Improved Right Ventricular Systolic Function After Cardiac Resynchronization Therapy in Patients With Heart Failure.

BACKGROUND: Since the introduction of cardiac resynchronization therapy (CRT) to improve left ventricular function, the effect of CRT on the right ventricle in patients with heart failure has not been well described. METHODS: We evaluated the effect of CRT on right ventricular systolic function in 20 patients (80% men; mean [SD] age, 58.5 [9.8] y) with cardiomyopathy and right ventricular systolic dysfunction (New York Heart Association class III or IV, left ventricular ejection fraction ≤35%, and QRS interval ≥120 ms). The median follow-up time was 15 months. Right ventricular systolic function, defined as a tricuspid annular plane systolic excursion (TAPSE) index of 16 mm or less, was evaluated in patients before and after CRT. RESULTS: Twelve (60%) patients had ischemic cardiomyopathy, and 12 (60%) patients had left bundle branch block detected using surface electrocardiogram. The mean (SD) QRS duration was 160.5 (24.4) ms. From before CRT to the time of follow-up after CRT, the mean (SD) ejection fraction increased significantly from 22.5% (5.6%) to 29.4% (7.4%) (P < .001). The mean (SD) TAPSE index also increased significantly from 13.70 (1.78) mm to 16.50 (4.77) mm (P = .018). Eleven (55%) patients showed improved right ventricular systolic function (TAPSE ≥16 mm) after CRT. Patients with a favorable right ventricular response to CRT were significantly older (64.6 [8.2] y vs 53.6 [8.4] y, respectively) and more likely to have nonischemic origin of cardiomyopathy than were patients with unimproved right ventricular function (66.7% vs 18.2%, respectively). CONCLUSION: Our findings indicate that CRT is associated with improved right ventricular systolic function in patients with heart failure and right ventricular systolic dysfunction. Patients with nonischemic heart disease more often show improved right ventricular function after CRT.

Measurement of mitral valve area in patients with mitral stenosis by 3D echocardiography: A comparison between direct planimetry on 3D zoom and 3D quantification.

BACKGROUND: Measurement of the mitral valve area (MVA) in patients with mitral stenosis (MS) by 3D echocardiography (3DE) is usually done via 3D quantification (3DQ). The present study on patients with severe MS sought to evaluate the agreement regarding the MVA measurement between 3DQ and direct planimetry on 3D zoom and also between 3DE and 2DE. METHODS: Twenty-six patients (22 female, mean age:34.5 ± 14.0 years) with severe MS diagnosed by 2D transthoracic echocardiography(2DTTE) underwent 3D transesophageal echocardiography (3DTEE). Direct planimetry, the pressure half-time (PTH), and the continuity equation(CE) constituted 3 conventional 2DTTE methods, and 3DQ and direct planimetry on 3D zoom comprised two 3DTEE methods applied for the MVA measurement. Agreement between the 2D and 3D methods was assessed using the Bland-Altman plot and measuring the intra-class correlation coefficient (ICC). RESULTS: The mean MVA measured by 3DQ was significantly larger than that derived by direct planimetry on 3D zoom (0.935 ± 0.23 cm2 vs 0.846 ± 0.22 cm2 , respectively; P = 0.026). The agreement between 3DQ and 3D zoom for the MVA measurement was moderate to good by the Bland-Altman plot (ICC = 0.67). The mean MVA measured by 2DE (all 3 methods of direct planimetry, the PTH, and the CE) was significantly larger than that derived by 3DE (both methods of 3DQ and direct planimetry on 3D zoom) (all Ps < 0.05). A moderate agreement between 3DQ and 2D planimetry (ICC = 0.43) was found by the Bland-Altman plot. CONCLUSIONS: The MVA measurement by direct planimetry on 3D zoom showed a moderate-to-good agreement with 3DQ; it may, thus, be used in clinical practice as a simple method for the measurement of the MVA in patients with MS.

Association between Latest Activated Sites in the Left Ventricle and Akinetic Segments in Patients with Ischemic Cardiomyopathy.

