Retrosternal hematoma causing torsade de pointes after coronary artery bypass graft surgery; a case report.

Myocardial infarction is among the top causes of mortality worldwide. Survivors may also experience several complications. Infarct-related torsade de pointes (TdP) is an uncommon complication. In the context of myocardial infarction, coronary artery bypass graft (CABG) surgery is the prevalent therapeutic modality associated with several early and late complications. Ventricular tachyarrhythmias, including TdP, because of electrical inhomogeneity, would potentially be a lethal complication of CABG. Here, we report the occurrence of medically intractable TdP in the presence of an uncommon case of a post-CABG retrosternal hematoma. Arrhythmia was properly resolved after hematoma removal surgically. It showed the possibility of a "cause and effect" relationship between these two complications. This unique case emphasizes the post-CABG medically-resistant TdP, considering the mechanical pressure effect of retrosternal hematoma that stimulates this potentially malignant arrhythmia, especially in the absence of electrolyte disturbances and evident symptoms of ongoing ischemia.

Factors That Predict Early Return to Work After Myocardial Infarction: Importance of Coworker Support.

Aim    Myocardial infarction (MI) affects the working-age group and cause many absences and lost days of work. Some occupational factors effect in the prognosis of MI patients. The objective of this study was to determine predictors of early, late and no return to work (RTW) after MI.Material and methods    In this cohort study, 240 pre-employed, male patients with MI from April 2020 through February 2022 provided data about their demographic, occupational, psychosocial, and medical information. Data was also collected about the treatment they received as patients, their feelings about socioeconomic support, and RTW time. RTW within two weeks after MI was defined as early RTW. The relationships of these variables and with early RTW and with late or no RTW were analyzed.Results    Ninety-four patients (39.6 %) returned to work within two weeks after MI, whereas 207 patients (87.3 %) returned to work by the end of six months. Many variables, including coworker support, were associated with early RTW in a univariate analysis. Regression analysis revealed that age, coworker support, marital status, the patient's own estimated RTW time, the number of the vessels with occlusion, and comorbidity were predictors of early RTW. Of these factors, only coworker support would be subject to modification.Conclusions    This study indicates that improving support from coworkers can increase early RTW after MI.

Association of the high-sensitive cardiac troponin T levels and long-term mortality in patients with acute aortic dissection type A.

Introduction: Acute aortic dissection type A is a life-threatening cardiovascular emergency necessitating rapid diagnosis and treatment. We sought a new prognostic tool with cardiac biomarkers and simple inflammatory factors. Methods: from 2003 to 2014, 50 patients with documented acute aortic dissection type A were entered to this study. These patients were followed up until December 2020; within median follow up of 93.6 months. The patients were evaluated on the association of the baseline characteristics, first laboratory investigation, echocardiographic findings, surgical approach, and long-term mortality. Results: Total number of mortality during the follow up was 29 (58%) patients, which was significantly higher in medical group (89.4% vs 38.7%, P value=0.001). Multivariable analysis showed only an increase in hs-cTnT levels was suggested as a predictor of mortality (95% CI: 1.06-1.38; HR=1.21; P=0.005), so that for every 100 units increase, patients were 21% more likely to have mortality in long term. Also, performing surgical treatment for aortic dissection was determined as the independent predictor of surviving, so that death was 74.6% less than those who received medical treatment (95% CI: 0.13-0.58; HR=0.27; P=0.001). Conclusion: hs-cTnT is a potential predictor of mortality in patients with acute aortic dissection type A.

A systematic review and meta-analysis of the normal reference value of the longitudinal left atrial strain by three dimensional speckle tracking echocardiography.

The normal reference value of the global longitudinal left atrial strain during the reservoir phase (LASr) by 3D speckle-tracking echocardiography (3DSTE) is needed to define the abnormal and normal spectra and to compare and interpret the obtained values. The present study is a meta-analysis of 3DSTE-derived normal reference value of the longitudinal LASr and an attempt to determine probable contributing factors in the variations of reported ranges. The databases of PubMed, Scopus, and Embase were searched for the following keywordS: "Left atrial/left atrium" and "strain/speckle/deformation" and "three-dimensional/3-dimensional/three dimensional/3 dimensional/three dimension/3 dimension/three-dimension/3-dimension/3D/3-D". The studies selected included those on adult healthy subjects without cardiovascular risk factors. A random-effect model was used to calculate the global 3DSTE-derived longitudinal LASr, and meta-regression was applied to determine inter-study heterogeneity. Our search yielded 316 adult subjects from 5 studies. The mean value of the global 3DSTE-derived longitudinal LASr was 27.5% (95% CI, 25.2-29.8%). There was significant heterogeneity between the studies. The meta-regression analysis revealed the publication year, the heart rate, and systolic and diastolic blood pressure as the sources of heterogeneity. The current meta-analysis determined a normal reference value of the global 3DSTE-derived longitudinal LASr of 27.5% (95% CI, 25.2-29.8%). The heterogeneity between studies may be explained by the publication year, the heart rate, and systolic and diastolic blood pressure.

