The Journal of Tehran University Heart Center

Protective Effect of Flaxseed Oil on Diazinon-Induced Cardiotoxicity in Rats in Sub-Chronic Exposure

2025-01-19T07:00:39+0330

Background: Diazinon (DZN), an organophosphate insecticide, exerts various adverse effects on human organs. In this study, we investigated the potential cardiotoxic effects of flaxseed oil (FS oil) on oxidative stress caused by DZN in the heart tissue of rats.
Methods: Thirty male rats were divided into five groups: a control group receiving normal saline, an FS oil group administered 200 mg/kg/d of FS oil, a DZN group treated with 70 mg/kg/d of DZN, and two co-treatment groups receiving DZN alongside FS oil at 100 and 200 mg/kg/d. We assessed oxidative stress biomarkers in heart tissue, including malondialdehyde, total oxidant status, catalase, superoxide dismutase, and total thiol content. Heart tissue morphology was analyzed using hematoxylin and eosin staining.
Results: DZN significantly increased the levels of malondialdehyde (12.04±1.16) and total oxidant status (0.43±0.01) and also decreased the content of catalase (23.09±1.99), superoxide dismutase (5.52±0.61), and total thiol content (6.31±0.77) in heart tissue. FS-oil + DZN decreased malondialdehyde (10.88±0.31) and total oxidant status (0.41±0.01) and also increased the content of catalase (29.34±1.77), superoxide dismutase (6.64±0.21), and total thiol content (8.20±0.15) in heart tissue. FS oil supplement consumption reversed oxidative stress status in a dose-dependent manner. Furthermore, FS oil ameliorated heart histopathological alterations induced by DZN.
Conclusion: Our findings confirmed that DZN induced heart toxicity and that FS oil had protective effects. Additionally, FS oil supplementation conferred protective effects on the heart against toxicity induced by DZN.

Transcatheter Fenestration Closure after Fontan Surgery

2025-01-19T07:00:43+0330

Background: Although several studies have examined patients who have undergone transcatheter fenestration closure, comprehensive evaluations of its long-term outcomes remain scarce. Therefore, this study aimed to evaluate the clinical status of these patients after a long-term follow-up period.
Methods: This cross-sectional analytical study evaluated the records of all children with congenital heart diseases admitted for transcatheter fenestration closure at Rajaie Cardiovascular Medical and Research Center, a tertiary care hospital specializing in congenital heart diseases in Tehran, Iran. We included patients with a history of fenestration following Fontan surgery who required fenestration closure between January 2012 and August 2020. Cardiac function data, such as ejection fraction (EF), pulmonary artery pressure (PAP), and O2 saturation, were extracted from electronic medical records.
Results: We assessed 26 patients (11 female and 15 male) with a mean age of 13.88±3.73 years. Comparing EF before and after fenestration closure revealed a significant difference (P=0.011), with only 2 patients (7.7%) experiencing a slight reduction (5.0%) in EF. No significant difference was observed in PAP before and after closure (P=0.068), although most patients (n=16, 61.5%) had a postprocedural reduction. Our results demonstrated a significant difference before and after the procedure (P<0.001), with all patients exhibiting increased O2 saturation after closure.
Conclusion: Our study demonstrated improvements in cardiovascular function and desirable organ function among patients. These findings suggest that transcatheter fenestration closure could serve as a beneficial complementary approach for patients with patent fenestration.

Efficacy of the Optimal Dosage of Lisinopril in Inhibiting Myofibroblast Differentiation for Attenuating Rheumatic Heart Disease Progression: An in Vitro Study

