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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
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.
  1,556 232 -
Left ventricular ejection fraction and mitral regurgitation assessment: A comparison study between echocardiography and angiography
Ahmad Mirdamadi, Negah Tavakolifard, Ehsan Ebrahimi
July-December 2017, 5(2):25-29
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.
  1,629 127 -
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
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.
  1,334 205 -
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
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.
  1,362 163 -
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
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.
  1,329 163 -
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
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.
  956 143 -
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
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]
  396 95 -
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
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]
  367 73 -
Cardiac metastasis from a renal cell carcinoma without contiguous vena caval involvement
Azin Alizadeasl, Feridoun Noohi, Farnoosh Larti, Saeid Hosseini, Majid Maleki
July-December 2017, 5(2):30-31
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.
  326 54 -
Arteriovenous fistula presented with right ventricular failure
Farveh Vakilan, Fereshte Ghaderi, Hoorak Poorzand, Mahmood Mohammadzadeh Shabestari, Arash Gholobi
July-December 2017, 5(2):37-40
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.
  312 40 -
Pregnancy complicated with severe aortic coarctation
Maryam Moshkani Farahani, Zahra Pour Jafar
July-December 2017, 5(2):35-36
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.
  310 40 -
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
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]
  259 82 -
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
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]
  270 71 -
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
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]
  251 82 -
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
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]
  272 57 -
Stress echocardiography in prosthetic heart valves
Anita Sadeghpour, Azin Alizadehasl
February 2016, 4(1):1-1
[ABSTRACT]   Full text not available  [PDF]
  252 77 -
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
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]
  273 55 -
Hypertrophic obstructive cardiomyopathy diagnosed during regadenoson stress test
Salahuddin Siddiqui, Khalid J Manzar
February 2016, 4(1):2-2
[ABSTRACT]   Full text not available  [PDF]
  251 75 -
Severe isolated rheumatic aortic valve regurgitation
Azin Alizadehas, Samaneh Pourhosseinali
May 2016, 4(2):1-1
[ABSTRACT]   Full text not available  [PDF]
  245 77 -
Exercise stress echocardiography and tissue synchronization imaging of myocardial dyssynchrony
Veronica Bordonaro, Sergio Buccheri, Corrado Tamburino, Ines Paola Monte
November 2015, 3(4):5-5
Background: Stress echocardiography represents one of the best possible imaging choice for the diagnosis and stratification of patients with coronary artery disease (CAD). However, this imaging technique presents some limitations such as the quality of the image, high inter-observer variability, and the operator-dependent expertise. New technologies have been recently developed to provide an objective, operator-independent, and quantitative analysis of regional myocardial function. Objectives: The aim of this study was to investigate regional myocardial dyssynchrony using tissue synchronization imaging (TSI) during exercise stress echocardiography (ESE). PatientsandMethods: The ESE and TSI analysis of left ventricular (LV) segments was performed for 30 patients with CAD previously treated with revascularization therapy (CADr group) and the results were compared to those in 30 healthy subjects (norm group). The echo protocol comprised echocardiographic examinations at baseline, at the peak of exercise, and at 5 minutes after recovery as well as biplane and triplane acquisitions, pulsed wave of mitral flow, continuous wave of tricuspid regurgitation, tissue Doppler at the mitral annulus, TSI with an automatically detected positive time-to-peak velocity (Tp), and the measurement of themaximum activation time delay between myocardial segments and its standard deviation at baseline and peak stress for each patient. Results: The CADr group showed a lower increase in E (P = 0.005), A (P = 0.006), S' (P < 0.001), and E' (P = 0.006) velocities at both baseline and peak stress and a significantly increased ventricular dyssynchrony at baseline and at peak stress (P < 0.01) compared to the norm group. The baseline-peak variations in the CADr group did not show significant differences. The relationships between the maximum activation delay and the other echocardiographic parameters showed a significant negative correlation with LV ejection fraction (r = 0.217; P = 0.031) and S' velocity (r = -0.393; P < 0.001) and a positive correlation with the E/E' ratio (r = 0.376; P < 0.001). The comparison between the different ischemic territories revascularized in terms of the delay in ventricular activation showed the greatest delay in the revascularized territory in 63% of the patients with ischemia. Conclusions: The TSI analysis in patients with CAD may be considered an interesting parameter in addition to the conventional echocardiographic parameters during ESE.
[ABSTRACT]   Full text not available  [PDF]
  269 52 -
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
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]
  252 61 -
Pulmonary arterial hypertension: A two-dimensional echocardiographic approach from screening to prognosis
Samir Kanti Saha
May 2016, 4(2):4-4
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]
  240 69 -
Multimodality imaging in hypertrophic cardiomyopathy associated with anomalous hypertrophied papillary muscles: A case report
Ikram Kammoun, Lemone Houchinne, Sonia Marrakchi, Wael Ben Amara, Zied Ibn Elhaj, Souha Mokrani, Faouzi Added, Salem Kachboura
May 2015, 3(2):2-2
Introduction: Multimodality imaging can help rule in/out the diagnosis of hypertrophic cardiomyopathy (HCM) in patients with significant left ventricular (LV) hypertrophy. Case Presentation: We describe a 73-year-old woman referred to us for consultation because of a giant negative T wave on her electrocardiography. Echocardiography revealed diffuse severe hypertrophy associated with hypertrophied anterolateral papillary muscles with a bifid head and with extensive wall insertion into the apicolateral segment. Three-dimensional echocardiography and cardiac magnetic resonance confirmed these data. Importantly, automated function imaging determined the global longitudinal strain at -10.2%. Conclusions: According to our multimodality imaging approach, hypertrophic cardiomyopathy was the most probable diagnosis.
[ABSTRACT]   Full text not available  [PDF]
  224 83 -
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
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]
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An echo-dense cap in the pericardial space after acute myocardial infarction: A case report
Azin Alizadehasl, Mazyar Gholampour, Mohsen Madani, Mohammad Mehdi Peighambari, Mahbubeh Pazouki, Ali Kazem Mousavi
August 2015, 3(3):6-6
Acute myocardial infarction can culminate in sudden cardiac death due to cardiogenic shock and ventricular fibrillation, and also rarely due to cardiac rupture. We present a case of post-infarction myocardial rupture after thrombolytic therapy diagnosed with transthoracic echocardiography and treated with direct closure and coronary artery bypass grafting.
[ABSTRACT]   Full text not available  [PDF]
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