فهرست مطالب

The Journal of Tehran University Heart Center
Volume:2 Issue: 1, Jan 2007

  • تاریخ انتشار: 1385/04/11
  • تعداد عناوین: 10
|
  • Shiva Tabatabai, Seyed Ali Keshavarz Pages 7-14
    Diseases of heart and stroke cause most deaths in both sexes of all ethnic groups. For more than 40 years epidemiological studies, experimental studies, and clinical trials have shown that numerous dietary risk factors affect serum lipids, atherogenesis and coronary heart disease (CHD). Substantial interest has recently focused on the hypothesis that the naturally occurring antioxidant vitamins such as vitamin E, vitamin C, and ß-carotene may prevent myocardial infarction, progression of coronary heart disease. Substantial laboratory, animal, and human data suggest that oxidation of low-density lipoprotein (LDL) cholesterol is an important step in the pathogenesis of atherosclerotic lesions. Oxidation of LDL cholesterol is important in both the initiation and progression of plaque or increases the risk for plaque rupture. The major lipid-soluble antioxidant vitamins are vitamin E (-tocopherol) and ß-carotene, a precursor of vitamin A. The major water-soluble antioxidant vitamin is vitamin C (ascorbic acid). Vitamin E is important in preventing oxidation of LDL cholesterol. ß-Carotene prevents oxidation of LDL cholesterol. Vitamin C prevents oxidation of LDL cholesterol and preserves vitamin E and ß-carotene levels during oxidative stress. It is increasingly recognized that folate and vitamin B6 may play a role in the prevention of cardiovascular disease. The primary mechanism proposed for their effect on coronary vascular disease (CVD) is a reduction in plasma homocysteine concentration by remethylation of homocysteine back to methionine. Minerals like magnesium, Potassium and calcium and also vitamin D have protective effect in blood pressure. Selenium is an important component of antioxidant defence and flavonoids which are derived from plants have been shown to inhibit platelet aggregation and adhesion, which may be another way they lower the risk of heart disease. In this article the role of micronutrients in prevention of cardiovascular diseases will be reviewed.
  • Tavvos Rahmani, Cherati, Manijhe Mokhtari, Dizaji, Masome Gity Pages 15-19
    Background
    Common carotid arterial stiffness can be assessed during carotid arterial ultrasonography, but its association with brachial stiffness, a well-defined cardiovascular risk factor, has not been clarified. The aim of this study was to examine the relationship between common carotid artery and brachial artery stiffness.
    Methods
    The static pressure-strain elastic modulus of the common carotid and brachial arteries were evaluated in 40 men with 15 healthy carotids, 15 mild carotid stenoses, and 10 severe carotid stenoses, by B-mode and Doppler ultrasonography. The local elastic modulus was estimated by the measurement of the arterial strain; the static pressure was also measured based on the peak-systolic and end-diastolic velocity in each artery.
    Results
    The elastic modulus of the right common carotid artery (RCCA) and right brachial artery (RBA) increased linearly with the growth of atherosclerosis from 1772±566 Pa and 2639±1096 Pa for the normal subjects to 6168±1026 Pa and 5587±1592 Pa for the severe stenosis group, respectively. In the three groups; healthy, mild stenosis, and severe stenosis; there was a significant difference in the elastic modulus of the right common carotid artery between the groups and also for the right brachial artery, separately (p-value<0.05). The Pearson correlation analysis showed a significant correlation between the elastic modulus of the right common carotid artery and the elastic modulus of the right brachial artery.
    Conclusion
    The brachial artery elastic modulus is associated with the common carotid elastic modulus. This study showed that atherosclerosis was a generalized process that might involve the entire vasculature. An evaluation of the elastic modulus of the RBA, however, showed that there were fundamental differences in the dynamic behavior of the brachial artery when compared to elastic arteries, such as the common carotid artery.
  • Alireza Mahoori, Rasoul Farasatkish, Nahid Aghdaie, Zohre Faritus, Golamali Mollasadeghi, Fahimeh Kashfi Pages 21-24
    Background
    Cardiovascular disease is an important non-obstetric cause of maternal and fetal /neonatal morbidity and mortality during pregnancy. For a pregnant woman with cardiac disease, the potential inability of the maternal cardiovascular system to contend with normal pregnancy-induced physiologic changes may produce deleterious effects on both mother and fetus. To determine the most frequent surgical indications of maternal and fetal mortality, we studied 15 cases of severe cardiac disease in pregnant women who required cardiac surgical procedures.
