Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 8 2 2015 10 13 65 69 EN Maryam Esmaeilzadeh Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. MohammadTaghi Salehi-Omran Roohani Hospital, Babol University of Medical Sciences, Babol, Iran. Majid Maleki Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Majid Haghjoo Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Feridoun Noohi Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Zahra Ojaghi-Haghighi Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Anita Sadeghpour Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Paridokht Nakhostin-Davari Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Hooman Bakhshandeh-Abkenar Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. 2015 10 11 2015 10 11 Background: Noninvasive techniques for the localization of the accessory pathways (APs) might help guide mapping procedures and ablation techniques. We sought to examine the diagnostic accuracy of strain imaging for the localization of the APs in Wolff-Parkinson-White syndrome. Methods: We prospectively studied 25 patients (mean age = 32 ± 17 years, 58.3% men) with evidence of pre-excitation on electrocardiography (ECG). Electromechanical interval was defined as the time difference between the onset of delta wave and the onset of regional myocardial contraction. Time differences between the onset of delta wave (δ) and the onset of regional myocardial contraction (δ-So), peak systolic motion (δ-Sm), regional strain (δ-ε), peak strain (δ-εp), and peak strain rate (δ-SRp) were measured. Results: There was a significant difference between time to onset of delta wave to onset of peak systolic motion (mean ± SD) in the AP location (A) and normal segments (B) versus that in the normal volunteers (C) [A: (57.08 ± 23.88 msec) vs. B: (75.20 ± 14.75)  vs. C: (72.9 0 ± 11.16); p value (A vs. B) = 0.004 and p value (A vs. C) = 0.18] and [A: (49.17 ± 35.79) vs. B: (67.60 ± 14.51) vs. C: (67.40 ± 6.06 msec); p value ( A vs. B) < 0.001 and  p value (A vs. C) = 0.12, respectively]. Conclusion: Our study showed that strain imaging parameters [(δ-So) and (δ-Strain)] are superior to the ECG in the localization of the APs (84% vs. 76%). https://jthc.tums.ac.ir/index.php/rhythm/article/view/285 https://jthc.tums.ac.ir/index.php/rhythm/article/download/285/278

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 8 2 2015 10 13 106 110 EN Hassan Teimouri Shahid Madani Hospital, Lorestan University of Medical Sciences, Lorestan, Iran. Feridoun Sabzi Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran. Babak Nasiri Shahid Madani Hospital, Lorestan University of Medical Sciences, Lorestan, Iran. 2015 10 11 2015 10 11 Right ventricular failure due to right coronary artery disease, right ventricular hypertrophy, stunning, abnormal septal motion, myocardial infarction, or non-homogeneous distribution of cardioplegia is an uncommon but serious complication of open heart surgery. We report a patient with severe right ventricular hypertrophy secondary to severe mitral valve stenosis and another patient with detachment of the right coronary artery due to the dissection of the ascending aorta. The patients developed right ventricular failure, which persisted after surgery and rendered weaning from cardiopulmonary bypass unsuccessful. Through a hemi-Fontan, or bidirectional cavopulmonary shunt, and an intra-aortic balloon pump, the patients were successfully weaned from cardiopulmonary bypass. This shunt may be an alternative to a right ventricular assist device in some patients with right ventricular failure. The long-term outcome and the indication of bi-directional cavopulmonary shunt has not been confirmed, although it is believed to be effective for saving the life of patients with low cardiac output and acute right ventricular failure. In our cases, six months following the operation, there was some degree of recovery of the right ventricular function. In long-term follow-up, however, it would be interesting for the authors to know if the improved right ventricular function, with better antegrade pulsatile flow in the pulmonary artery, in any way interferes with the functioning of the bidirectional cavopulmonary shunt. https://jthc.tums.ac.ir/index.php/rhythm/article/view/291 https://jthc.tums.ac.ir/index.php/rhythm/article/download/291/284

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 8 2 2015 10 13 119 120 EN Mohammad Hossein Mandegar Processor of Cardiac Surgery, Tehran University of Medical Sciences, Shariati General Hospital,Kargar Street, Tehran,Iran. Farideh Roshanali Shariati General Hospital, Kargar Street, Tehran, Iran. 2015 10 11 2015 10 11 No Abstract https://jthc.tums.ac.ir/index.php/rhythm/article/view/294 https://jthc.tums.ac.ir/index.php/rhythm/article/download/294/287

