Estimation of left ventricular end diastolic pressure (lvedp) in patients with ischemic heart disease by echocardiography and compare it with the results of cardiac catheterization

<strong>BACKGROUND:</strong> Doppler echocardiography has been proposed as an appropriate non-invasive<br />assay to estimate left ventricular end diastolic pressure (LVEDP). The aim of present research<br />was to estimate the LVEDP in patients with ischemic heart disease by echocardiography and<br />compare it with the results of cardiac catheterisation and to determine the effect of different<br />echocardiographic variables on its measurement.<br /><strong>METHODS:</strong> In this descriptive-analytic study, patients with diagnosed ischemic heart disease<br />were selected by nonrandomized sampling method. Selected population underwent M-mode<br />and pulse doppler echocardiographic evaluation and parameters such as Q-Mitral valve E<br />(Q-MVE), Q-Aortic valve closure (Q-AVC), Aortic valve closure-E (AVC-E), Q-Mitral valve<br />closure/Aortic valve closure-E (Q-MVC/AVC-E), left ventricle-deceleration time (LV-DT), peak<br />velocity-deceleration time (PV-DT) and A/E velocity time integral (A/E VTI) were evaluated.<br />Immediately after echocardiography all patients underwent left heart catheterization for LVEDP<br />measurement. The relation between different echocardiographic measurements and LVEDP,<br />obtained by cardiac catheterization, was evaluated.<br /><strong>RESULTS:</strong> In this study, 47 patients with ischemic heart disease with mean age (&plusmn;SD) of<br />53 &plusmn; 13 were studied. There was a significant correlation between LVDEP and A/E VTI (r=0.44,<br />P = 0.001, and also between LVEDP and PV-DT in patients with A/E VTI &ge;1.1(r = -0.58, P = 0.02).<br />There was a significant correlation between LVEDP and Q-MVC/AVC-E in patients with LVEDP<br />&gt;18mmHg (r = 0.76, P= 0.03) and those with LVEDP &le;18 mmHg and A/E VTI &lt; 1.1<br />(r = 0.37, P= 0.03). The correlation between LVEDP and A/E VTI was more significant in men,<br />in patients aged &gt; 50 years with EF &gt; 55%, without LVH, without MR and those with coronary<br />artery disease (P &lt; 0.05).<br /><strong>CONCLUSION:</strong> Some echocardiographic indices such as A/E VTI, Q-MVC/AVC-E and PV-DT<br />are able to measure LVEDP especially in male patients aged &gt; 50 years, without LVH, without<br />MR and those with coronary artery disease but it is necessary to determine specific conditions<br />and factors affecting these indices, by further studies.<br /><strong>Keywords:</strong> LVEDP, Coronary Artery Disease, Echocardiography

Percutaneous transvenous mitral commissurotomy in a patient with situs inversus and dextrocardia: a case report

<p class="abstract"><strong>INTRODUCTION:</strong> Dextrocardia situs inversus refers to the heart being a mirror image situated on the right side of the body. Distorted cardiac anatomy provides technical difficulties during fluoroscopy‐guided transcatheter procedures. This is even more difficult in the case with percutaneous transvenous mitral commissurotomy (PTMC). Mitral valvuloplasty is a minimally invasive therapeutic procedure to correct an uncomplicated mitral stenosis by dilating the valve using a balloon. Here, we describe a case of a 25 years-old male with situs inversus and dextrocardia.</p> <p class="abstract"><strong>CASE REPORT</strong>: A 25 years-old man, having situs inversus and suffering from mitral stenosis was referred to hospital for PTMC. His initial examination findings were unremarkable and an electrocardiographic (ECG), trans-esophageal and transthoracic echocardiographic evaluation were performed. Mitral valve (MV) was dome shape and severely stenotic with mild mitral regurgitation (MR). Left ventricular&nbsp;ejection Fraction (LVEF) was about 40%, Femoral arterial and venous punctures were made on the left side; the left femoral artery and vein were cannulated with a 5F arterial and 6F venous sheaths, respectively. Then special maneuvers were done to solve the mitral valve stenosis. At the end of the procedure, no MR was documented by checking LV angiogram and there were no signs of mitral stenosis (MS).</p> <p class="abstract"><strong>DISCUSSION:</strong> Mirror‐image dextrocardia, as in our case, has been estimated to occur with a prevalence of 1:10,000. However, there are only a few case reports in the literature on PTMC in similar settings. This might be due to the fact that many of these patients undergo surgical commissurotomy due to the technical difficulties involved in a percutaneous procedure in general. Trans-septal catheterization is considered a technical challenge in anatomically malpositioned hearts, as it is fraught with a higher risk of cardiac perforation. Despite the challenging anatomy, PTMC has been demonstrated to be a safe and feasible option for MS in patients with unusual cardiac anatomy.</p> <p class="abstract">&nbsp;</p> <p class="abstract">&nbsp;</p><table cellspacing="0" cellpadding="0" align="left"><tbody><tr><td width="35" height="12">&nbsp;</td></tr><tr><td>&nbsp;</td><td>&nbsp;</td></tr></tbody></table><p class="abstract"><strong>Keywords:</strong> PTMC, Dextrocardia, Surgical Commissurotomy</p

