Factors That Predict Early Return to Work After Myocardial Infarction: Importance of Coworker Support

Aim    Myocardial infarction (MI) affects the working-age group and cause many absences and lost days of work. Some occupational factors effect in the prognosis of MI patients. The objective of this study was to determine predictors of early, late and no return to work (RTW) after MI.Material and methods    In this cohort study, 240 pre-employed, male patients with MI from April 2020 through February 2022 provided data about their demographic, occupational, psychosocial, and medical information. Data was also collected about the treatment they received as patients, their feelings about socioeconomic support, and RTW time. RTW within two weeks after MI was defined as early RTW. The relationships of these variables and with early RTW and with late or no RTW were analyzed.Results    Ninety-four patients (39.6 %) returned to work within two weeks after MI, whereas 207 patients (87.3 %) returned to work by the end of six months. Many variables, including coworker support, were associated with early RTW in a univariate analysis. Regression analysis revealed that age, coworker support, marital status, the patient's own estimated RTW time, the number of the vessels with occlusion, and comorbidity were predictors of early RTW. Of these factors, only coworker support would be subject to modification.Conclusions    This study indicates that improving support from coworkers can increase early RTW after MI.

Association of the high-sensitive cardiac troponin T levels and long-term mortality in patients with acute aortic dissection type A

Introduction

Acute aortic dissection type A is a life-threatening cardiovascular emergency necessitating rapid diagnosis and treatment. We sought a new prognostic tool with cardiac biomarkers and simple inflammatory factors.

Methods

from 2003 to 2014, 50 patients with documented acute aortic dissection type A were entered to this study. These patients were followed up until December 2020; within median follow up of 93.6 months. The patients were evaluated on the association of the baseline characteristics, first laboratory investigation, echocardiographic findings, surgical approach, and long-term mortality.

Results

Total number of mortality during the follow up was 29 (58%) patients, which was significantly higher in medical group (89.4% vs 38.7%, P value=0.001). Multivariable analysis showed only an increase in hs-cTnT levels was suggested as a predictor of mortality (95% CI: 1.06-1.38; HR=1.21; P=0.005), so that for every 100 units increase, patients were 21% more likely to have mortality in long term. Also, performing surgical treatment for aortic dissection was determined as the independent predictor of surviving, so that death was 74.6% less than those who received medical treatment (95% CI: 0.13-0.58; HR=0.27; P=0.001).

Conclusion

hs-cTnT is a potential predictor of mortality in patients with acute aortic dissection type A.

Normal Ranges of Right Atrial Strain and Strain Rate by Two-Dimensional Speckle-Tracking Echocardiography: A Systematic Review and Meta-Analysis

Background: Normal range values of right atrial (RA) phasic function markers are essential for the identification of normal and abnormal values, comparison with reference values, and the clinical meaning of obtained values. Accordingly, we aimed to define the normal range values of RA phasic function markers obtained by 2D speckle-tracking echocardiography through a meta-analysis and determine the main sources of heterogeneity among reported values. Methods: PUBMED, SCOPUS, and EMBASE databases were searched for the following keywords: "right atrial/right atrium" and "strain/speckle/deformation" and "echocardiography." Studies were selected that included a human healthy adult group without any cardiovascular diseases or risk factors and that were written in the English language. For the calculation of each marker of RA phasic functions, a random-effect model was used. Meta-regression was employed to define the major sources of variabilities among reported values. Results: Fifteen studies that included 2,469 healthy subjects were selected for analysis. The normal range values for RA strain and strain rate were 42.7% (95% CI, 39.4 to 45.9%) and 2.1 s^-1 (95% CI, 2.0 to 2.1 s^-1) during the reservoir phase, respectively, 23.6% (95% CI, 20.7 to 26.6%) and -1.9 s^-1 (95% CI, -2.2 to -1.7 s^-1) during the conduit phase, correspondingly, and 16.1% (95% CI, 13.6 to 18.6%) and -1.8 s^-1 (95% CI, -2.0 to -1.5 s^-1) during the contraction phase, respectively. The sources of heterogeneity for the normal range of these markers were the number of participants, the type of software, the method of global value calculation, the right ventricular fractional area change, the left ventricular (LV) ejection fraction, the RA volume index, sex, the heart rate, the diastolic blood pressure, the body mass index, and the body surface area. Conclusions: Using 2D speckle-tracking echocardiography, we defined normal values for RA phasic function markers and identified the sources of heterogeneity as demographic, anthropometric, hemodynamic, and echocardiography factors. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021236578, identifier: CRD42021236578.

