Introduction Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are transformative lipid-lowering therapies, yet the structure of the research literature is strongly shaped by trial priorities. This study aimed to map global research trends on PCSK9 inhibitors using a bibliometric analysis of Scopus and PubMed. Methods Metadata on publication year, journal, citations, authorship, country, institution, and keywords were extracted. Annual output, mean citations, h-index correlations, and collaboration metrics were calculated, and networks were visualized using Bibliometrix and VOSviewer. Results Approximately 1,390 records published between 1994 and 2024 were identified, involving 7,601 authors and 51,555 citations, with a mean of 37.1 citations per document. Network mapping revealed eight collaboration clusters and an international collaboration index of 1.871. The United States contributed the largest share of corresponding-author articles, with 343 of 1,390 records (24.7%), while the top 10 countries accounted for approximately 65% of outputs. Publication volume increased sharply after 2013, with inclisiran emerging as a highly cited RNA-based therapeutic. However, annual publication volume was not significantly correlated with mean citations (r = 0.059, P = 0.832), indicating no proportional increase in per-article citation influence. Discussion Network analysis identified eight major collaboration clusters. International collaboration was modest, with limited contributions from low- and middle-income countries. Temporal trends showed a notable increase in publications after 2013. Emerging RNA therapeutics were visible in the dataset but had lower citation maturity compared with established monoclonal antibody studies. Conclusion Scopus and PubMed mapping reconstructs the translational progression of PCSK9 research and highlights collaboration patterns, country-level contributions, and the bibliometric visibility of emerging therapeutic modalities.
Introduction Atherosclerotic cardiovascular disease (ASCVD) is a low-grade inflammation of the vessels that underlies cardiovascular disease (CVD). Dietary factors significantly influence the development of ASCVD, as do traditional CVD risk factors. The Dietary Inflammatory Index (DII) is a tool to evaluate diet-inflammation relationships and their impact on CVD incidence. We aimed to compare the DII, dietary macronutrient intake, and body mass index (BMI) between patients with ASCVD and healthy controls in Hamadan City, Iran, in 2024. Methods This case-control study included a total of 103 newly diagnosed ASCVD patients and an equal number of healthy controls. Dietary intake was assessed using a validated food frequency questionnaire. DII was calculated based on 38 food items. Physical activity levels (PAL) were evaluated through two researcher-made questions. DII, PAL, and dietary factors were compared between patients and controls. Results ASCVD patients had higher DII and higher intakes of total fat (p<0.001), saturated fat (p=0.032), polyunsaturated fatty acids (PUFA) (p=0.023), and monounsaturated fatty acids (MUFA) (p<0.001) than controls. Each unit increase in the DII was associated with a 16.8% increase in ASCVD risk. Higher PAL was associated with a 50.2% reduced risk of ASCVD. Conclusion Based on the findings, diets high in proinflammatory foods, higher fat intake, and sedentary behavior are associated with an increased risk of ASCVD.
Background Pulmonary artery sarcoma (PAS) is a rare malignant tumor originating from the pulmonary arterial wall, often mimicking pulmonary thromboembolism. Echocardiography, computed tomography (CT), cardiac magnetic resonance imaging (MRI), and positron emission tomography-computed tomography (PET-CT) are crucial for early detection. Case Presentation A 35-year-old man presented with dyspnea, signs of pulmonary embolism, and right ventricular (RV) strain. Echocardiography suggested pulmonary embolism with a suspected mass in the right ventricular outflow tract (RVOT). Despite thrombectomy and thrombolysis, the filling defect persisted. The initial biopsy was negative for malignancy. Further imaging with CT, cardiac MRI, and PET-CT revealed a fluorodeoxyglucose (FDG)-avid mass extending from the RVOT into the main pulmonary artery, causing significant stenosis. Subsequent pleural and lung video-assisted thoracoscopic surgery (VATS) biopsies were also negative. After four months, a third CT-guided biopsy confirmed a high-grade spindle cell neoplasm. Retrospective examination of the thrombectomy specimen revealed a small focus of atypical spindle cells with an identical immunohistochemical profile. The tumor was inoperable, and chemotherapy was not initiated due to severe cardiac symptoms. The patient ultimately developed circulatory shock and succumbed to his illness. Conclusion This case highlights the importance of early diagnosis and intervention in PAS to prevent fatal outcomes. While histopathology remains the gold standard, initial negative biopsies delay treatment. In suspected cases, a thorough examination of thrombectomy specimens, along with ancillary studies, is critical. Advanced imaging techniques, including cardiac MRI and PET-CT, may provide sufficient diagnostic evidence to initiate treatment when biopsy results are delayed or inconclusive.
