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BACKGROUND: Enterococci are responsible for 5% to 18% of infective endocarditis (IE) cases. We aimed to determine demographic data, predisposing factors, clinical presentations, complications and echocardiographic findings concerning enterococcal endocarditis.METHODS: Since 2006, all adult patients with a possible or definite diagnosis of IE based on the modified Duke criteria have been enrolled in the Iranian Registry of Infective Endocarditis. In this study, patients with IE of enterococcal origin were detected and their demographic characteristics, predisposing factors, complications, laboratory data and echocardiographic findings were assessed.RESULTS: Out of 731 patients diagnosed with endocarditis. Enterococci were found in 60 patients: 32 men (53.3%) and 28 women (46.7%) at a mean age of 55.21 ± 17.9 years. Definite IE was diagnosed in 57 (95%) patients, and possible IE was suspected in 3 patients (5%). The most frequent predisposing factor was the prosthetic valve (n=28, 46.7%), followed by a history of previous endocarditis (n=12, 20%). An acute course (

Introduction: Epicardial fat thickness (EFT) can reflect risk of cardiovascular disease particularly coronary artery disease (CAD). The aim of this study was to investigate the association of EFT assessed by echocardiography and presence as well as severity of CAD. Methods: Two hundred and twenty consecutive patients who candidate for coronary angiography because of possible CAD were studied. EFT was evaluated in standard parasternal long axis (PlAX) and parasternal short axis (PSAX) view from 3 cardiac cycles at the end of systole and diastole. The severity of CAD was defined in two ways: (1) SYNTAX score, (2) number of vessels with significant lesion. Results: PLAX (EFTS ) (EFT in systole) and PLAX (EFTd ) (EFT in diastole) were significantly higher in patients with CAD in comparison with patients without CAD (P = 0.046, P = 0.041 respectively). There was a significant correlation between PLAX (EFTS ) (P = 0.05), PLAX (EFTd ) (P = 0.04) and SYNTAX score. There was no statistically significant relationship between EFT and number of diseased vessel (P > 0.05). Multivariate analysis was done for adjusting the effects of confounding factors and it showed that EFT (OR: 10.53, P = 0.004) was significantly correlated severe CAD as assessed by the SYNTAX score. Conclusion: EFT assessed by transthoracic echocardiography was higher significantly in patients with CAD than in normal patients. EFT as an easily available and cost-effective echocardiographic feature might be useful to predict complexity of CAD.

Introduction: The risk of contrast-induced nephropathy (CIN) as a common and important complication of coronary procedures may be influenced by the vascular access site. We compared the risks of CIN in diagnostic or interventional coronary management between patients treated via the transradial access (TRA) and those treated via the transfemoral access (TFA). Methods: Patients undergoing invasive coronary catheterization or percutaneous coronary intervention (PCI) were enrolled. We excluded patients with congenital or structural heart disease and those with end-stage renal disease on dialysis. Based on the vascular access site used for invasive coronary catheterization, the patients were divided into 2 study groups: the TFA and the TRA. CIN was defined as an absolute (≥0.5 mg/dL) or relative (>25%) increase in the baseline serum creatinine level within 48 hours following cardiac catheterization or PCI. Results: Overall, 410 patients (mean age = 61.3 ± 10.8 years) underwent diagnostic or interventional coronary management: 258 were treated via the TFA approach and 152 via the TRA approach. The patients treated via the TFA had a significantly higher incidence of postprocedural CIN (15.1% vs 6.6%; P = 0.01). The multivariate analysis showed that the TFA was the independent predictor of CIN (OR: 2.37, 95% CI: 1.11 to 5.10, and P = 0.027). Moreover, the BARC (Bleeding Academic Research Consortium) and Mehran scores were the other independent predictors of CIN in our study. Conclusion: The risk of CIN was lower with the TRA, and the TFA was the independent predictor of CIN after the diagnostic or interventional coronary management.

Background and Objectives: Cardiovascular diseases (CVDs) impose great burden on the health systems worldwide. The prevention of CVDs depends on the correct information about the perveance/incidence of them and their determinants in the community and population-based studies are the most accurate ways for obtaining these data. The objective of this study is to determine the prevalence of the classic risk factors of CVDs among healthy adult residents of Tehran and their changes through a 10-year follow-up in Tehran, the capital of Iran. This article presents the study protocol. Methods: Heart Assessment and Monitoring in RAjaie Hospital, is a population-based study conducted in Rajaie Cardiovascular Medical and Research Center, the largest tertiary care hospital for CVDs in Tehran. It consists two phases: A survey and a prospective cohort. People between 30 and 75 years of age, without known CVDs, invite through a multistage random sampling process. They will assess for the CVD risk factors, laboratory indices, electrocardiography and echocardiography features, diet, physical activity levels, psychological aspects, and peripheral vascular diseases. All the participants will be followed for 10 years and the changes in the above-mentioned factors and incidence of CVDs assessed. Discussion: It is expected that through obtaining valid, population-specific data, the information for policy making and efficient management of CVDs in Iranian people be provided.

Background: Cardiomyopathies are characterized by structural and functional abnormalities of myocardium that will probably lead to premature death from arrhythmia and/or progressive heart failure. Myocarditis is an inflammatory disease of the myocardium diagnosed by histological criteria definitively. To date, most information about the natural history and management of cardiomyopathies and myocarditis has derived from cohort studies in a small number of specialized centers. Aim: The prevalence of patients with cardiomyopathies who referred to Rajaei Cardiovascular medical and research center from all over the country is remarkable. Rajaie Cardiomyopathy and myocarditis Registry (RCMR) study is an observational registry of consecutive patients with four cardiomyopathy subtypes: hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM), arrhythmogenic right ventricular cardiomyopathy (ARVC), and restrictive cardiomyopathy (RCM) as well as myocarditis designed to determine clinical characteristics, natural history, current therapeutic approaches, response to treatment and long-term outcomes of patients with cardiomyopathy and myocarditis. Prediction of mortality and response to different treatments in these patients using artificial intelligence is another aim of this registry. Covid 19 Myocarditis and its sequence as cardiomyopathy seems a new challenge in forthcoming years. Methods: Patients with a history of documented cardiomyopathy/ myocarditis fulfilling standard diagnostic criteria based on the ESC guideline for cardiomyopathy/ myocarditis and willing and able to give informed consent or in the case of child consent from a parent will be included. At baseline visit , past medical history, clinical signs/ symptoms, risk factors, physical examination and family history of cardiomyopathy, as well current standards for diagnostic workup and clinical follow-up and where relevant electrocardiogram, echocardiography, cardiac magnetic resonance, Holter monitoring, or biomarker analyses will be checked. Based on the type of disease and the physician's opinion, patients will undergo exercise test, electrophysiology study or endomyocardial biopsy. Outcome and results of various therapeutic approaches currently employed for patients including implantable cardioverter defibrillator, cardiac resynchronization therapy, septal myectomy, ablation, cardiac transplantation and medications will be assessed. Long-term outcomes including the benefits and complications of therapeutic interventions will be collected. Follow-up visit will be scheduled after 12 months for all patients and survival status, hospitalizations, co-morbidities, medications will be assessed. Data will be collected on a research electronic data source (Regitory) and will be analyzed at regular intervals based on study objectives and also by using artificial intelligence. Conclusion: RCMR aims to make a major contribution to understanding the natural history of the cardiomyopathy/ myocarditis, as well as guiding evidence-based decision making. Potential gaps with existing recommendations will be discussed as well as some suggestions for improvement of health care provision.

