Background
Cirrhotic cardiomyopathy remains under-recognized in Southeast Asia, where chronic viral hepatitis and alcohol-related liver disease frequently coexist. The prognostic relevance of the updated 2020 Cirrhotic Cardiomyopathy Consortium (CCC) criteria, particularly the use of global longitudinal strain (GLS), has not been adequately studied in this region.
Objectives
We aimed to characterize cardiac dysfunction in Myanmar patients with cirrhosis, compare the diagnostic performance of the 2005 and 2020 CCM criteria, and determine cardiac predictors of 1-year mortality.
Methods
In this prospective cohort study, 200 consecutive cirrhotic patients underwent comprehensive echocardiography with speckle-tracking analysis and standard electrocardiography. The primary endpoint was all-cause mortality at 12 months. Multivariable Cox regression was used to identify independent predictors of death.
Results
The mean age was 54±11 years. Alcohol-associated liver disease (35%), hepatitis C (30%), and hepatitis B (25%) were the predominant etiologies. Although left ventricular ejection fraction was preserved, GLS was frequently impaired (mean −16.2±3.4%). The 2020 CCC criteria identified cirrhotic cardiomyopathy in 28% of patients compared with 54% by the 2005 criteria. Thirty patients (15%) died during follow-up. GLS <16% (HR 2.10, p<0.001) and QTc prolongation >440 ms (HR 1.75, p=0.018) were independently associated with mortality after adjustment for MELD score.
Conclusions
Subclinical myocardial dysfunction is common among Myanmar patients with cirrhosis. The 2020 CCC criteria demonstrate improved prognostic discrimination. Both impaired GLS and QTc prolongation independently predict mortality and should be incorporated into routine risk stratification.
Swe Min Oo, Myint Zaw, Tun Naing Oo et al.· International Journal of Med...· 0 citations
Background Cardiovascular disease is the leading cause of mortality among End-Stage Renal Disease (ESRD) patients in Southeast Asia. While left ventricular function is routinely assessed, the prognostic significance of right ventricular (RV) dysfunction remains critically understudied in Myanmar.
Objectives To determine the prevalence of RV dysfunction in maintenance hemodialysis patients and evaluate its independent association with a composite risk of one-year all-cause mortality and cardiovascular hospitalization.
Methods This prospective observational cohort study enrolled 200 adult ESRD patients. To minimize volume loading artifacts, comprehensive post-dialysis transthoracic echocardiography was performed. RV function was assessed using Tricuspid Annular Plane Systolic Excursion (TAPSE), RV Fractional Area Change, and Tissue Doppler Systolic Velocity. The primary composite endpoint evaluated 12-month all-cause mortality and decompensated heart failure hospitalization.
Results The cohort (mean age 53.1±12.4 years; 62% male) exhibited a 41.3% prevalence of RV dysfunction (TAPSE < 17 mm). Over a 12-month median follow-up, the primary endpoint occurred in 26.7% of patients. Non-survivors presented with significantly lower TAPSE (13.8±3.1 vs. 18.9±4.2 mm, p<0.001) and serum albumin. Kaplan-Meier analysis indicated significantly reduced event-free survival for patients with RV dysfunction (p<0.001). Following multivariable Cox regression adjustment for age, LVEF, dialysis vintage, and nutritional status, TAPSE < 17 mm remained a strong independent predictor of the composite outcome (HR: 2.38; 95% CI: 1.55-3.72; p<0.001).
Conclusions Despite overall mortality being lower than historical national averages, RV dysfunction was an independent predictor of adverse cardiovascular outcomes in this optimized hemodialysis cohort.
Swe Min Oo, Myint Zaw, Tun Naing Oo et al.· International Journal of Med...· 0 citations
Background
Myocardial bridging (MB) is a congenital anomaly where an epicardial coronary artery tunnels intramuscularly. Though traditionally considered a benign variant, its clinical relevance remains controversial, particularly regarding the risk of early hospital readmission and symptom burden in patients with non-obstructive coronary artery disease.
Methods
We conducted a retrospective cohort study at a 700-Bedded Hospital in Pyin Oo Lwin, reviewing 600 consecutive diagnostic coronary angiograms performed from January 2021 to December 2024. Patients with isolated MB—defined as systolic compression of 50% or greater without concomitant atherosclerosis—were evaluated against a propensity-matched control group. The primary endpoint was the incidence of Major Adverse Cardiovascular Events (MACE) at 12 months.
Results
Isolated MB was identified in 21 patients (3.5% prevalence). The cohort was predominantly male (81%) with a mean age of 49 ± 11 years. The left anterior descending artery was involved in 95% of cases. At 12 months, the MB group exhibited a significantly higher MACE incidence compared to controls (14.3% vs. 2.4%; p=0.04). Crucially, this difference was driven entirely by recurrent hospitalizations for unstable angina (14.3% vs. 2.4%; p=0.03). There were zero cases of cardiovascular death, non-fatal myocardial infarction, or revascularization. Multivariable Cox regression identified bridge length exceeding 25 mm as an independent predictor of symptom recurrence.
Conclusions
Isolated MB demonstrates excellent short-term survival but notable morbidity. The high rate of recurrent angina requiring hospitalization within one year indicates routine reassurance is insufficient. Symptomatic patients necessitate optimized medical therapy and close monitoring to effectively prevent early readmissions.
Swe Min Oo, Myint Zaw, Tun Naing Oo et al.· International Journal of Med...· 0 citations
Background
Rapid central venous access is essential in the management of cardiogenic shock. Although ultrasound-guided internal jugular vein cannulation is widely recommended, landmark-guided subclavian venous access remains necessary during emergency resuscitation when ultrasound guidance is not feasible. The optimal laterality for landmark-guided subclavian cannulation remains uncertain.
Objectives
Our Objectives are to compare the incidence of catheter malposition and complications between left- and right-sided landmark-guided subclavian venous cannulation in critically ill patients with cardiogenic shock in the coronary care unit.
Methods
We conducted a retrospective cohort study including 150 adult patients who underwent emergent landmark-guided subclavian venous catheterization in the coronary care unit. The primary outcome was catheter malposition confirmed by post-procedure chest radiography. Secondary outcomes included pneumothorax, arterial puncture, and hematoma formation.
Results
Among 150 patients, 72 underwent left-sided cannulation and 78 underwent right-sided cannulation. Catheter malposition occurred significantly more frequently following right-sided cannulation compared with left-sided cannulation (12.8% vs 2.8%; p = 0.03), corresponding to an approximately 4.6-fold higher risk of malposition. Mechanical complication rates were low and did not differ significantly between groups.
Conclusions
Right-sided landmark-guided subclavian cannulation was associated with a higher incidence of catheter malposition compared with the left-sided approach. The anatomical course of the left brachiocephalic vein may facilitate more reliable catheter placement during emergency central venous access.
Swe Min Oo, Myint Zaw, Tun Naing Oo et al.· International Journal of Med...· 0 citations
We use cookies to run the site and, with your consent, for analytics and to show ads.
See our Cookie Policy.
