Cardiovascular Biomedicine Journal

The role of artificial intelligence in postoperative care after cardiac surgery

Razieh Parizad — 2025-02-03

The Article Abstract is not available.

Comparison of cold and tepid modified delnido cardioplegia on myocardial protection in open heart surgery patients

Saeed Rostamani — 2025-02-03

Objectives: Cardioplegia is a crucial component of myocardial protection during aortic cross-clamping and cardiopulmonary bypass. It has been reported to provide effective myocardial protection and improved clinical outcomes with enhanced surgical flow in adult cardiac procedures. This study investigates the efficacy and safety of cold-modified Del Nido cardioplegia versus tepid blood cardioplegia in adult cardiac surgery patients using Myotherm, a device mainly used in cardiac surgery to monitor and manage the myocardial temperature during surgery.

Methods: After obtaining approval from the ethics committee and establishing entry criteria that included age, type of heart surgery, and absence of cardioplegic contraindications, the researchers defined exclusion criteria-such as previous heart surgery or significant comorbidities. Seventy patients were randomly divided into two groups: Group A received a cold solution at 4°C( n=35), while Group B received a tepid solution at 28°C (n=35).The amount of cardioplegia was 10 to 15 cc/kg and was injected with a pressure of 70 to 90 mm Hg in an anterograde manner. The temperature of cardioplegia was also adjusted with a Myotherm device. The day before the surgery, a written consent form was obtained from the patients, and the patients were informed about the study method. The sampling method is a double-blind clinical trial to achieve minimal bias, ensuring the reliability of the results and reducing influences on it. This study was conducted in Afshar Hospital in Yazd during 2023 and 2024.

Results: There were no significant differences between the two groups in terms of the need for an intra-aortic balloon pump (p=1.0), intraoperative and postoperative inotropic support (p=0.26), and postoperative pacemaker (p=0.49). Also, there were no significant differences between the two groups in terms of troponin I level after surgery (p=0.50), left ventricular ejection fraction after discharge (p=0.34), time to return of spontaneous heart rhythm (P=0.25), cross-clamp time (P=0.30), cardiopulmonary bypass time (P=0.07), and length of stay in the ICU (P=0.21).

Conclusions: The result showed that both techniques provide similar results. Although the time of cross-clamp and cardiopulmonary bypass was shorter in the group using tepid solution, these differences were not statistically significant. In other words, cold and tepid solutions are equally effective and safe to protect the myocardium, and doctors can use both types of solutions during open heart surgery.

The predictive significance of red cell distribution width in anterior ST- elevation myocardial infarction and its relationship with hospital mortality

Haleh Bodagh — 2025-02-03

Objectives: The clinical diagnosis of acute myocardial infarction (AMI) involves assessing the patient's medical history and indirect evidence of myocardial necrosis using biochemical, electrocardiogram (ECG), or imaging methods. Ischemia, hypoxia, and myocardial necrosis result from a disrupted blood supply to the coronary arteries, typically due to atherosclerosis, thrombosis, and coronary artery obstruction. Given the rising incidence and healthcare costs of ST-elevation myocardial infarction (STEMI), particularly anterior STEMI (ant-STEMI), this study examines the diagnostic value of red cell distribution width (RDW) in ant-STEMI patients and its impact on hospital and one-year mortality post-primary angioplasty.

Methods: This study focused on patients with ant-STEMI undergoing primary angioplasty at Shahid Madani Hospital, Tabriz, Iran, from 2018 to 2019. Exclusion criteria included patients receiving drug or antithrombotic treatment, undergoing coronary artery bypass grafting (CABG), not receiving primary percutaneous coronary intervention (PPCI), suffering from STEMI types other than anterior STEMI, having a history of thalassemia or anemia, and those with incomplete patient records. In-hospital complications, such as cardiogenic shock, hematoma, bleeding, and heart failure (HF), were recorded and analyzed using SPSS 23.

Results: In this retrospective and analytical study of 300 patients, there was no significant relationship between RDW levels and in-hospital (P-value=0.59) and one-year mortality (P-value=0.68). However, RDW was significantly associated with hospital complications such as HF, cardiogenic shock, angio-hematoma, gastrointestinal bleeding, and stent thrombosis (P-value<0.01).

Conclusions: Our study showed that RDW is not a reliable prognostic factor for mortality in anterior STEMI patients.

Incidence of major adverse cardiac and cerebrovascular events following primary percutaneous coronary intervention in central iran

Abbas Andishmand — 2025-02-03

Objectives: ST-segment elevation myocardial infarction (STEMI) is a critical form of acute coronary syndrome that requires immediate myocardial reperfusion to reduce infarct size and enhance patient outcomes. Despite improvements in the management of STEMI, it continues to be a global contributor to mortality. This study aimed to evaluate the long-term prognosis and outcomes of STEMI patients by investigating the incidence of major adverse cardiac and cerebrovascular events (MACCE).

Methods: This prospective cohort study enrolled 305 patients diagnosed with STEMI between March 2016 and February 2017 in Afshar Hospital, a tertiary cardiac hospital in central Iran. The researchers performed Primary percutaneous coronary intervention (PCI) using drug-eluting stents (DES), and patients received standard medical therapy. Data on major adverse cardiac and cerebrovascular events (MACCE), demographic characteristics, clinical factors, and procedural details were collected through patient interviews, medical records, and the myocardial infarction registry database.

