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<Journal>

<JournalID>12</JournalID>

<PubDate_Fa>Tabestan 1386</PubDate_Fa>

<PubDate_En>Summer 2007</PubDate_En>

<Volume>8</Volume>

<Number>2</Number>

<Abstract>

<AbstractID>82</AbstractID>

<Title>Evaluation of Statins in Decreasing the Early Mortality

and Morbidity of Acute Coronary Syndrome</Title>

<Author>M. M. Peighambari MD, A. Shahmohammadi Mousavi MD, M. Madani MD,

N. Zafaranloo MD* and L. Zahedi MD*</Author>

<Background>We enrolled 220 patients who had been hospitalized for an acute coronary syndrome

(unstable angina, non-ST elevation MI) within the preceding 30 days and compared 20 mg of

simvastatin daily (group B) with patients not receiving that (group A). The primary end point

was a composite of deaths, myocardial infarction, documented unstable angina requiring rehospitalization,

and urgent revascularization (performed at least 30 days after randomization).

Follow-up lasted for one month.</Background>

<Method>Median LDL cholesterol level achieved during treatment was similar; 90 mg/dl in group B

and 87.1 mg/dl in group A (P&gt; 0.05). Chi-square and t-test estimates of the rate of the

documented unstable angina requiring hospitalization were 26.4 percent in group B and 31

percent in group A (odds ratio= 4.5; 95% CI= 2.4-6; P= 0.01). Revascularization and early

angiography was 20.9 percent in group B and 48.2 percent in group A (odds ratio= 3.5; 95%

CI= 1.9-6.3; P&lt; 0.001). Group B had a lower risk of myocardial infarction after admission due

to acute coronary syndrome (odds ratio= 4; 95% CI= 1.1-6; P&lt;0.001), reflecting a reduction in

mortality (0.9% in group B and 2.7% in group A), but this difference was not significant (P=

0.6), at least partially because of the relatively small number of mortalities in this study

(1.8%).</Method>

<Result>Early use of simvastatin in ACS appears to decrease risk for cardiovascular events. We

believe statin therapy should be initiated early (at the latest before hospital discharge) in all

patients who have been hospitalized for acute coronary syndrome (Iranian Heart Journal

2007; 8 (2): 6-15).</Result>

<Conclusion>Early use of simvastatin in ACS appears to decrease risk for cardiovascular events. We

believe statin therapy should be initiated early (at the latest before hospital discharge) in all

patients who have been hospitalized for acute coronary syndrome (Iranian Heart Journal

2007; 8 (2): 6-15).</Conclusion>

<Keywords>acute coronary syndrome, blood lipids, statins, mortality, morbidity</Keywords>

</Abstract>

<Abstract>

<AbstractID>83</AbstractID>

<Title>Left Ventricular Wall Motion Score Index as an Early

Predictor of Hemodynamic State after Myocardial

Infarction</Title>

<Author>Negar Salehi MD, Majid Maleki MD, Feridoun Noohi MD, Anita Sadeghpour MD,

Mojdeh Nasiri Ahmad Abadi MD, S. Zahra Ojaghi Haghighi MD, Niloufar Samiei

MD, Maryam Esmailzadeh MD and Goldis Malek PhD.</Author>

<Background>Coronary artery disease is the most common etiology of disability and death in the

world. We evaluated the efficacy of echocardiography in patients after myocardial infarction,

as a diagnostic means for identifying risk of future cardiac events.</Background>

<Method>This is a cross  sectional study on 150 patients admitted with acute myocardial infarction

who were followed for three months. We compared the baseline wall motion score index

(WMSI) accessed within the first 24 hours and the hemodynamic function as determined

according to Killip s classification in patients admitted with acute myocardial infarction to

Shaheed Rajaie Cardiovascular Medical Center in Tehran, Iran.</Method>

<Result>There was a positive correlation between WMSI determined immediately following

admission in patients with acute myocardial infarction and good prognosis. Patients included

in this study were grouped into four Killip s classes: Class I (n=72 patients), Class II (n=58

patients), Class III (n=13 patients) and Class IV (n= 7 patients). Overall, patients with high

