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Introduction: Considering that the lack of correct understanding of tacrolimus serum levels leads to irreversible complications such as kidney failure, convulsions, etc. in heart transplant patients, it is very important to understand the factors affecting the metabolism and serum levels of this drug. In addition, saliva can be used as a more accessible source to measure tacrolimus levels. Materials and Methods: In our study, 7 patients including 4 men and 3 women were included in the study, 3 patients due to DCM, 1 patient due to myocarditis, 1 patient due to ICM, 1 patient due to ARVC and 1 patient due to RHD underwent heart transplant surgery.: In this study, we aim to compare the levels of tacrolimus in the saliva and serum of patients after heart transplantation. We hypothesize that there may be a correlation between the levels of tacrolimus in saliva and serum, as both are potential sources for drug monitoring in heart transplant patients. Results: Our study highlights the importance of accurately monitoring tacrolimus levels in heart transplant patients. While saliva-based monitoring of tacrolimus levels may be a convenient alternative to blood draw, our findings suggest that it may not provide accurate Conclusion: These findings indicate that caution should be exercised when using salivary tacrolimus levels as a sole indicator of drug concentration and further research is necessary to better understand and interpret salivary tacrolimus levels in clinical practice and to optimize post-transplant care for heart transplant patients. [ABSTRACT FROM AUTHOR]

Introduction: Recent developments in echocardiography made assessing pulmonary arterial hypertension (PAH) in the heart, a suitable choice. This study aimed to investigate the association of myocardial right ventricular relaxation time and systolic pulmonary artery pressure (SPAP) in PAH patients. Materials and Methods: The present study evaluated 74 patients with PAH (n=49) and age- and sex-matched healthy controls (n=25). All patients underwent transthoracic echocardiography. We evaluated the right ventricular (RV) function's echocardiographic parameters, including IVRT, IVCT, S, E, A, S', E', A', ET, DT, TAPSE, FAC, and SPAP. Results: We found no significant differences in age and gender between the two studied groups (p>0.05). However, we observed a significant difference in IVRT, IVCT, E', A' (p=0.004), A, S', DT, TAPSE, FAC and SPSP (p<0.001 for all cases) between two studied groups. Unlike the control group, we revealed a significant correlation between S' and E' (r=0.45, p=<0.001), S' and A' (r=0.66, p=<0.001), S' and FAC (r=0.3, p=0.035), A and A'(r=0.4, p=0.004), TAPSE and FAC (r=0.82, p=<0.001), TAPSE and SPAP (r= -0.43, p=0.002), MPI and A (r= - 0.35, p=0.013), MPI and ET (r= -0.72, p=<0.001), E/A and E/E'(r=0.47, p=<0.001), and BSA and S' (r= -0.3, p=0.011). In addition, no meaningful association was found between SPAP and IVRT and IVCT (p>0.05). Conclusion: Our findings revealed that IVRT and IVCT might not be affected by the SPAP and, therefore, could be used in the assessment of right ventricular function in patients with PAH. [ABSTRACT FROM AUTHOR]

Purpose: The mortality rate of cardiovascular diseases in such developing countries as Iran is on the rise. Despite sufficient evidence pointing to its efficacy, cardiac rehabilitation (CR) approach is only employed to a limited extent. In the present study, barriers to participation in center-based cardiac rehabilitation programs and patients' attitude toward home-based cardiac rehabilitation model were examined. Methods: In this study, 204 eligible patients for CR visiting an academic hospital were examined during the first three months of 2017. Patients had either abandoned rehabilitation programs midway through or had not attended one in the first place. Data about perceived barriers were collected using the modified Cardiac Rehabilitation Barriers Scale. Also, Patients' attitude toward home-based CR was collected using a pre-validated researcher-made questionnaire. Results: The results revealed that the most effective barriers were transportation problems (70%), travel costs (70%), considerable distance to the rehabilitation center (67%), and lack of insurance coverage for rehabilitation costs (64%), respectively. Patients with longer than 30-minute drive time were less likely to attend in training sessions in the center. In addition, the important patient expectations about home-based CR programs included: communication with specialists, training before entering the rehabilitation program, and making periodic visits to maintain motivation and adhere to the home-based CR programs. Conclusions: The results revealed that logistical factors were the major barriers to participation in rehabilitation programs. Alternative models such as home-based CR programs, positively evaluated by the participants, can be used to overcome these barriers. [ABSTRACT FROM AUTHOR]

Cardiac complications including arrhythmia and especially atrial fibrillation (AF) are common causes of death in β‐thalassemia patients. The main factor in the etiopathogenesis of these complications is iron overload, which results in increased oxidative stress. Although there is a known association between cardiac complications and iron overload in β‐thalassemia patients, there is no comprehensive review on AF and excessive iron with a focus on oxidative stress in these patients. The aim of this article was to review the different aspects of AF in β‐thalassemia patients with a focus on the prevention and treatment of AF by using iron chelators and/or anti‐oxidants. AF in β‐thalassemia patients is more common than in the general population. One of the most important causes of AF is cardiac iron overload and the harmful effects of increased oxidative stress. Iron‐induced AF can be reversed by using an intensive iron chelation regimen. Based on a few experimental studies, the combination of iron chelators with some anti‐oxidants, including NAC, vitamin C, and acetaminophen, can lead to improved cardiac protection. However, the effect of such combinations on cardiac arrhythmias should be further evaluated with animal and human studies. [ABSTRACT FROM AUTHOR]

