bluuebunny/crossref_metadata_2025 huggingface dataset:
The Impact of 24/7 On-call Schedule of Interventional Cardiologists on the PCI Outcomes of STEMI Patients (ICONIC POST Study)
Authors: Villasis Ramon Christian S.M , Prado Paolo A
Published: July 2024

INTRODUCTION: Percutaneous coronary intervention (PCI) is the preferred treatment for ST elevation myocardial infarction (STEMI) and should be done within the recommended door-to balloon time (D2B) of 90 minutes or less. Progressive delays between onset of symptoms and PCI result in significantly higher in-hospital and long-term mortality. Various initiatives are done to  augment timely administration of PCI. 

METHODS: This ambidirectional cohort study was conducted to investigate the effect of  implementing a 24/7 on-call schedule of interventional cardiologists on D2B and In- hospital all cause mortality of STEMI patients admitted in a local tertiary hospital. The study entailed review  of the Cardiovascular Institute’s AMI Data registry and Chest Pain Pathway Data from September  14, 2015 until Sept 15, 2018.  

RESULTS: Eighty-seven patients, 32 to 85 years old, with STEMI and underwent emergent  PCI were included in this study. The results of data analyses showed decreasing trend in D2B  of the Revised group compared to the Baseline group (mean D2Bbaseline 116 minutes vs. mean  D2Brevised 113.48 minutes). Decreasing trend was also noted in the Disposition-to-Balloon  time (Dis2B) (mean Dis2Bbaseline=94.3 minutes vs mean Dis2Brevised=85.6 minutes). The results  further showed 4% mortality decrease during the Revised period (Mortalitybaseline 11.1% vs.  Mortalityrevised=7.1%). However, these observed differences were not statistically significant. In  terms of D2B, the institution lags behind the international standard but performs better compared  to the nationwide performance of 1,249.43 minutes in the Philippine ACS Registry. This study  supports the continuation of the on-call schedule among interventionist responding to STEMI  cases. 

KEYWORDS: 24/7 On-call schedule, Door-to-balloon time, Disposition-to-baloon time, Mortality,  STEMI
Comparison of Accuracy of Bleeding Risk Scores in Predicting Bleeding Events in Patients with Mechanical Prosthetic Valve
Authors: Tuplano Romelie M , Lacson Sharon , Jaluague-Villanueva Maria Johanna
Published: July 2024

INTRODUCTION: Individualizing dose alteration of warfarin remains a challenge while optimizing  the benefit from warfarin and avoiding bleeding events. Hence, this study aimed to compare  the accuracy of bleeding risk scores in predicting bleeding events in patients with a mechanical  prosthetic valve. 

METHODOLOGY: This is a prospective cohort study that includes 123 adult patients who  underwent warfarin therapy after mechanical valve replacement done between January 2019  to March 2020. Bleeding risk stratification based on RIETE, HASBLED and ATRIA scorings and  telephone follow-up until 1 year to check for the bleeding outcome were done. 

RESULTS: Bleeding was noted in 23 patients (18.7%). There is no significant difference between  the demographic and clinical profile of patients in the bleeding and non-bleeding group except  for the highest INR obtained during admission for valve surgery. The mean highest INR obtained  in the bleeding group is 4.34 + 2.67 which was significantly higher than in the non-bleeding  group (2.83 + 1.8). Using the scorings, risk stratification for bleeding between the groups was the  same. 

CONCLUSION: There is no sufficient evidence to conclude that RIETE, HASBLED, and ATRIA  are accurate in predicting bleeding events in patients who underwent mechanical valve surgery.  Labile INR is a significant predictor of bleeding events.
Single Antiplatelet Therapy Versus Dual Antiplatelet Therapy After Transcatheter Aortic Valve Replacement: A Meta-analysis of Randomized Controlled Trials
Authors: Sayat Glein M , Gerodias Ferdinand R , Gonzales Porciuncula Lea Arceli D
Published: July 2024

INTRODUCTION: After transcatheter aortic valve replacement (TAVR), ischemic/embolic complications and bleeding remain important because it correlates with mortality. The optimal antithrombotic regimen after successful TAVR remains unclear. This study compared the efficacy and safety of single antiplatelet therapy (SAPT) versus dual antiplatelet therapy (DAPT) among post-TAVR patients. 

METHODS: Extensive search of PubMed, MEDLINE, Cochrane, and Ovid was done for articles published until November 20, 2020. Studies were limited to randomized controlled trials. Outcome measures include stroke, myocardial infarction (MI), all-cause mortality, and major bleeding. Two reviewers independently reviewed the studies. Results were gathered from published articles, journals, and clinical trials. Studies were critically appraised with regard to methods of minimizing bias. All four studies included received a quality scale for meta-analysis overall score of not less than B. Statistical analysis was done using Review Manager V5.4. 

RESULTS: Four randomized controlled trials with 1086 patients were included in this meta-analysis. Overall, the risk of stroke (odds ratio [OR], 0.94 [0.54–1.64]), MI (OR, 0.50 [0.18–1.40]), and overall mortality (OR, 1.01 [0.65–1.57]) did not differ significantly between DAPT and SAPT. There was increased risk of bleeding noted with DAPT, thus favoring SAPT (OR, 0.44 [0.30–0.65]). 

CONCLUSION: Among patients who underwent TAVR, DAPT compared with SAPT had similar rates of stroke, MI, and death. Because of lower rates of bleeding, we recommend using single antiplatelet therapy after TAVR. 

