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Acute coronary syndrome (ACS) is defined as a range of conditions which the blood flow to the heart was reduced or stopped. This disorder is correlated to a systemic inflammatory response and some biochemical factors. Therefore, the aim of this study was investigations of serum C-reactive protein (CRP) and uric acid levels in ST-segment elevation myocardial infarction (STEMI) and non-ST-elevation ACS (NSTE ACS), as common subtypes of ACS. Patients with ACS (n = 140) were assessed with coronary arteriography and divided into STEMI and NSTE ACS groups. The serum levels of hs-CRP and uric acid were investigated using a routine clinical chemistry analyzer. Patients with STEMI showed a significant increase in uric acid level compared to those with NSTE ACS (P <.0001). Other data indicated that hs-CRP level in patients with STEMI was significantly higher than individuals with NSTE ACS (P <.0001). Modeling analysis revealed that the increased levels of acid uric and hs-CRP in patients with STEMI were independent of the effects of age, gender, background diseases, and familial history (P <.001). The current study provides further evidence to indicate that hs-CRP and uric acid may be considered as biofactors for comparing STEMI from NSTE ACS and determining disease outcome. [ABSTRACT FROM AUTHOR]

Background: Contrast induced nephropathy (CIN) is one of the most common complications after radiographic procedures using intravascular radiocontrast media. The aim of the current study was to assess the effect of atorvastatin on prevention of CIN in patients undergoing coronary angiography. Materials and Methods: In a clinical trial study, 200 patients referred for angiography were randomly divided into two groups of using 80 mg atorvastatin and placebo before the procedure. Furthermore, 100 patients who were under chronic treatment of statins were included as the third group. Serum creatinine (Scr) levels before and after the procedure were evaluated and incidence of CIN (post-procedural Scr of >0.5 mg/dl or >25% from baseline) was assessed. Results: Mean age of the participants was 60.06 ± 0.69 years and 276 (92%) were male. There were no significant differences between group with respect to age and gender. In pre-operation atorvastatin, placebo and long term statin groups, the incidence of CIN was 1%, 2% and 1%, and mean changes of Glomerular filtration rate (GFR) was 3.68 ± 1.32, −0.77 ± 1.21 and 1.37 ± 0.86; and mean changes of creatinine (Cr) was −0.05 ± 0.02, 0.02 ± 0.02 and −0.01 ± 0.01 respectively. (P = 0.776, 0.026 and 0.041 respectively). In pre-operation atorvastatin group, Cr decreased, and GFR increased significantly (P = 0.019 and 0.007 respectively). Conclusion: pre-operation short term high dose atorvastatin use was associated with a significant decrease in serum Cr level and increase in GFR after angiography. [ABSTRACT FROM AUTHOR]

Background: The finding of bundle branch block (BBB) in patients with syncope suggests that paroxysmal atrioventricular block (AVB) or ventricular tachyarrhythmia (VT) may be the cause of syncope. Guidelines for cardiac pacing and cardiac resynchronization therapy have been recommended to perform electrophysiological study (EPS) for confirming main cause of syncope. Therefore, the aim of our study was to evaluate the role of EPS in patients with syncope and BBB. Materials and Methods: We evaluated 133 patients (mean age 63 ± 13.8 years) with past history of syncope and BBB from April 2002 to December 2010 who referred to Arrhythmia clinic in two tertiary care centers. All patients underwent EPS on admission time. The frequency distributions of AVB and VT in patients were determined. Results: Left bundle branch block was diagnosed in 184 (82.1%) patients. 133 of them had preserved left ventricular ejection fraction (LVEF ≥45%) that in 91 (68.4%) of those, EPS finding was normal. In 41 (30.8%) patients AVB was reported. In 2 (1.5%) patients VT and atrioventricular nodal reentrant tachycardia were seen. Coronary artery disease was more common in patients with AVB and abnormal EPS finding (P = 0.02). Conclusion: Ventricular tachyarrhythmia was a rare electrophysiological finding in those with syncope, bifascicular block, and preserved LVEF. Considering cost-effect benefit, pacemaker or implantable loop recorder implantation is suggested; however, EPS may not be necessary to perform before permanent pacemaker implantation. [ABSTRACT FROM AUTHOR]

