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International Journal of Cardiovascular Practice

ijcp
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Published by Shahid Beheshti University of Medical Sciences

ISSN : 24767174 EISSN : 2476468X DOI : -

Core Subject : Health,

Medicine & Pharmacology

International Journal of Cardiovascular Practice(IJCP) is an international quarterly journal dedicated to a broad spectrum of topics in cardiology. All manuscripts must be prepared in English, and are subject to a rigorous and fair peer-review process. Accepted papers will immediately appear online followed by printed hard copy.

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Articles 198 Documents

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Acute Myocardial Infarction in a Patient With Elevated ST-Segment in aVR Lead and Diffuse ST Segment Depression in Other Leads: A Case Report Safi, Morteza; Khaheshi, Isa; Memaryan, Mehdi
International Journal of Cardiovascular Practice Vol 1, No 1 (2016)
Publisher : International Journal of Cardiovascular Practice

ST elevation in aVR in conjunction with diffuse ST depression in precordial leads may indicate occlusion of very proximal portion of the left anterior descending artery. We present a 54-year old man, with crushing retrosternal pain and ST-segment elevation only in aVR lead and diffuse ST-segment depression in inferior, lateral and precordial leads. The patient was scheduled for emergent coronary angiography, which showed that left anterior descending (LAD) artery was cut off at very proximal portion and urgent CABG was performed for the patient.

Updated Meta-Analysis of Randomized Trials Comparing Safety and Efficacy of Intraoperative Defibrillation Testing with No Defibrillation Testing On Implantable Cardioverter-Defibrillator Implantation Bonanno, Carlo; Rossillo, Antonio; Paccanaro, Mariemma; Ramondo, Angelo; Raviele, Antonio
International Journal of Cardiovascular Practice Vol 2, No 4 (2017)
Publisher : International Journal of Cardiovascular Practice

Introduction: There is an ongoing debate regarding the need to conduct intraoperative defibrillation testing (DFT) at the time of implantable cardioverter-defibrillator (ICD) implantation. To provide sufficiently strong evidence for the feasibility of omitting intraoperative DFT in clinical practice, we conducted a meta-analysis of randomized controlled trials (RCT) comparing patients with DFT and no-DFT.Methods: We systematically searched Medline (via PubMed), ClinicalTrial.gov, the Cochrane Central Register of Controlled Trials, and Embase for studies evaluating DFT vs. no-DFT on ICD implantation with regard to total mortality and arrhythmic death, efficacy of first and any appropriate shock in interrupting ventricular tachycardia (VT)/ventricular fibrillation (VF), and procedural adverse events. Effect estimates [risk ratio (RR) with 95% confidence intervals (CI)] were pooled using the random-effects model.Results: Our meta-analysis included 4 RCTs comprising 3770 patients (1896 with DFT and 1874 without DFT). Total mortality (RR = 1.00, 95% CI 0.86â1.17; P = 0.98) and arrhythmic death (RR = 1.60, 95% CI 0.46-5.59: P = 0.46) were not statistically different. Both first (RR = 0.94, 95% CI 0.89â0.98; P = 0.004) and any appropriate ICD shock (RR = 0.97, 95% CI 0.95â1.00; P = 0.02) significantly increased the rate of VT/VF interruption in the group with no-DFT in comparison with DFT. Finally, the incidence of adverse events was lower in no-DFT patients (RR = 1.23; 95% CI 1.00â1.51; P = 0.05).Conclusions: The practice of DFT (as opposed to no-DFT) did not yield benefits in mortality or the overall rate of conversion of VT/VT. Moreover, a slightly higher incidence of perioperative adverse events was observed in the DFT group.

Low dose radiation exposure and cardiovascular diseases: a review Gao, Ling; Ding, Chun-Yan
International Journal of Cardiovascular Practice Vol 2, No 4 (2017)
Publisher : International Journal of Cardiovascular Practice

ICRP stated that particular attention should be paid to radiation effects in the cardiovascular system because of recent published observations of radiation effects in this systems occurring after much lower doses than reported previously (ICRP, 2007 and 2012). The review was based on scientific articles available in the open literature, major reviews by other organizations, in particular International Commission on Radiation Protection (ICRP, 118). In this review, we describe low-dose ionizing radiation effect, causes of cardiovascular diseases, relationship between low-dose ionizing radiation and cardiovascular diseases, as well as the importance and urgent of elucidate the relationship between low dose ionizing radiation and cardiovascular disease.

Role of Imaging in Left Atrial Appendage Occlusion Lempereur, Mathieu; Aminian, Adel; Dulgheru, Raluca; De Potter, Tom; Oury, CÃƒÂ©cile; Lancellotti, Patrizio
International Journal of Cardiovascular Practice Vol 2, No 2 (2017)
Publisher : International Journal of Cardiovascular Practice

Percutaneous left atrial appendage (LAA) occlusion is now a valid alternative to long-term oral anticoagulation in patients with non-valvular atrial fibrillation at high thrombo-embolism risk, especially for patients who are considered ineligible for anticoagulation. The most frequently used occluders worldwide include the WATCHAMN (Boston Scientific, Natick, MA, USA) and the Amplatzer Cardiac Plug or Amulet (St. Jude Medical/Abbott, St Paul, MN, USA) devices. Multimodality imaging is key in the understanding of 3D aspects of the LAA and surrounding structures anatomy. Imaging is essential for procedural planning, during each step of the procedure and for device surveillance after implantation. Multimodality imaging, including 2D/3D echocardiography, fluoroscopy, and cardiac computed tomography can increase the safety and efficacy of the procedure.

