Illness perception and cardiovascular risk factors in patients with myocardial infarction undergoing percutaneous coronary intervention in Iran.

BACKGROUND: Knowing of perception of the illness, and cardiovascular risk factors in patients with myocardial infarction is crucial in engaging in effective secondary prevention. This study aimed to examine illness perception and cardiovascular risk factors in patients with myocardial infarction undergoing percutaneous coronary intervention. METHODS: The participants comprised 131 patients undergoing a first-time percutaneous coronary intervention at a metropolitan, tertiary referral hospital in Tabriz, Iran. The convenience sampling method was employed to select the research sample within a six-month period. The instruments used were as follows: (1) Demographic and health information form, (2) The Brief Illness Perception Questionnaire (3) The Health Risk Assessment framework developed by the Centers for Disease Control and Prevention. The design of the study was descriptive, cross sectional. The continuous variables were analyzed using Independent t-test and analysis of variance (ANOVA); and categorical variables were compared using the chi-square test. RESULTS: Most participants had a positive family history of cardiovascular disease (54.2%), with 66.4% of participants having at least one cardiovascular risk factor such as diabetes (36.6%) hypertension (32.8%) and dyslipidemia (16%). Most participants were physically inactive (78.6%), about 48.9% were overweight, 34.4% suffered from obesity and 26% were smokers. Illness perception in this study was seen to be high (6.21), with highest scores occurring in the illness control dimension (6.83) and lowest scores occurring in the understanding dimension (3.77). There was a significant relationship between illness perception and physical activity, nutrition, sleep and general health. Direct significant relationships between biometric values (cholesterol, glucose, blood pressure); psychological factors (depression, anxiety and stress) and illness perception were also found to exist. CONCLUSIONS: Low scores in two dimensions of illness perception may lead to psychological consequences such as stress, anxiety, and depression. The relationship between illness perception and some risk factors of cardiovascular disease such as physical activity, diet and biometric values, reveal the need for more attention to patient education and counselling.

The association between T wave inversion in leads with ST-elevation and patency of the infarct-related artery.

BACKGROUND: Up to over half of the patients with ST-segment elevation myocardial infarction (STEMI) are reported to undergo spontaneous reperfusion without therapeutic interventions. Our objective was to evaluate the applicability of T wave inversion in electrocardiography (ECG) of patients with STEMI as an indicator of early spontaneous reperfusion. METHODS: In this prospective study, patients with STEMI admitted to a tertiary referral hospital were studied over a 3-year period. ECG was obtained at the time of admission and patients underwent a PPCI. The association between early T wave inversion and patency of the infarct-related artery was investigated in both anterior and non-anterior STEMI. RESULTS: Overall, 1025 patients were included in the study. Anterior STEMI was seen in 592 patients (57.7%) and non-anterior STEMI in 433 patients (42.2%). Among those with anterior STEMI, 62 patients (10.4%) had inverted T and 530 (89.6%) had positive T waves. In patients with anterior STEMI and inverted T waves, a significantly higher TIMI flow was detected (p value = 0.001); however, this relationship was not seen in non-anterior STEMI. CONCLUSION: In on-admission ECG of patients with anterior STEMI, concomitant inverted T wave in leads with ST elevation could be a proper marker of spontaneous reperfusion of infarct related artery.

Evaluation of the serum levels of Mannose binding lectin-2, tenascin-C, and total antioxidant capacity in patients with coronary artery disease.

BACKGROUND: Coronary artery disease (CAD) develops as a result of atherosclerosis. Atherosclerosis is a condition that leads to clogged arteries and can be caused by a variety of factors. Several studies have shown that various factors contribute to the development and progression of CAD. The aim of this study was to investigate the serum levels of MBL-2, TNC and TAC in patients with CAD and the relationship between these biochemical parameters and the progression of CAD. METHODS: In this study, 60 serum samples were obtained from CAD patients as the case group and 20 healthy serum samples as the control group. Serum levels of MBL-2 and TNC were measured by the ELISA method. Serum TAC level was determined by calorimetry (spectrophotometry). In addition, MDA serum level was measured by reaction with thiobarbituric acid (TBA). RESULTS: The mean age in the case and control groups was 58.4 ± 9.5 years and 85 ± 9.8 years, respectively. There was no significant difference in age, sex and family history in patients with CAD (p > 0.05), but there was a significant difference in blood pressure and smoking history (p > 0.05). Serum cholesterol, triglyceride, and LDL levels were significantly increased in the case group compared to the control group, while serum HDL-C levels were significantly decreased in the case group. Serum levels of MBL-2, TNC, and MDA were significantly increased in the case group compared to the control group. The serum level of TAC was significantly lower in the case group than in the control group. CONCLUSION: This study suggests that it is possible to diagnose patients with coronary artery disease (CAD) in the early stages of their disease and take preventive measures by measuring these parameters in serum. However, more research is needed before these serum parameters can be considered diagnostic biomarkers or therapeutic targets.