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 8 2 2015 10 13 70 75 EN Fardin Yousefshahi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Khashayar Azimpour Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Ali Boroumand Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Mahdi Najafi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Khosro Barkhordari Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Mitra Vaezi Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran Nahid Rouhipour Moayeri Hospital, Social Security Organization, Tehran, Iran. 2015 10 11 2015 10 11 Background: Central venous (CV) catheters play an essential role in the management of critically ill patients in the Intensive Care Unit (ICU). CV lines are, however, allied to catheter-associated blood stream infections. Bacterial colonization of CV lines is deemed the main cause of catheter-associated infection. The purpose of our study was to compare bacterial colony counts in the catheter site before CV line insertion in two groups of post-cardiac surgery patients: a group receiving Sanosil (an antiseptic agent composed of H2 O2 and silver) and a control group. Methods: This interventional prospective double-blinded clinical trial recruited the patients in three post-cardiac surgeryICUs of a heart center. The participants were divided into interventional (113 patients) and control (136 patients) groups. Sanosil was added to the routine preparation procedure (Chlorhexidine bath one day before and scrub with Povidone-Iodine just before the CV line insertion). After the removal of the CV lines, the catheters tips were sent for culture and evaluation of colony counts. Results: Catheter colonization occurred in 55 (22.1%) patients: 26 (23%) patients in the Sanosil group and 29 (21.3%) in the control group; there was no significant statistical difference between the two groups (p value = 0.75, RR = 1.05, 95%CI:0.76-1.45). The most common organism having colonized in the cultures of the catheter tips was staphylococcus epidermis:20 cases in the control group and 16 cases in the intervention group. Conclusion: Catheter colonization frequently occurs in post-cardiac surgery patients. However, our results did not indicate the effectiveness of adding Sanosil to the routine preparation procedure with respect to reducing catheter bacterial colonization. https://jthc.tums.ac.ir/index.php/rhythm/article/view/286 https://jthc.tums.ac.ir/index.php/rhythm/article/download/286/279

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 8 2 2015 10 13 111 115 EN Mohammad Dalili Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Jayakeerthi YRao Heart Rhythm Management Center, Universitair Ziekenhuis Brussels – Vrije Universiteit Brussel, Brussels, Belgium. Pedro Brugada Heart Rhythm Management Center, Universitair Ziekenhuis Brussels – Vrije Universiteit Brussel, Brussels, Belgium. 2015 10 11 2015 10 11 Catheter ablation is an accepted, highly effective modality of treatment for cardiac arrhythmias in children. The success rate depends on the operator’s experience, especially in cases involving complex anatomies. We hereby report our recent experience of successful ablation of accessory pathways in three children with complex congenital heart diseases. The first case was a 7-year-old girl with tricuspid atresia and a previous Glenn shunt, in whom a sub-epicardial overt accessory pathway was successfully ablated via the coronary sinus. The second case, a 9-year-old girl, received accessory pathway ablation via the fenestration of an extracardiac Fontan pathway. The third case was a 14-year-old boy with dextrocardia, common atrium, common ventricle, and a previous extracardiac Fontan operation, in whom ablation of a concealed accessory pathway was carried out retrogradely from the aorta. All the ablations were done in Rajaie Cardiovascular, Medical and Research Center, Tehran, and all the patients were discharged from the hospital without any complication. https://jthc.tums.ac.ir/index.php/rhythm/article/view/292 https://jthc.tums.ac.ir/index.php/rhythm/article/download/292/285

