Iranian Heart Journal
Volume:16 Issue: 1, Spring 2015

There is limited evidence regarding the application of tissue Doppler imaging (TDI) parameters in assessing the severity of coronary artery disease (CAD). To determine the value of TDI parameters to assess the presence and severity of CAD. Fifty consecutive patients suspected of CAD and 20 gender- and age-matched healthy individuals were assessed using TDI to assess both systolic and diastolic parameters. Those with a previous history of myocardial infarction, hypertension, diabetes mellitus, or left ventricular systolic dysfunction were not included. The patients underwent coronary angiography to determine the presence and severity of CAD. Comparing echocardiographic left ventricular systolic and diastolic parameters between the patients and healthy groups showed lower mean E, A, S'', E'', and A'' parameters as well as higher mean E/A ratio and deceleration time parameters in the patient group than in the healthy controls. Also, comparing the right ventricular systolic and diastolic parameters between the patient and healthy groups revealed that the former group had a significantly lower mean Eparameter than the healthy group. TDI velocity indices had a high value in the diagnosis of the left ventricular dysfunction due to CAD and thus can be a good option to discriminate CAD from healthy condition

Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiovascular disorder and is estimated to have affected one out of every 500 people. The symptoms of HCM can be diagnosed from early childhood and include dyspnea on exertion, chest pain, pre-syncope, and syncope resulting from the left ventricular (LV) outflow tract obstruction, LV systolic and diastolic dysfunction, and ventricular and supraventricular arrhythmia. We assessed the effect of the LV mass index on syncope and sudden death in 60 HCM patients who were more than 16 years of age and referred to Rajaie Cardiovascular, Medical and Research Center between 2009 and 2012. The patients were studied using magnetic resonance imaging. The study results indicated that the patients were on average 45.53±16.85 years old. The t-test showed that gender exerted no influence on the following variables: palpitations; family history; maximum thickness of the LV wall; sudden death; and syncope. In contrast, the age variable had a meaningful effect on the maximum thickness of the LV wall, LV mass, and LV mass index. There was no significant relationship between the LV mass index and sudden cardiac death. Our results were indicative of a negative and significant relationship between age and all of the aforementioned variables. Also, there was no significant relationship between the LV mass index and sudden cardiac death.

Evidence suggests that the serum myeloperoxidase level has a diagnostic and predictive role in patients with chronic heart failure (CHF). We evaluated the association between the serum myeloperoxidase level and the severity and prognosis of CHF. Materials: In a prospective observational study, patients with CHF were evaluated. The myeloperoxidase serum level was measured at baseline by enzyme-linked immunosorbent assay. Transthoracic echocardiography was done at baseline and then after 6 months. History and duration of admission and also mortality were recorded during follow-up. Fifty patients at a mean age of 64.7±1.8 years (70% male) were evaluated. The mean ser into two groups of A and B with a serum myeloperoxidase level of less and more than 51 Heart Association functional class (NYHA III 20.5% vs. 27.3%; p value=0.456), left ventricular ejection fraction (30.3±10.0 vs. 29.8±10.1%; p value=0.873), systolic dysfunction (48.7% vs. 54.5%; p value=0.500), or diastolic dysfunction (38.5% vs. 63.6%; -up. The serum myeloperoxidase level was not associated with admission history or mortality. We found no significant association between the serum myeloperoxidase level and echocardiography parameters, admission history, or mortality in patients with CHF. Further studies with larger samples of patients are required in this regard.

