Iranian Heart Journal
Volume:17 Issue: 3, Fall 2016

We sought to assess the feasibility and outcome of primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI).
Between April 2014 and April 2015, consecutive STEMI patients who underwent primary PCI were prospectively enrolled in a primary PCI registry. The patients’ demographics, risk factors, procedural characteristics, and in-hospital and 6-month major adverse cardiac events (MACE) were assessed.
A total of 393 patients underwent primary PCI during this period. The mean age was 58±11 years and 80.6% were male. Additionally, 40.7% of the patients were hypertensive, 37.9% had dyslipidemia, 37.7% were smokers, and 29% had diabetes mellitus. Single-vessel disease was found in 36.6% of the study population, 2-vessel disease in 30.5%, and multivessel disease in 27.7%. At admission, 74.5% of the patients had TIMI grade 0 flow. Following revascularization, 74.7% achieved TIMI grade 3 flow, 22% TIMI grade 2 flow, and 1.8% TIMI grade 1 flow—as 1.5% had TIMI grade 0 flow. The predictors of the TIMI flow grade after primary PCI included history of diabetes mellitus, lesion severity, time elapsed symptom onset to admission, and use of thrombectomy.
Stent thrombosis developed in 5.6% of the patients; it was more frequent among those receiving bare-metal stents. The in-hospital and 6-month mortality rates were 5.9% and 2.3%, correspondingly. In-hospital mortality was strongly related to the TIMI flow grade.
Our study demonstrated that the outcome of primary PCI was strongly related to the postprocedural TIMI flow grade. Patients with lower TIMI flow grades postprocedurally should receive special attention. (Iranian Heart Journal 2016; 17(3):6-11)

It has been determined in animal models that hyperoxia-induced preconditioning could reduce the ischemia/reperfusion injury of the heart tissue. Short-term ischemia and the subsequent reperfusion occur unavoidably in coronary angioplasty. The purpose of the present study was to determine the possible effects of oxygen pretreatment in inducing preconditioning during percutaneous transluminal coronary angioplasty (PTCA).
Thirty-two patients, referred for elective angioplasty, were randomly divided into the control group and the oxygen group. The subjects in the oxygen group were exposed to normobaric oxygen (nearly 70% O2) via non-rebreathing masks for 1 hour at 12 and 2 hours before PTCA. One hour after the last oxygen pre-exposure period, the patients underwent PTCA (20 s of balloon inflation and 2 min of reperfusion). The chest pain score and cardiac injury biomarkers were assessed 12 hours after coronary angioplasty. The biomarker data and the chest pain scores were analyzed using the Mann–Whitney test and the Wilcoxon t- test. Also, the ratio of patients with positive C-reactive protein results was compared between the groups using the Fisher exact test.
The troponin I and CKMB levels were elevated in both groups after angioplasty, but there was no significant difference between the groups in this regard (P=0.23 and P=0.47, respectively). The average pain score during balloon inflation in the oxygen group was lower than that in the control group (2.8±1.2 vs. 4.11±1.21; P=0.008).
Two episodes of 1-hour pre-exposure to normobaric hyperoxia (nearly 70% O2) at 12 and 2 hours before PTCA had no significant effect on myocardial injury biomarkers, troponin I, and CKMB. (Iranian Heart Journal 2016; 17(3):18-26)

Coronary artery bypass graft surgery is a customary therapy for vascular-related diseases, with many thousands of such a surgical modality reported annually. In this surgery, the saphenous vein, internal mammary artery, or radial artery is grafted in order to replace the coronary arteries. Using a device designed in our own laboratory, we primarily sought to find a suitable model representing the mechanical behavior of the human saphenous vein wall and then to assess its mechanical properties. The most important feature of this device is its ability to simulate the physiological conditions that exist inside the human body. We obtained 2 samples the saphenous opening and the medial epicondyle in patients with hypertension. After performing measurements at frequencies near to the heart beat frequency and finding the loss and storage moduli for each frequency, we found that—in the scanned frequency range—the Kelvin model was the best approach to evaluating the viscoelastic behavior of the vessels. Our findings also indicated that the elasticity and damping coefficients could be deemed equal along the length of the saphenous vein. Accordingly, we would advise that heart surgeons not consider the changes in the mechanical properties along the length of the saphenous vein at the time of transplantation. (Iranian Heart Journal 2016; 17(3):27-35

We aimed to identify the clinical and echocardiographic factors related to false results in the exercise tolerance test (ETT).
The present study included all patients who underwent transthoracic echocardiography and the ETT, followed by coronary angiography, within 6 months prior to echocardiography between March 2008 and March 2013. Clinical, 12-lead resting ECG, ETT, transthoracic echocardiography, and coronary angiography data were extracted. The multivariable logistic regression analysis was used to investigate the independent predictors of the false results of the ETT.
Totally, 4057 patients, who underwent transthoracic echocardiography, ETT, and angiography, were enrolled. 1132 patients with no significant coronary stenosis on angiography, 979 (84%) had false-positive results in the ETT and 153 (14%) had true- negative ETT results. In patients with significant coronary artery disease (CAD), there were 2728 (93%) true-positive and 197 (7%) false-negative ETT results. In our univariate analysis, the patients with false ETT results were more likely to be female and younger than the group with true ETT results. In our multivariable model, female gender increased and right bundle branch block and dilated left ventricular diastolic internal dimension (LVID) decreased the likelihood of a false-positive result in the ETT. The probability of a false- negative result in the ETT was increased by resting ECG changes, hemiblocks, and dilated LVID.
The diagnostic value of the ETT in patients with suspected CAD should be adjusted according to sex, presence of resting ECG changes, CAD risk factors, and traditional echocardiographic measurements. A dilated LV increases the risk of false-negative results and decreases the likelihood of a false-positive result in the ETT. (Iranian Heart Journal 2016; 17(3):36-45)

Intracardiac masses found on 2D echocardiography in patients with leukemia can present diagnostic challenges. A correct differentiation between thrombi, metastases, and infective vegetations is important in the management of patients with leukemia. We describe a 24-year-old male patient, who was diagnosed with acute myelogenous leukemia (APL, AML M3). 2D transthoracic echocardiography showed 2 inhomogeneous highly mobile masses (10×13 and 6×9 mm) in the right ventricle (RV).
The masses were attached to the chordae tendineae and exhibited movements compatible with the cardiac cycle. Cardiac magnetic resonance imaging revealed 3 mobile masses in the RV attached to the RV trabeculations with isosignal intensity on steady-state free precession sequence. There was no obvious evidence of mass invasion or necrosis. On the last transesophageal echocardiography (6 months after the initial admission), the mass did not exist anymore. At the time of paper compilation, the patient has no complaints and is in remission. This report underscores the importance of cardiac magnetic resonance imaging in differentiating intracardiac thrombi aggregations of tumoral cells in APL, AML M3. (Iranian Heart Journal 2016; 17(3):46-50)

The tuberous sclerosis complex (TSC) is most commonly diagnosed around the age of 5 years. Neonatal TSC is rare. The important neonatal manifestations include cardiac rhabdomyomas, central nervous system abnormalities, and skin manifestations. We describe a neonate suffering the TSC with large and multiple cardiac rhabdomyomas. The largest rhabdomyoma measured 3.6 cm × 2 cm almost filling the right ventricle. The neonate did not have any symptoms. She continued to remain asymptomatic until 8 months’ follow-up.