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Background Methadone is a synthetic opioid mostly used for detoxification therapy, as its use increases; the possibility for methadone-induced cardiotoxicity may rise. The aim of this study was to determine the association of high-sensitivity troponin I levels as a predictor of cardiac injury in methadone toxicity. Methods Sixty methadone toxicity patients included in this prospective cross-sectional study from October 2018–November 2020. High-sensitivity troponin I level and electrocardiogram were assessed in patients at admission. All patients underwent echocardiography at admission and 30 days later and compared this finding between two groups based on high-sensitivity troponin I results. Results Mean age of the patients was 34.5 ± 11.1 years (males: 67%). Twenty (20%) patients had positive high sensitive-troponin results. Long QT interval and inverted T in precordial leads were mostly observed in individuals with positive high-sensitivity troponin I (75% vs. 35%, P = 0.013 and 83% vs. 16%, P P P P = 0.020). Conclusion Patients with simultaneous methadone toxicity and positive high-sensitivity troponin I had worse cardiac outcomes and this biomarker could be probably used for better implementation of therapeutic interventions and prognosis.

Electrocardiographic (ECG) study is a principle for the symptoms contributed to the acute myocardial infarction (AMI)/acute coronary syndrome (ACS). The diagnosis of involved coronary artery based on ECG changes is still a challenge. This study is aimed to evaluate the association of mere changes in I and aVL leads with the involved region found through echocardiography and involved coronary artery through angiography.This cross-sectional study was conducted on 100 patients referred with AMI/ACS symptoms that had mere ECG changes in I and aVL leads (ST elevation + Q wave/ST depression + inverted-T). Transthoracic echocardiography (TTE) and coronary angiography (CAG) were performed for the patients. The correlation of ECG with echocardiography and angiography was assessed.Among the studied population, 39 patients (39%) were women with the mean ± standard deviation (SD) of age of 64.60 ± 9.39 years. There was no significant association between ECG changes in leads I and aVL with neither the stenosis of first diagonal (D1) coronary artery found through angiography (P = 0.580) nor the mid-anterior wall dyskinesia found through echocardiography (P = 0.380). A remarkable association between the echocardiographic findings representing mid-anterior wall ischemic dyskinesia with the stenosis of D1 coronary artery was detected (P0.001). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 100%, 54.54%, 94.68%, and 100% were respectively found as the diagnostic values of mentioned factors.Our findings showed significant association between D1 involvement and mid-anterior dyskinesia in echocardiography, while the changes in ECG were associated neither with echocardiographic nor angiographic outcomes.

It has been proposed that left ventricular diastolic dysfunction (LVDD) is a possible physiological link between high body mass index (BMI) and future occurrence of heart failure (HF). The present cross-sectional study was aimed to analyze the association between BMI and LVDD by transthoracic echocardiography (TTE).This study was conducted from May 2017 to September 2019 in Khorshid Hospital of Isfahan University of Medical Sciences, Isfahan, Iran. Based on the calculated BMI (kg/m²), patients were divided into three groups: group 1: subjects with BMI25, as a normal group (n = 75), group 2: volunteer cases with 40BMI ≥ 30, as an obese group (n = 98), and group 3: patients with BMI ≥ 40, as a morbidly obese group (n = 100). TTE was performed by a trained cardiologist and associated variables including left atrium (LA) volume, E, septal e', lateral e', and E/e' were assessed and also subjects were characterized as normal diastolic function, abnormal diastolic function, and inconclusive diagnosis of diastolic dysfunction (DD).Apart from the ejection fraction (EF) and the tricuspid regurgitation velocity (TRV), there was a significant difference between the other echocardiographic variables including LA volume, E, septal e', lateral e', and E/e' (P0.05). One patient with morbid obesity in our study revealed LVDD. There was no significant difference between three groups (P = 0.42).There is no considerable relationship between obesity and LVDD. It seems that the absence of associated comorbidities such as diabetes, coronary disorders, etc. plays a crucial role in preventing LVDD, but for realistic and definitive decision, more cellular and molecular investigations and studies with larger sample size are necessary.

