INTRODUCTION

Secondary hypertension should be suspected among young individuals and patients with recent onset of hypertension or drug-resistant hypertension. Among the causes of secondary hypertension, renovascular hypertension is well-established and correctible if diagnosed appropriately. We report the case of a young female with an unusual cause of renovascular hypertension.

CLINICAL PRESENTATION:

A 29-year-old female was admitted for elevated blood pressure and headache, unresponsive to multiple antihypertensives. The workup for secondary hypertension was mostly unremarkable. However, renal Doppler ultrasound showed elevated peak systolic velocity in the left renal artery. CT angiogram revealed an outpouching between the left gonadal and renal veins. No renal artery stenosis was found on renal angiography, but venography revealed an aneurysm between the left gonadal and renal veins. An aberrant vein draining into the inferior vena cava (IVC) and severe reflux into a dilated left gonadal vein were also noted.

MANAGEMENTCONCLUSION

This case highlights a rare cause of renovascular hypertension due to renal vein congestion from severe left gonadal vein reflux and a renal/gonadal vein aneurysm. Additional mechanisms may include external compression of the renal artery or a suction effect caused by multiple venous outflows. Regardless of the exact pathophysiology, coiling of the aneurysm and gonadal vein successfully restored normal venous return and resolved hypertension.

Human ; Female ; Adult: 25-44 Yrs Old ; Veins ; Research Report ; Renal Veins ; Pharmaceutical Preparations ; Patients ; Hypertension, Renovascular ; Hypertension ; Female ; Aneurysm

INTRODUCTION

Dual antiplatelet therapy (DAPT) with aspirin plus P2Y12 receptor inhibitor has become a cornerstone in patients with coronary artery disease undergoing percutaneous coronary intervention (PCI) for the prevention of stent thrombosis. However, aspirin intolerance poses a problem in the lack of guideline-based alternatives with proven benefit. In this study, we aim to determine the efficacy and safety of cilostazol-based DAPT as an alternative treatment for aspirin among patients undergoing PCI.

METHODS

A comprehensive literature search was performed. All studies that investigated cilostazol as an alternative to aspirin on top of P2Y12 inhibitors for patients undergoing PCI were included. Outcomes of interest in this meta-analysis were reduction of major adverse cardiovascular events (MACE) and bleeding.

RESULTS

Three cohort studies including 1,227 patients on cilostazol and 1,480 on aspirin, both with a P2Y12 inhibitor were analyzed. Pooled estimates showed no significant difference in MACE (OR 1.32, 95% CI 0.79–2.23; p = 0.29) or acute myocardial infarction (OR 0.94, 95% CI 0.46–1.89; p = 0.85) between groups. However, cilostazol-based DAPT was associated with significantly less bleeding (OR 0.52, 95% CI 0.27–0.99; p = 0.05). All outcomes were statistically homogeneous (p>0.1, I²CONCLUSION

Cilostazol compared to aspirin, both on top of a P2Y12 receptor inhibitor, is as efficient in the reduction of MACE and acute myocardial infarction; and even safer in terms of bleeding. Cilostazol-based DAPT may serve as an alternative to standard DAPT among aspirin-intolerant patients undergoing PCI.

Human ; Male ; Female ; Cilostazol ; Percutaneous Coronary Intervention ; Hemorrhage ; Aspirin ; Angioplasty

INTRODUCTION

Early, high-quality cardiopulmonary resuscitation (CPR) improves survival in cardiac arrest. In the Philippines, guidelines specify chest compression depth, but challenges like fatigue and limited staff affect outcomes. This has led to interest in devices like the LUCAS, a portable, battery-powered machine that provides consistent compressions. This study evaluates the clinical profile, outcomes and risks of patients treated with LUCAS at a private tertiary hospital in the Philippines.A

METHODS

This retrospective cohort study was conducted at a private tertiary hospital, reviewing records of patients who received LUCAS-assisted compressions (March 2023–September 2024) and manual compressions (March 2023–January 2024) based on inclusion criteria.

