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BMJ Open Ophthalmology May 2024To investigate the recurrent non-arteritic retinal artery occlusion (RAO) in the same or opposite eye.
OBJECTIVES
To investigate the recurrent non-arteritic retinal artery occlusion (RAO) in the same or opposite eye.
METHODS
We searched the RAO registry at Seoul National University Bundang Hospital and included patients with recurrent RAO in the present study. Ophthalmic and systemic features were analysed to identify risk factors and visual outcomes.
RESULTS
Of the 850 patients in the non-arteritic RAO cohort, 11 (1.3%) experienced a second RAO recurrence, either in the same (5 patients; 0.6%) or opposite (6 patients; 0.7%) eye. The same eye group experienced an earlier recurrence (1-2 months, median 1 month) than the opposite eye group, where the time to recurrence was notably longer (8-66 months, median 22 months). Best corrected visual acuity (BCVA) in the same eye group decreased after the recurrence of RAO. In the same eye group, initial BCVA ranged from 20/200 to counting fingers (CF), while BCVA during RAO recurrence ranged from CF to hand motion. When RAO recurred in the opposite eye, the reduction in visual acuity was less severe than the reduction of the initial episode: initial episode ranged from 20/400 to light perception and recurrent episode ranged from 20/25 to 20/400. Patients exhibited varying degrees of carotid (81.8%) and cerebral (9.1%) artery occlusions. Additionally, one patient in each group (total 2 patients, 18.2%) experienced a stroke 6 months after RAO recurrence.
CONCLUSIONS
Since the RAO recurrences could lead to devastating visual impairment, it is essential to emphasise the importance of risk factor screening to patients while collaborating with neurologists and cardiologists.
Topics: Humans; Retinal Artery Occlusion; Recurrence; Male; Female; Visual Acuity; Middle Aged; Aged; Risk Factors; Retrospective Studies; Adult; Registries; Fluorescein Angiography; Aged, 80 and over; Tomography, Optical Coherence; Follow-Up Studies
PubMed: 38816011
DOI: 10.1136/bmjophth-2024-001636 -
The Turkish Journal of Pediatrics May 2024Cardiovascular system involvement is quite common and the leading cause of morbidity and mortality in patients with Williams syndrome (WS), most of whom need surgery....
BACKGROUND
Cardiovascular system involvement is quite common and the leading cause of morbidity and mortality in patients with Williams syndrome (WS), most of whom need surgery. The present study aimed to provide a detailed evaluation of the features of surgical procedures and outcomes of patients with WS given as single-center experience, and additionally to make a detailed review from Türkiye.
MATERIALS AND METHODS
Thirty-five children with WS diagnosed between the years 1992 and 2021 were evaluated retrospectively including cardiovascular data, surgical treatment features, and outcomes. A total of six articles from Türkiye were evaluated.
RESULTS
A total of 35 patients with Williams Syndrome (24 male) with a median age of cardiologic diagnosis of 6 months (range, 2 days-6 years) were evaluated. The cardiac defects of the patients with WS were found as supravalvular aortic stenosis (SVAS) (n=30, 85%) and peripheral pulmonary stenosis (PPS) (n=21, 65%). Additional cardiac anomalies were seen in 71% patients. The rate of SVAS and PPS surgery in all patients with WS was 77.1%. The median surgical age of the patients was 2.5 years (range, 7 months-15.5 years). No patients died due to surgery. But one patient died because of ventricular tachycardia due to anesthesia at the beginning of angiography. A total of 138 (63% male) patients with WS were evaluated from the articles published in Türkiye. Of 138 patients, 64.4% had SVAS, 52.1% had PPS, and 39.8% had additional cardiac anomaly. The median follow-up period ranged from 17 months to 18 years, and six (4.3%) patients died in the early postoperative period.
CONCLUSION
Cardiovascular system involvement is extremely common and is the leading cause of morbidity and mortality in patients with WS, often requiring surgical intervention. As seen in our study including 35 patients with WS and in publications from Türkiye, SVAS in patients with WS generally requires surgery, especially in the first year of life. PPS, on the other hand, requires surgery less frequently than SVAS, and pulmonary stenosis appears to decrease over time.
