Publications by authors named "Omid Shafe"

23 Publications

  • Page 1 of 1

Cost-effectiveness of a population-based AAA screening program for men over 65 years old in Iran.

Cost Eff Resour Alloc 2021 May 13;19(1):29. Epub 2021 May 13.

Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Vali-Asr Ave, 1995614331, Tehran, Iran.

Background: Screening program tend to recognized patients in their early stage and consequently improve health outcomes. Cost-effectiveness of the abdominal aortic aneurysm (AAA) screening program has been scarcely studied in developing countries. We sought to evaluate the cost-effectiveness of a screening program for the abdominal aortic aneurysm (AAA) in men aged over 65 years in Iran.

Methods: A Markov cohort model with 11 mutually exclusive health statuses was used to evaluate the cost-effectiveness of a population-based AAA screening program compared with a no-screening strategy. Transitions between the health statuses were simulated by using 3-month cycles. Data for disease transition probabilities and quality of life outcomes were obtained from published literature, and costs were calculated based on the price of medical services in Iran and the examination of the patients' medical records. The outcomes were life-years gained, the quality-adjusted life-year (QALY), costs, and the incremental cost-effectiveness ratio (ICER). The analysis was conducted for a lifetime horizon from the payer's perspective. Costs and effects were discounted at an annual rate of 3%. Uncertainty surrounding the model inputs was tested with deterministic and probabilistic sensitivity analyses.

Results: The mean incremental cost of the AAA screening strategy compared with the no-screening strategy was $140 and the mean incremental QALY gain was 0.025 QALY, resulting in an ICER of $5566 ($14,656 PPP) per QALY gained. At a willingness-to-pay of 1 gross domestic product (GDP) per capita ($5628) per QALY gained, the probability of the cost-effectiveness of AAA screening was about 50%. However, at a willingness-to-pay of twice the GDP per capita per QALY gained, there was about a 95% probability for the AAA screening program to be cost-effective in Iran.

Conclusions: The results of this study showed that at a willingness-to-pay of 1 GDP per capita per QALY gained, a 1-time AAA screening program for men aged over 65 years could not be cost-effective. Nevertheless, at a willingness-to-pay of twice the GDP per capita per QALY gained, the AAA screening program could be cost-effective in Iran. Further, AAA screening in high-risk groups could be cost-effective at a willingness-to-pay of 1 GDP per capita per QALY gained.
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http://dx.doi.org/10.1186/s12962-021-00283-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8120703PMC
May 2021

Spontaneous Intramural Esophageal Hematoma Secondary to Thrombolysis in the Setting of Pulmonary Embolism.

Vasc Endovascular Surg 2021 Jul 8;55(5):510-514. Epub 2021 Feb 8.

Cardiovascular Intervention Research Center, 158776Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.

Intramural hematoma of the esophagus (IHE) represents a rare condition on the spectrum of esophageal injuries. The most common symptoms are hematemesis, epigastric pain or retrosternal chest pains, odynophagia, and dysphagia. Early recognition of IHE is important as it may mimic other diseases such as myocardial infarction, pulmonary embolism, Mallory-Weiss tears, Boerhaave's syndrome, ruptured aortic aneurysms, and aortic dissection. Computed tomography is the preferred investigation method, and treatment is usually conservative. We herein present 2 cases of IHE associated with catheter-directed thrombolysis in the setting of pulmonary embolism.
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http://dx.doi.org/10.1177/1538574421989863DOI Listing
July 2021

Hybrid management of thoracic aortic aneurysm in a patient with massive hemoptysis: A case report.

Int J Surg Case Rep 2020 16;77:595-598. Epub 2020 Nov 16.

Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Science, Tehran, Iran. Electronic address:

Introduction: Thoracic aortic aneurysm (TAA) is a cardiovascular disorder, associated with high rates of mortality and morbidity. Here, we report a case of massive hemoptysis in a patient with TAA.

