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Cardiovascular and Thoracic Research - Volume:9 Issue: 2, Jun 2017

Journal of Cardiovascular and Thoracic Research
Volume:9 Issue: 2, Jun 2017

  • تاریخ انتشار: 1396/04/26
  • تعداد عناوین: 10
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  • Yasin Ahmadi, Amir Ghorbanihaghjo*, Hassan Argani Pages 64-70
    Hydroxy-Methyl-Glutaryl-CoA reductase (HMGCR) – the main enzyme of the cholesterol biosynthesis pathway – is mostly inhibited by statins in hepatocytes. In spite of the other tissues, liver utilizes cholesterol in different ways such as the synthesis of bile acids, excretion in to the intestine and synthesis of lipoproteins. Therefore, statins theoretically alter these pathways; although, there have not been such effects. In this review, we aim to show the roles of extra-hepatic tissues, in particular intestine, adipose and cutaneous tissues in providing the cholesterol after reduction of the whole body cholesterol content by statins.
    Keywords: Adipose Tissue, Cholesterol, HDL-C, Statins, Ileum
  • Fotios M. Mitropoulos, Meletios A. Kanakis, Christos Ntellos, Constantinos Loukas, Periklis Davlouros, Theophili Kousi, Andrew C. Chatzis* Pages 71-77
    Introduction
    Development of pulmonary insufficiency in patients with surgically corrected tetralogy of Fallot (TOF) may lead to severe right heart failure with serious consequences. We herein present our experience with pulmonary valve replacement (PVR) in these patients.
    Methods
    From 2005-2013, 99 consecutive patients (71 males/28 females, mean age 38±8 years), underwent PVR after 7 to 40 (mean 29 ± 8) years from the initial correction. Seventy nine of the symptomatic patients presented in NYHA II, 14 in III and 2 in IV. All underwent PVR with a stented bioprosthetic valve, employing a beating heart technique with normothermic extracorporeal circulation support. Concomitant procedures included resection of aneurysmal outflow tract patches (n = 37), tricuspid valve annuloplasty (n = 36), augmentation of stenotic pulmonary arteries (n = 9), maze procedure (n = 2) and pulmonary artery stenting (n = 4).
    Results
    There were 2 perioperative deaths (2%). One patient developed sternal dehiscence requiring rewiring. Median ICU and hospital stay was 1 and 7 days respectively. Postoperative echocardiography at 6 and 12 months showed excellent bioprosthetic valve performance, significant decrease in size of the right cardiac chambers and reduction of tricuspid regurgitation (TR) in the majority of the patients. At mean follow-up of 3.6 ± 2 years, all surviving patients remain in excellent clinical condition.
    Conclusion
    Probability of reoperation for pulmonary insufficiency in patients with surgically corrected TOF increases with time and timely PVR by preventing the development of right heart failure is crucial for long-term survival. Current bioprosthetic valve technology in combination with the beating heart technique provides excellent immediate and short-term results. Further follow-up is necessary to evaluate long-term outcome.
    Keywords: Adult Congenital Heart Disease, Congenital Heart Surgery, Pulmonary Valve, Reoperation
  • Mirhamid Paytakhti Oskouei, Masoud Pezeshkian, Naser Safaie, Masoud Darabi, Amir Fattahi, Hossain Bijanpour, Maghsod Shaaker, Ahmad Reza Jodati, Mohammad Nouri Pages 78-84
    Introduction
    Considering importance of fatty acids in developing coronary artery disease (CAD) and lack of information about saphenous vein which is commonly used as coronary arterial bypass, in this study we investigated differences in fatty acids composition between saphenous vein and aorta tissues in patients with CAD.
    Methods
    Biopsy samples of aortic tissues and saphenous veins as well as blood samples were obtained form 42 patients with CAD. Fatty acids composition of the tissues was determined using gas chromatography and also serum lipid profile was evaluated by commercial kits.
