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  • ISSN: 2333-6676
    Volume 9, Issue 1
    Research Article
    Christine JE de Vries-Rink*, Gerdien A Zeilmaker-Roest, Maarten ter Horst, Kevin Veen, Emma L Peschier-van der Put, Dick Tibboel, Enno D Wildschut, Anouk E Muller, Inge de Liefde, Ad JJC Bogers
    Introduction: Cefazolin is the first choice antibiotic prophylaxis during cardiac surgery and is widely used to prevent deep sternal wound infections (DSWI). Recently, the Dutch guideline has been changed where the cefazolin dose given at the onset of cardiopulmonary bypass (CPB), has been removed and the postoperative dosages are both halved. The aim of the study is to assess if adequate cefazolin plasma levels are obtained with the new Dutch guideline.
    Methods: Twenty-four adults undergoing cardiac surgery with cardiopulmonary bypass (CPB), receiving cefazolin were studied. The main goal is 100% fT >MIC during surgery and epidemiological cutoff is 2 mg/L. During the postoperative phase the goal is 40% fT >MIC. Per patient 9 to 11 blood samples were collected to measure plasma cefazolin concentrations.
    Results: During surgery 100% of the measured concentrations were above the ECOFF of 2mg/L. BMI was not significantly associated with unbound cefazolin concentrations. Sex, age, albumin levels preoperative and duration of CPB were also not significantly associated with cefazolin unbound concentration. Redose was significantly associated with higher total plasma concentration. In the postoperative phase 85% were above the ECOFF of 2mg/L.
    Conclusion: This study shows that the unbound cefazolin concentration during surgery is 100% above the ECOFF of 2mg/L, though sometimes close to the minimum. In the postoperative period more than 85% was above the ECOFF of 2mg/L.
    Bermet Kurmanbekova* and Aygul Noruzbaeva
    Background: IR promotes the development of early atherosclerosis and may increase the risk of cardiovascular complications, which is of great importance in patients with CHF. Thus, the assessment of the relationship between IR and clinical indicators of CHF is relevant in the clinical aspect and needs detailed research.
    Objective: To evaluate the relationship between IR and clinical parameters in hospitalized ischemic etiology CHF patients without concomitant CMD. Methods. The study included 174 hospitalized patients with a stable course of CHF FC III (NYHA), and CAD from 18 to 65 years old, without previously identified CMD. Anthropological, clinical, laboratory examination was carried out. The neurohormonal profile included insulin (IR by HOMA-IR), aldosterone, and Nt-proBNP levels assessment. To study the relationship of IR with clinical parameters in CHF and CAD patients, a correlation analysis was performed.
    Results: A statistically significant relationship between IR and the following parameters was revealed: BMI (r = 0.186, p = 0.045), total FINDRISC score (r = 0.386, p = 0.000), SBP (r = 0.247, p = 0.007), DBP (r = 0.173, p = 0.063), HbA1c (r = 0.388, p = 0.000), insulin concentration (r = 0.833, p = 0.000). To identify independent predictors influencing IR, we carried out multivariate linear regression analysis with stepwise inclusion of indicators in the model, in which HOMA-IR was used as a dependent variable, and BMI, total FINDRISK scores, SBP, DBP, HbA1c levels were included as independent variables. It turned out that the independent factors associated with IR are HbA1c (β = 0.144; p = 0.000) and the FINDRISK scale points (β = 0.064; p = 0.05).
    Conclusions: In patients with CHF and CAD, IR is interrelated with such indicators as BMI, FINDRISC total points, SBP, DBP, HbA1c. Independent predictors influencing IR are HbA1c and the FINDRISK total points.
    Urfan Jafarov, Nazmi Gultekin*, and Emine Kucukates
    Background and Aim: Βeta-Tubulin is a microtubule that binds with α-Tubulin to form tubulin heterodimer which is a structural protein of cardiomyocytes. Colchicine inhibits tubulin polymerization.The aim of our study is to determine the β1 -tubulin level, which is one of the cardiomyocyte structure proteins in serum and to investigate the relationship with heart failure, and also to investigate the importance of microtubule inhibition via β1 -tubulin- levels,in stage 4 heart failure with reduced ejection fractıon (HFrEF).
    Methods: We investigated serum β1- tubulin levels according to etiological classifications (ischemic/non-ischemic subgroups). Also, the subgroup with 13 non-ischemic HFrEF patients using low dose colchicine (0.5-1mg), as a microtubule inhibitor for at least three months was also included. Blood samples have been centrifuged and β1- tubulin plasma concentrations were measured by the Elisa method with Human β1- tubulin Chain Elisa kit.
    Results: β1- tubulin levels had increased in ischemic HFrEF patients according to the non-ischemic subgroup (p:0.26). Besides, in the subgroup analysis of non-ischemic HFrEF patients used colchicine (n=13), was detected decreased levels of β1- tubulin (p=0.29), and NT*proBNP (p=0.69). But, for at least three months low dose colchicine used patient subgroup had better EF (p=0.009), and smaller diastolic left ventricular diameters (p=0.002), respectively.
