bluuebunny/crossref_metadata_2025 huggingface dataset:
Complete Percutaneous Coronary Intervention versus Culprit Only Percutaneous Coronary Intervention for Acute ST Elevation Myocardial Infarction with Multivessel Coronary Artery Disease: A Meta-analysis
Authors: Almelor Lorraine Grace B , Fomaneg Cheryl K , Dayag Aleano L , Reganit Paul Ferdinand M
Published: July 2024

BACKGROUND: Current guidelines recommend that primary percutaneous coronary intervention (PCI) in hemodynamically stable acute ST-elevation myocardial infarction (STEMI) patients should be limited to the culprit vessel despite significant stenosis in nonculprit coronary arteries. Recent studies and meta-analyses provide conflicting data.

OBJECTIVES: This review compared the efficacy of culprit (infarctrelated artery only) primary PCI versus complete (infarctrelated artery and at least one other artery with significant stenosis) primary PCI in acute STEMI patients with multivessel coronary artery disease (CAD).

METHODS: We systematically searched the electronic databases, MEDLINE and CENTRAL, and the clinical trial registries, ClinicalTrials.gov and ISRCTN registry, for all published and unpublished randomized controlled trials (RCTs) comparing culprit primary PCI versus complete primary PCI in acute STEMI with multivessel CAD. Manual searching was done by reviewing the references of available studies. Data were extracted from full text reports of eligible trials, and evaluated independently by the authors using the Cochrane Collaboration’s tool for assessing risk of bias. Statistical analyses were performed using RevMan 5.3.

RESULTS: Four RCTs (3 published,1 unpublished) involving 979 patients were analyzed. Complete PCI was associated with a decreased risk for both cardiovascular (RR 0.45 [95% CI 0.22, 0.94]; p=0.03) and all cause mortality (RR 0.63 [95% CI 0.37, 1.05]; p=0.08), as well as repeat revascularization (RR 0.37 [95% CI 0.26, 0.53]; p<0.00001) and repeat non-fatal myocardial infarction (MI) (RR 0.37 [95% CI 0.19, 0.71]; p=0.003). No heterogeneity was detected (I2 statistic was 0% for all outcomes).

CONCLUSION: Complete PCI is associated with a significant decrease in the risk of cardiovascular mortality, repeat revascularization and repeat nonfatal MI in patients with acute STEMI and multivessel CAD.
Wellens Syndrome, an Impending Doom: A Case Report
Authors: Benitez Victor Jonathan S
Published: July 2024

BACKGROUND: Wellens syndrome, also known as “widow maker,” was first described by de  Zwaan et al as a pattern of electrocardiographic changes for patients with significant left anterior  descending coronary artery infarction. Early recognition could prevent an extensive infarction of  the anterior wall, which could possibly lead to the demise of the patient. We present the case of  a 60-year-old man who presented with sudden onset of chest pain with diaphoresis and cold  clammy extremities. He was initially managed as a case of unstable angina. Further workup,  which included serial electrocardiograms, led to the diagnosis of Wellens syndrome. The patient  also underwent coronary angiography and angioplasty with good outcome. The patient’s course  and a review of literature on Wellens syndrome are reported in this article.
Red Cell Distribution Width and Mortality in Patients with Acute Coronary Syndrome: A Meta-Analysis on Prognosis
Authors: Abrahan Lauro L , Cunanan Elleen L , Ramos John Daniel A , Tiongson Marc Denver A
Published: July 2024

BACKGROUND: Red cell distribution width (RDW), a routine component of the CBC, measures variation in the size of circulating erythrocytes. It has been associated with several clinical outcomes in cardiovascular (CV) disease. We aimed to describe the association between RDW and mortality in patients admitted for acute coronary syndrome (ACS) through pooled analysis.

Methods: This study was a meta-analysis of observational studies that included reported data on all-cause or CV mortality associated with RDW in patients admitted for ACS and used logistic regression analysis to control for confounders. A search for eligible studies was conducted Using MEDLINE, Clinical Key, ScienceDirect, Scopus and Cochrane Central Register of Controlled Trials databases. The quality of each study was evaluated using the Newcastle-Ottawa Quality Assessment Scale. Using RevMan version 5.3, we performed Mantel-Haenzel analysis of random effects to determine the association of RDW with all-cause or CV mortality and major adverse cardiovascular events (MACE).

Results: We identified 13 trials comprising 10,410 ACS patients. Pooled analysis showed that a low RDW was associated with a significantly lower all-cause or CV mortality (RR 0.35; 95% CI 0.30-0.40); p<0.00001; I2=53%). A low RDW was also associated with a lower risk for MACEs after an ACS (RR 0.56; 95% CI 0.51-0.61; p<0.00001; I2=91%].

Conclusion: A low RDW during an ACS is associated with lower all-cause or CV mortality and lower risk of subsequent MACEs, providing us with a convenient and inexpensive risk stratification tool in ACS patients.

Keywords: red cell distribution width, acute coronary syndrome, myocardial infarction.
Prognostic Impact of Coronary Collaterals in Acute Coronary Syndrome: A Meta-Analysis (PICC-ACS)
Authors: Aherrera Jaime Alfonso M , Ramos John Daniel A , Chiong Lowe L , Vicente Mark A , Punzalan Felix Eduardo R
Published: July 2024

Background: The coronary collateral circulation (CCC) is an alternative source of blood supply in coronary artery disease (CAD). A recent meta-analysis found that among patients with stable CAD, the presence of CCC has a relevant protective effect in terms of mortality. Among patients with acute coronary syndrome (ACS), surrogate end-points such as infarct size, systolic function, ventricular dilatation and post-infarct aneurysm formation have positive results in relation to the presence of CCC. The prognostic value of the presence of CCC at the time of ACS is still undefined with regard to hard outcomes, specifically, reduction of mortality.

