Predicting outcomes in patients with low ejection fraction undergoing coronary artery bypass graft.

Introduction: Reduced left ventricular ejection fraction (LVEF) is a well-known predictor of adverse events after cardiac surgery. We aimed to assess the outcomes in patients with low LVEF undergoing coronary artery bypass graft. Methods: In this retrospective cohort, we included all patients with left ventricular ejection fraction ≤ 40 who underwent coronary artery bypass grafting between March 2007 and March 2016 (with a median follow-up of nine years) at Tehran Heart Center. Demographics and clinical characteristics were extracted from the data registry. Akaike information criterion (AIC) was used. The univariate Cox regression was performed. We investigated the predictors of mortality and major adverse cardiac and cerebrovascular events (MACCE) using Cox multivariable regression. Results: In total, 5,532 cases (79 % male) with a mean age of 65.58 were included in the study. The nine-year overall survival was calculated at 68 %, and more than half of the patients had MACCE (55 %). In adjusted multivariable Cox regression analysis, moderate to severe mitral valve regurgitation, glomerular filtration rate ≤ 60, mild right ventricular dysfunction, and valvular heart disease independently predicted higher mortality. The abovementioned predictors and peripheral vascular disease significantly increased MACCE. Conclusion: Our study indicates the clinical significance of mitral regurgitation, valvular heart disease, and renal function in patients with low ejection fraction treated by coronary artery bypass grafting surgery. Identifying predictors of adverse events can help with clinical decision-making and risk stratification, ultimately improving patient outcomes.

A randomized clinical trial on the antitumoral effects of low molecular weight heparin in the treatment of esophageal cancer.

The current treatment approaches for esophageal cancer are associated with poor survival, and there are ongoing efforts to find new and more effective therapeutic strategies. There are several reports on the antitumoral effects of low-molecular-weight heparins (LMWHs). We have assessed the possible survival benefit of LMWHs in esophageal malignancies. This was a randomized, single-blind, multicenter, Phase II clinical trial on nonmetastatic esophageal cancer candidate for neoadjuvant chemoradiotherapy. Patients were randomly assigned to the chemoradiotherapy-only arm or chemoradiotherapy plus enoxaparin arm using 1:1 allocation. Radiotherapy was delivered in 1.8-Gy daily fractions to a dose of 50.4 Gy in both groups. Paclitaxel 50 mg/m2 and carboplatin (AUC 2) were administered weekly, concurrent with radiotherapy. In the intervention group, patients received enoxaparin (40 mg) and chemoradiation daily. 4-6 weeks after treatment, all patients underwent esophagectomy. After a median follow up of 7 months, estimated 1 year disease-free survival (DFS) in the intervention group was 78.9% and was 70% in the control groups ( p = 0.5). Toxicity from the experimental treatment was minimal, and there were no treatment-related deaths. A pathologically complete response in intervention and control group was 64.8% and 62.5%, respectively ( p = 0.9). There was a nonsignificant trend toward improved survival by the addition of enoxaparin to the concurrent chemoradiotherapy regimen. However, 1 y DFS of both groups were high as expected. A longer follow-up and a larger sample size are required.

Anti-tumoral effects of low molecular weight heparins: A focus on the treatment of esophageal cancer.

Esophageal cancer is one of the most prevalent types of cancer globally. With current treatment options, the survival is poor, and there are ongoing efforts to find new and more efficient therapeutic approaches. There are several reports on the anti-tumoral effects of low-molecular-weight heparins (LMWH). We have assessed the possible survival benefits and underlying mechanisms of LMWHs in malignancies with a focus on esophageal cancer. We conclude that the effects of LMWHs on survival of cancer patients is probably due to a combination of direct anti-tumoral, anti-angiogenic, and immunomodulatory effects and indirect effects on the coagulation system.

Anthropometric indices of obesity and the prediction of cardiovascular risk factors in an Iranian population.

The prevalence of hypertension, diabetes, dyslipidemia, and metabolic syndrome are increasing globally. The present study was conducted in an attempt to define optimal cutoff values for several anthropometric variables in an Iranian population, as these may vary with ethnicity. Iranian subjects (2483 men and 2445 women), aged 15-65 years, were recruited using a cluster-stratified sampling method from rural and urban areas within the Khorasan province. Receiver operating characteristics (ROC) analysis was used to define optimal anthropometric cutoff values. The prevalence of hypertension, diabetes, dyslipidemia, and metabolic syndrome were 28, 5.5, 67, and 39.9%, respectively. The gender-specific cutoff values for waist:height ratio to predict hypertension, diabetes, dyslipidemia, and metabolic syndrome among men were 0.52 (sensitivity = 66%; specificity = 66%), 0.54 (sensitivity = 65%; specificity = 65%), 0.50 (sensitivity = 58%; specificity = 57%), and 0.53 (sensitivity = 73%; specificity = 70%), and for women were 0.59 (sensitivity = 61%; specificity = 61%), 0.61 (sensitivity = 64%; specificity = 64%), 0.57 (sensitivity = 61%; specificity = 61%), and 0.59 (sensitivity = 77%; specificity = 77%) (p < 0.05). Significant correlations were found between waist:height ratio and hypertension, diabetes mellitus, dyslipidemia, and metabolic syndrome, particularly in women. Waist circumference cutoffs were higher for women than men for hypertension, diabetes mellitus, and dyslipidemia.