Iranian Heart Journal
Volume:10 Issue: 1, Spring 2009

To assess the value of 24-hour redistribution imaging after 201Tl reinjection for the detection of myocardial viability, we compared the results of 201Tl reinjection imaging with those obtained 24 hours after reinjection. In total, 35 patients aged 57±8 years (mean ± SD) who showed one or more persistent perfusion defects on stress reinjection images after myocardial infarction were assessed for myocardial viability. After pharmacological stress and 4-hour reinjection imaging, 25 patients who showed non-viable segments at reinjection image underwent 24-hour redistribution imaging. The stress, reinjection, and 24-hour redistribution images were analyzed quantitatively. Criteria for viability definition were:1) segments which showed at least 50% uptake of peak activity of normal regions at stress phase and 2) segments with less than 50% uptake at stress image which showed at least 20% redistribution at the later phases. Of the 102 abnormal myocardial regions on the stress images, 19 segments at reinjection images and another 17 segments at 24-hour redistribution images demonstrated redistribution. On the other hand, 24-hour imaging showed viability in 17 out of 83 segments (20.4%), which were considered non-viable regions at reinjection image, occurring in 8 out of 25 patients. In stress reinjection protocol by 201Tl, 24-hour redistribution imaging is proposed to be performed in patients who show significant non-viable myocardial tissue at 4-hour reinjection imaging for a better recognition of viable myocardium

The coronary sinus (CS) blood flow can be used as a non-invasive measure of cardiac perfusion. Besides transesophageal echocardiography, transthoracic echocardiography with Doppler flow measurement has been introduced as a feasible and reproducible method to determine the CS blood flow. The purpose of this study was to assess the coronary flow reserve (CFR) by transthoracic imaging of the CS flow in patients with coronary artery disease before and after coronary artery bypass graft surgery (CABG). Twenty-nine patients with coronary artery disease who were candidates for CABG were evaluated in this study. CFR was measured using the CS flow profile. Twenty-one patients, comprised of 15 men and 6 women at a mean age of 56.7 ± 9.1 years, were evaluated. All the patients had a pre-operative increase in their coronary blood flow during the dipyridamole stress test (mean CFR/beat=1.38±0.2, mean CFR/min=1.54±0.18). CFR was significantly higher in post-operative status (mean CFR/beat=2.25±0.45, mean CFR/min=2.55±0.43, p <0.001). Our study, in accordance with previous studies, denotes that a transthoracic measurement of CFR can be used as a feasible and reproducible method to monitor the changes in cardiac perfusion after revascularization

Neurocognitive dysfunction after cardiac surgery with cardiopulmonary bypass (CPB or “pump”) is a common complication, reported in up to 53% of patients. In many patients this morbidity is only mild and transient, but in 5% of cases, it is severe. In this prospective study from June 2002 to July 2004,186 cases underwent coronary artery bypass graft surgery (CABG) using CPB or off-pump CABG (OPCAB), and they were evaluated for neurocognitive complications by mini-mental status examination. The average age of the patients was 56±6.2 years, 62% were male and 38% were female. 121 operations were performed with CPB (on-pump) and 65 operations were done off-pump. Mini-mental status test was normal in 50% of off-pump CABGs and in 43% of on-pump CABGs, very mild disturbance was seen in 48% of off-pump CABGs and in 54% of on-pump CABGs (p value=0.192, NS), mild disturbance was seen in 2% of off-pump CABGs and in 3% of on-pump CABGs (p value 0.392, NS), and moderate or severe disturbance was not seen in either group. In our study, there was no significance difference in the frequency of postoperative neurocognitive complications between off-pump and on-pump CABG patients

Epidemiological evidence shows that among women the incidence of acute myocardial infarction (AMI), risk factors of cardiovascular disease, and mortality rate of AMI are different. The objective of this study was to compare the baseline characteristics, risk factors, medical care, and mortality of AMI between women and men. In this descriptive-analytical study, we examined data from medical charts and administrative files of patients that were hospitalized with AMI between 1994 and 2003 in Birjand hospitals. Questionnaires were completed by two educated nurses under the supervision of a cardiologist and the data were analyzed with SPSS software. From 918 patients, 71.9% were male (M) and 28.1% were female (F). The women were older than the men (mean age 65.62 ± 10.56yr in F vs. 58.98 ± 12.11yr in M) and had a greater incidence of hypertension (50% in F vs. 24.6% in M, p<0.001) and diabetes mellitus (17% in F vs. 9.8% in M, p<0.006), but smoking was more common in the men (13.7% in F vs. 36.3% in M, p<0.001). Intra-hospital mortality was higher in the women but not significantly (10.4% in F vs. 8.6% in M, p=0.42). Fasting blood sugar (FBS), cholesterol level, and diastolic blood pressure (DBP) were significantly higher amongst the women. Women with AMI had older age and higher incidence of diabetes and hypertension. Thus designing interventional programs for reducing these risk factors by education in women is needed.

