فهرست مطالب

The Journal of Tehran University Heart Center
Volume:2 Issue: 4, Oct 2007

  • تاریخ انتشار: 1386/10/11
  • تعداد عناوین: 11
|
  • Hossein Ahmadi Tafti, Ehsan Fayazzadeh Page 187
  • Leila Moezi, Shahram Ejtemaei Mehr, Ahmad Reza Dehpour Page 191
    Cirrhosis is characterized by marked abnormalities in the cardiovascular system. A hyperdynamic splanchnic and systemic circulation is typical of cirrhotic patients and has been observed in all experimental forms of portal hypertension. The hyperdynamic circulation is most likely initiated by arterial vasodilatation, leading to central hypovolemia, sodium retention, and an increased intravascular volume. Despite the baseline increase in cardiac output, ventricular inotropic and chronotropic responses to stimuli are blunted, a condition known as cirrhotic cardiomyopathy. This review briefly examines the major mechanisms that may underlie these cardiovascular abnormalities, concentrating on nitric oxide, endocannabinoids, prostaglandins, carbon monoxide, endogenous opioids, and adrenergic receptor changes. Future work should address the complex interrelationships between these systems.
  • Mojtaba Salarifar, Kamran Ali Moghaddam, Seyed Ebrahim Kassaian, Mohammad Alidoosti, Ali Mohammad Haji Zeinali, Hakimeh Sadeghian, Jalil Majd Ardakani, Elham Hakki Kazazi, Ardeshir Ghavamzadeh Page 201
    Background
    Early clinical investigations indicate that an infusion of autologous bone-marrow cells into the infarct-related coronary artery is feasible after acute myocardial infarction. There is increasing evidence that cell transplantation may improve the perfusion and contractile function of the ischemic myocardium. The present study reports primarily the safety of intracoronary bone marrow mononuclear cell (BMMNC) injections and secondarily the hypothesis that intracoronary injections of autologous BMMNC in patients with acute myocardial infarction may have a favorable impact on tissue perfusion and contractile performance.
    Methods
    Twelve patients with acute ST-elevation myocardial infarction of the anterior wall treated with percutaneous coronary intervention were enrolled in this prospective, nonrandomized, open-label study. Left ventricular function and number of nonviable segments were assessed with the use of echocardiography and Technetium-sestamibi single photon emission tomography respectively at baseline and after a 4-month follow-up.
    Results
    At 4 months’ follow-up, global left ventricular ejection fraction in echocardiography increased from a mean of 31.78±7.56% at baseline to 38.89±6.97% (p=0.018). Mean wall motion score in rest echocardiography was 29.5±6.67 in basal and 26.75±5.44 at 4 months’ follow-up (p=0.05). Nuclear perfusion imaging studies in the patients for the mean number of nonviable segments were 6.5 at baseline and 6 in 4 months’ follow-up (p=0.17). Three patients were lost to follow-up and did not undergo the 4-month evaluations.
    Conclusion
    This study is small and very preliminary. Data from large, randomized, controlled trials are needed to clarify the effect of stem-cell injection in myocardial function
  • Tahereh Dehdari, Alireza Heidarnia, Ali Ramezankhani, Saeed Sadeghian, Fazlollah Ghofranipour, Gholamreza Babaei Ruchi, Soraya Etemadi Page 207
    Background
    Patients with psychological problems after coronary artery bypass graft surgery (CABG) show poorer outcomes; nevertheless, there is a paucity of research into the effects of cardiac rehabilitation programs on such patients. The purpose of this study was to determine the effect of phase III cardiac rehabilitation programs on the anxiety and quality of life of anxious patients who had undergone CABG in Iran.
    Methods
    Six weeks after CABG, 83 anxious patients participated in an 8-week cardiac rehabilitation program that consisted of formal supervised exercise training and educational sessions. The state/trait anxiety inventory and SF-36 questionnaire were two instruments for collecting data in the present study. Of the total of 83, 66 participants saw out the eight-week period.
    Results
    With the exception of the mental health aspect, significant improvements were noted in the following components of the quality of life measures after the cardiac rehabilitation program: physical functioning (P<0.001), role-physical (P<0.001), bodily pain (P<0.001), social functioning, (P=0.003), general health (P=0.020), vitality (P=0.006), and role-emotional (P=0.003). Additionally, significant reductions were observed in state anxiety (P=0.010) and trait anxiety (P=0.010(.
    Conclusion
    These findings suggest that phase III cardiac rehabilitation may be an effective therapy for improving psychological outcomes of patients with psychological problems after CABG.
