Reliability and validity of the Persian version of patient assessment of constipation- quality of life [PAC-QOL] questionnaire

Aim: The present study aimed to assess the reliability and validity of Persian version of patient assessment of constipation: quality of life [PAC-QOL] questionnaire in Iranian patients

Background: Chronic constipation has significant effects on daily living, wellbeing and individuals' quality of life [QOL]. Validated tools can help us to assessing QOL in affected ones and facilitating clinical management of them

Methods: The English version of Patient Assessment of Constipation: Quality of Life [PAC-QOL] was translated into the Persian language and was confirmed by back-translation. One hundred and forty patients with functional constipation, according Rome III criteria, completed the questionnaires .The questionnaires were analyzed using Cronbach's Alpha internal consistency score to determine the reliability. Twenty medical experts were then asked to evaluate the PAC-QOL and the results were used to calculate the Content Validity Ratio [CVR] and Content Validity Index [CVI]

Results: Due to obtained value for Cronbach's alpha [0.975] and also for the subscale of physical discomfort [0.930], psychosocial discomfort [0.975] and worries and concerns [0.915], the internal consistency is established. According to medical experts' opinions, the value of CVR ranged from 0.5 to 0.8 and the value of CVI was 0.81

Conclusion: The Persian version of PAC-QOL questionnaire is shown to have acceptable reliability and validity to be used for psychometric evaluation in Iranian patients complaining of functional constipation

C1019T polymorphism in the connexin 37 gene and myocardial infarction risk in premature coronary artery disease

Background: the C1019T polymorphism of the connexin-37 [GJA4] gene is a single-nucleotide polymorphisms involved in atherosclerotic plaque rupture and atherosclerosis predisposition. We examined the association between the C1019T polymorphism of the GJA4 gene and the occurrence of myocardial infarction [MI] in patients with premature coronary artery disease [CAD]

Methods: our study recruited 1000 patients with the final diagnosis of premature CAD and classified them into 2 groups: with a history of MI [n = 461] and without it [n = 539]. The polymorphism variants were determined via the PCR-RFLP, and then genotyping was conducted through the high-resolution melting method. From a total of 1000 patients, 554 patients, who had been previously followed-up with a median follow-up time of 45.74 months vis-à-vis long-term major adverse cardiac events, were enrolled in this retrospective cohort phase

Results: the frequencies of the wild, heterozygous, and mutant genotypes of the C1019T polymorphism were 54.0%, 40.6%, and 5.4% in the MI group and 49.2%, 43.2%, and 7.6% in the non-MI group [p value = 0.187]. After adjustment for the baseline covariates, no difference was found between the MI and non-MI groups apropos the frequency of the heterozygous genotype [p value = 0.625] and the mutant genotype [p value = 0.452]. Regarding the level of human connexin-37, the serum level of this marker was not different between the MI and non-MI groups

Conclusion: the C1019T polymorphism of the GJA4 gene may not be useful for predicting the occurrence of MI in patients with premature CAD. The presence of this polymorphism in such patients may also have a low value for predicting long-term CAD complications

Discriminative power of EuroSCORE in predicting morbidity and prolonged hospital stay in an Iranian sample population

EuroSCORE is a simple and rigorous risk stratification model and is, thus, commonly used in predicting the early and late outcomes of cardiac surgery across the world. We aimed to assess the discriminative power of the EuroSCORE model to predict postoperative morbidity and total prolonged length of stay in hospital [LOS] and Intensive Care Unit [ICU] stay in an Iranian group of cardiac surgical population. In a prospective study, the additive EuroSCORE model was applied to 570 patients undergoing isolated coronary artery bypass grafting [CABG] at Tehran Heart Center. The discrimination power of the EuroSCORE model was tested by the area under the receiver operating characteristic [ROC] curve and the calibration by comparing the observed and predicted outcomes across the risk spectrum assessed using the Hosmer-Lemeshow goodness-of-fit test. Mean age was 59.03 +/- 0.73 years and 429 out of 570 [75.3%] patients were men. The overall morbidity rate was 47.5%. The observed morbidity in the high-risk patients [EuroSCORE > 6] was significantly greater than that in the low-risk patients [EuroSCORE 14 days] and prolonged ICU stay [> 72 hours] were more prevalent in the high-risk group than in the low-risk group. The discriminative power of EuroSCORE in predicting morbidity, prolonged LOS, and ICU stay was poor with an area under the ROC curve of 0.617, 0.598, and 0.581, respectively. However, this risk score showed good calibrations for morbidity [p value = 0.119], prolonged LOS [p value = 0.958], and prolonged ICU stay [p value = 0.620]. EuroSCORE provided inappropriate discrimination in predicting early morbidity and prolonged LOS and ICU stay in our study population. Creating a revised model may enable us to accurately predict outcomes in Iranian CABG patients