Introduction: Heart failure with reduced ejection fraction (HFrEF) is a debilitating disease in which Left Ventricular Ejection Fraction (LVEF) is = 40%, and it involves various organs. Regarding the novelty of stem cell therapy in HF, we aimed at studying the effect of stem cell therapy on the QoL of patients with HFrEF. Materials and Methods: In a prospective study, 30 patients diagnosed with HFrEF who had undergone stem cell injection (study group) and 30 patients with HFrEF receiving guideline-directed medical therapy (control group) were recruited by convenience sampling during 2016 in Mashhad, Iran. Patients' quality of life, left ventricular ejection fraction and their disability degree were studied twice with a 3-month interval. For data analysis, paired t-test, chi2 and multivariate linear regression were used. Results: The mean age of study and control groups was 61.3±10.24 and 60.93±7.88 years respectively. Ninety percent of the cases and 56.7% of the controls were male (P=0.003). A significant difference in QoL was observed before and after treatment in each group (P<0.05). However, the QoL score showed no statistical difference between the two groups following treatment (P=0.13). The same result was achieved for LVEF (P=0.18); whereas the NYHA function class showed a significant difference between the two groups following treatment (P=0.017). Conclusions: According to the results, it seems that the treatment of HFrEF patients with stem cells is as effective as conventional therapies in improving the LVEF and QoL and more efficient than conventional treatments in increasing the patients' general satisfaction with life. [ABSTRACT FROM AUTHOR]

Introduction: Noninvasive positive pressure ventilation (NIPPV) has become an integral tool in the management of acute hypercapnic respiratory failure (AHRF) in chronic obstructive pulmonary disease (COPD). This study was performed to evaluate the early effects of NIPPV on pulmonary artery pressure (PAP), serum N-terminal pro BNP (NT-proBNP), and ventilatory parameters in the COPD patients with AHRF. Materials & Methods: This quasi-experimental study was conducted on 20 COPD patients with AHRF. The participants received the standard treatment in addition to NIPPV. There was no contraindication for NIPPV. Arterial blood gas analysis, Doppler echocardiography (for measuring PAP), and plasma NT-proBNP measurements were performed before and after NIPPV. Results: According to the results, the mean age of the participants was 54.57±15.43 years. Furthermore, the mean pressures of carbon dioxide (PCO2), NT-proBNP levels, and PAP were 72.33±13.96 mmHg, 4333.90±6542.20 pg/ml, and 47.5±6.38 mmHg, respectively. After one week of NIPPV, there were statistically significant differences among the mean pH, PaCO2, PAP, and NT-proBNP (P<0.001, P=0.003, P<0.001, and P<0.001, respectively). Conclusion: As the findings of the present study indicated, the application of NIPPV in the COPD patients with AHRF can not only improve arterial blood pH and carbon dioxide tension, but also instantly decrease NT-proBNP levels and PAP. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular disease is a leading cause of death in many societies. Arterial stiffness is an initial sign of structural and functional changes in the arterial wall. Pulse wave velocity (PWV) is the gold standard for non-invasive evaluation of aortic stiffness and a modifiable cardiovascular risk factor. Curcumin is a major component of turmeric with known anti-inflammatory and anti-oxidative effects. Since arterial stiffness is affected by inflammation and oxidative stress, it may be improved by curcumin supplementation. The purpose of this clinical trial was to investigate the potential effects of curcumin on improving arterial stiffness in patients with metabolic syndrome. Methods: This placebo-controlled, double-blind, randomized clinical trial was conducted among metabolic syndrome patients. Sixty-six eligible individuals were randomly assigned to active intervention or control groups. The active intervention group received curcumin supplement at a dose of 500 mg daily for 12 weeks, whereas the control group received placebo capsule. Physical activity, daily dietary energy intake, anthropometric, body composition, biochemical, hemodynamic, and arterial stiffness parameters were evaluated at baseline and the end of the study. Results: In this study, body weight decreased significantly in the curcumin group compared to placebo. Also, curcumin intervention improved PWV, which remained significant after adjustment for potential confounding factors (P=0.011). Conclusion: The current clinical trial demonstrated that daily intake of 500 mg of curcumin for 12 weeks can lead to the improvement of arterial stiffness and weight management among subjects with metabolic syndrome. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular disease is a leading cause of death in many societies. Arterial stiffness is an initial sign of structural and functional changes in the arterial wall. Pulse wave velocity (PWV) is the gold standard for non-invasive evaluation of aortic stiffness and a modifiable cardiovascular risk factor. Curcumin is a major component of turmeric with known anti-inflammatory and anti-oxidative effects. Since arterial stiffness is affected by inflammation and oxidative stress, it may be improved by curcumin supplementation. The purpose of this clinical trial was to investigate the potential effects of curcumin on improving arterial stiffness in patients with metabolic syndrome. Methods: This placebo-controlled, double-blind, randomized clinical trial was conducted among metabolic syndrome patients. Sixty-six eligible individuals were randomly assigned to active intervention or control groups. The active intervention group received curcumin supplement at a dose of 500 mg daily for 12 weeks, whereas the control group received placebo capsule. Physical activity, daily dietary energy intake, anthropometric, body composition, biochemical, hemodynamic, and arterial stiffness parameters were evaluated at baseline and the end of the study. Results: In this study, body weight decreased significantly in the curcumin group compared to placebo. Also, curcumin intervention improved PWV, which remained significant after adjustment for potential confounding factors (P=0.011). Conclusion: The current clinical trial demonstrated that daily intake of 500 mg of curcumin for 12 weeks can lead to the improvement of arterial stiffness and weight management among subjects with metabolic syndrome. [ABSTRACT FROM AUTHOR]

