ORIGINAL_ARTICLE
Estimation of left ventricular end diastolic pressure (LVEDP) in patients with ischemic heart disease by echocardiography and compare it with the results of cardiac catheterization
BACKGROUND: Doppler echocardiography has been proposed as an appropriate non-invasiveassay to estimate left ventricular end diastolic pressure (LVEDP). The aim of present researchwas to estimate the LVEDP in patients with ischemic heart disease by echocardiography andcompare it with the results of cardiac catheterisation and to determine the effect of differentechocardiographic variables on its measurement.METHODS: In this descriptive-analytic study, patients with diagnosed ischemic heart diseasewere selected by nonrandomized sampling method. Selected population underwent M-modeand pulse doppler echocardiographic evaluation and parameters such as Q-Mitral valve E(Q-MVE), Q-Aortic valve closure (Q-AVC), Aortic valve closure-E (AVC-E), Q-Mitral valveclosure/Aortic valve closure-E (Q-MVC/AVC-E), left ventricle-deceleration time (LV-DT), peakvelocity-deceleration time (PV-DT) and A/E velocity time integral (A/E VTI) were evaluated.Immediately after echocardiography all patients underwent left heart catheterization for LVEDPmeasurement. The relation between different echocardiographic measurements and LVEDP,obtained by cardiac catheterization, was evaluated.RESULTS: In this study, 47 patients with ischemic heart disease with mean age (±SD) of53 ± 13 were studied. There was a significant correlation between LVDEP and A/E VTI (r=0.44,P = 0.001, and also between LVEDP and PV-DT in patients with A/E VTI ≥1.1(r = -0.58, P = 0.02).There was a significant correlation between LVEDP and Q-MVC/AVC-E in patients with LVEDP>18mmHg (r = 0.76, P= 0.03) and those with LVEDP ≤18 mmHg and A/E VTI < 1.1(r = 0.37, P= 0.03). The correlation between LVEDP and A/E VTI was more significant in men,in patients aged > 50 years with EF > 55%, without LVH, without MR and those with coronaryartery disease (P < 0.05).CONCLUSION: Some echocardiographic indices such as A/E VTI, Q-MVC/AVC-E and PV-DTare able to measure LVEDP especially in male patients aged > 50 years, without LVH, withoutMR and those with coronary artery disease but it is necessary to determine specific conditionsand factors affecting these indices, by further studies.Keywords: LVEDP, Coronary Artery Disease, Echocardiography.
https://arya.mui.ac.ir/article_10218_578fd6bc97d8e57650a0732d705eb4fb.pdf
2011-04-23
1
6
Masoud
Pourmoghaddas
m_pourmoghadas@med.mui.ac.ir
1
Professor, Cardiac Rehabilitation Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
LEAD_AUTHOR
Hamid
Sanei
2
Associate Professor, Cardiac Rehabilitation Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
AUTHOR
Aliakbar
Tavassoli
3
MD, Associate Professor of Cardiology, Cardiac Rehabilitation Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
AUTHOR
Mohammad
Shojaei
4
Cardiologist, Cardiac Rehabilitation Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
AUTHOR
ORIGINAL_ARTICLE
The effect of contrast dye injection and balloon inflation on QTC and QTC dispersion in 12 leads surface ECG during PTCA
BACKGROUND: Considering that determining the effect of both contrast dye injection and balloon inflation on electrophysiological parameters would help us to predict the ischemic event during PTCA, the aim of this study was to determine the effects of these factors on QTc and QTc dispersion during PTCA in Isfahan. METHODS: In this cross-sectional study, consecutive patients undergoing elective PTCA in Chamran hospital in Isfahan enrolled. All patients were in sinus rhythm. A 12-lead electrocardiogram was continuously recorded before (baseline) and during PTCA after dye injection and balloon inflation. QTc and QT dispersion was calculated in all 12 leads of electrocardiogram during the mentioned times and compared with each other. RESULTS: 33 patients with mean age of 49.1 ± 16.2 years were studied. Anatomic distribution of the coronary artery stenosis was as follows: left anterior descending artery (LAD) in 76.7% patients, left circumflex (Cx) in 16.6% and right coronary (RCA) in 6.66%. Mean of QTc at baseline, after contrast dye injection and after balloon inflation was 423.9 ± 28.5, 437 ± 29 and 437 ± 22 msec, respectively (P < 0.05). Mean of QTc dispersion at baseline, after contrast dye injection and after balloon inflation was 92.3 ± 7.2, 95.4 ± 8.3 and 93.75 ± 7.5, respectively (P > 0.05). CONCLUSION: The findings of this research supports the fact that during PTCA a transient myocardial ischemia occurs but further studies is recommended to accurately determine the stages at which ischemia occurred and the extent of its effect of it on cardiac depolarization and repolarization periods.Keywords: PTCA, QTc, QTc dispersion, Balloon inflation, Contrast dye injection.
