Cardiology Research and Practice The latest articles from Hindawi © 2018 , Hindawi Limited . All rights reserved. Retracted: Subclinical Hypothyroidism and Its Association with Increased Cardiovascular Mortality Sun, 14 Jan 2018 00:00:00 +0000 Cardiology Research and Practice Copyright © 2018 Cardiology Research and Practice. All rights reserved. Corrigendum to “Current Status of Sodium Bicarbonate in Coronary Angiography: An Updated Comprehensive Meta-Analysis and Systematic Review” Mon, 08 Jan 2018 00:00:00 +0000 Sadeq Ali-Hasan-Al-Saegh, Seyed Jalil Mirhosseini, Elham Rahimizadeh, Zahra Ghodratipour, Zahra Sarrafan-Chaharsoughi, Ali Mohammad Dehghan, Mohammad Reza Lotfaliani, Mohammad Rezaeisadrabadi, Elham Kayvanpour, Farbod Sedaghat-Hamedani, Mohamed Zeriouh, Alexander Weymann, Anton Sabashnikov, and Aron-Frederik Popov Copyright © 2018 Sadeq Ali-Hasan-Al-Saegh et al. All rights reserved. Recurrent Stroke after Transcatheter PFO Closure in Cryptogenic Stroke or Tia: Long-Term Follow-Up Thu, 21 Dec 2017 00:00:00 +0000 Background. There are few data on the mechanism of recurrent neurological events after transcatheter closure of patent foramen ovale (PFO) in cryptogenic stroke or TIA. Methods. We retrospectively reviewed PFO closure procedures for the secondary prevention of cryptogenic stroke/TIA performed between 1999 and 2014 in Bologna, Italy. Results. Written questionnaires were completed by 402 patients. Mean follow-up was 7 ± 3 years. Stroke recurred in 3.2% (0.5/100 patients-year) and TIA in 2.7% (0.4/100 patients-year). Ninety-two percent of recurrent strokes were not cryptogenic. Recurrent stroke was noncardioembolic in 69% of patients, AF related in 15% of patients, device related in 1 patient, and cryptogenic in 1 patient. AF was diagnosed after the procedure in 21 patients (5.2%). Multivariate Cox’s proportion hazard model identified age ≥ 55 years at the time of closure (OR 3.16, ) and RoPE score < 7 (OR 3.21, ) as predictors of recurrent neurological events. Conclusion. Recurrent neurological events after PFO closure are rare, usually noncryptogenic and associated with conventional vascular risk factors or AF related. Patients older than 55 years of age and those with a RoPE score < 7 are likely to get less benefit from PFO closure. After transcatheter PFO closure, lifelong strict vascular risk factor control is warranted. Elisabetta Mariucci, Andrea Donti, Luisa Salomone, Marta Marcia, Marta Guidarini, Roberto Formigari, Daniela Prandstraller, Anna Balducci, Gabriele Bronzetti, and Marco Bonvicini Copyright © 2017 Elisabetta Mariucci et al. All rights reserved. Factors Affecting Health Related Quality of Life in Hospitalized Patients with Heart Failure Wed, 01 Nov 2017 00:00:00 +0000 This study identified factors affecting health related quality of life (HRQOL) in 300 hospitalized patients with heart failure (HF). Data were collected by the completion of a questionnaire which included patients’ characteristics and the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Analysis of data showed that the median of the total score of MLHFQ was 46 and the median of the physical and mental state was 22 and 6, respectively. Also, participants who were householders or had “other” professions had lower score of 17 points and therefore better quality of life compared to patients who were civil/private employees ( and , resp.). Patients not receiving anxiolytics and antidepressants had lower quality of life scores of 6 and 15.5 points, respectively, compared to patients who received ( and , resp.). Patients with no prior hospitalization had lower score of 7 points compared to those with prior hospitalization (), whereas patients not retired due to the disease had higher score of 7 points (). Similar results were observed for the physical and mental state. Improvement of HF patients’ quality of life should come to the forefront of clinical practice. Georgia Audi, Aggeliki Korologou, Ioannis Koutelekos, Georgios Vasilopoulos, Kostas Karakostas, Kleanthi Makrygianaki, and Maria Polikandrioti Copyright © 2017 Georgia Audi et al. All rights reserved. Corrigendum to “Falls and Fractures in the Elderly with Sinus Node Disease: The Impact of Pacemaker Implantation” Thu, 19 Oct 2017 00:00:00 +0000 Nazmi Krasniqi, Diana Segalada, Thomas F. Lüscher, Kurt Lippuner, Laurent Haegeli, Jan Steffel, Thomas Wolber, Corinna Brunckhorst, Johannes Holzmeister, David Hürlimann, and Firat Duru Copyright © 2017 Nazmi Krasniqi et al. All rights reserved. Clinical Characteristics, Management, and Outcomes of Suspected Poststroke Acute Coronary Syndrome Mon, 09 Oct 2017 00:00:00 +0000 Background. Acute coronary syndrome (ACS) can complicate acute ischemic stroke, causing significant morbidity and mortality. To date, literatures that describe poststroke acute coronary syndrome and its morbidity and mortality burden are lacking. Methods. This is a single center, retrospective study where clinical characteristics, cardiac evaluation, and management of patients with suspected poststroke ACS were compared and analyzed for their association with inpatient mortality and 1-year all-cause mortality. Results. Of the 82 patients, 32% had chest pain and 88% had ischemic ECG changes; mean peak troponin level was 18, and mean ejection fraction was 40%. The medical management group had older individuals (73 versus 67 years, ), lower mean peak troponin levels (12 versus 49, ), and lower mean length of stay (12 versus 25 days, ) compared to those who underwent stent or CABG. Troponin levels were significantly associated with 1-year all-cause