Red blood cell distribution width is associated with adverse cardiovascular events after septal myectomy

BackgroundRed blood cell distribution width (RDW) is associated with increased morbidity and mortality in several cardiovascular diseases. However, the prognostic significance of RDW in patients with hypertrophic obstructive cardiomyopathy (HOCM) who underwent septal myectomy remains unclear as no studies have been conducted on this topic. This study aimed to assess the prognostic significance of RDW in these patients.MethodsA total of 867 adults with HOCM who underwent septal myectomy at Fuwai Hospital from 2011 to 2017 were retrospectively studied. All patients were assessed comprehensively, including their medical history, echocardiograms, and blood test results.ResultsThe median age of patients was 47.9 [interquartile range (IQR), 37.0–56.0] years and 61.5% of patients were men. During a median follow-up period of 32 (IQR, 17–53) months, 26 patients died and 23 had a cardiovascular death during follow-up. Compared to patients in the lowest RDW quartile, those in the highest quartile had a significantly lower 5-year survival free from all-cause and cardiovascular death (95.9% vs. 87.6%, P<0.001; 95.9% vs. 89.9%, P<0.001). Compared with lower RDW, higher RDW was significantly associated with all-cause and cardiovascular death after adjustment for age, sex, body mass index, and relevant clinical risk factors [per RDW standard deviation (SD) hazard ratio (HR) increase =1.76, 95% confidence interval (CI): 1.54–2.05, P<0.001; per RDW SD HR =1.91, 95% CI: 1.63–2.22, P for trend <0.001].ConclusionsHigher RDW is independently associated with all-cause and cardiovascular death in patients with HOCM after septal myectomy. Therefore, this readily available biomarker could be considered as an additive biomarker for risk stratification in these patients.     

Impact of septal myectomy on diastolic function in patients with obstructive hypertrophic cardiomyopathy

BackgroundThe impact of septal myectomy on diastolic function in patients with obstructive hypertrophic cardiomyopathy is not well studied.MethodsA transcatheter hemodynamic study was performed before and 3 to 6 months after septal myectomy in 12 patients with obstructive hypertrophic cardiomyopathy (HCM).ResultsPostoperative hemodynamic studies were done 4.4±1.2 months after myectomy. The left ventricular outflow tract peak-to-peak gradient decreased from 83.2±43.3 mmHg preoperatively to 11.6±4.3 mmHg after myectomy (P<0.00). The left ventricular diastolic time constant (Tau) was 64.2±26.1 ms before surgery and 42.2±15.7 ms postoperatively (P=0.029). The average left atrial pressure (LAP) decreased from 20.2±7.0 to 12.1±4.5 mmHg after myectomy (P=0.008). Pulmonary artery hypertension was present in 6 patients preoperatively and remained in 2 patients after myectomy. Mean pulmonary artery pressure decreased from 29.3±16.2 to 20±6.7 mmHg after surgery (P=0.05), and the systolic pulmonary artery pressure decreased from 46±26.9 to 30.5±8.3 mmHg (P=0.048). Pulmonary vascular resistance decreased from 5.7±4.1 to 3.6±1.6 wood after surgery (P=0.032).ConclusionsSeptal myectomy improved left ventricular diastolic function and subsequently relieved the right ventricular congestion in patients with obstructive HCM.     

The sST2 level is an independent influencing factor associated with atrial fibrillation in heart failure patients: a case-control study

