Iranian Heart Journal
Volume:20 Issue: 3, Fall 2019

Cardiac rehabilitation (CR) programs effectively decrease mortality,lead to a better quality of life. Our study addresses the effects of these programs on the myocardial performance index (MPI) as a marker of cardiac function in post-bypass patients. To evaluate the effects of CR on the MPI as a quantitative cardiac function index according to different baseline characteristics including the left ventricular ejection fraction,we designed this cohort before-and-after trial. We enrolled 65 outpatients with a history of coronary artery bypass surgery (CABG). The MPI,ejection fraction indices were measured before,after the completion of an individualized 12-session CR program. After the successful completion of a CR program by the subjects,the mean MPI showed a significant decline (0.50 vs 0.55,P < 0.001),the left ventricular ejection fraction exhibited a significant rise (P < 0.001). The change was more pronounced specifically in the group with a moderately reduced left ventricular dysfunction (mean MPI,0.52 vs 0.63). We successfully showed that a supervised individualized CR program can affect the MPI,systolic ejection fraction indices in post-bypass patients positively. Thus,an individualized CR program should be considered for this group of patients as a complement to the standard therapy.

In spite of achievements in the field of pediatric cardiology and surgical techniques, which have increased the chance of children with congenital heart diseases to reach adulthood, the inherent problems with the disease create a large number of complications for them in later life, including cardiac dysfunction. It is important to know the prevalence of cardiac dysfunction and its influential factor among adults with congenital heart diseases (CHDs); hence, the present study aimed to answer this question. We measured the prevalence of cardiac dysfunction based on echocardiographic guidelines among ACHDS referred to Rajaie Cardiovascular, Medical, and Research Center between December 2017 and June 2018. Data analysis was performed using the χ2 test and logistic regression through the SPSS software. Left and right ventricular dysfunction was 60.6% and 77.7%, respectively. Moreover, 58.7% of the patients were affected by both left and right ventricular dysfunction, while 20.9% had only one of the left or right ventricular dysfunction. Eighty-eight (20.4%) patients did not have dysfunction at the time of the study. The variables of moderately complex congenital heart disease, cyanosis, moderate pulmonary hypertension, the Eisenmenger syndrome, and the type of intervention were the predictors of left ventricular dysfunction. The prevalence of cardiac dysfunction among our adult patients with CHDs was very high. Given that cardiac dysfunction starts at a young age in this group of patients in comparison with the general population, the quality of life of the former group is more seriously threatened. Our results identified factors that increased the likelihood of developing cardiac dysfunction. These factors should be considered when approaching patients with cardiac dysfunction

The aim of this study was to investigate the relationship between serum endothelial cellspecific molecule-1 endocan levels and coronary artery ectasia (CAE). This cross-sectional study was conducted on 99 patients. According to angiographic data, the patients were divided into 3 groups: 1) patients with isolated CAE (n = 33), 2) patients with documented coronary artery diseases without CAE (n = 33), and 3) those with normal coronary arteries (n = 33). The endocan concentration was measured via the ELISA technique. patients with isolated CAE had significantly lower levels of endocan than did the controls (261.30 ± 61.34 vs 564.58 ± 81.69; P < 0.05). There was no significant correlation between endocan levels and the severity of CAE according to the Markis classification (P > 0.05). The patients who used opium had a significantly higher prevalence rate of CAE (65.6% vs 35.3%; P = 0.012). Moreover, in the group with ectasia, by comparison with the non-ectatic group, significantly high levels of serum triglyceride, cholesterol, and LDL levels, as well as low HDL levels, were detected. Among our study population, a decrease in endocan levels was a sensitive and accurate indicator for predicting the presence of CAE, although the level of this marker was not very effective in determining the severity of ectasia. In addition to a drop in endocan expression levels, the use of opium and also an abnormal lipid profile were the other predictors of CAE.

