Main clinical determinants of the presence of coronary artery disease in patients with left bundle branch block.

BACKGROUND: Considering clinical parameters as main predictors for coronary artery dis-ease (CAD)in patients with left bundle branch block (LBBB) can be very helpful to explain high likelihood of ischemic events in LBBB conditions. In the present study, we attempted to identify major clinical determinants to predict CAD occurrence in patients with LBBB. METHODS: A retrospective chart review of 229 consecutive patients with the diagnosis of complete LBBB pattern on electrocardiograms was conducted. The final diagnosis of LBBB was based on the Criteria Committee of the New York Heart Association. The participants were also classified based on coronary angiography evidences into two groups including CAD patients (n =99) and non-CAD patients (n =130). RESULTS: Among 99 patients with CAD, 27 (27.3%) had single vessel disease, 30 (30.3%) had two-vessel disease and 42 (42.4%) had three-vessel disease. Also, only two of them had left main lesions. The number of diseased coronary vessels was significantly higher in men than in women so that three vessels disease in men was revealed in 28% and in women was observed in 10.9% (p = 0.002). Using a multivariable logistic regression analysis, male gender (2.445, 95% CI: 1.372-4.367, p = 0.002), advanced age (1.063, 95% CI: 1.032-1.095, p < 0.001), and cigarette smoking (4.112, 95% CI: 1.145-8.635, p = 0.012) were main predictors of CAD in LBBB patients. CONCLUSION: A notable number of patients with LBBB suffered concomitantly from CAD that the presence and severity of this ischemic event could be predicted by male gender, advanced age, and history of smoking in these patients.

Metabolic syndrome and its association with left ventricular dysfunction in patients with left bundle branch block.

BACKGROUND: The present study and for the first time hypothesizes that the patients with left bundle branch block (LBBB) suffer considerably from metabolic syndrome (MetS) and this metabolic phenomenon can be associated with cardiac dysfunction status such as ventricular dilation and reduced left ventricular ejection fraction (LVEF) in these patients. METHODS: A retrospective study was conducted on 220 consecutive patients with diagnosed LBBB. MetS status was diagnosed using the Adult Treatment Panel III of the National Cholesterol Education Program criteria. Systolic function state was assessed using two-dimensional echocardiography. RESULTS: The overall prevalence of MetS among studied LBBB patients was 16.8%. Regarding left ventricular functional status in the two groups, the mean LVEF in the groups with and without MetS was 37.03 ± 9.09% and 43.43 ± 15.62% with a significant difference (p = 0.017). However, left ventricular dilation was similarly detected in both groups with and without MetS (21.6% versus 30.6%, p = 0.273). Multivariable linear regression model showed subjects with MetS had lower LVEF in the presence of confounders (Beta = 6.915, p = 0.039). CONCLUSION: A notable number of LBBB patients suffered from MetS and this metabolic phenomenon is significantly associated with lowering left ventricular function in LBBB patients.

Clinical determinants of left ventricular ejection fraction deterioration in patients suffered from complete left bundle branch block.

BACKGROUND: Recently, the deleterious effects of left bundle branch block (LBBB) on left ventricular systolic function have been taken into consideration. OBJECTIVES: The present study aimed to identify underlying factors that predict left ventricular ejection fraction (LVEF) deterioration in patients suffered from complete LBBB. PATIENTS AND METHODS: In a retrospective case-control study, the data of 220 consecutive patients diagnosed with LBBB on their electrocardiograms were assessed. They were referred to Isfahan Heart Center in Isfahan Province, Iran in 2013. LVEF deterioration was defined as a decrease in LVEF at least 10% between the baseline and follow-up echocardiography study. Thus, achieving the LVEF values ≤ 40% in patients with an initial EF of > 50% was considered LVEF deterioration. RESULTS: Among 220 patients, 40% of LBBB patients suffered LVEF deterioration within 3 months of initial assessment. The group with LVEF deterioration had higher male to female ratio, had higher NYHA score, and suffered more from systolic hypertension than another group. Those with coronary artery disease (CAD) had also significantly lower LVEF than non-CAD ones. Adverse associations were revealed between systolic blood pressure and LVEF measurement (r = -0.193, P = 0.006) as well as between NYHA score and LVEF (r = -0.215, P = 0.002). A multivariable logistic regression model showed that among baseline variables, male gender (OR = 3.218, P < 0.001), history of systolic hypertension (OR = 2.012, P = 0.029), higher NYHA score (OR = 1.623, P = 0.005), and the presence of coronary artery disease (OR = 2.475, P = 0.028) could effectively predict LVEF deterioration in patients with LBBB. CONCLUSIONS: Male gender, history of hypertension, high NYHA score, and the presence of CAD predict LVEF deterioration in patients with LBBB.

