Efficacy of Combination Therapy of Statin and Vitamin C in Comparison with Statin in the Prevention of Post-CABG Atrial Fibrillation.

PURPOSE: Atrial fibrillation (AF) is the most frequent arrhythmia that follows coronary artery bypass graft (CABG). Patients developing postoperative AF (POAF) have significantly higher mortality rates. The consistent prophylactic effectiveness of statins and vitamin C are well-accepted; however, no evaluation on combined therapy has been performed. We aimed at assessing the efficacy of combination therapy with statin and vitamin C in comparison with statin alone in the prevention of post CABG-AF. METHODS: In a randomized double blind clinical trial, 120 candidates of CABG were recruited in Tabriz Madani Educational Center in a 15-month period of time. Patients were randomized into two groups of 60 receiving oral atorvastatin (40mg) plus oral vitamin C (2g/d operation day and 1g/d for five consequent days) for intervention group and oral atorvastatin (40mg) for control group. Occurrence of post CABG AF was compared between the two groups. RESULTS: There were 60 patients, 43 males and 17 females with a mean age of 61.0±11.5 (29-78) years, in the intervention group and sixty patients, 39 males and 21 females with a mean age of 60.5±11.3 (39-81) years, in the control group. The post CABG AF occurred in 6 cases (10%) in the interventional group and 15 patients (25%) in the controls (P=0.03, odds ratio=0.33, 95% confidence interval 0.12-0.93). CONCLUSION: Based on our findings, combination prophylaxis against post CABG AF with oral atorvastatin plus vitamin C is significantly more effective than single oral atorvastatin.

Effect of left atrium volume on patients' prognosis following acute myocardial infarction.

Evaluating left atrium volume is a good way to estimate prognosis in acute myocardial infarction patients because it indicates to time and severity of diastolic dysfunction and longer-term results of acute myocardial infarction. The present study aims at evaluating the effect of left atrium volume on patients' prognosis following acute myocardial infarction. This is a cohort study conducted on 100 patients who were admitted with acute myocardial infarction. They were studied for 9 months and their one-month mortality rate was evaluated. The patients were studied considering demographic factors, risk factors, mechanical and arrhythmic complications and echocardiography indexes such as systolic and diastolic functions and left atrium volume. It was seen that mortality (27.3%, 6.22) in patients with atrium index > 32 mL m(-2) is more than cases with lower atrium index (1.3%, 1.78) (p = 0.001). There was not any meaningful difference in mortality rate of the patients considering age and gender (p > 0.05). This study indicated to lack of any meaningful difference in patients' mortality rate in terms of hypertension, diabetes, smoking and dyslipidemia. But, mortality rate was significantly higher in MI as a result of elevated-ST, diastolic dysfunction, restrictive pattern, ejection fraction of left atrium < 40%, left atrium volume index > 32 mL m(-2). High volume left atrium independently refers to bad prognosis in patients with acute myocardial infarction which is confirmed with outcome clinical predictors and common echocardiography indexes even following modification.

Evaluation of anthropometric indices of patients with left ventricle dysfunction fallowing first acute anterior myocardial infarction.

INTRODUCTION: In the current study, we evaluated the effect of anthropometric indices on ejection fraction following first acute anterior myocardial infarction. METHODS: In an analytic-cross sectional study, 50 patients with acute anterior myocardial infarction and abnormal anthropometric indices (Body Mass Index (BMI) ≥ 30, Waist Hip Ratio (WHR) ≥ 1 and ≥ 0.85 in males and females respectively and Waist Circumference (WC) ≥ 102 cm and ≥ 88 cm in males and females respectively) were recruited as case group and 50 patients with acute anterior myocardial infarction and normal anthropometric indices as control group. Subsequently, the relation between anthropometric indices and left ventricle dysfunction was evaluated and compared between two groups. RESULTS: 77 people of the studied patients were male and 23 female with the mean age of 59± 1.2 years and an age range of 32-90 years. To evaluate the left ventricle function, the mean ejection fraction of the patients was measured as 34.3± 7.2 % and 44.8± 6.3% in patients with abnormal anthropometric indices and patients with normal anthropometric indices respectively (P= 0.0001). Calculation of the correlation coefficient between ejection fraction and BMI, WHR and WC in males and females revealed a moderate reverse (r=-0.521 to r=-0.691) and statistically significant (P= 0.0001) relations which was of more strength in females. CONCLUSION: Anthropometric indices including BMI and waist circumference influence cardiac function following myocardial infarction.

