scholarly journals Cardiovascular and pregnancy outcomes in women with coronary microvascular dysfunction: a case series

2019 ◽  
Vol 3 (2) ◽  
Author(s):  
Christine Pacheco ◽  
Janet Wei ◽  
Margo Minissian ◽  
Chrisandra L Shufelt ◽  
Sarah J Kilpatrick ◽  
...  
Keyword(s):  
Functional Capacity ◽  
Pregnancy Outcomes ◽  
Case Series ◽  
Microvascular Dysfunction ◽  
Coronary Microvascular Dysfunction ◽  
Childbearing Age ◽  
Spontaneous Miscarriage ◽  
Severity Scores ◽  
History Of ◽  
The Impact

Abstract Background Coronary microvascular dysfunction (CMD) is associated with adverse cardiovascular outcomes. Coronary microvascular dysfunction is observed in women of childbearing age, however, the frequency of adverse pregnancy outcomes (APO) is unknown. Case summary Women previously enrolled in a single centre prospective CMD registry diagnosed using invasive coronary reactivity testing were included. Among 279 women enrolled, 5 of 47 (10.6%) of childbearing age (18–44 years) subsequently became pregnant, representing a fertility rate of 36.8 births per 1000 women-years. None had history of hypertension, diabetes, or smoking. Four (80%) had a history of prior spontaneous miscarriage. Median age at CMD diagnosis was 32 years (IQR: 32–35). During pregnancy, most reported stable or improved angina, while one reported increased angina frequency, an emergency room visit and accelerated anti-anginal therapy. None experienced gestational hypertension, diabetes, pre-eclampsia, myocardial infarction, or death. Two (40%) experienced APO of preterm delivery and small neonate for gestational age. Following pregnancy, angina severity scores, and/or functional capacity decreased in three women (60%). Discussion In this first case-series of five women with CMD who became pregnant, increased angina and accelerated care during pregnancy and post-partum was not commonly observed. Fertility rates were lower than the national average, while prior spontaneous miscarriage and subsequent APO were higher. Further studies are warranted to understand and manage pregnancy in women with CMD, as well as the impact of pregnancy on longer term angina, functional capacity, and outcomes.

scholarly journals The Impact of Ischemia Assessed by Magnetic Resonance on Functional, Arrhythmic, and Imaging Features of Hypertrophic Cardiomyopathy

2021 ◽  
Vol 8 ◽  
Author(s):  
Sílvia Aguiar Rosa ◽  
Boban Thomas ◽  
António Fiarresga ◽  
Ana Luísa Papoila ◽  
Marta Alves ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Magnetic Resonance ◽  
Functional Capacity ◽  
Cardiopulmonary Exercise Testing ◽  
Clinical Manifestations ◽  
Microvascular Dysfunction ◽  
Left Ventricular ◽  
Coronary Microvascular Dysfunction ◽  
Imaging Features ◽  
The Impact

