Various techniques for transcatheter retrieval of the atrial septal defect or patent foramen ovale closure devices: a systematic review.

Atrial septal abnormalities are common congenital lesions that remain asymptomatic in many patients until adulthood. Adults with atrial septal defects (ASD) most commonly have ostium secundum ASD. Transcatheter closure has become increasingly popular in recent years as a successful alternative method to surgery for treating ASD and patent foramen ovale (PFO). The overall rate of ASD transcatheter closure device embolization has been reported to be less than 1%; however, retrieving the device via surgery or by trans-catheter route can be necessary. The current manuscript describes a systematic review of the techniques used to retrieve ASD closure devices, as well as their success rates, complications, and limitations. A comprehensive search was performed covering various databases including PubMed, MEDLINE, SCOPUS, Google Scholar, and Cochrane Library from inception until April 2022 for English-published case reports, case series, and experimental studies investigating the indications, safety, and limitations of ASD closure and ASD device retrieval by trans-catheter approaches. Finally, 20 studies were included in our review. Our findings showed that most of the studies used a single snare technique; of these, all but one reported 100% success. Double tool retrieval methods (snare plus snare, snare plus bioptome, or snare plus forceps) and the gooseneck snare technique yielded 100% success. One study that used the lasso technique reported unsuccessful retrieval and the need for surgical intervention. More recently, the novel "coronary wire trap technique" was introduced, which provides a simpler method for embolized device removal by trapping the device for retrieval using coronary wire.

The clinical manifestation and outcome of COVID-19 in patients with a history of ischemic heart disease; a retrospective case-control study.

INTRODUCTION: Coronary artery disease (CAD) is considered an independent risk factor for COVID-19. However, no study has specifically examined the clinical manifestations and outcomes of COVID-19 in patients with ischemic heart disease (IHD). METHODS: In a retrospective case-control study between 20 March 2020 to 20 May 2020, the medical record of 1611 patients with laboratory-confirmed SARS-CoV-2 infection was reviewed. IHD was defined as a history of an abnormal coronary angiography, coronary angioplasty, coronary artery bypass graft (CABG), or chronic stable angina. Demographic data, past medical history, drug history, symptoms, vital signs, laboratory findings, outcome, and death were investigated from medical records. RESULTS: 1518 Patients (882 men (58.1%)) with a mean age of 59.3 ± 15.5 years were included in the study. Patients with IHD (n = 300) were significantly less likely to have fever (OR: 0.170, 95% CI: 0.34-0.81, P < 0.001), and chills (OR: 0.74, 95% CI: 0.45-0.91, P < 0.001). Patients with IHD were 1.57 times more likely to have hypoxia (83.3% vs. 76%, OR: 1.57, 95% CI: 1.13-2.19, P = 0.007). There was no significant difference in terms of WBC, platelets, lymphocytes, LDH, AST, ALT, and CRP between the two groups (P > 0.05). After adjusting for demographic characteristics, comorbidities and vital signs, the risk factors for mortality of these patients were older age (OR: 1.04 and 1.07) and cancer (OR: 1.03, and 1.11) in both groups. In addition, in the patients without IHD, diabetes mellitus (OR: 1.50), CKD (OR: 1.21) and chronic respiratory diseases (OR: 1.48) have increased the odds of mortality. In addition, the use of anticoagulants (OR: 2.77) and calcium channel blockers (OR: 2.00) has increased the odds of mortality in two groups. CONCLUSION: In comparison with non-IHD, the symptoms of SARS-CoV-2 infection such as fever, chills and diarrhea were less common among patients with a history of IHD. Also, older age, and comorbidities (including cancer, diabetes mellitus, CKD and chronic obstructive respiratory diseases) have been associated with a higher risk of mortality in patients with IHD. In addition, the use of anticoagulants and calcium channel blockers has increased the chance of death in two groups without and with IHD.

Cardioembolic stroke, the most common subtype of stroke in COVID 19: A single center experience from Isfahan, Iran.