https://arya.mui.ac.ir/article_10225_55d7de66550aecb09c6cc7aabd50fc31.pdf
2011-04-23
7
10
Hamid
Sanei
saneei@med.mui.ac.ir
1
Associate Professor, Cardiac Rehabilitation Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
LEAD_AUTHOR
Masoud
Pourmoghadas
m_pourmoghaddas@med.mui.ac.ir
2
Professor, Cardiac Rehabilitation Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
AUTHOR
Mansour
Sholevar
3
Professor of Medicine and Cardiology, Isfahan University of Medical Sciences, Isfahan, Iran.
AUTHOR
ORIGINAL_ARTICLE
The association between epicardial fat thickness in echocardiography and coronary restenosis in drug eluting stents
BACKGROUND: The association between epicardial fat and coronary in-stent restenosis hasnot been evaluated. The objective of the present study was to evaluate the relationship ofechocardiographic epicardial fat thickness (EFT) with restenosis in drug eluting stents (DES).METHODS: In this study, 117 patients who underwent coronary angiography due to recurrentclinical symptoms or findings of non-invasive cardiac tests one year after stent implantationwere selected. According to angiographic results, they were divided into two groups, 65 patientswith in-stent restenosis (case group) and 52 patients without such finding (control group). EFTwas measured perpendicularly on the free wall of the right ventricle at the end of systole in twoechocardiographic views (parasternal short and long axis) at least in three cardiac cycles. Theaverage of obtained values was determined and recorded as EFT. Furthermore, the history ofhypertension, smoking and diabetes, age and sex were investigated and body mass index (BMI)of each patient was also calculated.RESULTS: There were no significant differences in the baseline characteristics (P = 0.812).Patients with in-stent restenosis did not have statistically significant difference (4.6 ± 1.8 mm)in EFT compared to subjects with patent stents (4.5 ± 1.8 mm; P = 0.88). The above results werealso confirmed using multiple linear regressions. No significant correlation was found betweenEFT and other clinical variables (P > 0.05).CONCLUSION: In this selected population, the risk of restenosis was not correlated withepicardial fat thickness. Future studies for determining the role of epicardial fat in developmentof in-stent restenosis are warranted.Keywords: Epicardial Fat Thickness, Echocardiography, In-stent Restenosis (ISR).
https://arya.mui.ac.ir/article_10219_0d1567633c017b2f06653242f103371d.pdf
2011-04-23
11
17
Fariborz
Nikaeen
1
Associate Professor, Department of Cardiovascular Diseases, School of Medicine, Najaf-Abad Branch, Islamic Azad University, Isfahan
AUTHOR
Masoud
Pourmoghadas
m_pourmoghadas@med.mui.ac.ir
2
Professor, Cardiac Rehabilitation Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical
Sciences, Isfahan
LEAD_AUTHOR
Hasan
Shemirani
3
Professor, Department of Cardiovascular Diseases, School of Medicine, Isfahan University of Medical Sciences, Isfahan
AUTHOR
Seid Ahmad
Mirdamadi
4
MD, Assistant Professor, Department of Cardiology, School of Medicine, Najaf Abad Branch, Islamic Azad University, Isfahan,
AUTHOR
Mojtaba
Akbari
5
MSc, Epidemiologist, School of Medicine, Isfahan University of Medical Sciences, Isfahan,
AUTHOR
ORIGINAL_ARTICLE
Can doubling the maintenance dose of clopidogrel prevent from early stent thrombosis after the primary percutaneous coronary intervention?
