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Volume 58, Issue 4 (7-2000)
This is retrospective double-blind research, which was carried out in Imam Khomeini hospital in order to study the accuracy of color Doppler ultrasonography for detecting the site and grade of stenosis in cervical carotid artery. 40 patients with mean age of 62 years studied with color Doppler before DSA angiography. The most common sites of stenosis were left internal carotid (39.5%) and right internal carotid arteries (38.4%). We measured peak systolic and end-diastolic velocities (PSA and EDV) and ratios of PSA and EDV at stenosis sites to CCA (PSV ratio and EDV ratio). Results showed that PSA has the highest sensitivity and accuracy in all grades of stenosis: Mild to moderate stenosis: Sensitivity (90.5%), accuracy (89.5%) Severe stenosis: Sensitivity (82.1%), accuracy (92.8%) Total occlusion: Sensitivity (93.8%), accuracy (96.5%). There is no difference between accuracy of Doppler parameters for detection of total occlusion (96.5%) but in other grades after PSV, EDV (Mild-moderate 86%, severe 87.2%). EDV ratio and PSV ratio (Mild-moderate both 84.8%, severe both 86%) have the highest accuracies. We concluded that color Doppler sonography can reliability detect stenosis in carotid arteries & PSV has the highest accuracy.
Volume 65, Issue 7 (10-2007)
Background: Epidemiological studies have suggested an association between higher body iron stores and coronary artery disease. It is believed that inflammation and oxidation are important mechanisms involved in the complex pathological process of atherogenesis. Free radical production is catalyzed and accelerated in the presence of iron. The determination of plasma ferritin levels is a convenient iron balance assessment method. The purpose of this study was to define the correlation of ferritin levels with severity and extent of coronary artery atherosclerosis.
Methods: In this cross-sectional study, 240 consecutive patients underwent previously indicated coronary artery angiography and were divided into two groups according to their angiographic findings: group 1 with 50% stenosis or less in each of the coronary arteries, and group 2 with more than 50% stenosis of the coronary arteries. Blood samples were taken for routine biochemical tests, including evaluation of serum ferritin levels. The severity and extension of coronary artery stenosis was determined by Gensini score.
Results: Group 1 consisted of 120 patients with a mean age of 52 6.8 years, and group 2 had 120 patients with a mean age of 58.1 10.4 years. We found a correlation between serum ferritin level and severity of coronary artery stenosis among men (p=0.02) however, there was no significant difference in serum levels of ferritin between the two groups (63.88 ng/ml vs. 44.26 ng/ml). Furthermore, there was no significant difference in serum ferritin levels of subgroups of patients with major risk factors such as hypertension, hyperlipidemia, hyperglycemia and smoking.
Conclusion: Overall this study cannot confirm a strong correlation of serum ferritin levels with severity of coronary atherosclerosis in our study population. However, in men it could have a role in the promotion and augmentation of coronary atherosclerosis, suggesting that ferritin could be a comparable index in patients with ischemic heart disease. Therefore, further study is necessary to assess etiological relationship between serum ferritin levels and extension of coronary artery stenosis.
Volume 67, Issue 8 (11-2009)
Background: In kidney transplantation decision about the proper kidney donation is different between surgeons, but simple vasculature anatomy and a kidney without abnormalities are the most important reasons of choosing a kidney. Therefore complete assessment of renal vessels of a live donor with noninvasive techniques is a necessity for nephrectomy. For delineation of the kidney vasculature anomalies and urinary system abnormalities, Multi-Detector CT seems to be excellent method for evaluation.
Methods: In this study 59 live donors were assessed with Multi-Detector CT Angiography. After injection of contrast media, we acquired images with 0.6 mm slice thickness. Processing and three dimentional reconstructions were done and the accessory arteries, early branching of main renal artery, the number of main renal vessels and the ureters were assessed. Findings were compared with the nephrectomy results.
