Evaluation of the role of conventional and tissue doppler imaging echocardiography in detection of acute cardiac allograft rejection in heart transplant recipients

Background: Endomyocardial Biopsy (EMB) is the gold standard test for diagnosis of acute allograft cardiac rejection. Objectives: The present study aimed to assess the role of echocardiographic parameters in discriminating patients with and without evidence of acute cardiac allograft rejection. Materials and Methods: In the present cross-sectional study, using convenience sampling, 63 EMB specimens were collected from the patients who had undergone biatrial orthotropic cardiac transplantation. The mean age of the recipients and donors was 30.46 ± 9.49 and 24.55 ± 7.64 years, respectively. There were 51(81) male recipients and 39(62) male donors. Echocardiographic examination was performed within the 24 hours of EMB. The data were entered into the SPSS statistical software, version 19 and were analyzed by chi-square test, student�s t-test, and one-way ANOVA as appropriated. All the data were two-tailed and P < 0.05 was considered to be statistically significant. Results: Among the 63 EMB specimens evaluated in the present study, mild and moderate acute rejections were seen in 19(30) and 5(8) cases, respectively. On Doppler examination, the three groups (without rejection, with mild rejection, and with moderate acute rejection) were significantly different only regarding trans-tricuspid E wave (P = 0.040). Pulsed-wave Tissue Doppler Imaging (TDI) also revealed a significant difference between the patients with and without allograft rejection regarding early diastolic tricuspid and mitral annular motion velocities (P = 0.005 and P = 0.02, respectively). Conclusions: It seems that echocardiographic parameters, including TDI, might be adjunct to, rather than substitution for, EMB findings for early diagnosis of acute allograft rejection. © 2016, Iranian Cardiovascular Research Journal. All right reserved

Measurement of pulmonary arterial elastance in patients with systolic heart failure using Doppler echocardiography

Objective: A reliable and easy-to-perform method for measuring right ventricular (RV) afterload is desirable when scheduling patients with systolic heart failure to undergo heart transplantation. The present study aimed to investigate the accuracy of echocardiographically-derived pulmonary arterial elastance as a measurement of pulmonary vascular resistance by comparing it with invasive measures. Methods: Thirty-one patients with moderate to severe systolic heart failure, including 22 (71) male patients, with a mean age of 41.16±15.9 years were enrolled in the study. Right heart catheterization and comprehensive echocardiography during the first hour after completion of cardiac catheterization were performed in all the patients. The pulmonary artery elastance was estimated using the ratio of end-systolic pressure (Pes) over the stroke volume (SV) by both cardiac catheterization Ea (PV)-C and echocardiography Ea (PV)-E. Results: The mean Ea (PV)-C and Ea (PV)-E were estimated to be 0.73±0.49 mm Hg/mL and 0.67±0.44 mm Hg/mL, respectively. There was a significant relation between Ea (PV)-E and Ea (PV)-C (r=0.897, p<0.001). Agreement between echocardiography and catheterization methods for estimating Ea (PV), investigated by the Bland-Altman method, showed a mean bias of -0.06, with 95% limits of agreement from -0.36 mm Hg/mL to 0.48 mm Hg/mL. Conclusion: Doppler echocardiography is an easy, non-invasive, and inexpensive method for measuring pulmonary arterial elastance, which provides accurate and reliable estimation of RV afterload in patients with systolic heart failure. © 2016 by Turkish Society of Cardiology

Heart failure with preserved ejection fraction in coronavirus disease 2019 patients: the promising role of diuretic therapy in critically ill patients

The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on diastolic function is less known. We describe a 46-year-old man with a history of mild hypertension who presented to the emergency department with fever, cough, and myalgia for 2 days. The patient was tested positive for SARS-CoV-2. He was admitted and started on a combination of antiviral and antimicrobial therapy. He developed respiratory distress 2 days later, and O2 saturation declined. Blood tests showed an increased N-terminal pro-B type natriuretic peptide (NT-proBNP) level, and echocardiography showed normal left ventricular ejection fraction and E/e� ratio of 16. Computed tomography scan showed interstitial pulmonary oedema and prominent peripheral pulmonary vascular markings. Given these findings, heart failure with preserved ejection fraction (HFpEF) was considered. Low-dose diuretic was started, and fluid administration was restricted, resulting in a decrease in NT-proBNP level, clinical and haemodynamic stabilization, and improved oxygenation. This case highlights the occurrence of HFpEF in coronavirus disease 2019. © 2021 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology

Prasugrel results in higher decrease in high-sensitivity C-reactive protein level in patients undergoing percutaneous coronary intervention comparing to clopidogrel

Objectives: A growing body of clinical and laboratory evidence indicates that inflammation plays a crucial role in atherosclerosis. In the present study, we compared the effects of clopidogrel and prasugrel on high-sensitivity C-reactive protein (hs-CRP) in patients undergoing percutaneous coronary intervention (PCI). Methods: The present randomized, double-blind clinical trial included 120 patients who underwent PCI. Eligible patients were randomly assigned 2:1 to one of the two groups: 80 patients in the first group received clopidogrel (Plavix®; loading dose and maintenance dose of 300 and 75 mg daily, respec-tively) and 40 patients in the second group received prasugrel (Effient®; loading dose and maintenance dose of 60 and 10 mg, respectively) for 12 weeks. The hs-CRP levels between baseline and 12th week were compared.Results: Of the 120 patients, 69 patients (57.5) were male. Pretreatment hs-CRP level was statistically comparable in clopidogrel (median, 15.10 mg/dL; interquartile range IQR, 9.62-23.75 mg/dL) and prasugrel groups (median, 18 mg/dL; IQR, 14.25-22 mg/dL; P = 0.06). Patients taking clopidogrel showed a significant reduction in hs-CRP level compared with the baseline values (P < 0.001). Prasugrel administration also resulted in a significant reduc-tion in hs-CRP level (P < 0.001). A significant 73% overall reduction in the hs-CRP level was seen with prasugrel compared with 39% overall reduction in hs-CRP level with clopidogrel (P = 0.002). Conclusion: Prasugrel seems to be superior to clopidogrel in the reduction of hs-CRP in patients undergoing PCI. © the authors, publisher and licensee Libertas Academica Limited

Heart failure with preserved ejection fraction in coronavirus disease 2019 patients: the promising role of diuretic therapy in critically ill patients

The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on diastolic function is less known. We describe a 46-year-old man with a history of mild hypertension who presented to the emergency department with fever, cough, and myalgia for 2 days. The patient was tested positive for SARS-CoV-2. He was admitted and started on a combination of antiviral and antimicrobial therapy. He developed respiratory distress 2 days later, and O2 saturation declined. Blood tests showed an increased N-terminal pro-B type natriuretic peptide (NT-proBNP) level, and echocardiography showed normal left ventricular ejection fraction and E/e� ratio of 16. Computed tomography scan showed interstitial pulmonary oedema and prominent peripheral pulmonary vascular markings. Given these findings, heart failure with preserved ejection fraction (HFpEF) was considered. Low-dose diuretic was started, and fluid administration was restricted, resulting in a decrease in NT-proBNP level, clinical and haemodynamic stabilization, and improved oxygenation. This case highlights the occurrence of HFpEF in coronavirus disease 2019. © 2021 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology

Zonation of groundwater quality for agricultural purposes using GIS technology in Khouzestan - Avan plain

Aim. Appreciation of hydrochemical and zonation status helps us to describe various strategies for water abstraction which has application for various purposes including agriculture. GIS can play a significant role in the analysis of suitable sites by considering the water quality requirements of agriculture and identifying and mapping locations within a region that meet these necessities. The purpose of this article is to use GIS technology for qualitative zonation of Avan groundwater resources for agricultural purposes. Methods. Mapping groundwater quality zoning based on physico chemical data in 18 wells were Avan plain import data environments with GIS, layers and Na, SAR, Ec and comparative RSC interpolation was prepared, according to the prepared layers Boolean logic layers to create zoning and finally the overlapping layers creation by a final map quality in terms of agricultural zoning, respectively. Results and conclusion. Based on early plain zoning maps, approximately half of the Plains (southern part of West and North) in the category of inappropriate agricultural placed. These maps can show the locations which are suitable for agriculture and decision makers can manage the region by considering the quality of water in selected areas by updating the information

An Intracardiac Mass in a Pregnant Woman Presenting with Ventricular Tachycardia

A pregnant patient presented with symptomatic ventricular tachycardia. Echocardiography revealed a large intramyocardial mass. Surgical resection was attempted in conjunction with cryoablation of the surrounding myocardial tissue. Histologic examination of the resected mass revealed cardiac neurofibroma. To the best of our knowledge, this is the first report of cardiac neurofibroma in a pregnant patient in the absence of any neurocutaneous syndromes such as neurofibromatosis. © 2016 The Society of Thoracic Surgeons

Wells' prediction rules for pulmonary embolism: valid in all clinical subgroups?

