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   Table of Contents - Current issue
Coverpage
July-September 2018
Volume 7 | Issue 3
Page Nos. 107-158

Online since Monday, September 10, 2018

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REVIEW ARTICLE  

Cardiomyocyte mitochondrial dynamics in health and disease and the role of exercise training: A brief review p. 107
Babak Ebadi, Arsalan Damirchi, Karim Azali Alamdari, Amir Darbandi-Azar, Nasim Naderi
DOI:10.4103/rcm.rcm_11_18  
Mitochondria as dynamic organelle constantly undergo fusion and fission reactions, leading to continuous reconstruction of the mitochondrial network for elongated or fragmentation shapes and ultimately the mitophagy. This mitochondrial network dynamics is sensitive to stress and different physiological conditions and plays an essential role in cell function and survival during pathophysiological conditions. There is a strong interaction between the mitochondrial network morphology and proteins involved in energy metabolism and dynamics. It is suggested that changes in cellular energy status during exercise training are due to mitochondrial network dynamics and mitophagy. Accordingly, growing evidence reveals that exercise training results in alterations in mitochondrial phenotype and dynamics that resist apoptotic stimuli and ischemia-reperfusion-induced mitochondrial damage. However, the signaling pathways of mitochondrial dynamics and mitophagy regulation during exercise training are still interesting areas of research. In this review, we focus on the recent findings addressing cellular signaling mechanisms of mitochondrial dynamics and cardiac mitophagy in response to exercise training and the pathological stimulus in heart disorders.
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ORIGINAL ARTICLES Top

