Research in Cardiovascular Medicine
Volume:12 Issue: 42, Jan -Mar 2023

Context: 

It seems that the threat of death increases among diabetic patients with coronavirus infection disease-2019 (COVID-19). Statins have anti-inflammatory and anti-thrombogenic properties along with lowering blood cholesterol. Therefore, statins could be considered as an important factor in reducing the mortality rates in diabetic patients with COVID-19. This systematic review and meta-analysis study was performed to investigate the effect of statin on mortality in diabetic patients with COVID-19.

Evidence Acquisition: 

This study was done based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Electronic databases such as PubMed, Embase, Scopus, Web of Science, and Cochrane Library were searched from December 2019 until the end of September 2022. Meta-analysis was used by the comprehensive meta-analysis software to combine the results. A funnel plot and Egger’s regression test were used to investigate the publication bias.

 Six studies were included in the meta-analysis. Nine thousand five hundred and thirty-three diabetic patients with COVID-19 were studied. The heterogeneity between studies was significant. According to the meta-analysis, using the random-effects model, we found that the rate of mortality due to COVID-19 in diabetic patients who used statins was 9% lower than other patients. Publication bias between studies included in the meta-analysis was not significant.

 In this study, there was no significant difference between the mortality rates of diabetic people with COVID-19 who used statins and individuals who did not consume statins – this difference was just 9%. Therefore, it could be said that more clinical trials are needed to ensure the clinical efficacy of statins among diabetic patients with COVID-19.

The objective of this study was to identify the level of treatment adherence and also sought to explore several demographic, clinical, comorbidities, and self-care behavior factors that may affect adherence among patients with heart failure (HF).

This single-center cross-sectional, questionnaire-based study was conducted on 500 adult HF patients referred to the clinic of Rajaie Cardiovascular, Medical, and Research Center, in Tehran, Iran, from February to July 2022. The level of treatment adherence was assessment through Modanloo’s questionnaire. An unadjusted and adjusted binary logistic regression model was used to check the effect of different factors on the patients’ adherence level.

Among 474 responders, 51.7% had “good” adherence to treatment. According to the results, age >54 years (odds ratio [OR]: 0.967, 95% confidence interval [CI]: 0.946–0.988, P = 0.002), mitral valve regurgitation (OR: 0.597, 95% CI: 0.362–0.982, P = 0.042) and HF duration (OR: 0.486, 95% CI: 0.274–0.862, P = 0.014) were found as independent variables associated with “poor” treatment adherence. However, higher educational level (OR: 3.313, 95% CI: 2.632–4.067, P < 0.001), New York Heart Association class I (OR: 3.231, 95% CI: 1.587–4.661, P = 0.002), ejection fraction (EF) >40% (OR: 1.023, 95% CI: 1.005–1.041, P = 0.013), HF with preserved EF (OR: 2.728, 95% CI: 1.387–5.365, P = 0.004), familiar with social media (OR: 3.792, 95% CI: 1.777–4.268, P < 0.001) and high awareness of HF (OR: 2.385, 95% CI: 1.072–3.044, P = 0.006) were significant positive predictors for good adherence to treatment.

Adherence to the treatment regimen has improved compared to previous studies, but is still suboptimal, particularly with respect to awareness of HF. Therefore, improving the awareness of patients as well as encouraging and supporting them for self-care behaviors can have a positive effect on treatment adherence.

Context: 

Angiotensin receptor-neprilysin inhibitor (ARNi) has been established as the standard medication for heart failure. However, the blood pressure (BP)-lowering effect circumvented its administration and titration in patients with borderline hypotension.

This study aimed to determine the correlation between ARNi dosage and hemodynamic impacts. Subjects and

A network meta-analysis was conducted to interrogate the BP impact of ARNi (sacubitril/valsartan 100 mg/d, 200 mg/d, 400 mg/d) and angiotensin receptor blocker (ARB) counterparts. Individuals with mild-to-moderate systolic hypertension were enrolled in respective studies. The outcomes were set as the change from baseline systolic and diastolic BP. Statistical Analysis Used: Network meta-analysis, node-splitting, and inconsistency model methods in Bayesian approach were employed.

A total of 14 manuscripts with 7705 subjects were included for pooled analysis. Compared with ARB, sacubitril/valsartan 400 mg/d and 200 mg/d, but not 100 mg/d, were associated with significantly greater reduction effect of systolic and diastolic BP, either by office documentation or 24-h ambulatory monitoring. The BP-lowering effect of sacubitril/valsartan 400 mg/d and 200 mg/d was nevertheless equivalent.

ARNi exerts a dose-dependent effect on BP reduction. Such hemodynamic impact exceeds ARB at higher doses.

Neurological complications (NCs) (stroke) remain a devastating complication after cardiovascular surgical procedures despite advances in perioperative monitoring and management. The incidence of NC related to cardiovascular surgeries (CS) is comparatively very high and associated with high morbidity and mortality. The aim of this study is to evaluate the overall incidence of neurological complications in adult as well as pediatric patients and various pattern of neurological injury on noncontrast computed tomography head (NCCT) associated with various types of CS.

