World Journal of Cardiology最新文献

{"title":"Related mechanisms and research progress in straight back syndrome.","authors":"Mo-Wei Kong,&nbsp;Zhen-Ying Pei,&nbsp;Xiong Zhang,&nbsp;Qiu-Juan Du,&nbsp;Qiang Tang,&nbsp;Jun Li,&nbsp;Guo-Xiang He","doi":"10.4330/wjc.v15.i10.479","DOIUrl":"https://doi.org/10.4330/wjc.v15.i10.479","url":null,"abstract":"<p><p>Despite the high prevalence of straight back syndrome (SBS), there is still limited research on this condition, posing challenges for effective diagnosis and treatment. The disease has been known for a long time, but there have been few related studies, which mostly consist of case reports. These studies have not been systematically summarized, making it difficult to meet the current needs of diagnosis and treatment. This article summarized the existing literature and comprehensively reviewed the diagnosis, pathogenesis, treatment, and research status of mitral valve prolapse related to SBS. We specifically emphasized the mechanisms and prognosis of SBS combined with mitral valve prolapse and discussed the latest research progress in this disease.</p>","PeriodicalId":23800,"journal":{"name":"World Journal of Cardiology","volume":"15 10","pages":"479-486"},"PeriodicalIF":1.9,"publicationDate":"2023-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10600793/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71414168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Establishment of a prediction model for prehospital return of spontaneous circulation in out-of-hospital patients with cardiac arrest.","authors":"Jing-Jing Wang, Qiang Zhou, Zhen-Hua Huang, Yong Han, Chong-Zhen Qin, Zhong-Qing Chen, Xiao-Yong Xiao, Zhe Deng","doi":"10.4330/wjc.v15.i10.508","DOIUrl":"10.4330/wjc.v15.i10.508","url":null,"abstract":"<p><strong>Background: </strong>Out-of-hospital cardiac arrest (OHCA) is a leading cause of death worldwide.</p><p><strong>Aim: </strong>To explore factors influencing prehospital return of spontaneous circulation (P-ROSC) in patients with OHCA and develop a nomogram prediction model.</p><p><strong>Methods: </strong>Clinical data of patients with OHCA in Shenzhen, China, from January 2012 to December 2019 were retrospectively analyzed. Least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression were applied to select the optimal factors predicting P-ROSC in patients with OHCA. A nomogram prediction model was established based on these influencing factors. Discrimination and calibration were assessed using receiver operating characteristic (ROC) and calibration curves. Decision curve analysis (DCA) was used to evaluate the model's clinical utility.</p><p><strong>Results: </strong>Among the included 2685 patients with OHCA, the P-ROSC incidence was 5.8%. LASSO and multivariate logistic regression analyses showed that age, bystander cardiopulmonary resuscitation (CPR), initial rhythm, CPR duration, ventilation mode, and pathogenesis were independent factors influencing P-ROSC in these patients. The area under the ROC was 0.963. The calibration plot demonstrated that the predicted P-ROSC model was concordant with the actual P-ROSC. The good clinical usability of the prediction model was confirmed using DCA.</p><p><strong>Conclusion: </strong>The nomogram prediction model could effectively predict the probability of P-ROSC in patients with OHCA.</p>","PeriodicalId":23800,"journal":{"name":"World Journal of Cardiology","volume":"15 10","pages":"508-517"},"PeriodicalIF":1.9,"publicationDate":"2023-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10600787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71414166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Candida endocarditis: Update on management considerations.","authors":"Yasser Jamil,&nbsp;Akintayo Akinleye,&nbsp;Mojtaba Mirzaei,&nbsp;Matthew Lempel,&nbsp;Kassem Farhat,&nbsp;Samuel Pan","doi":"10.4330/wjc.v15.i10.469","DOIUrl":"10.4330/wjc.v15.i10.469","url":null,"abstract":"<p><p>The rise in incidence rates of invasive candidiasis warrants an increase in attention and efforts toward preventing and treating this virulent infection. Cardiac involvement is one of the most feared sequelae and has a poor prognosis. Despite the introduction of several novel antifungal agents over the past quarter century, complications and mortality rates due to Candida endocarditis have remained high. Although fungal endocarditis has a mechanism similar to bacterial endocarditis, no specific diagnostic criteria or algorithm exists to help guide its management. Furthermore, recent data has questioned the current guidelines recommending a combined approach of antifungal agents with surgical valve or indwelling prostheses removal. With the emergence of multidrug-resistant <i>Candida auris</i>, a focus on improved prophylactic measures and management strategies is necessary.