregnancy; Humans; Female; Adult; Rheumatic Heart Disease; Cross-Sectional Studies; Tanzania; Stroke Volume; Ventricular Function, Left; Contraception
PubMed: 37653369
DOI: 10.1186/s12905-023-02332-0 -
World Journal of Virology Sep 2023Alcohol-associated cirrhosis (AC) contributes to significant liver-related mortality in the United States. It is known to cause immune dysfunction and coagulation...
BACKGROUND
Alcohol-associated cirrhosis (AC) contributes to significant liver-related mortality in the United States. It is known to cause immune dysfunction and coagulation abnormalities. Patients with comorbid conditions like AC are at risk of worse clinical outcomes from coronavirus disease 2019 (COVID-19). The specific association between AC and COVID-19 mortality remains inconclusive, given the lack of robust clinical evidence from prior studies.
AIM
To study the predictors of mortality and the outcomes of AC in patients hospitalized with COVID-19 in the United States.
METHODS
We conducted a retrospective cohort study using the National Inpatient Sample (NIS) database 2020. Patients were identified with primary COVID-19 hospitalizations based on an underlying diagnosis of AC. A matched comparison cohort of COVID-19 patients without AC was identified after 1:N propensity score matching based on baseline sociodemographic characteristics and Elixhauser comorbidities. Primary outcomes included median length of stay, median inpatient charges, and in-hospital mortality. Secondary outcomes included a prevalence of systemic complications.
RESULTS
A total of 1325 COVID-19 patients with AC were matched to 1135 patients without AC. There was no difference in median length of stay and hospital charges in COVID-19 patients with AC compared to non-AC ( > 0.05). There was an increased prevalence of septic shock (5.7% 4.1%), ventricular fibrillation/ventricular flutter (0.4% 0%), atrial fibrillation (13.2% 8.8%), atrial flutter (8.7% 4.4%), first-degree atrioventricular nodal block (0.8% 0%), upper extremity venous thromboembolism (1.5% 0%), and variceal bleeding (3.8% 0%) in the AC cohort compared to the non-AC cohort ( < 0.05). There was no difference in inpatient mortality in COVID-19 patients with non-AC compared to AC, with an odds ratio of 0.97 (95% confidence interval: 0.78-1.22, = 0.85). Predictors of mortality included advanced age, cardiac arrhythmias, coagulopathy, protein-calorie malnutrition, fluid and electrolyte disorders, septic shock, and upper extremity venous thromboembolism.
CONCLUSION
AC does not increase mortality in patients hospitalized with COVID-19. There is an increased association between inpatient complications among COVID-19 patients with AC compared to non-AC.
PubMed: 37970569
DOI: 10.5501/wjv.v12.i4.221 -
ESC Heart Failure Feb 2024Outcomes reported for patients with hospitalization for acute heart failure (AHF) treatment vary worldwide. Ethnicity-associated characteristics may explain this... (Observational Study)
Observational Study
AIMS
Outcomes reported for patients with hospitalization for acute heart failure (AHF) treatment vary worldwide. Ethnicity-associated characteristics may explain this observation. This observational study compares characteristics and 1-year outcomes of Kyrgyz and Swiss AHF patients against the background of European Society of Cardiology guidelines-based cardiovascular care established in both countries.