Introduction: Metabolic Syndrome (MetS), a prevalent contributing factor for cardiac complications in patients with diabetes mellitus (DM), adversely affects their quality of life (QoL). The objective of the study was to assess the QoL and the occurrence of MetS among patients with Type 2 DM. Methods: The cross-sectional study included 191 inpatients aged 25-75 with Type 2 DM, diagnosed for over six months, and on diabetic medications. Patients with Type 1 DM, gestational DM, cognitive impairment, mental retardation, those on ventilator support, and outpatients were excluded. MetS and QoL were evaluated by the International Diabetes Federation (IDF) guidelines and the Audit of Diabetes Dependent Quality of Life Questionnaire (ADDQoL), respectively. Results: Among the enrolled participants, 44.0% had MetS, with a greater impact observed in females. Type of treatment (p=0.001), physical activity (p<0.00), body mass index (p<0.000), alcohol intake (p=0.007), eating habits (p=0.003), frequency of exercise (p<0.00), smoking (p=0.007), waist circumference (p<0.000), and hypertension (p<0.000) were statistically predominant in those with DM and MetS. Both genders reported a comparable negative impact on QoL domains, with no statistically significant difference in the Average Weighted Impact Score between males and females (p=0.644). Discussion: The high prevalence of MetS among hospitalized Type 2 DM patients highlights a significant yet often overlooked health burden. Its presence was significantly associated with various lifestyle and clinical risk factors. All QoL domains showed a decline, indicating that diabetes and its complications have a negative impact on quality of life. Conclusion: In conclusion, MetS appears to be very common in patients with DM, and it negatively affects QoL.
Background Guillain-Barr & eacute; syndrome (GBS) is the most common cause of acute flaccid paralysis, which is characterized by ascending, rapid-onset, symmetrical limb weakness and sensory disturbances that are typically established 3-6 weeks after an antecedent infection, usually an upper respiratory tract infection.Case Report/Case Representation We present the case of a 19-year-old man who was acutely admitted to the emergency room due to the sudden onset and gradual worsening of symmetrical lower extremity paresis, sensory disturbance, and pain occurring 3 weeks after an upper respiratory tract infection.GBS was the initial diagnosis. However, this was ruled out after thorough neurological examination due to the rapid progression of neurological deficiency, intense pain, and the absence of a pulse in the lower extremity arteries. CT angiography revealed occlusion of the abdominal aorta, and an intracardiac thrombus was detected. The myocarditis complicated by intracardiac thrombus formation and subsequent embolization into the aorta was finally concluded as the actual reason for the patients' complaints, initially mimicking GBS.Conclusion This case report highlights a rare combination of two distinct, life-threatening conditions that together mimicked Guillain-Barr & eacute; syndrome. The initial physical examination played a crucial role in establishing the correct differential diagnosis.
Introduction Blunt cardiac injury (BCI) is a critical yet underdiagnosed condition in patients with blunt chest trauma, often leading to significant morbidity and mortality. Despite its clinical importance, there is a lack of standardized diagnostic criteria, making early identification and management challenging. This study aimed to investigate the incidence, associated factors, and outcomes of BCI in patients with blunt chest trauma, addressing a significant research gap in trauma care. Methods This retrospective observational study included 180 patients with blunt chest trauma from 2020 to 2021. Data on age, sex, cause of trauma ( e.g ., car accidents, motorcycle accidents, falls), and clinical outcomes were collected. BCI was diagnosed based on elevated troponin levels, echocardiographic findings, or CT imaging. Injury Severity Scores (ISS), length of hospital stay, and mortality rates were also recorded. Results Among 180 patients, BCI was diagnosed in 13.3% (n=24). There was no significant difference in age, sex, or mechanism of trauma between patients with and without BCI. Motorcycle accidents were the most common cause of BCI (66.7%). Patients with BCI had significantly higher mortality rates (20.8% vs . 7.1%, P<0.01) and higher ISS scores (35.37 vs . 32.14, P<0.05) compared with those without BCI. Pulmonary contusion was significantly more prevalent in BCI patients (70.8% vs . 39.7%, P<0.01). Discussion BCI in patients with blunt chest trauma is associated with higher mortality, greater injury severity, and an increased incidence of pulmonary contusion. Conclusion These findings underscore the need for early and accurate diagnosis of BCI using troponin levels and imaging, as well as tailored management strategies to improve outcomes.
