21 research outputs found

    Association of platelet collagen receptor polymorphisms with premature acute myocardial infarction

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    The impact of platelet collagen receptor polymorphisms in the pathogenesis of myocardial infarction at young age remains unknown. To determine whether either of the two platelet collagen receptor polymorphisms (GP VI T13254C and GP Ia C807T) was associated with premature acute myocardial infarction. One hundred patients with premature acute myocardial infarction and 100 age-matched controls with normal coronary angiograms were studied. Genotyping was done using PCR followed by restriction fragment length polymorphism (RFLP). GP Ia C807T polymorphism was more frequent in the patient group (65) than in the control group (53). However, there was no association between this polymorphism and premature acute myocardial infarction (PU0.08). The prevalence of T13254C polymorphism did not differ between patients (38) and controls (33), and this polymorphism was not associated with premature acute myocardial infarction (PU0.46). Logistic regression analysis also indicated no association between these polymorphisms and premature acute myocardial infarction (C807T with PU0.51 and T13254C with PU0.20). There is no association between GP VI T13254C or GP Ia C807T polymorphisms and premature acute myocardial infarction. © 2012 Wolters Kluwer Health

    In-hospital and six-month outcomes of elderly patients undergoing primary percutaneous coronary intervention for acute st-elevation myocardial infarction

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    BACKGROUND: Elderly patients constitute a rapidly growing proportion of the population, and hence the increasing rises in the number of patients with ST-segment-elevation myocardial infarction (STEMI). Primary percutaneous coronary intervention (PCI), which is now established as the preferred reperfusion strategy in STEMI patients, has been inadequately investigated in this high-risk group. The aim of the present study was to investigate the in- hospital and 6-month outcomes of primary PCI in elderly patients (� 75 years) with STEMI. METHODS: A total of 100 elderly patients with STEMI including those with cardiogenic shock were included. Primary PCI procedures were performed in a tertiary referral center between 2009 and 2014. In-hospital and 6-month outcomes of patients were recorded and analyzed. RESULTS: The average age of the patients was 79.6 ± 3.8 years (range = 75-90 years) and 27.0 were women. Cardiovascular risk factors and prior events were common. Nearly, half of the patients had three-vessel disease and the left anterior descending artery (LAD) was the most common infarct-related artery. The presence of cardiogenic shock but not the other variables was associated with less anatomic and procedural success (P < 0.001). It was also the major independent predictors of 6-month mortality in the patients aged � 75 years, hazard ratio (HR) = 8.02; 95% confidence interval (CI): 1.75-25.97, P < 0.001. In-hospital mortality was 2.4% in the patients without and 83.0% in those with cardiogenic shock. CONCLUSION: Primary PCI in aged patients could be associated with low complication rates and improved survival if performed in high-volume centers with experienced operators. Considering the very high rate of mortality in patients with cardiogenic shock, there should be measures to treat these patients before the onset of hemodynamic instability. © 2016, Isfahan University of Medical Sciences(IUMS). All rights reserved

    Economic evaluation of programs against COVID-19: A systematic review

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    Background: The COVID-19 pandemic has become a public health emergency and raised global concerns in about 213 countries without vaccines and with limited medical capacity to treat the disease. The COVID-19 has prompted an urgent search for effective interventions, and there is little information about the money value of treatments. The present study aimed to summarize economic evaluation evidence of preventing strategies, programs, and treatments of COVID-19. Material and methods: We searched Medline/PubMed, Cochrane Library, Web of Science Core Collection, Embase, Scopus, Google Scholar, and specialized databases of economic evaluation from December 2019 to July 2020 to identify relevant literature to economic evaluation of programs against COVID-19. Two researchers screened titles and abstracts, extracted data from full-text articles, and did their quality assessment by the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Then, quality synthesis of results was done. Results: Twenty-six studies of economic evaluations met our inclusion criteria. The CHEERS scores for most studies (n = 9) were 85 or higher (excellent quality). Eight studies scored 70 to 85 (good quality), eight studies scored 55 to 70 (average quality), and one study < 55 (poor quality). The decision-analytic modeling was applied to twenty-three studies (88) to evaluate their services. Most studies utilized the SIR model for outcomes. In studies with long-time horizons, social distancing was more cost-effective than quarantine, non-intervention, and herd immunity. Personal protective equipment was more cost-effective in the short-term than non-intervention. Screening tests were cost-effective in all studies. Conclusion: The results suggested screening tests and social distancing to be cost-effective alternatives in preventing and controlling COVID-19 on a long-time horizon. However, evidence is still insufficient and too heterogeneous to allow any definite conclusions regarding costs of interventions. Further research as are required in the future. © 2020 IJS Publishing Group Lt