Chronic Total Occlusion-Angioplasty with Antegrade Approach: A two-Year Experience in âModarres Hospitalâ, A Tertiary University Hospital, Tehran, Iran Safi, Morteza; Namazi, Mohammad Hasan; Sadeghi, Hamid; Saadat, Habibollah; Vakili, Hossein; Alipour Parsa, Saeed; Khaheshi, Isa; Ataeinia, Bahar
International Journal of Cardiovascular Practice Vol 1, No 3 (2016)
Publisher : International Journal of Cardiovascular Practice

Introduction: New techniques for the percutaneous treatment of coronary chronic total occlusions (CTO) have had a high success rate since a few years ago, so the interest for this treatment has been increasing these days.Methods: The current observational study was performed in Modarres hospital as a tertiary referral center. All the patients with documented stable angina who had failed to response to full guideline-mediated medical therapy, referred to our hospital, were candidates for coronary angiography. Antegrade strategy was applied for all these patients. The length of the lesion, the fluoroscopy time of the CTO angioplasty, consumed contrast volume, the number of guide wires used, whether a corsair or tornus micro-catheter was used or not, and the success rate of the angioplasty were documented for further analysis.Results: A total of 47 patients with documented stable angina were finally included. The median age was 59 (45-78) and 70.2% were male. The mean length of the lesion was 34.0 Â± 1.1 .The mean fluoroscopy time and contrast volume were 57.9 Â± 3.2 minutes and 525.9 Â± 20.9 mL, respectively. In average, 2.2 guide wires were used. Corsair and tornus micro-catheters were applied in 30 (63.8%) and 5 (10.6%) of the cases, respectively. Seven complications (all including coronary dissection) occurred. In-hospital major adverse cardiac events (MACE) rate was 10.6%, all of which were non-Q wave myocardial infarction. The success rate was 85.1%. The higher number of used wires, use of corsair, and tornus micro-catheter were not significantly concordant with success rate (P-value > 0.05); in addition, longer lesion was not concordant with unsuccessfulness rate (P-value > 0.05).Conclusions: Patient selection for CTO-angioplasty should be performed more carefully. Patientsâ quality of life and risk of probable procedural complications and future cardiac events should be assessed to decide the best treatment approach. Radiation exposure, contrast consumption and fluoroscopy time are recommended to be monitored during the procedure and thresholds should be defined to enhance safety and efficacy.

His Bundle Extrasystole or A Dual Atrioventricular Nodal Response Akbarzadeh, Mohammad Ali
International Journal of Cardiovascular Practice Vol 3, No 1 (2018)
Publisher : International Journal of Cardiovascular Practice

A dual atrioventricular (AV) nodal response and His bundle extrasystole cannot be different in many cases with certainty. We present a 31-year-old man with episodes of palpitation and conducted and non-conducted His bundle extrasystole detected during an electrophysiology study.

Reviewing EKGs in Thalassemia Patients to Evaluate Their Cardiac Function Bagheri, Abdolhamid; Karimi, Mitra; Afradi, Hojat; Hadipour Dehshal, Mahmoud
International Journal of Cardiovascular Practice Vol 1, No 1 (2016)
Publisher : International Journal of Cardiovascular Practice

Introduction: There are more than 18000 thalassemia patients in Iran. In a current study, a high rate of mortality in these patients due to heart failure, is shown. Main factors for evaluating this disorder in thalassemia patients were their electrocardiograms (EKGs) and Serum Ferritin Levels (SFLs).Methods: We studied the cardiac function in 91 patients (73 major and 18 intermediate thalassemia patients) treated in Zafar Thalassemia Center, of whom 35 (38.45%) were male and 56 (61.55%) were female. The Factors in this study contains: EKGs, mean annual serum ferritin (at least, three SFL had been recorded in each patient treatment file in 2009), mean annual hemoglobin (Hb) levels and mean annual hematocrit (Hct) levels (average, 12 recorded hematocrit levels during 2009).Results: Our findings have shown that Q-T interval did not correlate with ferritin (r = 0.05, P > 0.05). In both patients with LVH and without LVH, there was no significant difference in SFL (P > 0.05). Although, the mean rate among the thalassemia patients was 85.34 Â± 12.91, it did not correlate significantly with QRS duration and P-R Interval (r = -0.08, P > 0.05). In addition, ferritin did not correlate significantly with QRS duration and P-R Interval (r = 0.1, r = 0.05 and P > 0.05, P > 0.05). Furthermore, there was no difference in SFL in patients with normal cardiac axis and those with cardiac axis deviation.Conclusion: There is no correlation between SFL and variations in EKG. Although EKG is an available method for checking cardiac function in thalassemic patients, especially in developing countries, physicians cannot rely on it for diagnosis or prognosis of cardiac failure in thalassemia patients. Therefore, other methods such as MRIT2* and Echocardiography are suggested to be used periodically in order to check the cardiac function in thalassemia patients.

