فهرست مطالب

Tehran University Heart Center - Volume:15 Issue: 4, Oct 2020

The Journal of Tehran University Heart Center
Volume:15 Issue: 4, Oct 2020

  • تاریخ انتشار: 1400/01/21
  • تعداد عناوین: 10
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  • Maryam Esfahani, Saeed Bashirian, Fereshteh Mehri, Salman Khazaei* Pages 151-157
    Background

    Silica exposure is detrimental to health and has, thus, been a global health concern. We performed a systematic review and meta-analysis of existing articles to assess the involvement of silica exposure in cardiovascular disease (CVD) mortality.

    Methods

    Electronic databases including Web of Sciences, Scopus, PubMed, and Google Scholar were searched for eligible publication until December 2019. The pooled standard mortality ratio (SMR) and the 95% confidence interval (CI) were used to detect the association between silica exposure and CVD mortality.

    Results

    The pooled estimates of SMR indicated a nonsignificant association between silica exposure and CVD mortality (SMR: 1.26; 95% CI: 0.88-1.63). The subgroup analysis based on the type of CVD indicated a significant positive association between silica exposure and mortality from hypertensive heart disease (SMR: 2.45; 95% CI: 2.16 -2.74) and pulmonary heart disease (SMR: 4.03; 95% CI: 3.87-4.20).

    Conclusion

    This study confirmed that silica exposure is associated with an enhanced risk of mortality of hypertensive and pulmonary heart diseases. The verification of these results may have important effects on basic preventive strategies for health-care providers. Because of the mismatch in the silica exposure classification, some works in the literature were excluded. Also, the years of silica exposure may be important in CVD mortality. We suggest that these potential confounders be considered in future research.

    Keywords: Silicosis, Cardiovascular diseases, Coronary artery disease, Angina pectoris
  • AliReza Ahmadi, MohammadReza Sabri, Zohreh Sadat Navabi, Mehdi Ghaderian, Bahar Dehghan, Chehreh Mahdavi, Somaieh Khodarahmi Pages 158-164
    Background

    In 2016, a prospective registry for pediatric patients with congenital heart disease (CHD) was established in Isfahan, Iran. Data on pediatric CHD in Iran are scant; accordingly, we aimed to report the early results of the Persian Registry Of cardioVascular diseasE (PROVE/CHD) Registry in Isfahan.

    Methods

    All patients with CHD and associated defects diagnosed by pediatric cardiologists were assessed via echocardiography for inclusion in the present study between late 2016 and August 2019. The participants’ sociodemographic characteristics, maternal history, birth history, medical history, current clinical presentations in the clinic or hospital, paraclinical data, cardiac diagnoses based on the International Classification of Diseases, 10th Revision (ICD-10), disease management plans, and medications were entered into a questionnaire by the subjects’ parents/legal custodians and physicians and then transferred to the PROVE/CHD Registry.

    Results

    The PROVE/CHD registry encompasses 1252 patients with CHD (49.9% male) at a mean age of 6.50±6.36 years. The most frequent cardiac diagnoses were ventricular septal defect (39.3%), atrial septal defect (29.7%), patent ductus arteriosus (25.4%), pulmonary stenosis (11.0%), tetralogy of Fallot (6.1%), coarctation of the aorta (5.4%), and aortic stenosis (5.1%), respectively. The most frequent interventions were patent ductus arteriosus closure (4.3%), atrial septal defect closure (3.6%), pulmonary valvuloplasty (2.2%), coarctation of the aorta angioplasty (1.9%), and ventricular septal defect closure (1.1%), correspondingly. The approximate corresponding rates of corrective and palliative surgeries were 32.0% and 13.1%. The corrective surgeries were mainly comprised of ventricular septal defect closure (7.8%), patent ductus arteriosus closure (7.3%), atrial septal defect closure (5.1%), and tetralogy of Fallot repair (3.8%), respectively. The palliative surgeries mainly consisted of the Glenn shunt (9.0%) and pulmonary artery banding (3.6%).

    Conclusion

    The PROVE/CHD Registry collects data on pediatric patients with CHD. The results of this registry can provide epidemiological data and a set of homogeneously defined cases for further studies.