Presentation Of Case: A 49-year-old man presented with massive hemoptysis and true aneurysm of the aortic arch from the origin of the left common carotid artery to the first segment of the descending aorta. We adopted hybrid method for TAA repair. The patient remained in good condition after hybrid management.

Discussion: Although most cases of TAA are asymptomatic, it can present with a wide range of symptoms and complications. Chest pain is the most important symptom of TAA, and its sudden occurrence is a sign of rapid aneurysm expansion, dissection, or rupture. This was a rare case of TAA, as hemoptysis is not a common symptom of TAA.

Conclusion: This rare case was managed using the hybrid method which resulted in resolution of hemoptysis without any complications.
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http://dx.doi.org/10.1016/j.ijscr.2020.11.058DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7708770PMC
November 2020

Intravascular Ultrasound for Assessment of Residual Coarctation of the Aorta after Balloon Angioplasty in Infants.

Pediatr Cardiol 2021 Feb 4;42(2):442-450. Epub 2021 Jan 4.

Evelina London Children's Hospital, London, UK.

Intravascular ultrasound (IVUS) has been introduced as an accurate and minimally invasive diagnostic technique for the assessment of vascular anatomy and its abnormalities. We believe that IVUS can be used for clarifying the reasons for failure of balloon angiography in infantile coarctation of the aorta (CoA), because post-balloon angioplasty tearing, intimal flap, thrombosis and pseudoaneurysm of the aorta can be evaluated by IVUS with greater sensitivity and specificity. We aimed to assess the outcome of balloon angioplasty of CoA using angiography as the gold standard and IVUS as a new method in infants, comparing the two techniques for the evaluation of the diameter and area of CoA segment pre- and post-procedure. This cross-sectional study was performed on 18 infants hospitalized with a final diagnosis of CoA. All the infants underwent angiography and were also assessed by IVUS to measure the preoperative and postoperative diameter of the narrow segment in the two anterior-posterior and lateral views. In assessment by IVUS, the mean diameter of the coarctation site increased from 2.10 ± 0.30 mm to 4.50 ± 0.94 mm (P < 0.001). Similarly, the average minimum area of the coarctation level increased from 5.26 ± 1.50 mm to 13.77 ± 3.48 mm after angioplasty (P < 0.001). Comparing these findings, angiography and IVUS showed a high level of agreement. In the assessment of a dissection flap, there was a high level of agreement between angioplasty and IVUS before the procedure, but IVUS had higher accuracy after the procedure. Our study showed that IVUS was more reliable than angiography in the assessment of residual coarctation. IVUS yielded high sensitivity (58.3%) and specificity (100%) for discriminating the presence and absence of residual coarctation as well as the need for repeating the procedure. The assessment of coarctation before and after angioplasty procedures in children is possible using the IVUS method, with high accuracy. IVUS can offer greater accuracy than angiography in the evaluation of the coarctation area, detecting tears, dissection and flaps, and assessment of residual coarctation.
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http://dx.doi.org/10.1007/s00246-020-02503-yDOI Listing
February 2021

Acute coronary syndrome following arteriovenous fistula creation in a post CABG patient: A steal phenomenon from coronary artery to subclavian artery.

Semin Dial 2021 Jan 22;34(1):89-93. Epub 2020 Nov 22.

Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.

A 70-year-old man with a history of coronary artery bypass grafting 15 years back and arteriovenous (AV) fistula creation in the left arm 1 month back presented with acute coronary syndrome (ACS). He had not received dialysis before his referral. We felt the most likely etiology for these complaints was increased cardiac oxygen demand from an increased cardiac output related to the newly formed left AV fistula. Coronary angiography was done to detect any significant stenosis in the native or grafted vessels. This revealed that the left subclavian artery was totally occluded in the ostioproximal segment and the coronary arteries did not have occlusions to explain the ACS setting. CT angiography confirmed the angiographic findings of the totally occluded left subclavian artery followed by a well-developed and patent left internal mammary artery to left anterior descending artery. This led to the consideration of a steal syndrome from the coronary artery by the subclavian artery distal to the occlusion. A successful percutaneous endovascular intervention on the left subclavian artery occlusion was performed. Subsequently, the patient became asymptomatic and experienced a dramatic increase in left ventricular ejection fraction.
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http://dx.doi.org/10.1111/sdi.12933DOI Listing
January 2021

Paradigm Shift in the Management of Isolated Interrupted Aortic Arch in Adulthood.