METHODS AND RESULTS
The primary endpoint was 1 year all-cause mortality (ACM); the secondary endpoint was 1 year ACM or HF-related rehospitalization. A total of 538 Kyrgyz and 537 Swiss AHF patients were included. Kyrgyz patients were younger (64.0 vs. 83.0 years, P < 0.001); ischaemic or rheumatic heart disease and chronic obstructive pulmonary disease were more prevalent (always P < 0.001). In Swiss patients, smoking, dyslipidaemia, hypertension, and atrial flutter/fibrillation were more frequent (always P ≤ 0.035); moreover, left ventricular ejection fraction (LVEF) was higher (47% vs. 36%; P < 0.001), and >mild aortic stenosis was more prevalent (P < 0.001). Other valvular pathologies were more prevalent in Kyrgyz patients (P < 0.001). At discharge, more Swiss patients were on vasodilatory treatment (P < 0.006), while mineralocorticoid receptor antagonists (P = 0.001), beta-blockers (P = 0.001), or loop diuretics (P < 0.001) were less often prescribed. In Kyrgyz patients, unadjusted odds for the primary and secondary endpoints were lower [odds ratio (OR) 0.68, 95% confidence interval (CI): 0.51-0.90, P = 0.008; OR 0.72, 95% CI: 0.56-0.91, P = 0.006, respectively]. After adjustment for age and LVEF, no difference remained (primary endpoint: OR 1.03, 95% CI: 0.71-1.49, P = 0.894; secondary endpoint: OR 0.82, 95% CI: 0.60-1.12, P = 0.206).
CONCLUSIONS
On the background of identical guidelines, age- and LVEF-adjusted outcomes were not different between Central Asian and Western European AHF patients despite of large ethnical disparity.
Topics: Humans; Stroke Volume; Ventricular Function, Left; Heart Failure; Cardiology; Asia
PubMed: 38059306
DOI: 10.1002/ehf2.14591 -
The American Journal of Case Reports Mar 2024BACKGROUND Lymphocytic myocarditis is an inflammatory condition of the heart that may present with a wide spectrum of symptoms and signs, ranging from asymptomatic to...
BACKGROUND Lymphocytic myocarditis is an inflammatory condition of the heart that may present with a wide spectrum of symptoms and signs, ranging from asymptomatic to life-threatening cardiogenic shock and ventricular arrhythmia. Lymphocytic myocarditis usually presents as chamber dilation. However, increased left ventricular thickness is relatively rare. We present a case of lymphocytic myocarditis with increased left ventricular thickness which mimics the presentation of cardiac amyloidosis. CASE REPORT An 80-year-old Chinese man presented to the emergency room due to recurrent chest tightness. Wheezing and crackling were heard in both lungs, along with bilateral lower-extremity edema. He had elevated cardiac troponin T and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels. Bedside echocardiogram showed left ventricular diastolic dysfunction and increased left ventricular thickness. Holter monitoring showed paroxysmal atrial fibrillation (AF) and atrial flutter. ⁹⁹ᵐTechnetium-pyrophosphate scintigraphy showed grade 1 myocardial uptake. Endomyocardial biopsy revealed lymphocytic myocarditis. The patient was put on steroids, managed with diuretics to alleviate the symptoms of congestion, and amiodarone for conversion of AF to sinus rhythm. He had no deterioration of cardiac function in the follow-ups, but there was still asymmetric interventricular septal hypertrophy. CONCLUSIONS Lymphocytic myocarditis may lead to increased left ventricular thickness in some rare cases. In the setting of unexplained increased left ventricular thickness, one should consider lymphocytic myocarditis as a differential diagnosis. In addition, endomyocardial biopsy should be performed as early as possible to confirm the diagnosis and identify the type of inflammation, which helps with treatment and prognosis.
Topics: Male; Humans; Aged, 80 and over; Myocarditis; Myocardium; Echocardiography; Amyloidosis; Atrial Fibrillation
PubMed: 38523340
DOI: 10.12659/AJCR.942760 -
Cardio-oncology (London, England) Jun 2024First generation Bruton tyrosine kinase inhibitors (BTKi) such as ibrutinib have been associated with cardiovascular toxicities. Newer generation BTKi...
BACKGROUND
First generation Bruton tyrosine kinase inhibitors (BTKi) such as ibrutinib have been associated with cardiovascular toxicities. Newer generation BTKi (e.g.,acalabrutinib and zanabrutinib) have been associated with lower incidence of cardiotoxicity in clinical trials.
