CardSegNet: An adaptive hybrid CNN-vision transformer model for heart region segmentation in cardiac MRI

Cardiovascular MRI (CMRI) is a non-invasive imaging technique adopted for assessing the blood circulatory system's structure and function. Precise image segmentation is required to measure cardiac parameters and diagnose abnormalities through CMRI data. Because of anatomical heterogeneity and image variations, cardiac image segmentation is a challenging task. Quantification of cardiac parameters requires high-performance segmentation of the left ventricle (LV), right ventricle (RV), and left ventricle myocardium from the background. The first proposed solution here is to manually segment the regions, which is a time-consuming and error-prone procedure. In this context, many semi- or fully automatic solutions have been proposed recently, among which deep learning-based methods have revealed high performance in segmenting regions in CMRI data. In this study, a self-adaptive multi attention (SMA) module is introduced to adaptively leverage multiple attention mechanisms for better segmentation. The convolutional-based position and channel attention mechanisms with a patch tokenization-based vision transformer (ViT)-based attention mechanism in a hybrid and end-to-end manner are integrated into the SMA. The CNN- and ViT-based attentions mine the short- and long-range dependencies for more precise segmentation. The SMA module is applied in an encoder-decoder structure with a ResNet50 backbone named CardSegNet. Furthermore, a deep supervision method with multi-loss functions is introduced to the CardSegNet optimizer to reduce overfitting and enhance the model's performance. The proposed model is validated on the ACDC2017 (n=100), M&Ms (n=321), and a local dataset (n=22) using the 10-fold cross-validation method with promising segmentation results, demonstrating its outperformance versus its counterparts.

Antianginal effects of empagliflozin in patients with type 2 diabetes and refractory angina; a randomized, double-blind placebo-controlled trial (EMPT-ANGINA Trial)

INTRODUCTION

Sodium-glucose cotransporter 2 (SGLT2) inhibitors are emerging antidiabetic agents with various potential cardiovascular benefits. The EMPT-ANGINA trial examined the effect of empagliflozin on the angina burden in those with concurrent type 2 diabetes mellitus (T2DM) and refractory angina (RA).

METHOD

In this 8-week, double-blind, randomized, placebo-controlled trial, 75 patients with T2DM and RA were randomly assigned to one of two groups: empagliflozin (n = 37) and placebo (n = 38). The primary outcome was an improvement in angina, which was assessed by the Seattle Angina Questionnaire (SAQ). The secondary outcomes of this study included alterations in the SAQ domains and exercise test components.

RESULTS

The mean age of individuals in the empagliflozin and placebo groups was 67.46 ± 9.4 and 65.47 ± 7.0 years, respectively (p = .304). Patients who received empagliflozin showed a significant improvement in both the primary endpoint, which was the SAQ Summary Score (192.73 ± 20.70 vs. 224 ± 25.36, p < .001) and the secondary endpoints. Exercise test components, including treadmill exercise duration, time till angina, 1 mm ST-segment depression onset, and heart rate (HR) recovery, were all significantly improved in the empagliflozin group. This positive impact was reached with no clinically significant changes in resting and exertion HR or blood pressure. There were no significant side effects in the empagliflozin group (p = .125).

CONCLUSION

Empagliflozin can be safely added as a metabolic modulator agent to existing antianginal medications in individuals with concurrent T2DM and RA to reduce angina symptoms and enhance exercise capacity with minimal side effects.

Medical therapy versus percutaneous coronary intervention or coronary artery bypass graft in stable coronary artery disease; a systematic review and meta-analysis of randomized clinical trials

BACKGROUND

Ischemic heart disease (IHD) is the first cause of mortality in the world. Stable coronary artery disease (CAD) is the most common IHD. Medical therapy (MT), percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG) are three strategies for the management of this disease. The main aim of this study was the comparison of MT with PCI or CABG in terms of cardiovascular (CV) mortality, myocardial infarction (MI), unplanned revascularization (UR), stroke, and freedom from angina in managing stable CAD.

METHODS

The Cochrane Central Register of Controlled Trials, Embase, PubMed, and Scopus were searched. Two reviewers independently appraised the titles and abstracted data of the identified studies. After the Full-text reviewing phase, eligible studies were analyzed through the random-effect meta-analysis method. Finally, a sensitivity analysis was conducted for the robustness of findings.

RESULTS

Nine randomized controlled trials (RCTs) were included. The pooled RR of CV mortality associated with MT compared with PCI and CABG was 1.22 and 1.385, respectively. Overall, The RR of MT associated with MI, UR, stroke, and freedom from angina compared with PCI was 1.001, 1.151, 0.799, and 0.801, respectively.

CONCLUSION

Our results revealed no statistically significant difference between MT and PCI in terms of studied primary outcomes. The findings also highlighted that there is no statistically significant difference between MT and CABG in terms of CV mortality.

Evaluating value of positive T wave in lead V1 and TV1 > TV6 pattern in predicting significant coronary artery disease in patients undergoing coronary angiography

BACKGROUND

The aim of this study was to predict significant coronary artery disease (CAD) in patients undergoing coronary angiography.

METHODS

In this cross-sectional study, data of 384 patients who underwent angiography during 2015-2017 were reviewed. Electrocardiograms (ECGs) were evaluated in terms of having positive T wave in lead V1 (TV1) described as T wave with amplitude of more than 0.15 mV and angiography records were assessed for presence of significant CAD defined as presence of ≥ 70% internal diameter stenosis in at least one major epicardial coronary artery or more than 50% stenosis in left main artery (LMA).

RESULTS

Out of 384 patients who participated in this study with mean age of 63.6 ± 10.2 years (40-89 years), 71.6% showed positive TV1 and significant CAD simultaneously and left anterior descending artery (LAD) and left circumflex artery (LCX) lesions were more frequently reported in coronary angiography. Based on chi-square test, the prevalence of significant CAD was obviously more in those with positive TV1 as compared to those without this finding [odds ratio (OR) = 2.74, 95% confidence interval (CI): 1.80-4.19, P < 0.001]. Mann-Whitney test showed significant difference in number of coronary arteries involved in CAD between presence of positive and negative T wave in lead V1 (P < 0.001). Great number of patients with significant CAD had remarkably higher T wave amplitude in lead V1 in comparison to lead V6 (OR = 6.22, 95% CI: 3.14-12.30, P < 0.001).

CONCLUSION

Positive TV1 and TV1 > TV6 pattern can be considered as a predictor for significant CAD in patients with otherwise normal ECG.

Comparing efficacy of receiving different dosages of eptifibatide in bleeding after percutaneous coronary intervention in patients with myocardial infarction

BACKGROUND

Acute coronary syndrome (ACS) is a common condition that needs appropriate treatment like percutaneous coronary intervention (PCI). Glycoprotein IIb/IIIa inhibitors (GPI) like eptifibatide prevent procedural ischemic complications after PCI. Eptifibatide has increased the risk of bleeding complications, although it is effective in reducing mortality and morbidity. Eptifibatide is routinely used in bolus and infusion forms and the aim of this study is to evaluate the efficacy of bolus-only dose and bolus + infusion strategy for administrating eptifibatide in bleeding complications and consequences after PCI.