Double Orifice Fissured Subaortic Membrane in the Adult Zampi, Giordano; Cottini, Marzia; Pergolini, Amedeo; Polizzi, Vincenzo; Musumeci, Francesco
International Journal of Cardiovascular Practice Vol 2, No 1 (2017)
Publisher : International Journal of Cardiovascular Practice

Left ventricle outflow tract obstruction is a relatively common form of congenital heart disease, occurring in 2.8 out of 10,000 live births and accounts for 3-6% of congenital heart diseases. Subvalvular aortic stenosis can be either a fixed stenosis resulting from subaortic membrane or a dynamic stenosis because of hypertrophic cardiomyopathy. We described an original and rare image of double orifice fissured subaortic membrane in the adult.

One- and Six-month Outcomes of Patients with Non-ST Elevation Myocardial Infarction Vakili, Hossein; Sadeghi, Roxana; Toofaninejad, Neda; Akbari, Tooba; Kachoueian, Naser
International Journal of Cardiovascular Practice Vol 1, No 3 (2016)
Publisher : International Journal of Cardiovascular Practice

Introduction: Use of risk scoring systems in patients with acute coronary syndrome helps with summarizing important prognostic data of the disease and facilitates calculating confidence limits and comparing survival rates between different treatments. In the present study, the researchers first aimed at assessing mid-term outcome of patients with non-ST elevation myocardial infarction (NSTEMI), and then determining main predictors of this outcome to improve definitive criteria for designing a risk scoring system in the population.Methods: In a prospective cohort study, 124 patients with NSTEMI, diagnosed according to ACC/AHA guidelines and hospitalized in an academic hospital in 2013, were consecutively assessed. Baseline characteristics were collected via interviewing, physical examination, and reviewing the recorded files. All the patients were followed for one and six months to assess mid-term outcomes regarding mortality and major adverse cardiac events (MACE). MACE is defined as the occurrence of at least one of the events of death, myocardial infarction, repeated revascularization, or re-hospitalization.Results: One-month death occurred in 3.2%, re-hospitalization in 4.0%, and myocardial infarction in none of the patients. In addition, regarding the six-month outcomes status, mortality rate was determined in 6.4%, re-hospitalization in 22.6%, and myocardial infarction in 4.8% of patients. Hence, one- and six-month MACE rates were 7.3% and 27.4%, respectively. Furthermore, three- and six-month survival rates were estimated to be 96.8% and 93.6%, respectively. According to the Cox-proportion hazard modeling, only reduced left ventricular ejection fraction (LVEF) (HR = 0.909, P = 0.017), history of chronic kidney injury (HR = 8.884, P = 0.005), and Inotrope use (HR = 35.759, P = 0.012) could predict the six-month MACE. None of the other indexes including general coronary risk factors, echocardiography parameters, and level of cardiac enzymes could predict mortality rate.Conclusions: Patients with NSTEMI may face high six-month MACE which can be predicted by low LVEF, history of renal injury and use of inotrope. Therefore, to define risk stratification system, these indicators should be considered as well.

Predictive Implications of Serum Lipid Metabolism over Time in Intensive Care Unit Admitted Patients Motafaker Azad, Mehdi; Abbasi, Mohammad Amin; Basharzad, Niloofar; Fadaei, Abbas
International Journal of Cardiovascular Practice Vol 3, No 2 (2018)
Publisher : International Journal of Cardiovascular Practice

Introduction: Serum lipoprotein levels change during hospitalization and effect patientâs outcome in case of sepsis. The aim of this study was to investigate the prognostic values of the serum levels of lipids in Intensive Care Unit (ICU) admitted patients.Methods: Intensive Care Unit admitted patients with various etiologies were enrolled in this study. Serum lipid level was collected on the first and seventh day of admission. Clinical outcome and baseline characteristics, including age, gender, cause of admission, length of ICU stay, and discharge or death were monitored prospectively in a short cohort.Results: A total of 108 patients were enrolled in this study. The overall mortality rate was 45%. The average duration of hospitalization at the ICU was significantly lengthier in the un-survived group. Lipid profile had a similar pattern in both genders. Triglyceride level seemed to increase from Day one to Day seven. These changes were observed in both unsurvived and survived group and were not significantly different. A considerable decline of 24% in High Density Lipoprotein (HDL) was detected among unsurvived patients. The mean value of TG on day seven among unsurvived patients was significantly higher than that of the survived group. Receiver Operating Characteristic (ROC) curve illustrated the higher diagnostic ability of HDL level in comparison with other parameters. On day seven, serum HDL cutoff value of 32 (sensitivity 75%; specificity 60%) was observed for predicting the mortality.Conclusions: Cholesterol is essential for integrity as well as the function of the cell membrane, therefore, dyslipidemia occurring during hospitalization may negatively influence the outcome. Consequently, changes in lipid profile could be a prognostic biomarker for predicting mortality in ICU-admitted patients.

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