Risk factor profile and angiography findings in military and non-military patients with coronary artery disease

Military personnel come from the general population and have the same epidemiological style for coronary artery disease [CAD]. There are two significant questions: Is there a higher rate of premature CAD in military personnel in comparison with general population and does the risk factor profile in military personnel differ from that of the general population? The present study was designed to answer these questions. The present case control study was performed on all military and non-military patients referred to angiographic departments due to CAD symptoms between 2003 and 2005. We collected demographic data with major coronary risk factors such as diabetes mellitus, hyperlipidemia, hypertension, and smoking [cigarette or pipe]. We divided the recruited patients according the angiographic findings and the number of involved vessels into three groups. Among the patients, 9709 [81%] were affected by CAD. From this total, 3586 [36.93%] were military and 6123 [63.07%] were non-military patients. Premature CAD in the military personnel [868, 24.21%] was significantly higher in the non-military [503, 8.3%] persons [P=0.00]. Diabetes and hypertension were significantly lower in the military personnel in comparison with the non-military group. Smoking in the military personnel was significantly higher than in the non-military group. There was a significant association between the number of risk factors and involved vessels in our participants. In light of the fact that the rate of premature CAD was higher in the military personnel in our study, we suggest that screening programs with sensitive tools might be necessary for an earlier detection of the military personnel at a higher risk of CAD

Tissue doppler imaging and doppler studies in patients with transmural and non-transmural myocardial infarction

Myocardial longitudinal shortening play an important role in cardiac contraction [1,2]. Tissue velocity imaging [TVI] is an ultrasonographic technique that measure myocardial motion and providing a quantitative agreement of left ventricular regional myocardial function in different modalities [3]. The present review discusses the most recent development in the application of TDI in coronary artery disease. Seventy patients with myocardial infarction [transmural and nontransmural] were included in the study. These subjects were diagnosed with recent myocardial infarction wall [septal side of mitral annulus] and basal segment of base of RV free wall were examined for tissue Doppler study with complete transthoracic echocardiography study. Mean age in group of inferior MI, anterior MI and non Q wave MI are as follows: 61.87 +/- 10.7, 57.04 +/- 10.7, 58.45 +/- 9.2. Sm was significantly reduced in anterior MI groups than non Q wave MI [PV=0.01]. In patients with inferior myocardial infarction 88% of patients had left ventricular ejection fraction [LVEF]>45% and in patients with anterior MI 18.2% patients had EF>45%. In non Q wave MI groups 60% patients had LVEF>45%. Except for Sm, other TDI parameters had no significant difference between two groups [transmural and nontransmural infarction] but it has significant changes in reduced left ventricle function and could be of determinants for prognosis

Five-year follow-up of the local autologous transplantation of CD133+ enriched bone marrow cells in patients with myocardial infarction

The implantation of a CD133+ bone marrow cell population into an ischemic myocardium has emerged as a promising therapeutic modality for myocardial regeneration and restoration of ventricular contractility. While previous studies have documented the short-term safety and efficacy of CD133+ cell transplantation in patients with acute myocardial infarction, there are few reports of long-term follow-up results. Here, we present the results of long-term follow-up of our acute myocardial infarction patients who were treated with intra-myocardial injection of CD133+ cells after coronary bypass graft. After five years, 13 patients in the cell transplantation group and 5 patients in the control group underwent safety and efficacy investigations by New York Heart Association classification and two-dimensional echocardiography [2D echo]. During the five-year study period, no major cardiac adverse events were reported among patients who received CD133+ stem cells. Regarding efficiency, we observed no statistically significant treatment effects for the echocardiographic parameters [left ventricular end-diastolic and end-systolic volumes, and resting ejection fraction] measured during the follow-up period. However, detailed analysis of regional wall motion revealed an improvement in the Wall Motion Score Index from baseline to the six month follow-up, which was maintained during the follow-up period. Taken together, the long-term results of the present study indicate that transplantation of CD133+ is a safe and feasible procedure; however, we could not show any major benefits in our patients. Thus, this issue needs to be addressed by conducting other studies with more patients

[ acute effects of cardiac resynchronization therapy on severity of mitral regurgitation in end-stage heart failure patients]