Aims: The aim of the study is to investigate the association between the degree of ischemia due to coronary microvascular dysfunction (CMD) and the left ventricular (LV) tissue characteristics, systolic performance, and clinical manifestations in hypertrophic cardiomyopathy (HCM).Methods and Results: This prospective study enrolled 75 patients with HCM without obstructive epicardial coronary artery disease. Each patient underwent cardiovascular magnetic resonance (CMR) including parametric mapping, perfusion imaging during regadenoson-induced hyperemia, late gadolinium enhancement (LGE) and three-dimensional longitudinal, circumferential, and radial strains analysis. Electrocardiogram, 24-h Holter recording, and cardiopulmonary exercise testing (CPET) were performed to assess arrhythmias and functional capacity. In total, 47 (63%) patients were men with the mean age of 54.6 (14.8) years, 51 (68%) patients had non-obstructive HCM, maximum wall thickness (MWT) was 20.2 (4.6) mm, LV ejection fraction (LVEF) was 71.6 (8.3%), and ischemic burden was 22.5 (16.9%) of LV. Greater MWT was associated with the severity of ischemia (β-estimate:1.353, 95% CI:0.182; 2.523, p = 0.024). Ischemic burden was strongly associated with higher values of native T1 (β-estimate:9.018, 95% CI:4.721; 13.315, p < 0.001). The association between ischemia and LGE was significant in following subgroup analyses: MWT 15–20 mm (β-estimate:1.941, 95% CI:0.738; 3.143, p = 0.002), non-obstructive HCM (β-estimate:1.471, 95% CI:0.258; 2.683, p = 0.019), women (β-estimate:1.957, 95% CI:0.423; 3.492, p = 0.015) and age <40 years (β-estimate:4.874, 95% CI:1.155; 8.594, p = 0.016). Ischemia in ≥21% of LV was associated with LGE >15% (AUC 0.766, sensitivity 0.724, specificity 0.659). Ischemia was also associated with atrial fibrillation or flutter (AF/AFL) (OR-estimate:1.481, 95% CI:1.020; 2.152, p = 0.039), but no association was seen for non-sustained ventricular tachycardia. Ischemia was associated with shorter time to anaerobic threshold (β-estimate: −0.442, 95% CI: −0.860; −0.023, p = 0.039).Conclusion: In HCM, ischemia associates with morphological markers of severity of disease, fibrosis, arrhythmia, and functional capacity.

Burden of Congenital Rubella Syndrome (CRS) in Bangladesh: Systematic Review of Existing Literature and Transmission Modelling of Seroprevalence Studies

2020 ◽  
Vol 20 (3) ◽  
pp. 284-290
Author(s):  
Jocelyn Chan ◽  
Yue Wu ◽  
James Wood ◽  
Mohammad Muhit ◽  
Mohammed K. Mahmood ◽  
...  
Keyword(s):  
Systematic Review ◽  
Deterministic Model ◽  
Case Series ◽  
Controlled Vocabulary ◽  
Congenital Rubella Syndrome ◽  
Free Text ◽  
Childbearing Age ◽  
Vaccination Programs ◽  
Congenital Rubella ◽  
The Impact

Background and Objectives: Congenital Rubella Syndrome (CRS) is the leading cause of vaccine-preventable congenital anomalies. Comprehensive country-level data on the burden of CRS in low and middle-income countries, such as Bangladesh, are scarce. This information is essential for assessing the impact of rubella vaccination programs. We aim to systematically review the literature on the epidemiology of CRS and estimate the burden of CRS in Bangladesh. Methods: We conducted a systematic review of existing literature and transmission modelling of seroprevalence studies to estimate the pre-vaccine period burden of CRS in Bangladesh. OVID Medline (1948 – 23 November 2016) and OVID EMBASE (1974 – 23 November 2016) were searched using a combination of the database-specific controlled vocabulary and free text terms. We used an age-stratified deterministic model to estimate the pre-vaccination burden of CRS in Bangladesh. Findings: Ten articles were identified, published between 2000 and 2014, including seven crosssectional studies, two case series and one analytical case-control study. Rubella seropositivity ranged from 47.0% to 86.0% among all age population. Rubella sero–positivity increased with age. Rubella seropositivity among women of childbearing age was 81.0% overall. The estimated incidence of CRS was 0·99 per 1,000 live births, which corresponds to approximately 3,292 CRS cases annually in Bangladesh. Conclusion: The estimated burden of CRS in Bangladesh during the pre-vaccination period was high. This will provide important baseline information to assess the impact and cost-effectiveness of routine rubella immunisation, introduced in 2012 in Bangladesh.

