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Key Clinical Message: To confirm the diagnosis of cardiac lipomas, it is crucial to use multimodality imaging and also histopathology examination if the patient underwent surgery. But surgery is not needed in many cases unless there are life‐threatening situations. Cardiac lipoma is a rare condition which is believed as a benign tumor; here, we want to present a case of young adult lady who came to our hospital complaining of chest pain and diagnosed cardiac mass by echocardiography that underwent cardiac MRI which showed cardiac lipoma and managed conservatively by serial echocardiography. [ABSTRACT FROM AUTHOR]

Introduction: Trastuzumab is one of the most effective treatments in HER - 2 positive breast cancer patients. One of the important side effects of trastuzumab is cardiotoxicity, which usually occurs as a reduction in the left ventricular ejection fraction (LVEF). Discontinuing the treatment due to cardiotoxicity may lead to cancer progression and worsen prognosis. The aim of the cur rent study was to evaluate the cardiac function in HER - 2 positive breast cancer patients who were candidates for trastuzumab therapy but had already left ventricular dysfunction prior to initiation of the treatment. Methods: HER - 2 positive breast cancer patients with asymptomatic LV dysfunction with LVEF 40 - 53% who were candidates for receiving trastuzumab (after initial chemotherapy) included in this study. Patients were visited in the Cardio - Oncology clinic before initiating the treatment and then before every two cycles of trastuzumab. They also received the standard treatment for heart failure including a beta - blocker (carvedilol) and ACE - I (Lisinopril), up to the maximum tolerated dose, if there were no contraindications. Patients were followed up 6 months after the end of treatment. Myocardial infarction (MI), cardiac arrhythmia, heart failure(HF) symptoms and any death that occurred due to Cardiovascular diseases were recorded as cardiac events. If the LVEF decreased below 40%, the treatment was temporarily interrupted for one or two cycles, and spironolactone was added to the patient's treatment. but If the LVEF improved(=40%), trastuzumab was rechallenged. Results: Thirty - six patients were included in the study. LVEF reduction of more than 10% occurred in 16.7% of the patients, and a GLS reduction of more than 15% was detected in 11.1% of the patients. There was a significant association between a =10% reduction in LVEF and baseline systolic blood pressure (P - value: 0.04). LVEF reduction below 40% was observed in 3 patients, that trastuzumab was interrupted in them. All of these three patients had obesity and uncontrolled HTN, and one of them had symptoms of heart failure (NYHA class II), for whom the trastuzumab treatment was discontinued. In the two other patients, after the temporary interruption of trastuzumab, LVEF improved to above 40%, and the treatment was restarted with close cardiac monitoring; therefore, they could complete the entire one - year treatment period. Conclusions: Continuing the treatment with trastuzumab seems to be safe in patients with reduced LVEF (LVEF = 40 - 53%), but they should be strictly monitored and controlled for cardiovascular risk factors, especially HTN. [ABSTRACT FROM AUTHOR]

