The Improvement of Myocardial Function by Granulocyte Colony Stimulating Factor Following Acute Anterior Myocardial Infarction: A Double Blind Placebo Controlled Study

en The Improvement of Myocardial Function by Granulocyte Colony Stimulating Factor Following Acute Anterior Myocardial Infarction: A Double Blind Placebo Controlled Study Background: In patients with acute myocardial infarction (AMI), reperfusion of the occluded infarct-related artery significantly improves acute and late clinical outcome. There is increasing evidence that transplantation of autologous stem cells improves cardiac function after AMI. For propagation of peripheral blood stem cells, application of granulocyte–colony stimulating factor (G-CSF) has been shown to be feasible, effective, and safe. Methods: Ten patients in the treatment group and 10 patients in the control group were enrolled in this prospective, randomized controlled and double blind study. Two weeks after myocardial infarction that was followed by successful recanalization and stent implantation, the patients of the treatment group received 10 μg/kg body weight per day (divided BID) G-CSF subcutaneously for a maximum duration of 5.0 days. In both groups, ejection fraction was evaluated with echocardiography and cardiac perfusion scans 10 days and 6 months after myocardial infarction. The Tei index was measured by echocardiography. Results: No severe side effects of G-CSF treatment were observed. There was no significant improvement of left ventricular ejection fraction when the G-CSF treated group was compared to the control group (P=0.821 for cardiac scan and P=0.705 for echocardiography). Changes in Tei index was not significant in the treatment group (P=0.815); however, it was significantly deteriorated in the control group (P=0.005). Conclusion: In patients with acute anterior myocardial infarction, treatment with G-CSF, is feasible and safe and seems to be effective in improving global cardiac function without affecting the ejection fraction under clinical conditions. Granulocyte–Colony Stimulating Factor, Myocardial Infarction 0 0 http://www.icrj.ir/Ui/Pblc/ViewIssu.aspx?ic=15 J Kojuri Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran kojurij@yahoo.com ICRJ-941 Yes A Moaref Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran ICRJ-942 No

en A Comparison between Methods Used to Extract Maximum and Minimum Myocardial Velocities by Spectral Pulsed-TDI Background: Tissue Doppler imaging is an echocardiographic useful method in the assessment of left ventricular myocardial function in the clinical condition. Pulsed Doppler interrogation measures the instantaneous velocities of the myocardium which passes through the sample volume during the cardiac cycle. Objective: The present study attempts to verify a computerized method to determine myocardial maximum and minimum velocities throughout the cardiac cycles using spectral pulsed-tissue Doppler imaging. The data of curves might be used to calculate myocardial physical and mechanical parameters throughout the cardiac cycle. Methods: Spectral pulsed-TDI was performed to evaluate longitudinal function in 23 healthy volunteers by using a sample volume placed in 170 left ventricular segments. The velocities were extracted automatically based on four common edge detection algorithms using Matlab software. Labeling of connected components in boundary of spectrum allowed comparing the methods. In addition to analysis of variance and t-test, linear correlation and Bland-Altman analysis were calculated to assess the relationships and agreements between the systolic and diastolic results of measurements before and after using the computed program. Results: Comparison of the means of the four edge detection methods showed that there are statistically signifi- cant differences between methods (number of labels were 12 3 for Canny, 20 4 for Roberts, 31 4 for Sobel and 39 5 for Prewitt respectively, P<0.05). There were not significant differences between measured velocities in the segments; before and after application of the Canny method. There was significant correlations (r=0.99 and r=0.96, P=0.01) at the base and mid segments, respectively with Bland-Altman analysis significant agreements between the measurements. Conclusion: It is concluded that the proposed method automatically extracts myocardial velocities using spectral pulsed images. Canny method showed relatively favorable results and seems to be a preferable option to extract velocities from the spectral images. Correlation study and Bland-Altman analysis confirmed a good agreement between the measurements. Echocardiography, Pulsed Doppler, Velocity, Software Verification 0 0 http://www.icrj.ir/Ui/Pblc/ViewIssu.aspx?ic=15 H Moladoust Faculty of Medicine, Heshmat Cardiovascular Research Center, Guilan University of Medical Sciences, Rasht, Iran hmoladost@yahoo.com ICRJ-945 Yes Z Ojaghi-Haghighi Department of Echocardiography, Shaheed Rajaei Cardiovascular Medical and Research Center, Tehran University of Medical Sciences, Tehran, Iran ICRJ-944 No

