Prevalence of self-reported coronary heart disease and its associated risk factors in Tabari cohort population.

BACKGROUND: Prevalence of coronary heart disease (CHD) risk factors are increasing in developing countries. The present study aimed to assess the prevalence of self-reported CHD and evaluate the role of various risk factors on its prevalence in the Tabari cohort study (TCS) population. METHODS: The enrollment phase of TCS was performed between June 2015 and November 2017. In the current study, data were derived from information collecting from the enrollment phase of TCS. In the enrollment phase, 10,255 individuals aged 35-70 living in urban and mountainous areas of Sari (northern part of Iran) were entered into the study. Educational level, socioeconomic and marital status, history of smoking, opium and alcohol abuse/addiction, level of daily physical activity, indices of obesity, and traditional risk factors of the participants were determined. RESULTS: The prevalence of CHD was measured at 9.2%. Older individuals (P<0.001), people with a body mass index≥30kg/m2 (P<0.001), diabetics (P<0.001), and hypertensive (P<0.001) have been shown to have an increased risk for CHD compared with participants of without CHD. Furthermore, the CHD was more prevalent in individuals with higher waist circumference (P<0.001), higher low-density lipoprotein cholesterol (P<0.001), lower high-density lipoprotein cholesterol (P<0.001), and a higher waist to hip ratio (P<0.001). In addition, individuals with low socioeconomic status, illiterate people, and opium users had a higher prevalence of CHD (P<0.001). The results of the multivariable logistic regression analysis showed that the probability of CHD among individuals who had 8-10 risk factors was estimated at 8.41 (95% confidence interval: 5.75-12.31) times higher than those with less than 3 risk factors. CONCLUSION: According to the results of the present study, it seems that the prevalence of CHD in the Iranian population is relatively high.

Correlation between overweightness and the extent of coronary atherosclerosis among the South Caspian population.

BACKGROUND: Reported effects of obesity on the extent of angiographic coronary artery disease(CAD) have been inconsistent. The present study aimed to investigate the relationships between the indices of obesity and other anthropometric markers with the extent of CAD. METHODS: This study was conducted on 1008 consecutive patients who underwent coronary angiography. Body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR) were separately calculated for each patient. Extent, severity, and complexity of CAD were determined by the Gensini and SYNTAX scores. RESULTS: According to the results, there was a significant inverse correlation between the SYNTAX score with BMI (r = - 0.110; P < 0.001), WC (r = - 0.074; P = 0.018), and WHtR (r = - 0.089; P = 0.005). Furthermore, a significant inverse correlation was observed between the Gensini score with BMI (r = - 0.090; P = 0.004) and WHtR (r = - 0.065; P = 0.041). However, the results of multivariate linear regression analysis did not show any association between the SYNTAX and Gensini scores with the indices of obesity and overweight. On the other hand, the patients with an unhealthy WC had a higher prevalence of diabetes mellitus (DM) (P = 0.004) and hypertension (HTN) (P < 0.001), compared to the patients with healthy values. Coexistence of HTN and DM was more prevalent in subjects with an unhealthy WC and WHR, compared to that in those with healthy values (P = 0.002 and P = 0.032, respectively). CONCLUSION: It seems that the anthropometric indices of obesity are not the predictors of the angiographic severity of CAD. However, they are associated with an increased risk of cardiovascular risk factors and higher risk profile.

Undiagnosed inferior vena cava type of sinus venosus atrial septal defect in a middle-aged woman: A rare case report.

Sinus venosus atrial septal defect (ASD) accounts for 5% to 10% of ASDs. In contrast with the more common superior vena cava (SVC) type, the inferior vena cava (IVC) type of sinus venosus ASD with overriding IVC is extremely rare. The sinus venosus defect occur posterior to the fossa ovalis and is not regarded as true ASD. Transesophageal echocardiography (TEE) is a diagnostic procedure of choice due to close proximity of atrial septum to TEE transducer. However; it may not constantly yield detailed anatomical and functional characterization, and other imaging modalities such as cardiac magnetic resonance imaging (MRI) may be needed. We report the case of a 45-year-old woman with an undiagnosed hemodynamically significant IVC-type ASD without any anomalous drainage of pulmonary veins, who presented with progressive dyspnea.

