Background: Echocardiography is widely used to diagnose or exclude cardiac disease. The reports on reference values based on an Asian population are limited. Objectives: We conducted a study to determine normal values for two-dimensional, M-mode, and Doppler echocardiographic measurements and evaluate the relationship between these parameters and age and gender in a large, healthy Iranian population. Patients and Methods: Among a total of 400 volunteers in a cross-sectional study, 368 healthy individuals aged between 30 and 70 years [171 males at a mean age of 47.6 (9.9) and 197 females at a mean age of 47.6 (9.5)] were enrolled. Standard comprehensive transthoracic echocardiography (TTE) was performed based on the guidelines of the American Society of Echocardiography. The normal limits are presented as mean (SD) and are also indexed to body surface area (BSA). Results: There was no significant difference between the men and women regarding left ventricular (LV) ejection fraction (57.97% vs. 57.99%). The mean of LV end-diastolic diameter (LVEDD), LV end-systolic diameter (LVESD), interventricular septum (IVS), posterior wall (PW) thickness, and right ventricular diastolic diameter (RVDd) was significantly greater in the men than in the women. However, there was an inverse relationship when LVEDD, RVDd, and left atrial (LA) diameter and area were indexed to BSA. There was no significant difference in the mean of LA area between the males and females (14.28 vs. 13.6 cm2). The LV diastolic parameters correlated negatively with age. A peakE /A velocity ratio <1 was found in the subjects over 50 years old. The mean of all the measurements in our study was less than the reference values in the published guidelines. Conclusions: Our study, the first and largest investigation of its kind, provides reference values for the echocardiographic evaluation of the cardiac size and function of Iranian healthy individuals. The mean of our measurements was significantly less than that reported in the published guidelines.

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Background: Two-dimensional (2D) Strain is a new reproducible technique for assessing regional myocardial function; however, its application for evaluation of left atrium (LA) function is less studied. Objectives: We sought to assess LA function in heart failure patients using velocity vector imaging (VVI). Patients and Methods: Thirty five patients (mean age: 43.34 ± 18.1 years, 59.3% male) with systolic dysfunction [left ventricle ejection fraction (LVEF) < 35%] enrolled. Standard Doppler echocardiography and 2D strain were performed on all subjects. Strain measurements were obtained from apical views. Results: A significant differences in LA volume index (LAVI) and strain were found in patients with systolic heart failure (SHF) versus normal subjects (23.8 ± 4.1 versus 57.8 ± 19.7 ml/m², P < 0.001 and 39.6 ± 10.6 versus 8.2 ± 5.3%, P < 0.001). Multivariate analysis of separate walls revealed significant inverse relationship between LA size and volume with total and regional (2-ch view) 2D strains of LA. Significant inverse relationship were also detected between pulmonary artery systolic pressure and both total LA strain (22 ± 8 versus 42 ± 10 mmHg, r = -0.4, P < 0.001) and LA strain in 2-chamber (r = -0.5, P < 0.001). A cutoff value of total average LA strain (≥ 23.28%) can differentiate normal and abnormal LA function with a sensitivity of 93% and specificity of 100% and a cutoff value of total LA strain (in average) of 17.2% can differentiate mild and moderate and severe diastolic dysfunction with a sensitivity of 100% and a specificity of 97%. Conclusions: LA strain seems to be a better determinant for diagnosis of abnormal LA function and the degree of diastolic dysfunction in SHF.

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Background: Atrial fibrillation (AF) was recognized as a major cause of morbidity and mortality after coronary artery bypass graft surgery (CABGS). Finding an accurate method to identify patients with increased risk may prevent or lower the occurrence of the related complications. Objectives: This study aimed to evaluate the association between interval of P-wave initiation in surface electrocardiogram, a-wave initiation in doppler study of mitral valve, MV annular velocity by TDI and compare them with conventional echocardiographic findings to investigate the associated factors related to the occurrence of AF in the first 72 hours after the CABGS. Patients and Methods: Four hundred and four patients with sinus rhythm, who were candidate for CABGS between June 2010 and July 2012 were examined before the surgery by conventional echocardiography and Tissue Velocity Imaging Methods and were monitored for 72 hours after surgery. Data collection and analysis were done by SPSS statistical software. Results: The mean age of patients was 60 ± 9.9 years. Statistically significant relationship between the occurrence of AF with Mitral valve annulus, LA Volume Index (LAVI), Right ventricle function, and type of surgery (off pump or on pump) were detected in our study (P < 0.05) . There was no statistically significant relationship between the occurrence of AF and time interval of P wave to A wave onset in conventional Doppler echocardiographic study (P-A), P-A' onset and P-A' peak in TDI examination (P > 0.05). Conclusions: Based on our findings, MV annulus, LAVI, RV function and on pump CABGS were independent factors related to the occurrence of AF post CABGS. Echocardiographic study associated with clinical data could be helpful for risk stratification of occurrence of post-operative AF.

