Journal of Cardiovascular and Thoracic Research
Volume:10 Issue: 3, Sep 2018

The Emblica officinalis (EO) fruit has traditionally been considered as a cardioactive medication and has demonstrated remarkable cardiovascular effects in the pharmacological literature. The present study systematically reviews EO’s potential for prevention and therapy of cardiovascular diseases (CVD). PubMed, ScienceDirect, Scopus, Proquest, Ebsco, Google, Google Scholar, Ovid, and Cochrane databases were searched from 1966 to 2017 for the English and non-English literature using the terms including the cognates of EO including amla, Emblic myrobalan, Emblica officinalis, Emblica pectinata, Indian gooseberry, and Phyllanthus emblica together with antioxidant, arrhythmia, cardioprotective, cardiotoxicity, heart disease, heart failure, hyperlipidemia, hypertension, myocardial dysfunction, and oxidative stress. The inclusion criteria were in vitro, animal, and clinical cardiovascular pharmacological studies conducted on EO and full-text accessibility. The exclusion criterion was studies in which a combination of EO and at least one other plant was investigated. The reference lists of the retrieved articles were also searched manually for additional eligible articles. The methodological quality of clinical trials was assessed by the Jadad scale, and animal studies were evaluated by the ARRIVE checklist. Nineteen articles concerning the cardiovascular pharmacological effects of EO were included in this review. The plant has shown antiatherogenic, anticoagulant, hypolipidemic, antihypertensive, antioxidant, antiplatelet, and vasodilatory effects as well as lipid deposition inhibitory properties. Moreover, it prevents from doxorubicin and isoproterenol cardiotoxicity and myocardial ischemia/reperfusion injury, and improves vascular endothelial function in animal studies. Some high-quality clinical studies report the vasodilatory and myocardial antioxidant properties as well as anti-platelet aggregation effects of this plant. EO influences various cardiovascular risk-factors. However, there is not sufficient evidence to confirm the plant efficacy in preventing and treating CVD.

The incidence of atherosclerosis is increasing rapidly all over the world. Inflammatory processes have outstanding role in coronary artery disease (CAD) etiology and other atherosclerosis manifestations. Recently attentions have been increased about gut microbiota in many fields of medicine especially in inflammatory diseases like atherosclerosis. Ineffectiveness in gut barrier functions and subsequent metabolic endotoxemia (caused by rise in plasma lipopolysaccharide levels) is associated with low-grade chronic inflammation i.e. a recognized feature of atherosclerosis. Furthermore, the role of trimethylamine-N-oxide (TMAO), a gut bacterial metabolite has been suggested in atherosclerosis development. On the other hand, the effectiveness of gut microbiota modulation that results in TMAO reduction has been investigated. Moreover, considerable evidence supports a role for the endocannabinoid system (ECS) in atherosclerosis pathology which affects gut microbiota, but their effects on atherosclerosis are controversial. Therefore, we presented some evidence about the relationship between gut microbiota and ECS in atherosclerosis. We also presented evidences that gut microbiota modulation by pre/probiotics can have significant influence on the ECS.

The understanding of gross cardiac anatomy has been relatively stable over the last 80 years, reliant on well-established autopsy findings. The advent of dynamic imaging by cardiac MRI and CT provides a window to view anatomic features in vivo, providing insights typically masked at autopsy due to death. Hypothesis: We hypothesize that cardiac magnetic resonance (CMR) with its high spatial and temporal resolution allows detection of anatomic features not previously appreciated at autopsy. Two hundred fifty-five sequential, CMR examinations were retrospectively examined to describe the anatomic features of the LV (left ventricular) PM (papillary muscles). Specifically, the origin of the base of the PM was delineated. The insertion of the PM was seen in 255/255 patients. In 249 out of 255 patients (97.6%), the appearance of the PM was not a uniform muscle arising from the inner face of the LV myocardium, but was a finger-like series of long, slender trabeculae carneae traversing >1 cm before inserting into the main body of PM challenging our previous understanding of PM anatomy. The capabilities of dynamic CMR to view cardiac features in vivo non-invasively provides a useful tool to study cardiac anatomy. Unlike the widely accepted representation of papillary muscles, uniformly arising from the floor of the LV, the base resolves into a ‘cypress-tree’ root-like structure with multiple thin projections before coalescing into a thick muscle head. Such observations have far reaching clinical implications in areas such as mitral regurgitation, post-MI remodeling and electrical transmission of the His-Purkinje system, and further work is indicated to delineate the role of non-invasive imaging in these areas.

