Cardiovascular Biomedicine Journal

Editorial

Seyed Jalil Mirhosseini — 2025-08-31

The Article Abstract is not Available.

AL amyloidosis with cardiac involvement: a case report with literature review

Sanjay Arya — 2025-08-31

Objectives: To present a case of rapidly progressing cardiac immunoglobulin light chain (AL) amyloidosis, highlighting diagnostic challenges, management complexities, and the importance of early intervention. AL amyloidosis is a rare and severe disorder that causes organ damage, especially in the heart, leading to restrictive cardiomyopathy, heart failure, and arrhythmias. This case report highlights diagnostic difficulties and management issues, showcasing advanced imaging techniques and a multidisciplinary approach.

Methods: A 68-year-old man presented to Wigan Infirmary, Wrightington, Wigan, and Leigh (WWL) NHS Trust in July 2024 with dyspnea, nocturnal cough, and decreased exercise tolerance due to rapidly progressing cardiac AL amyloidosis. The diagnostic workup included chest X-ray, echocardiography, cardiac MRI, and a Technetium-99m-labeled 3, 3-diphosphono-1, 2-propanodicarboxylic acid (Tc-DPD) scan. Fat aspirate biopsy confirmed the diagnosis by showing Congo red positivity with characteristic apple-green birefringence under polarized light. Laboratory tests supported the diagnosis, revealing lambda free light chain levels over 2000 mg/L, elevated B-type natriuretic peptide (BNP) at 4174 pg/mL, and impaired kidney function. This case emphasizes the importance of early detection and treatment of cardiac amyloidosis, as well as the difficulties of managing this condition alongside concurrent infections.

Results: Despite early diagnosis and vigorous treatment, the patient's condition rapidly declined, leading to several hospitalizations for decompensated heart failure and infections. Treatment focused on reducing amyloid production and managing cardiac issues. For infection-related admissions, the treatment regimen included intravenous furosemide, dexamethasone, and piperacillin-tazobactam (Tazocin). However, over these admissions, the patient’s condition worsened due to recurring infections and the progressive decline in renal and hepatic function. Sadly, the patient died in early January 2025 during the final hospitalization due to severe refractory heart failure.

Conclusions: The case highlights the vital importance of early detection and a multidisciplinary approach to managing cardiac AL amyloidosis. It stresses the need for collaboration among various specialties, including cardiology, hematology, and infectious disease, to effectively handle the complexities of concurrent cardiac failure, arrhythmias, and infections. This coordinated care approach is essential for optimizing treatment planning and orders.

Unveiling the association between air pollution and cardiovascular diseases: the silent threat to heart health

Razieh Parizad — 2025-08-31

Cardiovascular diseases (CVDs) remain the leading cause of death worldwide, accounting for about 17.9 million deaths annually—making up roughly 31–32% of all global deaths (1, 2). Among various risk factors, air pollution has emerged as a major public health concern because of its strong link to CVDs. It is responsible for an estimated 20% of the global burden of CVD-related deaths, resulting in over 3 million deaths each year (3, 4). Air pollution is a complex mix of particulate matter, ozone, and nitrogen dioxide (NO), originating from both outdoor and indoor sources. Indoor air pollution is increasingly recognized as a main risk factor, especially in low- and middle-income countries (LMICs), where the use of solid fuels for cooking and heating is prevalent (5). As awareness about the health impacts of air quality grows, emerging research highlights the urgent need for comprehensive public health efforts to tackle this critical issue. Epidemiological studies consistently show a strong link between exposure to air pollution and higher risks of various cardiovascular problems, including heart attacks, strokes, and heart failure (HF) (6, 7). Notably, long-term exposure to fine PM2.5 has been linked to increased morbidity and mortality, highlighting that even concentrations below current safety standards can pose significant health risks (6, 8). The World Health Organization (WHO) has updated its air quality guidelines, urging countries to adopt more stringent standards to protect public health. However, substantial disparities still exist in the global implementation of effective air quality policies (9, 10). The biological mechanisms connecting air pollution to CVDs mainly involve oxidative stress and inflammation, which contribute to vascular dysfunction and speed up the development of atherosclerosis (11, 12). Vulnerable populations, including older adults and those with pre-existing health conditions, face a higher risk from the harmful effects of air pollution due to their increased physiological sensitivity (6). Ongoing research is essential to better understand these processes and to guide targeted interventions, especially in regions heavily affected by poor air quality. The growing body of evidence linking air pollution to negative cardiovascular outcomes has sparked renewed debate about regulatory frameworks and policy measures aimed at reducing health risks. Although some countries have made progress in adopting air quality standards aligned with WHO recommendations, many still lack sufficient laws to effectively protect public health (13). In light of these challenges, effective strategies—including personalized medicine, evidence-based interventions, and comprehensive public health policies—are crucial for reducing the health impacts of air pollution and improving cardiovascular outcomes (3, 14). Additionally, a review of various studies emphasizes that indoor air pollution, especially from solid fuel combustion, presents significant health risks that are often underestimated in traditional epidemiological models, which mainly focus on outdoor air quality (6). This gap highlights the need for further research focused on specific populations and environments to enable a more accurate assessment of exposure and its health effects (6). Addressing these challenges requires integrating personalized medical approaches, scientifically supported interventions, and coordinated public health policies. Implementing such strategies can significantly lessen the health burden of air pollution and promote better cardiovascular health outcomes worldwide scale.