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Background: The torsional parameters of the left ventricle (LV) are sensitive indicators of the cardiac performance. The torsion/twist of the LV is the wringing motion of the heart around its long axis created by oppositely directed apical and basal rotations and is determined by contracting myofibers in the LV wall which are arranged in opposite directions between the subendocardial and subepicardial layers. This motion is essential for regulating the LV systolic and diastolic functions. Objectives: Recent advances in echocardiography techniques have allowed for quantification of LV mechanics. The aim of the present study was to compare various LV twisting and untwisting parameters in healthy human subjects determined by velocity vector imaging (VVI) and tissue Doppler imaging (TDI) at rest. Patients and Methods: All volunteers (47 healthy subjects in two groups: 24 subjects in VVI group and 23 subjects in TDI group) underwent complete echocardiographic study, and LV torsional parameters were assessed by VVI or TDI methods. In addition, LV torsion and LV twisting/untwisting rate profiles were calculated throughout cardiac cycle. Results: Twist degree was significantly lower in the VVI group than in the TDI group (P = 0.008, r = 0.56). LV torsion was lower in the VVI group but was not significant. (P = 0.13, r = 0.38). Twisting rate (P = 0.004, r = 0.66) and untwisting rate (P = 0.0001, r = 0.61) were lower in the VVI group, but when timing of untwisting rate was normalized by systolic duration, there was no significant difference between the two groups (P = 0.41, r = 0.59). Similarly, when peak untwisting rate was normalized by LV length, there was a significant decline in normalized peak untwisting rate in the VVI group (P = 0.004, r = 0.62), but not in peak twisting rate normalized by LV length (P = 0.12, r = 0.42). Peak untwisting rate normalized by LV torsion was not statistically different between the two groups (P = 0.05, r = 0.53). Conclusions: Results suggest that these methods cannot be interchanged, and VVI showed significantly lower LV peak twist, peak twisting rate and peak untwisting rate. However, when LV twist and LV twisting rates were normalized to LV length, values were comparable for both imaging techniques.

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Introduction: Cardiac hydatid cysts are rare and represent less than 2% of all hydatid cases. They can occur as part of a widespread systemic infection or an isolated event. Case Presentation: Here, we presented a case of cardiac hydatid cyst in interventricular septum. Conclusions: The case presented had some findings that suggested the specific diagnosis of hydatid cyst.

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Introduction: The cardiac outcome in tuberous sclerosis patients is usually favorable, and cerebral manifestations determine the ultimate prognosis in these patients. Case Presentation: Our tuberous sclerosis patient developed arrhythmia unexpectedly while his tumors were in regression, presenting a challenge to us as to whether or not opt for surgery. Conclusions: This case report underscores the role of fetal echocardiography in the prenatal diagnosis of cardiac disease and illustrates rhabdomyomas in a tuberous sclerosis patient. Rhabdomyomas are histologically benign; however, they may cause severe arrhythmia even when they are regressing.

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Introduction: Tetralogy of Fallot (TOF) in the absent of pulmonary valve is a rare congenital anomaly (3%of TOF patients). Case Presentation: We are presenting an 18- year-old male with history of dyspnea on exertion and cyanosis since childhood. Despite the diagnosis of congenital heart disease, no intervention was done due to his poor socioeconomic culture. At age of 18, he referred to our center for further evaluation of heart problem. After physical examination and other diagnostic tests, our final diagnosis was tetralogy of fallot, absent pulmonary valve and double-chamber right ventricle. The absence of mature PV tissue leads to severe pulmonary regurgitation, which is often associated with significant dilatation of the pulmonary arteries. After further evaluation of main pulmonary artery, its branches and other abnormalities of the heart, total correction of tetralogy and pulmonary valve replacement was done. His post operation period was uneventful without any complication and he discharged after 10 days. Conclusions: We believe that the prognosis for those patients in this era is good and complete surgical treatment is tolerated well by them.

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