Isolated partial right lower lobe pulmonary venous drainage into the right atrium as a cause of pulmonary hypertension in a middle-aged woman.

Partial anomalous pulmonary venous connection is a rare congenital disease characterized by drainage of one or several pulmonary veins into the systemic venous system. It is extremely rare as an isolated anomaly. We report the case of a middle-aged woman with isolated drainage of an enormously enlarged right lower pulmonary vein into the right atrium with significant left-to-right shunt, severe right ventricular enlargement, and pulmonary hypertension.

The coexistence of left ventricular non-compaction cardiomyopathy, significant coronary artery disease and massive thrombus formation in left ventricular cavity: A rare case report.

Non-compaction of the left-ventricular myocardium is an extremely rare cardiomyopathy. The most common clinical manifestations are heart failure, ventricular arrhythmia, thromboembolism, and sudden cardiac death. The condition is diagnosed by two-dimensional echocardiography or magnetic resonance imaging. We report a rare case of a 55-year-old man with coexistence of left ventricular non compaction cardiomyopathy, significant coronary artery disease and massive thrombus formation within recesses in left ventricular cavity.

Remote ischemic preconditioning to reduce contrast-induced acute kidney injury in chronic kidney disease: a randomized controlled trial.

BACKGROUND: The impact of contrast-induced acute kidney injury (CI-AKI) on patients with chronic renal disease is well-known. Remote ischemic preconditioning (RIPC) is a non-invasive method that can reduce the risk of CI-AKI, but studies on RIPC have had different results. The aim of the present study was to assess the potential impact of RIPC on CI-AKI. METHODS: In a randomized, double blinded, controlled trial, 132 patients with chronic renal dysfunction (glomerular filtration rate < 60 mL/min/m2) who underwent coronary angiography or angioplasty received adequate hydration. RIPC was performed in 66 patients by applying an upper arm blood pressure cuff. The cuff was inflated four times for 5 min to 50 mmHg above the systolic blood pressure, followed by deflation for 5 min. In the control group, the blood pressure cuff was inflated only to 10 mmHg below the patient's diastolic blood pressure. The primary endpoint was an increase in serum cystatin C ≥ 10% from baseline to 48-72 h after exposure to the contrast. RESULTS: The primary endpoint was achieved in 48 (36.4%) patients (24 in each group). RIPC did not show any significant effect on the occurrence of the primary endpoint (P = 1). In addition, when the results were analyzed based on the Mehran risk score for subgroups of patients, RIPC did not reduce the occurrence of the primary endpoint (P = 0.97). CONCLUSIONS: In patients at moderate-to-high risk of developing CI-AKI when an adequate hydration protocol is performed, RIPC does not have an additive effect to prevent the occurrence of CI-AKI. TRIAL REGISTRATION: The clinical trial was registered on (Identification number IRCT2016050222935N2 , on December 19, 2016 as a retrospective IRCT).

Congenital aortocaval fistula between right aortic sinus of Valsalva and superior vena cava: A rare case report.

Thoracic aortocaval fistula is a very rare cause of left to right shunt. Drainage of fistula into the superior vena cava (SVC) is very uncommon. Clinical symptoms depend on the size of the shunt. We report a rare case of an asymptomatic 27-year-old woman with congenital aortocaval fistula to the SVC with a small amount of left to right shunt that was considered for serial medical follow-up.

Association of dietary patterns with sociodemographic and health-related factors among coronary artery disease (CAD) patients.

This study aimed to identify the association of dietary patterns with sociodemographic and health-related characteristics among coronary artery disease patients. In this cross-sectional study, the participants were 250 patients coronary artery disease aged ≥ 40 years old. Data collection was done using questionnaires related to sociodemographics, health-related factors, and food-frequency intake information. Three dietary patterns (traditional, western, and healthy) were obtained using principal component analysis. The result showed that dietary patterns were associated with sociodemographic and health-related factors. According to the result, all the factors were taken very seriously when planning a promotional program for healthy lifestyle in prevention of CAD.

Accessory tricuspid valve leaflet and an anomalous muscle bundle in the right ventricular outflow tract in a patient with double-outlet right ventricle: a rare case report.