Steroid Use for Recovery of advanced atrioVentricular block Immediately after VALvular surgery (SURVIVAL): A preliminary randomized clinical trial.

BACKGROUND: Atrioventricular block (AVB) is an important complication following valvular surgery. Several factors including inflammation-mediated injury might trigger AVB. METHODS: Patients with advanced postoperative AVB were randomly assigned to receive either dexamethasone (0.4 mg/kg, maximum 30 mg/day) intravenously for 3 days or conservative care only. Primary endpoint was recovery rate in Day 5 since randomization. Secondary endpoints were recovery rate in Day 7 and Day 10, cumulative AVB time, permanent pacemaker (PPM) implantation rate, length of stay in critical care units, and postoperative major adverse events (MAE). RESULTS: We enrolled 139 subjects (48.9% male) with mean age of 59.9 years randomly allocated to intervention group (n = 69) and control group (n = 70). Dexamethasone led to higher recovery rates at Day 5 (82.6% vs. 62.9%, p = .009) and Day 7 (88.4% vs. 61.4%, p < .0001) respectively. This benefit ceased at Day 10 (83.05% vs. 78.6%, p = .547). Median cumulative AVB time was shorter in dexamethasone group compared with control group (41 h vs. 64 h, p = .044). PPM implantation rates were similar between the dexamethasone and control groups (15.9% vs. 17.1%, respectively, p = .849). Median length of stay in intensive care unit (ICU) (10 days vs. 12 days, p = .03) and MAE (17.4% vs. 25.7%, p = .133) tended to be lower with dexamethasone. CONCLUSION: Dexamethasone may serve as a safe and effective medication to help hasten recovery of advanced AVB after valvular surgery.

Concomitant ventricular septal rupture and interventricular septal aneurysm in neglected inferior myocardial infarction misdiagnosed with congenital ventricular septal defect: A case report.

This study emphasizes that VSD should not be immediately diagnosed as a congenital disorder; instead, regional wall motion abnormalities in the left ventricle should also be taken into account since it may result from mechanical complications of neglected myocardial infarction.

Normal Ranges of Right Atrial Strain and Strain Rate by Two-Dimensional Speckle-Tracking Echocardiography: A Systematic Review and Meta-Analysis.

Background: Normal range values of right atrial (RA) phasic function markers are essential for the identification of normal and abnormal values, comparison with reference values, and the clinical meaning of obtained values. Accordingly, we aimed to define the normal range values of RA phasic function markers obtained by 2D speckle-tracking echocardiography through a meta-analysis and determine the main sources of heterogeneity among reported values. Methods: PUBMED, SCOPUS, and EMBASE databases were searched for the following keywords: "right atrial/right atrium" and "strain/speckle/deformation" and "echocardiography." Studies were selected that included a human healthy adult group without any cardiovascular diseases or risk factors and that were written in the English language. For the calculation of each marker of RA phasic functions, a random-effect model was used. Meta-regression was employed to define the major sources of variabilities among reported values. Results: Fifteen studies that included 2,469 healthy subjects were selected for analysis. The normal range values for RA strain and strain rate were 42.7% (95% CI, 39.4 to 45.9%) and 2.1 s-1 (95% CI, 2.0 to 2.1 s-1) during the reservoir phase, respectively, 23.6% (95% CI, 20.7 to 26.6%) and -1.9 s-1 (95% CI, -2.2 to -1.7 s-1) during the conduit phase, correspondingly, and 16.1% (95% CI, 13.6 to 18.6%) and -1.8 s-1 (95% CI, -2.0 to -1.5 s-1) during the contraction phase, respectively. The sources of heterogeneity for the normal range of these markers were the number of participants, the type of software, the method of global value calculation, the right ventricular fractional area change, the left ventricular (LV) ejection fraction, the RA volume index, sex, the heart rate, the diastolic blood pressure, the body mass index, and the body surface area. Conclusions: Using 2D speckle-tracking echocardiography, we defined normal values for RA phasic function markers and identified the sources of heterogeneity as demographic, anthropometric, hemodynamic, and echocardiography factors. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021236578, identifier: CRD42021236578.

