فهرست مطالب

Arya Atherosclerosis
Volume:7 Issue: 1, Spring 2011

  • تاریخ انتشار: 1390/05/25
  • تعداد عناوین: 8
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  • Masoud Pourmoghaddas, Hamid Sanei, Aliakbar Tavassoli, Mohammad Shojaei Page 1
    Background
    Doppler echocardiography has been proposed as an appropriate non-invasive assay to estimate left ventricular end diastolic pressure (LVEDP). The aim of present research was to estimate the LVEDP in patients with ischemic heart disease by echocardiography and compare it with the results of cardiac catheterisation and to determine the effect of different echocardiographic variables on its measurement.
    Methods
    In this descriptive-analytic study, patients with diagnosed ischemic heart disease were selected by nonrandomized sampling method. Selected population underwent M mode and pulse doppler echocardiographic evaluation and parameters such as Q-Mitral valve E (Q-MVE), Q-Aortic valve closure (Q-AVC), Aortic valve closure-E (AVC-E), Q-Mitral valve closure/Aortic valve closure-E (Q-MVC/AVC-E), left ventricle-deceleration time (LV-DT), peak velocity-deceleration time (PV-DT) and A/E velocity time integral (A/E VTI) were evaluated. Immediately after echocardiography all patients underwent left heart catheterization for LVEDP measurement. The relation between different echocardiographic measurements and LVEDP, obtained by cardiac catheterization, was evaluated.
    Results
    In this study, 47 patients with ischemic heart disease with mean age (±SD) of 53 ± 13 were studied. There was a significant correlation between LVDEP and A/E VTI (r=0.44, P = 0.001, and also between LVEDP and PV-DT in patients with A/E VTI ≥1.1(r = -0.58, P = 0.02). There was a significant correlation between LVEDP and Q-MVC/AVC-E in patients with LVEDP >18mmHg (r = 0.76, P= 0.03) and those with LVEDP ≤18 mmHg and A/E VTI < 1.1 (r = 0.37, P= 0.03). The correlation between LVEDP and A/E VTI was more significant in men, in patients aged > 50 years with EF > 55%, without LVH, without MR and those with coronary artery disease (P < 0.05).
    Conclusion
    Some echocardiographic indices such as A/E VTI, Q-MVC/AVC-E and PV-DTare able to measure LVEDP especially in male patients aged > 50 years, without LVH, without MR and those with coronary artery disease but it is necessary to determine specific conditions and factors affecting these indices, by further studies.
  • Hamid Sanei, Masoud Pourmoghadas, Mansour Sholevar Page 7
    Background
    Considering that determining the effect of both contrast dye injection and balloon inflation on electrophysiological parameters would help us to predict the ischemic event during PTCA, the aim of this study was to determine the effects of these factors on QTc and QTc dispersion during PTCA in Isfahan.
    Methods
    In this cross-sectional study, consecutive patients undergoing elective PTCA in Chamran hospital in Isfahan enrolled. All patients were in sinus rhythm. A 12-lead electrocardiogram was continuously recorded before (baseline) and during PTCA after dye injection and balloon inflation. QTc and QT dispersion was calculated in all 12 leads of electrocardiogram during the mentioned times and compared with each other.
    Results
    33 patients with mean age of 49.1 ± 16.2 years were studied. Anatomic distribution of the coronary artery stenosis was as follows: left anterior descending artery (LAD) in 76.7% patients, left circumflex (Cx) in 16.6% and right coronary (RCA) in 6.66%. Mean of QTc at baseline, after contrast dye injection and after balloon inflation was 423.9 ± 28.5, 437 ± 29 and 437 ± 22 msec, respectively (P < 0.05). Mean of QTc dispersion at baseline, after contrast dye injection and after balloon inflation was 92.3 ± 7.2, 95.4 ± 8.3 and 93.75 ± 7.5, respectively (P > 0.05).
    Conclusion
    The findings of this research supports the fact that during PTCA a transient myocardial ischemia occurs but further studies is recommended to accurately determine the stages at which ischemia occurred and the extent of its effect of it on cardiac depolarization and repolarization periods.
  • Fariborz Nikaeen, Masoud Pourmoghadas, Hasan Shemirani, Seid Ahmad Mirdamadi, Mojtaba Akbari Page 11
    Background
    The association between epicardial fat and coronary in-stent restenosis has not been evaluated. The objective of the present study was to evaluate the relationship of echocardiographic epicardial fat thickness (EFT) with restenosis in drug eluting stents (DES).
