Journal of Cardio -Thoracic Medicine
Volume:11 Issue: 4, Autumn 2023

Gamma-glutamyl transferase (GGT) is a liver enzyme that is involved in inflammation and oxidative stress. It has been hypothesized that elevated GGT may occur secondary to oxidative stress in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and can be used as an indicator of inflammation in these patients. The present study aimed to determine the relationship between serum GGT and arterial blood gas (ABGs) on the one hand and COPD severity in AECOPD patients on the other hand. Patients with AECOPD were evaluated for disease severity based on the global initiative for chronic obstructive lung disease (GOLD), Modified British Medical Research Council (mMRC), COPD Assessment Test (CAT), and spirometry assessment upon admission at the hospital. Moreover, the GGT level in patients was analyzed based on the severity of the disease. The data were analyzed using SPSS software (version 25.0) by proper statistical tests. The significance level was P˂0.05. The mean±SD of the CAT score in the patients was obtained at 19.6± 4.6. According to the mMRC scale, most patients were grade 2 (n=29, 52.7%) and grade 1 (n=17, 30.9%), respectively. In addition, according to GOLD criteria, most patients (n=34, 61.8%) had moderate and severe (n=16, 29.1%) disease, respectively. The median (IQR) GGT levels in patients with mMRC 0-1 were 28.7 (12.98) IU/L, and those with mMRC 2-4 were 21 (33) IU/L (P=0.770). Additionally, the median (IQR) of GGT levels in patients in GOLD A-B were obtained at 26(18) IU/L, and in patients in GOLD C-D were reported as 18 (23.80) IU/L (P=0.222). The results showed a significant positive relationship between GGT level and AECOPD severity (r=+0.277, P=0.04). Moreover, a significant negative relationship was observed between GGT level and forced vital capacity (FVC) (r=-0.268, P=0.04). According to the Pearson correlation test, There was no significant correlation between GGT level with arterial HCO3 (P=0.123), PCO2 (P=0.511), PO2 (P=0.888), FEV1 (P=0.356), and FEV1/FVC (P=0.975). In conclusion, while a significant positive relationship was found between GGT levels and AECOPD severity, the study suggests that serum GGT levels may not have clinical efficacy in differentiating between patients with varying intensities of AECOPD periods. Further research with larger sample sizes and consideration of additional factors is warranted to confirm these findings.

Cardiovascular disease (CVD) is the leading cause of mortality and one of the main challenges for health systems worldwide. In this study, we aimed to evaluate the association of socio-demographic, lifestyle, psychological and anthropometric factors and underlying diseases such as hypertension (HTN), diabetes mellitus (DM) and metabolic syndrome (MS) with CVD risk among a subpopulation of Iranian adults. In this prospective study, a total of 235 CVD patients along with 8405 healthy and non-symptomatic individuals who participated in MASHAD cohort study were enrolled. CVD diagnosis was performed by taking electrocardiogram (ECG) and medical history and performing physical examination for each participant. Health and lifestyle questionnaires, the Beck’s anxiety inventory (BAI), Beck’s depression inventory (BDI) and the James and Schofield human energy requirements equations were completed for all participants. Anthropometric measurements were also recorded for all subjects. All statistical analyses including chi-square and student independent T-test were performed using SPSS 16.0 software (SPSS Inc., Chicago, IL, USA) at a significant level of 0.05. We found that there were significant associations between CVD risk and age, body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), diabetes mellitus (DM) and family history (FH) of CVD in both genders; though, there was a significant negative correlation between physical activity level (PAL) and risk of CVD among men and women. Also hypertension (HTN), metabolic syndrome (MS), depression and anxiety were positively and higher education level was negatively associated with CVD events only in females. While, waist-to-hip ratio (WHR) was an independent predictor of CVD among males (P-value< 0.05). There are several modifiable and non-modifiable risk factors that are independently considered as CVD predictors among the MASHAD study population. It is recommended to prioritize the lifestyle modification, development of local risk calculators and gender-related stratified strategies in order to prevent and manage CVD among the Iranian population.

