International Journal of Cardiovascular Practice

International Journal of Cardiovascular Practice

Basic info

  • Publisher: Shahid Beheshti University of Medical Sciences
  • Country of publisher: iran, islamic republic of
  • Date added to EuroPub: 2019/Sep/29

Subject and more

  • LCC Subject Category: Medicine, Cardiology
  • Publisher's keywords: Cardiology, Heart, Cardiovascular, Medicine
  • Language of fulltext: english

Publication charges

  • Article Processing Charges (APCs): No
  • Submission charges: No
  • Waiver policy for charges? No

Editorial information

Open access & licensing

  • Type of License:
  • License terms
  • Open Access Statement: No
  • Year open access content began: 2016
  • Does the author retain unrestricted copyright? False
  • Does the author retain publishing rights? False

Best practice polices

  • Permanent article identifier: DOI
  • Content digitally archived in: LOCKSS, CLOCKSS
  • Deposit policy registered in: None

This journal has '19' articles

Frequency of HLA-B27 in Patients With Conductive System Disturbance and Implanted Permanent Pacemaker in Iran

Frequency of HLA-B27 in Patients With Conductive System Disturbance and Implanted Permanent Pacemaker in Iran

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Abstract

Introduction: HLA-B27 is considered as one of the causes of heart conductive disorders. We studied the frequency of HLA-B27 among Iranian patients who had undergone permanent pacemaker implantation. Methods: This descriptive and analytical study was performed among patients who underwent permanent pacemaker implantation. The questionnaire contains demographic data, underling diseases, and history of heart disease or heart surgery. The type of conductive heart disorder was mentioned there, too. We determined the regurgitation of aorta valve and its severity. Finally, HLA-B27 was accessed. All the data was entered in SPSS software and analyzed. Results: From a total of 103 patients entered in this study, only 6 (5.8%) were HLAB-27 positive. The disturbance of conductive heart disorders based on the HLA-B27 positive or negative patients was not statistically different. Patients with HLA-B27 mostly had regurgitation of the aorta valve. Conclusions: We concluded that the frequency of positive HLA-B27 genotype in patients with permanent pacemakers did not have any significant difference with the ones with negative HLA-B27 genotype. However; this genotype was associated with regurgitation of the aorta valve.

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Venous Obstruction Following Pacemaker or Implantable Cardioverter-Defibrillator Implantation, Mini Review

Venous Obstruction Following Pacemaker or Implantable Cardioverter-Defibrillator Implantation, Mini Review

Authors: Mohammad Ali Akbarzadeh
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Abstract

Venous obstruction is relatively frequent following permanent pacemaker or implantable cardioverter-defibrillator (ICD) implantation. However, most of them are asymptomatic. Although the exact risk factor for this complication is not known, number of leads, heart failure and infection may prone the patient to this complication. The goal standard for detection of vein stenosis is venography; however, ultrasound sonography has an acceptable accuracy. Anticoagulant therapy may be considered for symptomatic patients. For device upgrading, non-functional leads removal, venoplasty and rarely surgical treatment may be indicated.

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Value of Admission HbA1c Level in Non-diabetic Patients With Unstable Angina

Value of Admission HbA1c Level in Non-diabetic Patients With Unstable Angina

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Introduction: There have been incompatible evidences about the prognostic value of HbA1c on the adverse outcomes in acute coronary syndrome. Also, these data are so limited in nondiabetic patients with unstable angina. Methods: In this cross-sectional study, HbA1c level of 231 nondiabetic patients admitted with unstable angina, was measured using high performance liquid affinity chromatography (HPLC) at admission. Then transthoracic echocardiography (TTE) was performed for evaluation of ejection fraction (EF) using Simpson method. Results: Our data revealed that HbA1c was significantly higher in patients with EF≤ 50% in comparison with EF>50% group (P value=0.01). Conclusions: HbA1c may be a helpful prognostic marker in nondiabetic patients admitted in emergency department with diagnosis of unstable angina.

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Drug-related Atrioventricular Block: Is It a Benign Condition?

Drug-related Atrioventricular Block: Is It a Benign Condition?

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Abstract

Introduction: Prognosis of the patients with beta blocker or calcium channel blocker induced AV block is not well known to date. Methods: All patients with symptomatic second-degree or third-degree atrioventricular block (AV) referred to our institution during one year were recuited prospectively and classified in two groups based on drug consumption (beta blocker/calcium channel blocker versus none). They were followed for six months and then collected data was analyzed. Results: The study included 49 patients, 28 patients (age 60.1 ± 20, 19 male) did not use any beta blocker or calcium channel blocker (No- DU group) and other 21 patients (age 73.5 ± 10.4, 7 male) receivd beta blocker, calcium channel blocker or both at the time of AV block (DU group). No-DU group was significantly younger than DU group. The most common atrial rhythm in both groups was sinus. There was no significant difference in QRS wideness or ventricular rate. AV block regressed in 43% of the DU group after discontinuation of drug for five half-life, but, Mobitz type 2 or complete AV block occurred again during six months in 50% of them without consumption of the culprit drug. Conclusions: More than two third of the patients who developed AV block on beta blocker and/or calcium channel blocker needed permanent pacemaker in six months of follow- up, so we concluded that the development of AV block was not as benign as it seems in these patients.

