Publications by authors named "Arash Gholoobi"

20 Publications

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Cost-utility analysis of home-based cardiac rehabilitation as compared to usual post-discharge care: systematic review and meta-analysis of randomized controlled trials.

Expert Rev Cardiovasc Ther 2020 Nov 3;18(11):761-776. Epub 2020 Oct 3.

Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences , Mashhad, Iran.

Introduction: Determining cost-utility differences between home-based cardiac rehabilitation (HBCR) on the one hand, and usual post-discharge care (UC) on the other, can improve resource-allocation in healthcare settings.

Areas Covered: In June 2019, PubMed, Web of Science, Scopus, and Cochrane library were searched for randomized controlled HBCR trials. Standardized mean differences (SMDs) of cost and quality-adjusted life years (QALYs) between HBCRs and UCs were calculated using random effect models. Heterogeneity was assessed by inconsistency index (I2) and publication bias by funnel plot and Egger's regression test. Thirteen articles, representing 2,992 participants, were deemed representative for final analysis. In the meta-analysis, a significant difference with respect to QALYs favored HBCR, while no significant cost difference was observed between HBCR and UC. However, subgroup-analysis of trials with different follow-up durations revealed somewhat different results, and HBCR was found to be significantly better with regard to both cost and QALYs for patients with heart failure. Cost-utility analysis categorizing interventions as 'dominant', 'effective', 'doubtful', and 'dominated', found HBCRs dominant.

Expert Opinion: Although HBCR tended to be superior compared to UC in this review, larger and more robust trials addressing specific patients groups are needed for definitive results.
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http://dx.doi.org/10.1080/14779072.2020.1819239DOI Listing
November 2020

Investigating the Manifestation of Coronary Artery Disease and Determining the Role of Effective Factors in the Need for Pacemaker Insertion in These Patients.

Open Access Maced J Med Sci 2019 Jul 14;7(13):2108-2113. Epub 2019 Jul 14.

Department of Cardiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Background: Many patients who are candidates for a pacemaker are also at the same time risk factors for coronary artery disease such as high blood pressure, hypertension, diabetes, and hyperlipidemia, and therefore the probability of having coronary artery disease is significant. Effective diagnostic measures can be taken to prove the factors affecting the incidence of CAD in patients undergoing pacemakers at high-risk, including angiography. Therefore, it can prevent complications during and after pacemaker implantation, which leads to an increase in the quality of treatment in patients requiring pacemaker implantation.

Aim: Therefore, the purpose of this study was to determine the predictive factors of significant coronary artery disease in patients with pacemaker implantation to identify patients in need of coronary angiography at the time of pacemaker implantation.

Methods: This retrospective study was carried out to examine the patients' files that were placed at the heart of Imam Reza Hospital during the period between March 2017 and September 2017. Demographic data, risk factors, echocardiography findings, and angiography, were collected and then recorded using a checklist. Statistical analysis was performed using SPSS software version 22 and Chi-square, and Mann-Whitney tests were used for determining significates variables.

Results: A group of 102 patients who had undergone a permanent cardiac pacemaker insertion due to an atrioventricular (AV) Block were included in the study, and also coronary anatomy was determined coronary angiography. Based on the results, 13.7% of patients with cardiac pacemaker had obstructive coronary artery disease (stenosis > 70%). Factors affecting coronary artery stenosis on angiography include gender, chest pain, history of myocardial infarction, angioplasty, diabetes, smoking, history of aspirin intake, calcium blocker and Plavix, high hematocrit, ST elevation and ST depression in the ECG, and severe mitral regurgitation.

Conclusion: It seems that in most patients requiring permanent pacemaker insertion because of the atrioventricular (AV) Block, angiography does not change the patient's fate, and so can be ignored. However, in patients who have several risk factors from the listed above, coronary angiography is recommended during admission.
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http://dx.doi.org/10.3889/oamjms.2019.608DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6698118PMC
July 2019

Comparison of the prevalence of enteroviruses in blood samples of patients with and without unstable angina.

