Predictive factors for type A aortic dissection mortality based on electrocardiogram parameters and clinical presentations.

BACKGROUND: Aortic dissection is a rare but potentially lethal disorder and may be associated with electrocardiogram (ECG) changes. In this study, we aim to investigate ECG-related parameters alongside clinical presentations of type A aortic dissection to come up with the predictive factors for the severity of the disease and its mortality rate. METHODS: In this retrospective study, 201 patients with type A aortic dissection were studied between March 2015 and March 2020. Two expert cardiologists blinded to the diagnosis studied former and new patients' ECGs and recorded changes. RESULTS: Two-hundred and one patients, including 143 (71.1%) men and 58 (28.9%) women, presented with acute dissection of the aorta, were studied. Forty-four (21.8%) and 84 (41.7%) patients had ST-segment elevation and depression in ECG, respectively. Bivariate analysis revealed that higher heart rate (p = 0.006), longer QTc (p = 0.044), and ST-segment elevation in aVR lead (p = 0.044) were associated with mortality in the patients. Multivariate regression showed higher heart rate (OR = 1.022, CI = 1.003-1.041, p = 0.012) and ST-segment elevation in aVR (OR = 4.854, CI = 2.255-10.477, p < 0.001) were independently associated with increased odds of mortality in aortic dissection patients. ROC curve analysis showed heart rate equal to or >60 per minute (AUC = 0.625, sensitivity = 86%, specificity = 10%, p = 0.019) and ST-segment elevation in aVR >0.5 mm (AUC = 0.854, sensitivity = 75%, specificity = 92%, p < 0.001) were associated with a higher mortality rate. CONCLUSION: Heart rate equal or >60 and ST-segment elevation >0.5 mm in aVR lead can be used as predictive factors for mortality of patients with type A aortic dissection.

Relationship between dietary variety, adequacy, moderation, and balanced diet and cardiovascular risk factors.

BACKGROUND: The relationship between dietary variety, adequacy, moderation, and balanced diet as diet quality indices and cardiovascular risk factors has not been yet evaluated amongst patients with Mmyocardial Iinfarction (MI). METHOD: This cross-sectional study was conducted on 225 males and 93 females with MI who were admitted in two heart hospitals, Shiraz, Iran from November 2019 to April 2020. Dietary intake was assessed using a validated food frequency questionnaire and the Diet Quality Index-International (DQI-I). DQI-I included four subscales, namely variety (20 scores), adequacy (40 scores), moderation (30 scores), and balanced diet (10 scores). RESULTS: The mean age of the participants was 54 ± 8 years. The mean scores of total DQI-I and variety, adequacy, moderation, and balanced diet subscales were 58 ± 12.2, 12.7 ± 3.8, 28.5 ± 7.0, 9.88 ± 5.6, and 7.8 ± 1.1, respectively. The results showed that waist circumference (WC) was influenced by adequacy (-0.26 ± 0.04) and moderation (-0.28 ± 0.03) subscales, while body mass index (BMI)was only related to the moderation subscale (0.15 ± 0.07). Additionally, low density lipoprotein (LDL) cholesterol was influenced by variety (-0.18 ± 0.01), adequacy (-0.14 ± 0.02), moderation (-0.2 ± 0.02), and balanced diet (-0.2 ± 0.003) subscales, while total cholesterol was associated with the adequacy subscale (-0.18 ± 0.01). In addition, high density lipoprotein (HDL) cholesterol was related to variety (0.16 ± 0.03), moderation (0.14 ± 0.04), and balanced diet (0.13 ± 0.01) subscales,while triglyceride was only influenced by the variety subscale (-0.15 ± 0.004). CONCLUSION: Dietary advice based on variety, adequacy, moderation, and balanced diet could be useful in practice to provide personalized messages to improve the risk factors amongst patients with MI.

Fatal eosinophilic coronary periarteritis leads to dissection in a young patient: A case report.

Eosinophilic coronary periarteritis (ECPA) is a poorly studied type of coronary arteritis. It causes myocardial ischemia and most cases are diagnosed at autopsy. We report the case of a 35-year-old woman who presented with sudden unexpected cardiac arrest and was brought to the emergency ward. Cardiopulmonary resuscitation was started by ambulance paramedic. On arrival, the patient was transferred to the catheterization laboratory due to sudden aborted cardiac death. The angiography was performed and dissection of the left main coronary artery, extended to the left anterior descending artery was detected. Pathological study confirmed ECPA. It appears that young and healthy patients with a history of intermittent vasospastic angina should be evaluated for ECPA. .

Baseline and postoperative levels of C-reactive protein and interleukins as inflammatory predictors of atrial fibrillation following cardiac surgery: a systematic review and meta-analysis.

BACKGROUND: Postoperative atrial fibrillation (POAF) is a leading arrhythmia with high incidence and serious clinical implications after cardiac surgery. Cardiac surgery is associated with systemic inflammatory response including increase in cytokines and activation of endothelial and leukocyte responses. AIM: This systematic review and meta-analysis aimed to determine the strength of evidence for evaluating the association of inflammatory markers, such as C-reactive protein (CRP) and interleukins (IL), with POAF following isolated coronary artery bypass grafting (CABG), isolated valvular surgery, or a combination of these procedures. METHODS: We conducted a meta-analysis of studies evaluating measured baseline (from one week before surgical procedures) and postoperative levels (until one week after surgical procedures) of inflammatory markers in patients with POAF. A compre-hensive search was performed in electronic medical databases (Medline/PubMed, Web of Science, Embase, Science Direct, and Google Scholar) from their inception through May 2017 to identify relevant studies. A comprehensive subgroup analysis was performed to explore potential sources of heterogeneity. RESULTS: A literature search of all major databases retrieved 1014 studies. After screening, 42 studies were analysed including a total of 8398 patients. Pooled analysis showed baseline levels of CRP (standard mean difference [SMD] 0.457 mg/L, p < 0.001), baseline levels of IL-6 (SMD 0.398 pg/mL, p < 0.001), postoperative levels of CRP (SMD 0.576 mg/L, p < 0.001), postoperative levels of IL-6 (SMD 1.66 pg/mL, p < 0.001), postoperative levels of IL-8 (SMD 0.839 pg/mL, p < 0.001), and postoperative levels of IL-10 (SMD 0.590 pg/mL, p < 0.001) to be relevant inflammatory parameters significantly associated with POAF. CONCLUSIONS: Perioperative inflammation is proposed to be involved in the pathogenesis of POAF. Therefore, perioperative assessment of CRP, IL-6, IL-8, and IL-10 can help clinicians in terms of predicting and monitoring for POAF.