Comparison between Emergency Severity Index and Heart Failure Triage Scale in heart failure patients: A randomized clinical trial / 世界急诊医学杂志（英文）

BACKGROUND@#It is not clear whether Emergency Severity Index (ESI) is valid to triage heart failure (HF) patients and if HF patients benefit more from a customized triage scale or not. The aim of study is to compare the effect of Heart Failure Triage Scale (HFTS) and ESI on mistriage among patients with HF who present to the emergency department (ED).@*METHODS@#A randomized clinical trial was conducted from April to June 2017. HF patients with dyspnea were randomly assigned to HFTS or ESI groups. Triage level, used resources and time to electrocardiogram (ECG) were compared between both groups among HF patients who were admitted to coronary care unit (CCU), cardiac unit (CU) and discharged patients from the ED. Content validity was examined using Kappa designating agreement on relevance (K*). Reliability of both scale was evaluated using inter-observer agreement (Kappa).@*RESULTS@# Seventy-three and 74 HF patients were assigned to HFTS and ESI groups respectively. Time to ECG in HFTS group was significantly shorter than that of ESI group (2.05 vs. 16.82 minutes). Triage level between HFTS and ESI groups was significantly different among patients admitted to CCU (1.0 vs. 2.8), cardiac unit (2.26 vs. 3.06) and discharged patients from the ED (3.53 vs. 2.86). Used resources in HFTS group was significantly different among triage levels (H=25.89; df=3; P<0.001).@*CONCLUSION@# HFTS is associated with less mistriage than ESI for triaging HF patients. It is recommended to make use of HFTS to triage HF patients in the ED.

correlation between left and right ventricular ejection fractions in patients with ischemic heart disease, documented by cardiac magnetic resonance imaging

Introduction: The correlation between right and left ventricular ejection fractions [RVEF and LVEF, respectively] has been studied in only a small number of patients with a marked decrease in RVEF and LVEF. The aim of the present study was to compare LVEF and RVEF in patients with ischemic heart disease. RVEF and LVEF were measured by Cardiovascular Magnetic Resonance [CMR] imaging

Materials and Methods: This observational study was done in Ghaem general hospital in 2014. LVEF and RVEF were measured in a series of 33 patients with ischemic heart disease, undergoing CMR for the evaluation of myocardial viability. The correlation between RVEF and LVEF in patients with ischemic heart disease was studied, using Pearson product-moment correlation coefficient analysis

Results: Right ventricular end diastolic volume [186.33 +/- 58.90] and left ventricular end diastolic volume [121.72 +/- 61.64] were significantly correlated [r=0.223, P=0.005]. Moreover, there was a significant correlation between right ventricular end systolic volume [88.18 +/- 40.90] and left ventricular end systolic volume [140.96 +/- 35.33] [r=0.329, P=0.000]. The most significant association was observed between RVEF and LVEF [r=0.913, P=0.000]

Conclusion: Based on the findings, RVEF and LVEF were significantly correlated in patients with ischemic heart disease, although this association was not always present in all cardiac patients. The cause of this discrepancy is still unknown

Epicardial adipose tissue and coronary artery disease: an article review

Adipose tissue surrounding the heart may contribute in the progression of coronary atherosclerosis due to its proximity to the coronary arteries. In addition, epicardial adipose tissue has paracrine and endocrine functions. It can secrete numerous bioactive molecules. Most previous studies examined the relation between coronary artery disease and epicardial adipose tissue have used echocardiography and have reported controversial results, probably due to differences in measurement techniques and study populations. This study aimed to give a brief review on the value of echocardiographic assessment of epicardial adipose tissue in the prediction of coronary artery disease severity. Epicardial adipose tissue, easily and non-invasively evaluated by transthoracic echocardiography, can be considered as an adjunctive marker to classical risk factors despite all the limitations. Moreover, it might be recommended as a useful quantitative screening examination for the prediction of the presence and the severity of coronary artery disease and the extent of atherosclerosis

Acute ST-Elevation myocardial infarction after coronary stent fracture

The invention of the drug-eluting stent [DES] has brought about revolutionary changes in the field of interventional cardiology. In the DES era, in-stent restenosis has declined but new issues such as stent thrombosis have emerged. One of the emerging paradigms in the DES era is stent fracture. There are reports about stent fracture leading to in-stent restenosis or stent thrombosis. Most of these reports concern the Sirolimus-eluting stent. The present case is a representation of a Biolimus-eluting stent fracture. We introduce a 64-year-old male patient, for whom the BioMatrix stent was deployed in the right coronary artery. Five months after the implantation, he experienced acute myocardial infarction, with stent fracture leading to stent thrombosis being the causative mechanism. Another DES [Cypher] was used to manage this situation, and the final result was good

