Iranian Heart Association Iranian Heart Journal 20 1 2019 01 01 Comparison of the Predictive Power of the CRUSADE, MEHRAN, and ACTION Bleeding Risk Scores in Patients With the Acute Coronary Syndrome 6 14 82647 EN Abbas Andishmand Department of Cardiology, Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, IR Iran. Seyed Ali Sadr Bafghi Department of Cardiology, Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, IR Iran. Seid Kazem Razavi-Ratki Department of Radiology, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, IR Iran. Journal Article 2019 02 12 Background: Various risk scores are used to predict the bleeding risk in patients with the acute coronary syndrome (ACS), including ACTION, CRUSADE, and MEHRAN. The purpose of the present study was to compare the accuracy of these 3 risk scores in the prediction of the bleeding risk in patients with the ACS. Methods: We studied 745 consecutive patients with the ACS undergoing coronary arteriography and calculated the ACTION, CRUSADE, and MEHRAN bleeding risk scores for all the patients. Then, we compared their prediction accuracy for major bleeding events and serious (major or minor) bleeding episodes with C-statistics. Results: The majority of the patients (72.6%) had non–ST-elevation myocardial infarction (NSTEMI), and the others (25.4%) had STEMI. The mean age of the patients was 62.55±12.12 years, and 62.4% were male. Bleeding complications were reported in 141 (18.9%) patients, with the catheterization site being the most frequent site of bleeding. The major bleeding rate was predicted in 29.1%, 28.4%, and 4.8% of the patients according to the CRUSADE, MEHRAN, and ACTION risk scores, respectively. The C-index values (AUC) for the ACTION, MEHRAN, and CRUSADE risk scores were 0.6182, 0.5413, and 0.6185, respectively. Pairwise comparisons between the scores showed no statistically significant differences in the discriminatory power between the ACTION and the CRUSADE (P=0.970); however, the differences between the CRUSADE and the MEHRAN (P=0.051) or between the ACTION and the MEHRAN (P=0.053) were near to significant. Conclusions: The bleeding risk score was predicted accurately by the ACTION, CRUSADE, and MEHRAN risk scores without significant differences among the 3 risk scores in our patients with the ACS undergoing coronary arteriography. These results showed that the predictive power was not excellent in any of the 3 risk scores.

https://journal.iha.org.ir/article_82647_809bb220f4971ff9c6b15eb7ba56299f.pdf

Iranian Heart Association Iranian Heart Journal 20 1 2019 01 01 Association Between 25-Hydroxyvitamin D Levels and the Carotid Intima-Media Thickness 15 19 82648 EN Maryam Shojaeifard Echocardiography Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, IR Iran. Negar Omidi Cardiac Primary Prevention Research Center, Department of Cardiology, School of Medical Sciences, Tehran, IR Iran. Saba Homatash Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, IR Iran. Ali Daryanavard Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, IR Iran. Anahita Esmaeli Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, IR Iran. Hamidreza Rahmanpour Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, IR Iran. Sajad Erami Shahid Sadoughi University of Medical Sciences, Yazd, IR Iran. Hossein Dehghani Mohammad Abadi Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, IR Iran. Journal Article 2019 02 12 Background: There are insufficient data on the association between the serum level of vitamin D and the carotid intima-media thickness (CIMT). The aim of this study was to investigate the association between the level of serum 25-hydroxyvitamin D and the CIMT. Methods: This cross-sectional study recruited 341 patients. The level of 25-hydroxyvitamin D was measured with radioimmunoassay, and the CIMT was measured with color Doppler ultrasound. Results: The mean serum level of 25-hydroxyvitamin D was 14.88±14.63 ng/mL in the patients with asignificant carotid artery involvement and 17.02±13.56 ng/mL in those without a carotid involvement, with the difference between the 2 groups constituting statistical significance (P=0.034). The prevalence rate of vitamin D deficiency in those with and without a carotid involvement was 88.6% and 74.4%; the rate was significantly higher in the former group (P=0.039). Conclusions: Our study confirmed recent suggestions regarding the association between vitamin D deficiency and the progress of atherosclerosis in carotid arteries as CIMT.

