Iranian Heart Association
Iranian Heart Journal
21
3
2020
07
01
Opium Addiction is Associated With Increased Damage to Cardiomyocytes: Protective Roles Played by Apelins
6
14
EN
Alireza
Tavanai
Cardiovascular Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, IR Iran.
Gholamreza
Asadikaram
Kerman Neuroscience Research Center, Kerman University of Medical Sciences, Kerman, IR Iran.
Mohammad
Masoumi
Cardiovascular Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, IR Iran.
<strong><em>Background:</em></strong> It has been reported that opium can deteriorate the complications of acute myocardial infarction (AMI). Apelins are molecules whose protective roles against cardiomyocytes have been documented previously. The aim of this study was to evaluate the effects of opium on the serum apelin levels in patients with AMI.
<strong><em>Methods:</em></strong> This study was performed on 60 patients with AMI (30 addicted and 30 nonaddicted). The serum levels of apelins, low-density lipoprotein, high-density lipoprotein, triglyceride, cholesterol, total creatine phosphokinase (CPK), and CPK-MB were evaluated using commercial kits.
<strong><em>Results: </em></strong>The results showed that although the serum level of apelins was not different between the addicted and nonaddicted patients, it was significantly associated with heart rate and CPK levels in the addicted patients.
<strong><em>Conclusions: </em></strong>Considering our results, opium addiction may be associated with increased damage to cardiomyocytes. Additionally, the positive association between apelins and CPK may indicate the protective roles played by these molecules during AMI.<strong><em> (Iranian Heart Journal 2020; 21(3): 6-14)</em></strong>
Opium,Acute myocardial infarction,apelin
http://journal.iha.org.ir/article_110162.html
http://journal.iha.org.ir/article_110162_bb72f6a815a1ee7d1b10c84a7c0546f6.pdf
Iranian Heart Association
Iranian Heart Journal
21
3
2020
07
01
Comparisons of QTd and QTcD and Arrhythmia Prevalence Between Fibrinolytic Therapy and Primary Percutaneous Coronary Intervention
15
24
EN
Alireza
Abdollahi Moghadam
Atherosclerosis Prevention Research Center, Imam Reza Educational Hospital, Mashhad University of Medical Sciences (MUMS), Mashhad, IR Iran.
Hoda
Raffiei Jelodar
Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
<strong><em>Background:</em></strong> The inter-lead variations in the measurements of the QT interval reflect regional variations in ventricular repolarization. This increased dispersion results in susceptibility to ventricular arrhythmias.<br /> <br /> <strong><em>Methods:</em></strong> We reviewed the medical records of 60 patients with ST-segment-elevation myocardial infarction (STEMI) over the last 6 years who received thrombolytic therapy (30 cases) or underwent primary percutaneous coronary intervention (PCI) (30 cases) in Ghaem Hospital and Emam Reza Hospital in Mashhad, Iran. The patients’ demographic characteristics, risk factors, treatment success, QTd and QTcD before and 24 hours after treatment, arrhythmias, and echocardiographic information were analyzed. Statistical analysis was conducted using the SPSS software, version 22, and a <em>P</em> value of less than 0.05 was considered statistically significant.<br /> <br /> <strong><em>Results:</em></strong> The success rates (50% reduction in ST-segment elevation) of primary PCI and thrombolytic therapy were 66.66% and 33.33%, respectively. In addition, QTd and QTcD were significantly decreased in both successful procedures (<em>P</em> = 0.04 and 0.03, respectively). However, no significant difference in the variations of QTd and QTcD was seen between the 2 successful procedures (<em>P = </em>0.91 and <em>P</em> = 0.87, respectively). Further, ventricular arrhythmias were evident in 36.6% of the patients with thrombolytic therapy, but no ventricular arrhythmia was observed in those who underwent primary PCI.<br /> <br /> <strong><em>Conclusions:</em></strong> QTd and QTcD were identified as useful predictors of ventricular arrhythmias. A significant reduction in QTd and QTcD in both successful procedures was evident, leading to a decrease in ventricular arrhythmias. Moreover, the success rate of primary PCI was higher than that of thrombolytic therapy. Therefore, primary PCI was identified as a more appropriate procedure for STEMI. <strong><em>(Iranian Heart Journal 2020; 21(3): 15-24)</em></strong>
QTcD,QTd,Myocardial Infarction,Primary PCI
http://journal.iha.org.ir/article_110210.html
http://journal.iha.org.ir/article_110210_a005d3c1fddd105e9ce304ba2d51740c.pdf
Iranian Heart Association
Iranian Heart Journal
21
3
2020
07
01
Effects of Preoperative Risk Factors on the Occurrence of Atrial Fibrillation Following Coronary Artery Bypass in Farshchian Cardiovascular Subspecialty Hospital
25
32
EN
Maryam
Rajabi
Nursing and Midwifery School, Hamadan University of Medical Sciences, Hamadan, IR Iran.
