Is there any association between contrast-induced nephropathy and serum uric acid levels?

Introduction: During the recent years, several studies have investigated that hyperuricemia is associated with greater incidence of contrast induced nephropathy (CIN). Most of them are in acute conditions like primary percutaneous coronary interventions. This study aimed to assess the relationship between high serum uric acid and incidence of acute kidney injury in patients undergoing elective angiography and angioplasty. Methods: This prospective study was conducted on 211 patients who were admitted to hospital for elective coronary angiography or angioplasty. The researchers measured serum creatinine and uric acid on admission and repeated creatinine measurement in 48 hours and seven days after the procedure. According to serum uric acid, the patients were divided into two groups; group 1 with normal uric acid and group 2 with hyperuricemia which was defined as uric acid more than 6 mg/dL in women and 7 mg/dL in men. CIN is defined as an increased creatinine level of more than 0.5 mg/dL or 25% from the baseline in 48 hours after the intervention. Results: In total, 211 patients with mean age of 60.58 years were enrolled in the study. Of these, 87 (41.2%) patients were in the high uric acid group and 124 (58.8%) were in the normal uric acid group. CIN was occurred in 16 patients (7.5%). Seven out of 16 (8.04%) were in the high uric acid and nine (7.2%) were in the normal uric acid group. There were no significant differences between the two groups (P =0.831). Conclusion: The frequency of CIN development was not different in the patients with hyperuricemia.

Relationship between Pulmonary Function Tests and Severity of Coronary Artery Disease in Patients with Chronic Obstructive Pulmonary Disease.

BACKGROUND: The aim of this study was to examine relationship between the parameters of pulmonary function and the severity of coronary artery disease (CAD) in chronic obstructive lung disease patients. MATERIALS AND METHODS: Four hundred and twenty four patients with ischemic heart diseases who underwent coronary angiography were studied. The demographic characteristics and medical history of the patients were obtained from their medical records.The severity of COPD was determined according to the Global Initiative for Chronic Obstructive Lung Disease. In addition, the severity of CAD was quantified by SYNTAX scoring. RESULTS: Eighty-eight (21.2%), 270 (65.1%), 52 (12.5%), and 5 (1.2%) of the patients had the grade 1, 2, 3, or 4 COPD, respectively. In addition, 46 (11.1%), 319 (76.9%), and 50 (12.0%) of them had low, intermediate, and high CAD, respectively. A statistically significant relationship was observed between the severity of COPD and the severity of CAD. Significant relationships were found between age, sex, BMI, LDL, EF, and systolic pressure of pulmonary artery with the severity of COPD. The odds of higher CAD in females were 1.849 times higher than male patients. In addition, the odds of high CAD in the patients with grade 1 or 2 COPD were 0.006 and 0.068 times of the patients with grades 3 and 4 COPD, respectively. CONCLUSIONS: The findings of the present study indicate that the parameters of pulmonary function and the severity of CAD are associated with the severity of COPD.

Investigation of short-term prognosis of fragmented QRS complexes in patients with acute myocardial infarction in two groups that received invasive and fibrinolytic therapy.

BACKGROUND: Studies have shown that the primary causes of death in patients with acute coronary syndrome are arrhythmias and heart failure. The aim of this study is to evaluate the short-term prognosis of fragmented QRS (f-QRS) in patients with acute myocardial infarction (MI). METHODS: This study was a prospective and longitudinal analytic study performed on all patients with acute MI admitted to Rasht Heshmat Hospital Emergency during 2018-2019. Serial Electrocardiography (ECG) was performed in the emergency room after patient admission and was repeated 24 h after percutaneous coronary intervention and fibrinolytic therapy, as well as at the time of patient discharge. Short-term prognosis of f-QRS in patients was evaluated by a cardiologist within admission, 40 days after hospitalization and three months later again. RESULTS: In this study, 453 patients with MI were evaluated in two treatment methods of fibrinolytic and invasive with and without f-QRS. Based on the data of this study, the four study groups had no statistically significant difference in arrhythmia (p = 0.196). In addition, the effect of study groups on left ventricular ejection fraction index was not statistically significant (p = 0.597). The probability of adverse outcomes occurrence was not statistically significant among the four groups (p = 0.07). CONCLUSION: The final results of this study showed that there was no significant difference between the four study groups and arrhythmia status. Therefore, f-QRS was not introduced as an independent predictor of arrhythmia in patients with acute MI.