Background: Some studies showed the cerebrovascular manifestation in patients with recently pandemic coronavirus 2 named the coronavirus disease 2019 (COVID-19). However, there are rare reports about stroke subtypes in these patients. Here, we reported the stroke subtype in patients with laboratory-confirmed diagnosis of COVID-19 and treated at our hospitals, which are located in Isfahan, Iran. Materials and Methods: This is a retrospective, observational case series. Data were collected from March 01, 2020, to May 20, 2020, at three designated special care centers for COVID-19 of Isfahan University of Medical Sciences. The study included 1188 consecutive hospitalized patients with laboratory-confirmed diagnosis of COVID-19. Results: Of 1188 COVID-19 patients, 7 (0.5%) patients developed stroke. Five (0.4%) had ischemic arterial stroke, 1 (0.08%) hemorrhagic stroke and 1(0.08 %) cerebral venous and sinus thrombosis. Sixty percent of ischemic stroke were cardioembolic stroke (CE) and the rest 2 (40%) were embolic stroke of undetermined source. Three male patients (40%) had stroke as a presenting and admitted symptom of COVID-19. Four patients (57%) had severe COVID-19. Conclusion: Stroke was an uncommon manifestation in COVID-19 patients. CE was a common subtype of stroke in COVID-19 patients in our centers.

Public Stroke Knowledge, Awareness, and Response to Acute Stroke in Isfahan Iran: What is Less or Misinterpreted in Developing Countries.

BACKGROUND: Considering the high burden of stroke in developing countries, it is important for the community to have adequate information and awareness of this disease. In this study, the baseline knowledge of an Iranian population towards stroke has been evaluated. METHOD: This study was conducted in a governmental hospital in Isfahan, Iran. The participants were selected from the companions of non-cardio-vascular hospitalized patients. A self-administered questionnaire was designed for gathering information RESULTS: A total of 630 questionnaires were analysed. Hypertension and stress were the most frequently identified risk factors (recognised by 83.7% and 75.8% respectively), while pregnancy, oral contraceptives, and anti-coagulants were the least (recognised by 3.5%, 14.2% and 15.8% respectively). Knowledge of other important risk factors such as cardiac diseases was also relatively low (39.4%). Sudden visual difficulties and irrelevant speech were the least identified warning signs of stroke (45.3% and 34.6% respectively), however, knowledge towards all other warning signs was moderately good (each identified by 60-70%). Importantly only 44.2% of respondents were aware that stroke treatment should be started within the first 3 hours. Participants tended to have moderately good insight of most stroke complications and rehabilitation (60-70%). Urban residence, high level of education and knowing someone with a history of stroke were significant predictors of a higher level of stroke awareness. CONCLUSION: The findings of this study indicate that there is a need to improve general knowledge of cardiac and hypercoagulable related risk factors. Furthermore, understanding of the importance of time critical stroke management and the ineffectiveness of traditional medicine needs to be raised in the general community.

Effect of COVID-19 medications on corrected QT interval and induction of torsade de pointes: Results of a multicenter national survey.

BACKGROUND: There are some data showing that repurposed drugs used for the Coronavirus disease-19 (COVID-19) have potential to increase the risk of QTc prolongation and torsade de pointes (TdP), and these arrhythmic side effects have not been adequately addressed in COVID-19 patients treated with these repurposed medications. METHODS: This is the prospective study of 2403 patients hospitalised at 13 hospitals within the COVID-19 epicentres of the Iran. These patients were treated with chloroquine, hydroxychloroquine, lopinavir/ritonavir, atazanavir/ritonavir, oseltamivir, favipiravir and remdesivir alone or in combination with azithromycin. The primary outcome of the study was incidence of critical QTc prolongation, and secondary outcomes were incidences of TdP and death. RESULTS: Of the 2403 patients, 2365 met inclusion criteria. The primary outcome of QTc ≥ 500 ms and ∆QTc ≥ 60 ms was observed in 11.2% and 17.6% of the patients, respectively. The secondary outcomes of TdP and death were reported in 0.38% and 9.8% of the patients, respectively. The risk of critical QT prolongation increased in the presence of female gender, history of heart failure, treatment with hydroxychloroquine, azithromycin combination therapy, simultaneous furosemide or beta-blocker therapy and acute renal or hepatic dysfunction. However, the risk of TdP was predicted by treatment with lopinavir-ritonavir, simultaneous amiodarone or furosemide administration and hypokalaemia during treatment. CONCLUSION: This cohort showed significant QTc prolongation with all COVID-19 medications studied, however, life-threatening arrhythmia of TdP occurred rarely. Among the repurposed drugs studied, hydroxychloroquine or lopinavir-ritonavir alone or in combination with azithromycin clearly demonstrated to increase the risk of critical QT prolongation and/or TdP.

The relation between obesity and left ventricular diastolic function in young people: A cross-sectional study.

