Arya Atherosclerosis
Volume:10 Issue: 5, Sep 2014

Heart valve disease is a significant and increasing global problem in the developing world. The aim of this study is to evaluate the incidence of postoperative complications and mortality in patients who underwent heart valve replacement. In this prospective study, 320 adult cases (186 females and 134 males, mean age of: 45.7 ± 15.0) with valvular heart diseases who underwent heart valve replacement at our center, from June 2011 to January 2012 were enrolled. All the required demographic, echocardiographic, and electrocardiogram data were studied. The incidence of intraoperative and early postoperative complications and mortality were evaluated. Among total, 96.3% of the cases underwent elective surgery. Mitral valve replacement surgery was occurred the most in 58.8% of the cases. In 11.3% of the cases, bioprosthetic valves and in 88.8% of the patients prosthetic valves were required. Early postoperative complications were occurred in 85 patients (26.6%), including: valve-related events: 7 cases, postoperative arrhythmia: 24 patients, worsening function of the repaired valve: 16 cases and general complications: 38 patients. Mortality was occurred in 25 patients (7.8%), 10 cases due to cardiac problems versus 15 patients due to non-cardiac problems. There were significant correlations between age, simultaneous valve repair and replacement, the anatomic site of the valve and the incidence of postoperative complications. Age, history of diabetes mellitus (DM), hypertension (HTN), and high grade of functional capacity were reported the significant causes of postoperative mortality. Age, DM, HTN, functional capacity and multivalve disease are significant predictors of post-valvular surgery morbidity and mortality.

The role of plasma fibrinogen, a key regulator of inflammation processes and increased carotid intima-media thickness (cIMT) to predict metabolic syndrome (MetS) is currently under investigation. We assessed differences in the indicators of cIMT and also plasma fibrinogen level between MetS and non-MetS subjects. We also assessed the role of these two parameters for independently relationship with MetS state. The subjects in this cross-sectional survey were population-based samples of 93 men and women aged ≥ 35 years and over who were selected from the Isfahan cohort study, Isfahan, Iran. Fibrinogen was measured by the clotting assay of Clauss. Ultrasound studies of the carotid artery were performed to measure cIMT. MetS defined based on the National Cholesterol Education Program’s Adult Treatment Panel III. The mean level of plasma fibrinogen was not different in the two groups with and without MetS (240.10 ± 27.80 vs. 242.56 ± 35.82, P = 0.714), but the mean of cIMT was considerably higher in MetS group than in non-MetS group (0.85 ± 0.06 mm vs. 0.66 ± 0.09 mm, P < 0.001). Using a multivariable logistic regression model, high cIMT could effectively predict MetS state with the presence of different components of MetS (odds ratio = 17.544, 95% confidence interval: 2.151-142.860, P = 0.008). The optimal cutoff point of cIMT for discriminating these two clinical states was 0.6 mm yielding a sensitivity of 61.5% and a specificity of 59.6%. Individuals with MetS demonstrated increased cIMT values compared with those without MetS. However, high plasma fibrinogen level may not be associated with MetS state.

Atherosclerosis and apolipoprotein E4 (APOE4) are known risks for Dementia. We sought to evaluate the relationship between coronary atherosclerosis and APOE4 with mild cognitive impairment (MCI). In a case-control study, subjects with age more than 60 years and recent coronary angiography were evaluated by mini-mental state examination and neuropsychiatry Unit Cognitive Assessment Tool (NUCOG) to find the patients with MCI (n = 40) and the controls with normal cognition (n = 40). Coronary angiography records were re-assessed to find the severity of coronary artery disease by the Gensini scores. Plasma levels of APOE4 were measured. There were no-significant difference between the 2 groups regarding the plasma APOE4 levels (P = 0.706) and the Gensini scores (P = 0.236). Associations between the Gensini scores and the NUCOG scores in the MCI group (r = −0.196, P = 0.225) and the control group (r = 0.189, P = 0.243) were not significant. However, the interaction effect between the Gensini and the NUCOG scores based on allocation to the control or the patient groups showed statistically significant difference (F(1,67) = 4.84, P = 0.031). Although atherosclerosis has been considered as known risk factor for dementia and MCI, this study could not reveal that coronary atherosclerosis-related to declining in cognitive functioning. There was no significant association between plasma APOE4 levels and MCI.

Statins are shown effective by some studies in preventing contrast-induced nephropathy (CIN). We evaluated the effectiveness of atorvastatin in the prevention of CIN in computed tomography angiography (CTA) candidates. This study was conducted on patients referring for elective CTA with normal renal function. Patients received atorvastatin (80 mg/day) or placebo from 24 h before to 48 h after administration of the contrast material. Serum creatinine was measured before and 48 h after contrast material injection. CIN was defined as an increase in serum creatinine level of ≥ 0.5 mg/dl or ≥ 25% of the baseline creatinine. A total of 236 patients completed the study; 115 atorvastatin, 121 placebo, mean age = 58.40 ± 9.80 year, 68.6% male. Serum creatinine increased after contrast material injection in both the atorvastatin (1.00 ± 0.16-1.02 ± 0.15 mg/dl, P = 0.017) and placebo groups (1.03 ± 0.17-1.08 ± 0.18 mg/dl, P < 0.001). Controlling for age, gender, comorbidities, drug history, and baseline serum creatinine level, patients who received atorvastatin experienced less increase in serum creatinine after contrast material injection (beta = 0.127, P = 0.034). However, there was no difference between the atorvastatin and placebo groups in the incidence of CIN (4.3 vs. 5.0%, P = 0.535). In patients undergoing CTA, a short-term treatment with high dose atorvastatin is effective in preventing contrast-induced renal dysfunction, in terms of less increase in serum creatinine level after contrast material injection. Further trials including larger sample of patients and longer follow-ups are warranted.

