INTERNATIONAL CARDIOVASCULAR RESEARCH JOURNAL
Year:2017 | Volume:11 | Issue:2|Papers Count:8

Background: Due to over production of reactive oxygen species, oxidative stress forms one of the major reasons for progression of Cardiovascular Diseases (CVDs) and the associated cardiomyopathies. Thus, controlling these reactive radicals is one of the major management strategies for CVDs. Natural compounds and phytochemicals have already proven their potency in preventing oxidative stress and the molecular mechanism behind the action of most of these bioactive compounds is still an enigma.Objectives: The present study aimed to assess the cardioprotective effects of quercetin on isoproterenol-induced toxicity in H9c2 cardiomyoblast cells.Materials and Methods: H9C2 cells were treated with different concentrations of isoproterenol and quercetin and the cells viability was determined by Mitochondrial Tetrazolium (MTT) assay. The non-toxic concentration of quercetin was used to check its protective effect on the cells treated with 50 μM isoproterenol. Indeed, intracellular antioxidants, such as catalase, reduced glutathione (GSH), and lipid peroxidation, were determined spectrophotometrically in cell lysates. Moreover, mRNAs isolated from the treated groups were subjected to expression studies of FOXO3 and STAT3 genes by reverse transcriptase Polymerase Chain Reaction (PCR).Results: According to the results of MTT assay, the effective concentration of isoproterenol for inducing toxicity in H9c2 cells was 50 μM and the protective concentration of quercetin was 5 μm. Treatment with quercetin elicited a protective effect by enhancing the antioxidant status of the cells. This was confirmed by the decrease in peroxidation of membrane lipids, increase in catalase induction, and increase in GSH reserve. Gene expression analysis of FOXO3 and STAT3 genes revealed that the protective effect was mediated through up regulation of FOXO3 transcription factor.Conclusions: The study results signified the potential of quercetin in relieving oxidative stress and the associated cardiomyopathies.

Background: Anthracyclines, as cancer chemotherapeutic agents, play an undeniable role in treatment of several cancers. As cardiotoxicity is an important adverse reaction of anthracyclines, elucidation of asymptomatic and potentially symptomatic changes in Left Ventricular Ejection Fraction (LVEF) is of significant interest in patients receiving chemotherapy.Objectives: This study aimed to examine the cardiac effects of Adriamycin therapy based on Speckle-Tracking Echocardiography (STE) and early diagnosis of patients at risk of cardiotoxicity.Patients and Methods: This study was conducted on 30 breast cancer patients (>18 years old) who were treated with Adriamycin-based chemotherapy. Conventional echocardiography, STE, Electrocardiogram (ECG), and biochemical markers measurements (troponin I and CK-MB) were performed prior to and after chemotherapy. In addition, longitudinal strain analysis was performed via STE using automated functional imaging.Results: Echocardiographic findings showed significant decreases in Ejection Fraction (EF) after the therapy. However, no significant differences were found regarding pulse rate, systolic and diastolic blood pressure, ECG changes, troponin I, and CK-MB after the therapy. Based on the global longitudinal strain, the longitudinal strain was significantly decreased in the patients after the therapy (-22.1±2.1 prior to and -19±2.2 after the therapy, P=0.001).Conclusions: Cardiotoxicity during the early phase of anthracycline treatment can be detected via STE prior to observation of systolic function deterioration by conventional echocardiography. In fact, anthracycline-induced cardiotoxicity can be observed much earlier via STE compared to conventional echocardiography.

