Dilated cardiomyopathy as a rare presentation of the pulmonary sequestration: A case report with aberrant vessel from aorta to left lower pulmonary lobe

Late onset non-ischemic cardiomyopathy is a rare manifestation of the presence of aberrant vessel from descending thoracic aorta to left lower lobe of lung. This congenital anomaly is associated with pulmonary sequestration. Our case was a 23-year-old male who was under observation since the age of 19 years for evaluation of shortness of breath, functional class II. He had history of professional athletic training and he denied consumption of any compound. Ejection fraction had deteriorated during three years from 45�50 to 40 and left ventricular size increased from normal size to mild enlargement. Cardiac computed tomography showed presence of aberrant artery from descending aorta to left lower pulmonary lobe with pulmonary sequestration. His cardiac function improved after successful coil embolization of aberrant vessel. In conclusion, pulmonary sequestration and aberrant pulmonary supply from aorta should be considered as a rare cause of dilated cardiomyopathy which can be reversible by proper intervention. © 2019 Japanese College of Cardiolog

The predictors of no-reflow phenomenon after primary angioplasty for acute myocardial infarction

Background: No-reflow phenomenon is a serious complication of primary Percutaneous Coronary Intervention (PCI), which may increase the risk of progressive myocardial damage, profound left ventricular dysfunction, and death. Objectives: This study aimed to investigate the incidence of no-reflow phenomenon and its clinical, para-clinical, and angiographic determinants in patients who underwent primary PCI for ST Elevation Myocardial Infarction (STEMI). Patients and Methods: This non-randomized prospective cohort study was conducted on 397 patients in a cardiovascular tertiary care center in Tehran, Iran from April 2012 to April 2014. The inclusion criteria of the study were presenting with acute STEMI of � 12 h duration or having admitted between 12 and 24 hours after onset with symptoms and signs of ongoing ischemia. The participants underwent standard coronary angiography. No-reflow phenomenon was defined as a Thrombolysis In Myocardial Infarction (TIMI) flow � 2 and no presence of spasm, distal embolization, or dissection after completion of the procedure. The association between no-reflow and its determinants was assessed by chi-square, student�s t-test, or Mann�Whitney U test. Logistic regression models were also used for multivariate analysis. P values < 0.05 were considered to be statistically significant. Results: The participants� mean (SD) age was of 59 (12.2) years and female/male ratio was 83/314. The incidence of no-reflow phenomenon was 63 (15.9). Besides, the results of multivariate analysis showed that only thrombus burden, lesion length, time to reperfusion, and type of occlusion had an adjusted association with this phenomenon. Conclusions: The study results suggested that no-reflow phenomenon after primary PCI would be predictable. Thus, preventive measures, such as using distal protective devices or administration of platelet glycoprotein IIb/IIIa antagonists, are advised to be used in high-risk patients. © 2016, Iranian Cardiovascular Research Journal. All rights reserved

Comparison of prevalence of metabolic syndrome between idiopathic and secondary deep vein thrombosis

Background- The association of the metabolic syndrome with idiopathic or secondary deep vein thrombosis (DVT) remains uncertain. In addition, the relevance of the different features of the metabolic syndrome as an independent or pivotal risk factor for DVT is controversial. We aimed to evaluate the prevalence of the metabolic syndrome in patients with idiopathic or secondary DVT and also compare the prevalence of the different components of this syndrome in the two clinical etiological conditions of DVT. Methods- In a cross-sectional study, 115 consecutive patients with a recent objective diagnosis of DVT (idiopathic in 87 patients and secondary to a known risk factor in 28 patients) who were referred to Rajaei Heart Center between April 2009 and January 2010 were enrolled in the study. In all the patients, DVT was diagnosed by means of compression Doppler ultrasonography. The metabolic syndrome was defined according to the ATP III recommendations. Results- Overall prevalence of the metabolic syndrome in the study participants was 9.6, and the prevalence of the metabolic syndrome in patients with idiopathic or secondary DVT was 9.2 and 10.7, respectively, which was not different between them. Relative to the presence of the different numbers of the metabolic syndrome features, no difference was found between the groups with idiopathic or secondary DVT. The presence of no feature was found in 6.9 and 7.1, the presence of one feature was seen in 51.7 and 42.9, and the presence of two features was found in 32.2 and 39.3, respectively. Conclusion- Regardless of the etiology of DVT, the overall prevalence of the metabolic syndrome in our DVT subjects ranged from 9.2 to 10.7, and this prevalence was independent of the etiology (idiopathic or secondary) of DVT

Systems Analysis Implicates WAVE2&nbsp;Complex in the Pathogenesis of&nbsp;Developmental Left-Sided Obstructive&nbsp;Heart Defects.