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 8 2 2015 10 13 76 88 EN Feridoun Sabzi Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran. Hashem Kazerani Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran. Arash Jalali Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Mojgan Samadi Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran. Fahime Ghasemi Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran. 2015 10 11 2015 10 11 Background: The incidence of coronary artery bypass grafting surgery (CABG) in elderly patients has been increasing. There are contradictory reports on the early outcome of elderly coronary artery patients as compared with their young counterparts. We designed this retrospective study to address this issue. Methods: We retrospectively analyzed the results of 1489 on–pump CABG cases performed at our hospital during a 4.5-year period. Perioperative data such as demographic, medical, clinical, operative, and postoperative variables were collected and compared between patients 70 years old or younger (Group A, n = 1164) and patients above 70 years of age (Group B, n = 325). Statistical analysis was performed using the t-test for the continuous and the X2 tests for the categorical variables. Significant variables according to the univariate analysis (X2 and t-test) were further analyzed using multivariate logistic regression analysis. Results: The variables of weight (P value < 0.001), preoperative Po2(P value = 0.005), ejection fraction > 30% (Pvalue = 0.001), body surface area (P value = 0.003), and hypercholesterolemia (P value = 0.007) were higher in Group A, whereas preoperative myocardial infarction (P value < 0.001), postoperative low cardiac output syndrome (P value = 0.019), emergent surgery (P value = 0.003), inotropic drug use (P value < 0.001), preoperative heparin use (P value < 0.001), re-exploration for bleeding (P value = 0.015), hospital stay (P value < 0.001),  low ejection fraction (≤ 30%) (P value = 0.001), preoperative creatinine > 1.5 mg/dl (P value < 0.001), chronic obstructive pulmonary disease (P value < 0.001), intra-aortic balloon pump use (P value < 0.001), infection (P value < 0.001), pulmonary complications (P value < 0.001), atrial fibrillation (P value < 0.001), postoperative renal complications (P value < 0.001), and death (P value = 0.012) were more frequent in Group B. Conclusion: CABG in the elderly patients had certain surgical risks such as chronic obstructive pulmonary disease, preoperative myocardial infarction, emergent surgery, and death. Also, postoperative complications such as pulmonary complications, inotropic drug use, intra-aortic balloon pump use, and infection were more frequent in the elderly than in the younger patients.   https://jthc.tums.ac.ir/index.php/rhythm/article/view/287 https://jthc.tums.ac.ir/index.php/rhythm/article/download/287/280

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 8 2 2015 10 13 116 118 EN Seyed Ebrahim Kassaian Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Kyomars Abbasi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Ayman Atmaz Al-Sibaie Rashid Hospital, Dubai, United Arab Emirates. 2015 10 11 3115-7270 8 3 2015 10 11 164 166 EN Yaser Jenab Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Marzieh Pakbaz Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Neda Ghaffari-Marandi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 11 2015 10 11 Takotsubo cardiomyopathy (TCM), also known as stress-induced cardiomyopathy, is a clinical syndrome of transient left ventricular (LV) apical wall motion abnormality with relative preservation of the basal heart segments in the absence of any significant atherosclerosis. Recurrence of this condition is rare. We report a postmenopausal woman, who experienced two episodes of TCM within 4 months following emotional and physical stress. In the first episode, she was admitted due to severe dyspnea, accompanied by sudden-onset, prolonged, burning chest pain and palpitation. Transthoracic echocardiography revealed akinesia of the LV, with the exception of the basal regions. Coronary angiography demonstrated no significant coronary artery disease, and follow-up echocardiography showed normalization of the LV wall motion abnormalities. In the second episode, she experienced similar symptoms and echocardiography revealed similar changes. Multi-detector computed tomography revealed normal coronary arteries. After 9 days, she was discharged in good condition; and at 3 months’ follow- up, she was symptom-free with normal echocardiography. https://jthc.tums.ac.ir/index.php/rhythm/article/view/303 https://jthc.tums.ac.ir/index.php/rhythm/article/download/303/296

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 8 3 2015 10 11 140 145 EN Alireza Amirzadegan Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Amir Shakarami Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Ali Borumand Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Gholamreza Davoodi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Neda Ghaffari-Marandi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Arash Jalali Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 11 2015 10 11 Background: The existing evidence suggests that plasma adiponectin concentrations can be indicative of the presence and severity of coronary artery disease (CAD). However, the results of the studies conducted hitherto on this subject are inconsistent. We sought to investigate the possible correlation between plasma adiponectin levels and the presence and severity of CAD in patients undergoing non-urgent coronary angiography. Methods: In 399 consecutive patients undergoing non-urgent coronary angiography for CAD survey, plasma adiponectin, triglyceride, total cholesterol, high-density lipoprotein and low-density lipoprotein cholesterol, and fasting blood sugar levels were measured and demographic characteristics such as age, sex, Body Mass Index, diabetes mellitus history, systemic hypertension history, and family history of CAD were collected. According to the angiography results, the patients were divided into two groups of CAD and non-CAD. The severity of coronary atherosclerosis in the CAD group was defined using the Gensini score system. Results: Average age was 61.4 ± 9.94 years in the CAD group and 57.9 ± 10.75 years in the non-CAD group. Also, 73.7% of the CAD group and 55.4% of the non-CAD group were male.  Totally, 278 (69.7%) patients were found to have CAD. Patients without CAD did not have higher mean plasma adiponectin concentrations than did those with CAD (13.38 ± 11.96 vs. 14.95 ± 14.11 mcg/ml; p value = 0. 896). After adjustment for CAD conventional risk factors, plasma adiponectin levels still were not associated with CAD. No association was found between plasma adiponectin levels and the Gensini score. Furthermore, in contrast to the fairly strong correlation previously reported, there was no correlation between adiponectin levels and conventional CAD risk factors. Conclusion: We could not observe any relationship between plasma adiponectin concentrations and the presence or severity of CAD in patients undergoing coronary angiography. https://jthc.tums.ac.ir/index.php/rhythm/article/view/298 https://jthc.tums.ac.ir/index.php/rhythm/article/download/298/291