    Conclusions: Our study gives the impression that the adverse remodeling of the left ventricle can be reversed by low dose colchicine.Thus, actin microfilaments are more effective in the microenvironment, and due to the inhibition of microtubules, they bind more to myosin heads (myotropes effect).
    Review Article
    Noah WH and JL Cook*
    While obstructive sleep apnea (OSA), has a mortality and prevalence similar to hypercholesterolemia, few patients with cardiovascular disease (CVD), undergo evaluations for OSA. Historically poor adherence to continuous positive airway pressure (CPAP), and the failure of CPAP to reduce cardiovascular (CV), events in randomized controlled trials (RCTs), may be responsible.
    Observational data, including secondary analysis of RCTs, showed improvement in CV outcomes in patients who used CPAP 4 or more hours per night long-term. RCTs were limited by exclusions for ethical constraints and poor CPAP adherence. “Wearing” CPAP clearly improves CV outcomes despite confounding factors and considering the low cost and low risk of CPAP, patients with CVD should be evaluated for OSA and not denied the likely benefits of CPAP.
    Poor long-term CPAP adherence likely results from lack of focus from sleep medicine providers and lack of requirements for medical equipment companies. However, utilizing motivational enhancement, patient education, and remote monitoring, long-term adherence rates for CPAP may exceed that of many CV medications.
    Therefore, physicians, particularly cardiologists, should consider OSA screening when assessing other CV risk factors and choose a sleep medicine program that provides convenient and cost-efficient testing and has ample trained staff to produce long-term CPAP adherence which is required for improved CV outcomes.
    Iqbal Akhtar Khan* and Hamza Iltaf Malik
    Human heart, “a wondrous magic casket”, has been believed to be the seat of intelligence, emotion and sensation in ancient scriptures and non-Abrahamic religions. According to monotheistic religions, it has psychological, moral and spiritual functions. It could either be healthy or diseased. The modern scientific research has proved that an emotional brain is formed long before a rational one, and the heart has its own independent complex nervous system known as ‘the brain in the heart.’ The heart sends out electromagnetic field which controls our emotions. Whereas the theory of cellular memories states that memories, as well as personality traits, are not only stored in the brain but may also be stored in organs such as the heart, it has been reported that the heart transplant recipients seem to be the most susceptible to significant changes in personality, the possible mechanism being the transfer of memory through heart. The heart also manufactures and secretes oxytocin, referred as “love or social-bonding hormone”. Moreover, its role in cognition, tolerance, trust and friendship and the establishment of enduring pair-bonds has been well recognized.
    Research Article
    Rotashock Therapy: An Observational Study
    Background/Purpose: Calcified coronary lesions restrict stent delivery and expansion during percutaneous coronary intervention (PCI). Intravascular Lithotripsy (IVL /Shockwave Medical) is a novel tool that treats coronary calcification. However, standalone IVL may be inadequate and combination with rotablation (rotashock) may be required.We performed detailed analysis of “rotashock” patients.
    Materials/Methods: We conducted retrospective analysis of the PCI database from 2 United Kingdom (UK) centres (2018–2020). Patients who underwent rotashock therapy were analysed for patient and procedural characteristics and compared to those who underwent IVL. All patients had intracoronary imaging.
    Results: Eighty eight patients were included in the analysis. One third of the patients (29.5%, n=26) underwent rotashock therapy. Patients who underwent rotashock more likely had hypercholesterolemia (65.4% versus 35.5%, p=0.01) and significantly more angiographic calcification assessed by the Birmingham Calcium Score (BCS: 0: wall calcification; 1: luminal spiculated calcium, 2: focal intraluminal calcium <1/2 vessel diameter and 3: focal intraluminal calcium ≥1/2 vessel diameter) (rotashock: BCS 2/3 96.2% versus IVL alone: BCS 2/3 61.3%, p=0.001). BCS correlated with Intra Coronary imaging (Kendall’s tau 0.34, p=0.02). Procedural complication rates (burst IVL balloon, Ellis 3 perforation, side branch occlusion, stent fracture, retained microcatheter tip) were no different between the groups (rotashock 11.5% versus IVL alone 14.5%, p= ns). No major complications such as death, myocardial infarction, stroke or referral for emergency bypass graft surgery occurred.
    Conclusions: Rotashock can be safely performed with a low rate of in-hospital complications. BCS may help guide choice of tool for calcium modification in addition to intracoronary imaging.
    Haleh Farzin*
    Introduction: Thrombocytopenia in patients undergoing major heart surgery, is a common event. Various events such as cardiopulmonary bypass induced platelet damage and hypothermia are known as contributing factors but, exact role of CBP application has not been studied . The aim of this study is a comparison of acute change of platelet count and functioning after coronary artery bypass surgery with or without cardiopulmonary pump.
