International Journal of Cardiovascular Practice


Original Articles

Impact of Lesion Length on Functional Significance in Intermediate Coronary Lesions

Morteza Safi, Isa Khaheshi, Vahid Eslami, Mohammad Mehdi Beheshtian, Mohammadreza Naderian

International Journal of Cardiovascular Practice, Vol. 2 No. 3 (2017), 30 July 2017, Page 57-60

Introduction: The present study aimed at assessing the role of lesion length in predicting Fractional Flow Reserve (FFR) value for physiological evaluation of intermediate coronary lesions.

Methods: In the current study, 68 patients with 83 coronary lesions were enrolled. All of the patients in this study underwent routine coronary angiography, according to appropriate indications. To evaluate physiologically significant intermediate coronary stenosis (defined between 40% and 70% on visual estimation), the Fractional Flow Reserve (FFR) study was performed and the Quantitative Coronary Angiography (QCA) data were also assessed for measurement of lesion length. The correlation between QCA data and FFR values was also examined.

Results: Eighty-three lesions were evaluated from 68 patients. Stenosis was considered physiologically significant when FFR was lower than 0.75. The FFR was significant in twelve lesions (14.5%). There was a negative correlation between FFR value and lesion length (r = -0.294 and P = 0.013). Moreover, lesion length in physiologically significant FFR group (21.07 ± 6.9) was greater than that of the non-significant FFR group (15.23 ± 6.5) (P value < 0.05). Furthermore, the correlation between QCA data and FFR values was also investigated, yet, there was only a positive correlation between FFR and Minimum Luminal Diameter (MLD) values (r = 0.248 and P value = 0.04). The Receiver Operating Characteristic (ROC) curve analysis for predicting the significant FFR value demonstrated that a lesion length greater than 17.5 mm was the best cut-off point for prediction of the significant FFR value with acceptable sensitivity and specificity of 83.3% and 68.8%, respectively.

Conclusions: There is a negative correlation between lesion length and FFR value in intermediate coronary lesions. In addition, a lesion length greater than 17.5 mm is the best cut- off point for prediction of significant FFR values.

Evaluation of the pulse pressure index at the peak of exercise before and after cardiac rehabilitation

Amir Hossein Yazdi, Parnian Kazemi, Farzaneh Esna-Ashari, Mehrnaz Olfat, Leila Najmafshar

International Journal of Cardiovascular Practice, Vol. 2 No. 3 (2017), 30 July 2017, Page 61-64

Background and Objectives: As a new supplementary therapeutic option, cardiac rehabilitation (CR) is getting more attention each day. Several studies have proved the positive impact on qualitative criteria but few studies have been done on quantitative criteria.The purpose of the survey in this study is to evaluate the impact of CR on non-invasive estimated maximum cardiac output by Pulse Pressure index (PPI) at the  peak of exercise.

Methods: This is a nonrandomized prospective cohort study conducted in Hamadan, Iran in 2015.100 eligible patients who underwent coronary artery bypass surgery, based on cardiologist permission and an informed consent, participated in our study. The PPI was measured at the peak of exercise before and after standard CR program.

Result: In overall, mean of PPI was not significantly different before and after CR. PPI was noticeably increased in patients younger than 60 years old (p = 0.022). In contrast to hypertensive patients, PPI in non-hypertensive patients increased significantly after CR (p=0.002). PPI considerably increased in non-diabetic patients after CR (p=0.046), but not in diabetic individuals. Other variables had not any significant effect on PPI in response to CR.

Conclusion: it is clear that PPI is associated with vascular atherosclerosis, as well as cardiac output; Positive effects of CR diminish in older, diabetic and hypertensive patients with more progressive atherosclerosis.

Short-term Cost-effectiveness of Reteplase versus Primary Percutaneous Coronary Intervention in Patients with Acute STEMI a Tertiary Hospital in Iran

Khalil Alimohammadzadeh, Roxana Sadeghi, Ali Maher, Mohammad Kazem Kazemi

International Journal of Cardiovascular Practice, Vol. 2 No. 3 (2017), 30 July 2017, Page 65-69


 Introduction: This study aimed to compare primary percutaneous coronary intervention (PPCI) versus reteplase in terms of clinical and para-clinical outcomes; as well as cost-effectiveness in patients with ST-segment-elevation myocardial infarction (STEMI).Primary percutaneous coronary intervention is the method of choice in all patients especially those at higher risks. But an on-site professional team in a 24/7 facilitated system is a difficult goal to achieve in many areas and countries, therefore the cost-effectiveness of these two treatment strategies (PPCI and reteplase) needs to be discussed.

Methods: This prospective cohort study included 220 patients presented with STEMI who were admitted to a university hospital between January 2014 to July 2016. Patients were divided into two groups of 120, either receiving reteplase or PPCI. Clinical outcomes were considered duration of hospital stay and MACE (Major Advanced Cardiovascular Events) including death, cerebrovascular accident, need for repeat revascularization, and major bleeding. LVEF (Left ventricular ejection fraction) was considered as a para-clinical outcome. The outcomes and total hospital cost were compared between two treatment groups.

Results: Demographic characteristics between two groups of PPCI or reteplase didn’t show any significant differences. But in para-clinical outcomes, patients in PPCI group showed higher LVEF, compared with reteplase group (45.9 ± 11.5% versus 42.0 ± 11.8%; P = 0.02). Complication rates were similar in both groups but repeat revascularization or coronary artery bypass surgery was more prevalent in those who received thrombolytic therapy (P < 0.05). Length of hospital stay in both groups was similar in two groups but total cost was higher in patients who have received PPCI. (147769406.9 ± 103929358.9 Tomans vs. 117116656.9 ± 67356122.6 Tomans; respectively, P = 0.01).

Conclusions: In STEMI patients who present during off-hours, thrombolytic therapy seems to represent a safe alternative to PPCI. Higher costs for patients with PPCI may be decreased with shorter duration of hospital stays according to guidelines.

Case report

Intramural Ventricular Septal Defect

Sedigheh Saedi, Mozhgan Parsaee

International Journal of Cardiovascular Practice, Vol. 2 No. 3 (2017), 30 July 2017, Page 70-72

Intramural ventricular septal defects (VSDs) are less frequently encountered but clinically significant type of residual interventricular communications seen after complex congenital heart surgeries. Hemodynamically significant intramural VSDs can lead to higher postoperative morbidity and mortality. This case highlights the clinical challenges including the need multiple interventions faced in affected patients.