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Epidemiological, Clinical and Angiographic Profile of Chronic Coronary Syndromes in the Catheterization Room. Single-centre Study Carried Out in the cardiology Department of the Chu Aristide Le Dantec in Dakar (Senegal)

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World Journal of Cardiovascular Diseases 2023年第10期13卷 674-685页

作者： Cheikh Mouhamadou Bamba Mbacke Diop Radja Juste Bissakonou Nzaya Joseph Salvador Mingou Papa Guirane Ndiaye Youssou Diouf Khadimu Rassoul Diop Demba Ware Balde Ahmadou Bamba Samb Malick Bodian Fatou Aw Simon Antoine Sarr Mouhamadou Bamba Ndiaye Abdoul Kane Maboury Diao cardiology Department CHU Aristide Le Dantec Dakar Senegal cardiology Department Dalal Jamm Hospital Dakar Senegal

Background: Ischaemic heart disease is the cause of 7.4 million deaths per year. Their prevention is based on the management of cardiovascular risk factors, but also on the early detection and management of chronic coronary syndromes (CCS), for which few data are available in Africa. The main objective of our study was to determine the factors related to significative coronary artery disease in patients undergoing coronarography for suspected chronic coronary syndrome (CCS). Methodology: We conducted a retrospective descriptive and analytical study over 2 years (from January, 1st, 2018 to December 31st, 2019) in the cardiology Department of the University Hospital Aristide Le DANTEC in Dakar. All patients admitted for coronary angiography for suspected chronic coronary syndrome were included. Results: One hundred and fifty-two patients were included with a mean age of 60.79 ± 9.73 years, the most represented age group was 60 - 69 years. Advanced age was the most frequent risk factor (77.63%) followed by sedentary lifestyle (56.58%) and hypertension (41.45%). Diabetes was present in 17.1% of cases. A history of angioplasty was found in 1.97% of patients. Typical pain was found in 71.05% of cases, atypical pain in 19.74% and exertional dyspnoea in 2.63%. The pre-test probability was intermediate in 67.1% of cases, low in 25% and high in 7.9%. Significative coronary lesion was found in 52.63% of the patients, while coronary angiography was normal in the remaining cases. Tritroncular status was observed in 37.50%, it was bitroncular in 26.25% and monotroncular in 36.25% of cases. Factors associated with significative coronary artery disease were age (p = 0.0001), diabetes (p = 0.006), previous angioplasty (p = 0.023), previous myocardial infarction (p = 0.018), typical angina (p = 0.001), intermediate pretest probability (p = 0.001). Low pretest probability was significantly correlated with the absence of a coronary lesion with a p = 0.001. Conclus

关键词： Chronic Coronary Syndroms Coronarography Aristide Le Dantec Hospital Dakar

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Is dual therapy the correct strategy in frail elderly patients with atrial fibrillation and acute coronary syndrome?

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Journal of Geriatric cardiology 2020年第1期17卷 51-57页

作者： Alessio Menditto Roberto Antonicelli cardiology Unit Italian National Research Centre on Aging

Atrial fibrillation(AF)is a very common arrhythmia in clinical *** incidence and prevalence are age-related and are growing in the last *** is a risk factor also for coronary artery disease(CAD),and with the evolution of preventive care,the first event(acute coronary syndrome(ACS)or percutaneous coronary intervention(PCI))takes place at a later *** elderly patients with AF and CAD undergo ACS or PCI,they have indication to assume triple *** therapy(oral anticoagulation(OAC)plus dual antiplatelet therapy(DAPT))exposes patients to high bleeding *** the last 10 years,several clinical trials have tested dual therapy(OAC plus single antiplatelet therapy)in AF patients who undergo ACS or elective *** trial has tested warfarin+clopidogrel against triple *** AF-PCI trial has tested low-dose rivaroxaban+P2Y12 inhibitor or very low-dose rivaroxaban+DAPT against standard triple therapy with ***-DUAL PCI trial has tested two doses of dabigatran+P2Y12 inhibitor against standard triple therapy with *** trial has tested apixaban against warfarin both in dual therapy with P2Y12 inhibitor and in triple therapy with a P2Y12 inhibitor and ***-AF PCI,last published study,has tested edoxaban+P2Y12 inhibitor against triple *** these trials show dual therapy reduces significantly bleeding risk than triple *** this paper,we analyze these clinical trials to understand if dual therapy results can be applied to elderly patients and what is probably the better approach in elderly AF patients undergo to ACS or PCI.

