bluuebunny/crossref_metadata_2025 huggingface dataset:
Spontaneous Coronary Artery Dissection Causing ST-Elevation Myocardial Infarction in a Young Adult: A Case Report
Authors: Tiongson Marc Denver A , Sison Eric Oliver D , Aherrera Jaime Alfonso , Regalado Justin Joseph , Bayani Dioscoro DC , Mojica Joerelle , Daud Nashiba , Ramos John Daniel
Published: July 2024

Introduction: ST-elevation myocardial infarction (STEMI) rarely occurs among patients 18 to 34 years old. Spontaneous coronary artery dissection (SCAD) is a rare cause of STEMI that is frequently described among patients in peripartum period. SCAD has a high mortality rate when not recognized and treated immediately. We present a case of SCAD presenting as STEMI in a nineteen-year-old non pregnant patient.

Case: A nineteen-year-old female with chronic kidney disease complained of sudden-onset substernal chest pain. Physical examination showed blood pressure of 140/90 mmHg, heart rate of 112 beats per minute, with findings of of bibasilar rales, pedal edema and cold and clammy extremities.

Electrocardiogram (ECG) showed ST-elevation in leads V3 to V6. Cardiac troponin was elevated, and echocardiography revealed left ventricular segmental hypokinesia and depressed systolic function. Patient was diagnosed with acute anterolateral wall STEMI. Coronary angiogram revealed total occlusion of the mid segment of the left anterior descending artery (LAD), while the rest of the coronary arteries were strikingly normal. After initial balloon angioplasty and stenting of the mid LAD, coronary artery dissection was noted at the distal LAD. A stent was successfully deployed, achieving thrombolysis-in-myocardial-infarction (TIMI) flow grade III with no residual stenosis. Patient remained stable and was discharged improved.

Discussion: STEMI rarely happens in young adults. Moreover, literature highlights the rarity of STEMI caused by SCAD. SCAD usually occurs among young pregnant patients who have no risk factors for atherosclerosis. In this report, we highlight the importance of suspecting SCAD among young patients who present with STEMI and of prompt treatment with revascularization in similar clinical situations.

Conclusion: SCAD remains a rare cause of STEMI, but it should be considered when young individuals present with STEMI. Treatment is primarily urgent revascularization especially if there is persistent chest pain or ischemic ECG changes, hemodynamic instability, or unstable arrhythmia.

Keywords: spontaneous coronary artery dissection, SCAD, acute coronary syndrome, ACS, ST-elevation myocardial infarction, STEMI
Effectiveness of Ultrafiltration in the Treatment of Acute Decompensated Heart Failure: A Meta-Analysis of Randomized Controlled Trials
Authors: Cawed Roberta Maria N , Pelat Joannah Fatima B
Published: July 2024

BACKGROUND: Acute decompensated heart failure (ADHF) is defined as the new onset or recurrence of gradually or rapidly developing symptoms and signs of heart failure requiring urgent or emergent therapy and resulting in hospitalization. Ultrafiltration emerges as a promising alternative to diuretics in patients with signs and symptoms of volume overload. It allows extracorporeal removal of plasma from the whole blood across a semi-permeable membrane through a transmembrane pressure gradient. The objective of this meta-analysis is to compare the benefit of ultrafiltration vs intravenous loop diuretics in patients with ADHF.

METHODS: This was a meta-analysis of randomized controlled trials that compared the effectiveness of ultrafiltration vs intravenous loop diuretics in reducing systemic congestion among ADHF patients. Articles were identified through PubMed, Medline, Cochrane and internet electronic databases. Two reviewers independently assessed and abstracted data from the included studies using the Quality Scale for Meta-analytic Review Form and Data Extraction Form for randomized controlled trials. Analyses were performed using RevMan 5.2.

RESULTS: Ultrafiltration was superior to intravenous loop diuretics in terms of mean change in weight from baseline (WMD -1.78 kg; 95%CI -2.40 to -1.17; p<0.00001). The test for heterogeneity was not significant (chi-square=1.08; p=0.58; I2=58%) after doing a sensitivity analysis. The outcomes on mean change in re-hospitalization and mortality were similar between the two arms. The outcome of change in creatinine clearance was inconclusive.
PSE/PHA Interim Guidelines for Enhanced Quality and Safety at the Echocardiography Laboratory amidst Emerging Infections: Recommendations from the Task Force on Quality and Safety during Echocardiography of the Philippine Society of Echocardiography, Inc. and the Philippine Heart Association Council on Echocardiographys
Authors: Magno Jose Donato A , Cornel Mylene U , Sumalpong Jehan Karen G , Pua Emmet Vi Ladlad , Jumangit Joyce S , Ubaldo Rylan Jasper , Nunez Jonnie Bote , Carpo Patrick R , Gamponia Aurora Muriel S , Flores Viannely Berywn F , Senga Aileen C , Uy Celia Catherine C , Bantala-Supnet Kristine Hashim , Rillera-Posadas Karla Rhea G , Santos Romeo J , Lazaro Victor L , Rogelio Gregorio G , Obillos Stephanie Martha O , Valencia Ofelia N , Go Loewe O , Alimurung Benjamin N , Ramirez-Ragasa Rosemarie , Reyes Eugene B , Sibal Josephus R , Del Rosario Jose Jonas D , Fernandez Ma. Bridget D , S. Supe Myla Gloria , Tucay Edwin S
Published: July 2024

Quality and safety go hand in hand in the practice of echocardiography. This fact becomes  increasingly relevant amidst the pandemic that poses a number of extraordinary challenges  to the healthcare community. The field of cardiovascular ultrasonography is no exception, as  physicians, sonographers and allied health professionals carry out their tasks in the backdrop of  a more intimate patient setting. The Philippine Society of Echocardiography, recognizing its key  leadership role not only in the country but in the Asia-Pacific region, teamed up with the Philippine  Heart Association Council on Echocardiography and the heads and training officers of various  cardiovascular laboratories and training centers in the country to come up with a summary of best  practices that are intended to elevate quality and infection control in echocardiography. 

