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1.
J Clin Ultrasound ; 49(5): 472-478, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33523475

RESUMO

BACKGROUND: Albuminuria is considered as a significant predictor of cardiovascular morbidity and mortality in patients with diabetes mellitus. The main purpose of this study was to determine the correlation between albuminuria and global left ventricular (LV) function in patients with type 2 diabetes (T2D). METHODS: This observational study was conducted on 80 consecutive asymptomatic patients with T2D and an LV ejection fraction ≥55%. The patients were divided into two groups depending on the presence or absence of albuminuria. Echocardiography-derived indices of the LV function were then compared between these groups. RESULTS: The patients with albuminuria were older (mean ± SD: 60.37 ± 9.05 vs 54.52 ± 10.26 years of age, P = .01) and had higher hemoglobin A1c (HbA1c) levels (8.45 ± 1.97 vs 7.25 ± 1.93 mg/dL, P = .012) than those without albuminuria. Among the echocardiographic variables, the patients with albuminuria had higher LV Tei-index (median [lower-upper quartile]: 0.620 [0.455-0.824] vs 0.441 [0.336-0.586], P < .001), more prolonged early filling (E)-wave deceleration time (274.87 ± 75.97 vs 239.40 ± 61.35 ms, P = .032), increased interventricular septal wall thickness (1.11 ± 0.31 vs 0.95 ± 0.21 cm, P = .012), and lower mean early diastolic mitral annular velocity (7.57 ± 2.34 vs 8.68 ± 2.46 cm/s, P = .046) than those without albuminuria. Among risk factors, only albuminuria and HbA1c levels were associated with a significant increase in LV Tei-index (Beta = 0.426 and P < .001, Beta = 0.226 and P = .042, respectively). CONCLUSION: The LV Tei-index was significantly higher in diabetic patients with than without albuminuria. Low HbA1c levels were correlated with a decrease in LV Tei-index.


Assuntos
Albuminúria/complicações , Diabetes Mellitus Tipo 2/complicações , Ecocardiografia Doppler , Disfunção Ventricular Esquerda/complicações , Disfunção Ventricular Esquerda/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Volume Sistólico , Disfunção Ventricular Esquerda/fisiopatologia
2.
Heart Lung Circ ; 30(9): 1292-1301, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33744193

RESUMO

BACKGROUND: Heart failure (HF), as a serious health condition, is characterised by the decreasing ability of the heart to pump enough blood around the body. This study compared the effects of spironolactone and eplerenone on the echocardiographic variables of the left ventricular (LV) function in symptomatic patients diagnosed with new-onset systolic HF. METHOD: This study was a randomised controlled trial, including 85 symptomatic patients with new-onset systolic HF (namely, dilated cardiomyopathy). The patients were then randomly assigned to two groups in a 1:1 ratio and received either spironolactone or eplerenone in addition to optimal HF therapy for 6 months. Echocardiography was performed to visualise alterations in two-dimensional, pulse Doppler, tissue Doppler, and deformation indices of LV function. RESULTS: The results revealed that the group receiving eplerenone had a significantly greater increase in LV ejection fraction (LVEF) and a decrease in end-systolic LV internal diameter compared with the group receiving spironolactone (intergroup p=0.002 and p=0.006, respectively). There was a significant reduction in the end-diastolic LV internal diameter and the left atrial diameter, and a significant rise in tissue Doppler peak systolic mitral annular velocity in the group taking eplerenone; there were no significant changes in these variables in the group receiving spironolactone (intergroup p=0.006 and p=0.049, respectively). Accordingly, eplerenone had greater favourable effects on LVEF and the global longitudinal strain than spironolactone (B=5.207 [p<0.001] and B= -2.072 [p=0.044]), respectively. CONCLUSIONS: This study established that adding eplerenone to optimal HF therapy might be associated with more improvements in echocardiographic variables of LV function than spironolactone in symptomatic patients with new-onset systolic HF.


