Evaluation of the diagnostic value of the renal resistive index as a marker of the subclinical development of cardiorenal syndrome in MMVD dogs

Introduction: Myxomatous mitral valve disease (MMVD) in dogs inevitably causes renal dysfunction. These interactions are known as the cardiorenal syndrome (CRS). The main aims of the study were to evaluate whether renal resistive index (RRI) may be useful as a non-invasive marker in subclinical stage of kidney injury in dogs with MMVD and to compare RRI with SDMA and Cyst C. Methods: Forty-four dogs were divided into two groups: control—15 healthy dogs and the heart group—29 dogs with MMVD (ACVIM class Cc). Study protocol included: anamnesis, clinical examination, electrocardiography, echocardiography, chest radiography, abdominal ultrasonography with measurements of the renal resistive index (RRI), urine, and blood analysis. Results: The RRI in the heart group was significantly higher 0.725 ± 0.035 versus control group 0.665 ± 0.028 ( p < 0.00085). The RRI cut-off point in dogs with stable chronic heart failure (CHF) under 8 years is 0.775, in older 0.64. RRI was similar in MMVD dogs treated with ACE-I + furosemide and dogs treated ACE-I + torasemide + pimobendan + spironolactone. There was no correlation between RRI and SDMA or Cyst C. Conclusion: RRI is more sensitive than creatinine, SDMA and Cyst C to reveal kidney injury in MMVD dogs class Cc younger than 8 years.

Beating-heart versus conventional mitral valve replacement; a randomized clinical trial

Background: Various methods have been developed to overcome the deleterious effects of ischemia/ reperfusion injury that occurs after cardioplegic arrest. The aim of the study was to assess the safety, efficacy, and applicability of the beating-heart mitral valve replacement (MVR) compared to the conventional MVR. Methods: Forty patients scheduled for mitral valve replacement were randomly assigned into two groups, conventional MVR as the control group (n= 20) and beating-heart MVR with continuous antegrade coronary perfusion as the study group (n=20). Three patients in the beating-heart group were converted to the conventional technique because of the blood-flooded field and excluded from the analysis. Results: The preoperative clinical and echocardiographic variables were comparable between both groups. There was no significant difference between both groups regarding cardiopulmonary bypass time (79.4± 14 vs. 75.7± 10.9 minutes; p= 0.398) and total operative time (200± 55.6 vs. 183.9± 67.5 min; p= 0.458) in the conventional and beating-heart group, respectively. Serum troponin I level was significantly higher in the conventional MVR group 6 hours postoperatively (4.9±4 vs. 2.7±1.2 ng/ml; p= 0.036), while there was no significant difference between both groups regarding total CK and CK-MB (p= 0.565 & 0.597 respectively). Eight patients (44%) in the conventional MVR group needed inotropic support compared to 3 patients (19%) in the beating-heart MVR group (P = 0.11). There was no operative mortality or major morbidity in both groups. At 6-months follow-up, there was no difference in NYHA class (1.3±0.3 vs. 1.2±0.3; p= 0.336) and the ejection fraction (60.0±6.3 vs. 63.2±6 %; p= 0.139) in the conventional vs. beating-heart group. Conclusion: Beating-heart MVR is a safe alternative to the conventional method with comparable outcomes. There is a relatively blood-filled field compared to the conventional technique.

In-Hospital Outcomes and Trends of Tricuspid Valve Surgery in Heart Transplant Patients

Introduction: Tricuspid valve (TV) regurgitation is the most common valvular pathology after orthotopic heart transplant (OHT). The number of transplants being performed is increasing with patients living longer after heart transplant. Data on TV surgery in OHT recipients is limited. Methods: We sought to analyze the outcomes of patients undergoing TV surgery from a large diverse, multicentric, nationwide cohort using the Nationwide Inpatient Sample (NIS) database. Results:A total of 42,766 TV repair or replacement (bioprosthetic and mechanical) involving adult patients (age ≥18 years) between 2007 and September 2015 were identified. Of these, 366 were performed in patients with OHT. TV repair was the most common surgery performed in both groups (OHT group and native heart group). Compared to the native group, patients with OHT had a significantly higher incidence of cardiogenic shock (20 vs. 11%, p = 0.024), acute kidney injury (AKI) (59 vs. 30%, p < 0.001), and AKI requiring hemodialysis (13 vs. 4%, p < 0.001). Also, the mean length of stay for the index admission was significantly longer in the OHT group (27 vs. 17 days, p = 0.008). The mortality rate was similar between the two groups (7 vs. 8%, p = 0.753). The number of TV surgeries performed in OHT patients from 2007 to 2014 have remained stable (p = 0.803) compared to those in native heart patients which showed a significantly increasing trend (p = 0.019) during the same time period. Conclusions: TV surgery remains an important treatment modality among the OHT population and carries a similar mortality during index hospitalization as that in native heart patients undergoing TV surgery.