Objective: To determine whether the presence of CCC demonstrated by coronary angiography during an ACS is associated with a reduction in mortality

Methodology: We conducted a systematic search of studies using MEDLINE, EMBASE, ScienceDirect, Scopus, and the Cochrane Central Register of Controlled Trials databases in all languages and examined the reference lists of the studies. The inclusion criteria for studies were (1) observational or randomized controlled trials; (2) population included adults ≥19 years old with ACS; (3) reported data on mortality in association with the presence or absence of CCC on angiography; and (4) if observational study, should have controlled for confounders by using logistic regression analysis. Studies identified were assessed for quality using either the Newcastle-Ottawa Quality Assessment Scale for observational studies or the Cochrane Tool for Assessing Risk of Bias for randomized trials. The outcome of interest was reduction in all-cause mortality, assessed using Mantel-Haenszel analysis of random effects to compute for relative risk, carried out using Review Manager (RevMan) 5.3.

Results: Pooled analysis from 12 identified trials showed that among patients with ACS who underwent coronary angiography, the presence of CCC showed a trend towards benefit in terms of mortality but no statistical difference from no CCC (RR 0.69, 95% CI 0.44–1.08, p<0.0001, I2=73%). In the secondary analysis, patients with ACS and CCC treated with PCI had a significant reduction in mortality compared to those without CCC (RR 0.48, 95% CI 0.35–0.65, p<0.00001, I2=0%).

Conclusion: The presence of CCC during ACS showed a trend towards mortality reduction. Further, among patients treated with PCI, those with CCC had an incremental significant reduction in mortality compared to those without CCC.

Keyword: coronary collaterals, acute coronary syndrome.
Why lose the peer review
Authors: Javier Saturnino P
Published: July 2024

Most scientific journals employ the peer review process for all their published manuscripts. Editorial peer review is considered a vital mechanism [a quality filter] for scholarly scientific publishing and is touted to benefit editors, authors, reviewers, readers, and researchers - by reducing or managing bias, ensuring adherence to ethical standards and thus enhancing the overall quality of the published manuscript.
The State of Cardiovascular Resources and Expertise in Echocardiography Nationwide: The Philippine Survey on Echocardiography (The PHIL-SCREEN Study)
Authors: Magno Jose Donato A , Ubaldo Rylan Jasper C , Nunez Jonnie B , Cornel Mylene U , Cuyco Ronald E , Tucay Edwin S , Santos Romeo J
Published: July 2024

INTRODUCTION: Maldistribution of echocardiographic expertise is a relevant issue in an archipelago such as the Philippines. We specifically looked at (1) the nationwide census of physician echocardiographers, cardiac sonographers, and cardiac laboratory managers; (2) their geographic distribution; and (3) background training and laboratory classification.

METHODS: Data from paper and online surveys conducted in 2015 and 2021 were consolidated alongside the existing society database. Surveys (Google Forms; Google, Mountain View, California) were disseminated through a variety of online, social media, and communication avenues and focused on three categories of respondents: (1) physician echocardiographers, (2) cardiac sonographers, and (3) laboratory managers. The main variables of interest included estimated census per category and geographical distribution. Secondary variables included training background and laboratory classification.

RESULTS: In 2021, there were 651 physician echocardiographers, 2487 cardiac sonographers, and 443 cardiac laboratory managers on record, with 86 readers, 405 sonographers, and 101 managers responding to the survey. The majority of the surveyed readers (41.2%), sonographers (48.3%), and laboratory managers (28.2%) were situated in the National Capital Region. Close to half of the readers were level III echocardiographers. The majority of the sonographers (46.7%) were nurses, followed by medical technologists (21.8%) and radiologic technologists (18.9%). Most laboratory managers were in nontraining hospitals (38.2%) or stand-alone facilities (20.9%). The minority were in hospitals with cardiology (18.2%) or internal medicine (22.7%) training programs.

CONCLUSION: Geographical maldistribution of echocardiographic resources is still evident, with the majority of human resources being concentrated in the metropolis. The majority of the sonographers have nursing as their training background, and many laboratory managers are situated in facilities with no established training programs.

KEYWORDS: echocardiography, laboratory, reader, resources, sonographer, survey
Left Atrial Metastasis Presenting as Right-sided Heart Failure in a Patient with Acute T-cell Lymphoblastic Leukemia
Authors: Paler Florante T , Tamayo Juliana G , Sta. Maria Maria Helga F
Published: July 2024

Background: Cardiac metastasis is usually seen with lung carcinomas or malignant melanoma, but rarely with leukemia, and is usually a post-mortem diagnosis. Secondary cardiac tumors arising from the left atrium, where benign myxomas predominate, are uncommon.

Case presentation: We report a 22-year old Filipino male, recently diagnosed with acute T-cell lymphoblastic leukemia, presenting with right-sided heart failure symptoms. On work-up, transthoracic echocardiogram showed a mass with mixed echogenicity, irregular borders and broad-base attachment to the anterior and posterior walls of the left atrium. He was treated with nitrates, ivabradine, captopril and digoxin; and subsequently underwent chemotherapy with vincristine, doxurubicin, intrathecal methotrexate and cytarabine. Right-sided heart failure symptoms improved after initiation of chemotherapy. Resolution of the left atrial tumor was documented after completion of induction chemotherapy.

