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   Table of Contents - Current issue
January-June 2022
Volume 4 | Issue 1
Page Nos. 1-36

Online since Thursday, June 30, 2022

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Assessment of left ventricular systolic function p. 1
Govindan Vijayaraghavan
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Clinical characteristics, outcomes, and genetic findings of patients with catecholaminergic polymorphic ventricular tachycardia in Hong Kong: A systematic review p. 3
Jeremy Man Ho Hui, Yan Hiu Athena Lee, Kyle Hui, Jiandong Zhou, Danish Iltaf Satti, Cheuk To Chung, Danny Radford, Ishan Lakhani, Amir Hossein Behnoush, Leonardo Roever, Khalid Bin Waleed, Sharen Lee, Gary Tse
Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a rare cardiac ion channelopathy. This was the first systematic review of published works on the clinical characteristics, outcomes, and genetic findings of patients with CPVT from Hong Kong. PubMed and Embase were searched electronically from their inception until February 2022. The Joanna Briggs Institute Critical Appraisal Checklist was used to critically appraise included studies. Studies written in English describing at least one patient with CPVT were included. Studies describing overlapping CPVT patients from previous reports were excluded. Two studies describing 17 patients with CPVT were included. All included studies were rated of acceptable quality. The largest case series evaluated 16 CPVT patients with a mean presentation age of 11 ± 4 years. Of these, 15 patients (93.8%) were symptomatic at initial presentation. Ten patients presented with both premature ventricular complexes (PVCs) and ventricular tachycardia/ventricular fibrillation (VT/VF), whereas one had PVCs without VT/VF. Among the 14 patients (87.5%) who underwent genetic testing, eight (57.1%) tested positive for the ryanodine receptor 2 (RyR2) gene. Over a mean follow-up duration of 116 ± 36 months, six patients (37.5%) had incident VT/VF. In a 5-year review of autopsy data retrieved from public mortuaries for 289 sudden cardiac death patients, one CPVT patient (0.03%) was identified. All patients with CPVT in Hong Kong presented at or below 19 years old, of whom a majority were initially symptomatic or had incident VT/VF events. Novel genetic variants in the RyR2 gene not reported beyond our locality were identified.
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Clinical characteristics, incidence, and outcomes of transcatheter aortic valve implantation stratified by new-onset left bundle branch block: A single-center pilot study p. 9
Fajer Alabdulrazzaq, Mohammed Al Jarallah, Rajesh Rajan, Raja Dashti, Nader Alasousi, Vladimir Kotevski, Ahmed Said Taha Mousa, Gary Tse, Kobalava D Zhanna, Parul Setiya, Ahmad Al-Saber, Peter A Brady, Joud Al Balool
Background: Clinical outcomes after transcatheter aortic valve implantation (TAVI) patients have not been reported in the Gulf region. Objectives: To define the baseline electrocardiographic (ECG), echocardiographic, and computed tomographic findings of patients undergoing TAVI and analyze the predictors of developing new-onset persistent left bundle branch block (LBBB). Methods: Patients with severe aortic stenosis who underwent TAVI between 2013 and 2021 at the Sabah Al-Ahmed Cardiac Centre in Al-Amiri Hospital in the state of Kuwait were included in this study. Baseline characteristics, electrocardiography (ECG), echocardiography, and preprocedural computed tomography data were extracted. The primary outcome was new-onset LBBB. Results: A total of 61 patients were included (65.6% females; mean age: 73.5 ± 9 years; baseline ejection fraction: 55.5% ± 9.7%). Of these, 18 developed new-onset LBBB. Those who developed LBBB tended to have lower ejection fraction (52.5 ± 9.6 vs. 56.8% ± 9.5%; P = 0.116). Those who developed LBBB were more likely to develop 1st degree atrioventricular block post-TAVI (P = 0.001). Conclusion: The incidence of new-onset LBBB post-TAVI was 29.5%. The new-onset LBBB group was more likely to develop conduction abnormalities requiring permanent pacemaker implantation.
