Study of the efficacy of low-level laser in myocardial perfusion of patients with chronic stable angina

A sizable portion of patients with angina pectoris secondary to underlying coronary artery disease [CAD] can be effectively treated. Anti-anginal medication has proven efficacious in most patients, and percutaneous coronary revascularization or coronary artery bypass grafting can successfully treat the rest. Low-level laser therapy [LLLT] via its direct, heat-independent effect on the process of tissue repair may play a significant role in the treatment of patients with advanced CAD. We aimed at assessing the safety and efficacy of LLLT in advanced multi-vessel CAD patients not suitable for myocardial revascularization. We evaluated various clinical parameters as well as the results of laboratory tests to seek the indices of the potential impact of laser therapy on the study population. Twenty-two patients [mean age, 61 years old and male gender, 68.1%] with advanced CAD and a history of myocardial infarction underwent two series of irradiation therapy, each series comprising 10 sessions of LLLT and conducted with a three-month interval. In each series, LLLT was administered every other day for 20 minutes per session [excluding one session that lasted only 10 minutes]. The pre-laser evaluation consisted of blood pressure, heart rate, basic biochemical test, electrocardiogram [ECG], six-minute walk test, transthoracic echocardiography, and ECG-gated single photon emission computed tomography [SPECT] perfusion imaging. Three months later, the pre-laser evaluation was repeated. No side effects associated with laser biostimulation or performed clinical tests were noted. An improvement in functional class, and distance covered in the six-minute walk test and decrease in systolic blood pressure was observed. There was also a significant change in the myocardial perfusion of most anterior segments of the heart according to SPECT [visually and by computer software, P<0.05]. There was no significant change in diastolic blood pressure, heart rate, left ventricular ejection fraction by transthoracic echocardiography, and ECG gated SPECT. LLLT resulted in an improvement in functional capacity and myocardial perfusion as well as a reduction in the frequency of angina symptoms during the six-minute walk test. There were no significant changes, however, in the left ventricular function according to transthoracic echocardiography and ECG-gated SPECT. In the short term, LLLT proved to be a safe method. These encouraging results should be confirmed by larger, placebo-controlled studies

Cardiac MRI in a patient with myocarditis

A 19-year-old man presented with atypical chest pain, history of flu-like symptoms for the previous 14 days, and a rise in cardiac enzymes. His electrocardiogram revealed inferolateral ST elevation with mild PR depression. Cardiac MRI demonstrated focal myocarditis following his viral illness

Cardiac MRI in a patient with amyloidosis

A 42-year-old man presented with orthopnea, paroxysmal nocturnal dyspnea, and ascites, which had progressed for the previous two months. Electrocardiogram was low voltage. Transthoracic echocardiography showed concentric left ventricular hypertrophy and increased brightness and speckling pattern in the ventricular septum, consistent with amyloidosis. Cardiac magnetic resonance imaging confirmed the echocardiographic findings, and gingival biopsy was positive for amyloidosis

Heme oxigenase 2 gene polymorphisms as genetic risk factor in atherosclerosis in Iranian patients

Heme oxygenase 2 [HMOX2] is an important antioxidative stress enzyme found in the endothelial cells of blood vessels and adventitial nerves. This enzyme in collaboration with heme oxygenase 1 metabolizes heme molecules into ferrous iron, carbon monoxide [CO] and biliverdin while the later is further converted to bilirubin. Both biliverdin and bilirubin are potent antioxidants, reducing the chance of atherosclerosis. HMOX2 also induces endothelial relaxation by synthesizing CO. Heme oxygenase 2 gene mutations were studied in 137 patients with atherosclerosis and in 100 normal controls. Pairs of primers were designed to amplify 2[nd], 3[rd] and 5[th] exons of HMOX2 gene. These products were analyzed by single strand conformation polymorphism [SSCP] analysis and the shifted fragments were separated from SSCP polyacrylamide gel for further sequencing. Two sequence variations were observed among 13 patients with atherosclerosis, consisting of C to A substitution in codone A70D [GCC to GAC] which was reported for the first time and A to G substitution in codone K89E [AAG to GAG]. A significant association was noticed between A to G mutation in codon K89E of hemoxygenase 2 gene and the risk of atherosclerosis was supported with p=0.01 and chi[2]>6.82. However, no significant associations were observed among C to A substitution in codon A70D, p=0.11 and chi[2]>2.97 and the risk of atherosclerosis. Our findings denoted to the importance of K89E mutation in the development of atherosclerosis in Iranian cases. Further studies are required to show the importance of hemoxygenase 2 gene mutation in other populations