Abstract P296: Poor Functional Capacity is Associated With Peripheral Microvascular Dysfunction in Coronary Artery Disease

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Jeong Hwan Kim ◽  
Ahmed Al-Badri ◽  
Muhammad Hammadah ◽  
Ibhar Al Mheid ◽  
Kobina Wilmot ◽  
...  
Keyword(s):  
Functional Capacity ◽  
Reactive Hyperemia ◽  
Microvascular Dysfunction ◽  
Adverse Outcomes ◽  
Rehabilitation Programs ◽  
Pressure Cuff ◽  
Duke Activity Status Index ◽  
History Of ◽  
Artery Disease ◽  
Stable Cad

Introduction: Reduced functional capacity, assessed by self-reported Duke Activity Status Index (DASI) is associated with adverse outcomes. Peripheral microvascular dysfunction, measured as reduced digital reactive hyperemia index (RHI) is also associated with adverse events. Whether microvascular dysfunction is related to functional capacity is unknown. Hypothesis: We hypothesized that peripheral microvascular dysfunction is associated with diminished functional capacity. Methods: In 531 patients with stable CAD (age 62±9, 75% male, 30% Black, EF 55±13%) enrolled in the Mental Ischemia Prognosis Study, self-reported functional capacity was assessed with the DASI questionnaire with a score of >25 as the cutoff for normal. Pulsatile arterial tonometry (EndoPat, Itamar Inc.) was used to measure digital RHI during 5 minutes of upper arm occlusion with blood pressure cuff followed by reperfusion. Logistic regression was used to model reduced RHI (<median) as a function of normal vs low DASI score (>25 vs ≤ 25). Results: Median RHI was 2.01 [IQR 1.67, 2.49] while median DASI score was 45 [29,53], equivalent to 8.3 METs. Compared to those with normal DASI score (>25; N=425), subjects with low DASI score (≤25; N=106) had lower RHI (1.88 [1.64, 2.24] vs 2.06 [1.69, 2.54], P=0.048), higher BMI (32±7 kg/m 2 vs 29±5 kg/m 2 , P<0.001), were more likely to be female (48% vs 20%, P<0.001) and Black (42% vs 28%, P=0.005), and more likely to have a history of hypertension (87% vs 75%, P=0.009), diabetes (39% vs 29%, P=0.046), and heart failure (34% vs. 20%, P=0.003). After adjusting for the aforementioned variables in addition to history of dyslipidemia, smoking and prior MI, those with a low DASI score had a significantly higher likelihood of a reduced RHI (<median) (OR 1.72, 95% CI 1.08 - 2.74, P=0.023) Conclusion: Poor functional capacity is independently associated with microvascular dysfunction in patients with stable CAD, and illustrates a potential mechanism by which reduced functional capacity increases cardiovascular risk. Whether improvement in functional capacity by exercise/rehabilitation programs improves microvascular function requires further investigation.

scholarly journals Hepatitis C and pregnancy outcomes: a systematic review protocol

BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e024288 ◽  
Author(s):  
Stephanie Parent ◽  
Kate Salters ◽  
Lindila Awendila ◽  
Lianping Ti
Keyword(s):  
Systematic Review ◽  
Hepatitis C ◽  
Gestational Diabetes ◽  
Pregnancy Outcomes ◽  
Cochrane Library ◽  
Childbearing Age ◽  
Hcv Treatment ◽  
Conference Abstract ◽  
Hcv Transmission ◽  
The Impact

IntroductionMany women living with hepatitis C (HCV) are of childbearing age. While the risk of vertical HCV transmission has been well established, the impact of HCV on pregnancy outcomes are equivocal, with some studies reporting risks of preterm birth, low gestational weight, gestational diabetes and hypertension, while other studies report no such risks. With the shift of the HCV treatment landscape to more effective, tolerable and shorter medications, understanding pregnancy outcomes of women living with HCV are an important consideration in order to provide a baseline from which to consider the usefulness and safety of HCV treatment for this population. The objective of this systematic review will be to investigate pregnancy outcomes associated with maternal HCV infection.Methods and analysisThis systematic review will incorporate articles relevant to pregnancy outcomes among women living with HCV (eg, gestational diabetes and caesarean delivery). Articles will be retrieved from academic databases including MEDLINE, EMBASE, CINAHL, clinicaltrial.gov and the Cochrane Library and hand searching of conference proceedings and reference lists. A database search will not be restricted by date, and conference abstract will be restricted to the past 2 years. The Newcastle-Ottawa Quality Assessment Scale will be used to assess the quality of the retrieved studies. Data will be extracted and scored independently by two authors. A narrative account will synthesise the findings to answer the objectives of this review.Ethics and disseminationThis systematic review will synthesise the literature on the pregnancy outcomes of women living with HCV. Results from this review will be disseminated to clinical audiences, community groups and policy-makers, and may support clinicians and decision-makers in developing guidelines to promote best outcomes for this population.