BACKGROUND: Treatment of significant coronary artery disease with primary percutaneous coronary intervention (PCI) seems better than angioplasty balloon; because the incidence of restenosis is lower in this method, however, a serious complication of PCI is stent thrombosis which would lead to repeated myocardial infarction (MI) and increase the mortality and morbidity. One of the frequent medications which is used to prevent from stent thrombosis is clopidogrel, but, stent thrombosis was seen in many of the patients despite given the conventional dosage of this drug. This study aimed to evaluate the effect of doubling the maintenance dose of clopidogrel to prevent from early stent thrombosis, MI and mortality rate. METHODS: This was a clinical trial study which was done in Shahid Chamran Hospital in winter 2010 in Isfahan, Iran. A total of 400 patients with PCI were prospectively followed-up for 30 days. All the patients were randomly allocated into two groups. The control group received a maintenance dose of 75 mg clopidogrel while the case group received 150 mg clopidogrel after the initial dosage of 600 mg for 30 days after the PCI. The incidence of primary outcome such as total mortality was recorded during the study. RESULTS: Early stent thrombosis was observed in 4 patients (1%) (One subject in the control group and 3 in the case group) during the first 30 days after PCI, but the difference was not significant between the two groups (p = 0.62). Mortality due to stent thrombosis occurred in 2 patients in the case group which showed no significant difference in this group (p = 0.5). In addition, MI occurred in 2 patients (1 in each group) which also showed no significant difference between the two groups (p = 1). Drug complication such as major bleeding had no significant difference between the two groups (p = 0.9). CONCLUSION: The present study showed that doubling dose of clopidogrel could not reduce the incidence of early stent thrombosis, mortality and myocardial infarction in comparison with conventional dosage; therefore it is recommended that more studies be done in Iranian and Asian race for clinical decision-making to prevent form stent thrombosis using high dose of clopidogrel.Keywords: Primary coronary intervention, Early stent thrombosis, Clopidogrel, Coronary stenting.
https://arya.mui.ac.ir/article_10220_2f9bf0e6c66e567010ed8bb4234dfba1.pdf
2011-04-23
18
23
Farshad
Roghani
1
Cardiologist, Interventional Fellowship, Associate Professor of School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
AUTHOR
Azam
Hemmat
2
Resident of Cardiology, Cardiac Rehabilitation Research center, Isfahan Cardiovascular Research Institute, Isfahan University of
Medical Sciences, Isfahan, Iran.
AUTHOR
Alahyar
Golabchi
golabchi@edu.mui.ac.ir
3
Resident of Cardiology, Cardiac Rehabilitation Research center, Isfahan Cardiovascular Research Institute, Isfahan University of
Medical Sciences, Isfahan, Iran.
LEAD_AUTHOR
ORIGINAL_ARTICLE
Immediate results and six-month outcomes after percutaneous coronary intervention in a referral heart center in Isfahan, Iran
BACKGROUND: There is a lack of data in our society on the outcomes, complications, and prognostic factors in patients with coronary artery disease who underwent percutaneous coronary intervention (PCI). We evaluated the success rate, early and late outcomes, and prognostic factors in a referral university center in Isfahan, IRAN. METHODS: This prospective cohort study was conducted in Chamran University Hospital in Isfahan (IRAN) from March 2010 to February 2011. Patients consequently were included if they have the indication for emergent or elective PCI. Outcomes included procedural success, complications, and major adverse cardiovascular events (MACE) during hospitalization and 6 months follow-up. RESULTS: A total of 282 patients (74.1% females) with mean age of 57.0±3.2 years were studied. Most of the patients (89.7%) underwent elective PCI. Angiographic and procedure success rates were 95.7% and 94.6%, respectively. In-hospital MACE included two cases of death (0.7%) and one MI (0.3%); 2/29 (6.9%) of the emergent PCI and 1/253 (0.4%) of the elective PCI cases. MACE during follow-up included three cases of death (1.0%) and two MI (0.7%); 2/252 (0.8%) of the elective PCI and 1/28 (3.5%) of the emergent PCI cases. The overall MACE was calculated as 8 cases (2.8%) which included 5/29 (17.2%) of the emergent and 3/253 (1.1%) of the elective cases; P < 0.001. In multivariate analysis, none of the factors including gender, age, emergency of the procedure, lesion type, number of stenotic vessels, or stent type were associated with total MACE (P > 0.05). CONCLUSION: PCI is performed with an acceptable success rate in our center in Isfahan and mortality and complications are within the range reported by other highly specialized centers in IRAN. Further studies with larger sample size are needed to find predictive factors.Keywords: Percutaneous coronary intervention, Myocardial infarction, Acute coronary syndrome, Reperfusion therapy, Outcome, Mortality.
