Journal of Cardiovascular and Thoracic Research
Volume:14 Issue: 4, Dec 2022

The focus of this research was to explore the link between CRP (C-reactive protein) /albumin ratio (CAR), a novel inflammatory response marker, and no-reflow (NR) phenomena in non-ST elevation myocardial infarction (non-STEMI) patients during percutaneous coronary intervention (PCI).

The current study recruited 209 non-STEMI participants who underwent PCI. The patients were divided into two groups based on their post-intervention Thrombolysis in Myocardial Infarction (TIMI) flow grade; those with and without NR.

In all, 30 non-STEMI patients (6.9%) had NR after PCI. CAR values were substantially greater in the NR group. The CAR was identified to be a determinant of the NR (OR: 1.250, 95% CI: 1.033-1.513, P=0.02), although CRP and albumin were not independently related with NR in the multivariate analysis. In our investigation, low density lipoprotein-cholesterol levels and high thrombus burden were also predictors of the occurrence of NR. According to receiver operating characteristic curve evaluation, the optimal value of CAR was>1.4 with 60% sensitivity and 47% specificity in detecting NR in non-STEMI patients following PCI.

To the best of knowledge, this is the first investigation to demonstrate that the CAR, a new and useful inflammatory marker, can be utilized as a predictor of NR in patients with non-STEMI prior to PCI.

 Recanalized thrombus is an under diagnosed clinical entity. Aim was to investigate the utility of optical coherence tomography (OCT) in identifying spontaneously recanalized thrombi (SRCT) for management in clinical practice.

 This was a retrospective study analyzing 2678 coronary angiograms over a 4-year period which included intravascular imaging guidance in 75.8% of the percutaneous coronary interventions (PCI). Angiographic suspicion of SRCT has hazy appearance seen in 34 patients.

 Eight patients (7 males and 1 female) were confirmed with SRCT on OCT and two underwent intravascular ultrasound (IVUS). Median age was 52 years (range 33-67 years). Based on clinical symptoms, diagnosis was STEMI-2, NSTEMI-1, unstable angina-3 and chronic stable angina-2. Angiographic patterns were veiled/hazy appearances in 3; braided in 2; pseudo dissection in 2; and near occlusion in 1 patient. OCT findings displayed multiple small cavities, signal-rich with high backscattering and thin septa with smooth inner borders dividing the lumen and intercommunications. Presence of multiple holes conferred typical “Swiss cheese” or ‘lotus root’ like appearance, characteristic of recanalized thrombi. SRCT lesion length was (median interquartile ranges [IQR], 16.5[12.07-21.5] mm) and minimal luminal area (median [IQR], 1.77 [0.93-3.26] mm2 ) with significant stenosis (median [IQR], 74.0[67.0-81.0] %). Minimum/maximum number of channels were (median [IQR], 2.0[2.0-2.0]) and (median [IQR], 4.50[4.0-6.75]) respectively. Lipid rich plaque was predominant. IVUS demonstrated echo-lucent channels with small cavities. All but one patient underwent PCI.

 Intravascular imaging by OCT delineates the characteristics of recanalized thrombi and distinguishes ambiguous lesions. Majority of the lesions involving SRCT were significant both symptomatic and stenosis severity wise on OCT requiring PCI.

Dyspnea is a common complaint in pregnant women with no cardiac and pulmonary diseases. We aimed to assess whether physiological dyspnea of pregnancy was correlated with subtle changes in ventricular systolic and diastolic function.

This cross-sectional study enrolled 40 healthy pregnant women in their second and third trimesters with no complaints of dyspnea and 40 healthy pregnant women in the same trimesters with a complaint of dyspnea. Parameters of echocardiography were compared between the 2 groups.

Global left ventricular ejection fraction (59.65±6.44 and 58.49±4.95 P=0.418 in patients without and with dyspnea respectively), and global longitudinal strain were not significantly different (18.72±2.90 and 18.94±3.07, P=0.57 in the same order). Global circumferential strain(GCS)was lower in patients with dyspnea. ( 20.19±4.86 vs 22.61±4.69 ,P=0.03). Systolic volume (33.17±8.94 vs 32.63±8.09) and diastolic volume(80.75±18.73 vs 78.37±16.63) and left ventricular end-diastolic diameter(47.5±4.24 vs 46.23±3.21)were not different (P=0.784, 0.560 and 0.146 respectively) .Left ventricular end-systolic diameter was significantly lower in the case group (32.52±4.66 vs 29.92±4.05, P=0.011). Left atrial area index in the patients with dyspnea was lower.( 8.13±1.42 vs 8.94±1.4, P=0.014) . Other findings were a high E/E’ and high pulmonary artery pressure in the patients with dyspnea.

