Background: Patients undergoing percutaneous coronary intervention are at serious risk of different complications such as periprocedural bleeding that can lead to myocardial injuries. Blood loss through puncture site hematoma formation and through catheter aspiration causes periprocedural hemoglobin drop. Objectives: Although percutaneous coronary intervention is an effective treatment of coronary artery disease, it seems necessary to investigate the impact of complications on outcomes including myocardial infarction and possible mortality. The purpose of this study was to evaluate the relationship between periprocedural hemoglobin levels and cardiac enzyme changes as a predictor of cardiac adverse outcomes in patients undergoing percutaneous coronary intervention. Patients and Methods: This study was conducted on 1012 consecutive patients with a diagnosis of coronary artery disease who underwent percutaneous coronary intervention. Hemoglobin levels were measured immediately before and post-procedurally and based on the baseline levels the patients were classified into anemic and non-anemic groups. The samples for TnI and CP-MB were collected before the procedure and at 8, 16, and 24 hours post-procedurally. The patients were stratified into three categories of myocardial injuries: patients with CK-MB ≥ 3×; those with TnI > 0.06 μu/l and individuals with both CK-MB ≥ 3× and TnI > 0.06 μu/l. Results: All categories divided by cardiac enzyme status either in positive or in negative groups were classified in non-anemic group. Although in all groups hemoglobin level decreased post-procedurally, in the second category (TnI ≥ 0.06) the positive patients had significantly lower hemoglobin amounts after the procedure (P = 0.008). Conclusion: Post-procedure hemoglobin dropping may be considered as a predictor of cardiac adverse outcome in patients undergoing PCI. We suggest that a good bleeding control during and after the procedure can reduce the risk of cardiac enzyme elevation post-procedurally.

Background: According to previous studies on the deformation properties of the left atrium, the systolic strain and strain rates represent the atrial reservoir function and the early and late diastolic strain rates show the conduit and booster functions, respectively. Objectives: We sought to evaluate the intra and interatrial asynchrony using strain/strain rate imaging in systolic heart failure patients. Patients and Methods: Twenty five patients with systolic heart failure (LVEF ≤ 40%) were enrolled into the study. Asynchrony quantifications were performed according to the standard deviation of time-to peak (TP-SD) of deformation of three segments manually located along the perimeter of the left atrium free wall, right atrium free wall and interatrial septum, as imaged in an apical four-chamber view. We also calculated classic echocardiography parameters such as LV end-diastolic dimension index, LA volume index, RA area, as well as deceleration time (DT) on transmitral pulsed wave Doppler and E/E' ratio on mitral annular tissue Doppler imaging. Results: In heart failure patients either inter or intra-atrial asynchrony were far more common in comparison with normal subjects (P=0.008 and P=0.007 respectively). Conclusions: Left ventricular systolic heart failure, may result in inter and intra-atrial asynchrony even in clinically stable patients without significant pulmonary hypertension and diastolic dysfunction.

Background: Tricuspid regurgitation (TR) is a common echocardiographic finding, which often accompanies left sided valve disease. Data on mortality and morbidity in patients with severe TR are limited. Objectives: We sought to assess the outcome of patients with severe TR with the hypothesis that significant TR adversely impacts quality of life and survival, independent of pulmonary artery pressure (PAP) and left ventricular ejection fraction (LVEF). Materials and Methods: Between 2002 and 2012, 358 consecutive patients (mean age of 54.67± 13.25years, 75.5% female) with severe TR based on history and transthoracic echocardiography (TTE) were enrolled. Patients with severe left sided valvular heart disease and congenital heart disease were excluded. The prevalence of heart failure symptoms, rehospitalization, and duration of hospitalization were evaluated. Survival was calculated according Kaplan Meier curve analysis. Results: Heart failure (50%) was the most cause of death. Mean years of survival from diagnosis of severe TR was 4.35±3.66, and mean years of survival from onset of symptom was 2.28±1.40. Ninety cases (25.1%) were admitted due to heart failure and through mean of 1.9±0.8 year- follow up (6-32month), 14% of all patients and 36.8% of patients with right heart failure rehospitalized. Atrial fibrillation was reported in 70.5% of patients. Conclusions: There is a significant increased incidence of mortality, prolonged hospitalization, and rehospitalization in symptomatic patients with severe TR. Therefore, we recommend more aggressive approach toward TV repair or replacement in these patients regardless of PAP and systolic function.

Background: Atherosclerosis is a progressive disease characterized by the accumulation of lipids and fibrous elements in the large arteries which now has become the pre-eminent health problem worldwide. Objectives: To investigate the effect and mechanism of Losartan intervention on atherosclerosis in rabbits fed with high-cholesterol diet. Materials and Methods: 32 New Zealand rabbits were randomly divided into three groups: control group, high-cholesterol group and Losartan group. The level of weights, serum lipid levels and inflammatory factors, such as IL-6 and hs C-reactive protein were detected before the Losartan intervention and two months after the Losartan intervention respectively. The content of AngII was detected on later stage of the experiment. Pathological examination of the iliac arteries was performed to measure the thickness of endothelium and media. Results: After the atherosclerosis model was established, the level of the serum lipids, hs CRP and IL-6 of rabbits in high-cholesterol group and Losartan group increased significantly in comparison with control group(P < 0.05), but there was no statistical difference between the two groups (P > 0.05). After the Losartan intervention, the levels of serum hs CRP and IL-6 were higher in high-cholesterol group and Losartan group in comparison with control group (P < 0.05), and they were significantly lower in Losartan group than high-cholesterol group (P < 0.05). Serum lipids levels of rabbits in high-cholesterol group and Losartan group also increased significantly in comparison with control group (P < 0.05), but there was no statistical difference between them (P > 0.05). Ratio of endothelium thickness to the media thickness was higher in high-cholesterol group and Losartan group in comparison with control group (P < 0.05), and the ratio in Losartan group was significantly lower than high-cholesterol group (P < 0.05). Content of Angiotensin was higher in high-cholesterol group and Losartan group compared to control group, and there was no statistical difference between them. Conclusions: The effect of Losartan on atherosclerosis is to prevent the development of atherosclerosis by inhibiting inflammatory process and may not be related to the lipid metabolism.

