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   2019| April-June  | Volume 8 | Issue 2  
    Online since October 3, 2019

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Pulp stones as risk predictors for coronary artery disease: An intriguing, prevalence study
Pratyaksha S Panwar, J Debkant, Nagarjuna G Chowdary, KS Dwijendra, Pradyumna Kumar S, Manoj Kumar S, Abhishek S Nayyar
April-June 2019, 8(2):54-58
Context and Aim: Coronary artery disease (CAD) has been recorded as the leading cause of morbidity and mortality worldwide. Studies indicate that participants with CAD show higher degree of pulp calcifications. Localized pulp calcifications are microscopically apparent in more than half of the teeth in young adolescents. However, pulp stones extending to the entire dentition are infrequent and need further evaluation to predict the risk of other probabilities of associated diseases. The present study was planned to estimate the prevalence of pulp stones in participants diagnosed with or undergoing treatment for CAD. Materials and Methods: The present study consisted of 300 participants within an age range of 20–55 years who were divided into the study group consisting of 150 participants, including 108 males and 42 females and 150 age- and sex-matched controls. Pulp stones were imaged using bitewing radiographs using the paralleling technique under standard conditions. The radiographs were interpreted separately by two experienced radiologists. Statistical Analysis Used: The statistical analysis was performed using IBM SPSS statistics version 20 Core system software (SPSS Inc., Chicago, IL, USA), whereas statistical tests used were unpaired t-test and Z-test. The Chi-square test was used to check the prevalence of pulp stones in CAD participants in addition to their arch-wise and region-wise distribution while value of P < 0.05 was considered statistically significant. Results: CAD participants exhibited the 100% prevalence of pulp stones while posterior teeth were predominantly affected (P < 0.05). Furthermore, pulp stones were significantly higher in the maxilla than in the mandible in both the groups (P < 0.05). No statistically significant difference was found in gender predilection in the study group, although the control group showed a definite preponderance for the males for the development of pulp stones (P < 0.05). Conclusion: CAD participants have a high chance of being affected with pulp stones. Higher prevalence of this entity in multiple teeth may warrant such an individual, in the presence of other compounding risk factors, as a candidate for CAD to be ruled out.
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Multidisciplinary therapeutic and active follow-up protocols to reduce the rate of amputations and cardiovascular morbidities in patients with critical limb ischemia: IRANCLI study design and rationale – A prospective single-center registry in Iran
Omid Shafe, Jamal Moosavi, Seifollah Abdi, Hosein Ali Basiri, Hamidreza Pouraliakbar, Ali Setayesh, Sara Yasini Ardakani, Saman Alilou, Shirin Rafatnia, Hooman Bakhshandeh, Farhad Jalili, Parham Sadeghipour
April-June 2019, 8(2):46-53
Objectives: The endovascular treatment (EVT) of patients with critical limb ischemia (CLI) has received considerable interest in recent years and has significantly affected the associated amputation and survival rates. Nonetheless, that this management modality may be influenced by various logistical and regional situations prompted us to design a local registry to evaluate its applicability and efficacy in our community.Methods: The IRANCLI study is a prospective, observational study that has been established as a registry. The therapeutic and follow-up protocols of this study have been approved by a multidisciplinary team. Recruited patients with CLI are followed up after in-hospital therapeutic management, endovascular revascularization, or minor amputations or debridement in cases with ulcers. The follow-up consists of active monitoring to spot patients with a recurrence of CLI signs and symptoms at early stages. Within 3 years, eligible patients are recruited to the study and are followed up for 3 years. Analyses are carried out to evaluate outcomes – comprising major adverse limb events (the primary outcome), amputation-free survival, limb salvage, event-free survival, major adverse cardiovascular and cerebrovascular events, 30 days' postprocedural adverse events, and procedural success. The predictors of procedural failure and long-term follow-up adverse events are assessed. Result and Conclusion: The IRANCLI study evaluates postendovascular revascularization outcomes and the long-term follow-up of patients with CLI. Uncovering the predictors of EVT failure and adverse events during the follow-up may improve the prospect of cases with CLI by streamlining the determination of both the patients who would benefit the most from EVT and those who would need a closer active follow-up.
