Background: Peripheral arterial disease (PAD) is a vascular condition for which many therapeutic decisions are well established; nonetheless, the potential role of trimetazidine (TMZ) in diabetic patients with PAD remains debatable and warrants further investigation. Objective: This study aimed to determine the effect of TMZ on diabetic patients with intermittent claudication. Methods: In this two-center prospective study, 188 diabetic patients with PAD received guideline-directed medical therapy (GDMT) with (n =93) or without (n =95) TMZ. Baseline and 6-month assessments included the 6-minute walk test (6MWT), ankle-brachial index (ABI), duplex ultrasound, and diabetic foot outcomes (P <0.05). Results: The study included 188 diabetic patients with symptomatic PAD. Patients were divided into Group I, which received all GDMT with TMZ as part of chronic coronary syndrome treatment (93 patients), and Group II, which received all GDMT without TMZ (95 patients). All patients were evaluated at baseline and after a 6-month follow-up period for exercise performance via 6MWT, lower limb hemodynamics via ABI, and the incidence of diabetic foot requiring amputation. At the end of the follow-up period, 6MWT and ABI improved significantly from baseline findings in both groups. The TMZ group demonstrated a substantial improvement in 6MWT, a nonsignificant improvement in ABI, and a nonsignificant reduction in diabetic foot requiring amputation compared with the non-TMZ group. Conclusions: TMZ may improve exercise performance in diabetic patients with PAD, while its role in improving limb hemodynamics or ischemia is nonsignificant and uncertain.
Introduction: Transient ST-segment elevation myocardial infarction (TSTEMI) is often associated with better prognosis due to spontaneous reperfusion, yet its progression to Wellens syndrome indicates severe left anterior descending (LAD) occlusion and raises the risk of anterior infarction. Case Presentation: We describe a 61-year-old woman with the initial presentation of typical chest pain (numeric rating scale [NRS]: 6/10) and ST-segment elevation at the extensive anterior leads at the referring hospital. The patient was given dual antiplatelet treatment and referred to our hospital. Upon arrival, her symptoms resolved (NRS: 0/10), and her ST-segment elevation was evolved to biphasic T waves in leads V2-V6 along with ST elevation-T-wave inversion in leads I and aVL, similar to Wellens syndrome. Cardiac biomarkers were markedly elevated, and echocardiography revealed hypokinetic wall motion abnormalities. Coronary angiography revealed proximal LAD occlusion, a feature of Wellens syndrome. Despite the potential for extensive myocardial damage, the patient was managed under a delayed invasive strategy. She remained stable after the intervention and at 3 months' follow-up at the outpatient clinic. Conclusions: Conversion of TSTEMI to Wellens syndrome raises clinical dilemma regarding invasive strategy decision-making. TSTEMI occurs due to spontaneous resolution, which can be partial or total, yet the risk of spontaneous reocclusion is also inevitable. TSTEMI requires an early invasive strategy (< 24 h) with close monitoring of new or worsening ischemic signs; however, the urgency may be individualized on a case-by-case basis.