Curr Probl Cardiol 2021 Mar 24;46(3):100717. Epub 2020 Sep 24.

An interrupted aortic arch (IAA) is a rare type of congenital heart disease, and few patients survived into the adulthood. Surgical reconstruction is still the recommended approach, despite its complexity and considerable complication. In addition, patients with IAA usually suffer from several other important congenital heart anomalies, which increase the complexity of surgical management of IAA. Although endovascular therapy has replaced surgery in the treatment of the majority of non-IAA, its applicability in IAA is still matter of debate. In the present review, we have discussed about various therapeutic solutions of IAA, and present a stepwise approach for its endovascular management.
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http://dx.doi.org/10.1016/j.cpcardiol.2020.100717DOI Listing
March 2021

Side-hole catheters have higher thrombus aspiration efficiency than regular end-hole catheters in an in vitro model.

Diagn Interv Radiol 2020 Nov;26(6):565-569

Islamic Azad University of Medical Sciences, Tehran, Iran.

Purpose: We aimed to evaluate and compare thrombus aspiration efficiency between side-hole and end-hole thrombus-aspirating catheters.

Methods: Using an in vitro model of acute thrombus occlusion, we performed thrombus aspiration with two catheter designs. Two end-hole and two side-hole catheters, 8 F and 10 F in diameter, were examined. Thrombus aspiration was performed with each catheter 30 times, and the amount of thrombotic material aspirated in each attempt was determined. The mean weight of the thrombotic material and the mean weight of the non-fluid thrombotic material extracted in all 30 attempts by each catheter were also determined.

Results: The 10 F side-hole catheter aspirated more thrombotic material than did the 10 F end-hole catheter (44.76 g vs. 28.35 g). The 8 F side-hole catheter had higher thrombus aspiration capacity than did the 8 F end-hole catheter in terms of the mean weight of the aspirated thrombus at each aspiration attempt (1.41 g vs. 0.58 g; P < 0.001) and the mean volume of the aspirated thrombotic material at each aspiration attempt (1.79 mL vs. 1.01 mL; P < 0.001). The mean weight of the non-fluid thrombotic material aspirated with the side-hole catheters was higher than that aspirated by the end-hole catheters with the same diameter size (31.06 g vs. 22.41 g for the 10 F catheters; P < 0.001; and 4.54 g vs. 2.99 g for the 8 F catheters; P < 0.001).

Conclusion: Side-hole catheters are more effective in aspirating acute thrombi. The added benefit of the side-hole design is more remarkable in smaller-sized catheters. Animal models are needed to examine their aspiration capacity in a real elastic vascular conduit and in the presence of wall-adherent thrombi.
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http://dx.doi.org/10.5152/dir.2020.19529DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7664749PMC
November 2020

Double Whammy: Concomitant Acute Type B Aortic Dissection and Acute Pulmonary Embolism.

Vasc Specialist Int 2020 Sep;36(3):158-162

Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.

The concomitant occurrence of acute type B aortic dissection (TBAD) and acute pulmonary embolism (PE) is a rare but challenging condition. Although anticoagulation therapy is essential in the treatment of PE, it may increase the risk of aortic rupture and bleeding complications. We herein describe a patient with acute TBAD complicated by PE, which was successfully treated with early thoracic endovascular aortic repair (TEVAR) followed by anticoagulation. The present case report demonstrates that early TEVAR not only treats the aortic pathology but also allows the safe initiation of anticoagulation therapy.
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http://dx.doi.org/10.5758/vsi.200025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7531301PMC
September 2020

Diagnostic accuracy of two-dimensional coronary angiographic-derived fractional flow reserve-Preliminary results.