关键词： Acute coronary syndrome Atrial fibrillation Dual therapy Oral anticoagulation The elderly

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Effect of dynamic light at the coronary care unit on the length of hospital stay and development of delirium： a retrospective cohort study

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Journal of Geriatric cardiology 2018年第9期15卷 567-573页

作者： Tobias Pustjens Antonius MC Schoutens Loes Janssen Wilfred F Heesen Department of cardiology Division of Cardiology Viecuri Medical Centre Venlo the Netherlands Flux Plus Tilburg the Netherlands Department of Clinical Epidemiology Viecuri Medical Centre Venlo the Netherlands

Background Disturbed circadian rhythm is a potential cause of delirium and is linked to disorganisation of the circadian rhythmicity. Dynamic light （DL） could reset the circadian rhythm by activation of the suprachiasmatic nucleus to prevent delirium. Evidence regarding the effects of light therapy is predominantly focused on psychiatric disorders and circadian rhythm sleep disorders. In this study, we investi- gated the effect of DL on the total hospital length of stay （LOS） and occurrence of delirium in patients admitted to the Coronary Care Unit （CCU）. Methods This was a retrospective cohort study. Patients older than 18 years, who were hospitalized longer than 12 h at the CCU and had a total hospital LOS for at least 24 h, were included. Patients were assigned to a room with DL （n = 369） or regular lighting condi- tions （n = 379）. DL was administered at the CCU by two ceiling-mounted light panels delivering light with a colour temperature between 2700 and 6500 degrees Kelvin. Reported outcome data were： total hospital LOS, delirium incidence, consultation of a geriatrician and the amount of prescripted antipsychotics. Results Between May 2015 and May 2016, data from 748 patients were collected. Baseline charac- teristics, including risk factors provoking delirium, were equal in both groups. Median total hospital LOS in the DL group was 100.5 （70.8-186.0） and 101.0 （73.0-176.4） h in the control group （P = 0.935）. The incidence of delirium in the DL and control group was 5.4% （20/369） and 5.0% （19/379）, respectively （P = 0.802）. No significant differences between the DL and control group were observed in secon- dary endpoints. Subgroup analysis based on age and CCU LOS also showed no differences. Conclusion Our study suggests exposure to DL as an early single approach does not result in a reduction of total hospital LOS or reduced incidence of delirium. When delirium was diagnosed, it was associated with poor hospital outcome.

关键词： Delirium Dynamic light application Length of hospital stay

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The Prognostic Value of Myocardial Deformation in Patients with Congenital Aortic Stenosis

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Congenital Heart Disease 2021年第3期16卷 221-232页

作者： Roderick W.J.van Grootel Allard T.van den Hoven Dan Bowen Tijmen Ris Jolien W.Roos-Hesselink Annemien E.van den Bosch Department of cardiology Erasmus Medical CentreRotterdamThe Netherlands

Aims:To assess the prognostic value of left ventricular(LV)global longitudinal strain(GLS)and global longitudinal early diastolic strain rate(GLSre)with regard to cardiovascular events,as congenital aortic stenosis(AoS)is associated with significant mortality and morbidity but predictors for clinical outcome are *** analysis provides a robust and reproducible method for early detection of LV dysfunction,which might be of prognostic ***:This prospective study,included clinically stable patients with congenital AoS between 2011–*** GLS and GLSre was performed in the apical 4,3 and 2-chamber views using Tomtec *** endpoint was a composite of death,heart failure,hospitalization,arrhythmia,thrombo-embolic events and ***:In total 138 patients were included(33[26–43]years,86(62%)male),NYHA class I:134(97%).Mean LV GLS was–15.3±3.2%,GLSre 0.66±0.18 s–*** correlated with NT-proBNP,LV volumes and ejection fraction(strongest LV GLS with LV EF:r–0.539,p<0.001,strongest LV GLSre with age:r–0.376,p<0.001).During median follow-up of 5.9[5.5–6.2]years,the endpoint occurred in 53(38%)patients:4 patients died,9 developed heart failure,22 arrhythmias,8 thrombo-embolic events and 35 *** LV GLS(standardized HR(sHR 0.62(95%CI 0.47–0.81)and GLSre(sHR 0.62(95%CI 0.47–0.83)were associated with the *** multivariable analysis showed that both GLS and GLSre were associated independent of left atrial volume,NT-proBNP and prior ***:Left ventricular GLS and GLSre are reduced in adult patients with congenital *** markers are associated with adverse cardiac events and have clear clinical relevance.

