فهرست مطالب

Arya Atherosclerosis
Volume:10 Issue: 1, Oct 2014

  • تاریخ انتشار: 1392/12/20
  • تعداد عناوین: 12
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  • Masoud Pourmoghaddas, Majid Rabbani, Javad Shahabi, Mohammad Garakyaraghi, Reza Khanjani, Pegah Hedayat Pages 1-5
    Background
    Heart failure is one of the leading causes of mortality, is a final common pathway of several cardiovascular diseases, and its treatment is a major concern in the science of cardiology. The aim of the present study was to compare the effect of addition of the coenzyme Q10 (CoQ10)/atorvastatin combination to standard congestive heart failure (CHF) treatment versus addition of atorvastatin alone on CHF outcomes.
    Methods
    This study was a double-blind, randomized placebo-controlled trial. In the present study, 62 eligible patients were enrolled and randomized into 2 groups. In the intervention group patients received 10 mg atorvastatin daily plus 100 mg CoQ10 pearl supplement twice daily, and in the placebo group patients received 10 mg atorvastatin daily and the placebo of CoQ10 pearl for 4 months. For all patients echocardiography was performed and blood sample was obtained for determination of N-terminal B-type natriuretic peptide, total cholesterol, low density lipoprotein, erythrocyte sedimentation rate, and C-reactive protein levels. Echocardiography and laboratory test were repeated after 4 months. The New York Heart Association Function Class (NYHA FC) was also determined for each patient before and after the study period.
    Results
    Data analyses showed that ejection fraction (EF) and NYHA FC changes differ significantly between intervention and placebo group (P = 0.006 and P = 0.002, respectively). Changes in other parameters did not differ significantly between study groups.
    Conclusion
    We deduce that combination of atorvastatin and CoQ10, as an adjunctive treatment of CHF, increase EF and improve NYHA FC in comparison with use of atorvastatin alone.
    Keywords: Coenzyme Q10, Atorvastatin, Clinical Trial, Congestive Heart Failure
  • Minoo Dianatkhah, Mehdi Rahgozar, Mohammad Talaei, Masoud Karimloua, Masoumeh Sadeghi, Shahram Oveisgharan, Nizal Sarrafzadegan Pages 6-12
    Background
    Competing risks arise when the subject is exposed to more than one cause of failure. Data consists of the time that the subject failed and an indicator of which risk caused the subject to fail.
    Methods
    With three approaches consisting of Fine and Gray, binomial, and pseudo-value, all of which are directly based on cumulative incidence function, cardiovascular disease data of the Isfahan Cohort Study were analyzed. Validity of proportionality assumption for these approaches is the basis for selecting appropriate models. Such as for the Fine and Gray model, establishing proportionality assumption is necessary. In the binomial approach, a parametric, non-parametric, or semi-parametric model was offered according to validity of assumption. However, pseudo-value approaches do not need to establish proportionality.
    Results
    Following fitting the models to data, slight differences in parameters and variances estimates were seen among models. This showed that semi-parametric multiplicative model and the two models based on pseudo-value approach could be used for fitting this kind of data.
    Conclusion
    We would recommend considering the use of competing risk models instead of normal survival methods when subjects are exposed to more than one cause of failure.
    Keywords: Competing Risks, Cumulative Incidence Function, Fine, Gray Model, Binomial Approach, Pseudo, value Approach, Cardiovascular Diseases
  • Mehrdad Taherioun, Mohammad Hassan Namazi, Morteza Safi, Habibolah Saadat, Hossein Vakili, Saeed Alipur, Parsa, Hasan Rajabi, Moghadam, Shamsedin Pedari Pages 13-17
    Background
    Stent underexpansion is the most powerful predictor of long-term stent patency and clinical outcome. The purpose of this study was to evaluate the incidence and predictors of stent underexpansion despite adjunctive post-dilatation with non-compliant balloon.
    Methods
    After elective coronary stent implantation and adjunctive post-dilatation with non-compliant balloon and optimal angiographic result confirmed by the operator, intravascular ultrasound (IVUS) was performed for all the treated lesions. If the treated lesions fulfilled the IVUS criteria, they are considered as the optimal stent group; if not, they are considered as the suboptimal group.
    Results
    From 50 patients enrolled in this study 39 (78%) had optimal stent deployment and 11 (22%) had suboptimal stent deployment. In the suboptimal group 7 (14%) had underexpansion, 2 (4%) malposition, and 2 (4%) had asymmetry. There were no stent edge dissections detected by IVUS. We did not find any correlation between lesion calcification, ostial lesions, stent length, and stent underexpansion. Stent diameter ≤ 2.75 mm had a strong correlation with stent underexpansion.
    Conclusion
    Despite adjunctive post-dilatation with noncompliant balloon, using a relatively small stent diameter was a strong predictor for underexpansion. IVUS guided percutaneous coronary intervention (PCI) may be considered for drug eluting stent (DES) implantation in relatively small vessels.
