INTERNATIONAL CARDIOVASCULAR RESEARCH JOURNAL
Year:2017 | Volume:11 | Issue:1|Papers Count:8

Background: Rate of mortality due to cardiovascular diseases is high in Maintenance Hemodialysis (MHD) patients. Additionally, prolonged QT interval is reportedly associated with high-risk ventricular arrhythmia and sudden death. Vascular calcification may be related to QT dispersion interval in MHD patients because the extensive nature of the calcification process may involve the conducting system and myocardium.Objectives: This study aimed to evaluate the relationship between QT interval and Pulse Wave Velocity (PWV) as a sign of arterial stiffness associated with atherosclerosis in MHD patients.Patients and Methods: This prospective, observational study was conducted on 149 eligible MHD patients for 12 months. Patients using drugs known to affect QT interval were excluded. The patients were divided into four groups as follows: normal corrected QT (QTc) interval at the beginning and end of the study (n=44, 29.5%), normal QTc interval at the beginning but prolonged QTc interval at the end of the study (n=30, 20.1%), prolonged QTc interval at the beginning but normal QTc interval at the end of the study (n=24, 16.1%), and prolonged QTc interval at the beginning and end of the study (n=51, 34.2%). Demographic parameters, laboratory parameters, and PWV were assessed at the beginning and the 12th month of the study. Then, the data were analyzed using ANOVA or Pearson 2 test and P<0.05 was considered to be statistically significant.Results: The study groups were similar with respect to age and comorbidities, including diabetes mellitus, hypertension, and dyslipidemia. In addition, there were no significant differences among the groups regarding the initial PWV (P=0.412); however, the ending PWV showed significant differences (P=0.029). The results of multivariate analysis showed that PWV was independently associated with change in the maximum QTc (confidence interval: 0.039 – 1.787, P=0.031, b=0.178).Conclusions: The results suggested inclusion of QTc interval prolongation, as a predictor of cardiovascular disease, either alone or in combination with PWV in such high-risk patients.

Background: Obesity is a well-known principal risk factor for metabolic disorders and cardiovascular diseases. Resistin is one of adipocyte-derived molecules, which plays important roles in inflammation as well as in endocrine and cardiovascular systems.Objectives: The present study aimed to determine the association between serum resistin level and presence/severity of Coronary Heart Disease (CHD).Patients and Methods: This cross-sectional study was conducted on 155 individuals referred for coronary angiography. Information about the patients’ age, gender, and cardiovascular risk factors was recorded. Their weight, height, and waist and hip circumferences were measured, as well. Each coronary angiogram was reported for two scoring methods (number of vessel diseases (usual method) and Gensini scoring system) by one cardiologist who was not aware of the participants’ serum resistin levels. Then, the relationship between serum resistin level and presence/severity of CHD was evaluated.Results: The results revealed no significant associations between the mean serum resistin level and the presence of CHD by both methods of evaluation of the coronary angiograms after adjustment for all conventional risk factors for CHD. In addition, no significant association was detected between serum resistin level and the severity of CHD based on the usual method of reporting the coronary angiograms (number of vessel diseases) (P=0.332). Yet, serum resistin level was positively correlated to body mass index and waist and hip circumferences and negatively related to height and fasting blood sugar level. Moreover, no linear correlation was found between serum resistin level and Gensini score (P=0.35). Finally, hip circumference (P=0.002) and height (P=0.018) were determined as the predictors of serum resistin level.Conclusions: This cross-sectional study showed no significant associations between serum resistin level and presence/severity of CHD.