BackgroundMost heart failure (HF) patients were complicated with atrial fibrillation (AF). Previous study has reported a correlation between soluble suppression of tumorigenicity 2 (sST2) and HF. While the association between sST2 and AF in HF patients remains elusive, which will strengthen our understanding of sST2 in HF patients.MethodsIn the study, a case-control study was conducted with 306 HF patients enrolled from June 2019 to June 2020 at Beijing Anzhen Hospital. All the patients were divided into the following two groups, based on whether they AF complications prior to admission: (I) the HF group (patients with HF alone) and the HF-AF group (HF patients complicated with AF). Baseline data and sST2 levels were assessed and compared between the two groups, and the influencing factors associated with AF in HF patients were screened.ResultsThe sST2 level in the HF-AF group was 40.6 (25.9–53.6) ng/mL, which was significantly higher than that in the HF group [23.7 (16.3–35.9) ng/mL] (P<0.001). Correlation analysis showed that sST2 level in the HF-AF group was positively correlated with age (r=0.287, P=0.001), New York Heart Association (NYHA) grade (r=0.470, P<0.0001), left ventricular diameter (LVD) (r=0.311, P=0.001), serum creatinine (r=0.320, P<0.0001), NT-pro-brain natriuretic peptide (r=0.540, P<0.0001), and D-dimer (r=0.322, P<0.0001), and negatively correlated with left ventricular ejection fraction (LVEF) (r=−0.259, P=0.004), hemoglobin (r=−0.188, P=0.039), and glomerular filtration rate (r=−0.283, P=0.002). Logistic regression analysis results indicated that history of coronary heart disease [odds ratio (OR): 0.176, 95% confidence interval (CI): 0.081–0.380, P<0.0001], LVEF (OR: 0.956, 95% CI: 0.915–0.998, P=0.039), LVD (OR: 1.156, 95% CI: 1.059–1.261, P=0.001), left arterial diameter (OR: 0.761, 95% CI: 0.695–0.833, P<0.0001), and sST2 (OR: 0.942, 95% CI: 0.917–0.967, P<0.0001) were independent influencing factors associated with AF in HF patients.ConclusionsThe sST2 level is an independent influencing factor associated with AF in HF patients, which may favor to optimize the clinical strategies in the management of HF patients complicated with AF.     

Risk factors for cardiac rupture after acute ST-segment elevation myocardial infarction during the percutaneous coronary intervention era: a retrospective case-control study

BackgroundIn percutaneous coronary intervention (PCI) era, more clinically valuable risk factors are still needed to determine the occurrence of cardiac rupture (CR). Therefore, we aimed to provide evidence for the early identification of CR in ST-segment elevation myocardial infarction (STEMI).MethodsA total of 22,016 consecutive patients with STEMI admitted to Cangzhou Central Hospital and Tianjin Chest Hospital from January 2013 to July 2021 were retrospectively included, among which 195 patients with CR were included as CR group. From the rest 21,820 STEMI patients without CR, 390 patients at a ratio of 1:2 were included as the control group. A total of 66 patients accepted PCI in the CR group, and 132 patients who accepted PCI in the control group at a ratio of 1:2 were included. The status of first medical contact, laboratory examinations, and PCI characteristics were recorded. Multivariate logistic regression analysis was used to investigate the risk factors related to CR.ResultsThere was a higher proportion of patients with myocardial infarction (MI) in the high lateral wall in the CR group (23.6% vs. 8.2%, P<0.001). The proportion of single lesions was lower in the CR group (24.2% vs. 45.5%, P=0.004). Female (OR =2.318, 95% CI: 1.431–3.754, P=0.001), age (OR =1.066, 95% CI: 1.041–1.093, P<0.001), smoking (OR =1.750, 95% CI: 1.086–2.820, P=0.022), total chest pain time (OR =1.017, 95% CI: 1.000–1.035, P=0.049), recurrent acute chest pain (OR =2.750, 95% CI: 1.535–4.927, P=0.001), acute myocardial infarction (AMI) in the high lateral wall indicated by ECG (OR =5.527, 95% CI: 2.798–10.918, P<0.001), acute heart failure (OR =3.585, 95% CI: 2.074–6.195, P<0.001), and NT-proBNP level (OR =1.000, 95% CI: 1.000–1.000, P=0.023) were risk factors for CR in all patients. In patients who accepted PCI, single lesion (OR =0.421, 95% CI: 0.204–0.867, P=0.019), preoperative thrombolysis in myocardial infarction (TIMI) grade (OR =0.358, 95% CI: 0.169–0.760, P=0.007), and postoperative TIMI grade (OR =0.222, 95% CI: 0.090–0.546, P=0.001) were risk factors for CR.ConclusionsNon-single lesions and preoperative and postoperative TIMI grades were risk factors for CR in patients who accepted PCI. In addition to previously reported indicators, we found that AMI in the high lateral wall maybe helpful in early and accurate identification and prevention of possible CR.     

