Iranian Heart AssociationIranian Heart Journal17320160901Outcome of Primary PCI in ST-Segment-Elevation Myocardial Infarction61183147ENSeyedeh Samaneh AhmadiDepartment of Interventional Cardiology, Rajaie cardiovascular, Medical and Research center, Iran University of Medical Sciences, Tehran, I.R.IranHamidreza SanatiDepartment of Interventional Cardiology, Rajaie cardiovascular, Medical and Research center, Iran University of Medical Sciences, Tehran, I.R.IranMajid HajikarimiDepartment of Interventional Cardiology, Rajaie cardiovascular, Medical and Research center, Iran University of Medical Sciences, Tehran, I.R.IranAlireza Hoghooghi EsfahaniDepartment of Interventional Cardiology, Rajaie cardiovascular, Medical and Research center, Iran University of Medical Sciences, Tehran, I.R.IranSomayeh BeikmohammadiDepartment of Interventional Cardiology, Rajaie cardiovascular, Medical and Research center, Iran University of Medical Sciences, Tehran, I.R.IranEhsan KhalilipurDepartment of Interventional Cardiology, Rajaie cardiovascular, Medical and Research center, Iran University of Medical Sciences, Tehran, I.R.IranHooman BakhshandehDepartment of Interventional Cardiology, Rajaie cardiovascular, Medical and Research center, Iran University of Medical Sciences, Tehran, I.R.IranMaryam HajimolaaliDepartment of Interventional Cardiology, Rajaie cardiovascular, Medical and Research center, Iran University of Medical Sciences, Tehran, I.R.IranMehdi FarzanehDepartment of Interventional Cardiology, Rajaie cardiovascular, Medical and Research center, Iran University of Medical Sciences, Tehran, I.R.IranMehdi NooriDepartment of Interventional Cardiology, Rajaie cardiovascular, Medical and Research center, Iran University of Medical Sciences, Tehran, I.R.IranJournal Article20190228Background: We sought to assess the feasibility and outcome of primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). Methods: Between April 2014 and April 2015, consecutive STEMI patients who underwent primary PCI were prospectively enrolled in a primary PCI registry. The patients’ demographics, risk factors, procedural characteristics, and in-hospital and 6-month major adverse cardiac events (MACE) were assessed. Results: A total of 393 patients underwent primary PCI during this period. The mean age was 58±11 years and 80.6% were male. Additionally, 40.7% of the patients were hypertensive, 37.9% had dyslipidemia, 37.7% were smokers, and 29% had diabetes mellitus. Single-vessel disease was found in 36.6% of the study population, 2-vessel disease in 30.5%, and multivessel disease in 27.7%. At admission, 74.5% of the patients had TIMI grade 0 flow. Following revascularization, 74.7% achieved TIMI grade 3 flow, 22% TIMI grade 2 flow, and 1.8% TIMI grade 1 flow—as 1.5% had TIMI grade 0 flow. The predictors of the TIMI flow grade after primary PCI included history of diabetes mellitus, lesion severity, time elapsed symptom onset to admission, and use of thrombectomy. Stent thrombosis developed in 5.6% of the patients; it was more frequent among those receiving bare-metal stents. The in-hospital and 6-month mortality rates were 5.9% and 2.3%, correspondingly. In-hospital mortality was strongly related to the TIMI flow grade. Conclusions: Our study demonstrated that the outcome of primary PCI was strongly related to the postprocedural TIMI flow grade. Patients with lower TIMI flow grades postprocedurally should receive special attention. (Iranian Heart Journal 2016; 17(3):6-11)Iranian Heart AssociationIranian Heart Journal17320160901Association between Diastolic Function Parameters and MRI T2* Measurements in a Sample of Iranian Patients with Major Thalassemia1217102482ENFatemeh RajabipourPediatric Department of Baharlou Hospital, Tehran University of Medical Sciences, Tehran, I. R. Iran.Seyed Abdolhossein TabatabaeiDepartment of Cardiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, I.R. Iran.Atoosa MostafaviDepartment of Cardiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, I.R. Iran.Seyedeh Sahel RasoulighasemloueiDepartment of Cardiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, I.R. Iran.Siamak KhavandiDepartment of Cardiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, I.R. Iran.Journal Article20160120<span><strong><em>Background: </em></strong><span>The aim of the present study was to investigate the relationship between the<span> echocardiographic indices of diastolic dysfunction and MRI T2* measurements, indicating<span> myocardial iron loadings, in patients with thalassemia major and normal left ventricular<span> ejection fractions.