KEYWORDS: echocardiography, cardiovascular laboratory, quality, safety, infection control
Hybrid Transcatheter Thoracic Endovascular Aortic Repair With Total Debranching of Supra-aortic Trunks: A Case Report
Authors: Lucero Jonald O , Posas Fabio Enrique B
Published: July 2024

Here we report the case of a patient who underwent TEVAR with total debranching of supra-aortic trunks. Thoracic endovascular aortic repair (TEVAR) can be limited by inadequate proximal and distal landing zones. Debranching or hybrid TEVAR has emerged as an important modality to expand landing zones and facilitate TEVAR. The incidence of intraoperative surgical conversion remains low, but late complications and remedial secondary procedures may necessitate complex aortic reconstructions that demand advanced endovascular skills.

KEYWORDS: hybrid TEVAR, thoracic aneurysm, debranching of supra-aortic trunks
Availability of Healthcare Provider and Healthcare Facility for Adult Filipino Patients Hospitalized for Congestive Heart Failure
Authors: Pestaño Noemi S , Tumanan-Mendoza Bernadette A , Mendoza Victor L , Punzalan Felix Eduardo , Bermudez April Ann A , Natividad Rudy Boy , Macabeo Renelene , Shiu Louie Alfred
Published: July 2024

INTRODUCTION: Congestive heart failure (CHF), especially if acute and severe, needs immediate medical attention and often requires hospitalization.

OBJECTIVE: To describe the available healthcare providers, the number and type of healthcare facilities where CHF patients were hospitalized in 2014.

METHODOLOGY: This was a descriptive study of patients aged >19 years old, admitted for CHF in the Philippine Health Insurance (PhilHealth) accredited hospitals in 2014. Data of patients hospitalized for CHF were collected from the PhilHealth database, while the data regarding three specialties, namely, family medicine physicians, internists and cardiologists were extracted from the PhilHealth website. Data were then tabulated and analyzed through descriptive statistics. Results Among the specialists attending to CHF patients, internists had the most number (56%) practicing in the Philippines, while cardiologists were the fewest (9.0%). Among the 17 regions in the Philippines, National Capital Region had the most number of specialists. CHF patients were attended to mostly by cardiologists in all regions except Region IV-B. The ratios of patients to specialist for the entire country were 5.8:1.0 (internist), 36.6:1.0 (cardiologist) and 9.6:1.0 (family medicine specialist). However, most regions, except for NCR, Region VI and Region VII had higher ratios than the national figure. The region with the highest ratio for cardiologists was Region XII (281 cases to one cardiologist). In terms of type of facilities where CHF patients were hospitalized, 68.7% was categorized as tertiary centers while 28.9% was secondary centers. Region IV-A had the highest number of tertiary (14%) and secondary hospitals (13.4%).

CONCLUSION: Region IV-A had the highest number of patients hospitalized for CHF, the highest number of tertiary and secondary hospitals. However, most regions are largely underserved in varying degrees in terms of patient load per specialist. The information can help health advocates and policymakers identify areas that need more attention in terms of availability of health-care providers and facilities.

Keywords: health-care provider, health-care facility, congestive heart failure.
Obstructive CAD in Filipino Women vs Men Diagnosed with ACS in the Philippine ACS Registry
Authors: Beltejar-Pimentel Lisa Marie V , Iboleon-Dy Maria Adelaida , Caoili-Ang Imelda
Published: July 2024

Introduction: To date, no study in published literature has investigated the prevalence of obstructive coronary artery disease (CAD) among Filipino women diagnosed with ACS. This is a pilot study.

Objectives: To determine the prevalence of obstructive CAD among Filipino women and categorize them as ST-elevation myocardial infarction (STEMI), non-STEMI (NSTEMI), or unstable angina (UA); and to determine the risk factors associated with acute coronary syndrome (ACS) among Filipino women in terms of age, smoking history and comorbidities, in comparison with Filipino men.

Methods: This is a cross-sectional study performed from November 2011 through September 2015 using information from patients listed at Philippine ACS Registry of the Philippine Heart Association. The collected data included demographic information such as sex, age, smoking history, comorbidities, medical management, cardiac procedures and mortality.

Results: The study population was composed of 3,346 patients, 31.6% (n=1,059) of whom were females. Out of the 1,169 (34.9%) patients who underwent cardiac catheterization, 25.8% (n=302) were females. All these female patients who underwent cardiac catheterization—whether diagnosed with STEMI (n=133), NSTEMI (n=131), or UA (n=38)—had single- or multiple-vessel disease. In the overall study population, the risk factors that showed statistically significant association with ACS (p<0.05) were age (mean age 59.39 vs 66.60 years), hypertension (73.9% vs 80.5%), diabetes (36.1% vs 42.9%), smoking history (67.8% vs 15.6%), prior MI (11.0% vs 8.6%), previous catheterization (3.5% vs 2.1%) and history of transient ischemic attach (TIA; 1.4% vs 1.0%).

