Vol 1 No 2 (2006): J Teh Univ Heart Ctr
Cardiovascular disease remains the principal cause of death in the modernized world. Several novel noninvasive imaging techniques have been recently developed to improve diagnosis of cardiac and coronary disease. Of these advances, multidetector computed tomographic (MDCT) angiography has evolved most dramatically to transform computed tomography from a single-slice trans-axial modality to a three-dimensional volumetric technique. Current generation 64-detector row CT scanners allow for large volume coverage with submillimeter spatial and sub-second temporal resolution. These advances enable important new applications for MDCT in the assessment of cardiac and coronary anatomy. In this report, we discuss in depth potential appropriate uses of cardiac and coronary MDCT angiography.
Background: Several studies showed that elevated plasma homocysteine level is a risk factor for coronary artery disease (CAD). A common polymorphism C677T of methylenetetrahydrofolate reductase (MTHFR) gene is reported to be associated with decreased enzyme activity and increased blood homocysteine level.
Methods: This study evaluated the association between C677T polymorphism and blood homocysteine level with CAD in 100 patients compared to 100 normal controls.
Results: Higher prevalence of the C677T polymorphism as well as elevated level in blood homosysteine were observed in Iranian CAD cases compared to the normal control. The C677T MTHFR common polymorphism was significantly associated with CAD, supported by a P value 0.032 and Chi-square equal to 6.87.
Conclusions: The TT genotype of MTHFR gene was attributed to increased blood homocysteine level in patients compared to T/C and C/C genotypes in studied Iranian cases. This study shows the advantage of testing C677T polymorphism in affected patients as a risk factor for coronary artery disease.
Background: Considering suggested formula in the references and PCWP measured by catheterism, in the present study the relation between pulmonary capillary wedge pressure (PCWP) measured the flow velocity of mitral valve and mitral annulus motion through tissue doppler imaging is evaluated
Methods: 52 cases of severe MS were admitted for Balloon Mitral Valvolotomy (BMV) are included in this study. Mean age was 35±5 years consisting of 40 females and 12 males. Valve area, Pulmonary artery systolic pressure (PAP), E (Maximum Velocity of mitral valve at the beginning of diastole) & Em (Maximum rate of mitral annular motion at the beginning of diastole which is recorded through septal or lateral wall annulus site) velocity and left atrial (LA) size were also measured by echocardiography and PCWP & PAP through catheterism. All patients had normal ejection fraction (EF) and coronary arteries; there was no other valvular diseases and shunts.
Results: There was a significant correlation between PAP in echocardiography and catheterism. Mean PAP was 53±19 mmHg in echocardiography and 53.9±17.8mmHg in catheterism. There wasn't any correlation between PCWP in echocardiography and catheterism (P=0.33) and also no relation between PCWP and mitral valve area (MVA) or LA size (P=0.2). E/Em ratio increased in severe MS cases.
Conclusion: E/Em ratio and suggested formula would overestimate the wedge pressure so echocardiography is not a reliable method for measuring PCWP in severe MS. Em velocity and E/Em ratio may be used for estimating MS severity.
Background: We report experimental myocardial infarction by occluding coronary arteries in ovine models.
Methods: Twelve ewes were included in the study. After the chest was opened by left lateral thoracotomy incision, the second diagonal branch of the left anterior descending coronary artery was ligated at a point approximately 40% distant from its base. Prophylactic antiarrhythmics were administered. Animals were mechanically ventilated during surgery and stayed in the ICU for 24h afterwards. Experiments were then evaluated by echocardiographic, electrocardiographic, hemodynamic, serologic and morphologic investigations. Echocardiographic measurements were repeated after two months and animals were then sacrificed for postmortem cardiac examinations.
Results: All animals survived the surgical procedure. Cyanotic discoloration and hypokinesia in the cardiac tissue in an area of 3×4 cm plus ST-segment elevations was detected immediately after vessel ligation. More over, there were pathologic Q- waves 2 months later. Echocardiographic evaluations revealed an average of 22% relative decrease in cardiac ejection fraction. Wall motion analysis demonstrated anteroapical hypokinesia and akinesia in all animals one day and two months after operation. Thin walled infarcted areas with tissue fibrosis were evident in pathologic investigations two months after surgery.
Conclusion: In conclusion, we developed a practical and safe method of producing myocardial infarction in large animal models.
Background: Permanent pacemakers provide effective relief of symptoms and are life-saving in patients with symptomatic heart block. Implantable cardioverter defibrillators (ICD) are also increasingly recognized as life-saving tools in various groups of patients with malignant ventricular tachyarrhythmias.
Methods: As part of the “world survey on pacemaker and ICD implantations”, a survey of all device implantations in Iran during the year 2001 was performed. Data was collected and cross-checked through three sources i.e. direct contact with implanting physicians, pacemaker companies and the governmental pacemaker distributing body.