Fine versus coarse atrial fibrillation in rheumatic mitral stenosis: The impact of aging and the clinical significance.

BACKGROUND: Atrial fibrillation (AF) as the most rhythm disturbance in patients with rheumatic mitral stenosis (MS), is classified in to coarse and fine subtypes according to the height of fibrillatory wave amplitude. The aim of this study is to identify the factors associated with the presence of fine versus coarse morphology in patients with rheumatic MS. METHODS: In this cross-sectional study, patients with confirmed diagnosis of severe rheumatic MS admitted between March 2013 and March 2017 were screened. Patients were categorized to sinus rhythm (SR) and AF rhythm (coarse and fine subtypes) groups according to the admission electrocardiogram. The association between various clinical and echocardiographic factors and the development of fine versus coarse AF were examined. RESULTS: Among 754 patients with the diagnosis of rheumatic MS, 288 (198 female) were found to have AF (38%). Among them 206 (71.5%), and 82 (28.5%) patients had fine and coarse morphology respectively. Patient in these two groups were quite similar in terms of echocardiographic parameters and comorbidities. However, patients with fine morphology AF were significantly older. (p-Value=.007). CONCLUSION: Coarse morphology of AF is common in patients with rheumatic MS. While echocardiographic or most clinical parameters do not seem to associate with the occurrence of coarse or fine morphology, age seems to be the only independent factor correlated with the presence of fine subtype of AF in this population.

Clinical and laboratory predictors of coronary slow flow in coronary angiography.

BACKGROUND: The coronary slow-flow phenomenon (CSFP) is a multifactorial angiographic finding with no established pathogenesis. OBJECTIVE: To investigate the role of clinical profile and laboratory findings in patients with CSFP. METHODS: We prospectively recruited 69 patients with angiographically diagnosed CSFP and compared them with 88 patients with normal coronary flow. Demographic information, comorbidities and laboratory analysis, including complete blood count with differential, lipid profile and serum biochemical analysis, were documented and compared in univariate and multivariate analyses. RESULTS: Patients with CSFP were more likely to be male and active smokers. Total cholesterol, triglyceride, hemoglobin and hematocrit, platelet count, mean platelet volume, platelet distribution width and red cell distribution width (RDW) were all higher in patients with CSFP. In multivariate regression analysis, including smoking, total cholesterol, hematocrit, fasting blood glucose and red cell distribution width, except fasting blood glucose, all variables were independently associated with CSFP. Receiver operating characteristic curve analysis revealed a cut-off point of 13.05% for RDW with a sensitivity of 74.6% and a specificity of 77.3% (p<0.001, AUC = 0.802) A cut-off value of 11.35% for PDW had a 89.9% sensitivity and 98.9% specificity for the prediction of CSFP (p<0.001, AUC = 0.970) Conclusion: The changes of circulating blood cell components in patients with CSFP may be indicative of underlying inflammation and endothelial dysfunction that should be investigated in experimental studies.

Correlation between Pulmonary Artery Pressure Measured by Echocardiography and Right Heart Catheterization in Patients with Rheumatic Mitral Valve Stenosis (A Prospective Study).