    Results
    Levels of palmitic acid (16:0) were significantly higher in aorta in compared with saphenous (P
    Conclusion
    Our results revealed difference between fatty acids composition of aorta and saphenous vein tissues and existence of correlations between the fatty acids levels with serum lipid profile. The saphenous vein had higher poly-unsaturated fatty acids in compared to aorta tissue and thus this vein is not at risk of atherosclerosis and can be used as coronary arterial bypass.
    Keywords: Coronary Artery Disease, Fatty Acid, Atherosclerosis, Aorta, Saphenous Vein
  • Lucky R. Cuenza*, Tamara Louise J. Razon, Juan Carlo Dayrit Pages 85-89
    Introduction
    Nonalcoholic fatty liver disease (NAFLD) is a prevalent condition which is known to be related to factors that predispose to the development of coronary artery disease as well as development of metabolic syndrome. The study aimed to determine the association between ultrasound-based grading of hepatic steatosis with metabolic profile and estimated cardiovascular risk using the Framingham Risk Score (FRS).
    Methods
    This was a cross-sectional study on 100 Filipino patients without established cardiovascular disease who underwent a general wellness health evaluation. Cases with NAFLD diagnosed on the basis of ultrasound grading were analyzed. Comparison of demographics and metabolic parameters between grades of hepatic steatosis was performed using Kruskal Wallis test. FRS was used to assess cardiovascular risk with Spearman rank test for correlation with the degree of NAFLD.
    Results
    Mean age was 47 ± 9.6 years, with 70% males. Mean body mass index (BMI) was 28.7 ± 5.1. Most patients had grade I NAFLD (53%), 34% were grade II, and 13% were grade III. BMI (P =0.034), liver enzymes (alanine aminotransferase [ALT], P = 0.001; aspartate aminotransferase [AST], P = 0.00), triglycerides (P = 0.047), and fasting blood sugar [FBS] (P = 0.049) were associated with fatty liver grade. No association was noted with total cholesterol (P = 0.569), high density lipoprotein (HDL) (P = 0.220), and low density lipoprotein (LDL) (P = 0.792). Using the FRS 43% were stratified as low (20% risk). Severity of fatty liver was directly correlated with the FRS (Spearman rank 0.741, P = 0.009).
    Conclusion
    Ultrasound-based grading of the severity of NAFLD is associated with abnormalities in the metabolic profile of patients. The FRS is correlated with increasing severity of NAFLD based on ultrasound. These findings suggest that the presence of NAFLD may be a marker for the presence of increased cardiovascular risk and may help identify patients who may benefit from more aggressive therapies to prevent development of adverse cardiovascular events.
    Keywords: Cardiometabolic, Nonalcoholic Fatty Liver Disease, Framingham Risk Score
  • Ali Aliyev, Magid Seyedghodraty, Mustafa Mohammadi, Fariba Mirzaei, Marzieh Marahem* Pages 90-94
    Introduction
    During atherosclerosis process, vasoconstriction phenomenon occurs which in turn leads to tissue hypoxia. A few studies have been performed on the combination of atherosclerosis and hypoxia as stressors that may accelerate secretion of constrictors. The aim of present study was to evaluate the effects of atherosclerosis and hypoxia on serum levels of main vasoconstrictors (epinephrine, norepinephrine and renin).
    Methods
    In this interventional study, 32 New Zealand white rabbits were randomly divided into four groups (n = 8): normal diet (control group), normal diet exposed to hypoxia (11%, 10 days), high-fat diet (cholesterol-2%, 8 weeks), and high-fat diet with hypoxia. Later, serum levels of renin, epinephrine and norepinephrine were measured on second, 56th and 66th days.