KEYWORDS: TAVR, TAVI, antiplatelet, single antiplatelet therapy, antithrombotic, DAPT
Epidemiology of Cardiovascular Diseases in Southeast Asia: A Systematic Review
Authors: Valencia Jeffrey , Malaluan Namphril , Cheng Paula Victoria Catherine , Alvarez Michael Brian , Sy Rody , Punzalan Felix Eduardo
Published: July 2024

BACKGROUND: Cardiovascular disease (CVD) is a group of disorders of the heart and blood  vessels, which includes coronary heart disease, cerebrovascular disease, and peripheral  artery disease. It is currently the leading cause of death worldwide. Currently, there is paucity  in the available epidemiologic data of CVD in Southeast Asia (SEA). 

OBJECTIVE: To determine the prevalence, mortality rate, and associated risk factors of  CVD (specifically ischemic heart disease, stroke, and peripheral artery disease) among adult  populations in SEA. 

METHODS: A systematic review of published articles between 2015 and 2020 was  conducted. The authors also searched the World Health Organization database and publicly  available health department websites of Southeast Asian countries. 

RESULTS: The overall prevalence of CVDs in SEA is 5.48%. Specifically, the prevalence of  ischemic heart disease is 1.54% and is highest in Thailand (2.54%). Ischemic stroke has a  prevalence of 1.03% and is highest in Indonesia (1.97%). Prevalence of peripheral artery  disease is 1.36% and is also highest in Thailand (1.92%). Mortality rate from CVD in SEA  is 13.41%. Hypercholesterolemia, smoking, and hypertension are the most common risk  factors, with prevalence of 41.2%, 21.1%, and 20.9%, respectively. 

CONCLUSION: The prevalence and mortality rate of CVD in SEA remain high and are  associated with high prevalence of underlying risk factors. Interventions should be  strengthened to improve the overall picture in the region. Collaborative efforts among  Southeast Asian countries are essential not only in generating comparative epidemiologic  data but also in sharing best practices in lowering CVD mortality and morbidity. 

KEYWORDS: cardiovascular disease, ischemic heart disease, stroke, peripheral artery  disease, risk factors, Southeast Asia
July - December 2020 Editorial
Authors: Bernan Alisa P
Published: July 2024

We need research for scientific advancement, to contribute to what we know or contradict what is known. We need to test theories in a systematic manner and for our results to be communicated, hopefully be replicated, and generate more questions for the future.

The research papers submitted to the PJC are either descriptive, exploratory, explanatory or correlational and could be quantitative or qualitative according to the type of data used. We are limited to these types of research as we are inclined more on being clinicians rather than researchers with budgetary constraints. In this era of the Covid 19 pandemic, our attention is centered on patient care and survival, both for ourselves and our family. Hence, research in Cardiology had to take a back seat as we grapple with the reality of this pandemic. It is with pride though that we are able to come up with enough articles for this issue of the PJC. We commend the efforts of our fellows and fellows-in- training for keeping the fire of research burning. We also have a great PJC team who work in harmony to produce something of value worthy of being read for years to come.

Mag-ingat po tayo at mabuhay tayong lahat!
Low-Dose Thrombolysis in an Intermediate High-Risk Submassive Pulmonary Embolism With Right Atrial Thrombus: A Case Report
Authors: Suero Joyce Karla , Patiño Irene , Mendoza Jeffrey
Published: July 2024

BACKGROUND: Venous thromboembolism, encompassing pulmonary embolism (PE) and deep  vein thrombosis (DVT), is the third most common acute cardiovascular syndrome. It requires  prompt diagnosis and risk-based treatment strategies. 

CASE: A 47-year-old male, 30-pack-year smoker who recently underwent open reduction and  internal fixation of the right femur presented with dyspnea. There was no hemodynamic instability.  Twelve-lead electrocardiogram showed sinus rhythm with incomplete right bundle-branch  block, and troponin was elevated. Chest x-ray showed dilated right descending pulmonary  artery. Two-dimensional echocardiogram revealed right atrial thrombus with right ventricular  dysfunction. Computed tomography of the pulmonary artery confirmed massive PE with infarct  on the posterobasal segment of the right lower lobe. Venous duplex scan of the lower extremities  showed an acute DVT of the right femoral vein, popliteal vein, and peroneal vein. Anticoagulation  was started. With a dilemma of a recent surgery in an intermediate high-risk submassive  PE, options other than guideline-recommended systemic thrombolysis were considered. A  multidisciplinary consensus recommended the administration of low-dose thrombolysis, which  later resulted to clinical improvement. 

CONCLUSION: This is the first documented local case of successful resolution of a right  atrial thrombus with pulmonary thrombus and DVT using low-dose thrombolysis, without  complications of bleeding, in a patient with contraindications to thrombolysis. With more clinical  experience and studies of low-dose recombinant tissue plasminogen activator in this special  population, it can offer a promising treatment option. 

KEYWORDS: pulmonary embolism, submassive, low-dose systemic thrombolysis,  contraindication for thrombolysis, alteplase, tPA, right atrial thrombus
Clinical Profiles and Short-term Outcomes Among Young Filipino Adults Diagnosed with Acute Coronary Syndrome: Results from the PHA ACS Registry
Authors: Lerios Jeannica Kriselle G , Yaneza Liberty , Ramboyong Raul E
Published: July 2024

BACKGROUND: There is increasing incidence of acute coronary syndromes (ACS) among patients younger than 40 years old. This study describes the clinical and angiographic profiles of these patients in the Philippine setting, along with their chosen treatment strategies and short-term outcomes up to one year from diagnosis.

METHODS: Data was analyzed from 3,346 consecutive patients from November 2011 to November 2015, as part of the Philippine Heart Association ACS registry. The profiles of patients less than 40 years old were compared against those 40 years old and above.

