Association between parities and duration of breastfeeding and the severity of coronary artery disease in women above 30 years old age (A pilot study).

Background: The prevalence and mortality of CVD in women increase over time. We conducted this research to evaluate the severity of coronary artery disease with the number of live births and breastfeeding duration. Methods: Patients aged 30-50 years old with positive exercise tests or evidence of cardiac ischemia who were candidates for coronary angiography were included. All the participants had at least one child. Syntax score was used to evaluate the severity of coronary arteries. Results: Mean number of children was 3.72±1.85, in those patients with <2 live births no one had a syntax score≥1, but in the>5 live births group most patients had a syntax score≥1. In patients with zero syntax score, it was estimated as 4.91±39.7; in patients with 1≤ syntax score, it was 4.48±7.29 (P =0.76). Among patients with > 5 birth lives, those with higher syntax scores had older ages (P=0.497). After adjusting age, the association between live births and syntax score became non-significant (P=0.850). Conclusion: By increasing the number of live births >5, the severity of coronary artery disease, increases. However, this association was not significant after adjusting the age of patients.

Speckle Tracking Echocardiography in Patients with Ankylosing Spondylitis and Evaluation of Subclinical Involvement.

Introduction: Ankylosing spondylitis (AS) is a chronic inflammatory condition primarily affecting the spine and the joints. It also affects multiple organs in the body including the cardiovascular system. Left ventricular (LV) global longitudinal strain (GLS) is a good measure for recognizing subclinical myocardial dysfunction. This study aimed to investigate if there is sub-clinical LV myocardial systolic dysfunction present in AS patients independent of the presence of cardiovascular disease risk factors. We also aimed to see if the GLS is associated with the aortic root abnormality present in these patients. Methods: Twenty-eight AS patients (mean age 40.6±10.9 years) were investigated in this cross-sectional case-control study. The control group (mean age 45.2±5 years) comprised 26 healthy individuals. Conventional and speckle tracking echocardiography was performed for all patients. LV systolic myocardial function was assessed by systolic GLS. Aortic diameters and diastolic function were also evaluated. Results: The baseline characteristics and cardiovascular risk factors of the case and control groups were similar and did not differ significantly. The AS patients were suffering more from diastolic dysfunction in comparison to the control group (p=0.009). We only found a significantly impaired longitudinal strain in the 3-chamber view of AS patients when compared to the control group. There was no significant association between the GLS and aortic root abnormality. Conclusion: Although the impaired longitudinal strain present in AS patients is not associated with the aortic root abnormality, it can be an early sign of cardiovascular involvement.

Long-Term Prognosis in Patients with Coronary Slow Flow.

Background: Coronary slow flow (CSF) is defined as decreased coronary blood circulation velocity and delayed opacification of contrast media during angiography. Evidence is insufficient regarding the course and prognosis of CSF patients. Long-term follow-up can help better understand the physiopathology and outcome of CSF. Accordingly, we assessed the long-term outcomes of CSF patients in this study. Methods: This retrospective cohort study was carried out on 213 CSF patients consecutively admitted to a tertiary health care center from April 2012 through March 2021. After data collection from the patients' files, follow-up was done via telephone call invitations and assessments of existing data in the outpatient cardiology clinic. The comparative analysis was conducted using a logistic regression test. Results: The mean follow-up length was 66.26±15.32 months, 105 patients (52.2%) were male, and the mean age of the patients was 53.81±11.91 years. The left anterior descending was the main affected artery (42.8%). At long-term follow-up, 19 patients (9.5%) required repeated angiography. Three patients (1.5%) had a myocardial infarction and 5 (2.5%) died from cardiovascular etiologies. Three patients (1.5%) underwent percutaneous coronary intervention. No patient required coronary artery bypass grafting. The need for a second angiography had no association with sex, symptoms, and echocardiographic findings. Conclusion: The long-term outcome of CSF patients is good, but their follow-up is necessary for the early diagnosis of cardiovascular-related adverse events.

Prone-Position Ventilation in a Pregnant Woman with Severe COVID-19 Infection Associated with Acute Respiratory Distress Syndrome.

A 25-year-old pregnant woman (gestational age: 24 weeks) presented with severe coronavirus disease-2019 (COVID-19) infection. Deterioration of her respiratory status resulted in her admission to the intensive care unit and mechanical ventilator support. Considering the lack of improvement in oxygen saturation, teleconsultation was performed, suggesting prone-position ventilation (PPV). Significant improvements were observed in oxygen saturation. The patient was extubated after five days of intermittent PPV and supine-position ventilation and was discharged 20 days after admission. Also, assessments revealed that the fetus was unharmed by the intervention. We suggest considering PPV for pregnant women with acute respiratory distress syndrome (ARDS).

Association of coronary artery dominance and mortality rate and complications in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention.

BACKGROUND: Percutaneous coronary intervention (PCI) is the treatment of choice for patients with ST-segment elevation myocardial infarction (STEMI). Effect of coronary artery dominance on the patients' outcome following primary PCI (PPCI) is not fully investigated. We investigated the association of coronary artery dominance with complications and 1-year mortality rate of PPCI. MATERIALS AND METHODS: In this retrospective study, patients with STEMI treated with PPCI from March 2016 to February 2018 were divided into three groups based on their coronary dominancy: left dominance (LD), right dominance (RD), and codominant. Demographic characteristics, medical history, results of physical examination, electrocardiography, angiography, and echocardiography were compared between the groups. RESULTS: Of 491 patients included in this study, 34 patients (7%) were LD and 22 patients (4.5%) were codominant. Accordingly, 54 propensity-matched RD patients were included in the analysis. The demographics and comorbidities of the three groups were not different (P > 0.05); however, all patients in the RD group had thrombolysis in myocardial infarction (TIMI) 3, while five patients in the LD and five patients in the codominant group had a TIMI ≤2 (P = 0.006). At admission, the median left ventricular ejection fraction (LVEF) was highest in RD patients and lowest in LD and codominant patients (34%, P = 0.009). There was no difference in terms of success or complications of PCI, in-hospital, and 1-year mortality rate (P > 0.05). CONCLUSION: Patients with left coronary artery dominance had a higher value of indicators of worse outcomes, such as lower LVEF and TIMI ≤ 2, compared with RD patients, but not different rates of success or complications of PCI, in-hospital, and 1-year mortality. This finding may suggest that interventionists should prepare themselves with protective measures for no-reflow and slow-flow phenomenon and also mechanical circulatory support before performing PPCI in LD patients.