Iranian Heart Journal
Volume:25 Issue: 2, Spring 2024

The risk of cardiovascular disease increases dramatically with aging. It is now fully understood that fibrotic remodeling is the primary cause of cardiac structural and functional changes related to the normal aging process. However, the related signaling pathways and mechanisms are not completely understood. Therefore, finding new therapeutic approaches targeting cardiac fibrotic remodeling may be necessary to develop preventive care in the geriatric population against cardiovascular diseases. In this study, we evaluated the potential role of osteopontin (OPN) as a novel mediator of age-dependent fibrotic pathways in the heart, as well as the effect of eplerenone on cardiac fibrosis reversal.
 

Fischer-344 (F-344) rats were used in 3 groups: young rats (2–3 months old), aged rats (22-24 months old) without any treatment, and aged rats treated with eplerenone (100 mg/kg/day) for 2 weeks. The mRNA expression level of OPN was evaluated using real-time PCR, and histological assessments were done to assess cardiac tissue fibrosis.
 

The expression level of OPN was significantly higher in aged rats than in young rats. Treatment with eplerenone significantly attenuated the level of OPN and cardiac fibrosis compared with untreated aged rats.
 

Targeting cardiac fibroblast function with eplerenone could decrease the expression of the OPN marker and reverse age-related cardiac fibrotic changes.

Chronic obstructive pulmonary disease (COPD) and heart failure represent 2 entities of a growing global burden that share common clinical and etiological characteristics. Timely identification of heart failure is imperative for effective management. This study aimed to investigate subclinical left ventricular (LV) dysfunction by conventional and speckle-tracking echocardiography (STE) methods in COPD patients. 

This is a prospective cohort study on 46 (54.1%) newly diagnosed patients with COPD without comorbidities (formerly diagnosed with confounders for evaluating cardiac performance: arrhythmias, diabetes, old age, hypertension, renal failure, and cardiovascular or valvular disease) (46.80±4.67 y, 30 (65.2%) males), and 39 (45.9%) age- and sex-matched healthy control smokers. COPD patients were classified based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages. 

Contrary to conventional echocardiographic parameters, STE revealed impairment of the LV basal circumferential strain (BCS) among COPD patients (-21.20%±3.89% vs -23.70±5.75; P=0.003) and gradually reduced with the severity of COPD GOLD (P=0.007), indicating LV dysfunction. Regarding global circumferential or longitudinal STE, COPD patients did not vary significantly (P=0.10, 0.57). In multiple linear regression analysis, spirometry parameters (FEV1(L), FEV%, FVC(L), FVC%, and FEV1/FVC) predicted BCS (P=0.023).Right bundle branch block was observed more frequently (P=0.005) and the tricuspid annular plane systolic excursion level was significantly lower (P=0.017) among the COPD group. The results were associated with the degree of COPD GOLD severity (P=0.036), indicating right ventricular dysfunction. 

COPD seems to be accompanied by impaired subclinical right ventricular and regional-level LV deformation properties that worsen in stages of COPD GOLD. 

The routine practice of early coronary angiography in patients who have suffered an out-of-hospital cardiac arrest without ST-segment elevation remains a subject of controversy. 

We searched electronic databases for randomized controlled trials that compared early or emergency coronary angiography with delayed or no coronary angiography in patients who had an out-of-hospital cardiac arrest without ST-segment elevation. A random-effects meta-analysis was performed to estimate the odds ratio (OR) with a 95% confidence interval (CI). The outcomes of interest were mortality and neurological prognosis, based on the cerebral performance categories (CPC 1–2) scale. 

Seven studies involving 1623 patients (the early group [n=816] and the delayed group [n=807]) were included in the final analysis. Compared to delayed coronary angiography, early coronary angiography was associated with similar odds of mortality (OR, 1.07; 95% CI, 0.87 to 1.31; P=0.52) and a favorable neurological prognosis (OR, 0.97; 95% CI, 0.78 to 1.19; P=0.74). 

For patients with an out-of-hospital cardiac arrest without ST-segment elevation, there was no benefit concerning mortality and neurological prognosis with early coronary angiography compared with delayed coronary angiography. 

Recent guidelines recommend the use of the predicting bleeding complications in patients undergoing stent implantation and subsequent dual antiplatelet therapy (PRECISE-DAPT) score for bleeding risk stratification and determining the appropriate duration of DAPT following primary percutaneous coronary intervention (PPCI). Our study aimed to assess the predictive value of the PRECISE-DAPT score for not only bleeding complications but also in-hospital and short-term complications, including major adverse cardiovascular events (MACEs) and no-reflow.
 

The study included 241 patients diagnosed with STEMI and eligible for PPCI. The patients were divided into 3 groups according to their PRECISE-DAPT score value: low (<17), intermediate (17–24), and high (≥25) score groups. Finally, in-hospital and short-term (180 d) follow-ups for MACEs, no-reflow, and bleeding complications were done.
 

