Background

Cardiovascular diseases are one of the most dreaded ailments in both the developing and developed nations. Their morbidity, mortality and economic toll is unparalleled. The importance of primary prevention of these diseases, in the form of lifestyle modification remains the most favored approach to reduce the disease burden and the same has been echoed by most of the recent guidelines. Herein lies the role of yoga.

Main body

Yoga is an ancient practice dating back thousands of years, with its origin in the Harrapan and Mohenjo-Daro civilizations. It has many physical and spiritual aspects. Hatha yoga which comprises of physical movements and breathing techniques is commonly practiced nowadays. The usefulness and health benefits of yoga have recently come to the fore, and are a subject of ongoing research, even in the Western world. Yoga has been shown to be beneficial in both primary and secondary prevention of diseases, especially cardiovascular diseases, and their risk factors. Our study aims to review the physiology of yoga, the recent studies on its effect on prevention and control of cardiovascular diseases, and the clinical implications of the same.

Conclusions

Emerging evidence points to the significant positive alterations of yoga at the physiological and neurohormonal level leading to overall improvement in health. At a time when the world is focussing on the importance of lifestyle modifications and looking for ways to reduce the pill-burden and polypharmacy, yoga seems to provide a compelling solution. In our review, we bring together an amalgamated evidence surrounding yoga and discuss approaches for its incorporation in real-world setting. Most of the recent evidence surrounding yoga has been included here and our interpretation and conclusions discussed.

ABSTRACT

Background: Maintenance of an optimal mean arterial pressure (MAP) is vital for cerebral blood flow and the overall health of the patients undergoing coronary artery bypass graft (CABG). This study investigated the impact of low MAP on cerebral blood flow and in-hospital clinical outcomes in CABG candidates at our hospital.

Methods: We compared a convenient sample of 55 patients with low MAP (55 mm Hg) and 54 patients with MAP (75 mm Hg) who underwent CABG at Tehran Heart Center in 2023. We recorded the patients' demographic and clinical characteristics of patients by measuring cerebral oximeter reading and lactate levels pre- and post-operation. We then compared the baseline and postoperative characteristics between the two groups and determined the impact of MAP on their postoperative changes.

Results: The groups were statistically similar at baseline, except for a lower pH in the low MAP (55 mm Hg) group (P=0.016). The preoperative and postoperative measurements (including lactate levels and cerebral oximeter reading) did not differ between the two groups. However, the heart rate was significantly higher in the MAP (75 mm Hg) group (P=0.034). The adjusted effect of baseline MAP on selected postoperative characteristics showed that it can significantly but inversely influence heart rate (beta coefficient=-5.952; P=0.017) and has a borderline effect on troponin (beta coefficient=1.734; P=0.051) and HCO3 (beta coefficient= 0.785; P=0.062).

Conclusion: The MAP did not influence clinical outcomes in our study. However, maintaining an optimal MAP is essential for preventing cerebral injury and ensuring adequate cerebral oxygenation in CABG patients CABG.

Background: Noninvasive estimation of elevated left ventricular end-diastolic pressure (LVEDP) is a necessary step in evaluating left ventricular diastolic dysfunction (LVDD). Most echocardiographic parameters used for this purpose have limitations. Left atrial (LA) strain was recently found useful for noninvasive estimation of LVEDP. Therefore, this study aimed to investigate the correlations between LA deformation parameters assessed by speckle-tracking echocardiography (STE) and invasively obtained LVEDP.

Methods: This study was prospectively performed on 82 patients in sinus rhythm who underwent left heart catheterization at our center. All the patients underwent complete transthoracic echocardiography and peak atrial longitudinal strain (PALS) evaluation by STE within 12 hours before catheterization.

Results: LVEDP was elevated in 45 patients (54.9%) and normal in 37 (45.1%). PALS, LA ejection fraction, and septal E’ had moderate inverse correlations with LVEDP (r= −0.590, P=0.001, r= −0.463, P=0.001, and r= −0.449, P=0.001, respectively). The E/E` ratio also had a moderate correlation with LVEDP (r= 0.567, P=0.001). Lateral E’ and the E/A ratio demonstrated a rather weak inverse correlation with LVEDP (r= −0.231, P=0.037 and r= −0.229, P=0.038, respectively). In multivariate logistic regression, age (OR, 1.14; 95% CI, 1.02 to 1.27), PALS (OR, 0.77; 95% CI, 0.65 to 0.91), and the E/E` ratio (OR, 1.36; 95% CI, 1.11 to 1.89) were independent predictors of an LVEDP≥12 mm Hg. PALS demonstrated the highest diagnostic accuracy 0.849 (0.764–0.935, P<0.001) to predict an LVEDP≥12 mm Hg. A cutoff of 35% had sensitivity =81.1%, and specificity =81.4% for prediction of increased LVEDP.

