ZipFix Versus Conventional Sternal Closure: One-Year Follow-Up.

BACKGROUND: The present study aimed to compare postoperative complications commonly revealed after sternotomy closure by new sternal ZipFix™ (Synthes GmbH, Oberdorf, Switzerland) implant and conventional steel wire. METHODS: Among the initial 360 subjects, 326 patients enrolled in this randomised control trial who were candidates for cardiac surgery from April 2014 to March 2015. After the surgery, the sternal closure was randomly done with poly-ether-ether-ketone (PEEK) based sternal ZipFix (ZF) on the sternal body (n=168) or with conventional wires (CWs) (n=158). Patients were followed postoperatively as well as 1, 3, 6, and 12 months after discharge regarding postoperative complications such as pain severity, dehiscence, and infection including incisional infections (superficial or deep), and organ/space infection (mediastinitis or osteomyelitis). RESULTS: The mean age of the ZF and CW groups were 63.58±10.9 and 62.42±7.1years, respectively (p=0.262). In addition, there was no significant difference between the two groups' baseline characteristics (p>0.05). Our study showed higher mean pain severity score in the conventional closure group compared with ZipFix closure group at all study time points (p<0.001). Infection was seen in 2.76% of the overall participants with no significant difference of incisional and organ infection between the two groups throughout the study. After 1-month follow-up, five patients in the CW group had sternal dehiscence whereas no patients in ZF had dehiscence (p<0.001). CONCLUSIONS: Our trial demonstrates greater clinical advantages in terms of pain and sternal dehiscence post surgery by using sternal ZipFix compared to conventional steel wire.

Effects of selenium supplementation on expression of SEPP1 in mRNA and protein levels in subjects with and without metabolic syndrome suffering from coronary artery disease: Selenegene study a double-blind randomized controlled trial.

Selenoprotein P (SePP) is involved in the protection against diseases. The present study is the first investigation of the effect of selenium supplementation on plasma selenium and expression of SEPP1 in mRNA and protein levels based on metabolic syndrome (MetS), in individuals suffering from coronary artery diseases. In this clinical trial, 160 patients with angiographically documented stenosis of more than 75% in each vessel were enrolled. Patients received either 200-mg selenium yeast tablets or placebo tablets orally after a meal, once daily for 60 days. The mRNA and protein levels of the selenium and SePP1 products were determined before and after the study. From the initial 160 participants, 145 subjects (71 MetS-affected individuals, 74 MetS-unaffected individuals) enrolled in this study. Comparing the selenium and placebo groups, no significant percentage changes of plasma selenium, △Ct SEPP1, or SePP were shown (P > 0.05). Moreover, beyond a significant difference for the expression of SePP in the selenium group compared to its baseline level (P < 0.05), no other significant differences were revealed for plasma selenium and △Ct SEPP1 after the intervention in either group (P > 0.05). Selenium supplementation did not affect plasma selenium or the mRNA or protein level of SePP in either groups after a 2-months intervention beyond a significant increase of SePP in the MetS group. This trial suggests that further studies should investigate the long-term use of selenium supplementation and the effect of a SePP increase on MetS as a potential therapeutic effect.

Cardiac Tamponade as a Very Rare Complication of Pseudoaneurysm of Mitral Aortic Intervalvular Fibrosa: A Case Report.

