فهرست مطالب

Tehran University Heart Center - Volume:10 Issue:1, 2015
  • Volume:10 Issue:1, 2015
  • تاریخ انتشار: 1393/11/16
  • تعداد عناوین: 11
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  • Soheila Ranjbaran, Tahereh Dehdari, Khosro Sadeghniiat, Haghighi, Mahmood Mahmoodi Majdabadi Pages 1-8
    Background
    Poor sleep quality (SQ) is common among patients after coronary artery bypass graft surgery (CABG). This study attempted to determine the status of SQ following an intervention based on the PRECEDE-PROCEED model in patients with poor SQ after CABG.
    Methods
    This study was a randomized clinical trial. The study sample, including 100 patients referred to the Cardiac Rehabilitation Clinic of Tehran Heart Center, was assigned either to the intervention (recipient of exercise and lifestyle training plus designed intervention based on the PRECEDE-PROCEED model) or to the control group (recipient of exercise and lifestyle training). Eight training sessions over 8 weeks were conducted for the intervention group. Predisposing, enabling, and reinforcing factors as well as social support and SQ were measured in the intervention group before and one month after the intervention and compared to those in the control group at the same time points.
    Results
    The mean age of the patients in the intervention (24% women) and control (24% women) groups was 59.3 ± 7.3 and 59.5 ± 9.3 years, respectively. The results showed that the mean scores of SQ (p value < 0.001), knowledge (p value < 0.001), beliefs (p value < 0.001), sleep self-efficacy (p value < 0.001), enabling factors (p value < 0.001), reinforcing factors (p value < 0.001), and social support (p value < 0.001) were significantly different between the intervention and control groups after the intervention.
    Conclusion
    Adding an intervention based on the PRECEDE-PROCEED model to the cardiac rehabilitation program may further improve the SQ of patients.
  • Nazila Javadi, Azar Darvishpour, Nasrin Mokhtari Lakeh, Neda Mehrdad Pages 9-17
    Background
    Sleep disorders among heart failure (HF) patients negatively influence the quality of life. Awareness of sleep disturbances, as one of the disturbing factors of the quality of life among HF patients, and its related factors would help health care staff to provide more comprehensive care. Hence, this study was conducted to determine the quality of sleep and its related factors in hospitalized patients with HF.
    Methods
    This cross-sectional survey study was conducted on 240 patients with HF hospitalized in one of the health centers of Guilan University of Medical Sciences between July and December 2013. Samples were selected by convenience sampling. The Pittsburgh Sleep Quality Index and a researcher-designed questionnaire on sleep disturbing factors were the instruments of this study. The correlation and relationship between sleep quality and variables related to personal, environmental, and disease factors were assessed.
    Results
    The majority of the samples (91.2%) had a poor sleep quality. A significant positive correlation was found between sleep quality and age (r = 0.322; p value < 0.001), body mass index (r = 0.212; p value < 0.001), number of comorbidities (r = 0.205; p value = 0.001), number of hospitalizations (r = 0.202; p value < 0.001), number of drugs consumed (r = 0.178; p value = 0.003), and length of stay in hospital (r = 0.149; p value = 0.011). Also, significant differences were seen between sleep quality and sex (p value = 0.014), smoking (p value = 0.038), educational level (p value = 0. 047), and hospital noise (p value = 0. 004).
    Conclusion
    Age, sex, educational level, smoking, and obesity were the most significant factors affecting the sleep quality in our HF patients.
  • Mohammad Alidoosti, Mojtaba Salarifar, Ali Mohammad Hajizeinali, Seyed Ebrahim Kassaian, Ebrahim Nematipour, Hasan Aghajani, Masoumeh Lotfi, Tokaldany, Elham Hakki Kazazi Pages 18-23
    Background
    Studies have shown controversial effects of obesity on major adverse cardiac events (MACE) after percutaneous coronary intervention (PCI). We sought to investigate the impact of the body mass index (BMI) on the mid-term outcome following successful PCI.
    Methods
    Between March 2006 and August 2008, 3948 patients underwent successful elective PCI in Tehran Heart Center, Tehran, Iran, and were retrospectively included in this study. Patients who underwent PCI on the same day as the occurrence of myocardial infarction were excluded. The demographic, procedural, in-hospital, and follow-up information of these patients was extracted from the PCI Data Registry of our institution. The patients were divided into three groups: normal weight (No. 1058, BMI < 25 kg/m2 age = 58 ± 10 years); overweight (No. 1867, 25 ≤ BMI < 30 kg/m2, age = 57 ± 10 years); and obese (No. 1023, BMI ≥ 30 kg/m2, age = 56 ± 10 years). MACE included death, myocardial infarction, target vessel revascularization, and target lesion revascularization.
    Results
    Compared with the other patients, the obese individuals were significantly younger and more frequently female, had a higher ejection fraction, and more frequently presented with hypertension, diabetes, and hyperlipidemia. There was no association between the BMI and the angiographic and procedural findings in the univariate analysis. While no difference was found in the rate of in-hospital death between the groups, the number of the obese patients undergoing emergent cardiac surgery was marginally different in the univariate analysis (p value = 0.06). At 9 months'' follow-up, MACE had occurred in 92 (2.3%) patients and cardiac mortality was 9 (0.2%). After adjustments for confounders, no significant difference was observed in terms of MACE between the BMI groups.
