International Cardiovascular Research Journal
Volume:4 Issue: 4, Dec 2010

In this study we compared the diagnostic performance of serum ischemia modified albumin (IMA) and sensitive cardiac troponin I (cTnI) assay for the detection of acute coronary syndrome (ACS) in patients presenting to the emergency department (ED) with acute chest pain. A prospective study was conducted on 123 patients presenting to the ED within three hours of acute chest pain. A 12-lead ECG was recorded and IMA and cTnI were measured on arrival at the ED. After diagnostic testing, the patients were classified as either ACS (n=70) or non- ACS (n= 53). The results of IMA, ECG, and cTnI, alone and in combination, were correlated with final diagnoses. IMA showed higher sensitivity (84%) and negative predictive value (NPV, 88%) compared to cTnI (sensitivity 42%, NPV 66%) and ECG (sensitivity 58%, NPV 74%). Combined use of IMA, cTnI and ECG significantly improved the sensitivity (96%, P<0.05) and NPV (96%) of IMA. The diagnostic performance of IMA was similar in the case of non-ST-segment-elevation ACS (sensitivity 80%, NPV 80%). The sensitivity and specificity of IMA for diagnosis of acute myocardial infarction (AMI) were 88% and 48%, respectively. Measuring IMA at the time of ED admission improves the early diagnosis of ACS and non-ST-segment-elevation ACS in patients with acute chest pain. However, the test is not an effective tool for diagnosis of AMI in patients with chest pain presenting to ED.

The distribution and magnitude of left ventricular hypertrophy (LVH) are not uniform in patients with hypertrophic cardiomyopathy (HCM), which results in regional heterogeneity of left ventricular (LV) systolic function. The aim of this study was to evaluate LV regional systolic dyssynchrony in patients with HCM by Tissue Doppler Imaging (TDI) and to find any correlation between TDI data and syncope. A total of 44 consecutive patients with HCM are recruited in the present study.. All patients, underwent complete clinical and echocardiographic evaluation including TDI. The following were measured in 6 different basal and 6 mid-myocardial segments: systolic peak velocity(Sm), early diastolic myocardial velocity (Em), pre-contraction time(Q-Sm) from beginning of Q- wave of ECG to the onset of Sm, total asynchrony index, interventricular mechanical delay(difference in Q-Aortic valve opening and Q-Pulmonic valve opening) and maximum difference in time to peak systolic velocity between 2 of 12 segments(ΔPVI). TDI analysis in HCM subgroup with syncope showed both significant interventricular (36.72±26.26 vs 14.74±11.30 msec, P<0.001) and intraventricular delays(39.40±22.38 vs27.70±17.32 msec, P=0.07). The prevalence of LV systolic dyssynchrony was from 20.5% to 38.6% based on different methods. Patients with syncope had greater impairment of regional systolic and early diastolic function, remarkably lower Sm and Em velocities. The impairment of inter and intraventricular systolic synchronicity is significantly related to syncope in patients with HCM.TDI analysis may be able to select subgroups of HCM patients at increasing risk of syncope and major cardiac events.

Although primary percutaneous transluminal coronary angioplasty is the method of choice for reperfusion in ST- levation myocardial infarction, the intravenous thrombolysis is a more frequently used method. Thus it is important to identify the risks of reperfusion failure. In this regard, CRP as an inflammatory marker has shown promising value. The aim of this study is to investigate whether CRP level on admission is indicative of intravenous thrombolysis failure. This study comprised 84 patients with STEMI. Samples were taken for CRP before initiation of thrombolysis. The correlation of CRP levels with thrombolysis results was investigated at the end of the study. The study population was divided according to their plasma CRP level on admission. The first group had CRP levels<0.5 mg/L (22 patients) and the second group had CRP levels≥0.5 mg/L (62 patients). There was a statistically significant difference (P=0.01) between the respondents to thrombolysis in the first (59.1%) and second groups (29.0%). It was demonstrated that patients with low CRP levels on admission showed better response to intravenous thrombolysis while those with high levels of CRP showed unfavorable response.