Conclusion: There was a 100% prevalence of obstructive CAD among Filipino women who underwent cardiac catheterization with a diagnosis of STEMI, NSTEMI, or UA. Hypertension and diabetes were more prevalent among women, while smoking history, prior MI, previous catheterization, and history of TIA were more prevalent among the men. Men diagnosed with ACS were younger than the women.
Ductal Stenting Through the Left Internal Carotid Artery in a 5-Year Old Male with PVA: A Case Report
Authors: Cheng Dexter D , Malanyaon Olympia Q , Del Rosario Jose Jonas , Valle Andrea Orel , Capero Maycibel , Martinez Bee Jane T
Published: July 2024

Patients diagnosed with Tetralogy of Fallot (TOF) with Pulmonary Vavle Atresia (PVA) are dependent on a persistent ductus arteriosus (PDA) or collaterals for continued pulmonary blood flow and oxygenation. If collateral flow or the PDA flow is insufficient, a modified Blalock-Taussig shunt (mBTS) is a necessary step to stimulate the growth of the pulmonary arteries prior to placement of a conduit from the right ventricle to the pulmonary arteries. Stenting of a restricted PDA is now widely considered a viable alternative to mBTS. However, this procedure is more commonly performed in the neonatal period. This is followed by total correction via open heart surgery, and may be done in a young child. In a developing nation, ideal cardiac repair is not always feasible. We successfully carried out ductal stenting via the left internal carotid artery in a 5-year old male patient diagnosed with TOF, PVA with a restrictive vertically positioned PDA supplying the pulmonary arteries and no other collateral blood flow. He had severely decreased oxygen saturation prior to ductal stenting which increased to 85 % from 52% after the procedure. This is the first reported case of the performance of ductal stenting via the left internal carotid artery in an older child in the Philippines. This report demonstrates that ductal stenting in older children, like those in neonates, can also be safely and effectively performed.

KEY WORDS ductal stenting, left internal carotid artery, fluoroscopy, modified Blalock-Taussig shunt, PVA, ductus arteriousus, tetralogy of Fallot
Mitral Valve Replacement: The St. Luke’s Medical Center Quezon City Experience
Authors: Kunardi Sidharta , Ongjoco Edgar Y
Published: July 2024

INTRODUCTION: The St. Luke’s Medical Center Quezon City Heart Institute is one of the leading cardiac centers in the country. However, there has been no cardiac valve surgery census published since the establishment of the Heart Institute in 1986.

OBJECTIVE: This study was conducted to present the institution’s experience on mitral valve surgery.

STUDY DESIGN AND METHODOLOGY: This was a retrospective study that reviewed the cardiac valve surgery census from January 2006 to September 2013.

RESULTS: Of the 53 patients who were admitted during the study period, 41 patients had complete medical records. The mean patient age was 44.8 years. Most patients were female (73.2%). The most common etiology of the mitral valve lesion was rheumatic heart disease. Most patients received mechanical valves (90.3%). Tricuspid valve annuloplasty was the most common concomitant procedure done (41.5%). Mortality rate was 4.9%. Hospital acquired pneumonia was the most common complication (26.8%). The mean hospital stay was 17 days.
The Neutrophil-Lymphocyte Ratio Predicts Mortality in Acute Coronary Syndrome (NLR-ACS): A Meta-analysis
Authors: Timbol Edgar Wilson G , Ramos John Daniel A , Aherrera Jaime Alfonso M , Chiong Lowe L , Punzalan Felix Eduardo R
Published: July 2024

BACKGROUND: The neutrophil to lymphocyte ratio (NLR) is a recently described biomarker of inflammation that is an independent predictor of death and myocardial infarction. It integrates two leukocyte subtype counts with opposing actions in terms of vascular inflammation. This can be readily derived from a simple routine complete blood count taken during admission. We conducted a meta-analysis on the usefulness of a high NLR value in predicting mortality among patients with acute coronary syndrome (ACS).

OBJECTIVE: To determine the association of neutrophil to lymphocyte ratio and mortality among patients with acute coronary syndrome.

METHODS: We conducted a systematic search of studies using MEDLINE, EMBASE, ScienceDirect, and Cochrane Central Register of Controlled Trials databases and examined reference lists of studies that used the NLR in ACS patients in reporting mortality. We identified 12 studies that met inclusion criteria including 2 local studies. The study title, follow-up period, neutrophil-lymphocyte ratio, and mortality outcomes were extracted from these studies. Each study was assessed using the Newcastle-Ottawa Quality Assessment Scale. These were done independently by the authors resolving disagreements, if any, by discussion. The outcome of interest was assessed using Mantel Haenzel analysis to compute for odds ratio, and evaluation of heterogeneity were carried out using Review Manager (RevMan) 5.0.18 (The Nordic Cochrane Centre, The Cochrane Collaboration).

RESULTS: Data were combined from 12 studies enrolling 9,835 patients. Pooled analysis showed that a high NLR was predictive of increased total mortality among patients presenting with ACS compared to those patients whose NLR were not high (8.65% vs 2.26%, OR 4.10, 95% CI 3.36, 5.00; p<0.00001). Data were homogenous (I2=0%) and there was no evidence of publication bias by funnel-plot method. Thirty-day mortality, including in-hospital death, was likewise increased among those with high NLR (7.78% vs 2.22%, OR 3.67, 95% CI 2.93, 4.58; p<0.00001; I2=0%).

CONCLUSION: A high NLR value is associated with high mortality among patients with ACS. This parameter can be easily derived from a routine complete blood count taken during hospital admission and is a useful parameter to determine prognosis and may indicate a more intensive approach to therapy.