https://journal.iha.org.ir/article_82648_be12e7f0f8de169a361afbd150d2ce59.pdf

Iranian Heart Association Iranian Heart Journal 20 1 2019 01 01 Efficacy of Treatment With Carvedilol in Preventing Early-Stage Left Ventricular Dysfunction in Patients With Breast Cancer Candidated to Receive Trastuzumab Using 2D Speckle-Tracking Echocardiography 20 31 82789 EN Maryam Moshkani Farahani Atherosclerosis Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran Saeed Nourian Atherosclerosis Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran Hamed Reza Jalalian School of Medicine, Baqiyatallah University of Medical Sciences, Tehran, IR Iran Arezoo Khosravi Atherosclerosis Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran Mahmmod Salesi Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran Journal Article 2019 02 16 Background: Treatment-induced cardiotoxicity is one of the major side effects of trastuzumab treatment in patients with breast cancer. Left ventricular (LV) dysfunction is the leading cause of treatment-induced cardiotoxicity. The development of treatment-induced cardiotoxicity during cancer treatment may force patients to modify or quit the treatment. In this trial, we evaluated the prophylactic effects of carvedilol on LV dysfunction in patients with breast cancer receiving trastuzumab using 2D speckle-tracking echocardiography (2DSTE). Methods: We conducted an open-label randomized clinical trial and enrolled 71 non-metastatic HER-2 positive patients with breast cancer candidated to receive trastuzumab. Carvedilol was administered concomitantly with the trastuzumab standard regimen at a dosage of 6.25 mg twice a day and up-titrated to the maximum tolerated dosage. The 2DSTE parameters to evaluate the LV systolic and diastolic functions were evaluated initially and 3 months thereafter. Results: Thirty-six patients were randomly assigned to the carvedilol group and 35 patients to the control group. The mean left ventricular ejection fraction (LVEF) was not significantly different either in both groups or between the 2 groups (P=.61) during the follow-up. In contrast, the global longitudinal strain of the LV (GLS) (P=.000) and the strain rate of the LV systolic function (SRS) (P=.004) as markers of the LV systolic function were reduced in the control group. Furthermore, the LV strain rate of the early (SRE) and late (SRA) diastolic functions were preserved in the patients who received prophylactic carvedilol (P=.000 and P=.005, respectively). Conclusions: Concomitant carvedilol treatment with a maximum tolerable dose in patients with nonmetastatic HER2-positive breast cancer under treatment with trastuzumab might be effective on the reduction of systolic and diastolic echocardiographic findings other than the LVEF in patients with weak markers of heart failure.

https://journal.iha.org.ir/article_82789_cd0029c598046aea6254c595842b7ea1.pdf

Iranian Heart Association Iranian Heart Journal 20 1 2019 01 01 Impact of the Anatomical Factors of the Left Anterior Descending Coronary Artery in Patients With Single-Vessel Disease 32 38 82790 EN Amir Hossein Yazdi Department of Cardiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, IR Iran Ehsan Khalilipur Department of Cardiology, Birjand University of Medical Sciences, Birjand, IR Iran Behshad Naghshtabrizi Department of Cardiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, IR Iran Mohammad Khaled Naghshbandi Department of Cardiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, IR Iran Farzaneh Esna-Ashari Department of Epidemiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, IR Iran Journal Article 2019 02 16 Background: Despite the recognition of the common risk factors for coronary artery disease (CAD), it appears that there is a wider range of risk factors. The purpose of the present study was to evaluate the association between the anatomical factors and the increased risk of CAD occurrence and its clinical consequences. Methods: in this study, 50 cases with a single coronary artery stenosis of the left anterior descending artery (LAD) and 50 controls with a normal coronary angiography or non-obstructive CAD were enrolled, and the objective of the study was compared between the 2 groups. Results: The number of the branches before the LAD stenosis significantly increased in the patients with LAD disease, and there was a meaningful increase in the number of both the diagonal and septal branches originating before the stenosis (P<0.001). The average number of the diagonal branches was the same in both groups, which was statistically insignificant. (P=0.986) The mean value of the angle between the largest diagonal branch or septal branch and the LAD in the cases with CAD and the controls showed no significant difference. A family history of the early-onset cardiovascular disease in the control group with non-obstructive CAD was 6% versus 20% in the CAD group, and this difference was statistically significant (P≤0.03). Conclusions: According to our study, it appears that the sum of the septal and diagonal branches of the LAD can be a statistically significant risk factor for the progression of atherosclerosis in the LAD as well. The LAD involvement is significantly associated with the familial type of CAD

