Background: Sinus venosus atrial septal defect (SVASD) is a congenital heart defect involving an opening between the superior vena cava (SVC) and the right upper pulmonary vein (RUPV). Surgical closure is the standard treatment. Nonetheless, it is more complex than secundum ASD reconstruction and is associated with higher complication rates. Transcatheter closure is an emerging alternative. Methods: We report 5 cases of transcatheter SVASD closure and 1 case of failure requiring surgical intervention. All patients underwent preprocedural computed tomography angiography to assess defect size and location and optimal stent dimensions. SVC stenting was performed using balloon-expandable stents, followed by RUPV angioplasty if necessary. Results: Final angiograms and pressure measurements in the SVC, RUPV, and right atrium confirmed the absence of residual shunt and pulmonary venous obstruction. Stent migration to the pulmonary artery occurred in 1 patient, necessitating surgical retrieval and defect closure. Conclusions: Balloon expansion testing is not mandatory before stent implantation. If RUPV obstruction occurs, flow can be reestablished via ballooning or stent implantation within the RUPV, and associated mild residual shunts may resolve spontaneously.
Background: Data on the link between use of antihypertensive medications and the risk of developing or dying from cancer have uncertain credibility and certainty. Objectives: We sought to evaluate the credibility of evidence from observational studies and the certainty of evidence from randomized controlled trials (RCTs) on the association between antihypertensive medication use and cancer risk, mortality, or survival outcomes. Methods: Comprehensive searches were performed in PubMed, Embase, Scopus, and the Cochrane Database of Systematic Reviews from their creation through July 2024. The study included systematic reviews and meta-analyses of epidemiological research investigating the relationships between antihypertensive therapies and cancer risk, mortality, or survival outcomes. The credibility of evidence from observational studies was categorized as convincing, highly suggestive, suggestive, weak, or nonsignificant. Through the GRADE framework, the certainty of evidence from RCTs was categorized as high, moderate, low, or very low. Results: A total of 109 meta-analyses were identified, with 90 originating from observational studies and 23 from RCTs. The observational studies provided highly suggestive evidence that calcium channel blockers (CCBs) and diuretics were associated with an increased cancer risk (equivalent odds ratio [eOR], 1.07; 95% CI, 1.04 to 1.10; and eOR, 1.15; 95% CI, 1.10 to 1.20, respectively). Evidence suggests that β-blockers are associated with an increase in cancer-specific survival (eOR, 0.78; 95% CI, 0.69 to 0.89). No association satisfied the standards for convincing evidence. Pooled analyses of RCTs determined that CCB use was associated with an increased cancer risk (eOR, 1.06; 95% CI, 1.01 to 1.12; moderate certainty). Conclusions: No strong or consistent evidence was found to support a causal relationship between antihypertensive medications and cancer outcomes. The observed associations were of very small magnitude, suggesting limited clinical relevance.
Objective: The removal of residual antibiotics from whole homograft tissues after disinfection is a matter of concern. To avoid bacteriostasis, which causes falsely negative culture results, we investigated the effectiveness of a novel method applicable to whole homografts. Methods: Thirty homografts, assessed as unsuitable for transplantation, were obtained from 24 deceased donors. Fourteen days after freezing, each homograft was thawed and divided lengthwise into 2 halves, with one serving as an unexposed control and the other as an exposed sample. Exposure was conducted using 400 µg/mL vitamin C. Five-step microbiological assays were performed using direct tissue samples and cryopreservation solution after thawing. The presence of residual antibiotics in tissue homogenates and cryopreservation solution was assessed by an agar diffusion test on seeded plates with 8 virulent strains. The effect of the intervention was determined by comparing the inhibition zones of exposed and unexposed tissue homogenates. Results: Blood culture results from all donors were negative. The initial contamination rate was 13.3%, and the isolates were not detected after disinfection. Thawed tissues that were not exposed to vitamin C all yielded negative culture results, whereas one tissue sample exposed to vitamin C had a positive result (Pantoea eucrina). The diameter of the inhibition zone in seeded plates was 14.4% smaller with tissue exposed to vitamin C than that of controls (P=0.021). Conclusion: The retention of antibiotics and carryover effect are unavoidable. Vitamin C can break down antimicrobial molecules and produce soluble by-products, which leads to a diminished amount of residual antimicrobials and a higher probability of detecting microorganisms in post-disinfection cultures.