Results: In Multi-Detector CT Angiography the prevalence of accessory renal artery was 3/4% with 98% accuracy, early branching of main renal artery was 8/4% with 100% accuracy. Multiplicity of renal veins was seen in 8/4% of donors with 98% accuracy. Duplicated ureter was not seen in any of the donors.
Conclusions: The accuracy of CT Angiography is 95% for depicting accessory renal artery and multiple renal artery and 100% for early branching. These results were comparable with findings in conventional angiography. Studies showed this method more valuable than M.R. Angiography and digital subtraction angiography. It is less invasive and can be named as the gold standard method in the diagnosis of anomalies of vessels & collecting system in live donors.
Volume 68, Issue 3 (6-2010)
Background: Coronary Artery Disease (CAD) is one of the leading causes of mortality and morbidity all over the world. One of the most important predictors of outcome of patients with coronary aterey disease is the site of stenosis i.e. Proximal versus nonproximal stenosis. This study designed to evaluate the relationship between CAD risk factors and site of stenosis. Methods: In this case- control study in the patients undergone coronary angiography (CAG) in Imam Khomeini Hospital, Tehran, Iran a total of 125 CAD patients with proximal lesion in CAG enrolled the study as case group and equal sex and age matched number of patients with non proximal lesion selected as control group. Two groups were compared based on presence or absence of DM, hypertension, hyper cholestrolemia, hypertriglyceridemia and cigarette smoking. Results: Relative frequency of DM was 33.6% and 10.4% in case and control group respectively (p< 0.0001). Relative frequency in two groups were 33.6 vs 28.8% For HTN (p= 0.41), 30.4% vs 29.6% for hyper cholestrolemia (p= 0.89), 19.2% vs 16.8% for hypertriglyceridemia (p= 0.062) and 28.8 vs 39.2 for C/S (p= 0.08). Multivessle disease was significantly more prevalent in diabetics compared with non diabetic patients 89.1% vs 61% (p< 0.0001), no relationship was seen with HTN (p= 0.41), Hyper cholest- rolemia (p= 0.052) hypertriglyceridemia (p= 0.38) and cigarette smoking (p= 0.375). Conclusion: Proximal involvement of coronary arteries and multivessle disease in CAD patients is related to the history of DM but not to the history of hypertension, hypercholestrolemia, hypertriglyceridemia and cigarette smoking.
Volume 68, Issue 6 (9-2010)
Background: The relationship between Coronary Artery Disease (CAD) and the prevalence of Renal Artery Stenosis (RAS) has been demonstrated. Despite high incidence of heart diseases and high frequency of CAD risk factors among Iranian population, this relation has not been clearly determined. This study estimated the prevalence of RAS and its determinants in Iranian angiographic candidates. We also tried to find which risk factors of atherosclerosis are associated more frequently with renal artery stenosis.
Methods: In a cross-sectional study that was performed at the Tehran Heart Center, in Tehran, Iran, 146 patients who were candidate for angiography with suspected CAD were consecutively included. Selective renal angiography was performed following coronary angiography in all patients with established coronary artery stenosis and the presence and severity of RAS was evaluated.
Results: Prevalence of RAS in study patients was 25.3% (men, 13.7% and women 47.1%, (p<0.001). We found that only 6.2% of the patients had bilateral R.A.S. Also, RAS≥50% was found in 17.1% of patients. Regarding number of defected coronary vessels, two- and three-vessel diseases were found in 30.0% and 39.0% of participants, respectively. No significant relationship was found between the number of involved coronaries and the severity as well as side of RAS (p=0.716) Significant multivariate predictors of RAS were female gender (p=0.001), advanced age, (p=0.046) duration of hypertension (p=0.032) and baseline serum creatinine concentration (p=0.018).
Conclusions: Routine angiographic assessment of renal arteries following coronary angiography is recommended especially in women as well as those with long-term duration of hypertension or renal dysfunction.
