ARYA Atherosclerosis最新文献

Background: Pulmonary hypertension (PH), defined as mean pulmonary arterial pressure >20 mmHg, has diverse etiologies and high morbidity and mortality, necessitating early, accurate diagnosis.

Methods: A 42-year-old woman, misdiagnosed with chronic thromboembolic pulmonary hypertension (CTEPH) and treated with anticoagulation for four years, had a rare congenital vascular anomaly. She presented with cough, hemoptysis (~200 mL of fresh blood two hours before admission), progressive dyspnea, and chest discomfort. Examination revealed a loud P2, suggesting right ventricular strain. Echocardiography showed elevated pulmonary artery pressure with right ventricular dysfunction. Chest CT angiography revealed abnormal vascular anatomy; pulmonary angiography confirmed unilateral pulmonary artery hypoplasia (UPAH) as the cause of PH. Anticoagulation was stopped, and embolization was performed successfully. At the two-month follow-up, symptoms had resolved and hemoptysis had not recurred.

Results: UPAH is a rare congenital cause of PH that can mimic CTEPH, leading to misdiagnosis and inappropriate prolonged anticoagulation. Symptoms often overlap with common conditions such as pulmonary thromboembolism. In this case, lack of treatment response prompted reevaluation. Careful reassessment of prior imaging, history, and rare differential diagnoses was essential. This case highlights the importance of reconsidering the diagnosis when the course deviates from expectations and the need for individualized management in uncommon PH etiologies.

Background: Multisystem Inflammatory Syndrome in Children (MIS-C) is a rare but severe condition that can develop in children who have had COVID-19. It can lead to cardiovascular complications, potentially caused by endothelial dysfunction and arterial stiffness.

Methods: This study aimed to investigate the cardiovascular health of children with MIS-C compared to healthy controls. Fifty-nine children with MIS-C and fifty-nine healthy individuals were included in this cohort study. Non-invasive techniques were employed to measure the brachial artery's flow-mediated dilation (FMD), aortic distensibility (AD), and aortic strain (AS).

Results: The MIS-C group demonstrated significantly higher systolic blood pressure (P = 0.012), with a mean of 100.2 (10.1) mmHg compared to 95.3 (9.6) mmHg in the healthy group. The relative risk (RR) for elevated pulse pressure in the MIS-C group was borderline higher than in the healthy group (RR 95% CI: 1.06 [1.01-1.14]; P = 0.046). However, FMD, AS, and AD values were lower in the MIS-C group, with means of 13.6 (8.9), 10.4 (4.1), and 15.5 (2.7), respectively, although no significant differences were observed (P > 0.05).

Conclusion: Children with MIS-C exhibited higher pulse pressure, indicating potential arterial stiffness. They also showed lower FMD, suggesting endothelial dysfunction. FMD appears to be a more reliable indicator of endothelial dysfunction in MIS-C patients compared to aortic strain. These findings underscore the importance of early assessment and monitoring of cardiovascular complications in MIS-C patients. Endothelial dysfunction and arterial stiffness are well-established risk factors for future cardiovascular events.

Background: Eggs, while nutrient-rich, have high cholesterol content. The link between egg consumption and cardiovascular disease (CVD) remains debated. This study investigates how egg intake correlates with minor and major electrocardiogram (ECG) abnormalities, which serve as potential indicators of CVD.

Methods: In this cross-sectional study, a total of 5,928 participants without cardiovascular disease (CVD), aged between 35 and 65 years, were included. Dietary egg consumption was evaluated using a validated food frequency questionnaire. The Minnesota coding system was employed to identify minor and major ischemic abnormalities on ECG. Odds ratios (ORs) for major and minor ischemic patterns across different egg consumption categories were calculated using multivariable logistic regression.

Results: Using several statistical models, this study showed that higher egg consumption was associated with lower odds of isolated major ECG abnormalities in men, but not in women. In the fully adjusted model, consuming more than four eggs per week, compared to the lowest category (<1/week), was correlated with a 40% decrease in the odds of major ischemic changes on ECG in men (OR: 0.60, 95% CI: 0.39-0.93). Regarding minor ischemic abnormalities, there was no significant association with egg consumption in either women or men.

Conclusion: Our findings suggest a gender-specific effect of egg consumption on the presence of major ischemic changes on ECG. Further research is warranted to explore the underlying mechanisms and to inform tailored dietary guidelines for different populations.

Background: Statistics indicate that approximately 25,000 open-heart surgeries are performed annually in Iran, with coronary artery bypass grafting (CABG) surgeries accounting for 50-60% of these procedures. Although CABG offers numerous benefits to patients with coronary artery disease (CAD), some cases have reported negative consequences, such as heart failure (HF).

