A Meta-Analysis on the Impact of High BMI in Patients Undergoing Transcatheter Aortic Valve Replacement.

BACKGROUND: A paradoxical association of obesity with lower risk of transcatheter aortic valve replacement (TAVR) outcomes has been reported. We aimed to systematically review the literature and compare TAVR-related morbidity and mortality among individuals with overweight or obesity and their peers with normal body mass index (BMI). METHODS: PubMed and Embase databases were systematically searched for studies reporting TAVR outcomes in different BMI groups. Separate meta-analyses were conducted for studies reporting hazard ratios (HR) and odds ratios/relative risks. Short- and mid-/long-term outcomes were examined. RESULTS: 26 studies with a total of 74,163 patients were included in our study. Overweight was associated with lower risk of short-term mortality (HR: 0.77; 95% CI: 0.60-0.98) and mid-/long-term mortality (HR: 0.79; 95% CI: 0.70-0.89). Obesity was associated with lower risk for mid-/long-term mortality (HR: 0.79; 95% CI: 0.73-0.86), but no difference was observed in short-term mortality, although a trend was noted (HR: 0.87l 95% CI: 0.74-1.01). Individuals with obesity demonstrated an association with higher odds of major vascular complications (OR: 1.33; 95% CI: 1.05-1.68). Both overweight (OR: 1.16; 95% CI: 1.03-1.30) and obesity (OR: 1.26; 95% CI: 1.06-1.50) were associated with higher likelihood for receiving permanent pacemakers after TAVR. CONCLUSION: Individuals with overweight and obesity were associated with lower mortality risk compared to those with normal BMI but with higher likelihood of major vascular complications and permanent pacemaker implantation after TAVR.

Epidemiologic and clinical characteristics of infective endocarditis: a single-center retrospective study in the Bronx, New York.

OBJECTIVE: There is paucity of data on the epidemiological, microbiological, and clinical characteristics of patients admitted with infective endocarditis (IE) in the Bronx, New York. PATIENT AND METHODS: We conducted a retrospective study at Jacobi Medical Center, a tertiary care hospital in the Bronx. All adult patients who were hospitalized with a primary diagnosis of new-onset IE between January 1st, 2010 and September 30th, 2020 were included. The primary outcome was in-hospital mortality. A logistic regression model was used to identify baseline variables associated with in-hospital mortality. RESULTS: 182 patients were included in this analysis (female sex: 38.5%, median age: 54 years). 46 patients (25.3%) reported intravenous drug use. 153 patients (84.1%) had positive blood cultures. Staphylococcus aureus (S. aureus) was the most common isolated pathogen (45.1% of monomicrobial IE). Nearly half of the cases secondary to S. aureus were methicillin resistant Staphylococcus aureus (MRSA) (34/69). 164 patients (90.1%) were diagnosed with native valve IE. The mitral valve was involved in 32.4% of patients followed by the aortic valve (19.8%). The in-hospital mortality was 18.1%. The mortality was higher in the cohort 2010-2015 compared to the cohort 2016-2020 (22.1% vs 14.6%). Increasing age, MRSA IE, and active malignancy were the only variables found to have significant association with in-hospital death. CONCLUSION: S. aureus was the most common causative agent and MRSA accounted for about half of the S. aureus IE cases. The incidence of IE in patients with intravenous drug use increased over time, while the median age decreased. The in-hospital death rate was higher in 2010-2015 compared to 2016-2020.

A Silent Left Atrial Myxoma: A Rare Benign Cardiac Tumor.

Primary cardiac tumors are extremely rare. In one study, incidence was reported being less than 0.1%. The purpose of this case report is to review different presentations of cardiac myxoma. A 34-year-old female with past medical history of drug abuse was brought into the emergency department (ED) after a motor vehicle collision. She was found to have multiple fractures with a hypodense mass in the left atrium. Further evaluation showed a left atrial myxoma. The patient underwent myxoma resection. The clinical appearance of myxoma varies from non-specific to life-threatening complications, such as stroke, acute heart failure, or even sudden death. A surgical resection is the treatment of choice for cardiac myxomas.

Antidromic Atrioventricular Reentry Tachycardia with Wolff Parkinson White Syndrome: A Rare Beast.