BACKGROUND: Cigarette smoking increases the risk of ventricular fibrillation and sudden cardiac death (SCD). QT dispersion (QTD) is an important predictor of cardiac arrhythmia. The aim of this study was to assess the acute effect of smoking a single standard cigarette containing 1.7 mg nicotine on QT interval and QTD in healthy smokers and nonsmokers. METHODS: The study sample population consisted of 40 healthy male hospital staff, including 20 smokers and 20 nonsmokers. They were asked to refrain from smoking at least 6 h before attending the study. A 12-lead surface electrocardiogram (ECG), recorded at paper speed of 50 mm/s, was obtained from all participants before and 10 min after smoking of a single complete cigarette. QT interval, corrected QT interval, QTD, and corrected QT dispersion (QTcD) were measured before and after smoking. RESULTS: Smokers and nonsmokers did not have any significant differences in heart rate (HR) (before smoking = 67.35 ± 5.14 vs. 67.70 ± 5.07, after smoking = 76.70 ± 6.50 vs. 76.85 ± 6.50, respectively), QTD (before smoking = 37.75 ± 7.16 vs. 39.15 ± 6.55, after smoking = 44.75 ± 11.97 vs. 45.50 ± 9.58, respectively), and QTcD (before smoking = 39.85 ± 7.40 vs. 41.55 ± 6.57, after smoking = 50.70 ± 14.31 vs. 51.50 ± 11.71, respectively). However, after smoking a single cigarette, HR, mean QTD, and QTcD significantly increased (all had P value <0.001) in comparison to the measures before smoking. CONCLUSION: Smoking of a single complete cigarette in both smokers and nonsmokers results in significant QTD increase, which can cause arrhythmia and SCD. [ABSTRACT FROM AUTHOR]

Background: The effectiveness of a theory‑based educational intervention on intension for sexual abstinence among female university students was evaluated. Materials and Methods: Female students were recruited from humanity sciences department through cluster sampling. Educational intervention was applied for four 90‑min sessions and by application of cognitive theories during 4 weeks. Results: One hundred and nine female students with mean age of 20.74 ± 1.57 years took part in the study. Despite the similarity of two groups of intervention (n = 53) and control (n = 59) at baseline, there were significant differences between the two groups in mean scores of the variables, knowledge (4.62 ± 1.38 vs. 3.53 ± 1.61), perceived susceptibility (14.05 ± 1.51 vs. 12.37 ± 2.11), and perceived benefits (28.41 ± 2.14 vs. 27.51 ± 3.05), at follow‑up time after 3 months (P < 0.05). Additionally, these variables were observed with improvement over 3 months in the intervention group (P < 0.05). However, this study showed no significant effect on the behavior intention and self‑efficacy. Conclusion: This study showed that educational intervention could improve knowledge, perceived benefits, and self‑efficacy of the female students regarding HIV/AIDS. [ABSTRACT FROM AUTHOR]

BACKGROUND: Current guidelines recommend cardiac rehabilitation programs (CRP) as a means to improve functional status of patients after coronary revascularization. However, research supporting this recommendation has been limited and positive effects of CRP on diastolic function are controversial. The aim of this study was to examine the effects of an 8-week CRP on left ventricular diastolic function. METHODS: This randomized, clinical trial included 29 men with ST elevation myocardial infarction (MI) who had received reperfusion therapy, i.e. coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). They were randomized to a training group (n = 15; mean age: 54.2 ± 9.04 years old) and a control group (n = 14; mean age: 51.71 ± 6.98 years old). Patients in the training group performed an 8-week CRP with an intensity of 60-85% of maximum heart rate. Exercise sessions lasted 60-90 minutes and were held three times a week. At the start and end of the study, all patients performed symptom-limited exercise test based on Naughton treadmill protocol. Pulsed-wave Doppler echocardiography was also used to determine peak velocity of early (E) and late (A) waves, E/A ratios, and the deceleration time of E (DT). RESULTS: Left ventricular diastolic indices (E, A, E/A ratio, DT) did not change significantly after the CRP. Compared to baseline, patients in the training group had significant improvements in functional capacity (8.30 ± 1.30 vs. 9.7 ± 1.7) and maximum heart rate (118.50 ± 24.48 vs. 126.85 ± 22.75). Moreover, resting heart rate of the training group was significantly better than the control group at the end of the study (75.36 ± 7.94 vs. 79.80 ± 7.67; P < 0.001). CONCLUSION: An 8-week CRP in post-MI patients revascularized with PCI or CABG led to improved exercise capacity. However, the CRP failed to enhance diastolic function. [ABSTRACT FROM AUTHOR]