Comparison of the Length of Hospital Stay between the Patients with Atrial Fibrillation Treated with Amiodarone and Patients with Normal Sinus Rhythm after Coronary Artery Bypass Graft.

INTRODUCTION: Postoperative atrial fibrillation occurs in 20 % to 40 % of patients undergoing coronary artery bypass grafting ( CABG ) and contributes to increasing length of stay and hospital cost . The purpose of our study was to compare the length of hospital stay between patients of postoperative atrial fibrillation treated with amiodarone (experimental) and those with normal sinus rhythm ( NSR ) (Control ) after CABG. METHODS: From October of 2008 to October 2010, our experimental group including 26 patients was treated with amiodarone in Tabriz Madani Heart Center. The background variables, length of atrial fibrillation, and length of hospital stay were recorded. The experimental group was compared with a control group of 50 patients. The two groups were the same in terms of age, gender, ejection fraction, vascular diseases and risk factors. RESULTS: The hospital stay duration was 8.0 ±1.6 and 7.4 ±1.4 days (p = 0.08) for experimental, and control groups respectively. Atrial fibrillation occurred mainly (60%) on the second postoperative day. CONCLUSION: 25 patients out of 26 patients (96 %) returned to NSR after starting the amiodarone protocol and the length of hospital stay in the experimental group was not significantly different from that of the control group. Thus, treating with Amiodarone in postoperative atrial fibrillation can reduce hospital stay duration compared to that of normal sinus patients.

Association between Diabetic Retinopathy and Left Ventricular Dysfunction in Diabetic Patients with Unstable Angina.

INTRODUCTION: Diabetes mellitus (DM) is associated with serious complications including macro- and microvascular problems such as diabetic retinopathy. Coronary involvement in diabetic patients is believed to be a consequence of microvascular complications. However, the available data are inconclusive and scarce. This study aimed to evaluate the probable association between diabetic retinopathy and left ventricular dysfunction in diabetic patients with unstable angina (UA). METHODS: In this cross-sectional study, 200 diabetic patients with UA (100 cases with diabetic retinopathy and 100 cases without diabetic retinopathy) were enrolled in a teaching hospital. Left ventricular ejection fraction (LVEF) as well as the frequency of cases with left ventricular dysfunction (LVEF<50%) were compared between the two groups and different degrees of diabetic retinopathy (proliferative and non-proliferative). RESULTS: Patients' demographic variables were comparable between the two groups. Mean diagnosis time of DM was significantly higher in the patients with diabetic retinopathy (8.40±6.60 vs. 3.81±3.58 years; P<0.001). Mean LVEF was significantly lower in the retinopathy group (50.50±6.91% vs. 53.07±4.87%; P=0.003). Frequency of cases with left ventricular dysfunction was significantly higher in the group with diabetic retinopathy (31% vs. 12%; P=0.001, OR=3.33, 95%CI: 1.58-7.14). The frequency of cases with left ventricular dysfunction was significantly yet independently higher in patients with proliferative vs. non-proliferative diabetic retinopathy. CONCLUSION: Left ventricular dysfunction is more common in diabetic patients with unstable angina and diabetic retinopathy compared with their counterparts without diabetic retinopathy.

Chronobiological rhythms in onset of massive pulmonary embolism in Iranian population.

BACKGROUND: To investigate whether there is any chronobiological rhythms in onset of massive pulmonary embolism in Iranian population and to study any time variation in occurrence of this disease in patients' subgroups. METHODS: This study was conducted in an emergency department of a referral teaching hospital from March 2003 to March 2007. All medical records of patients with definite diagnosis of massive pulmonary embolism were reviewed for chronobiological rhythms in hourly, daily, monthly and season periods. RESULTS: One hundred and twenty patients (49 women and 71 men) included in the study. The mean age of patients was 63.63 +/- 17.21 years. Massive pulmonary embolism showed a statistical increase in onset in the morning period (p = 0.004) with peak of occurrence between 9:00 to 10:00, in the first three day of the week (p < 0.001), and during winter (p = 0.003). In addition, hourly and weekly rhythms in onset of massive pulmonary embolism in diabetic patients is different from nondiabetic patients and occur most frequent in evening hours and in the end of week. CONCLUSION: Our findings revealed that massive pulmonary embolism has a peak of onset during morning hours and in the winter. We also found that massive pulmonary embolism also has a weekly rhythm. Circadian and weekly rhythms of massive pulmonary embolism were different in diabetic patients and this is a novel finding of this study.