    Results
    High-fat diet and hypoxia caused significant increase in epinephrine and norepinephrine concentrations on days 56 and 66 compared to the control group (P
    Conclusion
    Both high-fat diet and hypoxia increase renin levels in male rabbits. Furthermore, the combination of high-fat diet and hypoxia immensely increases renin levels. Both hypoxia and combined of high-fat diet and hypoxia increase norepinephrine levels. However epinephrine is only increased in the combination of high-fat diet and hypoxia. So the presence of hypoxia in combination with high-fat diet, cause accelerated
    and aggravated atherosclerosis.
    Keywords: Atherosclerosis, Hypoxia, Renin, Angiotensin, Epinephrine, Norepinephrine
  • Peyman Rezaei-Hachesu, Azadeh Oliyaee, Naser Safaie, Reza Ferdousi* Pages 95-101
    Introduction
    Coronary artery disease (CAD) is one of the major causes of disability and death in the world. Accordingly utilizing from a national and update guideline in heart-related disease are essential. Finding interesting rules from CAD data and comparison with guidelines was the objectives of this study.
    Methods
    In this study 1993 valid and completed records related to patients (from 2009 to 2014) who had suffered from CAD were recruited and analyzed. Total of 25 variable including a target variable (CAD) and 24 inputs or predictor variables were used for knowledge discovery. To perform comparison between extracted knowledge and well trusted guidelines, Canadian Cardiovascular Society (CCS) guideline and US National Institute of Health (NIH) guideline were selected. Results of valid datamining rules were compared with guidelines and then were ranked based on their importance.
    Results
    The most significant factor influencing CAD was chest pain. Elderly males (age >54) have a high probability to be diagnosed with CAD. Diagnostic methods that are listed in guidelines were confirmed and ranked based on analyzing of local CAD patients data. Knowledge discovery revealed that blood test has more diagnostic value among other medical tests that were recommended in guidelines.
    Conclusion
    Guidelines confirm the achieved results from data mining (DM) techniques and help to rank important risk factors based on national and local information. Evaluation of extracted rules determined new patterns for CAD patients.
    Keywords: Coronary Artery Disease, Data Mining, Knowledge Discovery, Guideline
  • Mohammad Mostafa Ansari-Ramandi, Majid Maleki, Azin Alizadehasl, Ahmad Amin, Sepideh Taghavi, Mohammad Javad Alemzadeh-Ansari, Ali Kazem Moussavi, Nasim Naderi* Pages 102-107
    Introduction
    Allopurinol used in the treatment of gout has been shown to improve the vascular endothelial dysfunction and reduce the dysfunction of the failing heart. This study was done to evaluate the effect and safety of allopurinol in non-hyperuricemic patients with chronic severe left ventricular (LV) dysfunction.
    Methods
    In this study, 35 consecutive cases of non-hyperuricemic patients with chronic heart failure who had severe LV systolic dysfunction (ejection fraction of less than 35%) and were on optimal guideline directed medical therapies for at least 3 months were included. Allopurinol was administered with the dose of 300 mg po daily for 1 week and then it was up-titrated to a dose of 600 mg po daily for 3 months. Six minute walk test, strain imaging, laboratory testing were done for every patient at baseline and after 3 months treatment with allopurinol.
    Results
    In this study 30 heart failure (HF) patients with a mean age of 49.3 ± 14.4 years old were evaluated. No adverse effects were reported except for one case of skin rash after 4 days treatment which was excluded from the study. Study showed significant improvement of six minute walk test of the patients from 384.5 ± 81.5 meters to 402.8 ± 89.6 meters and the global longitudinal peak strain (P
    Conclusion
    Allopurinol could be of benefit in non-hyperuricemic patients with severe LV systolic dysfunction without significant adverse effects. Randomized clinical trials are needed in future to confirm the results.
    Keywords: Allopurinol, Severe LV Systolic Dysfunction, Strain Imaging, Quality of Life, NT-proBNP
  • Somayeh Pourhoseini, Mohammad Bakhtiari, Abdolreza Babaee, Mohammad Ali Ostovan, Seyed Hassan Eftekhar-Vaghefi, Nikan Ostovan, Pooyan Dehghani Pages 108-112
    Introduction
    Myocardial bridge (MB) is a segment of a major epicardial coronary artery that goes intramurally under a bridge of overlying myocardium. Complications have been reported during or after stent implantation particularly coronary perforation. The aim of this study was to determine histological differences between proximal left anterior descending artery (LAD) and the tunneled segment that may have a possible role in increased risk of coronary artery perforation during percutaneous coronary intervention.
