Demographic and Regional Trends of Infective Endocarditis-Related Mortality in the United States, 1999 to 2019.

We sought to identify temporal, geographic, age and sex-based mortality trends of IE in the US over the past 2 decades. This population-based study utilized the CDC WONDER database to identify IE-related deaths occurring within the US between 1999 and 2019. IE-related crude and age-adjusted mortality rates (CMRs and AAMRs, respectively) were determined. Joinpoint regression was used to determine trends in CMR/AAMR using annual percent change (APC) in the overall sample in addition to demographic (sex, race/ethnicity, age) and geographic (rural/urban, statewide) subgroups. Between 1999 and 2019, a total of 279,154 deaths related to IE were reported. The overall AAMR declined from 54.2/1,000,000 in 1999 to 51.4 in 2019. However, AAMRs increased among several sub-groups over the past decade including men [2009-2019 APC = 0.4%, 95%CI, 0.1%-0.6%], non-Hispanic (NH) whites [APC of 0.8% from 2009 to 2019 (95%CI 0.5%-1.1%)], NH American Indians or Alaskan Natives [APC of 1.4% during the study period (95%CI, 0.7%-2.0%)], and those in rural areas [APC of 1.0% from 2009 to 2019 (95%CI 0.5%-1.5%)]. The CMRs increased among subjects 40-64 years old [APC of 2.8% from 2010 to 2019 (95%CI 2.2%-3.5%)] and 15-39 years old [APC of 16.4% from 2010 to 2017 (95%CI 13.5%-19.4%)]. IE-related CMR/AAMR increased among men, NH whites, NH American Indian or Alaskan Natives, those <65-year-old, and those from rural areas. Discerning the reasons for the increase in IE-related mortality among these groups and examining the impact of the social determinants of health may represent important opportunities to enhance care.

Association of Zika Virus with Myocarditis, Heart Failure, and Arrhythmias: A Literature Review.

As the concerns regarding Zika virus (ZIKV) are mostly of neurological disorders, especially in neonates and infants, other possible threats of the virus may have been overlooked. Our study focuses on the potential threat that ZIKV may pose to the heart like that of similar arboviral diseases. We conducted a literature search of multiple terms in March 2017 using the search engines, PubMed, Embase, and SCOPUS. Articles were then reviewed by two independent reviewers, adhering strictly to our review criteria. No discriminations were made whether the studies were conducted on human or non-human subjects. Three relevant studies were shortlisted and finalized. The nature of the studies is as follows: prospective observational multicenter study (n = 9), case report (n = 1), and animal studies (n = 5). The studies suggested an association between cardiovascular complications and ZIKV in the acute phase of the infection. We recognize the limitations of our study owing to the paucity of the sample size of our literature review. However, the significant findings have also proved the dire need to conduct more research to further back the possibility of ZIKV's influence on the cardiac cells. Closely studying these associations can eventually help develop a vaccine for ZIKV in the near future.

Link Between Non-Alcoholic Fatty Liver Disease and Atrial Fibrillation: A Systematic Review and Meta-Analysis.

Association between non-alcoholic fatty liver disease (NAFLD) and various cardiovascular diseases has been demonstrated previously. Recent clinical studies have shown that increased circulating levels of γ glutamyl transpeptidase and liver transaminase, markers which are elevated in NAFLD, increase the risk of new-onset atrial fibrillation. We conducted a systematic review and meta-analysis of the available evidence to establish the possible association of increased chances of atrial fibrillation in patients with NAFLD. We extensively searched the PubMed, EMBASE, Cochrane Library, ISI Web of Science and Scopus databases to identify all possible studies that investigated the possible association of NAFLD with atrial fibrillation. Random effect models were used to pool the data between NAFLD and non-NAFLD group. I2 testing was done to assess the heterogeneity of the included studies. Our primary outcome was atrial fibrillation. A total of three studies including 1044 patients in the NAFLD arm and 1016 in the placebo arm were included. On pooled analysis, it was observed that patients with NAFLD had 2.5 times significantly higher chance (OR = 2.47, CI = 1.30-4.66, p = 0.005) of developing new-onset atrial fibrillation. Our meta-analysis identifies the paucity of high-quality evidence regarding the association between NAFLD and atrial fibrillation. More studies are needed to confirm the link between NAFLD and atrial fibrillation.

