Babak Bagheri

Effects of depression and anxiety symptoms on cardiac mortality following myocardial infarction: a 2-year follow-up.

Abstract Objective. The purpose of this study was to determine the impact of symptoms of depression and anxiety on mortality in patients hospitalized for acute myocardial infarction (MI). Methods. A total of 806 consecutive patients were screened within 15 days after MI and 24-month survival rate was ascertained. The Beck Depression Inventory and the State-Trait Anxiety Inventory were completed by patients hospitalized for MI. We tested the BDI × STAI interaction effect in addition to the BDI and STAI main effects. Results. At 24 months’ follow up cardiac mortality was assessed in 540 of 806 eligible patients (67% response rate); 531 of 806 for whom baseline data were collected (65.9%) were depressed and 556 (69.0%) were anxious after their MI. Fifty-five (10.2%) patients died during the 24-month follow-up. Neither state of anxiety nor depression scores at entry was different between patients who died from those who survived. Conclusions. Symptoms of depression and anxiety did not predict cardiac mortality after MI, but despite the negative results regarding the impact of depression on cardiac outcome, it should be stressed that this does not mean that physicians and cardiologists could ignore depression and anxiety.

Serum level of copper in patients with coronary artery disease

Background: Atherosclerotic disease is the most important cause of mortality in the world. Oxidation is an important pathway in the pathogenesis of coronary artery disease (CAD) through oxidation of low-density lipoprotein (LDL) and free radical formation. Copper (Cu) is an essential micronutrient for enzymes that catalyse LDL oxidation reactions. Therefore, an evaluation of Cu in the atherosclerotic disease is important. Materials and Methods: In this study, 334 subjects without recent cardiac event and history of collagen vascular or infectious disease were investigated. All patients divided into four groups to evaluate severity of CAD according to Syntax scoring system. All groups were matched in cardiovascular risk factors. Results: The serum level of Cu was significantly higher in total atherosclerotic groups than normal group (P value = 0.001) and significantly increased with severity of atherosclerosis. Conclusion: The finding indicated that the serum level of Cu is higher in atherosclerotic patients and it increases with severity of atherosclerosis. Therefore, it may be possible that the basic relationship exist between serum Cu level and atherosclerosis and an association between Cu level and severity of atherosclerosis.

Relationship between epicardial fat and coronary microvascular dysfunction

BACKGROUND Coronary microvascular dysfunction (CMVD) is often suggested in patients with typical chest pain and abnormal stress test results that are indicative of myocardial ischaemia, in whom coronary angiography fails to show fixed stenosis inepicardial coronary arteries. The efficacy of pharmacologic treatment on clinical outcome remains to be determined. AIM To determine the relationship between CMVD and epicardial fat thickness (EFT). METHODS A case-controlled study was conducted on 124 patients, aged 40-91 years. A matched set of 62 symptomatic and 62 asymptomatic patients underwent an exercise electrocardiogram and transthoracic echocardiography. Coronary angiography was performed in patients with abnormal exercise test results. Patients without coronary artery disease were considered for the study. EFT was measured by transthoracic echocardiography in all patients. RESULTS EFT was significantly higher in patients with positive exercise test results (but normal epicardial coronary arteries) compared to patients with negative exercise test results (p < 0.001). Additionally, the HDL-cholesterol level was significantly lower in patients with positive exercise test results (but normal epicardial coronary arteries) compared to patients with negative exercise test results (p < 0.0001). CONCLUSIONS Patients with increased EFT are at an increased risk for developing angina, recurrent hospitalisation and adverse outcomes, even with normal epicardial coronary arteries.

Coincidence of Total Anomalous Pulmonary Venous Drainage to the Superior Vena Cava, Common Atrium, and Single Ventricle: A Very Rare Condition

Single ventricle defects, including inflow emptying into 1 ventricle, occur at an incidence of 0.05–0.1 per 10,000 live births. The association of total anomalous pulmonary venous drainage (TAPVD) with single ventricle defects is a risk factor for poor outcome. Conversely, common atrium, a rare congenital anomaly, is an endocardial cushion defect. We present a rare case of an unoperated patient with coincidence of a single ventricle defect, TAPVD with direct drainage from the pulmonary veins into the superior vena cava, and common atrium. To the best of our knowledge, such a case has not been previously reported in the literature.