    Keywords: Heart defects, congenital, Disease management, Registries
  • Negar Omidi, Saeed Sadeghian, Mojtaba Salarifar, Arash Jalali, Seyed Hessam Abbasi, Negin Yavari, Seyyed Mojtaba Ghorashi, Mohammad Alidoosti, Hamidreza Poorhosseini* Pages 165-170
    Background

    Acute coronary syndrome (ACS) is one of the main causes of mortality worldwide. We sought to evaluate the correlation between the severity of coronary artery disease (CAD) and conventional coronary artery risk factors in a large cohort of patients with ACS.

    Methods

    This study included all patients admitted to the coronary care unit with a diagnosis of ACS between 2003 and 2017. The patients were divided into 2 groups: 1) unstable angina and 2) myocardial infarction. The aims of this study were to evaluate the effects of the risk factors and extension of coronary artery stenosis in patients with ACS according to the Gensini score.

    Results

    Of a total 40 319 patients who presented with ACS, 18 862 patients (mean age =60.4±11.14 y, male: 67.2%) underwent conventional coronary angiography and met our criteria to enter the final analysis. The median of the Gensini score was 50 (25–88) in the study population. The multivariable analysis showed that age, sex, diabetes mellitus, hypertension, dyslipidemia, family history, cigarette smoking, opium consumption, and myocardial infarction increased the risk of positive Gensini scores. All the aforementioned risk factors, except cigarette smoking and opium consumption, increased the severity of stenosis in those with positive Gensini scores. The strongest relationship was seen vis-à-vis myocardial infarction, sex, and diabetes mellitus.

    Conclusion

    Our findings suggest that age, sex, diabetes mellitus, dyslipidemia, hypertension, family history, and myocardial infarction have significant effects on the severity of CAD. The obesity paradox in relation to CAD should be taken into consideration and needs further investigation in patients with ACS.

    Keywords: Acute coronary syndrome, Coronary artery disease, Myocardial infarction, Risk factors
  • Alireza Amirzadegan, Seyed Ali Sadre Bafghi, Saeed Ghodsi, Hamidreza Soleimani, Mehrnaz Mohebi, Ebrahim Nematipour, Ali Mohammad Haji Zeinali, Mojtaba Salarifar, Hamidreza Pourhosseini, Yones Nozari, Masih Tajdini, Hassan Aghajani, Mohammad Alidoosti, Yaser Jenab, Negar Omidi, Arash Jalali, Zahra Hosseini Pages 171-177
    Background

    Coronary artery ectasia (CAE) is a rare condition with unclear pathophysiology, optimal treatment, and prognosis. We aimed to determine the prognostic implications of CAE following coronary angioplasty.

    Methods

    We conducted a retrospective cohort study on 385 patients, including 87 subjects with CAE, who underwent percutaneous coronary intervention (PCI). Major adverse cardiovascular events (MACE) were considered to consist of mortality, nonfatal myocardial infarction (MI), repeated revascularization, and stroke.

    Results

    The mean age of the participants was 57.31±6.70 years. Multivariate regression analysis revealed that patients with diabetes, ST-segment–elevation MI at presentation, and high thrombus grades were more likely to have suboptimal post-PCI thrombolysis in myocardial infarction (TIMI) flow. However, CAE was not a predictor of a decreased TIMI flow (OR: 1.46, 95% CI: 0.78–8.32; P=0.391). The Cox-regression model showed that CAE, the body mass index, and a family history of MI were risk factors for MACE, while short lesion lengths (<20 vs >20 mm) had an inverse relationship. The adjusted hazard ratio (HR) for the prediction of MACE in the presence of CAE was 1.65 (95% CI: 1.08–4.78; P=0.391). All-cause mortality (HR: 1.69, 95% CI: 0.12–3.81; P=0.830) and nonfatal MI (HR: 1.03, 95% CI: 0.72–4.21; P=0.341) occurred similarly in the CAE and non-CAE groups. Conversely, CAE increased urgent repeat revascularization (HR: 2.40; 95% CI: 1.13–5.86; P=0.013).

    Conclusion

    Although CAE had no substantial short-term prognostic effects on post-PCI TIMI flow, considerable concerns regarding adverse outcomes emerged during our extended follow-up. Stringent follow-ups of these patients should be underscored due to the high likelihood of urgent revascularization.