Background: It is not clear whether the latest activation sites in the left ventricle (LV) are matched with infracted regions in patients with ischemic cardiomyopathy (ICM). We aimed to investigate whether the latest activation sites in the LV are in agreement with the region of akinesia in patients with ICM. Methods: Data were analyzed in 106 patients (age = 60.5 ± 12.1 y, male = 88.7%) with ICM (ejection fraction ≤ 35%) who were refractory to pharmacological therapy and were referred to the echocardiography department for an evaluation of the feasibility of cardiac resynchronization therapy. Wall motion abnormalities, time to peak systolic myocardial velocity (Ts) of 6 basal and 6 mid-portion segments of the LV, and 4 frequently used dyssynchrony indices were measured using 2-dimensional echocardiography and tissue Doppler imaging (TDI). To evaluate the influence of the electrocardiographic pattern, we categorized the patients into 2 groups: patients with QRS ≤ 120 ms and those with QRS >120 ms. Results: A total of 1 272 segments were studied. The latest activation sites (with longest Ts) were most frequently located in the mid-anterior (n = 32, 30.2%) and basal-anterior segments (n = 29, 27.4%), while the most common sites of akinesia were the mid-anteroseptal (n = 65, 61.3%) and mid-septal (n = 51, 48.1%) segments. Generally, no significant concordance was found between the latest activated segments and akinesia either in all the patients or in the QRS groups. Detailed analysis within the segments indicated a good agreement between akinesia and delayed activation in the basal-lateral segment solely in the patients with QRS duration ≤ 120 ms (Φ = 0.707; p value ≤ 0.001). Conclusion: The akinetic segment on 2-dimensional echocardiogram was not matched with the latest activation sites in the LV determined by TDI in patients with ICM.

Anxiolytic-Like Effects and Increase in Locomotor Activity Induced by Infusions of NMDA into the Ventral Hippocampus in Rat: Interaction with GABAergic System.

INTRODUCTION: In this study, we investigated the role of N-Methyl-D-Aspartate (NMDA) receptors in the ventral hippocampus (VH) and their possible interactions with GABAA system on anxiety-like behaviors. METHODS: We used an elevated-plus maze test (EPM) to assess anxiety-like behaviors and locomotor activity in male Wistar rats. RESULTS: The results showed that intra-VH infusions of different doses of NMDA (0.25 and 0.5 µg/rat) increased locomotor activity, and also induced anxiolytic-like behaviors, as revealed by a tendency to increase percentage of open arm time (%OAT), and a significant increase in percentage of open arm entries (%OAE). The results also showed that intra-VH infusions of muscimol (0.5 and 1 µg/rat) or bicuculline (0.5 and 1 µg/rat) did not significantly affect anxiety-like behaviors, but bicuculline at dose of 1 µg/rat increased locomotor activity. Intra-VH co-infusions of muscimol (0.5 µg/rat) along with low doses of NMDA (0.0625 and 0.125 µg/rat) showed a tendency to increase %OAT, %OAE and locomotor activity; however, no interaction was observed between the drugs. Interestingly, intra-VH co-infusions of bicuculline (0.5 µg/rat) along with effective doses of NMDA (0.25 and 0.5 µg/rat) decreased %OAT, %OAE and locomotor activity, and a significant interaction between two drugs was observed. DISCUSSION: It can be concluded that GABAergic system may mediate the anxiolytic-like effects and increase in locomotor activity induced by NMDA in the VH.

A comparison between size of the occluder device and two-dimensional transoesophageal echocardiographic sizing of the ostium secundum atrial septal defect.

OBJECTIVES: Transcatheter closure of a secundum atrial septal defect (ASD II) has become an effective alternative for surgical treatment. In this study we evaluated the correlation between the two-dimensional transoesophageal echocardiographic (2D TEE) sizing of ASDs and the actual diameter of occluders in patients undergoing device closure. METHODS: The records of 54 patients who underwent transcatheter ASD closure were reviewed. ASD characteristics and maximum defect diameter were evaluated using preprocedure 2D TEE images. Appropriate device size was determined by the balloon sizing method, which measures the balloon occlusive diameter (BOD) via TEE and fluoroscopy. ASD closure was performed under continuous TEE monitoring using the Amplatzer occluder in all patients. RESULTS: The mean of the TEE-derived maximum defect diameter was significantly lower than the mean of the BOD (17.8 ± 4.5 vs 22.1 ± 5.1 mm; p < 0.001) and the mean size of the implanted occluder device (17.8 ± 4.5 vs 23.3 ± 5.1 mm; p < 0.001). However, a good correlation was found between the TEE-derived defect size and the BOD (BOD = 0.898 × TEE defect size + 6.212, R = 0.824; p < 0.001) and between the TEE measurement and the final size of the implanted Amplatzer (device size = 0.928 × TEE defect size + 6.853, R = 0.822; p < 0.001). CONCLUSION: 2D TEE may provide a good equation to predict the BOD or the size of the occluder device; however, further studies are needed to investigate whether it is feasible to perform transcatheter ASD occlusion without balloon sizing.