Today, health literacy is introduced as a global issue and debate, and low health literacy appears to be related to nonadherence to healthy lifestyle behaviors and health inequalities. Therefore, the aim of this study was to investigate the health status of patients with cardiovascular disease and its relationship with the patients’ adherence status to their drug therapy. The present study was a descriptive correlational study. The research population comprised the patients referred to our clinics. Four hundred participants were selected based on the inclusion and exclusion criteria from the research population. The sampling method was simple random sampling. The instrument consisted of 2 parts: the first part evaluated demographic information and the second part was based on the combination of 2 standard instruments of cardiovascular literacy and adherence to treatment, which were used after being modified and reassessed in terms of validity and reliability. The obtained information was analyzed with the SPSS software, version 19. Descriptive and analytical statistics were used. The Spearman test indicated general health literacy had a significant relationship with treatment (r = 0.31, P < 0.001). This correlation was also observed in relation to the subscales of perception of health (r = 0.27) and health behavior by adherence to treatment (r = 0.29, P < 0.001). If the participants received information through their physicians, they showed a significant relationship between health literacy (in all subscales) and adherence to treatment (P < 0.001). The results showed a high correlation between health literacy and adherence to treatment. Therefore, considering the importance of cardiovascular diseases, as well as the importance of health literacy and its relevance to adherence to treatment, we suggest that the television sets located in the clinics of the center broadcast educational videos during the waiting period for the clients.

Several studies in the past have shown that lead causes elevated blood pressure in humans and animals and exerts devastating effects on various organs of the body, including the cardiovascular system. This study was typically conducted to investigate the effects of the grape seed extract on the treatment of lead-induced hypertension and the correction of the aortic response to isolated vascular factors. Experiments were carried out from January to March 2009 in the Physiology Research Center of Ahvaz Jundishapur University of Medical Sciences. In total, 50 experiments were carried out on 5 groups of Wistar rats in 5 groups, each group receiving water containing lead acetate and the grape seed extract in different patterns for 8 weeks, in accordance with the groups listed in the original text. Blood pressure was measured weekly through the tail-cuff. The response of the isolated aorta to the vasoconstrictor and vasorelaxant was evaluated in the groups. Statistical analysis was performed using the SPAS software, version 22, via one-way ANOVA followed by the LSD test. A P value < 0.05 was considered significant. Discontinuation of lead and administration of the extract caused a faster drop in blood pressure. Increased contractile responses to phenylephrine were observed in the rats that continued to consume lead and did not receive the extract. Additionally, the response to acetylcholine in the extract group was higher than that in the continued lead group. The current study showed that the use of the grape seed extract, even after the occurrence of lead-induced hypertension, could be a useful treatment. Considerably, the grape seed extract failed to have an effect on vascular responsiveness to vasodilator and vasoconstrictor drugs.

Sexual dysfunction is one of the most common problems in men after coronary artery bypass graft surgery (CABG). The aim of this study was to compare male sexual function before and 6 months after CABG. This cross-sectional study recruited 70 CABG candidates who completely fulfilled the inclusion criteria without any exclusion criteria. The patients were asked to complete the International Index of Erectile Function (IIEF) questionnaire before and also 6 months after the operation. Demographic data and also the type of surgery were recorded. At the end of the study period, different dimensions of sexual function were compared before and after CABG. The mean age of the patients was 57.7 ± 7.86 years, and 15 (21.4%) cases were diabetic. Six months after CABG, a significant decrease was observed in all the aspects of sexual function (P < 0.001). The mean erectile function score decreased from 19.91 ± 6.4 to 17.46 ± 6.82, the mean orgasmic function score from 7.19 ± 2.62 to 6.17 ± 2.99, the mean sexual desire score from 6.44 ± 2.47 to 4.91 ± 2.76, the mean intercourse satisfaction score from 8.59 ± 3.57 to 7.4 ± 3.77, the mean overall satisfaction score from 6.71 ± 2.29 to 5.34 ± 2.77 and the total score of the IIEF from 48.84 ± 13.26 to 41.29 ± 14.75. Comparisons of sexual function quality before and after CABG divided by diabetic and nondiabetic patients also demonstrated the same results in all the domains. Except for the intercourse satisfaction in the nondiabetic patients, sexual function decreased significantly. The results of this study indicated the negative effect of CABG on all the different aspects of sexual function. Given the direct impact of sexual function on patients’ quality of life, it is essential to take this aspect of patients’ function into account more than before by applying empowerment therapies after CABG, if necessary.

