Hearts, Volume 3, Issue 1 (March 2022) – 6 articles

Background: Cardiovascular disease remains the leading cause of death in the United States. Coronary artery disease alone accounted for approximately 13% of deaths in the US in 2016. Some studies have suggested an increased prevalence of coronary artery disease (CAD) in chronic inflammatory conditions, such as celiac disease (CD). Chronic subclinical systemic inflammation, decreased absorption of cardio-protective nutrients and drugs have all been postulated as the driving mechanisms for this increased risk of CAD. Methods: We reviewed a Nationwide Inpatient Sample from 2007 to 2017, using Acute Coronary syndrome as a principal diagnosis with CD as the secondary diagnosis, utilizing validated ICD-9-CM and ICD-10 codes. We examined the annual trends in the number of cases and hospitalization charges yearly and used survey regression to calculate adjusted odds ratios (aOR) for hospital mortality and other outcomes. Results: We identified a total of 8,036,307 ACS hospitalizations from 2007 to 2017, of which 5917 (0.07%) had a diagnosis for CD. The proportion of patients with CD in ACS hospitalizations increased from 0.015% in 2007 to 0.076% in 2017. These patients were significantly older (70.3 vs. 67.4 years, p < 0.02), more likely female (51.9% vs. 39.5%, p < 0.01), and more likely to be white (93.8% vs. 76.6%; p < 0.01) than ACS patients without CD. After adjusting for age, gender, race, Charlson Comorbidity index and hospital level characteristics, ACS hospitalizations for CD patients had a lower odds ratio for hospital mortality (aOR = 0.39; 95% CI = 0.23–0.67; p < 0.01). Additionally, length of stay in this patient population was shorter (4.53 vs. 4.84 days, p < 0.01) but the mean hospitalization charges were higher (USD 64,058 vs. USD 60,223, p < 0.01). Conclusion: We found that the number of ACS-related admissions in CD patients has risen more than five-fold between 2007 and 2017. However, the odds of in-hospital mortality in these patients is not higher than patients without CD. The results of our study demonstrate that although the systemic inflammation related to CD is associated with an increasing prevalence of ACS hospitalizations, on the contrary, the mortality rate is significantly higher in patients without celiac disease. Full article

Atrial fibrillation (AF), a heart condition, has been a well-researched topic for the past few decades. This multidisciplinary field of study deals with signal processing, finite element analysis, mathematical modeling, optimization, and clinical procedure. This article is focused on a comprehensive review of journal articles published in the field of AF. Topics from the age-old fundamental concepts to specialized modern techniques involved in today’s AF research are discussed. It was found that a lot of research articles have already been published in modeling and simulation of AF. In comparison to that, the diagnosis and post-operative procedures for AF patients have not yet been totally understood or explored by the researchers. The simulation and modeling of AF have been investigated by many researchers in this field. Cellular model, tissue model, and geometric model among others have been used to simulate AF. Due to a very complex nature, the causes of AF have not been fully perceived to date, but the simulated results are validated with real-life patient data. Many algorithms have been proposed to detect the source of AF in human atria. There are many ablation strategies for AF patients, but the search for more efficient ablation strategies is still going on. AF management for patients with different stages of AF has been discussed in the literature as well but is somehow limited mostly to the patients with persistent AF. The authors hope that this study helps to find existing research gaps in the analysis and the diagnosis of AF. Full article

The NOTION trial compares transcatheter aortic valve implantation versus surgical aortic valve replacement in low-risk patients. Looking carefully at the outcomes of this trial, there is no doubt that the transcatheter aortic valve implantation results were outstanding. The same thing cannot be said for the results of the surgery. We tried to understand the reason for that. Full article

Cardiac implantable electronic device (CIED) implants are rising in an older, more co-morbid population. The prevalence of CIED infection ranges from 1–4%. Whilst complete extraction of all transvenous hardware is recommended for infected, eroded, or pre-eroding CIEDs, this approach is not without risk and may be unacceptable to some patients. Long-term data on a more conservative strategy is lacking. We report on our experience of conservative management with pocket revision as a primary strategy in carefully selected patients. Method: A retrospective review of all CIED revision procedures was undertaken at a large tertiary center, over a 7-year period, with a mean follow-up timeframe of 39 months. Results: A total of 86 patients underwent 96 revision procedures; 7 patients required further revisions and 13 went on to undergo CIED extraction by the end of the follow-up period. The overall rate of mortality at 12 months was 8.1%, increasing to 24.4% at the end of the follow-up period. Conclusion: Our data provide important outcome information on an alternative strategy to lead extraction in carefully selected patients where the risk of extraction is perceived to be unacceptable. The absence of systemic infection appears to predict better outcomes than previously reported, and over two-thirds of patients remained complication-free at 12 months. Full article