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   Table of Contents - Current issue
October-December 2019
Volume 5 | Issue 4
Page Nos. 109-162

Online since Monday, November 25, 2019

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Comparative assessment of left ventricular function after coronary artery bypass grafting and percutaneous coronary intervention to LAD by speckle tracking echocardiography study p. 109
Mahmoud S Abd El Moneum, Eman Saeed Elkeshk, Khaled Emad El-Din El-Rabbat, Adem M Ahmed
Background: Speckle-tracking echocardiography (STE) is a noninvasive imaging technique that analyzes global and regional myocardial function. Aims: This study aims to compare the assessment of the left ventricular (LV) function after percutaneous coronary intervention (PCI). Settings and Design: One hundred patients presented to the catheterization laboratory and cardiothoracic operating room in Benha University Hospital and Kasr Al–Ainy University Hospital for PCI and coronary artery bypass grafting (CABG) to left anterior descending artery (LAD). Patients and Methods: This study enrolled 100 patients. They were divided into two groups: Group I: 50 patients with PCI to LAD and Group II: 50 patients with CABG to LAD. Echocardiography (conventional echocardiography and two-dimensional STE) was performed for all patients 24 h before and 1 month after the procedures. Statistical Analysis Used: Data management and statistical analysis were done using SPSS version 25. Results: There were significant increases in global circumferential strain (GCS) after CABG surgery with mean value of −17.8 before the procedure and −23.8 after it while there were no significant increases in global longitudinal strain (GLS) after the same procedure with mean value of −17.5 before the procedure and −18.1 after it. There were significant increases in GLS with mean value of −17.0 before PCI and −21.2 after it, and there were significant increases in GCS with mean value of −17.1 before PCI and −25.4 after it with improvement in myocardial function after this procedure. GLS and GCS were significantly higher in patients with PCI than patients with CABG with P < 0.001. Conclusions: GLS and GCS are more effective than the parameters of standard echocardiography such as the LV end-diastolic volume, LV end-systolic volume, wall motion score index, and ejection fraction for evaluating LV function after PCI and CABG surgery. GLS and GCS are significantly higher in patients with PCI than patients with CABG surgery to LAD.
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Transesophageal echocardiography and scopy co-guided percutaneous mitral balloon valvuloplasty procedure: Experience of a tertiary health center with a literature review p. 116
Emre Ozdemir, Sadik Volkan Emren, Nihan Kahya Eren, Cem Nazli, Mehmet Tokaç
Objective: Rheumatic valvular heart disease (RVHD) is an important health problem in Turkey, as in all developing countries. There is no exact prevalence data for RVHD in Turkey. But according to the Jones criteria, Turkey has a moderate risk for acute rheumatic fever (ARF). Patients with recurrent bouts of ARF resulting in carditis can progress to RVHD. The aim of this study was to evaluate percutaneous mitral balloon valvuloplasty (PMBV) procedures and compared the findings with the literature. Materials and Methods: PMBV procedure indication was determined according to the guidelines and heart team consensus. Echocardiography was evaluated prior to PBMV in all patients. The study included a total of 131 patients who underwent PMBV in the cardiology clinic of our hospital in the period 2007–2017. All PBMV procedures were performed under intraprocedural transesophageal echocardiography (TEE) guidance in addition to fluoroscopy with general anesthesia. Results: The patients comprised 83% female and 17% male with a mean age of 41.2 ± 10.1 years. Mean ejection fraction was 60.3% ± 3.1%, mean left atrium diameter was 46.7 ± 5.3 mm, and mean Wilkins score was 8.7 ± 1. After procedure with there was no mortality. There was statistically significant increase on mitral valve area and statistically significant decrease on pulmonary arterial pressure and statistically significant decrease on transmitral gradient. Conclusion: This is one of the few studies worldwide to have detected the safety and efficacy of PBMV with TEE and scopy coguidance. It is the first such study in Turkey. In accordance with the literature, the procedures performed with TEE and fluoroscopy co-guidance in our clinic have increased the safety of the procedure and decreased complication rates.