With the onset of the coronavirus disease-2019 (COVID-19) pandemic, hospitalization and treatment of non-covid patients decreased worldwide. The aim of this study is to evaluate the admission and treatment of patients with coronary artery diseases (CADs) by examining coronary Cath labs activities in some centers of Iran during the COVID-19 period.A retrospective, multi-center survey was conducted in four cites in Iran which participated in National Persian Registry Of CardioVascular diseasE (N-PROVE). Two periods of COVID-19 occurrence peak in Iran were compared with the same date in 2019. Information was collected on the number of diagnostic and therapeutic coronary catheterizations in both stable ischemic heart diseases (SIHDs) and acute coronary syndrome (ACS) settings.In the first peak of COVID-19 pandemic, coronary angiographies and angioplasties decreased by 37 and 38% compared to the same period in 2019, respectively. The most common indication for coronary angiography during this period was ACS [especially ST-Segment Elevation Myocardial Infarction (STEMI)]; however, at the time of peak decrease, the SIHDs were the most. In the second peak of COVID-19 pandemic in Iran, 34% and 27% decrease in diagnostic and therapeutic coronary procedures were seen, respectively. During this period, the number of elective admissions increased, although it was still lower than that in 2019. The tendency to rescue percutaneous coronary intervention increased in most centers during the COVID-19 era, especially in the second peak.A significant reduction in the coronary Cath lab activity has been observed during the COVID-19 pandemic that can indicate an increased risk of cardiovascular mortality and morbidity.

BACKGROUND Previous studies have proved that intracoronary injection of eptifibatide is safe and more effective in infarct size reduction and clinical outcomes than intravenously injection in the patients with acute myocardial infarction (AMI). This study aimed to compare the effect of localized and intracoronary injection of eptifibatide on myocardial perfusion improvement and its outcomes. METHODS We conducted a randomized clinical trial study of 60 patients presented with thrombotic AMI. The patients underwent percutaneous coronary intervention (PCI), and were randomly divided into two equal number groups. The first group received two bolus doses of 180 μg/kg eptifibatide through guiding catheter. The second group received the same bolus doses through export aspiration catheter into the coronary lesion directly. Thrombolysis in myocardial infarction (TIMI) flow, myocardial blush grade (MBG), and no-reflow phenomenon were primary end points. Secondary end points were pre- and postprocedure cardiac arrhythmia, in-hospital mortality, adverse effects, reinfection, pre-discharge ventricular systolic function, and re-hospitalization and mortality after 6 month of follow up. RESULTS The mean ages of group I and group II were 58.3 ± 1.8 and 57.0 ±2.0 years, respectively, and most of patient were men (90% in group I and 80% in group II). Postprocedural TIMI flow grade 3 was achieved in 60.0% and 76.7% of the intracoronary and intralesional groups, respectively (P = 0.307). Postprocedural MBG grade 3 was achieved in 53.3% and 70.0% in intracoronary and intralesional groups, respectively (P = 0.479). There was no significant difference between the groups in no-reflow assessment. Moreover, no significant difference was seen between the two groups in secondary end-point analysis. CONCLUSION Both methods of intracoronary and intralesional eptifibatide administration during primary PCI in patients with acute ST-elevation myocardial infarction (STEMI) were safe and similar in myocardial perfusion outcomes.

BACKGROUND The aim of this study was to predict significant coronary artery disease (CAD) in patients undergoing coronary angiography. METHODS In this cross-sectional study, data of 384 patients who underwent angiography during 2015-2017 were reviewed. Electrocardiograms (ECGs) were evaluated in terms of having positive T wave in lead V1 (TV1) described as T wave with amplitude of more than 0.15 mV and angiography records were assessed for presence of significant CAD defined as presence of ≥ 70% internal diameter stenosis in at least one major epicardial coronary artery or more than 50% stenosis in left main artery (LMA). RESULTS Out of 384 patients who participated in this study with mean age of 63.6 ± 10.2 years (40-89 years), 71.6% showed positive TV1 and significant CAD simultaneously and left anterior descending artery (LAD) and left circumflex artery (LCX) lesions were more frequently reported in coronary angiography. Based on chi-square test, the prevalence of significant CAD was obviously more in those with positive TV1 as compared to those without this finding [odds ratio (OR) = 2.74, 95% confidence interval (CI): 1.80-4.19, P < 0.001]. Mann-Whitney test showed significant difference in number of coronary arteries involved in CAD between presence of positive and negative T wave in lead V1 (P < 0.001). Great number of patients with significant CAD had remarkably higher T wave amplitude in lead V1 in comparison to lead V6 (OR = 6.22, 95% CI: 3.14-12.30, P < 0.001). CONCLUSION Positive TV1 and TV1 > TV6 pattern can be considered as a predictor for significant CAD in patients with otherwise normal ECG.