    Keywords: Coronary artery disease, Percutaneous coronary intervention, Dilatation, pathologic, Mortality, Prognosis
  • Marija Bjelobrk, Slobodan Dodic, Tatjana Miljkovic, Golub Samardzija, Ilija Bjeljac, Dragana Dabovic, Biljana Dodic, Milenko Rosic, Mila Kovacevic, Aleksandar Redzek, Miklos Fabri Pages 178-182

    The most common cause of coronary artery aneurysms is atherosclerosis, which is associated with over 50% of all aneurysms diagnosed in adults. Although patients can be asymptomatic throughout their lives, giant coronary artery aneurysms can manifest themselves as myocardial infarction, aneurysmal rupture, and sudden cardiac death as well. Herein, we describe an asymptomatic patient with numerous risk factors and a positive cardiopulmonary exercise test who was admitted to the cardiology clinic for coronary angiography. A giant coronary artery aneurysm (3.0×2.0 cm in diameter) in the left anterior descending coronary artery and significant stenosis in both left and right coronary arteries were found. After discussing possible treatment options, the hospital’s heart team recommended the surgical resection of the aneurysm and double coronary artery bypass graft. Four years after the cardiac surgery, at the time of writing the current manuscript, the patient is still in good condition and with no symptoms.

    Keywords: Coronary aneurysm, Atherosclerosis, Cardiac surgical procedures, Prognosis
  • Roya Sattarzadeh, Saeed Ghodsi, Masoud Eslami, Reza Mollazadeh, Reza Safaei Nodehi, Zahra Hosseini Pages 183-188

    Cutaneous T-cell lymphomas constitute a rare category of non-Hodgkin lymphomas, which may involve the heart in the timeline of their natural course as an infrequent picture with a poor prognosis. Syncope, either due to outflow obstruction or conduction block, is also an uncommon presentation of cardiac metastasis. We herein describe a 35-year-old man, who presented with weight loss, dyspnea of 6 months’ duration, an indolent skin ulcer in the left flank, lower limb deep vein thrombosis (DVT), and recurrent syncope. He underwent implantation of a permanent pacemaker due to a complete heart block and received anticoagulants for the DVT. Skin biopsy demonstrated a T-cell lymphoma. The syncopal episodes ceased thereafter. Echocardiography and computed tomography scan revealed cardiac metastasis, which responded to systemic chemotherapy. In the first follow-up visit after 3 months, he was still pacemaker-dependent. However, the DVT was partially resolved, and the symptoms had disappeared.

    Keywords: Lymphoma, T-cell, Syncope, Neoplasm metastasis, Atrioventricular block, Consolidation chemotherapy, Echocardiography
  • Mehdi Peighambari, Marziyeh Pakbaz, Azin Alizadehasl *, Saeid Hosseini, Hamidreza Pouraliakbar Pages 189-194

    Coronary artery fistulas constitute a rare anomaly defined as an abnormal communication between a coronary artery and a great vessel or any cardiac chamber. The majority of these fistulas arise from the right coronary artery and the left anterior descending coronary artery; the circumflex coronary artery is rarely involved.  We present an unusual case of a coronary artery fistula in a middle-aged woman who presented with symptoms of heart failure and abnormal auscultation. Echocardiography and conventional and computed tomography angiography showed that the coronary fistula originated from the left circumflex coronary artery and drained majorly into the right ventricle. Given the complex anatomy of the fistula, we managed it surgically rather than percutaneously. There were no complications early after surgery and at 1 year’s follow-up.

    Keywords: Heart Defects, Congenital, Fistula, Computed tomography angiography
  • Marjan Hadadi, Ali Hosseinsabet*, Ali Bozorgi Pages 195-196
  • Saeed Changizi Ashtiyani, MohammadHossein Asadi Pages 197-198
  • Behshad Naghshtabrizi, Saeed Bashirian, Naghme Shirafkan, Nima Naghshtabrizi, Fereshteh Mehri Pages 199-201

    In  this letter we have focused on two important issues, possible risk of MI in patients who are infected with SARS- Cov-2 and different therapeutic protocols that are currently applying for management of them which may be harmful in this group of patients with heart disorders who are infected with SARS- Cov-2 patients and must be replaced with safer ones. So, Calcineurin inhibitor and cyclosporine are more likely to have less cardiac side effects in these patients. Finally, it should be considered that Calcineurin inhibitor and cyclosporine require extensive clinical trial for evaluation of their effects in patients with heart disorders who are infected with SARS- Cov-2 patients.