International Cardiovascular Research Journal
Volume:15 Issue: 1, Mar 2021

Context: 

Atrial Fibrillation (AF) is the most prevalent arrhythmia in human populations with a growing world-wide burden. The present review aimed to determine the genetic factors in the development of AF.

Evidence Acquisition: 

The present study included the studies, which probed into the genetic factors of AF. The searches were done in PubMed, Scopus, Web of Science, Embase, and Google Scholar databases. The review highlighted two main directions of AF genetic studies; i.e., rare mutations in structural genes, including potassium and sodium channels, connexins, and transcription factors genes, and genome-wide association studies of significant common variants. The main focus was on the most important loci confirmed by numerous studies with both rare and common variants.

Research on the genetic basis of AF has remained a hot topic due to its growing worldwide burden. Recent advances in genome-wide studies have provided the ground for gaining insight on minor genetic factors with cumulative effects, which are distributed more widely than previously known rare mutations.

Far more potential candidate genes and/or regulatory sequences have been already discovered, and there are much more to be explored in the near future. This will potentially result in a better understanding of AF and other arrhythmic conditions as well as their impacts on human health, and will provide new ways to improve diagnostics and treatment strategies.

Recent advances in the early detection and management of breast cancer have conferred longer patient survival. Breast irradiation-induced cardiotoxicity has been associated with a decrease in the echocardiographic markers of myocardial function and an increase in cardiac mortality.

This study aimed to determine the cardiac effects of radiotherapy on patients with breast cancer based on cancer laterality.

The present study assessed the records of 72 consecutive women with breast cancer who were referred to the Cardio-Oncology Department of Rajaie Cardiovascular Medical and Research Center between April 2017 and September 2020 and had baseline echocardiographic examinations and at least one follow-up echocardiographic examination within the first year of the initial examination. The patients were divided into left- and right-sided breast cancer groups to compare the results. The two groups were compared regarding the means of 2D Left Ventricular Ejection Fraction (LVEF), 3D LVEF, Global Longitudinal Strain (GLS), and Global Circumferential Strain (GCS) before and after radiotherapy. Analysis of Covariance (one-way ANCOVA) was used to compare the results (alpha = 0.05). All analyses were carried out using the SPSS software, version 26.

The changes in the means of 2D LVEF, 3D LVEF, GLS, and GCS were statistically significant among all the patients irrespective of cancer laterality (P < 0.001, P < 0.001, P = 0.001, and P = 0.002, respectively). However, no significant differences were observed between the left- and right-sided breast cancer groups vis-à-vis the means of 2D LVEF, 3D LVEF, GLS, and GCS (P = 0.44, P = 0.65, P = 0.21, and P = 0.25, respectively).

The study results showed significant declines in the means of 2D LVEF, 3D LVEF, GLS, and GCS following radiotherapy. The patients with right-sided breast cancer exhibited a significant decrease in all the mentioned measures, whereas those with left-sided breast cancer showed no significant decline in post-radiotherapy speckletracking parameters. In addition, comparison of the patients with left- and right-sided breast cancers revealed no significant difference in the echocardiographic parameters of cardiotoxicity regarding cancer laterality.

Chest pain, anxiety, and readmission are patients’ adverse outcomes after Myocardial Infarction (MI). Therefore, post-MI patients require a proper care program to overcome these outcomes.

This study aimed to determine the effect of a continuous nursing care program on patients' anxiety level, episodes of chest pain, and readmission rate after MI.

In this randomized, controlled trial, 120 patients who met the inclusion criteria were selected using convenience sampling. The patients were allocated into the control (n = 60) and intervention (n = 60) groups using numbered opaque sealed envelopes. A demographic information form and the State-Trait Anxiety Inventory (STAI) were used to collect the data (primary outcome). The patients in the intervention group received education and practical rehabilitation exercises from the beginning of hospitalization until 12 weeks after discharge. However, the control group only received the routine care. Checklists were used to record the episodes of chest pain and readmission rate (secondary outcomes). The data were analyzed using the SPSS software, version 16.0. The data were distributed normally based on the results of Shapiro–Wilk test. Hence, they were analyzed using descriptive (mean, standard deviation, number, and percentage) and inferential (independent t-test, paired t-test, chi-square, Mann–Whitney U test, and Fisher's exact test) statistics.