INTRODUCTION: The mitral-aortic intervalvular fibrosa (MAIVF) has a vital role in the integrity of the mitral and aortic valves. Pseudoaneurysm of the MAIVF (P-MAIVF) usually ensues as a complication of aortic valve surgery, and endocarditis can itself result in several catastrophic complications. CASE PRESENTATION: A 54-year-old male with acute dyspnea was admitted to our hospital. Upon physical and cardiac examination, low blood pressure, low O2 saturation, tachycardia, and a muffled heart were observed. Findings from the transthoracic echocardiography (TTE) were normal besides a massive pericardial effusion with clot formation in the pericardial space, and a pulsatile echo-free space at the posterior aspect of the aortic prosthesis. Accordingly, transesophageal echocardiography (TEE) was performed and confirmed the presence of a P-MAIVF that was rupturing into the pericardial space, causing cardiac tamponade. The patient presented with an unstable hemodynamic situation. A cardiac surgical operation was planned, however, cardiac arrest occurred at the time of induction. The operation was unsuccessful, and the patient expired in the operating room. CONCLUSIONS: Awareness of P-MAIVF formation after cardiac surgery, particularly after aortic valve replacement (AVR) due to an infected bicuspid aortic valve, is vital in order to prevent the occurrence of cardiac tamponade, a fatal event following this phenomenon. TEE is a modality of choice for identifying P-MAIVF in selected patients.

Metabolic Syndrome and the Risk of Ischemic Stroke.

BACKGROUND: Metabolic syndrome (MetS) is recently proposed as a predictor for the occurrence of vascular defects causing ischemic stroke. However, details on the association of MetS with stroke are scare in our region. The present study aimed to assess the predictive value of MetS and its components for stoke among the Iranian population. METHODS: A longitudinal population-based study was conducted on adults aged 35 years or older who were living in 3 districts in central part of Iran and followed for 10 years. Stroke was diagnosed using World Health Organization guidelines, and MetS was defined according to the Adult Treatment Panel-III definition. RESULTS: Among the 5398 subjects, 2021 suffered from MetS with an incidence of 37.4%. The incidence rates of stroke in those with and without MetS were 2.6% and 1.1%, respectively, with a higher significance in the former group (P = .026). Compared to the controls, participants with stroke exhibited a higher prevalence of some components of MetS including hyperglycemia and hypertension. On Cox proportional hazard analysis, the hazard ratio for a long-term risk of ischemic stroke was 1.37 overall (95% confidence interval: 1.15-1.63, P < .001) in subjects with MetS. Considering different components of MetS, hyperglycemia (hazard ratio = 1.83, P = .011) and hypertension (1.74, P = .019) could effectively predict occurrence of long-term ischemic stroke. CONCLUSION: MetS and its main components can be potent predictors for long-term ischemic stroke. Thus, the focus should be on identification and appropriate control of MetS components to prevent stroke occurrence.

Selective serotonin reuptake inhibitors and cardiovascular events: A systematic review.

BACKGROUND: Given the importance of the role of depression in predicting the outcome of cardiovascular disorders, current medications for treating depression, particularly selective serotonin reuptake inhibitors (SSRIs), are taken into consideration. This study aimed to systematically review the published findings in the use of SSRIs and the risk for cardiac events. MATERIALS AND METHODS: An independent review of the Web of Science, PubMed, Scopus, Cochrane, CINAHL, index Copernicus, and Google Scholar, up to 2014, was performed. We identified studies evaluating the effect of SSRIs, on cardiovascular events. Articles in English with full text availability, review articles, and experimental studies were included in the study. Among 150 studies reviewed based on the included keywords, 17 met the study criteria and were finally reviewed. RESULTS: The use of some types of SSRIs may prevent platelet adhesion and aggregation; control the cardiovascular risk profile including hypertension, insulin resistance, and body weight; and also inhibit inflammatory processes. The appearance of adverse cardiac events, including cardiac arrhythmias (torsade de pointes and QT prolongation), syncope, increased systolic and diastolic right ventricular volume, and the production of pro-inflammatory cytokines leading atherosclerosis development, has also been expected with the chronic use of some types of SSRIs. CONCLUSION: According to our systematic review, both beneficial and adverse cardiovascular events can be established following the chronic use of various types of SSRIs. Therefore, when taking SSRIs, the cardiovascular effect of each SSRI has to be carefully considered, based on patients' cardiovascular risk profiles.

Percutaneous coronary intervention outcomes based on American College of Cardiology/American Heart Association coronary lesion classification over 14 years - Melbourne interventional group (MIG) registry.

