Iranian Heart Journal
Volume:14 Issue: 3, Fall 2013

In this study, factors contributing to abnormal angiographic findings in coronary vessels were evaluated in a training heart center in Tehran, Iran. In this cross-sectional study, 280 patients under angiography in a training heart center in Tehran, Iran, in 2012 were enrolled and the frequency distributions of demographic characteristics and clinical factors were evaluated and compared between patients with and without abnormal angiographic findings to determine the factors contributing to abnormal angiographic findings. The contributing factors to abnormal angiographic findings in coronary arteries were older age, higher Body Mass Index, higher systolic blood pressure and pulse rate, lower ejection fraction, history of hypertension and dyslipidemia, typical chest pain, and ST elevation in the EKG (p value < 0.05). It may be concluded that coronary artery disease is a multi-factorial disease and demographic, clinical, electrocardiographic, and echocardiographic characteristics as well as previous history of some diseases are effective in its development.

There is a greater risk of mortality and morbidity for patients with left bundle branch block (LBBB). In most cases, LBBB is accompanied by left ventricular dysfunction. We investigated the electrocardiographic characteristics of LBBB patients with and without congestive heart failure to determine parameters for the follow-up of this group of patients. In this cross-sectional study, all patients who referred to our tertiary center with LBBB (with preserved left ventricular function) candidated for cardiac resynchronization therapy were included between January 2007 and January 2008. Electrocardiographic characteristics such as QRS notching, intrinsicoid deflection, and QRS duration were compared between two groups. Seventy-five patients were enrolled (mean age = 60.20±12.55 years, range=18-77). There was a statistically significant relationship between QRS notching in the precordial leads and severe left ventricular dysfunction (72.7% of patients with severe left ventricular dysfunction vs. 27.8% of patients with preserved left ventricular function; p value=0.04). The relationship between QRS notching in the limb leads and severe left ventricular dysfunction was not statistically significant (70.7% in patients with severe left ventricular dysfunction vs. 29.3% in patients with preserved left ventricular function; p value >0.05). Our study showed a significant relationship between QRS wave duration in the precordial and limb leads and severe left ventricular dysfunction (p value <0.05), but there was no significant relation between intrinsicoid deflection and severe left ventricular dysfunction (p value >0.05). QRS wave fragmentation (presence of a notch in R or S) may be associated with inactivation and dyssynchronization, both of which can reflect ischemic condition. There are reports of a correlation between this disorder and dyssynchronization; this can be one of the causes of the pathophysiology of congestive heart failure. Increase in QRS duration in the ECG was strongly associated with some changes in left ventricular function and structure, which can be allied to congestive heart failure. Also, dyssynchronization due to LBBB can increase the risk of congestive heart failure.

Contrast nephropathy is the third leading cause of new-onset renal failure in hospitalized patients. Contrast nephropathy has been associated with increased in-hospital and long-term morbidity and mortality. Several interventions for the prevention of contrast nephropathy have been tested in clinical trials. Recent studies have produced conflicting results regarding the efficacy of the antioxidant agents.

The aim of this study was to evaluate the preventive effect of Pentoxifylline and Ascorbic Acid on contrast-induced nephropathy.

This clinical trial study was done in 2012 in Rajaie Cardiovascular, Medical and Research Center. Totally, 328 patients who were candidated for coronary artery angioplasty were entered in the study. Pentoxifylline and Ascorbic Acid 24 hours before the procedure and 24 hours after the procedure were administered orally in 164 patients (case group), and the 164 patients did not receive the medication (control group), randomly. Contrast nephropathy was defined by an absolute increase of serum creatinine >0.5 mg/dL or a relative increase of >25% measured after the procedure. Contrast nephropathy was compared between the two groups.

Totally, 121 (73.8%) patients in the case group and 113 (68.9%) in the control group were male (p value=0.329). Mean of age was 58.8±10 and 58.5±10.5 years in the case and control groups, respectively (p value=0.756). Contrast nephropathy was detected in 14 (8.5%) patients in the case group and 23 (14%) in the control group (p value=0.116; odds ratio=0.572, CI 95%: 0.243-1.150).

Prophylactic oral administration of Pentoxifylline and Ascorbic Acid could not protect against contrast nephropathy in the patients undergoing a coronary procedure. More future studies are necessary for final judgment.

In this study, the results of medical therapy and surgical therapy were compared in patients with prosthetic valve dysfunction referring to a training hospital between 2001 and 2011. In this case-series study, 40 patients with prosthetic valve dysfunction referring to a training hospital between 2001 and 2011 were enrolled. Thirty-one subjects had left-side involvement and 9 subjects had right-sided disease. In each group, some subjects received medical therapy and some were treated with surgery and the results and side effects were compared between the two groups. In this study, all confounding factors in the two groups were matched (p value < 0.05). There were no significant differences as regards clinical symptoms, echocardiographic findings, and side effects between the two groups (p value > 0.05). It may be concluded that both medical therapy and surgical therapy are almost equally effective in the treatment of prosthetic valve dysfunction.

Heart block is common among patients with inferior infarction. The aim of this study was to evaluate heart block frequency after revascularization therapy in patients with inferior infarction. One hundred thirty-three patients with inferior wall myocardial infarction (MI) were enrolled in this study and underwent myocardial revascularization therapy (thrombolytic therapy, coronary artery bypass graft, and percutaneous angioplasty). Heart block (based on electrocardiography) was evaluated before revascularization therapy. The relationship between heart block recovery time and treatment type was defined. Twenty-six (19.5%) patients were female (mean age=24.6±6.5 years). Fifty-nine (44.4%) patients did not have heart block. First, second, and third-degree heart block were seen in 59 (44.4%), 4 (3.1%), and 11 (8.3%) patients, respectively. Heart block recovery during 24 hours after inferior MI was seen in 30.8% in the patients treated by thrombolytic therapy, 50.1% in the patients treated by precutaneous angioplasty, and 11.1% in the patients treated by medical therapy (p value=0.01). Heart block recovery during 24 hours after inferior wall MI was more frequent in the patients treated by percutaneous coronary intervention. Rapid revascularization may cause fast recovery from heart block in patients with inferior MI.