Association between comorbid cardiomyopathy and composite endpoints of patients with congestive heart failure in the intensive care unit: a retrospective cohort study

BackgroundCongestive heart failure (HF) is a common condition in the intensive care unit (ICU). Cardiomyopathy is an important etiological factor in HF. However, few studies have explored the effect of cardiomyopathy on the prognosis of HF. This study explored the association between comorbid cardiomyopathy and the outcomes of critically ill patients with congestive HF.MethodsA retrospective cohort study was performed using data extracted from Medical Information Mart for Intensive Care IV (MIMIC-IV) database. All adult patients with the first ICU admission were enrolled as participants but those diagnosed with cardiomyopathy alone were excluded. The demographics, comorbidities, vital signs, laboratory tests, scoring systems, and treatments of patients were extracted to further analyze. The composite endpoints included in-hospital mortality, cardiac arrest, and re-admission to the ICU. The association between cardiomyopathy comorbidity and the composite endpoints was assessed using propensity-score matching (PSM) and multivariable logistic regression models.ResultsA total of 27,901 critically ill patients were enrolled, including 1,023 patients diagnosed with cardiomyopathy and congestive HF. The average age of the cohort was 64.37±17.36 years, and 58.13% of the patients were men. The ethnicity of patients was mainly white (64.67%). Multivariable logistic regression analyses found the risk of composite endpoints in patients with cardiomyopathy was higher than other groups [odds ratio (OR) =1.87; 95% confidence interval (CI): 1.62–2.15; P<0.001]. Compared to patients with congestive HF alone (OR =1.43; 95% CI: 1.26–1.62; P<0.001), patients with cardiomyopathy had a similar risk of in-hospital death (OR =1.35; 95% CI: 1.06–1.71; P=0.014). Moreover, the risks of cardiac arrest (OR =1.53; 95% CI: 1.01–2.34; P=0.029) and re-admission to the ICU (OR =1.74; 95% CI: 1.39–2.17; P<0.001) were both higher in patients with cardiomyopathy than other groups. After PSM, the risk of composite endpoints was still higher in patients with cardiomyopathy (OR =1.64; 95% CI: 1.33–2.02; P<0.001). The association was consistent among patients admitted to the coronary care unit (CCU) and medical ICU (MICU)/surgical ICU (SICU).ConclusionsComorbid cardiomyopathy increased the risk of composite endpoints in patients with congestive HF admitted to the ICU. Cardiomyopathy is related to the poor outcomes of critically ill patients with congestive HF.     

Interest of anatomical segmentectomy over lobectomy for lung cancer: a nationwide study

BackgroundAnatomical segmentectomy is an alternative to lobectomy for early-stage lung cancer (LC) or in patients at high risk. The main objective of this study was to compare the morbidity and mortality associated with these two types of pulmonary resection using data from the French National Epithor database.MethodsAll patients who underwent lobectomy or segmentectomy for early-stage LC from January 1^st 2014 to December 31^st 2016 were identified in the Epithor database. The primary endpoint was morbidity; the secondary endpoint was postoperative mortality. Propensity score matching was implemented and used to balance groups. The results were reported as odds ratios (OR) and 95% confidence intervals (CI).ResultsDuring the study period, 1,604 segmentectomies (9.78%) and 14,786 lobectomies (90.22%) were performed. After matching, the segmentectomy group experienced significantly less atelectasis (OR 0.54; 95% CI: 0.4–0.75, P<0.0001), pneumonia (OR 0.72; 95% CI: 0.55–0.95, P=0.02), prolonged air leaks (OR 0.75; 95% CI: 0.64–0.89, P=0.001) or bronchopleural fistula (OR 0.35; 95% CI: 0.14–0.83, P=0.017), and fewer patients had at least one complication (OR 0.7; 95% CI: 0.62–0.78, P<0.0001). According to the Clavien-Dindo classification, postoperative complications were significantly less severe in the segmentectomy group (OR 0.52; 95% CI: 0.37–0.74, P<0.0001). There was no significant difference in postoperative mortality at 30 days (OR 0.67; 95% CI: 0.38–1.20, P=0.18), 60 days (OR 0.78; 95% CI: 0.42–1.47, P=0.4), or 90 days (OR 0.77; 95% CI: 0.45–1.34, P=0.36).ConclusionsAnatomical segmentectomy is an alternative surgical approach that could reduce postoperative morbidity, but it does not appear to affect mortality.     

