amirreza sajjadieh

Atrial fibrillation is the most common sustained arrhythmia and is associated with poor outcomes, including stroke. The ability of anticoagulation therapy to reduce the risk of stroke has been well established; however, the frequency of anticoagulation therapy uses is unknown in our community. This study aims to evaluate the frequency of anticoagulation therapy and its different types among patients with atrial fibrillation.

In this cross-sectional study between April 2015 to April 2016 (before the Covid-19 pandemic), a number of 200 patients with non-valvular atrial fibrillation, in two groups of 100 patients with and without recent embolic events were studied who were hospitalized in Al-Zahra hospital in Isfahan. The CHA2DS2-VASc score and the amount and type of anticoagulant usage were evaluated in each group.

In included 200 patients (mean age 70 years, 55% women), hypertension and diabetes were the most prevalent diseases. There was no significant difference in the mean of the CHA2DS2-VASc score between the two groups; 3.8 vs 3.6. (P > 0.05). There was a history of anticoagulant use in 48% of the patients hospitalized without embolic events and a mean CHA2DS2-VASc score: of 3.6.

About half of the hospitalized patients without embolic events and one-third of the patients with embolic events took anticoagulants for thromboembolic prevention, mostly warfarin. In patients with atrial fibrillation, despite the need to receive anticoagulants to prevent stroke, including people with a high CHA2DS2-VASc score, the consumption of direct thrombin inhibitors was seen at a very low level.

The coronary artery calcium score is a reliable measure of coronary atherosclerosis. This study evaluated the relationship between coronary artery calcium score, cardiovascular events, and metabolic syndrome.

This cross-sectional study was performed in Al-Zahra Hospital in 2019 and included patients who referred to the emergency department of Al-Zahra Hospital with a complaint of typical and atypical chest pain and admitted to the emergency ward of the hospital. Those with a pre-test probability between 5-15 percent underwent coronary CT angiography and their coronary calcium score was calculated and recorded. The data were analyzed using Mantel-Haenszel Chi-square statistical tests of two domains and correlation test (Bivariate Correlations).

The correlation between metabolic syndrome and coronary artery calcium score was meaningful. The odds ratio of men with metabolic syndrome with a coronary artery calcium score was about 4 times higher than women. After adjusted for gender by Mantel-Haenszel method, the chance of developing metabolic syndrome and coronary artery calcium score of 1 or above was 9.96. With bivariate correlations test, the correlation between coronary artery calcium score and metabolic syndrome was statistically significant.

Coronary artery calcium score is more common in patients with metabolic syndrome (MetS) and these are two valuable predictors for coronary artery disease.

Pregnancy increases the risks of thromboembolism for the mother and fetus in patients with mechanical heart valves. The results of some studies have indicated that low molecular weight heparin (LMWH), in comparison with unfractionated heparin (UFH), leads to a lower incidence rate of thrombocytopenia and a decrease in bleeding.

The present randomized clinical trial involved 31 pregnant women with mechanical heart valves at their first trimester (0-14 weeks) of pregnancy. To perform the study, the patients were divided into two groups, i.e. group A (LMWH group-16 patients) and group B (UFH group-15 patients). The birth weight, mode of delivery, and gestational age at birth as well as the maternal and fetal complications were compared between the two groups.

The mean age of mothers in the UFH and LMWH groups was 32.67±9.11 and 31.50±5.81 years, respectively (P value > 0.05). Although the rate of maternal and fetal complications was higher in the UFH group as compared with the LMWH group, the observed difference was not significant (P value > 0.05).

LMWH can be regarded as a safer therapy for both the mother and fetus due to its lower number of refill prescriptions and fewer changes in the blood level.

Considering the role of Vitamin D in cardiovascular disease (CVD) and the relationship between coronary artery calcification (CAC) and CVD, we aimed to investigate the association between the serum level of Vitamin D and CAC.

This was a cross‑sectional study on 67 consecutive patients who were referred for performing computed tomography angiography. We used Spearman correlation to evaluate the relationship between Vitamin D and CAC and then linear regressions to control for demographics and vascular risk factors.

There was no association between CAC and Vitamin D levels (Spearman coefficient = −0.03, P = 0.805). After controlling for age, sex, hypertension, hyperlipidemia, diabetes mellitus, and smoking, there was still no association between Vitamin D and CAC score (estimate = 0.001, S. E. = 0.020, P = 0.942).

We did not find the association between the serum level of Vitamin D and coronary artery calcification.

The aim of this study was to evaluate the influences of iterative model reconstruction (IMR) and hybrid-iterative reconstruction (HIR) techniques on quantitative and qualitative image analysis of 256-slice coronary computed tomography angiography (CCTA).

Sixty-one patients (30 men and 31 women with mean age of 60.68 ± 9.13 years) who had undergone CCTA by the 256-slice CT scanner were evaluated. The raw data were reconstructed using HIR and IMR algorithms. For objective assessment of image quality, parameters of noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were obtained for both reconstruction algorithms. For subjective assessment, two physician specialists evaluated image quality using a 5-point scale.

The mean image noise on HIR and IMR images was 32.74 ± 6.04 and 25.15 ± 3.59, respectively. In IMR, the CNR method (28.81 ± 5.13) was significantly better than HIR method (23.06 ± 5.03) (P < 0.001). However, the HIR method (4.62 ± 0.39) was higher than the IMR method (4.48 ± 0.45) in terms of qualitative or subjective criteria (P < 0.001).

 The IMR method can improve quantitative criteria of image, reduce noise, and increase SNR and CNR of images better than HIR method. However, the images which reconstructed by HIR were superior to IMR in terms of qualitative criteria.