The mechanical circulation support used in treatment of low cardiac output at most is the intra-aortic balloon pump (IABP). Its usage fields are the complications occurring due to ischemic heart disease, disrupted left ventricle function, and the low cardiac output syndrome occurring during coronary artery by-pass surgery. During 28 years from 1985 to 2013, IABP support has been implemented to 3135 patients in our cardiac surgery operating theater and intensive care unit. The mean age of the patients was 61.4 ± 13.2 years (16-82). 2506 patients (80%) were the ones whom the cardiac surgery has been implemented. IABP support has been provided for 629 (20%) patients for medical treatment. We utilized IABP most frequently in coronary artery patients (70%). The first choice for placing the balloon catheter is the femoral artery in 3093 cases (98.7%). The most frequently observed balloon complication was the lower extremity ischemia in 383 cases (12.2%).The leg ischemia was statistically significantly more frequent in patients with sheath (P=0.004). The extremity ischemia has developed in 4 of 12 patients with balloon placed from upper extremity. The local bleeding and balloon rupture were more frequent in patients whom the balloon has been placed without sheath. The mortality due to IABP has occurred in only 5 patients. Despite increase in IABP usage frequency rapidly, the complications due to catheter are still seen. We believe that the leg ischemia that is the most frequently seen complication can be prevented via IABP use without sheath.

There is some controversy over the efficacy of statins for the prevention of contrastinduced nephropathy (CIN). There have also been reports on varying efficacies of different statins. Hence, in this study the efficacy of atorvastatin and rosuvastatin for the prevention of CIN was assessed. This single-blind randomized clinical trial was performed on 495 random patients with myocardial infarction with ST-segment elevation undergoing primary percutaneous coronary intervention (PCI) in a training referral hospital in 2015. Patients were randomly assigned to receive either atorvastatin 80 mg at admission and daily or rosuvastatin 40 mg at admission and daily. CIN was defined based on serum creatinine elevation after 48 hours from the PCI. The incidence of CIN was observed in 63 patients (21.4%) After 48 hours from primary PCI. Of those, 17% (n = 50) were grade 1 CIN, while 4.4% (n = 13) were grade 2 CIN. There was no significant difference between rosuvastatin group compared with atorvastatin group, regarding the CIN grading (P = 0.14). Our results indicate that atorvastatin and rosuvastatin have similar efficacy for the prevention of CIN.

Cardiovascular disease (CVD) is one of the most important causes of mortality. Healthy diets can decrease CVDs and other chronic diseases especially in patients with type 2 diabetes. In this study, we investigate association between adherence to the modified Nordic diet and cardiovascular risk factors among patients with type 2 diabetes. This cross-sectional study was conducted among 339 type 2 diabetic patients. Anthropometric indices, blood pressure, and biochemical tests were evaluated. A validated and reliable semi-quantitative food frequency questionnaire (FFQ) was used to assess dietary intake. Nordic diet scores were calculated based on median intakes of six food groups. Body mass index (BMI) was higher among participants who were in the lowest tertile of adherence to the Nordic diet (P=0.006). There was a significant association between socioeconomic status (SES) and adherence to the Nordic diet (P<0.0001). Participants who were in the top category of adherence to the diet had significantly lower levels of aspartate aminotransferase (AST) (P<0.0001). There was a significant inverse association between adherence to the Nordic diet and low density lipoprotein (LDL) levels (odds ratio [OR]=0.29 95% CI: 0.09, 0.91, P=0.025), high systolic blood pressure (SBP) levels (OR=0.35 95% CI=0.17-0.74, P=0.015), and risk of obesity (OR=0.25 95% CI: 0.10, 0.63, P=0.03). Results suggest that adherence to the Nordic diet is associated with reductions in the prevalence of obesity, LDL levels and blood pressure among type 2 diabetic patients. However, additional studies are needed to confirm these findings.