Dyspnea in pregnant women can be a consequence of incomplete physiological adaptation to volume overload in pregnancy. Lower systolic and diastolic diameters of the left ventricle, left atrial area, and left atrial index may lead to increased filling pressure, manifested by a higher E/E’ ratio and pulmonary artery pressure.

 Our study objects to determine the diagnostic accuracy of two-dimensional speckle tracking echocardiography (2DSTE) in predicting presence and severity of coronary artery disease (CAD).

 Patients with stable angina pectoris with normal left ventricular function (>50%) undergoing coronary angiography were enrolled and subjected to speckle tracking echocardiography. Global longitudinal peak systolic strain was measured and correlated to the results of coronary angiography for each patient.

 Number of male (P=0.001), diabetes (P=0.01) and smoking (P=0.01) patients were significantly higher in the CAD group compared to non-CAD patients. Global longitudinal peak systolic strain (GLPSS) was significantly (P=0.0001) lower in CAD patients in comparison to non- CAD patients. GLPSS showed significantly lower in patients with Syntax score (SS)≥22 in comparison to SS<22. Cut-off value -19 for GLPSS could be used to predict the presence of significant CAD with 80.6% sensitivity and 76.5% specificity (area under curve (AUC) -0.83, P=0.0001). The mean GLPSS value decreased as the number of diseased coronary vessels increased (P=0.0001). The optimal cut-off value of -16 GLPSS with a sensitivity of 76.7% and specificity of 83.3% [AUC 0.84, P<0.0001] was found significant to predict CAD severity. Multivariate regression of GLPSS and another risk factor for predicting significant CAD, GLPSS showed OR=1.55 (CI-1.36-1.76) P=0.0001 for predicting the presence of CAD.

 2DSTE can be used as a non-invasive screening test in predicting presence, extent and severity of significant CAD patients with suspected stable angina pectoris.

In the present study, we aimed to investigate the relationship between H2FPEF score and Contrast Induced Nephropathy (CIN) in patients with myocardial infarction with ST segment elevation (STEMI).

A total of 355 patients who had been diagnosed with ST elevation-myocardial infarction and undergone primary coronary angioplasty were retrospectively included in the study. The patients were divided into two groups according to the presence of CIN and these groups were compared in terms of baseline characteristics and laboratory findings. The H2FPEF score was calculated for each patient on admission and later compared between the groups.

The distribution of the study population was as following: 63 (17.7%) CIN (+) and 292 (82.2%) CIN (-). In CIN (+) group, the mean H2FPEF Score (2.00±1.60 vs 1.25±1.26, P<0.001) was significantly higher than the CIN (-) group. H2FPEF Score (OR: 1.25, 95%CI: 1.01-1.55), and mean age (OR: 1.03, 95%CI: 1.00-1.06) were found to be independently associated with CIN development.

H2FPEF score is an independent predictor of CIN development in patients with acute STEMI. It is easily calculated and and may be used to estimate the CIN in STEMI patients.

Considering the effect of Apoptosis on cardiovascular disease, this study aimed to determine the combined effect of endurance exercise and rosehip extract supplementation on the expression of P53 and cytochrome C genes in the myocardium of male rats.

A total of 35 male rats were randomly divided into five groups (n=7) as follows: endurance exercise+rosehip extract supplementation (Ex+Supp), endurance exercise (Ex), rosehip extract supplementation (Supp), six-month control (Con2), and three-month control (Con). The subjects in Ex+Supp and Ex groups performed endurance exercise (running on a treadmill at 24-33 m/min for 10-60 min) for 12 weeks, five times a week. Subjects in Ex+Supp and Supp groups consumed 1000 milligrams/ kilogram of rosehip extract for 12 weeks. Also, Con and Con2 groups did not receive any intervention. To RNA extraction and synthesis cDNA and evaluate the P53 and cytochrome C genes of the myocardium of rats, RT-PCR analysis was used.

