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   Table of Contents - Current issue
January-March 2020
Volume 21 | Issue 1
Page Nos. 1-56

Online since Thursday, January 23, 2020

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Heart views in its 22nd year p. 1
Hajar A Albinali
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Cardiovascular news p. 3
Uma Velupandian
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Discovering novel biochemical and genetic markers for coronary heart disease in Qatari individuals: The initiative Qatar cardiovascular biorepository p. 6
Ayman El-Menyar, Jassim Al Suwaidi, Ramin Badii, Fayaz Mir, Angela K Dalenberg, Iftikhar J Kullo
Background: We aimed to describe the creation and challenge of a DNA and plasma biorepository (Qatar Cardiovascular Biorepository) with linkage to the electronic health record of cardiovascular risk factors to facilitate discovery of novel genetic and proteomic biomarkers for coronary heart disease in Qatari individuals. Methods: A prospective case–control study was conducted between October 2013 and February 2018. CHD was defined as a history of an acute coronary syndrome (myocardial infarction [MI]/unstable angina) or coronary revascularization. Controls were identified from blood donors who had no history of coronary heart diesase. After informed consent, blood samples were obtained for DNA and plasma. Demographic, laboratory, and clinical variables were derived from the electronic medical record, and information regarding history of cardiovascular diseases and risk factors was collected from surveys. Challenges in establishing the biorepository were noted, and processes to promote use of the biorepository by Qatari investigators were put in place. Results: During the study period, 2671 individuals were approached; of them, 2087 participants were recruited (1029 patients and 1058 controls). Relevant risk factors were ascertained from the electronic health record and surveys. The mean age was 49 ± 16 years, with 61% males. Challenges included setting up the infrastructure for qatar cardiovascular biorepository, developing an informed consent document in Arabic/English, and meeting target recruitment goals. The prevalence of diabetes mellitus, hypertension, dyslipidemia, and smoking was 41%, 44.5%, 40%, and 19%, respectively. History of myocardial infarction, percutaneous coronary intervention, and coronary artery bypass surgery was 55%, 68%, and 17%, respectively, among patients. Conclusions: This study addresses the challenges in setting up qatar cardiovascular biorepository, the first cardiovascular genomics biorepository in the Arab Middle Eastern region. QCBio is a unique resource for identifying genetic susceptibility variants and novel circulating markers for coronary heart disease in Qatari adults and enables individualized assessment of risk for coronary heart disease.
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Transcatheter device closure of perimembranous ventricular septal defect in pediatric patients: Long-term outcomes p. 17
Jayal Hasmukhbhai Shah, Sanket Pravinchandra Saraiya, Tushar Sudhakarrao Nikam, Mukesh Jitendra Jha
Aims: The aim of this study is to evaluate the safety and efficacy of transcatheter device closure of perimembranous ventricular septal defects in pediatric patients at long-term follow-up. Materials and Methods: We prospectively studied 376 patients with perimembranous VSDs between September 2008 and December 2015 who underwent percutaneous closure at our center. Transthoracic echocardiography (TTE) and electrocardiogram were done before and after the procedure in all the patients. All patients were subjected to follow-up evaluation at 1, 3, 6, 12 months, and annually thereafter with TTE and electrocardiogram. Results: A total of 376 patients (210 males and 166 females) underwent transcatheter closure of perimembranous VSD. Mean age of patients was 8.67 ± 3.02 (range 3–18 years) and mean weight was 21.15 ± 8.31 (range 8–65 kg). The procedure was carried out successfully in 98.93% of patients with no reported mortality. Rhythm disturbances occurred in 8.5% of patients after the procedure which included three cases of complete atrioventricular block. Conclusion: This study shows that in experienced hands transcatheter closure of perimembrnous VSD is safe and effective at long-term follow-up. With minimal morbidity and no mortality, the transcatheter is an effective alternative to surgical closure in selected patients.
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Role of smoking in the evolution of cardiovascular magnetic resonance and laboratory findings of acute myocarditis p. 22
Efstathios Detorakis, Rowland Illing, Ismini Lasithiotaki, Emmanouil Foukarakis, Maria Raissaki
Purpose: The purpose is to investigate cardiac magnetic resonance and laboratory findings in patients with clinically suspected acute myocarditis and re-assess the evolution of findings in relation to clinical parameters and smoking habits. Methods: We prospectively analyzed 68 consecutive patients (4 females, 64 males, median age 25 years) at baseline and 51 patients 12 months later with regard to age, symptoms, and signs, smoking history, cardiac troponin I, erythrocyte sedimentation rate, c-reactive protein blood levels, electrocardiography changes, and cardiac magnetic resonance findings. Statistical analysis included group comparisons and linear regression between clinical parameters and the obtained data. Results: A statistically significant correlation was recorded between smoking and late gadolinium enhancement extent, both at baseline and follow-up study. Late gadolinium enhancement extent was positively associated with cardiac troponin I serum levels and c-reactive protein and negatively with left ventricular ejection fraction at baseline study. Myocardial segments 4 and 5 were most frequently involved. Late gadolinium enhancement persisted in 96% of patients with no significant extent change at 12-month follow-up, while improved. Conclusions: A strong correlation was recorded between smoking patients with acute myocarditis and extent both at baseline and follow-up cardiac magnetic resonance. Myocardial segments 4 and 5 involvement was most prevalent. Late gadolinium enhancement persisted at follow-up, its incidence was higher than that reported in other studies and did not have an impact on the patient's clinical status or cardiac function. However, longer-term follow-up is highly recommended in these patients.
