Journal of Cardiovascular and Thoracic Research
Volume:15 Issue: 2, Jun 2023

Three-dimensional (3D) myocardial tissues for studying human heart biology, physiology and pharmacology have recently received lots of attention. Organoids as 3D mini-organs are created from multiple cell types (i.e. induced pluripotent stem cells (iPSCs) or embryonic stem cells (ESCs)) with other supporting co-cultured cells such as endothelial cells or fibroblasts. Cardiac organoid culture technologies are bringing about significant advances in organ research and allows for the establishment of tissue regeneration and disease modeling. The present review provides an overview of the recent advances in human cardiac organoid platforms in disease biology and for cardiovascular regenerative medicine.

Extubation can be associated with an adverse hemodynamic or respiratory response, which may be serious in cardiovascular written or in the elderly. The present study was conducted with the aim of investigating the effect of two different doses of dexmedetomidine in the prevention of extubation complications.

This randomized clinical trial was conducted in Isfahan in 2020-2021 on 174 patients undergoing elective surgery. Patients were randomly divided into 3 groups receiving dexmedetomidine 1 μg/kg (D1), dexmedetomidine 0.5 μg/kg (D2), and normal saline (S). Hemodynamic variables include heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and peripheral blood oxygen saturation (Spo2) was measured and recorded before removing the endotracheal tube and at 1, 3, 5 and 10 minutes after extubation. Also, airway responses to extubation such as cough, hoarseness, and laryngospasm were investigated.

SBP, MAP, and HR in the D1 group were significantly lower than in other groups. In the D2 group, these measurements were lower than the control group at 3, 5, and 10 minutes after extubation (P<0.05 for all). In placebo group, SBP, MAP, and HR increased significantly after extubation (P=0.01). In group D1, cough (P=0.007) and its intensity (P=0.013), nausea and vomiting (P=0.04) and chills (P=0.001) were less than in other groups.

In the D1 group, attenuation of autonomic response to extubation was more than other groups and side effects were less than D2 group, and in both groups, these side effects were less than the saline group.

Complex electrophysiologic (EP) procedures are time consuming and open to complications. Accurate and rapid recognition of cardiac pathologies is essential before, during, and immediately after such procedures. In this study, we aimed to compare hand-held echocardiography (HHE) with standard echocardiography (SE) to determine whether HHE can be used as a practical and reliable diagnostic tool during such procedures.

 One hundred consecutive patients undergoing complex EP procedures and catheter ablation were included in the study. All patients were evaluated with SE or HHE in terms of main cardiac pathologies at the beginning and immediately after the procedure. The diagnostic accuracy and evaluation time of both methods were compared at the beginning and after the procedure. The agreement between both methods was calculated.

 At the beginning and after the procedure, opening and evaluation times with HHE were significantly shorter than with SE (P<0.001 for all). There was significant agreement between the two methods in the diagnosis of cardiac pathologies (Agreement was 95% for minimal mild aortic regurgitation (AR), 99% for moderate/ severe AR, 93% for minimal/ mild mitral regurgitation (MR), 95% for moderate/ severe MR, 100% for pericardial effusion, and 100% for left ventricular thrombus at the beginning of the procedure).

 With the use of HHE during complex EP procedures, cardiac pathologies can be diagnosed with similar accuracy as SE. In addition, HHE has a significant advantage over SE in terms of time to diagnosis.

 Cardiac complications are the leading cause of death in thalassemia patients. It is assumed that progressive iron accumulation results in myocyte damage. Myocardial T2* measurement by cardiac MRI quantifies iron overload. We aimed to study the association between left and right ventricular (LV and RV) function and iron deposition estimation by cardiac MRI T2* in a sample of Iranian patients.

 Cardiac MRI exams of 118 transfusion-dependent thalassemia major patients were evaluated retrospectively. Biventricular function and volume and myocardial and liver T2* values were measured. The demographic and lab data were registered. Poisson and chi-square regression analyses investigated the correlation between the T2* value and ventricular dysfunction.

