فهرست مطالب

Arya Atherosclerosis
Volume:9 Issue: 2, Mar 2013

  • تاریخ انتشار: 1392/03/13
  • تعداد عناوین: 8
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  • Kavian Ghandehari, Mohammad Reza Khajedaluei, Zahra Yazdankhah, Kosar Ghandehari Page 119
    Background
    Assessing the risk of recurrent ischemic events in patients with transient ischemic attack (TIA) and minor ischemic stroke (MIS) is of a great importance in clinical practice.
    Methods
    Consecutive patients with TIA or MIS who were visited in Ghaem Hospital, (Mashhad, Iran) were enrolled in a prospective cohort study during 2010 to 2011. Diagnosis of TIA or MIS was accomplished by a stroke neurologist. Only those who presented within 24 hours from the onset of symptoms were recruited. MIS was considered as an ischemic stroke with National Institutes of Health Stroke Scale (NIHSS) < 4. The endpoint of the study was a new ischemic cerebrovascular event or vascular death in 90 days and additionally in 3 days. The decision to admit and type of treatment in each case was left to the discretion of the stroke neurologist. The association between 20 potential factors with recurrent ischemic events in 3 and 90 days was investigated using univariate and multivariate analysis (MVA).
    Results
    393 TIA patients (238 males and 155 females) and 118 MIS patients (77 males and 41 females) were enrolled in the study. Stroke occurred in 117 (23.2%) patients, TIA in 99 (19.6%), and there was 11 (2.2%) vascular deaths within 3 months in the total 511 patients with minor ischemic events. Crescendo TIAs and multiple TIAs were associated with greater risk of stroke in 3 days in a univariate analysis (OR = 5.12, P < 0.001) and (OR = 3.98, P = 0.003), respectively. Patients with index stroke had 11.5% lower risk of recurrent stroke in 3 days than patients with index TIA in multivariate analysis (OR = 0.115, P = 0.039). Diabetes was independently associated with 3 months stroke recurrence in the patients with minor ischemic events (OR = 2.65, P = 0.039).
    Conclusion
    Multiple and crescendo TIAs are the main predictors of stroke recurrence, derived from the univariate analysis of the patients with minor ischemic events.
    Keywords: Transient Ischemic Attacks, Infarction, Brain, Recurrence, Risk
  • Reza Karbasi, Afshar, Nematollah Jonaidi, Jafari, Amin Saburi, Mohammad Reza Motamedi Page 128
    Background
    Negative T (NT) wave in electrocardiography (ECG) is one of the important factors in determining short- and long-term outcomes in patients with acute myocardial infarction (MI). In this study, we compared clinical and paraclinical findings in post-MI patients according to presence or absence of NT wave.
    Methods
    A cross-sectional study was conducted on patients with acute ST elevation MI who presented to Shahid Modares Hospital (Tehran, Iran) during 2009-10. After undergoing streptokinase therapy, demographic characteristics and ECG and exercise test findings of the subjects were compared based on the presence or absence of NT wave.
    Results
    Overall, 116 patients including 69 cases with NT wave (NT group) and 47 cases without NT wave (PT group) were enrolled (mean age: 53.7 ± 7.1 vs. 54.1 ± 6.8 years old). Mortality rate during the first five days was 13% in the NT group and 29% in the PT group (P < 0.05). Ejection fraction values of the NT group were significantly higher than the PT group (P = 0.005). However, left ventricular end-diastolic diameter of the NT group was significantly less than the PT group (P = 0.005). Moreover, ST segment depression was significantly less frequent in the NT group compared to the PT group.
    Conclusion
    Patients with ST elevation MI accompanying with NT wave in ECG versus have better prognosis and myocardial function than similar patients without NT wave. Therefore, invasive procedures should be recommended for patients without NT wave
    Keywords: Echocardiography_Exercise Test_Myocardial Infarction_Negative T Wave_Echocardiography
  • Hossein Vakili, Roxana Sadeghi, Mahdiye Tabkhi, Morteza Safi Page 134
    Background
    This study aimed to assess the associations between corrected thrombolysis in myocardial infarction frame count (CTFC) of the infarct-related artery (IRA) and ejection fraction (EF) after three-six months in patients who underwent primary percutaneous coronary intervention (PPCI) for ST segment elevation myocardial infarction (STEMI).
