International Cardiovascular Research Journal
Volume:3 Issue: 2, Jun 2009

Atrial fibrillation (AF) is a common complication after CABG. It is associated with doubling of mortality rate and increased incidence of CHF, MI, renal insufficiency, and stroke which prolongs hospital stay and is associated with increased rate of re-hospitalization.In this study we examined the effect of CABG on atrial electrophysiology as reflected by P-wave dispersion.Patients and A total of 197 consecutive patients undergoing elective CABG due to CAD were monitoredfor 4 days in hospital and their daily ECGs were obtained.. Differences in P-wave dispersions were compared between the patients who developed AF and those maintaining sinus rhythms. Post-operative AF occurred in 18.2% of patients, who showed statistically significant increase of P wave duration, in lead aVL of pre-op ECG (79.4±25.0 vs 70.1±22.4; P = 0.032). In addition, P wave dispersion was significantly increased on first and third days of post-op period (77.2±22.0 vs 67.5±22.2; P=0.018) and (69.4±22.7 vs 61.1±20.3; P= 0.035) respectively, in those developing AF rhythm compared to patients remaining in sinus rhythm. Our result indicates that P-wave dispersion is a risk factor for development of AF in patients undergoing

Recent trials of platelet glycoprotein IIb/IIIa receptor inhibitors have improved our understanding to best use these powerful antiplatelet drugs in acute coronary syndrome. We tested the hypothesis that inhibition of GPIIb/IIIa platelet receptor with Eptifibatide is effective as an empiric therapy in patients with acute coronarysyndrome who do not necessarily undergo immediate revascularization. Since Feb 2006 one hundred and ninety-six patients who had presented with non ST-elevation acute coronary syndrome (NSTE-ACS) were randomly assigned to receive Eptifibatide in addition to standard therapy,for up to 72 hours or routine standard therapy. The primary end point was composite of death and non-fatalmyocardial infarction (MI) or urgent target vessel revascularization (TVR) in 30 days. The incidence of composite end point of death, non fatal MI and urgent TVR was significantly lower in Eptifibatide group than standard group (16% vs. 0% - P value <0.01),particularly in troponin positive subgroup of patients (27.8% vs. 0% - P value <0.01).Any major adverse reaction such as major bleeding, stroke, or thrombocytopenia was not seen. Early administration of GP IIb/IIIa receptor inhibitor is recommended in patients with high-risk acute coronary syndrome.

Left ventricular end diastolic pressure could be estimated collectively using various measures of mitral valve and pulmonary venous flow velocities. In patients with aortic regurgitation, the AR velocity reflects the diastolic pressure difference between the aorta and the left ventricle. We sought to predict the left ventricular end diastolic pressure by a new Doppler index as aortic regurgitation peak early to late diastolic pressure gradient ratio.Patients and Fifty three patients with at least moderate aortic regurgitation were enrolled in this study. Physical examination, electrocardiography and echocardiography were performed one day before cardiac catheterization. The severity of AR was graded according to the recommendations of American society for echocardiography. The pressure half time, aortic regurgitation early diastolic velocity, aortic regurgitation early diastolic pressure gradient, aortic regurgitation end diastolic velocity, aortic regurgitation end diastolic pressure gradient, and early diastolic to end diastolic pressure gradient ratio of averaged three beats were measured and recorded. The results from cardiac catheterization and echocardiography were compared. The early diastolic to end diastolic pressure gradient ratio was very accurate (80%) for determining the left ventricular end diastolic pressure (P =0.01). An early diastolic to end diastolic pressure gradient ratio of 1.5 has a sensitivity of 96% and a specificity of 32% for left ventricular end diastolic pressure ≤12 mmHg. The best cutoff value of early diastolic to end diastolic pressure gradient ratio for the prediction of left ventricular end diastolic pressure >12 mmHg was higher than 2.0, with a sensitivity of 71% and specificity of 96% We found no significant correlation between the left ventricular end diastolic pressure with either left ventricular ejection fraction or aortic regurgitation severity in cardiac catheterization (P =0.5). Doppler echocardiography is a viable alternative of cardiac catheterization for determination of the left ventricular end diastolic pressure. The early diastolic to end diastolic pressure gradient ratio is a simple, easy and new method for assessment of the LVEDP in patients with severe chronic aortic regurgitation.