关键词： Speckle tracking echocardiography congenital aortic stenosis strain prognosis

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Conduction abnormalities after transcatheter aortic valve implantation

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Journal of Geriatric cardiology 2018年第1期15卷 105-112页

作者： Panagiotis Karyofillis Anna Kostopoulou Sofia Thomopoulou Martha Habibi Efthimios Livanis George Karavolias Vassilis Voudris Department of Invasive cardiology Onassis Cardiac Surgery Centre Athens Greece

In the last few years, transcatheter aortic valve implantation （TAVI） has become an alternative procedure in patients with severe aortic stenosis and high risk for surgical aortic replacement. Due to the anatomic correlation between aortic valve structure and conduction system of the heart, one of the most common complications after TAVI is conduction system disturbances which including bundle branch block, complete heart block and need for permanent pacemaker implantation. Although these disturbances are usually not lethal, they may have a great influence on patients＇ state and long term-survival. Several risk factors for conduction disturbances have been identified which including age, anatomy of the heart, periprocedural factors, type of implanted valve, preexisting abnormalities and comorbidities. As this technique becomes more familiar to physicians, patients should be carefully screened for risk factors for the development of conduction abnormalities after TAVI in order to provide effective prevention and proper treatment.

关键词： Atrioventricular block Bundle branch block Pacemaker Transcatheter aortic valve implantation

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Cardiovascular rehabilitation in patients aged 70-year-old or older:benefits on functional capacity,physical activity and metabolic profile in younger *** patients

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Journal of Geriatric cardiology 2020年第9期17卷 544-553页

作者： Marta Fontes-Oliveira Maria Trêpa Patrícia Rodrigues Preza Fernandes Sandra Magalhães Sofia Cabral Mário Santos Severo Torres cardiology Department University Hospital Centre of PortoPortoPortugal Cardiac Rehabilitation Unit Cardiology DepartmentUniversity Hospital Centre of PortoPortoPortugal Pulmonary Vascular Disease Unit University Hospital Centre of PortoPortoPortugal

Background The benefits of exercise-based cardiac rehabilitation(EBCR)programs in post-acute myocardial infarction(AMI)patients have been *** aim was to assess the impact of EBCR in³70-years-old *** post-AMI *** We retrospectively evaluated patients who underwent a supervised EBCR protocol,twice a week during 6-12 *** evaluated changes in several outcomes based on pre-and post-CRP *** Of a total of 1607 patients,333(21%)were³*** the EBCR,an overall improvement on functional capacity,daily physical activity,lipid profile,body mass index,glycated hemoglobin(HbA1c),N-terminal pro-brain natriuretic peptide(NT-pro-BNP)and C-reactive protein was observed in both younger and older patients(P<0.05).Older patients showed a smaller benefit on the increment of daily physical activity and lipid profile improvement,but a larger reduction in *** the multivariate analysis,only improvements on daily physical activity and HbA1c were dependent on *** As their younger counterparts,older patients,significantly improved functional capacity,metabolic parameters and level of daily physical activity after EBCR.

关键词： Aging Cardiovascular prevention Exercise-based cardiac rehabilitation

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The coronavirus disease-19 pandemic and acute coronary syndrome:a specific impact in the elderly

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Journal of Geriatric cardiology 2022年第5期19卷 325-334页

作者： ViktorČulić Ahmed AlTurki Riccardo Proietti Department of cardiology and Angiology University Hospital Centre SplitSplitCroatia University of Split School of Medicine SplitCroatia Division of cardiology McGill University Health CentreMontrealQuebecCanada Liverpool centre for Cardiovascular Science University of LiverpoolLiverpoolUnited Kingdom

The coronavirus disease-19(COVID-19)pandemic has dramatically burdened healthcare systems worldwide by creating new public health *** addition to the most prevalent presentation of COVID-19 with mild to moderate respiratory symptoms,which occasionally progresses to acute respiratory distress syndrome,cardiovascular complications of COVID-19 include arterial and venous thromboembolic events(pulmonary embolism,acute myocardial infarction(MI)and ischemic stroke),myocarditis/myocardial injury.

