Fractional Flow Reserve as a Standard of Reference for Ischemia Early After ST Elevation Myocardial Infarction.

BACKGROUND: The purpose of the present study was to assess the value of the fractional flow reserve (FFR) of the infarct-related artery (IRA) early after ST elevation myocardial infarction (STEMI) in detecting reversible ischemia. METHODS: Single photon emission computed tomography (SPECT) at rest and after dipyridamole stress, and within 24 hour FFR of the IRA was performed on 69 patients 3 to 7 days after STEMI. FFR was 0.80 or less in 61 (88.4%) of them. In these patients, percutaneous coronary intervention (PCI) was performed, and a second SPECT study was repeated within 14 days. RESULTS: SPECT showed reversible ischemia in 36 (59%) of these 61 patients, and converted to negative in 29 of them. Thus, the SPECT results of these 29 patients were defined as true positive before angioplasty and true negative after angioplasty. Considering the true-positive and true-negative SPECT results as the gold standard, the sensitivity, specificity, and positive and negative predictive values of the FFR of 0.80 or less compared to this gold standard were 96.7%, 100%, 100%, and 96.6%, respectively (ĸ = 0.97, P < 0.001). CONCLUSIONS: In the early phase after STEMI, the reliability of FFR to determine residual ischemia in the IRA is very high in those patients with true-positive SPECT before and true-negative SPECT after PCI.

Epicardial adipose tissue and its association with cardiovascular risk factors and mitral annular calcium deposits.

INTRODUCTION: Epicardial fat is a variety of visceral adipose tissue that secretes pro-inflammatory cytokines that can lead to progression of atherosclerosis. Previous studies have shown a correlation between cardiovascular risk factors and severity of mitral annular calcification. The aim of our study was to assess the correlation between epicardial fat thickness and mitral annular calcification. METHODS: This study recruited 188 patients who were considered for coronary angiography and underwent echocardiography within 24 hours of admission. Epicardial fat thickness was measured in the parasternal long axis view at the end-systole. Mitral annular calcification was visualized in the parasternal short-axis view and was grade as none, mild, moderate, and severe. Furthermore, left atrial diameter, severity of mitral regurgitation, left ventricular ejection fraction, and early diastolic velocities (E wave) determined by transmitral pulsed Doppler, the early mitral annular velocities measured by tissue Doppler (e'), and E/e' were obtained. RESULTS: Patients with an epicardial fat thickness ≥7 mm had higher prevalence of hypertension and higher SYNTAX score (p value = 0.002 and 0.0014, respectively). Also, mitral annular calcification was both more prevalent and more extensive (p value = 0.007 and <0.001, respectively) and left atrial diameter was larger in these patients compared with patients with epicardial fat thickness <7 mm (p value = 0.001). CONCLUSIONS: Our study showed significant association between increased epicardial fat thickness and calcium deposits in the mitral valve annulus that is a degenerative process associated with cardiovascular risk factors.

Isolated partial right lower lobe pulmonary venous drainage into the right atrium as a cause of pulmonary hypertension in a middle-aged woman.

Partial anomalous pulmonary venous connection is a rare congenital disease characterized by drainage of one or several pulmonary veins into the systemic venous system. It is extremely rare as an isolated anomaly. We report the case of a middle-aged woman with isolated drainage of an enormously enlarged right lower pulmonary vein into the right atrium with significant left-to-right shunt, severe right ventricular enlargement, and pulmonary hypertension.

The correlation between myocardial perfusion scintigraphy and three-dimensional echocardiography in ejection fraction and cardiac volumes for determination of the nearest filtering parameters.

