Assessment of Strain and Strain Rate in Patients with Coronary Artery Disease Before and After Percutaneous Intervention on Left Anterior Descending Coronary Artery

Introduction: Strain (S) and Strain Rate (SR) as echocardiography parameters are important in assessing changes in myocardial tissue and global and regional evaluation of systolic and diastolic functions and in detection of myocardial disorders as they change in early stages of myocardial ischemia. Therefore, the aim of this study was to compare changes of S and SR indices in systolic phase in patients with a significant stenosis of left anterior descending (LAD) before and after percutaneous coronary intervention (PCI).Methods: 48 patients candidate for PCI with significant lesion in LAD were enrolled in this study. Echocardiographic images taken one day before and a week after PCI. Echocardiographic scope of the LAD was defined as mid, basal, anteroseptal and mid-septal and apical segments then, S and SR parameters in all segments measured separately during systolic phase before and after PCI and compared together.Results: there was a significant increase after PCI only in two segments and SR values showed significant increase after PCI in four segments. In the analysis of sum of mean parameters, a significant increase was observed in SR values (10.12 to 11.30; P = 0.001), but not in S values (149.54 to 143.36; P = 0.1)Conclusions: The remedial effect of PCI on deformation values was observed in the first week. In early reperfusion period, S/SR indices have potential to be used as determinants of favorable response to revascularization therapy

Comparison of clinical outcomes of patients treated with Cre8TM versus Resolute Onyx™ stent

Introduction: This study aims to compare the clinical outcomes of patients treated with Cre8TM versus Resolute Onyx™ stent. Material and Methods: In this retrospective study, all patients who underwent Stenting in the catheterization department of ShahidMadani Hospital between 2015 and 2018, were included. Angiographic and angioplasty findings were recorded. The primary end point, which includes total mortality, myocardial infarction, revascularization (adverse events) were recorded. Results: The mortality rates were similar in both groups. Moreover the myocardial infarction and repeated revascularization did not differ in both groups (p>0.05).The rates of adverse events wasn't   significantly different between the two groups. Conclusion: Our study showed that efficacy and safety of Cre8™ stents is non-inferior to the Resolute Onyx™ stent

Anomalous left coronary artery from the pulmonary artery presenting with aborted sudden death in an octogenarian: a case report

<p>Abstract</p> <p>Introduction</p> <p>We report a rare coronary anomaly presenting with aborted sudden death in an octogenarian. An anomalous left coronary artery from the pulmonary artery is a rare coronary anomaly which usually presents in the first year of life. Survival into adulthood and the elderly years is extremely rare.</p> <p>Case presentation</p> <p>An 85-year-old Caucasian woman was brought to our hospital following cardiopulmonary arrest. After prolonged resuscitation and stabilization of our patient, further evaluation revealed an anomalous left coronary artery from pulmonary artery syndrome. She was discharged on medication.</p> <p>Conclusion</p> <p>An anomalous left coronary artery from the pulmonary artery can present in elderly and even octogenarian patients. Careful history, physical examination and an appropriate invasive study are needed to confirm the diagnosis.</p

