International Journal of Cardiovascular Practice

Review Article

Updates on Advanced Therapies for Acute Pulmonary Embolism

Bavand Bikdeli, Behnood Bikdeli

International Journal of Cardiovascular Practice, Vol. 1 No. 3 (2016), 1 October 2016, Page 47-50

Venous thromboembolism is the third common vascular disease after acute myocardial infarction and stroke, and acute pulmonary embolism (PE) remains as the most common preventable cause of in-hospital mortality. In addition to routine anticoagulant therapy, several advanced treatment options have been introduced over the past three decades. We provide a succinct and contemporary summary of the evidence base and important indications for inferior vena caval filter placement, systemic and catheter-based thrombolytic therapy, as well as percutaneous and surgical thrombectomy. Appropriate case selection for advance therapies for PE could minimize the adverse effects and costs, while optimizing the outcomes.

Original Articles

One- and Six-month Outcomes of Patients with Non-ST Elevation Myocardial Infarction

Hossein Vakili, Roxana Sadeghi, Neda Toofaninejad, Tooba Akbari, Naser Kachoueian

International Journal of Cardiovascular Practice, Vol. 1 No. 3 (2016), 1 October 2016, Page 51-56

Introduction: Use of risk scoring systems in patients with acute coronary syndrome helps with summarizing important prognostic data of the disease and facilitates calculating confidence limits and comparing survival rates between different treatments. In the present study, the researchers first aimed at assessing mid-term outcome of patients with non-ST elevation myocardial infarction (NSTEMI), and then determining main predictors of this outcome to improve definitive criteria for designing a risk scoring system in the population.

Methods: In a prospective cohort study, 124 patients with NSTEMI, diagnosed according to ACC/AHA guidelines and hospitalized in an academic hospital in 2013, were consecutively assessed. Baseline characteristics were collected via interviewing, physical examination, and reviewing the recorded files. All the patients were followed for one and six months to assess mid-term outcomes regarding mortality and major adverse cardiac events (MACE). MACE is defined as the occurrence of at least one of the events of death, myocardial infarction, repeated revascularization, or re-hospitalization.

Results: One-month death occurred in 3.2%, re-hospitalization in 4.0%, and myocardial infarction in none of the patients. In addition, regarding the six-month outcomes status, mortality rate was determined in 6.4%, re-hospitalization in 22.6%, and myocardial infarction in 4.8% of patients. Hence, one- and six-month MACE rates were 7.3% and 27.4%, respectively. Furthermore, three- and six-month survival rates were estimated to be 96.8% and 93.6%, respectively. According to the Cox-proportion hazard modeling, only reduced left ventricular ejection fraction (LVEF) (HR = 0.909, P = 0.017), history of chronic kidney injury (HR = 8.884, P = 0.005), and Inotrope use (HR = 35.759, P = 0.012) could predict the six-month MACE. None of the other indexes including general coronary risk factors, echocardiography parameters, and level of cardiac enzymes could predict mortality rate.

Conclusions: Patients with NSTEMI may face high six-month MACE which can be predicted by low LVEF, history of renal injury and use of inotrope. Therefore, to define risk stratification system, these indicators should be considered as well.

Association of Anticardiolipin Antibodies and Extent of Coronary Artery Disease in Military Personnel and Non Military Population With Acute Coronary Syndrome

Bahareh Hajibaratali, Shahram Baharvand, Shahrooz Yazdani

International Journal of Cardiovascular Practice, Vol. 1 No. 3 (2016), 1 October 2016, Page 57-61

Introduction: Cardiac involvement is one of the chief complications considerably contributing to the morbidity and mortality of patients with systemic autoimmune diseases. Anticardiolipin antibody is a marker of elevated myocardial infarction risk and it also predicts post cardiac intervention risk. In the current study, we aimed to evaluate the association between anticardiolipin IgM and IgG levels and atherosclerotic involvement of coronary arteries.

Methods: Patients with acute coronary syndrome admitted to a military hospital were included in the study. Patients were categorized to military personnel and non-military personnel. Laboratory data including lipid profile, blood sugar, anticardiolipin IgM and anticardiolipin IgG were verified. Existence and the extent of Coronary Artery Disease (CAD) were defined according to angiographic findings. The relationship between anticardiolipin antibody levels and the number of vessels were evaluated.

Results: According to our sample population calculation, we performed the study on a total of 92 patients. Measurement of both anticardiolipin antibodies (IgM and IgG) in military personnel and non personnel patients showed no significant difference. In both military personnel and non personnel groups, there was a significant association between anticardiolipin IgM and IgG levels and number of coronary arteries with significant stenosis. The C Reactive Protein (CRP) level was significantly higher in military personnel.

Conclusions: According to the study results, anticardiolipin antibody levels were the same in both military personnel and non personnel. Also systolic and diastolic blood pressures were not significantly different in both groups. Increased CRP level in military personnel may be a warning signal about the possibility of premature CAD in this population, hence aggressive risk factor modification is recommended. Paradoxically lipid profile and FBS levels were more favorable in military personnel, which indirectly reflects their higher state of physical activity.

The Effect of Hyperuricemia on the Rate of Contrast-Induced Nephropathy in Patients with Coronary Angiography

Hossein Vakili, Sara Chaghazardi, Isa Khaheshi, Mohammadreza Naderian

International Journal of Cardiovascular Practice, Vol. 1 No. 3 (2016), 1 October 2016, Page 62-64

Introduction: There is little information about the relationship between hyperuricemia and contrast induced nephropathy. The present study aimed to evaluate the relationship between hyperuricemia and contrast induced nephropathy among patients, who had undergone coronary angiography.