Background: Agranulocytosis is a serious, life-threatening condition characterized by a severe reduction in the number of peripheral neutrophils (<0.5 × 10⁹/L). It is most commonly caused by chemotherapy drugs but can be induced by antibiotics. Ceftriaxone is a widely used and generally safe third generation antibiotic for conditions such as infective endocarditis. Ceftriaxone induced agranulocytosis is an extremely rare adverse reaction. Evidence suggests that this adverse reaction is dose dependent and typically occurs following prolonged courses or high cumulative doses of the antibiotic. Despite improvements in management that reduce the mortality rate to approximately 5%, prompt recognition and treatment remain vital. Case Presentation: A 56-year-old man diagnosed with native valve infective endocarditis (Streptococcus mitis) was treated with 2 g/day of intravenous ceftriaxone. In the fifth week of treatment, after receiving a cumulative dose of 60 g, the patient developed severe agranulocytosis, reaching a neutrophil nadir of 0.1 × 10⁹/L. Ceftriaxone was promptly stopped and replaced with teicoplanin, and the patient received filgrastim (recombinant human granulocyte colony stimulating factor [rhG CSF]). The case was classified as a probable adverse drug reaction (Naranjo score, 6). Neutrophil recovery was complete by the seventh day, and the patient successfully underwent double valve replacement surgery. Conclusion: Ceftriaxone induced agranulocytosis, albeit rare, is a potentially fatal complication of prolonged therapy. Regular complete blood count monitoring and prompt management—based on drug withdrawal, appropriate antimicrobial coverage, and rhG CSF administration—are essential for favorable outcomes.
Background: Clinical evidence suggests an association between vitamin B12 deficiency and vasovagal syncope (VVS) in pediatric patients. This study investigated the association of vitamin B12 and folate deficiency with VVS in adults. Methods: In this case-control study, adult patients with VVS who presented to the tertiary syncope unit for head-up tilt table testing comprised the case group. Age- and sex-matched individuals without syncope history from the population-based Tehran Cohort Study served as the control group. Exclusion criteria included but were not limited to the use of vitamin B supplements, carbamazepine, or phenobarbital, and sleeve gastrectomy. Serum vitamin B12, folate, and homocysteine levels were measured and compared. Results: From February 2020 through February 2021, 44 patients comprised the case group, matched with 44 controls (mean age, 37.9 years; 23 [52.3%] females in each group). No statistically significant difference existed between the groups in vitamin B12 or folate deficiency or serum levels. Serum vitamin B12 levels were significantly lower in patients with frequent VVS (≥3 lifetime episodes) than in patients with infrequent VVS (<3 lifetime episodes) (233.8 [80.7] vs 305.2 [118.1] pg/mL; P=0.042), and the association remained significant after adjustment for confounders (P=0.026). Conclusion: No association existed between vitamin B12 or folate deficiency or serum levels and VVS. Frequent VVS was associated with lower serum vitamin B12 levels than infrequent VVS.