    Methods
    In this descriptive study, fifteen pregnant women who underwent cardiac surgery were studied. Maternal age ranged from 27 to 36 years, and gestational age varied from 4 to 22 weeks. Most of the patients were in New York Heart Association Classes II and III. Opioid- based anesthesia with fentanyl citrate (50µ/kg) or sufentanil (5µ/kg) plus low dose of thiopental were used for the induction of anesthesia. During non-pulsatile cardio-pulmonary bypass, core temperature was between 28-36 °C, average CBP time was 61.2±22 min, average aortic cross-clamp time was 34.13±14 min, and mean pump pressure was maintained between 65-80 mmHg.
    Results
    Ten patients had severe mitral valve disease (66.6%), three had aortic valve disease (20%), one had subvalvular aortic stenosis (6.7%), and the remaining one had left atrial myxoma (6.7%). There were five fetal deaths (33.3%) and one maternal death (6.7%).
    Conclusion
    It seems that open heart surgery in the first trimester is very hazardous for the fetus and may lead to fetal death. If possible, surgery should be carried out in the second trimester of pregnancy. The recommendations are simply guidelines because research data and clinical experience in this area are limited.
  • Seyed Mahdi Nassiri, Seyed Hossein Ahmadi, Zohreh Khaki, Masoud Soleimani, Issa Jahanzad, Shahram Rabbani, Mohammad Sahebjam, Farid Azmoudeh Ardalan, Mahmood Sheikh Fathollahi Pages 25-30
    Background
    Marrow-derived mesenchymal stem cells (MSCs) have been heralded as a source of great promise for the regeneration of the infarcted heart. There are no clear data as to whether or not in vitro differentiation of MSCs into major myocardial cells can increase the beneficial effects of MSCs. The aim of this study was to address this issue.
    Methods
    To induce MSCs to transdifferentiate into cardiomyocytes and endothelial cells, 5-Azacytidine and vascular endothelial growth factor (VEGF) were used, respectively. Myocardial infarction in rabbits was generated by ligating the left anterior descending coronary artery. The animals were divided into three experimental groups: I) control group, II) undifferentiated mesenchymal stem cell transplantation group, and III) differentiated mesenchymal stem cell transplantation group. The three groups received peri-infarct injections of culture media, autologous undifferentiated MSCs, and autologous differentiated MSCs, respectively. Echocardiography and pathology were performed in order to search for improvement in the cardiac function and reduction in the infarct size.
    Results
    Improvements in the left ventricular function and reductions in the infarcted area were observed in both cell transplanted groups (Groups II and III) to the same degree.
    Conclusions
    There is no need for prior differentiation induction of marrow-derived MSCs before transplantation, and peri-infarct implantation of MSCs can effectively reduce the size of the infarct and improve the cardiac function.
  • Ghaemian A., Mohammadpour Ra, Hosseini Sh, Emadi H. Pages 31-34
    Background
    Depression is common in chronic medical illnesses including HF. It has been established that depression has different rates in different races and the reported depression rates among hospitalized patients range from 13% to 77%; nevertheless, there is remarkably little information on the prevalence of depression and the impact of demographic and health status in the north of IRAN. The goal of this study was to determine the prevalence of depression in hospitalized heart failure (HF) patients, as well as the impact of age, gender, and functional status on this group of patients.
    Methods
    In this study, carried out in one heart center, a total of 196 hospitalized HF patients with New York Heart Association (NYHA) functional classes 2- 3 and 4 and an ejection fraction (EF) <40% were given questionnaires to assess depression. Depression was evaluated with the Beck Depression Inventory (BDI) questionnaire. Depression was defined as a score on the BDI of ≥17.
    Results
    A total of 23.5% of the patients scored as depressed. Men were more likely (33%) to be depressed than women and had a higher mean BDI score (p=0.004). Patients classified as NYHA functional class 3 were more likely to score as depressed than class 2 patients (p= 0.001), and patients with a higher BDI score had a lower EF (r=0.25, p=0.001).
    Conclusion
    Depression is common in patients with HF. Men and patients with lower health status are more likely to be depressed. Pharmacologic or non- pharmacologic treatment of depression in HF patients should be considered.
