International Cardiovascular Research Journal最新文献

Background: Galectin-3 is a soluble ß-galactoside-binding lectin released by activated cardiac macrophages. Galectin-3 has been proposed for diagnosis and prognosis of HF patients.

Objectives: The present study aimed to investigate the relationship between galectin-3 as a biomarker and ejection fraction and functional capacity in the patients with compensated systolic heart failure.

Patients and methods: In this study, serum levels of Galectin-3 were measured in 76 patients with compensated heart failure with New York Heart Association class I-IV and left ventricular ejection fraction < 45%. Galectin-3 was measured by an ELISA kit. Besides, echocardiography was used to evaluate left ventricular ejection fraction. Additionally, functional capacity was determined based on the patients' ability to perform a set of activities. After all, the data were analyzed used t-test, Kruskal-Wallis, one-way ANOVA, and chi-square test. P < 0.05 was considered as statistically significant.

Results: The patients' age ranged from 45 to 75 years, with the mean age of 63.85 ± 9 years. In addition 57.9% of the patients were male. The results revealed no significant correlation between Galectin-3 and age, body mass index, and estimated glomerular filtration rate. Also, no significant correlation was observed between Galectin-3 levels and left ventricular ejection fraction (P = 0.166) and functional capacity (P = 0.420). Yet, a significant difference was found between males and females regarding the mean of Galectin-3 (P = 0.039).

Conclusions: The study results suggested that Galectin-3 could not be used as a marker of disease progression in the patients under treatment, which could probably be the result of medication use in these patients.

Background: Fungal endocarditis, the most severe form of infective endocarditis, is characterized by excessive mortality and morbidity.

Objectives: The present study aimed to analyze the characteristics of fungal endocarditis to improve the management of these patients.

Materials and methods: In this cross-sectional study, vegetations on the mitral or tricuspid valves and embolic material surgically removed from the patients with suspected infective endocarditis between December 2009 and November 2011 were examined for fungal infection by direct smear and culture, and the susceptibility patterns of the isolated species were determined. Then, blood samples were cultured on BACTEC media and real-time PCR was done with blood and tissue samples.

Results: Of the 31 patients with suspected infective endocarditis who did not respond to antibacterial therapy, 11 had confirmed fungal endocarditis. The most frequent predisposing risk factors were previous surgery and drug abuse. The organisms isolated were Aspergillus spp. and Candida albicans. Resistance to amphotericin B and itraconazole was observed in Aspergillus species, and to fluconazole in Candida albicans. Positive PCR results were obtained in blood and tissue samples.

Conclusions: Fungal endocarditis should be considered in the patients not responsive to antimicrobials. Moreover, management of these patients can be improved with molecular diagnostic methods and by determining the susceptibility patterns of the etiologic agents.

Background: The prevalence of cardiovascular diseases is rising in industrial and developing countries. Coronary Artery Disease (CAD) is the most common cardiovascular disease. Thus, understanding the signs and risk factors of CAD from the patients' perspective and their ways of dealing with this disease is of vital importance.

Objectives: This qualitative study aimed to explore the Iranian patients' viewpoints about CAD and how they dealt with it in their first encounter.

Patients and methods: This study was a qualitative content analysis conducted on 18 patients with CAD. The data were collected through semi-structured interviews. Initially, purposeful sampling was performed followed by maximum variety. Sampling continued until data saturation. Then, all the interviews were recorded and transcribed verbatim. After all, the data were analyzed by constant comparative analysis using MAXQUDA2010 software.

Results: The themes manifested in this study included "invasion of disease" with subthemes of "warning signs" and "risk factors" and "confrontation strategies" with subthemes of "seeking for information", "follow-up", and "control measures".

Conclusions: The results of this study described the patients' perceptions of CAD and how they dealt with this disorder in early encountering. Based on the results, physicians and nurses should focus on empowerment of patients by facilitating this process as well as by educating them with regards to dealing with CAD.

Background: Right Ventricular (RV) dysfunction has been introduced as a predictor of mortality in acute myocardial infarction.

Objectives: This study aimed to investigate the effect of right coronary revascularization on systolic and diastolic RV dysfunction.

Patients and methods: This study was conducted on unstable angina patients who were candidate for elective Percutaneous Revascularization Intervention (PCI) on the right coronary artery. The participants were initially evaluated by transthoracic echocardiography and tissue Doppler imaging prior to PCI and the RV function parameters were assessed. Echocardiography was repeated two months after PCI and the results were compared with baseline. Paired t-test was used to compare the pre- and post-procedural measurements. Besides, Pearson's correlation was used to find out the linear association between the RV function parameters and Left Ventricular Ejection Fraction (LVEF). P value < 0.05 was considered as statistically significant.

