Evaluation of the efficacy and safety of rivaroxaban compared to warfarin in patients with left ventricular apical thrombus: a randomized clinical trial.

INTRODUCTION: This research is one of the pioneering randomized clinical trials (RCTs) aimed at assessing the effectiveness and safety of rivaroxaban in treating left ventricular thrombus (LVT) in patients who have experienced acute coronary syndrome (ACS). MATERIALS AND METHODS: This is a randomized, controlled, interventional, open-label study. The patients were randomly divided into warfarin and rivaroxaban groups. We performed transthoracic echocardiography at the start of the study and again after three months to measure the thrombus area in square millimeters. The morphology of the thrombus was categorized into mural and round, and the mobility was classified into immobile, semi-mobile and hypermobile. We also monitored for adverse events including bleeding, systemic embolic occurrences, rehospitalization, and major adverse cardiac events (MACE). RESULTS: The study included fifty-two patients in the intention-to-treat analysis, with an equal split between the rivaroxaban and warfarin groups (26 patients each). The average follow-up duration was three months. The thrombus resolution rates in the rivaroxaban (76.9%) and warfarin (69.2%) groups, as well as the thrombus size reduction, did not show statistical significance between groups. All semi-mobile or hypermobile thrombi transformed into immobile and all of the round LVTs changed into a mural in both rivaroxaban and warfarin groups. No significant difference was observed in bleeding complications and rehospitalization between the two groups. CONCLUSION: The trial demonstrated that rivaroxaban is as effective as warfarin in terms of thrombus resolution rate, reduction in thrombus size, bleeding risk, and rehospitalization rate. Our findings suggest that rivaroxaban is a viable alternative to warfarin for managing left ventricular thrombus.

Evaluation of correlation between digital vs. mercury sphygmomanometer in a middle-income country: The role of socio-economic situation.

BACKGROUND: Using manometer sphygmomanometers as standard measurement tool, there are controversial data regarding accuracy and validity of digital manometers for measurement of systolic (SBP) and diastolic blood pressure (DBP). Thus, we aimed to compare the accuracy of readings of digital sphygmomanometer in reference to mercury sphygmomanometer in a large population of healthy adults. METHODS AND MATERIALS: This cross-sectional study was performed on 1119 healthy adults. We measured participant's blood pressure once with mercury sphygmomanometer, as gold standard and again with digital mercury sphygmomanometer. Blood pressure was measured in sitting position after 5 min of rest and preferentially from right arm unless deformed. RESULTS: The mean ± standard deviation of age of participants was 37.25 ± 10.45 years. Majority of participants were male 588 (52.5%). The right/left SBP measured by digital sphygmomanometer were significantly higher compared with those measured by mercury sphygmomanometer: 115.37 ± 12.33 vs 110.95 ± 10.06/113.69 ± 11.77 vs 110.23 ± 10.34, respectively (P < .001), while an opposite result was observed about right/left DBP: 68.60 ± 8.55 vs 70.60 ± 8.31/69.39 ± 8.31 vs 70.75 ± 8.41, respectively (P < .001). In subgroup analysis in terms of marital status, education, and income, we observed similar findings. CONCLUSION: According to the results of our data analysis, it was shown that the digital device measurements had significant incompatibility with the mercury sphygmomanometers and it seems that digital devices still cannot be used as the gold standard in blood pressure measurement.

Right ventricular diastolic function predicts clinical atrial fibrillation after coronary artery bypass graft.

Background: Patients with moderate-severe left ventricular systolic dysfunction undergoing coronary artery bypass graft (CABG) surgery are at high risk of mortality and morbidity. Our aim is to evaluate the right ventricular (RV) diastolic function in these patients, and monitor its effects on postoperation outcomes. Materials and Methods: In a cohort study, patients with moderate-severe left ventricular systolic dysfunction (ejection fraction ≤35%) who were candidate for CABG were included. Baseline transthoracic echocardiography (TTE) was performed, and RV diastolic function measures were obtained. After CABG, the length of intubation, inotrope dependency, hospital stay in intensive care unit and ward, in-hospital and after discharge mortality, postoperative atrial fibrillation (POAF) were evaluated in all patients. Results: Sixty-seven patients were prospectively included in the study. The mean ± standard deviation age of our patients was 61.4 ± 9.3. There was no difference between grades of RV diastolic function and postoperative outcomes. However, we found significant difference between grades of RV diastolic function and onset of in hospital, and total POAF (P-value = 0.017). Multivariate analysis demonstrated that preoperative tricuspidEt/E't (ratio of peak early-diastolic flow rate across the tricuspid valve orifice to peak early-diastolic velocity at the lateral tricuspid annulus), left atrial volume and "high risk" Euroscore II were independent predictors for POAF during hospitalization and total POAF in patients with moderate to severely impaired left ventricular systolic function (P-values were 0.04, 0.003 and 0.001, respectively). Conclusion: We believe that patients with increased tricuspid Et/E't are high risk for POAF; therefore, any risk score for POAF should include a comprehensive TTE including evaluation of RV diastolic function before surgery.

