Echocardiographic Parameters Associated with Bendopnea in Patients with Systolic Heart Failure.

Background: Bendopnea, defined as dyspnea while bending, can be observed in patients with heart failure (HF). In this study, we investigated the frequency of this symptom in patients with systolic HF and its association with echocardiographic parameters. Methods: In this study, patients with left ventricular ejection fraction (LVEF) ≤45% and decompensated HF referred to our clinics were prospectively recruited. All the patients were examined by cardiologists for collecting data on the presence of bendopnea and baseline characteristics. They also underwent electrocardiographic and echocardiographic examinations. All findings were compared between the patients with or without bendopnea. Results: A total of 120 patients at a mean age of 65.19±12.62 years were evaluated, and 74.8% were men. Bendopnea was observed in 44.2% of the patients. The etiology of HF was ischemic in most patients (81.9%), and the functional class of most patients (85.9%) was III or IV. The mortality rate at the 6-month follow-up was comparable between the patients with or without bendopnea (6.1% vs 9.5%; P=0.507). The waist circumference (odds ratio [OR], 1.037, 95% confidence interval [CI], 1.005 to 1.070; P=0.023), paroxysmal nocturnal dyspnea (OR, 0.338, 95% CI, 0.132 to 0.866; P=0.024), and right atrial size (OR, 1.084, 95% CI, 1.002 to 1.172; P=0.044) were associated with bendopnea. Conclusion: Bendopnea can be frequently found among patients with systolic HF. This phenomenon is associated with obesity and baseline symptoms of patients and right atrial size upon echocardiographic examinations. It can help clinicians with the risk stratification of HF patients.

Ventricular Dysfunction in Patients with Coronary Slow-Flow Phenomenon: A Single-center Case-control Study.

BACKGROUND: Coronary slow-flow phenomenon (CSFP), characterized by delayed distal vessel opacification of contrast, in the absence of significant epicardial coronary stenosis, has effects on exercise capacity and clinical outcomes. The aim of this study was to explore the systolic and diastolic function of patients with CSFP and to compare it with a group of controls with normal coronary anatomy and flow. MATERIALS AND METHODS: In this case-control study, 45 consecutive CSFP patients and 45 age-, body mass index-, and presentation season-matched controls with normal coronary arteries and normal coronary flows were enrolled from Seyyedoshohada Heart Center from March 2015 to March 2016. A transthoracic echocardiography was done by a blinded echocardiographer using both conventional and tissue Doppler imaging techniques. RESULTS: Patients with CSFP were more likely to be male (P = 0.006) and smoker (P = 0.02) compared to controls. Other risk factors were not different between the two groups. There were no differences between groups in terms of the peak early (E) and late (A) diastolic velocities, deceleration time, early (E') and late (A') peak diastolic velocities at the mitral annulus, and the systolic mitral annular velocity (S'). Global longitudinal strain and peak systolic strain rates was lower in patients with CSFP compared to controls (-16.7% ±2.4% vs. -18.9% ±1.6%, P < 0.001 and 1.10 ± 0.1 vs. 1.24 ± 0.3, P = 0.008, respectively). CONCLUSION: Patients with CSFP showed signs of the left ventricular systolic dysfunction in tissue Doppler echocardiography, which underlines the importance of close follow-up in these patients. Patients with CSFP should be screened for ventricular function preferably by tissue Doppler echocardiography.

Short-Term High-Dose Vitamin E to Prevent Contrast Medium-Induced Acute Kidney Injury in Patients With Chronic Kidney Disease Undergoing Elective Coronary Angiography: A Randomized Placebo-Controlled Trial.