Results: This study was conducted on 30 patients (mean age = 60.00 ± 8.44 years; 24 [80%] males). In the pre-procedural echocardiography, 15 patients (50%) had normal RV function, 14 patients (46.7%) had grade-1 RV dysfunction, and only 1 patient (3.3%) had grade-2 RV dysfunction. Following PCI, however, all the patients had normal systolic and diastolic RV functions. Comparison of echocardiographic RV function parameters showed an improvement in both systolic and diastolic functional parameters of the RV. Nonetheless, no significant correlation was observed between these parameters and Left Ventricular (LV) function.

Conclusions: A significant improvement was found in RV function, but not LV function, after right coronary PCI. Revascularization of the right coronary artery may be beneficial for the patients who suffer from RV failure due to ischemia.

Background: Cardiovascular diseases are the main cause of 40% of deaths in Iran annually. Many patients undergoing coronary artery bypass graft surgery have previous cardiovascular risk factors which could be prevented.

Objectives: The present study aimed to assess the prevalence of cardiovascular risk factors in the patients undergoing coronary artery bypass graft surgery.

Materials and methods: In this cross-sectional (descriptive - analytical) study, a data collecting form was used. A total of 246 patients were selected from six hospitals of Shiraz using random stratification. Descriptive statistics were presented through figures and tables and t-test was used to analyze the continuous variables. All the statistical analyses were performed using the SPSS statistical software (version 15.0). Besides, P < 0.05 was considered as statistically significant.

Results: Among the study patients, only 11.67% had no risk factors and 88.33% had one or more risk factors. The most common risk factors observed in the patients were hypertension, obesity and overweight, hyperlipidemia, and diabetes mellitus. The results showed a significant difference between males and females regarding the prevalence of hypertension (P = 0.001), diabetes (P = 0.028), hypercholesterolemia (P = 0.020), and cigarette smoking (P = 0.001). In addition, the patients' mean levels of cholesterol, LDL, triglyceride, and fasting blood sugar were higher than the acceptable level, while that of HDL was lower than the accepted level.

Conclusions: These patients are recommended to be trained regarding lifestyle changes. Also, prevention strategies can play an important role in reducing patient morbidity and mortality.

Background: Poor sexual function is associated with impaired Health-Related Quality of Life (HRQoL), and patients with Coronary Artery Disease (CAD) are not exceptions. It is not known, however, if symptoms of depression mediate the effect of sexual function on HRQoL among men and women with CAD.

Objectives: This study aimed to determine the mediating effect of depressive symptoms on the association between sexual function and HRQoL among men and women with CAD.

Patients and methods: This cross-sectional study was conducted on 401 men and 156 women with CAD. Sexual function, measured by the Relation and Sexuality Scale (RSS), was the independent variable. In addition, physical and mental HRQoL measured using physical and mental health summary scores of Short Form 36 (SF-36) were dependent variables. Besides, the severity of depressive symptoms measured by the Hospital Anxiety and Depression Scale (HADS) was conceptualized as the mediator. Age, income, education, and medical comorbidities (Ifudu index) were control variables, and gender was the moderator. Multi-group path analysis was conducted using AMOS20.0 for data analysis.

Results: When the effects of age, education, income, and comorbidities were controlled, sexual function was correlated with poor mental HRQoL in both genders. However, the association between sexual function and poor physical HRQoL could be found only among men but not women. Evidence also supported partial mediation of depressive symptoms on the effect of sexual function on mental HRQoL of both men and women. Nonetheless, the results suggested partial mediation of depressive symptoms on the effect of sexual function on physical HRQoL only among men but not women.

Conclusions: Symptoms of depression may not have a similar role in explaining the effect of sexual function on physical HRQoL of men and women with CAD. Our findings suggest that only among men, depressive symptoms might be the mechanism by which sexual function affects the CAD patients' physical HRQoL.

Takayasu's arteritis is an inflammatory disease with a variety of manifestations, such as cardiac involvement. We describe a 52-year-old woman with clinical and echocardiographic manifestations mimicking infectious endocarditis, such as periaortic and mital-aortic intervalvular fibrosa abscess with extension to the anterior mitral leaflet. However, no infective tissue was discovered intraoperatively. Pathological evaluation demonstrated Takayasu's arteritis. To the best of our knowledge, Takayasu's arteritis can involve mitral-aortic intervalvular fibrosa and imitate infectious endocarditis.

Background: Atrial Fibrillation (AF) is a common complication after open heart surgery and is frequently associated with increased hospital stay, complications, and mortality rates. The effect of β-blockers on prevention of supraventricular arrhythmias has been confirmed in several prospective randomized studies.

Objectives: This clinical trial aimed to compare the preventive effects of carvedilol and metoprolol on occurrence of AF after CABG surgery.