Conclusion: Cardiac metastasis should be considered in patients with acute lymphoblastic leukemia presenting with right-sided heart failure. Chemotherapy and supportive cardiac medications should be considered in these cases. Other treatment options should also be investigated.
Symptomatic Anomalous Right Coronary Artery from the Opposite Sinus of Valsalva with a Malignant Course in a Filipino Adult Patient: A Case Report
Authors: Bayani Dioscoro , Hornilla Donna Ricca , Gonzales Eddieson , Balabagno Maria Margarita , Morales Felimon K , Sison Eric Oliver , Llanes Elmer Jasper
Published: July 2024

Anomalous coronary artery from the opposite sinus of Valsalva (ACAOS) is a rare congenital condition with reported incidence of 1.07%. It is classically associated with risk for sudden death (SCD) based on autopsy reports. Several anatomic features of this anomaly have been correlated with its symptomatology and risk of SCD, and surgical revascularization has been suggested by guidelines. However, based on recent reviews, SCD risk in ACAOS patients may be overestimated and that these patients may be managed conservatively.

We present a case of a 53-year-old athletic Filipino male who consulted for sudden chest heaviness after a basketball game. He was initially managed as a case of acute coronary syndrome. However, subsequent coronary angiography revealed an anomalous right coronary artery arising from the left coronary sinus. Coronary computed tomography angiography showed an acute angle take-off of the right coronary artery with an interarterial course between the pulmonary artery and the aorta. The patient was managed conservatively with good outcomes. The patient’s management and a review of literature on ACAOS are reported in this paper.

KEYWORDS: ACAOS, coronary artery anomaly, sudden cardiac death.
Transcatheter Aortic Valve Replacement with the CoreValve: The St. Luke’s Global City Heart Institute Experience
Authors: Posas Fabio Enrique B , Alzate Ferdinand V , Najos-Valencia Ofelia , Divinagracia Ruth Marie M , Benavidez Dahlia Virginia E , De Castro Estanislao E
Published: July 2024

BACKGROUND: Symptomatic, severe aortic stenosis (AS) is a potentially life threatening and functionally limiting disease that typically affects the elderly. Transcatheter aortic valve replacement (TAVR) may be an effective, minimally invasive valve replacement technique comparable to surgical aortic valve replacement for high-risk patients with severe, symptomatic AS.

METHODS: We report our single-center TAVR experience with the CoreValve system (Medtronic) in 27 high-risk, extra high-risk, or inoperable patients that underwent TAVR using Corevalve at the St. Luke’s Medical Center. All patients underwent computerized tomography angiogram and 2D echocardiography designed to assess vascular access, aortic anatomy, ventricular function and annular dimensions. TAVR was performed at the cardiac catheterization laboratory, under general anesthesia and transesophageal echocardiography guidance. The femoral approach was used whenever possible. Those with unsuitable femoral anatomy underwent subclavian or direct aortic implantation.

RESULTS: Since our team performed the first TAVR in the Philippines in February 2012, a total of 27 patients have undergone TAVR. Fourteen (52%) were males. The mean age was 79.96 years (range 52-91). Twenty-six had severe, symptomatic, calcific AS and one had severe, valvar and paravalvar aortic regurgitation (AR) of a Carpentier-Edwards perimount bioprosthetic valve.

TAVR was performed via the transfemoral approach in 23 patients (85%); direct aortic approach in three patients (11%); and left subclavian approach in one patient (4%). There were 30 valves implanted. Out of 27 patients, two patients (7%) required 23 mm valves; eight patients (30%) required 26 mm valves; 12 patients (44%) used 29 mm valves; and 5 patients (19%) required 31 mm valves. Three patient required two valves following valve dislocation during implantation.

Procedural success was 100% with no cardiac mortality at 30 days. Mean hospital stay was 12.61 days. Five (18%) had permanent pacemaker implantation for high grade atrioventricular block. On follow up, three patients (11%) died of non-cardiac causes. Serial echocardiograms demonstrated no AR in 13 patients (48%) and trivial to mild AR in 14 patients (52%). There were no patients with moderate or severe AR.

CONCLUSION: TAVR in high-risk and extra high-risk or inoperable patients can be performed with high procedural success and no 30-day cardiac mortality. There was no follow up evidence of significant AR nor paravalvar leaks. Non-cardiac mortality appears to be a function of multiple, complex comorbidities among extra high-risk or inoperable patients.
A Retrospective Study on the Use of Transradial Versus Transfemoral Approach for Coronary Angiography and Intervention at a Tertiary Hospital
Authors: Mercadal Gerard Ryan T , Prado Jose Paolo A , Ramboyong Raul E
Published: July 2024

OBJECTIVES: The aim of this study is to analyze and compare femoral versus radial access for coronary angiography and intervention at the Cardiac Catheterization Laboratory of The Medical City, a tertiary hospital in the Philippines, from October 2010 to January 2011.

METHODOLOGY: This is a retrospective study of all patients who underwent coronary angiography with or without intervention. Medical records of identified patients were reviewed to determine, analyze and compare the baseline characteristics, course, outcome and complications of the two groups.