A meta-analysis of the association of atrial septal abnormalities and atrial vulnerability

Background:The mechanism of cryptogenic stroke (CS) in patients with atrial septal abnormalities remains unclear, and the increased incidence of atrial vulnerability may be one of the reasons. We performed this meta-analysis to clarify the association between atrial septal abnormalities and atrial vulnerability, and to provide evidence-based basis for the prevention and mechanism of CS.Methods:We systematically searched for studies on the association between atrial septal abnormalities and atrial vulnerability, and pooled available data on types of atrial septal abnormalities, types of atrial vulnerability, and methods of atrial vulnerability detection. The primary endpoints were the occurrence of atrial arrhythmias or P wave abnormalities. Random-effects models were used to calculate odds ratios (OR) and 95% confidence intervals (CI).Results:Twelve case-control studies were eligible. Compared with the control group, patients with atrial septal abnormalities had a higher risk of atrial vulnerability (OR: 1.93; 95% CI: 1.13-3.30, P = .02). Data based on stroke patients showed that the group with atrial septal abnormalities had a higher risk of atrial vulnerability than the control group (OR: 2.00; 95% CI: 1.13–3.53, P = .02). However, there was no significant difference in the incidence of atrial vulnerability between the 2 groups of nonstroke patients. Subgroup analysis showed that although atrial septal abnormality increased the risk of atrial vulnerability in the subgroup of atrial septal aneurysm (OR: 1.68; 95% CI: 0.47–5.95, P = .42), the subgroup of atrial fibrillation (AF)/atrial fluster (OR: 1.81; 95% CI: 0.94–3.46, P = .07) and the subgroup of subcutaneous recording system (OR: 1.33; 95% CI: 0.68–2.61, P = .41), the difference was not statistically significant.Conclusions:Atrial septal abnormalities can increase the risk of atrial vulnerability, and atrial arrhythmia caused by atrial septal abnormalities may be one of the mechanisms of CS.     

Risk factors and survival analysis of arrhythmia following lung cancer surgery: a retrospective study

BackgroundSurgical treatment of lung cancer is one of the important treatments for early-stage non-small cell lung cancer (NSCLC). However, arrhythmia, especially atrial fibrillation (AF) and supraventricular arrhythmia, are quite common among patients after surgical treatment of lung cancer. The impact of postoperative arrhythmia (PA) on survival is rarely reported. Our aim was to evaluate the risk factors of PA and its impact on overall survival (OS) after lung cancer surgery.MethodsA total of 344 patients diagnosed with NSCLC who underwent lung cancer surgery were enrolled in this study. These patients were divided into two groups based on the occurrence of PA. Univariate and multivariate logistic regression analyses were conducted to identify the risk factors of PA. The Kaplan-Meier method was applied to show the OS differences between the two groups.ResultsThe incidence of PA was 16% (55/344). Among these 55 patients, 20 had AF, 30 had sinus tachycardia, and 5 had premature beats. A total of 332 patients underwent lung cancer radical resection. Operation type (P<0.001), preoperative abnormal ECG (P=0.032), transfusion (P=0.016), postoperative serum potassium concentration (P=0.001) and clinical stage (P<0.05) were risk factors for PA. PA (HR 2.083, 95% CI, 1.334–3.253; P=0.001), age (HR 1.543, 95% CI, 1.063–2.239; P=0.025) and mediastinal lymph node metastasis (HR 2.655, 95% CI, 1.809–3.897; P<0.001) were independent prognostic risk factors for OS by multivariate cox analysis.ConclusionsWe identified PA as an independent prognostic risk factor to predict poor OS in patients who underwent lung cancer surgery and had risk factors for PA. We therefore provides guidance for PA in improving the prognosis of lung cancer patients.     

