bluuebunny/crossref_metadata_2025 huggingface dataset:
Estimation of OptiVol Alert for Identifying Heart Failure in Conventional Bradyarrhythmia Pacing Patients with Preserved Left Ventricular Function: A Multicenter Prospective Cohort Study (OptiVol Study)
Authors: Ajiroa Yoichi , Sekiguchia Haruki , Akitae Takako , Fukunagag Hiroshi , Iwadeb Kazunori
Published: July 2024

BACKGROUND: The usefulness of OptiVol, an algorithm to detect heart failure (HF) using continuous intrathoracic impedance monitoring, is established in high-power device patients with reduced left ventricular ejection fraction (LVEF). However, the utility of OptiVol in conventional bradyarrhythmia pacing patients with preserved LVEF is not established.

OBJECTIVES: This study aimed to describe the utility of the OptiVol alert feature in monitoring HF in conventional pacemaker or implantable-cardioverter defibrillator (ICD) patients with preserved LVEF.

METHODS: Forty-three patients implanted with a conventional pacemaker or ICD with the OptiVol function were enrolled. Of these, 39 completed the observation period. OptiVol fluid index and cumulative percentage of right ventricular pacing (%RVp) were obtained every three months for 12 months after device implantation. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) to predict HF hospitalization of the OptiVol alert defined by an OptiVol fluid index >100Ω-day or >60Ω-day were compared. The combination of OptiVol positivity and right ventricular pacing site and/or %RVp >40% for the prediction of HF hospitalization were also assessed.

RESULTS: Three patients (7.6%) had HF hospitalization within one year after device implantation. The sensitivity, specificity, PPV and NPV of OptiVol alert definition with OptiVol fluid index >100Ω-day were 100%, 64%, 19%, and 100%, while those of OptiVol alert definition with OptiVol fluid index >60Ω-day were 100%, 42%, 13% and 100%, respectively. These parameters were improved by the combination of OptiVol fluid index >100Ω-day and RV apex pacing and/or %RVp >40%, attaining values of 100%, 97%, 75%, and 100%, respectively; by the combination of OptiVol alert and RV apex pacing; or their combination.

CONCLUSION: The OptiVol alert using cut-off value of 100Ω-day would be useful for the prediction of HF hospitalization in conventional bradyarrhythmia pacing patients with preserved LVEF. The utility of OptiVol alert would be emphasized in patients with RV apex pacing and/or %RVp >40%.

KEYWORDS: Heart failure; bradycardia; cardiac pacing; OptiVol; intrathoracic impedance
Comparison of the Clinical Outcomes and Costs Between Transcatheter Device Occlusion and Surgical Closure for the Treatment of Isolated Ventricular Septal Defect
Authors: Valdez Bernadette B , Reganion Juan G , Villareal Jean Antonio G
Published: July 2024

INTRODUCTION: The most common congenital heart disease (CHD) in childhood is ventricular septal defect (VSD), and the standard mode of treatment for defects that need correction is surgical closure under cardiopulmonary bypass. Advancements in technology are leading us into the era of percutaneous closure of VSDs. The current trend in the correction of CHD is to use techniques that would allow early hospital discharge and come with the least morbidity risk. The objective of this study was to compare the costs and the clinical outcomes of transcatheter device occlusion and surgical closure as modes of treatment for isolated VSD among pediatric patients of the Philippine Heart Center (PHC).

METHODOLOGY: This was a prospective cohort study of pediatric patients who underwent either device occlusion or surgical closure of uncomplicated VSD in PHC from January 2014 to December 2014. Complications that occurred immediately after the procedure, during the hospital stay and one month after discharge were compared. The lengths of post-procedural hospital stays were likewise compared. Actual in hospital charges and costs of complications during the hospital stay were noted.

RESULTS: All cases of VSD that were included in the study were closed successfully with no residual shunts for either group. The complications noted were blood loss requiring blood transfusion (22.6% for the surgical group, 12.9% for the device group), procedure-related infection (12.9% for the surgical group; 0% for the device group) and pneumothorax (12.9%, surgical group; 0%, device group). The mean post-procedural days were 4.7 for the surgical group and 1.2 for the device group (p<0.001); the mean post-procedural days for patients with complications in the surgical group was about seven days. There was a significant difference in the hospital and procedural costs between the two groups, i.e., the surgical group’s expenses were greater by ₱75,200.00 (p<0.001).

CONCLUSION: The results of this study support the continued use of transcatheter occlusion as a treatment option for the closure of isolated VSD.

KEYWORDS: ventricular septal defect, transcatheter closure of VSD.
A Comparative Study on the Alternative Ankle Brachial Index (ABI) Method Versus the Traditional ABI Method Among Screened Patients: A 1-year Retrospective Review
Authors: Chan Keith Andrew L , Alcazar Jeremy Anne A , Buaya Carlo Andrew A , L. Gallardo Elaine
Published: July 2024

BACKGROUND: Peripheral artery disease (PAD) of the lower extremities is a chronically  progressive disorder characterized by the presence of arterial occlusion. Screening for PAD by  the Ankle–Brachial Index (ABI) is recommended and traditionally computed using the higher  ankle pressure divided by the higher brachial pressure. Alternative methods that utilize the lower  pressure of the pressures have been proposed with the premise of reclassifying a greater number  of at-risk individuals. 

