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Does opium have benefit for coronary artery disease? A systematic review
Tolou Hasandokht, Arsalan Salari, Soheil Soltani Pour, Heidar Dadkhah Tirani, Bijan Shad, Elyas Rajabi
April-June 2018, 7(2):51-58
Opium is a plant with euphoria effect. People from some parts of the world traditionally use opium for cardioprotective effects. We did a systematic review to assess the effect of opium on coronary artery disease (CAD). A systematic database search was conducted in PubMed, Web of Science, Google Scholar, Cochrane library, Scopus, and SID from their onset up to June 2016. The quality of the studies was assessed with a standardized scoring system. Articles assessing the effect of opium consumption as orally or smoked were included in this review. Outcome was defined as age on CAD disease, risk of CAD, and morbidity from CAD. Poor methodological studies, animal studies, and studies on cardiovascular risk factors or serum markers were excluded from the review. Three case–control, three cohort, and eight cross-sectional studies were included in this systematic review. The age at the occurrence of myocardial infarction, coronary bypass surgery, and percutaneous intervention in opium users was signifi cantly lower than that of nonusers. Odds ratio of opium consumption for CAD ranged from 1.3 to 3.8 in different studies. Hazard ratio of opium consumption for ischemic heart disease was 1.90 (1.57–2.29) with modification by sex, ethnicity, education level, marital status, residential place, and cigarette smoking. We concluded, in spite of the traditional belief, that the current evidence did not support the protective effect of opium on CAD. Future well-designed studies concerning probable confounders in Iran and other similar parts of world are required.
  19,329 572 8
Acute Complications in Cardiac Electrophysiology Procedures: A Prospective Study in a High-volume Tertiary Heart Center
Ali Vasheghani-Farahani, Akbar Shafiee, Mohammadali Akbarzadeh, Negar Bahrololoumi-Bafruee, Abolfath Alizadeh-Diz, Zahra Emkanjoo, Amirfarjam Fazelifar, Hooman Bakhshandeh, Majid Haghjoo
January-March 2018, 7(1):20-25
Background: Several complications can occur during electrophysiology (EP) study and radiofrequency catheter ablation (RFCA). In this study, we aimed to determine the frequency and types of complications following EP study and RF ablation in a tertiary cardiovascular center. Methods: Between September 2012 and December 2012, patients undergoing RF ablation and EP studies were prospectively enrolled. Demographic and clinical data of the patients, as well as the underlying arrhythmia and indication for EP study, were recorded. Complications occurring during the procedure and admission period were documented. Results: A total of 382 procedures were performed in 357 patients with the mean age of 47 ± 18 years within the study period. The most common arrhythmia was atrioventricular nodal reentrant tachycardia (26.4%). Major complication happened in 10 (2.6%) procedures while minor complications occurred in 36 (9.4%) procedures. Tamponade was the most common major complication (n = 3 [0.7%]), and pericardial effusion was the most common minor complication (n = 19 [4.9%]). Patients with complication were significantly younger and had a lower ejection fraction (P = 0.003 and P = 0.02, respectively). Conclusion: The complications observed in this study are comparable to previous reports, and EP study and RFCA can be considered as safe procedures.
  9,586 550 -
Black Pleural Effusion
Surya S Palakuru, Praveen Vijhani, Sujith V Cherian
January-March 2018, 7(1):1-4
Pleural effusions are common in clinical practice. In general, the diagnostic approach starts with thoracentesis. Serous (yellow) and blood tinged (reddish) pleural effusions are the most common types of pleural fluid at thoracentesis. Black colored pleural effusions are an extremely rare entity and knowledge regarding this entity is limited to case reports. A thorough systemic search on PubMed database was done looking at all reported cases of black pleural effusion. Broadly, dividing black pleural effusion based on etiology, the causes are as follows: (1) infectious – especially fungal – Aspergillus niger, Rhizopus oryzae, (2) malignancy -metastatic melanoma and primary lung cancers, (3) pancreaticopleural fistula, and (4) miscellaneous causes-including crack cocaine use, rheumatoid pleurisy, and charcoal containing empyema. Treatment of these effusions involves treatment of the underlying cause. Black pleural effusions are very rare entities with a limited differential, which the treating clinician should consider when encountered in clinical practice.
  7,918 423 4
The Effect of Negative Pressure Applied on Chest Tubes in the Amount of Pleural Effusions in Postcoronary Artery Bypass Grafting Patients
Ali Sadeghpour Tabaie, Rasoul Azarfarin, Bahador Baharestani, Shariar Mali, Sepehr Sadeghpour Tabaei
January-March 2018, 7(1):10-14
Background: Application of negative pressure on chest tubes is one of the most common methods for management of chest tubes drainage after cardio-thoracic surgeries. However, the effect of this measure on long-term outcome of these patients and especially on postoperative pleural effusions is not thoroughly evaluated. For this reason, we designed a clinical randomized trial for the evaluation of the effect of negative pressure application on early and late pleural effusions after coronary artery bypass grafting (CABG) operations. Methods: A total of 440 patients entered in this study and divided into two groups: 220 patients, their chest tubes managed by application of −10–−20 cmH2O negative pressure (negative pressure drainage group) and those who managed conventionally by simple under-water seal method (control group, n = 220). Evaluation for pleural effusion performed by signs and symptoms and chest X-rays at 3rd and 7th postoperative days and for those became symptomatic after 30th day of operation. Results: The occurrence of moderate and massive effusions at 3rd and 7th days after operation was the same in both groups. The most striking difference was in patients' required pleural tap or chest tube insertion, late after surgery due to pleural effusion. This was significantly more common in patients in control group (P < 0.001). Conclusion: Negative pressure application on chest tubes after CABG surgery is a safe and effective method for decreasing the occurrence of late pleural effusion.
