Arya Atherosclerosis
Volume:15 Issue: 4, Jul 2019

Candidates for cardiac surgery usually suffer from preoperative anxiety. Although there are various anxiety reduction techniques, it is unclear which one is the most effective. Therefore, the present study was conducted to explore the effects of an orientation tour on preoperative anxiety in candidates for coronary artery bypass grafting (CABG). In this randomized clinical trial study, 70 patients who were candidate for CABG were recruited from February 2016 to May 2017. They were randomly assigned to two groups of 35. The intervention group members were taken on an orientation tour and the control group received routine care. Data were collected using the State-Trait Anxiety Inventory (STAI). The statistical tests revealed that there was no significant difference between the intervention group (42.43 ± 13.24) and the control group (45.11 ± 10.19) with respect to the pre-intervention state anxiety level (P = 0.340); however, before surgery, the state anxiety level was significantly lower in the intervention group (34.83 ± 11.15) than in the control group (47.69 ± 11.30) (P < 0.001). Moreover, the independent t-test showed that there was no significant difference between the intervention (43.71 ± 12.04) and control (45.03 ± 8.76) groups with respect to the pre-intervention trait anxiety level (P = 0.600). Nevertheless, before surgery, the trait anxiety level was significantly lower in the intervention group (35.40 ± 10.24) than in the control group (46.91 ± 9.51) (P < 0.001). The preoperative orientation tour had a positive impact on the anxiety level in the candidates for CABG. Hence, the tour can be used as a remarkably effective technique for reducing anxiety.

Air pollution is associated with increased risk of cardiovascular disease (CVD). This study aims to evaluate the correlation between air pollutants and hospitalization due to myocardial infarction (MI) as part of "correlation of air pollution with hospitalization and mortality of CVDs and respiratory diseases (CAPACITY) study". This case-crossover study analyzed the data of 319 patients who were admitted with diagnosis of ST-elevation MI (STEMI) or non-ST-elevation MI (NSTEMI) in three main hospitals of Isfahan, Iran. The data of airborne pollutants including particulate matter < 10 µm (PM10), particulate matter < 2.5 µm (PM2.5), nitrogen dioxide (NO2), sulfur dioxide (SO2), carbon monoxide (CO), and ozone (O3) as well as climatic indices (temperature, wind speed, and humidity) at 24 hours, 48 hours, and one week before admission were extracted from CAPACITY study. The conditional logistic regression method was used to evaluate the correlation between air pollutants and MI hospitalization. 319 patients with mean age of 63.15 ± 28.14 years, including 238 men (74.6%), and 207 patients (64.8%) with STEMI. The risk of hospitalization significantly increased in STEMI patients with 10-unit increment in PM2.5 at 48 hours before admission [odds ratio (OR) = 3.70, 95% confidence interval (CI): 1.69-7.69]. Although, majority of air pollutants had positive association with hospitalization in patients with NSTEMI, they were not statistically significant. This study showed significant association between elevated PM2.5 at 48 hours with hospitalization of patients with STEMI. This finding can warn policy makers to design and provide better care services for patients at risk of acute MI during the times of increased air pollution.

Both canola and sesame oils consumption have been associated with favorable effects on cardio-metabolic biomarkers. However, to the best of our knowledge, no study has compared their effects on cardiovascular risk factors. The present study aimed to assess the effect of canola, sesame, and sesame-canola oils consumption on cardio-metabolic biomarkers in patients with type 2 diabetes mellitus (T2DM‎). This study was a randomized, triple-blind, three-way, crossover clinical trial. The study participants included 102 individuals with T2DM‎. Their spouses were also included in the study. The participants were entered into a 4-week run-in period. After that, their regular dietary oil was replaced with canola, sesame, or sesame-canola oils (a blend of sesame and canola oils) in three 9-week phases, which were separated by two 4-week washout periods (sunflower oil was consumed during the run-in and the washout periods). Dietary, physical activity, blood pressure, and anthropometric measurements were assessed at the beginning, middle (week 4-5), and end of each treatment phase. Blood samples were taken at the beginning and at the end of each phase. Serum, plasma, buffy coat, and whole blood samples were extracted and kept at -80 ºC for further analysis. Serum fasting blood sugar (FBS), triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol‎ (HDL-C)‎, and low-density lipoprotein cholesterol (LDL-C) were selected as the primary outcomes. 102 participants with T2DM were randomly assigned to one of the 6 rolling methods. Through them, 93 individuals (91.2%) completely participated in all phases. The present study will provide an exceptional opportunity to examine the effect of canola, sesame, and sesame-canola oil on cardio-metabolic markers in adults with and without T2DM‎. This trial will also provide a good medium for the investigation of gene-dietary oils interaction in the future.

