International Cardiovascular Research Journal
Volume:13 Issue: 2, Jun 2019

Coronary Artery Disease (CAD) is a major cause of morbidity and mortality world-wild. Thus, its early diagnosis and treatment could be life-saving. Mitral Valve (MV) and mitral annular velocities as well as left atrial and left ventricular wall strain have been claimed to be helpful for prediction of the presence of CAD. This case-control study aimed to assess the predictive value of these echocardiographic parameters for detection of CAD. Eighty consecutive individuals referring with acute angina-like chest pain and requiring diagnostic coronary angiography and had a concomitant echocardiographic Left Ventricular Ejection Fraction (LVEF) ≥ 50% were divided into two groups: those with significant CAD (n = 45) and those with non-significant CAD (n = 35). Tissue Doppler Imaging (TDI) was employed for all participants. Peak early and late MV velocities (E and A, respectively), peak longitudinal systolic myocardial velocity (mitral S′), peak early and late diastolic velocities (e′ and a′, respectively) from medial mitral annulus, E/e′ ratio, peak Left Atrial (LA) strain, and Left Ventricular Global Longitudinal Strain (LV GLS) were measured and compared in the two groups. Chi-square and t-test were used to compare the two groups as appropriated. Multiple logistic regression was also performed to detect the impact of categorical variables on the predictors of the presence of CAD. Receiver operating characteristic curves were constructed as needed. A P value ≤ 0.05 was considered to be statistically significant. Mitral S′ and E/e′ were significantly different in the two groups. Mitral S′ was lower and E/e′ was higher in the patients with CAD compared to the control group (P = 0.01 and P = 0.03, respectively). Considering 5.3 cm/sec as the cut-off point for mitral S′, sensitivity and specificity for significant CAD were 67.40% and 68.60%, respectively with an odds ratio of 0.275. The cut-off point for mitral E/e′ was defined as 12.65, with sensitivity and specificity for significant CAD to be 52.17% and 77.14%, respectively with an odds ratio of 1.249. This study showed that mitral S′ and E/e′ could predict the presence of significant CAD in patients with chest pain and preserved LVEF. Thus, TDI could be used as a simple, reliable, and non-invasive tool to achieve this goal.

Patient Health Questionnaire-9 (PHQ-9) and Patient Health Questionnaire-2 (PHQ-2) have been characterized as appropriate screening tools for coronary heart patients. However, their psychometric properties have not been assessed in Iranian coronary heart patients. This study aimed to determine the psychometric properties of the Persian versions of PHQ-9 and PHQ-2 in patients with Coronary Heart Disease (CHD). This cross-sectional study was conducted to investigate the psychometric properties of the Persian versions of PHQ-9 and PHQ-2 in patients with CHD. Totaly, 284 patients with CHD referred to Imam Ali Hospital in Kermanshah were selected through purposive sampling. They were first given a structured clinical interview (SCID-I) and were then asked to complete PHQ-9, PHQ-2, and Beck Depression Inventory-version 2 (BDI-II). The data were analyzed by descriptive statistics, Cronbach’s α, Spearman’s correlation coefficient, exploratory factor analysis, and Receiver Operating Characteristic (ROC) curve. Cronbach’s alpha was 0.86 for PHQ-9 and 0.77 for PHQ-2. The correlation between PHQ-9, and BDI-II and PHQ-2 was 0.74 and 0.80, respectively (P < 0.001). Additionally, the correlation between PHQ-2 and BDI-II was 0.64 (P < 0.001). Using exploratory factor analysis, a one-factor structure was extracted. The optimal cutoff point for PHQ-9 was ≥ 8 with the sensitivity of 0.80, specificity of 0.81, and Area Under the Curve (AUC) of 0.87 (95% confidence interval: 0.83 - 0.91). Additionally, the optimal cutoff point for PHQ-2 was ≥ 3 with the sensitivity of 0.68, specificity of 0.83, and AUC of 0.81 (95% confidence interval: 0.75 - 0.86). The Persian versions of PHQ-9 and PHQ-2 possessed acceptable psychometric properties and could, consequently, be used to screen depression in CHD patients.

Atrial Flutter (AFL) and Atrial Fibrillation (AF) are among the most common supraventricular tachyarrhythmias. Sometimes, differentiation of the two arrhythmias using surface electrocardiography becomes difficult. This study aimed to compare the Left Atrial Appendage (LAA) ejection flow waves of AFL and AF to determine whether it can serve as a method for differentiating the two arrhythmias. This cross-sectional study was conducted on 20 patients with AF and 20 ones with AFL selected via simple sampling method. During Trans-Esophageal Echocardiography (TEE), pulsed Doppler sampling was laid 1 cm inside the LAA and pattern of LAA ejection flow waves was recorded in terms of rate (number per minute), velocity (centimeter per second), and regularity. The two groups were compared using Mann-Whitney U-test. P ≤ 0.05 was considered to be statistically significant. The rate of LAA ejection flow waves was 493.75 ± 50.57 in the AF group and 303.50 ± 16.31 in the AFL group (P < 0.001). Besides, the mean velocity was 0.172 ± 0.069 m/s in the AF group and 0.302 ± 0.106 m/s in the AFL group (P < 0.001). Velocity more than 0.17 m/s had a sensitivity of 95.0% (95% CI, 75.1 - 99.2%), specificity of 70.0% (95% CI, 45.7 - 88.0%), positive predictive value of 76.0%, and negative predictive value of 93.03% for diagnosing AFL. All patients in the AF group had irregular patterns, but all those in the AFL group had regular patterns. Since TEE is a usual part for evaluation of patients suspected to have AF or AFL, it may be helpful for differentiating AFL from AF by examining LAA ejection flow waves.

