2024-03-29T19:16:24Z
http://journal.iha.org.ir/?_action=export&rf=summon&issue=10657
Iranian Heart Journal
2018
19
2
Comparison of Bleeding Complications Between Primary PCI and Rescue PCI Procedures
Ali-Asghar
Farsavian
Seifollah
Abdi
Mohsen
Maadani
Hosein
Farsavian
Meisam
Mojri
Background: Bleeding during or after primary percutaneous coronary intervention (PCI) is the most
common noncardiac complication in patients treated for cardiac ischemic events. The present
study aimed to compare bleeding complications between primary and rescue PCI procedures.
Methods: In a prospective study, the recorded files of 95 consecutive patients who underwent one of
the 2 procedures of primary PCI (n=90) or rescue PCI (n=5) were evaluated. The consequences
of bleeding were assessed through the measurement of serum hemoglobin levels before,
immediately after, and 24 hours after the procedures. Within the hospitalization period and
before discharge, any occurrence of bleeding was recorded.
Results: Regarding postoperative events, hematoma was revealed in 3.3% in the primary PCI group
and 20% in the rescue PCI group, with no significant difference (P=0.224). Additionally,
gastrointestinal bleeding was reported in 2.2% of the patients who underwent primary PCI and
none of those in the other group, without any difference (P=0.999). In total, postoperative
morbidity was seen in 5.6% in the primary PCI group and in 20% in the rescue PCI group, with
no difference (P=0.314). The mean of the decreased level of serum hemoglobin in the primary
PCI group and the rescue PCI group was 1.22±1.31 and 1.33±0.90, respectively, with no
difference (P=0.849). A multivariate linear regression model, after adjustments for the baseline
parameters, showed no difference between the 2 procedures regarding the decreased level of
serum hemoglobin. Advanced age was the only variable able to predict higher morbidity.
Conclusions: There were no significant differences in postprocedural complications regarding major
bleeding between the 2 procedures of rescue PCI and primary PCI. The main predictor for
bleeding after PCI was advanced age.
Primary PCI
Rescue PCI
Bleeding
2018
06
01
6
12
http://journal.iha.org.ir/article_82808_42ea22fe0ac5704c0047a5fabaecd2e9.pdf
Iranian Heart Journal
2018
19
2
Imperative Role of Education of ICU Nurses regarding Postoperative Pain Management After Pediatric Cardiac Surgery
Mohsen
Ziyaeifard
Rasoul
Azarfarin
Khadijeh
Zamani
Azin
Alizadehasl
Yasaman
Khalili
Maryam
Moradian
Zahrasadat
Koleini
Hamidreza
Pouraliakbar
Background: Management and evaluation of pain in children can be challenging due to difficulties inexpression and verbalization. The imperative role of nurses in the assessment and managementof pain should be considered. The aim of this study was to evaluate the role of the education ofICU nurses in pain assessment and measurement in order to reduce postoperative pain inchildren.Methods: In this clinical trial, 146 children aged 3 to 15 years who underwent cardiac surgery wereallocated to 2 groups. The control group (n=73) was managed routinely in that analgesics wereadministered as needed at the discretion of each anesthesiologist. In the trained nurses group(n=73), the ICU nurses received an education program including a pain assessment andtreatment protocol. In both groups, pain scores were evaluated and recorded according to theWong–Baker FACES Pain Rating Scale on the first and second postoperative day. Analgesicswere administered to alleviate moderate and severe pain, and the nurse was asked to record allpain scores and analgesic drug doses.Results: Pain scores on the second day decreased in both groups (P<0.001); however, this decreasingtrend was steeper in the patients with trained nurses. Analgesic use was higher in the trainednurses group than in the control group (P=0.0001). The postoperative use of sedative drugs inthe trained nurses group was less than that in the control group on the first postsurgical day butnot on the second day (P=0.120).Conclusions: Implementation of our pain management protocol by ICU nurses led to an increase inanalgesic use and a decrease in sedative drug administration and better pain control in pediatricpatients undergoing cardiac surgery.
