Background: The use of cardiac resynchronization therapy (CRT) in heart failure patients with right bundle branch block (RBBB) is under debate. We present early and late echocardiographic characteristics of a series of heart failure patients with RBBB who underwent CRT.  

Methods: This is retrospective descriptive study. A total of 18 patients with RBBB morphology in surface electrocardiogram underwent CRT between 2005 and 2015.  All patients had New-York-Heart-association class III/IV, left ventricular ejection fraction (LVEF)≤35%, and QRS duration ≥120 ms. Median follow up duration was 19 month. Echocardiographic response was based on ≥5% increase of LVEF.  

Results:   Within 48 hours after CRT implantation, LVEF increased from 24.58% ±7.08% before to 28.46±8.91% post CRT (P value=0.005) and to 30.00±9.44% at follow up (P value= 0.008). Among 18 patients, 12 (66.7%) were responder within 48 hours after CRT. Following baseline echocardiographic parameters were higher in responders compared to those without increased LVEF, although the difference did not reach statistically significant level; septal-lateral wall delay (48.33±33.53 vs. 43.33±38.82 ms), anteroseptal-posterior wall delay (4.17±1.75 vs. 38.33±18.35 ms) and interventricular mechanical delay (48.50 ± 21.13 vs. 31.17±19.93 ms).  Mean QRS duration was higher in responders compared to non-responders (183.58± 40.69 vs. 169.00± 27.36 ms). Death occurred in 3 out of 1816.7%) at follow up. The three dead patients had higher baseline IVMD compared to those who survived. 

Conclusion: there were shreds of evidence that RBBB patients might benefit from CRT and those with higher intra and interventricular dyssynchrony, and wider QRS may show better response.

Background: Hypertension (HTN) is known to be a modifiable risk factor for Cardiovascular Disease (CVDs), stroke, and kidney disease. The present study aimed to determine awareness, treatment, and control of HTN and the related factors in Kherameh, Iran.

Methods: This cross-sectional study was performed on 10663 individuals aged 40-70 years using Kherameh cohort data. HTN was defined as either Systolic/Diastolic Blood Pressure (SBP/DBP) ≥140/90 mmHg or taking medications. Logistic regression was used to examine the relationship between awareness to have HTN, treatment, and control and their related factors. The

Results: Prevalence, awareness, treatment, and control proportion of HTN in patients were 27.7% (95% CI: 26.86-28.54), 80.3% (95% CI: 79.56-81.04), 78% (95% CI: 77.22-78.78), and 53.6% (95% CI: 52.66-54.54), respectively. Age, gender, body mass index, and CVD were associated with all dependent variables in the regression model. In addition, occupation, diabetes, chronic diseases, history of CVD in the first- and second-degree relatives, and history of chronic diseases in the second-degree relatives were related to all dependent variables, except for treatment.

Conclusion: The results indicated that despite the high level of awareness to have HTN, the proportion of patients under treatment and control gradually decreased, such a way that about half of the patients had abnormal blood pressure, which indicates the need for planning to increase awareness and better control of the disease.

Abstract

Background: Clopidogrel is a P2Y₁₂ platelet antagonist commonly used for patients with acute coronary syndrome (ACS). However, higher risk of vascular ischemic complications and hypo-responsiveness of some patients to its therapeutic effects limits its use. Ticagrelor, a newer option with a better efficacy and safety profile, was approved by US FDA in 2011 and it was launched in Iran 3 years ago, however it is not included in Iran reimbursement coverage lists yet. This study aimed to determine the cost- effectiveness of ticagrelor in comparison with clopidogrel in Iranian ACS patients.

Methods:  A one-year decision tree model combined with a 20-year Markov transition model was used to stimulate long-term cost and effectiveness of both ticagrelor and clopidogrel in Iran based on an Iranian payer perspective. The clinical efficacy data were extracted from PLATO trial and other published studies.  Costs were estimated based on local costs in public sectors.  Deterministic and probabilistic sensitivity analysis were used to test robustness of base case results over uncertainties of model inputs.

Results: Compared with the clopidogrel, treatment of Iranian ACS patients with ticagrelor for 20 years resulted in an additional cost of 2.39 USD $ in hypothetical cohort of 1000 patient. On the other hand, ticagrelor led to 7.2 QALY gain per 1000 hypothetical patients. Accordingly, the estimated incremental cost effectiveness ratio (ICER) for this analysis was 332.032 USD $ per one QALY gained.

Conclusion: Ticagrelor was a cost-effective antiplatelet medicine compared with clopidogrel in Iranian patients with ACS.

Trial Registration: Not applicable

Keywords: Acute coronary syndrome; Ticagrelor; Clopidogrel; Cost effectiveness analysis

Background: The systemic immune inflammation index is an inflammatory biomarker recently been investigated for cardiovascular diseases. This study aimed to evaluate the relation between left atrial thrombus (LAT) and systemic immune-inflammation index (SII) in patients with non-valvular atrial fibrillation (NVAF).

Methods: A total of 403 patients with NVAF who were applied transesophageal echocardiography (TEE) procedure to detect LAT before cardioversion or catheter ablation were included in the study. The patients' demographics, clinical, laboratory, and echocardiographic characteristics were recorded. According to TEE findings, the patients were separated into LAT (+) and (-) groups. SII was calculated as platelet×neutrophil /lymphocyte counts.

