فهرست مطالب

Tehran University Heart Center - Volume:10 Issue: 4, Oct 2016

The Journal of Tehran University Heart Center
Volume:10 Issue: 4, Oct 2016

  • تاریخ انتشار: 1394/10/20
  • تعداد عناوین: 12
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  • Seyed, Ebrahim Kassaian, Sepideh Saroukhani, Farshid Alaeddini, Mojtaba Salarifar, Davide Capodanno, Hamidreza Poorhoseini, Masoumeh Lotfi, Tokaldany, Massoud A. Leesar, Hassan Aghajani, Elham Hakki, Kazzazi Page 167
    Background
    The aim of the present study was to develop a scoring system for predicting 1-year major adverse cardiac events (MACE), including mortality, target vessel or target lesion revascularization, coronary artery bypass graft surgery, and non-fatal myocardial infarction after percutaneous coronary intervention (PCI).
    Methods
    The data were extracted from a single center PCI registry. The score was created based on the clinical, procedural, and laboratory characteristics of 8206 patients who underwent PCI between April 2004 and October 2009. Consecutive patients undergoing PCI between November 2009 and February 2011 (n= 2875) were included as a validation data set.
    Results
    Diabetes mellitus, increase in the creatinine level, decrease in the left ventricular ejection fraction, presentation with the acute coronary syndrome, number of diseased vessels, primary PCI, PCI on the left anterior descending artery and saphenous vein graft, and stent type and diameter were identified as the predictors of the outcome and used to develop the score (R² = 0.795). The models had adequate goodness of fit (Hosmer-Lemeshow statistic; p value = 0.601) and acceptable ability of discrimination (c-statistics = 0.63). The score categorized the individual patients as low-, moderate-, and high-risk for the occurrence of MACE. The validation of the model indicated a good agreement between the observed and expected risks.
    Conclusion
    An individual risk-scoring system based on both clinical and procedural variables can be used conveniently to predict 1-year MACE after PCI. Risk classification based on this score can assist physicians in decision-making and postprocedural health care.
    Keywords: Patient_specific modeling • Prognosis • Percutaneous coronary intervention
  • Leila Mahdavi Anari, Mahdieh Ghanbari, Firoozabadi, Zahra Ansari, Mahmoud Emami, Mohammadreza Vafaii Nasab, Mahdieh Nemaiande, Fatemeh Boostany, Mohamadreza Neishaboury Page 176
    Background
    It has been suggested that the autonomic system function and the metabolic syndrome can significantly affect patient's survival. The aim of the current study was to investigate the impact of the cardiac rehabilitation program on the autonomic system balance in patients with coronary artery disease.
    Methods
    Patients with a previous diagnosis of coronary artery disease who were referred to the Cardiovascular Rehabilitation Center of Afshar Hospital (Yazd, Iran) between March and November 2011 were enrolled. All the patients participated in rehabilitation sessions 3 times a week for 12 weeks. Heart rate recovery (HRR) was measured as an indicator of the autonomic system balance. In order to calculate HRR, the maximum heart rate during the exercise test was recorded. At the end of the exercise test, the patients were asked to sit down without having a cooldown period and their heart rate was recorded again after 1 minute. The difference between these 2 measurements was considered as HRR.
    Results
    A total of 108 patients, including 86 (79.6%) men and 22 (20.4%) women, completed the rehabilitation course. The mean age of the study participants was 58.25 ± 9.83 years. A statistically significant improvement was observed in HRR (p value = 0.040). Significant declines were also observed in the patient's waist circumference (p value < 0.001) and systolic and diastolic blood pressures (p value = 0.018 and 0.003, respectively). A decreasing trend was observed in the patient's body mass index, but it failed to reach statistical significance (p value = 0.063). No statistically meaningful changes were noted in fasting blood glucose (p value = 0.171), high-density lipoprotein (p value = 0.070), or triglyceride concentrations (p value = 0.149).
    Conclusion
    The cardiac rehabilitation program may help to improve HRR and several components of the metabolic syndrome in patients with coronary heart disease.
    Keywords: Rehabilitation • Heart rate • Metabolic syndrome X
  • Mehdi Ghaderian, Mahmood Merajie, Hodjjat Mortezaeian, Mohammad Yoosef Aarabi Moghadam, Akbar Shah Mohammadi Page 182
    Background
    The ventricular septal defect (VSD) is the most common form of congenital heart defects. The purpose of this study was to evaluate the results of the early complications and mid-term follow-up of the transcatheter closure of the VSD using the Amplatzer VSD Occluder.