BACKGROUND: Pericardial mesothelioma cyst occurs rarely, and is often found incidentally. The coexistence between large pericardial mesothelial cyst and hypertrophic obstructive cardiomyopathy (HOCM) can make difficulties in medical management.CASE REPORT: Our case was a 33-year-old man presented with dizziness and pallor while standing since four years before, and recent syncope. On admission, transthoracic echocardiography reveled presence of hypertrophic cardiomyopathy in association with relatively small right ventricular and atrium due to compression effect by a large echo-free space at the right side of heart suggestive of pericardial cyst. Cardiac computed tomography confirmed presence of HOCM and large pericardial cyst. Patient underwent surgical septal myectomy and large mesothelial pericardial cyst excision because of persistent symptoms and compression effect of cyst on the right chambers despite beta-blocker therapy.CONCLUSION: To best of our knowledge, the coexistence of the large pericardial mesothelial cyst and HOCM has not been reported before.

Abstract Patients with the underlying valvular heart disease are at the high risk of developing sub-acute or chronic endocarditis secondary to Coxiella burnetii. Q fever endocarditis is the most common manifestation along with persistent the infection. There is some serologic and molecular evidence of C. burnetii infection in humans and livestock in Iran. As it is possible to observe chronic Q fever in Iran, it seems necessary to study the prevalence of Q fever endocarditis in this country. In the present study, Infective Endocarditis (IE) patients (possible or definite based on Duke Criteria) hospitalized in Rajaie Cardiovascular Medical and Research Center were enrolled from August 2016 to September 2018. Culture-negative endocarditis patients were evaluated by Raoult criteria for diagnosis Q fever endocarditis. The serological results for brucellosis were negative for all subjects. All blood and tissue samples including valve samples were tested for C. burnetii infection using serology and Polymerase Chain Reaction (PCR). In this study, 126 patients who were admitted to the hospital were enrolled; of which 52 subjects were culture-negative IE. Among the participants, 16 patients (30.77%) were diagnosed with Q fever IE and underwent medical treatment. The mean age of patients was 46.6 years ranging from 23 to 69 years and 75% of them were male. Considering the high prevalence of Q fever IE, evaluation of the patients with culture-negative IE for C. burnetii infections was highly recommended.

Objectives: Parents with children suffering from congenital heart disease (CHD) faced with a severe emotional crisis. This study was conducted based on the idea that the more knowledgeable the parents are about such diseases, the more they can cooperate with the physician in the child’s treatment process. Materials and Methods: Given the aim of the study, parents’ information of 104 children who were referred to the outpatient clinic was collected by a questionnaire. The instrument contained five questions regarding the awareness of the name of the child’s heart disease, the ability to indicate the location of the disease on a schematic image of the heart, the knowledge of the symptoms of the heart disease, the awareness of the causes of CHD, and the importance of children’s oral hygiene. Results: Children’s mean age was 4.8 ± 4.3 years. Based on the results, there was a significant association between parents’ education and the above-mentioned parameters except for the importance of children’s oral hygiene (P

Objective(s): Recent progress in understanding the pathogenesis of premature ventricular contraction (PVC)-induced cardiomyopathy (PIC) has suggested a key role for inflammation. The aim of this study was to evaluate the expression of messenger RNAs (mRNAs) and the protein production of interleukin-6 (IL-6), IL-10, tumor necrosis factor alpha (TNF-α) and interferon-γ (IFN-γ) and two circulating micro-RNAs related to inflammation and cardiovascular disease; miR-155 and miR-146.Materials and Methods: The study population was comprised 25 patients with PIC and 25 patients with normal left ventricular ejection fraction despite frequent PVCs. TNF-α, IL-6, IL10, and IFN-γ levels were evaluated in peripheral blood mononuclear cells (PBMCs) by flow cytometry and their mRNAs were assessed by real time PCR. We analyzed circulating levels of these cytokines by enzyme linked immunosorbent assay (ELISA). Two circulating micro-RNAs, miR-155 and miR-146a, were also investigated.Results: The flow cytometry findings showed that the median fluorescence intensity (MFI) of antibodies reacted with the IL-6 and TNF-α were higher in PIC group than the control group (P-value0.05).Conclusion: In our patients with PIC, there was an elevation in the expression levels of IL-6 and TNF-α in PBMCs. This finding may provide further insights into the inflammatory pathways involved in PIC.

Aims: Infective endocarditis (IE) remained a potentially fatal disease with high rate of mortality and morbidity. The epidemiology and global burden of IE are largely different between the countries. We aimed to address the epidemiological aspects of IE in a tertiary hospital in Tehran, Iran. Methods and Results: Between 2006–2018, all adults patients with diagnosis of IE were enrolled in the Iranian Registry of Infective Endocarditis (IRIE). The data were analyzed using the χ2, Kolmogorov–Smirnov, and Mann–Whitney U tests. Overall, 602 patients, 407 (67.6%) men, mean age 46 ± 16 years were recruited. Positive blood culture found in 49%.The most common underlying heart diseases were: Congenital heart diseases (CHD) particularly bicuspid aortic valves (BAV) and ventricular septal defects (VSD) in 37%, followed by degenerative heart diseases :flail and mitral valve prolapse (16.3%), intravenous drug user in 12.6%, prosthetic valves in 11.1%, previous IE (8.9%), rheumatic heart diseases (RHD) in 8.4%. The most causative microorganisms were Staphylococcus aureus, Enterococci, coagulase-negative staphylococci and Streptococcus viridans. Cardiac or extra cardiac complications occurred in 56.6% of the patients. Conclusions: Based on IRIE, IE occurs in the younger population in Iran with high rates of blood culture-negative IE. RHD are not the main cause of IE in Iran, CHD including BAV and VSDs, followed by prolaptic or flail mitral valve were the most common. These 2 groups can be considered a high-risk group for IE. More than half of the patients with IE had cardiac or extra cardiac complications.

