...nearly all infections of the “Neglected Tropical Diseases and other Infectious Diseases” (NET-Heart project) 7 - endemic conditions affecting the cardiovascular system in some specific countries, ...might be seen all over the world. Early recognition and treatment of ZIKV-related cardiovascular complications are essential to reduce morbidity and mortality. ...as we still have no specific antiviral treatment or vaccine, the development of public health strategies to prevent its transmission is of paramount importance, including innovative strategies for the control of Ae. aegypti mosquitos 17. ...climate change is expected to impact across every domain of society, including health 19.
Introduction
Advanced interatrial block (IAB) on a 12‐lead electrocardiogram (ECG) is a predictor of stroke, incident atrial fibrillation (AF), and AF recurrence after catheter ablation. The ...objective of this study was to determine which features of IAB structural remodeling is associated with left atrium (LA) magnetic resonance imaging structure and function.
Methods/Results
We included 152 consecutive patients (23% nonparoxysmal AF) who underwent preprocedural ECG and cardiac magnetic resonance (CMR) in sinus rhythm before catheter ablation of AF. IAB was defined as P‐wave duration ≥120 ms, and was considered partial if P‐wave was positive and advanced if P‐wave had a biphasic morphology in inferior leads. From cine CMR and late gadolinium enhancement, we derived LA maximum and minimum volume indices, strain, LA fibrosis, and LA dyssynchrony. A total of 77 patients (50.7% paroxysmal) had normal P‐wave, 52 (34.2%) partial IAB, and 23 (15.1%) advanced IAB. Patients with advanced IAB had significantly higher LA minimum volume index (25.7 vs 19.9 mL/m2, P = .010), more LA fibrosis (21.9% vs 13.1%, P = .020), and lower LA maximum strain rate (0.99 vs 1.18, P = .007) than those without. Advanced IAB was independently associated with LA (minimum P = .032 and fibrosis P = .009). P‐wave duration was also independently associated with LA fibrosis (β = .33; P = .049) and LA mechanical dyssynchrony (β = 2.01; P = .007).
Conclusion
Advanced IAB is associated with larger LA volumes, lower emptying fraction, and more fibrosis. Longer P‐wave duration is also associated with more LA fibrosis and higher LA mechanical dyssynchrony.
Tuberculosis and the Heart López-López, José Patricio; Posada-Martínez, Edith L; Saldarriaga, Clara ...
Journal of the American Heart Association,
04/2021, Volume:
10, Issue:
7
Journal Article
Peer reviewed
Open access
Acquired tuberculosis continues to be a challenge worldwide. Although tuberculosis has been considered a global public health emergency, it remains poorly controlled in many countries. Despite being ...primarily a pulmonary disease, tuberculosis could involve the heart. This systematic review is part of the "Neglected Tropical Diseases and Other Infectious Diseases Involving the Heart" (the NET-Heart Project) initiative from the Interamerican Society of Cardiology. This project aims to review the cardiovascular involvement of these heterogeneous diseases, advancing original algorithms to help healthcare providers diagnose and manage cardiovascular complications. In tuberculosis, pericardium involvement is relatively common, especially in AIDS, and tuberculosis is the most common cause of constrictive pericarditis in endemic countries. Myocarditis and aortitis by tuberculosis are rare. Clinical manifestations of cardiovascular involvement by tuberculosis differ from those typically found for bacteria or viruses. Prevailing systemic symptoms and the pericarditis diagnostic index should be taken into account. An echocardiogram is the first step for diagnosing cardiovascular involvement; however, several image modalities can be used, depending on the suspected site of infection. Adenosine deaminase levels, gamma interferon, or polymerase chain reaction testing could be used to confirm tuberculosis infection; each has a high diagnostic performance. Antituberculosis chemotherapy and corticosteroids are treatment mainstays that significantly reduce mortality, constriction, and hospitalizations, especially in patients with HIV. In conclusion, tuberculosis cardiac involvement is frequent and could lead to heart failure, constrictive pericarditis, or death. Early detection of complications should be a cornerstone of overall management.
Artificial intelligence (AI) is increasingly used in electrocardiography (ECG) to assist in diagnosis, stratification, and management. AI algorithms can help clinicians in the following areas: (1) ...interpretation and detection of arrhythmias, ST-segment changes, QT prolongation, and other ECG abnormalities; (2) risk prediction integrated with or without clinical variables (to predict arrhythmias, sudden cardiac death, stroke, and other cardiovascular events); (3) monitoring ECG signals from cardiac implantable electronic devices and wearable devices in real time and alerting clinicians or patients when significant changes occur according to timing, duration, and situation; (4) signal processing, improving ECG quality and accuracy by removing noise/artifacts/interference, and extracting features not visible to the human eye (heart rate variability, beat-to-beat intervals, wavelet transforms, sample-level resolution, etc.); (5) therapy guidance, assisting in patient selection, optimizing treatments, improving symptom-to-treatment times, and cost effectiveness (earlier activation of code infarction in patients with ST-segment elevation, predicting the response to antiarrhythmic drugs or cardiac implantable devices therapies, reducing the risk of cardiac toxicity, etc.); (6) facilitating the integration of ECG data with other modalities (imaging, genomics, proteomics, biomarkers, etc.). In the future, AI is expected to play an increasingly important role in ECG diagnosis and management, as more data become available and more sophisticated algorithms are developed.
