Cardiovascular and Cardiometabolic Journal (CCJ)

The Role of Artificial Intelligence in Predicting Mortality Risk of Transcatheter Aortic Valve Replacement: A Systematic Review

Hidtsa Aqila Noor Arasyi, Firqa Aqila Noor Arasyi; Rizky Pratama — Mon, 30 Sep 2024 00:00:00 +0700

Highlights:

1. Understanding how Artificial Intelligence could play a crucial role in diagnosing patients’ mortality could be challenging, however, this article could provide a discussion that readers might want to take notice.

Background: Artificial intelligence plays a crucial role in the field of cardiovascular medicine, particularly in diagnosing and predicting patient mortality in heart disease.

Objective: Therefore, we conducted a systematic review to understand the role of artificial intelligence in predicting mortality risk in patients with aortic stenosis following transcatheter aortic valve replacement (TAVR).

Method: This study is a systematic review using secondary data. The data in this research consist of literature on the role of artificial intelligence in TAVR patients, obtained through the PubMed, ScienceDirect, and Google Scholar search engines, with a publication date range from 2019 to October 2023. Using the PRISMA flow diagram, six studies on the role of artificial intelligence in TAVR patients were identified. It was found that the ability of artificial intelligence to predict mortality in patients with aortic stenosis undergoing Transcatheter Aortic Valve Replacement (TAVR) is superior compared to the TAVI2-Score, CoreValve Score, STS/ACC Score, and several other prediction scores.

Conclusion: Artificial intelligence has a superior ability to predict mortality risk in patients with aortic stenosis undergoing Transcatheter Aortic Valve Replacement (TAVR).

Precordial Catch Syndrome: Unveiling a Benign Yet Noteworthy Cause of Chest Pain in the Young

Jonathan Koswara, Jery Chen, Irianto Yap, Denny Suwanto — Mon, 30 Sep 2024 00:00:00 +0700

Highlights:

1. An insight on how precordial catch syndrome could be a potential research base for further research because of its rarity.

Background: This syndrome is rarely discussed in the differential diagnosis of chest pain, as it deserves wider recognition. Pediatricians report that PCS accounts for 80% to 90% of chest discomfort in the absence of trauma, primarily in adolescent and young adults. The classic pain history can help identify precordial catch syndrome, often eliminating the need for further testing or referrals. The diagnosis of precordial catch can be challenging due to various inconclusive workups. However, once diagnosed, this condition can be managed conservatively.

Objective: This review sought to describe the distinctive features of the syndrome and its management strategy.

Method: Descriptive review method was used in this study to provide a comprehensive overview for this study.

Results: The pain is sudden in onset, is severe, and is localized above the cardiac apex (fifth intercostal space within the left midclavicular line). General testing is required to exclude various conditions., but several tests like ECG and chest x-ray can be done to rule out other causes of chest pain. Though in pediatric considerations, classic pain history can help identify PCS, often eliminating the need for further testing or referrals.

Conclusion: This syndrome deserves wider recognition because it is rarely discussed in the differential diagnosis of precordial pain. Pediatricians report that precordial catch accounts for 80% to 90% of chest pain once any chest trauma is excluded

Acute Kidney Injury as Predictor of Major Adverse Cardiac Event (MACE) in 3 Months after Admission of Acute Heart Failure Patients in Haji Adam Malik General Hospital Medan

Mon, 30 Sep 2024 00:00:00 +0700

Highlights:

1. This study provides novel evidence that acute kidney injury (AKI) is a strong predictor of major adverse cardiovascular events (MACE) in patients with acute heart failure, highlighting the critical need for early detection and intervention to improve outcomes.

2. This research underscores the importance of incorporating kidney function assessment into the comprehensive management of acute heart failure patients.

Background: Acute heart failure is a condition with high morbidity and mortality. Decreased renal function after hospitalization is a predictor of longer hospitalization and increased mortality. Patients with acute renal failure, especially injury or failure grade, have a worse long-term prognosis compared to patients without acute renal failure, which will lead to MACE. Major adverse cardiovascular events are a combination of non-fatal stroke, non-fatal myocardial infarction, or cardiovascular death.

Material and Methods: This study was a retrospective cohort study of 159 patients with acute heart failure at HAM General Hospital from April 1, 2023 to December 31, 2023. Electrocardiographic, laboratory, and echocardiographic data were collected. Patients were categorized according to RIFLE classification and monitored to see MACE in the samples. Bivariate tests were performed to see the correlation between samples. Furthermore, Kaplan-Meier curves were analyzed to see the survival rate.

Results: Total subjects were 159 patients consisting of 98 acute heart failure patients with AKI and 61 heart failure patients without AKI. There was a correlation between heart failure patients who developed acute renal failure and the number of days of hospitalization (p = 0.000), in hospital mortality (p = 0.002), rehospitalization in less than 3 months (p = 0.000), and mortality in less than 3 months (p = 0.001).

Conclusion: Acute kidney injury has a correlation with MACE so that it can be a predictor of major cardiovascular events in patients with acute heart failure.

Hyperkalemia Diagnosis and Management for a Total AV Block Patient with a Pseudo-STEMI Infarction Pattern: A Case Report

Sofi Aliyatul Himah Sofi, Hidayanto Perdana — Mon, 30 Sep 2024 00:00:00 +0700

Highlights:

1. A surprising finding in which manifestation of hyperkalemia depends on potassium levels and comorbidities.

2. The manifestation as ST elevation and total AV block are considered rare cases, which is why this article is very interesting to read.