<br /><span><strong><em>Methods: </em></strong><span>A series of consecutive patients with known thalassemia major under treatment with<span> regular blood transfusions and iron chelation therapy were enrolled in the current study<span> between July 2012 and June 2015 at Baharlou Hospital, Tehran, Iran. All the patients<span> underwent cardiac MRI with the measurement of T2* for the liver and heart,<span> echocardiographic examination with tissue Doppler assessment, and serum ferritin assay.<span> The correlation between diastolic function parameters and T2* measurements was assessed<span> using statistical software. Standard diastolic indices, comprising early (E) and late (A)<span> transmitral peak flow velocities and early deceleration time (DT), were recorded.<br /><span><strong><em>Results: </em></strong><span>The mean E/A, mean E/E′, and mean E′ were 2.09±0.54, 0.07±0.011, and 14±1.40 cm/s,<span> respectively. The mean deceleration time (dt) was 190.97±35.89. The average serum ferritin<span> level was 1498±783.08 ng/mL (range =212.7 to >3000 ng/mL). The mean cardiac T2*<span> derived from MRI was 26.58±7.54 ms. The frequencies of the different severities of<span> myocardial iron loading based on myocardial T2* were as follows: 44 (80%) normal, 4<span> (7.3%) mild, 2 (3.6%) moderate, and 5 (9.1%) severe. MRI T2* did not have a significant<span> correlation with E/A (<span><em>r</em><span>=0.091; <span><em>P</em><span>=0.508), E′ (<span><em>r</em><span>=0.130; <span><em>P</em><span>=0.345), E/E′ (<span><em>r</em><span>=0.005; <span><em>P</em><span>=0.971),<span> and dt (<span><em>r</em><span>=0.028; <span><em>P</em><span>=0.838). Hepatic iron loading based on the MRI T2* values also did not<span> have any correlation with the echocardiographic indices of left ventricular diastolic<span> dysfunction—namely E/A (<span><em>r</em><span>=0.151; <span><em>P</em><span>=0.270), E′ (<span><em>r</em><span>=0.034; <span><em>P</em><span>=0.804), E/E′ (<span><em>r</em><span>=0.083;<br /><span><em>P</em><span>=0.547), and dt (<span><em>r</em><span>=0.128; <span><em>P</em><span>=0.351).<br /><span><strong><em>Conclusions</em></strong><span><em>: </em><span>None of the echocardiographic diastolic function parameters examined in this study<br /><span>were found to be suitable for cardiac surveillance in transfusion-dependent patients affected<br /><span>by thalassemia major. Longitudinal studies are needed to evaluate the utility of<br /><span>echocardiographic and MRI parameters to predict cardiac events. At the moment, we cannot<br /><span>recommend the replacement of cardiac MR and T2* measurements, indicating myocardial<br /><span>iron loading, by Doppler echocardiography in patients with a normal systolic function.</span></span></span></span></span></span></span></span></span><br /></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span>Iranian Heart AssociationIranian Heart Journal17320160901Pre-Exposure to Normobaric Hyperoxia Has No Effect on Myocardial Injury Biomarkers after Percutaneous Transluminal Coronary Angioplasty182683148ENAsghar Mohammadi MohammadiDepartment of Cardiology, Madani Hospital, Lorestan University of Medical Sciences, Khorramabad, I.R.Iran.Shahin RaoufiDepartment of Cardiology, Madani Hospital, Lorestan University of Medical Sciences, Khorramabad, I.R.Iran.Mehrdad NamdariDepartment of Cardiology, Madani Hospital, Lorestan University of Medical Sciences, Khorramabad, I.R.Iran.Amir RaoufiDepartment of Cardiology, Madani Hospital, Lorestan University of Medical Sciences, Khorramabad, I.R.Iran.Khatereh AnbariDepartment of Cardiology, Madani Hospital, Lorestan University of Medical Sciences, Khorramabad, I.R.Iran.Shiba TahzibiDepartment of Cardiology, Madani Hospital, Lorestan University of Medical Sciences, Khorramabad, I.R.Iran.Mohammad AlmasianDepartment of Cardiology, Madani Hospital, Lorestan University of Medical Sciences, Khorramabad, I.R.Iran.Bahram RasoulianRazi Herbal Medicines Research Center and Department of Physiology and Pharmacology, Lorestan University of Medical Sciences,Khorramabad, I.R.Iran.Journal Article20190228Background: It has been determined in animal models that hyperoxia-induced preconditioning could reduce the ischemia/reperfusion injury of the heart tissue. Short-term ischemia and the subsequent reperfusion occur unavoidably in coronary angioplasty. The purpose of the present study was to determine the possible effects of oxygen pretreatment in inducing preconditioning during percutaneous transluminal coronary angioplasty (PTCA). Methods: Thirty-two patients, referred for elective angioplasty, were randomly divided into