Double-outlet right ventricle (DORV), a clinically important congenital heart disease, occurs in 1-3% of persons with congenital heart disease. It may occur as an isolated cardiac defect, together with other cardiac lesions, or in association with extracardiac anomalies. Other rare cardiac anomalies include an anomalous muscle bundle (AMB) in the right ventricular outflow tract (RVOT) and an accessory tricuspid valve leaflet. We report a very rare case of concomitant DORV, AMB in the RVOT and accessory tricuspid valve leaflet in a 17-year-old male patient. The patient eventually died from severe decompensated heart failure. To the best of our knowledge, such a case has not been previously reported in the literature.

Contribution of depression and anxiety to impaired quality of life in survivors of myocardial infarction.

OBJECTIVE: To quantify the adverse influence of depression and anxiety assessed at the time of myocardial infarction, on the quality of life 5 years after the infarction. METHODS: The Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory (STAI) were completed in a group of 196 patients admitted in the hospital following non-fatal myocardial infarction, and the SF-12 quality of life questionnaire was administered during the 5- year follow-up. RESULTS: Regression analysis showed a strong association between baseline depression and QoL in both the physical and mental domains; the higher the depression scores, the poorer the QoL. However, anxiety present at the time of myocardial infarction did not predict later QoL. CONCLUSIONS: Depression but not anxiety following MI predicts longer-term quality of life in myocardial infarction survivors.

Non-invasive fractional flow reserve estimation using deep learning on intermediate left anterior descending coronary artery lesion angiography images.

This study aimed to design an end-to-end deep learning model for estimating the value of fractional flow reserve (FFR) using angiography images to classify left anterior descending (LAD) branch angiography images with average stenosis between 50 and 70% into two categories: FFR > 80 and FFR ≤ 80. In this study 3625 images were extracted from 41 patients' angiography films. Nine pre-trained convolutional neural networks (CNN), including DenseNet121, InceptionResNetV2, VGG16, VGG19, ResNet50V2, Xception, MobileNetV3Large, DenseNet201, and DenseNet169, were used to extract the features of images. DenseNet169 indicated higher performance compared to other networks. AUC, Accuracy, Sensitivity, Specificity, Precision, and F1-score of the proposed DenseNet169 network were 0.81, 0.81, 0.86, 0.75, 0.82, and 0.84, respectively. The deep learning-based method proposed in this study can non-invasively and consistently estimate FFR from angiographic images, offering significant clinical potential for diagnosing and treating coronary artery disease by combining anatomical and physiological parameters.

Rupture of a noncoronary sinus of Valsalva aneurysm into the left atrium: a rare cause of acute pulmonary edema.

A sinus of Valsalva aneurysm is a dilatation of the aortic wall caused by the lack of continuity between the middle layer of the aortic wall and the aortic valve. It has an incidence of <0.1%. The most common cause of a sinus of Valsalva aneurysms is congenital, although they may also be acquired. The most common complication is rupture into the right atrium or ventricle, with rupture into the left chambers occurring very rarely. We present a 40-year-old man admitted to the hospital with an acute onset of respiratory distress and pleuritic chest pain. Transthoracic echocardiography followed by transesophageal echocardiography showed rupture of a noncoronary aneurysm of Valsalva sinus into the left atrium. The jet from the fistula caused retrograde flow into the pulmonary veins.

The Effect of Acupressure on Preventing Constipation in Patients with Acute Myocardial Infarction under Primary Percutaneous Coronary Intervention.

Background: Cardiac patients are prone to experiencing constipation. The main purpose of the present study was to assess the effect of acupressure on preventing constipation in patients with acute myocardial infarction (AMI) under primary percutaneous coronary intervention. Methods: The present randomized clinical trial was conducted on 90 patients with AMI (30 patients in each group) who were randomly allocated based on inclusion criteria. The intervention was carried out among the patients with AMI on the acupressure points SJ6, LI4, ST25, and SP6 two times a day (10 am and 6 pm) for three sequential days. Results: On the first and second days of the study, all of the patients had no defecation, and the first defecation occurred on the third day of the study. In the intervention, sham, and control groups, 93.3%, 46.7%, and 50.0% had normal defecation on the third day of the study, respectively. The results of the Chi-square test revealed significant differences among the three groups (P<0.001). Conclusion: The results of the present study showed that patients with AMI in the intervention group had significant improvement in terms of stool consistency based on the Bristol stool scale. So, acupressure can be used as a nursing intervention in critical care units.

