Iranian Heart Journal
Volume:6 Issue: 1, Spring-Summer 2005

LIPID FACTORS ARE CURRENTLY CONSIDERED TO BE THE MAIN AGENT RESPONSIBLE FOR CARDIOVASCULAR RISK IN YOUNG INDIVIDUALS. SEVERAL EPIDEMIOLOGICAL STUDIES HAVE SHOWN THAT ATHEROSCLEROSIS BEGINS IN CHILDHOOD. THEREFORE, THERE IS A GENERAL CONSENSUS THAT THE EARLIER THE CONTROL BEGINS, THE BETTER THE RESULTS WILL BE. NOW THERE ARE MANY CONTROVERSIES REGARDING THE EARLY DIAGNOSIS OF HYPERLIPIDEMIA IN CHILDREN. THE AIM OF THIS STUDY WAS TO EVALUATE SERUM LIPID LEVELS IN CHILDREN WHOSE PARENTS SUFFER FROM PREMATURE CORONARY ARTERY DISEASE (CAD).
IN THIS CROSS SECTIONAL STUDY, 76 CHILDREN BETWEEN 2-10 YEARS OLD (38 CHILDREN, WHOSE PARENTS HAD PREMATURE CAD, AND 38 HEALTHY, AGE AND SEXMATCHED CONTROLS, WHOSE PARENTS DID NOT HAVE PREMATURE CAD) WERE STUDIED. THE HEIGHT, WEIGHT AND BODY MASS INDICES WERE SIMILAR IN BOTH GROUPS. SERUM LIPID LEVELS [TOTAL CHOLESTEROL,
TRIGLYCERIDE, HIGH DENSITY LIPOPROTEIN (HDL) AND LOW DENSITY LIPOPROTEIN (LDL)] WERE MEASURED AFTER 10 HOURS FASTING FOR 2 TIMES, ONE WEEK APART,
AND THE MEAN OF THE TWO VALUES WAS CONSIDERED AS THE AMOUNT OF EACH VARIABLE. DATA WERE ANALYZED WITH EPI 6, AND P<0.05 WAS CONSIDERED AS SIGNIFICANT.
RESULTS SHOWED THAT MEAN TOTAL CHOLESTEROL
AND LDL WERE 167±20 AND 135±30MG/DL IN THE CASE GROUP AND 121±20MG/DL AND 101±20MG/DL IN THE CONTROL GROUP AND THAT THESE DIFFERENCES WERE
SIGNIFICANT STATISTICALLY. THERE WERE NO DIFFERENCES BETWEEN THE TWO GROUPS FOR TRIGLYCERIDES AND HDL. IN THE CASE GROUP, SIX CASES
HAD LDL LEVELS GREATER THAN 160MG/DL, WHILE THERE WERE NO SUCH CASES IN THE CONTROL GROUP.
We Therefore Concluded That Total Cholesterol And LDL Levels Were Higher In Children Of Parents With Premature CAD. This Necessitates Evaluation Of Serum Lipid Levels In Children Of Parents With Premature CAD

BACKGROUND:DRY COUGHS ARE THE MOST COMMON ADVERSE EFFECT AND LIMITING FACTOR OF ALL ANGIOTENSIN CONVERTING-ENZYME INHIBITORS (ACEI). PROSTAGLANDINS HAVE BEEN PINPOINTED AS PLAYING AN IMPORTANT ROLE IN THE GENESIS OF THIS PROBLEM. The Effect of Aspirin on ACEI- Induced Coughs E. Nadimi MD, et al . THIS DOUBLE BLIND CLINICAL TRIAL WAS DESINGED TO COMPARE
THE EFFICACY OF 500 MILIGRAM(MG) ASPIRIN VERSUS PLACEBO IN CONTROLLING ACEI-INDUCED COUGHS.
METHODS:THE SUBJECTS WERE 32 PATIENTS, WHO HAD DEVELOPED ACEIINDUCED COUGHS.THEY WERE RANDOMIZED TO A DAILY DOSE OF 500 MG ASPIRIN OR PLACEBO FOR A TREATMENT PERIOD OF 4 WEEKS.THE MEANS OF COUGH SEVERITY BEFORE AND EACH WEEK FOR 4 WEEKS WERE COMPARED IN THE TWO GROUPS.
RESULTS: MEANS OF COUGH SEVERITY IN THE ASPIRIN AND PLACEBO GROUPS BEFORE AND AT THE END OF THE FIRST WEEK OF TREATMENT DID NOT SHOW ANY SIGNIFICANT DIFFERENCE. AFTER THE SECOND, THIRD AND FOURTH WEEKS, THE COUGH SEVERITY SCORE WAS SIGNIFICANTLY REDUCED IN THE ASPIRIN GROUP
(P<0.001).
500mg aspirin once daily can suppress or abolish ACEI-induced coughs, and this finding proposes alternative therapeutic approaches for ACEI-related coughs

