| 1. |
- Bobbio, Emanuele, et al.
(författare)
-
Diagnosis, management, and outcome of cardiac sarcoidosis and giant cell myocarditis: a Swedish single center experience.
- 2022
-
Ingår i: BMC cardiovascular disorders. - : Springer Science and Business Media LLC. - 1471-2261. ; 22
-
Tidskriftsartikel (refereegranskat)abstract
- Cardiac sarcoidosis (CS) and giant cell myocarditis (GCM) are rare diseases that share some similarities, but also display different clinical and histopathological features. We aimed to compare the demographics, clinical presentation, and outcome of patients diagnosed with CS or GCM.We compared the clinical data and outcome of all adult patients with CS (n=71) or GCM (n=21) diagnosed at our center between 1991 and 2020.The median (interquartile range) follow-up time for patients with CS and GCM was 33.5 [6.5-60.9] and 2.98 [0.6-40.9] months, respectively. In the entire cohort, heart failure (HF) was the most common presenting manifestation (31%), followed by ventricular arrhythmias (25%). At presentation, a left ventricular ejection fraction of<50% was found in 54% of the CS compared to 86% of the GCM patients (P=0.014), while corresponding proportions for right ventricular dysfunction were 24% and 52% (P=0.026), respectively. Advanced HF (NYHA≥IIIB) was less common in CS (31%) than in GCM (76%). CS patients displayed significantly lower circulating levels of natriuretic peptides (P<0.001) and troponins (P=0.014). Eighteen percent of patients with CS included in the survival analysis reached the composite endpoint of death or heart transplantation (HTx) compared to 68% of patients with GCM (P<0.001).GCM has a more fulminant clinical course than CS with severe biventricular failure, higher levels of circulating biomarkers and an increased need for HTx. The histopathologic diagnosis remained key determinant even after adjustment for markers of cardiac dysfunction.
|
|
| 2. |
- Bobbio, Emanuele, et al.
(författare)
-
Incidental cardiac findings on somatostatin receptor PET/CT: What do they indicate and are they of clinical relevance?
- 2022
-
Ingår i: Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology. - : Springer Science and Business Media LLC. - 1532-6551. ; 29:3, s. 1159-1165
-
Tidskriftsartikel (refereegranskat)abstract
- We present the case of a 47-year-old man with a history of recurrent episodes of frontal headache, fever, and chest discomfort as well as longstanding, difficult to treat arterial hypertension. Clinical work-up revealed the unexpected finding of an underlying pheochromocytoma as well as recent "silent" myocardial infarction. Our case highlights the importance of paying attention to incidental cardiac findings on somatostatin receptor positron emission tomography/computed tomography, as routinely performed in patients with clinically suspected neuroendocrine tumors. These incidental cardiac findings cannot only indicate a primary or secondary (metastatic) neuroendocrine tumor, but also areas of myocardial inflammation, as somatostatin receptors cannot only be found on the majority of neuroendocrine tumors, but also among other tissues on the surface of activated macrophages and lymphocytes. The detection of myocardial inflammation is of clinical importance and its underlying etiology should be evaluated to prompt eventual necessary treatment, as it is a potential driving force for cardiac remodeling and poor prognosis.
|
|
| 3. |
- Rezk, Mary, et al.
(författare)
-
Clinical Course of Postoperative Atrial Fibrillation After Cardiac Surgery and Long-Term Outcome.
- 2022
-
Ingår i: The Annals of thoracic surgery. - : Elsevier BV. - 1552-6259 .- 0003-4975. ; 114:6, s. 2209-2215
-
Tidskriftsartikel (refereegranskat)abstract
- New-onset postoperative atrial fibrillation (POAF) after cardiac surgery is associated with worse short- and long-term outcome. Although the clinical presentation of POAF varies substantially, almost all studies model it with a dichotomous yes/no variable. We explored potential associations between the clinical course of POAF and long-term outcome.This retrospective observational single-center study included 6435 CABG and/or valve patients between 2010 and 2018. POAF patients were grouped into 1) spontaneous/pharmacological conversion to sinus rhythm, 2) sinus rhythm after electrical cardioversion, and 3) sustained atrial fibrillation (AF) at discharge. Multivariable Cox regression models adjusted for age, sex, type of surgery, co-morbidities, and early-initiated oral anticoagulation were used to study associations between the clinical course of POAF and long-term risk for mortality, ischemic stroke, thromboembolic events, heart failure hospitalization, and major bleeding. Median follow-up time was 3.8 years (range: 0-8.3 years).POAF occurred in 2172 (33.8%) of the patients, 94.9% of whom converted to sinus rhythm before discharge. Of these, 73.6% converted spontaneously or with pharmacological treatment, and 26.4% after electrical cardioversion. Both sustained AF and electrical cardioversion were independently associated with an increased long-term risk for heart failure (adjusted hazard ratio for sustained AF at discharge: 2.55, 95%CI: 1.65-3.93, p<0.001; for electrical cardioversion: 1.28, 95%CI: 1.00-1.65, p=0.047), but not with increased long-term risk for death, thromboembolic complications, or bleedings.A more complicated POAF course is associated with increased long-term risk for heart failure hospitalization, but not for all-cause mortality or thromboembolic complications.
|
|
| 4. |
- Taha, Amar, 1978, et al.
(författare)
-
Stroke Risk Stratification in Patients With Postoperative Atrial Fibrillation After Coronary Artery Bypass Grafting.
- 2022
-
Ingår i: Journal of the American Heart Association. - 2047-9980. ; 11:10
-
Tidskriftsartikel (refereegranskat)abstract
- Background The CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75years, diabetes, previous stroke or TIA [transient ischemic attack], vascular disease, age 65 to 74years, sex category female; 2 indicates 2 points, otherwise 1 point) scoring system is recommended to guide decisions on oral anticoagulation therapy for stroke prevention in patients with nonsurgery atrial fibrillation. A score ≥1 in men and ≥2 in women, corresponding to an annual stroke risk exceeding 1%, warrants long-term oral anticoagulation provided the bleeding risk is acceptable. However, in patients with new-onset postoperative atrial fibrillation, the optimal risk stratification method is unknown. The aim of this study was therefore to evaluate the CHA2DS2-VASc scoring system for estimating the 1-year ischemic stroke risk in patients with new-onset postoperative atrial fibrillation after coronary artery bypass grafting. Methods and Results All patients with new-onset postoperative atrial fibrillation and without oral anticoagulation after first-time isolated coronary artery bypass grafting performed in Sweden during 2007 to 2017 were eligible for this registry-based observational cohort study. The 1-year ischemic stroke rate at each step of the CHA2DS2-VASc score was estimated using a Kaplan-Meier estimator. Of the 6368 patients included (mean age, 69.9years; 81% men), >97% were treated with antiplatelet drugs. There were 147 ischemic strokes during the first year of follow-up. The ischemic stroke rate at 1year was 0.3%, 0.7%, and 1.5% in patients with CHA2DS2-VASc scores of 1, 2, and 3, respectively, and ≥2.3% in patients with a score ≥4. A sensitivity analysis, with the inclusion of patients on anticoagulants, was performed and supported the primary results. Conclusions Patients with new-onset atrial fibrillation after coronary artery bypass grafting and a CHA2DS2-VASc score <3 have such a low 1-year risk for ischemic stroke that oral anticoagulation therapy should probably be avoided.
|
|
