فهرست مطالب

Iranian Heart Journal - Volume:20 Issue: 1, 2019
  • Volume:20 Issue: 1, 2019
  • تاریخ انتشار: 1397/11/11
  • تعداد عناوین: 10
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  • Abbas Andishmand, Seyed Ali Sadr Bafghi *, Seid Kazem Razavi, Ratki Pages 4-16
    Background
    Various risk scores are used to predict the bleeding risk in patients with the acute coronary syndrome (ACS), including ACTION, CRUSADE, and MEHRAN. The purpose of the present study was to compare the accuracy of these 3 risk scores in the prediction of the bleeding risk in patients with the ACS.
    Methods
    We studied 745 consecutive patients with the ACS undergoing coronary arteriography and calculated the ACTION, CRUSADE, and MEHRAN bleeding risk scores for all the patients. Then, we compared their prediction accuracy for major bleeding events and serious (major or minor) bleeding episodes with C-statistics.
    Results
    The majority of the patients (72.6%) had non–ST-elevation myocardial infarction (NSTEMI), and the others (25.4%) had STEMI. The mean age of the patients was 62.55±12.12 years, and 62.4% were male. Bleeding complications were reported in 141 (18.9%) patients, with the catheterization site being the most frequent site of bleeding. The major bleeding rate was predicted in 29.1%, 28.4%, and 4.8% of the patients according to the CRUSADE, MEHRAN, and ACTION risk scores, respectively. The C-index values (AUC) for the ACTION, MEHRAN, and CRUSADE risk scores were 0.6182, 0.5413, and 0.6185, respectively. Pairwise comparisons between the scores showed no statistically significant differences in the discriminatory power between the ACTION and the CRUSADE (P=0.970); however, the differences between the CRUSADE and the MEHRAN (P=0.051) or between the ACTION and the MEHRAN (P=0.053) were near to significant.
    Conclusions
    The bleeding risk score was predicted accurately by the ACTION, CRUSADE, and MEHRAN risk scores without significant differences among the 3 risk scores in our patients with the ACS undergoing coronary arteriography. These results showed that the predictive power was not excellent in any of the 3 risk scores.
    Keywords: Acute coronary syndrome, Bleeding, Risk score
  • Maryam Shojaeifard, Negar Omidi*, Saba Homatash, Ali Daryanavard, Anahita Esmaeli, Hamidreza Rahmanpour, Sajad Erami, Hossein Dehghani Mohammad Abadi Pages 15-19
    Background
    There are insufficient data on the association between the serum level of vitamin D and the carotid intima-media thickness (CIMT). The aim of this study was to investigate the association between the level of serum 25-hydroxyvitamin D and the CIMT.
    Methods
    This cross-sectional study recruited 341 patients. The level of 25-hydroxyvitamin D was measured with radioimmunoassay, and the CIMT was measured with color Doppler ultrasound.
    Results
    The mean serum level of 25-hydroxyvitamin D was 14.88±14.63 ng/mL in the patients with asignificant carotid artery involvement and 17.02±13.56 ng/mL in those without a carotid involvement, with the difference between the 2 groups constituting statistical significance (P=0.034). The prevalence rate of vitamin D deficiency in those with and without a carotid involvement was 88.6% and 74.4%; the rate was significantly higher in the former group (P=0.039).
    Conclusions
    Our study confirmed recent suggestions regarding the association between vitamin D deficiency and the progress of atherosclerosis in carotid arteries as CIMT.
    Keywords: Vitamin D deficiency_Carotid plaque_Intima-media thickness_Atherosclerosis
  • Maryam Moshkani Farahani, Saeed Nourian*, Hamed Reza Jalalian, Arezoo Khosravi, Mahmmod Salesi Pages 20-31
    Background
    Treatment-induced cardiotoxicity is one of the major side effects of trastuzumab treatment in patients with breast cancer. Left ventricular (LV) dysfunction is the leading cause of treatment-induced cardiotoxicity. The development of treatment-induced cardiotoxicity during cancer treatment may force patients to modify or quit the treatment. In this trial, we evaluated the prophylactic effects of carvedilol on LV dysfunction in patients with breast cancer receiving trastuzumab using 2D speckle-tracking echocardiography (2DSTE).
    Methods
    We conducted an open-label randomized clinical trial and enrolled 71 non-metastatic HER-2 positive patients with breast cancer candidated to receive trastuzumab. Carvedilol was administered concomitantly with the trastuzumab standard regimen at a dosage of 6.25 mg twice a day and up-titrated to the maximum tolerated dosage. The 2DSTE parameters to evaluate the LV systolic and diastolic functions were evaluated initially and 3 months thereafter.