BACKGROUND: The American College of Cardiology / American Heart Association (ACC/AHA) introduced a coronary lesion classification in 1988 to stratify coronary lesions for probability of procedural success and complications after coronary angioplasty. Our aim is to assess the validity of the ACC/AHA lesion classification in predicting outcomes of percutaneous coronary intervention (PCI) in a contemporary cohort of patients. METHODS: Consecutive PCI procedures performed between 2005 and 2018, were divided into three periods. At each period, the ACC/AHA lesion classification (A, B1, B2, C) was analysed with respect to procedural characteristics, in-hospital and 30-day outcomes, as well as long-term mortality by linkage to the National Death Index (NDI). RESULTS: In total, 21,437 lesions were included with 7399 lesions (2005-2009), 6917 lesions (2010-2014) and 7121 lesions (2015-2018). There was a progressive increase in the number of complex lesions treated over time with ACC/AHA type C (15 %, 21 % and 26 %, p < 0.01). The rate of PCI procedural success decreased with increase in the complexity of lesions treated across all three periods (p < 0.01). Further, in-hospital and 30-day major adverse cardiovascular events (MACE), major adverse cardiac and cerebrovascular events (MACCE) increased across all three time periods (all p < 0.05). CONCLUSIONS: Our study validates the ACC/AHA lesion classification as a meaningful tool for prediction of PCI outcomes. Despite advances in PCI techniques and technology, complex lesion PCI defined by this classification continues to be associated with adverse outcomes.

Precision medicine and metabolic syndrome.

Metabolic syndrome (MetS) is one of the most important health issues around the world and a major risk factor for both type 2 diabetes mellitus (T2DM) and cardiovascular diseases. The etiology of MetS is determined by the interaction between genetic and environmental factors. Effective prevention and treatment of MetS notably decreases the risk of its complications such as diabetes, obesity, hypertension, and dyslipidemia. According to recent genome-wide association studies, multiple genes are involved in the incidence and development of MetS. The presence of particular genes which are responsible for obesity and lipid metabolism, affecting insulin sensitivity and blood pressure, as well as genes associated with inflammation, can increase the risk of MetS. These molecular markers, together with clinical data and findings from proteomic, metabolomic, pharmacokinetic, and other methods, would clarify the etiology and pathophysiology of MetS and facilitate the development of personalized approaches to the management of MetS. The application of personalized medicinebased on susceptibility identified genomes would help physicians recommend healthier lifestyles and prescribe medications to improve various aspects of health in patients with MetS. In recent years, personalized medicine by genetic testing has helped physicians determine genetic predisposition to MetS, prevent the disease by behavioral, lifestyle-related, or therapeutic interventions, and detect, diagnose, treat, and manage the disease. Clinically, personalized medicine is providing effective strategies for the prevention and treatment of MetS by reducing the time, cost, and failure rate of pharmaceutical clinical trials. It is also eliminating trial-and-error inefficiencies that inflate health care costs and undermine patient care.

The incidence and outcome of severe hyperlactatemia in critically ill patients.

This study aimed to assess the incidence, persistence, and associated mortality of severe hyperlactatemia in a large cohort of unselected critically ill patients. Also, we evaluated the association between 12 h lactate clearance, the timing of severe hyperlactatemia, and the maximum lactate levels with ICU mortality. In this retrospective, single-center study, we used data from the Multiparameter Intelligent Monitoring in Intensive Care III (MIMIC-III) database. Data extracted to screen 23,598 ICU patients for severe hyperlactatemia. A total of 23,598 critically ill patients were eligible for this study. Overall, ICU mortality in the 23,598 ICU patients was 12.1%. Of these, 760 patients had lactate concentration [Formula: see text] 10 mmol/L and ICU mortality in this group was 65%. Our findings confirm the association between hyperlactatemia and ICU mortality [odds ratio 1.42 (95% CI 1.35; 1.49; P < 0.001)]. Data for 12 h lactate clearance was available for 443 patients (276 nonsurvivable vs. 167 survival). 12 h lactate clearance yielded a high area under the curve (AUC) of 0.78, (95% CI 0.74 and 0.83). Severe hyperlactatemia is associated with extremely high ICU mortality in a heterogeneous ICU population. Lactate derived variables (the timing and persistence of severe hyperlactatemia, maximum level, and 12 h clearance) are shown to be associated with ICU mortality in patients with severe hyperlactatemia. Our results suggest that maximum lactate level and 12 h lactate clearance were clinically useful prognostic parameters for patients with severe hyperlactatemia.