Background: The positive effects of cardiac rehabilitation programs (CRPs) on cardiovascular patients have been demonstrated. However, their effectiveness in improving systolic function and preventing remodeling process needs to be further evaluated. The aim of this study was to examine the effects of an 8-week CRP on left ventricular systolic function and mass in patients after myocardial infarction. Methods: A total number of 29 male patients with myocardial infarction were allocated into cardiac training group (n = 15; mean age = 54.2 ±9.04 years) and control group (n = 14; mean age = 51.71 ± 6.98 years). Patients in the training group performed an 8-week CRP with an intensity of 60-85% of maximum heart rate. The program was performed 3 times a week and each session lasted 60 minutes. Before the CRP and at the end of the study, all patients underwent 2-dimentional echocardiography for left ventricular systolic function and mass to be assessed. Findings: Our findings showed that the 8-week CRP improved left ventricular systolic function in the patients. At the end of the CRP, left ventricular end diastolic dimension increased in the control group. On the other hand, end diastolic volume and end systolic volume decreased significantly in the training group. In addition, ejection fraction and stroke volume increased significantly in the training group. Although left ventricular mass decreased in the training group, the difference between the two groups was not significant. Conclusion: An 8-week CRP in post-myocardial infarction patients can lead to improved systolic function and decreased left ventricular mass and thus prevent cardiomegaly. [ABSTRACT FROM AUTHOR]

Background: Takotsubo syndrome is a transient apical or midventricular dilation with reducuction in left ventricular ejection fraction that mimic an acute myocardial infarction symptoms in the absence of atherosclerosis. There are important differences between its treatment and the treatment of acute myocardial infarction. In this study, we reported a case with Takotsubo syndrome. Case Report: The case was a 40 years old woman with a surgery for urinary incontinence. After the surgery she suffered from chest pain. In her electrocardiogram ST elevation was seen but there is not any obstructive lesion in her coronary angiography. In her ventriculography an apical dilation with a Takotsubo syndrome appearance was reported. She was treated conservatively but she died after 3 days due to sepsis. [ABSTRACT FROM AUTHOR]

Background: Cardiac rehabilitation and secondary prevention is an integral part of the treatment of patient with cardiovascular disease to date, however the effect of this programs on systolic and diastolic function is controversial. The aim of this study was to evaluate the effect of 8 weeks cardiac rehabilitation program on diastolic function and functional capacity in patients with myocardial infarction. Methods: twenty-nine post myocardial patient enrolled in this study, which was completed in cardiac rehabilitation group (15 men) and control group (14 men). Echocardiographic measures of diastolic filling and functional capacity by symptom limited exercise test based on naughton protocol on treadmill were performed at baseline and after 8 weeks of training. Data were analyzed using repeated analysis of covariance (ANCOVA) in P < 0.05 level. Findings: After 8 weeks cardiac rehabilitation program, diastolic filling indicators did not change significantly (E velocity, A velocity, E/A ratio and deceleration time). But functional capacity increase significantly in cardiac rehabilitation group. But, functional capacity, resting HR and maximal HR improved significantly in the training group compared to the control group. Conclusion: This study revealed that Cardiac rehabilitation program for 8 weeks significantly improves functional capacity in post myocardial patients but diastolic function did not change significantly. It seems likely that the improvement in functional capacity largely pertain to non cardiac effects. [ABSTRACT FROM AUTHOR]

Background: This study was conducted to determine the relationship between metabolic syndrome and ankle to brachial index (ABI). Methods: This study is a part of Isfahan Cohort study that was conducted in 2009 in 132 patients with and with ought metabolic syndrome. Waist circumference, weight, height, blood pressure and ABI were measured in decubites position by Echo Doppler. Glucose, total cholesterol, HDL, LDL cholesterol, HDL cholesterol and triglycerides were measured. The relationship between ABI and metabolic syndrome was assessed by logistic regression. Finding: From 264 participants, in above 60 years old, in hypertensive patients, ABI was lower in patients with metabolic syndrome than patients without it. Our results showed that low ABI and hypertension had significant relationship in subjects with metabolic syndrome (P < 0.001). Conclusion: ABI was lower in subjects with metabolic syndrome. It was significantly related to hypertension in subjects with metabolic syndrome. Therefore measurement of ABI in patients with metabolic syndrome could be useful to determine subclinical atherosclerosis in them. [ABSTRACT FROM AUTHOR]

