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May 2015 DOI 10.14302/issn.2329-9487.jhc-13-210
Background. Adherence to the Mediterranean Diet (MedD) is associated with a reduction of overall mortality and mortality from cardiovascular diseases and cancer. In a previous study we found a relationship between intake of antioxidant vitamins with diet and risk of atrial fibrillation (AF). The present study focuses on gender differences relative to diet and antioxidant intake in patients (pts) with a first detected episode of AF. Methods. A group of 400 pts, 205 men and 195 women, was investigated. A control group of 400 subjects, age and sex matched, was selected and compared. Nutritional parameters were assessed by a self-administered food frequency validated questionnaire (116 items) completed by an interviewer-administered 24 h diet recall. We previously constructed a MedD adherence score based on a prior scoring system developed for the Greek population. Consumption of cereals, vegetables, legumes, fruit, fish, dairy products, cups of espresso coffee, chocolate snacks, soda drinks and wine was investigated. Results. The MedD Score was higher in women compared to men (28.8 + 2.0 vs 20.1 + 2.5; p<0.001) and was higher in healthy subjects compared to patients with AF (27.9 + 5.6 vs 22.3 + 3.1; p<0.001). In pts with AF the estimated intake of total antioxidants was higher in women (19.9 ± 5.6 vs 11.2 ± 7.4 mmol/d; p<0.001), and women had higher intake of antioxidants from fruit and vegetables. Conclusions. Women showed high adherence to the MedD and higher intake of antioxidants from fruit and vegetables compared to AF men. Men had higher intake of antioxidants from coffee. Women that developed AF were older, with lower adherence to the MedD, and were more sedentary.
Mar 2013 DOI 10.14302/issn.2329-9487.jhc-12-edt1
A concise review of chronic atrial fibrillation covers mechanisms, stroke risk, and rate versus rhythm control. It highlights anticoagulation strategies and shared decision‑making to individualize therapy.
Dec 2023 DOI 10.14302/issn.2329-9487.jhc-23-4848
Introduction Rheumatic heart disease is mostly common in low-income or developing parts of the world, such as Sub-Saharan Africa, with a high morbidity and mortality rate. There are few data that are available in Chad on rheumatic heart disease. Our objective was to study the clinical, echocardiographic, therapeutic, and progressive aspects of rheumatic heart disease at the Renaissance University Hospital Center and the National Reference Teaching Hospital in N’Djamena, Chad. Patient and methods This was a prospective, multicenter and observational cohort study, covering a consecutive series of patients consulted and/or hospitalized for rheumatic heart disease, documented by an echocardiogram from January 2015 to January 2021. Results Among the 4456 patients consulted and/or hospitalized, 398 cases of rheumatic heart disease (8.9%) were collected, and 364 patients had met the inclusion criteria. The mean age was 31.2 ± 14.4 years, and 193 patients (53%) were female. On admission, heart failure was present in 214 patients (58.8%), ischemic stroke in 10 patients (2.7%) and supraventricular arrhythmias such as atrial fibrillation in 94 patients (25.8%) and atrial flutter in 6 patients (1.6%). Mitral regurgitation was observed in 49.7% (n=181) of cases, aortic regurgitation in 33.2% (n=121), mitral stenosis in 31.3% (n=114), and aortic stenosis in 7.7% (n=28). At least two valvular disorders were combined in 48.4% of cases. A surgical intervention such as a heart valve replacement and/or valvuloplasty was performed in 80 patients (22.2%). At least one rehospitalization was noted in 56.9% of patients. Forty-two of the 150 patients free of heart failure at inclusion (28%) had experienced the first episode of decompensated heart failure during follow-up. On the other hand, in 119 patients (55.6%), it was the second episode of decompensated heart failure. Other progressive complications included atrial fibrillation (13.8%), thromboembolic complications (6.3%), infective endocarditis (6.0%) and prosthetic valve dysfunction (1.4%). Altogether, the mortality rate was 10.4%. It was 9.9% in non-operated patients compared to 12.5% in operated patients (p=0.49). Conclusion The present study shows that morbidity and mortality of rheumatic heart disease remain high in our context and often affect children, young adults, and women. Treatment is essentially based on cardiac surgery which is not available in Chad.