    Keywords: Stent, Percutaneous Coronary Intervention, Ultrasound, Post, dilatation
  • Firouzeh Sajjadi, Mojgan Gharipour, Noushin Mohammadifard, Fatemeh Nouri, Maryam Maghroun, Hasan Alikhasi Pages 18-24
    Background
    Epidemiologic studies have shown an inverse association between dietary fiber and metabolic syndrome (MetS). Therefore, the purpose of this study was to investigate the association between MetS and consumption of legumes in adults in Isfahan, Iran.
    Methods
    This cross-sectional study was carried out on 2027 individuals who were a subsample of the 3rd phase of the Isfahan Healthy Heart Program (IHHP). Basic characteristics information such as age, sex, smoking status, and physical activity were collected using a questionnaire. A validated 48-item food frequency questionnaire was used to assess dietary behaviors. Blood pressure, waist circumference (WC), glucose, triacylglycerols, and high-density lipoprotein cholesterol were measured, and MetS was defined based on Adult Treatment Panel III guidelines. Multiple logistic regression models examined associations of frequency consumption of legumes with MetS occurrence and its components.
    Results
    All MetS components were less prevalent among subjects with regular legume intake (P < 0.01). Legume intake was inversely associated with the risk of MetS, after adjustment for confounding factors in women. Life style adjusted odds ratio of Mets between highest and lowest tertile and no consumption (as reference category) of legume intake were 0.31 (0.13, 0.70), 0.38 (0.17, 0.87), respectively, in women (P = 0.01).
    Conclusion
    This study showed that age has a crucial role in MetS incidence; therefore, after further age adjustment to lifestyle adjusted model there was no significant difference in lower and higher tertile of legume intake and MetS.
    Keywords: Legumes, Metabolic Syndrome, Iran
  • Somayeh Arabzadeh, Masoumeh Sadeghi, Katayoun Rabiei, Nizal Sarrafzadegan, Ladan Taheri, Jafar Golshahi Pages 25-31
    Background
    Uncontrolled hypertension, a major concern among hypertensive patients, may be caused by various factors such as inadequate knowledge and inappropriate attitude, unhealthy lifestyle, and ineffective treatment. The present study tried to cast light on factors leading to uncontrolled hypertension.
    Methods
    In this cross-sectional study, all hypertensive participants of the third phase of the Isfahan Healthy Heart Program were contacted and invited to take part in the study. A questionnaire including knowledge of and attitude toward hypertension and its control and treatment methods, and practice about lifestyle and pharmacological treatment was completed for all patients who consented to participate. The participants’ anthropometric indices and blood pressure were then measured. Chi-square and Student’s t-tests were used to compare the groups with controlled and uncontrolled blood pressure. The effect of each factor on uncontrolled blood pressure was assessed by employing stepwise logistic regression.
    Results
    Of 114 participants, 43 (37.12%) and 71 (62.28%) individuals had controlled and uncontrolled blood pressure, respectively. Stepwise logistic regression revealed body mass index > 25 kg/m2 to have the greatest effects on uncontrolled blood pressure [Odds ratio (OR) = 13.091, Confidence interval of 95% (95% CI): 1.437-116.352, P = 0.021). In addition, male gender increased the risk for uncontrolled blood pressure (OR = 8.475, CI95%: 1.276-56.313, P = 0.027), while inappropriate attitude decreased the mentioned risk (OR = 0.047, CI95%: 0.007-0.318, P = 0.002).
    Conclusion
    According to our findings, obesity is the most important cause of uncontrolled blood pressure. Therefore, weight has to be closely monitored and controlled in hypertensive patients.
    Keywords: Uncontrolled Hypertension, Obesity, Attitude
  • Ali Pourmoghaddas, Hamid Sanei, Mohammad Garakyaraghi, Fatemeh Esteki, Ghashghaei, Maryam Gharaati Pages 32-36
    Background
    Iron is essential for many physiological processes; whereas, iron overload has been known as a risk factor in progression of atherosclerosis. The aim of this study was to investigate the importance of serum ferritin levels, which are known as an indicator of body iron stored in the incidence of coronary artery disease (CAD).
    Methods
    In a case-control study, we evaluated 432 eligible men who underwent coronary angiography at Chamran Cardiology Hospital, Isfahan, Iran. They were separated into two groups of case (with CAD) and control (without CAD). All subjects had given written informed consents. Then, the blood samples were taken after 12-14 hours of fast by a biologist for measuring cardiovascular risk factors and body iron stores, including serum ferritin, serum iron, and total iron binding capacity (TIBC). For statistical analyses, chi-square test, Student’s t-test, one-way ANOVA, and the logistic regression were used.