    Results
    Thirty-six patients were randomly assigned to the carvedilol group and 35 patients to the control group. The mean left ventricular ejection fraction (LVEF) was not significantly different either in both groups or between the 2 groups (P=.61) during the follow-up. In contrast, the global longitudinal strain of the LV (GLS) (P=.000) and the strain rate of the LV systolic function (SRS) (P=.004) as markers of the LV systolic function were reduced in the control group. Furthermore, the LV strain rate of the early (SRE) and late (SRA) diastolic functions were preserved in the patients who received prophylactic carvedilol (P=.000 and P=.005, respectively).
    Conclusions
    Concomitant carvedilol treatment with a maximum tolerable dose in patients with non- metastatic HER2-positive breast cancer under treatment with trastuzumab might be effective on the reduction of systolic and diastolic echocardiographic findings other than the LVEF in patients with weak markers of heart failure.
    Keywords: Cardioprotection, Carvedilol, Trastuzumab, Breast cancer
  • Amir Hossein Yazdi, Ehsan Khalilipur*, Behshad Naghshtabrizi, Mohammad Khaled Naghshbandi, Farzaneh Esna, Ashari Pages 32-38
    Background
    Despite the recognition of the common risk factors for coronary artery disease (CAD), it appears that there is a wider range of risk factors. The purpose of the present study was to evaluate the association between the anatomical factors and the increased risk of CAD occurrence‏ and its clinical consequences.
    Methods
    in this study, 50 cases with a single coronary artery stenosis of the left anterior descending artery (LAD) and 50 controls with a normal coronary angiography or non-obstructive CAD were enrolled, and the objective of the study was compared between the 2 groups.
    Results
    The number of the branches before the LAD stenosis significantly increased in the patients with LAD disease, and there was a meaningful increase in the number of both the diagonal and septal branches originating before the stenosis (P<0.001). The average number of the diagonal branches was the same in both groups, which was statistically insignificant. (P=0.986) The mean value of the angle between the largest diagonal branch or septal branch and the LAD in the cases with CAD and the controls showed no significant difference. A family history of the early-onset cardiovascular disease in the control group with non-obstructive CAD was 6% versus 20% in the CAD group, and this difference was statistically significant (P≤0.03).
    Conclusions
    According to our study, it appears that the sum of the septal and diagonal branches of the LAD can be a statistically significant risk factor for the progression of atherosclerosis in the LAD as well. The LAD involvement is significantly associated with the familial type of CAD.
    Keywords: Coronary artery disease, Left anterior descending artery (LAD), Anatomical factors
  • Elham Khalaf, Adeli , Touraj Babaee , Behshid Ghadrdoost , Fereshteh Baghizadeh , Seyed Mostafa Alavi * Pages 39-44
    Background
    Contact of blood with the cardiopulmonary bypass (CPB) circuit during cardiac surgery induces acquired multifactorial coagulopathy, which results in an increased risk of bleeding and transfusion requirements. In this study, we investigated the effects of the preoperative administration of fibrinogen concentrates on bleeding and transfusion requirements in cardiac surgery.
    Methods
    Seventy-eight patients scheduled for elective coronary artery bypass graft (CABG) or valvular surgery were included in this clinical trial between March 2017 and November 2017. The patients were randomly assigned to fibrinogen and control groups. In the fibrinogen group, the patients received 2 g of fibrinogen dissolved in 100 mL of normal saline over a 15-minute period 30 minutes after the induction of anesthesia. In the control group, the patients received the same volume of normal saline during the same period of time. The evaluation of the coagulation system was performed via thromboelastometry (Rotem device). Postoperative bleeding was recorded as the overall mediastinal drainage or the other drainage at the surgical site during a 24-hour period after surgery. The volumes of transfused packed red blood cells, fresh frozen plasma (FFP), and platelet concentrates were recorded.
    Results
    The value of Fibtem-MCF did not show any significant difference between the groups (12.4±4 vs 11.7±4 0.46; P=0.46). The mean volume of bleeding was significantly lower in the fibrinogen group than in the control group (168±12 vs 344±37; P=0.001). The mean volume of the platelet concentrate used was significantly lower in the fibrinogen group than in the control group (P<0.05). However, there was no significant difference in terms of RBCs and FFP consumption between the groups.
    Conclusions
    It appears that although preoperative supplementation with fibrinogen has no effect on transfusion with RBCs and FFP, it results in a reduction in postoperative blood loss and platelet concentrate requirement during cardiac surgery.
    Keywords: Fibrinogen, Cardiac surgery, Transfusion
  • Seyed Ahmad Reza Ziaee, Mersedeh Karvandi, Negar Sadat Ziaee, Zohre Gholizadeh Ghozloujeh, Mohammad Amin Shahrbaf, Azamolsadat Roshan * Pages 45-52
    Background
    There is recent evidence that aldosterone plays a role in the pathogenesis of cardiovascular diseases in dialysis patients, which leads to the opportunity to block its actions for the benefit of these patients. In non-dialytic chronic kidney diseases, spironolactone was safe and effective in reducing left ventricular hypertrophy. However, its routine use has been precluded in hemodialysis patients due to the risk of hyperkalemia. The aim of the present study was to verify the safety and efficacy of spironolactone in the regression of left ventricular hypertrophy and ejection fraction in hemodialysis patients undergoing pharmacotherapeutic monitoring.