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Admission plasma glucose and maternal prognostic factors in preeclampsia p. 121
Ozgur Kirbas, Ebru Hacer Biberoglu, Nuri Danisman
Aims: We aimed to investigate if admission plasma glucose (PG) level was a significant and independent risk factor for the patients' length of stay at the intensive care unit (ICU), as the primary outcome parameter, and also for the maternal and fetal complications, as the secondary outcome parameters, among a group of nondiabetic pregnant women with severe preeclampsia. Materials and Methods: In this prospective case–control study including 63 pregnant women, admission PG, glycosylated hemoglobin, neutrophil–lymphocyte ratio, platelet count, liver enzymes, and other laboratory parameters and clinical characteristics including length of stay at the hospital, maternal, and fetal complications were investigated. Results: Admission PG levels were found to be significantly elevated in preeclamptic women with poor outcome. Furthermore, platelet count, fibrinogen, alanine aminotransferase, and aspartate aminotransferase values were significantly associated with the length of stay at ICU. Conclusion: We claimed that hyperglycemia was an acute reaction, reflecting the severity of preeclampsia and PG levels to be added to the routine high-risk pregnancy panel on initial presentation to the hospital.
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Correlation of B-type natriuretic peptide with severity of coronary artery disease assessed by SYNTAX score ii in st elevation acute coronary syndrome patients p. 129
Onur Tasar, Gonenc Kocabay, Metin Cagdas, Yavuz Karabag
Background: We aimed to evaluate the role of B-type natriuretic peptide (BNP) in assessing severity of coronary artery disease by SYNTAX score (SS) II in a prospective study among ST elevation acute coronary syndrome (ACS) patients. Methods: One thousand and six patients with ST elevation myocardial infarction (STEMI) who admitted for primary percutaneous intervention were included. The patients were divided into two groups according to SS II values (≤32 and >32). The independent predictors of high SS II were investigated, and the best cutoff value of BNP, high-sensitivity C-reactive protein (hs-CRP), peak troponin I, and hemoglobin level in predicting high SS II was determined.Results: There was a positive correlation between BNP, white blood cell, hs-CRP, fasting blood glucose, peak troponin I, and SS I. SS II and hemoglobin were negative, but other parameters were positively correlated. High SS II group independent predictors of hypertension, diabetes mellitus, smoking, multivessel disease, high Killip class, BNP, peak troponin I, hemoglobin, and hs-CRP levels were found in STEMI patients. The value of BNP >87.15 pg/ml with 59% sensitivity and 77% specificity (area under the curve [AUC]: 0.722 [95% confidence interval [CI]: 0.689–0.756], P < 0.001), hs-CRP >10.85 mg/dl with 64% sensitivity and 64% specificity (AUC: 0.685 [95% CI: 0.65–0.72], P < 0.001), peak troponin I >77.83 ng/mL with 68% sensitivity and 63% specificity (AUC: 0.704 [95% CI 0.67–0.738], P < 0.001), and hemoglobin >16.75 g/dL with 4% sensitivity and 97% specificity (AUC: 0.345 [95% CI: 0.309–0.382] P < 0.001) independently predicted high SS II group. Conclusion: Serum BNP level was independently associated with the severity of coronary atherosclerosis in patients with ACS together with multivessel disease, left ventricular ejection fraction, hs-CRP, and troponin. Therefore, BNP assessment gives additional prognostic information for early risk stratification of patients with ACS.
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Heart disease: Lifestyle, knowledge, and perception among young Nigerian adults p. 134
Ejiroghene Martha Umuerri
Background: The proliferation of heart-unhealthy lifestyles may in part be responsible for the unabated scourge from heart disease. Assessments of knowledge and perception are key factors in curbing lifestyle-related diseases. Aims: The aim of the study is to determine the prevalence of heart-unhealthy lifestyles and its association with knowledge and perception of heart disease among young adults in Delta State, Nigeria. Settings and Design: A cross-sectional observational study conducted in Oghara, Nigeria. Materials and Methods: Three hundred healthy adults aged 18–35 years were recruited using the multistage sampling technique. The study instrument was a modified structured interviewer-administered questionnaire. Ethical approval was obtained before conducting the survey. Statistical Analysis Used: Obtained data were summarized and analyzed using SPSS version 22.0 software. Results: The response rate was 98% (294/300): 103 males and 191 females. The mean and median age of the respondents was 27 years. Majority of the respondents had at least 6 years of formal education. Heart-unhealthy lifestyles were prevalent: lack of exercise (71.4%), inadequate fruit intake (46.9%), alcohol consumption (26.5%), and tobacco smoking (19%). The mean knowledge score for heart disease was 39.49%. Using a score of 50% as the benchmark for good knowledge, 59% of the respondents had poor knowledge. Majority of the respondents did not perceive that they were at risk of heart disease. Conclusion: Heart-unhealthy lifestyles are common among young Nigerian adults. Knowledge of and self-perceived susceptibility to heart disease were poor in this study. There is a need for increased and refocused heart-health education at all ecological levels from early on in life.
