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Background: Thalassemia is the most prevalent hereditary anaemia worldwide. Severe forms of thalassemia can lead to reduced life expectancy due to disease-related complications. Objectives: To investigate the survival of thalassemia patients across varying disease severity, causes of death and related clinical factors. Patients and methods: We conducted a retrospective review of thalassemia patients who received medical care at Chiang Mai University Hospital. The analysis focused on survival outcomes, and potential associations between clinical factors and patient survival. Results: A total of 789 patients were included in our study cohort. Among them, 38.1% had Hb H disease, 35.4% had Hb E/beta-thalassemia and 26.5% had beta-thalassemia major. Half of the patients (50.1%) required regular transfusions. Sixty-five patients (8.2%) had deceased. The predominant causes of mortality were infection-related (36.9%) and cardiac complications (27.7%). Transfusion-dependent thalassemia (TDT) (adjusted HR 3.68, 95% CI 1.39-9.72, p = 0.008) and a mean serum ferritin level ≥3000 ng/mL (adjusted HR 4.18, 95% CI 2.20-7.92, p < 0.001) were independently associated with poorer survival. Conclusions: Our study highlights the primary contributors to mortality in patients with thalassemia as infection-related issues and cardiac complications. It also underscores the significant impact of TDT and elevated serum ferritin levels on the survival of thalassemia patients. [ABSTRACT FROM AUTHOR]

Viral cardiac diseases have a significant impact on global health, and RNA viruses play a crucial role in their pathogenesis. This literature review aims to provide a comprehensive understanding of the complex relationship between RNA viruses and cardiac diseases, focusing on the molecular processes and clinical implications of these interactions. The paper begins by discussing the various RNA viruses that have been linked to cardiac infections. Subsequently, the study explores the mechanisms through which RNA viruses can cause cardiac injury, including direct viral invasion, immune‐mediated responses, and molecular mimicry. The review extensively examines the intricate interplay between the host immune system and RNA viruses, shedding light on both protective and harmful immune responses. Additionally, it investigates the role of viral persistence and chronic inflammation in the long‐term effects on cardiac health. The thorough analysis presented not only enhances our scientific understanding of how RNA viruses contribute to the development of cardiac diseases but also highlights potential avenues for future research and breakthroughs in this field. Given the significant global health threat posed by viral cardiac disorders, unraveling the molecular foundations of these diseases is essential for advancing diagnostic capabilities and therapeutic interventions. [ABSTRACT FROM AUTHOR]

Background: Tetanus is a clinical rarity due to the successful globally adopted childhood vaccination programme. The rising elderly population in the United Kingdom creates a subset of individuals whom are prone to develop Tetanus as they preceded this vaccination drive. Case summary: A 76 year old Caucasian lady presented with a soil contaminated laceration injury on her knee following a fall. Though she received urgent assessment and wound care, the relevance of the injury in the backdrop of her age was not appreciated and her tetanus post exposure prophylaxis was overlooked. She readmitted seeking further management 1 week later with an infected wound with Trismus and clinical features favoring Generalized tetanus. During her stay she developed Takotsubo-cardiomyopathy with congestive cardiac failure and required prolonged care in the intensive unit with mechanical ventilation and rehabilitation before being discharged home. Conclusion: First contact physicians should have a greater appreciation of the types of injuries and at-risk individuals who are more prone to develop tetanus upon exposure to ensure early and appropriate identification. There should be greater situational awareness with regard to the elderly in view of their heightened risk of development of tetanus specially those born before the vaccination drive. Knowledge regarding post exposure prophylaxis measures for tetanus should be regularly updated using local guidance to ensure awareness, so as to despite its rarity Tetanus remains an adequately appreciated disease. [ABSTRACT FROM AUTHOR]

Abstract Background Tetanus is a clinical rarity due to the successful globally adopted childhood vaccination programme. The rising elderly population in the United Kingdom creates a subset of individuals whom are prone to develop Tetanus as they preceded this vaccination drive. Case summary A 76 year old Caucasian lady presented with a soil contaminated laceration injury on her knee following a fall. Though she received urgent assessment and wound care, the relevance of the injury in the backdrop of her age was not appreciated and her tetanus post exposure prophylaxis was overlooked. She readmitted seeking further management 1 week later with an infected wound with Trismus and clinical features favoring Generalized tetanus. During her stay she developed Takotsubo-cardiomyopathy with congestive cardiac failure and required prolonged care in the intensive unit with mechanical ventilation and rehabilitation before being discharged home. Conclusion First contact physicians should have a greater appreciation of the types of injuries and at-risk individuals who are more prone to develop tetanus upon exposure to ensure early and appropriate identification. There should be greater situational awareness with regard to the elderly in view of their heightened risk of development of tetanus specially those born before the vaccination drive. Knowledge regarding post exposure prophylaxis measures for tetanus should be regularly updated using local guidance to ensure awareness, so as to despite its rarity Tetanus remains an adequately appreciated disease.

Abstract Background The Revised Cardiac Risk Index (RCRI) and the American Society of Anaesthesiologists (ASA-PS) classification system are two commonly used tools for preoperative risk assessment. This study aimed to assess the accuracy of RCRI compared to the ASA-PS classification system in preoperative risk assessment for pulmonary and cardiac problems among non-cardiothoracic surgery patients admitted at Muhimbili National Hospital (MNH). Methods This was a prospective cohort study design conducted from August 2022 to April 2023 among 184 patients of 18 years and above admitted at MNH for elective non-cardiothoracic surgery. Data Analysis was conducted using STATA software version 16. Means and standard deviations were used to summarize continuous data. Frequencies and percentages were used to summarize categorical data. The logistic regression and ROC curve analysis were used to determine the correlation between variables. Results The majority of patients (43.3%) had an RCRI score of 1 point, and 39.9% were classified as ASA class 1. Patients in ASA classes 3 and 4 had higher odds of developing cardiac and pulmonary complications (AUC = 0.75 and 0.77, respectively). Patients with an RCRI score of 2 or ≥ 3 points were also more likely to experience cardiac and pulmonary complications (AUC = 0.73 and 0.72, respectively). There was no significant difference in the predictive ability of the two tools. Both RCRI and ASA-PS classification systems were equally effective in predicting these complications. Conclusion Both the RCRI and the ASA-PS classification system demonstrated good predictive ability for cardiac and pulmonary complications among patients undergoing non-cardiothoracic surgery.

Abstract Diabetes mellitus (DM) is a progressive, chronic metabolic disorder characterized by high oxidative stress, which can lead to cardiac damage. Methionine sulfoxylation (MetO) of proteins by excessive reactive oxygen species (ROS) can impair the basic functionality of essential cellular proteins, contributing to heart failure. Methionine sulfoxide reductase B2 (MsrB2) can reverse oxidation induced MetO in mitochondrial proteins, so we investigated its role in diabetic cardiomyopathy. We observed that DM-induced heart damage in diabetic mice model is characterized by increased ROS, increased protein MetO with mitochondria structural pathology, and cardiac fibrosis. In addition, MsrB2 was significantly increased in mouse DM cardiomyocytes, supporting the induction of a protective process. Further, MsrB2 directly induces Parkin and LC3 activation (mitophagy markers) in cardiomyocytes. In MsrB2, knockout mice displayed abnormal electrophysiological function, as determined by ECG analysis. Histological analysis confirmed increased cardiac fibrosis and disrupted cardiac tissue in MsrB2 knockout DM mice. We then corroborated our findings in human DM heart samples. Our study demonstrates that increased MsrB2 expression in the heart protects against diabetic cardiomyopathy. Graphic Abstract

