فهرست مطالب

Tehran University Heart Center - Volume:4 Issue: 3, Jul 2009

The Journal of Tehran University Heart Center
Volume:4 Issue: 3, Jul 2009

  • تاریخ انتشار: 1388/06/11
  • تعداد عناوین: 10
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  • Matko Marusic, Ana Marusic Page 143
  • Habibollah Saadat, Roxana Sadeghi, Mohammad Reza Motamedi, Mohammad Hasan Namazi, Morteza Safi, Hosein Vakili, Kambiz Sadaghiani, Zahra Saadat Page 149
    The clinical and economic importance of heart failure is widely recognized. The incidence of heart failure is on the increase, particularly with the aging of the population around the world. It is time for a paradigm shift in heart failure management. Alternative non-pharmacological strategies to remodel the failing ventricle will shape a major portion of heart failure therapy in the decade ahead.Exposure to heat is widely used as a traditional therapy in many cultures. In this paper, we will review recent data that suggest thermal therapy may be helpful as an adjunctive non-pharmacological treatment for heart failure.
  • Soheil Saadat, Saeed Sadeghian, Reza Hamidian, Mohammad Ali Najafi Page 159
    Background
    There are some reports on the association between air pollution and myocardial infarction, arrhythmia, and mortality due to cardiac problems in susceptible individuals. We aimed to evaluate the association of air pollution and the emergency visits due to cardiovascular diseases, in a specialized heart hospital in Tehran.
    Methods
    The study design was cross-sectional. Patients admitted to the emergency ward of Tehran Heart Center were consecutively included. Records of meteorological data for the study period were obtained from Air Quality Control Company that monitors the concentration of air pollutants through its several stations including one near to Tehran Heart Center. The principal component analysis was used to examine the association between daily air pollution level and the number of patients admitted as a result of unstable angina, myocardial infarction, and arrhythmia.
    Results
    The principal component score -reflecting the daily air pollution level- was higher on the admission date of the patients who died in hospital compared to that of the patients who discharged alive from the hospital and the difference was statistically significant. After adjustment for the effect of age, sex, smoking, hypertension, hyperlipidemia and diabetes, a statistically significant relationship between principal component score and the unstable angina and arrhythmia was detected in patients referred to the emergency department.
    Conclusion
    Air pollution was associated with the unstable angina and arrhythmia in patients referred to the emergency department of Tehran Heart Center, adjusted for the effect of other risk factors.
  • Maryam Esmaeilzadeh, Azadeh Sadatnaseri, Feridoun Noohi, Majid Maleki, Anita Sadeghpour, Ahmad Mohebbi Page 165
    Background
    There is some evidence indicating improvement in myocardial performance after atrial septal defect closure, either device closure or surgical, but ventricular dyssynchrony has not been evaluated before and after surgical closure. The aim of this study was to evaluate ventricular mechanical dyssynchrony in patients with atrial septal defect before and after surgical closure.
    Methods
    Twenty patients (mean age: 23±11years) with isolated secundum or sinus venosus type atrial septal defect, unsuitable for device closure, were evaluated before and after successful surgical closure. Interventricular and intraventricular dyssynchrony (using 6 basal and 6 mid-segmental models) were determined.
    Results
    A significant reduction in the right atrial and right ventricular dimensions and the tricuspid regurgitation peak gradient was noted after atrial septal defect closure (3.6±0.54 cm versus 4.2±0.7, P=0.009; 3.5±0.29 cm versus 4.3±0.41, P=0.02; and 20.4±10.5 mmHg versus 35.3±6.5, P<0.002; respectively).There was no significant difference in the maximum difference in time-to-peak systolic velocity and the standard deviation of time-to-peak systolic velocity of the l2 left ventricular myocardial segments in the patients with atrial septal defect before and after surgical closure in comparison with the normal subjects (normal: 26±10.64 ms versus before closure: 21.0±33.9 versus after closure: 27±29.5, both P=0.68) and the left ventricular asynchrony index after atrial septal defect closure (normal: 14.9±8.7 versus before closure: 11.46±8.5 versus after closure: 18.12±13.6, both P=0.2). There was a significant positive relation between the tricuspid regurgitation peak gradient and the left ventricular asynchrony index (r=0.67, P=0.03) and an insignificant negative relation between the left ventricular ejection fraction and the asynchrony index before atrial septal defect closure (r=−0.53, P=0.11). No significant relation was found between the total asynchrony index and the atrial septal defect size, the degree of left-to-right shunt, and the tricuspid regurgitation peak gradient.
    Conclusion
    There was no significant ventricular dyssynchrony in the patients with atrial septal defect before and after surgical closure.
  • Siamak Sabour, Marie Louise Bartelink, Annemarieke Rutten, Diederick E. Grobbee, Mathias Prokop, Yvonne T. Van Der Schouw, Michiel L. Bots Page 171
    Background
    Myocardial infarctions at different locations have been related to different sets of risk factors. This study was designed to examine the association between cardiovascular risk factors and specific coronary artery calcification (CAC).
    Methods
    The study population comprised 573 postmenopausal women selected from a population-based cohort study. Established vascular risk factors were measured. The women underwent a multi detector-row computed tomography (16-MDCT) (Philips Mx 8000 IDT 16) to assess coronary calcium. The Agatston score was used to quantify coronary calcium. Logistic regression models were utilized to assess the relations.
