International Cardiovascular Research Journal
Volume:5 Issue: 4, des 2011

Cardiac resynchronization therapy (CRT) represents one of the recent advances in heart failure (HF) management. It implies an attempt to establish left ventricular synchronous contraction in order to improve left ventricular hemodynamics; thereby improving functional class, and quality of life. CRT has come a long way from an incidental treatment modality to an accepted and indicated treatment strategy for patients suffering from severe and chronic heart failure. With its ever increasing use, it is important that we become conversant with its role in the management of heart failure. This article aims to review the evidence for CRT, how CRT benefits patients of heart failure and reveals the indications of CRT implantation in HF patients

Left ventricular (Lv) torsion angle is a key parameter of cardiac performance but is difficult to measure. The purpose of this study is to describe a noninvasive imaging method for the assessment of these complex cardiac motions. In this study, left ventricular torsion angle and normalized torsion angle were estimated in the short axis view for healthy persons.Patients and We acquired basal and apical short axis left ventricular Lv images in the short axis view for 14 healthy men to estimate Lv torsion angle by echo tracking under a block-matching (BM) algorithm. By extracting the instantaneous changes in total displacement vector in the short axis view throughout a cardiac cycle, we calculated the instantaneous rotation and torsion angles in the short axis view. To account for differences in heart size, normalized torsion was calculated based on the radius of both the apical and basal slices in the end diastolic frame. Apical and basal rotation was measured from short axis images by automatic frame-to-frame tracking of grayscale echo patterns. The vertical and horizontal displacements of the apical level were more than those of the basal level. All data are expressed as mean ± standard deviation (Sd). data was tested for normal distribution and homogeneity of variance by the Kolmogorov-Smirnov test (K-S) and Levene’s test respectively.The peak rotation angles of the basal and apical levels and Lv torsion angle in the short axis view were 8.0 ± 1.6°, 9.5 ± 1.8°, and 17.3 ± 2.5°, respectively. The normalized torsion was calculated as 7.8 ± 1.3°, based on the basal maximum radius, the apical maximum radius,and the distance between the apical and basal levels. We conclude that the normalized torsion angle is an important biomechanical parameter, because it is independent of heart size and distorted geometries in pathological ventricles.

The myocardial performance index (MPI), also known as the Tei index, was introduced by Tei et al. to evaluate cardiac function in adults with dilated cardiomyopathy.This index is defined as the sum of isovolumic contraction time (ICT) and isovolumic relaxation time (IRT), divided by ejection time (ET). To determine the correlation between pulsed doppler (Pd)- and tissue doppler imaging (TdI)-derived Tei indices in fetuses.Patients and Right and left ventricle Pd and TdI echocardiographic data were obtained from 59 fetuses (11 pregnant women who were positive for anti-SSA-Ro or anti- SSB-La antibodies, 18 women who were referred due to dysrhythmia, and 30 women who had normal clinical findings). Mean fetal gestational age was 27 ± 6.4 weeks. Mean Pd Tei index of the mitral and tricuspid valve was 0.58 ± 0.05 and 0.53 ± 0.08, respectively. Mean TdI indices for the mitral and tricuspid valve were 0.56 ± 0.09 and 0.55 ± 0.08, respectively. There were no significant differences between mitral and tricuspid Pd- and TdI-derived Tei indices (P = 0.87, P= 0.21),but the Bland-Altman diagrams showed no fine agreement between the indices (the mean difference ± 1 standard deviation of the right ventricular Pd- and TdI-derived Tei indices was 0.24 ± 0.02 and 0.29 ± 0.04 for the left ventricle). There were no significant differences in Pd- and TdI-derived Tei indexes between groups of evaluated fetuses (Mitral valve: Pd-Tei P=0.69, TdI-Tei P=0.49; Tricuspid valve: Pd-Tei P=0.41, TdI-Tei P=0.36). Although the mean values of the two indices did not differ significantly, the TdI-derived and Pd-derived Tei indices did not have fine agreement.

A significant proportion of patients who begin CR (cardiac rehabilitation) do not complete the program. The purpose of this study was to determine the predicting factors that interfere with adherence and completion of an outpatient CR program.Patients and A cross-sectional survey was conducted with all 128 patients who entered the CR program at the Rajaie Cardiovascular Medical and Research Center in Tehran, IR Iran, from March 2009 to March 2010. The demographic variables included age, sex, education, employment status, insurance status, and return to work. These variables were compared in patients who completed and did not complete phase II CR. The reason for CR incompletion was asked in follow-up phone interviews. The most frequent clinical diagnosis among the patients enrolled in the CR program was coronary artery disease. 83.6% of patients who participated had a CABG or PCI procedure during the last year. CR participation increased when cardiac revascularization procedures were performed during the first hospitalization. 88 of the 128 patients dropped out, yielding a dropout rate of 68.7%, which was significantly (P < 0.01) higher than the same study in other countries. Sex and age did not predict the completion rate.As education increased, cardiac rehabilitation utilization and completion increased. Unemployed patients were less likely than employed patients to complete the program. Our data indicate a low rate of CR completion, with lower rates among nemployed, uninsured, and less educated patients.