Percutaneous transvenous mitral commissurotomy: significance of echocardiographic assessment in prediction of immediate result.

BACKGROUND: The current study aims to identify demographic, clinical characteristics, echocardiographic and/or mitral valve morphological parameters that may predict the successful result of percutaneous transvenous mitral commissurotomy (PTMC).  METHODS: The medical records of 196 patients (48 males, mean age: 42.7 ± 11.5 years) who underwent PTMC were reviewed. Prior to PTMC, a combination of transthoracic and transesophageal echocardiography were used to investigate substantial mitral valve morphological subcomponents (thickening, mobility, calcification, and subvalvular thickness) and suitability for PTMC. The second transthoracic echocardiographic assessment was performed within six weeks after PTMC. Patients were divided into two categories of successful or unsuccessful according to PTMC results. Successful PTMC was defined as: final mitral valve area (MVA) ≥1.5 cm2 without a post-procedure mitral regurgitation (MR) grade >2. The significant predictor of the result was identified by comparing demographic data, initial echocardiographic assessments and mitral valve morphological scores within both groups.  RESULTS: The mean MVA increased from 1.0 ± 0.2 cm2 to 1.7 ± 0.4 cm2, and mitral valve mean gradient (MVMG) decreased from 11.5 ± 5.2 to 5.2 ± 3.3 mmHg (P < 0.001 for both). Successful results were obtained in 139 (70.9%) patients compared to unsuccessful results in 57 (29.1%). Unsuccessful results were due to suboptimal secondary MVA < 1.5 cm2 in 50 (25.5%) patients and post-procedure MR grade >2 in 7 (3.6%). Multiple logistic regression analysis indicated that young age, lower size of the left atrium (LA), and smaller degree of mitral valve thickness were the predictors of successful result.  CONCLUSION: Pre-procedure echocardiographic assessment appears to be helpful in predicting PTMC results. Successful PTMC is influenced by the patients' age, LA size, and mitral valve thickness.

The effect of a high dose of atorvastatin on the occurrence of atrial fibrillation after coronary artery bypass grafting.

BACKGROUND: Recent studies have suggested that statins reduce the incidence of atrial fibrillation (AF) after cardiac operations. Statin therapy at intensive doses, however, has yet to be thoroughly investigated. METHODS: We retrospectively studied 1,839 consecutive patients (1,177 men [73.2%]) who underwent isolated coronary artery bypass grafting and had no history of previous AF, pacemaker implantation, or antiarrhythmic medication. Data recorded included the atorvastatin dose during hospitalization, demographic, echocardiographic, and angiographic data, medical history, drug treatment, and procedural characteristics. Continuous telemonitoring during the first 72 postoperative hours assessed for AF, which was defined as episodes lasting more than 5 minutes. The dose-related effect of atorvastatin on postoperative AF was investigated by logistic analysis in 1,607 patients: 75 (4.7%) did not receive atorvastatin vs 1,047 (65.1%) and 485 (30.2%) who received 40 mg/d or 80 mg/d, respectively, for at least 3 days before the operation. RESULTS: The study population was a mean age of 60.6 ± 9.5 years. Multivariate logistic regression demonstrated that a lack of atorvastatin pretreatment along with older age, enlarged left atrium, and male sex, and not taking ß-blockers, tended to be associated with an increased risk of postoperative AF. There was no significant difference between the effect of a higher (80 mg/d) and a lower dose (40 mg/d) in reducing postoperative AF. CONCLUSIONS: Atorvastatin pretreatment significantly reduced the occurrence of AF after bypass grafting; nonetheless, the difference between the beneficial effects of intensive and routine atorvastatin treatments on postoperative AF was not significant.

Glomerular filtration rate is related to severity of obstructive coronary artery disease in patients undergoing coronary angiography.