Volume 69, Issue 6 (9-2011)
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Background: This study was designed to explore the contribution of risk factors for
coronary artery disease (CAD) in patients with
indication for coronary angiography. Coronary angiography is defined as the
radiographic visualization of the coronary vessels after injection of radio
opaque contrast media. Despite the recognition of risk factors for
CAD, the association between related risk factors and angiographic
findings remains controversial. The aim of the present study was to explore the
association between Gensini scores and major cardiovascular risk factors in
patients with indications for coronary angiography.
Methods: We retrospectively enrolled 495 patients who had
been hospitalized at Dr. Shariati Hospital during September 2009
to September 2010 and had undergone
coronary angiography. The patients were evaluated for the severity of coronary
lesions on the angiogram by Gensini scoring system. The patients were also
evaluated for the presence or absence of DM,
hypertension, family history of cardiac diseases, low HDL,
hyperlipoproteinemia, hypertriglyceridemia and cigarette smoking. Statistical
analysis wad done to find any relationship between Gensini scores and cardiovascular
risk factors.
Results: The study population consisted of 249
men (50.3%) and 245
woman (49.5%) with a mean age of 58.1±10.3
years. A positive correlation
was found between age (P=0.04), sex (P=0.008),
HDL (P=0.04) smoking (P=0.0001)
and diabetes (P<0.013) with Gensini scores.
Conclusion: In
patients with indications of angiography, Gensini scores provide valuable
prognostic information on cardiovascular risk factors. Age, sex, HDL, smoking
and diabetes are related to the severity of coronary
lesions on the angiograms.
Volume 69, Issue 8 (11-2011)
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Background: Previous studies were suggestive of a good prognosis in patients
with acute coronary syndrome (ACS) and absence of any critical stenosis in coronary angiography but recent
limited reports have revealed that patients with non-obstructive acute coronary
syndrome are at a higher risk of future clinical coronary events.
Methods : A concurrent prospective cohort study was designed and 146 male patients with ACS and non-obstructive coronary
artery disease were regarded as the unexposed group, while 191 female patients with non-obstructive
coronary artery disease were regarded as the exposed group. Coronary events were
recorded within one year of follow-up. Prognostic factors were evaluated at
baseline by using a standardized protocol.
Results : Of the 337 patients with ACS, 191 (56.6%) were female. Coronary events in female patients after one year of
follow-up were: ST EMI 3 (1.6%), unstable angina pectoris 22 (11.5%),
Q-wave MI
1 (0.5%) and no syncope. In male patients the outcomes
were: ST EMI 4 (2.7%), unstable angina pectoris 29 (19.9%),
Q-wave MI 1
(0.7%), and syncope 1 (0.7%). Multivariate adjusted
relationships revealed that physical inactivity (P=0.035),
dyslipidemia (P=0.001), low ankle brachial
index (P=0.024) and
age between 40-50 years (P=0.004) were significantly associated with coronary events in women. In
male patients, body mass index of 30-39.99
(P=0.011) was associated with a higher
rate of ST-segment elevated MI.
Conclusion: Prognostically,
coronary events and clinical endpoints were significantly different between men
and women with acute coronary syndrome. Persistence of symptoms over one year seems
to relate to the development and progression of coronary atherosclerosis.
Volume 69, Issue 8 (11-2011)
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Background: Neutrophil
Gelatinase Associated Lipocalin (NGAL) is a new biomarker which can predict acute kidney injury (AKI) in critically ill patients.
Usefulness of NGAL in the early diagnosis of all types of AKI is under question. We
hypothesized NGAL is an early predictive biomarker of contrast-induced nephropathy (CIN).
Methods: In this process evaluation study, we enrolled 122 patients (Mean age 59.7±10.8 years) undergoing elective
angiography/angioplasty with contrast media during April to September 2009. Serial urine samples were
analyzed in a double-blind fashion by NGAL enzyme-linked immunosorbent assay. CIN was defined as a 25% increase in baseline serum creatinine.
