Right Ventricular Function Indices at Rest and During Exercise in Hyperthyroid Patients: A Cross-sectional Study.

Background: Since hyperthyroidism could be associated with right ventricular dysfunction, this study intended to investigate right ventricular (RV) function using strain echocardiography in hyperthyroid patients both at rest and in maximum-stress conditions. Methods: This cross-sectional study was conducted at Rajaie Cardiovascular Medical and Research Center, Tehran, Iran, from January 2019 to January 2020. All study participants completed a maximum treadmill exercise test, as well as a complete two-dimensional echocardiogram at rest and the peak of stress test. The data were analyzed using SPSS statistical software. The independent samples t test and Mann-Whitney U test were used for numerical, and the Chi square test was used for nominal variables. P<0.05 was considered statistically significant. Results: The final analysis included 52 participants (26 subjects in each group). In a maximal stress situation, we found that among the RV function indices, RV global longitudinal strain (P=0.0001), systolic strain rate (P=0.0001), diastolic strain rate (P=0.0002), and tricuspid annular plane systolic excursion (P=0.019) were reduced significantly in the hyperthyroid patients compared to the control group. There was also a linear correlation between RV size and thyroid stimulating hormone (TSH) level (P=0.009, r=0.36). Moreover, we found a negative linear correlation between TSH level with maximum stress RV strain and diastolic strain rate (P<0.001). Conclusion: The findings of the present study revealed a significant change in RV function indices among hyperthyroid patients. Therefore, it highlights the necessity of early diagnosis and treatment of hyperthyroidism, as well as RV function evaluation in these patients.

The Long-Term Response to Treatment with Calcium Channel Blockers in Patients with Idiopathic Pulmonary Arterial Hypertension.

Background: Long-term outcomes in patients with idiopathic pulmonary arterial hypertension (IPAH) treated with calcium channel blockers (CCBs) are not well documented. Therefore, this study aimed to determine the long-term response to treatment with CCBs in patients with IPAH. Methods: This retrospective cohort study was performed on 81 patients with IPAH admitted to our center. Vasoreactivity testing with adenosine was performed in all patients. Twenty-five patients showed a positive response to vasoreactivity testing and were included in the analysis. Results: Of 24 patients, 20 (83.3%) were female, and the mean age of the patients was 45.90±10.42 years. Fifteen patients improved after 1 year on CCB therapy (the long-term CCB responders group), and 9 showed no improvement (the CCB failure group). The CCB responders group had a greater proportion of patients in New York Heart Association (NYHA) functional class I or II (93.3%), a longer distance walked, and less severe hemodynamic parameters. At the 1-year evaluation, the long-term CCB responders had more improvements in the mean 6-minute walk test result (437.43±125.32 vs 268.17±130.06; P=0.040), the mixed venous oxygen saturation level (71.84±9.87 vs 59.03±9.95; P=0.041), and the cardiac index (4.76±1.12 vs 3.15±0.90; P=0.012). Additionally, mPAP was lower in the long-term CCB responders group (47.35±12.70 vs 67.23±14.08; P=0.034). Finally, all the CCB responders were in NYHA functional class I or II (P=0.001). Conclusion: Our study illustrated that long-term treatment with oral CCBs was effective in 60% of acute responders and 18.5% of the entire study population.

Hemodynamic Profile of Patients with ESKD Referred to Heart Failure Department of Rajaie Heart Center, A Data from Right Heart Catheterization Registry.