BACKGROUND: It has been proposed that left ventricular diastolic dysfunction (LVDD) is a possible physiological link between high body mass index (BMI) and future occurrence of heart failure (HF). The present cross-sectional study was aimed to analyze the association between BMI and LVDD by transthoracic echocardiography (TTE). METHODS: This study was conducted from May 2017 to September 2019 in Khorshid Hospital of Isfahan University of Medical Sciences, Isfahan, Iran. Based on the calculated BMI (kg/m²), patients were divided into three groups: group 1: subjects with BMI < 25, as a normal group (n = 75), group 2: volunteer cases with 40 > BMI ≥ 30, as an obese group (n = 98), and group 3: patients with BMI ≥ 40, as a morbidly obese group (n = 100). TTE was performed by a trained cardiologist and associated variables including left atrium (LA) volume, E, septal e', lateral e', and E/e' were assessed and also subjects were characterized as normal diastolic function, abnormal diastolic function, and inconclusive diagnosis of diastolic dysfunction (DD). RESULTS: Apart from the ejection fraction (EF) and the tricuspid regurgitation velocity (TRV), there was a significant difference between the other echocardiographic variables including LA volume, E, septal e', lateral e', and E/e' (P < 0.05). One patient with morbid obesity in our study revealed LVDD. There was no significant difference between three groups (P = 0.42). CONCLUSION: There is no considerable relationship between obesity and LVDD. It seems that the absence of associated comorbidities such as diabetes, coronary disorders, etc. plays a crucial role in preventing LVDD, but for realistic and definitive decision, more cellular and molecular investigations and studies with larger sample size are necessary.

Cardiac involvement according to echocardiographic findings in severe coronavirus disease 2019.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has led to considerable morbidity and mortality worldwide and myocardial injury has been one of the most common findings in the affected patients. However, published evidence of cardiac evaluation by imaging techniques including echocardiography is rare. We aimed to evaluate myocardial involvement by echocardiography in patients with severe COVID-19. METHODS: We studied 64 patients with severe COVID-19 who were admitted in the intensive care unit (ICU) in Khorshid Hospital, Isfahan, Iran, from February 20, 2020 until May 20, 2020. Demographic characteristics, laboratory tests, and electrocardiography (ECG) data were collected and transthoracic echocardiography (TTE) using a focused time-efficient echocardiography protocol was performed. RESULTS: Mean age of the participating patients was 66.40 ± 14.14 years (range: 34.0-92.0 years), and 35 patients (54.7%) were men. Reduced left ventricular (LV) systolic function was seen in 20 (32%) patients. Only 4 patients had LV ejection fraction (LVEF) less than 40%. Cardiac troponin I (cTn-I) was elevated (over 15 pg/ml) in 39 (60.9%) patients and was significantly associated with higher mortality in these patients (P = 0.05). In addition, dynamic ST and T wave changes and new bundle branch blocks had a significant association with adverse clinical outcome (P = 0.05 and P = 0.02, respectively). CONCLUSION: New LV systolic dysfunction (LVSD) in patients with severe COVID-19 was mild to moderate and not uncommon and had no significant adverse effect on the prognosis of these patients, although elevation of cardiac biomarkers could predict mortality and had an adverse effect on clinical outcome.

Pulmonary arterial pressure detects functional mitral stenosis after annuloplasty for primary mitral regurgitation: An exercise stress echocardiographic study.

INTRODUCTION: The restrictive mitral valve annuloplasty (RMA) is the treatment of choice for degenerative mitral regurgitation (MR), but postoperative functional mitral stenosis remains a matter of debate. In this study, we sought to determine the impact of mitral stenosis on the functional capacity of patients. METHODS: In a cross-sectional study, 32 patients with degenerative MR who underwent RMA using a complete ring were evaluated. All participants performed treadmill exercise test and underwent echocardiographic examinations before and after exercise. RESULTS: The patients' mean age was 50.1 ± 12.5 years. After a mean follow-up of 14.1 ± 5.9 months (6-32 months), the number of patients with a mitral valve peak gradient >7.5 mm Hg, a mitral valve mean gradient >3 mm Hg, and a pulmonary arterial pressure (PAP) ≥25 mm Hg at rest were 50%, 40.6%, and 62.5%, respectively. 13 patients (40.6%) had incomplete treadmill exercise test. All hemodynamic parameters were higher at peak exercise compared with at rest levels (all P < .05). The PAP at rest and at peak exercise as well as peak transmitral gradient at peak exercise were higher in patients with incomplete exercise compared with complete exercise test (all P < .05). The PAP at rest (a sensitivity and a specificity of 84.6% and 52.6%, respectively; area under the curve [AUC] = .755) and at peak exercise (a sensitivity and a specificity of 100% and 47.4%, respectively; AUC = .755) discriminated incomplete exercise test. CONCLUSION: The RMA for degenerative MR was associated with a functional stenosis and the PAP at rest and at peak exercise discriminated low exercise capacity.

