Iranian Heart Journal
Volume:13 Issue: 4, Winter 2013

Diabetes mellitus type 2 (DM2) is one of the leading causes of morbidity and mortality owing to its role in the development of cardiovascular disease. This study sought to evaluate the relationship between diabetic retinopathy (DR) and myocardial ischemia using myocardial perfusion imaging (MPI). Thirty-three patients with DM2 (age =59 ± 8 years) were examined for evidence of DR. The subjects were divided into two groups on the basis of the presence [DR(+)] or absence [DR(-)] of diabetic retinopathy. MPI was performed for all the patients as well. Eighteen and fifteen patients were categorized as DR(+) and DR(-), respectively. Ischemia was significantly more frequent in the DR(+) group than in the DR(-) group (p <0.05). There was also a positive association between the grade of retinopathy and the grade of ischemia (odds ratio (OR)[confidence interval (CI)95%] =7.1 [1.7-29.6], p =0.007). Severe nonproliferative/proliferative DR was independently related to the summed difference and summed stress scores (?=13.2, p =0.024 and? =15.4, p =0.013, respectively). The results of our study suggest that the presence of DR increases the risk of abnormal perfusion and the degree of retinopathy is correlated with the extent and severity of ischemia in patients with DM2. (Iranian Heart Journal 2013; 13(4):6-14).

Previous studies have demonstrated that Quantitative Rest-Redistribution Thallium Imaging is one of the most accurate protocols for the assessment of myocardial viability. This study was conducted to evaluate the alteration of the relative segmental activity of quantification analysis in patients undergoing theRest-Redistribution Thallium-201 Study via theSingle Photon Emission Computed Tomography(SPECT) method for the assessment of viability before(NC)and after introducing CT-based attenuation correction (CTAC). Forty-two patients with left ventricular dysfunction who were referred for viability assessment with Thallium-201 Rest-Redistribution protocol were included. A series of two acquisitions, comprising twenty-minute rest and four-hour redistribution acquisitions, were performed for all the patients. CT acquisition of the same region of the SPECT acquisition was performed for attenuation correction, immediately after the completion of each SPECT study. All the images were analyzed quantitatively to obtain normalized segmental activity on the basis of seventeen-segment model. Forty-two patients (9 women and 33 men) at a mean age of 64 ± 12.2 years and a mean ejection fraction (EF) of 24.4 ± 10.1% were recruited in the study. There was a significant agreement between the NC and CTAC images in the apex, apical anterior, apical septum, apical lateral, mid anterior, mid inferoseptal, mid anterolateral, basal anterior, basal anteroseptal, basal inferoseptal, basal inferolateral, and basal anterolateral segments between the two methods (p value <0.05) for predicting viability. However, no significant agreement was noted in the apical inferior, mid anteroseptal, mid inferior, mid inferolateral, and basal inferior segments. The results of the present study suggest that CT-based attenuation correction can play a role in minimizing the patient's body-related attenuation artifact, resulting in a different quantification result in a Rest-Redistribution Thallium-201 Viability study, particularly in the territory of the right coronary artery.

Reduced left ventricular (LV) systolic and diastolic function after myocardial infarction (MI) is a common finding. Studies have shown that mitral valve annulus velocities change in this condition. We sought to evaluate the prognostic value of mitral valve annulus velocitiesby Tissue Doppler Imaging (TDI) in patients with first anterolateral wall MI and determine its relationship with early mortality. We enrolled 50 patients with first anterolateral wall MI and evaluated their LV function by mitral annulus velocity using TDI. We then compared these results with findings in a control group and also in expired patients. We also studied the LV ejection fraction (LVEF) and the regional wall motion abnormality index (RWMAI). The MI patients showed a significant reduction in mitral annulus peak systolic velocity and early and late diastolic velocities in the lateral, septal, and anterior sides compared with the control group. (For example,S, E and A velocities in the lateral side in the patient vs. the control group: 5.31 +/-1.80 vs. 13.9 +/-3.6; 7.1 +/-2.2 vs. 17.34 +/-4.54; 9.49 +/- 2.15 vs.18.3 +/-5.9, respectively; p value <0.001.) Moreover,all these parameters were very low in the expired patients.These findings had a significant correlation with the LVEF and RWMAI(p value <0.001). Mitral annular velocities can be easily measured by TDI after MI. Reduction in these velocities is a marker for LV regional dysfunction in systole and also for diastolic dysfunction. These findings correlate well withthe LVEF and RWMAI and increased mortality after MI.