RESULTS: A total of 231 coronary procedures were performed on 219 patients, with 141 (61.04%) utilizing the radial artery for vascular access compared to 90 (38.96%) for the femoral artery. The overall success rate at first attempt to vascular access was 95.24%, with failure rate to vascular access of 7.28% and 1.25% in the radial and femoral group, respectively. The cross-over rate from radial to femoral access was 4.33%. Procedural success rates for percutaneous coronary intervention (PCI) were 100% and 95.45% for radial and femoral access, respectively. Arterial access was obtained with a significantly smaller introducer sheath in the radial compared to the femoral group in both coronary angiography (5.55 mm vs. 6.05 mm, respectively; p<0.000) and PCI procedures (5.86 mm vs. 6.36mm, respectively; p<0.000). Amount of contrast used and procedural time were similar between the two groups. Fluoroscopy time was significantly longer in the radial (39.87 min) compared to the femoral group (19.41 min; p<0.000). Complication rates were similar between the two groups. The incidence of bleeding was 2.13% and 2.22% in radial and femoral group, respectively (p>0.05).

CONCLUSION: The present study demonstrates that radial vascular access is increasingly being utilized in our institution. Transradial approach can be safely offered to patients with its high success rate and low conversion to femoral route. Complications of coronary procedures in the femoral and radial group were comparable in this study.
A Meta-analysis on the Effects of Tolvaptan in Patients with Chronic Heart Failure
Authors: Ines Philipp C , Fernandez Francis Charles L , Catalan Francis Carl L , Celedonio Irene L , Atibagos Florido A
Published: July 2024

BACKGROUND: Vasopressin levels are often elevated in heart failure patients and left ventricular dysfunction, and this may contribute to the increase in systemic vascular resistance via stimulation of the V1a receptor. Among the recent novel therapies for heart failure are the vasopressin receptor antagonists. Tolvaptan is an oral, non-peptide, selective vasopressin V2-receptor antagonist that causes aquaresis by acting on the distal nephron to increase secretion of electrolyte-free water. This meta-analysis aimed to test the hypothesis that tolvaptan is beneficial and results in clinical improvement in the treatment of heart failure.

METHODS: This was a meta-analysis that included randomized controlled trials that compared the efficacy of tolvaptan 30 mg daily vs placebo among heart failure patients. We obtained relevant publications from PubMed, Cochrane and Australasian Medical Index. Abstracted data were assessed from the five (5) included studies using the JADAD Quality Scale. Outcomes measured were changes in body weight and serum sodium levels, from baseline to 24 hours of initiating treatment and at the end of follow-up. Data analysis was done using the Review Manager 5 software version 5.1.7. Analysis of the mean difference was used as effect measure.

RESULTS: In this meta-analysis, the total pooled patient population was 4,899 patients (2,281 patients assigned to the tolvaptan group and 2,279 patients assigned to the placebo group). The outcome of the mean difference in body weight after 24 hours and at end of follow-up was -0.93 kg (95% CI: -1.12 to -0.74) and -1.34 kg (95% CI: -1.66 to -1.02) respectively. The outcome of the mean difference in serum sodium after 24 hours of treatment and at end of follow-up was 3.05 mEq/L (95% CI: 1.85 to 4.25) and 2.25 mEq/L (95% CI: 0.83 to 3.66) respectively.

CONCLUSION: This meta-analysis demonstrated significant weight reduction and increase in serum sodium in patients with heart failure treated with tolvaptan during the first day and up to the end of follow-up treatment. These are important properties for the treatment of heart failure.

KEYWORDS: Tolvaptan, Heart Failure, Meta-Analysis.
Correlation of Preoperative Neutrophil Lymphocyte Ratio with EuroSCORE as a Predictor of In-Hospital Mortality Following an Isolated Coronary Artery Bypass Graft: A 7-year Retrospective Study
Authors: Sayruddin Cashmere Malaine C , Gallardo Elaine
Published: July 2024

Background Patients undergoing coronary artery bypass graft (CABG) are risk stratified preoperatively by computing the EuroSCORE. Studies have shown that neutrophil-to-lymphocyte ratio (NLR) is a specific predictor of increased cardiovascular risk. This study aimed to determine the correlation between NLR and EuroSCORE and postoperative in-hospital mortality following isolated CABG.

Methods This was a seven -year retrospective chart review that included patients who underwent isolated elective or urgent CABG. The patients’ EuroSCORE was computed based on patient records. Correlation was assessed using Pearson’s correlation test and receiver operating characteristics (ROC) curve analysis was used to determine the optimum cut-off level of preoperative NLR to predict mortality.

Results Out of the 103 included patients, only seven died (all following urgent CABG). Compared to survivors, those who died had a higher proportion of diabetes mellitus (DM) (p=0.030), a lower clearance (p=0.024), a higher EuroScore (p<0.001) and a higher NLR (p<0.001). Logistic multivariate analysis showed that only the presence of DM was associated with mortality. A threshold NLR value of 4.7 was able to predict mortality (AUC= 1.0, sensitivity: 43%, specificity: 100%).

Conclusion NLR is a practical, clinically acceptable biomarker linked to predicting mortality following an isolated CABG.