https://journal.iha.org.ir/article_82790_43460ad10a789231b34cea114872aaa6.pdf

Iranian Heart Association Iranian Heart Journal 20 1 2019 01 01 Effects of the Preoperative Administration of a Fibrinogen Concentrate on Bleeding and Transfusion Requirements in Cardiac Surgery 39 44 82791 EN Elham Khalaf-Adeli Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, IR Iran Touraj Babaee ajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, IR Iran Behshid Ghadrdoost Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, IR Iran Fereshteh Baghizadeh Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, IR Iran Seyed Mostafa Alavi Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, IR Iran Journal Article 2019 02 16 Background: Contact of blood with the cardiopulmonary bypass (CPB) circuit during cardiac surgery induces acquired multifactorial coagulopathy, which results in an increased risk of bleeding and transfusion requirements. In this study, we investigated the effects of the preoperative administration of fibrinogen concentrates on bleeding and transfusion requirements in cardiac surgery. Methods: Seventy-eight patients scheduled for elective coronary artery bypass graft (CABG) or valvular surgery were included in this clinical trial between March 2017 and November 2017. The patients were randomly assigned to fibrinogen and control groups. In the fibrinogen group, the patients received 2 g of fibrinogen dissolved in 100 mL of normal saline over a 15-minute period 30 minutes after the induction of anesthesia. In the control group, the patients received the same volume of normal saline during the same period of time. The evaluation of the coagulation system was performed via thromboelastometry (Rotem device). Postoperative bleeding was recorded as the overall mediastinal drainage or the other drainage at the surgical site during a 24-hour period after surgery. The volumes of transfused packed red blood cells, fresh frozen plasma (FFP), and platelet concentrates were recorded. Results: The value of Fibtem-MCF did not show any significant difference between the groups (12.4±4 vs 11.7±4 0.46; P=0.46). The mean volume of bleeding was significantly lower in the fibrinogen group than in the control group (168±12 vs 344±37; P=0.001). The mean volume of the platelet concentrate used was significantly lower in the fibrinogen group than in the control group (P<0.05). However, there was no significant difference in terms of RBCs and FFP consumption between the groups. Conclusions: It appears that although preoperative supplementation with fibrinogen has no effect on transfusion with RBCs and FFP, it results in a reduction in postoperative blood loss and platelet concentrate requirement during cardiac surgery.