Background: Rheumatic heart disease (RHD) remains a major cause of preventable cardiovascular morbidity and mortality, particularly in low- and middle-income countries. Despite the World Health Organization’s 2018 resolution calling for the global elimination of RHD, substantial disparities in disease burden persist across regions and levels of socioeconomic development. Although previous studies have reported global trends, a clear comparative assessment of long-term changes in both fatal and nonfatal RHD burden across sociodemographic and geographic regions remains limited. This study aimed to assess long-term changes in the global burden of RHD between 1990 and 2021, with a focus on regional and sociodemographic disparities, using the most recent estimates from the Global Burden of Disease Study 2021. We additionally assessed temporal trends across sociodemographic index (SDI) groups and GBD regions, with a focus on fatal (years of life lost [YLL]) and nonfatal (years lived with disability [YLD]) components of disease burden. Methods: We conducted a secondary analysis of model-based estimates from the Global Burden of Disease Study 2021 to assess the burden of RHD between 1990 and 2021. Metrics included age-standardized and all-age incidence, prevalence, mortality, YLL, YLD, and disability-adjusted life years (DALYs). Data were stratified by 5 SDI levels and 13 global regions. Estimates were produced using DisMod-MR 2.1 and CODEm and are reported as means with 95% uncertainty intervals (UIs). Results: Globally, age-standardized mortality and DALY rates for RHD declined by 56% and 53%, respectively, from 1990 through 2021. YLL decreased by 59%, whereas YLD increased by 11%, indicating a shift toward chronic nonfatal burden. For example, the global age-standardized mortality rate decreased from 9.1 (95% uncertainty interval [UI], 8.4 to 9.8) to 4.0 (95% UI, 3.6 to 4.5) per 100,000. High- and high-middle–SDI regions achieved the greatest reductions across all indicators. In contrast, low- and low-middle–SDI regions experienced persistently high absolute deaths and DALYs, with South Asia accounting for more than 27% of global RHD deaths in 2021. Females consistently had a higher nonfatal burden (YLD) than males. Although the dataset includes the COVID-19 era, the specific impacts of the pandemic on RHD care and outcomes require further investigation. Across all SDI groups and regions, declines in DALYs were largely driven by reductions in YLL, whereas YLD remained relatively stable. Conclusions: Although global RHD mortality declined, substantial regional and socioeconomic disparities persist. The epidemiologic transition toward disability highlights the need for long-term care infrastructure, particularly for women, children, and low-SDI regions. Although based on modeled estimates, this analysis provides the best available insight into global RHD epidemiology and informs data-driven health policy and planning. Despite overall improvement, disparities remain between low- and high-SDI settings, underscoring the need for context-specific prevention and long-term management strategies.
Background: Arrhythmia is a common and clinically significant complication during hospitalization for ST-segment elevation myocardial infarction (STEMI). This study aimed to identify factors associated with the occurrence of arrhythmia in the acute phase of STEMI. Methods: This single-center cross-sectional study was conducted among adult patients hospitalized with STEMI. Demographic and clinical variables, including cardiovascular risk factors and disease severity (Killip class, Thrombolysis in Myocardial Infarction [TIMI] score, and Global Registry of Acute Coronary Events [GRACE] score), were obtained from medical records. The primary outcome was in-hospital arrhythmia, defined as documented atrial or ventricular tachyarrhythmia or clinically significant bradyarrhythmia. Factors associated with arrhythmia were assessed using bivariate analyses followed by multivariable logistic regression. Results: This study involved 113 patients, with a mean age of 56.4 (11.1) years. Arrhythmia occurred in 26.5% (30 patients) during hospitalization. In bivariate analyses, arrhythmia was associated with higher Killip class (P<0.001), higher TIMI score (P=0.005), higher GRACE score (P=0.001), lower tricuspid annular plane systolic excursion (P=0.002), elevated serum potassium level (P=0.010), and impaired renal function, reflected by higher urea (P=0.005) and creatinine levels (P = 0.004). After multivariable adjustment, only Killip class remained independently associated with arrhythmia: patients presenting with Killip class I had a significantly lower risk of arrhythmia than those with higher Killip classes (adjusted OR, 0.404; 95% CI, 0.20 to 0.80; P=0.009). Conclusion: In hospitalized patients with STEMI, arrhythmic risk is chiefly driven by early clinical severity. Killip class is a simple bedside predictor of in-hospital arrhythmia and can aid early risk stratification and monitoring.