Topics: Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Male; Follow-Up Studies; Heart Defects, Congenital; Retrospective Studies; Turkey; Williams Syndrome; Adolescent
PubMed: 38814298
DOI: 10.24953/turkjpediatr.2024.4591 -
Turkish Journal of Medical Sciences 2023This study aimed to examine changes in the thickness of individual macular retinal layers in eyes with pathological myopia (PM) and to compare the thickness of each...
BACKGROUND/AIM
This study aimed to examine changes in the thickness of individual macular retinal layers in eyes with pathological myopia (PM) and to compare the thickness of each retinal layer between the PM and control groups to gain insights into retinal perfusion.
MATERIALS AND METHODS
The study included 51 eyes in the PM group and 51 eyes in the control group. Optical coherence tomography (OCT) was used to measure the thickness of each retinal layer in the central fovea, parafoveal, and perifoveal regions. Optical coherence tomography angiography (OCT-A) was used to evaluate the retinal capillary density.
RESULTS
In the PM group, the retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), and inner nuclear layer (INL) were thicker than in the control group (p = 0.004, p = 0.027, p = 0.020, and p < 0.001, respectively), whereas the outer nuclear layer (ONL) and photoreceptor layer (PRL) were thinner (p = 0.001 and p = 0.003, respectively). In other regions, the RNFL was thicker in the myopic group, whereas the GCL, IPL, INL, and ONL were thinner. OCT-A did not reveal any significant difference between the groups in terms of radial capillary plexus density (p = 0.381); however, the densities of the other plexuses were lower in the PM group.
CONCLUSIONS
The results showed alterations in the thickness of retinal layers and capillary plexus density in PM. Thus, assessment of the thickness of individual retinal layers may serve as an indicator of vascular diseases that affect the circulation of the retina and choroid.
Topics: Humans; Tomography, Optical Coherence; Male; Female; Adult; Myopia, Degenerative; Middle Aged; Macula Lutea; Retina; Retinal Vessels
PubMed: 38813500
DOI: 10.55730/1300-0144.5751 -
Behçet's disease detecting by hemoptysis and recurrent epididymo-orchitis: A case report from Syria.SAGE Open Medical Case Reports 2024Behçet's disease is a chronic systemic inflammatory vasculitis of unknown etiology. It is characterized by recurrent episodes of oral aphthous ulcers, genital ulcers,...
Behçet's disease is a chronic systemic inflammatory vasculitis of unknown etiology. It is characterized by recurrent episodes of oral aphthous ulcers, genital ulcers, skin lesions, ocular lesions, and other manifestations. This disease affects many organs and systems, showing a wide range of clinical features. Although pulmonary artery involvement is not common in Behçet's disease, its presence carries a substantial risk of mortality. This report provides a detailed history of a 25-year-old male who was admitted with productive cough, hemoptysis, dyspnea on minimal exertion, fever, and chest pain. He had recurrent orchitis and epididymitis for 7 years, as well as oral and genital ulcers and severe headache. Clinical examination revealed decreased breath sounds at the right middle lung. Thoracic computed tomography angiography confirmed multiple pulmonary artery aneurysms bilaterally. The patient was diagnosed with Behçet's disease, and immunosuppression therapy was initiated. During follow-up, the patient did not report any complications. This case report underscores the significance for clinicians to consider Behçet's disease as a differential diagnosis in patients presenting with hemoptysis and a history of orchitis and epididymitis, given that Behçet's disease rarely causes pulmonary artery aneurysms.
PubMed: 38812835
DOI: 10.1177/2050313X241257441 -
Frontiers in Cardiovascular Medicine 2024During the SARS-CoV-2 pandemic it was speculated that the virus might be associated with a persistent increase of cardiovascular risk. The present study compares pre-...
BACKGROUND
During the SARS-CoV-2 pandemic it was speculated that the virus might be associated with a persistent increase of cardiovascular risk. The present study compares pre- and post-pandemic hospital admission rates for hypertension and coronary artery disease.