ARYA Atheroscler 2017 Jul;13(4):161-166

Assistant Professor, Atherosclerosis Prevention Research Center AND Department of Cardiovascular Diseases, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Background: Although the role of enteroviruses has been proved in heart diseases, extensive information is not available on the association between enteroviruses and unstable angina. In the present study, the authors compared the prevalence of enteroviruses in patients with and without unstable angina.

Methods: Blood samples were taken from 51 patients with unstable angina and 55 patients without unstable angina or myocardial infarction that were admitted to Imam Reza and Ghaem hospitals (Mashhad, northeast of Iran). Reverse transcription polymerase chain reaction (RT-PCR) was performed using specific primers for the detection of the enteroviruses in blood samples of study subjects.

Results: Patients with and without unstable angina were similar in age with mean ± standard deviation of 62.6 ± 12.8 and 59.7 ± 12.7 years, respectively (P = 0.243) and there were no differences in gender in these two groups (P = 0.174). Prevalence of the enteroviruses in patients with unstable angina was higher only in 66-80 years age group compared to the control group (patients without unstable angina, P = 0.032). There was a higher prevalence of enterovirus RNA positivity in the blood samples of women with unstable angina (75.9%) than those without unstable angina (41.7%, P = 0.011), however, no significant difference was observed in men (P = 0.983).

Conclusion: Our data showed that enteroviral RNA positivity was higher in patients with unstable angina compared to those without unstable angina. However, the differences between the two groups were not statistically significant.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5677318PMC
July 2017

Myocardial bridging of the posterolateral branches of the right coronary artery.

Authors:
Arash Gholoobi

ARYA Atheroscler 2016 Nov;12(6):297-298

Assistant Professor, Atherosclerosis Prevention Research Center, Imam Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5455330PMC
November 2016

Effects of a 3D segmental prosthetic system for tricuspid valve annulus remodelling on the right coronary artery: a human cadaveric coronary angiography study.

Interact Cardiovasc Thorac Surg 2017 09;25(3):350-355

Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran.

Objectives: A prosthetic system to repair secondary tricuspid valve regurgitation was developed. The conceptual engineering of the current device is based on 3D segmental remodelling of the tricuspid valve annulus in lieu of reductive annuloplasty. This study was designed to investigate the operational safety of the current prosthetic system with regard to the anatomical integrity of the right coronary artery (RCA) in fresh cadaveric human hearts.

Methods: During the study period, from January to April 2016, the current prosthetic system was implanted on the tricuspid valve annulus in fresh cadaveric human hearts that met the study's inclusion criteria. The prepared specimens were investigated via selective coronary angiography of the RCA in the catheterization laboratory. The RCA angiographic anatomies were categorized as normal, distorted, kinked or occluded.

Results: Sixteen specimens underwent implantation of the current prosthetic system. The mean age of the cadaveric human hearts was 43.24 ± 15.79 years, with vehicle accident being the primary cause of death (59%). A dominant RCA was noticed in 62.5% of the specimens. None of the specimens displayed any injury, distortion, kinking or occlusion in the RCA due to the implantation of the prostheses.

Conclusions: In light of the results of the present study, undertaken on fresh cadaveric human heart specimens, the current segmental prosthetic system for 3D remodelling of the tricuspid valve annulus seems to be safe vis-à-vis the anatomical integrity of the RCA. Further in vivo studies are needed to investigate the functional features of the current prosthetic system with a view to addressing the complex pathophysiology of secondary tricuspid valve regurgitation.
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http://dx.doi.org/10.1093/icvts/ivx102DOI Listing
September 2017

Anomalous Intercoronary Communication with Unidirectional Flow in the Absence of Obstructive Coronary Artery Disease: A Case Report.

