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Intramyocardial dissecting hematoma: A systematic review and pooled analysis of available literature
Reihaneh Zavar1, Azam Soleimani2, Marzieh Tajmirriahi3
1Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
Insights
Older patients with intramyocardial dissecting hematoma (IDH) face a higher mortality risk. Diagnostic tools like angiography and cardiac MRI improve outcomes, while pericardial effusion worsens prognosis for IDH patients.
Area of Science:
- Cardiology
- Internal Medicine
- Pathology
Background:
- Intramyocardial dissecting hematoma (IDH) is a rare cardiac condition.
- Understanding its demographics, clinical features, management, and prognosis is crucial.
Purpose of the Study:
- To systematically review and pool data on intramyocardial dissecting hematoma.
- To analyze demographic characteristics, clinical findings, management, and prognosis.
Main Methods:
- Systematic search of PubMed, Scopus, and Web of Science databases up to February 2023.
- Pooled analysis of case reports and case series data.
- Statistical significance set at P < 0.05 using SPSS software.
Main Results:
- 77 patients with IDH were analyzed; mean age 58.7 years, 22.1% women.
- Increased mortality risk observed in older patients (OR=1.05, P=0.014).
- Angiography (OR=0.25, P=0.010) and cardiac MRI (OR=0.19, P=0.004) reduced mortality risk.
- Pericardial effusion diagnosis significantly increased mortality risk (OR=3.92, P=0.017).
Conclusions:
- Older age is associated with a poor prognosis in IDH.
- Angiography and cardiac MRI improve patient prognosis.
- Pericardial effusion is a significant risk factor for mortality in IDH patients.
Background:
The current systematic review and pooled analysis were conducted to answer several questions using findings from case reports and case series as follows: (1) Demographic characteristics; (2) clinical findings; (3) management approach; and (4) prognosis of individuals diagnosed with intramyocardial dissecting hematoma.
Methods:
Electronic databases, including PubMed (Medline), Scopus, and Web of Science, were systematically searched from the earliest available date up to February 2023 using selected keywords. All analyses were performed using SPSS software version 27 (IBM Corp, Armonk, NY, USA), and a P-value less than 0.05 was considered statistically significant.
Results:
A total of 77 patients diagnosed with Intramyocardial dissecting hematoma (IDH) comprised the study population, with a mean (standard deviation) age of 58.72 (13.99) years, of which 22.1% were women. Patients of higher age experienced a higher risk for mortality compared to younger subjects (OR=1.05, 95% CI: 1.01, 1.10; P=0.014). In addition, the implementation of angiography (OR=0.25, 95% CI: 0.08, 0.71; P=0.010) and cardiac magnetic resonance (OR=0.19, 95% CI: 0.06, 0.60; P=0.004) in the context of diagnosis reduced the risk of death compared to those who did not receive these interventions. Similarly, the diagnosis of pericardial effusion significantly increased the risk of mortality compared to those without pericardial effusion (OR=3.92, 95% CI: 1.27, 12.07; P=0.017).
Conclusion:
The authors found that older patients experience a poor prognosis compared to younger ones. In addition, the utilization of angiography and cardiac magnetic resonance improves the prognosis of individuals. Likewise, the diagnosis of pericardial effusion in patients with IDH increases the odds of mortality.
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