Background: The Revised Cardiac Risk Index (RCRI) and the American Society of Anaesthesiologists (ASA-PS) classification system are two commonly used tools for preoperative risk assessment. This study aimed to assess the accuracy of RCRI compared to the ASA-PS classification system in preoperative risk assessment for pulmonary and cardiac problems among non-cardiothoracic surgery patients admitted at Muhimbili National Hospital (MNH). Methods: This was a prospective cohort study design conducted from August 2022 to April 2023 among 184 patients of 18 years and above admitted at MNH for elective non-cardiothoracic surgery. Data Analysis was conducted using STATA software version 16. Means and standard deviations were used to summarize continuous data. Frequencies and percentages were used to summarize categorical data. The logistic regression and ROC curve analysis were used to determine the correlation between variables. Results: The majority of patients (43.3%) had an RCRI score of 1 point, and 39.9% were classified as ASA class 1. Patients in ASA classes 3 and 4 had higher odds of developing cardiac and pulmonary complications (AUC = 0.75 and 0.77, respectively). Patients with an RCRI score of 2 or ≥ 3 points were also more likely to experience cardiac and pulmonary complications (AUC = 0.73 and 0.72, respectively). There was no significant difference in the predictive ability of the two tools. Both RCRI and ASA-PS classification systems were equally effective in predicting these complications. Conclusion: Both the RCRI and the ASA-PS classification system demonstrated good predictive ability for cardiac and pulmonary complications among patients undergoing non-cardiothoracic surgery. [ABSTRACT FROM AUTHOR]

The literature has widely described the interaction between cardiac complications and COVID‐19. However, the diagnosis of cardiac complications caused by COVID‐19 using Computed Tomography (CT) images remains a challenge due to the diverse clinical manifestations. To address this issue, this study proposes a novel configuration of Convolutional Neural Network (CNN) for detecting cardiac complications derived from COVID‐19 using CT images. The main contribution of this work lies in the use of CNN techniques in combination with Long Short‐Term Memory (LSTM) for cardiac complication detection. To explore two‐class classification (COVID‐19 without cardiac complications vs. COVID‐19 with cardiac complications), 10 650 CT images were collected from COVID‐19 patients with and without myocardial infarction, myocarditis, and arrhythmia. The information was annotated by two radiology specialists. A total of 0.926 was found to be the accuracy, 0.84 was the recall, 0.82 was the precision, 0.82 was the F1‐score, and 0.830 was the g‐mean of the suggested model. These results show that the suggested approach can identify cardiac problems from COVID‐19 in CT scans. Patients with COVID‐19 may benefit from the proposed LSTM‐CNN architecture's enhanced ability to identify cardiac problems. [ABSTRACT FROM AUTHOR]

Background Cardiac injury caused by iron overload is the leading cause of mortality and morbidity in patients with beta-thalassemia, owing to frequent blood transfusion, increased iron overload, and blood hemolysis. Objective This research aimed to assess several novel cardiac biomarkers in the blood samples of children and adult patients with beta-thalassemia major (βTM), along with their respective control groups. These biomarkers included endothelin 1 (ET-1), N-terminal pro-brain natriuretic peptide (NT-proBNP), atrial natriuretic peptide (ANP), growth differentiation factor-15 (GDF-15), and renalase (RNLS). Methods This case-control study was done on 46 patients with βTM (23 children <18 years, and 23 adults ≥18 years) from the Genetic Hematology Center in Thi-Qar province, Iraq, and 42 comparable controls in 2 groups (21 for each group) in the period from February to April 2023. Results Levels of ET-1, NT-proBNP, ANP, GDF-15, RNLS, and ferritin were higher in the children and adults with βTM than in the control subjects. Conclusion Elevations of the novel cardiac biomarkers ET-1, NT-proBNP, ANP, GDF-15, and RNLS in the sera of children and adult patients with βTM when compared with comparable control subjects confirm that the majority of patients with βTM are at risk of cardiac and cardiovascular complications even when there are no obvious symptoms, especially in children, which gives suitable predictive biomarkers. [ABSTRACT FROM AUTHOR]

Hypothyroidism has adverse effects on heart metabolism and functions including reduced heart rate, cardiac output and cardiac contractility. The therapeutic effects of alpha lipoic acid (LA) and metformin (MET) against hypothyroidism-induced myocardial complications were assessed in the current study. Rats were divided into control, propylthiouracil (PTU)-induced hypothyroidism model, hypothyroidism model treated with LA and/or MET. Serum thyroid hormones (T3, T4 and TSH) were measured. Lipid peroxidation (MDA), nitric oxide (NO), reduced glutathione (GSH), nuclear factor erythroid 2–related factor 2 (NrF2), B-cell lymphoma 2 (BCL2), nuclear factor kappa B (NF-κB), serotonin (5-HT), norepinephrine (NE) and dopamine (DA), acetylcholinesterase (AChE), monoamine oxidase (MAO) and Na+,K+,ATPase were measured in the cardiac tissue. The histopathological changes were also assessed. PTU significantly decreased T3 and T4 and significantly increased TSH. A significant increase in MDA, GSH, NrF2, BCL2, NF-κB, 5-HT, NE, DA, AChE, MAO and Na+,K+,ATPase and a significant decrease in NO were observed in the cardiac tissue of hypothyroidism model. This was associated with histopathological changes. LA alone or with MET restored T3 and TSH and improved almost all the biochemical changes except the decreased NO and the increased DA. MET restored T3, T4 and TSH and the biochemical changes induced in the cardiac tissue. MET ameliorated the histopathological changes that were still observed with LA alone or with MET. The present findings indicate that MET had cardioprotective effect against hypothyroidism and its myocardial complications. This effect was less prominent with LA alone or in combination with MET. [ABSTRACT FROM AUTHOR]

Introduction: Cardiovascular disease is one of the leading causes of morbidity and mortality worldwide. It has been demonstrated that the risk of recurrent acute myocardial infarction is related to modifiable risk factors. Despite management and prevention guidelines, adherence to established goals remains unsatisfactory. Objective: To understand the impact of cardiovascular risk factors on complications and changes in the quality of life of the patients. Materials and method: Prospective cohort study involving 49 patients with acute myocardial infarction between December 2020 and March 2021. Follow-ups were conducted at three and six months. Subsequently, univariate, bivariate, and binomial logistic regression analyses were performed to determine the association between variables and the presence of cardiovascular complications. Results: 47% of the included patients had acute myocardial infarction with ST-segment elevation, and 26.5% had acute myocardial infarction without ST-segment elevation and unstable angina. At the three-month follow-up, three deaths were recorded (6.1%), two of which were caused by a new cardiovascular event. The higher risk of cardiovascular complications at the six-month follow-up was observed among patients with NYHA functional class II (RR: 1.34; 95% CI: 1.28-1.65) and those not engaging in physical activity (RR: 1.44; 95% CI: 1.37-1.81). These two factors were the most significant in explaining the presence of cardiovascular complications. Conclusions: Lack of physical activity and functional class are factors with proven evidence to consider. Physical activity, as a modifiable factor, must be emphasized during both hospitalization and ambulatory care to achieve favorable short and long-term clinical outcomes. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has not only affected the respiratory system but has also led to significant cardiac complications, including myocarditis, pericarditis, arrhythmias, and thrombotic events. This document reviews the immune niche alterations in the heart following COVID-19 outbreaks, focusing on the direct viral effects, immune response, observed cardiac complications, long-term implications, therapeutic approaches, and future directions. SARS-CoV-2 infiltrates cardiac cells via ACE2 receptors, leading to viral myocarditis and myocardial injury. The immune response triggered by the virus contributes to myocardial inflammation and tissue damage. Cardiac complications observed in COVID-19 patients include myocarditis, pericarditis, arrhythmias, and thrombotic events. Long-term implications of COVID-19 on cardiac health include persistent inflammation, myocardial fibrosis, autoimmune responses, postural orthostatic tachycardia syndrome (POTS), and long-term arrhythmias, among others. Management of these complications requires a multidisciplinary approach, including anti-inflammatory treatments, antiviral therapies, immunomodulatory agents, cardiac-specific therapies, and longterm monitoring and rehabilitation programs. Future research aims to identify biomarkers for early detection of cardiac involvement, develop personalized treatment strategies, and explore innovative therapies such as regenerative medicine approaches. Understanding the immune niche alterations in the heart post-COVID-19 is crucial for improving outcomes and mitigating the burden of cardiac complications in affected individuals. [ABSTRACT FROM AUTHOR]

