فهرست مطالب

  • Volume:14 Issue: 2, 2020
  • تاریخ انتشار: 1399/04/11
  • تعداد عناوین: 8
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  • Mani Hassanzadeh, Amir Aslani *, Zahra Mehdipour Namdar, Anis Amirhakimi, MohammadHossein Nikoo, MohammadVahid Jorat Pages 39-41
    Background

    Sotalol is the most effective anti-arrhythmic drug in patients with Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC).

    Objective

    This retrospective study aimed to evaluate the effect of sotalol on Signal Averaged ECG (SAECG) parameters in patients with ARVC.

    Methods

    This retrospective study was performed on 11 ARVC patients who were recruited from the cardiology clinic. SAECG was performed in all patients at baseline and six weeks after treatment with sotalol. To assess the effects of sotalol on SAECG, the three following parameters were taken into account: 1) filtered QRS duration, 2) duration of terminal QRS < 40 µv, and 3) Root Mean Square (RMS) voltage of terminal 40 ms. Patients with coronary artery disease, dilative or hypertrophic cardiomyopathy, congenital heart disease, and significant valvular heart disease were excluded from the study.

    Results

    In total, 11 patients with confirmed ARVC were included. The mean age of the participants was 28 ± 11 years and all patients were male. History of syncope was reported in four patients, ventricular tachycardia in three patients, positive family history of cardiac disorders in two patients, and Epsilone wave in four patients. Besides, Implantable Cardioverter Defibrillators (ICDs) were implanted in five patients. No significant change was detected in the filtered QRS duration following the use of sotalol (P = 0.542). However, a significant reduction was observed in the Low Amplitude Signal (LAS) duration below 40 µv (P = 0.002). Additionally, a significant increase was found in the RMS voltage in the last 40 ms of the QRS (P = 0.043).

    Conclusion

    Sotalol decreased the duration of terminal QRS < 40 µv. Because of this valuable effect, sotalol should be considered as the first-line therapy for treating ARVC patients.

    Keywords: Arrhythmia, Ventricular Tachycardia, Sotalol, Arrhythmogenic Right Ventricular, Cardiomayopathy
  • Maryam Nabati *, Soheil Bakhshinasab, Aliasghar Farsavian, Fatemeh Rasolpor, Jamshid Yazdani Charati Pages 42-47
    Background

    Atrial Fibrillation (AF) and Heart Failure (HF) most commonly coexist, and each condition can exacerbate and complicate the course of treatment of the other. The relationship between these two conditions is not entirely understood. Loss of atrial systole is an important contributing factor in decreasing cardiac output and can increase the risk of blood stasis, thromboembolism, inflammation, and cardiac myocyte dysfunction.

    Objective

    This study aimed to assess the relationship between AF and cardiovascular mortality and high-risk clinical, laboratory, and echocardiographic variables in patients with acute decompensated HF.

    Methods

    This historical cohort study was conducted on 298 consecutive patients admitted with acute decompensated HF. The patients were divided into sinus rhythm (198 patients, 66.44%) and AF (100 patients, 33.56%) groups. The two groups were compared regarding demographic, laboratory, and echocardiographic variables and cardiovascular mortality within six months after index hospitalization using independent t-test, chi-square, and Fisher’s exact tests. In addition, independent echocardiographic risk factors for development of AF were determined by a logistic regression model. Variables with P < 0.05 were considered to be significant. All statistical analyses were done by SPSS/PASW software.

    Results

    The results showed that the patients with AF were older and had female predominance, a lower prevalence of diabetes mellitus, a lower rate of glomerular filtration, and a higher six-month cardiovascular mortality compared to those with sinus rhythm (P = 0.011, 0.05, 0.005, 0.043, and 0.041, respectively). These patients also had a larger left atrial diameter (P < 0.001) and a higher prevalence of right ventricular enlargement, systolic dysfunction, and moderate or severe functional mitral regurgitation compared to those with sinus rhythm (P = 0.02, 0.016, and 0.011, respectively). The results of logistic regression analysis indicated that left atrial diameter was the only independent predictor of AF (odds ratio = 2.27, 95% confidence interval [1.38 – 3.75]).

    Conclusion

    The results showed that AF was associated with increased cardiovascular mortality and high-risk clinical, laboratory, and echocardiographic markers in patients with decompensated HF.

    Keywords: Atrial Fibrillation, 3D Echocardiography, Acute Heart Failure, Right Ventricular Dysfunction
  • Elham Dehghan, Reza Nouri *, AliAsghar Ravasi, Maryam Nekooei Pages 48-53
    Background

    Physical activities are associated with a decreased risk of Coronary Heart Disease (CHD), which is one of the widespread Cardiovascular Diseases (CVDs).