Pulmonary embolism is major cause of hospital death. Clinical prediction rules such as Wells’ prediction rules can help in selection of at-risk patients who need further testing for pulmonary embolism. We evaluated the usefulness of such criteria for detection of patients with diagnosed pulmonary embolism. Patients enrolled in National Research Institute of Tuberculosis and Lung Disease (NRITLD) deep venous thrombosis (DVT) registry were evaluated and those with objective data about presence or absence of pulmonary embolism were selected for this study. Diagnosis of pulmonary embolism was based on computed tomography pulmonary angiography (CTPA). We calculated the embolic burden in those with CTPA-confirmed pulmonary embolism. Eighty-six patients entered the study (58 males, 28 females, mean age = 54.39 ± 1.74 years). Fifty-four cases had coexisting pulmonary embolism (embolic burden score: 10.77 ± 1.181). Embolic burden score was correlated to presence of massive pulmonary embolism (Pearson rho: 0.43, P = 0.002). There was no association between Wells’ pulmonary embolism score and the occurrence of pulmonary embolism (Spearman's rho: 0.085, P = 0.51). Dividing the patients into two, or three, risk groups according to Wells’ model did not reveal an association with occurrence of pulmonary embolism either (P = 0.99 and P = 0.261, respectively). Tachycardia and hemoptysis were the only parameters from the Wells’ pulmonary embolism score correlated to presence of pulmonary embolism (Spearman's rho: 0.373, P < 0.000 and Spearman's rho: 0.297, P = 0.005, correspondingly). Wells’ pulmonary embolism score could not predict the occurrence of pulmonary embolism in DVT patients suspected of having coexisting pulmonary embolism. Until further studies shed light on this patient subset, overreliance on Wells’ prediction rules as the solo decision making tool should be cautioned.Babak Sharif-Kashani, Bavand Bikdeli, Solmaz Ehteshami-Afshar, Mandana Chitsazan, Neda Behzadnia, Ehsan Chitsaz, Saeid Kermani-Randjbar, Leila Saliminejad, Mohammad-Reza Masjedi and Behnood Bikdel

Initial assessment of recharge areas for large karst springs: a case study from the central Zagros Mountains, Iran

Sousan Spring emerges from the Keyno Anticline, Zagros Mountains (Iran), and the mean annual discharge is ~24 m3 /s. Geological and hydrochemical evaluations suggest that the spring recharge is from the limestone Ilam-Sarvak Formation (Cretaceous) but the Mafaroon Fault, a major thrust feature, influences the regional groundwater flow path by juxtaposing other strata. Geological, geochemical, stable isotope and water balance studies were employed to interpret this behavior. Using the isotope data, the sources and elevations of the recharge area were found. Temporal variations of the isotopic data were compared with variations of electrical conductivity (EC). Unexpectedly, high EC was associated with a relative increase of discharge and depletion of δ18O. Several hypotheses were investigated and approximate water balance studies employed for validation. It was found that an elongated catchment on the Keyno Anticline plus a lesser catchment on a pair of parallel anticlines recharge the aquifer. While the long groundwater flow path along the Keyno Anticline plus guidance by Mafaroon Fault and the adjacent Garou shaly strata lead to increased EC in the Sousan Spring at the end of the dry season, a flow pulse from two adjoining anticlines (Mahalbakh and Shirgoon) arrives at the same time to increase the discharge and deplete the δ18O signal. Apparently the spring did not experience true base flow conditions during the recorded hydrological year. Although the spring response to specific precipitation events was similar to typical karst aquifers, standard interpretation of recession curves and related coefficients will not be practical at Sousan