Seyed Reza
Borzou
Department of Medical Surgical Nursing, Member of Chronic Disease (Home Care) Research Center, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, IR Iran.
Aliasghar
Moeinipour
Department of Cardiovascular Surgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran.
Hamid
Hoseinikhah
Department of Cardiovascular Surgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran.
Gholamreza
Safarpoor
Department of Cardiac Surgery, Faculty of Medical Sciences, Farshchian Heart Center, Hamadan University of Medical Sciences, Hamadan, IR Iran.
<strong><em>Background:</em></strong>Atrial fibrillation (AF) is the most common cardiac dysrhythmia; it occurs following coronary artery bypass graft (CABG) surgery. The occurrence of this dysrhythmia causes hemodynamic disorders, prolongs the duration of hospitalization, and increases costs.
<strong><em>Methods:</em></strong>The present retrospective cohort study was conducted using the census method on 330 patients. Data were extracted from the records of patients undergoing CABG and were used to fill in the data collection form. The data were analyzed using the independent samples <em>t</em>-test and the χ<sup>2</sup> test in SPSS, version 21, at the alpha level of 0.05.
<strong><em>Results:</em></strong>The mean age of the patients was 61.76 ± 9.2 years, and 70.1% were male. The incidence of AF was significantly associated with mean age, the body mass index, creatinine, and the consumption of diuretic medications (<em>P</em> < 0.05). However, sex, paraclinical results (ie, sodium, potassium, and the ejection fraction), clinical history (ie, hypertension, hyperlipidemia, diabetes, smoking, a history of myocardial infarction, and anterior myocardial infarction), medications (ie, beta-blockers, calcium channel blockers, angiotensin receptor blockers, and statins), and the number of involved arteries did not affect the incidence of AF (<em>P</em> > 0.05).
<strong><em>Conclusions:</em></strong> Considering the prevalence and importance of AF, effective preoperative risk factors can be decreased or eliminated through interventions, thereby reducing the incidence of this cardiac dysrhythmia. <strong><em>(Iranian Heart Journal 2020; 21(3): 25-32)</em></strong>
Atrial Fibrillation,CABG,Preoperative risk factors,Postoperative AF
http://journal.iha.org.ir/article_110213.html
http://journal.iha.org.ir/article_110213_2225eafd0875f884152363fd92751d72.pdf
Iranian Heart Association
Iranian Heart Journal
21
3
2020
07
01
Endotracheal Tube Cuff Pressure in Patients Admitted to Intensive Care Units After Cardiac Surgery
33
39
EN
Ziae
Totonchi
Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
Mehdi
Harorani
School of Nursing and Midwifery, Arak University of Medical Sciences, Arak, IR Iran.
Mokhtar
Mahmoudi
School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, IR Iran.
Hadi
Jafarimanesh
School of Nursing and Midwifery, Arak University of Medical Sciences, Arak, IR Iran.
Rezvan
Ghafarzadegan
Instructor, Department of Nursing, Faculty of Nursing and Midwifery, Khomein University of Medical Sciences, Khomein, IR Iran.
Hooman
Bakhshandeh Abkenar
Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
Mohamad
Golitaleb
School of Nursing and Midwifery, Arak University of Medical Sciences, Arak, IR Iran.
<strong><em>Background:</em></strong> The endotracheal tube (ETT) cuff pressure must be kept within the range of 20 to 30 cmH<sub>2</sub>O in order to prevent tube displacement and air leakage, maintain the circulation of the tracheal capillaries, and prevent the aspiration of oral and gastric contents to the lower parts of the respiratory tract. This study aimed to determine the ETT cuff pressure and appropriate intervals for measuring it in patients admitted to intensive care units (ICUs).
<strong><em>Methods:</em></strong> This descriptive cross-sectional study was conducted on 100 patients after cardiac surgery with general anesthesia admitted to ICUs between May and November 2017. For each research unit, the ETT cuff pressure was measured twice at a 6-hour interval using a cuff pressure manometer. Descriptive (ie, mean, standard deviation, and frequency distribution) and inferential (ie,<em> t</em>-test, Pearson, and ANOVA) statistics were used to describe the data. All the ETT cuff pressure measurements were performed with a calibrated manometer. The data were analyzed using the SPSS software, version 22.0.
<strong><em>Results:</em></strong> The mean ETT cuff pressure was 38.3 ± 24.9 cmH<sub>2</sub>O. In the first measurement, the ETT cuff pressure was normal in only 17% of the subjects, while this figure increased to 78% after the 6-hour control period and cuff-pressure correction. There was a significant relationship between the number of days of intubation and the ETT cuff pressure in both first (<em>P</em> = 0.003) and second (<em>P</em> = 0.01) measurements.
