mohammadjavad alemzadeh-ansari

Job burnout can reduce the quality of life, performance, and organizational commitment of nurses and increase the intention to leave the job. Various studies have shown that empowerment of employees and involving them in decision-making can reduce their job burnout. Effective empowering behaviors of supervisors and nursing managers play an important role in empowering nurses. This study aims to determine the relationship between nursing manager’s empowering behaviors and nurses’ job burnout.

This descriptive-correlational study was conducted in 2020. The study population includes all nurses working in the special care units (CCU and ICU) of Shahid Rajaee Heart Hospital. Participants were 165 nurses who were selected by a convenience sampling method. The empowering leadership questionnaire (ELQ) and the Maslach burnout inventory (MBI) were used to collect data. Data analysis was performed using Pearson’s correlation test and multiple linear regression analysis in SPSS software, version 24.

The mean age of participants was 36.73±7.20 years (ranged 24-53 years). One-hundred four nurses (63%) were female and 61(37%) were male. Most of the nurses (59.4%) were married. Pearson’s correlation coefficients showed a negative significant relationship between the scores of the ELQ dimensions and the scores of the MBI dimensions of emotional exhaustion and depersonalization (P<0.001). There was a positive significant relationship between the scores of the ELQ dimensions and the MBI dimension of personal accomplishment (P<0.001).

The empowering behaviors of nursing managers in the study hospital were at a moderate level. The increase in the use of empowering behaviors by nursing managers can lead to a more decrease in the job burnout of nurses in different dimensions.

Coronary artery disease (CAD) is the leading health complication worldwide because of its high prevalence and mortality. The association between CAD susceptibility and the rs599839 (C/T) polymorphism in the human proline and serine-rich coiled-coil (PSRC1) was reported in a genome-wide association study. To validate this association, we performed this case-control study to genotype the 1p13.3 (rs599839) locus in a sample of the Iranian population with CAD (stenosis≥70% in≥1 coronary artery).

We performed an association analysis with PCR and Sanger sequencing of rs599839 (C/T) polymorphism and CAD risk in 280 CAD patients and 287 healthy controls defined as a coronary calcium score of zero and no noncalcified plaques in coronary computed tomography angiography. SPSS, version 16.0, was applied for statistical analysis.

The rs599839 (C/T) locus showed a significant association with CAD (P value<0.001). TT and CT genotypes were associated with CAD (P value<0.001). Furthermore, the dominant status (TT+CT vs. CC) was associated with an increased risk of CAD (OR, 9.14; 95% CI, 3.77 to 22.15; and P value<0.001).

The study findings indicate strong evidence for rs599839 (C/T) association with CAD risk.

Diagnosis and early treatment of the cardiac causes of chest pain are of particular importance. This study aimed to investigate the association between NT-pro-BNP levels as a cardiac marker and the prognosis of patients with chest pain.

All patients visiting the emergency department of a tertiary cardiovascular center with chest pain between October 2016 and March 2017 were evaluated for eligibility. Demographic data, proBNP levels, final diagnosis on angiography, echocardiography, and other symptoms were recorded.

A total of 222 patients at a mean age of 59.0±14.8 years were studied. Totally, 127 patients (57.2%) were male. A significant inverse relationship was found between proBNP levels and the left ventricular ejection fraction (r= -0.316; P<0.001). NT-proBNP levels showed a significant elevation in patients with abnormal size and function of the right ventricle, with regional wall motion abnormalities, and with valvular heart diseases (P<0.05). The BNP level in patients with abnormal angiographic results was 1148.5 (405.3–3214.0), significantly higher than that in patients with normal results (545.0: 90.3–2807.8; P=0.009). The level of this marker in patients with obstructive coronary artery disease (1192.0: 438.8–3233.0) was significantly higher than that in patients with non-obstructive coronary artery disease (620.0: 108.0–2792.0; P=0.001). BNP>841 pg/mL had a sensitivity of 92.9% and a specificity of 47.9% in identifying cases at risk of complications.