Microalbuminuria is a diagnostic tool for screening patients at risk of developing nephropathy. It is also known that patients with microalbuminuria have a greater incidence of cardiovascular events and early mortality. In this study, reliability of the microalbuminuria as an indicator of a risk of progressive cardiovascular disorders was tested by detection of the relationship between microalbuminuria and extension of
atherosclerotic coronary lesions.
The subjects for this study were 228 patients with angiographically confirmed coronary atherosclerotic lesions and mean of age 60 years; they were referred to Madani Hospital Tabriz, Iran. Age and sex-matched apparently healthy individuals (n=114) were used as the control group for a comparative study. The levels of glucose and creatinine and that of post-prandial glucose were determined in venous blood samples by standard methods. The immunoturbidimetric method was employed in the measurement of microalbuminuria.
A direct relationship between microalbuminuria and extension of atherosclerotic coronary lesions was noticed (P = 0.009). The increased albumin / creatinine ratio was markedly correlated with fasting blood sugar, systolic and diastolic blood pressure (P<0.05).
The presented results indicate the existence of significant correlation between extent of atherosclerotic lesions and microalbuminuria. The relationship between diabetes and microalbuminuria was meaningful. These facts may contribute to the higher cardiovascular risk in diabetic patients. An association between hypertension and microalbuminuria was noticed. The result suggests that although risk factors such as hypertension and diabetes are known to cause cardiovascular disease, microalbuminuria may in fact be a contributor indicator of cardiovascular events

Coronary artery bypass grafting (CABG) is a common surgical procedure performed in the world. Coronary artery disease (CAD) has become prevalent in Iran, and the aim of this study is to assess the effects of CABG on LV systolic and diastolic function indices. We also attempted to disclose the CABG effect on the myocardial performance (Tei) index.
50 patients were enrolled in this study, all of whom were given instructions about the research program. They were admitted to our center electively for CABG; the first echocardiography was taken just prior to surgery, and the second TTE was performed between 1 and 43 weeks after surgery (mean=11 weeks).
60 years old) are both associated with more preoperative diastolic dysfunction and are negative predictors for diastolic function recovery after CABG. Isovolumetric relaxation time (IVRT), E-wave
deceleration time (EDT), peak E-wave velocity (PEV) and peak A-wave velocity (PA) all show significant improvement after CABG. There was no mortality in our series.
CABG has important positive and significant effects on many LV systolic and diastolic indices including LVEF, LVESV, IVRT, PEV, PAV and EDT as well as on the myocardial performance (Tei) index.

Results of studies seeking for the association between periodontal diseases and coronary artery disease (CAD) are significantly inconsistent. Such inconsistency has been attributed to the varying definitions for CAD and whether or not adjustment for common risk factors has been performed. The main objective of this study was to investigate the association between angiographically- defined CAD and periodontal
diseases.
Fifty-eight patients, who referred to Shaheed Rajaie Cardiovascular Medical Center, were recruited into a case-control design study. They were examined for
periodontal indices such as the papillary bleeding index (PBI), probing depth (PD), plaque index (PI) and clinical periodontal attachment level (AL). The subjects were classified as having CAD (CAD) if they had at least 50% stenosis in at least one major epicardial artery.
Thirty-nine patients (67.2%) were CAD and 19(32.8%) were CAD- .CAD patients were more likely to be male than female (90.3% versus 40.7%, p=0.000) and of older ages (55±2.7 versus 40.6±4.8, p=0.000). Among periodontal parameters, no significant association was found between the mean of PBI, PD and CAD. On the other hand, there was a significant association between the amount of AL, PI, number of missing teeth and CAD. There was also correlation between the amount of AL and the number of vessels involved (r=0.428). The results of this study remained unchanged after adjustment for CAD risk factors, performing multilogistic regression analysis.
The observation showed a significant relationship between angiographicallydefined CAD and periodontal diseases, which can emphasize the importance of early diagnosis and complete treatment of periodontal infections, particularly in CAD susceptible individuals ).