  6,853 394 -
Immediate effect of yogic postures on autonomic neural responses
Anup De, Samiran Mondal
October-December 2019, 8(4):106-113
Aim: The aim of this study is to identify the autonomic responses after immediate yogasana practices. Materials and Methods: Ten male (n = 10) yoga practitioners having more than 8 years of experience in yogasana practice were selected as subjects. Before and after immediate practices of six specific yoga postures were assessed on three different consecutive days for 15 min, 22.5 min, and 30 min. Heart rate variability (HRV) low frequency, HRV high frequency (HF), HRV amplitude, galvanic skin resistance (GSR), and blood volume pulse were assessed under the condition of autonomic neural activity and measured using NeXus-10 device. Results: Findings of the data generalized increasing of GSR (47.93% and 14.40%) and HF HRV (7.74% and 6.69%) and decreasing of low-frequency HRV (5.43% and 5%) immediately after 15 min and 22.5 min practice of yogasana, which indicates parasympathetic (vagal) activation. However, in the case of 30-min yoga practice, it decreased the GSR (11.03%) and HF HRV (2.59%), increased low-frequency HRV (2.23%) which, in turn, indicates the sympathetic activation. Discussion: The possible mechanism of vagal activation is an increase of baroreceptor sensitivity, tissue oxygenation, nervous system metabolism, and activation of vasodilation. It may be attributed to the activation of the head ganglion of the autonomic nervous system and inhibition of the posterior hypothalamic area. The sympathetic activation depends on the release of epinephrine and norepinephrine hormones, activation of vasomotor center, central neural integration, and peripheral inhibitory/excitatory reflex mechanisms. Conclusions: Immediate yogasana practices may enhance the parasympathetic (vagal) dominance, which increases autonomic flexibility and associates with a calm mental state.
  6,223 601 5
Pulse oximetry screening of neonates for congenital heart disease
NB Mathur, Surendra Bahadur Mathur
October-December 2017, 6(4):1-7
We tried to discuss the impact of early diagnosis on outcome of critical congenital heart diseases (CCHDs), current options, and their limitations in timely diagnosis, utility of pulse oximetry screening (POS), current recommendations for screening and challenges in resource constrained countries and to suggest further avenues to cover existing gaps. Evidence acquisition process was performed on the PubMed database and Google scholar for every available article in peer reviewed journals. Prevalence of congenital heart disease (CHD) at birth is estimated to be 8/1,000 live births. About 25% of CHDs are life threatening CCHDs. The current guidelines for POS recommend that all neonates in well newborn nurseries should preferably be screened after 24 h of life. A screen is taken to be positive, “out of range” or a fail if oxygen saturation is (i) <90%, (ii) <95% in right hand and one foot after three measurements (each taken 1 h apart), or iii) difference of >3% in preductal and postductal saturations after three measurements (each separated by 1 h). POS has a specificity of 99.9% for the detection of CCHDs. It has a false positive rate of 0.05% for the same. It is estimated that POS may be able to detect nearly 50%–70% of infants born with undiagnosed CCHDss. Opportunity and feasibility for POS is higher in the sick nursery even in the resource constrained setting where most of the well nurseries may not have availability of pulse oximeter, echocardiography and neonatal cardiothoracic surgery services. CCHDs can be detected early using POS which is a convenient, noninvasive and cost effective method. All necessary criteria required for inclusion to universal newborn screening panel are fulfilled by POS. The current POS guidelines are for asymptomatic newborns in well newborn nurseries. Evidence based guidelines are still lacking for screening infants in neonatal intensive care settings. We also propose here a protocol for POS in the neonatal Intensive Care Unit.
  5,338 569 1
Clinical results of combined amiodarone and mexiletine therapy in refractory ventricular tachycardias
Shabnam Madadi, Mehdi Nemati, Amirfarjam Fazelifar, Farzad Kamali, Majid Haghjoo
January-March 2019, 8(1):11-13
Background: Refractory recurrent ventricular tachycardia is a difficult therapeutic problem. There are implantable cardioverter-defibrillator (ICD) patients with amiodarone-refractory of ventricular arrhythmia (VA) who are not eligible for catheter ablation. The aim of this cohort study was to assess the efficacy of mexiletine in combination with amiodarone in the reduction of VA in this group of patients. Methods: This was a retrospective study of all consecutive ICD patients who were treated by adding mexiletine to amiodarone in refractory electrical storm or frequent VA episodes. The enrolled patients were ineligible for catheter ablation. Results: Thirty-seven patients (32 males; mean age, 57 ± 14 years; range, 26–81 years) were studied. Adding mexiletine to amiodarone had no significant effect on QRS width, QTc interval, and PR interval (all P > 0.05). We observed a significant decrease in the number of total ICD shock and significant increase in appropriate antitachycardia pacing during follow-up after initiating mexiletine. Mexiletine therapy also significantly reduced the amiodarone dose during the follow-up. No mortality was observed in the present cohort during the study period. Conclusions: Mexiletine, when added in case of amiodarone failure, reduces VA episodes and appropriate therapies in patients with an implantable cardioverter defibrillator.