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Validity of Initial Clinical Diagnosis of Unstable Angina Based on the Invasive and Noninvasive Studies

Validity of Initial Clinical Diagnosis of Unstable Angina Based on the Invasive and Noninvasive Studies

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Introduction: A few studies have focused on diagnostic performance of residents for controlling the patients with acute chest pain referring to chest pain units. We aimed to assess diagnostic performance of cardiology residents for controlling the patients with acute chest pain, considering invasive and non-invasive diagnostic modalities as the key standards to confirm or refuse diagnosis of unstable angina. Methods: One hundred and twenty nine patients with chest pain or angina referring to chest pain unit of Modarres hospital between 2013 and 2014 were assessed. The patients were categorized into two subgroups. The first group included 23 patients who were discharged by the resident in initial evaluation because of ruling-out diagnosis of unstable angina, but were assessed non-invasively by exercise test or SPECT as key standards. The second group included 106 patients who were hospitalized and admitted to CCU by residents’ order and also were assessed invasively by coronary angiography or noninvasively by exercise test or SPECT. Results: Overall, of 129 patients, 23 were initially diagnosed not to be necessarily hospitalized and thus were discharged by resident’s order. Of those, assessing by SPECT indicated positive result in five of 19 patients and by exercise test indicated positive result in 1 of 4 patients yielding a sensitivity of 83.3%, a specificity of 17.6%, a PPV of 26.3%, a NPV of 75.0%, and an accuracy of 34.8% for assessing disease by resident. The remaining 106 patients were admitted to CCU ward in accordance with the resident’s order. Among those patients, 85 underwent coronary angiography with positive results in 53 patients. Also, SPECT was positive in 10 of 19 patients and exercise test was positive in one of two patients yielding a sensitivity of 95.3%, a specificity of 0.0%, a PPV of 59.2%, a NPV of 0.0%, and an accuracy of 57.5%. Conclusions: For patients with suspicion to unstable angina, the decision of residents in chest pain units for discharging or admitting patients suspected to unstable angina is accompanied with high sensitivity but unacceptable specificity and thus using supplement diagnostic tools such as exercise test or SPECT can be very helpful for diagnosing unstable angina.

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Pulmonary Hypertension and Its Determinants in β-thalassemia Major and Intermedia Considering Left Ventricular Functional State

Pulmonary Hypertension and Its Determinants in β-thalassemia Major and Intermedia Considering Left Ventricular Functional State

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Abstract

Introduction: Pulmonary hypertension (PHT) is a common complication in β-thalassemia. We aimed to determine the prevalence of PHT and its main indicators in patients with β thalassemia Major (TM) and β-thalassemia Intermedia (TI), considering left ventricular function. Methods: Pulmonary hypertension (PHT) is a common complication in β-thalassemia. We aimed to determine the prevalence of PHT and its main indicators in patients with β thalassemia Major (TM) and β-thalassemia Intermedia (TI), considering left ventricular function. Results: The overall prevalence of PHT in TM and TI group was estimated to be 35.2% and 29.3%, respectively; while reduced LVEF was evident in 22.7% and 10.1% of patients with TM and TI, respectively. No significant correlation was observed between mean PAP and LVEF in the patients with TI (Pearson coefficient = -0.096, P value = 0.345); while, an adverse association was revealed between mean PAP and LVEF in patients with TM (Pearson coefficient = -0.227, P value = 0.033). Upon univariate analysis, the only significant association was observed between LVEF and pulmonary hypertension among TM patients (P value = 0.001).Our results did not indicate that male gender and aging may affect the development of PHT. Conclusions: According to our findings, a considerable proportion of patients with TM and TI may have PHT. We detected an adverse association between mean PAP and LVEF in patients with TM. Left ventricular function was reduced in patients with PHT among TM group.

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Acute Myocardial Infarction in a Patient With Elevated ST-Segment in aVR Lead and Diffuse ST Segment Depression in Other Leads: A Case Report

Acute Myocardial Infarction in a Patient With Elevated ST-Segment in aVR Lead and Diffuse ST Segment Depression in Other Leads: A Case Report

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Abstract

ST elevation in aVR in conjunction with diffuse ST depression in precordial leads may indicate occlusion of very proximal portion of the left anterior descending artery. We present a 54-year old man, with crushing retrosternal pain and ST-segment elevation only in aVR lead and diffuse ST-segment depression in inferior, lateral and precordial leads. The patient was scheduled for emergent coronary angiography, which showed that left anterior descending (LAD) artery was cut off at very proximal portion and urgent CABG was performed for the patient.