Background: Atrial fibrillation (AF) with fast ventricular response over an overt accessory pathway (AP) (preexcited AF) with a short anterograde refractory period is a potentially malignant arrhythmia. This study aimed to evaluate the safety and efficacy of amiodarone for preexcited AF management. Materials and Methods: This study enrolled 103 patients with evidence of AP in electrocardiography. Patients with preexcited AF were included in the study. Intravenous amiodarone (300 mg) was infused for 30 min for all patients in the AF rhythm. Electrophysiological parameters were evaluated before amiodarone injection and 2 h after pharmacological or electrical cardioversion. Results: Antegrade and retrograde refractory periods of the atrioventricular node (AVN) and AP, as well as antegrade and retrograde Wenckebach points of AVN, were increased significantly after amiodarone infusion. Furthermore, the mean of the shortest preexcited RR interval was increased during the monitoring period. Comparing the preexcited index at the beginning of the study and before cardioversion (2 h later) revealed that the QRS complexes changed to a wider pattern as the preexcitation index changed from 80.61 to 92.26 (P < 0.001). Nineteen (18.4%) patients converted to the sinus rhythm with amiodarone infusion. No ventricular arrhythmia was detected during monitoring. Conclusion: Amiodarone could be considered a safe drug in patients with preexcited AF for rate control despite its relatively low efficacy in conversion to the sinus rhythm.

BACKGROUND: In the coronavirus disease 2019 pandemic era, clinical programs and mandatory hands-on activities have been supplanted by remote teaching to maintain the fundamental capabilities of medical training and to furnish medical students with quality education. Nonetheless, the satisfaction of faculty members with this training method in the current pandemic has yet to be assessed. The aim of this study was to design a Persian questionnaire with appropriate validity and reliability on cardiology professors' satisfaction level with virtual education. MATERIALS AND METHODS: In this cross-sectional study, a questionnaire was devised drawing upon scientific sources and Iranian medical educators' expertise. Seventeen faculty members in various specialties evaluated the questionnaire concerning face and content validity. Content validity was assessed through the calculation of the content validity ratio (CVR) (values >0.62 were considered acceptable) and the content validity index (CVI) (values >0.79 were considered acceptable), construct validity was evaluated through principal component factor analysis by the Kaiser–Meyer–Olkin (KMO) statistic and Bartlett's sphericity test, internal reliability was measured through the calculation of Cronbach's alpha coefficient, and consistency was appraised through the use of test-retest reliability at two different time points. RESULTS: The questionnaire had a reliability rate of 95%, indicating high internal validity. Concerning test-retest reliability, the intraclass correlation coefficient was 0.96 (P < 0.001), demonstrating relatively good stability. The CVI was 0.81, and the CVR was 0.85. The KMO measure of sampling adequacy was 0.954, indicating the acceptability of the degree of common variance among the all items. CONCLUSIONS: This Persian questionnaire on virtual education aimed at cardiology faculty members in the current pandemic with its low question count and appropriate domains had high reliability and validity. By knowing the level of professors' satisfaction with the new method of education, it is possible to take steps to better provide specialized medical education to cardiology residents.

Introduction: Having good health literacy can improve quality of life and decrease re-hospitalization of the patients including patients with heart failure (HF). Considering the importance of knowledge about HF and health literacy in these patients and the existence of contradictory texts, this study aimed to determine the relationship between health literacy and knowledge of HF, with re-admission of HF patients. Methods: The present study was a cross-sectional study in which 238 patients aged over 18 years old with an ejection fraction of 35% and less with the ability to read, write, and speak, and no psychological, neurological and cognitive disorders were included in the study after they signed the consent form of the research. Data collection was done through demographic information questionnaire, Short-Test of Functional Health Literacy in Adult-16 standard health literacy questionnaire, and Van Der Wal knowledge about HF questionnaire (2005). Both questionnaires were validated and their reliability was investigated before starting the study. The Chi-square test, Fisher's exact test, or the Mann–Whitney tests were used to compare variables. Results: Most of the patients were male (66%) and married (80%). The results showed that the majority of study population had proper health literacy and about half of them had enough information about HF. This study showed that there is a significant relationship between health literacy and knowledge. In other words, the higher the health literacy of the people, the greater their awareness of their illness (P = 0.02). However, the findings showed that there is no significant relationship between health literacy and awareness of HF with the number of admissions. Conclusion: The results of this study show that the higher the health literacy of the people may lead to the higher their knowledge and awareness about HF and better understanding the recommendations regarding their illness.

Background: Along with advances in end-stage heart failure (HF) treatments, such as heart transplantation (HTx) and ventricular assist devices as destination therapy, there is an increasing need to define scoring systems for selecting the most suitable candidates for these interventions. Furthermore, constraints in donor number necessitate the precise evaluation of patients before candidacy for HTx. Methods: We enrolled eighty patients with severe symptomatic HF, left ventricular ejection fraction < 30%, and New York Heart Association Functional Class III–IV. All patients underwent right heart catheterization for hemodynamic assessment and were followed for 18 months. We defined cSVO2 as the ratio of right atrial pressure (RAP) to mixed venous saturation. Results: During follow-up, 13 patients died, 7 patients underwent HTx, and 36 patients were hospitalized with signs and symptoms of HF. Among hemodynamic parameters, RAP and cSVO2had strongest association with prognosis and clinical worsening. Conclusion: Defining predictors of clinical worsening has great importance in HF. The current study showed cSVO2as a strong predictor of clinical worsening in end-stage HF.