BACKGROUND: Contrast medium-induced acute kidney injury (CIAKI) is a leading cause of acquired renal impairment. The effects of antioxidants have been conflicting regarding the prevention of CIAKI. We performed a study of vitamin E use to decrease CIAKI in patients undergoing elective coronary angiography. METHODS AND RESULTS: In a placebo-controlled randomized trial at 2 centers in Iran, 300 patients with chronic kidney disease-defined as estimated glomerular filtration rate <60 mL/min per 1.73 m(2)-were randomized 1:1 to receive 0.9% saline infusion 12 hours prior to and after intervention combined with 600 mg vitamin E 12 hours before plus 400 mg vitamin E 2 hours before coronary angiography or to receive placebo. The primary end point was the development of CIAKI, defined as an increase ≥0.5 mg/dL or ≥25% in serum creatinine that peaked within 72 hours. Based on an intention-to-treat analysis, CIAKI developed in 10 (6.7%) and 21 (14.1%) patients in the vitamin E and placebo groups, respectively (P=0.037). Change in white blood cell count from baseline to peak value was greater in the vitamin E group compared with the placebo group (-500 [-1500 to 200] versus 100 [-900 to 600]×10(3)/mL, P=0.001). In multivariate analysis, vitamin E (odds ratio 0.408, 95% CI 0.170-0.982, P=0.045) and baseline Mehran score (odds ratio 1.257, 95% CI 1.007-1.569; P=0.043) predicted CIAKI. CONCLUSIONS: Prophylactic short-term high-dose vitamin E combined with 0.9% saline infusion is superior to placebo for prevention of CIAKI in patients undergoing elective coronary angiography. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov/. Unique identifier: NCT02070679.

Prognostic value of mean platelet volume in patients undergoing elective percutaneous coronary intervention.

OBJECTIVE: We sought to determine the role of mean platelet volume (MPV) for predicting long-term outcomes of elective percutaneous coronary intervention (PCI). METHODS: On the basis of retrospective cohort study, we collected characteristics of 680 patients undergoing elective PCI from October 2005 to August 2010. The patients who had preoperative MPV were assessed for developing major adverse cardiac events (MACE) during 1-year follow-up. They were categorized into two groups including MPV <9.6 fL (n=89) and MPV ≥9.6 fL (n=92). Data were analyzed using t-test, chi-square test, Pearson correlation, receiver operating characteristic (ROC) curve and logistic regression. RESULTS: One-hundred eighty one patients (26.6%) met inclusion criteria. The MACE was observed in 29 patients (16%); and its rate in low- and high-MPV groups was 11.2% and 20.7%, respectively (p=0.084). MPV was significantly higher in the patients with left ventricular ejection fraction (LVEF) <40% compared with that of ≥40% (p<0.001). There were a significant and negative correlation between MPV and platelet count (r=-0.305, p<0.001), and significant and positive correlations between MPV and platelet distribution width (PDW) and platelet large cell ratio (P-LCR) (r=0.615, p<0.001 and r=0.913, p<0.001; respectively). The best MPV cut-off point was 9.25 fL; the sensitivity and specificity were 79% and 38%, respectively. Elevated MPV was the best predictor of MACE at 1-year follow-up (OR=11.359, 95% CI 2.481-51.994, p=0.002). CONCLUSION: The results indicate that preoperative MPV is an independent predictor of the MACE at 1-year follow-up in the patients undergoing elective PCI. Moreover, it may be useful for risk stratification in such cases.

Slow coronary flow phenomenon and increased platelet volume indices.

BACKGROUND AND OBJECTIVES: We sought to determine the relationship between mean platelet volume (MPV), platelet distribution width (PDW), and platelet larger cell ratio (P-LCR) with slow coronary flow (SCF). SUBJECTS AND METHODS: Eighty participants who underwent coronary angiography were divided into two groups, 50 participants with SCF as case group, and 30 with normal coronary flow (NCF) as control group. Baseline characteristics and laboratory data were collected before angiography. RESULTS: Platelet volume indices MPV (10.8±1.2 fL), PDW (14.5±2.2 fL), and P-LCR (30.5±8.1%) in the SCF group were significantly (p<0.05) higher than those (10.1±0.9 fL, 13.2±1.8 fL, and 26.8±6.8%, respectively) in the NCF group. The patients with three SCF arteries had significantly higher platelet volume indices compared to those with NCF arteries; however, the patients with one SCF artery did not. Based on linear regression model, MPV, PDW, and P-LCR were independent predictors of mean infarction frame counting (TFC). In multivariate analysis, MPV {odds ratio (OR)=32.393, 95% confidence interval (CI)=1.189-882.606, p=0.039} and P-LCR (OR=0.566, 95% CI=0.330-0.937, p=0.028) were independent predictors of SCF. CONCLUSION: Platelet volume indices MPV, PDW, and P-LCR were associated with both the presence and extent of SCF.

Acute pulmonary embolism caused by enlarged uterine leiomyoma: a rare presentation.

