International Cardiovascular Research Journal
Volume:15 Issue: 2, Jun 2021

Ventricular Septal Rupture (VSR) is a rare but challenging complication after Myocardial Infarction (MI).

The present study aimed to evaluate the surgical outcomes of VSR over 18 years.

This multicenter study was conducted on 88 patients with post-MI VSR during 2000 - 2018.

A consecutive series of 88 patients with surgical repair of VSR was evaluated. The patients (n = 11) presenting hemodynamic deterioration at the time of hospital admission died before any attempt for surgery. The mean intervals between MI and VSR diagnosis and between admission and operation were 7.5 ± 7.2 and 5 ± 5 days, respectively. VSR location did not influence the outcomes (P = 0.1). Concomitant coronary bypass was done for all patients. Only 25 patients survived and left the hospital (13 patients died in the operating room due to pump weaning failure and 50 patients died in the ICU due to low cardiac output). The predictors of poor prognosis included low ejection fraction (P = 0.01), prolonged pump time (P = 0.01), and operation in the second half of the study period (P = 002). However, the results of multivariate analysis showed that none of them was an independent predictor of perioperative mortality.

The perioperative mortality rate of VSR has remained high in case of inaccessibility to assist devices. Hence, VSR repair is recommended to be limited to certain centers with adequate experiences.

Rheumatic mitral stenosis leads to depressed ventricular function, which is not detectable through the measurement of ejection fraction. Whether pancarditis or changes in loading condition results in subclinical Left Ventricular (LV) dysfunction has yet to be fully elucidated.

The aim of this study is to evaluate the effect of loading condition on left ventricular function.

The present observational, case-control study was conducted on 104 cases who were referred to the echocardiography department including 71 patients with different severity degrees of rheumatic mitral stenosis and 33 healthy individuals with no past history of cardiac or other medical illnesses and with normal echocardiography who were matched with the cases in terms of age, gender, and body surface area. The strain, strain rate, rotation, torsion, and twist parameters of the left ventricle were measured via 2D speckle-tracking echocardiography. The data were analyzed using Kolmogorov– Smirnov test, independent student t-test, and one-way Analysis of Variance (ANOVA), as appropriated. Correlation analysis was also performed using linear regression, and the results were expressed as Pearson’s correlation coefficients.

The LV Global Longitudinal Strain (GLS), Global Longitudinal Strain Rate (GLsr), and Global Circumferential Strain Rate (GCsr), but not Global Circumferential Strain (GCS), basal and apical rotations, twist, and torsion, were significantly lower in the subgroup with progressive mitral stenosis (17.7%, 1.07s-1, 22.85%, and 1.05s-1 , respectively) compared to the healthy group (19.76%, 1.17 s-1, 24.15%, and 1.27 s-1, respectively) (P = 0.001, 0.032, 0.104, and < 0.001, respectively). Increase in the severity degree of mitral stenosis was accompanied by a significant decrease in the mentioned parameters.

The rheumatic process led to a reduction in ventricular function, which was detectable through the measurement of the GLS, GLsr, and GCsr, but not GCS, twist, rotation, and torsional parameters of the left ventricle. As the severity of the stenosis progressed, other indices of the LV function such as rotation, twist, and torsion decreased significantly, indicating their more susceptibility to loading conditions compared to the rheumatic process per se.

Ischemic Heart Disease (IHD) is the leading cause of death worldwide. The primary pathological process resulting in IHD is coronary artery atherosclerosis. Despite advances in CT scan technology, the Agatson method is still the most popular method for measuring coronary artery calcification. Various studies have shown that determining the degree of calcification using Coronary Artery Calcium Score (CACS) is the most reliable noninvasive method of risk assessment. Coronary CT Angiography (CCTA) might be required following CACS measurements. However, there is no consensus regarding a specific CACS cut-off for determining the need for CCTA.

This study aimed to compare the severity of coronary calcification to CTA findings.

This retrospective study was conducted on 261 patients with cardiovascular risk factors or atypical symptoms. An ECG-gated multi-detector CT scan was performed to calculate CACS using the Agatston method. Then, CCTA was performed by injection of the IV contrast agent. The presence of significant coronary artery stenosis was defined as ≥ 50% diameter reduction in CCTA images. Univariate and multivariate analyses were performed using binary logistic regression.

Among the patients, 58.2% had no stenosis and 17.6% had significant stenosis. According to the results of univariate analysis, higher age, hypertension, and lower estimated Glomerular Filtration Rate (eGFR) were associated with a significant increase in coronary artery stenosis. Following multivariate analysis, only GFR was suggested as an independent risk factor, which indicated the important role of GFR as a confounder. Approximately half of the cases (48.6%) had no calcification (CACS = 0), among whom only one patient (0.8%) had significant stenosis on CCTA images. In the minimal subgroup (0 < CACS ≤ 10), one patient (3.1%) showed significant stenosis (P < 0.01). The results revealed a gradual and independent association between higher CAC scores and increase in the incidence of significant stenosis.