Background:

Hyperkalemia is an electrolytic disorder that is often encountered in hospitals and may be life-threatening. The ECG abnormalities that occur vary from tall T to deadly arrhythmia. ST segment elevation is rarely encountered and may be confused for the alternative diagnosis of myocardial infarction.

Case Summary: The patient is a 53 year-old male with total AV block with an ECG pseudo-STEMI infarction pattern. Initial diagnosis was acute myocardial infarction; it was then known that the patient suffered from chronic kidney disease with hyperkalemia. The patient recovered after obtaining hyperkalemia therapy.

Conclusion: In summary, hyperkalemia manifestation on ECG depends on potassium levels and comorbidities. Manifestation as ST segment elevation and total AV block are rare case, prompt diagnosis and right treatment may reduce the mortality.

Severe Aortic Stenosis Mimicking STE-ACS at Hospital in Remote Areas: A Case Report

Istiana Hairiah Abas, Fira Ardianti Fabanyo, Megawati Abubakar, Fikri — Mon, 30 Sep 2024 00:00:00 +0700

Highlights:

1. The value of a detailed physical assessment in patients with angina pectoris is crucial, as emphasized in this report.

Background: This case highlights the need for a comprehensive and accurate physical examination in patients with angina pectoris.

Case Summary: A 46-year-old man was admitted to the hospital with chest pain and anterior ST segment elevation on electrocardiogram. Given the limited drugs and equipment in remote hospitals, initial treatment for ACS was given immediately. However, no significant improvement was seen with this treatment. An echocardiogram was performed right away and the results showed a severe AVS. B-blockers, ACE-I, diuretics, and MRA antagonists were administered, and the patient had good clinical results, and was recommended for immediate referral to a hospital with primary facilities for valve replacement surgery.

Conclusion: Severe AVS can cause subendocardial ischemia, so the clinical findings may correspond to ACS. A thorough physical examination allows us to provide more accurate treatment.

The Dilated Cardiomyopathy Related to Hyperthyroidism with Cardiogenic Shock and Inadequate Diuretic Therapy: A Case Report

Mon, 30 Sep 2024 00:00:00 +0700

Highlights:

1. This article highlights the complexity of thyroid dysfunction and how individual assessments are crucial in determining the effective management of it.

Background: Dilated Cardiomyopathy (DCM) is a non-ischemic heart muscle disease characterized by structural and functional myocardial abnormalities. One of its causes is hyperthyroidism. Hyperthyroidism can lead to a hyperdynamic circulatory state, increasing cardiac output and metabolic demands, which can ultimately result in heart failure.

Case Presentation: A 35-year-old woman presented with complaints of acute shortness of breath that worsened at night, accompanied by bilateral lower limb edema and palpitations. Physical examination showed low BP (84/60 mmHg), tachycardia 110 BPM, and elevated JVP. Auscultation detected fine bilateral crackles and mitral regurgitation. Echocardiography showed consistent with DCM.

Conclusion: Effective management of heart failure in the context of thyroid dysfunction requires a multidisciplinary approach that encompasses the disease's cardiac and endocrine components. This case illustrates the complexity of treating DCM with hyperthyroidism and the need for individualized therapy to optimize patient outcomes. Managing cardiomyopathy related to hyperthyroidism presents unique challenges, as it requires treatment for both hyperthyroidism and heart failure, especially when cardiogenic shock is present with an inadequate response to diuretics. This case highlights the complex interaction between thyroid dysfunction and heart failure, as well as the therapeutic strategies used to manage this condition.

Femorofemoral Bypass using Accessory Saphenous Vein Graft in Superficial Femoral Artery Total Occlusion: A Case Report

Putu Garry Cori Aditya, Victor Jesron Nababan, Darma Satria — Mon, 30 Sep 2024 00:00:00 +0700

Highlights:

1. While GSV has its advantage as a conduit of choice, in certain cases it might not be a suitable option for the patient depending on how complex the case is.

2. This article discusses the usage of ASV as alternative vein conduit and it shows an interesting result.

Background: PAD can be treated with either endovascular intervention and open surgery. Great saphenous vein (GSV) is the most commonly used vein conduit for infrainguinal vascular bypass.

Case Summary: 38-years old man presented with intermittent claudication for 2 months and diabetic foot ulcer on his left cruris. Left pedal artery pulse was absent with ABI of <0.4. Angiography showed a chronic total occlusion of left superficial femoral artery (SFA). Upon intraoperative, an aneurysmatic GSV and a good accessory saphenous vein (ASV) were found through the same incision. Thus, ASV was chosen as the vein conduit. Postoperative period of 3 days was steady. Two months follow up revealed his ability to walk normally, good pulse and perfusion, and no deterioration on his ulcer.

Discussion: GSV performed better than prosthetic conduits with a 5-year patency rate of 80%, thus it becomes the conduit of choice in 2024 ESVS guideline. However, the GSV was found inadequate, and the prosthetic graft was unavailable, in this case. ASV was decided to be more suitable to be used as an alternative vein conduit. In the absence of adequate GSV, alternative autologous vein can be used and even perform better than prosthetic conduits.