T RAF7 -related cardiac, facial, and digital anomalies with developmental delay (CAFDADD), a multisystemic neurodevelopmental disorder caused by germline missense variants in the TRAF7 gene, exhibits heterogeneous clinical presentations. We present a detailed description of 11 new TRAF7 -related CAFDADD cases, featuring eight distinct variants, including a novel one. Phenotypic analysis and a comprehensive review of the 58 previously reported cases outline consistent clinical presentations, emphasizing dysmorphic features, developmental delay, endocrine manifestations, and cardiac defects. In this enlarged collection, novelties include a wider range of cognitive dysfunction, with some individuals exhibiting normal development despite early psychomotor delay. Communication challenges, particularly in expressive language, are prevalent, necessitating alternative communication methods. Autistic traits, notably rigidity, are observed in the cohort. Also, worth highlighting are hearing loss, sleep disturbances, and endocrine anomalies, including growth deficiency. Cardiac defects, frequently severe, pose early-life complications. Facial features, including arched eyebrows, contribute to the distinct gestalt. A novel missense variant, p.(Arg653Leu), further underscores the complex relationship between germline TRAF7 variants and somatic changes linked to meningiomas. Our comprehensive analysis expands the phenotypic spectrum, emphasizing the need for oncological evaluations and proposing an evidence-based schedule for clinical management. This study contributes to a better understanding of TRAF7 -related CAFDADD, offering insights for improved diagnosis, intervention, and patient care. [ABSTRACT FROM AUTHOR]

The purpose of the study was to assess and compare short- and long-term cardiac complications of the multisystem inflammatory syndrome in children (MIS-C) by predominant severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants throughout the pandemic. The analysis of prospectively collected data comparing cardiac complications of MIS-C during and after hospitalization across the original/alpha, delta, and omicron waves. Cardiac complications were defined as cardiac failure with systolic function impairment or hypotension or abnormalities in echocardiographic findings (decrease in LVEF, FS, valvular insufficiency, pericardial effusion, or coronary artery abnormalities). A total of 120 patients with MIS-C admitted to the Children's Hospital of Krakow between November 1, 2020, and May 5, 2023, were included in the study (74 during original/alpha dominance, 31 delta, and 15 omicron). Patients in the omicron group were found to be younger than those in the alpha and delta groups (37 vs. 75 vs. 80 months, p = 0.03). The frequency of cardiac failure with systolic function impairment or hypotension was diagnosed more frequently in the original/alpha and delta groups than in the omicron group (44.59% vs. 41.94% vs. 13.33%, p = 0.08) also echocardiographic abnormalities changed, with rates of 60.8%, 35.5%, and 13.3% (p < 0.001) accordingly. The multivariable regression revealed an older age (OR = 1.19, 95% CI = 1.07–1.33, p = 0.002) as the only independent factors of cardiac failure with systolic function impairment or hypotension. In all patients, signs of cardiac failure resolved during the hospitalization. Moreover, in 98.3% of patients, all echocardiagraphic abnormalities resolved completely during the observation period. Conclusion: The cardiac complications of MIS-C appeared to advance less severely in younger children during the Omicron outbreak. In long-term observation, symptoms of cardiac failure resolve completely. Similarly, also echocardiographic abnormalities normalize in the vast majority of patients. What is Known: • Knowledge about the long-term cardiac complications of MIS-C is still evolving and uncertain. • The greatest concern of MIS-C is cardiac complications, including cardiac failure and coronary artery dilatation. What is New: • Long-term observations revealed complete resolution of cardiac complications in the vast majority of patients with MIS-C, irrespective of the dominant variant. • Cardiac complications of MIS-C were less common in younger children during subsequent pandemic waves in our patient population. [ABSTRACT FROM AUTHOR]

Cardiac complications after major noncardiac surgery are common and associated with high morbidity and mortality. How preoperative use of beta-blockers may impact perioperative cardiac complications remains unclear. In a multicentre prospective cohort study, preoperative beta-blocker use was ascertained in consecutive patients at elevated cardiovascular risk undergoing major noncardiac surgery. Cardiac complications were prospectively monitored and centrally adjudicated by two independent experts. The primary endpoint was perioperative myocardial infarction or injury attributable to a cardiac cause (cardiac PMI) within the first three postoperative days. The secondary endpoints were major adverse cardiac events (MACE), defined as a composite of myocardial infarction, acute heart failure, life-threatening arrhythmia, and cardiovascular death and all-cause death after 365 days. We used inverse probability of treatment weighting to account for differences between patients receiving beta-blockers and those who did not. A total of 3839/10 272 (37.4%) patients (mean age 74 yr; 44.8% female) received beta-blockers before surgery. Patients on beta-blockers were older, and more likely to be male with established cardiorespiratory and chronic kidney disease. Cardiac PMI occurred in 1077 patients, with a weighted odds ratio of 1.03 (95% confidence interval [CI] 0.94–1.12, P =0.55) for patients on beta-blockers. Within 365 days of surgery, 971/10 272 (9.5%) MACE had occurred, with a weighted hazard ratio of 0.99 (95% CI 0.83–1.18, P =0.90) for patients on beta-blockers. Preoperative use of beta-blockers was not associated with decreased cardiac complications including cardiac perioperative myocardial infarction or injury and major adverse cardiac event. Additionally, preoperative use of beta-blockers was not associated with increased all-cause death within 30 and 365 days. NCT02573532. [ABSTRACT FROM AUTHOR]

Cardiac complications are a rare but potentially serious consequence of hyperbaric oxygen treatment (HBOT), resulting from increased blood pressure and decreased heart rate and cardiac output associated with treatment. These physiologic changes are generally well-tolerated by patients without preexisting cardiac conditions, although those with known or undetected cardiac disease may be more vulnerable to treatment complications. Currently, there are no universally accepted guidelines for pre-HBOT cardiac screening to identify these patients at heightened risk, leading to variability in practice patterns. In the absence of HBOT-specific evidence, screening protocols might be adapted from the diving medicine community; however, given the important differences in physiological stressors, these may not be entirely applicable to patients undergoing HBOT. Traditional cardiac investigations such as electro- and echo-cardiograms are limited in their ability to detect relevant risk modifying states in the pre-HBOT patient, stymieing their cost-effectiveness as routine tests. In the absence of strong evidence to support routine cardiac investigation, we argue that a comprehensive history and physical exam - tailored to identify high-risk patients based on clinical parameters - may serve as a more practical screening tool. While certain unique patient groups such as those undergoing dialysis or with implanted cardiac devices may warrant specialised assessment, thorough evaluation may be sufficient to identify many patients unlikely to benefit from cardiac investigation in the pre- HBOT setting. A clinical decision-making tool based on suggested low-risk and high-risk features is offered to guide the use of targeted cardiac investigation prior to HBOT. [ABSTRACT FROM AUTHOR]

