Open Access Systematic Review Article

Treatment of ST Elevation Myocardial Infarction from Fibrinolysis to Primary PCI: In Terms of Risks and Benefits

Hadi A. R. Hadi Khafaji, Jassim M. Al-Suwaidi

Cardiology and Angiology: An International Journal, Page 40-77
DOI: 10.9734/CA/2015/11149

The treatment of ST elevation myocardial infarction (STEMI) has undergone significant advances over the past three decades. Current practice guidelines raise the importance of promptly restoring normal coronary blood flow and myocardial perfusion in the infarct zone after the onset of chest pain, through either pharmacologic or mechanical reperfusion strategies.

Fibrinolytic therapy remains the most widely used reperfusion strategy worldwide. With the development of newer fibrinolytic agents and adjuvant potent anti-platelets therapies, this approach carries an increased risk of bleeding complications. The current research present up-date review of the use of reperfusion strategies for the treatment of STEMI, using data through the search of MEDLINE, PubMed, EMBASE, as well as related extracts from the annual report of the American Heart Association, the American College of Cardiology, and the European Society of Cardiology. We summarized data from the available studies conducted over the past last 30 years in relation to pharmacologic reperfusion therapy in regards to risks and benefits.

Conclusion: Fibrinolytic therapy remains the main reperfusion strategy used for the treatment of STMI worldwide. In the current era, there is a lack of fibrinolytic therapy trials, mainly because of increased focus in mechanical reperfusion therapies’ studies in the developed world. Clinical trials on the use of the fibrinolytics with newer platelet agents are urgently needed. 


Open Access Short Research Article

Changes of Pre Ejection Period and Left Ventricular Ejection Time during Head up Tilt

Ahlam Kadhim Al Hamdany

Cardiology and Angiology: An International Journal, Page 12-16
DOI: 10.9734/CA/2015/12229

Objective of the Study: Evaluate changes in Pre ejection period (PEP) and left ventricular ejection time (LVET) during head up tilt (HUT).

Methods: Twenty healthy male subjects were involved in this study, with mean age 29.3±5 years, mean body mass index (BMI) 21.3±0.2Kg/m2. Measurement of PEP, LVET of Doppler wave form of the aortic flow were done at supine, 30 and 60 degree HUT. Measurement of HR and BP were done at these positions of tilting. Comparison of changes of these variables at different degrees of HUT was done by paired T-Test.

Results: PEP values were significantly higher in 60 degree and 30 degree HUT than PEP values at supine position (p<0.0001). PEP values at 60 degree HUT were significantly higher than PEP values at 30 degree HUT (P=0.05).

LVET values were significantly lower at 60 degree and 30 degree HUT than values at supine position (p<0.001), and LVET values were significantly lower at 60 degree HUT than values at 30 degree HUT (p<0.001).

Conclusion: Key findings of PEP and LVET during HUT are progressive prolongation of PEP and shortening of LVET with increasing head up tilting. 


Open Access Original Research Article

Atypical Cardiac Autonomic Neuropathy Identified with Entropy Measures

David J. Cornforth, Herbert F. Jelinek

Cardiology and Angiology: An International Journal, Page 1-11
DOI: 10.9734/CA/2015/12524

Aims: To identify Cardiac Autonomic Neuropathy (CAN) from a range of measures extracted from Heart Rate Variability (HRV), including higher moments of RR intervals and a spectrum of entropy measures of RR intervals.

Study Design: Analysis of HRV measured from participants at a diabetes screening clinic. Groups were compared using t-tests to identify variables that provide separation between groups.

Place and Duration of Study: Charles Sturt Diabetes Complications Clinic, Albury, NSW Australia.

Methodology: Eleven participants with definite CAN, 67 participants with early CAN, and 71 without CAN had their beat-to-beat fluctuations analyzed using two spectra of HRV: the spectrum of moments of RR intervals and the spectrum of Renyi entropy measures. RR intervals were extracted from ECG recordings and were detrended before analysis.

Results: Higher moments of RR intervals identified a previously unnoticed sub-group of patients who are atypical within the definite CAN group. Classification of CAN progression was better with Renyi entropy measures than with moments of RR intervals. Significant differences between early and definite CAN were found with the sixth and eighth moments, (P=.022 and P=.042 respectively), but for entropy measures P values were orders of magnitude smaller.