    Methods
    In this study, 117 patients who underwent coronary angiography due to recurrent clinical symptoms or findings of non-invasive cardiac tests one year after stent implantation were selected. According to angiographic results, they were divided into two groups, 65 patients with in-stent restenosis (case group) and 52 patients without such finding (control group). EFT was measured perpendicularly on the free wall of the right ventricle at the end of systole in two echocardiographic views (parasternal short and long axis) at least in three cardiac cycles. The average of obtained values was determined and recorded as EFT. Furthermore, the history of hypertension, smoking and diabetes, age and sex were investigated and body mass index (BMI)of each patient was also calculated.
    Results
    There were no significant differences in the baseline characteristics (P = 0.812). Patients with in-stent restenosis did not have statistically significant difference (4.6 ± 1.8 mm) in EFT compared to subjects with patent stents (4.5 ± 1.8 mm; P = 0.88). The above results were also confirmed using multiple linear regressions. No significant correlation was found between EFT and other clinical variables (P > 0.05).
    Conclusion
    In this selected population, the risk of restenosis was not correlated with epicardial fat thickness. Future studies for determining the role of epicardial fat in development of in-stent restenosis are warranted.
  • Farshad Roghani, Azam Hemmat, Alahyar Golabchi Page 18
    Background
    Treatment of significant coronary artery disease with primary percutaneous coronary intervention (PCI) seems better than angioplasty balloon; because the incidence of restenosis is lower in this method, however, a serious complication of PCI is stent thrombosis which would lead to repeated myocardial infarction (MI) and increase the mortality and morbidity. One of the frequent medications which is used to prevent from stent thrombosis is clopidogrel, but, stent thrombosis was seen in many of the patients despite given the conventional dosage of this drug. This study aimed to evaluate the effect of doubling the maintenance dose of clopidogrel to prevent from early stent thrombosis, MI and mortality rate.
    Methods
    This was a clinical trial study which was done in Shahid Chamran Hospital in winter 2010 in Isfahan, Iran. A total of 400 patients with PCI were prospectively followed-up for 30 days. All the patients were randomly allocated into two groups. The control group received a maintenance dose of 75 mg clopidogrel while the case group received 150 mg clopidogrel after the initial dosage of 600 mg for 30 days after the PCI. The incidence of primary outcome such as total mortality was recorded during the study.
    Results
    Early stent thrombosis was observed in 4 patients (1%) (One subject in the control group and 3 in the case group) during the first 30 days after PCI, but the difference was not significant between the two groups (p = 0.62). Mortality due to stent thrombosis occurred in 2 patients in the case group which showed no significant difference in this group (p = 0.5). In addition, MI occurred in 2 patients (1 in each group) which also showed no significant difference between the two groups (p = 1). Drug complication such as major bleeding had no significant difference between the two groups (p = 0.9).
    Conclusion
    The present study showed that doubling dose of clopidogrel could not reduce the incidence of early stent thrombosis, mortality and myocardial infarction in comparison with conventional dosage; therefore it is recommended that more studies be done in Iranian and Asian race for clinical decision-making to prevent form stent thrombosis using high dose of clopidogrel.
  • Alireza Khosravi, Masoud Pourmoghaddas, Kourosh Asadi, Ahmadnoor Abdi, Ali Gholamrezaei Page 24
    Background
    There is a lack of data in our society on the outcomes, complications, and prognostic factors in patients with coronary artery disease who underwent percutaneous coronary intervention (PCI). We evaluated the success rate, early and late outcomes, and prognostic factors in a referral university center in Isfahan, IRAN.
    Methods
    This prospective cohort study was conducted in Chamran University Hospital in Isfahan (IRAN) from March 2010 to February 2011. Patients consequently were included if they have the indication for emergent or elective PCI. Outcomes included procedural success, complications, and major adverse cardiovascular events (MACE) during hospitalization and 6 months follow-up.
    Results
    A total of 282 patients (74.1% females) with mean age of 57.0±3.2 years were studied. Most of the patients (89.7%) underwent elective PCI. Angiographic and procedure success rates were 95.7% and 94.6%, respectively. In-hospital MACE included two cases of death (0.7%) and one MI (0.3%); 2/29 (6.9%) of the emergent PCI and 1/253 (0.4%) of the elective PCI cases. MACE during follow-up included three cases of death (1.0%) and two MI (0.7%); 2/252 (0.8%) of the elective PCI and 1/28 (3.5%) of the emergent PCI cases. The overall MACE was calculated as 8 cases (2.8%) which included 5/29 (17.2%) of the emergent and 3/253 (1.1%) of the elective cases; P < 0.001. In multivariate analysis, none of the factors including gender, age, emergency of the procedure, lesion type, number of stenotic vessels, or stent type were associated with total MACE (P > 0.05).