J Tehran Heart Cent 2016 Oct;11(4):203-205

Cardiovascular Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

Large intercoronary communications in the absence of obstructive coronary artery disease constitute a very rare coronary artery anomaly in which there is a readily visible connection between the 2 coronary arteries with a unidirectional or bidirectional blood flow; consequently, this anomaly may be misinterpreted as a functioning collateral vessel, indicative of an unrecognized proximal coronary artery occlusion. In contrast to collateral vessels that are seen in the presence of critical coronary artery stenosis and total occlusions, these arterial communications are vessels that are single, extramural, straight, and large in diameter. Myocardial ischemia could result from the coronary steal phenomenon by a unidirectional intercoronary communication. Herein, we describe a 57-year-old female with chest pain who was found in coronary angiography to have a single large intercoronary channel between the posterolateral branch of the right coronary artery and the distal left circumflex artery with a unidirectional flow.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5424847PMC
October 2016

Acute Myocardial Infarction following Naltrexone Consumption; a Case Report.

Emerg (Tehran) 2017 14;5(1):e45. Epub 2017 Jan 14.

Addiction Research Centre, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.

Cardiovascular effects of opioid withdrawal have long been studied. It was reported that patients with underlying ischemic heart disease and atherosclerotic vessels may be complicated by a sudden physical and emotional stress due to withdrawal syndrome. But some other believes sudden increase in catecholamine level as a sympathetic overflow might effect on heart with and without underlying ischemia. In the current study, a patient on methadone maintenance therapy (MMT) who experienced myocardial infarction (MI) after taking naltrexone was described.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5325916PMC
January 2017

Relationship between gated myocardial perfusion SPECT findings and hemodynamic, electrocardiographic, and heart rate changes after Dipyridamole infusion.

Int J Cardiovasc Imaging 2017 Jun 1;33(6):951-956. Epub 2017 Feb 1.

Department of Nuclear Medicine, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.

After dipyridamole infusion, electrocardiographic (ECG), blood pressure and heart rate (HR) changes were seen. We tried to investigate whether there is a relationship between hemodynamic, ECG and HR changes after dipyridamole infusion and gated myocardial perfusion SPECT findings. We studied 206 consecutive patients which underwent a 2-day protocol Dipyridamole Stress/Rest Tc99m-Sestamibi gated myocardial perfusion SPECT. Systolic blood pressure (SBP), diastolic blood pressure (DBP), HR and ECG were recorded. HR was mildly increased while SBP and DBP were mildly decreased after Dipyridamole infusion. There was only statistically significant difference between ECG changes as well as transient ischemic dilation (TID) ratio between normal scans and scans with ischemia (P = 0.02 and P = 0.01 respectively). There was correlation between these variables and summed stress score (SSS) and summed difference score (SDS). Patients with ischemia in their scans, 44.3% had ST depression after Dipyridamole infusion. Also ST depression most frequently was seen in patients with left anterior descending artery disease. From patients with abnormal scan + ST depression after Dipyridamole infusion (33 patient), 27 patient (81.81%) had ischemia. There was an association between TID ratio as well as ECG changes after Dipyridamole infusion and SSS, SDS and coronary artery territory abnormality. Difference between calculated left ventricular ejection fraction using stress and rest images had significant correlation with SSS and SDS. ST depression after Dipyridamole infusion and TID ratio had association with ischemia, SSS and SDS. So in equivocal Gated SPECT findings, they could be very useful for interpretation.
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http://dx.doi.org/10.1007/s10554-017-1074-6DOI Listing
June 2017

Anomalous Origin of the Right Coronary Artery from the Midportion of the Left Anterior Descending Artery: A Rare Coronary Anomaly.