BACKGROUND: Treatment of significant coronary artery disease with primary percutaneous coronary intervention (PCI) seems better than angioplasty balloon; because the incidence of restenosis is lower in this method, however, a serious complication of PCI is stent thrombosis which would lead to repeated myocardial infarction (MI) and increase the mortality and morbidity. One of the frequent medications which is used to prevent from stent thrombosis is clopidogrel, but, stent thrombosis was seen in many of the patients despite given the conventional dosage of this drug. This study aimed to evaluate the effect of doubling the maintenance dose of clopidogrel to prevent from early stent thrombosis, MI and mortality rate. METHODS: This was a clinical trial study which was done in Shahid Chamran Hospital in winter 2010 in Isfahan, Iran. A total of 400 patients with PCI were prospectively followed-up for 30 days. All the patients were randomly allocated into two groups. The control group received a maintenance dose of 75 mg clopidogrel while the case group received 150 mg clopidogrel after the initial dosage of 600 mg for 30 days after the PCI. The incidence of primary outcome such as total mortality was recorded during the study. RESULTS: Early stent thrombosis was observed in 4 patients (1%) (One subject in the control group and 3 in the case group) during the first 30 days after PCI, but the difference was not significant between the two groups (p = 0.62). Mortality due to stent thrombosis occurred in 2 patients in the case group which showed no significant difference in this group (p = 0.5). In addition, MI occurred in 2 patients (1 in each group) which also showed no significant difference between the two groups (p = 1). Drug complication such as major bleeding had no significant difference between the two groups (p = 0.9). CONCLUSION: The present study showed that doubling dose of clopidogrel could not reduce the incidence of early stent thrombosis, mortality and myocardial infarction in comparison with conventional dosage; therefore it is recommended that more studies be done in Iranian and Asian race for clinical decision-making to prevent form stent thrombosis using high dose of clopidogrel. [ABSTRACT FROM AUTHOR]

BACKGROUND: Interrupted aortic arch (IAA) is defined by a lack of the luminal continuity between the ascending and descending thoracic aorta. It is a rare, severe congenital heart defect which without surgery is associated with high mortality in the neonatal period. The aims of this study were to present a case with IAA who was alive until the age of 59 years without any surgical intervention and to review the literatures that have presented IAA cases. CASE REPORT: The patient was admitted with respiratory distress and pulmonary edema. Echocardiography showed the sever stenosis in aortic valve and sever left ventricular dysfunction. Cardiac catheterization and angiography confirmed interrupted aorta (type A). The descending thoracic aorta was supplied by extensive collateral vessels from the vertebrobasilar system down to the posterior chest wall and the spine. Surgical correction including coronary artery bypass graft and aortic valve replacement and repair of interruption of the aorta was performed. Three weeks later the patient was died due to uncontrollable gastrointestinal bleeding and hospital acquired pneumonia. We described diagnosis and management of our case. CONCLUSION: This case was very interesting for us, because the patient had not been diagnosed until the recent presentation. Similar cases with this diagnosis do not reach adulthood, but our patient was alive up to 59 years of age. [ABSTRACT FROM AUTHOR]

BACKGROUND: In true aneurysm, the wall of aneurysm is composed of the normal histological components of aorta. A false aneurysm (pseudoaneurysm) represents a rupture which does not contain the normal histological components of aorta. It is a fibrous peel that has formed from a small perforation of aorta. We describe an unusual presentation that has signs which some of them are only manifested in true aneurysm and some others only in pseudoaneurysm. CASE REPORT: An 85-year-old man underwent elective coronary angiography for chest pain work-up. Our evaluation by invasive angiography and CT angiography showed aortic dissection. In surgery we found that dissection flap was composed of some parts of intima and media layers. These signs leaded to confusing symptoms. Localized bulging of ascending aorta had continued to brachiocephalic artery (transverse arch involvement). Dissection flap was composed of some part of intima and media layers. It was a strange case, it was not solely a perivascular hematoma and it did not have all three layers of aorta wall. Partial aorta replacement was performed. The operation and recovery was uneventful. CONCLUSION: This unusual presentation of disease has not been mentioned in literatures. Our experience can help to manage similar cases. This case was the first unusual presentation of its type. [ABSTRACT FROM AUTHOR]

The author offers his views on the need for an effective period of cardiac rehabilitation program in Iran. The benefits of CR include reduction in mortality, symptom relief, smoking cessation, improved physical fitness, risk factor modification, and improved overall psychosocial well-being. Physician-prescribed exercise, cardiac risk factor modification, psychosocial assessment, outcomes assessment, and individualized treatment plan.

