Pulmonary hypertension among maintenance hemodialysis patients in Somalia: a hospital-based observational studySpringer Science and Business Media LLC - Tập 74 - Trang 1-7 - 2022
Gökhan Alıcı, Mohamud Mire Waberi, Mohamed Abdullahi Mohamud, Ahmed Muhammad Bashir, Ömer Genç
This study aims to examine the prevalence and related factors of pulmonary hypertension (PHT) in patients on hemodialysis (HD) at the only referral institution in Somalia. A total of one hundred and forty-three patients who had received regular HD therapy for at least three months and underwent transthoracic echocardiography (TTE) were included in the study. Patients with a systolic pulmonary artery pressure (sPAP) value > 35 mmHg at rest on TTE were considered having PHT. The relationship of TTE parameters, demographic, and clinic characteristics of participants with PHT were evaluated. The number of patients with PHT was 73 (51%). The mean age was 54.2 ± 18.4 years. The majority of patients were 65 years of age or older. (n: 46, 32.2%) and 65 (45.5%) were male. Median sPAP was found to be 35 mmHg. Systolic pulmonary artery pressure was positively correlated with right atrium (RA) diameter (r: 0.6, p < 0.001) and negatively correlated with left ventricular ejection fraction (LVEF) (r: − 0.4, p < 0.001). In addition, LVEF, RA diameter, presence of pericardial effusion (PE) were found to be independent predictors of PHT. Pulmonary hypertension has a relatively high prevalence in end-stage renal disease (ESRD) patients on regular HD. Besides, the presence of PE and certain right and left heart parameters were independently associated with PHT.
Prognostic value of right ventricular diastolic dysfunction in patients with inferior ST-elevated myocardial infarctionSpringer Science and Business Media LLC - Tập 75 Số 1
Ahmed Mahmoud El Amrawy, Shaimaa Abd ElKhalek Zaghloul, Eman Mohamed El Sharkawy, Mohamed Sobhy
Abstract
Background
Right ventricle infarction (RVI) is predominantly a complication of inferior wall myocardial infarction; it occurs in approximately one third of these patients. Right ventricular dysfunction in patients with inferior STEMI and RV infarction was under assessed. Nevertheless, studies which targeted RV assessment by echocardiography, did not routinely evaluate RV diastolic dysfunction. In this study, we aimed to evaluate RV diastolic dysfunction and its prognostic value in patients with inferior STEMI and RVI.
Results
Sixty patients with inferior STEMI and RV infarction, who underwent primary PCI were enrolled in the study. Patients with pre-existing clinical conditions that might affect RV function, were excluded. Echocardiography was performed within twenty-four hours following the PCI, to assess the RV systolic and diastolic functions with special focus on tricuspid inflow velocities (E velocity, A velocity and E/A ratio) by pulsed wave (PW) doppler and tricuspid annular velocities by tissue doppler index (TDI) (E′, A′ and E/E′ ratio). Clinical features and MACE, including cardiogenic shock, arrhythmia, stroke, reinfarction and death were analyzed in all our patients within 3 months follow up period. The average age of the study population was 51.58 ± 10.11 years, 10% were females. Five patients developed MACE (death, cardiogenic shock and pulmonary edema, anterior STEMI and cardiogenic shock, recurrent inferior STEMI, and arrhythmia and stroke), of whom four occurred in hospital within the first 48 h. Patients who developed MACE had high filling pressures, as all of them had E/E′ > 6. E′ velocity ≤ 6 cm/sec was associated with increased MACE as 25% of patients with E′ velocity ≤ 6 had MACE compared with 2.3% of patients with E′ velocity > 6 with a p value of 0.015.
Conclusions
Tricuspid annular velocities by TDI are essential when evaluating RV diastolic dysfunction. E/E′ and E′ velocity have a prognostic value in patients with inferior STEMI and RV infarction; E/E′ > 6 and E′ velocity ≤ 6 cm/sec were associated more MACE in patients with inferior STEMI and RVI.