Factor structure of the world health organization's quality of life questionnaire-BREF in patients with coronary artery disease

The World Health Organization Quality of Life Questionnaire [WHOQOL]-BREF is one of the most known general questionnaires for assessment of quality of life [QOL] in both healthy populations and in various diseases subgroups. The aim of the present study was to examine the construct validity of this questionnaire in patients with coronary artery disease [CAD] using factor analysis. Two hundred and seventy-five patients aged 35-80 years old with the diagnosis of CAD admitted to the Tehran Heart Center operating room for coronary artery bypass were consecutively entered into the study. QOL was assessed using the WHOQOL-BREF. To estimate the reliability of the QOL questionnaire, Cronbach's alpha coefficient was measured. To assess the structure of the questionnaire, we firstly performed confirmatory factor analysis to test the hypothesized factor models. Exploratory factor analysis was then performed using the principal component method with varimax rotation. Reliability of the questionnaire was low [Cronbach's alpha for different domains ranged from 0.24 to 0.74]. In confirmatory factor analysis, only the 1-factor model indicated a good fit to the data. The exploratory factor analysis indicated a five-factor solution that jointly accounted for 55.7% of the variance observed. Also, the pattern of item loading was very different from the original structure of the questionnaire. The findings suggest that the WHOQOL-BREF might only be a measure of the overall QOL in patients with CAD, and is not a suitable instrument for measuring the different QOL dimensions as expected in this population

Plausible impact of dietary habits on reduced blood sugar in diabetic opium addicts with coronary artery disease

The effect of opium on glycemic control in diabetics is a controversial issue, as some studies have shown glucose lowering effect of opium in diabetes while the results of other studies do not support this idea. The possible role of opioid peptides in the regulation of food intake has been previously investigated. However, there is no data available about relationship between opium using and dietary pattern. The aim of the present study was to determine the daily intake of different nutrients in opium addict with diabetes diagnosed with coronary artery disease [CAD]. This study comprised 232 consecutive diabetic patients with CAD, and candidates for isolated coronary artery bypass surgery in Tehran Heart Center. Of these, 26 patients were opium addicts. Nutritional assessment was obtained by a validated semi-quantitative food frequency questionnaire [FFQ]. In opium addicts compared to non-addicts, consumption of carbohydrates [360.0 +/- 120.9 versus 447.8 +/- 249.8 Gr/day, P=0.016] and vitamin A [1170.4 +/- 570.2 versus 1496.3 +/- 889.6 micro g/d as Retinol Activity Equivalent [RAE], P=0.040] was lower than non-addicts and intake of other nutrients were similar across two group of patients. Opium addiction in diabetic patients may lead to decrease of vitamin A and carbohydrate intake. This study showed that carbohydrate intake in addicted diabetic patients is lower than their non-addict counterpart. Thus, the so called lowering effect of opium on blood sugar may be due to nutritional habit of addicted patients

Characterization of suitability of coronary venous anatomy for targeting left ventricular lead placement in patients undergoing cardiac resynchronization therapy