Introduction: Heart failure with reduced ejection fraction (HFrEF) is a severe clinical condition associated with high mortality and morbidity rates. The -786T/C (rs2070744) polymorphism in the NOS3 gene may influence nitric oxide production and alter cardiovascular outcomes in HFrEF patients. Methods: A cross-sectional descriptive study was conducted at Bac Lieu General Hospital, Vietnam from April 2023 to June 2024. Ninety patients with HFrEF (LVEF <40%) underwent genotyping for NOS3 rs2070744 polymorphism using RFLP-PCR. Patients were followed up at 3 and 6 months for heart failure-related readmission and mortality outcomes. Results: Of the 90 patients (mean age 64.5 +/- 13.3 years; 53.3% male), genotype frequencies were TT (61.1%), CT (32.2%), and CC (6.7%). At 3 months, 32.2% were readmitted for heart failure and 10.0% died; at 6 months, readmission and mortality rates were 25.9% and 8.6%, respectively. The CC genotype was associated with significantly higher readmission and mortality rates at 3 months (p<0.05). Multivariate Cox regression identified CC/CT genotype (HR=4.24; 95% CI=1.03-17.39; p<0.05) and dyslipidemia (HR=8.63; 95% CI=2.12-41.03; p<0.05) as independent predictors of mortality. Discussion: The presence of the C allele may influence adverse cardiovascular outcomes in HFrEF patients, potentially via modulation of nitric oxide production, endothelial dysfunction, and autonomic dysregulation. Conclusion: The rs2070744 polymorphism in the NOS3 gene may serve as a prognostic biomarker for poor outcomes in HFrEF. Patients with CC/CT genotypes and dyslipidemia have higher risks of readmission and mortality.
Introduction Despite the introduction of first-generation drug-eluting stents, lesion length has remained a predictor of target lesion revascularization. To address this limitation, stents with thinner struts, more advanced polymers, and drugs with more controlled release were developed. However, the impact of second-generation drug-eluting stent (DES2) length on clinical outcomes remains uncertain. Objective The objective of this study was to evaluate the impact of DES2 length on long-term safety and efficacy by comparing outcomes between patients who underwent implantation of long and short DES2. Methods This observational, retrospective, non-randomized, single-center study included all patients who received only DES2 from January 1, 2011, to December 31, 2017. Patients were divided into two groups based on the length of the implanted DES2: 1) long stent group (LSG) with at least one stent measuring 30 mm or longer, and 2) short stent group (SSG) with one or more stents measuring 20 mm or shorter without overlap. The primary endpoint was target lesion failure (TLF) during a three-year follow-up period. Results A total of 278 patients were assigned to the SSG (mean stent length: 19.32±8.6 mm), while 436 patients were assigned to the LSG (mean stent length: 55.38±23.3 mm). The LSG showed a significantly higher incidence of TLF: 16.7% versus 10.4% [SHR (95%CI): 1.78 (1.15-2.76), p=0.01]. No significant differences were observed in the secondary endpoints. Conclusion Despite technological advances, the use of DES2 measuring 30 mm or longer has been associated with a higher TLF rate. Therefore, the implantation of longer DES2, compared with DES2 measuring 20 mm or shorter, significantly impacted long-term clinical outcomes related to TLF, while secondary outcomes were not affected.
Considering that the risks of cardiovascular disease still pose a significant challenge despite preventive and therapeutic efforts, we need new pathophysiological models for a better understanding of risks and treatment based on new concepts. Arterial Stiffness (AS) has been increasingly studied as an independent cardiovascular risk factor. The mechanisms by which AS develops are not yet fully understood. However, it clearly involves not only structural changes but also endothelial functional changes. There are several clinical studies showing that vascular damage is an important risk factor for structural and functional injury of high-flow organs. Carotid-femoral Pulse Wave Velocity (PWV-cf) has been considered the gold standard for the evaluation of AS, with a large body of evidence demonstrating its association with cardiovascular disease, regardless of traditional risk factors. Based on the impact of high PWV-cf on cardiovascular prognosis, achieving a decrease in PWV would possibly reduce cardiovascular events. However, the significance of lowering AS to reduce cardiovascular events under treatment remains to be unequivocally demonstrated. Regarding resistant hypertension, it shares risk factors with AS, including advanced age, endothelial dysfunction, left ventricular hypertrophy, obesity, diabetes, and chronic kidney disease. On the other hand, increased AS in resistant hypertensives presents a two-way interaction, where uncontrolled blood pressure results in progressive vascular damage while vascular stiffness increases blood pressure, making its control more difficult and establishing a vicious circle. In this scenario, the better the understanding of the complex interaction of factors to AS development, the more treatment options should become clinically available.