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Accelerated dobutamine stress echocardiography protocol versus the standard one in the assessment of coronary artery disease p. 141
Ahmed Bendary, Hani Alkhazragy, Alshaymaa Sabry, Mohamed Osama, Khalid Elrabbat
Objectives: The steady-state concentration of dobutamine at any infusion rate is not reached except after 10 min. Nevertheless, dobutamine stress echocardiography (DSE) still employs an incremental 3-min interval infusion protocol. Constant infusion of a higher dobutamine dose appears to overcome this pitfall. We aimed to evaluate the safety and efficacy of an accelerated DSE protocol for the assessment of coronary artery disease. Methods: From June 2018 to January 2019, forty consecutive patients underwent accelerated protocol for DSE (constant infusion of 50 μg/kg/min, with discontinuation of infusion at 10 min if no stress endpoint appears). Their hemodynamic responses and adverse effects' profile were compared to a control group (40 patients who underwent the standard protocol within the preceding 6 months). Results: Both groups were matched in all baseline characteristics. Peak heart rate (HR) (143 ± 13 vs. 145 ± 13 bpm, P = 0.54) and peak systolic blood pressure (160 ± 29 vs. 155 ± 42 mmHg, P = 0.53) were similar in both protocols. The accelerated protocol produced a significantly more rapid increase in HR (11.5 ± 2.3 vs. 5.3 ± 1.3 bpm, P< 0.001) and resulted in marked reduction in test duration (6 ± 2 vs. 14 ± 3 min, P < 0.001). The mean total cumulative dobutamine dose was lower in the accelerated group (275 ± 63 vs. 355 ± 144 μg/kg, P = 0.029). Both groups experienced similar rates of both arrhythmic and nonarrhythmic adverse effects. Conclusion: Accelerated DSE protocol seems as feasible, safe, effective, and more time-saving compared to the standard one. This might be of value to busy echocardiographic laboratories.
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Coronary artery dominance and atrial fibrillation recurrence after cryoballoon pulmonary vein isolation p. 146
Ahmet Korkmaz, Ilyas Emre Yakıcı, Bekir Demirtaş, Funda Başyigit, Havva Tugba Gursoy, Emrullah Kızıltunc, Ender Ornek, Ozgul Ucar Elalmis, Mehmet Ileri, Umit Güray
Background and Aim: Catheter-based atrial fibrillation (AF) ablation primarily for pulmonary vein isolation (PVI) has become a significant therapeutic alternative for symptomatic and drug-refractory AF patients. It is evident that AF time and left atrium diameter (LAD) have the most critical impact on AF recurrence. In this study, we aimed to evaluate the role of coronary artery dominance for predicting AF recurrence after cryoballoon PVI. Methods: We retrospectively analyzed clinical, laboratory, and angiographic data from consecutive patients who underwent coronary angiography and successful cryoballoon PVI. Images of the coronary angiography were retrospectively reviewed for the coronary artery dominance by two experienced observers. The coronary artery system was classified as right dominant (RD) and left dominant. Results: A total of 140 patients without coronary artery disease and structural heart disease who underwent successful cryoballoon PVI were included in the study. There were 101 RD (72%) and 39 left-dominant (28%) patterns. A total of 26 patients (22%) had developed AF recurrence during follow-up. AF recurrence rates were 41% in the left coronary-dominant group and 15% in the right coronary-dominant group (P = 0.001). According to AF recurrence after cryoballoon PVI, only follow-up time (15.7 ± 2.4 vs. 14 ± 1.8 months, P = 0.001), LAD (41.8 ± 2 vs. 40.6 ± 1.8 mm, P = 0.003) and coronary artery disease (CAD) (left CAD, 51.6% vs. 21.1%, P = 0.001) were significantly associated with AF recurrence. AF recurrence rates in multivariable logistic regression analysis according to AF recurrence after cryoballoon PVI, follow-up time, LAD, and CAD were independent predictors of AF recurrence. Conclusions: Our findings suggested that left CAD may be related to AF recurrence after cryoballoon PVI. Coronary artery dominance may be an additional predictor of AF recurrence if supported by larger prospective studies.