</p>","PeriodicalId":23800,"journal":{"name":"World Journal of Cardiology","volume":"15 10","pages":"469-478"},"PeriodicalIF":1.9,"publicationDate":"2023-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10600790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71414145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular complications following medical termination of pregnancy: An updated review.","authors":"Tejveer Singh, Ajay K Mishra, Nikhil Vojjala, Kevin John John, Anu A George, Anil Jha, Michelle Hadley","doi":"10.4330/wjc.v15.i10.518","DOIUrl":"10.4330/wjc.v15.i10.518","url":null,"abstract":"<p><strong>Background: </strong>Around 1 million cases of medical termination of pregnancy (MTP) take place yearly in the United States of America with around 2 percent of this population developing complications. The cardiovascular (CVD) complications occurring post MTP or after stillbirth is not very well described.</p><p><strong>Aim: </strong>To help the reader better understand, prepare, and manage these complications by reviewing various cardiac comorbidities seen after MTP.</p><p><strong>Methods: </strong>We performed a literature search in PubMed, Medline, <i>RCA</i>, and google scholar, using the search terms \"abortions\" or \"medical/legal termination of pregnancy\" and \"cardiac complications\" or \"cardiovascular complications\".</p><p><strong>Results: </strong>The most common complications described in the literature following MTP were infective endocarditis (IE) (<i>n</i> = 16), takotsubo cardiomyopathy (TTC) (<i>n</i> = 7), arrhythmias (<i>n</i> = 5), and sudden coronary artery dissection (SCAD) (<i>n</i> = 4). The most common valve involved in IE was the tricuspid valve in 69% (<i>n</i> = 10). The most observed causative organism was group B Streptococcus in 81% (<i>n</i> = 12). The most common type of TTC was apical type in 57% (<i>n</i> = 4). Out of five patients developing arrhythmia, bradycardia was the most common and was seen in 60% (3/5) of the patients. All four cases of SCAD-P type presented as acute coronary syndrome 10-14 d post termination of pregnancy with predominant involvement of the right coronary artery. Mortality was only reported following IE in 6.25%. Clinical recovery was reported consistently after optimal medical management following all these complications.</p><p><strong>Conclusion: </strong>In conclusion, the occurrence of CVD complications following pregnancy termination is infrequently documented in the existing literature. In this review, the most common CVD complication following MTP was noted to be IE and TTC.</p>","PeriodicalId":23800,"journal":{"name":"World Journal of Cardiology","volume":"15 10","pages":"518-530"},"PeriodicalIF":1.9,"publicationDate":"2023-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10600792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71414146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrated analysis of comorbidity, pregnant outcomes, and amniotic fluid cytogenetics of fetuses with persistent left superior vena cava.","authors":"Xin Yang,&nbsp;Xin-Hui Su,&nbsp;Zhen Zeng,&nbsp;Yao Fan,&nbsp;Yuan Wu,&nbsp;Li-Li Guo,&nbsp;Xiao-Yan Xu","doi":"10.4330/wjc.v15.i10.500","DOIUrl":"https://doi.org/10.4330/wjc.v15.i10.500","url":null,"abstract":"<p><strong>Background: </strong>Persistent left superior vena cava (PLSVC) is the most common venous system variant. The clinical characteristics and amniotic fluid cytogenetics of fetuses with PLSVC remain to be further explored.</p><p><strong>Aim: </strong>To develop reliable prenatal diagnostic recommendations through integrated analysis of the clinical characteristics of fetuses with PLSVC.</p><p><strong>Methods: </strong>Cases of PLSVC diagnosed using prenatal ultrasonography between September 2019 and November 2022 were retrospectively studied. The clinical characteristics of the pregnant women, ultrasonic imaging information, gestational age at diagnosis, pregnancy outcomes, and amniocentesis results were summarized and analyzed using categorical statistics and the chi-square test or Fisher's exact test.</p><p><strong>Results: </strong>Of the 97 cases diagnosed by prenatal ultrasound, 49 (50.5%) had isolated PLSVC and 48 (49.5%) had other structural abnormalities. The differences in pregnancy outcomes and amniocentesis conditions between the two groups were statistically significant (<i>P</i> < 0.05). No significant differences were identified between the two groups in terms of advanced maternal age and gestational age (<i>P</i> > 0.05). According to the results of the classification statistics, the most common intracardiac abnormality was a ventricular septal defect and the most common extracardiac abnormality was a single umbilical artery. In the subgroup analysis, the concurrent combination of intra- and extracardiac structural abnormalities was a risk factor for adverse pregnancy outcomes (odds ratio > 1, <i>P</i> < 0.05). Additionally, all abnormal cytogenetic findings on amniocentesis were observed in the comorbidity group. One case was diagnosed with 21-trisomy and six cases was diagnosed with chromosome segment duplication.