The association between C-reactive proteins (CRP), a marker of inflammation, and major coronary risk factors has been highlighted in several nvestigations. CRP is associated with acute cardiac events and can predict their occurrence. The aim of this study was to evaluate the association between CRP serum level and coronary artery disease (CAD) along with it’s major risk factors, in patients with stable angina pectoris.Patients and In a cross-sectional case control study, CRP and major coronary risk factors including cholesterol, diabetes mellitus (DM) smoking and hypertension were evaluated in 200 angiographically documented CAD (case group) and 120 subjects with normal coronary arteries(control group). Of 320 subjects 50 in both case and control groups were presented with a CRP≥6 mg/dl, with 30 (60%) female and 20 (40%) male patients. There was a significant association between CRP≥6 mg/dl and those with age>60 years (P=0.002), hypertensive subjects (P<0.05), diabetic patients (P<0.05), hypercholesterolemic patients (P<0.05), Low HDL (P<0.05) and smokers (P<0.05) in both the case and control groups. Multivariate analysis showed a significant correlation with CRP and angiographically documented CAD independent of coronary risk factors. The present study showed a significant relationship between C-reactive protein levels and coronary risk factors and also demonstrated an independent relationship between angiographically documented CAD and elevated CRP serum levels in patients with chronic stable ischemic heart disease

Administration of Protamine sulfate for heparin neutralization after cardiopulmonary bypass may be associated with adverse reactions such as transient hypotension to cardiovascular collapse. Although catastrophic events are rare and occur only in 2.6% of cardiac surgeries, it is associated with adverse postoperative outcome. The aim of this study is to investigate whether bolus administration of calcium gluconate can minimize the adverse hemodynamic effects of protamine.Patients and This randomized clinical trial (RCT) prospective study was conducted between Feb. 2006 to Dec. 2008. The patients were randomly allocated into three groups including group A (42 patients) who received only protamine after weaning from cardiopulmonary, group B (44 patients) concomitantly treated with protamine sulfate and calcium gluconate, and group C (40 patients) receiving calcium gluconate 5 minutes before administration of protamine. Hemodynamic variables such as systolic and diastolic blood pressures, mean of arterial pressure, central venous pressure and heart rate were obtained 0, 2, 4, 6, 8 and 10 minutes after protamine administration from each group. Systolic blood pressure in groups A (control) and C (calcium administration before protamine) 0,2,4,6,8 and 10 minutes after protamine administration initially decreased and increased subsequently (P=0.228). Also no statistically significant difference was found in diastolic blood pressure (DBP), mean arterial pressure (MAP), central venous pressure (CVP), and heart rate (HR) in 0,2,4,6,8, and 10 minutes in any of the three groups. In our study, hemodynamic changes in 10 minutes after protamine administration for heparin neutralization in patients with good left ventricular systolic function after coronary artery bypass grafting surgery were mild, and prophylactic calcium gluconate administration concurrent with or before protamine injection was not recommended.

An anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital coronary anomaly. It usually presents in infancy with intractable left sided heart failure. Most patients die in infancy, but survival into adulthood is possible. Patients may complain of dyspnea, syncope or effort angina. They may remain asymptomatic; or experience sudden death after exercise. A 56-year-old woman presented with a twomonth history of exertional chest discomfort. Echocardiography showed a coronary anomaly with preserved systolic function and no resting regional wall motion abnormality. The coronary and CT (computed tomography) angiography studies revealed the anomalous origin of the left coronary artery. A review of ALCAPAstudies is presented along with images from the echocardiogram, coronary angiogram and CT scan performed for this case.

Mitral- aortic intervalvular fibrosa pseudoaneurysm a rare complication of aortic valve replacement, that was diagnosed in a 55 years-old 2 years after operation.