سید محمدحسن عادل

Exercise-based cardiac rehabilitation(CR) programs increase physiological function. However, it’s not yet clear which feature of exercise is most effective in improving important physiological performance indicators in heart patients. Therefore, the aim of this study was to compare the effects of high-intensity interval training(HIT) and moderate-intensity continuous training(MCT) on metabolic equivalent of tasks(METs), submaximal myocardial oxygen consumption(MVO2submax), and heart rate recovery(HRR) of heart patients after coronary artery bypass graft(CABG) surgery.

Twenty-four post-CABG patients (15 males and 9 females) with a mean age of 60.75±3.16 years and a mean body mass index (BMI) of 28.40±1.09 kg/m2 were randomly divided into three groups of HIT, MCT and control group (CG). The training groups (HIT and MCT) trained for eight-weeks, three-sessions per week, and 45minutes per session. The research variables (METs, MVO2submax and HRR) were measured and compared in two stages before and after eight-weeks of CR programs.

After eight-weeks of CR programs, patients in both training groups showed a significant improvement in METs, MVO2submax and HRR (P<0.05), and the HIT group showed significantly greater improvement in METs (P=0.001) and HRR (P=0.001) compared to the MCT group, as well the MCT group showed a significantly more improvement in MVO2submax (P=0.001) than the HIT group. Also, no cardiovascular adverse events related to HIT or MCT occurred during the implementation of the study.

According to the results of the present study, HIT seems to be more effective than MCT in improving METs and HRR of post-CABG patients, and is safe as well.

Percutaneous coronary intervention (PCI) is a reperfusion strategy to increase survival and ejection fraction in patients with ST-elevation myocardial infarction (STEMI). Therefore, the aim of the present study was to determine and evaluate the ejection fraction in patients with acute myocardial infarction undergoing percutaneous coronary intervention.

This is a cross-sectional descriptive study that was conducted on 176 patients in Golestan and Imam Khomeini hospitals in Ahvaz in 2022. Patients who underwent angioplasty in the first 12 hours (without receiving fibrinolytic drug) and patients who underwent angioplasty within 12-24 hours after referral (after receiving fibrinolytic drug), 40 days after treatment, all Patients were reevaluated. Patients were compared based on the type of lesion, the number of involved vessels, the type of involved vessel and the location of the lesion in terms of the increase in ejection fraction. Descriptive statistics were used to present quantitative data in the form of mean ± standard deviation and for qualitative variables in the form of percentages, tables and graphs. Chi-square test was used to compare frequency in two groups. T-test was used to compare the mean in two groups. Odds ratio was calculated to compare two groups of case and control in terms of the frequency of each genotype. The collected data were analyzed using Chi-square and t-test.

The most frequent type of lesion diagnosed in patients was type B (61.4%) and the most common vessel involved in patients was the left anterior descending coronary artery (60.2%). The most frequent area involved in the studied patients was diagnosed as anterior (56.8%). There was no significant difference in the increase of jump fraction between the two groups (p=0.2). A marked difference was seen between the ejection fraction, 40 days after treatment based on the involved area (p<0.001), so that at the beginning of the heart attack and before angioplasty, the highest and lowest amount of ejection fraction was observed in patients with involvement, respectively. It was in the posterior region (46.2±5.9) and anterior region (32.2±6.4), after angioplasty regardless of the time, the increase in the second ejection fraction (40 days after myocardial infarction) in patients with obstruction The anterior artery was observed. Correspondingly, the highest rate of ejection fraction was seen in patients with involvement of the right coronary artery (45.7±7) and the lowest amount of ejection fraction was seen in the involvement of the left anterior descending coronary artery (32.4±6.4) (p<0.001). No difference was seen between patients in terms of lesion type (p=0.2). The number of involved vessels had no effect on EF level after treatment (p=0.9) and no significant relationship was observed between the effect of risk factors and EF level (p<0.05).

Based on the results of the present study, the left anterior descending coronary artery and the anterior region were the most involved areas in ST-segment elevation myocardial infarction patients, which led to a further decrease in the ejection fraction. Furthermore, after angioplasty, a greater increase in the second ejection fraction was observed (40 days after a heart attack).

Diabetes mellitus is associated with an increased risk of cardiovascular disease. The effects of add-in Sodium-glucose cotransporter 2 (SGLT2) inhibitors to standard statin treatments in acute coronary syndrome (ACS) patients remains controversial. The effects of the empagliflozin treatment after percutaneous coronary intervention (PCI) on the lipid profile of patients with type 2 diabetes mellitus (T2DM) have not been investigated yet. This study aimed to evaluate the efficacy of empagliflozin administration on lipid profile in diabetic patients with ACS after PCI.

This randomized, double-blind, placebo-controlled trial study was conducted from March until December 2020 on type 2 diabetes patients who underwent PCI and were referred to the Golestan and Imam Khomeini Hospitals. 93 patients (56 males and 37 females, mean age of 56.55 years old) were included. The patients were randomly assigned into two groups of receiving empagliflozin (10 mg, once daily) or a matching placebo, in addition to standard therapies for 6 months. The changes in metabolic parameters including lipid profile before and 6 months after interventions were assessed.