Anomalous Origin of Right Coronary Artery Originating from the Pulmonary Trunk (ARCAPA): an Incidental Finding in a Patient Presenting with Chest Pain.

Anomalous origin of the right coronary artery originating from the pulmonary trunk (ARCAPA) is a rare congenital coronary anomaly with an estimated prevalence of 0.002%. Most patients are asymptomatic and the anomaly is detected incidentally during evaluation for other problems. Occasionally, ARCAPA may lead to myocardial ischemia and/or sudden cardiac arrest. We present a case of a 55-year-old female with a history of hypertension who presented to the emergency department with intermittent chest discomfort for three days. Laboratory results showed an elevated troponin of 0.18 ng/ml and subsequently increased to 0.39 ng/ml. The initial electrocardiogram study demonstrated sinus tachycardia with no acute changes. The patient was diagnosed with non-ST-segment elevation myocardial infarction. She underwent cardiac catheterization that showed 90% stenosis of the left main/left anterior descending artery. Reflux of contrast from the right coronary artery (RCA) ostium to the pulmonary artery was seen along with left to right collaterals with retrograde filling of the RCA. There was no significant obstruction of the RCA when viewed via left to right collaterals. Right heart catheterization and pulmonary angiography were performed which confirmed the origin of the RCA from the pulmonary trunk. The patient was referred for surgery and ligation of the aberrant RCA originating from the pulmonary artery was performed along with coronary artery bypass grafting x 2, left internal mammary artery to left anterior descending artery (LAD) and saphenous vein graft to the proximal posterior descending artery. The patient was discharged home with marked improvement of her symptoms. Origin of the RCA from the pulmonary artery (ARCAPA) is a rare congenital malformation with a potentially malignant outcome for the patient. The majority of patients with ARCAPA remain asymptomatic. In this case report, the chest discomfort was due to occlusion of the LAD and was probably unrelated to the coronary malformation. However, sudden cardiac death has been linked to ARCAPA and therefore a corrective operation is recommended even for asymptomatic patients. Of the surgical techniques available, which include: simple ligation of the RCA, ligation of the RCA with saphenous vein bypass grafting and re-implantation of the RCA into the aorta, the last method is believed to be superior for the restoration of myocardial blood supply. However, its long-term benefits have not been conclusively demonstrated. Therefore, in our patient, ligation of RCA with saphenous vein bypass grafting was done as it is recognized as a less traumatic surgical alternative to RCA implantation into the aorta.

Does Hemodynamic-Guided Heart Failure Management Reduce Hospitalization? A Systematic Review.

Heart failure (HF) is a pressing health concern as the expense of hospitalization financially burdens the health care system. Hemodynamic monitoring has the potential to detect increases in intracardiac filling pressures weeks before clinical deterioration; hence, preliminary findings of volume overload with the use of these devices may prevent the progression of disease and lead to a reduction in HF-associated hospitalizations. We extensively searched PubMed, Ovid SP, Embase, and Cochrane databases to identify all the possible studies that assess the effect of hemodynamic monitoring on hospitalizations in HF patients. The main outcomes considered were the rate of HF hospitalization, mortality, quality of life, and improvement in New York Heart Association (NYHA) functional class in the monitored group. Seven studies met all the eligibility criteria and were incorporated in our systematic review. Out of the seven studies we reviewed, three studies inserted the sensor in the pulmonary artery, three in the right ventricle, and only one in the left atrium. On an average, the single study on the left atrium showed the highest reduction (59.0%) in HF hospitalization followed by the pulmonary artery (56.3%) and right ventricle (31.0%), respectively. Our systematic review demonstrates that the use of hemodynamic sensors in HF patients helps to reduce HF-related hospitalizations. Therefore, a combination of outpatient monitoring via the use of hemodynamic sensors and fluid management is needed to reduce HF hospitalizations and improve outcomes in HF patients.

