Iranian Heart Journal
Volume:25 Issue: 3, Summer 2024

This single-blind, parallel-design randomized clinical trial aimed to assess the impact of mild and moderate hypothermia on brain oxygenation changes in pediatric patients with noncyanotic cardiac disorders undergoing cardiac surgery.
In this trial, 68 pediatric patients undergoing noncyanotic cardiac surgery at Rajaie Cardiovascular, Medical, and Research Center were included. Participants were randomly allocated to mild hypothermia (32 ˚C) and moderate hypothermia (28 ˚C) groups. Outcomes were measured and compared between the groups at baseline, during, and after cardiopulmonary bypass.
The mean bypass and cross-clamp times were 147.72±68.30 minutes and 92.03±54.91 minutes, respectively. There were no significant differences between the groups in terms of bypass time, ICU length of stay, and ventilation time. The frequency of neurological complications was also similar between the groups (P>0.05).
The results of this trial demonstrated no significant differences in perioperative and postoperative outcomes, including ICU length of stay, mechanical ventilation time, and neurological outcomes, between the groups managed with mild or moderate hypothermia during cardiopulmonary bypass in noncyanotic pediatric patients undergoing surgery for the correction of congenital heart anomalies. (Iranian Heart Journal 2024; 25(3): 6-15)

This study aims to compare atherosclerosis risk factors between patients with coronary artery ectasia (CAE) and those with triple-vessel coronary artery disease (3VD). CAE is characterized by diffuse dilation in epicardial coronary arteries and is associated with risk factors for atherosclerosis.
 

This retrospective cross-sectional study examined patients who underwent coronary angiography in our center between 2012 and 2016 and were diagnosed with CAE. Patients with 3VD served as the control group. Eligible patients’ medical records were reviewed, and relevant data, including demographic and clinical characteristics, atherosclerotic risk factors, and laboratory and inflammatory markers, were collected and documented.
 

The study population comprised 157 patients with CAE and 156 patients with 3VD. There was a significantly higher proportion of male patients in the 3VD group (P<0.001). Smoking (P<0.001), a history of acute coronary syndromes (P<0.001), and dyslipidemia (P<0.001) were significantly more prevalent in the 3VD group. The mean neutrophil-to-lymphocyte ratio was significantly higher in the 3VD group than in the CAE group (3.6±3.0 vs 2.3±1.9; P<0.001).

The findings of this study suggest that atherosclerosis risk factors and inflammatory markers may play a role in the development of CAE. (Iranian Heart Journal 2024; 25(3): 16-20)

Preoperative anemia is associated with increased morbidity and mortality rates among patients undergoing major surgery. This study aimed to investigate the prevalence of preoperative iron deficiency in patients scheduled for cardiac surgery at a cardiovascular medical and research center in Iran.
 
This prospective cross-sectional study was conducted at the Rajaei Cardiovascular Medical and Research Center in Iran between October 2018 and September 2019. A total of 165 patients aged 18 years or older who were scheduled for elective cardiac surgery were included. The prevalence of iron deficiency anemia was determined using several iron parameters: serum iron levels, serum ferritin levels, total iron-binding capacity, transferrin saturation, complete blood count, serum blood urea nitrogen levels, serum creatinine levels, and C-reactive protein. Data were collected from patients' medical records.
 
A total of 165 patients were included in the study, with a male-to-female ratio of 1.3:1. The mean age was 60.6±9.9 years. The prevalence of anemia was 52.1%, higher in women than in men (55.8% vs 44.2%). Iron deficiency anemia was the most common type (75.6%), followed by anemia of chronic disease (15.1%) and other types (9.3%). Iron deficiency anemia was more prevalent in women (60%) than in men (24.7%), whereas anemia of chronic disease was more frequent in men (11.8%) than in women (2.9%).
 
Our study revealed a high prevalence of anemia among cardiac surgery patients, particularly iron deficiency anemia. These findings emphasize the importance of preoperative anemia screening and management in cardiac surgery settings, which has significant implications for patient care. (Iranian Heart Journal 2024; 25(3): 21-26)

Circadian fluctuations in acute myocardial infarction (AMI) onset have been noted, peaking between 06:00 and 12:00 hours. While myocardial ischemia can occur anytime, circadian variation may influence acute ischemic heart disease onset. This study aimed to evaluate the impact of circadian rhythm on clinical and angiographic characteristics of ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI).
 
