Rozita Jalalian

The late onset of significant symptoms in this case provides valuable insight for future research on multiple neoplasia and endocrine syndromes, emphasizing the challenges of timely recognition. As syndromic features may regress over time, careful attention to detailed clinical history and subtle past manifestations remains essential for diagnosis and management.

Background: ST-segment elevation myocardial infarction (STEMI) can lead to significant changes in left ventricular (LV) structure, ultimately resulting in left ventricular remodeling (LVr). Objectives: The present study aims to investigate the capability of speckle tracking echocardiography (STE) and Post Systolic Shortening Index (PSSI) to predict LVr, improvement in left ventricular ejection fraction (LVEF), and the detection of viable myocardium in STEMI patients. Methods: This prospective cohort study included 47 patients with STEMI and Q-ST elevation in V1 - V4 precordial leads on electrocardiogram (ECG), who underwent percutaneous coronary intervention (PCI) after 24 hours (late PCI). Echocardiography was performed before PCI and 6 weeks post-PCI. Results: Left ventricular remodeling and improvement in LVEF were observed in 15 (31.9%) and 23 (48.9%) patients, respectively, after PCI. The average pre-PCI PSSI in patients with LVr was significantly lower (P = 0.005) than in those without remodeling. Conversely, the average pre-PCI PSSI in patients with improved LVEF was significantly higher (P = 0.004) than in those without improvement. The receiver operating characteristic (ROC) curves indicated that pre-PCI PSSI can predict LVr (AUC = 0.74; 95% CI: 0.6 - 0.91; P = 0.005) and LVEF improvement (AUC = 0.75; 95% CI: 0.6 - 0.89; P = 0.004) post-PCI. Cut points of 19 and 20 for pre-PCI PSSI had the highest accuracy for predicting LVr and LVEF improvement post-PCI (74.47% and 72.34%, respectively). Conclusions: The study demonstrates that in STEMI patients undergoing late PCI, STE indicators, including PSSI, are predictive of LVr, LVEF improvement, and can identify viable myocardium.

Few studies have investigated the potential predictive value of glycosylated hemoglobin A (HbA1c) and clinical outcomes in diabetic patients after percutaneous coronary intervention (PCI), and the results of the reports have often been inconclusive and contradictory. We have organized a study to investigate the relationship between HbA1c and the occurrence of major adverse cardiovascular events (MACE) in diabetic patients after PCI. This case-cohort study was conducted on 563 diabetic patients who underwent PCI. All studied patients had an HbA1c level measured within 24 h before angioplasty. All patients were followed for six months regarding the occurrence of MACE, and the HbA1c level was measured again at the end of the sixth month of follow-up. In the case of MACE, the subjects were considered the case group, and other non-MACE patients were included in the control group. 505 patients remained in the study at the end of follow-up. MACE occurred in 23 (4.6%) patients during the first month and in 57 (11.3%) patients by the end of the sixth month. Baseline HbA1c was an independent predictor of MACE and mortality at the end of month-6 (P = 0.008 and 0.001, respectively). The level of HbA1c at the time of admission has a significant predictive value for the occurrence of MACE in diabetic patients who undergo PCI. However, post-PCI glycemic control may not effectively reduce the risk of MACE in this population. Not applicable.

Non-bacterial thrombotic endocarditis (NBTE) presented a diagnostic dilemma in a 54-year-old woman with metastatic colon cancer. A large mass on the tricuspid valve initially suggested tumoral invasion. However, prompt anticoagulation led to complete resolution, indicating NBTE. This case highlights the challenges of differentiating NBTE from metastatic disease in high-risk patients. While transthoracic and transesophageal echocardiography (TTE and TEE) raised suspicion of tumor spread, anticoagulant therapy achieved successful resolution, potentially offering an alternative management approach. The case report proposes considering novel oral anticoagulants (NOACs) like apixaban for such scenarios.

Key Clinical Message: Systemic lupus erythematosus (SLE) can have various manifestations. Although cardiac involvement is very common in SLE patients, a severe acute pericarditis as the first manifestation of SLE in a male patient is relatively rare. A 36‐year‐old male was admitted to our hospital with acute pericarditis, large circumferential fibrinous pericarditis, and major criteria of a high‐risk case of acute pericarditis. After a complete investigation, the underlying disease was revealed to be SLE. All of his symptoms were completely resolved after 6 weeks of treatment with non‐steroidal anti‐inflammatory drugs and corticosteroids with no need for a pericardiocentesis. Patients with acute fibrinous pericarditis should be considered and precisely investigated for multiorgan autoimmune process such as SLE, to avoid unnecessary intervention, and minimize the risk of recurrence and chronicity of the condition.