PURPOSE: Chronic kidney disease is independently associated with an increased risk of cardiovascular events; however, the relationship between the glomerular filtration rate (GFR) and coronary artery disease (CAD) in patients undergoing coronary angiography has yet to be fully elucidated. METHODS: This retrospective study enrolled a total of 7968 patients who underwent diagnostic coronary artery catheterization [mean age = 54.8 ± 10.6 years, 74.4% males] and did not have any previous history of coronary revascularization, diabetes mellitus, hypertension, end-stage renal disease treated by dialysis or renal transplantation, and were not taking diuretics or drugs acting on renin angiotensin system. The severity of CAD was defined as the number of coronary arteries with a luminal stenosis ≥50% on the angiogram, and the GFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI). RESULTS: There were 2133 (26.8%) patients with GFR ≥ 90 ml/min/1.73 m(2), 4574 (57.4%) patients with 60 ≤ GFR < 90 ml/min/1.73 m(2), 1073 (13.5%) with 45 ≤ GFR < 60 ml/min/1.73 m(2) and 181 (2.3%) with 15 < GFR < 45 ml/min/1.73 m(2). After adjustment for traditional cardiovascular risk factors (age, sex, dyslipidemia, low to high-density lipoprotein ratio, smoking status, and family history), the GFR showed a significant association with the severity of CAD and remained a significant predictor of CAD (Odds Ratio raised from 1.1 in patients with 60 ≤ GFR < 90 ml/min/1.73 m(2) to 1.8 in patients with 15 < GFR < 45 ml/min/1.73 m(2)). CONCLUSIONS: A reduced kidney function, even mildly, is significantly associated with CAD severity, independently of other traditional CAD risk factors.

Comparison between tissue doppler imaging (TDI) and tissue synchronization imaging (TSI) in evaluation of left ventricular dyssynchrony in patients with advanced heart failure.

BACKGROUND: Assessment of left ventricular (LV) dyssynchrony has an important role in optimizing the selection of cardiac resynchronization therapy (CRT) candidates. We compared a new semiautomatic echocardiographic modality, tissue synchronization imaging (TSI) with a manual method, color-coded tissue Doppler imaging (TDI), in the assessment of LV dyssynchrony in patients with heart failure (HF). METHODS: Ninety-five patients (age = 54.5 ± 17.1 years, 66.3% male) with advanced HF (NYHA functional class ≥III and ejection-fraction ≤35%) were included in the study and evaluated echocardiographically. The time to regional peak systolic velocity (Ts) in six basal and six middle segments of the LV was measured manually using velocity curves from TDI and semiautomatically using TSI and seven parameters of systolic dyssynchrony were computed. RESULTS: Overall, a moderate-to-good association was found between Ts derived by these two modalities, whereas the mean of Ts via TSI was significantly lower than that measured by TDI in many LV segments. The agreement between these two modalities in identifying LV dyssynchrony varied from weak to moderate according to various dyssynchrony indices. In comparison to the TDI-derived dyssynchrony indices, TSI showed a high sensitivity of more than 90% using Ts delay at the basal/all LV segments and the indices for their standard deviations (SD) for identifying LV dyssynchrony, whereas the highest specificity of 80% was achieved using the septal-lateral dyssynchrony index in the prediction of LV dyssynchrony. CONCLUSION: With the aid of selected LV dyssynchrony indices, the TSI method may confer enough sensitivity for a speedy evaluation and initial screening of LV dyssynchrony in HF patients; however, the current technology of TSI does not seem specific enough to replace TDI in the evaluation of dyssynchrony.

Mitral annular calcification predicts immediate results of percutaneous transvenous mitral commissurotomy.

BACKGROUND: Many previous studies have evaluated the impact of mitral valve (MV) deformity scores on the percutaneous transvenous mitral commissurotomy (PTMC) outcome in patients with mitral stenosis; however, the relationship between mitral annulus calcification (MAC) and the PTMC result has not yet been established. The current study aimed to investigate whether MAC could independently influence the immediate result of PTMC. METHODS: Of all patients undergoing PTMC in our institution between April 2005 and November 2009, we included 87 patients (28.7%male, mean ± SD age = 42.8 ± 12.6 years) with rheumatic mitral stenosis who had additional data on the echocardiographic evaluation of MAC along with MV leaflets morphology. Echocardiographic assessments were repeated up to six weeks after PTMC to evaluate the immediate PTMC outcome. The frequency of the optimal PTMC result (secondary MV area > = 1.5 cm(2) with > = 25% increase and without final mitral regurgitation grade > 2) was compared between two groups of patients with MAC (n = 17) and those without MAC (n = 70). RESULTS: The optimal result was obtained in 55 (63.2%) patients, whereas the result was suboptimal in 32 (36.8%) patients due to insufficient MV area increase in 31(96.9%) subjects and post-procedure mitral regurgitation grade > 2 in 1(3.1%). The rate of optimal PTMC results was less in patients with MAC in comparison to those without MAC (29.4% vs.71.4%). After adjustments for possible confounders such as age and leaflets morphological subcomponents (thickening, mobility, calcification, and subvalvular thickening), MAC remained a significant negative predictor of a suboptimal PTMC result (odds ratio = 0.154; 95%CI = 0.038-0.626, p value = 0.009) together with leaflet thickening (odds ratio = 0.214; 95%CI = 0.060-0.770, p value = 0.018). CONCLUSIONS: MAC appeared to independently influence the immediate result of PTMC; therefore, mitral annulus evaluation may be considered in the echocardiographic assessment of the mitral apparatus prior to PTMC.

