Relationship between QRS complex notch and ventricular dyssynchrony in patients with heart failure and prolonged QRS duration

Background: Cardiac resynchronization therapy (CRT) has been accepted as an established therapy for advanced systolic heart failure. Electrical and mechanical dyssynchrony are usually evaluated to increase the percentage of CRT responders. We postulated that QRS notch can increase mechanical LV dyssynchrony independently of other known predictors such as left ventricular ejection fraction and QRS duration. Methods: A total of 87 consecutive patients with advanced systolic heart failure and QRS duration more than 120 ms with an LBBB-like pattern in V1 were prospectively evaluated. Twelve-lead electrocardiogram was used for detection of QRS notch. Complete echocardiographic examination including tissue Doppler imaging, pulse wave Doppler and M-mode echocardiography were done for all patients. Results: Eighty-seven patients, 65 male (75) and 22 female (25), with mean (SD) age of 56.7 (12.3) years were enrolled the study. Ischemic cardiomyopathy was the underlying heart disease in 58 of the subjects, and in the others it was idiopathic. Patients had a mean (SD) QRS duration of 155.13 (23.34) ms. QRS notch was seen in 49.4 of the patients in any of two precordial or limb leads. Interventricular mechanical delay was the only mechanical dyssynchrony index that was significantly longer in the group of patients with QRS notch. Multivariate analysis revealed that the observed association was actually caused by the effect of QRS duration, rather than the presence of notch per se. Conclusions: QRS notch was not an independent predictor of higher mechanical dyssynchrony indices in patients with wide QRS complex and symptomatic systolic heart failure; however, there was a borderline association between QRS notch and interventricular delay. © 2008 Via Medica

Prevalence of Left Atrial and Auricular Clot in Patients with Atrial Flutter Regarding Background Diseases

Introduction: Most current evidence suggests the risk of left atrial and or auricular thrombi(LA &LAA) in patients with atrial flutter rhythm is similar to patients with atrial fibrillation, but there is still uncertainty in the risk level and the patient's need to receive anticoagulant therapy. Different studies report various frequencies for atrial thrombi and left atrial spontaneous echo-contrast. This is important to identify patients with LA or LAA clot before applying electrical or medical cardioversion. At present, there is not absolute agreement about the best strategy in patients with AFL before cardioversion. The present study focuses on assessing the risk. Methods: This research was a case series on patients referred to Shahid Rajaee Heart Center(Tehran-Iran) in a 2 year period. We performed TEE for all of the patients with AFL rhythm and duration of more than 48h, without any contraindication for TEE. Then, presence or absence of LA and LAA thrombi was evaluated. Results: Among total cases of about 110 individuals, 40 patients fulfilled the inclusion criteria and entered to our evaluation. Average age of patients was 48.4 years. Forty percent of them were females and 60% were males. Four patients(10%) had LA or LAA thrombi. In respect to underlying diseases, all positive cases had a history of rheumatic heart disease(100%). Among these patients, severe MS was the most prevalent disease(71%). Prevalence of LA or LAA clot among patients with severe MS was 40%. Conclusion: Although, we found10% prevalence in LA or LAA clot in patients With AFL, this prevalence was prominent in patients with rheumatic heart disease as the underlying disease. This rate was significant in patients with severe MS. Indeed we didn't find any LA or LLA clot in patients with AFL and other underlying disorders. We advise paying attention only to this group of patients before electrical or medical cardioversion and exclude other underlying diseases for evaluation of LA or LAA clot by TEE before cardioversion

Blunt cardiac trauma complicated by ventricular tachycardia, AV block and right bundle branch block

Blunt or non-penetrating cardiac trauma is a relatively common body injury in industrialized communities. We report a young man who sustained a heavy non-penetrating chest trauma and developed ventricular tachycardia, atrioventricular block, and right bundle block with ST elevation in the right precordial lead. He was treated successfully and was discharged home. The true incidence of blunt chest injury (myocardial contusion) after chest trauma is not known. Severe myocardial injury can occur with little evidence of external chest trauma. Blunt cardiac trauma may be mild with only epicardial ecchymosis. More severe contusion causes muscle injury and infarction,1-2 and the injuries that are likely to occur include contusion and valve injuries, especially in the aortic valve, which is the most frequently involved valve in blunt cardiac trauma. Injury of the mitral valve is less common and involves the rupture of the papillary muscle or the chordal apparatus. Injury to the tricuspid valve is second to the aortic valve.3 Atrial or ventricular septal defect or frank cardiac rupture, not least in the right ventricle, can also occur

Incidence and predictors of cardiac markers elevation after coronary intervention