Orthodromic atrioventricular reentrant tachycardia (AVRT) is the second-most-common form of supraventricular tachycardia (SVT) and is inducible in approximately 55% of individuals with Wolff Parkinson White (WPW) syndrome. Antidromic AVRT, where the accessory atrioventricular connection is used as the antegrade limb and the atrioventricular node serves as the retrograde limb of the circuit, has been clinically documented in less than 5% of patients with WPW syndrome and may be induced in less than 10% of these WPW cases in the electrophysiology laboratory. Left lateral pathways are considered more frequent and septal locations are less common when associated with antidromic AVRT. We report a case of 21-year-old male with a history of WPW syndrome who had undergone a prior electrophysiology study in 2010 at an outlying facility, documenting an anteroseptal accessory pathway near the His bundle along with an unsuccessful attempt at radiofrequency ablation at that time. No supraventricular tachycardia was induced at that previous study. The surface electrocardiogram (ECG), at this time, was consistent with the anteroseptal WPW pattern. The patient now presented with a complaint of intermittent palpitations with no definitive trigger. He also described a recent syncopal episode while walking inside his home. His physical exam and all lab work were within normal limits for his age. He underwent a repeat electrophysiology (EP) study where the baseline PR interval was 62 milliseconds and the QRS duration was 172 milliseconds in a pre-excited pattern. There was found to be an antegrade-only conducting accessory pathway at the anteroseptal region near the His bundle. Antegrade AVRT was induced with a single ventricular extra stimulus while on 2 mcg/min isoproterenol. Cryoablation was performed in a position slightly posterior to the His bundle, which successfully resolved the accessory pathway conduction. First-degree atrioventricular (AV) block was noted in the sinus rhythm with a PR interval of 226 milliseconds post-cryoablation. There was no recurrence of accessory pathway conduction on follow-up ECG 24 hours post-cryoablation. Antidromic AVRT is a very rare finding in WPW syndrome during an EP study. Catheter ablation is the treatment of choice for patients who have symptomatic WPW syndrome. Catheter ablation can be especially challenging when the accessory pathway is in close proximity to the normal conduction pathways. The prognostic significance of inducible antidromic AVRT is controversial in asymptomatic patients and limited data indicate it may be a poor prognostic sign in children. In adults, the prognostic significance is not well-established. Cryoablation is an option for the ablation of accessory pathways that are close to the normal conduction pathways. "Cryomapping" is designed to have precise ablation and to reassure the absence of complications.

Anomalous Origin of Coronary Arteries Arising from the Right Coronary Cusp: A Rare Presentation.

The anomalous origin of coronaries is rare. The purpose of this case report is to show a rare anomalous origin of coronaries. A 64-year-old female presented with chest pain that was typical in nature. The patient had left heart catheterization that showed an anomalous origin of coronaries, where all the coronaries were arising from the right coronary cusp. The patient had a significant disease in the distal left anterior descending artery, but it was a small vessel. Medical management was chosen. This is a rare presentation of the coronary anatomy.

A Case Report of Dilated Biventricular Heart Failure from Hyperthyroidism: A Rare Presentation.

Hyperthyroidism is a common metabolic disorder with many cardiovascular manifestations. In rare cases, untreated hyperthyroidism can lead to thyrotoxic cardiomyopathy with severe left ventricular (LV) dysfunction. This case report aims to discuss the pathogenesis of heart failure in hyperthyroidism and the available treatment options. A 51-year-old male with a past history of untreated hyperthyroidism presented to our hospital for the evaluation of shortness of breath and dysphagia. Workup revealed atrial flutter and severe biventricular dilated cardiomyopathy. Stabilization thyroidectomy was performed due to dysphagia, and treatment with oral antithyroid medications was initiated. The patient was discharged on synthroid and beta-blockers. Untreated hyperthyroidism can lead to biventricular failure even in the young. Untreated hyperthyroidism leads to significant mortality and morbidity. Untreated hyperthyroidism is associated with atrial fibrillation, heart failure, pulmonary hypertension (PH), and angina-like symptoms. Further studies should be done to evaluate the pathogenesis of Graves/Goiter hyperthyroidism and the least-invasive, safe, and definitive treatment options should be discovered. Current treatment options are limited and include medication that needs to be taken lifelong; they are associated with toxicity. Radioactive iodine ablation comes with the drawback of long-term replacement therapy. The last option is surgery, which is invasive and has its own complications.