Study on the role of environmental parameters and HIF-1A gene polymorphism in coronary collateral formation among patients with ischemic heart disease.

OBJECTIVES: To evaluate the association between collateral formation and some environmental factors along with a polymorphism in HIF-1A gene in selected Iranian patients with CAD. DESIGN AND METHODS: Patients with ≥ 70% narrowing in at least one coronary vessel according to coronary angiography were enrolled. The patients' demographic, clinical and biochemical data were collected. The presence of C1772T polymorphisms within HIF-1A was analyzed using the polymerase chain reaction-based restriction fragment length polymorphism (PCR-RFLP). RESULTS: There is no significant difference between the patients with and without collaterals according to the frequency of T allele or HIF-1A variants. The higher severity of coronary vessel obstruction was positive predictor of collateral formation (OR=1.026, 95%, CI: 1.02-0.04, p<0.001), whereas aging and cigarette smoking were negative predictors (OR=0.95, 95% CI: 0.91-0.99, p<0.05; OR=0.30, 95% CI: 0.11-0.79, p <0.05; respectively). CONCLUSIONS: The findings indicate not any significant association between collateral formation and polymorphic variants of HIF-1A and P582S substitution does not appear to influence the collateral formation in patients with myocardial ischemia.

Systemic opioid receptor antagonism blocks swim stress-induced retention impairment independently from CA1 and BLA opioidergic pathways.

AIMS: The basolateral amygdale (BLA) and dorsal hippocampus (CA1) are critical sites in mediating the effects of stress hormones on memory formation. Severe stress exposure induces memory impairment probably through activating inhibitory modulatory mechanisms such as opioidergic pathways. However, the detailed mechanisms and effect sites are not well understood. The present study was designed to investigate whether opioidergic agents, specifically in the BLA and CA1, are implicated in memory impairment induced by stressful situations. MAIN METHODS: Rats carrying bilateral cannulae aimed at the BLA or CA1 were trained in a step-through passive-avoidance task and immediately were exposed to a forced swim (SW) stress (10 min, 20°C). Retention was assessed 24 h after the training session after the animals had received a systemic or microinjection of naltrexone (a classical opioid antagonist) into the BLA/CA1 before training. KEY FINDINGS: The systemic administration of naltrexone (0.5, 1.5, and 3 mg/kg) blocked SW stress-induced memory impairment in a dose-dependent manner, while the microinjection into the BLA (5, 10, and 20 µg/rat) or CA1 (5, 10, and 20 µg/site) exhibited no effect on the disruptive pattern. SIGNIFICANCE: These findings, albeit confirming the role of opioidergic agents in stress-induced memory impairment, rule out the involvement of the BLA and CA1 in this effect. Future studies are needed to evaluate the opioidergic sites which mediate the disruptive effects of stress exposure on memory formation.

The Rey Auditory Verbal Learning Test: alternate forms equivalency and reliability for the Iranian adult population (Persian version).

BACKGROUND: Increasing demand for memory assessment in clinical settings in Iran, as well as the absence of a comprehensive and standardized task based upon the Persian culture and language, requires an appropriate culture- and language-specific version of the commonly used neuropsychological measure of verbal learning and memory, the Rey Auditory Verbal Learning Test (RAVLT). METHODS: The Persian adapted version of the original RAVLT and two other alternate word lists were generated based upon criteria previously set for developing new word lists. A total of 90 subjects (three groups of 30 persons), aged 29.75±7.10 years, volunteered to participate in our study and were tested using the original word list. The practice effect was assessed by retesting the first and second groups using the same word list after 30 and 60 days, respectively. The test-retest reliability was evaluated by retesting the third group of participants twice using two new alternate word lists with an interval of 30 days. RESULTS: The re-administration of the same list after one or even two months led to significant practice effects. However, the use of alternate forms after a one-month delay yielded no significant difference across the forms. The first and second trials, as well as the total, immediate, and delayed recall scores showed the best reliability in retesting by the alternate list. CONCLUSION: The difference between the generated forms was minor, and it seems that the Persian version of the RAVLT is a reliable instrument for repeated neuropsychological testing as long as alternate forms are used and scores are carefully chosen.  