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 8 3 2015 10 11 146 151 EN Hamid Reza Sanati Cardiovascular Intervention Research Center, Shaheed Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Mohammad Parsa Mahjoob Cardiovacsular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Ali Zahedmehr Cardiovascular Intervention Research Center, Shaheed Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Farshad Shakerian-Ghahferokhi Cardiovascular Intervention Research Center, Shaheed Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Ata Firoozi Cardiovascular Intervention Research Center, Shaheed Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Reza Kiani Cardiovascular Intervention Research Center, Shaheed Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Zohreh Sadeghi Cardiovascular Intervention Research Center, Shaheed Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Abolfath Alizadeh-Diz Cardiac Electrophysiology Research Center, Shaheed Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Hooman Bakhshandeh-Abkenar Cardiovascular Intervention Research Center, Shaheed Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. 2015 10 11 2015 10 11 Background: Although  percutaneous  coronary  intervention  (PCI)  improves  outcomes  compared  to  thrombolysis,  a substantial number of ST-elevation myocardial infarction (STEMI) patients do not achieve optimal myocardial reperfusion. This study was designed to evaluate factors related to suboptimal myocardial reperfusion after primary PCI in patients with STEMI. Methods: Totally, 155 patients (124 men; mean age = 56.6 ± 11.03 years, range = 31- 85 years) with STEMI undergoing primary PCI were retrospectively studied. Additionally, the relationships between the occurrence of reperfusion failure and variables such as age, sex, cardiac risk factors, family history, Body Mass Index, time of symptom onset, ejection fraction, previous PCI, coronary artery bypass graft surgery or previous myocardial infarction, and angiographic data were analyzed. Results: Procedural success was 97.1% and complete ST resolution occurred in 43.2%. Age; cardiac risk factors; family history; body mass index; previous MI, coronary artery bypass graft surgery, or PCI; and use of thrombectomy device and GPIIb/IIIa inhibitor were not the determining factors (p value > 0.05). According to our multivariate analysis, time of symptom onset (OR [95% CI]: 045 [0.2 to 0.98]; p value = 0.044) and ejection fraction (OR [95% CI]:0.37 [0.26 to .091]; p value = 0.050) had reverse and male gender had direct significant associations with failed reperfusion (OR [95%CI]:0.34 [0.11 to 1.08]; p value = 0.068). More degrees of ST resolution occurred when the right coronary artery was the culpritvessel (p value = 0.001). The presence of more than three cardiac risk factors was associated with failed reperfusion (p value= 0.050). Conclusion: Considering the initial risk profile of patients with acute STEMI, including time of symptom onset and ejection fraction, as well as the accumulation of cardiac risk factors in a given patient, we could predict failed myocardial reperfusion to design a more aggressive therapeutic strategy. https://jthc.tums.ac.ir/index.php/rhythm/article/view/299 https://jthc.tums.ac.ir/index.php/rhythm/article/download/299/292

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 8 3 2015 10 11 152 157 EN Afsaneh Rajabiani Shariati Hospital, Tehran university of Medical Sciences, Tehran, Iran. Abbas Mohaghgheghi Shariati Hospital, Tehran university of Medical Sciences, Tehran, Iran. Daryoush Kamal- Hedayat Shariati Hospital, Tehran university of Medical Sciences, Tehran, Iran.