Bilateral deep vein thrombosis (DVT) is a rare condition among adolescents and represents an uncommon pattern of venous thromboembolism. We report a case of bilateral DVT occurring in the setting of severe pulmonary hypertension and right-sided heart failure secondary to congenital heart disease associated with congenital rubella syndrome (CRS). A 19-year-old female patient, with a history of CRS characterized by the classical triad of unilateral cataract, sensorineural deafness, and congenital heart disease, was admitted to our hospital with shortness of breath, swelling in both legs, and abdominal discomfort. Doppler ultrasonography demonstrated partial thrombotic obstruction of the femoral, popliteal, and posterior tibial veins in both lower extremities. A diagnosis of DVT was established on the fourth day of hospitalization. This case highlights the importance of considering bilateral DVT in patients with CRS who present with lower extremity edema, particularly in the presence of cardiovascular complications.
Background: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and is associated with substantial morbidity and mortality. AF occurring in individuals without structural heart disease or conventional risk factors, currently referred to as AF without overt comorbidity, remains poorly understood. Genetic susceptibility is thought to contribute, but the underlying molecular mechanisms are incompletely defined. This study aimed to identify key genes and biological processes associated with AF without overt comorbidity using an in-silico bioinformatics approach. Methods: Genes associated with AF without overt comorbidity were retrieved from the GeneCards database using a knowledge-based, database-driven strategy. Functional enrichment analysis of Gene Ontology biological processes was performed using WebGestalt. Protein-protein interaction (PPI) analysis was conducted using STRING and visualized in Cytoscape. Hub genes were identified exclusively using the Density of Maximum Neighborhood Component (DMNC) algorithm via the CytoHubba plugin. Three-dimensional protein structures of selected hub genes were modeled using SWISS-MODEL and evaluated using PROCHECK for exploratory structural characterization. Results: Eighty-one genes associated with AF without overt comorbidity were identified. PPI analysis demonstrated significant interaction enrichment (P<1.0×10⁻¹⁶), indicating a nonrandom and biologically coherent network. Functional enrichment analysis revealed cardiac muscle cell action potential and cardiac muscle contraction as the most significantly enriched biological processes. Ten hub genes were identified based on DMNC ranking. Among these, GPD1L, SCN1B, SCN4B, and KCNE2 showed central network positions and acceptable stereochemical quality in exploratory structural evaluation. Conclusion: This in silico study identifies candidate genes and biological processes potentially involved in AF without overt comorbidity. The findings are hypothesis generating and warrant further functional and clinical validation.
Introduction: Medication adherence in patients with cardiovascular disease remains a significant challenge and directly affects treatment success, morbidity, and healthcare costs. Although many studies have examined clinical and individual factors that influence adherence, the role of regulatory agencies has received less attention. The Iranian Food and Drug Administration (IFDA) is the leading authority responsible for regulating drugs, Understanding the strategic functions of this agency, and aligning them with adherence factors can be crucial for improving patient outcomes and maintaining the sustainability of the healthcare system. Methods: This study was conducted in 3 stages. First, regulatory activities of the IFDA were gathered from regulations, policy documents, organizational reports, and semistructured interviews. Second, the identified factors were validated by clinical and pharmaceutical experts, and monitoring activities were matched with medication adherence through a mapping matrix approach. Third, the importance-performance analysis (IPA) method was applied to evaluate systematic strengths and weaknesses, and the performance gap and normal weight were calculated. Results: Twenty-eight strategic-level tasks of the organization were classified into 4 IPA quadrants. The “Immediate Focus” quadrant consisted of 8 tasks (28.6%) with the highest normal weight (50.7%) and an average performance gap of 2.69, indicating serious weaknesses in the areas of innovation and research, strategic planning of production/imports, quality monitoring, and currency policies. The “Continuing the Good” quadrant encompassed 6 tasks (21.4%, 25.1% weight) reflecting strengths in drug supply, continuous access, equitable distribution, drug information systems, and communications. The “Low Priority” (5 tasks, 17.9%) and “Overfocus” (9 tasks, 32.1%) quadrants reflected administrative or ineffective activities that allocated disproportionate resources. Conclusion: The findings of this study suggest that the strategic-level tasks of the IFDA play a crucial role in promoting adherence to cardiovascular medication for patients. While good performance was observed in the areas of drug supply and access, significant deficiencies were identified in innovation, financial planning, quality monitoring, and patient education.