Objective: To evaluate the effect of bone marrow-derived mononuclear cells (BM-MNCs) on clinical outcome and cardiac function in chronic heart failure (HF). Methods: An uncontrolled, open-label trial was performed on symptomatic patients (New York Heart Association [NYHA] Functional Classification II–IV) receiving maximal medical therapy for at least 2 months, with a left ventricular (LV) ejection fraction

Background: Secundum atrial septal defects (ASD2) are one of the most common congenital disorders in children which includes about 10%–20% of congenital heart defects. In recent years, closure of secundum ASD percutaneously has been proposed to reduce mortality, morbidity, and become the standard method in both pediatric and young adults. The aim of this study was to determine the right ventricular (RV) function by strain and strain rate echocardiography parameters in children who underwent surgically versus percutaneous ASD2 device closure. Methods: In this cohort study, all children underwent ASD2 treatment from May 2014 to April 2016 were enrolled in this study. Echocardiography was performed 24 h after transcatheter closure and 3 days after surgical closure. MyLab 60 echo machine (Esoate, Florance, Italy) equipped with a multi-frequency 5 MHz transducer was used, and all echocardiographic data were collected by same pediatric cardiologist. All demographic characteristics and echocardiography indices were compared using SPSS version 18 between two groups. Results: Thirty-six patients (63.2%) were treated by the transcatheter closure and 21 (36.8%) underwent surgery. Longitudinal RV strain (S), longitudinal RV strain rate (S'), and early diastolic longitudinal RV strain rate (E') were improved significantly in device patients in comparison with surgical patients (P < 0.001). There were no significant differences between RV longitudinal dimension and Mid RV size change after procedures in two groups (P > 0.05). However, tricuspid valve annular diameter was significantly decreased in patients who underwent ASD percutaneous device closure in comparison with a surgical group (P = 0.004). Conclusion: The results of this study showed that percutaneous ASD2 device closure will results in better RV function in comparison to surgical closure

Background: The impact of prosthesis-patient mismatch (PPM) on early and late outcomes after aortic valve replacement (AVR) remains controversial. In this study, we aimed to investigate the patient and surgery-related factors leading to various severities of PPM following AVR. Methods: Ninety-six patients who had undergone AVR with a prosthetic valve between 2001 and 2013 and later found to have PPM were enrolled. PPM was defined as the indexed effective orifice area (iEOA) of the aortic prosthesis to be ≤0.8 cm2/m2. PPM was considered to be of moderate or severe degrees if the iEOA was between 0.66 and 0.85 cm2/m2 or ≤0.65 cm2/m2, respectively. Results: The mean age of patients was 26 ± 15 years, and 51% of patients were female. Sixteen patients (15.2%) had mild PPM, 40 patients (38.1%) had moderate PPM, and 40 patients (38.1%) had severe PPM. The majority of our patients had surgery due to congenital causes. Prosthetic valve size and preoperative left ventricular outflow tract diameter were factors statistically related to PPM in the three groups (P < 0.05). There was only one death that was in severe PPM group due to severe heart failure. Conclusion: PPM is a substantial yet underrated clinical entity in patients undergoing prosthetic valve replacement surgery. Patients with smaller body surface areas, surgery at earlier age, and underlying congenital heart disease are more commonly prone to the development of PPM. As our center is referral for the patients affected with congenital aortic valve disease, mindful scheduling and performance of the aortic valve replacement surgery in this patient population is highly recommended.

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Background: Carotid artery lesions frequently coexist with coronary arterial disease (CAD). The aim of this study was to investigate the relation between carotid intima-media thickness (CIMT) and the extent of CAD and whether CIMT could be predictive of severity of coronary atherosclerosis. Methods: Coronary angiography and carotid ultrasound evaluations of 100 consecutive patients with CAD who had undergone elective coronary angiography were reviewed. IMT was measured at both carotid arteries. CIMT and severity of CAD relationship based on SYNTAX score was assessed. The relation between CIMT and cardiovascular risk factors was determined. Results: Mean overall SYNTAX score was 15.76 + 4.82. Mean right CIMT was 0.86 ± 0.29 and mean left CIMT was 0.83 ± 0.24. There were no significant correlation between the SYNTAX score and CIMT (r: 10, P: 30). There was significant relationship between hypertension,diabetes and CIMT (P: 0.01). Conclusion: we found no relationship between CIMT and SYNTAX score in patients who underwent coronary angiography. Diabetes mellitus and hypertension are related to increased carotid intima-media thickness. Keywords: Carotid intima-media thickness, Coronary artery disease, SYNTAX score

Background: According to American Heart Association guidelines, QRS duration and morphology are used to select patients for cardiac resynchronization therapy (CRT). But still there are some patients who are not responding to this device. We investigated whether the Cardiogoniometry (CGM) as a three-dimensional vectorcardiogram method can improve patient selection. Methods: Echocardiography and CGM were performed for 25 consecutive patients with Left bundle branch morphology who were candidate for CRT implantation and were in sinus rhythm. Patients re-evaluated by echocardiography after 6 months post CRT implantation. Results: The mean age of the patients was 63 ± 13 years and 17 (68%) were males. The mean LVEF was 19.4 ± 7.4% and 24.2 ± 11.5% before and after CRT implantation respectively. Median of the duration of the R loop before the R maximum demonstrated a negative correlation with the increase in LVEF, (r = −0.36, P = 0.07) and mean of maximal spatial velocity of the T-loop for all measured showed a positive correlation (r = 0.39, p = 0.04). Other parameters didn't show any significant differences. Conclusions: Three-dimensional vectorcardiogram parameters can be helpful to predict the CRT response. Shorter duration of the R loop before the maximum R and smaller R loop area are predictors for responder patients. Keywords: Cardiac resynchronization therapy, Cardiogoniometry, Left bundle branch block

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has prompted the further virtualization of medical education. The satisfaction level of specific users such as cardiology residents with virtual education can augment its quality; hence, the significance of a valid and reliable questionnaire to obtain feedback is needed. This study aimed to design and measure validity and reliability of a satisfaction questionnaire for virtual education of cardiology residents during COVID-19 pandemic. MATERIALS AND METHODS: In this cross-sectional study, a self-administered questionnaire was developed by the faculty members of Rajaie Cardiovascular Medical and Research Center. Reliability was tested utilizing Cronbach's alpha and intercorrelation which was tested using Pearson's correlation coefficient test (ICC). Factor analysis was done by the Kaiser–Meyer–Olkin measure of sampling adequacy and Bartlett's sphericity test. The statistical analyses were performed with the SPSS software version 22. RESULTS: The face validity index was determined via an assessment of the relevance, clarity, and simplicity of each item, and values >0.79 were accepted. The total Cronbach's alpha coefficient was calculated 0.93. Concerning test–retest reliability, the correlation between two rounds of evaluation was >80 (P > 0.001) and ICC was 0.99 (P = 0.001). The content validity evaluation yielded an index of 0.95 and a ratio of 0.91. The principal component factor analysis, conducted to investigate construct validity, generated four domains. CONCLUSIONS: The study results confirmed the validity and reliability of the designed questionnaire to evaluate the level of satisfaction of cardiology residents with virtual learning in COVID-19 pandemic.

An isolated right superior vena cava (RSVC) draining into the left atrium represents a very rare congenital malformation, especially in the absence of a partial anomalous pulmonary venous return. This condition leads to hypoxemia, cyanosis, and clubbing without any other signs of heart defects. We describe an 8-year-old girl, who was referred to our hospital due to unexplained cyanosis. Segmental approach in transthoracic echocardiography showed left atrial drainage of the RSVC, which was subsequently confirmed by contrast echocardiography and angiography. Surgical repair via trans-section and anastomosis of the superior vena cava to the right atrium was performed to prevent the complications of right-to-left shunting and cyanosis. During a 4-year follow-up, the patient remained in very good clinical status and her serial echocardiography was normal except for very mild left atrial and left ventricular enlargement.

