Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 5 2 2010 04 15 57 68 Mohammadali Boroumand Tehran Heart Center, Tehran University of Medical Sciences, Iran. Hamidreza Goodarzynejad Tehran Heart Center, Tehran University of Medical Sciences, Iran. 2015 10 03 Clinicians should be aware of new developments to familiarize themselves with pharmacokinetic and pharmacodynamic characteristics of new anticoagulant agents to appropriately and safely use them. For the moment, cardiologists and other clinicians also require to master currently available drugs, realizing the mechanism of action, side effects, and laboratory monitoring to measure their anticoagulant effects. Warfarin and heparin have narrow therapeutic window with high inter- and intra-patient variability, thereby the use of either drug needs careful laboratory monitoring and dose adjustment to ensure proper antithrombotic protection while minimizing the bleeding risk. The prothrombin time (PT) and the activated partial thromboplastin time (aPTT) are laboratory tests commonly used to monitor warfarin and heparin, respectively. These two tests depend highly on the combination of reagent and instrument utilized. Results for a single specimen tested in different laboratories are variable; this is mostly attributable to the specific reagents and to a much lesser degree to the instrument used. The PT stands alone as the single coagulation test that has undergone the most extensive attempt at assay standardization. The international normalized ratio (INR) was introduced to ‘‘normalize’’ all PT reagents to a World Health Organization (WHO) reference thromboplastin preparation standard, such that a PT measured anywhere in the world would result in an INR value similar to that which would have been achieved had the WHO reference thromboplastin been utilized. However, INRs are reproducible between laboratories for only those patients who are stably anticoagulated with vitamin K antagonists (VKAs) (i.e., at least 6 weeks of VKA therapy), and are not reliable or reproducible between laboratories for patients for whom VKA therapy has recently been started or any other clinical conditions associated with a prolonged PT such as liver disease, disseminated intravascular coagulation, and congenital factor deficiencies. In contrast to marked progress in the standardization of PT reagents for INR reporting, no standardization system has been globally adopted for standardization of PTT reagents. Recently College of American Pathologists recommend that individual laboratories establish their own therapeutic range by using aPTT values calibrated against accepted therapeutic unfractionated heparin (UFH) levels calibrated against accepted therapeutic UFH levels performing anti-Xa test (which is the most accurate assay for monitoring UFH therapy). Herein, we review recent data on the monitoring of conventional anticoagulant agents. Marked interlaboratory variability still exists for PT, INR, and PTT tests. Further research should be focused on improving the standardization and calibration of these assays. https://jthc.tums.ac.ir/index.php/jthc/article/view/163 https://jthc.tums.ac.ir/index.php/jthc/article/download/163/161

