ABSTRACT
Background: Echocardiographic evaluations of the longitudinal axis of the left ventricular [LV] function have been used in the diagnosis and assessment of heart failure with normal ejection fraction [HFNEF]. The evaluation of the global and segmental peak systolic longitudinal strains [PSLSs] by two-dimensional speckle tracking echocardiography [STE] may correlate with conventional echocardiography findings. We aimed to use STE to evaluate the longitudinal function of the LV in patients with HFNEF
Methods: In this study, 126 patients with HFNEF and diastolic dysfunction and 60 normal subjects on conventional echocardiography underwent STE evaluations, including LV end-diastolic and end-systolic dimensions; interventricular septal thickness; posterior wall thickness; LV volume; LV ejection fraction; left atrial volume index; early diastolic peak flow velocity [E]; late diastolic peak flow velocity [A]; E/A ratio; deceleration time of E; early diastolic myocardial velocity [e?]; late diastolic myocardial velocity [A?]; systolic myocardial velocity [S]; and global, basal, mid, and apical PSLSs. The correlations between these methods were assessed
Results: The mean age was 57.50 +/- 10.07 years in the HFNEF patients and 54.90 +/- 7.17 years in the control group. The HFNEF group comprised 69.8% males and 30.2% females, and the normal group consisted of 70% males and 30% females. The global, basal, mid, and apical PSLSs were significantly lower in the HFNEF group [p value < 0.001 for all]. There was a significant positive correlation between the global PSLS and the septal e' [p value < 0.001]. There was a negative correlation between the global PSLS and the E/e' ratio [p value = 0.001]. There was a significant negative correlation between the E/e' ratio and the mid PSLS [p value = 0.002] and the basal PSLS [p value = 0.001]. There was a weak positive correlation between the septal e' and the mid PSLS [p value = 0.001] and the basal PSLS [p value < 0.001]. There were also weak negative correlations between the isovolumic relaxation time and the global PSLS [p value = 0.022] and the mid PSLS [p value = 0.018] and also between the New York Heart Association functional class and the mid PSLS [p value = 0.041] and the basal PSLS [p value = 0.009]
Conclusion: Our HFNEF patients on conventional echocardiography had different STE findings compared to our normal subjects, which is indicative of diastolic dysfunction. The longitudinal systolic function of the LV, which was measured by STE, was reduced in all the segments, denoting some degree of subclinical systolic dysfunction in these patients
ABSTRACT
Background: Percutaneous coronary intervention [PCI] for long coronary lesions is associated with poor angiographic and clinical outcome compared with focal lesions. Here we describe our experience in PCI of such lesions with bare [BMS] or drug eluting stents [DES]. Methods: Between October 2008 and September 2009, One hundred patients with one significant coronary artery stenosis of longer than 20 mm were enrolled in this prospective study. Demographic, clinical and angiographic data were collected and the rate of ischemic events and major adverse cardiac events [MACE] were evaluated in a mean follow up period of about 11.3 +/- 3.2 months. Results: Mean age of participants was 58.08 +/- 8.97 years. Seventy two [72%] patients were male and the remainders were females. Majority of patients underwent DES implantation [25 [25%] BMS, 75 [75%] DES, P<0.001]].There was no difference in frequency of major risk factors distribution among DES or BMS groups. Mean diameter of implanted stent was 2.8 +/- 0.033mm in DES group and 2.9 +/- 0.35 in group with BMS [P=0.214]. The mean length of implanted stent was 25.8 +/- 3.08mm in DES and 23.36 +/- 0.mm in BMS groups [P<0.001]. In-stent restenosis rate was significantly higher in BMS group [6[24%] in BMS and 5[6.9%] in DES, P=0.02]. MACE were observed in 7[9.3%] of patients with DES and 7 [28%] of patients with BMS [P=0.04]. Conclusion: In long coronary lesions implantation of DES was associated with lower MACE compared with BMS in one year follow up. Studies with longer term follow up are needed to further clarify this issue
ABSTRACT
A 20-year old female with a rare anomaly of aortocaval tunnel to superior vena cava is presented. Rare cases of congenital communications between aorta and right sided of the heart has been reported previously. The patient underwent surgical repair and had uneventful recovery
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A 44 years old male patient with acute coronary syndrome and polycystic kidney disease is described. Coronary angiography showed ectatic coronary arteries. Polycystic kidney disease is the most common inherited kidney disorder which is commonly associated with extra renal manifestations including cardiovascular conditions. Involvement of vessels may lead to arterial aneurysms which most commonly present as intracranial aneurysms. The rare association between coronary aneurysms and polycystic kidney disease has also been noted