INTRODUCTION: Right heart catheterization (RHC) remains the gold standard for hemodynamic assessment of the right heart and pulmonary artery. However, this is an invasive tool, and noninvasive alternatives such as transthoracic echocardiography (TTE) are preferable. Nonetheless, the correlation between measurements by TTE and RHC are debated. In this study, we prospectively examined the correlation between systolic and mean pulmonary artery pressures (sPAP and mPAP) measured by RHC and TTE in patients with hemodynamically significant rheumatic mitral stenosis (MS). MATERIAL AND METHODS: Three hundred patients with hemodynamically significant MS undergoing TTE who were scheduled to undergo RHC within 24 hours were analyzed. PAP measurements were taken for all patients by RHC (sPAP(RHC), mPAP(RHC)). Maximum velocity of tricuspid regurgitation (TR) jet obtained by continuous-wave Doppler with adding right atrial (RA) pressure was used for measuring sPAP by TTE (sPAP(TRVmax)). Mean PAP was measured using either pulmonary artery acceleration time (mPAP(PAAT)) method or by adding RA pressure to velocity-time integral of TR jet (mPAP(TRVTI)). RESULTS: A good correlation between sPAP(RHC) and sPAP(TRVmax) (r = 0.89, P < 0.001), between mPAP(RHC) and mPAP(PAAT) (r = 0.9, P < 0.001), and between mPAP(RHC) and mPAP(TRVTI) (r = 0.92, P < 0.001) was found. Sensitivity and specificity of sPAP(TRV) max in detecting pulmonary hypertension (PH) were 92.8% and 86.6% and of mPAP(PAAT) were 94.1% and 73.3%, respectively. CONCLUSION: The noninvasive assessment of sPAP and mPAP by TTE correlates well with invasive measurements and has an acceptable specificity and sensitivity in detecting PH in patients with hemodynamically significant MS.

A pilot randomized trial of pentoxifylline for the reduction of periprocedural myocardial injury in patients undergoing elective percutaneous coronary intervention.

PURPOSE: Periprocedural myocardial injury (PMI) following percutaneous coronary intervention (PCI) has received great attention due to its significant association with mortality and morbidity. Accordingly, cardioprotection during PCI is one of the important therapeutic concerns. Regarding the potential cardiovascular benefits of pentoxifylline this study was performed to evaluate whether the pretreatment pentoxifylline could reduce PMI in patients who are undergoing elective PCI. METHODS: A randomized clinical trial on 85 patients undergoing elective PCI was performed. The intervention group (n = 41) received 1200 mg pentoxifylline in divided doses plus the standard treatment before PCI, while the control group (n = 44) received the standard treatment. For assessing myocardial damage during PCI, the levels of CK-MB and troponin-I were measured at baseline, 8, and 24 h after the procedure. Then, patients were followed up for a 1-month period regarding the major adverse cardiac effect. RESULTS: Comparing with the control group, no significant change of CK-MB at 8 (p = 0.315) and 24 h (p = 0.896) after PCI was documented in pentoxifylline group. Similarly, no significant change was found in troponin-I at 8 (p = 0.141) and 24 h (p = 0.256) after PCI. CONCLUSIONS: This study could not support the pretreatment with pentoxifylline in the prevention of PMI in patients undergoing elective PCI. However, the trend was toward the potential benefit of pentoxifylline.

Prosthetic valve thrombosis.

BACKGROUND: We conducted a retrospective, single center study to evaluate the clinical characteristics and outcomes of all consecutive patients with prosthetic valve thrombosis (PVT) over a 10 year period. METHODS: Data from 85 episodes of PVT in 80 patients treated over a 10-year period between 2001 and 2011 were analyzed. The diagnosis of PVT was confirmed by echocardiography and/or fluoroscopy. PVT was considered obstructive if there was an increased pressure gradient on the echo study or reduced or fixed leaflet mobility on fluoroscopy. The primary treatment approaches included: redo surgery or thrombolysis for obstructive PVT and the intensification of anticoagulation in nonobstructive PVT. RESULTS: The mean age was 49.4 ± 13.1 years (range: 13-79) and 40% were male. Thrombosed valves included 53 mitral, 22 aortic, six tricuspid, and both mitral and aortic position in nine patients. Subtherapeutic INR (less than 2.5) was observed in 58 patients (68.2%). Ten patients died before any definite therapeutic strategy in obstructive PVT. In ten patients, episodes were considered nonobstructive. Sixteen patients received fibrinolysis (streptokinase) that was successful in nine patients (56.2%). Intracranial hemorrhage occurred in three (18.7%) patients, and there were four deaths in this group. In the surgical group, 49 patients underwent operation as first line therapy and seven patients after failed thrombolysis. One brain hemorrhage and three (5.3%) deaths occurred during or after surgery. Total complications were significantly less frequent in the surgery group compared with those in the thrombolytic group (14.2% vs. 68.7%, p-value < 0.001). Higher NYHA functional class and lower systolic blood pressure were associated with in-hospital mortality. CONCLUSION: Thrombolysis is less effective and has more complications compared to surgery in treatment of obstructive PVT. Compromised hemodynamic status during presentation of these patients denotes higher in-hospital mortality.