Is it safe to discharge blunt abdominal trauma patients with normal initial findings?

BACKGROUND: Trauma is the leading health concern among young adults. Blunt abdominal trauma (BAT) is the most common type of blunt traumas. BAT patients may prove normal in the initial clinical assessments, but since the time required for an intra-abdominal injury to be clinically apparent is not predictable, deciding when to safely discharge these patients could be a dilemma. The purpose of this study is to determine whether follow-up of the early discharged or further diagnostic assessment of the later discharged BAT patients with normal initial findings reveals any abnormal findings. METHODS: Totally, 389 hemodynamically-stable patients suspected of BAT who arrived at the emergency department (ED) of two university hospitals in Tehran from September 2013 to September 2014 were included in this study. Upon arrival at the ED, all subjects underwent abdominal examination and FAST, and were assessed for hematocrit and base deficit levels and presence of hematuria. These assessments were repeated in the patients who were discharged after 6 h, at 6 or 12 h post-arrival. All patients were followed-up after 24 h and one week by phone call. RESULTS: Out of all study participants, 158 patients (40.6%) had normal findings in all initial assessments. These patients were discharged from the ED after a median of 5 h. After one week of follow-up, none of them had any symptom or complication, or had sought medical attention after being discharged from the study hospitals. Out of these patients, 78 patients (49.4%) were discharged after 6 hours by their physician's decision, and underwent the same diagnostic assessments for the second or third time. None of these assessments revealed any abnormal findings. CONCLUSIONS: A combination of normal abdominal exam, normal FAST, normal hematocrit, normal base deficit, and absence of hematuria rules out intra-abdominal injury in BAT patients. It is safe to discharge patients after they prove normal for these assessments. Longer observation and repeated diagnostic assessment of these patients does not yield any new findings, and seems to be unnecessary.

Compare efficacy and safety of autologous blood clot injection with C-clamp vascular closure device in treatment of iatrogenic pseudoaneurysm after femoral artery puncture.

INTRODUCTION: Iatrogenic femoral artery pseudoaneurysm (FAP) is a complication following femoral artery puncture, with an incidence rate of 0.2%-5.5% post-cardiac catheterization procedures. Management typically involves observation or interventional treatments such as ultrasound-guided compression (UGC) or ultrasound-guided thrombin injections. This study compares the efficacy and safety of ultrasound-guided autologous blood clot injection (UGCI) with C-clamp vascular closure device-assisted UGC in treating FAP. MATERIALS AND METHODS: Conducted at a high-volume training and research center, this prospective study enrolled patients with iatrogenic FAP post-femoral artery puncture. Patients were randomized into two treatments: UGC with a C-clamp device or UGCI. Primary endpoints were thrombosis induction within 24 h, average procedure time, and length of hospital stay (LOS). RESULTS: The study included 105 patients with 51 undergoing UGCI and 54 undergoing UGC. UGCI achieved a primary success rate of 96% versus 63% for UGC. The mean procedure duration for UGCI was significantly shorter (22 min) compared with UGC (49 min, p ⩽ 0.0001). LOS was also reduced in the UGCI group (1.5 days) compared to the UGC group (4.5 days). Complication rates were low for both procedures, with one deep vein thrombosis and one infection observed in the UGC group. CONCLUSION: UGCI demonstrated to be a safe, efficient, and faster alternative for treating iatrogenic FAPs with a higher success rate, reduced LOS, and similar low complication rates compared to UGC. This study suggests that UGCI could be considered a preferred method for the management of FAP post-femoral artery catheterization.

Left anterior descending coronary artery-left circumflex coronary artery bifurcation angle and severity of coronary artery disease; is there any correlation? A cross-sectional study.

