International Cardiovascular Research Journal最新文献

We report an asymptomatic patient in whom the intravenous pacemaker (PM) lead was inadvertently implanted in LV through the perforated interventricular septum. He had no embolic events during the last 9 years after the implantation. Possible explanation of the uncomplicated follow-up period is that the patient had been taking warfarin because of mechanical mitral valve prosthesis.

Background: Most studies on mental health associates of obesity have focused on depression and less is known about the role of anxiety in obesity.

Objectives: This study compared the additive effects of General Anxiety Disorder (GAD) and Major Depressive Disorder (MDD) on Body Mass Index (BMI) across sub-populations of Blacks based on the intersection of ethnicity and gender.

Methods: Data came from the National Survey of American Life (NSAL), 2001 - 2003. The participants consisted of 3,570 African Americans and 1,621 Caribbean Blacks. Twelve-month MDD and GAD were determined using the World Mental Health Composite International Diagnostic Interview (CIDI). Levels of BMI were categorized based on being equal to or larger than 25, 30, 35, and 40 kg/m(2). We fitted linear regression models specific for our groups, which were defined based on the intersection of ethnicity and gender. Additionally, age, education, marital status, employment, and region were controlled.

Results: Among Caribbean Black men and African American women, lifetime GAD, but not MDD, was associated with high BMI. Among Caribbean Black women, lifetime MDD, but not GAD, was associated with high BMI.

Conclusions: Intersection of ethnicity and gender may determine how anxiety and depression are associated with BMI among Blacks. Sub-populations of Blacks (e.g. based on ethnicity and gender) may have specific mental health determinants or consequences of obesity. Future research should investigate how and why the additive effects of anxiety and depression on obesity vary across ethnic and gender groups of Blacks.

Background: Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital anomaly which represents one of the most common causes of myocardial ischemia and infarction in children. This anomaly, if left untreated, results in a very high mortality rate within the first year of life. Yet, immediate surgical correction can lead to excellent results.

Objectives: The present study aimed to determine the surgical outcome of ALCAPA.

Methods: This study was conducted on 53 patients with ALCAPA operated from January 2005 to December 2012. Surgical repair was carried out as soon as the diagnosis was made. Surgery was thus undertaken on an urgent basis (within 48 hours) in the patients with congestive heart failure or critical clinical status and on a semi- elective basis (within a few days) in the remaining children. Operations for all the patients were performed through a median sternotomy using established standard cardiopulmonary bypass technique. Grouped variables were compared using chi-square test with Yates' correction. Besides, McNemar's test was used to assess the relationship between preoperative ejection fraction and mitral incompetence. All the analyses were performed using the SPSS statistical software, version 11.5 (SPSS Inc., Chicago, IL).

Results: The patients' median age at presentation was 4 months. The mean preoperative ejection fraction was 36.5%. The results showed a significant relationship between age at presentation and impairment of ejection fraction (P < 0.001). At first, 23% of our patients presented with ejection fraction < 35%. However, 6 months after the operation, the ejection fraction improved to a mean of 53.07% (SD = 8.5) ranging from 38 - 66%. There were 5 postoperative hospital deaths with an overall mortality rate of 9.6%.

Conclusions: Excellent results with desirable long-term outcomes can be achieved in the infants with ALCAPA using coronary artery implantation techniques. The best potential for recovery of the left ventricular function is in younger symptomatic infants despite the worst initial presentation. Normalization of cardiac function is expected within the first year in all operative survivors with a patent dual coronary system.

Background: The interest in beating heart surgery is growing since better results can be obtained with this procedure compared to conventional myocardial protection techniques using cardioplegic solutions. This led us to consider mitral valve replacement with beating heart.

Objectives: This study aimed to determine the safety and efficacy of beating heart mitral valve replacement without cross clamp.

Methods: This prospective study was conducted on the patients with isolated mitral valve disease requiring mitral valve replacement according to ACC / AHA guidelines. In this study, 15 patients underwent mitral valve replacement using beating heart technique (Group A) and 15 ones underwent mitral valve replacement using arrested heart technique (Group B). The patients were randomized using block randomization. The data were analyzed using the SPSS statistical software.