METHODS: This study is a retrospective analysis. Data from inpatients screened for ABI from  March 1, 2018, to March 31, 2019, were included. All ABIs were computed via traditional  methods, with all abnormal ABIs (<0.9) grouped accordingly (ABI A). The remaining patients were  then retested using the alternative method, and those with abnormal ABIs were then grouped  (ABI B). The remaining patients were designated to have normal ABIs. Patients assessed as  outpatients and those with incomplete clinical information or with ABIs of greater than 1.4 were  excluded. Differences among the clinical parameters among groups were analyzed via t test or χ2 test (P < 0.05).  

RESULTS: A total of 226 patients were analyzed. Through traditional ABI computation, 18  patients (7.96%) had abnormal values. The remainder had ABIs computed via the alternative  method, with an additional 15 patients (6.64%) having abnormal ABIs, with a significantly higher  percentage of patients having abnormal ABIs with the traditional versus alternative methods  (7.96% vs 14.6%). Patients with abnormal ABIs were significantly older (p = 0.003, p = 0.061),  with patients traditionally screened having higher cholesterol (p = 0.015). All other demographic  and clinical characteristics were similar among all groups. 

CONCLUSION: The alternative ABI method detects a significantly higher number of patients  compared with the traditional method; apart from age and cholesterol, there exist no significant  differences in clinical characteristics among the groups, emphasizing the need for diligent ABI  screening for PAD. 

KEYWORDS: Ankle Brachial Index; Alternative Method ABI; ABI Computation
Philippine Heart Association-Acute Coronary Syndrome Registry- 2 Year Results
Authors: Yaneza Liberty O , Abanilla Joel M , Abola Maria Teresa B , Ang Imelda Caole V , Fernandez Ma. Bridget D , Lopez Eleanor A , Punzalan Felix Eduardo R , Reyes Eugene B
Published: July 2024

BACKGROUND: An acute coronary syndrome (ACS) registry was initiated by the Philippine Heart Association and launched in November 2011, enrolling 1,939 patients for its preliminary 2-year enrollment period.

RESULTS: Results showed that ACS occurred predominantly in males (67%), and patients had a median age of 61 years. Hypertension (77.1%), diabetes (39%) and smoking history (33.4%) were the common risk factors for ACS. A significant number of post-menopausal women (30%) suffered from ACS. Chest pain or heaviness (74.5%) was the common presenting symptom, while atypical presentation or angina equivalents and aborted sudden cardiac death occurred in 24.4% and 0.6%, respectively. Non-ST elevation myocardial infarction was the most common spectrum of ACS (49%), followed by ST elevation myocardial infarction (36%) and unstable angina (14.5%). The median time interval from symptom to emergency room was 360 minutes or 16 hours. Time from Door to Needle and Door to Balloon was 60 minutes and 180 minutes, respectively. There was good adherence (>85%) to class 1 recommended drugs, namely beta blockers, angiotensin-converting enzyme inhibitors/ angiotensin receptor blockers, statins, and dual anti-platelet therapy. There was low adherence to discharge lifestyle counseling and referral to cardiac rehabilitation program. The mortality and bleeding rates were 7.8% and 1.15%, respectively.

KEYWORDS: Acute Coronary Syndrome, Unstable Angina, Non ST Elevation Myocardial Infarction, ST Elevation Myocardial Infarction.
One Artery to Rule it All: A Case of 30-year-old Male with Single Coronary Artery
Authors: Banluta Andre Russell F , Buensuceso Jill , Cornel Mylene , Lim Bernadette Semilla , Macabeo Renelene
Published: July 2024

Single coronary artery (SCA) is a rare congenital anomaly in which there is an isolated coronary  artery that arises from a single coronary ostium and provides coronary blood supply to the  entire myocardium. SCA is classified based on Lipton Classification which includes the origin,  branching pattern and course. We aim to present a rare case of congenital anomaly that  presented with atypical symptoms and to discuss the features and classification of a single  coronary artery. This is a case of a 30-year-old Filipino, male, known type 1 diabetes mellitus  came in with diarrhea and vomiting, which later had severe abdominal pain. A consideration  of Mesenteric ischemia was entertained due to abdominal pain not compatible with physical  exam findings. He then underwent CT angiogram of the abdomen which was unremarkable, so  a consideration of atypical presentation of chest pain was considered since patient is diabetic  hence he underwent CT coronary angiogram and was noted to have SCA as an incidental  finding.
Determination of the Optimal Cut-off Value of Cardiac Troponin I for the Diagnosis of Acute Myocardial Infarction in Patients with Chronic Kidney Disease at the Manila Doctors Hospital (CTNI-CKD MDH Study)
Authors: Mabbagu Ethel P , Arias Crizelle C , Punzalan Felix Eduardo R , Tumanan-Mendoza Bernadette A , Pestaño Noemi S
Published: July 2024

INTRODUCTION: Acute myocardial infarction (AMI) among chronic kidney disease (CKD) patients may present with atypical symptoms and nonspecific electrocardiographic findings. Diagnosis of AMI has been dependent on cardiac biomarkers, especially cardiac Troponin I (cTnI), but is usually elevated in CKD patients. This study aimed to determine the optimal cut-off value of cTnI in CKD patients with angina/anginal equivalents admitted at Manila Doctors Hospital (MDH) to diagnose AMI.

METHODOLOGY: This was a cross-sectional chart review study on adult CKD patients with angina or angina equivalents. cTnI levels were determined using Vitros Eci Troponin I ES Assay. The optimal cut-off to diagnose AMI was determined using receiver operator characteristic (ROC) curve analysis.

RESULTS: The prevalence of AMI was 60.71%. The median troponin I levels for patients with AMI was 0.41ng/ ml, and 0.1ng/ml for those without AMI (p<0.001). An elevated troponin I was defined here as higher than 0.034 ng/mL; the median troponin I levels of both patients with or without AMI were above this level. The optimal cut off value was 1 ng/ml, with an area under the ROC curve was 0.72, a sensitivity of 30.15%, and a specificity of 88.64%.