mortality. Conclusion. Age and troponin level appear to play a role in the current clinical decision making for patient with suspected poststroke ACS. Troponin level appears to significantly correlate with 1-year all-cause mortality. In the management of poststroke acute coronary syndrome, optimal medical therapy had similar inpatient and all-cause mortality compared to PCI and/or CABG. Sylvia Marie Biso, Marvin Lu, Toni Anne De Venecia, Supakanya Wongrakpanich, Mary Rodriguez-Ziccardi, Sujani Yadlapati, Marina Kishlyansky, Harish Seetha Rammohan, and Vincent M. Figueredo Copyright © 2017 Sylvia Marie Biso et al. All rights reserved. Effect of Remote Ischemic Preconditioning on Perioperative Cardiac Events in Patients Undergoing Elective Percutaneous Coronary Intervention: A Meta-Analysis of 16 Randomized Trials Thu, 14 Sep 2017 06:23:46 +0000 Background. The main objective of this meta-analysis was to investigate whether remote ischemic preconditioning (RIPC) reduces cardiac and renal events in patients undergoing elective cardiovascular interventions. Methods and Results. We systematically searched articles published from 2006 to 2016 in PubMed, EMBASE, Web of Science, Cochrane Library, and Google Scholar. Odds ratios (ORs) with 95% confidence intervals (CIs) were used as the effect index for dichotomous variables. The standardized mean differences (SMDs) with 95% CIs were calculated as the pooled continuous effect. Sixteen RCTs of 2435 patients undergoing elective PCI were selected. Compared with control group, RIPC could significantly reduce the incidence of perioperative myocardial infarction (OR = 0.64; 95% CI: 0.48–0.86; ) and acute kidney injury (OR = 0.56; 95% CI: 0.322–0.99; ). Metaregression analysis showed that the reduction of PMI by RIPC was enhanced for CAD patients with multivessel disease (coef.: −0.05 , ). There were no differences in the changes of cTnI () and CRP () in two groups. Conclusion. Our meta-analysis of RCTs demonstrated that RIPC can provide cardiac and renal protection for patients undergoing elective PCI, while no beneficial effect on reducing the levels of cTnI and CRP after PCI was reported. Xiangming Wang, Na Kong, Chuanwei Zhou, Deeraj Mungun, Zakaria Iyan, Yan Guo, and Zhijian Yang Copyright © 2017 Xiangming Wang et al. All rights reserved. Divorce and Severity of Coronary Artery Disease: A Multicenter Study Mon, 24 Jul 2017 10:06:14 +0000 The association between marital status and coronary artery disease (CAD) is supported by numerous epidemiological studies. While divorce may have an adverse effect on cardiac outcomes, the relationship between divorce and severe CAD is unclear. We conducted a multicenter, observational study of consecutive patients undergoing coronary angiography during the period between April 1, 2013, and March 30, 2014. Of 1,068 patients, 124 (12%) were divorced. Divorce was more frequent among women (27%) compared to men (6%). Most divorced patients had been divorced only once (49%), but a subset had been divorced 2 (38%) or ≥3 (12%) times. After adjusting for baseline differences, there was no significant association between divorce and severe CAD in men. In women, there was a significant adjusted association between divorce and severe MVD (OR 2.31 [1.16, 4.59]) or LMD (OR 5.91 [2.19, 15.99]). The modification of the association between divorce and severe CAD by gender was statistically significant for severe LMD ( 0.0008) and marginally significant for CAD ( 0.05). Among women, there was a significant adjusted association between number of divorces and severe CAD (OR 2.4 [95% CI 1.2, 4.5]), MVD (OR 2.0 [95% CI 1.4, 3.0]), and LMD (OR 3.4 [95% CI 1.9, 5.9]). In conclusion, divorce, particularly multiple divorces, is associated with severe CAD, MVD, and LMD in women but not in men. Amin Daoulah, Mushabab Al-Murayeh, Salem Al-kaabi, Amir Lotfi, Osama E. Elkhateeb, Salem M. Al-Faifi, Saleh Alqahtani, James Stewart, Jon Heavey, William T. Hurley, Mohamed N. Alama, Mazen Faden, Mohamed Al-Shehri, Ali Youssef, and Alawi A. Alsheikh-Ali Copyright © 2017 Amin Daoulah et al. All rights reserved. Comparison of the Effects of Carperitide and Tolvaptan on Patients with Left Ventricular Dysfunction: A Two-Center Retrospective Study Wed, 12 Jul 2017 00:00:00 +0000 In patients with left ventricular (LV) dysfunction, diuretics can reduce blood pressure and lead to electrolyte abnormalities. The aim of this study was to compare the effects of tolvaptan (T group) and carperitide (C group) in these patients. Sixty-one consecutive patients admitted to the Iwate Prefectural Kuji Hospital or the Emergency Center of the Iwate Medical University between July 2011 and April 2015 were included in this study. These patients had acute heart failure (HF) and were initially treated with furosemide. Patients were excluded from the study if they received combined carperitide and tolvaptan, if they received tolvaptan or cardiotonic drugs prior to the study period, if their LV ejection fraction was ≥40%, and if they had renal dysfunction (serum creatinine > 2.0 mg/dL). There were no differences in the change in serum electrolytes in both groups, and none of the patients in the T group received supplementary dobutamine therapy. Oxygen administration was stopped successfully after a significantly shorter treatment period in the T group. These findings suggest that patients treated with tolvaptan did not require dobutamine as frequently as those treated with carperitide and indicated that tolvaptan may improve respiratory function more rapidly in patients with LV dysfunction. Chikahiko Koeda, Shohei