Non-Alcoholic Fatty Liver Disease Association with Cardiac Arrhythmias.

Non-alcoholic fatty liver disease (NAFLD) has become a public health burden all over the world. A significant percentage of the patients with NAFLD have a co-existing metabolic syndrome that is a risk factor for cardiovascular disease. Clinical as well as epidemiological research shows that NAFLD is not simply related to liver-related morbidity and mortality but is also associated with an elevated risk of coronary heart disease (CHD), irregularities of cardiac function as well as cardiac structure, valvular heart disease, and arrhythmias. Animal studies suggest that NAFLD by itself exacerbates systemic/hepatic insulin resistance, leads to atherogenic dyslipidemia and generates a number of pro-inflammatory, pro-coagulant and profibrogenic mediators which play an essential role in the pathophysiology of cardiac abnormalities including arrhythmias. Hence, it is suggested that the patients with NAFLD may derive benefit from intensive monitoring and treatment methods to reduce the risk of CHD along with other cardiac/arrhythmic complications. The intent of this clinical review is to sum up the quickly increasing body of evidence that provides support for a robust relationship between NAFLD and cardiac arrhythmias and to present the putative biological mechanisms underlying this correlation.

Association of Non-alcoholic Fatty Liver Disease with Conduction Defects on Electrocardiogram.

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is a leading cause of liver disease in developed countries. The association of NAFLD with conduction defects is unknown. The aim of our study was to find whether an association exists between conduction defects and NAFLD. METHODS: This is a case-control retrospective study of 700 patients admitted to Orange Park Medical Center, Orange Park, Florida from 2009 to 2015. Patients with a history of alcohol use, congenital heart disease, infiltrative malignancy, and myocarditis were excluded from the study. NAFLD was diagnosed by detection of hepatic steatosis on abdominal ultrasound or computerized tomography (CT) scan. Electrocardiograms (EKGs) were performed on all 700 patients and were interpreted by a cardiologist. Univariate logistic regression was used to assess the association between NAFLD and the variables of demographics, clinical characteristics, medicine use, EKG changes, and conduction defects, while multivariate logistic regression with backward elimination method was performed to determine if NAFLD is one of the most important risk factors for conduction defects. RESULTS: The study population included 408 patients with NAFLD and 292 patients with No-NAFLD. A total of 155 conduction defects occurred in 140 patients; conduction defects included 25.7% (36) patients with first degree block, 2.1% (three) patients with Mobitz type 1 block, 41.4% (58) patients with right bundle branch block (RBBB), 17.9% (25) patients with left bundle branch block (LBBB), 11.4% (16) patients with bifascicular block, and 12.1% (17) patients with nonspecific intraventricular block. Multivariate logistic regression with backward elimination method identified six risk factors for conduction defects; these included NAFLD (odds ratio (OR) 2.38; 95% confidence interval (CI) 1.51-3.73, p<0.0001), hypertrophy (OR 2.52; 95% CI 1.57-4.05, p=0.0001), congestive heart failure (CHF) (OR 3.05; 95%CI 1.46-6.38, p=0.0031), male sex (OR 1.79; 95%CI 1.19-2.69, p=0.0051), diabetes mellitus (OR 1.63; 95% CI 1.08-2.47, p=0.02), and age (OR 1.04; 95% CI 1.02-1.06, p<0.0001). CONCLUSION: NAFLD is associated with conduction defects. Prospective randomized trials are needed to demonstrate that NAFLD causes conduction defects.