The Relation Between Ankle-Brachial Index (ABI) and Coronary Artery Disease Severity and Risk Factors: An Angiographic Study

<br /><strong>BACKGROUND</strong>: The current study aims to determine the relation between ankle&ndash;brachial<br />index (ABI) and angiographic findings and major cardiovascular risk factors in patients with<br />suspected coronary artery diseases (CAD) in Isfahan.<br /><strong>METHODS</strong>: In this cross-sectional descriptive-analytic research, patients with suspected CAD<br />were studied. Characteristics of studied subjects including demographics, familial history, past<br />medical history and atherosclerotic risk factors such as diabetes mellitus, hypertension,<br />hyperlipidemia and smoking were obtained using a standard questionnaire. ABI was measured<br />in all studied patients. ABI &le; 0.9 (ABI+) was considered as peripheral vessel disease and ABI &gt;<br />0.9 (ABI-) was considered as normal. Then, all studied patients underwent coronary artery<br />angiography. The results of the questionnaire and angiographic findings were compared in ABI+<br />and ABI- groups. Data were analyzed by SPSS 15 using ANOVA, t-test, Spearman's rank<br />correlation coefficient, and discriminant analysis.<br /><strong>RESULTS</strong>: In this study, 125 patients were investigated. ABI &le; 0.9 was seen in 25 patients (20%).<br />The prevalence of ABI+ among men and women was 25.9% and 7.5%, respectively (P = 0.01). The<br />prevalence of atherosclerotic risk factors was significantly higher in ABI+ patients than in ABIones<br />(P &lt; 0.05). ABI+ patients had more significant stenosis than ABI- ones. The mean of<br />occlusion was significantly higher in ABI+ patients with left main artery (LMA), right coronary<br />artery (RCA), left anterior descending artery (LAD), diagonal artery 1 (D1) and left circumflex<br />artery (LCX) involvements (P &lt; 0.05).<br /><strong>CONCLUSION</strong>: The findings of this research indicated that ABI could be a useful method in<br />assessing both the atherosclerotic risk factors and the degree of coronary involvements in<br />suspected patients. However, in order to make more accurate decisions for using this method in<br />diagnosing and preventing CAD, we should plan further studies in large sample sizes of general<br />population.<br /><strong>Keywords</strong>: Ankle&ndash;Brachial Index, Angiography, Atherosclerotic Risk Factors

Do Intervention Strategies of Women Healthy Heart Project (WHHP) Impact on Differently on Working and Housewives?

<p class="abstract"><strong>BACKGROUND:</strong> The purpose of this study is to evaluate the possible difference of the impact of Women Healthy Heart Project on lifestyle, as well as physical/biochemical parameters of working women and housewives.</p> <p><strong>&nbsp;&nbsp; METHODS:</strong><strong> </strong>This was a community-based intervention study conducted over 5 years (2002-2007) in the counties of Isfahan and Najafabad (intervention areas) and Arak (control). Pre-study situation analysis of women was followed by 5 years of wide-ranging interventions (educational/environmental) conducted by various organizations using different methodologies. The interventions were aimed at modifying/improving lifestyle by increasing physical activity, encouraging healthy eating, and tobacco use cessation. The organizations involved in performing the interventions included the local radio and television authority, health/treatment centers, the Red Crescent Society, Municipalities, the Relief Committee, the Center for Retirees&rsquo; Welfare, and the Literacy Campaign Organization. After 5 years, final phase same as first phase was planed. The subjects studied in all phases` the pre- and post-intervention phases consisted of 10586 women aged above 18 years. Demographic data, obesity index, smoking, physical activity and eating habit were assessed before and after the study. Data were analyzed using SPSS-15 using Student&rsquo;s t-test, chi-square test, the general linear model of ANOVA, and logistic regression.</p> <p class="abstract"><strong>&nbsp;&nbsp; RESULTS:</strong> We studied 10586 women (6105 and 4481 women, pre- and post-intervention, respectively). Mean age of working women was 34.14 &plusmn; 10.09 and 34.08 &plusmn; 9.35 years before and after the study, respectively. Mean age of housewives before and after the study was 40.05 &plusmn; 14.61 and 40.36 &plusmn; 15.32 years, respectively. Interventions conducted during 5 years improved eating habits and decreased tobacco use in working women and housewives. In every phase of the study, there was a significant age difference between housewives and working women (P &lt; 0.001). Hence data were adjusted according to age in each phase. Overall physical activity of housewives and working women increased, but the percentage of passive smokers among housewives remained unchanged. Waist circumference and waist-to-hip ratio changed significantly in housewives following interventions (P &lt; 0.001). The parameter which improved significantly in working women was waist circumference (P &lt; 0.05). However, after adjusting for age, no significant difference was seen between working women and housewives following interventions.<strong></strong></p> <p class="abstract"><strong>&nbsp;&nbsp; </strong><strong>CONCLUSION:</strong> Community-based interventions, especially those directed at housewives, can lead to significant improvements in lifestyle and cardiovascular risk reduction. It seems that working women require tailored interventions to suit their conditions. Although short-term outcomes may seem insignificant, persistence and continuity of lifestyle changes may lead to reduced prevalence of cardiovascular diseases. Then longer-term studies are warranted.</p><p class="abstract"><strong>Keywords:</strong> Women, housewives, working, risk factors, lifestyle modification.</p