Predictive Inflammation-related microRNAs for Cardiovascular Events Following Early-Onset Coronary Artery Disease.

BACKGROUND: Early-onset coronary artery disease (EOCAD) increases the risk of major cardiac adverse events (MACE) at the level of safety/effectiveness-related events. Since adverse events affect the quality of life of young patients with EOCAD, MACE prediction is of great importance for improving medical decision-making. AIMS OF THE STUDY: We sought to determine whether the most important inflammation-related microRNAs in atherogenesis could predict MACE among patients with EOCAD. METHODS: This nested case-control study recruited 143 young patients (males ≤45 and females ≤55 years old), selected from a cohort of patients with premature coronary atherosclerosis at a median follow-up period of 64.1 months. Total RNAs were extracted from their peripheral blood mononuclear cells. The expression levels of 18 miRNAs, which are involved in inflammation and atherogenesis, were analyzed via quantitative reverse transcription PCR. RESULTS: A scoring model based on the upregulation of miR-146a_1 and miR-342_1, along with a history of myocardial infarction and the chronic usage of antithrombotic drugs, was able to predict MI/death at the level of safety-related events (higher vs lower risk scores: sHR: 4.61, 95% CI: 1.57-13.57, and p = 0.005). Another prediction model based on the downregulation of miR-145_1, age, and a history of unstable angina was also able to predict revascularization at the level of effectiveness-related events (higher vs lower risk scores: sHR: 2.90, 95% CI: 1.49-5.66, and p = 0.002). CONCLUSIONS: Our results highlighted the role of miRNAs in adverse cardiac events and suggest that miR-146a_1, miR-342_1, and miR-145_1 may be useful biomarkers in predictive and preventive cardiology.

Interaction effect of myocardial infarction and obesity on left atrial functions.

PURPOSE: To determine whether myocardial infarction (MI) would lead to a greater decrease in left atrial (LA) functions in subjects with than without obesity. METHODS: A total of 310 consecutive patients were divided into four groups according to the presence or absence of obesity and MI. The functions of the LA were evaluated in terms of longitudinal deformation of the LA myocardium via 2D speckle-tracking echocardiography. RESULTS: The adjusted analysis showed a reduction in the strain and strain rate during the reservoir and contraction phases and in the strain rate during the conduit phase in patients with MI and in subjects with obesity (P < .05). In addition, there was a significant interaction effect of obesity and MI on the strain rate during the contraction phase (P = .048). CONCLUSIONS: There is an independent and additional interaction effect of obesity and MI on the reservoir and conduit functions of the LA. MI was more deleterious to the contraction function in subjects without than with obesity, so that the contraction function was similar in MI patients without obesity and MI patients with obesity.

Prediabetes, heart mechanics, and echocardiography: A narrative review.

Prediabetes is a dysglycemic state that affects many around the world and is a known risk factor for the occurrence of type 2 diabetes mellitus in the future, accompanied by vascular complications. Evidence abounds regarding myocardial involvement in prediabetes. We herein review studies having applied tissue Doppler imaging or speckle-tracking echocardiography to evaluate myocardial function in subjects with prediabetes to depict a picture of cardiac mechanics in individuals with prediabetes in comparison with patients suffering from diabetes mellitus and individuals in the normoglycemic state. Finally, we present the detrimental effects of prediabetes on cardiac mechanics.

Bloody Pericardial Effusion with a Huge Pericardial Mass: A Case Report.

Nowadays, the early diagnosis of tumoral diseases is more possible and accurate with multiple diagnostic imaging modalities such as chest X-ray, echocardiography, computed tomography, and magnetic resonance imaging, especially for cardiac tumors which are usually asymptomatic, even in large sizes. In cardiac masses, the patients' presentations are non- specific and dependent on the tumor size and site as well as its compressive effect on the adjacent structures. On the other hand, the first and last signs could be sudden cardiac death. However, cardiac masses are either benign or malignant and metastatic in their malignant type, and their definite diagnosis is only possible by surgical tumor resection and tissue biopsy. In this paper, we describe an old patient with severe pericardial effusion and an unusual intrapericardial tumor in transthoracic echocardiography, representing a rare case of a giant ectopic thymoma after surgical resection and pathologic assessment.

