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Abstract Background: Current electrocardiography (ECG) criteria are insensitive for the detection of posterior acute myocardial infarction (AMI) and most of these cases remain undiagnosed. The purpose of this study has been evaluated of prevalence and clinical value of ST-segment in posterior electrocardiography leads during acute myocardial infarction. Materials and Methods: In cross- sectional analytic study, posterior ECG leads (V7, V8 and V9) as well as standard 12 leads in 210 consecutive patients with acute myocardial infarction admitted to CCU wards of Shahid Rijaie hospital. Reinforcing, continuous arrhythmia, hypotension, cardiologic shock, marked heart failure and/or acute pulmonary edema were considered. Related parameters to basic characteristics and next process of patients in two groups with/ without ST- segment elevation in posterior ECG lead were compared. Results: There were 153 patients with ST-segment elevation 1 mm in 2 contiguous leads. 12.4% patients had STE1 mm in 2 posterior leads, either as an isolated finding (4.6%) or in association with STE at inferior or lateral sites (7.8%). The standard 12-lead electrocardiogram was normal in two patients and 5 other patients were admitted with the diagnosis of non-Q infarctions. Tall R waves in V1/V2 developed in 5 cases. In-hospital complications were significantly more frequent among patients with STE in posterior leads (47.4% vs. 20.9% respectively, P=0.01). Conclusion: STE in posterior electrocardiography leads is not uncommon during acute myocardial infarction and may portend a worse in-hospital course.

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Background: Since cardiac surgeons have not kept up with advancements in pacing technology, there has been a tendency to limit the implantation of pacemakers by surgeons. This study compares two eras of pacing therapy including pacemaker implantation by cardiac surgeons and pacemaker set-up by a group of cardiologists in Shahid Rajaee Hospital in Tehran. Materials and Methods: In this cross-sectional study, we compared the existing data from all pacemaker implantations in the first half of 1999 (surgical era, era 1) to that of the first half of 2001 (cardiologists era, era 2). Results: During era 1, a total 114 pacemakers (46.5% male, mean age 63.3 ±18.4) and during era 2, 299 pacemakers (63.9% male, mean age 63.9±18.2) had been implanted. Indications for implantation were nearly similar, with AV block as the most common reason in 21.9% and 19.1% of implantations in eras 1 and 2, respectively. Single chamber pacemakers comprised 86% of implantations during era 1 compared to 54% during era 2 (p<0.01). The mean duration of admission was 18 days during era 1 while it was 10 days during era 2. Pacemaker malfunctions were detected following 7.9% of implantations in era 1 compared to 0.3% of cases in era 2 (p<0.01). Re-do procedures were performed after 2.7% of implantations during era 1 in comparison to 0.3% during era 2 (p<0.01). Conclusion: Pacemaker implantation was performed better by a coordinated pacemaker service run by cardiologist trained in pacemaker implantation.

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Background: Positive electrocardiogram (ECG) changes in patients with unstable angina or non-ST elevation myocardial infarction are well known, but problem arises when no specific changes in ECG are identified. The aim of this study is to evaluate the prevalence of these changes in hospitalized patients at Amir Kabir Hospital of Arak. Materials and Methods: This study was a cross-sectional one that was conducted on 124 patients hospitalized at the heart emergency ward of Arak Amir Kabir Hospital with unstable angina and non-ST elevation myocardial infarction. ECG changes and serum cardiac enzyme levels were analyzed on admission and 12 hours after admission. Results: According to patients’ history and serum cardiac enzymes, 62 patients had undergone myocardial infarction without ST segment elevation, 98.4% of whom had ECG changes and 1.5% showed no ECG changes. Of the 60 patients, who had been hospitalized with unstable angina, 90% showed ECG changes and the rest 10% revealed no such changes. Conclusion: In comparison to other studies reporting that 50% of patients with unstable angina and non ST elevation myocardial infarction reveal no ECG changes, a high percentage of patients referring with a chest pain to the heart emergency ward of Amir Kabir Hospital, had no significant changes in their ECG and were not hospitalized.