METHODS

This randomized clinical trial was conducted on subjects who experienced PCI after incidence of myocardial infarction (MI). Patients were randomly divided into two groups who received bolus-only dose (n = 51) or bolus + infusion form of eptifibatide (n = 50). Then, PCI blood pressure, mean time duration of hemostasis after arterial sheath removal, laboratory data, need for blood transfusion, and presence of bleeding complications were evaluated. After 6 months, patients were followed for needs for additional coronary interventions.

RESULTS

The mean age of participants was 61.68 ± 1.50 years. The prevalence of men was 70.29%. There was no significant difference in mean of systolic blood pressure (SBP) and diastolic blood pressure (DBP) during hospitalization (P > 0.050). The mean time duration of hemostasis was 8.13 ± 0.45 minutes in the bolus-only group and 16.46 ± 0.71 minutes in the bolus + infusion group (P < 0.001). There was no significant difference in the hemoglobin (Hb) level, platelet count, white blood cell (WBC), blood urea nitrogen (BUN), and creatinine level (P > 0.050).

CONCLUSION

The results of this study suggested that bolus-only dose of eptifibatide before PCI could be able to decrease significantly bleeding complication and other clinical and cardiovascular outcomes.

Factors in relation with fatigue and illness perception in patients with myocardial infarction and the changes in fatigue due to intervention on illness perception: Research design, methodology, and preliminary results

BACKGROUND

In physical diseases including cardiovascular diseases (CVDs), illness perception (IP) plays an important role in illness outcomes. Fatigue is a major bothersome symptom after myocardial infarction (MI). This manuscript presents the research design, methodology, and primary findings of a study on factors in relation with fatigue and IP in patients with MI, and changes in fatigue after intervention on IP.

METHODS

241 patients with MI who experienced a first-time acute MI (AMI) participated in this study in 2016-2017. During hospitalization, the demographic and clinical information of participants were collected. After four months, the information regarding fatigue, IP, coping with stress, type D personality, perceived social support (PSS), and locus of control of the participants was collected at their houses. About one year later, based on the results of phase one of the study, a psychoeducation course was conducted for 35 of the patients as intervention group while 36 patients were supervised as control group. Two months later, the role of IP in fatigue changes of the participants was assessed.

RESULTS

155 (65%) of the patients had positive family history of coronary heart disease (CHD). 103 (43%) were cigarette smokers, 100 (43.5%) had high blood cholesterol, and 72 (30%) had sedentary life style before MI.

CONCLUSION

The overview of the factors related to fatigue and IP of the patients with MI could help the care teams to provide better care in the recovery period of the illness.

Undesired Outcomes of the Catania Stent Compared to the Xience Stent in Patients Undergoing Angioplasty: A Double-Blind Randomized Controlled Trial

Background

The present study tries to compare the unintended outcomes of the Catania stent versus Xience stent in patients undergoing angioplasty.

Materials and Methods

In a three month, follow-up, double-blinded, randomized controlled trial, 83 patients undergoing angioplasty, who met the inclusion criteria were entered into the study. After randomization 43 patients were treated with the Xience stent and 40 patients with the Catania stent. Stent-related outcomes such as Cardiac and Non-Cardiovascular Death, Myocardial Infarction (MI), Target Lesion Revascularization (TLR), Stent Thrombosis (ST), Coronary Artery Bypass Grafting (CABG), Peripheral vasculopathy, and Cerebral Vascular Accident (CVA) were compared between the groups.

Results

There was no statistically significant difference in the incidence rate of complications and clinical outcomes between the two treatment groups (P > 0.05). The incidence of MI, TLR, CABG operation, peripheral vasculopathy, or CVA was not observed in any patient and there was no statistically difference in mortality (4.7% vs. 2.5%; P = 0.527) and stent thrombosis (2.3% vs. 2.5%; P = 0.735).

Conclusion

All in all, the present study could not find the significant differences between the Catania stent and Xience stent in terms of clinical outcomes during the follow-up period.

Effects of Collaboration Care Model on the Quality of Life in Patients after Coronary Angioplasty: A Randomized Controlled Clinical Trial

BACKGROUND

Coronary artery diseases and therapies such as coronary angioplasty would lead to changes in the quality of life in patients. The aim of this study was to determine the effects of collaborative care model on the quality of life in patients after coronary angioplasty.

METHODS

This randomized controlled clinical trial was conducted in Isfahan, Iran during 2015. In this study, 50 samples were selected by simple sampling and randomly allocated into two equal groups of intervention and control. Collaborative care model was performed in the intervention group for 3 months. Data were collected using quality of life (SF-36) questionnaire which includes 36 questions on physical and psychological dimensions and was completed before and one month after the intervention in both groups. Data were analyzed using descriptive and analytical statistics and by independent t- test, paired t test, Chi square and Mann-Whitney tests through SPSS 18.

RESULTS

After the intervention, the mean score of quality of life in the intervention group was significantly higher than the control group (P<0.05). The results of independent t-test showed a significant difference between both groups regarding the mean of changes in the score of quality of life and its dimensions in patients undergoing coronary angioplasty 3 months after the intervention (P<0.001).

CONCLUSION

Results revealed that patients who had been cared based on collaborative care model had better scores of quality of life in all the physical, mental and social dimensions than the control group. Therefore, using this model for taking care of patients after coronary angioplasty is recommended. Trial Registration Number: IRCT2015120120912N4.

The Effect of Interactive Text Message Follow-up on Health Promoting Lifestyle of Patients with Acute Coronary Syndrome

Background:

Lifestyle modification is an essential factor in the promotion of health in patients with acute coronary syndrome (ACS). One of the interventions to promote lifestyle is interactive follow-up, which, according to the traditional methods, requires spending significant amount of time and cost. Therefore, this study aimed to determine the effectiveness of interactive text message follow-up on health promoting lifestyle of patients with ACS.

Materials and Methods:

This was a randomized controlled trial among 100 patients suffering from ACS during October–February 2016. The participants were randomly assigned to the experimental and control groups. Collection of data on lifestyle was performed before, 3, and 4 months after the beginning of the intervention using Walker's Health Promoting lifestyle questionnaire. Six messages were sent to the intervention groups each week, and participants asked the questions by sending text message, each week 1 message were sent to the control group for 12 weeks. The statistical analysis of data was performed using independent t-test, Chi-square, Mann–Whitney U test, and repeated measures analysis of variance (ANOVA).

Results:

Before the intervention, there was no significant difference between the mean score of lifestyle of the two groups, however, 3 months and 4 months after the beginning of the intervention, the mean score of lifestyle in the intervention group was significantly higher than that of the control group (P < 0.001).

Conclusion:

The interactive text message follow-up is effective in promoting the lifestyle of patients with ACS and can be considered in the planning of follow-up of patients with ACS.

Immediate outcomes of eptifibatide therapy during intracoronary stent implantation

BACKGROUND

The objective of the present study was to assess the major immediate outcomes of eptifibatide therapy during intracoronary stent implantation.