Minimally-invasive versus transcatheter aortic valve implantation: systematic review with meta-analysis of propensity-matched studies

BackgroundMinimally invasive aortic valve replacement (MiAVR) and transcatheter aortic valve implantation (TAVI) provide aortic valve replacement (AVR) by less invasive methods than conventional surgical AVR, by avoiding complete sternotomy. This study directly compares and analyses the available evidence for early outcomes between these two AVR methods.MethodsElectronic databases were searched from inception until August 2019 for studies comparing MiAVR to TAVI, according to predefined search criteria. Propensity-matched studies with sufficient data were included in a meta-analysis.ResultsEight studies with 9,744 patients were included in the quantitative analysis. Analysis of risk-matched patients showed no difference in early mortality (RR 0.76, 95% CI, 0.37–1.54, P=0.44). MiAVR had a signal towards lower rate of postoperative stroke, although this did not reach statistical significance (OR 0.42, 95% CI, 0.13–1.29, P=0.13). MiAVR had significantly lower rates of new pacemaker (PPM) requirement (OR 0.29, 95% CI, 0.16–0.52, P<0.0001) and postoperative aortic insufficiency (AI) or paravalvular leak (PVL) (OR 0.05, 95% CI, 0.01–0.20, P<0.0001) compared to TAVI, (OR 0.42, 95% CI, 0.13–1.29, P=0.13), while acute kidney injury (AKI) was higher in MiAVR compared to TAVI (11.1% vs. 5.2%, OR 2.28, 95% CI, 1.25–4.16, P=0.007).ConclusionsIn patients of equivalent surgical risk scores, MiAVR may be performed with lower rates of postoperative PPM requirement and AI/PVL, higher rates of AKI and no statistical difference in postoperative stroke or short-term mortality, compared to TAVI. Further prospective trials are needed to validate these results.     

室间隔消融术治疗肥厚型心肌病的Meta分析

目的:评价分析消融术治疗肥厚型心肌病的疗效以及安全性。方法:检索PubMed数据库、MedLine数据库、Embase数据库、Cochrane临床对照试验中心注册库和CNKI全文数据库、万方全文数据库、维普全文数据库自建库以来至2013公开发表的与室间隔消融术治疗肥厚型心肌病相关的文章,并加手工检索。限定文献发表类型为临床随机对照试验(RCT)。对资料进行筛选,选取针对性强的文章,排除重复研究。对筛选出的文献查找全文。采用RevMan5.0.25软件对纳入的试验结果进行meta分析。结果:共纳入7篇RCT,共445名肥厚性心肌病患者,Meta分析结果表明:室间隔射频消融与室间隔部分切除术相比,其术后全因病死率(RD=0.00,95%CI:-0.03-0.04,P=0.88)、左室流出道压差的改变(4.50,95%CI:-1.08-10.07,P=0.11)均无明显差异,而且室性心律失常发生率、起搏器置入率(OR=1.67,95%CI:0.86-3.26,P=0.13)、二尖瓣关闭不全发生率两组之间无显著差异;而与室间隔部分切除术相比室间隔射频消融术对心功能改善的效果较差(0.31,95%CI:0.16-0.45,P0.01)。结论:室间隔射频消融术与室间隔部分切除术相比在治疗肥厚性心肌病的疗效及安全性无明显差异,仅在对肥厚性心肌病患者心功能改善的效果上较差。     

Association of smoking with postoperative atrial fibrillation in patients with cardiac surgery: A PRISMA-compliant article

Background:Cigarette smoking is an important modifiable risk factor for incident atrial fibrillation. However, the impact of smoking on postoperative atrial fibrillation in patients undergoing cardiac surgery remains controversial. We performed this meta-analysis to explore the association of smoking with postoperative atrial fibrillation in patients with cardiac surgery.Methods:We systematically searched 2 computer-based databases (PubMed and EMBASE) up to July 2019 for all relevant studies. A random-effects model was selected to pool the odds ratios (ORs) and 95% confidence intervals (CIs). In this meta-analysis, the protocol and reporting of the results were based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement.Results:A total of 36 studies were included in this meta-analysis. Overall, smoking was not associated with an increased risk of postoperative atrial fibrillation in patients undergoing cardiac surgery (odds ratio [OR] = 0.89; 95% confidence interval [CI] 0.79–1.02). The corresponding results were stable in the subgroup analyses. Specifically, smoking was not associated with an increased risk of postoperative atrial fibrillation regardless of the type of cardiac surgery: coronary artery bypass grafting (OR = 0.91; 95% CI 0.77–1.07), valve surgery (OR = 0.15; 95% CI 0.01–1.56), and coronary artery bypass grafting+valve surgery (OR = 0.91; 95% CI 0.70–1.18).Conclusions:Based on currently published studies, smoking was not associated with an increased risk of postoperative atrial fibrillation in patients undergoing cardiac surgery.     

