Cardiac involvement in sarcoidosis: Evolving concepts in diagnosis and treatment

Clinically evident cardiac involvement has been noted in at least 2 to 7% of patients with sarcoidosis, but occult involvement is much higher (> 20%). Cardiac Sarcoidosis (CS) is often not recognized as an antemortem, as sudden death may be the presenting feature. Cardiac involvement may occur at any point during the course of sarcoidosis and may occur in the absence of pulmonary or systemic involvement. Sarcoidosis can involve any part of the heart. The prognosis of CS is related to the extent and site(s) of involvement. Most deaths due to CS are due to arrhythmias or conduction defects, but granulomatous infiltration of the myocardium may cause progressive and ultimately lethal cardiomyopathy. The definitive diagnosis of isolated CS is difficult and the yield of Endomyocardial Biopsies (EMB) is low. Treatment of CS is often warranted even in the absence of histologic proof. Radionuclide scans are integral to the diagnosis. Gadolinium-enhanced cardiac magnetic imaging scans and 18Fluorodeoxyglucose (18FDG)-Positron Emission Tomography (PET) are the key imaging modalities to diagnose CS. The prognosis of CS is variable, but mortality rates of untreated CS are high. Randomized therapeutic trials have not been done, but corticosteroids (alone or combined with additional immunosuppressive agents) are the mainstay of therapy. Additionally, anti-arrhythmic agents and therapy for heart failure are often required. Because of the potential for sudden cardiac death, an Implantable Cardioverter-Defibrillator (ICD) should be placed in any patient with CS and serious ventricular arrhythmias or heart block and should be considered for cardiomyopathy. Cardiac transplantation is a viable option for patients with end-stage CS refractory to medical therapy.

Anthropometric indices as predictors of 10-year cardiovascular risk among Sub-Sahara Africans with type 2 diabetes

Background: Body mass index, waist circumference, waist-hip ratio and waist-height ratio are simple clinical tools for determining obesity. Type 2 diabetes mellitus is often associated with multiple cardiovascular risk factors and increased cardiovascular death. The study was aimed at determining the relationship between these anthropometric indices and 10-year cardiovascular risk among sub-saharan Africans with type 2 diabetes mellitus. Methods: It was a cross-sectional study involving 67 adults (with 50.7% females) managed for type 2 diabetes mellitus in a referral hospital in Nigeria. Ethical approval was obtained at the institution review board and the participants also gave written consent. Anthropometric indices were determined using standard protocols. Fasting lipid profile, fasting plasma glucose, glycated haemoglobin and plasma creatinine were assayed using standard laboratory techniques. Atherogenic index of plasma, estimated glomerular filtration rate and the WHO-ISH cardiovascular risk score were also determined. Data was analyzed with SPSS version 22. Pearson correlation coefficient, Students’ t test, Chi square test, ROC curve analysis were performed as appropriate. Results: The mean age was 54.12±9.03 years. Obesity was found in 37.3%, 66.5%, 70.1% and 95.5% of the participants using BMI, WHR, WC and WHtR respectively. Intermediate/high cardiovascular risk was found in 38.2% and 24.2% of the males and females respectively. BMI and WC significantly correlated with blood pressure. There was no significant correlation between anthropometric indices and other cardiovascular risk factors studied. Using ROC curve analysis, BMI and WHtR had the highest AUC of 0.613 and 0.577 respectively. Conclusion: Among sub-sahara Africans with type 2 diabetes mellitus, there is a significant association between WC and BMI with the blood pressure. BMI and WHtR have the highest 10-year cardiovascular risk predictability among the anthropometric indices in this cohort of individuals. Larger and prospective studies are needed to validate these findings.

Impaired cardiopulmonary test performance as a marker of early functional impairment in patients with Anderson-Fabry disease

Anderson-Fabry disease (AFD) is an X-linked lysosomal storage disease characterized by progressive glicosphingolipid accumulation in multiple organs, due to α-galactosidase a deficiency [1]. It is considered a rare disease although newborn genetic screening showed non-negligible prevalence (∼1:3.900) [1]. Cardiac manifestations include progressive Left Ventricular (LV) Hypertrophy (LVH), which may be extreme and provoke both reduced stroke volume and dynamic LV outflow tract obstruction [2-6].

A Twin-Herbal Combination was found to have Cardio-Vascular Protection Effects after repeated RCTs on four groups of patients with Different Disease Background A Cross-Biostatical Study

Background and Objective: To perform an integrated Cross-Biostatical analysis of four randomized controlled trials (RCTs) to assess the efficacy and safety of oral administration of D&G capsule (D&G) for the maintenance of cardiovascular health.