Background and Aims: The aim of this study is to evaluate the association of coronary computed tomography angiography derived (CCTA) plaque characteristics and the left anterior descending coronary artery (LAD) and left circumflex coronary artery (LCX) bifurcation angle with severity of coronary artery disease (CAD). Methods: All the stable patients with suspected CAD who underwent CCTA between January to December 2021 were included. Correlation between CCTA-derived aggregated plaque volume (APV), LAD-LCX angle, remodeling index (RI), coronary calcium score with Gensini score in conventional angiography were assessed. One hundred and twenty-two patients who underwent both CCTA and coronary angiography were analyzed. Results: Our analysis showed that the median (percentile 25% to percentile 75%) of the APV, LAD-LCx angle, and calcium score were 31% (17%-47%), 58° (39°-89°), and 31 (0-186), respectively. Also, the mean ± SD of the RI was 1.05 ± 0.20. Significant correlation between LAD-LCx bifurcation angle (0.0001-0.684), APV (0.002-0.281), RI (0.0001-0.438), and calcium score (0.016-0.217) with Gensini score were detected. There was a linear correlation between the mean LAD-LCx bifurcation angle and the Gensini score. The sensitivity and specificity for the cut-off value of 47.5° for the LAD-LCX angle were 86.7% and 82.1%, respectively. Conclusion: There is a direct correlation between the LAD-LCx angle and the Gensini score. In addition to plaque characteristics, anatomic-based CCTA-derived indices can be used to identify patients at higher risk for CAD.

Assessment of lytic therapy effect in patients with intermediate-high risk pulmonary embolism for prevention of chronic thromboembolic pulmonary hypertension: A randomized, double-blind trial.

Background and Aims: This study aims to compare the effectiveness of thrombolytic therapy and anticoagulation in preventing chronic thromboembolic pulmonary hypertension (CTEPH). Method: A total of 60 patients with intermediate-high risk pulmonary embolism (PE) were randomly assigned to receive either thrombolytic therapy (n = 30) or anticoagulation (n = 30). Results: Echocardiographic assessments demonstrated no significant differences between the two treatment approaches in terms of right ventricular size (RVS) (on discharge in thrombolytic group: 31.17 ± 3.43 vs. anticoagulant group: 32.73 ± 5.27, p = 0.912), tricuspid annular plane systolic excursion (TAPSE) (on discharge in thrombolytic group: 17.66 ± 2.39 vs. anticoagulant group: 16.73 ± 2.93, p = 0.290), and systolic pulmonary artery pressure (SPAP) (on discharge in thrombolytic group: 32.93 ± 9.73 vs. anticoagulant group: 34.46 ± 9.30, p = 0.840). However, significant changes were observed in all assessed parameters within each treatment group (p < 0.001). The 6-month follow-up showed no significant difference between the two groups in terms of CTEPH incidence (p = 0.781) or functional class of the patients (p = 0.135). Conclusion: Based on the findings of this study, neither thrombolytic therapy nor anticoagulation demonstrated superiority over the other in reducing adverse outcomes associated with intermediate-high risk PE, including right ventricular size, SPAP, TAPSE, or CTEPH.

Antianginal effects of empagliflozin in patients with type 2 diabetes and refractory angina; a randomized, double-blind placebo-controlled trial (EMPT-ANGINA Trial).

INTRODUCTION: Sodium-glucose cotransporter 2 (SGLT2) inhibitors are emerging antidiabetic agents with various potential cardiovascular benefits. The EMPT-ANGINA trial examined the effect of empagliflozin on the angina burden in those with concurrent type 2 diabetes mellitus (T2DM) and refractory angina (RA). METHOD: In this 8-week, double-blind, randomized, placebo-controlled trial, 75 patients with T2DM and RA were randomly assigned to one of two groups: empagliflozin (n = 37) and placebo (n = 38). The primary outcome was an improvement in angina, which was assessed by the Seattle Angina Questionnaire (SAQ). The secondary outcomes of this study included alterations in the SAQ domains and exercise test components. RESULTS: The mean age of individuals in the empagliflozin and placebo groups was 67.46 ± 9.4 and 65.47 ± 7.0 years, respectively (p = .304). Patients who received empagliflozin showed a significant improvement in both the primary endpoint, which was the SAQ Summary Score (192.73 ± 20.70 vs. 224 ± 25.36, p < .001) and the secondary endpoints. Exercise test components, including treadmill exercise duration, time till angina, 1 mm ST-segment depression onset, and heart rate (HR) recovery, were all significantly improved in the empagliflozin group. This positive impact was reached with no clinically significant changes in resting and exertion HR or blood pressure. There were no significant side effects in the empagliflozin group (p = .125). CONCLUSION: Empagliflozin can be safely added as a metabolic modulator agent to existing antianginal medications in individuals with concurrent T2DM and RA to reduce angina symptoms and enhance exercise capacity with minimal side effects.