RESULTS

Out of the 188 cases, 63 patients received mechanical cardiopulmonary resuscitation (mCPR) and 122 received manual compressions. Demographics were similar between the groups with notable differences in hypertension and coronary artery disease prevalence. The causes of arrest varied: arrhythmias and cardiogenic shock were more common in the mCPR group, while septic shock and COVID-19 were predominant in the manual compression group. The mCPR group showed higher survival rates, improved rhythm recovery and lower asystole rates. However, no significant differences in long-term survival or other vital signs were observed between the groups.

DISCUSSION AND CONCLUSION

The study suggests mCPR may improve immediate outcomes, particularly in cases of arrhythmias and cardiogenic shock, though long-term effects remain unclear. Chest fractures were commonly observed in LUCAS recipients. As the first Philippine study on mechanical CPR, it highlights potential benefits and underscores the need for further research on its risks and broader applications.

Human ; Male ; Female ; Asian ; Heart Arrest ; Cardiopulmonary Resuscitation ; Thorax

INTRODUCTION

Dual antiplatelet therapy (DAPT) with aspirin plus P2Y12 receptor inhibitor has become a cornerstone in patients with coronary artery disease undergoing percutaneous coronary intervention (PCI) for the prevention of stent thrombosis. However, aspirin intolerance poses a problem in the lack of guideline-based alternatives with proven benefit. In this study, we aim to determine the efficacy and safety of cilostazol-based DAPT as an alternative treatment for aspirin among patients undergoing PCI.

METHODS

A comprehensive literature search was performed. All studies that investigated cilostazol as an alternative to aspirin on top of P2Y12 inhibitors for patients undergoing PCI were included. Outcomes of interest in this meta-analysis were reduction of major adverse cardiovascular events (MACE) and bleeding.

RESULTS

Three cohort studies including 1,227 patients on cilostazol and 1,480 on aspirin, both with a P2Y12 inhibitor were analyzed. Pooled estimates showed no significant difference in MACE (OR 1.32, 95% CI 0.79–2.23; p = 0.29) or acute myocardial infarction (OR 0.94, 95% CI 0.46–1.89; p = 0.85) between groups. However, cilostazol-based DAPT was associated with significantly less bleeding (OR 0.52, 95% CI 0.27–0.99; p = 0.05). All outcomes were statistically homogeneous (p>0.1, I²CONCLUSION

Cilostazol compared to aspirin, both on top of a P2Y12 receptor inhibitor, is as efficient in the reduction of MACE and acute myocardial infarction; and even safer in terms of bleeding. Cilostazol-based DAPT may serve as an alternative to standard DAPT among aspirin-intolerant patients undergoing PCI.

Human ; Male ; Female ; Cilostazol ; Percutaneous Coronary Intervention ; Hemorrhage ; Aspirin ; Angioplasty

INTRODUCTION

Early, high-quality cardiopulmonary resuscitation (CPR) improves survival in cardiac arrest. In the Philippines, guidelines specify chest compression depth, but challenges like fatigue and limited staff affect outcomes. This has led to interest in devices like the LUCAS, a portable, battery-powered machine that provides consistent compressions. This study evaluates the clinical profile, outcomes and risks of patients treated with LUCAS at a private tertiary hospital in the Philippines.A

METHODS

This retrospective cohort study was conducted at a private tertiary hospital, reviewing records of patients who received LUCAS-assisted compressions (March 2023–September 2024) and manual compressions (March 2023–January 2024) based on inclusion criteria.

RESULTS

Out of the 188 cases, 63 patients received mechanical cardiopulmonary resuscitation (mCPR) and 122 received manual compressions. Demographics were similar between the groups with notable differences in hypertension and coronary artery disease prevalence. The causes of arrest varied: arrhythmias and cardiogenic shock were more common in the mCPR group, while septic shock and COVID-19 were predominant in the manual compression group. The mCPR group showed higher survival rates, improved rhythm recovery and lower asystole rates. However, no significant differences in long-term survival or other vital signs were observed between the groups.