  5,320 358 -
The relationship between health literacy and knowledge about heart failure with recurrent admission of heart failure patients
Rezvan Razazi, Jaleh Mohammad Aliha, Ahmad Amin, Sepideh Taghavi, Behshid Ghadrdoost, Nasim Naderi
July-September 2018, 7(3):123-129
Introduction: Having good health literacy can improve quality of life and decrease re-hospitalization of the patients including patients with heart failure (HF). Considering the importance of knowledge about HF and health literacy in these patients and the existence of contradictory texts, this study aimed to determine the relationship between health literacy and knowledge of HF, with re-admission of HF patients. Methods: The present study was a cross-sectional study in which 238 patients aged over 18 years old with an ejection fraction of 35% and less with the ability to read, write, and speak, and no psychological, neurological and cognitive disorders were included in the study after they signed the consent form of the research. Data collection was done through demographic information questionnaire, Short-Test of Functional Health Literacy in Adult-16 standard health literacy questionnaire, and Van Der Wal knowledge about HF questionnaire (2005). Both questionnaires were validated and their reliability was investigated before starting the study. The Chi-square test, Fisher's exact test, or the Mann–Whitney tests were used to compare variables. Results: Most of the patients were male (66%) and married (80%). The results showed that the majority of study population had proper health literacy and about half of them had enough information about HF. This study showed that there is a significant relationship between health literacy and knowledge. In other words, the higher the health literacy of the people, the greater their awareness of their illness (P = 0.02). However, the findings showed that there is no significant relationship between health literacy and awareness of HF with the number of admissions. Conclusion: The results of this study show that the higher the health literacy of the people may lead to the higher their knowledge and awareness about HF and better understanding the recommendations regarding their illness.
  5,107 503 3
Preoperative predictors of postoperative aspiration risk after cardiac surgery
B Jason Bowles, Jo Puntil-Sheltman, Dallas Mullins, Katie M Craig, Jose Benuzillo
October-December 2017, 6(4):24-28
Background: Aspiration is a common complication among hospitalized patients, and patients undergoing cardiac surgery are at increased risk. Our aim was to determine if screening for frailty could identify patients at risk for aspiration. Patients and Methods: A prospective cohort study of patients 65 and older undergoing nonemergent heart surgery at a single community hospital for 1 year was performed. All patients were screened for frailty before surgery using the 5-m walk test. All patients were screened for aspiration before and after surgery using 90-mL water swallow challenge protocol. Preoperative risk factors and postoperative outcomes were analyzed. Results: Of 166 patients studied, 16 (9.6%) were considered frail. Eleven patients (6.6%) failed the swallow screen preoperatively, and 34 patients (20.5%) failed postoperatively. Frail patients were 3.4 times more likely to fail the postoperative swallow screen than their nonfrail counterparts (odds ratio [OR] = 3.36; 95% confidence interval [CI]: 1.42–7.96; P = 0.01). After adjusting for age, comorbidities, and surgical factors, the likelihood of aspiration risk was still three times higher in frail patients (OR = 3.01; 95% CI: 1.06–8.98; P = 0.04). Conclusions: Frail patients are at increased risk of aspiration after cardiac surgery, but frailty screening does not identify all patients at risk. The 90-mL water swallow challenge is a simple and inexpensive test that can be used to identify patients at risk for aspiration.
  5,047 392 3
Effect of various patient positions on endotracheal tube cuff pressure after adult cardiac surgery
Mohsen Ziyaeifard, Rasoul Ferasatkish, Azin Alizadehasl, Zahra Faritous, Seyed Mostafa Alavi, Hamidreza Pouraliakbar, Maryam Zare, Ehsan Dehdashtian
October-December 2017, 6(4):34-37
Background: To avoid microaspiration or tracheal injury, the target endotracheal tube cuff pressure must be maintained 20–30 cmH2O. Changing in patients' positions may effect on endotracheal tube cuff pressure. The aim of this study was to investigate the effect of various patients' positions on endotracheal tube cuff pressure after adult cardiac surgery. Methods: This prospective, interventional study was conducted on 25 adult patients with orotracheal intubation for the cardiac surgery. Patients' endotracheal tube cuff pressure was assessed after surgery in a neutral starting position during an end-expiratory hold, and cuff pressure was regulated at 25 cmH2O. Then, ten changes in head position were performed: anteflexion, hyperextension, left and right lateral flexion, left and right rotation, semi-recumbent position (head elevation in 45°), recumbent position (head elevation in 10°), horizontal supine position, and finally, Trendelenburg position (10°). The observed cuff pressures were compared with the basic cuff pressure at the starting position. Results: Of total 250 measurements (25 participants in 10 positions), 109 (43/6%) were greater than the upper target limit of 30 cmH2O. In contrast, no measurements were less than the lower target limit of 20 cmH2O. 141 (56/4%) measurements were between the target limit of 20–30 cmH2O. All ten changes of patients' head position lead to statistically significant increase in endotracheal tube cuff pressure (P < 0.05). Conclusion: Simple changes in intubated patients' position could significantly increase in endotracheal tube cuff pressure that may potentially damage tracheal mucosa.