Results: Preoperative parameters were comparable in the two groups. Most of the patients in both study groups were in NYHA class III or IV. Postoperatively, however, most of the patients in the two groups were either in NYHA class I or II. No mortality occurred in the beating heart group, while one mortality occurred in the arrested heart group. The results showed a significant difference between the two groups regarding the mean bypass time, mean operating time, mean ICU stay, and mean length of hospital stay.

Conclusions: Beating heart mitral valve replacement is equally safe as the arrested heart technique. Thus, it is recommended as an appropriate alternative to the arrested heart technique for mitral valve replacement.

Background: Increase in the number of patients treated with Implantable Cardioverter Defibrillator (ICD) requests more attention regarding its complications.

Objectives: This study aimed to assess the generator- and lead-related complications at implantation and during follow-up in the patients who were treated with ICD for primary and secondary prevention reasons.

Methods: We retrospectively reviewed 255 consecutive patients who underwent transvenous ICD implantation for the first time in a 7-year period and were followed-up for 3 years at Tehran Heart Center. The personal and clinical data of the patients as well as specific data on the ICD implantation were retrieved. The frequency of each of the complications was reported and the study variables were compared between the patients with and without complications using Student's t-test and chi-square test where appropriate. P values less than 0.05 were considered as statistically significant.

Results: Out of a total of 525 implanted leads and 255 implanted devices in 255 patients (mean age = 62.57 ± 13.50 years; male = 196 [76.9%]), complications leading to generator or lead replacement occurred in 32 patients (12.5%). The results revealed no significant difference between the patients with and without complications regarding gender and age (P = 0.206 and P = 0.824, respectively). Also, no significant difference was found between the two groups concerning the ejection fraction (P = 0.271). Lead fracture was the most frequent lead-related complication and was observed in 17 patients (6.6%). Besides, it was mainly observed in the RV leads. Generator-related complications leading to generator replacement were observed in 2 patients (0.7%).

Conclusions: Despite considerable improvements in the ICD technology, the rate of the ICD complications leading to device replacement and surgical revision, especially those related to the leads, is still clinically important.

Background: Although many electrocardiographic abnormalities have been reported previously, prolonged QTC interval represented as the most important ECG finding in patients with liver cirrhosis. Echocardiography can detect structural cardiac abnormalities in cirrhotic patients.

Objectives: The present study aimed to determine the correlation between QTC prolongation and echocardiographic findings in end stage liver cirrhosis.

Methods: The present study was conducted on 100 patients selected through convenient sampling. We recruited 80 cirrhotic patients with CHILD score > B or MELD score > 15 from the transplantation ward of Nemazee educational hospital. A complete echocardiographic study, including chamber quantification, a complete flow Doppler, and tissue Doppler analysis, was performed for each patient using a GE vivid 3 system equipped with Tissue Doppler Imaging (TDI). Then, twelve-lead ECG was carried out and QTc interval was calculated in all patients. The data were analyzed using the SPSS statistical software (v. 13) and Pearson's correlation coefficient. P value < 0.05 was considered statistically significant.

Results: The patients' age ranged from 20 to 60 years old and 62.5% of them were male. According to the results, the only parameter which was significantly associated with prolonged QTc interval was Left Ventricular End Diastolic Dimension (LVEDD). Additionally, a linear direct relationship was found between corrected QT interval and LVEDD (r = 0.41, P < 0.001).

Conclusions: The current study showed a positive correlation between QTC prolongation as an electerocardiographic finding and LVEDD in echocardiography of the cirrhotic patients. This may indicate a direct relationship between the electrophysiological problems and the severity of volume overload in cirrhotic patients.

Percutaneous pulmonary balloon valvuloplasty as a procedure of choice in adults has been established since the last three decades. Even though the complications are rare, they are scarcely reported in the literature. We report such a case in an adult female patient of severe pulmonary valular stenosis in whom, entrapped catheter across the fossa ovalis was noted in chest x-ray and echocardiogram following unsuccessful percutaneous pulmonary balloon valvuloplasty. Our case emphasizes this rare complication and its successful surgical outcome.

Background: Obstetricians regard maternal age of 20 to 35 years as the optimal age for pregnancy. Adolescent pregnancy and pregnancy at the ages of 35 years and above are associated with higher risks. Pregnancy is pro-arrhythmic and rarely precipitates ventricular arrhythmias.

Objectives: QT dispersion is an index of heterogeneity of ventricular repolarization and a predictor of propensity of ventricular arrhythmias. In this study, this index was used to find any relationship between maternal age and ventricular arrhythmia risk.

