Journal of Cardiovascular and Thoracic Research
Volume:14 Issue: 3, Sep 2022

In this investigation, we aimed to explore the relationship between the triglyceride-glucose (TyG) index and the non-dipping blood pressure (BP) pattern in newly diagnosed hypertensive patients.

In this retrospective study, 216 consecutive newly diagnosed hypertensive patients who had undergone 24-hour ambulatory blood pressure (ABPM) monitoring and had not received anti-hypertensive drugs were included. Non-dipping status was evaluated by a 24-h ABPM monitoring in all patients. We categorized the patients into two groups as; dippers (n=104 cases) and non-dippers (n=112 cases). The TyG index was derived from the fasting triglyceride and fasting glucose levels using the formula; ln[fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2].

Non-dipper group had a higher TyG index than the dipper group. The TyG was an independent predictor of non-dipping BP in hypertensive individuals, according to multivariable analysis. The TyG index was negatively associated with a decrease in both systolic and diastolic BP during the nighttime. The ideal cutoff value of the TyG index in detecting non-dipping status was≥9.01 with 74.1% sensitivity and 71.2% specificity. A ROC comparison indicated that the area under the curve value of TyG index was superior to fasting triglyceride, fasting glucose, and homeostasis model assessment of IR (HOMA-IR) in detecting non-dipping BP.

The TyG index was an independent predictor of non-dipping status in newly diagnosed hypertensive patients who had undergone 24-hour ABPM monitoring and had not received anti-hypertensive drugs. As a simple and easily obtained parameter, the TyG index can be used to detect such pattern among these patients.

Despite having clinical relevance, arterial stiffness is neglected and not routinely used parameter for evaluation of atherosclerosis. This study aimed to investigate the predictive role of simple non-invasive echocardiographic index of aortic stiffness aortic velocity propagation (AVP), Framingham risk score (FHS) and QRISK3 score for presence and severity of CAD.

This cross-sectional comparative study included 250 patients who required conventional coronary angiogram for stable CAD. The relationship of AVP, FHS and QRISK3 score with CAD were evaluated using spearman’s correlation, logistic regression analysis and ROC curve.

On logistic regression analysis, AVP, FHS and QRISK3 were found significant predictors for the presence and severity of CAD. Inverse correlation between AVP and presence of CAD, number of coronary vessels involved and severity of CAD was observed with P=0.001. AVP value≤78 cm/s predicted presence of CAD with 86.4% sensitivity and 84.6% specificity (P≤0.0001, AUC=0.948) and≤39 cm/s predicted severe CAD (Syntax score>22) with 66.7% sensitivity and 97.9% specificity (P≤0.0001, AUC=0.868). FHS value>10 predicted the presence of CAD with a sensitivity of 33.9% and specificity of 91 % (P=0.01, AUC=0.644). QRISK3value>13.4 predicted presence of CAD with 57.1% sensitivity and 87% specificity (P≤0.0001, AUC=0.788).

Arterial stiffness parameter AVP is inversely associated with the presence and severity of CAD. AVP and QRISK3 score may be used as a simple bedside tool for risk stratification of patients suspected of having atherosclerotic CAD.

The tissue kallikrein-kinin system is an endogenous homeostatic pathway, which its stimulation is associated with cardioprotection. The present study aimed to determine the effect of exercise training on plasma tissue kallikrein (TK) and bradykinin (BK) and their association with cardiac hypertrophy.

22 non-athlete and 22 athlete women were exposed to acute (Bruce test) and chronic (12-week swimming training) exercises. 2D echocardiography was used to evaluate morphological and functional features of the heart. Plasma concentrations of TK and BK were quantified by ELISA.

Athletes had significantly higher values of left ventricle end-diastolic diameter index (LVEDDI) and left ventricle mass index (LVMI) than non-athletes. Exercise intervention affected echocardiographic features in neither of the study groups. Chronic exercise training notably increased plasma levels of TK and BK, which increase was more pronounced in the athletes. Plasma TK negatively correlated with LVEDDI (r=−0.64, P=0.036 and r=−0.58, P=0.027) and LVMI (r=−0.51, P=0.032 and r=−0.63, P=0.028) in the non-athlete and athlete groups. In opposition, there was a positive correlation between plasma TK and left ventricle ejection fraction in non-athletes (r=0.39, P=0.049) and athletes (r=0.53, P=0.019).