Associated factors with delayed door to balloon time in STEMI patients

Introduction: The time interval from hospital arrival to the balloon inflation of catheter in coronary arteries is defined as Door to Balloon Time (DBT). Door to balloon time is a marker of primary Percutaneous Coronary Intervention (PCI) timeliness. Door to balloon time duration, associated factors and it’s relation to outcomes are not similar in various centers. Herein we aimed to define these issues in our region. Methods: In this study, 188 patients with ST Elevation Myocardial infarction (STEMI) diagnosis eligible for primary PCI were included. Demographic, clinical and time intervals from arrival in hospital to catheterization data of patients were recorded. Patients were followed for six-month in terms of mortality and admission. Results: After excluding patients with missed data, 174 patients were entered in the study. Mean age of patients were 60.8±11.81 years and 78% of patients were male. Median DBT was 70 minutes (IQR 25-75: 55-97 minute). One hundred and twenty three patients (71%) had timely door to balloon time. Patients with delayed door to balloon time had lower age, lower prevalence of typical chest pain and higher prevalence of PCI on Left Circumflex Artery (LCX) than timely group but these differences were not significant. (p values were 0.068, 0.074 and 0.070 respectively). Delayed DBT was evident in three segments of door to ECG, ECG to code and code to cath times (p values were, &lt; 0.0001, 0.009 and &lt; 0.0001 respectively) but the cath to balloon time was not significantly different between two groups (p value: 0.159). Although in-hospital mortality was higher in delayed group than timely group but the difference was not meaningful. (11.7% vs 4.9%, p value: 0.103) Six-month mortality and admission rate were not different between two groups. Conclusion: Door to balloon time was acceptable in this study and was comparable to developed countries. Albeit there is room for improvement due to modifiable delayed parts

Dual Left Anterior Descending Artery: Clinical Overview and Interventional Management

Congenital coronary artery anomalies are relatively rare, occurring in approximately 0.6%-1.3% of cases undergoing coronary angiography. Among these anomalies, a unique cardiac abnormality known as a dual left anterior descending artery (LAD) stands out. A dual LAD is characterized by the presence of 2 LADs in the anterior interventricular sulcus. This structural deviation consists of a shorter LAD that terminates high in the anterior interventricular sulcus and a longer LAD that extends to the distal sulcus, supplying blood to the cardiac apex. Percutaneous procedures on dual LADs are even less frequent. We describe a 53-year-old woman with typical burning chest pain, ST-elevation in leads I and aVL, and positive troponin I enzyme. Coronary angiography revealed a thrombotic lesion with 99% stenosis at the proximal part of the LAD. The main LAD originated properly from the left coronary cusp, and the remainder of its course was supplied by a second branch originating from the right coronary cusp. Computed tomography angiography and echocardiography were performed for the LAD course. The patient was discharged after an uneventful 1-week hospital stay. Our case is particularly noteworthy for several reasons. Firstly, this dual LAD anomaly is uncommon, and patients with dual LADs less frequently have a ramus artery. Secondly, there have been only a few documented cases of percutaneous transluminal coronary angioplasty performed on short LADs. The key takeaway from this scintillating case study is the significance of identifying the artery responsible for blood supply to the cardiac apex

Comparison of the Efficacy of Atorvastatin and Rosuvastatin in Preventing Atrial Fibrillation after Coronary Artery Bypass Grafting: A Double-blind Randomized Comparative Trial

Background: Atrial fibrillation (AF) is a supraventricular tachyarrhythmia characterized by disorganized atrial activity and subsequent mechanical atrial failure. Postoperative AF is a frequent complication of coronary artery bypass grafting (CABG). Although there is evidence of decreased AF after CABG with statin usage, information is scarce regarding a direct comparison between atorvastatin and rosuvastatin. The present study was conducted to compare the efficacy of rosuvastatin and atorvastatin in preventing post-CABG AF. Methods: The present double-blind randomized comparative clinical trial selected CABG candidates with stable ischemic heart disease or acute coronary syndromes. Atorvastatin (40 mg per day) or rosuvastatin (20 mg per day) was prescribed 1 week before surgery, and the outcomes were compared. Results: Two-hundred patients, 100 cases in each group, completed the study. Twenty-five patients in each group were female, and the mean age was 59.30±8.42 years in the rosuvastatin group and 60.13±9.40 years in the atorvastatin group (P=0.513). The frequency of AF was 31% in the atorvastatin group and 27% in the rosuvastatin group (P=0.534). No significant differences existed between the groups concerning the length of hospital and ICU stay (P=0.333 and P=0.161) and in-hospital and 3-month mortality (P=0.315 and P=0.648). A subgroup analysis of only patients with stable ischemic heart disease could not detect a significant difference between the study groups in any of the investigated outcomes. Our logistic regression analysis showed an association only between age and the incidence of AF after CABG (OR, 1.12; 95% CI, 1.05 to 1.20; P<0.01). Conclusion: Rosuvastatin and atorvastatin are similar concerning the prevention of post-CABG AF, but there is a need for future well-designed multicenter studies on this topic.

