Impact of Cardiopulmonary Resuscitation on Cardiac Transplantation outcome

Introduction: Donor heart shortage limits heart transplantations programs while the number of patients waiting for cardiac transplant continues to increase. Optimizing the use of all available donor hearts is a vital key to reduce waiting list mortality. Among different extended criteria, prolong cardiopulmonary resuscitation (CPR), i.e. more than 20 min, has been considered under doubt to be a selection criterion in donor selection. The aim of this study was to compare the outcomes of heart transplantation from cardiopulmonary-resuscitated donors to those who received hearts from donors who did not require cardiopulmonary resuscitation.Methods: This study was a retrospective analysis of adult heart transplantation program in Masih Daneshvari Hospital in Tehran, Iran from 2010 to 2019. Donors and recipients’ demographics, cause of end-stage heart disease and brain death, duration of hospitalization for both donors and recipients and also the duration of cardiopulmonary resuscitation and other factors related to it were investigated. Qualitative variables were compared using Chi-square test. Quantitative variables were compared using T-test. Patient and graft survival rates were calculated using the actuarial method and compared using Wilcoxon's test.Results: Among 92 recipients, 39 were transplanted with cardiac grafts from CPR-suffering donors. There were no significant differences regarding sex, age, donor and recipient hospitalization periods, early rejection and 1-year-survival rate considering CPR and non-CPR grafts. However, we detected a strong negative correlation between the duration of CPR and 3-year-survival rate (P = 0.02 and R-value = -0.62) and also its association with post-transplant arrhythmias (P = 0.04).Conclusion: There is a negative possible influence of long-lasting CPRs (especially more than 20 minutes) in midterm survival and post-transplant complications

Superselective Angioembolisation: A Report of Two Rare Cases of Hemoptysis

Superselective bronchial embolization is recently performed with a high success rate. The current study aimed at discussing the procedure and reporting two cases underwent embolization in the Masih-Daneshvari Hospital, a large center for this procedure, in Iran

The acute effects of Water-pipe smoking on Ankle Brachial Index: A cross-sectional Study

Introduction: Numerous studies have shown that waterpipe smokers as well as cigarette smokers are at increased risk of cardiovascular diseases. In this study we sought to evaluate the acute effects of waterpipe smoking (WPS) on ankle brachial index (ABI), an indicator of atherosclerosis and an independent predictor of mortality.Methods: This prospective cross-sectional study was conducted in October 2017. Twenty nine healthy male volunteers who had a history of WPS were enrolled. Demographic data and cigarette and WPS status were recorded via self-reporting questionnaire. Resting heart rate and brachial systolic and diastolic blood pressures of participants were recorded first and ABI measurements were done. Then subjects smoked waterpipe for about 20 minutes and ABI was measured immediately after WPS.Results: A total of 29 male adults with a mean age of 32 ± 9 years were included. The right-sided ABI was 1.05 ± 0.11 before WPS and significantly decreased to 0.98 ± 0.13 after WPS (P value = 0.006). The left-sided ABI before and after WPS were 1.09 ± 0.20 and 0.95 ± 0.18 respectively and the decrease was statistically significant (P value = 0.037). Vital signs before and after one session of WPS showed significant changes in heart rate (P < 0.001) and no significant changes in systolic and diastolic blood pressures (P = 0.09, and P = 0.14, respectively).Conclusion: WPS has an acute effect on ABI as well as heart rate so it should be considered as a potential risk factor for cardiovascular diseases

Cardiopulmonary Exercise Test in Advanced Heart Failure Among Heart Transplantation Candidates

Cardiopulmonary exercise test has been raised through recent decades as a brilliant prognostic tool in a wide field of diseases and clinical conditions which makes it valuable to be used in prognostic assessment during the current study among chronic heart failure (CHF) patients. This study recruited 71 patients with severe CHF who were candidates for heart transplantation. Bicycle-protocol Cardiopulmonary Exercise Test was done, and several parameters were measured and compared between four groups of patients based on their VO2/kg to show four grades of the disease from G1 to G4. Total 71 CHF subjects from 18 to 46 year of age enrolled in the study. Statistically significant correlations were determined between HRR, VE/VCO2, VE/VO2, BR and the severity of CHF. VO2max, HRR, VE/VO2, VE/VCO2, BR, and AT were the most prominent factors of CPET which showed their validity and reliability in terms of prognosis of CHF. It seems that combination of CPET and other cardiac prognostic tools like echocardiography and measurement of the pressure in cardiac chambers can improve the prognosis in CHF