Purpose: Chronic stress has been reported to induce oxidative damage of the brain. A few studies have shown that Crocus Sativus L., commonly known as saffron and its active constituent crocin may have a protective effect against oxidative stress. The present work was designed to study the protective effects of saffron extract and crocin on chronic – stress induced oxidative stress damage of the brain, liver and kidneys. Methods: Rats were injected with a daily dose of saffron extract (30 mg/kg, IP) or crocin (30 mg/kg, IP) during a period of 21 days following chronic restraint stress (6 h/day). In order to determine the changes of the oxidative stress parameters following chronic stress, the levels of the lipid peroxidation product, malondialdehyde (MDA), the total antioxidant reactivity (TAR), as well as antioxidant enzyme activities glutathione peroxidase (GPx), glutathione reductase (GR) and superoxide dismutase (SOD) were measured in the brain, liver and kidneys tissues after the end of chronic stress. Results: In the stressed animals that receiving of saline, levels of MDA, and the activities of GPx, GR, and SOD were significantly higher (P

Background: This study was designed to investigate the effect of intravenous magnesium sulfate on hemodynamic changes induced by pneumoperitoneum in patients undergoing laparoscopic cholecystectomy. Methods: A randomized, placebo controlled study was performed on 52 ASA class I or II aged 20-70 years patients undergoing laparoscopic cholecystectomy with pneumoperitoneum with carbon dioxide. Before induction, Magnesium group received 50 mcg.kg-1 magnesium sulfate, within 10 minutes, in 100 ml of normal saline and control group received 100 ml normal saline. Hemodynamic variables were recorded before induction, before the infusion of magnesium sulfate, during intubation, during pneumoperitoneum and finally during extubation, every 10 minutes. Postoperative pain and other complications were recorded in post anesthesia care unit (PACU) also. Results: Variations in heart rate and mean arterial pressure between the two groups during pneumoperitoneum were not significantly different (P>0.05). Propofol consumption in the magnesium group compared with the control group was significantly decreased (P

Background: Toxoplasmosis is caused by an intracellular protozoan, Toxoplasma gondii. In pregnant women with toxoplasmosis, the parasite can be transmitted to the fetus, causing severe complications. The aim of this study was to determine the seroprevalence and risk factors of toxoplasmosis in women of reproductive age in Tehran, Iran, to provide detailed information for health authorities regarding the prevention and control of the disease. Methods: In this cross-sectional study conducted in 2013, completion of the questionnaires was done and blood samples were collected from 300 women of 18-40 years of age. Levels of IgG and IgM antibodies against Toxoplasma gondii were determined by enzyme-linked immunosorbent assay (ELISA) test and the risk factors cited in questionnaires were also analyzed. Findings: Among 300 studied sera, 85 (28.3%) cases were positive for IgG, 4 (1.3%) for IgM and 3 (1%) for both classes. There were no significant relationship between toxoplasmosis and factors such as employment, education, eating raw meat and vegetables and contact with cats (chi-square test); but there was a significant relationship between toxoplasmosis and age (Mann-Whitney test, P = 0.04). Conclusion: 70.4 percent of selected women in the study were seronegative. It is necessary to avoid the risk factors during and before the pregnancy for women via health education.

49-year-old man with Lutembacher's syndrome associated with frontal meningioma referred to our hospital. He also suffered from exertional dyspnea. Transthoracic echocardiography demonstrated mitral valve area of 1.48 cm2, moderate mitral stenosis, and left atrial dimension (LAD) of 5.6 cm with no clot. TEE revealed severe mitral stenosis, mitral valve area of 1.05 cm2 with wilkins 8-10 score, ejection fraction of 50%, and enlarged left atrium (LAD = 5.8 cm) with no clot. Induction of anesthesia was commenced taking into account the patient's specific circumstances, which meant the risk of surgery was high. During surgery, the mitral valve was replaced and the atrial septal defect was repaired without a patch. This case underscores the significance of the adoption of an appropriate therapeutic strategy in the treatment of Lutembacher's syndrome with meningioma before meningioma surgery.

Background: Pulmonary complications following cardiac valvular surgery are common and contribute to increased rate of hospital stay, morbidity and mortality. This study was conducted to determine the incidence of pulmonary complications after cardiac valvular surgery and to investigate perioperative clinical factors for postoperative pulmonary complications at a tertiary university hospital. Methods: Overall, 180 consecutive adult patients (> 18 years), whounderwent nonemergency aortic, mitral, pulmonary or tricuspid valvular surgery were enrolled. Before surgery, lung function and gas exchange were measured. Complete history taking, vital signs and clinical examination was done and Chest X-Ray, Electrocardiogram (ECG), echocardiography, blood gas analysis, and complete blood tests were obtained and patients were followed throughout surgery and after that, till discharge from the hospital for detection of respiratory complications. The relevant pre-, intra-, and post-operative data of all patients were investigated and analyzed. Results: The cumulative incidence of pulmonary complications was 50 (90 of 180) with a mortality rate of 6.6% (6 of 90) and the overall mortality among all patients was 3.3% (6 of 180). Type of valvular surgery was significantly associated with postoperative pulmonary complications (POPC). With regards to cardiac risk factors, Hypertension (HTN) and smoking had a significant relationship with POPC (P < 0.0001, P 0.003 respectively). Bivariate analyses showed that older patients were more susceptible to POPC (P < 0.0001). There was no significant difference in POPC (P = 0.55) between males and females. Prolongation of operation time (P = 0.03), cross clamp time (P = 0.04) and pump time (P < 0.0001) were associated with POPC. There was a significant relationship between PaO2 in AIR and 100% FIO2, and POPC (P = 0.02, P = 0.007, respectively).There was a significant relationship between death and POPC (P = 0.01). Conclusions: Type of valvular surgery, hypertension, smoking, older age, pump time, operation time, cross clamp time and Pao2 in air and 100% O2 were the most important factors associated with postoperative pulmonary complications.