BACKGROUND: Atrial fibrillation (AF) is the most common tachyarrhythmia and an important risk factor for thromboembolic stroke. CHA2DS2-VASc score was introduced for assessment of embolic events and as criteria for starting anticoagulants. This study was performed to evaluate the left ventricular diastolic dysfunction (LVDD) in patients with non-hemorrhagic stroke and AF. METHODS: This cross-sectional study consisted of 76 consecutive patients with suspected non-hemorrhagic stroke referred to the Cardiology Department of Alzahra and Ayatollah Kashani hospitals in Isfahan, Iran, during 2015-2016. Demographic, anthropometric and clinical characteristics were evaluated for all patients at baseline. CHA2DS2-VASc score was calculated for all. All eligible patients underwent transthoracic echocardiogram (TTE) and LVDD was measured in the patients. RESULTS: The mean age of the patients was 64.64 ± 5.95 years and 28 subjects (36.8%) were women. The most common underlying disease in the patients was hypertension (HTN) (65.8%). Median (range) CHA2DS2-VASc score was 4 (1-7). Four patients (5.3%) had paroxysmal AF and 16 cases (21.1%) had LVDD. Analysis showed that LVDD in patients with non-hemorrhagic stroke and coexisting AF was not associated with CHA2DS2-VASc score (r = 0.151, P = 0.192). CONCLUSION: LVDD is not associated with CHA2DS2-VASc score in patients with non-hemorrhagic stroke and coexisting AF.&nbsp

BACKGROUND: Myocardial infarction (MI) is a cardiac cell death following the imbalance of supply and demand. Electrocardiography (ECG) is a diagnostic test for MI and can help the clinicians to estimate the severity and size of infarction, to suggest the artery related to the infarct and localize the pathology. The aim of this study is to evaluate the diagnostic value of ECG in posterior MI (PMI) compared with angiographic findings. METHODS: In a prospective observational study, using simple sampling patients with diagnosis of PMI (ST elevation in at least two consecutive leads V7, V8, and V9) were enrolled and all standard 12 leads and also V7, V8, V9 and right leads, including V3R and V4R were recorded and angiography was performed. ECG changes were recorded and compared with angiography findings. RESULTS: In this study, totally 138 patients were enrolled (mean ± standard deviation age of 65.00 ± 12.97 and 76.8% male). Left circumflex artery (LCX), right coronary artery (RCA) and left anterior descending artery (LAD) occlusions occurred in 65.9, 50.7, and 29 percent respectively. Patients with LCX occlusion had a significantly higher frequency of ST elevation in V5, V6, I and AVL (P ≤ 0.001). Patients with RCA occlusion had a significantly higher frequency of ST elevation in V1, V3R, and V4R and also ST depression in V5 and V6 (P ≤ 0.001). CONCLUSION: In PMI, there is a relationship between ECG findings and different coronary artery occlusions. Hence that ECG is a useful tool to predict the LCX or RCA occlusion in PMI.&nbsp