    Methods
    Between April 2012 and October 2013, 110 patients underwent the percutaneous closure of the perimembranous VSD. During the procedure, the size and type of the VSD were obtained via ventriculography. A device at least 2 mm larger than the VSD diameter measured via ventriculography was deployed. The size of the VSD, size of the Amplatzer, and device-size to VSD-size ratio were calculated. After the confirmation of the suitable position of the device via echocardiography and left ventriculography, the device was released. Follow-up evaluations were done at discharge as well as at 1, 6, and 12 months and yearly thereafter for the VSD occlusion and complete heart block.
    Results
    The study population comprised 62 females and 48 males. The mean age and weight of the patients at procedure were 4.3 ± 5.6 years (range: 2 to 14) and 14.9 ± 10.8 kg (range: 10 to 43). The average device size was 7.0 ± 2.5 mm (range: 4 to 14). The VSD occlusion rate was 72.8% at the completion of the procedure and rose up to 99.0% during the follow-up. The most serious significant complication was complete atrioventricular block, which was seen in 2 patients. The mean follow-up duration was 10.9 ± 3.6 months.
    Conclusion
    The transcatheter closure of the perimembranous VSD was a safe and effective treatment with excellent closure rates in our study population. This procedure had neither mortality nor serious complications.
    Keywords: Heart septal defect_ventricular • Heart defects_congenital • Septal occluder device
  • Omid Rezahosseini, Mohamadreza Rezaei, Seyed Hossein Ahmadi Tafti, Arash Jalali, Payvand Bina, Atefeh Ghiasi, Abbasali Karimi, Kiomars Abbasi, Mahmood Shirzad, Saeed Davoodi, Abbas Salehi Omran Page 188
    Background
    Many patients with mitral valve diseases need surgical procedures for the repair or replacement of their mitral valve. There is a great deal of controversy over the outcomes of the transseptal (TS) and left atrial (LA) approaches to the mitral valve. We sought to evaluate the outcomes of each approach more accurately by eliminating the possible biases in case selection and matching.
    Methods
    This retrospective study included patients who had surgery for mitral valve diseases via either the TS approach or the LA approach between 2004 and 2011 in Tehran Heart Center. Patients with surgical approaches other than the TS and LA were excluded. To control for the confounding effects, a propensity score matching technique was applied and the patients were matched for 14 demographic and preoperative variables. After the selection of controls, the effect of the TS approach (163 patients) versus the LA approach (652 patients) on the outcomes was presented through odds ratio (OR) with 95% confidence intervals (CI).
    Results
    The mean age of the patients was 53.15 ± 12.02 years in the TS group and 52.93 ± 13.56 years in the LA group. Females comprised 119 (73.0%) patients in the TS group and 462 (70.9%) in the LA group. There was a significant association in the prevalence of new postoperative atrial fibrillation in the two groups (OR = 1.539, 95%CI: 1.072-2.210; p value = 0.019). Temporary pacemaker placement had no statistically significant difference between the two groups (p value = 0.418). The TS patients had significantly longer pump (p value < 0.001) and cross-clamp (p value < 0.001) times. The mortality rate was 4.1% (27 patients) in the LA group and 6.1% (10 patients) in the TS group (p value = 0.274).
    Conclusion
    In our study population, the TS approach was associated with higher pump and cross-clamp times as well as risk of postoperative atrial fibrillation, but it did not increase the rates of permanent pacemaker placement, re-operations, and mortality.
    Keywords: Mitral valve • Heart septum • Heart atria • Atrial fibrillation
  • Mehrnoush Toufan, Saeed Mohammadzadeh Gharebaghi, Leili Pourafkari, Elham Delir Abdolahinia Page 194
    Background
    Echocardiographic evaluations of the longitudinal axis of the left ventricular (LV) function have been used in the diagnosis and assessment of heart failure with normal ejection fraction (HFNEF). The evaluation of the global and segmental peak systolic longitudinal strains (PSLSs) by two-dimensional speckle tracking echocardiography (STE) may correlate with conventional echocardiography findings. We aimed to use STE to evaluate the longitudinal function of the LV in patients with HFNEF.
    Methods
    In this study, 126 patients with HFNEF and diastolic dysfunction and 60 normal subjects on conventional echocardiography underwent STE evaluations, including LV end-diastolic and end-systolic dimensions; interventricular septal thickness; posterior wall thickness; LV volume; LV ejection fraction; left atrial volume index; early diastolic peak flow velocity.
