Educating correct ECG interpretation is a way to promote the satisfaction and competency the diagnostic service providers

Background

Given electrocardiogram (ECG) interpretation as one of the diagnostical challenges for medical students and health professionals, this research was carried out to present an experience of web-based teaching method and novel approaches used for training of ECG interpretation.

Methods

This online program was conducted in three days. The main content of the class was taught during one hour, and after that, the teacher spent enough time for responding the asked questions. The components of a normal ECG and different changes that can occur in these waves were taught through clinical case-based scenarios using the web platform and Adobe Connect software. The participants' satisfaction was assessed with a 12-item questionnaire, and the short-term retention of ECG interpretation skill was examined by comparing the posttest scores with pretest.

Results

A total of 224 individuals completed the course. Total satisfaction score was 53.05±6.98 (out of the maximum score of 60). Based on the results of the paired t test, the interpretation skill scores of the participants increased significantly from 2.5 ± 1.57 to 6.96 ± 1.89. (p<0.001, CI = -4.8 to- 4.11).

Conclusion

This web-based nationwide training program provided a supplementary resource for ECG learning among medical students and health-care providers.

Complications of Implantable Cardioverter Defibrillator and Their Potential Risk Factors in Patients with Hypertrophic Cardiomyopathy

Background

Hypertrophic cardiomyopathy (HCM) has different complications such as cardiac arrhythmia and sudden cardiac death (SCD). Insertion of an implantable cardioverter defibrillator (ICD) is recommended for HCM patients who are at high risk of SCD and malignant arrhythmias, despite having their own potential complications. Hypothesis. We aimed to investigate the prevalence of different complications of ICD insertion and the impact of the potential influential baseline characteristics in a one-year follow-up period.

Methods

This was a retrospective study with a total of 71 HCM patients with ICD insertion. We evaluated the prevalence of different complications of ICD implantation and the impact of baseline characteristics on the occurrence of ICD complications using multivariate regression analysis in three 4-month periods.

Results

In a one-year follow-up, 13 patients (18.3%) experienced at least one of the complications including pneumothorax, lead failure, ICD infection, inappropriate shocks, perforation, and upper limb deep vein thrombosis (DVT) with no mortality. Inappropriate shocks were reported as the most common (11.3%) complication during this period, with a gradual increase in the second (4.2%) and third (5.6%) follow-up sessions. Among all of the baseline characteristics that were investigated in this study, a positive history of hypertension was the only risk factor with significant impact on the occurrence of complications (P = 0.01).

Conclusion

We demonstrated the occurrence of complications during a one-year follow-up as 18.3% in HCM patients with ICD insertion. A positive history of hypertension was the only baseline characteristic affecting the occurrence of complications, and inappropriate shocks were the most common complication.

Impact of Negative Fluid Balance on Mortality and Outcome of Patients with Confirmed COVID-19

Purpose

Maintaining the proper fluid balance is a fundamental step in the management of hospitalized patients. The current study evaluated the impact of negative fluid balance on outcomes of patients with confirmed COVID-19.

Methods

We considered the negative fluid balance as a higher output fluid compared to the input fluid. The fluid balance was categorized into four groups (group 4: -850 to -500 ml/day; group 3: -499 to -200 ml/day, group 2: -199 to 0 ml/day, and group 1 : 1 to 1000 ml/day) and included ordinally in the model. The outcomes were all-cause mortality, length of hospitalization, and improvement in oxygen saturation.

Results

The fluid balance differed significantly among nonsurvivors and survivors (MD: -317.93, 95% CI: -410.21, -225.69, and p < 0.001). After adjusting for potential confounders, there was a significantly lower frequency of mortality in patients with negative fluid balance compared to the controls (aRR: 0.69, 95% CI: 0.57, 0.84, and p < 0.001). Similarly, the length of hospitalization was significantly shorter in the negative fluid balance group in comparison to the control group (aMD: -1.01, 95% CI: -1.74, -0.28, and p=0.006).

Conclusion

We determined that the negative fluid balance was associated with favorable outcomes in COVID-19 patients. The negative fluid balance was associated with the reduced mortality rate and length of hospitalization as well as improvement in oxygen saturation. Moreover, the NT-proBNP >781 pg/mL and fluid balance >-430 mL might be the predictors for positive fluid balance and mortality, respectively.