Ischemic heart disease (IHD) is a growing health problem in Iran and silent myocardial ischemia (SMI) is not an uncommon manifestation of that, necessitating an early diagnosis of IHD. We sought to clarify the association between some major cardiovascular risk factors and SMI in asymptomatic patients with clinical intermediate risk for coronary artery disease (CAD) referred to our department for myocardial perfusion imaging (MPI). A total of 306 patients (122 male, mean age =60 ± 11 years) with intermediate pre-test likelihood for CAD referred for MPI to our Nuclear Medicine Department were enrolled in this cross-sectional study. They were all asymptomatic individuals with one or more major cardiovascular risk factors, consisting of hypertension, diabetes type II, dyslipidemia, and obesity and with no previous cardiac events or known CAD. Stress Dipyridamole MPI scan was performed for all the patients according to the predefined two-day protocol. The scans were assessed by two expert nuclear medicine physicians visually as well as by quantitative methods. After removing the effect of confounding variables, a significant correlation was detected between SMI and age (CI= 95%, OR= 1.03; p value =0.033), male gender (CI= 95%, OR= 1.85, p value =0.029), diabetes (CI=95%, OR= 1.97; p value =0.011), duration of diabetes (CI= 95%, OR=1.20; p value <0.001), and body mass index (BMI) (CI= 95%, OR= 1.069; p value =0.032). In addition, no significant association was noted between SMI and hypertension (CI= 95%, OR=1.056; p value 0.563) or its duration (CI= 95%, OR= 1.010; p value =0.680), nor was there an association between SMI and dyslipidemia (CI= 95%, OR=0.854; p value 0.532) or its duration (CI= 95%, OR=0.979; p value =0.582). The results of the present study suggest that among the asymptomatic Iranian individuals with a positive history of hypertension, diabetes type II, and dyslipidemia and with intermediate pre-test likelihood for CAD, age, male gender, and obesity are the predictors of higher risk of SMI, as are the presence and duration of diabetes type II.

Atrial Fibrillation (AF) is the most common chronic arrhythmia. Strategies to control the ventricular rate nowadays are well accepted. Many patients receiving medication to control the ventricular rate have no symptoms, but may have inappropriate ventricular responses despite normal routine examinations, including heart auscultation and ECG. Patients who seem to have the appropriate ventricular response but complain of symptoms should be investigated further. Sixty-two patients with AF who were treated under the rate control and in their clinical examinations seemed to have the proper ventricular response were evaluated by 24-hour Holter monitoring. The patients were instructed to write down any symptoms, including pre-syncope, weakness, dizziness, palpitation, and syncope during the monitoring process. The results from Holter monitoring were printed, and the clinical manifestations that were associated with the events recorded by Holter monitoring were analyzed. Only 11.3% of the patients with AF undergoing treatment and control of the ventricular rate appeared to have had an appropriate ventricular response. The incidence of syncope and presyncope had concurrency with considerable compensatory pauses of more than 5 seconds. The most common clinical symptoms were dizziness and palpitation, which had the most concurrency with a rapid ventricular response. The ventricular response from the patients with combined digoxin and beta-blocker medication regimens was more appropriate than that of the other patients. Evaluation of the ventricular response in patients with AF using only routine examinations, including auscultation and ECG, is not reliable and conducting a 24-hour Holter monitoring is reliable and more useful in this regard

