Research in Cardiovascular Medicine

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Background: Refractory periods are measured by the extrastimulus technique, whereby a single extrastimulus is introduced at progressively shorter coupling intervals until a response is no longer elicited. Purpose: As refractoriness of cardiac tissues depends on prior cycle length, refractory periods should be determined at a fixed cycle length within the physiologic range. The extrastimulus is delivered after a train of 8 to 10 paced complexes to allow time for reasonable stabilization of refractoriness, which is usually accomplished after the first 3 or 4 paced beats. Objectives: We conducted this study to compare the effect of 6 vs 8 stimuli in basic cycle length (BCL) in measurement of effective refractory period (ERP). Materials and Methods: During electrophysiologic study (EPS) of 100 consecutive patients, anterograde and retrograde ERP of atrioventricular node (AVN) were measured by introduction of 6 vs 8 stimuli in BCL and premature beat, then the results were compared. Results: Recorded anterograde and retrograde ERP of AVN applying 6 vs 8 stimuli in BCL were compared and no difference was detected. Conclusion: We concluded that for ERP measurement of AVN, 6 stimuli in BCL is comparable to 8 stimuli in reaching the steady state.

Introduction: We herein present the preliminary results of our center's chronic thromboembolic pulmonary hypertension (CTEPH) registry of the tertiary outcomes of patients diagnosed with CTEPH and treated with pulmonary endarterectomy (PEA), balloon pulmonary angioplasty (BPA), or medical treatment. Methods: The present retrospective cross-sectional study was conducted on patients who received treatment for CTEPH in Rajaie Cardiovascular Medical and Research Center over the past four years, from 2016 to 2020. The data were obtained from routine hospital admission and outpatient visit records. The patients were divided into PEA, BPA, and medical treatment groups, and the outcomes and complications of the procedures were reported. Results: Twenty-eight patients, at a median age of 40 (33–59) years were included in our study and were followed for approximately 20.0 (16.2–23.7) months. PEA was performed on 13 (46%) patients, BPA on 10 (35%), and medical therapy only on 5 (17%). Death occurred in 4 (30%) patients after surgery, and 10 (77%) had a surgical complication. There were no deaths or recorded complications in the other two groups, but the rates of postprocedural pulmonary hypertension (30% vs. 91%; P = 0.006) and rehospitalization (7% vs. 73%; P < 0.001) were significantly lower in the operated patients. The 1-year survival rate among the entire study population was 85.7%. Conclusions: The possibility of CTEPH incidence, especially in high-risk patients with dyspnea, should always be borne in mind given its large morbidity and mortality rate and its chances of curability with early diagnosis and proper treatment.

Introduction: It is crucial to define the normal ranges of echocardiographic parameters and their relationships with age, sex, race, and geographical differences given the failure of the existing literature to reflect the diversity of the world's populations. This study aimed to determine the normal ranges of echocardiographic systolic and diastolic values and the incidence of valvular heart lesions with or without rheumatic involvement in a sample of Iranian population. Methods: The Echocardiography Heart Assessment and Monitoring in Rajaie Hospital study is a population-based investigation conducted in Rajaie Cardiovascular Medical and Research Center. A total of 2229 Iranian individuals between 30 and 75 years of age without clinical cardiovascular diseases were invited through a multistage random sampling process, and they underwent two-dimensional and Doppler echocardiography. The left ventricular (LV) ejection fraction, the interventricular septal thickness, the ascending aortic size, the LV diastolic function, the valvular heart disease (VHD) severity, and rheumatic valvular involvement were assessed. Results: The study population comprised 2229 patients: 882 men (40%) and 1347 women (60%) at an age range of 39–58 years and a mean age of 48 years. The average body mass index was 28.8 kg/m² (25.9–32 kg/m²), and the median body surface area was 1.86. Mildsystolic dysfunction was reported in 119 patients (5.7%) and moderate systolic dysfunction in 19 (0.9%). LV systolic dysfunction was significantly correlated with the male sex, age, and hypertension (P < 0.001). The mean interventricular septal thickness was 8 mm. Mild LV hypertrophy (LVH) was detected in 5.5% of all the patients and moderate LVH in 0.4%. The mean interventricular septal thickness significantly increased with age (P < 0.001), and it was higher in the men than in the women (8.2 mm [7.8–9.2] vs. 8 mm [7–8.25]; P < 0.001). Mild LVH and moderate LVH were significantly correlated with hypertension, diabetes mellitus, hyperlipidemia, chronic kidney disease, and diastolic dysfunction (P < 0.001). Diastolic dysfunction was found in 29% of the patients (28.6% mild and 0.2% moderate). Significant correlations were found between LV diastolic dysfunction and age, the female sex, diabetes mellitus, hypertension, hyperlipidemia, and hypercholesterolemia (P < 0.001). The mean ascending aortic size was 31 mm in the men and 29 mm in the women. The ascending aortic size exceeded 37 mm in 5% of the men and 3.5% of the women. The indexed ascending aortic size was 1.54 cm/m² in the men and 1.66 cm/m² in the women. Valvular heart lesions were diagnosed in about half of the study population. The most common findings were mild regurgitation in the mitral and tricuspid valves. Multiple valvular disorders were found in 55% of the patients. Among significant (moderate and more-than-moderate) VHDs, tricuspid regurgitation (36%), mitral regurgitation (33%), and aortic regurgitation (19%) were the most frequent VHDs. Rheumatic valvular involvement was diagnosed in 31 (1.4%) patients. Conclusions: Echocardiographic parameters vary with age, sex, and race, and they should be population adjusted. We recommend further research in different areas of Iran to obtain sufficient data for the creation of an applicable guideline regarding echocardiographic parameters.

