Response: Impact of implantable cardioverter defibrillator on survival in patients with nonischemic dilated cardiomyopathy

Our previous study aimed to investigate overall survival (OS) and sudden cardiac death (SCD) variables in nonischemic dilated cardiomyopathy (DCM) patients treated only with standard medical treatments versus those who received implantable cardioverter defibrillator (ICD) in addition to routine medical treatments. Our findings revealed no significant difference in OS between the two groups (p = .25), but a significant decrease in SCD rate due to ICD insertion (p = .02). Furthermore, we found no significant difference between the two groups concerning baseline characteristics and type of medical treatments received. We attempted to answer and clarify the concerning points regarding the survival benefits of ICD insertion in nonischemic DCM patients that were mentioned.

The impact of implantable cardioverter defibrillator on the prognosis of nonischemic dilated cardiomyopathy patients compared with standard medical treatments

BACKGROUND

Patients with nonischemic dilated cardiomyopathy (DCM) are susceptible to arrhythmias and implantable cardioverter defibrillator (ICD) in addition to medical treatments may help prevent sudden cardiac death (SCD) and improve survival in this population.

HYPOTHESIS

We aim to investigate the impact of ICD insertion on survival and prognosis of patients with nonischemic DCM.

METHODS

We retrospectively analyzed data from patients with nonischemic DCM treated with medical therapy with or without ICD who referred to our hospital from January 2020 to November 2021. Patients were divided based on the treatment that they had received into two equal groups. Different variables including demographic features, comorbidities, medical treatments, hospitalization rate, function class, and left ventricular ejection fraction before and after treatments were investigated in this study. In addition, variables in survival including overall survival (OS) and SCD were compared between the two groups.

RESULTS

A total of 120 patients were investigated in this study. Mean ± SD of age and follow-up time of patients were 64.0 ± 12.7 years old and 59.5 ± 14.8 months, respectively. Ten (16.7%) patients with medical therapy, and seven (11.7%) patients with ICD and medical therapy died during the follow-up period (p = 0.25). However, the two groups had a significant difference regarding SCD (11.7% vs. 1.7%, p = 0.02).

CONCLUSION

In patients with nonischemic DCM who had undergone ICD insertion in addition to standard medical treatments, SCD was significantly reduced compared with patients receiving just medical treatments. OS had no significant difference between our two studied groups.

Anti-coagulation therapy following coronary endarterectomy in patient with coronary artery bypass graft

Background

Since there is a lack of research on postoperative anticoagulation protocol in patients undergoing coronary artery bypass graft (CABG) / coronary endarterectomy (CE), we recommend a new protocol for anticoagulation in these patients.

Methods

In this double-blind randomized clinical trial study, 52 patients undergoing CABG / CE entered the study and were divided into two groups. In group 1, the patients were given warfarin(international normalized ratio (INR) between 2-3) together with 80 mg aspirin daily for 3 months. In group 2, the patients were given 75 mg plavix daily together with 80 mg aspirin daily for 3 months. We evaluated patients with electrocardiography, echocardiography and checking ceratin phosphokinase MB and troponin I in the several stages. The data were analysed SPSS Version18 software.

Results

There was no significant difference between pre and post-operative Ejection fraction in patients with plavix (P=0.21) and warfarin (P=0.316) regimen. However, wall mrotion score was significantly better in clopidogrel - aspirin patients in late (3 months) post operation (p<0.001).

Conclusions

Since warfarin has serious hemorrhagic complications and requires closed monitoring of serum drug activity by serial INR checking, it is recommended that clopidogrel - aspirin can be the preferred alternative anticoagulation therapy in CABG / CE patients.

Noninvasive localization of accessory pathways in patients with wolff-Parkinson-white syndrome: a strain imaging study

BACKGROUND

Noninvasive techniques for the localization of the accessory pathways (APs) might help guide mapping procedures and ablation techniques. We sought to examine the diagnostic accuracy of strain imaging for the localization of the APs in Wolff-Parkinson-White syndrome.

METHODS

We prospectively studied 25 patients (mean age = 32 ± 17 years, 58.3% men) with evidence of pre-excitation on electrocardiography (ECG). Electromechanical interval was defined as the time difference between the onset of delta wave and the onset of regional myocardial contraction. Time differences between the onset of delta wave (δ) and the onset of regional myocardial contraction (δ-So), peak systolic motion (δ-Sm), regional strain (δ-ε), peak strain (δ-εp), and peak strain rate (δ-SRp) were measured.

RESULTS

There was a significant difference between time to onset of delta wave to onset of peak systolic motion (mean ± SD) in the AP location (A) and normal segments (B) versus that in the normal volunteers (C) [A: (57.08 ± 23.88 msec) vs. B: (75.20 ± 14.75) vs. C: (72.9 0 ± 11.16); p value (A vs. B) = 0.004 and p value (A vs. C) = 0.18] and [A: (49.17 ± 35.79) vs. B: (67.60 ± 14.51) vs. C: (67.40 ± 6.06 msec); p value (A vs. B) < 0.001 and p value (A vs. C) = 0.12, respectively].

CONCLUSION

Our study showed that strain imaging parameters [(δ-So) and (δ-Strain)] are superior to the ECG in the localization of the APs (84% vs. 76%).

Evaluation of the role of opium addiction in acute myocardial infarction as a risk factor

Background : More than half of myocardial infracted (MI) patients have no conventional risk factors. Regarding the belief that opium addiction has a protective effect on heart diseases, addiction prevalence has unfortunately increased in recent years. This study was conducted to investigate the effect of opium addiction on patients with acute myocardial infarction.

METHODS

This case-control study was performed on 118 patients with acute myocardial infarction admitted to CCU ward (case group), and 118 patients with no history of MI to other wards (control group) of Shahid Beheshti Hospital in Babol, Iran. Opium addiction conventional risk factors were evaluated for both groups, and the data were analyzed using chi-square test and logistic regression model was used to adjust the conventional risk factor effects. Moreover, demographic variables as well as the extent of MI (extensive or non-extensive), and infarction type (ST-elevated or non-ST elevated) also were evaluated.

RESULTS

Sixty-seven patients in MI and 6 subjects in control group had a history of opium consumption (p<0.0001, OR=24.5). Blood pressure, hyperlipidemia, and smoking showed a significant difference between the two groups (p<0.05), whereas, no significant difference was observed for diabetes and family history. The results of adjusted model report a significant effect of opium consumption with the development of MI (OR=26.3). No significant difference was found in terms of infarction type and the extent between the addicts and non addicts in MI group.

CONCLUSION

The results show that opium addiction is a strong risk factor for myocardial infarction.