METHODS
Systematic multicentric retrospective cohort analysis of 57.795 hospital admissions in an urban region in Germany during two different periods (pre-pandemic 01-06/2019 vs. post-pandemic era 01-06/2023). Information on hospital admissions for arterial hypertension, chronic coronary syndrome, unstable angina pectoris and acute myocardial infarction were extracted from the hospitals data systems. Additionally, six comorbidities and performed coronary interventions were monitored.
RESULTS
Compared to the pre-pandemic era, there was no increase in hospitalizations for arterial hypertension (516 vs. 483, -6.8%, = 0.07) or myocardial infarction (487 vs. 349, -23.8%, < 0.001), but the total number of patient admissions with chest pain as the presenting symptom increased (chronic coronary syndrome: 759 vs. 943, +24.2%, < 0.001; unstable angina pectoris: 270 vs. 451, +67.0%, < 0.001). At the same time, the number of performed coronary angiographies increased, but less patients underwent percutaneous interventions. Patients admitted with chest pain in the post-pandemic era were in general healthier with less comorbidities.
CONCLUSION
The present multicenter cohort study found no evidence for an increase in hospitalizations for arterial hypertension or coronary artery disease after the end of the pandemic. However, further studies with larger sample sizes are needed to confirm our results.
PubMed: 38812747
DOI: 10.3389/fcvm.2024.1333749 -
Diabetes, Metabolic Syndrome and... 2024The clinical background and prognostic impact of diabetes mellitus (DM) on vasospastic angina (VSA) are unclear; thus, in this retrospective study, we investigated...
PURPOSE
The clinical background and prognostic impact of diabetes mellitus (DM) on vasospastic angina (VSA) are unclear; thus, in this retrospective study, we investigated whether they differ based on the presence or absence of DM in patients with VSA.
PATIENTS AND METHODS
We included 272 Japanese patients with VSA diagnosed by coronary angiography (CAG) and the spasm provocation test (SPT). The diagnosis of DM was determined by measuring fasting blood glucose and hemoglobin A1C and by the patient's current oral medications. On CAG, the presence of atherosclerotic lesions (20%-50%) was checked. On SPT, the coronary spasm was defined as transient coronary vasoconstriction >90% on CAG, accompanied by chest symptoms and/or ST-T changes. Focal spasm was defined as coronary spasm occurring within one segment of the American Heart Association classification on CAG. Blood and urine tests and vascular endothelial function were also evaluated when possible. A major adverse cardiovascular event (MACE), which is defined as cardiac mortality and rehospitalization due to cardiovascular illness, was the basis for determining the prognosis.
RESULTS
There were 49 patients (18%) in the DM group and 223 (82%) in the non-DM group. No significant differences in urinary albumin levels and peripheral vascular function were between groups. On CAG, atherosclerotic lesions were observed significantly more frequently in the DM group (63% vs 46%; P = 0.028). Results of SPT showed a trend toward fewer focal spasms in the DM group (24% vs 39%; P = 0.072). No significant differences in MACE were noted between groups in the primary analysis of DM, whereas sub-analyses of focal spasms showed lower MACE-free survival in the DM group (P = 0.042).
CONCLUSION
The study results support the hypothesis that DM associated with VSA should be treated appropriately, especially in cases of focal spasm, which may require more attention in treatment.
PubMed: 38812745
DOI: 10.2147/DMSO.S462234 -
BMC Cardiovascular Disorders May 2024Our study aimed to assess the safety and efficacy of cardiac contractility modulation (CCM) therapy in patients with heart failure with reduced ejection fraction (HFrEF)...
OBJECTIVES
Our study aimed to assess the safety and efficacy of cardiac contractility modulation (CCM) therapy in patients with heart failure with reduced ejection fraction (HFrEF) depending on HF etiology.
METHODS
We enrolled 166 patients with optimal medical therapy-resistant HFrEF (median age 59 years, 83.7% males, median NYHA class - 2, median left ventricular ejection fraction (LVEF) - 29.0%) who underwent CCM therapy device implantation from 2013 to 2019 in four medical centers in Russia. The HF etiology was determined based on invasive coronary angiography or cardiac MRI data. Transthoracic echocardiography (TTE), 6-minute walking test (6MWT), and NTproBNP-tests were performed at a baseline and 12 months after the implantation.
