Open Access Case Study

Unguarded Tricuspid Orifice with Congenitally Corrected Transposition of the Great Arteries and Aortic Atresia- A Highly Unusual Case

Carolin Puegge, Isabell Altmann, Michael Weidenbach

Cardiology and Angiology: An International Journal, Page 67-72
DOI: 10.9734/ca/2021/v10i430181

Unguarded tricuspid orifice is a very rare anomaly. It is characterised by the absence of one or more of the tricuspid valve leaflets resulting in severe tricuspid regurgitation and right heart failure. It is rarely an isolated anomaly but more often associated with pulmonary atresia and intact ventricular septum. When the ventricles are inverted however, the result of outflow tract obliteration is not pulmonary atresia, but aortic atresia. This anomaly has been described in the literature in only 2 cases so far. We present a case of a neonate with unguarded tricuspid orifice with absence of all tricuspid leaflets, congenitally corrected transposition of the great arteries and aortic atresia. The severe tricuspid regurgitation and right ventricular enlargement would have required a Norwood-like procedure combined with a right ventricular plication. Due to the complexity of this lesion no surgical therapy was attempted in consent with the parents.

Open Access Short Communication

Large Psoas Hematoma Complicating Anti-coagulant Therapy Poses a Diagnostic and Therapeutic Challenge

Brahim Nassour A., Hissein Hagguir, Noel Mahoungou, Harouna Seydou, Fadoul Adam, Salim Arous, Leila Azzouzi, Abdel Nasser Dirghil, Rachida Habbal

Cardiology and Angiology: An International Journal, Page 40-44
DOI: 10.9734/ca/2021/v10i430177

Spontaneous psoas haematoma in patients on anti-coagulant therapy is a rare phenomenon. It poses a real diagnostic problem and a real therapeutic challenge. We report the case of a 51 year old patient, under anti-vitamin K (acenocoumarone) following a stenosante and tricuspid mitral plasty who presented with right lumbar pain radiating to the lower limb leading to functional impotence. Clinically, he was hemodynamically stable with a hematoma measuring 88x29 mm and extending to 161 mm. The ultrasound scan showed a large collection at the expense of the lumbar psoas muscle and the CT scan showed a swollen appearance of the right psoas muscle in its iliac portion. Management was conservative: discontinuation of anti-vitamin K, bed rest, antibiotic therapy, and monitoring (clinical, biological and radiological). The ultimate outcome was favourable.

Open Access Original Research Article

A Novel Method for Measuring Myocardial Performance Index using Non-contact Ballistocardiogram System

K. R. Nishanth, Aashit Singh, Gaurav Parchani, Gulshan Kumar, Vibhor Saran, Cholenahally Manjunath, Deepak Padmanabhan

Cardiology and Angiology: An International Journal, Page 1-12
DOI: 10.9734/ca/2021/v10i430173

Aim: The aim was to validate the Systolic Time Intervals (STI) measured by Ballistocardiography (BCG) with STI derived from simultaneously performed Transthoracic Echocardiogram (TTE) and attempt to create an AI algorithm that automatically calculates Tei Index from BCG tracings.

Study design:  Cross-sectional study.

Place and Duration of Study: Department of Cardiology and Department of Electrophysiology of Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bangalore, India, between January 2020 and January 2021.

Methodology: Two hundred seventy-four patients with clinically indicated TTE were enrolled in the study, average age was 52. Simultaneous recordings on BCG and TTE were done. 150 patients had clinically usable TTE images for accurate calculations. STI was calculated independently by operators experienced in TTE and BCG. Results were compared using Pearson’s R. A proprietary AI algorithm for automatically calculating the MPI, was trained over a subset of patients. Its accuracy in detecting STI was compared to that of TTE and manually calculated STI from BCG.

Results: There was a strong positive correlation (r=0.766, P<0.00, 99%CI [0.691,0.824]) between the TTE and BCG derived MPI values. The result was validated over predetermined subgroups of subjects with reduced EF (EF<50) and subjects with normal EF (EF>=50). The AI algorithm had correlation of 0.54(p<0.01) with the MPI calculated by TTE and 0.34(P<0.10) with the manually calculated MPI on the BCG.

Conclusion: BCG derived manual and automated MPI correlates well with TTE derived MPI in a variety of EF fraction subgroups. Automated calculation algorithms for MPI derived from BCG remain a work under progress.