Yamaya, Maiko Hozawa, Masayuki Sato, Kazuhiro Nasu, Tomohiro Takahashi, and Katsutoshi Terui Copyright © 2017 Chikahiko Koeda et al. All rights reserved. Subclinical Hypothyroidism and Its Association with Increased Cardiovascular Mortality Sun, 28 May 2017 00:00:00 +0000 Thyroid hormones play an important role in regulating different metabolism functions and multiple organs’ performance. Changes in the thyroid hormone axis can lead to profound effects on the stability of vital organs and systems, especially the cardiovascular system. Hypothyroidism is classified according to the clinical presentation as overt and subclinical. There is some evidence supporting the benefits of thyroxine hormone replacement for subclinical hypothyroidism on cardiovascular mortality outcomes. However, the clinical relevance of measuring and treating high thyroid-stimulating hormone (TSH) levels in newly diagnosed heart failure patients with preserved ejection fraction requires further study. In this report, we review the current evidence regarding the prognostic significance of subclinical hypothyroidism in heart failure patients with preserved ejection fraction. Alvaro Altamirano Ufion, Beenish Zulfiqar, Abdalla Hassan, Roshanak Habibi, and Prajwal Boddu Copyright © 2017 Alvaro Altamirano Ufion et al. All rights reserved. The Relationship between Body Mass Index and the Severity of Coronary Artery Disease in Patients Referred for Coronary Angiography Sun, 23 Apr 2017 07:39:46 +0000 Background and Aim. Obesity is associated with an increased risk of cardiovascular disease and may be associated with more severe coronary artery disease (CAD); however, the relationship between body mass index [BMI (kg/m2)] and CAD severity is uncertain and debatable. The aim of this study was to examine the relationship between BMI and angiographic severity of CAD. Methods. Duke Jeopardy Score (DJS), a prognostic tool predictive of 1-year mortality in CAD, was assigned to angiographic data of patients ≥18 years of age (). Patients were grouped into 3 BMI categories: normal (18.5–24.9 kg/m2), overweight (25.0–29.9 kg/m2), and obese (≥30 kg/m2); and multivariable adjusted hazard ratios for 1-year all-cause and cardiac-specific mortality were calculated. Results. Cardiac risk factor prevalence (e.g., diabetes, hypertension, and hyperlipidemia) significantly increased with increasing BMI. Unadjusted all-cause and cardiac-specific 1-year mortality tended to rise with incremental increases in DJS, with the exception of DJS 6 (). After adjusting for potential confounders, no significant association of BMI and all-cause (HR 0.70, 95% CI .48–1.02) or cardiac-specific (HR 1.11, 95% CI .64–1.92) mortality was found. Conclusions. This study failed to detect an association of BMI with 1-year all-cause or cardiac-specific mortality after adjustment for potential confounding variables. Anne B. Gregory, Kendra K. Lester, Deborah M. Gregory, Laurie K. Twells, William K. Midodzi, and Neil J. Pearce Copyright © 2017 Anne B. Gregory et al. All rights reserved. The Prevalence and Awareness of Cardiovascular Diseases Risk Factors among the Lebanese Population: A Prospective Study Comparing Urban to Rural Populations Thu, 30 Mar 2017 00:00:00 +0000 Introduction. CVDs are largely driven by modifiable risk factors. This study sought to determine the awareness and prevalence of the modifiable CVDs risk factors among the Lebanese population. Methods. In a cross-sectional survey, 1000 participants aged ≥ 45 years were randomly selected from pharmacies and interviewed. The data was analyzed with SPSS version 21.0 software. Results. Differences between urban and rural areas include alcohol consumption (2.8% versus 1.7%; ), cardioprotective vegetable servings (6.1% versus 2.3%; ), sedentary hours per day (18.6% versus 15.1%; ), and hypertension (38.5% versus 25.4%; ). The prevalence of overweight and obesity (77.3% versus 75.2%; ), smoking (39.3% versus 43.3%; ), diabetes (25.4% versus 21.4%; ), and dyslipidemia (25 versus 21.2%) was reported. Measurements revealed 19.3% of undiagnosed hypertension (12.4% versus 22.4%, ), 61.7% of hypertension (59.8% versus 62.6%; ), and 7.9% of undiagnosed diabetes (6.6% versus 8.6%; ). The declared awareness of CVDs risk factors was highest for smoking (91.5% versus 89.7%; ) and lowest for diabetes (54.4 versus 55.7%; ). Conclusion. This study has shown a high prevalence of modifiable CVDs risk factors in the Lebanese population ≥ 45 years, among which hypertension is the most prominent. Iqbal Fahs, Zainab Khalife, Diana Malaeb, Mohammad Iskandarani, and Pascale Salameh Copyright © 2017 Iqbal Fahs et al. All rights reserved. The Personalization of Clopidogrel Antiplatelet Therapy: The Role of Integrative Pharmacogenetics and Pharmacometabolomics Tue, 21 Mar 2017 00:00:00 +0000 Dual antiplatelet therapy of aspirin and clopidogrel is pivotal for patients undergoing percutaneous coronary intervention. However, the variable platelets reactivity response to clopidogrel may lead to outcome failure and recurrence of cardiovascular events. Although many genetic and nongenetic factors are known, great portion of clopidogrel variable platelets reactivity remain unexplained which challenges the personalization of clopidogrel therapy. Current methods for clopidogrel personalization include CYP2C19 genotyping, pharmacokinetics, and platelets function testing. However, these methods lack precise prediction of clopidogrel outcome, often leading to insufficient prediction. Pharmacometabolomics which is an approach to identify novel biomarkers of drug response or