Keywords: neutrophil-lymphocyte ratio, NLR, acute coronary syndrome, mortality, ACS, NSTEMI, STEMI, unstable angina, ST-segment myocardial infarction, non-ST-segment myocardial infarction
A Meta-Analysis on Efficacy and Safety of Mild Hypothermia Compared with Normothermia Among Post–Cardiac Arrest Patients
Authors: Diansuy Nina Noreen P , Mabbagu Ethel P , Pestaño Noemi S , Punzalan Felix Eduardo R , Tumanan-Mendoza Bernadette , Collantes Epifania
Published: July 2024

Background: Sudden cardiac death (SCD) represents a major health problem, with its exceedingly high mortality rates and dismal prognosis for SCD survivors. The mortality rate and prognosis of SCD patients with pulseless electrical activity (PEA) or asystole is higher compared to those who have ventricular tachycardia (VT) or ventricular fibrillation (VF). Cerebral anoxic injury is a significant contributor of overall mortality and neurologic deterioration among post–cardiac arrest patients. Mild hypothermia has been shown to decrease neurologic injury, translating into improved survival and neurologic outcomes. This meta-analysis aims to determine the efficacy of mild hypothermia in decreasing overall mortality, neurologic deterioration and the risk of developing adverse events among post–cardiac arrest patients.

Methods: The authors searched PubMed and Medline databases to identify randomized controlled trials involving adult patients (>18 years old) admitted for SCD with return of spontaneous circulation (ROSC) after resuscitation and treated with either mild hypothermia (32–34°C) or normothermia (36–37°C), with free text and relevant MeSH headings. Measured outcomes were overall mortality, neurologic deterioration and adverse events. Data was extracted and encoded using Review Manager version 5.3. Two independent reviewers assessed each trial.

Results: Among post–cardiac arrest patients, there were no statistically significant differences noted between mild hypothermia and normothermia in terms of overall mortality (RR 0.97; 95% CI 0.91–1.03; p=0.25; I2=24%) and neurologic deterioration (RR 1.03; 95% CI 0.92–1.15; p=0.72; I2=0%). Among patients with initial cardiac rhythm of VF/VT, there was no significant difference noted between mild hypothermia and normothermia in terms of overall mortality (RR 0.88; 95% CI 0.75–1.02; p=0.1; I2=51%) or neurologic deterioration (RR 0.66; 95% CI 0.36–1.19; p=0.72; I2=0%). Among patients with initial cardiac rhythm of PEA/asystole, there were no significant differences noted between mild hypothermia and normothermia in terms of overall mortality (RR 1.02; 95% CI 0.95–1.08; p=0.15; I2=48%) and neurologic deterioration (RR 0.55; 95% CI 0.26–1.18; p=0.72; I2=0%). Mild hypothermia was associated with increase in the odds of developing infection (OR 1.32; 95% CI 1.05–1.68).

Conclusion: Among post–cardiac arrest patients regardless of initial cardiac rhythm, there was no statistically significant difference between mild hypothermia and normothermia on its impact on overall mortality and neurologic deterioration upon discharge. Mild hypothermia is associated with an increased risk of developing infection compared to normothermia (OR 1.32; 95% CI 1.05-1.68; p= 0.17; I2=48%).

Keywords: sudden cardiac death, therapeutic hypothermia
Four-Year Clinical Outcomes of Filipino Patients with or at Risk for Atherothrombotic Events from the REACH Registry
Authors: Abola Maria Teresa B , Punzalan Felix Eduardo R , Roxas Artemio A
Published: July 2024

Background: Patients with established atherothrombotic disease (EAD) or those with atherothrombotic risk factors are at high risk for cardiovascular events and death. There are scant data on the clinical profile of stable Filipino patients with risk factors for atherothrombosis, and their long-term outcomes.

Objective: To present the baseline clinical profile and four-year cardiovascular outcomes of Filipino out patients with EAD and those with multiple atherothrombotic risk factors.

Methodology: The Reduction of Atherothrombosis for Continued Health (REACH) Registry is an international, prospective cohort of 68,236 patients aged at least 45 years old with either EAD or at least three atherothrombotic risk factors enrolled from 44 countries from 2003 to 2004. The Philippine cohort consists of 913 patients with EAD and 127 subjects with at least three atherothrombotic risk factors, who were consecutively enrolled and followed up for at least one to four years for the occurrence of cardiovascular (CV) death, myocardial infarction (MI) or stroke.

Results: Of the 1,040 Filipino patients enrolled, 995 completed the four-year follow-up (96%). Their mean age was 65.5 years, with a balanced sex distribution. Forty-six percent have diabetes, 87.4% have hypertension, 62.9% have hypercholesterolemia, and 29.7% are ever-smokers. Ninety two percent had EAD (43% with coronary artery disease, 45% with cerebrovascular disease and 4% with peripheral artery disease or PAD). The rate of the combined primary endpoint of CV death/MI/stroke was 14.7%, but was higher (19.8%) among those with poly-vascular disease. Cerebrovascular disease patients had the highest CV death/MI/stroke rates (17.6%). PAD patients had the highest CV death/MI/stroke and hospitalization rate (33.2%). At baseline, 81.1% were receiving antiplatelet agents, 62.6% were receiving statins and 69% were receiving either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. After the fourth year of follow-up, medication usage rates were lower at 72.6%, 62.3%, and 37.2%, respectively.