  4,763 501 1
Tadalafil and exercise capacity after fontan operation
Zahra Khajali, Mohammad Mehdi Peighambari, Sara Lotfian, Maryam Golari, Bahar Galeshi, Morteza Rouhani, Zahra Alizadeh
April-June 2018, 7(2):64-68
Background: Patients with congenital heart defects that have single functional ventricle undergo Fontan surgery. After the surgery, patients will develop reduced capacity for physical activity and exercise. Phosphodiesterase inhibitor drugs have vasodilatory effects and can decrease blood flow resistance. Thereby, they can help to improve the exercise capacity of patients. The aim of this study was to assess the effect of tadalafil on exercise capacity in these patients. Materials and Methods: In this before and after interventional study, 16 patients who had undergone Fontan operation were treated with tadalafil (10 mg daily for 2 weeks and then 10 mg every 12 h for 6 months). Demographic data, heart disease morphology, pulse oximetry, blood pressure (BP), functional class, age at the time of surgery, and the surgery type were collected. Pulmonary function and exercise capacity were assessed by 6-min walk test and VO2 max (maximal oxygen consumption). Results: Mean distance based on 6-min walk test increased from 418.75 m to 439.06 m (P = 0.004). Mean maximal oxygen consumption increased from 0.84 L/min to 1.07 L/min (P < 0.001). Furthermore, preexercise test oxygen saturation increased from 89% to 90.94% (P = 0.02). No significant change was observed regarding other variables. Conclusion: Tadalafil was found to be effective in improving exercise capacity of the patients with a previous history of Fontan surgery. However, tadalafil had no significant effect on systolic or diastolic BP and heart rate.
  4,701 403 1
Cardiomyocyte mitochondrial dynamics in health and disease and the role of exercise training: A brief review
Babak Ebadi, Arsalan Damirchi, Karim Azali Alamdari, Amir Darbandi-Azar, Nasim Naderi
July-September 2018, 7(3):107-115
Mitochondria as dynamic organelle constantly undergo fusion and fission reactions, leading to continuous reconstruction of the mitochondrial network for elongated or fragmentation shapes and ultimately the mitophagy. This mitochondrial network dynamics is sensitive to stress and different physiological conditions and plays an essential role in cell function and survival during pathophysiological conditions. There is a strong interaction between the mitochondrial network morphology and proteins involved in energy metabolism and dynamics. It is suggested that changes in cellular energy status during exercise training are due to mitochondrial network dynamics and mitophagy. Accordingly, growing evidence reveals that exercise training results in alterations in mitochondrial phenotype and dynamics that resist apoptotic stimuli and ischemia-reperfusion-induced mitochondrial damage. However, the signaling pathways of mitochondrial dynamics and mitophagy regulation during exercise training are still interesting areas of research. In this review, we focus on the recent findings addressing cellular signaling mechanisms of mitochondrial dynamics and cardiac mitophagy in response to exercise training and the pathological stimulus in heart disorders.
  4,616 479 -
Supraclavicular versus Infraclavicular Subclavian Vein Catheterization in Coronary Artery Bypass Graft Surgery
Masoud Tarbiat, Afshin Farhanchi, Maryam Davoudi, Maryam Farhadian
January-March 2018, 7(1):5-9
Background: Percutaneous central vein catheterization is one of the most invasive procedures commonly performed by anesthesiologists during cardiac surgery. Objectives: The aim of this study was to investigate the complications of supraclavicular (SC) versus infraclavicular (IC) approaches for subclavian vein catheterization during coronary artery bypass graft surgery. Materials and Methods: Between October 2014 and June 2015, this prospective, randomized clinical trial was performed in 280 patients. The patients were randomly cannulated by SC or IC approach. The success and complication rates were compared for the two approaches. The outcome of this study was analyzed using SPSS software and through Chi-square test. Results: In the first attempt of catheterization, the success rate in SC (78.6%) group was lower than IC (94.3%) group (P = 0.0001). The overall success rate in two attempts were 136 (97.1%) in the IC approach and 132 (94.3%) in the SC approach (P = 0.238). In 12 (4.3%) patients, subclavian catheterizations were failed after two attempts in both approaches. In 28 (10%) patients, hematoma at puncture site occurred, 1 (0.7%) in IC approach, and 27 (19.3%) in SC approach (P = 0.0001). The differences in other complications on two approaches were statistically insignificant. Conclusions: Compared with the SC approach, the IC approach resulted in fewer hematomas at puncture sites. The incidence of overall cannulation failure and other complications were similar on both approaches.
  4,617 399 4
The effectiveness of psychosexual education program on psychological dimensions of sexual function and its quality in cardiac rehabilitation patients
Ali Soroush, Saeid Komasi, Behzad Heydarpour, Parvin Ezzati, Mozhgan Saeidi
April-June 2018, 7(2):82-86
Objectives: The study aimed to assess the efficacy of a psychosexual education program (PSEP) on the psychological dimensions of sexual function and its quality in cardiac rehabilitation (CR) patients. Methods: In this randomized clinical trial, 43 male patients undergoing coronary artery bypass graft were selected randomly and then divided into case (n = 23) or control groups (n = 20). The research instruments consist of multidimensional sexual questionnaire and Sexual Quality of Life Questionnaire. Levin's PSEP (two 1-hour sessions) is presented as an intervention program. Data were analyzed through multivariate analysis of covariance to control the baseline scores. Results: Approximately 84% of patients (cases: 87% and controls: 80%) completed the final assessment. The results indicated that PSEP is significantly effective in the enhancement of sexual assertiveness (P = 0.034) and reduction of fear about intercourse (P = 0.007). There were no significant differences between two groups in other variables (P > 0.05). Conclusion: The results of the study indicated that PSEP is effective in the promotion of sexual assertiveness and fear of intercourse among CR patients. As the resumption of sexual function is one of the most important components in the psychosocial improvement of patients, it seems that this intervention should be included as a priority among educational programs in Iranian CRs.