Differences in the quantity and distribution of coronary veins between patients with ischemic and non-ischemic cardiomyopathy might affect the potential for the left ventricular [LV] lead targeting in patients undergoing cardiac resynchronization therapy [CRT]. In the current study, we assessed and compared the suitability of the coronary venous system for the LV lead placement in ischemic and dilated cardiomyopathy. This single-centre study, performed at our hospital, retrospectively studied 173 patients with the New York Heart Association class III or IV who underwent CRT. The study population was comprised of 74 patients with an ischemic underlying etiology and 99 patients with a non-ischemic etiology. The distribution of the veins as well as the final lead positions was recorded. There was no significant difference between the two groups in terms of the position of the available suitable vein with the exception of the posterior position, where the ischemic group had slightly more suitable veins than did the dilated group [48.4% versus 32.1%, p value - 0.049]. There was also no significant difference with respect to the final vein, through which the LV lead was inserted. Comparative analysis showed that the patients with previous coronary artery bypass grafting surgery [CABG] had significantly fewer suitable veins in the posterolateral position than did the non-CABG group [16.3% versus 38.7%, p value = 0.029]. There was, however, no significant difference between the two subgroups regarding the final vein position in which the leads were inserted. The final coronary vein position suitable and selected for the LV lead insertion was not different between the cases with cardiomyopathy with different etiologies, and nor was it different between the ischemic cases with and without a history of CABG. Patients with a history of procedures around the coronary vessel may have an intact or recovered venous system and may, therefore, benefit from transvenous LV lead placement for CRT

Effects of cardiac rehabilitation program on right ventricular function after coronary artery bypass graft surgery

Cardiac rehabilitation has been recognized as one of the most effective strategies for managing cardiovascular indices as well as controlling the cardiovascular risk profile, in particular after coronary artery bypass graft surgery [CABG]. However, the effect of this program on right ventricular function following CABG is unclear.The aim of this study was to evaluate the impact of cardiac rehabilitation on the right ventricular [RV] function in a cohort of patients who underwent CABG. A total of 28 patients who underwent CABG and participated consecutively in an 8-week cardiac rehabilitation program at Tehran Heart Center were studied. The control group consisted of 39 patients who refused to attend cardiac rehabilitation and only received postoperative medical treatment after registration in the Cardiac Rehabilitation Clinic. Two-dimensional and Doppler echocardiography was performed to assess the RV function in both groups at the three time points of before surgery, at the end of surgery, and at the end of the rehabilitation program. Significant increase of RV function parameters were observed in both rehabilitation group [RG] and control group [CG] at the end of the rehabilitation program compared with post-CABG evaluation in terms of tricuspid annular plane systolic execution [RG: 12.50 mm to 14.18 mm; CG: 13.41 mm to 14.56 mm], tricuspid annular peak systolic velocity [RG: 8.55 cm/s to 9.14 cm/s; CG: 9.03 cm/s to 9.26 cm/s], and tricuspid annular late diastolic velocity [RG: 8.93 cm/s to 9.39 cm/s; CG: 9.26 cm/s to 9.60 cm/s].The parameters of the RV function did improve in both groups, but this improvement was not associated with participation in the complete cardiac rehabilitation program. The R Vfunction parameters gradually improved after CABG; this progress, however, was independent of the exercise-based cardiac rehabilitation program

Increased carotid artery intima-media thickness in pregnant women with gestational diabetes mellitus

Pregnant women with previous gestational diabetes mellitus are at increased risk of progressive carotid artery disorders. The current study evaluated carotid intima-media thickness [IMT] in pregnant women with gestational diabetes at two time points of mid-term and full-term pregnancy to determine whether gestational diabetes mellitus causes increased IMT. This cross-sectional study carried out at Afzalipour Hospital [Kerman, Iran] between 2009 and 2010, recruited 50 women who were at high risk of gestational diabetes during pregnancy and had an oral glucose challenge test [OGCT] as screening for gestational diabetes. B-mode ultrasound scans were performed at baseline and at two time points of midterm pregnancy [20 to 24 weeks] and full-term pregnancy [36 to 38 weeks] on all the participants. The mean IMT of common carotids and internal carotid arteries from two walls [near and far walls] at four different angles was assessed. An overall comparison between the impaired OGCT test group and the control group revealed significant differences in carotid IMT in the mid-term [0.65 +/- 0.07 vs. 0.59 +/- 0.06 mm; p value = 0.002] and full-term [0.65 +/- 0.05 vs. 0.59 +/- 0.04 mm; p value < 0.001] pregnancy; however, the trend of the changes in carotid IMT during mid to full-term pregnancy was insignificant in each group [p value > 0.05]. Carotid IMT was significantly higher in the women with gestational diabetes than that in the normoglycemic group in different trimesters. This finding denotes that atherosclerosis might start years before the diagnosis of gestational diabetes in vulnerable women

