ARYA Atherosclerosis最新文献

Background: Ischemic heart disease (IHD) is the leading cause of 16% of deaths globally. Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are the main treatment options. Saphenous vein grafts (SVGs) remain the most frequently used conduits for CABG. In addition, PCI in cases previously undergoing CABG is related to worse long-term outcomes. This study aimed to evaluate PCI's short-term and long-term clinical outcomes on SVGs.

Methods: Sixty-three patients who underwent PCI on SVGs from 2017 to 2019 were enrolled. Short-term and long-term cardiac outcomes of patients in the 6-month follow-up, including major adverse cardiac events (MACE) and all causes of death, were collected. The collected data were also analyzed through statistical methods.

Results: The mean age of the subjects was 63.26 ± 8.74 years. Out of 63 patients, five patients (7.94%) died. Two of them died because of cardiac death a day after PCI, and three other cases passed away during the 6 months after angioplasty. Four and three cases had non-fatal myocardial infarction and stroke 6 months after PCI, respectively.

Conclusion: In conclusion, in patients with coronary artery disease, PCI and CABG are complementary therapies. Revascularization on saphenous vein grafts seems to be a safe and practical technique in patients.

Background: The relationship between hemoglobin A1c (HbA1c) levels and coronary artery disease (CAD) severity is still a matter of debate in non-diabetic patients. This study aimed to determine the association between HbA1c and the severity of CAD in non-diabetic patients.

Methods: The present cross-sectional study was conducted in 2018-2019 on 133 non-diabetic patients with stable angina, unstable angina, or myocardial infarction (MI). They were selected through systematic random sampling. The data were collected by taking a complete medical history, calculating the SYNTAX score, and measuring HbA1c.

Results: A SYNTAX score of >22 was significantly correlated with age, left ventricular ejection fraction, HbA1c, and total cholesterol. The mean SYNTAX score was higher in male patients, those with HbA1c >5.6, and patients with a primary clinical presentation of MI. The association between the SYNTAX score and HbA1c was found to be statistically significant (r = 0.659; P < .001). The odds of having a SYNTAX score of >22 for those with HbA1c >5.6 was 5.48 times higher than for those with HbA1c ≤ 5.6 (odds ratio [OR], 5.48; P < .001). The odds of three-vessel disease in individuals with an HbA1c level greater than 5.6 were found to be 4.80 times higher than in those with HbA1c levels at or below 5.6 (OR, 4.80; P = 0.002).

Conclusion: The present findings showed that HbA1c has the potential to predict the severity of CAD in non-diabetic individuals. HbA1c, even at levels within the normal range, was significantly correlated with SYNTAX scores.

Background: The study explores the enduring challenges of cardiovascular disease mortality, emphasizing myocardial infarction rates as a proxy for cardiovascular disease in Iran. It analyzes the 28-day mortality trends after Acute Myocardial Infarction (AMI) from 2000 to 2017.

Methods: This retrospective cohort study is based on data from a multi-centric hospital-based registry in Isfahan. Univariate and multivariate frailty Cox regression analyses were performed to identify Hazard Ratios (HRs) for the 28-day mortality rate of AMI based on age, gender, and living region.

Results: The study enrolled 121,284 patients with an average age of 62.00±12.82 years. Older age than 65 years was found to be associated with an increased risk of AMI (HR: 3.2, 95% CI: 2.7-3.8 from 2000 to 2002 and HR: 4.6, 95% CI: 3.7-5.7 for 2015-2017). There was also an association between living in the urban region and a decreased risk of AMI from 2000 to 2005 (HR: 0.64, 95% CI: 0.46-0.90), from 2000 to 2002 (HR: 0.55, 95% CI: 0.43-0.71 for 2003-2005). Results showed that the trend of change in 28-day mortality declined more significantly from 2006 to 2017 compared to 2000-2002. Younger age (61.76±12.69 vs 71.12±11.73), female gender (HR:0.77, 95%CI: 0.67,0.89), and living in urban regions (HR: 0.69, 95%CI: (0.52,0.94) were the protective factors for the 28-days mortality rate of AMI.

Conclusion: It can be concluded that 28-day mortality had a descending trend from 2006 to 2017. Older age, male gender, and living in a rural region were the risk factors that affected the 28-day mortality rate of AMI.

Background: There is a high mortality rate in cyanotic patients with congenital heart disease (CHD) due to cardiovascular complications. The cardiovascular prognosis is negatively affected by endothelium dysfunction, increased arterial stiffness, and impaired vascular system. This study aimed to determine carotid intimal mean thickness (CIMT) and flow-mediated dilatation (FMD) in a group of children with cyanotic CHD (CCHD).

Methods: FMD and CIMT were evaluated for 45 children with CHKD and 38 patients who did not have CHKD over the period 2021 to 2022, as part of this case-control study. In terms of age and gender, the case group has been compared to controls.