    Objectives

    The present study aimed to compare the effects of continuous and non-continuous aerobic exercises on serum Vascular Endothelial Growth Factor (VEGF) and Endostatin (ES) in rats with coronary artery disease.

    Methods

    In this study, 40 healthy male Wistar rats (age: two months, weight: 200 - 250 g) were divided into continuous and non-continuous aerobic exercises with Myocardial Infarction (MI), control, and sham groups. After treatment of the rats by Isoproterenol (ISO), the experimental groups underwent continuous and non-continuous aerobic exercises on a treadmill for eight weeks. The means of the variables were compared using ANOVA. Moreover, Scheffe’s post hoc test was used to clarify the exact zones of differences in the SPSS 21 software (P ≤ 0.05).

    Results

    The results demonstrated that both continuous and non-continuous aerobic exercises increased VEGF in comparison to the control group (P = 0.001). However, no significant difference was observed between the experimental groups and the control group with respect to ES (P = 0.09).

    Conclusion

    Continuous and non-continuous aerobic exercises could increase angiogenesis in coronary artery disease. Moreover, both methods might have the same positive effect on rehabilitation of patients with MI. Therefore, such exercises could be used as a complementary treatment alongside medications for MI patients.

    Keywords: Endostatin, Acute Myocardial Infarction, Vascular Endothelial Growth Factor
  • MohammadHossein Nikoo *, MohammadVahid Jorat, Amir Aslani, Sara Barzegar, Milad Anvaree Pages 54-58
    Background

    Cardiac Resynchronization Therapy (CRT) is one of the suggested managements in patients with Left Bundle Branch Block (LBBB) and heart failure with reduced ejection fraction. Finding a predictor for poor response to CRT may help better candidate selection for device implantation and better final outcome.

    Objective

    This retrospective study aimed to assess QRS left axis deviation as a novel indicator of clinical and echocardiographic response to CRT.

    Methods

    This retrospective single-center analysis was done on 95 CRT patients with LBBB in their electrocardiograms (47 patients had normal QRS axis and 48 had left QRS axis deviation). These patients were followed up for 19 ± 3 months after CRT implantation. Response to CRT was evaluated by assessment of New York Heart Association (NYHA) functional class, echocardiographic examination, and number of hospitalizations within six months before and after CRT implantation.

    Results

    The response rate to resynchronization was 65.9% in the left axis group and 77.3% in the normal axis group, and the difference was statistically significant (P = 0.013). Improvement in echocardiographic findings, including increase in the left ventricular ejection fraction (P = 0.004), decrease in the end diastolic volume (P = 0.010), and decrease in the end systolic volume (P = 0.014), were also noted. However, improvement in NYHA class was reported in both groups without any statistically significant difference (P = 0.066).

    Conclusion

    Left axis deviation was associated with a lower rate of CRT response in patients with CRT implantation and LBBB.

    Keywords: Heart Failure, Cardiac Resynchronization Therapy, Bundle Branch Block
  • MohammadJavad Zibaeenezhad, Majid Yavarian *, Mohsen Fathzadeh, Mohammad Heydari Kamrodi, Mostafa Fattahi Mofrad, Hajar Khazraei, Zahra Daneshvar Pages 59-64
    Background

    Proprotein Convertase Subtilisin/Kexin type 9 (PCSK9), a serine protease, plays an important role in the regulation of cholesterol metabolism. PCSK9 interacts with Low Density Lipoprotein Receptor (LDLR) on the surface of hepatocytes, promoting its lysosomal degradation, thus leading to the accumulation of cholesterol outside the cells followed by hypercholesterolemia.

    Objective

    This study aimed to assess three polymorphisms (rs662145, rs505151, and rs562556) of the PCSK9 gene in two Iranian ethnic groups (Turk and Lur) with Coronary Artery Disease (CAD) in Fars province.

    Methods

    In this cross-sectional study, 114 Turk and 73 Lur patients with CAD were selected based on the clinical examination by a cardiologist. The three polymorphisms were assessed by Real-Time Polymerase Chain Reaction (PCR) method using specific primers and probes. Chi-square test was used to compare the two groups regarding the qualitative variables. All analyses were performed using the SPSS 18 software and P < 0.05 was considered to be statistically significant.

    Results

    The results revealed no significant difference between the Turk and Lur groups regarding the three polymorphisms (P > 0.05). In addition, no significant relationship was observed between the rs662145 polymorphism and clinical characteristics like family history of CAD, diabetes, Myocardial Infarction (MI), Body Mass Index (BMI), and High Density Lipoprotein (HDL) level (P > 0.05). However, a significant relationship was found between the rs505151 polymorphism and MI (P = 0.03) and Low Density Lipoprotein (LDL) level (P = 0.04) in Turk patients. Nonetheless, no significant correlation was detected between the rs505151 polymorphism and clinical parameters (P > 0.05). The results also showed no significant relationship between the rs505151 polymorphism and clinical parameters in Lur patients (P > 0.05). Analysis of the rs562556 polymorphism also revealed no significant relationship between this polymorphism and clinical characteristics in both Turk and Lur samples (P > 0.05).

