Iranian Heart Journal
Volume:20 Issue: 4, Winter 2019

There is a growing interest in noninvasive methods for the assessment of sufficient coronary flow after coronary artery bypass graft surgery (CABG) by transthoracic echocardiography (TTE).

We performed this study to evaluate the coronary sinus diameter (CSD), as a confident marker of the coronary blood flow, by TTE among patients undergoing CABG. A total of 104 elective CABG patients with double, triple, or more coronary artery diseases were enrolled in this cross-sectional study. Four patients were lost to follow-up because of poor echocardiographic window or death. One day before and 7 days after CABG, all the patients underwent TTE.

The mean CSD was calculated by averaging the diameters of the middle and terminal segments of the coronary sinus. The left ventricular ejection fraction (LVEF) was calculated using the Simpson methods. The CSD in the middle (11.1%; P < 0.0001) and terminal (10.1%; P < 0.0001) segments was significantly increased after CABG among all the patients. Additionally, the diameter change was most prominent among those with triple vessel disease. Similarly, a significant increase was observed in the mean CSD after CABG (11.3%; P < 0.0001).

No significant changes were observed after CABG with respect to the LVEF in the first postoperative week. The findings showed that the TTE-determined CSD could be a potential surrogate for sufficient coronary perfusion and graft patency after CABG. 

Patients’ relatives who receive insufficient information suffer immense anxiety before their patients’ surgery and hospitalization. Providing information and training via social media alleviates anxiety and boost satisfaction among patients’ relatives. This research was conducted to evaluate the effects of social media-based training on anxiety and satisfaction among the family members of patients at the intensive care unit (ICU) following coronary artery bypass graft surgery (CABG).

In the present quasi-experimental research, the study population was divided into intervention and control groups. Data were collected on 100 family members of patients at the ICU after CABG in the year 2017. The sample was ed via the convenience sampling method in Rajaie Cardiovascular, Medical, and Research center. The intervention group became members of a Telegram channel and subsequently received information about CABG and postoperative treatments through this channel. For the control group, however, only traditional methods were performed. For data collection, the Spielberger State-Trait Anxiety Inventory (STAI) questionnaire and and ICU family satisfaction questionnaire were used. The data were analyzed in SPSS.

Based on the findings, there were no statistically significant differences between the 2 groups before the intervention. However, after the intervention, the average score for the STAI questionnaire showed a significant drop and the amount of satisfaction after receiving information exhibited a significant rise in the intervention group, as compared with the control group (P < 0/0001).

Based on our findings, social media-based training confers increased satisfaction and reduced anxiety among the family members of post-CABG patients at the ICU. (Iranian Heart Journal 2019; 20(4): 13-21)

Inflammatory mechanisms can cause left ventricular (LV) remodeling. These mechanisms include increased matrix metalloproteinases and the tissue inhibitors of metalloproteinases. Doxycycline is an antibiotic (macrolide) and a broad inhibitor of matrix metalloproteinases. This study evaluated the effects of early short-term doxycycline treatment on LV remodeling in patients suffering ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).

In the present double-blinded randomized control trial, 68 post-MI patients who underwent primary PCI for STEMI were assigned to 2 groups, each consisting of 34 volunteers. Over a 7- day period, all these volunteers took 100 mg of Doxycycline twice a day. A placebo with the same order was prescribed for the control group. The cardiac function, the LV diameter, the left atrial diameter, and the LV torsion were measured at baseline and 40 days afterward.

The mean age of the control and experimental groups was 53.7 years and 56.1 years, respectively. The averages of the left atrial volume (P = 0.03), the LV end-diastolic volume (P = 0.03), and the LV end-systolic volume (P = 0.01) in the experimental group rose less significantly than those in the control group. However, the LV torsion such as basal rotation (P = 0.03), apical rotation (P = 0.02), twist (P = 0.02), and torsion (P = 0.002) increased more substantially in the experimental group than in the control group.

Early administration of doxycycline attenuated LV remodeling measured by speckle- tracking echocardiography in our patients with anterior STEMI after primary PCI, vs. our control group subjects, who were on a placebo diet. 

