Clinical outcomes of transcatheter aortic valve replacement stratified by left ventricular ejection fraction : a single centre pilot study

Introduction: To define baseline echocardiographic, electrocardiographic (ECG) and computed tomographic (CT) findings of patients with heart failure undergoing transcatheter aortic valve replacement (TAVR) and analyze their overall procedural outcomes. Methods: Between 2018 and 2021, patients with severe aortic stenosis (AS) who performed transcatheter aortic valve replacement (TAVR) in Sabah Al Ahmad Cardiac Centre, Al Amiri Hospital were identified. A retrospective review of patients' parameters including pre-, intra-, and post-procedural data was conducted. Patients were grouped in 2 subgroups according to their EF: EF <40% (HFrEF) and EF ≥ 40%. The data included patients’ baseline characteristics, electrocardiographic and echocardiographic details along with pre-procedural CT assessment of aortic valve dimensions. Primary outcomes including post-operative disturbances, pacemaker implantation and in-hospital mortality following TAVR were additionally analyzed. Results: A total of 61 patients with severe AS underwent TAVR. The mean age was 73.5 ± 9, and 21 (34%) of the patients were males. The mean ejection fraction (EF) was 55.5 ± 9.7%. Of 61 patients, 12 (20%) were identified as heart failure with reduced EF (<40%). These patients were younger, more often males, and were more likely to have coronary artery disease (75% versus 53.1%). Left ventricular hypertrophy and diastolic dysfunction was documented in 75% and 58.3% of patients with heart failure with reduced ejection fraction (HFrEF) respectively. Post TAVR conduction disturbances, with the commonest being LBBB was observed in 41.7%. Permanent pacemaker was implanted in 3 of patients with HFrEF (25%). There were no significant differences between the two groups with regards to in hospital mortality (p = 0.618). Conclusion: Severe AS with EF <40% constitute a remarkable proportion of patients undergoing TAVR. Preliminary results of post-operative conduction disturbances and in hospital mortality in HFrEF patients were concluded to not differ from patients with LVEF ≥40%

In-hospital mortality in SARS-CoV-2 stratified by hemoglobin levels : a retrospective study

This study is to estimate in-hospital mortality in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients stratified by hemoglobin (Hb) level. Patients were stratified according to hemoglobin level into two groups, that is, Hb 100 g/L. A total of 6931 patients were included. Of these, 6377 (92%) patients had hemoglobin levels >100 g/L. The mean age was 44 ± 17 years, and 66% of the patients were males. The median length of overall hospital stay was 13 days [2; 31]. The remaining 554 (8%) patients had a hemoglobin level 100 g/L (52, 0.82%). Risk factors associated with increased mortality were determined by multi- variate analysis. The Kaplan-Meier survival analysis showed hemoglobin as a predictor of mortality. Cox proportional hazards regression coefficients for hemoglobin for the HB ≤ 100 category of hemoglobin were significant, B = 2.79, SE = 0.17, and HR = 16.34, p < 0.001. Multivariate logistic regression showed Hb < 100 g/L had a higher cumu- lative all-cause in-hospital mortality (22.4% vs. 0.8%; adjusted odds ratio [aOR], 0.33; 95% [CI]: [0.20–0.55]; p < 0.001). In this study, hemoglobin levels <100 g/L were found to be an independent predictor of in-hospital mortality

Arrhythmogenic right ventricular cardiomyopathy mimicking Brugada - a case report

We report a rare case of arrhythmogenic right ventricular cardiomyopathy (ARVC). Middle-aged Kuwaiti gentleman presented to a polyclinic with complaints of dizziness and palpitation. Electrocardiogram (ECG) at the polyclinic showed polymorphic ventricular tachycardia, and hence he was referred to our center. ECG at the emergency room showed a Brugada pattern with epsilon waves. Echo showed right ventricular dysfunction with pulmonary arterial hypertension. Magnetic resonance imaging showed evidence of ARVC. He was referred to the electrophysiology team and implanted an implantable cardioverter-defibrillator electively

Outcomes of tocilizumab therapy in severe or critical COVID-19 patients : a retrospective cohort, single-centre study