Prediction of clinical outcomes of patients treated with percutaneous coronary intervention for ST-Elevation myocardial infarction using familial history of premature coronary artery disease

Introduction: ST-elevation myocardial infarction (STEMI) is a relatively common cause of mortality among patients. The effects of risk factors as predictors of mortality in patients has been shown in different studies. The present study was performed aiming to evaluate the association between a family history of premature coronary artery diseases (CADs) with clinical outcomes among patients treated with percutaneous coronary intervention (PCI) for STEMI. Methods: This descriptive-analytical study was conducted in Shahid Madani Hospital of Tabriz University of Medical Sciences, Tabriz, Iran, on 200 patients with STEMI with a PCI. 100 out of these 200 patients had a family history of premature CAD. Patients were followed up within 48 hours after PCI, as well as one year after admission, and the secondary outcomes including myocardial infarction (MI), heart failure, ventricular arrhythmias (VAs), pulmonary edema, and death were evaluated. Results: The mean age of the patients with positive and negative family history of premature CAD was 56.37 ± 8.20 and 61.72 ± 7.42 years, respectively. The mean age of the patients with a family history of a premature CAD was significantly lower than that of patients without a family history of a premature CAD (P = 0.001). There was no significant difference in the frequency of CAD risk factors, angiographic findings, and its complications, ST-segment resolution and frequency of secondary outcomes during 48 hours and one year after admission between the study groups (P > 0.050). Conclusion: The present study showed that a family history of premature CAD does not predict the clinical outcomes in patients treated with PCI for STEMI which should be validated across future studies

Mitral Regurgitation after Percutaneous Balloon Mitral Valvotomy in Patients with Rheumatic Mitral Stenosis: A Single-Center Study

Background: Percutaneous balloon mitral valvotomy (BMV) is the gold standard treatment for rheumatic mitral stenosis (MS) in that it causes significant changes in mitral valve area (MVA) and improves leaflet mobility. Development of or increase in mitral regurgitation (MR) is common after BMV. This study evaluated MR severity and its changes after BMV in Iranian patients. Methods: We prospectively evaluated consecutive patients with severe rheumatic MS undergoing BMV using the Inoue balloon technique between February 2010 and January 2013 in Madani Heart Center, Tabriz, Iran. New York Heart Association (NYHA) functional class and echocardiographic and catheterization data, including MVA, mitral valve mean and peak gradient (MVPG and MVMG), left atrial (LA) pressure, pulmonary artery systolic pressure (PAPs), and MR severity before and after BMV, were evaluated. Results: Totally, 105 patients (80% female) at a mean age of 45.81 ± 13.37 years were enrolled. NYHA class was significantly improved after BMV: 55.2% of the patients were in NYHA functional class III before BMV compared to 36.2% after the procedure (p value < 0.001). MVA significantly increased (mean area = 0.64 ± 0.29 cm2 before BMV vs. 1.90 ± 0.22 cm2 after BMV; p value < 0.001) and PAPs, LA pressure, MVPG, and MVMG significantly decreased. MR severity did not change in 82 (78.1%) patients, but it increased in 18 (17.1%) and decreased in 5 (4.8%) patients. Patients with increased MR had a significantly higher calcification score (2.03 ± 0.53 vs.1.50 ± 0.51; p value < 0.001) and lower MVA before BMV (0.81± 0.23 vs.0.94 ± 0.18; p value = 0.010). There were no major complications. Conclusion: In our study, BMV had excellent immediate hemodynamic and clinical results inasmuch as MR severity increased only in some patients and, interestingly, decreased in a few. Our results, underscore BMV efficacy in severe MS. The echocardiographic calcification score was useful for identifying patients likely to have MR development or MR increase after BMV