Prognostic Factors for Survival at 6-Month Follow-up of Hospitalized Patients with Decompensated Congestive Heart Failure

Abstract:BACKGROUND: The prevalence of Congestive Heart Failure (CHF) is increasing in recent years. Factors associated with mortality in CHF patients are important to be determined in order to select therapeutic modality by physicians. The purpose of the current study was to declare predictors of 6-months survival in patients hospitalized for decompensated CHF in Isfahan.METHODS: A cohort of 301 hospitalized patients with decompensated CHF were recruited in this study. The diagnosis of CHF was based on previous hospitalizations and Framingham criteria for heart failure (HF). Information regarding past history, accompanying diseases such as cerebrovascular accidents (CVA), chronic obstructive pulmonary diseases (COPD), clinical data, medications and echocardiography were obtained by a cardiologist. Patients were followed for their survival for 6 months by telephone calls. Kaplan-Meier method was used for uni variate survival analysis and Cox proportional hazard model was used for multivariate analysis.RESULTS: Mean age of patients was 71.9 &plusmn; 12.2 years and 59.8% was male. During 6-months follow-up 138 (45.8%) patients died. Mean survival was 119.2 &plusmn; 4.4 days (Mean &plusmn; SEM). Significant prognostic factors for 6 months survival were high education level (HR = 0.74, CI 95% 0.59&mdash;0.93), COPD (HR = 1.91, CI 95% 1.2&mdash;3.04), CVA (HR = 1.69, CI 95% 1.03&mdash;2.78), Angiotensin Converting enzyme (ACE) inhibitors use (HR = 0.44, CI 95% 0.3&mdash;0.66) and Diuretics (HR = 0.63, CI 95% 0.41-0.96).CONCLUSION: Six-month survival of hospitalized decompensated CHF patients in Iran is not favorable. Many factors particularly accompanying diseases and medications affected the patient&rsquo;s 6-months survival.Keywords: Heart failure, Survival,&nbsp; Mortality.</p

Stress Level and Smoking Status in Central Iran: Isfahan Healthy Heart Program

<p class="abstract"><strong>BACKGROUND:</strong> Individuals are faced with numerous stressful life events which can negatively influence mental health. Many individuals use smoking as a means of confronting stress. Given the relatively high prevalence of smoking in central Iran, the present study was conducted to compare stress levels in smokers, non-smokers and those who had quit smoking.</p> <p class="abstract"><strong>&nbsp;&nbsp; METHODS:</strong><strong> </strong>This study was conducted as part of Isfahan Cardiovascular Research Program on 9752 individuals in the cities of Isfahan, Arak, and Najafabad in 2008. Sampling was performed using multi-stage cluster randomization method. Data on age, sex, demographic characteristics, and smoking status was collected through interviews. Stress level detected by General Health questionnaire.Logistic regression and chi- squere test was used for data analyzing<strong>.</strong></p> <p class="abstract"><strong>&nbsp;&nbsp; RESULTS:</strong> In the present study, 30% of non-smokers, 32.1% ex- smoker and 36.9% of smokers had GHQ of 4 and higher (P = 0.01). In regression analysis, the final model which was controlled for age, sex, socioeconomic statues (including place of residence, marital status and education level) showed that the odds ratio of stress in smokers and ex- smoker was significantly higher than in non-smokers (OR = 1.66 and OR = 1.12, respectively).<strong></strong></p> <p class="abstract"><strong>&nbsp;&nbsp; </strong><strong>CONCLUSION:</strong> Since in conducted studies, mental problems and stresses have had an important role in people&rsquo;s smoking, it seems suitable to use the results of this study to present intervention for correct methods of coping with stress towards reducing the prevalence of smoking in the community.</p><p class="abstract"><strong>Keywords:</strong> Cigarette, Stress, Community-based Program.</p

Can Timi Risk Score Predict Angiographic Involvement in Patients with St-Elevation Myocardial Infarction?