After treatment in placebo group the level of LDL-C (median 0.90 mg/dl to 0.82, P=0.008) and HDL-C (median 0.40 mg/dl to 0.35, P=0.090) were decreased, while in the empagliflozin group the levels of LDL-C (median 0.87 mg/dl to 0.96, P=0.875) and HDL-C (median 0.38 mg/dl to 0.48), P=0.007) increased. Treatment with Empagliflozin and placebo had no significant effect on changing the levels of total cholesterol, TG and eGFR (P>0.05). The weight loss and FBS reduction in the empagliflozin group were significantly higher than placebo (P=0.001 and P=0.048, respectively).

Our results showed that adding Empagliflozin to standard treatment compared with a placebo for 6 months significantly increased LDL-C and significantly increased HDL-C. Also, except for weight loss and FBS, Empagliflozin was not more effective in improving the metabolic parameters of diabetic patients after PCI compared with placebo, so it seems that the use of this drug in diabetic patients with ACS after PCI is not very cost-effective.

There is little information about the prognostic role of preoperative serum albumin levels in postoperative outcomes following coronary artery bypass grafting (CABG). The aim of this study was to evaluate preoperative hypoalbuminemia as a predictor for complications after CABG.

This prospective observational study was conducted in 200 patients undergoing CABG in Ahvaz Golestan Hospital, 2020. The patients were classified into two groups based on pre-operative hypoalbuminemia (serum Alb <3.5 g/dL). The association between hypoalbuminemia and clinical characteristics and outcomes including postoperative complications, ventilator duration, and length of hospital stay was assessed.

Preoperative hypoalbuminemia was observed in 38 (19%) patients. Patients with hypoalbuminemia had higher postoperative complications including hemorrhage, infection, cardiac arrest, AKI, and in-hospital mortality than patients with normal albumin levels (84.2% vs. 13%, P<0.0001). Ventilator duration, length of hospital stay and ICU were significantly longer in hypoalbuminemia patients than normal albumin group (P<0.0001). Preoperative hypoalbuminemia (P<0.0001), ventilator duration (P=0.025), and length of hospital stay (P=0.002) were independent predictors of CABG postoperative complications.

Preoperative hypoalbuminemia was associated with postoperative mortality and complications, including hemorrhage, infection, stroke, and AKI development in patients undergoing CABG procedure. Thus, serum albumin measurement before CABG as a clinically implementable and easy method could be used for management and prevention of postoperative complications.

Transradial access is one of the main access techniques in angiography. This method is technically more difficult as it is associated with radial artery occlusion. Radial artery cannulation from the dorsal surface of the hand in the snuffbox area has been introduced as a suitable solution to overcome some of the disadvantages of the standard radial artery method. This study was conducted to compare the incidence of radial artery occlusion and other complications in the two methods.

This study was conducted on 100 patients Who were referred to the Imam Hospital in Ahvaz from 22 September 2020 to 19 Mach 2021. 50 patients underwent angiography with normal radial artery access and 50 patients underwent snuffbox angiography. Basic characteristics including age, sex, underlying disease (diabetes mellitus, hypertension, and dyslipidemia), family history of coronary artery disease, medical history including chronic coronary artery disease, stable ischemic heart disease, smoking, and LVEF, and also the length of hospital stay was also collected and recorded. All subjects in the two groups underwent radial artery ultrasound in the forearm and snuffbox 24 hours after angiography. Also, angiographic complications including radial artery occlusion (thrombosis), pain, hematoma and anesthesia were recorded.

In the present study, the mean age in the two groups was similar (about 50-60 years). The distribution of sex, diabetes, weight, height and blood pressure was homogeneous in both groups. There was a statistically significant difference in the incidence of thrombosis and pain between the two groups. The results of this study showed that in the snuffbox angiography group, the number of uncomplicated cases was significantly more than the radial angiography group and in the snuffbox angiography group, the number of postoperative pain and thrombosis cases was significantly lower. The length of hospital stay in the Snuffbox group was shorter than the radial group, but there was no statistically significant difference.

Snuffbox angiography has fewer complications compared to the usual transradial method, so it can be used as a safe method for angiography.

Peak oxygen uptake(VO2peak) is a strong predictor of survival in cardiac patients. LVEF is reflection of the functional capacity of the heart. The aims of this study were to compare the effects of high intensity interval training(HIIT) to moderate intensity continuous training(MICT) on VO2peak and LVEF of heart patients after coronary artery bypass graft surgery(POST CABG).

Twenty-four POST CABG patients(15men and 9women) with an average age of 60.75±3.16 years and average body mass index(BMI) of 28.40±1.09 kg/m2 were randomly divided into three groups, HIIT, MICT and control group(CG). The training groups, Exercised for 8weeks, 3sessions per week and 45min per session. One-way ANOVA and post-hoc bonferroni test were used for statistical analysis.

Both HIIT and MICT groups showed significant improvement in VO2peak after eight weeks of CR program(p < 0.05), and improvement in VO2peak in the HIIT group was significantly greater than the improvement in the MICT group(P=0.011). Patients' LVEF did not significant change after eight weeks of CR program in either groups HIIT and MICT(P>0.05), also was not observed significant difference between the two groups(P=1.000).

According to the results of this study, HIIT is more effective than MICT for improving VO2peak in POST CABG patients, and despite the high intensity of HIIT, its use in the CR programs of these patients can be safe. These results can help sports medicine professionals choose the optimal style and intensity of CR exercise and thus improve the exercise capacity and quality of life of heart patients.