Risk factors of reperfusion failure following primary angioplasty for ST-segment elevation myocardial infarction [STEMI]

Although percutaneous coronary intervention [PCI] improves outcomes compared to thrombolysis, a substantial number of ST-elevation myocardial infarction [STEMI] patients do not achieve optimal myocardial reperfusion. This study was designed to evaluate factors related to suboptimal myocardial reperfusion after primary PCI in patients with STEMI. Totally, 155 patients [124 men; mean age = 56.6 +/- 11.03 years, range = 31- 85 years] with STEMI undergoing primary PCI were retrospectively studied. Additionally, the relationships between the occurrence of reperfusion failure and variables such as age, sex, cardiac risk factors, family history, Body Mass Index, time of symptom onset, ejection fraction, previous PCI, coronary artery bypass graft surgery or previous myocardial infarction, and angiographic data were analyzed. Procedural success was 97.1% and complete ST resolution occurred in 43.2%. Age; cardiac risk factors; family history; body mass index; previous MI, coronary artery bypass graft surgery, or PCI; and use of thrombectomy device and GP2b/3a inhibitor were not the determining factors [p value > 0.05]. According to our multivariate analysis, time of symptom onset [OR [95% CI]: 045 [0.2 to 0.98]; p value = 0.044] and ejection fraction [OR [95% CI]:0.37 [0.26 to .091]; p value = 0.050] had reverse and male gender had direct significant associations with failed reperfusion [OR [95% CI]: 0.34 [0.11 to 1.08]; p value = 0.068]. More degrees of ST resolution occurred when the right coronary artery was the culprit vessel [p value = 0.001]. The presence of more than three cardiac risk factors was associated with failed reperfusion [p value = 0.050]. Considering the initial risk profile of patients with acute STEMI, including time of symptom onset and ejection fraction, as well as the accumulation of cardiac risk factors in a given patient, we could predict failed myocardial reperfusion to design a more aggressive therapeutic strategy

Noninvasive localization of accessory pathways in patients with Wolff-Parkinson-White syndrome: a strain imaging study

Noninvasive techniques for the localization of the accessory pathways [APs] might help guide mapping procedures and ablation techniques. We sought to examine the diagnostic accuracy of strain imaging for the localization of the APs in Wolff-Parkinson-White syndrome. We prospectively studied 25 patients [mean age = 32 +/- 17 years, 58.3% men] with evidence of pre-excitation on electrocardiography [ECG]. Electromechanical interval was defined as the time difference between the onset of delta wave and the onset of regional myocardial contraction. Time differences between the onset of delta wave [delta] and the onset of regional myocardial contraction [delta-So], peak systolic motion [delta-Sm], regional strain [delta-epsilon], peak strain [delta-epsilonp], and peak strain rate [delta-SRp] were measured. There was a significant difference between time to onset of delta wave to onset of peak systolic motion [mean +/- SD] in the AP location [A] and normal segments [B] versus that in the normal volunteers [C] [A: [57.08 +/- 23.88 msec] vs. B: [75.20 +/- 14.75] vs. C: [72.9 0 +/- 11.16]; p value [A vs. B] = 0.004 and p value [A vs. C] = 0.18] and [A: [49.17 +/- 35.79] vs. B: [67.60 +/- 14.51] vs. C: [67.40 +/- 6.06 msec]; p value [A vs. B] < 0.001 and p value [A vs. C] = 0.12, respectively]. Our study showed that strain imaging parameters [[delta-So] and [delta-Strain]] are superior to the ECG in the localization of the APs [84% vs. 76%]

[Incidence rate of pressure sores after cardiac surgery during hospitalization and its relevant factors]

This study was conducted to assess incidence rate sores after cardiac surgery during hospitalization and its relevant factors, also discussed differences between sore and burn as a result of unstandard connections of electrocautery system in operating room. Surgical patients because of risk factors that exist in operating room, have more potential to develop pressure sore than general acut patients. Pressure sores and burn may both occur in the intraoperative environments and are often difficult for personnel to differentiate upon postoperative inspection. This descriptive cross-sectional study was conducted on 333 patients in 6 month, who were operated in Shaheed Rajaei Cardiovascular Medical and Research Center. Samples were selected Unrandomly. Demographic information, pre-intra-post operation [ICU and surgical ward] were collected by questionnaire.Data were analyzed using software SPSS 15 and descriptive statistical tests. Incidence rate of pressure sores after cardiac surgery was 21.3%.71 patients were involved with pressure sores, 67 cases in ICU and 4 cases after admission in ward.68[95.7%]were first degree and 3[4.2%]were second degree. This Shows meaning relationship with, sex, hypertension, myocardial infarction, intraoperative Hypoxemia ,Using mattress postoperatively, inotropic drugs, blood pressure<80mmhg,reoperation,decreased hematocrit and albumin, hospitalization and duration of staying in ward. More skin damage were seen after operation in ICU immediately or in the first 24 hours. It is worthful to control comorbidities before, during and after operation. Incidence of pressure sores can be minimized by providing enough perfusion during operation, using silicon mattress on bed of operating room, using mattress and changing position especially during stay in ICU, also paying attention to nutritional states and other known factors in study. Electrocautery system of operating rooms must always and periodically be checked, also taking care of probably bums to prevent from converting into pressure sores is very important

