فهرست مطالب

  • Volume:13 Issue: 4, 2019
  • تاریخ انتشار: 1398/10/09
  • تعداد عناوین: 6
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  • Bahman Naghipour, Sajjad Ahmadi, Gholamreza Faridaalaee*, Allahveirdy Arjmand, Farzaneh Soleimani Page 109
    Context

    In some studies, Fresh Frozen Plasma (FFP) transfusion in severely ill patients was accompanied with an increase in the risk of nosocomial infection. However, there are no comprehensive data in terms of FFP transfusion and its relationship with nosocomial infection in heart surgery. Hence, the present systematic review and meta-analysis aimed to investigate the relationship between FFP transfusion and nosocomial infection risk in the patients undergoing cardiac surgery.Evidence Acquisition:Study selection: The present study included all the studies, which probed into nosocomial infection after FFP transfusion in patients with cardiac surgery.

    Data sources

    Medline, Web of Science, Embase, Central, and Scopus electronic databases were searched to the end of March 2019.

    Results

    Finally, five articles and three abstracts that studied nosocomial infection were entered into the present systematic review. FFP increased the rate of nosocomial infection in cardiac surgery in one article, but this was not the case in the remaining four articles. The three abstracts also reported that FFP increased the rate of nosocomial infection in cardiac surgery.

    Conclusion

    The studies indicated that the benefit of FFP administration outweighed the probable risk of infection. Indeed, none of the studies indicated a strong relationship between FFP transfusion and infection rate after cardiac surgery.

    Keywords: Cardiac, Heart, Infection, Cross Infection, Surgery
  • Mohammadreza Edraki, Rafat Noiaghdam, Hossein Moravej *, Hamid Amoozgar Page 115
    Background

    Type I Diabetes Mellitus (T1DM) is one of the most common endocrine diseases in the world. It is also the dominant type of diabetes mellitus among children and adolescents that, if left uncontrolled, becomes a major risk factor for cardiovascular disorders and may cause clinical and subclinical cardiac dysfunction.

    Objective

    This study aimed to compare uncontrolled pediatric and adolescent patients and similar healthy people regarding cardiac function according to echocardiography and B-type Natriuretic Peptide (BNP).

    Methods

    This case-control study was carried out in the Outpatient Department of Nemazi tertiary hospital in Shiraz, Iran between June and September 2016. The study included 29 consecutive outpatient cases aged 5 - 18 years who had been diagnosed with T1DM for more than three years and had normal ejection fraction in M-mode echocardiography. The control group consisted of 29 age- and gender-matched healthy non-diabetic volunteers. Both cases and controls were selected by simple random sampling. The participants underwent clinical evaluation, including BNP assay and echocardiographic examination composed of two-dimensional echocardiography, M-mode echocardiography, pulsed Doppler imaging, and Tissue Doppler Imaging (TDI). P-value ≤ 0.05 was considered to be statistically significant.

    Results

    The results revealed a decline in cardiac function in TDI, which was related to the HbA1C level and duration of the disease. A significant difference was found between the cases and the controls regarding the left ventricular posterior wall, interventricular septal diameters in diastole, and E/A ratio of tricuspid valve (P = 0.047, P = 0.001, and P = 0.021, respectively). A significant difference was also observed between the two groups in terms of septal S´ and E´ parameters (P = 0.004 and P = 0.002, respectively). Moreover, diminished E/A ratio of tricuspid valve annulus was related to the increased duration of the disease. Even though left ventricular hypertrophy occurred in the patients, no significant increase was observed in BNP values.

    Conclusion

    The results indicated that M-mode, two-dimensional, pulsed Doppler, and TDI echocardiography might efficiently evaluate cardiac function in patients with preserved ejection fraction. However, BNP measurement might not be useful for screening of cardiac function.

    Keywords: Heart Failure, Doppler Echocardiography, Type I Diabetes Mellitus
  • Ali Mohammadzadeh, Sara Tavasoli, Madjid Shakiba, Ali Borhani, Maryam Mohammadzadeh * Page 120
    Background

    Diagnosis of Constrictive Pericarditis (CP) is a clinical challenge. Echocardiography and Magnetic Resonance Imaging (MRI) are the most commonly used modalities for evaluating pericardial diseases, such as CP.