Conclusions: PALS proved to be a suitable noninvasive parameter to predict elevated LVEDP. It can potentially be used as a measure for earlier identification of LVDD.

Background: This study aimed to assess and compare the hemodynamic responses to propofol, etomidate, and midazolam following the induction of anesthesia and intubation in patients undergoing coronary artery bypass graft (CABG) surgery.

Materials and Methods: A double-blind randomized clinical trial was conducted involving 90 patients with coronary artery disease. These patients were randomly assigned to one of three groups receiving either propofol (1.5 mg/kg), etomidate (0.2 mg/kg), or midazolam (0.15 mg/kg). Hemodynamic variables, including systolic and diastolic blood pressure (SBP and DBP), mean arterial blood pressure (MABP), and heart rate (HR), were measured at baseline, before intubation, and one and five minutes after intubation.

Results: HR, SBP, DBP, and MABP all exhibited significant decreases in all three groups after induction and during intubation. The etomidate group demonstrated the least extent of change in SBP (P<0.001), MABP (P<0.001), and DBP (P=0.056), followed by the midazolam group. As for HR, the least change was observed in the midazolam group, followed by the propofol group (P=0.688). Following intubation, blood pressure increased almost equally in the etomidate and midazolam groups compared to during intubation. In contrast, the propofol group exhibited a downward trend in blood pressure post-intubation, a significant difference across all three groups. The propofol group also required additional drugs to manage hemodynamic changes to a greater extent, which was statistically significant.

Conclusion: This study, conducted on candidates for coronary artery surgery, demonstrated that the induction of anesthesia with etomidate and midazolam resulted in less variation in hemodynamic variables compared to propofol.

Background:  During the last decade, the consumption of dairy products in Iranian households has decreased. The purpose of this study was to determine the population attributable risk of dairy products to common non-communicable diseases.

Methods: This cross-sectional-analytical study was conducted on 628 adults over 18 years old in Hamadan city in 2021. The clusters were selected based on comprehensive urban health centers. The standardized Iranian version of the food frequency questionnaire was used. To categorize participants, we used three levels of dairy product consumption: no consumption, less than one serving per day, 1-2 servings per day and >2 servings per day.

Results: The participation rate was 89%. The mean (standard deviation) of age was 38.05 (12.54) and 42.36% of participants were male. Forty-nine percent of people mentioned insufficient consumption of dairy products. Cheese (54.5%), yogurt (39.7%), and milk (30.4%) had the highest frequency of daily consumption. Women had a higher consumption of dairy products than men (56% vs. 44%, P=0.037). People with university education had a higher probability of dairy product consumption (OR=2.61, P=0.140).

Conclusions: The prevalence of insufficient consumption of dairy products was 48.6%, which is higher compared to previous studies.  Insufficient consumption of dairy products was the explainer of hypertension (9.26%), cardiovascular (5.55%), and (5.07%) osteoporosis.

Background: Numerous people are diagnosed with heart failure (HF) or die from it. One of the most effective HF treatments is hAMSCs-CM therapy. For the first time, we used an animal model of heart failure to perform an experiment to determine the hAMSCs-CM's method of action, focusing on TGF-β/Galactin-3, MCP1, BNP, and Ald.

Methods: Using the categories of Control, HF, Culture Medium, and Conditioned Medium (CM), 40 rats were divided into 4 groups. All rats other than the control received an injection of isoproterenol (ISO). Rats given CM received CM, and rats given culture medium received culture media. Then, an ELISA was used to measure the serum fibrotic factors.

Results: hAMSCs-CM treatment dramatically reduced all variables in HF rats when compared to HF and culture media, while increasing them significantly in controls. Conclusion: Because hAMSCs-CM modified inflammatory and fibrogenic cytokines such as TGF-β/Galactin-3, MCP1, BNP, and Ald in ISO-stimulated HF male rats, our findings partially addressed the gap in HF therapy.

study was aimed to assess the possible changes in heart stiffing due to dilated cardiomyopathy and causes of severity in pediatric population.

Methods

Forty-eight children who had DCM and 96 healthy children were the subjects of this case-control study. The patients had an echocardiography determination of enlarged cardiomyopathy and healthy children were chosen randomly from the individuals who had alluded to the cardiac clinic for yearly examination. M-mode echocardiography was used to measure the ascending aorta's systolic and diastolic diameters, and modified Ross classification was used to classify heart failure. The Statistical Package for the Social Sciences, version 18 (SPSS, Chicago, USA), was used for statistical analysis. The level of statistical significance was set at p less than 0.05.

Results

 Of children 48 had DCM and 96 were healthy, were matched in gender (X²=0.014, p=0.905).  The parameters of EF (P<0.001), FS (P<0.001), IVSD (P<0.001), PWD (P<0.001), PWS (P<0.001), LVMI (P<0.001), RWT (P=0.009), AS (p=0.014). AD (p=0.004), ASBI (p=0.001) and PSEM (p=0.004) were different in groups significantly. After treatment, based on the EF and FS cutoffs none of elasticity parameters changed except ASβI that changed by ROSS classification.