The results revealed a significant reduction in the readmission rate (P = 0.014) and episodes of chest pain (P = 0.025) in the intervention group after the implementation of the continuous nursing care program. The results also showed a significant difference between the two groups regarding the mean scores of trait and state anxiety 12 weeks after discharge (P = 0.001). Accordingly, anxiety levels reduced significantly in the intervention group after the intervention (P = 0.001).

This continuous nursing care program, as a low-cost and non-pharmacological approach, played a vital role in caring for the patients after MI and positively affected the patients' recovery. Hence, this program could be used to improve post-MI outcomes in patients and accelerate their recovery.

People's perception of heart disease risk is effective in their response to disease, potential risks, decision making, and reduction of heart disease and is an important predictor of adopting healthy lifestyle behaviors. However, no tool is available to assess the risk of heart disease in Iran.

This study aimed to develop an instrument for healthcare providers’ perception of heart disease to be used in Iran.

This mixed-method study was conducted in three stages. In the first stage, the concept of healthcare providers’ perception of the risk of heart disease was explained using the hybrid concept analysis method. In the second stage, the items of the instrument were developed using the results of the qualitative part, including eight interviews with healthcare providers and a review of the literature on the research problem. In the third stage, using a methodological study, the psychometric properties of the instrument were assessed using face validity, content validity (content validity ratio and content validity index), and exploratory factor analysis. Its reliability was also determined using Cronbach's alpha and test-retest methods. All data analyses were performed using the SPSS 21 software.

After defining heart disease risk perception, a pool containing 30 items was extracted. After assessing the face validity and quantitative and qualitative content validity, the number of items was reduced to 28. The instrument was then distributed among 300 medical staff and the results of exploratory factor analysis showed that the instrument consisted of 27 items divided into four factors, namely “warning to avoid the risk, “risk of unhealthy lifestyle”, “perceiving the risk of heart disease”, and “perceiving the power to control the risk factors”. These four factors explained 70.028% of the total variance of the instrument. The reliability of the instrument was confirmed using internal consistency (α = 0.931) and its stability was approved by the test-retest method (ICC = 0.8).

Given the acceptable validity and reliability of the 27-item Healthcare Providers Perception of Heart Disease (HPPHD) instrument, it is recommended to be used.

Retroperitoneal Hematoma (RPH) is one of the most serious complications after Intra-Aortic Balloon Pump (IABP) insertion. Although advances in clinical experience regarding IABP insertion have led to a decrease in vascular complications such as RPH, its rate has remained considerably high.

This study aimed to evaluate the factors predicting RPH following IABP insertion site injury.

This retrospective cohort study of 2508 patients undergoing off-pump Coronary Artery Bypass Graft (CABG) surgery over 4.5 years allowed the identification and evaluation of all patients with RPH. The patients were divided into with RPH and without RPH groups. RPH prediction was analyzed by multivariate stepwise logistic regression analysis. SPSS, version 22 (SPSS Inc., Chicago, IL) was used for statistical analysis.

RPH developed in 16 patients (overall prevalence: 0.63%), with the highest frequency in low ejection fraction patients (3%). Female gender, compartment syndrome, IABP insertion site, preoperative Clopidogrel usage, use of post-operative inotropic drugs, and body surface area were the predictors of RPH in multivariate analysis. Moreover, in-hospital mortality was significantly higher in the patients who had developed RPH compared to those who had not (50% vs. 1.9%, P = 0.004).

RPH is a serious vascular access site complication of IABP, which has been associated with high morbidity and mortality. The current study findings indicated that such factors as female gender, BSA, IABP insertion site, preoperative Clopidogrel usage, IABP usage, and post-operative inotrope drugs use could predict RPH. Identification of RPH risk factors could in turn prevent this problem.

Human health has been challenged drastically by the emergence of COVID-19. This pandemic has imposed a serious burden on different aspects of life. Apart from the high rates of morbidity and mortality, reporting of newly formed variants with enhanced contagious capacity has made the future vague. Existence of different comorbidities is a prominent factor towards poor prognosis and fatal outcomes.

