Prognostic value of strain and strain rate in the prediction of postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting: a systematic literature review

Introduction: Atrial fibrillation [AF] is a common dysrhythmia postoperatively after coronary artery bypass grafting [CABG]. Myocardial strain and strain-rate imaging is used for the assessment of postoperative atrial fibrillation [POAF] as a new echocardiographic method

Methods: PubMed and Scopus were searched thoroughly using the following search terms: [strain and strain rate] AND [atrial fibrillation OR AF] on March 2015 to find English articles in which the strain and strain-rate echocardiographic imaging had been used for the evaluation of AF in patients undergone CABG. Full text of the relevant papers was fully reviewed for data extraction

Result: Of overall 6 articles found in PubMed, 10 records found in Scopus and 4 articles found through reference list search, only 6 papers fully met the inclusion criteria for further assessment and data extraction. The results of strain and strain-rate assessment showed that in total of 542 patients undergoing CABG, POAF occurred in 106 patients. Studies showed that the reduction of left atrial [LA] strain rate is correlated with AF. Consistently, the results of present review showed that LA strain and strain-rate in patients who developed AF postoperatively after CABG are significantly reduced, suggesting that strain and strain-rate could be a predictor of POAF

Conclusion: Based on the obtained results, strain and strain-rate is a suitable and accurate echocardiographic technique in the assessment of left atrial function, and it might be helpful to detect the patients who are at high risk of POAF

Malondialdehyde-modified LDL IgG antibody levels and indices of cardiac function in valvular heart and coronary artery disease patients

To compare the changes in anti-malondialde-hyde-modified low-density lipoprotein [MDA-LDL] IgG levels among patients undergoing off-pump and on-pump coronary artery bypass grafting [CABG] or valvuloplasty. A total of 38, 39 and 34 patients who underwent off-pump CABG, on-pump CABG and valvuloplasty, respectively, were enrolled in this study. Serum anti-MDA-LDL IgG values were measured 24 h before and after the operative procedures and at discharge. Echocardiogra-phy was also done before surgery and before discharge. The results were compared with values from 50 healthy controls. In all patients, a reduction in antibody titers was observed post-operatively. However, the decrease was significant only in the off-pump CABG - before surgery: 42.33 [25.83-58.51], after surgery: 30.86 [16.36-51.33] and at discharge: 10.96 [6.82-23.57; p = 0.027]. There was a significant positive association between anti-MDA-LDL IgG levels and ejection fraction [r = 0.248, p = 0.036] and a negative association with E/E', a marker of pulmonary capillary wedge pressure, in the coronary patients [r = -0.345, p = 0.012], but no significant associations were found in patients with valvular heart disease. Serum anti-MDA-LDL IgG levels were associated with cardiac function indices in coronary patients undergoing CABG

improvement of the atrial flutter rhythm upon the removal of the infected permanent pacemaker lead

Pacemaker infection has multiple risk factors. Its presentation is most often similar to infected endocarditis and the diagnosis is made through studying blood cultures. Transesophageal echocardiography can confirm the diagnosis. The most common microorganisms are staphylococcus speciesis. As a matter of fact, complete pacemaker removal appears to be the only definite treatment. We presented a case of infected pacemaker lead which was firstly referred with fever and nephritic syndrome. She had intermittent atrial flutter rhythm. Therefore, a total infected pacemaker system was removed under cardiopulmonary bypass support. Yet, the lead was firmly attached to the septal leaflet of tricuspid valve while leaflet repair was needed. As a result, atrial flutter rhythm was converted into sinus rhythm after an incidental interruption of the macroreentrant circuit in the process of the tricuspid leaflet surgery

An Unusual Biatrial Cardiac Myxoma in a Young Patient

This is a report of a biatrial cardiac myxoma in a young man with a 10-month history of exertional dyspnea and palpitation. The echocardiogram revealed biatrial myxoma prolapsing through the mitral and tricuspid valves during diastole. All cardiac chambers were enlarged and dysfunctional. The electrocardiogram revealed a rapid ventricular response with atrial flutter rhythm. The masses were resected and diagnosed as myxoma by a histological examination. The follow-up echocardiogram revealed significant improvement in ventricular function and reduction in the cardiac chambers' volume. There was no evidence of myxoma recurrence. The most probable cause of the patient's heart failure was considered to be tachycardia-induced cardiomyopathy.