Background: In stent restenosis (ISR) following endovascular interventions is the main limitation of their long-term success. Despite advances have been made during recent years to decrease restenosis, it remains a challenging clinical problem.The aim of this study was to evaluate the relationship between angiographic coronary in stent restenosis, inflammation after successful stent implantation. Methods: This study included 78 patients, 35year old and higher who underwent coronary angiography more than 1 year after drug-eluting stent (DES) implantation because of symptoms suggestive ischemia. Patients were divided into ISR group (case) and patent stent group (control) according to angiography results. For all patients blood lipids and high sensitivity C-Reactive Protein (hsCRP) were measured simultaneously. Results: Age, sex, hypertension, current smoking, and lipid profile other than High Density Lipoprotein (HDL-C) of patients in the case and control groups were similar .However, HDL-C < 40mg/L was more prevalent with ISR (66.7% vs. 30.8%, p=0.002). The hsCRP level was 2.98±2.06 mg/L in the case group and 2.50±1.80 mg/L in the control group. There were no significant differences in mean hsCRP concentration between the two groups (p=0.14), however mean hsCRP level was significantly higher in men of case group than control group (3.35mg/L vs. 2.21mg/L, p

OBJECTIVE: To investigate the relation between major depressive disorder and metabolic risk factors of coronary heart disease. INTRODUCTION: Little evidence is available indicating a relationship between major depressive disorder and metabolic risk factors of coronary heart disease such as lipoprotein and apolipoprotein. METHODS: This case-control study included 153 patients with major depressive disorder who fulfilled the criteria of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), and 147 healthy individuals. All participants completed a demographic questionnaire and Hamilton rating scale for depression. Anthropometric characteristics were recorded. Blood samples were taken and total cholesterol, high-and low-density lipoproteins and apolipoproteins A and B were measured. To analyze the data, t-test, χ2 test, Pearson correlation test and linear regression were applied. RESULTS: Depression was a negative predictor of apolipoprotein A (β = -0.328, p

Objectives: Left ventricular (LV) dysfunction heart failure is one of the causes of morbidity and mortality following ST elevation myocardial infarction (STEMI). This study was done to determine the clopidogrel effect in preventing reduced LV function in pa-tients with STEMI. Methods: In this study, 144 patients with STEMI admitted to the Isfahan University of Medical Sciences hospitals were followed in two groups for one month. The case group received Clopidogrel, 300 mg, on admission and then, 75 mg daily, while the control group received routine therapy for STEMI without Clopidogrel. Left ventricular ejection fraction (LVEF) on the 4 th day and one month after STEMI was measured by echocardiography. The re-sults of LVEF were compared within and between groups. Results: The mean LVEF in the case group on the 4 th day and one month after STEMI were 45.92 and 52.15%, respectively (P

BACKGROUND: Despite conventional treatment methods of acute myocardial infarction, its complications and mortality rates are still very high. Finding new cost-effective treatments like regulation of ischemic muscle metabolism at the time of thrombolytic therapy can meet this requirement to some extent. This study investigated the efficacy of the pharmaceutical combination of glucose, insulin, potassium (GIK) and magnesium along with thrombolytic therapy.METHODS: In a double-blind, controlled clinical trial, 200 patients with acute myocardial infarction who had the indication for thrombolytic treatment were selected and divided to 6 groups of almost 30 people. A specific treatment protocol was designed for each group. The patients in the first 5 groups were compared with the ones in the sixth group as the control group in terms of frequency of complications and in-hospital mortality and also mortality during 3 and 6 months after the treatment.RESULTS: Mean age of the patients was 58.77 ± 2.6 years. Males constituted 77% of the study population. Heart failure, in-hospital arrhythmia and ejection fraction (EF) at discharge showed favorable results in the five groups which received metabolic regulations as compared to the control group. In-hospital mortality of no groups was different from that of the control group (P > 0.05). Three months after the treatment, mortality of the group that received GIK and magnesium was lower than that of the control group (P < 0.05). After 6 months, none of the patients who received high-dose GIK and magnesium along with thrombolytic therapy died while the mortality rate of the control group was 44.4% (P < 0.05).CONCLUSION: The infusion of GIK and magnesium solution along with thrombolytic therapy can lead to a decrease in the long-term mortality and complications in patients with acute myocardial infarction.Keywords: Acute Myocardial Infarction, Glucose, Insulin, Potassium, Magnesium, Thrombolytic Therapy, Cardiovascular Diseases, Clinical Trial