Methods: In the current study, 200 consecutive patients with coronary artery disease, who underwent coronary angiography in Modarres hospital, were enrolled. According to the available data, the upper limit normal level of uric acid was defined as 7 mg/dl in males and 6.5 mg/dl in females. By increasing level of serum creatinine to 0.5 mg/dl (or 25% enhancement) from basic level of creatinine during 48 hours of introduction of contrast agent, diagnosis of Contrast Induced Nephropathy (CIN) was established. The relationship between hyperuricemia and CIN was then assessed.

Results: There is a significant difference between normouricemic patients and hyperuricemic patients, in aspect of weight (P = 0.011) and uric acid (P = 0.001); however, other quantitative and qualitative variables including age, volume of contract agent, creatinine level after angiography, hemoglobin level, gender, arterial access type, number of involved vessels, were insignificant between the two groups (P > 0.05). Moreover, as an essential finding, CIN was shown in 9% of normouricemic patients and 10% of hyperuricemic  patients with no significant difference between the two groups (P = 0.6).

Conclusions: Our study suggests that hyperuricemia may not significantly increase the rate of the contrast-induced nephropathy in patients, who had undergone angiography

Chronic Total Occlusion-Angioplasty with Antegrade Approach: A two-Year Experience in “Modarres Hospital”, A Tertiary University Hospital, Tehran, Iran

Morteza Safi, Mohammad Hasan Namazi, Hamid Sadeghi, Habibollah Saadat, Hossein Vakili, Saeed Alipour Parsa, Isa Khaheshi, Bahar Ataeinia

International Journal of Cardiovascular Practice, Vol. 1 No. 3 (2016), 1 October 2016, Page 65-67

Introduction: New techniques for the percutaneous treatment of coronary chronic total occlusions (CTO) have had a high success rate since a few years ago, so the interest for this treatment has been increasing these days.

Methods: The current observational study was performed in Modarres hospital as a tertiary referral center. All the patients with documented stable angina who had failed to response to full guideline-mediated medical therapy, referred to our hospital, were candidates for coronary angiography. Antegrade strategy was applied for all these patients. The length of the lesion, the fluoroscopy time of the CTO angioplasty, consumed contrast volume, the number of guide wires used, whether a corsair or tornus micro-catheter was used or not, and the success rate of the angioplasty were documented for further analysis.

Results: A total of 47 patients with documented stable angina were finally included. The median age was 59 (45-78) and 70.2% were male. The mean length of the lesion was 34.0 ± 1.1 .The mean fluoroscopy time and contrast volume were 57.9 ± 3.2 minutes and 525.9 ± 20.9 mL, respectively. In average, 2.2 guide wires were used. Corsair and tornus micro-catheters were applied in 30 (63.8%) and 5 (10.6%) of the cases, respectively. Seven complications (all including coronary dissection) occurred. In-hospital major adverse cardiac events (MACE) rate was 10.6%, all of which were non-Q wave myocardial infarction. The success rate was 85.1%. The higher number of used wires, use of corsair, and tornus micro-catheter were not significantly concordant with success rate (P-value > 0.05); in addition, longer lesion was not concordant with unsuccessfulness rate (P-value > 0.05).

Conclusions: Patient selection for CTO-angioplasty should be performed more carefully. Patients’ quality of life and risk of probable procedural complications and future cardiac events should be assessed to decide the best treatment approach. Radiation exposure, contrast consumption and fluoroscopy time are recommended to be monitored during the procedure and thresholds should be defined to enhance safety and efficacy.

Case report

Cardiac failure secondary to hypocalcemia

Mohammad Hasan Namazi, Isa Khaheshi, Mahsa Charkhkar, Shooka Esmaeeli, Habib Haybar

International Journal of Cardiovascular Practice, Vol. 1 No. 3 (2016), 1 October 2016, Page 68-70

Hypocalcemic cardiomyopathy due to hypoparathyroidism is a very atypical and rare circumstance, which is usually intractable to conventional therapy for cardiac failure, but responds satisfactorily to restoration of normocalcemia.

We describe a young woman who developed clinical signs of hypocalcemia due to hypoparathyroidism, reduced left ventricular ejection fraction and polymorphic ventricular tachycardia as consequences of hypocalcemia.

This case underscores the importance of biochemical abnormalities like hypocalcemia as a rare cause of secondary cardiomyopathy and emphasizes on the need for effective and immediate treatment of hypocalcemia and its related causes.

Acute Compartment Syndrome of the right lower extremity following Autologous Blood transfusion: A Case report

Feridun Sabzi, Aghigh Heidari, Fataneh Ghasemi, Abbas Ahmadi

International Journal of Cardiovascular Practice, Vol. 1 No. 3 (2016), 1 October 2016, Page 71-73

Compartment syndrome (CS) is an extremely rare complication during cardiac surgery and rare case reports have been linked to coronary artery bypass surgery.

We report one case of right lower extremity compartment syndrome (CS) following inadvertent blood transfusion through a catheter which was inserted into a vein in the related extremity. Forceful pushing of blood through a delicate vein led to rupture of the vein wall and subsequent extravasation of blood into the perivascular tissue as into an intra-compartment portion of the lower extremity.

Late detection of this complication led to compartment syndrome. The patient underwent emergency fasciotomy and concomitant removal of intra compartment and subcutaneous blood and fluids. After fasciotomy, the normal color of skin and pulse were recovered.