Echocardiographic Epicardial Adipose Tissue as a New Indicator of Cardiovascular Risk

Abstract Background and Purpose: Epicardial fat is the true visceral fat located around the heart, particularly around sub-epicardial coronary arteries that may locally interact and modulate the coronary arteries and myocardium through paracrine or vasocrine secretion of anti-inflammatory and proatherogenic cytokines. Most previous studies have used echocardiography and reported controversial results, probably due to differences in measuring techniques and study population. Materials and Methods: A review of literature was conducted using the PubMed and Google Scholar databases in addition to Google and Yahoo search engines. The purpose was to look for articles describing the association between echocardiographically measured EAT and the major related outcomes including coronary artery disease, left ventricular systolic, diastolic dysfunction, and atrial fibrillation. Finally, 34 articles were included in the results of the present review. Result: The potential role of echocardiographic epicardial fat thickness as a marker and predictor of cardio metabolic risk has been suggested. Conclusion: The potential role of echocardiographic epicardial fat thickness as a marker and predictor of cardio metabolic risk, metabolic syndrome, excess visceral fat accumulation, insulin resistance, subclinical atherosclerosis, and CAD has been documented in the present study

Comparison between Revascularization and Optimal Medical Therapy in Patients with Stable Angina Pectoris

Background and Purpose: Regarding usefulness of revascularization versus optimal medical therapy in patients with stable angina pectoris, data are challenging. The aim of this 12-month follow-up study was to compare the survival benefit associated with revascularization versus optimal medical therapy on the patients with stable angina pectoris. Materials and Methods: A prospective clinical study was conducted on 181 patients with stable angina pectoris or an evidence of myocardial ischemia that underwent coronary arteriography. Patients with left main or left main equivalent were excluded from our study. Of these patients, 57 received full medical therapy alone, 79 were assigned to the percutaneous coronary intervention (PCI) and 45 to the coronary artery bypass graft (CABG) group. The patients were compared for primary outcomes including cardiac death and non-fatal myocardial infarction and secondary outcomes including disabling angina by chi-square and Fisher’s exact test. Results: After 12 months, cardiac death occurred in 8.8% of patients in the medical group and 0.0% of patients in the PCI and CABG group. This was statistically significant (P = 0.004). Disabling angina occurred in 23.1% of patients in the medical group, 17.7% of patients in the PCI group, and 15.5% of patients in CABG group (P = 0.349). Cerebrovascular accident occurred in 1.9% of patients in the medical group, 1.3% of patients in the PCI group, and 6.7% of patients in CABG group (P = 0.167). These were not statistically significant. Conclusion: Revascularization compared with the optimal medical therapy may be a better strategy in reducing cardiovascular mortality in patients with stable angina pectoris and suitable coronary anatomy

Association between Socio-economic Factors and Geographical Pattern of Death Due to Cardiovascular Diseases in Kurdistan Province

Background and purpose: The aims of this study were to investigate the geographical distribution of mortality rates caused by cardiovascular diseases in Kurdistan province and to identify the high risk areas. Materials and methods: This ecological study was done using the data on mortality due to due to cardiovascular disease in Kurdistan province, Iran 2013-2015. To determine the standardized mortality rates and effective factors, Poisson model and negative binomial model were fitted to the data and the Akaike Information Criterion (AIC) was used to identify the most efficient model. Data analysis was done in R software and the maps were drawn using Arc GIS10 software. Results: A total of 8596 (41.54% from total deaths in the province) death due to cardiovascular diseases was reported in 55.6% males (mean age: 69.1±20.8 years) and 44.2% females (mean age: 71.86±19.7 years). The overall mortality rate was 178 per hundred thousand. The death rate caused by cardiovascular diseases was not symmetric throughout Kurdistan province. However, the rate was higher in Southern areas. The negative binomial model showed mean age (RR=0.29, P>0.001), sex ratio (RR=25.02, P=0.02), number of emergency departments (RR>0.001, P>0.001), and literacy ratio (RR=0.9, P>0.001) to be significantly associated with mortality rates of cardiovascular disease. Conclusion: According to current study, enhancing the awareness of people and suitable facilities in emergency services could considerably reduce mortality rates due to cardiovascular disease