Background: The effect of balloon angioplasty in treatment of coarctation of the aorta (COA) in pediatric patients is very important.Objectives: This study aimed to assess the efficacy and safety of balloon angioplasty for coarctation of the aorta (CoA) and its effects on heart function in children above 3 months of age.Patients and Methods: In this retrospective study, we reviewed the immediate outcomes of 100 consecutive pediatric patients above 3 months of age with native CoA who were treated by balloon angioplasty at a tertiary pediatric heart center from June 2002 to August 2012. The patients were followed by echocardiography. Statistical analyses were performed by descriptive statistics using the SPSS statistical software, version 20 and the significance level was set at 0.05.Results: The patients’ ages ranged from 4 months to 15 years, with the mean of 51.56 ± 42.22 months. Additionally, their body weight ranged from 4 to 63 kg (mean: 15.44 ± 10.62 kg) at the time of CoA repair. Technical success of balloon dilation was achieved in 91/95 patients (95.7%). Besides, systolic gradient significantly reduced from 48.29±21.62 mmHg (range 7 - 82 mmHg) to 13.21±9.96 mmHg (range 0 - 34 mmHg) (P<0.0001). The mean follow-up period was 2.21±0.94 years. Recoarctation and cardiac dysfunction occurred only in 4 patients. Z-scores of the Left Ventricular (LV) end diastolic and systolic dimensions were more than 2 standard deviations in 15 (17.1%) and 22 (25%) patients, respectively. In addition, there were 16 children (18.8%) with abnormal E/A ratios and 6 ones (6.8%) with E/Ea>15.Conclusions: Percutaneous balloon angioplasty was a safe and effective treatment option for native CoA in the children above 3 months old. However, impairment of LV diastolic function should be mentioned as an important issue in long-term follow-up.

Background: Heart Failure (HF) is a major cause of morbidity and mortality worldwide. Additionally, Worsening Renal Function (WRF) during hospitalization has a significant effect on re-hospitalization and mortality in such patients.Objectives: The present study aimed to determine the prevalence and prognostic significance of WRF complicating acute HF in patients enrolled into Rajaie Acute Systolic Heart Failure (RASHF) registry.Patients and Methods: RASHF registry is a single-center, prospective, observational, hospital-based study of systolic HF patients with Left Ventricular Ejection Fraction (LVEF) £ 35% admitted with acute decompensation. The patients were enrolled for 10 months from March 2012 to February 2013. The primary endpoint of the study was WRF. In addition, the secondary endpoints were in-hospital mortality and death within 3 months after discharge.Results: This study was performed on 230 patients (82% male). About one thirds of the patients (29.1%) developed WRF. Although some characteristics of the patients with WRF, including etiology of HF, NYHA functional class, and presence of risk factors, were similar to those of other patients, they were older, had more congestive symptoms, and had higher baseline creatinine levels. The incidence of in-hospital mortality was 9.6%. Length of hospital stay (14 days versus 8 days, P<0.001), in-hospital mortality (23.9% versus 4.9%, P<0.001), and death during 3 months after discharge (19.4% versus 13.4%, P<0.001) were higher among the patients with WRF.Conclusions: WRF was quite common in the patients with Acute Heart Failure (AHF) and was associated with higher in-hospital mortality and decrease in early survival after discharge.

Background: The incidence of Celiac Disease (CD) raises in children with Dilated Cardiomyopathy (DCM).Objectives: This study aimed to investigate the prevalence of CD in children with DCM compared with controls.Patients and Methods: This case-control study was conducted on 38 patients with DCM and 76 healthy controls to evaluate tTG and IgA during 2013 - 2014. Echocardiography was performed for all patients to detect cardiomyopathy. The exclusion criteria were IgA deficiency, history of digestive, endocrine, and metabolic disorders, iron deficiency, kidney disease, fever, and chronic diseases. Samples were centrifuged and the separated sera were kept at -70°C until tTG IgA and total IgA were measured by ELISA kit. After all, the data were entered into the SPSS statistical software, version 20 and were analyzed using parametric and non-parametric tests. Significance level was set at P<0.05.Results: This study was performed on 114 children; 38 in the case and 76 in the control group. The results showed no significant difference between the two groups regarding the means of continuous variables, including sex, tTG status, and diseases. From the 38 patients in the case group, 31 ones (81.58%) had normal tTG (£20) and 7 ones (18.42%) had abnormal tTG (³20). However, 72 participants in the control group (94.74%) showed normal tTG status (³20). The results showed a significant difference between the two groups regarding tTG status (chi-square=5.031, P=0.025).Conclusions: The results revealed a positive association between CD and DCM regardless of serology- or pathology-based diagnostic tools. This suggests the need for increasing awareness of patients with DCM regarding CD.