The Impact of the COVID-19 Pandemic on Hospitalization Rates due to Prosthetic Valve Thrombosis.

Background: Studies have shown a decline in the admission rates of various diseases during the COVID-19 pandemic. Prosthetic valve thrombosis (PVT) is a rare condition followed by surgical or transcatheter valvular interventions. Considering the lack of data on hospitalization rates due to PVT during the pandemic, this study evaluated the implications of the COVID-19 pandemic on PVT admissions and characteristics in a tertiary referral center. Methods: Data from all the consecutive patients hospitalized due to PVT between February 2020 and February 2021 (the first year of the pandemic) were collected from medical records and compared clinically with the corresponding time before the pandemic (February 2019 through February 2020). Variables of interest included the number of hospitalization, patient and valve characteristics, diagnostic and management strategies, and in-hospital events. Results: Forty patients (32.5% male, age: 54.0 [46.5-62.0 y] comprised the study population. We observed a considerable decline in hospitalization rates during the pandemic, from 31 to 9 patients. Admitted patients were 8 years younger, had a higher proportion of the New York Heart Association functional class III or IV symptoms (44.4% vs 22.6%), were more often treated with fibrinolysis (33.3% vs 22.6%) or surgical approaches (33.3% vs 22.6%), and were discharged 6 days sooner. Conclusion: We described a reduction in PVT hospitalization. Patients presented with a higher proportion of severe dyspnea and had increased treatment with fibrinolysis/surgical approaches. These observations highlight the necessity of the active surveillance of patients with prosthetic valves by caregivers for timely diagnosis and appropriate management during the pandemic.

Five-Year Survival and Complications of Thoracic Endovascular Aortic Repair (TEVAR): A Single Tertiary Center Registry for All-Comers Patients.

INTRODUCTION: Studies on the mid and long-term outcomes of thoracic endovascular aortic repair (TEVAR) are scarce. This study aimed to investigate the long-term outcomes of TEVAR for all-comers patients with various types of thoracic aortic pathologies, predominantly thoracic aortic dissections and thoracic aortic aneurysms. METHODS: Between January 2005 and December 2015, 123 consecutive patients with thoracic aortic pathologies underwent TEVAR. The patients were divided into groups based on aortic pathologies (dissections or aneurysms) and the type of procedure (hybrid TEVAR or non-hybrid TEVAR). Mortality, complications, and reintervention rates were compared between these four groups. The Kaplan-Meier curve and the Cox regression analysis were employed to estimate survivals and factors associated with 5-year mortality. RESULTS: One hundred twenty-three consecutive patients with various aortic pathologies undergoing TEVAR were evaluated. Hypertension (79.7 %) and smoking (39 %) were the most common comorbidities in the study population. The patients were followed up for a mean duration of 58.1 ± 7.1 months to evaluate the postprocedural surveillance. Most complications occurred in the dissection and hybrid groups; however, these differences were nonsignificant. The overall 5-year surveillance and reintervention rates were 65 % and 12.1 %, respectively. A significant difference existed in 5-year survival between the patients with aneurysmal and aortic dissection pathologies based on the log-rank test (P = 0.01). On the other hand, no significant differences were observed in 5-year survival between the patients who underwent hybrid and non-hybrid TEVAR. The Cox regression analysis confirmed that chronic kidney disease, previous coronary artery bypass grafting, age >65 years, platelet counts <150∗ 103/µL, aneurysmal aortic pathology, and ejection fraction ≤ 50 % were predictors of 5-year mortality. CONCLUSIONS: The long-term outcomes of TEVAR for various aortic pathologies disclosed that this procedure was well-tolerated in a group of patients with high comorbid conditions. The five-year survival rate of TEVAR for thoracic aortic dissections was more favorable than that for thoracic aortic aneurysms, but there were no significant differences between hybrid and non-hybrid procedures regarding the mortality rate.

