Research in Cardiovascular Medicine
Volume:3 Issue: 8, Jul-Sep 2014

Patients undergoing percutaneous coronary intervention are at serious risk of different complications such as periprocedural bleeding that can lead to myocardial injuries. Blood loss through puncture site hematoma formation and through catheter aspiration causes periprocedural hemoglobin drop.. Although percutaneous coronary intervention is an effective treatment of coronary artery disease, it seems necessary to investigate the impact of complications on outcomes including myocardial infarction and possible mortality. The purpose of this study was to evaluate the relationship between periprocedural hemoglobin levels and cardiac enzyme changes as a predictor of cardiac adverse outcomes in patients undergoing percutaneous coronary intervention..Patients and This study was conducted on 1012 consecutive patients with a diagnosis of coronary artery disease who underwent percutaneous coronary intervention. Hemoglobin levels were measured immediately before and post-procedurally and based on the baseline levels the patients were classified into anemic and non-anemic groups. The samples for TnI and CP-MB were collected before the procedure and at 8, 16, and 24 hours post-procedurally. The patients were stratified into three categories of myocardial injuries: patients with CK-MB ≥ 3×; those with TnI > 0.06 µu/l and individuals with both CK-MB ≥ 3× and TnI > 0.06 µu/l.. All categories divided by cardiac enzyme status either in positive or in negative groups were classified in non-anemic group. Although in all groups hemoglobin level decreased post-procedurally, in the second category (TnI ≥ 0.06) the positive patients had significantly lower hemoglobin amounts after the procedure (P = 0.008).. Post-procedure hemoglobin dropping may be considered as a predictor of cardiac adverse outcome in patients undergoing PCI. We suggest that a good bleeding control during and after the procedure can reduce the risk of cardiac enzyme elevation post-procedurally..

Heart valve injury following blunt chest trauma of car accidents is increasing. Although aortic valve involvement is rare, however, in survivors of blunt cardiac trauma it is the most commonly involved valve and the most frequent valve lesion is isolated injury of the noncoronary cusp of aortic valve.. A 31-year-old man with a history of car accident (five months before) was referred to our clinic because of shortness of breath. A holo-diastolic blowing murmur was heard on physical examination. Transesophageal echocardiography demonstrated severe aortic insufficiency secondary to rupture of the left coronary cusp associated with avulsion of aortic valve commissure.. Since the aortic valve is rarely affected in blunt cardiac injury, it will be generally undiagnosed during the primary evaluation of a patient with blunt chest trauma. However, any patient presenting dyspnea after chest trauma should be examined for suspected aortic valve injury..

Fibrinogen is the main biomarker for bleeding. To prevent excessive postoperative bleeding, it would be useful to identify high-risk patients before coronary artery bypass grafting (CABG).. In order to predicating bleeding after CABG, we sought to determine whether preoperative fibrinogen concentration was associated with the amount of bleeding following CABG..Patients and A total of 144 patients (mean age = 61.50 ± 9.42 years; 65.7% men), undergoing elective and isolated CABG, were included in this case-series study. The same anesthesia technique and medicines were selected for all the patients. In the ICU, the patients were assessed in terms of bleeding at 12 and 24 hours post-operation, amount of contingent blood products received, and relevant tests. Statistical tests were subsequently conducted to analyze the correlation between preoperative fibrinogen concentration and the amount of post-CABG bleeding.. The mean and standard deviation of bleeding at 12 and 24 hours post-operation was 285.37 ± 280.27 and 499.31 ± 355.57 mL, respectively. The results showed that postoperative bleeding was associated with different factors whereas pre-anesthesia fibrinogen was not correlated with bleeding at 12 (P = 0.856) and 24 hours (P = 0.936) post-operation. There were correlations between the extra-corporal circulation time and bleeding at 12 hours post-operation (ρ = 0.231, P = 0.007) and bleeding at 24 hours post-operation (ρ = 0.218, P = 0.013).. Preoperative assessment of plasma fibrinogen levels failed to predict post-CABG bleeding..

