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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
Hoorak Poorzand, Tayebeh Sadat Manzari, Farveh Vakilian, Parvaneh Layegh, Zahra Badiee, Farzaneh Norouzi, Negar Morovatdar, Zahra Alizadeh Sani
January-June 2017, 5(1):1-5
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.
  673 73 -
Left ventricular ejection fraction and mitral regurgitation assessment: A comparison study between echocardiography and angiography
Ahmad Mirdamadi, Negah Tavakolifard, Ehsan Ebrahimi
0, 0(0):0-0
DOI:10.4103/ACVI.ACVI_7_18  
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.
  472 26 -
CASE REPORTS
Role of multimodality imaging in postsurgical calcified aneurysm of patent ductus arteriosus
Daryoush Saed, Anita Sadeghpour, Azin Alizadehasl, Hamidreza Pouraliakbar, Ata Firouzi, Saeid Hosseini, Parvin Bayati
January-June 2017, 5(1):17-20
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.
  423 44 -
ORIGINAL ARTICLES
Prognostic value of dobutamine stress echocardiography in patients with myocardial dysfunction undergoing coronary artery bypass grafting
Mohsen Mirmohammad Sadeghi, Ahmad Mirdamadi, Zahra Arabi, Amir Banazadeh Dardashti
January-June 2017, 5(1):6-10
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.
  388 45 -
CASE REPORTS
Coronary artery perforation during percutaneous coronary artery intervention: A case report and literature review
Arsalan Salari, Zohre Heydarnezhad, Mahboobe Gholipur, Maedeh Rezaeidanesh, Fatemeh Moaddab
January-June 2017, 5(1):21-24
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.
  323 42 -
RESEARCH ARTICLES
The right ventricle: A comprehensive review from anatomy, physiology, and mechanics to hemodynamic, functional, and imaging evaluatio
Anita Sadeghpour, Azin Alizadehasl
November 2015, 3(4):4-4
DOI:10.5812/acvi.35717  
The right ventricle (RV) is a complex structure with abstruse function that reveals important differences when compared to the left ventricle (LV), so it cannot be described as a simple geometric form and achromatic physiology. As an inference from this fact, in the present review, weaim to describe RV structure including theembryology, anatomy, and physiology and present a functional, hemodynamic, and imaging assessment of the normal and failing RV. So that, we conducted a thorough review based on the database sources such as MEDLINE, PubMed, Cochrane and Google scholar. No restrictions were placed on study date, study design, or language of publication. We searched all valuable and relevant information considering the anatomy, physiology, mechanics, hemodynamic and imaging evaluation of RV.
[ABSTRACT]   Full text not available  [PDF]
  179 44 -
The effects of curcumin on left ventricular function in patients with chronic renal failure
Arezoo Khosravi, Hesam Hashemi, Maryam Moshkani Farahani, Mitra Dolatkhah, Zohreh Rostami, Younes Panahi
February 2016, 4(1):6-6
DOI:10.5812/acvi.38087  
Background: Curcumin, a yellow substance found in turmeric, has not only antioxidative features and beneficial effects in the treatment of cancer, liver, heart, and pulmonary diseases but also anti-inflammatory and anticoagulative effects. This chemical has cardioprotective effects too. Objectives: In this study, we examined the effects of curcumin on left ventricular (LV) function in patients receiving dialysis for chronic renal failure. Methods: This study is a double-blind, placebo-controlled trial conducted on 35 patients with chronic renal failure undergoing dialysis in the dialysis center of Baqiyatallah hospital. The patients were randomly divided into 2 groups: the curcumin group (n = 20) and the control group (n = 15). The curcumin group received curcumin capsules at a dose of 500 mg every 8 hours for 6 weeks (1500 mg/d) and the control group received a placebo for 6 weeks at the same dose. Echocardiography was done before the use of the drug and once after the 6th week. Also, the ejection fraction (EF), representing LV function and size, was measured in both groups. Results: Themeanage was 44.2±13.4 years for the curcumin group and 45.4±6.2 years for the placebo group. The study population comprised 22 male and 13 female patients. There were no significant differences regarding demographic variables such as age, sex, and body mass index between the 2 groups. In the curcumin group, LVEF based on the volume changed from 50.6% ±7.1% to 51.5% ± 6.8% (P = 0.130). In the curcumin group, LVEF based on the diameter changed from 51.8% ± 3.8% to 52.4% ± 3.5% (P = 0.112). The changes in the mean EF before and after the intervention were not significant in each group. The EF, based on ventricular volume and diameter, was not significantly different between the 2 groups. In addition, the pulmonary artery pressuremeanin both groups did not significantly change after the intervention (P > 0.05). Conclusions: The administration of curcumin in patients undergoing dialysis had no positive effects on enhancing LVEF and LV function. Further research is required to shed sufficient light on this issue.
