فهرست مطالب reza faramarzzadeh

Pulmonary embolism (PE) is challenging to diagnose due to nonspecific symptoms. While computed tomography pulmonary angiography (CTPA) is the gold standard, transthoracic echocardiography (TTE) is frequently used first. This study aimed to evaluate the accuracy of TTE findings in predicting the severity of CTPA-confirmed PE.  This retrospective study in 2023, analyzed 124 patients who underwent CTPA for suspected PE at Seyed Al Shohada Hospital of Urmia, Iran. The Pulmonary Embolism Severity Index (PESI), as a risk stratification tool for pulmonary embolism, was measured in the first hours of hospitalization. TTE was performed 48 hours following hospital admission, with an emphasis on Key TTE parameters, including McConnell’s sign, D-shape septum sign, right ventricular (RV) dimensions, left ventricular dimensions, pulmonary artery (PA) diameter, tricuspid regurgitation gradient (TRG), Tricuspid annular plane systolic excursion (TAPSE)  and PA acceleration time (PaACT). Sensitivity, specificity and predictive value were all calculated.  Most patients were women (53.23%) over 60 (38.71%). Several TTE measures showed promise for predicting PE: RV dilation (sensitivity 84%, specificity 77%), PA diameter (84% and 28%), TRG (66% and 58%), and PA acceleration time (92% and 62%). However, McConnell’s sign had low accuracy (area under ROC curve 0.62). Tricuspid annular plane systolic excursion (TAPSE) and PA acceleration time showed the best predictive performance (AUC 0.95-0.92) and can be used as screening tools for life-threatening massive PE.PESI index test, when compared to the gold standard CT scan (which shows lung involvement), does not provide additional valuable information and accurate predictions about the severity of PE.  TAPSE and PaACT showed excellent predictive ability to CTPA-detected PE. RV dilation and PA diameter also showed good predictive capability. Findings support using some TTE indices to screen for PE severity and risk assessment before CTPA when access is limited.

Delirium and dementia are considered to be the most significant postoperative neurocognitive complications in patients undergoing cardiac surgery, particularly those aged 60 years and older, which reduces the post-surgery quality of life, prolongs hospitalization, increases costs, and ele-vated the rates of mortality. Nevertheless, the etiology, risk factors, and predictive biomarkers, have not been well elucidated particularly, in patients with unmanifested underline cognitive im-pairments. The present study aimed to review the findings on the etiology, factors increasing the risk of incidence, and predictive biomarkers of postoperative delirium and dementia after cardiac surgery, and to describe the suggested pharmacological and non-pharmacological interventions.

Cardiovascular diseases (CVDs) are considered the most prevalent noncommunicable disease and the leading cause of death worldwide. A plethora of evidence has revealed that microRNAs (miRNAs) could control the inhibition or progression of CVDs by regulating pivotal cell pro-cesses ranging from metabolism and homeostasis to programmed cell death (PCD). Pyroptosis and ferroptosis are two major types of nonapoptotic PCDs involved in the pathogenesis of heart failure. However, no study has discussed the crosstalk between miRNAs and these two types of PCDs in the CVDs. The current review demonstrated that different types of miRNAs can regu-late both ferroptosis and pyroptosis and thereby affect CVDs progression and inhibition. Alto-gether, the discussed content encourages further studies to confirm that mentioned pathways are suitable to be considered as novel therapeutic approaches against CVDs.

Numerous recent studies have emphasized the role of kidney failure in developing ischemic heart disease (IHD) and the resulting adverse consequences. The purpose of the present study was to quantitatively assess the effect of kidney failure based on glomerular filtration rate (GFR) in predicting clinical outcomes in patients with unstable angina (U/A). This retrospective cohort study included 129 patients with unstable angina with preserved left ventricular function. Serum creatinine levels were specified at the beginning of their admission. The GFR at admission time was determined based on the MDRD index. Based on the GFR value, patients were classified into two groups, i.e., normal GFR (>60) and decreased GFR (<60). The frequency of one-month mortality in <60 GFR and >60 GFR was 3.2% and 0.0%, respectively. Furthermore, the prevalence of 6-month mortality in <60 GFR and >60 GFR was 8.1% and 0.0%, respectively. The frequency of readmission in <60 GFR and >60 GFR was 29% and 11%, respectively. Likewise, the frequency of revascularization through coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI) in <60 GFR and >60 GFR was 25.8% and 8.9%, respectively. According to the multivariate logistic regression model, <60 GFR increased the risk of 6-month mortality up to 0.2 times (probability ratio of 2.081, P-value of 0.023). Regarding readmission, <60 GFR increased the need for readmission up to 2.4 times (probability ratio of 2.433, P-value of 0.049). On the other hand, the risk of CABG or PCI recurrence following initial intervention was 2.8 times higher in patients with <60 GFR than in the >60 GFR group (probability ratio 2.882, p-value .03. The study revealed that <60 GFR compared to higher values ​​of GFR is associated with an increased risk of 6-month mortality, increased readmission, and increased revascularization in patients with unstable angina.

Takotsubo cardiomyopathy (TCM) is a transient left ventricular wall motion abnormality commonly following physical and emotional stress that can be resolved entirely. Recent case reports and some case-control studies have suggested a likely close association between thyrotoxicosis and TCM. It was shown that resolving thyroid functional status led to resolving TCM symptoms leading to normal cardiac function without a significant sequela, emphasizing a triggering role of thyrotoxicosis for flaring TCM. Here, the literature on the association between thyroid dysfunction and the likelihood of TCM is reviewed to describe the likely pathophysiology of TCM associated with thyroid dysfunction.

Although the myocardial bridge is considered as a benign congenital anomaly, atherosclerotic stenosis of coronary artery segments adjacent to muscle bridge has made some concerns about its direct role in triggering atherosclerosis. This study tries to investigate the role of the conventional risk factors of atherosclerosis in this phenomenon.

Between June 2011 and July 2018, a total of 342 patients with coronary artery Muscle Bridge in coronary artery angiography were investigated for concomitant coronary artery stenosis and the presence of conventional risk factors of atherosclerosis.

86 (25.1%) patients had coronary artery stenosis adjacent to muscle bridge. The mean age of patients was 56±11.76 and 49.2±11.34 years in coronary artery stenosis and normal coronary groups, respectively. (p- value= 0.001) Multivariate regression analysis showed that male gender (OR=2.8), diabetes mellitus (OR=2.3), and hypertension (OR=2.0) were independent predictors of coronary artery stenosis adjacent to muscle bridge.

Our study showed that conventional risk factors of coronary artery disease play an important role in atherosclerotic stenosis adjacent to muscle bridge.