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After ischemia trial, what is the role of ischemia detection on noninvasive testing? p. 31
Abdul Rahman Arabi, Awad Alqahtani, Jassim Alsuwaidi
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Anticoagulation in patients with atrial fibrillation and coronary artery disease p. 32
Fahad Abdullah Alkindi, Ihsan Mahmoud Rafie
The management of antithrombotic therapy in patients with atrial fibrillation undergoing percutaneous coronary intervention for coronary artery disease remains a challenge in clinical practice. This group of patients has indications for both oral anticoagulation and antiplatelet therapy. Such combination will require careful considerations of both thromboembolic and bleeding risks. There have been several big trials looking at the rationale of treating those patients with an oral anticoagulant in combination with one (dual-therapy strategy) or two antiplatelet agents (triple-therapy strategy).
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Acute ST-segment elevation: Don't rush me to the catheter laboratory- please wait p. 37
Bassim Albizreh, Mohammad Alibrahim, Tahir Hamid
We report a case of a young woman with no cardiac history who presented with out-of-hospital cardiac arrest and ST-segment elevation on the electrocardiogram. The cardiac arrest initially was suspected to be secondary to coronary artery disease. Further history was taken from a relative who said that the patient had a severe headache before the cardiac arrest. It was subsequenly found on computed tomography of the head that the patient had infratentorial subarachnoid hemorrhage and diffurse brain edema. The management of course was totally different from what was contemplated initially. This case illustrates that ST-segment elevation can be caused by other conditions besides on occlusive thrombus in the coronary arteries.
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De winter t-wave electrocardiogram pattern due to thromboembolic event: A rare phenomenon p. 40
Yaser Alahmad, Sundus Sardar, Hisham Swehli
De winter pattern on the ECG is associated with occlusion of proximal left anterior descending artery. It is an atypical presentation of acute myocardial infarction due to LAD occlusion. We report a case due to thromboembolic occlusion of LAD after chemical cardioversion. It is imperative for cardiologists and physicians to instantly identify the De Winter pattern on ECG to appropriately triage these patients without delay.
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Utility of MitraClip XTR system in percutaneous edge-to-edge mitral valve repair for severe flail leaflet p. 45
Mohammed Al-Hijji, Abdallah El Sabbagh, Erin A Fender, Jeremy Thaden, Charanjit S Rihal, Mackram F Eleid
Transcatheter mitral valve (MV) edge-to-edge repair provided alternative solutions to high surgical risk patients with degenerative MV regurgitation (MR) and patients with functional MR leading to symptomatic heart failure. However, the procedure cannot be performed in certain MV anatomy such as excessive mitral annular or leaflet calcification with coexisting stenosis or excessive flail leaflet with wide gap and width. The introduction of MitraClip XTR system with its extended arms provided a wider range of MV anatomies that can be treated with MV edge-to-edge repair. In this report, we present the successful treatment of excessive flail posterior leaflet with MitraClip XTR device.
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Transcatheter aortic valve replacement valve in transcatheter aortic valve replacement valve for severe periprosthetic regurgitation p. 49
Sneha Nandy, Siu-Hin Wan, Kyle Klarich
The management of postprocedure severe aortic periprosthetic regurgitation after transcatheter aortic valve replacement (TAVR) is unknown. While valve-in-valve TAVR has been associated with favorable outcomes for degenerative surgically implanted bioprosthetic valves, there are no evidence-based guidelines for immediate TAVR valve in TAVR valve for periprosthetic regurgitation. We present a patient who underwent a TAVR valve in TAVR valve implantation within 48 h of her first procedure and showed a good response.
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Paravalvular mitral leak clossure with amplatzer occluder using coronary balloon in crossing a thick and fibrous interatrial septum p. 52
Tufan Cinar, Vedat Çiçek, Mert Ilker Hayiroglu, Sükrü Akyüz, Can Yücel Karabay
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Eternal magic of the pharoahs p. 54
Sherif Mahmoud Helmy
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Genetics in cardiovascular disease p. 55
Rachel Hajar
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