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   Table of Contents - Current issue
July-December 2017
Volume 5 | Issue 2
Page Nos. 25-43

Online since Tuesday, July 16, 2019

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Left ventricular ejection fraction and mitral regurgitation assessment: A comparison study between echocardiography and angiography Highly accessed article p. 25
Ahmad Mirdamadi, Negah Tavakolifard, Ehsan Ebrahimi
Introduction: Measurement of the left ventricular ejection fraction (LVEF) is a common tool for evaluating the left ventricle (LV) systolic function. The aim of this study was to evaluate and compare the LVEF and mitral regurgitation (MR) severity as estimated by angiography and echocardiography in patients with coronary artery disease (CAD) and LV systolic dysfunction. Methods: In this observational study, 39 men and 11 women at a mean age of 60 years were recruited. The patients underwent catheterization and echocardiography, and the data on the LVEF and MR by both methods were registered. Results: The mean LVEF by echocardiography and angiography was significantly correlated (correlation coefficient = 0.698; P < 0.0001). Although there was agreement between these methods in the estimation of the mean EF (mean difference in the LVEF = 1.23 ± 7.63% and 95% limit of agreement = −12.5–19) and the κ coefficient was 45.7% (P = 0.001), the estimated mean EF was 32.6 ± 10.25% by echocardiography and 29.8 ± 8.2% by angiography (P = 0.007). Furthermore, there was a statistically significant difference in the estimated MR severity between the two methods (P = 0.0001), with echocardiography reporting higher degrees of severity than angiography. Conclusions: In our patients with CAD and LV systolic dysfunction, after the exclusion of age, sex, number of diseased coronary arteries, and myocardial infarction history from the analysis, although the mean LVEF by echocardiography and angiography was significantly correlated, echocardiography estimated higher LVEF values than angiography, especially in the patients with triple-vessel disease. Moreover, echocardiography showed higher degrees of MR severity than angiography.
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Cardiac metastasis from a renal cell carcinoma without contiguous vena caval involvement p. 30
Azin Alizadeasl, Feridoun Noohi, Farnoosh Larti, Saeid Hosseini, Majid Maleki
Tumors that involve the heart are more likely to represent metastatic disease than do primary cardiac neoplasms. Cardiac metastases from a renal cell carcinoma are rare and would be unique when there is no contiguous vena caval involvement such as the case that will be described here.
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Isolated congenital left ventricular diverticula: A rare cardiac anomaly p. 32
Nahid Rezaeian, Homa Najafi
Ventricular diverticula are a rare congenital abnormality characterized by synchronized contractility. Isolated diverticula mostly remain asymptomatic until adulthood. In this case report, we describe a 22-year-old woman with a history of pain in her arms and cold-induced skin discoloration. She was evaluated with echocardiography and cardiac magnetic resonance imaging, which illustrated a muscular basal diverticulum in the left ventricle.
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Pregnancy complicated with severe aortic coarctation p. 35
Maryam Moshkani Farahani, Zahra Pour Jafar
Coarctation of the aorta (COA) is a congenital disease with significant stenosis of the aorta which is associated with some complications such as hypertension. A 37-year-old pregnant woman was referred to our Cardiology Department for control of hypertension. She was in the 26th week of her gestation and she had another uneventful pregnancy 4 years ago. Echocardiography before delivery showed significant coarctation with pressure gradient (PG)= 120 mmHg and cesarean section was done without any abnormal event. Six months later, stenting of aortic stenosis was done with a patient in a good condition. Coarctation (repaired or nonrepaired) is an important clinical condition during pregnancy which needs full investigation.
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Arteriovenous fistula presented with right ventricular failure p. 37
Farveh Vakilan, Fereshte Ghaderi, Hoorak Poorzand, Mahmood Mohammadzadeh Shabestari, Arash Gholobi
Arteriovenous fistula could be traumatic with one manifestation as high-output heart failure. We present a 29-year-old male, referred for unexplained right-sided enlargement and the symptoms of right ventricular failure for 8 months ago. Considering right-sided dilatation, marked inferior vena cava plethora, and increased pulmonary passage of flow in the absence of intracardiac shunts, arteriovenous shunt was suspected. He had a history of penetrating abdominal trauma which raised the suspicion for further evaluation. Abdominal sonography and contrast-enhanced computed tomography revealed a large arteriovenous fistula between the left common iliac artery and vein. The patient underwent successful percutaneous repair with a stent graft and dramatic improvement in symptoms and resolution of flushing and edema.
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Postpartum inverted takotsubo cardiomyopathy after intravenous atropine administration p. 41
Rienzi Diaz-Navarro, Petros Nihoyannopoulos
Postpartum Takotsubo cardiomyopathy is mainly induced by drugs that enhance sympathetic nervous activity. We report a novel case of postpartum inverted Takotsubo cardiomyopathy triggered by intravenous atropine administration resulting in acute pulmonary edema. Cardiac troponin I and beta-type natriuretic peptide were elevated. Transthoracic color Doppler echocardiography demonstrated a nondilated left ventricle with mid-basal akinesis, a hyperdynamic apex, and moderate-to-severe mitral regurgitation likely linked to papillary muscle dysfunction. Coronary computed tomography angiography revealed normal coronary arteries. Atropine inhibits the parasympathetic nervous system, alters the autonomic system balance, and, thus, leads to increased sympathetic nervous activity, which seems to have been the cause of Takotsubo cardiomyopathy in this patient. Atropine should be listed among the drugs triggering Takotsubo cardiomyopathy.
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