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Impact of Lesion Length on Functional Significance in Intermediate Coronary Lesions

Impact of Lesion Length on Functional Significance in Intermediate Coronary Lesions

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Introduction: The present study aimed at assessing the role of lesion length in predicting Fractional Flow Reserve (FFR) value for physiological evaluation of intermediate coronary lesions. Methods: In the current study, 68 patients with 83 coronary lesions were enrolled. All of the patients in this study underwent routine coronary angiography, according to appropriate indications. To evaluate physiologically significant intermediate coronary stenosis (defined between 40% and 70% on visual estimation), the Fractional Flow Reserve (FFR) study was performed and the Quantitative Coronary Angiography (QCA) data were also assessed for measurement of lesion length. The correlation between QCA data and FFR values was also examined. Results: Eighty-three lesions were evaluated from 68 patients. Stenosis was considered physiologically significant when FFR was lower than 0.75. The FFR was significant in twelve lesions (14.5%). There was a negative correlation between FFR value and lesion length (r = -0.294 and P = 0.013). Moreover, lesion length in physiologically significant FFR group (21.07 ± 6.9) was greater than that of the non-significant FFR group (15.23 ± 6.5) (P value < 0.05). Furthermore, the correlation between QCA data and FFR values was also investigated, yet, there was only a positive correlation between FFR and Minimum Luminal Diameter (MLD) values (r = 0.248 and P value = 0.04). The Receiver Operating Characteristic (ROC) curve analysis for predicting the significant FFR value demonstrated that a lesion length greater than 17.5 mm was the best cut-off point for prediction of the significant FFR value with acceptable sensitivity and specificity of 83.3% and 68.8%, respectively. Conclusions: There is a negative correlation between lesion length and FFR value in intermediate coronary lesions. In addition, a lesion length greater than 17.5 mm is the best cut- off point for prediction of significant FFR values.

Keywords: Coronary Artery Bypass Fractional Flow Reserve, Myocardial Quantitative Coronary Angiography
Evaluation of the pulse pressure index at the peak of exercise before and after cardiac rehabilitation

Evaluation of the pulse pressure index at the peak of exercise before and after cardiac rehabilitation

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Background and Objectives: As a new supplementary therapeutic option, cardiac rehabilitation (CR) is getting more attention each day. Several studies have proved the positive impact on qualitative criteria but few studies have been done on quantitative criteria.The purpose of the survey in this study is to evaluate the impact of CR on non-invasive estimated maximum cardiac output by Pulse Pressure index (PPI) at the peak of exercise. Methods: This is a nonrandomized prospective cohort study conducted in Hamadan, Iran in 2015.100 eligible patients who underwent coronary artery bypass surgery, based on cardiologist permission and an informed consent, participated in our study. The PPI was measured at the peak of exercise before and after standard CR program. Result: In overall, mean of PPI was not significantly different before and after CR. PPI was noticeably increased in patients younger than 60 years old (p = 0.022). In contrast to hypertensive patients, PPI in non-hypertensive patients increased significantly after CR (p=0.002). PPI considerably increased in non-diabetic patients after CR (p=0.046), but not in diabetic individuals. Other variables had not any significant effect on PPI in response to CR. Conclusion: it is clear that PPI is associated with vascular atherosclerosis, as well as cardiac output; Positive effects of CR diminish in older, diabetic and hypertensive patients with more progressive atherosclerosis.

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Short-term Cost-effectiveness of Reteplase versus Primary Percutaneous Coronary Intervention in Patients with Acute STEMI a Tertiary Hospital in Iran

Short-term Cost-effectiveness of Reteplase versus Primary Percutaneous Coronary Intervention in Patients with Acute STEMI a Tertiary Hospital in Iran