A combination of Propofol and Fentanyl is used as a method to induce general anesthesia. Although Propofol is widely used for the induction and maintenance of anesthesia, It has a significant effect on reducing the arterial blood pressure.It has been suggested that calcium gluconate, when administered simultaneously with Propofol, may reduce the inotrope negative effect of Propofolon the heart function. We sought to determine the efficacy of calcium gluconate in decreasing the negative effect of Propofol. This randomized, controlled, double-blind clinical trial, divided 70 patients undergoing elective coronary artery bypass graft surgery (CABG) into two groups: Group A (calcium gluconate) and Group B (placebo group).Each patient was injected with Fentanyl (4 µg/kg) andPancuronium (0.1 mg/kg),followed by Propofol(1.5mg/kg) during 60 secondsviaa CVline. Calcium gluconate (30 mg/kg) was administered to Group A and saline (placebo) was given to Group B as well. Homodynamic data were obtained at baseline (T0), 4 minutes after anesthesia induction (T1), and 2 minutes after tracheal intubation (T2).The data were analyzed using descriptive statistics and repeated measurement as well as t tests. A p value <0.05 was considered statistically significant. The mean and standard deviation (SD) of the mean arterial pressure(MAP) at T0 was 101.11± 13.63 for Group A and 107.142±14.59 for Group B (non-significant). These data for T1 (4 minutes after anesthesia induction) and T2 (2 minutes after tracheal intubation) were 70.14±14.67 and 80.22± 23.29 for Group A and 72.05±15.45 and 82.42±14.86 for Group B, respectively (non-significant). The findings of this research indicated no differences between the two groups. Moreover, calcium gluconate appeared to have no efficacy in reducing the negative effect of Propofol.

The aim of this study was to examine the effects of opium consumption on some of inflammatory markers, IL-6, CRP, and WBC count. This case-control study included 42 opium addicted men and 48 nonopium addicted men. The two groups were matched in terms of age and history of cigarette smoking. The differences in bio-markers between the addicts and non-addicts were assessed using a linear regression model. The mean age of both groups was approximately 43 years (p value =0.57). There were no significant differences in the levels of IL6, CRP, and WBC count between the two groups. In contrast to cigarette smoking, it seems that opium addiction does not have any effect on the level of inflammatory markers.

To elucidate the impairment of diastolic function in subjects with the metabolic syndrome, the parameters of left ventricular diastolic filling pattern, including A velocity, E velocity, E/A ratio, and Ea velocity, measured by echocardiography were assessed. In a cohort study, consisting of 468 consecutive individuals, 194 and 274 subjects with and without the metabolic syndrome according to the National Cholesterol Education Program’s Adult Treatment Panel III(ATP-III) criteria were recruited. Two-dimensional and Doppler echocardiography was done for all. Linear regression analysis was performed to examine the relationship between E/A and the Ea index and the indicators of the metabolic syndrome. The mean left ventricular ejection fraction was normal in the two groups. The left ventricular end-diastolic dimension significantly increased in the metabolic syndrome group compared to the control group. The A velocity was higher, and the Ea and E/A ratio were both lower in the participants with the metabolic syndrome than in those without it (p value <0.05). Both E/A and the Ea indices correlated significantly (p value <0.05) with the clinical components of the metabolic syndrome such as systolic and diastolic blood pressures and waist circumference, but not with fasting blood sugar and lipid profile. Diastolic dysfunction occurred in the subjects with the metabolic syndrome even with a preserved systolic function, and it independently correlated with some components of the metabolic syndrome, including systolic and diastolic blood pressures as well as with central obesity.

Verapamil is a well-known agent among medications for hypertrophic cardiomyopathy but it might be hazardous in certain types. CasePresentation: Here we describe a hypertrophic obstructive cardiomyopathy (HOCM) patient who developedpulmonary edema upon intake of Verapamil and was treated by an uncommon strategy:intravenous fluid. Although famous for its therapeutic effects, Verapamil could induce a lethal pulmonary edema in HOCM, which should be managed by intravenous hydration and vasoconstrictors.