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   2021| July-September  | Volume 22 | Issue 3  
    Online since October 11, 2021

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The effect of ivabradine on hospitalization of heart failure patients: A retrospective cohort study
Sara Al-Balushi, Mohammed Fasihul Alam, Abdul Rehman Abid, Amal Sharfi
July-September 2021, 22(3):165-173
Background: Ivabradine is recommended in heart failure (HF) patients to reduce cardiovascular death and hospitalization due to worsening of HF symptoms. Aims and Objectives: To study the effect of Ivabradine in addition to guideline-directed medical therapy (GDMT) in a group of HF patients with HR more than 70 bpm, HF with reduced ejection fraction (HFrEF) left ventricular ejection fraction (LVEF ≤ 40%), and New York Heart Association class II-IV. Methods: The study was conducted at Heart Hospital, Hamad Medical Corporation, Qatar. HF patients with age > 18 years, LVEF ≤40%, on GDMT, and HR of ≥70 bpm were included. The study population was divided into two groups: ivabradine group and non-ivabradine group. The primary outcomes were risk, number and length of hospitalizations due to worsening HF, and cardiovascular mortality. The secondary outcome was all-cause mortality. Baseline characteristics were collected at enrollment. Study outcomes were compared in the two groups by applying Chi-square and Fisher's exact tests. Logistic regression model was applied to assess both hospitalizations and cardiovascular mortality. Results: A total of 111 patients were studied, 37 (33.94%) ivabradine group and 74 (66.67%) non-ivabradine group. Risk of hospitalization was lower in Ivabradine group compared to non-Ivabradine group (odds ratio: 0.43, 95% confidence interval [CI]: 0.16–1.015, P = 0.094). Average length of hospitalization in ivabradine and non-ivabradine groups was 12.54 and 8.91 days, respectively (incidence rate ratio [IRR]: 1.63, 95% CI: 0.79–3.38, P = 0.187). Compared to non-ivabradine, ivabradine patients had lower number of hospitalizations (IRR: 1.13, 95% CI: 0.61–2.11, P = 0.694). Death rate in both ivabradine and non-ivabradine groups was 3. Conclusions: Ivabradine along with GDMT reduces the risk of hospitalization due to worsening HF symptoms. Ivabradine had no significant effect on cardiovascular mortality and all-cause mortality. HFrEF non-Arabs patients have lower risk, number and length of hospitalization, and mortality compared to Arabs.
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Influence of COVID-19 pandemic on cardiac services in bahrain: Building cardiovascular protocol for future pandemics
Fawaz Khalil Bardooli, Jasim Hasan, Tajammul Hussain, Abdulkarim Abdulrahman, Shereen Al Shaikh
July-September 2021, 22(3):174-183
Background: There are different protocols initiated to maintain the workflow in cardiovascular units around the world. Variable responses were seen in different populations. We adapted certain protocols during coronavirus disease-2019 (COVID-19) pandemic because we want to know the key element that maintains an acceptable standard of cardiovascular care during future pandemics. Methods: Four hundred and fifty-four cardiac patients were admitted during COVID-19 era. Patients from March to July 2020 were included in this study. Those patients were divided into two periods: strict-COVID-19 from March 19, 2020, to May 18, 2020 (132 patients) and mid-COVID-19 from May 19, 2020, to July 18, 2020 (322 patients). These were compared to admissions at the pre-COVID-19 era from January 19, 2020, to March 18, 2020 (600 patients). All patients' data were collected through the quality department from the electronic medical records. Results: Throughout the COVID-19 pandemic, the admission number and ST-elevation myocardial infarction (STEMI) cases were dramatically reduced during the strict-COVID-19 time yet recovered back in the mid-COVID-19 period. The admission rate was reduced from 600 to 132, while the STEMI cases dropped from 91 in pre-COVID-19 to 41 in strict-COVID-19 and then back to 81 cases in mid-COVID 19 period (P > 0.05/P = 0.02 between pre and mid-COVID-19 periods). Conclusion: Our cardiac center continues to serve our population without a complete lockdown period due to multiple key elements adapted during this pandemic. The flexibility in the protocols of managing acute cardiac cases has maintained the mortality rate stable through all COVID-19 periods and return to working efficiently to near-normal levels.