2025-01-19T07:00:47+0330

Background: Rheumatic heart disease (RHD) is exacerbated by chronic inflammation that stimulates the release of proinflammatory cytokines, most notably transforming growth factor-beta 1 (TGF-β1), which promotes myofibroblast differentiation. This study aims to determine the optimal dosage of Lisinopril, an angiotensin-converting enzyme inhibitor, for mitigating the fibrotic changes associated with RHD.
Methods: This in vitro, posttest-only control group study involved obtaining valvular interstitial cells from the heart valves of 25 male New Zealand rabbits (Oryctolagus cuniculus). Valvular interstitial cells were divided into 5 groups: a control group exposed to TGF-β1, and 4 experimental groups exposed to various Lisinopril doses (1 µM, 10 µM, and 100 µM) in addition to TGF-β1. The effect of Lisinopril on myofibroblast differentiation was assessed by measuring alpha-smooth muscle actin (αSMA) expression through immunocytochemical methods. Statistical significance was determined using an independent T-test with a P value of less than 0.050.
Results: Independent T-tests conducted on 25 male Oryctolagus cuniculus demonstrated significantly lower αSMA expression in the groups treated with various Lisinopril doses (1 µM, 10 µM, and 100 µM) compared with the TGF-β1-induced control group (P<0.050). The most significant reduction in αSMA expression was observed in the group treated with the highest Lisinopril dose of 100 µM.
Conclusion: Lisinopril demonstrates a significant ability to inhibit TGF-β1-induced myofibroblast differentiation in rabbit valve interstitial cells, with the 100 µM dose proving most effective. These results suggest that Lisinopril may have the potential to curb RHD progression, warranting further investigations in vivo.

The Predictive Value of Heart Rate Variability for Long-Term Outcomes in Patients Undergoing Coronary Artery Bypass Grafting and ICU Referrals

2025-01-19T07:00:51+0330

Background: Heart rate variability (HRV) is known to play a significant role in predicting poor prognosis after acute myocardial infarction. Nonetheless, its potential for predicting long-term adverse outcomes following revascularization procedures remains unclear. This study aims to elucidate this relationship.
Methods: This prospective cohort study included 258 consecutive patients undergoing elective isolated coronary artery bypass grafting (CABG). All patients required ICU referral before hospital discharge. A 3-week cardiac rehabilitation program with 24-hour ECG Holter monitoring was planned for all patients. HRV was analyzed by computer and manually over-read. During a follow-up period ranging from 1 to 3 years, patients were contacted via phone to assess long-term outcomes, including death and major adverse cardiovascular events (MACE), such as myocardial infarction, reoperation, or brain stroke.
Results: Out of 258 patients (177 males and 81 females) with an average age of 58.80±9.60 years, 4.3% of patients died due to cardiovascular events, and 15.1% experienced long-term MACE. A comparison of HRV indicators between the non-surviving and surviving subgroups revealed significantly lower mean RR, mean standard deviation of normal-to-normal HRV interval (SDNN), and low and high-frequency values in the former group. However, when comparing HRV indicators between the subgroups with and without long-term MACE, no significant differences were observed. Cox proportional hazard analysis demonstrated that decreased HRV (SDNN) effectively predicted long-term mortality in patients who underwent CABG.
Conclusion: Lower postoperative HRV serves as a valuable predictor of long-term mortality after CABG in ICU patients, with reduced SDNN values particularly relevant for anticipating long-term adverse events.

Relationship between Color-Coded Anatomical M-Mode, Strain Imaging, and Tissue Doppler Imaging in Assessing Myocardial Asynchrony in Normal Subjects

2025-01-19T07:00:54+0330

Background: This study aimed to compare the time-to-peak systolic contraction time (Tc) by color-coded anatomical M-mode (AMM), the time-to-peak systolic strain (Tst) by strain rate imaging (SRI), and the time-to-peak systolic velocity (Ts) by tissue Doppler imaging (TDI) in the left (LV) and right (RV) ventricular segments of normal subjects. We also sought to determine the relationship between these methods for defining asynchrony indices in normal subjects.
Methods: Conventional echocardiography, color-coded AMM, SRI, and TDI were performed on 44 healthy adult volunteers (at the Tehran Heart Center and Shariati Hospital) to measure Tc, Tst, and Ts for 12 LV and 2 RV segments at mid and basal levels. Additionally, delays and standard deviations (SDs) were measured in all 12 LV segments.
Results: In the assessed segments, Tc by AMM and Tst by SRI were significantly greater than Ts by TDI (P<0.001). No significant differences were noted between Tc and Tst in 8 LV and 2 RV segments (P<0.05). For the septal basal segment, the respective values were Ts=170.43±36.76 ms, Tst=372.34±72.21 ms, and Tc=374.19±42.76 ms. A moderate correlation was observed between AMM and SRI in assessing asynchrony and SD for all LV segments, but no correlation existed between AMM and TDI.
Conclusion: Tc by AMM and Tst by SRI were significantly higher than Ts by TDI in the LV and RV segments. There was no correlation between AMM and TDI in defining asynchrony indices.