Objectives A lack of public knowledge about coronary heart disease [CHD] contributes to the elevated incidence of delayed onset symptoms to the first medical contact and major adverse cardiac events. Health promotion intervention should be the first option in order to direct individuals toward adopting healthy behaviors to avert CHD, and improve their knowledge and attitude in handling CHD-related symptoms. Therefore, this study aimed to observe the impact of educational programs on the improvement of public knowledge about CHD in Yogyakarta, Indonesia. Methods A quasi-experimental approach was implemented utilizing a questionnaire developed by the researchers, which included pharmacists and cardiologists and was based on the BASNEF model. An hour-long educational program was carried out three times a month by inserting the program into the community's routine agenda. A descriptive analysis, t-test, and multivariate regression were performed to evaluate the influence of the program on participants' knowledge regarding CHD. Results A higher proportion of participants with a smoking environment [79.6%], diabetes mellitus [88.9%], abnormal waist circumference [61.9%] and abnormal 2 h postprandial blood glucose [77%] among 113 were involved in this study. Significant improvement was observed among the overall results of pre-test [75.59±15.29] and post-test [86.05±8.99] with p-value <0.001. Older participants and participants with acute coronary syndrome history [ACS] significantly improved their knowledge of CHD after the health promotion program with p-values of 0.022 and 0.008, respectively. Conclusion These findings suggest that educational interventions could increase participants' knowledge of CHD. Local health officials should implement more health promotion to significantly enhance public knowledge of CHD.
Introduction Ischemic Heart Disease (IHD) remains a critical health concern both in Russia and globally. Surgical interventions, such as Coronary Artery Bypass Grafting (CABG) and coronary stenting, are commonly used to address IHD. However, in certain cases, single-stage complete revascularization may not be feasible. Hybrid Coronary Revascularization (HCR), a technique combining CABG with subsequent endovascular interventions, offers a potential solution to this challenge. Purpose This study aims to compare the efficacy and safety of surgical myocardial revascularization using CABG vs. staged HCR. Materials and Methods This retrospective, single-center, cohort, non-randomized study included 95 patients with IHD who underwent myocardial revascularization at the Pirogov National Medical and Surgical Center between 2017 and 2021. Group I (n=45) consisted of patients who received complete myocardial revascularization through CABG. Group II (n=50) comprised patients who underwent Hybrid Myocardial Revascularization (HMR), with CABG followed by Percutaneous Coronary Intervention (PCI). The median interval between CABG and PCI in Group II was 32.1±15.7 days. Results Intraoperatively, the total procedure duration significantly differed between the groups, with Group I (CABG) having a mean duration of 242.8±45.9 min compared with 310±55.8 min in Group II (HMR) P<0.001). During the perioperative period, the need for inotropic support differed significantly between the groups (24.4% in group I, 8.0% in group II P=0.028). No significant differences were observed between the groups regarding the length of stay in the intensive care unit, the number of blood transfusions required, or the incidence of Myocardial Infarctions (MI), postoperative bleeding, or strokes. With a mean follow-up period of 755±286 days, the frequency of Major Adverse Cardiovascular Events (MACEs) did not differ significantly between the two groups. The rate of Venous Graft Failure (VGF) was also comparable, with 18 cases (22.8%) in Group I and 6 cases (18.8%) in Group II (P=NS). Meanwhile, group II demonstrated a higher incidence of restenosis with 2 cases [10.5%] vs. 10 cases [16.1%], P=0.023) over the 24-month follow-up. Early and long-term postoperative mortality rates were similar between the groups, with no statistically significant differences. Conclusion The efficacy and safety of standard CABG with extensive myocardial revascularization possible and the staged hybrid approach are comparable in the surgical treatment of patients with diffuse Coronary Artery Disease (CAD).
