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BACKGROUND: Ischemic heart disease (IHD) is the leading cause of 16% of deaths globally. Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are the main treatment options. Saphenous vein grafts (SVGs) remain the most frequently used conduits for CABG. In addition, PCI in cases previously undergoing CABG is related to worse long-term outcomes. This study aimed to evaluate PCI's short-term and long-term clinical outcomes on SVGs. METHODS: Sixty-three patients who underwent PCI on SVGs from 2017 to 2019 were enrolled. Short-term and long-term cardiac outcomes of patients in the 6-month follow-up, including major adverse cardiac events (MACE) and all causes of death, were collected. The collected data were also analyzed through statistical methods. RESULTS: The mean age of the subjects was 63.26 ± 8.74 years. Out of 63 patients, five patients (7.94%) died. Two of them died because of cardiac death a day after PCI, and three other cases passed away during the 6 months after angioplasty. Four and three cases had non-fatal myocardial infarction and stroke 6 months after PCI, respectively. CONCLUSION: In conclusion, in patients with coronary artery disease, PCI and CABG are complementary therapies. Revascularization on saphenous vein grafts seems to be a safe and practical technique in patients. [ABSTRACT FROM AUTHOR]

Background: Vitamin D and parathyroid hormone (PTH) are related but impact cardiovascular functions differently. Objectives: This study investigated the roles of PTH and vitamin D serum levels in the severity of coronary artery disease and left ventricular systolic function (LVSF). Methods: This cross-sectional study was conducted on 271 participants who underwent elective coronary angiography at Dr. Heshmat Hospital, selected by convenience sampling over four months. 25-hydroxyvitamin D (25 (OH) D) and PTH levels were obtained from patients' blood samples. Vitamin D levels were categorized into three categories. The SYNTAX score was used to evaluate the severity of coronary artery disease (CAD), classified across three categories. The chi-squared test, independent samples t-test, and multivariable logistic regression were used for statistical analysis. Data were analyzed by SPSS ver.21. Results: Diabetes, hypertension, dyslipidemia, and lower vitamin D levels were independent variables affecting patients' high-risk conditions. The highest SYNTAX score was in patients with vitamin D deficiency (P < 0.001). Patients with different ejection fractions did not have statistically significant differences in vitamin D (25.38 ± 14.23) and PTH levels (66.62 ± 17.39) (P = 0.4). The severity of CAD in patients with PTH > 40 was higher than in patients with PTH ≤ 40, but this was not statistically significant (P = 0.06). Conclusion: Our results showed an inverse relation between CAD and vitamin D. However, the CAD risk did not change with PTH levels. [ABSTRACT FROM AUTHOR]

Nowadays, cardiovascular disease, including coronary artery disease, is the leading cause of death around the world. Duke Treadmill Score (DTS) is used as a prognostic score for patients suspected of coronary artery disease. Investigating the Relationship between DTS and syntax score (SxScore) as an indicator of complexity and severity of coronary artery disease in patients with intermediate and high Duke Score. This cross-sectional study was conducted at the exercise test unit of Heshmat Hospital in Rasht from September 2017 to December 2018. Among 1033 patients that passed exercise cardiac stress testing (EST), 118 patients who had positive exercise testing for CAD were enrolled. Coronary angiography was performed, and SxScore, a marker of CAD complexity, was determined. The relationship between DTS and SxScore was then evaluated. The data were analyzed by SPSS version 21. The risk of positive EST raised age more than 61 years (OR=1.072; 95%; CI=1.046-1.099), Hypertension (OR=3.235; 95%; CI=2.097-4.992), Hyperlipidemia (OR=2.109; 95%; CI=1.371-3.242) and Diabetes Mellitus (OR=2.15; CI=1.22-3.14). The presence of the following factors reduced positive EST: female (OR=0.377;95%; CI=0.133-1.068), retired (OR=0.128;95%; CI=0.045-0.361). The results of the present study showed that there was no significant difference between the degree of coronary artery involvement based on syntax with Duke scores (P=0.328). Although both DTS and Syntax scores are useful in evaluating coronary artery disease, there isn't a significant relationship between these scores, and they don't coincide. In other words, we cannot use DTS to predict the Syntax score. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this randomized control trial study was to understand the effects of happiness training by Fordyce method on life expectancy in patient's candidates for heart surgery. This study was conducted on 66 patients who were candidates for heart surgery referred to Heshmat Heart Hospital in Rasht. Patients were randomly divided into two groups of intervention (n=34) and control (n=32) via blocked randomized method. The instrument included a standard Miller questionnaire. The intervention method of Fordyce Happiness Model was implemented via face-to-face sessions within 7 days before surgery every day for 20 to 30 minutes. Data analysis was conducted, based on the results obtained before the intervention, there was no significant difference between the two groups in terms of mean life expectancy score (p=0.643). Life expectancy score after the intervention in the case group was significantly higher than the control group (p=0.032). The findings of this study indicate that Fordyce happiness training can effect on life expectancy in patients undergoing heart surgery. [ABSTRACT FROM AUTHOR]

