Which risk factor best predicts coronary artery disease using artificial neural network method?

BACKGROUND: Coronary artery disease (CAD) is recognized as the leading cause of death worldwide. This study analyses CAD risk factors using an artificial neural network (ANN) to predict CAD. METHODS: The research data were obtained from a multi-center study, namely the Iran-premature coronary artery disease (I-PAD). The current study used the medical records of 415 patients with CAD hospitalized in Razi Hospital, Birjand, Iran, between May 2016 and June 2019. A total of 43 variables that affect CAD were selected, and the relevant data was extracted. Once the data were cleaned and normalized, they were imported into SPSS (V26) for analysis. The present study used the ANN technique. RESULTS: The study revealed that 48% of the study population had a history of CAD, including 9.4% with premature CAD and 38.8% with CAD. The variables of age, sex, occupation, smoking, opium use, pesticide exposure, anxiety, sexual activity, and high fasting blood sugar were found to be significantly different among the three groups of CAD, premature CAD, and non-CAD individuals. The neural network achieved success with five hidden fitted layers and an accuracy of 81% in non-CAD diagnosis, 79% in premature diagnosis, and 78% in CAD diagnosis. Anxiety, acceptance, eduction and gender were the four most important factors in the ANN model. CONCLUSIONS: The current study shows that anxiety is a high-prevalence risk factor for CAD in the hospitalized population. There is a need to implement measures to increase awareness about the psychological factors that can be managed in individuals at high risk for future CAD.

Failed primary percutaneous coronary intervention in a middle-aged man without cardiovascular risk factors: left atrium myxoma.

Embolic events are rare presentation of myxoma, which is one of the most prevalent benign cardiac tumors. Here we report the case of a 53-year-old man with presentation of acute anterior infarction and occlusion of the left anterior descending artery in association with left atrial myxoma. Intracoronary aspiration thrombectomy along with frequent balloon inflation was failed to recover distal coronary blood flow.

The effects of foot reflexology on back pain after coronary angiography: A randomized controlled trial.

BACKGROUND AND AIMS: Back pain is among the most common complaints of patients during the first hours after coronary angiography (CA), i.e. when they are restricted to complete bed rest. This study aimed to evaluate the effects of foot reflexology on back pain after CA. METHODS: This randomized controlled trial was conducted in 2018-2019 on patients hospitalized in the post-angiography unit of Razi hospital, Birjand, Iran. Through convenience sampling, 120 patients were recruited and their demographic characteristics and baseline back pain intensity were assessed immediately after angiography using a demographic questionnaire and a visual analogue scale, respectively. Then, patients were randomly allocated to a control (n = 60) and a reflexology (n = 60) group through block randomization. Patients in the reflexology group received 8-min foot reflexology for each foot (16 min for both feet) while their counterparts in the control group solely received routine post-angiography care services. Back pain assessment was repeated for all participants immediately, two, four, and 6 h after the intervention. Data were analyzed using the SPSS software (v. 16.0). FINDINGS: Back pain intensity significantly increased after angiography in both groups (P < 0.05). Yet, pain intensity in the reflexology group at all post-intervention measurement time points was significantly less than the control group (P < 0.001). CONCLUSION: Foot reflexology is effective in significantly reducing back pain after CA.

Cardiogenic Shock Due to Aluminum Phosphide Poisoning Treated with Intra-aortic Balloon Pump: A Report of Two Cases.

The mortality rate from aluminum phosphide (AlP) poisoning is as high as 70-100%, with refractory hypotension and severe metabolic acidosis being the two most common presentations in this poisoning. As this poisoning has no specific antidote, treatments revolve around supportive care. Cardiogenic shock created by toxic myocarditis is considered the main cause of mortality in these patients. Meanwhile, the intra-aortic balloon pump (IABP) has been suggested for the treatment of cardiogenic shock. This article reports the successful treatment of cardiogenic shock caused by AlP poisoning in a 17-year-old man and a 21-year-old woman using the IABP procedure.

Comparison of atherogenic index and lipid profiles in candidates for coronary artery bypass graft surgery versus normal people.