CONCLUSION: The prevalence of AMI among CKD patients at MDH is high at 60.71%. The median level of troponin I among patients with CKD is elevated regardless of whether they suffered AMI or not. However, the median level of troponin I in patients with AMI was higher than those without AMI. The optimal cut-off value to diagnose AMI in patients with CKD and angina or angina equivalents is 1ng/ml. Elevations of troponin I among CKD patients may represent myocardial injury, and further cardiac evaluation is sought until proven otherwise.
Validation of a Predictive Score for Radial Artery Spasm in Patients Undergoing Elective Transradial Percutaneous Coronary Procedures
Authors: Ramirez Joseph Michael L , Ho James
Published: July 2024

BACKGROUND: Radial artery spasm (RAS) is one of the most common complications during transradial coronary procedures and can increase access-site-related adverse events. There is no standard tool to determine patients at high risk of RAS who would benefit from intensive spasm preventive measures. This study aims to validate a RAS risk score in patients undergoing elective transradial coronary procedures.

METHODOLOGY: The study population consisted of a prospective cohort of patients who underwent elective transradial coronary angiography and PCI (n=210). A RAS risk score was used to classify patients as high or low risk. Spasm incidence was recorded and the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of the RAS risk score were determined.

RESULTS: RAS incidence was 11.43%. A greater number of patients who had RAS were females (p=0.023), weighed less (64.4 ± 9.20 kg, p=0.0353), had lower body mass index (BMI) (19.9 ± 2.33, p=0.0512), were current smokers (p=0.031) and had peripheral artery disease (PAD) (p<001). The RAS risk score had a sensitivity of 87.50%, a specificity of 76.34%, PPV of 32.31%, NPV of 97.93% and accuracy of 77.62% with c-statistic of 0.8685.

CONCLUSION: The RAS risk score may be a good tool to identify patients at high risk of RAS during elective transradial coronary procedures in whom more intensive spasm-preventive measures can possibly lead to a significant reduction in the frequency of RAS and potentially reduce access-site-related adverse events.

KEYWORDS: Radial artery spasm, radial artery spasm risk score, predictor of radial artery spasm
Comparison of Drug Eluting Stents Versus Bare Metal Stents in Femoropopliteal Artery Occlusive Disease: A Systematic Review and Meta-analysis
Authors: Yaneza Liberty O , Verdillo Leah T
Published: July 2024

OBJECTIVES: To compare the angiographic and clinical outcomes in patients who have undergone peripheral artery intervention using either drug eluting stents (DES) or bare metal stents (BMS).

METHODS: A meta-analysis of randomized studies that compare DES and BMS in patients with femoropopliteal occlusive artery disease.

RESULTS: Five clinical trials met the inclusion criteria. Results showed that using DES yielded a higher arterial patency rate (RR 1.41; 95% CI 1.23-1.61), reduced restenosis rate (RR 0.46; 95% CI 0.33-0.63), and had a lesser tendency for repeat revascularization (RR 0.29; 95% CI 0.16-0.51) compared with BMS. However, no statistical significance was noted between the two interventions in terms of mortality rate (RR 0.93; 95% CI 0.47-1.83) and ankle brachial index score (mean difference of 0.06; 95% CI 0.02-0.09).

KEY WORDS: Peripheral artery disease, peripheral artery intervention, drug eluting stents, bare metal stents, femoropopliteal occlusive disease
Tetralogy of Fallot: A Philippine Heart Center Review
Authors: Jara Raul D , Jara Mikaela Nikkola A
Published: July 2024

INTRODUCTION: Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease (CHD) in the adult. The Philippine Heart Center (PHC) performs surgery on most TOF patients, averaging 50 patients per year. This study aimed to provide a comprehensive review of literature regarding TOF post operative outcomes in the Philippines.

METHOD: Studies conducted at PHC that included 20 or more patients were included and reviewed independently by two investigators for validity.

RESULTS: Five published and 22 unpublished studies were retrieved, with 12 studies meeting the inclusion criteria and validity standards. The mean mortality rate with TOF correction at the PHC from 1975 to 2011 was 6.7%. From 2000-2011, the mortality rate was 5.50%. Complications included myocardial failure, arrhythmias, infective endocarditis, and growth retardation. Electrocardiography and two dimensional echocardiography were indispensable tools in the follow-up of TOF patients post correction. Most patients had New York Heart Association Functional Class I, and had normal exercise tolerance, intelligence, and fertility.

CONCLUSION: Although surgical outcome has been good in the Philippines, there should be emphasis on earlier intervention to avoid complications. With the growing number of TOF patients who survive into adulthood, it is important to have consistent follow-up with an expert cardiologist keen on CHD.
Weathering an Adenosine-Insensitive Right Ventricular Outflow Tract Ventricular Tachycardia Storm in an Adolescent Female: A Case Report
Authors: Duya Jose Eduardo DL , Naud Nashiba , Mojica Joerelle V , Gervacio Giselle G , Agbayani Michael Joseph , Go Louisa , Malanyaon Olympia Q
Published: July 2024