Catheter Cardiovasc Interv 2021 Mar 27;97(4):E484-E494. Epub 2020 Jul 27.

Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.

Aim: Noninvasive fractional flow reserve (NiFFR) is an emerging method for evaluating the functional significance of a coronary lesion during diagnostic coronary angiography (CAG). The method relies on the computational flow dynamics and the three-dimensional (3D) reconstruction of the vessel extracted from CAG. In the present study, we sought to evaluate the diagnostic performance and applicability of 2D-based NiFFR.

Methods: In this prospective observational study, we evaluated 2D-based NiFFR in 279 candidates for invasive CAG and invasive fractional flow reserve (FFR). NiFFR was calculated via two methods: variable NiFFR, in which the contrast transport time was extracted from the angiographic view, and fixed NiFFR, in which a prespecified frame count was applied.

Results: The final analysis was performed on 245 patients (250 lesions). Variable NiFFR had an area under the receiver operating characteristic curve of 81.5%, an accuracy of 80.0%, a sensitivity of 82.2%, a specificity of 82.2%, a negative predictive value of 91.4%, and a positive predictive value of 63.6%. The mean difference between FFR and NiFFR was -0.0244 ±.0616 (p ≤.0001). A pressure wire-free hybrid strategy was possible in 68.8% of our population with variable NiFFR.

Conclusions: Our 2D-based NiFFR yielded results comparable to those derived from 3D-based software. Our findings should; however, be confirmed in larger trials.
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http://dx.doi.org/10.1002/ccd.29150DOI Listing
March 2021

Effect of drug-coated balloons versus bare-metal stents on endothelial function in patients with severe lower limb peripheral artery disease.

Vascular 2020 Oct 26;28(5):548-556. Epub 2020 Apr 26.

Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran.

Background: Research shows impaired endothelial function in patients with vascular diseases and improved endothelial function following revascularization and medical treatment. There is, however, a dearth of data on the effects of different endovascular therapeutic strategies on endothelial function. We sought to compare the effects of two endovascular strategies of drug-coated balloons versus stenting on endothelial function.

Methods: The reactive hyperemia index, the ankle-brachial index, and the toe-brachial index were measured in patients undergoing endovascular revascularization preprocedurally and on the 90th postprocedural day. After adjusting for baseline line characteristics, reactive hyperemia index were compared between the two groups at baseline and at 90 days.

Results: Between January 2018 and March 2019, 86 patients were prospectively included in a non-randomized manner. Drug-coated ballooning alone was carried out on 46 patients, and bailout stenting after plain balloon angioplasty was performed on the remaining 40 patients The post-revascularization reactive hyperemia index exhibited a significant rise in both groups (1.58 ± 0.21 vs. 1.43 ± 0.20; =0.0001). There was no difference in the postprocedural reactive hyperemia index between the two treatment groups. Additionally, the follow-up reactive hyperemia index showed no significant change compared with the postprocedural reactive hyperemia index (1.58 ± 0.23 vs. 1.57 ± 0.22). The results of subgroup analysis between a group of clinically high-risk patients and a group of patients with complex lesions were similar to the aforementioned results.

Conclusions: The reactive hyperemia index was significantly improved by endovascular therapy in our study population. However, no difference was observed between drug-coated ballooning and bare-metal stenting, which highlights the effects of vessel patency on endothelial function.
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http://dx.doi.org/10.1177/1708538120921316DOI Listing
October 2020

Rivaroxaban in patients undergoing surgical mitral valve repair.

J Thromb Thrombolysis 2020 Apr;49(3):475-479

Heart Valve Diseases Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Vali-Asr Ave, 1995614331, Tehran, Iran.

