Obstructive sleep apnea and severity of coronary artery disease.

BACKGROUND: It has been implicated that obstructive sleep apnea (OSA) is associated with increased risk of cardiovascular disease including stroke, myocardial infarction, coronary artery disease (CAD) and hypertension. The aim of this study was to investigate the correlation between OSA and severity of atherosclerosis assessed by angiography. METHODS: This study included 337 patients undergoing diagnostic coronary angiography at Tehran Heart Center, Iran. The Gensini score was obtained from each patient for coronary angiogram, and OSA were assessed by using Multivariable apnea prediction (MAP) risk index on the day of cardiac catheterization. The Gensini scores increased in accordance with increases in the MAP value. RESULTS: The prevalence rates of three-vessel disease were 68.0% in OSA group and 32.0% in non-OSA group. The MAP index was the most significant independent determinant for the Gensini score. CONCLUSIONS: The independent association between OSA and CAD, even after adjustment for traditional confounders, suggests that, OSA should be taken into account when considering risk factors for CAD.

Effect of exercise-based cardiac rehabilitation following coronary artery bypass surgery on ventricular repolarization indices.

PURPOSE: Indices of ventricular repolarization heterogeneity are associated with future arrhythmias and sudden cardiac death. We investigated the effect of exercise-based cardiac rehabilitation (CR) on these indices in a sample of Iranian patients. METHODS: Patients (N 122), who had undergone coronary artery bypass surgery (CABGS), were enrolled in this cohort study. Sixty patients attended 15 or more sessions of CR (CR group) and the remaining 62 patients attended 5 or fewer sessions of CR (control group). A standard 12-lead electrocardiogram was recorded for each patient. QT interval dispersion (QTd), RR interval variability (RRV), and heart rate-corrected QTd (QTc-d) were measured 3 times as follow: just before surgery, at the beginning of the first session of the CR program, and at the end of the 15th session for the CR group or the last session for the control group. RESULTS: Following completion of the exercise-training program, the CR group showed a significant decrease in QTd (Δ = -49.4%, P < .0001) and QTc-d (Δ = 52.8%, P .0001), but not in the control group (Δ = 13.4% and 17.9%, respectively, P > .05 for both). In both groups, no statistically significant change in RRV was observed. After adjustment for variables such as age, gender, digoxin use, ß-blocker use, and prerehabilitation ejection fraction, CR remained the independent predictor of QTd and QTc-d. CONCLUSION: Results suggest that cardiac rehabilitation and exercise training programs significantly improve the indices of ventricular repolarization heterogeneity in patients with coronary artery disease who received CABGS.

Role of fine-needle aspiration in the management of thyroid nodules.

OBJECTIVE: To show the benefits of fine-needle aspiration biopsy (FNAB) in managing thyroid nodules. METHODS: As a retrospective study, reports of 888 FNABs of the thyroid performed during a period of 11 years (1996-2007) at Tehran University of Medical Sciences, Sina Hospital and Endocrine Clinic, Tehran, Iran were reviewed. Histological diagnoses were available for 182 cases, and we compared cytological diagnoses of FNAB with pathologic reports. RESULTS: The cytology diagnoses by FNAB were: papillary 6 (3.2%); follicular neoplasm 51 (28%); follicular adenoma 10 (5.4%); Hurthle cell neoplasm 8 (4.3%); suspicious 20 (10.9%); inconclusive 2 (1%); and benign 85 (46.4%). Due to surgery pathologic reports, malignant cytologies were: 6 (100%) for papillary, 1 (1.96%) for follicular neoplasm, 4 (50%) for Hurthle cell neoplasm. In suspicious reports, 11 (55%) reports of pathology were malignant; and in inconclusive reports, one report (50%) was malignant. CONCLUSION: Fine needle aspiration is a useful technique for selecting patients with nodular thyroid disease for surgery.