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Tantiworawit A, Kamolsripat T, Piriyakhuntorn P, Rattanathammethee T, Hantrakool S, Chai-Adisaksopha C, Rattarittamrong E, Norasetthada L, Fanhchaksai K, Charoenkwan P. Survival and causes of death in patients with alpha and beta-thalassemia in Northern Thailand. Ann Med 2024; 56:2338246. [PMID: 38604224 PMCID: PMC11011226 DOI: 10.1080/07853890.2024.2338246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 03/13/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Thalassemia is the most prevalent hereditary anaemia worldwide. Severe forms of thalassemia can lead to reduced life expectancy due to disease-related complications. OBJECTIVES To investigate the survival of thalassemia patients across varying disease severity, causes of death and related clinical factors. PATIENTS AND METHODS We conducted a retrospective review of thalassemia patients who received medical care at Chiang Mai University Hospital. The analysis focused on survival outcomes, and potential associations between clinical factors and patient survival. RESULTS A total of 789 patients were included in our study cohort. Among them, 38.1% had Hb H disease, 35.4% had Hb E/beta-thalassemia and 26.5% had beta-thalassemia major. Half of the patients (50.1%) required regular transfusions. Sixty-five patients (8.2%) had deceased. The predominant causes of mortality were infection-related (36.9%) and cardiac complications (27.7%). Transfusion-dependent thalassemia (TDT) (adjusted HR 3.68, 95% CI 1.39-9.72, p = 0.008) and a mean serum ferritin level ≥3000 ng/mL (adjusted HR 4.18, 95% CI 2.20-7.92, p < 0.001) were independently associated with poorer survival. CONCLUSIONS Our study highlights the primary contributors to mortality in patients with thalassemia as infection-related issues and cardiac complications. It also underscores the significant impact of TDT and elevated serum ferritin levels on the survival of thalassemia patients.
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Affiliation(s)
- Adisak Tantiworawit
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Thalassemia and Hematology Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Thansita Kamolsripat
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pokpong Piriyakhuntorn
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Thanawat Rattanathammethee
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sasinee Hantrakool
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Chatree Chai-Adisaksopha
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Ekarat Rattarittamrong
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Lalita Norasetthada
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kanda Fanhchaksai
- Thalassemia and Hematology Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pimlak Charoenkwan
- Thalassemia and Hematology Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Hao X, Zhu M, Sun Z, Li P, Meng Q, Tan L, Chen C, Zhang Y, Yang L, Zhang J, Huang Y. Systemic immune-inflammation index is associated with cardiac complications following acute ischemic stroke: A retrospective single-center study. Clin Neurol Neurosurg 2024; 241:108285. [PMID: 38636361 DOI: 10.1016/j.clineuro.2024.108285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/31/2024] [Accepted: 04/11/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Stroke-induced heart syndrome is a feared complication of ischemic stroke, that is commonly encountered and has a strong association with unfavorable prognosis. More research is needed to explore underlying mechanisms and inform clinical decision making. This study aims to explore the relationship between the early systemic immune-inflammation (SII) index and the cardiac complications after acute ischemic stroke. METHODS Consecutive patients with acute ischemic stroke were prospectively collected from January 2020 to August 2022 and retrospectively analyzed. We included subjects who presented within 24 hours after symptom onset and were free of detectable infections or cancer on admission. SII index [(neutrophils × platelets/ lymphocytes)/1000] was calculated from laboratory data at admission. RESULTS A total of 121 patients were included in our study, of which 24 (19.8 %) developed cardiac complications within 14 days following acute ischemic stroke. The SII level was found higher in patients with stroke-heart syndrome (p<.001), which was an independent predictor of stroke-heart syndrome (adjusted odds ratio 5.089, p=.002). CONCLUSION New-onset cardiovascular complications diagnosed following a stroke are very common and are associated with early SII index.
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Affiliation(s)
- Xiaodi Hao
- Department of Neurology, Zhengzhou University People's Hospital, Zhengzhou University, Zhengzhou, Henan 450003, China
| | - Mingfang Zhu
- Department of Neurology, Zhengzhou University People's Hospital, Zhengzhou University, Zhengzhou, Henan 450003, China
| | - Zhengyu Sun
- Department of Neurology, Zhengzhou University People's Hospital, Zhengzhou University, Zhengzhou, Henan 450003, China
| | - Penghui Li
- Department of Neurology, Zhengzhou University People's Hospital, Zhengzhou University, Zhengzhou, Henan 450003, China
| | - Qi Meng
- Department of Neurology, Zhengzhou University People's Hospital, Zhengzhou University, Zhengzhou, Henan 450003, China
| | - Leilei Tan
- Department of Neurology, Zhengzhou University People's Hospital, Zhengzhou University, Zhengzhou, Henan 450003, China
| | - Chen Chen
- Department of Neurology, Zhengzhou University People's Hospital, Zhengzhou University, Zhengzhou, Henan 450003, China
| | - Yakun Zhang
- Department of Neurology, Zhengzhou University People's Hospital, Zhengzhou University, Zhengzhou, Henan 450003, China
| | - Lihua Yang
- Department of Neurology, Zhengzhou University People's Hospital, Zhengzhou University, Zhengzhou, Henan 450003, China
| | - Jiewen Zhang
- Department of Neurology, Zhengzhou University People's Hospital, Zhengzhou University, Zhengzhou, Henan 450003, China.
| | - Yue Huang
- Department of Neurology, Zhengzhou University People's Hospital, Zhengzhou University, Zhengzhou, Henan 450003, China.
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Ptak K, Olszewska M, Szymońska I, Olchawa-Czech A, Mól N, Rudek-Budzyńska A, Kukla K, Cisowska M, Sabat O, Grzyb A, Kwinta P. Should we be afraid of long-term cardiac consequences in children with multisystem inflammatory syndrome? Experience from subsequent waves of COVID-19. Eur J Pediatr 2024:10.1007/s00431-024-05528-0. [PMID: 38517518 DOI: 10.1007/s00431-024-05528-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/12/2024] [Accepted: 03/14/2024] [Indexed: 03/24/2024]
Abstract
The purpose of the study was to assess and compare short- and long-term cardiac complications of the multisystem inflammatory syndrome in children (MIS-C) by predominant severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants throughout the pandemic. The analysis of prospectively collected data comparing cardiac complications of MIS-C during and after hospitalization across the original/alpha, delta, and omicron waves. Cardiac complications were defined as cardiac failure with systolic function impairment or hypotension or abnormalities in echocardiographic findings (decrease in LVEF, FS, valvular insufficiency, pericardial effusion, or coronary artery abnormalities). A total of 120 patients with MIS-C admitted to the Children's Hospital of Krakow between November 1, 2020, and May 5, 2023, were included in the study (74 during original/alpha dominance, 31 delta, and 15 omicron). Patients in the omicron group were found to be younger than those in the alpha and delta groups (37 vs. 75 vs. 80 months, p = 0.03). The frequency of cardiac failure with systolic function impairment or hypotension was diagnosed more frequently in the original/alpha and delta groups than in the omicron group (44.59% vs. 41.94% vs. 13.33%, p = 0.08) also echocardiographic abnormalities changed, with rates of 60.8%, 35.5%, and 13.3% (p < 0.001) accordingly. The multivariable regression revealed an older age (OR = 1.19, 95% CI = 1.07-1.33, p = 0.002) as the only independent factors of cardiac failure with systolic function impairment or hypotension. In all patients, signs of cardiac failure resolved during the hospitalization. Moreover, in 98.3% of patients, all echocardiagraphic abnormalities resolved completely during the observation period. Conclusion: The cardiac complications of MIS-C appeared to advance less severely in younger children during the Omicron outbreak. In long-term observation, symptoms of cardiac failure resolve completely. Similarly, also echocardiographic abnormalities normalize in the vast majority of patients. What is Known: • Knowledge about the long-term cardiac complications of MIS-C is still evolving and uncertain. • The greatest concern of MIS-C is cardiac complications, including cardiac failure and coronary artery dilatation. What is New: • Long-term observations revealed complete resolution of cardiac complications in the vast majority of patients with MIS-C, irrespective of the dominant variant. • Cardiac complications of MIS-C were less common in younger children during subsequent pandemic waves in our patient population.
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Affiliation(s)
- Katarzyna Ptak
- Department of Pediatrics, Jagiellonian University Medical College, Krakow, Poland.
| | - Marta Olszewska
- Department of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Izabela Szymońska
- Department of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Anna Olchawa-Czech
- Department of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Nina Mól
- Department of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | | | - Kornelia Kukla
- Department of Pediatrics, University Children's Hospital, Krakow, Poland
| | - Marta Cisowska
- Department of Pediatrics, University Children's Hospital, Krakow, Poland
| | - Oliwia Sabat
- Department of Pediatrics, Jagiellonian University Medical College, Students' Scientific Group, Krakow, Poland
| | - Aleksandra Grzyb
- Department of Pediatrics, Jagiellonian University Medical College, Students' Scientific Group, Krakow, Poland
| | - Przemko Kwinta
- Department of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
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Palma-Milla C, Prat-Planas A, Soengas-Gonda E, Centeno-Pla M, Sánchez-Pozo J, Lazaro-Rodriguez I, Quesada-Espinosa JF, Arteche-Lopez A, Olival J, Pacio-Miguez M, Palomares-Bralo M, Santos-Simarro F, Cancho-Candela R, Vázquez-López M, Seidel V, Martinez-Monseny AF, Casas-Alba D, Grinberg D, Balcells S, Serrano M, Rabionet R, Martin MA, Urreizti R. Expanding the Phenotypic Spectrum of TRAF7-Related Cardiac, Facial, and Digital Anomalies With Developmental Delay: Report of 11 New Cases and Literature Review. Pediatr Neurol 2024; 155:8-17. [PMID: 38569228 DOI: 10.1016/j.pediatrneurol.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/22/2024] [Accepted: 03/07/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND TRAF7-related cardiac, facial, and digital anomalies with developmental delay (CAFDADD), a multisystemic neurodevelopmental disorder caused by germline missense variants in the TRAF7 gene, exhibits heterogeneous clinical presentations. METHODS We present a detailed description of 11 new TRAF7-related CAFDADD cases, featuring eight distinct variants, including a novel one. RESULTS Phenotypic analysis and a comprehensive review of the 58 previously reported cases outline consistent clinical presentations, emphasizing dysmorphic features, developmental delay, endocrine manifestations, and cardiac defects. In this enlarged collection, novelties include a wider range of cognitive dysfunction, with some individuals exhibiting normal development despite early psychomotor delay. Communication challenges, particularly in expressive language, are prevalent, necessitating alternative communication methods. Autistic traits, notably rigidity, are observed in the cohort. Also, worth highlighting are hearing loss, sleep disturbances, and endocrine anomalies, including growth deficiency. Cardiac defects, frequently severe, pose early-life complications. Facial features, including arched eyebrows, contribute to the distinct gestalt. A novel missense variant, p.(Arg653Leu), further underscores the complex relationship between germline TRAF7 variants and somatic changes linked to meningiomas. CONCLUSIONS Our comprehensive analysis expands the phenotypic spectrum, emphasizing the need for oncological evaluations and proposing an evidence-based schedule for clinical management. This study contributes to a better understanding of TRAF7-related CAFDADD, offering insights for improved diagnosis, intervention, and patient care.
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Affiliation(s)
- Carmen Palma-Milla
- Unidad de Dismorfología y Genética (UDisGen), Hospital Universitario 12 de Octubre, Madrid, Spain; Department of Genetics, Hospital Universitario 12 de Octubre, Madrid, Spain.
| | - Aina Prat-Planas
- Faculty of Biology, Department of Genetics, Microbiology and Statistics, Institute of Biomedicine (IBUB), Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Institut de Recerca Sant Joan de Déu (IRSJD), Esplugues de Llobregat, Spain
| | - Emma Soengas-Gonda
- Unidad de Dismorfología y Genética (UDisGen), Hospital Universitario 12 de Octubre, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Mónica Centeno-Pla
- Faculty of Biology, Department of Genetics, Microbiology and Statistics, Institute of Biomedicine (IBUB), Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Institut de Recerca Sant Joan de Déu (IRSJD), Esplugues de Llobregat, Spain; Clinical Biochemistry Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Jaime Sánchez-Pozo
- Unidad de Dismorfología y Genética (UDisGen), Hospital Universitario 12 de Octubre, Madrid, Spain; Department of Pediatric Endocrinology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Irene Lazaro-Rodriguez
- Unidad de Dismorfología y Genética (UDisGen), Hospital Universitario 12 de Octubre, Madrid, Spain; Department of Pediatric Endocrinology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Juan F Quesada-Espinosa
- Unidad de Dismorfología y Genética (UDisGen), Hospital Universitario 12 de Octubre, Madrid, Spain; Department of Genetics, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Ana Arteche-Lopez
- Unidad de Dismorfología y Genética (UDisGen), Hospital Universitario 12 de Octubre, Madrid, Spain; Department of Genetics, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Jonathan Olival
- Genomic Unit, Molecular and Genetic Medicine Section, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Marta Pacio-Miguez
- INGEMM, Institute of Medical Genetics, Hospital Universitario La Paz, Madrid, Spain
| | - María Palomares-Bralo
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; INGEMM, Institute of Medical Genetics, Hospital Universitario La Paz, Madrid, Spain; ITHACA - European Reference Network, INGEMM, Institute of Medical Genetics, Hospital Universitario La Paz, Madrid, Spain
| | - Fernando Santos-Simarro
- Unidad de Diagnóstico Molecular y Genética Clínica, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Ramón Cancho-Candela
- Neuropediatrics, Faculty of Medicine, Hospital Universitario Río Hortega, Universidad de Valladolid, Valladolid, Spain
| | | | - Veronica Seidel
- Clinical Genetics, Pediatrics Department, Hospital Gregorio Marañón, Madrid, Spain
| | - Antonio F Martinez-Monseny
- Institut de Recerca Sant Joan de Déu (IRSJD), Esplugues de Llobregat, Spain; Department of Genetic Medicine, Pediatric Institute of Rare Diseases (IPER), Hospital Sant Joan de Déu, Barcelona, Spain
| | - Didac Casas-Alba
- Institut de Recerca Sant Joan de Déu (IRSJD), Esplugues de Llobregat, Spain; Department of Genetic Medicine, Pediatric Institute of Rare Diseases (IPER), Hospital Sant Joan de Déu, Barcelona, Spain
| | - Daniel Grinberg
- Faculty of Biology, Department of Genetics, Microbiology and Statistics, Institute of Biomedicine (IBUB), Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Institut de Recerca Sant Joan de Déu (IRSJD), Esplugues de Llobregat, Spain
| | - Susanna Balcells
- Faculty of Biology, Department of Genetics, Microbiology and Statistics, Institute of Biomedicine (IBUB), Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Institut de Recerca Sant Joan de Déu (IRSJD), Esplugues de Llobregat, Spain
| | - Mercedes Serrano
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Institut de Recerca Sant Joan de Déu (IRSJD), Esplugues de Llobregat, Spain; Pediatric Neurology Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Raquel Rabionet
- Faculty of Biology, Department of Genetics, Microbiology and Statistics, Institute of Biomedicine (IBUB), Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Institut de Recerca Sant Joan de Déu (IRSJD), Esplugues de Llobregat, Spain
| | - Miguel A Martin
- Unidad de Dismorfología y Genética (UDisGen), Hospital Universitario 12 de Octubre, Madrid, Spain; Department of Genetics, Hospital Universitario 12 de Octubre, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Grupo de Enfermedades Mitocondriales y Neurometabólicas, Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Roser Urreizti
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Institut de Recerca Sant Joan de Déu (IRSJD), Esplugues de Llobregat, Spain; Clinical Biochemistry Department, Hospital Sant Joan de Déu, Barcelona, Spain
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Guo B, Zhao C, He MZ, Senter C, Zhou Z, Peng J, Li S, Fitzpatrick AL, Lindström S, Stebbins RC, Noppert GA, Li C. Identifying patterns of reported findings on long-term cardiac complications of COVID-19: a systematic review and meta-analysis. BMC Med 2023; 21:468. [PMID: 38017426 PMCID: PMC10685580 DOI: 10.1186/s12916-023-03162-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 11/07/2023] [Indexed: 11/30/2023] Open
Abstract
INTRODUCTION Prior reviews synthesized findings of studies on long-term cardiac complications of COVID-19. However, the reporting and methodological quality of these studies has not been systematically evaluated. Here, we conducted a systematic review and meta-analysis on long-term cardiac complications of COVID-19 and examined patterns of reported findings by study quality and characteristics. METHODS We searched for studies examining long-term cardiac complications of COVID-19 that persisted for 4 weeks and over. A customized Newcastle-Ottawa scale (NOS) was used to evaluate the quality of included studies. Meta-analysis was performed to generate prevalence estimates of long-term cardiac complications across studies. Stratified analyses were further conducted to examine the prevalence of each complication by study quality and characteristics. The GRADE approach was used to determine the level of evidence for complications included in the meta-analysis. RESULTS A total number of 150 studies describing 57 long-term cardiac complications were included in this review, and 137 studies reporting 17 complications were included in the meta-analysis. Only 25.3% (n = 38) of studies were of high quality based on the NOS quality assessment. Chest pain and arrhythmia were the most widely examined long-term complications. When disregarding study quality and characteristics, summary prevalence estimates for chest and arrhythmia were 9.79% (95% CI 7.24-13.11) and 8.22% (95% CI 6.46-10.40), respectively. However, stratified analyses showed that studies with low-quality scores, small sample sizes, unsystematic sampling methods, and cross-sectional design were more likely to report a higher prevalence of complications. For example, the prevalence of chest pain was 22.17% (95% CI 14.40-32.55), 11.08% (95% CI 8.65-14.09), and 3.89% (95% CI 2.49-6.03) in studies of low, medium, and high quality, respectively. Similar patterns were observed for arrhythmia and other less examined long-term cardiac complications. CONCLUSION There is a wide spectrum of long-term cardiac complications of COVID-19. Reported findings from previous studies are strongly related to study quality, sample sizes, sampling methods, and designs, underscoring the need for high-quality epidemiologic studies to characterize these complications and understand their etiology.