 The study participants’ mean (SD) age was 32.7y (9.02), and 47.46% were female. Forty-nine cases (41.52%) revealed at least uni-ventricular dysfunction. LV dysfunction was noted in 20 cases, whereas 47 patients revealed RV dysfunction. The risk of LV dysfunction was 5.3-fold higher in patients with cardiac T2* value less than 10msec (RR=5.3, 95% CI=1.6, 17.1, P<0.05). No association was found between age, liver T2* value, serum ferritin level, and chelation therapy with the risk of LV and RV dysfunction.

 Cardiac MRI T2* measure is a good indicator of LV dysfunction. Moreover, MRI parameters, especially RV functional measures, may have a substantial role in patient management. Therefore, cardiac MRI should be included in beta-thalassemia patients’ management strategies.

 Acute Myocardial injury defined by increased troponin I level is associated with poor in-hospital outcomes and cardiovascular complications in patients with COVID-19. The current study was designed to determine the implications and clinical outcome of myocardial injury in COVID-19.

 This retrospective study included hospitalized COVID-19 patients. Myocardial injury was defined by high sensitivity Troponin I (hs-TNI)≥26ng/l. Cardiac biomarkers, inflammatory markers and clinical data were systemically collected and analyzed. Hazard ratio for in-hospital mortality and logistic regression for predictors of acute myocardial injury were analyzed.

 Of the 1821 total patients with COVID-19, 293(16.09%) patients died and 1528 (83.91%) patients survived. Patients who died had significantly higher association with presence of cardiovascular risk factors, severe CTSS ( CT severity score ) and myocardial injury as compared to survived group. 628 (34.5%) patients had evidence of myocardial injury and they had statistically significant association with cardiovascular risk factors, in-hospital mortality, procalcitonin; higher hospital, and ICCU stay. We found significant hazard ratio of diabetes (HR=2.66, (CI:1.65-4.29)), Severe CT score (HR=2.81, (CI:1.74-4.52)), hs-TNI≥26 ng/l (HR=4.68, (CI:3.81-5.76)) for mortality. Severe CTSS score (OR=1.95, CI: 1.18-3.23, P=0.01) and prior CVD history (OR=1.65, CI:1.00-2.73, P=0.05) were found significant predictors of myocardial injury in regression analysis.

 Almost one third of hospitalized patients had evidence of acute myocardial injury during hospitalization. Acute myocardial injury is associated with higher hospital and ICCU stay, mortality, higher in-hospital infection which indicates more severe disease and the poor in-hospital outcomes.

 Providing a stable hemodynamic in extubation is important. We aimed to compare the effect of two different doses of intravenous labetalol on the cardiovascular response to endotracheal extubation.

 This double-blind randomized trial was performed in 2019-2020 in Isfahan on 72 patients under general anesthesia. Patients using Random Allocation software were divided into three groups and received 0.1 mg/ kg or 0.2 mg/kg labetalol and normal saline intravenously 10 min before extubation. Hemodynamic variables including heart rate (HR), Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and peripheral blood oxygen saturation(SPO2) was measured for each patient before induction of anesthesia and 1, 3, 5 and 10 minutes after extubation.

 SBP changes were significantly different between the three groups at 1, 3, 5 minutes after extubation (P=0.036, P=0.009, P=0.005 respectively) unlike the other two groups, patients who received 0.2 mg/kg labetalol did not have an increase in DBP after extubation (P>0.05). DBP was significantly different between the three groups one minute after extubation (P=0.03). At minutes 1 and 3 following extubation, there was a significant difference in the MAP between the three groups. (P=0.029 and P=0.012 respectively). There was no significant difference between the three groups regarding heart rate (P>0.05).

 Tracheal extubation is usually associated with an increase in hemodynamic variables. Both doses of labetalol attenuate the hemodynamic response accompanying tracheal extubation. But labetalol 0.2 mg/kg in reducing hemodynamic response to extubation acted more effectively than labetalol 0.1mg/kg.

 Inflammation and oxidative stress are contributed to cardiovascular diseases. Vitamin D (Vit D) has antioxidant and anti-inflammatory properties. In the current research, the effect of Vit D on cardiac fibrosis and inflammation, and oxidative stress indicators in cardiovascular tissues was studied in lipopolysaccharides(LPS) injected rats.

