Can brain natriuretic peptide predict cardiovascular complications in severe preeclampsia? A case-control study

Background: Preeclampsia is one of the most common pregnancy complications, which is one of the major causes of fetal and maternal mortality. Objective: To compare the serum Brain Natriuretic Peptide (BNP) level in patients with severe preeclampsia and normal pregnancy and investigate associated cardiovascular complications. Materials and Methods: This case-control study was performed on 94 women with a singleton pregnancy (severe preeclampsia and normal pregnancy) at Imam Reza Hospital in Mashhad, Iran. The venous blood samples were collected to evaluate the serum BNP level. All patients were subjected to echocardiography performed by a single cardiologist. Results: The mean pro-BNP levels were 480.36 ± 754.52 and 67.46 ± 106.24 pg/dL in the severe preeclampsia and normal pregnancy patients, respectively (p < 0.001). However, adjusted BNP for maternal and gestational age was not different in the two groups (ANCOVA, p = 0.69). Furthermore, the two study groups showed no significant difference in terms of the cardiac parameters, including ejection fraction (EF), left ventricle end-diastolic and -systolic diameters (LVEDD and LVESD, respectively), tricuspid annular plane systolic excursion (TAPSE), and ratio of the early transmitral flow velocity to the early diastolic tissue velocity (E/Em). However, the serum BNP level showed a significant correlation with EF (r = -0.39, p = 0.008), TAPSE (r = -0.47, p = 0.001), and E/Em ratio (r = 0.48, p = 0.001) in patients with severe preeclampsia. Conclusion: It seems that BNP can be used as a predictor for some of the main cardiac functional indices (i.e., E/Em, EF, and TAPSE) in severe preeclampsia patients. Key words: Brain natriuretic peptide, Echocardiography, Stroke volume, Preeclampsia, Pregnancy

A novel causative functional mutation in GATA6 gene is responsible for familial dilated cardiomyopathy as supported by in silico functional analysis

Funding Information: This study was supported by grants from the Mashhad University of Medical Sciences (Grant Number 980955). The authors thank the management of advanced computational centre, Khayyam Innovation Ecosystem, Mashhad, Iran for providing the facilities and encouragement to carry out this research work.Peer reviewedPublisher PD

Dark or Bright Half of the Moon: A Qualitative Study Exploring the Experience of Iranian Heart Failure Patients Regarding their Quality of Life

BACKGROUND: Heart failure (HF) is a major public health problem in different societies and has numerous impacts on quality of life (QOL). AIM: The present study was carried out with the aim to explore the experience of HF patients regarding the negative effects of the disease on their QOL. METHODS: In this qualitative exploratory study data collection was performed through face-to-face, semi-structured, in-depth interviews with 19 patients with HF, who were selected through purposive sampling method from April to September 2017. Data analysis was carried out based on the framework analysis method. RESULTS: The negative consequences of HF on QOL emerged in the form of 6 main themes including symptoms, disease complications, cognitive impairment, psychological distress, functional limitations and economic problems. Most of the participants (14 out of 19) assessed their QOL as well or very well. CONCLUSION: The majority of the patients in this study, despite the many negative impacts of HF, had a high QOL that could indicate their satisfaction and effective coping with HF by creating a positive outlook and the perceived positive effects of the disease

Peripartum cardiomyopathy (A literature review)

Heart failure (HF) is a serious and growing public health concern, which has many causes. Pregnancy is a critical condition with significant hemodynamic and immunologic changes. Peripartum cardiomyopathy (PPCM) is a disease of unknown cause in which left ventricular (LV) dysfunction occurs during the last trimester of pregnancy or the early puerperium. PPCM is known to be the most common cardiovascular cause of severe complications in pregnancy.  Risk factors for peripartum cardiomyopathy include advanced maternal age, twin pregnancy, smoking, pregnancy-related hypertension and preeclampsia, multiparity, African descent, and long-term tocolysis. Oxidative stress and some inflammatory markers have been diagnosed in PPCM pathophysiology. Recent observations have suggested that bromocriptine might favor recovery of LV systolic function in patients with PPCM. Patients developed peripartum cardiomiopathy treated with bromocriptine showed significantly improved LV ejection fraction and heart failure symptoms. This article tries to have a short review on this clinical scenario