RESULTS: A total of 129 (3.86%) patients were less than 40 years of age. The majority were male (89.1% vs. 67.5%; p=0.0001), obese (53.1% vs 41%; p=0.26), current smokers (51.9% vs. 27.2%; p=0.0001), and had a family history of CAD (30.2% vs 22.8%; p=0.027). Hypertension was common to both age groups. The young had higher total cholesterol, LDL, HDL, and triglyceride mean levels.

Twenty percent of the total population utilized government health insurance, while half had no form of insurance coverage. Younger patients had a shorter trend for symptom-to-door time with typical angina as the predominant complaint (87.6% vs. 75.3%; p=0.006). Among the patients who underwent coronary angiography (34%), majority of the young had single-vessel disease (51.5% vs 32%; p=0.011). Referral to cardiac rehabilitation was similar across groups. A higher percentage of younger patients continued to smoke on follow-up (14.3% vs 6.19%; p=0.01). Survival rates up to a year were comparable across both groups (100% vs 98.2%; p=0.564).

CONCLUSION: ACS among young Filipino adults occurs mostly in males. Risk factors are predominantly modifiable such as dyslipidemia, smoking, and obesity, except for a family history of CAD. Majority had ST elevation myocardial infarction as initial presentation. Overall, only a third of the young patients opted for reperfusion strategies and were referred to cardiac rehabilitation. In-hospital morbidity was better in the young, but mortality rates up to one year of follow-up were comparable. Stringent risk factor modification and improvements in government insurance policies are therefore recommended especially for the young.
Early and Late Outcome of Surgery for Ebstein Anomaly: A 20-year Experience in Philippine Tertiary Centers
Authors: Jara Raul , Javier Angelo Dave C , Lasco Jun Maximo F , Chiong Lowe L
Published: July 2024

BACKGROUND: Ebstein Anomaly (EA) is a rare congenital heart disease. Clinical presentation depends on the severity of tricuspid valve displacement and associated intracardiac congenital anomalies. Surgical indications have been described on recent guidelines, resulting in favorable outcomes in well-selected patients. There is no published experience in tricuspid valve surgery for EA in the Philippines.

OBJECTIVES: To describe the clinical profile of patients who underwent cardiac surgery for EA from 1992 to 2012 in the Philippines, and to compare the clinical characteristics of survivors and immediate non-survivors of tricuspid valve surgery for EA.

METHODOLOGY: This was a retrospective cohort study on patients who underwent cardiac surgery from 1992 to 2012, at the Philippine Heart Center and Philippine General Hospital. Characteristics between survivors and non-survivors were compared.

RESULTS: Twenty-eight patients underwent cardiac procedures for EA from 1992 to 2012 in the Philippines. The mean age at operation was 12 years. Majority of the patients were males (57%) and were at least 18 years old (75%). Among the 28 patients, 21 were identified to have undergone a definitive treatment (i.e., either tricuspid valve (TV) repair or replacement. Mean total bypass time was 148.71 minutes ± 133.31. Mean total cross-clamp time was 89.89 minutes ± 46.65. The most common surgical complications were prolonged intubation (32%) and atrial arrhythmias (21%). The average length of hospital stay was 20.67 days ± 11.64. Follow-up was possible in 20 out of the 21 patients (95%). There were three early deaths (< 30 days), all of whom had TV repair. Of the 18 survivors, 15 underwent TV repair while three underwent TV replacement. Non-survivors had significantly lower arterial oxygen saturation (p=0.045), more post-operative bleeding (p=0.014), and greater post-operative need for hemodialysis (p=0.014). Exact logistic regression did not reveal any significant predictor of mortality among the various characteristics analyzed, probably due to the small number of patients in this study.
Factors Associated with Reperfusion Lung Injury After Total Correction of Tetralogy of Fallot
Authors: Gayeta Claudio , Reganion Juan , Sanz Bianca , Zampaga Sarah
Published: July 2024

INTRODUCTION: Reperfusion lung injury (RLI) is one of the most common complications after Tetralogy of Fallot (TOF) correction which leads to prolonged hospitalization and significant  morbidity. This study aimed to investigate the different factors that may be associated with RLI after TOF correction. 

METHODS: All patients who underwent TOF correction from January 2015 to December 2016 in a tertiary cardiovascular referral center were included. Baseline characteristics, echocardiographic and intraoperative findings along with their post-operative course were reviewed. Serial chest radiographs were reviewed and each lung was given a pulmonary edema score prior to and after surgery to determine the presence of RLI. Statistical analysis was performed using Stata SE version 13. Factors associated with RLI were determined using logistic logarithm analysis. The level of significance was set at 5%. 

RESULTS: RLI was present in 41 of 114 (36%) patients after TOF correction. Female sex was associated with the development of RLI (OR 2.9; 95% CI 1.29-6.55; p=0.01). Intraoperative use of propofol was a protective factor, with an OR of 0.24 (95% CI 0.07-0.85, p=0.027). We did not identify a significant association between the occurrence of RLI and the factors that reflect the degree of pulmonary stenosis. 

CONCLUSION: RLI is common after TOF correction. Female sex increases the odds of its occurrence while intraoperative use of propofol is a protective factor. 