Effects of Everolimus-Eluting Stents on the Left Ventricular Systolic and Diastolic Functions

Background: The drug-eluting stent (DES) decreases the rate of coronary restenosis and re-obstruction. The aim of this study was to assess prospectively the effectiveness of the new generation DES on the left ventricular (LV) systolic and diastolic functions in patients with isolated severe proximal left anterior descending (LAD) coronary artery stenosis. Methods: A prospective study was conducted on 50 patients with isolated severe proximal LAD stenosis. Successful percutaneous coronary intervention (PCI) with Everolimus-eluting stents was performed for the whole study population. All the patients underwent transthoracic echocardiography within 24 hours before and one month after PCI, and LV systolic and diastolic parameters were compared before and after PCI using the paired samples t-test. Results: The mean age of the study population was 57.68 ± 8.82 years. Within the study population, 26 (52%) patients were male and 24 (48%) were female. There was a significant 10.6% and 5.2% increase in the early diastolic mitral annular motion (e') and the LV ejection fraction following PCI, respectively (p value = 0.005 and p value = 0.044, respectively). Before PCI, wall motion abnormality was seen in 2.21 ± 2.91 segments, which significantly decreased to 1.49 ± 2.58 segments (p value = 0.04) after the procedure. Also, the wall motion score index was 1.18 ± 0.26 before PCI, which significantly decreased to 1.13 ± 0.23 after PCI (p value < 0.001).Also, there was a trend toward a higher ratio of transmitral peak early diastolic velocity to peak late diastolic velocity after PCI (p value = 0.068). Conclusion: Our study showed that the use of the Everolimus-eluting stents improved the LV systolic and diastolic functions in patients with isolated severe LAD stenosis

The correlation between epicardial fat thickness and longitudinal left atrial reservoir strain in patients with type 2 diabetes mellitus and controls

Abstract Background Diabetes mellitus (DM) has been documented among the strongest risk factors for developing heart failure with preserved ejection fraction (HFpEF). The earliest imaging changes in patients with DM are the left atrial (LA) functional and volumetric changes. The aim of this study was to determine the correlation between epicardial fat thickness (EFT) and longitudinal LA reservoir strain (LARS) in patients with type 2 DM (T2DM), as compared with non-diabetic controls. Results The study samples in this case-control study comprised of consecutive patients with T2DM (n=64) and matched non-diabetic controls (n=30). An echocardiography was performed on all patients and EFT, volumetric and longitudinal LARS, left ventricular (LV) global longitudinal strain (LVGLS), pulsed-wave Doppler-derived transmitral early (E wave) and late (A wave) diastolic velocities, and tissue-Doppler-derived mitral annular early diastolic (e′) and peak systolic (s') velocities were obtained. The study results demonstrated that the patients with T2DM had thicker EFT (5.96±2.13 vs. 4.10±3.11 mm) and increased LA volume index (LAVI) (43.05± 44.40 vs. 29.10±11.34 ml/m2) in comparison with the non-diabetic ones (p-value: 0.005 and 0.022, respectively). On the other hand, a direct association was observed between EFT and the E/e′ ratio, and an inverse correlation was established between EFT and LARS in patients with T2DM (r=0.299, p-value=0.020 and r=− 0.256, p-value=0.043, respectively). However, regression analysis showed only LV mass index (LVMI) (β=0.012, 95% CI 0.006–0.019, p-value<0.001), LAVI (β=− 0.034, 95% CI − 0.05–0.017, p-value<0.001), and EFT (β=− 0.143, 95% CI − 0.264–− 0.021, p-value=0.021) were independently correlated with LARS. Conclusions LARS is considered as an important early marker of subclinical cardiac dysfunction. Thickened epicardial fat may be an independent risk factor for decreased LA reservoir strain. Diabetics are especially considered as a high risk group due to having an increased epicardial adipose tissue thickness

Spontaneous Aortic Dissection Limited to the Sinus of Valsalva: Report of Two Cases