Background: Burned-out hypertrophic cardiomyopathy (BO-HCM) is complicated by substantial adverse events. However, few studies have focused on clinical or echocardiographic features and their prognostic values among patients with BO-HCM. Objective: This study evaluated the clinical manifestations and prognostic value of echocardiography in patients with BO-HCM. Methods: The present retrospective study evaluated 401 consecutive patients referred to the echocardiography ward of Rajaie Cardiovascular Center for evaluation of HCM during the period from January 2010 to February 2018. Three hundred six patients who completed the follow-up were included: 78 (25.4%) had BO-HCM and an EF of < 50% (group 1), and 228 (74.5%) had a normal EF in their baseline TTE (group 2). Among the group 2 population, 183 patients had a preserved EF of > 50% (group 2B), and 45 became BO-HCM at the end of their follow-up (group 2A). Clinical data were analyzed, including medical history, electrocardiography, and echocardiography. Generalized estimating equation (GEE) regression was performed to assess the association between patient characteristics and burned-out HCM. Results: An atrial fibrillation (AF) rhythm was more common in the groups with BO-HCM (groups 1 and 2A) (32.8 vs. 14%; P = 0.002), as were Frequent premature ventricular contractions (PVCs) (13.98 vs. 5%; P = 0.040). Moderate or severe systolic anterior motion (SAM) was significantly more common in group 2B (LVEF > 50%) compared with group 1 and 2A, who had an EF of ≤ 50% (32.3% vs. 7.6%; P = 0.006). The S-wave of the right ventricle was significantly lower in groups 1 and 2A (9.73 vs. 11.8 cm/s; P < 0.001). Systolic pulmonary artery pressure (SPAP) was significantly higher in groups 1 and 2A (38.28 vs. 29.74 mmHg, P < 0.001). The differences in the prevalence of asymmetrical septal hypertrophy (ASH), left ventricular outlet (LVOT) obstruction, pericardial effusion (PE), diastolic dysfunction, and mitral regurgitation (MR) were insignificant between all groups. Conclusions: Among the patients suffering from HCM, the presence of AF rhythm, frequent PVCs, significant RV dysfunction, and absence of systolic anterior motion (SAM) of mitral valve leaflets have prognostic value and might be considered predictors for progression to BO-HCM. [ABSTRACT FROM AUTHOR]

Adherence to capecitabine, an effective oral chemotherapy agent, is essential in achieving treatment response in cancer. In this study, we aimed to investigate factors associated with non-adherence to capecitabine in a sample of patients with gastrointestinal cancer. We enrolled 98 patients with colon, rectal or gastric cancers who were undergoing treatment with capecitabine as part of their single or multi-agent chemotherapy regimen. The patients were followed during cohort time up to four consecutive cycles of their chemotherapy. For adherence measurement, the participants were asked to bring back the leftover medicines at the time of follow-up visits and were considered adherent if they had taken ≥95% of their prescribed dose. The mean adherence rate was 97.7%, and the patients were adherent to capecitabine in 93.1% of their cycles. The patients who underwent neoadjuvant chemotherapy were significantly less adherent to capecitabine (60%) as compared with adjuvant (95.2%) and palliative chemotherapy (94.6%) [P=0.004]. Multivariable logistic regression revealed that neoadjuvant chemotherapy and the presence of nausea and mucositis were inversely associated with adherence rate. We did not find any association between adherence and any of our laboratory findings. Our findings suggest a high adherence rate to capecitabine among patients with gastrointestinal cancers. Neoadjuvant chemotherapy and the presence of nausea and mucositis may play a significant role in non-adherence to capecitabine. [ABSTRACT FROM AUTHOR]

Background: Cardiotoxicity, a common complication of chemotherapy, may have irreversible adverse effects on the heart. Anthracycline-based chemotherapy for breast cancer can lead to dilation-hypokinetic cardiomyopathy, eventuating in heart failure. As the primary diagnostic tool for cardiovascular toxicity, echocardiography may be essential in evaluating the heart function of such patients. Objectives: This study aimed to identify the most important echocardiography findings for proper and timely diagnosis of cardiotoxicity in patients with HER2-positive breast cancer undergoing anthracycline-based chemotherapy. Methods: Our final analysis included 132 female patients who were HER2-positive and had breast cancer. All of these patients had one pre-chemotherapy echocardiography and at least one echocardiography after three episodes of anthracycline-based chemotherapy. The patients' age, body mass index, and history of chemotherapy were recorded. Mean alterations from baseline echocardiography to echocardiography after three episodes of chemotherapy were calculated for all parameters evaluated. Data analysis was conducted using the Statistical Package for the Social Sciences v. 26. Results: Significant changes were seen in three-dimensional left ventricular ejection fraction (LVEF 3D), two-dimensional left ventricular ejection fraction (LVEF 2D), left ventricular global circumferential strain (LVGCS), left ventricular global longitudinal strain (LVGLS), left ventricular end-diastolic volume (LVEDV), stroke volume (SV), left ventricular end-systolic volume (LVESV), right ventricular end-systolic dimension (RVESD) in patients with breast cancer (P < 0.0001). RVESD, LVESV, LVEDV, and SV significantly increased after three chemotherapy episodes, but LVEF (3D and 2D), absolute LVGCS, and absolute LVGLS fell significantly. Conclusion: LVEF (3D and 2D), LVGCS, LVGLS, LVEDV, LVESV, SV, and RVESD are important echocardiography parameters in diagnosing cardiotoxicity in patients with HER2-positive breast cancer. [ABSTRACT FROM AUTHOR]