[ABSTRACT]   Full text not available  [PDF]
  172 36 -
CASE REPORTS
Large coronary-cameral fistulas in an adult patient: A rare coronary anomaly with concealed clinical findings (Case Report and Literature Review)
Hamidreza Pouraliakbar, Anita Sadeghpour, Azin Alizadehasl, Ata Firoozi, Kianoush Homightoun, Nazila Alborzi, Pravin Bayati, Masoud Movassaghi
May 2016, 4(2):2-2
DOI:10.5812/acvi.40954  
Coronary-cameral fistulas (CCFs) constitute a rare anomaly that can be incidentally detected during angiography. CCFs are solitary, large or small assemblies that originate from coronary arteries and enter one of the cardiac chambers. We describe a 29-year-old woman, whoreferred to our clinic with the chief complaints of palpitation, atypical chest pain, and dyspnea on exertion (functional class II). Multimodality imaging confirmed the diagnosis of a CCF from the left main with extension to the right atrium and drainage therein. The CCF was closed percutaneously with a patent ductus arteriosus occluder successfully.
[ABSTRACT]   Full text not available  [PDF]
  147 51 -
ORIGINAL ARTICLES
Outcomes after coronary computed tomography angiography of patients at low to intermediate risk for acute coronary syndrome
Ata Firouzi, Hamidreza Pouraliakbar, Golnaz Banisadr, Zahra Hosseini, Mostafa Yarahmadi
January-June 2017, 5(1):11-16
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.
  165 31 -
BRIEF REPORT
Role of computed tomographic angiography in central venous catheter related complications in dialysis patients
Konstantinos Spanos, Christos Karathanos, George Kouvelos, Athanasios Athanasoulas, Aikaterini Drakou, Athanasios D Giannoukas
May 2016, 4(2):3-3
DOI:10.5812/acvi.41807  
Background: The central venous catheter (CVC) is broadly used in medical practice. However, its use constitutes an invasive procedure with morbidity. Objectives: To assess the role of computed tomographic angiography (CTA) in CVC related complications and the mid-term outcome of dialysis patients after their treatment. Methods: This is a retrospective analysis of prospectively collected data of dialysis patients treated for CVC-related complications and their monitoring during a midterm follow-up. Results: From 2012 - 2014, eight patients (mean age 59±1.2 years; 6 males) with CVC related complication were treated. All complication were diagnosed and verified by a CTA (100%). Two patients presented with local hematoma, 3 with major bleeding, 2 with a retained guide-wire, and 1 with a disconnected part of a port-catheter. The direct repair of an arterial or venous wall injury was undertaken in 7 patients, with the simultaneous removal of a retained guide-wire in 2 and the removal of a misplaced CVC in 1 of them. One patient had the endovascular approach with the removal of the disconnected part. No death or major complication occurred during the procedures. During the follow-up (range =12 - 24 mon), no re-intervention, clinical episode of venous thromboembolism, or death was recorded. Conclusions: Invasive treatment of dialysis patients for CVC related complications is effective and durable during mid-term follow up with no re-intervention, clinical episode of VTE or death. CTA is a reliable mean for the diagnosis of CVC related complications.
[ABSTRACT]   Full text not available  [PDF]
  161 30 -
RESEARCH ARTICLES
Does the post-systolic shortening of the left ventricle by tissue doppler imaging predict coronary artery disease?