  • Mahmood Mirhoseini, Shahram Rabbani, Sirus Darabian, Saeed Sadeghian, Abbasali Karimi, Seyed Hesameddin Abbasi Page 213
    Background
    Dilated cardiomyopathy is associated with a progressive deterioration in cardiac function and eventually death. Initial interest in this hypothesis was to create another large animal model for dilated cardiomyopathy in addition to pigs and dogs.
    Methods
    After the induction of anesthesia to 10 female sheep, a carotid-jugular shunt was created in all the animals via a 1-cm fistula between the carotid artery and jugular vein. Six sheep out of the total of 10, were given intravenous Doxorubicin. Echocardiographic studies were performed before surgery and 3 months after that. The 4 animals not injected with Doxorubicin were evaluated for echocardiographic parameters after one year.
    Results
    There was no abnormality in echo parameters in the 4 sheep that had not received Doxorubicin; in addition, their valves and cardiac output were normal. As regards the six sheep injected with Doxorubicin, 4 received a dose of 2 mg/kg weekly and expired after the second injection due to the toxicity of the drug, 1 was given Doxorubicin 1 mg/kg and died after one week, and 1 had Doxorubicin 0.5 mg/kg but showed no abnormality in terms of dilated cardiomyopathy.
    Conclusion
    We conclude that the sheep is sensitive to Doxorubicin and that the dosage that is enough for creating dilated cardiomyopathy in dogs is very toxic for the sheep.
  • Mohammad Ali Ostovan, Reza Mollazadeh Page 217
    Background
    Small side branches, albeit less important than their larger counterparts, have not yet received due attention in the literature. Nor has there ever been a comparison between drug-eluting stents and bare metal stents apropos side branch occlusion. The aim of this study was to compare the patency of small (≥0.5 and ≤1.5 mm in diameter) side branches with respect to bare metal vs. drug-eluting stents immediately after their deployment.
    Methods
    This prospective bi-center study, conducted between June 2005 and January 2007, enrolled 82 patients treated with ≥1 of two stents (TAXUSTM LiberteTM or LiberteTM). Side branches ≥0.5 and <1.5 mm in diameter arising from the main vessel at the lesion site were evaluated.
    Results
    Thirty-eight patients were treated with 42 LiberteTM stents (58 side branches) and forty-four patients with 50 TAXUSTM LiberteTM (102 side branches). The rate of small side branch occlusion was 35.3% (36) in the TAXUSTM LiberteTM group compared to 29.31% (15) in the LiberteTM group (P-value= 0.7). The presence of type 1 side branch morphology (Lefevre classification) was the most powerful predictor of small side branch occlusion (P-value=0.03).
    Conclusion
    This study shows that drug-eluting stents are not inferior to bare metal stents as regards small side branch occlusion during coronary stenting.
  • Hakimeh Sadeghian, Masoumeh Lotfi, Tokaldany, Nader Fallah, Seyed Hesameddin Abbasi, Seyed Hossin Ahmadi, Abas Ali Karimi, Mojtaba Salarifar, Salehi Rezvanyieh Page 223
    Background
    This study was designed to investigate the accuracy of dobutamine stress echocardiography (DSE) in detecting the post-revascularization recovery rate of contractile reserve (CR) in ischemic myocardium.
    Methods
    A total of 112 segments from seven patients with low ejection fraction (<35%) and coronary artery disease were evaluated with DSE one week before and 12 weeks after coronary artery bypass graft surgery (CABG). Sensitivity, specificity, and positive and negative predictive values of DSE for detecting the recovery rate of CR were calculated based upon their standard definition and were presented with 95% confidence intervals (CI).
    Results
    The mean baseline left ventricular ejection fraction was 31±4%, which reached 35±7% after CABG unremarkably. The recovery rates of resting function and CR were 18.2% and 50% for hypokinetic and 15.6% and 24.1 for akinetic segments respectively. Specificity, sensitivity, and positive and negative predictive values of DSE for detecting the recovery of CR were 83% (CI=69-97), 89% (CI=83-96), 94% (CI = 88-99), and 73 % (CI = 55-88), respectively.
    Conclusion
    Despite acceptable sensitivity, specificity, and positive predictive value, DSE has a relatively lower negative predictive value for detecting the recovery of CR in ischemic myocardium and, consequently, the full extent of myocardial viability. Further sensitive techniques may, therefore, be needed to provide complementary information regarding long-term functional outcome.
