Vol 13 No 2 (2018): J Teh Univ Heart Ctr

Original Article(s)

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    Background: Diabetes is a chronic disease that reduces cardiorespiratory fitness and increases systolic and diastolic blood pressures as well as resting heart rate due to the activity level of the sympathetic nervous system. The aim of this study was to assess the effectiveness of 2 types of aerobic exercise, with and without external loading, on cardiac parameters in diabetic patients.
    Methods: This randomized controlled trial was carried out on 45 volunteers. These individuals were randomly divided into aerobic, weighted vest, and control groups. The aerobic protocol comprised 24 sessions of aerobic exercise. The exercise program for the weighted vest group was identical to that of the aerobic group, except that the subjects wore a weighted vest. The parameters were measured before and after the 24 sessions.
    Results: The mean age of the study population was 48.30 ± 5.02 years in the aerobic group, 48.33 ± 5.74 years in the weighted vest group, and 48.60 ± 4.79 years in the control group. Males comprised 7 (53.8%) patients in the aerobic group, 7 (58.3%) in the weighted vest group, and 8 (53.3%) in the control group.  After 8 weeks, maximum oxygen consumption in the aerobic group (mean ± SD = 37.54 ± 8.02 mL/kg/min, 95% CI: 5.48 to 11.60; p value < 0.001) and the weighted vest group (mean ± SD = 35.92 ± 3.96 mL/kg/min, 95% CI: 4.36 to 9.64; p value < 0.001) was increased, similar to metabolic equivalent of task in the aerobic group (mean ± SD = 11.60 ± 1.62 kcal/kg×h, 95% CI: 1.48 to 2.72; p value < 0.001) and the weighted vest group (mean ± SD = 11.21 ± 1.11 kcal/kg×h, 95% CI: 1.23 to 2.28; p value < 0.001). Furthermore, resting heart rate decreased significantly in the aerobic group (mean ± SD = 90.23 ± 8.90 bpm, 95% CI: -13.93 to -1.29; p value = 0.022) and the weighted vest group (mean ± SD = 90.58 ± 9.19 bpm, 95% CI: -0.16 to -12.33; p value = 0.045).
    Conclusion: These findings suggest that 24 aerobic exercise sessions might improve cardiac parameters in type 2 diabetes. 

  • XML | PDF | downloads: 155 | views: 197 | pages: 52-57

    Background: Acute kidney injury (AKI) after coronary artery bypass graft surgery (CABG) is a common complication. The present study sought to determine AKI risk factors based on the Acute Kidney Injury Network (AKIN) classification.
    Methods: In a cross-sectional study, performed from March 2010 to April 2012 at Tehran Heart Center, affiliated with Tehran University of Medical Sciences, 29 independent risk factors for AKI based on the AKIN criteria were examined in isolated post-CABG patients. The patients’ demographic data and risk factors were extracted from the Electronic Database of Tehran Heart Center. According to restricted inclusion and exclusion criteria as well as a creatinine rise to AKI Stage 1, the patients were divided into 2 groups of AKI-negative and AKI-positive and the risk factors were compared between these groups.
    Results: Out of 3473 included patients at a mean age of 60.78 (± 9.46) years, the majority (2474 [71.23%]) were male. Totally, 958 (27.7%) patients had AKI, according to a creatinine rise to AKI Stage 1. Logistic regression analysis demonstrated that higher age (OR = 1.021; p value < 0.001), higher body mass index (OR = 1.035; p value < 0.001), lower preoperative creatinine level (OR = 0.417; p value < 0.001), longer cardiopulmonary bypass time (OR = 1.004; p value = 0.007), blood transfusion in the ICU (OR = 1.408; p value = 0.001), and lack of intraoperative blood transfusion (OR = 0.823; p value = 0.044) were the independent risk factors for AKI after CABG.
    Conclusion: Based on the findings of the current study, older age, higher body mass index, lower preoperative creatinine level, more blood transfusion in the intensive care unit (ICU), lack of intraoperative blood transfusion, and high cardiopulmonary bypass time may serve as risk factors for the development of AKI in CABG patients.

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    Background: Recently, rs9289231 genetic variations of kalirin (KALRN) have been introduced as potential genetic markers for coronary artery disease (CAD). However, the influence of KALRN single-nucleotide polymorphisms (SNPs) on serum kalirin levels has not been investigated in CAD patients so far. Thus, the present study aimed to survey whether SNP T > G (rs9289231) was associated with the risk of early-onset CAD and serum kalirin levels among the study subjects.
    Methods: The rs9289231 polymorphism of the KALRN was genotyped in 512 subjects (61.5% male, mean age = 46.3 ± 7.1 y), comprising 268 subjects with angiographically diagnosed CAD and 244 controls using an HRM assay. Also, the levels of serum kalirin were compared between 133 CAD subjects and 123 controls using a sandwich ELISA assay. 
    Results: The CAD subjects had more frequently GG genotypes than the controls. The odds ratio (OR) remained significant after adjustment for known CAD risk factors (OR = 4.13, 95% CI: 2.48–9.10; p value < 0.001). A significant difference was also observed in that the G allele was more frequent among the CAD subjects. The G allele at the rs9289231 polymorphism was associated with a higher risk of CAD (OR = 2.11, 95% CI: 1.27–2.59; p value = 0.001). The mean kalirin level of the CAD patients was higher than that of the controls (p value = 0.041). No significant correlation was seen in the different genotypes with serum kalirin levels.
    Conclusion: The KALRN rs9289231 T > G variant was considerably related with an increased risk of early-onset CAD.  High kalirin levels were found in young CAD patients compared to the control subjects, with the levels not affected by the different genotypes of rs9289231.