Associations between sinus tachycardia and adverse cardiovascular outcomes and mortality in cancer patients

BackgroundSinus tachycardia in cancer reflects a significant multi-system organ stressor and disease, with sparse literature describing its clinical significance. We assessed cardiovascular (CV) and mortality prognostic implications of sinus tachycardia in cancer patients.MethodsWe conducted a case-control study of 622 cancer patients at a U.S. urban medical center from 2008 to 2016. Cases had ECG-confirmed sinus tachycardia [heart rate (HR) ≥100 bpm] in ≥3 different clinic visits within 1 year of cancer diagnosis excluding a history of pulmonary embolism, thyroid dysfunction, left ventricular ejection fraction <50%, atrial fibrillation/flutter, HR >180 bpm. Adverse CV outcomes (ACVO) were heart failure with preserved ejection fraction (HFpEF), HF with reduced EF (HFrEF), hospital admissions for HF exacerbation (AHFE), acute coronary syndrome (ACS). Regression analyses were conducted to examine the effect of sinus tachycardia on overall ACVO and survival.ResultsThere were 51 cases, age and sex-matched with 571 controls (mean age 70±10, 60.5% women, 76.4% Caucasian). In multivariate analysis over a 10-year follow-up period, sinus tachycardia (HR ≥100 vs. <100 bpm) was an independent predictor of overall ACVO (OR 2.8, 95% CI: 1.4–5.5; P=0.006). There was increased incidence of HFrEF (OR 3.3, 95% CI: 1.6–6.5; P=0.004) and AHFE (OR 6.3, 95% CI: 1.6–28; P=0.023), but not HFpEF or ACS (P>0.05) compared with controls. Sinus tachycardia was a significant predictor of overall mortality after adjusting for significant covariates (HR 2.9, 95% CI 1.8–5; P<0.001).ConclusionsIndependent of typical factors that affect cardiovascular disease, sinus tachycardia around the time of cancer treatment is associated with increased ACVO and mortality in cancer patients at 10 years of follow-up.     

Influence of operator volume on early outcomes of septal myectomy for isolated hypertrophic obstructive cardiomyopathy

BackgroundGuidelines on the diagnosis and management of hypertrophic cardiomyopathy (HCM) recommend that septal myectomy be performed by experienced operators. However, the impact of operator volume on surgical treatment outcomes for isolated HCM has been poorly investigated.MethodsFrom 2002 to 2014, 435 consecutive patients with isolated HCM undergoing myectomy at the Fuwai Hospital were retrospectively enrolled. All 29 surgeons were divided into beginner surgeons (operator volume ≤20) and experienced surgeons (operator volume >20) according to the guidelines for the diagnosis and treatment of HCM. Propensity score matching of patients in the two groups was performed.ResultsBaseline differences included advanced New York Heart Association classification and older age in the experienced surgeon group. After matching, in the beginner surgeon group (107 cases), residual obstruction (18.7% vs. 0.9%, P<0.001) was more common, and the postoperative left ventricular outflow tract pressure gradient (20.7±15.1 vs. 14.3±7.4 mmHg, P<0.001) was higher than that of the experienced surgeon group. In the experienced surgeon group (107 cases), the incidence of mitral valve replacement (1.9% vs. 11.2%, P<0.001) and permanent pacemaker implantation (1.9% vs. 3.7%, P<0.001) was significantly lower than that in the beginner surgeon group. However, there was no difference in procedural mortality (1.9% vs. 1.9%) between the two groups.ConclusionsOperator volume is an important factor in achieving better obstruction obliteration after septal myectomy in patients with isolated HCM.     