    Methods
    We performed a controlled, randomized, double-blind study evaluating 48 hemodialysis patients divided into 2 groups. The first group received spironolactone at a dose of 25 mg after hemodialysis over a few weeks, and the second group was the control. The patients were followed up for 9 months.
    Results
    Both groups were composed of 24 patients each. The study groups did not differ in their baseline characteristics. The group receiving spironolactone had a significant improvement in the left ventricular mass index and ejection fraction in comparison with the control group (P<0.05).
    Conclusions
    Spironolactone treatment in hemodialysis patients was safe and effective in regressing left ventricular hypertrophy and improving the ejection fraction as major risk factors for cardiovascular events in these patients.
    Keywords: Chronic kidney disease, Echocardiography, Left ventricular hypertrophy, Spironolactone, Ejection fraction
  • Seyedeh Samaneh Ahmadi, Hamidreza Sanati*, Hooman Bakhshandeh, Sepideh Jafari Naeini, Majid Hajikarimi, Alireza Hoghooghi Esfahani, Roya Rezaee, Alireza Ziaee Pages 53-59
    Background
    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).
    Methods
    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.
    Results
    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.
    Conclusions
    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.
    Keywords: Total bilirubin level, ST-segment elevation myocardial infarction, Primary percutaneous coronary intervention, Thrombolysis, Major adverse cardiovascular events
  • Masoud Tarbiat, Gholamreza Safarpoor *, Abbas Sedighinejad, Vali Imantalab Pages 60-63
    The incidence of acute pulmonary thromboembolism is rare during surgery. It could, however, be coincident with a right-sided heart thrombus (RHT). It is mandatory to remove an RHT as soon as possible to avoid death. We report the case of acute pulmonary thromboembolism during the surgical removal of an RHT in a 48-year-old woman with multiple comorbid medical conditions which was treated successfully with surgical embolectomy. (Iranian Heart Journal 2019; 20(1):60-63)
    Keywords: Pulmonary Embolism, Thrombosis, Embolectomy
  • Ramin Heidari, Behshid Ghadrdoost, Mohaddeseh Behjati * Pages 64-66
    Background
    The long-term resistance of indwelling hemodialysis catheters leads to the development of the superior vena cava (SVC) syndrome due to the obstruction of the dialysis catheters. The management of these cases needs technically challenging interventional procedures using balloon inflation or stent implantation at the SVC/right atrium junction. Hereby, we report 2 cases of the SVC syndrome in the setting of hemodialysis catheters which were successfully treated via interventional angioplasty.
    Case Presentation
    The first case was a 57-year-old man who was referred to us with facial congestion, gradual loss of consciousness, and fever. The patient underwent emergent hemodialysis. The source of the fever was found to be an infected permacath in the left internal jugular vein. He underwent hemodialysis through a right-sided access catheter. Upon the termination of the fever, the jugular access was exited and an arteriovenous fistula (AVF) was implanted in the right arm. After a while, the patient experienced swelling in the right arm. Finally, he underwent angioplasty on the occluded AVF. On follow-up, the arm swelling had faded gradually. The second case was a 60-year-old man who was referred to us with a diagnosis of under-dialysis. On admission, the patient’s permacath was removed and an AVF was implanted in his right arm to replace a dysfunctional AVF previously ed in his left arm. After the maturation of the right arm’s AVF, the patient underwent regular hemodialysis sessions without complications. After 1 year, under-dialysis occurred again. On venous angiography, a cut-down venous drainage the origin of the brachiocephalic vein up to its entry into the right atrium was seen.
    Conclusions
    Interventional angioplasty is a therapeutic approach to the SVC obstruction in the presence of hemodialysis catheters.
    Keywords: Superior vena cava obstruction, Interventional angioplasty, Hemodialysis, Catheter
  • Nahid Aghdaii, Mohsen Ziyaeifard*, Fatemehshima Hadipoorzadeh Pages 67-71
    Visual loss is a relatively rare but devastating and unpredictable complication of open heart surgery with cardiopulmonary bypass. The most common cause of postoperative visual loss following cardiac surgery is ischemic optic neuropathy (ION), which is generally categorized as anterior ischemic optic neuropathy (AION) and posterior ischemic optic neuropathy (PION). PION is clinically differentiated AION with a normal-appearing optic nerve head. PION is relatively more common in cases of spinal surgery and radical neck dissection, while AION appears to be more common than PION after cardiac surgery. We report a very rare case of transient bilateral visual loss due to PION in a 44-year-old man undergoing mitral valve replacement and coronary artery bypass graft surgery.
    Keywords: Visual, Optic neuropathy, Cardiac surgery