Life Psychosocial Stresses and Coronary Artery Disease

Background: It is hypothesized that the impacts of life events accumulate and can trigger and promote atherosclerosis in susceptible individuals. In the current study, the correlation of total life stressors during 1 year was investigated relative to coronary artery disease (CAD). Methods: The study population consisted of 148 males and 152 females aged 35–76 years. The subjects were classified as CAD cases and controls according to the results of coronary angiography. The severity of CAD was scored on the basis of the number and the extent of lesions at coronary arteries. The stressful events of life were assessed using Holmes-Rahe Questionnaire and was presented as total psychological stress scores per year (TPSS). Results: The frequency of cigarette smoking, diabetes mellitus, and hypertension was more prevalent in CAD cases than control subjects. The levels of TPSS were increased in patients with CAD compared to the controls (160.3 ± 71.3 vs. 139.8 ± 66.5, P = 0.020). TPSS was also associated positively with the levels of uric acid, erythrocytes counts, erythrocyte sedimentation rate, aspirin consumption, and negatively with high-density lipoprotein-cholesterol and apo-AI. In logistic regression analysis, TPSS correlated with the occurrence of CAD by the odds ratio of 1.773 (1.073–2.930), P = 0.025, but the association was weakened after adjustment for classical risk factors, especially hypertension. TPSS exhibited significant association with the severity of CAD [F (3,274) = 2.6, P = 0.051]. Conclusions: The results suggest that TPSS are associated with the occurrence and severity of CAD significantly, but the association is not independent.

Coincidence of Congenital Agenesis of Left Lung and Common Atrium: A Very Rare Case

Pulmonary agenesis is characterized by undeveloped pulmonary vessels, bronchi as well as lung parenchyma and is a rare congenital anomaly with unknown etiology. It is usually diagnosed during childhood. Nearly, one third of these patients have concomitant congenital heart diseases. While more than 50% of these patients die before the age of 5 years, some other patients may be asymptomatic throughout their life. On the other hand, common atrium, another rare congenital anomaly, is characterized by complete absence of the atrial septum and is usually accompanied by atrioventricular valve malformations. An 18‐year‐old male presented with concomitant pulmonary agenesis and common atrium and had not undergone surgery due to high risk for mortality.

Esterification of HDL cholesterol is Decreased in Diabetes Mellitus and CAD and Enhanced Following Treatment with Statins

Background: The main goal of using statins is to reduce the level of plasma cholesterol, meanwhile they have a wide spectrum of actions. Objectives: To identify the effect of statins on fractional cholesterol esterification (FCE) as well as the complete profile of lipids and (apo)lipoproteins. Design and methods: In an age and sex matched case-control study, 400 subjects who were referred for coronary angiography were divided into two groups according using statins. Results: Total cholesterol was decreased significantly following treatment with statins (165.6 ± 38.0 mg/dL vs. 205.3 ± 48.4, p≤0.001). About 90% of the reduction was occurred in nonHDL and 10% in HDL fraction. Reduction of nonHDL cholesterol (125.2 ± 35.2 mg/dL vs. 162.8 ± 45.2, p≤0.001) occurred on both unesterified (52.4 ± 21.5 mg/dL vs. 65.2 ± 25.5, p≤0.001) and esterified cholesterol (74.7 ± 27.3 mg/dL vs. 96.6 ± 34.1, p≤0.001). But the decrease in HDL cholesterol (40.4 ± 10.0 mg/dL vs. 42.3 ± 9.9, p≤0.079) happened exclusively in unesterified fraction (10.9 ± 3.4 vs. 15.2 ± 5.1, p≤0.001) and was counterbalanced with a significant increase in esterified portion (29.5 ± 8.2 mg/dL vs. 27.2 ± 9.5, p≤0.020). The ratio of esterified- per total- cholesterol in HDL was 67.5 ± 8.1% in the control group and was decreased to 58.0 ± 14.9% (p≤0.01) in diabetes and CAD and increased to 73.5 ± 6.9 (p≤0.01) after using statins. Conclusions: The results suggest that the percent of esterified cholesterol in HDL fraction is decreased in diabetes and CAD patients and increased by using statins.

