Exosomes: Potential Player in Endothelial Dysfunction in Cardiovascular Disease.

Exosomes are spherical bilayer membrane vesicles with an average diameter of 40-100 nm. These particles perform a wide range of biological activities due to their contents, including proteins, nucleic acids, lipids, lncRNA, and miRNA. Exosomes are involved in inflammation induction, oxidative stress and apoptosis, which can be effective in endothelial dysfunction. Due to the induction of mentioned processes in the endothelial cells, the intercellular connections are destroyed, cell permeability increases and finally cell efficiency decreases and functional defects occur. Cardiovascular disease (CVDs) are of consequences of endothelial dysfunction. Thus by identifying the exosome signaling pathways, which induce inflammation, oxidative stress, and apoptosis, endothelial dysfunction and subsequently CVDs can be reduced; exosomes can be used for appropriate target therapy.

Comparison of left ventricular systolic function by 2D speckle-tracking echocardiography between normal pregnant women and pregnant women with preeclampsia.

Introduction: In light of previous studies reporting the significant effects of preeclampsia on cardiac dimensions, we sought to evaluate changes in the left ventricular (LV) systolic and diastolic functions in patients with preeclampsia with a view to investigating changes in cardiac strain. Methods: This cross-sectional study evaluated healthy pregnant women and pregnant women suffering from preeclampsia who were referred to our hospital for routine healthcare services. LV strain was measured by 2D speckle-tracking echocardiography. Results: Compared with the healthy group, echocardiography in the group with preeclampsia showed a significant increase in the LV end-diastolic diameter (47.43 ± 4.94 mm vs 44.84 ± 4.30 mm; P = 0.008), the LV end-systolic diameter (31.16 ± 33.3 mm vs 29.20 ± 3.75 mm; P = 0.008), and the right ventricular diameter (27.93 ± 1.71 mm vs 24.53 ± 23.3; P = 0.001). The mean global longitudinal strain was -18.69 ± 2.8 in the group with preeclampsia and -19.39 ± 3.49 in the healthy group, with the difference not constituting statistical significance (P = 0.164). The mean global circumferential strain in the groups with and without preeclampsia was -20.4 ± 12.4 and -22.68 ± 5.50, respectively, which was significantly lower in the preeclampsia group (P = 0.028). Conclusion: The development of preeclampsia was associated with an increase in the right and left ventricular diameters, as well as a decrease in the ventricular systolic function, demonstrated by a decline in global circumferential strain.

Early diagnosis of cardiac involvement in systemic lupus erythematosus via global longitudinal strain (GLS) by speckle tracking echocardiography.

Introduction: Systemic lupus erythematosus (SLE) myocarditis occurs in between 5% and 10% of patients with lupus. Global longitudinal strain (GLS) via speckle tracking echocardiography can detect cardiac involvement in patients suffering from SLE. We decided to determine the echocardiographic features and subsequent early diagnosis of cardiac involvement in patients with SLE utilizing the GLS index via speckle tracking echocardiography. Methods: In this cross-sectional study, we compared female patients with SLE of at least 2 years' duration and healthy controls in terms of the left ventricular (LV) GLS via speckle tracking echocardiography. After data collection in both groups, the GLS index and the ejection fraction were evaluated. Results: We analyzed and compared the LV echocardiographic parameters of 33 patients with SLE (mean age=25.45±0.63 years) with those of 35 healthy controls (mean age=27±0.45 years). The apical 2-chamber view indicated a significant decrease in the LV GLS in the case group by comparison with the healthy controls (P=0.005). The LV GLS in the apical 3-chamber view was significantly lower in the case group than in the control group (P=0.006). The LV GLS in the apical 4-chamber view revealed no significant difference between the case and healthy control groups (P=0.2). While there was a significant difference between the case and control groups visà- vis the LV GLS (P=0.02), the LV ejection fraction measured with the Simpson method showed no significant difference between the 2 groups (P=0.96). Conclusion: GLS speckle tracking echocardiography is a noninvasive method with diagnostic and prognostic values; it may, therefore, be a sensitive marker for the diagnosis of myocarditis and other cardiac involvements in patients with SLE.

Regional quantification of left atrial early diastolic strain in two groups of patients with mitral stenosis: normal sinus rhythm vs atrial fibrillation.