In patients undergoing mitral valve repair (MVre), a 3-month course of anticoagulation is currently recommended. The role of the non-vitamin K antagonist oral anticoagulants has here been scarcely studied. In the present mixed cohort study, the safety and efficacy of rivaroxaban (prospective analysis) were compared with those of warfarin (retrospective analysis) in patients undergoing MVre. Anticoagulation therapy was continued for at least 3 months, and the patients were followed for 1 year following surgery. The present study recruited 736 patients undergoing MVre with or without concomitant coronary artery bypass or surgical repair on the other valves. Concomitant valvular replacement and severe chronic kidney diseases were the most important exclusion criteria. The final analysis was conducted on 153 patients treated with rivaroxaban and 144 patients treated with warfarin. Dissimilarities in baseline characteristics necessitated propensity score matching, in which 104 patients in each group were compared. No major bleeding or cerebrovascular accident occurred during the 1-year follow-up. Clinically relevant non-major bleeding was reported in 2 patients in the rivaroxaban group and 4 patients in the warfarin group, a difference non-statistically significant before and after propensity score matching (P = 0.371 and P = 0.407, respectively). The type of anticoagulation did not predict the 1-year outcome (HR 2.165, 95% CI 0.376 to 12.460; P = 0.387). In this mixed cohort study, rivaroxaban was both safe and efficient in patients with MVre. Such preliminary results should prompt larger randomized controlled trials.
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http://dx.doi.org/10.1007/s11239-020-02046-2DOI Listing
April 2020

Left ventricular end-diastolic pressure-guided hydration for the prevention of contrast-induced acute kidney injury in patients with stable ischemic heart disease: the LAKESIDE trial.

Int Urol Nephrol 2019 Oct 22;51(10):1815-1822. Epub 2019 Jul 22.

Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Vali-Asr Ave, Tehran, Iran.

Objectives: Contrast-induced acute kidney injury (CI-AKI) is a serious complication in patients undergoing diagnostic cardiac angiography or percutaneous coronary intervention. We aimed to evaluate the preventive effects of left ventricular end-diastolic pressure (LVEDP)-guided hydration for the prevention of CI-AKI in patients with chronic kidney disease undergoing cardiac catheterization.

Methods: This prospective randomized single-blind clinical trial enrolled 114 eligible patients with an estimated glomerular filtration rate (eGFR) of 15 < eGFR ≤ 60 mL/min/1.73 m [according to the level-modified Modification of Diet in Renal Disease formula (MDRD)] and stable ischemic heart disease undergoing coronary procedures. The patients were randomly allocated 1:1 into the LVEDP-guided hydration group (n = 57) or the standard hydration group (n = 57). CI-AKI was defined as a greater than 25% or greater than 0.5 mg/dL (44.2 mmol/L) increase in the serum creatinine concentration compared with the baseline value. Hydration with 0.9% sodium chloride at a rate of 1 mL/kg/h (0.5 mL/kg/h if left ventricular ejection fraction < 40%) within 12 h was given to all the patients in both groups before the procedure. In the LVEDP-guided group, the hydration infusion rate was adjusted according to the LVEDP level during and after the procedure.

Results: The incidence of CI-AKI was 7.01% (4/57) in the LVEDP-guided group vs 3.84% (2/52) in the standard hydration group (summary odds ratio 0.53, 95% CI 0.093-3.022; P = 0.463). Major adverse cardiac events, hemodialysis, or related deaths occurred in neither of the groups during hospitalization or the 30-day follow-up.

Conclusions: In the present study, LVEDP-guided fluid administration, by comparison with standard hydration, failed to offer protection against the risk of CI-AKI in patients with renal insufficiency undergoing coronary angiography with or without percutaneous coronary intervention.
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http://dx.doi.org/10.1007/s11255-019-02235-wDOI Listing
October 2019

Half-dose thrombolytic therapy in patients with right heart thrombi.

J Int Med Res 2019 Jul 30;47(7):3400-3407. Epub 2019 May 30.

1 Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.

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http://dx.doi.org/10.1177/0300060519850399DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6683889PMC
July 2019

Outcomes and Complications of Bronchial Angioembolization in Patients with Massive Hemoptysis.