NT-proBNP could be a good diagnostic and prognostic marker for patients with chest pain complaints. Measuring this marker upon arrival can help identify patients with cardiac diseases. It is recommended to evaluate patients with elevated levels of this marker for earlier diagnosis and treatment. 

Coronary microvascular function can predict the infarct size and Left Ventricular (LV) functional recovery in patients diagnosed with ST-Elevation Myocardial Infarction (STEMI). Multiple invasive and non-invasive methods are used to evaluate coronary microvascular function. The Non-invasive Index of Microvascular Resistance (NiMR) is a method to evaluate microvascular resistance.

This study aimed to assess the relationship between NiMR and Left Ventricular Ejection Fraction (LVEF) measured by Transthoracic Echocardiography (TTE) in patients with acute STEMI undergoing primary Percutaneous Coronary Intervention (PCI).

This prospective observational study was conducted on 39 patients with STEMI. NiMR was measured instantly after primary PCI. After that, the patients were divided into two groups based on their NiMR: Group 1 (n = 20) with slighter microvascular dysfunction (NiMR < 24) and Group 2 (n = 19) with more severe microvascular dysfunction (NiMR ≥ 24). In the first 24 hours (Echo1) and one month after primary PCI (Echo2), LVEF and the Global Longitudinal Strain (GLS) were measured by TTE.

The mean age of the patients was 58.0 ± 11.3 years, and 34 ones (87.1%) were male. In Echo1, there were no significant differences between the two groups regarding LVEF (39.6 ± 7.8% vs. 38.8 ± 8.6%; P = 0.761) and GLS (−10.2 ± 2.5 vs. −10.9 ± 3.2; P = 0.487). However, LVEF improvement was higher in Group 1 than in Group 2 (Δ LVEF = 5.8 ± 7.3% in Group 1 vs. Δ LVEF = 1.3 ± 8% in Group 2; P = 0.073), but the difference was not statistically significant (OR: 2.8, 95% CI: 0.72 - 10.7; P = 0.13). GLS also exhibited an improvement in both study groups after a month (Δ GLS = 5.4 ± 3.1 in Group 1 vs. Δ GLS = 2.4±3.2 in Group 2; P = 0.005), but this improvement was statistically significant only in Group 1 (OR: 5.5, 95% CI: 1.32 - 22.8; P = 0.01).

In patients with lower NiMR values, LV systolic function recovery (defined by improvement in GLS) was significantly higher one month after STEMI. Thus, NiMR can be used as an early marker of LV performance recovery after acute STEMI.

In tanscatheter aortic valve replacement (TAVR) era, knowing complications related to the procedure guides interventional cardiologist in predicting the obstacles and helps them in manage these infirmities. We describe a case of TAVR which deploying the valve resulted in left ventricle outlet tract (LVOT) obstruction which was perfectly managed pacing and medical therapy.

Transcatheter pulmonary valves (TPVs) are feasible and much less invasive options for surgical right ventricular outflow tract (RVOT) repair or valve replacement in patients with degeneration of the pulmonary valve bioprosthesis or RVOT conduit failure. In 2005, the first Sapien valve was implanted in the pulmonic position, and proceeding In March 2016, the Food and Drug Administration approved the SAPIEN valve (Edwards Lifesciences) for use in malfunctioning RVOT conduits.

We describe the first ten cases of TPV-in-valve procedure conducted in our center, along with the patients’ prior surgical history, procedural details, and their clinical and echocardiographic data.