Hypertension (HT) is one of the most common cardiovascular (CV) pathologies and a key risk factor for the development of CV disease and its complications. There are two main etiopathogenetic types of HT: primary and secondary. As a result of HT, damage to many organs (heart, blood vessels, retina, etc .) can occur. These organs are considered the main target organs in HT and assessment of their condition plays an important role for optimal management of patients with HT. Increased levels of cardiospecific troponins T and I, localized in the main type of myocardial cells (cardiomyocytes), may indicate myocardial damage. At the same time, the degree of myocardial damage may correlate with the degree of increase in cardiospecific troponins T and I. In recent studies, cardiospecific troponins T and I have established themselves as early and highly specific criteria for myocardial damage not only in myocardial infarction, but also in many other cardiac ( e.g. , arrhythmias, endocarditis, myocarditis, takotsubo syndrome, or cardiomyopathy) and extra-cardiac ( e.g. , renal failure, sepsis, or diabetes mellitus) conditions. Many authors suggest using cardiospecific troponins T and I as prognostic markers for the above pathologies. Thus, the determination of cardiospecific troponins T and I can provide additional diagnostic advantages in the management of patients with pathological conditions that damage the myocardium. The purpose of this article is to systematize information about the pathogenetic mechanisms of myocardial damage in HT and to consider the diagnostic contribution of cardiospecific troponins T and I for the management of patients with HT.
Background: Advanced diastolic dysfunction (DDys) correlates with elevated LV filling pressures and predicts heart failure readmission (HF-R). As grade 2-3 DDys has predictive value for HF-R, and requires 2 of 3 criteria (left atrial volume index >34 ml/m2, E/e’>14, or tricuspid regurgitation velocity >2.8 m/s), we hypothesized that all 3 criteria would predict greater HF risk than any 2 criteria. Methods: In this single-center retrospective study that included 380 patients in sinus rhythm with HF and reduced ejection, we recorded patient characteristics, Doppler-echo, and HF-R with follow-up to 2167 days (median=1423 days; interquartile range=992-1821 days). Results: For grade 1 DDys (223 patients), any single criteria resulted in greater HF-R as compared to 0 criteria (HR=2.52, (1.56-3.88) p<0.0001) with an AUC (area under curve)=0.637, p<0.001. For grade 2 DDys (94 patients), there was greater HF-R for all 3 (vs. 0 criteria: HR=4.0 (2.90-8.36), p<0.0001). There was greater HF-R for 3 vs any 2 criteria (HR=1.81, (1.10-3.39), p=0.0222). For all 3 criteria, there was moderate predictability for HF-R (AUC=0.706, p<0.0001) which was more predictive than any 2 criteria (AUC difference 0.057, (0.011-0.10), p=0.009). For grade 3 DDys (63 patients), E/A>2+2-3 criteria identified a subgroup with the greatest risk of HF-R (HR=5.03 (4.62-22.72), p<0.0001) compared with 0 DDys criteria with moderate predictability for 2-3 criteria (AUC=0.726, p<0.0001) exceeding E/A>2+0-1 criteria (AUC difference=0.120, (0.061-0.182), p<0.001). Conclusion: Increasing the number of abnormal criteria increased the risk and predictive value of HF-R for grade 1-3 DDys in patients with HF with reduced ejection fraction.
Background: High rate of coagulopathy and pulmonary thromboembolism in coronavirus disease 2019 (COVID-19), which is represented by an increase in plasma D-Dimer levels is believed to be related to pulmonary hypertension (PH) and right ventricle (RV) dysfunction. Objective: To evaluate the relationship between plasma D-Dimer levels with PH and RV dysfunction assessed from transthoracic echocardiography (TTE) in patients post COVID-19 pneumonia. Methods: Observational research with a cross-sectional design. Estimated mean pulmonary arterial pressure (mPAP) was calculated from Mahan's formula obtained from pulmonary artery acceleration time (PAAT) and RV function was assessed from RV free wall strain (RV FWS), tricuspid annular plane systolic excursion (TAPSE), and fractional area change (FAC). D-Dimer levels during hospitalisation were obtained from medical records and actual D-Dimer was obtained at the time of echocardiography. Results: Total 40 patients post-COVID-19 pneumonia underwent TTE in a median of 11 days after negative PCR. There was a significant correlation between peak D-Dimer levels with mPAP (r=0.526, p<0.001), RV FWS (r=-0.506, p=0.001), TAPSE (r=-0.498, p=0.001), and FAC (r=0.447, p=0.004). Multivariate analysis found peak D-Dimer ≥4530 µg/L independently associated with PH with odds ratio (OR) 6.6, (95% CI 1.1-10; p=0.048), but not with RV dysfunction. Conclusion: Peak D-Dimer level correlates with echocardiographic parameters of RV function and mPAP in patients with COVID-19 infection. Peak D-Dimer ≥4530 µg/L might increase risk of PH, but not RV dysfunction in patient post pneumonia COVID-19.