Empagliflozin Effects in Patients with ST-Elevation Myocardial Infarction Undergoing Primary PCI: The EMI-STEMI Randomized Clinical Trial.

INTRODUCTION: Empagliflozin, a sodium-glucose cotransporter 2 (SGLT2) inhibitor, improves cardiovascular outcomes in heart failure patients, but data regarding the efficacy of empagliflozin in the setting of acute myocardial infarction (AMI) is still unclear. The current study aimed to evaluate whether treatment with empagliflozin before primary percutaneous coronary intervention (PCI) improves parameters associated with patients' outcomes. METHODS: We randomly assigned 101 non-diabetic and non-heart failure patients with ST-elevation myocardial infarction (STEMI) who underwent primary PCI to receive either empagliflozin (10 mg before PCI and once daily for 40 days) or placebo, in addition to the standard treatment. The primary outcomes were changes in left ventricular ejection fraction (LVEF) 40 days after PCI, changes in cardiac troponin I (cTnI) and estimates of its area under the curve (AUC) and the peak level, and resolution of ST-segment in > 50% of leads 90 min after PCI. RESULTS: No significant difference was observed in terms of the occurrence of ST-segment resolution > 50% (46.0% versus 45.0%; p = 0.92) and the mean level of cTnI at each time point between the two groups. The estimated mean [standard deviation (SD)] AUC of cTnI was 955.0 (595.7) ng h/ml in the intervention and 999.7 (474.7) ng h/ml in the control groups (p = 0.85) without any significant difference in peak cTnI level. The mean (SD) LVEF 40 days after primary PCI was significantly higher in empagliflozin-treated patients than the placebo group [43.2% (5.8%) versus 39.2% (6.7%); p = 0.002]. CONCLUSION: In this study, no significant differences were observed across the groups in terms of cTnI levels and ST-segment resolution in patients with STEMI undergoing primary PCI. However, it shed light on the potential benefits of empagliflozin in improving LVEF following STEMI. REGISTRATION: Iranian Registry of Clinical Trials Platform ( https://irct.behdasht.gov.ir/ ) identifier number IRCT20111206008307N42.

Effectiveness of edaravone in preventing contrast-induced nephropathy in high-risk patients undergoing coronary angiography: A randomized, double-blind trial.

Contrast-induced nephropathy (CIN) is a serious complication that occurs subsequent to the administration of contrast media for therapeutic angiographic interventions. As of present, no effective therapy exists to prevent its occurrence. This single-center double-blind randomized controlled trial aimed to evaluate the effect of edaravone, an antioxidant, in a group of high-risk patients undergoing coronary angiography. Ninety eligible patients with chronic kidney disease Stages 3-4 were randomly assigned to either the control group (n = 45) or the intervention group (n = 45). In the intervention group, one dosage of edaravone (60 mg) in 1 L of normal saline was infused via a peripheral vein 1 h prior to femoral artery-directed coronary angiography. Patients in the control group received an equal amount of infusion in their last hour before angiography. Both groups received intravenous hydration with 0.9% sodium 1 mL/kg/h starting 12 h before and continuing for 24 h after angiography. The primary outcome measure was the onset of CIN, defined as a 25% increase in serum creatinine levels 120 h after administration of contrast media. The occurrence of CIN was observed in 5.5% (n = 5) of the studied population: 2.2% of patients in the intervention group (n = 1) and 8.9% of controls (n = 4). However, this difference was not statistically significant. Administration of a single dosage of edaravone 1 h prior to infusion of contrast media led to a reduction in the incidence of CIN. Further investigations, employing larger sample sizes, are warranted to gain a comprehensive understanding of its efficacy.