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The comparing of short clinical cardiovascular outcomes with wraparound and nonwraparound left anterior descending artery in patients with anterior st-segment elevation myocardial infarction
Hassan Shemirani, Reihaneh Zavar, Alireza Khosravi, Maryam Tavakoli
July-September 2021, 22(3):184-188
Background: The relation between left anterior descending artery (LAD) anatomy and clinical outcomes in patients with anterior ST-segment elevation myocardial infarction (STEMI) has not been fully investigated. The aim of this study was to determine the frequency and severity of short-term cardiovascular outcomes in patients with Anterior ST-Segment Elevation Myocardial Infarction (STEMI) undergoing primary percutaneous intervention (PCI), based on wraparound and non-wraparound left anterior descending artery (LAD). Methods: In a cross-sectional study, 126 patients with anterior STEMI who were admitted to Shahid Chamran Hospital in Isfahan during 2020 were studied. Patients were evaluated for anatomical features of LAD coronary artery and clinical outcomes determined and compared based on wraparound LAD and non-wraparound LAD during hospitalization and up to one month after PCI. Results: The prevalence of wraparound LAD in the studied patients was 73% and left ventricular systolic dysfunction in admission was greater and more severe in patients with wraparound LADs compared with those with non-wraparound. Severe LV systolic dysfunction in the wraparound and non-wraparound groups was 39.6% and 8.8%, respectively (P < 0.001). Also, the frequency of arrhythmias in the wraparound group (21.7%) was higher than the non-wraparound group (5.9%) (P = 0.037). Conclusion: The patients with anterior STEMI and wraparound LAD have a worse clinical outcome and more severe left ventricular systolic dysfunction. Therefore, it seems that the study of the anatomical condition of the LAD artery at the time of angiography is of great importance in the way of observation and care, and treatment of patients.
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Anaemia in heart failure patients, associated with angiotensin – Renin – aldosterone system altering medications
Neda Jonaitiene, Grytė Ramantauskaitė, Jolanta Laukaitienė
July-September 2021, 22(3):196-200
Heart failure (HF) remains one of the most common diseases and one of the major causes of death worldwide. HF is often associated with other chronic diseases, most commonly with anemia. Anemia increases patients' mortality and lowers their quality of life. There are a few pathophysiological mechanisms that explain anemia in patients with HF – hemodilution, absolute or functional iron deficiency, activation of the inflammatory cascade, chronic kidney disease, and impaired erythropoietin production and activity. Moreover, congestive HF is often treated with angiotensin-converting enzyme inhibitors and aldosterone receptors blockers, which could be linked to the development of anemia.
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Case series and brief review report: Excimer laser coronary atherectomy, facilitating daily complex interventional challenges
Fawaz Khalil Bardooli, Tajammul Hussain, Haitham Amin, Sadananda Shivappa, Husam A Noor
July-September 2021, 22(3):206-211
The excimer laser has revolutionary impact on lesion preparation and chronic total occlusion outcomes. Furthermore, this technology has made huge progression in modern percutaneous intervention, especially in ones labeled as noncrossable lesions. This device has the advantage of crossing lesions that 0.14 wire pass through. The mechanism through which excimer laser coronary atherectomy (ELCA) works are photochemical, photothermal, and photomechanical. In this review cases article, we discuss the uses of ELCA in daily catheterization laboratory alone and with other plaque modification tools. We touch on acute coronary syndrome uses of ELCA, no-balloon crossing lesion, and intervening on deformed stents.
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Morphological changes of coronary arteries in cases of sudden death due to cardiac causes - An autopsy-based 10-year retrospective study
Shivakumarswamy Udasimath, KR Nagesha, Puruhotham Ramaiah
July-September 2021, 22(3):189-195
Introduction: Ischemic heart disease (IHD) is the most common cause of cardiac deaths worldwide, mainly due to atherosclerosis. Prevalence of atherosclerosis evaluation, in an autopsy-based study, can be a valuable tool on subjects who died of cardiac causes. With this hypothesis, we conducted this 10-year retrospective study on the hearts of subjects who died due to cardiac causes. Materials and Methods: This study was conducted from January 2010 to May 2020 at Department of Pathology, Hassan Institute of Medical Sciences, Hassan, Karnataka. Autopsy was conducted at our hospital in the deceased patients who died of suddenly due to cardiac causes. Standard procedures were followed for the removal of intact heart. Heart specimens were sent to our department for histopathological analysis. After fixation in 10% formalin, specimens of the heart were examined in detail. Heart specimens were weighed and measured. The three main coronary arteries were identified and dissected out according to the standard guidelines. These arteries were carefully examined for any histological evidence of atherosclerosis and associated pathological lesions. After detailed study, the lesions were graded according to the classification given by the American Heart Association from Grade I to Grade VI and coronary luminal narrowing by White and Edwards method. Results: Evaluation of a total of 682 autopsy cases was done. In the evaluation, 574 cases were due to sudden cardiac caused deaths. 436 (76.03%) subjects had evidence of atherosclerosis in coronary arteries. In our study, 468 (81.53%) were male and remaining 106 (18.46%) were female. The most commonly involved coronary artery was left anterior descending coronary artery (LADA, 412 cases, 71.74%). Triple-vessel disease was found in 118 cases (20.55%) of subjects. Conclusion: In Indian population, atherosclerosis of the coronary arteries begins at a younger age. Therefore, thorough screening for the same should begin at an early age. Our study showed alarmingly high prevalence of atherosclerosis in coronary arteries, especially in the LADA. Coronary atherosclerosis is an important risk factor for IHDs in both sexes, even though the incidence of atherosclerosis is more common in males when compared to females.
