International Cardiovascular Research Journal
Volume:12 Issue: 3, Sep 2018

Rat model of chronic myocardial infarction and heart failure is associated with endothelial dysfunction, which has partly been attributed to increased oxidative stress.
This study aimed to examine the effects of oleuropein on vascular endothelial dysfunction in rats with chronic myocardial infarction.
The rats were subjected to coronary artery ligation or sham operation. On the next day, they were divided into a sham and a coronary-ligated group receiving distilled water (1 mL/day) and two coronary artery-ligated groups receiving 10 or 20 mg/kg/day oleuropein. Five weeks later, hemodynamic variables were measured, isolated aortic studies were performed, and serum concentrations of superoxide dismutase and malondialdehyde were determined. The data were entered into Sigmastat Statistical Software and were analyzed using one-way ANOVA followed by Duncan’s Multiple Range. P ≤ 0.05 was considered to be statistically significant.
The rats with myocardial infarction receiving vehicle had a significantly lower left ventricular systolic pressure (P = 0.04), rate of rise (P = 0.03), decrease of left ventricular pressure (P = 0.03), relaxation response to acetylcholine (P = 0.01), and serum levels of superoxide dismutase (P = 0.01). Oleuropein treatment prevented the reduction of these variables. Moreover, the myocardial infarction group receiving vehicle had a significantly higher contraction response to phenylephrine (P = 0.03) and serum levels of malondialdehyde (P = 0.02) compared to the sham group. Treatment with oleuropein prevented the increase of these variables. There was no significant difference among the study groups regarding heart rate.
The findings indicated that chronic myocardial infarction resulted in heart failure and was associated with endothelial dysfunction. They also demonstrated that oleuropein attenuated endothelial dysfunctions, possibly, by antioxidative effects.

Right Ventricular Septal (RVS) pacing is often recommended as a more physiological alternative to Right Ventricular Apical (RVA) pacing.
This study aimed to determine the long-term outcomes in patients persistently paced following Atrioventricular Node (AVN) ablation.
This study was conducted on 200 patients who underwent Permanent Pacemaker (PPM) implantation prior to AVN ablation with either RVA- or RVS-pacing. Primary endpoints were hospitalization due to Heart Failure (HF) and death. Secondary endpoints included changes in Ejection Fraction (EF), inter- and intra-ventricular dyssynchrony measures, and paced QRS duration. Demographic data were obtained from all patients. In addition, CT chest examinations were analyzed to confirm RVS lead position.
The mean survival time from AVN ablation was 6.32 ± 4.294 years in the RVA group and 3.00 ± 2.546 years in the RVS group (hazard ratio = 3.512, P = 0.0001). The results showed no significant differences between the two sites regarding hospitalization due to HF. Baseline and follow-up EFs were respectively 48.4 ± 13.8% and 53.1 ± 8.5% for RVA pacing and 52.0 ± 10.6% and 55.2 ± 11.3% for RVS pacing (P = 0.911). Moreover, 76% of the patients in the RVS group had a septal lead confirmed on CT chest review. Twenty-four percent of the RVS leads were in alternate sites, including the RVA and free wall.
The results revealed was no diminution in EF with either lead position at long-term follow-up. The mortality rate was significantly less in RVA pacing compared to documented septal pacing although a quarter of the RVS leads were found in alternate sites on CT chest review.

Despite the clear role of the Nkx2-5 gene mutations as the trigger for Congenital Heart Disease (CHD) in different populations, the condition of these mutations in our population remains obscure.
The present study aimed to assess different Nkx2-5 gene mutations in a sample of Iranian patients with CHD.
Patients and This cross-sectional study was conducted on 79 consecutive suspected non-syndromic CHD patients at Rajaie Cardiovascular Medical and Research Center between 2016 and 2017. Detailed clinical evaluations were performed and CHD was confirmed by echocardiography. The exons of the Nkx2-5 gene were sequenced. In silico analysis was done using Mutation taster, SNP nexus, and Vienna RNA package. In addition, statistical analysis was performed using the SPSS statistical software, version 16.0. P ≤ 0.05 was considered to be statistically significant.
The study results revealed four synonymous polymorphisms; i.e., rs2277923, rs703752, rs3729753, and c.217C > T, the last of which was novel. Regarding the frequency of different Single Nucleotide Polymorphism (SNP) genotypes, the overall frequency of wild, heterozygous, and mutant genotypes was respectively 65.8%, 31.6%, and 2.5% for rs2277923, 54.4%, 0.0%, and 45.6% for rs703752, 96.2%, 3.8%, and 0.0% for rs3729753, and 93.7%, 6.3%, and 0.0% for c.217 C > T. Bioinformatics analysis demonstrated that the detected novel variants were not pathogens. Moreover, the genotypic variants of all SNPs were independent of gender, type of heart defect, and hereditary form of the disease.
The results could not show any major roles for different exon-related SNPs on the Nkx2-5 gene as the candidate risk profile for CHD. The results also demonstrated no significant associations between such mutations and increased likelihood of specific heart defects.