Introduction:Pericardial syndromes are not uncommon manifestations in clinical practice [1]. About 5% of all patients admitted to the emergency department with the chief complaint of chest pain, are diagnosed with acute pericarditis [2]. Cardiac involvement is a common presentation of different autoimmune rheumatic diseases. Systemic lupus erythematous (SLE) is a chronic autoimmune rheumatic disease with multiorgan involvement. Cardiac involvement has been reported in about 50% of SLE patients; in some cases, as their first presentation of SLE [3]. The most common type of cardiac involvement in SLE patients is pericarditis [4]. While it is classically known that SLE like most of other autoimmune diseases are more prevalent in women, cardiac involvement as pericarditis in SLE is more prevalent in male patients [2]. Although being a common manifestation of SLE, it is uncommon for acute fibrinous pericarditis with constrictive features to be the first presentation of SLE in patients with severe manifestations and in need for hospital admission [5].

Background: ST-segment elevation myocardial infarction (STEMI) is usually caused by a rupture in the atherosclerotic plaque, followed by platelet aggregation which ultimately leads to acute coronary artery occlusion. So far, few studies have investigated the effect of maintenance dose of Eptifibatide (glycoprotein IIb/IIIa inhibitor) in STEMI patients who underwent primary percutaneous coronary intervention (PPCI). Therefore, in this study, we investigated the effect of maintenance dose of Eptifibatide in patients with STEMI who underwent PPCI. 264 patients who had acute chest pain suggestive of STEMI were entered in the study. All patients received the same dose of bolus dose of Eptifibatide in the cardiac catheterization laboratory. Then the patients were randomly divided into two groups, one group (n = 147) received a maintenance dose of intravenous Eptifibatide (infusion of 2 μg/kg/min) and the other group (n = 117) did not receive this treatment. Standard medical treatment of STEMI after PPCI was performed based on guidelines and the same in both groups. All patients were evaluated 1, 2, and 3 months after the start of treatment in terms of predicted outcomes.Results: The occurrence of 3-month major adverse cardiovascular events (MACE) between the case and control groups did not have a statistically significant difference (28.6% versus 35.0%;Pvalue: 0.286). Also, investigations showed that the rate of re-infarction (Pvalue: 0.024) and target lesion revascularization (Pvalue: 0.003) was significantly lower in the group that received Eptifibatide infusion.Conclusions: Eptifibatide maintenance dose infusion in patients who undergo PPCI in the context of STEMI, does not significantly reduce MACE, although it does significantly reduce re-infarction and target lesion revascularization. It also does not increase the risk of bleeding and cerebrovascular events.

Aim: ST-segment elevation myocardial infarction (STEMI) is usually caused by a rupture in the atherosclerotic plaque, followed by platelet aggregation which ultimately leads to acute coronary artery occlusion. In this study, we investigated the effect of maintenance dose of Eptifibatide (intravenous drug of GP IIb/IIIa inhibitor) in patients with STEMI who underwent primary percutaneous coronary intervention (PPCI). Methods: 264 patients who had acute chest pain suggestive of STEMI were entered in the study. All patients received the same dose of bolus dose of eptifibatide. Then the patients were randomly divided into two groups, one group (n=147) received a maintenance dose of intravenous eptifibatide (infusion of 2g/kg/min) and the other group (n=117) did not receive this treatment. All patients were evaluated 1 and 3 months after the start of treatment in terms of predicted outcomes. Results: The occurrence of three-month MACE between the case and control groups did not have a statistically significant difference (28.6% versus 35.0% ; P-value: 0.286). Re-hospitalization occurred in 10 patients (6.8%) from the case group and 30 patients (25.6%) from the control group, which was statistically significant (P-value: 0.000). Also, investigations showed that the rate of re-infarction (P-value: 0.024) and target lesion revascularization (P-value: 0.003) was significantly lower in the group that received Eptifibatide infusion. Conclusion: Eptifibatide maintenance dose infusion in patients who undergo PPCI in the context of STEMI, does not significantly reduce MACE, although it does significantly reduce re-hospitalization and re-infarction. It also does not increase the risk of bleeding and cerebrovascular events.

Pulmonary artery and pulmonary valve sarcoma are malignant and very rare vascular tumors with aggressive clinical course and very poor outcomes. Patients affected by coronavirus disease of 2019 (COVID-19) are at a higher risk for thromboembolism complication. We describe a young woman with a history of coronavirus pneumonia and progressive dyspnea, hemodynamic disturbance, edema with initial evaluation, and clinical diagnosis of pulmonary thromboembolism. But further imaging study and pathology demonstrated giant sarcoma of pulmonary valve, obstructing pulmonary valve and extending to right ventricular outflow tract and main of pulmonary artery.

Pulmonary artery and pulmonary valve sarcoma are malignant and very rare vascular tumors with aggressive clinical course and very poor outcomes. Patients affected by coronavirus disease of 2019 (COVID-19) are at higher risk for thromboembolism complication. we describe young woman with history of corona virus pneumonia and progressive dyspnea, hemodynamic disturbance, edema with initial evaluation and clinical diagnosis of pulmonary thromboembolism. But further imaging study and pathology demonstrated, Giant sarcoma of pulmonary valve, obstructing pulmonary valve and extending to right ventricular outflow tract and main of pulmonary artery.