INTRODUCTION: Randomised controlled trials (RCTs) have informed guideline recommendations for the management of stable coronary artery disease (CAD). However, the real-world impact of contemporary guidelines and trials on practising physicians in the Asia-Pacific region remains uncertain. We aimed to evaluate the knowledge, attitudes and practices among cardiovascular physicians in the region regarding stable CAD management. METHOD: An anonymised cross-sectional electronic survey was administered to cardiovascular practitioners from the Asia Pacific, assessing 3 domains: 1) baseline knowledge on recent trials and society guideline, 2) attitudes towards stable CAD, and 3) case scenarios reflecting management preferences. Correlations among knowledge, attitudes and practice scores were assessed between physicians from developed and developing countries using Pearson correlation. RESULTS: Overall, 713 respondents from 21 countries completed the survey. The mean knowledge score was 2.90±1.18 (out of 4), with 37.3% of respondents answering all questions correctly, while 74.6% noted that guidelines have significant impact on their practice. Despite guidelines recommending optimal medical therapy, majority chose revascularisation (range 53.4- 90.6%) as the preferred strategy for the case scenarios. Practitioners from developed regions had higher knowledge scores and lower attitude scores compared to developing regions, while practice scores were similar in both groups. Weakly positive correlations were noted between knowledge, attitude and practice scores. CONCLUSION Variations exist in knowledge and attitudes towards guideline recommendations and correspondingly actual clinical practice in the Asia Pacific, with most practitioners choosing an upfront invasive strategy for the treatment of stable CAD. These differences reflect real-world disparities in guideline interpretation and clinical adoption.
Humans ; Coronary Artery Disease/therapy* ; Cross-Sectional Studies ; Practice Patterns, Physicians'/statistics & numerical data* ; Asia ; Health Knowledge, Attitudes, Practice ; Surveys and Questionnaires ; Male ; Practice Guidelines as Topic ; Female ; Attitude of Health Personnel ; Middle Aged ; Developing Countries

INTRODUCTION COVID-19 (coronavirus disease 2019), which is caused by the human severe acute respiratory syndrome coronavirus 2 (SARS-COV-2), has reached a pandemic level. As a novel disease, local epidemiologic data are important to determine high-risk age groups, as well as risk factors that contribute to mortality. This study is a retrospective cohort study of 182 COVID-19–positive patients confirmed by real-time polymerase chain reaction. Baseline demographics and data on the preexisting cardiovascular comorbidities of 182 COVID-19 patients were collected by chart review and underwent statistical analysis using STATA 14 software (StataCorp, College Station, Texas). In the study, the majority of COVID-19 patients were 61 years or older (44.5%), with a higher prevalence of individuals 61 years or older among those who died (68.4%) compared with survivors (38.2%) (P = 0.005). In terms of gender, half of the patients were male (57.7%). In terms of cardiovascular disease, the most prevalent was hypertension (48.3%), followed by diabetes (28.0%). The prevalence of coronary artery disease (CAD) was significantly higher among patients who died (15.8%) compared with survivors (2.8%) (P = 0.022). In the univariate logistic regression analysis, older age was significantly associated with increased odds for mortality (odds ratio, 1.06; 95% confidence interval, 1.03–1.09). In terms of comorbidities, having CAD was significantly associated with increased odds for mortality (odds ratio, 6.6; 95% confidence interval, 1.7–24.6). Other variables were not significantly associated with mortality. In our study, advanced age and the presence of underlying CAD have been associated with an increased risk of in-hospital mortality among COVID-19 patients.
Cardiovascular Diseases ; COVID-19 ; mortality ; Sex

Background: Cardiovascular disease is the leading cause of death in both genders worldwide. Gender differences in clinical presentation and treatment have been reported. Objective: This study aims to describe and compare the cardiovascular risk factors and management strategies for primary prevention among Filipinos. Methods: An analytical cross-sectional study was done on 2,082 patients at the Preventive Cardiology Clinic of a tertiary referral center in Quezon City, Philippines from January 1, 2002 to December 31, 2017. Results: Seventy-two percent of the patients were females with a higher mean age compared to males (57.67 + 10.50 vs 55.66 + 11.82, p 0.002). There were more women who were unemployed (75.2 vs 45.9, p<0.001). There was no significant difference in the prevalence of hypertension (68.6% vs 67.9%, p=0.542) and type 2 diabetes mellitus (19.8% vs 21.5%, p=0.437) in both genders. Beta blockers (24.1%), calcium channel blockers (22.9%) and angiotensin receptor blockers (22.1%) were the most commonly prescribed anti-hypertensive drugs. Biguanides were the most commonly prescribed glucose-lowering drug (11.3%). Compared to men, more women had dyslipidemia (51.8% vs 38.6%, p<0.001). Statins were more commonly prescribed in women (22.4 vs 18.1%, p=0.033). Conclusion There were significantly more women seen in our Preventive Cardiology clinic. Smoking and alcoholic drinking were higher in males. BMI, total cholesterol and HDL were significantly higher in females than in males.
Sex Characteristics ; Heart Disease Risk Factors ; Primary Prevention ; Preventive Medicine