    Conclusion
    The BMI had no significant effect on the rate of MACE at 9 months'' follow-up in our study population. Interventionists'' recommendations for patients undergoing PCI should, therefore, not be significantly influenced by the BMI status.
  • Shervin Assari Pages 24-33
    Background
    Patients with heart disease experience limited activities of daily living (ADL). This is a cross-country comparison of the additive effects of Socioeconomics, health behaviors, and the number of medical comorbidities on disability among patients with heart disease.
    Methods
    The current study used a cross-sectional design. Data came from the Research on Early Life and Aging Trends and Effects (RELATE). The current analysis utilized data on elderly individuals (age ≥ 60 y) from 13 countries. The outcome was any ADL limitation (i.e. bathing, dressing, using toilet, transferring, lifting heavy things, shopping, and eating meals). Socioeconomics (i.e. age, gender, education, and income), health behaviors (i.e. exercise, smoking, and drinking), and number of chronic medical conditions (i.e. hypertension, respiratory, arthritis, stroke, and diabetes) were entered into country-specific logistic regressions, considering at least one limitation in ADL as the main outcome.
    Results
    Number of comorbid medical conditions and age were positively associated with disability in 85% of the countries. Physical activity and drinking were linked to disability in 54% and 31% of countries, respectively. Higher education and income were associated with lower disability in 31% and 23% of the countries, respectively. Female gender was associated with higher disability only in 15% of the countries. Smoking was not associated with disability, while the effects of socioeconomics, drinking, exercise, and medical comorbidities were controlled.
    Conclusion
    Determinants of disability depend on the country; accordingly, locally designed health promotion interventions may be superior to the universal interventions for patients with heart disease. Medical comorbidities, however, should be universally diagnosed and treated.
  • Seyed Hesameddin Abbasi, Seyed Ebrahim Kassaian, Saeed Sadeghian, Abbasali Karimi, Soheil Sadat, Flora Peyvandi, Arash Jalali, Tahereh Davarpasand, Nazila Shahmansouri, Masoumeh Lotfi, Tokaldany, Maryam Amiri Abchouyeh, Farah Esfahani, Frits Rosendaal Pages 34-42
    Background
    Data on premature coronary artery disease (CAD) are scarce. The Tehran Heart Center''s Premature Coronary Atherosclerosis Cohort Study (THC-PAC) is the first study of its kind in the Middle East to assess major adverse cardiac events (MACE) in young CAD patients.
    Methods
    The cohort consists of CAD patients, males ≤ 45 years old and females ≤ 55 years old. The participants are residents of Tehran or its suburbs and underwent coronary angiography between June 2004 and July 2011. A 10-year follow-up, via either clinical visits or telephone calls at least once a year, was commenced in August 2012. The end point is considered MACE, encompassing death, myocardial infarction, stroke, new coronary involvement, percutaneous coronary intervention, and coronary artery bypass grafting.
    Results
    The cohort comprises 1232 eligible patients (613 [49.8%] males) at a mean age of 45.1 years (SD = 5.8). High frequencies of conventional risk factors, including hyperlipidemia (884 [71.8%]), hypertension (575 [46.7%]), positive family history (539 [43.8%]), cigarette smoking (479 [38.8%]), and diabetes mellitus (390 [31.7%]), were seen in the participants. The mean body mass index (BMI) of the enrolled patients was high (29.2 ± 4.8 kg/m2), and 532 (43.3%) and 440 (35.8%) of them were overweight and obese, respectively. The females’ BMI was higher (30.4 ± 5.3 vs. 28.0 ± 3.9 kg/m2; P < 0.001) and they had a greater mean abdominal circumference (99.9 ± 13.5 vs. 98.1 ± 9.3 cm; P = 0.035). Between August 2012 and August 2013, follow-up was successful in 1173 (95.2%) patients (median follow-up duration = 55.3 months, 95%CI: 53.5-57.0 months).
    Conclusion
    Our young patients with CAD had a high frequency of risk factors compared to the same-age general population and all-age CAD patients, which may predispose them to higher incidence of recurrent MACE.
  • Ahmet Baris Durukan, Hasan Alper Gurbuz, Murat Tavlasoglu, Halil Ibrahim Ucar, Cem Yorgancioglu Pages 43-45
    Global myocardial ischemia and ischemia-reperfusion injury are potential adverse events related with cardioplegic arrest. Beating heart surgery has avoided such complications and adapted to valve surgery following successful results published on myocardial revascularization. Difficulty in weaning from cardiopulmonary bypass may be lessened by using on-pump beating heart surgery for mitral valve interventions. Here we describe a 64-year-old male patient with severe mitral regurgitation and dilated cardiomyopathy. Beating heart mitral valve replacement surgery was performed without aortic cross-clamping through a right thoracotomy approach. We believe that, particularly in patients with poor left ventricular functions, beating heart mitral valve surgery may be advantageous.