Congenital Aortic Stenosis (AS) is a common problem among congenital heart diseases and balloon valvuloplasty is known as the procedure of choice for treatment.
This study aimed at evaluation of the function and remodeling of the heart after a successful balloon AS valvuloplasty.
Patients and From September 2012 to 2016, 33 patients with congenital AS who had successful balloon valvuloplasty were enrolled into this study. All patients were evaluated by 2D, M-mode, Doppler, and tissue Doppler echocardiography before and after the procedure. The data were analyzed using the SPSS statistical software.
The median duration of follow-up was 2 years (range = 6 months to 7.4 years). Besides, the mean of immediate peak-to-peak gradient reduction was 41.50 ± 17.36 mmHg. Moderate to severe aortic insufficiency occurred in less than 28% of the patients. Additionally, M-mode echocardiography showed residual left ventricular hypertrophy in 50% of the patients. Moreover, E∕A ratio was less than -2 Z-scores in 73% of the patients. E/Ea ratio was also more than 2 Z-scores in 50% of the patients, which was an indicator of diastolic dysfunction. The most common associated lesion was bicuspid aortic valve in 48% of the cases.
Balloon aortic valvuloplasty effectively reduced peak systolic pressure gradient across the aortic valve in patients with congenital AS although left ventricular hypertrophy and diastolic dysfunction persisted in a significant number of patients.

Cardiac abnormalities are common complications in Transfusion Dependent Thalassemia (TDT).
This study aimed to assess functional and structural cardiac abnormalities in TDT patients in Zabol, Sistan and Baluchistan province in south-east of Iran.
Patients and This cross-sectional study was conducted on 85 TDT patients selected via simple random sampling. Demographic information was obtained using a questionnaire. Additionally, clinical and laboratory data were extracted from medical records. Cardiac assessment was conducted by standard Doppler echocardiography. After all, the data was statistically analyzed using the SPSS statistical software, version 19.
In this study, 54 participants (63.5%) were female and 31 ones (36.5%) were male. The participants’ mean age was 19.2 ± 6.1 years. In addition, 58 patients (68.2%) had at least one cardiac abnormality. The mean of Left Ventricular Ejection Fraction (LVEF) was 60.3 ± 8.5% (range: 40 - 80%). The most common cardiac conditions were Tricuspid Regurgitation (TR) (58.8%), Left Ventricular Diastolic Dysfunction (LVDD) (43.5%), Pulmonary valve Insufficiency (PI) (35.3%), and Mitral Regurgitation (MR) (32.9%). Moreover, Left Ventricular Systolic Dysfunction (LVSD), Aortic Insufficiency (AI), and pericard effusion were detected in 6 (7.1%), 2 (2.4%), and 2 patients (2.4%), respectively. The results revealed a significant association between LVDD and splenomegaly, splenectomy, hepatomegaly, chelation therapy, and anti-HCV positivity. Indeed, anti-HCV positivity was significantly associated with MR and lower LVEF. Patients with positive anti-HCV results presented a higher risk of cardiac dysfunction (OR = 4.1, 95% CI: 0.8 - 19.8, P = 0.022) and LVEF The results indicated anti-HCV positivity as a significant risk factor for heart dysfunction in TDT patients. Thus, cardiac functionality is recommended to be assessed regularly in TDT patients.

Spontaneous Coronary Artery Dissection (SCAD) is an unusual but important cause of acute coronary syndromes. We presented a case suffering from acute myocardial infarction with extensive SCAD confirmed on angiography. The use of intravascular ultrasound enabled identification of the extent of the disease and served as an important adjunct to successful percutaneous interventional treatment.

Accessory chamber is an extremely rare congenital abnormality, which is often detected as an incidental finding on echocardiography. We described a case of accessory pseudo Left Atrium (LA) firstly detected by echocardiography and confirmed by Cardiac Magnetic Resonance imaging (CMR). Case presentation- A 4-year-old girl referred to our center with recent fatigue and exertional dyspnea. A large accessory LA was clearly visible on transthoracic echocardiography. CMR demonstrated an isolated wide base round “auricle like” chamber with large pectinate muscles simulating bear’s paw. The accessory LA’s only connection was to the Left Ventricle (LV) through an orifice that functioned as a dysplastic valve at the level of Left Ventricular Outflow Tract (LVOT). This valve had severe regurgitation and stenosis with no papillary connection. Conclusion- This entity differs from cor-triatriatum of the LA because there is a superior-inferior septum between the two left-sided atria with no interatrial communication and no pulmonary venous drainage to the accessory chamber.