Baseline systolic blood pressure response to exercise stress test can predict exercise indices following cardiac rehabilitation program

Systolic blood pressure recovery [rSBP] is of prognostic value for predicting the survival and co-morbidity rate in patients with coronary artery disease [CAD]. This study investigated the association between rSBP and exercise indices after complete cardiac rehabilitation program [CR] in a population-based sample of patients undergoing coronary artery bypass grafting [CABG]. The sample population consisted of 352 patients who underwent pure CABG. The patients underwent standard symptom-limited exercise testing immediately before and also after the completion of the CR sessions. rSBP was defined the ratio of the systolic blood pressure at 3 minutes in recovery to the systolic blood pressure at peak exercise. An abnormal baseline rSBP after exercise was a strong predictor of exercise parameters in the last session, including metabolic equivalents [beta = -0.617, SE = 0.127, p value < 0.001] and peak O2 consumption [beta = 1.950, SE = 0.363, p value < 0.001] measured in the last session adjusted for baseline exercise characteristics, demographics, function class, and left ventricular ejection fraction. The current study strongly emphasizes the predictive role of baseline rSBP after exercise in evaluating exercise parameters following CR. This baseline index can predict abnormal METs value, peak O2 consumption, post-exercise heart rate, and heart rate recovery after a 24-session CR program

Intravenous sufentanil and morphine for post-cardiac surgery pain relief using patient-controlled analgesia [PCA] device: a randomized double-blind clinical trial

Selection of the best analgesic technique in patients undergoing major surgeries can result in lower morbidity and satisfactory postoperative pain relief. In the present study, we tried to compare the effect of morphine and sufentanil on postoperative pain severity and hemodynamic changes by using patient-controlled analgesia [PCA] device in patients who were candidate for coronary artery bypass surgery [CABG]. It was a randomized double-blinded clinical trial in which 120 patients aged 30-65 years, ASA physical status I-Ill, candidate for CABG in Shahid Rajaee hospital in Tehran were included. Before anesthesia, patients were randomly assigned to one of three groups to receive sufentanil [n=40], morphine [n=40] or normal saline [n=40]. After tracheal extubation at intensive care unit, PCA was started by, sufentanil 4mg for the first group, morphine 2mg for the second group and normal saline, at same volume for the third group, intravenously with 10 minute lockout interval. Postoperative pain was evaluated by VAS scale, 1, 6, 12, 18 and 24 hours after extubation and systolic blood pressure, arterial oxygen saturation, PCO2 and PO2 were recorded 24 hours after extubation. VAS scores at rest revealed significantly less pain for patients in sufentanil and morphine groups than normal saline group, throughout the twenty-four hours after operation [P<0.001]. However, there were no significant differences in the means of VAS scores between sufentanil and morphine groups. Among studied hemodynamic parameters, only systolic blood pressure was reduced more in morphine than sufentanil group [P<0.001]. After CABG surgery, administration of intravenous sufentanil and morphine using PCA can lead to similar reduction of postoperative pain severity

Relationship between calcium-phosphorus product and severity of valvular heart insufficiency in patients undergoing chronic hemodialysis

