Cardiovascular Biomedicine Journal

Mid-term results of percutaneous transmitral commissurotomy (PTMC) in central iran

Abbas Andishmand — 2024-08-11

Objectives: Percutaneous Trans-Mitral Commissurotomy (PTMC) is an effective non-surgical treatment in patients with severe rheumatic mitral valve stenosis. This study aimed to evaluate the mid-term results of this procedure in central Iran.

Methods: This retrospective study was performed on 101 patients with severe mitral valve stenosis who underwent successful PTMC from March 2011 to September 2018 in Afshar Hospital in Yazd. At follow-up, all patients underwent clinical examination, two-dimensional and color Doppler echocardiography, and events were recorded. Data were analyzed using SPSS software version 19.

Results: The mean age of the patients was 44.79± 11.72 years, and 83.3% were female. The mean follow-up time was 38.98 23.33 months (6-94 months).25.8% had AF rhythm, and 12% had previous PTMC or OMVC or CMVC. After percutaneous Trans-Mitral Commissurotomy, 97% of patients were in NYHA functional class I, II and the mitral valve area (MVA) increased from 0.92 ± 0.18 to 1.66± 0.29 cm2 (p<0.0001). Pulmonary artery systolic pressure decreased from 46.96± 18.56 mmHg to 38.43±14.02 mmHg (p<0.0001). The Mean mitral valve gradient decreased from 12.37± 3.99 mmHg to 4.79± 2.38 mmHg (p<0.0001). Restenosis rate and severe mitral regurgitation resulting in mitral valve replacement (MVR) were 10.9% and 2%, respectively. Two patients died because of intracranial hemorrhage (ICH). During the follow-up event, free survival was 82.2%. Multivariable analysis revealed that the predictors of shorter event-free survival were AF rhythm (HR; 4.5, 95%CI;1.59-12.9, P=0.005) and post PTMC higher NYHA functional class (HR;2.2, CI;1-4.8,p=0.049).

Conclusions: Mid-term results of percutaneous transmitral commissurotomy (PTMC) in central Iran are the same as in other parts of the world. This procedure is an effective and low-risk treatment for severe mitral valve stenosis.

Unlocking the power of echocardiography: strategies in risk stratification of patients with PE using echocardiography

Venus Shahabi Raberi — 2024-08-11

Objectives: Pulmonary embolism (PE) is challenging to diagnose due to nonspecific symptoms. While computed tomography pulmonary angiography (CTPA) is the gold standard, transthoracic echocardiography (TTE) is frequently used first. This study aimed to evaluate the accuracy of TTE findings in predicting the severity of CTPA-confirmed PE.

Methods: This retrospective study in 2023, analyzed 124 patients who underwent CTPA for suspected PE at Seyed Al Shohada Hospital of Urmia, Iran. The Pulmonary Embolism Severity Index (PESI), as a risk stratification tool for pulmonary embolism, was measured in the first hours of hospitalization. TTE was performed 48 hours following hospital admission, with an emphasis on Key TTE parameters, including McConnell’s sign, D-shape septum sign, right ventricular (RV) dimensions, left ventricular dimensions, pulmonary artery (PA) diameter, tricuspid regurgitation gradient (TRG), Tricuspid annular plane systolic excursion (TAPSE) and PA acceleration time (PaACT). Sensitivity, specificity and predictive value were all calculated.

Results: Most patients were women (53.23%) over 60 (38.71%). Several TTE measures showed promise for predicting PE: RV dilation (sensitivity 84%, specificity 77%), PA diameter (84% and 28%), TRG (66% and 58%), and PA acceleration time (92% and 62%). However, McConnell’s sign had low accuracy (area under ROC curve 0.62). Tricuspid annular plane systolic excursion (TAPSE) and PA acceleration time showed the best predictive performance (AUC 0.95-0.92) and can be used as screening tools for life-threatening massive PE.PESI index test, when compared to the gold standard CT scan (which shows lung involvement), does not provide additional valuable information and accurate predictions about the severity of PE.

Conclusions: TAPSE and PaACT showed excellent predictive ability to CTPA-detected PE. RV dilation and PA diameter also showed good predictive capability. Findings support using some TTE indices to screen for PE severity and risk assessment before CTPA when access is limited.

Prevalence of cardiomyopathy following pacemaker insertion in an iranian population; a cross-sectional study

Faezeh Dehghani-Tafti — 2024-08-11

Objectives: This study aimed to determine the prevalence of pacemaker-induced cardiomyopathy in patients with pacemaker implantation and to identify the associated risk factors.

Methods: This cross-sectional study examined all patients who were implanted with a pacemaker at Afshar Hospital Yazd in 2019 and wore it for two to three years. A new EF test was performed for all patients and compared with the old EF. If a reduction in EF of more than 10% was observed, or the EF was less than 50% due to another reason, it was considered HF. All data were analyzed using SPSS, version 22.

Results: One hundred eleven patients participated in this study, 52 (46.8%) men and 59 (53.2%) women. The results showed that ejection fraction (EF) was more than 50% in 93 patients (83.8%). The mean EF decreased from 62.1 to 36.2% over three years. Statistical analysis showed that there is a significant association between diabetes and the incidence of cardiomyopathies in these patients (p = 0.016), but there was no association with hypertension. The mean length of the QRS wave in the electrocardiogram was significantly longer in the group with cardiac pacemakers than in the other patients (P = 0.49).

Conclusions: We concluded that 22.5% of referring patients with implantation of a right ventricular pacemaker will develop cardiomyopathy within 2-3 years.

Survival benefit of ICD implantation for primary prevention in dilated cardiomyopathy

Alimoahammad Akrami — 2024-08-11

Objectives: Dilated cardiomyopathy (DCM) represents a significant cause of heart failure unrelated to ischemic heart disease, posing a high risk of sudden cardiac death (SCD) due to low left ventricular ejection fraction (LVEF). This study evaluates the survival benefits of implantable cardiac defibrillators (ICDs) for primary prevention in DCM patients.

Methods: We enrolled 52 symptomatic non-ischemic cardiomyopathy patients (LVEF ≤ 35%, NYHA class II-III) eligible for ICD implantation in Afshar Hospital, Yazd, Iran, from 2014 to 2015. Exclusion criteria included those with ischemic indications or requiring cardiac resynchronization therapy. We divided patients into ICD recipients and those on a waiting list, collected the baseline data (age, functional class, LVEF), then followed up with patients to assess mortality rates.

Results: Among 45 patients, 64.5% received ICDs while 35.5% were on the waiting list. The mean age was 57±13 years, predominantly male (67.3%). The ICD group had a significantly lower mortality rate (17.3%) than the waiting list group (42.7%, p = 0.54). Although age and functional class did not significantly predict outcomes, lower LVEF was a crucial factor for long-term survival. Despite some studies suggesting no survival benefit in non-ischemic heart failure, our findings highlight the efficacy of ICDs in reducing mortality among DCM patients.

Conclusions: ICD implantation in DCM patients substantially reduces all-cause mortality compared to those awaiting the procedure, underscoring the importance of timely ICD deployment for primary prevention in this population.

Asessment of blood urea nitrogen to creatinine ratio as a predictor of mortality in ST-elevation myocardial infarction patients undergoing thrombolytic therapy: a cross-sectional study

Haleh Bodagh — 2024-08-11

Objectives: Given the increasing number of ST-elevation myocardial infarction (STEMI) and the related healthcare expenses and medical outcomes, as well as the frequent occurrence of kidney problems in this patient population, the current research aims to explore the effect of blood urea nitrogen to creatinine (BUN/Cr) ratio on the in-hospital mortality (IHM) of STEMI patients undergoing thrombolytic therapy.

Methods: This study is a cross-sectional analytical study conducted in 2021 at Shahid Madani Hospital, affiliated with Tabriz University of Medical Science, which investigated the relationship between the BUN/Cr ratio and IHM in patients with STEMI who received thrombolytic treatment between 2017 and 2019. Patients with other causes of ST elevation, those undergoing dialysis, or those with incomplete medical records were excluded. Data were collected from patient medical records. The primary outcome was in-hospital mortality, with secondary outcomes including the occurrence of heart failure and the need for blood transfusion—chi-square tests for categorical and t-tests for continuous variables. A p-value of less than 0.05 was considered statistically significant.