We retrospectively analyzed all the NCCT heads of the postoperative cardiovascular surgery patients done in the immediate and early postoperative period (<7 days) who developed postoperative neurological deficits between April 2016 and February 2020. The medical records of all these cardiac surgery patients were analyzed for various variants such as the total number of patients who underwent CS, various types of cardiac surgery done during the study period, demographic information, associated comorbidities, various types of NC, postoperative data and various spectrum of computed tomography (CT) findings in the brain.

A total of 12,896 adult and pediatric cardiac surgeries were performed at our institute. Out of these, 1115 patients (8.6%) underwent CT brain for suspected neurological injury. A total of 215 patients (1.6%) had a positive finding on their NCCT head. Out of 215 patients, 148 (68.9%) were adult patients, whereas 67 (31.1%) were pediatric patients. A total of 156 (72.5%) patients had ischemic infarction (stroke), whereas hemorrhagic lesions were present in 59 patients (27.4%). The various types of positive CT scan findings were-156 ischemic infarcts (72.5%), 20 intraparenchymal hemorrhages (9.3%), 16 subdural hemorrhage (7.4%), 15 subarachnoid hemorrhage (6.9%), 01 cerebrovascular thrombosis (0.4%), and 07 intraventricular hemorrhage (3.2%). In an adult patient, pattern of ischemic infarct comprised middle cerebral artery (MCA) territory in 42 patients (41.5%), posterior territory in 34 patients (33.6%), anterior cerebral territory in seven patients (7.0%), multi-territory infracts in 11 patients (11.0%) and global ischemia in six patients (6.0%). Intraparenchymal hemorrhage was present in 17 patients (11.4%). In a pediatric subset of patient, the pattern of ischemic infarct included global hypoxic injury (GHI) in 30 patients (54.5%), posterior cerebral artery territory in nine patients (16.3%), MCA territory in eight patients (14.5%), multi-territory involvement in five patients (9.0%), and anterior cerebral artery territory in three patients (5.4%). In the hemorrhage group, five patients (7.4%) developed subarachnoid hemorrhage (SAH).

In an adult patient, subset MCA territory infarcts were common in the infract group, whereas intra parenchymal haemorrhage (IPH) in the hemorrhage group. In the pediatric patient subset, GHI was common in infract group and SAH in hemorrhage group. Moreover, NCCT of the head is very useful in diagnosing early postoperative neurological complications in cardiovascular surgeries and managing the complications accordingly.

Prosthetic valve thrombosis is of the serious long-term complications of heart valve replacement that its treatment particularly in left-sided valves is controversial. Both surgery and thrombolysis are associated with their own merits and drawbacks. Hence, the aim of the present study is the evaluation of response to surgery and thrombolytic therapy in patients with aortic prosthetic valve thrombosis in a tertiary heart center in Tehran, Iran, during 2007–2019.

In this retrospective study, 85 patients with aortic prosthetic valve thrombosis (including 63 case of surgery and 22 case of thrombolytic therapy) were evaluated. Response to clinical and hemodynamic treatment and frequency of complications and mortality were determined in each group.

Clinical complete response in surgery group (84.13%) was significantly more than patients with thrombolytic therapy (64.63%). The frequency of complications in surgery and the thrombolytic group was 12.7% and 9.09%, respectively, which show no significant difference. Mortality was seen in 1.58% and 4.53% of patients with surgery and thrombolytic therapy respectively that was not statistically significant. Complete failure of treatment was seen in 18.18% of patients with thrombolytic therapy and re-surgery was done for them. The surgery success rate was significantly more than thrombolytic success rate in patients with a therapeutic range of international normalized ratio (INR) level.

Surgery versus thrombolytic therapy has more efficacy and similar safety in patients with aortic prosthetic valve thrombosis and may be preferable treatment for these patients. However, thrombolytic therapy also can be used as a suitable alternative, particularly in patients with a high risk of surgery.

Atrial septal defect (ASD) is one of the most common congenital heart defects (3.78/10,000 live births). For several decades, surgical closure has been considered the standard method of repairing an ostium secundum ASD. Surgical treatment is safe and effective, but the complications relate to bleeding, arrhythmia, and residual defects. However, over the years, percutaneous device closure using the Amplatzer ASD occluder (AGA Medical Corp., Golden Valley, Minnesota) has been widely used for the treatment of ASD and has proven to be effective and safe as traditional surgical repair. However, procedure- or device-related complications can occur; Complications commonly associated with ASD closure device includes residual shunt, device malposition or embolization, thrombosis in the vena cava or atrium and erosion of the surrounding tissue which may lead to perforation of the heart, which could be fatal. We report an unusual case of a 16-year-old female with embolization of the ASD occluder device into the right ventricle immediately after device deployment. We removed the device surgically and closed the ASD in a standard manner, with an autologous pericardial patch. The patient was discharged from the hospital without any complications.

The anomalous origin of the left coronary artery (LCA) from the pulmonary artery (PA) is a very uncommon congenital anomalous that can be fatal. The adult type of this coronary abnormality can be the presence of varied from asymptomatic to sudden cardiac death. In this study, we present a 35-year-old female with a diagnosis of LCA from the PA that present with exertional dyspnea due to systolic dysfunction after myocardial ischemia secondary to this anomaly. She underwent successful Takeuchi repair without any complications.