Keywords Neutrophil-to-lymphocyte ratio, EuroSCORE, mortality, CABG.
The Words of the Year: Rizz, Hallucinate, Artificial Intelligence, and Authentic
Authors: Ramirez Marcellus Francis L
Published: July 2024

Since the year 1972, several organizations have assigned “words of the year” or WOTY to define what is considered the most important word of the year, basically reflecting the theme or expression that best describes the year that was. It can be a cultural phenomenon, a controversy, an influential concept, or a popular thought. This WOTY is voted upon by linguists and lexicographers and the bodies that designate these include the American Dialect Society, Cambridge University for the Cambridge Dictionary, Collins English Dictionary, Dictionary.com, Macquarie Dictionary, Merriam Webster, and Oxford University Press for the Oxford Dictionary, among others.
Incidence and Clinical Profile of Bleeding Among Adult Acute Coronary Syndrome Patients Admitted in a Tertiary Hospital (BLEED-ACS)
Authors: Estur Michael Anthony C , Punzalan Felix Eduardo , Reganit Paul Ferdinand , Llanes Elmer Jasper
Published: July 2024

Background: Current guidelines recommend the use of multiple antithrombotic drugs and aggressive invasive strategies in the management of patients with acute coronary syndromes (ACS). However, these interventions could result in bleeding, both minor and life-threatening. This study aimed to determine the incidence of bleeding among adult patients admitted for ACS treated with antiplatelets, anticoagulants and/or thrombolytics.

Methods: This was a prospective observational study of adult patients admitted in the medical intensive care unit (ICU) for ACS and treated with antiplatelets, anticoagulants and/or thrombolytics from January 2016 to August 2016. The patients were observed for occurrence of any form of bleeding, and factors associated with bleeding were identified.

Results: Fifty-eight patients were included in the study. The overall incidence of bleeding was 25.86%. Female sex and prior history of vascular disease or cerebrovascular disease were independently associated with a higher risk of bleeding (RR of 2.45 and 3.1, respectively; p<0.05). There were no statistically significant differences in morbidity and mortality between those with and without bleeding. However, the number of days of ICU hospital stay among patients with bleeding occurrence was higher compared to those without bleeding (median: 6 vs 4 days).

Conclusion: Bleeding is a common non-cardiac complication of current management for ACS and is associated with prolonged hospital stay. Simple baseline demographic and clinical characteristics identify patients at increased risk of bleeding.
Factors Affecting Surgical Mortality for Patients With D-Transposition of the Great Arteries: Single-Institution Experience From a Developing Country
Authors: Canto Ceres P , Hernandez Ruzenette Felicitas R , Catalan Gisel T
Published: July 2024

INTRODUCTION: Arterial switch operation (ASO) is the preferred surgical management for  D-transposition of the great arteries. It was first performed in this institution in 1991, with a high  mortality from the expected learning curve. Two decades later, there is a need to revisit our  outcomes to further improve surgical treatment of this common cyanotic condition. 

METHODS: This is a retrospective cohort study on ASO patients between January 2010 and  June 2017 from a single institution. The following parameters were collected through review  of patient charts and two-dimensional echocardiography videos: clinical data, laboratory and  echocardiographic results, and intraoperative and postoperative outcomes. The study was  approved by the institutional ethics review board of the hospital.  

RESULTS: Among 117 subjects, the median age was 1 month (range, 1 day to 6 years),  and 76% were males. Transposition of the great arteries with intact septum (62%) was  more frequently seen. Mortality decreased from 49% to 30%. Preoperatively, balloon atrial  septostomy was associated with mortality (p = 0.013). Intraoperatively, mortality increased with  prolonged cardiopulmonary bypass (p = 0.007), bleeding (p = 0.015), rebypass (p = 0.001),  and metabolic acidosis (p = 0.005). Postoperatively, use of inotropes (p = 0.003), prolonged  intubation (p = 0.028), pulmonary edema or severe congestion (p = 0.01), bleeding (p < 0.001),  increased international normalized ratio (p = 0.047), acute renal failure (p < 0.001), peritoneal  dialysis (p < 0.001), metabolic acidosis (p = 0.005), and increased C-reactive protein (p = 0.028)  increased mortality. On multivariate analysis, rebypass (95% confidence interval, 1.86–175.49)  and renal failure (95% confidence interval, 2.98–109.50) were strong independent predictors of  mortality. 

CONCLUSION: Overall mortality remains high compared with other institutions. Strategies  should therefore be used to avoid statistically significant endpoints in order to improve operative  outcomes. Careful preoperative planning and early institution of dialysis should be performed  when needed. 

KEYWORDS: D-TGA, arterial switch operation, predictors of mortality, balloon atrial septostomy
Primary Malignant Pericardial Mesothelioma in a 55 Year Old Female Presenting as Massive Pericardial Effusion: A Case Report
Authors: Montejo Abe F , Montejo Yvonne Bettina E
Published: July 2024

Malignant diseases of the pericardium are classified into primary and secondary tumors. Secondary tumors are more frequent, with metastases from the lung and breast being the most common. R.M. is a 55 year old female who was admitted for complaints of dyspnea. She is a known diabetic treated with maintenance metformin.
The value of prediction
Authors: Javier Saturnino P
Published: July 2024

Like in most disciplines in Medicine, the value of predicting the occurrence of a disease or event is an important realm in the field of Cardiology that repeatedly invites numerous clinical investigations. This has given rise to numerous scoring schemes, probability indices and prediction tools that enable the clinician to expect a complication or outcome with reasonable scientific certainty.

Developing new insights to determine the probability of occurrence of a clinical event accompanying various disease entities ensures that clinicians have scientific guidance and logical basis in the diagnosis and management of cardiovascular diseases. This becomes even more imperative in economies where the resources are not limitless, yet ironically, where the scourge of the affliction is somehow endless.

Thus, every pathway of investigative work that leads to elucidative outputs on chronic disease remains vital. In this issue, our Japanese colleagues explored the usefulness of OptivolTM, an algorithmic analysis based on continuous intrathoracic impedance monitoring, in conventional bradyarrhythmia pacing patients. On the other hand, our local counterparts looked into speckle-tracking echocardiography (STE)-derived mitral annular displacement after TAVI. Both investigations look into parameters dealing with cardiovascular entities which are addressed by new technologies. Quite expectedly, the necessity for new data is paramount when innovations and advancements are made in the management of cardiovascular diseases.