Background: Apical Hypertrophic Cardiomyopathy (ApHCM) is a rare form ofhypertrophic cardiomyopathy with sarcomere protein gene mutations, which predominantly affects the apex of the left ventricle. Sudden Cardiac Death (SCD) and cardiovascular morbidity are less likely to occur in patients with isolated ApHCM. However, recent data suggested annual cardiac death rates of 0.5 - 4%, approaching those for classic HCM. Objectives: The present study aimed to assess the prevalence of burned-out ApHCM and its predictors. Methods: In this retrospective cross-sectional study, echocardiographic data and electrocardiography features of 230 patients with ApHCM including premature ventricular contraction and atrial fibrillation were gathered and analyzed at baseline and after a mean follow-up of five years. All data were obtained from the data registry of Rajaie Cardiovascular Medical and Research Center, Tehran, Iran. The data were included in a retrospective study, which was approved by the local Ethics Committee. The patients were divided into two groups as follows: 1- Left Ventricular Ejection Fraction (LVEF) ≥ 50% and 2- LVEF < 50% known as burned-out ApHCM. Data analysis was also based on LVEF. Generalized Estimating Equation (GEE) regression was performed to assess the association between the patients' characteristics and burned-out ApHCM. The clinical features demonstrating P < 0.05 in the univariate GEE analysis were included in a multivariate model to identify the independent predictors. Results: The prevalence of burned-out ApHCM, defined as LVEF < 50%, was 13.9%. There was no significant difference between males and females in this regard (P = 0.48). After a mean follow-up of five years, atrial fibrillation was significantly more common in the patients with LVEF < 50% (48.7% vs. 24.4%, P = 0.007). Additionally, left atrial enlargement was identified as the most important predictor of BO-ApHCM (odds ratio = 2.4, P = 0.003). Moreover, right ventricular dysfunction was more severe in the patients with burned-out ApHCM (P < 0.001). Conclusions: The prevalence of burned-out HCM was higher in the present study than in the previous studies (13.9%). Besides, right ventricular systolic dysfunction and left atrial enlargement were two main predictors of the ApHCM progression. [ABSTRACT FROM AUTHOR]

Background: This study evaluated the effect of adjuvant chemotherapy and hormone therapy on overall survival and disease-free survival in patients with breast cancer with hormone receptor-positive, HER2-negative tumors without lymph node involvement. Methods: Breast cancer patients with hormone receptor-positive, HER2-negative, and no lymph node involvement were included in this retrospective cohort study. Patient records were used to collect data on sex, age, time of disease onset, tumor subtype, tumor size, grade, lymphovascular and perineural involvement, ki67, and treatment protocols. Patients were divided into 2 groups: Patients who received both adjuvant chemotherapy and hormonal therapy and patients who received hormonal therapy only. Disease-free survival index (DFS) and overall survival index (OS) were evaluated. Results: Sixty-seven female patients were enrolled in this study. Of them, 68.2% received both adjuvant chemotherapy and hormonal therapy and 31.6% received hormonal therapy only. During follow-up, recurrences occurred in 8 patients. The 3-year and 5-year DFS were 93.4% and 90%, respectively. The 3-year and 5-year DFS was 94% and 92%, respectively, in patients who received both adjuvant chemotherapy and hormonal therapy, and 91% and 85%, respectively, in patients who received hormonal therapy. None of the factors studied affected the 3-year and 5-year DFS. The 3-year and 5-year DFS OS were 98.6% and 96.9%, respectively Conclusion: Adjuvant chemotherapy in patients with breast cancer with hormone receptor-positive, HER2-negative, and no lymph node involvement compared with similar patients receiving hormone therapy alone had no significant difference in disease-free survival index and overall survival index. [ABSTRACT FROM AUTHOR]