DISCUSSION AND CONCLUSION

The study suggests mCPR may improve immediate outcomes, particularly in cases of arrhythmias and cardiogenic shock, though long-term effects remain unclear. Chest fractures were commonly observed in LUCAS recipients. As the first Philippine study on mechanical CPR, it highlights potential benefits and underscores the need for further research on its risks and broader applications.

Human ; Male ; Female ; Asian ; Heart Arrest ; Cardiopulmonary Resuscitation ; Thorax

BACKGROUND AND OBJECTIVE

COVID-19 has been associated with cardiac injury, often detectable through electrocardiographic (ECG) changes. This study seeks to characterize the cardiovascular and electrocardiographic profiles of adult patients diagnosed with COVID-19.

METHODS

This study included adult patients with confirmed COVID-19 from June 2021 to June 2022. Clinical profiles and 12-lead ECG tracings were obtained from electronic medical records and reviewed independently by three cardiologists. Descriptive analysis was performed to summarize the cardiovascular and electrocardiographic findings in this population.

RESULTS

The study included 998 COVID-19 patients (mean age: 50 years; 53.7% male). The most common comorbidities were hypertension, diabetes, and dyslipidemia. A majority (31.36%) presented with severe COVID-19 infection. The most frequent significant ECG abnormalities observed at admission were sinus tachycardia (22.8%), and atrial fibrillation (11.02%). Additional ischemic findings included ST segment depression (2.91%), T-wave inversion (1.70%), and ST segment elevation (2.71%).

CONCLUSION

The baseline ECG findings among COVID-19 patients were predominantly normal; however, significant abnormalities were also identified. The most frequent abnormalities included sinus tachycardia, atrial fibrillation, and ischemic changes, all of which may have clinical implications.

Human ; Coronavirus Disease 19 ; Covid-19 ; Electrocardiography ; Atrial Fibrillation

BACKGROUND AND OBJECTIVE

COVID-19 has been associated with cardiac injury, often detectable through electrocardiographic (ECG) changes. This study seeks to characterize the cardiovascular and electrocardiographic profiles of adult patients diagnosed with COVID-19.

METHODS

This study included adult patients with confirmed COVID-19 from June 2021 to June 2022. Clinical profiles and 12-lead ECG tracings were obtained from electronic medical records and reviewed independently by three cardiologists. Descriptive analysis was performed to summarize the cardiovascular and electrocardiographic findings in this population.

RESULTS

The study included 998 COVID-19 patients (mean age: 50 years; 53.7% male). The most common comorbidities were hypertension, diabetes, and dyslipidemia. A majority (31.36%) presented with severe COVID-19 infection. The most frequent significant ECG abnormalities observed at admission were sinus tachycardia (22.8%), and atrial fibrillation (11.02%). Additional ischemic findings included ST segment depression (2.91%), T-wave inversion (1.70%), and ST segment elevation (2.71%).

CONCLUSION

The baseline ECG findings among COVID-19 patients were predominantly normal; however, significant abnormalities were also identified. The most frequent abnormalities included sinus tachycardia, atrial fibrillation, and ischemic changes, all of which may have clinical implications.

Human ; Coronavirus Disease 19 ; Covid-19 ; Electrocardiography ; Atrial Fibrillation

Objective. Several studies showed that genetic factors affect responsiveness to statins among different populations. This study investigated the associations of candidate genetic variants with poor response to statins among Filipinos.

Methods. In this unmatched case-control study, dyslipidemic participants were grouped into statin responders and poor responders based on the degree of reduction in LDL-c from baseline. DNA from blood samples were genotyped and analyzed. The association of candidate variants with statin response was determined using chi-square and logistic regression analysis.

Results. We included 162 adults on statins (30 poor responders as cases, 132 good responders as controls). The following variants are nominally associated with poor response to statin among Filipinos at a per-comparison error rate of 0.05: rs173539 near CETP (OR=3.05, p=0.015), rs1800591 in MTTP (OR=3.07, p=0.021), and rs1558861 near the BUD13-ZPR1-APOA5 region (OR=5.08, p=0.004).

