فهرست مطالب

Iranian Heart Journal
Volume:14 Issue: 2, Summer 2013

  • تاریخ انتشار: 1392/06/22
  • تعداد عناوین: 9
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  • Farshad Shakerian , Marjan Ramezani , Hamid Reza Sanati, Ata Firouzi Pages 6-12
    Noninvasive، cheaper، and more feasible methods have always been of great interest to all investigators and physicians in the diagnosis of coronary artery disease. We aimed to investigate the relationship between chest pain and electrocardiographic findings and the culprit artery diagnosed by coronary angiography. This study was conducted on 200 patients with a diagnosis of coronary artery disease who underwent coronary angiography. Electrocardiogram interpretation was assessed according to the different types of rhythms، ST-T interval changes، and cardiac axis deviations. According to the coronary angiography findings، the culprit vessel was defined. All the included patients who experienced chest pain and its characteristics (quality، location، and duration) were registered on a self-explanatory basis. The correlation between the obtained clinical characteristics and the culprit vessel was analyzed. Although in all the groups divided according to the involved coronary vessels heavy chest feeling was the most frequent، differences were insignificant. Most of the patients with left circumflex artery involvement (p value = 0. 028) and left anterior descending artery disease (p value = 0. 045) experienced epigastric pain. There were no significant differences between the frequency of patients with sinus and non-sinus rhythm in the groups divided according to the involved coronary vessels. Patients with ST-T interval changes were more likely to experience left circumflex artery involvement (p value < 0. 001). Axis deviations were markedly more frequent in patients with right coronary artery (p value < 0. 001)، left circumflex artery (p value = 0. 014)، and left anterior descending artery disease (p value = 0. 040). Electrocardiogram findings may be helpful but certainly not reliable enough to predict the involved coronary vessel. There was no considerable relationship between chest pain type and culprit artery. Epigastric pain may be considered a strong marker for coronary artery disease
    Keywords: Chest pain, Electrocardiography, Coronary angiography
  • Evaluation of Sternal Wound Infection after Median Sternotomy Using 99mTc-Labeled Ubiquicidin 29-41
    Nezafati Mh , Esfahanizadeh J. , Hosseinzadeh M. Nezafati P. Page 7
    Background
    Many small-sized trials have evaluated the effectiveness of cold blood cardioplegia (CBC) compared with crystalloid cold cardioplegia (CCC) for myocardial protection during pediatric cardiac surgery. We hypothesized that CBC might preserve the myocardium more effectively than St. Thomas’ crystalloid cardioplegia in pediatric cardiac surgery and، thus، investigated the efficacy of CCC versus CBC in terms of myocardial metabolism protection in patients undergoing the corrective repair of Tetralogy of Fallot (TOF).
    Methods
    Thirty pediatric patients with TOF were randomly allocated to either CBC (n=15، 4:1 dilution، potassium chloride 15 mEq/L) or CCC (4 °C، n=15). Arterial and coronary sinus blood samples were analyzed for lactate and oxygen contents.
    Results
    The patients were demographically similar in both groups. The lactate concentration in coronary sinus blood was not significantly different between the two groups exactly after cardiopulmonary bypass (2. 5±1. 3 vs. 2. 5±1. 0 mmol/L; p value = 0. 9) but coronary sinus blood O2 saturation was higher early after cardiopulmonary bypass in the CBC group (59. 0±18. 5 vs. 44. 0±17. 6 meq; p value = 0. 03).
    Conclusions
    Our results showed no significant clinical advantages of antegrade CBC over CCC during hypothermic cardioplegic arrest in pediatric cardiac surgery (Iranian Heart Journal 2013; 13 (2): 24-29).
    Keywords: Tetralogy of Fallot repairing, Cold blood cardioplegia, Crystalloid cardioplegia
  • Mitra Azarasa , Zahra Faritous , Alireza Jalali , Maziar Gholampour Dehaki , Gholamreza Massoumi Pages 13-18
    Background
    The aim of this study was to study the effect of low-dose Dopamine on the blood lactate levels as a sign of visceral perfusion in coronary artery bypass graft surgery (CABG) patients.