Role of transthoracic echocardiography in the evaluation of patients with retinal vein occlusion

Introduction: Retinal vein occlusion is a common vascular disorder disrupting vision. Two basic types of RVO are branch retinal vein occlusion and central retinal vein occlusion [CRVO]. Retinal vein occlusion is a multifactor process including systemic illness and local retinal factors. RVO may be associated with atherosclerotic risk factors. We analyzed the role of 2 dimensional transthoracic echocardiography [TTE] for detecting the cardiac disease in patients with retinal veins occlusion

Materials and Methods: In this cross-sectional study 70 recently diagnosed patients with RVO enrolled in the study. The clinical diagnosis of retinal vein occlusion and its type was confirmed by a vitreoretinal specialist. The Patients were then referred for performing complete TTE

Results: The prevalence of RVO increased with age, but did not vary by sex. The most frequent cardiovascular risk factor was hypertension. The findings of our study revealed that a variety of echocardiographic abnormalities may be presented in patients with RVO. Diastolic dysfunction was the most frequent echocardiographic finding and we found positive correlation between diastolic dysfunction with increasing age and the presence of hypertension. Other findings included mitral regurgitation [52.9%], mitral stenosis [2.9%], mitral annulus calcification [1.4%], mitral valve prolapse [8.6%], aortic insufficiency [22.9%], sclerotic aortic valve [27.1%], tricuspid regurgitation [45.7%], pulmonary insufficiency [8.6%], mild pulmonary hypertension [8.6%], and moderate to severe pulmonary hypertension [4.3%] Mild LVH [11.4%], Moderate LVH [8.6%]. Abnormality on IAS was defined in these patients, including paten foramen ovale, lipomatosis IAS, exaggerated motion of IAS, and aneurysm of IAS

Conclusion: In our study, the most common echocardiographic finding was diastolic dysfunction which was compatible with the patients' age and the fact that the most prevalent risk factor was hypertension. Other findings were not more prevalent than general population. We think that a routine workup for structural heart diseases is unwarranted in these patients

Frequency of ischemic mitral regurgitation after first-time acute myocardial infarction and its relation to infarct location and in-hospital mortality

Ischemic mitral regurgitation [IMR] is a common complication after acute myocardial infarction [AMI]. We aimed to investigate the frequency of IMR following first-time AMI and its association with infarct location, in-hospital mortality, and complications. From September 2011 to November 2012, all patients with a diagnosis of first-time acute ST-elevation MI were enrolled in the study. Patients with previous MI and heart failure, organic mitral valve disorders, and previous mitral surgery were excluded from the study. The patients' baseline characteristic, echocardiographic parameters, and complications were recorded. The frequency of IMR after AMI and its relation to infarct location and in-hospital mortality were evaluated. Altogether, 250 patients [180 male] at a mean age of 60.21 +/- 12.90 years were studied. IMR was detected in 114 [45%] patients. There was no association between the presence of MR and gender, systemic hypertension, smoking, diabetes mellitus, or body mass index; however, serum LDL-cholesterol and triglyceride levels were significantly higher in the patients with IMR. The most frequent territory of MI was anterior in the patients without MR, while the anterolateral territory was the most common one in the patients with IMR. The patients with IMR had more reduced left ventricular ejection fraction, more elevated left ventricular end-diastolic pressure, and higher pulmonary arterial pressure [p values < 0.001, < 0.001, and < 0.001, respectively]. Stage III diastolic dysfunction was more frequent in the patients with IMR. All the deaths occurred in the IMR patients, who also had more complicated AMI. IMR following AMI is highly prevalent, and it complicates about half of the patients. Regarding its relation to the AMI complications, assessment of the MR severity is necessary to make an appropriate decision for treatment

Carcinoid heart disease and the utility of 3D trans-thoracic and trans-esophageal echocardiography: two clinical cases

Carcinoid tumors are rare neuroendocrine malignancies. We present two cases of metastatic carcinoid tumors, complicated by carcinoid syndrome and by cardiac valve involvement. Carcinoid syndrome is characterized by secretory diarrhea, episodic flushing, and bronchospasm. Cardiac involvement occurs in up to 50% of patients with metastatic carcinoid tumors which commonly causes abnormalities of the right sided valves. Echocardiography is the best available and non invasive technique for diagnosis. Characteristic features of carcinoid heart disease are thickened, shortened, retracted, and fixed or partially fixed valve leaflets. Three-dimensional [3D] echocardiography provided an en face view of pulmonary and tricuspid valve, not obtainable by two-dimensional echocardiography, and improved delineation of the relationship between these structures and cardiac chambers

An Improved Technique for Pulmonary Endarterectomy

We report a modified technique for pulmonary endarterectomy (PEA) on a 67-year-old man with chronic thromboembolic pulmonary hypertension (CTEPH) who presented with dyspnea. He was referred to our medical center for coronary artery bypass grafting. CTEPH had not been detected in his first visit to another medical center, but upon re-evaluation, the diagnosis was confirmed. PEA was performed with a modified method, which seems to be safe and suitable for the removal of clot and fibrotic materials. Iatrogenic dissection was performed with normal saline injection in the pulmonary artery, and then, the clot was removed completely. Although the technique may not be applicable for all cases, it can be used as an alternative to using an aspirating dissector and a pair of forceps.