KEYWORDS: Tetralogy of Fallot, TOF correction, reperfusion lung injury
Comparison of the EuroSCORE II, STS and Ambler Scoring Systems in Predicting In-hospital Mortality Among Patients Undergoing Heart Valve Surgery
Authors: Awaloei Andre S , Ongjoco Edgar Y , Rico Aquileo C
Published: July 2024

Background: Risk models are helpful in planning perioperative care in patients undergoing heart valve surgery. In the absence of a local risk model, the European System for Cardiac Operative Risk Evaluation (EuroSCORE II), Society of Thoracic Surgery (STS) risk score and Ambler scores are frequently used in our institution to predict in-hospital mortality after heart valve surgery.

Objective:To compare the accuracy of the EuroSCORE II, STS and Ambler scoring systems in predicting in-hospital mortality among patients who underwent heart valve surgery.

Methods: From January 2008 to December 2015, the data of 162 patients who underwent heart valve surgery were collected through medical record review. EuroSCORE II, STS and Ambler scores were calculated for each patient. Calibration of these scores were assessed by the Hosmer–Lemeshow test and discrimination was tested by calculating the area under the receiver operating characteristic (ROC) curve.

Results: The overall observed mortality was 6.17%. The EuroSCORE II, STS and Ambler scores underestimated in-hospital mortality (4.13%, 3.47%, and 4.12%, respectively; p<0.05 for all) but had good discriminative power (ROC area 0.82, 0.88 and 0.77, respectively) in patients who underwent single heart valve surgery. In the subgroup analysis of those who underwent isolated mitral valve surgery, the EuroSCORE II, STS and Ambler scores underestimated in-hospital mortality but had good discriminative power. In the subgroup analysis of patients who underwent aortic valve surgery, the EuroSCORE II, STS and Ambler scores showed good calibration in predicting in-hospital mortality, but only the STS score showed excellent discrimination. For dual valve surgery (observed mortality 4.0%), the EuroSCORE II and Ambler score showed good calibration (2.58% and 2.6%, p>0.05 for both) and discrimination (ROC area 0.83 and 0.85, respectively) in predicting in-hospital mortality.

Conclusion: In this single-center retrospective study, the EuroSCORE II, STS and Ambler scores underestimated overall in-hospital mortality after heart valve surgery. All three scores had good discriminative power; however, the STS score showed better performance compared to the EuroSCORE II and Ambler score in identifying high surgical risk individuals who underwent heart valve surgery.
UP- PGH Division of Cardiovascular Medicine Fellowship Training and COVID-19: Opportunities and Innovations
Authors: Punzalan Felix Eduardo , Agustin Ruth Divine , Evangelista Lauren Kay , Tuazon Cecileen Anne , Beluso Michael Vic , Gloria Frederick Philip B , Magno Jose Donato A
Published: July 2024

BACKGROUND: The COVID-19 pandemic greatly affected training programs because  of changes in patient load and service assignments. This posed certain challenges in the  implementation of the pre–COVID-19 training curriculum recommendations by the Philippine  Heart Association Specialty Board on Adult Cardiology. 

OBJECTIVE: This article describes the challenges, training adjustments and innovations,  and the impact on the training program of these changes instituted by the University of the  Philippines–Philippine General Hospital (UP-PGH) Division of Cardiovascular Medicine (DCVM)  during the COVID-19 pandemic. 

METHODS: This is a descriptive article based on review of changes and improvements of the  UP-PGH DCVM training manual and guidelines adopted during the COVID-19 pandemic. 

FINDINGS: The COVID-19 pandemic challenges provided opportunities for innovation of the  training program. The program emphasized focus on maximizing team-based learning from  every clinical encounter toward achievement of learning outcomes and competency. The  training committee closely monitored the learning environment and trainee’s learning progress  to achieve outcomes beyond the traditional metrics such as census and procedural numbers.  It adopted online clinical encounters, conference, and case discussion. To enhance learning,  virtual engagement supplemented physical encounters between consultants and training fellows  assigned to various clinical rotations. Real-world research results on the impact of COVID-19  on cardiovascular health were utilized to enhance knowledge. Risk mitigation and transmission  reduction strategies were adopted to ensure safety of all staff. The division also incorporated  a strong wellness program to provide holistic approach to trainees’ and trainers’ health. New  competencies were developed such as telemedicine, infection prevention and control, and  creation of virtual patient education programs. 

CONCLUSION: The training institution met the challenges posed by the COVID-19 pandemic  with resiliency and unity. The adjustments and innovations in training instituted by PGH DCVM  proved useful in addressing the challenges posed by the pandemic. The situation was viewed  

as an opportunity to innovate and pursue a better program adaptive of the ever-changing  environment, toward forming competent future cardiologists by enhancing focus not only on  numbers but rather on the process of achievement of learning outcomes, embracing virtual and  online strategies, institutionalization of wellness program, and development of new guidelines in  the approaching patient management cognizant of both health care provider and patient safety  and new competencies such as patient virtual education and telemedicine in cardiology.
Bifurcation Stenting Using Bioresorbable Vascular Scaffold in an Adult Male With Radiation-Induced Coronary Artery Disease and Hodgkin Lymphoma: A Case Report
Authors: Lucero Jonald O , De Jesus Jeffrey , Cruz Jose Nicholas , Tiongco Richard Henry
Published: July 2024