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Cardiovascular research mentorship platforms: Productivity, diversity, inclusion, and equity p. 15
Yuki Ka Ling Shum, Gary Tse, Tong Liu, Adrian Baranchuk, Sharen Lee
Background: There has been increasing awareness on the issue of underrepresentation in academic cardiology. However, to date, most mentorship programs are not designed specifically tailored for future careers in cardiology or cardiovascular medicine. We present our 6-year experience in running two research mentorship platforms, the International Health Informatics Study Network and the Cardiovascular Analytics Group. Objective: To study the underrepresentation in academic cardiology. Methods: Researchers were prospectively recruited into the mentorship programs between September 2015 and September 2021. A combination of online mentorship approaches was employed, including one-to-one mentoring (between faculty and students and between peers), group mentorship, and teaching sessions. Outcomes included the number of publications related to cardiovascular medicine, including those with student members in key authorship positions, and students serving as mentors. Female representation was assessed. Results: A total of 117 researchers from 19 countries were recruited between September 2015 and September 2021, leading to the successful publication of 164 research articles on cardiovascular medicine or epidemiology. Students participated in 80% of the articles (n = 131). At least one student served as the first author in 34% of the articles (n = 56; at least one female student as the first author in 48% of the 56 articles; n = 27), as the senior author in 7.3% of the articles (n = 12), and as a mentor in 15% of the articles (n = 26; at least one female student served as a mentor in 42% of the 26 articles; n = 11). Female researchers occupied one of the four key authorship positions in 43% of the articles (n = 70; 47 female first authors; 10 female co-first authors; 6 female co-corresponding authors; and 17 female last authors). There was a 12% increase in the percentage of females in key authorship positions between the periods 2016–2018 and 2019–2021, from 47% (n = 33) and 53% (n = 37) of the 70 publications having at least one female in key authorship positions, respectively. Conclusions: Online-based mentorship programs can promote the development of independent research and leadership skills in students, with a positive impact on diversity, gender equity, inclusion, and productivity in cardiovascular research.
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Gender differences in coronary profiles of chronic coronary syndrome patients: A single-center pilot study from Kuwait p. 20
Maraam AlRashed, Rajesh Rajan, Mohammed Al-Jarallah, Raja Dashti, Salman Hussain, Ahmad Al Saber, Peter A Brady, Ibrahim Al Zakwani, Ibrahim El Khouly
Background: Chronic coronary syndrome (CCS) is a recently defined entity that necessitates evaluating individual clinical risk factors in this cohort. Objective: The objective of the present study was to evaluate patients with CCS and examine their coronary profiles in order to delineate differences between genders. Methods: A cross-sectional analysis was conducted on 51 patients who met the criteria of CCS and have undergone both coronary angiography and CT coronary angiography. Analyses were conducted using univariate statistics. Results: The cohort consisted of mainly Kuwaiti nationals with an average age of 61 ± 10 years. Females consisted 41% of the cohort, were older by an average of 9 years (P = 0.001), and were overweight (67% vs. 44%). Males were more likely to be cigarette consumers (47% vs. 14%; P = 0.022). Females had more comorbidities such as hypertension (86% vs. 80%) and atrial fibrillation (24% vs. 10%), excluding stroke (0% vs. 3.3%), and coronary artery disease (71% vs. 83%). Males had an elevated level of creatinine (88 vs. 72 umol/L; P = 0.045). Other results were not significantly different between genders. Males were more likely to be prescribed aspirin upon admission (100% vs. 81%; P = 0.026), however, this difference decreased upon discharge (97% vs. 86%; P = 0.297). Recurrent ischemia (12%; n = 6) was the most common major outcome recorded. Conclusions: This study shows that females were more likely to be older than their male counterparts whereas males were more often on aspirin and more likely to be cigarette smokers. We found no significant differences in comorbidities, admission laboratory and imaging results, nor outcomes between genders.
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Massive cerebral air embolism due to aortography: A case presentation p. 27
Ozkoc Alptekin, Aydogdu Ozlem
Though rare, air embolism as a serious complication may occur in patients undergoing coronary angiography and aortography. If gas embolism is diagnosed, hyperbaric oxygen therapy should be initiated immediately after the air source is cutoff and vital functions are stabilized. In this case presentation, a patient went into a coma after a massive iatrogenic cerebral air embolism that developed during the aortography procedure. The patient was discharged with hyperbaric oxygen therapy without any sequelae.
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Electrocardiographic evolution of heart block in lyme carditis p. 30
Lubka B Ilieva, Essam Saad, Marc Iskandar, Peter A Brady
A 23-year-old male presented with dizziness and weakness and reported travel to a tick-prevalent region 1 month prior. Initial electrocardiogram showed a high-grade atrioventricular block with narrow-complex escape rhythm, which progressed to a complete heart block with a wide-complex escape the next day. Resolution of the heart block was documented at follow-up after treatment with appropriate antibiotic therapy. Heart block in Lyme carditis is more commonly reported to be supra-Hisian, manifesting as a narrow-complex escape rhythm. Infra-Hisian block is rare, which manifests as a wide-complex escape rhythm, and may occasionally require permanent pacemaker implantation.
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A case of COVID-19 STEMI complicated by second: Degree heart block without pulmonary involvement p. 33
Ibrahim Mahmoud Ibrahim Elkholy, Mohammed Al-Jarallah, Raja Dashti
We present a case of a coronavirus disease 2019 (COVID-19) patient who presented with acute myocardial infarction and was treated successfully with primary percutaneous intervention and stent implantation. During the hospital stay, the patient did not develop respiratory manifestations either clinically or radiologically. This report highlights the effect of COVID-19 disease on the cardiovascular system and its effect beyond common respiratory complications.
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