the control group and the oxygen group. The subjects in the oxygen group were exposed to normobaric oxygen (nearly 70% O2) via non-rebreathing masks for 1 hour at 12 and 2 hours before PTCA. One hour after the last oxygen pre-exposure period, the patients underwent PTCA (20 s of balloon inflation and 2 min of reperfusion). The chest pain score and cardiac injury biomarkers were assessed 12 hours after coronary angioplasty. The biomarker data and the chest pain scores were analyzed using the Mann–Whitney test and the Wilcoxon t- test. Also, the ratio of patients with positive C-reactive protein results was compared between the groups using the Fisher exact test. Results: The troponin I and CKMB levels were elevated in both groups after angioplasty, but there was no significant difference between the groups in this regard (P=0.23 and P=0.47, respectively). The average pain score during balloon inflation in the oxygen group was lower than that in the control group (2.8±1.2 vs. 4.11±1.21; P=0.008). Conclusions: Two episodes of 1-hour pre-exposure to normobaric hyperoxia (nearly 70% O2) at 12 and 2 hours before PTCA had no significant effect on myocardial injury biomarkers, troponin I, and CKMB. (Iranian Heart Journal 2016; 17(3):18-26)Iranian Heart AssociationIranian Heart Journal17320160901Measuring and Modeling the Viscoelastic Properties of the Human Saphenous Vein Using the Pressure–Diameter Test273583149ENMorteza DarjaniDepartment of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, I.R. Iran.Ali EstekiDepartment of Biomedical Engineering and Physics, Shahid Beheshti University of Medical Sciences, Tehran, I.R.Iran.Ahmad HassantashModares Hospital, Institute of Cardiovascular Research, Shahid Beheshti University of Medical Sciences, Tehran, I.R. Iran.Journal Article20190228Coronary artery bypass graft surgery is a customary therapy for vascular-related diseases, with many thousands of such a surgical modality reported annually. In this surgery, the saphenous vein, internal mammary artery, or radial artery is grafted in order to replace the coronary arteries. Using a device designed in our own laboratory, we primarily sought to find a suitable model representing the mechanical behavior of the human saphenous vein wall and then to assess its mechanical properties. The most important feature of this device is its ability to simulate the physiological conditions that exist inside the human body. We obtained 2 samples the saphenous opening and the medial epicondyle in patients with hypertension. After performing measurements at frequencies near to the heart beat frequency and finding the loss and storage moduli for each frequency, we found that—in the scanned frequency range—the Kelvin model was the best approach to evaluating the viscoelastic behavior of the vessels. Our findings also indicated that the elasticity and damping coefficients could be deemed equal along the length of the saphenous vein. Accordingly, we would advise that heart surgeons not consider the changes in the mechanical properties along the length of the saphenous vein at the time of transplantation. (Iranian Heart Journal 2016; 17(3):27-35Iranian Heart AssociationIranian Heart Journal17320160901Echocardiographic and Clinical Factors Related to the False Results of the Exercise Tolerance Test364583150ENHakimeh SadeghianDepartment of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, I.R. Iran.Seyed Abdolhussein TabatabaieDepartment of Cardiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, I.R. Iran.Mahmmod Sheikh FathollahiDepartment of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, I.R. Iran.Elham Hakki KazaziDepartment of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, I.R. Iran.Arezou ZoroufianDepartment of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, I.R. Iran.Mahmood SahebjamDepartment of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, I.R. Iran.Ali Mohammad Haji ZeinaliDepartment of Cardiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, I.R. IranJournal Article20190228Background: We aimed to identify the clinical and echocardiographic factors related to false results in the exercise tolerance test (ETT). Methods: The present study included all patients who underwent transthoracic echocardiography and the ETT, followed by coronary angiography, within 6 months prior to echocardiography between March 2008 and March 2013. Clinical, 12-lead resting ECG, ETT, transthoracic echocardiography, and coronary angiography data were extracted. The multivariable logistic regression analysis was used to investigate the independent predictors of the false results of the ETT. Results: Totally, 4057 patients, who underwent transthoracic echocardiography, ETT, and angiography, were enrolled. 