Objectives-This study evaluated the incidence and predictors of CK-MB and troponin elevation after successful coronary intervention. Background- CK-MB and troponin elevation after coronary intervention correlate with late cardiac events and survival.1,2,19,24 We investigated the incidence and predictors of CK-MB and troponin elevation in patients who underwent percutaneous coronary intervention in Rajaie Cardiovascular, Medical and Research Center. Results CK-MB and troponin elevation was detectable in 203 (70) patients. Predictors of cardiac enzyme elevation were hyperlipidemia, functional class, and smoking. There were no in-hospital adverse events in the CK-MB and troponin elevation group. Conclusion- Cardiac enzyme elevation after coronary intervention was detected in 70 of all our patients and was more common in diffuse atherosclerosis hyperlipidemia, smoking, and high functional class. Enzyme elevation was observed even in the absence of discernible procedural complications, and early discharge of patients with CK-MB and troponin elevation is safe. Midterm survival of patients with CK-MB and or troponin elevation was similar to those with normal enzymes

Correlation between angiographic findings and pain and its palliative factors in patients with chest pain referring to rajaie cardiovascular, medical and research center

Background: In patients referred for an evaluation of chest pain, the incidence of cardiac disease may be as low as 11�27. Furthermore, the incidence of normal coronary anatomy in patients investigated invasively varies widely, between 11 and 37, at different cardiac centers. In this study, we evaluated the correlation between angiographic findings and pain and its palliative factors in patients with chest pain referring to Rajaie Cardiovascular, Medical and Research Center. Methods: All patients with chest pain who were admitted to the Emergency Department of Rajaie Cardiovascular, Medical and Research Center between September 2013 and March 2014 and needed coronary angiography were enrolled. Demographic data and the results of physical examinations and characteristics of pain and its palliative factors and the chest pain score based on a check list were collected. Thereafter, angiography was performed and correlations between angiographic findings and pain (characteristics and score) and its palliative factors were assessed. Results: Totally, 194 patients with the average age of 58±10 years were investigated. Of the 194 patients, coronary arteries were normal in 57 (29) patients. Of these patients, 37 patients were women and 20 patients were men. Single-vessel disease was observed in 53 (40), 2- vessel disease in 39 (30), and 3-vessel disease in 40 (30). Left main stenosis was observed in 1 (0.5) patient, and 3-vessel disease accompanied with the left main was documented in 4 (2.1). Also, slow flow was observed in 5 (2.6) patients. Regarding the localization of the involved vessel, left main involvement was observed in 5 (3.1) patients, left anterior descending in 82 (24.3), left circumflex in 62 (32), and right coronary artery in 54 (27.8). A pain score of 0 was present in 24 (12) patients, pain score of 1 in 47 (24), pain score of 2 in 73 (37), and pain score of 3 in 50 (25). The sensitivity value of the pain score in our research was calculated to be 80 by taking advantage of a chest pain score of 0 as the negative predictor of the coronary vessel disease and a chest pain score of 1 to 3 as the positive predictor of coronary vessel disease. Conclusions: In the present study, there was no relationship between pain characteristics and the results from the involved vessel and the final angiographic results. The pain score is greatly useful in patients with a higher risk of coronary artery disease, whereas in patients with an intermediate pain score, it is important to perform otherexaminations such as scan or treadmill tests for correct decision-making. © 2015, Iranian Heart Association. All rights reserved

256-slice computed tomography in the diagnosis of coronary artery disease in patients presenting with aortic dissection between 2011 and 2014 and the influence of concomitant coronary artery disease on in-hospital mortality

Background: In recent years, noninvasive methods have replaced angiography in the diagnosis of aortic dissection and concomitant coronary artery disease (CAD). Computed tomography (CT) angiography allows the assessment of CAD in this setting. Methods: In this retrospective study, we investigated the incidence of CAD in patients presenting with type A or B aortic dissection between 2011 and 2014 as assessed by CT angiography and the influence of concomitant CAD and coronary artery bypass grafting (CABG) on the in-hospital outcomes of these patients. Results: Ninety-one patients (67 male) were included in this study. Thirty-five (38.5) patients had concomitant CAD on their CT angiography, and coronary artery ectasia was observed in 17 (18.7) patients. Sixty-seven (73.6) patients underwent surgery for their aortic dissection. Concurrent CABG was performed in 22 (62.8) patients, who had significant coronary stenosis on coronary CT angiography. Mortality was significantly higher in the patients who had concomitant CAD. (Sixty-seven percent of the patients with CAD died; P<0.001.) The total in-hospital mortality rate was 29.7 (n =27). Mortality was higher in the patients with more severe CAD in terms of 2- and 3-vessel diseases, and CABG was significantly associated with higher mortality. Conclusions: Nowadays, invasive coronary angiography is infrequently performed in acute type A aortic dissection due to delay in surgery and increase in the risk of rupture. Multi-slice coronary CT angiography is a good alternative modality for the diagnosis of aortic dissection and CAD simultaneously with acceptable accuracy. � 2016, Iranian Heart Association. All rights reserved