Results: A total of 398 patients were diagnosed with STEMI and treated with thrombolytic 330 (82.9%) patients were men. High BUN and Cr had a significant correlation with high mortality rates (P <0.01). However, BUN/Cr didn’t have a substantial relationship with IHM and one-year mortality (P-value = 0.46). The most common in-hospital complication was heart failure (HF), and a higher need for blood transfusion was significantly related to high rates of BUN/Cr (P <0.01).

Conclusions: While high BUN and Cr levels were significantly associated with increased mortality rates, the BUN/Cr ratio was not significantly related to IHM. These results suggest that although elevated BUN and creatinine indicate poor prognosis, the BUN/Cr ratio may not be a standalone predictor of in-hospital mortality. Further research is needed to validate these findings and identify other factors affecting patient outcomes.

The role of serum uric acid in predicting left ventricular function and outcomes in patients with STEMI following PCI

Hasan Haghaninejad — 2024-08-11

Objectives: Percutaneous coronary intervention (PCI) is the preferred treatment for ST-elevation myocardial infarction (STEMI); however, reduced left ventricular ejection fraction (LVEF) remains a critical issue post-PCI. Serum uric acid (SUA) has emerged as a biomarker linked to cardiovascular events and may be associated with LVEF. This study aims to investigate the relationship between SUA levels and LVEF in STEMI patients treated with primary PCI and identify potential biomarkers for predicting patient outcomes.

Methods: This prospective study was conducted at Afshar Hospital, Shahid Sadoughi University of Medical Sciences of Yazd, from September 2019 to March 2021. Participants included 254 consecutive ST-elevation myocardial infarction (STEMI) patients undergoing primary PCI. Exclusion criteria were contraindications for angiography, history of myocardial infarction, PCI, CABG, NSTEMI, thrombolytic treatment, kidney diseases, gout, or alcoholism. Demographic data, clinical history, SUA levels, and echocardiographic parameters were collected. Statistical analysis was performed using SPSS version 20.0, with significance at p<0.05.

Results: 81.49% of patients were male, with a mean age of 57.7±11.47 years. Hypertension was the most prevalent condition (42.9%). SUA levels did not significantly differ between patients with LVEF below and above 40% (p=0.39). However, smoking was significantly associated with reduced LVEF (p<0.001). A weak negative correlation between SUA and LVEF was observed in males (p=0.012) but not in females (p=0.097). Overall, a weak negative correlation between SUA and LVEF was statistically significant (p=0.05).

Conclusions: Our findings revealed a weak but statistically significant overall negative correlation between SUA and EF. Further research with larger, more diverse populations is necessary to elucidate the relationship between SUA and cardiac function in STEMI patients.

Impact of preexisting hypertension and antihypertensive medication on prognosis of COVID-19 patients

Mohsen Gholinataj Jelodar — 2024-08-11

Objectives: Coronavirus disease-2019(COVID-19) patients with comorbidities experience severe disease. Hypertension (HTN) is one of the most common comorbidities seen in these patients. The published reports are conflicting regarding the role of HTN and antihypertensive medication on the in-hospital prognosis of COVID-19 patients. This study investigated the effect of HTN on the prognosis of hospitalized COVID-19 individuals and sought to identify the risk factors for worse clinical outcomes in this population.

Methods: This descriptive-analytical observational study was conducted on COVID-19 patients hospitalized in two teaching hospitals (Shahid Rahnemoon and Shahid Sadoughi) in Yazd, Iran from February 20, 2022, to April 20, 2022. All hospitalized patients with positive polymerase chain reaction (PCR) tests for COVID-19 were included in the study. The demographic, laboratory, imaging, pharmaceutical and clinical data were extracted and analyzed by SPSS v-26.