A letter to the editor is presented in response to a paper by T. Hasandokht et al titled "Life Style Interventions for Hypertension Treatment Among Iranian Women In Primary Health-Care Settings: Results of a Randomized Controlled Trial."

Background: High blood pressure (BP) has been known as a major risk factor for many chronic diseases. It should be noted, a psychiatric disorder which is common in the people living modern lifestyle may be one of the leading causes of hypertension, and many people are prescribed antidepressant each year. Hence, the purpose of this study was to evaluate the effect of selective serotonin reuptake inhibitors (SSRIs) and alprazolam which defined as antidepressant on the BP levels, and to compare the BP levels between the group of users and nonusers., Methods: This randomized clinical trial study was conducted at the Nohom Dey Hospital in the Torbat-e Heydarieh, Iran between December 2011 and March 2012. Participants comprised 101 psychiatric patients with hypertension that randomly separated into users and nonusers of antidepressant. The period of intervention lasted for 3 months. The mean of BP calculated by this formula (systolic BP [SBP] +2 diastolic BP [DBP])/3 which was the main outcome of the study., Results: Users of antidepressant drugs did not have any significant changes in BP levels, except in patients who received SSRIs alone, significant improvement was observed in DBP (P = 0.04) and mean of BP (P = 0.03). While, in nonusers of antidepressant, significant development was observed in DBP, and mean of BP. Comparing the users and nonusers did not show any significant differences in SBP, DBP, and Mean of BP; even, when outcomes were adjusted for risk factors and antihypertensive drugs., Conclusions: Three months treatment with SSRIs and alprazolam did not have any effect on lowering BP level in patients with the psychiatric disorder.

Background: Cardiac resynchronization therapy (CRT) is an established treatment in patients with end-stage heart failure and wide QRS complex. However, about 30% of patients do not benefit from CRT (non-responder). Recent studies with tissue Doppler imaging yielded disappointing results in predicting CRT responders. Phase analysis was developed to allow assessment of LV dyssynchrony by gated single photon emission computed tomography (SPECT) myocardial perfusion imaging (GMPS)., Objectives: The aim of present study was to investigate the role of quantitative GMPS-derived LV dyssynchrony data to predict CRT responder., Patients and Methods: Thirty eligible patients for CRT implantation underwent GMPS and echocardiography. Response to CRT was evaluated six months after the device implantation. Clinical response to CRT was defined as 50 meters increase in 6-minute walking test (6-MWT) distance. Echocardiographic response to CRT was defined as ≥ 15% decrease in left ventricular end-systolic volume (LVESV). The lead position was considered concordant if it was positioned at the area of latest mechanical activation, and discordant if located outside the area of latest mechanical activation., Results: Clinical response to CRT was observed in 74% of patients. However, only 57% of patients were responder according to the echo criteria. There were statistically significant differences between CRT responders and non-responders for GMPS-derived variables, including phased histogram bandwidth (PHB), phase SD (PSD), and Entropy. Moreover, a cutoff value of 112° for PHB with a sensitivity of 72% and specificity of 70%, a cutoff value of 21° for PSD with a sensitivity of 90% and specificity of 74%, and a cutoff of 52% for Entropy with a sensitivity of 90% and a specificity of 80% were considered to discriminate responders and non-responders. CRT response was more likely in patients with concordant LV lead position compared to those with discordant LV lead position., Conclusions: GMPS-derived LV dyssynchrony variables can predict response to CRT with good sensitivity and specificity.