Background: The benefit of chemoprophylaxis (CPX) agents in preventing venous thromboembolism must be weighed against potential risks. Current literature regarding the efficacy of CPX after laminectomies with or without fusion is limited, with no clear consensus to inform guidelines. Objective: This study evaluated the association between CPX and surgical complications after lumbar laminectomy with and without fusion. Study Design: Retrospective study of patients at a single large academic institution. Methods: The medical records of patients who underwent lumbar laminectomies with or without lumbar fusion from 2018 to 2020 were reviewed for demographics, surgical characteristics, CPX agents, postoperative complications, epidural hematomas, and wound drainage. Patients receiving CPX (n = 316) were compared with patients not receiving CPX (n = 316) via t test following propensity score matching, and patients on CPX were further stratified by fusion status. Results: The CPX group had higher body mass index and American Society of Anesthesiologists grades. Rates of venous thromboembolism, epidural hematomas, infections, postoperative incision and drainage, transfusions, wound dehiscence, and reoperation were not associated with CPX. Moist dressings were more frequent, and average days of drain duration were longer with CPX. Overall postoperative complication rate and length of stay (LOS) were greater with CPX. The fusion subgroup had a lower Charlson Comorbidity Index, had a lower American Society of Anesthesiologists grade, was younger, had more women, and underwent more minimally invasive laminectomies. While estimated blood loss, operative times, and LOS were significantly greater in the fusion group, there was no difference in rate of intraoperative and postoperative complications. Conclusion: CPX after lumbar laminectomies with or without fusion was not associated with increased rates of epidural hematomas, wound complications, or reoperation. Patients receiving CPX had more postoperative cardiac complications, but it is possible that surgeons were more likely to prescribe CPX for higher-risk patients. They also had higher rates of ileus and moist dressings, greater LOS, and longer length of drain duration. Patients who underwent lumbar laminectomy with fusion on CPX tended to be lower risk yet incurred greater blood loss, operative times, LOS, cardiac complications, and hematomas/ seromas than patients not undergoing fusion. Clinical Relevance: This retrospective study compared surgical complications of lumbar laminectomies in patients who received chemoprophylaxis vs patients who did not. Chemoprophylaxis was not associated with increased rates of epidural hematomas, wound complications, or reoperation, but it was associated with higher rates of postoperative cardiac complications and ileus. Level of Evidence: 3. [ABSTRACT FROM AUTHOR]

Scrub typhus, a zoonotic disease caused by Orientia tsutsugamushi and transmitted by chiggers, predominantly affects the Asia-Pacific region. Complications of Scrub Typhus involve multiple systems, including cardiovascular (pericarditis, arrhythmia, myocarditis), respiratory (acute respiratory distress syndrome), hepatic (hepatitis), and renal (azotemia). In this review, we comprehensively focused on the cardiac manifestations caused due to scrub typhus. Scrub typhus-induced pericarditis should be suspected in patients residing in endemic regions presenting with fever, thrombocytopenia, and pericardial effusion. If undetected, it frequently leads to cardiomegaly, pericardial effusion, and congestive heart failure. Heart failure with scrub typhus commonly occurs following myocardial inflammation, particularly in patients with pre-existing cardiac disorders. Scrub typhus myocarditis is a relatively rare, but serious cardiac complication with a high mortality rate of up to 24.0%. Arrhythmias arise due to the involvement of the interventricular septum, coronary artery, or cardiac valves causing variable ECG findings including sinus arrhythmia, T wave changes, and QTc interval prolongation. Atrial fibrillation due to scrub typhus is associated with a 1.3 fold increase in 3-month mortality. These cardiac complications are mainly assessed using electrocardiography (ECG) and echocardiography. Serology is the primary diagnostic tool for O. tsutsugamushi. While the Scrub Typhus Detect IFA test offers 100% sensitivity, the Weil Felix test is specific and cost-effective. Nested PCR and ELISA are effective for early detection but are limited to resource-rich settings. Diagnostic difficulties arise from nonspecific symptoms and current testing limitations. Vaccine development using extracellular vesicles, nanoparticles, and subunit vaccines shows promise. Combined therapy with doxycycline and azithromycin is recommended for cardiac complications, alongside guideline-directed therapy. The review underscores the need for heightened clinical awareness and prompt management of scrub typhus, especially in endemic regions. It also highlights the necessity for further research into the pathogenesis of cardiac involvement and the development of more effective diagnostic tools and treatments.

Background Acute myocardial injury is associated with poor outcomes in patients with acute ischemic stroke, but its prognostic significance in patients with spontaneous intracerebral hemorrhage remains unclear. We investigated whether acute myocardial injury and the direction of the cardiac troponin I (cTnI) change (rising versus falling) affect post‐intracerebral hemorrhage outcomes. Methods and Results We re‐analyzed the FAST (Factor‐Seven‐for‐Acute‐Hemorrhagic‐Stroke) trial. Acute myocardial injury was defined as at least 1 cTnI value above the upper reference limit with a rise/fall of >20%. Logistic regression tested for associations (1) between acute myocardial injury (presence versus absence) and poor outcome (modified Rankin Scale 4–6) and mortality at 15 and 90 days; (2) among 3 groups (rising versus falling versus no acute myocardial injury) and outcomes. Among the 841 FAST participants, 785 patients were included. Acute myocardial injury was detected in 29% (n=227); 170 had rising cTnI. At 15 and 90 days, respectively, those with acute myocardial injury had higher odds of poor outcome (adjusted odds ratio) ([aOR] 2.3 [95% CI, 1.3–3.9]); and adjusted odds ratio 2.5 [95% CI, 1.6–3.9];, and higher odds of mortality (adjusted odds ratio 2.4 [95% CI, 1.4–4.3]; and adjusted odds ratio 2.2 [CI, 1.3–3.6]) than patients without. There was no interaction between FAST group assignment and myocardial injury, and associations between myocardial injury and outcomes were consistent across group assignments. Rising cTnI was associated with the highest risk of poor outcomes and mortality. Conclusions In this secondary analysis of the FAST trial, acute myocardial injury was common and associated with poor outcomes. The direction of the cTnI change might provide additional risk stratification after intracerebral hemorrhage.

This study investigated the prevalence of adverse cardiac events following a total joint arthroplasty and subsequently analyzed risk factors that may increase the likelihood of these events. Data for this study were extracted from a large national database. Chi -squared analyses and multivariate modelings were performed to determine the risk factors associated with 30-day perioperative troponin elevation, myocardial infarction (MI), and heart failure. We identified 80,544 total hip arthroplasty (THA) patients and 112,531 total knee arthroplasty (TKA) patients and analyzed the following cardiac risk factors: diabetes, renal insufficiency, prior MI, hypertension, and cerebrovascular disease. There were 34% of THA patients and 52% of TKA patients who had at least one of the studied risk factors. At-risk THA patients had 2.2, 5.9, and 5.3 times the odds of troponin elevation, MI, and postoperative heart failure, respectively, within 1 month compared to the control group (P <.0001). The TKA group had 2.9, 5.3, and 5.9 times the odds of troponin elevation, MI, and postoperative heart failure within 1 month compared to the control group (P <.0001). For both procedures, prior MI had the highest odds of resulting in perioperative troponin elevation and MI. Renal insufficiency had the highest odds of resulting in perioperative heart failure. Risk stratification for postoperative complications in orthopedic surgery is important to minimize adverse outcomes. This study highlights the need for consideration of risk factors prior to joint arthroplasty surgery. Level III, Prognostic. [ABSTRACT FROM AUTHOR]

Background: Previous studies report that intraoperative hypotension worsens outcomes after aneurysmal subarachnoid hemorrhage (aSAH). However, the hypotensive harm threshold for major adverse cardiovascular events (MACE) remains unclear. Methods: The authors included aSAH patients who had general anesthesia for aneurysmal clipping/coiling. MACE were defined by a composite of acute myocardial injury, acute myocardial infarction, and other cardiovascular complications identified by electrocardiogram and echocardiography. The authors initially used logistic regression and change-point analysis based on the second derivative to identify mean arterial pressure (MAP) of 75 mmHg as the harm threshold. Thereafter, our major exposure was MAP below 75 mmHg characterized by area, duration, and time-weighted average. The area below 75 mmHg represents the severity and duration of exposure and was defined as the sum of all areas below a specified threshold using the trapezoid rule. Timeweighted average MAP was derived by dividing area below the threshold by the duration of anesthesia. All analyses were adjusted for baseline risk factors including age greater than 70 years, female sex, severity of intracerebral hemorrhage, history of cardiovascular disease, and preoperative elevated myocardial enzymes. Results: Among 1029 patients enrolled, 254 (25%) developed postoperative MACE. Patients who experienced MACE were slightly older (59 ± 11 vs. 54 ± 11 years), were slightly more often women (69 vs. 58%), and had a higher prevalence of cardiovascular history (65 vs. 47%). Adjusted cardiovascular risk increased nearly linearly over the entire range of observed MAP. However, there was a slight inflexion at MAP of 75 mmHg. MACE was significantly associated with area [adjusted odds ratios (aOR) 1.004 per 10 mmHg.min, 95% CI: 1.001-1.007, P=0.002), duration (aOR 1.031 per 10min, 95%CI: 1.009-1.054, P=0.006), and time-weighted average (aOR 3.516 per 10 mmHg, 95% CI: 1.818-6.801, P<0.001) of MAP less than 75 mmHg. Conclusions: Lower blood pressures were associated with cardiovascular complications over the entire observed range, but worsened when MAP was less than 75 mmHg. Pending trial data to establish causality, it may be prudent to keep MAP above 75 mmHg in patients having surgical aSAH repairs to reduce the risk of MACE. [ABSTRACT FROM AUTHOR]