toxicity in biofluids has been investigated to predict drug response. The advantage of pharmacometabolomics is that it does not only predict the response but also provide extensive information on the metabolic pathways implicated with the response. Integrating pharmacogenetics with pharmacometabolomics can give insight on unknown genetic and nongenetic factors associated with the response. This review aimed to review the literature on factors associated with the variable platelets reactivity response to clopidogrel, as well as appraising current methods for the personalization of clopidogrel therapy. We also aimed to review the literature on using pharmacometabolomics approach to predict drug response, as well as discussing the plausibility of using it to predict clopidogrel outcome. Arwa M. Amin, Lim Sheau Chin, Dzul Azri Mohamed Noor, Muhamad Ali SK Abdul Kader, Yuen Kah Hay, and Baharudin Ibrahim Copyright © 2017 Arwa M. Amin et al. All rights reserved. Aerobic Training Intensity for Improved Endothelial Function in Heart Failure Patients: A Systematic Review and Meta-Analysis Mon, 27 Feb 2017 14:05:49 +0000 Objective. Flow-mediated dilation (FMD) is widely utilised to assess endothelial function and aerobic exercise improves FMD in heart failure patients. The aim of this meta-analysis is to quantify the effect of aerobic training intensity on FMD in patients with heart failure. Background. A large number of studies now exist that examine endothelial function in patients with heart failure. We sought to add to the current literature by quantifying the effect of the aerobic training intensity on endothelial function. Methods. We conducted database searches (PubMed, Embase, ProQuest, and Cochrane Trials Register to June 30, 2016) for exercise based rehabilitation trials in heart failure, using search terms exercise training, endothelial function, and flow-mediated dilation (FMD). Results. The 13 included studies provided a total of 458 participants, 264 in intervention groups, and 194 in nonexercising control groups. Both vigorous and moderate intensity aerobic training significantly improved FMD. Conclusion. Overall both vigorous and moderate aerobic exercise training improved FMD in patients with heart failure. M. J. Pearson and N. A. Smart Copyright © 2017 M. J. Pearson and N. A. Smart. All rights reserved. Avoiding the Learning Curve for Transcatheter Aortic Valve Replacement Thu, 26 Jan 2017 14:16:21 +0000 Objectives. To evaluate whether collaboration between existing and new transcatheter aortic valve replacement (TAVR) programs could help reduce the number of cases needed to achieve optimal efficiency. Background. There is a well-documented learning curve for achieving procedural efficiency and safety in TAVR procedures. Methods. A multidisciplinary collaboration was established between the Minneapolis VA Medical Center (new program) and the University of Minnesota (established program since 2012, ) 1 year prior to launching the new program. Results. 269 patients treated with TAVR (50 treated in the first year at the new program). Mean age was 76 (±18) years and STS score was 6.8 (±6). Access included transfemoral (, 70%), transapical (, 16%), transaortic (, 4%), and subclavian (, 10%) types. Procedural efficiency (procedural time versus , ), device success (96% versus 87%, ), length of stay ( versus days, ), and safety (in hospital mortality 4% versus 6%, ) were similar between programs. We found no difference in outcome measures between the first and last 25 patients treated during the first year of the new program. Conclusions. Establishing a partnership with an established program can help mitigate the learning curve associated with these complex procedures. Sergey Gurevich, Ranjit John, Rosemary F. Kelly, Ganesh Raveendran, Gregory Helmer, Demetris Yannopoulos, Timinder Biring, Brett Oestreich, and Santiago Garcia Copyright © 2017 Sergey Gurevich et al. All rights reserved. Pediatric Heart Failure, Lagging, and Sagging of Care in Low Income Settings: A Hospital Based Review of Cases in Ethiopia Wed, 16 Nov 2016 08:41:54 +0000 Introduction. Causes of acute heart failure in children range from simple myocarditis complicating chest infection to complex structural heart diseases. Objective. To describe patterns, predictors of mortality, and management outcomes of acute heart failure in children. Methods. In retrospective review, between February 2012 and October 2015 at a tertiary center, 106 admitted cases were selected consecutively from discharge records. Data were extracted from patients chart and analyzed using SPSS software package. -test and statistical significance at value < 0.05 with 95% CI were used. Result. Acute heart failure accounted for 2.9% of the total pediatric admissions. The age ranged from 2 months up to 14 years with mean age of 8 years. Male to female ratio is 1 : 2.1. Rheumatic heart disease accounted for 53.7%; pneumonia, anemia, infective endocarditis, and recurrence of acute rheumatic fever were the main precipitating causes. Death occurred in 19% of cases. Younger age at presentation, low hemoglobin concentration, and undernutrition were associated with death with value of 0.00, 0.01, and 0.02, respectively. Conclusions and Recommendation. Pediatric heart failure in our settings is diagnosed mainly in older age groups and mostly precipitated due to preventable causes. Significant mortality is observed in relation to factors that can be preventable in children with underlying structural heart disease. Early suspicion and diagnosis of cases may reduce the observed high mortality. Solmon