    Methods
    Twenty specimens of MB were obtained from dissection of 45 cadavers. Sections were stained using hematoxylin and eosin (H&E), and trichrome methods. The proximal section and the tunneled artery were compared with a normal sample in terms of the characteristics of a muscle artery.
    Results
    The findings of this study showed an MB prevalence of 51%, as 23 out of the 45 examined cadavers were discovered to be afflicted by the MB. The intima layer in the suffering artery had gone through significant hypertrophy, while it had remained thin in the tunneled artery section. The epithelial cells under the bridge were spindle-shaped, while they were polygonal in the proximal section. In the myocardium the nuclei of the muscle fibers in the MB section were smaller than the normal section. Adventitial layer was almost normal.
    Conclusion
    The histopathological differences between MB and proximal part of vessel combined with small vessel diameter in the tunneled segment can explain the high incidence of the LAD rupture and perforation in the section under the bridge.
    Keywords: Myocardial Bridge, Coronary Perforation, Histopathology, Percutaneous Coronary Intervention
  • Hassan Soleimanpour*, Jafar Sadegh Tabrizi, Asghar Jafari Rouhi, Samad Ej Golzari, Ata Mahmoodpoor, Robab Mehdizadeh Esfanjani, Maryam Soleimanpour Pages 113-117
    Introduction
    Presence of family and patients’ relatives throughout resuscitation procedure is one of the most challenging concerns.
    Methods
    In an interventional (quasi-experimental) study that was conducted during a 6 months period, the patients’ relatives were randomly divided into two groups of intervention (the relatives who were eager to be present throughout the resuscitation procedure- under the family protection protocol, all of the procedure steps were explained to the relatives by an expert nurse who was not involved in the resuscitation procedure and control group (those who were not invited routinely to be present throughout the resuscitation procedure. However, if the control group were eager to be present, they were allowed to observe the procedure (these people were not supported by the protocol). After 90 days, subjects were contacted through telephone and filled standard questionnaires (Hospital Anxiety and Depression Scale [HADS]) and Impact of Event Scale (IES) were completed for all subjects. These questionnaires focus on anxiety, depression and post-traumatic stress disorder (PTSD). The obtained data were analyzed.
    Results
    One hundred thirty three relatives were divided into two groups of control (59 subjects) and intervention (74 people). No significant difference was observed between two groups regarding demographic features. The evaluation after 90 days revealed depression, anxiety disorders and PTSD to be significantly more prevalent in control group than the intervention group (P
    Conclusion
    Emotional and psychological support and intervention on the patients’ relatives are efficient and can prevent the emergence of psychological disorders.
    Keywords: Cardiopulmonary Resuscitation, Anxiety, Depression
  • Mahim Malik*, Konstantin Shilo, Ahmet Kilic Pages 118-120
    Cardiac papillary fibroelastomas (CPF) are rare cardiac tumors, mostly found on the valvular surfaces in the heart. These tumors are frond like in nature and are benign, intracardiac masses, rarely causing any hemodynamic disturbances. However, excision of these masses is indicated due to their propensity to embolize. We present a case report of the tumor found on the coumadin ridge, causing transient ischemic attacks in a patient. We performed complete excision of the tumor via median sternotomy on cardiopulmonary bypass support with cardiac arrest. The diagnosis was confirmed by histological examination. The patient had an uneventful postoperative course and was discharghed on postoperative day 4. She has had complete resolution of her symptoms post excision. The diagnosis of the mass was confirmed on histological examination.
    Keywords: Fibroelastoma, Tumor, Left Atrium