Clinical outcomes of subcutaneous implantable cardiac defibrillator implantation - Iran SICD registry

BACKGROUND

The subcutaneous implantable-defibrillator (S-ICD) is a relatively new alternative to the transvenous ICD system to minimize intravascular lead-related complications. This paper presents outcome of SICD implantation in patients enrolled in Iran S-ICD registry.

METHODS

Between October 2015 and June 2022, this prospective multicenter national registry included 223 patients with a standard indication for an ICD, who neither required bradycardia pacing nor needed cardiac resynchronization to evaluate the early post-implant complications and long-term follow-up results of the S-ICD system.

RESULTS

The mean age of the patients was 45 ± 17 years. The majority (79.4%) were male. Ischemic cardiomyopathy (39.5%) was the most common underlying disorder among patients selected for S-ICD implant. Most study patients (68.6%) had ICD for primary prevention of sudden cardiac death. Seven patients (3.1%) were found to have suboptimal lead positions. Six patients (2.7%) developed a pocket hematoma; all were managed medically. During a mean follow-up of 2 years, the appropriate therapy was recorded in 13% of the patients and inappropriate ICD intervention mainly due to supraventricular tachycardia in 8.9%. Pocket infection was observed in four patients (1.8%) and five patients (2.2%) died mainly due to heart failure.

CONCLUSION

S-ICDs were effective at detecting and treating both induced and spontaneous ventricular arrhythmias. Major clinical complications were rare.

A Multiple-Center, Retrospective Study of Characteristics and Outcomes of Hospitalized COVID-19 Patients with Cardiovascular Disease in North Iran

Background

In this retrospective study, we investigated the outcomes and demographic characteristics of COVID-19 patients with and without a history of CVD.

Methods

This large retrospective, multicenter study was performed on inpatients with suspected COVID-19 pneumonia who were admitted across four hospitals in Babol, Northern Iran.Demographic data, clinical data, and cycle threshold value (Ct) results of Real Time PCR were obtained. Then, participants were divided into two groups: (1) cases with CVDs, (2) cases without CVDs.

Results

A total of 11097 suspected COVID-19 cases with a mean ± SD age of 53 ±25.3 (range: 0 to 99) years were involved in the present study. Out of whom 4599 (41.4%) had a positive RT-PCR result. Of those, 1558 (33.9%) had underlying CVD. Patients with CVD had significantly more co-morbidities such as hypertension, kidney disease, and diabetes. Moreover, 187 (12%) and 281 (9.2%) of patients with and without CVD died, respectively. Also, mortality rate was significantly high among the three groups of Ct value in patients with CVD, with the highest mortality in those with Ct between 10 and 20 (Group A = 19.9%).

Conclusions

In summary, our results highlight that CVD is a major risk factor for hospitalization and the severe consequences of COVID-19. Death in CVD group is significantly higher compared to non-CVD. In addition, the results show that age-related diseases can be a serious risk factor for the severe consequences of COVID-19.

Highly sensitive C-reactive protein, pentraxin-3 and mannose-binding lectin in patients with hemodialysis and their association with cardiovascular complications and mortality

Introduction: Cardiovascular disorder(CVD) is one of the most important comorbidities in patients with hemodialysis(HD). Several markers for kidney disease and kidney transplantation have been investigated. Objectives: This study aimed to evaluate the association between three inflammatory biomarkers including C-reactive protein (CRP), pentraxin 3 (PTX-3) and mannose-binding lectin (MBL) with CVD events and mortality in HD patients. Patients and Methods: This study was carried on patients with immunosuppressive therapy aged between 18-80 years with chronic renal failure undergoing HD. Patients were visited at baseline and every six month for 12 months. The levels of biomarkers and complications were recorded before, one week later and 2 months after transplantation. Echocardiography and calculation of ejection fraction(EF) were performed to determine the occurrence of CVD events. Results: Ninety patients with the mean age of 54.0±3.24 years were included. All biomarkers had significant area under the curve for accurate diagnosis between the patients with low EF (with a decreasing measure) and normal EF patients (p<0.05); however, none of them had a significant accurate diagnosis between patients with low EF (with a constant measure) and normal EF patients (P>0.05). PTX-3 and MBL showed a significant correlation to detect CVD events (r=0.987; p<0.0001). Also, PTX-3 and MBL had significant correlations with hs-CRP (P<0.05). None of these markers had significant accuracy for prediction of mortality. Conclusion: Serum level of PTX-3 and MBL not only increase reactive protein, but also may be considered as diagnostic biomarkers for early detection of CVD events in patients with end stage renal disorders.