Cardiac resynchronization therapy [CRT] has proved as an efficient treatment in patients with end stage Heart failure. Previous studies showed the beneficial long term effects of CRT on the severity of mitral regurgitation [MR]. The aim of this study was to evaluate acute effects of CRT on severity of MR. This study was a double blind randomized trial performed from 1387 to 1388 in Imam Khomeini Hospital. Echocardiographic parameters including severity of MR were measured before and after CRT implantation with different echocardiographic methods. Patients had a significant improvement in severity of MR [14% Vs. 11% P<0/05], in increasing ejection fraction [18/04 Vs. 24/42 P<0/05] and in decreasing end systolic diameters [6/14 Vs. 5/98 P<0/05] and end diastolic diameters [7 Vs. 6/8 P<0/05] after CRT implantation. The reduction of MR was significantly correlated with the improvement of ejection fraction [P=0.07]. The mechanism of decreasing severity of MR is not yet truly understood and may be different in acute and chronic phases. Correction of left ventricular dyssynchrony might influence the improvement of MR severity. Also, synchronization of papillary muscle and increased transmitral pressure with more forceful mitral valve closure, decreases regurgitation fraction and volumes is proposed for these beneficial effects. If posterior papillary muscle is involved in dyssynchrony, the acute reduction of MR following CRT is expected but if the dyssynchrony is mainly at the lateral parts of left ventricle MR might be improved in longer durations

Prediction of primary slow-pathway ablation success rate according to the characteristics of junctional rhythm developed during the radiofrequency catheter ablation of atrioventricular nodal reentrant tachycardia

Nowadays, developed junctional rhythm [JR] that occurs during slow-pathway radiofrequency [RF] catheter ablation of atrioventricular nodal reentrant tachycardia [AVNRT] has been focused upon as a highly sensitive surrogate end point for successful radiofrequency ablation. This study was conducted to assess the relationship between the presence and pattern of developed JR during the RF ablation of AVNRT and a successful outcome. Seventy-five patients aged between 14 and 88 who underwent slow-pathway RF ablation due to symptomatic AVNRT were enrolled into the study and received a total of 162 RF energy applications. Combined anatomic and electrogram mapping approach was used for slow-pathway RF ablation. The ablation procedure consisted of 60-second, 60 [degree sign] C temperature-controlled energy delivery. After each ablation pulse, successful ablation was assessed according to the loss of AVNRT inducibility via isoproterenol infusion. Four different patterns were considered for the developed JR, namely sparse, intermittent, continuous, and transient block. Success ablation rate was assessed with respect to the position, pattern, and number of junctional beats. Successful RF ablation with a loss of AVNRT inducibility was achieved in 43 [57.3%] patients using 119 RF energy applications [73.5%]. JR developed in 133 of the 162 [82.1%] applications with a given sensitivity of 90.8% and low specificity of 41.9% as an end point of successful RF ablation, with a negative predictive value of 62.1%. The mean number of the developed junctional beats was significantly higher in the successful ablations [p value <0.001], and the ROC analysis revealed that the best cut-off point of the cumulative junctional beats for identifying accurate AVNRT ablation therapy is 14 beats with 90.76% sensitivity and 90.70% specificity. There were no significant differences in terms of successful ablation rates according to the four different patterns of JR and its positions [p value = 0.338, p value = 0.105, respectively] in the univariate analyses. JR is a sensitive but non-specific predictor of the successful RF ablation of AVNRT. Nevertheless, according to the results, its specificity could increase with the presence of more than 14 cumulative junctional beats. Although the development of JR during slow-pathway RF ablation seems not to be reliable as a success end point, its absences could be a marker of requiring more energy application to ablate the slow pathway

Left-sided angiosarcoma of heart: a rare case

A 22-year-old man presented with exertional dyspnea commencing one month prior to his admission. Echocardiography revealed a non-homogenous mass, and the pathology examination of the pericardial biopsy was compatible with angiosarcoma

Transient severe left ventricular diastolic dysfunction during intraoperative transesophageal echocardiography - A case report

A 55-year-old man with significant lesion of left anterior descending artery and left ventricular systolic dysfunction, became candidate for coronary artery bypass grafts surgery. Intraoperative transesophageal echocardiography [TEE] was done for evaluation of severity of mitral regurgitation. During surgery, suddenly systolic blood pressure dropped to 50 mmHg and lasted for 2 minutes and grade III left ventricular [LV] diastolic dysfunction occurred. After restoring blood pressure to 110/60 mmHg, LV diastolic pattern returned to baseline pattern. The decreased coronary perfusion pressure and its effect on diastolic function may be responsible for this pattern of diastolic dysfunction