PATIENT: Female, 42. FINAL DIAGNOSIS: Acute pulmonary embolism. SYMPTOMS: Chest pain • dyspnea. MEDICATION: Streptokinase • Warfarin. CLINICAL PROCEDURE: .- SPECIALTY: Cardiology and Neoplasm. OBJECTIVE: Management of emergency care. BACKGROUND: Deep venous thrombosis (DVT) and subsequent pulmonary embolism (PE) caused by pelvic vein compression are rare and life-threatening complications of leiomyoma of the uterus. CASE REPORT: We report a 42-year-old virgin woman with a history of leiomyoma who presented to the emergency department with complaints of dyspnea and pleuritic chest pain with transient spotting. On physical examination, she had a non-tender abdomen with a 20-week size uterus. Imaging investigations revealed an acute DVT in her left leg and a huge uterine-derived mass compressing the common iliac veins. Transesophageal echocardiography (TEE) demonstrated an echogenic mass in her right pulmonary artery consistent with thrombosis. The patient was completely cured using thrombolytic therapy and myomectomy, and was well at 1 year after thrombolysis. CONCLUSIONS: PE caused by pelvic vein compression is a rare complication of leiomyoma, which should be considered. Thrombolytic therapy associated with myomectomy can be implemented for treating such cases, and TEE can be used for diagnosing suspected high-risk PE.

The relationship between vitamin D status and idiopathic lower-extremity deep vein thrombosis.

BACKGROUND: Vitamin D has been shown to have an anticoagulant effect. A decrease in 25-hydroxyvitamin D [25(OH)D] concentration has also been associated with an increased risk of venous thromboembolism. Hence, we sought to determine the relationship between 25(OH) D levels and idiopathic lower-extremity deep vein thrombosis (DVT). METHODS: In a case control study, a total of 82 participants with idiopathic lower-extremity DVT were enrolled along with 85 sex- and age-matched healthy participants as controls. The plasma 25(OH)D levels were measured in all the studied samples. RESULTS: The participants' mean age was 47.1±12.3 years. Baseline characteristics were not significantly different between the groups. The concentration of 25(OH)D was significantly lower in the DVT group compared to that of the control group (17.9±10.3 versus 23.1±12.5 ng/mL, P=0.004). The prevalence of participants with deficient 25(OH)D levels was significantly higher in the both DVT and control groups than those with sufficient 25(OH)D levels (68.3% versus 13.4%, and 49.4% versus 28.2%, respectively, P=0.027). In a multivariate analysis, 25(OH)D levels and sex were found to be the only independent predictors of DVT (odds ratio [OR] 1.05, 95% confidence interval [CI] 1.02-1.08, P=0.001 and OR 0.51, 95% CI 0.26-1.00, P=0.049, respectively). CONCLUSION: Low levels of 25(OH)D are associated with idiopathic lower-extremity DVT. Further investigation is needed to establish determinants and probable causative role of 25(OH)D.

Frequency of Helicobacter pylori and cytotoxine associated gene A antibodies in patients with cardiac syndrome X.

BACKGROUND: Cardiac syndrome X (CSX) is a condition in which patients have the pain of angina despite normal coronary angiogram. Recently, Helicobacter pylori (H. pylori) bacteria has been associated with CSX. However, there is no obvious data about the frequency of its virulent strain (cytotoxine associated gene A: CagA) in patients with CSX. We surveyed the frequency of H. pylori and CagA antibodies in patients with cardiac syndrome X and healthy controls. MATERIALS AND METHODS: Plasma samples from 100 CSX patients (61 females and 39 males; mean age: 51.8 ± 12.3 years) and 100 healthy controls (61 females and 39 males; mean age: 48.9 ± 6.3 years) were tested for the presence of IgG antibody to H. pylori using enzyme linked immunosorbent assay (ELISA) method. Also, infected patients were determined by the presence of IgG antibody to CagA by ELISA method. Statistical analysis was carried out using chi-square test and independent samples T-test. RESULTS: Ninety two percent (92/100) of patients were anti-H. pylori positive (anti-H. pylori+), while only 56.0% (56/100) of control group were anti-H. pylori+ (P<0.01). However, prevalence of anti-CagA positive (anti- CagA+) in H. pylori infected- CSX patients and control groups were 59.8% (55/92) and 60.7% (34/56), respectively (P>0.05). CONCLUSION: Thus, due to the high frequency of anti-H. pylori in CSX patients, and the probable causative effect of chronic infection in vascular diseases, it is suggested that H. pylori has a probable role in the pathogenesis of CSX.