Background: Health literacy is an important factor in facilitating disease management among individuals with hypertension. This study aimed to determine the effect of health literacy on adherence to antihypertensive treatment in elderly patients with controlled and uncontrolled hypertension.
Methods: This descriptive and comparative study included 203 elderly patients diagnosed with hypertension for at least 6 months who were on antihypertensive treatment. Data were collected using a patient information form, the Health Literacy Scale (HLS), and the Medication Adherence Self-Efficacy Scale Short Form (MASES-SF).
Results: The mean age of the participants was 69.70±12.49 years. Age, duration of disease, and duration of medication use were higher in patients with uncontrolled hypertension. Moreover, patients with controlled hypertension were more likely to have regular health check-ups, watch health-related programs in the media, and research the accuracy of disease-related information (P<0.05). In addition, patients with controlled hypertension were more likely to use medication once daily, have another chronic disease, and have a family history of hypertension (P<0.05). The mean MASES-SF and HLS scores of patients with controlled hypertension were statistically higher than those of patients with uncontrolled hypertension (P<0.01).
Conclusions: Controlled hypertension showed a positive correlation with health literacy and treatment adherence. Furthermore, the health literacy level was identified as a determinant of medication adherence in elderly patients.

Objective: To evaluate the impact of radiofrequency ablation (RFA) on dyssynchrony in children with Wolff-Parkinson-White (WPW) syndrome.
Methods: This pre-post interventional study was conducted at Rajaie Cardiovascular Institute in Tehran, Iran, and included patients with WPW syndrome who had accessory pathways and were candidates for RFA. Demographic and baseline data, such as age and sex, were recorded. Patients underwent ECG studies and RFA of their accessory pathways. Twelve-lead ECG was performed before and one day after RFA. Standard echocardiographic views were obtained using a Vivid S60 system with appropriate transducers in 1D (M-mode) and 2D modes, along with Doppler evaluation. Intraventricular and interventricular dyssynchrony indices were assessed, and 2D strain analysis was performed. Data were analyzed using IBM SPSS Statistics for Windows, version 26.0.
Results: This study included 54 patients with WPW syndrome, 17 of whom had ventricular dyssynchrony. Ablation significantly affected QRS duration, PR interval, fractional shortening, left ventricular ejection fraction, and septal-to-posterior wall motion delay but did not significantly alter interventricular mechanical delay. The most common accessory pathways were left lateral, right posteroseptal, and left posteroseptal. The location of the accessory pathway was not significantly associated with the occurrence of dyssynchrony.
Conclusions: Based on the findings of this study, RF ablation eliminated dyssynchrony in all WPW patients and improved functional and strain parameters in this population. These improvements enhance cardiac function and reduce associated risks, particularly in pediatric patients.

Background: Mitral stenosis (MS) is typically assessed using both echocardiographic and invasive methods, which are critical for treatment planning. The present study analyzed the correlation between invasively measured left atrial pressure (LAP) and mitral valve area (MVA) assessed by three-dimensional transesophageal echocardiography (3D-TEE) in patients with rheumatic MS undergoing percutaneous transluminal mitral commissurotomy (PTMC).
Methods: We conducted a cross-sectional study of 135 patients with severe rheumatic MS who were candidates for PTMC at Shahid Madani Heart Hospital, Tabriz, Iran, between April 2023 and April 2024. All patients underwent two-dimensional transthoracic echocardiography (2D-TTE) and 3D-TEE for MVA measurement. Invasive LAP and pulmonary pressures were recorded pre-procedure. Comparisons were made between patients with MVA<1 cm² and those with MVA≥1 cm².
Results: The mean MVA measured by 3D-TEE was 1.03±0.07 cm². LAP was significantly higher in patients with MVA<1 cm² than in those with MVA≥1 cm² (P=0.040). Pulmonary artery pressures also differed significantly between the groups (P=0.016 and P=0.012). Among the 135 participants, 109 patients (63.3% with MVA<1 cm² and 93.6% with LAP>15 mm Hg) reported dyspnea, while 20 patients (65% with MVA<1 cm² and 100% with LAP>15 mm Hg) reported fatigue.
Conclusions: In this study, we observed a significant correlation between invasive LAP and MVA measured by 3D-TEE. These findings suggest that invasive LAP measurement offers additional value in assessing the hemodynamic burden of severe MS.