<p class="abstract"><strong>BACKGROUND:</strong> In most studies, the agreeable risk scores for ST-elevation myocardial infarction (STEMI) consist of thrombolytic in myocardial infarction (TIMI) risk score and modified Gensini risk score. Researchers showed significant relations between TIMI with angiography scores in patients with UA/NSTEMI. We studied this relation in patients with STEMI.</p> <p class="abstract"><strong>&nbsp;&nbsp; METHODS:</strong><strong> </strong>We studied CCU patients with STEMI hospitalized in several hospitals of Isfahan, Iran from September 2007 to June 2008. Sampling method of 240 patients was random and simple. Exclusion criteria were incomplete history, nonspecific electrocardiogram changes, left bundle branch block and not accomplished angiography or accomplished angiography after 2 months of STEMI. Questionnaire indices collected on the basis of TIMI (0-14 points). Echocardiography and angiography were done and then, we used Gensini (0-400 points) to review films of angiography. Spearman`s rank test and Pearson correlation coefficient were used to study the relation between these scores.</p> <p class="abstract"><strong>&nbsp;&nbsp; RESULTS:</strong> One hundred and sixty one patients were male and their average age was 60.02 years. Averages of TIMI and Gensini scores were 6.30 &plusmn; 2.5 and 120.77 &plusmn; 50.4, respectively. Study showed significant relation between TIMI, age and LVEF (P &lt;0.001, r=-0.46). Also, between Gensini and age, gender and LVEF significant relation was found (P &lt;0.001). But, a meaningful correlation didn&rsquo;t exist between TIMI and the gender (P =0.08). Our study proved direct relation between TIMI risk scores and modified Gensini scores (P &lt;0.001, r=0.55).<strong>&nbsp;</strong></p> <p class="abstract"><strong>&nbsp;&nbsp; </strong><strong>CONCLUSION:</strong> We may decide quickly and correctly in emergency room to distinguish which patients with STEMI could derive a benefit from invasive strategies using TIMI score. Also, TIMI risk score can be a good predictor to determine the extension of coronary artery disease in patients with STEMI. As a result, we suggest determination of TIMI score for any patient entered emergency room. Also, this score should be recorded at the time patient&rsquo;s discharge.</p> <table cellspacing="0" cellpadding="0" align="left"><tbody><tr><td width="35" height="12">&nbsp;</td></tr><tr><td><br /></td> <td>&nbsp;</td></tr></tbody></table><p class="abstract"><strong>Keywords:</strong> TIMI Risk Score, Modified Gensini Risk Score, LVEF, STEMI.</p

THE CORRELATION BETWEEN LIPID PROFILE AND STRESS LEVELS IN PART CENTRAL IRAN: ISFAHAN HEALTHY HEART PROGRAM

Abstract&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Background: Previous studies suggest that mental status may influence serum lipid levels. This study was conducted on adult population living in rural and urban areas in Central Iran to assess the correlation between stress level and lipid profile disorders.Methods: Data was extracted from final evaluation of Isfahan Healthy Heart Program (IHHP) in 2008. Multistage and random cluster methods were used for sampling. The study population consisted of 9752 adults aged &ge;19 years living in three districts namely Isfahan, Arak and Najaf Abad. Demographic data, age and sex were recorded. Blood samples were taken to determine the lipid levels including total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), low levels of high-density lipoprotein cholesterol (HDL-C) and triglycerides. Stress levels were assessed using the General Health Questionnaire. Logistic regression and chi-square tests were used for statistical analysis.Results: The odds ratios of high stress in individuals with high levels of TC, LDL-C and low levels of HDL-C compared to normal individuals after adjustment for age and sex were as follows respectively: 1.05 (1.02,1.15), 1.06 (1.02,1.18), 1.06 (1.01,1.17).Conclusion: Intervention activities towards reduction of stress levels at the community level may be useful as part of the strategy for cardiovascular disease prevention.&nbsp;Keywords: Cholesterol, Triglycerides, Stress, Questionnaire, Adult</p

An exploration study to find important factors influencing on brand in car accessory market

Supplying car accessory is one of the most important growing industries in the world. Every year, millions of cars are produced and people need to have the access to necessary car accessory. In this paper, we present an exploration study to detect important factors influencing car accessory market. The proposed study designs a questionnaire in Likert scale consists of 16 questions, distributes it among 200 experts and analyses it using factor analysis. Cronbach alpha and Kaiser-Meyer-Olkin Measure of Sampling Adequacy are calculated as 0.823 and 0.863, which validate the overall questionnaire. The results indicate that there are three influencing factors including brand capability, brand characteristics and consumers’ believe