THE JOURNAL OF TEHRAN UNIVERSITY HEART CENTER
Year:2011 | Volume:6 | Issue:4|Papers Count:10

The recently updated EASE Guidelines for Authors and Translators of Scientific Articles are reproduced in this issue by permission of the European Association of Science Editors (EASE).Their major objective is to help scientists from all over the world to communicate the results of their research effectively.This increases the probability that the manuscripts will be published in high-quality journals and cited frequently. Attention is paid also to ethical issues, such as authorship, acceptable secondary publication, and avoidance of plagiarism.The guidelines have already been translated by volunteers into 17 languages, e.g. Arabic, French, Persian, and Spanish.All the language versions can be downloaded for free as PDFs from the EASE website (www.ease.org.uk).Individual sections of the document, including 8 appendices on selected issues (in English only), can be also read directly on the website, with hyperlinks to on-line references.

Using kitchen scales, carefully weight out 4 kilograms of rice and pour it into a deep saucepan. Now put your hands into the rice and let the grains run between your fingers.Contemplate carefully each grain. The number of grains (about 140,000) is approximately the number of lives that could be saved each year world-wide if all hospitalized trauma patients with significant bleeding were treated with tranexamic acid (TXA) within 3 hours of injury. TXA is cheap and widely available. All that is needed to reap these human benefits is that doctors use it.That TXA is a potent inhibitor of fibrinolysis was first reported by Shosuke and Utako Okamoto in The Keio Journal of Medicine in September 1962.Since then TXA has been widely used to treat heavy menstrual bleeding and to reduce blood loss in elective surgery where it reduces blood transfusion by about one third.2 The CRASH-2 collaborators hypothesized that TXA might also reduce bleeding in trauma patients. The CRASH-2 trial was a UK government funded randomized trial of the effects of the early administration of TXA on death, vascular occlusive events and blood transfusion in bleeding trauma patients.

Historically, biomarkers have been used in two major ways to maintain and improve better health status: first, for diagnostic purposes, and second, as specific targets to treat various diseases. A new era in treatment and even cure for the some diseases using reprograming of somatic cells is about to be born. In this approach, scientists are successfully taking human skin cells (previously considered terminally-differentiated cells) and re-programming them into functional cardiac myocytes and other cell types in vitro. A cell reprograming approach for treatment of cardiovascular diseases will revolutionize the field of medicine and significantly expand the human lifetime. Availability of a comprehensive catalogue for cardiac biomarkers is necessary for developing cell reprograming modalities to treat cardiac diseases, as well as for determining the progress of reprogrammed cells as they become cardiac cells. In this review, we present a comprehensive survey of the cardiac biomarkers currently known.

Background: Despite the positive impact of cardiac rehabilitation (CR) on quality of life and mortality, the majority of people who could benefit from this program fail to participate in it. The lack of referral from the physician is a common reason that patients give for not seeking CR. The objective of this study was to compare factors affecting CR referral by cardiologists.Methods: A cross-sectional survey of 122 cardiologists, including 89 general cardiac specialists and 33 fellows in cardiology from 11 major cardiology training centers in Iran, was done in 2010. They responded to the 14-item investigator generated survey, examining the physician's attitudinal and knowledge factors affecting CR referral.Results: 47.9% of the subjects reported having available CR centers but only 6.6% reported continuous medical education on the topic. 90.7% of the physicians reported that less than 15% of patients are referred to CR centers. The main factor affecting the low referral rate was limited general knowledge about CR programs (79.5%) such as program attributes and benefits, methods of reimbursement. Lack of insurance coverage, unavailability of CR centers in the community and low physicians' fee were other factors reported by the physicians.Conclusion: Cardiologists’ inadequate general knowledge of and attitude toward CR programs seem to be a potential threat for cardiac prevention and rehabilitation in some societies.

Background: Left ventricular (LV) dyssynchrony is a prevalent feature in heart failure (HF) patients. The current study aimed to evaluate the prevalence of inter and intraventricular dyssynchrony in HF patients with regard to the QRS duration and etiology.Methods: The available data on the tissue Doppler imaging (TDI) of 230 patients with refractory HF were analyzed. The patients were divided into three groups according to the QRS duration: QRS duration<120 ms, 120-150 ms, and ³ 150 ms and the patients were re-categorized into two subgroups depending on the underlying etiology: ischemic cardiomyopathy (ICM) or dilated cardiomyopathy (DCM). The time-to-peak myocardial sustained systolic velocity (Ts) in six basal and six middle segments of the LV was measured manually using the velocity curves from TDI. LV dyssynchrony was defined as interventricular mechanical delay ³ 40 ms and tissue Doppler velocity all segments delay ³ 105 ms, standard deviation (SD) of all segments ³ 34.4 ms, basal segments delay ³ 78 ms, SD of basal segments ³ 34.5 ms, and opposing wall delay ³ 65 ms.Results: After adjustment for the possible confounders, interventricular dyssynchrony was more prevalent in the patients with QRS duration ³ 150 ms than in those with QRS duration 120-150 ms and<120 ms. The patients with DCM also had a higher percentage of interventricular dyssynchrony than those with ICM in the wide QRS groups. Turning to the intraventricular dyssynchrony indices, the patients with QRS duration ³ 150 ms and 120-150 ms revealed a significantly greater delay between Ts at the basal and all segments than did those with QRS duration<120 ms, while etiology did not influence the frequency of these indices in each QRS group.Conclusion: The prevalence of both inter and intraventricular dyssynchrony indices was greater in the patients with wide QRS than in those with narrow QRS duration. The underlying etiology may affect the frequency of interventricular but not intraventricular dyssynchrony indices.