The main objective of this study was to evaluate the prevalence of central obesity and some related factors in the north of Iran (Golestan province) in 2006. This was a population –based cross-sectional study that comprised 2471 subjects (1250 males and 1221 female), using stratified cluster sampling. Interviewers recorded the data using the multidimensional questionnaire and anthropometric indexes. Waist circumference ≥102 and ≥88 cm categorized as central obesity for men and women respectively. SPSS 16.0 software was used for statistical analysis. The mean and standard deviation of age was 39.2±14.28 years and waist circumference was 87.1±13.7 cm in men and 90.2±15.8 cm in women, respectively. In total, the prevalence of central obesity was 32.01% and it was significantly higher in women (57.2%) than in men (15.8%), in urban area (40.5%) than in rural areas (31.9%) and in uneducated people (52.3%) than in college educated people (19.9) (P=0.001). Logistic regression analysis revealed that central obesity was significantly associated with age, urbanization, parity and illiteracy (P<0.05). Central obesity was the most serious health problem in the north of Iran and it was more prevalent in women than men. Socio-demographic factors such as younger age (between 15-25 and 25-35 years), urbanization, marital status and illiteracy were associated with central obesity. Further studies are necessary to establish the association between central obesity and racial differences in this area.

One of the most important complications during pregnancy is hypertension which is responsible for a widespread range of harms in mothers and fetuses. This investigation was designed to study the prevalence of hypertensive disorders during pregnancy in Shiraz, Iran. This is a descriptive cross-sectional study, and comprised all pregnant women referred to Hafez and Zeinnabieh hospitals affiliated to Shiraz University of Medical sciences. Prevalence of various groups of hypertensive disorders of pregnancy, age proportion and method of delivery were recorded during one year period. Of a Total of 24196 pregnant women, 563 individuals (2.32%) were hypertensive and the prevalence of chronic hypertension, preeclampsia and eclampsia were 2.13%, 0.17%, 0.03% respectively. Moreover, 45.8% of all patients with Hypertension disorders of pregnancy experienced caesarian section method of delivery. Results of present study showed that the prevalence of hypertension in the pregnant women in Shiraz is much lower compared with the acceptable universal estimations and many countries.

Exhaustive exercise is well known to pose a variety of health hazards, such as sudden cardiac death reported in ultra-marathon runners. Depressed parasympathetic tone is associated with increased risk of sudden cardiac death, thus parasympathetic withdrawal in post-exercise phase may be a high risk period for sudden death. To date, the effect on cardiac electrophysiology after exhaustive strenuous exercise has not been described. The aim of this study was to evaluate the impact of severe exhaustive exercise on cardiac electrophysiology. The subjects in ranger training were invited to participate in this prospective study. The parameters measured consisted of PR interval, QRS duration, and macro T wave alternans as well as corrected QT, QTc dispersion, Tpeak –Tend interval and Tpeak –Tend dispersion. The study group consisted of 40 consecutive male rangers who completed training and the control group (22 healthy age and height matched male subjects). In regard to electrocardiographic criteria, no differences were found between rangers before and after training program. In respect of the repolarization markers, there were no significant differences between the rangers before and after training program. There was no significant change in cardiac repolarization markers after severe exhaustive exercise. Additionally, there was no relationship between sudden cardiac death and electrophysiologic changes after exercise.

Appropriate sensing is indispensable for appropriate functioning of implantable cardioverter-defibrillator (ICD). Oversensing is a major clinical dilemma in patients with ICD leading to inappropriate ventricular arrhythmia detection and therapy. T-wave oversensing is an important clinical problem leading to QRS double counting with inappropriate therapy, in particular. We present a patient with dilated cardiomyopathy and intermittent T wave oversensing by an ICD which could be resolved by device reprogramming.

We present a 33 years-old smoker male with dyspnea on exertion, the cause of which was finally identified as atrial tachyarrhythmia after performing echocardiography, coronary angiography, right, and left sided cardiac catheterization During electrophysiology study; upper loop reentry (ULR) a rare form of atypical Atrial flutter was diagnosed and ablated by conventional technique. New mapping technology improved our understanding of the mechanism and pathways of arrhythmia, and allowed complex ablations made easier and more costeffective.

Coarctation of the abdominal aorta is an extremely rare vascular defect in whichcongenital or acquired etiologies have been described. This case concerns a 30-year-old pregnant woman with 15-years history of uncontrolled hypertension and lower limb claudication presented with worsened hypertension during her first pregnancy. Magnetic resonance angiography study of aorta revealed a stenosis in abdominal aorta about 12mm from the origin of celiac axis accompanied by left sided aortic arch and right aberrant subclavian artery. This case highlights the importance of a throughout physical examination in patients presented with hypertension and it emphasizes considering the coarctation of the abdominal aorta during the diagnostic workup of hypertension, especially in young patients. In such cases magnetic resonance angiography of the aorta is a useful tool to reach a definitive diagnosis especially in pregnant women. Also to our knowledge, this patient is the first one found to have aortic arch malformation combined with an abdominal coarctation.