Characteristics and outcomes of hospitalized patients with cardiovascular complications of covid-19

Funding Acknowledgements

Type of funding sources: None.

Introduction

Recent reports have indicated that a considerable portion of patients experiences a cardiac injury, ranging from 7.2% to 22.2%, which is linked to higher mortality. Nevertheless, previous studies have exclusively focused on the cardiac injury defined as a raised cardiac marker without a definitive diagnosis. To our knowledge, the present retrospective cohort study is the first study to comprehensively address cardiovascular (CV) complications and related outcomes in COVID-19 patients.

Purpose

To address CV complications and their relationship to clinical outcomes in hospitalized patients with COVID-19.

Methods

A total of 196 adult hospitalized patients admitted to our hospital with a confirmed diagnosis of COVID-19 and a consultation requested from the cardiology department were enrolled in this retrospective single-center cohort study from September 10, 2020, to December 10, 2020, with a median age of 65 years (IQR, 52-77). Cardiac examinations included cardiac biomarkers, electrocardiography, and echocardiography. Data regarding complications during hospitalization were extracted, and patients were categorized into two groups concerning the presence or absence of CV complications. All transthoracic echocardiographic (TTE) assessments were performed by a single cardiologist, who was provided with personal protective gear according to national guidelines. Follow-up continued for 3 months after hospital discharge.

Results

CV complication was observed in 54 (27.6%) patients, with arrhythmia being the most prevalent (14.8%) followed by myocarditis, acute coronary syndromes, ST-elevation myocardial infarction, cerebrovascular accident, and deep vein thrombosis in 15 (7.7%), 12 (6.1%), 10 (5.1%), 8 (4.1%), and 4 (2%) patients, respectively. The proportion of patients with elevated hs-TpI, NT-proBPN, left ventricular diastolic dysfunction, and heart failure with preserved ejection fraction was greater in the CV complication group. Severe forms of COVID-19 comprised nearly two-thirds (64.3%) of our study population and constituted a significantly higher share of the CV complication group members (75.9% vs 59.9%; P = 0.036). Intensive care unit admission (64.8% vs 44.4%; P = 0.011) and stay (5.5 days vs 0 day; P = 0.032) were notably higher in patients with CV complications. Among 196 patients, 50 died during hospitalization and 10 died after discharge, yielding all-cause mortality of 30.8%. However, there were no between-group differences concerning mortality. Heart failure, cancer/autoimmune disease, severity, interferon beta-1a, and arrhythmia were the independent predictors of all-cause mortality during and after hospitalization.

Conclusion

CV complications occurred widely among COVID-19 patients. Moreover, arrhythmia, as the most common complication, was associated with increased mortality. Abstract Figure.

Characteristics and outcomes of hospitalized patients with cardiovascular complications of COVID-19

Introduction: To address cardiovascular (CV) complications and their relationship to clinical outcomes in hospitalized patients with COVID-19.

Methods: A total of 196 hospitalized patients with COVID-19 were enrolled in this retrospective single-center cohort study from September 10, 2020, to December 10, 2020, with a median age of 65 years (IQR, 52-77). Follow-up continued for 3 months after hospital discharge.