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Affiliation(s)
- Boya Guo
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Chenya Zhao
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mike Z He
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Camilla Senter
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Zhenwei Zhou
- Department of Biostatistics, School of Public Health, Boston University, Boston, MA, USA
| | - Jin Peng
- Department of Biostatistics, School of Global Public Health, New York University, New York, NY, USA
| | - Song Li
- Division of Cardiology, University of Washington Medical Center, Seattle, WA, USA
| | - Annette L Fitzpatrick
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Sara Lindström
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Rebecca C Stebbins
- Social, Genetic, & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Grace A Noppert
- Institute for Social Research, University of Michigan, Ann Arbor, MI, 48104, USA.
| | - Chihua Li
- Institute for Social Research, University of Michigan, Ann Arbor, MI, 48104, USA.
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
- Department of Epidemiology, School of Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Salehi M, Khalili H, Khoshavi M, Mollazadeh R, Jahanshahi B, Hosseini MS. Brucella myocarditis with unusual clinical features & abnormal cardiac MRI: A case report. IDCases 2023; 33:e01868. [PMID: 37583787 PMCID: PMC10424257 DOI: 10.1016/j.idcr.2023.e01868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 07/31/2023] [Accepted: 07/31/2023] [Indexed: 08/17/2023] Open
Abstract
Brucellosis is a zoonotic disease that remains an important public health problem in developing countries. It can affect almost all organs, including the heart. While cardiac complications of brucellosis are not common, they usually manifest as endocarditis. Brucella myocarditis, on the other hand, is a highly rare complication of brucellosis. In this case report, we present the case of a 35-year-old woman who was admitted to the hospital with severe palpitations, fever, and fatigue. Due to the patient's long history of brucellosis and clinical symptoms, she underwent cardiac evaluation, including cardiac magnetic resonance imaging, which was a promising method to diagnose Brucella myocarditis. Hopefully our patient responded well to Rifampin and Doxycycline with gentamicin. It is important to raise awareness of this rare but potentially serious complication of brucellosis and to emphasize the value of early diagnosis and treatment.
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Affiliation(s)
- Mohammadreza Salehi
- Research Center for Antibiotic Stewardship and Antimicrobial Resistance, Imam Khomeini Hospital Complex, Department of Infectious Diseases, Tehran University of Medical Sciences (TUMS), Iran
| | - Hossein Khalili
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Meysam Khoshavi
- Department of Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Mollazadeh
- Department of Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahare Jahanshahi
- Tehran University of Medical Sciences, Cardiovascular Department, Tehran, Iran
| | - Mahnaz Sadat Hosseini
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences (TUMS), Tehran, Iran
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7
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Ferreira VM, Plein S, Wong TC, Tao Q, Raisi-Estabragh Z, Jain SS, Han Y, Ojha V, Bluemke DA, Hanneman K, Weinsaft J, Vidula MK, Ntusi NAB, Schulz-Menger J, Kim J. Cardiovascular magnetic resonance for evaluation of cardiac involvement in COVID-19: recommendations by the Society for Cardiovascular Magnetic Resonance. J Cardiovasc Magn Reson 2023; 25:21. [PMID: 36973744 PMCID: PMC10041524 DOI: 10.1186/s12968-023-00933-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 03/14/2023] [Indexed: 03/29/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is an ongoing global pandemic that has affected nearly 600 million people to date across the world. While COVID-19 is primarily a respiratory illness, cardiac injury is also known to occur. Cardiovascular magnetic resonance (CMR) imaging is uniquely capable of characterizing myocardial tissue properties in-vivo, enabling insights into the pattern and degree of cardiac injury. The reported prevalence of myocardial involvement identified by CMR in the context of COVID-19 infection among previously hospitalized patients ranges from 26 to 60%. Variations in the reported prevalence of myocardial involvement may result from differing patient populations (e.g. differences in severity of illness) and the varying intervals between acute infection and CMR evaluation. Standardized methodologies in image acquisition, analysis, interpretation, and reporting of CMR abnormalities across would likely improve concordance between studies. This consensus document by the Society for Cardiovascular Magnetic Resonance (SCMR) provides recommendations on CMR imaging and reporting metrics towards the goal of improved standardization and uniform data acquisition and analytic approaches when performing CMR in patients with COVID-19 infection.
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Affiliation(s)
- Vanessa M Ferreira
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Oxford British Heart Foundation Centre of Research Excellence, The National Institute for Health Research Oxford Biomedical Research Centre at the Oxford University Hospitals NHS Foundation Trust, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Sven Plein
- Department of Biomedical Imaging Science, University of Leeds, Leeds, UK
| | - Timothy C Wong
- Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Qian Tao
- Department of Imaging Physics, Delft University of Technology, Delft, The Netherlands
| | - Zahra Raisi-Estabragh
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Supriya S Jain
- Division of Pediatric Cardiology, Department of Pediatrics, Maria Fareri Children's Hospital at Westchester Medical Center, New York Medical College, New York, USA
| | - Yuchi Han
- Cardiovascular Medicine, Wexner Medical Center, The Ohio State University, Columbus, USA
| | - Vineeta Ojha
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - David A Bluemke
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Kate Hanneman
- Department of Medical Imaging, Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Jonathan Weinsaft
- Department of Medicine, Division of Cardiology, Weill Cornell Medicine/New York Presbyterian Hospital, Weill Cornell Medical College, New York, USA
| | - Mahesh K Vidula
- Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, USA
| | - Ntobeko A B Ntusi
- Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital; Cape Heart Institute, University of Cape Town, South African Medical Research Council Extramural Unit On Intersection of Noncommunicable Diseases and Infectious Diseases, Cape Town, South Africa
| | - Jeanette Schulz-Menger
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between Charité and MDC, Charité University Medicine, Berlin, Germany
- Department of Cardiology and Nephrology, Helios Hospital Berlin-Buch, Berlin, Germany
| | - Jiwon Kim
- Department of Medicine, Division of Cardiology, Weill Cornell Medicine/New York Presbyterian Hospital, Weill Cornell Medical College, New York, USA.
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8
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Ahmad I, Souchet L, Hamzy F, Ceballos P, Desbrosses Y, Ravinet A, Turlure P, Villate A, Borel C, Benbarkat H, Yakoub-Agha I, Guillaume T. [ Cardiac complications following allogeneic hematopoietic stem cell transplantation: Recommendations of the SFGM-TC]. Bull Cancer 2023; 110:S56-S66. [PMID: 35662519 DOI: 10.1016/j.bulcan.2022.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/22/2022] [Accepted: 03/30/2022] [Indexed: 10/18/2022]
Abstract
Autologous and allogeneic hematopoietic stem cell transplantation (HSCT) can lead to early cardiac complications as well as late sequelae. A cardiac evaluation is essential in the pre-transplant assessment given the patient's comorbidities and previous chemotherapy treatments received. Various thresholds of cardiac function are recommended as eligibility criteria. The rise of haplo-identical transplantation with the use of post-transplant high-dose cyclophosphamide (PT-Cy) as a prophylaxis against graft-versus-host disease (GVHD) is accompanied by a resurgence of cardiological concerns. Arrhythmias are also a concern and the list of drugs implicated in this complication is growing. The rare occurrence of cardiac GVHD has been reported, although the entity is not well defined. Finally, although long-term follow-up recommendations exist, they are not accompanied by specific targets for cardiovascular risk factors, the presence of which is nevertheless increased after HSCT. In the framework of the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC) practice harmonization workshops held in Lille in September 2019, the prophylaxis, the diagnostic approach and the treatments of cardiac complication following HSCT were reviewed after analysis of published studies.
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Affiliation(s)
- Imran Ahmad
- Université de Montréal, hôpital Maisonneuve-Rosemont, service d'hématologie et oncologie médicale, 5415 Boulevard de l'Assomption, Montréal, QC, H1T2M4, Canada
| | - Laetitia Souchet
- Centre hospitalier La Pitié-Salpêtrière, service d'hématologie, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Fati Hamzy
- Hôpital Universitaire International Cheikh Zaïd, Cite al Irfane-Hay Ryad, service d'hématologie et greffe de moelle osseuse, Av. Allal al Fassi, BP 6533, Rabat, Maroc
| | - Patrice Ceballos
- Centre hospitalier Saint-Éloi, UGH hématologie, 80, avenue Augustin-Fliche, 34080 Montpellier, France
| | - Yohann Desbrosses
- CHRU Jean-Minjoz Besançon, service d'hématologie, 3, boulevard Flemming, 25030 Besançon cedex, France
| | - Aurélie Ravinet
- CHU Estaing, université d'Auvergne, service d'hématologie, 1, place Lucie-Aubrac, 63000 Clermont-Ferrand, France
| | - Pascal Turlure
- CHU Dupuytren Limoges, service d'hématologie, 2, avenue Martin-Luther-King, 87000 Limoges, France
| | - Alban Villate
- CHU Bretonneau Tours, service d'hématologie et thérapie cellulaire, 2, boulevard Tonnelé, 37044 Tours cedex 9, France
| | - Cécile Borel
- Institut universitaire du cancer de Toulouse - Oncopole, service d'hématologie, 1, avenue Irène-Joliot-Curie, 31100 Toulouse, France
| | - Hanane Benbarkat
- Université de Montréal, hôpital Maisonneuve-Rosemont, service de cardiologie, 5415 Boulevard de l'Assomption, Montréal, QC, H1T2M4, Canada
| | - Ibrahim Yakoub-Agha
- CHU de Lille, université de Lille, service d'hématologie, Infinite, Inserm U1286, 59000 Lille, France
| | - Thierry Guillaume
- CHU de Nantes, Hôtel-Dieu, service d'hématologie clinique, 1, place Ricordeau, 44000 Nantes, France.
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9
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Taheri SK, Bawand R, Sanginabadi F, Khansari N, Moradi A. One-year survey of methadone-induced cardiac complications. Caspian J Intern Med 2023; 14:43-46. [PMID: 36741481 PMCID: PMC9878909 DOI: 10.22088/cjim.14.1.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/03/2021] [Accepted: 12/11/2021] [Indexed: 02/07/2023]
Abstract
Background Methadone is one of the most useful opioids that can be used to achieve many therapeutic goals, and also it may be abused as an illicit drug. Methadone can cause different gastrointestinal, neurological, and cardiac complications. This study was performed to obtain a better understanding of the cardiac side effects of methadone in patients with methadone poisoning. Methods This cross-sectional study was performed on 210 samples in Sina Hospital of Hamadan in a one-year period from March 2019 to March 2020. After assessing patients who had methadone poisoning and completing their demographic information and evaluation of changes in patients' EKGs, the data was collected and analyzed by SPSS 16 software. Results Out of 210 participants, 178 (84.8%) were males and the rest were females. The average age of the studied patients was 39.56 years old. The study found that 6.1% of methadone-poisoned patients were illiterate. It was found in this study that the most common cardiac complications of methadone intoxication were sinus tachycardia (20%), QT interval prolongation (6.64%), and sinus bradycardia (4.3%), respectively; nevertheless, 66.2% of patients did not have any EKG abnormalities. Conclusion According to the findings, it is necessary to have continuous cardiac monitoring for patients with methadone intoxication and by transferring such findings to medical centers, steps can be taken to use methadone more intelligently.
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Affiliation(s)
- Seyed Kazem Taheri
- Department of Forensic Medicine and Toxicology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran,Correspondence: Seyed Kazem Taheri, Poisoning Ward, Farshchian Hospital, Mirzadeheshghi Ave. Hamadan, Iran. E-mail: , Tel: +98 8138274191
| | - Rashed Bawand
- School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Farid Sanginabadi
- School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Nakisa Khansari
- Department of Cardiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Abbas Moradi
- Department of Community Medicine, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
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10
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Arab Y, Choueiter N, Dahdah N, El-Kholy N, Abu Al-Saoud SY, Abu-Shukair ME, Agha HM, Al-Saloos H, Al Senaidi KS, Alzyoud R, Bouaziz A, Boukari R, El Ganzoury MM, Elmarsafawy HM, ELrugige N, Fitouri Z, Ladj MS, Mouawad P, Salih AF, Rojas RG, Harahsheh AS. Kawasaki Disease Arab Initiative [Kawarabi]: Establishment and Results of a Multicenter Survey. Pediatr Cardiol 2022; 43:1239-1246. [PMID: 35624313 PMCID: PMC9140321 DOI: 10.1007/s00246-022-02844-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 02/03/2022] [Indexed: 11/13/2022]
Abstract
Studies on Kawasaki disease (KD) in Arab countries are scarce, often providing incomplete data. This along with the benefits of multicenter research collaboratives led to the creation of the KD Arab Initiative [Kawarabi] consortium. An anonymous survey was completed among potential collaborative Arab medical institutions to assess burden of KD in those countries and resources available to physicians. An online 32-item survey was distributed to participating institutions after conducting face validity. One survey per institution was collected. Nineteen physicians from 12 countries completed the survey representing 19 out of 20 institutions (response rate of 95%). Fifteen (79%) institutions referred to the 2017 American Heart Association guidelines when managing a patient with KD. Intravenous immunoglobulin (IVIG) is not readily available at 2 institutions (11%) yet available in the country. In one center (5%), IVIG is imported on-demand. The knowledge and awareness among countries' general population was graded (0 to 10) at median/interquartiles (IQR) 3 (2-5) and at median/IQR 7 (6-8) in the medical community outside their institution. Practice variations in KD management and treatment across Arab countries require solid proactive collaboration. The low awareness and knowledge estimates about KD among the general population contrasted with a high level among the medical community. The Kawarabi collaborative will offer a platform to assess disease burden of KD, among Arab population, decrease practice variation and foster population-based knowledge.