Use of a deep-learning-based lumen extraction method to detect significant stenosis on coronary computed tomography angiography in patients with severe coronary calcificationSpringer Science and Business Media LLC - Tập 74 - Trang 1-11 - 2022
Hidekazu Inage, Nobuo Tomizawa, Yujiro Otsuka, Chihiro Aoshima, Yuko Kawaguchi, Kazuhisa Takamura, Rie Matsumori, Yuki Kamo, Yui Nozaki, Daigo Takahashi, Ayako Kudo, Makoto Hiki, Yosuke Kogure, Shinichiro Fujimoto, Tohru Minamino, Shigeki Aoki
Coronary computed tomography angiography examinations are increasingly becoming established as a minimally invasive method for diagnosing coronary diseases. However, although various imaging and processing methods have been developed, coronary artery calcification remains a major limitation in the evaluation of the vascular lumen. Subtraction coronary computed tomography angiography (Sub-CCTA) is a method known to be able to reduce the influence of coronary artery calcification and is therefore feasible for improving the diagnosis of significant stenosis in patients with severe calcification. However, Sub-CCTA still involves some problems, such as the increased radiation dose due to plain (mask) imaging, extended breath-holding time, and misregistration due to differences in the imaging phase. Therefore, we considered using artificial intelligence instead of Sub-CCTA to visualize the coronary lumen with high calcification. Given this background, the present study aimed to evaluate the diagnostic performance of a deep learning-based lumen extraction method (DL-LEM) to detect significant stenosis on CCTA in 99 consecutive patients (891 segments) with severe coronary calcification from November 2015 to March 2018. We also estimated the impact of DL-LEM on the medical economics in Japan. The DL-LEM slightly improved the per-segment diagnostic accuracy from 74.5 to 76.4%, and the area under the curve (AUC) slightly improved from 0.752 to 0.767 (p = 0.030). When analyzing the 228 segments that could not be evaluated because of severe calcification on the original CCTA images, the DL-LEM improved the accuracy from 35.5 to 42.5%, and the AUC improved from 0.500 to 0.587 (p = 0.00018). As a result, DL-LEM analysis could have avoided invasive coronary angiography in 4/99 cases (per patient). From the calculated results, it was estimated that the number of exams that can be avoided in Japan in one year is approximately 747 for invasive coronary angiography, 219 for fractional flow reserve, and 248 for nuclear exam. The total amount of medical fee that could be reduced was 225,629,368 JPY. These findings suggest that the DL-LEM may improve the diagnostic performance in detecting significant stenosis in patients with severe coronary calcification. In addition, the results suggest that not a small medical economic effect can be expected.
Relation of the left ventricular geometric patten to coronary artery disease in hypertensive patients using a 320-detector-row CT scannerSpringer Science and Business Media LLC - Tập 75 - Trang 1-11 - 2023
Ahmed Shehata Mohamed Ismail, Mohamed Ahmed Aouf, Reda Hussein Diab, Yasser Kamel Baghdady
It was estimated that about 1.3 billion people were diagnosed to be hypertensive in 2015. All countries consistently show this high prevalence. Ischemic heart disease stands as the most common cause of systolic blood pressure-related deaths per year. Left ventricular hypertrophy determined by echocardiography can predict cardiovascular morbidity and mortality. The question of whether the LV geometric pattern has an additional prognostic value is still not clearly answered. Currently, coronary computed tomography is widely used in clinical practice with a great capability of simultaneous evaluation of the LV mass and the coronary arterial tree. Our study aims to examine the relationship between LV mass and geometry and coronary artery disease using an ECG-gated 320-detector- row CT scanner. Two hundred ninety-eight hypertensive Egyptian individuals were enrolled in our study, the mean age was 57.5 ± 10.5, and males comprised 76.5% of the study population. The mean LV mass and LV mass index were 193 ± 60 gm and 95.2 ± 27.5 g/m2 respectively. One-fifth of the patient had CAD luminal stenosis ≥ 50%. Normal LV geometric pattern was observed in about 37% of the study population. About one-third of the patients showed concentric remodeling. Patients with increased LV mass index represented one-third of the study population with a greater percentage of the concentric hypertrophy pattern than the eccentric hypertrophy pattern. Patients with high CAD-RADS showed statistically significant higher LV mass, LV mass index, and septal wall thickness. Patients with high CAD-RADS showed a greater percentage of concentric and eccentric hypertrophy. The LV geometric pattern was the only independent predictor of the high CAD-RADS. The LV geometric patterns associated with high RADS ordered from the highest to the lowest, were concentric LVH, Eccentric LV, and concentric remodeling. LV geometric pattern is the only independent predictor of high CAD-RADS after adjustment for LV mass index and septal wall thickness. Among abnormal LV geometric patterns, concentric hypertrophy stands as the most important predictor of high CAD-RADS.