As technology and science change the manner by which we diagnose and manage cardiovascular diseases, so will these realms bring about the need to keep abreast with changes in physiology, metabolism and biochemistry brought about by devices and interventions. Be it pacing, or a transcatheter-implanted valve stent, or a left ventricular assist device, the concomitant alterations in hemodynamics and structural relationships will naturally bring about new domains that will require insightful evaluations and analysis.

Understandably, we look to big data that will be able to impact healthcare analytics – as they provide us with the statistical capacity and robustness of information in applying them to clinical practice. We likewise eagerly await mega clinical trials – as they will solidly impact the clinician’s capability and decision making as he confronts common medical emergencies and routine clinical situations. Nonetheless, there is always room for well-conducted, pivotal reports and prospective investigations to lead us to valid conclusions – notwithstanding the challenges and limitations imposed by small sample sizes, limited funding, short study durations, among others.
Association of Blood Pressure Patterns with the Clinical Profile of Patients at St. Luke’s Medical Center Quezon City
Authors: Kasilag Mae C , Del Moro Manuel , Igualada Vivaldi
Published: July 2024

INTRODUCTION: Ambulatory blood pressure (BP) monitoring (ABPM) is useful for the assessment of hypertension and nighttime blood pressure (BP) patterns. This study aims to determine the prevalence of abnormal nocturnal BP patterns among Filipinos and its associated risk factors.

METHODS: This was a cross-sectional study of patients (n=304) who underwent ABPM. Age, sex, BMI (≥25 kg/m2 ) hypertension, diabetes, smoking, lipid profile, creatinine, fasting glucose, previous MI and stroke were recorded. The degree of relationship of clinico-demographic factors with dipping and non-dipping BP patterns was determined.

RESULTS: Assessing for risk factors associated with abnormal nocturnal BP, only age (55 years, p=0.009) and diabetes (27.22%, p=0.038) were statistically significant. Age was a significant predictor of abnormal nocturnal BP, explaining 1.69% in the variation of nocturnal BP pattern (p=0.008). For every one-year increase in age, the odds of an abnormal nighttime BP pattern increase by approximately 2.5% (p=0.009).

CONCLUSION: There is a statistically significant association of age and diabetes with dipping and non-dipping BP patterns.
Renal Artery Stenosis in Takayasu’s Arteritis Causing Early-Onset Hypertension: A Report of Four Cases at the UP-Philippine General Hospital
Authors: Abrahan Lauro L , Cunanan Elleen L , Prieto Percy Jun G , Aherrera Jaime Alfonso M , Faltado Antonio L , Abola Maria Teresa B
Published: July 2024

Background: In foreign literature, 90% of renal artery stenosis (RAS) is atherosclerotic, while 10% is secondary to fibromuscular dysplasia (FMD). However, an important differential for hypertension in the young Asian population is Takayasu’s arteritis. We present four patients who initially presented with hypertension in the young due to RAS. Clinical criteria coupled with non-invasive studies in all four cases led to the diagnosis of Takayasu’s arteritis. All four patients had good outcomes.

Case: Four patients (one male and three females) all presented with early-onset hypertension in the third decade of life. Two of the females were pregnant at the time they were seen by the Cardiology service at our institution. Physical examination of the abdomen and peripheral pulses provided clinical clues that suggested the diagnosis of Takayasu’s arteritis. All four patients had confirmed significant RAS on CT aortogram studies, thus explaining their elevated blood pressures. None of them had significant elevations in serum creatinine. The patients were given varying combinations of anti-hypertensive medications with or without prednisone to control vasculitic flares/disease activity. All four patients had good outcomes. The two pregnant in-patients were successfully discharged after their emergency cesarean sections, and all four went on regular follow-up at the outpatient clinic with controlled blood pressure levels.

Significance: This case series highlights that with the rarity of Takayasu’s arteritis, a thorough history and and conclusions physicalexamination are crucial in raising our index of suspicion for this disease as a possible cause of RAS and secondary hypertension. This report also emphasizes the complexity of managing pregnant patients with Takayasu’s arteritis. Early recognition, a multidisciplinary team, and optimal medical management are the keys to successful outcomes.

Keywords: renal artery stenosis, Takayasu’s arteritis, secondary hypertension, vasculitis.
Commentary on “Clinical Profile and Management Approach of Patients Diagnosed with Resistant Hypertension in the Philippine General Hospital”
Authors: Aherrera Jaime Alfonso M
Published: July 2024

This descriptive cohort conducted at the Philippine General Hospital focused on the burden of resistant hypertension in the institution’s hypertension clinic. Resistant hypertension is generally defined as uncontrolled blood pressure despite maximum doses of three anti hypertensives (including a diuretic) after ruling out pseudo-resistant hypertension (e.g., improper measurements, white coat effect, poor adherence to medications). In this cohort, the authors were able to identify 51 (from 93) patients with resistant hypertension.
Comparison of Body Mass Index, Waist-to-hip Ratio and Waist-to- height Ratio as Predictor of the Severity of Coronary Artery Disease Based on Gensini Scoring System on Coronary Angiography
Authors: Tomandao Kathy Lou B , Tiempo Edwin K
Published: July 2024

OBJECTIVE: This study aimed to determine the correlation of body mass index (BMI), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) with the severity of coronary artery disease (CAD) based on the Gensini scoring system on coronary angiography among Filipinos.

