Journal of Cardiovascular and Thoracic Research
Year:2019 | Volume:11 | Issue:1|Papers Count:14

Introduction: Iliac vein aneurysm is a rare clinical entity. Iliac venous tract is the least common location for venous aneurysms. There are a few cases of common, external and internal iliac vein aneurysms in the literature. However, undiagnosed and ruptured iliac venous aneurysms could have hazardous consequences. Herein, we reviewed all literature cases of iliac vein aneurysms. Their potential diagnostic and therapeutic challenges are discussed. Literature Review: Following a systematic search, 50 cases of iliac venous aneurysms were identified. We used MEDLINE [1900-March 2018] and EMBASE [until March 2018]. MeSH terms of iliac vein/veins/venous, hypogastric, inferior vena cava and aneurysm/aneurysms were used. Fifty patients with venous aneurysms located in common, external or internal iliac veins were found in our systematic search. Seventeen patients were female (35. 4%) and 31 patients were male (64. 6%). The age range was 13 to 70 years of age. The aneurysm was located in right side in 17 patients (34%). It was located in left side in 29 patients (58%) and it was bilateral in 4 patients (8%). The aneurysm was located in common, external and internal iliac veins in 15 (30%), 31 (62%) and 4 (8%) patients respectively. The aneurysm was due to a previous arteriovenous fistula (AVF) in 19 patients (38%) and of them, 16 patients (32%) had a history of AVF resulting from a previous trauma. 29 patients (59. 2%) underwent open surgical treatment. Five patients (10. 2%) underwent endovascular treatment. One patient (2. 0%) underwent hybrid treatment. Conservative treatment was used in 14 patients (28. 6%). Conclusion: Iliac vein aneurysms are extremely rare. Its diagnosis necessitates precise clinical suspicion and the treatment is based on patients’ clinical scenario and radiological features. Both open and endovascular techniques could be feasible. Iliac vein aneurysms are more common in men. Left sided aneurysms are more common. The most common anatomic location is external iliac vein. The most common cause of iliac aneurysms is dilatation of vein secondary to a traumatic AVF.

Introduction: Cardiovascular fitness is an important goal in cardiac rehabilitation (CR) programs and is predictive of outcomes. We sought to determine the utility of a novel clinical treadmill score in determining prognosis of coronary artery disease (CAD) patients after CR. Methods: Demographic, clinical and exercise data of 262 patients (mean age 55. 8 ± 10. 1 years) who completed an outpatient CR program were analyzed. The FIT treadmill score was determined prior to program initiation and after completion. Patients were classified according to risk category using the FIT scores after CR completion and were followed up for the occurrence of 10 year all cause mortality. Results: On median follow up of 10. 3 years, 52 patients died. An improvement of the FIT treadmill score by 18. 2 points was associated with a 21% reduction in mortality (multivariate-adjusted Hazard Ratio 0. 79, 95% CI 0. 56-1. 08, P ≤ 0. 05). Kaplan-Meier survival curves showed increased occurrence of mortality in the high-risk group. After adjustment for confounders a high-risk FIT score category on exit (HR: 2. 7, 95% CI 1. 41-5. 17, P ≤ 0. 05) was predictive of increased mortality. Both an improvement in the FIT score (AUC=0. 81) and the FIT score category on exit (AUC=0. 92) had good discrimination in predicting mortality. Conclusion: The FIT treadmill score is predictive of all cause mortality in patients with CAD undergoing CR. An improvement in the FIT score after CR is associated with improved survival. The FIT score may be a useful prognostic marker of overall cardiovascular fitness and successful outcome for patients who participate in CR programs.

