Background. Obstruction of the access vein following cardiac pacemaker and defibrillator implantation is a common complication. However, the exact incidence and contributing risk factors are unknown. The aim of this study is to determine the incidence and analyze the contribution of each risk factor.Methods. 57 consecutive patients candidate for their first transvenous pacemaker, implantable cardioverter-defibrillator (ICD), or cardiac resynchronization therapy device implantation were enrolled. After implantation, venography of the ipsilateral peripheral arm was performed. Patients underwent their second venography after the follow-up period of 3 to 6 months.Results. 42 patients (13 females, mean age 59.71 ± 12.33) completed the study. The followup venography showed significant venous obstruction (more than 50%) in 9 (21%) patients, but in none of the individuals, venography revealed total occlusion of the veins. Patients with obstruction had more leads in their veins (2.56 ± 0.53 vs 1.58 ± 0.71, P = 0.001). Venous obstruction was significantly more prevalent in patients with implanted cardiac resynchronization therapy device compared with an ICD or pacemaker (p = 0. 01). Age, gender, diabetes mellitus, hypertension, ischemic heart disease and antiplatelet consumption did not reveal any other contribution to the risk of thrombosis. In multivariate analysis, total lead number was a positive predictor for venous occlusion (P = 0.015, OR:19.2, and CI: 1.7-207.1).Conclusion. Venous obstruction is relatively frequent after pacemaker or ICD implantation. This study also shows that pacemaker and ICD leads have a similar risk for lead-related venous obstruction. However, patients with multiple leads are associated with an increased risk.
Compression of left main coronary artery (LMCA) secondary to pulmonary trunk dilatation is a newly recognized entity that has been associated with severe pulmonary hypertension. In this paper we present a case of extrinsic compression of LMCA caused by dilated pulmonary trunk secondary to pulmonary hypertension documented using 64-slice multidetector computed tomography (MDCT) coronary angiography. This case is followed by a review of the literature.
IntroductionThe extrinsic compression of left main coronary artery (LMCA) secondary to pulmonary artery trunk dilatation is a relatively newly described syndrome that has been associated with severe pulmonary hypertension. It is primarily related to congenital heart disease or idiopathic pulmonary hypertension 1 -6 but other causes of pulmonary hypertension can be the triggering factor for this syndrome. The following case is an example of extrinsic LMCA compression caused by secondary pulmonary hypertension related to chronic sarcoidosis and pulmonary embolism.
This study has been registered in ClinicalTrial.gov with identifier NCT01521845 and under registry name of "Study of the Effect of omega3 on Biomarkers of Cardiac Necrosis (CKMB and Troponin I) and Inflammation Marker (CRP) After Elective Percutaneous Coronary Intervention (PCI)"
SUMMARYObjective: This study sought to investigate the effect of omega-3 polyunsaturated fatty acids (PUFAs) on cardiac biomarkers, CK-MB, and troponin I in patients undergoing PCI. Background: Restenosis remains as a major long-term complication following percutaneous coronary intervention (PCI). It appears that there is strong relationship between post-PCI creatine kinase-MB (CK-MB) and troponin I elevation and cardiovascular events after PCI. Methods: In this randomized clinical trial, a total of 90 patients planned to undergo PCI were randomly assigned into two groups: Group A-receiving omega-3 PUFAs (3 g, 12 h before PCI) plus standard treatment (n = 43) and Group B-control group, receiving only standard therapy (n = 47). Standard treatment included aspirin 325 mg and clopidogrel 600 mg loading dose. The plasma CK-MB level was measured before the procedure (baseline), at 8 and 24 h after PCI. The plasma troponin I was measured at baseline and 24 h after PCI. Results: In comparison with control, omega-3 PUFAs could significantly reduce the level of CK-MB in 8 (P = 0.001) and 24 h (P = 0.012) after its prescription in the omega-3 PUFAs group. Omega-3 PUFAs could not significantly decrease troponin I. Conclusion: Our results revealed that omega-3 PUFAs can be considered as a safe adjunctive medication to the standard regimen before PCI for the aim of decreasing cardiovascular event after PCI.
