搜索结果：The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology

Objective. To explore the effect of combined etomidate-ketamine anesthesia on perioperative electrocardiogram (ECG) and postoperative cognitive dysfunction (POCD) of elderly patients with rheumatic heart valve disease (RHVD) undergoing heart valve replacement. Methods. The data of 100 elderly RHVD patients treated in our hospital from May 2019 to May 2020 were selected for the retrospective analysis, and by adopting the double-blind method, the patients were divided into the ketamine group (n = 50) and the combined group (n = 50) according to the anesthesia methods. During the induction of anesthesia, the patients of the two groups were given a small dose of ketamine (0.5 mg/kg) at 5 μg/kg/min continuously via pump injection until the end of surgery, and on this basis, with the same anesthesia measures, those in the combined group were given etomidate (0.3 mg/kg) additionally. The patients’ perioperative ECG indicators, POCD scores, and Numeric Rating Scale (NRS) scores were compared between the two groups. Results. Compared with the ketamine group, the combined group presented significantly lower incidence of ST-T wave changes after anesthesia induction and at the time of intubation and skin incision ( <a:math xmlns:a="http://www.w3.org/1998/Math/MathML" id="M1"> <a:mi>P</a:mi> <a:mo>&lt;</a:mo> <a:mn>0.05</a:mn> </a:math> ), significantly lower average magnitude of ST-segment depression after anesthesia induction ( <c:math xmlns:c="http://www.w3.org/1998/Math/MathML" id="M2"> <c:mi>P</c:mi> <c:mo>&lt;</c:mo> <c:mn>0.001</c:mn> </c:math> ), significantly lower average magnitude of ST-segment elevation after anesthesia induction and extubation ( <e:math xmlns:e="http://www.w3.org/1998/Math/MathML" id="M3"> <e:mi>P</e:mi> <e:mo>&lt;</e:mo> <e:mn>0.001</e:mn> </e:math> ), significantly lower POCD incidence (6.%, <g:math xmlns:g="http://www.w3.org/1998/Math/MathML" id="M4"> <g:mi>P</g:mi> <g:mo>&lt;</g:mo> <g:mn>0.05</g:mn> </g:math> ), and significantly better NRS score after surgery ( <i:math xmlns:i="http://www.w3.org/1998/Math/MathML" id="M5"> <i:mi>P</i:mi> <i:mo>&lt;</i:mo> <i:mn>0.001</i:mn> </i:math> ). Conclusion. Combined etomidate-ketamine anesthesia can stabilize the perioperative ECG indicators of elderly RHVD patients undergoing heart valve replacement, improve their postoperative cognitive function, and reduce their pain sensation, which should be promoted and applied in practice.

The right atrial appendage is an important anatomical marker of the right heart. With the developments in cardiology, more attention has been paid to the right atrial appendage. This article summarizes the progress in research regarding the right atrial appendage anatomy and its clinical value, to collate and augment the relevant data. The shape of the right atrial appendage differs from the left atrial appendage: its outer surface is relatively flat and its internal structure comprises a terminal crest and musculi pectinati. In clinical interventional therapy, the right atrial appendage is often used as the electrode implantation site. The thickness of the musculi pectinati and the wall thickness of the right atrial appendage are closely related to the outcomes in atrial lead implantation. In terms of atrial fibrillation, wherein thrombi formation is frequent, the right atrial appendage is one of the predilection sites of thrombosis. However, the incidence of thrombosis in the right atrial appendage is lower than that in the left atrial appendage. Familiarity with the anatomy of the right atrial appendage is of prime importance in atrial lead implantation, and the role of the right atrial appendage in atrial fibrillation requires further investigation.