Background: Pain is a symptom of discomfort or tissue injury experienced by patients. Amongpatients in intensive care unit (ICU), pain is a common phenomenon. Objectives: The purpose of this study was to evaluate the effect of preferred music listening on behavioral measures of pain, as an indicator of pain assessment, in patients undergoing coronary artery bypass graft surgery (CABG). Patients and Methods: This blinded clinical trial was performed on 60 patients admitted to ICU following CABG. Patients intubated and those under mechanical ventilation were unable to report their pain. The study population was randomly divided into two groups of control and music intervention groups (preferred music listening). In the intervention group, preferred music (including classical, instrumental and traditional music as well as Quran recitation) was played via a headphone for 30 minutes. In the control group, patients were in bed at the same time and only mute headphones were used. The pain levels of patients were assessed at three time intervals; a) during rest, b) 10 minutes prior to receiving music, following a painful procedure (e.g., change of position for dressing change) and c) in the final 3 minutes of music following a painful procedure using the method of “critical care pain observation tools” (CPOT). Results: The mean pain behavior scale score 10 minutes prior to receiving music, following a painful procedure, was 2.77 ± 1.04 in the music intervention group and 2.33 ± 1.12 in the control group. The score increased after a painful procedure compared to that before the procedure in the control group and reached 2.67 ± 1.124; this increase (0.34 unit) in the control group was statistically significant (P = 0.008). In contrast, the score in the music intervention group dropped to 2.20 ± 1.06 and statistical tests showed a significantly reduced pain behavior scale score in the music intervention group (P < 0.001). Conclusions: The results of this study showed beneficial effect of preferred music listening on reducing pain sensation during painful procedures in intubated patients after CABG.

Background: Appropriate treatment methods lead to a reduced rate of mortality and morbidity, and an improved quality of life, in patients with multi-vessel coronary artery disease. Objectives: In this study, we compared short and long-term outcomes of coronary artery bypass grafting (CABG) versus medical therapy in patients 80 years of age and older with multi-vessel coronary artery disease (MVCAD). Patients and Methods: In this retrospective study, 50 octogenarian patients with MVCAD who underwent CABG were compared with 50 patients in the same condition who were treated with medical therapy during the same time. The primary objective was to compare mortality and morbidity rates, as well as other factors such as the occurrence of chest pain, deterioration of the NYHA functional class, and re-hospitalization, between the two groups. The comparison was made using medical records from the five years post-treatment. Results: After five years, the overall mortality rate included 11 patients (22%) in the CABG group versus 18 patients (36%) in the medical therapy group; this difference was not significant between the two groups (P = 0.186). Regarding short-term outcomes, in the CABG group, cardiogenic shock occurred in 9 patients (18%), renal failure in 13 patients (26%), pulmonary complications in 9 patients (18%) and neurologic complications in 3 patients (6%); in the medical therapy group, these same complications occurred, respectively, in 6 patients (12%), 7 patients (14%), 10 patients (20%) and 1 patient (2%). In addition to these factors, freedom from chest pain and improvement in the functional class among the CABG group was significantly higher than among the medical therapy group (P =

Background: Thrombolytic therapy in patients with sub-massive pulmonaryembolism (SMPTE) needs further assessment. Objectives: The current study aimed to assess a potential benefit of thrombolytic and non-thrombolytic therapy in patients with SMPTE. Patients and Methods: One hundred-nineteen patients were enrolled with SMPTE from 2006 to 2010 in the tertiary care center of Rajaie medical and research center. The patients who had pulmonary thromboemboli (PTE) and received thrombolytic plus heparin therapy and or non-thrombolytic (unfractionated heparin alone) were evaluated for hemodynamic changes (blood pressure, pulse rate, pulmonary artery systolic pressure, right ventricular failure and right ventricle enlargement), before and after 48 hours of treatment. The mortality rate was also assessed. Results: Forty-five percent of the patients with SMPTE received thrombolytic therapy (streptokinase) and 55% of SMPTE patients received non-thrombolytic therapy (unfractionated heparin). Pulse rate, pulmonary arterial pressure and tricuspid regurgitation gradient in patients receiving thrombolytic therapy reduced significantly (P = 0.001, P = 0.01 and P= 0.001, respectively). There was no significant difference before and after treatment regarding systolic blood pressure (P = 0.4), diastolic blood pressure (DBP) (P = 0.5), systolic arterial pressure (SPAP) (P= 0.1), Right ventricular (RV) function (P = 0.1) and RVsize (P = 0.1). In patients who received a non-thrombolytic therapy, there were no significant differences between the groups regarding SBP(P= 0.2), DBP( P= 0. 4) and PR (P=0.1), SPAP (P = 0.6), TRG (P = 0.4), RV function (P= 0.4) and RVsize (P = 0.2) before and after treatment. There were no significant differences between the groups according to mortality rate. Conclusions: Thrombolytic therapy lead to earlier relief of hemodynamic condition in comparison to non-thrombolytic therapy but no changes were observed in mortality rate.

Background: Prolongation of the QT interval is considered a risk factor for cardiac adverse events and mortality. Left bundle branch block (LBBB) lengthens the QT interval. The corrected QT interval (QTc) is most likely overestimated because its prolongation is caused by increases in depolarization duration and not in repolarization. Objectives: In this study, we aimed to apply corrected JT interval (JTc) as an appropriate measure of ventricular repolarization for predicting QTc in a formula. Patients and Methods: The study population consisted of 101 patients with sinus rhythm (SR) and narrow QRS complexes (< 120 milliseconds). All patients underwent electrophysiology studies or ablation. A diagnostic catheter was positioned in the right ventricular apex (RVA) to induce LBBB at two different cycle lengths (CLs; 600 and 700 mv). The intrinsic QRS complex, QT time, and JT time were measured during SR and subsequent RVA pacing. The JTc was derived simply by subtracting the QRS duration from the QTc. Results: Stimulation from the RVA increased the QTc from 456.20 ± 38.63 ms to 530.67 ± 47.73 ms at a CL of 600 (P < 0.0001) and to 502.32 ± 47.26 ms at 700 CL (P < 0.0001). JTc showed no significant changes with stimulation from the RVA (102.97 ± 11.35 ms vs. 103.59 ± 10.67 ms, P = 0.24). There was no significant correlation between JTc and QRS complex duration. A significant correlation was seen between QRS and QTc at both CLs. The ROC curve indicated that sensitivity of 80% and specificity of 67% were obtained with JTc duration of 92.6 ms. Conclusions: Right ventricular pacing increases the QT interval without increasing the JT interval. Our results confirm that JTc, as an index of repolarization, is independent of ventricular depolarization. Therefore, it can be applied for predicting QTc in patients with LBBB.