INTRODUCTION: Cardiovascular disorders are the leading cause of mortality and morbidity in patients with end-stage kidney disease (ESKD). We aimed to describe different patterns of cardiovascular abnormalities, the hemodynamics and the outcomes of ESKD patients referred to a tertiary center for heart failure programs, in detail. METHODS: In this cohort, all ESKD patients who were referred by nephrologists for cardiovascular consultation and scheduled for right heart catheterization between July 2009 to October 2021, were assessed. The outcome of the selected patients in terms of all-cause mortality or successful kidney transplantation was followed up until January 2022. RESULTS: A total of 73 patients (54.7% male) were selected. With the exception of four patients who had a specific cardiovascular disease, the remainder were referred due to a low left ventricular ejection fraction or pulmonary hypertension in order to determine the potential for kidney transplantation. Most of the patients (63%) were categorized as heart failure with reduced ejection fraction (HFREF). More than 87% of study population had pulmonary hypertension (PH). Post capillary PH (isolated or combined) was the most common type of PH (81%). The median interquartile range (IQR) of time to kidney transplantation or all-cause mortality was 1 (0.5 to 2) year. Twenty-five (36.2%) patients received a successful kidney transplant. The all-cause mortality rate was 28.8%. Older age, lower left ventricular ejection fraction (LVEF) and presence of pericardial effusion were independent predictors of all-cause mortality in multivariate analysis. CONCLUSION: ESKD patients with HFREF and/or pulmonary hypertension will have remarkable improvement in terms of their cardiac performance parameters following kidney transplantation.  DOI: 10.52547/ijkd.7105.

Predictors of readmission in hospitalized heart failure patients.

Introduction: Heart failure(HF) related hospitalization constitutes a significant proportion of healthcare cost. Unchanging rates of readmission during recent years, shows the importance of addressing this problem. Methods: Patients admitted with heart failure diagnosis in our institution during April 2018to August 2018 were selected. Clinical, para-clinical and imaging data were recorded. All included patients were followed up for 6 months. The primary endpoints of the study were prevalence of early readmission and the predictors of that. Secondary end points were in-hospital and 6-month post-discharge mortality rate and late readmission rate. Results: After excluding 94 patients due to missing data, 428 patients were selected. Mean age of patients was 58.5 years (±17.4) and 61% of patients were male. During follow-up, 99patients (24%) were readmitted. Early re-admission (30-day) occurred in 27 of the patients(6.6%). The predictors of readmission were older age (P = 0.006), lower LVEF (P <0.0001), higher body weight (P = 0.01), ICD/CRT implantation (P = 0.001), Lower sodium (P = 0.01), higher Pro-BNP(P = 0.01), Higher WBC count (P = 0.01) and higher BUN level (P = 0.02). Independent predictors of early readmission were history of device implantation (P = 0.007), lower LVEF (P = 0.016), QRS duration more than 120 ms (P = 0.037), higher levels of BUN (P = 0.008), higher levels of Pro-BNP(P = 0.037) and higher levels of uric acid (P = 0.035). Secondary end points including in-hospital and 6-month post-discharge mortality occurred in 11% and 14.4% of patients respectively. Conclusion: Lower age of our heart failure patients and high prevalence of ischemic cardiomyopathy, necessitate focusing on more preventable factors related to heart failure.

COVID-19 in heart transplant recipients.

Introduction: After solid organ transplantation, patients require lifelong immunosuppressive medication, increasing susceptibility to COVID-19. We evaluated the clinical outcomes of heart transplant recipients in patients with COVID-19. Methods: We enrolled twenty-two COVID-19 cases of adult heart transplantation from February 2020 to September 2021. Results: The most common symptoms in patients were fever and myalgia. The death occurred in 3 (13.6 %). Conclusion: Although heart transplantation mortality may increase in the acute rejection phase concomitant with COVID-19, immunosuppressive dose reduction may not be necessary for all heart transplant patients with COVID-19.

A heart in a heart: a case report of spontaneous flail of bicuspid aortic valve.

BACKGROUND: Aortic regurgitation is attributed to congenital and acquired abnormalities of the aortic valve or aortic valve supporting structures. The most common cause of aortic regurgitation is atherosclerotic degeneration of the valve, especially in the presence of a bicuspid aortic valve. A 25-year-old Persian man with no past medical history, developed dyspnea since 1 week before his first visit to the physician. He was an active person up to this time, and had no history of trauma or chest pain. Transthoracic echocardiography showed severe aortic regurgitation in the context of flail bicuspid aortic valve, with no evidence of endocarditis. Laboratory tests including blood cultures were negative for infection. The patient underwent aortic valve replacement and the diagnosis was confirmed at time of surgery. CONCLUSION: This case represents noninfective and nontraumatic spontaneous flail of bicuspid aortic valve.