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Background: Left main coronary artery divides into left anterior descending and circumflex arteries. Total occlusion of the left main coronary artery without extensive MI and cardiogenic shock is a rare finding. Case: The patient is a 50-year-old man that had referred to doctor’s office with history of exert ional chest pain two months earlier. Although he did not have history of rest angina, he had history of smoking as well as positive family history for coronary artery diseases. Exercise test with echocardiography revealed significant S-T depression. Hence, coronary angiography was done for the patient which showed total occlusion of the left main and originated left circumflex artery from right coronary artery and left anterior obliq filled from right coronary artery. The patient was candidate for coronary artery bypass graft. Conclusion: Total occlusion of the left main coronary artery without cardiogenic shock and death is a rare finding. This phenomenon occurs when occlusion is chronic and it is followed by right coronary artery with well-developed collateral which might be presented with stable angina. The mainstay treatment for total occlusion of the left main coronary artery is coronary artery bypass graft

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Background: Nowadays, many patients with cardiovascular diseases require pacemaker implantation that is associated with few complications such as cardiac and valvular insufficiency. This study aims to compare the development of tricuspid and mitral regurgitation in right ventricular outflow tract (RVOT) and right ventricular apex (RVA) pacing.

Materials and Methods: In this single-blind clinical trial, 164 candidates for permanent pacemaker (PPM) implantation due to sick sinus syndrome or atrioventricular block were randomly divided into 2 equal groups to receive either RVOT or RVA pacing. Patients with heart failure or valvular diseases were excluded from the study. Pre and post-procedural echocardiography after 6 months were performed and the results were compared for the development of mitral and tricuspid regurgitation and probable changes in the ejection fraction (EF).

Results: Age, gender, pacing mode, and baseline cardiac rhythm did not significantly differ between RVOT and RVA pacing groups. The incidence of mitral regurgitation was significantly higher in the RVA group (p=0.033), whereas the incidence of tricuspid regurgitation was similar in both groups (p>0.05). There was a trend toward less tricuspid regurgitation in the RVOT group however, it was not statistically significant. Ejection fraction was not significantly different between the study groups.

Conclusion: It seems that the incidence of mitral regurgitation in RVA pacing is significantly higher than RVOT although this needs further investigation in future studies.

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Background: Traditionally levels of cholesterol and triglyceride are used to identify individuals at risk of coronary artery disease (CAD). The aim of this study is examining the association of ApoA1 and ApoB with severity of coronary artery disease and whether these parameters are better predictor of CAD.

Materials and methods: This is a cross- sectional study. All patients that referred to ARAK amirallmomenin hospital and enrolled for coronary angiography was entered to study. Before angiography and after gathering informed consent, levels of apoA1 apoB, cholesterol, TG, LDL, VLDL, HDL and FBS were measured. The results of coronary angiography were reviewed by two experienced cardiologist separately. Severity of coronary artery disease involvement was determined by Gensini score (GS), the data were analyzed with statistical methods by SPSS software.

Results: There is a statistically significant correlation Between apoB and GS (r=0.127, p=0.047). Logistic regression model showed that among predictors for CAD entered model eg gender, age, cholesterol, TG, HDL, LDL , VLDL, ApoA1, ApoB and ApoB/Apo- A1 ratio, only ApoB and gender were proper predictors of coronary artery Disease( CAD) (p=0.002, , p=0.001). In comparison with angiography for diagnosis of CAD, ROC analysis represent that using ApoB can be useful test (p=0.047).

Conclusion: According to result of this study, using ApoB in addition to conventional parameters for assessing the patient at risk to having CAD would be reasonable and could be an independent risk factor for CAD.

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Background: Cardiac accidents due to Coronary Artery Disease are the most common cause of mortality in the world. On the other hand, vitamin D deficiency is known as an emerging risk factor of this disease. Considering the high prevalence of vitamin D deficiency in Iran we investigated the prevalence of vitamin D deficiency in angioplasty patients, effect of gender and its relationship with Coronary Artery Disease severity.

Materials and Methods: In this cross sectional study serum level of 25(OH) D3 in was measured in 149 patients undergoing PCI between May and September 2013 in Baqiatallah hospital. Patients with renal failure (Cr>2mg/dl), liver disease, and those treated with glucocorticoids or anti-epileptic drugs were excluded. Data were analyzed with SPSS 21 software. Chi-square and T-Test were used and P value<0.05 was considered statistically significant.

Results: The prevalence of vitamin D deficiency in patients was 77.2% (men 86% and women 62.5%) (p=0.0005). Vitamin D deficiency severity was related to the number of involved vessels in men (p=0.046). Vitamin D deficiency was related with stent length in patients with right coronary angioplasty (p=0.041).

Conclusion: The effect of vitamin D deficiency on coronary artery disease seems to be different in men and women. Complementary studies are needed to elucidate this issue further.

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Background: Early, complete, and stable coronary revascularization is the main criteria for standard treatment in patients with ST segment elevation myocardial infarction (STEMI). The aim of this study was to evaluate the safety and efficacy of integrilin as glycoprotein IIb/IIIa receptor inhibitor in treatment of STEMI patients undergoing primary percutaneous coronary intervention (PCI).