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The relationship between the presence of fragmented QRS and iron overload determined by magnetic resonance imaging T2* in patients with beta-thalassemia major
Zahra Alizadeh Sani, Majid Haghjoo, Bordbar Armin, Ghobadi Fard Ebrahim
April-June 2019, 8(2):41-45
Background: Patients with beta-thalassemia major are categorized as high risk for cardiovascular complications due to myocardial iron overload that leads to reduce both systolic and diastolic function as well as cardiac arrhythmias. The present study aimed to assess the relationship between the presence of fragmented QRS and iron overload determined by magnetic resonance imaging (MRI) T2* in patients with beta-thalassemia major. Materials and Methods: This cross-sectional study was performed on 71 consecutive patients with beta-thalassemia major that referred to Shahid Rajaei Heart Center in 2014 for assessing myocardial T2* using cardiac MRI. The cardiac MR T2* values and electrocardiograms (ECGs) of the patients were evaluated. The patients' 12-lead surface ECGs were analyzed for the presence of fragmented QRS. Results: The presence of fragmented QRS was revealed in 19.7% of patients. The study showed the presence of a significant relationship between cardiac T2* value and fragmented QRS in ECG that the mean myocardial T2* in those with and without fragmented QRS was 11.46 ± 6.63 and 21.72 ± 9.49 (P < 0.001). Using the multivariable linear regression model, it was shown a significant association between the presence of fragmented QRS and myocardial T2* value (standardized beta = −0.318, P = 0.007). In those with fragmented QRS, a significant association was found between myocardial and liver T2* values [r = 0.677, P = 0.008. Conclusion: A notable number of patients with beta-thalassemia major have fragmented QRS pattern in ECGs that is accompanied with lowering myocardial T2* value in these patients.
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Correlation between cardiorespiratory fitness and modifiable anthropometric parameters in chronic heart failure patients
Rohit Sane, Gurudatta Amin, Snehal Dongre, Rahul Mandole
April-June 2019, 8(2):63-66
Introduction: A decrease in cardiorespiratory function is associated with increased body mass index (BMI) in normal individuals according to scientific evidence. However, the relationship has not been studied in patients with chronic heart failure (CHF). Hence, we planned to evaluate the relationship between modifiable anthropometric measurements and cardiorespiratory parameters in CHF patients. Methodology: This research was a retrospective study conducted utilizing the data of CHF patients who had visited the Madhavbaug clinics in Maharashtra for consultation, between July 2018 and December 2018. The correlation between the modifiable anthropometric measurements (BMI and abdominal girth) and the exercise indices ([INSIDE:1] and metabolic equivalents [METs]) was calculated. Results: Of the 147 patients included in the study, 74.15% were males with mean age of 59.15 ± 10.28 years. Mean BMI and abdominal girth were 26.69 ± 4.97 kg/m2 and 98.82 ± 12.74 cm, respectively. Mean [INSIDE:1] and METs were calculated to be 17.1 ± 6.78 ml/kg/min and 5.99 ± 2.01 units. The correlation coefficients (R) between [INSIDE:1] and the anthropometric variables were indicative of negligible correlation (R = 0.01 with BMI and R = −0.05 with abdominal girth, P > 0.05). However, the correlation between METs and the anthropometric variables was found to indicate moderate negative correlation, which was also statistically significant (R = −0.23 with BMI and R = −0.33 with abdominal girth, P < 0.05). Conclusion: Higher BMI and abdominal girth in CHF patients were found to have a negative correlation with METs, indicating higher energy expenditure on physical activities. Lifestyle modifications will help improve the cardiorespiratory fitness in CHF patients and have a positive impact on METs.
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Coronary sinus filling time as a marker of microvascular dysfunction in patients with angina and normal coronaries
Farshad Shakerian, Nasrin Panahifar
April-June 2019, 8(2):59-62
Objective: Although chest pain and normal coronary arteries (known as cardiac syndrome X [CSX]) remained a prevalent clinical condition, underlying pathogenesis has not been fully explained. Microvascular dysfunction has been considered as the most likely cause of CSX. In this research, we attempted to evaluate the coronary sinus filling time (CSFT) at angiographic films, and also introducing it as a new indicator for microvascular function. Patients and Methodology: Patients with typical angina or abnormal chest pain with stress-induced ischemia in prior stress tests formed angina group and control group consisted of patients with severe mitral stenosis underwent coronary artery angiography before the balloon mitral valvuloplasty. CSFT was explained as the time necessary for the contrast with pass through myocardial capillaries and reach to the coronary sinus origin at coronary angiography. Furthermore, thrombolysis in myocardial infarction (TIMI), frame count, and myocardial blush score were evaluated for each group. At the end, we compared these parameters and reported the results. Results: The angina group consisted of 128 patients and there were 71 patients in the control group. The mean of the CSFT in angina group was 47.2 ± 9.9 (in frame count), which was greater than the mean of the control group (mean: 32.2 ± 3, P = 0.0001). Corrected TIMI frame count was 21.1 ± 3.4 in angina group and 20.1 ± 3.1 in the control group, and the differences were not statistically significant (P = 0.75). Myocardial blush score in the angina and the control group had not indicate any meaningful difference (P = 0.52). Conclusion: CSFT in contrast with TIMI frame count and myocardial blush score, was significantly prolonged in patients with angina and normal coronary arteries.
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Erratum: Could Biglycan be a Biomarker of Coronary Artery Disease? A Pilot Human Study

April-June 2019, 8(2):67-67
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