One of the negative effects of cardiac sympathetic hyperactivity is pathologic hypertrophy. Recent studies have indicated that large tumor suppressor (LATS) is one of the molecules which play a critical role in cardiomyocyte apoptosis. Considering the preventive role of exercise training, we evaluated the effects of endurance training on LATS gene expression and its upstream pathway in the present study. Eighteen male Wistar rats were randomly divided into 2 groups: endurance and control. Endurance training was performed for 8 weeks, 1 hour per day, and 6 days per week on the treadmill at a 15° inclination. Pathologic hypertrophy was induced with the injection of 3 mg/kg-1 of isoproterenol for 7 days; and after 24 hours, the left ventricle was separated and the gene expressions of LATS, MST, and MAP4K were measured. The apoptosis cells of the left ventricle were counted via TUNEL assay. The data were analyzed using the t-test and the Mann–Whitney test. The gene expressions of LATS and MAP4K in the training group decreased significantly (P ≤ 0.001). In addition, the apoptosis levels of cardiomyocytes in the training group decreased and the left ventricular weight increased significantly. There were no differences in MST gene expression between the groups (P = 0.061). Our results showed that endurance exercise training diminished LATS suppression by reducing the expression of MAP4K, preventing the propagation of apoptosis induced by hypertrophy in the cardiomyocytes of the Wistar rats.

Despite impressive advances in therapeutics in the last years, acute heart failure (AHF) remains a major cause of cardiovascular morbidity and mortality. Additionally, worsening renal failure (WRF) during hospitalization has a significant effect on rehospitalization and mortality in such patients. In this study, we aimed to determine the factors impacting on WRF and inhospital mortality in patients with AHF. During a 9-month period (September 2016 to May 2017), 104 patients with an episode of AHF (mean age: 75 y) were included in this study. The effects of demographic, echocardiographic, and laboratory findings on WRF and in-hospital outcomes (mortality and urgent heart transplantation) were evaluated retrospectively. Out of the 104 patients, 44.3% developed WRF; the incidence of in-hospital mortality and heart transplantation was 13.4%. Among the laboratory parameters, the specific gravity of urine was significantly associated with WRF (P = 0.03), and higher blood uric acid levels (P = 0.01) and lower left ventricular ejection fractions (P = 0.04) were associated with adverse in-hospital outcomes. Additionally, low hemoglobin (P = 0.03), high pro-BNP (P = 0.05), and low left ventricular ejection fractions (P = 0.04) were associated with a prolonged in-hospital stay. Laboratory data can be used upon patient admission to guide the therapy of heart failure in an attempt to reduce WRF and in-hospital stay.

Left ventricular (LV) synchrony is a clear indicator of cardiac performance. However, left ventricular dyssynchrony (LVD) is not necessarily a sign of heart malfunction. Individuals at a higher risk of developing heart failure can be identified by LVD. Gated SPECT myocardial perfusion imaging (MPI) allows the simultaneous assessment of LV perfusion, function, and mechanical dyssynchrony through phase analysis. The aim of this study was to evaluate the prevalence and predictors of LVD in patients undergoing MPI. A total of 907 consecutive patients referred to the Nuclear Medicine Department of Farshchian Heart Center, Hamadan, Iran, for diagnostic purposes were examined. The patients underwent gated SPECT MPI with a 2-day stress/rest protocol. Auto-Quant software package was used to evaluate perfusion, function, and phase analysis. Additionally, significant LVD was assessed based on the following criteria: standard deviation of the LV phase distribution > 19.6 and a phase histogram > 72.5 in the stress phase of the examination. Several variables were evaluated using univariate and multivariate analyses. The variables significantly associated with LVD were sex (male), obesity, hypertension, diabetes, QRS > 120 ms, a history of coronary artery disease, myocardial perfusion defects reported on MPI, and LV dysfunction. Our results suggested that the prevalence of significant LVD as a predictor of adverse cardiovascular events, death, and progression to heart failure was 12.9%. The multivariate analysis revealed that variables such as obesity, diabetes, hypertension, sex (male), coronary artery disease, and QRS >120 ms were highly associated with LVD.

