International Cardiovascular Research Journal
Volume:18 Issue: 1, Dec 2024

Aortic aneurysms are dilatations of the aorta that carry a potential risk of rupture. The most common type is the abdominal aortic aneurysm (AAA), while thoracic aortic aneurysms, particularly those in the ascending part, are also significant. Perivascular adipose tissue is an ectopic fat that affects vessels locally by producing bioactive substances. Additionally, central obesity is associated with local aortic diseases.

The current study aimed to measure periaortic adipose tissue and evaluate its association with the indexed aortic diameter based on multidetector computed tomography (CT) scan findings.

This retrospective and cross-sectional study was conducted in a tertiary center for cardiovascular diseases, continually recruiting 149 patients who had indications for thoracic and abdominal CT angiography. Patients with serious underlying diseases were excluded. The diameters of the aorta and adipose tissue, as well as Body Mass Index, were measured. Data analysis was performed using chi-square, Fisher exact, independent t -test, and Mann–Whitney test with SPSS software, version 16. Comparisons were performed using chi-square or Fisher exact tests for categorical variables, independent t -test for normally distributed data, and Mann–Whitney test for non-normally distributed data.

The study population consisted of 149 patients. The prevalence rates of thoracic aortic aneurysm and AAA were 8.7% and 24.8%, respectively. The prevalence of AAA was significantly higher in males (P = 0.025). Patients with AAA and an abdominal aortic diameter exceeding 30 mm were significantly older than the others (P = 0.003). There was a significant correlation between the fat volume around the aorta and the aortic diameter (P < 0.001, r = 0.504). Additionally, significant relationships were found between age and fat volume around both the thoracic and abdominal aorta (P < 0.001 and P < 0.007, r = 0.379 and r = 0.222, respectively), and between body mass index and fat volume around the abdominal aorta (P = 0.044, r = 0.165).

The correlation between the volume of periaortic fat tissue and aortic aneurysms was significant in both the thoracic and abdominal aortae. The volume of periaortic fat in AAA was correlated with indexed values, unlike in thoracic aortic aneurysms. In candidates for aortic CT angiography, meticulous measurement of periaortic adipose tissue provides additional valuable data for optimal management.

The site of acute myocardial infarction (MI) plays a pivotal role in determining the prognosis and risk assessment for patients experiencing their first ST-segment elevation MI (STEMI).

This study aims to compare one-year survival rates in patients with anterior versus inferior ST-elevation myocardial infarction.

This registry-based cohort study was conducted from July 2018 to December 2019, examining data from STEMI patients. A total of 643 patients diagnosed with STEMI who met the inclusion criteria were enrolled. Patients were categorized based on the location of their myocardial infarction (MI) into two groups: Those with anterior MI and those with inferior MI. Their progress was meticulously followed over the course of one year. For data analysis, Cox proportional hazards models were used to calculate two sets of hazard ratio estimates: The initial unadjusted (crude) hazard ratios and the fully adjusted hazard ratios, which accounted for potential confounding factors. Along with these hazard ratio estimates, their corresponding 95% confidence intervals (HR, 95% CI) were obtained. All statistical analyses were performed using R software version 4.2.1.

Throughout the follow-up period, totaling 598 patients and 4,109 person-days, only 7 patients (1.09%) were lost to follow-up. The analysis revealed no significant difference in one-year mortality rates between the inferior and anterior STEMI groups, with rates of 37 (8.39%) versus 15 (7.69%), respectively, yielding a P-value of 0.767. However, it is noteworthy that the mortality risk trended higher in the inferior MI group, with a hazard ratio of 1.093 (95% CI: 0.60 - 1.99).

In conclusion, our study highlights the heightened mortality risk associated with inferior wall MI. These results underscore the prognostic value of MI location, shedding light on its potential role in predicting the severity and extent of infarction, thereby guiding clinical decision-making and risk management strategies in STEMI patients.

This study aimed to evaluate the prognostic utility of the neutrophil-to-lymphocyte ratio (NLR) and the perioperative change in NLR [Neutrophil Change Index (NCI)] in pediatric patients undergoing surgery with cardiopulmonary bypass (CPB) and to assess their correlations with clinical outcomes.

A retrospective observational study was conducted with 416 patients from Children’s Medical Center in Tehran, Iran, spanning November 2021 to November 2022. Perioperative neutrophil and lymphocyte counts were collected, along with data on the presence or absence of complications. The prognostic value of NLR and NCI was evaluated concerning the length of ICU stay and mechanical ventilation among three groups: A no-complications survival group, a complications survival group, and a mortality group.

All patients showed an average rise in NLR postoperatively. The postoperative NLR magnitude did not significantly differ among the groups (P = 0.237) and was only correlated with mechanical ventilation duration (P = 0.0497), not with ICU stay length. However, the NCI was significantly lower in the mortality group compared to both the no-complication and surviving-complication groups (P < 0.001 and P = 0.032). Neutrophil Change Index also showed a statistically significant correlation with ICU stay and mechanical ventilation duration (P = 0.004 and P = 0.002). ROC analysis indicated that NCI had some ability to discriminate mortality cases, with an AUC of 0.734.

While NLR showed perioperative changes, its magnitude alone was not correlated with clinical outcomes. In contrast, the NCI demonstrated a significant relationship with outcomes, with surviving-complication patients having a higher perioperative NCI than those in the mortality group. A higher NCI was associated with shorter ICU stays, reduced mechanical ventilation time, and lower mortality risk in pediatric patients undergoing CPB surgery. Overall, NCI proved to be a more effective tool than NLR in predicting adverse outcomes in this patient population.