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Affiliation(s)
- Yousra Arab
- University of Sherbrooke, Sherbrooke, QC Canada
| | - Nadine Choueiter
- Department of Pediatrics, Albert Einstein College of Medicine, Children’s Hospital at Montefiore, 3415 Bainbridge Ave, Bronx, NY 10467 USA
| | - Nagib Dahdah
- Division of Pediatric Cardiology, CHU Ste-Justine, Université de Montréal, 3175 Côte Sainte-Catherine, Montreal, QC H3T 1C5 Canada
| | - Nermeen El-Kholy
- Pediatric Cardiology Department, AlJalila Children’s Specialty Hospital, Dubai, United Arab Emirates
- Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Sima Y. Abu Al-Saoud
- Department of Pediatrics, Makassed Hospital, Faculty of Medicine, Al- Quds University, East-Jerusalem, Palestine
| | | | - Hala M. Agha
- Pediatric Cardiology Division, Cairo University, Cairo, Egypt
| | - Hesham Al-Saloos
- Division of Cardiology, Sidra Medicine, Doha, Qatar
- Clinical Pediatrics, Weill Cornell Medicine, Doha, Qatar
| | | | - Raed Alzyoud
- Pediatric Immunology, Allergy, and Rheumatology Division, Queen Rania Children’s Hospital, Amman, Jordan
| | - Asma Bouaziz
- Headmaster of Children and Neonatal Department, Hôpital Régional, Ben Arous, Tunisia
| | - Rachida Boukari
- Pediatric Department, University Hospital Mustapha Bacha, Algiers University, Algiers, Algeria
| | - Mona M. El Ganzoury
- Pediatric Cardiology Division, Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hala M. Elmarsafawy
- Pediatric Cardiology Division, Children Hospital, Mansoura University, Mansoura, Egypt
| | - Najat ELrugige
- Pediatric Cardiology Department, Benghazi Children Hospital, Faculty of Medicine, Benghazi University, Benghazi, Libya
| | - Zohra Fitouri
- Unit of Rheumatology, Emergency and Outpatient Department, Pediatric Hospital of Béchir Hamza of Tunis, University Tunis El Manar, 1007 Djebel Lakhedher Bab Saadoun, Tunis, Tunisia
| | - Mohamed S. Ladj
- Pediatric Department, Djillali Belkhenchir University Hospital, Algiers, Algeria
- Faculty of Medicine, Algiers University, Algiers, Algeria
| | - Pierre Mouawad
- Pediatric Department, Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Aso F. Salih
- Pediatric Cardiology Department/Children’s Heart Hospital- Sulaimani College of Medicine- Sulaimani University, Al-Sulaimaniyah, Iraq
| | - Rocio G. Rojas
- Clinical Research Program, Division of Pediatric Cardiology, CHU Sainte-Justine, Montreal, QC H3T 1C5 Canada
| | - Ashraf S. Harahsheh
- Division of Cardiology, Department of Pediatrics, Children’s National Hospital, George Washington University School of Medicine & Health Sciences, 111 Michigan Ave, NW, Washington, DC 20010 USA
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11
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Chu JY, Kaliwal Y, Koh M, Chen R, Chow CM, Ko DT, Liu PP, Moe GW. COVID-19 and its Cardiac and Neurological Complications among Ontario Visible Minorities. Can J Neurol Sci 2022; 49:504-513. [PMID: 34162448 PMCID: PMC8365110 DOI: 10.1017/cjn.2021.148] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 06/19/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Due to lack of data on the epidemiology, cardiac, and neurological complications among Ontario visible minorities (Chinese and South Asians) affected by coronavirus disease (COVID-19), this population-based retrospective study was undertaken to study them systematically. METHODS From January 1, 2020 to September 30, 2020 using the last name algorithm to identify Ontario Chinese and South Asians who were tested positive by PCR for COVID-19, their demographics, cardiac, and neurological complications including hospitalization and emergency visit rates were analyzed compared to the general population. RESULTS Chinese (N = 1,186) with COVID-19 were found to be older (mean age 50.7 years) compared to the general population (N = 42,547) (mean age 47.6 years) (p < 0.001), while South Asians (N = 3,459) were younger (age of 42.1 years) (p < 0.001). The 30-day crude rate for cardiac complications among Chinese was 169/10,000 (p = 0.069), while for South Asians, it was 64/10,000 (p = 0.008) and, for the general population, it was 112/10,000. For neurological complications, the 30-day crude rate for Chinese was 160/10,000 (p < 0.001); South Asians was 40/10,000 (p = 0.526), and general population was 48/10,000. The 30-day all-cause mortality rate was significantly higher for Chinese at 8.1% vs 5.0% for the general population (p < 0.001), while it was lower in South Asians at 2.1% (p < 0.001). CONCLUSIONS Chinese and South Asians in Ontario affected by COVID-19 during the first wave of the pandemic were found to have a significant difference in their demographics, cardiac, and neurological outcomes.
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Affiliation(s)
- Joseph Y. Chu
- Division of Neurology, Department of Medicine, Toronto Western Hospital-University Health Network and William Osler Health System, University of Toronto, Toronto, Canada
| | | | | | - Robert Chen
- Krembil Research Institute, University Health Network and Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Chi-Ming Chow
- Division of Cardiology, Department of Medicine, St. Michael’s Hospital, University of Toronto, Toronto, Canada
| | - Dennis T. Ko
- ICES, Toronto, Canada
- Schulich Heart Program, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, Canada
| | - Peter P. Liu
- University of Ottawa Heart Institute and Department of Medicine and Cellular & Molecular Medicine, University of Ottawa and Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Gordon W. Moe
- Division of Cardiology, Department of Medicine, St. Michael’s Hospital, University of Toronto, Toronto, Canada
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12
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Kvarda P, Puelacher C, Clauss M, Kuehl R, Gerhard H, Mueller C, Morgenstern M. Perioperative myocardial injury and mortality after revision surgery for orthopaedic device-related infection. Bone Joint J 2022; 104-B:696-702. [PMID: 35638215 DOI: 10.1302/0301-620x.104b6.bjj-2021-1486.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Periprosthetic joint infections (PJIs) and fracture-related infections (FRIs) are associated with a significant risk of adverse events. However, there is a paucity of data on cardiac complications following revision surgery for PJI and FRI and how they impact overall mortality. Therefore, this study aimed to investigate the risk of perioperative myocardial injury (PMI) and mortality in this patient cohort. METHODS We prospectively included consecutive patients at high cardiovascular risk (defined as age ≥ 45 years with pre-existing coronary, peripheral, or cerebrovascular artery disease, or any patient aged ≥ 65 years, plus a postoperative hospital stay of > 24 hours) undergoing septic or aseptic major orthopaedic surgery between July 2014 and October 2016. All patients received a systematic screening to reliably detect PMI, using serial measurements of high-sensitivity cardiac troponin T. All-cause mortality was assessed at one year. Multivariable logistic regression models were applied to compare incidence of PMI and mortality between patients undergoing septic revision surgery for PJI or FRI, and patients receiving aseptic major bone and joint surgery. RESULTS In total, 911 consecutive patients were included. The overall perioperative myocardial injury (PMI) rate was 15.4% (n = 140). Septic revision surgery for PJI was associated with a significantly higher PMI rate (43.8% (14/32) vs 14.5% (57/393); p = 0.001) and one-year mortality rate (18.6% (6/32) vs 7.4% (29/393); p = 0.038) compared to aseptic revision or primary arthroplasty. The association with PMI persisted in multivariable analysis with an adjusted odds ratio (aOR) of 4.7 (95% confidence interval (CI) 2.1 to 10.7; p < 0.001), but was not statistically significant for one-year mortality (aOR 1.9 (95% CI 0.7 to 5.4; p = 0.240). PMI rate (15.2% (5/33) vs 14.1% (64/453)) and one-year mortality (15.2% (5/33) vs 9.1% (41/453)) after FRI revision surgery were comparable to aseptic long-bone fracture surgery. CONCLUSION Patients undergoing revision surgery for PJI were at a risk of PMI and death compared to those undergoing aseptic arthroplasty surgery. Screening for PMI and treatment in specialized multidisciplinary units should be considered in major bone and joint infections. Cite this article: Bone Joint J 2022;104-B(6):696-702.
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Affiliation(s)
- Peter Kvarda
- Center for Musculoskeletal Infections, University Hospital Basel, Basel, Switzerland.,Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Christian Puelacher
- University of Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Martin Clauss
- Center for Musculoskeletal Infections, University Hospital Basel, Basel, Switzerland.,Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Richard Kuehl
- University of Basel, Basel, Switzerland.,Department of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Hatice Gerhard
- University of Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Christian Mueller
- University of Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Mario Morgenstern
- Center for Musculoskeletal Infections, University Hospital Basel, Basel, Switzerland.,Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Basel, Switzerland.,University of Basel, Basel, Switzerland
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13
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Gerardin JF, Cohen S. Counseling for Perinatal Outcomes in Women with Congenital Heart Disease. Clin Perinatol 2022; 49:43-53. [PMID: 35210008 DOI: 10.1016/j.clp.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
As the adult congenital heart disease population grows, more women are reaching childbearing age. Women with moderate to complex congenital heart disease have an increased risk of morbidity and mortality than the general population. There is increased risk of prematurity and intrauterine growth restriction in infants. Regular preconceptual adult congenital heart disease care, contraception counseling, and multidisciplinary care during a pregnancy can help minimize the risk during pregnancy for both mother and baby.
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Affiliation(s)
- Jennifer F Gerardin
- Department of Internal Medicine, Division of Cardiovascular Medicine, Medical College of Wisconsin, 8915 W. Connell Ct, PO Box 1997, Milwaukee, WI 53226, USA; Department of Pediatrics, Division of Pediatric Cardiology, Medical College of Wisconsin, 8915 W. Connell Ct, PO Box 1997, Milwaukee, WI 53226, USA
| | - Scott Cohen
- Department of Internal Medicine, Division of Cardiovascular Medicine, Medical College of Wisconsin, 8915 W. Connell Ct, PO Box 1997, Milwaukee, WI 53226, USA; Department of Pediatrics, Division of Pediatric Cardiology, Medical College of Wisconsin, 8915 W. Connell Ct, PO Box 1997, Milwaukee, WI 53226, USA.
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14
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Errahmani MY, Thariat J, Ferrières J, Panh L, Locquet M, Lapeyre-Mestre M, Guernec G, Bernier MO, Boveda S, Jacob S. Risk of pacemaker implantation after radiotherapy for breast cancer: A study based on French nationwide health care database sample. Int J Cardiol Heart Vasc 2022; 38:100936. [PMID: 35005214 PMCID: PMC8717594 DOI: 10.1016/j.ijcha.2021.100936] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 12/19/2021] [Indexed: 11/12/2022]
Abstract
Background Among cardiac complications of breast cancer radiotherapy (BC RT), there are very limited data on arrhythmia and conduction disorders, in particular severe cases requiring permanent pacemaker implantation (PPMI). Therefore, this exploratory study aimed to evaluate the risk of PPMI for BC patients treated with RT, compared with the general population and with BC patients not treated with RT. Methods The study was performed on a 1/97 representative sample of the French health care database (EGB database). Adult women with a first BC treated with or without RT between 2008 and 2016 were included, followed until 2018, and de novo PPMI were identified. We compared the PPMI incidence in BC cohort relative to the general population with standardized incidence ratio (SIR) and evaluated the risk of PPMI in RT patients compared to patients without RT with a competing risk survival analysis. Results A total of 3853 BCE patients were included. Among BC patients treated with RT, 28 PPMI cases were observed compared with 13 expected cases, corresponding to a SIR of 2.18 [95% CI: 1.45-3.06]. For BC patients not treated with RT, the SIR was 1.01 [95% CI: 0.40-1.90]. Patients treated with RT showed a borderline significant higher risk of PPMI compared with those not treated with RT (subdistribution Hazard Ratio = 2.08, 95% CI 0.87-4.97, p = 0.09). Conclusions Our exploratory findings indicate that, over the last decade in France, BC patients treated with RT appeared to be at higher risk of PPMI than general population. Further studies are needed to expand on this topic.
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Affiliation(s)
- M Y Errahmani
- Laboratory of Epidemiology, Institute for Radiation Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France.,University Paris-Saclay, Gif-sur-Yvette, France
| | - J Thariat
- Department of Radiotherapy, Centre de Lutte Contre le Cancer A. Baclesse, University of Caen Normandie, Caen, France
| | - J Ferrières
- INSERM, UMR 1295 - CERPOP Centre d'Epidémiologie et de Recherche en santé des POPulations, Toulouse, France.,Department of Cardiology, Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - L Panh
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
| | - M Locquet
- Laboratory of Epidemiology, Institute for Radiation Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | - M Lapeyre-Mestre
- Department of Medical and Clinical Pharmacology, CIC 1436, University of Toulouse 3, Toulouse, France
| | - G Guernec
- INSERM, UMR 1295 - CERPOP Centre d'Epidémiologie et de Recherche en santé des POPulations, Toulouse, France
| | - M O Bernier
- Laboratory of Epidemiology, Institute for Radiation Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | - S Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
| | - S Jacob
- Laboratory of Epidemiology, Institute for Radiation Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
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15
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Heller SR, Geybels MS, Iqbal A, Liu L, Wagner L, Chow E. A higher non-severe hypoglycaemia rate is associated with an increased risk of subsequent severe hypoglycaemia and major adverse cardiovascular events in individuals with type 2 diabetes in the LEADER study. Diabetologia 2022; 65:55-64. [PMID: 34704120 PMCID: PMC8660716 DOI: 10.1007/s00125-021-05556-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 07/05/2021] [Indexed: 11/06/2022]
Abstract
AIMS/HYPOTHESIS Hypoglycaemia is a common side effect of insulin and some other antihyperglycaemic agents used to treat diabetes. Severe hypoglycaemia has been associated with adverse cardiovascular events in trials of intensive glycaemic control in type 2 diabetes. The relationship between non-severe hypoglycaemic episodes (NSHEs) and severe hypoglycaemia in type 2 diabetes has been documented. However, an association between more frequent NSHEs and cardiovascular events has not been verified. This post hoc analysis of the LEADER (Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results) trial aimed to confirm whether there is an association between NSHEs and severe hypoglycaemic episodes in individuals with type 2 diabetes. In addition, the possible association between NSHEs and major adverse cardiac events (MACE), cardiovascular death and all-cause mortality was investigated. METHODS LEADER was a double-blind, multicentre, placebo-controlled trial that found that liraglutide significantly reduced the risk of MACE compared with the placebo. In this post hoc analysis, we explored, in all LEADER participants, whether the annual rate of NSHEs (defined as self-measured plasma glucose <3.1 mmol/l [56 mg/dl]) was associated with time to first severe hypoglycaemic episode (defined as an episode requiring the assistance of another person), time to first MACE, time to cardiovascular death and time to all-cause mortality. Participants with <2 NSHEs per year were used as reference for HR estimates. Cox regression with a time-varying covariate was used. RESULTS We demonstrate that there is an association between NSHEs (2-11 NSHEs per year and ≥12 NSHEs per year) and severe hypoglycaemic episodes (unadjusted HRs 1.98 [95% CI 1.43, 2.75] and 5.01 [95% CI 2.84, 8.84], respectively), which was consistent when baseline characteristics were accounted for. Additionally, while no association was found between participants with 2-11 NSHEs per year and adverse cardiovascular outcomes, higher rates of NSHEs (≥12 episodes per year) were associated with higher risk of MACE (HR 1.50 [95% CI 1.01, 2.23]), cardiovascular death (HR 2.08 [95% CI 1.17, 3.70]) and overall death (HR 1.80 [95% CI 1.11, 2.92]). CONCLUSIONS/INTERPRETATION The analysis of data from the LEADER trial demonstrated that higher rates of NSHEs were associated with both a higher risk of severe hypoglycaemia and adverse cardiovascular outcomes in individuals with type 2 diabetes. Therefore, irrespective of the cause of this association, it is important that individuals with high rates of hypoglycaemia are identified so that the potentially increased risk of cardiovascular events can be managed and steps can be taken to reduce NSHEs. TRIAL REGISTRATION ClinicalTrials.gov (NCT01179048).
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Affiliation(s)
- Simon R Heller
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.
| | | | - Ahmed Iqbal
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Lei Liu
- Novo Nordisk A/S, Søborg, Denmark
| | | | - Elaine Chow
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
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16
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Ramadan MS, Bertolino L, Marrazzo T, Florio MT, Durante-Mangoni E. Cardiac complications during the active phase of COVID-19: review of the current evidence. Intern Emerg Med 2021; 16:2051-2061. [PMID: 34046852 PMCID: PMC8158084 DOI: 10.1007/s11739-021-02763-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/12/2021] [Indexed: 12/15/2022]
Abstract
Growing reports since the beginning of the pandemic and till date describe increased rates of cardiac complications (CC) in the active phase of coronavirus disease 2019 (COVID-19). CC commonly observed include myocarditis/myocardial injury, arrhythmias and heart failure, with an incidence reaching about a quarter of hospitalized patients in some reports. The increased incidence of CC raise questions about the possible heightened susceptibility of patients with cardiac disease to develop severe COVID-19, and whether the virus itself is involved in the pathogenesis of CC. The wide array of CC seems to stem from multiple mechanisms, including the ability of the virus to directly enter cardiomyocytes, and to indirectly damage the heart through systemic hyperinflammatory and hypercoagulable states, endothelial injury of the coronary arteries and hypoxemia. The induced CC seem to dramatically impact the prognosis of COVID-19, with some studies suggesting over 50% mortality rates with myocardial damage, up from ~ 5% overall mortality of COVID-19 alone. Thus, it is particularly important to investigate the relation between COVID-19 and heart disease, given the major effect on morbidity and mortality, aiming at early detection and improving patient care and outcomes. In this article, we review the growing body of published data on the topic to provide the reader with a comprehensive and robust description of the available evidence and its implication for clinical practice.