Gebremariam and Tamirat Moges Copyright © 2016 Solmon Gebremariam and Tamirat Moges. All rights reserved. Impact of Lifestyle Intervention on HDL-Induced eNOS Activation and Cholesterol Efflux Capacity in Obese Adolescent Mon, 14 Nov 2016 08:50:41 +0000 Background. Endothelial dysfunction occurs in obese children and adolescent and is regarded as a key step in the development of atherosclerosis. Important components for the development of endothelial dysfunction are reduced activity of endothelial nitric oxide synthase (eNOS) and an increase in cholesterol deposition in the vessel wall, due to reduced reverse cholesterol transport (RCT) activity. High density lipoprotein (HDL) exhibits antiatherosclerotic properties including modulation of eNOS activity and cholesterol efflux capacity. Lifestyle intervention programs can modify endothelial dysfunction in obese adolescents, but their impact on HDL-mediated eNOS activation and RCT is unknown so far. Methods. Obese adolescents ( years, BMI > 35 kg/m2) where randomized either to an intervention group (IG, ; restricted diet and exercise) or to a usual care group (UC, ). At the beginning and after 10 months of treatment HDL-mediated eNOS phosphorylation and cholesterol efflux capacity were evaluated. Results. Ten months of treatment resulted in a substantial weight loss (−31%), an improvement of endothelial function, and an increase in HDL-mediated eNOS-Ser1177 phosphorylation and RCT. A correlation between change in eNOS-Ser1177 phosphorylation or RCT and change in endothelial function was noted. Conclusion. A structured lifestyle intervention program improves antiatherosclerotic HDL functions, thereby positively influencing endothelial function. Jenny Wesnigk, Luc Bruyndonckx, Vicky Y. Hoymans, Ann De Guchtenaere, Tina Fischer, Gerhard Schuler, Christiaan J. Vrints, and Volker Adams Copyright © 2016 Jenny Wesnigk et al. All rights reserved. Coronary Angiography Safety between Transradial and Transfemoral Access Thu, 03 Nov 2016 09:48:47 +0000 Background and Aim. The aim of study was to evaluate safety, feasibility, and procedural variables of transradial approach compared with transfemoral approach in a standard population of patients undergoing coronary catheterization as one of the major criticisms of the transradial approach is that it takes longer overall procedure and fluoroscopy time, thereby causing more radiation exposure. Method. Between January 2015 and December 2015, a total of 1,997 patients in LPS Institute of Cardiology, GSVM Medical College, Kanpur, UP, India, undergoing coronary catheterization were randomly assigned to the transradial or transfemoral approach. Result. Successful catheterization was achieved in 1045 of 1076 patients (97.1%) in the transradial group and in 918 of 921 patients (99.7%) in the transfemoral group (). Comparing the transradial and transfemoral approaches, fluoroscopy time ( versus  min; ), procedure time ( versus  min; ), contrast volume ( versus  mL; ), radiation dose as dose area product ( versus  Gycm2; ), and postprocedural rise of serum creatinine (% versus %; ) were not significantly different while vascular access site complications were significantly lower in transradial group than transfemoral group (3.9% versus 7.6%; ). Conclusion. The present study shows that transradial access for coronary angiography is safe among patients compared to transfemoral access with lower rate of local vascular complications. Santosh Kumar Sinha, Vikas Mishra, Nasar Afdaali, Mukesh Jitendra Jha, Ashutosh Kumar, Mohammad Asif, Ramesh Thakur, and Chandra Mohan Varma Copyright © 2016 Santosh Kumar Sinha et al. All rights reserved. Prevalence of Hepatitis C Virus Seropositivity and Its Impact on Coronary Artery Disease among Egyptian Patients Referred for Coronary Angiography Wed, 02 Nov 2016 12:13:09 +0000 Background. We tested the prevalence and impact of HCV seropositivity among Egyptian patients referred for coronary angiography. Subjects and Methods. This cross-sectional study was conducted in Zagazig University hospitals including 509 patients scheduled for elective coronary angiography between June 2013 and June 2014. By taking full history on admission, laboratory workup including HCV Ab, echocardiography study, and coronary angiography, we calculated the mean number of coronary artery lesions and the mean number of affected coronary artery vessels for all patients. The severity of the coronary lesions was estimated using the Gensini score. Results. HCV seropositive patients referred for coronary angiography were about 30.3% (which is greater than the prevalence of HCV seropositivity among general population in Egypt), patients proved to have CAD who are HCV antibody positive had more severe coronary lesions than in seronegative one (), and patients proved to have CAD who are HCV antibody positive had comparable prevalence of cardiovascular risk factors as seronegative patients except for diabetes and hypertension which are more prevalent in seronegative patients (). Conclusion. Prevalence of HCV antibody positive patients referred for coronary angiography was about 30.3%, and CAD patients who are HCV antibody positive had more severe coronary lesions and less prevalence of diabetes and hypertension than HCV antibody negative. Ragab Abd El Salam, Baher Nabil, Marawan Saber, Hany A. AbdelWahab, and Tamer Saber Copyright © 2016 Ragab Abd El Salam et al. All rights reserved. Kansas City Cardiomyopathy Questionnaire Utility in Prediction of 30-Day Readmission Rate in Patients with Chronic Heart Failure Sun, 30 Oct 2016 07:28:14 +0000 