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   Table of Contents - Current issue
January-March 2021
Volume 7 | Issue 1
Page Nos. 1-32

Online since Monday, March 29, 2021

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The 1-Year impact of coronavirus disease-19 pandemic on clinical research and publications p. 1
Mehdi Zoghi
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The relation between platelet/lymphocyte ratio and the occurrence of no reflow in patients with ST-segment elevation myocardial infarction managed by primary percutaneous coronary intervention p. 2
Ahmed Mohamed El Missiri, Mohamed Rashad Awad, Sameh Maamoun Shaheen
Introduction: No reflow phenomenon following primary percutaneous coronary intervention (PCI) is a strong predictor of mortality. Platelet/lymphocyte ratio (PLR) is an indicator of long-term outcome in ischemic heart disease patients. The aim of this study was to assess the relation between PLR measured on admission and the occurrence of no-reflow phenomenon in patients presenting with acute ST-segment elevation myocardial infarction (STEMI) managed by primary PCI. Methods: This was a prospective study including 100 patients with acute STEMI managed by primary PCI. Venous blood samples were obtained on admission to assess hemoglobin level, platelet count, and lymphocyte count. Thrombolysis in myocardial infarction (TIMI) flow grade, myocardial blush grade (MBG), and TIMI thrombus scale were assessed immediately following revascularization. During hospital stay, peak creatinine kinase MB fraction (CK-MB) was recorded, and transthoracic echocardiography was performed to assess left ventricular ejection fraction (LVEF). Results: Patients were divided into two groups based on the TIMI flow grade following PCI: Normal coronary flow group (TIMI 3 flow grade, n = 71) and reduced coronary flow (no-reflow) group (TIMI 0, 1, and 2, n = 29). There was a larger proportion of diabetic patients in the no-reflow group (P = 0.028). In addition, patients in the no-reflow group had a more advanced Killip class on presentation (P = 0.001), a lower LVEF (P < 0.0001), and a significantly higher PLR 213.66 ± 115.35 versus 122.81 ± 59.82 (P < 0.0001). PLR was significantly higher in patients with lower TIMI flow grade and lower MBG (P < 0.0001 for both). A significant correlation existed generally between PLR and peak CK-MB more in the no-reflow group (r = 0.471, P = 0.01). A PLR more than 108.08 predicted no-reflow with a sensitivity of 53%, a specificity of 86%, PPV of 80.%, and a NPV of 43.1% (AUC = 0.73). PLR was found to be an independent predictor of no-reflow multivariate regression analysis for predictors of no-reflow (ß = 0.0023, 9% CI = 0.0014–0.0032, P < 0.0001). Conclusions: PLR measured on admission is elevated in patients with STEMI who develop no-reflow during primary PCI. PLR is an independent predictor of no-reflow in such patients.
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An online survey of the changing trends of the cardiac surgeries in the era of COVID-19 p. 9
Virwar Kumar Jha
Objectives: To collect and assess cardiac surgeons' viewpoint about the changing cardiac surgery practices in India during COVID-19 pandemic. Methods: An online web-based study was conducted through an online questionnaire which was mailed to various cardiac surgeons in India (as retrieved from the cardiac surgeon directory). The responses were received and entered in an MS Excel spreadsheet and were analyzed. The ethical clearance for the study was not required as it was an online survey-based study without any patient data or treatment modification. Results: Out of 52 surgeons to whom the questionnaire was sent, 34 responded. Large number of surgeons (47.1%) pointed that reduction in cardiac surgical volume for long time during pandemics is associated with surgical expertise attrition. Importantly, in addition to 44.1% response rate for substantial reduction of patient management in cardiac surgery during pandemic, 38.2% of surgeons responded for its complete discontinuation. Another 44.1% of surgeons responded that the risk of exposure in a COVID-19-negative subject during perioperative period is increased and affects outcomes. Multiple responses were obtained regarding repetition of COVID-19 testing in postoperative period. Conclusion: This pandemic is not going to end in the immediate future. However, to put cardiac surgery in standby mode till pandemic last is not an option. Measures should be taken by hospital and regulatory bodies to resume services of cardiac surgery in addition to containing ad preventing infection by COVID-19. In the absence of evidence-based recommendation, strong consensus opinion of practicing cardiac surgeon will guide clinical decision-making.
