Association of Serum Vitamin D Level and Serum Lipids Profile

Introduction: High level of vitamin D is associated with a better health status. The role of vitamin D deficiency in the incidence of cardiovascular events is demonstrated in previous studies. The current study aimed at evaluating the effect of vitamin D supplement therapy on serum lipids profile, as a risk factor for cardiovascular diseases.Methods: The current prospective cohort study included 221 patients admitted to a university hospital from March 2014 to March 2015. The baseline levels of the patients' serum vitamin D and lipid profile of the study subjects were recorded. After three months treatment with vitamin D, the patients' serum vitamin D level and lipid profile were re-evaluated. The results before and after the supplement therapy were compared using statistical methods.Results: The mean age of the patients was 48.2 ± 14.0 years. The mean vitamin D level was 21.0 ± 16.6 ng/mL at baseline, which increased to 35.8 ± 32.7 ng/mL (P = 0.001) after a three-month vitamin D supplement therapy. Mean low-density lipoprotein (LDL) decreased from 112.1 ± 30.0 to 98.7 ± 31.7 mg/dL (P = 0.003) after the supplement therapy. Mean high-density lipoprotein (HDL) increased from 42.8 ± 11.2 to 44.5 ± 9.0 mg/dL, but the difference was insignificant before and after the treatment (P = 0.2). Mean cholesterol reduced from 183.8 ± 42.3 to 169.5 ± 41.9 mg/dL (P = 0.02) and the mean TG dropped from 147.5 ± 98.7 to 134.7 ± 71.1 mg/dL, (P = 0.1) after vitamin D intake.Conclusions: The mean levels of LDL and cholesterol significantly decreased during the three-month intervention; in addition, although some changes were observed in the level of HDL and TG, the differences were statistically insignificant. Further studies on larger sample sizes and longer follow-ups are recommended

Value of Brain Natriuretic Peptide in Predicting Prognosis of Coronary Artery Disease in Myocardial Infarction

Background: Brain natriuretic peptide (BNP) is an important predictor of outcomes in patients with heart failurebut the prognostic value of BNP elevation in patients with myocardial infarction (MI) is not completely defined.This study aims to identify the prognostic value of BNP in patients with MI.Materials and Methods: We studied patients with MI who were hospitalized in the Coronary Care Unit of ImamHossein Hospital. Patients' demographic data, past medical and drug history besides echocardiography report andBNP levels were documented during the hospital stay and echocardiography was repeated after 3 months.Results: This prospective observational cross-section study was done between January 2018 through January2019. During the study period, 124 patients were recruited. There was significant negative correlation betweenBNP levels and ejection fraction (P=0.001), systolic blood pressure (P=0.012), diastolic blood pressure(P=0.003) and ratio between early mitral inflow velocity and early diastolic mitral annular velocity (E/e')(P=0.03) and EF in follow up (P=0.001). The correlation between BNP levels with infarction location (P=0.40),arterial involvement in the left main coronary artery (P=0.15), left anterior descending artery (P=0.53), leftcircumflex artery (P= 0.97), right coronary artery (P=0.50) and hospital stay (P=0.66) were not significant.Conclusion: BNP is a valuable marker for predicting prognosis in patients with the acute coronary syndrome.Also, it could be considered as a prognostic long-term marker for predicting the EF of patients with AMI

In-hospital and late outcome of rescue versus primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction

Introduction: Despite high technical success of rescue Percutaneous Coronary Intervention (PCI) and also its significant impact on left ventricular function, the therapeutic outcome of this PCI technique in comparison with primary PCI for coronary reperfusion has remained uncertain. The present study aimed to conduct a comparative analysis of early and long-term results of patients with ST-Elevation Myocardial Infarction (STEMI), who had undergone primary or rescue PCI.Methods: One hundred and twenty-nine consecutive patients with the diagnosis of STEMI, who underwent primary PCI (n = 107) or rescue PCI (n = 22) from April 2012 to September 2013 were retrospectively included. In addition to early assessment of procedural consequences, the patients were followed-up to assess and compare long-term mortality and major adverse cardiovascular events.Results: Comparing in-hospital consequences of the two rescue PCI and primary PCI procedures showed no significant differences in in-hospital mortality (9.5% vs. 3.7%, P = 0.255), total hospital stay (6.32 ± 2.24 days vs. 6.61 ± 3.43 days, P = 0.720) and also in early procedural complications. Long-term death was found only in 1.9% of patients in the primary group and none of the patients in the rescue group (P = 0.999). There was also no difference in the prevalence of late stent thrombosis between the two groups. However, the in-hospital Left Ventricular Ejection Fraction (LVEF) was lower in the rescue PCI group vs. primary PCI group (36.82 ± 11.19 vs. 43.48 ± 9.14, P = 0.014), but after six months, LVEF was similar between the two groups (41.05 ± 9.57 vs. 44.29 ± 10.35, P = 0.082).Conclusions: Our study showed no difference in early and late procedural outcome between the primary and rescue PCI techniques in STEMI patients, but LVEF had better improvement in the rescue PCI group