Introduction: Data suggest that brain natriuretic peptide (BNP) and NT pro-BNP partially reflect ventricular pressure and could have a role in the early detection of diastolic abnormalities in hypertensive patients with normal systolic function. This study aimed to assess the role of NT pro-BNP for early detection of diastolic dysfunction in patients with hypertension and to correlate its level with echocardiographic parameters of diastolic dysfunction. Methods: This is a comparative cross-sectional study. Hundred cases of asymptomatic hypertensive patients with normal left ventricular (LV) systolic function and 100 healthy subjects were subjected to echocardiography and measurement of serum NT-pro BNP who received care at outpatient department of internal medicine, B. P. Koirala Institute of health sciences, Nepal. Results: Both systolic and diastolic blood pressures were significantly higher (≥ 160 and/or 100 mm Hg) in cases compared to controls (<120/80 mm Hg). Echocardiographic parameters of diastolic dysfunction: E/A ratio, E/E’ ratio, deceleration time and isovolumetric relaxation time showed a significant difference between cases and controls. Mean serum NT-proBNP was significantly higher in patients with hypertension (213. 19 ± 184. 3 pg/mL) compared to controls (58. 51 ± 11. 01 pg/mL) (P = 0. 008). There was no significant difference in mean serum NT-pro BNP levels between cases with no LV diastolic dysfunction (n=14) and controls (n=100) but it showed a significant difference between cases with LV diastolic dysfunction of all grades (n=86) and controls (n=100) (P = 0. 00). NT-proBNP levels were higher in both group of patients with E/A ratios <0. 9 and 0. 9-1. 5 (245. 72 ± 166. 73 pg/mL and 210. 69 + 143. 53 pg/mL respectively) as compared to controls. Mean serum NT-proBNP levels were significantly higher in patients with IVRT >90 ms (270. 43 ± 180. 81 pg/mL) as compared to controls (P = 0. 03) but the difference was not significant between cases with IVRT of 60-90 ms (152. 02 ± 100. 23 pg/mL) and controls (P = 0. 09). NT-proBNP levels were significantly higher in all groups of patients with E/E’ ratios <8, 8-12, >12 (197 ± 121. 25 pg/mL, 263. 12 ± 122. 52 pg/mL and 180 ± 106. 56 pg/mL respectively) compared to controls. Conclusion: Mean serum NT-proBNP was significantly higher in patients with hypertension as compared to controls. There is some correlation between echocardiographic parameters of diastolic dysfunction and serum NT-proBNP. Hence, NT-proBNP may be useful for early detection of LV diastolic dysfunction in patients with hypertension.

Introduction: Lipid metabolism is one of the main concerns of cardiovascular disease and atherosclerosis. Little is known about the association between dietary patterns and dyslipidemia. Therefore, the present study aimed to determine such association among Iranian adults. Methods: This cross-sectional study was conducted on 1433 Iranian adults in Isfahan Healthy Heart Program (IHHP). Usual dietary intakes were assessed with the use of a 48 items food frequency questionnaire (FFQ). Factor analysis was used to identify dietary patterns. Three major dietary patterns were identified: western, semi healthy and healthy fat patterns. Results: After adjustment, subjects in the upper quartiles of western dietary pattern were more likely to have high total cholesterol concentrations than those in the first quartile (odds ratio [OR]: 2. 07; 95% CI: 1. 25-3. 42). Individuals with greater adherence to western dietary pattern had greater odds of having high low-density lipoprotein-cholesterol (LDL-C) levels compared with those in the lowest quartiles (2. 53; 1. 45-4. 40). Conclusion: Semi healthy dietary pattern was not associated with cardiovascular disease (CVD) risk factors. Same trend was observed for healthy fat dietary pattern. Significant association was found between western dietary pattern and dyslipidemia among Iranian adults.