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Interventricular septal hematoma: A rare complication of retrograde chronic total occlusion intervention
Mohamed Salah Abdelghani, Ammar Chapra, Hossam Abed, Awad Al-Qahtani, Fahad Alkindi
July-September 2021, 22(3):201-205
Retrograde percutaneous coronary intervention to chronic total occlusion coronary arteries can have complications due to its complexity. One of its complications is an interventricular septal hematoma which we report here.
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Intervention challenges in patients with congenital heart disease with coexisting interruption of the inferior vena cava - A case series
Saurabhi Das, Mahua Roy, Amitabh Chattopadhya, Debasree Ganguly
July-September 2021, 22(3):224-230
Interruption of the inferior vena cava with azygos continuation is a rare congenital anomaly. This anomaly becomes clinically important during cardiac interventions.
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Rachel Hajar
July-September 2021, 22(3):233-234
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Cardiac amyloidosis
Salah Elbdri, Rachel Hajar
July-September 2021, 22(3):231-232
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First case of tricuspid valve surgery in a neurofibromatosis type 1 patient
Matteo Saccocci, Francesco Ferraro, Stefania Blasi, Niccolò Del Zanna, Emmanuel Villa, Antonio Messina, Marco Cirillo, Zean Mhagna, Margherita Dalla Tomba, Giovanni Troise
July-September 2021, 22(3):214-219
The neurofibromatosis is a large class of different genetic disorders: Neurofibromatosis type 1, type 2, type 3 (or Schwannomatosys), which have different clinical characterization. Neurofibromatosis type 1 (NF1), also known as Von Recklinghausen disease, represents 95% of the total cases. It is a complex autosomal dominant disorder with multisystem involvement, frequently associated to cardiac malformation. We present the case of a 52-years-old male affected by NF-1 with severe tricuspid regurgitation and atrial septal defect (ASD). No previous report about tricuspid valve surgery in NF-1 are available in the literature. A complete perioperative assessment was performed, including dermatologist evaluation, angio-CT scan and trans-esophageal echocardiography. The patient underwent uneventfully tricuspid valve replacement and ASD closure, with no wound complication even at 6-months follow-up. Treating congenital malformation in patient with complex genetic disorders like NF-1 is safe and can be resolutive, permitting to reduce long-term risk of complications for the patients. Preoperative assessments are fundamental, as well as in-hospital care and expertise on congenital heart defects.
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Transcatheter mitral valve repair using mitraclip in secondary mitral valve regurgitation guided by real-time pressure–volume loops
Samantha Espinosa, Abdallah El Sabbagh, Atta Behfar, Parag Patel
July-September 2021, 22(3):212-213
Worsening of left ventricular (LV) function is a potential complication after repair of secondary mitral valve regurgitation, and one which has limited methods for predicting its risk of occurrence. We present a case utilizing real-time pressure–volume loops intraprocedurally to monitor hemodynamic changes before and after application of a trancatheter MitraClip device in a patient with severe symptomatic secondary mitral regurgitation (MR). Worsening of LV function is a potential complication after repair of secondary mitral valve regurgitation. We present a case utilizing real-time pressure–volume loops intraprocedurally to monitor hemodynamic changes before and after application of a transcatheter MitraClip device in a patient with severe symptomatic secondary MR.
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Surgical resection of very small multiple papillary fibroelastomas of the aortic valve
Dritan Useini, Markus Schlömicher, Matthias Bechtel, Justus Strauch
July-September 2021, 22(3):220-223
Papillary fibroelastomas (PFEs) in multiple presentations on the aortic valve surface are extremely rare tumors that can cause sudden major cardio-cerebral adverse events. The treatment of these tumors varies from conservative care strategy to curative surgical resection. The bigger the tumor size, the bigger seems the tendency toward surgical treatment concepts. Here, we present the case of a completely healthy young woman who suffered sudden myocardial infarction and occlusion of the circumflex artery caused by very small multiple PFEs of the aortic valve. The patient underwent cardiac surgery for resection at our institution. The surgical approach appears to be recommended as a solitary reasonable treatment option once multiple PFEs have been detected.
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