A distinctive posterior mitral valve infective endocarditis and a large mycotic aneurysm

Case presentationA 72-year-old man with a background of hypertension and atrial fibrillation presented with confusion, lumbar back pain and pyrexia. Clinical examination identified a pansystolic murmur radiating to the left axilla.</p

COVID-19 and STEMI: A snapshot analysis of presentation patterns during a pandemic

The coronavirus disease 2019 (COVID-19) pandemic has emerged as a major global public health emergency [1]. Many countries, including the Republic of Ireland, have instituted restrictions on their citizens in order to reduce the transmission of the virus [2,3], colloquially referred to as ‘lockdown’. Concern has been raised regarding an observed decrease in the number of ST elevation myocardial infarction (STEMI) presentations during this period [4,5]. Numerous theories have been proposed regarding this phenomenon [4]. The most concerning hypothesis is that patients with symptoms of acute myocardial ischemia may not be presenting to medical attention due to lockdown measures or concern regarding COVID-19.</p

Revascularisation of left main stem disease: a prospective analysis of modern practice and outcomes in a non-surgical centre

Purpose In this study, we sought to prospectively analyse the management and long term outcomes associated with revascularisation of left main stem disease via percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in our centre.Methods This prospective study enrolled all patients with unprotected left main stem disease undergoing revascularisation from January 2013 to June 2014. Baseline characteristics, hospital presentation and hospital stay length were collected. Patients were followed up at 1, 2 and 3 years. Primary outcomes of Major Adverse Cardiovascular and Cerebrovascular Events (MACCE) were defined as death, Q wave myocardial infarction, stroke, repeat revascularisation and readmission within 30 days.Results 56 patients with significant left main stem coronary artery disease were identified from the clinical registry. 27 patients underwent PCI (median age 67.7) and 29 CABG (median age 68.6). PCI patients had a higher surgical risk as measured by mean euroSCORE (4.95±5.8 vs 3.11±3.85). At 3 years, total MACCE occurred in 29.6% of the PCI cohort and 27.5% of the CABG cohort. Death occurred in three patients in the PCI group within the first 6 months. Death occurred in one patient in the CABG group over 2 years postprocedure. Two patients in the CABG cohort presented with Transient Ischemic Attacks (TIAs) at 2-year follow-up. At 3 years, revascularisation occurred in three patients in the PCI cohort. There were no revascularisation events in the CABG cohort.Conclusions PCI with modern drug eluting stents is a reasonable treatment option for unprotected left main stem disease in a non surgical centre.</p

Performing diagnostic radial access coronary angiography on uninterrupted direct oral anticoagulant therapy: a prospective analysis

Purpose We sought to assess the safety of performing diagnostic radial access coronary angiography with uninterrupted anticoagulation on patients receiving direct oral anticoagulant therapy. Background Direct oral anticoagulants have become a popular choice for the prevention of thromboembolism. Risk factors for thromboembolism are common among cardiovascular conditions and indications for direct oral anticoagulant therapy as well as coronary angiography often overlap in patients. It has been hypothesised that uninterrupted direct oral anticoagulant therapy would increase haemorrhagic and access site complications, however data in this area is limited. Methods This was a prospective observational analysis of 49 patients undergoing elective diagnostic coronary angiography while receiving uninterrupted anticoagulation with direct oral anticoagulants. This population was compared with a control group of 49 unselected patients presenting to the cardiology service for elective diagnostic coronary angiography. Continuous variables were analysed using the independent samples t-test and categorical variables using Pearson’s χ2 test. Results The mean duration of radial compression for the control group was 235.8±62.8min and for the uninterrupted direct oral anticoagulant group was 258.4±56.5min. There was no significant difference in mean duration of radial compression (p=0.07; 95% CI=-1.4 to 46.5). There was also no difference in the complication rate between the two groups (p=1). Conclusions We observed similar complication rates and radial artery compression time postangiography in both groups. This small prospective observational study suggests that uninterrupted continuation of direct oral anticoagulants during coronary angiography is safe. Larger randomised control studies in this area would be beneficial</p

Impact of TAVI on baseline anemia and renal function.

<p>(<b>A–C</b>) Results in all patients (n = 253) dichotomized by the presence of baseline anemia (A+) versus no baseline anemia (A−). (<b>D–F</b>) Results in all patients with baseline anemia (n = 124) dichotomized by recovery from anemia (Hb-R) versus no recovery from anemia (Hb-NR) at 1 year after TAVI. Hb, hemoglobin; Creat, creatinine; NS, not significant.</p

Clinical outcome following TAVI.

<p>(<b>A</b>) Improvement in NYHA functional class and (<b>B</b>) re-hospitalization rates within one year after TAVI in the three different subgroups: non-anemic patients (NA), anemic patients with Hb-recovery (Hb-R), and anemic patients without Hb-recovery (Hb-NR). (<b>C</b>) Univariate regression analysis was performed in order to study the differences between the three subgroups regarding functional improvement ≥2 NYHA classes and re-hospitalization within one year after TAVI (odds ratio [OR], 95% CI).</p

Logistic regression analysis for factors associated with Hb-recovery following TAVI.

<p>Abbreviations: CI, confidence interval; CKD, chronic kidney disease; LVEF, left ventricular ejection fraction; OR, odds ratio.</p><p>Logistic regression analysis for factors associated with Hb-recovery following TAVI.</p

Association between peak AV velocity (m/sec) and ΔHb-level (g/dL) at 1 year after TAVI.

<p>A positive correlation between ΔHb-level at 1 year and peak AV velocity was found – the diagnonal solid line represents the regression line and the dashed lines are approximate 95% confidence intervals.</p

Flow chart of the study population selection.

<p>Flow chart of the study population selection.</p

Baseline characteristics.

<p>Abbreviations: AKI, acute kidney injury; AMI, acute myocardial infarction; AVA, aortic valve area; BMI, body mass index; CABG, coronary artery bypass graft surgery; CAD, coronary artery disease; CKD, chronic kidney disease; COPD, chronic obstructive pulmonary disease; LVEF, left ventricular ejection fraction; MR, mitral regurgitation; NYHA, New York Heart Association; PAD, peripheral artery disease; PCI, percutaneous coronary intervention; PM, pacemaker; PVL, paravalvular leakage; TAVI, transcatheter aortic valve implantation.</p><p>Baseline characteristics.</p