Effects of depression and anxiety symptoms on cardiac mortality following myocardial infarction: a 2-year follow-up.

OBJECTIVE: The purpose of this study was to determine the impact of symptoms of depression and anxiety on mortality in patients hospitalized for acute myocardial infarction (MI). METHODS: A total of 806 consecutive patients were screened within 15 days after MI and 24-month survival rate was ascertained. The Beck Depression Inventory and the State-Trait Anxiety Inventory were completed by patients hospitalized for MI. We tested the BDI × STAI interaction effect in addition to the BDI and STAI main effects. RESULTS: At 24 months' follow up cardiac mortality was assessed in 540 of 806 eligible patients (67% response rate); 531 of 806 for whom baseline data were collected (65.9%) were depressed and 556 (69.0%) were anxious after their MI. Fifty-five (10.2%) patients died during the 24-month follow-up. Neither state of anxiety nor depression scores at entry was different between patients who died from those who survived. CONCLUSIONS: Symptoms of depression and anxiety did not predict cardiac mortality after MI, but despite the negative results regarding the impact of depression on cardiac outcome, it should be stressed that this does not mean that physicians and cardiologists could ignore depression and anxiety.

Fractional Flow Reserve as a Standard of Reference for Ischemia Early After ST Elevation Myocardial Infarction.

BACKGROUND: The purpose of the present study was to assess the value of the fractional flow reserve (FFR) of the infarct-related artery (IRA) early after ST elevation myocardial infarction (STEMI) in detecting reversible ischemia. METHODS: Single photon emission computed tomography (SPECT) at rest and after dipyridamole stress, and within 24 hour FFR of the IRA was performed on 69 patients 3 to 7 days after STEMI. FFR was 0.80 or less in 61 (88.4%) of them. In these patients, percutaneous coronary intervention (PCI) was performed, and a second SPECT study was repeated within 14 days. RESULTS: SPECT showed reversible ischemia in 36 (59%) of these 61 patients, and converted to negative in 29 of them. Thus, the SPECT results of these 29 patients were defined as true positive before angioplasty and true negative after angioplasty. Considering the true-positive and true-negative SPECT results as the gold standard, the sensitivity, specificity, and positive and negative predictive values of the FFR of 0.80 or less compared to this gold standard were 96.7%, 100%, 100%, and 96.6%, respectively (ĸ = 0.97, P < 0.001). CONCLUSIONS: In the early phase after STEMI, the reliability of FFR to determine residual ischemia in the IRA is very high in those patients with true-positive SPECT before and true-negative SPECT after PCI.

Tabari Cohort Profile and Preliminary Results in Urban Areas and Mountainous Regions of Mazandaran, Iran.

BACKGROUND: The Tabari cohort study (TCS), part of the Prospective Epidemiological Research Studies in IrAN (PERSIAN), is a large longitudinal prospective cohort designed to better understand the risk factors associated with major non-communicable diseases (NCDs) across two urban and mountainous regions in north of Iran. METHODS: The enrollment phase of TCS started in June 2015 and ended in November 2017. During this phase, individuals aged 35-70 years from urban and mountainous regions of Sari township (Mazandaran province) were invited to the cohort center by health volunteers (urban regions) and Behvarz (mountainous areas) using census information. Data was collected based on the PERSIAN cohort study protocols. Hypertension was defind as systolic blood pressure ≥140 mm Hg or a diastolic blood pressure ≥90 mm Hg or history of diagnosis with hypertension or taking antihypertensive medications among participants free from cardiovascular diseases. Diabetes was defined as fasting blood sugar ≥126 mg/dL or a history of diagnosis or taking glucoselowering medications among all participants. RESULTS: A total of 10,255 participants were enrolled in TCS, 59.5% of whom were female. Among the total population, 7,012 participants were urban residents (68.4%). The prevalence of daily smoking in the total population was 9.1%. Body mass index in 75.9% of participants was ≥25 kg/m2. The prevalence of hypertension, diabetes, and thyroid disorders were 22.2%, 17.2%, and 10.5%, respectively. CONCLUSION: The Tabari cohort is different from other cohorts in terms of levels of risk factors associated with NCDs. This study has certain important strengths including its population-based design and large sample size that provides a valid platform for conducting future investigations and trials. A biobank that has been designed to store blood, nail, hair and urine samples for future research is another strength of this study. Researchers who are interested in using the information can refer to the following web page: http://persiancohort.com.