    Methods
    In a double-blinded, randomized clinical trial, 100 adult patients – who were candidated for elective isolated CABG surgery - were divided equally into two groups of low-dose Dopamine group (2 µg / kg / min) and control group (n=50 in each). Lactate levels, arterial blood gas analyses, blood pressure, and heart rate were recorded intraoperatively at four time points: before the induction of anesthesia; 15 minutes after the beginning of cardiopulmonary bypass (CPB); during CPB at rewarming to 34?C; and 15 minutes after separation from CPB. These biochemical and hemodynamic parameters were compared in these four time points between the two study groups.
    Results
    Arterial blood gas and hemodynamic parameters were similar between the two groups during surgery (p values > 0.05). There were no significant differences between the lactate levels in the Dopamine and control groups at the beginning of CPB (3.1 ± 2.5 vs. 2.6 ± 2.0 mg/dl; p value = 0.453), at the time of rewarming (3.1 ± 2.5 vs. 2.6 ± 2.0 mg/dl; p value = 0.510), and after CPB (3.1 ± 2.5 vs. 2.6 ± 2.0 mg/dl; p value = 0.551) - respectively.
    Conclusions
    The use of low-dose Dopamine did not decrease lactate levels in our CABG patients using CPB
    Keywords: Coronary artery bypass grafting, Lactate level, low, dose Dopamine, Arterial blood gas analysis
  • Amirfajam Fazelifar , Taimor Scot , Ata Firozi , Mohammadreza Bayanati , Alireza Tatina , Mona Heidarali Pages 19-23
    Background
    Myocardial infarction (MI) is the leading cause of morbidity and cardiovascular mortality. The presence of collateral coronary vessels is believed to be a good prognostic factor. Accordingly, this study was performed to compare electrocardiographic (ECG) changes in MI patients with and without collaterals.
    Methods
    This study was performed as a cross-sectional study among 200 patients admitted for MI in a training hospital in 2011 and 2012. The study population was divided into two categories: patients with collateral coronary vessels and those without them. ECG findings were compared between the two groups.
    Results
    Among the ECG findings, only the QRS pattern in V1 was associated with the presence of collateral vessels. Abnormal QRS axis, pathological Q wave, persistent ST increase/decrease, QRS notch, PR interval, and QRS duration were not related to the presence of collateral vessels (p value > 0.05).
    Conclusions
    According to our results, it may be concluded that ECG changes are not related to the presence of collateral coronary vessels in angiographic assessment. It is recommended that further studies be carried out with evaluation of ECG and after one-month catheterization results of patients to obtain more definite results
    Keywords: Myocardial infarction, Collateral coronary vessels, Electrocardiography
  • Vali Imantalab , Abbas Seddighinejad , Ali Mir Mansouri , Alimohammad Sadeghi Meibodi , Heidar Dadkhah , Said Farzam , Kambiz Forghan-Parast Pages 30-36
    Introduction
    A combination of Propofol and Fentanyl is used as a method for inducing general anesthesia. Although Propofol is widely used for the induction and maintenance of anesthesia, it has a significant effect on reducing arterial blood pressure. It has been suggested that Calcium Gluconate, when administered simultaneously with Propofol, may reduce the inotrope negative effect of Propofol on heart function.
    Objectives
    To determine the effect of Calcium Gluconate in decreasing the negative effect of Propofol.
    Methods
    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). Each patient was injected with Fentanyl (4 µg/kg), Pancuronium (0.1 mg/kg), and Propofol (1.5 mg/kg) within 60 seconds via a central vein line. Calcium Gluconate (30 mg/kg) and saline (placebo) were administered to Group A and Group B, respectively. 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, repeated measurement, and T tests; a p value < 0.05 was considered statistically significant.