Nursing
Education
Pediatric
Pain management
Cardiac Surgery
2018
06
01
13
19
http://journal.iha.org.ir/article_82809_1b15379cb3544b1f0f2d0fde36c38736.pdf
Iranian Heart Journal
2018
19
2
Association Between Occupational Stress and Risk Factors of Cardiovascular Disease in Locomotive Operators
Akram
Shahbazi
Nahid
Rahmani
Milad
Abbasi
Reza
Nabi Amjad
Hossein
Marioryad
Alireza
Khammar
Monir
Alimohammadi
Mohsen
Poursadeghiyan
Background: Occupational stress is the leading cause of many disorders in employees. Drivers are ahigh-risk group for work-related stress. The purpose of this study was to determine theassociation between cardiovascular risk factors and occupational stress among locomotiveoperators.Methods: This cross-sectional study recruited 350 locomotive operators. The Osipow questionnairewas used to measure stress. After 10 hours of fasting, systolic and diastolic blood pressureswere recorded. Intravenous blood samples were also taken. Two groups of job stress wereincluded as “trivial and trivial-to-average stress” and “average-to-acute and acute stress”. TheMann–Whitney U test was utilized to compare the risk factors of cardiovascular diseasebetween the 2 groups. The association between education level and job experience was assessedusing the χ2 test.Results: Of the 350 participants, 250 (71.43%) individuals reported average-to-acute stress, 30 (8.57%)reported acute stress, and 70 (20%) reported average stress. There was a significant relationshipbetween education level and job experience (P=0.000). There were no significant differencesbetween the 2 groups in the smoking rate (P=0.92), triglyceride level (P=0.55), and diastolicblood pressure (P=0.21), while the trivial and trivial-to-average stress group had significantlyhigher blood glucose levels (P=0.024) and systolic blood pressures (P=0.000) than the othergroup. Finally, the blood cholesterol level in the average-to-acute and acute stress group wassignificantly higher than that of the other group (P=0.000).Conclusions: High rates of occupational stress were reported in the studied locomotive operators.Stress may have effects on blood glucose, triglyceride, and cholesterol levels in this job group
risk factors
Cardiovascular disease
Occupational Stress
Osipow
Locomotive operators
cardiovascular risk factors
2018
06
01
20
26
http://journal.iha.org.ir/article_82810_980ee0505dee17b4cd5c5fb1dfcf9cab.pdf
Iranian Heart Journal
2018
19
2
Comparison of Left Ventricular Ejection Fraction Measurements by Echocardiography and Contrast Ventriculography: A Study on a Large Hospitalized Population
Hakimeh
Sadeghian
Ebrahim
Nematipour
Ali
Kazemi Saeid
Masomeh
Lotfi-Tokaldany
Neda
Ghaffari-Marandi
Elham
Hakki Kazazi
Mehran
Mahmoodian
Seyed Hesameddin
Abbasi
Background: The evaluation of the left ventricular ejection fraction (LVEF) is important for predictingmortality and identifying high-risk patients. We aimed to identify factors affecting the variationin the LVEF measurement via echocardiography and contrast left ventriculography (CVG).Methods: A total of 4422 patients (mean age=59.0±10.52 y, range=22–88) who underwentechocardiography and CVG within the same hospitalization period (0- to 14-day intervals) wereincluded. Data were obtained from the Echocardiography Data Bank and the CoronaryAngiography Data Bank in Tehran Heart Center.Results: The correlation between the estimation of the EF by echocardiography and CVG was good(r=0.716); however, there was no point-by-point agreement. In 21.5% of the patients,echocardiography and CVG estimated the EF equally, and a difference greater than 20% wasfound in 1.8% of the patients. The differences between the 2 measurements were remarkableeither in the patients with EFs greater than 50% or in those with EFs of 50% or less by CVG(59.71±3.72 by CVG vs 55.96±7.57% by echocardiography in EFs>50% and 40.69±8.96 byCVG vs 43.90±10.71% by echocardiography in EFs≤50%). By linear regression analysis, thepresence of pathologic Q wave, atrial fibrillation and left bundle branch block, moderate andsevere mitral regurgitation, increased LV size, and increased interventricular septal diameterresulted in a higher EF value via CVG, whereas in those with EFs of 50% or less, the EF byechocardiography was higher. No effect of time gap between the measurements was found.Conclusions: According to our study, the EF measurements obtained by echocardiography and CVGvaried on an individual basis. The level of the EF was the most important factor correlating withthe difference between the measurements by the methods.