Non-Hodgkin's Lymphoma Presenting as Constrictive Pericarditis: A Rare Case Report.

Constrictive pericarditis (CP) is an uncommon post inflammatory disorder. It is described as pericardial thickening, myocardial constriction, and impaired diastolic filling. The most common etiologies are idiopathy, mediastinal radiotherapy, and prior cardiac surgery. Less common etiologies include viral infections, collagen vascular disorders, renal failure, sarcoidosis, tuberculosis, and blunt chest trauma. CP can less commonly be caused by malignancy. We report a very rare case of non-Hodgkin's lymphoma (NHL) presenting twice with attacks of decompensated heart failure. Echocardiography revealed that CP was responsible for the patient's symptoms as the first manifestation of NHL. Chest computed tomography scan and biopsy findings were compatible with the diagnosis of NHL. The patient received R-CHOP (cyclophosphamide, hydroxydaunorubicin, Oncovin®, and prednisone or prednisolone, combined with the monoclonal antibody rituximab) chemotherapy. Three months later, there was significant improvement in the patient's symptoms and considerable decrease in pericardial thickness.

Fuzzy Rule-Based Classification System for Assessing Coronary Artery Disease.

The aim of this study was to determine the accuracy of fuzzy rule-based classification that could noninvasively predict CAD based on myocardial perfusion scan test and clinical-epidemiological variables. This was a cross-sectional study in which the characteristics, the results of myocardial perfusion scan (MPS), and coronary artery angiography of 115 patients, 62 (53.9%) males, in Mazandaran Heart Center in the north of Iran have been collected. We used membership functions for medical variables by reviewing the related literature. To improve the classification performance, we used Ishibuchi et al. and Nozaki et al. methods by adjusting the grade of certainty CF j of each rule. This system includes 144 rules and the antecedent part of all rules has more than one part. The coronary artery disease data used in this paper contained 115 samples. The data was classified into four classes, namely, classes 1 (normal), 2 (stenosis in one single vessel), 3 (stenosis in two vessels), and 4 (stenosis in three vessels) which had 39, 35, 17, and 24 subjects, respectively. The accuracy in the fuzzy classification based on if-then rule was 92.8 percent if classification result was considered based on rule selection by expert, while it was 91.9 when classification result was obtained according to the equation. To increase the classification rate, we deleted the extra rules to reduce the fuzzy rules after introducing the membership functions.

Levels of anxiety and depression as predictors of mortality following myocardial infarction: A 5-year follow-up.

BACKGROUND: Post-myocardial infarction (MI) depression is a highly prevalent disorder, affecting nearly 18% of all MI patients, and it is a major predictor of disability in the year post-MI. We sought to expand this analysis by: comparing case-level anxiety, depression, and comorbid anxiety and depression as predictors of long term mortality during a 5-year follow-up period after MI; and investigating the role of potential modifying and confounding factors. METHODS: A total of 285 patients were screened on average 6 days after their MI and a 5-year survival rate was ascertained. The Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory (STAI) were completed by patients hospitalized for MI. In addition we tested the BDI × STAI interaction effect. RESULTS: During the 5 years of follow-up, cardiac mortality was assessed in 274 of 285 eligible patients. Of the 274 patients whose survival data were available, 91 (33.2%) died. At entry, BDI score of 192 (67.4%) patients was ≥ 10 and 145 (50.9%) patients had STAI score ≥ 40. Anxiety was not associated with mortality, whereas depression significantly predicted death, but this association was attenuated to non-significance with full adjustment with disease severity and confounders. CONCLUSIONS: Depression following MI does not predict longer-term survival with full adjustment.

Infective left atrial dissecting flap after cardiac surgery.

Left atrial dissection (LatD), defined as the forced separation of the left atrial (LA) wall layers by blood, is a rare and severe complication of cardiac surgery. It is most frequently associated with atrioventricular junction injuries. We report a case of infected LatD after coronary artery bypass graft, mitral valve replacement, aortic valve replacement and ascending aortic root replacement. The patient was presented with septicemia and disseminated intravascular coagulation. To the best of our knowledge, this is the first case report of LA dissecting flap concomitant with attached infective vegetations identified by transesophageal echocardiography.