  4,308 388 4
Evaluation of the effect of heart failure reversal therapy on the exercise capacity in patients with chronic heart failure and their association with comorbidities
Rohit Sane, Gurudatta Amin, Snehal Dongre, Rahul Mandole
January-March 2019, 8(1):1-5
Background: New treatment modalities are needed to improve the aerobic capacity of patients with chronic heart failure (CHF) considering the increasing disease prevalence. This study was done to evaluate the effect of heart failure reversal therapy (HFRT) on exercise indices, namely VO2 max and metabolic equivalents (METs). Methodology: This retrospective study screened data of 147 patients who had visited Madhavbaug Clinics between July 2018 and December 2018. The mean VO2 max and METs on day 30 of HFRT initiation was compared with that at baseline. Regression analysis was used to calculate the odds for increase in VO2 max and METs by HFRT, in specific comorbidity. Results: Of the 64 patients who fit the study criteria, majority were males (n = 51) with mean age of 57.89 ± 8.14 years. The most common comorbidity was hypertension (n = 45) followed by diabetes mellitus (n = 36) and coronary artery disease (n = 27). Mean VO2 max and METs increased significantly at day 30 of HFRT initiation compared to the mean values on day 1 (P < 0.05). Odds for elevation in VO2 max and METs were maximum in patients with myocardial infarction (MI) (VO2 max: odds ratio [OR] = 4.95; confidence interval [CI] = 0.26–91.5. METs: OR = 3.46; CI = 0.18–65.54), ischemic heart disease (IHD) (VO2 max: OR = 2.85; CI = 0.32–24.7. METs: OR = 1.67; CI = 0.18–15.29), or obesity (VO2 max: OR = 2.57; CI = 0.29–22.4. METs: OR = 1.5; CI = 0.16–13.78). All odds were statistically insignificant (P > 0.05). Conclusion: HFRT leads to significant increase in the VO2 max and METs in CHF patients, indicating improved aerobic capacity. Odds for increased exercise indices with HFRT were maximum in CHF patients suffering from MI, IHD, and obesity.
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Systemic review and meta-analysis of diagnostic efficacy of fractional flow reserve using computed tomography angiography for first-time diagnosis of coronary artery disease
Narendra Kumar, Ajay Kumar Sinha, Pramod Kumar, Arun Kumar Jha, Karuppiah Arunachalam, Sanjeev Kumar, Ahmad Zakariya, Shaimaa Mostafa
October-December 2018, 7(4):159-164
Coronary artery disease is a leading global cause of mortality. It can be diagnosed by fractional flow reserve (FFR) estimation using computed tomography (CT) angiography. This systematic review aims to review the literature about the diagnostic efficacy of FFR estimation using CT scan (FFR-CT) for the diagnosis of coronary artery disease. The dual databases of Medline and Cochrane Central Register of Controlled Trials were searched for relevant literature from their inception till August 15, 2017. The methodological quality was assessed using the Cochrane risk of bias tool. Pooled estimates of specificity and sensitivity were assessed with the corresponding 95% confidence intervals (CI). After careful screening, five studies involving a total of 296 patients were included in the study. For FFR-CT, on meta-analysis of the pooled risk ratio per patient, random-effects model value was 3.79 (95% CI, 2.93–4.90) and odds ratio per patient was 11.78 (95% CI, 8.08–17.17). The odds ratio by year to see if heterogeneity is due to sample size was 2.50 (95% CI, 1.06–5.91). FFR-CT appears to be a reliable and efficacious noninvasive imaging modality, as it demonstrates high accuracy in the determination of anatomy and lesion-specific ischemia, which justifies the performance of additional randomized controlled trials to evaluate the clinical benefits of FFR-CT-guided coronary revascularization.