Background. Heart failure (HF) is one of the most common diagnoses associated with hospital readmission. We designed this prospective study to evaluate whether Kansas City Cardiomyopathy Questionnaire (KCCQ) score is associated with 30-day readmission in patients hospitalized with decompensated HF. Methods and Results. We enrolled 240 patients who met the study criteria. Forty-eight (20%) patients were readmitted for decompensated HF within thirty days of hospital discharge, and 192 (80%) patients were not readmitted. Compared to readmitted patients, nonreadmitted patients had a higher average KCCQ score (40.8 versus 32.6, P = 0.019) before discharge. Multivariate analyses showed that a high KCCQ score was associated with low HF readmission rate (adjusted OR = 0.566, P = 0.022). The c-statistic for the base model (age + gender) was 0.617. The combination of home medication and lab tests on the base model resulted in an integrated discrimination improvement (IDI) increase of 3.9%. On that basis, the KCQQ further increased IDI of 2.7%. Conclusions. The KCCQ score determined before hospital discharge was significantly associated with 30-day readmission rate in patients with HF, which may provide a clinically useful measure and could significantly improve readmission prediction reliability when combined with other clinical components. Shengchuan Dai, Manoucher Manoucheri, Junhong Gui, Xiang Zhu, Divyanshu Malhotra, Shenjing Li, Jason D’souza, Fnu Virkram, Aditya Chada, and Haibing Jiang Copyright © 2016 Shengchuan Dai et al. All rights reserved. Impact of Body Mass Index on Short-Term Outcomes in Patients Undergoing Percutaneous Coronary Intervention in Newfoundland and Labrador, Canada Wed, 07 Sep 2016 11:45:50 +0000 Background and Aim. Obesity (BMI ≥ 30 kg/m2) is associated with advanced cardiovascular disease requiring procedures such as percutaneous coronary intervention (PCI). Studies report better outcomes in obese patients having these procedures but results are conflicting or inconsistent. Newfoundland and Labrador (NL) has the highest rate of obesity in Canada. The aim of the study was to examine the relationship between BMI and vascular and nonvascular complications in patients undergoing PCI in NL. Methods. We studied 6473 patients identified in the APPROACH-NL database who underwent PCI from May 2006 to December 2013. BMI categories included normal, 18.5 ≤ BMI < 25.0 (); overweight, 25.0 ≤ BMI < 30 (); and obese, BMI ≥ 30.0 (). Results. Patients with obesity were younger and had a higher incidence of diabetes, hypertension, and family history of cardiac disease. Obese patients experienced less vascular complications (normal, overweight, and obese: 8.2%, 7.2%, and 5.3%, ). No significant differences were observed for in-lab (4.0%, 3.3%, and 3.1%, ) or postprocedural (1.0%, 0.8%, and 0.9%, ) nonvascular complications. After adjusting for covariates, BMI was not a significant factor associated with adverse outcomes. Conclusion. Overweight and obesity were not independent correlates of short-term vascular and nonvascular complications among patients undergoing PCI. Anne B. Gregory, Kendra K. Lester, Deborah M. Gregory, Laurie K. Twells, William K. Midodzi, and Neil J. Pearce Copyright © 2016 Anne B. Gregory et al. All rights reserved. Association between Stable Coronary Artery Disease and In Vivo Thrombin Generation Thu, 11 Aug 2016 06:40:32 +0000 Background. Thrombin has been implicated as a key molecule in atherosclerotic progression. Clinical evidence shows that thrombin generation is enhanced in atherosclerosis, but its role as a risk factor for coronary atherosclerotic burden has not been proven in coronary artery disease (CAD) stable patients. Objectives. To evaluate the association between TAT levels and homocysteine levels and the presence of coronary artery disease diagnosed by coronary angiography in patients with stable CAD. Methods and Results. We included 95 stable patients admitted to the Haemodynamics Department, including 63 patients with significant CAD and 32 patients without. We measured the thrombin-antithrombin complex (TAT) and homocysteine concentrations in all the patients. The CAD patients exhibited higher concentrations of TAT (40.76 μg/L versus 20.81 μg/L, ) and homocysteine (11.36 μmol/L versus 8.81 μmol/L, ) compared to the patients without significant CAD. Specifically, in patients with CAD+ the level of TAT level was associated with the severity of CAD being 36.17 ± 24.48 μg/L in the patients with bivascular obstruction and 42.77 ± 31.81 μg/L in trivascular coronary obstruction, . Conclusions. The level of in vivo thrombin generation, quantified as TAT complexes, is associated with the presence and severity of CAD assessed by coronary angiography in stable CAD patients. Benjamin Valente-Acosta, Manuel Alfonso Baños-González, Marco Antonio Peña-Duque, Marco Antonio Martínez-Ríos, Leslie Quintanar-Trejo, Gad Aptilon-Duque, Mirthala Flores-García, David Cruz-Robles, Guillermo Cardoso-Saldaña, and Aurora de la Peña-Díaz Copyright © 2016 Benjamin Valente-Acosta et al. All rights reserved. Impact of Rosuvastatin Treatment on HDL-Induced PKC-βII and eNOS Phosphorylation in Endothelial Cells and Its Relation to Flow-Mediated Dilatation in Patients with Chronic Heart Failure Tue, 02 Aug 2016 12:46:11 +0000 Background. Endothelial function is impaired in chronic heart failure (CHF). Statins upregulate endothelial NO synthase (eNOS) and improve endothelial function. Recent studies demonstrated that HDL stimulates NO production due to eNOS phosphorylation at Ser1177, dephosphorylation at Thr495, and diminished phosphorylation of PKC-βII at Ser660. The aim of this study was to elucidate the impact of rosuvastatin on HDL mediated eNOS and PKC-βII phosphorylation and its relation to endothelial function. Methods. 