    Results
    In the present study, 212 participants with CAD in the case group and 220 participants free of CAD in the control group were included in the analysis. At baseline, there were significant differences in serum ferritin (P < 0.001) and other cardiovascular risk factors between the two groups. Moreover, when other risk factors of CVD were included in the model, serum ferritin [Odd Ratio (OR) = 1.006, 95% confidence interval of 95% (95% CI) 1.00-1.01, P = 0.045] and serum ferritin ≥ 200 (OR = 4.49, 95% CI 1.72-11.70, P < 0.001) were associated with CAD.
    Conclusion
    High iron store, as assessed by serum ferritin, was associated with the increased risk of CAD. Furthermore, it was a strong and independent risk factor in the incident of atherosclerosis in the Iranian male population.
    Keywords: Iron, Ferritin, Coronary Artery Disease, Coronary Angiography
  • Alireza Ahmadi, Mohammadreza Sabri, Hamid Bigdelian, Bahar Dehghan, Mojgan Gharipour Pages 37-40
    Background
    Various devices have been recently employed for percutaneous closure of the patent ductus arteriosus (PDA). Although the high effectiveness of device closure techniques has been clearly determined, a few studies have focused on the cost-effectiveness and also postoperative complications of these procedures in comparison with open surgery. The present study aimed to evaluate the clinical outcome and cost-effectiveness of PDA occlusion by Amplatzer and coil device in comparisong with open surgery.
    Methods
    In this cross-sectional study, a randomized sample of 201 patients aged 1 month to 16 years (105 patients with device closure and 96 patients with surgical closure) was selected. The ratio of total pulmonary blood flow to total systemic blood flow, the Qp/Qs ratio, was measured using a pulmonary artery catheter. The cost analysis included direct medical care costs associated with device implantation and open surgery, as well as professional fees. All costs were calculated in Iranian Rials and then converted to US dollars.
    Results
    There was no statistical difference in mean Qp/Qs ratio before the procedure between the device closure group and the open surgery group (2.1 ± 0.7 versus 1.7 ± 0.6, P = 0.090). The mean measured costs were overall higher in the device closure group than in open closure group (948.87 ± 548.76 US$ versus 743.70 ± 696.91 US$, P < 0.001). This difference remained significant after adjustment for age and gender (Standardized Beta = 0.160, P = 0.031). PDA closure with the Amplatzer ductal occluder (1053.05 ± 525.73 US$) or with Nit-Occlud coils (PFM) (912.73 ± 565.94 US$, P < 0.001) was more expensive than that via open surgery. However, the Cook detachable spring coils device closure (605.65 ± 194.62 US$, P = 0.650) had a non-significant cost difference with open surgery. No event was observed in the device closure group regarding in-hospital mortality or morbidity; however, in another group, 2 in-hospital deaths occurred, two patients experienced pneumonia and seizure, and one suffered electrolyte abnormalities including hyponatremia and hypocalcemia.
    Conclusion
    Although open surgery seems to be less expensive than device closure technique, because of lower mortality and morbidity, the latter group is more preferable.
    Keywords: Cost, effectiveness, Outcome, Device Closure, Open Surgery Closure, Patent Ductus Arteriosus
  • Hasan Shemirani, Reza Khanjani, Mehrdad Mohammadi, Sichani, Sarah Mozafarpour, Majid Rabani, Javad Shahabi Pages 41-45
    Background
    Percutaneous nephrolithotomy is the treatment of choice in large and staghorn renal stones, and myocardial infarction is one the possible complications during and after the surgery. We investigated if renal and skeletal muscle injury, caused by percutaneous nephrolithotomy, can cause elevation in cardiac troponins (cTn).
    Methods
    This study was conducted on otherwise healthy patients with renal stone undergoing percutaneous nephrolithotomy. A baseline 12-lead electrocardiogram, echocardiography, and cTn assessment confirmed no cardiac pathology in any patients. Cardiac troponins T (cTnT) and I (cTnI), and also creatine kinase (CK) were assessed before and after surgery.
    Results
    A total of 55 patients (69.1% males, mean age: 40.5 ± 13.8 year) were included. Serum creatinine level ranged from 0.7 to 1.3 mg/dl (mean = 1.03 ± 0.17). The level of CK was significantly increased by 469.5 ± 201.4 U/l (P < 0.001), and no positive cTnT or cTnI was observed after surgery.