1132 patients with no significant coronary stenosis on angiography, 979 (84%) had false-positive results in the ETT and 153 (14%) had true- negative ETT results. In patients with significant coronary artery disease (CAD), there were 2728 (93%) true-positive and 197 (7%) false-negative ETT results. In our univariate analysis, the patients with false ETT results were more likely to be female and younger than the group with true ETT results. In our multivariable model, female gender increased and right bundle branch block and dilated left ventricular diastolic internal dimension (LVID) decreased the likelihood of a false-positive result in the ETT. The probability of a false- negative result in the ETT was increased by resting ECG changes, hemiblocks, and dilated LVID. Conclusions: The diagnostic value of the ETT in patients with suspected CAD should be adjusted according to sex, presence of resting ECG changes, CAD risk factors, and traditional echocardiographic measurements. A dilated LV increases the risk of false-negative results and decreases the likelihood of a false-positive result in the ETT. (Iranian Heart Journal 2016; 17(3):36-45)Iranian Heart AssociationIranian Heart Journal17320160901Right Ventricle Tumoral Mass in Acute Promyelocytic Leukemia (AML M3): Cardiac Magnetic Resonance Findings465083151ENFarahnaz NikdoustDepartment of Cardiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, I.R. IranZahra Alizadeh SaniDepartment of MRI,Shahid RajaieCardiovascular, Medical, and ResearchCenter, Iran University of Medical Sciences, Tehran, I.R. Iran.Seyed Abdolhussein TabatabaeiDepartment of Cardiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, I.R. Iran.Journal Article20190228ntracardiac masses found on 2D echocardiography in patients with leukemia can present diagnostic challenges. A correct differentiation between thrombi, metastases, and infective vegetations is important in the management of patients with leukemia. We describe a 24-year-old male patient, who was diagnosed with acute myelogenous leukemia (APL, AML M3). 2D transthoracic echocardiography showed 2 inhomogeneous highly mobile masses (10×13 and 6×9 mm) in the right ventricle (RV). The masses were attached to the chordae tendineae and exhibited movements compatible with the cardiac cycle. Cardiac magnetic resonance imaging revealed 3 mobile masses in the RV attached to the RV trabeculations with isosignal intensity on steady-state free precession sequence. There was no obvious evidence of mass invasion or necrosis. On the last transesophageal echocardiography (6 months after the initial admission), the mass did not exist anymore. At the time of paper compilation, the patient has no complaints and is in remission. This report underscores the importance of cardiac magnetic resonance imaging in differentiating intracardiac thrombi aggregations of tumoral cells in APL, AML M3. (Iranian Heart Journal 2016; 17(3):46-50)Iranian Heart AssociationIranian Heart Journal17320160901Neonatal Tuberous Sclerosis Complex with Large and Multiple Cardiac Rhabdomyomas515483152ENRamesh Bhat YDepartment of Pediatrics, Kasturba Medical College, Manipal University, Manipal-576104, Udupi District, Karnataka, India.Leslie E LewisDepartment of Pediatrics, Kasturba Medical College, Manipal University, Manipal-576104, Udupi District, Karnataka, India.Jayashree PDepartment of Pediatrics, Kasturba Medical College, Manipal University, Manipal-576104, Udupi District, Karnataka, India.Prakashini KDepartment of Radiodiagnosis and Imaging, Kasturba Medical College, Manipal University, Manipal-576104, Udupi District, Karnataka, IndiaRanjan SDepartment of Cardiology, Kasturba Medical College, Manipal University, Manipal-576104, Udupi District, Karnataka, India.Krishnananda NDepartment of Cardiology, Kasturba Medical College, Manipal University, Manipal-576104, Udupi District, Karnataka, India.Journal Article20190228The tuberous sclerosis complex (TSC) is most commonly diagnosed around the age of 5 years. Neonatal TSC is rare. The important neonatal manifestations include cardiac rhabdomyomas, central nervous system abnormalities, and skin manifestations. We describe a neonate suffering the TSC with large and multiple cardiac rhabdomyomas. The largest rhabdomyoma measured 3.6 cm × 2 cm almost filling the right ventricle. The neonate did not have any symptoms. She continued to remain asymptomatic until 8 months’ follow-up. (Iranian Heart Journal 2016; 17(3):51-54)