    Results
    The mean and SD of mean arterial pressure at T0 was 101.11 ± 13.63 for Group A and 107.142 ± 14.59 for Group B (non-significant). These figures 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 (non- significant).
    Conclusions
    The findings of this research indicated no differences between the two groups. Calcium Gluconate appeared to exert no impact on reducing the negative effect of Propofol.
    Keywords: Cardiac surgery, Calcium Gluconate, Propofol, Fentanyl, Blood pressure
  • Ashkan Hashemi , Arash Hahshemi , Mohammad Mahdi Peighambari , Azin Alizadehasl , Anita Sadeghpour , Mousa Mirinazhad , Siamack Yazdchi , Sima Rafyean , Rasul Azarfarin Pages 37-42
    Introduction
    Ischemic mitral regurgitation (MR) is frequently seen after the first acute ST-elevation myocardial infarction (MI) and is an independent predictive factor for long-term cardiovascular mortality after MI. Timing and severity of MR after MI is relevant to the location and extent of MI. We sought to evaluate the severity of post-MI ischemic MR and evaluate its relationship with the type of MI.
    Methods
    In our case-control study, we enrolled 80 patients with first MI. The patients were divided into two groups: one without MR or with mild ischemic MR (control group) and one with? moderate ischemic MR (case group). Echocardiographic evaluation was done on the third day after MI in both groups, and the severity of ischemic MR was determined based on the American Echocardiographic Association’s guideline.
    Results
    The mean age was significantly higher in the case group (p value < 0.05). The prevalence rates of anterior and inferior-inferolateral MI in the control group were 31 and 66%, respectively. This was seen in 51 and 39% in the case group (p value < 0.05). The main pathology in the case group was mono or bi-leaflet tethering. In addition, ejection fraction was lower in the case group (p value < 0.05).
    Conclusions
    Our findings showed that significant ischemic MR was prevalent in patients with anterior MI
    Keywords: Myocardial infarction, Mitral regurgitation, Echocardiography
  • Hamid Reza Sanati , Farnoosh Farhangi , Reza Kiani , Ali Zahedmehr , Maryam Ardeshiri , *Ata Firouzi , Farshad Shakerian Pages 43-49
    Background
    glycemic control in cardiac patients is necessary to improve mortality and morbidity; however, the impact of admission glycemic control in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) has not been extensively investigated. The aim of this study was to evaluate the association between the serum glucose level (BG) on admission and the rate of cumulative in-hospital and 6-month adverse events in non-diabetic ACS patients undergoing PCI.
    Methods
    This case-series study analyzed 100 non-diabetic patients - with intermediate to high-risk unstable angina or non-ST elevation myocardial infarction - who were candidated for early PCI. BG was measured on admission and adverse events were recorded during the hospital course and up to six months.
    Results
    The mean level of BG on admission was 147.70 ± 66.20 mg/dL (range = 72 to 382 mg/dL). Among the patients followed up, the rate of major adverse events (MACCE) was 6.0%. The mean BG on admission in the group with MACCE was significantly higher than that among patients without MACCE (192.50 ± 77.34 mg/dL vs. 144.84 ± 64.85 mg/dL; p value = 0.010). According to the ROC curve analysis, BG on admission had an acceptable value for predicting MACCE (c = 0.723, 95% CI: 0.601 – 0.844). The best cut-off point of BG for discriminating MACCE from non-MACCE status was 140 mg/dL with a sensitivity of 67.0% and a specificity of 73.0%. Considering this cut off value, 66.7% of the patients with MACCE and only 31.9% of the non-MACCE patients had glucose levels > 140 mg/dL (relative risk = 4.267, 95% CI: 1.236 – 14.726).
    Conclusions
    Measuring BG on admission can predict untoward events in patients with ACS treated with elective PCI.