Objective: We aimed to investigate safety and efficacy of preoperative chemotherapy using EOX regime in patients with locally advanced gastric and GEJ cancer who were admitted at Imam-Khomeini Oncology clinic and Aram clinic. Method: We performed a mix-cohort study in 51 gastric cancer patients. In the beginning, we performed contrast thorax and abdominal CT scan or ECO cardiograph to determine cancer staging. After that, each patient received 3-weeks EOX regime in 6 cycle. After each three cycles follow-up CT scan was performed to assess any possible progression. Response to the treatment, Overall survival, and Progression-Free Survival were the main outcomes that we evaluated in the current study. We used Kaplan-Meier approach and Cox regression to address survival rate and its prognostic factors. Results: Overall, 72.5% percent were male and mean age of study participants was 57.6. Complete response rate was observed in 11.1%, while 51.1% showed partial response. Median of overall survival and Progression-Free Survival was estimated 35.0 and 28.0 month, respectively. The 5-year overall survival was 74.2% and for PFS it was estimated at 57.7%. Conclusion: Preoperative chemotherapy using EOX regime could increase survival rate among patients with gastric and GEJ cancer. [ABSTRACT FROM AUTHOR]

Background: The presence of concomitant Mitral Regurgitation (MR) and Pulmonary Hypertension (PH) is a common issue in patients undergoing Transcatheter Aortic Valve Replacement (TAVR). Transthoracic echocardiography plays a role in detecting MR severity and PH before and after TAVR. Objectives: This study aimed to investigate the impact of TAVR on MR severity and PH and to detect the predictors of their improvement. Methods: Totally, 111 patients underwent TAVR at Rajaee Heart Center, Tehran, Iran from December 2012 to January 2021. In this retrospective study, these patients were evaluated for MR and PH improvement after TAVR. The final analysis was performed separately on 32 patients who had moderate or more severe baseline MR and 56 patients with any grade of PH at baseline. Group comparisons based on the MR severity, PH severity, and improvement of MR and PH were analyzed using student t-test for continuous variables and chi-square or Fisher's exact test for categorical ones. Finally, the percentage of the patients with improved MR or PH as well as the factors associated with the improvements were determined. Results: Moderate or more severe baseline MR improved by at least one grade one year post-TAVR in 56.2% of the cases, and TAVR with a balloon-expandable valve was associated with a higher probability of MR improvement. Baseline left ventricular ejection fraction was significantly lower in patients with a higher degree of PH than in those with lower degrees (43% vs. 30%, P < 0.001). In addition, right ventricular dysfunction was more prevalent in patients with a higher degree of PH. Post-TAVR reduction in systolic pulmonary pressure (at least 10 mmHg) was observed in 77% of the patients after one year. Conclusions: TAVR positively affected MR and PH and reduced their severity in most patients. Tricuspid native aortic valve (in comparison with bicuspid), normal sinus rhythm (in comparison with atrial fibrillation), left ventricular ejection fraction improvement, and absence of left atrial enlargement were associated with a greater MR improvement after TAVR. Left ventricular ejection fraction improvement and TAVR with a balloon-expandable valve were also significantly associated with PH improvement post TAVR. [ABSTRACT FROM AUTHOR]

Background: DNA oxidation is one of the essential destructive effects of reactive oxygen species (ROS) on the cell membrane macromolecules leading to the deformation of cellular DNA. The most abundant oxidative DNA product on which most studies have focused is re-oxidized DNA, 8 oxo-deoxyguanosine (8-oxodG). This deformation of cellular DNA is associated with various cancer initiation and progression. DNA damage can be a cancer marker including 8-oxodG, thymidine glycol, 8-oxoadenine, etc. DNA oxidation is affected by environmental and non-environmental factors. Age, diet, and metabolism are at the heart of this process. This review study summarizes the types of cancer-related DNA oxidation that serve as a cancer biomarker. Also, we will look at the factors influencing their formation. [ABSTRACT FROM AUTHOR]