Pregnancy failure in patients with obstetric antiphospholipid syndrome with conventional treatment: the influence of a triple positive antibody profile

Lupus ◽  
2017 ◽  
Vol 26 (9) ◽  
pp. 983-988 ◽  
Author(s):  
J O Latino ◽  
S Udry ◽  
F M Aranda ◽  
S D A Perés Wingeyer ◽  
D S Fernández Romero ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Antiphospholipid Syndrome ◽  
Pregnancy Outcomes ◽  
Conventional Treatment ◽  
Poor Response ◽  
Anticardiolipin Antibodies ◽  
History Of ◽  
Obstetric Antiphospholipid Syndrome ◽  
The Impact

Conventional treatment of obstetric antiphospholipid syndrome fails in approximately 20–30% of pregnant women without any clearly identified risk factor. It is important to identify risk factors that are associated with these treatment failures. This study aimed to assess the impact of risk factors on pregnancy outcomes in women with obstetric antiphospholipid syndrome treated with conventional treatment. We carefully retrospectively selected 106 pregnancies in women with obstetric antiphospholipid syndrome treated with heparin + aspirin. Pregnancy outcomes were evaluated according to the following associated risk factors: triple positivity profile, double positivity profile, single positivity profile, history of thrombosis, autoimmune disease, more than four pregnancy losses, and high titers of anticardiolipin antibodies and/or anti-βeta-2-glycoprotein-I (aβ2GPI) antibodies. To establish the association between pregnancy outcomes and risk factors, a single binary logistic regressions analysis was performed. Risk factors associated with pregnancy loss with conventional treatment were: the presence of triple positivity (OR = 5.0, CI = 1.4–16.9, p = 0.01), high titers of aβ2GPI (OR = 4.4, CI = 1.2–16.1, p = 0.023) and a history of more than four pregnancy losses (OR = 3.5, CI = 1.2–10.0, p = 0.018). The presence of triple positivity was an independent risk factor associated with gestational complications (OR = 4.1, CI = 1.2–13.9, p = 0.02). Our findings reinforce the idea that triple positivity is a categorical risk factor for poor response to conventional treatment.

scholarly journals Smoking, alcohol and opioids effect on coronary microcirculation: an update overview

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zahra Jalali ◽  
Morteza Khademalhosseini ◽  
Narjes Soltani ◽  
Ali Esmaeili Nadimi
Keyword(s):  
Myocardial Infarction ◽  
Significant Proportion ◽  
Microvascular Dysfunction ◽  
Coronary Microcirculation ◽  
Coronary Microvascular Dysfunction ◽  
Cardiac Events ◽  
Excessive Alcohol Consumption ◽  
Artery Disease ◽  
Health Complications ◽  
The Impact

AbstractSmoking, heavy alcohol drinking and drug abuse are detrimental lifestyle factors leading to loss of million years of healthy life annually. One of the major health complications caused by these substances is the development of cardiovascular diseases (CVD), which accounts for a significant proportion of substance-induced death. Smoking and excessive alcohol consumption are related to the higher risk of acute myocardial infarction. Similarly, opioid addiction, as one of the most commonly used substances worldwide, is associated with cardiac events such as ischemia and myocardial infarction (MI). As supported by many studies, coronary artery disease (CAD) is considered as a major cause for substance-induced cardiac events. Nonetheless, over the last three decades, a growing body of evidence indicates that a significant proportion of substance-induced cardiac ischemia or MI cases, do not manifest any signs of CAD. In the absence of CAD, the coronary microvascular dysfunction is believed to be the main underlying reason for CVD. To date, comprehensive literature reviews have been published on the clinicopathology of CAD caused by smoking and opioids, as well as macrovascular pathological features of the alcoholic cardiomyopathy. However, to the best of our knowledge there is no review article about the impact of these substances on the coronary microvascular network. Therefore, the present review will focus on the current understanding of the pathophysiological alterations in the coronary microcirculation triggered by smoking, alcohol and opioids.