Results: During the year studied, 1635 patients received permanent pacemakers. 88% were new implants at an estimated rate of 24 per million population. The mean age of patients was 65 years and 56.2% were male. 40 cardiologists and 19 surgeons implanted the pacemakers at 27 centers throughout the country. Complete heart block was consistently the most common indication at all centers (mean 56.1%), sick sinus syndrome being the next most common one (mean 20.8%). 69% of the pacemakers were single chamber pacemakers. Transvenous insertion of bipolar steroid-eluting passive fixation leads was the predominant practice at most centers. A total of 60 ICDs were implanted at 7 centers by 9 cardiologists. 45% of ICD implants were dual chamber devices.
Conclusion: The survey is the only one available right now and provides useful information about the prevailing pacemaker and defibrillator implantation practice in Iran. Future surveys would be facilitated if a standardized implant registry such as that used in Europe were established in this country.
Background: Contrast nephropathy will increase mortality up to 30% following angiographic procedures. Adenosine is a crucial mediator of contrast-induced nephropathy. The purpose of this study was to investigate whether the adenosine antagonist Theophylline reduces the incidence of CN after coronary angiography.
Methods: In this randomized, double-blind, placebo-controlled clinical trial study, carried out from February 2004 to September 2005 at the Fatemeh Zahra Hospital, 70 patients who were undergoing coronary angiography were divided into two groups. Case group (n=35) received oral Theophylline 200 mg bid. 24 h before and for 48 h after angiography. The control group (n=35) received placebo. Serum Na+, K+, blood urea nitrogen (BUN), creatinine, glomerular filtration rate (GFR) were measured before and after angiography.
Results: In the case group there were no significant change in serum creatinine (0.90± 0.7 vs. 0.92±0.3 mg/dl), BUN (17.76±7.8 vs. 19.35±9.6 mg/dl), GFR (83.01±26.7 vs. 81.36±24.9 ml/min) Na+ (139.08±3.6 vs. 138.54±2.7 mEq/l) and K+ (4.30±0.4 vs. 4.19±0.3 mEq/l). In the control group, there was a significant fall in GFR after angiography (86.10±34.8 vs. 80.7±30.4 ml/min, P=0.03). Following angiography, there were no significant difference in serum creatinine, BUN, GFR, Na+ and K+ level between the two groups. None of the patients in either group faced contrast induced nephropathy.
Conclusion: Theophylline does not appear to add a protective role in preventing against contrast induced nephropathy in patients undergoing angiographic procedures.
Background: Coronary artery disease is recognized as one of the three major causes of mortality around the world. The role of inflammation in producing coronary artery disease has been established in previous studies. Since periodontitis, which is highly prevalent, is considered as a cause of inflammation, its influence on producing coronary artery disease was investigated in the present study considering its four main indices.
Methods: In this case-control study, 60 patients with angiographically proven coronary artery disease were selected as case group After matching for some baseline characteristics including educational level, age, sex, and some established risk factors for coronary artery disease, 60 healthy individuals were selected as control group from a population in whom coronary artery disease had been angiographically ruled out. Then, the existence of periodontitis was compared with statistical methods in these two groups, considering four different dental indices.
Results: The mean plaque index (PI) was 57.82±2.92% in cases vs. 35.73±2.53% in controls (p<0.05). Mean bleeding on probing (BOP) was 36.3±3.38% in cases versus 18.6±2.6% in controls, while mean Attachment Loss>4mm was 35.14±3.89% and 15.48±2.79% in cases and controls, respectively (P<0.05). The mean loss of teeth (LOT) was not significantly different in cases and controls (5.08±0.52 versus 5.38±0.53, P>0.05). Therefore, except for the number of lost teeth, there was a statistically significant difference between these two groups. For an evaluation of independent variables, multiple logistic regression analysis was used. Odds ratio was 1.02 for attachment loss and 2.2 for BOP.
Conclusion: Periodontitis may be counted as a risk factor for coronary artery disease and it is essential to study the effects of control and management of these diseases as primary and secondary prevention for coronary artery disease in future studies.
Noncompaction of the ventricular myocardium is an embryonic cardiomyopathy that is increasingly being recognized. Noncompaction of LV myocardium, right ventricular myocardium, or both can occur in isolation, in congenital heart diseases, in valvular heart diseases, in neuromuscular disorders, skeletal abnormalities and in endocrinologic abnormalities. Clinical manifestations of ventricular non-compaction include congestive heart failure, arrhythmia, sudden cardiac death and embolic events.This report is illustrative of non-compaction left ventricle associated with WPW syndrome in a 12-year-old girl presented with aborted sudden cardiac death and heart failure.
The overall rate of atrial pacing lead dislodgement is estimated to be about 3%. These leads are generally repositioned via a second operation through opening the pacemaker pocket.
Some operators have introduced percutaneous techniques using snare system or deflectable catheters for this purpose.
In this article we present our experience with five cases of percutaneous lead repositioning. Three cases were performed using deflectable ablation catheters and in two cases we used a specially designed urologic basket. The procedural success rate was 100% at the beginning but the long term success rate was 60%.
2023 CiteScore: 0.9
pISSN: 1735-8620
eISSN: 2008-2371
Editor-in-Chief:
Abbasali Karimi, MD.
Senior Associate Editor:
Ali Bozorgi, MD.
Section Editors:
Masih Tajdini, MD.
Entezar Mehrabinasab, MD.
This journal is a member of, and subscribes to the principles of, the Committee on Publication Ethics (COPE).
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