<strong><em>Conclusions:</em></strong> The ETT cuff pressure often exceeds the recommended normal range, which can serve as a reminder that it may be necessary to control it at shorter intervals to avoid complications caused by increases or decreases in the cuff pressure. <strong><em>(Iranian Heart Journal 2020; 21(3): 33-39)</em></strong>
Endotracheal tube,Cuff pressure,Intensive Care Units,Cardiac Surgery
http://journal.iha.org.ir/article_110215.html
http://journal.iha.org.ir/article_110215_ab6074b466f3afeb1449ebf77c22773a.pdf
Iranian Heart Association
Iranian Heart Journal
21
3
2020
07
01
Best Parameter for the Evaluation of Right Ventricular Function by 2D Echocardiography in Patients With Corrected Tetralogy of Fallot
40
47
EN
Niloufar
Samiei
Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
Mohammad
Kasaei
Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Science, Tehran, IR Iran.
Mahmood
Salesi
Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, IR Iran.
Mohammad Reza
Eftekhari
Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Science, Tehran, IR Iran.
<strong><em>Background:</em></strong>Echocardiography has a widespread role in measuring cardiac function and hemodynamics. Nevertheless, the evaluation of right ventricular (RV) function is a puzzle, especially by 2D echocardiography, because of the complex anatomy of this chamber. Tetralogy of Fallot (ToF) is the most common cyanotic congenital heart disease, and an accurate evaluation of RV function is important for planning the time for pulmonary valve surgery after initial correcting surgery. Although cardiovascular magnetic resonance imaging (CMR) is the gold standard tool for measuring the right ventricular ejection fraction (RVEF), we sought to determine which classic factor for the evaluation of RV function by 2D echocardiography matched relevant CMR findings the most.
<strong><em>Methods:</em></strong>All patients (N = 26) with corrected ToF referred for CMR in Rajaie Cardiovascular Medical and Research Center between June 2018 and January 2019 were evaluated by 2D echocardiography. The findings relating to RV function by the 2 methods were analyzed using the SPSS software, version 22.
<strong><em>Results:</em></strong>Of the 4 classic parameters for the evaluation of RV function by 2D echocardiography, only fractional area change had a statistically significant correlation with RVEF by CMR (AUC for the evaluation of RVEF ≥ 45%: 0.813, <em>P</em> = 0.012; the Spearman correlation coefficient: 0.40, <em>P</em> = 0.04). Additionally, tricuspid annular plane systolic excursion, S’, and the RV index of myocardial performance could not predict RVEF in our patients with corrected ToF.
<strong><em>Conclusions:</em> </strong>Fractional area change is a suitable parameter for the evaluation of RVEF in patients with ToF; nonetheless, the other classic parameters of RV function in 2D echocardiography cannot predict RV function in these patients.<strong><em> (Iranian Heart Journal 2020; 21(3): 40-47)</em></strong>
Right ventricular function,TETRALOGY OF FALLOT,2D ECHOCARDIOGRAPHY
http://journal.iha.org.ir/article_110216.html
http://journal.iha.org.ir/article_110216_97b4e7d748c9e109104d7b503bf73285.pdf
Iranian Heart Association
Iranian Heart Journal
21
3
2020
07
01
Pleural Effusion After Open Cardiac Surgery
48
54
EN
Mohamad
Golitaleb
Department of Critical Care, School of Nursing, Arak University of Medical Sciences, Arak, IR Iran.
Rezvan
Ghafarzadegan
Instructor, Department of Nursing, Faculty of Nursing and Midwifery, Khomein University of Medical Sciences, Khomeini, IR Iran.
Azin
Alizadehasl
Cardio-Oncology Department and Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
Faranak
Kargar
Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
<strong><em>Background:</em></strong> Pulmonary complications after cardiac surgery are a major source of morbidity and mortality, as well as increased lengths of hospital stay and resource utilization. Pleural effusion following coronary artery bypass graft surgery (CABG) has been reported in 65% to 89% of cases. The present study was designed to determine the prevalence of pleural effusion after open-heart surgery.
<strong><em>Methods:</em></strong> This study evaluated 600 patients who underwent open-heart surgery. The study population was divided into 3 groups: group A consisted of 200 patients who underwent CABG, group B comprised 200 patients who underwent aortic valve replacement (AVR) and mitral valve replacement (MVR), and group C encompassed 200 patients who underwent valve surgery and CABG. Chest radiography was performed before surgery and afterward on the first, third, and seventh postoperative days.
<strong><em>Results:</em></strong> The study population was comprised of 330 (55%) men and 270 (45%) women. The size of the pleural effusion was small in a large proportion of the patients (45%, n = 270). Additionally, 90 (15%) patients had moderate effusion, occupying between 20% and 40% of the hemithorax, and 84 (14%) patients had large effusion.
