American Journal of Cardiology Research and Reviews

Research Article of American Journal of Cardiology Research and Reviews FAILURE TO CONSIDER FUTURE ATRIAL FIBRILLATION RATE CONTROL NEEDS AFTER PRESENTATION TO THE EMERGENCY DEPARTMENT WITH RAPID RATE Shabnam Tiwari, MD,2 Katherine White, MD,1 Shubash Adhikari, MD,2 Johnathan Cobb, MS4,1 Johnathan Shakesprere, MS4,1 Erik Hanson, PharmD,4 Suzanne Kemper, MPH,3 Elaine Davis, RN, MBA,  EdD,3 William Carter, MD,3* 1West Virginia University Health Sciences Center, Department of Internal Medicine, Charleston Division/Charleston Area Medical Center, Charleston, WV 2West Virginia University Health Sciences Center, Morgantown, WV 3Charleston Area Medical Center, Health Education and Research Institute, Charleston, WV 4University of Charleston School of Pharmacy, Charleston, WV Atrial fibrillation (AF) usually presents to the emergency room (ED) with a rapid ventricular rate, which commonly, but not always, is symptomatic. Rate control is usually easily managed with diltiazem (DTZ) and beta blockers (BBs), typically metoprolol (MTP). Sinus rhythm is frequently restored within 48 hours by means of spontaneous conversion, electrical cardioversion, or medications. However, AF recurs within one year in 60-80% of these subjects. There are little data describing doses of DTZ and MTP used for AF rate control at discharge. A retrospective study of 576 patients presenting with acute AF were evaluated for admission and discharge rate control medications (RCMs). For the 319 (68%) patients with a ventricular rate ≥110bpm the admission and discharge dose of MTP was 61mg and 63mg and DTZ was 195mg and 204mg, respectively. Those who remained in AF had a modest increase in the two medications compared to the patients who converted to sinus rhythm. Current guidelines recommend DTZ up to 300 to 400mg and MTP up to 300mg for rate control for select patients.  Concerns about high doses of MTP are mitigated by the MERIT-HF Trial demonstrating improved mortality and symptoms with doses of MTP up to 200mg demonstrating the ...

Research Article of American Journal of Cardiology Research and Reviews EXTERNAL DEFIBRILLATION/ CARDIOVERSION PROTOCOL IN PATIENTS WITH AN IMPLANTED CARDIOVERTER DEFIBRILLATOR OR PACEMAKER: SYSTEMATIC REVIEW AND META-ANALYSIS Maurizio Santomauro1*, Mario Petretta2, Carla Riganti3, Andrea Santomauro1, Francesco Maffettone1, Gaetano Castellano4, Pasquale Abete1 and Francesco Cacciatore1 1Department of Cardiovascular Emergency, Internal Medicine and Geriatric, University of Naples “Federico II” - Italy 2Istituto di Ricovero e Cura a Carattere Scientifico, I.R.C.C.S.  S.D.N., Napoli 3General Direction, AOU Federico II, University of Naples “Federico II” - Italy 4Department of Anesthesia and Intensive Care, Gemelli Molise Hospital, Campobasso Introduction: The use of cardiac implantable electronic devices (CIED) is increasing, and implanted patients require more often interventional procedures such as external defibrillation (ED) and electrical cardioversion (ECV). The creation of periprocedural care algorithms for patients with CIED is complex: the different programming capabilities of currently manufactured devices, confusion regarding the differences between pacemakers (PM) and implanted cardiac defibrillator (ICD), the use of old devices in some patients and lastly the continuous evolution in CIED technology with the introduction of leadless PM and subcutaneous implanted cardioverter defibrillators (S-ICD). Procedural advisories have been developed by professional societies, but the recommendations of these societies differ regarding to ED and ECV use. Methods: We performed a systematic database search of studies published between January 2000 and October 2021 assessing ED and ECV by the selection process (PRISMA) and identified 5 prospective eligible articles. Two meta-analyses assessed the proportion of patients with complications and the proportion of patients with no clinicallly relevant parameter modifications, respectively. Results: The final population for the meta-analysis included 2077 patients. The meta-analysis showed a weighted random pooled effect size of 0.55% (95% CI = 0.04% − 1.06 %) for complications, and of  22.4% (95% CI = 2.03% – 42.7%) for no clinically relevant modification parameters. Conclusions: Our review indicates ...