Introduction: Many studies have been conducted on non-adherence with the antihypertensive treatment regime in various countries, considering the burden of cardiovascular disease (CVD) on the public health system, it is essential to carry out studies in this regard. Methods: Patients with hypertension evaluated at the family medicine clinic of Tabriz University of Medical Sciences were enrolled using simple sampling. Data gathering tool was a questionnaire consisting of three sections including the Hill-Bone compliance questionnaire, the disease characteristics, and patients’ socioeconomic. Results: Of 254 patients with hypertension, gender, income satisfaction, the occupation and the level of education did not correlate with the acceptance of the treatment. However, the number of antihypertensive medications had a significant effect on adherence with dietary orders and appointment keeping (P < 0. 01 and P = 0. 01, respectively). The number of antihypertensive drugs could statistically significantly predict overall score obtained from the questionnaire, F (1, 251) = 22. 29, P < 0. 018. Conclusion: Factors related to the history of the disease and socioeconomic status had no effect patients adherence with treatment; however, the number of the prescribed antihypertensive drugs is in association with higher overall scores obtained through the Hill-Bone questionnaire.

Introduction: Human amnion-derived mesenchymal stem cells (hAMSCs) have been used in the treatment of acute myocardial infarction. In the current study, we investigated the efficacy of hAMSCs for the treatment of chronic model of myocardial ischemia and heart failure (HF) in rats. Methods: Male Wistar rats weighing between 250 to 350 g were randomized into three groups: sham, HF control and HF+hAMSCs. For HF induction, animals were anesthetized and underwent left anterior descending artery ligation. In HF+hAMSCs group, 2×106 cells were injected into the left ventricular muscle four weeks post ischemia in the border zone of the ischemic area. Cardiac function was studied using echocardiography. Masson’ s trichrome staining was used for studying tissue fibrosis. Cells were transduced with green fluorescent protein (GFP) coding lentiviral vector. Immunohistochemistry was used for detecting GFP, vascular-endothelial growth factor (VEGF) and troponin T markers in the tissue sections. Results: Assessment of the cardiac function revealed no improvement in the myocardial function compared to the control HF group. Moreover, tissue fibrosis was similar in two groups. Immunohistochemical study revealed the homing of the injected hAMSCs to the myocardium. Cells were stained positive for VEGF and troponin T markers. Conclusion: injection of hAMSCs 4 weeks after ischemia does not improve cardiac function and cardiac muscle fibrosis, although the cells show markers of differentiation into vascular endothelial cells and cardiomyocytes. In sum, it appears that hAMSCs are effective in the early phases of myocardial ischemia and does not offer a significant advantage in patients with chronic HF.

Introduction: microRNAs (miRNAs) are highly conserved, noncoding RNA molecules that regulate gene expression on the post-transcriptional level. Some evidence indicates that microRNAs dysfunction plays a crucial role in human disease development. The role of microRNAs in cardiac growth, hypertrophy, heart failure, cardiovascular complications in diabetes and many other hearth conditions are demonstrated. In this study we aimed to evaluate the expression of six microRNAs (mir-100, mir-126, mir-127, mir-133a, mir-133b and mir-145) that have been shown to overexpress in aortic and carotid plaques. Methods: Thirty Coronary Artery Disease patients who underwent elective coronary artery bypass graft surgery were enrolled in the study. The expression patterns of six miRNAs (mir-100, mir-126, mir-127, mir-133a, mir-133b, and mir-145) were examined in 30 patients of whom we obtained aorta and saphenous vein samples. Results: In three miRNAs, mir-100, mir-127 and mir-133b, we did not obtain expression data from real-time experiments. We found that the expression level of mir-126, mir-133a and mir-145 were lower in aorta in comparison with saphenous vein. Mir-126 was highly expressed in saphenous vein samples (13. 8± 1. 1) when compared with aorta samples (20. 2± 1. 1), although mir-133a was highly expressed in saphenous vein samples (16. 1± 0. 5) when compared with the aorta (17. 9± 1. 5). Expression of mir-145 saphenous vein samples was also dramatically higher than aorta (7. 2± 0. 5 versus 10. 8± 0. 6) that was statistically significant (P < 0. 05). Conclusion: Understanding the role of miRNAs in cardiovascular physiology and diseases might suggest miRNA-based therapeutic methods in the management of coronary artery disease.