Assuntos
Insuficiência Cardíaca Sistólica , Insuficiência Cardíaca , Ecocardiografia , Eplerenona , Insuficiência Cardíaca Sistólica/tratamento farmacológico , Humanos , Antagonistas de Receptores de Mineralocorticoides , Espironolactona , Função Ventricular Esquerda
3.
Toxicol Ind Health ; 36(11): 908-915, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33025846

RESUMO

INTRODUCTION: Simultaneous exposure to noise and dust may have detrimental health effects. This study was conducted to determine the effect of exposure to noise and dust on oxidative stress. METHODS: In this cross-sectional study, 82 employees of two livestock and poultry feed factories in Golestan Province, Iran, were selected as the exposed group and 82 office workers were selected as the control group. Occupational noise and dust exposure were measured using a dosimeter, sampling pump, and vinyl chloride filter. Oxidative stress was determined by measuring the levels of malondialdehyde (MDA) and superoxide dismutase (SOD) in blood samples. T-tests, one-way analysis of variance, and multivariate linear regression were used to analyze the data. RESULTS: The levels of MDA and SOD in the exposed group were significantly higher and lower than the control group (p < 0.001), respectively. The results showed the subgroup with both over the threshold dust and noise exposure had the highest MDA levels. The SOD level among those exposed to noise more than the recommended level, in the subgroup with more dust exposure, was significantly less than the subgroup with low noise exposure (p = 0.017). CONCLUSION: Noise and dust exposure probably increase the level of oxidative stress by increasing the level of lipid peroxidation (MDA) and reducing the level of antioxidant enzymes (SOD).


Assuntos
Ração Animal , Poeira/análise , Ruído Ocupacional/estatística & dados numéricos , Exposição Ocupacional/análise , Estresse Oxidativo/fisiologia , Adulto , Animais , Estudos Transversais , Relação Dose-Resposta a Droga , Feminino , Humanos , Irã (Geográfico) , Gado , Masculino , Malondialdeído/metabolismo , Saúde Ocupacional , Aves Domésticas , Fumar/epidemiologia , Fatores Socioeconômicos , Superóxido Dismutase/metabolismo
4.
Echocardiography ; 36(4): 687-695, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30901114

RESUMO

BACKGROUND: Left bundle branch block (LBBB) is associated with a high risk of death, particularly from ventricular tachyarrhythmia and myocardial infarction. It is difficult to clinically differentiate between ischemic and nonischemic LBBB. In this study, we investigated whether advanced echocardiographic variables, such as strain delay index (SDI) and postsystolic index (PSI), can be used to distinguish coronary artery disease (CAD) in patients with LBBB. METHODS: Our study included 102 patients with LBBB. All patients underwent echocardiography. The left ventricular ejection fraction (LVEF), left ventricular mass, PSI, SDI, global longitudinal strain (GLS), and time-to-peak longitudinal strain were then calculated. Coronary angiography was performed, and the patients were divided into groups with significant CAD and without significant CAD. RESULTS: Patients in the group with significant CAD were older than the patients in the group without significant CAD. The group had a higher prevalence of diabetes mellitus, hypertension, hyperlipidemia, and family history of CAD than the group without significant CAD. The group with significant CAD also had lower LVEF and GLS than the group without significant CAD. The group without significant CAD showed a direct correlation between LVEF and SDI and an inverse correlation between LVEF and PSI: P value = 0.040 and r = 0.255, and P value = 0.001 and r = -0.427, respectively. However, the group with significant CAD did not show any significant correlation between LVEF and SDI or PSI. CONCLUSION: Strain delay index and PSI may be useful markers in distinguishing CAD in patients with LBBB and preserved LVEF.


Assuntos
Bloqueio de Ramo/diagnóstico por imagem , Doença da Artéria Coronariana/diagnóstico por imagem , Ecocardiografia/métodos , Interpretação de Imagem Assistida por Computador/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Bloqueio de Ramo/fisiopatologia , Doença da Artéria Coronariana/fisiopatologia , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sístole
5.
BMC Nephrol ; 19(1): 373, 2018 12 22.
Artigo em Inglês | MEDLINE | ID: mdl-30577785

RESUMO

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).


Assuntos
Injúria Renal Aguda/prevenção & controle , Meios de Contraste/efeitos adversos , Cistatina C/sangue , Precondicionamento Isquêmico/métodos , Insuficiência Renal Crônica/complicações , Injúria Renal Aguda/induzido quimicamente , Idoso , Angioplastia , Angiografia Coronária , Doença das Coronárias/diagnóstico por imagem , Doença das Coronárias/terapia , Método Duplo-Cego , Feminino , Hidratação , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
6.
J Cardiovasc Pharmacol ; 69(5): 279-285, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28141699