Patients and methods: This prospective, double-blind, randomized clinical trial was conducted on 150 patients (55 females, 95 males; mean age: 59 ± 10 years) who underwent CABG surgery. The patients with no contraindication for β-blocker use were randomly divided into two groups of carvedilol and metoprolol Tartarate (n = 75). Treatment with β-blocker was started on the first postoperative day (metoprolol, 25 mg BD; carvedilol, 6.25 mg, BD) and the dosage was regulated according to the patients' hemodynamic response. All the patients were monitored 5 days after the surgery and incidence of AF and other complications was recorded in both groups.

Results: AF was detected in 18 patients in the carvedilol group and 21 patients in the metoprolol group (P = 0.577). The results of Fisher Exact test showed no significant relationship between the type of the drug and the occurrence of AF (P < 0.05). Nevertheless, the prevalence of AF was higher in the renal failure group. AF was mostly recorded on the second and third days after the surgery. The results showed an association between old age and higher occurrence of AF. AF was recorded in 11 patients (14%) in the metoprolol group and 9 ones (12%) in the carvedilol group, with Left Ventricle Ejection Fraction (LVEF) being between 35% and 45% (P = 0.587). However, no significant difference was found between the two groups in this regard.

Conclusions: In the patients with sufficient ejection fraction, no difference was observed in using carvedilol or metoprolol in prevention of post-CABG AF. Yet, given the anti-oxidant and anti- inflammatory effects of carvedilol, it might be more beneficial in comparison to metoprolol, particularly in the patients with lower ejection fractions or heart failure.

Background: Chronic Heart Failure (CHF) is highly prevalent and is associated with high morbidity and mortality rates. It has been well established that excessive intake of sodium chloride (salt) induced hypertension in some populations. Although salt seems to induce cardiovascular diseases through elevation of blood pressure, it has also been indicated that salt can induce cardiovascular diseases independently from blood pressure elevation.

Objectives: The present study aimed to evaluate the association between salt consumption and inflammation in CHF patients.

Patients and methods: This study was conducted on 86 patients between 18 and 65 years old who were diagnosed with New York Heart Association (NYHA) functional class I and II heart failure. Salt intake was calculated by using 24 hour urine sodium excretion. Besides, the association between inflammation and daily salt intake was evaluated regarding C - reactive protein (CPR), High sensitive CRP (HsCPR), Erythrocyte Sedimentation Rate (ESR), and ferritin and fibrinogen levels using Pearson correlation analysis.

Results: Our results showed a statistically significant difference between the low (n = 41) and high (n = 45) salt intake groups in terms of serum HsCRP levels (5.21 ± 2.62 vs. 6.36 ± 2.64) (P < 0.048). Additionally, a significant correlation was observed between the amount of salt consumption and HsCRP levels. In this study, daily salt consumption of the enrolled patients was 8.53 gram/day. The medications and even the blood pressures were similar in the two groups, but daily pill count, prevalence of hypertension, and coronary heart disease were higher in the high salt intake group; however, the differences were not statistically significant (P = 0.065). Also, no significant difference was observed between the groups concerning the inflammation markers, such as CRP, ESR, ferritin, and fibrinogen.

Conclusions: Neurohumoral and inflammatory factors are thought to contribute to high mortality and morbidity rates in CHF. Yet, inflammatory markers may early diagnose CHF and predict the prognosis. Excessive salt intake also worsens the inflammation as well as volume control.

Background: No clear evidence is available in the literature regarding the acute effect of different styles of music on cardiac autonomic control.

Objectives: The present study aimed to evaluate the acute effects of classical baroque and heavy metal musical auditory stimulation on Heart Rate Variability (HRV) in healthy men.

Patients and methods: In this study, HRV was analyzed regarding time (SDNN, RMSSD, NN50, and pNN50) and frequency domain (LF, HF, and LF / HF) in 12 healthy men. HRV was recorded at seated rest for 10 minutes. Subsequently, the participants were exposed to classical baroque or heavy metal music for five minutes through an earphone at seated rest. After exposure to the first song, they remained at rest for five minutes and they were again exposed to classical baroque or heavy metal music. The music sequence was random for each individual. Standard statistical methods were used for calculation of means and standard deviations. Besides, ANOVA and Friedman test were used for parametric and non-parametric distributions, respectively.

Results: While listening to heavy metal music, SDNN was reduced compared to the baseline (P = 0.023). In addition, the LF index (ms(2) and nu) was reduced during exposure to both heavy metal and classical baroque musical auditory stimulation compared to the control condition (P = 0.010 and P = 0.048, respectively). However, the HF index (ms(2)) was reduced only during auditory stimulation with music heavy metal (P = 0.01). The LF/HF ratio on the other hand decreased during auditory stimulation with classical baroque music (P = 0.019).

Conclusions: Acute auditory stimulation with the selected heavy metal musical auditory stimulation decreased the sympathetic and parasympathetic modulation on the heart, while exposure to a selected classical baroque music reduced sympathetic regulation on the heart.