</p><p><strong>Conclusion: </strong>Examination for other structural abnormalities is strongly recommended when PLSVC is diagnosed. Poorer pregnancy outcomes and increased amniocentesis were observed in PLSVC cases with other structural abnormalities. Amniotic fluid cytogenetics of fetuses is recommended for PLSVC with other structural abnormalities.</p>","PeriodicalId":23800,"journal":{"name":"World Journal of Cardiology","volume":"15 10","pages":"500-507"},"PeriodicalIF":1.9,"publicationDate":"2023-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10600788/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71414167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systemic right ventricle complications in levo-transposition of the great arteries: A case report and review of literature.","authors":"Mohamed Ramzi Almajed,&nbsp;Abdulla Almajed,&nbsp;Naoshin Khan,&nbsp;Mark S Obri,&nbsp;Karthikeyan Ananthasubramaniam","doi":"10.4330/wjc.v15.i10.542","DOIUrl":"10.4330/wjc.v15.i10.542","url":null,"abstract":"<p><strong>Background: </strong>Congenitally corrected levo-transposition of the great arteries (L-TGA) is a congenital heart disease in which the ventricles and great arteries are transposed from their typical anatomy. In L-TGA, the double discordance, atrioventricular and ventriculoarterial, create an acyanotic milieu which allows patients to survive their early decades, however, progressive systemic right ventricle (sRV) dysfunction creates complications later in life. sRV dysfunction and remodeling predisposes patients to intracardiac thrombus (ICT) formation.</p><p><strong>Case summary: </strong>A 40-year-old male with L-TGA presented with symptoms of acute decompensated heart failure. In childhood, he had surgical repair of a ventricular septal defect. In adulthood, he developed sRV dysfunction, systemic tricuspid valve (sTV) regurgitation, and left-bundle branch block for which he underwent cardiac resynchronization therapy. Transthoracic echocardiogram showed a sRV ejection fraction of 40%, severe sTV regurgitation, and a newly identified sRV ICT. ICT was confirmed by ultrasound-enhancing agents and transesophageal echocardiography. Our patient was optimized with guideline-directed medical therapy and diuresis. Anticoagulation was achieved with a vitamin K antagonist (VKA) and he was later referred for evaluation by advanced heart failure and heart transplant services.</p><p><strong>Conclusion: </strong>Anticoagulation with VKA is the mainstay of treatment in the absence of conclusive data supporting direct oral anticoagulant use in ICT in patients with congenital heart disease. This case illustrates the natural history of L-TGA and highlights the importance of surveillance and monitoring with dedicated cardiac imaging to identify complications.</p>","PeriodicalId":23800,"journal":{"name":"World Journal of Cardiology","volume":"15 10","pages":"542-552"},"PeriodicalIF":1.9,"publicationDate":"2023-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10600789/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71414169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do cardiopulmonary resuscitation real-time audiovisual feedback devices improve patient outcomes? A systematic review and meta-analysis.","authors":"Nitish Sood,&nbsp;Anish Sangari,&nbsp;Arnav Goyal,&nbsp;Christina Sun,&nbsp;Madison Horinek,&nbsp;Joseph Andy Hauger,&nbsp;Lane Perry","doi":"10.4330/wjc.v15.i10.531","DOIUrl":"https://doi.org/10.4330/wjc.v15.i10.531","url":null,"abstract":"<p><strong>Background: </strong>Cardiac arrest is a leading cause of mortality in America and has increased in the incidence of cases over the last several years. Cardiopulmonary resuscitation (CPR) increases survival outcomes in cases of cardiac arrest; however, healthcare workers often do not perform CPR within recommended guidelines. Real-time audiovisual feedback (RTAVF) devices improve the quality of CPR performed. This systematic review and meta-analysis aims to compare the effect of RTAVF-assisted CPR with conventional CPR and to evaluate whether the use of these devices improved outcomes in both in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA) patients.</p><p><strong>Aim: </strong>To identify the effect of RTAVF-assisted CPR on patient outcomes and CPR quality with in- and OHCA.