OBJECTIVE
Given paucity in real-world data on the overall cardiac risk factor profile, especially with the newer BTKi, our study evaluated the incidence of cardiotoxicity with various BTKi among a large, commercially insured population of patients.
METHODS
We performed a retrospective cohort analysis of all adults with a diagnosis of B-cell malignancy undergoing treatment with BTKi acalabrutinib and ibrutinib between January 2018 and June 2020 using Optum's de-identified Clinformatics® Data Mart Database. We then identified patients who had pre-existing cardiac disease one year prior to starting BTKi. New incidence of atrial fibrillation/flutter, hypertension, bleeding, ventricular tachycardia/fibrillation and sudden cardiac death from the time of index presciption were compared with standard Chi Square or Student t-test where appropriate. Multivariate logistic regression models were also estimated to evaluate for confounding.
RESULTS
A total of 1691 patients were included in the final analysis. 1595 (94%, median age 75 (19-90) years, 61% male gender) patients received ibrutinib, and 96 (6%, median age 73.5 (32-90) years, 62.5% male gender) patients received acalabrutinib. The median duration of drug exposure of ibrutinib was 238 (2-1084) days vs. 150 (30-870) days for acalabrutinib. There was lower new incidence of atrial fibrillation/flutter (4.6%-vs-17%, p = 0.013), hypertension (6.3%-vs-25%, p = NS), sudden cardiac arrest/death (0% vs. 1.5%, p = NS) in the acalabrutinib group compared to ibrutinib, of which only the lower incidence of atrial fibrillation/flutter was statistically significant. This was despite the finding of a higher prevalence of atrial fibrillation/flutter at baseline in patients receiving acalabrutinib.
CONCLUSIONS
There was lower incidence of new atrial fibrillation/flutter with acalabrutinib when compared to ibrutinib in a real-world cohort of patients.
PubMed: 38824606
DOI: 10.1186/s40959-024-00237-x -
World Journal of Clinical Cases Aug 2023Atrial arrhythmias such as paroxysmal supraventricular tachycardia (PSVT) and atrial flutter (AF) are common in the perioperative setting. They commonly resolve...
BACKGROUND
Atrial arrhythmias such as paroxysmal supraventricular tachycardia (PSVT) and atrial flutter (AF) are common in the perioperative setting. They commonly resolve spontaneously. However, occasionally, they may continually progress to fatal arrhythmias or cause complications. Therefore, prompt and appropriate management is important.
CASE SUMMARY
A 46-year-old female patient diagnosed with cervical C6-7 radiculopathy characterized by decreased sensation in the right third, fourth and fifth fingers underwent C6-7 anterior cervical disc fusion surgery. Electrocardiography showed PSVT and ventricular tachycardia during C6-7 disc retraction. However, the patient remained stable. Initial treatment with esmolol and lidocaine for ventricular tachycardia was ineffective. Carotid massage and Valsalva maneuver were attempted but PSVT did not resolve. The surgery was paused, and the patient's fraction of inspired oxygen was set to 100%. Adenosine was administered for pharmacological management of PSVT. The arrhythmia temporarily resolved. However, it then transformed into AF. Diltiazem was administered, which briefly decreased blood pressure, which immediately recovered. Surgery resumed while the patient was in normal sinus rhythm. She was discharged safely on postoperative day 6 without complications or abnormalities. Currently, she is living a healthy life without arrhythmia recurrence.
CONCLUSION
Ganglia associated with cardiac arrhythmias in the surgical site should be identified during cervical spine surgery.
PubMed: 37727714
DOI: 10.12998/wjcc.v11.i24.5789 -
Clinical Cardiology Jan 2024While ivabradine has demonstrated benefits in heart rate control and prognosis for chronic heart failure patients, its application in acute decompensated heart failure...
BACKGROUND
While ivabradine has demonstrated benefits in heart rate control and prognosis for chronic heart failure patients, its application in acute decompensated heart failure remains underexplored.
