فهرست مطالب

  • Volume:14 Issue: 1, 2020
  • تاریخ انتشار: 1399/01/17
  • تعداد عناوین: 6
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  • Ali Garavand, Hassan Emami, Reza Rabiei *, Mehdi Pishgahi, Mojtaba Vahidi Asl Pages 1-6
    Context

    The use of registries to Coronary Artery Disease (CAD) data management plays an important role in the improvement of healthcare processes and reduction of outcomes for patients and healthcare providers. The present study aimed to compare the data management processes of CAD registries in the selected countries.

    Evidence Acquisition

    This review study was conducted comparatively in 2019. After selecting countries based on some criteria, the required data were collected by searching valid databases, more useful search engines, and related websites to CAD registries for the selected countries as well as by sending E-mails containing a data extraction form to the related organizations.

    Results

    Totally, five registries were chosen in the selected countries as follows: CADOSA (Australia), APPROACH (Canada), START (Italy), CLARIFY (Spain), and GWTG-CAD (US). The results showed that 60% of the selected registries made use of the electronic case report form for data gathering. The main data elements included demographic and general information, risk factors, vital sings, medication, laboratory tests results, examination results, ECG results, invasive measures and interventions, patient’s status on discharge, results of follow-ups, and post-discharge outcomes.

    Conclusion

    Developing CAD registries based on the data management principles provides the context to conduct cohort studies with very low costs. With regard to the study results, attention should be paid to data management processes, include data gathering, data processing, and information distribution, in development of CAD registries.

    Keywords: coronary artery disease, registry, data management
  • Maria Trepa *, Raquel Baggen Santos, Marta Fontes Oliveira, Ines Silveira, Ricardo Costa, Maria Joatilde o Sousa O, Carla Roque, Hipolito Reis, Vasco Dias, Severo Torres Pages 7-11
    Background

    Functional Mitral Regurgitation (FMR) is associated with poor prognosis in patients with Heart Failure (HF) and reduced Left Ventricular Ejection Fraction (LVEF). Cardiac Resynchronization Therapy (CRT) has been shown to lead to long-term and accurate improvement in FMR.

    Objective

    This study aims to identify the determinants of FMR improvement after CRT and determine their impacts on clinical outcomes.

    Methods

    In this retrospective single-centered study of consecutive CRT implantations, echocardiographic evaluation was performed before CRT implantation and at 6-12-month follow-up. FMR improvement was defined as ≥ 1 grade reduction in MR class. Independent predictors of FMR improvement were determined by multivariate analysis. The composite outcome of HF hospitalization and mortality was used to determine the prognosis.

    Results

    This study was conducted on 192 patients with a median follow-up of 50 ± 35 months. At baseline, FMR was present in 85% of the participants (48% mild, 30% moderate, and 7% severe). Improvement after CRT was observed in 74% of the patients with significant FMR. The variables associated with CRT improvement were atrial fibrillation, diabetes, and wider QRS, septal right ventricular lead, and posterolateral left ventricular lead. After multivariate analysis, only QRS duration was an independent predictor of FMR improvement (OR: 1.08, 95% CI: 1.00 - 1.17, P = 0.041). ‘Improvers’ had a higher survival-rate free of composite outcome at follow-up (74% vs. 33%, P = 0.015). Yet, the clinical benefit of FMR improvement was independent from CRT responsiveness (p-interaction = 0.338).

    Conclusion

    FMR was prevalent in patients undergoing CRT implantation, and three-fourths of the patients experienced a reduction in regurgitation severity. The only independent predictor of FMR improvement was QRS duration. Moreover, improvement was associated with better prognosis, independently from CRT responsiveness.

    Keywords: cardiac resynchronization therapy, heart failure, mitral valve insufficiency
  • Erfan Tasdighi, Ali Zahed Mehr, Arman Karimi Behnagh, Reza Arefizadeh, Maziar Gholampour Dehaki, Zahra Ghaemmaghami, Mehrzad Gholampour Dehaki* Pages 12-17
    Background

    Thyroid hormones are well-known for their various effects on the cardiovascular system. However, contradictory results have been obtained regarding the association between thyroid hormones within the Reference Range (RR) and Coronary Artery Disease (CAD). Moreover, scarce evidence is available regarding the association between thyroid hormones and Coronary Slow Flow Phenomenon (CSFP).

    Objective

    This study aimed to investigate the relationship between thyroid hormones in the RR, and CSFP and CAD.

    Methods

    A total of 1033 euthyroid patients who underwent coronary angiography were enrolled and divided into four groups based on their coronary angiography and Thrombolysis in Myocardial Infarction (TIMI) flow grade: Normal Coronary Artery (NCA), CSFP, Non-obstructive CAD (N-CAD), and Obstructive CAD (O-CAD). Multivariate multinomial regression analysis was conducted to assess the association between thyroid hormone levels and CSFP as well as CAD. Thereafter, the prediction accuracy of Free Triiodothyronine (FT3) levels for the presence of CSFP and CAD was evaluated by the Receiver Operating Characteristic (ROC) curve analysis.

    Results

    FT3 serum level was significantly lower in the CSFP and both CAD groups compared to the NCA group (P < 0.001). FT3 level was inversely correlated to the presence of CSFP and CAD (both N-CAD and O-CAD) only in young females. Moreover, TSH was found to be an independent predictor of O-CAD in young individuals, regardless of their gender. Furthermore, FT3 levels ≤ 2.56 pg/mL predicted the presence of CSFP (78% sensitivity and 62% specificity) and FT3 levels ≤ 2.38 pg/mL predicted the presence of CAD (64% sensitivity and 75% specificity) in young females.