Results: CV complication was observed in 54 (27.6%) patients, with arrhythmia being the most prevalent (14.8%) followed by myocarditis, acute coronary syndromes, ST-elevation myocardial infarction, cerebrovascular accident, and deep vein thrombosis in 15 (7.7%), 12 (6.1%), 10(5.1%), 8 (4.1%), and 4 (2%) patients, respectively. The proportion of patients with elevated high-sensitivity troponin I, N-terminal pro-B-type natriuretic peptide, left ventricular diastolic dysfunction, and heart failure with preserved ejection fraction was greater in the CV complication group. Severe forms of COVID-19 comprised nearly two-thirds (64.3%) of our study population and constituted a significantly higher share of the CV complication group members (75.9%vs 59.9%; P =0.036). Intensive care unit admission (64.8% vs 44.4%; P =0.011) and stay (5.5days vs 0 day; P =0.032) were notably higher in patients with CV complications. Among 196patients, 50 died during hospitalization and 10 died after discharge, yielding all-cause mortality of 30.8%. However, there were no between-group differences concerning mortality. Age, heart failure, cancer/autoimmune disease, disease severity, interferon beta-1a, and arrhythmia were the independent predictors of all-cause mortality during and after hospitalization.

Conclusion: CV complications occurred widely among COVID-19 patients. Moreover,arrhythmia, as the most common complication, was associated with increased mortality.

Effect of COVID-19 medications on corrected QT interval and induction of torsade de pointes: Results of a multicenter national survey

BACKGROUND

There are some data showing that repurposed drugs used for the Coronavirus disease-19 (COVID-19) have potential to increase the risk of QTc prolongation and torsade de pointes (TdP), and these arrhythmic side effects have not been adequately addressed in COVID-19 patients treated with these repurposed medications.

METHODS

This is the prospective study of 2403 patients hospitalised at 13 hospitals within the COVID-19 epicentres of the Iran. These patients were treated with chloroquine, hydroxychloroquine, lopinavir/ritonavir, atazanavir/ritonavir, oseltamivir, favipiravir and remdesivir alone or in combination with azithromycin. The primary outcome of the study was incidence of critical QTc prolongation, and secondary outcomes were incidences of TdP and death.

RESULTS

Of the 2403 patients, 2365 met inclusion criteria. The primary outcome of QTc ≥ 500 ms and ∆QTc ≥ 60 ms was observed in 11.2% and 17.6% of the patients, respectively. The secondary outcomes of TdP and death were reported in 0.38% and 9.8% of the patients, respectively. The risk of critical QT prolongation increased in the presence of female gender, history of heart failure, treatment with hydroxychloroquine, azithromycin combination therapy, simultaneous furosemide or beta-blocker therapy and acute renal or hepatic dysfunction. However, the risk of TdP was predicted by treatment with lopinavir-ritonavir, simultaneous amiodarone or furosemide administration and hypokalaemia during treatment.

CONCLUSION

This cohort showed significant QTc prolongation with all COVID-19 medications studied, however, life-threatening arrhythmia of TdP occurred rarely. Among the repurposed drugs studied, hydroxychloroquine or lopinavir-ritonavir alone or in combination with azithromycin clearly demonstrated to increase the risk of critical QT prolongation and/or TdP.

Novel SCN5A variants identified in a group of Iranian Brugada syndrome patients

Brugada syndrome (BrS) is a rare hereditary arrhythmia syndrome that increases an individual's risk for sudden cardiac death (SCD) due to ventricular fibrillation. This disorder is regarded as a notable cause of death in individuals aged less than 40 years, responsible for up to 40% of sudden deaths in cases without structural heart disease, and is reported to be an endemic in Asian countries. Mutations in SCN5A are found in approximately 30% of patients with Brugada syndrome. This study aimed to investigate mutations in the SCN5A gene in a group of Iranian Brugada syndrome patients. Nine probands (n = 9, male, mean age = 39) diagnosed with Brugada syndrome were enrolled in this study. Exon 2 to 29 were amplified by PCR and subjected to direct sequencing. Eight in silico prediction tools were used to anticipate the effects of non-synonymous variants. Seven known polymorphisms and 2 previously reported disease-causing mutations, including H558R and G1406R, were found in the studied cases. Twenty novel variants were identified: 15 missense, 2 frameshift, 2 synonymous, and one nonsense variants. In silico tools predicted 11 non-synonymous variants to have damaging effects, whereas frameshift and nonsense variants were considered inherently pathogenic. The novel variants identified in this study, alongside previously reported mutations, are highly likely to be the cause of the Brugada syndrome phenotype observed in the patient group. Further analysis is required to understand the physiological effects caused by these variants.