Abstract After severe infantile pneumonia accompanied by heart failure, the evaluation of cardiac function using two-dimensional speckle tracking-based ultrasonic imaging technology was looked into both before and after milrinone treatment. The study’s research subjects included 82 kids with severe pneumonia and heart failure. According to therapeutic methods, they were divided into the Conv group (conventional treatment for 31 cases) and the Milrinone group (conventional treatment combined with milrinone for 31 cases). Conventional children’s ultrasonocardiography was collected to implement wavelet threshold denoising before and after treatment. The modeling was performed using statistical methods, i.e., Canny arithmetic was used to check the edge outlines of abnormal areas. Besides, the global search block matching method was utilized to monitor three consecutive cardiac cycle images. The differences between cardiac function, right ventricular longitudinal strain after two-dimensional speckle tracking imaging, serum inflammatory factors (interleukin (IL)-6, IL-10, tumor necrosis factor (TNF)-α, and brain natriuretic peptide (BNP)), and complication rate of children were evaluated. In comparison to Gaussian low-pass filter and mean filter techniques, the results showed that mean square error (MSE), peak signal to noise ratio (PSNR), and mean structural similarity (MSSIM) of pictures following wavelet threshold denoising were all superior. When Canny arithmetic and global search block matching were used, the cardiac speckle tracking time was 0.07 ms, and the detection accuracy was 95.5%. Compared with the Conv and Milrinone groups, normal respiration, pulmonary moist rale disappearance, and liver recovery time were all shortened ( P &lt;0.05). Besides, children’s cardiac functions, including aortic peak flow velocity, left ventricular ejection fraction, corrected ejection time, and stroke volume index, significantly increased compared with those of Conv group and Milrinone group ( P &lt;0.05). Heart rate (HR), the overall longitudinal strain of right ventricle during systole, the overall longitudinal strain of the free wall, and the overall longitudinal strain of the interventricular septum were remarkably decreased ( P &lt;0.05). Compared with the Conv and Milrinone groups, serum IL-6, IL-10, TNF-α, and BNP levels of children were remarkably reduced ( P &lt;0.05). The total complication rate of the children in Conv group and Milrinone group were 16.1% (5/31) and 3.2% (1/31), respectively. The differences between the two groups were statistically significant ( P &lt;0.05). In conclusion, two-dimensional speckle tracking imaging can benefit from employing image processing technology to improve detection precision. When used as a clinical treatment for severe infantile pneumonia and heart failure, milrinone can lower the level of inflammatory factors in children’s bodies. Furthermore, it improved children’s cardiac function, reduced complication rate, and was beneficial to the prognosis of children.

Background: Speckle tracking echocardiography is new technique to evaluate left ventricular function.Objective: To evaluate sensitivity and specificity of two dimension global longitudinal strain ( 2D-GLS) estimated by speckle tracking echocardiography (2D-STE) to predict the diagnosis and degree of severity of CAD( coronary artery disease) in patient suspected to have stable ischemic heart diseases (IHD).Patients and Methods: An observational cross-sectional study, patients underwent echocardiography (TTE), left ventricular (LV)systolic function were estimate initially, (calculate LVEF) then assessment of LV global and regional longitudinal strain (GLS) were calculated next.All patient underwent coronary angiography in the catheterization unite and according to the result of coronary angiography, we separated patients into two groups: one how have significant (≥70%) coronary arteries stenosis (group A),and another group with non- significant(&lt;70%) coronary arteries stenosis (group B). The study was done in echocardiography unit and catheterization lab in Ibn-Albitar center of cardiac surgery, the study carried out from April 2018 to May 2019. Results: This study 93 patients were included , there is mean ages was (60.2 ±6.3) years, majority of cases were males (72.0%), 47.3% of all cases had ≥3 risk factors, and according to angiography study (67.7%) had significant CAD .The frequency of DM, dyslipidemia, and the occurrence of ≥3 risk factors were significantly elevated in group A(patients with significant coronary artery stenosis ) in comparison to the group B. Mean EF and GLS were considerably lower in group A related to group B. There was not much difference in GLS between single and two vessels involvement, however, the GLS value in three vessels was significantly lower compared to single and two vessels involvement. GLS were independent predictor of significant coronary artery stenosis, independent of the effect DM, dyslipidemia, and the presence of ≥3 concomitant risk factor. Conclusion: Assessment (GLS) value by 2D speckle tracking echocardiography is good test for predicating diagnostic and severity of coronary arteries diseases, global longitudinal strain had positive relationship with increasing number of stenotic coronary arteries, and provides high quantitative diagnostic information for detection of the CAD. Keywords: Echocardiography, significant coronary artery disease