Background: Coagulopathy after cardiopulmonary bypass (CPB) may lead to increased morbidity and mortality. Routine conventional coagulation tests are not always suitable to detect rapid changes in patient's coagulation status. A point-of-care instrument such as ROTEM (rotational thromboelastometry) is a timely and comprehensive method to evaluate hemostasis during cardiac surgery may reduce the need for blood transfusion. Objectives: In this study, ROTEMwas compared to coagulation tests routinely performed during cardiac surgery for postoperative bleeding volume and consumption of blood products. Patients and Methods: Fifty patients undergoing cardiac surgical procedures were enrolled. Blood was obtained before the operation and after CPB weaning. Twenty-five of patients were checked only by traditional blood coagulation test and 25 other patients were checked by ROTEM in addition to routine coagulation tests. The results of these two groups of patients were compared. Results: There was a significant correlation between platelet count (PLT) and fibrinogen level with EXTEM-MCF (r = 0.79, P value: 0.008, r = 0.55, P value: 0.04 respectively). EXTEM-CT was correlated with prothrombin time (PT) (r = 0.56, P value: 0.01) and International normalized Ratio (INR) (r = 0.57, P value: 0.01). There was a significant correlation between PLT count and fibrinogen level with INTEM-MCF (r = 0.69, P value: 0.02, r = 0.71, P value: 0.01, respectively). INTEM-CT was correlated with partial thromboplastin time (PTT) (r = 0.57, P value: 0.02). There was a significant correlation between FIBTEM-MCF and fibrinogen level (r = 0.80, P value: 0.001). HEPTEM was not correlated with any of the coagulation variables. Postoperative consumption of packed blood cell (BPC) was increased in non-ROTEM group in comparison with ROTEM group (645.17 ± 279.16 in Non-ROTEM vs. 387.50 ± 262.88 in ROTEM, P: 0.03) Conclusions: ROTEM can be used to detect postoperative hemostatic changes following cardiac surgery appropriately and can be useful to choose suitable blood products that may reduce the need for blood transfusion, contributing to better patient blood management.

Background: Ablation will efficiently lead to sinus rhythm preservation, which consequently improves left ventricular function; however, the strain rate and its indices as functional systolic factors of the left ventricle have not been studied. Objectives: To assess the improvements in different patterns of radial, longitudinal, and circumferential strain rates separately. Methods: In this case series, 31 patients with symptomatic tachycardia who were candidates for ablation between october 2011 and March 2012 in our tertiary cardiovascular center in Iran were enrolled. Patients underwent trans-thoracic echocardiography 24 hours before and 24 hours and three months after ablation, and left ventricular ejection fraction deformation indices were assessed using the two-dimensional (2D) speckle tracking method during normal sinus rhythm. Results: Strain and strain rate indices in different aspects (radial and circumferential in the short axis view, and for longitudinal in the long axis view) improved remarkably during the three-month follow-up period (P< 0.05). The improvements in ventricular indices were usually between 24 hours to three months after ablation. The systolic strain rate (SR) and strain (SN) were significantly different at echocardiographic views before and 24 hours after ablation (P< 0.05), which revealed that myocardial function developed in the first 24 hours of ablation. Conclusions: Echocardiography and 2D speckle tracking strain imaging shows improvements in left ventricular deformation indices in atrioventricular reentrant tachycardia (AVRT) and atrioventricular nodal reentrant tachycardia (AVNRT) patients for the mean systolic strain and strain rate at 24 hours and the three-month follow-up. In spite of the normal LVEF, even during sinus rhythm, deformation indices maybe abnormal before and after ablation.

Background: Congenital lesions of the mitral valve are relatively rare and are associated with a wide spectrum of cardiac malformations. The surgical management of congenital mitral valve malformations has been a great challenge. Objectives: The aim of this study was to evaluate the early and intermediate-term outcome of congenital mitral valve (MV) surgery in children and to identify the predictors for poor postoperative outcomes and death. Patients and Methods: In this retrospective study, 100 consecutive patients with congenital MV disease undergoing mitral valve surgery were reviewed in 60-month follow-up (mean, 42.4 ± 16.4 months) during 2008 - 2013. Twenty-six patients (26%) were under one-year old. The mean age and weight of the patients were 41.63 ± 38.18 months and 11.92 ± 6.12 kg, respectively. The predominant lesion of the mitral valve was MV stenosis (MS group) seen in 21% and MR (MR group) seen in 79% of the patients. All patients underwent preoperative two- dimensional echocardiography and then every six months after surgery Results: Significant improvement in degree of MR was noted in all patients with MR during postoperative and follow-up period in both patients with or without atrioventricular septal defect (AVSD) (P = 0.045 in patients with AVSD and P = 0.008 in patients without AVSD). Decreasing trend of mean gradient (MG) in MS group was statistically significant (P = 0.005). In patients with MR, the mean pulmonary artery pressure (PAP) had improved postoperatively (P < 0.001). Although PAP in patients with MV stenosis was reduced, this reduction was not statistically significant (P = 0.17). In-hospital mortality was 7%. Multivariate analysis demonstrated that age (P < 0.001), weight (P < 0.001), and pulmonary stenosis (P = 0.03) are strong predictors for mortality. Based on the echocardiography report at the day of discharge from hospital, surgical results were optimal (up to moderate degree for MR group and up to mild degree for MS group) in 85.7% of patients with MS and in 76.6% of patients with MR. Age (P = 0.002) and weight (P = 0.003) of patients are strong predictors for surgical success in multivariate analysis. Conclusions: Surgical repair of the congenital MV disease yields acceptable early and intermediate-term satisfactory valve function and good survival at intermediate-term follow-up. Strong predictors for poor surgical outcome and death were age smaller than 1 year, weight smaller or equal than 6 kg, and associated cardiac anomalies such as pulmonary stenosis.

Background: Cardiogoniometry (CGM) is a novel spatiotemporal electrocardiographic method utilizing computer-assisted three- dimensional data on cardiac potentials. Objectives: This study compares the accuracy of CGM and electrocardiography (ECG) by detecting coronary artery disease (CAD) with reference to angiography as a well-known gold standard. Patients and Methods: A total of 390 patients undergoing coronary angiography with CAD were enrolled. CGM was performed a few hours prior to coronary angiography. A standard 12-lead ECG was recorded after the CGM. The CGM and ECG results were recorded and analyzed by an independent investigator blinded to all patient data and the results of the coronary angiography. Results: The coronary angiography showed a normal coronary artery in 263 patients (67.4%). A median of CGM score was 1 (0-2), the minimum score was 0 and maximum score was 8. A total of 90 patients (31%) showed predefined ST-segment/T-wave changes in the resting 12-lead ECG. CGM yielded a sensitivity of 84% and specificity of 81% and the ECG yielded a sensitivity of 29% and specificity of 67% when compared with the coronary angiography. Conclusions: CGM is a non-invasive technique recently developed for quantitative three-dimensional vectorial analysis of myocardial activity and detection of ischemia and infarction. This technique is clearly more sensitive and more specific than a standard resting 12-lead ECG.