Opiates cause coronary artery disease (CAD), which is one of the most common complicated cardiovascular diseases and is responsible for morbidity and mortality rates. The mechanism of the association between opiates and CAD is not well known. Therefore, the aim of this study was to evaluate antioxidant enzymes serum levels in patients with CAD and opium addiction.

This case-control study was performed on 188 cases (40 in the CAD group, 39 in the CAD and opium addiction group, and 60 in the control group). Superoxide dismutase (SOD) and glutathione peroxidase (GPx) were measured by enzymatic methods and compared between the groups.

The serum level of SOD was 744.55 ± 506.16 U/L, which was lowest among the patients who had CAD with opium consumption (465.46 ± 67.8 U/L) and highest in the control group (1304.46 ± 545.69 U/L) (P < 0.001). Furthermore, the serum level of GPx was 1076.92 ± 778.28 U/L, which was lowest among the patients who had CAD with opium consumption (769.79 ± 506.77 U/L) and highest in the control group (1661.41 ± 615.11 U/L) (P < 0.001).

The serum levels of SOD and GPx were significantly lower in our CAD cases with opium addiction. Opiates cause oxidative stress. Pharmacological and psychiatric approaches can reduce the toxicological effects of opiates. (Iranian Heart Journal 2019; 20(4): 31-37)

Cardiovascular disease risk factors are associated with lifestyle, and patients undergoing coronary angioplasty require a great deal of training on modifying their lifestyle. The aim of this study was to survey the effects of educational intervention on lifestyle among Iranian patients after coronary angioplasty in Tehran in 2017.

This research was a randomized clinical trial with 2 groups of control (n = 29) and intervention (n = 28). The patients’ lifestyle was evaluated by using a healthy lifestyle questionnaire at baseline and then at 1 month and 3 months after an educational intervention. The data were analyzed using SPSS, version 20.

The mean age of the intervention and control groups was 62.54 ± 4.23 and 60.52 ± 5.37 years old, respectively. The Mann–Whitney U and Friedman tests showed that the scores of healthy lifestyle, healthy nutrition, and exercise and physical activity significantly improved in the intervention group in comparison with the control group at 1 month and 3 months after the educational program (P < 0.001). The Friedman test showed a significant increase in the score of avoiding tobacco and alcoholic beverages, health responsibility, health-based purchase, and healthy lifestyle in both groups at 1 month and 3 months after the educational program (P < 0.05). The results revealed that the score of stress management in both groups did not increase significantly during the survey.

In the present study, our educational program had a considerable effect on modifying lifestyle among the Iranian patients after coronary angioplasty. Psychological support programs for managing the stress of these patients are suggested. 

Primary percutaneous coronary intervention (PPCI) is the gold standard for the treatment of ST-segment-elevation myocardial infarction (STEMI). Guidelines emphasize the importance of STEMI networks in order to facilitate rapid acute reperfusion therapy and improve prognosis. The outcomes of PPCI in a single tertiary university hospital in Hormozgan Province in Iran are reported herein.

We performed an observational study including all the consecutive STEMI cases admitted to our interventional cardiology department. Symptom to door, door to ECG, door to diagnosis, door to cath lab, door to balloon, and mortality were reported. Descriptive statistics (median, quartile 1-3) and nonparametric tests (Kruskal–Wallis and Mann–Whitney) were used.

Totally, 195 patients were considered eligible for PPCI. The mean age of the patients was 54.90 years old (range =21–91 y). Women accounted for 28.2% of the study population. All the patients successfully underwent PPCI with a 100% rate of stenting. The in-hospital mortality rate was 1.45%. The median time for symptom-to-door, door-to-diagnosis, code-activation, symptom-to-device, and door-to-device times was 167.50, 23, 35, 266, and 60 minutes, respectively.

Our results, in line with previous studies, confirm the role of PPCI as the frontline approach to STEMI. Our results display the continuous efforts provided to reduce the in- hospital procedural times; nevertheless, ongoing efforts are needed to decrease symptom-to- door times. 

Coronary artery disease (CAD) is one of the most common complicated cardiovascular diseases causing morbidity and mortality. Early detection of CAD can help us choose the best therapeutic procedures and gain optimal results. This study aimed to evaluate cystatin C serum levels in patients with CAD.

This cross-sectional study was performed on 95 cases (60 in the CAD group and 35 in the control group). Cystatin C was measured via the enzymatic method and the sensitivity and specificity of cystatin C for diagnosing CAD were measured by ROC curve.

