Background: Our study aimed to demonstrate the short-term impacts of right ventricular apical pacing (RVAP) and right ventricular septal pacing (RVSP) on left ventricular (LV) regional longitudinal strain (RLS) and global longitudinal strain (GLS) in patients with preserved ejection fraction (EF). LV strain and functions may be altered by RVAP. RVSP might be a better alternative. The detrimental effect of right ventricular (RV) pacing may be mediated by regional LV impairment. Methods: Sixty-two patients indicated for permanent pacemaker implantation and preserved LV systolic function were included. Dual chamber pacemakers were implanted in all patients. Patients were divided into two groups according to RV lead position: group A (RVAP, n = 32) and group B (RVSP, n = 30). Patients were examined at baseline and after 6 months of implantation for LV systolic functions, global and regional strain by echocardiography and 2D speckle tracking echocardiography. Results: Paced QRS duration was significantly shorter in group B compared to group A patients (P = 0.02). Regarding ventricular strain, there was no statistically significant difference between both groups at baseline measurements in comparisons of GLS, relative apical longitudinal strain (rALS) and RLS (P > 0.05). In contrast, there was statistically significant difference between both groups in results of GLS (P = 0.01) at 6 months. In addition, RLSs in septal, apical and rALS were affected after 6 months with P values of 0.02, 0.03 and 0.03, respectively. Conclusion: RVAP appears to worsen GLS more than RVSP, and the resultant decrease in apical strain is most correlated region to decrease in GLS. Cardiol Res. 2016;7(1):17-24 doi: http://dx.doi.org/10.14740/cr454w

Previous trials remain inconsistent regarding the advantages and hazards related to intracoronary (IC) compared with intravenous (IV) administration of thrombolytics. We aimed to evaluate the safety and effectiveness of IC versus IV tirofiban administration in diabetic patients (DM) with acute ST-segment elevation myocardial infarction (STEMI) during primary percutaneous coronary intervention (PCI). This trial included 95 patients who were randomised to high-dose bolus plus a maintenance dose of tirofiban administered either IV or IC. The groups were compared for the incidence of composite major adverse cardiac events (MACE) at 30 days. Levels of cardiac markers were recorded pre- and post-intervention for myocardial perfusion. The MACE were not different between the groups, but post-procedure myocardial blush grade (MBG) 3 and thrombolysis in myocardial infarction (TIMI) 3 flow were significant in the IC group (p = 0.45, 0.21, respectively), favouring the IC strategy. Peak values of both creatine kinase-muscle/brain (CK-MB) and high-sensitivity troponin T (hs-TnT) were significantly lower in the IC group (155.68 ± 121, 4291 ± 334 ng/dl) versus the IV group (192.4 ± 86, 5342 ± 286 ng/dl) (p = 0.021, p = 0.035, respectively). The peak value was significantly lower in the IC group than the IV group in terms of ST-segment resolution and 30-day left ventricular ejection fraction (LVEF) (p = 0.016 and 0.023, respectively). Thirty days post PCI, IC tirofiban was more efficient in ameliorating blood flow in the coronary arteries and myocardial tissue perfusion in DM patients after STEMI despite bleeding events, and MACE rates showed no significant difference between the groups. The IC group showed better improvement in LVEF.

Background: Type 2 diabetes mellitus (T2DM) patients with small-diameter stents (SDS), that are equal to or less than 2.5 mm in diameter, face increased risks of restenosis and complications. This study aimed to evaluate the 1-year follow-up to assess the rate of major adverse cardiac events (MACE) and bleeding risk between ticagrelor and clopidogrel in T2DM patients after SDS implantation. Methods: The study was a single-center, prospective controlled registry trial, which included 332 T2DM patients who underwent percutaneous coronary intervention with SDS implantation. Follow-up was conducted for 1 year. Results: Following propensity score matching, the 1-year analysis revealed no significant difference in the risk of the composite MACE between clopidogrel and ticagrelor groups (P = .295). Male gender, history of ischemic heart disease, ejection fraction (EF), coronary lesion type, and chronic kidney disease (CKD) were identified as potential predictors for the composite endpoint. In a sub-analysis of CKD patients, the 12-month rates of composites of cardiac death (CD), myocardial infarction (MI), stroke, and target vessel revascularization (TVR) were lower in the ticagrelor group than in the clopidogrel group (P = .024). However, the ticagrelor group was associated with a higher rate of bleeding compared to the clopidogrel group (20% vs. 9%) (P = .041). Conclusion: Our study demonstrated that ticagrelor did not show improvement in the composite of CD, MI, stroke, TVR, or the risk of bleeding events defined by the BARC criteria in patients with T2DM and SDS compared with clopidogrel emphasizing the importance of individualized treatment decisions based on patient characteristics. However, the results may not be representative of the entire population.

Left ventricular thrombosis was present in 7-46 percentage of patients with myocardial infarction, dilated cardiomyopathy and acute myocarditis.

Background: The effectiveness and safety of oral anticoagulants (OAC) in patients with chronic kidney disease (CKD) and non-valvular atrial fibrillation (NVAF) in Frail Elderly patients has not been fully established. Objectives: To determine the safety and effectiveness related to OACs in Frail Elderly patients with AF and CKD stage II and III. Methods: Frail Elderly patients ≥65 years with AF and CKD who received OAC from January 2022 to June 2024 were retrospectively identified. Primary endpoints were composite of ischemic stroke and systemic embolism (IS/SE), and composite of intracranial bleeding (ICH) and/or gastrointestinal (GI) bleeding. Secondary endpoints included any bleeding. Results: The study enrolled 365 patients, of whom 141 (38.6%) initiated warfarin therapy and 224 (61.3%) initiated DOACs. CHA2DS2-VASc score was non-significant, (2.6±1.01 vs 2.8±0.89, p value 0.054), for GFR ≥ 60 and GFR < 60 mL/min/1.73m² patients respectively. HAS-BLED score (1.9±0.67 vs 2.3±0.70, p value 0.071) for GFR ≥ 60 and GFR < 60 mL/min/1.73m² patients respectively. While the observed incidence of ICH/GI bleeding was numerically higher in patients with GFR <60 mL/min/1.73m², Cox proportional hazards regression did not demonstrate a statistically significant difference in hazard between the groups. The incidence of composite IS/SE was 8.5% in GFR ≥60 mL/min/1.73m² vs. 8.7% in GFR <60 mL/min/1.73m² (HR 1.02, 95% CI 0.60–1.74, p=0.24). Composite ICH/GI bleeding occurred in 7.1% vs. 9.3% (HR 0.89, 95% CI 0.45–2.72, p=0.41). Conclusion: In this study comparing Frail Elderly patients with NVAF and CKD stage II versus stage III receiving OACs, we observed No significant difference in the risk of IS/SE or ICH/GI bleeding between groups. These findings suggest that within moderate CKD (eGFR 30-89 mL/min), renal function stage may not independently influence OAC-related outcomes when anticoagulation is well-managed. Our results may not generalize to less frail populations or those with advanced CKD. Further prospective studies with larger sample size are needed to provide clearer guidance on the optimal use of OACs in this challenging clinical scenario.