Hanan Radwan, Ahmed Shawky, Abd Elhakem Selem
May 2016, 4(2):5-5
DOI:10.5812/acvi.41788  
Background: Abnormalities in the velocity and pattern of myocardial shortening on tissue Doppler imaging (TDI) have been proposed to aid in the noninvasive diagnosis of coronary artery disease (CAD). Objectives: We investigated the diagnostic value of post-systolic shortening (PSS), a delayed ejection velocity of the myocardium after the closure of the aortic valve, on TDI in the diagnosis of CAD among patients with chest pain and normal resting wall motion on standard 2D echocardiography. Methods: Eighty consecutive patients (49% female) with typical ischemic chest pain but without prior myocardial infarction, coronary revascularization, arrhythmia, or heart failure, who had no regional wall motion abnormalities on resting echocardiography revascularization, arrhythmia, or heart failure, who had no regional wall motion abnormalities on resting echocardiography at 2 levels (basal and mid left ventricle [LV]) in each of the 4 LV walls (i.e., septal, anterior, inferior, and lateral). Coronary angiography was performed and interpreted per standard clinical protocols. Results: Compared to the patients with normal coronaries, those with angiographic CAD showed significantly increased myocardial isovolumic relaxation time (IVRT) velocity (P < 0.001) and significantly prolonged IVRT (P < 0.001) at the septal, anterior, inferior, and lateral LV walls. With a cutoff value > 4.0 m/sec, a positive PSS velocity had about 65% sensitivity and 85% specificity with a positive predictive value > 90% in predicting angiographic CAD. Conclusions: Among patients with chest pain and normal LV wall motion on 2D echocardiography, a prominent and prolonged IVRT on TDI may help predict the presence of significant CAD.
[ABSTRACT]   Full text not available  [PDF]
  149 36 -
RESEARCH ARTICLE
Echocardiographic assessment of right atrium deformation indices in healthy young subjects
Zahra Ojaghi Haghighi, Azin Alizadehasl, Majid Maleki, Nasim Naderi, Maryam Esmaeilzadeh, Fereidoon Noohi, Hassan Moladoust, Hooman Bakhshandeh, Paridokht Nakhostin Davari, Rasoul Azarfarin, Hossein Ojaghi Haghighi
August 2013, 1(1):2-7
DOI:10.5812/acvi.11107  
Background: Recently, assessment of the atrial motion and deformation indices obtained via Doppler myocardial imaging (DMI) has been proposed as a new method of exploring the atrial function. Objective: Our aim was to assess the right atrial (RA) regional function using myocardial velocities, strain, and strain rate imaging (SRI) and compare it with the function of the inter-atrial septum (IAS) and left atrial (LA) lateral wall in healthy young adults. Patients and Methods: A total of 75 healthy young individuals (35 women and 40 men) underwent standard transthoracic echocardiography and DMI at rest. Myocardial velocities, strain, and SRI profiles from the RA free wall, IAS, and LA lateral wall were calculated throughout the three cardiac cycles. Peak systolic, diastolic and time to peak were derived, and the average of the three cardiac cycles was taken into account for analysis in this study. Results: The RA peak systolic, peak of early, and late diastolic velocities were 9.2 ± 1.6 cm/s, -9.5 ± 1.8 cm/s, and -8.3 ± 2.1 cm/s, respectively. The RA peak systolic strain was 152% ± 51%. The RA systolic strain was significantly higher than that of the IAS (87% ± 21%, P = 0.001) and the LA lateral wall (89% ± 15%, P = 0.001). The RA peak systolic, peak early and late diastolic SR were 6.3±3.0 s-1, -5.4 ± 1.7 s-1, and -4.5 ± 2.2 s-1, respectively. Conclusions: DMI proved to be a feasible and reproducible method for the assessment of the RA function in healthy young subjects. Study of myocardial properties showed that the RA free wall myocardial motion and deformation were significantly higher than those of the IAS and the LA lateral wall, but the rate of the RA free wall deformation was not significantly higher than that of the IAS and the LA lateral wall.