Results: The overall success rate of primary PCI was 92.8%. Hypertension was the most prevalent risk factor for coronary artery disease (41.1%). During the one-year follow-up, the incidence of MACCE was 15.1% (46 patients), with death being the most common occurring in 33 patients (10.8%). Mortality rates were highest within the first six months. The multivariate logistic regression analysis revealed that age (P=0.001) and stent length exceeding 30 mm (P=0.036) were significant predictors of mortality.

Conclusions: This study provides important insights into primary PCI outcomes in STEMI patients in central Iran. The findings indicate a high success rate for PCI and emphasize the necessity for timely and appropriate management. MACCE incidence, especially mortality, highlights the importance of ongoing surveillance and comprehensive follow-up care.

Assessment of relationship between red blood cell distribution width and renal function in patients with acute heart failure

Nesa Naji — 2025-02-03

Objectives: To investigate the association between Red Blood Cell Distribution Width (RDW) and renal function in patients experiencing acute decompensated heart failure (ADHF).

Methods: A retrospective analysis was conducted on the medical records of 254 patients admitted to Seyyed Al-Shohada Hospital in Urmia, Iran, between July 2021 and July 2023. Patients' RDW values and Glomerular Filtration Rate (GFR) were analyzed using statistical methods.

Results: The study revealed a significant inverse relationship between RDW and GFR. Patients with elevated RDW levels (greater than 14.5%) demonstrated reduced GFR values compared to those with lower RDW levels. The mean GFR in patients with RDW ≤14.5% was 59.31 ml/min, while in patients with RDW >14.5% it was 49.71 ml/min (p < 0.001).

Conclusions: RDW is an important biomarker for evaluating renal function and predicting outcomes in ADHF patients. RDW inclusion in evaluating ADHF patients could improve risk stratification and facilitate early intervention. Additional studies are necessary to validate these findings and examine the underlying mechanisms. RDW Integration into routine clinical practice may enhance the identification of patients at higher risk for renal complications, enabling timely therapeutic interventions and potentially improving overall patient management and outcomes.

Evaluating the incidence of syncope and electrocardiogram changes in methadone-treated volunteers quitting addiction in yazd

Hesam Hosseini — 2025-02-04

Objectives: Methadone is a synthetic opioid with a high affinity for opioid receptors, widely used as an effective intervention for opioid dependence and the management of acute and chronic pain. However, its use has been associated with serious cardiac side effects, including torsades de pointes (TdP) and prolonged QTc intervals. This study investigated the incidence of syncope and electrocardiogram (ECG) changes in individuals who underwent methadone treatment for addiction.

Methods: This cross-sectional study, conducted in Yazd in 2020, involved 100 participants seeking methadone treatment at an addiction clinic. A cardiologist recorded initial ECGs using a 12-lead ECG device, assessing parameters such as heart rhythm, QTc interval, and premature contractions. Participants were informed about the study procedures and the necessity of follow-up ECGs one week and three months after starting methadone. The researchers monitored the patients for three months with regular outpatient visits.

Results: The findings revealed a significant difference in syncope incidence based on ECG rhythm on day seven and month three, with higher rates observed in patients exhibiting junctional rhythms or PVC (p-value=0.000). Additionally, a significant relationship was found between syncope frequency and U wave status at month three (p-value=0.046).No significant associations were noted for ST segment changes or T wave variations. Furthermore, higher methadone doses, longer QTc intervals on day seven, and prolonged PR intervals correlated with increased syncope occurrences.

Conclusions: This study indicates that ECG-related variables and methadone dosage significantly influence syncope incidence among treated patients. Specifically, individuals with junctional rhythms or PVC and those receiving higher doses of methadone were at greater risk for syncope. Monitoring PR and QTc intervals is crucial for preventing syncope in patients undergoing methadone treatment.

Predictors of in hospital mortality in cardiogenic shock following ST-elevation myocardial infarction (STEMI)

Abbas Andishmand — 2025-02-04

Objectives: Cardiogenic shock (CS) is a severe complication of ST-Elevation Myocardial Infarction (STEMI) and is associated with high mortality rates. This study aimed to identify predictors of in-hospital mortality in patients experiencing cardiogenic shock following STEMI.

Methods: A retrospective cohort study was conducted at Afshar Hospital in Yazd from 2018 to 2023, analyzing clinical data from 62 STEMI patients diagnosed with CS. The mean age of the cohort was 64.9 ± 13.5 years, with a male predominance of 69.5%. Key variables assessed included left ventricular ejection fraction (LVEF), comorbidities, and treatment interventions. Survival analysis and Cox regression were employed to evaluate mortality outcomes.

Results: LVEF less than 30% emerged as a significant predictor of in-hospital mortality, with a hazard ratio of 11.1 (95% CI: 2.6–47.4; p < 0.001). The mean survival time was 7.0 days (95% CI: 5.8–8.3). Additionally, hyperlipidemia was associated with increased mortality, presenting an odds ratio of 11.3 (95% CI: 1.1–114.1; p = 0.040). The prevalence of chronic kidney disease was notably higher in the deceased cohort (28.0% vs. 8.1%; p = 0.042). Although urgent percutaneous coronary intervention (PCI) was performed in the majority of cases, mortality remained significant.

Conclusions: This study highlights that LVEF and hyperlipidemia are critical predictors of in-hospital mortality in patients with cardiogenic shock following STEMI. Other studies also suggest the prognostic value of LVEF in various cardiac conditions, particularly in the context of acute coronary syndromes [14, 15]. Also, the combination of renal dysfunction left ventricular ejection fraction, and advanced age has been proposed as a predictor of in-hospital mortality [18]. These findings underscore the importance of early identification and targeted management strategies to improve patient outcomes in this high-risk population.