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This research identifies the main themes and internal states of heart disease experience in individuals and families of patients with cardiovascular difficulties.It is applied in terms of purpose and methodologically qualitative and phenomenological. Its population is patients admitted to Baqiyatallah Azam Hospital. It includes the patients who had a long and severe chronic illness in this area (or without long and severe chronic illness). We performed in-depth semi-structured interviews with 6 patients in the CCU ward of Baqiyatallah Al-Azam Hospital. With the introducing 4 family members of the participants, the number of people with whom we worked until the final stages reached 10 (two participants refused to introduce their family members). We analyzed data using the methods proposed by Van Manen and Colaizzi.According to the results, the main themes of experiencing heart disease are initial experience of cardiovascular (malfunction) difficulty, experience of internal conditions related to cardiovascular disease, family's initial experience of cardiovascular disease, atmosphere governing the participant's life before heart disease, the last slices of life before experiencing cardiovascular disease, perceived changes after experiencing cardiovascular disease, and experiencing cardiovascular disease. Regarding the initial experience of cardiovascular difficulty (dysfunction), sub-themes include reported symptoms, type of diagnosis, and duration of illness.

The present study aimed to identify changes in echocardiographic parameters before and after three-month high-intensity interval training (HIIT) and continuous moderate-intensity training (CMT) in male employees. For this purpose, using a convenience sampling method, 33 male employees of the Islamic Republic of Iran Army (office workers with a sedentary lifestyle) aged 30 through 40 were selected. Participants were divided into three groups of HIIT, CMT, and control (11 for each group) including all anthropometric data (body fat percentage, body mass index, height, weight, and VO2 max) with no history of chronic diseases, metabolic syndrome, confirmed heart disease or congenital heart defect, and hospitalization due to chronic diseases or consumption of medication affecting cardiovascular indicators. A one-way ANOVA was conducted to compare the groups. The results demonstrated that the end-systolic volumes (ESVs) (p < 0.01) and relative wall thickness (RWT) in the CMT group (p < 0.01) and the end-diastolic volumes (EDVs) (p < 0.01), stroke volumes (SVs) (p < 0.01), end-systolic and diastolic diameters (ESD, EDD) (p < 0.01), as well as the RWT and left ventricle diastolic function (E/A ratio) in the HIIT group (p < 0.05) were significantly different before and after the 12-week training (Bonferroni correction was used for pairwise comparisons). The results revealed a significant increase in the end-systolic diameters (ESDs) of the HIIT group, whereas no such increase was observed in the ESDs of the CMT group (p < 0.51). Moreover, a significant increase was observed in left ventricular (LV) RWT and aerobic power of both training groups. The significant decrease of ESVs and the significant increase in E/A ratio, ESDs, EDDs following HIIT (two to three sessions per week) may indicate beneficial and optimal LV structural adaptations and improved LV function in nonathletes (even with a sedentary lifestyle).

Introduction: Coronary Artery Disease (CAD) is known as the major cause of morbidity and mortality in the world with a growing trend, especially in some developing countries. CAD commonly observed in elderly cases, however; recently it is usually found in young adults. In this study, we aimed to evaluate the prevalence of anti-phospholipid antibody syndrome (APS) in patients with premature CAD. Methods: The cross-sectional study was conducted in Baqiyatallah hospital from April 2012 to April 2016. Patients with premature CAD were included in the study. The data regarding the laboratory tests, echocardiography, and angiography were obtained from all cases. Results: Overall 133 eligible patients were included in the study. In the first set of the laboratory test, 18 patients were recognized to have APS (13.53%). The second confirmatory APA test was showing 3 of 18 patients were considered to have APS (2.25%). Conclusion: The results showed there is an association between the risk of developing Premature CAD and APS could potentially. The APS may have significant effects on the risk of coronary heart disease, especially in young adults.

Corona virus disease 2019(COVID-19) pandemic has caused a significant burden on the global health system. Considerable cardiovascular involvement has been reported among COVID-19 patients with higher ICU admission and mortality rates among patients with cardiovascular comorbidities. Consequently, diagnostic cardiovascular evaluations such as echocardiography are a crucial part of the disease management. On the other hand, providing safety for the patients and the healthcare personnel is a matter of great concern in the pandemic state. In this document, we have provided recommendations on performing echocardiography in hospital echocardiography labs and outpatient echocardiography clinics during the current COVID-19 (Coronavirus disease of 2019) outbreak.

