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JACC. Advances Feb 2024
PubMed: 38939380
DOI: 10.1016/j.jacadv.2023.100788 -
Cureus May 2024Reverse takotsubo cardiomyopathy is a rare variant of the classic stress-induced takotsubo cardiomyopathy. It is associated with transient left ventricular (LV) systolic...
Reverse takotsubo cardiomyopathy is a rare variant of the classic stress-induced takotsubo cardiomyopathy. It is associated with transient left ventricular (LV) systolic dysfunction characterized by basal hypokinesis and apical hyperkinesis. We present a case of a 27-year-old woman who presented to an outside facility for a scheduled cesarean section and developed perioperative chest tightness, hypoxemia, and hypotension. Her electrocardiogram (ECG) showed sinus rhythm with marked ST segment depressions in leads V4-V6. High sensitivity troponin was elevated to 474 ng/L. Transthoracic echocardiography revealed an LV ejection fraction of 52% (Simpson's) with hypokinesis of the basal myocardial segments and hyperdynamic systolic function of the apical segments. Subsequent coronary angiography showed angiographically normal epicardial coronaries. Left ventriculography showed ballooning of the basal segments with apical hyperkinesis. She was subsequently diagnosed with reverse takotsubo cardiomyopathy and managed conservatively with beta-blockers. In this case, we highlight the need for collaboration between the cardiology and obstetric teams for tailored management strategies to ensure the well-being of both mother and baby.
PubMed: 38939286
DOI: 10.7759/cureus.61225 -
JACC. Advances Jul 2023Coarctation of the aorta (CoA) is associated with intracranial aneurysms (IAs); however, the prevalence and risk factors (RFs) are not well described. Current practice...
BACKGROUND
Coarctation of the aorta (CoA) is associated with intracranial aneurysms (IAs); however, the prevalence and risk factors (RFs) are not well described. Current practice guidelines offer inconsistent recommendations on screening for IAs in this patient population ranging from "not recommended" (European Society of Cardiology 2020) to "recommended" (American Heart Association 2018).
OBJECTIVES
The purpose of this study was to determine the prevalence and RFs for IAs in patients with CoA.
METHODS
We completed a systematic review and meta-analysis of studies utilizing computed tomography or magnetic resonance angiographic screening for IAs in patients with CoA.
RESULTS
Five cohort studies were included, representing 442 patients. The pooled prevalence of IAs in patients with CoA was 3.8% [95% CI: 0.1%-12.3%]. The results met our prespecified definition for high heterogeneity. Of 5 RFs evaluated, only hypertension was associated with the development of IAs with an odds ratio of 3.1 [95% CI: 1.1-8.2; = 0.03]. There was an observed downward trend over time in the prevalence of IAs among the studies included.
CONCLUSIONS
The development of IAs is likely multifactorial in etiology and there may be modifiable RFs in their development. Considering the low prevalence of IAs in the pooled result, routine screening of patients with CoA for IAs is likely of low-value.
PubMed: 38938992
DOI: 10.1016/j.jacadv.2023.100394 -
JACC. Advances Jun 2024People with HIV (PWH) have a high burden of coronary plaques; however, the comparison to people without known HIV (PwoH) needs clarification.
BACKGROUND
People with HIV (PWH) have a high burden of coronary plaques; however, the comparison to people without known HIV (PwoH) needs clarification.
OBJECTIVES
The purpose of this study was to determine coronary plaque burden/phenotype in PWH vs PwoH.
METHODS
Nonstatin using participants from 3 contemporary populations without known coronary plaques with coronary CT were compared: the REPRIEVE (Randomized Trial to Prevent Vascular Events in HIV) studying PWH without cardiovascular symptoms at low-to-moderate risk (n = 755); the SCAPIS (Swedish Cardiopulmonary Bioimage Study) of asymptomatic community PwoH at low-to-intermediate cardiovascular risk (n = 23,558); and the PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) of stable chest pain PwoH (n = 2,291). The coronary plaque prevalence on coronary CT was compared, and comparisons were stratified by 10-year atherosclerotic cardiovascular disease (ASCVD) risk, age, and coronary artery calcium (CAC) presence.