Authors:
Arash Gholoobi

J Tehran Heart Cent 2016 Jul;11(3):149-152

Atherosclerosis Prevention Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

The anomalous origin of the right coronary artery (RCA) as a branch from the left anterior descending artery (LAD) is a very rare variation of the single coronary artery anomaly. The anomalous vessel arises from the proximal or midportion of the LAD and courses anterior to the pulmonary artery trunk in most instances. In this case report, a 61-year-old woman is introduced who underwent coronary angiography following inferoposterior myocardial infarction, in which an anomalous RCA was seen originating from the midportion of the LAD. There was also a separate small artery originating from the right coronary sinus, which was most probably a right atrial branch.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5148818PMC
July 2016

Cardiovascular Disease Risk Factors Profile in Individuals With Diabetes Compared With Non-Diabetic Subjects in North-East of Iran.

Iran Red Crescent Med J 2016 Aug 24;18(8):e29382. Epub 2016 Apr 24.

Department of Community Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran.

Background: Diabetes mellitus is assumed to be a strong risk factor for cardiovascular diseases (CVD) and is frequently associated with other CVD risk factors.

Objectives: The aims of this study were to assess the prevalence of different patterns of dyslipidemia in individuals with diabetes compared with non-diabetic subjects and evaluate other accompanied CVD risk factors between the two groups.

Patients And Methods: This was an analytical cross-sectional study on 230 participants, aged 28 - 66 years old, who were referred to different urban health centers of Khorasan Razavi province (north-east of Iran). Data from the participants were collected during their first visit by primary care physicians. Statistical package for social science (version 11.5) was used to analyze the data. The chi-square or Fisher's exact, student's t or the Mann-Whitney U and correlation tests were used in the analysis.

Results: The age and gender of the participants were not different between the two groups (P = 0.1 and P = 0.4, respectively). The most common patterns of dyslipidemia in both groups were isolated dyslipidemia followed by combined dyslipidemia. Prevalence of dyslipidemia as a whole (one, two or three lipid profile abnormalities) in patients with diabetes and non-diabetic participants was 89.3% and 82.6%, respectively and the difference between the two groups was not statistically significant (P = 0.1). Subjects with diabetes had higher systolic blood pressure (P < 0.001), higher diastolic blood pressure (P = 0.002) and higher body mass index (P = 0.09) compared to non-diabetics. Moreover, they were more likely to have higher levels of total cholesterol (P = 0.01), triglycerides (P = 0.001) and low density lipoprotein cholesterol (P = 0.009) and lower levels of high density lipoprotein cholesterol (P = 0.2).

Conclusions: Cardiovascular diseases risk factors are more common in patients with diabetes; however, non-diabetic individuals also had a high prevalence of risk factors in our region, predisposing them to diabetes. Therefore, further attention by the medical community is necessary to choose effective strategies for a more a aggressive approach to prevent and manage these risk factors.
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http://dx.doi.org/10.5812/ircmj.29382DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5056601PMC
August 2016

Left Brachiocephalic Vein Cannulation in Bicaval Venous Drainage Is Safe, Effective, and Technically Advantageous.

Tex Heart Inst J 2016 Apr 1;43(2):144-7. Epub 2016 Apr 1.

Direct cannulation of both venae cavae (bicaval venous cannulation) is the gold standard for right atrial isolation in intracavitary surgery, but there has been no consensus about an alternative site. Therefore, we studied an alternative method for bicaval venous drainage in which the left brachiocephalic vein (LBCV) is cannulated instead of the superior vena cava. From 2012 through 2014, we performed routine LBCV cannulation in 150 consecutive patients as part of bicaval venous drainage before right atrial isolation. We prospectively collected demographic information, operative data, total pump and LBCV cannula flows with their respective calculated and indexed rates, central venous pressures, and perioperative complications. All patients survived surgery. There were no adverse technical outcomes or functional deficits associated with the technique. The mean indexed LBCV cannula flow was 1,520 ± 216 mL/min/m(2), representing an LBCV cannula-to-calculated pump-flow ratio of 64%. The mean central venous pressure during right atrial isolation was 3.7 ± 1.9 mmHg. Cannulation of the LBCV is intrinsically a safe and reproducible procedure with proven hemodynamic adequacy. Its versatility can be an asset to surgical techniques and perfusion methods. Furthermore, the hemodynamic results in our series promise alternative intrathoracic and extracardiac cannulation sites for mini-extracorporeal circulation, on-pump beating-heart procedures, and short-term circulatory assist device implementation.
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http://dx.doi.org/10.14503/THIJ-14-4983DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4845566PMC
April 2016

The Impact of Remote Ischemic Pre-Conditioning on Contrast-Induced Nephropathy in Patients Undergoing Coronary Angiography and Angioplasty: A Double-Blind Randomized Clinical Trial.