Atherosclerosis is a progressive disease characterized by the accumulation of lipids and fibrous elements in the large arteries which now has become the pre-eminent health problem worldwide.. To investigate the effect and mechanism of Losartan intervention on atherosclerosis in rabbits fed with high-cholesterol diet.. 32 New Zealand rabbits were randomly divided into three groups: control group, high-cholesterol group and Losartan group. The level of weights, serum lipid levels and inflammatory factors, such as IL-6 and hs C-reactive protein were detected before the Losartan intervention and two months after the Losartan intervention respectively. The content of AngII was detected on later stage of the experiment. Pathological examination of the iliac arteries was performed to measure the thickness of endothelium and media.. : After the atherosclerosis model was established, the level of the serum lipids, hs CRP and IL-6 of rabbits in high-cholesterol group and Losartan group increased significantly in comparison with control group(P < 0.05), but there was no statistical difference between the two groups (P > 0.05). After the Losartan intervention, the levels of serum hs CRP and IL-6 were higher in high-cholesterol group and Losartan group in comparison with control group (P < 0.05), and they were significantly lower in Losartan group than high-cholesterol group (P < 0.05). Serum lipids levels of rabbits in high-cholesterol group and Losartan group also increased significantly in comparison with control group (P < 0.05), but there was no statistical difference between them (P > 0.05). Ratio of endothelium thickness to the media thickness was higher in high-cholesterol group and Losartan group in comparison with control group (P < 0.05), and the ratio in Losartan group was significantly lower than high-cholesterol group (P < 0.05). Content of Angiotensin was higher in high-cholesterol group and Losartan group compared to control group, and there was no statistical difference between them.. The effect of Losartan on atherosclerosis is to prevent the development of atherosclerosis by inhibiting inflammatory process and may not be related to the lipid metabolism..

Coronary artery disease (CAD) is the result of the accumulation of athermanous plaques within the walls of coronary arteries, which supply the myocardium with oxygen and nutrients. CAD leads to heart attacks or strokes and is, thus, one of the most important causes of death worldwide. Angiography, an imaging modality for blood vessels, is currently the most accurate method of diagnosing artery stenosis. However, the disadvantages of this method such as complications, costs, and possible side effects have prompted researchers to investigate alternative solutions..

The current study aimed to use data analysis, a non-invasive and less costly method, and various data mining algorithms to predict the stenosis of arteries. Among many people who refer to hospitals due to chest pain, a great number of them are normal and as such do not need angiography. The objective of this study was to predict patients who are most probably normal using features with the highest correlations with CAD with a view to obviate angiography costs and complications. Not a substitute for angiography, this method would select high-risk cases that definitely need angiography..Patients and

Different features were measured and collected from potential patients in order to construct a dataset, which was later utilized for model extraction. Most of the proposed methods in the literature have not considered the stenosis of each artery separately, whereas the present study employed laboratory and echocardiographic data to diagnose the stenosis of each artery separately. The data were gathered from 303 random visitors to Rajaie Cardiovascular, Medical and Research Center. Electrocardiographic (ECG) data were studied in our previous works. The goal of this study was, therefore, to seek the accuracy of echocardiographic and laboratory features to predict CAD patients that require angiography..

Bagging and C4.5 classification algorithms were drawn upon to analyse the data, the former reaching accuracy rates of 79.54%, 61.46%, and 68.96% for the diagnosis of the stenoses of the left anterior descending (LAD), left circumflex (LCX), and right coronary artery (RCA), respectively. The accuracy to predict the LAD stenosis was attained via feature selection. In the current study, features effective in the stenosis of arteries were further determined, and some rules for the evaluation of triglyceride, hemoglobin, hypertension, dyslipidemia, diabetes mellitus, and ejection fraction were extracted..

The current study presents the highest accuracy value to diagnose the LAD stenosis in the literature..

Prolactin (PRL) has increasingly been recognized to play a stimulatory role in inflammatory response. Recently, studies have reported an increase in prolactin level among patients with chronic heart failure, however, there is conflicting data about its role as a prognostic factor in these patients.. We aimed to measure PRL level in male patients with idiopathic dilated cardiomyopathy (IDC) and its relationship with some prognostic factors..Patients and Serum prolactin level was assessed in 33 men with a diagnosis of IDC, left ventricle ejection fraction (LVEF) less than 35% on standard medical therapy for heart failure and New York Heart Association class II-III. Serum NT-Pro BNP (N terminal pro brain natriuretic peptide), hs-CRP (High sensitive C reactive protein) and six-minute walk test (6MWT) were also measured. Our secondary endpoints were mortality, transplantation and hospitalization due to acute heart failure and all patients were followed for one year.. The mean age was 33±7 years (24-45 years) and the mean LVEF was 23% ± 6.5. The mean PRL level was 16±7.7 ng/mL (95% confidence interval: 13.3-18.7 ng/mL), which was significantly higher than normal reference values (4.04-15 ng/mL) (P < 0.0001). There was no correlation between PRL levels and pro BNP, hs-CRP or 6MWT test, however, the serum PRL level was slightly higher among patients who died or were hospitalized or transplanted.. Considering our study results, prognostic implication of PRL should be questioned. However, it seems that the significant increase in serum PRL in the study population needs more consideration and may have its own pathophysiologic importance. Further studies are recommended for better addressing the role of PRL in chronic heart failure patients..