Results:  In multivariate logistic regression analysis, high white blood cell count (WBC) (OR: 1.258, 95%CI: 1.049-1.508; p=0.013), SII (OR: 1.001, 95%CI : 1.000-1.002; p=0.003) and low left ventricle ejection fraction (OR: 0.946, 95%CI: 0.903-0.990; p=0.018) were revealed to be independent predictors of LAT(+). In addition, spontaneous echo contrast in the left atrium (OR: 2.606, 95% CI: 1.456-4.666; p=0.001) was associated with LAT(+). SII values above 693.6 predicted LAT(+) with 71.6% sensitivity and 71.7% specificity (AUC: 0.768; 95%CI: 0.709-0.827; p<0.001). This predictiveness of SII was statistically similar to neutrophil-lymphocyte ratio (0.768 vs. 0.739, p=0.093) while larger than platelet-lymphocyte ratio (0.768vs 0.671, p<0.001) and WBC (0.768vs 0.694, p=0.031)

Conclusion: SII is an independent and significant predictor of LAT in patients with NVAF. Therefore, SII may be a helpful marker used in non-invasive risk scoring models to identify LAT(+) in this patient population.

Backgrounds: Studies have shown a decline in admission rates of various diseases during the COVID-19 pandemic. Heart valve thrombosis (HVT) is a rare condition followed by valve diseases, valve procedures, endocarditis, or hypercoagulable states. Data regarding the impact of the pandemic on hospitalizations due to HVT is missing. We aimed to evaluate the implications of the pandemic on HVT admissions in a tertiary referral center.

Methods: We collected data from all the consecutive patients who were hospitalized due to native or prosthetic valve thrombosis between February 2020-February 2021 (the first year of the pandemic) and compared them clinically with the corresponding time before the pandemic (February 2019-February 2020) regarding the hospitalization number and clinical characteristics.

Results: We observed a considerable decline in hospitalization numbers during the pandemic, from 36 to 10 patients. Admitted patients were 10 years younger, had a higher proportion of New York Heart Association III or IV symptoms (40% vs. 19%), were more often treated with fibrinolysis (30% vs. 19%) or surgical approaches (30% vs. 19%), and were discharged four days sooner.

Conclusion: We described a reduction in HVT hospitalization. Patients presented with higher proportion of severe dyspnea and had increased treatment with fibrinolysis/surgical approaches. These observations highlight the necessity of active surveillance of patients with valvular diseases or prosthetic valves by caregivers for timely diagnosis and appropriate management of HVT during the pandemic.

Coronary artery aneurysm (CAA) occurs when the artery dilates 1.5 times the reference vessel. It occurs most commonly because of atherosclerosis. CAA is a rare phenomenon, and it is even rarer to find a giant CAA, which is roughly defined as a size 400% above the reference vessel. It is commonly found in the right coronary artery. Sinoatrial nodal artery (SNA) aneurysm is among the least common sites for CAA involvement. Sometimes, there is communication between the aneurysm and one chamber of the heart or a great vessel. The consequences of the fistula depend on its size. Because of the rarity of the condition, guidelines are not well developed. However, small CAA can be managed conservatively, whereas the giant CAA requires resection, ligation, and bypass graft. CAA has a predilection for males and the elderly. We present a case of 40 years old, South Asian female, who presented with mild dyspnea on exertion for one year. Echocardiography showed a cystic sac of 60*60 mm, confirmed by computerized tomography, which showed three large aneurysms of size 70*61 mm and three small aneurysms in the SNA. Coronary angiography showed that SNA was branching off the LMCA and the aneurysm had communication with RCA. The aneurysm was partially resected and plicated.

Anomalous aortic origin of a coronary artery (AAOCA)is a rare congenital condition in which the coronary artery arises from the opposite sinus of Valsalva. Although many patients are asymptomatic at the time of presentation or diagnosis, surgical correction is recommended due to the risk of sudden ischemic death. The purpose of this paper is to show an extremely rare anomalous origin of left coronary artery(LAD) from the right coronary cusp (RCC).

Tachyarrhythmias have been well defined in patients with Tako-tsubo cardiomyopathy (TTCM) and is estimated to occur in almost 13.5% of the patients. However, there is paucity of data available on bradyarrythmias in patients with TTCM. The pathophysiology, clinical implications and management is not well defined in this subgroup. We report a case of 53-year-old female, who presented to us in complete heart block with TTCM. Another 73-year-old female, presented with syncope with complete heart block with TTCM. Both of them had persistent conduction delay despite recovery of ventricular function and eventually required permanent pacemaker implantation. The pacing dependency was up to 90% in both of them at 6 month follow up.

Background: Cardiovascular diseases, specifically acute myocardial infarction (AMI), are the leading cause of death worldwide. In this review, we explain the characteristics of AMI in Iran.

Methods: We searched PubMed, Google, and Google Scholar for articles containing Myocardial Infarction, STEMI, and MI + Iran in English and Persian words.

Results: The age-standardized incidence rate of MI was 73.3 per 100,000. The mean±SD age of the patients was 61.20±13.40 years. In-hospital mortality (IHM) of Patients with AMI in IMIR was 12.1 %. AMI complications reported in IMIR: 5.8% experienced VT and 2.5% experienced VF. The one-year mortality rate in the IPACE2 study was 4.3%.

Conclusion: There have been limited national studies conducted in Iran regarding patients with AMI. A federal surveillance program that continuously monitors and tracks coronary events is essential to improve population health.