Methods: This study explored several influential blood indices related to HF following CABG surgery using manuscripts extracted from PubMed, Scopus, and Google Scholar. The analysis focused on indicators that can exacerbate HF, including fibrotic factors such as catecholamines and the renin-angiotensin-aldosterone system (RAAS).Conversely, it also investigated anti-fibrotic factors, including adrenomedullin (ADM), the natriuretic peptide system (NPS), NP-converting enzymes, and NP receptors. Additionally, the study evaluated the impact of various exercise training programs on these variables.

Results: Some fibrotic factors, such as catecholamines and the RAAS, contrast with anti-fibrosis factors, including NPs, their producing enzymes, receptors, production and excretion processes, ADM, and others. Research suggests these elements can be positively influenced by exercise rehabilitation.This study highlights the beneficial effects of exercise rehabilitation, specifically in reducing fibrotic factors and enhancing anti-fibrosis factors.

Conclusion: All types of exercise training-including endurance, resistance, and combined training, in both continuous and interval modes with moderate and high intensity-can delay fibrotic pathways after surgery and prevent subsequent adverse structural (pathologic hypertrophy) and functional changes in the heart, such as HF.

Background: Research suggests that C1q/TNF-related proteins (CTRPs) play a role in inflammation and may impact coronary artery disease (CAD). This study aimed to measure their levels in CAD patients and assess their correlation with disease severity.

Methods: This study involved 88 individuals (50 men and 38 women) who underwent coronary angiography. Among them, 47 patients had significant coronary obstruction and were selected as the case group, and 41 individuals without significant obstruction were considered as the control group. Serum levels of CTRP1 and CTRP3 were quantified using the ELISA method, whereas other parameters were assessed by standard laboratory techniques. Multiple logistic regression analysis was used to examine the association between CTRP1 and CTRP3 levels with CAD.

Results: The mean age of CAD patients was 62.1 ± 11.5 years. Thirty-one patients were male and sixteen were female. The control group comprised nineteen men and twenty-two women, with a mean age of 62.3 ± 12.7 years. The concentrations of CTRP1 and CTRP3 proteins were significantly higher in individuals with CAD relative to controls. Except for serum HDL levels, which were lower in the CAD group than in the control group, there were no significant differences in the demographic or clinical features between the studied groups. A direct and significant association was discovered between the amounts of assessed adipokines and the severity of CAD.

Conclusion: A greater concentration of both CTRP1 and CTRP3 was strongly associated with the presence and severity of CAD, indicating that these adipocytokines may serve as markers for CAD.

Aortic valve replacement surgery technique has been revolutionised with the introduction of sutureless valves. Perceval sutureless aortic valve (PSV) is one of the most widely used examples. However, oversizing the PSV has been reported to be an issue. After a case of PSV stent recoil in our institution, a new technique was developed, where only the white obturator is used to size the valve. Recently, this technique was also mentioned by different authors. With this technique, we achieved low rates of paravalvular leaks and pacemaker implantation, with good transvalvular gradients. Therefore, we recommend this technique over the manufacturer's instructions.

Background: The incidence of acute myocardial infarction (AMI) is on the rise, partly due to exposure to particulate matter (PM). However, the nature of the events and individuals at higher risk is unclear. This study examines the relationship between air pollution exposure, specifically particles with a diameter <2.5 microns (PM2.5), and the occurrence of non-ST-segment elevation myocardial infarction (NSTEMI).

Methods: In this case-crossover study, NSTEMI patients in Imam Hossein Hospital during 2021-2024 were considered. PM2.5 particle levels in Tehran during the 24 hours before NSTEMI admission and during three control periods (7, 14, and 21 days earlier) were recorded. Data were analyzed using Stata 17 and conditional logistic regression.

Results: Of 4,686 patients, 216 (4.61%) experienced NSTEMI. The median PM2.5 level was 91.5 μg/m³ (interquartile range = 78-113). PM2.5 levels did not differ between risk and control times (P = 0.740). Median PM2.5 levels were highest in autumn, followed by winter, and lowest in spring (P < 0.001). PM2.5 levels were not strongly associated with the occurrence of NSTEMI (P = 0.268). Considering PM2.5 levels, the occurrence of NSTEMI during winter was 3.42-fold greater than in autumn (OR = 3.42, 95% CI = 1.07-10.59). A significant association between PM2.5 levels and NSTEMI was observed only in winter, where each 1 μg/m³ increase in PM2.5 was associated with slightly reduced odds of NSTEMI (OR = 0.98, 95% CI: 0.97-0.99).

Conclusion: Exposure to PM2.5 was not related to the incidence of NSTEMI. Nevertheless, seasonal factors, particularly in autumn and winter, could be responsible for NSTEMI events.

Background: Aortic stenosis (AS), a progressively degenerative cardiac condition, poses a substantial burden on morbidity and mortality. This study responds to the scarcity of comprehensive data on moderate to severe AS, focusing on risk factors, clinical manifestations, and one-year outcomes.