Background: Vast majority of cardiac patients who refer to cardiac rehabilitation program (CRP) are obese and obesity is associated with coronary heart disease (CHD). So, the aim of this study is to investigate the effects of CRP on obesity indexes, lipid profiles, and functional capacity (FC) in obese men with CHD and to explore whether significant weight reduction affected these risk factors and FC or not., Materials and Methods: In an observational study, we evaluated 536 patients, including 464 non-obese men and 72 obese men. All participants completed CRP for 2 months; then, obese patients were divided into two groups: patients with weight reduction ≥ 5% and patients who didn't have significant weight reduction. Data were analyzed with SPSS software version 15. For comparing the mean of outcomes independent t-tests and paired t-tests were used., Results: Results showed following CRP, non-obese men had significant improvement in obesity indexes (P = 0.00), lipid profiles (P < 0.05), and FC (P = 0.00) and in obese men, favorable improvement were seen in obesity indexes (P = 0.00), FC (P = 0.00), and total cholesterol (P = 0.02). Comparing two groups revealed that there were significant differences in obesity indexes, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio. In addition, comparing subgroup of obese patients revealed that there were significant differences in FC (P = 0.00) and low-density lipoprotein cholesterol/ high-density lipoprotein cholesterol ratio (P = 0.04)., Conclusion: CRP has more advantage in management of obesity, FC, and lipid profiles in both obese and non-obese patients. Also, weight reduction may cause greater improvement in FC and fitness levels in obese men with CHD.

Background: The aim of this study was finding the association between anti- Streptokinase (SK) levels based on previous streptococcus infection and the clinical outcome of acute myocardial infarction (AMI) among Iranian patients after SK treatment., Methods: In this prospective study, 31 consecutive patients presented to the emergency room of a referral university hospital within six hours of the onset of symptoms of AMI were recruited over a 3-year period (2007-2010). Blood samples for the analysis of the effect of neutralizing antibodies to SK assays were obtained immediately on arrival at the hospital. In-hospital and out-hospital clinical outcome defined as including return of typical chest pain after 48 hours, appearance of complex arrhythmia after 24 hours, maximum CPK serum concentration during first three days of admission, Left Venticular Ejection Fraction (EF) on the last day of admission, surgical interventions (CABG, PTCA), re-MI and re-admission due to cardiac problems during the one-year follow-up., Results: Overall, 31 patients (7 female, 24 male with the mean age of 56.83 +/- 2.21 years) were included in this study. The recurrence of typical ischemic chest pain 48 hours after AMI, appearance of complex arrhythmia during the admission to CCU and 24 hours after AMI, maximum CPK serum concentration during the first three days of admission, and left EF on the last day of admission were not significantly different between the two compared groups (p > 0.05)., Conclusion: According to this study, previous exposure to streptococcal infections may not reduce the efficacy of a single dose of SK and it does not seem necessary that its titer be measured before SK administration.

Stress-induced cardiomyopathy or Takotsubo cardiomyopathy is a recently increasing diagnosed disease showed by transient apical or mid left ventricular dilation and dysfunction. This sign is similar to acute myocardial infarction but without significant coronary artery stenosis and intra coronary clots. On the other hand there are important and essential differences in their management. Consequently, our physicians should know about its pathophysiology, diagnosis and treatment.

Objectives: Left ventricular (LV) dysfunction heart failure is one of the causes of morbidity and mortality following ST elevation myocardial infarction (STEMI). This study was done to determine the clopidogrel effect in preventing reduced LV function in patients with STEMI., Methods: In this study, 144 patients with STEMI admitted to the Isfahan University of Medical Sciences hospitals were followed in two groups for one month. The case group received Clopidogrel, 300 mg, on admission and then, 75 mg daily, while the control group received routine therapy for STEMI without Clopidogrel. Left ventricular ejection fraction (LVEF) on the 4(th) day and one month after STEMI was measured by echocardiography. The results of LVEF were compared within and between groups., Results: The mean LVEF in the case group on the 4(th) day and one month after STEMI were 45.92 and 52.15%, respectively (P<0.001). The mean LVEF in the control group on 4(th) day and one month after STEMI were 44.72 and 42.71%, respectively., Conclusions: We suggest that Clopidogrel is effective in prevention of LVEF reduction in patients with STEMI.