Recent interests have mainly focused on the roles of serum calcium and phosphorus and their product [Ca-P product] in the development of valvular heart disease. The present study assessed the relationship between the Ca-P product and the severity of valvular heart disease in end-stage renal disease [ESRD] patients undergoing chronic hemodialysis. This cross-sectional study reviewed the clinical course of 72 consecutive patients with the final diagnosis of ESRD candidated for chronic hemodialysis. The severity of valvular heart disease was determined using M-mode two-dimensional echocardiography. The serum calcium and phosphate values adopted were those values measured on the day between the two consecutive dialyses, and the Ca-P product was calculated. The most common causes of ESRD were diabetic nephropathy, malignant hypertension, and chronic glomerulonephritis. The mean Ca-P product level in the dialysis patients was 50.44 +/- 17.78 mg2/dL2. The receiver-operator characteristic [ROC] curve illustrated that a Ca-P product level>42 mg2/dL2 was the optimal value in terms of sensitivity and specificity for predicting the presence of valvular insufficiency. Aortic insufficiency was directly associated with a high Ca-P product value after adjustment for age, gender, serum albumin, diabetes, hypertension, hyperlipidemia, coronary artery disease, and serum creatinine [P=0.412, SE=158, p value=0.011]. A positive relationship between the Ca-P product value and the severity of aortic insufficiency is expected. Achieving an appropriate control of the Ca-P product level may decrease aortic valve calcification and improve the survival of patients on chronic hemodialysis

Ablation of focal right upper pulmonary vein tachycardia using retrograde aortic approach

The use of diagnostic and therapeutic methods for assessing pulmonary vein due to its status as a main source of ectopic beats for the initiation of atrial dysrrythmias is strongly recommended. We report the case of a 13-year-old girl who was admitted to our hospital with the electrocardiogram manifestation of an ectopic atrial tachycardia. The focus of arrhythmia was inside the right upper pulmonary vein. The patient underwent successful ablation with a conventional electrophysiology catheter via the retrograde aortic approach. We showed that when the origin of atrial tachycardia is in the right upper pulmonary vein, it is possible to advance the catheter into this vein via the retrograde aortic approach and find the focus of arrhythmia. This case demonstrates that right upper pulmonary vein mapping is feasible through the retrograde aortic approach and it is also possible to ablate the arrhythmia using the same catheter and approach

Diagnostic performance of the post-exercise systolic blood pressure response for the detection of severe coronary artery disease

Systolic blood pressure recovery [rSBP] immediately after exercise effectively predicts survival and co-morbidity in those with atherosclerotic heart disease. The aim of this study was to evaluate the diagnostic value of the rSBP index for detecting coronary artery disease [CAD] severity. Prospective cross-sectional study Shafa Hospital, Kerman Province, Iran between March and August 2009 Ninety-four consecutive adult patients who were candidates for evaluation of CAD Interventions: Exercise stress testing and initial coronary angiography Main Outcome Measures: The rSBP was calculated by dividing the SBP three minutes after exercise by the SBP at peak exercise. Subjects with a high ratio of SBPs at 3 min of recovery to peak exercise were more likely to have severe CAD, adjusting for age, gender and body mass index using multivariate logistic regression analysis. The sensitivity, specificity, positive predictive value and negative predictive value of abnormal rSBP for predicting severe CAD were 42.6%, 81.8%, 50.0% and 77.1%, respectively. According to the ROC curve analysis, the rSBP measurement was a good indicator of severe CAD with areas under the ROC curves 0.652 [95% CI: 0.524 - 0.780]. The optimal cut-off value for rSBP for predicting severe CAD was identified at 0.78 yielding a sensitivity of 60.7% and a specificity of 65.2%. Systolic blood pressure ratio at three minutes post-exercise is a good diagnostic marker for predicting severe CAD with a high specificity and a good discriminative power

Return to work following cardiac rehabilitation in patients undergoing cardiac procedures with an approach to patient's viewpoints and attitude

To estimate the rate of return to work [RTW] after cardiac rehabilitation and determine the relationship between RTW and clinical and socio-demographic factors with an approach to patient's attitude. Prospective follow-up study. Tehran Heart Center, Iran. Two hundred and forty six consecutive patients undergoing different types of cardiac procedures between May and September 2007 were studied. A checklist was completed for patients according to medical history and physical examination recorded in medical files. A complementary interview was also carried out by phone. Rate of RTW after cardiac rehabilitation and the relationship between RTW and clinical and socio-demographic factors. Two groups were matched for gender, age, occupation type and the type of cardiac procedures. Rehabilitated patients in comparison with control group had higher rates of RTW three month [55.4 Vs 26.2%] and eight months [94.7 Vs 81.0%] after the time of cardiac rehabilitation. Positive attitude toward RTW was observed more in rehabilitated patients three month and eight months after cardiac procedures. Cardiac rehabilitation programs [OR: 3.507, p = 0.027], preoperative functional class [OR: 6.541, p < 0.001], experience of regular physical activity at home before RTW [OR: 3.836, p = 0.004] and job support programs [OR: 4.050, p = 0.022] were main predictors for RTW eight months after cardiac procedures. Patients undergoing cardiac procedures benefit from cardiac rehabilitation to preserve work status. The need for appropriate supportive protocols can guarantee RTW after cardiac rehabilitation and improve patients' attitude toward continuing their jobs