Background Rheumatic heart disease (RHD) is still a concerning issue in developing countries. Among delayed RHD presentations, rheumatic mitral valve stenosis (MS) remains a prevalent finding. Percutaneous transvenous mitral commissurotomy (PTMC) is the intervention of choice for severe mitral stenosis (MS). We aimed to assess the mid-term outcome of PTMC in patients with immediate success. Methods In this retrospective cohort study, out of 220 patients who had undergone successful PTMC between 2006 and 2018, the clinical course of 186 patients could be successfully followed. Cardiac-related death, undergoing a second PTMC or mitral valve replacement (MVR) were considered adverse cardiac events for the purpose of this study. In order to find significant factors related to adverse cardiac outcomes, peri-procedural data for the studied patients were collected.The patients were also contacted to find out their current clinical status and whether they had continued secondary antibiotic prophylaxis regimen or not. Those who had not suffered from the adverse cardiac events were additionally asked to undergo echocardiographic imaging, in order to assess the prevalence of mitral valve restenosis, defined as mitral valve area (MVA) 2 and loss of ≥ 50% of initial area gain. Results During the mean follow-up time of 5.69 ± 3.24 years, 31 patients (16.6% of patients) had suffered from adverse cardiac events. Atrial fibrillation rhythm (p = 0.003, HR = 3.659), Wilkins echocardiographic score > 8 (p = 0.028, HR = 2.320) and higher pre-procedural systolic pulmonary arterial pressure (p = 0.021, HR = 1.031) were three independent predictors of adverse events and immediate post-PTMC mitral valve area (IMVA) ≥ 2 cm2 (p 2 (p = 0.001, OR = 0.240). Conclusion The mid-term results of PTMC are multifactorial and may be influenced by heterogeneous peri-procedural determinants. IMVA had a great impact on the long-term success of this procedure. Continuing secondary antibiotic prophylaxis was not a protective factor against adverse cardiac events in this study. (clinicaltrial.gov registration: NCT04112108).

BACKGROUND: It has been indicated that the acute exercise increases the thrombotic events that stem from platelet hyper-reactivity. The present randomized controlled trial study was carried out with the aim to compare high-intensity interval exercise (HIIE) with moderate intensity continuous exercise (MICE) in terms of platelet indices and function in patients who had undergone post coronary artery bypass graft (CABG).METHODS: 30 men with a history of CABG were recruited and divided into 3 groups (MICE, HIIE-1, and HIIE-2). The MICE protocol consisted of running for 40 minutes with 65% of maximal heart rate (HRmax). Subjects in HIIE-1 group performed an interval exercise with work to rest ratio of 1:1 in which 10 rounds of running (95% HRmax) were followed by active recovery (35% HRmax). HIIE-2 subjects performed an interval exercise with work to rest ratio of 2:1 in which 7 rounds of running (85% HRmax) were followed by active recovery (45% HRmax). Before and immediately after the exercise protocols, blood samples were taken from subjects and analyzed to measure the variables.RESULTS: Although platelet count (PLT) and hematocrit (HCT) were increased significantly after HIIE-1 and HIIE-2 in comparison to MICE (P < 0.050), the other platelet indices [mean platelet volume (MPV), platelet distribution width (PDW), plateletcrit (PCT)] were not significantly changed among groups (P > 0.050). The platelet aggregation and fibrinogen were further increased after HIIE-1 and HIIE-2 as compared with MICE; however, such increment were significant between HIIE-2 and MICE (P < 0.050).CONCLUSION: It seems that HIIE, regardless of the type, has higher thrombotic potentials compared with MICE. Accordingly, MICE is safer than HIIE for rehabilitation in patients undergoing CABG.