<strong><em>Conclusions:</em></strong> Pleural effusion was detected in 37% of the patients after CABG, 25% after valve surgery (MVR+AVR), and 20% after CABG and valve surgery. Most of the cases of effusion after cardiac surgery were left-sided.<strong><em> (Iranian Heart Journal 2020; 21(3): 48-54)</em></strong>
Pleural Effusion,Open cardiac surgery,complication,Cardiopulmonary bypass
http://journal.iha.org.ir/article_110217.html
http://journal.iha.org.ir/article_110217_f0c503ec8e61a7a2c9d8c2d68d8dd37b.pdf
Iranian Heart Association
Iranian Heart Journal
21
3
2020
07
01
Cost-effective Analysis of the Fractional Flow Reserve in an Iranian Cohort With Multivessel Coronary Artery Disease
55
63
EN
Hooman
Bakhshandeh
Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
Feridoun
Noohi
Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
fnoohib@yahoo.com
Parham
Sadeghipour
Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
Sadaf
Esfahani
Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
Hossein Ali
Basiri
Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
Ali
Zahedmehr
Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
Omid
Shafe
Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
Ahmad
Tashakori Behesht
Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
Sanam
Alilou
Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, IR Iran.
Zahra
Behroozifar
Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
Hamid
Sedigh
Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
Jamal
Moosavi
Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
<strong><em>Background:</em></strong> The fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) has proven effective in decreasing cardiac events by comparison with all-comers stenting. In this study, we aimed to evaluate the cost-effectiveness of this method in an Iranian population.<br /> <br /> <strong><em>Methods:</em></strong> In this prospective cohort, patients with moderate stenosis (50%–70% severity) were included, while those with acute coronary syndrome were excluded. The patients were divided into 2 groups: the FFR group, for whom revascularization was performed based on FFR results, and the control group, for whom revascularization was performed based on the interventionist’s assessment. An FFR of less than 0.80 was considered ischemic in this investigation.<br /> <br /> <strong><em>Results:</em></strong> A total of 188 patients with moderate coronary artery lesions scheduled for elective PCI were included: 98 patients were assigned to the FFR group and 90 to the control group. Readmission and major adverse cardiac events (MACE) were decreased significantly in the FFR group (24.4% vs 11.2%; <em>P</em> = 0.017 and 25.6% vs 12.2%; <em>P </em>= 0.019, respectively). The quality-adjusted life-year (QALY) value was improved in the FFR group in comparison with the control group (0.8643 ± 0.0961 vs 0.7449 ± 0.10139, respectively; <em>P </em>< 0.001), resulting in a lower cost for each QALY in the FFR group than in the control group (131 395 349 QALY/rials vs 210 666 667 QALY/rials, respectively; <em>P</em> < 0.001). Additionally, our calculation of the incremental cost-effectiveness ratio showed that the cost-effectiveness of the FFR utilization was at least 409 million rials and at most 431 million rials for each QALY, depending on the inclusion of the cost of the FFR catheter.<br /> <br /> <strong><em>Conclusions:</em></strong> Our results demonstrated the effectiveness of FFR in diminishing MACE. The method was cost-effective according to various calculation methods in an Iranian population. <strong><em>(Iranian Heart Journal 2020; 21(3): 64-72)</em></strong>
Percutaneous Coronary Intervention,Fractional flow reserve,Cost-Effectiveness
http://journal.iha.org.ir/article_110219.html
http://journal.iha.org.ir/article_110219_70e7c4b1973e82fc1ed1013499e170c1.pdf
Iranian Heart Association
Iranian Heart Journal
21
3
2020
07
01
Structural Equation Modeling of the Relationships Between Executive Functions and the Percentage of Artery Blockage in Patients With Cardiovascular Disease: Mediation by the Big Five Personality Characteristics
64
77
EN
Fatemeh
Seid Abadi
Department of Psychology, Azad University, Karaj Branch, Alborz, IR Iran.
Majid
Kyavar
Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
Akbar
Nikpajouh
Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
Saeed
Malih al-zakerini
Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
Hassan
Ahadi
Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
<strong><em>Background:</em></strong> This study aimed to determine the relationship between executive functions and the percentage of artery blockage as mediated by the big 5 personality characteristics in patients with cardiovascular disease (CVD). Accordingly, we used structural modeling to test a hypothesized model.<br /> <br /> <strong><em>Methods:</em></strong> The research method was descriptive and correlational, and the statistical population was comprised of 183 patients with CVD selected via the available sampling method from those who referred to Rajaie Cardiovascular Medical and Research Center in Tehran, Iran. The percentage of artery blockage was recorded by coronary angiography. The measuring instruments were the Subjective Neurocognition Inventory (SNI) and the NEO Five-Factor Inventory (NEO-FFI). The data were analyzed using structural equation modeling. In this regard, the data were calculated using the Spearman correlation coefficient among the factors (the SPSS software) and the path analysis (the LISREL software).<br /> <br /> <strong><em>Results:</em></strong> The results showed that the personality mediated the relationship between executive functions and the percentage of artery blockage.<br /> <br /> <strong><em>Conclusions:</em></strong> Executive functions were associated with the percentage of artery blockage, and a part of this relationship was mediated by the big 5 personality characteristics. Therefore, personality traits should be considered in treating patients with CVD. <strong><em>(Iranian Heart Journal 2020; 21(3): 73-86)</em></strong>
Executive Functions,Percentage of artery blockage,Big five personality characteristics
http://journal.iha.org.ir/article_110220.html
http://journal.iha.org.ir/article_110220_791dcc69a870f8f808ecfb47bfce778b.pdf
Iranian Heart Association
Iranian Heart Journal
21
3
2020
07
01
Assessment of Right Ventricular Myocardial Fibrosis and Restrictive Physiology in Patients With Repaired Tetralogy of Fallot: A Comparison Between Cardiac Magnetic Resonance and Transthoracic Echocardiography
78
88
EN
Zahra
Alizadeh Sani
Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
Zahra
Khajali
Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
Fatemeh
Mirrazeghi
Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
Mostafa
Rouzitalab
Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
Mohaddeseh
Behjati
Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
Behshid
Ghadrdoust
Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
Shahin
Rahimi
Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
Niloufar
Samiei
Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
Maryam
Bayat
Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
Delara
Gholamipoor
Imam Khomeini Hospital Complex, Tehran University of Medical Science, Tehran, IR Iran.