Background: Treatment of critical Aortic Stenosis (AS) in hemodynamically unstable patients is a major clinical challenge.Objectives: This study aimed to retrospectively investigate the safety of antegrade Balloon Aortic Valvuloplasty (BAV) using the Inoue balloon and an Intra-Aortic Balloon Pump (IABP) for treating AS with cardiogenic shock and to determine the immediate efficacy of the procedure with respect to hemodynamic improvements in patients with critical symptomatic AS.Patients and Methods: This retrospective study was conducted on 47 symptomatic critical AS patients excluded from undergoing surgical aortic valve replacement who were treated using antegrade BAV. The high-risk group included 14 cases whose mean Left Atrial Pressure (LAP) remained above 25 mmHg despite aggressive medical therapy. These cases were treated using antegrade BAV and an IABP (BAV-IABP group). On the other hand, 33 cases with stable hemodynamics due to medications comprised the relatively low-risk group and were treated using antegrade BAV alone (BAV-alone group).Results: Immediate procedural success was achieved in all cases within 24 h. In the BAVIABP group, the proportion of patients with improved aortic valve areas (125.6±56.7% vs.70.9±32.3%, P<0.004), reduced pressure gradients (67.8±9.1% vs.59.6±17.2%, P<0.040), and decreased LAP (48.4±15.4% vs.17.9±9.9%, P<0.001) was significantly larger compared to the BAV-alone group.Conclusions: Antegrade BAV under IABP provided safe and effective immediate valvuloplasty in very high-risk patients who were not suitable for definitive therapy.

Background: Cardiac Radiofrequency (RF) ablation is used for treating some types of heart rhythm problems. The number of RF ablation procedures is increasing rapidly due to lower complication risks than surgery and high success rates. Due to higher patient exposure to X-ray radiation in different cardiac ablation procedures, public concerns are increasing regarding the detrimental effects of ionizing radiation, including skin injury, genetic effects, and malignancy.Objectives: This study aimed to determine patient absorption doses during Electrophysiological Study (EPS) and RF ablation of different cardiac arrhythmias in an electrophysiology laboratory unit with a flat panel detector.Patients and Methods: This cross-sectional study was performed on 223 patients who underwent cardiac EPS and RF ablation. All procedures were executed on a single panel angiography unit with floor mounted C-arm. Dose Area Product (DAP), Entrance Skin Dose (ESD), and Fluoroscopy Time (FT) were recorded in all different procedures. Also, Total FT (TFT), total DAP, and total ESD were analyzed in the 223 procedures separately. Pearson’s correlation test was used to estimate the relationships between FT and DAP, FT and ESD, and ESD and DAP.Results: In this study, 56.1% of the patients were female. The mean age of male and female patients was 43.9 and 47.7 years, respectively. Medians of TFT, total ESD, and total DAP were 7.4 min, 165 mGy, and 19.2 Gycm2, respectively. Total ESD was strongly correlated to DAP (r=0.945, P<0.001). Significant correlations were also observed between FT and DAP (r= 0.843, P<0.001) and between FT and ESD (r=0.747, P<0.001). AF ablation procedures had the highest medians of DAP, ESD, and FT values during all types of cardiac arrhythmias.Conclusions: For prevention of deterministic and stochastic effects of radiation exposure, such as skin damage and cancer, operators should attempt to reduce patients’ radiation exposure as low as reasonably achievable. In the current study, none of the patients’ ESDs exceeded the threshold dose. The maximum ESD and DAP values were attributed to AF ablation procedures. Significant correlations between DAP and FT as well as between ESD and FT and the strong correlation between DAP and ESD showed that ESD could be reduced by reducing FT and DAP.