WMSI were subclassified within higher Killip s classes. Early mortality rate was greater in

patients with both WMSIe"2 and a higher Killip s class. Patients with anterior myocardial

infarction (MI), WMSIe"2 and high Killip s class had higher peak CPK-MB levels.</Result>

<Conclusion>Echocardiographic left ventricular WMSI obtained shortly after an acute myocardial

infarction is an affordable and readily available technique, which provides important

prognostic information regarding patients  clinical outcome and prognosis. We conclude that

patients presenting with high WMSI need early invasive procedures for improved prognosis

(Iranian Heart Journal 2007; 8 (2): 16-21).</Conclusion>

<Keywords>wall motion score index, myocardial infarction, killip s class</Keywords>

</Abstract>

<Abstract>

<AbstractID>84</AbstractID>

<Title>Assessment of Activated Partial Thromboplastin Time

Level in Patients with Acute Myocardial Infarction

Receiving Fixed-Dose Intermittent Intravenous Heparin

Therapy</Title>

<Author>Mahmoud Ebrahimi MD and Saeed Bajouri MD</Author>

<Background>Heparin is one of the current and necessary medications in acute myocardial

infarction (MI). Given the narrow therapeutic dose and unpredictable pharmacokinetics of

heparin, its anticoagulant effect should be measured precisely. Despite the widespread

utilization of heparin in intermittent fixed doses and weight-independent IV administration,

our data about the range of aPTT as a monitoring marker are quite limited. Thus we prepared

this study to measure if the custom method fills the target therapeutic range.</Background>

<Method>This cross-sectional study was performed on 144 patients admitted to our department

with acute MI in 2004, who received heparin 5000 units q4h and had daily aPTT checked on

three consecutive days. We chose the second day samples for this study, and the data were

gathered by a checklist and analyzed with SPSS software.</Method>

<Result>12.5% of patients had aPTT levels in the therapeutic range, 6.2% of patients had a mean

aPTT level above therapeutic range and remarkably, 81.3% of patients never achieved the

therapeutic range. Our results also demonstrated that older age and female sex are associated

with higher aPTT levels, and smoking unlike diabetes is associated with lower aPTT levels.</Result>

<Conclusion>Despite tolerability by patients and staff, the above findings necessitate

reconsideration in the dose and interval of customary heparin administration (5000 unit IV

q4h) and changing to continuous infusion method or use of low molecular weight heparins

(Iranian Heart Journal 2007; 8 (2): 22-25).</Conclusion>

<Keywords>partial thromboplastin time, myocardial infarction, heparin</Keywords>

</Abstract>

<Abstract>

<AbstractID>85</AbstractID>

<Title>Comparison of Selenium, Zinc, Copper, TNF-a and IL-6

Serum Levels and Erythrocyte GSH-PX Activity in

Patients with Acute and Chronic Coronary Artery Disease</Title>

<Author>M. Hassanzadeh MD, R. Farid MD, M. Mahini MD, M. H. Ayati MD,

F. Farid MD, A. Ranjbar MD and P. M. Nasiri MD</Author>

<Background>Selenium (Se) is part of the enzyme glutathione peroxidase (GSH   Px) that plays an

important role in the antioxidant defense of the body. Evidence has demonstrated that

populations with low intake of selenium in the diet have a 2-3 fold risk of ischemic heart disease.

Positive statistically significant correlations have been found between trace element

concentrations (Cu, Zn, Se) of heart tissue with physiological parameters (CO: cardiac output,

EF: ejection fraction) of the heart. Increased plasma concentration of TNF-± has been found in

patients with coronary artery disease. Stressed myocardium activates pro-inflammatory

cytokines, such as TNF-±, which produce abnormalities in myocyte contractile function. This

study was done to determine the circulating levels of Cu, Zn, Se, IL- 6, TNF - ±, and erythrocyte

GSH - PX activity in two groups of patients with chronic coronary artery disease (CCAD), acute

myocardial infarction (AMI) and normal individuals (IHD-free).</Background>

<Method>Patients were divided into two groups: 25 with chronic CAD (CCAD) and 25 with acute

myocardial infarction (AMI). The control group was 50 normal individuals that did not have

any symptoms for IHD, and was gender and age-matched with the patients. Blood samples were

collected during the first hours after the onset of chest pain in the acute MI group. Serum levels

of Se, Cu, and Zn were determined by atomic absorption spectrometry, TNF-± and IL-6 were

measured with ELISA and erythrocyte GSH-PX activity with Paglia and Valentine methods.</Method>