Dissection of the sinus of Valsalva is a rare and life-threatening event. It often occurs during percutaneous coronary intervention in the right coronary artery (RCA). Dissection flap usually involves the RCA and the right sinus of Valsalva. Here we report two extremely rare cases of spontaneous dissection limited to the non-coronary sinus of Valsalva, causing severe aortic valve regurgitation: a male aged 51 years presenting with back pain, weakness, and presyncope and another male aged 71 years presenting with orthopnea and weakness. The dissection was found by transesophageal echocardiography. Surgical treatment was successful for both patients. One year after surgery, both patients were asymptomatic and follow- up transthoracic echocardiography did not show any abnormality

Alterations in echocardiographic left ventricular function after percutaneous coronary stenting in diabetic patients with isolated severe proximal left anterior descending artery stenosis

Background: There are conflicting theories regarding the use of percutaneous coronary intervention (PCI) of isolated severe proximal left anterior descending (LAD) artery stenosis in place of left internal mammary artery grafting in diabetic patients. The aim of this study was to investigate the effect of PCI on left ventricular function and determine difference between diabetics and non-diabetics. Methods: A prospective study was conducted on 50 patients with isolated severe proximal LAD stenosis: 23 diabetic and 27 non-diabetic patients. Successful PCI with everolimus-eluting stents was performed for all of the patients. These patients underwent transthoracic echocardiography within 24 h before and 1 month after PCI, and alterations in the left ventricular parameters were compared between the two groups. Results: There was a significant 12% increment in the mitral annular peak systolic velocity (s′) (p = 0.02), 21% decrement in the trans mitral early filling deceleration time (DT) (p < 0.001), 10% decrement in the systolic left ventricular internal dimension (LVIDs) (p = 0.002), significant increment in the left ventricular ejection fraction (LVEF) (p = 0.004), and significant decrement in the left atrial diameter (p = 0.006) in the diabetic patients after performing PCI. Conversely, the non-diabetic patients showed a statistically significant 14% increase in the DT, 6.3% decrease in the s′ velocity, 8% increase in the LVIDs, significant increment in the left atrial diameter and no change in LVEF after PCI. Conclusion: Our study demonstrated that everolimus-eluting stents favorably improved the markers of left ventricular systolic and diastolic function in diabetic patients with isolated severe proximal LAD stenosis compared with those of non-diabetic patients with the same condition

Non-Hodgkin’s Lymphoma Presenting as Constrictive Pericarditis: A Rare Case Report

Constrictive pericarditis (CP) is an uncommon post inflammatory disorder. It is described as pericardial thickening, myocardial constriction, and impaired diastolic filling. The most common etiologies are idiopathy, mediastinal radiotherapy, and prior cardiac surgery. Less common etiologies include viral infections, collagen vascular disorders, renal failure, sarcoidosis, tuberculosis, and blunt chest trauma. CP can less commonly be caused by malignancy. We report a very rare case of non-Hodgkin’s lymphoma (NHL) presenting twice with attacks of decompensated heart failure. Echocardiography revealed that CP was responsible for the patient's symptoms as the first manifestation of NHL. Chest computed tomography scan and biopsy findings were compatible with the diagnosis of NHL. The patient received R-CHOP (cyclophosphamide, hydroxydaunorubicin, Oncovin®, and prednisone or prednisolone, combined with the monoclonal antibody rituximab) chemotherapy. Three months later, there was significant improvement in the patient’s symptoms and considerable decrease in pericardial thickness

Association between Coronary Artery Sclerosis and Dental Pulp Calcification in Patients Attending Sari Touba Clinic, 2019

Background and purpose: Coronary artery disease is a major cause of mortality, morbidity, and disability in society and patients incur high expenditure on treatment. Pulp stones are ectopic calcifications of the pulp vessel walls, so, they can have similar pathogenesis as those of other organs and coronary atherosclerosis. The purpose of this study was to investigate the correlation between coronary artery sclerosis and dental pulp calcification in panoramic dental radiography. Materials and methods: This case-control study, was performed in 94 patients aged 30-65 years old attending Sari Touba Clinic for coronary angiography. They were divided into two groups: case group with significant angiography results and control group with normal angiography results. Panoramic dental radiographs were obtained and examined for the presence of pulp stone. Data were analyzed in SPSS V16 using Chi-square test. Results: Findings showed a significant association between coronary artery sclerosis and presence of pulp stone (P<0.05). Conclusion: Coronary artery sclerosis and dental pulp calcification were found to be significantly associated. Dental radiography could be an early identification method for coronary artery disease