20 years view study_of dry waste recycling in Qom and it's economic benefits

Background and Objective: According to the existing documents a major portion of municipal solid wastes in Iran is being land filled and small portion of this material is recycled, while the municipal waste management in developing countries has moved towards source separation and recycling. This research was conducted by the purpose of estimating Qom municipal solid waste recycling potential and cost benefits in a 20-year vision since 2006

Materials and Methods: This Research is a cross-sectional study. Firstly, according to the reports given by waste management organization in Qom city, dry solid waste recycling in 2006 and 2011 was estimated. Then two scenarios consisted of 20 and 60 percents of recycling were estimated to process the solid waste in 2011 and 2028 for enhancing recycling level, and then cost benefit of them was determined

Results: The average of produced solid waste was 718 ton per day in Qom city in 2011. Due to this producing process in 1407 we will have 1145 ton solid waste per day in this city. Daily economic benefit of dry solid waste recycling in 2011 was 15801520 Rials. If the recycling programs promotes, this benefit can be increased to 63211640 and 189664400 Rials for 20 to 60%recycling level

Conclusion: Despite of 21 % potential for dry solid waste recycling in Qom city, nowadays about 5% of this substances are recycling. By upgrading the plan for 10 to 20 years, amount of economic benefit can be increased to 4 to 12 times

Acute myocardial infarction in a 17-year-old boy secondary to lightning strike

Although lightning is an uncommon phenomenon in nature; it can cause many destructive incidents. In the event of a lightning strike, multiple organs particularly the cardiovascular systems are at risk of injury. Short-term mortality depends on its cardiac effects. In this paper, the authors report the development of myocardial infarction and pericardial effusion after lightning injury, a typical example of "side splash"

[ effect of cardiopulmonary pump on hearing loss after cardiopulmonary bypass graft]

Coronary artery bypass graft is one of the most common surgeries in hospitals. Almost 50% of patients have complications. One of these complications is hearing loss. Coronary artery bypasses grafting patients having inclusion criteria participated. One day before surgery, One day after surgery and if patients had hearing loss, the nest week otoacoustic emission test was done. Patients were divided in to two groups: on pump and off pump bypass surgeries. Hearing loss occurred in 12%. Hearing loss in on-pump patients was 14.3% and in off-pump was 6/7% [p=0.09]. The relation of preoperative OAE test and final OAE was tested and it was significant [p<0.005]. In male patients, hearing loss in on-pump operation was 18/6% [p=0.002] and in females in on-pump operation was 7/4% and in off-pump operation was 18.2% [p=0.1]. Hearing loss occurred in 4/2% in 1500, 2000 HZ; 12./5% in 2500, 3000 HZ and 83/3% in 3500, 4000 HZ. It after coronary artery bypass graft is rather Frequents [12%] and is more common in on-pump surgery, and occurs in high frequency, hearing loss is more common in male patients

Etiology and outcome of patients with upper gastrointestinal bleeding: a study from South of Iran

The prevalence of acute upper gastrointestinal bleeding [AUGIB] has undergone a change after implementation of eradication therapy for Helicobacter pylori in peptic ulcers effective prevention of esophageal variceal bleeding and eventually, progressive use of low dose aspirin and other nonsteroidal antiinflammatory drugs [NSAIDs]. To evaluate this subject, we performed a prospective study in two main University Hospitals of Shiraz [the largest city of southern Iran]. All adults who were admitted in emergency room with impression of AUGIB and existing patients who developed AUGIB were included in the study. Gastroscopy was done with a follow-up for the next 15 days. 572 patients [mean age: 54.9 years] entered in the study. The most common presenting symptom was hematemesis or coffee-ground vomits [68%]. 75% of patients gave history of consumption of low dose aspirin or other NSAIDs regularly. Gastric and/or duodenal ulcers were the most common causes [252/572, 44%] of AUGIB [Gastric ulcer: 173/572, 30% and duodenal ulcer: 93/572, 16%, respectively]. Esophageal varices were the third common cause [64/572, 11%]. 36 [6%] of the patients died. Mean age of these patients was higher than the patients who were alive [64.8 vs. 54.2 years, P = 0.001]. Other than age, orthostatic hypotension on arrival [267/536 vs. 24/36, P = 0.018] and consumption of steroids [43/536 vs. 10/36, P = 0.001] were significant factors for increasing mortality. The most common cause of AUGIB, secondary only to NSAIDs consumption, is gastric ulcer. Mortality of older patients, patients who consumed NSAIDs and steroids concomitantly, and patients with hemodynamic instability on arrival were higher