The Association of Sleep Duration and Quality with Heart Rate Variability and Blood Pressure.

BACKGROUND: The current study was conducted to evaluate the relation of sleep duration and quality with blood pressure (BP) and heart rate variability (HRV). MATERIALS AND METHODS: This cross-sectional study was carried out in 2017 among 260 staff of a university hospital in Isfahan, Iran. They were selected by multi-stage random method from different wards. Time domain spectral analysis was used to measure a number of HRV parameters. The long-term components of the HRV were estimated using the standard deviation of the normal-to-normal interval (SDNN). The square root of the mean squared differences of successive NN intervals (RMSSD) was calculated by statistical time domain measurements; SNN50, and PNN50 were measured. Pittsburg sleep quality index (PSQI) questionnaire was used to assess sleep quality. RESULTS: Higher PSQI score correlated with lower SDANN rise (OR=0.92). Fairly bad to very good subjective sleep quality had association with lower SDANN (OR=0.43). Very high sleep latency to very low sleep latency ratio had association with lower SDANN (OR=0.39) and lower PNN50 (OR= 0.44). Sleep duration and HRV parameters had no significant association. Fairly bad sleep efficiency to very good sleep efficiency ratio was correlated with lower SDANN (OR= 0.29). Very high daytime dysfunction to very low daytime dysfunction ratio had correlation with lower SDANN (OR=0.35). Very bad compared to very good subjective sleep quality had significant correlation with higher Heart rate (HR) (B=0.03). Very high sleep latency compared to no sleep latency was associated with higher HR (B=4.74). Very high compared to very low amount of sleep disturbances correlated with higher SBP levels (B=15.2). Using sleep medication less than once a week compared with no history of taking such drugs was associated with higher HR (B=16.4). CONCLUSION: Our findings showed that poor sleep quality are adversely associated with HRV, HR and BP. This finding should be considered in clinical and preventive recommendations.

Pregnancy outcome in women with mechanical prosthetic heart valvesat their first trimester of pregnancy treated with unfractionated heparin (UFH) or enoxaparin: A randomized clinical trial.

Introduction: Pregnancy increases the risks of thromboembolism for the mother and fetus in patients with mechanical heart valves. The results of some studies have indicated that low molecular weight heparin (LMWH), in comparison with unfractionated heparin (UFH), leads to a lower incidence rate of thrombocytopenia and a decrease in bleeding. Methods: The present randomized clinical trial involved 31 pregnant women with mechanical heart valves at their first trimester (0-14 weeks) of pregnancy. To perform the study, the patients were divided into two groups, i.e. group A (LMWH group-16 patients) and group B (UFH group-15 patients). The birth weight, mode of delivery, and gestational age at birth as well as the maternal and fetal complications were compared between the two groups. Results: The mean age of mothers in the UFH and LMWH groups was 32.67±9.11 and 31.50±5.81years, respectively (P value > 0.05). Although the rate of maternal and fetal complications was higher in the UFH group as compared with the LMWH group, the observed difference was not significant (P value > 0.05). Conclusion: LMWH can be regarded as a safer therapy for both the mother and fetus due to its lower number of refill prescriptions and fewer changes in the blood level.

Correlation between vitamin D level and coronary artery calcification.

BACKGROUND: Considering the role of Vitamin D in cardiovascular disease (CVD) and the relationship between coronary artery calcification (CAC) and CVD, we aimed to investigate the association between the serum level of Vitamin D and CAC. MATERIALS AND METHODS: This was a cross-sectional study on 67 consecutive patients who were referred for performing computed tomography angiography. We used Spearman correlation to evaluate the relationship between Vitamin D and CAC and then linear regressions to control for demographics and vascular risk factors. RESULTS: There was no association between CAC and Vitamin D levels (Spearman coefficient = -0.03, P = 0.805). After controlling for age, sex, hypertension, hyperlipidemia, diabetes mellitus, and smoking, there was still no association between Vitamin D and CAC score (estimate = 0.001, S. E. = 0.020, P = 0.942). CONCLUSION: We did not find the association between the serum level of Vitamin D and coronary artery calcification.

The Value of Multi-slice Computed Tomography Compared to Conventional Coronary Angiography for Detecting In-stent Restenosis.

BACKGROUND: Diagnostic value of multi-slice computed tomography (MSCT) for detecting in-stent restenosis in comparison with conventional coronary angiography remained uncertain. The present study aimed to determine the value of MSCT for detecting in-stent restenosis. MATERIALS AND METHODS: This historical cohort study was included 226 patients with the history of percutaneous coronary intervention from 2000 to 2014 that referred to MSCT Unit at Alzahra Heart Center in Isfahan. The subjects were followed-up by telephone with regard to performing coronary angiography up to 3 months after MSCT and their status about cardiac events. RESULTS: Among all participants, 63 stents (27.9%) underwent coronary angiography up to 3 months after MSCT that 2 stents in left circumflex artery (LCX) assessment, 2 in left anterior descending (LAD) assessments and none in right coronary artery (RCA) assessment were uninterpretable. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of MSCT was 92.9%, 66.6%. 92.9%, 66.6%, and 88.2%, respectively for detection of occlusion in LCX stents, 100%, 100%, 100%, 100%, and 100%, respectively for detection of occlusion in LAD stents, and 80.0%, 0.0%, 80.0%, 0.0%, and 66.7%, respectively for detection of occlusion in RCA stents. Overall, MSCT had sensitivity of 93.8%, specificity of 70.0%, PPV of 93.8%, NPV of 70.0%, and accuracy 89.7% for detection of coronary stent restenosis. CONCLUSION: MSCT has high diagnostic value for detecting in-stent restenosis. Diagnostic accuracy of MSCT for detecting stent restenosis is considerably different between the coronary arteries with the highest diagnostic values for LAD and the lowest diagnostic values for RCA.

Diagnostic performance of 64-row coronary CT angiography in detecting significant stenosis as compared with conventional invasive coronary angiography.

BACKGROUND: The aim of the present study is to evaluate the accuracy of 64-multidetector-row computed tomography angiography (CTA) in comparison to conventional invasive angiography (CIA) in the diagnosis of significant stenosis (≥ 50%) of coronary artery tree. METHODS: Assessment of CTA in the detection of coronary artery disease (CAD) was performed in patients referred because of symptoms or stress studies suggestive of ischemia. For this purpose, among more than 1000 cases of coronary CTA in a 20 months period a study population of 54 patients suspected to have significant stenosis of the coronary artery tree was investigated. The CIA procedure was performed in these patients one month after CTA. The accuracy of CTA in detecting significant stenosis was compared to CIA. RESULTS: For vessel based analysis of 179 coronary vessels, CTA had a sensitivity of 96%, specificity of 87.5%, positive predictive value of 90.5%, and negative predictive value of 94.6%. For patient-base analysis, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CTA were 97.9%, 28.6%, 66.6%, and 90.2%, respectively. CONCLUSION: The findings of this study reveal that CT angiography with 64-slice scanner could be considered as a suitable technique for rapid triage of patients presenting to hospitals with chest pain. High values of sensitivity and PPV reveal the good performance of CTA in detecting CAD.