INTRODUCTION: Radiation-induced coronary artery disease is associated with absolute risk between 0.1% and 0.5% per year after mediastinal radiotherapy of Hodgkin disease. Risk increases with time and becomes statistically significant after 10 years. This often involves the left anterior descending (LAD) and right coronary arteries with proximal arterial narrowing involving the coronary ostia. This is the first documented case of radiation-induced coronary artery disease in a 25-year-old Filipino man diagnosed with nodular sclerosing-type Hodgkin lymphoma stage IIA treated with percutaneous revascularization using bioresorbable vascular scaffolds in a bifurcation type of lesion admitted at St Luke’s Medical Center for chest pain. Patient reported progressive worsening of exertional angina 16 months after chemotherapy and external beam radiation therapy in the neck and mediastinum. Treadmill exercise test revealed inducible ischemia in the inferior leads at stage 3, 7 metabolic equivalents. Coronary angiogram showed severe stenosis involving the midsegment of the proximal LAD artery and the ostial-to-proximal segment of the first diagonal branch, a bifurcation lesion, Medina 1,1,1. A percutaneous coronary intervention was successfully done using two bioresorbable vascular scaffolds via T-and-protrude bifurcation stenting technique and achieves a brisk TIMI (Thrombolysis In Myocardial Infarction) 3 flow. Follow-up after 6 months showed a normal treadmill exercise test. However, patient still complains of occasional chest pain and epigastric discomfort. Coronary angiogram was repeated demonstrating an 80% stenosis in the proximal LAD without evidence of in-stent stenosis. This was confirmed by optical coherence tomography with adequate stent apposition to the intima with a note of a large chronic red thrombus proximal to the previously deployed stent; thus, percutaneous coronary intervention using drug-eluting stent was performed.

KEYWORDS: radiation-induced coronary artery disease, Hodgkin lymphoma, bifurcation stenting, bioresorbable vascular scaffold, optical coherence tomography
Association of Intraoperative Factors with Difficult Weaning from Cardiopulmonary Bypass Among Patients with Preserved Left Ventricular Ejection Fraction Who Underwent Coronary Artery Bypass Grafts
Authors: Roche Meludee Joy , Nuevo Florian
Published: July 2024

OBJECTIVE: To determine the incidence and the associated intraoperative factors that  contribute to difficult weaning from cardiopulmonary bypass (CPB) among coronary artery  bypass graft (CABG) patients with preserved left ventricular ejection fraction (LVEF). 

METHODS: This study was a prospective observational cohort study conducted at a specialty  center from September 1, 2019, to May 15, 2020. It included adult patients diagnosed with  coronary artery disease (CAD) admitted for elective CABG under the CABG Z-Benefit Package,  with an LVEF of greater than 50%. After institutional review board approval, data on consecutive  patients scheduled for elective, isolated CABG and meeting the inclusion criteria were  prospectively collected and analyzed. Descriptive or qualitative statistics was used to summarize  the demographic and clinical characteristics of the patients.  

RESULTS: Data from 52 patients who met the inclusion criteria were included in the analysis,  with 17.3% (n = 9/52) meeting the criteria for difficult weaning from CPB. Of these nine patients,  nine (100%) required use of more than one inotrope and/or vasopressor, and two of the nine  (22.22%) needed to return to CPB after coming off. Of those patients with nondifficult weaning  from CPB, 74.44% (n = 32/43) used a single inotrope, and 42.26% (n = 11/43) successfully  separated from CPB without any need for pharmacological support. Among the various  parameters assessed, logistic regression analysis showed that every unit increase in base deficit  after release of aortic cross-clamp increased the odds of having difficult separation from CPB  by 40.21%. Patients who received nicardipine were also 7.8 times more likely to have difficult  separation from CPB. 

CONCLUSION: In this study of patients with preserved left ventricular function undergoing  CABG surgery, we identified two intraoperative variables associated with difficult weaning from  CPB: (1) base deficit at release of aortic cross-clamp and (2) the use of nicardipine infusion.
Baseline High-density Lipoprotein Cholesterol as a Predictor of Major Adverse Cardiac Events After Elective Percutaneous Coronary Stenting Among Filipinos
Authors: Lasco Jun Maximo F , Vilela Gilbert C
Published: July 2024

BACKGROUND: Low high density lipoprotein (HDL), a common problem among Filipinos, is associated with cardiovascular disease. The association between HDL and outcomes of coronary stenting particularly among Filipinos has not been evaluated.

OBJECTIVE: To determine the association of baseline HDL levels to major adverse cardiac events (MACE) at 1 month and 1 year after percutaneous coronary stenting among Filipinos.

METHODOLOGY: Adult patients who underwent elective coronary stenting were included in the study. Baseline demographic, clinical and angiographic variables were determined. Baseline lipid profile was taken. Association between baseline HDL stratified into low (<40mg/dL in men, <45 mg/dL in women) and high levels (≥ 40 mg/dL in men and ≥ 45 mg/dL in women) with MACE at 1month and 1 year was prospectively determined.

RESULT: A total of 126 patients, 55 with high HDL and 71 with low HDL, were included in the study. The mean levels of HDL of the two groups were 50 mg/dL and 34 mg/dL, respectively. The high HDL group was generally older, had lower triglyceride levels, had fewer smokers, and had more left anterior descending artery involvement. Both groups had similar event-rates during the first 30 days post-stenting. However, the composite of MACE during the 31st day to 1 year was significantly higher in the low HDL group (5 (9.1%) vs 13 (18.3%); p= 0.007) even after adjusting for baseline characteristics. This result was largely driven by acute myocardial infarction and stroke (9.8% vs 1.8 and 8.5 vs 5.5% for low and high HDL group, respectively).

CONCLUSION: Low baseline HDL (<40mg/dL in men, <45 mg/dL in women) is an independent predictor of MACE at one year among Filipinos who underwent coronary stenting.
Ductal Stenting to Retrain the Involuted Left Ventricle in a Late Presenter Infant With Transposition of the Great Arteries, Intact Interventricular Septum
Authors: Quitola Ma. Rosita S , Reganion Juan G , Villareal Jean Antonio G
Published: July 2024

INTRODUCTION: Ductal stenting can be a nonsurgical option and less morbid method to  provide pressure and volume overload to the regressing left ventricle in late presenters of  transposition of the great arteries, intact ventricular septum (TGA-IVS), prior to arterial switch  operation (ASO). 