METHODOLOGY: This was a cross-sectional, analytical study conducted at Perpetual Succour Hospital–Cebu Heart Institute. It included all admitted Filipino patients who were suspected to have CAD with indications to undergo coronary angiography from March 1, 2014 to September 30, 2014.

RESULTS: A total of 101 patients were included in the study. The mean BMI was 26.83 kg/m2, with most patients (45.5%) having normal BMI. Forty percent were overweight, 7.9% were obese and 6% were very obese. The mean WHR was 0.98 and 97% of patients had a high ratio. The mean WHtR was 0.59 and 96% had a high ratio. Fifty-six percent had significant CAD. The mean Gensini Score was 41.14 and 50.5% of patients had a score of >20. BMI showed no correlation with the severity of CAD by Gensini score (p=0.355). There was a trend towards a weak positive correlation between WHR and Gensini score (r=0.194; p=0.052). WHtR did not show a significant relationship with severity of CAD based on Gensini score (p=0.801).

CONCLUSION: BMI, WHR and WHtR did not show significant correlations with the presence of significant CAD. However, there was a trend towards a weak positive correlation between WHR and CAD severity by Gensini score; hence, it may still be useful as a predictor for CAD severity among Filipinos.

KEYWORDS: Anthropometric indices, body mass index, waist-to-hip ratio, waist-to-height ratio, coronary artery disease, Gensini score.
Achromobacter Xylosoxidans Late-onset Prosthetic Mitral Valve Infective Endocarditis: A Case Report
Authors: Reganit Paul Ferdinand M , Parreno Luna , Santos Roman
Published: July 2024

This is the case of a 35-year-old Filipino female who presented to the Philippine General Hospital with a chief complaint of fever. Two weeks prior to admission, she experienced high-grade fever (39 degrees Celsius) accompanied by chills, anorexia, and easy fatigability. A few hours prior to admission, she complained of slurred speech, right upper and right lower extremity weakness, and high-grade fever. She was diagnosed with rheumatic heart disease in the past, with mitral stenosis, and atrial fibrillation. She has undergone prosthetic mitral valve replacement. She denies intravenous drug use.

On examination, she was awake, with stable vital signs and a body temperature of 39 degrees Celsius. Auscultation revealed an irregular heart rhythm, metallic S1, accentuated S2, and a 3/6 systolic murmur at the fourth left paqrasternal border. Motor strength was normal.

She had leukocytosis (11.6 X 109 cells/L)þ and nromal coagulation profile. Transthoracic echocardiography revealed a dilated left atrium, a prosthetic mitral valve with good opening and closing motion, and a 0.2 x 0.4 cm oscillating mass in the ventricular aspect of the mitral valve. Blood cultures revealed Achromobacter xylosoxidans sensitive to piperacillina-tazobactam, co-trimoxazole, and ciprofloxacin.

Piperacillin-tazobactam 4.5 g IV every 8 hrs and co-trimoxazole 800/160, 1 tab po every 8 hrs were given; however, due to resulting leukopenia, ciprofloxacin 500 mg/tab 1 ½ tab po q 12 hrs was substituted. Surveillance blood cultures were all negative. A follow-up transesophageal echocardiography revealed a prosthetic mitral valve with good opening and closing motion with no vegetations seen.

CONCLUSION: A xylosoxidans is a rare human pathogen and causes invasive disease such as infective endocarditis in immunocompromised and debilitated patients resulting in high mortality. Prompt and effective use of antimicrobials improves survival, but removal of prostheses may be considered in the presence of unresponsive or recurrent infection.

KEYWORDS: Achromobacter xylosoxidans, prosthetic valve, infective endocarditis
Continuous-Flow Left Ventricular Assist Device (LVAD) Implantation as Destination Therapy in a Patient with End-Stage Heart Failure Complicated with Cardiorenal Syndrome
Authors: Manaloto Jastin Gilbert G , Arellano-Simon Fe-Aileen F , Cristobal Donald C , Garcia Jorge M
Published: July 2024

End-stage heart failure (HF) has a one-year mortality rate of >50% and the only definitive management is heart transplant. However, left ventricular assist device (LVAD) as destination therapy has demonstrated a significant mortality benefit compared to optimal medical therapy in patients who are deemed ineligible for heart transplant. We present the case of a 70-year old Filipino, male, known to have severe left ventricular systolic dysfunction and had repeated admissions due to decompensated HF. His condition was complicated with cardiorenal syndrome (CRS) necessitating hemodialysis. A continuous-flow LVAD (Heartmate II) was implanted as destination therapy. The patient remained hemodynamically and clinically stable post-operatively and eventually discontinued hemodialysis. He was discharged with improved functional capacity (New York Heart Association [NYHA] functional class II-III) and was no longer readmitted for worsening of HF thereafter. No further hemodialysis was needed after six months. This is the first reported case of a successful continuous-flow LVAD implantation in the Philippines in a patient with end-stage HF complicated with CRS.