MATERIALS AND METHODS

In an interventional study, patients undergoing percutaneous coronary intervention (PCI) were randomized into either the eptifibatide (n = 100) or the control (n = 107) group. In each group, demographic and clinical characteristics such as cardiac death, stent thrombosis (ST), myocardial infarction (MI), rates of target lesion and vessel revascularization, cerebral vascular accident (CVA), and emergency coronary artery bypass grafting (CABG) were recorded.

RESULTS

The overall rates of major adverse events such as mortality, Stent thrombosis (ST), Myocardial Infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), CVA, and emergency CABG within 24 h after stent implantation were low and comparable between the two groups; P > 0.05 considered significant for all comparisons.

CONCLUSION

There were no statistical differences between the clinical outcomes of groups administered with single-dose intracoronary eptifibatide and control groups among patients undergoing PCI during stent implantation.

Atorvastatin and prevention of contrast induced nephropathy following coronary angiography

BACKGROUND

Contrast induced nephropathy (CIN) is one of the most common complications after radiographic procedures using intravascular radiocontrast media. The aim of the current study was to assess the effect of atorvastatin on prevention of CIN in patients undergoing coronary angiography.

MATERIALS AND METHODS

In a clinical trial study, 200 patients referred for angiography were randomly divided into two groups of using 80 mg atorvastatin and placebo before the procedure. Furthermore, 100 patients who were under chronic treatment of statins were included as the third group. Serum creatinine (Scr) levels before and after the procedure were evaluated and incidence of CIN (post-procedural Scr of >0.5 mg/dl or >25% from baseline) was assessed.

RESULTS

Mean age of the participants was 60.06 ± 0.69 years and 276 (92%) were male. There were no significant differences between group with respect to age and gender. In pre-operation atorvastatin, placebo and long term statin groups, the incidence of CIN was 1%, 2% and 1%, and mean changes of Glomerular filtration rate (GFR) was 3.68 ± 1.32, -0.77 ± 1.21 and 1.37 ± 0.86; and mean changes of creatinine (Cr) was -0.05 ± 0.02, 0.02 ± 0.02 and -0.01 ± 0.01 respectively. (P = 0.776, 0.026 and 0.041 respectively). In pre-operation atorvastatin group, Cr decreased, and GFR increased significantly (P = 0.019 and 0.007 respectively).

CONCLUSION

pre-operation short term high dose atorvastatin use was associated with a significant decrease in serum Cr level and increase in GFR after angiography.

Short term high dose atorvastatin for the prevention of contrast-induced nephropathy in patients undergoing computed tomography angiography

BACKGROUND

Statins are shown effective by some studies in preventing contrast-induced nephropathy (CIN). We evaluated the effectiveness of atorvastatin in the prevention of CIN in computed tomography angiography (CTA) candidates.

METHODS

This study was conducted on patients referring for elective CTA with normal renal function. Patients received atorvastatin (80 mg/day) or placebo from 24 h before to 48 h after administration of the contrast material. Serum creatinine was measured before and 48 h after contrast material injection. CIN was defined as an increase in serum creatinine level of ≥ 0.5 mg/dl or ≥ 25% of the baseline creatinine.

RESULTS

A total of 236 patients completed the study; 115 atorvastatin, 121 placebo, mean age = 58.40 ± 9.80 year, 68.6% male. Serum creatinine increased after contrast material injection in both the atorvastatin (1.00 ± 0.16-1.02 ± 0.15 mg/dl, P = 0.017) and placebo groups (1.03 ± 0.17-1.08 ± 0.18 mg/dl, P < 0.001). Controlling for age, gender, comorbidities, drug history, and baseline serum creatinine level, patients who received atorvastatin experienced less increase in serum creatinine after contrast material injection (beta = 0.127, P = 0.034). However, there was no difference between the atorvastatin and placebo groups in the incidence of CIN (4.3 vs. 5.0%, P = 0.535).

CONCLUSION

In patients undergoing CTA, a short-term treatment with high dose atorvastatin is effective in preventing contrast-induced renal dysfunction, in terms of less increase in serum creatinine level after contrast material injection. Further trials including larger sample of patients and longer follow-ups are warranted.

The effects of beta-glucan rich oat bread on serum nitric oxide and vascular endothelial function in patients with hypercholesterolemia

INTRODUCTION

Oats are high in soluble fibers and effective in reducing the risk of cardiovascular diseases (CVD). We assessed the effects of beta-glucan from oat bran on serum nitric oxide (NO) endothelial function in patients with hypercholesterolemia.

METHOD

Sixty hypercholesterolemic patients were randomly divided to receive an experimental bread rich in beta-glucan from oat bran (intervention) or bread rich in wheat fiber (control) for four weeks. All subjects had the same diet for two-week baseline period and hypocaloric diet for four weeks of intervention. Serum NO concentration and flow-mediated dilation (FMD) were determined before and after the experiment.

RESULTS

Mean age of the participants was 51.1 ± 9.3 years and 65% (n = 39) were female. After intervention, serum NO concentration increased by 50.2 ± 19.8 μmol/lit in the intervention group (P = 0.017), but no change was observed in the control group (17.5 ± 27.5 μmol/lit; P = 0.530). No change of FMD was observed in the intervention (0.48 ± 0.78%; P = 0.546) or in the control group (0.59 ± 0.92%; P = 0.533).

CONCLUSION

Consumption of oat bread for four weeks increases serum NO concentration but has no effect on FMD. Further studies are warranted in this regard.

The relation between occupational exposure to lead and blood pressure among employed normotensive men

BACKGROUND

Lead is a pollutant with numerous adverse effects on health. Since it can affect blood pressure, peripheral blood vessels, and the heart, the present study aimed to evaluate the relation between occupational exposure to lead and blood pressure.

MATERIALS AND METHODS

This cross-sectional study included male individuals working in battery firms in Isfahan. A questionnaire covering demographic characteristics and the history of different diseases and occupational exposure to lead was completed. Each participant's blood pressure was also measured and recorded. After obtaining blood samples and determining lead levels, mean and frequency analyses were performed. In addition, Pearson's correlation test and linear regression were used to assess the relation between blood lead levels (BLLs) and systolic and diastolic blood pressure. All analyses were performed in SPSS.19.

RESULTS

The mean age of the 182 studied workers was 42.85 ± 13.65 years. They had worked in battery firms for a mean period of 23.67 ± 14.72 years. Moreover, the mean value of BLLs among the participants was 7.92 ± 3.44 μg/dL. Correlation between BLL and systolic and diastolic blood pressure was not significant. The effects of lead on systolic and diastolic blood pressure after stepwise regression were B = -0.327 [confidence interval (CI) 95%: -0.877 to 0.223] and B = -0.094 (CI 95%: -0.495 to 0.307), respectively.

CONCLUSION

This study revealed that BLLs in battery firm workers to be normal. Additionally, BLLs were not significantly related with either systolic or diastolic blood pressure which might have been the result of normal BLLs.

Prediction of short-term clinical outcome of percutaneous coronary intervention in patients with acute coronary syndrome through myeloperoxidase levels

BACKGROUND

The present study assessed the significance of troponin and myeloperoxidase levels in the prediction of major adverse cardiac events (MACE) during the 1st month after percutaneous coronary intervention (PCI).