Results: Out of 615 participants, 243 had HTN. Hypertensive patients had significantly more need for Intensive Care Unit (ICU) admission (P=0.001) and endotracheal intubation (P<0.001) and experienced higher mortality (P<0.001). The length of hospital and ICU stay and duration of endotracheal intubation were not significantly different. No antihypertensive medication was found to impact the patient's prognosis significantly. In hypertensive individuals, the multivariate regression analysis revealed the vaccination status (OR=0.27; CI 95%: 0.10-0.69), a score of Computed tomography (CT) scan involvement (OR=7.49; CI 95%: 3.50-16.01), and neutrophil-to-lymphocyte ratio (NLR) (OR=1.05; CI 95%: 1.00-1.11) as the predictors of need to ICU admission.

Conclusions: Hypertensive COVID-19 patients experience higher mortality and require more ICU admission and endotracheal intubation. None of the antihypertensive drugs had a significant effect on prognosis. The vaccination status, NLR, and the degree of lung involvement in chest imaging predicted the need for ICU admission in this subgroup of patients.

Vitamin D deficiency and its impact on outcomes in myocardial infarction patients: a prospective observational study

Mirhossein Seyed-mohammadzad — 2024-08-11

Objectives: Vitamin D deficiency has been linked to cardiovascular diseases, but its impact on outcomes in myocardial infarction (MI) patients remains unclear. This study investigated the relationship between serum vitamin D levels and short-term and medium-term outcomes in patients with myocardial infarction. Ischemic heart diseases (IHD) are the most common cause of death in the world. Identifying risk factors and predictors can play a critical role in identifying high-risk people in screenings, identifying high-risk patients during admission to the hospital, and adjusting these risk factors in patients to improve prognosis.

Methods: This prospective observational study was conducted on 212 patients diagnosed with myocardial infarction at Seyed al-Shohada Hospital in Urmia, Iran. Having been admitted, the patients had their serum vitamin D levels measured using the same blood sample for routine tests. Levels of vitamin D were categorized as normal (>30 ng/ml), insufficient (21-29 ng/ml), or deficient (<20 ng/ml). The patient's files provided the demographic, clinical, and biomedical information, echocardiography, and angiography data. The patients were followed for at least six months post-MI, with a maximum follow-up of 11 months. Follow-up occurred through monthly phone calls and outpatient clinic visits as needed. Primary outcomes included in-hospital complications (such as death, significant bleeding, acute pulmonary edema, cardiogenic shock, and arrhythmias), cardiac readmissions, and mortality. Logistic regression and Cox regression analyses were used to examine the connection between outcome variables and vitamin D levels, adjusting for potential confounders including age, gender, blood pressure, diabetes, blood lipids, creatinine, disease severity (SYNTAX score*), and left ventricular ejection fraction. The mean serum level of vitamin D in patients on admission was 33. 62 ng/dL. The average number of hospitalization days was 4.8 days, and the rate of re-hospitalization was 26.6% in the six-month follow-up and 30.3% in the 9-month follow-up. The hospital mortality rate was equal to 1.4%, and the mortality rate at the end of the follow-up period was equal to 8.3%. The most common complication during hospitalization among the patients was ventricular tachycardia. However, in follow-up, re-hospitalization due to previous issues was the most common complication.

Results: The mean serum vitamin D level was 33. 62 ng/ml,with 52.8% of patients having insufficient or deficient levels. The most common in-hospital complication was ventricular tachycardia (11.5%). Vitamin D deficiency was not significantly associated with in-hospital complications. However, during the follow-up period, vitamin D deficiency was significantly related to increased risk of readmission to hospital (HR: 6.984, 95% CI: 3.500-13.936, p<0.001). The 6-month readmission rate was 26.6%, increasing to 30.3% at 9 months. Vitamin D deficiency was also associated with increased cardiac mortality (HR: 12.936, 95% CI: 1.494- 112.016, p=0.020) during follow-up. The 9-month mortality rate was 8.3%. Other factors contributing to cardiac mortality included disease severity (SYNTAX score) and female gender.

Conclusions: While vitamin D deficiency did not impact short-term complications, it was associated with increased risk of hospitalreadmission and mortality in MI patients during medium-term follow-up. These findings suggest that vitamin D status can significantly impact long-term outcomes for MI patients