Assessment of Left Ventricular Dyssynchrony in Heart Failure Patients Regarding Underlying Etiology and QRS Duration.

BACKGROUND: Left ventricular (LV) dyssynchrony is a prevalent feature in heart failure (HF) patients. The current study aimed to evaluate the prevalence of inter and intraventricular dyssynchrony in HF patients with regard to the QRS duration and etiology. METHODS: The available data on the tissue Doppler imaging (TDI) of 230 patients with refractory HF were analyzed. The patients were divided into three groups according to the QRS duration: QRS duration < 120 ms; 120-150 ms; and ≥ 150 ms and the patients were re-categorized into two subgroups depending on the underlying etiology: ischemic cardiomyopathy (ICM) or dilated cardiomyopathy (DCM). The time-to-peak myocardial sustained systolic velocity (Ts) in six basal and six middle segments of the LV was measured manually using the velocity curves from TDI. LV dyssynchrony was defined as interventricular mechanical delay ≥ 40 ms and tissue Doppler velocity all segments delay ≥ 105 ms; standard deviation (SD) of all segments ≥ 34.4 ms; basal segments delay ≥ 78 ms; SD of basal segments ≥ 34.5 ms; and opposing wall delay ≥ 65 ms. RESULTS: After adjustment for the possible confounders, interventricular dyssynchrony was more prevalent in the patients with QRS duration ≥ 150 ms than in those with QRS duration 120-150 ms and < 120 ms. The patients with DCM also had a higher percentage of interventricular dyssynchrony than those with ICM in the wide QRS groups. Turning to the intraventricular dyssynchrony indices, the patients with QRS duration ≥ 150 ms and 120-150 ms revealed a significantly greater delay between Ts at the basal and all segments than did those with QRS duration < 120 ms, while etiology did not influence the frequency of these indices in each QRS group. CONCLUSION: The prevalence of both inter and intraventricular dyssynchrony indices was greater in the patients with wide QRS than in those with narrow QRS duration. The underlying etiology may affect the frequency of interventricular but not intraventricular dyssynchrony indices.

Psychological and behavioral traits in smokers and their relationship with nicotine dependence level.

BACKGROUND: Although several studies have been performed to evaluate the personality differences amongst smokers with different dependency levels, they do not use constant criteria for patients selection. The inconsistencies between some of these findings suggest the need for using solid criteria such as the modified Fagerstrom Tolerance Questionnaire (mFTQ) score to evaluate the relation between personality traits and impulsivity differences and the severity of nicotine dependency. MATERIALS AND METHODS: In this study, 22 heavily dependent, 37 lightly dependent and 30 non-smokers were recruited using the mFTQ score, a widely used test of nicotine dependence. All participants completed the Beck Depression Inventory, Cattle Anxiety Scale, Temperament, and Character Inventory and three other personality questionnaires intended to measure impulsivity: the Barratt's Impulsiveness Scale, Eysenck Impulsiveness Questionnaire, and Zuckerman's Sensation Seeking Scale. Participants also had to perform a behavioral choice task, the Delay Discounting Choice, which is designed to assess impulsivity. RESULTS: Although heavily dependent smokers scored higher than non-smokers and lightly dependents on the Beck depression Inventory and most of the impulsivity subscales; lightly dependent smokers scored higher than non-smokers only on a few subscales of the impulsivity scores. CONCLUSIONS: The mFTQ scores correlated significantly with many scores of the impulsivity subscales. These results would be helpful to design more specific questionnaires for the psychological assessment of smokers according to nicotine dependence level and to adopt more etiologic oriented treatment approaches in the future.

Association between Androgenic Hormone Levels and Left Ventricular Ejection Fraction.