RESUMO

PURPOSE: Anthracyclines (ANTs) are a class of active antineoplastic agents with topoisomerase-interacting activity that are considered the most active agents for the treatment of breast cancer. We investigated the efficacy of carvedilol in the inhibition of ANT-induced cardiotoxicity. METHODS: In this randomized, single-blind, placebo-controlled study, 91 women with recently diagnosed breast cancer undergoing ANT therapy were randomly assigned to groups treated with either carvedilol (n = 46) or placebo (n = 45). Echocardiography was performed before and at 6 months after randomization, and absolute changes in the mean left ventricular ejection fraction, left ventricular end diastolic volume, and left ventricular end systolic volume were determined. Furthermore, the percentage change in the left atrial (LA) diameter and other variables of left ventricular (LV) diastolic function, such as transmitral Doppler parameters, including early (E wave) and late (A wave) diastolic velocities, E/A ratio and E wave deceleration time, pulmonary venous Doppler signals, including forward systolic (S wave) and diastolic (D wave) velocities into LA, late diastolic atrial reversal velocity, and early diastolic tissue Doppler mitral annular velocity (e') were measured. In addition, tissue Doppler mitral annular systolic (s') velocity, as a marker of early stage of LV systolic dysfunction, E/e' ratio, as a determinant of LV filling pressure, and troponin I level, as a marker of myocardial necrosis were measured. RESULTS: At the end of follow-up period, left ventricular ejection fraction did not change in the carvedilol group. However, this parameter was significantly reduced in the control group (P < 0.001). Echocardiography showed that both left ventricular end systolic volume and LA diameter were significantly increased compared with the baseline measures in the control group. In pulse Doppler studies, pulmonary venous peak atrial reversal flow velocity was significantly increased in the control group. Moreover, a significant decrease in the mitral annuli early diastolic (e') and peak systolic (s') velocities and a significant increase in the E (the peak early diastolic velocity)/e' ratio in the control group were also observed. However, none of these variables were adversely changed at the end of follow-up in the carvedilol group. Furthermore, the TnI level was significantly higher in the control group than in the carvedilol group (P = 0.036) at 30 days after the initiation of chemotherapy. CONCLUSIONS: Prophylactic use of carvedilol may inhibit the development of anthracycline-induced cardiotoxicity, even at low doses.


Assuntos
Antraciclinas/efeitos adversos , Antibióticos Antineoplásicos/efeitos adversos , Neoplasias da Mama/tratamento farmacológico , Carbazóis/uso terapêutico , Fármacos Cardiovasculares/uso terapêutico , Cardiopatias/prevenção & controle , Propanolaminas/uso terapêutico , Adulto , Idoso , Função do Átrio Esquerdo/efeitos dos fármacos , Biomarcadores/sangue , Carbazóis/efeitos adversos , Cardiotoxicidade , Fármacos Cardiovasculares/efeitos adversos , Carvedilol , Ecocardiografia Doppler de Pulso , Feminino , Cardiopatias/induzido quimicamente , Cardiopatias/diagnóstico por imagem , Cardiopatias/fisiopatologia , Humanos , Irã (Geográfico) , Pessoa de Meia-Idade , Propanolaminas/efeitos adversos , Medição de Risco , Fatores de Risco , Método Simples-Cego , Volume Sistólico/efeitos dos fármacos , Fatores de Tempo , Resultado do Tratamento , Troponina I/sangue , Função Ventricular Esquerda/efeitos dos fármacos , Adulto Jovem
7.
Med Pr ; 68(4): 449-458, 2017 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-28604767

RESUMO

BACKGROUND: Manganese (Mn) used as raw material for melting process in the ferrous foundry is considered as hazardous neurotoxic substance because it accumulates in the central nervous system and may cause neurological disorders. The furnace-men and melting department workers are potentially exposed to manganese particles or fume in the workplace. The objective of the research has been to investigate the sources and levels of manganese exposure in the foundry by correlation of blood-manganese (B-Mn) and air-manganese (air-Mn) measurement. MATERIAL AND METHODS: Air-Mn and Mn of blood serum were measured involving workers who worked in a big-sized foundry during 1 year. The standard method of the Occupational Safety and Health Administration (OSHA) ID-121 was used for air and blood assessment and atomic absorption spectroscopy (AAS) was carried out for air and blood sample analysis. RESULTS: The air sampling results have revealed that there is a high exposure to manganese (4.5 mg/m3) in the workplace as compared to the National Institute for Occupational Safety and Health's (NIOSH) time weighted average (the reference time-weighted average (TWA) = 1 mg/m3). The average blood serum Mn concentration was 2.745 µg/l for subjects working for shorter than 3 months and 274.85 µg/l for subjects working 3-12 months. CONCLUSIONS: Against the research hypothesis there was no correlation between the air-Mn concentration and the B-Mn (serum) level of manganese in the serum of the exposed subjects. It may be due to short time of air sampling of manganese airborne particles, and a real-time monitoring of airborne manganese particles is suggested for any future study. Med Pr 2017;68(4):449-458.