Background: Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome associated with substantial morbidity, mortality, and impaired quality of life. Despite its rising prevalence, particularly among older adults and women, HFpEF has historically been characterized as a “therapeutic graveyard” because of decades of inconclusive or neutral clinical trials. Methods: A secondary qualitative analysis of the literature indexed in PubMed, Scopus, and Embase from January 2018 through June 2025 was conducted. Randomized controlled trials, systematic reviews, meta-analyses, guideline statements, and high-quality observational studies were included. Data were extracted and synthesized thematically across five domains: epidemiology, pathophysiology, diagnostic strategies, therapeutic approaches, and future directions. Results: Epidemiological data confirm increasing global prevalence, driven by aging demographics and clustering of comorbidities such as obesity, hypertension, diabetes, and atrial fibrillation. Pathophysiological insights highlight a complex, multiorgan syndrome with distinct phenotypes. Diagnostic accuracy remains hampered by overlapping comorbidities, limited biomarker sensitivity in obese or renally impaired patients, and heterogeneity in imaging findings. Artificial intelligence and machine learning approaches are emerging but not yet established in clinical care. Therapeutically, sodium–glucose cotransporter-2 (SGLT2) inhibitors represent the first pharmacologic agents to consistently reduce hospitalization and improve outcomes in HFpEF, while lifestyle modification, rehabilitation, and device-based interventions offer complementary benefits. Emerging strategies emphasize precision medicine, digital health, and biomarker-driven stratification. Conclusion: HFpEF remains a major unexplained challenge in cardiovascular management. The efficacy of sodium–glucose cotransporter-2 inhibitors can mark a paradigm shift; however, significant weaknesses persist in diagnostic and therapeutic areas. Further progress depends on phenotype-specific, multimodal, and patient-centered strategies that combine clinical care, digital innovation, and molecular research.
Background: Primary malignant pericardial mesothelioma (PMPM) is an exceptionally rare and aggressive cancer originating from the mesothelial lining of the heart. This distinct and challenging oncologic entity is typically discovered at an advanced stage due to vague, nonspecific symptoms—most commonly chest pain and dyspnea. These clinical features often mimic more common conditions, making early detection difficult. Diagnostic confirmation usually requires detailed histopathologic analysis, often obtained through surgical procedures or postmortem examination. The disease’s elusive nature and rapid progression contribute to its generally poor prognosis, underscoring the need for heightened clinical awareness and advanced diagnostic strategies.Case Report: A 58-year-old patient was diagnosed with malignant pericardial mesothelioma, which progressed rapidly and resulted in death within 1 month of diagnosis.Conclusions: PMPM remains a rare and highly aggressive cancer characterized by swift, fatal progression. Diagnosis is difficult because of nonspecific clinical symptoms. Accurate diagnosis is essential for subsequent treatment planning. Nonetheless, limited treatment alternatives, coupled with the minimal effectiveness of immunotherapy in advanced disease, highlight the pressing need for further research and therapeutic advances
Atrial fibrillation (AF) is highly prevalent in patients undergoing cardiac surgery, and persistent AF poses significant challenges in postoperative rhythm management. This study investigated whether maintaining high-normal potassium levels (>4.4 mmol/L) during and after cardiopulmonary bypass (CPB) enhances SR restoration and stability in patients with persistent AF. A prospective observational study of 245 patients undergoing elective cardiac surgery was conducted, with potassium levels maintained above 4.5 mmol/L during CPB and supplemented postoperatively for 48 hours. Outcomes included SR conversion rates, hemodynamic parameters, and predictors of rhythm stability. Results showed that 87% of patients reverted to SR post-CPB, with 71% maintaining SR at 48 hours. Higher intraoperative potassium levels (mean, 4.54 vs 4.41 mmol/L; P=.02) significantly predicted successful cardioversion, whereas larger left atrial diameter (67.2 vs 53.8 mm; P<.001) correlated with AF persistence. Hemodynamic stability improved in patients with SR, with lower heart rates, higher mean arterial pressures, and reduced ICU stays (52.5 vs 58.8 h; P<.001). The study concludes that maintaining high-normal potassium levels during and after CPB facilitates SR restoration and short-term stability in patients with persistent AF, improving hemodynamics and reducing ICU dependency. Left atrial enlargement remains a key determinant of AF recurrence. These findings support perioperative potassium optimization as a feasible strategy to enhance postoperative outcomes, warranting further multicenter trials for validation