The prevalence of Metabolic syndrome (MetS) has been increased in Asian countries. It represents a cluster of cardiovascular risk factors including obesity, insulin resistance, lipid abnormality and hypertension.. The purpose of this study was to assess the association between MetS and outcome in patients undergoing coronary artery bypass grafting surgery (CABG)..Patients and This prospective study was performed on patients scheduled for coronary artery bypass grafting surgery (CABG). All the patients were followed up in hospital and three months afterward. Patients were excluded if they were younger than 18 years or had severe comorbidities, a history of valvular heart disease, and low ejection fraction.. A total of 235 patients (135 women) with a mean age of 59 ± 9.3 years were included. MetS was more prevalent in women (P < 0.001). The most prevalent complications were bleeding [20 (8.5%)] and dysrhythmia [18 (7.7%)]. At three months follow-up, the frequency rates of readmission [24 (10.2%)] and mediastinitis [9 (3.8%)] were higher than other complications. Diabetes and MetS were risk factors for a long ICU stay (> 5 days) and atelectasia (P < 0.05). Significant associations were observed between diabetes and pulmonary embolism (P = 0.025) and mediastinitis (P = 0.051).. Identification of MetS before CABG can predict the surgery outcome. Patients with MetS have increased risks for longer ICU stay and atelectasia..

Recent studies have introduced glucose intolerance and insulin resistance (IR) as novel risk factors in patients with pulmonary arterial hypertension (PAH).. We aimed to investigate the prevalence of glucose intolerance and IR in patients with PAH and their correlation with functional capacity and prognostic factors..Patients and Sixty-nine patients with pulmonary arterial hypertension (class I Pulmonary hypertension in accordance with updated clinical classification of pulmonary hypertension) scheduled for right heart catheterization were enrolled. FBS, HbA1c, lipid profile, pro –BNP and hs-CRP were measured along with a 6-minute walk test (6-MWT) and obtaining demographic, functional and hemodynamic data. Fasting triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C) was used as a surrogate of insulin sensitivity. Using published criteria, HbA1c ≤ 5.9% defined as normal, 6.0-6.4% as glucose intolerance, and ≥ 6.5% as diabetes. All patients were followed for a year regarding development of any cardiovascular event (mortality and/or hospitalization).. In total, 76.8% of patients were female: 61% of them had idiopathic PAH, 33% Eisenmenger syndrome, and 6% PAH secondary to a connective tissue disease. With respect to TG/HDL-C, 43.5% of patients had IR and 47.8% of patients had HbA1c > 6. There was no difference between IR and insulin sensitive (IS) group or glucose intolerance and sensitive group regarding NYHA class, 6MWT, Pro BNP, hs-CRP and hemodynamic data and there was no correlation between IR or glucose intolerance and any event.. Unrecognized glucose intolerance and IR are common in PAH. However, further studies are needed to show whether glucose or insulin dysregulation plays any role in PAH pathogenesis or it is secondary to advanced PAH..

Bacterial pericarditis is an important cause of post-surgery mortality and morbidity. This can be a preventable complication and the involved pathogens vary according to the time and location.. The aim of this study was to investigate the bacteriologic profile in patients with pericardial infections after cardiac surgery in the largest tertiary care center for cardiovascular diseases in Iran. The results can be applied for prevention, diagnosis, and treatment of similar patients in Iran..Patients and This prospective study was performed in Rajaie Cardiovascular Medical and Research Center (RCMRC), the largest tertiary care center for cardiovascular disease in Iran from March 2011 to March 2012. Patients who had undergone cardiac surgery with cardiopulmonary bypass and showed suggestive sign and symptoms of pericardial infections were registered and samples from their pericardial fluids were obtained to perform standard bacteriologic and antibiogram tests.. A total of 158 patients were registered. Bacteriologic findings were positive in 30 patients (19%). Staphylococcus epidermidis was the most frequent isolated organism, which was found in 22 patients (73.3%) with eight of them being methicillin-resistant strains.. The bacteriologic profile in our patient is specific to our own community. Knowledge about this profile can help us to improve prevention, diagnosis, and treatment of the affected patients..