Background: No-reflow is a major challenging issue in the management of patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). This study aimed to investigate the clinical, laboratory, and procedural predictors of no-reflow. Methods: This study was conducted on 378 patients with STEMI admitted to Dr. Heshmat Educational and Remedial Center (a referral heart hospital in Rasht, Iran) between 2015 and 2017. The study population was divided based on the thrombolysis in myocardial infarction (TIMI) flow grade and the myocardial blush grade into no-reflow and reflow groups. The clinical, laboratory, and procedural characteristics at admission were compared between the 2 groups using the multivariate logistic regression analysis. Results: The mean age of the participants was 58.57±11.49 years, and men comprised 74.1% of the study population. The no-reflow phenomenon was found in 77 patients. The no-reflow group was significantly older and more likely to be female; additionally, it had higher frequencies of hypertension, diabetes mellitus, hyperlipidemia, and a history of cardiovascular diseases. The multivariate logistic regression analysis showed that age >60 years (OR=1.05, 95% CI:1.00-1.09), hypertension (OR=2.91, 95% CI:1.35-6.27), diabetes (OR=4.18, 95% CI:1.89-9.22), a low systolic blood pressure (OR=3.53, 95% CI:1.02-12.2), a history of cardiovascular diseases (OR=4.29, 95% CI:1.88-9.77), chronic heart failure (OR=4.96, 95% CI:1.23-20), a low initial TIMI flow grade (OR=7.58, 95% CI:1.46-39.2 ), anemia (OR=3.42, 95% CI:1.33-8.77), and stenting vs. balloon angioplasty (OR=0.42, 95% CI:0.19-0.91) were the significant independent predictors of no-reflow. Conclusion: This study revealed some clinical, laboratory, and procedural predictors of no-reflow for the prediction of high-risk patients and their appropriate management to reduce the risk of no-reflow. [ABSTRACT FROM AUTHOR]

Background: Cardiac resynchronization therapy (CRT) has been introduced as a promising therapeutic choice in heart failure (HF) patients with ventricular dyssynchrony, shown with a wide QRS. In previous study, we showed a positive effect of CRT on ejection fraction. This study aimed to evaluate the effect of CRT on the severity of mitral regurgitation (MR) quantitatively using the volumetric Doppler method in HF patients. Materials and Methods: In this prospective before-after survey, 22 HF patients with wide QRS (≥120 ms) and NYHA class III who were included. All patients were evaluated initially for QRS width, NYHA class, MR volume, MR fraction and mitral valve area (MV area). Biventricular pacing was done through cardiac-resynchronization device along with three pacing leads and same evaluations were done after CRT. Results: The mean (SD) QRS width and NYHA class were significantly decreased after CRT in HF patients (p<0.001). Also MR volume (46.9±30.2 mL vs. 27.0±26.4 mL, p<0.001) and fraction (40.1±25.5% vs. 26.8±22.7%, p=0.002) were improved following CRT. The decrease of MV area after CRT was also significant (10.6±3.0 cm² vs. 8.6±2.6 cm2, p<0.001). Conclusion: As MR is associated with morbidity and mortality in HF patients and the standard surgical therapy may not be practical for a majority of them, this novel treatment may improve their disease condition significantly. [ABSTRACT FROM AUTHOR]