Introduction: Chronic kidney disease (CKD) is a common, often late-diagnosed and progressive condition associated with increased morbidity and mortality, mainly due to elevated cardiovascular risk. Diabetes is the one of the leading causes of CKD. Due to the significant role that excessive mineralocorticoid receptor (MR) activation plays in the development of diabetic kidney disease (DKD), new therapies that target this pathway, are being investigated. Finerenone is a non-steroidal selective antagonist that reduces inflammation and fibrosis by blocking MR overactivity in the kidneys, heart, and blood vessels. Materials and Methods: This review is based on a comprehensive analysis of studies on the use of finerenone in patients with CKD and type 2 diabetes (T2D). Additionally, this article explores the potential applications of finerenone. The review was developed using a PubMed database and ClinicalTrials.gov. Results: The results of the FIDELIO-DKD and FIGARO-DKD trials, as well as the FIDELITY pooled analysis, showed that finerenone significantly improved renal and cardiovascular outcomes. They also showed that although hyperkalemia is a major adverse effect of finerenone treatment, the therapy is safe with appropiate monitoring and dose adjustment. In addition, its possible beneficial effects are in non-diabetic CKD, heart failure with preserved (HFpEF) and mildly reduced (HFmrEF) ejection fraction, advanced of CKD with lower estimated glomerular filtration rate (eGFR), and diabetic retinopathy. Conclusion: Clinical studies have confirmed that finerenone is a valuable addition to nephroprotective and cardioprotective strategies in the management of CKD associated with T2D, as reflected in latest clinical guidelines. Its safety profile is generally acceptable. Ongoing clinical trials will help clarify whether the approved indications for finerenone can be extended to non-diabetic CKD or additional clinical settings.

Cardiovascular illness encompasses a group of diseases affecting the blood vessels and the structure of the heart, and it remains one of the most prevalent non-communicable diseases worldwide. Over the years, the rate of death from cardiovascular diseases has shown a significant decline in several high-income countries, primarily due to reductions in risk factors and advancements in cardiovascular disease management. Nonetheless, the global burden of cardiovascular diseases remains substantial, with an estimated 55 million deaths occurring in 2017, out of which 17.7 million were attributed to cardiovascular disease. The focus of this review is to explore the burden of illness, risk factors, and physical activity levels in populations affected by cardiovascular diseases. Studies have identified 14 potentially modifiable risk factors that were strongly associated with cardiovascular disease and mortality, surpassing the significance of body mass index (BMI), as evidenced by the PURE (Prospective Urban and Rural Epidemiology) study and prior research. While cardiovascular deaths have decreased in several developed countries, there has been a significant increase in low- and middle-income countries. Physical activity has emerged as a critical factor in reducing the risk of mortality and major cardiovascular events, regardless of the type of physical activity and other risk factors. The Physical Activity Guidelines (PAG) for Americans in 2008 recommended a range of moderate and vigorous physical activity and highlighted its inverse association with all-cause mortality, cardiovascular disease mortality, and incident CVD. Emphasizing the importance of physical activity, this low-cost approach holds tremendous potential in reducing deaths and cardiovascular diseases on a global scale. Overall, this review highlights the ongoing global challenge of cardiovascular diseases and underscores the importance of preventive measures, including promoting physical activity, to improve cardiovascular health and reduce the burden of illness worldwide.

Introduction: The most common valvular heart disease is mitral stenosis. Mitral stenosis is an abnormality of the heart valve which causes reduced blood flow from the left atria to the left ventricle due to narrowing of mitral valve orifice during its opening motion. If the condition continues, it will result in complications. The most common complications are pulmonary hypertension, atrial fibrillation, heart failure, and stroke. Appropriate treatment for mitral stenosis may produce more favorable prognosis in these patients. Therefore, the aim of this study was to describe the profile of patients with mitral stenosis in Department of Cardiology and Vascular Medicine, Dr. Soetomo General Hospital, Surabaya from January 2015 to December 2017. It is expected that mitral stenosis can be detected earlier, thus the appropriate treatment can be administered promptly and further complications can be prevented. Methods: This study was a descriptive retrospective study with cross-sectional approach and accidental sampling method obtained from the inpatients medical records of patients diagnosed with mitral stenosis from echocardiography in Department of Cardiology and Vascular Medicine Dr. Soetomo General Hospital, Surabaya from January 2015 to December 2017. The variables were age, gender, disease severity, and the patient’s educational background. The data was processed using Microsoft Excel and IBM SPSS version 20. Results: This study obtained 41 patients who met the inclusion criteria, then the patients were categorized according to their age, gender, disease severity, and educational background. The results of the study showed that the subjects were dominated by those of productive age at 30-39 years old (39%), the most prevalent gender was female (85.4%), severe disease severity (85.4%), and educational level was from high school (85.4%). Conclusion: The majority of the patients with mitral stenosis were from productive age, female, with severe disease severity, and educational background from middle educational level (high school).