Background: Heart failure with preserved ejection fraction (HFpEF) has a high hospitalization rate. While recent guidelines recommend parameters like E/e’ and e’ velocity for diagnosis, their accuracy remains limited. Left atrial (LA) strain is a potential diagnostic parameter, yet its role in the Vietnamese population is unclear. This study aims to evaluate LA strain’s diagnostic value in HFpEF among Vietnamese patients, exploring its relationship with established parameters of left ventricle diastolic function.
Methods: A cross-sectional study (15/04/2022 - 01/12/2023) included 49 patients with HFpEF and 69 individuals without cardiac dysfunction. The study subjects were evaluated for LA strain and HFA-PEFF score. Diagnostic criteria for HFpEF were based on the 2021 European Society of Cardiology guidelines for diagnosing and treating acute and chronic heart failure.
Results: LA strain including LA reservoir (LASr), conduit (LAScd), and contractile (LASct) functions, in the HFpEF group were 20.80% [13.30-26.50], 10.89±5.16%, and 9.08±6.18%, respectively. The control group had corresponding LASr, LAScd, and LASct values of 34.45% [31.14-38.07], 17.38±4.41%, and 17.33±5.72% (p<0.001). The area under the curve (AUC) for LASr, LAScd, LAScr, and HFA-PEFF score to diagnose HFpEF was 0.852, 0.770, 0.778, and 0.890, respectively. Comparing the AUCs for diagnosing HFpEF between LASr and HFA-PEFF score, no difference was found with p=0.419.
Conclusion: LASr has a diagnostic value equivalent to the HFA-PEFF score in diagnosing HFpEF and could be incorporated into the existing HFpEF diagnostic guidelines.

Background: Nephrotic syndrome (NS) is a common pediatric glomerular disorder traditionally considered renal-limited. Nonetheless, growing evidence suggests systemic implications, including subclinical cardiovascular involvement. This study aimed to evaluate early myocardial dysfunction in children with idiopathic NS using Doppler tissue echocardiography (DTE).
Methods: In a case-control study, 87 children with idiopathic NS and 87 age- and sex-matched healthy controls were enrolled between 2021 and 2023 at Ali Asghar Pediatric Hospital in Zahedan, Iran. All participants underwent comprehensive DTE from apical four-chamber views to assess systolic and diastolic function. Key parameters included S′, E′, and A′ velocities; isovolumetric contraction time (ICT); isovolumetric relaxation time (IRT); ejection time (ET); myocardial performance index (MPI); and E/E′ and A/A′ ratios. Laboratory data and treatment response were also analyzed. Data were analyzed using SPSS version 26, with a significance level set at 0.05.
Results: Children with NS demonstrated significantly reduced S′, E′, and A′ velocities; prolonged left ventricular IRT; shortened ICT and ET; and elevated MPI values, indicating early biventricular dysfunction. The right ventricular E/E′ ratio was significantly lower in treatment responders, suggesting improved diastolic function. MPI and timing parameters showed strong correlations with renal and metabolic markers, including blood urea nitrogen, serum albumin, and lipid levels.
Conclusions: DTE-derived MPI serves as a valuable noninvasive marker for the early detection of subclinical cardiac dysfunction in pediatric NS. Incorporating MPI into routine cardiac assessments may improve risk stratification and guide therapeutic monitoring in this population.

Background: Sarcopenia is a predictor of mortality in multiple conditions, but the potential prognostic value of sarcopenia indices in pulmonary hypertension (PH) has not been clarified. This study aimed to determine whether there is an association between computed tomography (CT) scan-measured pectoralis muscle area (PMA) and density (PMD) and adverse clinical outcomes in PH patients.
Methods: In this cross-sectional study, the medical records of PH patients (clinical classes I and IV) referred to Rajaie Cardiovascular Institute from March 2016 through March 2021 were retrospectively reviewed. CT scan-measured PMA and PMD were compared between survivors and non-survivors, along with blood biomarkers and right heart catheterization variables. Binary logistic regression analysis was performed to identify potential predictors of mortality.
Results: A total of 45 patients with PH (34 survivors and 11 non-survivors) were included in the analysis. PMA was not significantly different between the two groups (P=0.12), whereas PMD differed weakly between survivors and non-survivors (survivors: 45 HU [25.8–51.3] vs. non-survivors: 31 HU [23–36]; P=0.062). In logistic regression analysis, none of the sarcopenia indices predicted mortality (P >0.05). Nonetheless, phosphodiesterase-5 (PDE-5) inhibitor use, right atrial pressure, and systemic arterial oxygen saturation were identified as potential predictors (P<0.05).
Conclusions: Although CT scan-measured PMA and PMD showed only a weak correlation with the prognosis of PH, these factors may serve as potential markers of mortality in patients with idiopathic and chronic thromboembolic PH. Further confirmation is needed through future studies with larger sample sizes.