关键词： acute respiratory distress

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Feasibility of emergent transcatheter aortic valve replacement sequentially followed by cardiac computed tomography angiography:experience from the procedure

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Journal of Geriatric cardiology 2023年第8期20卷 602-607页

作者： Dong-Kai SHAN Bo JIANG Ze-Yu SUN Jing WANG Yun-Dai CHEN Chang-Fu LIU Senior Department of cardiology the Sixth Medical CentreChinese PLA General HospitalBeijingChina

Transcatheter aortic valve replacement(TAVR)has emerged as an effective alternative to surgical aortic valve replacement in symptomatic aortic stenosis(AS).^([1,2])Approximately one in five cases of AS are emergent with acute decompensation of cardiac function;^([3])therefore,emergent TAVR is an essential approach for severe AS patients with acute condition.

关键词： aortic acute stenosis

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Antithrombotic treatment tailoring and risk score evaluation in elderly patients diagnosed with an acute coronary syndrome

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Journal of Geriatric cardiology 2017年第7期14卷 442-456页

作者： Alexandru Nicolae Mischie Catalina Liliana Andrei Crina Sinescu Gani Bajraktari Eugen Ivan Georgios Nikolaos Chatziathanasiou Michele Schiariti Invasive cardiology Unit Centre Hospitalier de Montlufon Montlufon France Carol Davila University of Medicine and Pharmacy Bucharest Romania Clinic of cardiology University Clinical Centre of Kosova Prishtina Republic of Kosovo Comanche Memorial Hospital Lawton USA 5Cardiology Clinic Preveza Greece cardiology Clinic Preveza Greece Department of Cardiovascular Sciences Sapienza University of Rome Rome Italy

Age is an important prognostic factor in the outcome of acute coronary syndromes （ACS）. A substantial percentage of patients who ex- perience ACS is more than 75 years old, and they represent the fastest-growing segment of the population treated in this setting. These pa- tients present different patterns of responses to pharmacotherapy, namely, a higher ischemic and bleeding risk than do patients under 75 years of age. Our aim was to identify whether the currently available ACS ischemic and bleeding risk scores, which has been validated for the general population, may also apply to the elderly population. The second aim was to determine whether the elderly benefit more from a spe- cific pharmacological regimen, keeping in mind the numerous molecules of antiplatelet and antithrombotic drugs, all validated in the general population. We concluded that the GRACE （Global Registry of Acute Coronary Events） risk score has been extensively validated in the elderly. However, the CRUSADE （Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early imple- mentation of the ACC/AHA Guidelines） bleeding score has a moderate correlation with outcomes in the elderly. Until now, there have not been head-to-head scores that quantify the ischemic versus hemorrhagic risk or scores that use the same end point and timeline （e.g., ischemic death rate versus bleeding death rate at one month）. We also recommend that the frailty score be considered or integrated into the current existing scores to better quantify the overall patient risk. With regard to medical treatment, based on the subgroup analysis, we identified the drugs that have the least adverse effects in the elderly while maintaining optimal efficacy.

关键词： Acute coronary syndrome Antithrombotic treatment Elderly patients Risk score evaluation

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Contemporary perspective on endogenous myocardial regeneration

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World Journal of Stem Cells 2015年第5期7卷 793-805页

作者： Dejan Milasinovic Werner Mohl Department of cardiology Clinical Centre of Serbia Department of Cardiac Surgery Medical University of Vienna

Considering the complex nature of the adult heart, it is no wonder that innate regenerative processes, while maintaining adequate cardiac function, fall short in myocardial jeopardy. In spite of these enchaininglimitations, cardiac rejuvenation occurs as well as restricted regeneration. In this review, the background as well as potential mechanisms of endogenous myocardial regeneration are summarized. We present and analyze the available evidence in three subsequent steps. First, we examine the experimental research data that provide insights into the mechanisms and origins of the replicating cardiac myocytes, including cell populations referred to as cardiac progenitor cells(i.e., c-kit+ cells). Second, we describe the role of clinical settings such as acute or chronic myocardial ischemia, as initiators of pathways of endogenous myocardial regeneration. Third, the hitherto conducted clinical studies that examined different approaches of initiating endogenous myocardial regeneration in failing human hearts are analyzed. In conclusion, we present the evidence in support of the notion that regaining cardiac function beyond cellular replacement of dysfunctional myocardium via initiation of innate regenerative pathways could create a new perspective and a paradigm change in heart failure therapeutics. Reinitiating cardiac morphogenesis by reintroducing developmental pathways in the adult failing heart might provide a feasible way of tissue regeneration. Based on our hypothesis "embryonic recall", we present first supporting evidence on regenerative impulses in the myocardium, as induced by developmental processes.

关键词： Cardiac regeneration Cardiac development Embryonic recall Pressure-controlled intermittentcoronary sinus occlusion Heart failure Myocardialinfarction

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