A case of Marfan's syndrome with multi-level aortic dissections.

BACKGROUND: Although Marfan's syndrome is a disease with various phenotypes, but the major mechanism of death is cardiovascular complication. Aortic dissection is a major cause of death in Marfan syndrome. CASE REPORT: A 30-year-old man with severe refractory chest and left flank pain and history of previously surgically repaired Type A aortic dissection was referred to the hospital. His typical manifestations of Marfan's syndrome were identified. Cardiovascular imaging showed an acute spiral dissection in the descending aorta extending to the left renal and femoral arteries with no evidence of thrombosis in its huge false lumen (8 cm). By the diagnosis of acute, expanded, spiral, Type B aortic dissection, he underwent the stent grafting of dissected aorta. He discharged without any complication. On follow-up cardiovascular imaging, thrombosed false lumen in stented aorta from descending aorta to the proximal abdominal aorta was seen. CONCLUSION: Endovascular treatment of Type B dissection is an effective treatment in Type B dissection, even in patients with Marfan syndrome.

Comparing Diagnostic Techniques of Magnetic Resonance Angiography (MRA) and Doppler Ultrasonography in Determining Severity of Renal Artery Stenosis.

BACKGROUND: Renal artery stenosis is one of the important causes of hypertension and end stage renal failure. Magnetic resonance angiography (MRA) and Doppler ultrasonography are non-invasive and safe diagnostic techniques that have also high sensitivity and specificity. Since the accuracy and reliability of these techniques depend upon technicians and softwares, we decided to evaluate and compare the sensitivity and specificity of these techniques in Isfahan. METHODS: Our study included all the patients (37 patients) who underwent renal artery angiography during 2 years from May 2003 to May 2005 and up to six months after that had underwent MRA (21 patients) and Doppler sonography (16 patients) in Isfahan. Renal artery angiography was considered as the gold standard. RESULTS: Sensitivity, specificity, positive and negative predictive values of 100%, 25%, 25%, and 100% were obtained for MRA respectively. Specificity and positive predictive values (PPV) of Doppler sonography were 67%. Its sensitivity and negative predictive values (NPV) were 57%. CONCLUSION: Although it seems that technician dependency, technical and software problems were the reasons of low specificity of gadolinium-enhanced MRA in our study, further studies with larger sample sizes are recommended.

Early chest tube removal after coronary artery bypass graft surgery.

BACKGROUND: There is no clear data about the optimum time for chest tube removal after coronary artery bypass surgery. AIM: The aim of this study was to assess the impact of the chest tube removal time following coronary artery bypass grafting surgery on the clinical outcome of the patients. MATERIAL AND METHODS: An analysis of data from 307 patients was performed. The patients were randomized into two groups: in group 1 (N=107) chest tubes were removed within the first 24 hours after surgery, whereas in group 2 (N=200), chest tubes were removed in the second 24 hours after surgery. Demographics, lactate and pH at the beginning, during and after the operation, creatinine, left ventricular ejection fraction, inotropic drugs administration, length of ICU stay, and mortality data were collected. Respiratory rate and pain level was assessed. RESULTS: In these surgeries, the mean± standard deviation for the aortic clamping time was 49.18±17.59 minutes and cardiopulmonary bypass time was 78.39±25.12 minutes. The amount of heparin consumed by the second group was higher (P <0.001) which could be considered as an important factor in increasing the drainage time after the surgery (P =0.047). The pain level evaluated 24 hours post-operation was lower in the first group, and the difference in the pain level between the 2 groups evaluated 30 hours post-operation was significant (P=0.016). The mean time of intensive care unit stay was longer in the second group but it was not statistically significant. CONCLUSION: Early extracting of chest tubes after coronary artery bypass graft surgery when there is no significant drainage can lead to pain reduction and consuming oxygen is an effective measure after surgery toward healing; it doesn't increase the risk of creation of plural effusion and pericardial effusion.