Oral l-citrulline malate in patients with idiopathic pulmonary arterial hypertension and Eisenmenger Syndrome: A clinical trial

AbstractBackground and purposeCitrulline is an amino acid which is produced by the urea cycle and also a precursor for NO, that is, a vasodilator for normal function of pulmonary vasculature. Thereby, enhancing l-citrulline malate in patients with idiopathic pulmonary arterial hypertension and those with congenital heart disease identified as Eisenmenger Syndrome results in reduction of pulmonary hypertension.Methods and subjectsIn this clinical trial before and after study, we assigned 25 patients with arterial pulmonary hypertension (idiopathic or Eisenmenger Syndrome) to receive l-citrulline malate 1g three times daily for two weeks. The primary measurement was the change in exercise capacity, as considered as a result of the total distance walked in six minutes, from baseline to week 2. We also assessed mean pulmonary artery pressure, the change in the quality of life, and the change in pro-brain natriuretic peptide (BNP) level. The study was not powered to evaluate mortality.ResultsThe mean walking distance in six minutes was significantly increased by about 44m (p=0.005) after receiving l-citrulline malate. Mean pulmonary artery pressure significantly reduced from 83.34mmHg before receiving l-citrulline malate to 79.1mmHg after that (p=0.01). All dimensions of the quality of life had statistical differences after receiving l-citrulline malate except limit due to physical health, limit due to emotional health and social functioning (p>0.05). Finally, pro-BNP difference was not statistically significant (p=0.9).Conclusionl-Citrulline malate improves the distance walk in six minutes and also the quality of life of patients with idiopathic arterial pulmonary hypertension and Eisenmenger Syndrome and also reduced mean arterial pulmonary hypertension

Remdesivir associated sinus bradycardia in patients with COVID-19: A prospective longitudinal study

Background: Remdesivir is effective against SARS-Cov-2 with little evidence of its adverse effect on the cardiac system. The aim of the present study is investigating the incidence of bradycardia in COVID-19 patients treated with Remdesivir.Methods: This prospective longitudinal study was conducted in a tertiary center on COVID-19 patients for Remdesivir therapy. The objectives were to investigate the incidence of sinus bradycardia, and also the association between their demographics, underlying diseases, and the disease severity with developing bradycardia in COVID-19 patients treated with Remdesivir.Results: Of 177 patients, 44% were male. The mean (±standard deviation) age of patients was 49.79 ± 15.16 years old. Also, 33% were hospitalized due to more severe symptoms. Oxygen support was required for all hospitalized subjects. A total of 40% of the patients had comorbidities, with the most common comorbidity being hypertension. The overall incidence of bradycardia (heart rate<60 bpm) in patients receiving Remdesivir was 27%, of whom 70% had extreme bradycardia (heart rate <50 bpm). There was also a statistically significant reduction in heart rate after five doses of Remdesivir compared to the baseline heart rates. In the multivariable model, none of the covariates including age above 60 years, female sex, CRP>50 mg/L, O2 saturation<90%, underlying cardiovascular disease, hypertension and diabetes mellitus, and beta-blockers were associated with Remdesivir-induced bradycardia. No association was found between the COVID-19 severity indicators and bradycardia.Conclusion: As sinus bradycardia is a prevalent adverse cardiac effect of Remdesivir, it is recommended that all COVID-19 patients receiving Remdesivir, be evaluated for heart rate based on examination; and in the case of bradyarrhythmia, cardiac monitoring should be performed during administration to prevent adverse drug reactions

The Effects of Oral Pentoxifylline on the Prevention of Contrast-Induced Nephropathy in Patients with Chronic Kidney Disease and Normal Renal Function: A Randomized Clinical Trial: Pentoxifylline Effects on Contrast-Induced Nephropathy