Background Plasma PCSK9 levels, a novel and effective therapeutic target for CVD prevention, have been associated with CVD events irrespective of traditional risk factors. Whether PCSK9 levels predict coronary artery disease (CAD) burden and severity is a matter of dispute. Purpose To investigate the association between plasma PCSK9 levels and CAD characteristics, including number of major diseased vessels, severity of coronary stenosis, and the burden of coronary calcifications. Methods One hundred and one patients undergoing coronary angiography were recruited for this cross-sectional study. The number of major coronary diseased vessels was defined as the presence of ≥1 stenoses ≥50% in diameter of at least one major coronary artery. CAD severity was defined as either the absence of coronary stenosis (no-CAD), CAD Results Coronary angiography showed single, double and triple vessel disease in 26 (25.7%), 23 (22.8%) and 21 (20.8%) patients, respectively; 20 (19.8%) and 11 (10.9%) pts had either minimal CAD ( Conclusions Circulating PCSK9, whose plasma levels are significantly influenced by the presence of CKD, discriminates patients with significant coronary artery stenosis from those without CAD. In addition, both the number of diseased coronary vessels and total coronary calcifications are independently predicted by an elevated plasma PCSK9 level. Acknowledgement/Funding None

To investigate the association between plasma proprotein convertase subtilisin/kexin type 9 (PCSK9) concentrations, current acute coronary syndrome (ACS), coronary artery disease (CAD) presence, severity and extension and the burden of coronary calcifications in patients with suspected CAD.One hundred and one patients, with or without current ACS, were recruited for this cross-sectional study. CAD presence was defined based on either the presence or absence of at least one significant (≥50%) CAD lesion (SCAD). CAD severity was classified according to the absence of coronary lesions, the presence of non-significant (50%) CAD (MCAD) or SCAD in at least one major coronary artery. Patients with one, two or three significantly diseased major coronary arteries were defined as 1-SCAD, 2-SCAD and 3-SCAD, respectively. The cumulative length of SCAD lesions and the amount of calcifications in coronary arteries were estimated. Plasma PCSK9 concentrations were higher in patients with SCAD as compared to those without (p = .012). A significant increase in plasma PCSK9 concentrations was observed with greater CAD severity (p = .042). Higher plasma PCSK9 concentrations were found in 3-SCAD patients as compared to either 2-SCAD or 1-SCAD (p .001). PCSK9 increased with the cumulative length of SCAD lesions and the burden of calcifications (p .05 for both comparisons). Multivariable adjustment abolished the association between PCSK9 and either CAD presence or severity, but not the association between PCSK9 and the number of significantly diseased vessels, SCAD lesion length and the burden of coronary calcifications. ACS was associated with a borderline significant increase of plasma PCSK9 concentrations among patients not taking statins (p = .05).Circulating PCSK9 concentrations discriminate patients with greater coronary atherosclerotic lesion extension and calcification, and are increased in patients with current ACS.

Background: Aortic stenosis (AS) is the most common primary valvular disease. Currently, there is no pharmacological approach for the medical management of AS. We investigated the effect of osteoporosis therapy with alendronate on hemodynamic progression in patients concurrently affected by AS and osteoporosis. Materials and Methods: In this observational prospective study, we enrolled 37 women more than 60 years old with diagnosis of AS and concurrent osteoporosis from August 2017 to December 2019. These patients were treated with alendronate 70 mg every week added to their routine treatment for AS, and their outcomes were compared with 33 patients only affected by AS. Echocardiographic changes and N-terminal-prohormone of brain natriuretic peptide (NT-pro-BNP) level were evaluated during about 2 years of follow-up. Results: The mean follow-up time for the treated and nontreated groups was 20.89 ± 2.73 and 20.84 ± 2.76 months, respectively. Mean gradient (P = 0.02) and peak gradient (P = 0.04) of aortic valve were significantly different between the groups after follow-up. Aortic valve area was decreased 0.09 cm2 in the treated group by alendronate and 0.23 cm2 in the other group (P = 0.001). Furthermore, NT-pro-BNP was significantly decreased in patients treated by alendronate (P = 0.01), but it was increased in nontreated patients (P = 0.04). Conclusion: Treatment with alendronate in patients with AS and concurrent osteoporosis slows down the progression of stenosis and improves their prognosis. This study could open a new pathway for the treatment of AS. Further studies, particularly randomized controlled clinical trial, should be done for providing more evidence.