18 CHF patients were randomized to 12 weeks of rosuvastatin or placebo. At baseline, 12 weeks, and 4 weeks after treatment cessation we determined lipid levels and isolated HDL. Human aortic endothelial cells (HAEC) were incubated with isolated HDL and phosphorylation of eNOS and PKC-βII was evaluated. Flow-mediated dilatation (FMD) was measured at the radial artery. Results. Rosuvastatin improved FMD significantly. This effect was blunted after treatment cessation. LDL plasma levels were reduced after rosuvastatin treatment whereas drug withdrawal resulted in significant increase. HDL levels remained unaffected. Incubation of HAEC with HDL had no impact on phosphorylation of eNOS or PKC-βII. Conclusion. HDL mediated eNOS and PKC-βII phosphorylation levels in endothelial cells do not change with rosuvastatin in CHF patients and do not mediate the marked improvement in endothelial function. Ephraim B. Winzer, Pauline Gaida, Robert Höllriegel, Tina Fischer, Axel Linke, Gerhard Schuler, Volker Adams, and Sandra Erbs Copyright © 2016 Ephraim B. Winzer et al. All rights reserved. Cardiac Arrhythmias: Update on Mechanisms and Clinical Managements Sun, 31 Jul 2016 14:10:50 +0000 Yi-Gang Li, David G. Benditt, Thomas Klingenheben, Kai Hu, and Dali Feng Copyright © 2016 Yi-Gang Li et al. All rights reserved. The Concordance between Myocardial Perfusion Imaging and Coronary Angiography in Detecting Coronary Artery Disease: A Retrospective Study in a Tertiary Cardiac Center at King Abdullah Medical City Mon, 27 Jun 2016 14:25:26 +0000 Background. Coronary artery disease (CAD) is considered as the leading cause of the cardiovascular fatalities worldwide. CAD is diagnosed by many modalities of imaging such as myocardial perfusion imaging (MPI) and coronary angiography (CAG). Methods. A retrospective cross-sectional study was conducted that included all patients referred to the KAMC (King Abdullah Medical City) nuclear cardiology lab from its opening until the end of May 2014 (a period of 17 months). A total of 228 patient reports with a history of conducting either CAG or MPI or both were used in this study and statistically analyzed. Results. An analysis of the MPI results revealed that 78.5% of the samples were abnormal. On the other hand, 26.75% of the samples revealed that they were subjected to CAG and MPI. There was a significant and fair agreement between MPI and CAG by using all the agreement coefficients (kappa = 0.237, phi = 0.310, and value = 0.043). The sensitivity, specificity, and accuracy of MPI with reference to CAG were 97.8%, 20%, and 78.69%, respectively. In addition, positive predictive and negative predictive values were 78.95% and 75%, respectively. Conclusion. In a tertiary referral center, there was a significant agreement between MPI and CAG and a high accuracy of MPI. MPI was a noninvasive diagnostic test that could be used as a gatekeeper for CAG. Fatma Aboul-Enein, Majed O. Aljuaid, Hail T. Alharthi, Abdulkarim M. Almudhhi, and Mohammad A. Alzahrani Copyright © 2016 Fatma Aboul-Enein et al. All rights reserved. Myocardial Viability: From Proof of Concept to Clinical Practice Sun, 29 May 2016 12:29:34 +0000 Ischaemic left ventricular (LV) dysfunction can arise from myocardial stunning, hibernation, or necrosis. Imaging modalities have become front-line methods in the assessment of viable myocardial tissue, with the aim to stratify patients into optimal treatment pathways. Initial studies, although favorable, lacked sufficient power and sample size to provide conclusive outcomes of viability assessment. Recent trials, including the STICH and HEART studies, have failed to confer prognostic benefits of revascularisation therapy over standard medical management in ischaemic cardiomyopathy. In lieu of these recent findings, assessment of myocardial viability therefore should not be the sole factor for therapy choice. Optimization of medical therapy is paramount, and physicians should feel comfortable in deferring coronary revascularisation in patients with coronary artery disease with reduced LV systolic function. Newer trials are currently underway and will hopefully provide a more complete understanding of the pathos and management of ischaemic cardiomyopathy. Aditya Bhat, Gary C. H. Gan, Timothy C. Tan, Chijen Hsu, and Alan Robert Denniss Copyright © 2016 Aditya Bhat et al. All rights reserved. Frequency of Specific Cardiovascular Disease Risk Factors among Cameroonian Patients on Dialysis: The Cases of Anaemia, Inflammation, Phosphate, and Calcium Sun, 22 May 2016 08:15:19 +0000 Specific cardiovascular risk factors are known to contribute to increasing cardiovascular mortality in patients with chronic renal disease. However, little is known about their distribution in our population. This study aimed at determining the prevalence of anaemia, inflammation, and phosphocalcium disorders in Cameroonian patients on dialysis. Thirty-five participants with stage V chronic kidney disease (defined by glomerular filtration rate, GFR < 15 mL/1.73 m3) of age at least 20 years on haemodialysis were randomly recruited. A control group composed of persons without a history of renal or cardiovascular disease was also recruited. Haemoglobin concentration, serum phosphate concentration, serum calcium concentration, and CRP status as a marker of inflammation were determined for all participants. Anaemia, phosphocalcium