Iranian Heart Journal
Volume:15 Issue: 4, Winter 2015

Heart failure (HF) is currently a major concern for the middle-aged and elderly. Some studies have suggested the beneficial effects of coenzyme Q10 (CoQ10) on clinical symptoms and echocardiographic indices in patients with HF. Reduced selenium, a cofactor in the activation of CoQ10 levels, has also been found in HF. The present study evaluated the effects of the combination of CoQ10 and selenium on patients with HF. This randomized, double-blind, clinical trial was conducted on New York Heart Association (NYHA) class II and III patients. The subjects were randomly allocated to intervention and control groups (n = 32 each). A questionnaire containing demographic characteristics, history of diseases, consumed medications, and NYHA class was filled out prior to the intervention. Echocardiography (the Simpson method) was also performed to determine the left ventricular ejection fraction (LVEF) and the myocardial performance index (MPI). The intervention group then received 90 mg of CoQ10 and 200 μg of selenium per day for 3 months. The control group consumed placebos with an identical appearance during the same period. The NYHA class, LVEF, and MPI were reevaluated after the intervention. Two subjects from the intervention group and one from the control group were excluded during the course of the study. The two groups had no significant differences in terms of age, gender, history of diseases, consumed medications, and baseline NYHA class, LVEF, and MPI. However, intervention significantly improved the NYHA class, LVEF, and MPI. According to the analysis of covariance (ANCOVA) adjusted for age, gender, and baseline characteristics, the intervention improved the LV function indices in patients with HF. Based on our findings, combination therapy with selenium and CoQ10 led to clinical improvement and enhanced LV function indices in patients with HF. Further clinical trials with larger sample sizes and longer follow-up periods can clarify the appropriateness of adding these supplements to the treatment protocols for HF.

The diagnosis of the coarctation of the aorta is difficult in the presence of complex cardiac defects, congenital disease, or poor echocardiographic window. The carotid- subclavian artery index (CSAI) and the isthmus-descending aorta ratio (I/D) have been used in echocardiography in many studies, but only a few studies have utilized cardiac magnetic resonance imaging (MRI) for the detection of coarctation. In this prospective cohort study, all MRI cases (aged 0-40) with a diagnosis of coarctation between 2010 and 2011 were reviewed. The MRI measurement of the aortic arch was performed in order to calculate the CSAI and the I/D ratio. The CSAI is the ratio of the distal aortic arch diameter to the distance between the left carotid artery and the left subclavian artery and is highly suggestive of a coarctation when it is less than 1.5. The I/D ratio is defined as the diameter of the isthmus to the descending aorta and suggests an aortic coarctation when it is less than 0.64. Sixty-five patients with coarctation had a lower CSAI than the controls (84) (1.27±0.06 vs. 2.82± 0.9; P <0.05). The I/ D ratio was lower (0.4±0.14) than that in the previous study (0.64) (P <0.05). Associated cardiac defects, age, and sex did not have an effect on the CSAI or I/D ratio (P > 0.05). A cut-off point of 1.5 had 96% sensitivity and 76% specificity in the detection of the coarctation of the aorta. The positive and negative predictive values were 84.4% and 94.1%, respectively. The association between both indices improved sensitivity and permitted the diagnosis of coarctation in all the patients based solely on cardiac MRI measurements. The CSAI and I/D ratio, independent of clinical status, associated anomalies, age, and sex, are useful tools for detecting aortic coarctation via cardiac MRI.

Pulmonary arterial hypertension (PAH) is a progressive disease with increased mortality and high morbidity in patients with congenital heart disease (CHD). Electrocardiography (ECG), echocardiography, and right heart catheterization (RHC) are major diagnostic tools. We sought to analyze the diagnostic value of ECG and echocardiography in patients with PAH confirmed by RHC as the gold standard method for the diagnosis of PAH. Twelve-lead ECG, Doppler echocardiography (D-Echo), and RHC data were analyzed in 95 patients with CHD in order to determine the relative values of these noninvasive techniques as screening tests in detecting PAH. The sensitivity, specificity, and positive and negative predictive values of the selected parameters associated with PAH were calculated for each diagnostic technique. Results Ninety-five patients with CHD were enrolled in the study. PAH was confirmed by RHC in 29 (30.5%) patients and was ruled out in 66 (69.5%) patients. The sensitivity, specificity, and positive and negative predictive values of ECG in PAH-confirmed cases were 58.6%, 92.4%, 77.3%, and 83.5%, respectively. D-Echo had sensitivity of 72.4% and specificity of 89.3%, whereas its positive and negative predictive values were 75% and 88%, respectively. Most findings were highly specific for PAH. ECG and D-Echo were strongly specific in ruling out PAH. They may be useful for first-line surveillance in patients in whom PAH is suspected, although the confirmation of PAH should be based on RHC.