Hyperlipidemia is an important cause of coronary artery diseases. Linseed contains large amounts of omega-3 fatty acids, and it has a major role in lowering serum lipid levels. This study evaluated the effect of linseed powder in patients who did not respond to regular diet regimens.
160 or HDL<30 (mg/dl). We prepared the dose of 6 gr/day of linseed powder in the form of a biscuit and gave it to the patients for 3 months plus their regular diet regimen. The serum levels of lipids were measured before and after the 3-month intervention program. The data were analyzed using SPSS software with paired t-test.
The mean (±SD) of serum level of total cholesterol before treatment was 258 (±55.59) mg/dl and afterwards was 232.05 (±41.47) mg/dl (P=0.0001). The mean serum triglyceride level before and after treatment was 289.92 (±126.57) mg/dl, and 225.07 (±82.58), respectively (P=0.0001). Also, the mean serum LDL decreased from 173.82 ±52.87) to 141.12 (±39.94) mg/dl (P=0.0001). However, no significant difference on DL levels was found before and after intervention (43.89 (±25.66) vs. 43.53 (±13.84), =0.85). Overall, the linseed powder regimen for 3 months decreased the total holesterol by 10.2%, serum triglyceride by 22.33% and LDL cholesterol level by
18.8%. HDL level increased by 1.45%. B>Conclusion: Linseed powder plus regular diet decreased the lipoprotein levels significantly. hus, we recommend roughly 6 gr. daily consumption of linseed as a compliment of egular diet regimen in lowering the level of serum lipids

The aim of this study was to report the results of using PDA occluders (coil occluder and Amplatzer device), which has continued since December 1999 at the pediatric department of Rajaee Heart Center. Transcatheter Occlusion of PDA M. Meraji MD, et al.
Between December 1999 and September 2002, 193 cases of PDA were admitted at the pediatric ward. Seventy cases underwent transcatheter occlusion of PDA by the detachable coil occluder, and in 53 cases PDA was occluded by the Amplatzer device.
Successful coil placement was accomplished in 68 cases. Two cases of intravascular hemolysis were observed due to residual shunt .In one of them, acute tubular necrosis ensued, and peritoneal dialysis was performed. However, after surgical PDA closure, the renal performance was recovered eventually. Also, two cases of coil detachment to the LPA were observed with no long-term sequala on pulmonary function. Fifty-two of the 53 Amplatzer occlusions were successful. Only one failure was observed due to the small size of the Amplatzer in comparison to the duct diameter.
Retrograde and antegrade transcatheter closure of the PDA by the detachable coil occluder and Amplatzer device has been performed successfully in our department. The problem that we face has been PDA sizing and also the retrieval of detached coils

Whether atrio-ventricular plane displacement (AVPD) in echocardiography findings may help to diagnose ischemic heart disease (IHD) in the presence of normal systolic function is not clear. This study aimed to assess the relationship between AVPD and ischemic heart disease (IHD) in a group of IHD patients.
One hundred two outpatients (65 male and 37 female) aged 58.9±11.4 were examined for IHD by echocardiography, stress test and angiography, and 61 patients were found to have IHD. Echocardiographic findings, including AVPD, LVEF and RWMA, were compared in normal and IHD patients.
Comparison of echocardiography findings in the ischemic patients to the normal subjects showed that the subjects with IHD had significantly lower AVPD, LVEF and higher RWMA. Results of a logistic regression analysis indicated that AVPD was an independent predictor of IHD (OR=0.61, 95%CI= 0.46-0.79).
These data suggested that low AVPD was associated with increased risk of IHD. AVPD may help diagnose IHD when more sophisticated techniques are not available and/or applicable).

The purpose of this study was to assess frequency, risk factors, complications and mortality rate of young patients with acute myocardial infarction (AMI), in Yazd.
45 years (old). Risk factors, type of AMI, management, complications and hospital
outcomes of the 2 groups were evaluated.
The young patients represented 11.6% of all cases, and 10% of these individuals were female. Smoking (60.2% vs. 33.6%, P. value=0.000), positive family history (40.2% vs. 28.6%, P. value=0.017) and obesity (25% vs. 13.9% P. value=0.022) were more common in the young group. Diabetes mellitus (24.1% vs. 46.9%, P. value=0.000) and hypertension (15.1% vs. 43.3%, P. value=0.000) were more common in the old patients. Young male patients had less in-hospital mortality (1.2% vs. 9.1%, P. value=0.005) than old male patients, but in the females the difference of mortality between young and old was not significant (10% vs. 19.9%, P. value=0.3).
In this study, about one-tenth of the patients with AMI were £ 45 years old. Smoking, obesity and positive family history were more common in the young patients, and overall mortality rate was low in the young (Iranian Heart Journal
2005; 6 (1,2): 52-54).