Despite the high efficiency of beta blockers in controlling increased blood pressure in hypertensive patients, these types of drugs have clinically remained as one of the main etiologies of atrioventricular (AV) blocks and arrhythmias. The present study aimed to assess the electrophysiological pattern in patients treated with beta blockers after discontinuing the drug use and also to assess the relationship between these electrophysiological findings and the recurrence of bradyarrhythmias in these patients. In a prospective cohort study, 159 patients who were treated with different types of beta blockers and referred to Shariati Hospital in 2014 because of the onset of bradyarrhythmias were included into the study. All the participants were followed up for 6 months with respect to the recurrence of bradyarrhythmias. The rate of the occurrence of different AV blocks ranged between 13.8% and 23.3%, while these blocks also appeared within the follow-up period in the range of 7.5% to 11.3%, indicating a high recurrence rate of these blocks even after electrophysiological study (EPS) or pacemaker implantation. Assessing the relationship between the type of baseline rhythm and baseline characteristics showed a significant difference in the type of rhythm between the young and older patients (P=0.002), between patients with wide and narrow QRS complexes (p<0.001), and between those with normal and reduced left ventricular ejection fractions (P<0.001). Also, the type of baseline rhythm was significantly associated with HV interval in EPS (P<0.001), AV Wenckebach period (P<0.001), AERPAVN (P<0.001), and type of His disorder (P<0.001). The deteriorating effect of beta blockers as AV blocks type II or complete AV block can be more expected in patients with HV>55, AVWP>500, AERPAVN>500, as well as in infra-Hisian disorder. The recurrence of bradycardia after administrating beta blockers is a common finding. Along with old age, QRS complex widening, and left ventricular dysfunction, the presence of some cut-off points of EPS indices, including HV>55, AVWP>500, and AERPAVN>500, as well as in infra-Hisian disorder can be considered as the main determinants of beta blockers-induced bradyarrhythmias.

The importance of balancing fluid and serum electrolytes in critically ill patients necessitates the exact calculation of the intravenous fluid intake in this group. In the present study، the accuracy of this approach in calculating the amount of fluid intake in patients with cardiovascular disorders was compared with that of the flowmeter. This cross-sectional study was performed on 36 consecutive patients hospitalized in the CCU of Rajaie Cardiovascular، Medical and Research Center (Tehran، Iran) because of evident cardiovascular disorders. The amount of received intravenous fluid was measured by the flowmeter and by nurses using conventional prescription methods simultaneously. The difference between the flowmeter values and gold standard values was not significant (776. 11 ± 39. 75 vs. 764. 97 ± 37. 94، mean difference = -11. 14 ± 44. 51; p value = 0. 142)، whereas there was a significant difference between the nurses'' recordings and the gold standard values (p value< 0. 001). Also، the difference between the values measured by the nurses and those recorded by the flowmeter was slightly significant (mean difference = 4. 944، SD = 14. 873; p value= 0. 054). The intravenous measurement of fluid intake via the flowmeter can be considered equivalent to the gold standard، and it can lead to a decrease in biases and side effects of treatment protocols.

Case Report: Brucellosis is an infectious disease that can involve the cardiovascular system. Brucella aortic valve endocarditis is an uncommon presentation of it with aortic valve regurgitation and heart failure. Diagnosis of brucella endocarditis of aortic valve is done in most cases with echocardiography. Successful management of this disease requires a combination of appropriate antibiotic treatment and surgical valve replacement, followed by a long duration of antibiotic therapy postoperatively (Doxycycline and Rifampicin). We describe a 36-year-old man, with brucella endocarditis of aortic valve and paravalvular abscess, who was managed via aortic valve replacement using a mechanical prosthesis with good results.

Case Report: In recent years, transcatheter aortic valve implantation has become an emerging alternative for highrisk patients with severe aortic stenosis. A promising new indication in this modality could be the interventional treatment of degenerated bioprostheses. We used a vascular prosthesis access in our patient to facilitate the procedure in the absence of an adequate vascular access.

Case Report: The majority of coronary artery aneurysms are atherosclerotic in origin. Atherosclerotic coronary artery disease (CAD) is the predominant cause in adults. Other causes include Kawasaki''s disease, Marfan''s syndrome, Behçet''s disease, and use of stents. Their size and clinical manifestations are variable. Giant coronary aneurysms, meas coronary artery involvement is still rare. Our case was a 32-year-old lady with an incidental finding of multiple giant coronary artery aneurysms in the evaluation for cardiomyopathy.