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Affiliation(s)
- Mohammad Said Ramadan
- Department of Precision Medicine, University of Campania 'L. Vanvitelli' and Unit of Infectious and Transplant Medicine, AORN Ospedali Dei Colli-Monaldi Hospital, Piazzale E. Ruggieri, 80131, Napoli, Italy
| | - Lorenzo Bertolino
- Department of Precision Medicine, University of Campania 'L. Vanvitelli' and Unit of Infectious and Transplant Medicine, AORN Ospedali Dei Colli-Monaldi Hospital, Piazzale E. Ruggieri, 80131, Napoli, Italy
| | - Tommaso Marrazzo
- Department of Precision Medicine, University of Campania 'L. Vanvitelli' and Unit of Infectious and Transplant Medicine, AORN Ospedali Dei Colli-Monaldi Hospital, Piazzale E. Ruggieri, 80131, Napoli, Italy
| | - Maria Teresa Florio
- Department of Precision Medicine, University of Campania 'L. Vanvitelli' and Unit of Infectious and Transplant Medicine, AORN Ospedali Dei Colli-Monaldi Hospital, Piazzale E. Ruggieri, 80131, Napoli, Italy
| | - Emanuele Durante-Mangoni
- Department of Precision Medicine, University of Campania 'L. Vanvitelli' and Unit of Infectious and Transplant Medicine, AORN Ospedali Dei Colli-Monaldi Hospital, Piazzale E. Ruggieri, 80131, Napoli, Italy.
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17
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Le HQ, Nguyen NTT, Vo TNA, Van Nguyen T, Do KTN, Ho TTC, Nguyen SN, Phan XT, Nguyen DLM, Kieu DN, Ngo HD, Warrell DA. Envenoming by king cobras (Ophiophagus hannah) in Vietnam with cardiac complications and necrotizing fasciitis. Toxicon 2021; 200:127-133. [PMID: 34302855 DOI: 10.1016/j.toxicon.2021.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/08/2021] [Accepted: 07/12/2021] [Indexed: 11/18/2022]
Abstract
King Cobra (Ophiophagus hannah) bite is well-known for its potentially fatal neurotoxicity. However, fatalities still occur, despite specific antivenom and respiratory support. Cardiovascular disturbances, which have attracted little attention in published reports of O. hannah envenoming, could contribute to fatality. We present two cases of confirmed O. hannah envenoming in Southern Vietnam in which there were cardiac abnormalities including arrhythmias and electrocardiographic changes, as well as elevated markers of myocardial damage. Cardiac pacing was required. One patient developed critical multi-organ dysfunctions partly explained by extensive necrotizing fasciitis/myositis originating from an Aeromonas sobria wound infection. This resulted in rhabdomyolysis, disseminated intravascular coagulation and acute kidney injury. Specific antivenom reversed neurotoxic effects of envenoming. Additional therapeutic interventions included antibiotics, surgical debridement, continuous renal replacement therapy and therapeutic plasma exchange. Both patients eventually made full recoveries. Apart from the critical problem of rapidly evolving and severe neurotoxicity, our case reports also emphasises the risk of cardiotoxic envenoming, and the complications of an overwhelming secondary bacterial wound infection. We suggest a practical approach to diagnosis and management.
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Affiliation(s)
- Hung Quoc Le
- Department of Tropical Diseases, Cho Ray Hospital, 201B Nguyen Chi Thanh, District 5, Ho Chi Minh City, Viet Nam
| | - Ngan Thi Thuy Nguyen
- Department of Tropical Diseases, Cho Ray Hospital, 201B Nguyen Chi Thanh, District 5, Ho Chi Minh City, Viet Nam; Oxford University Clinical Research Unit, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Viet Nam.
| | - Tho Ngoc Anh Vo
- Department of Tropical Diseases, Cho Ray Hospital, 201B Nguyen Chi Thanh, District 5, Ho Chi Minh City, Viet Nam
| | - Thuan Van Nguyen
- Department of Tropical Diseases, Cho Ray Hospital, 201B Nguyen Chi Thanh, District 5, Ho Chi Minh City, Viet Nam
| | - Khanh Thi Ngoc Do
- Department of Tropical Diseases, Cho Ray Hospital, 201B Nguyen Chi Thanh, District 5, Ho Chi Minh City, Viet Nam
| | - Thanh Thi Chi Ho
- Department of Tropical Diseases, Cho Ray Hospital, 201B Nguyen Chi Thanh, District 5, Ho Chi Minh City, Viet Nam
| | - Sang Ngoc Nguyen
- Department of Tropical Diseases, Cho Ray Hospital, 201B Nguyen Chi Thanh, District 5, Ho Chi Minh City, Viet Nam
| | - Xuan Thi Phan
- Central Intensive Care Unit, Cho Ray Hospital, 201B Nguyen Chi Thanh, District 5, Ho Chi Minh City, Viet Nam
| | - Duy Ly Minh Nguyen
- Central Intensive Care Unit, Cho Ray Hospital, 201B Nguyen Chi Thanh, District 5, Ho Chi Minh City, Viet Nam
| | - Dung Ngoc Kieu
- Department of Arrhythmia, Cho Ray Hospital, 201B Nguyen Chi Thanh, District 5, Ho Chi Minh City, Viet Nam
| | - Hiep Duc Ngo
- Department of Burn and Plastic Surgery, Cho Ray Hospital, 201B Nguyen Chi Thanh, District 5, Ho Chi Minh City, Viet Nam
| | - David A Warrell
- Nuffield Department of Clinical Medicine, University of Oxford, UK
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18
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Sheikh M, Ostadrahimi P, Salarzaei M, Parooie F. Cardiac Complications in Pregnancy: A Systematic Review and Meta-Analysis of Diagnostic Accuracy of BNP and N-Terminal Pro-BNP. Cardiol Ther 2021; 10:501-514. [PMID: 34213737 PMCID: PMC8555044 DOI: 10.1007/s40119-021-00230-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/12/2021] [Indexed: 01/22/2023] Open
Abstract
Introduction Serum brain-type natriuretic peptide (BNP) levels may be involved in detecting the breakdown of defense mechanisms in pregnant women. BNP and N-terminal pro-BNP (NT-proBNP) levels can be used in emergency settings as a biomarker to rule out or confirm cardiac complications. The present study was conducted as an attempt to evaluate the performance of BNP and NT-proBNP as diagnostic tools for cardiac complications, including heart failure and pre-eclampsia, in pregnant and recently-delivered women. Methods This meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. To extract the data, articles meeting the inclusion criteria were directly reviewed by two of the authors. Disputes were resolved through discussion with all authors before data mining. In cases of unresolved disagreement, a third reviewer was consulted to achieve consensus. A quantitative analysis of the total bias of publications was performed using Stata software version 14.0, using funnel plots and Deek’s test. Results Overall, 13 unique studies were included in this review. The pooled sensitivity, specificity and positive and negative predictive values for diagnosing cardiac complications in pregnant women when BNP level was ≤ 100 ng/L, were determined to be 95, 62, 71 and 91%, respectively. The corresponding measures when the BNP levels were 100–500 ng/L were calculated to be 98, 92, 97 and 92%, respectively. The pooled sensitivity, specificity and positive and negative predictive values for diagnosing cardiac complications in pregnant women using NT-proBNP were 78, 74, 20.5 and 97%, respectively. Conclusion Our results suggest that both BNP and NT-proBNP levels can be used as diagnostic tools among pregnant and newly-delivered women to diagnose cardiac complications, including heart failure and pre-eclampsia. While BNP showed a relatively better diagnostic accuracy compared to NT-proBNP, it must be noted that the number of studies evaluating NT-proBNP included in this meta-analysis was low and the studies were inconsistent in terms of cutoff value. Further studies are required to confirm the prospective use of BNP and NT-pro BNP in assessing common symptoms that indicate cardiac complications during labor. Moreover, the clinical use of the NT-proBNP test in this field requires further study.
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Affiliation(s)
- Mahboobeh Sheikh
- Department of Cardiology, Faculty of Medicine, Zabol University of Medical Sciences, Zabol, Iran
| | - Pouya Ostadrahimi
- Faculty of Medicine, Zabol University of Medical Sciences, Zabol, Iran.
| | - Morteza Salarzaei
- Faculty of Medicine, Zabol University of Medical Sciences, Zabol, Iran
| | - Fateme Parooie
- Faculty of Medicine, Zabol University of Medical Sciences, Zabol, Iran
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19
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Wu HY, Cao YW, Gao TJ, Fu JL, Liang L. Pheochromocytoma in a 49-year-old woman presenting with acute myocardial infarction: A case report. World J Clin Cases 2021; 9:3752-3757. [PMID: 34046479 PMCID: PMC8130096 DOI: 10.12998/wjcc.v9.i15.3752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/15/2021] [Accepted: 03/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pheochromocytoma is a rare endocrine tumor arising from chromaffin cells and having extensive and profound effects on the cardiovascular system by continuously or intermittently releasing catecholamines. The clinical manifestations of pheochromocytoma are diverse, and the typical triad, including episodic headache, palpitations, and sweating, only occurs in 24% of pheochromocytoma patients, which often misleads clinicians into making an incorrect diagnosis. We herein report the case of a patient with intermittent chest pain and elevated myocardial enzymes for 2 years who was diagnosed with pheochromocytoma.
CASE SUMMARY A 49-year-old woman presented with intermittent chest pain for 2 years. Two years ago, the patient experienced chest pain and was diagnosed with acute myocardial infarction, with 25% stenosis in the left circumflex. The patient still had intermittent chest pain after discharge. Two hours before admission to our hospital, the patient experienced chest pain with nausea and vomiting, lasting for 20 min. Troponin I and urinary norepinephrine and catecholamine levels were elevated. An electrocardiogram indicated QT prolongation and ST-segment depression in leads II, III, aVF, and V3-V6. A coronary computed tomography angiogram revealed no evidence of coronary artery disease. Echocardiography showed left ventricular enlargement and a decreased posterior inferior wall motion amplitude. Contrast-enhanced computed tomography demonstrated an inhomogeneous right adrenal mass. The patient successfully underwent laparoscopic right adrenalectomy, and histopathology confirmed adrenal pheochromocytoma. During the first-year follow-up visits, the patient was asymptomatic. The abnormal changes on echocardiography and electrocardiogram disappeared.
CONCLUSION Clinicians should be aware of pheochromocytoma. A timely and accurate diagnosis of pheochromocytoma is essential for alleviating serious cardiac complications.
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Affiliation(s)
- Hao-Yu Wu
- Department of Cardiology, Shaanxi Provincial People’s Hospital, Xi'an 710068, Shaanxi Province, China
| | - Yi-Wei Cao
- Department of Electrocardiology, Shaanxi Provincial People’s Hospital, Xi'an 710068, Shaanxi Province, China
| | - Tian-Jiao Gao
- Department of Gastroenterology, Xi’an Children’s Hospital, Xi'an 710068, Shaanxi Province, China
| | - Jian-Li Fu
- Ultrasonic Diagnosis Center, Shaanxi Provincial People’s Hospital, Xi’an 710068, Shaanxi Province, China
| | - Lei Liang
- Department of Cardiology, Shaanxi Provincial People’s Hospital, Xi'an 710068, Shaanxi Province, China
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20
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Haybar H, Maniati M, Saki N, Zayeri ZD. COVID-19: imbalance of multiple systems during infection and importance of therapeutic choice and dosing of cardiac and anti-coagulant therapies. Mol Biol Rep 2021; 48:2917-28. [PMID: 33837899 DOI: 10.1007/s11033-021-06333-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/01/2021] [Indexed: 12/26/2022]
Abstract
The renin-angiotensin-aldosterone system and its metabolites play an important role in homeostasis of body, especially the cardiovascular system. In this study, we discuss the imbalance of multiple systems during the infection and the importance of therapeutic choice, dosing, and laboratory monitoring of cardiac and anti-coagulant therapies in COVID-19 patients. The crosstalk between angiotensin, kinin-kallikrein system, as well as inflammatory and coagulation systems plays an essential role in COVID-19. Cardiac complications and coagulopathies imply the crosstalks between the mentioned systems. We believe that the blockage of bradykinin can be a good option in the management of COVID-19 and CVD in patients and that supportive treatment of respiratory and cardiologic complications is needed in COVID-19 patients. Ninety-one percent of COVID-19 patients who were admitted to hospital with a prolonged aPTT were positive for lupus anticoagulant, which increases the risk of thrombosis and prolonged aPTT. Therefore, the question that is posed at this juncture is whether it is safe to use the prophylactic dose of heparin particularly in those with elevated D-dimer levels. It should be noted that timing is of high importance in anti-coagulant therapy; therefore, we should consider the level of D-dimer, fibrinogen, drug-drug interactions, and risk factors during thromboprophylaxis administration. Fibrinogen is an independent predictor of resistance to heparin and should be considered before thromboprophylaxis. Alteplase and Futhan might be a good choice to assess the condition of heparin resistance. Finally, the treatment option, dosing, and laboratory monitoring of anticoagulant therapy are critical decisions in COVID-19 patients.
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21
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Devaraj SM, Kriska AM, Orchard TJ, Miller RG, Costacou T. Cardiovascular health in early adulthood predicts the development of coronary heart disease in individuals with type 1 diabetes: 25 year follow-up from the Pittsburgh Epidemiology of Diabetes Complications study. Diabetologia 2021; 64:571-580. [PMID: 33190165 PMCID: PMC7867591 DOI: 10.1007/s00125-020-05328-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 10/01/2020] [Indexed: 12/19/2022]
Abstract
AIMS/HYPOTHESIS Type 1 diabetes increases CHD risk. We examined the use of the American Heart Association's cardiovascular health metrics (blood pressure, total cholesterol, glucose/HbA1c, BMI, physical activity, diet, smoking) to predict incidence of CHD among individuals with type 1 diabetes, with the hypothesis that a better American Heart Association health metric profile would be associated with lower incident CHD. METHODS Prevalence of the seven cardiovascular health metrics was determined using first and second visits from adult participants (mean age 28.6 years) in the Epidemiology of Diabetes Complications prospective cohort study of childhood-onset type 1 diabetes. An ideal metric score (0-7) was defined as the sum of all metrics within the ideal range, and a total metric score (0-14) was calculated based on poor, intermediate and ideal categories for each metric. Incident CHD development (medical record-confirmed CHD death, myocardial infarction, revascularisation, ischaemic electrocardiogram changes or Epidemiology of Diabetes Complications physician-determined angina) over 25 years of follow-up was examined by metric scores. RESULTS Among 435 participants, BMI, blood pressure, total cholesterol and smoking demonstrated the highest prevalence within the ideal range, while diet and HbA1c demonstrated the lowest. During 25 years of follow-up, 177 participants developed CHD. In Cox models, each additional metric within the ideal range was associated with a 19% lower risk (p = 0.01), and each unit increase in total metric score was associated with a 17% lower risk (p < 0.01) of CHD, adjusting for diabetes duration, estimated glomerular filtration rate, albumin excretion rate, triacylglycerols, depression and white blood cell count. CONCLUSIONS/INTERPRETATION Among individuals with type 1 diabetes, higher cardiovascular health metric scores were associated with lower risk of incident CHD. The American Heart Association-defined cardiovascular health metrics provide straightforward goals for health promotion that may reduce CHD risk in the type 1 diabetes population. Graphical abstract.
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Affiliation(s)
- Susan M Devaraj
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Andrea M Kriska
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Trevor J Orchard
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rachel G Miller
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tina Costacou
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA.