METHODS

This prospective, longitudinal study included 100 patients with acute coronary syndrome who underwent PCI. The participants' characteristics were recorded in a questionnaire. Blood samples were obtained before and 24 h after PCI, and troponin, and myeloperoxidase levels were measured. During the 1st month after PCI, death, myocardial reinfarction, and revascularization during admission were investigated through weekly phone calls. The value of troponin and myeloperoxidase levels before and after PCI in predicting MACE was evaluated using Cox regression.

RESULTS

Considering the obtained methods and the short duration of the study, 99% of the patients completed the study. Moreover, one death and four cases of myocardial infarction and revascularization were reported. Cox regression did not show significant relations between the incidence of MACE and myeloperoxidase levels before (hazard ratio = 1.12; 95% confidence interval 0.9, 1.39) and after PCI (hazard ratio = 0.86; 95% confidence interval = 0.43, 1.71), or troponin levels before (hazard ratio = 0.97; 95% confidence interval = 0.81, 1.17) and after PCI (hazard ratio = 1.03; 95% confidence interval = 0.96, 1.11).

CONCLUSION

It seems that the few cases of MACE, due to the small sample size and short duration of follow-up, had been insufficient for determining the predictive value of troponin and myeloperoxidase levels before and after PCI. Therefore, further studies with larger sample size and longer follow-up duration are recommended.

The relation between body iron store and ferritin, and coronary artery disease

BACKGROUND

Iron is essential for many physiological processes; whereas, iron overload has been known as a risk factor in progression of atherosclerosis. The aim of this study was to investigate the importance of serum ferritin levels, which are known as an indicator of body iron stored in the incidence of coronary artery disease (CAD).

METHODS

In a case-control study, we evaluated 432 eligible men who underwent coronary angiography at Chamran Cardiology Hospital, Isfahan, Iran. They were separated into two groups of case (with CAD) and control (without CAD). All subjects had given written informed consents. Then, the blood samples were taken after 12-14 hours of fast by a biologist for measuring cardiovascular risk factors and body iron stores, including serum ferritin, serum iron, and total iron binding capacity (TIBC). For statistical analyses, chi-square test, Student's t-test, one-way ANOVA, and the logistic regression were used.

RESULTS

In the present study, 212 participants with CAD in the case group and 220 participants free of CAD in the control group were included in the analysis. At baseline, there were significant differences in serum ferritin (P < 0.001) and other cardiovascular risk factors between the two groups. Moreover, when other risk factors of CVD were included in the model, serum ferritin [Odd Ratio (OR) = 1.006, 95% confidence interval of 95% (95% CI) 1.00-1.01, P = 0.045] and serum ferritin ≥ 200 (OR = 4.49, 95% CI 1.72-11.70, P < 0.001) were associated with CAD.

CONCLUSION

High iron store, as assessed by serum ferritin, was associated with the increased risk of CAD. Furthermore, it was a strong and independent risk factor in the incident of atherosclerosis in the Iranian male population.

Abdominal fat distribution and serum lipids in patients with and without coronary heart disease

 

OBJECTIVE

To investigate the association between obesity indices, abdominal fat distribution, and lipid profile in patients with stable angina (SA). 

METHODS

Body weight, height, waist circumference (WC), body mass index (BMI), and waist /height ratio (WHtR) of 123 patients with SA who underwent coronary angiography were measured. Fasting blood samples were taken to measure the levels of fasting blood sugar (FBS), total cholesterol (TC), low- and high-density lipoprotein cholesterol (LDL-C, HDL-C), apolipoproteins A and B (apo A and apo B), and triglycerides (TG). According to angiography reports, the participants were divided into patients with or without coronary heart disease (CHD). All patients underwent an abdominal computerized tomography (CT) scan to measure the visceral, superficial, and deep subcutaneous fat. 

RESULTS

The mean ages of the patients with CHD (n = 73) and without CHD (n = 50) were 50.5 ± 7.6 and 53.7 ± 7.6 years, respectively (P = 0.03).  The patients with CHD had significantly higher levels of TC, TG, and superficial subcutaneous fat, while the patients without CHD had higher levels of apo A (P ≤ 0.05). Multivariate analyses showed a significant association of visceral fat with TC, LDL-C, TG, and apo B, in the patients without CHD, while significant inverse associations were found between WC and HDL-C, WHtR, and apo A as well as visceral fat and LDL-C in the patients with CHD. 

CONCLUSIONS

Among anthropometrics and imaging indices of obesity, WC and WHtR have shown better association between central obesity with dyslipidemia in the patients with CHD, while CT-measured visceral adipose tissue area was the best correlate of dyslipidemia in the patients without CHD. 

Association of apolipoprotein B, apolipoprotein A, and the its ratio with body fat distribution

BACKGROUND

To evaluate the association of apolipoprotein B (apoB), apolipoprotein A (apoA), and apoB/apoA ratio with the body fat indicators in patients with stable angina pectoris (SA).

MATERIALS AND METHODS

One hundred and twenty two participants aged 40-60 years old, with a mean age of 52.1 ± 7.2 years and SA, were recruited for the present study. Body weight, height, and waist circumference (WC) were measured, and waist to height ratio (WHtR) was calculated. After 12 hours of fasting, a blood sample was obtained and serum levels of apoB and apoA were measured and the apoB/apoA ratio was calculated. These patients underwent an abdominal computerized tomography scan (CTS) to assess visceral and subcutaneous adipose tissue (VAT, SAT). Linear regressions were computed to assess the relation of apoB, apoA, and their ratio with various measurements of adiposity (VAT, SAT, WC, and WHtR), with adjustment for age, sex, and BMI ≥ 25, WC ≥ 80 in women and WC ≥ 90 in men and WHtR ≥ 0.59.

RESULTS

From totally 123 patients with SA with a mean age of 52.1 ± 7.2 years, 44.7% male and 55.3% women were entered. Significant positive associations were found between visceral fat area and the apoB/apoA ratio (P = 0.02, β = 0.2), and significant negative correlations were observed between visceral fat area and apoA concentrations (P = 0.04, β = -0.2).

CONCLUSION

As abdominal fat accumulation is associated with other risk factors such as apolipoproteins in ischemic patients, then we most focus on control of these factors.

Diagnostic performance of 64-row coronary CT angiography in detecting significant stenosis as compared with conventional invasive coronary angiography

BACKGROUND

The aim of the present study is to evaluate the accuracy of 64-multidetector-row computed tomography angiography (CTA) in comparison to conventional invasive angiography (CIA) in the diagnosis of significant stenosis (≥ 50%) of coronary artery tree.

METHODS

Assessment of CTA in the detection of coronary artery disease (CAD) was performed in patients referred because of symptoms or stress studies suggestive of ischemia. For this purpose, among more than 1000 cases of coronary CTA in a 20 months period a study population of 54 patients suspected to have significant stenosis of the coronary artery tree was investigated. The CIA procedure was performed in these patients one month after CTA. The accuracy of CTA in detecting significant stenosis was compared to CIA.