Results : The prevalence of CIN was 30.3%. Significant elevations in urinary NGAL concentrations were noted within 12-h and 24-h after the procedure in patients with CIN. NGAL concentrations after 12 hours was 90.62±105.63 vs. 27.6±45.8 ng/ml in patients with and without CIN, respectively P=0.0001, and 79.78±117.7 vs. 30.92±52.84 ng/ml, 24 hours afterwards P=0.002. Some patients had AKI after five days of exposure rather than the second day (P=0.0001). We found using a cut-off point
of 8
ng/ml with a sensitivity, specificity, negative predictive value and area under
the ROC curve
94%, 25%, 91% and
0.75 respectively
are good for the prediction of CIN in 12-h urinary NGAL and a cut-off point of 5.5 ng/ml with respective values of 97%,
24%, 95% and 0.70 for 24-h urinary NGAL.
Conclusion: Urine NGAL may represent a sensitive
early biomarker of acute AKI after angiography/angioplasty. We recommend the routine measurement
of NGAL in
high risk patients receiving contrast agents.
Volume 69, Issue 9 (12-2011)
Background: Left main coronary artery (LMCA) stenosis is a leading cause of mortality and morbidity in many countries. Metabolic syndrome (MS) is a risk factor for coronary artery disease (CAD). The effects of MS on left main coronary artery stenosis are not well-defined. The aim of this study was to examine the effects of MS on left main coronary artery stenosis.
Methods: A total number of 495 patients who underwent elective coronary angiography in the Catheter Laboratory of Cardiovascular in Shariati Hospital 2008-2010 were included in the study. MS definition was based on the National Cholesterol Education Program (NCEP)- Adult Treatment Panel III (ATP III) criteria. The stenosis in left main coronary arteries was determined by examining the coronary angiograms of the patients.
Results: The study population consisted of 249 (50.3%) men, and 246 (49.7%) women. The mean age of the participants was 58.01±10 years. MS was present in 86 (17.4%) of the patients based on NCEP- ATP III criteria. LMCA stenosis was seen in 25 (5%) patients. A positive correlation was found between MS and LMCA stenosis (r=0.305, P=0.012). Moreover, a positive correlation was found between age (r=0.192, P=0.05), sex (r=0.334, P=0.007), smoking (r=0.336, P=0.01) and diabetes (r=0.253, P=0.03) and LMCA stenosis.
Conclusion: The metabolic syndrome correlates with LMCA stenosis. LMCA stenosis and its correlation with MS is precipitated by high FBG, age, male sex, and smoking which may synergistically increase the risk for the disease.
Volume 76, Issue 1 (4-2018)
Methods: A total of 4177 patients whom underwent renal angiography from April 2001 to March 2016, were randomly assigned to a development and a validation dataset in ratio of 2:1 respectively. The clinical and laboratory data of patients were analyzed by multivariate regression analysis. The factors of female sex, history of hypertension and glomerular filtration rate were determined as predicting factors and they were assigned a weighted integer, the sum of the integers was a total risk score for each patient. This model was examined at validation set.
Results: We retrospectively evaluated all patients undergoing renal artery angiography since 15 years ago. We extracted all risk factors of RAS including age, sex, height, weight, and history of diabetes, hypertension and hyperlipidemia. We also looked at coronary or peripheral vascular diseases and presence of heart failure. The age of patients was 63.5±11.2 years and 40% of the patients were female. The significant RAS was defined as 70% or more narrowing of renal artery. The prevalence of renal artery stenosis was 14.4% and 13.5% in development and validation dataset respectively. The area under curve and confidence interval for final mode in development dataset was 67.9% (65.0-70.8%). The rates of RAS increased with increasing risk score. In 1402 patients in validation dataset the model showed good discrimination power (cstatistic= 0.76)
Conclusion: This model simply assesses the risk of RAS using available information. This model can be used both in clinical and research purposes. The power of model for diagnosis of RAS is estimated to be 72.6% (68.8%-76.4%).