The factors related to hospitalization period in patients with acute myocardial infarction treated after primary percutaneous coronary intervention.

BACKGROUND: Decreasing the hospital length of stay (LOS) in ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PPCI) is an issue which is related to reducing hospital costs. This study was aimed to determine the average number of hospital LOS among patients with STEMI treated by PPCI and predictors of longer LOS. METHODS: This cross-sectional study was performed on 561 patients with STEMI who referred to Heshmat Hospital, Rasht, north of Iran, within 2015-2018. As soon as STEMI was detected, patients were transferred to the catheterization laboratory (cath lab) in the shortest possible time and underwent PPCI. A questionnaire including characteristics of patients, procedures, and in-hospital adverse events was completed. Data were analyzed with SPSS software. RESULTS: The mean age of patients was 59.36 ± 11.90 years. 74.2% (n = 416) of subjects were men and 25.8% (n = 145) were women. The hospital LOS of 3 to 6 days had the highest prevalence up to 47%. The results of the multiple logistic regression showed that risk of hospital LOS > 6 days in unsuccessful percutaneous coronary intervention (PCI) was 33.2 versus 66.8 in successful PCI (P = 0.001). Moreover, the risk of hospital LOS > 6 days in subjects who had post-procedure complication, problems at admission, and primary comorbidities was 9.13 (7.22-11.53)-fold, 4.09 (2.86-5.85)-fold, and 1.75 (1.35-2.27)-fold more than those who had not, respectively. CONCLUSION: By identifying controllable predictive factors associated with prolonged hospitalization after PPCI, the length of hospitalization can be decreased; also, the patient remission can be enhanced and hospital costs reduced.

Clinical, Laboratory, and Procedural Predictors of No-Reflow in Patients Undergoing Primary Percutaneous Coronary Intervention.

Background: No-reflow is a major challenging issue in the management of patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). This study aimed to investigate the clinical, laboratory, and procedural predictors of no-reflow. Methods: This study was conducted on 378 patients with STEMI admitted to Dr. Heshmat Educational and Remedial Center (a referral heart hospital in Rasht, Iran) between 2015 and 2017. The study population was divided based on the thrombolysis in myocardial infarction (TIMI) flow grade and the myocardial blush grade into no-reflow and reflow groups. The clinical, laboratory, and procedural characteristics at admission were compared between the 2 groups using the multivariate logistic regression analysis. Results: The mean age of the participants was 58.57±11.49 years, and men comprised 74.1% of the study population. The no-reflow phenomenon was found in 77 patients. The no-reflow group was significantly older and more likely to be female; additionally, it had higher frequencies of hypertension, diabetes mellitus, hyperlipidemia, and a history of cardiovascular diseases. The multivariate logistic regression analysis showed that age >60 years (OR=1.05, 95% CI:1.00-1.09), hypertension (OR=2.91, 95% CI:1.35-6.27), diabetes (OR=4.18, 95% CI:1.89-9.22), a low systolic blood pressure (OR=3.53, 95% CI:1.02-12.2), a history of cardiovascular diseases (OR=4.29, 95% CI:1.88-9.77), chronic heart failure (OR=4.96, 95% CI:1.23-20), a low initial TIMI flow grade (OR=7.58, 95% CI:1.46-39.2 ), anemia (OR=3.42, 95% CI:1.33-8.77), and stenting vs. balloon angioplasty (OR=0.42, 95% CI:0.19-0.91) were the significant independent predictors of no-reflow. Conclusion: This study revealed some clinical, laboratory, and procedural predictors of no-reflow for the prediction of high-risk patients and their appropriate management to reduce the risk of no-reflow.

CHA2DS2-VASc Score Predict No-Reflow Phenomenon in Primary Percutaneous Coronary Intervention in Primary Percutaneous Coronary Intervention.