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 5 2 2010 04 15 69 73 Maryam Esmaeilzadeh Echocardiography Research Center of Shaheed Rajaei Cardiovascular Medical and Research Center, Tehran, Iran Ahmad Mirdamadi Echocardiography Research Center of Shaheed Rajaei Cardiovascular Medical and Research Center, Tehran, Iran Mozhgan Parsaee Echocardiography Research Center of Shaheed Rajaei Cardiovascular Medical and Research Center, Tehran, Iran Anita Sadeghpour Echocardiography Research Center of Shaheed Rajaei Cardiovascular Medical and Research Center, Tehran, Iran Majid Maleki Echocardiography Research Center of Shaheed Rajaei Cardiovascular Medical and Research Center, Tehran, Iran Hooman Bakhshandeh Abkenar Echocardiography Research Center of Shaheed Rajaei Cardiovascular Medical and Research Center, Tehran, Iran 2015 10 03 Background: The evaluation of prosthetic valves is very difficult with two-dimensional transthoracic echocardiography alone. Doppler and color flow imaging as well as transesophageal echocardiography are more reliable to detect prosthetic valve dysfunction. However, Doppler study sometimes tends to be misleading due to the load-depending characteristics of peak and mean pressure gradients. The peak-to-mean pressure decrease ratio is a load-independent measure, which was previously used for the detecting and grading of aortic valve stenosis. We assessed the usefulness of this method for the evaluation of aortic valve prosthesis obstruction. Methods: One hundred fifty-four patients with aortic valve prostheses were included in this study. Transthoracic and transesophageal echocardiographic examinations were performed in all the patients. Peak velocity and velocity time integral of the aortic valve and left ventricular outflow tract, peak and mean aortic valve pressure gradients, peak-to-mean pressure gradient ratio, and time velocity integral (TVI) index were measured. Results: There was a significant relation between the TVI index (p value < 0.001) and aortic prosthesis obstruction. A TVI index < 0.2 had a sensitivity of 71% and specificity of 100% for the detection of aortic valve prosthesis obstruction. However, no significant relation was found between the peak-to-mean pressure ratio and aortic valve prosthesis obstruction (p value = 0.09). Conclusion: Although the peak-to-mean pressure gradient (PG/MG) ratio is a simple, quick, and load-independent method which may be useful for the grading of aortic valve stenosis, it is poorly associated with aortic valve prosthesis obstruction. The TVI index is a useful measure for the detection of aortic prosthesis obstruction. https://jthc.tums.ac.ir/index.php/jthc/article/view/164 https://jthc.tums.ac.ir/index.php/jthc/article/download/164/162

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 5 2 2010 04 15 74 77 Hakimeh Sadeghian Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Alimohammad Hajizeinali Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Bahareh Eslami Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Masoumeh Lotfi-Tokaldany Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Mahmood Sheikhfathollahi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Sahebjam Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Elham Hakki Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Arezou Zoroufian Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Seyed Ebrahim Kassaian Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Alidoosti Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 03   Background: Transcatheter closure of atrial septal defect secundum (ASD-II) has become an alternative method for surgery. We sought to compare the two-dimensional transesophageal echocardiography (TEE) method for measuring atrial septal defect with balloon occlusive diameter (BOD) in transcatheter ASD-II closure. Methods: A total of 39 patients (71.1% female, mean age: 35.31 ± 15.37 years) who underwent successful transcatheter closure of ASD-II between November 2005 and July 2008 were enrolled in this study. Transthoracic echocardiography (TTE) and TEE were performed to select suitable cases for device closure and measure the defect size before the procedure, and BOD measurement was performed during catheterization via TEE. The final size of the selected device was usually either equal to or 1 – 2 mm larger than the BOD of the defect. Results: The mean defect size obtained by TEE and BOD was 18.50 ± 5.08 mm and 22.86 ± 4.76 mm, respectively. The mean difference between the values of ASD size obtained by TEE and BOD was 4.36 ± 2.93 mm. In comparison with BOD, TEE underestimated the defect size in 94.9%, but TEE value being equal to BOD was observed in 5.1%. There was a good linear correlation between the two measurements: BOD = 0.773 × ASD size by TEE+8.562; r2 = 67.9.1%. A negative correlation was found between TEE sizing and the difference between BOD and TEE values (r = -0.394, p value = 0.013). Conclusion: In this study, BOD was larger than ASD size obtained by two-dimensional TEE. However, TEE maximal defect sizing correlates with BOD and may provide credible information in device size selection for transcatheter ASD closure.   https://jthc.tums.ac.ir/index.php/jthc/article/view/165 https://jthc.tums.ac.ir/index.php/jthc/article/download/165/163