Our data provided safety and efficacy of transcatheter valve-in-valve procedure in degenerated pulmonary bioprotheses and our follow-up proved durability of this procedure

Atrial fibrillation (AF) is common in hypertrophic cardiomyopathy and it represents the most frequent cause of coronary artery embolism. We describe a male patient with hypertrophic cardiomyopathy with persistent AF, for which he consumed rivaroxaban. The patient received implantable cardioverter-defibrillator shocks for ventricular tachycardia, but he developed acute embolic occlusion in the left main coronary artery (LMCA) following the conversion of the AF rhythm into the sinus rhythm

Pulmonary embolism (PE) is among the deadliest diseases in that it can cause sudden death. The present study aimed to determine cardiac troponin I (CTnI) variation trends in patients with acute PE referred to Rajaie Cardiovascular Medical and Research Center.

This cross-sectional descriptive-analytical study consecutively enrolled 54 patients with acute PE. Variation trends of CTnI were measured in the study population at 5 different time points: upon admission and subsequently 8, 24, 48, and 72 hours post-admission. The relationships between CTnI variation trends and computed tomography angiography, echocardiography, and electrocardiography findings were investigated. CTnI variation trends were compared between a group undergoing catheter-directed thrombolysis (CDT) and a group receiving the conventional anticoagulant treatment. The data were analyzed using the SPSS software, version 20.

A reduction was observed in the CTnI variation trends of all the samples. Both groups exhibited a decline in CTnI levels, but the slope of this reduction was steeper in the CDT group (P=0.04). Additionally, a significant relationship was also detected between CTnI reduction and right ventricular function improvement (P=0.04). No significant association was observed between systolic pulmonary artery pressure changes and CTnI variation trends.

The results indicated a significant relationship between reduced CTnI levels and improved right ventricular function. Additionally, the CDT group showed a significant fall in the CTnI level compared with the anticoagulant-only group. (Iranian Heart Journal 2022; 23(1): 198-204)

Acute pulmonary thromboembolism (PTE) is the most common manifestation of venous thromboembolism (VTE). Due to the physiological response of circulating leukocytes to stress, circulation neutrophils increase and lymphocytes decrease. Therefore, the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) can be important measures to assess the severity of systemic inflammation. We sought to study NLR and PLR and their relationships with the severity of VTE and mortality.

The study enrolled 331 patients with VTE from 2014 through 2018. Based on the complete blood count obtained from the peripheral blood samples of the patients on admission, NLR and PLR were calculated. The incidence of VTE with or without PTE, as well as its severity, was determined based on computed tomography angiography findings and the patients’ clinical status.

A positive relationship was observed between PTE and NLR (P=0.01). There was a significant relationship between the NLR and PLR values and PTE based on computed tomography angiography findings (NLR: P=0.001, PLR: P=0.012), but no relationship was detected between the ratios and the patients’ PTE severity based on clinical status. A significant relationship was also observed between NLR and the main pulmonary artery and segmental involvement (P=0.009), while no such association was seen with PLR. Additionally, the results revealed a significant relationship between NLR and mortality (P=0.030).

Our results demonstrated a significant relationship between the NLR and PLR values and PTE severity based on computed tomography angiography results and also mortality in patients with PTE. (Iranian Heart Journal 2022; 23(1): 65-73)

Accurate diagnoses of cardiac masses constitute a challenge to the cardiologist. Echocardiography plays an essential role, but differentiating between benign and malignant masses that may mimic the features of each other may not be easy by echocardiography. Myxomas are primary benign tumors of the heart with typical echocardiographic features that are generally found in certain locations in the heart. Nonetheless, they are occasionally found in atypical locations in the heart chambers and echocardiographic features mimicking malignant tumors. Myxomas may present with obstructive, embolic, and constitutional symptoms, or they might be found incidentally based on the tumor size and location. Herein, we describe a 78-year-old man with a cardiac mass with echocardiographic features inconsistent with a benign tumor, although further evaluation confirmed it as a myxoma. Benign or malignant cardiac masses could mimic the typical imaging features of each other, and the diagnosis should be based on pathologic findings. (Iranian Heart Journal 2022; 23(1): 233-236)

It is crucial to define the normal ranges of echocardiographic parameters and their relationships with age, sex, race, and geographical differences given the failure of the existing literature to reflect the diversity of the world’s populations. This study aimed to determine the normal ranges of echocardiographic systolic and diastolic values and the incidence of valvular heart lesions with or without rheumatic involvement in a sample of Iranian population.