Introduction: No-reflow is one of the major complications of primary PCI in patients with acute ST elevation myocardial infarction. This phenomenon is associated with adverse outcomes in these patients. In the current study, we evaluated the effectiveness of CHA2DS2-VASc score in predicting no-reflow phenomenon. CHA2DS2-VASc score is a risk stratification method to estimate the risk of thromboembolism in patients with atrial fibrillation. Methods: In total, 396 patients with ST elevation myocardial infarction who had undergone primary PCI were evaluated in our study. Based on post interventional TIMI flow rate results, the patients were divided into two groups: control group (294 patients) and no-reflow group (102 patients). The CHA2DS2-VASc score was calculated for each participant. Multivariate regression analysis was performed to determine the predictive value of this score. Results: Our findings showed that CHA2DS2-VASc score can predict no-reflow independently (odds ratio: 3.06, 95%, confidence interval: 2.23-4.21, P <0 .001). Moreover, lower systolic blood pressure, higher diastolic blood pressure, grade 0 initial TIMI flow rate and smaller stent size were other independent predictors of the no-reflow in our study. We also defined a cut off value of ≥ 2 for the CHA2DS2-VASc score in predicting the no-reflow with a sensitivity of 88% and specificity of 67%, area under curve: 0.83 with 95% CI (0.79-0.88). Conclusion: The CHA2DS2-VASc score could be used as a simple applicable tool in the prediction of no-reflow before primary PCI in the acute ST elevation myocardial infarction patients.

Effect of multimorbidity on quality of life in adult with cardiovascular disease: a cross-sectional study.

BACKGROUND: The aim of present study was to describe the effect of multimorbidity on Health-Related Quality of Life (HRQoL) in patients with coronary artery disease (CAD). METHODS: A cross-sectional study with a simple sampling method of 296 patients undergoing coronary artery bypass surgery in a referral hospital of the northern part of Iran was conducted between April, 2015 and September, 2016. Multimorbidity was defined as the presence of at least two chronic diseases based on self-reporting and medical records. HRQoL was measured using the 36-item short form (SF-36) health status survey. We used analysis of variance (ANOVA) to assess the effect of multimorbidity on mental and physical component of HRQoL. RESULTS: Approximately, 69% of CAD patients had at least one other disease like diabetes or hypertension. Patients without multimorbidity compared with patients with multimorbidity were significantly older (p = 0.012) and more educated (p = 0.002). Both physical and mental component score of HRQoL was better in patients without any morbidity (48.82 vs. 43.93 with 95%CI of mean difference: 3.37-6.42 and 54.85 vs. 50.44 with 95% CI of mean difference: 1.68-7.15, respectively). Both physical and mental component score was significantly lower in female and lower educated patients (physical mean score 43.07 vs. 46.54 with P = .001 and 42.53 vs. 46.82 with P < .001 and mental mean score 49.98 vs. 52.65 with P = .055 and 49.80 vs. 52.75 with P = .022 for sex and education, respectively). Also, two-way ANOVA showed that regards to morbidity, physical component score was grater in patients with lower education level than higher education level (P < .001). CONCLUSION: The findings of this study suggest that women, lower education level and overweight reported lower quality of life. HRQoL is affected by multimorbidity among CAD patients specially in less educated.

The role of the fragmented QRS complexes on a routine 12-lead ECG in predicting non-responsiveness to cardiac resynchronization therapy.