https://journal.iha.org.ir/article_82791_f15e0ece2e1f26d4384bbb04a6337981.pdf

Iranian Heart Association Iranian Heart Journal 20 1 2019 01 01 Effects of Spironolactone on Cardiovascular Complications in Hemodialysis Patients of Taleghani Hospital During the Period of 2016-2017: A Randomized Double-Blind Controlled Clinical Trial 45 52 82792 EN Seyed Ahmad Reza Ziaee Department of Internal Medicine, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Mersedeh Karvandi Department of Cardiology, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Negar Sadat Ziaee Department of Internal Medicine, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Zohre Gholizadeh Ghozloujeh Clinical Research Development Unit (CRDU) of Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Mohammad Amin Shahrbaf Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Azamolsadat Roshan Department of Nephrology, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Journal Article 2019 02 16 Background: There is recent evidence that aldosterone plays a role in the pathogenesis of cardiovascular diseases in dialysis patients, which leads to the opportunity to block its actions for the benefit of these patients. In non-dialytic chronic kidney diseases, spironolactone was safe and effective in reducing left ventricular hypertrophy. However, its routine use has been precluded in hemodialysis patients due to the risk of hyperkalemia. The aim of the present study was to verify the safety and efficacy of spironolactone in the regression of left ventricular hypertrophy and ejection fraction in hemodialysis patients undergoing pharmacotherapeutic monitoring. Methods: We performed a controlled, randomized, double-blind study evaluating 48 hemodialysis patients divided into 2 groups. The first group received spironolactone at a dose of 25 mg after hemodialysis over a few weeks, and the second group was the control. The patients were followed up for 9 months. Results: Both groups were composed of 24 patients each. The study groups did not differ in their baseline characteristics. The group receiving spironolactone had a significant improvement in the left ventricular mass index and ejection fraction in comparison with the control group (P<0.05). Conclusions: Spironolactone treatment in hemodialysis patients was safe and effective in regressing left ventricular hypertrophy and improving the ejection fraction as major risk factors for cardiovascular events in these patients.

https://journal.iha.org.ir/article_82792_d513a3e175c50d1dbc92fd2656231392.pdf

Iranian Heart Association Iranian Heart Journal 20 1 2019 01 01 Association Between the Initial Total Bilirubin Level and the Clinical Outcome in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary PCI 53 59 82793 EN Seyedeh Samaneh Ahmadi 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 Hooman Bakhshandeh Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, IR Iran Sepideh Jafari Naeini Majid Hajikarimi Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, IR Iran Alireza Hoghooghi Esfahani Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, IR Iran Roya Rezaee Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, IR Iran Alireza Ziaee Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, IR Iran Journal Article 2019 02 16 Background: Clarification is needed as regards the relationship between the total bilirubin level and the outcome of primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). Methods: Between April 2015 and April 2016, consecutive patients with STEMI who underwent primary PCI were prospectively enrolled in a primary PCI registry. The patients’ demographics, initial total bilirubin levels, procedural characteristics, and in-hospital and 6 months’ major adverse cardiac events were assessed. Results: A total of 95 patients who underwent primary PCI were enrolled in the study. The mean bilirubin level was 1.04 mg/dL with a standard deviation of 1.154. We evaluated the relationships between the median of the initial total bilirubin level, the thrombolysis in myocardial infarction (TIMI) flow grade after PCI and following PCI, 6 months’ follow-up complications, the amount of the peak troponin and CK-MB levels, the amount of mitral regurgitation, the ejection fraction, and electrocardiographic changes including ST resolution and the Q-wave formation after primary PCI. Except for the levels of troponin and CK-MB, there were no relationships between the initial total bilirubin level and the other end points. Conclusions: Recent studies have shown that the serum total bilirubin level is independently associated with short-term outcomes in patients with STEMI. We found a direct relationship between the total bilirubin level and the peak levels of troponin and CK-MB after primary PCI. This outcome is consistent with other studies; nonetheless, we found no such relationships vis-à-vis the other end points. This result may be due to our small patient population.