The Echocardiography Heart Assessment and Monitoring in Rajaie Hospital study is a population-based investigation conducted in Rajaie Cardiovascular Medical and Research Center. Atotal of 2229 Iranian individuals between 30 and 75 years of age without clinical cardiovascular diseases were invited through a multistage random sampling process, and they underwent two‑dimensional and Doppler echocardiography. The left ventricular (LV) ejection fraction, the interventricular septal thickness, the ascending aortic size, the LV diastolic function, the valvular heart disease (VHD) severity, and rheumatic valvular involvement were assessed.

The study population comprised 2229 patients: 882 men (40%) and 1347 women (60%) at an age range of 39–58 years and a mean age of 48 years. The average body mass index was 28.8 kg/m2 (25.9–32 kg/m2 ), and the median body surface area was 1.86. Mildsystolic dysfunction was reported in 119 patients (5.7%) and moderate systolic dysfunction in 19 (0.9%). LV systolic dysfunction was significantly correlated with the male sex, age, and hypertension (P < 0.001). The mean interventricular septal thickness was 8 mm. Mild LV hypertrophy (LVH) was detected in 5.5% of all the patients and moderate LVH in 0.4%. The mean interventricular septal thickness significantly increased with age (P < 0.001), and it was higher in the men than in the women (8.2 mm [7.8–9.2] vs. 8 mm [7–8.25]; P < 0.001). Mild LVH and moderate LVH were significantly correlated with hypertension, diabetes mellitus, hyperlipidemia, chronic kidney disease, and diastolic dysfunction (P < 0.001). Diastolic dysfunction was found in 29% of the patients (28.6% mild and 0.2% moderate). Significant correlations were found between LV diastolic dysfunction and age, the female sex, diabetes mellitus, hypertension, hyperlipidemia, and hypercholesterolemia (P < 0.001). The mean ascending aortic size was 31 mm in the men and 29 mm in the women. The ascending aortic size exceeded 37 mm in 5% of the men and 3.5% of the women. The indexed ascending aortic size was 1.54 cm/m2 in the men and 1.66 cm/m2 in the women. Valvular heart lesions were diagnosed in about half of the study population. The most common findings were mild regurgitation in the mitral and tricuspid valves. Multiple valvular disorders were found in 55% of the patients. Among significant (moderate and more‑than‑moderate) VHDs, tricuspid regurgitation (36%), mitral regurgitation (33%), and aortic regurgitation (19%) were the most frequent VHDs. Rheumatic valvular involvement was diagnosed in 31 (1.4%) patients.

Echocardiographic parameters vary with age, sex, and race, and they should be population adjusted. We recommend further research in different areas of Iran to obtain sufficient data for the creation of an applicable guideline regarding echocardiographic parameters.

Spontaneous coronary artery dissection (SCAD) is a well-documented cause of acute coronary syndrome and could have life-threatening consequences. We report the case of young female with a prior history of cardiac surgery due to congenital aortic stenosis presenting with multi-vessel SCAD. She was successfully managed with medical treatment.

The size of the coronary stent has an important role in the efficacy of stenting and its complications. The present study focused on the clinical outcomes of undersized, normal-sized, and oversized stenting.

This historical cohort study, conducted from April 2016 to March 2017 at Rajaie Cardiovascular Medical and Research Center, analyzed the results of elective percutaneous coronary intervention (PCI) and angiography on patients who met the inclusion criteria. Based on the ratio between the stent and the reference vessel, the patients were divided into 3 groups: undersized stenting (stent diameter/reference vessel diameter <0.9), normal-sized stenting (ratio=0.9–1), and oversized stenting (ratio>1). Data on demographic characteristics, procedural characteristics, underlying diseases, the hospital length of stay, major adverse cardiac events (MACE), post- PCI restenosis, stent thrombosis, and post-PCI cerebrovascular accident were extracted from the patients’ files and entered into a checklist.