RESULTS
Compared to SCAPIS and PROMISE PwoH, REPRIEVE PWH were younger (50.8 ± 5.8 vs 57.3 ± 4.3 and 60.0 ± 8.0 years; < 0.001) and had lower ASCVD risk (5.0% ± 3.2% vs 6.0% ± 5.3% and 13.5% ± 11.0%; < 0.001). More PWH had plaque compared to the asymptomatic cohort (48.5% vs 40.3%; < 0.001). When stratified by ASCVD risk, PWH had more plaque compared to SCAPIS and a similar prevalence of plaque compared to PROMISE. CAC = 0 was more prevalent in PWH (REPRIEVE 65.2%; SCAPIS 61.6%; PROMISE 49.6%); among CAC = 0, plaque was more prevalent in PWH compared to the PwoH cohorts (REPRIEVE 20.8%; SCAPIS 5.4%; PROMISE 12.3%, < 0.001).
CONCLUSIONS
Asymptomatic PWH in REPRIEVE had more plaque than asymptomatic PwoH in SCAPIS but had similar prevalence to a higher-risk stable chest pain cohort in PROMISE. In PWH, CAC = 0 does not reliably exclude plaque.
PubMed: 38938873
DOI: 10.1016/j.jacadv.2024.100968 -
JACC. Advances Jun 2024
PubMed: 38938860
DOI: 10.1016/j.jacadv.2024.100974 -
Case Reports in Ophthalmological... 2024To the best of our knowledge, we present the first case of type II acute macular neuroretinopathy (AMN) exhibiting in a patient suffering from malarial retinopathy...
To the best of our knowledge, we present the first case of type II acute macular neuroretinopathy (AMN) exhibiting in a patient suffering from malarial retinopathy concomitant with cerebral malaria acquired after travelling to West Africa without taking the necessary antimalarial prophylaxis. The patient complained of bilateral blurring of vision after being removed off sedation whilst at the intensive care unit. Subsequent examination revealed bilateral retinal haemorrhages, cotton-wool spots, and foveal pigmentary changes in keeping malarial retinopathy. Macular optical coherence tomography (OCT) revealed patchy hyperreflective changes at the level of the outer plexiform and outer nuclear layers (ONL) in keeping with the areas of deep capillary plexus flow void noted on OCT-angiography (OCT-A). This case report sheds more light on the extent of neurosensory retinal ischaemia in malarial retinopathy and showcases a new imaging biomarker which may be utilized in assessing and quantifying the functional deficit created by this disease.
PubMed: 38938742
DOI: 10.1155/2024/1577127 -
JACC. Advances Nov 2023Cine images during coronary angiography contain a wealth of information besides the assessment of coronary stenosis. We hypothesized that deep learning (DL) can discern...
BACKGROUND
Cine images during coronary angiography contain a wealth of information besides the assessment of coronary stenosis. We hypothesized that deep learning (DL) can discern moderate-severe left ventricular dysfunction among patients undergoing coronary angiography.
OBJECTIVES
The purpose of this study was to assess the ability of machine learning models in estimating left ventricular ejection fraction (LVEF) from routine coronary angiographic images.
METHODS
We developed a combined 3D-convolutional neural network (CNN) and transformer to estimate LVEF for diagnostic coronary angiograms of the left coronary artery (LCA). Two angiograms, left anterior oblique (LAO)-caudal and right anterior oblique (RAO)-cranial projections, were fed into the model simultaneously. The model classified LVEF as significantly reduced (LVEF ≤40%) vs normal or mildly reduced (LVEF>40%). Echocardiogram performed within 30 days served as the gold standard for LVEF.
RESULTS
A collection of 18,809 angiograms from 17,346 patients from Mayo Clinic were included (mean age 67.29; 35% women). Each patient appeared only in the training (70%), validation (10%), or testing set (20%). The model exhibited excellent performance (area under the receiver operator curve [AUC] 0.87; sensitivity 0.77; specificity 0.80) in the training set. The model's performance exceeded human expert assessment (AUC, sensitivity, and specificity of 0.86, 0.76, and 0.77, respectively) vs (AUC, sensitivity, and specificity of 0.76-0.77, 0.50-0.44, and 0.90-0.93, respectively). In additional sensitivity analyses, combining the LAO and RAO views yielded a higher AUC, sensitivity, and specificity than utilizing either LAO or RAO individually. The original model combining CNN and transformer was superior to DL models using either 3D-CNN or transformers.