Comparison of short-term clinical outcome of non-ST elevation versus ST elevation myocardial infarction

Studies on the prognosis of ST elevation myocardial infarction [STEMI] versus non-ST elevation myocardial infarction [non-STEMI] have shown different results. The present study was designed to compare the early outcome and left ventricular systolic function of patients with ST and non-ST elevation myocardial infarction. The patients' information was derived from 10,065 consecutive patients hospitalized in Tehran Heart Center with acute MI [2007 patients with STEMI and 8058 with non-STEMI]. The baseline clinical characteristics, post-MI complications, left ventricular systolic functions, and 30-day mortality rates were compared. A history of current cigarette smoking, opium addiction, and brain stroke was more frequent in the STEMI patients, whereas hyperlipidemia, hypertension, and obesity were found more in the non-STEMI group. Ejection fraction was higher in the non-STEMI patients than that in the STEMI group, and anterior wall infarction was detected more frequently in the STEMI cases. A history of coronary artery bypass grafting and also percutaneous coronary intervention was observed more in the non-STEMI group. Amongst the in-hospital complications, ventricular arrhythmias [1.4 vs. 0.5, P<0.001] and pulmonary edema [0.4 vs. 0.1, P=0.002] were more prevalent in the STEMI cases. The 30-day mortality rate in the STEMI group was higher than that in the non-STEMI group [5.5 vs. 2.4, P<0.001]. Early mortality in both groups was dependant on advanced age, diabetes mellitus, post-MI bradycardia, and atrioventricular block. Also, female gender and pulmonary edema in the STEMI group and family history of MI in the non-STEMI patients could predict 30-day mortality. There were several differences in the baseline characteristics and early outcome between the two types of STEMI and non-STEMI. The 30-day mortality rate was higher in the STEMI group than that in the non-STEMI group

Do C-reactive protein and lipoprotein [a] have different impacts on the severity of coronary artery disease in diabetic and non-diabetic patients?

The potential role of lipoprotein [a] changes and also inflammation in coronary artery disease [CAD] have rendered these processes one of the most interesting objects of study in patients affected by type 2 diabetes mellitus. The aim of the current study was to evaluate lipoprotein [a] and other lipid profiles and also C-reactive protein [CRP] as the predictors of cardiovascular disease severity in non-insulin dependent diabetic subjects in comparison with non-diabetic CAD patients. Between June and September 2004, 372 patients with CAD were enrolled at Tehran Heart Center. Non-insulin dependent diabetics accounted for 102 of the cases, and the remaining 270 were non-diabetics. The severity of CAD was evaluated using the Gensini score, and the effect of patient variables such as serum lipid concentrations and CRP on CAD severity in the diabetics was investigated and compared with that of the non-diabetics. The mean of the Gensini score, CRP, and serum concentrations of all the lipid profiles were similar between the diabetic and non-diabetic patients. In the diabetic group, a high CRP concentration [?=0.200, Rs= 0.040; P=0.046] was effective on the Gensini score, whereas lipoprotein [a] and lipid profiles did not influence CAD severity. In the non-diabetics, no significant relationships were found between the Gensini score and all the studied laboratory indices. A high CRP level is an important predictor of the severity of CAD in diabetic patients with CAD