Gender variations in acute aortic dissection: insights from a retrospective cohort analysis

Abbas Andishmand — 2025-08-31

Objectives: Aortic dissection is a life-threatening cardiovascular condition, and this study aims to explore gender-related differences in clinical characteristics, treatment outcomes, and complications.

Methods: We conducted a retrospective cohort study analyzing medical records of 74 patients diagnosed with symptomatic aortic aneurysms at Afshar and Shahid Sadoughi Hospitals in Yazd from 2017 to 2023. We categorized patients by gender and collected the data on demographics, clinical presentations, comorbidities, treatment strategies, complications, and mortality.

Results: The study included 54 males and 20 females. Females were older at presentation (mean age 64.3 years) and had a higher prevalence of diabetes mellitus (45.0% vs. 14.8%, P=0.011). The time from symptom onset to admission was significantly longer for females (4.0 vs. 2.4 hours, P=0.039). Treatment strategies were similar across sexes. Complication rates, such as heart failure and cardiac tamponade, were higher in females (P=0.057), although overall mortality rates were similar (37.0% in males vs. 45.0% in females, P=0.933). Cox regression analysis showed age as a significant risk factor for mortality (HR 1.03, 95% CI 1.01-1.05, P=0.003).

Conclusions: Clinical presentations and treatment approaches for aortic dissection are generally similar between sexes, but differences in age at presentation and comorbidities are noteworthy. These findings underscore the importance of considering sex-specific factors in the management and prognosis of aortic dissection to improve patient outcomes

Comparative analysis of in-hospital outcomes in opioid-dependent vs. non-opioid-dependent STEMI patients

Razieh khakzar Bafrouei — 2025-08-31

Objectives: Myocardial infarction is a leading cause of death worldwide. The effect of opioid dependence on myocardial infarction outcomes remains uncertain, with conflicting results in the literature. This study aimed to assess the in-hospital and six-month outcomes of opioid-dependent compared to non-dependent patients with ST-elevation myocardial infarction (STEMI) at Afshar Heart Center, Yazd.

Methods: This cross-sectional analytical study included 200 STEMI patients admitted to Afshar Heart Center in Yazd, Iran, between 2020 and 2021. Patients were divided into opioid-dependent and non-opioid-dependent groups based on the DSM-IV criteria for opioid use. The inclusion criteria were chest pain lasting at least 30 minutes, specific ST-segment elevation on ECG, and elevated serum creatine kinase levels. Patients with a history of myocardial infarction or other cardiac or pulmonary diseases were excluded. Demographic and clinical data were collected from hospital records and analyzed using SPSS v.22.

Results: Multivariate analysis showed that opioid dependence was significantly linked to in-hospital outcomes. Although in-hospital mortality was higher for opioid-dependent patients compared to non-dependent patients (8.3% vs. 1.7%, p = 0.34), this difference was not statistically significant. Interestingly, six-month mortality occurred only in the non-dependent group (3.4% vs. 0%, p = 0.095). The duration from symptom onset to hospital arrival was considerably shorter in opioid users (154.01 ± 190.38 minutes) than in non-users (271.62 ± 287.58 minutes, p < 0.01), which may have contributed to earlier reperfusion. Despite these differences, there were no significant differences between the groups regarding revascularization strategies or left ventricular ejection fraction (EF: 38.15% vs. 38.52%, p = 0.974).