</p><p><strong>Methods: </strong>We searched PubMed, SCOPUS, the Cochrane Library, and EMBASE from inception to July 27, 2020, for studies comparing patient outcomes and/or CPR quality metrics between RTAVF-assisted CPR and conventional CPR in cases of IHCA or OHCA. The primary outcomes of interest were return of spontaneous circulation (ROSC) and survival to hospital discharge (SHD), with secondary outcomes of chest compression rate and chest compression depth. The methodological quality of the included studies was assessed using the Newcastle-Ottawa scale and Cochrane Collaboration's \"risk of bias\" tool. Data was analyzed using R statistical software 4.2.0. results were statistically significant if <i>P</i> < 0.05.</p><p><strong>Results: </strong>Thirteen studies (<i>n</i> = 17600) were included. Patients were on average 69 ± 17.5 years old, with 7022 (39.8%) female patients. Overall pooled ROSC in patients in this study was 37% (95% confidence interval = 23%-54%). RTAVF-assisted CPR significantly improved ROSC, both overall [risk ratio (RR) 1.17 (1.001-1.362); <i>P</i> = 0.048] and in cases of IHCA [RR 1.36 (1.06-1.80); <i>P</i> = 0.002]. There was no significant improvement in ROSC for OHCA (RR 1.04; 0.91-1.19; <i>P</i> = 0.47). No significant effect was seen in SHD [RR 1.04 (0.91-1.19); <i>P</i> = 0.47] or chest compression rate [standardized mean difference (SMD) -2.1; (-4.6-0.5)]; <i>P</i> = 0.09]. A significant improvement was seen in chest compression depth [SMD 1.6; (0.02-3.1); <i>P</i> = 0.047].</p><p><strong>Conclusion: </strong>RTAVF-assisted CPR increases ROSC in cases of IHCA and chest compression depth but has no significant effect on ROSC in cases of OHCA, SHD, or chest compression rate.</p>","PeriodicalId":23800,"journal":{"name":"World Journal of Cardiology","volume":"15 10","pages":"531-541"},"PeriodicalIF":1.9,"publicationDate":"2023-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10600786/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71414165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Value of cardiac magnetic resonance on the risk stratification of cardiomyopathies.","authors":"Rafael Vidal-Perez, Mariana Brandão, Wael Zaher, Ruben Casado-Arroyo, Alberto Bouzas-Mosquera, Ricardo Fontes-Carvalho, Jose Manuel Vazquez-Rodriguez","doi":"10.4330/wjc.v15.i10.487","DOIUrl":"10.4330/wjc.v15.i10.487","url":null,"abstract":"<p><p>Cardiomyopathies represent a diverse group of heart muscle diseases with varying etiologies, presenting a diagnostic challenge due to their heterogeneous manifestations. Regular evaluation using cardiac imaging techniques is imperative as symptoms can evolve over time. These imaging approaches are pivotal for accurate diagnosis, treatment planning, and optimizing prognostic outcomes. Among these, cardiovascular magnetic resonance (CMR) stands out for its ability to provide precise anatomical and functional assessments. This manuscript explores the significant contributions of CMR in the diagnosis and management of patients with cardiomyopathies, with special attention to risk stratification. CMR's high spatial resolution and tissue characterization capabilities enable early detection and differentiation of various cardiomyopathy subtypes. Additionally, it offers valuable insights into myocardial fibrosis, tissue viability, and left ventricular function, crucial parameters for risk stratification and predicting adverse cardiac events. By integrating CMR into clinical practice, clinicians can tailor patient-specific treatment plans, implement timely interventions, and optimize long-term prognosis. The non-invasive nature of CMR reduces the need for invasive procedures, minimizing patient discomfort. This review highlights the vital role of CMR in monitoring disease progression, guiding treatment decisions, and identifying potential complications in patients with cardiomyopathies. The utilization of CMR has significantly advanced our understanding and management of these complex cardiac conditions, leading to improved patient outcomes and a more personalized approach to care.</p>","PeriodicalId":23800,"journal":{"name":"World Journal of Cardiology","volume":"15 10","pages":"487-499"},"PeriodicalIF":1.9,"publicationDate":"2023-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10600791/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71414170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immediate in-hospital outcomes after percutaneous revascularization of acute myocardial infarction complicated by cardiogenic shock.","authors":"Bashir Ahmed Solangi,&nbsp;Jehangir Ali Shah,&nbsp;Rajesh Kumar,&nbsp;Mahesh Kumar Batra,&nbsp;Gulzar Ali,&nbsp;Muhammad Hassan Butt,&nbsp;Ambreen Nisar,&nbsp;Nadeem Qamar,&nbsp;Tahir Saghir,&nbsp;Jawaid Akbar Sial","doi":"10.4330/wjc.v15.i9.439","DOIUrl":"https://doi.org/10.4330/wjc.v15.i9.439","url":null,"abstract":"<p><strong>Background: </strong>Cardiogenic shock (CS) is a life-threatening complication of acute myocardial infarction with high morbidity and mortality rates. Primary percutaneous coronary intervention (PCI) has been shown to improve outcomes in patients with CS.