Concomitant ventricular septal rupture and interventricular septal aneurysm in neglected inferior myocardial infarction misdiagnosed with congenital ventricular septal defect: A case report

This study emphasizes that VSD should not be immediately diagnosed as a congenital disorder; instead, regional wall motion abnormalities in the left ventricle should also be taken into account since it may result from mechanical complications of neglected myocardial infarction.

Interaction effect of myocardial infarction and obesity on left atrial functions

PURPOSE

To determine whether myocardial infarction (MI) would lead to a greater decrease in left atrial (LA) functions in subjects with than without obesity.

METHODS

A total of 310 consecutive patients were divided into four groups according to the presence or absence of obesity and MI. The functions of the LA were evaluated in terms of longitudinal deformation of the LA myocardium via 2D speckle-tracking echocardiography.

RESULTS

The adjusted analysis showed a reduction in the strain and strain rate during the reservoir and contraction phases and in the strain rate during the conduit phase in patients with MI and in subjects with obesity (P < .05). In addition, there was a significant interaction effect of obesity and MI on the strain rate during the contraction phase (P = .048).

CONCLUSIONS

There is an independent and additional interaction effect of obesity and MI on the reservoir and conduit functions of the LA. MI was more deleterious to the contraction function in subjects without than with obesity, so that the contraction function was similar in MI patients without obesity and MI patients with obesity.

Steroid use for recovery of advanced atrioventricular block immediately after valvular surgery (survival): a randomized clinical trial

Funding Acknowledgements

Type of funding sources: None.

Background

Limited inconsistent evidence support use of steroids in recovery of atrioventricular block (AVB) after trans-catheter aortic valve implantation. However, there is no study to examine the efficacy of steroids in recovery of high-grade AVB following valvular surgery.

Purpose

 To assess the effect of high-dose dexamethasone on recovery of advanced AVB following valvular heart surgery.

Methods

In this randomized controlled trial, patients with advanced postoperative AVB (either Mobitz type II or third degree) were randomly assigned to receive either dexamethasone (0.4 mg /kg, maximum 30 mg /day in three divided doses) intravenously for three days or conservative care only. Primary endpoint was recovery rate in day five since randomization. Secondary endpoints were recovery rate in day 7 and day 10, cumulative AVB time, PPM implantation rate, length of stay in critical care units, and post-operative major adverse events (MAE) during one month. We defined MAE as composite of all-cause mortality, all-type infections, major bleeding, prolonged sternal dehiscence, new stroke, postoperative MI, complicated uncontrolled hyperglycemia and readmission for decompensated heart failure.

Results

We enrolled 139 subjects (48.9% male) with mean age of 59.9 years who were randomly allocated to intervention group (n= 69) and control group (n= 70). Dexamethasone led to higher recovery rates at day 5 (82.6% vs. 62.9%, P= 0.009) and day 7 (88.4% vs. 61.4%, P&lt; 0.0001) respectively. Random 24-hours ECG Holter monitoring of patients at day 5 revealed the same results and confirmed the superiority of dexamethasone for recovery of AVB (80.5% vs 61.2%, respectively, P = 0.024). Although this benefit ceased at day 10 (83.05 vs 78.6 %, P = 0.547), Generalized Estimating Equation analysis for recovery over 10 days favored intervention (odds ratio: 2.56, 95% CI: 1.27- 5.15, P = 0.008). Median cumulative AVB time was shorter in dexamethasone group compared to control group (41 hours vs 64 hours, P = 0.044). PPM implantation rates were similar between the dexamethasone and control groups (15.9% vs 17.1 %, respectively, P = 0.849). Median length of stay in ICU (10 days vs 12 days, P= 0.03) and MAE (17.4 % vs 25.7%, P = 0.133) tended to be lower with dexamethasone.