Relation of R-Spondin 3 Gene expression android obesity and Susceptibility to Cardiovascular disease in Sudanese Patients in Khartoum State.

Background: Obesity is a major risk factor for the development of cardiovascular disease. A growing database of clinical evidence implicates intra-abdominal adiposity as a powerful driving force for elevated cardiometabolic risk. Addressing intra-abdominal adiposity should play a central role in future strategies aimed at improving cardiovascular outcomes in patients with abdominal obesity and its associated cardiometabolic risk in Sudan. Several studies aimed to identify some factors controlling the size and function of different areas of fat. Our research is focusing on a particular gene called R-SPONDIN3, Objectives: It is to find the amount of R-Spondin3 Gene expression in Abdominal obesity and Susceptibility to Cardiovascular disease in Sudanese Patients in Khartoum State Material and methods: - The study was including 300 participants (156 males and 144 females) classified into three groups. The first group was including one hundred participants with abdominal obesity (obese), the second group was including one hundred participants already diagnosed with CVD entangled with obesity (Heart Group as positive control group), while the third group was include one hundred healthy lean volunteers (negative control group) Results: - The findings of this study showed Conventional PCR results were significantly different (P <0.001) in Heart group subjects as compared to healthy controls and obese group. Among heart group mutation was detected in some subjects (19%) and the rest without mutation (81%) but in obese group no mutation was detected. Comparison between the different studied groups according to gene expression showed significant differences (P <0.001) mean value of gene expression in healthy group subjects was 1.0 ± 0.0, Obesity group was 2.44 ± 0.50 and heart group subjects was 4.54 ± 0.87 respectively. Conclusion: The amount of R-SPONDIN3 gene expression among the obese and CVD patients is show up significant different and the amount of gene expressing among the CVD patients is higher than obese which is suggested that the amount of gene expressed in obese patients with heart disease more than obese patients without cardiovascular complications

Role of Roof plate-specific SPONDIN3 Mutation in the Determination of Obesity Phenotypes/Fat Distribution and Susceptibility to Cardiovascular disease in Sudanese Patients in Khartoum State

Background: Obesity is a major risk factor for the development of cardiovascular disease. A growing database of clinical evidence implicates intra-abdominal adiposity as a powerful driving force for elevated cardiometabolic risk (1). Addressing intra-abdominal adiposity should play a central role in future strategies aimed at improving cardiovascular outcomes in patients with abdominal obesity and its associated cardiometabolic risk in Sudan. Objectives: It is to find the mutation in R-SPONDIN3gene and its association to both of fat deposition around the abdomen and susceptibility to cardiovascular disease in Sudanese patients in Khartoum State. Material and methods: Conventional PCR was done to detect R- SPONDIN3 in 300 participants (males and females) classified into three groups. The first group will include one hundred participants with abdominal obesity, the second group will include one hundred participants already diagnosed with CVD entangled with obesity (positive control group), while the third group will include one hundred healthy lean volunteers (negative control group). Data was analyzed using SPSS Version 22 software. P value < 0.05 was considered as statistically significant. Results: In this study, the results of Conventional PCR were significantly different in (P <0.001) in Heart group subjects as compared to healthy controls and obese group. Comparison between the different studied groups according to gene expression showed significant differences (P <0.001) mean value of gene expression in healthy group subjects was 1.0 ± 0.0, Obesity group was 2.44 ± 0.50 and heart group subjects was 4.54 ± 0.87 respectively . Conclusion: clinically, detect R- SPONDIN3 mutation in patients with diagnosed with CVD entangled with obesity and amount of the gene expressed cleared different between obese and CVD subjects entangled with obesity. Keywords: R-SPONDIN3 gene, abdominal Obesity, CVD.