to investigate and record cardiac side effects of long-term use of hydroxychloroquine (HCQ) in patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). This study included 25 patients with RA and 25 with SLE. The study population was either in remission or demonstrated low disease activity, as assessed by the SLE disease activity index 2000 (SLEDAI-2 K) for SLE patients and the disease activity score 28 (DAS28) for RA patients. All patients had been receiving HCQ for at least two years. They did not exhibit any symptoms of coronavirus disease-2019 (COVID-19) and received COVID-19 vaccination. Cardiac adverse events were assessed through electrocardiogram (ECG) and echocardiography (ECHO) examinations. 94 % (n = 47) were females and 6 % (n = 3) were males. The age of the subjects ranged from 20 to 60 years, with a mean age of 41.6 ± 11.2 years. Out of the 50 ECGs assessed, 84 % (n = 42) exhibited no abnormalities. Additionally, all ECGs showed QTc within the normal range. Only 2 RA patients had heart failure characterized by reduced ejection fraction (EF). There was no significant association between the cumulative dosage of HCQ administered in SLE patients and the ECG abnormalities (p = 0.76), QTc (p = 0.228) or EF (p = 0.96). Moreover, there was no significant association between the cumulative dosage of HCQ administered in RA patients and the ECG abnormalities (p = 0.479), QTc (p = 0.85) or EF (p = 0.69). This study affirms the cardiac tolerability of HCQ in the sustained therapeutic management of SLA and RA patients. [ABSTRACT FROM AUTHOR]

BackgroundIntraoperative cardiac complications are a common cause of morbidity and mortality in non-cardiac surgery. The risk of these complications increased with the average age increasing from 65. In a resource-limited setting, including our study area, the magnitude and associated factors of intraoperative cardiac complications have not been adequately investigated. The aim of this study was to assess the magnitude and associated factors of intraoperative cardiac complications among geriatric patients undergoing non-cardiac surgery.MethodsAn institutional-based multi-center cross-sectional study was conducted on 304 geriatric patients at governmental hospitals in the southern region of Ethiopia, from 20 March 2022 to 25 August 2022. Data were collected by chart review and patient interviews. Epi Data version 4.6 and SPSS version 25 were used for analysis. The variables that had association (p 85 years (AOR = 6.01, CI = 5.12–12.21), and anesthesia time > 3 h (AOR =2.27, CI = 2.0.2–18.25) were factors significantly associated with intraoperative cardiac complications.ConclusionThe magnitude of intraoperative cardiac complications was high among geriatric patients who had undergone non-cardiac surgery. The independent risk factors of intraoperative cardiac complications for this population included age > 85, ST-segment elevation, perioperative hypertension (stage 3 with regular treatment), duration of anesthesia >3 h, intraoperative hypoxia, and intraoperative hypotension. Holistic preoperative evaluation, optimization optimal and perioperative care for preventing perioperative risk factors listed above, and knowing all possible risk factors are suggested to reduce the occurrence of complications.

Abstract Introduction Prior reviews synthesized findings of studies on long-term cardiac complications of COVID-19. However, the reporting and methodological quality of these studies has not been systematically evaluated. Here, we conducted a systematic review and meta-analysis on long-term cardiac complications of COVID-19 and examined patterns of reported findings by study quality and characteristics. Methods We searched for studies examining long-term cardiac complications of COVID-19 that persisted for 4 weeks and over. A customized Newcastle–Ottawa scale (NOS) was used to evaluate the quality of included studies. Meta-analysis was performed to generate prevalence estimates of long-term cardiac complications across studies. Stratified analyses were further conducted to examine the prevalence of each complication by study quality and characteristics. The GRADE approach was used to determine the level of evidence for complications included in the meta-analysis. Results A total number of 150 studies describing 57 long-term cardiac complications were included in this review, and 137 studies reporting 17 complications were included in the meta-analysis. Only 25.3% (n = 38) of studies were of high quality based on the NOS quality assessment. Chest pain and arrhythmia were the most widely examined long-term complications. When disregarding study quality and characteristics, summary prevalence estimates for chest and arrhythmia were 9.79% (95% CI 7.24–13.11) and 8.22% (95% CI 6.46–10.40), respectively. However, stratified analyses showed that studies with low-quality scores, small sample sizes, unsystematic sampling methods, and cross-sectional design were more likely to report a higher prevalence of complications. For example, the prevalence of chest pain was 22.17% (95% CI 14.40–32.55), 11.08% (95% CI 8.65–14.09), and 3.89% (95% CI 2.49–6.03) in studies of low, medium, and high quality, respectively. Similar patterns were observed for arrhythmia and other less examined long-term cardiac complications. Conclusion There is a wide spectrum of long-term cardiac complications of COVID-19. Reported findings from previous studies are strongly related to study quality, sample sizes, sampling methods, and designs, underscoring the need for high-quality epidemiologic studies to characterize these complications and understand their etiology.

Background Sex differences in presentation, treatment, and prognosis of cardiovascular disorders are well recognized. Although an association between acute myocardial injury and mortality after ischemic stroke has been demonstrated, it is unclear whether prevalence and outcome of poststroke acute myocardial injury differ between women and men. Methods and Results We prospectively screened consecutive patients with acute ischemic stroke and serial high‐sensitivity cardiac troponin T measurements admitted to our center. Acute myocardial injury was defined as at least 1 high‐sensitivity cardiac troponin T value above the upper reference limit (14 ng/L) with a rise/fall of >20%. Rates of acute myocardial injury were also calculated using sex‐specific high‐sensitivity cardiac troponin T cutoffs (women upper reference limit, 9 ng/L; men upper reference limit, 16 ng/L). Logistic regression analyses were performed to evaluate the association between acute myocardial injury and outcomes. Of 1067 patients included, 494 were women (46%). Women were older, had a higher rate of known atrial fibrillation, were more likely to be functionally dependent before admission, had higher stroke severity, and more often had cardioembolic strokes (all P values

Background Elevated cardiac troponin (cTn) is detected in 10% to 30% of patients with acute ischemic stroke (AIS) and correlates with poor functional outcomes. Serial cTn measurements differentiate a dynamic cTn pattern (rise/fall >20%), specific for acute myocardial injury, from elevated but stable cTn levels (nondynamic), typically attributed to chronic cardiac/noncardiac conditions. We investigated if the direction of the cTn change (rising versus falling) affects mortality and outcome. Methods and Results We retrospectively screened consecutive patients with AIS admitted to 5 stroke centers for elevated cTn at admission and at least 1 additional cTn measurement within 48 hours. The pattern of cTn was defined as rising if >20% increase from baseline, falling if >20% decrease, or nondynamic if ≤20% change in either direction. Logistic regression analyses were performed to assess the association of cTn patterns and 7‐day mortality and unfavorable discharge disposition. Of 3789 patients with AIS screened, 300 were included. Seventy‐two had a rising pattern, 66 falling, and 162 nondynamic. In patients with AIS with rising cTn, acute ischemic myocardial infarction was present in 54%, compared with 33% in those with falling cTn (P