BACKGROUND: We aimed to evaluate subepicardial and subendocardial left ventricular (LV)functions in patients with single coronary artery lesion at an early stage after percutaneouscoronary intervention (PCI).METHODS: Patients with left anterior descending (LAD) lesion (n = 40) were evaluated.Subjects underwent PCI and at least one coronary stent was placed. Before and one month afterPCI, patients underwent echocardiography. The ordinary Doppler indicators including E wavedeceleration time, A velocity and E velocity as well as the pulsed-wave tissue Doppler imaging(PW-TDI) parameters (Aa, Ea and Sa velocity) were measured. The findings before and afterintervention were compared.RESULTS: E wave deceleration time was the only factor that significantly improved in ordinaryDoppler and other parameters such as A velocity and E velocity did not show any changes.Among TDI parameters, Aa velocity and Ea velocity in septum area improved significantly butdespite an increase in Sa velocity in septum, it was not statistically significant. Ea velocitysignificantly improved in lateral area but Aa and Sa velocity insignificantly increased.CONCLUSION: In patients with coronary artery disease, the systolic and diastolic function isimpaired. It is simply diagnosable by TDI. Although the systolic function impairment isremained after PCI, the diastolic function considerable improved after angioplasty. Our studyshowed that diastolic function of left ventricle improved over time. In contrast with otherstudies, in this study, Aa velocity significantly improved one month after revascularization.Keywords: Angioplasty, Percutaneous Coronary, Echocardiography, Doppler, Tissue Doppler

Objective Epicardial fat is an indirect contact with coronary arteries. There are some studies about the relationship between this fat and metabolic syndrome and it has considered as an indicator of cardiovascular risk. Several studies have addressed the association between epicardial fat thickness (EFT) and coronary artery disease (CAD) with conflicting results. The aim of our study was to evaluate the hypothesis that echocardiographic EFT thickness could be a marker severe CAD. Methods Overall, 315 cases who underwent coronary angiography were classified in two groups: Normal and CAD. Measurement of EFT was done with echocardiography. The difference between mean EFT in two groups was analyzed. Califf scoring considered for severity of CAD. Then the relationship between EFT and age, sex, body mass index (BMI), serum lipids and severity of CAD was evaluated. The obtained data were compared by using ANCOVA test, Pearson and Spearman's partial correlation analyses. Results The EFT in CAD group was significantly higher than in normal group (5.4 ± 1.9 mm vs 4.4 ± 1.8 mm, p=0.0001). EFT had a positive relationship with Califf scoring of diseased coronary arteries (r=0.158 p=0.04), low-density lipoprotein cholesterol (p=0.04), female gender (p=0.02), BMI (p=0.001) and serum triglyceride levels (p=0.04). Conclusion This study shows an association between EFT thickness and severity of CAD.

Background: Numerous studies have now demonstrated that heart failure with a normal ejection fraction (HFnlEF) is common. Hypertension is also the most commonly associated cardiac condition in patients with HFnlEF. Despite the observed link between microalbuminuria, obesity, and cardiovascular disorders, this question has remained — ′Which is more important for the prediction and prevention of diastolic dysfunction in non-diabetic hypertensive patients?′ Methods: The current study was a cross-section study conducted on a total of 126 non-diabetic hypertensive patients screened to identify those with hypertension. Urine creatinine was measured by the picric acid method and urine albumin content was measured by a sensitive, nephelometric technique. The urinary albumin/creatinine ratio (UACR) was determined as an indicator of microalbuminuria. Complete two-dimensional, doppler, and tissue-doppler echocardiography was performed and the recording of the diastolic function parameters was carried out. Results: High body mass index and high systolic blood pressure were positively correlated with the appearance of left ventricular hypertrophy, whereas, the UACR index had no significant relationship with hypertrophy. Multivariable analysis also showed that advanced age and systolic blood pressure were significantly associated with the E/E annulus parameter. Conclusion: According to our investigation obesity is more important than microalbuminuria for the prediction and prevention of diastolic dysfunction in non-diabetic hypertensive patients.

