Background: Despite the well-known impact of baseline hostility and anger on subsequent cardiovascular mortality, few studies have tested whether predictive role of hostility and anger on mortality varies as a function of race and gender. Objectives: Current study explored role of race and gender in modifying the effects of baseline hostility and anger on cardiovascular mortality in a nationally representative sample in U.S. Materials and Methods: We used data from the Americans’ changing lives study, a nationally representative longitudinal cohort of U.S. adults. The study followed 1,593 Blacks or Whites for 10 years from 2001 to 2011. Independent variables were baseline hostility and anger (anger-in, and anger-out), measured at 2001, using 4 item Cook-Medley cynical hostility scale and Spielberger Anger Expres- sion scales, respectively. Dependent variable was time to death due to cardiovascular disease since 2001. Covariates were baseline socio-demographics (age and education), behaviors (smoking and drinking), and health (number of chronic medical conditions, self-rated health, and depressive symptoms) measured at 2001. We used Cox proportional hazard models in the pooled sample and specific to race, in the absence and presence of health variables. Results: In the pooled sample, baseline hostility and anger-out predicted cardiovascular mortality in the next 10 years. We found significant interactions between race and baseline hostility and anger-in on cardiovascular mortality, suggesting that these associ- ations are stronger for Whites than Blacks. Race did not interact with baseline anger-out on cardiovascular mortality. Gender also did not have any interactions with baseline hostility, anger-in, or anger-out on cardiovascular mortality. Conclusions: Hostility and anger-in better predict cardiovascular mortality among Blacks than Whites in the United States. Black - White difference in the associations of hostility and anger with cardiovascular mortality suggest these factors may have some role in shaping health disparities across racial groups.

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Background: Malnutrition is a common problem among elderly patients, especially those with heart failure, and is known to increase mortality rates. Objectives: The current study evaluated nutritional status to identify changes in the elderly patients with congestive heart failure (CHF) during hospital stay. Patients and Methods: This cross-sectional study recruited 225 CHF hospitalized elderly patients, comprised of 154 males (68.4%) and 71 females (31.6%) at ameanage of 71.1±7.35 years. The mini nutritional assessment (MNA) was performed to estimate functional, cognitive and nutritional status. The MNA, an18-item tool to evaluate subjective and objective findings, including anthropometric measurements for nutritional risk, is found to be sensitive, specific and accurate in identifying elderly people at nutritional risk. Results: According to the MNA questionnaire, 9.8% of the elderly were malnourished, 80.9% at risk of malnutrition and 9.3% well nourished.Weight loss, bedsore, and level of knowledge and income had a significant relationship with nutritional status based on the MNA (P value < 0.05). Conclusions: Considering the high percentage of elderly patients with malnutrition or at risk of malnutrition, the need for nutritional intervention is obvious. The MNA seems to be a reliable tool to identify individuals at risk of malnutrition. To decrease hospital stay duration and cost, application of the MNA is suggested.

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Background: Iron deficiency (ID) is one of the most common comorbidities in patients with heart failure (HF). The preferred form of iron supplementation is intravenously. Polysaccharide-iron complex (PIC) is an oral iron supplement that has a bioavailability of 100%; gastrointestinal complaints are absent or less frequent with PICs. Objectives: In this study we aimed to investigate if oral PIC was effective at increasing the ferritin level over 12 weeks in dilated cardiomyopathy patients with an absolute iron deficiency and to determine the incidence GI side effects with this type of treatment. Methods: Thirty patients with a diagnosis of non-ischemic dilated cardiomyopathy (left ventricular ejection fraction (LVEF) < 35%) and absolute iron deficiency (serum ferritin level < 100 mcg/L) were recruited. For all study participants, one capsule of Feramax-150 was prescribed on a daily basis for 12 weeks. All patients were asked to report any GI side effects, including heartburn, abdominal pain, nausea, vomiting, diarrhea, constipation, and bloating. Results: The mean (SD) age was 43.2 (13.4) years. The mean LVEF was 23%. The mean(SD) ferritin level was 48.8 (27.7) at baseline. After 12 weeks of treatment with Feramax-150, the mean(SD) ferritin level had increased to 69.9 (42) (P< 0.001). No patients reported any gastrointestinal side effects. Conclusions: PICs could be a good and well-tolerated medicine in the treatment of iron deficiency in patients with heart failure. It is recommended that PICs be prescribed to maintain body iron stores after IV iron therapies in HF patients.