Comparison of Pulmonary Emboli Management Between Pulmonary Emboli Response Team and the Conventional Method: The First Study From Iran.

BACKGROUND: We aimed to evaluate the effectiveness of the Pulmonary Embolism Response Team (PERT) for intermediate-high risk and high-risk pulmonary embolism (PE) patients. METHODS: This single-blind clinical trial was performed in 2019-2021, evaluating patients with intermediate-high risk and high risk of PE. Patients in the intervention group were managed by the PERT team, and treatment plans were implemented as soon as possible. Patients in the other group received conventional PE treatments based on the hospital protocols. We compared the primary outcome of short-term mortality between the 2 groups and secondary outcomes, including right ventricle indices, hospital length-of-stay, time to decision, 30-day and in-hospital bleeding. RESULTS: Data of 74 patients were analyzed. We found no significant differences between the 2 groups regarding short-term mortality (P = 0.642), bleeding, and other complications. However, the length-of-stay and time to decision were significantly lower in patients treated by the PERT team (P < 0.001 for both). Further evaluations revealed that patients in the intervention group had a more significant reduction in the right ventricle size and systolic pulmonary pressure compared with the control group (P = 0.015, P = 0.039, respectively). In addition, tricuspid annular plane systolic excursion and fractional area change increased more in the intervention group (P = 0.023, P = 0.016, respectively). CONCLUSIONS: The PERT team led to significantly less time to make decisions, and it was able to select patients for advanced treatments more appropriately. Due to these facts, patients treated by PERT had significantly lower hospitalization duration and better right ventricle indices compared to controls.

The relationship between cardiological parameters and PCR in patients with coronavirus infection: A cross-sectional study.

Cardiovascular injuries induced by SARS CoV-2 have been reported repeatedly in various studies. Therefore, it is necessary to understand cardiac complications at a low cost, quickly. This study aimed to determine the relationship between cardiological parameters and polymerase chain reaction (PCR) in patients with coronavirus infection. : Patients who were admitted to the emergency department due to the ongoing pandemic, all patients with similar symptoms to coronavirus disease 2019 infection were initially admitted to the respiratory emergency room and underwent subsequent evaluations to confirm or rule out SARS-COV2 infection symptoms were assessed for eligibility. Patient were categorized into 2 groups 1. Positive PCR and negative PCR groups. Binary logistic regression was performed to assess the effect of several factors on the likelihood of developing positive troponin, reduced ejection fraction (EF), and Positive brain natriuretic peptide (BNP). Among 195 patients included, 115 (58.9%) had positive PCR. Patient in the positive PCR and negative PCR were 58.04 ±â€…18.03 and 59.19 ±â€…15.38 years of age, respectively. Patients in the "positive PCR" were significantly less likely to have chronic kidney disease (6.69% vs 17.5%, P value: .022), consume calcium channel blockers (6.69% vs 18.75%, P value:0.012). At the univariable level, positive PCR was significantly associated with fewer odds for positive BNP (OR:0.46, P = .019); nevertheless, the association was no longer significant after adjusting for confounders (adjusted OR:0.56, P = .158). Unadjusted positive PCR results were not found to have a significant association with positive troponin or reduced EF. Likewise, multivariable regression revealed no association between positive PCR and positive troponin (aOR:1.28, P = .529) and reduced EF (aOR:0.65, P = .369). PCR positivity did not result in positive troponin and BNP and did not appear to decrease EF. In other words, serial troponin and BNP checks and initial echocardiography in coronavirus disease 2019 respiratory emergencies do not make significant differences in diagnostic and therapeutic management and inpatient outcomes of patients with positive or negative PCR and are not specific findings. Evidence suggests some coronavirus-induced cardiac complications will be manifested in the long term.

Caspofungin-Induced Cardiotoxicity in Patients Treating for Candidemia.