Electron Physician 2015 Dec 20;7(8):1557-65. Epub 2015 Dec 20.

Medical Student, Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran.

Background And Objective: Contrast-induced nephropathy (CIN) is an acute major complication following intravascular administration of iodinated contrast agents; however, the best approach for preventing CIN is not clear. Remote ischemic pre-conditioning (RIPC) is a new, non-pharmacological method that has been considered for the prevention of CIN following coronary angiography. This study assessed the effects of RIPC with four brief episodes of upper limb ischemia and reperfusion in the prevention of contrast-induced nephropathy (CIN) after coronary angiography and/or angioplasty.

Methods: In this double-blind randomized clinical trial, we enrolled 51 patients with chronic stable angina and non-ST elevation acute coronary syndrome (NSTE.ACS), and they underwent coronary angiography and/or angioplasty. Standard fluid therapy with normal saline was prescribed for all patients before and after the procedure. The patients were divided into two groups, i.e., a study group of patients who had undergone RIPC intervention and a control group of patients who had not undergone RIPC. One hour before the procedure, a sphygmomanometer cuff was placed around one arm and inflated up to 50 mmHg above the systolic pressure for five minutes; then, the cuff was deflated for another five minutes, and this cycle was repeated four times. The patients' serum creatinine levels were measured at baseline and 48 hours after the procedure, and the incidence of CIN was calculated.

Results: Twenty-one males and 30 females were studied in two groups, i.e., an RIPC intervention group (n = 25) and a control group (n = 26) that were homogenous considering baseline characteristics. No significant difference was observed in the mean level of serum creatinine between the two groups at a post-intervention time of 48 hours (RICP: 1.74 ± 0.70 mg/dL vs.

Control: 1.75 ± 0.87 mg/dL; P = 0.64). However, a lower incidence rate of CIN was observed 48 hours after the administration of the contrast medium in the RIPC group, but it was not statistically significant (RIPC: 23.1% vs.

Control: 12.0%; P = 0.30).

Conclusion: It seems that adequate fluid therapy is still the most effective strategy for preventing CIN and that RIPC might have additional protective effects in very high risk patients, such as those with severe renal insufficiency and heart failure.
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http://dx.doi.org/10.19082/1557DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4725407PMC
December 2015

Single coronary artery anomaly: Report of an extremely rare variation.

Asian Cardiovasc Thorac Ann 2017 Jul 17;25(6):459-462. Epub 2015 Dec 17.

Atherosclerosis Prevention Research Center, Imam Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

A 43-year-old man presented with unstable angina. Coronary angiography revealed a single coronary artery originating from the left sinus of Valsalva, giving rise to a left main stem trifurcating to the left anterior descending artery, left circumflex artery, and an anomalous right coronary artery. The anomalous right coronary artery had a retroaortic course and significant proximal tubular stenosis which was stented. The coronary anomaly and abnormal course was confirmed by transesophageal echocardiography. The patient was symptom-free at one-year follow-up. This anomaly does not predispose to accelerated atherosclerosis, and the premature atherosclerosis in our patient was probably due an unhealthy lifestyle.
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http://dx.doi.org/10.1177/0218492315622101DOI Listing
July 2017

Anomalous Origin of the Left Atrial Branch from the Left Main Trunk.