Conclusion

Our findings suggest that dexamethasone may serve as a safe and effective medication to improve recovery of advanced AVB after valvular surgery. Further studies are needed to confirm these findings, particularly regarding subsequent PPM implantation rate.

Predictive Inflammation-related microRNAs for Cardiovascular Events Following Early-Onset Coronary Artery Disease

BACKGROUND

Early-onset coronary artery disease (EOCAD) increases the risk of major cardiac adverse events (MACE) at the level of safety/effectiveness-related events. Since adverse events affect the quality of life of young patients with EOCAD, MACE prediction is of great importance for improving medical decision-making.

AIMS OF THE STUDY

We sought to determine whether the most important inflammation-related microRNAs in atherogenesis could predict MACE among patients with EOCAD.

METHODS

This nested case-control study recruited 143 young patients (males ≤45 and females ≤55 years old), selected from a cohort of patients with premature coronary atherosclerosis at a median follow-up period of 64.1 months. Total RNAs were extracted from their peripheral blood mononuclear cells. The expression levels of 18 miRNAs, which are involved in inflammation and atherogenesis, were analyzed via quantitative reverse transcription PCR.

RESULTS

A scoring model based on the upregulation of miR-146a_1 and miR-342_1, along with a history of myocardial infarction and the chronic usage of antithrombotic drugs, was able to predict MI/death at the level of safety-related events (higher vs lower risk scores: sHR: 4.61, 95% CI: 1.57-13.57, and p = 0.005). Another prediction model based on the downregulation of miR-145_1, age, and a history of unstable angina was also able to predict revascularization at the level of effectiveness-related events (higher vs lower risk scores: sHR: 2.90, 95% CI: 1.49-5.66, and p = 0.002).

CONCLUSIONS

Our results highlighted the role of miRNAs in adverse cardiac events and suggest that miR-146a_1, miR-342_1, and miR-145_1 may be useful biomarkers in predictive and preventive cardiology.

Prediabetes, heart mechanics, and echocardiography: A narrative review

Prediabetes is a dysglycemic state that affects many around the world and is a known risk factor for the occurrence of type 2 diabetes mellitus in the future, accompanied by vascular complications. Evidence abounds regarding myocardial involvement in prediabetes. We herein review studies having applied tissue Doppler imaging or speckle-tracking echocardiography to evaluate myocardial function in subjects with prediabetes to depict a picture of cardiac mechanics in individuals with prediabetes in comparison with patients suffering from diabetes mellitus and individuals in the normoglycemic state. Finally, we present the detrimental effects of prediabetes on cardiac mechanics.

Bloody Pericardial Effusion with a Huge Pericardial Mass: A Case Report

Nowadays, the early diagnosis of tumoral diseases is more possible and accurate with multiple diagnostic imaging modalities such as chest X-ray, echocardiography, computed tomography, and magnetic resonance imaging, especially for cardiac tumors which are usually asymptomatic, even in large sizes. In cardiac masses, the patients’ presentations are nonspecific and dependent on the tumor size and site as well as its compressive effect on the adjacent structures. On the other hand, the first and last signs could be sudden cardiac death. However, cardiac masses are either benign or malignant and metastatic in their malignant type, and their definite diagnosis is only possible by surgical tumor resection and tissue biopsy. In this paper, we describe an old patient with severe pericardial effusion and an unusual intrapericardial tumor in transthoracic echocardiography, representing a rare case of a giant ectopic thymoma after surgical resection and pathologic assessment.