Association of Selenoprotein S Expression and its Variants with Metabolic Syndrome in Subjects with Cardiovascular Disease.

BACKGROUND: Selenoproteins S (SELS or VIMP) may regulate cytokine production, and thus play a key role in the control of the inflammatory response. METHODS: This study consisted of 136 Iranian patients with cardiovascular disease (65 MetS-affected and 71 MetS un-affected individuals) in the selengene study. Expression of two variants of VIMP including VIMP I and II were analyzed in all subjects using Real-Time PCR and ELISA. RESULTS: The level of VIMP was lower in MetS+ compared to the MetS- subjects (p <0.05). We found no significant differences in quantitative expression of VIMP I and VIMP II in both groups. VIMP I reveal a reverse correlation with fasting blood sugar (FBS) (r = -0.45, p = 0.009). Moreover, SELS in protein level has negative correlation with WC (r = -0.171, p = 0.049) and positive correlation with HDL (r = 0.176, p = 0.046). CONCLUSIONS: Our study suggests that VIMP in protein level is significantly lower in MetS and shows a reverse correlation with WC and positive correlation with HDL. Therefore, with regard to the functional role of this protein, it is possible to deduce that its lower expression leads to the higher secretion of unfolded proteins into the cytosol and outside the cell, where they cannot play their exact roles in the different pathways. Moreover, the reverse correlation of VIMP I with FBS suggests further consideration of VIMP and its variant VIMP I expression in regards to potential development of major CVD risk factors.

Cardiovascular Disease Risk Assessment: Triglyceride/High-Density Lipoprotein versus Metabolic Syndrome Criteria.

BACKGROUND: As finding subjects at risk of cardiovascular diseases based on the presence of metabolic syndrome (MetS) is time-consuming for physicians, we aimed to compare the effectiveness of triglyceride (TG)/high-density lipoprotein cholesterol (HDL-C) compared to MetS criteria in identifying high-risk individuals. STUDY DESIGN: A prospective cohort study. METHODS: Isfahan cohort study was a longitudinal population-based study conducted on adults aged 35 yr or older, living in three districts in central part of Iran from Jan 2, 2001 to Sep 28, 2001. After 10 years of follow-up, participants were re-evaluated. The hazard ratio (HR) for cardiovascular disease events based on TG/HDL-C, sex-specific cut-off points, and MetS were also estimated. Akaike's information criteria (AIC) were used as indicators of the goodness of fit of the model and prediction error. RESULTS: TG/HDL-C alternate cut-off points of 3.76 and 4.42 had a strong predictive value for CVD events but did not perform as well as MetS criteria. The unadjusted HR was greatest in the high-risk individuals by the MetS criteria (HR=2.08, 95% CI: 1.80, 2.41) compared to those identified as high-risks by the TG/HDL cut-off points and continued to be greatest after adjustments in different models. Based on the AIC, the best model is adjusted for sex, age, diabetes, total cholesterol levels, current smoker, diet, physical activity, and BMI. CONCLUSION: MetS criteria appears to be a superior marker compared to TC/HDL-C to identify patients at cardiovascular risk, though lipid ratio also shows a remarkable predictive value and could be considered to achieve this goal when appropriate.

