Iranian Heart AssociationIranian Heart Journal11120100301IN-HOSPITAL COURSE OF EARLY INVASIVE STRATEGY IN ACUTE CORONARY SYNDROMES6983679ENH.ABASSIRIA.FIROOZIDEPARTMENT OF CARDIOVASCULAR MEDICINE, SHAHEED RAJAIE CARDIOVASCULAR MEDICAL AND RESEARCH CENTER, TEHRAN, IRANS.ABDIH.R.SANATIM.MAADANIF.SHAKERIANN.SALEHIF.NOOHIM.A.ALIANA.AMIRPOURJournal Article20190305Background: Unstable angina is emerging as a major public health problem worldwide. Two approaches - an early invasive strategy or a conservative strategy - are used for the management of non-ST elevation acute coronary syndrome (NSTE-ACS). An early invasive strategy involves the use of early coronary angiography and revascularization with percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG). A conservative strategy involves initial treatment with aggressive pharmacologic treatment, and coronary angiography with revascularization is used if there is evidence of spontaneous or provoked ischemia within the hospital stay.<br />Method: Two hundred sixty-one patients with acute coronary syndrome were enrolled in this study for early invasive strategy. Patients received aspirin, heparin, clopidogrel, and lipid-lowering therapy. The primary endpoint was a composite of death, non-fatal myocardial infarction, cerebrovascular accident, and recurrent chest pain.<br />Angiograms were assessed qualitatively by two expert invasive cardiologists.<br />Results: Sixty-seven percent of the patients underwent percutaneous (33%) or surgical (34%) revascularization. The overall death rate was 1.1%. In-hospital major adverse cardiac event (MACE) rate was 3.2% in the revascularization groups. According to the favorable in-hospital course in patients referred for PCI or CABG, it seems that accurate selection of patients who may be candidates for early invasive strategies is of paramount importance. We found that diabetes, cardiac enzyme elevations (Troponin T), ST/T changes, and the presence of two or more risk factors besides diabetes are powerful predictors of the patients who will undergo revascularization.<br />Conclusion: Proper selection of patients admitted with ACS for invasive strategy is warranted. Positive cardiac enzymes (Troponin T), diabetes mellitus, and presence of two or more major CAD risk factors are helpful for patient selection.https://journal.iha.org.ir/article_83679_7a2b2df1e4ee0e4e9a8d6ca834c586fc.pdfIranian Heart AssociationIranian Heart Journal11120100301HYPERTENSION AWARENESS, TREATMENT, CONTROL AND PREVALENCE IN ZANJAN PROVINCE, IRAN101683665ENSeyed AmirKassaeiZanjanMetabolic Research Center, Zanjan, Iran.MajidValizadehAssistant Professors at Zanjan University of Medical
Sciences, Zanjan, Iran.SaeidehMazloomzadehAssistant Professors at Zanjan University of Medical
Sciences, Zanjan, Iran.SepidehSokhanvarAssistant Professors at Zanjan University of Medical
Sciences, Zanjan, Iran.RezaHasanzadeh MakoieAssistant Professors at Zanjan University of Medical
Sciences, Zanjan, Iran.Journal Article20190305Background: Hypertension is a frequent and treatable risk factor for cardiovascular, cerebrovascular, renal and peripheral arterial disease. There are simple criteria for its diagnosis and no expensive equipment is needed. This article aims to determine how many hypertensive subjects are aware of their disease, how many of them actually treat it, what they utilize to treat it, and finally how many complete treatments successfully.<br />Method: A cross-sectional descriptive study was conducted on 1000 people in Zanjan Province in 2007. Random stratified cluster sampling based on postal code was used to enroll people aged between 15 to 67 years old. Their blood pressures were measured three times by automated device in the sitting position from the right arm at home. Hypertension was defined as recorded blood pressure above 140/90mmHg or taking anti-hypertensive medications.<br />Results: Two hundred seventy-eight (27.8%) hypertensive patients were detected in our sample. The prevalence of hypertension after age adjustment was 18.7% (95% CI, 16.1% - 21.3%) in Zanjan. Only 101 (36.3%) patients were aware of their disease, 38 (13.6%) of all hypertensives took medication, and the blood pressures of only 6 (2.1%) of all hypertensives were controlled.70 (25.1%) used non-pharmacologic treatment and 27 (9.7%) used traditional medications.