abdolmohammad ranjbar

Sepsis is a serious condition that can be fatal and has become more common in recent times. The impact of diastolic dysfunction on the early mortality rate of septic patients has not been extensively researched. This study aimed to assess the accuracy of serum procalcitonin (PCT) levels and diastolic dysfunction in predicting the mortality rate of patients diagnosed with sepsis and admitted to the intensive care unit.

In this cross-sectional study, 40 sepsis patients admitted to the ICU were examined. Their characteristics were meticulously recorded using the APACHE II and SOFA score questionnaires, and only those who met the criteria underwent echocardiography. In order to evaluate the serum levels of PCT, it was required to take 40 ml of venous blood samples from the patients on the first and fifth days of admission.  

Out of 40 patients, the average age was 63±17 years. Of these patients, 23 (57.5%) were discharged, while 17 (42.5%) unfortunately passed away. Results showed a notable correlation between diastolic dysfunction, CRP, SOFA score on days 1 and 2, APACHE II score, and PCT on day 5 (P˂0.05). However, when analyzed using logistic regression, only PCT on day 5 showed a significant association with mortality.

Based on our research, we found that PCT is an essential indicator in predicting the mortality rate of sepsis patients. While there was no significant correlation between diastolic dysfunction and mortality, it should still be considered a critical factor in determining the mortality rate.

The prevalence of chronic kidney disease (CKD) is increasing every year, which increases the risk of cardiovascular disease and even death. In Cardiorenal syndrome type 2 (CRS2), chronic cardiac dysfunction causes renal dysfunction. The aim of this study was to evaluate Doppler ultrasound of renal veins, calculate venous impedance index (VII) and determine their associations with the prognosis of CRS2 syndrome in patients with a history of chronic heart disease and CKD with a good forward function.

In this descriptive-analytical study, 49 patients referred to Imam Reza Hospital in Tabriz with heart failure and renal dysfunction were selected. Renal status, VII and ejection fraction (EF) were evaluated.

Mean age of the patients was 61.83±12.39 years, 42.9% of which were women and 57.1% were men. The durations of heart and renal failure were 33.16 ± 13.8 and 11.76±5.1 months, respectively. Significant associations were found between VII and EF of the right and left kidneys (P=0.01 and P =0.03, respectively). But there was no statistically significant relationship between renal function and EF (P =0.54). With increasing edema rate, both VII and EF were decreased; however, these associations were not statistically significant (P >0.05).

According to the results, significant associations were found between VII and EF of right and left kidneys, however, no statistically significant correlations were observed between edema and VII mean and EF.

 Acute aortic dissection is one of the catastrophic cardiovascular events with high in-hospital mortality. We aimed to assess the distribution of ABO blood groups in patients with acute aortic dissection, and to identify any association between their blood groups and in-hospital mortality.

In cross-sectional study, 147 patients with confirmed acute aortic dissection by computed tomography angiography were included. According to the type of their blood groups, patients were divided into non-O (including A, B, and AB blood groups) and O blood groups. According to the tearing location, patient were divided into proximal (ascending aorta) and distal (descending aorta) dissection groups. The data were statistically analyzed using chi-square, Fisher's exact, and independent t tests.

The mean age of patients was 58.77 ± 16.04 and 59.3 ± 15.32 years in non-O and O blood groups, respectively. From 147 patients with thoracic aortic dissection, 93 patients had non-O and 54 patients had O blood groups. A and O blood groups were seen more frequently among the patients. 54 patients (36.7%) died during their hospital course. Blood groups of AB [odds ratio (OR) = 3.52] and A (OR = 1.67) had stronger correlation with in-hospital mortality. Patients with blood group O had better in-hospital survival (OR = 0.40).

 It seems that patients with aortic dissection and O blood group have a better in-hospital survival than patients with non-O blood groups.

Anomalous origin of the left coronary artery from pulmonary artery (ALCAPA) is not a common anomaly in adulthood. Its early diagnosis requires physician suspicion and the early treatment of disease can prevent its serious side effects. In this article, we presented a young female with pansystolic murmur and heart failure with final diagnosis of ALCAPA syndrome.

Pulmonary thromboembolism (PTE) is one of the serious and lethal cardiopulmonary diseases. Rapid diagnosis and therapy is of paramount importance. In recent years, various factors including white blood cell count, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) have been used as prognostic factors in acute pulmonary embolism. This study aimed to evaluate the correlation between neutrophil-to-lymphocyte ratio and mortality rate in patients with pulmonary thromboembolism treated with thrombolytic drugs.
A total of 40 patients hospitalized whit diagnosis of pulmonary embolism and treated with thrombolytic drugs were enrolled. Clinical data, admission complete blood count (CBC) parameters, and neutrophil-to-lymphocyte ratio were all recorded. The clinical outcomes of study subjects were determined using hospital-reported mortality data.
Findings: The mean age was 59.90 ± 13.82 years, and 13 patients were women (32.5%). The mean white blood cell (WBC) count was 9673.25 ± 2885.37. The mean neutrophil-to-lymphocyte ratio was 4.80 ± 2.41; 7 patients (17.5%) died during hospital course. The mean neutrophil-to-lymphocyte ratio level was significantly higher among patients who died compared to those who survived (7.10 ± 1.37 vs. 4.31 ± 2.31; P This study showed a correlation between neutrophil-to-lymphocyte ratio and hospital mortality rate in patients with acute pulmonary thromboembolism treated with thrombolysis.