In-hospital and short-term complications were higher among the high-score group than in the other groups (P<0.001). The high-score group had lower thrombosis in myocardial infarction (TIMI flow<III) than the other groups, which was statistically significant (P= 0.001). The PRECISE-DAPT score had good predictive power for in-hospital complications (AUC=0.64) and short-term follow-up MACEs (AUC=0.80; P=0.004 and P<0.001, respectively), demonstrating good sensitivity and specificity of the PRECISE-DAPT score for the prediction of in-hospital complications, no-reflow, bleeding complications, and follow-up MACEs.
 

The PRECISE-DAPT score had a strong and independent predictive value for in-hospital, short-term MACEs, no-reflow, and bleeding complications among STEMI patients treated with PPCI.

We used the statin-associated muscle symptom clinical index (SAMS-CI) to evaluate misconceptions among cardiologists regarding the use of high-intensity statins (HIS) in relation to intolerance, including myalgia, and to determine the occurrence of HIS-induced myalgia in patients with acute coronary syndrome (ACS).
 

The present observational cohort study, performed in a tertiary care cardiac hospital in Karachi, Pakistan, consisted of 2 phases. Phase 1 involved an online survey among practicing cardiologists to identify obstacles to HIS prescription. The second phase involved observing 418 ACS patients who underwent HIS therapy. Myalgia was assessed using the SAMS-CI and categorized as unlikely (2–6), possible (7–8), or probable (9–11) cases of myalgia.
 

In the first phase, 77.8% (35/45) of physicians favored prescribing HIS therapy. However, the commonly perceived barriers were myalgia (31%), tolerability (29%), and affordability (22%). In the second phase, 418 patients were included. Among them, 19 patients (4.54%) experienced muscle symptoms based on the SAMS-CI score. Subsequently, 5 patients were classified as unlikely and continued the same dosage, while 6 patients were categorized as possible, leading to a reduction in dosage to moderate intensity. Consequently, their symptoms were resolved, and they continued the moderate-intensity regimen. Statin use was discontinued for the remaining 8 patients in the probable category for 4 weeks until the symptoms resolved, after which moderate-intensity statins were resumed.
 

Most patients tolerated a lower targeted dose of HIS without experiencing objective symptoms. Therefore, we confidently conclude that a lower targeted dose of HIS is generally well tolerated in the ACS setting and should be considered by physicians.

Premature ventricular contractions (PVCs) cause left ventricular (LV) dysfunction and may lead to premature ventricular contraction-induced cardiomyopathy (PVC-CM). Evaluation of left ventricular ejection fraction (LVEF) using 2D transthoracic echocardiography allows PVC-CM diagnosis only in the later stages. Therefore, this study aimed to investigate the association between left ventricular global longitudinal strain (LVGLS) and PVCs.
 

We assessed 53 patients admitted to Baqiyatullah Hospital with complaints of heart palpitations. These patients, who had normal LVEF and PVCs between 5000 and 10,000 based on ECG underwent LVGLS evaluation by echocardiography. Then, their LV strain values were compared with those of a corresponding control group.
 

The patient and control groups were well-matched concerning age, sex, and LVEF and had no significant differences. LVGLS was significantly lower in the patient group. ROC curve evaluation showed an acceptable diagnostic value for LVGLS regarding PVCs (AUC, 0.82; P=0.0001), with a sensitivity of 71.7% and a specificity of 84.9%.
 

Recurrent PVCs may cause LV dysfunction and CM independently of any underlying heart disease, despite a normal LVEF. Early detection of subtle ventricular dysfunction can be achieved with speckle-tracking echocardiographic methods other than conventional echocardiographic procedures. The former methods are, therefore, valuable as a critical adjunct in systolic function assessment. 

We sought to determine the frequency of postoperative pulmonary complications (PPCs) after cardiac surgeries in patients with obstructive, restrictive, and normal spirometry tests. 

This cohort study enrolled 623 patients who underwent cardiac surgeries at Rajaie Cardiovascular Medical and Research Center between 2017 and 2018 in 3 groups: obstructive, restrictive, and normal. The incidence of PPCs and their risk factors were noted. Associations between the incidence of PPCs and spirometry patterns and preoperative and intraoperative risk factors were evaluated statistically. 

Among all the PPCs evaluated in the patients, pulmonary edema/acute respiratory distress syndrome was much less common in the group with obstructive airflow limitations than in the groups with restrictive or normal lung patterns (P=0.010). The frequencies of other PPCs were not statistically significantly different between the 3 study groups (P>0.05). Among all the evaluated outcomes, the mean ventilation time was statistically different between the groups (P=0.059). Additionally, the incidence rate of pulmonary edema/acute respiratory distress was statistically significantly higher in the group with restrictive airflow limitations than in the other 2 groups. Operative mortality occurred in 15 cases (2.4%), and there were no significant differences in outcomes between the group with PPCs and those without them (P>0.05). 

Whereas there were no statistically significant differences concerning PPCs and in-hospital outcomes between the groups with obstructive, restrictive, and normal lung patterns, the 3 groups were meaningfully different regarding the estimated glomerular filtration rate, diabetes, thyroid-stimulating hormone, and history of morning fatigue. 

