ABSTRACT
Cardiac resynchronization therapy [CRT] has been introduced as a promising therapeutic choice in heart failure [HF] patients with ventricular dyssynchrony, shown with a wide QRS. In previous study, we showed a positive effect of CRT on ejection fraction. This study aimed to evaluate the effect of CRT on the severity of mitral regurgitation [MR] quantitatively using the volumetric Doppler method in HF patients. In this prospective before-after survey, 22 HF patients with wide QRS [>/=120 ms] and NYHA class III who were included. All patients were evaluated initially for QRS width, NYHA class, MR volume, MR fraction and mitral valve area [MV area]. Biventricular pacing was done through cardiac-resynchronization device along with three pacing leads and same evaluations were done after CRT. The mean [SD] QRS width and NYHA class were significantly decreased after CRT in HF patients [p<0.001]. Also MR volume [46.9 +/- 30.2 mL vs. 27.0 +/- 26.4 mL, p<0.001] and fraction [40.1 +/- 25.5% vs. 26.8 +/- 22.7%, p=0.002] were improved following CRT. The decrease of MV area after CRT was also significant [10.6 +/- 3.0 cm[2] vs. 8.6 +/- 2.6 cm[2], p<0.001]. As MR is associated with morbidity and mortality in HF patients and the standard surgical therapy may not be practical for a majority of them, this novel treatment may improve their disease condition significantly
ABSTRACT
Coronary artery anomalies are rare, with their incidence varying from 1 to 5%. Angiography is a commonly used modality for the assessment of coronary artery anomalies. Based on previous reports, a majority of coronary artery anomalies are of origin or distribution, with separate ostia of the left anterior descending artery and left circumflex artery. Coronary artery anomalies may cause myocardial ischemia secondary to atherosclerosis in the same artery. We present a rare case of duplicated right coronary artery with a separate ostium, which caused myocardial ischemia. Our patient was a 51-year-old diabetic woman with typical chest pain and dyspnea on exertion. Electrocardiography showed left axis deviation, poor R progression, andbiphasic Twave in the precordial leads. Echocardiography revealed left ventricular ejection fraction of 30-35% and global hypokinesia. Coronary angiography demonstrated three-vessel disease and a double ostial right coronary artery. We recommended coronary artery bypass graft surgery, but the patient refused it and we continued her treatment with anti-ischemic drugs
ABSTRACT
QT interval parameters have been suggested as a predictor of lethal arrhythmia and mortality in patients with myocardial infarction. The aim of the present study was to compare the value of QT interval indices in patients presenting with non-ST-segment elevation myocardial infarction [NSTEMI] between a group of patients with type 2 diabetes mellitus and a nondiabetic group of patients. This case-control study evaluated QT interval parameters in 115 patients [47 diabetic and 68 nondiabetic patients] diagnosed with NSTEMI between September 2011 and July 2012. The following QT interval indices were analyzed: maximum [max] and minimum [min] QT interval; max and min corrected QT interval [QTc]; QT dispersion [QTd]; and corrected QT dispersion [QTcd]. All the patients were observed for ventricular arrhythmia during their hospital course and underwent coronary angiography. They were selected to undergo coronary artery bypass surgery [CABG] or percutaneous coronary angioplasty [PCI] based on their coronary anatomy. The mean age of the patients was 60.8 +/- 11.4 years. The patients were 40.0% female and 60.0% male. There were no significant differences in clinical characters between type 2 diabetic and nondiabetic patients with NSTEMI. Compared with post-myocardial infarction patients without diabetes, those with type 2 diabetes had higher QTc max, QTd and QTcd [p value < 0.05]. There was a significant difference in QTd and QTcd in the patients needing coronary revascularization with diabetes as opposed to the nondiabetics [p value = 0.035 and p value = 0.025, respectively] as well as those who had ventricular arrhythmia with diabetes [p value = 0.018 and p value = 0.003, respectively]. QTcd was higher in the patients who had higher in-hospital mortality [p value = 0.047]. The QTc max, QTd and QTcd were significantly [all p values < 0.05] associated with ventricular arrhythmia, QTcd with need for revascularization and QTc max with in-hospital mortality in the diabetic patients. Based on the findings of this study, it seems that type 2 diabetics with NSTEMI have greater QTc max, QTd, and QTcd and these QT parameters may have a relationship with worse cardiac outcomes and poorer prognoses
ABSTRACT
Cardiac resynchronization therapy [CRT] has introduced as new treatment strategy in heart failure [HF] patients and some of its effects have been investigated. The aim of this study was to study the effectiveness of CRT in the improvement of left ventricular systolic function indicated by left ventricular ejection fraction [LVEF] in HF patients. In our prospective study 22 HF patients with NYHA class III and above, QRS duration>120 ms and EF [ejection fraction]
ABSTRACT
A double left anterior descending [LAD] coronary artery emerging from the left and right coronary arteries is classified among rare coronary anomalies. We herein report a 73-year-old man presenting with acute coronary syndrome [posterolateral myocardial infarction]. He was admitted with typical chest pain, and due to his progressive ischemic changes on electrocardiography [ECG] and elevated cardiac enzyme, he was candidated for cardiac catheterization. The coronary angiography revealed an anomalous LAD from the right sinus of Valsalva. The unusual coronary anatomy was perfectly matched with the distribution of ischemia and its clinical evidence on echocardiography and ECG. The culprit lesion was stented, and the patient was discharged in good physical condition from the hospital