Contrast-induced nephropathy: a review of literature

Today, radiological procedures using intravascular iodinated contrast media are being widely used for the diagnoses and treatment of various diseases, which highlight one of the main etiologies of contrast-induced nephropathy and hospital-acquired renal failure. Contrast-induced nephropathy development is associated with longer hospital stay, increase in both short- and long-term morbidity and mortality, in addition to greater health care costs. The pathogenesis of contrast-induced nephropathy has not yet been fully explained in detail; however it is clear that the root concept is medullary hypoxia-induced renal tubular damage. Chronic kidney disease and diabetes mellitus are the two most important intrinsic predisposing factors to contrast-induced nephropathy. As no treatment can specifically target contrast-induced nephropathy, the main goal for clinicians is prevention of the disease. While the best approach for achieving this goal is still controversial, optimization of the patients' circulating volume remains the only proven strategy to date. As contrast-induced nephropathy is a potentially preventable clinical condition, its better understanding will lead to better prevention of this disease. Hereby, we aimed to discuss contrast-induced nephropathy from 7 different aspects in clinical practice: 1] clinical aspect, 2] prevalence, 3] pathophysiology, 4] contrast agents and renal cell apoptosis, 5] different contrast media, 6] prevention, and 7] treatment

Optimal stent expansion by stent balloon multiple inflation at nominal pressure in resistant lesions: a new technique

Introduction: This study aimed to evaluate the effects of four-time inflation of the stent balloon at nominal pressure on optimal stent expansion in resistant lesions

Materials and Methods: This interventional study was conducted on 39 patients with coronary artery lesions, in whom Zotarolimus-eluting stents [N=20], Paclitaxel-eluting stents [N=11] and other stents [N=8] were deployed four times at nominal inflation pressure and increased inflation times [5, 15, 30 and 45 seconds]. After the deployments, enhanced stent visualization imaging technique [IC stent] was used to assess stent placement and artery expansion

Results: In this study, early success rate was estimated at 79.5% using the enhanced stent visualization imaging technique. In addition, major adverse cardiac event [MACE] was determined at 2.6%. Also, conventional methods resulted in lower success rate and higher MACE in resistant lesions

Conclusion: According to the results of this study, four-time stent balloon inflation at nominal pressure could allow adequate stent expansion in resistant lesions leading to lower MACE

No-reflow phenomenon in patients with St-elevation acute myocardial infarction, treated with primary percutaneous coronary intervention: a study of predictive factors

Introduction: No-reflow phenomenon in coronary vessels, manifested in some patients with reperfused acute myocardial infarction [MI], is associated with poor clinical and functional outcomes. Therefore, evaluation of predisposing risk factors can be helpful in risk assessment and identification of patients at higher risk. Herein, we aimed to study the predictive factors for the development of no-reflow phenomenon in patients with ST-elevation acute MI [STEMI], following primary percutaneous coronary intervention [PCI]

Materials and Methods: Overall, 141 patients with STEMI, treated with primary PCI, were enrolled in a cross sectional study. Angiographic data associated with no-reflow phenomenon including thrombolysis in MI [TIMI] were evaluated. Patients were divided into study and control [TIMI grade 3] groups. Demographic, clinical and laboratory [lab] data including cardiovascular risk factors [e.g., diabetes, hypertension, hyperlipidemia, smoking], door-to-balloon time, serum creatinine and glucose levels, white and red blood cell counts [WBC and RBC counts, respectively], mean platelet volume [MPV], and red cell distribution width [RDW] were evaluated in both groups

Results: The mean age of the patients was 60.3 +/- 11.9 years. No-reflow was observed in 35 [24.8%] cases. WBC count, MPV, serum creatinine, BS, and high-density lipoprotein [HDL] levels were significantly correlated with TIMI flow <3

Conclusion: Certain lab indices including MPV, WBC count, creatinine and HDL levels played significant independent roles in the no-reflow phenomenon. Thus, measuring such parameters might be helpful in predicting the risk of this condition in patients; however, further studies are required

[Influence of various factors on Response to Streptokinase therapy for acute myocardial Infarction]

Prevalence of ischemic heart diseases, especially acute myocardial infarction and its incidence in lower age has increased and treatment during the acute phase of myocardial infarction plays an important role in the prognosis and quality of life. In our study, we aimed to evaluate the effects of streptokinase on treatment of acute myocardial infarction based on different variables. In our study, we evaluated patients with acute myocardial infarction who received streptokinase. Information obtained from patients based on patient examination, ECG findings [before and after drug administration] and the results of relevant laboratory tests, then entered in the relevant checklist. Criteria for response to drug were reduced chest pain with at least 50 percent reduction in ECG ST Elevation in electrocardiography taken 30 or 90 minutes after the Streptokinase therapy. Relation between age [P<0.001], LDL [0.001], diabetes mellitus [P=0. 01], location of MI [P=0.001], Killip Class [P<0.001], patients referring delay [P<0.001] and the effect of streptokinase were significant. While gender, hypertension, smoking, previous ischemic heart disease, time of symptoms onset and type of streptokinase didn't affect significantly the response to streptokinase. Considering our results, patients with acute MI less than 30 years and more than 80 years, diabetics, LDL more than 100mg/dl, extensive anterior MI, new LBBB, Killip Class 3 or 4 and delay of referring more than 12 hours predict poor response streptokinase, and may benefit more from early invasive strategy than thrombotic therapy