[ABSTRACT]   Full text not available  [PDF]
  155 27 -
LETTERS
Severe isolated rheumatic aortic valve regurgitation
Azin Alizadehas, Samaneh Pourhosseinali
May 2016, 4(2):1-1
DOI:10.5812/acvi.41758  
[ABSTRACT]   Full text not available  [PDF]
  134 43 -
Hypertrophic obstructive cardiomyopathy diagnosed during regadenoson stress test
Salahuddin Siddiqui, Khalid J Manzar
February 2016, 4(1):2-2
DOI:10.5812/acvi.40908  
[ABSTRACT]   Full text not available  [PDF]
  135 35 -
CASE REPORTS
Fatal expanding thoracoabdominal aneurysm in known but mistreated behcet's disease in a young patient
Bakkali Tarik, Hamzi Mohamed Amine, Lekhel Brahim, Sefiani Yasser, Mesnaoui Abbes, Bensaid Younes
February 2016, 4(1):3-3
DOI:10.5812/acvi.38067  
Introduction: Arterial involvement in Behcet's disease has been previously described. We report a rare case of a large and longsegment thoracoabdominal aneurysm, which was associated with Behcet's disease and had an unfavorable evolution. Case Presentation: A 23-year-old man was diagnosed with Behcet's disease, as revealed by a carotid aneurysm, and was treated with a prosthetic graft reconstruction as well as immunosuppressive therapy. The patient was lost to follow-up. He stopped the medications of his own will 1 month after his discharge from the hospital. Two years later, he presented with chest pain of 1 week's duration. Alarge aneurysminvolving a long aorta segment from the sinus of Valsalva to the abdominal aorta above the renal arteries was identified by computed tomography angiography. Unfortunately, the patient died despite immunosuppressive therapy and before any surgical or endovascular intervention could be performed. Conclusions: This rare observation supports the role of immunosuppressive therapy in preventing the recurrence of lifethreatening vascular lesions in the management of Behcet's disease.
[ABSTRACT]   Full text not available  [PDF]
  138 29 -
LETTERS
Stress echocardiography in prosthetic heart valves
Anita Sadeghpour, Azin Alizadehasl
February 2016, 4(1):1-1
DOI:10.5812/acvi.39032  
[ABSTRACT]   Full text not available  [PDF]
  130 36 -
REVIEW ARTICLES
Pulmonary arterial hypertension: A two-dimensional echocardiographic approach from screening to prognosis
Samir Kanti Saha
May 2016, 4(2):4-4
DOI:10.5812/acvi.41818  
An elevated pulmonary artery pressure (PAP) from any cause is associated with increased mortality, especially in cases of primary pulmonary arterial hypertension (PAH). One of the many reasons behind a bad prognosis is the inherent difficulty in assessing right ventricular (RV) function with reproducible methods. Intensive research involving the left heart has made it relatively easy to assess left ventricular (LV) systolic and diastolic functions in many centers around the world. As for the RV, however, although increasing attention has been focused on the right-sided heart in the recent times, neither global longitudinal strain nor right ventricular ejection fraction (RVEF) has been studied well in relation to the outcome (unlike in the LV). Another issue is that the right heart functions in a circuitry involving the right atrium (RA), the RV, and the pulmonary artery. Hence, all 3 components of this circuit have important roles in unison to eject a cardiac output equivalent to the left-sided heart. In this review, we sought to discuss the ways to quantity the function of the entire circuit using both standard and advanced echocardiographic imaging modalities. As primary PAH is the classic form of pathology causing the RV to face an afterload with which it is not destined to cope, this review is mainly based on the assessment of the right heart as a circuit in idiopathic primary PAH.