Background: Glucose-insulin-potassium (GIK) may improve cardiovascular performance after coronary artery bypass graft surgery (CABG). Our study investigated whether an infusion of GIK during elective CABG surgery in type II diabetic patient improved left ventricular performance., Methods: We measured left ventricular ejection fraction and troponin (Tn), a myofibrillar structural protein. In this research, after ethics committee approval, 50 patients with type 2 diabetes mellitus (DM) were enrolled into a randomized simple sampling, prospective, double-blind clinical trial study. In the case group, 500 cc dextrose water 5% plus 80 IU regular insulin and 40 mEq KCL were infused at the rate of 30 cc/hr. Patients in control group received 5% dextrose solution at the rate of 30cc/hr. Venous blood samples were taken before induction of anesthesia, after removal of the aortic clamp and before discharging from hospital. The Mann-Whitney-test was used to test for differences in troponin concentration between the groups. Fisher's exact test was used to determine whether there was a difference in the proportion of patients with a low ejection fraction (<45%) in the case group compared with that in the control group. Changes in potassium and glucose concentrations over time within the groups were examined by ANOVA and paired t-tests. P < 0.05 was regarded as significant level for all tests., Results: In this study, 50 patients with type 2 DM were evaluated in case and control groups. The mean age ± SD in the case group was 57.7 ± 9.9 years and in the other group was 61.2 ± 8.4 years. The groups were well-matched for age, sex and number of bypass grafts. Randomization did not give an equal distribution of male and female patients. There wasn't any significant difference in ejection fraction between the case and control groups before and after CABG (P > 0.05). Troponin concentration in the case group was 3.3 ± 5.0 and in the control group was 3.9 ± 5.1. There was no significant difference in Tn between the two groups before and after CABG (P > 0.05). There was not any significant difference in hospitalization time between the two groups., Conclusion: The results suggested that GIK can't improve left ventricular performance in routine CABG surgery.

Background: In most studies, the agreeable risk scores for ST-elevation myocardial infarction (STEMI) consist of thrombolytic in myocardial infarction (TIMI) risk score and modified Gensini risk score. Researchers showed significant relations between TIMI with angiography scores in patients with UA/NSTEMI. We studied this relation in patients with STEMI., Methods: We studied CCU patients with STEMI hospitalized in several hospitals of Isfahan, Iran from September 2007 to June 2008. Sampling method of 240 patients was random and simple. Exclusion criteria were incomplete history, nonspecific electrocardiogram changes, left bundle branch block and not accomplished angiography or accomplished angiography after 2 months of STEMI. Questionnaire indices collected on the basis of TIMI (0-14 points). Echocardiography and angiography were done and then, we used Gensini (0-400 points) to review films of angiography. Spearman's rank test and Pearson correlation coefficient were used to study the relation between these scores., Results: One hundred and sixty one patients were male and their average age was 60.02 years. Averages of TIMI and Gensini scores were 6.30±2.5 and 120.77±50.4, respectively. Study showed significant relation between TIMI, age and LVEF (P<0.001, r=-0.46). Also, between Gensini and age, gender and LVEF significant relation was found (P<0.001). But, a meaningful correlation didn't exist between TIMI and the gender (P=0.08). Our study proved direct relation between TIMI risk scores and modified Gensini scores (P<0.001, r=0.55)., Conclusion: We may decide quickly and correctly in emergency room to distinguish which patients with STEMI could derive a benefit from invasive strategies using TIMI score. Also, TIMI risk score can be a good predictor to determine the extension of coronary artery disease in patients with STEMI. As a result, we suggest determination of TIMI score for any patient entered emergency room. Also, this score should be recorded at the time patient's discharge.

Background: Leptin and adiponectin are two adipose tissue hormones and their association with the incidence of cardiovascular diseases is under evaluation. The aim of this study was to determine the relationship of leptin and adiponectin with coronary artery diseases., Methods: One hundred and seventy patients with angina pectoris and indications of coronary angiography underwent angiography. Serum levels of blood lipids, leptin, and adiponectin were measured. The gathered data was evaluated using SPSS(15) software, by multivariate variance analysis., Results: Analysis of the data demonstrated that 45.1% of the patients had positive angiographic findings. The serum levels of leptin and adiponectin were significantly lower than the minimum levels specified by the kit. However, the two groups, i.e., patients with positive angiographic findings and those with negative findings were not significantly different according to the serum levels of the hormones. Moreover, no significant correlation between the serum levels of the hormones and serum lipids was observed., Conclusion: Various studies have demonstrated that high serum level of leptin and the incidence of coronary artery diseases are correlated. On the other hand, they have reported that adiponectin has cardioprotective role. Confirmation of these findings requires more detailed studies.