The impact of massage and dry cupping on dysrhythmia in cardiac patients: A randomized parallel controlled trial.

BACKGROUND: Heart disease is the leading cause of death in many countries around the world and is linked to numerous complications. In addition to conventional pharmacological treatments, complementary and alternative medicines like massage and dry cupping are employed to help manage the disease and its symptoms. This study aimed to compare the effects of massage and dry cupping on dysrhythmia in patients with heart diseases. METHODS: This randomized parallel controlled clinical trial study was conducted in two critical care units of Shafa hospital in Kerman, southeastern Iran, in 2019-2020. A total of 90 eligible patients were allocated into three groups: massage (n = 30), dry cupping (n = 30), and control (n = 30) using a stratified block randomization method. In the massage group, the head and face were massaged for three consecutive nights, while the dry cupping group received dry cupping between the fifth cervical vertebra and the second thoracic vertebra for the same duration. Each intervention session lasted 15 min. Data collection tools included a socio-demographic and clinical characteristics questionnaire, a form for hemodynamic parameters (systolic blood pressure, diastolic blood pressure, heart rate, respiratory rate, and peripheral oxygen saturation), and a form for assessing dysrhythmia using electrocardiogram readings. Dysrhythmia in the participants was evaluated after each session. RESULTS: The results within each group indicated a statistically significant difference in the prevalence of dysrhythmia in the dry cupping group after the intervention (P < 0.05), but this difference was not statistically significant in the massage and control groups. However, when comparing between the groups, no significant difference was found among the three groups. Additionally, there was no significant difference in the type of dysrhythmia between the groups (P > 0.05). CONCLUSION: While there was no difference in the type of dysrhythmia between the three groups, the additional reduction of dysrhythmia in the dry cupping group could hold clinical significance. Further studies are recommended to validate or refute the findings of the present study.

Outcomes of chronic total occlusion percutaneous coronary intervention from the RAIAN (RAjaie - Iran) registry.

OBJECTIVE: While most of the evidence in CTO interventions emerge from Western and Japanese studies, few data have been published up today from the Middle East. Objective of this study was to evaluate technical success rates and clinical outcomes of an Iranian population undergoing CTO PCI in a tertiary referral hospital. Moreover, we sought to evaluate the efficacy of our CTO teaching program. METHODS: This is a retrospective single-center cohort study including 790 patients who underwent CTO PCI performed by operators with different volumes of CTOs PCI performed per year. According to PCI result, all patients have been divided into successful (n = 555, 70.3 %) and unsuccessful (n = 235, 29.7 %) groups. Study endpoints were Major Adverse Cardiovascular Events and Health Status Improvement evaluated using the Seattle Angina Questionnaire at one year. RESULTS: A global success rate of 70 % for antegrade and 80 % for retrograde approach was shown despite the lack of some CTO-dedicated devices. During the enrollment period, the success rate increased significantly among operators with a lower number of CTO procedures per year. One-year MACE rate was similar in both successful and unsuccessful groups (13.5 % in successful and 10.6 % in unsuccessful group, p = 0.173). One year patients' health status improved significantly only in successful group. CONCLUSIONS: No significant differences of in-hospital and one-year MACE were found between the successful and unsuccessful groups. Angina symptoms and quality of life significantly improved after successful CTO PCI. The RAIAN registry confirmed the importance of operator expertise for CTO PCI success.

Aortic Valve Area and Strain Measurements by Cardiac MRI and Transthoracic Echocardiography in Severe Aortic Stenosis with Normal Left Ventricular Function.

Background: Transthoracic echocardiography (TTE) is the recommended imaging technique for the evaluation of patients with aortic stenosis (AS). However, in cases with inconclusive findings, cardiac magnetic resonance (CMR) planimetry is used to grade AS severity. This study aimed to compare the results derived from TTE and CMR in patients with severe AS with normal left ventricular (LV) function. Methods: In a prospective study, 20 patients with severe AS were recruited and data derived from TTE and CMR modalities were compared with the archived records of 28 age- and sex-matched healthy controls. The data included aortic valve area (AVA), MRI-derived biventricular global strains, and TTE-derived global longitudinal strain (GLS). SPSS software was used to analyze the data with independent samples t test, intraclass correlation coefficient (ICC), and Pearson correlation. P<0.05 was considered statistically significant. Results: An excellent agreement was found in AVA values derived from CMR and TTE with an average ICC of 0.932 (95% CI=0.829-0.973). There was a significant difference in LV-GLS, LV global radial strain (GRS), right ventricular (RV) GRS, and RV global circumferential strain between the groups. A good correlation was found between CMR- and TTE-derived GLS with an average ICC of 0.721 (95% C=0.255-0.896). The mean aortic valve pressure gradient in TTE had a significant inverse linear correlation with LV-GRS in CMR (r=-0.537). All P values were <0.05. Conclusion: There was a good agreement between AVA and strain values derived from cardiac MRI and TTE. The myocardial strain was impaired in patients with severe AS and normal LV function and correlated with disease severity.

Effects of the COVID-19 Pandemic on the Management of Patients With ST-elevation Myocardial Infarction in a Tertiary Cardiovascular Center.