Trastuzumab (Herceptin) is a monoclonal antibody used in the treatment of patients with breast cancer. This drug can cause cardiomyopathy. We evaluated the effects of Trastuzumab on the heart and Trastuzumab-induced cardiomyopathy 3 months after the initiation of the drug in patients with breast cancer. This observational cross-sectional analytical study, conducted between 2013 and 2014 in Imam Khomeini Hospital of Tehran University Of Medical Sciences, recruited 40 female patients with breast cancer. Findings related to cardiomyopathy were determined and compared before and 3 months after starting Trastuzumab. Diastolic function was exacerbated after the treatment course significantly: 25.9% of the patients before treatment and 43.6% after treatment had diastolic dysfunction (P = 0.001). Ejection fraction (EF) was reduced significantly after treatment (P = 0.002): 0% of the patients before treatment and 10.3% after treatment had an EF < 45%. Cardiac enzyme troponin I showed a significant rise after treatment: 0% of the patients before treatment and 6.7% after treatment had troponin I > 0.1. Our results demonstrated that Trastuzumab caused cardiomyopathy in some of our breast cancer patients. Therefore, cardiac monitoring of patients who use this agent is necessary at regular and close intervals.

Stenosis of the stent is an explanatory outcome of successful results in patients under angioplasty procedures for coronary artery disease. Determination of the risk factors for this phenomenon is an important step for programming to reduce the stenosis rate and improving the outcomes. Hence, this study was performed to determine the association between the metabolic syndrome and stent restenosis. In this cross-sectional descriptive-comparative study, 122 patients with the acute coronary syndrome or chronic stable angina admitted to Shariati hospital, Tehran, Iran, between 2012 and 2014, who had a history of percutaneous coronary intervention (PCI) with coronary stent insertion were enrolled and the prevalence of in-stent stenosis and association with the metabolic syndrome were determined. There was no significant association between the metabolic syndrome and stent stenosis (P=0.129), and 21 (35%) patients and 14 (22.6%) individuals among those with and without the metabolic syndrome had in-stent stenosis. The mean duration of stent placement was 3.63 ± 1.51 and 2.99 ± 1.61 years in those with and without stent stenosis, respectively, showing a significant difference (P=0.046). Among those with dyslipidemia 48.6% and among the patients without dyslipidemia 20% had stenosis in the stent, showing a significant difference (P=0.001). We conclude that the metabolic syndrome is not a contributing factor for stent stenosis.

Case Report: We report a case of myocardial infarction in the course of Behçet''s disease in a 23-year-old man with no coronary risk factor. The diagnosis of Behçet''s disease was established on the basis of a deep venous thrombosis of the lower limb, oral and genital ulceration, posterior uveitis, and a positive pathergy test. The myocardial infarction was complicated by a ventricular fibrillation reduced by external shock. Coronary angiography showed a lesion under threat in the anterior interventricular coronary. In the literature, twenty cases of myocardial infarction have been reported in Behçet''s disease. The pathophysiology, diagnosis, and treatment are still difficult to explain.

Bifid T waves are seen in healthy children and young adults. They also occur in certain pathological conditions, including organic heart diseases, disorders of the central nervous system, and alcoholism. Myocardial ischemia can affect the T-wave change as one of those is the bifid T wave, which is a QTc prolongation form occurring in the acute coronary syndrome. Case Report: A 48-year-old man referred to the emergency room because of typical chest pain of 2 days'' duration. He had a history of ischemic heart disease, and his vital signs were stable. At the time of his recent admission to the CCU, he experienced one episode of ventricular fibrillation (VF), which was converted to sinus rhythm with a 200j DC shock. In his first electrocardiogram after the VF, prolonged QTc as a bifid T wave was obvious. Myocardial ischemia can affect the T-wave morphology in a variety of ways, and one of those is the bifid T wave, which is a QTc prolongation diagnostic form that occurs in the acute coronary event and malignant arrhythmia.

Case Report: The congenital pericardial defect is a rare malformation that can be complete or partial. This kind of defect is associated with other congenital abnormalities in 30-50% of patients. Whereas the complete absence of the pericardium is mostly asymptomatic and has little clinical importance, partial ones may cause chest pain or dyspnea and can be life-threatening through the strangulation of the cardiac structure. The defect is partial in most cases and is more often left-sided than right-sided. We report a case of the congenital absence of the pericardium around the right ventricle and the posterior portion of the left ventricle without evidence of cardiac chamber herniation or strangulation.