Background: After successful pulmonary vein isolation (PVI) for atrial fibrillation (AF), the left atrium (LA) undergoes reverse remodeling. However, few studies have directly studied pulmonary vein (PV) remodeling and focused on whether pre PVI-PV conditions could predict outcome of the procedure. We hypothesize that: (I) post PVI, in addition to LA remodeling the PVs undergo a parallel degree of remodeling; and (II) that PV characteristics pre PVI can be used to identify patients more likely to sustain normal sinus rhythm (NSR).Methods: Patients (n=100) scheduled for PVI had a cardiovascular magnetic resonance (CMR) imaging before and 6±2 months following PVI. PV cross sectional areas (CSA) within 0.5 cm of the ostium and LA volumes were measured. Patients were categorized as responders (R) or non-responders (NR), based on two separate 14-day Holter monitoring.Results: PVs CSA were significantly reduced post procedure in both groups, R (233±53 to 192±52 mm 2 , P<0.001) and NR (241±54 to 207±44 mm 2 , P<0.001), however, the difference between R and NR post PVI was not significant (192±52 to 207±44 mm 2 , P=0.19). Reduction in PVs CSAs post procedure moderately correlated with the 3D LA volume reduction (r=0.48, P<0.001).Conclusions: PVs mirror the LA in that they significantly change in size following PVI yet they were not found to directly predict maintenance of NSR.
Cardiac masses are divided into neoplastic and non‐neoplastic. They usually represent a diagnostic challenge given their relative rarity, their infrequent symptoms, and the overall difficulty with dynamic imaging of the heart. While echocardiography is useful in the initial evaluation of a suspected mass, cardiac magnetic resonance (CMR) imaging is the best imaging modality to characterize cardiac tumors due to its superior tissue characterization and its higher contrast resolution. For neoplastic, primary cardiac tumors are rare (0.05%). Atrial myxoma is the most common cardiac (50%) mass. About 75%‐80% of myxoma are seen in the left atrium. Atypical myxoma is a term describing myxoma arising in other nonleft atrial locations. 20%‐25% myxomas arise from the right atrium and 5% or less from the ventricles. We present a case of a 59‐year‐old female patient presenting with severe dyspnea. Her chest noncontrast CT showed a calcified mass lesion in the right atrium extending into the inferior vena cava. She underwent cardiac MRI for better tissue characterization. The cardiac MRI revealed a very irregular, highly spiculated, heavily calcified, heterogeneous, and nonenhancing lesion within the right atrium extending into the inferior vena cava. Via dynamic imaging, no evidence of mobile components was present. Via T1, T2 along with pre‐ and postcontrast imaging, the mass was confirmed to be calcified without a fibrotic component or evidence of thrombus. The above findings raised the possibility of atypical myxoma.
Background Myocarditis is a highly heterogeneous disorder with a challenging diagnostic work-up. We aimed to focus on the possible diagnostic workup for this condition in settings where endomyocardial biopsy as a gold standard is not always feasible, detect the etiologic cardiotropic viruses in our locality, and follow the clinical course in patients admitted with clinically suspected myocarditis. Methods This is a prospective observational study. We recruited patients with clinically suspected myocarditis presenting at a university hospital from October 1st, 2020 until March 31st, 2021. All Patients had a diagnostic coronary angiography and were included only if they had a non-obstructive coronary artery disease. All patients also had cardiac magnetic resonance imaging (CMR) with contrast. Sera were obtained from all suspected patients for detection of antibodies against viruses using enzyme-linked immunosorbent assay, and viral genomes using polymerase chain reaction (PCR), and reverse transcription–PCR. Endomyocardial biopsy was done for patients with a typical CMR picture of myocarditis. Results Out of 2163 patients presenting to the hospital within the 6 months, only 51 met the inclusion criteria. Males represented 73%, with a mean age of 39 ± 16 years. CMR showed an ischemic pattern in 4 patients and thus they were excluded. We classified patients into two categories based on CMR results: group A (CMR-positive myocarditis), 12 patients (25.5%), and group B (CMR-negative myocarditis), 35 (74.5%) patients. On serological analysis, 66% of patients (n = 31/47) showed antibodies against the common cardiotropic viruses. Parvovirus B19 IgM in 22 patients (47%) and coxsackievirus IgM in 16 (34%) were the most observed etiologies. Regarding the outcome, 42.5% of patients recovered left ventricular ejection fraction and three patients died at 6 months’ clinical follow-up. Conclusion Patients with Clinically suspected myocarditis represented 2.2% of total hospital admissions in 6 months. CMR is only a good positive test for the diagnosis of acute myocarditis. Parvovirus B19 and coxsackievirus were the most common pathogens in our locality. Trial registration: Clinical trial registration no., NCT04312490; first registration: 18/03/2020. First recruited case 01/10/2020. URL: https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0009O3D&selectaction=Edit&uid=U0002DVP&ts=2&cx=9zdfin.
Objectives: The current study aimed to detect the BOS prevalence and determinants among residents working during the second wave of the COVID-19 pandemic in an Egyptian tertiary university referral hospital. Methods: A cross-sectional study evaluating the working period from June to November 2020 during the COVID-19 pandemic second wave, through a five sections questionnaire evaluating: 1 − sociodemographic characteristics, 2 − job characteristics, 3 − negative thoughts related to their job, 4 − resident’s health problems, and 5 − evaluating BOS through Maslach Burnout Inventory (MBI) scale (including emotional exhaustion [EE], depersonalization [DP], and personal accomplishment [PA] as subscales). Results: We included 230 residents with a median age of 27 years. The median MBI sub-scales (IQ Range) values were 30.0 (20, 39), 21.0 (15, 30), and 29.5 (22, 36) for EE, DP, and PA, respectively. About 51.0% and 83.0% of the residents were high in EE and DP, while 8.7% were low in PA. The median EE and DP were higher in younger age (⩽27 years; p = .002 and .024), males ( p = .001 and <.001), working >90 hours weekly ( p = .016 and <.001), exposure to harassment ( p < .001), and having COVID-19 infection ( p = .002 and .001). Residents working in surgical departments reported higher DP scores than those in non-surgical departments ( p = .03). There was a mild positive correlation between working hours per week and the total scores in EE and DP, r = .24 ( p < .001) and r = .23 ( p = .001) respectively, while it was found to have a negative correlation with the PA ( r = −.133 and p = .044). Conclusions: The BOS is evident and considerably high among the residents working during the COVID-19 pandemic. Younger age, males, working in surgical departments, and those who got COVID-19 infection were most vulnerable.
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