International Journal of Cardiovascular Practice

Review Article

Venous Obstruction Following Pacemaker or Implantable Cardioverter-Defibrillator Implantation, Mini Review

Mohammad Ali Akbarzadeh

International Journal of Cardiovascular Practice, Vol. 1 No. 2 (2016), 2 Mordad 2016, Page 20-22

Venous obstruction is relatively frequent following permanent pacemaker or implantable cardioverter-defibrillator (ICD) implantation. However, most of them are asymptomatic. Although the exact risk factor for this complication is not known, number of leads, heart failure and infection may prone the patient to this complication. The goal standard for detection of vein stenosis is venography; however, ultrasound sonography has an acceptable accuracy. Anticoagulant therapy may be considered for symptomatic patients. For device upgrading, non-functional leads removal, venoplasty and rarely surgical treatment may be indicated.

Original Articles

The role of the history of coronary heart disease among second degree relatives for predicting coronary artery disease

Saeed Alipour Parsa, Farzam Saemifar, Isa Khaheshi, Mohammadreza Naderian

International Journal of Cardiovascular Practice, Vol. 1 No. 2 (2016), 2 Mordad 2016, Page 23-26

Introduction: The history of atherosclerotic disease among second degree family members of patients as a risk factor has not been properly explained. The present study aimed to assess this role in the Iranian population.

Methods: This case-control study was performed on 500 consecutive patients, who were candidates for coronary angiography. The presence of Coronary Heart Disease (CHD) history among first and second degree relatives were determined by interviewing the participants.

Results: In total, 450 patients were shown to have CHD as the case group and 50 without CHD as the control group. Family history of CHD among first degree relatives was 39.1% for cases and 22.0% for the controls with a significant difference (P = 0.018), however the history of CHD among second degree relatives was not statistically different in the case group and the control group (17.8% vs. 8.0%, P = 0.079). In total, 80 patients had CHD with simultaneous history of disease among their second degree relatives, while 370 with CHD had no history of disease among their second degree relatives. Our study could not find a significant difference between the two CHD groups with and without history of disease among second degree relatives in terms of cardiovascular risk profile.

Conclusions: Despite the powerful effect of the presence of family history of CHD in first degree relatives on risk of CHD and its severity, the presence of this history among second degree relatives cannot predict the risk for CHD.

In-hospital and late outcome of rescue versus primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction

hossein vakili, Roxana Sadeghi, Solmaz Borjian, Naser Kachoueian

International Journal of Cardiovascular Practice, Vol. 1 No. 2 (2016), 2 Mordad 2016, Page 27-32

Introduction: Despite high technical success of rescue Percutaneous Coronary Intervention (PCI) and also its significant impact on left ventricular function, the therapeutic outcome of this PCI technique in comparison with primary PCI for coronary reperfusion has remained uncertain. The present study aimed to conduct a comparative analysis of early and long-term results of patients with ST-Elevation Myocardial Infarction (STEMI), who had undergone primary or rescue PCI.

Methods: One hundred and twenty-nine consecutive patients with the diagnosis of STEMI, who underwent primary PCI (n = 107) or rescue PCI (n = 22) from April 2012 to September 2013 were retrospectively included. In addition to early assessment of procedural consequences, the patients were followed-up to assess and compare long-term mortality and major adverse cardiovascular events.

Results: Comparing in-hospital consequences of the two rescue PCI and primary PCI procedures showed no significant differences in in-hospital mortality (9.5% vs. 3.7%, P = 0.255), total hospital stay (6.32 ± 2.24 days vs. 6.61 ± 3.43 days, P = 0.720) and also in early procedural complications. Long-term death was found only in 1.9% of patients in the primary group and none of the patients in the rescue group (P = 0.999). There was also no difference in the prevalence of late stent thrombosis between the two groups. However, the in-hospital Left Ventricular Ejection Fraction (LVEF) was lower in the rescue PCI group vs. primary PCI group (36.82 ± 11.19 vs. 43.48 ± 9.14, P = 0.014), but after six months, LVEF was similar between the two groups (41.05 ± 9.57 vs. 44.29 ± 10.35, P = 0.082).

Conclusions: Our study showed no difference in early and late procedural outcome between the primary and rescue PCI techniques in STEMI patients, but LVEF had better improvement in the rescue PCI group.

Effect of Nocturnal Oxygen Therapy on Electrocardiographic Changes Among Patients with Congestive Heart Failure

Mehdi Pishgahi, Rama Bozorgmehr, Masoud Rastgari, Mohammad Amin Abbasi

International Journal of Cardiovascular Practice, Vol. 1 No. 2 (2016), 2 Mordad 2016, Page 33-35

Introduction: Nocturnal hypoxia is an important factor in increasing the risk of mortality in patients with chronic heart failure and is associated with atrial and ventricular arrhythmias. In addition, QT dispersion (QTd) is used as a prognostic sign in determining future malignant arrhythmias and sudden cardiac death. In the current study, we investigated the effect of nocturnal oxygen therapy (NOT) on electrocardiographic changes among patients with chronic heart failure.

