Diagnostic value of NT-BroBNP in HF patients admitted with dyspnea in Emergency Department

Considering the increasing prevalence of patients with dyspnea and the possibility of heart disease, as well as unavailability of echocardiography specially in primary care situations and unreliability of echocardiography findings in some diseases and finding NTProBNP as a diagnostic factor in heart failure in these patients, this study was done to determine the accuracy of NTProBNP in comparison to echocardiography in the diagnosis of heart failure in Modarress Hospital, in Tehran, between 2006 and 2007. This study, with a clinical trial diagnostic design, was performed on patients with chief complaint of dyspnea. The NTProBNP marker of serum was determined by Elecsys and patients were categorized according to age adjusted reference book values into two groups of with and without heart failure. Then, the patients underwent Simpson Echocardiography and Tissue Doppler; and the positive and negative predictive value for NTProBNP in relation to the echocardiography was determined and analyzed by statistical tests. One hundred patients were analyzed. Mean age was 59 +/- 11.8 years and 70% were male. PPV was 84%, NPV was 70.4%, false positive was 16%, while false negative was 29.5%. Sensitivity was 78%, specificity 77%, and accuracy was equal to 78%. It seems that NTProBNP marker is a good test for screening patients with dyspnea and besides clinical criteria it has an acceptable diagnostic value. It would be good to perform other studies, using more precise laboratory methods and reevaluation of cut point especially for Iranian patients considering factors other than age to obtain a rapid, easy, and costeffective test in primary care

Diagnostic precision of the electrocardiogram for detection of culprit lesion of infarct related artery in acute st elevation myocardial infarction

Despite impressive advances in diagnosis over the past decades, ST elevation myocardial infarction [STEMI] continues to be a major public health problem in the many countries. In majority of patients with some STEMI, changes can be documented when serial electrocardiography [ECG] are compared: however, many factors limit the ability of ECG to diagnose and localize myocardial infarction [MI]. The aim of this study was to evaluate accuracy of ECG in diagnosis and localization of MI. This prospective study was conducted on patients with STEMI who were admitted in Modarress Hospital, in Tehran. All patients underwent electrocardiography and angiography. Then, findings of these two noninvasive and invasive diagnostic methods were described with two independent operators. 140 STEMI patients [80 patients with anterior and 60 patients with inferior MI] were enrolled in this study. Presence of complete right bundle branch block [CRBB] in ECG of patients with anterior MI had the least negative predictive value [NPV=69%]. ST segment depression more than 1mm in lead d1 had the most positive predictive value [ppb=97%] for right coronary artery involvement. ST segment elevation in leads v5 and v6 had the least positive value [ppv= 81%] for LCX involvement. ST segment depression in inferior leads had the most negative predictive value [94%] for LAD involvement. In patents with STEMI, electrocardiography alone is not a good diagnostic method to diagnose and localize MI

[Assessment of right ventricular function among hypertensive patients using pulse tissue doppler]

Classically, one's heart function is mostly based upon its systolic function, whereas the diastolic function steps on second order. In recent years it has been revealed that diastolic function plays an important role in both cardiac mortality and cardiac morbidity. On the other hand is hypertension which due to increasing the afterload, interferes with these functions of heart. In this study we assessed the diastolic function of hypertensive patients using pulse tissue Doppler. 30 patients with high blood pressure that had not consumed anti-hypertensive agents and along with 30 healthy control ones enrolled in our survey, all of whom had normal sinus rhythm without detectable symptoms corresponding to congestive heart failure, ischemia, valvular diseases and pulmonary problems. 2D echocardiography was performed in both groups as well as M Mode and Doppler ech. The PTD echo was performed by the lateral annulus of both tricuspid and mitral valves. Systolic and diastolic findings were measured by PTD. Hypertensive patients had negative diastolic findings but no negative systolic ones. PTS illustrated that E/A ratio [early peak velocity / late peak velocity] in right ventricle had significantly decreases [P<0.01] among these patients. In right ventricle, both RT [relaxation time] [P<0.01], DT [decelation time] [P<0.04] and Am [Late Peak Velocity] [P<0.03] were converesly increased. Right ventricular E/A ratio had a significant correlation with that of left ventricle [P<0.005, r =0.5]. It seems that hypertension is longitudinally related with diastolic disfunction of right ventricle. This disturbance would be represented by the lengthened RT and decreasing of E/A ratio which are both resulted from interfering of two ventricle's function and increased pressure of left ventricle. Therefore, PTD can be applied to evaluate the right ventricular diastolic function among patients with high blood pressure

[Determination of D-Dimer value in diagnosis of atrial thrombus in patients with atrial fibrillation]

Considering the and importance of formation of atrial Thrombus [AT] in patients who had developed atrial fibrilation [AF] and its early diagnosis, and with some regards to several reports on benefits of applying the D-Dimer test in such conditions, this study was carried out to detemine the accuracy and value of this test compared to the gold standard method of Trans-Esophageal Echocardiography [TEE] in patients referring to Modarres hospital. This clinical trial was performed on 73 patients whom were diagnosed as having AF. A more accurate method of TEE was applied to confirm if they had atrial thrombi. For determination of value of D-Dimer test in diagnosis of AT, 5 [cc] of blood was taken from any subjects. The results were regarded normal if the D-Dimer level was less than 500 ng/ml. Then positive and negative predictive values [PPV and NPV] were calculated as diagnostic measurments. Of the 73 subjects of this study [67% women versus 33% men] with mean age of 44.7 +/- 12 years old, there was 53.4% who had the history of Warfarin usage. According to the results of D-Dimer test, 33% had reached to positive levels, whereas 67% revealed to have no thrombus. The PPV of this test was calculated 48.6% and the NPV was 81.6%. Regarding the present condition of our patients and the excessive use of Warfarin among them and also probable failures of D-Dimer test, this test does not have the acceptible capability [particularly duringin these situations] in diagnosing AT