The upregulation of the tissue kallikrein-kinin system may be a protective mechanism against excessive cardiac hypertrophy induced by chronic exercise training.

Left ventricular assist device (LVAD) implantation is a common therapy for end-stage heart failure. Heart failure patients often present with atrial fibrillation (AF). The purpose of this study was to evaluate the influence of preoperative AF as well as vascular complications on outcome in LVAD patients.

Between 01/2010 and 12/2017, 168 patients (141 male) with end-stage heart failure underwent LVAD implantation at a single center. Patient outcome was retrospectively studied by using the Kaplan-Meier method for analyzing crude survival as well as Cox regression for analyzing risk factors.

Sixty-two patients suffered from preoperative atrial fibrillation at LVAD implantation. Mean age was 56.8±11.9 years (range: 22–79) and 141 (84%) were male. Postoperative vascular or visceral surgical management due to malperfusion was needed in 27 patients (16.1%) and did not correlate with postoperative mortality (P=0.121, HR=1.587, CI=0.885–2.845). Patients with preoperative AF had a worse outcome in the Kaplan-Meier analysis (P=0.069). In contrast, cox regression showed that postoperative AF could not to be considered to be an independent predictor of mortality in this study group.

Our data suggest that preoperative AF may be a potential predictor of mortality and impaired long-term outcome in LVAD patients. In contrast, preoperative ECLS and vascular or visceral surgery after LVAD implantation did not represent limiting factors with regard to mortality after LVAD implantation.

Here, we monitored the cytocompatibility of scaffolds consisting of poly (glycerol sebacate) (PGS) coated with collagen (Col) for endothelial cell activity after 72 hours.

Human endothelial cells were allocated into Control, PGS, and PGS+Col groups. Scaffolds were characterized using FTIR and HNMR spectroscopy. Contact angel analysis and SEM were used to study wettability, surface morphology, and cell attachment. Cell survival was assessed using LDH leakage assay. Levels of Tie-1, Tie-2, VE-Cadherin, and VEGFR-2 were measured using western blotting and real-time PCR.

FTIR and HNMR analyses revealed the proper blending in PGS+Col group. SEM imaging exhibited a flat surface in the PGS group while thin Col fibers were detected in PGS+Col surface. The addition of Col to the PGS reduced the contract angle values from 97.3˚ to 81.1˚. Compared to PGS substrate alone, in PGS+Col group, cells appropriately attached to the surface. PGS and PGS+Col did not alter the leakage of LDH to the supernatant compared to control cells, showing the cytocopatiblity of PGS-based scaffolds. SOD and NO levels were increased significantly in PGS (p<0.05) and PGS+Col groups (p<0.001), respectively. We found that PGS+Col decreased Tie-1 content in endothelial cells whereas protein levels of Tie-2 and VE-Cadherin and expression of VEGFR-2 remained unchanged compared to PGS and control groups.

Simultaneous application of Col and PGS can stimulate normal endothleial cell morphology without the alteration of tyrosine kinases receptors and cadherin.

 The study aimed to evaluate the diagnostic value of global and regional myocardial deformation parameters derived from two-dimensional speckle-tracking echocardiography to detect functionally significant coronary artery stenosis.

 Dobutamine stress echocardiography and cardiac magnetic resonance myocardial perfusion imaging (CMR-MPI) were performed on 145 patients with a moderate and high probability of coronary artery disease (CAD) and LVEF≥55%. Significant CAD was defined as>50% stenosis of the left main stem,>70% stenosis in a major coronary vessel, or in the presence of intermediate stenosis (50-69%) validated as hemodynamically significant by CMRMPI. Patients were divided in two groups: non-pathological (48.3%) vs pathological (51.7%), according to CAG and CMR-MPI results. Afterwards, off-line speckle-tracking analysis was performed to analyse myocardial deformation parameters.

 There were no differences in myocardial deformation parameters at rest between groups, except global longitudinal strain (GLS) and global radial strain (GRS) were significantly lower in the CAD (+) group: -21.3±2.2 vs.-16.3±2.3 (P<0.001) and 39.7±23.2 vs. 24.5±15.8 (P<0.001). GLS and regional longitudinal strain rate (SR) had the highest diagnostic value at high dobutamine dose with AUC of 0.902 and 0.878, respectively. At early recovery, GLS was also found to be the best myocardial deformation parameter with a sensitivity of 78%, specificity 67%, AUC 0.824.