Feb 2018 DOI 10.14302/issn.2329-9487.jhc-18-1932
The aim of this study was to assess the use of ambulatory acoustic cardiography during the initial data collection of the longitudinal study of a rural population in Switzerland (n=297, mean age 48.9 ±16.5 years, 57% female). Ambulatory acoustic cardiography non-invasively can assess sleep disordered breathing (SDB) and provides markers of left ventricular systolic and diastolic dysfunction. The percentage of the third heart sound detected during sleep decreased significantly across age groups (age < 40 years, 40-60 years, > 60 years) for both genders (males, p=0.04; females, p=0.02). The percentage of a fourth heart sound detected exhibited an increasing trend for both genders with age suggesting increased diastolic dysfunction with aging. Mean electromechanical activation time (EMAT) during sleep was within the normal range across age groups and both genders (male 93.7 ± 11.6 ms, female 94.6 ± 13.0 ms), and did not vary significantly with age. A large proportion of subjects had a high likelihood of sleep disordered breathing (17.6%). Baseline characteristics categorized by SDB severity indicate increasing age, male gender and being overweight (BMI ≥ 25) to be associated with greater SDB severity. Acoustic cardiography findings categorized by SDB severity reveal increased nocturnal non-dipping heart rate, presence of atrial fibrillation, prolonged QRS duration and QTc interval, increased percentage of fourth heart sound detected, and longer EMAT to be significantly associated with greater SDB severity. Overall, acoustic cardiography detected a very low prevalence of systolic dysfunction, age-related increases in diastolic dysfunction and a moderate prevalence of sleep disordered breathing.
Jan 2015 DOI 10.14302/issn.2372-6601.jhor-14-381
Haemorrhage is common to both dengue fever (DF) and dengue haemorrhagic fever (DHF). Thrombocytopaenia is exceedingly common, while prolonged partial thromboplastin time and reduced fibrinogen concentration are the other abnormal haemostatic indices evident from early in the disease course. These haematological abnormalities correlate better with the timing and severity of plasma leakage rather than the clinical haemorrhagic manifestations. Blood products including prophylactic platelet transfusions are hardly required in the management of DHF. Judicious fluid therapy is the most effective intervention to prevent complications and bleeding in DHF. Concealed haemorrhage is an important complication requiring early recognition and blood transfusions to improve outcomes. Understanding the pathogenesis of coagulopathy and the significance of altered haemostatic indices, and its co-relation to disease severity and phase of DHF, is essential for appropriate interventions particularly when DHF co-exists in patients on mandatory anticoagulation for prosthetic heart valves and atrial fibrillation.
Aug 2014 DOI 10.14302/issn.2329-9487.jhc-13-313
Objective: Ablation of foci within the atria has been shown to resolve symptoms of atrial fibrillation and atrial flutter. However, no standard has been established for anticoagulation after the procedure. Enoxaparin has been well described in the literature as a means to provide anticoagulation after ablation procedures. The only enoxaparin doses previously studied were 0.5 mg/kg and 1 mg/kg, both given every 12 hours. The purpose of the study was to compare the incidence of a major bleed or vascular complication in patients who received enoxaparin doses between 0.5 mg/kg and 1 mg/kg every 12 hours with patients who received either 0.5 mg/kg or 1 mg/kg every 12 hours. Methods: This IRB-approved, single-center, retrospective, cohort study included subjects greater than 18 years of age who received an atrial fibrillation or atrial flutter ablation procedure and at least one dose of enoxaparin post-ablation. Results: There were 119 subjects who satisfied the inclusion criteria. The primary outcome, incidence of major bleeding or vascular complication, did not demonstrate a statistically significant difference between groups (p = 0.92). The incidences were 4.8% with enoxaparin ≥ 1 mg/kg, 3% with enoxaparin between 0.5 mg/kg and 1 mg/kg, and 3.2% with enoxaparin ≤ 0.5 mg/kg. No subject experienced an ischemic stroke or transient ischemic attack within 28 days of a cardiac ablation procedure. Conclusion: Significant increases in major bleeding or vascular complications may not exist with an intermediate dose of enoxaparin provided after a cardiac ablation procedure.