Materials and Methods: In this clinical trial study, 106 STEMI patients who complained of acute chest pain and were referred to Amir Al Momenin hospital, Arak, entered the study. Patients were randomly divided into two equal groups. The first group was treated with integrilin immediately before angioplasty. The 2nd group was treated with conventional percutaneous coronary intervention.

Results: After receiving treatment and undergoing angioplasty, TIMI Frame Count was equal to 15.7±8.04 in the 1st group and 14.2±5.4 in the 2nd group which showed no significant difference between them (p=0.4). Ejection fraction in patients receiving integrilin was significantly more than control group in first (p=0.043) and third month (p=0.012) after treatment.

Conclusion: Based on the results of the present study, it seems that using integrilin in standard time, causes long-term benefits for patients and reduces damage to the heart wall.

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Background: Inflammation has an important role in the pathogenesis of atherosclerosis. The aim of this study was to evaluate the role of WBC (White Blood Cell) count and incidence of morbidity and mortality in patients with ACS.

Materials and Methods: This prospective study was carried out on 101 patients with ACS who admitted in Bu-ali Sina hospital. All patients were stratified according to WBC categories in to 3 groups, (WBC 1 :<7000 mm3, WBC 2:7000 -10000 mm3, WBC 3:> 10000 mm3). Demographic and laboratory data such as acute reactive protein, cardiac biomarker and etc. were recorded. Adverse cardiac events and mortality were recorded to a phone or in person for six months of follow up period. The collected data were analyzed using SPSS software (Statistical Package for Social Sciences, version 17.0). The Fisher´s exact chi-square test and the student t-test were applied. P-values less than 0.05 were considered significant.

Results: In our study, 5 patients (31.25%) in third group had recurrent non fatal cardiac event and the same percent (31.25%) were died after 6 months follow up. Multivariate analysis showed WBC count >10000 mm3 was strongest predictor of outcome in our patients.

Conclusion: WBC count can be considered one of the strong independent predictor of mortality and cardiac event in patients with ACS.

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Background: Statins are the most effective drugs for treatment of elevated level of cholesterol. In addition, they exhibit other effects unrelated to their lipid lowering effects (pleiotropic actions). In recent years, experimental and clinical evidences demonstrate that statins exert anti-inflammatory properties. The aim of this study is evaluation of association Atorvastatin in reduction of peak threshold in patients with permanent pacemaker.

Materials and Methods: In these clinical trial 64 eligible patients that candidate for permanent pacemaker enrolled. After in formed consent patients randomly divided to two equal groups. In first group atorvastatin 20 mg/daily administered orally for six weeks and second group considered as control. Peak atrial and ventricular threshold were measured in beginning of study and in sixth week. The data collected and analyzed and p<0.05 considered statistically meaning full.

Results: from 32 subjects in Atorvastatin group 17 (53.12%) were male and 15(46.87%) were female. Average mean age in Atorvastatin and control group was 72.43±17.27 and 68.59 ±10.98 years, respectively. No difference showed in atrial and ventricular threshold in two groups at beginning of study. At end of study atrial threshold in atorvastatin and control group were 0.55±0.23 and 0.45±0.19 respectively (p=0.4) and ventricular threshold in atorvastatin and and control group were 0.73±0.23 (p=0.4).

Conclusion: There is no association between atorvastatin therapy and reduction in pacemaker peak arterial and ventricular threshold.

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Background: Heart failure with normal ejection fraction (HFNEF) is commonly seen in adults. It is possible that old patients with HFNEF have severe clinical status. The aim of current study is to evaluate clinical and echocardiographic findings in old patients compared to young patients with HFNEF.

Materials and Methods: In this cross-sectional analytical study, 126 patients with HFNEF were evaluated in two groups of patients &ge60 years old (n=52) and <60 years old (n=74) for demographic, clinical and echocardiographic findings.

Results: Patients &ge60 years old had significantly more hyperlipidemia, less hypertension and more FC II. Patients &ge60 years old also had significantly larger septal wall thickness, lower end diastolic and systolic volume, end systolic diameter, E/A ratio and septal E’, lower diastolic dysfunction grade, higher left ventricle ejection fraction, left atrial volume index, E/E’ ratio and deceleration time compared to patients <60 years old.

Conclusion: Old patients with HFNEF have different clinical and echocardiographic findings compared to younger patients which are indicative of the disease severity in some cases. So, exact evaluation of the patients could be helpful in early diagnosis of these patients and providing an adequate treatment.

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Background: Cardiovascular diseases is one of the most prevalent causes of mortality in all around the world accounting for high rates of decrease of physical function and daily work. The aim of this study is to assess the effect of cardiac rehabilitation on quality of life dimensions Percutanous Coronary Intervention (PCI) patients.