Background: Pregnancy in women with pulmonary hypertension (PH) is contraindicated because of high mortality rates associated with physiological changes, particularly in the peripartum and postpartum periods. Termination is recommended early if pregnancy occurs. Consequently, clinical experience with continued pregnancy in patients with PH is scarce. Case Presentation: A 31-year-old woman was diagnosed with multiple bilateral pulmonary and right ventricular hydatid cysts. After surgical and pharmacologic treatments, she developed PH due to pulmonary artery obstruction 8 years later. Because of her condition, she was ineligible for surgery and received medical therapy, including tadalafil, bosentan, and eplerenone. After 3 years, she conceived despite advice to avoid pregnancy. At 37 weeks’ gestation, she underwent successful emergency cesarean delivery because of maternal dyspnea and tachycardia. Conclusion: Prompt treatment and regular follow-up in a tertiary care center using a multidisciplinary approach are crucial for managing pregnant patients with PH.
Background: Heart failure (HF) is rising among younger adults in sub-Saharan Africa, yet data on their clinical profile and outcomes are limited. We compared clinical characteristics, etiology, and 1-year outcomes between younger and older HF patients in the Ibadan Heart Failure Project. Methods: We included 1290 adults (≤50 y, n=430; >50 y, n=860) enrolled from 2016 through 2022. Baseline sociodemographic, clinical, laboratory, and echocardiographic data were collected. HF etiology was classified using ICD-10 codes. Medication use and 1-year outcomes, including rehospitalization, mortality, and a composite of rehospitalization and mortality, were assessed. Results: Younger patients are predominantly females, more often single and employed, and presented with advanced HF signs, including paroxysmal nocturnal dyspnea, raised jugular venous pressure, S3 gallop, and cardiomegaly. Older patients had a higher prevalence of hypertension, diabetes mellitus, and peripheral edema. Hypertensive heart disease and cor pulmonale predominated in older patients (76% vs 44%), whereas younger patients more frequently had dilated cardiomyopathy (16% vs 7.4%), peripartum cardiomyopathy, and rheumatic heart disease (15% vs 6.2%). Guideline-directed therapy use was similar across ages. One-year mortality, rehospitalization, and composite outcomes did not differ significantly between age groups. Conclusion: Younger HF patients in Nigeria present with severe nonischemic cardiomyopathies and advanced systolic dysfunction, whereas older patients have hypertensive and metabolic phenotypes. Despite these differences, 1-year outcomes were uniformly poor, reflecting the high burden of HF morbidity and mortality across all age groups in Nigeria.
Background: Myocardial infarction is a severe cardiovascular condition that necessitates prompt reperfusion therapies, particularly primary percutaneous coronary intervention (PCI), to prevent irreversible myocardial damage and associated complications. This study aimed to determine the average door-to-balloon (D2B) time in Iranian hospital emergency departments through a systematic review and meta-analysis. Methods: Following the PRISMA guideline, the protocol for this study was registered in PROSPERO (CRD420251171966). A comprehensive search with no time restrictions was conducted through the end of September 2025 in data resources such as PubMed, Scopus, Web of Science, Google Scholar, SID, and Magiran. A random-effects model was used for the meta-analysis, and heterogeneity among studies was assessed using the I² index. Publication bias was evaluated with Begg test. Results: Of 154 initial articles retrieved, 13 studies met the eligibility criteria and were included in the final analysis. The pooled mean D2B time was 85.05 minutes (95% CI, 75.32 to 94.78). A significant level of heterogeneity was observed among the included studies. Meta-regression analysis indicated a decreasing trend in D2B time over the years. Conclusion: The results of this study indicate that the average D2B time in Iran aligns with global standards. However, significant variability among hospitals highlights systemic gaps in STEMI care. Addressing these gaps requires coordinated emergency-PCI teams, nationwide 24/7 services, ongoing training, and uniform quality standards.
