Iranian Heart Journal
Year:2015 | Volume:16 | Issue:4|Papers Count:8

Background: Considering the nature of Behçet's disease (BD), which involves multisystem inflammation, we sought to compare the echocardiographic characteristics of BD>5 years’ duration with those of healthy subjects.Methods: We compared 73 patients with BD with 74 age- and sex-matched healthy controls. The subjects underwent transthoracic echocardiography and tissue Doppler imaging for the measurement of cardiac function and evaluation of the heart valves. The echocardiographic parameters were then compared between the study groups.Results: Among the echocardiographic parameters, only left ventricular end-diastolic diameter was significantly lower in the patients with BD (47.0±5.2) than that in the control group (50.8±4.7; P<0.001). There was also no relationship between the echocardiographic parameters and the active stage of the disease.Conclusions: Diastolic dysfunction was significantly more common in the patients with BD>5 years’ duration than in the control group. The other echocardiographic indices were similar in both groups.

Background: Contrast-enhanced cardiac magnetic resonance imaging (CMR) is an accurate imaging modality for the noninvasive evaluation of myocardial infarction (MI). We sought to assess the relationship between the severity of coronary involvement and the extent and pattern of myocardial scars in CMR of patients with a history of remote MI.Methods: The CMR of 60 patients with a history of remote ST-elevation or non-ST elevation MI who were candidated for selective coronary angiography and referred for CMR for an evaluation of myocardial viability was reviewed and compared with selective coronary angiographic findings.Results: Among the 60 patients with a history of old MI, 78.3% were male and the mean (SD) of age was 61.2±11.5 years. There was no association between the severity of coronary stenosis in each territory and the presence of myocardial scar detected by the late gadolinium enhancement of CMR. (P values for all the territories of the 3 vessels were>0.05.) There was a significant association between coronary artery run-off and the presence of late gadolinium enhancement in CMR. (P values for the left anterior descending, left circumflex artery, and right coronary artery were 0.002, <0.001, and<0.001, respectively.) We found a significant relationship between the pattern of the scars in terms of being transmural or non-transmural and the severity of coronary artery stenosis (P<0.001), and the pattern of the scars was not associated with coronary artery run-off (P=0.2).Conclusions: The results of this study support the hypothesis that the time window for revascularization will be increased in the presence of an antegrade coronary flow in the jeopardized myocardium and that it could limit infarct progression and result in a subsequent lesser extent of myocardial scar.

Background: We aimed to examine the value of C-reactive protein (CRP) and fibrinogen levels to predict cardiovascular events and compare their predicting power between patients with a history of the acute coronary syndrome, patients with a history of stroke (ischemic type), and healthy individuals.Methods: This case-control study assessed 79 patients with a history of the acute coronary syndrome and 88 patients with a history of stroke (cerebral ischemia) occurring at least 3 months previously. The patients were selected and followed up from September 2013 to September 2014 for 3 and 6 months after initial assessment to determine 6-month major adverse cardiac events (MACE). The serum levels of CRP and fibrinogen were measured using ELISA kits.Results: The serum CRP level was significantly higher in the group with the acute coronary syndrome than in the group with a history of stroke and in the healthy group (P=0.045). The Cox regression model showed increased levels of CRP (HR=1.29 [1.01-1.66]; P=0.038) and fibrinogen (HR=1.01 [1.01-1.02]; P<0.001) in the group with a history of the acute coronary syndrome. It also demonstrated increased levels of CRP (HR=1.61 [0.97-2.67]; P=0.065) and fibrinogen (HR=1.02 [1.01-1.04]; P=0.010) in the stroke group and increased levels of CRP (HR=2.06 [0.71-5.99]; P=0.183) and fibrinogen (HR=1.01 [0.99-1.04]; P=0.294) in the normal group. Consequently, the groups with a history of the acute coronary syndrome and a history of stroke effectively predicted 6-month MACE in the crude and age- and sex- adjusted models.Conclusions: Our study achieved 2 important findings. First, our results showed that higher values of these biomarkers were able to predict MACE, even after the inclusion of baseline covariates. Increased levels of CRP and fibrinogen, measured after evaluating the acute phase and their related outcome, were able to predict recurrent cardiovascular events in the patients with a history of cerebrovascular ischemia and the acute coronary syndrome. In addition, there were higher levels of both CRP and fibrinogen markers in the patients with a history of the acute coronary syndrome and stroke than in the healthy individuals.