Materials and Methods: This clinical trial study was conducted on 96 patients in the rehabilitation unit in Qom. Half of patients put in the test group and the others remained as control. Data of all patients including of demographic parameter and questionnaire of quality of life before and after rehabilitation (in case and control groups) were collected. Data analysis was done in SPSS 18 by central statistical indices and frequency distribution as well as independent t-test, pair t-test ans Chi-square and p-value below than 0.05 was significant.

Results: out of 96 patients, the mean age was 57.21±9.09 and 57.3± 10.89 years in case and control groups respectively and 70.8% were male and remains were female. There was significant relationship between quality of life and its subtypes except physical function (p<0.001). Moreover, difference between quality of life and six out of eight subtypes scores before and after rehabilitation in both groups was significant.

Conclusion: It seems that cardiac rehabilitation after PCI affects quality of life.

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Background: Post ischemic myocardial reperfusion can impair CABG outcomes and cause increased mortality, hospital stay and costs. Then, increased oxygen free radicals lead to lipid peroxidation and sulfhydryl group oxidation. The aim of this study is to evaluate whether N-acetylcysteine and Vitamin C as antioxidants could effect postoperative outcomes of on-pump CABG.

Materials and Methods: In this clinical trial, patients who had undergone CABG were studied in 4 groups receiving Vitamin C, N-acetylcysteine, Vitamin C & N-acetylcysteine and traditional drugs. The study population consisted of 50 patients in each group. Data were recorded in a checklist and analyzed by using SPSS 20.

Results: Mean pump time, ICU stay, hospital stay, the distribution of troponin positive serum, arrhythmia and need for reoperation were significantly different between groups. Gender distribution, mean cross-clamp time, serum creatinine level before and after surgery, the need for inotropic drugs and required dose level of it, showed no significant differences between groups.

Conclusion: It seems that the combination of N-acetylcysteine and  Vitamin C had a stronger effect on the defference between the mean of pump time, hospital length stay and  length of ICU stay versus the administration of N-acetylcysteine or Vitamin C alone.

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Background: High blood pressure increases various cardiovascular events about 2 to 3 times in a person. The purpose of this study is to recognize the effect of a course of pilates exercise on hypertension, nitric oxide, and resting heart rate in the eldrlymen with hypertension.

Materials and Methods: Subjects of this quasi-experimental research included 30 elderly men with hypertension grade one(in the range of systolic-diastolic 140/90 to 159/99mm Hg) who participated voluntarily and accessibly in the study and were divided randomly into two experimental peer (15 people) and control (15 people) groups. Weight, height and BMI of subjects were 75±80, 170±175 and 25-26, respectively. The experimental group did selected exercise of Pilates for eight weeks (three one-hour sessions per week). Desired variables of the subjects of both groups were evaluated 24 hours before the start of exercise and 24 hours after the last session. Data analysis was conducted using dependent and independent t-test by SPSS16 statistical software at the significant level of p≥0.05.

Results: The research results showed that the eight-week pilates exercise gave rise to reduction in blood pressure(p≤0.05) as well as resting heart rate (p≤0.05) and to increase in nitric oxide of elderly men with hypertension (p≤0.05).

Conclusion: The eight-week pilates exercise reduced blood pressure and resting heart rate and increased the production of nitric oxide in elderly men. So, it seems that the regular physical exercise can be effective as a preventive factor in the outbreak of cardiovascular diseases of the elderly men. 

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Abstract

Background: Heart attacks are the cause of 40% of deaths in Iran and due to its upswing in Iran and the world, the determination of its short-term survival rate in order to assess treatment methods is of great importance. The purpose of this study is to estimate patients’ short-term survival rate after heart attacks by Meta-analysis method.

Materials and Methods: This study is a systematic review. The analysis was based on data extracted from English and Persian data bases. To analyze the information obtained, including the average age of patients, and one-month and one-year short-term survival rates, the STATA 11.2 and the random effect model were used.

Results: The results of the study on 18 studies entering the Meta-analysis including 62486 patients, demonstrated that one-month and one-year short-term survival rate in Iran are respectively 87.7 and 85.2 percent and no significant difference was observed between the two genders. The average age of patients was reported 62.43 years and no significant difference was observed between the two genders in the occurance of health attack.

Conclusion: The results of this Meta-analysis showed that although the survival rate of an Iranian patient after a myocardial Infarction is the same as patients in developed countries, the average age of the patients in Iran is lower, which indicates that the load of disease in Iran is greater than in other countries regarding the years lost to the disease.