International Cardiovascular Research Journal
Volume:12 Issue: 2, Jun 2018

Both Transthoracic Echocardiography (TTE) and Transesophgeal Echocardiography (TEE) are effective investigation tools to detect cardioaortic sources of embolism in ischemic stroke. Nevertheless, there are still uncertainties about the cost-effectiveness of these methods in non-selected patients with acute stroke.
This study aimed to investigate the cost-effectiveness of TTE and TEE using a decision analytic model in non-selected patients with acute ischemic stroke with or without clinical and radiological signs of embolic pattern.
Patients and This cross-sectional cost-effectiveness study was performed in Nemazee hospital affiliated to Shiraz University of Medical Sciences from January 2014 to April 2014. TTE and TEE were performed for all 65 consecutive patients with ischemic stroke (51.3% male, mean age of 69.7 ± 17.9 years). The required data were direct costs related to performance of TTE and TEE, which were obtained from the patients’ bills in their charts. A decision analytic model was implemented to assess the cost-effectiveness of these two methods, which demonstrated an Incremental Cost-Ef-fectiveness Ratio (ICER). Effectiveness was determined based on the number of disorders diagnosed using each of the two echoes confirmed by two cardiologists. All analyses were done using Tree Age Pro 2011.
The results showed that TEE was more expensive than TTE in non-selected patients. Performing TEE increased the cost by 1494 USD and the effectiveness by 7%. As per ICER equation, for each increment unit in the effectiveness, performing TEE would increase the cost by 213.4 USD compared to TTE. TEE was cost-effective in comparison to TTE regardless of age factor considering the cutoff of Gross Domestic Product (GDP) by three for ICER. Moreover, TTE was cost-effective in 41-60- and 61-80-year-old age groups, while TEE was cost-effective in the 41-60-year-old age group. However, none of the techniques was cost-effective in patients above 81 years old.
The results of this study can help reduce the unnecessary use of echocardiography by considering the age group and their corresponding risk factors for developing ischemic stroke.

Hypertension is one of the causes of mortality that can be prevented. Self-efficacy with regard to patients’ performance predicts their abilities to change high-risk behaviors. Positive self-efficacy in patients with hypertension predicts compliance, adherence to medications, diet and exercise regimens, and behavioral self-management.
This study aimed to examine the psychometric features of self-efficacy questionnaire in patients with hypertension.
Patients and In this cross-sectional study, 260 patients with hypertension were selected by multistage cluster sampling in Tehran’s public places to complete the Persian version of hypertension self-efficacy questionnaire. Then, face validity, content, and structure of the questionnaire were evaluated. To determine the reliability of the questionnaire, test-retest method with a two-week interval and Cronbach’s alpha coefficient were used. All data analyses were performed using the SPSS statistical software, version 18.0.
According to the results of Content Validity Ratio (CVR), three items were eliminated. The results of exploratory and confirmatory analyses identified three factors, including diet regimen, disease management, and adherence to treatment. The goodness of fit of the three-factor self-efficacy model in patients with hypertension was confirmed based on standard indices (RMSEA = 0.082, NNFI = 0.90, CFI = 0.91, IFI = 0.91, and X2/df = 328.35). Besides, internal consistency of diet regimen, disease management, and adherence to treatment based on Cronbach’s alpha was 0.849, 0.471, and 0.572, respectively.
The three-factor structure of the self-efficacy questionnaire showed appropriate validity and reliability in patients with hypertension. Thus, this tool can help caregivers and health service providers assess self-efficacy of hypertensive patients and plan and implement educational and clinical interventions.

Mechanical PR Interval (MPRI) is an important parameter in the fetus as a surrogate for PR interval. Normal values of MPRI have been reported with controversial effects of Fetal Heart Rate (FHR) and Gestational Age (GA). However, the effect of HR-correction on PR interval is unknown.
This study aimed to obtain the reference values of fetal MPRI in a large series of normal fetuses by pulsed-Doppler fetal echocardiography. This was done to determine the influence of fetal sex, Heart Rate (HR), GA, and maternal age on MPRI and to calculate the novel HR-Corrected Mechanical PR Interval (CMPRI) to investigate whether HR-correction of PR interval can decrease the influence of HR.
This cross-sectional study was performed on 516 consecutive normal singleton fetuses. By extrapolation from Bazett’s formula, we corrected the MPRI for HR. Impact of fetal sex, HR, and GA on MPRI and CMPRI was studied. Mean ± standard deviation, 5th, 50th, 95th, and 99th percentiles of MPRI and CMPRI were also calculated. Then, the data were entered into Stata, version 12 and analyzed using t-test, ANOVA, and linear regression.
Reference values of MPPR and CMPRI were provided in four GA groups; i.e., 14 - 18, 19 - 22, 23 - 26, and 27 - 38 weeks. Fetal sex and maternal age had no influence on either MPRI or CMPRI. After adjustment for fetal sex, GA, and maternal age, there was a 0.14-millisecond (ms) decrease in MPRI and a 8.06-ms increase in CMPRI for every single increase in FHR. Additionally, adjusted linear regression model indicated a 0.43-ms increase in MPRI and a 2.53-ms increase in CMPRI per gestational week. The results of paired t-test showed no significant difference between fetal MPRI and neonatal PR interval.
This study provided reference values for MPRI and CMPRI in fetus from 14 to 38 weeks of gestation from the 5th to the 99th percentile. The results also revealed significant correlations between both FHR and GA and MPRI and CMPRI. Furthermore, HR correction of MPRI did not add any advantage in terms of HR-independency of mechanical PR interval.