</p><p><strong>Aim: </strong>To investigate the immediate mortality rates in patients with CS undergoing primary PCI and identify mortality predictors.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of 305 patients with CS who underwent primary PCI at the National Institute of Cardiovascular Diseases, Karachi, Pakistan, between January 2018 and December 2022. The primary outcome was immediate mortality, defined as mortality within index hospitalization. Univariate and multivariate logistic regression analyses were performed to identify predictors of immediate mortality.</p><p><strong>Results: </strong>In a sample of 305 patients with 72.8% male patients and a mean age of 58.1 ± 11.8 years, the immediate mortality rate was found to be 54.8% (167). Multivariable analysis identified Killip class IV at presentation [odds ratio (OR): 2.0; 95% confidence interval (CI): 1.2-3.4; <i>P</i> = 0.008], Multivessel disease (OR: 3.5; 95%CI: 1.8-6.9; <i>P</i> < 0.001), and high thrombus burden (OR: 2.6; 95%CI: 1.4-4.9; <i>P</i> = 0.003) as independent predictors of immediate mortality.</p><p><strong>Conclusion: </strong>Immediate mortality rate in patients with CS undergoing primary PCI remains high despite advances in treatment strategies. Killip class IV at presentation, multivessel disease, and high thrombus burden (grade ≥ 4) were identified as independent predictors of immediate mortality. These findings underscore the need for aggressive management and close monitoring of patients with CS undergoing primary PCI, particularly in those with these high-risk characteristics.</p>","PeriodicalId":23800,"journal":{"name":"World Journal of Cardiology","volume":"15 9","pages":"439-447"},"PeriodicalIF":1.9,"publicationDate":"2023-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10600783/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71414171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Remdesivir, dexamethasone and angiotensin-converting enzyme inhibitors use and mortality outcomes in COVID-19 patients with concomitant troponin elevation.","authors":"Chukwuemeka A Umeh,&nbsp;Heather Maoz,&nbsp;Jessica Obi,&nbsp;Ruchi Dakoria,&nbsp;Smit Patel,&nbsp;Gargi Maity,&nbsp;Pranav Barve","doi":"10.4330/wjc.v15.i9.427","DOIUrl":"https://doi.org/10.4330/wjc.v15.i9.427","url":null,"abstract":"<p><strong>Background: </strong>There are indications that viral myocarditis, demand ischemia, and renin-angiotensin-aldosterone system pathway activation play essential roles in troponin elevation in coronavirus disease 2019 (COVID-19) patients. Antiviral medications and steroids are used to treat viral myocarditis, but their effect in patients with elevated troponin, possibly from myocarditis, has not been studied.</p><p><strong>Aim: </strong>To evaluate the effect of dexamethasone, remdesivir, and angiotensin-converting enzyme (ACE) inhibitors (ACEI) on mortality in COVID-19 patients with elevated troponin.</p><p><strong>Methods: </strong>Our retrospective observational study involved 1788 COVID-19 patients at seven hospitals in Southern California, United States. We did a backward selection Cox multivariate regression analysis to determine predictors of mortality in our study population. Additionally, we did a Kaplan Meier survival analysis in the subset of patients with elevated troponin, comparing survival in patients that received dexamethasone, remdesivir, and ACEI with those that did not.</p><p><strong>Results: </strong>The mean age was 66 years (range 20-110), troponin elevation was noted in 11.5% of the patients, and 29.9% expired. The patients' age [hazard ratio (HR) = 1.02, <i>P</i> < 0.001], intensive care unit admission (HR = 5.07, <i>P</i> < 0.001), and ventilator use (HR = 0.68, <i>P</i> = 0.02) were significantly associated with mortality. In the subset of patients with elevated troponin, there was no statistically significant difference in survival in those that received remdesivir (0.07), dexamethasone (<i>P</i> = 0.63), or ACEI (<i>P</i> = 0.8) and those that did not.</p><p><strong>Conclusion: </strong>Although elevated troponin in COVID-19 patients has been associated with viral myocarditis and ACE II receptors, conventional viral myocarditis treatment, including antiviral and steroids, and ACEI did not show any effect on mortality in these patients.</p>","PeriodicalId":23800,"journal":{"name":"World Journal of Cardiology","volume":"15 9","pages":"427-438"},"PeriodicalIF":1.9,"publicationDate":"2023-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10600781/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71414185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}