Background: Cardiac resynchronization therapy (CRT) has introduced as new treatment strategy in heart failure (HF) patients and some of its effects have been investigated. The aim of this study was to study the effectiveness of CRT in the improvement of left ventricular systolic function indicated by left ventricular ejection fraction (LVEF) in HF patients. Materials and Methods: In our prospective study 22 HF patients with NYHA class III and above, QRS duration>120 ms and EF (ejection fraction) =35% who were candidates for CRT enrolled. Patients were evaluated for NYHA class, QRS width, left ventricular end-systolic volume (LVESV), left ventricular end-diastolic volume (LVEDV) and LVEF before and two months after the CRT procedure. Paired-t test analysis used to compare the before and post-CRT data statistically. Results: Initial evaluation showed that all of the patients were in NYHA class III before CRT. Two months after CRT, all of the patients improved their NYHA class in a way that 18 patients (82%) were in NYHA class I and the other 4 (18%) were in NYHA class II. The mean (SD) QRS width decreased significantly after biventricular (BiV) pacing (p<0.001). Also a significant decrease in LVESV, LVEDV and increase in LVEF was shown in HF patients after CRT (p<0.001). Conclusion: The present study showed the efficacy of CRT in improvement of LVEF in HF patients with wide QRS after two months from CRT [ABSTRACT FROM AUTHOR]

Background: Left ventricular twist/torsion is believed to be a sensitive indicator of systolic and diastolic performance. To obtain circumferential rotation using tissue Doppler imaging, we need to estimate the time-varying radius of the left ventricle throughout the cardiac cycle to convert the tangential velocity into angular velocity. Objective: The aim of this study was to investigate accuracy of measured LV radius using tissue Doppler imaging throughout the cardiac cycle compared to two-dimensional (2D) imaging. Methods: A total of 35 subjects (47±12 years-old) underwent transthoracic echocardiographic standard examinations. Left ventricular radius during complete cardiac cycle measured using tissue Doppler and 2D-imaging at basal and apical short axis levels. For this reason, the 2D-images and velocity-time data derived and transferred to a personal computer for off-line analysis. 2D image frames analyzed via a program written in the MATLAB software. Velocity-time data from anteroseptal at basal level (or anterior wall at apical level) and posterior walls transferred to a spreadsheet Excel program for the radius calculations. Linear correlation and Bland-Altman analysis were calculated to assess the relationships and agreements between the tissue Doppler and 2D-measured radii throughout the cardiac cycle. Results: There was significant correlation between tissue Doppler and 2D-measured radii and the Pearson correlation coefficients were 0.84 to 0.97 (P<0.05). Bland-Altman analysis by constructing the 95% limits of agreement showed that the good agreements existed between the two methods. Conclusion: It can be concluded from our experience that the tissue Doppler imaging can reasonably estimate radius of the left ventricle throughout the cardiac cycle. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented regarding a retrospective cohort study of the relationship between quality of life (QOL) and medication adherence in patients who underwent coronary artery bypass grafting (CABG).

Background: The aim of this study was to examine relationship between the parameters of pulmonary function and the severity of coronary artery disease (CAD) in chronic obstructive lung disease patients., Materials and Methods: Four hundred and twenty four patients with ischemic heart diseases who underwent coronary angiography were studied. The demographic characteristics and medical history of the patients were obtained from their medical records.The severity of COPD was determined according to the Global Initiative for Chronic Obstructive Lung Disease. In addition, the severity of CAD was quantified by SYNTAX scoring., Results: Eighty-eight (21.2%), 270 (65.1%), 52 (12.5%), and 5 (1.2%) of the patients had the grade 1, 2, 3, or 4 COPD, respectively. In addition, 46 (11.1%), 319 (76.9%), and 50 (12.0%) of them had low, intermediate, and high CAD, respectively. A statistically significant relationship was observed between the severity of COPD and the severity of CAD. Significant relationships were found between age, sex, BMI, LDL, EF, and systolic pressure of pulmonary artery with the severity of COPD. The odds of higher CAD in females were 1.849 times higher than male patients. In addition, the odds of high CAD in the patients with grade 1 or 2 COPD were 0.006 and 0.068 times of the patients with grades 3 and 4 COPD, respectively., Conclusions: The findings of the present study indicate that the parameters of pulmonary function and the severity of CAD are associated with the severity of COPD., Competing Interests: Conflict of interest None declared., (Copyright© 2020 National Research Institute of Tuberculosis and Lung Disease.)