Correlation of left atrial strain with invasively measured left ventricular end-diastolic pressure; determining LA strain cut-off value.

Left atrium longitudinal strain (LAS) with speckle tracking method has been proposed as a non-invasive method for the assessment of left ventricular filling pressure and diastolic dysfunction. This study aimed to investigate left atrial strain compared to invasively measured left ventricular filling pressure. All Patients candidates for coronary angiography were consecutively recruited. LAS measured by transthoracic echocardiography. Left ventricular end-diastolic pressure (LVEDP) pressure was invasively measured. Current echocardiographic modalities for diastolic function evaluated. A total of 125 people were included. 45 patients had preserved ejection fraction (EF ≥ 50%) and 85 patients had reduced EF (EF < 50%) and compared two groups. LVEDP was significantly higher in reduced EF compared to preserved EF (p-value < 0.001). LA-reservoir and LA-booster strains were significantly lower in patients with reduced EF compared to preserved EF (p-value = 0.008, mean Reservoir = 16.4% ± 6.4, mean Reservoir = 19.5% ± 5.6, respectively) and (p-value = 0.009, mean Booster = 9.09% ± 4.0, mean Booster =11. 9% ± 4.3, respectively). LA 4ch-reservoir strain <14.4%, and LA 2ch-reservoir strain <14.1% were related to LVEDP≥20 mmHg (sensitivity 63.5% and specificity 75%) (sensitivity 77.9% and specificity of 60%) respectively. LAS is significantly lower in patients with elevated LVEDP (≥ 20mmHg). LAS is significantly lower in patients with reduced EF. Both LA-reservoir and LA-booster strains have a significant relation to predicting LVFP but LA-reservoir strain is more accurate. The mean LA-reservoir strain less than 12.4% is associated with LVEDP ≥ 20mmHg.

Comparison of the Efficacy of Atorvastatin and Rosuvastatin in Preventing Atrial Fibrillation after Coronary Artery Bypass Grafting: A Double-Blind Randomized Comparative Trial.

Background: Atrial fibrillation (AF) is a supraventricular tachyarrhythmia characterized by disorganized atrial activity and subsequent mechanical atrial failure. Postoperative AF is a frequent complication of coronary artery bypass grafting (CABG). Although there is evidence of decreased AF after CABG with statin usage, information is scarce regarding a direct comparison between atorvastatin and rosuvastatin. The present study was conducted to compare the efficacy of rosuvastatin and atorvastatin in preventing post-CABG AF. Methods: The present double-blind randomized comparative clinical trial selected CABG candidates with stable ischemic heart disease or acute coronary syndromes. Atorvastatin (40 mg per day) or rosuvastatin (20 mg per day) was prescribed 1 week before surgery, and the outcomes were compared. Results: Two-hundred patients, 100 cases in each group, completed the study. Twenty-five patients in each group were female, and the mean age was 59.30±8.42 years in the rosuvastatin group and 60.13±9.40 years in the atorvastatin group (P=0.513). The frequency of AF was 31% in the atorvastatin group and 27% in the rosuvastatin group (P=0.534). No significant differences existed between the groups concerning the length of hospital and ICU stay (P=0.333 and P=0.161) and in-hospital and 3-month mortality (P=0.315 and P=0.648). A subgroup analysis of only patients with stable ischemic heart disease could not detect a significant difference between the study groups in any of the investigated outcomes. Our logistic regression analysis showed an association only between age and the incidence of AF after CABG (OR, 1.12; 95% CI, 1.05 to 1.20; P<0.01). Conclusion: Rosuvastatin and atorvastatin are similar concerning the prevention of post-CABG AF, but there is a need for future well-designed multicenter studies on this topic.

Novel diagnostic potential of miR-1 in patients with acute heart failure.