Majority of ventricular tachycardias (VT) are associated with structural disease. However, 10% are idiopathic, such as right ventricular outflow tract (RVOT) VT. A vast majority of RVOT VT demonstrates sensitivity to adenosine, consistent with a triggered mechanism. We present the case of a 15-year-old female patient with palpitations, lightheadedness and dyspnea and a past history of a similar episode of incessant palpitations a month ago, which necessitated electrical cardioversion and amiodarone. On admission, a wide complex tachycardia was documented. Detailed analysis of her wide complex tachycardia showed left bundle branch block (LBBB) morphology, atrioventricular dissociation and positive QRS complexes in inferior leads, suggestive of RVOT VT storm. The patient’s arrhythmia was not responsive to adenosine; hence, adenosine-insensitive RVOT VT was considered. Synchronous cardioversion terminated the tachyarrhythmia. On electrophysiological studies, the VT was induced and localized at the RVOT via 3D-electroanatomical mapping. Radiofrequency ablation of the focus was performed, immediately terminating the tachycardia. The patient was discharged well.
Cost of Hospitalization for Acute Coronary Syndrome in the Philippines
Authors: Mendoza Victor L
Published: July 2024

INTRODUCTION: Acute coronary syndrome (ACS), specifically myocardial infarction, accounted  for approximately 41% of deaths due to coronary artery disease in 2013. A large number of  Filipinos are affected by ACS; thus, it is important to determine its hospitalization cost. The  study objectives were to (1) define the hospital care pathways for ACS; (2) determine the  resources used; (3) estimate the hospitalization cost for uncomplicated ACS; and (4) determine  the difference between the estimated hospitalization cost and the coverage provided by the  Philippine Health Insurance Corporation (Philhealth). 

METHODS: A cost analysis study was done. Mixed qualitative and quantitative data collection  tools consisted of consultations with local cardiologists, key informant interviews, and self administered survey forms. Sensitivity analysis was performed through scenario analysis. 

RESULTS: The ACS hospital care pathway was derived after consultative meetings with invasive  and noninvasive cardiologists. Using this pathway, the resources used for ACS hospitalization  were identified, and the total hospitalization costs were calculated. For medical treatment alone,  the costs were approximately Philippine peso (₱) 67,000 to ₱90,000, whereas for medical  treatment with percutaneous coronary intervention (PCI), the costs were approximately ₱265,000  to ₱425,500. In comparison, Philhealth’s maximum coverage for ACS with PCI is ₱39,750. 

CONCLUSION: There is variation in the ACS hospitalization cost, depending on the  management strategy used and the type of hospital where a patient is confined. Medical plus  reperfusion with PCI increases the cost four to five times when compared with medical treatment  alone. Huge out-of-pocket expense is demonstrated because of the large discrepancy between  the actual hospitalization costs to Philhealth’s ACS coverage. 

KEYWORDS: acute coronary syndrome, cost analysis, Philhealth
Catheter-Directed Reperfusion Therapy after Unsuccessful Systemic Thrombolysis in a Patient with Evolving Sub-massive Pulmonary Embolism
Authors: Castillo Jennifer Doria-del , Dionisio Josephine D , Beltran Jenny L , Miranda Ariel A
Published: July 2024

Thrombolysis in sub-massive pulmonary embolism remains controversial. We present a case of a 52 year old obese male admitted for a 2-week history of dyspnea and swelling of the right leg. On admission, the patient was dyspneic and tachycardic. Venous duplex study showed acute partially occlusive thrombosis of the right femoral vein and totally occlusive thrombosis of the right popliteal vein. Echocardiography revealed a dilated right ventricle with severe pulmonary hypertension (95 mmHg). B-type natriuretic peptide and D-dimer levels were elevated. Computerized tomography (CT) angiogram showed a saddle thrombus in the main pulmonary artery with almost complete obstruction of the proximal left lower lobe segmental artery. Systemic thrombolysis with 100 mg of recombinant tissue plasminogen activator (r-TPA) was given, followed by low molecular weight heparin.

Approximately 30 hours after thrombolysis, the patient had recurrence of dyspnea, and became hypoxemic. A repeat CT angiogram of the pulmonary arteries revealed an interval thinning of pulmonary embolus of the main pulmonary artery, interlobar arteries and proximal branches, but the obstruction of the proximal left lower lobe segmental artery was unchanged. Right heart catheterization revealed a pulmonary artery pressure (PAP) of 68/30 mmHg. Pulmonary angiogram showed a large thrombus at the right main pulmonary artery, and total occlusion of the left lower lobe pulmonary artery. Catheter-directed thrombolysis to the pulmonary artery was done with 50 mg of r-TPA, given over 2 hours. An inferior vena cava filter was also inserted. PAP decreased to 50 mmHg after catheter-directed thrombolysis. There was relief of dyspnea, and his heart rate normalized.

This case demonstrated the safety and feasibility of systemic thrombolysis followed by catheter-directed thrombolysis in sub-massive pulmonary embolism and deep venous thrombosis done in the local setting.
Prevalence of Elevated Heart Rate Among the Philippine Lifecare Cohort (LIFT-LIFECARE Study)
Authors: Gumatay Wilbert Allan G , Sy Rody G , Sison Olivia T , Llanes Elmer Jasper B , Reganit Paul Ferdinand M , Castillo-Carandang Nina , Punzalan Felix Eduardo R , Velandria Felicidad V
Published: July 2024

OBJECTIVE: The study aimed to describe the resting heart rate of the LIFECARE Philippine Cohort and its relation to socio-demographic factors and traditional cardiovascular risk factors.

METHODOLOGY: A total of 3,072 apparently healthy participants aged 20-50 years old from four Philippine provinces were included in the study. Resting heart rate, anthropometric data and sociodemographic profiles were taken through interviews and standardized measurement techniques. The median heart rate was computed by sex, and the participants were divided into those with below-median heart rate and those with at-median/above-median heart rate. The correlation between heart rate and sociodemographic factors and traditional cardiovascular risk factors were analyzed.