It is now suggested that the hypertensive state in diabetic patients may be associated with the level of hemoglobin A1c (HbA1c). In line with this hypothesis, we aimed to compare the level of HbA1c in diabetic patients with and without hypertension to determine whether or not there is a correlation between HbA1c and the hypertension stage. This cross-sectional survey was conducted in collaboration with the Physiology Research Center at Kerman University of Medical Sciences on 563 patients with type 2 diabetes. HbA1c was measured via the high-performance liquid chromatography (HPLC) technique. Hypertension was staged as normal, prehypertension, hypertension stage 1, or hypertension stage 2. We found no difference in the mean fasting blood glucose level and the mean HbA1c level between the different subgroups of hypertension stages; hence, the degree of hypertension was not associated with diabetes control status. The value of HbA1c was correlated with neither systolic blood pressure (P = 0.800) nor diastolic blood pressure (P = 0.215). We also failed to show any significant relationship between the intensity of physical activity and the HbA1c level (P = 0.517). Our multivariable linear regression model revealed that opium addiction was the only determinant significantly correlated with HbA1c (P = 0.038). We showed no difference in the level of HbA1c between diabetic patients with and without hypertension. It appears that the degree of hypertension in such patients may not be associated with diabetes control status.

Slow coronary flow (SCF) is a condition defined as the delayed passage of the contrast agent in the absence of angiographic coronary artery stenosis. Left ventricular (LV) systolic and diastolic dysfunction has been reported in patients with SCF, which can influence their functional capacity. This study compared myocardial deformation between cases with normal coronary arteries and patients with SCF. This cross-sectional comparative study included 32 patients with SCF and 32 controls with normal epicardial coronary arteries (NECA). After coronary angiography, echocardiography was done for all the participants and the results were compared between the groups. A total of 64 patients were studied. The mean global longitudinal peak systolic strain (GLPS.Avg) was 16.85. SCF was significantly more frequent in the men than in the women (P < 0.05). Diabetes mellitus, systemic hypertension, a history of past or current smoking, and a family history of coronary artery disease (CAD) in the patients with SCF and dyslipidemia in the NECA group were more frequent, although these differences were not statistically significant. GLPS.Avg and global longitudinal peak systolic stress in the apical 4-chamber view (GLPS.A4C) in the patients with SCF were significantly lower than those in the NECA group. Global strain in the apical 2- and 3-chamber views (GLPS.A2C and GLPS.LAX), septal E, septal A, lateral E, lateral A, and right ventricular Sm (peak myocardial systolic velocity) were also nonsignificantly lower in the patients with SCF. Strain imaging using 2D echocardiography was abnormal in our patients with SCF, in comparison with the NECA group. These abnormalities may represent subtle systolic and/or diastolic dysfunction in patients suffering from SCF.

We describe a 1-year-old boy who underwent a percutaneous transthoracic biopsy of an incidentally detected cardiac tumor. The procedure was performed under ultrasound guidance to obviate the need for surgery. The benign nature of the mass precluded subsequent curative surgery. Ultrasound is a valuable modality in guiding percutaneous biopsy of thoracic lesions.

We describe a young boy with epigastric pains and transiently altered consciousness, admitted for surgery. After cardiology consultation and transthoracic echocardiography, a distal type aortic dissection was diagnosed. Computed tomography angiography for the evaluation of the aortic dissection was performed. Given the patient’s hemodynamically stable state and the distal type of the aortic dissection, he was discharged with medical follow-up.