Interleukin 10, lipid profile, vitamin D, selenium, metabolic syndrome, and serum antioxidant capacity in elderly people with and without cardiovascular disease: Amirkola health and ageing project cohort-based study

BACKGROUND

The age-related autoinflammation-mediated atherosclerosis is associated with some immunological, nutritional, and metabolic parameters and redox status. Here, we evaluated the association of circulatory interleukin 10 (IL-10) levels with lipid profile, some nutrients, and total anti-oxidant capacity in elderly people who presented cardiovascular disease (CVD) with or without metabolic syndrome (MetS) and in healthy subjects.

METHODS

In this cross-sectional case-control study, 258 sera prepared from elderly people (144 healthy and 114 patient subjects) who participated in a community-based study, the Amirkola Health and Ageing Project (AHAP), were analyzed for IL-10, lipid profile, vitamin D, selenium (Se), antioxidant capacity, and MetS.

RESULTS

Compared to patients, the healthy subjects exhibited higher levels of circulatory IL-10 among individuals with detectable serum IL-10 (P = 0.036). However, this difference was not observed when total subjects from both groups were compared, since more than 90% of those people were IL-10-negative. Se, vitamin D, and antioxidant levels were similar in both groups. There was a negative association between IL-10 and body mass index (BMI) (P < 0.050) and an equivocal association with vitamin D levels, whereas the association between IL-10 and other indicated variables was not significant. Significant association was observed between MetS and CVD prevalence (P < 0.001). There was a positive correlation between Se and total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and triglyceride (TG) (P < 0.010) in healthy subjects and with TC in patients (P < 0.050).

CONCLUSION

A major proportion of elderly people were serum IL-10-negative, whereas independently to IL-10, MetS was most common in patients with CVD. Weight loss may have the potential to increase IL-10 levels in the elderly.

Association of vitamin D deficiency and premature coronary artery disease

Background:

Evidence suggests hypovitaminosis D is associated with increased risk of coronary artery disease (CAD) and its extent and related risk factors. However, some investigations have produced contrary results. Therefore, we aimed to evaluate the association between serum vitamin D levels and the severity of premature coronary artery involvement.

Methods:

This randomized prospective, case-control study was conducted in Babol from April 2013 to June 2017. We collected the demographic data and measured serum 25-OH-D levels of 294 patients (age≤50 years) diagnosed with CAD with coronary angiography as case group as well as 438 age and sex-matched controls. CAD severity was assessed using the Gensini score. Statistical analyses were used to assess the associations and p<0.05 was considered as significant.

Results:

The mean serum level of 25-OH-D was 13.12±11.13 and 18.28±8.34 in case and control groups, respectively (P=0.036). In the case group, mean serum vitamin D levels were significantly lower among hypertensives (P=0.018), those with a family history of CVD (P=0.016) and those who used aspirin (P=0.036). The mean Gensini score of patients in the case group was 45.02±23.62 and was higher among men (P=0.022). There was a weak significant correlation between the serum vitamin D levels and the Gensini score (P=0.001 & R=-0.543). The mean Gensini score was not significantly different between patients with deficient (47.02±22.78), insufficient (26.0±21.72) and sufficient (39.0±43.84) vitamin D levels (P>0.05).

Conclusion:

The results showed that the lower levels of vitamin D is associated with increased risk and extent of coronary artery involvement as well as some of the risk factors of CAD, including male gender, hypertension and positive family history for CVD.

Pericardial Graft vs. Host Disease in a Patient with β-Thalassemia Major

Bone marrow transplantation (BMT) in young children improves results in β-thalassemia major. Graft versus host disease (GVHD) is an important complication of peripheral blood stem cell transplantation. GVHD affects heart with a behavior resembling an autoimmune disease, including pericardial effusion. We describe a 22-year-old β-thalassemia major patient who underwent bone marrow transplantation with an HLA-identical sibling donor. The patient didn't have any serious problem until 15 months after transplantation. He presented with chest discomfort and progressive dyspnea. Early echocardiogram showed mild pericardial effusion. Four days later, the effusion had increased, impending to cardiac temponade requiring pericardectomy. Immunospressive drugs and pericardectomy resulted in significant improvement in ventricular filling.  Cardiac cGVHD, an un-common complication of HSCT may be presented as pericardial effusion. Although early initiation of steroids is very important, heart monitoring is necessary to diagnose cardiac temponade.