Echinocandins selectively inhibit fungal cell wall synthesis and, therefore, have few side effects. However, there are reports of hemodynamic and cardiac complications. We conducted this study to investigate the effects of caspofungin both on the noninvasive echocardiographic indices of myocardial function and myocardial injury based on serum high-sensitivity cardiac troponin I (hs-cTnI) levels. This study was conducted on patients treated for candidemia. The hs-cTnI level and echocardiographic parameters were measured before and 1 h after the infusion of the induction dose of caspofungin. Data were compared between central and peripheral venous drug administration routes. Fifteen patients were enrolled in the study. There were no significant differences in the echocardiographic parameters between the baseline and post-treatment period. The mean hs-cTnI level exhibited a significant rise following drug administration (0.24 ± 0.2 ng/mL vs 0.32 ± 0.3 ng/mL; p = 0.006). There was also a significant difference concerning the hs-cTnI level between central and peripheral venous drug administration routes (p = 0.034). Due to differences in the hs-cTnI level, it appears that the administration of caspofungin may be associated with myocardial injury. Our findings also showed a higher possibility of cardiotoxicity via the central venous administration route.

Ventricular repolarization heterogeneity in patients with COVID-19: Original data, systematic review, and meta-analysis.

BACKGROUND: Coronavirus disease-2019 (COVID-19) has been associated with an increased risk of acute cardiac events. However, the effect of COVID-19 on repolarization heterogeneity is not yet established. In this study, we evaluated electrocardiogram (ECG) markers of repolarization heterogeneity in patients hospitalized with COVID-19. In addition, we performed a systematic review and meta-analysis of the published studies. METHODS: QT dispersion (QTd), the interval between T wave peak to T wave end (TpTe), TpTe/QT (with and without correction), QRS width, and the index of cardio-electrophysiological balance (iCEB) were calculated in 101 hospitalized COVID-19 patients and it was compared with 101 non-COVID-19 matched controls. A systematic review was performed in four databases and meta-analysis was conducted using Stata software. RESULTS: Tp-Te, TpTe/QT, QRS width, and iCEB were significantly increased in COVID-19 patients compared with controls (TpTe = 82.89 vs. 75.33 ms (ms), p-value = .005; TpTe/QT = 0.217 vs. 0.203 ms, p-value = .026). After a meta-analysis of 679 COVID-19 cases and 526 controls from 9 studies, TpTe interval, TpTe/QT, and TpTe/QTc ratios were significantly increased in COVID-19 patients. Meta-regression analysis moderated by age, gender, diabetes mellitus, hypertension, and smoking reduced the heterogeneity. QTd showed no significant correlation with COVID-19. CONCLUSION: COVID-19 adversely influences the ECG markers of transmural heterogeneity of repolarization. Studies evaluating the predictive value of these ECG markers are warranted to determine their clinical utility.

Clinical Features and Prognoses of Middle-Aged Women With ST-Elevation Myocardial Infarction With a Focus on Spontaneous Coronary Artery Dissection.

BACKGROUND: Spontaneous coronary artery dissection (SCAD) has become an increasingly recognized cause of acute coronary syndrome, particularly in young women, over the last decade. The goal of this study was to determine the prognoses and characteristics of adult women with SCAD who presented with ST-elevation myocardial infarction (STEMI). METHODS: This retrospective cohort study enrolled all adult women under the age of 60 who had undergone coronary artery angiography in the setting of STEMI. The patients were divided into 3 groups based on their angiographic characteristics: STEMI-SCAD (STEMI due to SCAD), STEMI-ATH (STEMI caused by an atherosclerotic lesion), and STEMI-others (STEMI due to other etiologies including Takotsubo cardiomyopathy and myopericarditis, as well as STEMI despite a normal epicardial coronary angiography). RESULTS: Fifteen women out of 311 female patients aged below 60 years with STEMI were diagnosed with SCAD (4.8%). There were no significant differences in body mass index, hypertension, dyslipidemia, smoking status, opium addiction status, family history, previous percutaneous coronary intervention, coronary artery bypass grafting, and cerebrovascular accidents between the STEMI-SCAD and STEMI-ATH groups. Nevertheless, the STEMI-SCAD and STEMI-others groups were more likely to be younger, less likely to be diabetic, and less likely to have 3 cardiovascular risk factors or more than was the STEMI-ATH group. The left anterior descending artery was the most common culprit lesion in the STEMI-SCAD group (80%) and the other 2 groups. Out of the 311 patients, 7 patients died during the index hospitalization: 1 patient in the STEMI-SCAD group, 6 patients in the STEMI-ATH group, and 0 patients in the STEMI-others group. None of the patients in the STEMI-others group experienced any major adverse cardiac events during the follow-up. In the other 2 groups, the most experienced outcomes were myocardial infarction and in-hospital cardiac death, followed by target lesion revascularization and target vessel revascularization. CONCLUSIONS: STEMI-SCAD is one of the known causes of STEMI in young women. Still, despite the complexity of revascularization in our patients with STEMI-SCAD, they had more favorable prognoses in both conservative and revascularization management modalities than our patients with STEMI-ATH.