Conclusion. Genetic variants near CETP, MTTP and the BUD13-ZPR1-APOA5 region are associated with poor response to statins among Filipinos. Further study is recommended to test the external validity of the study in the general Filipino population.

Lipids ; Hydroxymethylglutaryl-CoA Reductase Inhibitors

Background. Low levels of high-density lipoprotein cholesterol (HDL-c) is a well-recognized risk factor in the development of cardiovascular diseases. Associated gene variants for low HDL-c have already been demonstrated in various populations. Such associations have yet to be established among Filipinos who reportedly have a much higher prevalence of low HDL-c levels compared to other races.

Objective. To determine the association of selected genetic variants and clinical factors with low HDL-c phenotype in Filipinos.

Methods. An age- and sex-matched case-control study was conducted among adult Filipino participants with serum HDL-c concentration less than 35 mg/dL (n=61) and those with HDL-c levels of more than 40 mg/dL (n=116). Genotyping was done using DNA obtained from blood samples. Candidate variants were correlated with the low HDL-c phenotype using chi-squared test and conditional logistic regression analysis.

Results. Twelve single nucleotide polymorphisms (SNPs) were associated with low HDL-c phenotype among Filipinos with univariate regression analysis. The variant rs1260326 of glucokinase regulator (GCKR) (CT genotype: adjusted OR=5.17; p-value=0.007; TT genotype: adjusted OR=6.28; p-value=0.027) remained associated with low HDL-c phenotype, together with hypertension and elevated body mass index, after multiple regression analysis.

Conclusion. The variant rs1260326 near GCKR is associated with low HDL-c phenotype among Filipinos. Its role in the expression of low HDL-c phenotype should be further investigated prior to the development of possible clinical applications.

Cardiovascular Diseases ; Dyslipidemias ; Genetics ; Polymorphism, Single Nucleotide

Rationale: Coronary artery disease (CAD) is the leading cause of death worldwide and coronary angiography (CA) remains the gold standard for its diagnosis. However, proper patient selection for CA is important to avoid unnecessary risks and expense. The American College of Cardiology (ACC), with other major organizations, developed Appropriate Use Criteria (AUC) for CA. AUC assist clinicians in decision making on whether to use the tests according to indications and objectively assess if these tests are appropriately utilized. This is the first study to determine the appropriateness of CA performed and the clinical and angiographic profile among adult service patients in UP-PGH. Objectives: To determine (1) the indications for CA and its appropriateness based on 2012 AUC for Diagnostic Catheterization by the ACC, (2) the clinical profile of patients who underwent CA among adult service patients at UP-PGH and (3) the angiographic profile of these patients. Methods: This cross-sectional study included all CA studies performed on adult service patients from January to December 2019. Demographic and clinical profiles, non-invasive tests, and angiographic findings were collected. The primary outcome determined was the appropriateness of the indications for each CA performed based on AUC scores. Descriptive analysis using frequencies and mean values with standard deviations were used. Results: Among the 515 patients included, majority were males, above 50 years of age, with normal eGFR, presented initially with chest pain, and with a presenting diagnosis of chronic coronary syndrome. Majority of these patients had obstructive CAD (75%), with left anterior descending artery as the most frequently involved vessel. Non-obstructive CAD was found in 11% while normal coronaries were noted in 14% of these patients. Our findings showed that 99.8% of the CA performed were appropriate, of which majority (54%) had an AUC score of A9. STEMI or a suspicion of STEMI, with an A9 score, was the most frequently encountered indication at 33% of the time. Conclusion Majority (99%) of the CA studies performed in the PGH cardiac catheterization laboratory for the year 2019 were executed based on highly appropriate indications (AUC scores A7 to A9) and followed Class I and II recommendations from guidelines. The allocation of resources is deemed to be well-utilized based on the data generated from this study.
Coronary Angiography ; Cardiac Catheterization