Methods: A retrospective cross-sectional study was conducted at Chamran Hospital (2021-2022) involving 97 patients with moderate-to-severe AS. Exclusion criteria included infiltrative diseases, radiotherapy history, cardiogenic shock, ejection fraction <20%, fever, sepsis, and active infections. Data were collected using a standardized checklist with three sections: baseline demographics and risk factors, echocardiographic parameters, and outcomes (in-hospital events, surgical aortic valve replacement [AVR], and one-year mortality).

Results: Among the patients, 29 (29.9%) were classified as moderate AS and the remainder were severe AS. Severe AS patients exhibited higher systolic pulmonary artery pressure (sPAP) and higher prevalence of moderate to severe diastolic dysfunction and three-vessel disease (3VD). Echocardiographic parameters such as mean pressure gradient (MG), peak velocity (PV), and high sPAP were related to the severity of AS (moderate to severe) by odds ratios of 1.13, 6.09, and 1.15 folds, respectively.

Conclusion: AS imposes a significant burden of cardiovascular risk on the population. Patients with severe AS showed higher prevalence of increased filling pressures, moderate to severe diastolic dysfunction, 3VD, and higher sPAP compared with the moderate group, with no difference in clinical presentation and one-year outcome.

Background: One of the main complications after coronary artery bypass grafting (CABG) is postoperative clinical and para-clinical changes, which present a significant challenge.

Methods: This descriptive cross-sectional study included 109 patients who were candidates for CABG and were admitted to the surgical intensive care unit at Tehran Heart Center Hospital, selected using random sampling and a checklist. Relationships between variables were analyzed with the Kolmogorov-Smirnov (K-S) test, paired t-test, and regression.

Results: The findings from the mean changes before and after the pump showed that blood sugar (28.23 ± 33.43), lactate (6.59 ± 5.63), potassium (0.75 ± 0.47), and heart rate (12.36 ± 15.46) increased significantly after the pump compared to before the pump (p < 0.05), while hemoglobin (-2.5 ± 1.28), hematocrit (-6.61 ± 3.44), pH (-0.03 ± 0.06), PaO₂ (-92.95 ± 94.01), bicarbonate (-1.83 ± 2.38), and mean blood pressure (-2.25 ± 13.01) decreased significantly (p < 0.05). Gender had a significant effect on cerebral oximetry values on both the right (β = 5.461, p = 0.002) and left (β = 4.835, p = 0.004) sides, hemoglobin (β = 0.644, p = 0.017), and hematocrit (β = 2.055, p = 0.004). In addition, patients' comorbidities also had a positive effect on PaO₂ (β = 11.340, p = 0.044).

Conclusion: The clinical and para-clinical status in patients undergoing CABG surgery changes after on-pump surgery. In addition, comorbidities of patients have a positive and significant effect on PaO₂, as well as gender, on cerebral oximetry, hemoglobin, and hematocrit values.

Background: Congenital heart disease (CHD) profoundly impacts pediatric health, leading to increased morbidity and complex care requirements, often resulting in prolonged hospital stays. Nosocomial infections, particularly bloodstream infections (BSIs), pose a significant risk in the Pediatric Cardiac Intensive Care Unit (PCICU). This study aims to evaluate the prevalence of nosocomial BSIs in children with CHD within the PCICU and to identify associated risk factors.

Methods: A retrospective analysis was conducted on data recorded from patients under 18 years of age who had confirmed positive blood cultures and were hospitalized for a minimum of 48 hours from March 2019 to March 2022. Demographic, clinical, and microbiological information was collected, and statistical analyses were performed to determine the relationships between various risk factors and positive blood cultures.

Results: In this analysis of 510 patients evaluated, positive blood cultures were found in 16.7% of patients. Patients with positive cultures were significantly younger and had lower mean weights (P<0.05). Recovery status was a significant predictor of blood culture results (p<0.001). Device utilization, including urinary catheters and central venous lines, was notably higher in the positive culture group (P<0.05). Additionally, a higher proportion of patients with positive cultures had acyanotic CHD, with significant associations for Patent Ductus Arteriosus (PDA), Ventricular Septal Defect (VSD), and Atrial Septal Defect (ASD) (P<0.001). Improved recovery status decreased the likelihood of positive blood cultures by approximately 52.2% (odds ratio 0.478, p=0.0021).

Conclusion: Our findings reveal a high prevalence of BSIs in the PCICU, highlighting some associated risk factors such as recovery status, use of central vein catheters, dialysis and Foley catheters, younger age, and lower weight. This study emphasizes the necessity for rigorous infection control measures, particularly regarding the management of invasive devices and prompt clinical interventions, to improve patient outcomes in this high-risk population. Enhanced surveillance and tailored guidelines are essential for reducing the risks of nosocomial infections in pediatric cardiac care settings.