<Result>In both groups of patients, there was a significant reduction of Se in the serum (82.36±11.31

micg/l in CCAD, 74.08±11.31 in AMI vs. 105±32.52 in control group, P-value=0.03). No statistically significant difference was found in Zn and Cu serum levels (0.98±0.22 and 112±18 in

CCAD and 0.98±0.4 and 115±20 in AMI vs. 0.96±0.24 and 114±17 in control group). TNF-±

titers showed a significant difference in AMI patients compared to CCAD and control groups

(mean TNF-± level 37.44 pg/ml in CCAD, 914.32 pg/ml in AMI and 4.80 pg/ml in control group,

P value 0.01). Serum levels of IL-6 in the two groups of CCAD and AMI patients were

3.28±15.55 and 472±207.88 pg/ml, respectively, compared to 1.28 pg/ml in the control group, P=

0.001)</Result>

<Conclusion>These findings confirm the previous studies and demonstrate that patients suffering from

AMI exhibit a lower plasma concentration of selenium and TNF-± and IL - 6 significantly

increase during the first hours of AMI. Selenium concentration of whole blood was lower in the

two patient groups (CCAD, AMI) compared to the control group. GSH - PX activity has a

strong inverse association with CAD (Iranian Heart Journal 2007; 8 (2): 26-29).</Conclusion>

<Keywords>AMI, CAD, selenium, zinc, copper, TNF- ±, IL- 6, GSH- PX</Keywords>

</Abstract>

<Abstract>

<AbstractID>86</AbstractID>

<Title>Effects of Retrograde Filling on Antegrade Flow of

Coronary Artery with Significant (High Grade) Stenosis</Title>

<Author>Mahmoud Mohammadzadeh Shabestari MD, Leila Alizadeh MD,

Mehri Nikdoust MD, Fardin Mirblouk MD and Javad Mahmoodi</Author>

<Background>The aim of this study was to evaluate effects of

retrograde filling on the patency of significant (high-grade,

&gt;90%) coronary arterial stenosis.</Background>

<Method>The basis of our study was a comparison between the

first and the second angiography of 102 patients with at least a

3-month interval between the two angiographies. Seventy-four

of the patients were male (72.5%) and twenty-eight were female

(27.4%). The patients were between the ages of 40 and 75, and

the mean patient age was 61. Patients were not classified in

order of risk factors, and none of them had diabetes mellitus. All

102 patients were classified in two groups (A and B) in regard to

the presence or absence of retrograde filling. Group A (34

patients) consisted of patients with retrograde flow of grade 3

(complete perfusion) or 2 (partial collateral flow), whereas

patients with retrograde filling grade 1(barely detectable

collateral flow) or 0 (no collateral flow) were put into group B (68

patients).</Method>

<Result>In the second angiography, total occlusion occurred in the

target vessels of 30 patients (88.24%) in group A and 12

patients (17.65%) in group B. Ninety percent occlusion and

existence of antegrade flow was seen in 4 (11.76%) and 56

(82.35%) patients of group A and B, respectively. Results were analyzed through a Chi-square test. Total occlusion occurred in

the patients with retrograde collateral flow significantly more

than in patients without retrograde collateral vessels. (P=0.001).</Result>

<Conclusion>As the severity of obstruction leads to retrograde collateral development, significant retrograde collaterals

cause earlier total vessel occlusion (Iranian Heart Journal 2007; 8 (2): 30-34).</Conclusion>

<Keywords>antegrade flow, collateral artery, coronary artery, retrograde flow stenotic lesion,