Genetic variants are the primary driver of congenital heart disease (CHD) pathogenesis. However, our ability to identify causative variants is limited. To identify causal CHD genes that are associated with specific molecular functions, the study used prior knowledge to filter de novo variants from 2,881 probands with sporadic severe CHD. This approach enabled the authors to identify an association between left ventricular outflow tract obstruction lesions and genes associated with the WAVE2 complex and regulation of small GTPase-mediated signal transduction. Using CRISPR zebrafish knockdowns, the study confirmed that WAVE2 complex proteins brk1, nckap1, and wasf2 and the regulators of small GTPase signaling cul3a and racgap1 are critical to cardiac development

Correction to: Clopidogrel Pharmacogenetics in Iranian Patients Undergoing Percutaneous Coronary Intervention (Cardiovascular Toxicology, (2018), 10.1007/s12012-018-9459-x)

The original version of this article unfortunately contained a typo in the co-author name. © 2018, Springer Science+Business Media, LLC, part of Springer Nature

The incidence of arthropathy adverse events in efalizumab-treated patients is low and similar to placebo and does not increase with long-term treatment: pooled analysis of data from Phase III clinical trials of efalizumab

A large-scale, pooled analysis of safety data from five Phase III clinical trials (including open-label extensions of two of these studies) and two Phase III open-label clinical trials of efalizumab was conducted to explore whether arthropathy adverse events (AEs) were associated with efalizumab treatment in patients with moderate-to-severe chronic plaque psoriasis. Data from patients who received subcutaneous injections of efalizumab or placebo were stratified for analysis into phases according to the nature and duration of treatment. These included: the ‘first treatment’ phase (0–12-week data from patients who received either efalizumab, 1 mg/kg once weekly, or placebo in the five placebo-controlled studies); the ‘extended treatment’ phase (13–24-week data from seven trials for all efalizumab-treated patients); and the ‘long-term treatment’ phase (data from efalizumab-treated patients who received treatment for up to 36 months in two long-term trials). Descriptive statistics were performed and the incidence of arthropathy AEs per patient-year was calculated using 95% confidence intervals (CIs). During the first treatment phase, a similar proportion of patients had an arthropathy AE in the efalizumab group (3.3%; 58/1740 patients) compared with the placebo group (3.5%; 34/979 patients); the incidence of arthropathy AEs per patient-year was 0.15 in the efalizumab group (95% CI 0.11–0.19) and 0.16 in the placebo group (95% CI 0.11–0.22). Analysis of first treatment phase data from one study (n = 793) showed that the incidence of psoriatic arthropathy per patient-year was lower in efalizumab-treated patients (0.10; 95% CI 0.05–0.18) than in those given placebo (0.17; 95% CI 0.08–0.30). During the extended treatment phase, the incidence of arthropathy remained low (0.17; 95% CI 0.14–0.22). Data from two long-term studies showed that there was no increase in the incidence of arthropathy AEs over time in patients treated with efalizumab for up to 36 months. Patients who had an arthropathy AE during treatment with efalizumab appeared to be more likely to have a history of arthropathy prior to treatment. Efalizumab does not appear to increase the risk of arthropathy AEs compared with placebo

Intravascular Ultrasound for Assessment of Residual Coarctation of the Aorta after Balloon Angioplasty in Infants

Intravascular ultrasound (IVUS) has been introduced as an accurate and minimally invasive diagnostic technique for the assessment of vascular anatomy and its abnormalities. We believe that IVUS can be used for clarifying the reasons for failure of balloon angiography in infantile coarctation of the aorta (CoA), because post-balloon angioplasty tearing, intimal flap, thrombosis and pseudoaneurysm of the aorta can be evaluated by IVUS with greater sensitivity and specificity. We aimed to assess the outcome of balloon angioplasty of CoA using angiography as the gold standard and IVUS as a new method in infants, comparing the two techniques for the evaluation of the diameter and area of CoA segment pre- and post-procedure. This cross-sectional study was performed on 18 infants hospitalized with a final diagnosis of CoA. All the infants underwent angiography and were also assessed by IVUS to measure the preoperative and postoperative diameter of the narrow segment in the two anterior�posterior and lateral views. In assessment by IVUS, the mean diameter of the coarctation site increased from 2.10 ± 0.30 mm to 4.50 ± 0.94 mm (P &lt; 0.001). Similarly, the average minimum area of the coarctation level increased from 5.26 ± 1.50 mm2 to 13.77 ± 3.48 mm2 after angioplasty (P &lt; 0.001). Comparing these findings, angiography and IVUS showed a high level of agreement. In the assessment of a dissection flap, there was a high level of agreement between angioplasty and IVUS before the procedure, but IVUS had higher accuracy after the procedure. Our study showed that IVUS was more reliable than angiography in the assessment of residual coarctation. IVUS yielded high sensitivity (58.3) and specificity (100) for discriminating the presence and absence of residual coarctation as well as the need for repeating the procedure. The assessment of coarctation before and after angioplasty procedures in children is possible using the IVUS method, with high accuracy. IVUS can offer greater accuracy than angiography in the evaluation of the coarctation area, detecting tears, dissection and flaps, and assessment of residual coarctation. © 2021, Springer Science+Business Media, LLC, part of Springer Nature