Increased lipid profile after each meal can disturb the endothelial function. The present study assessed the effects of bread supplemented with oat bran on serum lipids and endothelial dysfunction in patients with hypercholesterolemia. This clinical trial was conducted on 60 isolated hypercholesterolemic patients. The subjects were randomly allocated to either intervention (consuming at least five daily servings of oat bread with 6 g beta-glucan) or control (receiving at least five servings of wheat bread). Anthropometric indicators, fasting blood sugar and lipid profiles ere measured at baseline and after 6 weeks (in the end of the intervention). Endothelial function was assessed using flow-mediated dilation (FMD). Within the group and between group differences were investigated using paired t-test and Student’s t-test, respectively. Oat bread consumption could significantly reduce total cholesterol (P = 0.029). A significant increase in baseline and after ischemia brachial artery diameters at the end of the study was seen. However, it did not have a significant effect on FMD (P = 0.825). In the control group, none of the measured indices had changed significantly at the end of the study. Finally, only the mean change of brachial artery diameter after ischemia and baseline brachial artery diameter were significantly higher in the intervention group than in the control group (P = 0.036 and P = 0.012 respectively). Oat bread with beta-glucan could successfully reduce cholesterol levels. Furthermore, in this study oat bread did not reduce FMD more than wheat bread. Since hypercholesterolemia is a proven risk factor for endothelial dysfunction, hypercholesterolemic patients can hence be advised to eat oat bread.

Leptin، a peptide contained 146 amino-acids، is mostly secreted from adipose tissue and it has a critical role on regulation of body weight، body fat mass، appetite، and food intakes. We tried to review the previous evidence regarding the effects of dietary intakes، including consumption of carbohydrates، fats and protein on concentrations of leptin concentration. We searched in PubMed search engine to January 2013 by using the following key words: dietary intake، diet، dietary fat، high-fat diet، dietary carbohydrate، high carbohydrate diet، dietary protein، high protein diet in combination with leptin، adipokine. Then، we recruited 35 articles to review in the present study. It seems that beside the amount of fats، type of fatty acids have the key roles on circulating leptin concentration. Energy intake also significantly associated with the hormone. Studies regarding the association between carbohydrate intake and concentration of lepton have been reached to contradictory results. It seems that protein intake can increase the lepton activity. Findings from several studies suggest that a diet display an important role on change the concentration of lepton.

Patent ductus arteriosus (PDA) at childhood is one of the five major and frequent congenital abnormalities, but it can be rarely seen in adults. Pulmonary hypertension (PHTN) and other presentations such as heart failure and edema are the identified complications of longstanding PDA, but adult case with no permanent heart symptoms and PHTN was rare. We reported a rare case of with an obvious PDA and normal pulmonary pressure.CASE REPORT: A 61-year-old woman presented with dyspnea (New York Heart Association class 2), chest pain, and lower limb edema. Echocardiogram showed; normal left ventricular chamber size and function, normal size of both atria. Furthermore, an obvious PDA (diameter = 6-7 mm) connecting the aortic arch to the pulmonary artery was reported in echocardiography. No lung congestion and evidence for PHTN was reported by computed tomographic angiography [Pulmonary capillary wedge pressure (PCWP) = 30 mmHg]. The patient was treated with antihypertensive drugs and after 1 and 3 months follow-up, edema and other symptoms were resolved. Finally, we conclude that PDA in adulthood can present with nonspecific cardiovascular symptoms, and it seems that PHTN is not a fixed echocardiographic finding in these patients.

Polyneuropathy, organomegaly, endocrinopathy, monoclonal syndrome (POEMS) is a rare paraneoplastic syndrome associated with plasma cell dyscrasia.CASE REPORT: A 48-year-old man presented with a 1-year history of paresthesia and progressive weakness of extremities. Diagnosis of POEMS syndrome was made for him on the basis of clinical presentation, additional physical findings, typical sclerotic bone lesion, and bone marrow findings. In last admission, he explained episodes of dyspnea and chest pain that associated with frequent premature ventricular contraction in his electrocardiograph. Patient heart monitoring showed some episodes of complete heart block. Infra-His atrioventricular block in electro-physiologic study was detected. He had no history of ischemic heart disease. His cardiopulmonary findings on examination were normal. All results of cardiac biomarkers and serum electrolytes and repeated echocardiography were within normal range. Cong red staining of rectal fat pad biopsy was negative. After pacemaker insertion radiation of sclerotic bone, lesion started for him, but radiotherapy was ineffective, and he expired with respiratory failure. Complete heart block in POEMS syndrome has not been reported previously, and it is the first POEMS case with complete heart block. Complete heart block is a cardiac manifestation of POEMS syndrome

Small dense low-density lipoprotein (sdLDL) is a sub-fraction of LDL considered to have the most atherogenic properties. The present trial aimed to assess changes in circulating sdLDL concentrations following supplementation with curcuminoids, polyphenolic compounds with diverse potential cardio-protective functions. This study was designed as a randomized double-blind placebo-controlled cross-over trial. A total of 30 obese dyslipidemic subjects were assigned to curcuminoids (1 g/day) or placebo for 4 weeks, followed by a 2-week washout and then treatment with the alternate for another 4 weeks. Serum sdLDL was measured at baseline and weeks 4, 6, and 10 of the trial. Supplementation with curcuminoids (1 g/day) did not cause any significant alteration in serum sdLDL (P > 0.05). Four-week supplementation with curcuminoids was not associated with any significant alteration in circulating sdLDL concentrations.