RESULTS

For vessel based analysis of 179 coronary vessels, CTA had a sensitivity of 96%, specificity of 87.5%, positive predictive value of 90.5%, and negative predictive value of 94.6%. For patient-base analysis, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CTA were 97.9%, 28.6%, 66.6%, and 90.2%, respectively.

CONCLUSION

The findings of this study reveal that CT angiography with 64-slice scanner could be considered as a suitable technique for rapid triage of patients presenting to hospitals with chest pain. High values of sensitivity and PPV reveal the good performance of CTA in detecting CAD.

Relationship between left ventricular ejection fraction and depression following myocardial infarction: an original article

BACKGROUND

The aim of this study was to examine the association between left ventricular ejection fraction (LVEF) and incidence of depression following the myocardial infarction (MI).

METHODS

In a prospective study, 176 patients aged 32-84 years with the mean age of 56 years (SD = 10.05) with a definitive diagnosis of myocardial infarction and admitted to one of the coronary care units (CCU) of Isfahan during April to August 2006 were selected through consecutive sampling method. The demographic and medical characteristics were collected by their medical record and also the results of the LVEF assessment of the patients were obtained through echocardiography or angiography following the myocardial infarction. Thereafter, the patients were given Beck Depression Inventory for the primary care (BDI-PC) in three months after myocardial infarction. The collected data were analyzed during the hospitalization and follow-up periods using logistic regression method.

RESULTS

The findings indicated that left ventricular dysfunction identified by the Left ventricular ejection fraction index was significantly correlated with depression three months after the myocardial infarction (P < 0.01). In addition, the exploratory model (which only includes LVEF variable) had the predictive validity of 64.8% with 55.7% sensitivity and 72.1% specificity.

CONCLUSION

Left ventricular dysfunction is associated with increased risk of depression following the myocardial infarction.

Effects of streptokinase on reflow in rescue percutaneous coronary intervention

BACKGROUND

Primary percutaneous coronary intervention (PPCI) is the preferred treatment method for ST elevation myocardial infarction (STEMI). However, the required equipments are not available in all hospitals. Thus, due to shortage of time, some patients receive thrombolysis therapy first. Patients with chest pain and/or persistent ST segment elevation will then undergo rescue percutaneous coronary intervention (PCI). The present study evaluated and compared the frequency of no-reflow phenomenon and 24-hour complications after PCI among patients who underwent PPCI or rescue PCI.

METHODS

This cross-sectional study assessed no-reflow phenomenon, 24-hour complications, and thrombolysis in myocardial infarction (TIMI) flow in patients admitted to Chamran Hospital (Isfahan, Iran) with a diagnosis of STEMI during March-September, 2011. Subjects underwent PPCI if they had received eptifibatide. Rescue PCI was performed if patients had chest pain and/or persistent ST segment elevation despite receiving streptokinase (SK). Demographic characteristics, history of diseases, medicine, angiography findings, PCI type, and complications during the first 24 hours following PCI were collected. Data was then analyzed by Student's t-test, chi-square test, and logistic regression analysis.

RESULTS

A total number of 143 individuals, including 67 PPCI cases (46.9%) and 76 cases of rescue PCI (53.1%), were evaluated. The mean age of the participants was 58.92 ± 11.16 years old. Females constituted 18.2% (n = 26) of the whole population. No-reflow phenomenon was observed in 51 subjects (37.1%). Although 9 patients (6.3%) died during the first 24 hours after PCI, neither the crude nor the model adjusted for age and gender revealed significant relations between rescue PCI and death or no-reflow phenomenon. Rescue PCI and no-reflow phenomenon were not significantly correlated even after adjustments for age, gender, history of diabetes, hypertension, hyperlipidemia, coronary artery disease, smoking, platelets number, myocardial infarction level, the extent of stenosis, and the involved artery.

CONCLUSION

According to the present study, although SK is more effective than eptifibatide in resolution of thrombosis and clots, rescue PCI did not differ from PPCI in terms of the incidence of no-reflow phenomenon or short-term complications.

Type D personality is associated with hyperlipidemia in patients with myocardial infarction

OBJECTIVE

There are many studies indicating the role of psychological factors in the pathogenesis of cardiovascular disorders. Type D as a new personality construct has been proposed by Denollet, characterized by the joint global traits including negative affectivity and social inhibition. The purpose of this study was to examine the link between type D personality and hyperlipidemia in patients with myocardial infarction (MI).

MATERIALS AND METHODS

One hundred and seventy-six consecutive patients admitted to the cardiac care unit (CCU) wards of nine hospitals in Isfahan, Iran, following MI, were selected based on the inclusive and exclusive criteria. The patients completed demographic questionnaire and Type D Personality Scale (DS14). Their medical data were obtained from medical records. Chi-squared test, Student's t-test, and multivariate logistic regression were used to analyze the data.

RESULTS

Of the 176 subjects, 63 patients (35.8%) were type D. In univariate analysis, hyperlipidemia was the only significant variable (56% vs. 40%, P = 0.041) found to be associated with type D. Also, by multivariable logistic regression analysis, hyperlipidemia [Odds Ratio (OR) 0.374; 95% confidence interval (CI) 0.175-0.796] was the only independently significant variable found to be linked with type D personality. No other statistically significant differences were found between the two groups on demographic and medical factors characteristics.

CONCLUSION

The type D personality was associated with hyperlipidemia. Thus, personality factors may make people vulnerable to metabolic syndromes.

Effects of occupational exposure to lead on left ventricular echocardio graphic variables

BACKGROUND

Lead contamination can affect many body organs including the heart. This study assessed a number of echocardiographic indices to clarify the effects of lead on cardiac function among battery factory workers who are in constant exposure to lead.

METHODS

In a cross-sectional study, 142 male battery factory workers who had been exposed to lead for at least 1 year were evaluated. The subjects aged 25-55 years old and were excluded if they had hypertension, diabetes, or cardiovascular diseases. Demographic characteristics, professional profile, lead exposure, history of respiratory diseases, drugs intake, and lifestyle information of the participants were collected. Height, weight and blood pressure measurements were then performed. Blood tests were also ordered to determine blood lead levels. The subjects finally underwent M-mode and Doppler echocardiography. Linear regression analysis was used to establish the effects of lead on the target indices. All statistical analyses were conducted in SPSS18.

RESULTS

The mean age and mean duration of lead exposure of the subjects were 41.78 ± 13.58 and 23.54 ± 14.44 years, respectively. The mean blood lead level was 7.59 ± 2.75 µg/dl. Left ventricular hypertrophy was detected in 12% of the participants. Blood lead levels were not significantly related with echocardiographic indices in the crude model or after adjustments for age alone or for age and other risk factors.

CONCLUSION

Blood lead levels of our participants were below standard values. In addition, no significant relation was found between left ventricular function indices and blood lead levels. The absence of such relations could have been caused by the exclusion of individuals with hypertension or cardiovascular diseases. Structural modifications in battery factories following legislations in Iran might have been responsible for low blood lead levels among the subjects.