<br />Conclusion: The potential for both better detection and treatment would appear to be huge in our region. Implementation of health care systems for this purpose is needed.https://journal.iha.org.ir/article_83665_5ce1f5bbd7130e1bf26966b6143a3976.pdfIranian Heart AssociationIranian Heart Journal11120100301EVALUATION OF EFFICACY AND COMPLICATIONS OF N-ACETYLGLUCOSAMINE FOR HEMOSTASIS OF FEMORAL ARTERIAL CATHETERIZATION WOUNDS172383667ENH. A.BassiriM.MaddaniDEPARTMENT MEDICAL AND RESEARCH CENTER, TEHRAN, IRAND.SAEDJournal Article20190305Background: Reports to the FDA of local vascular complications associated with the use of hemostasis devices following cardiac catheterizations and resulting in serious injuries have raised concerns about the safety of these devices. A review of the medical literature also has posed cause for concern. We performed this study to assess the efficacy and risks of local adverse events in hemostasis following cardiac catheterization with N-Acetylglucosamine facilitated manual compression versus manual compression alone.<br />Methods: N-Acetylglucosamine was used for hemostasis in 205 patients who underwent diagnostic cardiac catheterization performed via femoral access at a single site. Another 205 patients underwent diagnostic cardiac catheterization and received routine manual compression and served as the control group. Ambulation was permitted 12 hours after manual compression and 6 hours after using N-Acetylglucosamine. Poisson regression analysis using four different outcomes was used to assess the risk associated with the type of hemostasis, while controlling for confounding variables.<br />Results: Overall, the unadjusted incidence of any vascular complication was 4.8% for the manual compression and 5.4% for the N-Acetylglucosamine group. No serious adverse events were seen in this study.<br />Conclusions: N-Acetylglucosamine does not appear to pose a greater risk for local vascular complications following cardiac catheterization than the manual compression method. This method permitted early ambulation and was as safe as manual compression.https://journal.iha.org.ir/article_83667_4ad754212aca5c6f4df8912c7e8b781c.pdfIranian Heart AssociationIranian Heart Journal11120100301CORRELATION BETWEEN BLOOD LEVELS OF ADHESION MOLECULES ICAM-1 AND VCAM-1 AND THROMBOMODULIN WITH CORONARY ARTERY DISEASE232983669ENNozarGivtajAssociate Professor of Immunology Shaheed Rajaie Cardiovascular CenterH. A.BassiriAssociate Professor of Cardiology Shaheed Rajaie
Cardiovascular Center.NaderGivtajAssociate Professor of Cardiac Surgery Shaheed Rajaie Cardiovascular CenterB.V. BehnamG.P. Behsan Teb Azma
Company.Journal Article20190305Background: The results of studies on coronary artery disease risk factors have demonstrated that some adhesion molecules could be risk factors for coronary artery disease. ICAM-1 and VCAM-1 are the most important adhesion molecules. On the other hand, thrombomodulin is an anti inflammatory factor and can reduce the risk of coronary artery disease. In this study, as well as evaluating these factors, we also studied the effect of the interaction between these factors on coronary artery disease.<br />Methods: One hundred twenty-three patients between the ages of 45 and 70 years old who were admitted for coronary angiography in the cardiovascular center and met the inclusion criteria for the research, were selected in the first half of 2008. After recording their personal information and medical history in the questionnaires, blood samples were collected and after routine examination, the blood levels of these factors were measured. We then entered the acquired results of the blood examination and the angiography in the patient’s charts and analyzed the results using statistical methods.<br />Results: The angiography results in patients showed that 18 (14.7%) had normal coronary arteries, 5 (4%) had minimal coronary artery disease, 40 (32.5%) had single-vessel disease, 25 (20.3%) had two-vessel disease, and 35 (28.5%) had three-vessel disease. In laboratory tests, the mean soluble ICAM-1 level in patients with normal coronary arteries was 236 ngr/mL; 1 however, in patients with coronary artery disease, the mean level was 275 ngr/mL. The average amount of VCAM-1 in patients with normal coronary arteries was 697 ngr/mL, whereas patients with coronary artery disease had an average of 108 ngr/mL. Thrombomodulin in the normal coronary artery group was 42 ngr/mL, but in patients with coronary artery disease the average level was 30 ngr/mL.