Oversized stenting significantly reduced the incidence of MACE 1 year after PCI compared with undersized and normal-sized stenting. The incidence of rehospitalization for acute coronary syndrome was 7.5 times lower in oversized stenting than in undersized stenting (P=0.002). The incidence of re-PCI on the involved vessel decreased significantly with an increase in the stent size (P=0.017). Additionally, there was no incidence of stent restenosis in oversized stenting (P=0.001). The other outcomes had no significant correlation with the stent size.

Based on the results of our study, oversized stenting could improve clinical outcomes. (Iranian Heart Journal 2021; 22(2): 44-50)

Coronary artery disease is the leading cause of mortality worldwide. With the increasing number of elderly people and the development of stents, the tendency to perform percutaneous procedures has increased, leading to an increased risk of complications known as major adverse cardiovascular events (MACE). This study aimed to assess the association between demographic, laboratory, and angiographic findings and MACE in patients undergoing elective angiography.

This cross-sectional descriptive study enrolled 300 patients older than 18 scheduled for elective angiography in Rajaie Cardiovascular Medical and Research Center between 2015 and 2016. Those who did not undergo stenting or needed surgery initially were excluded, leaving 207 patients. The demographic, laboratory, and angiographic data of these patients were collected, and they were then followed for 2 years.

During a mean follow-up of 24 months, MACE occurred in 20 (9.60%) patients, with 1 patient experiencing 2 events. There was significant relationships between older age (P = 0.01), the female gender (P < 0.0001), the body mass index (P < 0.0001), total cholesterol (P = 0.01), low-density lipoprotein (P = 0.001), high-density lipoprotein (P = 0.003), triglycerides (P = 0.014), hemoglobin (P = 0.004), lower glomerular filtration rates (P < 0.0001), higher post-angiography troponin I (P < 0.0001), and fasting blood sugar (P < 0.0001) and MACE. There were also relationships between the incidence of cardiovascular diseases and the number of diseased vessels (P = 0.047) and between the need for repeated revascularization and the number of vessels (P = 0.01).

As many MACE risk factors are modifiable, we suggest that patients with the aforementioned risk factors be monitored more closely after percutaneous coronary interventions to predict and prevent the incidence of MACE. (Iranian Heart Journal 2020; 21(4): 93-102)

Cardiovascular diseases, including coronary artery disease (CAD), are among the most common causes of death in the elderly population. Recent studies have found that coronary artery calcium score (CACS) is a strong independent predictor of CAD. Here we aimed to investigate the association between CACS and demographic, clinical, laboratory, and CT angiographic findings in patients with suspected CAD.

From June 2008 to August 2018, we retrospectively reviewed 219 consecutive patients suspected with CAD who were referred for CT angiography in Rajaie Cardiovascular, Medical, and Research Center. Medical records were reviewed, and relevant demographic, clinical, laboratory and imaging were collected.

A total of 219 patients with an average age of 62.64±12.39 were included. Twelve patients (5.5%) had normal coronary angiography, and 50.2% had mild CAD. An obstructive CAD was found in 97 patients (44.3%). The median CACS was 76.4 (IQR, 13.0-289.1). The frequency of obstructive CAD was 28.1% in the CACS <100 group, and 67.0% in CACS >100 group (P<0.001). On multiple logistic regression analysis, age (OR=1.04 [1.01-1.07], P=0.006), CACS (OR= 4.31 [2.33-7.98], P<0.001), and neutrophil to lymphocyte ratio (NLR) (OR = 0.82 [0.68-0.98], P=0.027) were independent predictors of obstructive CAD.

We found a direct association between higher CACS and obstructive patterns in coronary CT angiography. Our findings indicate that the possibility of the presence of obstructive CAD was higher among symptomatic patients with older age, lower NLR, and CACS >100.

Clinical registries are a targeted way of data collection aimed at finding a solution to a specific clinical inquiry. The present report introduces the Rajaie Cardiovascular, Medical and Research Center percutaneous coronary intervention (RHC-PCI) Registry. The primary objectives of the RHC-PCI Registry consist of monitoring different complex PCI procedures and their mutual impact on interventional cardiology programs.

RHC is a large and well-known cardiovascular tertiary center in Iran. The RHC-PCI Registry was first launched in 2015, since which time it has collected >5000 parameters regarding the baseline, clinical, and procedural characteristics of various PCI procedures. Noncomplex coronary interventions, bifurcation stenting, left main interventions, chronic total occlusion (CTO) PCI, and bypass graft interventions comprise the major categories gathered by the RHC-PCI Registry. The main registry outcomes are comprised in-hospital mortality, major adverse cardiovascular events, vascular access site complications, and 6-month all-cause mortality.

In this primary report, we elaborate on the principal infrastructure of the RHC-PCI Registry and present a synopsis of the registry scope. During the first 40 months of the registry, 11,005 patients underwent PCI. The acute coronary syndrome was reported in 5043 (45.8%) patients. Bifurcation stenting, left main interventions, CTO PCI, and bypass graft interventions were performed in 1679 (15.2%), 236 (2.1%), 946 (8.5%), and 764 (6.9%) patients, respectively. The preferred access site was the femoral artery (n = 6614, 60%), and drug-eluting stents were deployed in 9230 (83.8%) patients. In-hospital mortality in the total registry data was reported in 104 (0.9%) patients.

This report introduces the RHC-PCI Registry, its primary objectives, infrastructure, and preliminary results (the 3-year outcome).

Cardiovascular diseases(CVDs) impose great burden on the health systems worldwide. The prevention of CVDs depends on the correct information about the perveance/incidence of them and their determinants in the community and population-based studies are the most accurate ways for obtaining these data. The objective of this study is to determine the prevalence of the classic risk factors of CVDs among healthy adult residents of Tehran and their changes through a 10-year follow-up in Tehran, the capital of Iran. This article presents the study protocol.

Heart Assessment and Monitoring in RAjaie Hospital, is a population-based study conducted in Rajaie Cardiovascular Medical and Research Center, the largest tertiary care hospital for CVDs in Tehran. It consists two phases: Asurvey and a prospective cohort. People between 30 and 75years of age, without known CVDs, invite through a multistage random sampling process. They will assess for the CVD risk factors, laboratory indices, electrocardiography and echocardiography features, diet, physical activity levels, psychological aspects, and peripheral vascular diseases. All the participants will be followed for 10years and the changes in the above-mentioned factors and incidence of CVDs assessed.

It is expected that through obtaining valid, population-specific data, the information for policy making and efficient management of CVDs in Iranian people be provided

In patients with heart failure, elevated levels of blood urea nitrogen (BUN) is a prognostic factor. In this study, we investigated the prognostic value of elevated baseline BUN in short-term mortality among patients with acute pulmonary embolism (PE).

Between 2007 and 2014, cardiac biomarkers and BUN levels were measured in patients with acute PE. The primary endpoint was 30-day mortality, evaluated based on the baseline BUN (≥14 ng/L) level in 4 groups of patients according to the European Society of Cardiology’s risk stratification (low-risk, intermediate low-risk, intermediate high-risk, and high-risk).

Our study recruited 492 patients with a diagnosis of acute PE (mean age=60.58±16.81 y). The overall 1-month mortality rate was 6.9% (34 patients). Elevated BUN levels were reported in 316 (64.2%) patients. A high simplified pulmonary embolism severity index (sPESI) score (OR: 5.23, 95% CI: 1.43–19.11; P=0.012), thrombolytic or thrombectomy therapy (OR: 2.42, 95% CI: 1.01–5.13; P=0.021), and elevated baseline BUN levels (OR: 1.04, 95% CI: 1.01–1.03; P=0.029) were the independent predictors of 30-day mortality. According to our receiver-operating characteristics analysis for 30-day mortality, a baseline BUN level of greater than 14.8 mg/dL was considered elevated. In the intermediate-low-risk patients, mortality occurred only in those with elevated baseline BUN levels (7.2% vs. 0; P=0.008).