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Background: Infants and children compared with adults have intensified stress responses that lead to increased morbidity and mortality. Stress control reduces the incidence of complications and improves recovery. In clinical and experimental studies, dexmedetomidine reduces the inflammatory and neuroendocrine responses. Objectives: This prospective randomized double-blinded clinical trial was conducted to assess the role of dexmedetomidine in reducing stress responses. Materials and Methods: According to convenient sampling method, 40 patients in two groups (case under treatment with dexmedetomidine and control, each including 20 patients) were selected from whom admitted for open heart surgery. Anesthe- sia was induced and maintained by fentanyl and midazolam. After central venous and arterial catheter insertion, patients were randomly allocated into one of two equal groups (n = 20 each). In the dexmedetomidine group, patients received an initial loading dose (0.5 μg/kg) during10 minutes immediately followed by a continuous infusion of 0.5 μg/kg. In the control group, normal saline solution with similar volume was infused. Results: Changes in heart rate, systolic and diastolic blood pressures and central venous pressure before administration of dexmedetomidine, in 10, 20 and 30 minutes after the operation, after skin incision, after sternotomy, after separation from the pump and at the end of procedure showed no significant difference between the two groups (P = 0.860, 0.067, 0.888 and 0.482, respectively). Changes in lactate, interleukin 6, tumor necrosis factor, C-reactive protein concentrations before administration of dexmedetomidine, after separation of pump and 24 hours after intensive care unit entrance showed no significant difference be- tween the two groups (P = 0.525, 0.767, 0.868 and 0.840, respectively). Conclusions: According to our findings, using dexmedetomidine as an adjuvant anesthetic medication with initial loading dose of 0.5 μg/kgand maintenance dose of 0.5 μg /kg in pediatric heart surgeries is a safe choice. However, further studies are needed to clarify the role of dexmedetomidine to reduce stress responses.

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Background: Studies have investigated racial differences in the relationship between depression and CVD mortality. Objectives: This study tested the hypothesis that race moderates the effect of baseline depressive symptoms on subsequent heart disease among a nationally representative sample of Black and White older Americans. Patients and Methods: Data came from ten waves of the health and retirement study (HRS), a nationally representative longitudi- nal study of US adults over age 50. The present study followed 7,444 Black and White individuals without a diagnosis of heart disease at baseline for up to 18 years for incident heart disease. Elevated depressive symptoms at baseline was the independent variable, time to incident heart disease was the dependent variable, while baseline sociodemographics, health risk behaviors, obesity, and chronic medical conditions were controls. We used Cox proportional hazards models in the pooled sample and stratified by race to test the effect of elevated depressive symptoms on the outcome net of other risk factors. Results: In the pooled sample, a significant positive interaction was found between the effect of elevated depressive symptoms and Black race (hazard ratio, 1.29; 95% CI = 1.01 -1.65), suggesting a stronger effect for Blacks compared to Whites. In fully adjusted race- stratified models, elevated depressive symptoms increased the risk of developing heart disease for Blacks (hazard ratio, 1.47; 95% CI = 1.04 - 2.07) but not Whites (hazard ratio, 1.13; 95% CI = 0.97 -1.32). Conclusions: Black and White older adults differ in the effect of depressive symptoms on subsequent heart disease over a long period of follow up. Elevated depressive symptoms are associated with a larger risk of incident heart disease among Black but not White older individuals.