Evaluation of heart rate reserve and high-sensitivity C-reactive protein in individuals with and without metabolic syndrome in Isfahan, Iran

BACKGROUND

Lack of heart rate increase proportionate to exercise causes poor prognosis. Moreover, inflammatory factors such as C-reactive protein (CRP) are associated with atherosclerosis. The current study compared these two indices in individuals with and without metabolic syndrome in Isfahan, Iran.

METHODS

This study was performed on 203 people without and 123 patients with metabolic syndrome who were randomly selected from the participants of the Isfahan Cohort Study. The demographic data, waist circumference, blood pressure, height, and weight of the participants were recorded. Moreover, serum tr`viglyceride (TG), fasting blood sugar (FBS), total cholesterol, high density lipoprotein (HDL), low density lipoprotein (LDL), and high-sensitivity CRP (hs-CRP) levels were measured. Exercise test was carried out according to the Bruce standard protocol and heart rate reserve (HRR) was determined and recorded. The age-adjusted data was analyzed using generalized linear regression and student's t-test in SPSS(15).

RESULTS

The mean ages of participants without and with metabolic syndrome were 54.16 ± 8.61 and 54.29 ± 7.6 years, respectively. The corresponding values for mean LDL levels were 116.17 ± 24.04 and 120.12 ± 29.55 mg/dl. TG levels were 140.38 ± 61.65 and 259.99 ± 184.49 mg/dl for subjects without and with the metabolic syndrome, respectively. The mean FBS levels were 81.81 ± 9.90 mg/dl in the participants without the syndrome and 107.13 ± 48.46 mg/dl in those with metabolic syndrome. The mean systolic blood pressure was 116.06 ± 13.69 mmHg in persons without metabolic syndrome and 130.73 ± 15.15 mmHg in patients with the syndrome. The values for mean diastolic levels in the two groups were 76.52 ± 6.69 and 82.84 ± 8.7 mmHg, respectively. While the two groups were not significantly different in terms of HRR (P = 0.27), hs-CRP levels in the metabolic syndrome group was significantly higher than the other group (P = 0.02).

CONCLUSION

We failed to establish a relationship between HRR and the metabolic syndrome. However, the observed relationship between metabolic syndrome and hs-CRP level, which is an inflammatory factor, indicates elevated levels of hs-CRP in patients with metabolic syndrome.

Gas transfer and pulmonary function tests in women with disseminated lupus erythematosus

BACKGROUND

Systemic lupus involves different body organs including lungs. However, there is limited information on the systemic lupus without respiratory symptoms. The aim of this study was to investigate the diffusing capacity of the lung for carbon monoxide in women with disseminated lupus erythematosus and to compare it with a control group.

METHODS

This prospective study was conducted during 2005 in the Rheumatology Clinic of Alzahra Hospital, Isfahan, Iran. The diffusing capacity of the lung for carbon monoxide and pulmonary parameters were measured using the unrelated samples in 76 female patients with systemic lupus.

RESULTS

Mean diffusing capacity of the lung for carbon monoxide in patients with lupus was lower than the control group (P ≤ 0.001). The amount of corrected volumetric capacity of carbon monoxide in lungs of patients was significantly different from the control group (P ≤ 0.001). Residual volume and total capacity of lungs in the female patients with lupus were higher than the control group (P ≤ 0.001).

CONCLUSION

Decreased diffusing capacity for carbon monoxide in lungs of females with systemic lupus without respiratory symptoms is prevalent. It indicates alveolar capillary membrane involvement in these patients. Increased residual volume and total capacity of lungs in these patients can be caused by bronchiolitis.

The effects of trinitroglycerin injection on early complications of angiography

BACKGROUND

Today, ischemic heart diseases (IHDs) are the most common diseases worldwide. Angiography is the best way to diagnose IHDs. Angiographic complications however can include death, myocardial infarction, nausea, spasm of the coronary arteries, chest pain, bradyarrhythmia, hypotension, or hypertension. This study aimed to determine the effects of a simultaneous injection of trinitroglycerin (TNG) with contrast agent on the early complications of angiography.

METHODS

This clinical trial was conducted in Chamran Hospital, Isfahan, Iran in 2005. Before the angiography, the study population were randomly assigned into two groups of intervention (n = 111) and placebo (n = 112). TNG was mixed with contrast material in the intervention group and distilled water was mixed with contrast agent in the placebo group to be used for angiography. Nausea, spasm of the coronary arteries, chest pain, bradyarrhythmia and the mean systolic and diastolic blood pressures were compared during and after the angiography in patients of both groups. The obtained data was analyzed by chi-square and t tests.

RESULTS

The mean age in the intervention and placebo groups were 59.93 ± 9.14 and 59.37 ± 10.12 years, respectively (P > 0.05). The two groups were not significantly different in terms of gender distribution. The frequency of nausea was 4.5% and 6.2% in the intervention and placebo groups, respectively. The corresponding values were 0.9% and 5.4% for coronary artery spasm and 1.8% and 6.3% for chest pain. Bradyarrhythmia occurred in 7.1% of patients in both groups. There were no significant differences in the abovementioned complications. Mean values of the highest and lowest systolic and diastolic blood pressures of the intervention group were significantly different from the placebo group (P = 0.001). Simultaneous injection of TNG and the contrast agent in this study resulted in positive findings (except for changes in blood pressure).

CONCLUSION

More studies are recommended with different doses of TNG, different times of injection and considering at-risk individuals.

The relationship between type D personality and perceived social support in myocardial infarction patients

BACKGROUND

Type D personality is based on two global and stable personality traits, including negative affectivity (NA) and social inhibition (SI). The aim of this study was to examine the relationship between type D personality and perceived social support in post myocardial infarction (MI) patients.

METHODS

One hundred seventy six consecutive patients following MI admitted to the cardiac care unit (CCU) of nine hospitals in Isfahan, Iran from April to September 2006 were selected based on the inclusive and exclusive criteria. The patients completed the Persian version of type D personality scale and the Persian version of multidimensional scale of perceived social support (MSPSS). Also, demographic and medical questionnaire was completed for each patient. Chi-squared test, t-test and MANOVA were used to analyze the data.

RESULTS

The findings indicated that 35.8% patients (35.8 %) were classified as type D. The results of MANOVA showed that type D patients were significantly different from non-type D patients (F = 8.72, p = 0.0001) on MSPSS scores and on all dimensions including family subscale (F = 11.52, p = 0.001), friends subscale (F= 16.16, p = 0.0001) and significant others subscale (F = 5.04, p = 0.026).

CONCLUSIONS

Type D personality substantially affects the way MI patients perceive availability of social support from different sources including family, friends, and significant others. One implication of this finding may be to develop tailor-made interventions for MI patients with type D.

Correlation between body fat distribution, plasma lipids and apolipoproteins with the severity of coronary involvement in patients with stable angina

BACKGROUND

Previous studies reported that the distribution of body fat is an important risk factor for coronary artery diseases (CAD) and abdominal adipose tissue is associated with severe CAD. This study was conducted to evaluate the relationship between body fat distributions, plasma lipids and the severity of CAD in patients with stable angina.