Several well-established echocardiographic parameters such as tricuspid annular plane systolic excursion (TAPSE), right ventricular outflow tract (RVOT) fractional shortening (FS), myocardial performance index, and Doppler tissue imaging have been used for the assessment of right ventricular (RV) performance. The aim of this study was to evaluate the response of various parameters of RV function to dobutamine infusion in healthy individuals. Thirty-eight participants with negative dobutamine stress testing for the left ventricle and with a mean age of 57 years (range: 40-85 yrs) underwent echocardiography, including measurement of TAPSE, fractional shortening (FS), and TDI (S velocity, strain and strain rate of base, mid, and apex) of the right ventricle at rest and after dobutamine infusion according to standard dobutamine stress testing (DSE) for the evaluation of changes in RV function after DSE. There were significant increases in S velocity (61.1%, P<0.001), FS (19.7%, P<0.001), TAPSE (6.4%, PV=0.026), strain rate (SR) in base (201%), apex (114%) and mid-wall (71%, all P<0.001), and strain in the apical portion (21%, PV=0.001) after dobutamine. There was no significant difference in SR between the RV free wall segments, but strain at mid-segment was more than that in the apical and basal segments at rest. All RV performance parameters increased with the infusion of dobutamine. The mean values for strain rate were homogenous in basal, mid, and apical segments at rest and significantly increased in all the segments. This was in marked contrast to mean strain values, which were greatest in the mid part of the RV free wall at rest and increased only in the apical segment after DSE.

Both high-sensitivity C-reactive protein (hs-CRP) and spiral computed tomography coronary artery calcium score are valid markers of cardiovascular risk. It is unknown whether hs-CRP is a marker of atherosclerotic burden or whether it reflects a process leading to acute coronary events. We studied the association of high-sensitivity C-reactive protein and coronary calcium score in 143 patients that were candidates for coronary artery bypass graft surgery. In our cross sectional study we found no significant association between high-sensitivity C-reactive protein and coronary calcium score in bivariants (p=0.162) and multivariable (p=0.062) analysis, but in patients who did not use statins, this association was significant and positive in bivariant (p=0.001) and in multivariant analysis this association was negative and significant (p=0.008). High-sensitivity C-reactive protein was not associated with coronary calcium score. The relation between C-reactive protein and clinical events might not be related to atherosclerotic burden. Measures of inflammation, such as C-reactive protein, and indices of atherosclerosis, such as coronary calcium score, are likely to provide distinct information regarding cardiovascular risk.

Cardiovascular diseases (CVD) are known as the major life-threatening factors and the most common causes of mortality around the world, especially in developed countries. Many risk factors for CVD are well known, like dyslipidemia, diabetes mellitus, cigarette smoking, hypertension, positive family history, and aging. However, there is evidence recently showing a relation between periodontal diseases (PD) and increased risk of CVD. The basis of this study was to determine any relation between PD and serum levels of total cholesterol, LDL, and HDL so as to investigate whether periodontal disease can facilitate coronary atherosclerosis due to dyslipidemia. In this experimental study, 20 healthy male rats weighing 200 – 250 grams were divided into case and control groups. In the case group (10 rats), we injected 0.6 ml of complete Freund’s adjuvant in the mid-buccal area of both upper and lower jaws; and a sample of blood was taken from all 20 rats to measure the LDL, HDL, and cholesterol. After two weeks, the injection was repeated in the same areas with the same amount of drug; and at the end of the 4th week, blood sampling was repeated in both groups. The inflammation in the case group was confirmed with direct clinical observation and based on histological study at the end of the 4th week. Finally, the serum levels of LDL, HDL, and total cholesterol were compared between the two groups using the independent samples t-test. The statistical tests did not show any significant difference between the two groups. Also, we found no significant difference between the lab test values before and after the study procedure. There was no certain relation between PD and cardiovascular diseases, except for their common risk factors. However, if any relation exists, it might be due to a mechanism other than the serum cholesterol level

Case Report: Coronary artery aneurysm is a relatively infrequent abnormality but its diagnosis has been increased after the advent of coronary angiography. Atherosclerosis accounts for the majority of cases of coronary aneurysms. Other etiologies include congenital aneurysms, dissection, infection, vasculitis, and some other inflammatory conditions. We describe a 41-year-old woman who presented with typical chest pain and dyspnea and had multiple small and large coronary aneurysms associated with stenotic segments

Case Report: An atrial septal aneurysm is an uncommon abnormality and may be the origin of thromboembolic events. We would like to present an unusual case of the septal abnormality with mitral stenosis and history of thrombo-embolic cerebrovascular accident