Congenital Heart Disease (CHD) occurs in nearly 1% of newborns due to genetic and environmental factors. There are many genes involved in CHD. Variants of Gap Junction Protein Alpha 1 (GJA1), Zic Family Member 3 (ZIC3), Nodal Growth Differentiation Factor (NODAL), and Forkhead Box H1 (FOXH1) genes are common to develop CHD. To date, no study has been published about CHD patients in Iran. Therefore, the present study aimed to evaluate the sequence variants of these genes in Iranian patients. This study was conducted on 73 patients with familial CHD and their family members. Genetic investigations were performed using Polymerase Chain Reaction (PCR) and direct DNA sequencing of the exons and flanking regions of the genes. The variants were evaluated using available online software tools. Mutation taster, PROVEAN, SIFT, PolyPhen-2, and CADD were used to predict the effects of the variants and I-TASSER was applied to evaluate the possible structural effects of the genetic variations. c.612G > A, c.717G > A, and c.895C > T in GJA1 were found in the study participants. c.1248T > G in the ZIC3 was observed in a twin with CHD. Besides, c.193 + 12C > T, c.-109T > C, c.494A > G, c.417C > T, and c.357C > T variants were detected in the NODAL gene. Additionally, c.-314T > G, c.175-30C > T, and c.373A > T sequence changes were determined in the FOXH1 gene. Two novel heterozygous variants, namely c.1061C > G and c.-465C > A, were also found in the FOXH1 gene. Bioinformatics analysis indicated that the detected reported/novel variants might not have a damaging effect among Iranian CHD patients. The study results indicated the first variation screening of GJA1, ZIC3, NODAL, and FOXH1 genes in Iranian familial CHD patients. The results also suggested a minor role for GJA1, ZIC3, NODAL, and FOXH1 genes in familial CHD pathogenesis. However, their exact role in CHD causation entails further research.

Patients’ knowledge, attitudes, and beliefs about heart attack can affect the treatment process and their request for help during heart attacks. A valid and reliable instrument is required to examine cardiac patients’ knowledge, attitude, and beliefs. This study aimed to translate and develop a reliable Persian version of the instrument for assessing cardiac patients’ knowledge, attitude, and beliefs regarding heart attack. In this methodological study, 306 patients with Acute Coronary Syndrome (ACS) were selected via convenience sampling to fill out the Persian version of the instrument for assessing cardiac patients’ knowledge, attitude, and beliefs regarding heart attack. This instrument was translated based on the World Health Organization’s (WHO) guidelines. Face, content, and construct validities of the instrument were assessed through exploratory and confirmatory factor analyses. Its reliability was also assessed using McDonald’s omega and the Cronbach’s alpha coefficient. Exploratory factor analysis led to the extraction of two factors in the attitude dimension, including ‘recognition of symptoms’ and ‘request for help’, which explained 77.31% of the total variance together. In the belief dimension, three factors were extracted that accounted for 49.59% of the total variance. Confirmatory factor analysis confirmed the goodness of fit of the two-factor model of attitude (RMSEA = 0.033, CFI = 1.00, NFI = 0.99, and PNFI = 0.40) and the three-factor model of belief (RMSEA = 0.038, CFI = 0.96, NFI = 0.89, PNFI = 0.54). Based on the Kuder-Richardson formula, the reliability of the knowledge dimension was reported as 0.938. The reliability of the two knowledge dimensions and the three attitude dimensions were reported as 0.776, 0.962, 0.527, 0.317, and 0.665, respectively. In addition, Cronbach’s alpha coefficients of 0.810, 0.904, 0.798, 0.757, and 0.906 were found for these dimensions, respectively. The Persian version of the instrument for assessing cardiac patients’ knowledge, attitude, and beliefs regarding heart attack had good validity and reliability. Therefore, it can be used in future studies on cardiac patients.

Spontaneous Coronary Artery Dissection (SCAD) is a rare cause of Acute Myocardial Infarction (AMI), which usually occurs in young or middle-aged healthy females. Here, we reported a 62-year-old male having SCAD in the Left Main Coronary Artery (LMCA) presenting with AMI. In this case, we could diagnose a spontaneous LMCA dissection with the help of contrast dye staining at the end of the collateral flow from the Right Coronary Artery (RCA). Even a small amount of contrast dye staining at the end of the collateral flow from the RCA provides an important clue for suspecting spontaneous LMCA dissection. Meticulous catheter manipulation should be required in such cases to prevent the extension of iatrogenic catheter-dissection during the procedure.

The authors regret that the authors’ list and affiliations for this article should be updated as below:Zakieh Rostamzadeh Khameneh 1, Alireza Rostamzadeh 2, Mohaddeseh Nemati 3, 4, Nariman
Sepehrvand 4, 5