Previous studies have detected adenovirus and cytomegalovirus (CMV) in cardiac tissue of patients with myocarditis. Therefore, in this study, we investigated the frequency of these viruses, which may be involved in the development of severe dilated cardiomyopathy (DCM). Myocardial tissue from of 23 cardiac transplant candidates with acute idiopathic DCM below the age of 40 years were analyzed by amplification of adenovirus and CMV DNA and subsequent sequencing. Adenovirus was detected in four (17.4%) and CMV in one (4.3%) of the patients. All controls were negative for the presence of both viruses. Our study shows that myocardial infection with adenovirus may play an important role in the pathogenesis of severe DCM and suggests that vaccination against adenovirus might be helpful in decreasing the prevalence of severe idiopathic DCM. This is the first study in which adenovirus type 8 has been detected in the hearts of patients with DCM.

Background: Psychological problems such as depression constitute a dilemma that patients with the implantable cardioverter-defibrillator (ICD) usually encounter and may impact their quality of life. The purpose of this study was to evaluate the prevalence of depression among adults with the ICD and the relationship between depression and associated factors. Methods: Totally, 115 individuals with the ICD participated in this cross-sectional study in Tehran, Iran, and depression and other related risk factors were evaluated in them. Two questionnaires, one for demographic characteristics and the Beck Depression Inventory, were applied for data acquisition. The data were analyzed, and the factors associated with depression in the patients with the ICD were assessed. Results: The mean age of the study population was 59.85 ± 11.46 years. Males comprised 88 (76.5%) and females 27 (23.5%) of the patients. The multivariate analysis on the 115 patients revealed that frequency of ICD shocks (OR = 1.08, 95%CI: 1.02 - 1.10), male sex (OR = 2.28, 95%CI: 1.027 - 5.07), more hospital admissions (OR = 1.19, 95%CI: 1.11 - 1.25), smoking cessation (OR = 9.8, 95%CI: 4.48 - 20.07), presence of ICD shocks (OR = 4.5, 95%CI: 2.45 - 7.38), dyslipidemia (OR = 2.8, 95%CI: 1.22 - 4.95), and family history of depression (OR = 6.4, 95%CI: 3.0 - 13.46) were significantly and independently associated with the Beck score classifications. Conclusion: These findings suggest that a poor psychosocial outcome in patients with the ICD may occur as a result of a variety of associated factors, most of which are predictable and preventable.

Background: Professional training regimens are accompanied with morphologic alteration and cardiac function which is known as “athlete’s heart” which is defined by left ventricular hypertrophy and other echocardiographic features. Objectives: The present study aims to evaluate the effect of different training protocols such as endurance-training, strength training protocols and concurrent protocols on heart structures. Patients and Methods: Forty five young female volunteer athletes were included and received different training regimens (endurancetraining, strength training and concurrent groups) for a 10 week period as study intervention. Standard color Doppler echocardiography was performed for assessment of the left ventricular activity. Results: As a result, 45 athletes ended the study training regimens. Mean of cardiac parameters was not significantly different among athletes under study before the beginning of the study training regiments. Mean of end diastolic diameter among athletes of strength-trained group had been significantly increased after receiving the study training regiments. Mean of posterior wall thickness had been significantly increased in athletes of strength and concurrent groups. Mean of posterior wall thickness had been decreased in athletes of endurancetraining group. Mean of heart rate was significantly decreased among the athletes of endurance-training and concurrent-training groups. Conclusion: The combination of both endurance-training and strength training protocols caused largest increases in left ventricular internal dimension and left ventricular wall thickness among the trial participants.

Background: Coronary artery bypass graft (CABG) failure may result in a wide range of problems. Objectives: The aim of the present study was to evaluate failure rate and risk factors in coronary bypass grafts. Patients and Methods: In this cross-sectional study, 250 post-CABG patients in Baqiyatallah hospital, Tehran, Iran in 2004 2014 were evaluated. Graft failure rate and predisposing factors were evaluated. Results: In this study, 250 patients with the mean age of 64.50 ± 7.63 years were evaluated. LIMA (left internal mammary artery) to LAD (left anterior descending artery) was patent in 187 patients (82.6%), SVG (saphenous vein graft) to OM (obtuse marginal artery) in 159 patients (81.9%), SVG to RCA (right coronary artery) in 49 patients (50.5%) and SVG to PDA (posterior descending artery) in 90 patients (68.2%). Lowest patency was in the right coronary artery and maximum patency in the left anterior descending artery. LIMA/SVG patency rates in 1 5 years, 5 10 years and over 10 years after CABG were 77.4%/92.7%, 81.5% / 71.6% and 100%/92.7%, respectively. Male gender, BMI > 30, diabetes, hypertension, hyperlipidemia and smoking were related to higher graft failure rate (P = 0.001). Conclusions: The LIMA grafts had the highest late patency rate, but were associated with a high rate of short-term occlusions. Also we found that patients with successful CABG and patent coronary were those who had less predisposing factors.