Clinical and echocardiographic evaluation of regional systolic function detected by tissue doppler imaging in hypertrophic cardiomyopathy

Hypertrophic cardiomyopathy [HCM] is the most common type of the genetic cardiovascular diseases. Regarding to tremendous heterogeneity in the phenotypic expression of HCM, which is generally unrelated to genotype, we aimed to study, clinical and echocardiographic parameters such as Tissue Doppler Imaging [TDI] in various subtypes of HCM patients and evaluate the influence of race and gender in Iranian patients. Patients with HCM underwent a complete clinical and echocardiographic study including TDI to assess regional systolic contraction [in the 12 segments] and early diastolic annular velocity [Em] from the septal mitral annulus. The study comprised 41 patients [20 women, mean age = 41 +/- 15 years] with mean LVEF 55% +/- 4.8% and mean maximal septal thickness 2.07cm. Considering LVOT gradient>30mmHg, hypertrophic obstructive cardiomyopathy [HOCM] was found in 18 [455]. Asymmetric septal hypertrophy [ASH] existed in 27 patients [67%], systolic anterior motion of anterior mitral leaflet [SAM] in 25 persons [64%]. Nineteen patients [46.3%] were included in NYHA function class [FC] II and 6 [14.7%] in FC III or higher. We found syncope in 10 [24.4%], chest pain in 4 [9.8%], atrial fibrillation in 14.6% and ventricular arrhythmias in [17.1%] of patients. History of ICD was seen in 7 [17.1%] and PPM in 9 cases. Mean E'velocity was 5.44 +/- 1.65 cm/sec and S velocity 5.70 +/- 1.49 cm/sec with significant lower S velocity and E' in syncope patients. Overall, HOCM patients had grade II diastolic dysfunction with E/E>15 [17.54 +/- 7.46]. Majority [25] of cases [61%] were categorized in type III of HCM. RV involvement was observed in 11 patients [28.2%]. No significant differences existed between prevalence of syncope and dysrhythmia among HCM and HOCM patients. In our study, we found lower detection of latent HOCM, compared to other studies, suggestive of inadequate use of appropriate provocative maneuvers such as exercise stress echocardiography and amyl nitrate. We detected remarkably lower S velocity [5.70 +/- 1.49 cm/sec] and E'velocity [5.44 +/- 1.65 cm/sec] in HCM patients compared to normal subjects, with more significant reduction in patients with syncope

Non-invasive assessment of left ventricular end-diastolic pressure in patients with chronic aortic regurgitation, comparison of the sensitivity and specificity of CW doppler echocardiography with angiography