  • Ali Kazemi Saeed, Gholamreza Namadanian, Darioush Kamal Hedayat Pages 35-37
    Background
    Atrial fibrillation (AF) is prevalent among cardiac patients; and as the risk of thromboembolism is high in this arrhythmia, discrimination of the effective risk factors in producing left atrial (LA) thrombosis is clinically important. The molecular structure of lipoprotein(a) [Lp(a)] is very similar to plasminogen, so it can be hypothesized that the high level of Lp(a) is a compromising factor for the prevention of fibrinolysis (thrombogenesis).
    Methods
    This case-control study was conducted in patients with chronic AF. Most of the subjects had mitral stenosis. LA thrombosis was confirmed by transthoracic and transesophageal echocardiography.
    Result
    The study group consisted of 50 chronic AF patients mostly with mitral stenosis. Half the patients had LA thrombosis (patient group or P) and the other half did not (control group or C). The mean age of the control group (C) and patient group (P) was 45±11 y and 57±9 y, respectively. There was no significant correlation between sex and LA gradient and existence of LA thrombus. LA size was 49±5 mm (C) and 56±9 mm (P), respectively. Left atrial blood velocity was 12±2 cm/sec (C) and 5±3 cm/sec (P), and Lp(a) concentration was 30±6.7 mg / dl (C) and 55±2.75 mg / dl (P). There was a significant correlation (p<0.001) between age, LA blood velocity, LA size, and serum concentration of Lp(a), which was confirmed by t-test.
    Conclusion
    There has been a great deal of research into the classic risk factors of LA thrombosis in chronic AF, but the study on the effect of Lp(a), which is an atherosclerosis risk factor, on the formation of LA thrombosis is almost new. According to the results of the present study, Lp(a) should be measured in all chronic AF patients. We can assume that lowering Lp(a) serum level may decrease the risk of LA thrombosis in chronic AF patients.
  • Rezayat Parvizi, Mohammad Rahbani Noubar, Susan Hassanzadeh Salmasi Pages 39-44
    Background
    It is well documented that coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) causes ischemia and oxidative stress of the whole body. To compare the effect of on – pump and off –pump CABG on the induction of the oxidative stress and the metabolism of homocysteine which is involved in the synthesis of glutathione was investigated in the CABG patients during the early postoperative period.
    Methods
    Plasma homocysteine, folate total antioxidant capacity (TAC) and malonedialdehyde (MDA) were determined by standard methods on blood samples obtained from 40 patients undergoing CABG, preoperatively and at 0,12,48,120 hours and 6 months after surgery, The patients were divided into two matched groups. One of the groups underwent off - pump and the other on – pump CABG.
    Results
    A marked reduction of homocysteine, folate and significant elevation of MDA were noticed at 0, 12, 48 hours after operation in the both groups (P<0.05). A negative and marked correlation between homocysteine and TAC but a positive and significant correlation between homocysteine and MDA were observed (P<0.05 in the both groups). In CABG operation because of oxidative stress and consumption of GSH (Reduced Glutathione) immediate reduction in the plasma levels of homocyteine occurs in the both techniques. However using off pump CABG induction of oxidative stress and changes in plasma levels of homocysteine are not as high as on- pump CABG.
    Conclusion
    The on-pump technique was correlated with a faster decrease in the homocysteine level during the first 12 hours and with a faster and higher elevation of the homocysteine concentration 12-48 hours postoperatively.
  • Kyomars Abbasi, Hakimeh Sadeghian, Arezoo Zoroufian, Banafsheh Alinejad Pages 45-47
    We report two cases of Tetralogy of Fallot with pulmonary valve bacterial endocarditis where one extended to the branch of pulmonary artery (PA). This is a rare occurrence. Aggressive supportive care plus early and radical surgery can be life saving.
  • Abbasali Rafighdoust, Mohammad Tayebi, Hoorak Poorzand Pages 49-53
    Pulmonary thromboembolism (PTE) has a wide spectrum of presentations, and its cardinal manifestations include chest pain, dyspnea, and syncope. Syncope as an initial presentation of PTE occurs in 10-14% of patients and is not restricted to massive PTEs. It can also occur in the setting of non- massive cases probably due to a vasovagal mechanism or the occurrence of conduction disturbances in preexisting complete left bundle-branch block. The next point discussed here is the use of thrombolytic therapy for submassive PTE with a normal blood pressure while marked right ventricular dyskinesia or dysfunction occurs.