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Background: In recent years, several systems have been implemented to achieve quick and non-invasive measurements of B-type natriuretic peptide (BNP). Among them, Alere™ heart check (AHC) BNP test represents the most recent advancement. It is a rapid point of care immunoassay (POC), projected for measuring BNP directly from a capillary whole blood sample. Objectives: This study aimed to compare analytical and clinical performances of this new POC to our reference method (Abbott architect system). Patients and Methods: 111 patients with stable chronic heart failure (CHF) referred to two cardiac rehabilitation centers were en- rolled from December 2013 to January 2015. These patients were subjected to a simultaneous capillary (AHC) and plasma (Abbott) BNP measurements. Clinical and analytical performance of AHC were assessed and compared to the reference method. Results: Capillary BNP showed a good correlation with the reference method (r = 0.94, P < 0.0001), although the values diverged when BNP was higher than 1500 pg /mL. Indeed, the AHC had a relatively poor precision and the coefficient of variability was 10.1% and 18% for low and high controls, respectively. However, both methods showed similar diagnostic performances in discriminating patients with heart failure in NYHA class I from those belonging to NYHA classes II-III, with values of area under the curve (AUC) of 0.983 and 0.984, respectively, and equivalent sensitivity, specificity and positive and negative likelihood ratios. Conclusions: The AHC BNP test is a good POC able to provide reliable information about hemodynamic status of CHF patients, especially of those belonging to NYHA classes I-III.

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Introduction: T-wave oversensing (TWOS) is generally seen in patients with hypertrophic cardiomyopathy (HCM) and is a rare cause of inappropriate implantable cardioverter defibrillator (ICD) shocks. TWOS rarely causes pacemaker dysfunction. Case Presentation: In this paper, we present two patients with hypertrophic cardiomyopathy (HCM). One patient had several in- appropriate ICD shocks, and the other experienced pacemaker dysfunction due to TWOS. ICD interrogation revealed that TWOS occurred only during high heart rates in the first patient. Attempts to fix TWOS, including a higher beta blocker dose, electrophysi- ology study, and ICD re-programming, were unsuccessful. Conclusions: We replaced the previously implanted ICD generator (Medtronic Maximo II DR) with a new one that has a specific diagnostic algorithm to prevent TWOS (Medtronic Protector). After replacement, the patient did not have any inappropriate shocks due to TWOS. The second patient had bradycardic pacemaker rhythm due to TWOS. Although we reposed, the ventricular lead did not stabilize with an adequate threshold, and thus we decided to replace the lead with a new one. The pacemaker dysfunction disappeared after the lead replacement. Patients with HCM must be observed carefully for these undesired conditions.

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Background: Left ventricular aneurysm (LVA) is a common complication of myocardial infarction (MI); however, the optimal sur- gical technique for LVA repair has remained controversial. Methods: In this retrospective study, we analyzed the long-term outcomes of 65 patients, who underwent LVA surgical repair be- tween January 2005 and December 2009. The LVA repair approaches comprised of patch plasty (n = 16), linear (n = 23), and plication (n = 26) repair techniques. Results: Male gender was predominant (89%), and the patients’ mean age was 56 ± 7.1 years. The rate of in-hospital mortality was 4.6%, 4.6%, and 9.2% in the plication, linear and patch plasty repair groups, respectively (P = 0.077). The amount of increase in early postoperative LV ejection fraction was 4.5%, 7% and 9.5%, in the plication, linear and patch plasty techniques, correspondingly (P < 0.001). During the follow-up period (50.6 ± 15.6 months), there were seven (16.7%) cardiac deaths: five deaths in the linear repair group, one in the plication, and one in the patch plasty repair group (P= 0.057). There was no significant difference regarding the survival rate between the patients undergoing different surgical repairs (P = 0.098). Conclusions: Despite having relatively high in-hospital and long-term mortality, LVA after MI could be repaired with similar out- comes using different surgical techniques, including linear, patch plasty, and plication techniques.