Assuntos
Poluentes Ocupacionais do Ar/sangue , Ferro , Manganês/toxicidade , Metalurgia , Adulto , Humanos , Masculino , Manganês/sangue , Pessoa de Meia-Idade
8.
J Ultrasound ; 27(3): 567-577, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-38551782

RESUMO

BACKGROUND: Non-ST-segment elevation myocardial infarction (NSTEMI) is more common than ST-segment elevation myocardial infarction (STEMI), consisting of 60-70% of myocardial infarctions. When left ventricular (LV) pressure increases during early systole, regionally ischaemic myocardium with a reduced active force exhibit stretching. The aim of this study was to evaluate the role of this parameter in determining high risk angiographic territory involvement in NSTEMI patients. RESULTS: This study was a descriptive correlational research that was conducted on 96 patients with NSTEMI and a left ventricular ejection fraction ≥ 50% who underwent coronary angiography (CAG). Patients were divided into two groups based on having or not having high risk angiographic territory involvement in CAG. All patients underwent a transthoracic echocardiography during the first day of hospitalization and early systolic lengthening (ESL), duration of ESL (DESL), left ventricular global longitudinal strain (LVGLS), pulsed-wave Doppler-derived transmitral early (E wave) and late (A wave) diastolic velocities, and tissue-Doppler-derived mitral annular early diastolic (e') and peak systolic (s') velocities were determined. The results of this study showed DESL, DESLLAD, and DESLLCX were longer in high risk angiographic territory group than other one (P value 0.016, 0.044, and 0.04, respectively). The logistic regression analysis showed among different variables, only age and ESLLAD had an independent association with high risk angiographic territory involvement (P = 0.01, odds ratio [OR] 1.09, 95% CI 1.021-1.164, and P = 0.024, odds ratio [OR] 1.243, 95% CI 1.029-1.50, respectively). CONCLUSIONS: Assessment of myocardial ESLLAD by speckle-tracking echocardiography may be helpful in predicting high risk angiographic territory involvement in patients with NSTEMI. Indeed, a higher value can be considered as a high risk parameter which may show benefit of an early invasive strategy versus a conservative approach.


Assuntos
Angiografia Coronária , Infarto do Miocárdio sem Supradesnível do Segmento ST , Sístole , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Infarto do Miocárdio sem Supradesnível do Segmento ST/diagnóstico por imagem , Infarto do Miocárdio sem Supradesnível do Segmento ST/fisiopatologia , Ecocardiografia , Idoso , Função Ventricular Esquerda , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Volume Sistólico
9.
Asian Pac J Cancer Prev ; 25(1): 333-342, 2024 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-38285801

RESUMO

INTRODUCTION: Colorectal cancer (CRC) ranks as the second leading cause of cancer-related deaths. This study aimed to predict survival outcomes of CRC patients using machine learning (ML) methods. MATERIAL AND METHODS: A retrospective analysis included 1853 CRC patients admitted to three prominent tertiary hospitals in Iran from October 2006 to July 2019. Six ML methods, namely logistic regression (LR), Naïve Bayes (NB), Support Vector Machine (SVM), Neural Network (NN), Decision Tree (DT), and Light Gradient Boosting Machine (LGBM), were developed with 10-fold cross-validation. Feature selection employed the Random Forest method based on mean decrease GINI criteria. Model performance was assessed using Area Under the Curve (AUC). RESULTS: Time from diagnosis, age, tumor size, metastatic status, lymph node involvement, and treatment type emerged as crucial predictors of survival based on mean decrease GINI. The NB (AUC = 0.70, 95% Confidence Interval [CI] 0.65-0.75) and LGBM (AUC = 0.70, 95% CI 0.65-0.75) models achieved the highest predictive AUC values for CRC patient survival. CONCLUSIONS: This study highlights the significance of variables including time from diagnosis, age, tumor size, metastatic status, lymph node involvement, and treatment type in predicting CRC survival. The NB model exhibited optimal efficacy in mortality prediction, maintaining a balanced sensitivity and specificity. Policy recommendations encompass early diagnosis and treatment initiation for CRC patients, improved data collection through digital health records and standardized protocols, support for predictive analytics integration in clinical decisions, and the inclusion of identified prognostic variables in treatment guidelines to enhance patient outcomes.