Introduction: Cardiac complications are the leading cause of mortality amongst transfusion-dependent thalassemia (TDT) patients. The multifactorial etiology of cardiac disorders makes their management challenging. Therefore, in addition to evaluating the incidence of heart failure (HF) and pulmonary hypertension (PHT), we assessed the associated factors among 737 TDT patients, aiming to achieve a plenary perspective of their cardiac disorders and relative factors. Material and methods: In this cross-sectional study, we evaluated the incidence of HF and PHT in 737 TDT patients while considering imperative factors such as endocrinopathies, iron status, and serum vitamin D level. Results: The incidence of total heart failure and pulmonary hypertension were estimated at 12.3% among participants, although the rate of cardiac iron overload was c.40%. Splenectomy, serum vitamin D, low bone mass, age, gender, hypoparathyroidism, hypogonadism, and diabetes significantly impaired the cardiac function of our patients. In univariate analysis, only the frequency of blood transfusion proved to have a risk effect on left ventricle ejection fraction. Conclusions: Cardiac iron overload has the highest impact on the incidence of cardiac disorders among TDT patients. We observed significant statistical associations between both HF and PHT with iron chelation regimen, endocrinopathies, splenectomy, serum vitamin D, and total body iron status in univariate analysis. Such results were not statistically significant in multiple logistic regression. However, in clinical practice, their effect could not be ignored. Further studies are required to achieve efficient management of thalassemia patients with cardiac disorders. [ABSTRACT FROM AUTHOR]

Background and Aims: One of the most common hemoglobinopathies globally related to blood transfusion and iron overload in the body is thalassemia syndrome. Increasing ferritin levels can cause severe damage to the patient's body organs. This study aims to evaluate the complications of iron overload on vital body organs in patients with transfusion‐dependent beta‐thalassemia. Methods: This descriptive cross‐sectional study was performed in Iran University of Medical Sciences Hospitals on patients with a beta‐thalassemia major with frequent blood transfusions. To evaluate the effect of iron overload on vital body organs, hematologic and blood analysis, echocardiography with measurement of pulmonary artery pressure (PAP) and ejection fraction (EF) tests, bone densitometry, and audiometric tests were performed for all patients. Results: Of the 1010 patients participating in this study, 497 (49%) were males, 513 were (51%) females aged 5–74 years, and the majority of participants (85%) were over 20 years old. This study demonstrated that increasing ferritin levels had no notable correlation with sex, cholesterol, low‐density lipoprotein, parathyroid hormone, T4, and aspartate aminotransferase. However, elevating ferritin levels had significant correlations with increasing triglyceride, phosphorus, thyroid stimulating hormone, alkaline phosphatase, alanine transaminase, and PAP levels, age, hearing disorders, splenectomy, osteoporosis, and decreasing high‐density lipoprotein, body mass index, calcium, and EF levels. Conclusion: Improvement in beta‐thalassemia patients' survival and quality of life can be due to multidisciplinary care in a comprehensive unit through regular follow‐up and early complication detection. [ABSTRACT FROM AUTHOR]

The pathophysiological mechanisms underlying severe cardiac dysfunction after aneurysmal subarachnoid haemorrhage (aSAH) remain poorly understood. In the present study, we focused on two categories of contributing factors describing the brain–heart relationship. The first group includes brain-specific cerebrospinal fluid (CSF) and serum biomarkers, as well as cardiac-specific biomarkers. The secondary category encompasses parameters associated with cerebral autoregulation and the autonomic nervous system. A group of 15 aSAH patients were included in the analysis. Severe cardiac complications were diagnosed in seven (47%) of patients. In the whole population, a significant correlation was observed between CSF S100 calcium-binding protein B (S100B) and brain natriuretic peptide (BNP) (rS = 0.62; p = 0.040). Additionally, we identified a significant correlation between CSF neuron-specific enolase (NSE) with cardiac troponin I (rS = 0.57; p = 0.025) and BNP (rS = 0.66; p = 0.029), as well as between CSF tau protein and BNP (rS = 0.78; p = 0.039). Patients experiencing severe cardiac complications exhibited notably higher levels of serum tau protein at day 1 (0.21 ± 0.23 [ng/mL]) compared to those without severe cardiac complications (0.03 ± 0.04 [ng/mL]); p = 0.009. Impaired cerebral autoregulation was noted in patients both with and without severe cardiac complications. Elevated serum NSE at day 1 was related to impaired cerebral autoregulation (rS = 0.90; p = 0.037). On the first day, a substantial, reciprocal correlation between heart rate variability low-to-high frequency ratio (HRV LF/HF) and both GFAP (rS = −0.83; p = 0.004) and S100B (rS = −0.83; p = 0.004) was observed. Cardiac and brain-specific biomarkers hold the potential to assist clinicians in providing timely insights into cardiac complications, and therefore they contribute to the prognosis of outcomes. [ABSTRACT FROM AUTHOR]

Data on factors contributing to the development of postoperative cardiac complications (myocardial infarction, heart failure, cardiac arrhythmias) in non-cardiosurgical operations are presented. Hypotension and blood loss are usually distinguished among such factors, but less attention is paid to the role of neuroendocrine reactions, in particular, hyperactivation of the sympathoadrenal system; the protective effect of anesthesia, in particular, regional anesthesia: epidural anesthesia and spinal anesthesia. Therefore, the review focuses on the description of the protective effects of regional anesthesia and their mechanisms, in particular, the prevention of the development of postoperative neurogenic dystrophy of internal organs, including the cardiovascular system.

The objective was to perform a comparative analysis of the information content of potential predictors of cardiovascular complications of various types in patients operated on for vascular diseases. Materials and Methods. We examined 129 patients aged 66 [61–70] years who underwent elective vascular surgery. We analyzed comorbidity, general clinical indicators, special cardiac risk indices and biomarkers: N-terminal segment of B-type natriuretic peptide prohormone (NT-proBNP) and cardiospecific troponin I. We used logistic regression and ROC analysis. Results. 21 (16.3 %) perioperative cardiovascular complications were registered in 17 (13.2 %) patients. In one-factor regression, the predictors of cardiovascular complications were coronary heart disease (OR 4.5904; 95 % CI 1.3119–5.9340; p = 0.0171), combination of coronary heart disease and chronic heart failure (OR 2.9419; 95 % CI 1.0140–8.5350; p = 0.047), ASA class > 3 (OR 2.9402; 95 % CI 1.0304–8.3899; p = 0.0438), high cardiac risk surgery (OR 3.4741; 95 % CI 1.1162-10.8126; p = 0.0316), Lee cardiac risk index (OR 2.2353; 95 % CI 1.2842–3.8911; p = 0.0045), the American College of Surgeons cardiac risk index for assessing the risk of perioperative myocardial infarction or cardiac arrest (OR 1.5312; 95 % CI 1.0927–2.1456; p = 0.0133) and the preoperative level of the N-terminal prohormone B-type natriuretic peptide (NT-proBNP) (OR 1.0048; 95 % CI 1.0021–1.0074; p = 0.0004). In multivariate regression, the predictors of cardiovascular complications were high-risk cardiac surgery (OR 5.7439; 95 % CI 1.1027–29.9181; p = 0.0379) and NT-proBNP (OR 1.0044; 95 % CI 1.0015–1.0073; p = 0.0033). The biomarker level > 218 pg/ml discriminated against cardiovascular complications with sensitivity of 82.4 % and specificity of 85.3 % (AUC 0.825; 95 % CI 0.747–0.887; p < 0.0001). Conclusion. In vascular interventions, the most significant predictors of cardiovascular complications are high-risk cardiac surgery and the preoperative level of NT-proBNP > 218 pg/ml with a sensitivity and specificity level exceeding 80 %.