Short-term Cost-effectiveness of Reteplase versus Primary Percutaneous Coronary Intervention in Patients with Acute STEMI a Tertiary Hospital in Iran

  Introduction: This study aimed to compare primary percutaneous coronary intervention (PPCI) versus reteplase in terms of clinical and para-clinical outcomes; as well as cost-effectiveness in patients with ST-segment-elevation myocardial infarction (STEMI).Primary percutaneous coronary intervention is the method of choice in all patients especially those at higher risks. But an on-site professional team in a 24/7 facilitated system is a difficult goal to achieve in many areas and countries, therefore the cost-effectiveness of these two treatment strategies (PPCI and reteplase) needs to be discussed.Methods: This prospective cohort study included 220 patients presented with STEMI who were admitted to a university hospital between January 2014 to July 2016. Patients were divided into two groups of 120, either receiving reteplase or PPCI. Clinical outcomes were considered duration of hospital stay and MACE (Major Advanced Cardiovascular Events) including death, cerebrovascular accident, need for repeat revascularization, and major bleeding. LVEF (Left ventricular ejection fraction) was considered as a para-clinical outcome. The outcomes and total hospital cost were compared between two treatment groups.Results: Demographic characteristics between two groups of PPCI or reteplase didn’t show any significant differences. But in para-clinical outcomes, patients in PPCI group showed higher LVEF, compared with reteplase group (45.9 ± 11.5% versus 42.0 ± 11.8%; P = 0.02). Complication rates were similar in both groups but repeat revascularization or coronary artery bypass surgery was more prevalent in those who received thrombolytic therapy (P < 0.05). Length of hospital stay in both groups was similar in two groups but total cost was higher in patients who have received PPCI. (147769406.9 ± 103929358.9 Tomans vs. 117116656.9 ± 67356122.6 Tomans; respectively, P = 0.01).Conclusions: In STEMI patients who present during off-hours, thrombolytic therapy seems to represent a safe alternative to PPCI. Higher costs for patients with PPCI may be decreased with shorter duration of hospital stays according to guidelines

One- and Six-month Outcomes of Patients with Non-ST Elevation Myocardial Infarction

Introduction: Use of risk scoring systems in patients with acute coronary syndrome helps with summarizing important prognostic data of the disease and facilitates calculating confidence limits and comparing survival rates between different treatments. In the present study, the researchers first aimed at assessing mid-term outcome of patients with non-ST elevation myocardial infarction (NSTEMI), and then determining main predictors of this outcome to improve definitive criteria for designing a risk scoring system in the population.Methods: In a prospective cohort study, 124 patients with NSTEMI, diagnosed according to ACC/AHA guidelines and hospitalized in an academic hospital in 2013, were consecutively assessed. Baseline characteristics were collected via interviewing, physical examination, and reviewing the recorded files. All the patients were followed for one and six months to assess mid-term outcomes regarding mortality and major adverse cardiac events (MACE). MACE is defined as the occurrence of at least one of the events of death, myocardial infarction, repeated revascularization, or re-hospitalization.Results: One-month death occurred in 3.2%, re-hospitalization in 4.0%, and myocardial infarction in none of the patients. In addition, regarding the six-month outcomes status, mortality rate was determined in 6.4%, re-hospitalization in 22.6%, and myocardial infarction in 4.8% of patients. Hence, one- and six-month MACE rates were 7.3% and 27.4%, respectively. Furthermore, three- and six-month survival rates were estimated to be 96.8% and 93.6%, respectively. According to the Cox-proportion hazard modeling, only reduced left ventricular ejection fraction (LVEF) (HR = 0.909, P = 0.017), history of chronic kidney injury (HR = 8.884, P = 0.005), and Inotrope use (HR = 35.759, P = 0.012) could predict the six-month MACE. None of the other indexes including general coronary risk factors, echocardiography parameters, and level of cardiac enzymes could predict mortality rate.Conclusions: Patients with NSTEMI may face high six-month MACE which can be predicted by low LVEF, history of renal injury and use of inotrope. Therefore, to define risk stratification system, these indicators should be considered as well