    Incremental values of cardiac mechanics in systolic and diastolic heart failure in hypertrophic cardiomyopathy

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    Background: The early diagnosis of heart failure in patients with hypertrophic cardiomyopathy (HCM) remains a challenge. In this study, we sought to evaluate cardiac mechanics in patients with HCM. Methods: Sixty patients (60 men, mean age = 45.8 ± 17 y) with documented HCM were identified from an ongoing clinical registry. Results: The values of maximal left ventricular (LV) wall thickness, the ejection fraction (EF), global the longitudinal strain (GLS), and the global circumferential strain (GCS) were 2.2 ± 0.5 cm, 54.1 ± 6.5, �15.3 ± 4.5, and �26.9 ± 7.5, consecutively. Cardiovascular magnetic resonance imaging (CMR) data on 34 patients were included in the analysis. Nearly half of the patients had obstructive HCM; and in comparison with nonobstructive HCM, there were no significant differences in terms of GLS, GCS, EF, and the New York Heart Association Functional Class (NYHA FC). EF was similar between the 2 NYHA FC groups (I and II vs III and IV). GLS had a meaningful difference between the NYHA FC groups. In patients with a late gadolinium enhancement (LGE) value of equal to or greater than 15, EF, GLS, and GCS were correlated and reduced. Additionally, in those with an LGE value of between 5 and 15, EF was preserved with a reduced GLS. GLS was worse in patients with an E/average E� ratio of equal to or greater than 14. Conclusions: Our study showed that an increased LV wall thickness and/or a reduced LV enddiastolic volume, with better GCS, maintained a normal EF despite a reduced GLS. GLS had a better correlation with NYHA FC and LGE in CMR than EF alone. © 2020, Iranian Heart Association. All rights reserved

    Relationship between the pulmonary artery pressure and the occurrence of atrial fibrillation after coronary artery bypass graft surgery

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    Background: Atrial fibrillation (AF) is one of the most common complications after cardiac surgeries. The incidence of postoperative AF has risen continuously over the past decades. AF is associated with lengthened hospital stays and risk of stroke. We sought to study the relationship between the pulmonary artery pressure (PAP) and the occurrence of AF after coronary artery bypass graft surgery (CABG). Methods: This prospective observational study was designed to assess the relationship between the PAP and the occurrence of post-CABG AF. Patients with chronic and paroxysmal AF before surgery were excluded. All the patients had complete evaluation via echocardiography, ECG, and laboratory testing. The patients were monitored for 3 days after surgery, and any tachycardia monitored as AF was noted. The study population was divided into 2 groups: with postoperative AF and without AF. Results: We selected 232 patients, 106 with AF and 126 with sinus rhythm. The results confirmed that the occurrence rate of AF after CABG was higher in the older patients (P � 0.001). Both univariate and multivariate analyses showed a significant relationship between a higher occurrence rate of post-CABG AF and a higher PAP (mean value = 26.5 vs 20 mm Hg) in the patients (P �0.001 and P = 0.01, respectively). Conclusions: Although age has been the most important predictor for the occurrence of AF after CABG in the past and present studies, there are many other variables affecting its occurrence. Among the variables evaluated in this study, a higher PAP was a significant predictor for a higher occurrence rate of AF following CABG. © 2017, Iranian Heart Association. All rights reserved

    Relationship between the pulmonary artery pressure and the occurrence of atrial fibrillation after coronary artery bypass graft surgery

