ARYA Atherosclerosis最新文献

Background: Arrhythmia is one of the important cardiac manifestations of SARS-CoV-2 disease with possible mechanisms such as direct damage to the myocardium, hypoxia, myocardial damage, cytokine storm, and electrolyte imbalances. Bradyarrhythmia is a manifestation of conduction system involvement, which is associated with an unfavorable prognosis and sometimes requires treatments such as implanting a pacemaker. Whether bradycardia in the acute phase of the COVID pandemic is a transient complication of the virus or whether it will be permanent can affect the treatment approach.Is the effect of SARS-CoV-2 on the conduction system of the heart temporary or permanent, and in the one-year follow-up, how many patients will need a pacemaker?

Methods: The study population was among patients with symptomatic bradyar-rhythmias who were referred to Chamran Heart Center, Isfahan, Iran, from the outbreak of SARS-CoV-2 (February 2020) until February 2022 and were diagnosed with COVID-19 based on the polymerase chain reaction (PCR) test. They underwent permanent pacemaker implantation and were monitored for 1 month and 12 months after device implantation.

Results: The most common comorbid disease was hypertension. Systolic blood pressure and respiratory rate in hospitalized patients decreased significantly during discharge. Also, oxygen saturation and heart rate increased significantly during discharge (P < 0.001). In this study, high-degree atrioventricular block remained permanent in most patients and was not transient.

Conclusion: Based on the experiences gained from this study, the implantation of a permanent pacemaker for the treatment of bradyarrhythmia should be done based on the existing guidelines, regardless of the status of COVID-19.

Background: An acute ST-elevation myocardial infarction (STEMI) is a medical event characterized by transmural myocardial ischemia that leads to myocardial injury or necrosis. This study was undertaken to develop, evaluate, and compare models for assessing the risk of hospital mortality in patients with acute myocardial infarction.

Methods: The study made use of data from the Yazd Cardiovascular Diseases Registry (YCDR), which is a cohort study of inpatient records of ischemic heart disease in Yazd province, Iran. A total of 1,861 patients who had experienced a STEMI were included in the analysis. Decision tree analysis was conducted using R software with the rpart package. Additionally, to analyze the data and adjust for any confounding variables, logistic regression was performed using the glm2 package. To compare the effectiveness of the two models, accuracy measures were used, and the Receiver Operating Characteristic (ROC) curve was applied.

Results: In this study, three clinical, laboratory, and clinical-laboratory models were created. In a clinical-laboratory model, variables such as blood sugar (BS), triglycerides, HDL cholesterol, peak myocardial band (MBpick), CVA history, and low ejection fraction (EF) were found to increase the risk of in-hospital mortality in patients with ST-elevation myocardial infarction (STEMI). Conversely, higher levels of hemoglobin, low HDL-C, and previous myocardial infarction (MI) were associated with a protective effect against the risk of in-hospital mortality from acute myocardial infarction.The performance of the models in terms of Receiver Operating Characteristic (ROC) curve was 86.5%, 79.5%, and 90.2% for logistic regression model in three different models: clinical, laboratory, and combined clinical-laboratory. The accuracy of these models was calculated to be 88.3%, 81.3%, and 93%, respectively. Important variables influencing the prediction of in-hospital mortality in STEMI patients included Killip class, triglycerides, blood sugar, creatinine levels, the need for treatment due to ventricular fibrillation or ventricular tachycardia (VF/VT), age, and hemoglobin (HB). In the ROC curve analysis of the decision tree algorithm across the clinical, laboratory, and combined clinical-laboratory models, the performance levels were 74.6%, 69.8%, and 81.7%, respectively. The accuracy of the decision tree was 93.0%, 92.5%, and 95.8%.

Conclusion: The findings of this study indicated that the decision tree algorithm had higher accuracy across all three models: clinical, laboratory, and combined clinical-laboratory compared to logistic regression. However, logistic regression showed higher sensitivity and better ROC curve performance than the decision tree algorithm.

Atherosclerosis, characterized by lipid accumulation in arterial walls, is a leading cause of cardiovascular morbidity and mortality, with increased prevalence among individuals with diabetes mellitus. Diabetes is a chronic condition marked by persistently high blood glucose levels, a condition that can potentially result in long-term complications, including heart, blood vessel, eye, kidney, and nerve damage. Diabetes, marked by chronic hyperglycemia, contributes to atherogenesis through mechanisms including endothelial dysfunction, oxidative stress, formation of advanced glycation end-products (AGEs), and chronic inflammation. This study provides a synopsis of the predominant characteristics of diabetes that may potentially impact the atherogenic process, including oxidative stress, altered protein kinase signaling, and the role of select microRNAs and epigenetic modifications. This review comprehensively examines literature from 1969 to 2025, focusing on the molecular and cellular pathways linking diabetes to atherosclerosis. Effective glycemic control and management of associated risk factors remain pivotal in mitigating atherosclerotic progression in diabetic patients. Understanding these interconnected mechanisms is essential for developing targeted therapies to reduce cardiovascular complications associated with diabetes.