Introduction: There is a correlation between endotracheal cuff pressure and airway complication; therefore, cuff pressure measurement is of an essential importance. The gold standard technique is measuring the cuff pressure by a calibrated manometer. However, there are several methods that injects air into balloon pilot and measures the cuff pressure. The aim of this study is to compare the tracheal cuff pressure measurement by two methods: fixed volume and minimal leak test (MLT). Methods: This descriptive study was performed at the emergency department on 110 patients. Patients were randomized into two groups. For one group, fixed volume technique and for the other group MLT was used. Results: Mean cuff pressure was 46. 07± 23. 54 cmH2O in the fixed volume group and 33. 72± 9. 14 cmH2O in the MLT group (P = 0. 05) which is significantly higher in the fixed volume group (P = 0. 028). In addition, 56. 4% and 78. 2% of the subjects had normal cuff pressure in the fixed volume group and MLT group, respectively; indicating a significantly higher rate in MLT group (P = 0. 025). Conclusion: Both techniques cause above normal intracuff pressure; however, MLT produces more acceptable pressure than fixed volume. It seems that the volume of 10 cc produces high pressures; therefore, fixed values may yield more appropriate results in lower volumes.

Introduction: Metabolic syndrome (Mets) has become most important public health problem in the world. We examined the association between Mets and different cardiometabolic phenotype in Azar cohort population. Methods: In the present study, the data of 13099 subjects who participated in Azar cohort study were cross-sectionally analyzed. Mets was defined according to the National Cholesterol Education Program’ s Adult Treatment Panel III report (ATPIII) criteria. Participants were categorized into four cardiometabolic phenotypes including metabolically healthy Lean (MHL), metabolically unhealthy lean (MUHL), metabolically healthy Obese (MHO), metabolically unhealthy obese (MUHO) according to BMI cut– off point (25 kg/m2), and the presence of Mets. Results: Totally, the prevalence of Mets was 33. 20% with the higher prevalence in women (40. 1%). About 46. 7% of participants were MHO and 1. 6% of them were MHL. In both genders, MUHL had the highest prevalence of hyperglycemia, hypertrigliceridemia, hypo-HDL-cholestrolemia and Frahmingham 10-year CVD risk. In both MUHL and MUHO phenotypes, hypertriglyceridemia (OR: 31. 97 [95% CI: 22. 31, 45. 81] and OR: 20. 28 [95% CI: 17. 32, 23. 75]) and hypo-HDL cholestrolemia (OR: 27. 97 [95% CI: 17. 35, 45. 09] and OR: 11. 0 [95% CI: 9. 62, 12. 58]) are the strongest predictor of incidence of Mets. Also, the results of multinominal regression analyses indicated that in all cardiometabolic phenotypes, Framingham 10-year CVD risks had the lowest power for predicting of Mets incidence. Conclusion: Based on the results, in addition to obese individuals, multiple metabolic abnormalities were seen in normal weight individuals and these subjects are even at higher risk of developing Mets compared with metabolically obese individuals. So, it seems that decision on initiation of lifestyle interventions should not be only based on the BMI; rather metabolic status seems to be even more important.

Introduction: This study aimed to evaluate the combination effect of voluntary exercise and garlic on oxidative markers, cholesterol level and histological alterations in streptozotocin (STZ)-induced diabetes in rat heart. Methods: Thirty-five male Wistar rats were randomly assigned into five experimental groups (n=7): Control, Diabetes, Diabetes+Garlic, Diabetes+Exercise, Diabetes+Garlic+Exercise groups. Diabetes was induced by STZ (ip, 50 mg/kg) in animals. Animals received garlic homogenate (250 mg/kg) by oral gavage or subjected to voluntary exercise alone or together for 6 weeks. At the end of intervention blood and heart tissue samples were obtained and used for measurement of glycosylated haemoglobin (HbA1c), cholesterol, total antioxidant capacity (TAC), malondialdehyde (MDA) levels and histological analysis. Results: Improved blood glucose, cholesterol, total antioxidant capacity, and MDA levels were established in both Diabetes+Garlic and Diabetes+Exercise groups. Additionally, staining with Hematoxylin and Eosin (H&E) revealed that voluntary exercise and garlic alone and together reduced interstitial edema, leukocyte infiltration, and myonecrosis. Furthermore, simultaneous treatment of diabetic rats with garlic and exercise training had an additive effect on these parameters. Conclusion: The findings indicated that combination therapy with garlic and voluntary exercise may present more beneficial effects in heart histological remodeling in diabetic rats than the use of garlic or voluntary exercise alone and that these beneficial effects might be associated with enhancement in cholesterol, total antioxidant capacity, and MDA levels.