    Results
    The prevalence of coronary artery calcification (Agatston score>0) was 61.5% (n=348). CAC was most common in the left anterior descending (LAD) artery with a prevalence of 43.9%; and the rates of prevalence in the right coronary artery (RCA), the circumflex (LCX), the left main artery (LM), and the posterior descending artery (PDA) were 23.1%, 19.4%, 15.8%, and 0.3%, respectively. In the multivariate regression models, age was predominantly related to the calcification in the LAD and LCX, low density lipoprotein to calcification in the LAD, and cholesterol to the calcification of the RCA. Hypertension, systolic and diastolic blood pressures were related to the calcification of the LCX, whereas smoking was predominantly related to the calcification of both LAD and RCA. Finally, age, body mass index, and systolic blood pressure were significantly related to the calcification in the LM.
    Conclusion
    Our findings showed that the consequences of elevated risk factor levels on the development of atherosclerosis appeared to be different across the segments of the coronary arteries.
  • Shapour Shirani, Madjid Shakiba, Maryam Soleymanzadeh, Mohammad Ali Boroumand, Seyed Hesameddin Abbasi, Maryam Sotoudeh Anvari, Sirous Darabian, Maryam Esfandbod Page 181
    Background
    The incidence of stroke after coronary artery bypass grafting (CABG) is between 0.9% and 6.7%, which significantly increases in-hospital and out-hospital costs. This study was designed to evaluate the prevalence of significant carotid stenosis and its risk factors in CABG.
    Methods
    In total, 2044 consecutive patients undergoing elective CABG were investigated through a pre-operative duplex scanning of the carotid arteries. The relation of age, sex, smoking, hypertension, diabetes, dyslipidemia, and coronary disease with carotid stenosis was evaluated.
    Results
    The prevalence of carotid stenosis was 7.6%. The multivariate analysis showed that age over 55 and left main coronary disease were significant independent risk factors for carotid stenosis. Female gender, smoking, hypertension, and diabetes were the risk factors in the univariate logistic regression model.
    Conclusion
    Carotid stenosis is prevalent in CABG candidates. It seems that age ≥55 years and left main coronary disease are the independent risk factors for carotid stenosis in CABG patients.
  • Patent Foramen Ovale in Young Adults with Cryptogenic Stroke or Transient Ischemic Attack
    Afsoon Fazlinezhad, Sara Azimi, Mahmoodreza Azarpazhooh, Mohammad Khajedaluee, Mohsen Mahdinezhad Kashani Page 185
    Background
    Stroke, one of the most important causes of morbidity and mortality in the world, is of great importance in young adults (15-45 years), amongst whom the causes of stroke and transient ischemic attack (TIA) are different from those in older ages and a significant portion of them have no known etiology. Patent foramen ovale (PFO) is considered a probable cause in this group.
    Methods
    Patients between 15 and 45 years of age with TIA or stroke were examined and evaluated for causes of cerebrovascular accidents. Patients with no definite cause for stroke or TIA, except for PFO, despite our extensive evaluations were categorized as cryptogenic. The controls were comprised of those between 15 and 45 years old who underwent transesophageal echocardiography (TEE) for reasons other than stroke. The frequency of PFO and its characteristics were compared between the two groups.
    Results
    The case group comprised 48 patients with cryptogenic stroke (n=31) and TIA (n=17), and the control group consisted of 57 patients. The age distribution of the groups was normal, and there was no significant difference between the age and gender of the two groups. The frequency of PFO in the case and control groups was 52% and 25%, respectively (p value=0.003, odds ratio=3.33, confidence interval=1.46-7.63). The exaggerated motion of the interatrial septum (IAS) in the case and control groups was 18.8% and 0%, respectively. Right-to-left shunt at rest in the case and control groups was 78% and 28%, respectively (significant differences). The differences in terms of PFO size, number of bubbles, and atrial septal aneurysm were not significant between the two groups.
    Conclusion
    PFO had a relation with stroke and TIA in the young adults, and right-to-left shunt at rest and exaggerated motion of the IAS could increase the possibility of paradoxical emboli. It seems that the presence of atrial septal aneurysm, number of bubbles, and PFO size did not increase the risk of cerebrovascular accidents.
  • Hossein Ahmadi, Mohammad Ali Boroumand, Maryam Sotoudeh Anvari, Abbasali Karimi, Naghmeh Moshtaghi Page 189
    Acinetobacter lwoffii, an important nosocomial pathogen, is a gram-negative aerobic bacillus that is a component of the normal flora on the skin, oropharynx, and perineum of about 20-25% of healthy individuals. We herein present a case of a 66-year-old man with combined mitral and aortic valve endocarditis associated with multi-drug resistance acinetobacter lowffii bacteremia.
  • Ahmadreza Afshar, Babak Nasiri Page 193
    This report presents a case of left radial artery pseudoaneurysm developing at the previous site of invasive monitoring. The patient had prosthetic mitral valve replacement one month earlier, and anti-coagulation therapy had started on the first post-operative day. The patient’s radial artery aneurysm with a 4-centimeter diameter was resected and the radial artery was ligated.
  • Mehran Asgari, Initsar Mirza, Shahrzad Ghaderi, Richard Cooke Ba (Law), Ahmed Hailan Page 197