Background: As percutaneous coronary intervention (PCI) technologies confer increasing patient advantage, the use of iodinated contrast media for diagnostic and interventional procedures is increased. Although contrast media obstacles are transient and mild, contrast-induced nephropathy (CIN) negatively affects long-term patient mortality. PCI creates a high-risk condition for the incidence of CIN even in patients with a normal renal function. Pentoxifylline (PTX) with a variety of mechanisms may prevent CIN. We sought to assess the positive effect of PTX administration at the beginning prior to contrast media use to 24 hours after PCI to prevent CIN in patients with STEMI.Methods: In this double-blind, single-center, clinical trial, we randomly assigned 296 consecutive patients to the control group (n=148) without PTX and the case group (n=148) with PTX 400 mg/tid at the time of hospitalization to 24 hours after the procedure. Serum creatinine was measured before and 48 hours after the procedure. The occurrence of CIN within 48 hours was our end point. CIN was defined as a 0.5 mg/dL increase or more in serum creatinine or a 25% increase or more above baseline serum creatinine.Results: A total of 296 patients were enrolled in this trial and were randomly assigned to receive either primary PCI plus PTX or only primary PCI. Out of 148 patients who received PTX, only 12.2% were seen to have CIN incidence (>0.5 mg/dL or a 25% increase in the Cr level); however, the difference between the 2 groups regarding CIN was not significant (P=0.4). Out of the 296 patients, only 20 were found to have chronic kidney disease (CKD) (CKD was defined as baseline Cr>1.5); and of those patients, 3 (15%) showed CIN incidence. Nevertheless, the difference between the 2 groups regarding CIN incidence was not significant (P=0.7). The regression test showed that between all confounding factors in the 2 groups of PTX positive and negative, sex and ejection fraction had positive effects on the rise in the Cr level and, consequently, the incidence of CIN (95% CI: 1.60 to 30.85; P=0.01 and 95% CI: 0.92 to 1; P=0.05).Conclusions: Administration of oral PTX to patients with increased risk for CIN scheduled for primary PCI may not reduce the Cr level and thus the occurrence of CIN. Given the higher prevalence of hypotension in the patients without PTX, higher prevalence of CKD in the patients without PTX, and absence of significant difference between the 2 groups regarding the incidence of CIN, PTX had no preventive effect on CIN occurrence in STEMI. Among all factors influencing CIN occurrence, sex and ejection fraction had positive effects on the rise in the Cr level.

Background: Electrocardiographic parameters for the detection of left ventricular hypertrophy (LVH) as an independent cardiovascular risk factor and signifier end-organ damage in patients with hypertension are known. The aim of this study was to evaluate the relation between QT interval parameters and LVH in patients with hypertension.Methods: This cross-sectional study recruited 100 patients with primary hypertension who underwent cardiac echocardiography for the evaluation of left ventricular mass (LVM). Standard 12-lead electrocardiography was performed for all the patients, and QT interval parameters (QTmax, QTcmax, QTd [dispersion], and QTdF [difference between maximum and minimum QT intervals]) were calculated. The data were analyzed using SPSS (version 18). The t-test was applied to assess the relationship between QT parameters and left ventricular mass index (LVMI), and the receiver operating characteristic (ROC) curve was drawn to determine the cutoff point for the mentioned electrocardiographic test.Results: The mean age of the patients was 60.52±9.74 years. The mean of QTd, QTmax, and QTcd in the patients with LVH was significantly greater than that of the patients without LVH (P<0.05). ROC curve analyses of QT interval parameters showed that the cutoff points for QTmax, QTd, QTcmax, and QTcd values were 420 (specificity=0.79 and sensitivity=0.40), 50 (specificity=0.58 and sensitivity=0.76), 478 (specificity=0.29 and sensitivity=0.58), and 59 (specificity=0.65 and sensitivity=0.76), respectively.Conclusions: According to our findings, QTcd and QTc would be better tests for the detection of LVH. We recommend further research with larger sample sizes to obtain more generalizable findings.