en A comparison of outcomes of routine early angiography versus delayed ischemia-guided angiography after thrombolytic therapy in ST segment-elevation myocardial infarction Background: Thrombolytic therapy continues to be the common treatment in acute ST elevation myocardial infarction in the majority of heart centers worldwide. However, thrombolytic therapy is associated with high re-occlusion and re-infarction rates. So, most patients now undergo early diagnostic angiography and possibly angioplasty of the culprit artery but the controversy about the timing of angiography after thrombolysis continues to remain unresolved. In this prospective cohort study, we compared the outcome of early invasive strategy versus delayed invasive approach in ST-elevation MI patients who had received successful thrombolytic therapy. Primary endpoint of the study was Major Adverse Cardiovascular Events or MACE ( the combined rate of death, re-infarction, major bleeding and cerebrovasular events. Secondary endpoints were re-infarction and re-hospitalization rate. Method: The study comprised 142 patients of which 87 had a routine angiography in less than 10 days of acute event and 55 underwent ischemia-guided angiography after 10 days of index event. Stenting of the culprit vessel was done in 60% of the routine angiography group and 63% of the ischemia-guided group. The patients were followed for 8.8 ± 2.8 months after the index event. Results: The primary endpoint occurred in 6.9% of routine angiography patients and 10.9% of the control group (P= 0.4). The rate of re-infarction was significantly higher in the delayed invasive arm than routine early invasive arm (10.9% vs. 1.1, P:0.01),and mostly occurring before angiography. Conclusion: routine angiography as soon as possible after thrombolysis can reduce re-infarction and was not associated with any increased risk of adverse events in our study. Coronary Angiography, Myocardial Infarction, Thrombolytic Therapy 0 0 http://www.icrj.ir/Ui/Pblc/ViewIssu.aspx?ic=15 R Kiani Department of Interventional Cardiology, Shaheed Rajaie Cardiovascular Center, Tehran University of Medical Sciences, Tehran, Iran re.kiani@gmail.com ICRJ-950 Yes HA Basiri Department of Interventional Cardiology, Shaheed Rajaie Cardiovascular Center, Tehran University of Medical Sciences, Tehran, Iran ICRJ-949 No

en Correlation between HDL-C and Smoking in Teachers Residing in Shiraz, Iran Background: Coronary Artery Disease (CAD) is the major cause of morbidity and mortality. The knowledge about correlation between the different risk factors of CAD provides valuable information for prediction and prevention of the disease in a specific population.The aim of this study was to evaluate the correlation between fasting blood sugar (FBS) and resting blood pressure in teachers residing in Shiraz, Iran Methods: A total of 3115 teachers from different educational centers of Shiraz, Iran were interviewed in this cross sectional study. The data obtained comprised demographic information including age, sex, and history of hypertension (HTN), diabetes mellitus (DM), and current use of medications. Other parameters measured were height, weight, fasting blood sugar (FBS) and resting blood pressure (BP) as well as calculating the body mass index (BMI). Results: Out of all the cases studied, undiagnosed and/or untreated cases of diabetes and hypertension were 1.5% and 15.2% respectively. FBS was higher in the elderly and in cases with higher BMI, but without any significant difference in relation to sex. The prevalence of HTN was higher in males, in older cases and in those with higher BMI. A significant relationship was observed between FBS and resting BP in hypertensive and prehypertensive groups (P < 0.001) as compared to normotensive subjects. Conclusion: There was a significant correlation between FBS and resting BP in hypertensive and prehypertensive teachers residing in Shiraz,Iran. But this correlation was not present in the vast majority of the population with normal resting blood pressure. The prevalence of neglected DM and HTN in this population was high enough to warrant regular screening. Diabetes mellitus, Hypertension, Cardiovascular risk factors 0 0 http://www.icrj.ir/Ui/Pblc/ViewIssu.aspx?ic=15 R Mozaffari Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran mozaffarir@gmail.com ICRJ-958 Yes M Zamiriam Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran ICRJ-956 No

