International Cardiovascular Research Journal
Volume:3 Issue: 4, Dec 2090

A 50–year–old woman presented to our center with effort angina. Angiography showed normal left main coronary artery, normal left circumflex (LCX) artery and critical discrete lesion (99% stenosis) in mid part of left anterior descending (LAD) artery with good distal flow. However, the right coronary artery (RCA) originated from the left main coronary artery. There was no evidence of external compression of the proximal portion of the RCA during systole or diastole. Consult with cardiac surgeon was done but the patient refused from the operation.

We sought to evaluate the impact of different therapeutic strategies on longitudinal regional myocardial systolic function in the early phase of acute myocardial infarction using strain rate imaging. A total of 38 patients (34 males), with first acute myocardial infarction (AMI) were evaluated. Our patients were divided into 3 groups according to the kind of therapy. The mean age of the patients was 55 ± 9.4 years (range: 39- 75 years). Mean left ventricular ejection fraction (LVEF) in the patients was 41 ± 10.7%. Primary percutaneous coronary intervention (PCI) was performed in 10 patients. Sixteen patients were treated by thrombolytic therapy using streptokinase (SK) and 12 were followed-up conservatively. All patients underwent a comprehensive echocardiography study including SR imaging within 3- 5 days after AMI. The parameters measured included peak systolic strain (peakε) and strain rate (SRs), end-systolic strain (εes), post systolic shortening (PSS), time to peak systolic strain rate (tSRs), time to end of shortening (teSRs), post systolic strain (PSε), post-systolic strain index (PSI), PSS ratio (PSS/ εMax) and peak postsystolic strain rate (SRPSS). There was not any association either between WMSI and tå (P=0.4), or MI location and PSS ratio (P=0.13). But there was an inverse relationship between WMSI and mean SRS, especially when WMSI was more pronounced. A significant relationship was found between tε and teSRs with the kind of therapy (shorter in PCI group (P= 0.04). Using a simple linear regression model, no association was found between PSS ratio and SRs (â=0.056, P =0.70), PSI and teSRs (β= -0.772, P=0.12). Simple linear regression model showed a weak but significant relationship between PSI and Median tε (β = -0.851, P =0.04; r =0.33). Our study showed that PCI resulted in early recovery of regional systolic function of infarcted myocardium during the early stage of acute myocardial infarction.

Ischemic left ventricular (LV) dysfunction is one of the major causes of LV dyssynchrony. This is indicative of poor prognosis in patients with LV dysfunction and correction of ischemia by Coronary Artery Bypass Grafting (CABG) may resynchronize LV contraction. The aim of this study was to evaluate the effect of CABG on LV dyssynchrony, systolic and diastolic function.Patients: The present study comprised 31 patients with ischemic LV dysfunction with Ejection Fraction (EF:25- 50%). Echocardiography with Tissue Doppler Imaging (TDI) was performed to assess LV dyssynchrony (calculated by basal LV segment),to evaluate diastolic function by measurement of peak early diastolic mitral annular velocity (Em), systolic function by measurement of peak early systolic mitral annular velocity (Sm) and Ejection Fraction (EF) by Simpson method. Mean LV dyssychrony before CABG was 30±16 ms that decreased to 22±14 ms after operation (P=0.04).There was also improved diastolic and systolic function after CABG (Em 0.04m/s versus 0.05 m/s, P=0.01 and Sm 0.06 m/s versus 0.08 m/s P=0.01).The mean ejection fraction rose from 40±8.6% to 42±8.2% (P=0.01). CABG is associated with improvement of LV dyssynchrony, systolic and diastolic function in patients with ischemic LV dysfunction.

The berries of a number of Vaccinium species do reduce blood pressure. The berries Vaccinium arctostaphylus, the species native to Iran have been advocated for the treatment of hypertension in the country’s folk medicine. The bjective was to examine the possible hypotensive activity of aqueous extract of Vaccinium arctostaphylus berries in rat model of two-kidney, one-clip hypertension. Rats were subjected to sham operation or the placement of plexiglass clips on left renal arteries. Four weeks later, renal artery clipped rats were given intravenous injection of normal saline or the extract at 10, 25, 75 or 100 mg/kg, and mean blood pressure and heart rate were measured before and 20, 40 and 60 minutes after drug administration. Compared to sham group, renal artery clipped groups had a significantly higher mean blood pressure, heart and right kidney weights, lower left kidney weights and significantly indifferent heart rate. Compared to vehicle treatment, the extract at 75 and 100 mg/kg, but not at 10 or 25 mg/kg, did significantly reduce mean blood pressure at 20, 40 and 60 minutes after administration without changing the heart rate. The findings showed, that in agreement with Iran’s folk medicine, the aqueous extract of Vacinium arctostaphylus berries did lower blood pressure. The exact hypotensive mechanism remains to be investigated.

