Prognostic value of troponin T after elective percutaneous coronary intervention

Cardiac troponin T [cTnT] is a sensitive and specific marker of myocardial necrosis. Prognostic significance of isolated minor elevations of cTnT is a matter of debate .The aim of this study was to assess the impact of minor elevations of cTnT on major adverse cardiac events [MACE] following percutaneous coronary intervention [PCI]. We measured cTnT levels before and after PCI and evaluated the outcomes of 112 patients with normal baseline cTnT and complex coronary artery disease who required nonemergency PCI. Elevations [more than 0.03ng/ml] in cTnT were seen in 39 patients [34.8%].The angiographic characteristics of patients with increased cTnT levels had borderline differences compared to those with normal post PCI cTnT levels. Over a mean follow-up duration of 22 months, myocardial infarction [p<0.01] and the combined rate of death, myocardial infarction and revascularization [p<0.001] were significantly higher in patients with increased levels of post PCI cTnT. Estimated 22-month MACE-free survival for patients with increased and normal cTnT levels were 66.7% and 93.2%, respectively. Isolated minor elevations in cTnT after elective PCI in complex coronary lesions affect long-term prognosis regarding death, myocardial infarction and the need for repeated revascularization procedures

Aortocoronary dissection during diagnostic coronary angiography: Treatment with multiple stenting of the coronary artery

Catheter-induced combined coronary artery- ascending aorta dissection following diagnostic coronary angiography is rare. Localized aortic dissection has been treated by stenting the coronary artery and sealing the entry point. We describe a very long spiral right coronary artery dissection extending to the ascending aorta during coronary angiography. The dissection was limited to the proximal 35mm of the ascending aorta evaluated by Transesophagial echocardiography and was successfully treated by multiple stenting of the right coronary artery including the entry point of the aortic dissection which was monitored by means of echocardiography

[Left ventricular systolic dysfunction among nocturnal myocardial infarctions]

Background and Objective: Diurnal variation in the onset of acute myocardial infarction with a peak in the morning has been demonstrated. Few data are available concerning about the left ventricular systolic dysfunction according to the infarct time. Regarding importance of onset of heart failure following acute myocardial infarction, this study was done to survey the effect of the time of acute myocardial infarction on left ventricular systolic dysfunction

Methods: This prospective study was performed on 100 patients with acute myocardial infarction [AMI]. Left ventricular systolic dysfunction [LVSD] was defined by echocardiography when ejection fraction [EF] was less than 55%

Findings: Of these patients, 72 had EF<55% and 37% of them experienced myocardial infarction between 6 am and 5:59 pm [Group 1] and 63 experienced their AMI between 6 pm and 5:59 am [Group 2]. Left ventricular EF less than 55% occurred in 22 [59.5%] patients of group 1 compared with 50 [79.4%] in group 2 [P=0.04]. Mild, moderate and severe LVSD were also more frequent in group 2 patients [P=0.01]

Conclusion: The risk of mild, moderate and severe left ventricular systolic dysfunction after AMI is higher among infarctions that begin at night

Left ventricular diastolic abnormalities in beta-thalassemia major with normal systolic function

In order to identify left ventricular diastolic function in patients with beta- thalassemia major and normal systolic function by noninvasive M-mode and Doppler echocardiography, an analytic study was designed in a university hospital in Sari. We have studied 44 patients [23 men and 21 women], mean age 15.48 +/- 2.16 [range 12 to 20] and 43 age and sex matched control subjects. Peak flow velocity in early diastole increased in patients compared with controls [98 +/- 14vs. 86 +/- 13 cm/sec; p<0.0001], rate of deceleration of flow velocity was also increased [778 +/- 142 vs. 592 +/- 193 cm/sec [2] and 2.24 +/- 51 vs. 1.73 +/- 36, respectively; p<0.0001]. Peak flow velocity during atrial contraction was not significantly different in patients and normal control subjects. Doppler diastolic indices had no correlation with age, serum ferritin levels and cumulative blood transfused in thalassemic patients. We concluded that left ventricular diastolic flow indices identified noninvasively by Doppler echocardiography in patients with thalassemia major are altered in an early phase, when systolic function is normal

Anticardiolipin antibodies in patients with ischemic events

To determine the presence of anticardiolipin [aCL] antibodies in patients with ischemic events, we designed a case-control study. We studied 33 patients with unstable angina, 33 male patients with myocardial infarction and 34 control subjects with no evidence of ischemic heart disease. Plasma samples were assessed for IgG anticardiolipin antibodies by enzyme-linked immunosorbent assay [ELISA]. The levels of aCL were [mean +/- SD of optical density multiplied by 1000]: 624 +/- 319, 486 +/- 318, and 239 +/- 202 for patients with unstable angina, myocardial infarction and controls, respectively [F=15.74 and p=0.0000]. High aCL levels were found more often in patients with acute ischemic events

Diagnosis of primary cardiac tumors: report of 30 cases

Between 1981 and 1993,30 cases of primary cardiac tumors were diagnosed at the Imam Khomeini Hospital. 20 patients were female and 10 were male, with an average age of 32 years [ranging from 17 days to 65 years of age]. The mean duration of symptoms before diagnosis was 6 months, with dyspnea and palpitation being the most common symptoms [60%] and cardiac murmurs the most usual signs [84%]. The diagnosis of cardiac tumors was made by echocardiography in all patients. Transesophageal echocardiography and cardiac catheterization were performed in 8 and 9 patients respectively for more precise localization of the tumor and evaluation of the coronary arteries. The left atrium was the only site of tumor in 60%. 4 patients had tumors in more than one chamber. 27 patients underwent surgery without mortality while 3 patients did not undergo surgery. Pathological examination revealed benign myxoma in 23 patients, fibroma [1 patient], round cell sarcoma [I patient], chondrosarcoma [1 patient], liposarcoma [1 patient], and undifferentiated sarcoma [1 patient]