en The Reduction in Anxiety and Depression by Education of Patients with Myocardial Infarction Background: The myocardial infarction is the interruption of blood circulation heart that causes its cells to die. This deprives the heart muscle of blood and oxygen, and causes chest pain and pressure sensation. Hypertension and other risk factors like high cholesterol, cigarette smoking, and physical inactivity, can lead to coronary heart diseases with symptoms of depression and anxiety that predict subsequent mortality. The purpose of this study was to determine the effect of education on anxiety and depression in patients with myocardial infarction in selected hospitals of Urmia hospitals in 2009. Methods: This study was a quasi-experimental study that comprised 124 patients selected randomly and divided into two groups. The experimental group was educated by a face to face training and educational booklet. Control group did not receive any intervention. The level of anxiety and depression was evaluated by using HADS questionnaire at 3 intervals .After 48 hours of admission, discharge day and 2 months after discharge. Results: The findings suggest that MI patients worried about their social role, interpersonal relations and personal health, which can exacerbate symptoms and complicate their future care. There was no significant difference between control and experimental groups before the intervention, But after the intervention, anxiety and depression in the experimental group was significantly less than control group (P<0.05). Conclusion: Considering the beneficial effect of intervention on reducing anxiety and depression in such patients, the patient’s education should be one of the health care goals. Most researches may also be required to confirm the results in other groups of patients. Education, Anxiety and Depression, Myocardial Infarction 0 0 http://www.icrj.ir/Ui/Pblc/ViewIssu.aspx?ic=15 F Sharif Faculty of Nursing, Shiraz University of Medical Sciences, Shiraz, Iran fsharif@sums.ac.ir ICRJ-966 Yes N Aghakhani Faculty of Nursing, Urmia University of Medical Sciences, Urmia, Iran ICRJ-965 No

en Undiagnosed Anemia in Pediatric Patients with Congenital Heart Diseases - - 0 0 http://www.icrj.ir/Ui/Pblc/ViewIssu.aspx?ic=15 H Amoozgar Division of Pediatric Cardiology, Department of Pediatrics, Shiraz University of Medical Sciences, Shiraz, Iran amozgah@sums.ac.ir ICRJ-971 Yes M Soltani Division of Pediatric Cardiology, Department of Pediatrics, Shiraz University of Medical Sciences, Shiraz, Iran ICRJ-972 No

en Lower-Loop Reentrant Atrial Flutter The mechanism of typical atrial flutter (AFL) has been well established. The isthmus between the tricuspid annulus and Eustachian ridge has been recognized as a critical part for maintaining the typical AFL circuit and the target site for ablation. However, a subtype of AFL, as double-wave reentry [lower loop reentry], has been described. This arrhythmia is due to the presence of 2 activation wavefronts rotating simultaneously. In this case report, we presented a case of counter-clockwise AFL with such activation circuit. Atrial Flutter, Double Wave Reentry, Lower Loop Reentry 0 0 http://www.icrj.ir/Ui/Pblc/ViewIssu.aspx?ic=15 M Haghjoo Department of Pacemaker and Electrophysiology, Shaheed Rajaie Cardiovascular Center, Tehran University of Medical Sciences, Tehran, Iran majid.haghjoo@gmail.com ICRJ-977 Yes A Aslani Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran ICRJ-975 No

en Limb Ischemia and Dyspnea; A Plausible Indication of Paradoxical Embolism Coexistence of pulmonary embolism and systemic arterial embolism can be one of the most life threatening conditions, diagnosed as paradoxical embolism which suggests the presence of intra-cardiac defects. The case presented herein, is a 46-year old male with paradoxical emboli. The patient was diagnosed as having pulmonary embolism and unilateral lower extremity arterial emboli through a previously undetected Patent oval foramen oval (PFO). This case shows the importance of evaluating paradoxical embolism in unexplained cases of acute limb ischemia. Paradoxical Embolism, Limb Ischemia, Patent Foramen Oval, Pulmonary Embolism 0 0 http://www.icrj.ir/Ui/Pblc/ViewIssu.aspx?ic=15 N Farsi Medical Sdudents research Committee, Tehran University of Medical Sciences, Tehran, Iran negilotania@yahoo.ca ICRJ-980 Yes Sh Hajsadeghi Rasoul-e-Akram Hospital, Tehran University of Medical Sciences, Tehran, Iran ICRJ-978 No