Background: Left Internal Mammary Artery (LIMA) and Saphenous Vein (SV) are two of the most commonly used conduits in Coronary Artery Bypass Grafting (CABG). Perioperative spasm of these conduits, especially LIMA, is associated with perioperative morbidity and mortality. Papaverine is the conventional vasodilator used intraoperatively to overcome the conduits spasm. Accumulating evidence linking papaverine to endothelial damage has prompted the search for alternative vasodilators.Objectives: This in vitro experimental study aimed to compare the effects of a combined solution of glyceryl trinitrate and verapamil (GV) and papaverine on isolated human LIMA and SV.Materials and Methods: Isolated segments of LIMA and SV from 14 patients undergoing CABG were cut into 3 mm rings and suspended on wire hooks in organ bath chambers. The rings were stretched to their physiological resting tensions and were then contracted by Norepinephrine (NE) 10-6 M. Cumulative concentrations of either GV or papaverine were applied to the contracted LIMA and SV rings (n=14 for each) and relaxation responses were recorded. When maximal relaxations were achieved, the vasodilators were washed out of the chambers and NE was reintroduced to the chambers after 1 h to assess the residual relaxing effects of the vasodilators.Results: GV was more potent compared to papaverine in fully (100%) relaxing both LIMA and SV (-log [half-maximal inhibitory concentration] (pIC50): 6.54±0.10 vs.4.58±0.05 –log M and 6.35±0.08 vs.4.62±0.05 –log M; P<0.001 for both). It also had a faster onset of effect (2.9±0.8 vs.8.1±1.0 min; P=0.004 and 2.4±0.6 vs.8.0±0.09 min; P<0.001). NE-induced contractions after vasodilator treatment were significantly suppressed compared to the initial contractions in LIMAs treated with either GV or papaverine (0.64±0.05 vs.0.31±0.04 g and 0.56±0.03 vs.0.08±0.00 g; P<0.001 for both), but only in SVs treated with papaverine (0.57±0.02 vs.0.40±0.06 g; P=0.014). Residual relaxations in the vessels treated with GV were not significantly different from those treated with papaverine after removing the drugs. Conclusions: The GV solution represented a potent, rapid-acting, and safe alternative to papaverine for reversal of spasm of LIMA and SV conduits and for inhibition of postoperative spasm in LIMA.

Mitral annular region and valvular apparatus injury during catheter ablation is a rare but serious complication. Although entrapment of a circular-tip mapping catheter in the mitral valve complex has been described as a major etiology of this rare complication, spring-tip guide wire entrapment in mitral valve complex during ablation procedures is unreported. We reported entrapment of a spring-tip guide wire in the mitral subvalvular apparatus during ablation of left lateral accessory pathway using transatrial septal approach. Various techniques were performed to make the guide wire free, which ultimately resulted in fracture of its distal end and subsequently surgical extraction. This unusual complication of catheter ablation would be a critical harm to patients undergoing trans-septal ablation approaches and great consideration should be warranted during the procedures.

Aortic wall with its poor blood supply is a very rare location of Hydatid Cyst (HC) infestation and mediastinal HC is a rare presentation of human hydatidosis. Here, we reported a case of primary mediastinal HC invading the ascending aorta, which initially presented as an aortic aneurysm. The patient underwent open cardiac surgery with cardiopulmonary bypass for resection of the aortic wall HC. During surgical exploration, it was found that the HC had ruptured into blood stream and residual cyst cavity contained a large thrombosis. Thus, the patient underwent ascending aorta replacement and removal of the cyst with thrombotic material. It seems that the signs and symptoms of stroke were related to emboli of cyst contents or thrombotic material into cerebral circulation. Invasion of aortic wall by hydatidosis is an exceedingly rare presentation of HC in the anterior mediastinum that may be wrongly diagnosed as a pseudoaneurysm of ascending aorta. Our study patient had an uneventful recovery and one-year follow-up revealed no recurrence of HC in mediastinum.