Comparison of Modified With Classic Morrow Septal Myectomy in Treating Hypertrophic Obstructive Cardiomyopathy

This study aimed to compare the efficacy and safety of the classic Morrow septal myectomy with the modified procedure in treating hypertrophic obstructive cardiomyopathy (HOCM).A retrospective study was conducted to compare the outcomes of classic with modified Morrow septal myectomy in 42 patients treated from January 2005 to July 2011. Preoperative and postoperative ventricular septal thickness, left ventricular (LV) outflow tract velocity and gradient were measured echocardiographically.In both groups, the ventricular septal thickness, LV outflow tract velocity, and LV outflow tract gradient were significantly decreased after the operation. The modified Morrow procedure group, however, showed significantly greater reduction in these echocardiographic parameters than the classic procedure group. All patients in the modified procedure group were asymptomatic postoperatively with a postoperative transvalvular pressure gradient <30 mm Hg. In the classic procedure group, only 14 (87.5%) patients, however, were asymptomatic postoperatively with a postoperative transvalvular pressure gradient <30 mm Hg, and 2 patients still had severe LV outflow obstruction postoperatively.The modified Morrow septal myectomy is safe and effective in treating HOCM patients, and is superior to the classic procedure in reducing the LV outflow tract gradient and velocity, restoring normal anatomic atrioventricular size, and alleviating symptoms associated with HOCM.     

Effectiveness of atrial fibrillation surgery in patients with hypertrophic cardiomyopathy

We report the results of atrial fibrillation surgery in 10 patients with hypertrophic cardiomyopathy, which is the largest case series to date. The Maze procedure, with concomitant septal myectomy if indicated, appears to be feasible in patients with hypertrophic cardiomyopathy and refractory atrial fibrillation.     

Effect of amiodarone-induced hyperthyroidism on left ventricular outflow obstruction after septal myectomy for hypertrophic cardiomyopathy

Patients with obstructive hypertrophic cardiomyopathy who undergo septal myectomy are at risk for developing postoperative atrial fibrillation. Amiodarone is effective in treating this arrhythmia but is associated with multiple adverse effects, often with delayed onset. A novel case is described of a patient who developed type 2 amiodarone-induced hyperthyroidism that presented as recurrence of outflow obstruction after septal myectomy. The patient's symptoms and echocardiographic findings of outflow obstruction resolved substantially with the treatment of the amiodarone-induced hyperthyroidism. Amiodarone-induced hyperthyroidism of delayed onset can be a subtle diagnosis, requiring a high index of suspicion. In conclusion, recognition of this diagnosis in patients with recurrence of outflow obstruction by symptoms and cardiac imaging after septal myectomy may avoid unnecessary repeat surgical intervention.     

Preoperative risk factors for successful extubation or not after lung transplantation

BackgroundThe purpose of this study was to uncover preoperative risk factors for extubation failure or re-intubation for patients undergoing lung transplant (LTx).MethodsWe performed a retrospective case-control study of LTx from our center between January 2017 and March 2019. Demographic and preoperative characteristics were collected for all included patients. Univariable analysis and multivariable logistic regression were used to analyze risk factors of postoperative unsuccessful extubation following LTx.ResultsAmong 107 patients undergoing first LTx investigated, 74 (69.16%) patients who were successfully liberated from mechanical ventilation (MV), and 33 (30.84%) patients who were unsuccessful extubation, which 18 (16.82%) patients suffered from reintubation. associated preoperative factors for unsuccessful extubation following LTx included preoperative extracorporeal membrane oxygenation (ECMO) support [OR =4.631, 95% confidence interval (CI): 1.403–15.286, P=0.012], the preoperative ability of independent expectoration (OR =4.517, 95% CI: 1.498–13.625, P=0.007), the age older than 65-year-old (OR =4.039, 95% CI: 1.154–14.139, P=0.029), and receiving the double lung and heart-LTx (OR =3.390, 95% CI: 0.873–13.162, P=0.078; and OR =16.579, 95% CI: 2.586–106.287, P=0.012, respectively). Further, we investigated the preoperative predicted factors for reintubation. Only the preoperative ECMO remained a significant predictor of re-intubation (OR =4.69, 95% CI: 1.56–15.286, P=0.012).ConclusionsPreoperative independent sputum clearance, preoperative ECMO, older than 65-year-old, and double lung or heart-LTx were four independent risk factors for unsuccessful extubation. Moreover, preoperative ECMO was the only independent risk factor for reintubation.     