Interaction Effect of Diabetes and Acute Myocardial Infarction on the Left Atrial Function as Evaluated by 2-D Speckle-Tracking Echocardiography

The aim of the study described here was to investigate, using 2-D speckle-tracking echocardiography, whether myocardial infarction (MI) leads to diminished left atrial function in diabetic patients by comparison with non-diabetic patients. A total of 310 consecutive patients were divided into four groups based on the presence or absence of diabetes mellitus (DM) and acute ST-elevation MI. In the adjusted analysis, systolic and early diastolic strain and strain rate were reduced in the diabetic patients. Additionally, all deformation markers were impaired in the patients with MI. The DM-MI interaction was not statistically significant. Although reservoir, conduit and contraction functions of the left atrium were reduced in the patients with MI, left atrial reservoir and conduit functions were decreased in the diabetic patients. The reduction in left atrial function caused by MI was similar for diabetic and non-diabetic patients. Thus, DM and MI additively damaged left atrial function.

Prognostic role of moderate functional tricuspid regurgitation in length of hospitalization in patients undergoing isolated coronary artery bypass grafting

Functional tricuspid regurgitation (FTR) is defined as abnormal systolic tricuspid leakage with normal valve structures, and its prognostic role and management in patients with left-heart valve disease is well known. Due to paucity of data on FTR in patients with ischemic heart disease, the aim of our prospective study was to compare the prognostic effect of FTR between patients with moderate FTR and those with less-than-moderate FTR undergoing isolated coronary artery bypass graft (CABG) surgery. This prospective cohort study included all the patients who were candidate for isolated CABG and were referred for preoperative transthoracic echocardiography between April 2018 and November 2018. Patients were categorized into two groups: less-than-moderate FTR and moderate FTR. The endpoints of the study were the prognostic effect of FTR on short-term mortality and morbidities as a composite endpoint, as well as length of hospitalization, length of intensive care unit (ICU) stay, and ventilation time. Of a total of 410 patients, 363 patients (mean age = 62.4 years, 63.7% men) entered our final analysis. Logistic regression analysis demonstrated that composite endpoints of short-term mortality and morbidities was not significantly different between the two groups, but moderate FTR had a statistically significant effect on length of hospitalization (P = 0.002) and the ventilation time (P = 0.048). This effect, however, did not persist after adjustments for probable known confounders. Our study indicated no significant prognostic effect for preoperative FTR versus less-than-moderate FTR on short-term mortality and morbidities, as well as length of hospitalization, length of ICU stay, and the ventilation time.

Bloody Pericardial Effusion with a Huge Pericardial Mass: A Case Report

Nowadays, the early diagnosis of tumoral diseases is more possible and accurate with multiple diagnostic imaging modalities such as chest X-ray, echocardiography, computed tomography, and magnetic resonance imaging, especially for cardiac tumors which are usually asymptomatic, even in large sizes. In cardiac masses, the patients' presentations are non- specific and dependent on the tumor size and site as well as its compressive effect on the adjacent structures. On the other hand, the first and last signs could be sudden cardiac death. However, cardiac masses are either benign or malignant and metastatic in their malignant type, and their definite diagnosis is only possible by surgical tumor resection and tissue biopsy. In this paper, we describe an old patient with severe pericardial effusion and an unusual intrapericardial tumor in transthoracic echocardiography, representing a rare case of a giant ectopic thymoma after surgical resection and pathologic assessment.

Prediabetes and Right Ventricular Function: What Should Be Done for Clarification?

The article's abstract is no available.

Comparison of the effect of 80 vs 40 mg atorvastatin in patients with isolated coronary artery bypass graft surgery: A randomized clinical trial

OBJECTIVES

Atorvastatin can decrease cardiac injury after coronary artery bypass graft (CABG) surgery. We compared the effects of 80 and 40  mg of atorvastatin per day on the levels of cardiac troponin T (cTnT) and creatine kinase-MB (CK-MB) after an isolated CABG.

METHODS

This randomized single-blind parallel clinical trial enrolled 125 patients (mean age = 60.59 ± 8.37 years) who were candidates for elective isolated CABG at the Tehran Heart Center between May 2017 and December 2017. Patients were randomly allocated into two groups to receive either 80 mg (n = 62) or 40 mg of atorvastatin (n = 63) per day, 5 days before surgery. The levels of cTnT and CK-MB, used as myocardial injury markers, were measured at baseline and then at 8 and 24 hours after CABG.