Predictive Role of Diastolic Echocardiographic Findings in the Outcome of Heart Failure with Preserved Ejection Fraction

The main predictors of Heart Failure with preserved Ejection Fraction (HFpEF) are increased systolic blood pressure, atrial fibrillation, and female gender. Heart Failure (HF) with reduced Ejection Fraction (EF) is associated with prior myocardial infarction and left bundle-branch block QRS morphology. This study aimed to evaluate the effect of diastolic echocardiographic findings on the outcome of patients with HFpEF. This systematic review was conducted via searching in databases such as Cochrane Library and MEDLINE until September 2015, and articles with available abstracts published in English were included in the study. Manual search was performed within the reference lists of the articles. Moreover, two reviewers independently assessed the inclusion criteria, quality and extracted data of the selected articles. In total, four articles were evaluated in this systematic review, with the earliest study published in 2007 and the most recent article published in 2015. According to the results of this review, Doppler echocardiography plays a pivotal role in the assessment of diastolic left ventricular filling dynamics. However, this technique is restricted by the confounding effects of the changes in the heart rate and loading conditions

Incidental Finding of Cor Triatriatum Sinistrum in a Middle-Aged Man Candidated for Coronary Bypass Grafting (with three-D imaging)

Cor triatriatum sinistrum is a rare congenital cardiac malformation, accounting for about 0.1-0.4% of all congenital heart diseases and characterized by the presence of a fibromuscular membrane that subdivides the left atrium into two chambers in the classical form. While classic cor triatriatum in most patients can be observed during the neonatal period or early infancy, it is very rare in adults.We herein present an incidental finding of cor triatriatum sinistrum in a middle-aged man with coronary artery diseasescheduled for coronary artery bypass graft surgery. The patient was admitted for exertional dyspnea and chest pain of a three-month duration. He had a past medical history of mild hyperlipidemia and mild hypertension. Transthoracic two-D echocardiography (TTE) demonstrated a visible presence of a membranous band in the mid portion of the left atrium with obvious obstruction by color and Doppler flow measurements, confirmed by three-D echocardiography. Selective coronary angiography also revealed a severe ostioproximal stenosis of the left anterior descending artery of up to 99%.On-pump coronary artery bypass grafting was performed without complications, during which the anastomosis of the left internal mammary artery to the left anterior descending artery and the removal of the membrane were done

Barriers to participation in center-based cardiac rehabilitation programs and patients’ attitude toward home-based cardiac rehabilitation programs

Purpose: The mortality rate of cardiovascular diseases in such developing countries as Iran is on the rise. Despite sufficient evidence pointing to its efficacy, cardiac rehabilitation (CR) approach is only employed to a limited extent. In the present study, barriers to participation in center-based cardiac rehabilitation programs and patients’ attitude toward home-based cardiac rehabilitation model were examined. Methods: In this study, 204 eligible patients for CR visiting an academic hospital were examined during the first three months of 2017. Patients had either abandoned rehabilitation programs midway through or had not attended one in the first place. Data about perceived barriers were collected using the modified Cardiac Rehabilitation Barriers Scale. Also, Patients’ attitude toward home-based CR was collected using a pre-validated researcher-made questionnaire. Results: The results revealed that the most effective barriers were transportation problems (70%), travel costs (70%), considerable distance to the rehabilitation center (67%), and lack of insurance coverage for rehabilitation costs (64%), respectively. Patients with longer than 30-minute drive time were less likely to attend in training sessions in the center. In addition, the important patient expectations about home-based CR programs included: communication with specialists, training before entering the rehabilitation program, and making periodic visits to maintain motivation and adhere to the home-based CR programs. Conclusions: The results revealed that logistical factors were the major barriers to participation in rehabilitation programs. Alternative models such as home-based CR programs, positively evaluated by the participants, can be used to overcome these barriers