Tanaffos 2019 Apr;18(4):310-314

Lung Transplantation Research Center, Department of Cardiology, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Massive hemoptysis is a potentially life threatening medical condition and one major problem for both patients and physicians. Choosing the appropriate treatment for the patients is crucial in order to decrease the complications and increase the success rate. Hence, in this study the outcomes and complications of bronchial angioembolization (BAE) were determined in patients with massive hemoptysis.

Materials And Methods: In this prospective cohort, 189 consecutive patients with moderate and severe hemoptysis who had referred to two large cardiovascular centers were enrolled. The Chest X Ray, CT Scan, Fiberoptic Bronchoscopy, Selective and Nonselective Bronchial Angiography were performed in patients. The outcomes with 20-month follow-up were compared.

Results: The immediate success rate was 97.3%. In 79.7% there were no complications. Temporary chest pain, subintimal dissection, temporary dysphagia, and pancreatitis were seen in 12.3, 2.4, 5.1, and 0.5%, respectively, without any major complication. The in-hospital mortality rate was 1.1% and mortality during 20-month follow-up was 9.6%, and recurrence rate was 28.3% on total.

Conclusion: Our case series showed that BAE is a safe and effective method in treating patients with hemoptysis. Compared to surgery, the procedure is faster and less invasive and might be used both as first line or bridging therapy. Importantly, no major complications have been detected.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7309885PMC
April 2019

Chronic thromboembolic pulmonary hypertension versus fibrosing mediastinitis.

Anatol J Cardiol 2019 Feb;21(2):E4-E5

Cardiovascular Intervention Research Center, Iran University of Medical Sciences; Tehran-Iran.

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http://dx.doi.org/10.14744/AnatolJCardiol.2018.12258DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6457413PMC
February 2019

Aberrant Vertebral Artery: An Intruder into the Aortic Arch (Atypical Bow Hunter's Syndrome).

JACC Cardiovasc Interv 2018 12 15;11(23):e191-e194. Epub 2018 Nov 15.

Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran; Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran. Electronic address:

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http://dx.doi.org/10.1016/j.jcin.2018.09.024DOI Listing
December 2018

Inferior vena cava diameter as a guide in hypotensive patients for appropriate saline therapy: An observational study.

Int J Crit Illn Inj Sci 2018 Jul-Sep;8(3):160-164

Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.

Background: Knowledge of intravascular volume (IV) status of a hypotensive patient is of utmost importance. Clinical evaluation and central venous pressure (CVP) measurement are routinely used as a guide for evaluation of IV in these patients. However, clinical assessment may be inaccurate, and CVP measurement is invasive. Moreover, CVP changes slowly with saline therapy, which is unfavorable for fluid resuscitation.

Aim: Our aim is to find the correlation and sensitivity of inferior vena cava (IVC) diameter measured by ultrasound to provide a noninvasive method for evaluation of IV among patients with hypotension and hypovolemia in the emergency department (ED).

Methods: We measured the IVC diameter of hypotensive patients before and after saline therapy. As all of the patients had central venous line (CV-line) in place, CVP was also measured before and after. Using MedCalc and SPSS software the correlation between these two was determined as expressed with "." Then, receiver operating characteristic (ROC) curve was sketched.

Results: Ninety-nine patients, 49 (49.5%) males, were evaluated. Mean systolic blood pressure was 90 mmHg with a mean hazard ratio about 104. IVC diameter was 7.44 ± 5.13 mm before and 9.84 ± 5.29 after ( = 0.002) saline therapy. There was a high correlation between IVC diameter and CVP ( = 0.941, < 0.0001 before saline therapy and = 0.95, < 0.0001 after saline therapy). ROC curve for IVC diameter shows a very high sensitivity for all criteria values.

Conclusion: IVC diameter measurement using ultrasonography has excellent correlation with CVP. This method is very sensitive to rapid IV changes thus useful to guide saline therapy in hypotensive patients referred to ED. However, its use in certain subsets of patients' needs further studies.
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http://dx.doi.org/10.4103/IJCIIS.IJCIIS_27_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6116307PMC
September 2018

Self-Expanding Versus Balloon-Expandable Stents in Patients With Isthmic Coarctation of the Aorta.