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Increased left ventricular end-diastolic pressure after left ventriculography is associated with subsequent congestive heart failure-related hospitalization p. 14
Tomitaka Wakaki, Naoki Ishibashi, Hidetsugu Yamao
Context: Left ventricular end-diastolic pressure (LVEDP) reportedly increases after left ventriculography (LVG), and patients with congestive heart failure (CHF) tend to have high LVEDP. We hypothesized that increased LVEDP after LVG is directly associated with hospitalization for CHF. Aims: This study aims to investigate whether a predictive association exists between increased LVEDP after LVG and CHF-related hospitalization. Settings and Design: This was retrospective, single-center (hospital), observational study. Subjects and Methods: We analyzed data of 68 consecutive patients who underwent LVG between March 2015 and July 2017. Patients were divided into the following two groups: those with ΔLVEDP ≥6 mmHg during LVG and those with ΔLVEDP <6 mmHg during LVG. The two groups had similar baseline characteristics, except for body mass index. Statistical Analysis Used: Multivariate Cox proportional hazards analysis was used to determine whether increased LVEDP was associated with CHF-related hospitalization. Results: During the follow-up period (median duration [interquartile range]: 699 [413–994] days), eight patients (11.8%) were hospitalized for CHF. The risk of CHF-related hospitalization was significantly higher in the group with ΔLVEDP ≥6 mmHg than in the group with ΔLVEDP <6 mmHg (hazard ratio, 8.4; 9% confidence interval, 1.3–55.7). A Kaplan–Meier analysis confirmed this finding (P = 0.002). Conclusions: Increased LVEDP after LVG is an independent predictor of CHF-related hospitalization. Determining ΔLVEDP values may facilitate the identification of patients who should undergo early interventions because they are at risk of CHF-related hospitalization.
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Evaluation of effects of cardiac resynchronization on coronary blood flow by coronary flow reserve and in patients with İdiopathic dilated cardiomyopathy: Does it predict the response? p. 21
Halil Akin, Ozcan Ozdemir, Onder Bilge, Onur Yildirim, Rojhat Altindag
Background: The results of previous studies evaluating the effects of cardiac resynchronization therapy (CRT) on myocardial blood flow (MBF) and their relation with the response to CRT are conflicting. Materials and Methods: Sixty-one patients diagnosed with idiopathic dilated cardiomyopathy (IDC), a functional capacity (New York Heart Association [NYHA]) Class II or III, and left bundle branch block (LBBB) (QRS width >150 ms) were enrolled in the study. We aimed to evaluate the effects of CRT on MBF in patients with IDC and LBBB by coronary flow reserve (CFR) measurements and thereby tried to predict the responders. Results: Sixty-one patients with IDC were enrolled. CFR and hyperemic fractional flow reserve (FFR) increased after CRT. The only parameter affecting the increase in CFR was the change in FFR after CRT. Then, 44 patients who responded to the CRT treatment at 6 months were compared with 17 patients who did not. Left ventricle outflow tract time-velocity integral (LVOT-TVI), stroke volume (SV) and cardiac output index (COi) was detected significantly higher also left ventricular end-diastolic pressure (LVEDP) was lower in the CRT responders. However, there were no significant differences in coronary flow velocity measurements between the two groups. Moreover the regression analysis revealed that the baseline NYHA class, LVOT TVI, SV, COi, and LVEDP, which were changed due to increased blood flow after CRT implantation, is not associated with response to CRT. Conclusions: Our results suggest that MBF increased after CRT in patients with IDC probably by improving microvascular functions. However, the response to CRT treatment is not related to the changes in the coronary blood flow velocities after CRT.
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Using speckle-tracking echocardiography to evaluate subclinical left ventricular dysfunction in patients with obstructive sleep apnea syndrome p. 26
Ibrahim Ersoy
Purpose: This study aims to evaluate left ventricular (LV) functions using speckle-tracking echocardiography (STE)-based analyses in the early stages of obstructive sleep apnea (OSA). Methods: Twenty-one healthy individuals and 79 OSA patients enrolled in the study. The OSA group was classified according to Apnea-Hypopnea Index (AHI) as mild, moderate, and severe. Two-dimensional tissue Doppler imaging and STE was performed. Results: The control and OSA groups were comparable for sex (P = 0.450) and age (P = 0.560), while diabetes (P < 0.001) and hypertension (P < 0.001) diagnoses and body mass index (P < 0.001) were higher in the OSA patients. In OSA group, global longitudinal strain (GLS) (-13.32±3.19%, P < 0.001), global circumferential strain (GCS) (-18.33±3.40%, P < 0.001) and global radial strain (GRS) (37.91±8.11%, P = 0.005) were reduced. GLS and GCS have a decreasing trend toward severe OSA, while GRS increased in mild and moderate OSA. According to linear regression analysis, GRS (β: −1.47, P = 0.001], GCS (β: −1.34, P = 0.001), GLS (β: −1.54, P < 0.001), systolic pulmonary artery pressure (β: 0.99, P = 0.001), and deceleration time (β: 0.13, P = 0.03) have an independent relationship with AHI. Conclusions: In our study, STE technique can be a practical method for manifesting LV functional impairment at the early stages of OSA.
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