In this prospective study, we enrolled 433 consecutive patients diagnosed with acute STEMI who underwent PPCI. Patients were assigned to 2 groups based on the time of AMI onset: the first group included patients with morning onset of AMI (between 06:00 and 12:00 hours), and the second group included those with AMI onset at other times.
 
Patients with morning presentation had higher initial and post-flow achievement thrombus scores, lower initial TIMI flow scores (P=0.035, P=0.016, and P=0.004, respectively), and more frequent bailout glycoprotein IIb/IIIa use.
 
Patients experiencing STEMI symptom onset in the morning had a higher thrombus burden than those with symptom onset at other times. (Iranian Heart Journal 2024; 25(3): 27-34)

Previous studies have reported a higher incidence of ischemic events in African Americans (AAs) than in non-AAs following percutaneous coronary intervention (PCI). Moreover, AAs are known to experience worse COVID-19-related outcomes. However, the impact of the COVID-19 pandemic on the first occurrence of ischemic events among race and gender-stratified post-PCI patients remains unknown.
 
In this retrospective study, we compared patient demographics and the first adverse events post-PCI before (2018-2020) and during (2020-2021) the COVID-19 pandemic. Continuous variables were expressed as mean ± standard deviation and compared using the 2-sample t-test, while categorical variables were compared using the χ2 test. Univariate and multivariate logistic regression analyses were performed using Stata17 software.
 
The study population consisted of 1022 patients, with 511 patients before and 511 after the onset of the pandemic. The first occurrence of cardiovascular death, ischemic events, and myocardial infarction was higher during the COVID-19 pandemic than during the pre-pandemic period (P<0.05). During the pandemic, AAs experienced a significantly higher incidence of first ischemic events than non-AAs (P=0.03). Notably, AA men had significantly higher rates of ischemic events than AA women, non-AA men, and non-AA women during the COVID-19 pandemic (P<0.05).
 
These findings further emphasize the importance of addressing the increased thrombogenic risk among AAs, who exhibit higher ischemic risk than their non-AA counterparts. (Iranian Heart Journal 2024; 25(3): 35-50)

This study aimed to investigate the frequency and types of complications observed in computed tomography angiography (CTA) following thoracic endovascular aortic repair (TEVAR) and endovascular aneurysm repair (EVAR).
 
This cross-sectional study included 96 patients who underwent TEVAR and EVAR for thoracic and abdominal aortic aneurysm treatment at the Rajaie Cardiovascular Medical and Research Center. Two experienced radiologists evaluated CTA results and recorded the types of complications following TEVAR and EVAR.
 
The mean patient age was 17.82±56.56 years, with 86.46% male patients. Post-intervention complications occurred in 47.8% of cases, with the most common complications being endoleak (33.3%), occlusion (11.5%), pelvic ischemia (9.4%), hemothorax (3.1%), and hemopericardium (1%), respectively. Although complications were more frequent among women and elderly patients, no significant correlation was found between age, sex, and complication frequency.
 
Over one-third of our patients experienced complications following TEVAR and EVAR. Endoleak, occlusion, and ischemia were the most common complications. To ensure early detection of potential complications, performing at least 1 CTA within a month after the interventions is recommended. (Iranian Heart Journal 2024; 25(3): 51-57)

Little is known about the impact of sex-related differences on clinical presentation, treatment adherence, and outcomes in patients with acute coronary syndrome (ACS) in developing countries, such as Iran.
 
This observational cross-sectional study used the Coronary Angiography and Angioplasty Registry (CAAR) data. We included all adults who underwent coronary angiography or angioplasty within 1 year, analyzing data from 1548 cases.
 