The mean serum level of cystatin C was 2.21 ± 0.97 mg/L; it was higher among the patients with CAD (3.57 ± 0.58 mg/L). The area under the ROC curve was calculated to be 0.702, with sensitivity of 88.5% and specificity of 82.4% based on 0.5 as the best cutoff point for serum cystatin C (P = 0.001, 95% CI: 0.59 to 0.81).

Our results showed that cystatin C serum levels with a cutoff point of 0.5 had high and acceptable sensitivity and specificity in diagnosing CAD and could, thus, play an important role in the early diagnosis of CAD and prevention of adverse cardiovascular events. (Iranian Heart Journal 2019; 20(4): 56-63)

Some studies have shown that opium is a potential risk factor for coronary artery disease (CAD). The method of opium use in most of these studies has been evaluated verbally. In the present study, we assessed the urinary morphine concentration to confirm opium addiction. This study aimed to evaluate the association between the urinary morphine concentration and the severity of coronary artery stenosis in opium addicts.

This study was conducted on 200 opium addicts admitted to the angiographic ward of a referral hospital at Kerman University of Medical Sciences. these patients, 134 cases with CAD according to angiographic results were ed for our study. The patients were divided into 2 groups of mild CAD with < 50% stenosis and severe CAD with > 50% stenosis. Opium addiction and its severity were diagnosed based on the DSM IV criteria and confirmed by the measurement of the urinary morphine concentration.

Severe coronary artery stenosis was detected in 77.6% of the opium addicts. A urinary morphine concentration exceeding the median index was associated with higher odds of severe CAD, but this association was not statistically significant (OR = 2.2, 95% CI: 0.62 to 7.9; P = 0.21).

The opium addicts in the current study were at a higher risk for severe CAD, but there was no significant relationship between the urinary morphine concentration and the severity of CAD. This paraclinical test was not an accurate marker for the assessment of the severity of CAD. The role of other alkaloids in opium should be evaluated. (Iranian Heart Journal 2019; 20(4): 64-70)

Several studies have demonstrated an association between vitamin D deficiency and cardiovascular diseases. Slow coronary flow (SCF) is a phenomenon in coronary angiography defined as the slow (delayed) opacification of the epicardial coronary arteries with contrast agents in the absence of coronary obstruction. We sought to evaluate the level of vitamin D in SCF patients against normal coronary conditions.

This cross-sectional study was carried out on 164 patients admitted for elective coronary angiography. For 15 months, among these patients, 82 patients with SCF and 82 patients with normal coronary arteries or mild coronary artery disease (CAD) who were matched for age and gender were ed and vitamin D levels were measured accordingly.

The mean age of the patients was 56 years in the normal coronary group and 54 years in the SCF group. The mean level of vitamin D was 23.84 ng/mL in the normal coronary group and 24.29 ng/mL in the SCF group. Vitamin D deficiency was observed in 44.4% of the patients in the normal coronary group and 41.2% of the patients in the SCF group. The Mann–Whitney U test showed no significant difference between the 2 groups in terms of vitamin D levels (P = 0.96).

The level of vitamin D was not significantly different between our 2 groups of patients with SCF and with normal coronary arteries (or mild CAD). 

The occurrence of cardiac structural and functional abnormalities in patients with scleroderma and pulmonary arterial hypertension has been clearly assessed; there are, however, only a few studies on cardiac manifestations in patients with normal pulmonary arterial pressure, which is the purpose of this study.

In this case-control study, 35 patients with known systemic sclerosis referred to the Systemic Sclerosis Clinic of Shariati Hospital in 2018 were ed. among individuals without systemic sclerosis that had referred only for routine clinical check-ups, 35 patients were ed as the control group. All the subjects were assessed by 2D echocardiography, tissue Doppler imaging, and speckle-tracking echocardiography.

Compared with the healthy control group, significant changes were observed in the left atrium, the aortic root, the interventricular septum diastolic thickness, the posterior wall diastolic thickness, the right ventricular diameter, and the right ventricular systolic motion in the patients with scleroderma. Additionally, the changes in left ventricular global circumferential strain and right ventricular global longitudinal strain in the apical 4-chamber view parameters were significant in these patients, although there was no difference between the 2 groups in terms of the left ventricular global longitudinal strain index. In the patients with scleroderma and normal pulmonary arterial pressure, there was a significant direct correlation between the age of the patients with the pulmonary artery size and an inverse correlation between age and E' septal and E' lateral.