Background: Cardiac rehabilitation (CR) is a critical intervention for reducing complications after cardiovascular procedures such as percutaneous coronary intervention (PCI). One of the key outcomes used to evaluate the effectiveness of CR programs is improvement in patients' work ability. This study aimed to assess the impact of a structured CR program on work ability in patients undergoing PCI.

Methods: A retrospective study was conducted, comparing 36 patients who participated in a structured CR program following PCI with 36 patients who did not receive rehabilitation. The CR program included educational and exercise components, delivered over four weeks with three sessions per week. Work ability was evaluated three months post-intervention using a standardized questionnaire. Statistical analyses, including independent t-tests and correlation assessments, were performed to examine the relationship between CR participation and work ability.

Results: The two groups were comparable in terms of age, gender, and underlying medical conditions (p > 0.05). Notably, 80% of patients in the CR group demonstrated good to excellent work ability, compared with only 25% in the control group (p < 0.001). The mean work ability score was significantly higher in the CR group than in the control group (mean difference = 7.55, p < 0.001).

Conclusion: Participation in a cardiac rehabilitation program significantly improves work ability in patients following PCI. These findings highlight the importance of integrating CR into post-PCI care. Future research should focus on randomized clinical trials incorporating diverse rehabilitation protocols and extended follow-up periods to further validate these results.

Background: This study aims to investigate the association between Coronary Artery Calcium (CAC) score and epicardial fat thickness (EFT) and pericardial fat thickness as indicators of inflammation in patients with chronic kidney disease (CKD).

Methods: This cross-sectional study measured patients' CAC scores using dual-source cardiac CT, quantified with Agatston's score and dedicated Ca-Scoring software. Epicardial and pericardial fat thicknesses were assessed via echocardiography.

Results: Thirty-one CKD patients participated in the study, with an average age of 54.45 ± 15.12 years. Of these, 22 were male (70.97%) and 9 were female (29.03%). Fifteen CKD patients (48.39%) had moderate to severe CAC scores. Patients with CKD exhibiting severe coronary calcification were found to be older (P = 0.003). A significant positive correlation was observed between epicardial fat thickness (r = 0.58, P < 0.001) and pericardial fat thickness (r = 0.56, P = 0.001) with CAC score. Multivariable analysis revealed that for each one-unit increase in EFT, the odds of having a moderate to severe CAC score were 2.88 times greater than those of a normal score (OR = 2.88, 95% CI = 1.04-7.96, P = 0.041). Similarly, a one-unit increase in pericardial fat thickness was associated with 1.51 times higher odds of a moderate to severe CAC score compared to a normal score (OR = 1.51, 95% CI = 0.93-2.46, P = 0.093).

Conclusion: The insights gained from this study advocate for a holistic approach to assessing cardiac function in patients with coronary calcification. By integrating echocardiographic analysis with traditional risk factor assessment, healthcare providers can gain a more comprehensive understanding of cardiovascular health, ultimately leading to better-targeted therapies to improve CKD patient outcomes.

Background: The CYP2D6 gene locus is complex and highly polymorphic. Given the clinical importance of the CYP2D6 enzyme in liver xenobiotic metabolism, genotyping its significant alleles among different ethnic groups is essential for evaluating the efficacy of certain drugs. In this study, we assessed the frequency of the CYP2D6*4, *9, *10, and *41 alleles in a healthy population from northwestern Iran.

Methods: Fifty unrelated healthy individuals from West Azerbaijan Province, Iran, were studied using PCR-RFLP and ARMS-PCR techniques.

Results: CYP2D6*9 (rs5030656) allele was not detected. The frequency (%) of CYP2D6*4 (rs3892097), CYP2D6*10 (rs1065852) and CYP2D6*41 (rs28371725) alleles were 10%, 13% and 8%, respectively.

Conclusion: Our findings indicate that the frequencies of "non-functional" and "reduced function" alleles are relatively high in this population. Determining Cytochrome P450 2D6 allele variations can contribute to risk assessment and patient management regarding adverse or poor drug responses, ultimately aiding in the prevention of increased mortality risks among different populations.

Background: Rivaroxaban, a direct Factor Xa inhibitor, primarily acts by disrupting the coagulation cascade. However, it may also influence oxidative stress. This effect likely stems from its ability to reduce thrombin-mediated reactive oxygen species (ROS) production and mitigate inflammation. The major aim of the present investigation was to assess the effects of Rivaroxaban on oxidative stress and antioxidant capacity in patients with heart failure.

