Background Primary pericardial mesothelioma (PPM) is a rare malignancy with a high prevalence of mortality. The diagnosis is usually challenging using a variety of imaging modalities and invasive procedures and is generally performed at the later stages of the disease or in autopsy. This case study points to an unconventional presentation of PPM and the challenges in diagnosing this rare mortal malignancy. Case presentation This study presents a 44-year-old woman with no remarkable medical history with an initial diagnosis of effusive constrictive pericarditis at first hospitalization. Imaging evaluations, including transthoracic echocardiography and chest computed tomography scan, demonstrated visible thickened pericardium, pericardial effusion, and mass-like lesions in pericardium and mediastinum. The definite diagnosis of primary pericardial mesothelioma was established after pericardiectomy and histopathology examinations. Chemotherapy with pemetrexed and carboplatin was administrated to the patient, and she has been through four cycles of chemotherapy with no complications to date. Conclusion Constrictive pericarditis is an uncommon presentation of PPM. Due to the high mortality rate and late presentation, difficulties and uncertainties in diagnosis, being aware of this rare malignant entity in different cardiac manifestations, particularly when there is no clear explanation or response to treatment in such conditions, is highly important.

Background Due to the contribution of coronary artery disease (CAD) to serious cardiovascular events, determining biomarkers that could robustly predict its risk would be of utmost importance. Thus, this research was designed to assess the value of traditional cardio-metabolic indices, and more novel atherogenicity indices and insulin resistance surrogate markers in the identification of individuals at risk of CAD. Methods A case‒control survey was conducted, in which 3085 individuals were enrolled. Their clinical and biochemical data were gathered at baseline. The investigated indices included the atherogenic index of plasma (AIP), triglyceride-glucose (TyG) index, TyG-body mass index (TyG-BMI), lipoprotein combine index (LCI), cholesterol index (CHOLINDEX), Castelli’s risk indices-I, II (CRI-I, CRI-II), and metabolic score for insulin resistance (METS − IR). To examine the relationship between these variables and CAD risk, multiple regression analyses adjusted for potential confounders were conducted. Results Overall, 774 angiographically confirmed CAD patients (mean age = 54 years) were compared with 3085 controls (mean age = 51 years). Higher triglyceride, total cholesterol and fasting blood sugar levels and lower HDL-C levels were related to an elevated risk of CAD (P-for-trend < 0.001), while the direct association between increased serum LDL-C concentrations and a greater risk of CAD only became apparent when excluding those with diabetes, and statin users. Among novel indices, greater values of the majority of these markers, including AIP, CRI-I, and -II, CHOLINDEX, LCI, and TyG-index, in comparison to the lower values, significantly elevated CAD risk (P-for-trend < 0.001). Conclusion According to the current findings, novel atherogenicity indices and insulin resistance surrogate markers, in particular, AIP, CRI-I and II, CHOLINDEX, LCI, and TyG-index, may be useful in predicting CAD risk.

This study aimed to evaluate the clinical features of COVID-19 patients diagnosed with acute coronary syndrome(ACS). After obtaining patients’ demographic and clinical data, ECG and transthoracic echocardiography were performed for all 228 patients. On average, patients aged 63.23 years. The most common underlying disease was hypertension (59.2%). The most common ECG abnormalities in COVID-19 patients with ACS were ST-T changes and pathological Q wave, and 12.3% experienced atrial fibrillation. According to the Multiple logistic regression analysis, a significant relationship between on admission tachycardia and left ventricular ejection fraction with in-hospital mortality was found (OR=24.06, 95% CI: 4.63- 125.11, OR=0.92, 95% CI: 0.087-0.98).

Objectives: We investigated the diagnostic accuracy of fragmented QRS (fQRS) numbers in surface electrocardiogram (ECG) in heart failure (HF) patients for prediction of cardiac resynchronization therapy (CRT) non-responders. Methodology: In this study, patients with HF who were candidates for CRT implantation were enrolled. A 12-lead surface electrocardiogram was conducted with the aim of finding fQRS. Presence of more than 2 notching in the R or S wave in wide QRS complexes in at least two adjacent leads corresponding to a coronary bed, considered as fQRS. All patients underwent transthoracic echocardiography 3-6 months after the CRT implantation for the evaluation of Left Ventricular End Diastolic Volume (LVEDV), Left Ventricular End Systolic Volume (LVESV), and Left ventricle ejection fraction (LVEF). The data were analyzed by SPSS v.22 software. P-value of less than 0.05 considered significant. Results: We investigated on a total of 73 patients with HF that 64.38% of them responded to CRT. Most of responders were patients without fQRS complexes (80%). LVEF, LVESV, and LVEDV were different significantly before and after CRT implantation in patients with fQRS (p<0.001). Our results showed that the presence of at least one fQRS can lead to non-responsiveness to CRT. Therefore, we take cut-off point equal-greater than one into account as the best cut-off point for response to CRT. The area under the curve (AUC) for CRT prediction was 0.715 (95% CI: 0.598-0.815, P=0.003). Conclusion: In conclusion, the presence of even one fQRS in the surface ECG can predict CRT non-responsiveness with good accuracy.