Patients with scleroderma or systemic sclerosis suffer systolic and diastolic dysfunction, which can be associated with significant atrial/ventricular structural and functional changes. These changes may be independent of pulmonary arterial pressure, but the risk of these abnormalities will be increased in advanced age. 

A prolonged hospital stay causes bed occupancy rates and increases hospital costs. This study aimed to determine the factors affecting the ICU length of stay after coronary artery bypass graft surgery (CABG).

In this descriptive cross-sectional study, 346 patients undergoing CABG between March 2015 and September 2016 were ed through convenience sampling. Based on their ICU length of stay, the patients were divided into 2 groups: ICU length of stay ≤ 72 hours (3 d) (Group A) and ICU length of stay > 72 hours (Group B).

Among the 346 patients studied, 93 (27%) patients had an ICU length of stay ≥ 72 hours and 253 (73%) patients had an ICU length of stay < 72 hours. There was no statistically significant difference in the ICU length of stay between the women and men (P = 0.536). The subjects with a history of diabetes and hypertension were more likely to stay in the ICU for a longer period. For the patients with an ICU stay > 72 hours, the number of blood products received; the use of inotropes; the duration of cardiopulmonary bypass; the duration of intubation; cardiac, pulmonary, neural, and renal complications; infection, receiving inotropes in the ICU; postoperative bleeding; return to the operating room; receiving blood; and a history of bleeding were among the influential factors during the patients’ stay in the ICU.

The results of this study showed that the factors increasing the ICU length of stay after CABG were old age, a reduced left ventricular ejection fraction, a prolonged cardiopulmonary bypass time, receiving inotropes, prolonged intubation, the use of the intra-aortic balloon pump, receiving blood products, and postoperative bleeding. 

We sought to assess the relationship between the baseline white blood cell (WBC) count and the neutrophil-to-lymphocyte ratio (NLR) and the 6-month outcome in patients with non–ST-segment elevation myocardial infarction (NSTEMI) undergoing percutaneous coronary intervention (PCI).

Between April 2016 and April 2017, consecutive NSTEMI patients who underwent PCI were prospectively enrolled in a PCI registry. The patients’ demographics, initial WBC count, NLR, and 6-month major adverse cardiac events (MACE) were assessed. The patients were divided into 3 groups based on their WBC count: WBC < 10000, WBC = 10000–12000, and WBC > 12000. According to the NLR, there were 3 groups: NLR < 2.5, NLR = 2.5–4.5, and NLR > 4.5. Finally, the association between these values and 6 months’ MACE was assessed.

The study was conducted on 161 patients with NSTEMI who underwent PCI. The mean age of the participants was 58.9 ± 11 years, and 135 (83.9%) of the patients were male. The results showed that 81.9% of the patients had WBC < 10000, 13.1% had WBC = 10000–12000, and 5% had WBC > 12000; additionally, 87 patients had NLR < 2.5, 57 patients had NLR = 2.5–4.5, and 20 patients had NLR > 4.5. There was no significant association between the time of admission, the WBC count, the number of involved coronary vessels, the reoccurrence of myocardial infarction, unstable angina, atrial fibrillation, cardiogenic shock, and death; nonetheless, there was a significant relationship between the admission NLR and the reoccurrence of myocardial infarction (P = 0.008) and unstable angina (P = 0.02).

The NLR can be considered a predictive parameter for long-term outcomes in NSTEMI patients undergoing PCI. 

Jervell and Lange-Nielsen syndrome (JLNS) is an uncommon hereditary condition. Characterized by deafness at birth, JLNS is associated with anomalies that distress the electrical system of the heart and causes long QT syndrome. Patients with long QT syndrome are at risk of severe ventricular arrhythmias. Every change in autonomic balance, particularly in the perioperative period, renders patients prone to the risk for torsades de pointes and sudden cardiac arrest and death. Herein, we describe a 6-year-old girl scheduled for left cardiac sympathetic denervation due to frequent implantable cardioverter-defibrillator shocks.