CONCLUSIONS
A novel DL algorithm demonstrated rapid and accurate assessment of LVEF from routine coronary angiography. The algorithm can be used to support clinical decision-making and form the foundation for future models that could extract meaningful data from routine angiography studies.
PubMed: 38938722
DOI: 10.1016/j.jacadv.2023.100632 -
JACC. Advances Nov 2023
PubMed: 38938719
DOI: 10.1016/j.jacadv.2023.100631 -
JACC. Advances Nov 2023Surgery for isolated functional tricuspid regurgitation (TR) poses a high risk. Several transcatheter approaches are being evaluated for the treatment of such patients....
BACKGROUND
Surgery for isolated functional tricuspid regurgitation (TR) poses a high risk. Several transcatheter approaches are being evaluated for the treatment of such patients. The K-Clip system is a percutaneous approach designed for functional TR; however, its utility remains unknown.
OBJECTIVES
This study aimed to report the 30-day echocardiographic and clinical outcomes with the K-Clip system for severe TR, including changes in TR severity and NYHA functional class.
METHODS
Transcatheter tricuspid valve annuloplasty was performed in 39 patients with intermediate or high surgical risk who underwent the K-Clip system. The right internal jugular vein procedure was performed with annuloplasty guided by fluoroscopy and echocardiography. The primary outcomes were clinical success and all-cause mortality at the 30-day follow-up.
RESULTS
The K-Clip was successfully implanted in all cases, with 1 to 3 devices deployed. At the 30-day follow-up, none of the patients had died. TR severity was reduced by at least one grade in all patients. There were no severe procedural or 30-day adverse events, except for 1 new pacemaker implantation. The proportion of NYHA class III-IV patients decreased from 79.5% to 5.1%, and the ascites disappeared. The 6-minute walk distance increased by 78 m ( < 0.05), and the Kansas City Cardiomyopathy Questionnaire score improved by 11 points ( < 0.05).
CONCLUSIONS
The K-Clip device is practical, safe, and effective for patients with severe TR. A 30-day reduction in TR and enhanced cardiac function and quality of life were associated with transcatheter tricuspid annuloplasty using the K-Clip device, according to short-term follow-up studies. (Confirmatory Clinical Study of Treating Tricuspid Regurgitation With K-Clip TM Transcatheter Annuloplasty System [TriStar]; NCT05173233).
PubMed: 38938712
DOI: 10.1016/j.jacadv.2023.100671 -
Polish Journal of Radiology 2024Late diagnosis is associated with high mortality rates in acute pulmonary embolism (PE), so early diagnosis and risk assessment are crucial. We aim to evaluate computed...
PURPOSE
Late diagnosis is associated with high mortality rates in acute pulmonary embolism (PE), so early diagnosis and risk assessment are crucial. We aim to evaluate computed tomography pulmonary angiography measurements to identify relationships with 30-day mortality in patients with pulmonary embolism. This study investigated the utility of computed tomography pulmonary angiography (CTPA) measures in determining 30-day PE-related mortality and identified various echocardiographic, demographic, and clinical variables that were independently associated with short-term mortality in patients with acute PE.
MATERIAL AND METHODS
This retrospective study examined data from July 2018 to April 2023. A total of 118 patients were included in the study. Clinical and demographic characteristics, laboratory findings, echocardiographic data, and CTPA images were retrieved from the electronic database and patient charts.
RESULTS
The rate of 30-day mortality was 14.41%. Deceased patients were significantly older than survivors (73.53 ± 14.17 vs. 60.23 ± 17.49 years; = 0.004), but the sex distribution was similar. In multivariable logistic regression, having received radiotherapy for malignancy, high pulmonary artery obstruction index % (> 46.2), high left pulmonary artery diameter (> 23.9 mm), and high coronary artery calcification score (> 5.5) were independently associated with mortality.
CONCLUSIONS
These results reveal specific parameters that can assist acute PE management by enabling the identification of critical events. Despite promising results in predicting short-term mortality in acute PE, further prospective cohort studies are needed to confirm the results of the present study.
PubMed: 38938660
DOI: 10.5114/pjr/186184