Am J Cardiol 2018 09 27;122(6):1062-1067. Epub 2018 Jun 27.

Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada.

Endovascular stent implantation has become the treatment of choice for the management of patients with native coarctation of the aorta (CoA). The aim of this study was to compare the outcomes of self-expandable stenting (SES) with balloon-expandable stenting (BES) in the treatment of native CoA. In this single-center retrospective study, all patients who underwent SES or BES for the management of native CoA were enrolled. Patients were followed up for a median period of 35 (inter-quartile range 15 to 71) months. The primary outcome of interest was a composite end point consisted of death, surgical repair, re-stenting, re-ballooning, and hospital admission for hypertension crisis. The CoA diameter has changed from 3.2 ± 2.1 to 14.2 ± 4.0 mm in the BES group and from 4.6 ± 2.6 to 12.2 ± 3.7 mm in the SES group (both p <0.001). The procedure was successful with residual pressure gradient <20 mm Hg in 99.0% and 98.6% of patients in the BES and SES groups, respectively. Major adverse events occurred in 6 (8.7%) in the SES groups and 14 (20.3%) in the BES group (p = 0.053). Kaplan-Meier curve showed no difference between the 2 groups in terms of survival from major adverse events (p = 0.10), but when groups were matched for the propensity of stenting methods, SES was associated with lower major adverse events (p = 0.01). In conclusion, the SES and BES methods were safe and durable in our cohort with low rates of adverse events. After adjustment for the propensity of treatment with each stenting method, SES was associated with better outcomes. Regardless of the outcome of each method, it should be noted that the taken approach should be tailored to the patient's anatomy.
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http://dx.doi.org/10.1016/j.amjcard.2018.06.005DOI Listing
September 2018

Simultaneous Thrombosis and Hemorrhage: Endovascular Approach to Both Conditions.

JACC Cardiovasc Interv 2018 May 18;11(9):906-908. Epub 2018 Apr 18.

Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran; Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Electronic address:

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http://dx.doi.org/10.1016/j.jcin.2017.12.013DOI Listing
May 2018

Iatrogenic IVC Perforation after Successful Catheter-Directed Thrombolysis.

Case Rep Vasc Med 2017 29;2017:3746815. Epub 2017 Aug 29.

Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.

Central vein perforation as a rare complication of venous interventions is considered a nightmare if occurring in thoracic cage but behaves benignly in abdominal or pelvic region. This is not a rule, as we unfortunately encountered during the procedure of venous intervention in our patient. Although mechanical control of iatrogenic perforation or rupture is the first and most critical step during interventional procedures, the importance of anticoagulant and thrombolytic agents reversal should not be overlooked.
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http://dx.doi.org/10.1155/2017/3746815DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5603125PMC
August 2017

Early and Midterm Results Following Interventional Coarctoplasty: Evaluation of Variables that Can Affect the Results.

Korean Circ J 2017 Jan 27;47(1):97-106. Epub 2016 Dec 27.

Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.

Background And Objectives: Stent coarctoplasty has been approved as the treatment of choice for adult patients with coarctation of the aorta. We have evaluated the early and midterm clinical and procedural results after interventional coarctoplasty. Also, variables that can affect these results were evaluated.

Subjects And Methods: Gathering clinical, angiographic and procedural data, we evaluated the pre-specified outcomes, including procedural success, complications, the incidence of hypertension after coarctoplasty etc., after the procedure. The effect of pre-specified variables including aortic arch shape, coarctation type and etc. on the procedural result was evaluated.

Results: Between February 2005 through March 2014, 133 stent coarctoplasty procedures were performed. Median age was 23.5 years old (interquartile range [IQR]:19-28), and 105 (71.9%) were male. Nearly all of the patients were undergone stent coarctoplasty, mostly with cheatham platinum (CP) stents. There was no association between aortic arch morphology and acute procedural complications. Balloon length more than 40 mm (p=0.028), aorta diameter at the site of Coarctation larger than 2.35 mm (p=0.008) was associated with higher rate of restenosis during follow-up. Comparison between the prevalence of hypertension (HTN) before and after coarctoplasty showed a significant reduction in the prevalence of HTN (117 [91.4%] vs. 95 [74.2%] p<0.001).