Conclusions: Opioid dependency greatly affects the prognosis of STEMI patients, highlighting the importance of targeted interventions and additional research

Review: Biomechanical impacts of vascular stents

Mohammad Moradi — 2025-08-31

Objectives: Coronary stents are widely used as an effective intervention for coronary artery disease (CAD). This study investigates the biomechanical and hemodynamic consequences of stent implantation on arterial blood flow. While stenting improves myocardial perfusion and decreases vascular resistance, it can also lead to adverse effects, such as altered flow patterns, endothelial injury, and increased arterial stiffness. These factors may contribute to restenosis and other complications. This review summarizes biomechanical alterations caused by stenting and highlights recent strategies aimed at enhancing stent performance. To investigate the biomechanical and hemodynamic consequences of coronary stent implantation on arterial blood flow and to assess strategies aimed at mitigating related complications

Evaluation of the prevalence and prognosis of various types of premature ventricular contractions (PVCs) following catheter ablation in patients at afshar hospital, yazd, iran (2015–2020)

Ahmad Abdolrezaie Anari — 2025-08-31

Objectives: Premature ventricular contraction (PVC) is a common cardiac arrhythmia characterized by heartbeats originating from the ventricles rather than the sinoatrial node. Although radiofrequency catheter ablation (RFCA) is a preferred treatment, its efficacy and prognostic impact remain incompletely established, particularly in developing countries where cardiovascular diseases are a leading cause of mortality. This study aims to investigate the prevalence and predictive outcomes of different PVC types following ablation therapy.

Methods: A retrospective, cross-sectional study was performed on all patients who underwent premature ventricular contraction (PVC) ablation at the Catheterization Laboratory of Afshar Hospital in Yazd, Iran, from 2015 to 2020. Patient data were collected using a census sampling approach, based on medical records, with PVC diagnoses confirmed by an electrophysiology specialist. The study examined demographic characteristics, PVC morphology based on surface electrocardiograms (ECGs), and the anatomical origin identified through electrophysiological mapping. Ablation success was defined as a reduction of ≥80% in PVC burden, while recurrence was defined as more than 10% PVCs on a 24-hour Holter monitor during follow-up. Data were analyzed using SPSS software.

Results: The study included 75 patients (56% male, 44% female) with a mean age of 47.0 ± 13.7 years. The most common site of PVC origin was the right ventricular outflow tract (RVOT), found in 54.7% of cases. Common comorbidities included hypertension (31%) and diabetes mellitus (11%). Palpitations were the most frequently reported symptom, seen in 63% of patients. The overall success rate of ablation was 81.3%. Complications were rare and included catheter site hematoma (2.7%) and thromboembolism (1.3%). Among patients who had successful ablation, 18% experienced recurrence. A statistically significant relationship was found between the anatomical origin of PVC and ablation success (p < 0.0001). However, the origin of PVCs was not significantly associated with recurrence or the timing of recurrence (p > 0.08).

Conclusions: This study identifies palpitations as the primary symptom in patients with premature ventricular contractions (PVCs), which most commonly originate from the ventricular outflow tracts. Hypertension and diabetes mellitus were identified as significant comorbidities. Radiofrequency ablation demonstrated a high success rate, with few complications and a low recurrence rate. Notably, the anatomical origin of PVCs was a substantial predictor of ablation success.

Evaluating the limited impact of therapy with empagliflozin on primary PCI patients' outcomes: the ELITE-PCI trial

Abbas Andishmand — 2025-08-31

Objectives: Empagliflozin, a sodium-glucose co-transporter 2(SGLT2) inhibitor, has demonstrated cardiovascular benefits in various patient groups. However, its effects on patients undergoing primary percutaneous coronary intervention (PCI) have not been extensively studied. This research aims to assess the impact of empagliflozin on clinical outcomes for participants in the ELITE-PCI trial.

Methods: The ELITE-PCI trial was a prospective, single-center, randomized, triple-blind, placebo-controlled study conducted from June 8, 2023, to May 25, 2024. It included 110 patients with acute myocardial infarction (AMI) undergoing primary PCI, who were assigned to receive either 10 mg of empagliflozin or a placebo. Clinical outcomes, including major adverse cardiovascular events (MACE) and rehospitalization rates, were assessed at 12 weeks post-intervention.

Results: The study included 110 participants, with 55 in each group. The mean age was 59.9 years (±10.7) for the empagliflozin group and 58.1 years (±11.9) for the placebo group (p = 0.392). Both groups had a consistent sex distribution (90.9% male, p > 0.999). Baseline characteristics, including BMI, GFR, blood pressure, and left ventricular ejection fraction, showed no significant differences. Diabetes prevalence was 47.3% in the empagliflozin group and 43.6% in the placebo group (p = 0.702). At 12 weeks, MACE was absent, while the empagliflozin group had a 7.2% readmission rate, primarily due to pulmonary edema, compared to 5.4% in the placebo group(p=0.405).

Conclusions: The findings of the ELITE-PCI trial suggest that short-term empagliflozin therapy does not have a significant impact on clinical outcomes in patients undergoing primary PCI. Nevertheless, these results highlight the necessity for further research to clarify the role of SGLT2 inhibitors within this patient population.