The Ratio of Unesterified/esterified Cholesterol is the Major Determinant of Atherogenicity of Lipoprotein Fractions

Background The hypothesis is proposed that the atherogenicity of lipoporotein fractions is correlated with the content of unesterified cholesterol. Objectives To evaluate the role and prognostic values of unesterified and esterified cholesterol in lipoprotein fractions for coronary artery disease (CAD). Design and methods The study population consisted of 400 patients who were divided to CAD controls and cases according to the data of coronary angiography. Fractional cholesterol esterification (FCE) as well as the complete profile of lipids and (apo)lipoproteins were determined. Results Total cholesterol was increased significantly in CAD patients (196.3 ± 52.3 mg/dL vs. 185.7 ± 48.0, p≤ 0.049) and the increment occurred totally in unesterified portion (77.2 ± 28.4 mg/dL vs. 71.1 ± 24.4, p≤ 0.031). HDL cholesterol showed a significant decrease in CAD group (39.9 ± 9.5 mg/dL vs. 44.6 ± 10.5, p≤ 0.001), but the decrement occurred wholly in the esterified portion (26.2 ± 9.2 mg/dL vs. 31.1 ± 8.1, p≤ 0.001). NonHDL cholesterol was increased significantly in CAD group (156.8 ± 48.3 mg/dL vs. 140.3 ± 43.6, p≤ 0.001), and the changes occurred in both un- and esterified portions. FCE in HDL was diminished significantly in CAD patients (64.8 ± 13.9% vs. 69.3 ± 7.9, p≤ 0.01). In multivariate logistic regression analysis, unesterified cholesterol in NonHDL (UeNonHDLc) and esterified cholesterol in HDL (EsHDLc) excluded total cholesterol and HDLc respectively from the regression equation. In ROC analysis, the ratio of UeNonHDLc/EsHDLc was the strongest predictor for CAD among cholesterol subfractions. Conclusions The results confirm that UeNonHDLc is atherogenic and EsHDLc is antiatherogenic and are independent risk factors for CAD.

The Role of Doppler Imaging in the Assessment of Right Ventricular Function: a Case-control Study of Acute Inferior Wall Infarction

Background Right ventricular infarction (RVI) develops in 30-50% of patients with inferior wall infarction (IWI). The rates of mortality, morbidity, and complications in these patients are greater than in the patients without RVI. We compared the tissue Doppler imaging (TDI) indices between a group of patients with IWI and RVI, with a similar group of patients who had IWI alone to investigate the application of TDI indices in the evaluation and detection of right ventricular function. Material and Methods We studied 49 patients with first acute IWI in two groups. Group 1 (N=24) were patients with IWI and RVI while group 2 consisted of patients with IWI alone (N=25), based on standard electrocardiogram criteria. The peak systolic (Sm), peak early (Em) and late (Am) diastolic velocities, and Em/Am ratio were obtained from the apical four chamber view, at the lateral side of the tricuspid annulus. We measured trans-tricuspid early (ET) and peak (AT) filling velocity, ET/AT ratio, right ventricular end diastolic diameter (RVEDD), and tricuspid annular plane systolic excursion (TAPSE) by M-mode TDI projected at the long axis of parasternal view. Results The RVEDD and E/Em ratio were increased, while the TAPSE was significantly decreased in the patients with RVI as compared to those without RVI (4.7± 0.6 vs. 3.1±0.2 cm; p < 0.005, 5.6±2.21 Vs 4.5±1.2; p<0.006 and 1.7±0.4 vs. 2.3±0.5 cm; p <0.0001, respectively). However, the other statistically measured parameters were not significantly different between these groups. Conclusion The measurement of RVEDD, E/Em ratio, and TAPSE, as right ventricular myocardial systolic and diastolic parameters by pulse wave TDI could be used to objectively assess the status of RV condition in patients with first acute IWI.

Iron hypothesis and coronary artery disease in geriatric patients

Abstract Context and aims: Iron is a pro-oxidant factor in the pathogenesis of CAD. The association of body iron status was investigated relative to the occurrence and severity of CAD. Design and methods: The subjects consisted of 110 males and 115 females who were classified as either a CAD case or a control according to the results of coronary angiography. Results: A new parameter, the “serum free iron index,” was defined as the ratio of serum iron to UIBC. The level of ferritin showed significant increase [97.2 (67.0–171.2) µg/L vs. 85.6 (52.5–129.4), p = .034], whereas serum total iron, free iron index, transferrin, UIBC and iron saturation were unchanged in CAD patients relative to control group. Among the indices of body iron only serum ferritin had significant association with the likelihood (OR of 1.004 (1.000–1.007), p = .04) and severity of CAD [χ2(3)= 7.99, p = .01], but the correlation was lessened in the presence of classical risk factors. Serum ferritin had also the highest and significant efficiency to predict CAD (AUC = 0.61, p = .020). Conclusions: Serum ferritin as a marker of intracellular iron has significant association with CAD; nevertheless, the correlation is not independent. Since iron deficiency is prevalent in elderly patients, iron hypothesis needs to expand to the both sides of iron deficiency and toxicity.