<strong><em>Background:</em></strong> Right ventricular (RV) restrictive physiology is a condition caused by the chronic elevation of systolic pressure in the RV, which is typically found in patients with tetralogy of Fallot (ToF) who had undergone total surgical correction and can be diagnosed either via cardiac magnetic resonance imaging (CMR) or finding the RV end-diastolic forward flow (EDFF) via echocardiography. We aimed to assess the relationship between RV restrictive physiology with myocardial fibrosis and functional indices on CMR, along with exercise capacity and diastolic dysfunction indicators measured by transthoracic echocardiography (TTE).<br /> <br /> <strong><em>Methods:</em></strong> All patients with a history of the total correction of ToF at childhood who referred to our center for the evaluation of postoperative severe pulmonary regurgitation were included. All the patients were examined using electrocardiography, the exercise test, TTE, and late gadolinium enhancement (LGE) CMR.<br /> <br /> <strong><em>Results:</em></strong>Among the study population, 17 (56.7%) patients were found to have RV EDFF on their echocardiograms, while 18 (60.0%) had RV restrictive physiology on their CMR. The 2 diagnostic modalities had a moderate significant agreement for the diagnosis of RV restrictive physiology (Kappa = 0.521, <em>P</em>= 0.004). There was a significant difference between the patients with or without RV restrictive physiology based on CMR findings regarding the QRS duration (<em>P</em> = 0.015), Sm (<em>P</em> = 0.045), and the RV end-diastolic volume index (<em>P</em> = 0.036).<br /> <br /> <strong><em>Conclusions: </em></strong>TTE may be a good alternative for the evaluation of RV restrictive physiology after the total correction of ToF. However, RV restrictive physiology measured by CMR and RV EDFF measured by echocardiography could not correlate with quantitative RV myocardial fibrosis measured by LGE CMR.<strong><em> (Iranian Heart Journal 2020; 21(3): 87-97)</em></strong>
Right ventricular restrictive physiology,TETRALOGY OF FALLOT,echocardiography,Cardiac magnetic resonance imaging
http://journal.iha.org.ir/article_110221.html
http://journal.iha.org.ir/article_110221_c4d5b975a32eeb567f1d2ac4b8ff801a.pdf
Iranian Heart Association
Iranian Heart Journal
21
3
2020
07
01
NT-proBNP in Mitral Stenosis: Can It Be a Predictor of Hemodynamic Status?
89
95
EN
Niloufar
Samiei
Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
Reza
Zolfaghari
Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
Hamidreza
Sanati
Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
Reza
Rezaei Tabrizi
Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
Ali
Zahedmehr
Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
Ata
Firouzi
Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
<strong><em>Background:</em></strong> Mitral valve area (MVA) and other indices of the severity of mitral stenosis poorly reflect the functional status, systolic pulmonary artery pressure, and cardiac output in patients with severe mitral stenosis. In the present study, we aimed to compare the strength of conventional stenosis indices and N-terminal pro B-type natriuretic peptide (NT-proBNP) levels in the prediction of major functional and hemodynamic consequences of mitral stenosis in a group of patients with a severe form of this disease.<br /> <strong> </strong><br /> <strong><em>Methods:</em></strong> Patients with severe symptomatic rheumatic mitral stenosis (MVA< 1.5 cm<sup>2</sup>) were enrolled. Comprehensive echocardiography and catheterization were performed for all the patients. MVA was measured via the 2D planimetry method, and NT-proBNP levels were measured during admission.<br /> <strong> </strong><br /> <strong><em>Results:</em></strong> Forty-one patients, 88% of whom were female, were enrolled in our study. The NT-proBNP level and MVA had a significantly negative correlation (ρ= −0.450 and <em>P</em> =0.003). The NT-proBNP level had a significant correlation with systolic pulmonary artery pressure (ρ= −0.423 and <em>P </em>= 0.006) and MV resistance (ρ= −0.506 and <em>P </em>= 0.001); however, the mean transmitral pressure gradient and the NT-proBNP level did not show a significant relationship. The strongest relationships were found between the NT-proBNP level and stroke volume and cardiac output, which were negatively significant (<em>P </em>= −0.601 and <em>P </em>= 0.000) and (ρ= −0.587 and <em>P </em>= 0.000), respectively.<br /> <strong> </strong><br /> <strong><em>Conclusions:</em></strong> It appears that the NT-proBNP level can be a good predictor of patients’ hemodynamic status such as cardiac output in addition to the echocardiographic features of mitral stenosis. <strong><em>(Iranian Heart Journal 2020; 21(3): 98-104)</em></strong>
Mitral stenosis,Brain natriuretic peptide,echocardiography,Cardiac output
http://journal.iha.org.ir/article_110222.html
http://journal.iha.org.ir/article_110222_7a14f31d75e4dca6daf63c8155e5c992.pdf
Iranian Heart Association
Iranian Heart Journal
21
3
2020
07
01
Hypothermia and Blood Lactate During Cardiopulmonary Bypass in Pediatric Patients
96
108
EN
Naser
Kachoueian
Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.