Cardiovascular Diseases (CVDs) are the major cause of mortality around the world. Knowledge about CVDs is an important subject in encouraging Cardiac Rehabilitation (CR) patients to make health changes related to their condition. However, it is still not clear how much knowledge Iranian patients have about such diseases.
This study aimed to investigate CR patients’ knowledge of CVDs in East of Iran.
Patients and This cross-sectional study was carried out on CR patients who had referred to a CR center in Mashhad, Iran between November 2016 and May 2017. A total of 161 patients were recruited using convenience sampling method. A reliable and valid questionnaire was used to assess the patients’ knowledge. The data were entered into the SPSS statistical software, version 16 and were analyzed using descriptive and analytical statistics. P The mean age of the patients was 54.12 ± 14.57 years (range: 19 to 74 years). Mean score of knowledge about CVDs was 40.66 ± 17.19. Most of the participants had a low level of knowledge about CVDs (52.8%). The results showed a significant difference between the mean scores of knowledge in different age groups (P = 0.008) and education levels (P = 0.001). Indeed, men had a higher level of knowledge in exercise (P = 0.009) and psychosocial risk subscales (P = 0.012).
The participants showed an insufficient level of knowledge about CVDs. Thus, appropriate training programs are recommended to improve such patients’ knowledge of CVDs. The research findings also provided a sound and fundamental basis for future studies in this field.

Acute Heart Failure (AHF) is a common cause of hospitalization in many countries. Rehospitalization due to AHF is also a very important economic issue for health services. Registries for AHF have been made in many countries to characterize such patients, which have provided great information about these patients for better care. To date, there is insufficient information about these patients in Iran and their rehospitalization and short- and long-term follow-up is unclear.
This study aims to describe the results of a small registry of AHF (HFrEF) patients in Iran and their short-term follow-up.
Patients and This study aimed to describe the earliest results of the AHF registry, which was started from September 2015 in two hospitals (Afshar Heart Center in Yazd and Rajaie Heart Center in Tehran). All patients with diagnosis of AHF and HFrEF were enrolled into this registry. During six months, 352 patients with diagnosis of AHF and HFrEF were entered into this registry. The patients’ demographic, clinical, and Para clinical data were collected during hospitalization and they were followed up for all-cause mortality and hospitalization for three months. Patients suffering from heart failure with preserved ejection fraction were excluded because of their small number and incomplete data.
The mean age of the patients was 55 ± 16 years and 76% were male. Besides, 77% of the patients had acute decompensation of chronic heart failure and 17% had new-onset AHF. Etiology of heart failure was ischemic heart disease in 52% of the patients. Additionally, the mean left ventricular ejection fraction was 20%. Moreover, length of hospital stay was 10.5±10 days and in-hospital mortality rate was 9.7%.
This small and limited registry of patients with AHF (HFrEF) in Iran delineated these patients’ characteristics with some discrepancies and similarities with western registries. Thus, a larger nationwide registry is needed for further clarification of the issue.

For patients with coronary anomalies, interventions can be challenging. This case report describes a coronary intervention on a patient with a right coronary artery arising from the left coronary sinus facilitated by CT-image overlay using Heart Navigator®.

Total Anomalous Pulmonary Vein Connection (TAPVC) is often reported in neonates and children. This report demonstrates an unusual adult TAPVC that the patient is survived in the fourth decade of life. It was diagnosed via application of echocardiography paired with multi detector-row computed tomography angiography. A 39-year-old man was referred for evaluation of dyspnea and cyanosis at rest worsening with exertion. On physical examination, decreased oxygen saturation, clubbing, and central and peripheral cyanosis were detected. In primary evaluation, large Atrial Septal Defect (ASD) was discovered. Cardiac catheterization showed a large ASD and benign variant of Persistent Left Superior Vena Cava (PLSVC). On Trans-Thoracic Echocardiography (TTE), no pulmonary hypertension was defined in direct contradiction of Eisenmenger syndrome. Due to suspicion of a complex shunt, he underwent Trans-Esophageal Echocardiography (TEE) followed by CT-angiography. Both of these image modalities clearly demonstrated the presence of TAPVC in addition to ostium secundum ASD. Due to the change in the main diagnosis, he underwent surgical correction with immediate and complete relief of both cyanosis and dyspnea after operation. Although some complex congenital heart diseases are usually seen in newborns and infants, their presence in adulthood is not impossible. Thus, some unusual findings similar to presence of cyanosis in the absence of pulmonary hypertension should be questioning. In such cases, alternative imaging studies can provide additional guidance in diagnosis. It is not an infrequent occurrence, as this case underscores, where more complete imaging overturns an initial diagnosis leading to completely different management.