This study was aimed at determining the effects of a 12-week aerobic exercise program on markers of hypertension in men. The study was of a semi-experimental design featuring repeated measurements. A total of 40 men (age range=37.9 ± 2.68) with primary hypertension were divided into two groups, namely, the exercise group (n=20) and the control group (n=20) (systolic blood pressure [SBP]: 140.531 ± 0.23, diastolic blood pressure [DBP]: 90.71 ± 0.05). The exercise group participated in a 12-week aerobic exercise program (55% to 70% of HRmax). Blood samples were taken from both groups at the baseline and at the 4th, 8th, and 12th weeks of the training program for the assessment of adiponectin, paraoxonase-1 (PON-1), and hydrogen peroxide (H2 O2 ) levels as the markers for investigation. A linear mixed model was also used to evaluate the association among the markers. In the exercise group, exercise reduced the SBP and DBP at week 12 (P=0.031 and 0.023, respectively), and adiponectin increased at weeks 8 and 12 (P=0.014 and 0.001, respectively). The plasma PON-1 level showed a significant increase in all the three stages of measurement (P=0.007, 0.004, and 0.002 at weeks 4, 8, and 12, respectively), whereas the H2 O2 levels showed a significant decrease at weeks 8 and 12 (P=0.013 and 0.011, respectively). The control group exhibited significantly decreased PON-1 (P=0.003) and adiponectin (P=0.025) levels but significantly increased SBP at week 12 (P=0.032). The exercise-induced reduction of oxidative stress exerts a considerable effect on the reduction of blood pressure in hypertensive patients. According to our results increase in oxidative stress has the great impact on the of blood pressure.

Ischemic mitral regurgitation (IMR) is common after acute myocardial infarction (AMI) which is associated with long-term cardiovascular mortality. Size, transmurality and location of the myocardial infarction (MI) has role on the development of IMR. In this study we evaluated the severity of IMR after different types of MI. One-hundred patients with the first AMI were recruited and according to echocardiographic findings were categorized to have moderate to severe IMR (case group, n=50) or trivial or no IMR (control group, n=50). Demographic and echocardiographic findings and MI location were compared between groups. Case group compared to control group had significantly higher Killip class, more cases with left ventricular ejection fraction (LVEF) <30% and inferolateral STEMI. They had significantly higher left ventricular (LV) and right ventricular (RV) diastolic dysfunction. Mechanism of IMR was mono leaflet tethering in 88%, both leaflets tethering in 12% and ring dilatation in 62%. MR jet origin-direction was medial commisure-posterior in 66%, lateral commisure-anterior in 11 22% and both commisure-central direction in 12%. IMR is common after AMI, especially in cases with inferior MI. The echocardiographic findings are indicative of left ventricular remodeling and abnormality of mitral valve apparatus.

Some advanced thoracic malignancy cannot be resected safely by using of conventional ventilation, so some sort of cardiopulmonary support is needed for hemodynamic and ventilation management of the patient. Using extracorporeal membrane oxygenation (ECMO) in comparing with cardiopulmonary bypass has some advantages. Three patients with huge thoracic tumors with different ages experienced major surgery in our center by using ECMO in order to face major complications mainly due to the size of mass to achieve better hemostatic stabilities, lower bleeding, and injuries to main airways and secure oxygenation. This is the first case series in Iran, as our best knowledge that explains cases of huge chest mass which were operated perfectly by using ECMO and short ICU stay and interestingly no major complications.

Vertebral artery occlusion (VAO) may result from closed head or neck trauma and can be lifethreatening due to brain-stem and cerebellar infarction. CT angiography is recommended as a screening diagnostic tool in selected patients after blunt cervical trauma. A 24-year-old woman was admitted to our emergency department with left hemiplegia two days after motor vehicle collision. Final diagnosis of occlusion of the right vertebral artery was made in CT angiography. She was treated with anticoagulant for 4 days then discharged with 5/5 muscle forces. She was advised to continue warfarin and atorvastatin for her after discharge.