End-diastolic volume (EDV), end-systolic volume (ESV), and ejection fraction (EF) are cardiac volumes that have crucial roles in diagnosis of cardiovascular diseases (CVD) in patients. There are differences between these mentioned parameters in echocardiography (Echo) and myocardial perfusion scintigraphy (MPS) in clinical practice. In this study, we determined the nearest filtering parameters in the analysis of MPS data in comparison with three-dimensional echocardiography (3DE). All of patients were in this study, and 3DE and MPS were performed for all patients at rest phase in the same day. MPS images were analyzed through quantitative gated single photon emission computer tomography (SPECT) software with Butterworth filter which was a fixed order (order = 5) and variable cutoffs (COs) of 0.3, 0.35, 0.4, 0.45, and 0.5. The EDV, ESV, and EF values were measured by 3DE and MPS and compared. Based on the above different COs, the ESVs of MPS were 15.5 ± 18 mL, 18 ± 20 mL, 21 ± 22.5 mL, 22 ± 23 mL, and 22.5 ± 23.5 mL, respectively, while ESV of 3DE was 44.4 ± 23.5 mL. It was observed as a significant difference between MPS and 3DE for ESV. The EDVs of MPS were 61.3 ± 24.5 ml, 64 ± 26.5 ml, 68 ± 29.5 ml, 72 ± 31 ml, and 76 ± 32.2 ml, respectively, while EDV of 3DE was 105 ± 30 ml, which was significantly different between two methods. The EFs of MPS were 79% ± 14%, 76% ± 13%, 73.5% ± 12%, 73.5% ± 11%, and 74% ± 11%, respectively. The EF of 3DE was 58.4% ± 10% ml. It was statistically significant difference in values of EF between SPECT analysis parameters and 3DE. It was interesting when the COs increased from 0.3 to 0.5; the cardiac volumes increased while the EF decreased. The measured ESV and EDV values were lower in females than males while the EFs of females were higher than males. Finally, we demonstrate that the nearest Cos for measuring of EF and cardiac volumes for analysis of MPS data in comparison with 3DE are 0.45 and 0.5, respectively.

Remote ischemic preconditioning to reduce contrast-induced acute kidney injury in chronic kidney disease: a randomized controlled trial.

BACKGROUND: The impact of contrast-induced acute kidney injury (CI-AKI) on patients with chronic renal disease is well-known. Remote ischemic preconditioning (RIPC) is a non-invasive method that can reduce the risk of CI-AKI, but studies on RIPC have had different results. The aim of the present study was to assess the potential impact of RIPC on CI-AKI. METHODS: In a randomized, double blinded, controlled trial, 132 patients with chronic renal dysfunction (glomerular filtration rate < 60 mL/min/m2) who underwent coronary angiography or angioplasty received adequate hydration. RIPC was performed in 66 patients by applying an upper arm blood pressure cuff. The cuff was inflated four times for 5 min to 50 mmHg above the systolic blood pressure, followed by deflation for 5 min. In the control group, the blood pressure cuff was inflated only to 10 mmHg below the patient's diastolic blood pressure. The primary endpoint was an increase in serum cystatin C ≥ 10% from baseline to 48-72 h after exposure to the contrast. RESULTS: The primary endpoint was achieved in 48 (36.4%) patients (24 in each group). RIPC did not show any significant effect on the occurrence of the primary endpoint (P = 1). In addition, when the results were analyzed based on the Mehran risk score for subgroups of patients, RIPC did not reduce the occurrence of the primary endpoint (P = 0.97). CONCLUSIONS: In patients at moderate-to-high risk of developing CI-AKI when an adequate hydration protocol is performed, RIPC does not have an additive effect to prevent the occurrence of CI-AKI. TRIAL REGISTRATION: The clinical trial was registered on (Identification number IRCT2016050222935N2 , on December 19, 2016 as a retrospective IRCT).

Correlation between epicardial fat thickness and aortic valve sclerosis.