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 5 2 2010 04 15 78 82 Masoumeh Kahnooji Physiology Research Center, Kerman University of Medical Sciences, Kerman, Iran. Mohammad Masoomi Physiology Research Center, Kerman University of Medical Sciences, Kerman, Iran. Ali Naderinasab Physiology Research Center, Kerman University of Medical Sciences, Kerman, Iran. Akram Zaeem Physiology Research Center, Kerman University of Medical Sciences, Kerman, Iran. Mehrdad Sheikhvatan Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 03 Background: Recent interests have mainly focused on the roles of serum calcium and phosphorus and their product (Ca-P product) in the development of valvular heart disease. The present study assessed the relationship between the Ca-P product and the severity of valvular heart disease in end-stage renal disease (ESRD) patients undergoing chronic hemodialysis. Methods: This cross-sectional study reviewed the clinical course of 72 consecutive patients with the final diagnosis of ESRD candidated for chronic hemodialysis. The severity of valvular heart disease was determined using M-mode two-dimensional echocardiography. The serum calcium and phosphate values adopted were those values measured on the day between the two consecutive dialyses, and the Ca-P product was calculated.  Results: The most common causes of ESRD were diabetic nephropathy, malignant hypertension, and chronic glomerulonephritis. The mean Ca-P product level in the dialysis patients was 50.44 ± 17.78 mg2/dL2. The receiver-operator characteristic (ROC) curve illustrated that a Ca-P product level > 42 mg2/dL2 was the optimal value in terms of sensitivity and specificity for predicting the presence of valvular insufficiency. Aortic insufficiency was directly associated with a high Ca-P product value after adjustment for age, gender, serum albumin, diabetes, hypertension, hyperlipidemia, coronary artery disease, and serum creatinine (β = 0.412, SE = 158, p value= 0.011). Conclusion: A positive relationship between the Ca-P product value and the severity of aortic insufficiency is expected. Achieving an appropriate control of the Ca-P product level may decrease aortic valve calcification and improve the survival of patients on chronic hemodialysis. https://jthc.tums.ac.ir/index.php/jthc/article/view/166 https://jthc.tums.ac.ir/index.php/jthc/article/download/166/164

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 5 2 2010 04 15 83 86 Mir Hatef Shojaei Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Shapour Shirani Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Reza Eshraghian School of Public Health, Tehran University of Medical Science, Tehran, Iran. Maryam Soleymanzadeh School of Public Health, Tehran University of Medical Science, Tehran, Iran. 2015 10 03 Introduction: Inappropriate body composition represents impaired energy and nutrient intake and can be a risk factor for many diseases, especially for cardiovascular disease. Different methods have been suggested for the estimation of body fat volume and its distribution. However, they may be either expensive or hazardous for some groups of patients. Sonography is a very accessible technique, which may be used for the evaluation of visceral and subcutaneous fat volume. The purpose of this study was to evaluate the sonographic prediction of body fat and its distribution in subcutaneous and visceral compartments. Methods: During a three-month period, we conducted sonographic evaluations for visceral and subcutaneous fat in 106 patients who were admitted to our hospital. The subcutaneous fat was measured at the para-umbilical region and visceral fat was measured in the right para-renal space. The results were compared with the data obtained from the body mass index (BMI) and bioelectric impedance analysis. Results: The mean age of the patients was 58.8 years, and the mean BMI was26.48 ± 0.33. The mean values of fat percent and fat mass obtained by the electric-method were 31.07 ± 0.81% and 22.12 ± 0.68 kg, respectively. The respective mean values of subcutaneous and visceral fat obtained by sonography were 20.50±0.56 mm and 24.14 ± 0.58 mm. The correlation between BMI and subcutaneous fat was 0.85 (p value < 0.0001) and the correlation between BMI and visceral fat was0.46 (p value < 0.0001). Conclusion: Sonography is a reliable and available method for the estimation of body fat and its distribution in cardiovascular patients, in subcutaneous and visceral compartments. https://jthc.tums.ac.ir/index.php/jthc/article/view/167 https://jthc.tums.ac.ir/index.php/jthc/article/download/167/165