BACKGROUND: Androgens have been shown to have diverse effects on the cardiovascular system. The aim of this study was to compare androgenic hormone levels in patients with different left ventricular ejection fractions (EF). METHODS: The study population consisted of 515 consecutive men who were referred for angiographic studies and whose results of echocardiography and coronary angiography were available. The patients were classified into four groups: EF < 35%, EF = 35-45%, EF = 45-54%, and EF ≥ 55% to evaluate the trends of baseline characteristics and serum androgens, including free testosterone (fT), total testosterone (tT), and dehydroepiandrosterone sulfate (DHEAS). To better elucidate the difference in the patients with severe heart failure, the patients were divided into two groups according to their EF level, and comparisons were repeated between those with EF < 35% and the ones with EF ≥ 35%. RESULTS: There were statistically significant trends in some characteristics in the patients with different levels of EF. The subjects with higher EF levels were less likely to have diabetes (p value < 0.001), coronary artery lesion (p value < 0.001), or high levels of C-reactive protein (CRP) (p value < 0.001). As regards the patients with severe heart failure, our regression analysis revealed that the fT level was significantly lower in those with EF < 35% than in the ones with EF ≥ 35% (5.82 ± 2.73 pg/mL vs. 6.88 ± 3.34 pg/mL, p value < 0.05). CONCLUSION: A significant association was found between the level of fT and EF < 35%. There is a need for further controlled prospective studies to delineate any possible causal relationship accurately.

Transcatheter closure of patent ductus arteriosus: initial study on echocardiographic estimation of device size.

BACKGROUND: Transcatheter occlusion of the patent ductus arteriosus (PDA) is a minimally invasive treatment. The appropriate device size is chosen based on the angiographic measurement of the PDA. The current study aimed to assess the relationship between the transthoracic echocardiographic (TTE) measurements of the PDA prior to the occlusion procedure and the actual size of the deployed device. METHODS: We reviewed the available records of 7 patients (2 male) who underwent the procedure at our institution (mean age: 21 ± 12.7 years, range: 7 to 46 years). PDA closure was performed successfully using the Amplatzer Duct Occluder (n = 5) and its Chinese copycat, Cardi-O-Fix Occluder (n = 2). RESULTS: The TTE measurement of the aortic end diameter of the PDA showed a good linear regression correlation with the size of the implanted duct occluder [duct occluder size = 0.543 + (0.941× TTE measured diameter), R = 0.907; p value ≤ 0.01]. CONCLUSION: TTE can provide a good estimation of the size of the Amplatzer duct occluder.

Role of ventral hippocampal GABA(A) and NMDA receptors in the anxiolytic effect of carbamazepine in rats using the elevated plus maze test.

BACKGROUND: The successful use of antiepileptic drugs to treat a wide range of nonepileptic disorders led us to evaluate the potential efficacy of carbamazepine (CBZ) in anxiety disorders. Anxiety may be related to the imbalance between gamma-aminobutyric acid (GABA) and glutamate neurotransmitters, systems that are also involved in the CBZ effects. We investigated the role of these systems in the ventral hippocampus (VH) and their interactions with the CBZ effect on anxiety-like behavior in rats using the elevated plus maze. METHODS: Animals received GABAergic and NMDA agents in a volume of 1 microl/rat, which was injected into the VH (0.5 microl for each side) 60 min after receiving systemic administration of CBZ. The test sessions took place 10 min later. RESULTS: The systemic administration of CBZ increased the percentage of open arm time (%OAT) at the dose of 40 mg/kg, which is representative of an anxiolytic response. Intra-VH injection of the GABA(A) receptor agonist muscimol (0.25-1 microg/rat) in the absence or presence of an ineffective dose of CBZ (30 mg/kg) did not show any significant changes in the parameters of anxiety-like behavior. The administration of GABA(A) receptor antagonist bicuculline by itself decreased %OAT at a dose of 1 microg/rat, indicating possible anxiogenic effect. The antagonist (0.75 and 1 microg/rat) also decreased CBZ response. A microinjection of NMDA (0.125 and 0.25 microg/rat) decreased %OAT, which was reversed by the administration of CBZ (40 mg/kg). This indicates interaction between the two drugs. However, the NMDA receptor antagonist DAP-5 (1 microg/rat) significantly increased %OAT, but combined with the lower dose of CBZ (30 mg/kg), it did not trigger any response on anxiety-like parameters. CONCLUSION: Both GABAergic and NMDA systems in the VH play a role in modulation of anxiety-like behavior of rats. The anxiolytic-like effects of CBZ seem to be mediated, at least in part, through an interaction with GABA(A) and NMDA systems in the VH.