Background: The association between epicardial fat thickness (EFT) and premature coronary artery disease (CAD) has not been elaborately studied. Objectives: In the present study, we sought whether such a relationship between EFT and CAD exists. Patients and Methods: Sixty two consecutive subjects, under 50 years of age, who underwent coronary angiography (CAG) with the aspect of CAD, were included in this case control study. They were divided into two groups of 31 subjects, namely CAD (cases) and non-CAD (controls) group, according to CAG data. Presence of conventional coronary risk factors, drug history, and anthropometric data were recorded. Then, each subject underwent standard transthoracic echocardiography for measuring EFT in the proximal part of right ventricular outflow tract in the parasternal long axis view at end diastole, as well as other parameters of systolic and diastolic function, and left ventricle (LV) mass. Images were stored for offline analysis when the echocardiocardiographers were blind to CAG data. Results: Among baseline characteristics, waist circumference, triglyceride levels, cigarette smoking and history of statin use were significantly higher in the CAD group. The body mass index (BMI) was significantly higher in the non-CAD group. According to echocardiographic data, the EFT with a cut off value of 2.95 mm could well differentiate subjects in each group. The LV mass and E/e were significantly higher in CAD group, in addition to EFT. Also, there was a significant correlation between EFT and waist circumference, as well as LV mass. However, no significant relation was between EFT and LV systolic and diastolic function. Conclusions: The EFT, as measured by echocardiography, with a cut off value 2.95 mm has a strong association with premature CAD.

Background: There is increasing evidence that endocrine system may be dysfunctional in patients with heart failure. Objectives: In the present study, we investigated hormonal abnormalities in heart failure and the effect of disturbed hormonal balance on prognostic outcomes of patients with systolic heart failure. Patients and Methods: Among patients followed in Heart Failure and Transplantation Clinic, 33 men with a diagnosis of idiopathic dilated cardiomyopathy receiving guidelines-directed medical therapies and with New York Heart Association Class II-III were enrolled. Serum concentrations of growth hormone (GH), insulin-like growth factor 1 (IGF-1), thyroid hormones, free testosterone, high-sensitive C-reactive protein (hs-CRP), and N-terminal pro-brain natriuretic peptide (NT Pro-BNP) were measured in all the patients. The physical performance of patients was assessed by six-minute walk test (6MWT). The patients were subsequently followed for a year and the data regarding their death, transplantation, or hospitalizations due to acute heart failure were recorded. Results: Except for testosterone level, the levels of GH, IGF-1, T3, and T4 concentrations in the patients were significantly lower than the normal values (P < 0.05). Among different hormone, only GH had correlation with NT Pro-BNP, hs-CRP, and 6MWT. There was no association between the occurrence of the combined events and different hormonal levels in multivariate analysis. Conclusions: The hormonal levels were low in patients with idiopathic dilated cardiomyopathy. However, the prognostic significance of different hormonal deficiencies was not clear in our study populations who were receiving standard therapies for heart failure and had a relatively stable clinical condition.

Background: Measuring cardiac markers in blood has been the main strategy for the diagnosis of acute myocardial infarction for nearly 50 years. Creatine kinase-MB (CK-MB) has been demonstrated to be a highly specific marker. Objectives: The present study aimed to assess the role of CK-MB changes following percutaneous coronary intervention (PCI) to predict one year outcomes of this procedure. Patients and Methods: This cohort study was conducted on 138 patients diagnosed with coronary artery disease who underwent PCI. Sixty-nine patients who had a CK-MB elevation ≥ 3 times upper limit of normal (ULN) post procedurally were considered as group I and 69 patients without cardiac enzyme rise after PCI were considered as the control group (group II). The composite end point of major adverse cardiac events (MACE) during one year was assessed by telephone follow-up or presentation at clinical visiting, and compared between the two groups. The MACE was defined as the appearance of at least one of the following events: mortality, repeated revascularization procedures, myocardial infarction, or cerebrovascular events. Results: Although one year mortality in the group I was 4 (5.8%), about two times greater than the other group 2 (2.9%), the difference was not significantly discrepant (P = 0.57). Moreover, 8 (11.6%) of patients in group I experienced one year MACE, while this rate in the other group was 4 (5.8%), with insignificant difference (P = 0.22). In group I, one case experienced coronary artery bypass surgery, one, exhibited cerebrovascular disease and one reported ST segment elevation myocardial infarction (STEMI), while two patients in the other group were suspicious of having non-ST segment elevation myocardial infarction (NSTEMI) and candidates for repeated PCI. Multivariate analysis revealed that increased post-procedural CK-MB ≥ 3 times UNL could not predict long-term MACE in patients who underwent selective PCI. Area under the curve (AUC) for predicting one year MACE was 0.593 (95% CI: 0.397 - 0.788), indicating inappropriate accuracy for this biomarker (P = 0.290). Conclusions: It seems that CK-MB ≥ 3 times ULN within 24 hours after PCI cannot independently predict one year MACE in patients undergoing PCI.

Background: The treatment of an occluded saphenous vein graft (SVG) with percutaneous coronary intervention may encounter major adverse cardiac events (MACE). MACE rates have been reduced significantly by using the embolic protection device (EPD). Objectives: The aim of this study was to clarify the risks and the benefits of embolic protection devices. Patients and Methods: In a prospective, non-randomized observational study, patients aged 33 to 85 years old who underwent elective percutaneous coronary intervention due to SVG stenosis at our tertiary care center were enrolled between 2009 and 2011. The incidence rates of adverse events, including MACE, were obtained during the patients' hospitalization and at 30-day and 6-month follow-up. MACE included death, Q-wave and non-Q-wave myocardial infarction, in-stent thrombosis, target lesion revascularization, and target vessel revascularization. Results: From 150 patients enrolled to the study, 128 (85.3%) patients underwent direct stenting and the rest underwent the EPD procedure. In-hospital MACE occurred in 17.2% of the patients in the direct stenting group versus only 9.1% in the EPD group (P = 0.530). MACE incidence was gradually increased at one and 6-month follow-up periods in the direct stenting group (19.5% and 21.9%, respectively), and remained unchanged in the EPD group (9.1% at six-month follow-up). Multivariate logistic regression model showed that the stenting procedure type could not predict early and midterm MACE with the presence of baseline characteristics as cofounders. Conclusions: Despite the considerable lower early and midterm MACE rates, numerically following the EPD procedure compared to direct stenting, the difference in the MACE rates between the two groups was not significant.