An elevated baseline BUN level in our patients with PE was an independent predictor of short-term mortality, especially among those in the intermediate-risk group.

Albeit coronary artery angiography is the gold standard of the diagnosis of coronary artery disease (CAD), coronary artery calcification (CAC) is a less invasive diagnostic method. We evaluated pulsed-wave velocity (PWV) as another accessible diagnostic tool to detect early CAD in the Iranian population.

From March 2016 to March 2017, we enrolled 350 patients referred for an evaluation of CAD to Rajaie Cardiovascular, Medical, and Research Center (Tehran, Iran). The patients underwent coronary artery computed tomography angiography, and their CAC scores were measured simultaneously. The PWV index was defined as the distance between the brachial and dorsalis pedis arteries divided by time, and the correlations between the PWV index and the CAC score and known CAD risk factors were assessed.

From 350 patients, 52.3% were men and the rest were women. The mean PWV was 8.7 ± 2.2 m/s and the mean CAC score was 251 ± 99.52. There was no significant relationship between the CAC score and the PWV index (P = 0.16). In the women, the CAC score and the PWV index were meaningfully higher (P ≤ 0.001 and P < 0.04, respectively). The CAC score was significantly different between the patients with and without CAD (P <0.001), whereas there was no difference concerning the PWV index (P = 0.31). Among all CAD risk factors, hypertension and diabetes mellitus were significantly correlated with the CAC score (P = 0.001 and P = 0.015, correspondingly) and the PWV index (P = 0.001 and P = 0.009, respectively).

In contrast to some recent studies that have shown a significant increase in the PWV index in relation to the CAC score, our results did not prove it. The PWV index, thus, needs further studies if it is to be fully utilized in clinical practice

A 60-year-old man presented with typical chest pain of the New York Heart Association function class III. The patient mentioned a history of stroke, hypertension, hyperlipidemia, and gastrointestinal bleeding. Angiography revealed a total cut in the mid-portion of the left anterior descending (LAD), a total cut in the ostial portion of the second branch of the diagonal branch of the left circumflex artery (LCX) as well as significant segmental stenosis in the mid-portion of the LCX, and also a significant lesion in the mid-portion of the right coronary artery (RCA). He was scheduled for a multivessel percutaneous coronary intervention (PCI). The LAD was wired with a 0.014-PILOT 150 guidewire, and 2 drug-eluting stents were deployed in the LAD. Six weeks later, the patient experienced chest pain again, despite receiving full medical treatment. The next angiography showed an unexpected pseudoaneurysm, in the mid-portion of the LAD exactly at the site of the stenting performed in the previous PCI. We considered coronary artery bypass grafting given the high possibility of thrombosis in the LAD and the presence of lesions in the RCA and the LCX. Conclusions Coronary aneurysms, albeit rare after PCI, can be life-threatening complications. Early diagnosis can be lifesaving. Chest pain after any intervention should flag up complications, especially in the absence of response to medical treatment. Regular follow-ups are the key to the diagnosis of any complications in the golden time for treatment. (Iranian Heart Journal 2020; 21(2): 84-89)

The risk of contrast-induced nephropathy (CIN) as a common and important complication of coronary procedures may be influenced by the vascular access site. We compared the risks of CIN in diagnostic or interventional coronary management between patients treated via the transradial access (TRA) and those treated via the transfemoral access (TFA).