Introduction. Severe acute pancreatitis (SAP) is an acute inflammatory condition of the pancreas with increasing incidence and mortality rates in recent years. The aim of this study was to evaluate the impact of age, comorbidities, and different scoring systems on the complications and outcomes of SAP. Materials and Methods. A retrospective study was conducted on 161 patients diagnosed and treated for SAP at the Bucharest University Hospital in the intensive care unit (ICU), in the period 2014-2021. The impact of risk factors for the development of SAP, occurrence of complications (respiratory, cardiac, etc.), length of hospital stays and mortality was analyzed using several scores (BISAP, Ranson, Apache II and SOFA) or modified computed tomography severity index. Preexisting chronic conditions were assessed using the Charlson Comorbidity Index (CCI). Multivariate statistics and non-parametric univariate were calculated in statistical analysis. Odds ratios with 95% confidence intervals were used. Results. Risk factors such as age, diet, medication, alcohol consumption, genetic factors and patient comorbidities contribute significantly to the development of a severe form of acute pancreatitis with critical course and high mortality. Conclusions. In our study, CCI was the most important factor correlated with death and duration of ICU treatment.

Background Cardiovascular complications after acute ischemic stroke (AIS) can be related to chronic/comorbid cardiac conditions or acute disruption of the brain–heart autonomic axis (stroke‐heart syndrome). Women are known to be more vulnerable to certain stress‐induced cardiac complications, such as Takotsubo cardiomyopathy. We investigated sex differences in cardiac troponin (cTn) elevation, cardiac events, and outcomes after AIS. Methods and Results We retrospectively analyzed consecutive patients with AIS from 5 stroke centers. Patients with AIS with elevated baseline cTn and at least 2 cTn measurements were included, while patients with acute comorbid conditions that could impact cTn levels were excluded. Poststroke acute myocardial injury was defined as the presence of a dynamic cTn pattern (rise/fall >20% in serial measurements) in the absence of acute atherosclerotic coronary disease (type 1 myocardial infarction) or cardiac death (type 3 myocardial infarction). From a total cohort of 3789 patients with AIS, 300 patients were included in the study: 160 were women (53%). Women were older, had a lower burden of cardiovascular risk factors, and more frequently had cardioembolic stroke and right insula involvement (P values all

Abstract Background and Aims One of the most common hemoglobinopathies globally related to blood transfusion and iron overload in the body is thalassemia syndrome. Increasing ferritin levels can cause severe damage to the patient's body organs. This study aims to evaluate the complications of iron overload on vital body organs in patients with transfusion‐dependent beta‐thalassemia. Methods This descriptive cross‐sectional study was performed in Iran University of Medical Sciences Hospitals on patients with a beta‐thalassemia major with frequent blood transfusions. To evaluate the effect of iron overload on vital body organs, hematologic and blood analysis, echocardiography with measurement of pulmonary artery pressure (PAP) and ejection fraction (EF) tests, bone densitometry, and audiometric tests were performed for all patients. Results Of the 1010 patients participating in this study, 497 (49%) were males, 513 were (51%) females aged 5–74 years, and the majority of participants (85%) were over 20 years old. This study demonstrated that increasing ferritin levels had no notable correlation with sex, cholesterol, low‐density lipoprotein, parathyroid hormone, T4, and aspartate aminotransferase. However, elevating ferritin levels had significant correlations with increasing triglyceride, phosphorus, thyroid stimulating hormone, alkaline phosphatase, alanine transaminase, and PAP levels, age, hearing disorders, splenectomy, osteoporosis, and decreasing high‐density lipoprotein, body mass index, calcium, and EF levels. Conclusion Improvement in beta‐thalassemia patients' survival and quality of life can be due to multidisciplinary care in a comprehensive unit through regular follow‐up and early complication detection.

We assessed the value of pancreatic T2* magnetic resonance imaging (MRI) for predicting cardiac events from a large prospective database of transfusion-dependent thalassemia (TDT) patients. We considered 813 TDT patients (36.47 ± 10.71 years, 54.6% females) enrolled in the Extension-Myocardial Iron Overload in Thalassemia Network. MRI was used to measure hepatic, pancreatic, and cardiac iron overload (IO), to assess biventricular function and atrial dimensions, and to detect replacement myocardial fibrosis. The mean follow-up was 50.51 ± 19.75 months. Cardiac complications were recorded in 21 (2.6%) patients: one with heart failure (HF) and 20 with arrhythmias. The single patient who developed HF had, at the baseline MRI, a reduced pancreas T2*. Out of the 20 recorded arrhythmias, 17 were supraventricular. Pancreatic T2* values were a significant predictor of future arrhythmia-related events (hazard ratio = 0.89; p = 0.015). Pancreas T2* remained significantly associated with future arrhythmias after adjusting for any other univariate predictor (age and male sex, diabetes, history of previous arrhythmias, or left atrial area index). According to the receiver-operating characteristic curve analysis for arrhythmias, a pancreas T2* < 6.73 ms was the optimal cut-off value. In TDT, pancreatic iron levels had significant prognostic power for arrhythmias. Regular monitoring and the development of targeted interventions to manage pancreatic IO may help improve patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Kawasaki disease (KD) is an acute febrile illness that largely affects young children before 5 years of age. Younger children with KD are reported to have a higher prevalence of coronary artery abnormalities. Little is known about infants in the first 3 months of age diagnosed with KD. Methods: A retrospective study was conducted at the National Institute of Pediatrics in Mexico City from 1995 to 2019. Clinical features, laboratory results and cardiac outcomes were recorded. Infants in the first 3 months of age were compared with older patients. Wilcoxon-Mann-Whitney analysis was performed for continuous variables and Fisher's exact test for categorical variables. Results: Six hundred and eighty-eight cases of KD were included in this study. Fourteen cases were diagnosed in the first three months of age. Heart failure and KD shock-syndrome was found in five cases (35.7%). Giant coronary artery aneurysms were found in six cases in the younger group (42.9%). Conclusions: Diagnosis of KD in children younger than 3 months of age is rare. In most cases, an incomplete presentation contributed to a delay diagnosis, treatment, and complications. Younger patients with KD have an increased risk of presenting cardiac complications, including giant coronary artery aneurysms, shock, and death.

Abstract Coronavirus disease 2019 (COVID-19) is an ongoing global pandemic that has affected nearly 600 million people to date across the world. While COVID-19 is primarily a respiratory illness, cardiac injury is also known to occur. Cardiovascular magnetic resonance (CMR) imaging is uniquely capable of characterizing myocardial tissue properties in-vivo, enabling insights into the pattern and degree of cardiac injury. The reported prevalence of myocardial involvement identified by CMR in the context of COVID-19 infection among previously hospitalized patients ranges from 26 to 60%. Variations in the reported prevalence of myocardial involvement may result from differing patient populations (e.g. differences in severity of illness) and the varying intervals between acute infection and CMR evaluation. Standardized methodologies in image acquisition, analysis, interpretation, and reporting of CMR abnormalities across would likely improve concordance between studies. This consensus document by the Society for Cardiovascular Magnetic Resonance (SCMR) provides recommendations on CMR imaging and reporting metrics towards the goal of improved standardization and uniform data acquisition and analytic approaches when performing CMR in patients with COVID-19 infection.

Background: Methadone is one of the most useful opioids that can be used to achieve many therapeutic goals, and also it may be abused as an illicit drug. Methadone can cause different gastrointestinal, neurological, and cardiac complications. This study was performed to obtain a better understanding of the cardiac side effects of methadone in patients with methadone poisoning. Methods: This cross-sectional study was performed on 210 samples in Sina Hospital of Hamadan in a one-year period from March 2019 to March 2020. After assessing patients who had methadone poisoning and completing their demographic information and evaluation of changes in patients' EKGs, the data was collected and analyzed by SPSS 16 software. Results: Out of 210 participants, 178 (84.8%) were males and the rest were females. The average age of the studied patients was 39.56 years old. The study found that 6.1% of methadone-poisoned patients were illiterate. It was found in this study that the most common cardiac complications of methadone intoxication were sinus tachycardia (20%), QT interval prolongation (6.64%), and sinus bradycardia (4.3%), respectively; nevertheless, 66.2% of patients did not have any EKG abnormalities. Conclusion: According to the findings, it is necessary to have continuous cardiac monitoring for patients with methadone intoxication and by transferring such findings to medical centers, steps can be taken to use methadone more intelligently.