Evaluation of Coronary Arteries in Non-Ischemic Cardiomyopathies: A Case Report

Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is a congenital cardiac disease with myocardial involvement, most probably right ventricular (RV) dysfunction, accounting for 20% of sudden cardiac deaths. Characterized by the fibro-fatty infiltration of the RV free wall, ARVD/C presents in adolescents with ventricular arrhythmias and heart failure symptoms and as biventricular failure in adults. The coronary risk in these patients is not clear. We present an incidental finding: the left anterior descending artery cut-off in a middle-aged man with ARVD/C. He had been under treatment for heart failure symptoms, which had decompensated frequently commencing 6 months earlier, and therefore he was scheduled for stem cell injection. He had no chest pain or coronary artery disease risk factors. Two-dimensional transthoracic echocardiography demonstrated RV enlargement with moderate to severe dysfunction and left ventricular ejection fraction (LVEF) of 35-40%, which was 45-50% two years before. Selective coronary angiography performed 8 years previously was normal but a new one revealed the cut-off of the left anterior descending artery at the proximal portion, for which percutaneous coronary intervention was performed and showed no significant lesion in the other vessels. One should consider coronary artery disease in uncontrolled heart failure with LVEF reduction, even in the absence of typical chest pain. It may not be the natural course of the underlying disease

Prenatal and cardiovascular outcome in pregnant patients with dyspnea

Background: Pregnancy is a physiologic phenomenon in women, which leads to significant hemodynamic changes in cardiovascular system. Many patients reach reproductive age due to improvements in diagnosis and treatment of cardiac diseases. Dyspnea is a common complaint in pregnant women and can be a sign to refer patients for an easy and feasible workup such as echocardiography. Objectives: We aimed to evaluate dyspnea as a common complaint in pregnant women and its prenatal outcome. Patients and Methods: Pregnant patients with dyspnea NYHA class > II were included. A thorough physical examination and routine lab tests were performed. Echocardiography was performed to rule out previous cardiac and lung diseases, anemia and thyroid disorders. It was repeated monthly till one month after delivery. Collected data was analyzed after one year. Results: Fifty patients were enrolled with a mean age of 30.49 ± 6.34 years. 58% of them, had NYHA class II, 40% III and 2% IV. Pulmonary rales were diagnosed in 8% and palpitation in 80%, while all had normal lab tests. Mean EF value was 52.26 ± 6.80; 54% had valvular diseases and 12% had pulmonary hypertension. Cesarean section was performed in 26, preeclampsia occurred in 7 and 21 had preterm labor. Three neonates had anomalies and six had an Apgar score below six. Mean birth weight was 2897 ± 540.00 grams. A significant association was found between NYHA Class with valvular disease (P = 0.007) and sys PAP (P = 0.036); however, it had an inverse correlation with LV EF (P = 0.06). Conclusions: Dyspnea may coincide with cardiac dysfunction and poor prenatal outcome in pregnant patients. In such cases echocardiography is a feasible screening tool

Correlation of echocardiographic findings of pulmonary hypertension with six-minute walk test and plasma pro b-type natriuretic peptide level in systemic lupus erythematous

Introduction: Pulmonary arterial hypertension (PAH) is an increasingly recognized complication of systemic lupus erythematous (SLE), which may remain undiagnosed if asymptomatic. Objective: This study aimed to determine the correlation between echocardiographic findings of PAH and six- minute walk test (6WMT) and serum pro b-type natriuretic peptide (proBNP) level in patients with SLE. Methods: This cross-sectional study was performed on 50 SLE patients selected from patients referring to the outpatient’s department of the Rheumatology Clinic at Imam Reza Hospital in Mashhad, Iran, from July 2013 through September 2014, using resting transthoracic echocardiography to estimate systolic pulmonary artery pressure (sPAP). Variables were summarized as counts and/or percentages or as mean±SD. Inter-group comparisons were made performing two-tailed Fisher’s exact test or Mann–Whitney U test, using SPSS 22. Results: In general, five out of fifty patients were diagnosed to have PAH with sPAP>30 mmHg (range: 31-40 mmHg) based on echocardiographic findings. Spirometric parameters did not show any differences between the two groups (p>0.05), while the difference in total distance walked during six minutes and serum proBNP level between SLE patients with and without PAH was significant (P<0.05). A high correlation was found between PAP and serum proBNP level, but not between PAP and the distance walked during six-minutes in SLE patients. Conclusion: The point prevalence of PAH in SLE patients was 10%; the significant correlation between PAP and serum proBNP level suggests that it can be used as a valuable marker for early diagnosis of asymptomatic pulmonary hypertension in patients with SLE