    Objective

    This study aimed to assess and compare the diagnostic accuracy of MRI and echocardiography in diagnosis of CP.

    Methods

    This cross-sectional, retrospective study was conducted on 45 patients suspicious for CP [n = 36] or non-constrictive pericarditis [n = 9]. Among the 36 patients suspicious for CP, 20 underwent pericardiectomy. Accordingly, 19 patients were proved to have CP based on histopathological assessments and were considered as the CP-positive group. In addition, the nine patients who were suspicious for pericarditis without the clinical findings of pericardial constriction were included in the CP-negative group [adding to one patient who was negative for CP after surgery, there were a total of 10 CP-negative patients]. MRI, echocardiographic, and clinical findings were obtained from the hospital digital archive and were compared with each other. Diagnostic accuracy indices of echocardiography and MRI in diagnosis of CP were also calculated.

    Results

    The mean age of the patients with proved CP and without CP was 48.1 ± 20.7 (12-77) and 50.6 ± 15.3 years (25 - 72), respectively. Additionally, 15 patients were male (78.9%), while six individuals were male (60%) in the CP-negative group. Among MRI and echocardiography variables, the diagnostic accuracy of MRI septal bounce was found to be the same as the gold standard. MRI pericardial thickening > 4 mm had the sensitivity of 100%, specificity of 80%, Positive Predictive value (PPV) of 90%, and Negative Predictive Value (NPV) of 100%. Echocardiographic parameters, including pericardial thickness, septal bounce, hepatic venous reversal flow, and respiratory variation in mitral flow, also showed high specificity (100%). Additionally, the Area Under the Curve (AUC) of MRI and echocardiography was 0.95 (95% CI = 0.85 - 1) and 0.89 (95% CI = 0.80 - 0.99), respectively (P = 0.43). Moreover, the sensitivity of MRI and echocardiography in diagnosis of CP was 100% and 78.9%, respectively (P = 0.045).

    Conclusion

    MRI was found to be more sensitive than echocardiography in diagnosis of CP. Indeed, MRI septal bounce had the best diagnostic accuracy for diagnosis of CP.

    Keywords: Constrictive Pericarditis, Magnetic Resonance Imaging, Echocardiography
  • Marta Fontes Oliveira *, Filipe Martins, Luis Gomes, Maria Trepa, Raquel Baggen Santos, Ricardo Costa, Patricia Rodrigues, Andre Luz, Sofia Cabral, Mario Santos, Severo Torres Page 127
    Background

    Patients with Acute Coronary Syndrome (ACS) with preserved Left Ventricular Ejection Fraction (LVEF) have an incidence of adverse outcomes despite the previously presumed benign prognosis.

    Objective

    We hypothesized that NT-pro-BNP could help refine the risk stratification of these patients.

    Methods

    In this observational retrospective study, laboratory and clinical data were collected from 232 consecutive patients with ACS and preserved LVEF (> 50%) and no previous history of Heart Failure (HF) at hospital discharge. Associations between NT-proBNP and the composite outcome of HF hospitalization, HF diagnosis de novo, and all-cause mortality were assessed by univariate and multivariable Cox models. Statistical analyses were performed using Stata software, version 12.1 and a two-sided P-value < 0.05 was considered to be statistically significant.

    Results

    The NT-proBNP median was 408 [IQR 177-853] pg/mL. Patients with increased NT-proBNP were older and were more likely to be female (P = 0.013), be non-smoker (P = 0.039), have worse renal function (P < 0.001), and have lower hemoglobin concentration (P < 0.001). They had more ST-Elevation Myocardial Infarction (STEMI) and evolved with higher Killip classes (P < 0.001). Increased NT-proBNP levels were also associated with higher peak values of Creatinine Kinase (CK) and troponin (r = 0.36, P < 0.001 and r = 0.37, P < 0.001), higher left ventricular mass (P = 0.021), larger left atria (P = 0.013), and higher prevalence of regional LV hypocontractility (P = 0.012 to P = 0.090). During the 4.2 [2.1-5.4] years of follow-up, the composite outcome occurred in 19 patients. After adjusting for age, sex, and Killip class, NT-proBNP was not associated with the composite outcome (HR = 1.18; 95% CI: 0.78 - 1.78).