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Introduction: This study aimed to compare primary percutaneous coronary intervention (PPCI) versus reteplase in terms of clinical and para-clinical outcomes; as well as cost-effectiveness in patients with ST-segment-elevation myocardial infarction (STEMI).Primary percutaneous coronary intervention is the method of choice in all patients especially those at higher risks. But an on-site professional team in a 24/7 facilitated system is a difficult goal to achieve in many areas and countries, therefore the cost-effectiveness of these two treatment strategies (PPCI and reteplase) needs to be discussed. Methods: This prospective cohort study included 220 patients presented with STEMI who were admitted to a university hospital between January 2014 to July 2016. Patients were divided into two groups of 120, either receiving reteplase or PPCI. Clinical outcomes were considered duration of hospital stay and MACE (Major Advanced Cardiovascular Events) including death, cerebrovascular accident, need for repeat revascularization, and major bleeding. LVEF (Left ventricular ejection fraction) was considered as a para-clinical outcome. The outcomes and total hospital cost were compared between two treatment groups. Results: Demographic characteristics between two groups of PPCI or reteplase didn’t show any significant differences. But in para-clinical outcomes, patients in PPCI group showed higher LVEF, compared with reteplase group (45.9 ± 11.5% versus 42.0 ± 11.8%; P = 0.02). Complication rates were similar in both groups but repeat revascularization or coronary artery bypass surgery was more prevalent in those who received thrombolytic therapy (P < 0.05). Length of hospital stay in both groups was similar in two groups but total cost was higher in patients who have received PPCI. (147769406.9 ± 103929358.9 Tomans vs. 117116656.9 ± 67356122.6 Tomans; respectively, P = 0.01). Conclusions: In STEMI patients who present during off-hours, thrombolytic therapy seems to represent a safe alternative to PPCI. Higher costs for patients with PPCI may be decreased with shorter duration of hospital stays according to guidelines.

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Intramural Ventricular Septal Defect

Intramural Ventricular Septal Defect

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Intramural ventricular septal defects (VSDs) are less frequently encountered but clinically significant type of residual interventricular communications seen after complex congenital heart surgeries. Hemodynamically significant intramural VSDs can lead to higher postoperative morbidity and mortality. This case highlights the clinical challenges including the need multiple interventions faced in affected patients.

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The role of the history of coronary heart disease among second degree relatives for predicting coronary artery disease

The role of the history of coronary heart disease among second degree relatives for predicting coronary artery disease

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Introduction: The history of atherosclerotic disease among second degree family members of patients as a risk factor has not been properly explained. The present study aimed to assess this role in the Iranian population. Methods: This case-control study was performed on 500 consecutive patients, who were candidates for coronary angiography. The presence of Coronary Heart Disease (CHD) history among first and second degree relatives were determined by interviewing the participants. Results: In total, 450 patients were shown to have CHD as the case group and 50 without CHD as the control group. Family history of CHD among first degree relatives was 39.1% for cases and 22.0% for the controls with a significant difference (P = 0.018), however the history of CHD among second degree relatives was not statistically different in the case group and the control group (17.8% vs. 8.0%, P = 0.079). In total, 80 patients had CHD with simultaneous history of disease among their second degree relatives, while 370 with CHD had no history of disease among their second degree relatives. Our study could not find a significant difference between the two CHD groups with and without history of disease among second degree relatives in terms of cardiovascular risk profile. Conclusions: Despite the powerful effect of the presence of family history of CHD in first degree relatives on risk of CHD and its severity, the presence of this history among second degree relatives cannot predict the risk for CHD.

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In-hospital and late outcome of rescue versus primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction

In-hospital and late outcome of rescue versus primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction

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Introduction: Despite high technical success of rescue Percutaneous Coronary Intervention (PCI) and also its significant impact on left ventricular function, the therapeutic outcome of this PCI technique in comparison with primary PCI for coronary reperfusion has remained uncertain. The present study aimed to conduct a comparative analysis of early and long-term results of patients with ST-Elevation Myocardial Infarction (STEMI), who had undergone primary or rescue PCI. Methods: One hundred and twenty-nine consecutive patients with the diagnosis of STEMI, who underwent primary PCI (n = 107) or rescue PCI (n = 22) from April 2012 to September 2013 were retrospectively included. In addition to early assessment of procedural consequences, the patients were followed-up to assess and compare long-term mortality and major adverse cardiovascular events. Results: Comparing in-hospital consequences of the two rescue PCI and primary PCI procedures showed no significant differences in in-hospital mortality (9.5% vs. 3.7%, P = 0.255), total hospital stay (6.32 ± 2.24 days vs. 6.61 ± 3.43 days, P = 0.720) and also in early procedural complications. Long-term death was found only in 1.9% of patients in the primary group and none of the patients in the rescue group (P = 0.999). There was also no difference in the prevalence of late stent thrombosis between the two groups. However, the in-hospital Left Ventricular Ejection Fraction (LVEF) was lower in the rescue PCI group vs. primary PCI group (36.82 ± 11.19 vs. 43.48 ± 9.14, P = 0.014), but after six months, LVEF was similar between the two groups (41.05 ± 9.57 vs. 44.29 ± 10.35, P = 0.082). Conclusions: Our study showed no difference in early and late procedural outcome between the primary and rescue PCI techniques in STEMI patients, but LVEF had better improvement in the rescue PCI group.

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