BACKGROUND: Strain rate imaging (SRI) is proposed for assessing atrial function. There are limited studies on the role of SRI in assessing the left atrial (LA) function in patients with mitral stenosis (MS). We decided to assess LA early diastolic strain to evaluate LA conduit function in two groups of patients with MS. METHODS: A total of 49 patients with moderate to severe MS, scheduled for percutaneous transluminal mitral commissurotomy, were categorized into two groups: normal sinus rhythm (NSR, n=24) and persistent atrial fibrillation (AF, n=25). Early diastolic strain was measured via SRI in four mid-left atrial walls by transthoracic echocardiography. RESULTS: Left atrial volume was significantly higher in AF group. LA early diastolic strain was significantly reduced in AF patients in three walls: interatrial septum (-6.78±6.22% vs -11.44±6.35%, P=.016), anterior wall (-4.47±4.30% vs -12.52±10.62%, P=.002), and inferior wall (-2.87±3.23% vs -9.73±9.67%, P=.003). After adjustment for age, heart rate, LA volume, LA thrombus, and LAA emptying velocity, there was a significant correlation between the presence of AF and left atrial average early diastolic strain. This correlation was also remarkable between existence of AF and two LA walls (i.e., anterior and inferior walls of the LA). CONCLUSION: There was reduced average early diastolic strain in the presence of AF compared to NSR in MS patients regardless of LA volume and age. In AF patients, there is not only a loss of atrial late diastolic contraction, but also there is a reduction in early diastolic shortening of LA myocardium.

Adherence to Antihypertensives in Patients With Comorbid Condition.

BACKGROUND: Comorbidity has been noted as a potential barrier to proper adherence to antihypertensive medications. OBJECTIVES: We decided to investigate whether comorbidity could significantly affect adherence of Iranian patients with hypertension to their medication regimen. PATIENTS AND METHODS: Two hundred and eighty consecutive hypertensive patients were interviewed in 4 cities of Iran. The 8-item Morisky medication adherence scale (MMAS-8) (validated in Persian) was used to assess medication adherence. This scale determines adherence by scores as lower than 6 (low adherence), 6 or 7 (moderate adherence), and 8 (high adherence). Comorbidity was considered as any concomitant medical condition, which necessitates the patient to take medicine for a minimum of 6 months prior to the interviews. RESULTS: The most common comorbid conditions were ischemic heart disease (65 patients, 23.2%), diabetes mellitus (55 patients, 19.6%), and dyslipidemia (51 patients, 18.2%). Mean (± SD) MMAS-8 score in comorbid group was 5.68 (± 1.85) and in non-comorbid hypertensive patients, it was 5.83 (± 1.91) (P = 0.631). Mean (± SD) number of comorbidities was 1.53 (± 0.75) in low adherence group compared to 1.54 (± 0.77) in moderate/high adherers (P = 0.98). With increasing the number of comorbid diseases, the proportion of patients with high adherence decreased successively from 20% in those with no comorbid disease to 14.1% in those with one or two comorbid conditions, and finally 11.1% in those with 3 to 5 comorbid conditions. CONCLUSIONS: With increasing the number of comorbid conditions, the proportion of patients with high adherence decreases. In our opinion, this finding is a useful clinical note for healthcare providers when managing patients with hypertension who have other medical problems at the same time.

The effect of elective percutaneous coronary intervention of the right coronary artery on right ventricular function.

BACKGROUND: Right Ventricular (RV) dysfunction has been introduced as a predictor of mortality in acute myocardial infarction. OBJECTIVES: This study aimed to investigate the effect of right coronary revascularization on systolic and diastolic RV dysfunction. PATIENTS AND METHODS: This study was conducted on unstable angina patients who were candidate for elective Percutaneous Revascularization Intervention (PCI) on the right coronary artery. The participants were initially evaluated by transthoracic echocardiography and tissue Doppler imaging prior to PCI and the RV function parameters were assessed. Echocardiography was repeated two months after PCI and the results were compared with baseline. Paired t-test was used to compare the pre- and post-procedural measurements. Besides, Pearson's correlation was used to find out the linear association between the RV function parameters and Left Ventricular Ejection Fraction (LVEF). P value < 0.05 was considered as statistically significant. RESULTS: This study was conducted on 30 patients (mean age = 60.00 ± 8.44 years; 24 [80%] males). In the pre-procedural echocardiography, 15 patients (50%) had normal RV function, 14 patients (46.7%) had grade-1 RV dysfunction, and only 1 patient (3.3%) had grade-2 RV dysfunction. Following PCI, however, all the patients had normal systolic and diastolic RV functions. Comparison of echocardiographic RV function parameters showed an improvement in both systolic and diastolic functional parameters of the RV. Nonetheless, no significant correlation was observed between these parameters and Left Ventricular (LV) function. CONCLUSIONS: A significant improvement was found in RV function, but not LV function, after right coronary PCI. Revascularization of the right coronary artery may be beneficial for the patients who suffer from RV failure due to ischemia.

