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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: 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.

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.