CASE PRESENTATION: This is a case of an infant diagnosed with TGA-IVS beyond the  neonatal period who underwent balloon atrial septostomy and ductal stenting to retrain involuted  left ventricle prior to definitive ASO. 

DISCUSSION: Ductal stenting is an alternative option in late presenters of transposition of the  great arteries with involuted left ventricle. It provides volume loading and, to a lesser extent,  pressure loading leading to left ventricular hypertrophy. Also, presence of the stented duct allows  improved oxygenation eliminating the need for aortopulmonary shunt. It can be a less morbid  method of left ventricular training because it avoids hemodynamic stress, pulmonary artery  distortion, and neoaortic valve regurgitation. 

CONCLUSION: Ductal stenting in late presenters with TGA-IVS successfully retrains the left  ventricle and achieves safe late ASO. 

KEYWORDS: congenital heart disease, transposition of great arteries, PDA stenting, arterial  switch operation
Myocardial Performance Index Combined with Framingham CHD Risk Score in Determining Angiographic Severity of CAD by Gensini Scoring
Authors: Castillo Jennifer Doria-Del , Tiempo Edwin K , Junia Alex T , Vestal Marivic V
Published: July 2024

OBJECTIVE: The aim of this study was to investigate whether myocardial performance index (MPI) and Framingham Coronary Heart Disease (CHD) score correlated with severity of coronary artery disease (CAD) as assessed by angiography (Gensini scoring), and whether combining the two parameters improved correlation with Gensini scoring.

STUDY DESIGN: Prospective, cross-sectional association study

SETTING: Perpetual Succour Hospital-Cebu Heart Institute

POPULATION: The study included patients suspected to have CAD from June 2011 to February 2012, and had undergone two-dimensional echocardiography and coronary angiography.

METHODS: After recording pertinent baseline characteristics, each patient’s Framingham CHD Risk Score was calculated. MPI was determined by echocardiography. Coronary angiography was performed by interventional cardiologists blinded to the patient’s Framingham Risk Score and MPI. Severity of the angiographic lesions was determined using Gensini scoring determined by a single angiographer.

RESULTS: Male sex and alcohol consumption showed correlation with obstructive CAD (p=0.048 and 0.00, respectively). Framingham CHD Risk Score did not show significant correlation with severity of CAD assessed by Gensini score (r=0.118; p=0.332). MPI was moderately correlated with Gensini score (r=0.444; p-value=0.000), indicating a good predictive value in determining severity of CAD. The fitted model plot revealed that combined Framingham CHD Risk Score and MPI added incremental value in predicting severity of significant CAD (squared-multiple R=0.199)

CONCLUSION: This study shows that Framingham CHD Risk Score alone did not show a correlation with significant CAD. The MPI and combined Framingham CHD risk score showed correlation in determining severity of CAD assessed by Gensini score.
Abnormal Heart Rate Recovery as a Predictor of Coronary Artery Disease in Patients Undergoing Exercise Stress Myocardial Perfusion Imaging: A 4-Year Retrospective Study in Chong Hua Hospital
Authors: Dangazo Keuffel C , Pe Maria Nadith L
Published: July 2024

Background: Abnormal heart rate recovery (HRR) after exercise is associated with an increase in all-cause mortality in both asymptomatic individuals and patients with established heart disease. In clinical practice, myocardial perfusion imaging (MPI) is used to establish the diagnosis and prognosis of coronary artery disease (CAD). This study aimed to determine the relationship between the HRR and the MPI findings of patients who underwent exercise stress test using sestamibi MPI.

Methods: This was a four-year retrospective chart review study that included all patients who underwent exercise stress test using the sestamibi MPI at Chong Hua Hospital from January 2014 through December 2017. HRR was computed as the difference between peak HR and HR at the 60th second. Abnormal HRR was defined as either <12 beats per minute (bpm) from the peak HR after one minute with post-exercise cooldown. Patient demographics and clinical factors were reviewed and analyzed using parametric and nonparametric statistical tools.

Results: A total of 304 patients were included in the study: 68% were male, 86% were aged >40 years. The most common comorbidity was combined hypertension and dyslipidemia (35%). The mean HRR was 31 bpm, and the mean percentage of chronotropic response (PCR) was 86. Eighty-eight percent of the patients had normal HRR. Eighty-six percent had MPI results within normal ranges. The chi squared test results showed no significant relationship between HRR and the diagnosis of inducible ischemia (p=0.141).

Conclusion: About 88% of the study subjects were identified with normal HRR, while only 12% were classified as having abnormal HRR. There was no significant correlation between HRR and MPI findings of inducible ischemia among Filipino who underwent exercise stress MPI in this study.
Ivabradine Versus Beta-blockers in Mitral Stenosis in Sinus Rhythm: An Updated Meta-analysis of Randomized Controlled Trials
Authors: Abrahan Lauro L , Ramos John Daniel A , Cunanan Ellen L , Tiongson Marc Denver A , Punzalan Felix Eduardo R
Published: July 2024

Background: Symptoms of mitral stenosis (MS) are worsened during tachycardia and exercise. Beta-blockers (BB) are used in controlling heart rate (HR) in MS to relieve symptoms, but can cause significant side effects. Ivabradine has a selective action on the sinus node and is devoid of the usual side effects of BB. Only small studies have investigated the role of ivabradine in MS in sinus rhythm.