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22
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Arabi M, Nasab SH, Lorigooini Z, Boroujeni SN, Mortazavi SM, Anjomshoa M, Amini-Khoei H. Auraptene exerts protective effects on maternal separation stress-induced changes in behavior, hippocampus, heart and serum of mice. Int Immunopharmacol 2021; 93:107436. [PMID: 33556667 DOI: 10.1016/j.intimp.2021.107436] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/14/2021] [Accepted: 01/24/2021] [Indexed: 11/25/2022]
Abstract
Early life stress is associated with various complications. Auraptene has significant antioxidant and anti-inflammatory effects. This study aimed to assess the probable underlying mechanisms that mediate changes in the behavior, hippocampus, heart and serum in the mouse model of maternal separation (MS) stress. We evaluated the possible protective effects of auraptene in these changes focusing on inflammatory response and oxidative state. Mice were treated with auraptene (5, 10, and 50 mg/kg). In addition, anxiety-like behaviors were evaluated using behavioral tests; including open field test (OFT) and elevated plus maze (EPM). Hippocampus and heart samples were assessed histopathologically. Levels of malondialdehyde (MDA) and antioxidant capacity, as well as nitrite levels, were measured in serum, heart, and hippocampal tissues. Moreover, gene expression of inflammatory markers (Il-1β and Tlr-4) was evaluated in the heart and hippocampus. Results showed that auraptene reversed the negative effects of MS on behavior (increased time spent in central zone of the OFT and time and entries to the open arms of the EPM). Auraptene mitigated adverse effects of MS on the hippocampus (increased diameter and decreased percentage of dark neurons in the CA3 area). Accordingly, auraptene decreased MDA and nitrite levels and increased the antioxidant capacity in serum, and hippocampal samples. However, we observed different effects for different doses of auraptene in the heart samples. We concluded that MS is associated with anxiety-like behavior and cellular/molecular modifications in the heart, hippocampus and serum. We found that auraptene exerted protective effects against these negative effects of MS in mouse.
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Affiliation(s)
- Mehran Arabi
- Department of Animal Sciences, Faculty of Basic Sciences, Shahrekord University, Shahrekord, Iran
| | - Shohreh Hosseini Nasab
- Department of Animal Sciences, Faculty of Basic Sciences, Shahrekord University, Shahrekord, Iran
| | - Zahra Lorigooini
- Medical Plants Research Center, Basic Health Sciences Institute, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Shakiba Nasiri Boroujeni
- Medical Plants Research Center, Basic Health Sciences Institute, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Seyyed Mohsen Mortazavi
- Medical Plants Research Center, Basic Health Sciences Institute, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Maryam Anjomshoa
- Medical Plants Research Center, Basic Health Sciences Institute, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Hossein Amini-Khoei
- Medical Plants Research Center, Basic Health Sciences Institute, Shahrekord University of Medical Sciences, Shahrekord, Iran.
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23
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Sahranavard M, Akhavan Rezayat A, Zamiri Bidary M, Omranzadeh A, Rohani F, Hamidi Farahani R, Hazrati E, Mousavi SH, Afshar Ardalan M, Soleiman-Meigooni S, Hosseini-Shokouh SJ, Hejripour Z, Nassireslami E, Laripour R, Salarian A, Nourmohammadi A, Mosaed R. Cardiac Complications in COVID-19: A Systematic Review and Meta-analysis. Arch Iran Med 2021; 24:152-163. [PMID: 33636985 DOI: 10.34172/aim.2021.24] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 10/28/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND The newly emerged coronavirus disease 2019 (COVID-19) seems to involve different organs, including the cardiovascular system. We systematically reviewed COVID-19 cardiac complications and calculated their pooled incidences. Secondarily, we compared the cardiac troponin I (cTnI) level between the surviving and expired patients. METHODS A systematic search was conducted for manuscripts published from December 1, 2019 to April 16, 2020. Cardiovascular complications, along with the levels of cTnI, creatine kinase (CK), and creatine kinase MB (CK-MB) in hospitalized PCR-confirmed COVID-19 patients were extracted. The pooled incidences of the extracted data were calculated, and the unadjusted cTnI level was compared between the surviving and expired patients. RESULTS Out of 1094 obtained records, 22 studies on a total of 4,157 patients were included. The pooled incidence rate of arrhythmia was 10.11%. Furthermore, myocardial injury had a pooled incidence of 17.85%, and finally, the pooled incidence for heart failure was 22.34%. The pooled incidence rates of cTnI, CK-MB, and CK elevations were also reported at 15.16%, 10.92%, and 12.99%, respectively. Moreover, the pooled level of unadjusted cTnI was significantly higher in expired cases compared with the surviving (mean difference = 31.818, 95% CI = 17.923-45.713, P value <0.001). CONCLUSION COVID-19 can affect different parts of the heart; however, the myocardium is more involved.
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Affiliation(s)
- Mehrdad Sahranavard
- Student Research Committee, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Arash Akhavan Rezayat
- Infectious Disease Research Center, AJA University of Medical Sciences, Tehran, Iran.,Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Zamiri Bidary
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Omranzadeh
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farahnaz Rohani
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ramin Hamidi Farahani
- Infectious Disease Research Center, AJA University of Medical Sciences, Tehran, Iran
| | - Ebrahim Hazrati
- Department Anesthesiology and Critical Care, AJA University of Medical Sciences, Tehran, Iran
| | - Seyyed Hossein Mousavi
- Department of Cardiology, School of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Mohamed Afshar Ardalan
- Internal Medicine Department, School of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | | | | | - Zia Hejripour
- Department of Emergency Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Ehsan Nassireslami
- Toxin Research center, AJA University of Medical Sciences, Tehran, Iran.,Department of Pharmacology and Toxicology, Faculty of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Reza Laripour
- Education Development Center, AJA University of Medical Sciences, Tehran, Iran.,Center for Educational Research in Medical Sciences, Iran University of Medical Sciences, Tehran, Iran
| | | | - Abbas Nourmohammadi
- Faculty of Aerospace and Diving Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Reza Mosaed
- Department of Clinical Pharmacy, School of Medicine, AJA University of Medical Sciences, Tehran, Iran.,Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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Cairns L, Abed El Khaleq Y, Storrar W, Scheuermann-Freestone M. COVID-19 myopericarditis with cardiac tamponade in the absence of respiratory symptoms: a case report. J Med Case Rep 2021; 15:31. [PMID: 33494822 PMCID: PMC7833446 DOI: 10.1186/s13256-020-02618-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/06/2020] [Indexed: 01/09/2023] Open
Abstract
Background Previous reports have shown various cardiac complications to be associated with COVID-19 including: myocardial infarction, microembolic complications, myocardial injury, arrythmia, heart failure, coronary vasospasm, non-ischemic cardiomyopathy, stress (Takotsubo) cardiomyopathy, pericarditis and myocarditis. These COVID-19 cardiac complications were associated with respiratory symptoms. However, our case illustrates that COVID-19 myopericarditis with cardiac tamponade can present without respiratory symptoms. Case presentation A 58-year-old Caucasian British woman was admitted with fever, diarrhoea and vomiting. She developed cardiogenic shock and Transthoracic echocardiogram (TTE) found a pericardial effusion with evidence of cardiac tamponade. A nasopharyngeal swab showed a COVID-19 positive result, despite no respiratory symptoms on presentation. A pericardial drain was inserted and vasopressor support required on intensive treatment unit (ITU). The drain was removed as she improved, an antibiotic course was given and she was discharged on day 12. Conclusions Our case demonstrates that patients without respiratory symptoms could have COVID-19 and develop cardiac complications. These findings can aid timely diagnosis of potentially life-threatening COVID-19 myopericarditis with cardiac tamponade.
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Affiliation(s)
- Lauren Cairns
- Basingstoke and North Hampshire Hospital, Hampshire Hospitals Foundation Trust, Hampshire, United Kingdom.
| | - Yazeed Abed El Khaleq
- Basingstoke and North Hampshire Hospital, Hampshire Hospitals Foundation Trust, Hampshire, United Kingdom
| | - Will Storrar
- Basingstoke and North Hampshire Hospital, Hampshire Hospitals Foundation Trust, Hampshire, United Kingdom
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van Veldhuisen SL, van Woerden G, Hemels MEW, America YGCJ, de Boer RA, Rienstra M, van Veldhuisen DJ, Hazebroek EJ. Preoperative cardiac screening using NT-proBNP in obese patients 50 years and older undergoing bariatric surgery: a study of 310 consecutive patients. Surg Obes Relat Dis 2021; 17:64-71. [PMID: 33036941 DOI: 10.1016/j.soard.2020.08.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/14/2020] [Accepted: 08/24/2020] [Indexed: 12/28/2022]
Abstract
Background Obesity is associated with cardiovascular (CV) risk factors and diseases. Because bariatric surgery is increasingly performed in relatively elderly patients, a risk for pre- and postoperative CV complications exists. Objectives We aimed to assess the value of plasma N-terminal-probrain natriuretic peptide (NT-proBNP) as a CV screening tool. Setting High-volume bariatric center. Methods Between June 2019 and January 2020, all consecutive bariatric patients 50 years and older underwent preoperative NT-proBNP assessment in this cohort study to screen for CV disease. Patients with elevated NT-proBNP (≥125 pg/mL) were referred for further cardiac evaluation, including electrocardiography and echocardiography. Results We included 310 consecutive patients (median age, 56 years; 79% female; body mass index = 43±6.5 kg/m2). A history of CV disease was present in 21% of patients, mainly atrial fibrillation (7%) and coronary artery disease (10%). A total of 72 patients (23%) had elevated NT-proBNP levels, and 67 of them underwent further cardiac workup. Of these 67 patients, electrocardiography (ECG) showed atrial fibrillation in 7 patients (10%). On echocardiography, 3 patients had left ventricular ejection fraction (LVEF) <40%, 9 patients had LVEF 40%–49%, and 13 patients had LVEF ≥50% with structural and/or functional remodeling. In 2 patients, elevated NT-proBNP prompted workup leading to a diagnosis of coronary artery disease and consequent percutaneous coronary intervention in 1 patient. Conclusions Elevated NT-proBNP levels are present in 23% of patients 50 years and older undergoing bariatric surgery. In 37% of them, there was echocardiographic evidence for structural and/or functional remodeling. Further studies are needed to assess if these preliminary results warrant routine application of NT-proBNP to identify patients at risk for CV complications after bariatric surgery. This study assessed NT-proBNP as a cardiac screening tool in bariatric patients. Elevated NT-proBNP levels were present in 23% of patients ≥50 years. In 37% of them (n=25), echocardiography showed LV dysfunction or heart failure. NT-proBNP is a non-invasive tool that can detect new CV diseases in bariatric patients
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Demertzis ZD, Dagher C, Malette KM, Fadel RA, Bradley PB, Brar I, Rabbani BT, Suleyman G. Cardiac sequelae of novel coronavirus disease 2019 (COVID-19): a clinical case series. Eur Heart J Case Rep 2020; 4:1-6. [PMID: 33089042 PMCID: PMC7314080 DOI: 10.1093/ehjcr/ytaa179] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 04/21/2020] [Accepted: 05/27/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND COVID-19 caused by severe acute respiratory syndrome coronavirus 2 most commonly manifests with fever and respiratory illness. The cardiovascular manifestations have become more prevalent but can potentially go unrecognized. We look to describe cardiac manifestations in three patients with COVID-19 using cardiac enzymes, electrocardiograms, and echocardiography. CASE SUMMARIES The first patient, a 67-year-old Caucasian female with non-ischaemic dilated cardiomyopathy, presented with dyspnoea on exertion and orthopnoea 1 week after testing positive for COVID-19. Echocardiogram revealed large pericardial effusion with findings consistent with tamponade. A pericardial drain was placed, and fluid studies were consistent with viral pericarditis, treated with colchicine, hydroxychloroquine, and methylprednisolone. Follow-up echocardiograms showed apical hypokinesis, that later resolved, consistent with Takotsubo syndrome. The second patient, a 46-year-old African American male with obesity and type 2 diabetes mellitus presented with fevers, cough, and dyspnoea due to COVID-19. Clinical course was complicated with pulseless electrical activity arrest; he was found to have D-dimer and troponin elevation, and inferior wall ST elevation on ECG concerning for STEMI due to microemboli. The patient succumbed to the illness. The third patient, a 76-year-old African American female with hypertension, presented with diarrhoea, fever, and myalgia, and was found to be COVID-19 positive. Clinical course was complicated, with acute troponin elevation, decreased cardiac index, and severe hypokinesis of the basilar wall suggestive of reverse Takotsubo syndrome. The cardiac index improved after pronation and non-STEMI therapy; however, the patient expired due to worsening respiratory status. DISCUSSION These case reports demonstrate cardiovascular manifestations of COVID-19 that required monitoring and urgent intervention.
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Affiliation(s)
| | - Carina Dagher
- Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Kelly M Malette
- Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Raef A Fadel
- Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Patrick B Bradley
- Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, USA
- Division of Pulmonary Disease, Henry Ford Hospital, Detroit, MI, USA
| | - Indira Brar
- Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, USA
- Division of Infectious Disease, Henry Ford Hospital, Detroit, MI, USA
| | - Bobak T Rabbani
- Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, USA
- Division of Cardiology, Henry Ford Hospital, Detroit, MI, USA
| | - Geehan Suleyman
- Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, USA
- Division of Infectious Disease, Henry Ford Hospital, Detroit, MI, USA
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Liao CY, Tan TL, Lu YD, Wu CT, Lee MS, Kuo FC. Does preoperative dipyridamole-thallium scanning reduce 90-day cardiac complications and 1-year mortality in patients with femoral neck fractures undergoing hemiarthroplasty? J Orthop Surg Res 2020; 15:385. [PMID: 32894146 PMCID: PMC7487939 DOI: 10.1186/s13018-020-01918-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 08/24/2020] [Indexed: 11/10/2022] Open
Abstract
Background This study aimed to evaluate the effect of dipyridamole-thallium scanning (DTS) on the rates of 90-day cardiac complications and 1-year mortality in patients with a femoral neck fracture treated with hemiarthroplasty. Methods Between 2008 and 2015, 844 consecutive patients who underwent cemented or cementless hemiarthroplasty were identified from the database of a single level-one medical center. One-hundred and thirteen patients (13%) underwent DTS prior to surgery, and 731 patients (87%) did not. Patient characteristics, comorbidities, surgical variables, and length of the delay until surgery were recorded. A propensity score-matched cohort was utilized to reduce recruitment bias in a 1:3 ratio of DTS group to control group, and multivariate logistic regression was performed to control confounding variables. Results The incidence of 90-day cardiac complications was 19.5% in the DTS group and 15.6% in the control group (p = 0.343) among 452 patients after propensity score-matching. The 1-year mortality rate (10.6% vs 13.3%, p = 0.462) was similar in the two groups. In the propensity score-matched patients, utilization of DTS was not associated with a reduction in the rate of 90-day cardiac complications (matched cohort, adjusted odds ratio [aOR] = 1.32; 95% confidence interval [CI] 0.75–2.33, p = 0.332) or the 1-year mortality rate (aOR = 0.62; 95% CI 0.27–1.42, p = 0.259). Risk factors for cardiac complications included an American Society of Anesthesiologists grade ≥ 3 (OR 3.19, 95% CI 1.44–7.08, p = 0.004) and pre-existing cardiac comorbidities (OR 5.56, 95% CI 3.35–9.25, p < 0.001). Risk factors for 1-year mortality were a long time to surgery (aOR 1.15, 95% CI 1.06–1.25, p = 0.001), a greater age (aOR 1.05, 95% CI 1.00 to 1.10, p = 0.040), a low body mass index (BMI; aOR 0.89, 95% CI 0.81–0.98, p = 0.015), and the presence of renal disease (aOR 4.43, 95% CI 1.71–11.46, p = 0.002). Discussion Preoperative DTS was not associated with reductions in the rates of 90-day cardiac complications or 1-year mortality in patients with a femoral neck fracture undergoing hemiarthroplasty. The necessity for DTS should be re-evaluated in elderly patients with femoral neck fractures, given that this increases the length of the delay until surgery. Level of evidence Prognostic level III
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Affiliation(s)
- Chin-Yi Liao
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, No. 123, Ta Pei Road, Niao Sung Dist, Kaohsiung, Taiwan
| | - Timothy L Tan
- Rothman Institute Orthopedic Research Department, Thomas Jefferson University, Rothman Institute Sheridan Building, Suite 1000, 25 S 9th Street, Philadelphia, PA, 19107, USA
| | - Yu-Der Lu
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, No. 123, Ta Pei Road, Niao Sung Dist, Kaohsiung, Taiwan
| | - Cheng-Ta Wu
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, No. 123, Ta Pei Road, Niao Sung Dist, Kaohsiung, Taiwan
| | - Mel S Lee
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, No. 123, Ta Pei Road, Niao Sung Dist, Kaohsiung, Taiwan
| | - Feng-Chih Kuo
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, No. 123, Ta Pei Road, Niao Sung Dist, Kaohsiung, Taiwan.