  3,919 400 -
Clinical effects of adding tolvaptan to intravenous furosemide in patients with congestive heart failure
Mahoto Kato, Kazuto Tohyama, Toshiyuki Ohya, Atsushi Hirayama
October-December 2017, 6(4):14-19
Background: Tolvaptan, a vasopressin V2 receptor antagonist, is a strong diuretic with a new mechanism of action and has good adaptation to patients with congestive heart failure. Knowledge on the proper use of furosemide, an existing therapeutic drug, is not yet sufficient. Objectives: Clinical differences when 7.5 mg of tolvaptan was added to the usual furosemide therapy were examined. Materials and Methods: Patients who required hospitalization for congestive heart failure were randomly assigned to a group treated for 7 days with furosemide alone (FRO group) and a group treated with furosemide plus tolvaptan (TLV group) for 7 days and examined for symptoms. Physical examinations were performed every day, and blood testing, including N-terminal pro-brain natriuretic peptide (NT-proBNP) level, plasma renin activity (PRA), plasma aldosterone concentration (PAC), and noradrenaline (NAD) level, was performed on days 1, 3, and 7. Results: FRO and TLV groups consisted of 51 (age, 66.4 ± 11.8 years, 62% of males) and 47 patients (67.9 ± 14.5 years, 64% of males), respectively. During the study, the TLV group had higher urine volume and decreased blood pressure due to the suppressed diuretic effect. The two groups showed significant differences in the degree of improvement of the jugular venous pressure (FRO vs. TLV groups: 6.3 ± 1.6 vs. 7.6 ± 2.5 cmH2O, P < 0.001, on day 3) and other physical findings. Although no significant differences in NT-proBNP and NAD levels were found, there were significant differences in PRA (19.8 ± 12.9 vs. 11.8 ± 8.0 ng/[mL . h], P < 0.001, on day 3) and PAC (FRO vs. TLV groups: 180.4 ± 148.4 vs. 124.7 ± 95.5 ng/mL, P < 0.01 on day 3 and 79.4 ± 73.9 vs. 56.8 ± 38.2 ng/mL, P < 0.05 on day 7). Conclusion: Adding 7.5 mg of tolvaptan to existing treatments with furosemide resulted in differences in clinical findings and neurohormonal factors, even though the degree of improvement in congestive heart failure was the same.
  3,843 341 -
Fluoroscopic “calcium sign” or reverse “c” sign of the aortic knuckle in a case of chronic total occlusion of left anterior descending coronary artery
Debasish Das, Abhinav Kumar, Jogendra Singh, Subhas Pramanik
October-December 2021, 10(4):124-127
We describe an interesting fluoroscopic calcification of the aortic knuckle assuming a reverse “C” shape in an atherosclerotic aorta in a 42-year-old male presenting with anterior wall ST-elevation myocardial infarction with dyslipidemia. Although calcification of the aortic knuckle and dilatation of the aorta is a common phenomenon in the elderly population, otherwise known as the “unfolding of aorta,” we observed this interesting pattern of calcification in a middle-aged person in an atherosclerotic aorta with calcification. The patient had double-vessel coronary artery disease with chronic total occlusion in the left anterior descending coronary artery and significant stenosis in the mid-segment of the right coronary artery, which we revascularized with drug-eluting stents and achieved TIMI III flow. Although calcium sign or C sign is described in aortic dissection and it is not specific to it, we observed this interesting pattern of calcification in a middle-aged person in the atherosclerotic aorta with dyslipidemia.
  4,092 71 -
Prevalence of undiagnosed common mental disorders and its association with quality of life among patients attending the arrhythmia clinic of a large tertiary care hospital in Southern India
Gopal Chandra Ghosh, Donae Elizabeth George, Anandaroop Lahiri, Prasanna Samuel, David Chase, John Roshan Jacob
October-December 2017, 6(4):29-33
Objective: Studies are available from high-income countries exploring the prevalence of depression and anxiety among patients with cardiovascular diseases such as coronary artery disease, heart failure, and atrial fibrillation. Similar data are limited from low- and middle-income countries, particularly India. Data on how the quality of life (QOL) parameters are affected by common mental disorders (CMD) such as depression and anxiety are lacking. The aim of this study is to explore the prevalence of undiagnosed depression and anxiety in patients attending the arrhythmia clinic of a tertiary care hospital in Southern India and to look at their association with QOL. Methods: This cross-sectional study involved 282 patients attending the arrhythmia clinic of a tertiary care hospital in Southern India. Depression and anxiety were assessed using the “Patient Health Questionnaire-9” scale and “Hospital Anxiety and Depression Scale for Anxiety” scale, respectively. Patient demographics and potential risk factors were also assessed. Quality of life was assessed using the “Short Form Health Survey” questionnaire. Results: The proportion of patients with undiagnosed CMD (depression or anxiety or both) in our study was 45.74%. This included 32.98% with undiagnosed depression and 32.62% with undiagnosed anxiety. The presence of depression and anxiety are important determinants of quality of life. Presence of hypertension, diabetes mellitus, or smoking is not significantly associated with a poor quality of life in our study. Conclusions: Depression and anxiety are important associations of a poor quality of life. They are commonly seen among those attending the outpatient arrhythmia clinic. Having a screening program for CMD may assist in early diagnosis and intervention in those attending arrhythmia clinics.
  3,797 324 -
Hemodynamic stability and analgesic effects of intravenous dexmedetomidine premedication in adult patients undergoing coronary artery bypass graft surgery
Zahra Faritus, Ali Sadeghi, Mohsen Ziaiifard, Manijeh Yousefi Moghaddam, Ali Sadeghpour Tabaei, Farhad Gorjipour
April-June 2018, 7(2):87-91
Background: Sternotomy for coronary artery bypass surgery operation is associated with neuropathic pain, hypertension, tachycardia, agitation, and several other complications. In severe cases, the neuropathic pain may result in arrhythmia which is an important concern in cardiopulmonary bypass surgeries. Premedication for reducing the risk of hemodynamic instability, neuropathic pain, and other adverse associated consequences is very important. Objectives: We Scrutinized the effects of dexmedetomidine intravenous infusions on hemodynamic parameters and postsurgical pain in coronary artery bypass patients. Patients and Methods: A total of 60 coronary artery bypass surgery patients were recruited and were randomly allocated into two groups. 31 patients received placebo, and 29 received 1 μg/kg of dexmedetomidine 10 min before anesthesia and then 0.4 μg/kg/h of dexmedetomidine until the end of the operation. Heart rate, blood pressure, and postsurgical pain score according to the numerical rating scale were measured and recorded after recovery from anesthesia. Results: Blood pressure significantly decreased after bolus administration of dexmedetomidine which remained lower at the end of screening in most of the times. No remarkable adverse effects were observed, and its consumption was associated with significant reduction in the postsurgical pain scores as measured in 2, 4, and 6 h after surgery as well as the time of extubation. Conclusions: Infusion with 1 μg/kg of dexmedetomidine 10 min before anesthesia and 0.4 μg/kg/h of dexmedetomidine from the time of sternum closure until the extubation time appears to be effective for the maintenance of hemodynamics in coronary artery bypass surgery without remarkable adverse outcomes.