Methods: This study was performed among a group of healthy pregnant ladies between 36 and 40 weeks of gestation. An ECG was taken from each patient. QT dispersions were calculated on a computer screen with high magnitude. The results were then divided into three groups based on the age of the participants. The first, second, and third groups included the women below 20, between 20 and 35, and over 35 years, respectively. The three groups were compared using Kruskal-Wallis test.

Results: The mean QTd was 61.77 ms (± 16.61) in the first group, 64.15 ms (± 18.65) in the second group, and 55.95 ms (± 23.04) in the third group. Although QTd was prolonged in all, no significant difference was observed among the three groups regarding QTd.

Conclusions: Our results showed QT prolongation in pregnancy, but showed that maternal age did not affect the heterogeneity of ventricular repolarization and propensity of ventricular arrhythmias in pregnancy.

Background: Some patients with Coronary Artery Disease (CAD) have no well-known risk factors of this disease, but are diagnosed with cardiovascular events. The present study aimed to assess the association between Apo A1 and ApoB and the severity of CAD and determine whether these parameters are better predictors of Ischemic Heart Disease (IHD).

Methods: In this case control study, 271 individuals who were suspicious of having CAD and had been referred to Arak Amir-al-Momenin hospital underwent coronary angiography. Based on the results of angiography, the participants with presence or absence of coronary artery stenosis were allocated into the case and the control group, respectively. The severity of CAD involvement was determined by Gensini score. The data were entered into the SPSS statistical software and analyzed through parametric and non-parametric tests, sensitivity analysis, and logistic regression.

Results: The results revealed no significant correlation between apoA-1 and severity of CAD involvement (GS) (r = 0.017, P = 0.797). However, a significant correlation was found between apoB and GS (r = 0.127, P = 0.047). Logistic regression model showed ApoB, sex, DM and, FH as the only proper predictors of IHD (P < 0.048, P < 0.002, P < 0.040, and P < 0.001, respectively). In comparison to angiography for diagnosis of CAD, ROC analysis represented ApoB as a more useful predictor (P = 0.023).

Conclusions: In addition to measurement of conventional parameters for assessing CAD high risk groups, according to the results of this study using ApoB would be resonable as well. Further investigations are recommended to clear the problem.

Background: The present study aimed to investigate the relationship between Left Atrial Volume (LAV), a marker of diastolic dysfunction, and the frequency of malignant ventricular arrhythmia in the patients with left ventricular dysfunction and a previously implanted Implantable Cardioverter Defibrillator (ICD) device.

Methods: This cross-sectional study was conducted on 32 patients with ischemic or idiopathic dilated cardiomyopathy, each having had an ICD device implanted at least 1 year beforehand. The ventricular arrhythmia episodes which were detected and stored by the device were retrieved and evaluated. In addition to routine echocardiographic measurements, all the patients had their LAV and LAV indexes calculated. After all, student's t-test, Mann-Whitney U test, and Pearson correlation were used to analyze the data. Besides, P value < 0.05 was considered as statistically significant.

Results: This study was conducted on 4 female and 28 male patients with the mean age of 58.41 ± 9.97 years. Among the study patients, 21 had at least one previous myocardial infarction. In addition, 17 patients had experienced sustained VT or VF within the last year. No significant difference was found between the patients with and without malignant ventricular arrhythmias (sustained VT or VF) regarding LAV (17 patients with arrhythmia (68 + 23.39 mL) vs. 15 patients without arrhythmia (55.13 ± 20.41 mL); P = 0.100). However, the LAV index was significantly higher in the patients with arrhythmia compared to those without arrhythmia (39.27 ± 12.19 mL / m2 vs. 25.18 ± 7.45 mL / m2; P = 0.004). Both LAV (73.33 ± 17.64 mL and 57.52 ± 23.15 mL, respectively; P = 0.040) and LAV index (40.86 ± 8.47 mL / m2 and 28.20 ± 11.77 mL / m2, respectively; P = 0.010) were significantly greater in the patients with ICD shock therapy within the last year compared to the others. However, both groups were similar regarding Left Ventricular Volume (LVV), LVV index, and ejection fraction.

Conclusions: The study findings demonstrated that LAV and LAV index could be used in detecting the patients who are at high risk of malignant ventricular arrhythmias.