The prediction of right atrial pressure using electrocardiogram: a novel approach.

AIMS: Pulmonary hypertension (PH) is a serious disorder that can complicate pulmonary and cardiovascular diseases. Right atrial (RA) pressure is a robust predictor of the pulmonary hypertension severity, which is measured via right heart catheterization. Limited studies have been carried out to assess the association between electrocardiogram data and the RA pressure as a prognostic factor of PH. In this study, the relation between P wave and PR segment changes with RA pressure was evaluated. METHODS AND RESULTS: In this study, 94 patients in PH groups of 1, 3, and 4, based on the World Health Organization classification, were entered. RA pressure was measured using the right heart catheterization. PR segment and P wave morphology in leads II and V1 were evaluated in patient's electrocardiogram. The median age of the patients was 35.5 years old in which 64.9% of them were female. The distribution of patients in groups 1, 3, and 4 PH were 77.7%, 5.3%, and 17%, respectively. Among the studied P wave and PR segment changes, PR segment depression in lead II and pulmonary P wave in lead V1 had significant relation with the RA pressure (P-value <0.001). The sensitivity, specificity, and negative predictive values of PR segment depression for detection of patients with high RA pressure (RA pressure > 14 mmHg) were 80%, 84%, and 94%. The specificity and negative predictive values of pulmonary P wave in lead V1 were determined 89% and 88%. CONCLUSIONS: It was found that the PR segment depression in lead II and pulmonary P wave in lead V1 associate with the RA pressure in patients with precapillary PH. PR segment depression had useful sensitivity, specificity, and negative predictive values, and the pulmonary P wave in lead V1 had acceptable specificity and negative predictive values for detection of patients with high RA pressure. Therefore, the electrocardiogram can be used as a screening tool for determination of pulmonary hypertension severity.

Angiotensin receptor neprilysin inhibitor in inotrope dependent heart failure patients: A case series.

Patients with advanced heart failure (HF) symptoms constitute stage D heart failure with high mortality and less response to conventional guideline directed medical therapies. These patients are subjected to receive non-medical therapies including heart transplant or mechanical circulatory support for increasing survival. Considering the low availability and serious complications of these strategies,effective medical therapies for this group of patients would be pivotal for decreasing mortality and morbidity of them. Angiotensin receptor neprilysin inhibitor (ARNI) is a class of drugs approved for ambulatory heart failure patients. ARNI use like other groups of heart failure drugs has not been fully evaluated in end-stage heart failure patients. Herein, we describe four inotrope-dependent heart failure patients. Initiation of ARNI in these patients, lead to discontinuation of inotrope and reducing the need for inotrope in the follow-up period.

A new algorithm for arrhythmia interpretation.

BACKGROUND: Electrocardiogram (ECG) is an essential tool used to diagnose serious heart disease but its interpretation is challenging for undergraduate students and junior practitioners despite numerous methods that have been suggested to aid ECG interpretation. This paper aims to present a new algorithm for arrhythmia interpretation that is superior to current methods to be used as a supplement to lecture materials for medical students. METHODS: A new systematic algorithm is introduced in this paper. To evaluate the effectiveness of the proposed algorithm, a study was carried out in a medical university. Two groups of medical interns were educated via lecture and teaching rounds, either using the proposed algorithm or without using the algorithm. At the end of 1 month training, students of both groups were blindly evaluated. RESULTS: The group trained using the algorithm scored an average of 93% on the evaluation, while the group trained without it averaged 62%. This was found to be a statistically significant difference (p<0.01). CONCLUSION: The proposed method for education of arrhythmia interpretation can improve physicians' competency in ECG interpretation.