Information on incidence and risk factors of cardiovascular disease (CVD) is rare in the Middle East. This study aims to compare Iranian candidates for coronary artery bypass graft (CABG) surgery and healthy controls in terms of lipid profile, atherogenic index of plasma (AIP), and atherosclerosis index (ASTI). The individuals recruited in this study were 135 CVD patients before CABG surgery and 135 healthy subjects matching in age with the cases. Lipid profiles of the two groups were analyzed with a commercial kit. The AIP and ASTI indexes were calculated with related formula. The TC, TG, LDL-C and HDL-c parameters were dramatically changed (p<0.01) between study groups. AIP and ASTI indexes were significantly higher in patients than in healthy people (p=0.001). In individuals with CVD, it is suggested to measure these indexes in order for effective diagnosis before CABG surgery.

Comparison between Homocysteine, Fibrinogen, PT, PTT, INR and CRP in Male Smokers with/without Addiction to Opium.

BACKGROUND: Regarding the limited studies about effects of addiction on coagulation factors as a risk factor for increasing coagulation, and its relation to coronary artery disease, we decided to investigate the effect of opium on inflammatory and coagulation factors in a controlled setting. METHODS: This case-control study was performed using two groups of smoking males addicted to opium (27 cases) and not addicted to opium (27 cases). After collecting demographic data, venous blood samples were gathered and sent to laboratory for measuring homocysteine, fibrinogen, prothrombin time (PT), partial thromboplastin time (PTT), International Normalized Ratio (INR), and C-reactive protein (CRP) quantity. In order to analyze the data, we used independent t-test plus Mann-Whitney test with significance level of P < 0.05. FINDINGS: The average age in this study was 32.2 ± 6.2 in case group and 33.3 ± 6.2 in control group. Comparing case and control groups regarding age and education showed no significant difference (P = 0.598 and P = 0.848, respectively). Mean daily smoking in case group was 7.9 ± 5.4 and 8.1 ± 5.0 in control group. Mean smoking duration in case group and control group was 10.1 ± 6.5 and 9.0 ± 7.2 years, respectively. There was no significant difference between two groups regarding smoking duration (P = 0.567). Comparison of inflammatory and coagulation factors showed no significant difference except for CRP and fibrinogen for which P = 0.661 and P = 0.889, respectively. Consumption-based comparison of inflammatory and coagulation factors showed no significant difference except for PT in oral and inhaled consumptions which showed a significant difference (P = 0.035). CONCLUSION: Results of this study suggest that opium addiction can be an influential factor in blood parameters and can lead to inflammatory and coagulation processes complications.

Myocardial iron load measured by cardiac magnetic resonance imaging to evaluate cardiac systolic function in thalassemia.

BACKGROUND: The assessment of cardiac iron overload in thalassemia major has been considered as an important predictive factor of heart injury. The magnetic resonance imaging (MRI)-derived relaxation time parameter (T2*) varies inversely with iron level, and elevated myocardial iron levels by T2* are associated with depressed left ventricular (LV) ejection fraction (EF). We compared echocardiographic (ECHO) indices of systolic function to myocardial T2* in these patients. METHODS: A cross-sectional database review identified 200 consecutive patients with thalassemia who underwent both ECHO and MRI T2* assessment. RESULTS: There was a negative correlation between T2* measurement and ECHO EF (r = -0.389, P < 0.001). Using a cutoff value of 50% for differentiating LV normal and abnormal function by ECHO, T2* MRI had a sensitivity of 57.1%, a specificity of 89.9%, and an accuracy of 86.5% for predicting LV dysfunction. Receiver operating characteristic analysis showed that cardiac iron measurement had an acceptable value for discriminating normal and abnormal LV function (area under the curve = 0.769, 95% confidence interval: 0.653-0.885). With respect to the relationship between serum ferritin level and cardiac iron value, the level of serum ferritin was positively correlated with the level of cardiac iron load (r = 0.257, P < 0.001). CONCLUSION: Myocardial iron load assessed by MRI T2* is associated with deterioration of the LV function assessed by ECHO with a high specificity and moderate sensitivity. It is important to identify the thalassemic patients with a risk of iron overloaded cardiomyopathy and heart failure.