https://arya.mui.ac.ir/article_10221_7a5531bd7bc8aa52e20a3777886e334e.pdf
2011-04-23
24
30
Alireza
Khosravi
alirezakhosravif@gmail.com
1
Assistant Professor, Isfahan Cardiovascular Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
AUTHOR
Masoud
Pourmoghaddas
m_pourmoghadas@med.mui.ac.ir
2
Professor, Cardiac Rehabilitation Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
LEAD_AUTHOR
Kourosh
Asadi
3
Cardiologist, Isfahan Cardiovascular Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical
Sciences, Isfahan, Iran.
AUTHOR
Ahmadnoor
Abdi
4
Cardiologist, Isfahan Cardiovascular Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical
Sciences, Isfahan, Iran.
AUTHOR
Ali
Gholamrezaei
5
Cardiologist, Isfahan Cardiovascular Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical
Sciences, Isfahan, Iran.
AUTHOR
ORIGINAL_ARTICLE
Anthropometric indices associated with dyslipidemia in obese children and adolescents: a retrospective study in Isfahan, Iran
BACKGROUND: Central obesity is an important risk factor for cardiovascular diseases (CVD). Preventive interventions from childhood are necessary due to the increasing prevalence of childhood obesity. Body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR) and waist to height ratio (WSR) are anthropometric indices for measurement of obesity. This study aimed to assess the association between these anthropometric indices and dyslipidemia in obese children and adolescents. METHODS: This retrospective study was done on the records of 2064 obese children and adolescents aged 6-18 years at the obesity clinic, in Isfahan Cardiovascular Research center. Age, gender, weight, height, WC, hip circumference (HC), triglyceride (TG), total cholesterol (TC), LDL-cholesterol (LDL-C), HDL-cholesterol (HDL-C), Fasting blood sugar (FBS), diastolic blood pressure (DBP) and systolic blood pressure (SBP) were taken from patients’ record. Receiver operating characteristics (ROC) curve and Pearson correlation were used to analyze the data. RESULTS: 2064 girls and boys aged 6-18 years were divided into 3 age groups of 6-9.9 years, 10-13.9 years and 14-18 years. Prevalence of high LDL-C, TC, TG, FBS, SBP, DBP and low HDL-C was higher among the boys compared to the girls. There was a significant association between TC, LDL-C, TG and FBS with BMI, WC, WHR and WSR. However, no significant correlation was seen between HDL-C and the four anthropometric indices. CONCLUSION: Our study showed a significant correlation between BMI, WC and WSR with high levels of TC, TG and LDL-C in children and adolescents. Correlation between WHR and dyslipidemia in this study was significant but its predictive value was weaker than other three indices. Keywords: Body Mass Index, Waist Circumference, Waist to Hip Ratio, Waist to Height Ratio, Dyslipidemia, Children, Adolescents.
https://arya.mui.ac.ir/article_10222_eb77a65437f28da69d6d30dd3ed95c73.pdf
2011-04-01
31
39
Mahin
Hashemipour
hashemipour@med.mui.ac.ir
1
Professor, Department of Pediatric Endocrinology and Metabolism Diseases, Endocrinology and Metabolism Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
LEAD_AUTHOR
Mahnaz
Soghrati
2
General Practitioner, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
AUTHOR
Mohammad
Malek Ahmadi
malekahmadi@gmail.com
3
General Practitioner, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
AUTHOR
Mojgan
Soghrati
4
General Practitioner, Research Expert, Renal Diseases Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
AUTHOR
ORIGINAL_ARTICLE
Systemic thrombolysis in the upper extremity deep vein thrombosis
Almost 4% of all patients with venous thrombosis have upper extremity deep vein thrombosis(UEDVT) and the incidence of UEDVT increases over time. The frequency of post-thromboticsyndrome (PTS) after UEDVT is not low and upper extremity PTS is a potentially majormorbidity that adversely affects quality of life, particularly if the dominant arm is involved. Wediscuss briefly the role of thrombolytic therapy in the treatment of upper extremity deep veinthrombosis and also the role of systemic thrombolysis in selected patients.Keywords: Venous Thrombosis, Post-thrombotic Syndrome, Upper Extremity Deep VeinThrombosis, Paget-Schroetter Syndrome, Effort Induced Upper Extremity Deep Vein Thrombosis,Central Venous Catheter Thrombosis, Thoracic Outlet Syndrome, Axillary Vein, Subclavian Vein.