Anthropometric indices predicting incident hypertension in an Iranian population: The Isfahan cohort study.

OBJECTIVE: The aim of the present study was to assess different obesity indices, as well as their best cut-off point, to predict the occurrence of hypertension (HTN) in an Iranian population. METHODS: In a population-based study, subjects aged 35 years and older were followed for 7 years. Blood pressure was measured at baseline and after the follow-up. Anthropometry indices included body mass index (BMI), body adiposity index (BAI), the waist-to-height ratio (WHtR), the waist-to-hip ratio (WHpR), and waist and hip circumferences (WC and HC). Logistic regression was employed to calculate the odds ratio (OR) and 95% confidence intervals (CI) per standard deviation (SD) increment. The operating characteristic analysis was used to derive the best cut-off value for each index. RESULTS: Among original 6504 participants, 2450 subjects who had no cardiovascular diseases (CVD) and HTN at baseline were revisited, and 542 (22.1%) new cases of HTN were detected. There were minimal differences between most indices in the adjusted models; however, the best HTN predictors were BMI (OR per SD 1.32; 95% CI 1.12-1.56) and almost equally WC (1.35; 1.13-1.60) in men and WC (1.20; 1.04-1.39) in women. As a binary predictor, BMI with a cut-off point of 24.9 kg/m2 in men (1.91; 1.40-2.62) and WC with a cut-off point of 98 cm in women (1.57; 1.17-2.10) were the best in adjusted models. WC, WHpR, and WHtR were significantly associated with an increased risk of HTN only in participants whose weight was normal (BMI, 18.5-24.9 kg/m2). CONCLUSION: Therefore, BMI in men and WC in women were the best predictors of HTN, both as continuous and binary factors at their appropriate cut-off points.

Leptin level decreases after treatment with the combination of Radiofrequency and Ultrasound cavitation in response to the reduction in adiposity.

BACKGROUND: Obesity and overweight are major public health problem. Different-strategies have been developed for body contouring including Radiofrequency(RF) and Ultrasound(US). The aim of this study was to investigate changes in serum-leptin as a potential-modulator of food/energy intake, in overweight-women receiving RF/US and diet-therapy as well as the effect of therapy on modulation of lipid-profile and body-fat-mass. METHODS: Fifty overweight-females were enrolled in current randomized-clinical-trial and randomly divided into two groups. The case group received RF/US twice a week for 5 weeks with a low calorie diet whilst the control-group received just a low calorie diet. Demographic, biochemical markers as well as serum-leptin were determined. RESULTS: The level of leptin was reduced from 1.29 ±â€¯0.32 ng/ml to 1.14 ±â€¯0.34 ng/ml in case group, before and after therapy, respectively, whilst no significant differences were observed in the serum leptin levels of subjects in the control group. The combination of RF and US decreased the leptin-level. In particular, the mean reduction of abdominal-circumference and waist-circumference was significant (P < 0.05) after therapy. This reduction was inversely correlated with LDL levels. Weight was reduced in case and control groups and in both was significant, but no statistically significant differences were detected for weight between the groups(P < 0.93). CONCLUSION: Our findings demonstrated the reduction of the leptin after treatment with the combination of Radiofrequency/Ultrasound cavitation, which was associated with reduced body-fat-mass.

Proposal of a study protocol of a preliminary double-blind randomized controlled trial. Verifying effects of selenium supplementation on selenoprotein p and s genes expression in protein and mRNA levels in subjects with coronary artery disease: selenegene.