[ABSTRACT]   Full text not available  [PDF]
  132 34 -
BRIEF REPORT
Echocardiographic evaluation of the effects of high-intensity interval training on cardiac morphology and function
Arash Saadatnia, Khosrow Ebrahim, Amir Rashidlamir
February 2016, 4(1):5-5
DOI:10.5812/acvi.36007  
Background: High-intensity interval training (HIIT) is a time-efficient alternative to traditional prolonged training. In contrast to ample evidence describing the effects of prolonged training, there are few data describing cardiovascular adaptations arising from HIIT interventions. Objectives: The present study aimed to evaluate the effects of HIIT on heart morphology and function in untrained male subjects. Patients and Methods: Twenty-two young men (age = 23.34 ± 2.56 years, weight = 72.47 ± 12.01 kg, and height = 174.10 ± 5.75 cm) were recruited and randomly assigned into control (n = 10) and HIIT (n = 12) groups. Echocardiography was used to evaluate left ventricular mass (LVM), end-systolic volume (ESV), end-diastolic volume (EDV), interventricular septal wall thickness (IVSWT), stroke volume, and ejection fraction (EF). Also, the Bruce treadmill test was employed to estimate VO2max. Results: The HIIT subjects showed a significant increase in EDV (P = 0.001), LVM (P = 0.002), stroke volume (P = 0.003), and EF (P = 0.001). However, there was no change in ESV due to HIIT (P = 0.916). Additionally, following HIIT, IVSWT (P = 0.227), despite exhibiting a slight increase, was not significantly different from pre-training levels. Conclusions: HIIT in previously untrained subjects led to a significant change in left ventricle (LV) morphology, correlating with improvement in aerobic power (VO2max). Cardiac remodeling was characterized by an increased EDV and a similar increase in LVM.
[ABSTRACT]   Full text not available  [PDF]
  131 29 -
CASE REPORTS
Hypertrophic Obstructive Cardiomyopathy and Takotsubo Syndrome: Could They Coexist?
Pilar Egea-Serrano, Ivan Keituqwa, AnaI Pelaez, Juan R Gimeno
November 2015, 3(4):6-6
DOI:10.5812/acvi.36507  
Introduction: Takotsubo syndrome (TKS) is generally caused by a stressful condition, and it usually has a good prognosis after the recovery of left ventricular function. About 70% of the cases of hypertrophic cardiomyopathy may develop obstruction in the left ventricular outflow tract (LVOT), which is responsible for heart failure. Case Presentation: We present a unique case where TKS occurred in a middle-aged male patient with hypertrophic obstructive cardiomyopathy (HOCM) without a clearly identifiable initial stress trigger. Conclusions: In the setting of acute left ventricular function depression in HOCM, a comprehensive differential diagnosis should be established. Treatment should be based on hemodynamic changes. After recovery, the prognosis is related to HOCM.
[ABSTRACT]   Full text not available  [PDF]
  123 31 -
Bubbles in pericardial fluid: Multimodality imaging in iatrogenic hydropneumopericardium
Armin Attar, Mohammad Bagher Sharifkazemi, Ali Reza Moaref
February 2015, 3(1):5-5
DOI:10.5812/acvi.22787  
Introduction: The term hydropneumopericardium describes the simultaneous accumulation of fluid and gas in the pericardial sac. This condition is mostly caused by primary infiltrative lesions from the adjacent organs, pericardial infections, or trauma and is a very rare situation, usually with favorable outcomes. Case Presentation: We describe a female patient with Lutembacher's syndrome complicated by cardiac tamponade. After surgical treatment, she developed iatrogenic hydropneumopericardium, which was treated conservatively. Conclusions: Iatrogenic hydropneumopericardium can be managed conservatively with supportive measures, and most of these cases resolve spontaneously if they are not large and destabilizing.
[ABSTRACT]   Full text not available  [PDF]
  135 19 -
RESEARCH ARTICLES
Evaluation of tricuspid regurgitant jet velocity in thalassemia patients with splenectomy
Marzieh Nikparvar, Nehzat Akiash, Nader Fayazi, Sepideh Fouladi, Fatemeh Jafary, Mahboubeh Pazoki
February 2016, 4(1):4-4
DOI:10.5812/acvi.39394  
Background: β-thalassemia is an inherited disorder of β-globin biosynthesis. Dysfunction in hemoglobin chain production, ineffective erythropoiesis, and hemolysis occur in β-thalassemia. Pulmonary arterial hypertension (PAH) is increasingly detected in patients with β-thalassemia, and splenectomy which decreases the need for blood transfusion increases the pulmonary artery pressure (PAP). Objectives: This study aimed to assess the PAP in patients with β-thalassemia (male or female and major or intermedia) who had undergone splenectomy. Methods: A total of 137 patients suffering from β-thalassemia were evaluated during the study. All subjects were referred for cardiac evaluation. Clinical history, presence of cardiac symptoms, and previous splenectomy were noted. Standard M-mode, 2D, and Doppler echocardiographic examinations were performed for all subjects. Patients with a tricuspid regurgitant jet velocity (TRV) ≥2.5 m/s were considered at risk for PAH. Results: Average age of the patients was 21.15±6.68 years. No significant difference was observed in the PAP between the 2 groups of thalassemia major and intermedia and also the 2 sex groups. Indeed, 6.6% of the patients had an increased PAP. The significant finding of the study was that the patients who had had splenectomy were significantly at an increased risk of PAH (P = 0.046). Conclusions: The etiology of PAH in thalassemia is multifactorial such as inflammatory mediators. Also, the absence of the spleen plays an important role in developing a high TRV and PAH.