https://journal.iha.org.ir/article_82793_05351c19fa1799429772751a4ea5b337.pdf

Iranian Heart Association Iranian Heart Journal 20 1 2019 01 01 Acute Pulmonary Embolism During the Surgical Removal of a Right-Sided Heart Thrombus 60 63 82794 EN Masoud Tarbiat Clinical Research Development Unit of Farshchian Hospital, Department of Anesthesiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, IR Iran Gholamreza Safarpoor Clinical Research Development Unit of Farshchian Hospital, Department of Cardiac Surgery, School of Medicine, Hamadan University of Medical Sciences, Hamadan, IR Iran Abbas Sedighinejad Anesthesiology Research Center, Guilan University of Medical Sciences (GUMS), Rasht, IR Iran Vali Imantalab Anesthesiology Research Center, Guilan University of Medical Sciences (GUMS), Rasht, IR Iran Journal Article 2019 02 16 The incidence of acute pulmonary thromboembolism is rare during surgery. It could, however, be coincident with a right-sided heart thrombus (RHT). It is mandatory to remove an RHT as soon as possible to avoid death. We report the case of acute pulmonary thromboembolism during the surgical removal of an RHT in a 48-year-old woman with multiple comorbid medical conditions which was treated successfully with surgical embolectomy.

https://journal.iha.org.ir/article_82794_0224b1742c1d26f4b3db9ca0160e8d36.pdf

Iranian Heart Association Iranian Heart Journal 20 1 2019 01 01 Interventional Angioplasty, a Growing Therapeutic Approach to the Superior Vena Cava Obstruction in the Presence of Hemodialysis Catheters: A Report of Two Cases 64 66 82795 EN Ramin Heidari Hypertension Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, IR Iran Behshid Ghadrdoost 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 Journal Article 2019 02 16 Background: The long-term resistance of indwelling hemodialysis catheters leads to the development of the superior vena cava (SVC) syndrome due to the obstruction of the dialysis catheters. The management of these cases needs technically challenging interventional procedures using balloon inflation or stent implantation at the SVC/right atrium junction. Hereby, we report 2 cases of the SVC syndrome in the setting of hemodialysis catheters which were successfully treated via interventional angioplasty. Case Presentation: The first case was a 57-year-old man who was referred to us with facial congestion, gradual loss of consciousness, and fever. The patient underwent emergent hemodialysis. The source of the fever was found to be an infected permacath in the left internal jugular vein. He underwent hemodialysis through a right-sided access catheter. Upon the termination of the fever, the jugular access was exited and an arteriovenous fistula (AVF) was implanted in the right arm. After a while, the patient experienced swelling in the right arm. Finally, he underwent angioplasty on the occluded AVF. On follow-up, the arm swelling had faded gradually. The second case was a 60-year-old man who was referred to us with a diagnosis of under-dialysis. On admission, the patient’s permacath was removed and an AVF was implanted in his right arm to replace a dysfunctional AVF previously inserted in his left arm. After the maturation of the right arm’s AVF, the patient underwent regular hemodialysis sessions without complications. After 1 year, under-dialysis occurred again. On venous angiography, a cut-down venous drainage from the origin of the brachiocephalic vein up to its entry into the right atrium was seen. Conclusions: Interventional angioplasty is a therapeutic approach to the SVC obstruction in the presence of hemodialysis catheters.

https://journal.iha.org.ir/article_82795_e24590de2e6384ac92c0053a8cc31244.pdf

Iranian Heart Association Iranian Heart Journal 20 1 2019 01 01 Transient Bilateral Visual Loss due to Posterior Ischemic Optic Neuropathy After Cardiac Surgery: A Very Rare Case 67 71 82796 EN Nahid Aghdaii Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran Mohsen Ziyaeifard Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran Fatemehshima Hadipoorzadeh Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran Journal Article 2019 02 16 Visual loss is a relatively rare but devastating and unpredictable complication of open heart surgery with cardiopulmonary bypass. The most common cause of postoperative visual loss following cardiac surgery is ischemic optic neuropathy (ION), which is generally categorized as anterior ischemic optic neuropathy (AION) and posterior ischemic optic neuropathy (PION). PION is clinically differentiated from AION with a normal-appearing optic nerve head. PION is relatively more common in cases of spinal surgery and radical neck dissection, while AION appears to be more common than PION after cardiac surgery. We report a very rare case of transient bilateral visual loss due to PION in a 44-yearold man undergoing mitral valve replacement and coronary artery bypass graft surgery.

https://journal.iha.org.ir/article_82796_c3c24a12e5f8075343ee963770b8b07b.pdf