Background: Optimal timing and mode of treatment for patients with coarctation of the aorta (COA) remain controversial, particularly in children. Surgery, balloon dilatation, and stent implantation have all proven effective in the treatment of moderate or severe obstruction. The aim of this study was to investigate the complications of COA stenting angioplasty in pediatric patients.Methods: This retrospective, descriptive study was conducted on patients less than 20 years of age who underwent aortic stenting angioplasty because of congenital COA in the pediatric catheterization laboratory of Rajaie cardiovascular, medical and research Center, Tehran between 2005 and 2010.Results: A total of 26 patients (18 [65.4%] males and 9 [34.6%] females) with congenital COA who had undergone aortic stenting angioplasty were recruited. Nineteen (73.1%) of these patients had native COA and 7 (26.9%) had recurrent COA.Most of the early complications were minor and temporary, only one patient developed early major complications. During the follow-up, whereas none of the native group patients developed late complications, in the re-COA group 28.57% of the patients had re-stenosis and 14.28% had chronic systemic hypertension, requiring drug therapy.Conclusion: Our investigation into post-stenting complications in patients with native COA and re-COA showed that endovascular stenting could be an effective and safe method, even in young patients with native COA.

A strategy employing moderate hypothermia for the replacement of the aortic arch is proposed to avoid the complications of profound hypothermic circulatory arrest. Two patients underwent the complete replacement of the aortic arch using three pumps-for the brain, thoracoabdominal aorta, and heart, respectively. There were no complications and the patients were extubated uneventfully. The method preserved the auto-regulation of the cerebral blood flow without high vascular resistance.

Left ventricular non-compaction cardiomyopathy is a rare congenital cardiomyopathy that affects both children and adults.Since the clinical manifestations are not sufficient to establish diagnosis, echocardiography is the diagnostic tool that makes it possible to document ventricular non-compaction and establish prognostic factors. We report a 47-year-old woman with a history of dilated cardiomyopathy with unknown etiology. Echocardiography showed mild left ventricular enlargement with severe systolic dysfunction (EF=20-25%). According to cardiac magnetic resonance imaging findings non-compaction left ventricle with hypertrophic cardiomyopathy was considered, and right ventricular septal biopsy was recommended.Right ventricular end omyocardial biopsy showed moderate hypertrophy of cardiac myocytes with foci of myocytolysis and moderate interstitial fibrosis. No evidence of infiltrative deposition was seen.

A double left anterior descending (LAD) coronary artery emerging from the left and right coronary arteries is classified among rare coronary anomalies. We herein report a 73-year-old man presenting with acute coronary syndrome (posterolateral myocardial infarction). He was admitted with typical chest pain, and due to his progressive ischemic changes on electrocardiography (ECG) and elevated cardiac enzyme, he was candidated for cardiac catheterization. The coronary angiography revealed an anomalous LAD from the right sinus of Valsalva. The unusual coronary anatomy was perfectly matched with the distribution of ischemia and its clinical evidence on echocardiography and ECG. The culprit lesion was stented, and the patient was discharged in good physical condition from the hospital.

Conventional laryngoscopy with the Macintosh Laryngoscope has been the gold standard for tracheal intubation since 1940s.Failed attempts to intubate the trachea and secure airway, both in the operating room and outside, still remains a cause of anesthesia-related mortality and morbidity.Investigation is, therefore, in progress to find the best methods and/or equipment to augment the success rate and lessen the potential complications of tracheal intubation.The Airtraq Laryngoscope (Prodol, Meditec, Viscaza, Spain) (Figure 1) was first reported as a useful device for indirect laryngoscopy and tracheal intubation in 2006.Applications of the Airtraq are not limited to difficult intubation.Some studies have shown its advantages over the Macintosh Laryngoscope with regard to "first attempt success" rate and less intubation time.Others have focused on the Airtraq role as recommended intubation device in special situations such as emergent intubation in the operating room and outside the operating room as well as cervical spine immobilization.These studies have sought to assess the hemodynamic response to tracheal intubation, hypoxemia, esophageal intubation, regurgitation, airway trauma, and cardiac arrest. None of these studies has, however, mentioned the probable role of the Airtraq in decreasing dental trauma...