Physician-related factors affecting cardiac rehabilitation referral

Despite the positive impact of cardiac rehabilitation [CR] on quality of life and mortality, the majority of people who could benefit from this program fail to participate in it. The lack of referral from the physician is a common reason that patients give for not seeking CR. The objective of this study was to compare factors affecting CR referral by cardiologists. A cross-sectional survey of 122 cardiologists, including 89 general cardiac specialists and 33 fellows in cardiology from 11 major cardiology training centers in Iran, was done in 2010. They responded to the 14- item investigatorgenerated survey, examining the physician's attitudinal and knowledge factors affecting CR referral. 47.9% of the subjects reported having available CR centers but only 6.6% reported continuous medical education on the topic. 90.7% of the physicians reported that less than 15% of patients are referred to CR centers. The main factor affecting the low referral rate was limited general knowledge about CR programs [79.5%] such as program attributes and benefits, methods of reimbursement. Lack of insurance coverage, unavailability of CR centers in the community and low physicians' fee were other factors reported by the physicians. Cardiologists' inadequate general knowledge of and attitude toward CR programs seem to be a potential threat for cardiac prevention and rehabilitation in some societies

Growth status of Iranian children with hemodynamically important congenital heart disease

The relationship between congenital heart disease [CHD] and growth retardation is well documented. We investigated the growth condition of Iranian children with several types of congenital heart disease [CHD] and compared it with worldwide researches. Growth condition was investigated in 469 patients with important CHD aged from 1 month to 18 years. The patients were divided into two groups; infants [aged 12 months or less], and children [1-18 yrs of age]. Children with hemodynamically unimportant small VSDs or small ASDs were not studied. Other exclusion criteria were prematurity, known genetic disorders and neurologic disease affecting growth. All patients' cardiac diagnoses were made on the basis of clinical and laboratory examinations; including electrocardiography, echocardiography, cardiac catheterization, and angiography. Body weight and height of all patients were measured using conventional methods and compared with standard growth charts. In all patients body weights and heights were significantly lower than normal population. This difference was greater in the weight of female children. Other risk factors for growth failure were large left-to-right intracardiac shunts, pulmonary hypertension and cyanosis. Iranian children with CHD have growth failure somewhat different from other countries. Lower body weights of cyanotic patients and female children indicated that these patients need more nutritional and psychosocial attention

Evaluation of the relation between anterior mitral valve leaflet motion based on height-to-length ratio and the immediate outcome of percutaneous balloon mitral valvuloplasty

The purpose of this study was to investigate whether there is any relation between mitral leaflet motion based on height-to-length ratio of the anterior mitral valve leaflet doming in diastole and the immediate outcome of balloon mitral valvuloplasty,. The study population consisted of 49 patients [47 women, mean age: 43.7 +/- 13.35 years] with symptomatic rheumatic mitral stenosis who underwent balloon valvuloplasty. Complete transthoracic and transesophageal studies were performed in all the patients before valvuloplasty, and transthoracic study was repeated 24-48 hours after valvuloplasty. The severity of the restriction of the mitral valve leaflet motion was classified based on the heightto- length ratio of the anterior mitral valve leaflet doming. Mitral valve thickness, calcification, subvalvular thickening, and mobility were scored according to the Wilkins system. Optimal immediate outcome of balloon mitral valvuloplasty was defined as a valve area improvement of 50% or more or a final mitral valve area of >/= 1.5 cm[2] and mitral regurgitation Sellers' grade >/= 2. There was a significant relation between the total mitral valve score and its thickness with the optimal immediate post-balloon mitral valvuloplasty results [p value=0.03 and 0.04, respectively], but no relation was found between the Wilkins score and its components with the anterior mitral valve leaflet height-to-length ratio. There was no significant relationship between the amount of increase in the mitral valve area, decrease in trans-mitral pressure gradients, decrease in pulmonary artery pressure, and anterior mitral leaflet height-to-length ratio [all p values>0.05; all the correlation coefficients<0.2]. Our study showed that post-balloon mitral valvuloplasty results are mainly affected by valve thickness and the total Wilkins score. In addition, the severity of mitral leaflet motion restriction in terms of the height-to-length ratio of the anterior mitral valve leaflet has no significant relation with the immediate result of balloon mitral valvuloplasty

Is the peak-to-mean pressure gradient ratio useful for assessment of aortic valve prosthesis obstruction?

The evaluation of prosthetic valves is very difficult with two-dimensional transthoracic echocardiography alone. Doppler and color flow imaging as well as transesophageal echocardiography are more reliable to detect prosthetic valve dysfunction. However, Doppler study sometimes tends to be misleading due to the load-depending characteristics of peak and mean pressure gradients. The peak-to-mean pressure decrease ratio is a load-independent measure, which was previously used for the detecting and grading of aortic valve stenosis. We assessed the usefulness of this method for the evaluation of aortic valve prosthesis obstruction. One hundred fifty-four patients with aortic valve prostheses were included in this study. Transthoracic and transesophageal echocardiographic examinations were performed in all the patients. Peak velocity and velocity time integral of the aortic valve and left ventricular outflow tract, peak and mean aortic valve pressure gradients, peak-to-mean pressure gradient ratio, and time velocity integral [TVI] index were measured. There was a significant relation between the TVI index [p value<0.001] and aortic prosthesis obstruction. A TVI index<0.2 had a sensitivity of 71% and specificity of 100% for the detection of aortic valve prosthesis obstruction. However, no significant relation was found between the peak-to-mean pressure ratio and aortic valve prosthesis obstruction [p value=0.09]. Although the peak-to-mean pressure gradient [PG/MG] ratio is a simple, quick, and load-independent method which may be useful for the grading of aortic valve stenosis, it is poorly associated with aortic valve prosthesis obstruction. The TVI index is a useful measure for the detection of aortic prosthesis obstruction