Methods: This study included 39 patients (17 males and 22 females, aged 30-95 years) with Stage B heart failure (HF) who had never previously received Rivaroxaban. Patients were enrolled from Chamran Cardiovascular Hospital in Isfahan after providing written informed consent, approved by the Falavarjan University Ethical Committee (IR.IAU.FALA.REC.1398.029). All patients had structural cardiac abnormalities, including reduced left ventricular ejection fraction (LVEF < 40%) or diastolic dysfunction, but no clinical symptoms of HF. Rivaroxaban (20 mg/day) was administered orally to all patients for two months using a pre-post design. Blood samples were collected before and after treatment to assess oxidative stress and antioxidant biomarkers, including total antioxidant capacity (TAC), malondialdehyde (MDA), homocysteine (Hcy), and the enzymatic activities of paraoxonase-1 (PON1) and arylesterase. TAC, MDA, and enzyme activities were measured spectrophotometrically, while homocysteine levels were determined using ELISA.

Results: The results showed a significant reduction in MDA levels (P < 0.001), indicating reduced oxidative stress after Rivaroxaban treatment. However, no statistically significant changes were observed in other biomarkers, including homocysteine, arylesterase, paraoxonase, and TAC (P > 0.05).

Conclusion: In conclusion, Rivaroxaban appears to effectively reduce oxidative stress, as evidenced by decreased MDA levels.

Radial arteriovenous fistula (AVF) following radial intervention is exceedingly scarce. Here, we report a case of a 73-year-old man who was admitted with acute myocardial ischaemic syndrome and underwent transradial angioplasty of the proximal left anterior descending and circumflex artery. Fourteen months later, he presented with progressive swelling, dilated superficial veins, a palpable thrill, continuous bruit, and tingling at the local site. Doppler ultrasonography (DUS) diagnosed radial AVF with multiple fistulous communications draining into the cephalic vein, confirmed by contrast-enhanced computed tomography (CECT). Local compression using a prolonged compressive bandage (>12 hours) and a DUS probe was attempted but remained ineffectual. A 2.8 × 26 mm Graftmaster stent graft (Abbott Vascular, USA) was deployed into the radial artery across the fistula neck via a transbrachial approach, slowly expanded over 60 seconds at 12 atm pressure, and post-dilated with a 3 × 15 mm noncompliant balloon at 15 atm pressure. A post-procedure angiogram displayed complete closure of the fistula with restoration of palmar arch perfusion. This is the first reported case of successful exclusion of RAVF through transbrachial approach using a ever covered stent, and only the second case overall of percutaneous exclusion using a stent graft.

Ventricular septal defect (VSD) is a common congenital heart defect. In large VSDs with significant left-to-right shunting, percutaneous closure can be an effective alternative to surgical repair. In some cases, percutaneous closure of septal defects is a successful treatment. Our main objective in this case report is to discuss the transcatheter closure of ventricular septal defects in a low-birth-weight infant. We are presenting the case of a 9-month-old male infant who is experiencing failure to thrive (FTT) alongside a significant ventricular septal defect (VSD). The patient successfully underwent percutaneous closure of the VSD using an antegrade approach with a symmetric device. Follow-up evaluations after the procedure confirmed that the closure was effective, the device was in the correct position, and pulmonary hypertension had resolved. As far as we know, this case represents one of the youngest and lowest-weight infants reported in Iran for successful percutaneous VSD closure instead of open surgery.

Background: The use of contrast media in angiography has risen alongside the increasing incidence of cardiovascular diseases. Contrast agents cause acute kidney injury due to increased oxidative stress. Antioxidants such as crocin may help prevent contrast-induced acute kidney injury (CI-AKI).

Methods: A randomized controlled clinical trial involved 60 patients over 18 years old undergoing Percutaneous Coronary Intervention (PCI). Standard hydration therapy was administered to the patients in both groups. The intervention group received 30 mg crocin three consecutive times. Oxidative stress levels and antioxidant system activity were measured, including malondialdehyde (MDA), reactive oxygen species (ROS), glutathione peroxidase (GPx), catalase (CAT), and superoxide dismutase (SOD). The prevalence of CI-AKI was also examined by measuring serum creatinine (SCr), blood urea nitrogen (BUN), and the estimated glomerular filtration rate (eGFR).

Results: The analysis found no statistically significant differences between the groups for the GPx, CAT, MDA, ROS, SOD, SCr, BUN, and eGFR indices (P > 0.05). The study found a significant decrease in the average SCr and BUN in the intervention group post-PCI (P < 0.05). There were two incidences of CIN in the control group and none in the intervention group; however, the two groups did not differ significantly (P = 0.492). Conclusion: Although oral administration of 30 mg of crocin did not lead to significant changes in oxidant biomarkers, the capacity of the antioxidant defense system tended to increase. Moreover, SCr, BUN, and the incidence of CI-AKI were lower in the intervention group.