In recent years, mitral valve (MV) repair has become the procedure of choice for treating isolated mitral regurgitation (MR). The aim of this study was to evaluate immediate and long-term clinical and echocardiographic results of MV repair performed at a tertiary hospital in Oman. The study population consisted of patients with severe MR above 18years of age who had isolated MV repair between 2006 and 2016 at Royal Hospital, Oman. Retrospective observational study. Primary Endpoints: 1-year freedom from reoperation, recurrence of severe MR and mortality. Secondary Endpoints: Five-year echocardiographic recurrence of severe MR, ejection fraction (EF), NYHA class and mortality. The case records of 351 patients with MR who had MV surgery in Royal Hospital were reviewed. A total of 89 patients had isolated MV repair surgery with follow up 1 year. The etiology of mitral disease was degenerative in 58.42%, rheumatic in 20.22%, post endocarditis in 12.35%, congenital 5.61% and ischemic MR in 3.37%. Operative mortality was 2.24% (2/89). Pre-operative NHYA class III/IV was noted in 62.92% of patients (56/89). All the patients had an EF of > 60%.  Among the 87 patients followed up for one-year, 95.40 % (83/87) of patients were free from reoperation. Four patients (4.59%) had recurrence of severe MR needing MV replacement surgery. Of the 87 patients, 56 patients were followed in our institute for 5 years had demonstrated trivial to mild MR in 73.2% (41/56) moderate MR in 16.07% (9/56), and severe MR in 10.07% (6/56) of patients though 83.92% (47/56) patients were in NYHA class I. Majority of grade 3 (10.71%) and 4 MR (8.92%) occurred in patients with rheumatic etiology who underwent MV repair. Ejection fraction remained > 60% in 89.28% patients. There was no mortality at 5 years among the 56 patients followed-up. MV repair in a tertiary center in Oman showed favorable early and one-year results as regards mortality, freedom from reoperation and recurrence of significant MR. Those followed-up at five years, majority of patients were asymptomatic though echocardiographic recurrence of moderate and severe MR was high predominantly in patients with rheumatic etiology.

Cardiovascular diseases are a leading cause of mortality globally, with health literacy playing a crucial role in predicting mortality rates. Social media has emerged as an effective tool for disseminating information and promoting public health. This study aimed to assess social media usage among patients with ST-elevation myocardial infarction (STEMI). This prospective, observational, multicenter study was conducted between July 2021 and August 2023 in Tehran, IRAN. Patients of both genders, over 20 years of age, who experienced STEMI consecutively were included in the study. Data were obtained using questionnaires after obtaining permission. There were 221 patients, 44.3% (98/221) of patients at the Taleghani Hospital and 55.7% (123/221) at the Shahid Modarres Hospital. The mean age of patients was 57.34 ± 11.30, and 87.3% of patients were male. Totally, 94.5% (209/221) had cell phones, 71.0% (157/221) had smartphones, and 65.6% (145/221) used social networks. WhatsApp was the most commonly used social network, 91.0% (132/145). Patients with higher education had a significantly higher proportion of using email or smartphones. Also, younger patients had a higher proportion of email or smartphone usage. Most patients diagnosed with STEMI own smartphones and frequently use social networks. WhatsApp is the most commonly used social network platform. However, older individuals or those with lower literacy tend to use social networks less frequently.

Cardiogenic shock is one of the main concerns for cardiologists, especially heart failure specialists, and in the majority of cases, the underlying mechanism is an extensive acute myocardial infarction. Despite various interventional and therapeutic advancements in the management of these patients, the mortality and morbidity of these patients remain high and most noninvasive therapies are considered ineffective. Urgent revascularization and application of short-term mechanical circulatory support devices and early referral to heart transplant centers may improve outcomes. Herein we describe a 50-year-old patient presenting with cardiogenic shock, who was successfully treated by VA-ECMO and urgent heart transplant and experienced COVID-19 infection post-transplant.

Trans-catheter Aortic Valve Implantation (TAVI) is preferred in high surgical risk patients with severe aortic stenosis (AS), especially bicuspid aortic valve (BAV), over surgical aortic valve replacement (SAVR) because it is less invasive, does not require cardiopulmonary bypass (CPB), and less morbidity.TAVI has been performed using either balloon expandable SAPIEN (Edwards Lifesciences, Irvine, CA) or self-expanding Core-Valve (Medtronic, Minneapolis, MN).Patients experienced a TAVI complication and were then subsequently reconsidered for SAVR. TAVI grows with advanced time and technology. fortunately, its complications may occur that require SAVR.

Takayasu arteritis (TA) is a rare granulomatous panarthritis, characterized by stenosis or obliteration of large and medium-sized arteries, such as the aorta. The onset of symptoms tends to lead to a delay in diagnosis that can range from months to years, during which time vascular disease may initiate and progress to become symptomatic. In this context, TA may present with various uncommon cardiovascular complications such as dilated cardiomyopathy, valvulitis, and myocarditis. Herein, we report on a 29-year-old female who initially presented with active myocarditis and was later incidentally diagnosed with TA.