Evaluation of Ventricular Dyssynchrony Measured by Tissue Doppler Indices in Fetuses of Diabetic Mothers: A Case-Control Study

2025-01-19T07:00:59+0330

Background: This study aimed to evaluate the effects of overt maternal diabetes on fetal cardiac function.
Methods: In this case-control study, 26 pregnant women with overt diabetes (the case group) and 26 women with uncomplicated pregnancies (the control group) were examined using tissue Doppler echocardiography. Cardiac function was assessed twice in the fetal period (18–22 weeks and 28 weeks of gestation) and once in the neonatal period (1 week postnatal). Fetal cardiac function was assessed using early-diastolic maximum velocity index (Em), end-diastolic maximum velocity index (Am), Em/Am, left ventricular myocardial function index (LVMPI), and interventricular mechanical delay index (IVMDI).
Results: The case and control groups were not significantly different in maternal and gestational age in fetal Doppler evaluation. Em (P=0.007), Am (P<0.001), LVMPI (P=0.003), and IVMDI (P=0.026) were significantly higher in the case group than in the control group, while there was no significant difference in Em/Am (P=0.264). Eight fetuses (30.8%) of diabetic mothers had dyssynchrony, while no cases of dyssynchrony were seen in fetuses of non-diabetic mothers (P=0.004). Infants of diabetic mothers were 8.8 times more likely to develop adverse neonatal outcomes than infants of healthy mothers (RR: 8.8, 95% CI: 1.71 to 45.31, P=0.009).
Conclusion: The findings of the current study revealed significant cardiac dysfunction and dyssynchrony in fetuses of diabetic pregnant women. Additionally, IVMDI and LVMPI can be used to predict adverse neonatal outcomes in pregnancies complicated with overt diabetes.

Mixed Inferior Sinus Venosus and Secundum Atrial Septal Defects with Mixed Partial Anomalous Pulmonary and Systemic Venous Drainage: Key Insights and Practical Implications

2025-01-19T07:01:02+0330

Mixed atrial septal defects (ASDs) involving inferior vena cava (IVC)-type sinus venosus and secundum types and mixed partial anomalous pulmonary, systemic, and hepatic venous drainage are rare. We describe a 3-year-old acyanotic boy who presented with a large mixed inferior sinus venosus and secundum-type ASD. He exhibited an abnormal connection between the right upper pulmonary vein and the right atrium. Additionally, the IVC and a hepatic vein drained abnormally into the left atrium. The patient also had valvular and supravalvular pulmonary stenosis, as well as a small patent ductus arteriosus.
The ASD was surgically closed using a pericardial patch, positioned lower than usual to reroute the IVC and hepatic vein flow into the right atrium. The surgery was successful, with no residual lesions or complications. The patient recovered without issues and was discharged smoothly. At the 6-month follow-up, the child’s cardiac examination and oxygen saturation were normal. Furthermore, echocardiography confirmed normal drainage of the systemic and hepatic veins into the right atrium.

Computed Tomography Angiography Indications in the Follow-Up of Kawasaki Disease Patients

2025-01-19T07:01:06+0330

Kawasaki disease (KD), or mucocutaneous lymph node syndrome, is a vasculitis that primarily affects young children and results in coronary artery abnormalities. Echocardiography is the standard imaging modality for monitoring KD patients; however, this method does not detect some coronary artery anomalies. This case report demonstrates the significance of computed tomography (CT) angiography in identifying previously undiagnosed coronary abnormalities in a KD patient.
We herein describe a 7-year-old male who presented with symptoms consistent with KD and was treated subsequently with intravenous immune globulin (IVIG). Follow-up echocardiography showed no significant coronary artery abnormalities. Three years later, the patient presented with flu-like symptoms, and an ECG revealed anterolateral ischemic changes. Echocardiography showed normal coronary arteries. Nonetheless, a CT angiogram was performed due to the ischemic changes on ECG, and it identified a myocardial bridge in the left anterior descending artery, which had not been detected by echocardiography or ECG.
This case report emphasizes the importance of considering CT angiography as an adjunct imaging modality in the evaluation and follow-up of KD patients, particularly when echocardiographic findings are inconclusive or when clinical presentation raises concerns for potential coronary artery abnormalities. Further research is needed to establish evidence-based guidelines for the optimal timing and clinical indications for CT angiography in KD patients.