 Global and regional myocardial deformation parameters are highly sensitive and specific in detecting functionally significant CAD. The combination of deformation parameters and WMA provides an incremental diagnostic value for patients with a moderate and high probability of CAD, especially the combination with regional longitudinal SR.

The package of essential non-communicable diseases (PEN) has been implemented in 2016 in Iran. The present study aimed to evaluate the incidence rate of myocardial infarction (MI) and stroke, and the mortality rate due to these diseases, following the lunch of the PEN project.

This is a historical cohort study that was performed in 2020. Data were gathered through the hospital information system in the exposed and the control counties hospitals in the Isfahan province. The data about over 30-year-old patients who were hospitalized as definite cases of MI and/or stroke were collected via census sampling. The incidence rates of MI, stroke, and mortality due to those diseases were compared in 2015 (one year before the launch of the PEN project) and 2019 (4 years after the project initiation).

Following the implementation of the PEN project, the incidence and mortality rates due to MI among the over 30-year-old population in the exposed county, were reduced by 0.31 per 1000 and 9 per 100 000 respectively. Furthermore, the incidence rate due to stroke in the exposed county further slowed down, and the mortality rate due to stroke was reduced by 33 per 100,000 more than 30 years old population significantly.

Following the implementation of the PEN project, the incidence rate due to MI and mortality rates due to MI and stroke decreased significantly. In addition, the incidence rate due to stroke further slowed down in the exposed county in comparison with the control county.

FDA approved transcatheter aortic valve replacement (TAVR) for the treatment of symptomatic aortic valve (AV) stenosis. Recent evidence reveals that TAVR is the treatment of choice in most patients with AV stenosis who are at high risk for surgical aortic valve replacement (SAVR). Per AHA guidelines, repeat valve replacement has been recommended for bio-prosthetic AV stenosis. Urgent TAVR for hemodynamically unstable patients with prosthetic AV stenosis is not supported by significant scientific data. However, there have been a few cases reported on emergency TAVR procedures in hemodynamically unstable patients with severe native AV stenosis. We are reporting a unique case of successful emergency TAVR in a hemodynamically unstable patient, who had severe symptomatic bio-prosthetic AV stenosis at the time of presentation.

Glycoprotein IIb/IIIa inhibitors play a key role in the treatment of patients who have acute coronary syndromes and undergone percutaneous coronary intervention. However, its serious complication is diffused alveolar hemorrhage. A 73-year-old diabetic woman presented with chest pain and dynamic ST elevation in ECG and positive troponin. She had occlusion in two coronary arteries and underwent percutaneous coronary intervention. The eptifibatide was administered. After hours, she showed respiratory symptoms, as well as drop of blood pressure and hemoglobin. All differential diagnoses suggested for her clinical presentation were evaluated, and finally, on the sixth day diffuse alveolar hemorrhage was diagnosed. Although respiratory symptoms such as hemoptysis and dyspnea may occur as complications of pulmonary edema and/or pneumonia, assumed clinical suspicion for pulmonary hemorrhage leading to early detection of it. Moreover, there is no definitive guideline for decreased bleeding complications and treatment of alveolar hemorrhage caused by glycoprotein IIb/IIIa receptor inhibitors.

We report a case of a 56-year-old male who underwent Frozen Elephant Trunk procedure for residual type A chronic aortic dissection, complicated by the release of the distal endovascular portion of the hybrid prosthesis in the false lumen. This complication was successfully treated with a totally endovascular approach.

In this report, we present a patient with ventricular septal defect (VSD) that was detected at follow-up one month after transcatheter aortic valve implantation (TAVI) and successfully closed percutaneously. Before the procedure, a 29 mm Portico self-expanding aortic valve prosthesis was placed in the heavy calcific aortic valve position, and then the balloon was dilated due to aortic insufficiency and excellent results were obtained. One month after TAVI, the patient complained of shortness of breath at rest, and on physical examination a pansystolic murmur was detected. Transthoracic echocardiography (TTE) revealed a well-functioning prosthetic aortic valve; however, a VSD was detected causing left-to-right shunt in the interventricular septum. Later, we performed the interventional treatment of the defect using the Amplatzer muscular VSD occluder device with the transfemoral approach. Currently, five months after the combined procedure, the patient showed a significant improvement in symptoms and no significant shunt was observed.