Case Report: Coronary angiography and angioplasty via the radial route has rapidly gained popularity in recent years. This technique offers almost all femoral route access benefits but with a reduction in minor as well as life-threatening vascular access site complications. However، complications like hematoma، bleeding، arteriovenous fistula، and perforation of the radial artery، total or partial occlusion of the radial artery still exists. One unique complication that has been reported after this procedure is pain in the arm and forearm regions. We describe a 61-year-old male patient with severe arm pain appearing two days after the procedure.

Previous studies have demonstrated that 99mTc-labeled Ubiquicidin 29-41 (99mTc-UBI) can be used for the detection of bacterial infections as an accurate method.1 This study was conducted to evaluate the clinical use of 99mTc-UBI for the evaluation of sternal wound infection (SWI) after cardiac surgery. Twenty-one patients with suspected SWI after median sternotomy were included. Qualitative and quantitative voxel-based analyses of 99mTc-UBI images were performed by two experienced nuclear physicians and the images were reported as negative, positive for superficial, or positive for deep SWI on the basis of the uptake patterns. SWI was defined according to the Centres for Disease Control and Classifications’ guideline. Among the cases, only one subject with a final diagnosis of non-infectious inflammation was reported as superficial SWI in 99mTc-UBI scintigraphy. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for distinguishing SWI from sterile inflammation were equal to 100%, 83.3%, 93.8%, and 100%. After implicating a threshold of 3.08 for the target-to-background ratio, the specificity and PPV reached 100%. The sensitivity, specificity, positive, and negative predictive values for the detection of superficial and deep SWI were 100%, 92.9%, 87.5%, and 100% and 100%, 100%, 100%, and 100%, respectively. There was also a high interobserver agreement with all the kappa values exceeding 0.8. The results of the present study suggest that 99mTc-UBI could be of great use as an accurate method for the evaluation of suspected postoperative SWI and could help in the selection of appropriate treatment strategies for these patients.

Chronic thromboembolic pulmonary hypertension (CTEPH) is a serious and under diagnosed disorder with significant morbidity and mortality. For reasons that are still unclear, the lyses of blood clots does not occur in some survivors with acute pulmonary thromboemboli, which then evolve into the organization of the clot inside the pulmonary artery and CTEPH. Obstruction of the pulmonary artery results in increased vascular resistance and thereafter right heart strain and remodeling. Pulmonary artery endarterectomy is the treatment of choice with good outcome in these patients. The aim of the present study was to evaluate right ventricular function and pulmonary artery pressure before and then after pulmonary thrombo-endarterectomy for a preoperative classification system and risk stratification to aid in patient selection. In this study, all clinical and paraclinical data such as echocardiographic data of patients with CTEPH were obtained before and after pulmonary thrombo-endarterectomy. Pulmonary thrombo-endarterectomy was associated with significant improvement in right ventricular size (p value = 0.024), systolic pulmonary arterial pressure (p value = 0.012), and functional exercise capacity (p value = 0.007), but right ventricular systolic function did not show significant improvement after that. Pulmonary endarterectomy by well-experienced surgical and medical teams is the method of choice for the treatment of CTEPH with good long-term results and acceptable mortality and morbidity.

Hypertension is among the major causes of mortality and disability worldwide. Despite the development of various treatment protocols, a significant proportion of hypertensive patients cannot reach the target blood pressure. The present study followed the participants of the Isfahan Healthy Heart Program (IHHP) to evaluate the factors effective on blood pressure control. n a cross-sectional study, the names of hypertensive individuals in the IHHP were extracted. The subjects were then invited to fill out questionnaires - including demographics, socioeconomic status, knowledge, attitude, and performance toward hypertension, lifestylerelated information (diet, physical activity, smoking, and stress management), and history of diseases. Height, weight, and blood pressure measurements were then performed. Patients with blood pressure? 140/90 mm Hg were considered to have uncontrolled blood pressure. Data of the two groups with controlled and uncontrolled blood pressure were compared using the independent t and chi-square tests in SPSS15. Although 300 persons were invited, only 139 patients accepted to participate. Since 30 subjects did not fulfill hypertension criteria, a total number of 109 individuals were finally evaluated. Measurements revealed 30 (27.5%) patients to have blood pressure below 140/90 mm Hg. However, 79 (72.5%) subjects were identified to have uncontrolled blood pressure. Subjects with controlled and uncontrolled blood pressure were not significantly different in terms of mean age (61.07 ± 10.30 vs. 61.11 ± 9.82; p value = 0.982). The corresponding scores were 65.30 ± 14.24 and 70.48 ± 9.43 for knowledge (p value = 0.073) and 76.67 ± 23.61 and 82.91 ± 18.14 for attitude (p value = 0.144). The mean values of waist circumference and waist-to-hip ratio were significantly higher in patients with uncontrolled blood pressure. In addition, subjects with uncontrolled blood pressure had significantly better knowledge about the necessity of having physical activity, not smoking, and stress management. However, no other significant differences were observed between the two groups. According to our findings, patient education and follow-up, as well as designing supportive and reminder systems, must aim to control blood pressure through eliminating obesity. Evaluating the knowledge, attitude, and performance of Iranian physicians would further highlight factors affecting blood pressure control in the country.