Background: No-reflow is a major challenging issue in the management of patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). This study aimed to investigate the clinical, laboratory, and procedural predictors of no-reflow. Methods: This study was conducted on 378 patients with STEMI admitted to Dr. Heshmat Educational and Remedial Center (a referral heart hospital in Rasht, Iran) between 2015 and 2017. The study population was divided based on the thrombolysis in myocardial infarction (TIMI) flow grade and the myocardial blush grade into no-reflow and reflow groups. The clinical, laboratory, and procedural characteristics at admission were compared between the 2 groups using the multivariate logistic regression analysis. Results: The mean age of the participants was 58.57±11.49 years, and men comprised 74.1% of the study population. The no-reflow phenomenon was found in 77 patients. The no-reflow group was significantly older and more likely to be female; additionally, it had higher frequencies of hypertension, diabetes mellitus, hyperlipidemia, and a history of cardiovascular diseases. The multivariate logistic regression analysis showed that age >60 years (OR=1.05, 95% CI:1.00-1.09), hypertension (OR=2.91, 95% CI:1.35-6.27), diabetes (OR=4.18, 95% CI:1.89-9.22), a low systolic blood pressure (OR=3.53, 95% CI:1.02-12.2), a history of cardiovascular diseases (OR=4.29, 95% CI:1.88-9.77), chronic heart failure (OR=4.96, 95% CI:1.23-20), a low initial TIMI flow grade (OR=7.58, 95% CI:1.46-39.2 ), anemia (OR=3.42, 95% CI:1.33-8.77), and stenting vs. balloon angioplasty (OR=0.42, 95% CI:0.19-0.91) were the significant independent predictors of no-reflow. Conclusion: This study revealed some clinical, laboratory, and procedural predictors of no-reflow for the prediction of high-risk patients and their appropriate management to reduce the risk of no-reflow., (Copyright © 2020 Tehran University of Medical Sciences.)

Objective: Cardiac resynchronization therapy (CRT) is introduced as a promising therapeutic option in heart failure (HF) patients with ventricular dyssynchrony.The challenge, however, is identifying the patients who are suitable candidates for this procedure. Fragmented QRS (fQRS) is associated with subendocardial fibrosis and myocardial scars. In this study, we aimed to evaluate the role of fragmented QRS complex on a routine 12-lead ECG as a predictor of response to CRT., Methods: Sixty-five consecutive patients with HF who underwent CRT, were studied. Patients' resting 12-lead ECGs were analyzed to find presence of fQRS by a cardiologist. Echocardiographic response to CRT was defined as ≥15% decrease in left ventricular end-systolic volume (LVESV) after CRT implantation. Response to CRT was compared between patients with and without fQRS., Results: The study group included 27 women (41.5%) and 38 men (58.5%) with a mean (±SD) age of 62±12 years. 27 patients (41.5%) had fQRS in their basal ECGs. Totally 46 patients (70.8%) responded to CRT in a way that the mean left ventricular ejection fraction (%) significantly increased, and left ventricular end diastolic volume (LVEDV) significantly decreased after CRT (p<0.001 and p=0.001 respectively). In multivariate logistic analysis, lack of fQRS was found to be a predictor of response to CRT (OR: 4.553, 95% CI: 1.345-15.418, p=0.015)., Conclusion: We showed that the fQRS complex, as a sign of myocardial scar, predicts non-responsiveness to CRT. Therefore, fQRS may help selecting of CRT candidates.

Introduction: Electrocardiography parameters can predict cardiac events in ischemia. QT-interval parameters are potentially proposed as available non-invasive markers for assessing the ventricular homogeneity and electrical instability. Prolonged QT-interval (QTI) and QT dispersion (QTd) are predictors of poor prognosis and fatal arrhythmias. The improvement of cardiac perfusion may decrease QTI via percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery. The aim of this study was to compare the effects of PCI and CABG on QT parameters in chronic ischemia., Methods: A total of 141 consecutive patients with coronary artery disease (70 who underwent PCI and 71 who underwent CABG) were entered into the study. Standard 12-lead electrocardiograms were recorded immediately before the procedure, immediately post procedure, 24 hours post procedure, and 7 days post procedure; corrected QTI (QTc) and corrected QTd (QTcd) and their changes were assessed and compared across the two therapeutic groups., Results: QTc and QTcd reduced significantly after 7 days of revascularization. After PCI, QTc reduced from 444.7 ± 46.9 msec to 427.4 ± 40.6 msec and QTcd reduced from 47.1 ± 23.3 msec to 38.1 ± 1.1 msec. QTc increased immediately after CABG from 443.2 ± 36.6 msec to 461.9 ± 38.1 msec, but reduced within 7 days of the procedure to 430.2 ± 28.2 msec. QTcd reduced from 49.6 ± 23.2 msec to 30.9 ± 3.9 msec. The trend of QTcd reduction were similar in the two therapeutic groups but the trend of QTc alteration was different in that QTc increased upwardly and then decreased after CABG., Conclusion: Revascularization in chronic ischemia can improve QTI parameters following both PCI and CABG.