Conclusions: Filipino outpatients with, or at risk for, atherothrombosis experienced high long-term rates of CV events. This is the first report of long-term CV outcomes of stable Filipino outpatients with this high-risk profile.
Prevalence of Subclinical Right Ventricular Dysfunction Using Tissue Doppler Imaging Among Newly Diagnosed Obstructive Sleep Apnea (OSA) Patients in St. Luke’s Medical Center
Authors: Atienza-Ortiz Gerlie , Hipolito Olivia B , Cornel Mylene U
Published: July 2024

BACKGROUND: Obstructive sleep apnea (OSA) is a syndrome characterized by repetitive obstruction of the upper airway during sleep, and is associated with frequent episodes of transient nocturnal pulmonary hypertension and consequently, possible right heart dysfunction. The aim of this study is to determine the prevalence of subclinical right ventricular (RV) dysfunction in newly diagnosed OSA patients.

METHODS: This is a retrospective analytical study from March 2012 to February 2013. We reviewed the recent transthoracic echocardiography results of 37 patients diagnosed with OSA determined by the apnea hypopnea index (AHI) after an overnight polysomnography. Of these, 27 patients had complete echocardiographic data. We evaluated the RV systolic function and pulmonary artery (PA) pressure by standard echocardiography, specifically RV and right atrium (RA) diameters, tricuspid annular systolic excursion (TAPSE), pulmonary artery acceleration time (AT), systolic PA pressure; and tissue Doppler imaging for RV systolic and diastolic velocities.

RESULTS: Patients with OSA were predominantly male, obese with a body mass index of more than 30 kg/m2. Seventy percent were hypertensive and 30% were diabetic. Patients with OSA had normal TAPSE and RV systolic velocity. Although no significant difference in RV systolic parameters were noted between groups, OSA patients generally had lower early diastolic and a higher late (A’) annular velocities suggesting impaired relaxation. AHI and mean PA dimension were correlated (p<0.0001), and PA diameter was significantly increased among OSA patients, which may signify early structural cardiac changes related to chronic transient nocturnal pulmonary hypertension.

CONCLUSION: Subclinical RV diastolic dysfunction may be prevalent among OSA patients despite having normal left ventricular function and PA pressures.
Relationship of Left Atrial Volume Index with Exercise Functional Capacity among Post-Percutaneous Coronary Intervention Patients
Authors: Darunday-Patiño Irene , Supe Myla
Published: July 2024

INTRODUCTION: Recent evidence highlighted the importance of increased left atrial volume  index (LAVI) as a powerful predictor of mortality after acute myocardial infarction (AMI). This  study aimed to investigate whether LAVI correlates with the level of functional capacity  assessed by treadmill exercise test using metabolic equivalents (METS). 

METHODS: Twenty-four patients with AMI who underwent percutaneous coronary intervention  (PCI) were included in this study. Two-dimensional echocardiography done after PCI were  reviewed and the following parameters were obtained: left atrial size, LAVI and left ventricular  ejection fraction (LVEF). At least two weeks post-PCI, patients underwent symptom-limited  treadmill exercise test using the National Institute for Health (NIH)/NEPTET protocol. Pearson  product moment correlation was used to determine the linear correlation between LAVI and  exercise capacity measured by METS score. 

RESULTS: Majority of the patients were male with a mean age of 49.5 years. Majority were  hypertensive, overweight and were current smokers. The mean ejection fraction (56.0 + 1.0)  was preserved while the mean LAVI (21.3 + 5.8) was within normal ranges. The median METS  achieved patients was 7.5. Pearson product moment correlation showed that there was no  correlation between LAVI and exercise capacity measured by METS score.  

CONCLUSION: There is no correlation between LAVI and exercise capacity measured by  metabolic equivalents (METS) among post-PCI for myocardial infarction patients. 

KEYWORDS: left atrial volume index; functional exercise capacity; post-percutaneous  coronary intervention
Catheter Ablation of an Anteroseptal Accessory Pathway Guided by Three-dimensional Electroanatomical Mapping in Symptomatic Wolff-Parkinson-White Syndrome
Authors: Te Abigail Louise D , Tiongson Jay Erwin , Ang Edmund O
Published: July 2024

OBJECTIVE: To report a case of a successful anteroseptal accessory pathway ablation in a 32-year old male with symptomatic Wolf-Parkinson-White (WPW) syndrome with the guidance of three-dimensional (3D) electroanatomical mapping.

CLINICAL PRESENTATION: This is the case of a 32-year old male with symptomatic WPW syndrome presenting as frequent episodes of palpitations since 2002 despite being maintained on flecainide 100 mg twice daily. He was initially admitted in another institution for electrophysiological study (EPS), which showed orthodromic tachycardia using an anteroseptal pathway. Due to the proximity of the accessory pathway to the bundle of His, ablation was not attempted. He was referred to our institution and eventually underwent successful radiofrequency (RF) ablation of the anteroseptal accessory pathway with the guidance of 3D electroanatomical mapping.

At baseline, the His proximal electrodes appeared to have the earliest ventricular activation in sinus rhythm, and the earliest His bundle activation with ventricular pacing as well. During tachycardia, there was concentric ventriculo-atrial (VA) conduction via the accessory pathway, with the earliest VA conduction at the His electrode essentially fused. The accessory pathway was mapped to the anteroseptal region of the tricuspid annulus that was 2 to 3 mm from the Bundle of His. RF application in this area during sinus rhythm with 3D electroanatomical guidance resulted in loss of the delta wave after 2 seconds of energy application of 30 watts at 35° (right antero-oblique), which persisted after the ablation.

SIGNIFICANCE: EPS with RF ablation is the first-line treatment for symptomatic WPW syndrome. However, due to the potential for atrioventricular block especially in the anteroseptal accessory pathway ablation because of its close proximity to the His bundle, precise mapping of the tract is essential and can be accomplished using 3D electroanatomical mapping.