Left ventricular end diastolic pressure could be estimated collectively using various measures of mitral valve and pulmonary venous flow velocities. In patients with aortic regurgitation, the AR velocity reflects the diastolic pressure difference between the aorta and the left ventricle. We sought to predict the left ventricular end diastolic pressure by a new Doppler index as aortic regurgitation peak early to late diastolic pressure gradient ratio. Fifty three patients with at least moderate aortic regurgitation were enrolled in this study. Physical examination, electrocardiography and echocardiography were performed one day before cardiac catheterization. The severity of AR was graded according to the recommendations of American society for echocardiography. The pressure half time, aortic regurgitation early diastolic velocity, aortic regurgitation early diastolic pressure gradient, aortic regurgitation end diastolic velocity, aortic regurgitation end diastolic pressure gradient, and early diastolic to end diastolic pressure gradient ratio of averaged three beats were measured and recorded. The results from cardiac catheterization and echocardiography were compared. The early diastolic to end diastolic pressure gradient ratio was very accurate [80%] for determining the left ventricular end diastolic pressure [P =0.01]. An early diastolic to end diastolic pressure gradient ratio of 1.5 has a sensitivity of 96% and a specificity of 32% for left ventricular end diastolic pressure 12 mmHg was higher than 2.0, with a sensitivity of 71% and specificity of 96% We found no significant correlation between the left ventricular end diastolic pressure with either left ventricular ejection fraction or aortic regurgitation severity in cardiac catheterization [P =0.5]. Doppler echocardiography is a viable alternative of cardiac catheterization for determination of the left ventricular end diastolic pressure. The early diastolic to end diastolic pressure gradient ratio is a simple, easy and new method for assessment of the LVEDP in patients with severe chronic aortic regurgitation

Myocardial viability assessment: comparison between resting two dimensional visual assessment of dobutamine stress echocardiography and strain rate imaging

Patients with ischemic left ventricular dysfunction are increasingly referred for the assessment of myocardial viability. The issue of identifying dysfunctional but viable myocardium has crucial clinical importance, since revascularization increases survival only in patients with viable myocardial tissue. The aim of this study was to compare resting two-dimensional visual assessment of myocardial viability with dobutamine stress echocardiography and strain rate imaging. In this cross-sectional study, thirty-two consecutive patients [age: 55.3 +/- 22.7, 4 females] with ischemic left ventricular dysfunction were referred for myocardial viability assessment. Viability was evaluated using resting two-dimensional echocardiograms, dobutamine stress echocardiography and strain rate imaging. Viability was defined by the absence of brightness and thinning [<6 mm thickness] in akinetic segments, improvement by at least one grade or a biphasic response during dobutamine stress echocardiography or an increase in the peak systolic strain rate [more than -0.23 1/s]. A total of 254 segments were studied. Seventy- nine segments by dobutamine stress echocardiography, 70 segments by two-dimensional visual assessment, and 63 segments by strain rate were classified as non-viable [P< 0.001]. There was an almost perfect agreement among these diagnostic methods. Two-dimensional visual assessment with measurement of wall thickness is simple and practical methods for viability assessment, with almost perfect agreement with dobutamine stress echocardiography and strain rate imaging

Correlation of right ventricular DP/DT with functional capacity and RV function in patients with mitral stenosis

Evaluation of right ventricular [RV] contractility and systolic function in patients with right sided heart disease is an essential component of clinical management. The aim of this study was to assess RV systolic function by qualitative and quantitative methods and compare it to rate of ventricular pressure change during the isovolumic contraction period [dP/dt] as RV contractility index in patients with rheumatic mitral stenosis. In 56 consecutive patients with moderate to severe mitral stenosis, RV systolic function, RV dP/dt and dP/dt/Pmax, were calculated and compared. There was significant correlation between RV dP/dt and RV function [P < 0.001] and between RV dP/dt and New York Heart Association [NYHA] functional capacity [P < .001]. The mean of dP/dt was decreased with increasing severity of RV dysfunction [mean dP/dt was 648 +/- 159 for normal RV function, 592 +/- 126 for mild RV dysfunction, 319 +/- 146 for moderate RV dysfunction and 166 +/- 150 for severe RV dysfunction] Severity of tricuspid regurgitation and pulmonary hypertension had no significant effect on RV dP/dt and RV function. RV dP/dt/Pmax had also significant relationship with RV function and functional capacity [P < 0.001]. Measurements of dP/dt and dP/dt/Pmax, are practical methods for estimating RV contractility and results have a good correlation with RV systolic function and functional capacity