    Keywords: Acute coronary syndrome, Blood glucose, Percutaneous coronary intervention
  • Zahra Khajali , Sakineh Pedarpour , Nasim Naderi , Behdad Bahadorian , Mahdieh Aghababaei , Monireh Soltani Pages 50-54
    Background
    It is shown that about 10% of all congenital heart disease patients suffer from cyanosis and though maintaining their functional capacity and physical capabilities up to their thirties, they will face significant decreases in functional capacity and quality of life as the symptoms progress and ill consequences appear.3 Many of these patients reach adulthood with the help of palliative surgeries but drop in O2 saturation and cyanosis gradually ensues and progresses as the patients get older and the shunts become non-compliant.
    Methods
    one hundred two patients with CCD entered in the cross sectional study. Clinical and paraclinical data extract from medical files: complete blood cells, red cells indexes, serum iron, ferritin, transferrin saturation, echocardiography report, left and right ventricles ejection fraction, CKMB and troponin I. the relationship between these data and O2 saturation was evaluated.
    Results
    43 (42.2%) patients were female and 59 (57.8%) were male. Mean of age was 24.6±6.5 years. Mean of O2 saturation was 76.8±10.2 percent. Coefficient relationship between left ventricle EF and O2 saturation was 0.281 (P=0.017), hemoglobin and O2 saturation was -0.293 (P=0.008), MCV and O2 saturation was 0.255 (P=0.022), MCH and O2 saturation was 0.0388, ferritin and O2 saturation was 0.326 (p=0.007), serum iron and O2 saturation was 0.270 (P=0.026), TIBC and O2 saturation was -0.288 (P=0.022), Transferrin Saturation and O2 saturation was 0.329 (P=0.001) and CKMB and O2 saturation was 0.285 (P=0.025).
    Conclusions
    O2 saturation has significant relationship with heart function and anemia indexes in CCD patients. O2 saturation may be useful for screening of the heart function and the anemic indexes in these patients.
  • Neda Rayes Hoseini , Abolfath Alizadeh , Zahara Emkanjoo , Mona Heidarali , Batol Moradi , Shirin Hoseini Pages 55-61
    Background
    Silent atrial fibrillation (AF) detection with stored EGMs (SAFE) registry may identify patients at increased risk for stroke and death. This study evaluated the clinical predictors of newly detected atrial fibrillation in patients following dual-chamber permanent pacemaker (PPM) implantation and time course of AF incidence and development in a general pacemaker population with AF or without AF.
    Methods
    We evaluated 318 patients without documented AF who received dual-chamber PPMs with features that permit detection and storage of information about the date, time of onset, and duration of multiple, sequential episodes of AF. Patients were followed up for one month, six months, and one year. All demographic and clinical data were determined and assessed following PPM implantation.
    Results
    Totally, 318 patients with dual-chamber PPMs were enrolled. New incidence of AF was 18.9%. Of these patients, new AF occurrence during a one-month period after PPM implantation was 4.5%, after 6 months was 22.7%, and after one year of follow-up was 82.1%. Also, 57.8% of the new cases of AF experienced several atrial high rate episodes. Greater than 90% cumulative ventricular pacing was a significant predictor - with a risk of 1.6 in the occurrence of AF. Other factors influencing the incidence of AF after the implantation of dual-chamber pulse generators were heart failure, underling sinus node disorder, left ventricular dysfunction, P wave shape showing left atrial enlargement, and severity of ventricular disease.
    Conclusions
    AF episodes develop significantly after dual-chamber PPM implantation in a great number of patients. In this study, the effect of the underlying disease of sinus node, P wave form in the ECG, left ventricular dysfunction, valvular disease, and greater than 90% cumulative right ventricular pacing were determined as factors influencing the incidence of AF after dual-chamber PPM implantation. Also, the risk of AF incidence after one year in our patients with dual-chamber PPMs had an increase. Therefore, we would suggest that the cumulative percentage of ventricular pacing be decreased with a new method to prevent AF incidence
    Keywords: Atrial fibrillation, Dual, chamber pacemakers