Introduction: Cardiovascular disease is the most common cause of death globally, and its risk among women with breast cancer (BC) is not fully assessed. This study aimed to evaluate the cardiovascular risk among women with BC using atherogenic indices. Methods: Ninety women were recruited for this cross-sectional study and stratified into BC and controls. Anthropometric measurements were taken, followed by blood collection (5 mL) for lipid profile (TC, TG, LDL-c, and HDL-c) assay. Castelli risk index I and II (CRI-I and CRI-II), atherogenic index of plasma (AIP), atherogenic coefficient (AC), Cholindex (CI), and non-HDL-c (NHC) were calculated to estimate cardiovascular risks. Data were analyzed by SPSS 22 using the Student t test and the Pearson correlation and presented as mean +/- SD. A P value of less than 0.05 was considered significant. Results: Women with BC were significantly younger than controls (51.6 +/- 10.3 vs 59.0 +/- 12.7 y; P = 0.003) and had significantly lower mean waist circumference (90.5 +/- 11.3 vs 96.3 +/- 14.9 cm; P = 0.036). The mean serum TG and HDL-c (1.11 +/- 0.4 vs 1.36 +/- 0.5 mmol/L; P = 0.015 and 1.09 +/- 0.4 vs 1.48 +/- 0.3 mmol/L; P = 0.000) were significantly lower in the BC group. CRI-I, CRI-II, and AC were significantly higher in the BC group than in the controls (4.83 +/- 2.0 vs 3.69 +/- 0.9; P = 0.001 and 3.29 +/- 1.8 vs 2.24 +/- 0.8; P = 0.001 and 3.83 +/- 2.0 vs 2.68 +/- 0.9; P = 0.000), respectively. A higher proportion (80.4%, 38.3%, and 59.6%) of women with BC had a high risk of cardiovascular disease than controls (69.8%, 9.3%, and 27.9%), respectively, except for NHC. Conclusions: In this study, women with BC had a high risk of cardiovascular disease. Estimating the atherogenic indices of women with BC may be beneficial.
Background: Central venous catheters (CVCs) are essential for vascular access but are associated with catheter-related bloodstream infections (CRBSIs), which can cause significant morbidity and mortality, particularly among hemodialysis patients. This study aimed to investigate risk factors for CVC infections, evaluate the role of echocardiography in diagnosis and prognosis, and assess outcomes of different catheter management strategies. Methods: A longitudinal study of 166 patients with confirmed CVC infections was conducted at Rasoul Akram Hospital, Tehran, Iran, from 2014 through 2022. Data included demographics, comorbidities, catheter site/duration, microbiological cultures, echocardiographic findings, and treatment outcomes. Statistical analyses included the chi 2 test, the t test, ANOVA, and regression methods using SPSS, version 26. Results: Participants had a median age of 58 years (IQR, 45-67), and 54.8% were women. Fever was the most common presenting symptom (52.4%). Vegetations were detected in 52 patients (46.4%), most commonly at the catheter site. No significant difference in mortality was found between percutaneous and surgical catheter removal methods (P = 0.26). Vegetation size was not associated with mortality (P = 0.516). Patients with diabetes and transfusion history had longer hospital stays. Recurrence of infection was highest (37.9%) in those managed without catheter removal. Conclusions: Echocardiography plays a critical role in the diagnosis and prognosis of CVC infections. Catheter removal, whether percutaneous or surgical, did not influence in-hospital mortality, even in cases with large vegetations. However, failure to remove infected catheters increased the recurrence risk. (Iranian Heart Journal 2026; 27(2): 54-64)
Background: Risk stratification is the first step to prevent cardiovascular disease. Cardiac training tests perform it with the Duke Treadmill Score (DTS). The limitations and complications that may occur during cardiac training tests require alternative laboratory examinations. High-sensitivity C-reactive protein (hs-CRP) is an independent predictor of cardiovascular events. This study analyzed the relationship between hs-CRP and the Duke Treadmill Score. Methods: This study has a cross-sectional, observational analytical design. Blood samples were taken from 40 patients who underwent cardiac training at Airlangga University Hospital and Telkom Laboratory in Surabaya, Indonesia. Patients' hs-CRP levels were measured by TMS 24i Premium Tokyo Boeki in the clinical pathology laboratory of Airlangga University Hospital. Results: The average age of subjects was 43 years. Most subjects were male (60%) and had an increase in low-density lipoprotein cholesterol (92.5%). Hypertension was found in 22.5% of subjects. Most subjects were nonsmokers (70%), had a normal body mass index (82.5%), and did not have diabetic mellitus (82.5%). The mean hs-CRP level was 6.04 +/- 9.79 mg/L. DTS results showed-5.13 +/- 9.3. There was a correlation between serum hs-CRP and DTS by Spearman analysis (P =-0.85 and P < 0.05). Conclusions: Hs-CRP can be an alternative laboratory examination for stratifying cardiovascular event risks to cover DTS by cardiac training tests.