Implantable cardioverter-defibrillator in a patient with dextrocardia situs inversus

BACKGROUND

Dextrocardia is a congenital anomaly, which may have coexistent coronary artery disease (CAD), arrhythmias and conventional indications for device therapy. However, the implantation of transvenous leads can be technically challenging and the approach needs to be tailored to the patient's individual anatomy.

CASE PRESENTATION

A 54-year-old male with dextrocardia situs inversus and ischemic left ventricular dysfunction developed ventricular tachycardia and fibrillation. Therefore, left- sided approach, dual chamber implantable cardioverter-defibrillator (ICD) was applied using a conventional method and standard equipment after complete evaluation of cardiac anatomy and vascular assessment.

CONCLUSION

Electrical device implantation in patients with dextrocardia is possible after obtaining complete information about anatomy and/or coexisting congenital abnormalities, which helps in obtaining appropriate implantation approach.

Etiology of syncope in hospitalized patients

BACKGROUND

Syncope is a common clinical problem which can be remarkably debilitating and associated with high health care costs. Syncope is a clinical syndrome with many potential causes. The aim of the study was to determine the etiologies of patients with syncope in the emergency department (ED) of a referral and general university hospital.

METHODS

One hundred sixty-five consecutive patients aged more than 18 years old with syncope were admitted to the emergency department of Ayatollah Rouhani Hospital. Initially organized, systematic approach included detailed medical history and structured questionnaires for history taking, physical examination, ECG and cardiac monitoring, cardiology and neurology were done. Advanced diagnostic tests were carried out if the etiology of syncope remained unexplained.

RESULTS

Out of the 165 patients who presented to the ED between February 2012 and February 2013, 124 had definition of syncope. The mean age of male patients was 59.5±19.8, 58. The etiology of syncope was diagnosed in 104 (83%) patients. Neurocardiogenic syncope was found in 36 (29.03%) patients, cardiac arrhythmias in 40 (32.25%) patients, and acute coronary syndrome in 8 (6.45%) patients. There are some infrequent etiologies like intracranial hemorrhage in 5 patients, aortic stenosis in 4 patients, hypertrophic cardiomyopathy and aortic dissection in 3 patients, Brugada and pulmonary embolism in 2 patients and carotid hypersensitivity in one patient.

CONCLUSION

We found that cardiac arrhythmias and neurocardiogenic type are the frequent causes of syncope. In about one-sixth of the patients, no etiology was found. Approximately one-third of patients had traumatic syncope.

Aortic dissection and postpartum cardiomyopathy in a postpartum young woman: a case report study

Introduction:

Aortic dissection is a rare condition in young women and usually related with congenital anomalies of aorta and connective tissue disorders. We reported a 34-year-old postpartum woman with aortic dissection.

Case Presentation:

The patient complained of respiratory distress and weakness with no abdominal pain or chest pain 20 days after delivery and had no history of hypertension during pregnancy and perinatal or prior heart disease. Postpartum cardiomyopathy and left ventricular dysfunction were diagnosed by imaging study and cardiac enzyme level. Finally, CT-scan was performed and showed aortic dissection. The patient underwent surgery and after surgery, she was alive without any problem.

Conclusions:

Patients with peripartum cardiomyopathy and aortic dissection could be cured with good medical care.

Evaluation of tissue doppler echocardiography and T2* magnetic resonance imaging in iron load of patients with thalassemia major

BACKGROUND

Iron-mediated cardiomyopathy is the main complication of thalassemia major (TM) patients. Therefore, there is an important clinical need in the early diagnosis and risk stratification of patients. The aim of this study was to evaluate the efficacy of tissue doppler imaging (TDI) to study cardiac iron overload in patients with TM using T2* magnetic resonance (MR) as the gold-standard non-invasive diagnostic test.