metabolic disorders, and a positive CRP result among haemodialysed patients were estimated at 94.3%, 61.6%, and 77.1%, respectively. Anaemia was diagnosed in all female patients compared to 92% in males, while a positive CRP result was recorded in 90% of females and 72% of males. No significant differences were observed on the distribution of studied specific cardiovascular risk factors with duration of dialysis. Among the factors studied, anaemia was the most encountered. Olivier Pancha Mbouemboue, Olivier Djile Danbe, Marcel Tangyi Tamanji, and Jacques Olivier Ngoufack Copyright © 2016 Olivier Pancha Mbouemboue et al. All rights reserved. Epicardial Fat: Physiological, Pathological, and Therapeutic Implications Tue, 26 Apr 2016 16:17:55 +0000 Epicardial fat is closely related to blood supply vessels, both anatomically and functionally, which is why any change in this adipose tissue’s behavior is considered a potential risk factor for cardiovascular disease development. When proinflammatory adipokines are released from the epicardial fat, this can lead to a decrease in insulin sensitivity, low adiponectin production, and an increased proliferation of vascular smooth muscle cells. These adipokines move from one compartment to another by either transcellular passing or diffusion, thus having the ability to regulate cardiac muscle activity, a phenomenon called vasocrine regulation. The participation of these adipokines generates a state of persistent vasoconstriction, increased stiffness, and weakening of the coronary wall, consequently contributing to the formation of atherosclerotic plaques. Therefore, epicardial adipose tissue thickening should be considered a risk factor in the development of cardiovascular disease, a potential therapeutic target for cardiovascular pathology and a molecular point of contact for “endocrine-cardiology.” Juan Salazar, Eliana Luzardo, José Carlos Mejías, Joselyn Rojas, Antonio Ferreira, José Ramón Rivas-Ríos, and Valmore Bermúdez Copyright © 2016 Juan Salazar et al. All rights reserved. Incidence and Factors Predicting Skin Burns at the Site of Indifferent Electrode during Radiofrequency Catheter Ablation of Cardiac Arrhythmias Sun, 24 Apr 2016 09:35:20 +0000 Radiofrequency catheter ablation (RFA) has become a mainstay for treatment of cardiac arrhythmias. Skin burns at the site of an indifferent electrode patch have been a rare, serious, and likely an underreported complication of RFA. The purpose of this study was to determine the incidence of skin burns in cardiac RFA procedures performed at one institution. Also, we wanted to determine the factors predicting skin burns after cardiac RFA procedures at the indifferent electrode skin pad site. Methods. A retrospective case control study was performed to compare the characteristics in patients who developed skin burns in a 2-year period. Results. Incidence of significant skin burns after RFA was 0.28% (6/2167). Four of the six patients were female and all were Caucasians. Four controls for every case were age and sex matched. Burn patients had significantly higher BMI, procedure time, and postprocedure pain, relative to control subjects (p < 0.05, one-tailed testing). No one in either group had evidence of dispersive pad malattachment. Conclusions. Our results indicate that burn patients had higher BMI and longer procedure times compared to control subjects. These findings warrant further larger studies on this topic. Hussain Ibrahim, Bohuslav Finta, and Jubran Rind Copyright © 2016 Hussain Ibrahim et al. All rights reserved. The Modification Effect of Influenza Vaccine on Prognostic Indicators for Cardiovascular Events after Acute Coronary Syndrome: Observations from an Influenza Vaccination Trial Wed, 20 Apr 2016 13:07:29 +0000 Introduction. The prognosis of acute coronary syndrome (ACS) patients has been improved with several treatments such as antithrombotics, beta-blockers, and angiotensin-converting enzyme inhibitors (ACEI) as well as coronary revascularization. Influenza vaccination has been shown to reduce adverse outcomes in ACS, but no information exists regarding the interaction of other treatments. Methods. This study included 439 ACS patients from Phrommintikul et al. A single dose of inactivated influenza vaccine was given by intramuscular injection in the vaccination group. The cardiovascular outcomes were described as major cardiovascular events (MACEs) which included mortality, hospitalization due to ACS, and hospitalization due to heart failure (HF). The stratified and multivariable Cox’s regression analysis was performed. Results. The stratified Cox’s analysis by influenza vaccination for each cardiovascular outcome and discrimination of hazard ratios showed that beta-blockers had an interaction with influenza vaccination. Moreover, the multivariable hazard ratios disclosed that influenza vaccine is associated with a significant reduction of hospitalization due to HF in patients who received beta-blockers (HR = 0.05, 95% CI = 0.004–0.71, ), after being adjusted for prognostic indicators (sex, dyslipidemia, serum creatinine, and left ventricular ejection fraction). Conclusions. The influenza vaccine was shown to significantly modify the effect of beta-blockers in ACS patients and to reduce the hospitalization due to HF. However, further study of a larger population and benefits to HF patients should be investigated. Apirak Sribhutorn, Arintaya Phrommintikul, Wanwarang Wongcharoen, Usa Chaikledkaew, Suntara Eakanunkul, and Apichard Sukonthasarn Copyright © 2016 Apirak Sribhutorn et al. All rights reserved.