The association between myocardial early systolic lengthening and high risk angiographic territory involvement in patients with non-ST-segment elevation myocardial infarction.

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.

Can prolonged P-R interval predict clinical outcomes in non-ST elevation acute coronary syndrome patients?

BACKGROUND: The present study aimed to respond to clinical question, can prolonged P-R interval predict clinical outcomes in non-ST elevation acute coronary syndrome patients? METHODS: This descriptive-analytical study was conducted on cardiac patients. All of the non-ST elevation acute coronary syndrome (NSTEACS) including non-ST elevation myocardial infarction (NSTEMI) and unstable angina patients included in the study. Then they divided into two groups: prolonged P-R interval and normal P-R interval. The patients who had a history of digoxin and calcium channel blocker use, using antiarrhythmic drugs, known valvular or congenital heart disease and connective tissue, unreadable P-R interval and cardiac block were excluded. Data were collected using the questionnaire consisted demographic data and clinical outcomes and a follow-up part was completed by one of the researchers. RESULTS: Finally, 248 patients completed the study. The results showed both of the two groups had significant differences in terms of the history of myocardial infarction (MI) (p = 0.018), the level of high-density lipoprotein (HDL) (p = 0.004), heart rate (p = 0.042), inverted T wave (p = 0.017), anterior ST- segment depression (p = 0.008), normal report of coronary angiography (CAG) (p = 0.003), three vessels disease (p = 0.043), left main lesion (p = 0.045) and SYNTAX score (p = 0.032) based on the CAG report. The results of six-month follow-up showed although, the frequency of ischemic stroke, coronary artery disease (CAD) and cardiovascular death were higher in prolonged P-R interval groups. The chi-square test showed this difference was statistically non-significant (p > 0.05). The multivariate logistic regression model revealed non-significant relationships between prolonged P-R interval and SYNTAX score, significant CAD, three-vessel disease, inverted T wave, anterior ST depression, heart rate and HDL. CONCLUSIONS: Based on the results of our study the six-month follow-up showed non-significant outcomes. Further studies are recommended to assess the long-term outcomes.

The correlation between epicardial fat thickness and longitudinal left atrial reservoir strain in patients with type 2 diabetes mellitus and controls.

BACKGROUND: Diabetes mellitus (DM) has been documented among the strongest risk factors for developing heart failure with preserved ejection fraction (HFpEF). The earliest imaging changes in patients with DM are the left atrial (LA) functional and volumetric changes. The aim of this study was to determine the correlation between epicardial fat thickness (EFT) and longitudinal LA reservoir strain (LARS) in patients with type 2 DM (T2DM), as compared with non-diabetic controls. RESULTS: The study samples in this case-control study comprised of consecutive patients with T2DM (n=64) and matched non-diabetic controls (n=30). An echocardiography was performed on all patients and EFT, volumetric and longitudinal LARS, left ventricular (LV) 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 obtained. The study results demonstrated that the patients with T2DM had thicker EFT (5.96±2.13 vs. 4.10±3.11 mm) and increased LA volume index (LAVI) (43.05± 44.40 vs. 29.10±11.34 ml/m2) in comparison with the non-diabetic ones (p-value: 0.005 and 0.022, respectively). On the other hand, a direct association was observed between EFT and the E/e' ratio, and an inverse correlation was established between EFT and LARS in patients with T2DM (r=0.299, p-value=0.020 and r=- 0.256, p-value=0.043, respectively). However, regression analysis showed only LV mass index (LVMI) (ß=0.012, 95% CI 0.006-0.019, p-value<0.001), LAVI (ß=- 0.034, 95% CI - 0.05-0.017, p-value<0.001), and EFT (ß=- 0.143, 95% CI - 0.264-- 0.021, p-value=0.021) were independently correlated with LARS. CONCLUSIONS: LARS is considered as an important early marker of subclinical cardiac dysfunction. Thickened epicardial fat may be an independent risk factor for decreased LA reservoir strain. Diabetics are especially considered as a high risk group due to having an increased epicardial adipose tissue thickness.