[ABSTRACT]   Full text not available  [PDF]
  125 29 -
Comparison of left atrial function between hypertensive patients with normal atrial size and normotensive subjects using strain rate imaging technique
Mohammad Sahebjam, Asghar Mazareei, Masoumeh Lotfi-Tokaldany, Neda Ghaffari, Arezoo Zoroufian, Mahmood Sheikhfatollahi
February 2014, 2(1):2-2
DOI:10.5812/acvi.16081  
Background: Patients with hypertension are at risk of structural and functional changes in the left atrium (LA). There are only a few studies on the impact of hypertension on LA function, especially in hypertensive patients with a normal LA size. We, therefore, designed this study to evaluate LA function in patients with a normal LA size via deformation imaging. Objectives: We assessed regional longitudinal strain rate imaging (SRI) profiles along with tissue velocity imaging (TVI) in the LA walls to quantify LA reservoir function and explore changes in LA function in hypertensive patients with a normal value of LA size. Patients and Methods: One hundred twenty-four subjects with normal angiography (mean age = 56.28 ± 8.91 years, 46% male), who were referred to the Echocardiography Laboratory of our institution, were enrolled in this study. These subjects were categorized into two groups: hypertensive (75 cases) and age-matched normotensive (49 cases) groups. All the cases of the patient and control groups had a normal LA size. SRI parameters included strain (ST, %) and strain rate (SR, s-1), and tissue imaging parameters such as peak systolic velocity (Sm, m/s) were measured in four septal, lateral, anterior, and inferior LA walls at the mid-level. Results: Compared with the controls, the patients with a history of hypertension showed significantly lower values of Sm, ST, and SR in each segment of the LA. There was no effect of age on these indices. Also, no differences regarding Sm, ST, and SR were found between the septal, lateral, anterior, and inferior LA walls in each group. By multivariate linear regression analysis, a history of hypertension was the only independent determinant of average LA strain rate in the all the individuals (P < 0.001). When this analysis was repeated in the patients with a history of hypertension, the only independent determinant of average LA strain rate was heart rate (P = 0.026). Conclusions: In our subjects, with a normal value of LA size, the effect of hypertension on LA reservoir function was independent of age, sex, heart rate, left ventricular mass index, and left ventricular ejection fraction. Additionally, heart rate independently correlated with reduced TVI and SRI parameters in the patients with hypertension.
[ABSTRACT]   Full text not available  [PDF]
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CASE REPORTS
Multimodality imaging of a cardiac angiosarcoma
Roy Beigel, Joao Carlos Tress, Louise Elizabeth Jane Thomson, Daniel James Luthringer, Alexander Shturman, Alfredo Trento, Robert James Siegel
August 2014, 2(3):1-1
DOI:10.5812/acvi.20252  
Introduction: While primary malignant tumors of the heart are rare, angiosarcomas are the most common cardiac malignant tumors. Case Presentation: We describe a 23-year-old woman who presented with a right atrial mass, which was discovered to be a cardiac angiosarcoma. We demonstrate the use of several noninvasive imaging modalities along with pathology confirmation for the definitive and comprehensive diagnosis of a cardiac angiosarcoma, a rare entity by itself. Conclusions: With the increasing availability of noninvasive imaging techniques, the diagnosis of angiosarcomas can be made at earlier stages. If angiosarcomas are left untreated, their prognosis is very poor. Therapeutic options include surgical excision, chemotherapy, radiation therapy, and heart transplantation or a combination of these.
