International Journal of Cardiovascular Practice

Review Article

Coronary Microvascular Dysfunction and Microvascular Angina

Sun Yuhua, Wang Baoping

International Journal of Cardiovascular Practice, Vol. 4 No. 3 (2019), 9 November 2019, Page 62-68

Many patients present with myocardial ischemic symptoms, but fail to be diagnosed of obstructed coronary artery disease, since the normal coronary arteries or no any atherosclerosis stenosis ≥ 50% at coronary angiography. Myocardial ischemia can be caused by either abnormalities of epicardial coronary arteries or coronary microvascular dysfunction (CMD). Patient with microvascular angina in the absence of coronary artery disease and myocardial diseases, CMD is suggested to be the unique cause of symptoms. The previous clinical and pathogenetic classification of CMD is based on presence or absence of coronary artery disease, myocardial diseases, or other traditional risk factors, which would obscure the importance of the disease primarily provoked by CMD. The role of atherosclerotic plaque rupture in epicardial coronary arteries and the abnormality of hemorheology (especially in perimenopausal women) should be more stressed in the pathogenetic mechanism of CMD. The pathogenetic mechanism of CMD will be classified according to microvascular structure (embolization and stenosis), microvascular function and blood risk factors in this paper. The CMD related diseases including cardiac X syndrome and coronary slow flow would be better uniformly named as microvascular angina. While little data supported therapies for CMD related diseases so far, the blood healthy therapy as a novel method is recommended to treat microvascular angina, especially in the patients with high hematocrit, increased blood viscosity and coronary slow flow.

Original Articles

Correlation of platelet indices with TIMI frame count in patients undergoing primary PCI due to ST-segment elevation myocardial infarction

Ayoub Salehi, Mohammad Hasan Namazi, Morteza Safi, Hossein Vakili, Habibollah Saadat, Saeed Alipour Parsa, Mohammad Ali Akbarzadeh, Ameneh Moshtaghi, Isa Khaheshi

International Journal of Cardiovascular Practice, Vol. 4 No. 3 (2019), 9 November 2019, Page 69-73

Introduction: Given the fundamental role of platelet indices in the development of atherosclerotic plaque, these indices may play a predictive role for the occurrence of disturbed coronary reperfusion. The present study evaluated the relationship between platelet indices and coronary reperfusion status based on TIMI frame count.

Methods: This cross-sectional study was conducted on 98 consecutive patients with STEMI who were candidate for primary PCI at Modarres Hospital in Tehran between January 2016 and January 2018. Venous samples were extracted from all patients before primary PCI. To assess the condition of coronary reperfusion after primary PCI, TIMI frame count related to culprit artery in acute myocardial infarction was determined.

Results: The TIMI frame count was positively associated with platelet count (r = 0.320, p = 0.001) and more strongly with platelet to lymphocyte ratio (r = 0.375, p < 0.001), but not with other platelet indices such as PDW, MPV, or PLCR. According to the ROC curve analysis, platelet to lymphocyte ratio was introduced as a valuable parameter for differentiating complete from disturbed reperfusion (AUC = 0.735, 95%CI: 0.613 – 0.858, P = 0.001). The best cutoff value for platelet to lymphocyte ratio in predicting disturbed reperfusion was 146.5 yielding a sensitivity of 81.8% and a specificity of 60.5%. However, other platelet indices could not present this predictive role.        

Conclusion: From different platelet indices, the platelet to lymphocyte ratio with predictive accuracy and sensitivity predict coronary perfusion impairment based on the increase in TIMI frame count.

Lipid Profile Parameters and Coronary Artery Disease in Young Patients Undergoing Diagnostic Angiography

Ashwal Adamane Jayaram, Krishnanada Nayak, Sudhakar Rao, Jyothi Samanth, Sneha T Kvellur, Adamya Saleel, Yasir Almalki, Nirlip Gajiwala

International Journal of Cardiovascular Practice, Vol. 4 No. 3 (2019), 9 November 2019, Page 74-80