METHODS

A total of 100 TM patients with the mean age of 19±7 years and 100 healthy controls 18.8±7 years were evaluated. Conventional echocardiography, TDI, and cardiac MRI T2* were performed in all subjects. TDI measures included myocardial systolic (Sm), early (Em) and late (Am) diastolic velocities at basal and middle segments of septal and lateral LV wall. The TM patients were also subgrouped according to those with iron load (T2* ≤ 20 ms) and those without (T2* > 20 ms), and also severe (T2* ≤ 10 ms) versus the non-severe (T2* ≤ 10 ms).

RESULTS

Using T2* cardiovascular MR, abnormal myocardial iron load (T2* ≤ 20 ms) was detected in 84% of the patients and among these, 50% (42/84) had severe (T2* ≤ 10 ms) iron load. The mean T2* was 11.6±8.6 ms (5-36.7). A negative linear correlation existed between transfusion period of patients and T2* levels (r = -0.53, p=0.02). The following TDI measures were lower in patients than in controls: basal septal Am (p<0.05), mid-septal Em and Am (p<0.05), basal lateral Am (p<0.05), mid-lateral LV wall Sm (p<0.05) and Am (p<0.05).

CONCLUSION

Tissue doppler imaging is helpful in predicting the presence of myocardial iron load in Thalassemia patients. Therefore, it can be used for screening of thalassemia major patients.

Changes in QT interval before and after hemodialysis

Background : Cardiovascular mortality and morbidity are high in chronic renal failure (CRF) patients. Increased dispersion of QT intervals is known to predispose to ventricular arrhythmias and sudden cardiac death. This study was conducted to assess the effect of hemodialysis (HD) on corrected QT (QTc) intervals and their dispersions (QTd) in chronic hemodialyzed patients.

METHODS

Fifty-eight patients ( mean age 54.2±15.8 years) with chronic renal disease on chronic hemodialysis (HD) were assessed by standard examination including blood pressure, body weight, heart rate, 12-lead electrocardiography and laboratory tests like electrolytes (Na (+), K (+), Ca (++), phosphate), urea, and creatinine 30 minutes before and after HD. The QT intervals and QTc QTc= QT √R-R/ (in milli seconds [ms]) for each lead were measured manually by one observer using calipers. The difference between the maximum and the minimum of QT interval was noted as QT dispersion (QT d).

RESULTS

The mean of pre and post dialysis R-R intervals was 859.22±96.85 ms and 870.43±91.45 ms, respectively (p>0.05). The mean of corrected QT cmax intervals increased significantly from 423.45±24.10 to 454.41±30.25 ms (p<0.05). The mean of QT dispersions and the corrected QT interval dispersions changed from 51.56±12.45 to 63.21±14.43 ms (p<0.05) from 59.40±13.58 to 68.33±14.55 ms (p<0.05), respectively. The changes in serum potassium and calcium levels were related with QT interval prolongation.

CONCLUSION

QT and QTc interval and dispersion increase in HD patients. Prolonged QT interval indices had relation with K(+) and Ca(++) ions before but not after HD.

HLA-DRBeta1, circulating Th1/Th2 cytokines and immunological homunculus in coronary atherosclerosis

Coronary atherosclerotic disease is one of the most endangering health disorder worldwide. This study was designed to investigate the correlation between HLA-DR1 alleles and circulating Th1/Th2 type cytokines in coronary atherosclerosis. By Elisa, Th1/Th2 type cytokines were determined in serum samples of 31 subjects with unstable angina, 27 subjects with chronic stable angina and 24 individuals as normal control. By SSP-PCR, more than 100 alleles of HLA-DRBeta1 were typed in 24 subjects who had skewed serum levels of Th1/Th2 type cytokines. Lipid profiles were determined by the routine methods of clinical laboratory in all subjects. The mean serum concentration of IL-10 in normal control subjects was higher in comparison to the patient groups.0.33±0.59 pg/ml versus 0.064±0.3 pg/ml in unstable angina pectoris group (p<0.028) and 0.22±0.6 pg/ml in chronic stable subjects. There was no statistically significant difference among the groups in serum levels of other desired cytokines (IFN-Gamma, IL-4). 33.33% of normal control subjects were HLA-DR16 positive whereas none of the subjects with chronic stable angina or individuals with unstable angina pectoris was positive for this antigen. The mean concentration of serum LDL-cholesterol in normal control group was high 142.046±35.40 (pg/ml).This preliminary study shows that the atherogenic effect of the LDL- cholesterol may be dampened by HDL-cholesterol through anti inflammatory cytokine IL-10 and HLA-DR16, a phenomenon interpretable via immunological homunculus theory.