RESULTS

The levels of CK-MB and cTnT at baseline and at 8 and 24 hours following CABG were not significantly different between the two groups. Our repeated measures analysis of variance showed that the levels of CK-MB and cTnT increased significantly over time (P <  .001). No significant interaction was observed between time and the atorvastatin dosage on the levels of either CK-MB (P =  .159) or cTnT (P =  .646). In addition, the between-group effects were not significant for CK-MB (P =  .632) and cTnT (P =  .126).

CONCLUSION

The higher dose of atorvastatin (80 mg) did not exert a more protective effect than the standard dose of atorvastatin (40 mg) after CABG surgery.

Sex-dependent effects of diabetes mellitus on the revascularization rate in mid-term follow up of young patients with coronary artery disease

AIMS

We investigated the association between Type-2 diabetes mellitus (DM) and the need for revascularization at a 5-year follow-up of young coronary artery disease patients and the role of sex in this regard.

METHODS

Among 1121 young (males≤45, and females≤55years) patients (female: 49.7%) from Tehran Heart Center's Premature Coronary Atherosclerosis Cohort, 371(33.1%) had diabetes prior to angiography. Revascularization was considered as either percutaneous coronary intervention or coronary artery bypass graft surgery.

RESULTS

The mean follow-up duration was 57.67±22.43months. In the univariable analysis, diabetics were at a significantly higher risk of revascularization than nondiabetics (Sub-distributional Hazard Ratio [SHR]=1.843, P value<0.001). There was no association between DM and revascularization among men (SHR=1.232, P value=0.508). In contrast, women with DM had threefold more revascularization risk than women without DM (SHR=3.519, P value<0.001). After adjustment for confounding factors, the risk of revascularization in diabetics compared to nondiabetics increased to 2.139 fold (95% CI=1.473, 3.108) among the whole subjects, remained nonsignificant among men, and increased significantly to 3.725 fold (95% CI=2.067, 6.725) in women.

CONCLUSIONS

Our data showed that in women with premature CAD, but not in men, DM may have a significant role in emerging revascularization during a mean follow-up of 5years.

Ruptured Sinus of Valsalva Aneurysm Accompanied by Aortic and Tricuspid Valve Endocarditis: A Case Report

A ruptured sinus of Valsalva aneurysm rarely accompanies the aortic and tricuspid valve endocarditis. A 36-year-old woman presented with low-threshold dyspnea on exertion and fever. Transthoracic and transesophageal echocardiography showed a ruptured noncoronary sinus of Valsalva aneurysm with large vegetations on the tricuspid and aortic valves, resulting in moderately severe tricuspid regurgitation and severe aortic regurgitation. Blood culture was negative. The patient was initially treated with antibiotics and then subjected to the surgical repair of the sinus of Valsalva aneurysm and the tricuspid and aortic valve replacement. The patient's postoperative period was uneventful, and she was discharged healthy.

Constrictive Pericarditis and Primary Amenorrhea with Syndactyly in an Iranian Female: Mulibrey Nanism Syndrome

Mulibrey nanism is a rare autosomal recessive syndrome caused by a mutation in the TRIM37 gene with severe growth retardation and multiple organ involvement. Early diagnosis is important because 50% of the patients develop congestive heart failure owing to constrictive pericarditis, and this condition plays a critical role in the final prognosis. A 37-year-old female patient presented with symptoms of dyspnea on exertion and shortness of breath. She had severe growth failure and craniofacial dysmorphic feature. Cardiac evaluation showed constrictive pericarditis, moderate pulmonary hypertension, and mild pericardial effusion. The patient underwent pericardiectomy, but her thick and adhesive pericardium forced the surgeon to do partial pericardiotomy. Our report underlines the importance of attention to probable Mulibrey nanism when confronting patients with primary amenorrhea, growth retardation, and dysmorphic features. Early cardiac examination is of great significance in the course of the disorder, and patients must be pericardiectomized to relieve the symptoms and increase survival.

Factors Associated with Depressive Symptoms in Young Adults with Coronary Artery Disease: Tehran Heart Center's Premature Coronary Atherosclerosis Cohort (THC-PAC) Study

Objective: Depressed coronary artery disease (CAD) patients may experience a poorer prognosis than non-depressed patients. The aim of this study was to find the associated factors for depressive symptoms in young adults with CAD. Method: This was a cross-sectional study within Tehran Heart Center's Premature Coronary Atherosclerosis Cohort (THC-PAC) study. Young adult CAD patients (men ≤ 45 year-old and women ≤ 55 year-old) were visited from March 2013 to February 2014. Demographic, clinical and laboratory data were collected and all patients were asked to fill in the Beck Depression Inventory II. Informed consent was obtained from all participants. A logistic regression model was used to find multiple associated factors of depressive symptoms. Results: Seven hundred seventy patients (mean ±SD age: 45.34 ±5.75 y, men: 47.7%) were visited. The point prevalence of depressive symptoms was 46.9% in women and 30.2% in men (p < 0.001). Logistic regressions model revealed that the most important associated factors for depressive symptoms in the male premature CAD patients were opium usage (OR: 2.4, 95% CI: 1.33-4.43), major adverse cardiac events (MACE) (OR: 2.2, 95% CI: 1.17-3.93), initial coronary artery bypass grafting (CABG) treatment (OR: 2.1, 95% CI: 1.07-4.06), positive family history for CAD (OR: 1.8, 95% CI: 1.11-3.01) and cigarette smoking (OR: 1.7, 95% CI: 0.97-2.98). Hypertension showed a protective role in this group of patients (OR = 0.5, CI = 0.29-0.92). In the female patients, hypertension (OR = 1.5, CI = 0.96-2.22) and body mass index (BMI) (OR = 1.1, CI = 1.02-1.10) were associated with depressive symptoms. Conclusion: In premature CAD male patients, opium usage, MACE, initial CABG treatment, positive family history for CAD and cigarette smoking were associated with depressive symptoms; and hypertension and BMI were associated with depressive symptoms in women.

Factors Associated with Anxiety in Premature Coronary Artery Disease Patients: THC-PAC Study

Anxiety may negatively affect the course of coronary artery disease (CAD). The aim of this study was to assess which factors are associated with anxiety in young adults with CAD. A cohort of individuals with premature coronary artery disease was formed between 2004-2011, as the Tehran Heart Center's Premature Coronary Atherosclerosis Cohort (THC-PAC) study. Patients (men≤45-year-old, and women≤55-year-old) were visited between March 2013 and February 2014. All participants were examined, and their demographic, clinical, and laboratory data were collected. Then, all participants filled in the Beck Anxiety Inventory. Logistic regression models were used to identifying factors related to anxiety in both sexes. During the study, 708 patients (mean [SD] age: 45.3 [5.8] y, men:48.2%) were visited. Anxiety was present in 53.0% of participants (66.0% of women and 39.0% of men). The logistic regressions model showed that the associated factors for anxiety in men were opium usage (OR=1.89, 95% CI: 1.09-3.27), positive family history (OR=1.49, 95% CI:0.94-2.35), and creatinine serum level (OR=1.17, 95% CI:1.05-1.303); and in women were major adverse cardiac events (MACE) during follow-up (OR=2.30, 95% CI:1.25-4.23), hypertension (OR=1.71, 95% CI:1.07-2.73) and the duration of CAD (OR=0.99, 95% CI:0.98-1.00). In premature CAD patients, the determinants of anxiety seem to be different in each sex. Opium usage, positive family history of CAD, and creatinine serum levels in men, and MACE, hypertension, and duration of CAD in women appear the relevant factors in this regard.