The increased Tpe/QT ratio is a novel, promising predictor of cardiac arrhythmias. However, no consensus exists regarding the Tpe/QT measurement. This study aimed to evaluate Tpe/QT variability among standard ECG leads.

Tpe/QT magnitudes were analyzed in 8 standard ECG leads (I, II, V1–V6) in 33 patients with a definite diagnosis of arrhythmogenic right ventricular cardiomyopathy. Tpe/QT values were calculated in several ways: averaging against 1 or more leads over all the patients and searching the maximum value among all measured leads in each patient (the true maximum), followed by averaging over all the patients.

Maximum and minimum Tpe/QT values were distributed among all the tested ECG leads. In each lead, minimum and maximum Tpe/QT values could be observed in different patients. The dispersion of Tpe/QT magnitudes calculated in various ways reached the value of 0.055.

The Tpe/QT magnitude depends on the method of determining the T-wave ending and the number of ECG leads used for its calculation. To detect the increased Tpe/QT ratio, the analysis of all available ECG leads against 1 or a few leads is preferable.

ECGs are recognized as a useful tool for improving the prognosis and management of patients with heart failure (HF). However, the relationship between ECG findings and clinically important outcomes remains unclear in patients with HF. This study aimed to describe ECG findings in patients with HF and their prognosis.

This cross-sectional study was conducted on a convenience sample of 50 hospitalized patients with decompensated HF at Shafa Hospital, Kerman University of Medical Sciences, over a 1-year period, from 2017 through 2018. All eligible patients who met the inclusion criteria of having a history of HF and being likely to be hospitalized in the cardiology unit were enrolled during the study period. Upon admission and before discharge, ECGs were performed, and the findings (QT interval, QRS duration, and PR interval) were compared. Three months after discharge, a follow-up was done concerning mortality. The Wilcoxon test and the Mann-Whitney U test were used to compare the ECG indices of the patients. SPSS, version 23, was utilized for data analysis.

More than half of the patients were diagnosed with severe HF (n=29, 58%). The length of hospital stay and history of admission were higher in patients with severe HF than in those with moderate HF (P<0.0001). Heart rate significantly decreased in patients with moderate and severe HF (P=0.001 and P=0.04, respectively). There was no significant difference between survivors and nonsurvivors regarding ECG changes.

Based on the present findings, widened QRS, prolonged PR interval, and increased heart rate were associated with poor outcomes. QRS duration, PR interval, and heart rate measured upon admission could be used to improve physicians’ clinical decisions. 

Arrhythmogenic left ventricular cardiomyopathy (ALVC) is a rare inherited cardiomyopathy characterized by the progressive fibrofatty replacement of the left ventricular (LV) myocardium in combination with arrhythmias of LV origin. Herein, we present a case of the coincidence of ALVC and left ventricular non-compaction (LVNC) in a 34-year-old woman presenting with the chief complaint of palpitation. The patient had a history of an episode of severe common cold the previous year. Her mother was diagnosed with typical hypertrophic cardiomyopathy. The patient’s preliminary echocardiography demonstrated evidence of LVNC. Subsequent evaluation using cardiac magnetic resonance (CMR) imaging showed a mildly enlarged LV without hypertrophy, along with noticeable myocardial trabeculation (Fig. 1) and a mildly decreased systolic function. Late gadolinium enhancement illustrated a fibrotic layer in the mid-anterior LV segment (Fig. 2). There was an elongated, thick stripe of subepicardial fat deposition at the base-to-mid–anteroseptal, anterior, and anterolateral LV segments (Fig. 3 & Fig. 4). Right ventricular apical trabeculation was prominent, with a regular ventricular function. The CMR tissue characterization criteria indicated the coincidence of ALVC and LVNC. Advances in noninvasive imaging modalities have significantly improved the delineation of the morphologic appearance of ventricles in different cardiomyopathies, facilitating identification and diagnosis. (Iranian Heart Journal 2024; 25(2): 92-95)

Respiratory symptoms constitute one of the most significant manifestations of the coronavirus infection. SARS-CoV-2 (COVID-19) may lead to a life-threatening condition called “multisystem inflammatory syndrome in children (MIS-C),” which can affect many organs and systems, such as cardiovascular, respiratory, gastrointestinal, and renal systems. The condition might lead to severe and irreversible damage.
Myocarditis is one of the presentations of COVID-19 in children. Cardiac tissue inflammation could enhance the automaticity of cells and develop different arrhythmias.

Superior vena cava (SVC) syndrome is a set of clinical indications and symptoms that occur due to the partial or complete blockage of blood flow through this vein. This rare complication, which leads to vein occlusion, will be more complicated if there is a mediastinal mass. Although the incidence of SVC syndrome has decreased significantly in recent years, the anesthetic management of such patients remains challenging due to life-threatening side effects, such as airway obstruction and cardiovascular collapse. We report the successful management of a 56-year-old woman with a history of hemodialysis who was a candidate for cardiac pulmonary bypass and clot removal under local and general anesthesia.