Free floating right atrial thrombus in two asymptomatic patients after electrophysiological study: role of routine echocardiography after ablation

This report presents two patients with free floating right atrial and atrioventricular thrombi after electrophysiology study which were treated with thrombolysis in the first patient and surgical operation in the second patient without any complication.

Investigation of the effect of ginger on the lipid levels. A double blind controlled clinical trial

OBJECTIVE

To study the effect of fine powder of ginger on lipid level in volunteer patients.

METHODS

This is a double blind controlled clinical trial study in 2 cardiac clinics Cardiac Disease Clinic, Babol, north of Iran, between April to May 2004. We randomly divided the patients with hyperlipidemia into 2 groups, treatment group (receiving ginger capsules 3 g/day in 3 divided doses) and placebo group (lactose capsule 3 g/day in 3 divided doses) for 45 days. All subjects with diabetes mellitus, hypothyroidism, nephrotic syndrome, and alcohol drinking, pregnancy and peptic ulcer were excluded. Lipid concentrations profile before and after treatment was measured by enzymatic assay.

RESULTS

Forty-five patients in the treatment group and 40 patients in placebo group participated in this study. There was a significant reduce in triglyceride, cholesterol, low density lipoprotein (LDL), very low density lipoprotein (VLDL), levels of before and after study separately in each group (p<0.05). Mean changes in triglyceride and cholesterol levels of ginger group were significantly higher than placebo group (p<0.05). Mean reduction in LDL level and increase in high density lipoprotein level of ginger group were higher than the placebo group, but in VLDL level of placebo was higher than ginger (p>0.05).

CONCLUSION

The results show that ginger has a significant lipid lowering effect compared to placebo.

Optimal β-blocker for prevention of atrial fibrillation after on-pump coronary artery bypass graft surgery: Carvedilol versus metoprolol

BACKGROUND

Atrial fibrillation (AF) is the most common arrhythmia after coronary artery bypass graft (CABG) surgery. It has been shown that prophylactic oral beta-blocker administration reduces the incidence of post-CABG AF. However, the optimal beta-blocker has not been identified.

OBJECTIVE

This study sought to determine whether oral carvedilol (with its unique anti-inflammatory and antioxidant properties) is more effective than oral metoprolol for prevention of AF after CABG surgery.

METHODS

Between April 2006 and December 2006, 120 patients (63 men, mean age 61 +/- 9.4 years) who were scheduled to undergo their first on-pump CABG were enrolled in this study. The patients were randomized in a prospective 1:1 manner to receive either oral carvedilol (n = 60) or oral metoprolol (n = 60). The end point of the study was the occurrence of the new-onset AF during the first 5 days after CABG.

RESULTS

AF occurred in 29 of 120 patients (24.0%). The incidence of postoperative AF was 15.0% (9 of 60) in the carvedilol group and 33% (20 of 60) in the metoprolol group (P = .022). The carvedilol group was treated with mean daily dose of 46 +/- 9 mg and metoprolol group with mean daily dose of 93 +/- 11 mg. There were no differences between the study groups regarding any known preoperative, perioperative, or postoperative characteristics (all values were P >.05). No significant adverse effect was observed in either group.

CONCLUSION

This prospective study suggested that oral carvedilol is more effective than oral metoprolol in the prevention of AF after on-pump CABG. It is well tolerated when started before and continued after the surgery. However, further prospective studies are needed to clarify this issue.

ESR/Alanine gamma-dosimetry in the 10-30 Gy range

We report Alanine Dosimeter preparation, procedures for using the ESR/Dosimetry method, and the resulting calibration curve for gamma-irradiation in the range from 10-30 Gy. We use calibration curve to measure the irradiation dose in gamma-irradiation of human blood, as required in Blood Transfusion Therapy. The ESR/Alanine results are compared against those obtained using the thermoluminescent dosimetry (TLD) method.