    Conclusion

    FT3 level was negatively associated with CSFP and CAD in young females. In addition, high levels of TSH were associated with O-CAD only in young patients. Further studies are required to shed more light upon the regarded associations.

    Keywords: Coronary Artery Disease, Coronary Angiography, thyroid hormones, coronary slow flow phenomenon, Euthyroidism
  • Ziba Rahimianmashhad, SeyyedReza Attarzadeh Hosseini*, Amir Rashidlamir, MohammadAli Sardar, Sirous Nekooei, Ramesh Giti Pages 18-23
    Background

    Vascular stiffness, wall thickness, wave reflections, central hemodynamics, and endothelial function are the best indicators of arterial health. Numerous studies have evaluated the effect of exercise on the structure and function of the arteries in people with arteriosclerosis disorders. However, a limited number of studies have been carried out on healthy obese individuals.

    Objective

    This study aimed to compare the impacts of aerobic exercise and resistance training on arterial stiffness, endothelial function, and carotid Intima‐Media Thickness (cIMT) in sedentary obese females.

    Methods

    In this study, 27 sedentary obese females (30 - 40 years old) with the mean body mass index of 30.47 kg/m2 were randomly assigned to two groups of aerobic exercise (n = 14) and resistance training (n = 13). The first group was subjected to 24 sessions of aerobic exercise in form of riding a stationary bike at the intensity of 50 - 70% of the maximum heart rate reserve for 35 - 50 min. In the second group, the participants performed progressive resistance training for 24 sessions with 60 - 85% intensity of one repetition maximum for 8 - 12 repetitions. Maximal oxygen uptake (VO2 max), vascular stiffness, endothelial function, and cIMT were measured by color Doppler ultrasound in the 1st, 12th, and 24th sessions.

    Results

    The results revealed a significant increase in VO2max of the two groups. However, the changes in weight, body mass index, endothelial function, cIMT, and Pulse Pressure (PP) were not statistically significant.

    Conclusion

    The eight-week (aerobic or resistance) training program could not exert positive effects on the structural properties of the arterial wall and reduce vascular stiffness in obese sedentary females. In addition, it seemed that diverse exercise methods had distinct effects on shear stress patterns and hemodynamics. Yet, further research is required to determine the most efficient exercise guidelines to maximize the effectiveness of exercise in the arterial wall thickness.

    Keywords: Obesity, Women, Exercise, Vascular Stiffness, Carotid Intima‐Media Thickness
  • Aghigh Heydari, Feridoun Sabzi *, Atefeh Asadmobini Pages 24-29
    Background

    Researchers have tried to determine a clinical Fast-Track Extubation (FTE) for an efficient and safe approach to post-operative management in high-risk patients undergoing cardiac surgery. Opium consumption is one of the risk factors for coronary artery disease and is more prevalent among the patients with heart problems.

    Objective

    The present study aimed to determine the early outcomes of FTE in opium addicted patients after Off-Pump Coronary Artery Bypass Graft (OPCABG) surgery.

    Methods

    This single-centered retrospective cohort study was conducted on the patients who had undergone OPCABG between February 2008 and February 2011. The patients were divided into opium-negative and opium-positive groups. The patients were prepared for rapid recovery, emphasizing pre-operative physiotherapy, respiratory training, low dose fentanyl anesthesia, diuretic use, and autologous blood salvage to avoid the untoward effects of allogenic blood transfusion. Significant factors in successful FTE were analyzed by multivariate regression analysis. P-values less than 0.05 were considered to be statistically significant.

    Results

    Mortality was higher among the opium addicted patients (P = 0.007). Most of the patients with extubation time > 12 hours were opium addicted (P < 0.001). The results of multivariate regression analysis showed that age, gender, post-operative Myocardial Infarction (MI), smoking, extubation time, transfusion, and post-operative renal complications were the significant predictors of extubation time in the opium addicted patients.

    Conclusion

    FTE could be successfully performed in most of the patients undergoing OPCABG. Managing addicted patients and making effort to control post-operative MI, renal complications, smoking, and extubation time are important issues for a successful FTE.
     

    Keywords: Coronary artery bypass graft, Off-pump, Opium dependence
  • Fatemeh Bahrami, Shirin Hasanvand *, Fateme Goudarzi, Farzad Ebrahimzadeh, Nasrin Galehdar, Fardin Heidari Pages 30-35
    Background

    Patients’ perceptions of the quality of care can influence the quality of healthcare.

    Objective

    This study aimed to explore cardiac patients’ perception of a good nursing care.

    Methods

    In this cross-sectional study conducted from February to June 2017, 200 patients in 10 coronary care units of public hospitals of Lorestan province, Iran were selected by stratified random sampling. The revised form of Good Nursing Care Scale was used to measure the perceived quality of nursing care experienced by the patients. This scale contained 37 items and seven subscales responded through a five-option Likert scale. The data were entered into the SPSS software, version 21 and were analyzed using descriptive statistics, independent t-test, and one-way analysis of variance.

    Results

    The mean reported perception level was 2.81, which was relatively high. The highest level of quality was related to the nursing staff characteristics (M ± SD: 3.28 ± 0.90), while the lowest was related to the patients’ coping strategies (M ± SD: 2.37 ± 1.02). The results revealed a statistically significant difference in the patients’ perceptions of nursing care quality based on the place of hospitalization, having or not having the history of hospital stay, and information given about care and treatment.

    Conclusion

    From the perspective of the patients, the quality of nursing care was relatively high. Considering the findings of “the coping strategies” subscale and its importance in adapting patients to new conditions, it should be taken into account by the healthcare team. Additionally, the patients’ active participation in decision-making and effective interactions have to be considered in order to improve their coping with the disease.

    Keywords: Patients, Nursing Care, Coronary Care Unit, Quality of Health Care