Open Access Original Research Article

The Correlations between Admission Heart Rate and Corrected QT Interval Prolongations with Coronary Artery Disease in Patients with Acute Coronary Syndrome

Shaimaa Mohamed Amer Abo Elnoaas, Raghda Ghonimy El Sheikh, Mohamed Ahmed Abd Elaal, Ayman Ahmed El Sheikh

Cardiology and Angiology: An International Journal, Page 13-21
DOI: 10.9734/ca/2021/v10i430174

Background: Coronary heart disease is a major cause of mortality and this health problem is reaching pandemic in both developed, and developing countries. ACS carries significant morbidity and mortality and the prompt diagnosis, and appropriate treatment is essential. HR was identified as a risk predictor of ACS. Both continuous increase in high baseline heart rate and decrease in low baseline heart rate are associated with higher risk of CVD. Decreased heart rate could also cause dispersion of atrial repolarization which, in turn, initiate cardiovascular events.

Aim: The aim of this study was to assess the correlation between heart rate and severity of coronary artery disease in patient with acute coronary syndrome.

Patients and Methods: The retrospective study was conducted on 120 patients that fulfilled the inclusion criteria were recruited from Cardiology department in Tanta university hospitals presented with acute coronary syndrome.

Results: There was highly significant difference between both groups regarding admission heart rate & QTc interval. Both groups of low AHR< 60 bpm & high AHR >90bpm were significantly associated with severe CAD &.Mainly those patients with higher admission heart rate were more likely to have higher Syntax scores (severe coronary lesion). Also, patients with prolonged QTc had severe coronary artery diseases, higher SS & high probability to suffer adverse cardiac events more than patients without prolonged QTc interval.

Conclusion: The current study showed that QTc interval prolongation and admission HR are independent predictors of the severity of coronary artery disease in patients with acute coronary syndrome.

Open Access Original Research Article

Correlation of Triglyceride with Coronary Artery Disease Severity in Pre-Diabetic Chronic Stable Angina Patients

Mahmoud Mohammed Tolba, Mohamed Khalfallah, Sameh Samir Khalel, Hanan Kamel Kassem

Cardiology and Angiology: An International Journal, Page 31-39
DOI: 10.9734/ca/2021/v10i430176

Background: Individuals with prediabetes have multiple disturbances in lipoprotein metabolism resulting from multiple combinations of insulin deficiency, insulin resistance and hyperglycemia. Dyslipidemia is the commonest complication of prediabetes and diabetes, and it predispose to premature atherosclerosis causing cardiovascular complication. The aim of this study was to assess correlation of triglyceride (TG) with coronary artery disease (CAD) severity in pre-diabetic chronic stable angina patients.

Methods: Our cross-sectional observational study was conducted on 100 pre-diabetic patients (HbA1c 5.7% to 6.4%) with different levels of TG and stable CAD, referred to Tanta university hospitals. Each patient had been subjected to adequate history taking, complete clinical examination and laboratory investigations and electrocardiogram with transthoracic echocardiography. SYNTAX score was calculated.

Results: There were significant positive correlations between TG and LDL, ratio and TLC respectively while there was a significant negative correlation between TG and HDL. There was significant positive correlation between SYNTAX and LDL, ratio and urea respectively                            while there was high significant negative correlation between TG and HDL. TG level was significantly higher in male than female (p= 0.028). There was no significant difference in SYNTAX regarding gender. For the multivariate analysis, only LDL was a significant independent predictor for CAD.

Conclusions: There was a positive correlation between the TG and the severity of coronary lesions in pre-diabetic stable angina pectoris patients.

Open Access Original Research Article

Assessment of Subclinical Left Ventricular Systolic and Diastolic Dysfunction in Patients with Type 1 DM with and without Good Metabolic Control

Hesham Ali Elbahgy, Mohamed Khalfallah, Randa Mohamed Abdel-Meged, Mai M. Abd Elmoneim Salama

Cardiology and Angiology: An International Journal, Page 51-59
DOI: 10.9734/ca/2021/v10i430179

Background: Diabetic patients with normal left ventricular ejection fraction (LVEF)are frequently associated with diastolic dysfunction. However, LVEF is known not to be a sensitive marker for the detection of subclinical LV systolic dysfunction. This study aimed to assess left ventricular systolic and diastolic function in asymptomatic type 1 diabetic patients by conventional, tissue Doppler and two-dimensional speckle tracking echocardiography to assess subclinical left ventricular systolic and diastolic dysfunction.

Methods: Case-control study was conducted at 150 patients aged 15-35 y were subdivided into three equal groups: Group A: with type 1 diabetes mellitus (T1DM) with good metabolic control (Hb A1C <7.0), Group B: T1DM with poor metabolic control (Hb A1C>7.0), and Group C: Control group: included 50 normal healthy subjects.

Results: Tissue Doppler, diastolic function and strain parameters, AP4C LS, AP2C LS, AP3C LS, and GLS were significantly impaired among the three groups. AP4C LS, AP2C LS, AP3C LS, and GLS were significantly lower in group B than group A and group C and was significantly lower in group A than group C, A velocity was significantly impaired among the three groups. A velocity was significantly higher in group B than group A and group C and was insignificantly impaired in group A than group C.