Objectives: To compare the efficacy of ivabradine with BB in terms of exercise duration, maximum HR achieved, resting HR, mean gradient and working capacity among patients with MS in sinus rhythm

Methods: We conducted a systematic search of studies in all languages using MEDLINE, Google Scholar, ScienceDirect, Scopus, Clinical Key, Cochrane and clinicaltrials.gov databases and review of reference lists of studies. We included randomized controlled trials that compared ivabradine and BB in adults with MS in sinus rhythm and reported data on exercise duration, maximum HR achieved, resting HR, mean gradient or working capacity. Identified studies were assessed for risk of bias using the Cochrane Collaboration Tool for Assessing Risk of Bias. We used inverse variance analysis of fixed effects to compute for mean differences, carried out using Review Manager 5.3.

Results: Pooled analysis from five identified trials showed that among patients with MS in sinus rhythm, ivabradine was better than BB in increasing total exercise duration (mean difference of 32.73 s [95% CI 12.19, 53.27; p=0.002; I2=0%]), reducing maximum HR achieved after exercise (mean difference -3.87 beats per minutes [95% CI -5.88, -1.860; p=0.0002; I2=23%]) and improving work capacity (mean difference of 0.56 metabolic equivalents [95% CI 0.33, 0.80; p<0.00001; I2=0%]). Ivabradine was inferior to BB in resting HR achieved (mean difference of 1.83 s [95% CI 0.39, 3.28; p=0.01; I2=91%]); and similar to BB in terms of mean blood pressure gradient (mean difference of -0.52 mmHg [95% CI -1.20, 0.16; p=0.13; I2=6%]).

Conclusion: Ivabradine was better or at least similar to BB in most outcomes measured and may be considered as an alternative treatment for patients with MS in sinus rhythm who are intolerant to BB.

Keywords: ivabradine, mitral stenosis.
The Effectiveness of Omega-3 Polyunsaturated Fatty Acid Supplementation in Preventing Sudden Cardiac Death and Fatal Arrhythmias among Adult Coronary Artery Disease Patients: A Meta- analysis
Authors: De Guzman Maria Blanca A , Simon Sherrywin A , Ramirez Marcellus Francis L
Published: July 2024

BACKGROUND: Almost 90% of patients develop fatal arrhythmias after acute myocardial infarction. For three decades, studies recommended omega-3 polyunsaturated fatty acid (PUFA) intake in preventing sudden death and lethal arrhythmias in coronary artery disease (CAD). However, recent equivocal and contrasting data question the benefits of omega-3 PUFA.

OBJECTIVES: To evaluate the benefit of omega-3 PUFA in preventing sudden cardiac death (SCD) and fatal arrhythmias among CAD patients.

METHODS: This was a systematic review and meta-analysis of randomized controlled trials comparing the benefits of omega-3 PUFA vs control in preventing SCD and fatal arrhythmias. The primary outcomes were SCD and occurrence of fatal arrhythmias. Secondary outcomes included all-cause mortality; cardiovascular (CV) death, and occurrence of major adverse cerebrovascular and cardiovascular events (MACCE).

RESULTS: Eleven RCTs were included in the meta-analysis. The effect of omega-3 PUFAs on SCD was not significant (RR 0.95, [0.84, 1.08]; p=0.40; I2=0.40). Pooled analysis of five RCTs reporting the effect on fatal arrhythmias was also not significant (RR 0.98, [0.60, 1.61]; p=0.94; I2=0.68). Pooled analysis of the effect on CV death rate favored omega-3 PUFA use (RR 0.91, [0.83, 0.99]; p=0.02; I2=0.21). The effects on all-cause mortality (RR 0.95, [0.84, 1.08]; p=0.42; I2=0.47) and MACCE (RR 1.02, [0.88, 1.18]; p=0.81; I2=0.90) were not significant.

CONCLUSIONS: Omega-3 PUFA oral supplementation showed no benefit in preventing SCD and fatal arrhythmias in CAD. Furthermore, no favorable effects on all-cause mortality and occurrence of MACCE were noted. However, omega-3 PUFAs did PREVENT CV death among CAD patients.
The Risk of Bleeding in Triple Antiplatelet Therapy: Cilostazol Added to Aspirin and Clopidogrel for Coronary Artery Disease Patients Who Underwent Percutaneous Coronary Intervention: A Meta-Analysis Study of Randomized Controlled Trials
Authors: Dangazo Keuffel Caparuzo
Published: July 2024

BACKGROUND: A novel cilostazol-based triple antiplatelet therapy (TAT) was shown in a trial to have a lower restenosis rate than the usual clopidogrel and aspirin dual antiplatelet therapy (DAPT) among patients with coronary artery disease (CAD) who underwent percutaneous coronary intervention. However, TAT may also be associated with an increased risk of bleeding. A systematic review would show further evidence regarding the risk of bleeding among TAT-treated patients.

MAIN OBJECTIVE: To determine the risk of bleeding with TAT composed of cilostazol, aspirin and clopidogrel for CAD patients who underwent percutaneous coronary intervention.

METHODS: This systematic review included randomized controlled trials (RCT) published from 2005 to 2014. Only one study was blinded. These studies compared the risk of major bleeding between DAPT and TAT. Meta-analysis of this outcome was conducted using Review Manager (RevMan) Version 5.3 2014.