<br />Conclusion: The results in this research showed that increased levels of soluble ICAM-1 and also decreased levels of soluble thrombomodulin increased the risk and intensity of coronary artery disease, with statistical significance. The increase in soluble VCMA-1 also increased the risk of coronary artery disease; this was, however, not statistically significant. The important point is that increased levels of soluble ICAM-1 is a risk factor when the level of thrombomodulin is normal or below normal. When the levels of thrombomodulin and ICAM-1 have both increased, the increased risk and intensity of coronary artery disease is not statistically important.https://journal.iha.org.ir/article_83669_cc617957758640b1e9c944eadb83f95c.pdfIranian Heart AssociationIranian Heart Journal11120100301PROSTHETIC PULMONARY VALVE MALFUNCTION (CASE REOIRT)303383672ENHassanRiahiDEPARTMENT OF CARDIOVASCULAR MEDICINE, SHAHEED RAJAIE CARDIOVASCULAR MEDICAL AND RESEARCH CENTER, VALI ASR ST, MELLAT PARK, TEHRAN, IRANMajidMalekiMaryamEsmaeilzadehMozhganParsaeeAssistant Professor of Cardiology
From Shaheed Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IranJournal Article20190305Prosthetic heart valve thrombosis is a serious complication in which systemic thrombolysis has emerged as a suitable alternative to surgery, especially for right-sided prosthetic valve thrombosis.<br />We report here the case of a thrombosed Carbomedics Medical prosthetic valve placed in the pulmonary position, in a patient who had undergone total repair of tetralogy of Fallot, which was successfully treated with intravenous thrombolytic therapy with streptokinase.https://journal.iha.org.ir/article_83672_3cc8eccaf0d86c2b347f8c02b2d772bc.pdfIranian Heart AssociationIranian Heart Journal11120100301FUNGAL ENDOCARDITIS: REVIEW OF OUR CASES OVER A FOUR-YEAR PERIOD333783675ENKambizMozaffariSURGICAL PATHOLOGY LABORATORY, SHAHEED RAJAIE CARDIOVASCULAR MEDICAL AND RESEARCH CENTER, MELLAT PARK, VALI AS RAVE. PARK, VALI ASR AVEMEHDIPEIGHAMBARI MOHAMMADRAMINBAGHAEINADERGIVTAJSAEIDHOSSEINIMOZHGANPARSAEEMARYAMESMAEILZADEHJournal Article20190305Over a 4-year period, we studied six cases of fungal endocarditis, four of which were caused by Aspergillus sp. and the other two were candidal in origin. Both sides of the heart showed involvement by these infections. The vegetations of infective endocarditis tend to vary in size, but fungal lesions are often large. Our youngest patient was four months old and the oldest one was 62 years old. A high index of clinical suspicion, together with histopathological and microbiological studies, can be used as tools to diagnose and treat such patients in due course. It is important to send fresh specimens for tissue culture studies in sterile normal saline and not in fixatives such as formaldehyde.<br />Pathologically, not only are the special staining methods such as Periodic acid-Schiff useful in the demonstration of fungal elements in tissue or vegetation sections, but also the routine hematoxylin and eosin stain is capable of showing these structures clearly.https://journal.iha.org.ir/article_83675_47d361b88c20b4310795d98331be0b38.pdfIranian Heart AssociationIranian Heart Journal11120100301POST-SURGICAL RIGHT VENTRICULAR PSEUDOANEURYSM PRESENTING AS AN EPIGASTRIC PULSATILE MASS384083678ENANITASADEGHPOURSHAHEED RAJAIE CARDIOVASCULAR MEDICAL AND RESEARCH CENTER, IRAN UNIVERSITY OF MEDICAL SCIENCES, VALI ASR (A.S.) AVENUE, MELLAT PARK, TEHRAN, IRANAZADEHSADATNASERISAEIDHOSSEINIMARIASAADATIANNILOOFARSAMIEIMARYAM,ESMAILZADEHMAHSHID,OJAGHIMAJIDMALEKIFERIDOUNNOOHIAHMADMOHEBBIJournal Article20190305We report a case of right ventricular pseudoaneurysm three weeks after open mitral valve commissurotomy.<br />Transthoracic echocardiography showed a cavity of approximately 5x3 cm contiguous to the right ventricular inflow, communicating with the right ventricle by a small neck. Doppler study showed the presence of systolic and diastolic flow at the site of the rupture. Pseudoaneurysm is an infrequent surgical complication involving right ventriculotomy and often increases progressively in size. The association with open mitral valve commissurotomy has not been previously reported.https://journal.iha.org.ir/article_83678_8c5112602ffc130b03d0ddf3431d0d61.pdf