    Conclusion
    The results of the present study showed that renal cell injury, caused by percutaneous nephrolithotomy, is not associated with elevated cardiac troponins. These findings show that increasing troponins in patients undergoing percutaneous nephrolithotomy indicate a cardiovascular pathology.Keywords:
    Keywords: Percutaneous Nephrolithotomy, Coronary Artery Disease, Acute Coronary Syndrome, Cardiac Markers, Troponin
  • Abdollah Mohammadian, Hafshejanimadian, Nizal Sarrafzadegan, Shidokht Hosseini, Hamid Reza Baradaran, Hamidreza Roohafza, Masoumeh Sadeghi, Mohsen Asadi, Lari Pages 46-54
    Background
    Seasonal variation in admissions and mortality due to acute myocardial infarction has been observed in different countries. Since there are scarce reports about this variation in Iran, this study was carried out to determine the existence of seasonal rhythms in hospital admissions for acute myocardial infarction, and in mortality due to AMI in elderly patients in Isfahan city.
    Methods
    This prospective hospital-based study included a total of 3990 consecutive patients with acute myocardial infarction admitted to 13 hospitals from January 2002 to December 2007. Seasonal variations were analyzed with the Kaplan-Meier table, log rank test, and Cox regression model.
    Results
    There was a statistically significant relationship between the occurrence of heart disease based on season and type of acute myocardial infarction anatomical (P < 0.001). The relationship between the occurrence of death and season and type of acute myocardial infarction (AMI) according to International Classification of Diseases code 10 (ICD) was also observed and it was statistically significant (P = 0.026). Hazard ratio for death from acute myocardial infarction were 0.96 [Confidence interval of 95% (95% CI) = 0.78-1.18], 0.9 (95%CI = 0.73-1.11), and 1.04 (95%CI = 0.85-1.26) during spring, summer, and winter, respectively.
    Conclusion
    There is seasonal variation in hospital admission and mortality due to AMI; however, after adjusting in the model only gender and age were significant predictor factors.
    Keywords: Acute Myocardial Infarction, Season, Admission in Hospital, Mortality, Isfahan
  • Jamshid Najafian, Morteza Abdar-Esfahani, Morteza Arab-Momeni, Afshan Akhavan-Tabib Pages 55-58
    Background
    Obesity is a common health problem in both developed and developing countries. There are many unconventional therapies, including herbal medicine, to treat this condition. Some people believe that herbal medicines are safe. This case and review is about adverse complication of treating obesity with some herbal medicine.CASE REPORT: A 19 year old male with sever obesity (120 KG) used green tea (15 cups of green tea per day) and an intensive dietary regimen to lose weight. He lost 30 kg after 2 months. At that time, one day after usual exercise he suddenly lost consciousness due to left ventricular fibrillation.
    Conclusion
    Use of herbal medicine for weight reduction is not always safe. Moreover, for some herbal medicine the risk is sufficient to shift the risk–benefit balance against the use that medicine.
    Keywords: Herbal Medicine, Sudden Death, Complication, Obesity
  • Reza Karbasi-Afshar, Nematollah Jonaidi-Jafari, Amin Saburi, Arezoo Khosravi Pages 59-64
    Background
    Bicuspid aortic valve (BAV) is one of the most common and important congenital heart disorders in adults. If a patient with congenital disorders is not diagnosed early, the patient’s disease may progress to a severe condition and thus diagnosis of the main disorder will be rendered difficult.CASE REPORT: A 34 year-old male patient referred to a referral medical care unit for cardiac electrophysiological study with cardiac shock due to complete heart block 3 months ago and he underwent Dual-Chamber permanent pacemaker (PPM) implantation. Thick and calcified bicuspid AV with invasion to interventricular septum, moderate to severe AI, severe AS, and dilated ascending aorta were observed at his echocardiography. Aortic valve replacement (AVR), aneurysm of ascending aorta, root replacement with tube graft (Bentall Procedure), and also a 3 chambers intracardiac defibrillator (ICD) were used. After 2 weeks of operation, he was discharged and at the first post-hospitalization visit (1 week later), his cardiovascular condition was acceptable.
    Conclusion
    Thick calcified aortic root is a less studied and potential contributing risk factor for AV block after AVR. Therefore, in candidates of aortic valve replacement, considering conductive disorders, especially in patients with calcified valve, is mandatory. Irreversible AV block requiring PPM implantation is a rare condition following AVR.
    Keywords: Atrioventricular Block, Bicuspid Aortic Valve, Calcified Valve
  • Mohaddeseh Behjati Pages 65-69
    Since the leading cause of morbidity and mortality is cardiovascular diseases, every individual should think regularly about possessing and maintaining cardiovascular health. In reality, this self-processing is delayed until the occurrence of complications related to cardiovascular inefficiency manifested as chest pain and/or dyspnea. However, people should be trained to think about their cardiovascular health issues as a vital need from early childhood. This goal is achievable by understanding it as a «true human derive» and its consecutive «behaviors». Most people are unaware of their real needs, and even if they know all of their cardiovascular needs, this knowledge is not projected in their behaviors. In the present paper, I try to outline the Herzberg two-factor hypothesis and Maslow''s hierarchy of needs.
    Keywords: Maslow's Pyramid, Change Cycle, Cardiovascular Health