[ABSTRACT]   Full text not available  [PDF]
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RESEARCH ARTICLES
Total effective radiation dose attributable to medical imaging in patients with acute chest pain: A single-center comparison study between dual-source coronary CT angiography and usual care
Benjamin S Goins, Aaron Henderson, Charles K Lin, Anthony Charmforoush, Takor B Arrey-Mbi, Ryan L Prentice, Jennifer N Slim, Rosco S Gore, Ricardo C Cury, Ahmad M Slim, Dustin M Thomas
August 2015, 3(3):1-1
DOI:10.5812/acvi.34647  
Introduction: Coronary CT angiography (CCTA) can safely disposition low to intermediate risk chest pain (CP); however, there is conflicting data with respect to cumulative radiation exposure when compared with usual care over short follow-up intervals. Objectives: We report the effective radiation dose from index and downstream testing in low to intermediate risk symptomatic patients evaluated for chest pain in the ED with either CCTA or usual care to define various sources of patient radiation dose and quantify effective dose over a year and a half of follow-up. Patients and Methods: We evaluated radiation exposure from initial and downstream testing in a prospectively collected, matched cohort evaluated for CP in the emergency department (ED) with either CCTA compared with usual care over a median follow-up of 19.6 months. Effective radiation dose was calculated using published conversion factors. Results: Prospective, ECG-triggered acquisition using a 128-slice dual-source multidetector computed tomography (DSCT) scanner was performed in 92.9% of scans with a median effective dose from CCTA of 6.8 mSv (IQR 5.2, 9.1 mSv). CCTA cohort patients were more likely to undergo cardiac testing with exposure to radiation (P < 0.001); however, the median effective dose in patients exposed to radiation from cardiac testing was significantly lower in the CCTA cohort (7.1 mSv vs. 11.8 mSv, P < 0.001). Fewer patients in the CCTA cohort had additional non-cardiac thoracic imaging radiation exposure (40.8%) compared with usual care (92.8%). Total radiation exposure from any source was similar between the CCTA and usual care groups (100% vs 98.4%, P = 0.087), as was median total effective radiation dose (P = 0.105). Upfront CCTA was not associated with higher rates of incidental non-cardiac findings. Conclusions: Initial evaluation of acute chest pain in the ED with CCTA was not associated with an increase in total radiation exposure over a follow-up period of 19 months. CCTA offers a more comprehensive evaluation of multiple thoracic organ systems leading to reduced radiation exposure from non-cardiac thoracic testing and no increase in incidental imaging findings. This may represent an added benefit in this population of patients presenting acutely.
[ABSTRACT]   Full text not available  [PDF]
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CASE REPORTS
Subclavian stenosis in a patient with takayasu's arteritis and long-standing ankylosing spondylitis: Utility of IVUS imaging
Adil Sattar, Siegfried Yu, Warren K Laskey
August 2015, 3(3):4-4
DOI:10.5812/acvi.31552  
Introduction: Takayasu's arteritis (TA) is a chronic, idiopathic, inflammatory disease that affects large elastic arteries, including the aorta and its main branches. No consensus exists currently on the superiority of surgery over endovascular repair (angioplasty with or without stenting) for vascular lesions in TA. Case Presentation: A 54-year-old woman with an 11-year history of ankylosing spondylitis (AS) presented with left arm weakness and severe left arm claudication. Duplex ultrasonography of the left upper extremity showed vessel-wall edema of the subclavian, axillary, and brachial arteries. Aortic angiography demonstrated a 70 - 80% stenosis of the left subclavian artery and a long, high-grade stenotic segment of the axillary artery. Intravascular ultrasound (IVUS) of the stenotic subclavian segment showed extensive negative remodeling with minimal plaque formation. The patient responded well to balloon angioplasty on this segment with medical therapy for AS. Conclusions: Our case is the first report of IVUS imaging of subclavian stenosis resulting from Takayasu's arteritis and provides insight into the pathology behind such lesions.
[ABSTRACT]   Full text not available  [PDF]
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