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Diagnostic modality for evaluation of right ventricle in chronic thromboembolic pulmonary hypertension patients p. 152
Mustafa Oguz, Tarik Kivrak, Murat Sunbul, Fuad Dede, Bedrettin Yildizeli, Bulent Mutlu
Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is a progressive disease of pulmonary hypertension (PH) as a consequence obstructive of pulmonary arteries with thromboembolism. Augmented pulmonary vascular resistance and pulmonary artery pressure (PAP) can ultimately lead to the right ventricular dysfunction, which leads to adaptive and maladaptive changes. Right ventricle (RV) remodeling can cause clinical deterioration and RV failure. Aims and Objectives: We aimed to evaluate the RV functions with a new diagnostic modality 2-deoxy-2-(18F)-fluoro-D-glucose (FDG)-positron emission tomography (PET) in patients with CTEPH. Materials and Methods: We included 53 patients diagnosed with CTEPH who were planned to have pulmonary thromboendarterectomy (PEA) and did not have any contraindication for cardiac PET/computed tomography (CT). We performed transthoracic echo, cardiac PET/CT, 6-minute walk distance (6-MWT), and right heart catheterization 1 week before PEA surgery. Results: The patients divided into two groups according to RV/left ventricle (LV) FDG-PET uptake ratio, RV/LV ≤1, and RV/LV >1. Six-MWD was significantly higher in the RV/LV ≤1 group (P = 0.005). Pro-BNP was considerably higher in the RV/LV >1 group (P = 0.041). Conclusion: The present study aims to demonstrate the RV/LV FDG-PET uptake ratio could be used in the noninvasive diagnostic method in diagnosing, treatment strategy, and clinical follow-up in patients with CTEPH.
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Is Vitamin D level elevated in patients on statin treatment? p. 159
Gulcin Sahingoz Erdal, Nihan Turhan Caglar, Dilay Karabulut, Nursel Kocamaz, Nilgun Isiksacan
Context: Statins are effective agents on both primary and secondary prevention in patients who are at high risk of cardiovascular disease, and the number of patients taking statins has significantly raised recently. Aims: The aim of this study was to evaluate the association between Vitamin D levels and statin usage, statin type, dose, and duration. Settings and Design: We enrolled 210 control and 174 patients who were taking statins, and whose Vitamin D levels were checked in the past 3 months. 25-hydroxy Vitamin D levels were analyzed by immunoassay. Subgroup analysis was done firstly according to statin types and other lipid-lowering agents, namely fenofibrate. Subjects and Methods: Statin dosage's effect on Vitamin D levels were analyzed in patients taking low-dose (10–20 mg/day) and high-dose (40–80 mg/day) atorvastatin. Patients were divided into three groups according to statin usage duration (short term: >1 month, less than a year, medium-term: 1–5 years, long term: >5 years). Statistical Analysis Used: Kolmogorov–Smirnov, Kruskal–Wallis, Bonferroni Dunn's multiple comparisons, Spearman rank tests were used. Results: About 71.26% of the patient group was using atorvastatin, 13.21% rosuvastatin, 4.59% pitavastatin, and 10.91% were on fenofibrate treatment. Vitamin D levels were statistically different among statin subtypes (P < 0.001); the highest level was observed in patients taking atorvastatin (23.03 ± 9.94). Vitamin D levels were statistically significantly higher in short-term and medium-term statin usage than control group (P < 0.001). Conclusions: Our study demonstrated that even low-dose statin has a positive effect on Vitamin D. Thereby, it encourages patients to continue with statin therapy more willingly.
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