Myocardial bridging is a frequent anomaly of the heart in humans and other animals. A myocardial bridge is typically characterized by the systolic narrowing seen with traditional catheter angiography, but this abnormality is not by itself a sign of ischemia or the need for intervention. In particular, transient spontaneous angina must be corroborated by reproducible narrowing during acetylcholine testing; this narrowing occurs during resting conditions and is responsive to nitroglycerin administration. Ischemia in myocardial bridging can result from acquired arterial wall disease (coronary artery atherosclerotic disease) or from instances of coronary spasm. Clinical evaluation should seek to identify baseline features such as myocardial bridge thickness (by using computerized axial tomography or intravascular ultrasonography) and the severity of systolic compression or reproducible spasticity (by administering acetylcholine). Nuclear myocardial scintigraphy is usually negative in patients with isolated myocardial bridging. Spastic coronary hyperactivity must be treated initially with antispasmodic medications, such as calcium channel blockers and nitrates, rather than by percutaneous stent placement or bypass surgery. Only exceptionally prolonged and critically severe spasm can induce intraluminal clotting and acute myocardial infarction. Recognizing the exceptionality and variability of ischemic presentations related to myocardial bridging is essential, as is establishing appropriate investigational methods for each of these facets of the condition.Abstract
The impact of coronary artery aneurysms (CAAs) caused by Kawasaki disease (KD) on long-term health-related quality of life (HRQOL) in children has not been well documented. This study investigated long-term HRQOL in a large sample of children diagnosed with KD-related CAAs. A case-control, retrospective study included 66 patients with KD-related CAAs. A total of 98 hospitalized patients were matched as controls based on age and sex: 49 patients were allocated to a group with pneumonia and 49 patients were allocated to a group with arterio-arterial fistula. Both child-reported and parent-proxy–reported Pediatric Quality of Life Inventory surveys were collected. The median (IQR) follow-up period was 5.64 (3.81-7.47) years (range, 1.03-10.67 years). The mean (SD) age at diagnosis was 3.73 (1.93) years. At baseline, children and parents as their proxies reported similar HRQOL scores for KD-related CAAs and arterio-arterial fistula that were considerably lower than for pneumonia, respectively. At long-term follow-up, children in the small and medium-sized aneurysms group reported a mean (SD) score of 81.61 (19.50), which was comparable to the arterio-arterial fistula group (83.32 [18.24]), 9.51 points lower than that of the pneumonia group (P = .014), and 9.70 points higher than that of the giant aneurysms group (P = .012). Parents also reported a comparable mean (SD) score of 81.03 (12.57) vs 83.30 (15.17) in the small and medium-sized aneurysms group and arterio-arterial fistula group, both of which had statistically significantly lower scores than the pneumonia group (P = .010) and higher scores than the giant aneurysms group (P = .009). Despite improvement in HRQOL scores, children with documented KD-related CAAs without complete recovery often encountered issues that disrupted their well-being during long-term follow-up. Routine outpatient HRQOL screening could be instituted to help eliminate the risk of long-term disability following initial clinical improvement.Abstract
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Although the prognostic value of the CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or transient ischemic attack, vascular disease, age 65-74 years, and female sex) scoring system in patients with stroke has been explored in several studies, a research gap exists in its application, especially in patients without atrial fibrillation (AF). This study investigated the association between CHA2DS2-VASc score and prognosis at 1 year in patients with acute ischemic stroke (AIS) who do not have AF. A total of 993 patients with AIS but without AF were recruited between January 2019 and December 2022. Patients were categorized into high-risk (CHA2DS2-VASc score, >2; n = 424), moderate-risk (CHA2DS2-VASc score, 2; n = 218), and low-risk (CHA2DS2-VASc score, 0-1; n = 351) groups. The primary outcome was major adverse cardiac events (MACE) at 1 year after index AIS. Multivariate Cox regression analyses evaluated the prognostic value of CHA2DS2-VASc scores after controlling for potential confounding factors. A sensitivity analysis was performed based on 3 CHA2DS2-VASc groups generated using propensity score matching. The rate of MACE during 12-month follow-up was statistically significantly higher (P < .01) in patients with a CHA2DS2-VASc score greater than 2 (34.7%) than in patients with a score of 2 (23.9%) or of 0 or 1 (14.8%). Multivariate Cox regression models indicated that, compared with a CHA2DS2-VASc score of 0 or 1, the hazard ratio (HR) of MACE occurrence was 3.22 (95% CI, 1.93-5.37; P < .01) for a CHA2DS2-VASc score greater than 2 and 1.92 (95% CI, 1.24-2.98; P < .01) for a CHA2DS2-VASc score of 2. When included in the Cox regression model as a continuous variable, the CHA2DS2-VASc score remained strongly associated with higher risks of MACE (HR, 1.19 [95% CI, 1.11-1.26]; P < .01), all-cause mortality (HR, 1.14 [95% CI, 1.05-1.23]; P < .01), and recurrent stroke (HR, 1.15 [95% CI, 1.06-1.256]; P < .01). Sensitivity analyses based on populations generated by propensity score matching yielded similar results. The CHA2DS2-VASc score effectively predicts MACE in patients with AIS but without AF, providing more accurate risk stratification.Abstract
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At the Texas Heart Institute's 2024 Cardiometabolic Syndrome Conference, held on August 23, 2024, experts from diverse academic fields spoke about novel initiatives for addressing the worsening projections for cardiometabolic syndrome. Four major areas in which innovation is ongoing were highlighted: technology, policy, population health, and lifestyle and behavioral modification. This article presents a brief contextualization, summary, and analysis of the novel initiatives being implemented in each of these 4 areas to address cardiometabolic syndrome. Despite alarming projections, cardiometabolic syndrome presents a unique opportunity for innovators to drive change through collaborative, multidisciplinary efforts.Abstract