RESULTS
The ischemic etiology of HF was revealed in 100 patients (61.5%) (ICM group); the non-ischemic group (NICM) evolved 66 patients (38.5%). Patients in the ICM group were significantly older (61[57-69] vs. 55 [42.8-61], p < 0.001), more frequently had hypertension (79% vs. 42.4%, p < 0.001) and chronic kidney disease (43% vs. 22.7%, p = 0.012). Patients in the NICM group had significantly more often atrial fibrillation (AF) (58% vs. 74%, p = 0.048), larger end-diastolic volume (EDV) (249 [208-309] vs. 220 [192-271], p = 0.019) and end-systolic volume (ESV) (183 [147-230] vs. 154 [128-199], p = 0.003). There were no significant differences in mortality between ICM and NICM groups (14.4 vs. 10.8%, p = 0.51). In 12 months, there was a significant increase in LVEF in the NICM group (+ 2.0 [2-6] vs. +7.7 [2-12], p < 0.001), while the improvement in the 6MWT (+ 75 [22-108] vs. +80 [10-160], p = 0.851) and NYHA class did not reach the level of significance. The subanalysis between patients with improved NYHA class and those without improvement revealed that patients without improvement more frequently had AF (56% vs. 89%; p < 0.01), chronic obstructive lung disease (18% vs. 35% p = 0.047), higher blood pressure (110 [105-120] vs. 120[110-129]; p = 0.032).
CONCLUSION
In this multicenter retrospective study, patients with non-ischemic HFrEF showed a significantly higher improvement in LVEF and LV reverse remodeling following CCM therapy device implantation. There was no significant association between HF etiology and survival in drug-resistant HFrEF patients following CCM therapy.
Topics: Humans; Male; Female; Middle Aged; Ventricular Function, Left; Stroke Volume; Aged; Treatment Outcome; Heart Failure; Myocardial Contraction; Recovery of Function; Time Factors; Russia; Exercise Tolerance; Adult; Retrospective Studies; Peptide Fragments; Natriuretic Peptide, Brain; Functional Status
PubMed: 38811946
DOI: 10.1186/s12872-024-03950-8 -
BMC Cardiovascular Disorders May 2024Acute coronary syndrome due to coronary artery embolism in the setting of ascending aortic thrombus is an uncommon condition, even rarer when there is no aortic... (Review)
Review
BACKGROUND
Acute coronary syndrome due to coronary artery embolism in the setting of ascending aortic thrombus is an uncommon condition, even rarer when there is no aortic pathology such as aneurysm, severe atherosclerosis, aortic dissection, or thrombophilia (whether inherited or acquired).
CASE PRESENTATION
We report a case of a 58-year-old male presented with acute chest pain, electrocardiogram showing non-ST-elevation acute coronary syndrome. The computed tomography angiography of coronary artery revealed a mural thrombus in the proximal part of ascending aorta, located above the left coronary artery ostium, without any aortic pathologies. With the exception of hypertension and cigarette smoking, no other risk factors were identified in this patient that may increase the risk of thrombosis. Given the life-threatening risk of interventional therapy and surgery, the patient determinedly opted for anticoagulant and dual antiplatelet therapy. Then he experienced the reoccurrence of chest pain after 6-day treatment, progressed to anterior and inferior ST-segment elevation myocardial infarction. Coronary artery embolism originating from the ascending aortic thrombus was suspected. Considering the hemodynamic instability of the patient, the medical treatment was continued and bridged to warfarin and aspirin after discharge. Follow-up computed tomography angiography at 6 months showed no obstruction in coronary artery and complete resolution of the thrombus. No thromboembolic events occurred henceforward.
CONCLUSIONS
Acute coronary syndrome could be a manifestation of secondary coronary embolism due to ascending aortic thrombus. Currently, there is no standardized guideline for the treatment of aortic mural thrombus, individualized treatment is recommended. When surgical therapy is not applicable for the patient, anticoagulation and dual antiplatelet treatment are alternative treatments that may successfully lead to the resolution of the aortic thrombus.