Coronary microvascular dysfunction is not associated with a history of reproductive risk factors in women with angina pectoris—An iPOWER substudy

Maturitas ◽  
2018 ◽  
Vol 107 ◽  
pp. 110-115 ◽  
Author(s):  
Hannah Elena Suhrs ◽  
Anna Meta Kristensen ◽  
Anna Bay Rask ◽  
Marie Mide Michelsen ◽  
Daria Frestad ◽  
...  
Keyword(s):  
Risk Factors ◽  
Angina Pectoris ◽  
Microvascular Dysfunction ◽  
Coronary Microvascular Dysfunction ◽  
Reproductive Risk ◽  
History Of ◽  
Reproductive Risk Factors

scholarly journals An unexpected recovery of patients with pulmonary arterial hypertension and SARS-CoV-2 pneumonia: a case series

2020 ◽  
Vol 10 (3) ◽  
pp. 204589402095658
Author(s):  
Piermario Scuri ◽  
Attilio Iacovoni ◽  
Raffaele Abete ◽  
Alberto Cereda ◽  
Aurelia Grosu ◽  
...  
Keyword(s):  
Pulmonary Arterial Hypertension ◽  
Clinical Outcome ◽  
Arterial Hypertension ◽  
Case Series ◽  
History Of ◽  
Pulmonary Arterial ◽  
The Impact

Since the beginning of the SARS-CoV-2 outbreak, few cases of COVID-19 pneumonia in patients with pulmonary arterial hypertension have been reported. We present four patients with known history of PAH admitted to our hospital with SARS-CoV-2 pneumonia to analyze the impact of this disease on their clinical outcome.

scholarly journals Risk factors and pregnancy outcomes of heterotopic pregnancy secondary to in vitro fertilization-embryo transfer: A case series study

2020 ◽  
Author(s):  
Shaomi Zhu ◽  
Qinxiu Zhang ◽  
Linjiang Song
Keyword(s):  
Embryo Transfer ◽  
Pregnancy Outcomes ◽  
Case Series ◽  
Tubal Infertility ◽  
Vitro Fertilization ◽  
Operative Duration ◽  
History Of ◽  
Ectopic Pregnancies ◽  
Ivf Et

Abstract Background: The early diagnosis and treatment of heterotopic pregnancy (HP) remain one of the biggest challenges in the field of gynecology. A coexisting intrauterine gestation makes the ectopic pregnancy in HP more difficult to diagnose. This case series analysis is designed to explore factors affecting the incidence of HP secondary to in vitro fertilization-embryo transfer (IVF-ET) and that affecting pregnancy outcomes after surgical treatment of HP.Methods: From the IVF registry system, the clinical data of 29 patients with HP and 92 with an intrauterine-only pregnancy (IUP) following embryo transfer from January 2009 to December 2017 were retrospectively analyzed.Results HP had a higher proportion of previous ectopic pregnancies, multiple abortion history ( ≧ 2 times) and tubal indication for IVF than IUP. In patients with HP, 31.03% had spontaneous abortion, 25.00% had preterm delivery and 58.62% resulted in a live birth. According to the results from logistic regression, history of multiple abortions (odds ratio (OR) 3.031, 95% confidence intervals (CI) 1.087-8.453; P=0.034), tubal infertility (OR 3.844, 95% CI 1.268-11.656; P=0.017), previous ectopic pregnancies (OR 2.303, 95% CI 0.625-8.490; P=0.021) and multiple embryo transfer ( OR 0.300, 95% CI 0.092-0.983; P=0.037) resulted in an elevated proportion of HP in IVF cycles. Incidence of HP was comparable between patients transferred with blastocyst and cleavage embryos. Shorter operative duration, smaller size of the ectopic mass and location in the ampulla of the fallopian tube were associated with higher chance of survival in the coexistent intrauterine pregnancy after surgical treatment with HP.Conclusions:The early diagnosis of HP remains a challenge. Previous history of ectopic pregnancy, multiple abortions, tubal infertility and multiple embryo transfer may be considered as meaningful risk factors of subsequent HP following IVF-ET. In patients with HP treated by surgery, shorter operative duration, smaller size of the ectopic mass and location in the ampulla of the fallopian tube means better reproductive prognosis.

