Prevalence of Structural Heart Diseases Detected by Handheld Echocardiographic Device in School-Age Children in Iran: The SHED LIGHT Study.

Background: Structural heart disease (SHD) has great impacts on healthcare systems, creating further public health concerns. Proper data are scant regarding the magnitude of the affected population by SHD. Objectives: This study aimed to determine the prevalence of SHD among children and adolescents in an Iranian population. Methods: In this population-based study, a multistage cluster-random sampling was used to choose schools from the Tehran urban area. All students were examined using a handheld Vscan device by echocardiographer, and the results were concurrently supervised and interpreted by cardiologists. All the major findings were reevaluated in hospital clinics. Results: Of 15,130 students (6-18 years, 52.2% boys) who were examined, the prevalence of individuals with congenital heart disease (CHD) and cardiomyopathy was 152 (10.046 per 1,000 persons) and 9 (0.595 per 1,000 persons), respectively. The prevalence of definite and borderline rheumatic heart disease (RHD) was 30 (2 per 1,000 persons) and 113 (7.5 per 1,000 persons), correspondingly. Non-rheumatic valvular heart disease (VHD) was also detected in 465 (30.7 per 1,000 persons) students. Of all the pathologies, only 39 (25.6%) cases with CHD and 1 (0.007%) cases with RHD had already been diagnosed. Parental consanguinity was the strongest predictor of CHD and SHD (odds ratio [OR]: 1.907, 95% CI, 1.358 to 2.680; P < 0.001 and OR, 1.855, 95% CI, 1.334 to 2.579; P < 0.001, respectively). The female sex (OR, 1.262, 95% CI, 1.013 to 1.573; P = 0.038) and fathers' low literacy (OR, 1.872, 95% CI, 1.068 to 3.281; P = 0.029) were the strongest predictors of non-rheumatic VHD and RHD, correspondingly. Conclusions: The implementation of echocardiographic examinations for detecting SHD among young population is feasible which detected SHD prevalence in our population comparable to previous reports. Further studies are required to delineate its economic aspects for community-based screening.

Effect of a low dose of empagliflozin on short-term outcomes in type 2 diabetics with acute coronary syndrome after percutaneous coronary intervention.

OBJECTIVES: To study the effects of low dose of empagliflozin on improving outcomes in diabetic patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI). METHODS: This double-blind controlled clinical trial was carried out on 93 diabetic patients (56 males and 37 females, mean age of 56.55 years) with ACS who underwent PCI at 2 university teaching hospitals in 2020, Ahvaz, Iran. The patients were randomly assigned to receive empagliflozin (10 mg once daily) or placebo at similar doses for 6 months after PCI. In addition, to standard treatments with another hypoglycemic agent. Cardiovascular outcomes (including all-cause mortality, coronary revascularization, rehospitalization due to unstable angina, hospitalization due to heart failure, cardiovascular death, non-fetal myocardial infarction, and non-fetal stroke) were evaluated during period of 6 months follow-up after the empagliflozin treatment. RESULTS: There was no significant difference between the low dose empagliflozin and placebo groups after treatment in terms of cardiovascular mortality (2.2% versus [vs.] 4.2%; p=0.598), rehospitalization due to unstable angina (4.5% vs. 8.7%; p=0.433), and coronary revascularization (2.2% vs. 0%; p=0.312). CONCLUSION: The results of this study showed that adding low dose empagliflozin to standard care of ACS diabetic patients after PCI was associated with no significant reduction in negative cardiovascular outcomes during 6 months.

Primary mitral valve angiosarcoma: A multifaced ultra-rare tumor.

Malignant primary cardiac valve tumors are extremely rare neoplasms usually remaining silent up to late advanced stages. Getting to know the various features of this latent tumor, which needs prompt intervention, can assist in the earlier diagnosis. Herein we report a 24-year-old woman with angiosarcoma that originated from the mitral valve and manifested itself through dyspnea and pulmonary edema. The case is noteworthy with respect to appealing echocardiographic images.

Myocardial strain analysis as a non-invasive screening test in the diagnosis of stable coronary artery disease.

BACKGROUND: Coronary artery disease (CAD) is one of the most prevalent diseases around the world; however, finding the best noninvasive, low-cost, and more easily accessible test for its screening has been a challenge for several years. Eighty-nine patients suspected of stable CAD underwent 2D-speckle-tracking echocardiography (2DSTE) at resting position and offline longitudinal myocardial strain analysis, followed by coronary angiography. The correlation of the global longitudinal strain (GLS) and territorial longitudinal strain (TLS) with significant CAD (70% and more stenosis in at least one coronary artery) was then evaluated. RESULTS: The statistical analysis showed a significant correlation between low GLS and significant CAD (P=0.0001). The results also showed a significant correlation between low TLS and significant CAD in the left and right coronary artery territories. The optimal cut-off point of GLS for the detection of significant CAD was -19.25, with a sensitivity of 76.5% and specificity of 76.6%. CONCLUSION: This study confirmed the usefulness of 2DSTE myocardial strain analysis in diagnosis of CAD for detecting the affected coronary arteries using GLS and SLS.