Background: Cardiovascular (CV) diseases account for a large number of readmissions. Objective: Using data mining techniques, we aimed to predict the readmission of CV patients to Coronary Care Units of 4 public hospitals in Shiraz, Iran, within 30 days after discharge. Methods: To identify the variables affecting the readmission of CV patients in the present cross-sectional study, a comprehensive review of previous studies and the consensus of specialists and sub-specialists were used. The obtained variables were based on 264 readmitted and non-readmitted patients. Readmission was modeled with predictive algorithms with an accuracy of >70% using the IBM SPSS Modeler 18.0 software. Cross-Industry Standard Process for Data Mining (CRISP-DM) methodology provided a structured approach to planning the project. Results: Overall, 47 influential variables were included. The Support Vector Machine (SVM), Chi-square Automatic Interaction Detection (CHIAD), artificial neural network, C5.0, K-Nearest Neighbour, logistic regression, Classification and Regression (C&R) tree, and Quest algorithms with an accuracy of 98.60%, 89.60%, 89.90%, 88.00%, 85.90%, 79.90%, 78.60%, and 74.40%, respectively, were selected. The SVM algorithm was the best model for predicting readmission. According to this algorithm, the factors affecting readmission were age, arrhythmia, hypertension, chest pain, type of admission, cardiac or non-cardiac comorbidities, ejection fraction, undergoing coronary angiography, fluid and electrolyte disorders, and hospitalization 6-9 months before the current admission. Conclusion: According to the influential variables, it is suggested to educate patients, especially the older ones, about following physician advice and also to teach medical staff about up-to-date options to reduce readmissions.
Introduction: Myocardial injury, causing elevated troponin levels, have been associated with worse outcomes in coronavirus disease 2019 (COVID-19) disease patients. However, our anecdotal experience did not consistently reflect this pattern. Therefore, we evaluated the outcomes of COVID-19 patients with elevated troponin. Methods: This is a retrospective study of 1,024 COVID-19 patients admitted to two hospitals in Southern California in the United States. We categorized the troponin levels as normal (≤1× upper reference limit (URL)), mildly elevated (>1 to ≤3× URL), and severely elevated (>3× URL). We compared the characteristics of the three troponin groups using chi-square for categorical variables and one-way Anova for the continuous variables. Finally, backward selection Cox regression analysis was carried out using mortality as a dependent variable. Results: Of the COVID-19 1,024 patients included in the study, 944 (92%) had normal troponin, 45 (4.4%) had mild elevation, and 35 (3.4%) had a severe elevation in troponin levels. In the multivariate Cox regression analysis, troponin elevation in patients without ST-elevation on ECG was not independently associated with mortality (hazard ratio 0.92, 95% CI 0.64-1.3). Increased risk of death was independently associated with age as well as serum C-reactive protein and serum creatinine levels. Conclusion: Elevated troponins without ST-elevation on ECG on hospital admission were not independently associated with increased mortality in hospitalized COVID-19 patients. However, further research is needed to fully understand the absence of a relationship between troponin elevation and mortality in our study population.
Background: Early identification of hypertensive patients at risk of heart failure (HF) helps guide treatment intensification and predict prognosis. Global longitudinal strain (GLS) derived from two-dimensional speckle-tracking echocardiography (STE) uncovers subclinical left ventricular (LV) systolic dysfunction (SLVSD) in patients with hypertension (HT) and preserved LV ejection fraction (PLVEF). STE is unavailable and/or underutilized in our locality for financial and technical reasons. Objectives: We aim to identify clinical and echocardiographic parameters associated with and/or predictive of impaired GLS in hypertensive patients with PLVEF. Method: In this single-clinic, cross-sectional, observational study, 100 hypertensive patients with PLVEF were examined using conventional and 2D STE. Results: The average GLS was found to be mildly reduced (-18.4 ± 2.2%) in the study group. Lower GLS (than -19%) was more common among patients with poorly controlled HT (Odds Ratio (OR)=9), being on multiple anti-hypertensive agents (OR=5), positive Sokolow-Lyon electrocardiographic criteria (OR=4.3), and obesity (OR=2). Conventional echocardiographic parameters predicting impaired GLS included: mitral annular plane systolic excursion (MAPSE) (p=0.001), inter-ventricular septal thickness (IVSd) (p=0.003), LV mass (p=0.003), and LV remodelling (p=0.02). The aortic acceleration-to-ejection time ratio (AT/ET) had a good correlation with GLS (p=0.034). The novel product (IVSd x AT/ET) ≥2.7 mm was found to be the best predictor of GLS worse than -19% (AU ROC=0.8, 95% CI [0.68-0.93]; p=0.001). Conclusion: In hypertensive patients with PLVEF, GLS was found to correlate well with blood pressure (BP) control, body size, measures of LV mass, and MAPSE. These parameters predict at least 50% of the variance in GLS and could help practitioners with limited access to STE in risk-stratifying hypertensive patients.