RESULTS: The overall relative risk (RR) of major bleeding in TAT patients was 1.23 (CI 95% 0.90, 1.67; z=1.30, p=0.19). The heterogeneity of results of the seven studies was not statistically significant (p=0.88; I2=0%). When isolating those studies with favorable outcome with TAT, the risk of bleeding demonstrated in five studies was also not statistically significant (p=0.11; I2=0%). Sensitivity analysis on two studies with wider deviation and slightly lower rates of bleeding showed no significant influence on the risk of bleeding (RR 0.78; CI 0.29, 2.09; p=0.63; I2=0%).

CONCLUSION: Compared with DAPT, the trend towards increased major bleeding in cilostazol -based TAT did not reach statistical significance.
Clinical Profile, Treatment Strategies, and Outcomes of Filipino Adults with Brugada Pattern Electrocardiogram and Syndrome in a Tertiary Care Hospital in Manila, Philippines
Authors: Alegado-Aseniero Niña Carissa , Muñoz Vince Ryan , Yap Emily Mae , Gabriel Eden , Agbayani Michael Joseph
Published: July 2024

BACKGROUND: Brugada syndrome is an inheritable syndrome that carries an increased risk of sudden cardiac death. This study aims to delineate the natural history, clinical and electrophysiologic profile, treatment strategies, and outcomes of patients with Brugada pattern electrocardiogram (ECG) and Brugada syndrome in a tertiary care hospital in the Philippines.

METHODOLOGY: This is a retrospective observational study of patients diagnosed with Brugada pattern ECG and Brugada syndrome admitted in a single center from 2004 to 2019. 

RESULTS: Twenty-three patients were included in the study. All patients were male. In both groups, the majority were nonsmokers (n = 13) and nonalcoholic beverage drinker (n = 14). In patients with Brugada pattern ECG, all presented as an incidental finding (n = 10; P < 0.001), whereas in Brugada syndrome, six patients presented with out-of-hospital resuscitated cardiac arrest (46.15%, P = 0.019). There were only three patients with a family history of sudden cardiac death. All patients had normal ejection fraction and sinus rhythm. Twenty-one patients had ST elevation (91.30%). Fourteen patients had spontaneous type 1 Brugada pattern ECG, whereas the rest were inducible to type 1 after flecainide test. Seven patients underwent implantable cardioverter-defibrillator implantation before discharge; one patient died at the time of diagnosis, and one had recurrent admission for arrhythmia. No single patient received medical management.

CONCLUSION: Clinical profile, ECG findings, and outcomes were not significantly different between the two groups of patients except for the clinical presentation upon diagnosis. Treatment strategies were guideline-directed.

KEYWORDS: Brugada pattern ECG, Brugada syndrome
The Effectiveness of Using Repetition Drill Technique with Duolingo Application to Improve Vocabulary at Seventh Graders of MTs Al-Huda Reban
Authors: Kurnia Erika Dewi , Widyantoro Arif
Published: July 2024

Vocabulary is one of the elements to master, and this is important. Based on some difficulties in learning English, especially to improve vocabulary. Teachers must be able to find creative and effective ways to teach vocabulary to their students. This study aims to determine the efficacy of the repetition drill method by using Duolingo application to increase vocabulary in seventh grade in MTs Al-Huda Reban. This study employs a quantitative methodology. The study will employ an experimental design and involve two classes, each class consisting four meetings. One class studied English by using technique of repetition drill with Duolingo application and one class without this technique. It can be seen, the experimental class scored 80,54, whereas the controlled class scored 74,46. The two hypotheses are accepted (H1) and the null hypothesis (H0) is rejected (T-test result), as the significant value (2-tailed) 0,006 is less than alpha = 0,05. Based on the outcomes of the N-Gain computation, the average value of 55.0822 falls into the moderately effective category. Thus, it can be said that using the Duolingo application and the repetition drill approach is a useful way to increase vocabulary.
Strategi Hilirisasi Tanaman Purun menjadi Harta Karun di Kalimantan Selatan
Authors: Fadhillah Anas , Auliana Putri Eka , Samsudin Rofik
Published: July 2024

Tanaman Purun menjadi harta karun bagi sebagian masyarakat yang hidup di daerah tanah gambut, Tanaman ini bisa dimanfaatkan menjadi barang/kerajinan yang bernilai tinggi dan meningkatkan perekonomian masyarakat setempat. Selain itu, tanaman purun berpotensi sebagai Pendapatan Asli Daerah (PAD) Kalimantan Selatan. Sebab dapat dijadikan kerajinan seperti topi, sedotan, tas, dan tikar yang dijual kepada turis. Namun muncul berbagai macam kendala antara lain permodalan, peningkatan produk, inovasi produk hingga kelangkaan bahan baku produk. Tujuan dari penelitian ini adalah untuk menganalisis strategi optimalisasi pengembangan produk kerajinan purun yang tepat bagi masyarakat di Kalimantan Selatan dengan menggunakan pendekatan kuantitatif dan dengan metode analisis SWOT. Data yang digunakan adalah sekunder. Adapun hasil penelitian ini adalah  masuk ke dalam kuadran I, strategi yang harus diterapkan dalam kondisi ini adalah mendukung kebijakan pertumbuhan yang agresif. Untuk itu diperlukan strategi dan skema antara lain membentuk koperasi, regulasi penggunaan produk purun, pelatihan pengembangan produk purun, mendapat suntikan dari investor, mengikut sertakan pameran, perlu libatkan campur tangan pemerintah dan perbankan, dan gencar kampanye ekonomi hijau. Adapun saran dari hasil analisis ini adalah sebaiknya pengembangan produk purun terus dikembangkan karena menggunakan bahan yang ramah lingkungan, dan perlu adanya pembinaan dan regulasi dari pemerintah.