METHODS

NINETY SEVEN PATIENTS WHO UNDERWENT CORONARY ANGIOGRAPHY FOR STABLE ANGINA WERE ALLOCATED INTO TWO GROUPS: patients with mild or sever coronary artery involvement. Lipid profile (total cholesterol, LDL, HDL) and triglyceride (TG) and apolipoprotein A and B, were measured for all of the participants and a demographic data questionnaire was filled by the subjects. Participants underwent abdominal computed tomography (CT-Scan) for measurement of adipose tissues that was classified to visceral and superficial and deep subcutaneous fat tissue compartment.

RESULTS

Patients with severe coronary artery involvement had higher level of apo B (P=0.02). Significant correlation was seen between visceral fat index and TG (P=0.01), HDL-C (P<0.01) in patients with mild coronary involvement and with total cholesterol (P=0.02), LDL-C (P=0.01) and apoB (P<0.01) in patients with severe coronary involvement.No significant relationship was seen among deep cutaneous fat index and lipid profile in both groups.

CONCLUSION

Our findings showed that visceral adipose tissue is significantly associated with severe CAD and has a significant correlation with lipid profile as well as Apo B.

Arrhythmia Detection based on Morphological and Time-frequency Features of T-wave in Electrocardiogram

As the T-wave section in electrocardiogram (ECG) illustrates the repolarization phase of heart activity, the information which is accumulated in this section is so significant that it can explain the proper operation of electrical activities in heart. Long QT syndrome (LQT) and T-Wave Alternans (TWA) have imperceptible effects on time and amplitude of T-wave interval. Therefore, T-wave shapes of these diseases are similar to normal beats. Consequently, several T-wave features can be used to classify LQT and TWA diseases from normal ECGs. Totally, 22 features including 17 morphological and 5 wavelet features have been extracted from T-wave to show the ability of this section to recognize the normal and abnormal records. This recognition can be implemented by pre-processing, T-wave feature extraction and artificial neural network (ANN) classifier using Multi Layer Perceptron (MLP). The ECG signals obtained from 142 patients (40 normal, 47 LQT and 55 TWA) are processed and classified from MIT-BIH database. The specificity factor for normal, LQT, and TWA classifications are 99.89%, 99.90%, and 99.43%, respectively. T-wave features are one of the most important descriptors for LQT syndrome, Normal and TWA of ECG classification. The morphological features of T-wave have also more effect on the classification performance in LQT, TWA and normal samples compared with the wavelet features.

The effect of contrast dye injection and balloon inflation on QTC and QTC dispersion in 12 leads surface EKG during PTCA

BACKGROUND

Considering that determining the effect of both contrast dye injection and balloon inflation on electrophysiological parameters would help us to predict the ischemic event during PTCA, the aim of this study was to determine the effects of these factors on QTc and QTc dispersion during PTCA in Isfahan.

METHODS

In this cross-sectional study, consecutive patients undergoing elective PTCA in Chamran hospital in Isfahan enrolled. All patients were in sinus rhythm. A 12-lead electrocardiogram was continuously recorded before (baseline) and during PTCA after dye injection and balloon inflation. QTc and QT dispersion was calculated in all 12 leads of electrocardiogram during the mentioned times and compared with each other.

RESULTS

33 patients with mean age of 49.1±16.2 years were studied. Anatomic distribution of the coronary artery stenosis was as follows: left anterior descending artery (LAD) in 76.7% patients, left circumflex (Cx) in 16.6% and right coronary (RCA) in 6.66%. Mean of QTc at baseline, after contrast dye injection and after balloon inflation was 423.9±28.5, 437±29 and 437±22 msec, respectively (P<0.05). Mean of QTc dispersion at baseline, after contrast dye injection and after balloon inflation was 92.3±7.2, 95.4±8.3 and 93.75±7.5, respectively (P>0.05).

CONCLUSION

The findings of this research supports the fact that during PTCA a transient myocardial ischemia occurs but further studies is recommended to accurately determine the stages at which ischemia occurred and the extent of its effect of it on cardiac depolarization and repolarization periods.

Estimation of left ventricular end diastolic pressure (lvedp) in patients with ischemic heart disease by echocardiography and compare it with the results of cardiac catheterization

BACKGROUND

Doppler echocardiography has been proposed as an appropriate non-invasive assay to estimate left ventricular end diastolic pressure (LVEDP). The aim of present research was to estimate the LVEDP in patients with ischemic heart disease by echocardiography and compare it with the results of cardiac catheterisation and to determine the effect of different echocardiographic variables on its measurement.

METHODS

In this descriptive-analytic study, patients with diagnosed ischemic heart disease were selected by nonrandomized sampling method. Selected population underwent M-mode and pulse doppler echocardiographic evaluation and parameters such as Q-Mitral valve E (Q-MVE), Q-Aortic valve closure (Q-AVC), Aortic valve closure-E (AVC-E), Q-Mitral valve closure/Aortic valve closure-E (Q-MVC/AVC-E), left ventricle-deceleration time (LV-DT), peak velocity-deceleration time (PV-DT) and A/E velocity time integral (A/E VTI) were evaluated. Immediately after echocardiography all patients underwent left heart catheterization for LVEDP measurement. The relation between different echocardiographic measurements and LVEDP, obtained by cardiac catheterization, was evaluated.

RESULTS

In this study, 47 patients with ischemic heart disease with mean age (±SD) of 53±13 were studied. There was a significant correlation between LVDEP and A/E VTI (r=0.44, P=0.001, and also between LVEDP and PV-DT in patients with A/E VTI ≥1.1(r=-0.58, P=0.02). There was a significant correlation between LVEDP and Q-MVC/AVC-E in patients with LVEDP >18mmHg (r=0.76, P=0.03) and those with LVEDP ≤18 mmHg and A/E VTI <1.1 (r=0.37, P=0.03). The correlation between LVEDP and A/E VTI was more significant in men, in patients aged >50 years with EF >55%, without LVH, without MR and those with coronary artery disease (P<0.05).

CONCLUSION

Some echocardiographic indices such as A/E VTI, Q-MVC/AVC-E and PV-DT are able to measure LVEDP especially in male patients aged >50 years, without LVH, without MR and those with coronary artery disease but it is necessary to determine specific conditions and factors affecting these indices, by further studies.

Evaluation of leptin and adiponectin levels in patients with stable angina pectoris

BACKGROUND

Leptin and adiponectin are two adipose tissue hormones and their association with the incidence of cardiovascular diseases is under evaluation. The aim of this study was to determine the relationship of leptin and adiponectin with coronary artery diseases.

METHODS

One hundred and seventy patients with angina pectoris and indications of coronary angiography underwent angiography. Serum levels of blood lipids, leptin, and adiponectin were measured. The gathered data was evaluated using SPSS(15) software, by multivariate variance analysis.

RESULTS

Analysis of the data demonstrated that 45.1% of the patients had positive angiographic findings. The serum levels of leptin and adiponectin were significantly lower than the minimum levels specified by the kit. However, the two groups, i.e., patients with positive angiographic findings and those with negative findings were not significantly different according to the serum levels of the hormones. Moreover, no significant correlation between the serum levels of the hormones and serum lipids was observed.