A number of publications has shown a relation between increased QT dispersion and death from a cardiac cause. However, there are no published data on the value of QT interval dispersion after openheart surgery in the pediatric age group.
Three electrocardiograms (pre-operation, on the day of operation and the second day post-operation) were obtained from 18 children (11 males, 7 females), three to 14 years of age. Measurements were carried out from standard 12- lead ECGs recorded at a speed of 25 mm/s at rest. The QT and preceding RR intervals of at least one sinus beat (range one to three) were measured in a range of nine to 12 leads, and the mean QT and RR intervals were calculated. The corrected QT interval was calculated by Bazett’s method (QTc = QT/√RR). QT intervals were measured from the onset of the QRS complex to the end of QT Dispersion after Congenital Heart Surgery S. Rafiian MD, et al . the T wave. Dispersion of the QT and QTc were defined by the difference between the maximum and minimum QT and QTc intervals occurring in any of the 12 leads.
The mean QT dispersion in patients before surgery was 53 ± 22 ms, 72±31 ms on the day of operation and 65±27 one day after operation, and mean QTc dispersion before surgery was 62±22 ms, 95±27 ms on the day of operation and 97±41 ms on the day after operation. There was a significant increase in mean QT and QTc immediately after surgery (p<0.001). Although it decreased on the first day after surgery, it remained significantly high as compared to before surgery (p<0.02).
QT interval dispersion may increase after open-heart surgery, which may result in death following an arrhythmia. Open-heart surgery may have an independent role in the genesis of QT dispersion prolongation and should be considered as one of the mechanisms of arrhythmia after surgery

Carotid endarterectomy is superior to medical management for the prevention of stroke in patients with carotid and vertebral artery stenosis, but stenting with the use of emboli-protection devices is less invasive. We report our results with carotid artery stenting in five patients.
Stenting was done in five symptomatic male patients (mean age = 66.8 years), 20% and 40% of whom were diabetic and hypertensive, respectively, and 60% had coronary artery involvement. Indications for stenting were prior stroke in one, vertigo in one and transient ischemic attack in three patients.
Stenting with self-expandable stents was technically successful in all the cases. No stroke, restenosis or death occurred.
Stenting cerebral arteries are feasible with a high degree of technical success

Postoperative atrial fibrillation (AF) is a common complication of coronary artery bypass graft surgery (CABG) and is associated with an increased incidence of other complications and an increased hospital length of stay. Prevention of AF is a reasonable clinical goal. The aim of this study is to determine the predictive value of multiple clinical, hemodynamic and operative variables for the occurrence of postoperative AF.
Methods:This research is a descriptive study. Patients scheduled for elective CABG between 1997 and 1999 were recruited. The patients underwent holter monitoring for 3 consecutive days. Information was collected by a questionnaire. Statistical analysis was based on the SPSS software and was done through the descriptive statistical method.
200 patients underwent isolated CABG between 2001 and 2003. The patients with a mean age of 55±8 years old underwent holter monitoring for 3 days. AF occurred in 20% of the patients, postoperatively. 30% of the patients converted to sinus rhythm spontaneously, 60% converted with amiodarone and 10% of the patients required electric shock.
Beta blockers are the first line of medication for the prevention of postoperative AF. The incidence of AF during the first postoperative week after CABG varies between 5-40%; prolonged mechanical ventilation after CABG significantly increases the incidence of postoperative AF

Nowadays، the pathogenic role of atherosclerosis of the aorta in embolic stroke is well understood. TEE continues to play a prominent role in the evaluation of patients with stroke and finding the source of emboli. TEE shows that the incidence of strokes presumed to have a cardioembolic origin varies from 13-40% and that atherosclerotic TEE Evaluation of Aortic Plaques in Stroke A. H. Tabatabaei، MD، et al. disease of the aortic arch has been found in 40-60% of cerebral emboli. We investigated the prevalence and severity of atherosclerotic aortic plaques in patients with embolic stroke to ascertain their role as a risk factor for ischemic cerebral events.
Using TEE، we performed a cross-sectional study of the frequency and severity of aortic plaques in 60 patients admitted with ischemic stroke. Major atherosclerotic risk factors and the presence of coronary artery disease and carotid plaques were also surveyed.
TEE detected at least one potential source of embolism in 48 patients، aortic plaques in 29، carotid plaques in 11 and cardiac pathologies in 19. Atrial fibrillation and valvular heart diseases (mostly mitral stenosis) were the most prevalent cardiac anomalies. The remaining 12 patients were regarded as cryptogenic cases. Fifty patients had at least one major risk factor of CAD. The majority of the plaques were detected in the arch and ascending aorta; of these 13. 7% were complicated (grade III). There was a significant relation between aortic plaques and hypertension، male sex and CAD. Aortic calcification in CXR was strongly predictive of aortic plaques but not a sensitive
criterion.
Abnormalities are commonly found by TEE in patients with stroke. The results indicate a strong، independent association between atherosclerosis of the aorta and risk of stroke. TEE should be considered in patients after stroke as a routine test and ultimately for prophylaxis and treatment of stroke