Assuntos
Algoritmos , Neoplasias Colorretais , Humanos , Estudos Retrospectivos , Teorema de Bayes , Aprendizado de Máquina , Neoplasias Colorretais/diagnóstico
10.
Echocardiography ; 30(5): 505-11, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23305488

RESUMO

BACKGROUND: There are conflicting theories regarding the accuracy of echocardiography for determining the value of epicardial fat thickness in cardiovascular risk assessment. The aim of this study was to determine the relationship. METHOD: A historical cohort study was conducted on 143 patients, 40 to 87 years old, admitted for coronary angiography. The patients underwent transthoracic echocardiography and measurement of epicardial fat thickness in parasternal long-axis view at end-systole for 3 cardiac cycles. Both procedures were performed within a week before performing coronary angiography. RESULTS: Epicardial fat thickness was significantly correlated with the existence and severity of coronary artery disease (P-value <0.001). There was also a trend toward lower high-density lipoprotein in males with thicker epicardial fat. CONCLUSION: Epicardial fat thickness equal to or more than 7 mm may identify an individual with higher probability of having coronary atherosclerosis.


Assuntos
Tecido Adiposo/diagnóstico por imagem , Doença da Artéria Coronariana/diagnóstico por imagem , Ecocardiografia/métodos , Pericárdio/diagnóstico por imagem , Tecido Adiposo/patologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Angiografia Coronária/métodos , Doença da Artéria Coronariana/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pericárdio/patologia , Valor Preditivo dos Testes , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Método Simples-Cego
11.
Indian J Palliat Care ; 19(3): 166-9, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24347907

RESUMO

BACKGROUND AND AIMS: The hemodialysis (HD) patients are experiencing high biopsychosocial stress on all levels. Therefore, this study was designed to survey on physiologic and psychosocial stressors among HD patients in two educational hospitals of Northern Iran. MATERIALS AND METHODS: This cross-sectional study included 80 HD patients who were referred to Khomeini and Fatemeh Zahra hospitals in Mazandaran (Northern Iran) during the year 2011. Data were collected using a demographic information record sheet and Baldree Hemodialysis Stress Scale. FINDING: THE FOLLOWING PHYSIOLOGIC STRESSORS WERE NOTED: Fatigue (51.25%), limited time and places for enjoyment (46.25%), and physical activation limitation (32.5%). Similarly the following psychosocial stressors were observed: Fistula (58.75%), limitation of drinking water (47.5%), low quality of life (47.5%), travelling difficulties to the dialysis center (45%), treatment cost (41.5%), and low life expectancy. The stress level was high in women who were married, younger, less dialysis vintage, and belonged to a low education level. CONCLUSION: This study reports that HD patients have with significant physical and psychosocial problems and they need education, family, and social supports.

12.
Caspian J Intern Med ; 13(3): 511-518, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35974948

RESUMO

Background: Cardiovascular disease is the main cause of death among breast cancer survivors. Several chemotherapy drugs may cause cardiovascular toxicity. Our study aimed to assess the late effects of chemotherapy on left ventricular (LV) systolic and diastolic function in a group of female breast cancer survivors. Methods: Our study was a case-control study consisted of 60 breast cancer survivors who had undergone chemotherapy for more than 5 years and a control group of 49 women without breast cancer. All patients underwent echocardiography and left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), pulse-Doppler early transmitral peak flow velocity (E wave), early diastolic (e'), and left atrial (LA) diameter were calculated. Results: The mean LVEF and GLS were reduced in chemotherapy group (51.63±7.93% vs. 55.37±3.50%, P=0.002 and -17.99±3.27% vs. -19.25±2.27%, P=0.025). Also, the chemotherapy group had a larger left ventricular end-systolic internal diameter than the control group (1.74±0.44cm/m2 vs. 1.58±0.22cm/m2, P= 0.011). Logistic regression analysis showed among the different cardiovascular risk factors, chemotherapy had an association with decreasing LVEF. Conclusion: Breast cancer survivors might have an excess risk of having subclinical LV dysfunction over time. These findings present the potential benefits of echocardiographic assessment in breast cancer survivors.