Measurement of coronary sinus blood flow after first anterior myocardial infarction with transthoracic echocardiography and its correlation with wall motion scoring index.

OBJECTIVE: To measure the coronary sinus blood flow (CSBF) and coronary sinus velocity time integral (CSVTI) via transthoracic echocardiography (TTE) in patients with acute myocardial infarction (AMI) in association with the left ventricular ejection fraction (LVEF), and wall motion scoring index (WMSI). METHODS: In this case-control study, 20 patients with anterior AMI and 20 healthy individuals as the control group, were studied in 6 months period from March to September 2005 in Madani Heart Center, Tabriz, Iran. All patients received the same treatment for AMI (such as fibrinolytic). The CSBF, CSVTI, WMSI, and tissue Doppler imaging (TDI) data were obtained via TTE and compared between the 2 groups. RESULTS: Baseline variables were similar between the 2 groups (p>0.05). The CSBF in AMI group was 287.8 +/- 128 ml/min and in the control group was 415 +/- 127 ml/min (p=0.001). Also, CSVTI was significantly lower in AMI group than control group (11.16 +/- 2.85 and 17.56 +/- 2.72 mm, p=0.003). There was a significant correlation between CSBF and LVEF (r=0.52, p=0.01), WMSI (r=-0.77, p=0.0001) and CSBF and in-hospital mortality (r=0.58 p=0.03), also between CSVTI and LVEF (r=0.85, p=0.0001), WMSI (r=-0.57, p=0.0009) and in-hospital mortality rate (r=0.69, p=0.02). The CSBF and CSVTI had a good correlation with TDI findings: peak early diastolic velocity in the myocardium and peak systolic velocity in the myocardium). CONCLUSION: Our study demonstrated a good correlation between measured CSBF and CSVTI by 2D- Doppler TTE and LVEF, WMSI, in-hospital mortality and TDI findings.

Treatment of spontaneous coronary artery dissection with drug-eluting stents.

Spontaneous coronary artery dissection SCAD is a rare condition which may result in sudden coronary occlusion, acute myocardial infarction and sudden cardiac death. The prognosis of spontaneous coronary artery dissection is uncertain and optimal treatment is unknown. We describe a case of SCAD in a 29-year-old male with acute inferior wall myocardial infarction MI and post-MI angina that was treated with drug-eluting stents.

Cardiovascular disease risk factors in patients with confirmed cardiovascular disease.

OBJECTIVE: To assess the magnitude of the problem of cardiovascular risk factors in hospitalized patients, and to establish cardiovascular disease (CVD) risk factor profiles. METHODS: The study included 476 confirmed CVD patients selected by a multi stage stratified cluster random sampling technique in Tabriz Heart Center (Shaheed Madani Hospital), Tabriz, Iran from February 2004 to May 2005. After obtaining demographic information and performing physical examination, biochemical parameters were measured. Data was analyzed using the Statistical Package for Social Science version 10.05, where p value of <0.05 was considered significant. RESULTS: Obesity was the most common abnormality (93.5%) followed by diabetes mellitus (58.4%), low high-density lipoprotein cholesterol (HDL-c) (45.4%), low physical activity (41.6%), high total cholesterol (40.1%), high triglyceride (37.2%), high low-density lipoprotein cholesterol (30.7%), diastolic hypertension (28.4%), high systolic blood pressure (24.8%) and smoking (20%). Of the total number of patients, 93% had one risk factors for CVD, 43% had 2, 16% had 3, and 5% had 4 risk factors. The prevalence of lipid disorders in females was more than males except for low HDL-c (p<0.05). Between lipid profiles, only TG showed a correlation between age (p<0.05). It was noticed that obesity accompanied by lipid profile abnormalities as low serum levels of HDL-c and high level of TG, TC, and LDL-c were more seen in obese patients (p<0.05). CONCLUSION: This study revealed a high prevalence of risk factors in CVD patients; thus, urgent lifestyle modification is recommended.