INTRODUCTION: Studies on the association between the plasma concentration of lipoprotein (a) and coronary heart disease (CHD) have reported conflicting findings. METHOD AND MATERIALS: The objective of the present study was to evaluate the association between serum levels of lipoprotein (a) and ischemic heart disease as well as other cardiovascular risk factors in a population-based study. Lipoprotein (a) serum was measured in 142 patients with chronic stable angina undergoing clinically indicated coronary angiography. Lipid profile, fasting blood glucose, anthropometric and clinical parameters were analyzed. RESULTS: Lipoprotein (a) levels were significantly associated with coronary artery stenosis in men, but not in women. Also, an direct association between mean levels of lipoprotein (a) and coronary artery stenosis in men younger than 55 years old and an inverse association in men older than 55 years old were observed. CONCLUSION: Multivariate analysis revealed that lipoprotein (a) was considered an independent predictor for severity of CAD in men, especially in younger ages. Keywords: Lipoprotein (a), cardiovascular risk factors, Ischemic heart disease, coronary angiography.

BACKGROUND: Nephropathy is one of the serious adverse effects in administration of contrast media in percutaneous coronary intervention (PCI). This study was designed in order to evaluate the effect of ACEI and diuretics on contrast- induced nephropathy. METHODS: This randomized clinical trial was conducted in Isfahan University of Medical Sciences in 2006. Overall, 60 persons were randomly assigned for each group. Groups A and B were treated by angiotensin converting enzyme inhibitors (ACEI) and groups C and D were treated by diuretics. In group A, ACEI was discontinued from 36 hours before PCI and in group C diuretics were discontinued as well. The post-intervention and the amount of increase in the serum creatinin (Cr) level were compared by ANOVA between groups. FINDINGS: The increase in Cr level was not significantly different between groups A and B (0.07±0.22 vs.,0.06±0.13 mg/dL , respectively, p=0.7). Similarly, this difference was not significant between groups C and D (0.08±0.17vs. 0.05±0.14mg/dL, respectively, p=0.2). CONCLUSION: Regarding to non- significant difference of Cr level between the groups either continuing or discontinuing ACEI and diuretics,in the presence of normal kidney function, these drugss,have no side effect in patients undergoing PCI. KEY WORDS: Contrast induced nephropathy, percutaneous coronary intervention

BACKGROUND: Cigarette smoking and hypertension (HTN), are both major risk factors for premature atherosclerosis. Currently, limited information is available from the effect of these risk factors on the Pattern of vessel involvement and also on the left ventricular ejection fraction (LVEF) at coronary angiography. Our study compared their effects on angiography of patients with premature atherosclerosis. METHODS: The study included 240 consecutive patients, under age of 45 years old, cigarette smoker or hypertensive hospitalized with a diagnosis of acute coronary syndrome. These patients underwent coronary angiography. Number and type of vessel involvement and also LVEF were studied. Logistic regression was used for data analysis. FINDINGS: Of patients, 24 were both smoker and hypertensive, and were excluded from this study. In addition, 142 of 216 patients (65.7%) were smoker and 74 (33.4%) were hypertensive. Left anterior descending coronary artery (LAD) involvement was more common in smoker young patient and low LVEF was more common in these patients compared with hypertensive young patients (28.2% versus 17.6%, respectively). CONCLUSION: Our findings indicate that smoking is more prevalent risk factor for premature coronary artery disease. Smoking has a significant effect on the pattern of vessel involvement and LVEF at coronary angiography of young patients. Our study emphasized on the importance of modifying in young active population. KEY WORDS: Smoking, hypertension, premature coronary artery disease.

Background: Many patients with suspected acute myocardial infarction (AMI) and eligible for thrombolytic therapy may not be treated because of association between hemorrhagic complications especially intracranial hemorrhage (ICH), and severe hypertension (HTN) at presentation. Unfortunately, this leads to under use or delay in thrombolytic therapy. We assessed effect of decreasing elevated blood pressure before thrombolytic therapy in order to reduce the incidence of ICH without increasing mortality rate. Methods: This observational and analytical cohort study enrolled 293 patients (215males and 78 female) with STsegment elevation (AMI) that were hospitalized in emergency department of Noor hospital, Isfahan, Iran. Severe hypertension (blood pressure ≥180/110mmHg) was diagnosed in 132 patients. All of them received 1.5 million units streptokinase within one hour intravenously. In the hypertensive group, elevated blood pressure was lowered to less than180/110mmhg before thrombolysis and they were observed to detect development of symptomatic ICH and they underwent Brain CT scan, if required. Results: The incidence of total stroke, ICH and death were 1.4%, 0.7% and 4.8%, respectively. The incidence of death and ICH in patients with severe hypertension was less than control group (P value=0.13 and 0.59, respectively) Conclusion: Although we did not find any increase in ICH incidence in severe hypertensive patients treated be streptokinase due to AMI, but we recommend a multi-centric study with more cases and varied thrombolytic protocols. Key words: Acute myocardial infarction, Intracranial hemorrhage, Thrombolytic therapy