Neither endurance exercise nor rosehip alone nor together significantly affected the expression of cytochrome C and P53 genes in the heart muscle of male rats (P˃ 0.05). Also, endurance exercise (P=0.001) and rosehip supplementation (P=0.002) alone and in interaction (P<0.01) had a significant effect on body weight, myocardium weight, and the ratio of myocardium weight to body weight in male rats.

Twelve weeks of endurance exercise accompanied with rosehip extract did not significantly affect the expression of P53 and cytochrome C genes. Further studies are suggested to confirm these results.

 Since the coronavirus disease 2019 (COVID-19) pandemic, the use of angiotensin II receptor blockers (ARBs) in hypertensive patients with COVID-19 has been controversial. Following our previous study, after one year, we intended to extend our sample size and results to investigate the effects of ARBs with both in-hospital outcomes and 7-month follow-up results in patients with COVID-19.

 Patients with a diagnosis of COVID-19 who were admitted to Sina Hospital, Tehran, Iran, from February to October 2020 participated in this follow-up cohort study. The COVID-19 diagnosis was based on a positive polymerase chain reaction test or chest computed tomography scan according to guidelines. Patients were followed for disease severity, incurring in-hospital mortality, complications, and 7-month all-cause mortality.

 We evaluated 1413 patients with COVID-19 in this study. After excluding 124 patients, 1289 including 561(43.5%) hypertensive patients, entered the analysis. During the study, 875(67.9%) severe disease, 227(17.6%) in-hospital mortality, and 307(23.8%) 7-month all-cause mortality were observed. After adjusting for possible confounders, ARB was not associated with severity, in-hospital and 7-month all-cause mortality, and in-hospital complications except for acute kidney injury. Discontinuation of ARBs was significantly associated with higher in-hospital mortality and 7-month all-cause mortality (both P values<0.006). We observed a better 7-month outcome in those who continued their ARBs after discharge.

 The results of this study, along with the previous studies, provide reassurance that taking ARBs is not associated with the risk of mortality, complications, and poorer outcomes in hypertensive COVID-19 patients after adjustment for possible confounders.

 After solid organ transplantation, patients require lifelong immunosuppressive medication, increasing susceptibility to COVID-19. We evaluated the clinical outcomes of heart transplant recipients in patients with COVID-19.

 We enrolled twenty-two COVID-19 cases of adult heart transplantation from February 2020 to September 2021.

 The most common symptoms in patients were fever and myalgia. The death occurred in 3 (13.6 %).

 Although heart transplantation mortality may increase in the acute rejection phase concomitant with COVID-19, immunosuppressive dose reduction may not be necessary for all heart transplant patients with COVID-19.

A male infant with a history of ventriculoperitoneal (VP) implantation due to congenital hydrocephalus presented with fever and lethargy at the age of 8 month-old. Pericardial effusion was detected in transthoracic echocardiography, and he underwent pericardial window operation and was discharged in a stable condition. At 11 months of age, he presented again with fever, lethargy, recurrent vomiting, and respiratory distress. In both plain chest radiography and transthoracic echocardiography, VP shunt migration to the heart cavity was observed. The VP shunt had entered into the right ventricle after perforating the diaphragm and pericardium. The patient underwent open-heart surgery due to vegetation at the tip of the VP shunt inside the right heart. Vegetation was removed and the tip of the shunt was returned to the peritoneal cavity. Two weeks after discharge, the patient presented again with symptoms of tachypnea and lethargy. The imaging revealed the entry of the VP shunt about two centimeters into the anterior mediastinum. The patient was transferred to the operation room and the VP shunt was shortened and re-inserted into the peritoneal cavity. Antibiotic treatment was continued for six weeks and the patient was discharged in stable condition. In follow-up visits after two years, the VP shunt functioned well and no particular complication was observed. This case demonstrates that in patients with VP shunt implantation presenting with pulmonary and cardiac symptoms such as respiratory distress, pericardial effusion, and cardiac tamponade after VP shunt implantation, the possibility of VP shunt catheter migration to the mediastinal cavity should be considered.

Mitral valve replacement complications are more and more recognized due to the novel surgical techniques and the tendency to report such complications by young cardiologists and surgeons. Circumflex coronary artery injury is a rare complication that occurs during mitral valve replacement or repair by multiple mechanisms. We present the case of a 57-year-old female who underwent mitral valve replacement and ended up with heart failure after circumflex artery occlusion and failure of percutaneous coronary intervention.