BACKGROUND: Selenium is the component of selenocystein amino acid, which itself is the building block of selenoproteins having diverse effects on various aspects of the human health. Among these proteins, selenoprotein P is the central to the distribution and homeostasis of selenium, and selenoprotein S as a transmembrane protein is associated with a range of inflammatory markers, particularly in the context of cardiovascular disease. It is known that selenium status outside of the normal range is considered to confer different benefits or adverse cardiovascular risk factors. Therefore, for the first time, we aimed to verify effects of Selenium supplementation on Selenoprotein P and S Genes Expression in Protein and mRNA Levels in Subjects with Coronary Artery Disease (CAD). METHODS: This is the study protocol of a double blinded randomized clinical trial on 130 subjects with angiographically documented stenosis of more than 75% in one or more coronary artery vessels. In this 60-day study, 65 patients in each group received either a 200mg selenium yeast or placebo tablets once daily. During the study, subjects were followed by phone calls and visited our clinic twice to repeat baseline measurements. We hypothesized that our finding would enable a more basic and confirmed understanding for the effect of selenium supplementation by investigating its effect on gene expression levels in people with CAD. DISCUSSION: Upon confirmation of this hypothesis, the beneficial effect of inflammation regulation by supplementation with micronutrients could be considered for subjects with CVD.

Five chambered heart: case of a huge left atrial appendage aneurysm.

Aneurysmal enlargement of the left atrial appendage is an extremely rare pathology and can predispose to adverse events, including cardiac arrest, respiratory distress, arrhythmia, heart failure, systemic thromboembolism, or rupture. It is usually diagnosed incidentally or after the occurrence of atrial tachyarrhythmias or thrombotic events in the second to fourth decades of life. We describe a rare case of a symptomatic giant congenital left atrial appendage aneurysm (LAAA) in a 26-year-old man presenting with neurologic event, in whom surgical resection of the aneurysm was successfully performed. This is the largest LAAA reported in the literature so far.

Prediction of the ischemic origin of functional mitral regurgitation in patients with systolic heart failure through posterior mitral leaflet angle.

BACKGROUND: Differentiating ischemic from non-ischemic functional mitral regurgitationý (FMR) in patients with cardiomyopathy is important in terms of the therapeutic decision-making and prognosis, but might be clinically challenging. In this study, the deformation of mitral valve (MV) indices in the prediction of the etiology of FMR was assessed using 2D transthoracic and tissue Doppler echocardiography. METHODS: This case-control study was conducted from April 2015 to January 2016 in Imam Reza Hospital in Mashhad, Iran. The participants consisted of 40 patients with ischemic cardiomyopathy (ICM) and 22 with non-ischemic dilated cardiomyopathy (DCM) who referred to the heart failure clinic. Transthoracic echocardiography was performed using the conventional 2D and tissue Doppler imaging (TDI). MV tenting area (TA), coaptation distance (CD), anterior and posterior mitral leaflet angles (AMLA and PMLA), and regional systolic myocardial velocity (Sm) were measured. RESULTS: There were no significant differences in echocardiographic indices between the two groups, besides Sm and PMLA which were significantly lower and higher, respectively, in ICM subjects in comparison with DCM patients (P = 0.002). PMLA ≥ 40 degrees and Sm ≤ 4 cm/second have a relatively high value for discriminating the ischemic from non-ischemic origin of functional MR in subjects with systolic heart failure (sensitivity: 80.0% and 70.0%, specificity: 73.0% and 77.3%; P = 0.001 and P < 0.001; respectively). Multivariable logistic regression identified PMLA and anterior Sm as major determinants for ischemic MR {Odds ratio (OR) [95% confidence interval (CI)] = 0.89 (0.82-0.96), P = 0.003, OR (95% CI) = 0.29 (0.14-0.60), P = 0.001, respectively}. CONCLUSION: The present study showed that PMLA and Sm had an independent significant association with the mechanism of FMR. These findings are suggestive of the predictive role of mitral deformation echocardiographic indices in the determination of the etiology of FMR in systolic heart failure.

Selenium Homeostasis and Clustering of Cardiovascular Risk Factors: A Systematic Review.