Circadian Blood Pressure Variability in Normo and Hypertensive Diabetic Patients

Background: Diabetic patients have a higher prevalence of non-dipping pattern in blood pressure (BP) than general population. Non-dipping arterial pressure pattern is associated with increased cardiovascular risk. The objective of this study was to investigate the association between the clinical and paraclinical characteristics of the diabetic patients with circadian BP variability.Materials and Methods: This cross-sectional study included 114 diabetic patients (more than 18 years old) recruited by consecutive sampling. The patients were divided into two groups according to the results of systolic blood pressure dipping from day to night.Results: Mean age was 58.3±9.6 years; and 63% of the study population was male. Also, 80.7%, 78.1%, and 78.9% of the patients had non-dipper patterns in systolic, diastolic, and mean BP respectively. The dipping pattern did not have any significant association with baseline or clinical characteristics of the patients (p>0.05).Conclusion: The characteristics of the patients do not assist finding diabetic persons who are more likely to have non-dipping arterial pressure pattern. As such, ABPM is an essential tool for proper risk stratification in diabetic patients

Comparison of Face to Face vs. Group Training on Self-pulse Rate taking Ability of Patients

Introduction: Determining the rate and regularity of peripheral arterial pulses has a major role in assessing the clinical status of patients with cardiovascular disorders. We compared two training methods on the ability of patients to take their radial pulse rate accurately.Methods: Three-hundred patients were randomly divided into two arms. One arm received individual face-to-face training and the other arm received group training via displaying an animation movie. Immediately after the training and then after 48 hours, the patients were tested by a nurse to find out whether they have learned the correct technique of taking radial pulse rate or not.Results: Immediately after the intervention, 84.9% in face-to-face arm and 81.8% in group training arm were able to correctly count their radial pulse rate (P = 0.536). After 48 hours, 71.7% in face-to-face and 60.8% in group training arm were able to correctly count their radial pulse rate (P = 0.051).Conclusions: Both methods were effective to improve the ability of the patients to count their radial pulse rate correctly though face-to-face method was marginally superior to group training

Cardiogenic Shock Following Acute Myocardial Infarction: A Retrospective Observational Study

Introduction: Cardiogenic shock is a sudden complication that occurs in 5 to 10% of patients with acute myocardial infarction. According to statistics, mortality and morbidity from this event, despite all hospital care, are approximately 70-80%.Methods: This study was conducted over three years (2012 to 2014) in 28 cases of acute myocardial infarction, which was complicated by cardiovascular shock, before or after admission. We compared the outcomes of patients according to the treatment strategy, thrombolytic therapy, primary percutaneous coronary intervention (PCI), or other medical stabilization. The 30-day follow-up was the first endpoint, and the 3- month follow up was the second endpoint of the study.Results: 28 patients with cardiogenic shock included in this study. The mean (± SD) age of the patients was 62.99 ± 13.99 years. The median time to the onset of shock was 648.75 ± 1393.58 minutes after infarction. Most of the patients who underwent coronary angiography had 3-vessel or left main involvement. Two patients missed in follow up and five (80%) patients who received thrombolytic therapy passed away. Nine (100%) patients in the medical stabilization group and six patients (50%) underwent primary PCI group passed away too. The mortality in the primary PCI group was significantly lower than the other groups (P = 0.04).Conclusion: Although cardiogenic shock is a potential risk of early death, it is important that the thrombolytic in these patients doesn't increase survival and the primary PCI is more effective than thrombolytic agents

The Prognostic Value of Echocardiographic Findings in Prediction of In-Hospital Mortality of COVID-19 Patients

Introduction: The correlation between echocardiographic findings and the outcome of COVID-19 patients is still under debate. Objective: In the present study it has been endeavored to evaluate the cardiovascular condition of COVID-19 patients using echocardiography and to assess the association of these findings with in-hospital mortality. Methods: In this retrospective cohort study, hospitalized COVID-19 patients from February to July 2020 with at least one echocardiogram were included. Data were extracted from patients’ medical records and the association between echocardiographic findings and in-hospital mortality was assessed using a multivariate model. The findings were reported as relative risk (RR) and 95% confidence interval (95% CI). Results: Data from 102 COVID-19 hospitalized patients were encompassed in the present study (63.7±15.7 mean age; 60.8% male). Thirty patients (29.4%) died during hospitalization. Tricuspid regurgitation (89.2%), mitral valve regurgitation (89.2%), left ventricular (LV) diastolic dysfunction (67.6%), pulmonary valve insufficiency (PI) (45.1%) and LV systolic dysfunction (41.2%) were the most common findings on patients’ echocardiogram. The analyses of data showed that LV systolic (p=0.242) and diastolic (p=0.085) dysfunction was not associated with in-hospital mortality of COVID-19 patients, while the presence of PI (RR=1.85; 95% CI: 1.02 to 3.33; p=0.042) and patients’ age (RR=1.03; 95% CI: 1.01 to 1.08; p=0.009) were the two independent prognostic factors of in-hospital mortality. Conclusions: It seems that LV systolic and diastolic dysfunction was not associated with in-hospital mortality of COVID-19 patients. However, presence and PI and old age are possible prognostic factors of COVID-19 in-hospital mortality. Therefore, using echocardiography might be useful in management of COVID-19