RESULTS: The mean heart rate was 75.68 beats per minute (bpm). Females have higher mean heart rate (79.20 bpm) compared to males (71.08 bpm). The median heart rate was 70.33 bpm for males and 78.0 bpm for females.For both sexes, unemployment was significantly associated with elevated heart rates. For males, factors such as living in urban areas and higher education were significantly associated with elevated heart rates. Increasing age and financial stress showed no statistically significant association. There was a trend towards increased heart rates with the presence of stressful events in the last 12 months. For females, living in rural areas, unemployment and younger age groups were significantly associated with elevated heart rates. Higher financial stress was inversely correlated with heart rate. Education and presence of stressful events in the last 12 months did not show statistical significance. For both genders, hypertension, diabetes and metabolic syndrome were significantly associated with elevated heart rates. Increased body mass index (BMI) was significantly associated with higher heart rates for males. Although not statistically significant, there was a trend for higher heart rates for women with lower BMI. There was also a trend towards lower heart rates for participants of both sexes who exercised. Smoking history was significantly associated with lower heart rates in both sexes.

CONCLUSION: Elevated heart rate was consistently seen in both sexes with traditional cardiovascular risk factors. However, sociodemographic factors seem to influence heart rate differently between males and females.

KEYWORDS: heart rate, risk factors, socio-demographic risk factors, LIFECARE, Philippines.
Spontaneous Echo Contrast is Associated with Increased Risk for Cardioembolic Events: A Meta-analysis
Authors: Ramos ​​​​​​​John Daniel A , Aherrera Jaime Alfonso M , Chiong Lowe L , Timbol Edgar Wilson G , Punzalan Felix Eduardo R
Published: July 2024

Background: Spontaneous echo contrast (SEC) is a swirling smoke-like image seen inside the heart chambers or in the aorta on two-dimensional echocardiogram. It is theorized to be due to reduced blood flow, or stasis, and is considered a pre-thrombotic lesion. However, its association with cardioembolic (CE) events is not yet established. We aim to determine the association of SEC with CE events such as stroke and peripheral embolism.

Methods: This meta-analysis includes observational studies with populations composed of adults ≥19 years old with documented SEC either in the cardiac chambers or the aorta; with reported data on CE events, especially stroke; and controlled for confounding variables by doing logistic regression and/or multivariate analysis. The authors conducted a systematic search of studies within the MEDLINE, EMBASE, ScienceDirect, and Cochrane Central Register of Controlled Trials databases in all languages; examined reference lists of studies; identified 14 studies that met the inclusion criteria; and obtained full manuscripts of all of them. Each study was assessed for quality using the Newcastle-Ottawa Quality Assessment Scale. The outcome of interest was assessed using Mantel-Haenzel analysis of random effects to compute for risk ratios, carried out using Review Manager (RevMan) 5.0.18.

Results: Pooled analysis from the 14 studies enrolling a total of 4,659 patients showed that the presence of SEC was associated with increased CE events (27.9% vs. 26.4%; RR 3.50 95% CI 2.07–5.93 p < 0.00001 I2 = 89%). No evidence of publication bias was found by the funnel-plot method. To control for heterogeneity, we did subgroup and sensitivity analyses, which revealed that intracardiac SEC, particularly left atrial or left ventricular SEC, was primarily responsible for this association (22.8% vs. 5.8%; RR 4.69 95% CI 3.42–6.43 p < 0.00001 I2 = 0%), compared to extracardiac SEC, represented by aortic SEC (26.8% vs. 16.7%; RR 1.70 95% CI 1.05–2.77 p = 0.03 I2 = 53%).

Conclusion: The presence of SEC is associated with a significantly increased risk for CE events among adult patients. This supports the need to be aggressive in the management of patients with SEC, particularly in reducing CE event risk. Clinical trials are warranted.

Keywords: spontaneous echo contrast, rheologic stasis, cardioembolic events, embolic stroke
Suppression of Recurrent Electrical Storms in a Filipino Patient with Brugada Syndrome: A Case Report
Authors: Go-Sumalpong Jehan Karen T , Fadreguilan Erdie C
Published: July 2024

Brugada syndrome is an inherited form of arrythmogenic disease associated with a coved-type ST segment elevation in right precordial leads and an increased risk of sudden cardiac death due to ventricular fibrillation (VF) in young, otherwise healthy adults. Electrical storm is malignant but rare in patients with Brugada syndrome. This is the case of a patient who was diagnosed with Brugada syndrome with repetitive discharges of implantable cardioverter-defibrillator during episodes of ventricular tachycardia/VF. The patient was given oral quinidine, which successfully suppressed the recurrence of electrical storms.

KEYWORDS Brugada syndrome, bangungut, quinidine.
Hyperuricemia and Its Prognostic Value in Patients with Rheumatic Heart Disease
Authors: Villanueva Paolo P , Medrano Ana Beatriz D , Babilonia Noe A
Published: July 2024

BACKGROUND: Hyperuricemia has recently been linked to cardiovascular diseases, such as coronary artery disease and heart failure, as a marker of disease activity for prognostication. However, there are no studies correlating uric acid levels with heart failure among patients with rheumatic heart disease (RHD).

METHODOLOGY: This is a prospective cohort study correlating the increase in uric acid levels with the development of heart failure symptoms in patients with RHD. Fifty-one subjects with RHD and with good functional capacity (New York Heart Association [NYHA] Class I) were included in the study. The subjects were followed up for one year, in which 24 subjects fulfilled the Framingham criteria for heart failure and 27 remained in NYHA Class I.