Topics: Humans; Male; Middle Aged; Acute Coronary Syndrome; Treatment Outcome; Aortic Diseases; Recurrence; Thrombosis; Anticoagulants; Computed Tomography Angiography; Coronary Angiography; Platelet Aggregation Inhibitors; Non-ST Elevated Myocardial Infarction; Aortography
PubMed: 38811879
DOI: 10.1186/s12872-024-03956-2 -
Journal of Cardiovascular Magnetic... May 2024Three-dimensional (3D) contrast-enhanced MR angiography (CEMRA) is routinely used for vascular evaluation. With existing techniques for CEMRA, diagnostic image quality...
BACKGROUND
Three-dimensional (3D) contrast-enhanced MR angiography (CEMRA) is routinely used for vascular evaluation. With existing techniques for CEMRA, diagnostic image quality is only obtained during the first pass of the contrast agent or shortly thereafter, whereas angiographic quality tends to be poor when imaging is delayed to the equilibrium phase. We hypothesized that prolonged blood pool contrast enhancement could be obtained by imaging with a balanced T1 relaxation-enhanced steady-state (bT1RESS) pulse sequence, which combines 3D balanced steady-state free precession (bSSFP) with a saturation recovery magnetization preparation to impart T1 weighting and suppress background tissues. An electrocardiographic (ECG)-gated, 2D-accelerated version with isotropic 1.1-mm spatial resolution was evaluated for breath-hold equilibrium phase CEMRA of the thoracic aorta and heart. Main body The study was IRB approved. 21 subjects were imaged using unenhanced 3D bSSFP, time-resolved CEMRA, first pass gated CEMRA, followed by early and late equilibrium phase gated CEMRA and bT1RESS. 9 additional subjects were imaged using equilibrium phase 3D bSSFP and bT1RESS. Images were evaluated for image quality, aortic root sharpness, and visualization of the coronary artery origins, as well as using standard quantitative measures.
RESULTS
Equilibrium phase bT1RESS provided better image quality, aortic root sharpness, and coronary artery origin visualization than gated CEMRA (P<0.05), and improved image quality and aortic root sharpness versus unenhanced 3D bSSFP (P<0.05). It provided significantly larger apparent signal-to-noise and apparent contrast-to-noise ratio values than gated CEMRA and unenhanced 3D bSSFP (P<0.05) and provided ninefold better fluid suppression than equilibrium phase 3D bSSFP. Aortic diameter and main pulmonary artery diameter measurements obtained with bT1RESS and first pass gated CEMRA strongly correlated (P<0.05).
DISCUSSION AND CONCLUSION
We found that using bT1RESS greatly prolongs the useful duration of blood pool contrast enhancement while improving angiographic image quality compared with standard CEMRA techniques. Although further study is needed, potential advantages for vascular imaging include eliminating the current requirement for first pass imaging along with better reliability and accuracy for a wide range of cardiovascular applications.
PubMed: 38810732
DOI: 10.1016/j.jocmr.2024.101046 -
World Journal of Clinical Cases May 2024Invasive functional evaluation by fractional flow reserve (FFR) is considered as a gold standard for the evaluation of intermediate coronary stenosis. However, in...
BACKGROUND
Invasive functional evaluation by fractional flow reserve (FFR) is considered as a gold standard for the evaluation of intermediate coronary stenosis. However, in patients with diabetes due to accelerated progression of atherosclerosis the outcome may be worse even in the presence of negative functional testing.
CASE SUMMARY
We present a case of 55-year-old male diabetic patient who was admitted for chest pain. Diagnostic coronary angiography disclosed 2 intermediate stenoses of the obtuse marginal branch with no evidence of restenosis on previously implanted stent. Patient undergone invasive functional testing of intermediate lesion with preserved FFR (0.88), low coronary flow reserve (1.2) and very high index of microvascular resistance (84). Due to discrepancy in invasive functional parameters, intravascular imaging with optical coherence tomography showed fibrotic stenoses without signs of thin-sup fibroatheroma. Because of the preserved FFR and no signs of vulnerable plaque, the interventional procedure was deferred and the patient continued with optimal medications.
CONCLUSION
Combined functional and anatomic imaging of intermediate coronary stenosis in diabetic patients represent comprehensive contemporary decision pathway in the management of the patients.
PubMed: 38808347
DOI: 10.12998/wjcc.v12.i13.2269