    Keywords: Echocardiography • Heart failure • Heart ventricles
  • Zumrut Tuba Demirozu, Deniz Suha Kucukaksu Page 201
    Long-term mechanical circulatory support is a life-saving technology while briding to heart transplantation. It increases the quality of life and preserves end-organ function for patients with advanced heart failure. The number of patients with advanced heart failure scheduled for heart transplantation before comorbidities escalate is on the rise. However, the device function is complicated by the bleeding-thrombosis and infection paradigm, hence the interest in understanding device thrombosis and infection. We describe a 27-year-old man with idiopathic cardiomyopathy, advanced end-organ failure, and severe infection, who was bridged to heart transplantation after 8 months on the Berlin Heart EXCOR (Berlin Heart AG, Berlin, Germany) biventricular support. The patient was discharged from the hospital in the third postoperative week after the recovery of his end-organ functions. At 29 months’ post-transplantation follow-up, his last cardiac biopsy was grade 0, his ejection fraction was 60%, and he was enjoying a good quality of life.
    Keywords: Heart failure • Heart_assist devices • Heart transplantation • Infection
  • Abbasali Rafighdust, Ali Eshraghi Page 205
    The invention of the drug-eluting stent (DES) has brought about revolutionary changes in the field of interventional cardiology. In the DES era, in-stent restenosis has declined but new issues such as stent thrombosis have emerged. One of the emerging paradigms in the DES era is stent fracture. There are reports about stent fracture leading to in-stent restenosis or stent thrombosis. Most of these reports concern the Sirolimus-eluting stent. The present case is a representation of a Biolimus-eluting stent fracture. We introduce a 64-year-old male patient, for whom the BioMatrix stent was deployed in the right coronary artery. Five months after the implantation, he experienced acute myocardial infarction, with stent fracture leading to stent thrombosis being the causative mechanism. Another DES (Cypher) was used to manage this situation, and the final result was good.
    Keywords: Stents • Drug_eluting stents • Treatment failure • Myocardial infarction
  • Marouane Boukhris, Salvatore Azzarelli, Salvatore Davide Tomasello, Zied Ibn Elhadj, Francesco MarzÀ, Alfredo R. Galassi Page 208
    Regardless of the clinical setting, a good back-up represents one of the most important conditions to ensure guide wire and balloon advancement and stent delivery. As a “mother and child” system, the GuideLiner catheter (Vascular Solutions Inc., Minneapolis, MN, USA) provides an extension to the guide catheter with better coaxial alignment and stability. We report two didactic cases showing the usefulness of the GuideLiner device in everyday catheterization laboratory practice. The first case was a primary percutaneous coronary intervention (PCI) in a 71-year-old diabetic man admitted for inferior ST-elevation myocardial infarction, related to tight proximal stenosis in a dominant tortuous and calcified left circumflex. The second case was an elective PCI in a 76-year-old man admitted for stable angina (Canadian Cardiovascular Society [CCS] class III), related to focal intra-stent restenosis of a saphenous venous graft to the left anterior descending. In both cases, the GuideLiner catheter provided a good back-up insuring the success of PCI and drug-eluting stents implantation, with a good in-hospital outcome.
    Keywords: Percutaneous coronary intervention • Cardiac catheters • Equipment_supplies
  • Masoud Tarbiat, Gholamreza Safarpoor Page 215
    Iatrogenic coronary artery dissection during coronary angiography with or without rupture is a rare but feared complication. We herein report a case of iatrogenic left main coronary artery dissection in a 49-year-old female. Admitted to our hospital with a recent history of severe hypotension, she develpled apnea during angiography. She was intubated and resuscitated with an Epinephrine infusion in the Cath-Lab. The diagnosis was iatrogenic left main coronary artery dissection based on angiography. Immediately, the patient was transferred to the operating room in a lethargic state with an Epinephrine infusion and prepared for emergency coronary artery bypass graft surgery. In the ICU, she was completely alert with no hemodynamic complications and finally was discharged in a good overall condition. At 18 month's follow-up, the patient was in a stable situation with good daily function.
    Keywords: Coronary vessels, Dissection, Coronary artery bypass
  • Mahmood Hosseinzadeh Maleki, Toba Kazemi, Navid Davoody Page 219
  • Abdollah Mohammadian-Hafshejani, Salman Khazaei, Hamid Salehiniya Page 221