A total of 1548 patients were included in the analysis. Women were older than men when experiencing ACS and had a higher prevalence of atypical symptoms. Women were also more likely to have comorbid conditions such as hypertension, diabetes, obesity, dyslipidemia, and depression. Still, men were more likely to have a history of smoking and previous myocardial infarction (MI). Investigation of differences regarding invasive therapeutic procedures, culprit arteries, and numbers of diseased vessels showed no significant differences between women and men in the ST-elevation myocardial infarction (STEMI) and non-STEMI groups. However, there was a significant difference between women and men in these factors in patients with unstable angina and stable angina. Men in these groups were more likely to have the involvement of 2 or 3 coronary arteries and were more likely to be recommended for percutaneous coronary intervention and coronary artery bypass graft surgery. Nonetheless, there was no significant difference in acceptance rates of recommended treatment in these groups between men and women.
 
The study findings provide insight into the differences between male and female ACS patients in the Iranian population, highlighting the need for sex-specific approaches in treatment. (Iranian Heart Journal 2024; 25(3): 58-71)

Cardiomyopathies related to amyloidosis are recognized as a type of infiltrative disorder; however, the degree of infiltration does not align with the severity of hemodynamic impairment. We present a case involving an elderly woman without any known comorbidities or substance use history who presented with congestive heart failure at our hospital. She had been treated with long-term diuretic therapy for heart failure by various physicians. A strong suspicion of primary cardiomyopathy was maintained given the absence of prior comorbidity after a comprehensive medical history review and examination. Two-dimensional echocardiography, protein electrophoresis, and bone marrow examination collectively revealed cardiac amyloidosis secondary to plasma cell dyscrasia. Standard heart failure treatment was initiated alongside chemotherapy; nonetheless, the patient experienced sudden cardiac death at home during follow-up. This case underscores the importance of early diagnosis and treatment of heart failure for patients with cardiac amyloidosis, and it also brings attention to the fact that cardiac amyloidosis can be the first sign of multiple myeloma. (Iranian Heart Journal 2024; 25(3): 72-79)

Permanent junctional reciprocating tachycardia (PJRT) is a rare form of supraventricular tachycardia that primarily affects infants and young children. PJRT is a type of reentrant tachycardia, often involving an accessory pathway called the “Kent bundle.” This accessory pathway enables electrical impulses to bypass the normal electrical conduction system, leading to a rapid and abnormal heart rhythm. Common symptoms of PJRT include palpitations, fatigue, and shortness of breath, with infants frequently experiencing feeding difficulties. PJRT management usually consists of antiarrhythmic medications, such as β-blockers or calcium channel blockers, to control the heart rate. However, in cases where medications are ineffective in suppressing the arrhythmia, known as drug-resistant PJRT, alternative treatment options must be considered. PJRT is characterized by a re-entry pathway involving the atrioventricular node and an accessory pathway, resulting in incessant and rapid heart rates. In instances where medications are unsuccessful in controlling the arrhythmia, ablation utilizing 3D mapping technology offers a promising therapeutic option. This article examines a case where an infant with drug-resistant PJRT for 1 year was successfully treated with ablation, facilitated by the use of a 3D mapping system. (Iranian Heart Journal 2024; 25(3): 80-84)

Venous thromboembolism is a prevalent global health concern that includes 2 primary clinical manifestations: deep vein thrombosis and pulmonary embolism. In patients with heart failure, disruptions in homeostasis result from diminished cardiac output and malfunctioning cardiac chambers, leading to blood stasis. Consequently, these homeostatic abnormalities accelerate the activation of the coagulation system and fibrin formation, rendering patients with heart failure more susceptible to venous thromboembolism. This case report involves a 57-year-old woman presenting with shortness of breath following moderate exertion, such as sweeping and walking 100 meters, over the past month. The symptoms were alleviated by rest, and the patient occasionally experienced orthopnea, accompanied by pain and difficulty walking in the preceding week. The examination of the left lower extremity revealed edema, tenderness, erythema, venectasia around the left femur, and positive Homan’s and Pratt’s signs. Doppler imaging disclosed complete thrombosis in the popliteal veins and the left common femoral vein, partial thrombosis in the superficial femoral veins (the great saphenous vein), and subcutaneous edema in the left femur and lower extremity. Computed tomography findings for the thoracic region indicated pulmonary embolism at the bifurcation of the pulmonary artery, extending to the right and left pulmonary artery branches in the axial view. (Iranian Heart Journal 2024; 25(3): 85-91)