International Cardiovascular Research Journal
Volume:15 Issue: 4, Dec 2021

Post-Operative Atrial Fibrillation (POAF) is the most common cardiac arrhythmia, which occurs in nearly 15 - 40% of patients after Coronary Artery Bypass Graft (CABG) surgery. However, the exact mechanism of POAF development is unclear.

The present study aimed to investigate whether ischemic severity and preoperative coronary collateral circulation grade were associated with the development of POAF.

This cross-sectional, observational study assessed 246 patients who underwent CABG surgery from September 2017 to September 2019. The patients were divided into two groups according to the development of POAF; 51 patients in the POAF group and 195 patients in the group without POAF. Clinical variables were recorded. Additionally, coronary collateral circulation and the severity of coronary artery disease were assessed and recorded for each patient according to Rentrop classification and Gensini score.

POAF was observed in 51 patients (20.7%). The results of multivariate analysis showed that chronic obstructive pulmonary disease (OR = 5.4, CI = 1.17 - 25.1, P = 0.03) was the independent predictor of POAF development. However, no significant association was found between the development of POAF and coronary collateral circulation (OR = 0.82, CI = 0.44 - 1.52, P = 0.54) and severity of coronary artery disease (OR = 0.98, CI = 0.42 - 2.29, P = 0.97). Furthermore, the coronary collateral circulation status was poorer in patients with the history of chronic obstructive pulmonary disease who developed POAF.

Preoperative coronary collateral circulation and severity of coronary artery disease were not associated with the development of POAF. However, patients with the history of chronic obstructive pulmonary disease who developed POAF had poorer coronary collateral circulation, indicating that hypoxia might play a role in the development of POAF.

Heart Failure with Reduced Ejection Fraction (HFrEF) is a paramount medical condition affecting more than 23 million individuals worldwide. It is one of the leading causes of morbidity and mortality, particularly in the western world, making it a vital topic of discussion in the current clinical trials.

This study aimed to describe the response to sacubitril/valsartan in a group of Hondurans with heart failure and reduced Left Ventricular Ejection Fraction (LVEF) between January 2018 and June 2020.

This observational, descriptive, retrospective cohort study was conducted on 105 adult patients with HFrEF who received treatment with angiotensin-receptor antagonist/neprilysin inhibitors (sacubitril/valsartan) in a single medical center in Honduras. The study participants included the patients with LVEF < 40% treated with sacubitril/valsartan for at least one year. The patients also received optimal medical therapy for HFrEF according to the American Heart Association guidelines. The data were analyzed using the SPSS 25.0 software.

The results showed that the main etiology of HFrEF was ischemic heart disease (41%). The LVEF changed from a median of 30% to 45% after one year of treatment. Additionally, the overall Glomerular Filtration Rate (GFR) remained unchanged. However, the N-Terminal Pro B-type Natriuretic Peptide (NTProBNP) decreased from a median of 8800 pg/mL to 1900 pg/mL after 12 months.

The study population had sociodemographic and clinical similarities with the Latin American Cohort in the PARADIGM-HF trial with the significant improvement of the LVEF and functional class. However, the median level of NTProBNP was 8800 pg/mL at baseline in the current study, which was dramatically higher than 1760 pg/mL reported in the PARADIGM-HF trial, suggesting the need for further analyses in the Honduran population.

Myocardial protection during cardiopulmonary bypass requires essential techniques to preserve myocardial function and protect the myocardium from cellular damage.

This study aimed to investigate the efficacy of del Nido cardioplegia in mitral valve surgery compared to Buckberg solution.

All patients who underwent mitral valve surgery from April 2018 to December 2018 were recruited in the present trial. The patients were assigned randomly into del Nido and Buckberg groups. Trans-thoracic and trans-esophageal echocardiography were performed before and after the procedure to evaluate left ventricular ejection fraction, as the primary outcome.

A total of 152 patients (77 in the del Nido group and 75 in the Buckberg group) were included in the final analysis. The mean age of the participants was 51.3 ± 13.4 years, and 55.3% of the patients were female. The two groups were comparable in terms of all baseline characteristics. The results also showed no significant difference between the two groups regarding pre-operative ejection fractions (P = 0.063). However, ventilation time and the mean length of ICU stay were higher in the Buckberg group (0.018 and 0.001, respectively). Moreover, the results indicated a more prominent reduction in left ventricular ejection fraction measured via trans-thoracic and trans-esophageal echocardiography in the Buckberg group compared to the del Nido group (13.7% versus 4.7%, P < 0.001 for trans-thoracic echocardiography).

Del Nido cardioplegia solution exerted beneficial effects on myocardial protection evaluated by echocardiography compared to Buckberg in adult patients with preserved ejection fraction undergoing mitral valve surgery

In Heart Failure reduced Ejection Fraction (HFrEF), there is a clear Guideline Directed Medical Therapy (GDMT) for drug treatment. However, there are usually differences between what is recommended and what is actually done in the community. Additionally, no clear data are available regarding the types and doses of drugs used for HFrEF in patients with chronic heart failure.