Background Epicardial fat is a true visceral fat deposit with adverse effects through the secretion of numerous proinflammatory and proatherogenic cytokines. Previous studies showed an association between aortic valve sclerosis and coronary artery disease. The aim of this study was to determine the correlation between epicardial fat thickness and aortic valve sclerosis. Method The study involved 225 patients who were admitted for coronary angiography due to new-onset angina. They underwent transthoracic echocardiography and epicardial fat thickness was determined. The sclerosis scoring of each aortic cusp, average aortic valve sclerosis score index, and left ventricular ejection fraction were determined. The variables of left ventricular diastolic function obtained included the early diastolic velocity determined by transmitral pulsed Doppler, and early mitral annular velocity measured by tissue Doppler. Results Patients with an epicardial fat thickness ≥7 mm were older ( p = 0.006), with more hypertension ( p = 0.045) and hyperlipidemia ( p < 0.001). Their average aortic valve sclerosis score index was higher (1.4 ± 1.02 vs. 0.86 ± 0.85, p = 0.001), and left ventricular ejection fraction and early mitral annular velocity were lower ( p < 0.001 and 0.03, respectively). They also exhibited more left ventricular hypertrophy ( p = 0.026) and a trend towards more significant coronary artery disease and 3-vessel disease ( p = 0.086 and 0.073, respectively). Conclusion Our findings confirm that epicardial fat as a marker of visceral adipose tissue may have an important role in promoting inflammatory and atherosclerotic changes in the aortic valve.

Congenital aortocaval fistula between right aortic sinus of Valsalva and superior vena cava: A rare case report.

Thoracic aortocaval fistula is a very rare cause of left to right shunt. Drainage of fistula into the superior vena cava (SVC) is very uncommon. Clinical symptoms depend on the size of the shunt. We report a rare case of an asymptomatic 27-year-old woman with congenital aortocaval fistula to the SVC with a small amount of left to right shunt that was considered for serial medical follow-up.

Severe subvalvular pulmonic stenosis due to a ball-shaped accessory tissue in an asymptomatic woman with congenitally corrected transposition of great arteries and mesocardia: A rare case report.

Congenitally corrected transposition of great arteries (CCTGA) is a rare anomaly described by atrioventricular and ventriculoarterial discordance. On the other hand, mesocardia that is extremely rare includes two relatively well-defined apexes defined by each ventricle with the major axis of the heart lies in the midline. We describe a rare case of an asymptomatic 20-year-old woman with mesocardia, CCTGA, and severe subvalvular pulmonic stenosis due to a ball-shaped accessory tissue in left ventricular outflow tract.

Double-Orifice Tricuspid Valve: A Case Report and Literature Review.

Duplication of an atrioventricular valve is a rare congenital anomaly that usually involves the mitral rather than the tricuspid valve (TV). Isolated appearances of a double-orifice TV (DOTV) are extremely rare and in most cases are associated with other congenital anomalies. We report a rare case of an HIV-seropositive male with a DOTV, divided right atrium and Wolff-Parkinson-White syndrome admitted to our hospital with palpitations and dyspnea. After medical therapy, the patient's symptoms were alleviated. We summarized the characteristics of the DOTV and reviewed the literature.

Anomalous origin of the right coronary artery from the left circumflex coronary artery: an extremely rare coronary anomaly.

Isolated single coronary artery is an extremely rare anomaly with an incidence of 0.024% to 0.066% which may be associated with other congenital anomalies. This report describes a 50-year-old woman who was referred with recurrent chest discomfort and was diagnosed with anomalous origin of the right coronary artery from the left circumflex coronary artery.

Accessory tricuspid valve leaflet and an anomalous muscle bundle in the right ventricular outflow tract in a patient with double-outlet right ventricle: a rare case report.

Double-outlet right ventricle (DORV), a clinically important congenital heart disease, occurs in 1-3% of persons with congenital heart disease. It may occur as an isolated cardiac defect, together with other cardiac lesions, or in association with extracardiac anomalies. Other rare cardiac anomalies include an anomalous muscle bundle (AMB) in the right ventricular outflow tract (RVOT) and an accessory tricuspid valve leaflet. We report a very rare case of concomitant DORV, AMB in the RVOT and accessory tricuspid valve leaflet in a 17-year-old male patient. The patient eventually died from severe decompensated heart failure. To the best of our knowledge, such a case has not been previously reported in the literature.