KEYWORDS: Wolff-Parkinson-White syndrome, electroanatomical mapping, anteroseptal accessory pathway, septal ablation, radiofrequency ablation complications, atrioventricular block.
Perspectives of Adult Cardiology Consultants Regarding Practice of Clinical Cardiology in the COVID-19 Pandemic: A Q Methodology Study
Authors: Yamamoto Julianne Marie E , Mendoza Clarissa M
Published: July 2024

BACKGROUND: Coronavirus disease 2019 (COVID-19) has drastically changed lives, challenging all to adapt new norms and survive. Safety guidelines for physician have been set, yet fear for health and safety hounds the physician.

OBJECTIVE: The aims of this study were to segment cardiologists’ viewpoints according to perceived stressors and coping mechanisms in their clinical practice during the COVID-19 pandemic and to draw implications to coping in the light of the model of salutogenesis.

METHODS: Q methodology, a mixed-method type of research, was used after approval from the UST Hospital Research Ethics Committee. Using convenience sampling, 30 adult cardiologists were included in this study. Following an informed consent to participate, they ranked-order 33 statements that answer the questions: “What are the stressors has this COVID-19 pandemic brought in your clinical practice of cardiology? How did you cope?” This was done on a Q grid with two “most agree” statements and two “most disagree” statements (Q-sort). A short interview followed the sorting to understand their most agree and most disagree statements. Q-sorting and interview were done via teleconferencing and in person. The Q sorts were then entered into a web-based PQMethod software (http://schmolck.org/qmethod/downpqdos.htm). Typologies were generated through inductive approach.

RESULTS: Three typologies were generated: the profession-driven cardiologists, the protocol

driven cardiologists, and the faith-driven cardiologists.

CONCLUSION: This study painted different personas of cardiologists as they conduct their practice in this pandemic. These typologies enabled the formulation of individual and group salutogenic measures that can help health care providers cope in this COVID-19 pandemic.

KEYWORDS: cardiology, clinical practice, coping, COVID-19, Q methodology
The Effect of Rabeprazole on the Antiplatelet Efficacy of Clopidogrel: A Systematic Review
Authors: Reyes Eugenio B , Santos April Ann Bermudez-delos
Published: July 2024

Introduction: Clopidogrel is a P2Y12 receptor antagonist given to patients with coronary heart disease, usually in combination with aspirin. It is metabolized to its active component through the cytochrome P450 2C19 (CYP2C19) isoenzyme. Proton pump inhibitors (PPI) are commonly used in patients who are receiving clopidogrel, especially those at high-risk for gastrointestinal bleeding. However, certain PPIs are likewise metabolized through the CYP2C19 isoenzyme. Co-administration of the two classes of drugs may lead to lower levels of clopidogrel, leading to lower antiplatelet efficacy and lower effects on cardiovascular disease prevention of the drug.

Objective: To determine the effects of rabeprazole on platelet activity, major adverse cardiovascular outcomes and gastrointestinal bleeding among patients receiving clopidogrel

Methodology: We performed this meta-analysis that included all types of studies (randomized controlled trials, case control studies, prospective and retrospective cohort studies) that investigated rabeprazole versus no rabeprazole or placebo. The population consisted of patients who received clopidogrel for any indication with concomitant administration of rabeprazole versus clopidogrel alone. Randomized trials were assessed using Cochrane’s Collaboration tool for assessment of risk of bias. For non randomized studies, Newcastle-Ottawa Quality Assessment Scale for cohort studies was used. Dichotomous data were analyzed using risk ratio and 95% confidence interval, while continuous variables were analyzed using mean differences and standard deviation. Heterogeneity was tested using chi-square test and I2 statistics.

Results: There were no statistically significant differences noted in the outcomes of maximal platelet aggregation (mean difference 0.75, 95% CI -3.85 to 5.35), platelet reactivity index (mean difference -0.75, 95% CI -5.11 to 3.61), total cardiovascular events (RR 2.64, 95% CI 0.65 to 10.75) and gastrointestinal bleeding (RR 0.72, 95% CI 0.34 to 1.55) between clopidogrel-treated patients on rabeprazole compared to those without.. Data were not heterogenous, except on the outcome of total cardiovascular events. An influence analysis showed that removal of one trial made the outcome non-heterogenous, but the outcome difference was still not statistically significant (RR 1.25, 95% CI 0.66 to 2.37).

Conclusion: Rabeprazole in addition to clopidogrel did not significantly affect maximal platelet aggregation, platelet reactivity index, gastrointestinal bleeding and cardiovascular outcomes.
The CHADS2 and CHA2DS2 VASC Risk Stratification Systems for Stroke Risk in Atrial Fibrillation: Evaluation of their Correlation to In-hospital Clinical Outcomes
Authors: Rosario Rachel Rose A. Orteza-del , Cosca Katherine Z , Ramboyong Raul E , Ramirez Marcellus Francis L
Published: July 2024