Background: Curcumin, a yellow substance found in turmeric, has not only antioxidative features and beneficial effects in the treatment of cancer, liver, heart, and pulmonary diseases but also anti-inflammatory and anticoagulative effects. This chemical has cardioprotective effects too. Objectives: In this study, we examined the effects of curcumin on left ventricular (LV) function in patients receiving dialysis for chronic renal failure. Methods: This study is a double-blind, placebo-controlled trial conducted on 35 patients with chronic renal failure undergoing dialysis in the dialysis center of Baqiyatallah hospital. The patients were randomly divided into 2 groups: the curcumin group (n = 20) and the control group (n = 15). The curcumin group received curcumin capsules at a dose of 500 mg every 8 hours for 6 weeks (1500 mg/d) and the control group received a placebo for 6 weeks at the same dose. Echocardiography was done before the use of the drug and once after the 6th week. Also, the ejection fraction (EF), representing LV function and size, was measured in both groups. Results: Themeanage was 44.2±13.4 years for the curcumin group and 45.4±6.2 years for the placebo group. The study population comprised 22 male and 13 female patients. There were no significant differences regarding demographic variables such as age, sex, and body mass index between the 2 groups. In the curcumin group, LVEF based on the volume changed from 50.6% ±7.1% to 51.5% ± 6.8% (P = 0.130). In the curcumin group, LVEF based on the diameter changed from 51.8% ± 3.8% to 52.4% ± 3.5% (P = 0.112). The changes in the mean EF before and after the intervention were not significant in each group. The EF, based on ventricular volume and diameter, was not significantly different between the 2 groups. In addition, the pulmonary artery pressuremeanin both groups did not significantly change after the intervention (P > 0.05). Conclusions: The administration of curcumin in patients undergoing dialysis had no positive effects on enhancing LVEF and LV function. Further research is required to shed sufficient light on this issue.

Malignant melanoma has the heart metastasis rate of 50 - 71%, which seems to be the highest among other malignancies. When a patient presents with cardiac metastases of melanoma, the disease has already spread through the body and therefore hardly curable. This brief review tried to introduce this important condition and discuss its frequency, presentation, diagnosis, histologic findings and treatments.

Background: Coronary artery bypass grafting (CABG) is a revascularization method for coronary artery disease (CAD), which is done with and without cardiopulmonary bypass (CPB). CABG without CPB (off-pump) has been prevalent due to CPB related complications but a number of studies have not demonstrated superiority between these two methods. Objectives: This study designed to evaluate changes in patients’ echocardiography findings during 4 years after CABG with and without CPB. Patients and Methods: 118 patients who underwent CABG were included in this historical cohort study. Demographic data echocardiographs, serum creatinine and hemoglobin before and after surgery extracted from patients’ medical records. In the next visits, history taking, cardiovascular events, physical examination, and echocardiography considered in all patients. Data compared in Off-Pump and On-Pump CABG groups. Results: One hundred eighteen patients with the mean age of 59.47 ± 9.68 years were included (81 male and 37 female). On-pump CABG was done on 84 patients and off-pump on 34 patients. The mean age was significantly more and numbers of atherosclerotic vessels were less in off-pump patients. Left ventricle ejection fraction (EF) was significantly decreased in on-pump group and increased in off-pump group. Right ventricle EF was significantly decreased in both groups, with significant decrease in on-pump patients. Mitral and tricuspid valves regurgitation were significantly more in on-pump patients (P < 0.05). Conclusions: Our study showed superiority of off-pump CABG regarding LVEF, RVEF and valves regurgitations. Future studies with prospective structure, accurate randomization, longer follow up duration, and larger sample size are needed.

Context: Prevalence of patients with heart failure (HF) is increasing in worldwide, and also the number of people with HF traveling long distances is increasing. These patients are more prone to experience problems contributed air travel and needs more attention during flight. However, observational studies about problems of HF patients during flight and appropriated considerations for them are limited. Evidence Acquisition: We evaluated the conditions that may be encountered in a HF patient and provide the recommendations to prevent the exacerbation of cardiac failure during air travel. For this review article, a comprehensive search was undertaken for the studies that evaluated the complications and considerations of HF patients during flight. Data bases searched were: MEDLINE, EMBASE, Science Direct, and Google Scholar. Results: HF patients are more prone to experience respiratory distress, anxiety, stress, cardiac decompensation, and venous thromboembolism (VTE) during air travel. Although stable HF patients can tolerate air travel, but those with acute heart failure syndrome should not fly until complete improvement is achieved. Conclusions: Thus, identifying the HF patients before the flight and providing them proper education about the events that may occur during flight is necessary.

Background: Infective endocarditis (IE) is a serious complication in immunosuppressive patients that has adverse effects. Objectives: The aim of this study was to define the characteristics, outcomes, and correlating factors of mortality in renal transplant recipients. Patients and Methods: Infective endocarditis was diagnosed in 22 patients from three renal transplant centers in Iran between 2000 and 2010. Modified Duke criteria were applied to confirm the diagnosis. Results: Twenty-two renal transplant patients with IE were evaluated. Blood culture results were positive in 81%. Enteroccous and group D non-enterococcal were the causative microorganisms in 31% and 25% of patients, respectively. In-hospital and 12-month mortality was 41% and the mortality rate was higher in older patients in comparison to younger patients. Overall, the rates of one-year disease-free patient and graft survival were 49% and 88%, respectively. Conclusions: Despite the availability of different and potent antibiotics, the mortality caused by IE remains considerably high. These patients are significantly prone to endovascular infections that affect the mortality and survival.

Results: The mean age of the study population was 51.16 ± 12.88 years old and 36 (65.5%) patients were male. Right Tei index mean was 0.383 ± 0.213, which was abnormal in 19.1% of the patients. Left Tei index mean was 0.378 ± 0.230 and was abnormal in 52.9% of the patients. Pulmonary artery pressure mean was 18.32 ± 8.91 and was normal in 39 (70.9%) patients. Only basal septum strain (P = 0.015) and basal septum strain rate (P = 0.005) changes were associated with OSA severity. Conclusions: The main findings of this study were relative left ventricular systolic and diastolic dysfunction as well as dysfunction in some parameters of the right ventricle. The prevalence of these disorders and what constitutes the best echocardiographic parameter for their diagnosis are controversial and require further research.

Comparing the Efficasy of Tadalafil Versus Placebo on Pulmonary Artery Systolic Pressure and Right Ventricular Function in Patients with Beta-Thalassemia Intermedia. Rozita Jalalian, Mohamad Reza Iranian, Ahmad Tamadoni, Mehrdad Saravi, Ali Moghadamnia, Soraya Khafi. Mazandaran University of Medical Sciences, Sari, Iran, Department of Cardiology, Fatemeh Zahra Hospital, Sari, Iran; Babol University of Medical Sciences, Department of Cardiology, Babol, Iran; Babol University of Medical Sciences, Department of Hematology, Babol, Iran; Babol University of Medical Sciences, Department of Pharmacology, Babol, Iran; Babol University of Medical Sciences, Department of Epidemiology, Babol, Iran. Background & Objective: Pulmonary arterial hypertension (PAH) is the most important and the most common complication in patients with beta-thalassemia intermedia and its cardiac involvement is the main cause of death in these patients. This study was conducted to assess the effect of tadalafil on pulmonary artery pressure and right ventricular function in patients with betathalassemia intermedia. Methods-Materials: 44 patients with beta-thalassemia intermedia were inducted in the study based on the maximum amount of a normal pulmonary artery systolic pressure (PASP) and the tricuspid regurgitation velocity (TRV) measured by transthoracic echocardiography (TTE), which is the threshold for the diagnosis of pulmonary hypertension. Patients with hepatic or renal insufficiency and also patients who are treated with organic nitrates or alpha-blockers were excluded. And then patients were randomly divided into two groups of 22 patients and were treated for 6 weeks with tadalafil capsules (40 mg daily) or placebo capsules (containing lactose) that were same in weight, size and shape. PASP, TRV and variables related to systolic and diastolic function of the right ventricle (TAPSE, S0 and E / E’) were measured by TTE before and after treatment and finally were analyzed. Result: At the end, significant improvement in all of the variables were observed in the group who received tadalafil (p

Background: Anxiety is one of the most primary and common reactions to a cardiac event can lead to hypertension, tachycardia, and high cardiac output. Objectives: To investigate the predictors of clinical anxiety aggravation at the end of a cardiac rehabilitation (CR) program. Patients and Methods: This retrospective study used a database of a CR ward of a hospital in Iran. The demographic and clinical information of 574 patients participating in the CR program from April 2005 through April 2010 were analyzed. In order to determine the predictors of anxiety, binary logistic regression was performed. Results: After adjustment for gender, age and education, the results showed that 16.7% of the patients completed their CR program with increased levels of clinical anxiety. The following study variables were independently predictive of increased anxiety at the end of the CR program: male gender (OR = 2.04, 95% CI = 1.11 to 3.33, P = 0.048), no history of diabetes (OR = 4.24, 95% CI = 172 to 10.44, P = 0.002), family history of cardiac disease (OR = 2.63, 95% CI = 1.03 to 6.74, P = 0.043), and not quitting smoking (OR = 3.29, 95% CI = 1.38 to 7.85, P = 0.007). These variables could explain 9% - 15% of the variance in the dependent variable. Conclusions: It is possible to predict higher anxiety levels at the end of the CR program and implement preventive measures to control anxiety by considering certain demographic and clinical variables. Future studies should assess the predictive power of other variables.

To investigate the independent predictors of immediate success for atrioventricular nodal reentry tachycardia (AVNRT) catheter ablation in patients without accelerated junctional rhythm (JR). The study included 172 consecutive patients with AVNRT undergoing slow pathway ablation that had no JR during the radiofrequency pulses. The diagnosis of AVNRT was made using the classic criteria of documenting antegrade atrio–His or retrograde ventriculoatrial (VA) jump and arrhythmia induction. Successful ablation was defined as the inability to induce tachycardia with and without the infusion of isoproterenol and the absence of more than one AV-nodal echo. The clinical independent predictors of successful ablation in the studied patients were identified as age ≥60, ablation-site location (mid-septal rather than posteroseptal), and baseline heart rate ≥100 beat per minute. The predictive performance of the risk model was very good and the calibration of the risk model was acceptable. Our study suggests predictive factors that can be used to gauge procedural success in AVNRT patients without accelerated JR during ablation.

The implantation of a CD133+ bone marrow cell population into an ischemic myocardium has emerged as a promising therapeutic modality for myocardial regeneration and restoration of ventricular contractility. While previous studies have documented the short-term safety and efficacy of CD133+ cell transplantation in patients with acute myocardial infarction, there are few reports of long-term follow-up results. Here, we present the results of long-term follow-up of our acute myocardial infarction patients who were treated with intramyocardial injection of CD133+ cells after coronary bypass graft.After five years, 13 patients in the cell transplantation group and 5 patients in the control group underwent safety and efficacy investigations by New York Heart Association classification and two-dimensional echocardiography (2D echo).During the five-year study period, no major cardiac adverse events were reported among patients who received CD133+ stem cells. Regarding efficiency, we observed no statistically significant treatment effects for the echocardiographic parameters [left ventricular end-diastolic and end-systolic volumes, and resting ejection fraction] measured during the follow-up period. However, detailed analysis of regional wall motion revealed an improvement in the Wall Motion Score Index from baseline to the six month follow-up, which was maintained during the follow-up period.Taken together, the long-term results of the present study indicate that transplantation of CD133+ is a safe and feasible procedure; however, we could not show any major benefits in our patients. Thus, this issue needs to be addressed by conducting other studies with more patients.