The association between tissue doppler-derived E/(e's') ratio and coronary atherosclerosis severity measured by the SYNTAX score in patients with non-ST elevation-acute coronary syndrome.

BACKGROUND: The prognosis of patients hospitalized with non-ST elevation-acute coronary syndrome (NSTE-ACS) is typically determined by the existence and severity of myocardial necrosis and left ventricular (LV) remodeling. AIM: The present study was to assess the association between the E/(e's') ratio and the coronary atherosclerosis severity, measured by the SYNTAX score, in patients with NSTE-ACS. METHODS: Utilizing a descriptive correlational research design, this study was prospectively conducted on 252 patients with NSTE-ACS, undergoing an echocardiography to determine the left ventricular ejection fraction (LVEF), the left atrial (LA) volume, the pulsed-wave (PW) Doppler-derived transmitral early (E) and late (A) diastolic velocities, and the tissue Doppler (TD)-derived mitral annular early diastolic (e') and peak systolic (s') velocities. After that, a coronary angiography (CAG) was performed, and the SYNTAX score was calculated. RESULTS: The patients were divided into two groups, viz., those with the E/(e's') ratio < 1.63 and the cases with the ratio ≥ 1.63. The results revealed that the patients with a high ratio were older, had a higher prevalence of females, a SYNTAX score ≥ 22, and a lower glomerular filtration rate than those with a low ratio (p-value < 0.001). Besides, these patients had larger indexed LA volume and lower LVEF than others (p-value: 0.028 and 0.023, respectively). Furthermore, the multiple linear regression outcomes established a positive independent association between the E/(e's') ratio ≥ 1.63 (B = 5.609, 95% CI 2.324-8.894, p-value = 0.001) and the SYNTAX score. CONCLUSION: The study results demonstrated that the patients hospitalized with NSTE-ACS and the E/(e's') ratio ≥ 1.63 had worse demographic, echocardiographic, and laboratory profiles and a higher prevalence of a SYNTAX score ≥ 22 than those with a lower ratio.

Post-COVID-19 fatal Aspergillus endocarditis: A case report.

BACKGROUND: Aspergillus endocarditis (AE) is a rare fatal infection. The infection is often reported in patients with prosthetic heart valves, immunosuppressed, broad-spectrum antimicrobial use regimens, and drug abusers. METHODS: Herein, we report a rare case of native mitral valve AE in a 63-year-old man, with a probable COVID-19-associated invasive pulmonary aspergillosis nine months ago treated with antifungals. RESULTS: In the last admission, the lethargy, neurological deficit, and septic-embolic brain abscess in brain MRI led to suspicion of infective endocarditis. Transesophageal two-dimensional echocardiography and color Doppler flow velocity mapping showed a large highly mobile mass destroying leaflet and severe mitral regurgitation. The Surgical valve replacement is performed. The surgical valve replacement is performed. Direct microscopic examination and culture of the explanted and vegetative mass revealed Aspergillus section Fumiagati confirmed by molecular method. Despite the administration of voriconazole and transient improvement the patient expired. CONCLUSION: As AE is a late consequence of COVID-19-associated invasive pulmonary aspergillosis, therefore, long-term follow-up of invasive aspergillosis, and prompt diagnosis of surgical and systemic antifungal therapy treatment, are warranted to provide robust management.

Late consequences of chemotherapy on left ventricular function in women with breast cancer.

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.

Correlation Between Glycated Hemoglobin (HbA1c) and Post-Systolic Index Measured by Speckle-Tracking Echocardiography in Patients with Non-apparent Coronary Artery Disease.

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.

Potential Cardiotoxic Effects of Remdesivir on Cardiovascular System: A Literature Review.

