INTERNATIONAL CARDIOVASCULAR RESEARCH JOURNAL
Year:2010 | Volume:4 | Issue:2|Papers Count:9

Background: Coronary artery diseases (CAD) are the leading cause of mortality, morbidity and disability with high health care cost in any countries including Iran. The prevalence of all CAD risk factors including hypertension, diabetes, lipid profile abnormalities and obesity is rising in the population of Iran. Knowing the population at risk would lead to proper education to decrease these risk factors and ultimately would reduce CAD.Methods: This descriptive cross- sectional study was conducted in February to December 2009 and comprised a total of 3115 Shiraz educational staff, aged 21- 73 years. Questionnaires were applied to collect information including; demographic data, physical activity, history of CAD, hypertension, dyslipidemia, and smoking.In addition, waist circumference, height, weight, body mass index (BMI), and hip circumference (HC) were measured and serum biochemistry profiles were determined on venous blood samples. Such data helped identify the prevalence of diabetes, hypercholesterolemia, hypertriglyceridemia, hypertension, overweight and obesity, central obesity, and smoking.Results: The mean age of 3115 participant was 42.7 and 41.5 years for men and women respectively. The prevalence of pre-diabetes, diabetes hypertension, hypercholesterolemia and hypertriglyceridemia were %10.2, %4, %18.2, %38.30 and %33.2 respectively.Diabetes, hypertension and dyslipidemia were more prevalent among males and older subjects. The prevalence of central obesity was %75.05 (IDF criteria) and %40.64 (ATP- III criteria). The frequency of obesity, current smoking, ex-smoking and passive smoking were %12.1, %5.85, %1.52, %7.9 respectively which were below the reported prevalence in Iran in previous studies, but physical inactivity was %73.3 which is very high in this study group.Conclusion: Although CAD risk factors seem to be very common in the study population, clinical and paraclinical data indicated that teachers residing in Shiraz have a lower rate of CAD risk factors in comparison with previous studies done in general population of Iran. This may be related to high level of education, awareness and better lifestyle in the study group. But still further educating in regard to lifestyle modifications as well as dietary surveillance is needed in general population including those dealing with educating children and on a larger scale, the community as a whole.

Background: The Reference values of systolic and diastolic Blood Pressure (BP) levels of school children aged6–11 years by two different analytic strategies are presented and compared.Methods: From the cross-sectional study a total of 2064 children (52.3% boys and 47.7% girls) aged 6–11 years living in Shiraz (southern Iran) and considering their sex and height were used for this analysis. Polynomial Regression (PR) and Quantile Regression (QR) models based on Restricted Cubic Spline (RCS) were performed to calculate age and height specific reference ranges. To assess comparability of the two techniques, a chi-squaregoodness-of-fit within sex and age groups was preformed for each method.Results: Both statistical methods generated reference values of systolic and diastolic BP using data from apparently healthy children. Analysis of data by two approaches reflected an increase in BP measurements with age and height in both sexes based on a nonlinear manner up to age 11. We found 50th and 95th percentile differences by two methods in BP level between the tallest and the shortest individuals, ranging from 2-7 mmHg.Conclusion: Using the QR model based on RCS offered the most flexible and better fit than PR model. The advantages of the QR led to a better adaptation of reference limits to the original data. This statistical approach might be preferable for the calculation of reference ranges in particular by non-normal distributed variables.Our results might help clinicians reach a consensus on the definition of hypertension in Iranian children livingin Shiraz, south of Iran.