RESULTS:Mean baseline uric acid levels were similar between the two groups (heart failure 390±82 umol/L; no heart failure 388±134 umol/L; p=0.964). The mean difference between the baseline and endpoint serum uric acid levels in those without heart failure was not statistically significant (baseline 388±134 umol/L vs. endpoint 391±134 umol/L; p=0.77). In those who developed heart failure, the mean endpoint serum uric acid levels became significantly higher from baseline (baseline 390±82 umol/L vs. endpoint 437±106umol/L; p=0.0007). There was a significantly greater increase in serum uric acid levels in patients who eventually developed heart failure symptoms (heart failure 47.1±59.1 umol/L vs. no heart failure 2.6±46 umol/L; p=0.004). An increase in serum uric acid level by 30 umol/L from baseline had a sensitivity of 70.83% and a specificity of 74.07% for predicting the occurrence of heart failure symptoms.

CONCLUSION: Increasing serum uric acid levels are associated with the development of heart failure symptoms in patients with RHD.

KEYWORDS: rheumatic heart disease, mitral stenosis, mitral regurgitation, aortic stenosis, aortic regurgitation, congestive heart failure, uric acid, hyperuricemia
Compliance with In-Patient Performance Measures in the Management of Heart Failure Patients at the Manila Doctors Hospital
Authors: Bermudez April Ann A , Lim Allan A , Punzalan Felix Eduardo R , S. Pestano Noemi
Published: July 2024

Background: Heart failure (HF) is a growing public health problem, with a prevalence of 0.5% to 6.7% in Southeast Asian countries. Previous studies have shown that compliance with guidelines and performance measures decreases the rates of mortality and rehospitalization for HF. This study evaluated the adherence to in-patient measures of HF management at the Manila Doctors Hospital.

Study design: This was a retrospective cross-sectional study that involved HF patients admitted at the Manila Doctors Hospital from September 2013 to September 2014. The following performance measure sets were computed based on data from patient records: compliance with left ventricular systolic function (LVSF) assessment; beta-blocker (BB) therapy for left ventricular systolic dysfunction (LVSD); angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) therapy for LVSD; and post-discharge follow-up appointment rate.

Results: Seventy-seven patients were included in the study. Their mean age was 63±15 years. Seventy-one patients (92.2%) underwent echocardiographic assessment. The overall mean ejection fraction was 39.4±14.5%. For patients with HF with preserved ejection fraction, the mean ejection fraction was 59.4 ± 6.9%. For patients with HF with reduced ejection fraction, the mean ejection fraction was 28.4 ± 6.1%. Left ventricular ejection fraction assessment was done in 93.5%. In patients with LVSD, 82.5% received BB therapy (evidence-based BB, 78.7%), while ACEI/ARB therapy was given in 87.5%. All patients who were discharged were given follow-up appointments.

Conclusion: Based on the present data, the compliance of physicians of Manila Doctors Hospital to measures of care in HF management is at par with current international and local data.

Keywords: heart failure, preserved ejection fraction, reduced ejection fraction, performance measure compliance.
Accuracy of the Six-Minute Walk Test and Duke Activity Status Index in Determining Improvement of Functional Capacity Among Adult Patients Enrolled in Cardiac Rehabilitation
Authors: Cruz Rochelle Regina , Yape Irma
Published: July 2024

BACKGROUND: The six-minute walk test (6MWT) is a common outcome measurement in cardiac rehabilitation but there are no established guidelines on its use in cardiac rehabilitation. Furthermore, the Duke Activity Status Index (DASI) is a brief self-administered questionnaire that assesses the patient’s ability to perform common activities but its usefulness in cardiac rehabilitation has not yet been determined. This study aimed to assess the reliability of the 6MWT and DASI in determining improvement in functional capacity based on treadmill exercise test (TET) among patients enrolled in Phase I, II and III cardiac rehabilitation in Cardinal Santos Medical Center (CSMC) from September 2015-September 2016.

METHODS: This was a prospective analytical study of all patients enrolled in cardiac rehabilitation in CSMC from September 2015 to September 2016. All included patients completed the DASI questionnaire before cardiac rehabilitation and after completion of every Phase. The 6MWT and TET were done after Phase I, II and III of cardiac rehabilitation. The results were correlated with functional capacity using correlation analyses.

RESULTS: Among the 85 patients initially included in this study, there were 81, 34 and five patients who finished Phase I, II and III of cardiac rehabilitation, respectively. Progressive improvement of METs was observed with the progression of cardiac rehabilitation. Pearson correlation analysis revealed that peak VO2 based on DASI was moderately correlated with TET at Phase I and II (r=0.623 and 0.594, respectively) while the correlation was not statistically significant at Phase III. The peak VO2 based on 6MWT was also moderately correlated with TET but weaker correlation compared with DASI (r=0.481 and 0.471 for Phase I and Phase II, respectively). The correlation was not statistically significant at Phase III. The Lin concordance correlation coefficients for DASI were moderate for Phase I and II (ρ=0.5985 and 0.5087, respectively) and poor in Phase III (ρ=0.1051). On the other hand, 6MWT had fair agreement with TET in Phase I and Phase II (ρ=0.2432 and 0.3348, respectively). The correlation was not statistically significant at Phase III. Proportional bias was noted with the use of the 6MWT but not with DASI.