Quality of life in coronary artery disease: SF-36 compared to WHOQOL-BREF

The Short Form Health Survey [SF-36] and WHO Quality of Life-BREF [WHOQOL-BREF] questionnaires are two common tools to assess changes in quality of life [QOL] over the course of treatment, especially in patients with coronary artery disease [CAD]. However, the value of these two instruments among CAD patients has not been studied and compared. The objective of the present study was; therefore, to compare the SF-36 with the WHOQOL-BREF in these patients. Between May and September 2006, patients with a final diagnosis of CAD who were candidates for isolated coronary artery bypass grafting [CABG] and hospitalized in Tehran Heart Center were randomly divided into two groups of 268 patients [for assessment of QOL with the SF-36] and 275 patients [for assessment of QOL with the WHOQOL-BREF]. The correlations between the WHOQOL-BREF domains and SF-36 subscales, in addition to those between the SF-36 components summary scores and WHOQOL-BREF domains, were examined with Pearson's correlation coefficients. The correlations between the physical, psychological, and social domains of the WHOQOL-BREF and physical functioning, mental health, and social functioning of the SF-36 were weak with Pearson's correlation coefficients of 0.015, -0.036, and 0.042, respectively [r < 0.3]. There were also poor correlations between the physical component summary of the SF-36 and physical domain of the WHOQOL-BREF [r=0.001], and between the mental component summary of the SF-36 and mental domain of the WHOQOL-BREF [r=-0.082]. The correlation between the two questionnaires of the SF-36 and WHOQOL-BREF in the evaluation of QOL in CAD patients is weak

Early outcome of coronary artery bypass grafting in patients less than 40 years old comparing with eldery patients

Age is one of the most important factors that have consistently emerged as the most potent predictors of mortality and morbidity after coronary artery bypass graft [CABG] surgery. However, early results of CABG in young patients in comparison with elderly ones have been different in previous surveys. The aim of this study was to compare shortterm mortality and morbidity in young versus older patients and evaluate the presence of risk factors and their influence on outcome in both groups. We conducted a retrospective database review of 13222 patients divided into two age groups: patients less than 40 years old [411 patients] and those older [12811 patients], who underwent CABG at Tehran Heart Center between January 2002 and January 2007. We also compared preoperative, operative, and postoperative characteristics between them and assessed the influence of the variables on the length of stay in hospital [LOS] in the two groups. Among postoperative complications, only atrial fibrillation [P<0.001] was more prevalent in the elderly group and other complications were similar. The thirty-day mortality rate was higher in the elderly group [1.1% vs. 0%, P=0.023]. Also, prolonged LOS [P<0.001] and ICU stay [P<0.001] were found more prevalent in the elderly group. Among the preoperative and postoperative variables, emergency surgery, diabetes mellitus, and previous myocardial infarction influenced the prolonged LOS in the young patients. Early mortality rate and prolonged length of stay in ICU and hospital were higher in the elderly than those in the young patients; however, other postoperative early complications were similar between the two groups

Early outcome of coronary artery bypass grafting in patients with severe left ventricular dysfunction

Left ventricular dysfunction is one of the most powerful predictors of early and late outcomes in patients who undergo coronary artery bypass grafting [CABG]. The aim of this study was to assess the early results of CABG that predict 30-day mortality and prolonged length of hospital stay [LOS] after CABG in patients with an ejection fraction [EF] of 30% or less. Seven hundred seven patients who underwent CABG with EF 30% as the control group. Demographic and clinical characteristics and postoperative complications were considered. The thirty-day mortality rate [2.3% vs. 0.8%, P<0.0001], the mean of LOS [P<0.0001], and the mean of the length of ICU stay [P<0.0001] were higher in the severe left ventricular dysfunction group than in the control group. In patients with severe left ventricular dysfunction, the mean of NYHA score [P=0.0081], prolonged ventilation [P=0.0051], and renal failure [P=0.0606] were related to the 30-day mortality rate. Also, the prolonged LOS in these patients was correlated with the female gender [P=0.0018] and atrial fibrillation [P=0.0164]. Although left ventricular dysfunction is itself an important strong risk factor in patients undergoing CABG, the early outcome of CABG in patients with left ventricular dysfunction is acceptable and the management of this factor will help to reduce the mortality and total length of stay in hospital