Research Article of American Journal of Cardiology Research and Reviews ABSENCE OF OXIDATIVE STRESS AND SIRTUINS RECRUITMENT ON CARDIAC TISSUE POST STRESS Ana Elisa T.S. de Carvalho*, Marco A. Cordeiro, Luana S. Rodrigues, Daniela Ortolani, Regina C. Spadari* Department of Biosciences, Federal University of São Paulo (UNIFESP), Santos, SP, Brazil Stress has emerged as a factor associated with cardiovascular disease. Catecholamines released during the stress reaction by the sympathetic nerves and the adrenal medulla couple to β1-and β2-adrenoceptors in the cardiomyocytes membrane enhancing heart function in order to attend the organism demand. This might produce excessive reactive oxygen species what may culminate with oxidative stress and progression of several cardiac diseases. Sirtuins have been described as cardioprotective factors and important regulators of the cellular stress response in the heart. The aim of this work is to investigate the putative participation of oxidative stress and sirtuins in the heart of rats submitted to foot shock stress, an experimental model where there is up regulation of β2-adrenoceptors and downregulation of β1-adrenoceptors. The data have shown that in the myocardium of rats submitted to foot shock stress the H2O2 concentration, catalase and superoxide dismutase activity, NAD+/NADH ratio, as well as the protein expression of sirtuins 1 and 3 were not altered. Pharmacological blockade of the β2-adrenoceptors by ICI118,551, did not modify this scenario. It is concluded that foot shock stress does not cause disruptions in oxidative stress or redox state processes in the myocardium, and consequently, sirtuins are not recruited to stress response. Keywords: oxidative stress, sirtuins, foot shock stress, β2-adrenoceptor ...

Research Article of American Journal of Cardiology Research and Reviews AN EASY AFFORDABLE STATISTICAL AND ECONOMIC (EASE) APPROACH TO AVOID UNNECESSARY AND EXPENSIVE EXAMS TO MONITOR PATIENTS WITH SMALL AAA Vezzoli Marika1, Archetti Claudia2, Bianchessi Nicola3, Bonardelli Stefano4, Garrafa Emirena1* 1Department of Molecular and Translational Medicine, University of Brescia, Brescia, 25123, Italy. 2IDS Department, ESSEC Business School in Paris, Paris, 95021 Cergy-Pontoise Cedex, France. 3Department of Informatics “Giovanni degli Antoni”, University of Milan, Milan, 20133, Italy. 4Department of Clinical and Experimental Sciences, University of Brescia, Brescia, 25123, Italy. Abdominal Aortic Aneurysm (AAA) is a localized enlargement of the abdominal aorta, such that the diameter exceeds 30 mm. AAA is a progressive growth leading to rupture, with high risk of mortality, therefore elective surgical repair is indicated when AAA diamenter is >55 mm. Screening programs, that use morphological imaging, have been developed internationally with the aim of detecting AAA before rupture with important limitations in term of cost and benefit for patients. Furthermore, different biochemical markers have been proposed to monitor AAA progression to overcome the above-mentioned limitations but none of them is used in the clinical practice. In fact, most of the biomarkers proposed are expensive and not feasible in the majority of laboratories. Combining different methodologies coming from Statistics and Operational Research fields, we developed an algorithm able to assess the importance of common biomarkers, requested in the clinical practice to evaluate the health of patient, and therefore no exams are required. Furthermore, we develop an Easy, Affordable Statistics and Economic (EASE) model able to identify if the AAA remain below the cut off for surgical repair. This prediction can provide guidance to how closely the patient’s abdominal aorta should be monitored avoiding additional and expensive exams. Keywords: Abdominal Aortic Aneurysm, EASE ...