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   Table of Contents - Current issue
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January-June 2017
Volume 5 | Issue 1
Page Nos. 1-24

Online since Monday, January 21, 2019

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ORIGINAL ARTICLES  

Longitudinal strain in beta thalassemia major and its relation to the extent of myocardial iron overload in cardiovascular magnetic resonance p. 1
Hoorak Poorzand, Tayebeh Sadat Manzari, Farveh Vakilian, Parvaneh Layegh, Zahra Badiee, Farzaneh Norouzi, Negar Morovatdar, Zahra Alizadeh Sani
DOI:10.4103/ACVI.ACVI_6_18  
Background: Iron overload is a common problem in beta-thalassemia major. Finding a reliable and available modality to determine the presence of iron overload in the initial stages might decrease the risk of cardiomyopathy. We sought a reliable echocardiographic index to assess the extent of iron overload. Methods: This cross-sectional study was conducted on patients with beta-thalassemia major from June 2016 to May 2017. All the patients underwent T2* magnetic resonance imaging, conventional echocardiography, tissue Doppler study, and strain imaging for the measurement of ventricular systolic function indices including the left ventricular global longitudinal strain (LVGLS). The echocardiographic findings were compared between those with myocardial iron overload (T2* ≤20 ms) and those without it (T2* >20 ms) and in the second phase between those with nonsevere overload (20 ms >T2* >10 ms) and those with severe overload (T2* ≤10 ms). Results: Forty-four patients, comprising 23 (52.35%) males and 21 (47.7%) females, were enrolled. All the patients were receiving chelating drugs. The LVGLS showed a significant difference between those with myocardial iron overload and those without it (P = 0.012). Accordingly, a cutoff value of −17.5 for the LVGLS had 100% specificity and 43.8% sensitivity. Concerning the distinction between nonsevere and severe iron overload states, the average LVGLS (P < 0.001), LV end-diastolic volume index (P = 0.016), and LV end-systolic index (P = 0.016) showed significant differences between the groups. Conclusions: The LVGLS might be used as a reliable echocardiographic index for defining myocardial iron overload.
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Prognostic value of dobutamine stress echocardiography in patients with myocardial dysfunction undergoing coronary artery bypass grafting p. 6
Mohsen Mirmohammad Sadeghi, Ahmad Mirdamadi, Zahra Arabi, Amir Banazadeh Dardashti
DOI:10.4103/ACVI.ACVI_3_18  
Background: Given the high capability of dobutamine stress echocardiography (DSE) in the actual estimation of the ventricular function and the prediction of the intraoperative or postoperative outcomes of revascularization, especially following coronary artery bypass grafting (CABG), we aimed to assess the relationship between DSE findings and CABG outcomes. Methods: This retrospective case–control study was conducted on forty patients with left ventricular (LV) systolic dysfunction who underwent CABG during an 8-year period. All the patients were assessed with DSE to determine their ventricular functional status. Checklists containing DSE findings based on the latest guideline, demographics, and the outcomes of revascularization were filled out for the participants. Telephone follow-up was done for all the participants after 6 months. The data were analyzed using SPSS, version 16. Results: Resting LV ejection fraction (LVEF) ≤25%, peak DSE LVEF ≤35%, absolute increase in the LVEF (LVEF change) <8%, a minimum resting wall motion score index (WMSI) of 2, a post-DSE WMSI >2.25, a minimum pulmonary artery pressure (PAP) of 30 mmHg, and nonviable myocardium had positive correlations with the short- and long-term complications of CABG. These correlations were statistically significant between a maximum pre-DSE LVEF of 25% and an LVEF change of < 8% and the operating room complications (P < 0.001) and between nonviable myocardium and the complications in the intensive care unit (ICU; P < 0.001). However, our results did not show that the peak DSE LVEF, WMSI, PAP, and nonviable myocardium were the significant predictors of death due to CABG. It appears that only a pre-LVEF of <25% is a significant predictor of death after CABG (P < 0.001). Conclusions: DSE findings were able to predict complications in the operating room and in the ICU, especially in the participants with low LVEFs.
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Outcomes after coronary computed tomography angiography of patients at low to intermediate risk for acute coronary syndrome p. 11
Ata Firouzi, Hamidreza Pouraliakbar, Golnaz Banisadr, Zahra Hosseini, Mostafa Yarahmadi
DOI:10.4103/2322-5327.250545  
Background: Coronary computed tomography angiography (CTA) has recently been shown to enjoy a high negative predictive value for ruling out coronary heart disease and risk stratifying patients with acute coronary syndrome (ACS). Hence, we assessed the 1-year outcome associated with a CTA-guided strategy in patients presenting to the emergency department with low to intermediate risk for ACS graded according to the GRACE score. Methods: In this case-series study, 77 consecutive patients (mean age = 49.7 ± 10.1 and 53.2% female) who presented to the emergency department with ischemic-type chest pain and low to intermediate risk for ACS were evaluated prospectively. The patients underwent coronary CTA after the measurement of troponin I. Those with nonobstructive plaques and mild stenoses (<50% luminal narrowing) were discharged with optimal treatment without further evaluations, those with moderate stenoses (50%–70% narrowing) were discharged with optimal treatment and close follow-ups, and those with severe stenoses (>70% narrowing) underwent coronary angiography. The discharged patients were contacted and their medical records were reviewed to determine the rates of major adverse cardiovascular events (MACE)—comprising death, myocardial infarction, stroke, hospital admission, and revascularization. Results: A total of 89.6% of the patients were in the low-risk ACS group. There was no significant association between MACE and the subscales and the GRACE score (P > 0.05). There was no relationship between the GRACE score and the severity of coronary stenosis (P > 0.05) and the high-severity plaques (P > 0.05). However, the severity of stenoses in the proximal part of the left anterior descending artery (LAD) (P = 0.00), the mid part of the LAD (P = 0.004), and the first part of the obtuse marginal artery (P = 0.004) was associated with MACE. Furthermore, there were no relationships between MACE and the high-risk plaques and the risk factors (P > 0.05). Conclusions: CTA ruled out significant lesions and optimal treatment was accompanied by good prognoses in our patients. CTA may, therefore, be an optimal cost-benefit modality for the determination of the diagnosis and the therapeutic modality in patients at low to intermediate risk for ACS presenting to the emergency department.
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CASE REPORTS Top