The present study aimed to identify the most important comorbidities in the COVID-19 patients who passed away during the first wave in Fars province, Iran.

Trained general physicians obtained data from medical files in the referral hospitals of COVID-19 throughout the province. These included demographic data, past medical history, and existence of comorbidities. The data were analyzed using chi-square test, independent sample t-test, and Mann-Whitney test. P-values less than 0.05 were considered statistically significant.

Out of the 3700 confirmed cases, 87 patients died from February to May 2020. Among these patients, 81.1% had comorbidities, with hypertension, diabetes, and cardiovascular disease being the most prevalent ones. The results revealed no significant differences between the individuals with and without comorbidities regarding age, gender, and duration of ICU hospitalization. Oxygen saturation was also poor in both groups. However, the patients with comorbidities had significantly higher blood urea nitrogen and creatinine levels compared to their comorbidity-free peers.

Cardiovascular disease and the related risk factors contributed greatly to the deadly fate in COVID-19 patients. Hence, early prophylactic and therapeutic interventions should be considered in COVID-19 patients harboring such comorbidities. This can play a pivotal role in reducing the rate of mortality and the consequent financial and social harms.

Cardiac fibromas are rare primary tumors that mainly affect children and teenagers and are rarely found in adults. The patients may be asymptomatic or may present their disease with arrhythmia or even heart failure. However, bizarre presentations can be found. The present study aimed to report a case of cardiac fibroma presented with exertional dyspnea and palpitation.

A 29-year-old Caucasian male presented with the symptoms of exertional dyspnea and palpitation in the emergency room. Tachycardia was evident in physical examination and electrocardiography. On the echocardiographic assessment, a hyperechogenic mass was found in the proximal part of the anterior interventricular septum with calcified spots and without defined capsules around the mass suggestive of lipoma or other infiltrative mesenchymal tumors. Cardiac magnetic resonance assessment with fat suppression mode ruled out lipoma and bolded fibroma diagnosis. The patient underwent excisional surgery and survived the condition. On pathology and immunohistochemistry evaluation, the diagnosis of fibroma was confirmed. The patient survived the surgery with no morbidities. Hemodynamic study revealed no findings suggestive of heart failure.

Cardiac fibroma is a rare tumor in adults and usually happens in children under five years old. This condition can be diagnosed in echocardiography and the subsequent cardiac magnetic resonance imaging. The tumor is usually featured with central calcification.

In January 2020, a new coronavirus was identified as the source of a newly developing type of pneumonia (COVID-19) in China. The number of infected people has been rising swiftly throughout the world since then and it has been reported to affect multiple systems apart from causing usual atypical pneumonia, one of which being the cardiovascular system. The underlying mechanism leading to cardiac injury has been hypothesized to be linked to a cytokine storm with unbalanced response to T-cell subtypes or secondary hemophagocytic lympho-histiocytosis, direct cardiac injury through viral myocarditis or cardiomyopathy through the ACE2 receptor, oxygen supply/demand imbalance with or without coronary artery disease, hypoxemia, and positive pressure ventilation leading to increased right ventricular afterload due to respiratory acidosis.

A 49-year-old female with a non-notable medical history presented to the emergency department with the chief complaint of dyspnea, fever and chills, severe dry coughs, and diarrhea. COVID-19 was confirmed by chest Computed Tomography (CT) scan and Real-Time Polymerase Chain Reaction (RT-PCR). Due to high troponin levels, echocardiography was done, indicating that the patient had a reduced left ventricular ejection fraction with multiple large Left Ventricular (LV) clots, but she had no lesions in coronary angiography.

The pathological mechanism by which SARS-COV-2 causes viral myocarditis is still uncertain. However, it may result in cardiac injury via multiple mechanisms. COVID-19 may also predispose the body to thromboembolism in different ways. The current data suggested the existence of a hyper-coagulability state in patients with COVID-19 and endotheliitis could explain the reason why these patients seem more prone to venous and arterial thrombosis. However, further studies are needed to determine the other causes of the cardiovascular complications of COVID19.