Normal values for longitudinal tissue velocity and strain rate imaging in individual segments of the left and right ventricles of healthy adult hearts.

OBJECTIVES: To quantify the normal peak mean systolic velocities and strain rate parameters in the left ventricle (LV) and right ventricle (RV) and define their regional differences in normal adult hearts. METHODS: Sixty-nine healthy volunteers (42% male; mean age ± SD, 30.03 ± 5.35 years) underwent color tissue Doppler and strain rate imaging. The first and second peak mean systolic velocities, peak strain, and strain rate in the systolic ejection phase were determined for 16 LV segments, the apex (17th segment), and 3 RV free wall segments. RESULTS: The first peak mean systolic velocity was measurable in less than 50% of segments in the inferior and septal (-posterior) walls and RV free wall and in greater than 70% of segments of the other LV walls. The first and second peak mean systolic velocities of all LV walls and the RV free wall decreased significantly from the basal to apical region (P < .001).The strain and strain rate in the lateral and anterior walls decreased significantly from base to apex, whereas the anteroseptal and posterior walls were homogeneous. The strain rate in the inferior wall increased remarkably from base to apex, whereas it decreased significantly from the mid level to the apex. The strain in the RV was homogeneous, whereas the strain rate decreased significantly from the mid level to the apex. The apex (17th segment) showed the lowest value for each of the study parameters. CONCLUSIONS: Longitudinal velocities decreased from base to apex, whereas deformation measurements did not show uniform patterns in LV walls and the RV free wall. In most cases, there are 1 peak systolic velocity in the inferior and septal (-posterior) walls and 2 peak systolic velocities in the other 4 LV walls.

Quadricuspid aortic valve diagnosed by transesophageal echocardiography: a case report.

Quadricuspid aortic valve (QAV) is an uncommon congenital anomaly which was an incidental finding during surgery or autopsy in the past. We present the case of a 44-year-old woman with moderately severe aortic regurgitation due to unequal cusp size QAV diagnosed via transesophageal echocardiography. Due to echocardiographic imaging improvement, the diagnosis of QAV is now easier and earlier than the past.

Evaluation of longitudinal tissue velocity and deformation imaging in akinetic nonviable inferobasal segments of left ventricular myocardium by dobutamine stress echocardiography.

AIM: To study tissue velocity imaging (TVI) and strain rate imaging (SRI) indices in akinetic nonviable and normal left ventricular (LV) inferobasal segment and effect of dobutamine infusion on these indices in nonviable segments. METHODS: The study population consisted of two groups: 25 patients (mean age 60.75 +/- 8.69 years) with left ventricular akinetic inferobasal nonviable segment determined by dobutamine stress echocardiography (DSE) and 14 normal coronaries (mean age 56.67 +/- 11.90 years) with normal echocardiography as control group. The following TVI and SRI parameters were measured in patient and control group: ejection phase velocity (Sm [cm/sec]), peak systolic strain (ST [%]), and strain rate (SR [per second])). RESULTS: Ejection fraction was significantly lower in patient group (29.40%+/- 5.46% vs. 55.00%+/- 3.39%; P < 0.001). Several differences were observed in patients with nonviable inferobasal segments compared to control group: Sm was reduced (3.58 +/- 1.08 cm/sec vs. 5.56 +/- 1.28 cm/sec; P < 0.001); SR and ST were significantly decreased (-0.39 +/- 0.20/second vs. -1.44 +/- 0.64/second, and -3.86%+/- 4.12% vs. -17.64%+/- 7.44%, respectively; P < 0.001 in both). The range of SR for nonviable segments (-0.04 to -0.77/second) did not overlap with that of the normal segments (-0.80 to -3.0/second). This range for Sm and ST overlapped with those of the normal segments. CONCLUSION: All TVI and SRI parameters are reduced in akinetic nonviable inferobasal compared with normal segments. According to findings of this study, resting strain rate has a potential to discriminate nonviable inferobasal from normal segments.