BACKGROUND: A number of circulating micro-ribonucleic acids (miRNAs) have been introduced as convincing predictive determinants in a variety of cardiovascular diseases. This study aimed to evaluate some miRNAs' diagnostic and prognostic value in patients with acute heart failure (AHF). METHOD: Forty-four AHF patients were randomly selected from a tertiary heart center, and 44 healthy participants were included in the control group. Plasma levels of assessed miRNAs, including miR -1, -21, -23, and -423-5-p were measured in both groups. The patients were followed for one year, and several clinical outcomes, including in-hospital mortality, one-year mortality, and the number of readmissions, were recorded. RESULTS: An overall 88 plasma samples were evaluated. There was no significant difference in terms of demographic characteristics between the AHF and healthy groups. Our findings revealed that mean levels of miR-1, -21, -23, and -423-5-p in AHF patients were significantly higher than in the control group. Although all assessed miRNAs demonstrated high diagnostic potential, the highest sensitivity (77.2%) and specificity (97.7%) is related to miR-1 for the values above 1.22 (p = 0.001, AUC = 0.841; 95%CI, 0.751 to 946). Besides, the levels of miR-21 and -23 were significantly lower in patients with ischemia-induced HF. However, the follow-up data demonstrated no significant association between miRNAs and prognostic outcomes including in-hospital mortality, one-year mortality, and the number of readmissions. CONCLUSION: The result of our study demonstrated that miR-1, -21, -23, and -423-5-p can be taken into account as diagnostic aids for AHF. Nevertheless, there was no evidence supporting the efficacy of these miRNAs as prognostic factors in our study.

Association between Neutrophil-to-Lymphocyte Ratio and the Systemic Inflammatory Immunologic Index and the Angiographic SYNTAX Score and the TIMI Flow Grade in Acute STEMI: A Cohort Study.

Background: In patients with ST-segment-elevation myocardial infarction (STEMI), it is essential to determine the complexity of coronary lesions on presentation and predict the risk of no-reflow after primary percutaneous coronary intervention (pPCI). Given that inflammation plays an important role in the pathogenesis of atherosclerosis, using inflammatory indices might be helpful in this setting. Methods: This prospective cohort study recruited 200 consecutive patients with STEMI who underwent pPCI. The presentation neutrophil-to-lymphocyte-ratio (NLR) and the systemic inflammatory immunologic index (SII), calculated using the formula platelets × neutrophils/lymphocytes, were recorded. Study outcomes included the SYNTAX score and the TIMI flow grade before and after pPCI. The associations between the NLR and the SII and the study outcomes were investigated using univariate and multivariate logistic regression analyses. Results: Among 200 patients at a mean age of 59.85±11.23 years, 160 (80.0%) were male and 40 (20.0%) were female. The NLR and SII values were not statistically different between the 3 SYNTAX subgroups. While the mean NLR and SII values were similar between the patients with preprocedural TIMI flow grades 0/1 and 2/3, the mean NLR and SII were significantly lower in the group with a postprocedural TIMI flow grade 3. After adjustments for age and sex, the NLR and the SII were independent predictors of postprocedural no-reflow. Conclusion: In patients with STEMI, the presentation NLR and SII are useful for predicting the risk of no-reflow after pPCI. However, the NLR and the SII are not predictors of the SYNTAX score and the preprocedural TIMI flow grade.

Association of neutrophil to lymphocyte ratio (NLR) with angiographic SYNTAX score in patients with non-ST-Segment elevation acute coronary syndrome (NSTE-ACS).

Introduction: Considering the role of inflammation in pathogenesis of atherosclerosis, we aimed to investigate the association of presentation neutrophil to lymphocyte ratio (NLR) with complexity of coronary artery lesions determined by SYNTAX score in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). Methods: From March 2018 to March 2019, we recruited 202 consecutive patients, who were hospitalized for NSTE-ACS and had undergone percutaneous coronary intervention in our hospital. The association of presentation NLR with SYNTAX score was determined in univariate and multivariate linear regression analysis. Results: Higher NLR was significantly associated with higher SYNTAX score (beta = 0.162, P = 0.021). In addition, older age, having hypertension, higher TIMI score, and lower ejection fraction on echocardiographic examination were significantly associated with higher SYNTAX score. TIMI score had the largest beta coefficient among the studied variables (TIMI score beta = 0.302, P < 0.001). In two separate multivariate linear regression models, we assessed the unique contribution of NLR in predicting SYNTAX score in patients with NSTE-ACS. In the first model, NLR was significantly contributed to predicting SYNTAX score after adjustment for age, sex, and hypertension as covariates available on patient presentation (beta = 0.142, P = 0.040). In the second model, NLR was not an independent predictor of SYNTAX score after adjustment for TIMI score (beta = 0.121, P = 0.076). Conclusion: In NSTE-ACS, presentation NLR is associated with SYNTAX score. However, NLR does not contribute significantly to the prediction of SYNTAX score after adjustment for TIMI score. TIMI risk score might be a better predictor of the SYNTAX score in comparison to NLR.