Cardiovascular disease affects those affected negatively. In our country, two out of every three people die from cardiovascular diseases.. Centimetry is an easily applicable method of measurement. The relationship between certain higher values measured by centimeter and the presence of diseases of the cardiovascular system has been established. The aim of this report is to present the measured values by centimeter in patients after coronary artery stent insertion and to analyze the results comparing them with literature data.Materials and methods. We have used a centimeter. We measured the waist and hip circumferences as well as the height of the patients. Based on the obtained values in cm, we calculated the ratios: waist/hip, waist/height and abdominal volume index (AVI).Results and discussion. We used the statistical package Graph Pad Prism 3.0 for the processing of results. We have calculated the mean and standard deviation for the studied indicators. We studied 30 patients after insertion of the coronary arteries. The mean values of the hip measurement were 113.05±8.19 cm. The mean values of the waist measurement were 96.67±8.47 cm. The mean waist/hipratio was 0.86±0.04. The mean waist/height ratio was 0.56±0.04. The calculated mean abdominal volume index (AVI) values were 18.85 ±3.19.Conclusion. Circulation calculations and the ratios derived from them can be used to assess the risk of developing cardiovascular disease. Timely detection of elevated values would allow adequate lifestyle modification measures to be taken to counteract the risk of cardiovascular disease development.

Congenital heart anomalies are a significant cause of infant morbidity and mortality globally, requiring complex care from the prenatal period through adulthood. Fetal echocardiography stands out as an essential tool for the early diagnosis of these anomalies, allowing for planned therapeutic interventions and reducing the risk of severe complications after birth. The aim of this literature review is to compare neonatal outcomes between cases diagnosed in utero and those not diagnosed in utero, in order to provide solid evidence to improve clinical practices and enhance health outcomes for newborns affected by congenital heart anomalies. Additionally, it aims to promote health education in this region and in the medical field of diagnostic imaging. Studies show that prenatal diagnosis is associated with better neonatal outcomes, including lower morbidity and mortality and a reduction in the need for emergency surgeries. Despite advances in technology, the examination is still not accessible to everyone and is not routinely prescribed, resulting in the detection of heart anomalies only after birth, leading to serious complications. The literature review highlights the importance of multidisciplinary collaboration and the need for health education to improve access to early diagnosis in resource-limited areas. The review demonstrates that fetal echocardiography plays a crucial role in the early identification and effective management of congenital heart anomalies, significantly improving neonatal health outcomes.

Previous research has linked an imbalance of the tissue inhibitors of metalloproteinase-1 (TIMP-1) and fibronectin (FN) to heart failure as a part of the extracellular matrix network (ECM) biochemistry profile, which is vital for cardiac homeostasis. This study aimed to assess the diagnostic performance of FN, TIMP-1, and CK-MB in heart failure (HF). Sixty patients (45 with acute and 15 with chronic HF) were recruited. Thirty individuals (20 with ischemic heart diseases, as other cardiac diseases, and 10 healthy individuals) were recruited as a control group. The biotin double antibody sandwich technology determined levels of human fibronectin and tissue inhibitors of metalloproteinase-1. FN was the most effective biomarker in differentiating HF patients from healthy individuals (AUC = 0.850) (P < 0.001), followed by TIMP (AUC = 0.74) and CK MB (AUC = 0.660). The sensitivity and specificity of FN were 82% and 70%, respectively, at a cutoff of 80 ng/ml. In addition, FN and TIMP had the same AUC (0.71) and efficiency (65%) in distinguishing HF patients from controls, followed by CK-MB (AUC = 0.70). We developed a novel model for HF diagnosis named the HFD model based on three biomarkers (FN, TIMP, and CK MB). The HFD model had an AUC of 0.77 in distinguishing HF patients from healthy individuals, with a sensitivity, specificity, and accuracy reaching 80%. For differentiating HF patients from controls, the HFD model had 0.8 AUC, 76% sensitivity, 75% specificity, and 76% accuracy.

