Research in Cardiovascular Medicine
Volume:12 Issue: 43, Apr-Jun 2023

Major adverse cardiovascular events (MACEs) are frequently encountered in patients undergoing noncardiac surgeries. This study evaluated the utility of cardiac troponin I (cTnI) and brain natriuretic peptide (BNP) to predict MACE in elderly patients (aged ≥60 years) undergoing noncardiac surgeries.

This comparative cross-sectional study was carried out at a tertiary care center in India between November 2016 and August 2018. A total of 136 consecutive patients (aged ≥60 years) presenting for noncardiac surgeries under general/spinal/regional anesthesia in the departments of surgery, orthopedics, or gynecology were included in the study. Patients with chronic kidney disease stages 4 and 5 and those receiving hemodialysis or peritoneal dialysis for renal failure were excluded from the study. Peripheral blood samples for BNP and cTnI were obtained within 24 h preoperatively. The primary endpoint was the occurrence of MACE, defined as the composite of cardiac death, nonfatal myocardial infarction, heart failure, arrhythmias, and cardiac arrest at 6 days postsurgery.

The mean age of patients was 69.41 ± 7.56 years. Females comprised 54.1% of the study population. During the perioperative period and follow-up of 6 days, 12 MACE were recorded. Preoperative cTnI levels alone or both cTnI and BNP together (cTnI levels >0.07 ng/mL and BNP levels >40 pg/mL) increased significantly in the patients who experienced MACE (P < 0.05). The area under receiver operating characteristics curve for cTnI and BNP for predicting perioperative cardiac events was 0.817 (95% confidence interval [CI] 0.646–0.988; P < 0.001) and 0.520 (95% CI 0.337–0.704; P = 0.817), respectively.

In elderly patients undergoing noncardiac surgeries, a preoperative assessment of BNP and cTnI may help in the assessment of MACE.

Recent randomized controlled trials have demonstrated the benefit of patent foramen ovale (PFO) device closure over medical therapy alone for secondary prevention of cryptogenic stroke in carefully selected patients. In the current study, we sought to investigate the outcomes and complications of PFO device closure in our referral tertiary cardiovascular center.

In this retrospective study, 155 adult patients who underwent PFO device closure between 2006 and 2021 were included. Patient characteristics, recurrent neurologic events, and procedure-related complications were evaluated.

The follow-up period was 2.3 ± 1.2 years. The average age of the participants was 41.3 ± 10 years, and 59.4% were male. Six patients(3.9%) suffered recurrent cerebrovascular events in the follow‑up. No procedure‑related complications were reported in our study population. Two patients (1.3%) with recurrent stroke had developed newly diagnosed atrial fibrillation (AF).

PFO device closure is a safe and effective method for the prevention of recurrent ischemic stroke in patients with no other detectable etiology. Patients, particularly those with cardiovascular risk factors, should be meticulously investigated for the asymptomatic episodes of AF as the contributing factor with prolonged Holter monitoring or use of loop recorders.

Reperfusion can be done through primary percutaneous coronary intervention (PPCI) and thrombolytic administration. Patients with myocardial infarction should receive antiplatelet drugs from the P2Y12 receptor inhibitor category (such as ticagrelor, prasugrel, and clopidogrel). Based on recent researches, effectiveness of ticagrelor versus clopidogrel is still debatable.

A total of 128 patients who underwent PPCI, divided into two groups (Zyllt® group (600 mg received as a loading dose, maintenance with dose of 75 mg daily)) and Ticora® group (180 mg as a loading dose, maintenance with dose of 90 mg twice). Both the groups received aspirin 80 mg daily, too. They were followed up after 3 months.

In this study, 86.9% were men, and there was no significant difference in terms of gender and age in 2 groups. Risk factors, type of myocardial infraction (MI), number of involved and infarct‑related arteries, and presence of complications and their type were not statistically different in groups (P > 0.05). Among all complications, only one person had dyspnea in the Ticora group, one patient in the Ticora group, and 3 patients in the Zyllt group had chest pain. The difference in “TIMI Score” during Time was significant (P = 0.037).

Our study shows no difference between ticagrelor and clopidogrel after PPCI in patients with MI in terms of risk factors, type of MI, number of involved and infarct‑related arteries, and presence of complications and their type, in two studied groups.

This study aimed to establish a clinically relevant animal model for peripheral arterial disease (PAD) that better replicates the complexity observed in human patients.

Thirty male rats were randomly assigned into the sham (SM), femoral artery resection (FE), constrictor-induced ischemia (CI), two-stage ischemia (TS), or diabetic two-stage ischemia (DT) groups. In the FE group, rats underwent femoral artery resection, whereas the SM group had sham surgery. The CI group received progressive ischemia using two ameroid constrictors, and the TS and DT groups underwent a two-stage ischemia procedure involving initial gradual narrowing with two ameroid constrictors and subsequent femoral artery resection in healthy and diabetic rats, respectively. Perfusion evaluation and functional assessment were conducted at postoperative days 14, 28, and 42. On day 42, hypoxia-inducible factor (HIF)-1α and vascular endothelial growth factor (VEGF) protein expression were measured, along with histological examination and immunofluorescence analysis.

Motor function deficits and reduced limb reperfusion were most prominent in the TS and DT groups on days 28 and 42 (P < 0.05), exacerbated by type 2 diabetes. Gastrocnemius exhibited upregulated HIF-1α and VEGF protein expression, as well as increased capillary density in response to ischemia. However, the DT group showed significantly lower protein expression and capillary density, along with more severe structural damage compared to other groups (P < 0.05).

A clinically relevant rat model of PAD was established by implementing a twostage ischemia procedure involving initial progressive narrowing and subsequent femoral artery excision in the context of diabetes.

Despite many well‑documented benefits of the transvenous implantable cardioverter‑defibrillator in appropriate patients, there is a strong preference today for subcutaneous implantable cardioverter‑defibrillator (S‑ICD) implantation due to the significant late complications associated with intravenous leads, especially in young patients. We report on an 18-year-old woman with S-ICD due to hypertrophic cardiomyopathy who had idiopathic dextroscoliosis. In the follow-up analysis, we observed a disturbance in the normal detection of QRS complexes by the device, which significantly reduced when the patient changed the position from standing to supine and when the brace was closed. According to the absence of lead displacement in the chest radiograph, S‑ICD sense impairment was suggested due to skeletal deformity. Due to not solving this problem with device reprogramming, we had to reposition of the S-ICD lead in our patient.