Background: Coronary artery disease (CAD) is the result of the accumulation of athermanous plaques within the walls of coronary arteries, which supply the myocardium with oxygen and nutrients. CAD leads to heart attacks or strokes and is, thus, one of the most important causes of death worldwide. Angiography, an imaging modality for blood vessels, is currently the most accurate method of diagnosing artery stenosis. However, the disadvantages of this method such as complications, costs, and possible side effects have prompted researchers to investigate alternative solutions. Objectives: The current study aimed to use data analysis, a non-invasive and less costly method, and various data mining algorithms to predict the stenosis of arteries. Among many people who refer to hospitals due to chest pain, a great number of them are normal and as such do not need angiography. The objective of this study was to predict patients who are most probably normal using features with the highest correlations with CAD with a view to obviate angiography costs and complications. Not a substitute for angiography, this method would select high-risk cases that definitely need angiography. Patients and Methods: Different features were measured and collected from potential patients in order to construct a dataset, which was later utilized for model extraction. Most of the proposed methods in the literature have not considered the stenosis of each artery separately, whereas the present study employed laboratory and echocardiographic data to diagnose the stenosis of each artery separately. The data were gathered from 303 random visitors to Rajaie Cardiovascular, Medical and Research Center. Electrocardiographic (ECG) data were studied in our previous works. The goal of this study was, therefore, to seek the accuracy of echocardiographic and laboratory features to predict CAD patients that require angiography. Results: Bagging and C4.5 classification algorithms were drawn upon to analyse the data, the former reaching accuracy rates of 79.54%, 61.46%, and 68.96% for the diagnosis of the stenoses of the left anterior descending (LAD), left circumflex (LCX), and right coronary artery (RCA), respectively. The accuracy to predict the LAD stenosis was attained via feature selection. In the current study, features effective in the stenosis of arteries were further determined, and some rules for the evaluation of triglyceride, hemoglobin, hypertension, dyslipidemia, diabetes mellitus, and ejection fraction were extracted. Conclusions: The current study presents the highest accuracy value to diagnose the LAD stenosis in the literature.

Background: Due to current medical improvements, more women with cardiac disease are being operated during pregnancy. Fetal loss has been found to be significant between 9-30% of them and the surgery is supposed to be done maximal in the first trimester. Objectives: The aim of this study was to report our experience with urgent cardiopulmonary bypass carried out in early pregnancy and to analyze factors that may influence fetal and maternal morbidity and mortality after surgery. Materials and Methods: We have retrospectively reviewed the case notes of the patients who underwent cardiac surgery during early pregnancy in our institution from January 1997 to October 2011. Results: During that period cardiac surgery was done in 305 patients in childbearing age (between 15-50 years) from which 4 were pregnant and in the first half of their pregnancy. All of them had previous surgery due to rhumatismal heart disease .The surgery was emergent in 3 cases and urgent in 1 case. They were operated under normothermic conditions, high flow and hemodynamic stability throughout the procedure. There was no fetal loss but one patient sustained a cardiac arrest secondary to asthma complicated by post-anoxic brain injury. Conclusions: Normothermia and hemodynamic stability are the most important factors which help to reduce fetal loss during open heart surgery in pregnancy. The fetus has an auto-regulation which comes into play when the mother is experiencing shock.

Takotsubo cardiomypathy is a very rare cardiovascular syndrome leading to myocardial infarction and left ventricular dysfunction in the absence of a detectable coronary artery lesion. It is accepted as reversible left ventricular asynergy occuring typically after an intrinsic adrenergic hyperstimulation. In this report we present Takotsubo cardiomyopathy in a 75-year-old patient with multiple autoimmune disorders.

A 74-year-old male patient was admitted to our emergency department with post-MI angina. On account of the anginal complaint that continued for three days, a coronary artery angiography was undertaken. A percutaneous transluminal coronary angioplasty was performed, followed by the implantation of a coronary stent, and coronary perfusion (TIMI-3) was achieved in the left anterior descending artery. Medical treatment (with acetylsalicylic acid, clopidogrel, metoprolol, atorvastatin and enoxaparine) and tirofiban infusion were duly administered in the coronary care unit. After twenty-four hours, however, acute dyspne, hypotension and tachycardia developed, making it necessary to perform an echocardiography. Since the echocardiography revealed a frank pericardial effusion, the patient was immediately taken to the operation room. The ventricular free wall rupture was repaired with Surgicel, which was prepared in three layers and fixed to the myocardium by tissue glue; cardiopulmonary bypass was not used. To our knowledge, our study constitutes the first case report of a tirofiban-induced free wall rupture.