    Methods
    CTFC was determined by a digital system for 78 patients. EF was measured through Simpson’s method upon discharge and three-six months later. The subjects were divided into two groups of CTFC ≤ 20 (n = 54) and CTFC > 20 (n = 24). Association between CTFC and EF were then specified.
    Results
    CTFC ≤ 20 and CTFC > 20 were present in 69.2% and 30.8% of the patients, respectively. There was no significant difference between the two groups regarding baseline characteristics. EF at the time of discharge was 42.1% ± 10.2% and 43.5% ± 11.4% in groups with CTFC ≤ 20 and > 20, respectively. There was no significant association between EF at discharge and CTFC (P = 0.611). After three months, EF changed to 49.6% ± 8.7% and 41.6 ± 12.4% in the groups with CTFC ≤ 20 and CTFC > 20, respectively. Three months after PPCI, EF and CTFC had a significant relation (P = 0.007). Cumulative number and percentage of shock and death were 3 (3.8%) and 2 (2.6%), respectively.
    Conclusion
    Lower CTFC of the infarct-related artery in patients undergoing PPCI for STEMI was associated with higher left ventricular ejection fraction after three months.
    Keywords: Corrected Thrombolysis in Myocardial Infarction Frame Count, Ejection Fraction, Percutaneous Coronary Intervention, Myocardial Infarction
  • Majid Kolahdouzan, Hossein Khosravi‐, Boroujeni, Behnaz Nikkar, Elaheh Zakizadeh, Behnaz Abedi, Negar Ghazavi, Nima Ayoobi, Maryam Vatankhah Page 140
    Background
    Obesity has become one of the most important and the fastest growing health and nutritional problem, not only in developed but also in developing countries. White rice consumption causes an increase in postprandial blood glucose and could be a probable reason for obesity. This study was conducted to investigate the association between intake of white rice and central obesity in an Iranian population.
    Methods
    In the present cross-sectional study, a total of 212 subjects were selected based on convenience non-random sampling procedure. Expert interviewers collected socio-demographic and dietary intake data by a face to face method.
    Results
    We failed to find any significant association between frequency of white rice consumption and body mass index or waist circumference, neither in crude model nor in adjusted models.
    Conclusion
    Although there was no significant association between white rice intake and obesity factors in our study, more studies are necessary with larger population and better design.
    Keywords: White Rice, Body Mass Index, Central Obesity, Diet
  • Ali Reza Ahmadi, Mohammad Yusef Aarabi Page 145
    Background
    The exact survival rates and markers of survival after postoperative cardiac arrest in children with congenital heart abnormalities are unknown.
    Methods
    In this one-year study, we identified children younger than seven years of age with postoperative cardiac arrest in our pediatric cardiac intensive care unit database. Parameters from perioperative, pre-arrest, and resuscitation periods were analyzed for these patients. Comparisons were made between survivors and non-survivors after cardiopulmonary resuscitation (CPR). Fisher's exact, Student's t, and chi-square tests were used to analyze data.
    Results
    Of 529 evaluated children who underwent corrective heart surgery, 59 (11%) sustained a documented cardiac arrest. Of these, 22 (37%) survived and regained their vital signs. Perioperative parameters (age, weight, and duration of cardiopulmonary bypass pumping), ventricular physiology, oxygen saturation, and bicarbonate concentration did not influence the outcome of CPR. Greater use of inotropic agents was not associated with higher mortality. A significant relationship was seen between having history of cardiac arrest and CPR success (P < 0.001).
    Conclusion
    CPR had undesirable outcomes in patients with hemodynamic dysfunction (i.e. low mean arterial blood pressure). Patients with univentricular physiology or history of cardiac arrest are not prone to a higher risk of mortality following arrest.
