Afshin Amirpour

Nonbacterial thrombotic endocarditis (NBTE) is a rare cardiac disease with a nonspecific presentation associated with hypercoagulable states including malignancy and autoimmune disorders, such as antiphospholipid syndrome (APS) and systematic lupus erythematosus. A 34‐year‐old male with a history of pulmonary thromboembolism presented to the hospital complaining of chest pain as an initial symptom. Transthoracic echocardiography revealed the presence of a mass‐like lesion adhering to the anterior leaflet of the mitral valve. Once infective endocarditis was excluded, further imaging studies suggested that the cardiac neoplasm was the primary cause of the patient’s symptoms, and the patient underwent surgical excision of mass along with mitral valve replacement. Microscopic analysis of the removed mitral valve mass indicated the presence of fibrotic tissue with thick collagen bundles and no inflammatory infiltrates, supporting the diagnosis of NBTE. Investigations for underlying conditions demonstrated persistent elevated titers of anti–β2 glycoprotein I IgG, supporting a diagnosis of APS. The patient was started on warfarin therapy with a closely monitored International Normalized Ratio (INR). After 6 months of follow‐up, the patient reported no complications. This case highlights the importance of considering NBTE as a potential differential diagnosis in patients with intracardiac mass and inspecting associated conditions such as APS, as well as challenges encountered in diagnosis and management.

Left ventricular global longitudinal strain (LVGLS) is a highly sensitive echocardiographic biomarker that detects signs of myocardial dysfunction. It has been proven that exercise‐based cardiac rehabilitation (CR) improves LV‐GLS but whether high‐intensity interval training (HIIT) is more efficient than moderate‐intensity interval training (MIIT) to improve LV‐GLS as cardiac deformation index in cardiovascular patients is debatable. In the current systematic review and meta‐analysis, different digital databases including PubMed, Scopus, Web of Science (ISI), and Google Scholar were searched systematically with no time restriction to answer the abovementioned question. Studies were included that reported GLS as the outcome in CVD subjects before and after enrolling in HIIT and/or MITT. A random effects model was used for meta‐analysis. Eleven sets of results from nine articles—two of which had two sets of results—were included. The result of the sensitivity test to check the publication bias was not significant either for MIIT ( p = 0.211) or for HIIT ( p = 0.238). Our findings showed that GLS was improved significantly after both MIIT (−1.72. [−2.68, −0.77]) and HIIT (−1.86 [−3.01, −0.71]) in CVD patients; however, the effect of HIIT was greater than MIIT. Subgroup analysis results showed that baseline disease and duration of exercises do not influence the effect of training on GLS. More studies are needed to confirm the conclusion.

Introduction: Sodium–glucose cotransporter 2 (SGLT2) inhibitors are emerging antidiabetic agents with various potential cardiovascular benefits. The EMPT‐ANGINA trial examined the effect of empagliflozin on the angina burden in those with concurrent type 2 diabetes mellitus (T2DM) and refractory angina (RA).Method: In this 8‐week, double‐blind, randomized, placebo‐controlled trial, 75 patients with T2DM and RA were randomly assigned to one of two groups: empagliflozin (n = 37) and placebo (n = 38). The primary outcome was an improvement in angina, which was assessed by the Seattle Angina Questionnaire (SAQ). The secondary outcomes of this study included alterations in the SAQ domains and exercise test components.Results: The mean age of individuals in the empagliflozin and placebo groups was 67.46 ± 9.4 and 65.47 ± 7.0 years, respectively (p = .304). Patients who received empagliflozin showed a significant improvement in both the primary endpoint, which was the SAQ Summary Score (192.73 ± 20.70 vs. 224 ± 25.36, p < .001) and the secondary endpoints. Exercise test components, including treadmill exercise duration, time till angina, 1 mm ST‐segment depression onset, and heart rate (HR) recovery, were all significantly improved in the empagliflozin group. This positive impact was reached with no clinically significant changes in resting and exertion HR or blood pressure. There were no significant side effects in the empagliflozin group (p = .125).Conclusion: Empagliflozin can be safely added as a metabolic modulator agent to existing antianginal medications in individuals with concurrent T2DM and RA to reduce angina symptoms and enhance exercise capacity with minimal side effects.

Background: The objectives of this study were to assess the relation of blood groups and the rate of successful angioplasty in patients with ST-elevated myocardial infarction (STEMI) and also to investigate long-term adverse outcomes follow-up. Materials and Methods: In this study, 500 eligible patients with definitive diagnosis of STEMI who underwent primary percutaneous coronary intervention (PCI) were followed up for 3 years. The patient's angiography images were examined and thrombolysis in myocardial infarction (TIMI) flow rate and coronary artery patency rate were evaluated in different ABO blood groups. All patients were followed up after 3 years based on major adverse cardiovascular events. Results: There was no significant difference in coronary artery patency rate between the patients of the different blood types with respect to TIMI flow before (P = 0.19) and after revascularization (P = 0.69). The incidence of atrial fibrillation (AF) in blood Group A was the highest. Death in the blood Groups AB and O was significantly higher than the other groups. No significant differences were seen in different blood groups in the frequency of mortality (P = 0.13), myocardial infarction (P = 0.46), heart failure (P = 0.83), re-hospitalization, angiography (P = 0.90), PCI (P = 0.94), coronary artery bypass graft (P = 0.26), implantable cardioverter defibrillator (ICD) implantation (P = 0.26), and mitral regurgitation (P = 0.88). Conclusion: The incidence of AF in blood Group A and inhospital mortality in blood Groups AB and O were the highest. The blood group may be considered in assessment of clinical risk in STEMI patients.

Background. The probable impact of growth hormone (GH) as a heart failure (HF) treatment strategy is still less investigated. Therefore, we aimed to evaluate the relation of 3-month GH prescription on left ventricular ejection fraction (LVEF), interventricular septum (IVS), posterior left ventricle (LV) thickness, end systolic and end diastolic diameters (ESD and EDD), and pulmonary arterial pressure (PAP) among Iranian individuals suffering from HF due to MI attack. Methods. A total of 16 clinically stable participants with HF diagnosis and % were selected for enrollment in this pilot randomized double-blinded study. They were randomly assigned equally to groups received 5 IU subcutaneous GH or placebo. Injections were done every other day for a total of 3-month duration. After termination of intervention and nine months afterwards, cardiac outcomes were assessed. Results. Baseline and 12-month posttrial participants’ characteristics were similar. LVEF was increased significantly by three months started from baseline in individuals receiving GH (% to %, ). During the next 9 months of follow-up concurrent with cessation of injections, LVEF was declined (% to %, ). LVEF and ESD were remarkably higher and lower in GH group compared with controls by the end date of injections (% vs. %, and mm vs. mm, , respectively). No...