HYPOTHESIS
For patients with acute decompensated heart failure with reduced ejection fraction (HFrEF) who are intolerant to β-blockers or unable to further titrate their dosage, the use of ivabradine is hypothesized to be effective and safe is improving outcomes.
METHODS
This retrospective, multicenter database analysis included patients with hospitalized decompensated heart failure with a left ventricular ejection fraction of ≤40% from June 1, 2015 to December 31, 2020. The exclusion criteria were a baseline heart rate of <70 bpm, previous use of ivabradine, mortality during admission, existing atrial fibrillation, or atrial flutter. The primary outcome was the composite of cardiovascular death and hospitalization for heart failure.
RESULTS
Of the 4163 HFrEF patients analyzed, 684 (16.4%) were administered ivabradine during their index admission. After matching, there were 617 patients in either group. The results indicated that ivabradine use was not significantly associated with the risk of the primary composite outcome (hazard ratio: 1.10; 95% confidence interval: 0.94-1.29). Similarly, the risk of secondary outcomes and adverse renal events did not significantly differ between the ivabradine and non-ivabradine cohorts (all p > .05).
CONCLUSION
For hospitalized acute decompensated heart failure patients who are intolerant to β-blockers or cannot further titrate them, ivabradine offers a consistent therapeutic effect. No significant disparities were noted between the ivabradine and non-ivabradine groups in heart failure hospitalization and cardiovascular death.
Topics: Humans; Heart Failure; Ivabradine; Retrospective Studies; Stroke Volume; Ventricular Function, Left
PubMed: 38269634
DOI: 10.1002/clc.24206 -
International Journal of Telemedicine... 2024Traditional long-term ECG monitoring systems have primarily been used by cardiologist. New remote and wearable easy-to-use devices have led to increased use of ECG...
AIMS
Traditional long-term ECG monitoring systems have primarily been used by cardiologist. New remote and wearable easy-to-use devices have led to increased use of ECG recordings also outside cardiology clinics. The aims of this study were to assess the feasibility and diagnostic accuracy of interpretation of the one-lead ECG recordings from a patch ECG device (ECG247 Smart Heart Sensor system) by general practitioners (GP).
METHODS
Norwegian GPs were invited to digitally assess 10 long-term ECG recordings with different arrhythmias performed by the ECG247 Smart Heart Sensor system. For all ECG examinations, the presence/absence of different arrhythmias was registered.
RESULTS
A total of 40 GPs accepted the invitation and assessed all the 10 long-term ECG recordings. All the tests were assessed as interpretable by all the GPs. Arrhythmias (atrial fibrillation/flutter, supraventricular tachycardia, and ventricular tachycardia) were correctly identified in most cases, with sensitivity of 98% (95% CI 95-99%), specificity of 75% (95% CI 68-82%), and diagnostic accuracy of 89% (85-92%). Incorrect automatic system algorithm interpretations were rarely corrected by the GPs.
CONCLUSION
GPs interpreted one-lead recordings by the ECG247 Smart Heart Sensor system with high diagnostic accuracy for common arrhythmias. However, in cases with rare arrhythmias, we recommend consulting a cardiologist to confirm the diagnosis before treatment is initiated. This trial is registered with NCT04700865.
PubMed: 38425473
DOI: 10.1155/2024/6624344 -
Scientific Reports Jul 2023Pectus excavatum (PE) is a congenital malformation with a funnel-shaped depression of the sternum that can lead to cardiac symptoms. However, there are patients with...