Drug-eluting stent for acute Blalock-Taussig shunt thrombosis in a child—case reportSpringer Science and Business Media LLC - Tập 72 - Trang 1-3 - 2020
Arun Gopalakrishnan, Bijulal Sasidharan, Sabarinath Menon, Kavassery Mahadevan Krishnamoorthy
Blalock-Taussig shunt (BTS) continues to have a relatively high operative and short-term mortality, even in the current era. We report the use of drug-eluting stent in a child with acute shunt thrombosis, which has not been reported in the literature to date. A 7-month-old boy with double outlet right ventricle, severe pulmonary stenosis, and normally related great arteries underwent BTS placement for cyanotic spells. Ten days after discharge, he presented with shock due to a blocked BTS. He underwent emergency percutaneous revascularization of the shunt with a drug-eluting stent and is doing well at 9 months’ follow-up on dual antiplatelet therapy. Drug-eluting stents may be used in children with BTS thrombosis.
Disparities of demographics, clinical characteristics, and hospital outcomes of AMI pilgrims vs non-pilgrims—tertiary center experienceSpringer Science and Business Media LLC - Tập 72 - Trang 1-8 - 2020
Sheeren Khaled, Walaa Eldeen Ahmed, Ghada Shalaby, Hadeel Alqasimi, Rahaf Abu Ruzaizah, Mryam Haddad, Mroj Alsabri, Seham Almalki, Heba Kufiah, Fatma Aboul Elnein, Najeeb Jaha
Acute myocardial infarction (AMI) is usually caused by rupture of an atherosclerotic plaque leading to thrombotic occlusion of a coronary artery. Cardiovascular disease has recently emerged as the leading cause of death during hajj. Our aim is to demonstrate the AMI pilgrim’s related disparities and comparing them to non-pilgrim patients. Out of 3044 of patients presented with AMI from January 2016 to August 2019, 1008 (33%) were pilgrims. They were older in age (P < 0.001) and showed significantly lower rates cardiovascular risk factors (P < 0.001 for DM, smoking, and obesity). Pilgrims were also less likely to receive thrombolytic therapy (P < 0.001), show lower rate of late AMI presentation (P < 0.001), develop more LV dysfunction post AMI (P < 0.001), and have critical CAD anatomy in their coronary angiography (P < 0.001 for MVD and = 0.02 for LM disease) compared to non-pilgrim AMI patients. Despite AMI pilgrims recorded higher rate of primary percutaneous coronary intervention (PPCI) procedures, they still showed poor hospital outcomes (P < 0.001, 0.004, < 0.001, 0.05, and 0.001, respectively for pulmonary edema, cardiogenic shock, mechanical ventilation, cardiac arrest, and in-hospital mortality, respectively). Being a pilgrim and presence of significant left ventricular systolic dysfunction, post AMI was the two independent predictors of mortality among our studied patients (P = 0.005 and 0.001, respectively). Although AMI pilgrims had less cardiovascular risk factors and they were early revascularized, they showed higher rates of post myocardial infarction complication and poor hospital outcomes. Implementation of pre-hajj screening, awareness and education programs, and primary and secondary preventive measures should be taken in to consideration to improve AMI pilgrim’s outcome.
The treatment dilemma in adult patients with peripheral pulmonary artery stenosis of diverse etiologiesSpringer Science and Business Media LLC - - 2021
Zahra Hosseini, Ata Firouzi, Bahram Mohebbi, Ehsan Khalilipur, Mohammadreza Baay, Kiara Rezaei Kalantari, Iman Harirforoosh, Zahra Khajali
Peripheral pulmonary artery stenosis (PPAS) is a rare and underdiagnosed phenomenon that is reported infrequently in adult patients. Most patients with PPAS have concomitant congenital heart diseases, a history of palliative surgical therapies during childhood, or syndromic characteristics. Acquired cases are rare, and they are underestimated in adulthood and managed inappropriately. This case series describes 3 adult patients with PPAS of diverse etiologies and discusses their underlying causes, diagnostic modalities, and treatment strategies. In patients with PPAS, sufficient heed should be paid to endovascular interventions such as balloon dilation and primary or bailout stenting, not least vis-à-vis the type and size of balloons or stents as well as complications and preventive strategies.
