Article of the Year 2021
Cardiac Injury Biomarkers and the Risk of Death in Patients with COVID-19: A Systematic Review and Meta-AnalysisRead the full article
Cardiology Research and Practice publishes original research articles and review articles focusing on the diagnosis and treatment of cardiovascular diseases, including hypertension, arrhythmia, heart failure, and vascular disease.
Dr. Terrence Ruddy is Director of Nuclear Cardiology at the University of Ottawa Heart Institute, and Professor of Medicine and Radiology at the University of Ottawa. His research is in SPECT and PET imaging techniques in cardiovascular disease.
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Comparison of Electrocardiogram and QT Interval between Viral Hepatitis Cirrhosis and Alcoholic Cirrhosis
Objective. This study aims to compare the electrocardiogram (ECG) abnormalities and QT interval prolongation in 2,886 patients with viral hepatitis cirrhosis and 643 patients with alcoholic cirrhosis in order to understand the characteristics of ECG in patients with cirrhosis and provide information and evidence for clinical diagnosis and treatment. Methods. The ECG data of patients with viral hepatitis cirrhosis and alcoholic liver cirrhosis in the outpatients and inpatients of our hospital from August 2012 to July 2018 were reviewed. The ECG data were recorded, and the ECG report was issued by ECG experts to analyze the abnormal ECG and QT interval of patients in these two groups. Results. In the present study, 1,132 (39.22%) of the 2,886 patients with viral liver cirrhosis and 322 (50.08%) of the 643 patients with alcoholic liver cirrhosis had an abnormal ECG (P < 0.001). Among patients with QT prolongation, 388 patients had viral liver cirrhosis (13.44%) and 170 patients had alcoholic liver cirrhosis (26.44%, P < 0.001). Conclusion. The hemodynamics and electrophysiology of the myocardium are often changed in patients with cirrhosis, and ECG changes may also occur. QT interval prolongation is one of the most common electrophysiological abnormalities in patients with cirrhosis, and QT prolongation is more common in patients with alcoholic liver cirrhosis. Prolonged QT is associated with severe arrhythmia and sudden death and can warn of malignant arrhythmia and sudden death. Therefore, the routine detection of abnormal ECG and QT interval in patients with liver cirrhosis is of significant importance for preventing malignant events.
Predicting Postoperative Troponin in Patients Undergoing Elective Hip or Knee Arthroplasty: A Comparison of Five Cardiac Risk Prediction Tools
Background. Elderly patients undergoing hip or knee arthroplasty are at a risk for myocardial injury after noncardiac surgery (MINS). We evaluated the ability of five common cardiac risk scores, alone or combined with baseline high-sensitivity cardiac troponin I (hs-cTnI), in predicting MINS and postoperative day 2 (POD2) hs-cTnI levels in patients undergoing elective total hip or knee arthroplasty. Methods. This study is ancillary to the Genetics-InFormatics Trial (GIFT) of Warfarin Therapy to Prevent Deep Venous Thrombosis, which enrolled patients 65 years and older undergoing elective total hip or knee arthroplasty. The five cardiac risk scores evaluated were the atherosclerotic cardiovascular disease calculator (ASCVD), the Framingham risk score (FRS), the American College of Surgeon’s National Surgical Quality Improvement Program (ACS-NSQIP) calculator, the revised cardiac risk index (RCRI), and the reconstructed RCRI (R-RCRI). Results. None of the scores predicted MINS in women. Among men, the ASCVD (C-statistic of 0.66; ), ACS-NSQIP (C-statistic of 0.69; ), and RCRI (C-statistic of 0.64; ) predicted MINS. Among all patients, spearman correlations (rs) of the risk scores with the POD2 hs-cTnI levels were 0.24, 0.20, 0.11, 0.11, and 0.08 for the ASCVD, Framingham, ACS-NSQIP, RCRI, and R-RCRI scores, respectively, with values of <0.001, <0.001, <0.001, 0.006, and 0.025. Baseline hs-cTnI predicted MINS (C-statistics: 0.63 in women and 0.72 in men) and postoperative hs-cTnI (rs = 0.51, ). Conclusion. In elderly patients undergoing elective hip or knee arthroplasty, several of the scores modestly predicted MINS in men and correlated with POD2 hs-cTnI.
How is Ambulatory Electrocardiogram Predictive of Stroke in Atrial Fibrillation Patients?