KEYWORDS: Left ventricular assist device, LVAD, Heartmate II, destination therapy, end-stage heart failure
Clinical Profile of Patients with Chronic Venous Insufficiency in a Community-Based Population in the Philippines: National Nutrition and Health Survey
Authors: Abola Maria Teresa B , Maravilla Lilibeth M , Salvador David Raymund K
Published: July 2024

There is a scarcity of data on the prevalence and presentations of chronic venous disease (CVD) and chronic venous insufficiency (CVI) among Asians. Our study population comprised 7,212 subjects surveyed during the last National Nutrition and Health Survey (NNHeS) in 2008. The previously validated Southern Tagalog Venous Insufficiency Questionnaire (STVIQ) was used by research assistants to identify patients with CVD. The survey found that 52.5% of the subjects had CVD, while only 1.6% had CVI. CVD is common in the Philippines. It is reported in approximately five out of 10 Filipinos, both as a symptomatic condition (about 60% report symptoms) and as manifested by visible veins. CVD is more common among women, and it increases in prevalence with age. It may lead to loss of productivity and greater healthcare costs. Early recognition and education may be necessary to increase awareness of this disorder. Early therapy may likewise be warranted to prevent its long-term debilitating sequelae. Increasing awareness of CVI and CVD among primary care physicians and other healthcare providers, as well as providing them with a low-cost clinical screening tool, will significantly contribute towards diminishing the burden of CVD.
Percutaneous Transcatheter Closure of a Stented Patent Ductus Arteriosus in a Patient With Critical Pulmonary Stenosis: A Case Series
Authors: Quitola Ma. Rosita S , Reganion Juan G , Villareal Jean Antonio G
Published: July 2024

INTRODUCTION: TStenting of the ductus is an alternative to surgical shunt in patients with  critical pulmonary stenosis who remain ductal dependent following valvuloplasty. Stents close  spontaneously after improvement of right ventricular function; however, in rare cases, stents fail  to completely endothelialize, resulting in pulmonary overcirculation. 

CASE PRESENTATION: The first case was a 3-year-old who had critical pulmonary stenosis  at birth, and the second case was a 3-year-old boy who at 5 months of age was managed  for severe pulmonary valve stenosis. Both underwent stenting of the duct and percutaneous  pulmonary balloon valvuloplasty. On follow-up, the patent ductus arteriosus (PDA) stent of both  cases remained patent even after an adequate growth and improvement of the right ventricle,  resulting in significant left-to-right shunting and development of increased pulmonary blood flow;  hence, percutaneous transcatheter closure of the stented PDA was done. 

DISCUSSION: Stenting of the ductus allows significant and balanced growth of the pulmonary  artery in patients with duct-dependent congenital heart diseases leading to adequate growth  of the right ventricle. Persistence of patency of stent causing significant left-to-right shunting  warrants closure of the PDA stent. Closure of the stent is challenging and requires a high degree  of technical skill because of the difficulty to enter the partially closed stent. 

CONCLUSION: Percutaneous transcatheter closure of a stented PDA in patients with critical  pulmonary stenosis can be a technically challenging procedure because of the difficulty to  enter the stent due to the presence of intrastent endothelial proliferation. 

KEYWORDS: congenital heart disease, critical pulmonary stenosis, patent ductus arteriosus,  transcatheter device closure, stent
Risk Factors Associated with Acute Kidney Injury in Neonates and Infants Following Open Heart Surgery
Authors: Tria Kristine Gay S , Balderas Jhuliet J , Azcueta Ma. Bernadette A , Marbella Ma. Angeles G
Published: July 2024

BACKGROUND: The complexity of surgical cardiac procedures is on the rise, resulting in  prolonged cardiopulmonary bypass time and stay in the intensive care unit. One major complication  of cardiac surgery is acute kidney injury. The aim of this study is to investigate the incidence and  risk factors associated with acute kidney injury following open heart surgery. 

METHODOLOGY: This is a retrospective cohort study that involved chart review of patients <1  year old who underwent open heart surgery from January 2012 to December 2017 in a tertiary  cardiovascular referral center. Preoperative characteristics included age, gender, weight, cardiac  diagnosis, baseline serum creatinine, history of mechanical ventilation and cardiac catheterization  and pre operative medications given. Intra-operative characteristics included cardiopulmonary  bypass and cross clamp time of cardiac surgery, and degree of hypothermia . Post operatively,  urine output, systolic blood pressure, mean arterial pressure, highest serum creatinine and blood  urea nitrogen were recorded.  

RESULTS: Sixty one (61) patients were included in the study. Nine patients (15%) developed  post-operative acute kidney injury, two of which underwent peritoneal dialysis. Lowest systolic  blood pressure and lowest mean arterial pressure were noted to be significant in the development  of acute kidney injury with odds ratio of 0.95 (p=0.049) and 0.93 (p=0.025), respectively. The  duration of mechanical ventilation was also significantly increased in patients who developed acute  kidney injury (p=0.028).  

CONCLUSION: Lowest systolic blood pressure and lowest mean arterial pressure are significant  risk factors for acute kidney injury in neonates and infants following open heart surgery.  

KEYWORDS: acute kidney injury, acute renal failure, cardiac surgery in infants, congenital heart  disease, cardiopulmonary bypass time
The use of the Numbered Head Together (NHT) Learning Model to Improve the Learning Outcomes of Class V Elementary School
Authors: Rahmah Siti , Marlina Marlina , Saufi Muhammad
Published: July 2024

This research is classroom action research carried out in four stages, namely planning, implementation, observation, and reflection. This research aims to improve the science learning outcomes of fifth-grade students at Muhammadiyah Elementary School, who met 20 people consisting of 11 men and 9 women. Data collection was carried out using tests and observations. The research instruments used were test items on student learning outcomes and observation sheets of teacher and student activities. The results of this study stated that there was quite a good improvement, completeness in cycle I of meeting 2 was 50% complete, while in cycle II of meeting 2 completion reached 90%. Based on these data, it can be concluded that using the Numbered Head Together learning model can improve the science learning outcomes of Class V Muhammadiyah Elementary School students.