Interaction Effect of Diabetes and Acute Myocardial Infarction on the Left Atrial Function as Evaluated by 2-D Speckle-Tracking Echocardiography.

The aim of the study described here was to investigate, using 2-D speckle-tracking echocardiography, whether myocardial infarction (MI) leads to diminished left atrial function in diabetic patients by comparison with non-diabetic patients. A total of 310 consecutive patients were divided into four groups based on the presence or absence of diabetes mellitus (DM) and acute ST-elevation MI. In the adjusted analysis, systolic and early diastolic strain and strain rate were reduced in the diabetic patients. Additionally, all deformation markers were impaired in the patients with MI. The DM-MI interaction was not statistically significant. Although reservoir, conduit and contraction functions of the left atrium were reduced in the patients with MI, left atrial reservoir and conduit functions were decreased in the diabetic patients. The reduction in left atrial function caused by MI was similar for diabetic and non-diabetic patients. Thus, DM and MI additively damaged left atrial function.

Prognostic role of moderate functional tricuspid regurgitation in length of hospitalization in patients undergoing isolated coronary artery bypass grafting.

Functional tricuspid regurgitation (FTR) is defined as abnormal systolic tricuspid leakage with normal valve structures, and its prognostic role and management in patients with left-heart valve disease is well known. Due to paucity of data on FTR in patients with ischemic heart disease, the aim of our prospective study was to compare the prognostic effect of FTR between patients with moderate FTR and those with less-than-moderate FTR undergoing isolated coronary artery bypass graft (CABG) surgery. This prospective cohort study included all the patients who were candidate for isolated CABG and were referred for preoperative transthoracic echocardiography between April 2018 and November 2018. Patients were categorized into two groups: less-than-moderate FTR and moderate FTR. The endpoints of the study were the prognostic effect of FTR on short-term mortality and morbidities as a composite endpoint, as well as length of hospitalization, length of intensive care unit (ICU) stay, and ventilation time. Of a total of 410 patients, 363 patients (mean age = 62.4 years, 63.7% men) entered our final analysis. Logistic regression analysis demonstrated that composite endpoints of short-term mortality and morbidities was not significantly different between the two groups, but moderate FTR had a statistically significant effect on length of hospitalization (P = 0.002) and the ventilation time (P = 0.048). This effect, however, did not persist after adjustments for probable known confounders. Our study indicated no significant prognostic effect for preoperative FTR versus less-than-moderate FTR on short-term mortality and morbidities, as well as length of hospitalization, length of ICU stay, and the ventilation time.

Comparison of the effect of 80 vs 40 mg atorvastatin in patients with isolated coronary artery bypass graft surgery: A randomized clinical trial.

OBJECTIVES: Atorvastatin can decrease cardiac injury after coronary artery bypass graft (CABG) surgery. We compared the effects of 80 and 40 mg of atorvastatin per day on the levels of cardiac troponin T (cTnT) and creatine kinase-MB (CK-MB) after an isolated CABG. METHODS: This randomized single-blind parallel clinical trial enrolled 125 patients (mean age = 60.59 ± 8.37 years) who were candidates for elective isolated CABG at the Tehran Heart Center between May 2017 and December 2017. Patients were randomly allocated into two groups to receive either 80 mg (n = 62) or 40 mg of atorvastatin (n = 63) per day, 5 days before surgery. The levels of cTnT and CK-MB, used as myocardial injury markers, were measured at baseline and then at 8 and 24 hours after CABG. RESULTS: The levels of CK-MB and cTnT at baseline and at 8 and 24 hours following CABG were not significantly different between the two groups. Our repeated measures analysis of variance showed that the levels of CK-MB and cTnT increased significantly over time (P < .001). No significant interaction was observed between time and the atorvastatin dosage on the levels of either CK-MB (P = .159) or cTnT (P = .646). In addition, the between-group effects were not significant for CK-MB (P = .632) and cTnT (P = .126). CONCLUSION: The higher dose of atorvastatin (80 mg) did not exert a more protective effect than the standard dose of atorvastatin (40 mg) after CABG surgery.