Introduction: Finding preventive methods for Contrast-Induced Nephropathy (CIN) is essential for reducing the burden of complications. In this context, anti-oxidant agents such as pentoxifylline can be viable options. This study aimed to determine the effects of oral pentoxifylline on the prevention of contrast induced nephropathy in patients undergoing angiography. Methods and Results: In this randomized clinical trial 96 patients with chronic kidney disease (CKD) and 96 subjects with normal renal function were included and randomly assigned to receive either pentoxifylline or placebo. The Incidence of CIN was determined and compared between the groups. The incidence of CIN in healthy subjects receiving pentoxifylline or placebo was 4 (8.3%) and 2 (4.16%), respectively. (P-value = 1). The incidence of CIN in patients with CKD in the pentoxifylline and placebo group was 5 (10.41%) and 12 (25%) respectively. (P-value = 0.58). Conclusion: According to the obtained results, there was no difference between patients with CKD and those with normal renal function in terms of the pentoxifylline effects on the prevention of Contrast Induced Nephropathy

Characteristics of convalescent plasma donors for Covid-19: Barriers for consent

Background and Objective: Covid-19 pandemic is a worldwide bothersome issue. Although the appropriate strategy for plasma donation from recovered Covid-19 cases should be based on clinical, laboratory, and demographic characteristics of cases, consent for plasma donation is crucial. Moreover, the safety of donation is important not only for receiving cases but also for donor subjects. Accordingly in this study, the existing conditions in plasma donors for Covid-19 were assessed. Materials and Methods: In this descriptive cross-sectional study, 264 consecutive cases with positive Covid-19 infection history were enrolled in 2020 a total of 64 cases were eligible for plasma donation. The initial two stages for consent and medical history were done by phone call and two final steps including laboratory results and physical examination were carried out after patients’ attendance to the hospital. Results: Mean (standard deviation) age was 45.3 (9.1) years. There were 58 male cases (90.6%). Totally 70.3% had academic literacy and 90.6% were married. Even thirteen cases (20.3%) had underlying diseases. There was not any significant early or late complication during donation. Causes for plasma donation were mentioned help to humankind, severe disease experience, and help to research projects in 41 (64.1%), 14 (21.8%), and 9 (14.1%) cases, respectively. Conclusions: It is necessary to inform the post-covid-19 patient about the advantages of plasma donation as a safe way for critically ill patients to decrease the burden of the disease in their current condition without confirmed drugs

پیامدهای قلبی دسته ی دارویی گلیفلوزین در بیماران دیابتی نوع 2 مبتلا به نارسایی قلبی با کسر جهشی حفظ شده

زمینه: نارسایی قلبی یک سندرم بالینی است که منجر به اختلال در پر شدن بطن یا خروج خون از قلب می شود. تا 40 درصد از بیماران نارسایی قلبی، همزمان دیابت نوع 2 دارند و نسبت مشابهی، با اختلال تحمل گلوکز تظاهر می کنند که هر دو باعث افزایش مرگ و میر می شوند. مهارکننده‌های ناقل سدیم-گلوکز-2 ، دسته جدیدی از داروهای کاهنده ی قند خون هستند که توانایی خود را در بیماران در معرض خطر و مبتلا به دیابت نوع 2 ثابت کرده‌اند. بحث: مطالعات زیادی اثر این دسته ی دارویی بر کاهش حوادث قلبی و بستری شدن در بیمارستان به دلیل نارسایی قلبی را در بیماران مبتلا به دیابت نوع 2 و بیماری عروقی آترواسکلروتیک همزمان، بیماران دیابتیک با عوامل خطر متعدد قلبی یا بیماران نفروپاتی دیابتی بررسی کردند. نتیجه گیری: این مطالعه ی مروری نشان می دهد که در بیماران مبتلا به دیابت نوع 2 و خطر حوادث قلبی عروقی بالا، امپاگلیفلوزین، علاوه بر مراقبت استاندارد، بستری شدن در بیمارستان ناشی از نارسایی قلبی و مرگ ناشی از حوادث قلبی عروقی را کاهش می دهد