VEGF</Keywords>

</Abstract>

<Abstract>

<AbstractID>87</AbstractID>

<Title>Hemodynamic Evaluation of Mitral Stenosis

Using Stress Echocardiography</Title>

<Author>Maryam Esmaeilzadeh MD, Majid Malaki MD, Niloofar Samiei MD,

Anita Sadeghpour MD, Fereidoun Noohi MD, Zahra M. Ojaghi MD and

Ahmad Mohebbi MD</Author>

<Background>The aim of this study was to evaluate the relation of symptoms to valve stenosis. The

hemodynamic data were evaluated at rest and after exercise using exercise stress

echocardiography.</Background>

<Method>We prospectively studied hemodynamic data in 15 consecutive patients with moderate

mitral stenosis (MS) who were in NYHA function class two or higher. Treadmill exercise

stress echocardiography (Bruce protocol) was done (GE Vingmed CFM 800). Mitral valve

area (by planimetry and PHT method), mean TMVG, peak TMVG, and PAP were measured

in all the patients at rest and within 90 seconds after the termination of exercise.</Method>

<Result>In 66.7% of patients with moderate mitral stenosis, the stenosis was hemodynamically

significant regarding the increase in mean TMVG (2 times in comparison with rest, or more

than 15mmHg) and PAP after exercise.</Result>

<Conclusion>Our results suggest that in patients with moderate mitral stenosis, hemodynamic response to exercise has

better correlation with the degree of valve stenosis severity and the occurrence of symptoms. In these patients,

exercise stress Doppler echocardiography is a noninvasive and reliable method to assess the mitral flow

characteristics (Iranian Heart Journal 2007; 8 (2): 35-38).</Conclusion>

<Keywords>mitral stenosis, stress echocardiography, exercise</Keywords>

</Abstract>

<Abstract>

<AbstractID>88</AbstractID>

<Title>Myocardial Bridge: Surgical Outcome and Mid-term

Follow up</Title>

<Author>R. Parvizi MD, H. Javadzadeghan MD, A. Sajjadieh MD, S. Hassanzadeh PhD,

H. Hakim MD and J. Samadikhah MD</Author>

<Background>Myocardial bridge consists of muscle fiber bundles lining an epicardial coronary

artery for a variable distance. Although myocardial bridge is associated with a benign

prognosis, its presence has also been considered a cause of angina, myocardial infarction,

malignant arrhythmia and sudden death. There is no general consensus about therapeutic

strategies in symptomatic patients with myocardial bridge (medical therapy, coronary artery

bypass surgery, coronary stenting, supra-arterial myotomy).We report results of surgery and

long-term follow up in 26 patients who had disabling symptoms due to myocardial bridge

refractory to medical therapy.</Background>

<Method>From 1999 to 2004, among more than 18,800 coronary angiographies which were

performed in our department, 290 (1.5%) cases had the angiographic diagnosis of myocardial

bridge. From these, 26 (9%) patients underwent surgical myotomy for treatment of myocardial

bridge causing significant systolic arterial compression. The patients (19 male, 7 female) had a

history of typical chest pain and positive exercise test. All of them were examined with

radionuclide study preceding angiography, which was positive for ischemia in 20 cases (76%).

Coronary angiography and left heart catheterization revealed impaired blood flow due to

myocardial bridge in left anterior descending artery in all patients and there was additional

atherosclerotic stenosis of coronary arteries in 6 and mitral valve disease in one patient. Supra

arterial myotomy was performed in all patients.</Method>

<Result>There was no mortality or major intraoperative complication. Postoperative scintigraphic

and angiographic studies demonstrated restoration of coronary blood flow and myocardial

perfusion without significant residual compression of the artery, except in one patient who had

recurrent anginal chest pain after operation and coronary angiography showed residual

narrowing in the LAD despite myotomy. This patient underwent CABG of LIMA to distal

LAD. During 7-81 months of follow-up (mean: 34.2± 21), only two patients had symptoms of

angina which did not show significant residual compression, and symptoms were controlled

by medical treatment.</Result>

<Conclusion>In conclusion, surgical relief of myocardial ischemia due to myocardial bridge can be accomplished with

very low operative risk and excellent mid term results (Iranian Heart Journal 2007; 8 (2): 39-43).</Conclusion>

<Keywords>myocardial bridge¡ supra arterial myotomy¡ coronary artery bypass surgery, coronary angiography</Keywords>

</Abstract>

<Abstract>

<AbstractID>89</AbstractID>

<Title>Effect of Folic acid on Serum Homocysteine and Morbidity

in Patients with Chronic Coronary Artery Disease</Title>

<Author>F. Jalali, MD and K. O. Hajian-Tilaki*, PhD</Author>

<Background>In addition to traditional cardiovascular risk factors, high levels of plasma

homocysteine has been documented recently as independent risk factors for atherosclerosis.