    Conclusion
    PCI is performed with an acceptable success rate in our center in Isfahan and mortality and complications are within the range reported by other highly specialized centers in IRAN. Further studies with larger sample size are needed to find predictive factors.
  • Mahin Hashemipour, Mahnaz Soghrati, Mohammad Malek Ahmadi, Mojgan Soghrati Page 31
    Background
    Central obesity is an important risk factor for cardiovascular diseases (CVD). Preventive interventions from childhood are necessary due to the increasing prevalence of childhood obesity. Body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR) and waist to height ratio (WSR) are anthropometric indices for measurement of obesity. This study aimed to assess the association between these anthropometric indices and dyslipidemia in obese children and adolescents.
    Methods
    This retrospective study was done on the records of 2064 obese children and adolescents aged 6-18 years at the obesity clinic, in Isfahan Cardiovascular Research center. Age, gender, weight, height, WC, hip circumference (HC), triglyceride (TG), total cholesterol (TC), LDL-cholesterol (LDL-C), HDL-cholesterol (HDL-C), Fasting blood sugar (FBS), diastolic blood pressure (DBP) and systolic blood pressure (SBP) were taken from patients’ record. Receiver operating characteristics (ROC) curve and Pearson correlation were used to analyze the data.
    Results
    2064 girls and boys aged 6-18 years were divided into 3 age groups of 6-9.9 years, 10-13.9 years and 14-18 years. Prevalence of high LDL-C, TC, TG, FBS, SBP, DBP and low HDL-C was higher among the boys compared to the girls. There was a significant association between TC, LDL-C, TG and FBS with BMI, WC, WHR and WSR. However, no significant correlation was seen between HDL-C and the four anthropometric indices.
    Conclusion
    Our study showed a significant correlation between BMI, WC and WSR with high levels of TC, TG and LDL-C in children and adolescents. Correlation between WHR and dyslipidemia in this study was significant but its predictive value was weaker than other three indices.
  • Roxana Sadeghi, Morteza Safi Page 40
    Almost 4% of all patients with venous thrombosis have upper extremity deep vein thrombosis (UEDVT) and the incidence of UEDVT increases over time. The frequency of post thrombotic syndrome (PTS) after UEDVT is not low and upper extremity PTS is a potentially major morbidity that adversely affects quality of life, particularly if the dominant arm is involved. We discuss briefly the role of thrombolytic therapy in the treatment of upper extremity deep vein thrombosis and also the role of systemic thrombolysis in selected patients.
  • Aliakbar Tavassoli, Masoud Pourmoghaddas, Mahmood Emami, Mostafa Mousavizadeh, Tohid Emami Meybodi Page 47
    Introduction
    Dextrocardia situs inversus refers to the heart being a mirror image situated on the right side of the body. Distorted cardiac anatomy provides technical difficulties during fluoroscopy‐guided transcatheter procedures. This is even more difficult in the case with percutaneous transvenous mitral commissurotomy (PTMC). Mitral valvuloplasty is a minimally invasive therapeutic procedure to correct an uncomplicated mitral stenosis by dilating the valve using a balloon. Here, we describe a case of a 25 years-old male with situs inversus and dextrocardia.CASE REPORT: A 25 years-old man, having situs inversus and suffering from mitral stenosis was referred to hospital for PTMC. His initial examination findings were unremarkable and an electrocardiographic (ECG), trans-esophageal and transthoracic echocardiographic evaluation were performed. Mitral valve (MV) was dome shape and severely stenotic with mild mitral regurgitation (MR). Left ventricular ejection Fraction (LVEF) was about 40%, Femoral arterial and venous punctures were made on the left side; the left femoral artery and vein were cannulated with a 5F arterial and 6F venous sheaths, respectively. Then special maneuvers were done to solve the mitral valve stenosis. At the end of the procedure, no MR was documented by checking LV angiogram and there were no signs of mitral stenosis (MS).
    Discussion
    Mirror‐image dextrocardia, as in our case, has been estimated to occur with a prevalence of 1:10,000. However, there are only a few case reports in the literature on PTMC in similar settings. This might be due to the fact that many of these patients undergo surgical commissurotomy due to the technical difficulties involved in a percutaneous procedure in general. Trans-septal catheterization is considered a technical challenge in anatomically malpositioned hearts, as it is fraught with a higher risk of cardiac perforation. Despite the challenging anatomy, PTMC has been demonstrated to be a safe and feasible option for MS in patients with unusual cardiac anatomy.