  3,622 486 1
Study of prooxidant-antioxidant balance and some risk factors of coronary artery disease
Farzaneh Montazerifar, Mansour Karajibani, Sara Musavi Gilani, Ahmad Bolouri, Mohammad Hashemi, Alireza Dashipour
April-June 2018, 7(2):69-73
Background: There is evidence that oxidative stress can be considered as a critical event in the development of atherosclerotic complications. In this study, we aimed to assay the values of prooxidant-antioxidant balance (PAB) in patients with coronary artery disease (CAD), as a cardiovascular risk factor, and its relationship with some clinical, biochemical, and anthropometric parameters was examined. Materials and Methods: In a case–control study, forty CAD patients and forty age and body mass index (BMI)-matched healthy controls hospitalized in the cardiology section of Imam Ali hospital of Zahedan, Iran, were enrolled. The levels of serum lipid profile, C-reactive protein (CRP), blood pressure, BMI, and waist circumference (WC) were evaluated. The values of PAB were also assayed simultaneously by photometric method, using 3, 3′, 5, 5′-tetramethylbenzidine and its cation, used as an indicator of redox. Results: PAB was found to be significantly higher in CAD patients (P < 0.05) as compared with control group. The obese patients had higher values than nonobese patients and controls (P < 0.05). In CAD patients, a significant positive correlation was demonstrated between WC (r = 0.56, P = 0.05), high-sensitivity-CRP (r = 0.65, P = 0.04), cholesterol (r = 0.36, P = 0.052), and triglyceride (r = 0.29, P = 0.055) with PAB. Conclusion: The study shows that the PAB assay in conjunction with other risk factors can be used as an independent prognostic predictor of CAD, particularly in patients who need antioxidant therapy.
  3,744 351 2
Effect of exercise on left ventricular mass index by echocardiography in mild and moderate hypertension: A meta-analysis
Mohamed Teleb, Aaron Shanker, Alok Kumar Dwivedi, Debabrata Mukherjee
October-December 2017, 6(4):50-56
Background: Left ventricular (LV) hypertrophy is considered to be a significant manifestation of increased blood pressure, which is associated with an increased risk of cardiovascular morbidity and mortality. Exercise training is recommended for reducing blood pressure in mild and moderate hypertensive patients. Methods: We conducted a search for interventional studies evaluating the effect of exercise on LV mass index (LVMI) in hypertensive patients. Studies were searched using different databases from 1990 to 2015. The primary end points were change in LVMI, systolic blood pressure (SBP), and diastolic blood pressure (DBP). Of 122 studies, eight studies were found to be eligible for this meta-analysis. Results: The produced effect size was found to be large for LVMI (3.6, 95% confidence interval [CI]: 1.7–5.5) and DBP (2.8, 95% CI: 1.6–3.9) with significant heterogeneity, while moderate (0.56, 95% CI: 0.35–0.77) for SBP without significant heterogeneity. The estimated predictive intervals for LVMI (95% CI: −3.2–10.3) and DBP (95% CI: −1.3–6.8) showed a positive but not significant difference in the intervention and control groups. Conclusion: The study demonstrated a significant reduction in LVMI and DBP in hypertensive patients after exercise training. A moderate reduction in the SBP of these patients was also depicted after exercise. Our study supports the American College of Cardiology/American Heart Association guidelines for regular exercise in hypertension.
  3,765 300 1
Association of left ventricular global longitudinal strain with exercise capacity in heart failure with preserved ejection fraction
Ljubica Georgievska-Ismail, Zarko Hristovski, Planinka Zafirovska
October-December 2017, 6(4):8-13
Background: Left ventricular global longitudinal strain (GLS) analysis using two-dimensional (2D) speckle-tracking echocardiography (STE) is a method for detecting subclinical systolic dysfunction. We hypothesized that exercise capacity (EC) is more closely related to systolic than diastolic dysfunction, especially to GLS in patients with heart failure and preserved ejection fraction (HFpEF). Methods: We assessed LV systolic and diastolic function in 172 patients with HFpEF using 2D echocardiography and STE. EC measured in units of metabolic equivalents (METs) was assessed using Bruce protocol treadmill stress testing. We defined reduced EC as <7 METs. Results: Out of 172 patients, 54 (31.4%) had EC of <7 METs. Patients with reduced EC of <7 METs versus those with ≥7 METs were significantly older (P = 0.0001), female (P = 0.001) with higher body mass index (BMI) (P = 0.001) and waist circumference for both man and women (P = 0.040, P = 0.001, respectively) as well as with higher resting heart rate (HR) (P = 0.009). Logistic regression analysis of EC as the dependent variable revealed that conventional risk factors (age, female gender, higher waist circumference, increased resting HR, and increased diastolic resting blood pressure) appeared as independent predictors of <7 METs. When age, gender, and hypertension were omitted from the analysis the results demonstrated that increased resting HR (odds ratio [OR] 1.025, P = 0.059, 95% confidence interval [CI] 0.997–1.192), higher BMI (OR 1.148, P = 0.003, 95% CI 1.047–1.258) along with elevated E/E' average ratio (OR 1.090, P = 0.059, 95% CI 0.997–1.192) appeared as independent predictors of <7 METs. In addition, when we included only echocardiographic variables into the logistic model, the results showed that only lower GLS% (more positive) appeared as an independent predictor of <7 METs (OR 1.111, P = 0.044, 95% CI 1.003–1.231). Conclusion: Greater impairment of GLS in patients with HFpEF appeared as a significant independent predictor of reduced EC by METs achieved.