Papel dos Níveis de Sódio na Fibrilação Atrial na Insuficiência Cardíaca: Jogador Ativo ou Bystander?

BackgroundThe coexistence of hyponatremia and atrial fibrillation (AF) increases morbidity and mortality in patients with heart failure (HF). However, it is not established whether hyponatremia is related to AF or not.ObjectiveOur study aims to seek a potential association of hyponatremia with AF in patients with reduced ejection fraction heart failure (HFrEF).MethodsThis observational cross-sectional single-center study included 280 consecutive outpatients diagnosed with HFrEF with 40% or less. Based on sodium concentrations ≤135 mEq/L or higher, the patients were classified into hyponatremia (n=66) and normonatremia (n=214). A p-value <0.05 was considered significant.ResultsMean age was 67.6±10.5 years, 202 of them (72.2%) were male, mean blood sodium level was 138±3.6 mEq/L, and mean ejection fraction was 30±4%. Of those, 195 (69.6%) patients were diagnosed with coronary artery disease. AF was detected in 124 (44.3%) patients. AF rate was higher in patients with hyponatremia compared to those with normonatremia (n=39 [59.1%] vs. n=85 [39.7%), p= 0.020). In the logistic regression analysis, hyponatremia was not related to AF (OR=1.022, 95% CI=0.785–1.330, p=0.871). Advanced age (OR=1.046, 95% CI=1.016–1.177, p=0.003), presence of CAD (OR=2.058, 95% CI=1.122–3.777, p=0.020), resting heart rate (OR=1.041, 95% CI=1.023–1.060, p<0.001), and left atrium diameter (OR=1.049, 95% CI=1.011–1.616, p=0.002) were found to be predictors of AF.ConclusionAF was higher in outpatients with HFrEF and hyponatremia. However, there is no association between sodium levels and AF in patients with HFrEF.     

Predictors and long-term prognosis of left ventricular aneurysm in patients with acute anterior myocardial infarction treated with primary percutaneous coronary intervention in the contemporary era

BackgroundPrimary percutaneous coronary intervention (PCI) has been the standard reperfusion strategy for patients with acute myocardial infarction (AMI) in the contemporary era. Meanwhile, the incidence and prognosis of left ventricular aneurysm (LVA) in AMI patients remain ambiguous. The aim of the current study is to identify the predictor and long-term prognosis of LVA in patients with acute anterior myocardial infarction.MethodsWe prospectively enrolled 942 consecutive patients with acute anterior myocardial infarction who were treated by primary PCI. The baseline characteristics, procedural features, and one-year clinical outcomes were compared between the patients with and without LVA. The primary endpoint of major adverse cardiovascular and cerebrovascular events (MACCEs) was defined as a composite of cardiac death, target vessel revascularization, and ischemic stroke. Multiple logistic regression was applied to predict LVA formation and the receiver operating characteristic (ROC) curves were plotted to evaluate the accuracy of the multivariate analysis model.ResultsThe general incidence of LVA was 15.92%. At one-year clinical follow-up, patients in the LVA group had significantly higher incidence of MACCEs (15.33% vs. 6.44%, P<0.01), mainly driven by an increased incidence of cardiac death (8.00% vs. 2.78%, P<0.01), target vessel revascularization (5.33% vs. 2.27%, P=0.03), and ischemic stroke (4.00% vs. 1.39%, P=0.03). Multivariate analysis found that longer symptom-to-balloon time (S2B) [odds ratio (OR): 1.16, 95% confidence interval (CI): 1.11–1.21, P<0.01], higher initial and residual SYNTAX score (iSS, OR: 1.19, 95% CI: 1.14–1.24, P<0.01; rSS, OR: 1.33, 95% CI: 1.22–1.45, P<0.01), lower left ventricular ejection fraction (LVEF) (OR: 1.15, 95% CI: 1.11–1.18, P<0.01), and persistent ST segment elevation (OR: 1.89, 95% CI: 1.06–3.38, P=0.03) were independent predictors of LVA formation.ConclusionsLVA is still common in patients with acute anterior myocardial infarction in the contemporary PCI era, and the prognosis of these patients was significantly worse during the one-year clinical follow-up. Strategies of prompt reperfusion and complete revascularization may be helpful in preventing LVA formation and improving clinical outcomes.