Conclusion: Stronger correlation was seen with DASI questionnaire than 6MWT in determining functional capacity among patients enrolled in Phase I and II cardiac rehabilitation compared to TET.
Inducible Focal Atrial Tachycardia of Coronary Sinus Origin Masquerading as Ventricular Tachycardia
Authors: Timbol Edgar Wilson G , Gervacio Giselle G
Published: July 2024

CASE: This is the case of a 35-year old male physician presenting with a 12-year history of palpitations despite oral metoprolol. He had reversible left hemiparesis with right hemispheric lacunar infarctions on computerized tomography scan. The 12-lead electrocardiogram (ECG) recorded during an episode of palpitations revealed wide QRS (0.16 s) tachycardia (heart rate=214 beats per minute) with left bundle branch block (LBBB) QRS morphology; no identifiable P waves; QS pattern in leads V1 to V4; RS pattern in leads V5 and V6; and a QRS axis at -1300. There were no AV dissociation; fusion and captured beats; and precordial QRS concordance. Electrophysiology studies (EPS) were performed. During programmed electrical stimulation (PES) at the right ventricular apex, sustained narrow QRS (0.10 s) tachycardia (168 bpm) was induced. Examination of the intracardiac atrial (A) and ventricular (V) electrograms during the tachycardia revealed a 1:1 AV relationship; closer A electrogram to the preceding A electrogram than the following V electrogram producing a short RP tachycardia (<70 ms); variable VA intervals; VAAV response during ventricular overdrive maneuver, and termination of the tachycardia at the V electrogram. The above EP parameters favored a diagnosis of focal atrial tachycardia (FAT) over re-entrant supraventricular tachycardia (SVT). The earliest activation site of the induced SVT was recorded near the ostium of the coronary sinus (CS 9 and 10) which coincided with the findings on 3D mapping.

DIAGNOSIS: FAT with acceleration-dependent functional LBBB based on a mechanism of triggered automaticity arising from the coronary sinus ostium.

TREATMENT AND OUTCOME: Radiofrequency ablation was applied on the identified arrhythymogenic atrial focus and effectively restored sinus rhythm and rendered the FAT non-inducible.
Cardiovascular Effects , Safety and Efficacy of Therapeutic Hypothermia in Post-Cardiac Arrest Patients
Authors: Elcano Janet W , Ramboyong Raul E , Ramirez Marcellus Francis , Palo Jose Emmanuel
Published: July 2024

OBJECTIVE: It is well established that therapeutic hypothemia (TH) is neuroprotective and increases survival in cardiac arrest patients with shockable rhythm. This study seeks to determine effectiveness in improving overall hospital survival among post-cardiac arrest patients, as well as its cardiovascular effects and safety.

DESIGN: Retrospective chart review study.

SETTING: Intensive Care Unit (ICU) in a tertiary hospital in the Philippines.

PATIENTS: All post-CA adult patients admitted in the ICU from December 2008 to January 2012, either treated or not with TH.

INTERVENTIONS: TH or no TH, with a goal core temperature of 32-34 °C of TH, commenced within 6 hours of return of spontaneous circulation, and maintained for 12-24 hours.

MAIN OUTCOME MEASURE: Hospital survival and neurological outcomes assessed using the Cerebral Performance Category (CPC) scale; cardiovascular effects (mean arterial pressure and heart rate) and adverse effects.

RESULTS: A total of 140 patients were included, 95 of whom underwent TH and 45 patients served as control. Baseline characteristics between hypothermia treated and control groups were similar. Good neurological outcomes were found in 27 (28.4%) patients in the hypothermia group vs. 3 (6.7%) in the control group, (OR 5.56; 95% CI 1.587 to 19.446; p=0.003). There was a significant hospital survival benefit in the hypothermia group (36.8%) compared to the control group (20%) (p=0.045). Occurrence of adverse events and hemodynamic parameter values did not significantly differ between groups.

CONCLUSION: Among post-arrest patients, TH was associated with improved overall survival and good outcome on hospital discharge. It appears safe and showed no considerable systemic hemodynamic and cardiovascular effects.
Blood Pressure Morning Surge in Hypertensive Filipino Patients: A 24-Hour Ambulatory Blood Pressure Monitoring Study in a Tertiary Hospital
Authors: Santos Jason S , Naranjilla Raymund A
Published: July 2024

BACKGROUND: The prevalence of hypertension is increasing in the Philippines. Hypertension is often associated with an exaggerated increase in blood pressure (BP) in the morning, referred to as morning surge – a phenomenon known to increase the risk of cardiovascular events. This study aims to determine whether morning surge is present in hypertensive Filipino patients and whether this correlates with control of hypertension.

Methods: This was a retrospective study that included 134 hypertensive patients who underwent 24-hour ambulatory BP monitoring at the University of Santo Tomas Hospital from January to December 2016. The BP morning surge was defined as >20 mmHg difference between the BP two hours before and two hours after awakening. The prevalence was reported and analyzed by age, sex and hypertension control.

Results: The prevalence rate of BP morning surge (i.e., score >20 mmHg) was 36.6%. Patients with surge score >20 mmHg were older compared to those with lower surge scores (46.98 ± 14.45 vs 51.55 ± 13.89 years; p=0.031). The prevalence rate was significantly increased in male patients (65.3%) compared to female patients (34.69%; p=0.003). There was no significant correlation between the control of BP and the presence of morning surge (p=0.210). Multivariate analysis confirmed that sex was the risk factor most correlated with morning surge, with male patients having 2.7 times the risk of having a morning surge score >20 mmHg compared with female patients.

Conclusion: Morning surge was present in 36.6% of hypertensive Filipino patients who underwent 24-hour ABPM at the University of Santo Tomas Hospital over a one-year period. Male sex was correlated with the presence of morning surge while control of hypertension showed no correlation. The latter could be due to a blunting of the morning surge by higher trough BP in patients with uncontrolled hypertension.