  • Mohammad Reza Beyranvand, Mohammad Amin Emami, Ali Aliasgari, Ali Asghar Kolahi Page 229
    Background
    Cardiovascular disease (CVD) is the leading cause of mortality and morbidity worldwide. Acute myocardial infarction (AMI) represents the most dramatic presentation of CVD and is one of the most commonly seen acute medical emergencies. According to Iran’s Ministry of Health, 966,779 people (46%) died of CVD and 575, 257 (27%) potential years of life were lost to CVD in 2000. We, therefore, set out to evaluate the one-year outcome of the patients admitted to Loghman-Hakim Hospital between 2003 and 2004.
    Methods
    This historical cohort study selected patients that had been discharged from hospital a year earlier. The subjects were asked by telephone to come to the hospital so that their records could be assessed, and data on the following categories were extracted: coronary angiography results, revascularization (percutaneous coronary intervention [PCI], coronary artery bypass grafting [CABG]), re-admission, mortality and drug compliance.
    Results
    Among 132 AMI patients at a mean age of 59.2 years, 76.5% were male. Seventy nine point five percent of all the patients had had ST-elevation myocardial infarction (STEMI) and 20.5% non-STEMI. Fifty-eight percent of the subjects had received streptokinase and 42.4% had undergone cardiac catheterization. Revascularization had been performed on 12.8% via PCI and on 21.2% through CABG. The mortality and re-admission rates within one year of treatment stood at 6.1% and 14.3%, respectively. One year after discharge, the respective rates of drug compliance with beta-blockers, ASA, ACEI and statins were 74.2%, 98.5%, 71.2% and 67.4%.
    Conclusion
    Patients with AMI show satisfactory long-term drug compliance. Our patients'' mortality rate was comparable to that in other studies, and their adherence to prescribed medicines and recommended procedures (PCI, CABG) was relatively high.
  • Mohammad Hasan Namazi, Morteza Safi, Hassan Kamalzadeh, Reza Karbasi Page 233
    A 55-year-old man referred for cardiac resynchronization therapy (CRT) due to severe heart failure. A severe stenosis in the coronary sinus vein after the posterior branch disallowed the insertion of the lead. Nevertheless, the stenosis was dilated and the left ventricle (LV) lead was implanted in the lateral marginal branch.
  • Mehran Asgari, Jocelyn Bridge, Helen Talyor, Kayvan Kamalvand Page 235
  • Rasoul Azarfarin, Azin Alizadeh Asl Page 237
    Acute inferior myocardial infarction (MI) frequently involves the right ventricle (RV).1-3 We assessed the prognostic impact of RV myocardial involvement in patients with inferior MI. One hundred seventy patients were admitted to the cardiac care unit of Madani Heart Hospital (Tabriz-Iran) with the diagnosis of inferior MI with (group1) or without (group2) the simultaneous involvement of RV during the study period (from 2005 to 2006). Patients presenting within 12h of symptom onset were eligible for inclusion. Patients with simultaneous anterior wall MI or renal impairment (creatinine > 2 mg/dl), as well as those undergoing primary percutaneous translational coronary angioplasty, were excluded. Eighty eight percent of the patients with RVMI and 75% of those with isolated inferior MI had some type of arrhythmia. Atrioventricular (AV) block occurred in 42% of the infarctions with RV involvement and only in 29% of the control group. Intra-ventricular conduction disturbance (IVCD) was also more frequent in RVMI (29.4% vs. 13.1%, p=0.021), especially right bundle branch block (RBBB) (20% vs. 7.4%, P=0.003). There was, however, no meaningful difference in the incidence of left bundle branch block (LBBB) between the two groups (3.5% vs. 2.35%, P=0.95). Ventricular fibrillation (VF) was observed in 5.2% and 1.2% and ventricular tachycardia in 26% and 12.2% of the patients in groups 1 and 2, respectively. In 27% of patients with RVMI, it was necessary to implant a pacemaker as compared to 10% of those in the control group. Mortality was higher in the patients with inferior infarction extended to the RV (15.3% vs. 3.5%, P= 0.0001). Thus, the differences between the findings in the two groups in terms of the occurrence of post-MI arrhythmias and conduction disorders were quite significant, but there was no meaningful difference with respect to the incidence of LBBB between the two groups. Additionally, patients with inferior MI who also had RV myocardial involvement were at increased risk of death and arrhythmias. This suggests that the RV may be more arrhythmogenic than the LV; a hypothesis that warrants further investigation.