Background: Type 2 Diabetes Mellitus (T2DM) is one of the most important risk factors in cardiovascular disorders considered as a common clinical and public health problem. Early diagnosis can reduce the burden of the disease. Decision tree, as an advanced data mining method, can be used as a reliable tool to predict T2DM.Objectives: This study aimed to present a simple model for predicting T2DM using decision tree modeling.Materials and Methods: This analytical model-based study used a part of the cohort data obtained from a database in Healthy Heart House of Shiraz, Iran. The data included routine information, such as age, gender, Body Mass Index (BMI), family history of diabetes, and systolic and diastolic blood pressure, which were obtained from the individuals referred for gathering baseline data in Shiraz cohort study from 2014 to 2015. Diabetes diagnosis was used as binary datum. Decision tree technique and J48 algorithm were applied using the WEKA software (version 3.7.5, New Zealand). Additionally, Receiver Operator Characteristic (ROC) curve and Area Under Curve (AUC) were used for checking the goodness of fit.Results: The age of the 11302 cases obtained after data preparation ranged from 18 to 89 years with the mean age of 48.1±11.4 years. Additionally, 51.1% of the cases were male. In the tree structure, blood pressure and age were placed where most information was gained. In our model, however, gender was not important and was placed on the final branch of the tree. Total precision and AUC were 87% and 89%, respectively. This indicated that the model had good accuracy for distinguishing patients from normal individuals.Conclusions: The results showed that T2DM could be predicted via decision tree model without laboratory tests. Thus, this model can be used in pre-clinical and public health screening programs.

Sydenham Chorea (SC) is a childhood disease that most frequently occurs after infection with group A β-hemolytic streptococcus species. SC is the most commonly acquired childhood chorea, usually affecting 5 to 15-year-old children. Dextrocardia situs inversus refers to the heart being situated on the right side of the body. We found a case of SC with coexisting dextrocardia and situs inversus, which is rare to our knowledge. A 14-year-old girl was referred to Ali-Ibn-Abiltaleb Hospital due to choreoathetotic movements more in her upper than lower extremities, which impaired her usual function. Antistreptolysin O (ASO) titer was high. Her throat culture was positive for streptococci beta hemolytic. In cardiac study, moderate mitral regurgitation, tricuspid regurgitation, diastolic dysfunction, conus in the Right Ventricle Outlet (RVOT), rightsided aortic arch, dextrocardia, and situs inversus were reported. This was a rare case with SC that had such anomalies.

Microbubbles have been presumed as gaseous emboli, which originate during mechanical heart valve closure, but are not seen in bioprosthetic valves. In this report, we presented a cluster of microbubbles mimicking mobile thrombus in a patient with mechanical mitral valve prosthesis. A 30-year-old female with a history of implanted mechanical valve at the mitral position underwent a routine examination. She was asymptomatic and her physical examination was unremarkable. Transthoracic echocardiography showed a mobile thrombus-like mass on the ventricular side of the prosthetic mitral valve moving into the left ventricular outflow tract. However, close examination of images indicated that the mass was in fact intense microbubbles mimicking thrombus. Intense mobile microbubbles can be misdiagnosed as a mobile thrombus. We recommend and underscore the importance of detailed echocardiographic examination in case of mobile mass to avoid misdiagnosis in patients with mechanical heart valves.

Cardiac tumors constitute 0.2% of all tumors. Primary cardiac tumors occur infrequently with an incidence of 0.0017-0.19% as shown by autopsies performed in non-selected populations. Among these tumors, cardiac myxomas are most commonly encountered, with left atrial myxomas being more prevalent than right atrial ones. The classic triad of symptoms, of which at least one is present in a patient with atrial myxoma, are obstructive traits including dyspnea and syncope, constitutional symptoms such as fever and anorexia, and thromboembolic events. Surgical resection confers almost definitive treatment with recurrence rates being as low as 3%. A 50-year-old woman referred to the Emergency Unit with a sudden episode of chest heaviness and shortness of breath. There was no significant physical examination finding and all routine lab investigations were normal. She underwent an angiography that revealed tight left anterior descending artery stenosis. An angioplasty was also performed, but she had an episode of presyncope immediately. Then, echocardiogram was performed that showed a large left atrial myxoma causing severe mitral regurgitation. Thus, urgent open heart surgery was planned. The myxoma was identified and excised, the mitral annulus resolved, and normal flow was restored. The patient was then discharged home and followed up for 2 months with no complaints. In the current study, we reported a rare case where mitral regurgitation was caused by a left atrial myxoma. Our report highlighted the diverse clinical spectrum of myxoma and emphasized the need for early echocardiographic diagnosis to aid in identification of myxoma followed by early surgical intervention.