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Fiore A, Piscitelli M, Radu C, Folliguet T. Late cardiovascular complication after varicose vein endovascular ablation. Interact Cardiovasc Thorac Surg 2020; 30:785-787. [PMID: 31981354 DOI: 10.1093/icvts/ivz327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 11/25/2019] [Accepted: 12/08/2019] [Indexed: 11/12/2022] Open
Abstract
Venous insufficiency of the lower limbs is one of the most common vascular disorders affecting millions of people worldwide. Endovascular techniques are considered by current guidelines as simple, safe and effective. Persistence or even migration of foreign bodies after varicose vein endovascular surgery is a rare and unfeared complication. Herein, we present the case of a 39-year-old woman who underwent endoluminal treatment of varicose veins >2 years ago and she was admitted to our department for late cardiovascular complication caused by catheter or guidewire rupture and the dissemination of its fragments in the inferior vena cava, right heart chambers, liver and pulmonary arteries. A systematic verification of the length and integrity of the devices should be performed at the end of every endovascular procedure.
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Affiliation(s)
- Antonio Fiore
- Department of Cardiac Surgery, CHU Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France.,Biomechanics and Bioengineering Laboratory, UMR CNRS 7338, Université de Technologie de Compiègne, Alliance Sorbonne Université, Compiègne, France
| | - Mariantonietta Piscitelli
- Department of Cardiac Surgery, CHU Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Costin Radu
- Department of Cardiac Surgery, CHU Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Thierry Folliguet
- Department of Cardiac Surgery, CHU Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
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Hung G, Mercurio V, Hsu S, Mathai SC, Shah AA, Mukherjee M. Progress in Understanding, Diagnosing, and Managing Cardiac Complications of Systemic Sclerosis. Curr Rheumatol Rep 2019; 21:68. [PMID: 31813082 DOI: 10.1007/s11926-019-0867-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF THE REVIEW Systemic sclerosis (scleroderma) is a complex autoimmune disease that commonly involves the cardiovascular system. Even if often subclinical, cardiac involvement is considered a poor prognostic factor as it is a leading cause of death in scleroderma patients. We review the cardiac manifestations of scleroderma, the diagnostic methods useful in detection, and current advances in therapeutic management. RECENT FINDINGS Beside the routine exams for the assessment of cardiac status (including EKG, standard echocardiography, provocative tests) novel techniques such as myocardial strain imaging on echocardiography, cardiac magnetic resonance imaging, invasive hemodynamic assessment, and endomyocardial biopsy have been demonstrated to be useful in understanding the cardiac alterations that typically affect scleroderma patients. Recent application of novel cardiac detection strategies is providing increased insight into the breadth and pathogenesis of cardiac complications of scleroderma. Further studies coupling exercise provocation, invasive and imaging assessment, and mechanistic studies in scleroderma cardiac tissue are needed to develop the optimal approach to early detection of cardiac disease in scleroderma and targeted therapies.
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Affiliation(s)
- George Hung
- Division of Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Valentina Mercurio
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Steven Hsu
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Stephen C Mathai
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Ami A Shah
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 4100, Baltimore, MD, 21224, USA
| | - Monica Mukherjee
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, USA.
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Parlar-Chun R, Kakarala K, Singh M. Descriptions and outcomes of cardiac evaluations in pediatric patients hospitalized for asthma. J Asthma 2019; 57:1195-1201. [PMID: 31288567 DOI: 10.1080/02770903.2019.1642353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: Patients hospitalized for asthma can exhibit concurrent cardiac symptoms and undergo cardiac work up. We identify patients admitted for asthma that underwent cardiac workup and describe outcomes to evaluate the utility of cardiac testing in this population.Methods: Patients aged 4 to 17 years admitted for status asthmaticus from 2012 - 2016 were screened for EKG, ECHO, or cardiac enzyme obtainment.Results: Out of 1296 patients, 77 (6%) received cardiac testing. The most common reasons for testing were chest pain (25, 32%), blood pressure abnormalities (11, 14%), tachycardia (8, 10%), arrhythmia (6, 8%), and syncope (6, 8%). Sinus tachycardia (43, 66%) was the most common EKG finding. 4 out of 27 patients who underwent ECHOs had abnormalities: 2 with hypertrophic cardiomyopathy (HCM), 1 with vascular ring, and 1 with evidence of pulmonary hypertension. All patients who underwent an EKG to evaluate tachycardia had normalization of heart rate at discharge. Cardiac ischemia was not evident in any patients who underwent workup with cardiac enzymes to evaluate chest pain. All cases of arrhythmias resolved on discharge. Diastolic hypotension (DhTN) was found in 10 out of the 11 blood pressure abnormalities. There was mixed efficacy of fluid bolus in correcting DhTN. All DhTN resolved on discharge. One patient with syncope had a new diagnosis of HCM.Conclusions: While cardiac complications are seen in patients admitted for status asthmaticus, the etiology rarely stems from underlying cardiac disease. EKGs, ECHOs, and cardiac enzymes should have a minimal role in the management of the hospitalized asthmatic patient.
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Affiliation(s)
- Raymond Parlar-Chun
- Department of Pediatrics, Children's Memorial Hermann, Houston, TX, USA.,McGovern Medical School, University of Texas, Houston, TX, USA
| | - Kokila Kakarala
- Department of Pediatrics, Children's Memorial Hermann, Houston, TX, USA.,McGovern Medical School, University of Texas, Houston, TX, USA
| | - Mani Singh
- McGovern Medical School, University of Texas, Houston, TX, USA
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Galian-Gay L, Gordon B, Marsal JR, Rafecas A, Pijuan Domènech A, Castro MA, Subirana Domènech MT, Sureda C, Miranda B, Martí G, García-Dorado D, Dos Subirà L. Determinants of long-term outcome of repaired pulmonary valve stenosis. ACTA ACUST UNITED AC 2019; 73:131-138. [PMID: 31130344 DOI: 10.1016/j.rec.2019.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 02/27/2019] [Indexed: 11/15/2022]
Abstract
INTRODUCTION AND OBJECTIVES Although pulmonary valve stenosis (PVS) is considered a low risk congenital heart disease, there have been reports of complications and the need for reintervention throughout follow-up. The aims of this study were to evaluate the long-term outcome of repaired PVS and to identify predictors of cardiovascular complications and reintervention. METHODS We studied 158 adult patients with repaired PVS (repair procedures performed from 1957 to 2010) receiving active follow-up in a tertiary referral center. RESULTS A total of 95 patients (60%) received surgical treatment, and 63 patients (40%) received percutaneous pulmonary balloon valvuloplasty. At the end of follow-up (27 years, IQR, 20-33 years), most patients (n=134, 84.8%) were in New York Heart Association functional class I, but 61 patients (38.6%) required a reintervention, mainly pulmonary valve replacement (17.7%, n=28), and 19 patients (12%) had at least one cardiovascular complication: 13 (8.2%) supraventricular arrhythmias, 6 (3.8%) heart failure, 5 (3.2%) stroke, 1 (0.6%) death, 1 (0.6%) thromboembolism, and 1 (0.6%) ventricular arrhythmia. Multivariate analysis showed that age at PVS repair (HR, 1.08; 95%CI, 1.04-1.12; P <.001) and the presence of cyanosis before PVS repair (HR, 5.23; 95%CI, 1.99-13.78; P=.001) were independent predictors for cardiovascular complications. CONCLUSIONS Good long-term outcome can be expected after PVS repair, but complications and the need for reintervention may appear. Older age and the presence of cyanosis at PVS repair emerged as predictors of cardiovascular complications and identified a population that may merit stricter control.
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Affiliation(s)
- Laura Galian-Gay
- Servei de Cardiología, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Barcelona, España.
| | - Blanca Gordon
- Servei de Cardiología, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Barcelona, España
| | - Josep Ramón Marsal
- Unitat d'Epidemiologia, Servei de Cardiología, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, CIBERESP, Barcelona, España
| | - Agnès Rafecas
- Servei de Cardiología, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Barcelona, España
| | - Antonia Pijuan Domènech
- Servei de Cardiología, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Unitat Integrada de Cardiopaties Congènites de l'Adolescent i de l'Adult Vall d'Hebron-Sant Pau, Barcelona, España
| | - Miguel Angel Castro
- Servei de Cardiología, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Unitat Integrada de Cardiopaties Congènites de l'Adolescent i de l'Adult Vall d'Hebron-Sant Pau, Barcelona, España
| | - Maria T Subirana Domènech
- Servei de Cardiología, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Unitat Integrada de Cardiopaties Congènites de l'Adolescent i de l'Adult Vall d'Hebron-Sant Pau, Barcelona, España
| | - Carlos Sureda
- Servei de Cirurgia Cardiaca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - Berta Miranda
- Servei de Cardiología, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Unitat Integrada de Cardiopaties Congènites de l'Adolescent i de l'Adult Vall d'Hebron-Sant Pau, Barcelona, España
| | - Gerard Martí
- Servei de Cardiología, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Barcelona, España
| | - David García-Dorado
- Servei de Cardiología, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Barcelona, España
| | - Laura Dos Subirà
- Servei de Cardiología, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Unitat Integrada de Cardiopaties Congènites de l'Adolescent i de l'Adult Vall d'Hebron-Sant Pau, Barcelona, España
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To KKW, Chan KH, Ho J, Pang PKP, Ho DTY, Chang ACH, Seng CW, Yip CCY, Cheng VCC, Hung IFN, Yuen KY. Respiratory virus infection among hospitalized adult patients with or without clinically apparent respiratory infection: a prospective cohort study. Clin Microbiol Infect 2019; 25:1539-1545. [PMID: 31004768 PMCID: PMC7129190 DOI: 10.1016/j.cmi.2019.04.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/05/2019] [Accepted: 04/10/2019] [Indexed: 01/23/2023]
Abstract
Objectives To determine the viral epidemiology and clinical characteristics of patients with and without clinically apparent respiratory tract infection. Methods This prospective cohort study was conducted during the 2018 winter influenza season. Adult patients with fever/respiratory symptoms (fever/RS group) were age- and sex-matched with patients without fever/RS (non-fever/RS group) in a 1:1 ratio. Respiratory viruses were tested using NxTAG™ Respiratory Pathogen Panel IVD, a commercially-available multiplex PCR panel. Results A total of 214 acutely hospitalized patients were included in the final analysis, consisting of 107 with fever/RS (fever/RS group), and 107 age- and sex-matched patients without fever/RS (non-fever/RS group). Respiratory viruses were detected in 34.1% (73/214) of patients, and co-infection occurred in 7.9% (17/214) of patients. The incidence of respiratory virus was higher in the fever/RS group than in the non-fever/RS group (44.9% (48/107) versus 23.4% (25/107), p 0.001). Influenza B virus, enterovirus/rhinovirus and coronaviruses were detected more frequently in the fever/RS group, whereas parainfluenza virus 4B and adenovirus were detected more frequently in the non-fever/RS group. Among the non-fever/RS group, chest discomfort was more common among patients tested positive for respiratory viruses than those without respiratory virus detected (44% (11/25) versus 22% (18/82), p 0.04). Conclusions Respiratory viruses can be frequently detected among hospitalized patients without typical features of respiratory tract infection. These patients may be a source of nosocomial outbreaks.
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Affiliation(s)
- K K W To
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China; Department of Clinical Microbiology and Infection Control, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China; Department of Microbiology, Queen Mary Hospital, Pokfulam, Hong Kong Special Administrative Region, China; State Key Laboratory for Emerging Infectious Diseases, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - K-H Chan
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
| | - J Ho
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
| | - P K P Pang
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
| | - D T Y Ho
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
| | - A C H Chang
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
| | - C W Seng
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
| | - C C Y Yip
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China; Department of Microbiology, Queen Mary Hospital, Pokfulam, Hong Kong Special Administrative Region, China
| | - V C C Cheng
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China; Department of Microbiology, Queen Mary Hospital, Pokfulam, Hong Kong Special Administrative Region, China
| | - I F N Hung
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
| | - K-Y Yuen
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China; Department of Clinical Microbiology and Infection Control, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China; Department of Microbiology, Queen Mary Hospital, Pokfulam, Hong Kong Special Administrative Region, China; State Key Laboratory for Emerging Infectious Diseases, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong Special Administrative Region, China.
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Omidi-Ardali H, Lorigooini Z, Soltani A, Balali-Dehkordi S, Amini-Khoei H. Inflammatory responses bridge comorbid cardiac disorder in experimental model of IBD induced by DSS: protective effect of the trigonelline. Inflammopharmacology 2019; 27:1265-1273. [PMID: 30924005 DOI: 10.1007/s10787-019-00581-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 03/06/2019] [Indexed: 12/11/2022]
Abstract
Pathogenesis of the inflammatory bowel disease (IBD) involves the combination of immunological and inflammatory factors. IBD is associated with several extra-intestinal manifestations. The exact underlying bridge between the probable cardiac diseases in IBD patients is undetermined. Trigonelline is an alkaloid with several therapeutic potential properties. In this study, we aimed to assess the probable underlying mechanisms of this comorbidity as well as protective effect of trigonelline focusing inflammatory response and oxidative state in mouse model of colitis. Dextran sodium sulfate (DSS) was used for induction of colitis in mice. Trigonelline (10, 50 and 100 mg/kg) was administrated via intraperitoneal rout (i.p.) for 14 continuous days. Heart, intestine and serum samples were taken for assessment of total antioxidant capacity, malondialdehyde (MDA), gene expressions of inflammatory markers including tumor necrosis factor alpha (Tnf-α), interleukin 1-beta (Il/1β), toll- like receptor 4 (Tlr4) as well as for evaluation of histopathological alterations. Results demonstrated that trigonelline effectively attenuated the cellular/molecular and histopathological adverse effects of colitis in the intestine and heart tissues. In this regards, we found that trigonelline decreased the MDA level, attenuated the expression of Tnf-α, Il/1β and, Tlr4 as well as modulated the histopathological alterations in the intestine. Furthermore, trigonelline increased the antioxidant capacity in the related experimental groups. We concluded that IBD (colitis) is associated with comorbid cellular/molecular modifications in the heart and for the first time, we found that trigonelline has potential therapeutic effects (at least partially) to attenuate the cardiac manifestations of the colitis.
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Affiliation(s)
- Hossein Omidi-Ardali
- Medical Plants Research Center, Basic Health Sciences Institute, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Zahra Lorigooini
- Medical Plants Research Center, Basic Health Sciences Institute, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Amin Soltani
- Medical Plants Research Center, Basic Health Sciences Institute, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Shima Balali-Dehkordi
- Department of Basic Sciences, Faculty of Veterinary Medicine, Shahid Chamran University of Ahvaz, Ahvaz, Iran
| | - Hossein Amini-Khoei
- Medical Plants Research Center, Basic Health Sciences Institute, Shahrekord University of Medical Sciences, Shahrekord, Iran.
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Koohi F, Kazemi T, Miri-Moghaddam E. Cardiac complications and iron overload in beta thalassemia major patients-a systematic review and meta-analysis. Ann Hematol 2019; 98:1323-1331. [PMID: 30729283 DOI: 10.1007/s00277-019-03618-w] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 01/14/2019] [Indexed: 01/19/2023]
Abstract
Despite the major improvement in therapeutic management of thalassemia major, iron overload is considered a challenging conundrum in these patients and heart disease still remains a major cause of morbidity and mortality in these patients. Therefore, this study aimed to investigate the prevalence of cardiac iron overload and cardiovascular complications in transfusion-dependent thalassemia patients in the worldwide. The following databases were searched: ISI/Web of Science, Embase, PubMed, Scopus, up to February 30, 2018. The quality of the studies was evaluated using the Joanna Briggs Institute Prevalence Critical Appraisal Tool. The random model based on Metaprop was used. One hundred forty-two studies were included. The total number of patients included was 26,893. The mean age of patients was 22.6 (SD = 1.7) years. Based on Metaprop, the overall prevalence of cardiac iron overload/myocardial sidoresis (T2* < 20 ms) and cardiac complications in thalassemia major patients in the worldwide was 25% (95% CI 22-28%) and 42% (95% CI 37-46%), respectively. The results of this study show that the prevalence of cardiac iron overload and cardiovascular complications in patients with thalassemia major is almost high. Therefore, iron chelation and careful monitoring of serum ferritin level will prevent the cardiac iron overload, and interval monitoring of patients with transfusion-dependent thalassemia (TDT) by echocardiography and electrocardiography will help with early detection of cardiovascular complications.