Background: Heart failure (HF) is a chronic condition that affects a significant number of patients worldwide, requiring specialized management. Nurses have a great role in caring of such group of patients. Aim: The study aimed to investigate the effect of intervention program on nurses caring of patients with heart failure, at the Cardiac Care Unit (CCU). Method: A quasi-experimental research design was utilized in this study. The study included 30 nurses working at the Cardiac Care Unit. For data collection, two different tools were used. Tool I: A Structured interview Knowledge Questionnaire; Tool II: Nurses' Observational Checklist. Results: The study results showed significant differences pre and post implementation of the intervention program regarding nurses’ level of knowledge and practice compared to their pre-intervention levels with (p = 0.00). Conclusion, the results of this study concluded that the implementation of the intervention program revealed a significant positive improvement of nurses' knowledge and practice level regarding care of patients with heart failure. Recommendation, conducting in-service training programs for nurses caring patients with heart failure is recommended to keep them up to date with the latest information and evidence-based practices that related to care of patients with HF.

With the aging of the general population and the rise in surgical and transcatheter aortic valve replacement, there will be an increase in the prevalence of prosthetic aortic valves. Patients with prosthetic aortic valves can develop a wide range of unique pathologies compared to the general population. Accurate diagnosis is necessary in this population to generate a comprehensive treatment plan. Transthoracic echocardiography is often insufficient alone to diagnose many prosthetic valve pathologies. The integration of many imaging modalities, including transthoracic echocardiography, transesophageal echocardiography, cardiac computed tomography, cardiac magnetic resonance imaging, and nuclear imaging, is necessary to care for patients with prosthetic valves. The purpose of this review is to describe the strengths, limitations, and contemporary use of the different imaging modalities necessary to diagnose prosthetic valve dysfunction.

Background: Deferred stenting has been recognized as beneficial for patients with acute ST-segment elevation myocardial infarction (STEMI) accompanied by a high thrombus burden. Nevertheless, its efficacy and safety specifically in geriatric STEMI patients remain to be elucidated. This study aims to bridge this knowledge gap and assess the potential advantages of deferred stenting in an older patient cohort. Methods: In this study, 208 geriatric patients (aged ≥80 years) with STEMI and a high thrombus burden in the infarct-related artery (IRA) were enrolled. They were categorized into two groups: the deferred stenting group, where stent implantation was conducted after 7–8 days of continuous antithrombotic therapy, and the immediate stenting group, where stent implantation was performed immediately. Results: In the deferred stenting group, the stents used were significantly larger in diameter and shorter in length compared to those in the immediate stenting group (p &lt; 0.05). This group also exhibited a lower incidence of distal embolism in the IRA, and higher rates of the thrombolysis in myocardial infarction (TIMI) blood flow grade 3 and myocardial blush grade 3 (p &lt; 0.05). Additionally, the left ventricular ejection fractions at the 1-year follow-up were significantly higher in the deferred stenting group than in the immediate stenting group (p &lt; 0.05). The rate of the major adverse cardiac events in the deferred stenting group was significantly lower than in the immediate stenting groups (p &lt; 0.05). Conclusions: Deferred stenting for geriatric patients with STEMI and high thrombus burden demonstrates significant clinical benefits. This approach not only reduces the incidence of distal embolism in the IRA, but also enhances myocardial tissue perfusion and preserves cardiac ejection function. Moreover, deferred stenting has proven to be safe in this patient population, indicating its potential as a preferred treatment strategy in such cases.

INTRODUCTION: Prophylactic antifungal therapy has been widely used for critical patients, but it has failed to improve patient prognosis and has become a hot topic. This may be related to disruption of fungal homeostasis, but the mechanism of fungi action is not clear. As a common pathway in critical patients, intestinal ischemia-reperfusion (IIR) injury is fatal and regulated by gut microbiota. However, the exact role of enteric fungi in IIR injury remains unclear. OBJECTIVES: This is a clinical study that aims to provide new perspectives in clarifying the underlying mechanism of IIR injury and propose potential strategies that could be relevant for the prevention and treatment of IIR injury in the near future. METHODS: ITS sequencing was performed to detect the changes in fungi before and after IIR injury. The composition of enteric fungi was altered by pretreatment with single-fungal strains, fluconazole and mannan, respectively. Intestinal morphology and function impairment were evaluated in the IIR injury mouse model. Intestinal epithelial MODE-K cells and macrophage RAW264.7 cells were cultured for in vitro tests. RESULTS: Fecal fungi diversity revealed the obvious alteration in IIR patients and mice, accompanied by intestinal epithelial barrier dysfunction. Fungal colonization and mannan supplementation could reverse intestinal morphology and function impairment that were exacerbated by fluconazole via inhibiting the expression of SAA1 from macrophages and decreasing pyroptosis of intestinal epithelial cells. Clodronate liposomes were used to deplete the number of macrophages, and it was demonstrated that the protective effect of mannan was dependent on macrophage involvement. CONCLUSION: This finding firstly validates that enteric fungi play a crucial role in IIR injury. Preventive antifungal treatment should consider damaging fungal balance. This study provides a novel clue to clarify the role of enteric fungi in maintaining intestinal homeostasis.