Background: Diabetic patients constitute about 25% of patients undergoing coronary artery bypass graft surgery (CABG). The impact of diabetes on the results of this operation, especially in Asian patients is not well understood. The present study aims to evaluate the effect of this important risk factor on the early and midterm outcome following CABG.Methods: This study was performed in Shahid Madani Heart Hospital, Tabriz, Iran from April 1998 to April 2003. Considering our inclusion and exclusion criteria, 1269 patients available for follow up were enrolled and evaluated for their early (30 days) and midterm mortality.Results: Diabetic patients constituted 332 (26.2%) of our patients. Female gender, hypertension, hyperlipidemia and peripheral arterial disease (PAD) were more prevalent in diabetics. Early mortality was not significantly different between two groups (6.6% in diabetics vs. 5% in non-diabetics, P=0.300) and this was true for early cardiac death (6.3% in diabetics vs.4.7% in nondiabetics, P=0.200). However, in midterm follow up of 4.1 ± 1.6 years, diabetic patients had significantly higher mortality (18.7% in diabetics vs. 11.2% in nondiabetics, P<0.001). Also total mortality was significantly higher in diabetics (25.3% in diabetics vs. 16.2% in non-diabetics, P<0.001). In univariate regression analyses diabetes was an independent risk factor for midterm mortality.Conclusion: Diabetes may not be an independent risk factor for early death following CABG. However, it is an important predictor of midterm mortality.

Background: Superiority of paclitaxel-eluting stents over bare metal stents in angiographic and clinical outcomes have been shown in many trials. Eucatax stents is a newly developed paclitaxel eluting stent using biodegradable polymer matrix. To our knowledge there have been no studies directly comparing Eucatax paclitaxeleluting stents with EucaSTSflex bare metal stents. The aim of this study is to evaluate short-term benefits ofEucatax in comparison with EucaSTSflex in patients undergoing denovo coronary stenting.Methods: A retrospective comparison of Eucatax versus EucaSTSflex was conducted among 89 consecutive patients (44 Eucatax, 45 EucaSTSflex) in Kowsar heart institute, with at least one successfully deployed stent inde novo lesions over a 6-month period. Outcomes included death, nonfatal MI, CABG, late stent thrombosisat six month, as well as functional evidence of ischemia evaluated by exercise treadmill test (ETT) or cardiacscan (SPECT).Results: From April to July 2008, a total of 89 patients (44 Eucatax, 45 EucaSTSflex) were evaluated after PCI for de novo coronary lesions.After six month follow up no difference was observed in term of death, MI, CABG and late stent thrombosis between Eucatax compared with EucaSTSflex. Also a non-statistically significant lower rate of positive ETT (or SPECT) was found in Eucatax group after six month.Conclusion: Paclitaxel eluting stents (Eucatax) are not superior to bare metal stents (EucaSTSflex) in regard toshort-term clinical outcome.

Background: Metabolic syndrome (MetS) is rapidly rising at an alarming rate through all parts of the world.Elevated serum aminotransferase was proposed as a marker for early detection of MetS. In this investigation weprimarily aimed to evaluate the prevalence of MetS and its components among army and secondly to explore theassociation between elevated serum aminotransferase and the components of metabolic syndrome.Methods: A total of 380 army personnel from a military camp in Southern Iran participated in this cross-sectionalstudy. Life style related characteristics, anthropometric features, serum aminotransferase and components ofMetS, based on National Cholesterol Education Program.Adult Treatment Panel III, were measured. Statisticalsignificant was set as p value less than 0.05.Results: The mean age of participants was 35.0±7.5 year-old and the prevalence of metabolic syndrome was8.1%. The prevalence of the components of MetS including; central obesity, abnormal fasting blood glucose, hypertension, hypertriglycridemia and low HDL cholesterol level was 8.6%, 10.4%, 18.5%, 31%, and 45.5%respectively. MetS had significant relationship with obesity (P<0.001) and abnormal Waist Circumferance/HipCircumference ratio (P<0.001). Twenty-six percent of subjects had ALT.41 U/L and 4.9% of them had ALT.81. Elevated serum aminotransferase had significant association with presence of MetS (P=0.007).Conclusion: Although prevalence of metabolic syndrome among the studied army population was not high, lifestyle modification of army members is recommended. Liver function tests should be included in routine healthcheckup of military personnel.