13.
Cardiovasc Toxicol ; 22(6): 493-500, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35192134

RESUMO

Glycated hemoglobin (HbA1c) is a useful biomarker for the diagnosis of diabetes and also for determination of individuals with an increased risk of a severe disease. Some subtle changes in myocardial contractile function is measurable by post-systolic index (PSI) which is defined as late systolic shortening after aortic valve closure. The aim of our study was to determine the relationship between HbA1c and PSI in patients with non-apparent coronary artery disease (CAD) on angiograms. This study was a historical cohort study on 85 consecutive patients with a left ventricular ejection fraction ≥ 50% and non-apparent CAD on angiogram. Patients were divided into two groups based on their HbA1c levels, regardless of the diagnosis of diabetes in these patients, to patients with an HbA1c level of equal or higher than 5.7% and those with an HbA1c of less than 5.7%. A speckle-tracking echocardiography was performed for all patients and global longitudinal strain, PSI, left ventricular diameters, left atrial volume, pulsed-Doppler-derived transmitral early (E wave) and late (A wave) diastolic velocities, and tissue-Doppler-derived mitral annular early diastolic (e') and peak systolic (s') velocities were determined. PSI, E/e' ratio, and A wave were higher and e' velocity was lower in patients with HbA1c ≥ 5.7% than those with a level of < 5.7% (P value = 0.04, 0.001, 0.014, and 0.004, respectively). Other echocardiographic variables were not different between two groups. Multiple linear regression analysis showed the association between HbA1c and PSI was independent of other demographic, biochemical, and echocardiographic variables (B = 35.674, 95% CI 10.741-60.606, P value = 0.006). Our study showed PSI is more pronounced in individuals with an HbA1c > 5.7% than those with a lower value in the absence of CAD. Because PSI is an important indicator of adverse outcome and increased mortality, these data can underline the importance of an abnormal HbA1c level and its association with subtle cardiac dysfunction, irrespective of the diagnosis of diabetes in patients with non-apparent CAD.


Assuntos
Doença da Artéria Coronariana , Disfunção Ventricular Esquerda , Estudos de Coortes , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico por imagem , Ecocardiografia , Hemoglobinas Glicadas , Humanos , Volume Sistólico , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/etiologia , Função Ventricular Esquerda
14.
Ultrasound ; 29(3): 162-171, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34567228

RESUMO

PURPOSE: Hypertension is an important cause of nonischemic heart failure. It is important to identify subclinical left ventricular dysfunction in patients with hypertension in an early stage to lower the risk of progression to more severe illness. The aim of our study was to assess the correlation between indices of left ventricular function and aortic stiffness in patients with hypertension. METHODS: Our study was a case control study of 42 hypertensive and 40 normotensive patients with nonsignificant coronary artery disease. All the patients underwent echocardiography and left ventricular ejection fraction, global longitudinal strain, post systolic index, pulsed Doppler early transmitral peak flow velocity, early diastolic mitral annular velocity (e'), and aortic elasticity measurements were calculated. RESULTS: The hypertensive patients were older (58.47 ± 9.57 vs. 52.94 ± 10.38 years, p = 0.018) and had a higher body mass index (30.09 ± 5.08 vs. 27.48 ± 4.17 kg/m2, p = 0.013) and E/e' ratio (8.16 ± 1.81 vs. 6.56 ± 1.71, p < 0.001) and a lower e' velocity (8.25 ± 2.28 vs. 9.52 ± 2.34 cm/s, p = 0.015) than normotensives. They also had a lower aortic distensibility (p = 0.008) and a higher aortic stiffness index (p = 0.039) compared with the normotensive group. The hypertensive patients did not show any association between aortic elasticity and stiffness with age or e' velocity despite significant association in normotensives. CONCLUSION: Hypertension is associated with a high prevalence of diastolic dysfunction, elevated left ventricular filling pressure, and increased arterial stiffness, all of which have significant association with adverse outcomes. The measurements found in the hypertensive patients compared with the normotensive group may be due to several age-independent mechanisms.

15.
Int J Gen Med ; 13: 297-303, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32606894

RESUMO

BACKGROUND: Systolic and diastolic blood pressure is associated with physiologic changes of aortic wall and left ventricular structure. We aimed to evaluate aortic stiffness index and distensibility, global longitudinal strain (GLS), post systolic index (PSI) in hypertensive patients and compare these parameters with normotensive subjects. PATIENTS AND METHODS: Eighty-two patients (42 hypertensive compared with 40 normotensive subjects) with preserved left ventricular ejection fraction and without significant coronary artery disease were enrolled in the study. Systolic and diastolic blood pressure was measured by automated BP measurement system. Aortic stiffness index and distensibility, GLS and PSI were measured by transthoracic echocardiography and compared in both study groups. RESULTS: Aortic stiffness index (0.097 vs 0.069) and E/e´ (8.16 vs 6.56) were significantly higher in hypertensive patients, respectively (p<0.05). Aortic distensibility (cm2/dyn) (0.28 vs 0.42) and e´ (cm/s) (8.25 vs 9.52) were significantly lower in hypertensive patients than normotensive subjects (p<0.05). PSI and GLS were not significantly different between both study groups. Aortic stiffness index and distensibility had significant correlation with age in normotensive subjects while this correlation was not statistically significant in hypertensive patients. CONCLUSION: Hypertension is associated with diastolic dysfunction and abnormal aortic wall compliance. Age-related aortic wall changes can present early in hypertensive patients.