Factor V Leiden, factor V Cambridge, factor II GA20210, and methylenetetrahydrofolate reductase in cerebral venous and sinus thrombosis: A case-control study.

BACKGROUND: Factor V G1691A (FV Leiden), FII GA20210, and methylenetetrahydrofolate reductase (MTHFR) C677T mutations are the most common genetic risk factors for thromboembolism in the Western countries. However, there is rare data in Iran about cerebral venous and sinus thrombosis (CVST) patients. The aim of this study was to evaluate the frequency of common genetic thrombophilic factors in CVST patients. MATERIALS AND METHODS: Forty consequently CVST patients from two University Hospital in Isfahan University of Medical Sciences aged more than 15 years from January 2009 to January 2011 were recruited. In parallel, 51 healthy subjects with the same age and race from similar population selected as controls. FV Leiden, FII GA20210, MTHFR C677T, and FV Cambridge gene mutations by polymerase chain reaction technique were evaluated in case and control groups. RESULTS: FV Leiden, FII GA20210, and FV Cambridge gene mutations had very low prevalence in both case (5%, 2%, 0%) and control (2.5%, 0%, 0%) and were not found any significant difference between groups. MTHFR C677T mutations was in 22 (55%) of patients in case group and 18 (35.5%) of control group (P = 0.09). CONCLUSION: This study showed that the prevalence of FV Leiden, FII GA20210, and FV Cambridge were low. Laboratory investigations of these mutations as a routine test for all patients with CVST may not be cost benefit.

Electrocardiographic changes in patients with refractory epilepsy.

BACKGROUND: Epilepsy is the second most common type of chronic neurological disease. Its diagnosis carries an excess mortality, which is 2-3 times higher than that of general population. Mortality rates are increased among patients with uncontrolled seizures. The aim of this study was to characterize the electrocardiogram (ECG) changes during pre-ictal, ictal and post-ictal states in pharmaco-resistant epilepsy patients. MATERIALS AND METHODS: This retrospective study conducted by Department of Neurology and Department of Cardiology of Isfahan Medical University from September 2008 to December 2012, patients with medically refractory epilepsy who underwent standard pre-surgical assessment from Epilepsy ward of Kashani hospital in Isfahan city were recruited in this study. RESULTS: The heart rate (HR) varied significantly throughout the record. Significant difference in HR was identified between ictal and pre-ictal periods (P = 0.000), furthermore, the difference between ictal and pre-ictal HR {mean = 63.867 ± 0.061, P = 0.000}, ictal and post-ictal HR {mean = 38.833 ± 0.067, P = 0.003}, and between pre- and post-ictal HR {mean = 25.033 ± 0.089, P = 0.000}, was significant. CONCLUSION: ECG monitoring should be a part video- (electroencephalography) EEG monitoring to identify serious cardiac abnormalities, particularly in patients with refractory epilepsy.

Oral contraceptive misuse as a risk factor for cerebral venous and sinus thrombosis.

BACKGROUND: Consumption of oral contraceptive pills (OCP) is a known risk factor for cerebral venous and sinus thrombosis (CVST) among women. We determined whether misuse of OCP could increase the risk of CVST in women. METHODS: A case-control study was conducted from 2003 to 2007 on 64 female patients with CVST admitted to Al- Zahra medical center and 232 healthy age-matched female OCP users as controls. Patients and controls were interviewed and misuse of OCP was categorized to taking OCP for self-treatment of dysfunctional uterine bleeding, for family planning without physician consult, or for delaying menstruation in purpose of religious customs or traveling, and taking OCP in high dose during the preceding year. RESULTS: Among 64 cases and 232 controls, 30 (46.9 %) and 63 (27.2 %), respectively, had a history of OCP misuse (Odds Ratio = 2.36, 95% Confidence Intervals = 1.33 to 4.18, P = 0.002). Also, using cyproterone compound (Diane) was more frequent in the CVST group (P<0.001). Multivariate analysis controlling for age, OCP misuse, type of OCP, and history of coagulopathy showed that OCP misuse (P<0.001) and using Diane as the OCP (P = 0.006) were both independently associated with CVST. DISCUSSION: OCP misuse can be considered as an additional predisposing factor for CVST among women and partly responsible for larger proportion of female patients with CVST. These findings should alarm the healthcare system to create strategies controlling the inappropriate use of OCP among Iranian women.