echocardiography
Contrast ventriculography
Ejection fraction
2018
06
01
27
35
http://journal.iha.org.ir/article_82811_fb97af0b5f10dcd8617ee55f2bcbe94b.pdf
Iranian Heart Journal
2018
19
2
Prevalence and Prognostic Significance of Pericardial Effusion in Native Valve Endocarditis Based on Data From the Iranian Registry of Infective Endocarditis (IRIE)
Ata
Firouzi
Ronak
Ahmadi
Nargeuss
Abbaszade Marzbali
Anita
Sadeghpour
Zeinab
Norouzi
Hamidreza
Pasha
Reza
Golpira
Yousef
Moghaddam
Nasim
Naderi
Background: The presence of pericardial effusion (PE) in the setting of infective endocarditis (IE) maybe a sign of more severe IE. In this study, we aimed to determine the prevalence and prognosticsignificance of PE in patients with native valve IE.Methods: The Iranian Registry of Infective Endocarditis (IRIE) is a single-center observationalhospital-based study of patients with IE. Between 2002 and 2015, all patients with a diagnosisof IE who had been enrolled in the IRIE were evaluated.Results: A total of 445 patients (68.3% male) were enrolled in this registry, and 221 (49.7%) patientshad PE. PE was more prevalent in the patients with native valve IE and those with right-heartinvolvement (65% in right-heart IE vs 50% in left-heart IE; P=0.002). The rate of in-hospitalmortality was 20% and 19.2% in the patients with and without PE, respectively, and thepresence of PE was not a predictor of in-hospital death in our multivariate analyses.Additionally, there was no relationship between the rates of IE-related complications and theseverity of PE. However, the prevalence of PE was higher in the patients with right-sided IE aswell as in those with aortic root abscess and systemic emboli at presentation.Conclusions: The prevalence of PE in the setting of IE was relatively high in the present study. Mostcases of PE had mild effusion, and there was no relationship between the severity of PE and IErelated complications as well as in-hospital mortality.
Infective endocarditis
Pericardial effusion
2018
06
01
36
43
http://journal.iha.org.ir/article_82812_9c3f2b0938996e54424a08fc77599302.pdf
Iranian Heart Journal
2018
19
2
Isovolumic Relaxation Time as an Indicator of Diastolic Dysfunction in Hypertrophic Cardiomyopathy
Azin
Alizadehasl
Anita
Sadeghpour
Nehzat
Akiash
Background: Hypertrophic cardiomyopathy (HCM) is clinically characterized by the presence of leftventricular hypertrophy in the absence of hypertension and valvular heart disease. Diastolicdysfunction is an important pathology in patients with HCM, and it is characterized byabnormal relaxation, increased left ventricular filling pressure, pulmonary congestion, andultimately cardiac symptoms. The present study aimed to assess the isovolumic relaxation time(IVRT) in patients with HCM as an important indicator of diastolic dysfunction.Methods: Nineteen control subjects and 35 patients with HCM were included in the present study.Diagnosis was based on the confirmation of unexplained myocardial hypertrophy in the leftventricle by conventional echocardiography. The peak velocity of early (E) and late (A) filling,E-wave deceleration time (DT), and the E/A ratio were assessed using pulsed-wave Doppler(PWD) echocardiography at the tip of the mitral valve leaflets in the apical 4-chamber view.The IVRT was measured in the 4-chamber view via the PWD method. To that end, the filteringgain of the images was adjusted and the IVRT was estimated.Results: The mean age of the patients was 31±16 years. The IVRT more significantly increased in thepatients with HCM than in the control group (P<0.01). The IVRT rose more significantly in thepatients with no left ventricular outflow tract (LVOT) obstruction than in those with LVOTgradients (97±38 vs 82±29; P<0.001). The mean septal thickness was 24±7 mm in the patientswith HCM, and increased septal thickness was significant in the patients who receivedimplantable cardioverter defibrillators (P<0.05).Conclusions: The diastolic function was impaired in our patients with HCM. Moreover, the IVRT as anoninvasive index of the diastolic function was prolonged in those with HCM.