various treatment protocols for dyslipidemia and coronary artery disease have been suggested. In spite of lipid-lowering effects, various effects of statins and fi- brates have been reported in the literature. The aim of this study was to assess the cardiac efficacy of Simvastatin with or without fenofibrate on cardiac function.Patients and A cohort study was conducted on 124 patients with dyslipidemia and coronary artery disease. Patients were randomly divided into two groups: the first group (n = 64) received Simvastatin (60 - 20 mg/day) and fenofibrate (200 mg/day), and the second group (n = 60) received Simvastatin (20 - 60 mg/day) alone. Treatment lasted 1 year, and the patients were evaluated after treatment. The mean age was 54.3 ± 6.5 years, and 53.2% of patients were male. Compared to baseline, after 12 months of treatment the lipid profiles of both groups decreased significantly (P < 0.05). The change in left-ventricular ejection fraction in the first group was statistically significant (P = 0.01). The exercise test time and metabolic equivalent of tasks index significantly increased in the first group (P = 0.014, P = 0.006), but these changes were not significant in the second group (P = 0.289, P = 0.744). Lipid-regulating therapies including Simvastatin and fenofibrate improved myocardial function and reduced myocardial ischemia, so combined therapy is recommended for treating dyslipidemia in high-risk patients for cardiovascular problems.

Cardiac fatigue or myocardial damage following exercise until complete exhaustion can increase blood levels of brain natriuretic peptide (BNP) in athletes. The aim of the present study was to investigate the effect of resistance and acute moderate aerobic exercise on alterations in BNP levels in professional athletes. Forty professional athletes who had at least 3 years of a championship background in track and field (aerobic group) or body building (resistance group) volunteered to participate in the present study. Track and field athletes (n = 20) were requested to run 8 km at 60% to 70% of maximum heart rate. Body building athletes (n = 20) performed a resistance training session of 5 exercises in 3 sets of 10 repetitions at 75% of 1 RM (bench press, seated row, leg extension, leg curl, and leg press). Before and immediately after the exercise, plasma BNP levels of both groups of athletes were measured by PATHFASTTM NT-proBNP assay, an immunochemiluminescent assay using two polyclonal antibodies in sandwich test format, on a PATHFASTTM automated analyzer. Plasma BNP levels immediately following exercise increased significantly as compared with baseline values. Plasma BNP concentrations in the aerobic group were significantly higher than in the resistance group before and after exercise. Moreover, the increase in mean BNP concentrations in aerobic athletes was 7 times more than in resistance athletes. BNP levels in athlete who performed distance exercises increased signifi-cantly compared with resistance training. Possibly exercise program type, intensity of exercise, volume of exercise program, and field sport can be factors of changes in BNP levels.

A 67-year-old man presented with symptoms of typical chest pain. An electrocardiogram (EKG) showed ST elevation at the inferior leads and ST depression at the anterior leads.His blood pressure was 80/50 mmHg with a pulse rate of 100 beats/min. The glycoprotein IIb/IIIa inhibitor (eptifibatide) was administrated and a primary percutaneous coronary intervention PCI was done. despite the restoration of TIMI grade 3/3 flow, the patient’s blood pressure dropped and pulmonary edema occurred. On the second day following PCI, the hemoglobin level started to drop. While working up the case, the patient suddenly complained of dyspnea and had a bloody foamy discharge from his mouth. due to severe hypoxemia orotracheal intubation was carried out. A chest x-ray revealed an alveolar hemorrhage. Treatment with high dose hydrocortisone was started and the patient went on mechanical ventilation for seven days. Following extubation, the patient was put under close observation for five days and then discharged from hospital without any complications. during a 3 month follow-up, he has remained symptom free.

Dear Editor,Hemorheological factors, such as viscosity, are significant in determining blood flow characteristics and play an important role in the pathogenesis of thrombotic events and, therefore, cerebrovascular diseases. The viscosity of fluids depends on; particle concentration,shape of the particles, pH of the fluid, and temperature.Blood includes many different kinds of proteins such as;fibrinogen, albumin and globulins. Plasma viscosity and hematocrit values are the major determinants of whole blood viscosity (1-3). It should be bought to one’s attention,that although albumin comprises more than half of the total serum proteins (4), its effect on blood viscosity is very low (5). This is an inverse situation according to our physical knowledge of fluid viscosity. An interesting study by Lacombe et al. (6) showed that an elevation in fibrinogen concentration, leads to a more aggregated structure in red blood cell suspensions. Immediately after the albumin was added, increased aggregability of red blood cell was improved. It sems that there is a negative correlation between erythrocyte aggregability and plasma albumin.Here, we present, retrospectively identified patients whose albumin and fibrinogen levels had been studied in our center between 2001-2010. We excluded patients who were; younger than 18 years old, pregnant, anticoagulant therapy users, women who take oral contraceptives or suffering from any of the following conditions;any malignant disease, diabetes mellitus, liver disease,any hematologic disease, and acute or severe infections.Age, sex, hematocrits, and white blood cell count parameters were noted in addition to; albumin,ibrinogen and the presence or absence of a cardiovascular event. Two groups were formed. Group A: Patients who had had no cardiovascular event (n = 32). Group B: Patients who had had a cardiovascular event (n = 27). There was no significant difference between the two groups by gender (Group A: 18 women, 14 men. Group B: 13 women and 14 men). Hematocrit levels did not differ significantly be tween the two groups (P > 0,05), however, there was a significant (P < 0,05) difference between the two groupsin their mean ages, and plasma fibrinogen levels were significantly higher in Group B (P < 0,05). Plasma albumin levels were significantly lower in Group B (P < 0,05).The albumin/fibrinogen ratio was considerably higher in group B. Fibrinogen was higher in Group B,versely;albumin levels were lower in this group.In conclusion, we speculate that albumin levels should be taken into consideration while exploring the influence of fibrinogen on cardiovascular disease. We also believe that the influence of albumin on blood viscosity and cardiovascular disease should be investigated in more detailed studies.