    Keywords: Cardiac arrest, Congenital, Cardiopulmonary resuscitation, Pediatrics, Operation
  • Diana Keyhani, Mehdi Kargarfard, Nizal Sarrafzadegan, Masoumeh Sadeghi Page 150
    Background
    Few studies have investigated changes in autonomic function after training in patients with cardiovascular diseases, particularly patients with congestive heart failure (CHF). Heart rate recovery (HRR) is a strong predictor of mortality in CAD patients. The aim of this study was to determine the effect of 8 weeks of supervised exercise training on autonomic function, which were assessed by heart rate, systolic blood pressure (SBP), and rate-pressure product (RPP) in CHF patients.
    Methods
    65 patients aged 57-82 years with CHF were assigned to two groups randomly. The first group received a supervised 8-week aerobic training program of 30-45 min sessions, 3 days per week on alternate days, while controls received standard medical care and were followed up. Body weight, body mass index, functional capacity, resting heart rate, HRR, resting systolic blood pressure, peak heart rate, peak systolic blood pressure, and RPP were measured before and after the study period. Medications and diet recommendations remained unchanged in both groups during the study period.
    Results
    The exercise group consisted of 33 patients with mean age of 61.54 ± 5.89 years and the controls were 32 patients with mean age of 60.94 ± 5.03 years. One-way analysis of variance (ANOVA) with repeated measures revealed a statistically significant difference in the exercise group compared to the control group regarding body mass index, resting heart rate, heart rate recover, functional capacity, peak heart rate, peak systolic blood pressure, peak RPP after 8 weeks (P ≤ 0.05).
    Conclusion
    In conclusion, a multidisciplinary CR program with supervised exercise training support significantly improves functional capacity and autonomic function in CHF patients. Therefore, a supervised and guided exercise training program is safe and beneficial for patients with CHF with different etiologies.
    Keywords: Aerobic Exercise, Cardiorespiratory Fitness, Hemodynamics, Autonomic Function, CHF
  • Amirreza Sajjadieh, Ali Hekmatnia, Maryam Keivani, Abdollah Asoodeh, Masoud Pourmoghaddas, Hamid Sanei Page 157
    Background
    The aim of the present study is to evaluate the accuracy of 64-multidetector-row computed tomography angiography (CTA) in comparison to conventional invasive angiography (CIA) in the diagnosis of significant stenosis (≥ 50%) of coronary artery tree.
    Methods
    Assessment of CTA in the detection of coronary artery disease (CAD) was performed in patients referred because of symptoms or stress studies suggestive of ischemia. For this purpose, among more than 1000 cases of coronary CTA in a 20 months period a study population of 54 patients suspected to have significant stenosis of the coronary artery tree was investigated. The CIA procedure was performed in these patients one month after CTA. The accuracy of CTA in detecting significant stenosis was compared to CIA.
    Results
    For vessel based analysis of 179 coronary vessels, CTA had a sensitivity of 96%, specificity of 87.5%, positive predictive value of 90.5%, and negative predictive value of 94.6%. For patient-base analysis, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CTA were 97.9%, 28.6%, 66.6%, and 90.2%, respectively.
    Conclusion
    The findings of this study reveal that CT angiography with 64-slice scanner could be considered as a suitable technique for rapid triage of patients presenting to hospitals with chest pain. High values of sensitivity and PPV reveal the good performance of CTA in detecting CAD.
    Keywords: Coronary Artery Disease (CAD), Computed Tomography Angiography (CTA)
  • Laxman Dubey Page 164
    Coronary artery anomalies are a rare type of congenital anomalies with an incidence of 1.3% during routine cardiac catheterization. Anomalous origin of the coronary arteries is considered an incidental finding without clinical significance. This case describes a patient in whom evaluation of chest pain revealed an obstructive left anterior descending artery as well as an anomalous right coronary artery arising from the left coronary sinus. The patient underwent successful percutaneous coronary intervention of the left anterior descending artery and was discharged home free of angina 3 days later.
    Keywords: Anomalous Right Coronary Artery, Obstructive Left Anterior Descending Artery, Percutaneous Coronary Intervention