CONCLUSION

Various studies have demonstrated that high serum level of leptin and the incidence of coronary artery diseases are correlated. On the other hand, they have reported that adiponectin has cardioprotective role. Confirmation of these findings requires more detailed studies.

Can timi risk score predict angiographic involvement in patients with st-elevation myocardial infarction?

BACKGROUND

In most studies, the agreeable risk scores for ST-elevation myocardial infarction (STEMI) consist of thrombolytic in myocardial infarction (TIMI) risk score and modified Gensini risk score. Researchers showed significant relations between TIMI with angiography scores in patients with UA/NSTEMI. We studied this relation in patients with STEMI.

METHODS

We studied CCU patients with STEMI hospitalized in several hospitals of Isfahan, Iran from September 2007 to June 2008. Sampling method of 240 patients was random and simple. Exclusion criteria were incomplete history, nonspecific electrocardiogram changes, left bundle branch block and not accomplished angiography or accomplished angiography after 2 months of STEMI. Questionnaire indices collected on the basis of TIMI (0-14 points). Echocardiography and angiography were done and then, we used Gensini (0-400 points) to review films of angiography. Spearman's rank test and Pearson correlation coefficient were used to study the relation between these scores.

RESULTS

One hundred and sixty one patients were male and their average age was 60.02 years. Averages of TIMI and Gensini scores were 6.30±2.5 and 120.77±50.4, respectively. Study showed significant relation between TIMI, age and LVEF (P<0.001, r=-0.46). Also, between Gensini and age, gender and LVEF significant relation was found (P<0.001). But, a meaningful correlation didn't exist between TIMI and the gender (P=0.08). Our study proved direct relation between TIMI risk scores and modified Gensini scores (P<0.001, r=0.55).

CONCLUSION

We may decide quickly and correctly in emergency room to distinguish which patients with STEMI could derive a benefit from invasive strategies using TIMI score. Also, TIMI risk score can be a good predictor to determine the extension of coronary artery disease in patients with STEMI. As a result, we suggest determination of TIMI score for any patient entered emergency room. Also, this score should be recorded at the time patient's discharge.

Increasing contaminant burdens in an arctic fish, Burbot ( Lota lota ), in a warming climate

The temporal patterns of mercury (Hg), polychlorinated biphenyls (PCBs), and other contaminants in Arctic aquatic biota are usually attributed to changing atmospheric sources. However, climate variability and change is another means of altering contaminant fate and bioavailability. We show here that the concentrations of Hg and PCBs in Mackenzie River burbot ( Lota lota ), a top predator fish and important staple food for northern Canadian communities, have increased significantly over the last 25 years despite falling or stable atmospheric concentrations, suggesting that environmental processes subsequent to atmospheric transport are responsible. Using a dated sediment core from a tributary lake near the Mackenzie River sampling site, we show that variations in Hg concentrations downcore are strongly associated with labile, algal-derived organic matter (OM). Strong temporal correlations between increasing primary productivity and biotic Hg and PCBs as reflected by burbot suggest that warming temperatures and reduced ice cover may lead to increased exposure to these contaminants in high trophic level Arctic freshwater biota.

Historical interrelated variations of mercury and aquatic organic matter in lake sediment cores from a subArctic lake in Yukon, Canada: further evidence toward the algal-mercury scavenging hypothesis

This study investigates the role of climate-driven aquatic productivity increases in conrolling the sedimentary accumulation of mercury (Hg) in Kusawa Lake, Yukon, Canada. Organic geochemistry data reveals a significant link between the increasing trends of Hg and of labile algal-derived organic matter (OM) over the centuries and in particular over recent decades. Sedimentary Hg accumulation rates continue to increase even though atmospheric concentrations of Hg have remained the same or even declined. Together, these findings indicate that the significant rise in Hg content recorded in the sediments since the early 1950s may not be representative of increasing atmospheric Hg levels but are strongly influenced by elevated concentrations of algal-derived OM in the water-column. These likely increase the scavenging rate of "available" Hg from the water column. Therefore, recent increases in algal productivity may result in overestimation of the historical rates of atmospheric Hg deposition recorded in the sediments. This study confirms earlier published findings from two High Arctic lakes, and shows that the Hg-OM scavenging hypothesis may also apply to sub-Arctic lakes.

Monitoring the distribution and deposition of trace elements associated with a zinc-lead smelter in the Trail area, British Columbia, Canada

The atmospheric deposition and regional dispersion pattern of the elements As, Cd, Cu, Hg, Pb and Zn, emitted from Pb-Zn smelters at Trail, British Columbia, Canada, were studied for a period of two years using the passive collection moss-monitoring method. Concentrations of these elements in moss bags, exposed to atmospheric deposition for three months, were first corrected for geogenic input and then site-specific local background level to produce common background elemental concentrations for all monitoring stations. The results of this study indicate that the deposition of these elements is greatest in proximity to the smelter and decreases with an increase in distance. The regional dispersion pattern generally varies seasonally, with the magnitude of variation being dependent on the element under study and the location of the monitoring station. Overall, the deposition of these elements (as registered by moss-monitoring stations) appears to be a complex phenomenon involving various factors such as meteorological conditions (prevailing wind direction and precipitation), physiography (topography, valley shape and orientation) and in-process activities at the smelters (production level, emission control efficiency and the geochemistry of feed). However, the results of this study indicate that, on an annual basis, in-process activities, particularly production levels of Pb and Zn and the quantity of emissions from the stack, are more directly related to the observed deposition of the elements than any of the other factors.

Historical variation of elements with respect to different geochemical fractions in recent sediments from Pigeon Lake, Alberta, Canada

Geochemical analysis of elements and organic matter were conducted on vertical profiles of the recent sediments from Pigeon Lake, Alberta, Canada, to determine historical variations in elemental content of the sediments as related to their geochemical fractions. The elements are grouped according to their affinity with different geochemical fractions, by using cluster analysis and sequential extraction experiments. As a result, four elemental fractions were identified: clastic mineral detritus; carbonate; organic; and elements that show less similarity to the previous groups perhaps due to anthropogenic input or the influence of other fractions, such as oxyhydroxides. Following the identification of geochemical fractions in the sediments, a three-step normalizing method was applied using parameters that represent each geochemical fraction. These normalizing techniques appear to be important in verifying whether the variation of elements is indeed the result of anthropogenic and/or natural activities. The normalized data are correlated with the recent history of human activity and natural events near Pigeon Lake. Given the age of the lake sediments, this correlation indicates that the depth profiles of elements after being normalized to the organic and carbonate fractions reflect the variation of detrital input into the lake. However, the former mainly corresponds to the coarse-grained clastic minerals originating from high-energy erosion as the result of natural events (e.g., flooding), whereas the latter corresponds to the low-energy erosion of the fine particles (enriched in lithophile elements) due to deforestation in the drainage basin. Normalizing to the clastic mineral detritus fraction results in the increase of heavy metals in the uppermost part of the sediment profiles, which coincides with industrial activities during the past two decades in central Alberta. However, the concentration of these elements is negligible, as compared to the quantities released by geogenic processes (erosion).