Role of multimodality imaging in postsurgical calcified aneurysm of patent ductus arteriosus p. 17
Daryoush Saed, Anita Sadeghpour, Azin Alizadehasl, Hamidreza Pouraliakbar, Ata Firouzi, Saeid Hosseini, Parvin Bayati
DOI:10.4103/ACVI.ACVI_2_18  
A patent ductus arteriosus (PDA) is a common congenital malformation in pediatric patients and accounts for 7%–10% of congenital heart diseases. The PDA is a posttricuspid shunt resulting from an arterial communication between the upper descending aorta and the distal pulmonary artery, is an important part of a normal fetal cardiac anatomy and usually closes spontaneously within 1 week after birth. Closure is indicated in patients with significant related symptoms, history of endarteritis, or dilation of the left atrium and/or the left ventricle (LV). Before the development of percutaneous PDA closure, surgical closure was recommended as the main routine treatment. An occasional occurrence is the recanalization of a surgically ligated ductus arteriosus, which may be associated with the serious complication of aneurysm formation. Herein, we report a rare case of a longstanding neglected PDA aneurysm as a complication of postsurgical PDA closure and discuss the weaknesses and strengths of cardiac imaging in this regard. A 31-year-old man with a history of surgical ligation of the PDA 20 years ago was referred to us for preoperative evaluation before elective noncardiac surgery. Electrocardiography revealed a normal sinus rhythm and an LV volume-overload pattern. Severe LV enlargement and moderate systolic dysfunction associated with a large residual PDA were found on transthoracic echocardiography. Cardiac catheterization and cardiac computed tomography angiography confirmed the presence of a calcified aneurysm of PDA, which was not suitable for percutaneous PDA closure. The patient underwent successful surgical closure without any residue or complications.
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Coronary artery perforation during percutaneous coronary artery intervention: A case report and literature review p. 21
Arsalan Salari, Zohre Heydarnezhad, Mahboobe Gholipur, Maedeh Rezaeidanesh, Fatemeh Moaddab
DOI:10.4103/ACVI.ACVI_9_18  
Percutaneous coronary intervention (PCI), despite its remarkable efficacy in the treatment of coronary artery disease, has some complications such as coronary artery perforations, which are uncommon but may lead to pericardial effusion and progress to cardiac tamponade, myocardial infarction, and death. A 76-year-old woman with a history of exertional angina was admitted to our hospital for PCI. The angiographic feature of the patient's PCI was a major dye leakage into the pericardial sac with a frank perforation, representing Type III Ellis classification. Given her unstable hemodynamic state and a high risk for perforation, immediate pericardiocentesis was performed and a JoStent GraftMaster Stent was used. In addition, a decision was made to perform a covered stent implantation, as an alternative to surgery, because balloon dilation failed to stop the leakage. The perforation was sealed successfully. After the pericardiocentesis and the emergency covered stent implantation, the patient was stable and her hemodynamic state improved gradually. Coronary artery perforations with sequelae during the intervention, albeit a rare event, may lead to serious complications and even death. While prompt surgical intervention may be life-saving, expertise in the use of covered stents may provide a valuable rescue option for this serious complication.
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