https://arya.mui.ac.ir/article_10223_6b3299751cf4e018dfa8b660a9b5274a.pdf
2011-04-23
40
46
Roxana
Sadeghi
roxan.sadeghi@gmail.com
1
Assistant Professor of Cardiology, Cardiovascular Research Center, Department of Internal Medicine, School of Medicine,
Shahid Beheshti University of Medical Sciences (SUMS), Tehran
LEAD_AUTHOR
Morteza
Safi
2
Assistant Professor of Cardiology, Cardiovascular Research Center, Department of Internal Medicine, School of Medicine,
Shahid Beheshti University of Medical Sciences (SUMS), Tehran
AUTHOR
ORIGINAL_ARTICLE
Percutaneous transvenous mitral commissurotomy in a patient with situs inversus and dextrocardia: A case report
INTRODUCTION: Dextrocardia situs inversus refers to the heart being a mirror image situated on the right side of the body. Distorted cardiac anatomy provides technical difficulties during fluoroscopy‐guided transcatheter procedures. This is even more difficult in the case with percutaneous transvenous mitral commissurotomy (PTMC). Mitral valvuloplasty is a minimally invasive therapeutic procedure to correct an uncomplicated mitral stenosis by dilating the valve using a balloon. Here, we describe a case of a 25 years-old male with situs inversus and dextrocardia. CASE REPORT: A 25 years-old man, having situs inversus and suffering from mitral stenosis was referred to hospital for PTMC. His initial examination findings were unremarkable and an electrocardiographic (ECG), trans-esophageal and transthoracic echocardiographic evaluation were performed. Mitral valve (MV) was dome shape and severely stenotic with mild mitral regurgitation (MR). Left ventricular ejection Fraction (LVEF) was about 40%, Femoral arterial and venous punctures were made on the left side; the left femoral artery and vein were cannulated with a 5F arterial and 6F venous sheaths, respectively. Then special maneuvers were done to solve the mitral valve stenosis. At the end of the procedure, no MR was documented by checking LV angiogram and there were no signs of mitral stenosis (MS). DISCUSSION: Mirror‐image dextrocardia, as in our case, has been estimated to occur with a prevalence of 1:10,000. However, there are only a few case reports in the literature on PTMC in similar settings. This might be due to the fact that many of these patients undergo surgical commissurotomy due to the technical difficulties involved in a percutaneous procedure in general. Trans-septal catheterization is considered a technical challenge in anatomically malpositioned hearts, as it is fraught with a higher risk of cardiac perforation. Despite the challenging anatomy, PTMC has been demonstrated to be a safe and feasible option for MS in patients with unusual cardiac anatomy. Keywords: PTMC, Dextrocardia, Surgical Commissurotomy
https://arya.mui.ac.ir/article_10224_2e1295a3d1fc6408d9d9a01ef16c2db7.pdf
2011-04-01
47
50
Aliakbar
Tavassoli
1
MD, Associate Professor of Cardiology, Cardiac Rehabilitation Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
AUTHOR
Masoud
Pourmoghaddas
m.pourmoghaddas@gmail.com
2
Professor, Cardiac Rehabilitation Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
LEAD_AUTHOR
Mahmood
Emami
3
Cardiologist, Department of Cardiology, School of Medicine, Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Science, Yazd, Iran.
AUTHOR
Mostafa
Mousavizadeh
4
Medical Student, Department of Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
AUTHOR
Tohid
Emami Meybodi
5
Medical Student, Student Research Committee, Department of Medicine, School of Medicine, Shahid Sadoughi University of Medical Science, Yazd, Iran.
AUTHOR
ORIGINAL_ARTICLE
Journal Index
Click to download the index of this issue.
https://arya.mui.ac.ir/article_10217_f7e2c350ca3045be7138df591f156d5b.pdf
2011-04-01
Journal
Index
arya@crc.mui.ac.ir
1
LEAD_AUTHOR