ABSTRACT
To detect a reduction in the incidence of no-reflow, and a possible improvement in angiographic and clinical outcome after stepwise stenting in comparison with conventional method in the percutaneous coronary intervention [PCI] of patients with anterior ST elevation myocardial infarction. Between March 2007 and December 2009, patients with anterior acute myocardial infarction [AMI] treated with streptokinase less than 6 hours from presentation who underwent early PCI were enrolled in this multicenter randomized clinical trial. The study was carried out in the Cardiology Departments of Valiasr Hospital of Zanjan, Imam Reza, and Shahid Madani Heart Hospitals, Tabriz, Iran. Four hundred and three patients were enrolled in this study. Patients were randomly divided into 2 groups: Group I [n=202] with stepwise stent deployment [SSD], and Group II [n=201] with routine conventional stent deployment [CSD]. The patients' mean age was 57.7 +/- 10.7 years. After PCI, thrombolysis in myocardial infarction myocardial perfusion grade [TMPG] 0/1, suggestive of no-reflow was significantly higher in CSD group [p=0.0001]. In hospital based, death occurred in 15 patients [7.5%] from CSD group while 4 [2%] from the SSD group [p=0.01]. The TMPG was also significantly higher in SSD group [average 2.32 +/- 0.18] compared with CSD group, [average 1.66 +/- 0.24] [p=0.0001]. Conventional stenting technique was an independent predictor of no-reflow in multivariate logistic regression analysis [hazard ratio - 1.43; 95% confidence interval: 1.15-1.73; p=0.01]. The SSD was associated with improved angiographic reperfusion indices and reduced mortality in early PCI for AMI
Subject(s)
Humans , Female , Male , Stents , Coronary Angiography , Angioplasty, Balloon, Coronary , Treatment Outcome , Randomized Controlled Trials as TopicABSTRACT
To assess the association between electrocardiogram [ECG] changes in non-ST-segment elevation acute coronary syndrome [NSTE-ACS] patients with severity of coronary artery disease [CAD] and short-term outcome. In this cross-sectional descriptive -analytical study, 111 patients admitted to the Cardiology Department of Shahid Madani Heart Hospital, Tabriz, Iran between March 2005 and March 2007 with first NSTE-ACS, and had undergone coronary angiography during index event were evaluated. One hundred and eleven patients [64 males, and 47 females] were enrolled, and their in-hospital and short-term outcome with a mean follow-up period 4.6 +/- 1.8 months was evaluated. Patients with ST-T changes on admission had higher rates of death [16.7 versus 2.7%, p=0.01], recurrent angina [36.1 versus 6.7%, p=0.001], and pulmonary edema [8.3 versus 1.3%, p=0.045]. The mean left ventricular ejection fraction [LVEF] of patients with ECG changes were significantly lower than those without ECG changes [p=0.001]. Mitral regurgitatio [MR] was also common among those with ECG changes [p=0.006]. In a multivariate regression analysis, the only independent predictor of short-term mortality and adverse clinical event was ST depression on ECG [p=0.001]. In patients with first NSTE-ACS, ST deviation is associated with adverse short-term outcome including more severe CAD, lower LVEF, and more common MR
Subject(s)
Humans , Male , Middle Aged , Female , Coronary Disease/diagnosis , Electrocardiography , Severity of Illness Index , Prognosis , Case-Control Studies , Cross-Sectional StudiesABSTRACT
We describe 6 cases of chronic thromboembolic pulmonary hypertension, who underwent pulmonary thromboendarterectomy in our center. Transthoracic and transesophageal echocardiography provided valuable data on surgical accessibility of thrombus, its extension, chronicity and hemodunamic conse1uances on right ventricular transesophageal echocardiography as a rapid, bedside and easily available method has been a useful guide for diagnosis and guiding the treatment for these patients
ABSTRACT
A 36 years old woman with a history of treated pulmonary tuberculosis [TB] was hospitalized fir progressively worsening dyspnea on exertion. She had severe calcification of entire aorta and evidence of old 273 on chest roentgenogram Routine laboratory tests including erythrocyte sedimentation rate [ESR] and C- reactive protein [CRP] were normal and rheumatologic panel was negative. Echocardiography showed severe aortic insufficiency. Work-up for active tuberculosis was negative. The CT scan of the chest was in favor of old tuberculosis and also showed heavily calcified aorta. She underwent aortic valve replacement. Postoperative course was uneventful. At four-year follow up the patient is doing will. Considering her age and the absence of risk factors of atherosclerosis we postulated that porcelain aorta in this patient could be a sequel of remote tuberculosis aortitis