Background. Atrial fibrillation (AF) is a significant stroke risk factor. Further research is needed to clarify whether higher atrial fibrillation burden (AFB) link to the elevated risk of ischemic embolism, and how AF burden could combine with CHA2DS2-VASc score to improve the anticoagulation strategy. We aim to evaluate if the AF burden characterized using 24-hours Holter ECG monitoring is associated with the risk of ischemic stroke. Methods. This cohort study enrolled 210 Holter ECG monitoring detected atrial fibrillation patients. The burden of atrial fibrillation was defined as the percentage of time in atrial fibrillation during the monitoring period, and the AF burden and CHA2DS2-VASc score were compared between patients with and without thromboembolic outcomes. Multivariate regressions were conducted to estimate the predictors of thromboembolic outcomes. Results. Eighteen thromboembolic events occurred within a median follow-up of 11.39 months. Patients with ischemic stroke had higher CHA2DS2-VASc scores but not higher AF burden. After adjusting for age, hypertension, diabetes, anticoagulation, antithrombotic therapy, AF burden, and AF with higher CHA2DS2-VASc score was associated with increased risk for ischemic stroke (hazard ratio (HR), 15.17). CHA2DS2-VASc score > 4.5 was a predictor of significantly higher risk of future stroke (AUC 0.92). Conclusions. In Holter ECG monitoring detected AF, AF burden does not significantly impact the subsequent risk of stroke; whereas, CHA2DS2-VASc scoring is still a robust predictor of stroke risk. This may illustrate that once AF is detected from Holter ECG monitoring, underlying risk factors appear to be more predictive of subsequent stroke risk than atrial fibrillation burden.
Serum Zinc Ion Concentration Associated with Coronary Heart Disease: A Systematic Review and Meta-Analysis
Aim. Coronary heart disease is a major cause of mortality in developed and developing countries. Changes in the trace element concentration in the human body are one of the main reasons for the transition of the human body from a healthy to a diseased state. In this meta-analysis, we have studied the relationship between the reduction in serum zinc ion concentration and coronary heart disease. Methods. We used PubMed and Cochrane (as of June 30, 2021) databases for the literature search. Per the requirements of this systematic review, case-control studies involving serum zinc ion concentration and coronary heart disease were searched, and the quality of the included studies was evaluated before the meta-analysis. Results. A total of 3,981 cases were found across seven articles. The standard mean deviation (SMD) of serum zinc ion concentration was −0.22 [−0.28, −0.15], z = 6.52, and indicated that the difference was statistically significant. The forest plot results show that I2 = 34% < 50%, and the Q test showed . These results suggest a lack of heterogeneity among the selected articles. Results from the funnel chart indicated that this study was free from publication bias. Conclusion. The results of this meta-analysis reveal that a decrease in serum zinc ion concentration is related to the occurrence of coronary heart disease. Clinically, monitoring the serum zinc ion levels is proven to be of great significance for patients with coronary heart disease.
Associations between β-Blocker Therapy at Discharge and Long-Term Follow-Up Outcomes in Patients with Unstable Angina Pectoris
Background. The effects of β-blockers in patients with unstable angina pectoris (UAP) are unclear. We tried to evaluate associations between β-blockers in UAP and long-term outcomes. Methods. We enrolled 5591 UAP patients and divided them into 2 groups based on β-blockers at discharge: 3790 did β-blockers and 1801 did not used them. Propensity score matching at 1 : 1 was performed to select 1786 patients from each group. The primary endpoint was major adverse cardiac and cerebral events (MACCE) during the long-term follow-up period. Results. 67.8% of patients were on β-blockers at discharge; these patients were more likely to have CHD risk factors, lower ejection fraction, and severity of the coronary artery lesions. Over a median of 25.0 years, the incidence of MACCE was 25.5%. The risk was not significantly different between those on and those not on β-blocker treatment. The multivariate Cox regression analysis showed that no β-blocker use at discharge was not an independent risk factor for MACCE and sequence secondary endpoints. After propensity score matching, the results were similar. Conclusions. β-blocker use was not associated with lower MACCE and other secondary composite endpoints in long-term outcomes. This result adds to the increasing body of evidence that the routine prescription of β-blockers might not be indicated in patients with UAP. Trial registration had retrospectively registered.
The Predictive Value of Epicardial Fat Tissue Volume in the Occurrence and Development of Atrial Fibrillation: A Systematic Review and Meta-Analysis
Background. Atrial fibrillation (AF) is one of the most common arrhythmias in clinical practice. Although fat is currently considered to be a risk factor for AF and a pathogenic link between epicardial fat tissue (EFT) and AF has been speculated, there are currently few clinical studies and literature data domestically or abroad. Objective. This study conducted a meta-analysis of observational case series studies to verify the relationship between atrial fibrillation and EFT and to strengthen the predictive value of EFT in the occurrence, development, and postablative recurrence of AF. Methods. We conducted a systematic search of the literature in electronic databases until December 2021 and supplemented this through manual searches of individual studies, reviewed articles, and reference lists in conference proceedings. This study conducted a meta-analysis to compare the differences between different populations, such as healthy participants and AF patients, healthy subjects and AF subtype cases, and paroxysmal and persistent AF with AF recurrence and without AF recurrence after ablation. Results. Following the retrieval of 828 articles, only 22 articles were selected as research results. Accordingly, the meta-analysis results show that the volume of EFT in AF is greater than that in healthy subjects (MD = 39.34 ml, 95% CI = 27.11, 51.58); persistent AF is greater than paroxysmal AF (MD = 14.37 ml, 95% CI = 7.46, 21.27); and recurrence after ablation is greater than without recurrence (MD = 14.37 ml, 95% CI = 7.46, 21.27). Conclusion. The results of this study further confirm the connection between EFT and AF and that EFT has a certain predictive value for the occurrence and development of AF.