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Affiliation(s)
- F Koohi
- Student Research Committee, Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - T Kazemi
- Cardiovascular Diseases Research Center & Department of Cardiology, Faculty of Medicine, Birjand University of Medical Sciences, Birjand, Iran
| | - E Miri-Moghaddam
- Cardiovascular Diseases Research Center & Dep. of Molecular Medicine, Faculty of Medicine, Birjand University of Medical Sciences, Birjand, Iran.
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Abstract
Cardiovascular disease is a leading cause of death, especially in individuals with diabetes mellitus, whose risk of morbidity and mortality due to cardiovascular disease is markedly increased compared with the general population. There has been growing interest in the identification of biomarkers of cardiovascular disease in people with diabetes. The present review focuses on the current and potential contributions of these biomarkers to predicting cardiovascular risk in individuals with diabetes. At present, certain biomarkers and biomarker combinations can lead to modest improvements in the prediction of cardiovascular disease in diabetes beyond traditional cardiovascular risk factors. Emerging technologies may enable the discovery of novel biomarkers and generate new information about known biomarkers (such as new combinations of biomarkers), which could lead to significant improvements in cardiovascular disease risk prediction. A critical question, however, is whether improvements in risk prediction will affect processes of care and decision making in clinical practice, as this will be required to achieve the ultimate goal of improving clinical outcomes in diabetes.
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Affiliation(s)
- Katherine N Bachmann
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University School of Medicine, Nashville, TN, USA.
- Division of Diabetes, Endocrinology, and Metabolism, Vanderbilt University Medical Center, 2213 Garland Avenue, MRB IV Suite 7465, Nashville, TN, 37232, USA.
| | - Thomas J Wang
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University School of Medicine, Nashville, TN, USA
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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Abstract
In the Trial Comparing Cardiovascular Safety of Insulin Degludec vs Insulin Glargine in Patients with Type 2 Diabetes at High Risk of Cardiovascular Events (DEVOTE), insulin degludec was non-inferior to insulin glargine in terms of cardiovascular events and mortality. However, there were lower rates of severe hypoglycaemia with insulin degludec. DEVOTE investigators now extend these findings by presenting the results of two observational epidemiological analyses based on trial data. In the first of these analyses (DEVOTE 2), Zinman et al (Diabetologia DOI: 10.1007/s00125-017-4423-z ) demonstrate that, compared with individuals with lower day-to-day fasting glycaemic variability, those with higher day-to-day fasting glycaemic variability had a similar risk of major adverse cardiovascular events (MACE) but a higher risk of severe hypoglycaemia and all-cause mortality. In the second analysis (DEVOTE 3), Pieber et al (Diabetologia DOI: 10.1007/s00125-017-4422-0 ) found that individuals who experienced severe hypoglycaemia had a similar risk of MACE compared with those who never experienced severe hypoglycaemia, but had a more than twofold higher risk of subsequent total mortality and cardiovascular disease (CVD) mortality. The strengths of these studies relate to the availability of high-quality prospective data on adjudicated severe hypoglycaemia, MACE and mortality events in a large number of high-risk insulin-treated individuals with type 2 diabetes. Limitations include the observational nature of the data and thus residual confounding remains possible. Furthermore, the short duration of the trial resulted in limited statistical power for some analyses. Therefore, whilst DEVOTE 2 and DEVOTE 3 raise awareness of the mortality risks associated with glucose variability and severe hypoglycaemia in high-risk, insulin-treated patients with type 2 diabetes, they cannot clarify causal relationships. Preventing severe hypoglycaemia in those with type 2 diabetes should already be a priority in clinical practice. However, findings from future clinical trials are needed to guide physicians on whether it is beneficial to target glucose variability, and risk for severe hypoglycaemia, to reduce the risks for CVD events and mortality in these individuals.
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Affiliation(s)
- Martin K Rutter
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
- Manchester Diabetes Centre, 193 Hathersage Road, Central Manchester University hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, M13 0JE, UK.
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Rabadiya S, Bhadada S, Dudhrejiya A, Vaishnav D, Patel B. Magnesium valproate ameliorates type 1 diabetes and cardiomyopathy in diabetic rats through estrogen receptors. Biomed Pharmacother 2017; 97:919-927. [PMID: 29136770 DOI: 10.1016/j.biopha.2017.10.137] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 10/17/2017] [Accepted: 10/24/2017] [Indexed: 01/14/2023] Open
Abstract
Estrogen is known to exhibit cardioprotective and antihyperlipidemic action. Valproic acid has been shown to upregulate estrogen receptors (ERs) in breast and prostate cancer tissues. No pharmacological evaluations for magnesium valproate (MgV) so far have been done for diabetic cadio-lipidemic complications. Based on the above context, current study was undertaken to evaluate the therapeutic effectiveness of MgV in cardiac complications associated with type-1 diabetes mellitus in rats wherein diabetes was induced by single tail vein injection of streptozotocin (STZ, 45mg/kg, IV) in female Sprague Dawley rats and treatment of MgV (210mg/kg, PO) was given for eight weeks to diabetic animals, after which, various biochemical and cardiac biomarkers, hypertrophic, hemodynamic and histological parameters along with immunohistochemistry of ERs in the left ventricle (LV) were estimated. MgV treatment significantly controlled hyperglycemia and dyslipidemia, reduced elevated cardiac biomarkers and C-reactive protein(CRP), significantly improved hemodynamic functions and increased the rate of pressure development and decay. MgV also significantly reduced left ventricular hypertrophy index and cardiac hypertrophy index, LV wall thickness, LV collagen, cardiomyocyte diameter and prevented the oxidative stress with significant increase in Na+-K+-ATPase activity in LV. Moreover, MgV reversed STZ-induced histological alterations and decreased glycogen content in LV and increased the ERβ expressions in LV as evidenced by immunohistochemistry. The result indicated that MgV prevented disease progression in the early stage of diabetic cardiomyopathy which seems to be mediated by upregulation of estrogen receptors in LV tissue.
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Affiliation(s)
- Samir Rabadiya
- Department of Pharmaceutical Sciences, Saurashtra University, Rajkot, Gujarat, India
| | - Shradhha Bhadada
- Institute of Pharmacy, Nirma University, Ahmedabad, Gujarat, India
| | - Ashvin Dudhrejiya
- Department of Pharmaceutical Sciences, Saurashtra University, Rajkot, Gujarat, India
| | - Devendra Vaishnav
- Department of Pharmaceutical Sciences, Saurashtra University, Rajkot, Gujarat, India
| | - Bhoomika Patel
- Institute of Pharmacy, Nirma University, Ahmedabad, Gujarat, India.
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Ntiloudi D, Zegkos T, Bazmpani MA, Parcharidou D, Panagiotidis T, Hadjimiltiades S, Karvounis H, Giannakoulas G. Pregnancy outcome in women with congenital heart disease: A single-center experience. Hellenic J Cardiol 2017; 59:155-159. [PMID: 28873334 DOI: 10.1016/j.hjc.2017.08.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 08/21/2017] [Accepted: 08/24/2017] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE Pregnancies in patients with adult congenital heart disease (ACHD) are often complicated. We aimed to highlight the nature and the rate of these complications in a single-center patient population. METHODS We retrospectively studied all the pregnancies of women who presented on an outpatient basis, and all pregnancies were reviewed for maternal and fetal outcomes. RESULTS Of 117 pregnancies from 52 ACHD patients (age at pregnancy 28.3 ± 6.6 years), 10 were therapeutically aborted. A proportion of 41.1% of the remaining 107 pregnancies were complicated either with cardiac (3.7%), obstetric (15.0%), or fetal/neonatal (11.2%) adverse events or with spontaneous abortion (17.8%). Hospitalization during pregnancy was required in 10 patients. Elective cesarean sections were initially planned for 31% of the 87 pregnancies, which were finally completed, while 8% required an emergency cesarean section, mostly for obstetric reasons. NYHA class deterioration after pregnancy was detected in 9.3% of our cohort. Modified WHO class III/IV, prior medication use, and higher body mass index (BMI) were related to cardiac complications during pregnancy or NYHA deterioration. CONCLUSION Pregnancies in ACHD patients are at high risk for complications. Advanced modified WHO class, prior medication use, and high BMI were related to adverse cardiac events.
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Affiliation(s)
- Despina Ntiloudi
- Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece
| | - Thomas Zegkos
- Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece
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Mantovani A. Nonalcoholic Fatty Liver Disease (NAFLD) and Risk of Cardiac Arrhythmias: A New Aspect of the Liver-heart Axis. J Clin Transl Hepatol 2017; 5:134-141. [PMID: 28660151 PMCID: PMC5472934 DOI: 10.14218/jcth.2017.00005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 03/29/2017] [Accepted: 03/30/2017] [Indexed: 12/14/2022] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) is a pathologic condition frequently observed in clinical practice. To date, the prevalence of NAFLD is approximately 25-30% among adults of the general population in Western countries but increases to approximately 70-75% among patients with type 2 diabetes mellitus. In the last decade, accumulating evidence has clearly demonstrated that patients with NAFLD have not only an increased liver-related morbidity and mortality but also an increased risk of fatal and non-fatal cardiovascular events. In particular, several studies have documented the existence of an independent association among NAFLD and cardiac changes in structure and function in both non-diabetic and diabetic patients. In addition, mounting evidence also suggests that there is a strong relationship between NAFLD and cardiac arrhythmias, such as atrial fibrillation, QTc prolongation and ventricular arrhythmias. This is of clinical interest, as it could explain, at least in part, the increased risk of death for cardiovascular disease in patients with NAFLD. Therefore, seeing that cardiovascular disease complications are the leading cause of disability and death in NAFLD patients, the recent European clinical practice guidelines advised to check the cardiovascular system in all patients with NAFLD. This clinical mini review will briefly describe the increasing body of evidence regarding the association between NAFLD and cardiac arrhythmias, and discuss the potential biological mechanisms underlying this association.
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Affiliation(s)
- Alessandro Mantovani
- *Correspondence to: Alessandro Mantovani, Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata, Piazzale Stefani, 1, 37126 Verona, Italy. Tel: +39-45-8123110, Fax: +39-45-8122841, E-mail:
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Bianca I, Geraci G, Gulizia MM, Egidy Assenza G, Barone C, Campisi M, Alaimo A, Adorisio R, Comoglio F, Favilli S, Agnoletti G, Carmina MG, Chessa M, Sarubbi B, Mongiovì M, Russo MG, Bianca S, Canzone G, Bonvicini M, Viora E, Poli M. Consensus Document of the Italian Association of Hospital Cardiologists (ANMCO), Italian Society of Pediatric Cardiology (SICP), and Italian Society of Gynaecologists and Obstetrics (SIGO): pregnancy and congenital heart diseases. Eur Heart J Suppl 2017; 19:D256-D292. [PMID: 28751846 PMCID: PMC5526477 DOI: 10.1093/eurheartj/sux032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The success of cardiac surgery over the past 50 years has increased numbers and median age of survivors with congenital heart disease (CHD). Adults now represent two-thirds of patients with CHD; in the USA alone the number is estimated to exceed 1 million. In this population, many affected women reach reproductive age and wish to have children. While in many CHD patients pregnancy can be accomplished successfully, some special situations with complex anatomy, iatrogenic or residual pathology are associated with an increased risk of severe maternal and fetal complications. Pre-conception counselling allows women to come to truly informed choices. Risk stratification tools can also help high-risk women to eventually renounce to pregnancy and to adopt safe contraception options. Once pregnant, women identified as intermediate or high risk should receive multidisciplinary care involving a cardiologist, an obstetrician and an anesthesiologist with specific expertise in managing this peculiar medical challenge. This document is intended to provide cardiologists working in hospitals where an Obstetrics and Gynecology Department is available with a streamlined and practical tool, useful for them to select the best management strategies to deal with a woman affected by CHD who desires to plan pregnancy or is already pregnant.
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Affiliation(s)
- Innocenzo Bianca
- Pediatric Cardiology Unit, Maternity and Neonatal Department, ARNAS Garibaldi, Catania, Italy
| | - Giovanna Geraci
- Cardiology Department, PO Cervello, Az. Osp. Riuniti Villa Sofia-Cervello, Via Trabucco, 180, 90146 Palermo, Italy
| | - Michele Massimo Gulizia
- Cardiology Department, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione ‘Garibaldi’, Catania, Italy
| | - Gabriele Egidy Assenza
- Pediatric Cardiology and Adult Congenital Heart Program, Azienda Ospedaliera-Universitaria Sant’Orsola-Malpighi, Bologna, Itlay
| | - Chiara Barone
- Genetics Unit, Maternity and Neonatal Department, ARNAS Garibaldi, Catania, Italy
| | - Marcello Campisi
- Pediatric Cardiology Unit, Maternity and Neonatal Department, ARNAS Garibaldi, Catania, Italy
| | - Annalisa Alaimo
- Pediatric Cardiology Department, PO Di Cristina, ARNAS Civico, Palermo, Italy
| | - Rachele Adorisio
- Pediatric Cardiology Department, Ospedale Pediatrico Bambino Gesù, Roma, Italy
| | - Francesca Comoglio
- SCDU 2, Dipartimento di Scienze Chirurgiche (Surgical Sciences Department), Università di Torino, Italy
| | - Silvia Favilli
- Pediatric Cardiology Department, Azienda-Ospedalliero-Universitaria Meyer, Firenze, Italy
| | - Gabriella Agnoletti
- Pediatric Cardiology Department, Ospedale Regina Margherita, Città della Salute e della Scienza, Torino, Italy
| | - Maria Gabriella Carmina
- Cardiology Department, PO Cervello, Az. Osp. Riuniti Villa Sofia-Cervello, Via Trabucco, 180, 90146 Palermo, Italy
| | - Massimo Chessa
- Pediatric and Adult Congenital Heart Centre, IRCCS-Policlinico San Donato Milanese San Donato Milanese (MI), Italy
| | - Berardo Sarubbi
- Pediatric Cardiology and Cardiology SUN, Seconda Università di Napoli, AORN dei Colli, Ospedale Monaldi, Napoli, Italy
| | - Maurizio Mongiovì
- Pediatric Cardiology Department, PO Di Cristina, ARNAS Civico, Palermo, Italy
| | - Maria Giovanna Russo
- Pediatric Cardiology and Cardiology SUN, Seconda Università di Napoli, AORN dei Colli, Ospedale Monaldi, Napoli, Italy
| | - Sebastiano Bianca
- Genetics Unit, Maternity and Neonatal Department, ARNAS Garibaldi, Catania, Italy
| | - Giuseppe Canzone
- Women and Children Health Department, Ospedale S. Cimino, Termini Imerese (PA), Italy
| | - Marco Bonvicini
- Pediatric Cardiology and Adult Congenital Heart Program, Azienda Ospedaliera-Universitaria Sant’Orsola-Malpighi, Bologna, Itlay
| | - Elsa Viora
- Echography and Prenatal Diagnosis Centre, Obstetrics and Gynaecology Department, Città della Salute e della Scienza di Torino, Italy
| | - Marco Poli
- Intensive Cardiac Therapy Department, Ospedale Sandro Pertini, Roma, Italy
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Wang J, Xu H, Yang X, Zhao D, Liu S, Sun X, Huang JA, Guo Q. Cardiac complications associated with the influenza viruses A subtype H7N9 or pandemic H1N1 in critically ill patients under intensive care. Braz J Infect Dis 2016; 21:12-18. [PMID: 27912070 PMCID: PMC9425542 DOI: 10.1016/j.bjid.2016.10.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 10/05/2016] [Accepted: 10/05/2016] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND OBJECTIVE The clinical presentations and disease courses of patients hospitalized with either influenza A virus subtype H7N9 (H7N9) or 2009 pandemic H1N1 influenza virus were compared in a recent report, but associated cardiac complications remain unclear. The present retrospective study investigated whether cardiac complications in critically ill patients with H7N9 infections differed from those infected with the pandemic H1N1 influenza virus strain. METHODS Suspect cases were confirmed by reverse transcription polymerase chain reaction assays with specific confirmation of the pandemic H1N1 strain at the Centers for Disease Control and Prevention. Comparisons were conducted at the individual-level data of critically ill patients hospitalized with H7N9 (n=24) or pandemic H1N1 influenza virus (n=22) infections in Suzhou, China. Changes in cardiac biochemical markers, echocardiography, and electrocardiography during hospitalization in the intensive care unit were considered signs of cardiac complications. RESULTS The following findings were more common among the H7N9 group relative to the pandemic H1N1 influenza virus group: greater tricuspid regurgitation pressure gradient, sinus tachycardia (heartbeat≥130bpm), ST segment depression, right ventricular dysfunction, and elevated cardiac biochemical markers. Pericardial effusion was more often found among pandemic H1N1 influenza virus patients than in the H7N9 group. In both groups, most of the cardiac complications were detected from day 6 to 14 after the onset of influenza symptoms. Those who developed cardiac complications were especially vulnerable during the first four days after initiation of mechanical ventilation. Cardiac complications were reversible in the vast majority of discharged H7N9 patients. CONCLUSIONS Critically ill hospitalized H7N9 patients experienced a higher rate of cardiac complications than did patients with 2009 pandemic H1N1 influenza virus infections, with the exception of pericardial effusion. This study may help in the prevention, identification, and treatment of influenza-induced cardiac complications in both pandemic H1N1 influenza virus and H7N9 infections.