Predictors of second revascularization in patients with history of coronary artery bypass graft p. 116
Gholamreza Davoodi, Akbar Shafiee, Arash Jalali, Marjan Haddadi
DOI:10.4103/rcm.rcm_10_18  
Objective: The number of individuals with a history of coronary artery bypass graft surgery (CABG) who may require a second revascularization intervention is growing. We aimed to identify the predictors of revascularization in patients with a history of CABG who were referred for conventional coronary angiography due to acute coronary syndrome (ACS) or stable angina. Methods: Data of 536 patients (74% males) who had a previous history for CABG and were referred for coronary angiography due to ACS or stable angina were included in the study. Demographic, clinical, diagnostic, and angiographic characteristics of the patients were retrieved from our institutional databank and patient's records. Based on the final recommendation, the patients were divided into two groups for either medical treatment or revascularization and compared for the study variables as well as identifying the predictive factors for the second revascularization. Results: From a total of 536 patients, 194 (36.1%) patients were advised to continue medical therapy, and the rest were referred for revascularization (repeat CABG or percutaneous coronary intervention). Elapsed time after CABG for <1 year or >10 years (P = 0.016), use of diuretics (P = 0.002), and presenting in an inpatient setting (P = 0.009) were significant predictors for the feasibility of second revascularization treatment, using multiple regression analysis. Conclusion: Elapsed time after CABG and some other clinical factors can predict the feasibility of the second revascularization in patients with a history of CABG and new onset of cardiac symptoms.
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The relationship between health literacy and knowledge about heart failure with recurrent admission of heart failure patients p. 123
Rezvan Razazi, Jaleh Mohammad Aliha, Ahmad Amin, Sepideh Taghavi, Behshid Ghadrdoost, Nasim Naderi
DOI:10.4103/rcm.rcm_12_18  
Introduction: Having good health literacy can improve quality of life and decrease re-hospitalization of the patients including patients with heart failure (HF). Considering the importance of knowledge about HF and health literacy in these patients and the existence of contradictory texts, this study aimed to determine the relationship between health literacy and knowledge of HF, with re-admission of HF patients. Methods: The present study was a cross-sectional study in which 238 patients aged over 18 years old with an ejection fraction of 35% and less with the ability to read, write, and speak, and no psychological, neurological and cognitive disorders were included in the study after they signed the consent form of the research. Data collection was done through demographic information questionnaire, Short-Test of Functional Health Literacy in Adult-16 standard health literacy questionnaire, and Van Der Wal knowledge about HF questionnaire (2005). Both questionnaires were validated and their reliability was investigated before starting the study. The Chi-square test, Fisher's exact test, or the Mann–Whitney tests were used to compare variables. Results: Most of the patients were male (66%) and married (80%). The results showed that the majority of study population had proper health literacy and about half of them had enough information about HF. This study showed that there is a significant relationship between health literacy and knowledge. In other words, the higher the health literacy of the people, the greater their awareness of their illness (P = 0.02). However, the findings showed that there is no significant relationship between health literacy and awareness of HF with the number of admissions. Conclusion: The results of this study show that the higher the health literacy of the people may lead to the higher their knowledge and awareness about HF and better understanding the recommendations regarding their illness.
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Elevated high-sensitivity C-reactive protein after percutaneous coronary intervention in patients with stable coronary artery disease: A proof-of-concept study p. 130
Ahmed Bendary, Bassel Wagdy, Tarek Aboul Azm, Osama Sanad
DOI:10.4103/rcm.rcm_14_18  
Objectives: Elevated levels of high-sensitivity C-reactive protein (hs-CRP) is associated with increased incidence of cardiovascular events. We aimed to investigate whether iatrogenic disruption of plaques by percutaneous coronary intervention (PCI) in patients with stable coronary artery disease (CAD) would result in a meaningful rise in hs-CRP that could impact the short-term outcome. Methods and Results: From September 2017 to May 2018, we measured hs-CRP in 60 patients divided into three groups: Group I (20 patients with stable CAD undergoing elective PCI), Group II (20 patients with non-ST elevation-acute coronary syndromes undergoing PCI), and Group III (20 patients with stable and unstable CAD undergoing angiography without PCI). Samples for hs-CRP testing were withdrawn before the procedure, 6 and 24 h later. In Group I, levels increased from 2.4 ± 0.6 at baseline to 8.2 ± 1.7 mg/L 24 h later, P < 0.001. In Group II, levels increased from 7.7 ± 2.9 at baseline to 12.2 ± 3.5 mg/L 24 h later, P < 0.001. Group III showed no significant change. The median percentage change in Group I was significantly higher than both Groups II and III (239.09% [117.86–566.67] vs. 70.47% [−19.09–212.24] and 10.98% [−27.59–272.73], P < 0.001). No significant differences in baseline or 24-h hs-CRP levels were found between those who developed 30-day endpoints and those who did not. Conclusion: Iatrogenic disruption of plaques by PCI in stable CAD resulted in a significant rise of hs-CRP. However, this does not impact the short-term outcome.
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Nesiritide modulates inflammatory response during cardiac surgery: A pilot study p. 137
Thomas M Beaver, Jessica A Cobb, Abhilash Koratala, Kawther F Alquadan, Abutaleb A Ejaz
DOI:10.4103/rcm.rcm_15_18  
Objectives: We investigated the effects of nesiritide (NES) on inflammatory response during cardiac surgery. Materials and Methods: Twenty-nine cardiac surgery patients were randomized to an infusion of NES at 0.01 mcg/kg/min for 48 h versus placebo (Ctrl). A panel of candidate biomarkers and clinical parameters were measured at predetermined time points. Results: There were no significant differences between the groups with regard to urine neutrophil gelatinase-associated lipocalin (NES 230.3 + 71.5 ng/mL vs. Ctrl 554.4 + 263.3 ng/mL, P = 0.253) and urine interleukin (IL)-18 (NES 29.9 + 4.8 pg/mL vs. 254.5 + 118.3 pg/mL, P = 0.090), or to the incidence of acute kidney injury (NES 7.1% vs. Ctrl 13.3%, P = 0.374). A concerted biomarker kinetic pattern of time-differentiated peak concentrations was observed. IL-10, inflammatory protein (IP)-10, IL-6, IL-10, IP-10, monocyte IP (MIP)-1α, interferon (IFN)-α, IFN-α, IL-1a, IL-3, and IL-7 reached peak concentration at 0 h following the end of cardiopulmonary bypass; tumor necrosis factor (TNF)-α, endothelial growth factor (EGF), granulocyte macrophage-colony-stimulating factor (GM-CSF), IL-12p40, IL-17, MIP-1α, and monocyte chemoattractant protein-1 at 1 h; IL-18, vascular EGF (VEGF), IL-13 and IL-1ra at 2 h, TNF-α, G-CSF, IL-1b, IL-2, IL-4, IL-5, and IL-15 at 4 h; and endothelin (ET)-1 and IL-18 at 6 h. At 0 h, the NES group exhibited significant reduction of peak concentrations of IL-6 (P = 0.009), IL-10 (P = 0.009), IL-1α (P = 0.020), IP-10 (P = 0.001), and IFN-α (P = 0.032) compared to the Ctrl group. Significant reduction in peak concentrations of TNF-α (P = 0.007) and MIP1-α (P = 0.027) at 1 h and ET-1 (P = 0.020) at 6 h in the NES group compared to the Ctrl group was noted. Conclusion: NES modulated the concerted inflammatory response in cardiac surgery and also attenuated ET-1 response, thus suggesting that previously observed favorable renal effect may be linked to reduced renal vasoconstriction.
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Could Biglycan be a biomarker of coronary artery disease? A pilot human study p. 144
Atefeh Rezapour, Maryam Moradian, Saeed Nazemi, Seyyed Adel Moallem, Sobhan Issazadeh, Sepideh Elyasi, Mohammad Afshar, Zahra Baghshani, Azadeh Zaerzadeh, Amir Hooshang Mohammadpour
DOI:10.4103/rcm.rcm_23_18  
Background: Coronary artery calcification (CAC) is utilized as an important tool for the global risk assessment of cardiovascular events in individuals with intermediate risk. Biglycan (BGN) is a small leucine-rich proteoglycan that induces the calcification of arterial smooth muscle cell. This study aimed to evaluate the correlation between BGN serum concentration and CAC in human for the first time. Patients and Methods: Eighty-four patients with coronary artery disease (CAD) were included in the study. A questionnaire consisting of demographic data and traditional cardiovascular risk factors was completed for all patients. patients did not complete the questionnaire, it was completed by the pharmacy student. CAC score and BGN serum concentrations were determined using computed tomography angiography and enzyme-linked immunosorbent assay method, respectively. Results: There was no significant correlation between BGN serum concentration and total CAC score and also CAC of different branches of coronary artery (P > 0.05). Conclusion: On the basis of our results, BGN serum concentration is not a suitable biomarker of CAD. Studies with a higher sample size are necessary for its confirmation.
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Transcatheter closure of large atrial septal defects: A single-center experience p. 148
Sedigheh Saedi, Maryam Aliramezany, Zahra Khajali, Hamid Reza Sanati
DOI:10.4103/rcm.rcm_7_18  
Background: Despite the favorable history of surgical approach to repair secundum type atrial septal defects (ASDs), the transcatheter closure has increasingly become the preferred strategy because of its relatively high efficacy and lower morbidity compared to surgery in selected cases. However, there is some controversy around the preferred strategy and long-term complications of device closure of large ASDs. Here, we evaluated the early and midterm outcomes of adults with large ASDs who underwent transcatheter device closure with devices larger than 28 mm. Methods: A prospective single-center study was conducted encompassing all the patients who were 18 years of age or older and underwent device closure for secundum type ASD from 2006 to 2014 with device size of >28 mm, and early and midterm follow-up data were assessed. Results: The procedure was successful in 93.6% of the scheduled patients. Two and a half percent had nonsignificant residual shunt. Immediate device migration occurred in one patient (1.2%) who underwent surgical retrieval and defect closure. One case of device thrombosis (1.2%) was seen 1 month after the procedure who had successful medical treatment. There was a case of device erosion 1 month after the procedure referred for the surgery. Mild postintervention pericardial effusion was seen in 16.5% and reduced to 7.6% in the first outpatient visit. Conclusions: The study demonstrated that the vast majority of anatomically suitable large ASDs could be closed by using the transcatheter technique with a low complication rate. Therefore, the transcatheter closure could be recommended as the first-line strategy in adults with large ASDs. However, meticulous preprocedural imaging and evaluation by experts are necessary before scheduling patients with large ASDs for the percutaneous alternative.
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CASE REPORTS Top