Background: Heart Failure is a chronic, longstanding disease associated with high morbidity, mortality, and increased health care cost.Self care activities have been illustrated to improve quality of care of heart failure and disease outcomes.Aim: This study aimed to assess the relationship between multidimensional factors (knowledge, cognitive impairment, anxiety and depression, social support, quality of life) and self care behaviors among patients with heart failure.Study design: A descriptive co-relational research design was utilized to achieve the aim of this study.Setting: This study was conducted in the heart department at Ain Shams University hospital.Subjects: Purposeful sample of (60) adult patients with heart failure were selected to included in this study.Tools of Data collection: (1) Patients' demographic and clinical characteristics assessment tool.(2) The dutch heart failure knowledge scale.(3) Mini-mental state examination scale.(4) Patient health questionnaire-4.(5) The social support instrument.(6) The Kansas City cardiomyopathy questionnaire.(7) The self-care heart failure index.Results: This study revealed that 78.3% of patients with heart failure had unsatisfactory level of knowledge, 33.3% have cognitive impairment, 40% suffered from moderate level of anxiety and depression, 80% got high social support from their families, and 70% had fair quality of life.Moreover, it was illustrated that there was a correlation between the self-care behaviors and knowledge, cognitive impairment, anxiety and depression, social support, and quality of life among patients with heart failure where p value <0.05.Conclusion: Several factors are positively/negatively correlates with self care behaviors among patients with heart failure such as the knowledge of patients, cognitive impairment, anxiety and depression, level of social support, and quality of life.Recommendations: Ongoing assessment of factors that may impedes self care behaviors among patients with heart failure can help health care professionals in providing disease management based on individual needs.

Background: Chronic total occlusion (CTO) of the coronary arteries presents a significant challenge in the management of coronary artery disease, with diverse clinical manifestations and implications for patients with varying left ventricular ejection fraction (LVEF). The aim of this study is to investigate the impact of percutaneous coronary intervention (PCI) on echocardiographic parameters in patients with CTO and different LVEF, so as to optimize the care and outcomes of patients. Methods: We selected patients with CTO of coronary arteries treated at our hospital from June 2021 to June 2023 consecutively in this study. The patients were divided into two groups based on their LVEF: the low to moderate LVEF (&lt;50%) group and the high LVEF group. Echocardiographic parameters, medication use, and demographic characteristics were assessed before and after PCI. Statistical analyses were conducted to compare changes in LVEF, left ventricular end-systolic volume (LVESV), left ventricular end-diastolic volume (LVEDV), global longitudinal strain (GLS), and left ventricular wall motion score (LVWMS) between the two LVEF groups. Results: A total of 100 patients including 67 patients with Low &amp; Mid-range LVEF and 33 patients with High LVEF were included. Patients in the low and mid-range LVEF group demonstrated significant improvements in LVEF (p = 0.010), LVESV (p = 0.013), LVEDV (p = 0.034), GLS (p = 0.014), and LVWMS (p = 0.014) following PCI. In contrast, no significant changes in these parameters were observed in the high LVEF group after PCI. Conclusion: This study demonstrates that PCI leads to significant improvements in LVEF, LVESV, LVEDV, GLS, and LVWMS in patients with low to moderate LVEF, indicating potential benefits of revascularization in this patient subset.