    Conclusion

    rs662145 polymorphism was associated with LDL and Triglyceride (TG) levels in both Turk and Lur samples. Besides, rs505151 polymorphism was correlated to LDL level and MI in Turk patients. Therefore, in addition to other predisposing genes to CAD, analysis of PCSK9 mutations can be used for predicting hypercholesterolemia and premature CAD.

    Keywords: Polymorphism, Atherosclerotic Coronary Artery Disease, PCSK9
  • Abdullah Alhouri, *, Hasan Al Houri, Omar Obeidat, Bayan Baniissa, Malik Juweid Pages 65-67
    Introduction

    Coronary Artery Anomalies (CAAs) are rare, with their prevalence ranging from 0.6% to 1.3%.

    Case Presentation

    A 33-year-old man with no previous medical history was referred to the emergency department with Sudden Cardiac Arrest (SCA) while playing soccer. Systematic assessment revealed that the SCA was caused by a scarce CAA; the Left Anterior Descending (LAD) artery arising from the Right Sinus of Valsalva (RSV). There was also Left Ventricular (LV) systolic dysfunction with an LV ejection fraction of 35%. The patient subsequently underwent single vessel coronary artery bypass grafting of the Left Internal Mammary Artery (LIMA) to LAD as well as cardioverter-defibrillator placement and had no further incidence of SCA.

    Conclusions

    Comprehensive knowledge of CAAs and the related symptoms shortens the time to correct diagnosis and initiation of proper management and is likely to reduce the frequency of complications.

    Keywords: Heart Ventricles, Sudden Cardiac Arrest
  • Mohammad Hassani *, Peyman Bakhshaei, Mohammad Pishgahi Pages 68-70
    Introduction

    Abdominal Aortic Aneurysm (AAA) represents an important public health problem because of its prevalence and very high mortality associated with rupture. Timely diagnosis and treatment are essential to reduce the mortality rate associated with this disease.

    Case Presentation

    A 69-year-old man referred to our center because of severe left testicular pain and distal abdominal pain from two days ago. During examination, he had a non-expanding palpable mass in his lower abdomen with hypogastric tenderness and severe tenderness in the left testicle. On the initial evaluation, his systolic blood pressure was 160 mmHg, his diastolic blood pressure was 70 mmHg, and his heartbeat was 100 beats per minute. Hematocrit, hemoglobin, and creatinine concentrations were 32%, 10 g/dL, and 2.4 mg/dL, respectively. In addition, tumor markers such as Lactate Dehydrogenase (LDH), Alpha-Fetoprotein (AFP), and Beta Human Chronic Gonadotropin (BHCG) were negative in his preoperative laboratory tests. During the abdomen and pelvis ultrasound, an infrarenal abdominal aortic aneurysm with a diameter of 8 cm and a hyperheteroecho and isovascular mass measuring 35 * 22 mm were detected in the left testicle. Mass or infarction following embolization was in the differential diagnosis. The patient was candidate for an emergency operation. AAA was repaired by aortobifemoral bypass surgery and left orchiectomy was done through a left inguinal incision. The left testicle specimen pathology report was ischemic orchitis, which might have resulted from the emboli of the aortic aneurysm to the testicle.

    Conclusions

    Aortic aneurysm with the risk of rupture could present with some unusual symptoms, such as testicular pain, and every surgeon should be aware of this symptom for early diagnosis and treatment.

    Keywords: Aortic Rupture, Abdominal Aortic Aneurysm
  • Mehdi Taherpour, Zahra Emkanjoo* Pages 71-74
    Introduction

    Incessant Atrial Tachycardia (AT) is a relatively abnormal arrhythmia, but it is a well-known cause of Tachycardia-Induced Cardiomyopathy (TICMP).

    Case Presentation

    This case study was carried out on a patient who was suffering from focal AT originated from the Vein of Marshal (VOM) leading to TICMP, which was targeted from the endocaridal side of the left atrium through the left atrial ridge. One-year follow-up of the patient showed no evidence for the recurrence of AT. Meanwhile, improvement in Ejection Fraction (EF) was quite evident in echocardiography during follow-up.

    Conclusions

    This rare case study included a patient with AT, assuming to have originated from the Ligament of Marshal (LOM), with an unexpected P wave morphology.

    Keywords: Cardiomyopathies, Vein, Ectopic Atrial, Junctional Ectopic Tachycardia, Marshall Syndrome