  • Shokoufeh Hajsadeghi, Roozbeh Naghshin, Maral Hejrati, Scott Reza Jafarian Kerman Pages 46-49
    Factor V Leiden deficiency is the most common hereditary hypercoagulable disease in the United States and involves 5% of the Caucasian population. Up to 30% of patients who present with deep vein thrombosis (DVT) or pulmonary thromboembolism present with this condition. This is a case report of a 36-year-old man who experienced one episode of DVT within the previous year and was admitted to our hospital due to productive coughs and hemoptysis. Paraclinical studies demonstrated a right ventricular thrombus. Additional investigation was done to find the underlying cause. Laboratory tests were positive for Factor V Leiden mutation. Other factors for hypercoagulability states were normal. Given that Factor V Leiden mutation is a life-threatening condition with a relatively high prevalence and considering its thrombogenesis, screening tests are necessary in young patients without obvious reasons for recurrent thrombus formation. It seems that medical noninvasive treatments can be an alternative therapy to surgery when a ventricular thrombus is suspected in these patients.
  • Burak Acar, Muhammed Suleymanoglu, Cengiz Burak, Burcu Mecit Demirkan, Yesim Guray, Omac Tufekcioglu, Sinan Aydogdu Pages 50-52
    Blunt chest traumas mostly occur due to car accidents and can cause many cardiac complications such as septal rupture, free-wall rupture, coronary artery dissection or thrombosis, heart failure, arrhythmias, and chordae and papillary muscle rupture. One of the most serious complication is tricuspid regurgitation (TR), which can be simply diagnosed by physical examination and confirmed by echocardiography. We describe a 48-year-old female patient, diagnosed with severe TR 13 years after a blunt chest trauma due to a car accident. TR was diagnosed with transthoracic echocardiography and three dimensional transthoracic echocardiography had defined the exact pathology of the tricuspid valve. The patient underwent successful surgery with bioprosthetic valve implantation and was discharged at 6th postoperative day without any complication. The patient had no problem according to the follow-up one month and six months after operation.
  • Feridoun Sabzi Pages 53-57
    Giant left atria are defined as those measuring larger than 8 cm and are typically found in patients who have rheumatic mitral valve disease with severe regurgitation. Enlargement of the left atrium may create compression of the surrounding structures such as the esophagus, pulmonary veins, respiratory tract, lung, inferior vena cava, recurrent laryngeal nerve, and thoracic vertebrae and lead to dysphagia, respiratory dysfunction, peripheral edema, hoarse voice, or back pain. However, a huge left atrium is usually associated with rheumatic mitral valve disease but is very rare in a normally functioning prosthetic mitral valve, as was the case in our patient. A 46-year-old woman with a past medical history of mitral valve replacement and chronic atrial fibrillation was admitted to our hospital with a chief complaint of cough and shortness of breath, worsened in the last month. Physical examination showed elevated jugular venous pressure, respiratory distress, cardiac cachexia, heart failure, hepatomegaly, and severe edema in the legs. Chest radiography revealed an inconceivably huge cardiac sell-out. Transthoracic echocardiography demonstrated a huge left atrium, associated with thrombosis, and normal function of the prosthetic mitral valve. Cardiac surgery with left atrial exploration for the extraction of the huge thrombosis and De Vega annuloplasty for tricuspid regurgitation were carried out. The postoperative course was eventful due to right ventricular failure and low cardiac output syndrome; and after two days, the patient expired with multiple organ failure. Thorough literature review showed that our case was the largest left atrium (20 × 22 cm) reported thus far in adults with a normal prosthetic mitral valve function.
  • Javad Gholami, Maryam Zeinolabedini Pages 58-67
    Background
    As English has increasingly become the lingua franca in science and international journals require native-like academic writing standards from nonnative researchers, there is more pressure on nonnative scholars to write their research articles more accurately and appropriately in English.This study was conducted to determine the most-occurring language-related errors which Iranian medical authors/researchers commit while trying to have their research published in international English journals. Also, this article seeks to provide useful guidelines to reduce such linguistic mistakes.
    Methods
    The present study investigated the most common language-related errors in Iranian medical specialists'' research articles. To this end, the first drafts of 60 published research articles in medical sciences were cross-checked against their peer-reviewed published versions in order to identify the most frequent non-target language forms which received discoursal, lexical, grammatical, and mechanical revisions by peer editors.
    Results
    The findings revealed that the editors had surprisingly dealt with discoursal errors more than any other linguistic aspects of these research articles. This was followed by lexical replacements. In third place were grammatical improvements, where erroneous structures mostly related to tenses, usage of articles and prepositions, and agreement between verbs and nouns were treated. The least common revisions were on the mechanics of academic writing, consisting of hyphenating, spelling, case lettering, spacing, and spacing with commas.
    Conclusion
    Although most of the Iranian medical authors/researchers enjoyed a good level of proficiency in English, their manuscripts required discoursal, lexical, grammatical, and mechanical revisions before publication in credited international journals.
  • Manouchehr Hekmat, Hamid Ghaderi, Seyedeh Adeleh Mirjafari Pages 68-68