AIM: This study aims to compare the clinical efficacy and quality of life between transesophageal echocardiography (TEE)-guided and X-ray-guided percutaneous closure in adults with secundum atrial septal defect (ASD). METHODS: A retrospective cohort study was conducted on 130 adults with secundum ASD who underwent percutaneous closure in our hospital between January 2022 and January 2024. The patients were divided into an observation group (TEE-guided, n = 58) and a control group (X-ray-guided, n = 72). The patients were followed up for 12 months, and their baseline characteristics, operation success rate, ventricular function parameters, postoperative complications and the 36-Item Short Form Health Survey (SF-36) quality of life scores were comparatively analyzed. RESULTS: Compared to the control group, the observation group had shorter procedure times, higher rates of successful primary closure, shorter hospital stays, and lower early residual postoperative diversion rates (p &lt; 0.05). There were no significant differences in baseline right ventricular end-diastolic volume index (RVEDVi), right ventricular end-systolic volume index (RVESVi), right ventricular ejection fraction (RVEF), left ventricular end-diastolic volume index (LVEDVi), left ventricular end-systolic volume index (LVESVi), and left ventricular ejection fraction (LVEF) between the two groups (p &gt; 0.05). However, 3 months after surgery, both groups showed improvement in biventricular function, with the observation group exhibiting better right ventricular functional parameters (RVEDVi, RVESVi, RVEF) than the control group (p &lt; 0.05). Furthermore, the overall complication rate was significantly lower in the observation group than in the control group (p &lt; 0.05). There was no significant difference in pre-procedure SF-36 scores between the two groups (p &gt; 0.05); however, 12 months after surgery, SF-36 scores in all domains increased in both groups, with the observation group scoring higher (p &lt; 0.05). CONCLUSIONS: In treating adult secundum ASD, TEE-guided percutaneous ASD closure yields superior clinical outcomes compared to the X-ray-guided method regarding procedural efficiency, reduction of early residual shunts, recovery of right ventricular function, relief of complication, and improvement in quality of life.

Background: Coronary collateral circulation (CCC) is a crucial protective mechanism in acute myocardial infarction. This study aimed to identify early predictors of CCC in patients with acute ST-segment elevation myocardial infarction (STEMI) and develop a nomogram for predicting its presence. Methods: We conducted a retrospective study of STEMI patients admitted to the Beijing Friendship Hospital from January 2015 to December 2023. Patients with CCC, as confirmed by coronary angiography, were matched 1:3 with those without CCC based on the date of admission. We compared baseline characteristics, laboratory parameters, coronary features, and in-hospital outcomes between the two groups. Variable selection was performed using least absolute shrinkage and selection operator (LASSO) regression analysis, followed by univariable and multivariable logistic regression analyses to identify independent predictors of CCC. A nomogram was constructed based on significant predictors and was validated through receiver operating characteristic (ROC) curve analysis, calibration curves, and decision curve analysis. Results: A total of 668 patients with STEMI were included in the study (501 without CCC and 167 with CCC). Patients with CCC had a higher prevalence of right coronary artery (RCA) closure and multi-vessel disease, as well as elevated inflammatory markers and altered coagulation parameters. Multivariable logistic regression analysis identified a history of coronary heart disease (CHD), osmolality, levels of fibrinogen, and left anterior descending (LAD) artery closure, left circumflex (LCX) artery closure, and RCA closures, as well as the Gensini score, were independent predictors of CCC. The nomogram incorporating these predictors demonstrated good discrimination and calibration, indicating an accurate prediction of the presence of CCC. Conclusions: History of CHD, osmolality, levels of fibrinogen, LAD, LCX, and RCA closures, as well as the Gensini score, are independent predictors of CCC in patients with STEMI. The developed nomogram offers a clinically useful tool for identifying patients likely to have CCC, potentially aiding in personalized treatment strategies.

PURPOSE: This research aims to assess the impact of coronary microvascular dysfunction (CMD) on the systolic function of the left ventricle (LV) in patients with ischemia and no obstructive coronary artery disease (INOCA) by employing three-dimensional speckle tracking echocardiography (3D-STE). METHODS: A group of 66 individuals with INOCA participated in the research. They all went through regadenoson stress echocardiography and measurement of coronary flow velocity reserve (CFVR). Patients were divided into a CMD group with CFVR values less than 2.0 and a control group with CFVR values of 2.0 or higher. RESULTS: Compared with controls, the CMD group showed reductions in stress global longitudinal strain (GLS), stress global area strain (GAS), the change in GLS from rest to stress (ΔGLS), and the change in GAS from rest to stress (ΔGAS) (all p < 0.001). All four strain parameters exhibited significant correlations with CFVR. Univariate analysis revealed that stress GLS, stress GAS, ΔGLS, and ΔGAS possessed good predictive value for CMD, among which ΔGAS had higher predictive value, having areas under the curve (AUC) of 0.923. CONCLUSION: Strain parameters derived from 3D-STE under pharmacologic stress demonstrate excellent benefits in assessing LV systolic function in CMD patients. These parameters, especially ΔGAS, may serve as novel predictive indicators for the clinical assessment of CMD.