Background: Smoking is a known risk factor of atherosclerosis, endothelial dysfunction, athermanous plaque rupture, unstable coronary syndrome and sudden cardiac death.Methods: The present study comprised 40 randomly selected healthy male hospital staff without a history of hypertension or cardiac or pulmonary disease. Participants were divided into two groups. The first group included 20 professional smokers (at least 5 pack/year till the time of study) and the second group consisted of 20 nonprofessional smokers defined as 0.5 pack/ year or less till the time of study. Participants were instructed not to smoke for 6 hours before the study. Patients underwent echocardiography before smoking. The participants were then asked to smoke a whole cigarette. After smoking, echocardiography was repeated within 7 to 15 minutes.Echocardiographic indices of diastolic function (E wave, A wave, Ea, E/A ratio and deceleration time) were measured before and after smoking.Results: There was no statistically significant difference in the baseline measures in both groups before smoking and also there was no significant difference between measures in the two groups after smoking. The analysis of the pooled data from two groups showed that, smoking resulted in significant increase of heart rate (P<0.001).A wave, E wave, Ea, E/A ratio and deceleration time changed significantly after smoking (P<0.001, P=0.027, P=0.011, P<0.001 and P<0.001 respectively).Conclusion: Smoking of only a cigarette in both professional and nonprofessional smokers, resulted in the same significant diastolic dysfunction.

Background: Atrial fibrillation (AF) is the most common arrhythmic complication following coronary arterybypass surgery (CABG). The incidence of postoperative AF ranges from %10 to %0 and it usually tends to occur within 2 to 4 days after operation. The etiology of AF after cardiac surgery is incompletely understood. Aggressive prophylactic intervention should be directed and limited to high risk patients who are most likely to benefit from such procedure. The aim of this study was to identify the frequency of AF and to determine risk factors by using available clinical predictors of postoperative AF after CABG.Methods: The present study was a prospective observational investigation of 300 patients undergoing elective isolated CABG from 2006 to 2008 in Urumiyeh Imam Khomeini Hospital. Peri-operative risk factors were used to develop logistic regression equation in order to predict the development of post-operative AF.Results: A total of 300 patients aged 58 ± 10 (221 male) were included in the study. The incidence of AF was%12/3 (n=37). By univariate analysis, congestive heart failure (P=0.02), and low left ventricular ejection fraction (P=0.04) were associated with the development of post-CABG AF. However, in the logistic regression model CHF (OR: 4.87, 95%CI: 1.09-21.6, P=0.038) remained an independent predictor for the developmentof postoperative AF. On the other hand, patients with and without AF were similar regarding body mass index, preoperative heart rate, time of ventilation in ICU, pump time, grafting or absence of grafting on right coronaryartery (RCA) and the prevalence of chronic lung diseases, previous myocardial infarction, and diabetes mellitus.Patients who developed AF had longer ICU stay (OR=4.92, P=0/000).Conclusion: The results of the present study demonstrated that the combination of congestive heart failure, and low left ventricular ejection fraction can identify patients at high risk for occurrence of AF after CABG.

Since the first report of percutaneous retrieval of intravascular foreign body in 1964, it has been accepted as a favorite approach for intravascular foreign body removal. Various instruments such as snares, biopsy forceps, dormiabasket or tip deflecting wires are available for this approach. Herein, we report percutaneous retrieval of a dislodged guide-wire by dormia basket. The Patient was a 98-year-old female who was admitted in the Intensive care unit due to confusional state. The physian incharge left the guide-wire in her subclavian vein during central venous catheter insertion. He realized his fault immediately, so he started anti-coagulation therapy and requested surgical consult.Because of the patient’s high risk of surgery, the surgeon referred the patient to cardiologist for non-invasive guide wire removal. The guide wire was apprpached through femoral vein by a dormia basket (4/6 F) and it was removedwithout any difficulties or complications. Utilization of baskets for intravascular foreign body removal is frequently reported and has been successful with low complication rates; In addition, the low cost of the device makes it less of a burden to the patient and the hospital.

Catheter-induced combined coronary artery- ascending aorta dissection following diagnostic coronary angiography is rare. Localized aortic dissection has been treated by stenting the coronary artery and sealing the entry point. We describe a very long spiral right coronary artery dissection extending to the ascending aorta during coronary angiography. The dissection was limited to the proximal 35mm of the ascending aorta evaluated by Transesophagial echocardiography and was successfully treated by multiple stenting of the right coronary artery including the entry point of the aortic dissection which was monitored by means of echocardiography.