Background: CKMB elevation after percutaneous coronary intervention (PCI) correlates with major adverse cardiac and cerebrovascular events (MACCE). There is, however, some controversy over this issue, with some studies having reported different conclusions. We assessed the correlation between the CKMB level after PCI and one-year MACCE incidence in these patients.Methods: We measured the CKMB level before and after PCI in 221 patients with normal baseline CKMB who underwent PCI at Ekbatan University Hospital, Hamedan, Iran, between April 2013 and October 2013, and divided them into 4 groups based on the post-PCI CKMB level. Then, we evaluated one-year MACCE incidence.Results: CKMB elevation was detected in 81 (37.6%) patients and MACCE occurred in 11 (5%) patients. CKMB elevation after PCI was correlated to MACCE. The predictors of CKMB elevation were hyperlipidemia, number of deployed stents, stent diameter ³4 mm, and complicated PCI.Conclusions: CKMB elevation after PCI was detected in 37.6% of the study population and was common in the setting of hyperlipidemia, more than 1 stent deployment, stent diameter³4 mm, and complicated PCI. MACCE at 1 year occurred in 5% of the patients and was correlated with the post-PCI CKMB level³3 times of normal, history of diabetes mellitus, history of hypertension, and inappropriate use of clopidogrel.

Background: In patients referred for an evaluation of chest pain, the incidence of cardiac disease may be as low as 11–27%. Furthermore, the incidence of normal coronary anatomy in patients investigated invasively varies widely, between 11% and 37%, at different cardiac centers. In this study, we evaluated the correlation between angiographic findings and pain and its palliative factors in patients with chest pain referring to Rajaie Cardiovascular, Medical and Research Center.Methods: All patients with chest pain who were admitted to the Emergency Department of Rajaie Cardiovascular, Medical and Research Center between September 2013 and March 2014 and needed coronary angiography were enrolled. Demographic data and the results of physical examinations and characteristics of pain and its palliative factors and the chest pain score based on a check list were collected. Thereafter, angiography was performed and correlations between angiographic findings and pain (characteristics and score) and its palliative factors were assessed.Results: Totally, 194 patients with the average age of 58±10 years were investigated. Of the 194 patients, coronary arteries were normal in 57 (29%) patients. Of these patients, 37 patients were women and 20 patients were men. Single-vessel disease was observed in 53 (40%), 2- vessel disease in 39 (30%), and 3-vessel disease in 40 (30%). Left main stenosis was observed in 1 (0.5%) patient, and 3-vessel disease accompanied with the left main was documented in 4 (2.1%). Also, slow flow was observed in 5 (2.6%) patients. Regarding the localization of the involved vessel, left main involvement was observed in 5 (3.1%) patients, left anterior descending in 82 (24.3%), left circumflex in 62 (32%), and right coronary artery in 54 (27.8%). A pain score of 0 was present in 24 (12%) patients, pain score of 1 in 47 (24%), pain score of 2 in 73 (37%), and pain score of 3 in 50 (25%). The sensitivity value of the pain score in our research was calculated to be 80% by taking advantage of a chest pain score of 0 as the negative predictor of the coronary vessel disease and a chest pain score of 1 to 3 as the positive predictor of coronary vessel disease.Conclusions: In the present study, there was no relationship between pain characteristics and the results from the involved vessel and the final angiographic results. The pain score is greatly useful in patients with a higher risk of coronary artery disease, whereas in patients with an intermediate pain score, it is important to perform other examinations such as scan or treadmill tests for correct decision-making.

Friedreich's ataxia is an autosomal recessive, spinocerebellar, degenerative disease characterized clinically by the ataxia of the limbs and trunk, dysarthria, loss of deep tendon reflexes, sensory abnormalities, skeletal deformities, diabetes mellitus, and cardiac involvement. Friedreich's ataxia is generally associated with concentric hypertrophic cardiomyopathy. Cardiac death occurs primarily in those developing dilated cardiomyopathy. These patients tend to do poorly with rapid progression to end-stage congestive heart failure.