The effects of sodium valproate with fish oil supplementation or alone in migraine prevention: A randomized single-blind clinical trial.

BACKGROUND: Omega-3 polyunsaturated fatty acids (PUFA) have beneficial effects on both specific and non-specific inflammatory reactions. The aim of this study was to evaluate the effect of dietary supplementation with fish oil in migraine prevention. METHODS: A 12-week, randomized, single-blind clinical trial was conducted from October 2008 to June 2009. A total of 67 patients (52 women, 15 men) with migraine headache were randomly allocated to 2 groups. In the first group, 38 patients (30 females with a mean age of 35 ± 9 year) received 400 mg/day sodium valproate. In the second group, 29 patients (22 females with a mean age of 36 ± 9 years) received sodium valproate 400 mg daily plus fish oil supplementation (180 mg). Response to the treatment was assessed at 0, 1, 2, and 3 months after start of the therapy. RESULTS: A significant decrease in duration, monthly frequency, and severity of headache after month 1, 2, and 3 in comparison with month 0 occurred in both groups. There was a significant reduction in headache severity (P = 0.046) and frequency (P = 0.044) in the group with fish oil supplementation after month 1 in comparison with sodium valproate alone. In contrast, there was no significant difference between two treatment groups in duration of the headache after month 1. Mean intensity, mean duration and mean frequency of the attacks after month 2 and 3 were not significantly different between the two groups. CONCLUSION: This study demonstrated that sodium valproate plus fish oil supplementation significantly reduces migraine headache more than sodium valproate alone but only at the beginning of the treatment.

High frequency of IgM antiphospholipid antibodies in young Iranian patients with stroke.

OBJECTIVE: To investigate the presence of IgG and IgM types of anticardiolipin (aCL) and antiphospholipid (aPL) antibodies in younger Iranian patients with ischemic stroke. METHODS: Both IgG and IgM types of aPL (cardiolipin, anti phosphatidyl inositol, anti phosphatidyl serine, anti phosphatidic acid and beta 2-glycoprotein I [B2-GPI]) and aCL alone (cardiolipin and B2-GPI) were measured in 117 patients with ischemic stroke (aged <45 years) during an 18-month period from September 2002 to March 2004 in Al-Zahra Hospital, Isfahan, Iran. The demographic, clinical, and laboratory characteristics of patients with a positive titer were recorded. RESULTS: Seven men and 16 women (23 patients, 19.6%) had increased IgG types of aPL antibodies. Increased titers of IgM and IgG were found in 19 (82.6%) and 6 (26%) patients for aPL antibodies and in 15 (83.3%) and 8 (44.4%) cases for aCL alone. CONCLUSION: Despite European studies, high titers of IgM aPL antibodies found in a large number of patients can be caused by the presence of unknown triggering factors (infections or poisons), that are more prevalent in developing countries compared to developed countries. This hypothesis remains to be investigated further.

Orthostatic hypotension in Iranian patients with Parkinson`s disease.

OBJECTIVE: To prospectively investigate the prevalence and clinical relevance of orthostatic hypotension (OH) in Parkinson`s disease (PD) in Isfahan, Iran. METHODS: We investigated 150 consecutive patients with PD (42 women, 108 men) in Al-Zahra Hospital, Isfahan, Iran from January 2002 to January 2004. Blood pressure was measured first in a supine position following a rest of at least 10 minutes, and then after 3 minutes of active standing. Data concerning the age, gender, duration of disease, and drug consumption were recorded in a questionnaire. RESULTS: Orthostatic hypotension in PD is more frequent in women, patients taking a higher dose of levodopa, in higher age groups, and patients with longer duration of the disease, however, a statistically significant difference was seen in the female group and patients taking a higher dose of levodopa. CONCLUSION: Orthostatic hypotension is mainly related to PD pathology and the clinical relevance of OH to gender, age, and disease duration may be due to the natural course for progression of human autonomic dysfunction during life. Higher doses of levodopa may increase the risk of OH.