Intravascular Ultrasound for Assessment of Residual Coarctation of the Aorta after Balloon Angioplasty in Infants

Intravascular ultrasound (IVUS) has been introduced as an accurate and minimally invasive diagnostic technique for the assessment of vascular anatomy and its abnormalities. We believe that IVUS can be used for clarifying the reasons for failure of balloon angiography in infantile coarctation of the aorta (CoA), because post-balloon angioplasty tearing, intimal flap, thrombosis and pseudoaneurysm of the aorta can be evaluated by IVUS with greater sensitivity and specificity. We aimed to assess the outcome of balloon angioplasty of CoA using angiography as the gold standard and IVUS as a new method in infants, comparing the two techniques for the evaluation of the diameter and area of CoA segment pre- and post-procedure. This cross-sectional study was performed on 18 infants hospitalized with a final diagnosis of CoA. All the infants underwent angiography and were also assessed by IVUS to measure the preoperative and postoperative diameter of the narrow segment in the two anterior�posterior and lateral views. In assessment by IVUS, the mean diameter of the coarctation site increased from 2.10 ± 0.30 mm to 4.50 ± 0.94 mm (P &lt; 0.001). Similarly, the average minimum area of the coarctation level increased from 5.26 ± 1.50 mm2 to 13.77 ± 3.48 mm2 after angioplasty (P &lt; 0.001). Comparing these findings, angiography and IVUS showed a high level of agreement. In the assessment of a dissection flap, there was a high level of agreement between angioplasty and IVUS before the procedure, but IVUS had higher accuracy after the procedure. Our study showed that IVUS was more reliable than angiography in the assessment of residual coarctation. IVUS yielded high sensitivity (58.3) and specificity (100) for discriminating the presence and absence of residual coarctation as well as the need for repeating the procedure. The assessment of coarctation before and after angioplasty procedures in children is possible using the IVUS method, with high accuracy. IVUS can offer greater accuracy than angiography in the evaluation of the coarctation area, detecting tears, dissection and flaps, and assessment of residual coarctation. © 2021, Springer Science+Business Media, LLC, part of Springer Nature

Outcomes of chronic total occlusion percutaneous coronary intervention from the RAIAN (RAjaie - Iran) registry

Objective: While most of the evidence in CTO interventions emerge from Western and Japanese studies, few data have been published up today from the Middle East. Objective of this study was to evaluate technical success rates and clinical outcomes of an Iranian population undergoing CTO PCI in a tertiary referral hospital. Moreover, we sought to evaluate the efficacy of our CTO teaching program. Methods: This is a retrospective single-center cohort study including 790 patients who underwent CTO PCI performed by operators with different volumes of CTOs PCI performed per year. According to PCI result, all patients have been divided into successful (n&nbsp;=&nbsp;555, 70.3&nbsp;%) and unsuccessful (n&nbsp;=&nbsp;235, 29.7&nbsp;%) groups. Study endpoints were Major Adverse Cardiovascular Events and Health Status Improvement evaluated using the Seattle Angina Questionnaire at one year. Results: A global success rate of 70&nbsp;% for antegrade and 80&nbsp;% for retrograde approach was shown despite the lack of some CTO-dedicated devices. During the enrollment period, the success rate increased significantly among operators with a lower number of CTO procedures per year. One-year MACE rate was similar in both successful and unsuccessful groups (13.5&nbsp;% in successful and 10.6&nbsp;% in unsuccessful group, p&nbsp;=&nbsp;0.173). One year patients' health status improved significantly only in successful group. Conclusions: No significant differences of in-hospital and one-year MACE were found between the successful and unsuccessful groups. Angina symptoms and quality of life significantly improved after successful CTO PCI. The RAIAN registry confirmed the importance of operator expertise for CTO PCI success