Saeed
Taiyari
Cardiac Surgery Department, Children Medical Center, Tehran University of Medical Sciences, Tehran, IR Iran.
Mohammadreza
Mirza Aghayan
Cardiac Surgery Department, Children Medical Center, Tehran University of Medical Sciences, Tehran, IR Iran.
Ziae
Totonchi
Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
Ali
Sadeghpour Tabaei
Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
Farhad
Gorjipour
Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
Ali
Sadeghi
Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
Seyyed Mohammad Taghi
Razavi Tousi
Cardiovascular Diseases Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, IR Iran.
Meysam
Mortazian
Cardiovascular Surgery Department, AJA University Medical Science.
Pouya
Farokhnezhad Afshar
University of Social Welfare and Rehabilitation Sciences, Tehran, IR Iran.
Sara
Taiyari
Queen Marry University of London, UK.
Farnoosh
Elmi
Children Medical Center, Tehran University of Medical Sciences, Tehran, IR Iran.
<strong><em>Background:</em></strong> Hypothermic perfusion is widely used in pediatric cardiac surgery units. The present study evaluated the effects of hypothermia severity on the serum levels of lactate during cardiopulmonary bypass (CPB) in the surgical repair of congenital heart defects in children.<br /> <br /> <strong><em>Methods:</em></strong> A total of 185 pediatric patients candidated for the elective surgical repair of congenital heart diseases were recruited. The patients’ arterial serum lactate, central venous pressure, diuresis, glucose level, and arterial blood gases were measured and recorded at 4 time points: before CPB, in the cooling stage, in the warming stage, and after CPB and upon admission to the intensive care unit (ICU).<br /> <br /> <strong><em>Results:</em></strong>The mean age of the patients was 28.1 ± 19.6 months. The lactate level was significantly increased more quickly in the patients with hypothermia less than 30 °C than in those with hypothermia of 30 °C or greater (<em>P</em> < 0.001). These 2 groups were significantly different in terms of the duration of CPB (<em>P</em> < 0.001), the duration of cross-clamping (<em>P </em>< 0.001), and the volume of the blood filtered (<em>P</em> < 0.001). No statistically significant difference in the volume of the red blood cell transfused was observed between the 2 groups (<em>P</em> = 0.12).<br /> <br /> <strong><em>Conclusions: </em></strong>Deep hypothermia is associated with higher blood lactate levels, which may be associated with poor outcomes during and after CPB. It is recommended that normothermia or mild hypothermia be used during CPB in pediatrics. When the use of deep hypothermia is inevitable, patients should be strictly monitored and screened for adverse outcomes associated with hyperlactatemia.<strong><em> (Iranian Heart Journal 2020; 21(3): 105-117)</em></strong>
Cardiac Surgery,Congenital defects,lactate,HYPOTHERMIA,Cardiopulmonary bypass
http://journal.iha.org.ir/article_110223.html
http://journal.iha.org.ir/article_110223_85fafefc79fbb7794fb01641998cc0bf.pdf
Iranian Heart Association
Iranian Heart Journal
21
3
2020
07
01
Importance of Serum Selenium Levels in Acute Heart Failure
109
118
EN
Sepideh
Taghavi
Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Science. Tehran, IR Iran.
Seyed Amir Hooman
Qoreishi
Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Science. Tehran, IR Iran.
Nasim
Nadri
Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Science. Tehran, IR Iran.
Ahmad
Amin
Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Science. Tehran, IR Iran.
Farzaneh
Futuhi
Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Science. Tehran, IR Iran.
Siroos
Kordrostami
Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Science. Tehran, IR Iran.
Hooman
Bakhshandeh
Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Science. Tehran, IR Iran.
Hadi
Khalaj
Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Science. Tehran, IR Iran.