Due to the low prevalence of significant stenosis in patients with CACS ≤ 10, CCTA is not recommended in this group, resulting in less radiation exposure and reduced health system costs. In patients with CACS > 10, the likelihood of significant stenosis requiring invasive treatment increases.

Anthracyclines can induce injuries to cardiac myocytes. Performance of echocardiography to detect Anthracycline Induced Cardiotoxicity (ACIC) for all patients under chemotherapeutic regimens is neither feasible nor cost-effective.

This study aimed to investigate the changes in the serum levels of cardiac novel biomarkers after anthracycline usage to determine whether they are suitable candidates for screening or diagnosing ACIC.

In this pre-post study, patients without previous cardiovascular diseases who were candidates for chemotherapy with anthracyclines were recruited. The study was conducted on 30 patients selected through simple random sampling. Echocardiography and measurement of the serum levels of NT-pro Brain Natriuretic Peptide (BNP), soluble ST2, Galectin 3, and Growth Differentiation Factor-15 (GDF-15) were performed before chemotherapy and six months after the last session. ACIC was defined based on the echocardiographic criteria. Paired sample t-test was used to compare the biomarker levels. In addition, Receiver Operating Characteristic (ROC) curve was used to assess the specificity and sensitivity of the significant biomarkers in predicting the changes in Left Ventricular Ejection Fraction (LVEF).

This study was conducted on 30 patients, 16 ones of whom had developed ACIC. The results revealed a significant increase in the serum levels of soluble ST2 (134.71 ± 60.46 vs. 137.49 ± 61.38, P = 0.011) and galectin 3 (6.82 ± 3.18 vs. 7.19 ± 3.29 ng/mL, P < 0.001) among the patients who had developed ACIC. ROC curve analysis showed that a soluble ST2 level ≥ 46.63 ng/ml could predict the occurrence of ACIC with 62.5% sensitivity and 100% specificity (AUC = 0.835, P < 0.001, NPV = 70%, PPV = 100%).

This was the first study, which simultaneously evaluated multiple biomarkers for the detection of ACIC. Among these biomarkers, only soluble ST2 demonstrated a promising ability for the detection of ACIC.

In patients with Non-Ischemic Cardiomyopathy (NICM), Cardiac Resynchronization Therapy (CRT) has been shown to improve Left Ventricular Ejection Fraction (LVEF) and NYHA functional class. However, in some patients who received CRT, the results were not satisfying.

This study aimed to evaluate echocardiographic features as a predictor of positive response to CRT in patients with NICM.

This case series study was conducted on 11 consecutive patients with NICM who were eligible for CRT at Imam Khomeini Hospital Complex. The patients’ basic demographic and echocardiographic data including Septal Flash (SF), Sphericity Index (SI), and Global Longitudinal Strain (GLS) were recorded and followed for six months. Data analysis was done using the SPSS software, and paired t-test was used for comparison of the study variables.

The results revealed an improvement in the median NYHA functional class from 3 (interquartile range: 2 - 4) to 1 (interquartile range: 1 - 2) (P < 0.001) at the follow-up. Assessment of LVEF through the Simpson method also showed a significant improvement from 28.25% to 39.31% (P < 0.001). Moreover, GLS improved and SI and SF decreased post CRT implantation.

The results demonstrated that a GLS of less than -10.48 before device implantation, but not SI or SF, might be a predictor of a positive response to CRT in patients with NICM. In these patients, higher GLS at baseline might add data to the existing criteria for selecting suitable patients for CRT implantation.

The structure of the hemiazygos vein is often various in different individuals. There is a normal variation that connects the ascending hemiazygos vein to the left innominate vein, parallel with the subclavian and internal jugular veins.

A 33-year-old man who was a known case of End Stage Renal Disease (ESRD) was admitted to the emergency department due to Double Lumen (DL) dysfunction. The emergency physician inserted DL in his left jugular vein on the ultrasound guide. The result of angiography showed that DL was placed in his left hemiazygos vein.

This condition should be considered as part of the anatomical variation of the left hemiazygos vein during DL insertion by emergency physicians.

Balloon angioplasty has been successfully used to dilate vascular obstructions. However, its value in some conditions such as supravalvular pulmonary stenosis is still controversial. Although some surgical techniques have been reported to achieve acceptable short- and long-term successes, they are invasive and technically challenging and may result in higher morbidity and mortality compared to percutaneous procedures.

Successful balloon dilatation was reported for two patients with supravalvular stenosis. One of them had supravalvular pulmonary stenosis developed after pulmonary artery debanding and the second one had supravalvular pulmonary stenosis due to an obstructive congenital web at that site.

The use of balloon dilatation to treat supravalvular pulmonary stenosis is still controversial. However, experiences in two patients showed successful results.