Conclusion: Stent coarctoplasty is a low-risk procedure with favorable early and delayed outcomes. Most mortality is related to the patient's comorbid conditions and not to the procedure.
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http://dx.doi.org/10.4070/kcj.2016.0211DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5287194PMC
January 2017

Transcatheter closure of iatrogenic Gerbode defect with an Amplatzer duct occluder in a 23-year-old patient.

J Cardiol Cases 2015 Aug 11;12(2):45-47. Epub 2015 May 11.

Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical & Research Center, Iran University of Medical Sciences, Tehran, Iran.

A 23-year-old man was referred to our center with hematuria and hemolysis. The patient had undergone mitral and tricuspid valve replacement 3 months previously. Echocardiography and catheterization revealed a Gerbode-type ventricular septal defect. A decision was made to occlude the defect interventionally. The patient's hematuria ceased immediately after the occlusion of the defect. < Iatrogenic ventricular septal defects (especially Gerbode-type) are relatively rare complications after valvular surgery. Correction of such defects can be done both surgically and interventionally, but since the risk of another operation for correction is high, percutaneous ventricular septal defect closure is usually the preferred treatment option. Using an appropriate approach will increase the success rate.>.
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http://dx.doi.org/10.1016/j.jccase.2015.04.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6262122PMC
August 2015

Determination and comparison of mean random urine calcium between children with vesicoureteral reflux and those with improved vesicoureteral reflux.

Saudi J Kidney Dis Transpl 2011 Jan;22(1):79-82

Department of Pediatrics, Guilan University of Medical Sience, Rasht, Iran.

Urinary reflux can cause irreversible complications such as reflux nephropathy and ESRD. Diagnostic imaging such as voiding cystourethrogram (VCUG) is invasive and causes irradiation. Several studies have shown that markers such as urine IL-8 or serum Procalcitonin might be useful for the diagnosis of vesico-ureteral reflux (VUR) as a substitution for invasive methods. The aim of this study was to determine and compare the mean urine Ca/Cr ratio and hypercalciuria between two groups of children aged 2-10 years affected by VUR. This is a cross-sectional study in which 32 children having the following entrance criteria were included: children 2-10 years old not affected by urinary tract infection during the last three months and their reflux or recovery having been diagnosed by VCUG or direct radionuclide cystography, divided into two groups of affected by reflux and recovered from reflux. Then, the point urine specimens were collected with permission of their parents in a single laboratory and urine Ca and Cr for each specimen were measured. The Ca/Cr ratio was calculated for each child to evaluate Ca excretion from the urine, which was possible without collecting the 24-hours urine. The Ca/Cr ratio mean and the hypercalciuria were compared between the groups. To analyze our data, the Mann-Whiney test and the Chi-square test were used, using SPSS V.15. Thirty-two children, including 18 children recovered from reflux and 14 affected by reflux, were entered in our study. The Ca/Cr ratio mean was 0.692 ± 1.874 for the affected and 0.118 ± 0.187 for the recovered group. The Ca/Cr ratio mean for the affected male and female groups was 0.012 ± 0.008 and 0.805 ± 1.0913, respectively. This amount was 0.0175 ± 0.01767 for the recovered male and 0.131 ± 0.195 for the recovered female group. There was no significant statistical difference between the groups with respect to the Ca/Cr ratio mean, but there was a significant statistical difference between the two groups of females (P-value = 0.026). Also, there was no significant statistical difference between the two groups of males relative frequency of hypercalciuria was significantly higher in the group affected by reflux than in the recovered from reflux group (P-value = 0.017). Urine Ca excretion is elevated in children with reflux, and may be more useful as an appropriate marker for the diagnosis of VUR than other invasive methods.
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January 2011