Conclusion: Identification of early CAN provides the opportunity for early intervention and better treatment outcomes, as well as identifying atypical cases. Our findings illustrate the value of exploring a range of different measures when attempting to detect differences in groups of patients with CAN.


Open Access Original Research Article

The Prevalence of Extra-cranial Carotid Artery Disease in Chronic Heart Failure

Nasser Sherwi, Kenneth Wong, Jufen Zhang, Pierpaolo Pellicori, Olga Khaleva, Christos Bourantas, Azam Torabi, Andrew Clark, John G Cleland

Cardiology and Angiology: An International Journal, Page 17-26
DOI: 10.9734/CA/2015/10584

Background: The prevalence of carotid disease in patients with heart failure (HF) has not been described. This may be of importance for the implementation of novel interventions for heart failure that require surgery close to the carotid artery.

Objective: The aim of this study was to determine the prevalence of extra-cranial carotid artery stenosis (ECAS) in patients with HF.

Methods:  The study population comprised consecutive, patients with chronic stable HF due to left ventricular systolic dysfunction (LVSD). Patients were invited to have an ultrasound duplex scan of the internal and common extra-cranial carotid arteries (ECA) and stenoses were classified as minor if <50%, moderate if 50-69% and severe if >70%.

Results: Of 102 patients, the median age was 73 (IQR: 66-78) years and 95 were men. Ten patients had moderate ECAS of whom one also had severe ECAS in the contra-lateral artery. Thirteen patients gave a prior history of stroke or transient ischaemic attack. Of patients with ECAS, only three (30%) had had a neurological event and only three (23%) of those with a neurological event had moderate or severe ECAS (95% CI; 6-55%). Most neurological events had occurred in patients without ECAS.

Conclusion: There is a moderately high prevalence of ECAS in patients with HF. However, most patients with chronic heart failure (CHF) who have had a neurological event do not have ECAS and most patients with ECAS do not have neurological symptoms. The value of screening for and management of ECAS in patients with HF remains to be established.


Open Access Original Research Article

Left Ventricular Hypertrophy and Incidence of Acute Coronary Heart Disease and Mortality in the Reasons for Geographic and Racial Differences in Stroke Study (REGARDS)

Ronald J. Prineas, Anh Le, Stephen P. Glasser, Vera Bittner, William M. McClellan, Xin Wang, Yulia Khodneva, Monika M. Safford

Cardiology and Angiology: An International Journal, Page 27-39
DOI: 10.9734/CA/2015/13917

Objective: To examine the relationship between left ventricular hypertrophy (LVH) and the incidence of acute coronary heart disease (CHD) and mortality in the modern era. 

Methods: We studied 16, 390 black and white participants free of clinical CHD from a US national sample. The independent prognostic value of ECG-LVH was determined by Cornell voltage (CV) for risk of incident acute CHD and total mortality overall and by race and sex.

Results: 410 incident acute CHD events and 993 deaths occurred over a median follow-up of 4.8 years. CV LVH was associated with outcomes: more common in blacks (4.1%) than whites (1.2%) and in women (3.9%) than men (1.3%). However, men with CV LVH (HR 2.12 [95% CI 1.02-4.42) had greater risk for incident acute CHD than women (HR 1.29 [95% CI 0.79-2.11]) after adjusting for demographic, behavioral and clinical variables. By contrast, CV LVH conferred similar hazards for incident acute CHD among blacks (HR 1.63 [1.00-2.68; p=0.050]) and whites (HR 1.58 [95% CI 0.76-3.28; p=0.22]). Mortality associated with CV LVH was elevated overall (HR 1.31 [95% CI 1.00-1.71]) and for blacks (HR 1.36 [95% CI 1.00-1.86]) but not whites (HR 1.16 [95% CI 0.70-1.94]), with similar risk for women (HR 1.24 [95% CI 0.92-1.67] and for men (HR 1.30 [95% CI 0.72-2.35]).

Conclusion: In this contemporary cohort, CV LVH was significantly prognostic for incident acute CHD for men but not women and there was no evidence of race differences. However, CV LVH was significantly prognostic for total mortality for blacks but not whites without evidence of sex differences.