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Affiliation(s)
- Jiajia Wang
- The First Affiliated Hospital of Soochow University, Department of Medicine, Respiratory, Emergency and Critical Care Medicine, Suzhou, China
| | - Hua Xu
- The First Affiliated Hospital of Soochow University, Department of Medicine, Respiratory, Emergency and Critical Care Medicine, Suzhou, China
| | - Xinjing Yang
- The First Affiliated Hospital of Soochow University, Department of Medicine, Respiratory, Emergency and Critical Care Medicine, Suzhou, China
| | - Daguo Zhao
- The First Affiliated Hospital of Soochow University, Department of Medicine, Respiratory, Emergency and Critical Care Medicine, Suzhou, China
| | - Shenglan Liu
- The First Affiliated Hospital of Soochow University, Department of Medicine, Respiratory, Emergency and Critical Care Medicine, Suzhou, China
| | - Xue Sun
- The First Affiliated Hospital of Soochow University, Department of Medicine, Respiratory, Emergency and Critical Care Medicine, Suzhou, China
| | - Jian-An Huang
- The First Affiliated Hospital of Soochow University, Department of Medicine, Respiratory, Emergency and Critical Care Medicine, Suzhou, China
| | - Qiang Guo
- The First Affiliated Hospital of Soochow University, Department of Medicine, Respiratory, Emergency and Critical Care Medicine, Suzhou, China.
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Abstract
Survivors of hematopoietic stem cell transplant (HSCT) are at significant risk for cardiac disease and cardiac complications. While there may be cardiac complications during the acute period of HSCT, long-term survivors remain at risk for cardiovascular disease at a rate at least fourfold higher than the general population. Aggressive screening for cardiac risk factors such as diabetes, hypertension, and arrhythmias is warranted pretransplant. For those with risk factors, particularly a history of cardiovascular disease or atrial fibrillation, cardiology consultation is warranted in the pretransplantation period. Aggressive screening for cardiac risk factors such as diabetes, hypertension, and hyperlipidemia is warranted in HSCT survivors as well; early and aggressive treatment of left ventricular dysfunction is warranted. Collaboration between hematology/oncology and cardiology through a cardio-oncology clinic is an optimal way to help manage these patients.
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Affiliation(s)
- Anne Blaes
- Division of Hematology/Oncology/Transplantion, University of Minnesota, 420 Delaware Street, S.E., MMC 480, Minneapolis, MN, 55455, USA.
| | - Suma Konety
- Division of Cardiology, University of Minnesota, Minneapolis, MN, USA
| | - Peter Hurley
- Division of Hematology/Oncology/Transplantion, University of Minnesota, 420 Delaware Street, S.E., MMC 480, Minneapolis, MN, 55455, USA
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Mohammadzadeh I, Noei S, Babazadeh K, Zamani H, Barari-Savadkoohi R, Alizadeh-Navaei R. Comparison of early and late intravenous gamma globulin treatment of Kawasaki disease on fever and cardiovascular complications. Caspian J Intern Med 2016; 7:211-216. [PMID: 27757208 PMCID: PMC5062181 DOI: pmid/27757208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Cardiac involvement was the major leading cause of death in patients with Kawasaki and IVIG administration reduces cardiac complications. The objective of this study was to determine the frequency of cardiovascular complications and duration of fever with regard to the time of intravenous immunoglobulin (IVIG) administration of patients with Kawasaki disease. METHODS This follow-up study was done on all patients with Kawasaki disease who were hospitalized at Amirkola Children's Hospital between 2006 and 2011. Diagnosis of Kawasaki was clinical and included fever more than 5 days with 4 of 5 signs containing mucosal changes, scaling and skin rash, bilateral nonexudative conjunctivitis, cervical lymph adenopathy and edema in lower extremities. After diagnosis of Kawasaki, all patients received standard treatment (intravenous immunoglobulins and aspirin) and undergoing cardiac echocardiography in 2 weeks, 2 months and 6 months. Information including age, sex, sign of diseases, laboratory findings, and cardiac complications in echocardiography were recorded. RESULTS This study was performed on 100 patients (61 boys and 39 girls) with Kawasaki disease. The mean age of children was 2.8±2.6 years. Cardiac complication rate was 47% at the onset of the disease and had reached to 7% at the end of the sixth month (P=0.000). Distribution of cardiovascular complications in the second week, the second month and the sixth month after treatment was not significantly different according to the start of time of treatment (p>0.05). Duration of fever in patients who received treatment before 10th day (1.5±1.3) did not have significant difference (P=0.78) with patients who received after 10th day (1.6±0.9). CONCLUSION Result shows that most of patients (99%) responded to the treatment with IVIG and ASA and cardiovascular complication ratio decreased. There was not significant relationship between duration of fever and time of IVIG treatment initiation.
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Affiliation(s)
- Iraj Mohammadzadeh
- Non-Communicable Pediatric Research Center, Babol University of Medical Sciences, Babol, Iran
| | - Somayyeh Noei
- Non-Communicable Pediatric Research Center, Babol University of Medical Sciences, Babol, Iran
| | - Kazem Babazadeh
- Non-Communicable Pediatric Research Center, Babol University of Medical Sciences, Babol, Iran
| | - Hassan Zamani
- Non-Communicable Pediatric Research Center, Babol University of Medical Sciences, Babol, Iran
| | - Rahim Barari-Savadkoohi
- Infectious Diseases and Tropical Medicine Research Center, Babol University of Medical Sciences, Babol, Iran
| | - Reza Alizadeh-Navaei
- Gastrointestinal Cancer Research Center, Mazandaran University of Medical Sciences, Sari, Iran
- Correspondence: Iraj Mohammadzadeh, Non-Communicable Pediatric Research Center, Babol University of Medical Sciences, Babol, Iran. E-mail: ,Tel: 0098 11 32346963, Fax: 0098 11 32346963
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Targher G, Dauriz M, Tavazzi L, Temporelli PL, Lucci D, Urso R, Lecchi G, Bellanti G, Merlo M, Rossi A, Maggioni AP. Prognostic impact of in-hospital hyperglycemia in hospitalized patients with acute heart failure: Results of the IN-HF (Italian Network on Heart Failure) Outcome registry. Int J Cardiol 2015; 203:587-93. [PMID: 26574932 DOI: 10.1016/j.ijcard.2015.10.207] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 10/16/2015] [Accepted: 10/25/2015] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Although diabetes mellitus is frequently associated with heart failure (HF), the association between elevated admission glucose levels and adverse outcomes has not been well established in hospitalized patients with acute HF. METHODS We prospectively evaluated in-hospital mortality, post-discharge 1-year mortality and 1-year re-hospitalization rates in the Italian Network on Heart Failure (IN-HF) Outcome registry cohort of 1776 patients hospitalized with acute HF and stratified by their admission glucose levels (i.e., known diabetes, newly diagnosed hyperglycemia, no diabetes). RESULTS Compared with those without diabetes (n = 586), patients with either known diabetes (n = 749) (unadjusted-odds ratio [OR] 1.64, 95%CI 0.99–2.70) or newly diagnosed hyperglycemia (n = 441) (unadjusted-OR 2.34, 95%CI 1.39–3.94) had higher in-hospital mortality, but comparable post-discharge 1-year mortality rates. After adjustment for age, sex, systolic blood pressure, estimated glomerular filtration rate, left ventricular ejection fraction, HF etiology and HF worsening/de novo presentation, the results remained unchanged in patients with known diabetes (adjusted-OR 1.86, 95%CI 1.01–3.42), while achieved borderline significance in those with newly diagnosed hyperglycemia (adjusted-OR 1.81, 95%CI 0.95–3.45). One-year re-hospitalization rates were lower in patients with newly diagnosed hyperglycemia (adjusted-hazard ratio 0.74, 95%CI 0.56–0.96) than in other groups. CONCLUSIONS Elevated admission blood glucose levels are associated with poorer in-hospital survival outcomes in patients with acute HF, especially in those with previously known diabetes. This finding further highlights the importance of tight glycemic control during hospital stay and address the need of dedicated intervention studies to identify customized clinical protocols to improve in-hospital survival of these high-risk patients.
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Affiliation(s)
- Giovanni Targher
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Marco Dauriz
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care & Research, E.S. Health Science Foundation, Cotignola, RA, Italy
| | | | | | - Renato Urso
- Department of Medicine, Surgery and Neuroscience, Pharmacology Unit "G. Segre", University of Siena, Siena, Italy
| | - Gabriella Lecchi
- Department of Cardiology, San Leopoldo Mandic Hospital, Merate, LC, Italy
| | - Giancarlo Bellanti
- Department of Cardiology, Santa Maria delle Croci Hospital, Ravenna, Italy
| | - Marco Merlo
- Cardiovascular Department, Azienda Ospedaliero-Universitaria Ospedali Riuniti, University of Trieste, Trieste, Italy
| | - Andrea Rossi
- Division of Cardiology, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
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Fernandez Mdel C, Diaz M, López F, Martí-Obiol R, Ortega J. Cardiac complications after laparoscopic large hiatal hernia repair. Is it related with staple fixation of the mesh? -Report of three cases. Ann Med Surg (Lond) 2015; 4:395-8. [PMID: 26635954 DOI: 10.1016/j.amsu.2015.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 09/14/2015] [Accepted: 09/15/2015] [Indexed: 11/22/2022] Open
Abstract
Introduction Laparoscopic Nissen operation with mesh reinforcement remains being the most popular operation for large hiatal hernia repair. Complications related to mesh placement have been widely described. Cardiac complications are rare, but have a fatal outcome if they are misdiagnosed. Presentation of cases We sought to outline our institutional experience of three patients who developed cardiac complications following a laparoscopic Nissen operation for large hiatal hernia repair. Discussion Laparoscopic hiatoplasty and Nissen fundoplication are safe and effective procedures for the hiatal hernia repair, but they are not exempt from complications. Fixation technique and material used must be taken into account. We have conducted a review of the literature on complications related to these procedures. Conclusion In the differential diagnosis of hemodynamic instability after laparoscopic hiatal hernia repair, cardiac tamponade and other cardiac complications should be considered. Three cases with different clinical expression of cardiac tamponade after laparoscopic large hiatal hernia repair. We review cardiac complications related to laparoscopic hiatal hernia repair. It is necessary to consider the risk of injury to the surrounding tissues during the anchorage of the mesh to the diaphragm. Cardiac complications must be considered in the postoperative period of mesh hiatoplasty.
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Das M, Tapadar SR, Mahapatra ABS, Chowdhury SP, Basu S. Assessment of RV Function in Patients of (COPD). J Clin Diagn Res 2014; 8:11-3. [PMID: 24783066 DOI: 10.7860/jcdr/2014/6440.4090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 01/10/2014] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Chronic Obstructive Pulmonary Disease (COPD) has considerable effects on cardiac functions primarily affecting the pulmonary vasculature and then right ventricle along with left ventricle. One of the important causes of increased morbidity and mortality associated with COPD is cor pulmonale. Echocardiography provides a rapid, non-invasive method to evaluate cardiac changes. Our aim was to evaluate RVfunction in COPD as per guidelines of American Society of Echocardiography with an aim to find a simpler way of predicting cardiac morbidity. MATERIALS AND METHODS A cross sectional observational study was conducted on 17 COPD patients attending Respiratory Medicine outdoor of R. G. KAR Medical College, Kolkata, India, through history taking, clinical examination, PFT (PFT) and Echocardiography. Statistical analysis was done by using Statistical Package for the Social Sciences (SPSS) version-17. RESULTS Fractional area change of RV (FAC-%) was positively correlated with Forced Expiratory Volume in One Second (FEV1) (r = 0.4879), FEV1/ Forced Vital Capacity (FVC) ratio (r = 0.5048) and Peak Expiratory Flow Rate (PEFR) (r = 0.5361). There was strong negative correlation of Systolic Pulmonary Artery Pressure (SPAP) with FEV1/FVC ratio (r = -0.5553) and PEFR (r = - 0.4604). Right Index of Myocardial Performance (RIMP) of right ventricle was negatively correlated with FEV1/FVC ratio (r = - 0.598), PEFR (r = - 0.619), Forced Expiratory Flow (FEF) 25-75 (r = -0.515). Tricuspid annular plane systolic excursion (TAPSE) did not show any association with PFT parameters though it showed strong positive correlation with RV wall thickness. CONCLUSION This study substantiates that FAC% and RIMP can be vital prognostic factors for RV function apart from SPAP, TAPSE to define RV dysfunction and predict morbidity in COPD.
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Affiliation(s)
- Maumita Das
- Post Graduate Trainee, Department of Physiology, R. G. Kar Medical College and Hospital , Kolkata, India
| | - Sumit Roy Tapadar
- Assistant Professor, Department of Respiratory Medicine, R. G. Kar Medical College and Hospital , Kolkata, India
| | | | - Shankar Paul Chowdhury
- Professor, Department of Cardiology, R. G. Kar Medical College and Hospital , Kolkata, India
| | - Subrata Basu
- DM-PDT, Department of Cardiology, R. G. Kar Medical College and Hospital , Kolkata, India
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Ballestri S, Lonardo A, Bonapace S, Byrne CD, Loria P, Targher G. Risk of cardiovascular, cardiac and arrhythmic complications in patients with non-alcoholic fatty liver disease. World J Gastroenterol 2014; 20:1724-45. [PMID: 24587651 PMCID: PMC3930972 DOI: 10.3748/wjg.v20.i7.1724] [Citation(s) in RCA: 177] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 10/30/2013] [Accepted: 11/18/2013] [Indexed: 02/06/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) has emerged as a public health problem of epidemic proportions worldwide. Accumulating clinical and epidemiological evidence indicates that NAFLD is not only associated with liver-related morbidity and mortality but also with an increased risk of coronary heart disease (CHD), abnormalities of cardiac function and structure (e.g., left ventricular dysfunction and hypertrophy, and heart failure), valvular heart disease (e.g., aortic valve sclerosis) and arrhythmias (e.g., atrial fibrillation). Experimental evidence suggests that NAFLD itself, especially in its more severe forms, exacerbates systemic/hepatic insulin resistance, causes atherogenic dyslipidemia, and releases a variety of pro-inflammatory, pro-coagulant and pro-fibrogenic mediators that may play important roles in the pathophysiology of cardiac and arrhythmic complications. Collectively, these findings suggest that patients with NAFLD may benefit from more intensive surveillance and early treatment interventions to decrease the risk for CHD and other cardiac/arrhythmic complications. The purpose of this clinical review is to summarize the rapidly expanding body of evidence that supports a strong association between NAFLD and cardiovascular, cardiac and arrhythmic complications, to briefly examine the putative biological mechanisms underlying this association, and to discuss some of the current treatment options that may influence both NAFLD and its related cardiac and arrhythmic complications.
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