Conclusion: Conventional echocardiography parameters were insignificantly different between the study groups. 2D speckle tracking and tissue Doppler echocardiography showed that subclinical left ventricular systolic function may be affected even before affection of diastolic function. Longer duration and poor glycemic control of diabetes significantly affect GLS.

Open Access Original Research Article

Association of Epicardial Adipose Tissue Thickness with Left Atrial Size and Atrial Fibrillation

Ahmed M. Abd ElSalam, Amany M. Allaithy, Mona Elsaedy, Ekram Sadek Said

Cardiology and Angiology: An International Journal, Page 60-66
DOI: 10.9734/ca/2021/v10i430180

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with detrimental consequences. Epicardial fat is consistently associated with the presence, severity, and recurrence of AF.

Aim: The aim of the work was to investigate the association of epicardial adipose tissue thickness with left atrial size in patients with atrial fibrillation.

Patients and Methods: This study was conducted on 25 atrial fibrillation (AF) patients and 25 subjects with normal sinus rhythm as a control group matched in body weight. All patients underwent transthoracic echocardiogram. EAT (epicardial adipose tissue) thickness was measured on the right ventricular free wall of the two- dimensional parasternal long-axis view at end systole. 

Results: The results showed that there was a significant difference between the two groups in waist circumference, EAT (epicardial adipose tissue) thickness, left atrium diameter, LA volume. Receiver operating characteristics (ROC) analysis showed that an EAT thickness of > 0.30 cm maximizes the sensitivity and specificity to predict the development of AF.

Conclusion: Increases epicardial adipose tissue is associated with the occurrence of atrial fibrillation.

Open Access Original Research Article

Physical Training as a Blood Pressure Reducer and a Remodeler of Cardiac Fibers in Spontaneously Hypertensive Rats (SHR)

Mariana Molinar Mauad Cintra, Matheus Ribeiro Bizuti, Octávio Barbosa Neto, Marlene Antônia dos Reis, Lenaldo Branco Rocha, Débora Tavares de Resende e Silva

Cardiology and Angiology: An International Journal, Page 22-30
DOI: 10.9734/ca/2021/v10i430175

Background: Hypertension is the most prevalent of all cardiovascular diseases, reaching target organs such as the heart. Blood pressure control is critical for preventing organ damage induced by hypertension.

Objective: To analyze blood pressure, heart rate, left ventricular thickness, the percentage of cardiac fibrosis and the percentage of type III collagen in Spontaneously Hypertensive Rats (SHR) submitted to swimming physical training.

Methods: The experimental groups were composed of male Wistar Kyoto (WKY) rats (309-311g), which were divided into: 1) Normotensive Sedentary group (SN) (n = 6); 2) Trained Normotensive group (TN) (n = 6); 3) Sedentary Hypertensive group (SH) (n = 6); 4) Trained Hypertensive group (TH) (n = 6). After the end of the protocol, the animals were initially anesthetized to measure blood pressure.

Results: Physical training was responsible for decreasing blood pressure (F = 16,968; p <0.001) and heart rate (F = 10.710; p = 0.004) in the trained groups (normotensive and hypertensive). Moreover, training was responsible for providing an increase in the thickness of the left ventricle (F = 7,254; p = 0.014) and a reduction in the percentage of cardiac fibrosis (F = 16,081; p <0.001). Furthermore, it was observed that the trained group had lower values of type III collagen (F = 13,166; p = 0.002).

Conclusions: Physical swimming training triggered a decrease in blood pressure, heart rate, the percentage of fibrosis and the percentage of type III collagen. In addition, there was also a cardiac remodeling due to the increase in left ventricular hypertrophy.

Open Access Original Research Article

Hyperuricemia and Smoking Correlation in Egyptian Young Adults with Coronary Artery Disease: Observational Study

Ali Youssef El-Sayed Youssef, Seham Fahmy Badr, Mohamed Ahmed Abd El-Aal, Ayman Ahmed El-Sheikh

Cardiology and Angiology: An International Journal, Page 45-50
DOI: 10.9734/ca/2021/v10i430178

Background: Young adults, especially those under 35, are often overlooked; however, previous studies have shown that coronary artery disease (CAD) incidence increases rapidly. Previous studies proved many risk factors for CAD, such as hyperlipidemia, hypertension, diabetes, and smoking. The present study ultimately aimed to figure out the correlation between Hyperuricemia (HUA) and smoking in CAD Patients under the age of 35.

Methods: This observational study included 100 young adults (18–35 years of age) suspected of CAD. We used the Gensini Score system to ascertain coronary angiography outcome and CAD; based on the number of affected vessels, localization of the segment, and the stenosis grade.

The Gensini score being > 0 indicated the presence of CAD.

Results: In young adults under 35, there was a significant correlation between HUA and CAD. The interaction between HUA and smoking had a contrast for CAD that statistically shown the existence of CAD increased in patients who have hyperuricemia and non-smokers compared to smokers.