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    Background: Atrial fibrillation (AF) is one of the most common complications after cardiac surgeries. The incidence of postoperative AF has risen continuously over the past decades. AF is associated with lengthened hospital stays and risk of stroke. We sought to study the relationship between the pulmonary artery pressure (PAP) and the occurrence of AF after coronary artery bypass graft surgery (CABG). Methods: This prospective observational study was designed to assess the relationship between the PAP and the occurrence of post-CABG AF. Patients with chronic and paroxysmal AF before surgery were excluded. All the patients had complete evaluation via echocardiography, ECG, and laboratory testing. The patients were monitored for 3 days after surgery, and any tachycardia monitored as AF was noted. The study population was divided into 2 groups: with postoperative AF and without AF. Results: We selected 232 patients, 106 with AF and 126 with sinus rhythm. The results confirmed that the occurrence rate of AF after CABG was higher in the older patients (P � 0.001). Both univariate and multivariate analyses showed a significant relationship between a higher occurrence rate of post-CABG AF and a higher PAP (mean value = 26.5 vs 20 mm Hg) in the patients (P �0.001 and P = 0.01, respectively). Conclusions: Although age has been the most important predictor for the occurrence of AF after CABG in the past and present studies, there are many other variables affecting its occurrence. Among the variables evaluated in this study, a higher PAP was a significant predictor for a higher occurrence rate of AF following CABG. © 2017, Iranian Heart Association. All rights reserved

    Fibrinolytic Therapy for Mechanical Pulmonary Valve Thrombosis

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    Treatment of prosthetic heart valve thrombosis using intravenous thrombolytics, although an acceptable alternative to surgery, is not complication free, and the literature has a dearth of data on the subject. This study analyzed the results of fibrinolytic treatment (FT) among a single-center group of patients with mechanical pulmonary valve thrombosis. Between 2000 and 2013, 23 consecutive patients with 25 episodes of pulmonary valve thrombosis received FT. The diagnosis of mechanical pulmonary valve thrombosis was established by fluoroscopy and echocardiography. Streptokinase (SK) was used in 24 cases and alteplase in 1 case. The FT was continued a second day for 14 patients (58.3 ), a third day for 1 patient, and a fourth day for 1 patient. Echocardiography and fluoroscopy were performed every day until improvement of malfunction was achieved. Of the 23 patients, 19 had complete resolution of hemodynamic abnormalities after FT, 1 had partial resolution, and 2 showed no change. No patient had major complications. Five minor complications were detected, namely, fever, nausea, thrombophlebitis, epistaxi, and pain. Seven patients (30 ) experienced recurrence of thrombosis, whereas four patients had surgery (biological pulmonary valve replacement) without re-thrombolytic therapy, one patient was treated with Alteplase, one patient received SK, and one patient received intense anticoagulation using heparin and warfarin. Overall, FT had a success rate of 84 . The results indicate that regardless of the time to pulmonary valve replacement and echocardiographic and fluoroscopic findings, FT was effective in most cases of mechanical pulmonary valve thrombosis. The efficacy increased with second-day thrombolytic therapy. Major complications were not common after lytic therapy for mechanical pulmonary valve thrombosis. © 2014, Springer Science+Business Media New York

    Postoperative Atrial Fibrillation Following Cardiac Surgery: From Pathogenesis to Potential Therapies

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    Postoperative atrial fibrillation (POAF) is a major complication after cardiac surgery which can lead to high rates of morbidity and mortality, an enhanced length of hospital stay, and an increased cost of care. POAF is postulated to be a multifactorial phenomenon; however, some major pathogeneses have been proposed, including inflammatory pathways, oxidative stress, and autonomic dysfunction. Genetic studies also showed that inflammatory pathways, beta-1 adrenoreceptor variants, G protein-coupled receptor kinase 5 gene variants, and non-coding single-nucleotide polymorphisms in the 4q25 chromosomal locus are involved in this phenomenon. Moreover, several predisposing factors lead to the development of POAF, consisting of pre-, intra-, and postoperative contributors. The main predisposing factors comprise age, prior history of major cardiovascular risk factors, and ischemia-reperfusion injury during surgery. The management of POAF is based on the usual therapies used for non-surgical AF, including medications for either rate control or rhythm control in hemodynamically unstable patients. The perioperative administration of β-blockers and some antiarrhythmic agents has been recommended in major international guidelines. In addition, upstream therapies consisting of colchicine, magnesium, statins, and antioxidants have attenuated the incidence of POAF; however, some uncomfortable side effects developed in large randomized trials. The use of anticoagulation has also resulted in less mortality in patients with POAF at higher risk of thromboembolic events. Despite these recommendations, the actual regimen for the prevention of POAF remains controversial. In this review, we highlight the pathogenesis, predisposing factors, and potential therapeutic options for the management of patients at risk for or with POAF following cardiac surgery. © 2019, Springer Nature Switzerland AG
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