Longitudinal stent elongation or shortening after deployment in the coronary arteries: which is dominant?Springer Science and Business Media LLC - Tập 73 - Trang 1-11 - 2021
Magdy Algowhary, Mohammed Aboel-Kassem F. Abdelmegid
Stent manufacturers always record stent shortening data while they do not record stent elongation data. The aim of this study is to identify both stent shortening and elongation occurring after deployment in the coronary arteries and know their percentage. The length of coronary stents was measured by intravascular ultrasound (IVUS) by (1) edge-to-edge (E-E) length, measured from the appearance of the first distal strut to the last proximal strut, and (2) area-to-area (A-A) length, measured from the first distal struts seen at more than one IVUS quadrant to the last proximal struts seen at more than one IVUS quadrant. Stent shortening was defined as both E-E and A-A lengths were shorter than the manufacturer box-stated length (shortened group). Stent elongation was defined as both E-E and A-A lengths were longer than the manufacturer box-stated length (elongated group), otherwise unchanged group. Consecutive 102 stents deployed in ischemic patients were included. Stent elongation was detected in 67.6% (69 stents), and shortening was detected in 15.7% (16 stents), while unchanged stents were detected in 16.7% (17 stents). Although the 3 groups had similar box-stated length and predicted foreshortened length, they had significantly different measurements by IVUS, p<0.001 for each comparison. Differences from box-stated length were 1.9±1.4mm, −1.4±0.4mm, and 0.4±0.3mm, respectively, p<0.001. The elongated group had significantly longer differences from the corresponding box-stated and predicted foreshortened lengths, while the shortened group had significantly shorter differences from the corresponding box-stated length and similar foreshortened length. By multinomial regression analysis, the plaque-media area and stent deployment pressure were the independent predictors of the stent length groups, p=0.015 and p=0.026, respectively. Change in stent length is not only shortening—as mentioned in the manufacturer documents—but also stent elongation. Stent elongation is dominant, and the most important predictors of longitudinal stent changes are plaque-media area and stent deployment pressure.
QT dispersion có thể cải thiện độ chính xác của bài kiểm tra ECG gắng sức trong việc phát hiện thiếu máu cơ tim ở bệnh nhân CAD ổn định mãn tính? Một nghiên cứu hình ảnh tưới máu cơ tim trong điều kiện căng thẳng Dịch bởi AI Springer Science and Business Media LLC - Tập 73 Số 1 - 2021
Mohammad El Tahlawi, Ahmed Mohamed Sanad, Kamel Hasan Ghazal, Ahmed Taha Abdelwahed
Tóm tắtĐặt vấn đềPhân tán QT (QTd) liên quan đến các biến thể khu vực trong sự tái phân cực cơ tim. Nghiên cứu của chúng tôi nhằm đánh giá giá trị của QTd trong việc dự đoán thiếu máu cơ tim và mức độ nghiêm trọng của nó trong quá trình chẩn đoán hình ảnh gắng sức.
Chúng tôi đã tuyển chọn một trăm bệnh nhân mắc bệnh động mạch vành ổn định (CAD) và đáp ứng các "tiêu chí phù hợp cho hình ảnh hóa radionuclide tim" (MPI). Họ được chia thành nhóm I bao gồm các bệnh nhân có thiếu máu được phát hiện qua MPI (50 bệnh nhân) và nhóm II bao gồm các bệnh nhân có hình ảnh perfusion bình thường (50 bệnh nhân). Chúng tôi đã loại trừ các trường hợp CAD không ổn định và tất cả các nguyên nhân khác ảnh hưởng đến QTd. Trong quá trình quét đồng vị, ECG được ghi lại và QTd được tính toán ở trạng thái nghỉ ngơi và khi nhịp tim đạt tối đa.
Kết quảQTd cao hơn đáng kể ở nhóm thiếu máu cả khi nghỉ ngơi và khi hoạt động (P= 0.000). Sự khác biệt QTd, tức là sự khác biệt giữa QTd khi nghỉ ngơi và khi căng thẳng, đã được tính toán. Sự khác biệt QTd thấp hơn đáng kể ở nhóm bình thường so với nhóm thiếu máu (P= 0.003). Có sự tương quan dương đáng kể giữa sự khác biệt QTd và kích thước khiếm khuyết (P= 0.04).
Kết luậnQTd tăng lên trong thiếu máu và sự khác biệt QTd (giữa nghỉ ngơi và căng thẳng) tương quan dương với mức độ nghiêm trọng của thiếu máu.
QTd và sự khác biệt QTd có thể được sử dụng để cải thiện độ chính xác của bài kiểm tra hình ảnh gắng sức.