Metabolic syndrome, a cluster of interrelated disorders including abdominal obesity, insulin resistance, dyslipidemia, and hypertension (HTN) plays an important role in development of atherosclerotic lesions in arterial wall. Dysregulation of adipose tissue hormones (adipokines) production is a possible link between abdominal obesity and other manifestations of metabolic syndrome. Adiponectin is a well-known adipokine which affects metabolism and inflammatory response. However, data on its role in atherogenesis are still controversial. The aim of this study is to investigate whether adiponectin is present in atherosclerotic lesions of human aorta. Thirty-five autopsy segments from abdominal, thoracic aortas, and aortic arch of four men (mean age: 57 years) were fixed and stained for lipids [Oil Red O (ORO)], cells [hematoxylin-eosin (H&E)], and adiponectin [indirect immunoperoxidase assay (IPA) method]. Samples of both stable and unstable plaques were selected for analysis. Human adipose tissue, THP-1 monocytes/macrophages, and human endothelial hybrid cell line (EA.hy926) were chosen for detection of adiponectin messenger ribonucleic acid (mRNA) using reverse transcription polymerase chain reaction (RT-PCR). Adiponectin accumulations were found inside endothelial cells covering both stable and unstable atherosclerotic plaques. Focal depositions of adiponectin were also found in fibrous caps of stable lesions and atheromatous core of both stable and unstable plaques and also in adventitia. RT-PCR revealed mRNA expression of adiponectin gene in adipose tissue, but not in mononuclears and endothelial cells. Adiponectin is present in aortic plaques of humans, but is not synthesized in endothelial cells and mononuclears, at least in culture conditions. Detection of adiponectin in atherosclerotic lesions can serve as indirect evidence of possible participation of this adipokine in atherogenesis.

Acute coronary syndrome (ACS) is a common condition that needs appropriate treatment like percutaneous coronary intervention (PCI). Glycoprotein IIb/IIIa inhibitors (GPI) like eptifibatide prevent procedural ischemic complications after PCI. Eptifibatide has increased the risk of bleeding complications, although it is effective in reducing mortality and morbidity. Eptifibatide is routinely used in bolus and infusion forms and the aim of this study is to evaluate the efficacy of bolus-only dose and bolus + infusion strategy for administrating eptifibatide in bleeding complications and consequences after PCI. This randomized clinical trial was conducted on subjects who experienced PCI after incidence of myocardial infarction (MI). Patients were randomly divided into two groups who received bolus-only dose (n = 51) or bolus + infusion form of eptifibatide (n = 50). Then, PCI blood pressure, mean time duration of hemostasis after arterial sheath removal, laboratory data, need for blood transfusion, and presence of bleeding complications were evaluated. After 6 months, patients were followed for needs for additional coronary interventions. The mean age of participants was 61.68 ± 1.50 years. The prevalence of men was 70.29%. There was no significant difference in mean of systolic blood pressure (SBP) and diastolic blood pressure (DBP) during hospitalization (P > 0.050). The mean time duration of hemostasis was 8.13 ± 0.45 minutes in the bolus-only group and 16.46 ± 0.71 minutes in the bolus + infusion group (P < 0.001). There was no significant difference in the hemoglobin (Hb) level, platelet count, white blood cell (WBC), blood urea nitrogen (BUN), and creatinine level (P > 0.050). The results of this study suggested that bolus-only dose of eptifibatide before PCI could be able to decrease significantly bleeding complication and other clinical and cardiovascular outcomes.

Open-heart surgery is a stressful experience for the patients and their families. From the moment that patients are told they must undergo surgery until discharge, they experience different degrees of worry and nervousness. This study was conducted with the aim of identifying stress factors in heart surgery patients. This study was performed using a qualitative method on 21 participants (14 patients and 7 caregivers). The research environment was open-heart surgery wards of two educational hospitals in Ahwaz (south of Iran) in 2017. The participants were selected through purposive sampling. The data were collected through semi-structured interviews, and then, analyzed using the qualitative approach of content analysis proposed by Graneheim and Lundmnan (2004). The 5 themes of “physical stressors”, “self-care stressors”, “psychological stressors”, “religious stressors”, and “hospital stressors” were obtained. These themes were the result of the patients’ experiences and dimensions of patients’ perceptions regarding stressors in open-heart surgery. Stress in patients undergoing open-heart surgery is a contextual and relative concept and a subjective experience, which is experienced as a sense of worry. Identifying and clarifying stressors in open-heart surgery patients for nurses is vital, like a key for improving care quality. Nursing managers in clinical practice can also benefit from these findings regarding heart surgery in improving the care quality and professional performance of nurses.

Despite recent advances in diagnostic techniques in cardiology, electrocardiography (ECG) has yet remained the first and corner stone of detecting emergency cardiac events including myocardial infarction (MI). There are some ECG findings which are considered as equivalents to MI. De Winter ST-T wave pattern is one of the important ECG findings which is thought to be related to left anterior descending artery occlusion. However, the coexistence of this ECG pattern with other ECG abnormalities are not reported widely. In this report, we discussed a unique case of de Winter ST-T wave pattern in a patient with Wolff-Parkinson-White (WPW) syndrome for the first time. A 43-year-old man was referred because of an intermittent typical chest pain. The patient had no cardiovascular risk factor, and was not on any medication; laboratory tests showed elevated and raising troponin I. The first ECG showed pre-excitation (WPW) as well as de winter pattern. According to patient’s symptoms and suggestive ECG for probable left anterior descending (LAD) occlusion, emergent angiography was scheduled. The coronary angiography revealed sever LAD artery occlusion. The patient was symptom free after successful percutaneous coronary intervention, and was discharged on medication. The patient remained asymptomatic in 1-year follow-up period. Presence of de Winter ST-T changes with other ECG abnormalities is a rare issue, and here we addressed the first case of WPW and de Winter. The physicians should be aware that ECG changes in patients with WPW should not be interpreted as de Winter ST-T changes and vice versa.