Mathematical programming and meta-heuristics are two types of optimization methods. Meta-heuristic algorithms can identify optimal/near-optimal solutions by mimicking natural behaviours or occurrences and provide benefits such as simplicity of execution, a few parameters, avoidance of local optimization, and flexibility. Many meta-heuristic algorithms have been introduced to solve optimization issues, each of which has advantages and disadvantages. Studies and research on presented meta-heuristic algorithms in prestigious journals showed they had good performance in solving hybrid, improved and mutated problems. This paper reviews the sparrow search algorithm (SSA), one of the new and robust algorithms for solving optimization problems. This paper covers all the SSA literature on variants, improvement, hybridization, and optimization. According to studies, the use of SSA in the mentioned areas has been equal to 32%, 36%, 4%, and 28%, respectively. The highest percentage belongs to Improved, which has been analyzed by three subsections: Meat-Heuristics, artificial neural networks, and Deep Learning.
BackgroundThere is evidence that opium addiction has immunosuppressant effects. Coronary artery disease (CAD) is a condition resulted from atherosclerosis which is dependent on the immune response.PurposeTo evaluate plasma levels of interleukin-6 and interleukin-1Ra in 30 patients with three-vessel coronary artery disease, ejection fraction of more than 35% and to evaluate their changes after prognostic treadmill test in 15 opium addicted and 15 non-addicted patients.MethodsThe participants underwent prognostic treadmill test and plasma levels of interleukin-6 (IL-6) and interleukin-1Ra (IL-1Ra) were evaluated with ELISA method before, just after and 4 hours after the test.ResultsIL-1Ra (2183 pg/ml) tended to decrease over time in the opium addicted group (1372 pg/ml after prognostic treadmill test and 1034 pg/ml 4 hours after that), although such decrease did not reach the statistical significance. IL-1Ra levels were significantly higher in opium addicted than in non addicted patients. Opium addiction had no significant effect on IL-6 changes.ConclusionConsumption of opium in CAD patients is associated with higher IL-1Ra levels.
Background and ObjectivesThe aim of this study was to examine the hypothesis that pentraxin 3 (PTX3) can have a diagnostic value for predicting anatomical complexity of coronary artery stenosis as measured by the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) score.Subjects and MethodsWe investigated the association of systemic arterial PTX3 with SYNTAX score among 500 patients with ischemic heart disease assigned to medical treatment (251), percutaneous coronary intervention (PCI) (197), or coronary artery bypass graft (CABG) (52).ResultsThe clinical judgment of the cardiologists was near-perfectly concordant with the SYNTAX score. Mean {99% confidence intervals (CIs)} SYNTAX scores were 5.8 (5.1-6.6), 18.4 (17.1-19.8), and 33.2 (32.8-33.6) in patients assigned to medical therapy, PCI, and CABG, respectively. The AROC (95% CIs) for discriminating between patients with and without a high SYNTAX score (>23) was 0.920 (0.895-0.946) for systemic arterial levels of PTX3. As the systemic arterial level of PTX3 increased, the SYNTAX scores also increased almost in a curvilinear fashion, with the value corresponding to the SYNTAX score of 23 being 0.29 ng · dL-1. This cutpoint achieved a sensitivity of 0.66 (0.57-0.74), a specificity of 0.94 (0.91-0.96), a positive predictive value of 0.79 (0.70-0.87), and a negative predictive value of 0.89 (0.85-0.92).ConclusionWe observed that systemic arterial levels of PTX3 were associated with the SYNTAX score in a curvilinear fashion. The discriminatory power of systemic arterial levels of PTX3 for a high SYNTAX score was excellent. The interesting finding of this study was the near perfect concordance between the decisions made by the cardiologists based on their clinical judgment and the SYNTAX score. The systemic arterial PTX3 level of 0.29 ng · dL-1 was highly specific for diagnosing complex coronary artery stenosis.
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