Heart failure (HF) is a serious and growing public health concern, which has many causes. Pregnancy is a critical condition with significant hemodynamic and immunologic changes. Peripartum cardiomyopathy (PPCM) is a disease of unknown cause in which left ventricular (LV) dysfunction occurs during the last trimester of pregnancy or the early puerperium. PPCM is known to be the most common cardiovascular cause of severe complications in pregnancy. Risk factors for peripartum cardiomyopathy include advanced maternal age, twin pregnancy, smoking, pregnancy-related hypertension and preeclampsia, multiparity, African descent, and long-term tocolysis. Oxidative stress and some inflammatory markers have been diagnosed in PPCM pathophysiology. Recent observations have suggested that bromocriptine might favor recovery of LV systolic function in patients with PPCM. Patients developed peripartum cardiomiopathy treated with bromocriptine showed significantly improved LV ejection fraction and heart failure symptoms. This article tries to have a short review on this clinical scenario. [ABSTRACT FROM AUTHOR]

Cor triatriatum sinistrum is a rare congenital cardiac malformation, accounting for about 0.1-0.4% of all congenital heart diseases and characterized by the presence of a fibromuscular membrane that subdivides the left atrium into two chambers in the classical form. While classic cor triatriatum in most patients can be observed during the neonatal period or early infancy, it is very rare in adults. We herein present an incidental finding of cor triatriatum sinistrum in a middle-aged man with coronary artery disease scheduled for coronary artery bypass graft surgery. The patient was admitted for exertional dyspnea and chest pain of a three-month duration. He had a past medical history of mild hyperlipidemia and mild hypertension. Transthoracic two-D echocardiography (TTE) demonstrated a visible presence of a membranous band in the mid portion of the left atrium with obvious obstruction by color and Doppler flow measurements, confirmed by three-D echocardiography. Selective coronary angiography also revealed a severe ostioproximal stenosis of the left anterior descending artery of up to 99%. On-pump coronary artery bypass grafting was performed without complications, during which the anastomosis of the left internal mammary artery to the left anterior descending artery and the removal of the membrane were done. [ABSTRACT FROM AUTHOR]

Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is a congenital cardiac disease with myocardial involvement, most probably right ventricular (RV) dysfunction, accounting for 20% of sudden cardiac deaths. Characterized by the fibro-fatty infiltration of the RV free wall, ARVD/C presents in adolescents with ventricular arrhythmias and heart failure symptoms and as biventricular failure in adults. The coronary risk in these patients is not clear. We present an incidental finding: the left anterior descending artery cut-off in a middle-aged man with ARVD/C. He had been under treatment for heart failure symptoms, which had decompensated frequently commencing 6 months earlier, and therefore he was scheduled for stem cell injection. He had no chest pain or coronary artery disease risk factors. Two-dimensional transthoracic echocardiography demonstrated RV enlargement with moderate to severe dysfunction and left ventricular ejection fraction (LVEF) of 35-40%, which was 45-50% two years before. Selective coronary angiography performed 8 years previously was normal but a new one revealed the cut-off of the left anterior descending artery at the proximal portion, for which percutaneous coronary intervention was performed and showed no significant lesion in the other vessels. One should consider coronary artery disease in uncontrolled heart failure with LVEF reduction, even in the absence of typical chest pain. It may not be the natural course of the underlying disease. [ABSTRACT FROM AUTHOR]

Congenital aortocaval fistula in association with complex congenital heart disease has never been described before. We represent an adult with tetralogy of fallot and an undiagnosed subclavian artery to superior vena cava fistula in previous catheterisms. He underwent surgical correction, successfully. After 8 months post operation he was doing well with improved functional capacity and no cyanosis. [ABSTRACT FROM AUTHOR]

An abstract of the article "Relation between capillary wedge pressure measured by echocardiography using Tissue Doppler Imaging(TDI) method and catheterism in patients with mitral valve stenosis," by is presented.