Unexplained Multi-Site Thrombosis: A Step-by-Step Strategy for Factor V Leiden Detection in a Hypercoagulable Patient

2025-01-19T07:01:14+0330

Thrombotic manifestations involve the development of blood clots within blood vessels. These conditions can occur unexpectedly in different areas and are often linked to life-threatening situations, presenting challenges for both diagnosis and treatment.
We present a case of multi-site thrombosis in a patient with a confirmed hypercoagulable state, resulting from a positive factor V Leiden mutation. The patient’s medical history included hypertension, chronic obstructive pulmonary disease, previous thrombotic events, and changes in anticoagulant therapy.
This case highlights the challenges associated with multisystem thrombosis and underscores the necessity of employing various diagnostic techniques, such as echocardiography, computed coronary angiography, and Doppler ultrasonography. In this instance, the patient presented with a history of unprovoked lower limb deep vein thrombosis and multiple arterial thromboses.
The patient’s treatment regimen comprised anticoagulants, antiplatelet drugs, and vasodilators. While a reduction in thrombus size was noted, complete revascularization could not be attained.
Effective diagnosis and treatment of venous and arterial thrombosis often require multimodal imaging. Selective blood test screening can be beneficial in diagnosing or detecting inherited or acquired abnormalities linked to thrombosis development.

A Systematic Review of Oxidative Stress Markers and Risk of Coronary Artery Calcification

2025-01-19T07:01:19+0330

Background: Early diagnosis of atherosclerosis, particularly in its subclinical phase, is crucial for reducing mortality and morbidity associated with cardiovascular diseases. This study aims to investigate the relationship between oxidative stress markers and coronary artery calcification (CAC), enhancing our understanding of the pathophysiology of CAC.
Methods: In October 2022, we conducted a systematic search of the Web of Science, Scopus, PubMed, and Embase databases without language or time restrictions, screening a total of 557 records. We excluded studies involving animals, in vitro experiments, reviews, case reports, clinical trials, editorials, and clinical guidelines. Eligible human observational studies (cohort and cross-sectional) that examined the link between CAC and oxidative stress markers were included. The Newcastle-Ottawa Scale was employed to assess the quality of the included studies.
Results: Our systematic review encompassed 40 studies, all of which included both male and female participants, predominantly using cross-sectional designs. Participants included individuals at low, intermediate, or high risk of coronary artery disease, patients with type 2 diabetes, those with existing cardiovascular disease, and asymptomatic individuals. The studies investigated various oxidative stress markers, including serum uric acid and 8-isoprostane, both of which showed strong correlations with CAC incidence and severity.
Conclusion: Oxidative stress markers may positively correlate with CAC scores, indicating a potential avenue for identifying individuals at heightened risk. This review underscores the need for further studies to facilitate early diagnosis of cardiovascular complications and the establishment of novel pharmacological targets.

Pay Heed and Proceed: Acute Ascending Aortic Dissection Presenting as Acute Left Main Coronary Artery Occlusion

2025-01-19T07:02:17+0330

Accelerated Idioventricular Rhythm: Not Always a Reperfusion Arrhythmia

2025-01-19T07:02:20+0330

Accelerated idioventricular rhythm (AIVR) is a relatively slow ventricular rhythm that often occurs during the reperfusion phase of an acute myocardial infarction. It is generally considered a benign rhythm that does not require treatment. However, we present a case where AIVR was the presenting arrhythmia in a 41-year-old man with acute coronary syndrome, suggesting it might not be as benign as previously reported in the literature. The patient, who presented to our institute, underwent urgent coronary evaluation followed by revascularization, leading to the conversion of AIVR to normal sinus rhythm and improvement in anginal symptoms.

Persistent Pacemaker Dependence after Takotsubo Recovery Suggests that Complete Heart Block is the Trigger of Takotsubo

2025-01-19T07:02:23+0330

No Abstract