The probable mechanism is through endothelial dysfunction. Roughly 10% of the population

with coronary artery disease (CAD) may have hyper-homocysteinemia. Since folic acid is a

potential factor in lowering plasma homocysteine and dietary intake of folic acid is not

sufficient, it needs to be prescribed to CAD patients as a supplement. The purpose of this

study is to assess the effect of folic acid on plasma homocysteine levels and on morbidity in

stable CAD patients.</Background>

<Method>In this prospective interventional study, we recruited 52 stable CAD patients; the plasma

levels of homocysteine, folic acid and vitamin B12 were measured. The morbidity-related

indices (the number of sublingual TNGs per week, typical anginal chest pain per week, the

number of cardiovascular-related hospitalizations in the previous 3 months, functional class

and ECG changes) were determined. All patients received 2 mg oral folic acid daily for 3

months. At the end of the study, the level of homocysteine and morbidity were determined.</Method>

<Result>Folic acid supplementation for 3 months was associated with a decrease in homocysteine

level by 44% (P=0.000). We did not observe a significant change in levels of serum folic acid.

There were significant declines in all morbidity indices including TNG consumption,

frequency of chest pain, functional class and hospitalizations (P=0.001).</Result>

<Conclusion>The findings indicate that 2 mg folic acid orally daily for 3 months is associated with a

decrease in homocysteine level and morbidity in CAD patients (Iranian Heart Journal 2007;

8 (2): 44-50).</Conclusion>

<Keywords>serum homocysteine, folic acid, morbidity, coronary artery disease</Keywords>

</Abstract>

<Abstract>

<AbstractID>90</AbstractID>

<Title>Behçet s Disease Presenting as Recurrent Right

Ventricular Thrombus</Title>

<Author>Jalal Vahedian MD, FIAS, *Ali Sadeghpour Tabaee MD,

**Hossein Azarnik MD and **Niloufar Samiei MD</Author>

<CaseReport>heart thrombosis and pseudoaneurysm of the abdominal aorta. The patient was admitted to the

surgical unit because of malaise, tachycardia, easy fatigability and fever.

The patient had a history of long standing low-grade fever, weight loss, fatigue, long-term

headaches and non-specific skin lesions of the lower extremities. One month previously, an

echocardiographic examination had revealed a right ventricular mass, thought to be a thrombus in

an unusual location. The patient had consequently undergone surgery, and pathologic examination

had confirmed the mass to be a thrombus.

When the patient was subsequently re-admitted to the emergency unit of our center with complaints

of severe abdominal pain, fever, fatigue, sinus tachycardia and a pulsatile and tender abdominal

mass, a right ventricular thrombus and a large pseudoaneurysm of the abdominal aorta were found

on echocardiography and angiography, respectively. The patient underwent resection of the aortic

aneurysm and aortoplasty and received immunosuppressive and anticoagulation therapy. The

thrombus of the right ventricle disappeared 4 months later (Iranian Heart Journal 2007; 8 (2): 51-

55).</CaseReport>

<Keywords>Behçet s disease, cardiac thrombus, aortic pseudoaneurysm</Keywords>

</Abstract>

<Abstract>

<AbstractID>91</AbstractID>

<Title>Complete Absence of the Left Pericardium</Title>

<Author>L. Ghandili MD1, A. R. Mahoori MD2 and N. Malekpour MD3</Author>

<CaseReport>Pericardial defect is a rare congenital abnormality, and most of the presenting cases are reported

from intraoperative or post-mortem diagnosis. We report a case (46 yr-old male) with a 2-year

history of vague chest pain and dry cough.

Chest roentgenography showed a mass in the supero-medial portion of the left lung without

displacement of the heart. Computerized tomography supported the diagnosis of a cystic mass in the

medial part at the lingula lobe of the left lung. Echocardiography was normal.

He was operated for symptomatic pulmonary mass and intraoperative findings were complete absence of the left

pericardium and a bronchogenic cyst of the lingual (Iranian Heart Journal 2007; 8 (2): 56-58).</CaseReport>

<Keywords>complete absence of pericardium, bronchogenic cyst, chest mass</Keywords>

</Abstract>

</Journal>