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 5 2 2010 04 15 87 91 Ahmad Yaminisharif Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Gholamreza Davoodi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Ali Kasemisaeid Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Ali Vasheghani Farahani Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Fatemeh Ghazanchai Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Mansour Moghaddam Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 03   Background: Radiofrequency catheter ablation (RFCA) has been introduced as the treatment of choice for supraventricular tachycardia. The aim of this study was to evaluate the success rate as well as procedural and in-hospital complications of RFCA for the treatment of atrioventricular nodal reentrant tachycardia (AVNRT).   Methods: Between March 1995 and February 2009, 544 patients (75.9% female, age: 48.89 ± 13.19 years) underwent 548 RFCAs for AVNRT in two large university hospitals. Echocardiography was performed for all the patients before and aftertatus="epublish"> 2015 10 13 182 184 EN Ahmet Baris-Durukan Medicana International Ankara Hospital, Ankara, Turkey. Hasan Alper-Gurbuz Medicana International Ankara Hospital, Ankara, Turkey. Murat Tavlasoglu Diyarbakir Military Hospital, Diyarbakir, Turkey. Nevriye Salman Diyarbakir Military Hospital, Diyarbakir, Turkey. Halil Ibrahim-Ucar Medicana International Ankara Hospital, Ankara, Turkey. Cem Yorgancioglu Medicana International Ankara Hospital, Ankara, Turkey. 2015 10 10 A secundum atrial septal defect is the most common congenital heart defect. Transcatheter treatment of secundum atrial septal defects is a popular and less invasive alternative to surgery. Procedural complications may occur in a wide spectrum, particularly device embolus as the most emergent one, but luckily they do not commonly occur in the clinical setting. Mortality from adverse events related to transcatheter treatment strategies is twentyfold higher than that of primary elective surgical closure. Here, we report an Amplatzer device embolus in a secundum atrial septal defect patient. The device was successfully removed with surgery, postoperative course was uneventful, and the patient was discharged from the hospital on the 5th postoperative day. https://jthc.tums.ac.ir/index.php/jthc/article/view/270 https://jthc.tums.ac.ir/index.php/jthc/article/download/270/373

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 7 4 2015 10 13 185 187 EN Kyomars Abbasi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Hossein Ahmadi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Arezoo Zoroufian Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Sahebjam Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Naghmeh Moshtaghi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Seyed Hessamedin Abbasi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 10 2015 10 10 Blunt injury to the chest can affect any one or all components of the chest wall and thoracic cavity. The clinical presentation of patients with blunt chest trauma varies widely and ranges from minor reports of pain to florid shock. Traumatic tricuspid valve regurgitation is a rare cardiovascular complication of blunt chest trauma. Tricuspid valve regurgitation is usually begotten by disorders that cause the right ventricle to enlarge. Diagnosis is made by physical examination findings and is confirmed by echocardiography. We report two cases of severe tricuspid regurgitation secondary to the rupture of the chordae tendineae of the anterior leaflet following non-penetrating chest trauma. Both patients had uneventful postoperative courses. https://jthc.tums.ac.ir/index.php/jthc/article/view/271 https://jthc.tums.ac.ir/index.php/jthc/article/download/271/264

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 7 4 2015 10 13 188 190 EN Mohammad Sahebjam Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Abbas Salehiomran Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Neda Ghaffari-Marandi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Azam Safir Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 10 2015 10 10 One of the most serious complications of mitral valve replacement is left ventricular rupture and pseudoaneurysm formation, which is rare but potentially lethal. We herein present a late type of post mitral valve replacement and coronary artery bypass surgery pseudoaneurysm in a 74-year-old female, who was admitted to our hospital with a recent history of exertional dyspnea. She had the above-mentioned operation 10 months before. The diagnosis was made via two-dimensional and real-time three-dimensional transthoracic echocardiography. The prosthetic mitral valve was removed, and the large orifice of the pseudoaneurysm was closed by surgery. At one year's follow-up, the patient was in good condition. https://jthc.tums.ac.ir/index.php/jthc/article/view/272 https://jthc.tums.ac.ir/index.php/jthc/article/download/272/265

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM)