ARYA Atherosclerosis
Year:2018 | Volume:14 | Issue:2|Papers Count:8

BACKGROUND: Thalassaemia is a hereditary disorder and has an economic burden on patients and the government. The most prevalent complication in these patients is iron overload which is followed by cardiomyopathy. Digoxin is considered as a treatment against heart failure in thalassaemia. The present study evaluated the effect of two digoxin concentrations on iron content and antioxidative defense in cardiac tissue of iron-overloaded rats. METHODS: The study was conducted on 48 rats which were divided into 6 groups. Group 1 was the control group and did not receive any treatment and group 2 was the iron overload group. In addition groups 3 and 4 were the digoxin control groups which received 1 and 5 mg/kg/day of digoxin, respectively. Groups 5 and 6 received 1 and 5 mg/kg/day of digoxin plus iron-dextran, respectively. After 1 month, malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GPX), and total antioxidant status (TAS) were assessed in cardiac tissues. RESULTS: Co-administration of iron-dextran and digoxin (1 and 5 mg/kg/day) significantly increased SOD and TAS levels (P < 0. 0010) and reduced MDA (P < 0. 0010) in heart tissue compared to control and iron overload groups. GPX levels significantly reduced in groups 5 and 6 (iron + digoxin 1 (P < 0. 0500) and iron + digoxin 5) (P < 0. 0010) compared to the iron control group. CONCLUSION: Digoxin remarkably facilitates iron uptake by cardiomyocytes by affecting other channels such as L-type and T-type Ca2+ channels (LTCC and TTCC). Digoxin administration in the iron-overloaded rat model deteriorated antioxidative parameters and increased iron entry into heart tissue at higher doses. Therefore, in patients with beta thalassaemia major, digoxin must be administered with great care and serum iron and ferritin must be regularly monitored.

BACKGROUND: Atherosclerosis and periodontitis are both chronic inflammatory diseases. Although a strong relationship between the two has already been established, the underlying mechanism is unknown. The present study was conducted aiming to detect the deoxyribonucleic acid (DNA) of Aggregatibacter actinomycetemcomitans (A. a), Campylobacter rectus (C. r), and Porphyromonas gingivalis (P. g) in subgingival and atherosclerotic plaques of patients with both chronic periodontitis and cardiovascular disease (CVD). METHODS: In this cross sectional study, patients with coronary artery disease (CAD) and moderate to severe periodontitis which were scheduled for coronary artery bypass grafting (CABG) were enrolled in the study. The subgingival plaques were collected before surgery. All samples were examined for the detection of selected periopathogens using polymerase chain reaction (PCR). RESULTS: The subgingival and atherosclerotic plaque samples of 23 patients were examined. The DNA of P. g, A. a, and C. r were found to be positive in 43. 47%, 43. 47%, and 78. 26% of subgingival plaques, and 13. 04%, 17. 39%, and 8. 69% of atherosclerotic plaques, respectively. In all cases, the bacterial species found in atherosclerotic plaques were also found in the subgingival plaques of the same patient. CONCLUSION: This study demonstrated the presence of periopathogens in atherosclerotic plaques of patients with chronic periodontitis. More studies are required to ascertain the exact role of these periopathogens in atherosclerotic plaque formation.

BACKGROUND: The aim of this study was describing the sampling methods and sample size of the Isfahan Healthy Heart Program (IHHP) and its sub-studies in focus. METHODS: ehT IHHP was carried out between 2000 and 2007 in urban and rural areas in 3 districts, namely Isfahan and Najafabad (as the intervention areas), and Arak (as the reference area), Iran. It consisted of the 3 phases of baseline surveys during 2000-2001, interventions between 2002 and 2005, and post-intervention surveys during 2006-2007 on 4 target groups (adults, health professionals, cardiac patients, children, and adolescents). During 2002 to 2005, 4 evaluation studies were conducted to evaluate short-term results. An ongoing cohort study entitled the Isfahan Cohort Study was performed on those aged ≥ 35 years at baseline in 2001 to access the risk of cardiovascular disease (CVD) occurrence. RESULTS: Using stratified random cluster methods, 12514, 5891, 4793, 6096, 3012, and 9572 adults and 1946, 1999, 1427, 1223, 389, and 1992 adolescents were chosen in the 1st to 3rd phases. Furthermore, simple random sampling was used for selecting 923, 694, 1000, and 2015 health professionals and 814, 452, 420, and 502 cardiac patients. A multistage sampling method was adopted for the collection of samples from parents of preschoolers and primary school children aged 2-10 years, adolescents’ parents, and some teachers. A prospective cohort study was started on 6504 eligible individuals. CONCLUSION: The IHHP, as a comprehensive community-based interventional trial in Iran, among the few population-based studies around the world, has reasonable sampling methods and sample size.

BACKGROUND: Subclinical inflammation induced by persistent exposure to lipopolysaccharide (LPS) is found in some clinical conditions such as obesity or diabetes. This study aimed to investigate the effect of recurrent LPS exposure on inflammatory markers, oxidative stress balance and cardiac and renal fibrosis in male rats. METHODS: Male Wistar rats were divided into control and LPS-treated. LPS (10 mg/kg/week) was injected intraperitoneally. After 4 weeks, left ventricles and kidneys were homogenized and stained with hematoxylin and eosin (H&E) and Masson trichrome for histological examination. Serum levels of nitrite, interleukin 6 (IL-6) and tumor necrosis factor-α (TNF-α ) were measured and total thiol, malondialdehyde (MDA), superoxide dismutase (SOD) and catalase were evaluated in the heart and kidney homogenates. RESULTS: Serum inflammatory markers were higher in LPS group than control (nitrite: 37. 0 ± 2. 2 vs. 25. 5 ± 1. 9 μ mol/l; IL-6: 84 ± 3 vs. 98. 0 ± 4. 4 pg/ml; TNF-α : 75. 5 ± 4. 9 vs. 85. 3 ± 4. 7 pg/ml; respectively, P < 0. 050). Evaluation of total thiol concentration (heart: 10. 0 ± 0. 9 vs. 22. 5 ± 1. 2; kidney: 7. 0 ± 0. 5 vs. 27. 8 ± 3. 1 nmol/g tissue, respectively), catalase (heart: 0. 18 ± 0. 03 vs. 0. 66 ± 0. 04; kidney: 0. 17 ± 0. 03 vs. 0. 73 ± 0. 03, U/g tissue, respectively) and SOD (heart: 8. 01 ± 0. 70 vs. 12. 3 ± 0. 4; kidney: 7. 02 ± 0. 60 vs. 12. 0 ± 0. 2, U/g tissue, respectively) showed lower levels in LPS-treated group compared to control; while MDA concentration in LPS group was higher than control (P < 0. 05). Histopathological examination in LPS-treated group indicated infiltration of inflammatory cells and more collagen deposition in left ventricle wall and kidney compared to control group. CONCLUSION: We concluded that in clinical conditions with chronic LPS, cardiac and renal fibrosis occurs even in absence of preceding tissue injury due to imbalances in oxidative stress.

BACKGROUND: Acute pulmonary thromboembolism (PTE) is a common disease with a high mortality rate, and a variable and nonspecific clinical presentation. To detect the nonspecific signs and symptoms associated with this condition, several right ventricular (RV) echocardiographic parameters have been proposed as practical marker. METHODS: This cross-sectional study was performed on 93 patients with PTE diagnosed by computed tomography (CT) angiography, and 57 patients with negative PTE based on CT angiography. During the experiment, all patients underwent both transthoracic echocardiography (TTE) and multi-slice CT pulmonary angiography. Transthoracic echocardiography measurements were obtained as patients went through both experimental procedures. These measurements were later compared between the patients with and without PTE. RESULTS: Tricuspid annulus plain systolic excursion (TAPSE) (1. 65 ± 0. 09 vs. 2. 00 ± 0. 08 cm, P < 0. 001) and left ventricular (LV) end-diastolic diameter (4. 54 ± 0. 26 vs. 5. 40 ± 0. 24 cm, P < 0. 001) were significantly lower in patients with PTE as compared to patients without it. Whereas, RV end-diastolic and end-systolic diameters at the papillary muscle levels (3. 41 ± 0. 09 vs. 3. 02 ± 0. 12 cm, and 2. 48 ± 0. 08 vs. 2. 16 ± 0. 06 cm, respectively, P < 0. 001 for both), and tricuspid valve (TV) annulus tissue Doppler imaging (TDI) measurements (6. 02 ± 0. 10 vs. 5. 78 ± 0. 14, P < 0. 001) were significantly greater in patients with PTE. On the other hand, no significant difference was found between the two groups of patients regarding pulmonary artery pressure (PAP) (P = 0. 416), and RV fractional shortening (P = 0. 157). Moreover, our results indicated that RV/LV (cut-off point: 0. 6898) had high sensitivity (93. 5%), specificity (100%), positive predicting value (PPV) (100%), and negative predicting value (NPV) (90. 4%) in diagnosing PTE. CONCLUSION: TTE may be valuable as a substitute diagnostic method for patients with PTE. This technique may also assist in detecting the severity of the illness, by evaluating RV/LV in cut-off point of 0. 6898.

BACKGROUND: This systematic review and meta-analysis aimed to assess the effect of cardiac rehabilitation (CR) on serum C-reactive protein (CRP) as an indicator of the inflammatory state and predictor of recurrent cardiovascular events. METHODS: PubMed, SCOPUS, Cochrane library, and Google Scholar databases were searched up to January 2014 for original articles which investigated the effect of CR on CRP among adult patients with previous cardiovascular events. The random effects model was used to assess the overall effect of CR on the variation in serum CRP levels. RESULTS: In the present systematic review and meta-analysis, 15 studies were included. The analysis showed that CR might significantly reduce high-sensitivity CRP (hs-CRP) levels [Difference in means (DM) =-1. 81 mg/l, 95% confidence interval (CI):-2. 65,-0. 98; P = 0. 004). However, the heterogeneity between studies was significant (Cochran's Q test, P < 0. 001, I-squared = 84. 9%). To find the source of variation, the studies were categorized based on study design (quality) and duration. The negative effect was higher among studies which followed their participants for 3 weeks or less (DM =-2. 75 mg/l, 95% CI:-3. 86,-1. 64; P < 0. 001) compared to studies which investigated the effect of CR for 3-8 weeks (DM =-0. 89 mg/l, 95% CI:-1. 35,-0. 44; P < 0. 001) and those which lasted more than 8 weeks (DM =-1. 71 mg/l, 95% CI:-2. 53,-0. 89; P < 0. 001). There was no evidence of heterogeneity when the categorization was based on the follow-up period. CONCLUSION: Both short-and long-term CR have resulted in improvement in serum hs-CRP levels. CR can be perceived as a beneficial tool to reduce inflammatory markers among patients with previous cardiac events.

BACKGROUND: Trans-radial and trans-ulnar accesses have been practiced and recommended as default and alternative techniques for coronary angiography and angioplasty in recent years. In this study, we present new innovative approaches using more distal access points, i. e. transsnuff box and trans-palmar approaches. METHODS: We conducted dorsal hand access (trans-snuff box) for angiography and/or angioplasty on 235 patients, and trans-palmar access (superficial palmar branch of ulnar artery) on 175 patients in 3 hospitals in Isfahan City, Iran. RESULTS: In 221 patients out of 235 ones (94. 1%) [men: 76. 5%, age: 57. 4 ± 10. 4 (years); women: 23. 5%, age: 62. 4 ± 9. 5 (years)], our procedure through snuff box (dorsal hand) was successfully performed. In 159 patients out of 175 ones (90. 8%) [men: 76. 0%, age: 58. 1 ± 10. 5 (years); women: 24. 0%, age: 61. 2 ± 9. 6 (years)], our procedure through palmar artery was successfully performed. In total, the evaluated patients had mild pain (3. 4% for snuff box, and 4. 5% for palmar), ecchymosis in distal forearm (5. 1% for snuff box, and 2. 8% for palmar), with no major complications even one (amputation, infection, thrombosis, need for surgery, hand dysfunction, nerve palsy, and so forth). In addition, percutaneous coronary intervention (PCI) was done in 28. 9% and 18. 2% of cases via snuff box and palmar approaches, respectively. Meanwhile, hemostasis was very fast and easy with discharge time equivalent to other upper limb accesses. CONCLUSION: Although our procedures are at their early stages with about a follow-up period of 3-15 months, more researches are recommended to be conducted in forthcoming months and years, and this new innovative approaches could be suggested safe, feasible, and reliable with low complications.

BACKGROUND: Amyloidosis is a severe systemic disorder produces by the accumulation of inappropriately amyloid deposition in tissues. Cardiac involvement, as a main type of amyloidosis, has a major impact on prognosis. We describe a biopsy-proven cardiac amyloidosis in an old man with unexpected presentation. CASE REPORT: A 70-year-old man, with a complaint of severe weakness, lightheadedness, and lower limb paresthesia, was admitted to the emergency department. Electrocardiography revealed right bundle branch block and Trifascicular block. Echocardiography study showed a moderately increased thickness of left ventricular wall with concentric pattern as well. Laboratory investigations including serum and urine electrophoresis, and serum free light chain examination as immunofixation assay revealed that κ chains predominated over λ chains in a ratio of 3: 2. Our patient with final diagnosis of amyloid light-chain (AL) amyloidosis underwent chemotherapy with melphalan combined with high-dose dexamethasone, CPHPC and monoclonal antibodies for 2 weeks. CONCLUSION: It shows that rapid diagnosis of AL amyloidosis can enhance the prognosis. Applying an optimal strategy for the treatment leads to effective therapy, too.