Background: Cardiovascular diseases (CVD), especially acute myocardial infarction (AMI), remain a worldwide major cause of premature morbidity and mortality, with considerable health care costs. Metabolic, behavioural, environmental, and social risk factors are significant drivers of AMI, with obesity being a key determinant among them. Childhood obesity constitutes a major health threat that is considered a global epidemic of the 21st century. Objective: To assess whether excess weight from the first years of life acts as a predisposing factor in increasing the risk of AMI in young adults. Methods: This is a narrative review of the evidence concerning the epidemiology of early AMI and obesity, using PubMed and Google Scholar. Results: There is substantial evidence showing that excess weight during childhood multiplies the risk of AMI at an early age. Conclusion: Premature AMI seems to have significant drivers related to lifestyle factors, such as childhood obesity. In the era of a childhood obesity epidemic, the aforementioned relationship underlines the need for early prevention and management.
Background: Prehypertension is a pre-disease state wherein an individual has a blood pressure (BP) measurement above normal (≥120/80 mmHg) but below the hypertensive range (<140/90 mmHg). Large population-based studies have shown that individuals with a BP in the prehypertensive range have an increased risk of developing hypertension and cardiovascular events. Despite these risks and high mortality rates associated with pre-hypertension, there are currently no reviews that define the prevalence of pre-hypertension in the Saudi population. Objective: To determine the magnitude of the pre-hypertension problem among Saudi adults and identify areas for future research based on the current gaps in the literature. Methods: This narrative review considers studies addressing the prevalence of pre-hypertension among Saudi adults; 8 studies were identified for this review. Results: In total, 14,782 men and women participated in these studies. The overall prevalence of pre-hypertension in both sexes ranged from 18.5-54.9%. Men had higher rates of pre-hypertension (24.7-66.1%) than women (7-48.1%).A modifiable risk factor reported in the majority of the studies was increased adiposity. Conclusion: Lifestyle changes to reduce weight may be effective in preventing or at least delaying the progression to hypertension and its associated cardiovascular events. Large, prospective, epidemiological studies are needed to estimate the risk of incident hypertension and cardiovascular events in pre-hypertension patients. Randomized clinical trials are also needed to evaluate the effectiveness of lifestyle modification and/or pharmacotherapy in reducing the risk of incident hypertension.
Breast cancer is the most frequent malignant disease among women, being responsible for a considerable percentage of fatalities and comorbidities every year. Despite advances in early detection and therapy, evidence shows that breast cancer survivors are at increased risk of developing other chronic conditions, such as cardiovascular diseases. Autonomic dysfunction is an emerging, but poorly understood topic that has been suggested as a risk factor for cardiovascular disease in breast cancer patients. It clinically manifests through persistently elevated heart rates and abnormal heart rate variability, even before any signs of cardiovascular dysfunction appear. Since changes in the left ventricular ejection fraction only manifest when myocardial injury has already occurred, it has been hypothesized that autonomic dysfunction can constitute an early biomarker of cardiovascular impairment in breast cancer patients. This review focuses on the direct and indirect effects of cancer and its treatment on the autonomic nervous system in breast cancer patients. We highlight the mechanisms potentially involved in cancer and antineoplastic therapy-related autonomic imbalance and review the potential strategies to prevent and/or attenuate autonomic dysfunction. There are gaps in the current knowledge; more research in this area is needed to identify the relevance of autonomic dysfunction and define beneficial interventions to prevent cardiovascular disease in breast cancer patients.