    Methods and Materials: Present study is a descriptive cross- sectional study, and performed on 200 patients’ candidate elective bypass coronary artery surgery. The patients were allocated into two groups: on – pump as study group(N--100) and off- pump as control group (N=100). No intervention except bleeding time measurement was performed. Demographic variables, bleeding time and platelet count were recorded before and after surgery.
    Results: Results of this study showed that using of cardiopulmonary bypass in elective coronary artery bypass grafting significantly increased the operation time, need to exploration, increased consumptiction of corticosteroid, noradrenalin and adrenalin. Also, Thrombocytopenia frequency (45% vs 20% Pvalue<0.001), platelet dysfunction and subsequent increasing of BT (77.02 vs. 33.1% p=0.013), in comparison with off- pump surgery had statistically significant difference. Although, first day of bleeding rate was similar in both groups but need to reoperation was higher in on- pump group.
    Conclusion: Results showed that in comparison with off- pump CABG, using extracorporeal circulation can lead to further platelet count reduction and its function. Although; CBP had no effect on amount of bleeding b at first day of postoperative period.
    Sravani Avula*, Harshavardhan Reddy Ghadiam, Jishanth Mattumpuram, Sudhir Mungee, Tinoy Kizhakekuttu, Keattiyoat Wattanakit
    Severe aortic stenosis is defined based on the echocardiographic parameters including peak velocity, mean pressure gradient across the aortic valve and aortic valve area. Grading of AS solely based on these parameters may give discordant results and raise uncertainty about the true AS severity particularly in scenarios like less severe AS, low flow across the aortic valve due to reduced LVEF and presence of small aortic root. Low dose DSE has been validated to differentiate true versus pseudo severe AS. AVAproj can be utilized when low dose DSE is non-conclusive. The aim of this study is to evaluate the relationship between AT/ET and calculated AVAproj in patients with LFLG severe AS with reduced EF to determine a cutoff for this ratio to identify true severe AS in these patients.
    Review Article
    Demetrio Sharp Dimitri*, Mahyar Pourriahi, Sneha Sharma, and Jennifer L. Cook
    In chronic medical conditions remote patient monitoring (RPM), is beneficial to empower both medical providers and patients. RPM supports medical care and early interventions to potentially promote patient’s disease management and improve outcomes. In heart failure, although RPM holds significant promise, published trials provide evidence regarding historical success and failures that inform future efforts. Heart failure has increased in incidence and prevalence during the past years, leading to significant cost. We must find alternate ways to monitor daily disease progression and symptomatology to allow the patient and their health provider react to not only reduce cardiovascular outcomes but reduce hospitalizations and readmission rates. Here we display most up to date studies and analysis of our perspective on the role of RPM in heart failure.
    Case Report
    Sravani Avula*, Nikhil Kumar Kotla, and Barry S. Clemson
    Adrenal insufficiency commonly manifests as vague symptoms with or without abnormal lab findings such as hyponatremia, hyperkalemia, hypercalcemia or hypoglycemia. It is very crucial to diagnose adrenal insufficiency in the early stages, as the patient may acutely decompensate due to hypotension, shock, cardiac dysfunction, or respiratory failure. We present a unique case of adrenal insufficiency in a 27-year-old woman who tends to have some degree of cardiac complication with every adrenal crisis episode. Her initial manifestation of adrenal crisis was complex with pericardial effusion and cardiogenic shock from toxic cardiomyopathy due to neurohormonal stress requiring intra-aortic balloon pump and vasopressor/inotropic support. Her cardiac function fully recovered within a few days and returned to baseline prior to discharge. After 1 year she was noted to have a moderate pericardial effusion without cardiac dysfunction during another adrenal crisis episode while being treated for pneumonia. This episode of pericardial effusion resolved within a few days. Since then, she has had multiple episodes of chest pain from pericarditis unrelated to adrenal crisis. This is a rare case of predominant cardiac involvement with every adrenal crisis episode followed by recurrent pericarditis.
    Athanassios Antonopoulos* and Gian Andrea Amadei
    Interatrial block (IAB), is caused by abnormal conduction over the Bachmann’s bundle and is associated with development of atrial tachyarrhythmias, most commonly atrial fibrillation. It also represents a risk factor for systemic thromboembolic events due to abnormal left atrial contraction. Additionally, delay of post operative P wave duration may, most of the times, induce atrial fibrillation.
    Moreover, it is well known that impaired blood supply to the sinus node and Buchman fibers due to pre-existing chronic sinus node artery ischemia may be considered as a risk factor of atrial fibrillation (AF). This case report shows that in a patient with pre-existing impaired sinus node artery blood supply in the preoperative coronary angiogram, one month after coronary bypass surgery may lead to post-operative IAB and atrial fibrillation. We also discuss the importance of atrial blood supply, possible preventive intervention and some considerations regarding anticoagulation treatment initiation.
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