Transient cortical blindness (TCB) is an unusual postoperative complication following cardiac surgery. In this report, we present the case of a 54-year-old female who developed TCB after undergoing coronary artery bypass grafting (CABG) surgery. Her vision gradually improved over the course of two months post-operation. No causative ocular damage was found upon ophthalmologic examination, and assessments of related arteries (carotid, vertebral, and ophthalmic) were entirely normal. Following the onset of blindness, a non-contrast computed tomography scan showed bilateral subarachnoid hyperdensities in the occipital and parietal lobes. Magnetic resonance imaging was performed to confirm the presence of cerebral hemorrhage, but no pathology was detected. While the exact mechanism of TCB remains unclear, recognizing this potential complication after CABG is crucial.

"Gossypiboma," also known as "textiloma," refers to retained surgical items left in the body after an operation. These retained items can lead to a range of issues, from asymptomatic cases to life-threatening complications. Diagnostically challenging, gossypibomas can mimic malignant masses, making it essential to consider them in the differential diagnosis of postoperative patients with unexplained symptoms. Imaging is crucial for detection and management.

A 69-year-old female with a history of coronary artery bypass graft (CABG) surgery presented with exertional shortness of breath. Imaging revealed a large mass near the left atrium. Initially suspected to be a tumor, further investigation identified it as retained surgical gauze from her surgery ten years prior. Despite the mass, the patient exhibited only mild symptoms, and given her stable condition, regular follow-ups were recommended.

Gossypibomas are rare but serious complications that may surface years after surgery. This case highlights the importance of meticulous surgical practices and careful postoperative monitoring. It underscores the need for accurate gauze counting and effective communication in the operating room to prevent errors that can lead to health risks and potential legal issues.

The best method for accurately assessing the right ventricle (RV) after coronary artery bypass grafting (CABG) remains controversial. In this study, we aimed to investigate several echocardiographic RV function indices to determine which are most effective in evaluating RV function post-CABG.

Here, we aimed to assess RV functional parameters after CABG using echocardiography.

This prospective before-after study was conducted on 60 patients scheduled for CABG. The patients were assessed before and six weeks after CABG using standard echocardiography and Speckle-Tracking Echocardiography (STE). The significance of changes in study parameters was evaluated using the paired t -test or the non-parametric Wilcoxon test. Two-sided P-values ≤ 0.05 were considered statistically significant. Statistical analysis was performed using SPSS software, version 16.0.

Six weeks after CABG, we found significant changes in two parameters: Tricuspid annular plane systolic excursion (TAPSE) and S’ tissue Doppler imaging (20.82 ± 2.53 vs. 14.60 ± 1.84, P = 0.01; 11.79 ± 1.99 vs. 8.80 ± 0.88, P = 0.01, respectively). However, no significant changes occurred in the right ventricular global 2D longitudinal strain or free wall longitudinal strain (-18.83 ± 2.88 vs. -18.79 ± 2.66, P = 0.88; -21.29 ± 3.36 vs. -20.86 ± 3.17, P = 0.12, respectively).

Tricuspid annular plane systolic excursion and S’ tissue Doppler imaging indices change following CABG and cannot be considered standard echocardiographic parameters for assessing RV function after the procedure. However, the two major parameters for right ventricular functional assessment, global 2D longitudinal strain and free wall longitudinal strain, may be less affected by CABG and thus could be more reliable as standard parameters.

Ventricular dysrhythmia is a major cause of heart-related death. Despite the life-saving advantages of Cardioverter-defibrillator (ICD), patients with ICD experience adverse physical, psychological, and social consequences.

The aim of this study was to investigate the effect of continuous care program on short-term outcomes of patients with ICD.

The present study is a randomized clinical trial, which was conducted on 79 patients (37 control and 42 intervention group) referred to the Cardiac Educational Center of Tehran, Iran, for the first time to receive an implantable cardioverter-defibrillator. The Continuous care program was provided for patients in the intervention group after receiving ICT along with routine care. Convenience sampling based on inclusion criteria was done, then random allocation was done by block randomization method. The allocation sequence was generated using a web-based system. Short-term consequences such as anxiety, mean number of shocks received, and the number of emergency outpatient visits to the medical center were measured by Spielberger State-Trait Anxiety Inventory (STAI) and checklist. The validity and reliability of STAI in Iran were checked and confirmed with the Cronbach's alpha coefficient of 0.93, and its scoring system ranges from 20 to 80, with a higher score indicating a higher level of anxiety. Data were analyzed by SPSS-16 software. Inferential statistics (independent Student, Mann-Whitney, paired t -test, and Wilcoxon) were used to compare the data.

The results showed that there were no significant differences in the mean age, height, weight, BMI, and demographic variables between the two groups (P > 0.05). Comparisons between groups before and after the intervention, and also before and after within each group, were done for anxiety. The number of shocks and outpatient visits were compared between the two groups after the intervention. After the intervention, a significant decrease in the level of anxiety was observed in the intervention group compared to the control group and also compared to before the intervention (P < 0.001). The mean and standard deviation of the number of shocks in the control group was 1.2 ± 4.4 and in the intervention group was 5.1 ± 12.3, and the independent t -test showed a significant difference in this regard (P = 0.02). However, no significant difference was observed between the two groups in terms of the number of emergency outpatient visits to the medical center (P > 0.05).

The results of the present study revealed that the continuous care program can affect the short-term consequences of ICD insertion. It can also be used as an effective model in the care of cardiac patients with ICD.