Introduction: It is vital to understand the association between lipid profile and the severity of coronary artery disease (CAD) in young patients with suspected CAD. The clinical presentation, lipid profile and severity of CAD may differ in patients who develop CAD at young age and those at older age. Friesinger (FR) index is an important tool to assess the extent and severity of coronary artery lesions.
Methods: This study was a single center retrospective study involving patients below 40 years who underwent diagnostic coronary angiography. Demographic variables, lipid profile and FR index were estimated. Patients were divided into four groups based on the FR index scores of 0, 1–4, 5–10 and 11-15, respectively.
Results: A total of 158 patients (Mean ± SD of age; 35.65 ± 3.81 years) were included in the study. Among demographic variables, gender (P = 0.03) and body mass index (BMI) (P < 0.001) were found to be associated with FR index. In addition, total cholesterol (P < 0.001), low density cholesterol (LDL) cholesterol (P < 0.001), non-high density cholesterol (non-HDL) (P < 0.001) and ratio of triglycerides (TG) /non-HDL cholesterol (P = 0.004) showed significant differences between the FR groups. Logistic regression analysis showed that only diabetes (P = 0.02) and BMI (P = 0.004) were significant predictors of the extent and severity of coronary artery lesions in terms of FR index.
Conclusions: A strong direct relationship was observed between total cholesterol, LDL and non HDL cholesterol while a negative correlation with the TG/non HDL ratio. Diabetes and BMI also play a very significant role.

The acute effects of Water-pipe smoking on Ankle Brachial Index: A cross-sectional Study

Zahra Hesami, Hooman Sharifi, Neda Behzadnia, Farah Naghashzadeh, Gholam Reza Heydari, Babak Sharif-kashani, Payam Abbasi

International Journal of Cardiovascular Practice, Vol. 4 No. 3 (2019), 9 November 2019, Page 81-84

Introduction: Numerous studies have shown that waterpipe smokers as well as cigarette smokers are at increased risk of cardiovascular diseases. In this study we sought to evaluate the acute effects of waterpipe smoking (WPS) on ankle brachial index (ABI), an indicator of atherosclerosis and an independent predictor of mortality.
Methods: This prospective cross-sectional study was conducted in October 2017. Twenty nine healthy male volunteers who had a history of WPS were enrolled. Demographic data and cigarette and WPS status were recorded via self-reporting questionnaire. Resting heart rate and brachial systolic and diastolic blood pressures of participants were recorded first and ABI measurements were done. Then subjects smoked waterpipe for about 20 minutes and ABI was measured immediately after WPS.
Results: A total of 29 male adults with a mean age of 32 ± 9 years were included. The right-sided ABI was 1.05 ± 0.11 before WPS and significantly decreased to 0.98 ± 0.13 after WPS (P value = 0.006). The left-sided ABI before and after WPS were 1.09 ± 0.20 and 0.95 ± 0.18 respectively and the decrease was statistically significant (P value = 0.037). Vital signs before and after one session of WPS showed significant changes in heart rate (P < 0.001) and no significant changes in systolic and diastolic blood pressures (P = 0.09, and P = 0.14, respectively).
Conclusion: WPS has an acute effect on ABI as well as heart rate so it should be considered as a potential risk factor for cardiovascular diseases.

Impact of Cardiopulmonary Resuscitation on Cardiac Transplantation outcome

Meysam Mojtabaee, Farah Naghashzadeh, Fariba Ghorbani, Shahrzad Ghafarian, Shagin Shahryari, Farahnaz Sadegh Beigee

International Journal of Cardiovascular Practice, Vol. 4 No. 3 (2019), 9 November 2019, Page 85-88

Introduction: Donor heart shortage limits heart transplantations programs while the number of patients waiting for cardiac transplant continues to increase. Optimizing the use of all available donor hearts is a vital key to reduce waiting list mortality. Among different extended criteria, prolong cardiopulmonary resuscitation (CPR), i.e. more than 20 min, has been considered under doubt to be a selection criterion in donor selection. The aim of this study was to compare the outcomes of heart transplantation from cardiopulmonary-resuscitated donors to those who received hearts from donors who did not require cardiopulmonary resuscitation.
Methods: This study was a retrospective analysis of adult heart transplantation program in Masih Daneshvari Hospital in Tehran, Iran from 2010 to 2019. Donors and recipients’ demographics, cause of end-stage heart disease and brain death, duration of hospitalization for both donors and recipients and also the duration of cardiopulmonary resuscitation and other factors related to it were investigated. Qualitative variables were compared using Chi-square test. Quantitative variables were compared using T-test. Patient and graft survival rates were calculated using the actuarial method and compared using Wilcoxon's test.
Results: Among 92 recipients, 39 were transplanted with cardiac grafts from CPR-suffering donors. There were no significant differences regarding sex, age, donor and recipient hospitalization periods, early rejection and 1-year-survival rate considering CPR and non-CPR grafts. However, we detected a strong negative correlation between the duration of CPR and 3-year-survival rate (P = 0.02 and R-value = -0.62) and also its association with post-transplant arrhythmias (P = 0.04).
Conclusion: There is a negative possible influence of long-lasting CPRs (especially more than 20 minutes) in midterm survival and post-transplant complications.