Perioperative Cardiac Troponin T and Risk of Postoperative Atrial Fibrillation in Coronary Artery Bypass Graft Surgery.

BACKGROUND: Postoperative atrial fibrillation (AF) is a common complication after cardiac surgery. We investigated whether perioperative cardiac troponin T (cTnT) is associated with the risk of AF after coronary artery bypass grafting (CABG). METHODS: Two thousand four hundred twenty-one patients with isolated CABG were studied. High sensitivity cTnT (hs-cTnT) was assessed before and then at 80 hour and 24 hour after the operation. Logistic regression models were applied to investigate the association of perioperative hs-cTnT with postoperative AF. The ROC curve analysis was applied to determine the optimal cutoff values. RESULTS: Postoperative AF was occurred in 356 (14.7%) patients. Age (adjusted odds ratio [ORs] 1.087-1.090), male gender (OR 1.390), left atrium size (ORs 1.055-1.111), on-pump coronary bypass (OR 1.561), and application of intra-aortic balloon pump (ORs 2.890-2.966) were independently associated with AF. Preoperative hs-cTnT was associated with AF in patients with off-pump coronary bypass (ORs 1.997-2.375). However, the area under the curve for preoperative hs-cTnT was 0.625 in this group. On-pump coronary bypass had major influence on postoperative hs-cTnT levels regardless of the occurrence of AF. CONCLUSIONS: Preoperative hs-cTnT level is associated with the risk of AF after isolated CABG in patients undergoing off-pump coronary bypass, but the accuracy of this biomarker is yet inadequate. Postoperative levels of hs-cTnT have no predictive value considering large influence by the surgical technique and the cardiac surgery itself. Therefore, perioperative hs-cTnT is not a clinically useful biomarker for predicting AF following CABG.

Evaluating value of positive T wave in lead V1 and TV1 > TV6 pattern in predicting significant coronary artery disease in patients undergoing coronary angiography.

BACKGROUND: The aim of this study was to predict significant coronary artery disease (CAD) in patients undergoing coronary angiography. METHODS: In this cross-sectional study, data of 384 patients who underwent angiography during 2015-2017 were reviewed. Electrocardiograms (ECGs) were evaluated in terms of having positive T wave in lead V1 (TV1) described as T wave with amplitude of more than 0.15 mV and angiography records were assessed for presence of significant CAD defined as presence of ≥ 70% internal diameter stenosis in at least one major epicardial coronary artery or more than 50% stenosis in left main artery (LMA). RESULTS: Out of 384 patients who participated in this study with mean age of 63.6 ± 10.2 years (40-89 years), 71.6% showed positive TV1 and significant CAD simultaneously and left anterior descending artery (LAD) and left circumflex artery (LCX) lesions were more frequently reported in coronary angiography. Based on chi-square test, the prevalence of significant CAD was obviously more in those with positive TV1 as compared to those without this finding [odds ratio (OR) = 2.74, 95% confidence interval (CI): 1.80-4.19, P < 0.001]. Mann-Whitney test showed significant difference in number of coronary arteries involved in CAD between presence of positive and negative T wave in lead V1 (P < 0.001). Great number of patients with significant CAD had remarkably higher T wave amplitude in lead V1 in comparison to lead V6 (OR = 6.22, 95% CI: 3.14-12.30, P < 0.001). CONCLUSION: Positive TV1 and TV1 > TV6 pattern can be considered as a predictor for significant CAD in patients with otherwise normal ECG.

The relationship of the changes in lateral leads I and aVL in electrocardiogram with echocardiography and coronary angiography findings in patients with acute coronary syndrome.