  3,748 291 -
Comparison of Enoxaparin versus Heparin among Patients Undergoing Elective Coronary Angiography via Radial Artery Access
Reza Kiani, Mohammad Javad Alemzadeh-Ansari, Vahid Feghhi, Ata Firouzi, Hamid Reza Sanati, Ali Zahedmehr, Farshad Shakerian, Ahmad Shakeri, Reza Beheshti Namdar, Mohammad Reza Baay, Amir Mikailvand, Sayyed Shahrokh Taghavi
January-March 2018, 7(1):15-19
Background: Radial artery occlusion (RAO) is one of the few postprocedural complications of transradial approach (TRA) which may be symptomatic in some cases. The aim of this study was to investigate the safety and efficacy of enoxaparin compared with unfractionated heparin (UFH) for preventing RAO among patients who underwent elective diagnostic coronary artery angiography (CAG) via TRA. Patients and Methods: This randomized clinical trial study was conducted on patients who underwent TRA for elective diagnostic CAG. Then, the patients included were randomly divided into 2 groups. A group received 0.75 mg enoxaparin intravenously and the second group received 70–100 IU/Kg UFH single-bolus dose intravenously. During 24 h after the procedure and 3 months later, all the participants were monitored for the occurrence of RAO, access hematoma, periprocedural myocardial infarction, stroke, and death. Results: From 189 patients with mean age of 52.52 ± 6.23 years old, 95 patients received UFH (70–100 IU/kg), and the other group (n = 94) received enoxaparin after radial sheath insertion. After 24 h, decrease in radial pulse was observed in 17.6% patient (14.9% in UFH group and 20.2% in enoxaparin group) and only one patient had absent radial pulse in UFH group. There were no significant differences between UFH group compared with enoxaparin group in the reduction of the radial pulse that examined with reverse Allen test (P = 0.359). Furthermore, other complications did not differ significantly between the two groups. Conclusion: This study demonstrates that intravenous enoxaparin administration compared with intravenous UFH during diagnostic CAG via TRA is a safe and effective strategy for preventing RAO at 24 h after the procedure.
  3,608 345 -
The Effect of Intracoronary Infusion of Bone Marrow-derived Mononuclear Cells on Clinical Outcome and Cardiac Function in Chronic Heart Failure Patients: An Uncontrolled Study
Ahmad Amin, Ata Firouzi, Arezoo Mohamadifar, Nasim Naderi, Behshid Ghadrdoost, Hoda Madani, Nasser Aghdami
January-March 2018, 7(1):26-30
Objective: To evaluate the effect of bone marrow-derived mononuclear cells (BM-MNCs) on clinical outcome and cardiac function in chronic heart failure (HF). Methods: An uncontrolled, open-label trial was performed on symptomatic patients (New York Heart Association [NYHA] Functional Classification II–IV) receiving maximal medical therapy for at least 2 months, with a left ventricular (LV) ejection fraction <25%. Patients were divided into ischemic and nonischemic subgroups. All patients underwent BM aspiration, isolation of BM-MNCs using a standardized system, and intracoronary infusion of BM-MNCs. Primary endpoints assessed in 36 months were changes in (1) LV systolic function and LV end-diastolic diameter by echocardiography and (2) clinical improvement. Secondary measures included other echocardiography measures and major adverse cardiac events and HF hospitalization. Phenotypic and functional analyses of the cell product were performed by the Royan Institute for stem Cell Biology and Technology laboratory. Results: We enrolled 58 patients in our study. There was a significant improvement to exercise and functional capacity (evaluated by NYHA classification and 6-min walking distance) with both groups (for all P < 0.001). A significant decline in serum N-terminal Prohormone of Brain Natriuretic Peptide(NT- ProBNP) was observed in ischemic group (P = 0.01), but it was not statistically significant in nonischemic group. No significant changes were found in LV systolic and diastolic function, right ventricular size and function, severity of Mitral and Tricuspid regurgitation and pulmonary arterial pressure. There was minimal decrease in LV end-diastolic diameter which was statistically significant in ischemic and nonischemic group (P = 0.008 and P = 0.01 accordingly). Our study revealed a remarkably safe profile for BM-MNC infusion. Conclusion: It seems that intracoronary infusion of bone marrow-derived mononuclear stem cells is a safe treatment for patients with advanced HF and further studies need to address the best type of cell, route of administration, and criteria for patient selection.
  3,133 791 1