<strong><em>Background:</em></strong> The role of micronutrients such as selenium is linked to the different types of cardiomyopathies. Given the paradoxes and limitations of previous studies, we designed a descriptive-analytic study with a greater sample size and more variables in Iran.<br /> <br /> <strong><em>Methods:</em></strong> Fifty-five patients suffering from heart failure (HF) with glomerular filtration rates of 60 mL/min or higher were selected. At the onset of admission, the serum levels of selenium, proBNP, magnesium, calcium, potassium, and iron, as well as the variable of estimating prognosis (ie, 5 years’ survival based on the Seattle Heart Failure Model calculator), and also a history of diabetes mellitus, hypertension, cerebrovascular accidents, cigarette use, atrial fibrillation, and previous admissions for HF, were registered. Three months later, the New York Heart Association (NYHA) functional class, the left ventricular ejection fraction, and the proBNP level were rechecked.<br /> <br /> <strong><em>Results:</em></strong>Selenium deficiency (≤ 45µg/L) was detected in 25.4% of the patients. The mean serum level of selenium was 62 ± 24.9 µg/L, and it had no significant relationship with etiology; prognosis; the left ventricular ejection fraction; the proBNP level; the NYHA functional class; the dose of furosemide before admission; the consumption of angiotensin-converting-enzyme inhibitors/angiotensin II receptor blockers, beta-blockers, statins, and allopurinol; laboratory variables; age; sex; diabetes mellitus; hypertension; cerebrovascular accidents; atrial fibrillation; and cigarette use. Nonetheless, the mean serum level of selenium had significant reversed relationships with previous admissions for HF and potassium-sparing diuretic use (<em>P</em> = 0.012 and <em>P</em> = 0.026, respectively) (confidence interval = 95%).<br /> <br /> <strong><em>Conclusions:</em></strong>The prevalence of selenium deficiency in our patients with HF was considerable. The mean serum level of selenium was similar in both ischemic and nonischemic groups; nevertheless, the level had no significant relationship with the majority of clinical and paraclinical variables of HF severity and prognosis. Future studies should investigate the relationship between the serum level of selenium and the precise cumulative dose of diuretics at the end of the admission process and the interaction between selenium and mineralocorticoid receptors.<strong><em>(Iranian Heart Journal 2020; 21(3): 118-127)</em></strong>
Micronutrients,selenium,Cardiomyopathy,Heart failure,Diuretic
http://journal.iha.org.ir/article_110224.html
http://journal.iha.org.ir/article_110224_a8615d047605ed973e39c5482dfadc95.pdf
Iranian Heart Association
Iranian Heart Journal
21
3
2020
07
01
Evaluation of the Significance of Positive Troponin I in Patients With Methadone Toxicity
119
127
EN
Atoosa
Mostafavi
Department of Cardiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, IR Iran.
Mohammad Hossein
Mottaghi
Department of Cardiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, IR Iran.
Seyed Abdol Hussein
Tabatabaei
Department of Cardiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, IR Iran.
<strong><em>Background:</em></strong> Controversy continues surrounding the relationship between methadone and coronary artery disease (CAD). Given the evidence regarding methadone overdose and elevated high-sensitivity troponin I (hs-TnI) levels, we sought to determine whether elevated hs-TnI was associated with subtle CAD.<br /> <br /> <strong><em>Methods:</em></strong> This cross-sectional study was conducted on 100 cases with methadone overdose. Electrocardiography (ECG) was performed on day 1 after admission, and QTc intervals and ST-T segment changes were recorded. The venous level of hs-TnI was checked thrice. Patients aged below 20 years with no risk factors for atherosclerosis were evaluated by stress echocardiography, and the rest underwent coronary angiography.<br /> <br /> <strong><em>Results:</em></strong>The mean age of the study population was 41.51 ± 17.82 years. ECG was normal in 48% of the patients, despite elevated levels of hs-TnI. Extensive myocardial infarction was reported in 3% of the study population, and 49% showed ST-T changes. The mean QT-interval was 422.50 ± 77.35 ms in women and 434.28 ± 67.28 in men (<em>P</em> = 0.578). Patients with torsades de pointes had a QT-interval of greater than 500 ms. The mean left ventricular ejection fraction was 55.41 ± 9.85%. All the stress echocardiographic examinations were normal. Twenty-four patients had stenosis exceeding 50% in coronary angiography. The entire study population was older than 40 years of age with more than 1 coronary artery risk factor.<br /> <br /> <strong><em>Conclusions: </em></strong>Methadone elevated hs-TnI with and without ST-T changes. Most of our patients had normal coronary arteries in angiography and stress echocardiography. Indeed, even the patients with ST elevation in the anterior leads, combined with a reduced ejection fraction, were ultimately diagnosed as Takotsubo cardiomyopathy. We conclude that elevated hs-TnI in methadone toxicity should not be considered non–ST-segment elevation myocardial infarction. <strong><em>(Iranian Heart Journal 2020; 21(3): 128-136)</em></strong>
Methadone,Troponin,Coronary Angiography,QT-interval