Selenium is a trace element required for a range of cellular functions. It is widely used for the biosynthesis of the unique amino acid selenocysteine [Sec], which is a structural element of selenoproteins. This systematic review focused on the possible relation between selenium and metabolic risk factors. The literature was searched via PubMed, Scopus, ISI Web of Science, and Google Scholar. Searches were not restricted by time or language. Relevant studies were selected in three phases. After an initial quality assessment, two reviewers extracted all the relevant data, whereas the third reviewer checked their extracted data. All evidence came from experimental and laboratory studies. Selenoprotein P is the best indicator for selenium nutritional levels. In addition, high levels of selenium may increase the risk of metabolic syndrome while the lack of sufficient selenium may also promote metabolic syndrome. selenium supplementation in subjects with sufficient serum selenium levels has a contrary effect on blood pressure, LDL, and total cholesterol. According to the bioavailability of different types of selenium supplementation such as selenomethionine, selenite and selenium-yeast, it seems that the best nutritional type of selenium is selenium-yeast. Regarding obtained results of longitudinal studies and randomized controlled trials, selenium supplementation should not be recommended for primary or secondary cardio-metabolic risk prevention in populations with adequate selenium status.

Trend of blood pressure in hypertensive and normotensive volunteers during Ramadan fasting.

INTRODUCTION: It is believed that Ramadan fasting regulates blood pressure, heart rate, and other cardiovascular risk factors. This study aimed to investigate the effect of Ramadan fasting on ambulatory blood pressure in hypertensive patients. PATIENTS AND METHODS: This prospective, observational study was carried out in two groups: one group included hypertensive patients treated with two antihypertensive agents (n=6) and the other group included healthy individuals (n=12). We performed 24-h blood pressure monitoring at four time points: before Ramadan, during the first and last 10 days of Ramadan, and 1 month after Ramadan. All hypertensive patients followed their twice-daily treatment regimen. Mean 24-h blood pressure (as well as mean blood pressure values during awake and sleep periods), body weight, and waist circumference were measured in the two groups. RESULTS: There were no significant differences in the trends of systolic and diastolic blood pressure between the hypertensive and nonhypertensive groups during Ramadan and 1 month after it. However, the trends of variations in heart rate and body weight were not significantly different in the two groups (P<0.001 and P=0.016, respectively). There was a significant increase in heart rate during the first period of Ramadan in hypertensive patients (P=0.018), whereas it improved during the post-Ramadan period in comparison with the second period of measurements (P=0.019). Furthermore, there was a significant decline in heart rate during the post-Ramadan measurement compared with that before Ramadan in the nonhypertensive group (P=0.008).In addition, there was a significant weight gain in the third period in comparison with the previous period in the hypertensive group (73.1±11 vs. 72.2±12; P=0.011). CONCLUSION: This finding indicates that Ramadan fasting might be nonthreatening for patients with essential hypertension if the treatment regimen is complied with.

Echocardiographic characteristics of isolated left ventricular noncompaction.

BACKGROUND: Although isolated left ventricular noncompaction (ILVNC) has been described almost two decades ago, our knowledge about its diagnosis, presentation, echocardiographic features and clinical outcome is sparse. We aimed to assess the echocardiographic and clinical characteristics of ILVNC in a group of patients referred to our center. METHODS: Patients who were referred to a tertiary referral center, affiliated with Mashhad University of Medical Sciences, with primary diagnosis of dilated cardiomyopathy underwent comprehensive echocardiographic evaluation. The diagnosis of ILVNC was made based on the presence of two-structural layer in myocardium; ratio of noncompacted to compacted layers more than 2, and excessive trabeculation in the left ventricle. RESULTS: Final diagnoses of ILVNC were made in 42 patients. Mean age of patients was 32.9 ± 15.6 years (ranging from 9 to 70 years). Females comprised a higher proportion of patients (61.9%) and shortness of breath was the most reported symptom among patients (47.6%). Non-compacted layers were detected in inferior and lateral segments of apex in 97.6% of patients. A total of 26 (61.9%) patients had left ventricle (LV) dysfunction (defined as ejection fraction less than 50%). The only factor that showed significant association with LV dysfunction was the number of affected segments with noncompaction (P = 0.008). Reduced ejection fraction was not associated with either age or sex (P = 0.437 and P = 0.206, respectively). CONCLUSION: Based on the result of the current study, it can be suggested that apex of the heart is the most common site of noncompaction and increasing numbers of affected segments might be associated with LV dysfunction.