Methods: In this study, a consecutive of 154 patients (87 males and 67 females) known with chronic heart failure (EF ≤ 40%) were enrolled. The patients were administered NOT (oxygen flow of 2 L/min for 8 hours during sleeping). Electrocardiography was takenbefore and after the NOT, and RR interval, PR interval and QTd were measured each time.

Results: The mean age of the participants was 61.3 ± 11.4 years. Our results revealed significant reduction in QTd (55.8 ± 7.5 vs. 61.4± 9.1 msec, P = 0.001) and heart rate (79.6 ± 4.7 vs. 76.8 ± 4.3, P = 0.001) in a patient’s electrocardiogram after NOT.

Conclusions: In this study, NOT decreased heart rate and QTd in patients with chronic heart failure, but not PR interval, which could consequently decrease the risk of malignant arrhythmias and sudden cardiac death.

The Correlation between Serum Level of N-Terminal Pro-B-type Natriuretic Peptide and Gensini Score in Patients with Acute Coronary Syndrome

Mohammad Hassan Namazi, Hossein Vakili, Mahsa Charkhkar, Latif Gachkar, Isa Khaheshi

International Journal of Cardiovascular Practice, Vol. 1 No. 2 (2016), 2 Mordad 2016, Page 36-40

Introduction: N-terminal pro-B-type natriuretic peptide (NT-proBNP) has emerged as an important biomarker for developing the diagnosis and prognosis of cardiovascular diseases, as several studies have shown that serum levels of NT-proBNP elevate in acute coronary syndrome (ACS) and coronary artery disease (CAD). We performed this study to find any possible correlation between serum levels of NT-proBNP and Gensini score in patients diagnosed with ACS.

Methods: In a cross-sectional study, 100 consecutive patients with ACS who were candidates of angiography were recruited and their serum levels of NT-proBNP, Gensini scores, lipid profiles and troponin I levels were measured.

Results: Sixty six male and 34 female patients with a mean age of 57.5 years, including 44 with unstable angina, 33 with ST-elevation myocardial infarction, and 23 with non-ST-elevation myocardial infarction were enrolled. The mean serum NT-proBNP level and the Gensini score were 1987.16 pg/mL (17.9-8841) and 31.09 (6-92.5), respectively. The serum NT-proBNP levels and Gensini scores were significantly correlated with a Spearman correlation coefficient of 0.953 (P < 0.001). Serum levels of NT-proBNP were not different in patients with single-vessel disease, 2-vessel disease and 3-vessel disease (P = 0.257). NT-Pro-BNP levels were also correlated positively with troponin I levels (correlation coefficient = 0.779) and negatively with left ventricular ejection fraction (correlation coefficient = -0.55). Smoker patients had higher NT-proBNP levels (P = 0.047). Neither Gensini scores nor NT-Pro-BNP levels had significant correlation with lipid profile or blood sugar.

Conclusions: NT-proBNP is directly correlated with Gensini score in patients with ACS and might be used as an important marker for risk stratification in those patients.

Altered Pulmonary Venous Flow Pattern in Young Adults with Atrial Septal Defect

Mozhgan Parsaee, Sedigheh Saedi, Nahid Salehi, Tahereh Saedi

International Journal of Cardiovascular Practice, Vol. 1 No. 2 (2016), 2 Mordad 2016, Page 41-44

Introduction: Atrial septal defect (ASD) is a common congenital heart disease and causes left-to-right shunting and significant right ventricular (RV) volume overload. The goal of this study was to evaluate the influence of these hemodynamic changes on pulmonary venous flow pattern in young adults.

Methods: Complete echocardiographic examination was performed in a group of 40 young adults (aged < 40 years) who had secundum type ASD and was compared to 40 age-matched individuals in control group who had no cardiac abnormality. Systolic and diastolic flow velocities in pulmonary veins (PV), superior vena cava (SVC), inferior vena cava (IVC) and RV functional parameters were recorded and evaluated.

Results: As opposed to healthy young individuals who showed distinct S and D waves with diastolic predominance in pulmonary vein Doppler, in patients with ASD a continuous flow with increased systolic peak that began in systole and continued to the late diastole was observed. The RV systolic function increased compared to the control group.

Conclusions: In patients with ASD, the pattern of pulmonary veins flow transforms into a single continuous antegrade wave with systolic dominance due to persistent shunting of left atrial blood in to right heart chambers as well as increased RV pump function on pulmonary vein (by means of ASD), SVC and IVC, and could be used as a screening method for the presence of secundum type ASDs in young adults.

Case report

Syncope during pregnancy in a patient with permanent cardiac pacemaker, due to increased pacing threshold.

Mohammad Ali Akbarzadeh, Morteza Safi, Isa Khaheshi, Negar Bahrololoumi Bafruee

International Journal of Cardiovascular Practice, Vol. 1 No. 2 (2016), 2 Mordad 2016, Page 45-46

A 22-year-old pregnant woman referred with syncope due to pacemaker malfunction. During the second trimester of pregnancy, the right ventricular (RV) lead pacing threshold increased and led to early generator depletion. We believe that this might happen due to lead micro-dislodgement or less probably effect of hormonal changes during pregnancy on electrode-myocardium interface.