Correlation of Hematologic Indices with CT-pulmonary Arterial Obstruction Index in Patients with Acute Pulmonary Emboli

Taraneh Faghihi Langhroudi, Mahtab Borji Esfahani, Isa Khaheshi, Mohammadreza Naderian, Farbod Zahedi Tajrishi, Mohammad Javad Namazi

International Journal of Cardiovascular Practice, Vol. 4 No. 3 (2019), 9 November 2019, Page 89-93

Introduction: Acute Pulmonary thromboembolism (PTE) is an imperative medical condition with a considerable global impact. Inflammation is deemed to take a notable part in the pathophysiology of this potentially fatal disorder. The aim of the current study was to predict acute PTE severity in helical pulmonary CT-angiography using easily accessible hematological complete blood count (CBC) indices.

Methods: After exclusion of inflammatory conditions that may affect CBC parameters, a total of 69 consecutive patients with definite diagnosis of acute PTE according to pulmonary helical CT –angiography were recruited. Laboratory tests, including CBC parameters were performed on admission in the emergency unit, before initiation of any therapy. Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and RDW to platelet ratio (RPR) were calculated in each case of acute PTE. Ultimately, CT pulmonary arterial obstruction index (PAOI) was assessed subsequent to pulmonary helical CT-angiography for each patient.

Results: We found that NLR is positively correlated with acute PTE severity according to CT pulmonary arterial obstruction index (PAOI) (P < 0.01, r = 0.56); however, PLR, RDW and RPR did not appear to show such correlations (P > 0.05).

Conclusions: NLR could be an easily calculated and capable index to predict severity of acute PTE in pulmonary CT-angiography. Consequently, NLR might be used in precise risk stratification when suspicious for acute PTE and in accurately triage of patients who would benefit greatly from urgent diagnostic and therapeutic interventions.

Case report

Idiopathic Chylopericardium: A case Report and Breif Review of Literature

Majda Haraka, Monia El Mourid, Amine Mamoun Boutaleb, Khadija Khay, Leila Azzouzi, Rachida Habbal

International Journal of Cardiovascular Practice, Vol. 4 No. 3 (2019), 9 November 2019, Page 94-96

Chylopericardium is the accumulation of chylous fluid in the pericardial space. Many etiologies can be found and the treatment depends on the etiology and remains unclear. This rare entity needs some tests to determine its causes. Diagnosis is based on many tools; the pericardial biopsy puncture and lymphoscintigraphy are the most important ones. The treatment requires low fat diet, lipid lowering therapy and surgery in some cases. We here report the first case in the IBN ROCHD university hospital’s Cardiology department of Casablanca, Morocco. It deals with a 32-year-old patient who consulted for dyspnea exacerbation for 18 months, becoming at rest. Chest X-ray and echocardiography were performed discovering pericardial effusion. Pericardiocentesis was performed to confirm the nature of liquid and lymphoscintigraphy showed no abnormal communication between the thoracic duct and pericardium.

Dislodged Interatrial Septum Occluder was Found in an Incredible Place: A Case Report

Mehrdad Jafari Fesharaki, Azin Alizadehasl, Zahra Khajali, Melodi Farashi

International Journal of Cardiovascular Practice, Vol. 4 No. 3 (2019), 9 November 2019, Page 97-99

Secundum type atrial septal defect (ASD) is the most common type of interatrial septum defects. Transcatheter closure of secundum ASD has replaced traditional surgical ASD closure in most cases. Embolization of device is relatively uncommon (0.3%), but it can be a life-threatening situation that needs emergency open heart surgery. We presented a 44-year-old woman who underwent a successful ASD device closure, but the day after procedure, she presented with dyspnea and frequent paroxysmal supraventricular tachycardia with absence of device in interatrial septum (IAS) position. Further investigation by transesophageal revealed atrial septal occluder in the right pulmonary artery that extracted by surgery successfully.