Introduction: β-thalassemia, particularly the major form, is associated with significant morbidity, as it requires lifelong maintenance transfusion therapy to manage the condition. This transforms thalassemia from a fatal childhood disease into a chronic disorder. Nonetheless, this therapeutic approach presents challenges due to its pathological adverse effects on cardiac health, including heart failure and arrhythmias.
Discussion: Multiple lifelong transfusions, combined with the pathological effects of thalassemia—such as hemolysis and ineffective erythropoiesis—exacerbate excessive iron deposition, primarily in the liver but most critically in the heart. This creates a vicious cycle between iron overload and cardiac dysfunction. Due to their high dependence on blood transfusions, thalassemia major patients are predisposed to left-sided heart failure, resulting from both dilated and restrictive cardiomyopathy, as well as life-threatening arrhythmias and electrical disturbances. These complications arise from the heart’s overwhelmed capacity to clear free radicals. Cardiac dysfunction represents a critical complication requiring early detection and prompt intervention, underscoring the limitations of conventional echocardiography in diagnosing subclinical and systolic dysfunction—the latter often appearing only in advanced disease. Earlier risk stratification is essential, with recent studies highlighting the role of genetic predisposition, biomarkers, and advanced noninvasive imaging (MRI) in facilitating timely treatment initiation, such as iron-chelating therapy, to improve survival outcomes.
Conclusions: Iron overload is an inevitable consequence for thalassemia major patients requiring transfusions, as the human body lacks mechanisms to eliminate excess iron. These patients require careful observation, monitoring, and timely diagnosis according to standard guidelines to facilitate chelation therapy and prevent its harmful effects. This review examines the complex interplay between symptomatic management of thalassemia, subsequent iron overload, and cardiac dysfunction in treated patients, with the goal of promoting early detection of therapeutic complications and timely intervention.

Cardiac fibroma is a sporadic primary cardiac tumor that is more prevalent in children but accounts for approximately 1% of cardiac tumors in the adult population. It is a benign tumor consisting of fibroblasts and connective tissues, typically associated with a favorable prognosis. Nonetheless, large fibromas may have a poorer prognosis due to the increased risk of arrhythmias and sudden cardiac death.
In this case report, we describe a 38-year-old woman who experienced chest discomfort and shortness of breath roughly 3 months following the total resection of a left ventricular fibroma. The initial suspicion was the recurrence of fibroma, but upon further investigation, an intriguing scenario unfolded: the formation of a hematoma and abscess at the previous surgical site. Ultimately, the patient underwent redo-cardiac surgery.

Background: Cardiac tamponade is a life-threatening emergency caused by substantial pericardial accumulation of fluid, blood, or pus. This buildup compresses the cardiac chambers, resulting in hemodynamic compromise, shock, and possible death. Postoperative cardiac tamponade incidence ranges from 0.1% to 6%. We describe a case of late-onset type I left ventricular (LV) rupture after double-valve replacement (DVR), presenting as cardiac tamponade.
Case Presentation:  A 58-year-old woman was referred to our hospital with a 1-month history of progressive breathlessness and orthopnea. She had undergone DVR surgery, specifically an aortic and mitral valve replacement, 3 months prior to admission. Echocardiography performed at the referring hospital revealed a large, loculated pericardial mass, suspected to be a hemopericardium, that was compressing the LV structure and causing cardiac tamponade. Further imaging with cardiac computed tomography (CT) demonstrated contrast extravasation at the atrioventricular groove adjacent to the prosthetic mitral valve, which confirmed a type I LV rupture.
The patient was diagnosed with a late-onset type I LV wall rupture following DVR. Urgent pericardiocentesis was performed, followed by an open thoracotomy, the creation of a pericardial window, and the surgical repair of the rupture site.
Conclusions: Multimodal cardiac imaging, such as echocardiography and cardiac computed tomography, is essential for comprehensive assessment and characterization of the underlying etiology of postoperative cardiac tamponade.

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