http://journal.iha.org.ir/article_110225.html
http://journal.iha.org.ir/article_110225_15aa86a908eea6691e3f7a73d5aef232.pdf
Iranian Heart Association
Iranian Heart Journal
21
3
2020
07
01
Infantile Tachyarrhythmia: Management Strategy and Short-Term Results in a High-Volume Referral Center
128
135
EN
Mohammad
Dalili
Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
Faramarz
Ajri-Khamesloo
Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
Shabnam
Madadi
Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
Mohammad Yusef
Arabi-Moghaddam
Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
<strong><em>Background:</em></strong> Arrhythmia is an uncommon but serious cause of the admission of neonates and infants to emergency wards. The rarity of the condition creates challenges in the diagnostic and therapeutic process.<br /> <strong><em>Methods:</em></strong> The study was conducted in Rajaie Cardiovascular Medical and Research Center, Tehran, Iran. All infants (aged ≤ 12 mon) with tachyarrhythmias admitted within a 2-year period between September 2014 and August 2016 were included. Stepwise drug therapy based on the mechanism of the arrhythmia was selected for the whole study population. In cases refractory to drug therapy, catheter ablation was performed.<br /> <strong><em>Results: </em></strong>Of 55 cases, 47 infants were treated with antiarrhythmic drugs, 3 (with atrial flutter) received cardioversion, and 3 were treated with catheter ablation. In 1 case (atrial tachycardia), the arrhythmia was eliminated after a single dose of adenosine, and in another (atrial tachycardia), the arrhythmia was eliminated spontaneously. No mortality was reported.<br /> <br /> <strong><em>Conclusions: </em></strong>Most infantile arrhythmias are controllable with available antiarrhythmic drugs. Catheter ablation is a good choice for refractory cases.<strong><em>(Iranian Heart Journal 2020; 21(3): 137-144)</em></strong>
Infantile tachyarrhythmia,Ablation,Antiarrhythmic drugs
http://journal.iha.org.ir/article_110226.html
http://journal.iha.org.ir/article_110226_21c797aa5b24276d14c29f872d43fb69.pdf
Iranian Heart Association
Iranian Heart Journal
21
3
2020
07
01
Uterine Leiomyoma Extending to the Inferior Vena Cava and the Right Atrium
136
140
EN
Hamid
Hoseinikhah
Department of Cardiovascular Surgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran.
Shima
Sheybani
Department of Cardiovascular Surgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran.
Majid
Ghodsi
Department of Cardiovascular Surgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran.
Aliasghar
Moeinipour
Department of Cardiovascular Surgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran.
<strong>CASE PRESENTATION</strong><br /> Metastatic cardiac masses have different primary sites. On rare occasions, uterine tumors are responsible for such masses. We herein describe a woman with a metastatic cardiac mass originating from a benign uterine leiomyoma. The patient had severe and chronic abnormal uterine bleeding, for which she finally referred to our hospital. On admission, she had acute respiratory distress. Echocardiography showed a huge right atrial mass that had occupied most of this atrial space. The mass originated from the inferior vena cava (IVC) and extended across the tricuspid valve to the right ventricle. The mass was successfully resected under cardiopulmonary bypass. Subsequent evaluations, including a pathologic examination, revealed a metastatic uterine leiomyoma extending to the right atrium after invasion into the IVC. <strong><em>(Iranian Heart Journal 2020; 21(3): 145-149)</em></strong>
Cardiac mass,Cardiac Surgery,leiomyoma
http://journal.iha.org.ir/article_110227.html
http://journal.iha.org.ir/article_110227_c5a35b3f5a1e477003f0080c5eb907b8.pdf
Iranian Heart Association
Iranian Heart Journal
21
3
2020
07
01
Successful Heart Transplantation in Patients With Muscular Dystrophies: A Case Series
141
144
EN
Sepideh
Taghavi
Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
Nasim
Naderi
Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
Ahmad
Amin
Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
Maryam
Chenaghlou
Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
Marzieh
Mirtajaddini
Cardiovascular Research Center, Kerman University of Medical Sciences, Kerman, IR Iran.
Elahe
Zare
Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, IR Iran.
Muscular dystrophies constitute a group of disorders characterized by muscular weakness and the involvement of the other systems such as the cardiovascular system. In some patients, cardiac involvement is severe and necessitates heart transplantation. Although there are some concerns regarding heart transplantation in these patients due to post-transplantation complications and the deleterious side effects of immunosuppressant drugs, there are several cases of heart transplantation in these patients worldwide. There is, however, no reported case in our country, Iran. Herein, we present 3 successful heart transplantations in patients with muscular dystrophies in Iran. <strong><em>(Iranian Heart Journal 2020; 21(3): </em></strong><strong><em>1</em></strong><strong><em>50</em></strong><strong><em>-153)</em></strong>
Muscular dystrophy,Heart failure,Heart transplantation
http://journal.iha.org.ir/article_110228.html
http://journal.iha.org.ir/article_110228_0d892ef06e3564b08ba3a79b03722da7.pdf