 Rats were distributed into 5 groups and were treated for 2 weeks. Control: received vehicle(saline supplemented with tween-80) instead of Vit D and saline instead of LPS, LPS: treated by 1 mg/kg of LPS and was given vehicle instead of Vit D, LPS-Vit D groups: received 3 doses of Vit D (100, 1000, and 10000 IU/kg) of Vit D in addition to LPS. Vit D was dissolved in saline supplemented with tween-80 (final concentration 0.1%) and LPS was dissolved in saline. The white blood cell (WBC) was counted. Oxidative stress markers were determined in serum, aorta, and heart. Cardiac tissue fibrosis was also estimated using Masson’s trichrome staining method.

 WBC and malondialdehyde (MDA) were higher in the LPS group than the control group, whereas the thiol content, superoxide dismutase (SOD), and catalase (CAT) were lower in the LPS group than the control group (P<0.01 and P<0.001). Administration of Vit D decreased WBC (P<0.001) and MDA (P<0.05 and P<0.001) while enhanced thiol (dose 10000 IU/Kg) (P<0.001), SOD (dose 10000 IU/kg) (P<0.001), and CAT (P<0.05 and P<0.001) compared to the LPS group. All doses of Vit D also decreased cardiac fibrosis compared to the LPS group (P<0.001).

 Vit D protected the cardiovascular against the detrimental effect of LPS. This cardiovascular protection can be attributed to the antioxidant and anti-inflammatory properties of Vit D.

 Acute aortic dissection type A is a life-threatening cardiovascular emergency necessitating rapid diagnosis and treatment. We sought a new prognostic tool with cardiac biomarkers and simple inflammatory factors.

 from 2003 to 2014, 50 patients with documented acute aortic dissection type A were entered to this study. These patients were followed up until December 2020; within median follow up of 93.6 months. The patients were evaluated on the association of the baseline characteristics, first laboratory investigation, echocardiographic findings, surgical approach, and long-term mortality.

 Total number of mortality during the follow up was 29 (58%) patients, which was significantly higher in medical group (89.4% vs 38.7%, P value=0.001). Multivariable analysis showed only an increase in hs-cTnT levels was suggested as a predictor of mortality (95% CI: 1.06–1.38; HR=1.21; P=0.005), so that for every 100 units increase, patients were 21% more likely to have mortality in long term. Also, performing surgical treatment for aortic dissection was determined as the independent predictor of surviving, so that death was 74.6% less than those who received medical treatment (95% CI: 0.13–0.58; HR=0.27; P=0.001).

 hs-cTnT is a potential predictor of mortality in patients with acute aortic dissection type A.

Renal cell carcinoma represents 3% of solid tumors. In 4-10% of patients, venous tumor thrombosis is present, and 1% reaches the right atrium. Other tumors can be associated with tumor thrombosis. The natural history of venous tumor thrombosis implies a mean survival of 5 months. Between 2001 and 2021, 4 patients underwent resection of tumor thrombi into the right atrium, requiring cardiopulmonary bypass. None of the patients died within 30 days postoperatively. Mean follow-up time was 30.9 months (2.4- 96.1). Two patients are still alive and two died due to disease progression. Died patient’s follow-up was 7.5 and 17.4 months, surpassing life expectancy of those without surgery. We present a series of patients who underwent lumpectomy and IVC thrombectomy. IVC tumor thrombosis has an ominous prognosis, however surgical treatment has an important role by improving the survival of these patients. The multidisciplinary approach is necessary to obtain good postoperative results.

COVID-19 has been known to induce systemic inflammation and hyper coagulate state leading to different complications. Cardiovascular complications are one of the most important among complications following COVID-19 infection. A 57 years old woman with past medical history of COVID-19 infection about two months ago came to our hospital with presentation of fever and dyspnea. During workup, tricuspid valve infection associated with pulmonary septic emboli was diagnosed without any obvious risk factor for infective endocarditis. It seems that COVID-19 infection may increase the rate of endocarditis in patients with or without risk factors of endocarditis.