  • XML | PDF | downloads: 171 | views: 190 | pages: 65-72

    Background: Hypertension is a major risk factor for premature disability and death and is the leading risk factor for global disease burden. The present study aimed to assess the rates of prevalence, awareness, treatment, and control of hypertension in a sample of teachers, staff, and students at Isfahan University of Medical Sciences (IUMS).
    Methods: This cross-sectional survey was conducted from January to September 2015 on the staff, teachers, and students at IUMS. A total of 1500 subjects were randomly selected and were invited to participate in the survey. Hypertension was defined as an average of 2 blood pressure measurements of at least 140/90 mmHg. The rate of awareness was determined based on self-reports, treatment was defined as the regular use of blood pressure-lowering medications, and control was defined as the maintenance of blood pressure below 140/90 mmHg.
    Results: The study population comprised 1317 individuals (45.9% female) at a mean age of 41.4 ± 9.5 years. The prevalence rate of hypertension was 17.5% (231 of 1317 participants), and the rate of awareness was 54.5% (126 of 231 hypertensive patients). Seventy-nine (62.7%) patients were undergoing treatment, and 51.9% (41 of 79) controlled their disease. Institutional position (p value < 0.017), age (p value < 0.001), body mass index (p value < 0.001), education level (p value < 0.001), smoking status (p value < 0.001), and history of diabetes mellitus (p value < 0.001) were the most frequent risk factors associated with hypertension.
    Conclusion: The percentage of the hypertensive subjects who were aware, treated, and controlled was unacceptably low in our sample at IUMS. Hypertension is, therefore, a major health problem in this state institution.

Case Report(s)

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    Upper limb deep vein thrombosis (DVT) is a less common phenomenon than lower limb DVT.  Repeated trauma secondary to sport- or job-related arm movements and positions has been recognized as the predisposing factor for upper limb DVT. We describe a 38-year-old male computer programmer admitted with swelling and pain in his left upper limb. Venous duplex ultrasound confirmed the presence of axillary vein thrombosis. Coagulation studies for secondary thrombosis were unremarkable. The patient was treated with full anticoagulation using low molecular weight heparin and warfarin. On subsequent follow-up at 3 months, the patient was symptom free and duplex sonography showed no evidence of thrombosis.

  • XML | PDF | downloads: 125 | views: 124 | pages: 76-79

    Intrapericardial teratomas are rare primary cardiac tumors. These tumors, albeit benign in essence, can be fatal if they exert pressure on the cardiovascular and/or respiratory system. We describe a 34-day-old infant, who needed emergent surgery due to cardiovascular structure compromise. Proper anesthetic and surgical techniques conferred an uneventful postoperative course. Histologic examination confirmed the tumor as an intrapericardial teratoma. At 8 months’ postoperative follow-up, the child had a good developmental status and a normal echocardiogram.

  • XML | PDF | downloads: 122 | views: 133 | pages: 80-83

    The coronary sinus, whose electrical features play an important role in cardiac arrhythmias, is the integral part of the cardiac venous system. Here we describe a 67-year-old male patient with congestive heart failure who was referred to our hospital after the failure of the first cardiac resynchronization therapy defibrillator (CRT-D) implantation. During the cannulation of the coronary sinus, the separate orifice of the posterior cardiac vein was demonstrated by the retrograde filling of the coronary sinus via contrast injection into the posterior cardiac vein. Due to the serious tortuosity of the coronary venous sinus, a multipolar left ventricular lead was implanted using the separate ostium of the posterior cardiac vein. In our patient, the posterior cardiac vein directly drained into the right atrium. At 3 months’ follow-up with the CRT-D, he was asymptomatic (New York Heart Association functional class I).

  • XML | PDF | downloads: 152 | views: 98 | pages: 84-87

    An isolated right superior vena cava (RSVC) draining into the left atrium represents a very rare congenital malformation, especially in the absence of a partial anomalous pulmonary venous return. This condition leads to hypoxemia, cyanosis, and clubbing without any other signs of heart defects. We describe an 8-year-old girl, who was referred to our hospital due to unexplained cyanosis. Segmental approach in transthoracic echocardiography showed left atrial drainage of the RSVC, which was subsequently confirmed by contrast echocardiography and angiography. Surgical repair via trans-section and anastomosis of the superior vena cava to the right atrium was performed to prevent the complications of right-to-left shunting and cyanosis. During a 4-year follow-up, the patient remained in very good clinical status and her serial echocardiography was normal except for very mild left atrial and left ventricular enlargement.

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    Endovascular treatment of aortic diseases has improved in recent years. More complex thoracoabdominal and juxtarenal abdominal aortic aneurysms can now be treated with new stent grafts and techniques. Fenestrated endovascular aortic aneurysm repair (FEVAR) with fenestrated stent grafts was commenced in our center after hundred cases of endovascular aortic repair, and so far 4 serial complex cases deemed inoperable (2 juxtarenal abdominal aortic aneurysms, 1 thoracoabdominal aneurysm, and 1 thoracoabdominal pseudoaneurysm) have been treated with FEVAR. All these patients needed custom-made stent grafts, which were designed and implanted successfully under general anesthesia in the catheterization laboratory. They were followed up for more than 1 year, with a median follow-up period of 23.0 months. There were no major in-hospital or short-term complications. Only 1 patient had midterm unilateral iliac artery thrombosis, which was successfully managed interventionally. Computed tomography angiography at 1 year’s follow-up showed that the stent grafts were patent and their visceral branch cover stents had no endoleak.

Letter to the Editor