Contrast-induced nephropathy (CIN) is characterized by acute deterioration of renal function that occurs after parenteral administration of contrast media in the absence of other causes. Although no definite proof has been obtained yet, the risk of diuretics or angiotensin-converting enzyme inhibitors (ACEI) to exacerbate CIN has been reported because of their effects on renal perfusion. This study was conducted to assess the protective effect of hydration alone in the prevention of CIN after percutaneous coronary intervention (PCI) in patients on diuretics or ACEI. This randomized clinical trial was conducted at the Chamran Hospital, Isfahan University of Medical Sciences, Iran, during the years 2006-2007. The study patients were divided into four groups, each group containing 60 patients. Patients in groups A and B were on regular treatment with ACEI (captopril) and patients in groups C and D were on regular diuretic (furosemide) the-rapy. About 36 h before PCI, captopril in group A and furosemide in group C were discontinued. The serum creatinine (Cr) levels were measured at the time of performing PCI and 24 h and 48 h after PCI in all patients. All patients received 1 mL/kg/h normal saline (0.9%) 12 h before and 24 h after PCI. The occurrence of CIN after PCI was diagnosed based on the following formula: Cr level after PCI - Cr level before PCI. If this value was greater than 0.5 mg/dL, it was coded as one and if the value was less than 0.5 mg/dL, it was coded as zero. The mean difference was analyzed and compared among the four groups by the ANOVA test. Three patients (5%) in group A, two patients (3.3%) in group B, two patients (3.3%) in group C and one patient (1.6%) in group D had a >0.5 mg/dL difference in serum Cr. The difference seen between these groups was not statistically significant (P > 0.05). This study shows that although furosemide and captopril can exacerbate CIN by impairment of renal perfusion, this can be prevented by hydration and discontinuation of furosemide and captopril may not be required.

Background:Appearance of microalbuminuria, particularly in patients with hypertension, might be associated with a higher prevalence of left ventricular (LV) dysfunction and geometric abnormalities. This study was undertaken to determine whether high urine albumin to creatinine ratio (UACR) as a sensitive marker for microalbuminuria can be associated with LV hypertrophy (LVH) and systolic and diastolic LV dysfunction.Methods:The study population consisted of 125 consecutive patients with essential uncomplicated hypertension. Urine albumin and creatinine concentration was determined by standard methods. LVH was defined as a LV mass index >100 g/m2 of body surface area in women and >130 g/m2 in men. Echocardiographic LV systolic and diastolic parameters were measured.Results:The prevalence of microalbuminuria in patients with essential hypertension was 5.6 %. UACR was significantly no different in patients with LVH than in patients with normal LV geometry (21.26 ± 31.55 versus 17.80 ± 24.52 mg/mmol). No significant correlation was found between UACR measurement and systolic and diastolic function parameters, including early to late diastolic peak velocity (E/A) ratio (R=-0.192, p=0.038), early diastolic peak velocity to early mitral annulus velocity (E/E') ratio (R=-0.025, p=0.794), LV ejection fraction (R=0.008, p=0.929), and LV mass (R=-0.132, p=0.154). According to the receiver operator characteristic (ROC) curve analysis, UACR measurement was not an acceptable indicator of LVH with areas under the ROC curves 0.514 (95 % confidence interval 0.394–0.634). The optimal cut-off value for UACR for predicting LVH was identified at 9.4, yielding a sensitivity of 51.6 % and a specificity of 48.3 %.Conclusion:In patients with uncomplicated essential hypertension, abnormal systolic and diastolic LV function and geometry cannot be effectively predicted by the appearance of microalbuminuria.