Pectus excavatum (PE) is a congenital malformation with a funnel-shaped depression of the sternum that can lead to cardiac symptoms. However, there are patients with thoracic constriction (defined as elevated Haller-Index > 3.25 determined by cardiac magnetic resonance imaging (CMR)) without visible evidence of PE, leading to similar complaints. Between January 2004 till June 2020, patients who underwent CMR for further evaluation of the heart, due to cardiac symptoms were enrolled and compared to controls. Biventricular global strain analysis was assessed using feature tracking (CMR-FT). ECG and/or Holter recordings were performed to detect rhythm events. Cardiac symptoms were evaluated in detail using a questionnaire. Finally, 88 patients (male 35, female 53) with elevated Haller-Index (3.9 ± 0.8) were included and compared to CMR data from 25 individuals with confirmed PE and 25 healthy controls (HC). Mean age at time of CMR was 35 ± 16 years. The most common symptoms at presentation were palpitations (41%), followed by dyspnea (24%) and atypical chest pain (14%). Three patients (3%) had atrial fibrillation or atrial flutter. Concomitant phenomena were pericardial effusion in 39% and mitral valve prolapse (MVP) in 27% of the study cohort. While there were no differences in left ventricular function or volumes, right ventricular function (RVEF) was significantly lower in patients with internal PE compared to HC (RVEF (%) 50 ± 5 vs 59 ± 4, p < 0.01). Strain analysis revealed only discrete changes in RV strain, implying a purely mechanical problem in the absence of structural changes. RV dimensions were negatively correlated with the size of thoracic indices (r = 0.41), reflecting the extent of thoracic constriction. MVP was more prevalent in patients with greater thoracic indices (r = 0.24). The described cohort, referred to as internal PE because of the absence of external changes, showed similar CMR morphologic findings as patients with real PE (especially altered dimensions of the right heart and a lower RVEF). In addition, there was a high incidence of rhythm disturbances, such as extrasystoles or arrhythmias. In one-third of the study cohort additional abnormalities such as pericardial effusion or MVP were present, with MVP being found more frequently in patients with larger thoracic indices, suggesting a possible common pathogenesis.Trial registration: ISRCTN registry, ISRCTN15355937, retrospectively registered 03.06.2022, https://www.isrctn.com/ISRCTN15355937?q=15355937&filters=&sort=&offset=1&totalResults=1&page=1&pageSize=10 .
Topics: Humans; Male; Female; Young Adult; Adult; Middle Aged; Funnel Chest; Pericardial Effusion; Constriction; Magnetic Resonance Imaging; Heart; Mitral Valve Prolapse; Magnetic Resonance Imaging, Cine
PubMed: 37491452
DOI: 10.1038/s41598-023-38739-w -
Journal of Clinical Medicine Mar 2024This systematic review explores the effects of landiolol administration in individuals presenting with supraventricular tachyarrhythmia (SVT) and concurrent left... (Review)
Review
This systematic review explores the effects of landiolol administration in individuals presenting with supraventricular tachyarrhythmia (SVT) and concurrent left ventricular dysfunction, without being septic or in a peri-operative period. We systematically searched PubMed, Cochrane, Web of Science, and Scopus databases, retrieving a total of 15 eligible studies according to prespecified eligibility criteria. Patients treated with landiolol experienced a substantial reduction in heart rate (HR) (mean HR reduction: 42 bpm, 95% confidence intervals (CIs): 37-47, I = 82%) and were more likely to achieve the target HR compared to those receiving alternative antiarrhythmic therapy (pooled odds ratio (OR): 5.37, 95% CIs: 2.87-10.05, I = 0%). Adverse events, primarily hypotension, occurred in 14.7% of patients receiving landiolol, but no significant difference was observed between the landiolol and alternative antiarrhythmic receiving groups (pooled OR: 1.02, 95% CI: 0.57-1.83, I = 0%). No significant difference was observed between the two groups concerning sinus rhythm restoration (pooled OR: 0.97, 95% CI: 0.25-3.78, I = 0%) and drug discontinuation due to adverse events (pooled OR: 5.09, 95% CI: 0.6-43.38, I = 0%). While further research is warranted, this systematic review highlights the potential benefits of landiolol administration in the management of SVTs in the context of left ventricular dysfunction.
PubMed: 38541908
DOI: 10.3390/jcm13061683