The CHADS2 scoring system is the most widely used risk stratification method to assess stroke risk in atrial fibrillation (AF) patients. Recently, a CHA2DS2VASC scoring modification has been introduced. This is a retrospective study of patients diagnosed to have acute onset AF admitted to the critical care unit or telemetry unit at The Medical City. Sixty patients were included in the study. CHADS2 and CHA2DS2VASC scores were calculated for each patient and correlated with in-hospital clinical outcomes of the patients: primary end-points included conversion to sinus rhythm within 24 hours and length of hospital stay, while secondary end points included in-hospital outcome, and length of hospital stay. The mean age was 59.53 ± 17.98 years, Majority of the subjects were diabetic and hypertensive. The mean CHADS2 score was 1.26 ± 1.031 while the mean CHA2DS2VASC score was 2.25 ± 1.65. Only one patient expired. Two remained in AF on discharge. There was no significant difference in conversion of AF to sinus rhythm in less than 24 hours among patients with CHADS2 score of <2, 2 and > 2, regardless of the medications given (p=0.067). Patients with a CHADS2 score <2 had a shorter hospital stay compared to those with CHADS2 score >2 (2.79 ± 2.26 days vs 4.71 ± 3.45 days, P 0.032). Those with CHA2DS2VASC score <2 had a significantly shorter hospital stay than the group with score of > 2 (2.5 ± 1.60 days vs 3.65 ± 2.93 days; p=0.022). Discharge disposition did not significantly vary in the three risk groups. The added length of hospital stay in the higher risk group was not associated with anticoagulant initiation and bleeding parameters monitoring.
Role of ST2 in Predicting Major Adverse Cardiovascular Events in Acute Coronary Syndrome Patients who Underwent Percutaneous Coronary Intervention
Authors: Bacani Jason Roy , Estacio Ronaldo H , Sui James Ho Khe
Published: July 2024

The Gensini scoring system is an objective method to determine the severity of coronary artery  disease (CAD) according to angiographic findings and was noted to be independently associated  with in-hospital mortality in ST-Elevation Myocardial Infarction (STEMI) patients treated with  primary percutaneous coronary intervention (PCI). This was a single-center cross-sectional  study which included 56 participants who were diagnosed with acute coronary syndrome and  underwent coronary angiogram and percutaneous coronary intervention. ST2 Levels were  determined and Gensini scoring for severity of CAD was done. A cut-off value 71 ng/ml was  established to be a good predictor of outcomes with a sensitivity of 81.3% and specificity of  75% (LR+ 3.680 LR - 0.256 AUC 0.811). Patients with elevated ST2 levels on admission had  increased major adverse cardiovascular events within 1-year follow up, which included death  (p=0.128), worsening heart failure (p=0.015), arrhythmia (p=0.041) and worsening angina  (p=0.128). Likewise, they had increased Gensini scores (p=0.025), equating to more severe  coronary anatomy, more number of vessels involved and most had incomplete revascularization. 

CONCLUSION: Higher ST2 levels at presentation predisposes to higher risk of developing future  adverse events. Taking into account a combination of traditional risk factors, angiography-based  scores, and traditional or novel biomarkers such as ST2 could lead to improved prediction of  events in this cohort with coronary artery disease. 

KEYWORDS: ST2, coronary artery disease, acute coronary syndrome, percutaneous coronary  intervention, risk stratification, Gensini score
Clinical and Echocardiographic Outcomes of Tricuspid Regurgitation After Percutaneous Transmitral Commissurotomy: Prospective Cohort
Authors: Toledano Bryan Rene F , Jaluage-Villanueva Maria Johanna , Lacson Sharon Marisse
Published: July 2024

PURPOSE: The gap in evidence in the management of multivalvular lesions can be addressed  by providing more data on clinical and echocardiographic outcomes after percutaneous  transmitral commissurotomy (PTMC) in patients with concomitant significant tricuspid  regurgitation (TR) at baseline. 

METHODS: This is a single-center cohort study of adult Filipinos 19 years or older, admitted  between January 2019 and October 2020 due to severe mitral stenosis with moderate to  severe TR subjected to PTMC. The outcome post-PTMC was divided into 2 groups: significant  TR, which included the progression of moderate to severe TR or persistence of severe TR,  and insignificant TR group, which included those with mild TR, regression of moderate to mild  TR, severe to moderate, or persistence of moderate TR. The clinical and echocardiographic  parameters of these groups were compared at baseline, at 24 hours, 1 month, and 6 months  postprocedure. The numerical data between significant and nonsignificant TR were compared  using nonparametric Mann–Whitney U test and categorical data using the χ2 test. 

RESULTS: Thirty-eight patients with significant mitral stenosis and TR post-PTMC were  analyzed. At 24 hours post-PTMC, the significant TR group had significantly higher right atrial  volume index (42.3 vs 26.1, P = 0.004), right ventricular dimension (RVD) mid (3.81 vs 2.92,  P = 0.001), systolic pulmonary arterial pressure (60.5 vs 38.5, P = 0.003), and right ventricular  outflow tract (2.8 vs 2.2, P = 0.001) and lower mitral valve (MV) planimetry (1.25 vs 1.58,  P = 0.009). At 1 month, RVD mid (3.4 vs 2.8, P = 0.02) and tricuspid valve (TV) annulus (3.35  vs 2.76, P = 0.10) were significantly higher in the significant TR group. At 6 months, right atrial  volume index (59 vs 24.7, P = 0.001), RVD mid (4 vs 2.73, P = 0.006), and TV annulus (4.5 vs  2.67, P = 0.001) were significantly higher in the significant TR group. The insignificant TR group  on the sixth month had significantly improved functional class New York Heart Association I (32  vs 5 P = 0.019). 

CONCLUSION: Percutaneous transmitral commissurotomy improved functional class and  echocardiographic parameters of systolic pulmonary arterial pressure, MV planimetry, and MV  gradient on short-term follow-up on both groups of TR. The majority of outcomes after the  procedure had insignificant TR. However, those with significant TR had higher RVD mid and TV  annulus from 24 hours to 6 months when compared with the insignificant TR group. 