Background: Pulmonary embolism (PE) is a major public health concern, with a considerable mortality rate. In the present study, we have evaluated the impact of registry implementation on PE management. Methods: In the present single-center study, composed of two distinct cohorts, we have evaluated the impact of registry implementation (prospective arm-September 2015 to August 2018) on patient management and survival, and compared it with the same duration when no registry was implied (retrospective arm-September 2012 to August 2015). Results: One hundred and seventy and 182 patients were recruited in the prospective and retrospective arms, respectively. Guideline-recommended risk stratification was significantly overlooked before the introduction of PE registry (100% vs. 45.6% prospective and retrospective arms, respectively [P < 0.001]). A trend toward higher administration of thrombolytic therapy was noted in patients admitted during the registry time (20 [64.5%] vs. 3 [37.5%], P = 0.166). The registry had also significant impact on length of hospital stay (6.72 ± 4.39 days versus 9.35 ± 5.55, P = 0.001, in prospective and retrospective arms, respectively). No significant difference was detected on the 6-month all-cause mortality. However, re-venous thromboembolism was significantly reduced during registry time (2 [1.2%) vs. 22 [12.2%], P < 0.001). Finally, significantly more patients underwent guideline-recommended follow-up during the registry time (107 [72.3%] vs. 30 [16.5%], P < 0.001). Conclusion: Our study showed the implementation of registry had significant effect on PE-related outcome and might have direct impact on burden of pulmonary emboli on the healthcare system.

Severe acute respiratory syndrome coronavirus 2 (CoV-2), the cause of CoV disease 2019 (COVID-19), can lead to multi-organ injury including cardiac involvement. Acute myocarditis is one of the serious and fatal complications of COVID-19. In this report, we introduce two cases with acute myocarditis and negative real-time polymerase chain reaction test, presented during the COVID-19 pandemic and discuss the challenge of their diagnosis and management.

Marfan syndrome is a connective tissue disorder which involves various systems such as the cardiovascular system. One of the cardiovascular manifestations of Marfan syndrome is ventricular dysfunction. In this report, a case of Marfan syndrome was presented who suffered from acute heart failure due to Coronavirus disease 2019 (COVID-19). We discussed about several reasons of heart failure in this case and we suggested that COVID-19 related cardiovascular complications may be more prevalent in Marfan syndrome.

Infective endocarditis can cause several major complications, including valvular destruction, aneurysm formation, and aortic ring abscesses, and pseudoaneurysm formation in left ventricular outflow tract (LVOT) is quite a rare complication of infective endocarditis. Here, we present a rare case which had two simultaneous LVOT pseudoaneurysms, a bicuspid aortic valve (BAV) and abscess formation along with the presence of anerobic bacteria (Peptostreptococcus) in the tissue culture. We describe echocardiographic, computed tomography angiography findings, and the result of surgical repair. This is a unique case with 2 LVOT pseudoaneurysms, a BAV, and anerobic bacteria in the tissue culture which became complicated as a result of delayed intervention due to fear of coronavirus disease 2019.

We present an extreme rare case of acute pulmonary embolism in an 83-year-old male presenting as acute inferior wall ST-elevated myocardial infarction with right ventricular infarction (RVMI) in electrocardiogram (ECG). Acute pulmonary embolism presenting as acute inferior wall ST-elevation myocardial infarction with RVMI has not been described in the world literature so far. Our case is unique and first to describe the presentation of acute pulmonary embolism in the form of inferior wall ST-elevated myocardial infarction with evidence of RVMI in the ECG. It is of utmost important for the treating cardiologist and critical care physician to differentiate the same as treatment modalities of both conditions varies markedly and wrong therapeutic measures can land up in a catastrophe.

Amyloidosis is a clinical disorder caused by extracellular deposition of insoluble fibrils with beta-pleated sheet configuration. The protein misfolding abnormalities result in amyloid fibrils and may manifest as primary, secondary, familial, or senile amyloidosis. Amyloid deposition can occur in multiple organs (e.g. heart, liver, kidney, skin, eyes, lungs, and nervous system), resulting in a variety of clinical manifestations. Cardiac involvement is a progressive disorder resulting in early death due to congestive heart failure and arrhythmias. We report a rare case of cardiac amyloidosis presenting as recurrent pericardial effusion with features of restrictive cardiomyopathy.

Online since 6^the October 2017.