A new coronavirus infection (COVID-19), which has spread widely in the human population in the past few years, is often complicated by a damage to the cardiovascular system, central nervous system, gastrointestinal tract, and respiratory system organs. The review describes the features of the clinical course and treatment of SARS-CoV-2 infection, which can lead to the development of cardiac complications both in the early and long-term periods. It is assumed that there are three main causes for the development of such complications (the affinity of the virus to endothelial proteins, the damage to blood vessels and the heart as a result of the immune response of the body and the toxic effects of drugs used to treat infection). Among the pathogenic mechanisms of the course of a new coronavirus infection that can lead to the development of cardiovascular complications, the following can be distinguished: manifestations of systemic vasculitis, coagulopathy, thrombosis, the phenomenon of “cytokine storm”, the direct cytotoxic damage to the myocardium, metabolic disorders, imbalance of the ionic composition of the blood, hypoxia and its consequences. The most common complications include myocarditis with arrhythmia (sinus tachycardia, bradycardia, atrial fibrillation and flutter, QTc prolongation, sudden cardiac death), cardiomyopathy (biventricular, isolated dysfunction of the right or left ventricle), cardiogenic shock, coagulopathy, thromboembolism (including strokes), vasculitis. Following recovery from COVID-19, many patients retain (or develop) the symptoms caused by the heart damage: a pain in the region of the heart, palpitations, appearance or aggravation of chronic heart failure, decompensation of hypertension, acute coronary syndrome. The main proposed directions for minimizing the risk of developing cardiac complications in COVID-19 patients include ECG monitoring (assessment of the QT interval, rhythm, conduction and repolarization), echocardiography in patients at risk, 24-hour ECG recording in patients who report palpitations. In addition, it is recommended to adjust the dosages of cardiotoxic drugs and to be cautious when prescribing anticoagulant therapy.

Background and Aim: Notwithstanding the improvement in therapies, patients affected by thalassemia major (TM) and intermedia (TI) are still at high risk of cardiac complications. This study aimed at evaluating the incidence and predictive factors for developing cardiac events in adult β‐TM and TI patients. Population and Methods: Data on diagnosis and clinical history were collected retrospectively; prospective data on new‐onset cardiac failure and arrhythmias, echocardiographic parameters, biochemical variables including non‐transferrin‐bound iron (NTBI) and labile plasma iron (LPI), magnetic resonance imaging (MRI) T2* measurement of hepatic and cardiac iron deposits, and iron chelation therapy were recorded during a 6‐year follow‐up. Results: Thirty‐seven patients, 29 TM and 8 TI, were included. At baseline, 8 TM patients and 1 TI patient had previously experienced a cardiac event (mainly heart failure). All patients were on chelation therapy and only 3 TM patients had mild‐to‐severe cardiac siderosis. During follow‐up, 11 patients (29.7%) experienced a new cardiac event. The occurrence of cardiac events was correlated to high LPI levels (OR 12.0, 95% CI 1.56–92.3, p.017), low mean pre‐transfusion haemoglobin (OR 0.21, 95% C.I. 0.051–0.761, p.21) and echocardiographic parameters suggestive of myocardial hypertrophy. Multivariate analysis disclosed high LPI and left ventricle mass index (LVMI) as independent variables significantly associated with cardiac events. Cardiac iron deposits measured by MRI T2* failed to predict cardiac events. Conclusion: LPI, Hb levels and echocardiographic parameters assessing cardiac remodelling are associated with cardiac events in adult TM and TI patients. LPI might represent both a prognostic marker and a potential target for novel treatment strategies. Further studies are warranted to confirm our findings on larger populations. [ABSTRACT FROM AUTHOR]

Aims Trastuzumab, the first humanized monoclonal antibody that targets human epidermal growth factor receptor 2 (ERBB2/HER2), is currently used as a first-line treatment for HER2 (+) tumours. However, trastuzumab increases the risk of cardiac complications without affecting myocardial structure, suggesting a distinct mechanism of cardiotoxicity. Methods and results We used medium from trastuzumab-treated human umbilical vein endothelial cells (HUVECs) to treat CCC-HEH-2 cells, the human embryonic cardiac tissue-derived cell lines, and human induced pluripotent stem cell-derived cardiomyocytes (iPSC-CMs) to assess the crosstalk between vascular endothelial cells (VECs) and cardiomyocytes. Protein mass spectrometry analysis was used to identify the key factors from VECs that regulate the function of cardiomyocytes. We applied RNA-sequencing to clarify the mechanism, by which PTX3 causes cardiac dysfunction. We used an anti-human/rat HER2 (neu) monoclonal antibody to generate a rat model that was used to evaluate the effects of trastuzumab on cardiac structure and function and the rescue effects of lapatinib on trastuzumab-induced cardiac side effects. Medium from trastuzumab-treated HUVECs apparently impaired the contractility of CCC-HEH-2 cells and iPSC-CMs. PTX3 from VECs caused defective cardiomyocyte contractility and cardiac dysfunction in mice, phenocopying trastuzumab treatment. PTX3 affected calcium homoeostasis in cardiomyocytes, which led to defective contractile properties. EGFR/STAT3 signalling in VECs contributed to the increased expression and release of PTX3. Notably, lapatinib, a dual inhibitor of EGFR/HER2, could rescue the cardiac complications caused by trastuzumab by blocking the release of PTX3. Conclusion We identified a distinct mode of cardiotoxicity, wherein the activation of EGFR/STAT3 signalling by trastuzumab in VECs promotes PTX3 excretion, which contributes to the impaired contractility of cardiomyocytes by inhibiting cellular calcium signalling. We confirmed that lapatinib could be a feasible preventive agent against trastuzumab-induced cardiac complications and provided the rationale for the combined application of lapatinib and trastuzumab in cancer therapy. [ABSTRACT FROM AUTHOR]

According to the World Health Organisation, as of October 2022, there have been 55,560,329 reported cases of SARS‐COV‐2 in patients under 19 years old. It is estimated that about 0.06% of these patients may develop MIS‐C, representing more than 2 million children worldwide. This systematic review and meta‐analysis examined the pooled prevalence of cardiovascular manifestation and cardiac complications in children hospitalised with MIS‐C. The PROSPERO register number is CRD42022327212. We included case‐report studies, case‐control studies, cohort studies, and cross‐sectional studies, as well as clinical trials or studies describing cardiac manifestations of MIS‐C and its sequelae in a paediatric population. Initially, 285 studies were selected, but there were 154 duplicates, and 81 were excluded because they did not fit the eligibility criteria. Thus, 50 studies were selected for review, and 30 were included in the meta‐analysis. A total sample size of 1445 children was included. The combined prevalence of myocarditis or pericarditis was 34.3% (95% CI: 25.0%–44.2%). The combined prevalence for echocardiogram anomalies was 40.8% (95% CI: 30.5%–51.5%), that of Kawasaki disease presentation was 14.8% (95% CI: 7.5%–23.7%), and that of coronary dilation was 15.2% (95% CI: 11.0%–19.8%). The rate of electrocardiogram anomalies was 5.3% (95% CI: 0.8%–12.3%), and the mortality rate was 0.5% (CI 95%: 0%–1.2%). Furthermore, 186 children still had complications at discharge, with a combined prevalence of such long‐lasting manifestations of 9.3% (95% CI: 5.6%–13.7%). Studies that assess whether these children will have an increased cardiovascular risk with a greater chance of acute myocardial infarction, arrhythmias, or thrombosis will be essential for healthcare planning. [ABSTRACT FROM AUTHOR]