Early-Term Outcomes of Off-Pump versus On-Pump Beating-Heart Coronary Artery Bypass Surgery

Background The current study analyzed and compared early-term outcomes of off-pump versus on-pump beating heart coronary artery bypass surgery. Methods From January 2011 to January 2018, a total of 736 patients underwent isolated first-time elective beating-heart coronary artery bypass surgery without the use of aortic cross-clamping and cardioplegic arrest at our institution, and they were included in this study. Data of patients were collected and retrospectively analyzed. Patients were divided into two groups according to the use of cardiopulmonary bypass during the operation, as off-pump group (n = 399) and on-pump beating-heart group (n = 337). Both groups were compared with each other in terms of preoperative, intraoperative, and postoperative data. Results Groups were statistically similar with regard to baseline clinical characteristics and demographics. When compared with off-pump group, on-pump beating-heart group had a greater number of distal bypass, longer length of hospital stay, and lower postoperative hematocrit level, and received more blood product transfusion. No statistically significant differences were detected between the groups with respect to mortality and postoperative complications except for atrial fibrillation. Atrial fibrillation was significantly frequent in on-pump beating-heart group. Conclusion Our study suggested that off-pump and on-pump beating-heart coronary artery bypass procedures had similar early mortality and major complication rates except for atrial fibrillation. However, it seemed that off-pump procedure was superior to on-pump beating-heart procedure with regard to length of hospital stay, blood product transfusion, and atrial fibrillation development. Further prospective randomized studies with larger patient series are needed to support our research and attain more accurate data.

Clinical Outcome of CABG on Off-pump Beating Heart and On-pump Beating Heart: Experience in Ibrahim Cardiac Hospital & Research Institute (ICHRI)

Background: To avoid harmful effect of cardiopulmonary bypass (CPB) used in off-pump coronary artery bypass graft (CABG) surgery, cardiac surgeons are now inclined to on-pump beating heart surgery (ONBEAT). However, the superiority of ONBEAT over Off-pump has not yet been conclusively established. This study compares the outcomes between off-pump and on pump beating heart CABG surgery. Methods: A total 249 consecutive patients who underwent non-emergency, primary isolated CABG from January 2014 to December 2017 by a single surgeon were included. The selected patients were assigned to either OPCAB group (Patients who received Off-pump beating heart CABG surgery, n=193) or to ONBEAT group (patients who received On-pump beating heart CABG surgery, n=56). The clinical outcomes were investigated and compared. Result: Forty percent of the patients were in their 5th decade of life. A male predominance was also observed. The two study groups were almost identical in terms of age and sex (p=0.983 and p=0.153 respectively). None of the conventional risk factors of ischemic heart disease (smoking, diabetes, hypertension and dyslipidaemia) were any different between the study groups (p > 0.05). Cerebrovascular disease, recent MI, congestive heart failure and left main disease were significantly higher in the on-pump beating heart group compared to those in the off-pump beating heart group (p < 0.05). The left ventricular ejection fraction (LVEF) was significantly lower in the former group than that in the latter group (p= 0.007). Both groups required 3 grafts on an average. Two patients in the on-pump group required Intra-Aortic Balloon Pump (IABP) support as opposed to none in the off-pump group (p=0.050). The mean cardiopulmonary bypass (CPB) time was 105.8 ± 46.5 in the on-pump group. Fourteen patients (25%) from off-pump group needed urgent switching to on-pump group. Postoperative drainage in the first 24 hours was significantly voluminous in the on-pump group (p < 0.001). The incidence of pneumonia, respiratory failure, arrhythmia, renal failure requiring haemodialysis and perioperative MI were significantly higher in the on-pump group (p < 0.001, p < 0.001, p=0.037, p < 0.001 and p=0.050 respectively). The patients with prolonged mechanical ventilation were also more in the on-pump group. The left ventricular ejection fraction (LVEF) was much lower and Intensive Care Unit (ICU) stay was longer in the on-pump group compared to those in the off-pump group (p < 0.001). The incidence of in-hospital mortality was also higher in the former group (p=0.037). Conclusion: OPCAB was associated with lower operative morbidity compared to ONBEAT cardiac surgery. However, the increased morbidity in ONBEAT group might have been influenced by a sizable proportion of patients from OPCAB group being switched to ONBEAT group due to their haemodynamic deterioration and frequent ventricular fibrillation. But on-pump CABG can be performed safely on high risk patients. Use of cardiopulmonary bypass and elimination of cardioplegic arrest may be beneficial to hemodynamically unstable patients. Ibrahim Card Med J 2017; 7 (1&2): 15-22