Diagnostic efficacy of coronary calcium score in the assessment of significant coronary artery stenosis.

BACKGROUND: Coronary artery calcium score (CCS) is a quantitative assessment of calcifications detectable by multidetector computed tomography (MDCT). AIM: To evaluate diagnostic accuracy of CCS to detect significant stenosis in coronary arteries in symptomatic patients. METHODS: The study population included consecutive symptomatic patients with suspected coronary artery disease (CAD) who were referred for coronary angiography. The group included 158 patients (64.6% males) who were all evaluated by unenhanced 64-slice computed tomography where calcium was quantified according to the Agatston method. The ROC curves were constructed to evaluate the discriminating power of the total CCS and CCS for each individual coronary artery in predicting the presence of significant stenosis. RESULTS: The prevalence of significant CAD strongly increased with higher CCS. The area under the curve (AUC) for total CCS for diagnosing significant stenosis (> or = 50%) in at least one coronary artery was 0.83 (95% CI 0.74-0.92). Using the cut-off value of CCS > or = 7.7 at least one significant coronary stenosis was detected with the sensitivity and specificity of 86% and 71%, respectively. Significant coronary artery stenosis was better predicted by measuring CCS for individual coronary arteries than total CCS. The AUC of CCS for significant stenosis of each coronary artery was 0.80 for the right coronary artery (RCA), 0.72 for the left main (LM), 0.73 for the left anterior descending (LAD) and 0.76 for the left circumflex arteries (LCX). The optimal cut-off point was estimated for CCS of each coronary artery. It was set at > or = 3.1 for RCA, > or = 7.7 for LM, > or = 9.5 for LAD and > or = 4.5 for LCX. Positive and negative predictive values for an intact artery using a CCS of zero were 92.8% and 83.8%, respectively. Diagnostic performance of CCS for predicting stenosis of LM and LCX arteries was better in patients over age 65 than in younger patients. CONCLUSIONS: Coronary artery calcium score is useful in predicting coronary artery stenosis, especially in subjects in whom invasive diagnostic or therapeutic utilities seem to be used untimely. The current study suggests an optimal cut-off value of total CCS > or = 7.7 for detecting significant stenosis, and underlines the better predictive value for CCS of individual arteries.

Role of MicroRNAs in Diagnosis, Prognosis, and Treatment of Acute Heart Failure: Ambassadors from Intracellular Zone.

Acute heart failure (AHF) is one of the burdensome diseases affecting a considerable proportion of the population. Recently, it has been demonstrated that micro-ribonucleic acids (miRNAs) can exert diagnostic, prognostic, and therapeutic roles in a variety of conditions including AHF. These molecules play essential roles in HF-related pathophysiology, particularly, cardiac fibrosis, and hypertrophy. Some miRNAs namely miRNA-423-5p are reported to have both diagnostic and prognostic capabilities. However, some studies suggest that combination of biomarkers is a much better way to achieve the highest accuracy such as the combination of miRNAs and N-terminal pro b-type Natriuretic Peptide (NT pro-BNP). Therefore, this review discusses different views towards various roles of miRNAs in AHF.

Segmentation of cardiac fats based on Gabor filters and relationship of adipose volume with coronary artery disease using FP-Growth algorithm in CT scans.