BACKGROUND: Electrocardiographic (ECG) study is a principle for the symptoms contributed to the acute myocardial infarction (AMI)/acute coronary syndrome (ACS). The diagnosis of involved coronary artery based on ECG changes is still a challenge. This study is aimed to evaluate the association of mere changes in I and aVL leads with the involved region found through echocardiography and involved coronary artery through angiography. METHODS: This cross-sectional study was conducted on 100 patients referred with AMI/ACS symptoms that had mere ECG changes in I and aVL leads (ST elevation + Q wave/ST depression + inverted-T). Transthoracic echocardiography (TTE) and coronary angiography (CAG) were performed for the patients. The correlation of ECG with echocardiography and angiography was assessed. RESULTS: Among the studied population, 39 patients (39%) were women with the mean ± standard deviation (SD) of age of 64.60 ± 9.39 years. There was no significant association between ECG changes in leads I and aVL with neither the stenosis of first diagonal (D1) coronary artery found through angiography (P = 0.580) nor the mid-anterior wall dyskinesia found through echocardiography (P = 0.380). A remarkable association between the echocardiographic findings representing mid-anterior wall ischemic dyskinesia with the stenosis of D1 coronary artery was detected (P < 0.001). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 100%, 54.54%, 94.68%, and 100% were respectively found as the diagnostic values of mentioned factors. CONCLUSION: Our findings showed significant association between D1 involvement and mid-anterior dyskinesia in echocardiography, while the changes in ECG were associated neither with echocardiographic nor angiographic outcomes.

15-Year lipid profile effects on cardiovascular events adjusted for cardiovascular risk factors: a cohort study from Middle-East.

BACKGROUND: Dyslipidaemia is a risk factor for cardiovascular disease (CVD); however, there are only a few long-term cohort studies. The aim of this unique study is to evaluate the effects of several lipid markers on cardiovascular outcomes during a 15-year follow-up from the Isfahan cohort study (ICS). METHODS: This ongoing cohort study was started in 2001 in three cities of Iran. The study population includes 5432 individuals older than 35 years and with Iranian citizenship. All of the patients were evaluated every 2 years by telephone and a full medical examination with blood sampling was conducted every 5 years. The data were recorded in our checklists. Dyslipidaemia was defined according to the ATPIII criteria. Our endpoints in this study were any cardiovascular events such as stroke, sudden cardiac death, unstable angina or myocardial infarction (MI). RESULTS: cardiovascular events were significantly higher in males, older people, diabetics, smokers, patients with higher BMIs, higher blood pressure, dyslipidaemia and less educational level, physical activity index and global dietary index. Our adjusted multivariable analysis (for cardiovascular risk factors and demographic factors) revealed that dyslipidaemia could increase the risk of 15-year cardiovascular events by 1.59 times (HR = 1.59 [1.23-2.06], p value < .001) adjusted for demographic factors and baseline cardiovascular risk factors. CONCLUSIONS: Dyslipidaemia, as an independent risk factor, was associated with future cardiovascular events. In this regard, serum lipid screening can help to decrease the risk of long-term cardiovascular events.

The relationship between global longitudinal strain and pulmonary function tests in patients with scleroderma and normal ejection fraction and pulmonary artery pressure: a case-control study.

This study examined the relationship between global longitudinal strain (GLS) and pulmonary function tests (PFT) in patients with systemic sclerosis (SS) and normal ejection fraction (EF) and pulmonary artery pressure (PAP) and healthy controls. Sixty patients in two groups underwent extensive screening, including echocardiography, physical examination, the modified Rodnan Skin Score, and pulmonary function tests. Pulmonary interstitial disease was diagnosed by the pulmonary function test and by CT scan in case of indication. GLS score was computed as the mean peak systolic strain for 17 segments. The mean GLS score was - 18.36 ± 2.1 in the case group and - 20.66 ± 1.6 in the control group (P value < 0.001). GLS scores had a significant inverse relationship with the forced expiratory volume in one second (FEV1) to forced vital capacity (FVC) ratio (P value = 0.049) and both FEV and FVC in patients younger than 35 years old (P = 0.046 and 0.049, respectively). GLS scores had no significant relationship with time elapsed since the onset of skin manifestations, and Raynaud phenomenon, Rodnan score, EF, systolic PAP, or the six-minute walk test results. The patients' six-minute walk test had a significant positive relationship with FVC and right ventricular end diastolic diameter (P value = 0.018 and 0.047, respectively). According to our findings, GLS is significantly lower in patients with SS (with normal EF & PAP) than in healthy individuals. It is also related with certain pulmonary function indices including FEV1/FVC. The reduction in GLS is associated with reduced pulmonary function strength.