Conclusions: By monitoring various parameters in young adults ≤ 35 years old. This study strengthens the correlation between:1) hyperuricemia and the occurrence of CAD, 2) Smoking and the CAD. Furthermore, there is a clear association between HUA and the occurrence of CAD in non-smokers.

Open Access Original Research Article

Assessment of the Relationship between Reperfusion Success and T-peak to T-end Interval in Patients with ST Elevation Myocardial Infarction Treated with Percutaneous Coronary Intervention or Pharmacoinvasive Therapy

Sara Kamel Abdo Elezaby, Ayman Ahmed El-Sheikh, Mohamed Ahmed Abd Al-Aal, Magdi El-Masrie

Cardiology and Angiology: An International Journal, Page 73-82
DOI: 10.9734/ca/2021/v10i430182

Background: Acute coronary syndrome encompasses unstable angina, non-ST-segment elevation myocardial infarction (NSTEMI) and ST-segment elevation myocardial infarction (STEMI). STEMI is mostly caused by coronary artery occlusion which treated either by fibrinolytic therapy or primary percutaneous coronary intervention (pPCI). The aim of this work was to investigate the relationship between therapeutic plasma exchange (TPE) interval and successful perfusion in patients with STEMI treated with pPCI or pharmaco-invasive therapy.

Methods: This cohort prospective study was carried out on 60 patients admitted to cardiology department in Tanta University Hospitals with STEMI. All patients were subjected to full medical history taking, clinical examination, laboratory investigations, electrocardiography, transthoracic echo Doppler study, coronary angiography, follow up for early outcome during hospital stay and late outcome after 3 months and assessment of thrombolysis in myocardial infarction (TIMI) flow.

Results: There was a statistically non-significant difference regarding age, gender, hypertension and diabetes between both groups. Regarding vessel affected, in group I, there were 20% with RCA lesion, 46.7% with LAD lesion and 33.3% with LCX lesion while in group II there were 30% with RCA lesion, 43.3% with LAD lesion, 20% with LCX lesion and 6.7% was LM with statistically non-significant difference between the groups. In comparison TPE preprocedural and TPE post-procedural in successful PCI group, there was statistically highly significant difference with P value 0.001. While comparing TPE preprocedural and TPE Postprocedural in failed PCI group, there was statistically non-significant difference with P value =0.09. ROC curve analysis was done to pick up the best cut off value of TPE at admission for prediction of Pharmaco-invasive group which revealed TPE at admission more than 104.5 with sensitivity 73.3% and specificity 63.3%. Area under the curve 0.725 with 95% CI ranged from 0.596 to 0.854.

Conclusions: The present study demonstrated that prolonged TPE interval is associated with ischemia and thus shortened TPE could be used as a marker for reperfusion success. TPE prolongation also associated with poor prognosis in patients with STEMI

Open Access Original Research Article

Effect of Cigarette Smoking on Location of Infarction in Patients Presented with ST-Segment Elevation Myocardial Infarction

Ahmed Mohammed Sherrah, Ayman Ahmed Elshekh, Mohamed Ahmed Abd El-Al, Mohamed Elsayed Elsetiha

Cardiology and Angiology: An International Journal, Page 83-94
DOI: 10.9734/ca/2021/v10i430183

Background: In an acute ST-elevation myocardial infarction, transmural myocardial ischemia causes myocardial damage or necrosis (STEMI). In order to establish myocardial ischemia damage, the current clinical definition of myocardial infarction (MI) in 2018 includes abnormal cardiac biomarkers. STEMI is linked to a greater risk of mortality in the hospital compared to non-ST segment elevation acute coronary syndromes. The study's purpose was to investigate and assess the effect of cigarette smoking on the location of infarction in people who had ST-segment elevation myocardial infarction.

Methods: The present case-control research investigated 100 individuals who had a first ST segment elevation acute myocardial infarction and got split into two groups based on the smoking status: group 1 (50 patients): Group 1 (50 patients) were smokers, whereas group 2 (50 patients) were nonsmokers.

Results: Smokers were significantly younger than non-smokers (53.86±7.77) years vs. (58.20 ± 7.80), P = 0. 006. Gender distribution: Smokers were significantly more likely to be male (82.0% vs. 58.0%, P = 0.009). inferior STEMI was statistically significant difference among the two groups (P value =0.045*). Myocardial Infarction Localization by electrocardiogram was statistically significant different among the two groups (P value =0.045*). Ejection fraction (EF) was statistically significant different among the two groups (smoker and nonsmokers respectively 54.86 ± 8.58% vs. 49.04 ± 6.61%) (P value =0.001*).

Conclusions: Smoking raises STEMI risk, and smokers are more likely than non-smokers to develop coronary artery disease at an earlier age.