Some studies showed that two factors of calcium score and high-sensitivity C-reactive protein (HS-CRP) are related with coronary artery disease, but no definitive theory has been provided. The aim of this study was to determine the relationship between serum level of HS-CRP and calcium score with coronary artery disease.

In a cross-sectional study, 200 patients who were candidates for computed tomography (CT) angiography were studied. The level of HS-CRP and coronary artery calcium scores were measured and their correlation with the intensity of coronary artery disease were evaluated.

There was a direct and significant correlation between calcium score and HS-CRP level (r = 0.25, P < 0.001). Multivariate analyzes showed that the odds ratio of coronary artery disease was 3.5 fold more for male sex, 3.7 fold for smokers, 7.6 fold for positive family history, 5.8 fold for high blood pressure, 1.4 fold for calcium scores, 11.8 f fold or high HS-CRP, 1.8 fold for hyperlipidemia.

Our results show that HS-CRP level in patients with coronary artery disease is higher than those without coronary artery disease, and there is a direct and significant correlation between this index and calcium scores. HS-CRP seems to be a good indicator for predicting the risk of coronary disease. At the same time, further studies in this field are suggested.

Some of recent studies have shown that epicardial and abdominal fat are linked to heart diseases. The aim of this study was to determine the relationship between epicardial and peripheral fat thicknesses with coronary stenosis in patients undergoing multislice computed tomography (CT) angiography referring to Alzahra hospital, Isfahan, Iran, during 2014-2015. In a cross-sectional study, 190 patients undergoing multislice CT angiography were selected, and epicardial and peripheral fat thicknesses, as well as coronary stenosis, were measured among them. Then, the relationship between these variables was determined. The mean peripheral subcutaneous fat thickness was 20.39 ± 6.11 and 19.05 ± 8.91 mm in patients with and without significant coronary stenosis, respectively; and there was no statistically significant difference between the two groups (P = 0.240). The mean epicardial adipose tissue was 5.19 ± 0.58 and 3.86 ± 0.28 mm in patients with and without significant coronary stenosis, respectively; and the difference between the two groups was statistically significant (P < 0.001). Regarding the higher peripheral fat in patients with coronary stenosis, and according to high prevalence of cardiovascular diseases, diabetes mellitus, smoking, and other risk factors of atherosclerosis among them, and additive effect of these factors on these diseases, measurement of epicardial fat thickness in at-risk patients must be done. Moreover, several activities must be done to prevent and decrease epicardial and peripheral fat thickness.

Diagnostic value of multi-slice computed tomography (MSCT) for detecting in-stent restenosis in comparison with conventional coronary angiography remained uncertain. The present study aimed to determine the value of MSCT for detecting in-stent restenosis.

This historical cohort study was included 226 patients with the history of percutaneous coronary intervention from 2000 to 2014 that referred to MSCT Unit at Alzahra Heart Center in Isfahan. The subjects were followed-up by telephone with regard to performing coronary angiography up to 3 months after MSCT and their status about cardiac events.

Among all participants, 63 stents (27.9%) underwent coronary angiography up to 3 months afte r MSCT that 2 stents in left circumfl ex artery (LCX) assessment, 2 in left anterior descending (LAD) assessments and none in right coronary artery (RCA) assessment were uninterpretable. Sensitivity, specifi city, positive predictive value (PPV), negative predictive value (NPV), and accuracy of MSCT was 92.9%, 66.6%. 92.9%, 66.6%, and 88.2%, respectively for detection of occlusion in LCX stents, 100%, 100%, 100%, 100%, and 100%, respectively for detection of occlusion in LAD stents, and 80.0%, 0.0%, 80.0%, 0.0%, and 66.7%, respectively for detection of occlusion in RCA stents. Overall, MSCT had sensitivity of 93.8%, specifi city of 70.0%, PPV of 93.8%, NPV of 70.0%, and accuracy 89.7% for detection of coronary stent restenosis.

MSCT has high diagnostic value for detecting in-stent restenosis. Diagnostic accuracy of MSCT for detecting stent restenosis is considerably different between the coronary arteries with the highest diagnostic values for LAD and the lowest diagnostic values for RCA.

Statins are shown effective by some studies in preventing contrast-induced nephropathy (CIN). We evaluated the effectiveness of atorvastatin in the prevention of CIN in computed tomography angiography (CTA) candidates. This study was conducted on patients referring for elective CTA with normal renal function. Patients received atorvastatin (80 mg/day) or placebo from 24 h before to 48 h after administration of the contrast material. Serum creatinine was measured before and 48 h after contrast material injection. CIN was defined as an increase in serum creatinine level of ≥ 0.5 mg/dl or ≥ 25% of the baseline creatinine. A total of 236 patients completed the study; 115 atorvastatin, 121 placebo, mean age = 58.40 ± 9.80 year, 68.6% male. Serum creatinine increased after contrast material injection in both the atorvastatin (1.00 ± 0.16-1.02 ± 0.15 mg/dl, P = 0.017) and placebo groups (1.03 ± 0.17-1.08 ± 0.18 mg/dl, P < 0.001). Controlling for age, gender, comorbidities, drug history, and baseline serum creatinine level, patients who received atorvastatin experienced less increase in serum creatinine after contrast material injection (beta = 0.127, P = 0.034). However, there was no difference between the atorvastatin and placebo groups in the incidence of CIN (4.3 vs. 5.0%, P = 0.535). In patients undergoing CTA, a short-term treatment with high dose atorvastatin is effective in preventing contrast-induced renal dysfunction, in terms of less increase in serum creatinine level after contrast material injection. Further trials including larger sample of patients and longer follow-ups are warranted.

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. 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. 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. 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.