Authors:
Arash Gholoobi

J Tehran Heart Cent 2015 Apr;10(2):113-4

Atherosclerosis Prevention Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4477087PMC
April 2015

Giant cardiac hydatid cyst with rare adhesions.

Hellenic J Cardiol 2014 May-Jun;55(3):260-4

Preventive Cardiovascular Care Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences (MUMS) Mashhad, Iran.

We present a 29-year-old woman who was admitted to the emergency department with shortness of breath. Using echocardiography, a giant multi-cystic mass was detected in the right ventricle, attached to the septal leaflet of the tricuspid valve and basal portion of the interventricular septum. Serologic tests (hydatid cyst antibody) confirmed Echinococcus infection. Lung computed tomography with intravenous contrast showed involvement of the pulmonary vasculature. The patient underwent cardiac surgery and the large cardiac cyst and the one in the right pulmonary artery branch were both removed. The tricuspid valve was also replaced by a bioprosthetic one. Albendazole was started preoperatively and was continued for six months after surgery. The patient recovered uneventfully and was followed up for one year. This is a report of a rare case of a very large cardiac hydatid cyst complicated by pulmonary embolism with attachments to both the tricuspid valve and interventricular septum.
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January 2015

Multiple coronary fistula formation associated with a huge left atrial thrombus in rheumatic mitral valve stenosis.

J Cardiol Cases 2014 Mar 3;9(3):124-126. Epub 2014 Jan 3.

Atherosclerosis Prevention Research Center, Imam Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Acquired fistulous communication with the left atrial (LA) chamber has been described in the presence of LA mural thrombus in patients with rheumatic mitral stenosis (MS). Hereby, we present the case of a 74-year-old man with rheumatic MS and a huge LA thrombus found in echocardiography. Coronary angiography revealed an extensive fistula formation feeding mainly from the atrial branches of left circumflex and right coronary arteries and draining into the LA chamber. Moreover, left anterior descending (LAD) and right coronary arteries had slow flow with regional wall motion abnormality in the LAD territory and left ventricular ejection fraction of 35% in echocardiography. <: This is a unique case of neovascular formation in terms of number and extent of the fistulous connections. It appears that angiographic evidence of neovascularity and fistula formation in patients with rheumatic mitral stenosis is a highly specific sign for the presence of left atrial thrombus.>.
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http://dx.doi.org/10.1016/j.jccase.2013.11.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6277912PMC
March 2014

What is The Next Step When a Non-Compliant Balloon Does Not Pass through a Freshly Deployed Stent?

Authors:
Arash Gholoobi

J Tehran Heart Cent 2014 ;9(2):97-8

Assistant Professor of Cardiology, Atherosclerosis Prevention Research Center, Imam Reza Hospital, EbneSina Ave., Mashhad, Iran., 9137913316., Tel: +98 511 8544504. E-mail: .

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4389201PMC
April 2015

Unique echocardiographic markers of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) in the adult.

Echocardiography 2014 15;31(1):E13-5. Epub 2013 Oct 15.

Preventive Cardiovascular Care Research Center, Imam Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital heart defect in adults. We report a 38-year-old male presenting with exertional syncope. He was referred for the evaluation of multiple muscular ventricular septal defects diagnosed on an outpatient echocardiogram. Echocardiography revealed mild left ventricular enlargement, abnormal flow-pattern in the ventricular septum and dilatation of the right coronary artery. Pulsed-wave Doppler with sample volume placed in the coronary ostium showed systolic coronary flow predominancy. This unique finding is characteristic for ALCAPA and can differentiate it from other coronary anomalies. Coronary angiography confirmed ALCAPA syndrome. Surgical correction was planned.
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http://dx.doi.org/10.1111/echo.12378DOI Listing
August 2014

relationship between distribution of coronary artery lesions and renal artery stenosis in patients undergoing simultaneous coronary and renal angiography.

Clin Med Insights Cardiol 2011 Mar 20;5:35-40. Epub 2011 Mar 20.