Many cardiovascular procedures such as temporary pacemaker insertion, electrophysiological studies, and percutaneous transmitral commissurotomy are carried through inferior vena cava (IVC). Its malformations such as its interruption with azygous/hemiazygous continuation, left-sided IVC, and double IVC can make some difficulties for cardiologists during these procedures. In this case report, we present the case of a 75-year-old male with recurrent episodes of syncope and bradycardia. Due to interrupted IVC, temporary pacing lead was difficultly advanced from the IVC to the accessory hemiazygos vein, left brachiocephalic vein, superior vena cava, right atrium, and right ventricle. Temporary pacemaker insertion is an invasive procedure and should be performed under the guidance of fluoroscopy. However, rarely, IVC malformations such as interrupted IVC make it difficult to do procedure in a short period of time. Rupture of IVC and some complications due to severe bradycardia can be prevented by understanding rare IVC malformations.

Patients with heart failure experience debilitating symptoms lowering their life quality. Patients must use several methods of self-care in order to reduce symptoms and the rate of hospitalization and to improve their quality of life. The main purpose of this study was to design and create a mobile-based self-care application for patients with heart failure.
This was an applied developmental study. Initially, a questionnaire was prepared to assess information requierments, determine data elements and necessary capacities of the application. Then, 20 cardiologists working in Shahid Madany hospital, the specialty center of cardiovascular surgery affiliated to Tabriz University of Medical Sciences were asked to fill out the questionnaire. The obtained data were analysed and the application was developed accordingly. Finally, in order to evaluate its practical capability and patients’ satisfaction rate, it was used by 10 patients with heart failure.
The majority of data elements in the questionnaire were found necessary by the cardiologists. The main features of the designed application included alerts for daily monitoring, visit time and reminders of time of drug use, hypertention, increase of heart rate and weight gain. In evaluation of practical capability of the application by patients, it was evaluated in a good level with the mean score of 7.8 (out of 9).
Mobile-based self-care applications can be used to help patients with heart failure to manage their disease and to obtain self-care skills.

To determine the type and pattern of arrhythmic events following the 2012 Ahar-Varzegan Earthquake among patients implanted with cardiac defibrillators (ICDs) in East Azarbaijan province.
In a prospective cohort study, conducted in East Azerbaijan Province of Iran, 132 patients were enrolled in two comparison groups according to the region of residence i.e., earthquake region (n= 98) and non-earthquake (n= 34) region in 2012. Data were collected for those meeting standard criteria for sustained ventricular arrhythmias (VAs), or supraventricular tachycardias (SVTs) and triggered ICD therapies, either shock or anti-tachycardia pacing (ATP). The state version of the State-Trait Anxiety Inventory (STAI-S) was used to assess general symptoms of anxiety in both groups.
Males comprised 81.1% of the participants. Mean age of the participants was 59.7 ±15 years. The frequency of patients with sustained VAs increased significantly after the earthquake (p=0.008). There were more VAs (mean 2.16 vs. 6.23; p=0.008) and they occurred earlier (6th vs. 16th day; p= 0.01) in the earthquake area. The mean frequency of SVTs and the total number of delivered ICD therapies were similar between groups. Differences in anxiety levels were not significant between groups but there was a trend for presence of greater number of patients with anxiety (p=0.07) and the relative severity of anxiety (p=0.08) in the earthquake area.
In the earthquake area, the mean frequency of VAs increased and they occurred earlier in the earthquake area. The stress of anxiety might have served as a trigger for these events.

Most maternal cardiac disease in Western societies is now congenital in origin. This relates to the significant improvements in congenital cardiac surgery during the last years. Some patients will present for the first time in pregnancy with symptoms and learn that they have congenital heart disease. So all patients should have a detailed evaluation and appropriate counseling before pregnancy. Ebstein anomaly is a rare and complex congenital heart disorder occurring in 1 per 200 000 live births and, first described by a German physician Wilhelm Ebstein in 1866 in a report titled, “Concerning a very rare case of insufficiency of the tricuspid valve caused by a congenital malformation. This anomaly accounts for 0.5%–0.7% of cases of congenital heart disease. The average life duration of patients with Ebstein’s anomaly is 25–30 years. The malformation consists of apical displacement of the tricuspid valve with resultant regurgitation and enlargement of the right heart chambers, resulting in arrhythmias and heart failure. The common cardiac anomalies associated with the condition are atrial septal defect (ASD) in 90% of patients, anatomic or functional tricuspid atresia in 30%, Wolff-Parkinson-White (WPW) syndrome in 15% and less commonly ventricular septal defect (VSD), pulmonic stenosis or atresia and mitral valve prolapse. Survival into adulthood is common and patients present with cyanosis, dyspnea and palpitations.