OBJECTIVE: Cardiac resynchronization therapy (CRT) is introduced as a promising therapeutic option in heart failure (HF) patients with ventricular dyssynchrony.The challenge, however, is identifying the patients who are suitable candidates for this procedure. Fragmented QRS (fQRS) is associated with subendocardial fibrosis and myocardial scars. In this study, we aimed to evaluate the role of fragmented QRS complex on a routine 12-lead ECG as a predictor of response to CRT. METHODS: Sixty-five consecutive patients with HF who underwent CRT, were studied. Patients' resting 12-lead ECGs were analyzed to find presence of fQRS by a cardiologist. Echocardiographic response to CRT was defined as ≥15% decrease in left ventricular end-systolic volume (LVESV) after CRT implantation. Response to CRT was compared between patients with and without fQRS. RESULTS: The study group included 27 women (41.5%) and 38 men (58.5%) with a mean (±SD) age of 62±12 years. 27 patients (41.5%) had fQRS in their basal ECGs. Totally 46 patients (70.8%) responded to CRT in a way that the mean left ventricular ejection fraction (%) significantly increased, and left ventricular end diastolic volume (LVEDV) significantly decreased after CRT (p<0.001 and p=0.001 respectively). In multivariate logistic analysis, lack of fQRS was found to be a predictor of response to CRT (OR: 4.553, 95% CI: 1.345-15.418, p=0.015). CONCLUSION: We showed that the fQRS complex, as a sign of myocardial scar, predicts non-responsiveness to CRT. Therefore, fQRS may help selecting of CRT candidates.

Different obesity phenotypes, and incident cardiovascular disease and mortality events in elderly Iranians: Tehran lipid and glucose study.

AIM: To determine the impact of body mass index and the presence of metabolic syndrome (MetS) on cardiovascular disease (CVD) and mortality events in an elderly Tehranian population. METHODS: A population-based cohort of 1199 participants aged ≥65 years were followed for a mean of 9.74 years. Participants were stratified according to body mass index categories and MetS status. Cox regression analyses were used to estimate the hazard ratio of CVD and mortality events, given overweight participants without MetS as reference. RESULT: During follow up, 271 CVD events and 239 deaths (106 CVD deaths) occurred. Regarding CVD, multivariate-adjusted hazard ratios for CVD events in normal weight and obese participants without MetS were 1.21 (95% CI 0.77-1.91) and 1.46 (95% CI 0.64-3.34), respectively, and for normal weight, overweight and obese participants with MetS were 2.07 (95% CI 1.23-3.28), 1.72 (95% CI 1.13-2.62), and 1.53 (95% CI 0.95-2.45), respectively. Corresponding hazard ratios for CVD mortality were 2.08 (95% CI 0.93-4.82), 1.07 (95% CI 0.13-8.78), 3.71 (95% CI 1.55-8.85), 2.42 (95% CI 1.06-5.51) and 3.31 (95% CI 1.39-7.88), and for all-cause mortality were 1.41 (95% CI 0.9-2.23), 1.33 (95% CI 0.51-3.47), 1.84 (95% CI 1.1-3.09), 1.46 (95% CI 0.93-2.34) and 1.5 (95% CI 0.91-2.56), respectively. In the presence of diabetes in place of MetS, all of the diabetic participants regardless of body mass index category highlighted a significant risk for CVD and mortality events. CONCLUSION: Among the elderly population, the presence of MetS was necessary for exploring the risk of CVD events and its mortality; however, only the normal weight population with MetS had a significant risk for all-cause mortality

Corrected QT-interval and dispersion after revascularization by percutaneous coronary intervention and coronary artery bypass graft surgery in chronic ischemia.

INTRODUCTION: Electrocardiography parameters can predict cardiac events in ischemia. QT-interval parameters are potentially proposed as available non-invasive markers for assessing the ventricular homogeneity and electrical instability. Prolonged QT-interval (QTI) and QT dispersion (QTd) are predictors of poor prognosis and fatal arrhythmias. The improvement of cardiac perfusion may decrease QTI via percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery. The aim of this study was to compare the effects of PCI and CABG on QT parameters in chronic ischemia. METHODS: A total of 141 consecutive patients with coronary artery disease (70 who underwent PCI and 71 who underwent CABG) were entered into the study. Standard 12-lead electrocardiograms were recorded immediately before the procedure, immediately post procedure, 24 hours post procedure, and 7 days post procedure; corrected QTI (QTc) and corrected QTd (QTcd) and their changes were assessed and compared across the two therapeutic groups. RESULTS: QTc and QTcd reduced significantly after 7 days of revascularization. After PCI, QTc reduced from 444.7 ± 46.9 msec to 427.4 ± 40.6 msec and QTcd reduced from 47.1 ± 23.3 msec to 38.1 ± 1.1 msec. QTc increased immediately after CABG from 443.2 ± 36.6 msec to 461.9 ± 38.1 msec, but reduced within 7 days of the procedure to 430.2 ± 28.2 msec. QTcd reduced from 49.6 ± 23.2 msec to 30.9 ± 3.9 msec. The trend of QTcd reduction were similar in the two therapeutic groups but the trend of QTc alteration was different in that QTc increased upwardly and then decreased after CABG. CONCLUSION: Revascularization in chronic ischemia can improve QTI parameters following both PCI and CABG.