Heart mediastinal and epicardial fat tissues are related to several adverse metabolic effects and cardiovascular risk factors, especially coronary artery disease (CAD). The manual segmentation of those fats is that the high dependence on user intervention and time-consuming analyzes. As a result, the automated measurement of cardiac fats could be considered as one of the most important biomarkers for cardiovascular risks in imaging and medical visualization by physicians. In this paper, we validate an automatic approach for the cardiac fat segmentation in non-contrast CT images then investigate the correlation between cardiac fat volume and CAD using the association rule mining algorithm. The pre-processing step includes threshold and contrast enhancement, the feature extraction step includes Gabor filter bank based on GLCM, the cardiac fat segmentation step is predicated on pattern recognition classification algorithms, and eventually, the step of investigating the relationship between cardiac fat volume and CAD is using FP-Growth algorithm. Experimental validation using CT images of two databases points to a good performance in cardiac fat segmentation. Experiments showed that the accuracy of the designed algorithm using the ensemble classifier with the best performance over other classifiers for the cardiac fat segmentation was 99.2%, with a sensitivity of 96.3% and a specificity of 99.8%. The results of using the FP-Growth algorithm showed that the low volume of epicardial (Confidence = 0.6818, Lift = 1.0626) and mediastinal (Confidence = 0.6696, Lift = 1.0436) fat are associated with healthy individuals and the high volume of epicardial (Confidence = 0.8, Lift = 2.2326) and mediastinal (Confidence = 0.75, Lift = 2.093) fat are related to individuals of CAD. As a result, cardiac fats can be used as a reliable biomarker tool in predicting the extent of CAD stenosis.

Association Between Off-hour Presentations and In-hospital Mortality for Patients with Acute ST-Elevation Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention.

OBJECTIVES: This study aimed to assess the effect of the admission time (on-hours versus off-hours) on in-hospital mortality in patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PPCI) in a region without STEMI network. METHODS: We analysed in-hospital the mortality among 300 consecutive ST-segment elevation myocardial infarction (STEMI) patients treated with PPCI between March 2012 and February 2017. Patients were divided according to admission time into on-hours admission (08:00 AM until 08:00 PM on weekdays) versus off-hours admission (08:00 PM until 08:00 AM on weekdays and 24 h on weekends and holidays). Demographic and clinical data as well as in-hospital mortality were compared between the two groups. RESULTS: One hundred and seventy eight (59.3%) patients were admitted during on-hours, and 122 (40.7%) patients were presented in off-hours. The mean door-to-balloon time was 42.3 min in the off-hours group and 34.2 min in the on-hours group with no statistically significant difference (p = 0.39). The mortality rate was 3.9% at on-hours presentation versus 4.09% in off-hours admission (p = 0.58). Multivariate logistic regression analysis showed that off-hours presentation was not associated with in-hospital mortality. [odds ratio (OR) 0.74; 95% CI, 0.21-2.61, p = 0.64]. CONCLUSION: Despite no efficient STEMI network in present study, off-hour presentation had no significant impact on in-hospital prognosis in patients with STEMI treated with PPCI. Larger studies are warranted in order to determine the prognostic role of off-hour presentation in patients with STEMI undergoing PPCI.

The impact of oral nicorandil pre-treatment on ST resolution and clinical outcome of patients with acute ST-segment elevation myocardial infarction undergoing primary coronary angioplasty: A randomized placebo controlled trial.

Introduction: Literature has shown the effects of intravenous/intracoronary nicorandil on increased myocardial salvage in patients with ST-segment elevation myocardial infarction (STEMI) treated with mechanical reperfusion. However, the possible cardioprotective effect of oral nicorandil on the clinical outcome prior to primary coronary angioplasty is not well documented. Our aim was to assess the effect of oral nicorandil on primary percutaneous coronary intervention (PPCI). Methods: A total of 240 patients with acute STEMI undergoing PPCI were randomly assigned to oral nicorandil (Intervention, n=116) and placebo (Control, n=124) groups. The intervention group received 20 mg oral nicorandil at the emergency department and another 20 mg oral nicorandil in the catheterization laboratory just before the procedure. The control group received matched placebo. Our primary outcome was ST-segment resolution ≥50% one hour after primary angioplasty. Secondary outcome was in-hospital major adverse cardiovascular events (MACE), defined as a composite of death, ventricular arrhythmia, heart failure and stroke. Results: In the patients of intervention and control groups, the occurrence of ST-segment resolution ≥ 50% were 68.1% and 62.9% respectively, (P =0.27). In-hospital MACE occurred less frequently in the intervention group, compared to placebo group (11.2% vs. 22.5%, P =0.012). Conclusion: Although the administration of oral nicorandil before primary coronary angioplasty did not improve ST-segment resolution in patients with acute STEMI, its promoting effects was remarkable on in-hospital clinical outcomes. Clinical Registration: IRCT20140512017666N1.