KEYWORDS: rheumatic heart disease, mitral stenosis, percutaneous transmitral  commissurotomy, tricuspid regurgitation
2023 Philippine Working Group Consensus Statement on Renal Denervation Therapy for the Management of Hypertension
Authors:   Philippine Renal Denervation Consortium Group, Oliva Raymond , Ona Deborah Ignacia D , Santos Lourdes Ella G , Punzalan Felix Eduardo , Tan John David , Villela Gilbert , Balmores Benjamin , Yap-Uy Krizia Camille , Cawed-Mende Roberta Maria , Cruz Jose Nicholas
Published: July 2024

BACKGROUND: Hypertension is the most common risk factor for cardiovascular disease in the Philippines. Despite the availability of antihypertensive medications that are effective, safe, and tolerated by Filipino patients, the numbers of uncontrolled hypertensives are still increasing. Several factors play in the poor control of blood pressure, particularly resistant hypertension and hyperactive sympathetic nervous system. Renal denervation therapy is a novel device that has been shown to lower blood pressure in patients with resistant and difficult-to-treat hypertension and is deemed safe in clinical trials. A Philippine Working Group composed of specialists in cardiology, hypertension, vascular surgery, and clinical epidemiology has come up with consensus statements in identifying patients who will benefit from the procedure. Locally, there is a need to have hypertension centers treating uncontrolled and resistant hypertension and offer renal denervation therapy to appropriate Filipino patients.

KEYWORDS: blood pressure, difficult-to-treat hypertension, renal denervation therapy, resistant hypertension
Epidemiologic Burden of Hospitalization Among Adult Filipinos with Supraventricular Tachycardia Requiring Radiofrequency Ablation
Authors: Santos April Ann A. Bermudez-delos , Agbayani Michael-Joseph F , C. Fadreguilan Erdie , Gabriel Eden A , Tumanan-Mendoza Bernadette A , Mendoza Victor L , Pestaño Noemi S , David Gladys Ruth S , Punzalan Felix Eduardo R , Gervacio Giselle G , Segundo Luigi Pierre S , De Las Llagas Carlos E , Lagamayo Magdalena J
Published: July 2024

INTRODUCTION: Radiofrequency catheter ablation (RFA) is an interventional cardiac electrophysiologic procedure that uses heat energy for definitive management of supraventricular tachycardias. It is a class I recommendation for chronic management of most supraventricular arrhythmias. No local data exist in the incidence hospitalization for SVT and utilization of RFA for this condition. The study aimed to obtain the prevalence of hospitalization of patients with supraventricular tachycardias where RFA is utilized, including the patients’ demographic profile, length of hospitalization, and mortality rate. 

METHODOLOGY: Philippine Health Insurance Corporation claims for hospitalization from January 1, 2017, to December 31, 2018, were reviewed. Data analysis was done using median and interquartile range for continuous data, and frequency and percentage distribution for categorical data.  

RESULTS: There were 1121 and 1149 claims for hospitalization for SVTs (atrial paroxysmal tachycardia, atrioventricular paroxysmal tachycardia, nodal paroxysmal tachycardia, and junctional tachycardia) in 2017 and 2018, respectively. This represents four hospitalization claims for SVT per 10,000 of the total PHIC claims. The majority of patients were female with median age of 52 years. Only 25 and 19 patients underwent radiofrequency ablation in 2017 and 2018, respectively. The majority of these patients were male and younger with a median age of 31 years. No mortality was recorded among patients admitted for catheter ablation. 

CONCLUSION: In 2017 and 2018, hospitalization claims for SVT requiring catheter ablation were 0.04% (four hospitalization claims for SVT per 10,000 of the total claims) in both years. The majority of patients were admitted with pharmacologic therapy on discharge with very low utilization of radiofrequency ablation for long-term management. 

KEYWORDS: arrhythmia, supraventricular tachycardia, radiofrequency ablation, prevalence, hospitalization
Predictive Value of Liver Stiffness Using FIB-4 Index in Mortality of Heart Failure Patients (Philippine Heart Failure Registry)
Authors: Benitez Victor Jonathan S , Cantre Jennifer , De Guzman Arnold
Published: July 2024

BACKGROUND: Heart failure has an in-hospital mortality of 8.2% in the Philippines. The chronic  passive congestion caused by heart failure is known to cause liver stiffness, which is proven using  ultrasound elastography (US). However, US is not readily available in the Philippines; hence, a scoring system, the FIB-4 index, may have a prognostic value in patient with heart failure. This  study aimed to establish the utility of the FIB-4 index as an independent risk factor of mortality in  heart failure patients. 

METHODS: This was a prospective study that included heart failure patients diagnosed using the  Framingham criteria and enrolled in the Philippine Heart Failure Registry. FIB-4 index was computed  for each patient and classified as having minimal FIB-4 index (<1.45); moderate (1.46 to 3.25) or  advanced (>3.25). Regression analysis was performed to determine the association of FIB-4 index  to mortality rate.  

RESULTS: Of the 523 patients included in the study, majority were males (59.27%), newly  diagnosed with heart failure (54.50%) and had no previous hospitalization (44.9%). Paroxysmal  nocturnal dyspnea (82.41%) was the most common major criteria and dyspnea on exertion  (88.10%) was the most common minor criteria present. Most complained of dyspnea (59%) on  admission. The most common primary etiology of heart failure was hypertensive heart disease  (30%). Regression analysis showed a five-fold increased risk of mortality (p=0.0001, 95% CI  2.1–11.7) in patient with FIB-4 index value >3.25, which increased to a 14-fold increase in risk after  adjustment for covariates (p=0.0001, 95% CI 3.4–55.63), compared with patients with minimal to  moderate FIB-4 index value. 

CONCLUSION: Chronic passive congestion of the liver from heart failure leads to liver stiffness and  those patients with advanced FIB-4 index value have a 14 times higher risk of mortality compared  to those with minimal to moderate FIB-4 index value.