Objectives: To assess the effectiveness and safety of tocilizumab, a humanised anti-interleukin-6 receptor antibody, in the treatment of critical or severe coronavirus disease 2019 (COVID-19) patients. Methods: This was a retrospective cohort study of severe or critical COVID-19 patients (≥18 years) admitted to one hospital in Kuwait. Fifty-one patients received intravenous tocilizumab, while 78 patients received the standard of care at the same hospital. Both groups were compared for clinical improvement and in-hospital mortality. Results: The tocilizumab (TCZ) group had a significantly lower 28-day in-hospital mortality rate than the standard-of care-group (21.6% vs. 42.3% respectively; p = 0.015). Fifty-five per cent of patients in the TCZ group clinically improved vs. 11.5% in the standard-of-care group (p < 0.001). Using Cox-proportional regression analysis, TCZ treatment was associated with a reduced risk of mortality (adjusted hazard ratio 0.25; 95% CI: 0.11–0.61) and increased likelihood of clinical improvement (adjusted hazard ratio 4.94; 95% CI: 2.03–12.0), compared to the standard of care. The median C-reactive protein, D-dimer, procalcitonin, lactate dehydrogenase and ferritin levels in the tocilizumab group decreased significantly over the 14 days of follow-up. Secondary infections occurred in 19.6% of the TCZ group, and in 20.5% of the standard-of-care group, with no statistical significance (p = 0.900). Conclusion: Tocilizumab was significantly associated with better survival and greater clinical improvement in severe or critical COVID-19 patients

Validation of R-hf risk score for risk stratification in ischemic heart failure patients : a prospective cohort study

Background: The aim of this study was to validate R-heart failure (R-hf) risk score in ischemic heart failure patients. Methods: We prospectively recruited a cohort of 179 ischemic and 107 non-ischemic heart failure patients. This study mainly focused on ischemic heart failure patients. Non-ischemic heart failure patients were included for the purpose of validation of the risk score in various heart failure groups. Patients were stratified in high risk, moderate risk and low risk groups according to R-hf risk score. Results: A total of 179 participants with ischemic heart failure were included. Based on R-hf risk score, 82 had high risk, 50 had moderate risk and 47 had low risk heart failure scores. More than half of the patients having R-hf score of <5 had renal failure (n = 91, 50.8%) and anemia (n = 99, 55.3%). Notably, HFrEF was more prevalent in patients with high risk score (74, 90.2%). Patients with high risk score had significantly higher creatinine (2.63 ± 1.96, p < 0.001), Troponin-T HS (59.9 ± 38.0, p < 0.001) and PRO BNP (17842 ± 6684, p < 0.001) when compared to patients with low and moderate risk score. Patients with low risk score had significantly higher Hb (13.2 ± 1.85, p < 0.001), Albumin (3.69 ± 0.42, p < 0.001) and GFR (90.0 ± 8.04, p < 0.001). A R-hf score of <5 was a significant predictor of mortality in ischemic (OR = 50.34; 95% CI [16.94–194.00, p < 0.001) and non-ischemic (OR = 46.34; 95% CI [12.97–225.39], p < 0.001) heart failure patients. Conclusions: Lower R-hf risk score is a significant predictor of mortality in ischemic and non-ischemic heart failure patients. Risk score can be accessed at https://www.hfriskcalc.in

Clinical characteristics, incidence, and outcomes of transcatheter aortic valve implantation stratified by new‐onset left bundle branch block : a single‐center pilot study

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

An unusual Burkholderia gladioli double chain-initiating nonribosomal peptide synthetase assembles 'fungal' icosalide antibiotics.