Objectives: Hypertension is a major cause of cardiovascular and cerebrovascular morbidity and mortality worldwide. The ankle-brachial index (ABI) is a simple, noninvasive test usually used for peripheral artery disease detection, but its prognostic value in hypertensive patients is still poorly defined. In this study, we sought to systematically review the relationship between abnormal ABI values and cardiovascular and cerebrovascular events in adults with hypertension. Methods: A systematic literature search was conducted in PubMed, Scopus, and Web of Science up to March 2025 for observational studies evaluating ABI in hypertensive populations. Studies were included if they stratified outcomes by ABI categories and reported at least one cardiovascular or cerebrovascular outcome. Data on study design, population characteristics, measurement and cutoff values of ABI, outcomes, duration of follow-up, and adjustment for confounding variables were extracted. Study quality was assessed according to the Newcastle-Ottawa Scale. Results: Twenty-two studies from varied geographic and clinical populations were eligible. Both low ABI (≤0.9) and high ABI (>1.4) were consistently associated with elevated risks of myocardial infarction, heart failure, stroke, and all-cause or cardiovascular mortality, independent of conventional risk factors. Low ABI was also associated with subclinical target organ damage, such as left ventricular hypertrophy and silent brain infarct. Some studies have indicated that modified cutoffs (<1.05 or ≤1.10) help to detect risk in some populations, such as older and Asian cohorts. Measurement techniques and ABI cutoffs differed, reducing comparability. Conclusion: Abnormal ABI is independently associated with increased risks of adverse cardiovascular and cerebrovascular outcomes in patients with hypertension. Standardized protocols for ABI measurement and cutoff points are required to maximize its utility in risk stratification. Prospective studies are needed to determine whether ABI-guided interventions can improve outcomes.
Descending thoracic aorta tortuosity results from elongation of the descending aorta and is associated with aging. It acts as a risk factor for challenging endovascular procedures and has prognostic significance. It may, however, sometimes present as a vascular mass in the mediastinum, distorting nearby cardiac chambers, which may confuse physicians during transesophageal echocardiography. We describe an elderly woman with severe descending thoracic aorta tortuosity presenting with a tubular vascular mass located behind the left atrium, exerting compression on it. Recognizing the potential echocardiographic presentation of aortic tortuosity can aid in the timely identification of this condition during transesophageal echocardiography.
Background: Ischemic heart disease is the leading cause of death worldwide. Oxidative stress plays a key role in myocardial infarction (MI). Ferroptosis, a type of iron-dependent regulated cell death caused by lipid peroxide accumulation, has been identified as a key mechanism in ischemic injury. This study aimed to investigate the association between oxidative stress and ferroptosis in patients with non–ST-segment-elevation myocardial infarction (NSTEMI). Methods: In this case-control study, 25 patients with NSTEMI and 25 controls were included. In serum samples, cardiac markers (troponin I and CK-MB), oxidative stress biomarkers including lipid peroxidation (LPO), total antioxidant capacity (TAC), total thiol groups (TTG), superoxide dismutase (SOD) activity, glutathione peroxidase (GPx) activity, and iron and ferritin levels were measured. Results: In patients with NSTEMI, serum levels of cardiac markers (troponin I and CK-MB), LPO, iron, and ferritin were significantly higher than in controls. In contrast, TAC, TTG, and SOD and GPx activities were significantly lower in patients with NSTEMI. Conclusion: This study demonstrated a possible role of oxidative stress in the pathophysiology of NSTEMI. Elevated iron and LPO levels and reduced GPx activity may contribute to cardiac cell death through ferroptosis.