The present study aimed to investigate the current drug treatment for HFrEF in the community.

This cross-sectional study aimed to investigate the types and doses of drugs used by cardiologists for HFrEF patients. The data were collected using a researchermade questionnaire by attending cardiologists’ offices and reviewing patients’ drugs. Considering the probability of 20% of patients using optimal drug doses (according to a pilot study), the sample size was estimated as 250 patients. Thus, 300 patients with stable drug regimens for three months were enrolled into the study.

The mean age of the patients was 62.3 ± 14 years and 65% were male. The mean Left Ventricular Ejection Fraction (LVEF) was 27.3 ± 7%. Additionally, the rates of using Beta Blockers (BBs), Angiotensin Converting Enzyme Inhibitors/Angiotensin Receptor Blockers (ACEIs/ARBs), and Mineralocorticoid Receptor Antagonists (MRAs) were 91%, 89%, and 63%, respectively. Only 5% of the patients received the target dose of BBs and 11% took the target dose of ACEs/ARBs. A significant gap was discerned between the recommended target doses and the patients’ current doses.

The frequency of consumption of BBs, ACEs/ARBs, and MRAs in HFrEF was reasonably acceptable in the study population. However, there was a marked difference between the recommended and actual drug doses for HFrEF. Hence, further studies are required to evaluate and resolve the barriers.

Considering the high prevalence of cardiovascular diseases, angiography is important for diagnosis of diseases, pain, and fatigue following complete bed rest after percutaneous coronary intervention.

This study aimed to evaluate the effects of hand and foot surface stroke massage on pain intensity and anxiety level in hospitalized patients with acute coronary syndrome.

This clinical trial was conducted on 70 patients with acute coronary syndrome referred to Hajar Hospital, Shahrekord, Iran. The patients were randomly divided into an intervention and a control group (n = 35 for each). Anxiety level was measured using Spielberger’s Anxiety Inventory. Additionally, pain intensity was assessed by a visual analog scale 30 min before and 15 min after the intervention. The data were entered into the SPSS software and were analyzed using descriptive and inferential statistics (t-test, paired t-test, and chi-square test).

Descriptive statistics included frequency and percentage for qualitative variables and mean ± Standard Deviation (SD) for normally distributed quantitative variables. The results revealed a significant decrease in the mean intensity of pain and the mean level of anxiety in the intervention group five minutes after massage. However, no significant difference was observed in this regard in the control group after the intervention. Additionally, no significant difference was observed between the two groups in terms of pain intensity and anxiety level before the intervention (P ≤ 0.05).

Hand and foot massage was useful as a part of a nursing intervention in attenuating the pain intensity and decreasing the anxiety level in the patients with acute coronary syndrome.

Aortic Stenosis (AS) and Abdominal Aortic Aneurysm (AAA) typically affect elderly patients, both being associated with adverse outcomes if not adequately managed. Notably, these conditions can be present simultaneously in a significant percentage of cases. Choosing the optimal treatment for these patients is challenging and no clear recommendations are available. Yet, simultaneous treatment by the percutaneous intervention, especially in high surgical risk patients, appears attractive.

Herein, three cases of AAA and severe AS treated via Transcatheter Aortic Valve Implantation (TAVI) and Endovascular Aortic Repair (EVAR) within the same procedure have been reported in details for the first time.

The results indicated that one-stage intervention was an effective, safe, and feasible treatment for these two pathologies, especially in frail patients.

One of the common extrapulmonary involvements in COVID-19 is the cardiovascular system. The reported cases of arrhythmias were mainly among patients with such symptoms as dyspnea, palpitation, chest tightness, and syncope. This study aimed to present a COVID-19 case with gastrointestinal symptoms who developed complete Atrioventricular (AV) block.

The patient was a 19-year-old man with an active lifestyle and no previous illnesses who was admitted to the local hospital due to fever, fatigue, constipation, and one episode of syncope. In the primary evaluation, he had bradycardia and elevated C-Reactive Protein (CRP). In addition, the Real-Time fluorescence Polymerase Chain Reaction (RT-PCR) was positive for SARS-COV-2. Thus, he was referred to a tertiary hospital for management. The electrocardiogram revealed complete AV block and elevated cardiac troponin I level. However, echocardiography was normal. The patient was admitted to the intensive care unit and a temporary pacemaker was inserted. Then, the patient was transferred to the COVID ward and stayed there for nine days. During the admission, cardiac rhythm became sinusal and an improvement was observed in the patient’s general condition. Thus, he was discharged. In two weekly follow-up visits after discharge, the patient was asymptomatic and the ECG did not change. Follow-up echocardiography was also normal.

Cardiac involvement may occur in healthy individuals without cardiac risk factors and respiratory or cardiac presentations due to COVID-19 infection.