Patients undergoing invasive coronary catheterization or percutaneous coronary intervention (PCI) were enrolled. We excluded patients with congenital or structural heart disease and those with end-stage renal disease on dialysis. Based on the vascular access site used for invasive coronary catheterization, the patients were divided into 2 study groups: the TFA and the TRA. CIN was defined as an absolute (≥0.5 mg/dL) or relative (>25%) increase in the baseline serum creatinine level within 48 hours following cardiac catheterization or PCI.

Overall, 410 patients (mean age=61.3±10.8 years) underwent diagnostic or interventional coronary management: 258 were treated via the TFA approach and 152 via the TRA approach. The patients treated via the TFA had a significantly higher incidence of postprocedural CIN (15.1% vs 6.6%; P=0.01). The multivariate analysis showed that the TFA was the independent predictor of CIN (OR: 2.37, 95% CI: 1.11 to 5.10, and P=0.027). Moreover, the BARC (Bleeding Academic Research Consortium) and Mehran scores were the other independent predictors of CIN in our study.

The risk of CIN was lower with the TRA, and the TFA was the independent predictor of CIN after the diagnostic or interventional coronary management.

Duchenne muscular dystrophy is an X-linked disease and the carriers are almost asymptomatic but rarely, they may present with muscular and even cardiac manifestations.

This report presents a 41-year-old female case as a carrier of Duchenne muscular dystrophy who presented at our centre with cardiomyopathy, 2.5 months after delivery. Three differential diagnoses including DCM, postpartum cardiomyopathy and cardiomyopathy due to Duchenne muscular dystrophy were considered for this case. According to findings of patient’s CMR, cardiomyopathy due to Duchenne muscular dystrophy was recognized as the most probable disease in this case.

Based on the undertaken investigations, screening with cardiac MRI and echocardiography is recommended for carriers.

Primary aldosteronism is characterized by hypertension, suppressed plasma renin activity, increased aldosterone excretion, and hypokalemia with metabolic alkalosis. Ventricular arrhythmia is an uncommon finding. We report the case of a 46-year-old female who was referred to our center due to uncontrolled ventricular arrhythmia. The past medical history was positive for hypertension. On admission, echocardiography showed severe left ventricular (LV) dysfunction. Blood examination revealed severe hypokalemia. She had been diagnosed with acute coronary syndrome and decompensated heart failure elsewhere and was given diuretics. A diagnosis of primary aldosteronism due to adrenal adenoma was made according to laboratory findings and imaging modalities. The prompt management of bradycardia and correction of hypokalemia, along with surgical resection of adrenal adenoma, resulted in control of arrhythmias and improvement in LV function.

Radial artery occlusion (RAO) is one of the few postprocedural complications of transradial approach (TRA) which may be symptomatic in some cases. The aim of this study was to investigate the safety and efficacy of enoxaparin compared with unfractionated heparin (UFH) for preventing RAO among patients who underwent elective diagnostic coronary artery angiography (CAG) via TRA.
Patients and This randomized clinical trial study was conducted on patients who underwent TRA for elective diagnostic CAG. Then, the patients included were randomly divided into 2 groups. A group received 0.75 mg enoxaparin intravenously and the second group received 70–100 IU/Kg UFH single-bolus dose intravenously. During 24 h after the procedure and 3 months later, all the participants were monitored for the occurrence of RAO, access hematoma, periprocedural myocardial infarction, stroke, and death.
From 189 patients with mean age of 52.52 ± 6.23 years old, 95 patients received UFH (70–100 IU/kg), and the other group (n = 94) received enoxaparin after radial sheath insertion. After 24 h, decrease in radial pulse was observed in 17.6% patient (14.9% in UFH group and 20.2% in enoxaparin group) and only one patient had absent radial pulse in UFH group. There were no significant differences between UFH group compared with enoxaparin group in the reduction of the radial pulse that examined with reverse Allen test (P = 0.359). Furthermore, other complications did not differ significantly between the two groups.
This study demonstrates that intravenous enoxaparin administration compared with intravenous UFH during diagnostic CAG via TRA is a safe and effective strategy for preventing RAO at 24 h after the procedure.