Background
Atrial fibrillation (AF) is the most common arrhythmia and has significant morbidity. A score composed of easily measured electrocardiographic variables to identify patients at risk of AF ...would be of great value in order to stratify patients for increased monitoring and surveillance. The purpose of this study was to develop an electrocardiographic risk score for new‐onset AF.
Methods
A total of 676 patients without previous AF undergoing coronary angiography were retrospectively studied. Points were allocated based on P‐wave morphology in inferior leads, voltage in lead 1, and P‐wave duration (MVP). Patients were divided into three risk groups and followed until development of AF or last available clinical appointment.
Results
Mean age was 65 years, and 68% were male. The high‐ and intermediate‐risk groups were more likely to develop AF than the low‐risk group (odds ratio OR 2.4, 95% confidence interval CI 1.3–4.4; p = 0.006 and OR 2.1, 95% CI 1.4–3.27; p = 0.009, respectively). The high‐risk group had a significantly shorter mean time to development of AF (258 weeks; 95% CI 205–310 weeks) compared to the intermediate‐ (278 weeks; 95% CI 252–303 weeks) and low‐risk groups (322 weeks 95% CI 307–338 weeks), p = 0.005.
Conclusions
A simple risk score composed of easy‐to‐measure electrocardiographic variables can help to predict new‐onset AF. Further validation studies will be needed to assess the ability of this risk score to predict AF in other populations.
To the Editor, Vázquez Rodríguez et al.1 elegantly demonstrate that transcatheter aortic valve implantation (TAVI) is cost-effective even in low-surgical risk patients. This cost-effectiveness adds ...to the excellent data regarding survival reported in real-life settings in Spain even in cohorts of very old patients with frequent comorbidities.2 Former data also confirm the cost-effectiveness of this technique,3-5 as well as its favorable outcomes,6 thus making it a viable option for low-risk patients as well.7 Therefore, in the management of symptomatic severe aortic stenosis where both surgical aortic valve replacement (SAVR) and TAVI are feasible options, and once the patient has been properly informed and given his/her written informed consent, he/she should be able to choose TAVI even if the heart team recommends SAVR. We should remember that 2 different domains exist regarding decision-making: the professional or objective domain that determines whether treatment is proportionate (and benefits can be expected), and the one pertaining to the patient, also called subjective domain, that determines whether the procedure is a common one (that is, not perceived as an unbearable aggression) (figure 1). Denying the decision-making capacity of a properly informed patient is unethical, and as noted by Vázquez Rodríguez et al.,1 cannot be justified from a...
Reperfusion therapy led to an important decline in mortality after ST-segment elevation myocardial infarction (STEMI). Because the rate of cardiogenic shock has not changed dramatically, the authors ...speculated that a reduction in the incidence or fatality rate of mechanical complications (MCs), the second cause of death in these patients, could explain this decrease.
This study sought to assess time trends in the incidence, management, and fatality rates of MC, and its influence on short-term mortality in old patients with STEMI.
Trends in the incidence and outcomes of MC between 1988 and 2008 were analyzed by Mantel-Haenszel linear association test in 1,393 consecutive patients ≥75 years of age with first STEMI.
Overall in-hospital mortality decreased from 34.3% to 13.4% (relative risk reduction, 61%; p < 0.001). Although the absolute mortality due to MC decreased from 9.6% to 3.3% (p < 0.001), the proportion of deaths due to MC among all deaths did not change (28.1% to 24.5%; p = 0.53). The incidence of MC decreased from 11.1% to 4.3% (relative risk reduction 61%) with no change in their hospital fatality rate over time (from 87.1% to 82.4%; p = 0.66). The proportion of patients undergoing surgical repair decreased from 45.2% to 17.6% (p = 0.04), with no differences in post-operative survival (from 28.6% to 33.3%; p = 0.74).
Although the incidence of MC has decreased substantially since the initiation of reperfusion therapy in elderly STEMI patients, this reduction was proportional to other causes of death and was not accompanied by an improvement in fatality rates, with or without surgery. MCs are less frequent but remain catastrophic complications of STEMI in these patients.
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