Assessing Metabolic Syndrome Through Increased Heart Rate During Exercise.

The present study aimed to assess changes in resting and maximum heart rates as primary indicators of cardiac autonomic function in metabolic syndrome (MetS) patients and to determine their value for discriminating MetS from non-MetS. 468 participants were enrolled in this cross-sectional study and assessed according to the updated adult treatment panel III (ATP-III) definition of MetS. Resting and maximum heart rates were recorded following the Bruce protocol during an exercise. A receiver operating characteristic (ROC) curve was used to identify the best cutoff point for discriminating MetS from the non-MetS state. 194 participants (41.5%) were diagnosed as MetS. The mean resting heart rate (RHR) was not statistically different between the two groups (P=0.078). However, the mean maximum heart (MHR) rate was considerably higher in participants with MetS (142.37±14.84 beats per min) compared to the non-MetS group (134.62±21.63 beats per min) (P<0.001). In the MetS group, the MHR was positively correlated with the serum triglyceride level (ß=0.185, P=0.033) and was inversely associated with age (ß=-0.469, P<0.001). The MHR had a moderate value for discriminating MetS from the non-MetS state (c=0.580, P=0.004) with the optimal cutoff point of 140 beats per min. In MetS patients, the MHR was significantly greater compared to non-MetS subjects and was directly correlated with serum triglyceride levels and inversely with advanced age. Moreover, MHR can be used as a suspicious indicator for identifying MetS.

Comparison between European and Iranian cutoff points of triglyceride/high-density lipoprotein cholesterol concentrations in predicting cardiovascular disease outcomes.

BACKGROUND: High triglyceride (TG) and low high-density lipoprotein cholesterol (HDL-C) are important cardiovascular risk factors. The exact prognostic value of the TG/HDL-C ratio, a marker for cardiovascular events, is currently unknown among Iranians so this study sought to determine the optimal cutoff point for the TG/HDL-C ratio in predicting cardiovascular disease events in the Iranian population. METHOD: The Isfahan Cohort Study (ICS) is an ongoing, longitudinal, population-based study that was originally conducted on adults aged ≥ 35 years, living in urban and rural areas of three districts in central Iran. After 10 years of follow-up, 5431 participants were re-evaluated using a standard protocol similar to the one used for baseline. At both measurements, participants underwent medical interviews, physical examinations, and fasting blood measurements. "High-risk" subjects were defined by the discrimination power of indices, which were assessed using receiver operating characteristic (ROC) analysis; the optimal cutoff point value for each index was then derived. RESULTS: The mean age of the participants was 50.7 ± 11.6 years. The TG/HDL-C ratio, at a threshold of 3.68, was used to screen for cardiovascular events among the study population. Subjects were divided into two groups ("low" and "high" risk) according to the TG/HDL-C concentration ratio at baseline. A slightly higher number of high-risk individuals were identified using the European cutoff points of 63.7% in comparison with the ICS cutoff points of 49.5%. The unadjusted hazard ratio (HR) was greatest in high-risk individuals identified by the ICS cutoff points (HR = 1.54, 95% CI [1.33-1.79]) vs European cutoff points (HR = 1.38, 95% [1.17-1.63]). There were no remarkable changes after adjusting for differences in sex and age (HR = 1.58, 95% CI [1.36-1.84] vs HR = 1.44, 95% CI [1.22-1.71]) for the ICS and European cutoff points, respectively. CONCLUSION: The threshold of TG/HDL ≥ 3.68 is the optimal cutoff point for predicting cardiovascular events in Iranian individuals.