فهرست مطالب sepideh jafari naeini

The prognostic significance of filling pressures and the relationship between left and right heart filling pressures have been well characterized in patients with heart failure. In the present study, we sought to evaluate the prevalence of discordance between left- and right-sided filling pressures and their relationship with clinical characteristics, laboratory data, and outcome measures (mortality and heart transplantation) in patients who were registered in right heart catheterization registry of Rajaie Heart Center (RHC-RHC registry).

The hospital information system was queried for all adult patients with diagnosis of chronic heart failure who had undergone right heart catheterization between July 2009 and July 2019 in heart failure and transplantation department. The following variables were measured for each patient: mean right atrial pressure; systolic and end-diastolic right ventricular pressures; systolic, diastolic, and mean pulmonary artery pressure; pulmonary capillary wedge pressure (PCWP); mixed venous oxygen saturation; and cardiac output and cardiac index by Fick technique. The RAP/PCWP ratio was also calculated. The outcome of interest was all-cause mortality and heart transplantation after the index right heart catheterization. All of the patients were monitored for all-cause mortality or heart transplantation until July 2020.

Among 1941 patients, a total of 1078 patients (75% male) were selected. The mean (standard deviation) of age was 42.7 (15.7) years. Heart failure reduced ejection fraction (HFREF) was found in the majority of patients (85.1%), with nonischemic dilated cardiomyopathy and ischemic cardiomyopathy being the most frequent etiologies. The concordance between right and left filling pressures is more noticeable in patients with HFREF and heart failure mildly reduced EF than in patients with heart failure preserved EF (HFPEF). The median (interquartile range) of follow-up duration was 24 (6–48) months. During the follow-up time, 676 (62.7%) patients met the study outcomes of interest within <5 days to 96 months following the index RHC.

The results of this study show that right and left filling pressure may be discordant in up to one-third of patients with advanced heart failure. However, the right and left heart-filling pressures would be more concordance as the disease is more advanced.

Myocarditis with preserved ejection fraction (MCpEF) is a subgroup of myocarditis with normal or near-normal left ventricular systolic function. Its prevalence has been reported to be low, and there are limited data about the diagnostic strategy, management, and outcome. Initial manifestation of myocarditis can be new-onset heart failure, acute coronary syndrome-like presentation, life-threatening arrhythmia, or even sudden cardiac death. Echocardiography with two-dimensional speckle-tracking mode and cardiac magnetic resonance imaging have pivotal roles in diagnosis and management of the disease. The present study is based on a research on “myocarditis preserved ejection fraction (EF)” or “ myocarditis with normal EF” mainly in PubMed, Google Scholar, and Embase databases. The search focused on the aspects of the disease which is not usually mentioned clearly. In contrast to the myocarditis as a general concept, the total number of clinical studies or case reports in the context of myocarditis with preserved EF is really low. Most treatment strategies have been based on the patient’s initial presentation, and there are not enough clinical trials or long-term follow-up studies to confirm the most accurate diagnostic and therapeutic approach. In conclusion, although MCpEF has been known as a subgroup of myocarditis with specific clinical and imaging features, there are still a lot of questions about the diagnosis, management strategy, and patient prognosis which require further studies to be investigated

Clarification is needed as regards the relationship between the total bilirubin level and the outcome of primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). Between April 2015 and April 2016, consecutive patients with STEMI who underwent primary PCI were prospectively enrolled in a primary PCI registry. The patients’ demographics, initial total bilirubin levels, procedural characteristics, and in-hospital and 6 months’ major adverse cardiac events were assessed. A total of 95 patients who underwent primary PCI were enrolled in the study. The mean bilirubin level was 1.04 mg/dL with a standard deviation of 1.154. We evaluated the relationships between the median of the initial total bilirubin level, the thrombolysis in myocardial infarction (TIMI) flow grade after PCI and following PCI, 6 months’ follow-up complications, the amount of the peak troponin and CK-MB levels, the amount of mitral regurgitation, the ejection fraction, and electrocardiographic changes including ST resolution and the Q-wave formation after primary PCI. Except for the levels of troponin and CK-MB, there were no relationships between the initial total bilirubin level and the other end points. Recent studies have shown that the serum total bilirubin level is independently associated with short-term outcomes in patients with STEMI. We found a direct relationship between the total bilirubin level and the peak levels of troponin and CK-MB after primary PCI. This outcome is consistent with other studies; nonetheless, we found no such relationships vis-à-vis the other end points. This result may be due to our small patient population.

Although echocardiography has constituted the primary method of evaluating cardiac disease for many years now, using another method to complete the examination—especially in dubious situations such as calcified valvular diseases or poor echocardiography window—seems necessary. In studies in different countries, cardiac magnetic resonance imaging (CMR) has been introduced as an acceptable noninvasive complementary method for the evaluation of the severity of aortic stenosis (AS) with good reproducibility and reliable results in comparison with echocardiography.
In a cross-sectional survey in Rajaie Cardiovascular, Medical, and Research Center’s CMR Department between 2009 and 2014, all patients with a diagnosis of AS were evaluated for the severity of AS in terms of peak velocity and peak gradients via both echocardiography and CMR (velocity-encoded method), and the results were analyzed by SPSS using the t-test and ANOVA.
After the exclusion of patients with insufficient data, 26 patients were included and evaluated. There were no significant differences between the 2 groups (CMR vs. echocardiography) or between the subgroups (considering cardiovascular risk factors, ejection fraction, and valvular features).
CMR was comparable with echocardiography in evaluating AS severity in our study and was not inferior to echocardiography, although more studies are recommended for a more in-depth evaluation.

Although the use of Complementary and Alternative Medicine (CAM) has been evaluated globally, there are few studies in our country on this subject. The purpose of this study was to determine the prevalence, pattern of use, parental sources of information, and benefits of CAM in epileptic children in Tehran.One hundred thirty-three parents or relatives of epileptic children who were referred to outpatient clinics or admitted in neurologic ward of four major hospitals in Tehran, were interviewed by our researcher based on a structured questionnaire; from 2009 to 2010. The information obtained comprised the demographic data of patients and their parents, frequency and morphology of convulsions, the type and sources of CAM and finally, the benefits and adverseeffects of this practice.Forty-four percent of the respondents had used CAM methods either alone or in combination with other methods. The most frequently used CAM was written prayers followed by oral herbs and special diets. CAM was mainly introduced to them by relatives. Only 16.7% of these parents had discussed this matter with their children’s physicians. No efficacy to control seizure was observed for most of these methods.This study showed that use of CAM in our study group is relatively common and may have a potentially hazardous role in the treatment process. So, it is necessary for physicians to have enough information about CAM practice in their patients.