Assistant professor, Department of Interventional Cardiology, Shaheed Rajaie Cardiovascular Medical and Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Aims: We evaluated the relationship between distribution of lesions in coronary tree and atherosclerotic renal artery stenosis (RAS).

Methods And Results: Data collected prospectively on 500 consecutive patients who underwent simultaneous renal angiography following coronary angiography. Overall prevalence of RAS was 26.2% (131 patients). Significant (≥50% luminal diameter stenosis) RAS was present in 70 patients (14%). In 346 individuals of the study population, significant CAD was present (69.2%). Significant RAS was more common (18.4%) in this group. Older age, higher intra-arterial systolic blood pressure (SBP) and pulse pressure (PP) at the time of catheterization, and 3-vessel coronary artery disease (CAD) were associated with significant RAS in univariate analysis. Relationship between involved locations of coronary arteries [Left anterior descending (LAD), left circumflex (LCX), Right Coronary Artery (RCA), and their ostio-proximal portions] and RAS were significant except for left main (LM) disease. In multivariate model, age more than 62 years, SBP greater than 150 mmHg, PP in excess of 60 mmHg and RCA involvement were independent predictors of significant RAS.

Conclusion: Simultaneous renal angiography following coronary angiography might be justified in patients with significant RCA disease who are older with increased levels of intra-arterial SBP and PP.
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http://dx.doi.org/10.4137/CMC.S6819DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3072210PMC
March 2011

Relationship between coronary and renal artery disease and associated risk factors in hypertensive and diabetic patients undergoing coronary angiography.

EuroIntervention 2008 Nov;4(3):373-7

Department of Cardiology, Emam Reza Educational Hospital, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran.

Aims: Performing simultaneous renal angiography in patients undergoing coronary angiography for suspected coronary artery disease (CAD) is suitable for those who have a high probability for renal artery stenosis (RAS), thus better recognition of all potential candidates could have paramount importance.

Methods And Results: In a cross sectional study, 260 consecutive hypertensive and/or diabetic patients (135 males, 125 females with average age of 57.1 and 57.2 years respectively) underwent simultaneous coronary and renal angiography. RAS was identified in 55 patients (21.2%). Significant RAS (> 50%) was present in 37 patients (14.2%). Female sex (P=0.01), older age (62.1+/-10 vs 56.3+/-8.9 years, p=0.001), higher serum creatinine level (1.3+/-0.69 vs 0.98+/-0.35 mg/dl p=0.017), reduced estimated glomerular filtration rate (eGFR) (58.6+/-25.4 vs 81.8+/-28.1 ml/min/1.73 m2, p< 0.001), increased levels of intra-arterial systolic blood pressure (169.8+/-31.1 vs 155.1+/-28.4 mmHg, p=0.004) and pulse pressure (90.9+/-26.2 vs 77.5+/-21.9, p=<0.001) during catheterisation, history of hypertension alone (p=0.007) or accompanied with diabetes mellitus (DM) (p=0.014) and multi vessel CAD (> 2 vessels, p=0.002) were associated with significant RAS in univariate analysis and normal coronary arteries was a strong negative predictive factor (negative predictive value=95%). There was no significant relationship between involved location of coronary arteries, history of DM alone, history of dyslipidaemia and smoking with RAS. In multivariate model, female sex [odds ratio (OR) 0.3; 95% confidence interval (CI) 0.12-0.80, P=0.016], multivessel CAD (OR 1.88; 95% CI 1.25-2.83, P=0.002) and reduced eGFR (OR 0.96; 95% CI 0.95-0.99, P=0.002) were independent predictors of RAS.

Conclusions: Considering the limitations of non-invasive techniques, it seems worthwhile from both diagnostic and prognostic standpoints to perform simultaneous renal angiography following coronary angiography in patients with multivessel CAD, especially if other mentioned risk predictors are also present.
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http://dx.doi.org/10.4244/eijv4i3a66DOI Listing
November 2008