Double cardiac pseudoaneurysm in a postoperative patient

A mitral-aortic intervalvular fibrosa pseudoaneurysm is a rare complication after aortic and mitral valve replacement and aortic root replacement. A left ventricular pseudoaneurysm after mitral valve replacement is also a rare complication. Here, we describe a 48-year-old woman with a history of a Bentall operation and mitral valve replacement 6 years before, presenting with double pseudoaneurysms in the left ventricle and mitral-aortic intervalvular fibrosa, detected via transesophageal echocardiography.

Introducing the Tehran Heart Center's Premature Coronary Atherosclerosis Cohort: THC-PAC Study

BACKGROUND

Data on premature coronary artery disease (CAD) are scarce. The Tehran Heart Center's Premature Coronary Atherosclerosis Cohort Study (THC-PAC) is the first study of its kind in the Middle East to assess major adverse cardiac events (MACE) in young CAD patients.

METHODS

The cohort consists of CAD patients, males ≤ 45 years old and females ≤ 55 years old. The participants are residents of Tehran or its suburbs and underwent coronary angiography between June 2004 and July 2011. A 10-year follow-up, via either clinical visits or telephone calls at least once a year, was commenced in August 2012. The end point is considered MACE, encompassing death, myocardial infarction, stroke, new coronary involvement, percutaneous coronary intervention, and coronary artery bypass grafting.

RESULTS

The cohort comprises 1232 eligible patients (613 [49.8%] males) at a mean age of 45.1 years (SD = 5.8). High frequencies of conventional risk factors, including hyperlipidemia (884 [71.8%]), hypertension (575 [46.7%]), positive family history (539 [43.8%]), cigarette smoking (479 [38.8%]), and diabetes mellitus (390 [31.7%]), were seen in the participants. The mean body mass index (BMI) of the enrolled patients was high (29.2 ± 4.8 kg/m(2)), and 532 (43.3%) and 440 (35.8%) of them were overweight and obese, respectively. The females' BMI was higher (30.4 ± 5.3 vs. 28.0 ± 3.9 kg/m2; P < 0.001) and they had a greater mean abdominal circumference (99.9 ± 13.5 vs. 98.1 ± 9.3 cm; P = 0.035). Between August 2012 and August 2013, follow-up was successful in 1173 (95.2%) patients (median follow-up duration = 55.3 months, 95%CI: 53.5-57.0 months).

CONCLUSION

Our younger patients with CAD had a high frequency of risk factors compared to the same-age general population and all-age CAD patients, which may predispose them to higher incidence of recurrent MACE.

Triple valve replacement for rheumatic heart disease: short- and mid-term survival in modern era

OBJECTIVES

Triple valve replacement (TVR) is still deemed a complex and challenging choice for rheumatic heart disease (RHD) and carries significant mortality and morbidity. We report the short- and mid-term results after TVR in the last decade.

METHODS

In a historical cohort, ninety consecutive patients, at a mean age of 47 ± 12 years underwent TVR between 2003 and 2013 for RHD. Most of the patients were in the New York Heart Association (NYHA) functional class II or III. Univariate and multivariate analyses were performed to identify the predictors of overall and event-free survival.

RESULTS

The 30-day hospital mortality rate was 6% (n = 5). One-year and 4-year overall survival (cardiac survival) rates were 91.7 and 89.5%, respectively. One-year and 4-year rates of freedom from cardiac events (e.g. cardiac death, cardiac rehospitalization, cardiac reoperation, cerebrovascular events, anticoagulation-related major haemorrhage and significant valvular malfunction) were 83.5 and 69.5%, respectively. Age, diabetes and pump time were the independent predictors of overall survival, and diabetes and hypertension were the independent predictors of event-free survival. One-year and 4-year freedom rates from anticoagulation-related major haemorrhage were 96.6 and 90.7%, respectively. The 1-year and 4-year rates of freedom from a composite of valvular thrombosis, major bleeding events and thromboemboli were 94.1 and 88.5%, respectively. One-year and 4-year freedom rates from cardiac rehospitalization were 94.0 and 88.0%, respectively. One-year and 4-year rates of freedom from cardiac reoperation were 98.8 and 93.9%, respectively. One-year and 4-year rates of freedom from significant prosthetic valve malfunction (e.g. structural valve deterioration, valve thrombosis and paravalvular leakage) were 96.6 and 90.7%, respectively. The 1-year and 4-year rates of freedom from major adverse valve-related events were 86.3 and 78.5%, respectively.