Results: Men accounted for 61.3% of the participants, with a mean standard deviation age of 7.8 5.39 years. In subjects with CCHD, CIMT increased non-significantly and FMD decreased significantly, but systolic blood pressure was significantly higher in patients than in the healthy group. (P=0.003).

Conclusion: FMD was reduced in children with CCHD, but in controls, systolic blood pressure and CIMT were lower. The risk of developing atherosclerosis in CCHD patients may be increased by an increase in CIMT and systolic blood pressure.

Background: Secundum Atrial Septal Defects (ASDs) are the most common type of atrial septal defects. Today, using different types of occluders, transcatheter closure is widely used to treat ASD and has replaced the surgical procedure in anatomically suitable patients. This study was performed to evaluate the short-term clinical outcomes of treatment of adult patients requiring an ASD device closure referred to Shahid Chamran Cardiovascular Center in Isfahan, Iran.

Methods: All patients who underwent ASD treatment using transcatheter closure at Shahid Chamran Cardiovascular Center in 2020 and 2021 were recruited in this retrospective descriptive study. The characteristics of the treated lesion and the cardiovascular complications during treatment were recorded immediately and one month after treatment.

Results: A total of 70 patients (47 females and 23 males) with a mean age of 39.81±12.56 years were investigated in this study. The number of difficult anomalies was 46 (65.7%), and the most common type was the deficient aortic rim. In terms of the incidence of vascular complications, hematoma, bleeding, and pseudoaneurysm were observed in 8 patients. The most common cardiac complication was atrial fibrillation, which occurred in 12 patients. No cardiovascular complications were observed during the one-month follow-up.

Conclusion: The results of this single-institute study showed that ASD treatment by the transcatheter procedure using an ASO device at Shahid Chamran Cardiovascular Center was performed safely and successfully with very few complications. The short-term analysis of the outcomes indicated no major complications, deaths, or device malposition.

Background: Necrotizing fasciitis is a life-threatening soft tissue infection characterized by rapid tissue necrosis, often leading to sepsis and multisystem organ failure. Necrotizing fasciitis can rarely occur as a post-procedural complication, particularly following cardiac catheterization or angiography. This case report presents the clinical presentation and management of a 64-year-old female with a history of chronic endocarditis and valvular involvement who developed necrotizing fasciitis after femoral coronary angiography.

Case presentation: A 64-year-old female with a history of chronic endocarditis and valvular involvement underwent femoral coronary angiography as part of her cardiac evaluation. On the first postoperative day, the patient developed worsening pain, swelling, and redness in her right lower extremity, which worsened despite antibiotic therapy and pain management. The patient was diagnosed with necrotizing fasciitis. An emergent right lower extremity fasciotomy was performed to debride the necrotic tissue and release the tension caused by acute compartment syndrome.

Conclusion: This case underscores the importance of maintaining a high index of suspicion for NF in patients with persistent soft tissue infection symptoms post-procedure. Early recognition, prompt diagnosis, and aggressive surgical intervention are crucial for the successful management of post-procedural NF following femoral coronary angiography. This report emphasizes the need for a multidisciplinary approach and vigilance in caring for patients to ensure optimal outcomes in such rare but severe complications.

Background: Type 1 diabetes (T1D) carries a significant risk of atherosclerosis as the main driver for cardiovascular events. Atherosclerosis is initiated by the activation of the endothelium by various risk factors through the inflammation process. The anti-inflammatory cytokine TGF-β1 may inhibit the development of atherosclerosis.

Methods: In a cross-sectional study, a total of 40 patients aged 14.5±3.16 years old with T1D and 40 healthy controls aged 14.7±0.99 years old were involved. Common carotid artery IMT (cIMT) was measured by real-time M-echocardiography mode (Affinity 50G Philips) and Flow Mediated Dilatation (FMD), using high-resolution ultrasonography and Doppler flow characteristics. The TGF-β1 level was measured by indirect ELISA at Saiful Anwar Hospital Laboratory.

Results: There were no differences in age, gender, Body Mass Index (BMI), duration of diabetes, renal function, or nutritional status between the T1D and healthy groups (p>0.05). A significant difference in cIMT was observed between the T1D group and the healthy group (0.567 ± 0.87 mm vs. 0.387 ± 0.57 mm, p = 0.000), FMD (7.17 ± 3.98 mm vs. 11.22 ± 5.48 mm, p = 0.000), and the level of TGF-β1 cytokine (39.83±13.51 vs. 73.67±15.34 pg/ml, p = 0.000). A significantly negative correlation between TGF-β1 and cIMT (p = 0.000; r = -0.685) and a significantly positive correlation between TGF-β1 and FMD (p = 0.000; r = +0.55) were found.