Intracardiac foregut cyst, in a 42-year-old woman with partial atrioventricular septal defect, a rare incidental finding p. 152
Kambiz Mozaffari, Zahra Khajali, Nozar Givtaj, Hooman Bakhshandeh
DOI:10.4103/rcm.rcm_13_18  
A 42-year-old female with gradual-onset dyspnea on exertion and a systolic murmur is presented, in whom electrocardiogram showed left axis deviation with an Rsr' pattern in lead V1. Chest X-ray had a pulmonary vascular shunt and echocardiography marked a large ostium primum atrial septal defect together with a cleft in the mitral valve, leading to a diagnosis of the partial atrioventricular septal defect. Furthermore, magnetic resonance imaging depicted an incidental cyst on the roof of the left atrium. The operation was performed, and the cyst was excised. It measured 15 mm in diameter, had a fibrotic wall and contained homogeneous gelatinous material. Histopathology showed a small simple cyst with a fibrotic wall, lined by cuboidal to respiratory-type columnar cells. No evidence of malignancy was noted. The patient had an uneventful postoperative course and was discharged in good clinical condition.
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Dissection of the interventricular septum after compressive blunt chest trauma p. 154
Bahieh Moradi, Zahra Khajali, Shahzad Moradi, Azam Nazeri
DOI:10.4103/rcm.rcm_8_18  
We report the case of a 21-year-old woman who was referred after a severe compressive blunt trauma in the context of job injury. Myocardial contusion is a common injury; however, rupture of the ventricular septum after blunt chest trauma is a rare event. Echocardiography revealed a large ventricular septal rupture with two small ventricular septal defects. The patient was a candidate for surgical repair after early conservative management. We discuss about the prevalence and management of this rare traumatic complication.
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LETTER TO EDITOR Top

The diagnostic challenge of unfamiliar cases with black pleural effusion Highly accessed article p. 157
Yasser Ali Kamal, Muhammad Nagi Abdul Hakeem
DOI:10.4103/rcm.rcm_19_18  
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