INTRODUCTION: A vast number of COVID-19 cases have been reported worldwide since the initial outbreak in China, and the disease has since become a global pandemic. Knowledge on this predominantly respiratory illness is evolving with studies suggesting myocardial injury reflected by elevated cardiac enzymes portending to more severe disease. CT scoring indices provide visual, semi-quantitative assessment of lung involvement and have aided in determining extent of COVID-19 pneumonia but, none have been validated for prognostication. Establishing a relationship between these non-invasive diagnostic parameters could provide timely identification and proper allocation of limited medical resources to patients in need of more aggressive therapy. METHODS AND RESULTS: A total of 50 COVID-19 patients were retrospectively enrolled and their clinical parameters collected from an electronic medical database. There was a total of 31 patients with troponin I-HS with chest CT scan done and another 42 patients for NT-proBNP and chest CT. The levels of both cardiac biomarkers in patients with clinically severe COVID pneumonia were higher than those with mild and moderate disease. Rank-order analysis showed that both troponin I-HS (moderate, p=0.0003174) and NT-proBNP (moderate, p=0.006255) correlated positively with CT severity scores. Furthermore, there is a significant relationship between mortality and septic shock with both Troponin I-HS (p<0.001; p=0.002) and NT-proBNP (p=0.004; p=0.031). CONCLUSION The cardiac markers troponin I-HS and NT-proBNP increased significantly at more severe CT scores and more notably, these biomarkers predicted the development of septic shock and mortality in COVID-19 pneumonia.
COVID-19 ; NT-proBNP ; pro-brain natriuretic peptide (1-76) ; Troponin I

BACKGROUND. Acute myocardial infarction (AMI) among young people is relatively uncommon. The protection offered by a young age has been slowly taken away by the increased prevalence of risk factors for CHD in adolescents such as smoking, obesity, and lack of physical activity. CASE. This is a case of a 23-year-old male smoker with no known comorbid and heredofamilial diseases who was admitted due to sudden onset of severe, stabbing, substernal chest pain. ECG was done which showed sinus rhythm with some premature ventricular depolarizations occurring in bigeminy, and ST elevation on V4-V6, I and AVL with reciprocal ST depression on III, AVF (Fig 2) consistent with extensive anterior wall myocardial infarction. Troponin I was elevated (7.57 ng/ml). Coronary angiography was done revealing a luminal filling defect at the distal segment of the left main artery consistent with thrombus formation. The patient underwent percutaneous coronary intervention of the left main artery and left anterior descending artery with TIMI III flow after the procedure. He was then discharged improved and was advised to take his home medications with good compliance CONCLUSION. MI in younger patients does carry a better prognosis if appropriately treated to be taken into consideration when treating these young adults presenting with MI. Emphasis on the importance of secondary preventive measures should be noted.
Coronary Angiography ; Percutaneous Coronary Intervention ; Myocardial Infarction ; Risk Factors

Introduction: In contrast to embolic events to the brain, lungs and spleen which have been comprehensively discussed in literature, acute limb ischemia (ALI) due to septic embolism (SE) from infective endocarditis (IE) are uncommonly reported. There have been no reported cases of ALI as a complication of IE among Filipinos to date making this case report the first in our country Case Presentation: We report two cases of communityacquired native valve endocarditis caused by streptococcus spp. and enterococcus faecalis. Both patients had large and mobile vegetations in the mitral valve and aortic valve respectively on transthoracic echocardiography. The first one developed ALI (IIa) on the R leg after the initiation of antibiotics. The second case presented with ALI (IIa) on the R leg on admission. They were given the appropriate antibiotics and received systemic anticoagulation with heparin. The first case underwent successful emergency embolectomy on the R leg but developed new-onset ALI on the L leg and refused further intervention. Embolectomy was also recommended on the second patient who also re-fused any intervention. Despite maximal medical management, both patients subsequently expired Conclusion Infective endocarditis (IE) patients are at risk to develop SE before or during the initiation of appropriate antibiotics. ALI is a life threatening extra cardiac complication of IE. Early recognition and prompt aggressive management are therefore imperative.
Endocarditis