We describe the surgical management of a free-floating thrombus in the aortic arch in a patient with severe mitral stenosis, a left atrial appendage (LAA) clot, and an iliac artery thrombus. A 60-year-old woman complaining of dyspnea and pain in her right leg was referred to our multidisciplinary clinic. After a brief history was taken, an electrocardiography evaluation showed atrial fibrillation. Color Doppler sonography of the lower limb arteries showed decreased blood flow in distal branches of the internal iliac artery of the right leg. Transthoracic and transesophageal echocardiography evaluations revealed severe mitral stenosis, a large LAA clot, and a large mobile mass (2 � 1.5 � 1.5 cm) in the distal aortic arch. Additional investigations with computed tomographic angiography revealed that the thrombus extended from the aortic arch to the subclavian artery. Another bulky thrombus in the right iliac artery was also found. Given this complicated medical situation, emergency cardiac surgery was performed, and the clot was removed. The stenotic mitral valve was replaced with a prosthetic valve, The LAA was closed after clot removal, and the bulky thrombus was extracted from the right iliac artery. Transesophageal echocardiographic data were obtained postoperatively, and the patient's course in the intensive care unit was favorable. She was discharged from the hospital in good condition on warfarin, digoxin, aspirin, and metoprolol.

Introduction Several epidemiological studies have proposed an association between Helicobacter pylori infection and coronary artery disease. In the current study, we aimed to evaluate the prevalence and relevance of H. pylori infection, using polymerase chain reaction (PCR) methods, in the coronary arterial wall of Iranian patients who have already undergone coronary bypass grafting (CABG). Methods A total of 105 consecutive patients who underwent CABG at the Department of Cardiovascular Surgery of Baqiyatallah University of Medical Sciences were included in the study, and biopsy specimens from their coronary plaques were taken and analyzed using the PCR methods for detecting Helicobacter species (H Spp.). Fifty-three specimens from biopsies of the left internal mamillary artery in the same patients were also collected and tested. Results H. Spp. PCR test result was positive for 31 (29.5%) specimens from coronary artery atherosclerotic plaques. Serologic test results also showed 25 (23.8%) positive cases for H. pylrori immunoglobulin A (IgA) and 56 (53.3%) positive for anti- H. pylori immunoglobulin G. None of the specimens from the mamillary artery were positive for H Spp. genome when it was evaluated using PCR ( P H. pylori IgA were significantly more likely to have higher total cholesterol and low-density lipoprotein (LDL) levels than IgA-negative patients. Conclusion H Spp. infection replication in the coronary arterial wall is associated with atherosclerotic plaque formation. Seropositivity for H. pylori IgA may also enhance blood values of total cholesterol and LDL in these patients.

Background Thoracic aortic aneurysms and dissections (TAAD) is a critical condition that often goes undiagnosed with fatal consequences. While majority of the cases are sporadic, more than 20% are inherited as a single gene disorder. The most common familial TAA is Marfan syndrome (MFS), which is primarily caused by mutations in fibrillin-1 (FBN1) gene. Patients with FBN1 mutations are at higher risk for dissection compared to other patients with similar size aneurysms. Methods Fifteen family members were genotyped using Affymetrix-10K genechips. A genome-wide association study was carried out using an autosomal dominant model of inheritance with incomplete penetrance. Mutation screening of all exons and exon-intron boundaries of FBN1 gene which reside near the peak Lod score was carried out by direct sequencing. Results The index case presented with agonizing substernal pain and was found to have TAAD by transthoracic echocardiogram. The family history was significant for 3 first degree relatives with TAA. Nine additional family members were diagnosed with TAA by echocardiography examinations. The affected individuals had no syndromic features. A genome-wide analysis of linkage mapped the disease gene to a single locus on chromosome 15q21 with a peak Lod score of 3.6 at fibrillin-1 (FBN1) gene locus (odds ratio > 4000:1 in favour of linkage), strongly suggesting that FBN1 is the causative gene. No mutation was identified within the exons and exon-intron boundaries of FBN1 gene that segregated with the disease. Haplotype analysis identified additional mutation carriers who had previously unknown status due to borderline dilation of the ascending aorta. Conclusions A familial non-syndromic TAAD is strongly associated with the FBN1 gene locus and has a malignant disease course often seen in MFS patients. This finding indicates the importance of obtaining detailed family history and echocardiographic screening of extended relatives of patients with non-syndromic TAAD to improve the outcome. In addition, association of non-syndromic TAAD with the Marfan disease gene locus poses the question whether secondary prevention strategies employed for Marfan syndrome patients should be applied to all patients with familial TAAD.

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