Introduction: Natriuretic peptides such as brain natriuretic peptide (BNP), atrial natriuretic peptide (ANP) and pro-BNP are secreted in response to atrial and/or ventricular stretch. Left to right shunts such as ventricular septal defect (VSD), atrial septal defect (ASD), and patent ductus arteriosus (PDA), are treated medically or surgically. We aimed to evaluate whether the serum level of pro-BNP would be useful to measure the amount of the shunt. Methods: In this cross sectional study, 60 infants and children, in whom physical examinations approved heart murmur, and had undergone echocardiography by which VSD, ASD, or PDA had been proven, were included in the study. The relationship between serum BNP levels and severity of shunt (Qp/Qs) based on echocardiographic and hemodynamic evaluations, was studied. Results: There was a significant relationship between serum level of pro-BNP and the amount of the shunt in the patients with VSD, ASD, and PDA (P = 0. 01). A positive correlation was seen between pro-BNP serum level and Qp/Qs ratio. The mean ± SE serum level of pro-BNP in patients with Qp/Qs ratio of less than 1. 5, equal to 1. 5-2, and more than 2 was 30. 83± 2. 4, 217. 88± 44. 6, and 217. 13± 51. 8, respectively showing a significant relationship (P = 0. 0001). The cut-off point of pro-BNP demonstrating a Qp/Qs ratio more than 1. 5 was measured at the level of 40. 36 pg/mL, with a sensitivity and specificity of 92% and 79%, respectively. Conclusion: Based on our study, the cut-off point of 40. 36 pg/mL or more for pro-BNP, showing a Qp/Qs ratio more than 1. 5, can be considered as an indication for interventional procedures.

We report a rare case of inferior vena cava (IVC) aneurysm in a 22-year old Afghan-Iranian male patient. CT scan illustrated a saccular aneurysm of IVC originating from right side of the IVC below the renal veins (a saccular type 3 IVC aneurysm). We planned open resection and repair of the aneurysm. The patient had well recovery after the operation and his follow-up did not reveal any morbidity. IVC aneurysm is a rare clinical entity. Its diagnosis necessitates precise clinic suspicion and the management is based on anatomical location and associated anomalies.

A 57– year-old man presented with atypical chest pain. Transthoracic echocardiography was performed and revealed a very large and well defined intra-myocardial multicystic mass in the posterolateral and basal inferoseptal segments of left ventricle suggestive of hydatid cyst. Although the echocardiographic diagnosis was straightforward, serologic test (hydatid cyst antibody) with enzyme-linked immunosorbent assay (ELISA) was performed which was positive for echinococcal infection. Other works up showed no involvement of other organ system. Albendazol was started for him and he referred to cardiac surgeon for resection of cystic mass.

Dear Editor, We read the valuable manuscript with the title: Association of modified Nordic diet with cardiovascular risk factors among type 2 diabetes patients: a cross-sectional study that published in J Cardiovasc Thorac Res. 1 In this manuscript authors have said “ cluster random sampling methods were used to select participants. Throughout the five sectors of Isfahan, we randomly chose two centers (clinics) from each area. Based on previously calculated mean and standard deviations for BMI in this population, our target number of participants was 143”