Conclusion: Atherosclerosis is an inflammatory disease accelerated by diabetes. The inflammation process is more prominent in T1D patients. T1D patients show a decreased level of TGF-β1, increased measurement of cIMT (>0.5 mm), and a decreased measurement of FMD.

Background: Ventricular septal defect (VSD) is a common congenital heart defect that affects many individuals. Transcatheter closure has become a successful treatment method. However, certain devices used for closure can lead to life-threatening complications such as complete heart block. This systematic review aimed to assess the efficacy and safety of Amplatzer duct occluders (ADOs) types I and II for closing perimembranous VSDs (pmVSDs).

Methods: This review followed the PRISMA 2020 guidelines and searched multiple databases for English articles on pmVSD closure using ADO I/II published up to 2022. Relevant keywords were used and the data were categorized to report the incidence of common complications.

Results: The study, which involved 1,691 patients with primary pmVSD and ages ranging from 6 months to 15 years, found that ADO type I had a high success rate with low rates of complete heart block and other complications. ADO type II had a higher rate of severe complications, particularly complete heart block. The overall estimated success rate for device implantation was 97.3%, with only one procedure-related death. The occurrence of complete heart block was 2.3%, and residual shunts were the most frequent complication (4.8%).

Conclusion: The findings of this systematic review provide valuable insights into the use of ADO types I and II for closing pmVSDs. Healthcare professionals should be aware of these findings and closely monitor patients who undergo ADO device closure for pmVSDs. Further research is recommended to determine the specific indications for using each type of Amplatzer device in the relevant population.

Chordal systolic anterior motion (SAM) refers to the anterior motion of the mitral valve towards the left ventricular outflow tract (LVOT) that occurs during systole. Chordal SAM is a potentially fatal condition. Chordal SAM is linked to an elevated risk of sudden death and can lead to significant obstruction of the left ventricular outflow tract (LVOT) and mitral regurgitation. It is crucial to acknowledge and consider this phenomenon when assessing individuals experiencing dyspnea and chest discomfort. By doing so, unnecessary therapies related to heart failure and heart attack might be avoided. Ensuring timely diagnosis is crucial in order to prevent unnecessary and potentially dangerous therapies that can aggravate LVOT obstruction and lead to hemodynamic instability. In this paper, we present a 47-year-old woman who experienced sudden chest pain and dyspnea. The patient had a history of hypertension and previous myocardial infarction. ST-elevation was observed in the first ECG. The primary treatment for acute coronary syndrome was initiated. Coronary angiography demonstrated that coronary vessels were not obstructed. The diagnosis of chordal SAM was initially overlooked during the echocardiography, but it was later identified during a subsequent echocardiography after cardiac catheterization. When using beta-blockers, her clinical condition improved.

Background: Polypill or fixed-dose combination has been recognized as an effective secondary prevention strategy for patients with cardiovascular disease (CVD). This study aimed to evaluate the effectiveness of the polypill on one-year medication adherence, patient satisfaction, and lipid profile control in patients with ST-elevation myocardial infarction (STEMI).

Methods: This was an open-label, multicentric, randomized clinical trial study of STEMI patients who were prescribed a polypill (Aspirin 81 mg, Atorvastatin 40 mg, Metoprolol Succinate 47.5 mg, and Valsartan 40 mg) versus usual care (continued with separate medications) for secondary prevention. The primary outcome was to compare one-year medication adherence between groups. Other outcomes included comparing patient satisfaction and lipid profile after 12 months of follow-up, as well as identifying predictor factors of medication adherence.

Results: Of 624 STEMI participants, 289 patients were treated with the polypill (79.2% male; mean age 61.67 ± 8.54 years), and 335 patients received usual care (82.7% male; mean age 62.10 ± 9.63 years). After one-year follow-up, no significant differences were detected between groups regarding medication adherence (p-value = 0.351) and cholesterol levels (p-value = 0.808). The polypill strategy was associated with increased patient satisfaction and better control of LDL-C (p-value = 0.043) and HDL-C (p-value < 0.001). Patients with a history of chronic kidney disease (OR: 13.392; p-value = 0.001), cerebrovascular disease (OR: 4.577; p-value = 0.011), and higher waist circumference (OR: 1.01; p-value = 0.002) demonstrated a lower probability of medication adherence. In contrast, in-hospital complications such as arrhythmia (OR: 0.039; p-value = 0.010), bleeding (OR: 0.034; p-value = 0.007), and higher ejection fraction (OR: 0.965; p-value = 0.002) were associated with a higher probability of medication adherence.

Conclusion: In STEMI patients, participants treated with polypills were more satisfied and showed better lipid profile control. However, a longer follow-up duration is needed to examine the effectiveness of the polypill on medication adherence in this subgroup.