BACKGROUND: In the Coronavirus Disease 2019 (COVID-19) pandemic, the appropriate reperfusion strategy in patients with ST-segment elevation myocardial infarction (STEMI) is unclear. METHODS: This retrospective single-center study consecutively enrolled patients who presented with STEMI and scheduled for primary percutaneous coronary intervention (PPCI) during the outbreak of COVID-19. Due to the delay in the reporting of the polymerase chain reaction test results, our postprocedural triage regarding COVID-19, followed by the isolation strategy, was based on lung computerized tomography scan results. RESULTS: Forty-eight patients with STEMI referred to our center. PPCI was done for 44 (91%) of these patients. The mean symptom-to-device time was 490.93 ± 454.608 minutes, and the mean first medical contact-to-device time was and 154.12 ± 36.27 minutes. Nine (18%) patients with STEMI were diagnosed as having typical/indeterminate features indicating COVID-19 involvement. During hospitalization, 1 (2.0%) patient died of cardiogenic shock. The study population was followed for 35.9 ± 12.7 days. Two patients expired in another centers due to COVID-19. No cardiac catheterization laboratory staff members were infected by COVID-19 during the study period. CONCLUSIONS: Our small report indicates that by taking the recommended safety measures and using appropriate PPE, we can continue PPCI as the main reperfusion strategy safely and effectively.

The significance of coronary artery calcium score as a predictor of coronary artery stenosis in individuals referred for CT angiography.

Introduction: Cardiovascular diseases, including coronary artery disease (CAD), are among the most common causes of death in the elderly population. Recent studies have found that coronary artery calcium score (CACS) is a strong independent predictor of CAD. Here we aimed to investigate the association between CACS and demographic, clinical, laboratory, and CT angiographic findings inpatients with suspected CAD. Methods: From June 2008 to August 2018, we retrospectively reviewed 219 consecutive patients suspected with CAD who were referred for CT angiography in Rajaie Cardiovascular, Medical, and Research Center. Medical records were reviewed, and relevant demographic, clinical, laboratory and imaging were collected. Results: A total of 219 patients with an average age of 62.64±12.39 were included. Twelve patients(5.5%) had normal coronary angiography, and 50.2% had mild CAD. An obstructive CAD was found in97 patients (44.3%). The median CACS was 76.4 (IQR, 13.0-289.1). The frequency of obstructive CAD was 28.1% in the CACS <100 group, and 67.0% in CACS >100 group (P < 0.001). On multiple logistic regression analysis, age (OR=1.04 [1.01-1.07], P = 0.006), CACS (OR= 4.31 [2.33-7.98], P < 0.001), and neutrophil to lymphocyte ratio (NLR) (OR = 0.82 [0.68-0.98], P = 0.027) were independent predictors of obstructive CAD. Conclusion: We found a direct association between higher CACS and obstructive patterns in coronary CT angiography. Our findings indicate that the possibility of the presence of obstructive CAD was higher among symptomatic patients with older age, lower NLR, and CACS >100.

Relationship Between Thyroid Hormones and Left Ventricular Mass in Peritoneal Dialysis Patients.

INTRODUCTION: Non-thyroidal illness is prevalent in patients with advanced stages of chronic kidney disease and could be considered as a risk factor for cardiovascular mortality; this relation is partially explained by malnutrition and the concomitant condition of high inflammation. This study is designed to investigate the relationship between left ventricular mass and thyroid hormone abnormalities and evaluate this relationship after adjustment of inflammatory factors and nutritional status in peritoneal dialysis patients. METHODS: A total of 71 patients undergoing maintenance peritoneal dialysis were included. Serum concentration of total and free triiodothyronine (fT3), total and free thyroxine (fT4), and TSH were measured. LV mass index and the structural properties of heart including LVEDD, LVESD, PWD, and EF were assessed by transthoracic echocardiography. The Surrogates of Inflammation, including IL-6, albumin, and hs-CRP were measured. The nutritional status of patients was assessed by one point SGA scoring and biochemical data. The relation between thyroid hormones and echocardiographic variables, inflammatory and nutritional markers was determined. RESULTS: LVMI was significantly higher in the group with lower fT3 levels. Linear regression analyses showed statistically significant univariate association between fT3, tT3, and tT4; and LVMI. In multiple linear regression analysis adjusted for albumin, hs-CRP, IL- 6, and ferritin; only fT3 level had a meaningful negative correlation (P < .05) with LVMI, free T3 level was positively correlated with rGFR (P < .05, c = 0.39) and KT/V (P < .05, c = 0.27). CONCLUSION: Low fT3 level was negatively and significantly associated with LVML even after adjustments for known risk factors in peritoneal dialysis patients.

Association between the risks of contrast-induced nephropathy after diagnostic or interventional coronary management and the transradial and transfemoral access approaches.

Introduction: The risk of contrast-induced nephropathy (CIN) as a common and important complication of coronary procedures may be influenced by the vascular access site. We compared the risks of CIN in diagnostic or interventional coronary management between patients treated via the transradial access (TRA) and those treated via the transfemoral access (TFA). Methods: Patients undergoing invasive coronary catheterization or percutaneous coronary intervention (PCI) were enrolled. We excluded patients with congenital or structural heart disease and those with end-stage renal disease on dialysis. Based on the vascular access site used for invasive coronary catheterization, the patients were divided into 2 study groups: the TFA and the TRA. CIN was defined as an absolute (≥0.5 mg/dL) or relative (>25%) increase in the baseline serum creatinine level within 48 hours following cardiac catheterization or PCI. Results: Overall, 410 patients (mean age = 61.3 ± 10.8 years) underwent diagnostic or interventional coronary management: 258 were treated via the TFA approach and 152 via the TRA approach. The patients treated via the TFA had a significantly higher incidence of postprocedural CIN (15.1% vs 6.6%; P= 0.01). The multivariate analysis showed that the TFA was the independent predictor of CIN (OR: 2.37, 95% CI: 1.11 to 5.10, and P= 0.027). Moreover, the BARC (Bleeding Academic Research Consortium) and Mehran scores were the other independent predictors of CIN in our study. Conclusion: The risk of CIN was lower with the TRA, and the TFA was the independent predictor of CIN after the diagnostic or interventional coronary management.