16.
Curr Med Mycol ; 6(4): 41-46, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34195459

RESUMO

BACKGROUND AND PURPOSE: Cryptococcal meningitis (CM) is a serious fungal infection that especially affects patients with human immunodeficiency virus (HIV). In this regard, the present retrospective study aimed to analyze the clinical and laboratory features and therapeutic outcomes of patients with CM admitted to two teaching referral centers in the north of Iran during 2011-19. MATERIALS AND METHODS: This study was performed on all the hospitalized patients diagnosed with CM in two therapeutic centers of infectious diseases in the north of Iran. The required data, such as demographic characteristics and clinical and paraclinical features of patients, were extracted and entered in the information forms. Finally, the collected data were analyzed in SPSS software (version 16). RESULTS: For the purpose of the study, records of 12 confirmed CM patients were evaluated in this research. Based on the results, 75% of the patients were male. Moreover, the average age of the subjects was 40.33± 8.93 years old and 66.6% of them (n=8) were HIV-positive. Other underlying diseases among HIV-positive patients included infection with hepatitis C virus (25%) and a history of tuberculosis (25%). In total, three HIV-negative patients suffered from Hodgkin lymphoma (25%), sarcoidosis (25%), and asthma (25%) and one patient (25%) had no underlying disease. Headache (75%), weakness, and fatigue (75%) were the most common symptoms among the participants. The cluster of differentiation 4 (CD4) count in all HIV-positive patients was less than 100 cells/µl. There was no significant difference between symptoms in HIV-positive and HIV-negative patients. Besides, no significant difference was observed between the groups of HIV-positive and HIV-negative patients regarding the period between the onset of symptoms and diagnosis of CM, the length of hospital stay, and the duration of antifungal medication consumption. In total, three patients (25%) expired, and six patients recovered. The CM recurred in two HIV-negative and one HIV-positive subjects; the two HIV-negative patients were treated, while the HIV-positive patient expired due to this recurrence. CONCLUSION: Clinical features and cerebrospinal fluid parameters were not different in HIV-positive and HIV-negative participants. Despite the fact that CM is not common in Iran, due to the increasing number of immunosuppressive patients, the differential diagnosis of CM should be considered for patients with signs and symptoms of infection in the central nervous system.

17.
Cardiovasc Revasc Med ; 21(11): 1411-1416, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-31176706

RESUMO

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.


Assuntos
Reserva Fracionada de Fluxo Miocárdico , Isquemia Miocárdica , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Angiografia Coronária , Humanos , Isquemia , Valor Preditivo dos Testes , Reprodutibilidade dos Testes
18.
J Cardiovasc Pharmacol Ther ; 24(3): 233-241, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30599756

RESUMO

OBJECTIVE: Chemotherapy-induced cardiotoxicity is a major and leading cause of death in breast cancer survivors. It can present decades after chemotherapy and can manifest in different ways; some chemotherapeutic agents have a powerful dose-dependent relationship with cardiotoxicity. The aim of this study was to investigate the effect of rosuvastatin on preventing chemotherapy-induced cardiotoxicity in patients with breast cancer. METHODS: Our study was a randomized, single-blind, placebo-controlled trial that involved 89 women with newly diagnosed breast cancer who were scheduled to receive chemotherapy. Patients were randomly assigned to receive rosuvastatin or a placebo in a 1:1 ratio for 6 months. Echocardiography, using 2-dimensional (2D) Doppler, tissue Doppler, and speckle-tracking methods, was used to determine the absolute changes in the left ventricular systolic ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left atrial (LA) diameter, transmitral Doppler early diastolic velocity (E wave), tissue Doppler early diastolic (e') and peak systolic (s') mitral annular velocities, E/e' ratio, and global longitudinal systolic strain. RESULTS: The LVEF was significantly reduced in the placebo group at the end of the study when compared with the baseline value. However, there was no significant difference in the LVEF in the intervention group (intergroup P = .012). Furthermore, compared with the intervention group at the end of the study, there was a significant increase in the 4- and 2-chamber LVESV, LA diameter, and E/e' ratio in the placebo group (intergroup P = .019, P = .024, P < .001, and P = .021, respectively) and a significant decrease in the e' and s' velocities in the placebo group (intergroup P < .001 and P < .006, respectively). CONCLUSIONS: The present study showed that the prophylactic use of rosuvastatin may prevent the development of chemotherapy-induced cardiotoxicity.