Background: Breast cancer, as the most common malignancy among females, is a great concern for global health. Early diagnosis and advanced chemotherapy regimens have improved patients' survival, while increasing morbidities caused by chemotherapy in the long run. Chemotherapy regimens have caused a decrease in myocardial functional, which can be detected by echocardiography. Objectives: The present study aimed to assess the decline curve in the left ventricular function parameters following chemotherapy and to compare the results among patients based on their Human Epidermal Growth Factor Receptor-2 (HER2) status. Methods: This study was conducted on 427 consecutive female patients with breast cancer referred to the Cardio-Oncology Department of Rajaie Cardiovascular, Medical, and Research Center for pre-chemotherapy assessment between January 2019 and December 2020. The patients were divided into two groups based on the HER2 status. All the patients had at least one baseline (pre-chemotherapy) transthoracic echocardiography and were scheduled for four follow-up sessions: early post-anthracycline therapy and 3, 6, and 12 months following chemotherapy. Each echocardiography examination included the assessment of 2D Left Ventricular Ejection Fraction (LVEF), 3D LVEF, Global Longitudinal Strain (GLS), and Global Circumferential Strain (GCS). Linear mixed-effects models were utilized and the results were compared within and between the study groups. The R Project for Statistical Computing was used for data analysis. Results: The results revealed significant changes in the means of 2D LVEF, 3D LVEF, GLS, and GCS during the 12 months of follow-up (t = -27.04, -37.15, -33.3, and -21.5, respectively; P < 0.001). Besides, the decline was more prominent in the HER2 positive patients (t = -19.86, -15.35, -10.8, and -9.6, respectively; P < 0.001). Conclusions: The study results revealed a significant decline in the LV function parameters including 2D LVEF, 3D LVEF, GLS, and GCS following chemotherapy with anthracycline. This decline was more prominent in the HER2 positive patients who underwent Herceptin treatment. These results showed that the use of cardioprotective agents might lower the rate of decline in LV function parameters. [ABSTRACT FROM AUTHOR]

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Definitive radiotherapy was effectively used for treatment of de novo hypopharyngeal SCC in a previous esophageal cancer patient with a history of Fanconi anemia, resulting in a complete clinical response. [ABSTRACT FROM AUTHOR]

This study aimed to determine the prevalence of anxiety among breast cancer patients. In April 2019, three electronic databases (PubMed, Web of Science, and Scopus) were searched from January, 2000 to March, 2019. Key words included were as follows: breast neoplasm, prevalence, and anxiety. A total of 36 studies that included 16,298 breast cancer patients between 2000 and 2018 were enrolled in the study. The prevalence of anxiety among breast cancer patients was 41.9% [(CI: 95%): 30.7, 53.2]. The prevalence of anxiety among patients in Mediterranean countries was higher. The study showed a high level of anxiety among breast cancer patients, indicating the importance of psychological factors as well as physical in breast cancer patients. [ABSTRACT FROM AUTHOR]

Background: Type 2 diabetes mellitus (T2DM) and Vitamin D deficiency, are too common disorders in the world. Various investigations argues the association between two diseases, however, findings are contradictory and controversial. The aim of the present study was to examine the effect of complementary vitamin D supplementation on improvement of various glycemic parameters in T2DM. Methods: In a double blind randomized clinical trial, 60 persons of T2DM patients were selected and divided into 2 groups with 30 patients. Group 1 were treated with oral Vitamin D (50,000 unit /week for 12 week), and group 2 were treated with placebo drug. Findings: The age of studied population were between 34 to 76 years and the mean age was 55 ± 10.7 years. Age, sex, BMI and serum levels of HbA1c and 25(OH) vitamin D were not significantly different between two groups before the study. After 12 weeks treatment intervention, no significant difference was found in serum HbA1c and lipids between two groups. Conclusion: In this study weekly vitamin D supplementation for 12 weeks had not significant decremental effect on HbA1c and lipid profiles, however, further studies needs to evaluate clinical usefulness of our findings. [ABSTRACT FROM AUTHOR]