Introduction: Single coronary artery and coronary artery fistulas are unusual findings either alone or in combination. They may be incidental findings or can present with myocardial ischemia. Case Presentation: A 46-year-old male had chest pain accompanied by heart failure symptoms. He sought consult in our institution where further workups revealed that he suffered an acute coronary syndrome. He underwent diagnostic coronary angiogram which showed significant coronary artery disease. There was also a single coronary artery with a coronary artery fistula. Patient was appraised regarding surgical revascularization and repair but did not consent. He was stabilized and improved on optimal anti ischemic therapy. Discussion: Electrocardiogram revealed ST elevation myocardial infarction of the anterior wall. Two dimensional echocardiogram showed depressed systolic function with an ejection fraction of 48% and multisegmental wall motion abnormalities. Coronary angiogram revealed a 70-80% stenosis of the mid portion of the left anterior descending artery. There is a fistulous vessel draining to the main pulmonary artery. The left circumflex is super dominant with an 80-90% stenosis at its termination and supplying the right coronary circulation. The right coronary artery was absent. Conclusion Coronary artery fistula in combination with a congenitally absent coronary artery is extremely rare. The presence of these abnormalities alone or in combination can exacerbate ischemia, complicate pre existing coronary artery disease and may cause ischemic cardiomyopathy. This case emphasizes the importance of integration of clinical as well as imaging modalities to diagnose this uncommon abnormality and in guiding clinicians for definitive management.

Introduction: There is currently a lack of validated tools that measure knowledge level as an outcome of the educational component of cardiac rehabilitation programs in our local setting. The researchers aim to culturally adapt and validate a questionnaire that was designed to assess patients’ knowledge about coronary artery disease and participation in cardiac rehabilitation programs, the second version of the Coronary Artery Disease Education Questionnaire (CADE-Q II). Methods: Qualified translators did two independent translations of the questionnaire. After back translation, the questions were reviewed and modified by a committee of experts. The final Filipino version was tested in a pilot study. For psychometric validation the tool was administered to 109 patients enrolled in a cardiac rehabilitation program. Criterion validity was assessed with regards to differences in educational attainment and patient characteristics. Spearman rank was used to correlate patient’s level of knowledge with number of sessions attended. Internal consistency was assessed by use of cronbach’s alpha. Results: The final version of the questionnaire had 30 questions arranged in five domains consisting of medical condition, risk factors, exercise, nutrition, and psychosocial risk. Patients who were college graduates had significantly higher mean scores than non college graduates. The number of cardiac rehab sessions attended had a weak but statistically significant correlation with knowledge. (spearman rho 0.35, p=0.007). The overall internal consistency of the questionnaire was good (α=0.75) Conclusion The CADE-Q II questionnaire cross culturally adapted in Filipino is a valid and reliable tool which can be used to assess Filipino patients’ knowledge about their disease when participating in cardiac rehabilitation programs.
Coronary Artery Disease ; Patient Education as Topic

BACKGROUND: Infective endarteritis of the pulmonary artery is an unusual event. While congenital heart disease (CHD) is a risk factor, pulmonary endarteritis as a complication is a rare occurrence especially in the era of antibiotic therapy.
CASE PRESENTATION: We present a case of a 43-year-old female who initially sought consultation due to fever. Physical examination revealed a continuous murmur at the second intercostal space left parasternal border. There was no petechiae or any other skin lesions noted. Transthoracic two dimensional echocardiogram showed eccentric left ventricular hypertrophy with an ejection fraction of 65%. She had a patent ductus arterioscus as well as a bicuspid aortic valve. Further interrogation revealed a vegetation at the main pulmonary artery. Patient was initially started on ceftriaxone and gentamycin. Blood cultures were positive for coagulase negative Staphylococcus aureus. Ceftriaxone was then shifted to vancomycin, which was completed for 28 days.
OUTCOME: Clinical improvement was accompanied by the disappearance of the vegetation and negative blood cultures. Patient was maintained on enalapril and advised closure of the patent ductus arteriosus. She opted medical management for the time being and was discharge stable and improved.
CONCLUSION: Pulmonary endarteritis is an uncommon complication of CHD. A high index of suspicion must prompt careful evaluation, combining clinical, laboratory and echocardiographic modalitites in order to provide early diagnosis and effective treatment.

Human ; Female ; Adult ; Anti-bacterial Agents ; Coagulase ; Ductus Arteriosus, Patent ; Echocardiography ; Endarteritis ; Heart Defects, Congenital ; Heart Valve Diseases ; Hypertrophy, Left Ventricular ; Pulmonary Artery ; Risk Factors ; Staphylococcus Aureus ; Vancomycin