Conclusion

Concluded that AS, AD decreased when ASBI and PSEM were increased in DCM children. EF, FS status and ROSS classifications were improved after treatment. The elasticity parameters preserved their status based on status of EF, FS and ROSS except ASβI that increased by changes in ROSS classification.

Background: Sarcopenia is a predictor of mortality in multiple conditions but the potential prognostic value of indices of sarcopenia in pulmonary hypertension (PH) is not clarified. The aim of this study was to determine if there is an association between CT scan-measured pectoralis muscle area (PMA) and density (PMD) and adverse clinical outcomes in patients with PH.

Methods: Medical records of PH patients (clinical class I and IV) referred from March 2016 to March 2021 were retrospectively screened. CT scan-measured PMA and PMD were compared between survivors and non-survivors in addition to blood biomarkers and right heart catheterization variables. A binary logistic regression analysis was performed to determine the potential predictors of mortality.

Results: A total of 45 patients with PH (34 patients in survivor and 11 in non-survivor group) were included for data analysis. PMA was not significantly different between the two groups (p=0.12) whereas difference of PMD measures was weakly significant between survivors and non survivors (survivor: 45 (25.8-51.3), non-survivors: 31 (23-36); p=0.06)). In logistic regression analysis, none of the sarcopenia indices could predict mortality (p>0.05), although phosphodiesterase-5 (PDE-5) inhibitors, right atrial pressure (RAP), and systemic arterial oxygen saturation could serve as potential predictors (p<0.05).

Conclusion: Although CT scan-measured area and density of pectoralis muscle showed a weak correlation with prognosis of PH, there is a possibility that these factors could serve as potential markers for mortality in patients with idiopathic and chronic thromboembolic PH. Further confirmation is required through future studies with larger sample sizes.

Various electrocardiography (ECG) patterns can determine the location of occluded coronary artery and the size of threatened myocardium. The reported positive predictive value for “de Winter ECG pattern” in predicting acute left anterior descending artery occlusion is inconsistent. In addition, ST depression morphology and other ECG findings may have different severity and prognostic significance. This case illustrates the integration between other ECG findings, such as ST elevation, Q waves, and R/S, and the location of the de Winter pattern on the different ECG leads in predicting the culprit artery and assessing the anatomic extent of myocardial ischemia.

The concurrent presence of coarctation of the aorta, Ebstein's anomaly, and transposition of the great arteries is extremely rare. We report a unique case of complex congenital heart disease presenting with respiratory distress and cyanosis at birth. Echocardiography revealed congenitally corrected transposition of the great arteries (ccTGA), Ebstein's tricuspid anomaly, moderate to severe tricuspid regurgitation (TR), a small muscular ventricular septal defect (VSD) and an abnormal left arch with severe coarctation of the aorta (CoA). Because of unstable hemodynamic status, balloon angioplasty was performed for the patient. Long-term clinical follow-up confirmed the effectiveness of this intervention.

Brugada phenocopy is considered when Brugada-type ECG pattern is present, but with a

low probability of true Brugada syndrome indicated by negative family history, genetic

testing or provocative testing with drugs or normalization of ECG after removal of

precipitant. Brugada phenocopies are reported due to various causes like fever, electrolyte

imbalance etc. We report a case of aluminium phosphide poisoning who developed Brugada

phenocopy as a rare manifestation of associated toxic myocarditis.

After 3 years since the start of the COVID-19 pandemic, the World Health Organization declares end to COVID-19 global public health emergency in May 2023. Due to the hypercoagulable state of this disease, many studies have been conducted on the role of prophylactic or therapeutic anticoagulants in reducing mortality and occurrence of thromboembolic events. Despite numerous studies, optimal anticoagulant strategies in noncritically ill patients hospitalized with COVID-19 remains unknown.

Background and Objective: One way for preventing cardiovascular problems is the use of mobile health applications through creating an improvement in flexible risk factors. The current study aimed to find out the progress and efficiency of a pedagogic mobile app using an integrated change model to avoid risk factors of atherosclerotic cardiovascular disease (ASCVD) from average to high scores among individuals between 20-69 years old.

Methods: This study is a parallel, randomized, and single-blind medical trial conducted on 430 individuals employing the randomized blocks technique. The participants were divided into two groups: a control group (normal clinical activity) and an intervention group (normal clinical activity along with app-based education) for about 6 months.

 Discussion: This application was designed to enhance motivation, consciousness, and obtrusive habits in diminishing risk factors in individuals with an increased threat of ASCVD. Hence, the obtained results can enhance cardiovascular health knowledge, control biological risk factors, and change cardiac behaviors according to phone applications. In the case that its efficacy is verified, this app can be applied in the controlling plans of the National CVD.