Brain natriuretic peptide (BNP) reflects myocardial wall stress. BNP activities are similar to those of atrial natriuretic peptide, including diuresis, natriuresis, hypotension and smooth muscle relaxation as well as ability to inhibit the rennin aldosterone system. It is mainly produced and released into the circulation by the ventricle in response to increased ventricular wall pressure or stretching. Therefore, BNP can be served as a marker of left ventricular dysfunction. The aim of this study was to investigate effect of various professional exercises on plasma BNP levels. We enrolled 20 consecutive healthy professional athletic males from different sporting disciplines including 5 football players, 5 volleyball players, 5 bodybuilders and 5 water- polo players. Plasma BNP samples were taken immediately before and 1 hour after exercise. Plasma BNP level was significantly increased after exercise (30.01 ± 23.46 vs. 16.72 ± 10.86 pg/ml; P= 0.042). The highest increase in BNP level was found among volleyball players (mean values: 19.12 to 43.38 pg/ml; 126.3% increase after volleyball) compared to other exercises. Exercise can increase plasma BNP levels, particularly among volleyball players.

Severe mitral stenosis is occasionally associated with significant tricuspid regurgitation (TR) and this association has an adverse impact on morbidity and mortality in patients undergoing mitral valve intervention. However, the effect of successful mitral balloon valvotomy (MBV) on significant TR is not fully elucidated. The aim of this study was to investigate the course of TR after MBV in patients with severe mitral stenosis with TR. The present study was performed in Tabriz Madani heart center from March 2007 to February 2008. Among 110 patients with mitral stenosis who were candidates of MBV, 68 cases with more than mild TR were selected and the fate of TR after MBV and its predictors were evaluated. Among 68 patients who were enrolled in this study, 58 individuals (85.3%) were female with mean age of 36.85± 14.32 years. Before intervention, 48 patients (70.6%) had severe TR and 20 (29.4%) cases had moderate TR. After intervention, 14 patients suffered from mild TR, 22 from moderate TR and 32 patients from severe TR (P<0.05). There were significant changes in mitral valve area (MVA) (from 0.82±0.22 to 1.70±0.21 cm2; P<0.0005) and pulmonary artery systolic pressure (PASP) (from 53.00±12.04 to 34.91±11.26 cm2; P<0.0005) and right ventricle dimension (RVD) varying from 2.97±0.64 to 2.20±0.58 cm; P<0.0005). This study showed significant relationship between MVA, RVD, and PASP as TR regression determinants. In 6-month follow up no patient needed mitral valve surgery or repeated MBV. There was no procedure related mortality and no death was seen in 6 months follow up in the study group. Significant decrease of symptoms was observed in almost all patients after intervention which persisted during follow up period. Significant number of patients with severe MS and moderate or severe TR showed TR regression following MBV which persisted during 6 months follow up. Severity of MS, PASP and RVD were most important predictors of this regression.

Coronary Heart Disease is commonly associated with obesity, raised serum lipid levels and changes in blood pressure. The present study was designed to assess the effect of low fat- high calcium, and low fat- high fiber diets on weight reduction, lipid profile and blood pressure. The study sample consisted of 136 referred patients adult, obese men aged 53-64 years. Samples randomly were subdivided in two groups. Group 1 was advised 1600 calories, 20% fat, 1600 mg calcium rich diet and group 2 followed similar diet as for group 1 except a total daily intake of 55g fiber and 900 mg calcium per day for 12 weeks. Blood samples were collected and assayed for total cholesterol, LDL-cholesterol, HDLcholesterol and TG. Anthropometric assessments included measurement of weight, height, and waist circumferences followed by calculating Body mass index. Systolic and diastolic blood pressures were measured by using sphygmomanometer. Statistical analysis was performed with parametric and non-parametric methods as appropriate. Data analysis revealed a significant decrease in total cholesterol, LDL-cholesterol, and TG in two groups, without any significant changes in HDL-cholesterol. Weight and blood pressure decreased in two groups,but the rate of reduction in blood pressure, weight and waist circumference were more significant in group 1 compared to group 2. An increase in dietary calcium intake, together with a Low calorie, low-fat diet can increase lipolysis in fat tissues, make greater weigh loss, ameliorate blood pressure, improve lipid levels, and reduce the risk of coronary vascular diseases.

A 27–years-old woman, presented with progressive dyspnea on exertion and chest pain. Transthoracic echocardiography revealed severe pulmonary stenosis. Her tranesophageal echocardiography (TEE) showed a single, large, well-defined thin wall cystic mass with pressure on the main pulmonary artery at the level of pulmonic valve that caused severe pulmonary stenosis. Computed tomography (CT) scan of chest and abdomen confirmed presence of hydatid cyst in mediastinum and liver. Serologic test using Eliza was positive for echinococcal infection. Albendazol was started for the patient and she was referred to surgeon for resection of cystic mass but the patient refused the operation.