    Conclusion

    Post-ACS patients with preserved LVEF and increased levels of NT-proBNP were older, had more comorbidities, and presented with a more severe myocardial infarction. However, NT-proBNP levels measured during ACS hospitalization did not predict the clinical adverse outcomes.

    Keywords: Prognosis, NT-proBNP, Myocardial Infarction
  • Madjid Shafiayan, Mahdie Ghalenoee, Abbas Ebadi, Reza Ghanei Gheshlagh *, Arezoo Fallahi, Seyed Hassan Niksima Page 133
    Background

    Cardiovascular Disease (CVD) is a common chronic disease with a high mortality rate. Patients with CVD need to engage in cardiovascular health behaviors to prevent the complications of the disease.

    Objective

    The present study aimed to examine the psychometric properties of the Persian version of the Cardiac Health Behavior (CHB) scale among patients with CVD.

    Methods

    In this methodological study, a total of 325 patients with CVD were selected from public places in Tehran using convenience sampling. The instrument was translated based on the World Health Organization’s (WHO) guidelines. The face, content, and construct validities were examined using exploratory and confirmatory factor analyses. The reliability of the scale was also assessed using McDonald’s omega and Cronbach’s alpha coefficients. Data analyses were performed using Lisrel 8.8 and SPSS 20 software.

    Results

    Using Exploratory Factor Analysis (EFA), the five following factors were extracted: health responsibility, dietary habits, physical activities, smoking cessation, and stress management. These factors explained 64.96% of the total variance of cardiac health behavior. In Confirmatory Factor Analysis (CFA), the goodness of fit of the five-factor model for cardiac health behavior was confirmed based on standard indices (CFI = 0.92, IFI = 0.92, PNFI = 0.75, and RMSEA = 0.089). Using Cronbach’s alpha coefficient, the internal consistency of the total scale was found to be 0.887.

    Conclusion

    The five-factor model of cardiac health behavior showed good validity and reliability in patients with CVD. According to its good psychometric properties, the Persian version of the CHB scale reflected the importance of health behaviors in the daily activities of the patients with CVD.

    Keywords: Cardiovascular Disease, Factor Analysis, Health Behavior
  • Zahra Khajali, Fateme Jorfi *, Mozhghan Parsaee, Mohammad Kasaei, Mehrdad Jafarifesharaki Page 139

    Idiopathic right atrial dilation is known as a congenital anomaly in the absence of obvious causes that produce right ventricular pressure or volume overload. Congenital giant right atrium can cause functional tricuspid regurgitation, arrhythmia, and right-sided heart failure. A massive Idiopathic Dilation of Right Atrium (IDRA) was reported in a 30-year-old man presented with intermittent palpitation and dyspnea on effort. Transthoracic echocardiography revealed huge right atrium leading to severe tricuspid regurgitation, moderate right ventricular enlargement with moderate dysfunction, and no evidence of other valvular heart diseases increasing the right ventricular pressure or volume, left to right shunt, and Ebstein anomaly. Cardiac Magnetic Resonance Imaging (MRI) confirmed the right atrial enlargement. The estimated right atrium volume by MRI was about 700 mL. With regard to the patient’s symptoms, he was scheduled for surgical treatment. The patient underwent partial surgical resection of the dilated right atrium wall and mechanical tricuspid valve replacement because the tricuspid valve was unrepairable on the operation table. Idiopathic right atrial enlargement is a very rare disease and may be easily confused with other anomalies that lead to right atrial enlargement, such as Ebstein anomaly. Hence, the probability of this pathology should be kept in mind when the usual etiologies of right atrial enlargement are excluded. Partial surgical resection of the dilated right atrium is an effective therapeutic option in symptomatic patients.

    Keywords: Ebstein Anomaly, Heart Atria, Cardiomyopathies, Congenital Heart Disease