Assuntos
Antineoplásicos/efeitos adversos , Neoplasias da Mama/tratamento farmacológico , Substâncias Protetoras/uso terapêutico , Rosuvastatina Cálcica/uso terapêutico , Volume Sistólico/efeitos dos fármacos , Disfunção Ventricular Esquerda/prevenção & controle , Função Ventricular Esquerda/efeitos dos fármacos , Adulto , Idoso , Neoplasias da Mama/diagnóstico , Cardiotoxicidade , Ecocardiografia Doppler , Feminino , Humanos , Irã (Geográfico) , Pessoa de Meia-Idade , Estudos Prospectivos , Substâncias Protetoras/efeitos adversos , Rosuvastatina Cálcica/efeitos adversos , Método Simples-Cego , Fatores de Tempo , Resultado do Tratamento , Disfunção Ventricular Esquerda/induzido quimicamente , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/fisiopatologia
19.
Iran J Pathol ; 14(1): 8-16, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31531096

RESUMO

BACKGROUND & OBJECTIVE: This study was designed for the first time for the detec- tion of mutant BRAF V600E and its correlation with clinicophathologic features in a sample of Iranian patients with pathologically proved pigmented skin neoplasms. METHODS: 82 paraffin-embedded blocks, including melanocytic nevi, malignant melanoma, Basel cell carcinoma, and squamous cell carcinoma were evaluated for BRAF V600E expression by immunohistochemistry in the patients admitted to Ibn Sina Hospital, in the city of Sari, Mazandaran province, North of Iran. The evaluation of immunohistochemical staining was performed by two of the authoring pathologists, and staining intensity was graded from negative (0), weak (1+), moderate (2+) to strong (3+). If twenty percent (or greater) of the tumor cells showed modest to strong cytoplasmic immunoreactivity (score 3+), the neoplasm was considered positive for this tumor marker. RESULTS: Among 82 studied patients, 12 cases (60%) of the malignant melanoma group revealed a high intensity of immunostaining for BRAF V600E, while a signifi- cant expression of this marker did not occur in the other investigated skin neoplasm. A great relation between BRAF (V600E) expression and the histologic type of skin cancer was noted. No significant relationship with other parameters such as gender, age, and the grade differentiation of the non-melanoma skin cancer was found. BRAF V600E was weakly correlated with the Clark level of cutaneous malignant melanoma. CONCLUSION: This data provided further evidence for the strong role of the BRAF V600E mutation in the development of cutaneous malignant melanoma, compared to non-melanoma skin cancers in the North of Iran. We advised future studies to evaluate the beneficial effects of anti-BRAF V600E target therapy on the Iranian melanoma patient who harbors this marker by way of immunostaining tumor tissue.

20.
Ultrasound ; 27(4): 217-224, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31762779

RESUMO

INTRODUCTION: Epicardial fat is a variety of visceral adipose tissue that secretes pro-inflammatory cytokines that can lead to progression of atherosclerosis. Previous studies have shown a correlation between cardiovascular risk factors and severity of mitral annular calcification. The aim of our study was to assess the correlation between epicardial fat thickness and mitral annular calcification. METHODS: This study recruited 188 patients who were considered for coronary angiography and underwent echocardiography within 24 hours of admission. Epicardial fat thickness was measured in the parasternal long axis view at the end-systole. Mitral annular calcification was visualized in the parasternal short-axis view and was grade as none, mild, moderate, and severe. Furthermore, left atrial diameter, severity of mitral regurgitation, left ventricular ejection fraction, and early diastolic velocities (E wave) determined by transmitral pulsed Doppler, the early mitral annular velocities measured by tissue Doppler (e'), and E/e' were obtained. RESULTS: Patients with an epicardial fat thickness ≥7 mm had higher prevalence of hypertension and higher SYNTAX score (p value = 0.002 and 0.0014, respectively). Also, mitral annular calcification was both more prevalent and more extensive (p value = 0.007 and <0.001, respectively) and left atrial diameter was larger in these patients compared with patients with epicardial fat thickness <7 mm (p value = 0.001). CONCLUSIONS: Our study showed significant association between increased epicardial fat thickness and calcium deposits in the mitral valve annulus that is a degenerative process associated with cardiovascular risk factors.

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