Burkholderia is a multi-talented genus of Gram-negative bacteria, which in recent years has become increasingly recognised as a promising source of bioactive natural products. Metabolite profiling of Burkholderia gladioli BCC0238 showed that it produces the asymmetric lipopeptidiolide antibiotic icosalide A1, originally isolated from a fungus. Comparative bioinformatics analysis of several genome-sequenced B. gladioli isolates identified a gene encoding a nonribosomal peptide synthase (NRPS) with an unusual architecture that was predicted to be responsible for icosalide biosynthesis. Inactivation of this gene in B. gladioli BCC0238 abolished icosalide production. PCR analysis and sequencing of total DNA from the original fungal icosalide A1 producer revealed it has a B. gladioli strain associated with it that harbours an NRPS with an identical architecture to that responsible for icosalide A1 assembly in B. gladioli BCC0238. Sequence analysis of the icosalide NRPS indicated that it contains two chain-initiating condensation (CI) domains. One of these is appended to the N-terminus of module 1 - a common architecture for NRPSs involved in lipopeptide assembly. The other is embedded in module 3, immediately downstream of a putative chain-elongating condensation domain. Analysis of the reactions catalysed by a tridomain construct from module 3 of the NRPS using intact protein mass spectrometry showed that the embedded CI domain initiates assembly of a second lipopeptide chain, providing key insights into the mechanism for asymmetric diolide assembly

An unusual Burkholderia gladioli double chain-initiating nonribosomal peptide synthetase assembles ‘fungal’ icosalide antibiotics

Burkholderia is a multi-talented genus of Gram-negative bacteria, which in recent years has become increasingly recognised as a promising source of bioactive natural products. Metabolite profiling of Burkholderia gladioli BCC0238 showed that it produces the asymmetric lipopeptidiolide antibiotic icosalide A1, originally isolated from a fungus. Comparative bioinformatics analysis of several genome-sequenced B. gladioli isolates identified a gene encoding a nonribosomal peptide synthase (NRPS) with an unusual architecture that was predicted to be responsible for icosalide biosynthesis. Inactivation of this gene in B. gladioli BCC0238 abolished icosalide production. PCR analysis and sequencing of total DNA from the original fungal icosalide A1 producer revealed it has a B. gladioli strain associated with it that harbours an NRPS with an identical architecture to that responsible for icosalide A1 assembly in B. gladioli BCC0238. Sequence analysis of the icosalide NRPS indicated that it contains two chain-initiating condensation (CI) domains. One of these is appended to the N-terminus of module 1 - a common architecture for NRPSs involved in lipopeptide assembly. The other is embedded in module 3, immediately downstream of a putative chain-elongating condensation domain. Analysis of the reactions catalysed by a tridomain construct from module 3 of the NRPS using intact protein mass spectrometry showed that the embedded CI domain initiates assembly of a second lipopeptide chain, providing key insights into the mechanism for asymmetric diolide assembly.Open Access articlestatus: publishe

Ethnic disparities and outcomes of Edwards SAPIEN transcatheter aortic valve implantation in Kuwait : A single-center pilot study

Introduction: Clinical outcomes after transcatheter aortic valve implantation (TAVI) have not been reported in the Gulf region. This study aims to identify baseline characteristics of patients undergoing TAVI, based on nationality, and analyze their overall outcomes at a single center in Kuwait. Methods: A retrospective study of 61 patients with severe aortic stenosis undergoing TAVI between 2018 and 2021 in Sabah Al Ahmad Cardiac Centre in Kuwait. Clinical and baseline demographics data along with preprocedural computed tomography (CT) and echocardiography were reviewed. Postprocedural outcomes, including conduction disturbances and inhospital mortality rates, were analyzed. Patients were analyzed according to Kuwaiti and non-Kuwaiti citizens\u27 status. Results: The mean age of Kuwaiti patients was 72.2 ± 9.2, whereas the mean age of non-Kuwaiti citizens was 78.8 ± 5.5. No significant differences were observed between Kuwaiti and non-Kuwaiti in electrocardiogram (ECG) and CT parameters ( P \u3e 0.05). A statistically significant difference among Kuwaiti and non-Kuwaiti patients was observed only laboratory parameters, white blood cell (WBC) count, international normalized ratio (INR), and C-reactive protein (CRP). The mean value of WBC count (WBC), INR, and CRP was higher among non-Kuwaiti patients when compared to Kuwaiti patients ( P \u3c 0.05). Inhospital mortality was low 1/61 (1.6%). Conclusion: Cumulative inhospital mortality in TAVI was 1.6%. TAVI experience in Kuwait with Edwards SAPIEN valve is comparable to international cohorts. No significant differences in procedural outcomes, including conduction disturbance and mortality, were observed between the two subgroups