KEYWORDS: systemic arterial hypertension, 24-hour ambulatory blood pressure monitoring, blood pressure, morning surge, surge score.
Prevention of Perioperative Cardiac Events Using Clonidine in Patients with Coronary Artery Disease Undergoing Noncardiac Surgery: A Meta-Analysis
Authors: Maninang Noel O , Tan Aaron James P , Cheng Frederick C
Published: July 2024

Background: Clonidine may help prevent cardiac events in patients with coronary artery disease (CAD) undergoing noncardiac surgery by sympatholysis. This study aims to provide a systematic review of randomized controlled trials (RCTs) that assessed the efficacy of low-dose clonidine in preventing cardiac events perioperatively.

Methods: The authors independently searched the online sites of Medline, PubMed and the Cochrane Database of Systematic Reviews for RCTs involving human participants. The search terms clonidine, prevention, myocardial ischemia, myocardial infarction, and noncardiac surgery were used.

Results: Five trials comprising 10,618 participants were analyzed for the efficacy of low-dose clonidine in preventing cardiac events among patients with CAD undergoing noncardiac surgery. Low dose clonidine significantly reduced the incidence of myocardial ischemia in patients undergoing noncardiac surgery (RR 0.64; 95% CI, 0.50, 0.81), but it was not associated with any significant reduction in the risk of myocardial infarction (RR 1.09; 95% CI, 0.94, 1.27), congestive heart failure (RR 1.24; 0.83, 1.85), cardiac arrhythmia (RR 1.10; 95% CI, 0.84, 1.45), and death (RR 0.93; 95 % CI, 0.67, 1.29). Significantly more patients in the clonidine group had hypotension compared to placebo (RR 1.28; 95 % CI, 1.22, 1.34).

Conclusion: The meta-analysis suggests that perioperative low-dose clonidine reduced myocardial ischemia in patients at risk of CAD. However, it increased the risk of hypotension. The trend in reduction of mortality using low-dose clonidine was not statistically significant. The use of low-dose clonidine did not affect the risk of perioperative myocardial infarction, congestive heart failure and cardiac arrhythmia.
Atrial Fibrillation Following Coronary Artery Bypass Surgery in Medical Center Manila
Authors: Dayo Alfred Matthew , Reyes Michael Joseph
Published: July 2024

BACKGROUND: Atrial fibrillation (AF) after coronary artery bypass graft (CABG) surgery may  lead to prolonged hospital stay and increased morbidity and mortality. Identifying people at risk  may help in the management and improve the outcome of patients undergoing this procedure. 

OBJECTIVES: The aims of this were to determine the incidence of AF in patients who  underwent CABG surgery in ManilaMed–Medical Center Manila and whether certain factors were  associated with developing AF in patients who underwent the procedure. 

METHODS: This was a single-center, retrospective, cross-sectional study wherein adult patients  who underwent CABG, without previous AF, were included. 

RESULTS: Among patients included in the study, 29 developed AF, with an incidence of  27.62%. Patients who had AF after CABG were, on average, older (65.79 vs 59.29 years,  P = 0.002); had dyslipidemia (72% vs 47%, P = 0.021), a higher average left atrial volume index  (LAVI) (26.72 vs. 23.45, P = 0.038), an LAVI greater than 34 mL/m2 (24% vs 3%, P = 0.002), and  an episode of previous stroke (28% vs 11%, P = 0.038); and had been taking diuretics (28%  vs 9%, P = 0.027) but had a lower prevalence of having diabetes (41% vs 66%, P = 0.023). 

CONCLUSION: Atrial fibrillation remains to be a frequent arrhythmia after CABG occurring  in 28% of patients who had CABG. It may occur in older patients, patients with dyslipidemia,  patients with a large left atrium, patients who had a previous stroke, and patients taking diuretics.  On the other hand, the odds of a diabetic patient developing AF after CABG are low. 

KEYWORDS: Cardiac Biomarkers, Chest CT, COVID-19, CT Severity, NT-proBNP, Troponin I
Lutembacher Syndrome in a 35-Year-Old Filipino Woman: A Case Report
Authors: Reynoso Arch Anthony , Sibal Josephus , Magno Jose Donato , Medina Angelito , Reblando Myrna , Perez Melissa
Published: July 2024

INTRODUCTION: Lutembacher syndrome (LS) is an uncommon cardiac abnormality characterized by any association of a congenital or iatrogenic atrial septal defect (ASD) and a congenital or acquired mitral stenosis (MS). The hemodynamic effects of this syndrome are a result of the interplay between the relative effects of the ASD and MS.

CASE REPORT: A 35-year-old woman presented to the cardiology clinic with a 1-month history of easy fatigability, exertional dyspnea, and productive cough with whitish phlegm. She has no edema, orthopnea, paroxysmal nocturnal dyspnea, or fever. Two weeks before admission, she developed palpitation and still with persistence of symptoms. She sought consultation and was prescribed with clopidogrel 75 mg one tablet once a day, sildenafil 100 mg one tablet once a day, and verapamil 40 mg one tablet once a day, which provided relief. She has no history of hypertension, diabetes, cerebrovascular disease, coronary artery disease, or thyroid or renal disease. She is a nonsmoker and an occasional alcoholic drinker.

On general physical examination, blood pressure was 120/80 mm Hg; cardiac rate, 72 beats per minute; and respiratory rate, 20 cycles per minute. She was afebrile and had distended jugular veins with rales at the left lung base. Abdominal examination revealed neither organomegaly nor shifting dullness. There was neither cyanosis nor pedal edema.