Speckle tracking echocardiography in hypokinetic non-dilated cardiomyopathy: comparison with dilated cardiomyopathy.

AIMS: Hypokinetic non-dilated cardiomyopathy (HNDC), which is determined by impaired left ventricular (LV) systolic function despite normal LV size, has been categorized as a subgroup of dilated cardiomyopathy (DCM) spectrum. Lack of data regarding advanced echocardiographic data in this population motivated us to design the present study in order to assess LV myocardial deformation properties of HNDC patients against the ones with dilated left ventricle. METHODS AND RESULTS: Thirty-one HNDC patients and 23 DCM patients were enrolled in the study consecutively. Myocardial deformation parameters including global longitudinal strain, global circumferential strain, LV basal and apical rotation, LV twist, and LV mechanical dispersion were obtained with the use of two-dimensional speckle tracking-based methods in all patients. Left cardiac chamber volume was also measured using three-dimensional HeartModel application. Patients with enlarged left ventricle tend to have lower LV ejection fraction. Comparing with HNDC group, DCM patients showed worse global circumferential strain (coefficient ± standard error 3.59 ± 0.94, P < 0.001) and LV mechanical dispersion (coefficient ± standard error 16.46 ± 7.09, P = 0.02) after regression analysis, while neither the global longitudinal strain nor the LV twist was not significantly different between two study population. CONCLUSIONS: Left ventricular enlargement has a substantial effect on the circumferential strain and mechanical dispersion more than other deformation parameters that may play a role in the assumed poor prognosis of heart failure patients with dilated left ventricle.

Mitral annular calcification-related calcified amorphous tumor in a patient with normal renal function: a case report.

A calcified amorphous tumor (CAT) of the heart is a non-neoplastic mass, characterized by nodules of calcium on a background of amorphous fibrinous material. Mitral annular calcification (MAC) is one of the conditions most frequently associated with CAT. Most MAC-related CAT cases are reported in end-stage renal disease (ESRD) patients. This report is a description of a patient with normal renal function who was incidentally diagnosed with a CAT arising from MAC. An asymptomatic 43-year-old man with normal renal function underwent echocardiography. The echocardiography results revealed a highly mobile hyperechoic mass attached to the atrial side of the mitral annulus superimposed on a heavily calcified mitral annulus. Cardiac surgery and histopathological evaluation confirmed a diagnosis of MAC-related CAT. While MAC-related CAT is usually associated with ESRD patients, the precise etiology and management strategy of this benign tumor remain unclear. The rare incidence of this tumor in patients with normal renal function highlights the importance of further research of the pathology of this uncommon condition.

Effect of anti-epileptic drugs on serum immunoglobulin levels in children.

Epilepsy is one of the most frequent neurological disorders. Despite the advances and improvements in treatment of seizure disorders, immunologic alterations related to anticonvulsant drugs have been described. The aim of this paper is to assess the effect of some antiepileptic drugs on serum immunoglobulin levels in epileptic patients. Seventy-one patients with epilepsy were included in the study. Participants were divided into three groups based on their treatment with carbamazepine (n=33), sodium valproate (n=22) or phenobarbital (n=16) as monotherapy. Three samples were taken from each patient and serum immunoglobulin levels were measured before treatment, 3 months and 6 months after therapy. Overall, eleven patients out of 71 (15.5%) had a decrease in at least one serum immunoglobulin level (more than 2SD below age-matched control). In the patients receiving carbamazepine, 8 patients (24.2%) showed significant decline in at least one immunoglobulin (3 cases in IgA and 5 cases in IgG). In the group of treated with sodium valproate, 2 patients showed significant decrease in serum IgA level. Results of the last group indicated a significant reduction in serum IgG concentration only in one patient. No patient at all showed significant decrease in serum IgM level. This study suggests that anti-epileptic drugs could reduce serum immunoglobulins, especially IgA and IgG; among them carbamazepine effect is of more concern.

Effect of anti-epileptic drugs on serum level of IgG subclasses.

OBJECTIVE: There are some controversial studies on effects of anti-epileptic drugs (AEDs) on serum IgG subclasses; however, the role of these medications is still unclear. The aim of this study was evaluation the effects of anti-epileptic drugs on serum concentration of IgG and its subclasses METHODS: Serum IgG and IgG subclasses of 61 newly diagnosed epileptic patients were measured at the beginning of monotherapy with carbamazepine, sodium valproate, and phenobarbital, and 6 months later. Measurement of IgG and its subclasses was performed using nephlometry and ELISA techniques, respectively. FINDINGS: Reduction of at least one IgG subclass was found in 6 patients 6 months after treatment with AEDs. Among 27 patients receiving carbamazepine, decrease in at least one serum IgG subclass level was found in 5 patients. Among 20 patients using sodium valproate, only one patient showed decrease in IgG2 subclass. None of the 14 patients using phenobarbital revealed significant decrease in IgG subclasses. No infection was seen in the patients with reduction of subclasses. CONCLUSION: Although in our study, children with selective IgG subclass deficiency were asymptomatic, assessment of serum immunoglobulin levels could be recommended at starting the administration of AEDs and in serial intervals afterward in epileptic patients.