Factors influencing pre-hospital delay among patients with acute myocardial infarction in Iran.

BACKGROUND: Acute myocardial infarction (AMI) is the leading cause of morbidity and disability among Iranian population. Pre-hospital delay is an important cause of increasing early and also late mortality in AMI. Thus the aim of the present study was to identify the factors influencing pre-hospital delay among patients with AMI in Iran. METHODS: Between August 2010 and May 2011, a cross-sectional and single-center survey was conducted on 162 consecutive patients with ST-elevation myocardial infarction (STEMI) admitted to Cardiac Care Unit (CCU) of Dr. Heshmat Hospital, Rasht. All patients were interviewed by the third author within 7 days after admission by using a four-part questionnaire including socio-demographic, clinical, situational and cognitive factors. Data were analyzed by descriptive and Logistic regression model at P < 0.05 using SPSS 16. RESULTS: Mean age was (60.11 ± 12.29) years in all patients. Majority of patients (65.4%) were male. The median of pre-hospital delay was 2 hours, with a mean delay of 7.4 hours (± 16.25 hours). Regression analysis showed that admission in weekend (P < 0.04, OR = 1.033, 95%CI = 1.187 - 2.006) and misinterpretation of symptoms as cardiac origin (P < 0.002, OR = 1.986, 95%CI = 1.254 - 3.155) and perceiving symptoms to not be so serious (P < 0.003, OR = 3.264, 95%CI = 1.492 - 7.142) were factors influencing pre-hospital delay > 2 hours. CONCLUSIONS: Our findings highlight the importance of cognitive factors on decision-making process and pre-hospital delays. Health care providers can educate the public on AMI to enable them recognize the signs and symptoms of AMI correctly and realize the benefits of early treatment.

Effect of exercise-based cardiac rehabilitation on ejection fraction in coronary artery disease patients: a randomized controlled trial.

BACKGROUND: Exercise training as a part of cardiac rehabilitation aims to restore patient with heart disease to health. However, left ventricular ejection fraction (LVEF) is clinically used as a predictor of long-term prognosis in coronary artery disease (CAD) patients, there is a scarcity of data on the effectiveness of exercise-based cardiac rehabilitation on LVEF. OBJECTIVE: To investigate the effectiveness of exercise-based cardiac rehabilitation on LVEF in early post-event CAD patients. PATIENTS AND METHODS: In a single blinded, randomized controlled trial, post-coronary event CAD patients from the age group of 35-75 years, surgically (Coronary artery bypass graft or percutaneous coronary angioplasty) or conservatively treated, were recruited from Golsar Hospital, Iran. Exclusion criteria were high-risk group (AACVPR-99) patients and contraindications to exercise testing and training. Forty-two patients were randomized either into Study or Control. The study group underwent a 12-week structured individually tailored exercise program either in the form of Center-based (CExs) or Home-based (HExs) according to the ACSM-2005 guidelines. The control group only received the usual cardiac care without any exercise training. LVEF was measured before and after 12 weeks of exercise training for all three groups. Differences between and within groups were analyzed using the general linear model, two-way repeated measures at alfa=0.05. RESULTS: Mean age of the subjects was 60.5 ± 8.9 years. There was a significant increase in LVEF in the study (46.9 ± 5.9 to 61.5 ± 5.3) group compared with the control (47.9 ± 7.0 to 47.6 ± 6.9) group (P=0.001). There was no significant difference in changes in LVEF between the HExs and CExs groups (P=1.0). CONCLUSION: A 12-week early (within 1 month post-discharge) structured individually tailored exercise training could significantly improve LVEF in post-event CAD patients.