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Background: Cardiovascular diseases are among the major causes of mortality in industrialized countries. Prevention of cardio- vascular diseases and increasing stress tolerance are two of the main goals of physical training. Objectives: This study was designed to compare the effects of two exercise programs of different intensities on rat hearts with isoproterenol-induced myocardial injuries. Methods: Animals were randomly divided into four groups (n = 8 per group): control group (CTL); ISO group, administered iso- proterenol (85 mg/kg subcutaneously) for two consecutive days; low-intensity interval training + isoproterenol group (LIIT+ ISO: 5 minutes warm up at 40% VO₂ max,5 x 10 minutes at50% -60% VO₂ max [about 20-24 m/min]); and high-intensity interval training + isoproterenol group (HIIT+ ISO: 5 minutes warm-up at 40% VO₂ max, 5 x 5 min at 95% -105% VO₂ max [45 -50 m/min]). The train- ing groups performed high- and low-intensity interval training programs (5 days/week) on a motor-driven treadmill for 16 weeks. Seventy-two hours after the last training session, isoproterenol (85 mg/kg) was injected on two consecutive days. On the third day, hemodynamic parameters were recorded, blood samples were taken, and hearts were removed for laboratory analysis. Results: ISO-induced heart injury raised cardiac troponin I levels, significantly decreased + dp/dt max(P< 0.05) and-dp/dt max(P < 0.05), and significantly increased serum CTnI and tissue TNF α levels (P < 0.05). Exercise training had no significant effects on HR, LVSP, and LVEDP. Impairments of + dp/dt max and-dp/dt max were significantly improved in the HIIT+ ISO and LIIT+ISO groups (P < 0.05 for both groups versus ISO). In addition, exercise training groups especially HIIT + ISO to some reduce exacerbated the myocardial lesions induced by ISO (P < 0.05). Conclusions: These biochemical and histopathological findings suggest there is a protective role provided by both high- and low- intensity interval training protocols on ischemic hearts.

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Introduction: Left ventricular pseudoaneurysm; also referred to as contained left ventricular wall rupture, is a rare complication that is reported in about 0.2 to 0.3 percent of all myocardial infarction patients. Since it has a high risk of fatal rupture, early surgical repair is recommended once pseudoaneurysm is diagnosed. Case Presentation: In this case report, we are describing a case of a left ventricular inferior wall pseudoaneurysm which was diag- nosed by angiography, and was complicated by rupture and cardiac tamponade shortly after the patient received a powered assisted left ventricular angiogram. Conclusions: This case exemplifies that pseudoaneurysm represents a part of the ongoing process of ventricular rupture, that begins with a small tear in the endocardium and then extends to the myocardium and the pericardial cavity, causing hemoperi- cardium and cardiac tamponade. Therefore, earlier recognition and urgent surgical repair can be lifesaving.

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Background: Recent evidence suggests that skeletonization of the left internal mammary artery (LIMA) can improve the flow and length of the flow, reduce deep sternal infections and postoperative pain. Objectives: The present study aimed to investigate the effect of two LIMA harvesting techniques (skeletonization and pedicled) on postoperative pain and bleeding. Methods: This randomized double blind clinical trial study on patients undergoing LIMA harvest in Birjand was conducted dur- ing years 2012 to 2014. The patients were divided to two (skeletonization N: 30 and pedicled N: 30) groups according to the LIMA harvesting method. Their demographic information and other relevant data were collected by means of a questionnaire. Results: In total, 60 cases, who were candidates for coronary artery bypass grafting (CABG) at the cardiac surgery department of Valiasr hospital in Birjand, were studied. In the skeletonized group, the conduit length was significantly longer (17.96 vs. 17.27, P < 0.001), yet there was no significant difference between early and mid-term pain scores (P values: 0.32 and 1.0, respectively) and early postoperative bleeding (782.26 vs. 903.16, P = 0.657). Conclusions: The IMA skeletonized collection resulted in the reduction of postoperative pain and increased conduit length. Skele- tonization could not decrease postoperative bleeding.

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Introduction: Coronary-subclavian steal syndrome (CSSS) is not a common complication but it can cause recurrent angina following coronary artery bypass grafting(CABG). CSSS results from proximal subclavian artery stenosis causing reversal of blood flow in apatent in situ internal thoracic artery utilized as a conduit in CABG, leading to myocardial ischemia. Case Presentation: We present a case of CSSS successfully treated with carotid-subclavian bypass (CSB). A review of articles on the subject has also been conducted. Conclusions: Although CSSS is not a common condition, it should be strongly considered as a possibility in CABG patients presenting with recur- rent chest pain not to be confused with perioperative myocardial infarction (PMI). If indicated, carotid-subclavian bypass maybe performed as an effective treatment option with acceptable outcomes.

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