CONCLUSIONS

TVR for RHD appears to confer satisfactory short- and mid-term results with excellent symptomatic improvement. The overall mortality following TVR may be improved by early surgical treatment before the NYHA functional class IV.

Clinical characteristics and mid-term outcome of patients with slow coronary flow

OBJECTIVE

Due to uncertainty in the clinical implications of slow coronary flow (SCF), we aimed to investigate the clinical features and mid-term outcome of the Iranian patients with the slow coronary flow phenomenon.

METHODS

During a four-year period from January 2005 to December 2009, out of 3523 consecutive patients who underwent coronary angiography in the Tehran Heart Center, 325 patients with no stenosis, ectasia, or aneurysm were enrolled in the study. Among them 81 (2.2%) patients were diagnosed with SCF. Baseline characteristics, lab parameters, coronary risk factors and mid-term outcome were described, consequently. RESUITS: Typical chest pain was the most frequent complaint in both groups (normal flow; 118 (48.4%) vs slow flow; 45 (55.6%)). RCA was the most frequently involved vessel for coronary slow flow followed by LCX and LAD and the combination of LCX and LAD involvement for coronary slow flow accounts for 27.2% of cases and three vessel involvement counts for 23.5%. Most patients experienced no symptoms during the follow-up period (NI; 66.4% vs slow flow; 59.3%). However, three patients (3.7%) in the SCF group who underwent a second angiography 2-4 years later, were redefined as slow coronary flow.

CONCLUSIONS

We could not show any significant difference with respect to initial presentation, coronary risk factors and even mid-term outcome of these patients in comparison to the normal group. However, due to the persistence of the SCF phenomenon even after 2-4 years in the second angiography of our three patients, it seems that slow flow might be a permanent rather than a transient manifestation.

Effectiveness of Two-Year versus One-Year Use of Dual Antiplatelet Therapy in Reducing the Risk of Very Late Stent Thrombosis after Drug-Eluting Stent Implantation

BACKGROUND

Impact of 12 months' versus 24 months' use of dual antiplatelet therapy on the prevalence of stent thrombosis in patients undergoing percutaneous coronary intervention (PCI) with the drug-eluting stent (DES) is not clear. As a result, duration of dual antiplatelet therapy is still under debate among interventionists.

METHODS

From March 2007 until August 2008, all consecutive patients with successful PCI who received at least one DES and were treated with dual antiplatelet therapy (Clopidogrel + Aspirin) were included. All the patients were followed up for more than 24 months (mean = 35.27 ± 6.91 months) and surveyed for very late stent thrombosis and major cardiovascular events.

RESULTS

From 961 patients eligible for the study, 399 (42%) discontinued Clopidogrel after 12 months and 562 (58%) continued Clopidogrel for 24 months. The clinical and procedural variables were compared between the two groups. In the 12 months' use group, two cases of definite thrombosis occurred at 18 and 13 months post PCI. In the 24 months' use group, 2 cases of definite thrombosis occurred at 14 and 28 months post PCI, one of them with stenting in a bifurcation lesion. Five cases of probable stent thrombosis were detected at 21, 28, 32, 33, and 34 months after the procedure. It is of note that amongst the 10 cases of stent thrombosis, only 1(10%) thrombosis occurred when the patient was on Clopidogrel and Aspirin and all the other 9 (90%) cases of thrombosis appeared after the discontinuation of the dual antiplatelet therapy.

CONCLUSION

Extended use of dual antiplatelet therapy (for more than 12 months) was not significantly more effective than Aspirin monotherapy in reducing the risk of myocardial infarction or stent thrombosis, death from cardiac cause, and stroke.