Hypertrophic cardiomyopathy
Isovolumic relaxation time
diastolic dysfunction
2018
06
01
44
49
http://journal.iha.org.ir/article_82813_01f88050fb87deaa58efdbbbaadce001.pdf
Iranian Heart Journal
2018
19
2
Functional and Structural Heart Conditions Associated With White-Coat Hypertension in Comparison With True Hypertension and Normal Blood Pressure States
Ahmad
Mirdamadi
Mansoureh
Safdari
Mojgan
Gharipour
Mohammad
Garakyaraghi
Ali
Pourmoghadas
Background: This study attempted to evaluate functional and structural cardiac states usingechocardiography in patients with white-coat hypertension in comparison with truehypertension and normotensive conditions.Methods: The study population consisted of 72 individuals, aged 25 to 75 years. The subjects wereassigned to 4 groups: white-coat hypertensives (n=20), controlled true hypertensives (n=20),uncontrolled true hypertensives (n=12), and a normotensive group (n=20). Whilst the 4 subgroups in the study exhibited a similar gender distribution, the normotensive subjects weresignificantly younger; however, there was no discrepancy in the mean age between the whitecoat hypertensive group and the other hypertensive subgroups. Univariate comparisons betweenthe functional and structural cardiac parameters of the white-coat hypertensives and the otherstudy groups revealed low deceleration time and E’-wave velocity and high E-wave velocityand left ventricular internal dimension indices compared with the other 2 hypertensive groups.Results: After adjustment for sex and age, the white-coat hypertensive group revealed differing resultsin 2 indices of E’ wave velocity and interventricular septal thickness (IVST) when comparedwith the other three. A number of features were identified as the hallmarks of white-coathypertensives: specific functional and structural cardiac changes such as low IVST incomparison with the uncontrolled hypertensives; presence of diastolic dysfunction, which wasnot found in the normotensives; and greater cardiac mass than that in the normotensives, lessthan that in the uncontrolled hypertensives, but closer to that in the controlled hypertensives.Conclusions: Although the prognosis for patients with white-coat hypertension is not as grave as thatfor those with true hypertension, it is considerably worse than the prognosis among the normalpopulation.
function
structure
Heart
White-coat hypertension
2018
06
01
50
56
http://journal.iha.org.ir/article_82814_9f47893e8d38d02a04b2eb66113753b2.pdf
Iranian Heart Journal
2018
19
2
Value of Vitamin D Deficiency in Predicting the Severity of Coronary Artery Disease in Type 2 Diabetes
Nima
Akbarian
Mohammad
Masoomi
Maryam
Sedaghat
Maryam
Askari
Background: The present study aimed to assess the relationship between vitamin D deficiency and theseverity of coronary artery disease (CAD) in a sample of Iranian diabetic patients.Methods: This cross-sectional study was performed on 169 consecutive diabetic patients suspected ofCAD. The severity of CAD was defined based the number of involved coronary vessels. Theserum vitamin D level was measured via immunoassay, and its serum level was categorized asnormal (>30 ng/mL), insufficient (20–30 ng/mL), mildly-to-moderately deficient (10–20ng/mL), and severely deficient (<10 ng/mL).Results: There was no significant relationship between vitamin D deficiency and the number ofinvolved coronary vessels (P=0.423), and nor was there any difference in the serum level ofvitamin D in the individuals with CAD (24.84±18.53 ng/dL) and those without CAD(22.37±16.88 ng/mL) (P=0.409). Our multivariate logistic regression model showed thatvitamin D deficiency could not predict the presence of CAD (OR=0.963, 95% CI: 0.666 to1.392; P=0.842). Analysis of the area under the ROC curve indicated a low value for themeasurement of the vitamin D level in discriminating CAD from the normal coronary status(AUC=0.533, 95% CI: 0.437 to 0.629; P=0.496).Conclusions: Our study could not demonstrate a predictive role for vitamin D deficiency concerningthe severity of CAD in type 2 diabetes. Among the different CAD risk factors, smoking andopium use were significantly correlated with vitamin D deficiency.
Coronary Artery Disease
Vitamin D
Diabetes
risk factor
2018
06
01
57
64
http://journal.iha.org.ir/article_82815_f4bc96036655c5fc5ef6f34b9873a843.pdf