scholarly journals AB0814 PREGNANCY COURSE ASSESSMENT IN PATIENTS WITH RHEUMATIC DISEASES COMPARED TO CONTROLS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1431.2-1432
Author(s):  
O. Hamdi ◽  
M. Sellami ◽  
M. Yasmine ◽  
A. Fazaa ◽  
S. Miladi ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Rheumatic Diseases ◽  
Premature Delivery ◽  
Control Group ◽  
Study Group ◽  
Childbearing Age ◽  
Significant Difference ◽  
History Of ◽  
The Mean ◽  
The Impact

Background:Rheumatic diseases such as rheumatoid arthritis (RA) and spondyloarthritis (SA) may occur among women of childbearing age. Adverse events during pregnancy including disease flare, preterm delivery, and neonatal or fetal death have been reported.Objectives:Our aim was to assess the impact of rheumatic diseases on the course of pregnancy.Methods:We conducted a cross-sectional study involving patients with RA (2010 ACR/EULAR criteria) and SA (2009 ASAS criteria) (study group) as well as healthy controls (control group) matched by age and gender. All women included had at least one pregnancy. Data were collected through telephonic interviews. We used the Student t test to compare the study group and the control group.Results:We enrolled 57 patients (30 RA and 27 SA) and 57 controls. The mean age in the study and the control groups were respectively 43.2 ± 8.2 years [26-48] and 37.5 ± 6 years. The mean chronic inflammatory rheumatisms duration was 13.81 ± 6.2 years. A history of primary sterility was found in 3 patients (1 RA and 2 SA) and none in the control group. The mean age during the first pregnancy was significantly higher in the study group (28 ± 6.2 years versus 24 ± 7 years in the control group) (p=0.01). Eight patients (5 RA and 3 SA) had a history of spontaneous miscarriage. A terminated pregnancy was noted in 3 patients (1 RA and 2 SA). Complications during pregnancy in the study group were gestational diabetes (0.3%), premature delivery (0.3), premature rupture of membranes (0.3%), abortion threat (0.3%) and pre-eclampsia (6%). Pregnancy was more associated with complications in the study group (p=0.05). Cesarean section was more used in the study group (28 patients versus 9 in the control group; p= 0.00). The main indications of cesarean section in the study group were macrosomia (11 patients), scar uterus (6 patients), sacroiliitis (4 SA patients), twin pregnancy (2 patients), and undetermined reasons (6 patients). Fetal presentation in the study group was the seat presentation (3%), top presentation (4%), face (2%), and forehead presentation (0.3%) with no significant difference with the control group. Complications of childbirth in the study group were hemorrhage of delivery (10.3%), cord widening (6.6%), perinatal asphyxia (4.9%), and dystocia (1.9%). However, no statistically significant differences were found between the two groups in the prevalence of complications of childbirth. During pregnancy, 5 patients were on salazopyrine, 2 on corticosteroids and, 1 on non-steroidal anti-inflammatories.Conclusion:Our study showed that pregnancies with rheumatic diseases were at increased risk of having maternal complications and adverse neonatal outcomes.Disclosure of Interests:None declared

Sign in / Sign up

Export Citation Format

Share Document