Corona disease 2019 (COVID-19) pandemic continues to spread around the world with no efficacious treatment. Intravenous remdesivir is the only authorized drug for treatment of COVID-19 disease under an Emergency Use Authorization. Remdesivir is a 1'-cyano-substituted adenosine nucleotide prodrug which inhibits viral RNA synthesis. This metabolite is an adenosine analog but with a significantly longer half-life than adenosine. Adenosine is a powerful vasodilator that can cause profound hypotension which is followed by the compensatory release of catecholamines. It can also shorten atrial action potential and refractoriness and lead to atrial fibrillation (AF). These effects may also occur in ventricular cells and predispose patients to ventricular fibrillation. Remdesivir can also induce significant cytotoxic effects in cardiomyocytes that is considerably worse than chloroquine cardiotoxic effects. Remdesivir-induced cardiotoxicity is due to its binding to human mitochondrial RNA polymerase. On the other hand, remdesivir can increase field potential duration with decreased Na+ peak amplitudes and spontaneous beating rates in a dose-dependent manner that might induce prolonged QT interval and torsade de point. There are some reports of sinus bradycardia, hypotension, T-wave abnormalities, AF, and a prolonged QT interval and few cases of cardiac arrest and complete heat block following remdesivir infusion. It seems remdesivir have some cardiotoxic and proarrhythmic effects that are especially more pronounced in patients with previous cardiovascular diseases. The current safety profile of remdesivir is still not completely known and further prospective clinical trials are needed to assess its safety profile and potential adverse cardiovascular effects.

Effect of Melissa officinalis on systolic and diastolic blood pressures in essential hypertension: A double-blind crossover clinical trial.

For a long time, Melissa officinalis (M. officinalis) has been used to treat cardiovascular diseases. Therefore, this study aimed at evaluating the effects of M. officinalis on systolic and diastolic blood pressures in hypertensive patients. We conducted a double-blind, controlled, randomized crossover clinical trial on 49 patients who received either M. officinalis capsules (400 mg/d; n = 23) or the placebo (n = 26) three times per day for a 4-week period. After a 2-week washout period, the M. officinalis group received placebo and the other group received M. officinalis for another 4-week period. The systolic and diastolic blood pressures were measured once at baseline and then every 2 weeks for 10 weeks. The statistical analysis of the obtained data revealed that the chronology of the consumption of M. officinalis and placebo had no effect on the systolic and diastolic blood pressures in these two studied groups. Moreover, it was found that systolic and diastolic blood pressures significantly decreased after the consumption of M. officinalis, compared to placebo. Systolic and diastolic blood pressures in group A at the beginning of the study were 152.30 ± 5.312 mmHg and 95.52 ± 1.988 mmHg, respectively, and, after the first phase (drug use), reached 129.88 ± 9.009 mmHg and 80.13 ± 5.488 mmHg, respectively. Systolic and diastolic blood pressures in group B at the beginning of the study was 152.26 ± 5.640 mmHg and 94.44 ± 2.607 mmHg, respectively, and after the second phase (drug use), reached 131.77 ± 8.091 mmHg and 81.46 ± 7.426 mmHg, (p = .005), respectively. Also, no significant side effects were observed during the study. According to the results, M. officinalis can reduce systolic and diastolic blood pressures of the patients with essential hypertension.

Aortic wall elasticity and left ventricular function in hypertensive patients with nonsignificant coronary artery disease.

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.

The Effects of Spironolactone and Eplerenone on Left Ventricular Function Using Echocardiography in Symptomatic Patients With New-Onset Systolic Heart Failure: A Comparative Randomised Controlled Trial.

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.

Correlation between albuminuria and tissue Doppler-derived left ventricular myocardial performance index in patients with type 2 diabetes.

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.

Invasion of poorly differentiated large-cell neuroendocrine tumor of the lung through right pulmonary veins into the left atrium: A very rare case report.

Intracavitary cardiac metastasis is a rare manifestation of primary lung cancer which can be associated with a very poor prognosis. In this condition, the right chambers of the heart are more commonly involved and the invasion of the left atrium (LA) through the venous routes is highly exceptional. Poorly differentiated large-cell neuroendocrine tumors also include only 3% of all primary lung carcinomas which can have adverse outcomes. Therefore, in this report, a rare case of a 72-year-old male patient with poorly differentiated large-cell neuroendocrine carcinoma of the right lung spreading to the LA through the right pulmonary veins was described.

Relation Between Aortic Stiffness Index and Distensibility with Age in Hypertensive Patients.

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.

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.

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.

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.

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.