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Original Article(s)

  • XML | views: 164 | pages:

    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: In a cross-sectional study, medical records of PH patients (clinical class I and IV) referred to Rajaie Cardiovascular Center 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=0.124) whereas difference of PMD measures was weakly significant between survivors and non survivors (survivor: 45 HU (25.8-51.3), non-survivors: 31 HU (23-36); p=0.062)). 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.

  • XML | views: 66 | pages:

    Background: Adopting healthy nutritional behavior in patients with Heart Failure (HF) can play a crucial role in controlling symptoms of the disease. To develop effective interventions, it is recommended to recognize significant determinants of nutritional behavior based on theoretical frameworks in behavioral sciences and utilize valid instruments. The aim of this study was to develop and validate measurement tools for assessing the determinants of nutritional behavior among patients with HF based on the Theory of Planned Behavior (TPB) variables.

    Methods: In this psychometrics study, a preliminary instrument based on the TPB with five subscales was created. Additionally, an instrument for measuring the nutritional behavior of HF patients was developed. The face validity and content validity of the instruments were assessed using both quantitative and qualitative methods. The factor structure of the instrument for assessing TPB variables was examined through Exploratory Factor Analysis (EFA) using a sample of 330 patients with HF. Furthermore, the reliability of the instruments was evaluated.

    Results: In the stages of face validity and content validity assessment, 13 items were removed from the TBP instrument, and 14 items were modified in the two instruments. The EFA revealed that the 12 items of the TPB variables could be classified into 4 subscales, namely behavioral intention, attitude, and perceived behavioral control. The results of the EFA indicated that the Kaiser-Meyer-Olkin and Bartlett’s test of sphericity of the instrument were acceptable. These factors accounted for 87.03% of the variance. The TPB instrument subscales demonstrated acceptable levels of reliability, as indicated by Cronbach's alpha. Both instruments had acceptable levels of intraclass correlation coefficient.

    Conclusions: The results showed that the developed instruments were two valid and reliable tools for assessing the determinants of adopting nutritional behavior among patients with HF, utilizing TPB variables. These instruments can be used in conducting needs assessments and developing education intervention efforts for patients with HF.

  • XML | views: 125 | pages:

    Background: A sinus venous atrial septal defect (SVASD) is a type of congenital heart defect that predominantly involves an opening between the Superior Vena Cava (SVC) and the Right Upper Pulmonary Vein (RUPV). Surgical closure of SVASD has been the standard treatment; however, the surgical closure of SVASD is far more complex than mere ASD secundum reconstruction, and complications are more likely. Transcatheter closure of SVASD is an emerging alternative for surgical repair.

    Methods: We report five cases of successful transcatheter closure of SVASD and one case of failure that required surgical intervention. All patients underwent pre-procedure Computed Tomography Angiography (CTA) to determine the size and location of the defect and the optimal stent size and position. The SVC stenting was performed using balloon-expandable stents, followed by RUPV angioplasty if needed.

    Results:  Final angiograms and pressure measurements in the SVC, RUPV, and Right Atrium (RA) confirmed the absence of residual shunt and pulmonary venous obstruction. One patient experienced stent migration to the pulmonary artery, which necessitated surgical retrieval and defect closure.

    Conclusion: The balloon expansion test is not mandatory before stent implantation, as in the case of RUPV obstruction, its flow could be reestablished by ballooning and/or stent implantation within the RUPV with a mild residual shunt which might resolve spontaneously.

  • XML | views: 129 | pages:

    Background and objectives: Atrial Fibrillation (AF) is the most prevalent persistent arrhythmia with a great burden on people’s health and society. Due to associations between psychological factors and AF in previous studies, this study was conducted to investigate the association between perceived stress and arrhythmia.

    Methods: In this case-control study, participants were recruited from the outpatient clinic of Rajaie Cardiovascular, Medical and Research Center in Tehran, Iran, between May 2021 and September 2021 based on eligible criteria. Data were collected through face-to-face interviews by trained research nurses using the appropriate checklists. The stress level of participants was evaluated using the Perceived Stress Scale (PSS). Data were analyzed by Chi-square, independent T-test, and logistic regression model in SPSS 16.

    Results: One hundred fifty-five cases with arrhythmia and 144 controls were recruited for this study. The mean score of the perceived stress was 30.6 in cases and 25.07 in controls (P< 0.001). Stress-related symptoms including palpitation and chest discomfort were more common in patients with arrhythmia than healthy controls (P = 0.015 and P< 0.001 respectively). The risk of arrhythmia was independently associated with sex, diabetes mellitus, dyslipidemia, hypothyroidism, cardiomyopathy, concentration difficulty, chest discomfort, and stress score in the multivariate logistic regression model.

    Interpretation and conclusions: The results of this study demonstrate that AF arrhythmia is strongly associated with psychological stress and higher perceived stress scores. Interventions targeting reducing stress in those who are at high risk of developing AF are beneficial.

Case Report(s)