Volume 76, Issue 9 (12-2018)
Methods: This investigation is in the form of a descriptive-analytical study. The statistical population was all non-active male aged 34-73 years with CSF candidate for angiography referring to Seyedoshohada University Hospital, Urmia, Iran, from March 2015 to February 2017. After obtaining an inform consent, 74 male patients (mean age 54.77±9.00 years, height 1.74±0.12 cm, weight 73.13±6.85 kg, and BMI 26.98±3.83 kg/m2) were selected by convenience non-random sampling as the sample size (patients were eligible for diagnostic coronary artery angiography for the first time and referring to Seyedoshohada University Hospital in Urmia). Then all the patients were placed under angiography with one mobile angiography system. Patients were assessed for coronary blood flow with a quantitative method using corrected thrombolysis frame count in myocardial infarction (CTFC). All the patients with TFC larger than two standard deviation pre-published area for a specific vessel were counted as CSF. Demographic characteristics of age, height, weight, and BMI in male patients were measured by wall-meter with an accuracy of one millimeter, digital scale with precision of 100 g, and weight/hieght2 formula, respectively. The traditional risk factors including smoking, diabetes mellitus (DM), high blood pressure (HBP), dyslipidemia, and family history were also assessed using a checklist. Serum levels of Cys C were measured by ELISA machine.
Results: The mean demographic and physiological variables of subjects were: age 54.77±9.00 yr, height 1.74±0.12 cm, weight 73.13±6.85 kg, and BMI 26.98±3.83 kg/m2. Also, the results of this study showed that there were no significant correlations between serum levels of Cys C with CSF and BMI in male patients’ candidate for angiography referring to Seyedoshohada University Hospital (P=0.871 and P=0.494, respectively).
Conclusion: The results of this study suggest that serum levels of Cys C had no significant correlations with the CSF and BMI in male patients’ candidate for angiography aged 34-73 years.
Volume 79, Issue 4 (7-2021)
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Methods: This cross-sectional study was performed over a period of 6 months (May to November 2018) in a university-affiliated hospital. Data of 75 patients suspected of pulmonary embolism who were referred for CT angiography were collected. All CT scans were performed by a 16-slice CT scanner (Lights Speed, GE Healthcare) with fixed imaging parameters including 100 kVp and 100 mA. In order to evaluate the adequacy of pulmonary artery enhancement, the Hounsfield unit (HU) of the main pulmonary artery was measured in the aortic arch, upper, and lower segmental parts. Also, 8 factors affecting the image quality were examined.
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Results: The mean HU of the main pulmonary arteries was 312 in the range of 124 to 677. The mean HU in patients with and without pulmonary embolism was 358 and 302, respectively. Most CT images (61%) had poor quality for the diagnosis of pulmonary embolism. Only 2% of the images were acceptable compared to standard images and protocols. Late imaging was the most common quality confounding factor in this study.
Conclusion: A low-quality image reduces the accuracy of the physician's diagnosis that leads to misdiagnosis. Besides, sometimes poor image quality leads to repetitive imaging, which results in increased patient exposure and therefore increased radiation hazards. Therefore, modifiable confounding factors must be identified and corrected which one of the most important ones is wrong imaging timing protocols after contrast injection. |
Volume 79, Issue 6 (9-2021)
Methods: This study was conducted on 100 patients Who were referred to the Imam Hospital in Ahvaz from 22 September 2020 to 19 Mach 2021. 50 patients underwent angiography with normal radial artery access and 50 patients underwent snuffbox angiography. Basic characteristics including age, sex, underlying disease (diabetes mellitus, hypertension, and dyslipidemia), family history of coronary artery disease, medical history including chronic coronary artery disease, stable ischemic heart disease, smoking, and LVEF, and also the length of hospital stay was also collected and recorded. All subjects in the two groups underwent radial artery ultrasound in the forearm and snuffbox 24 hours after angiography. Also, angiographic complications including radial artery occlusion (thrombosis), pain, hematoma and anesthesia were recorded.
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Results: In the present study, the mean age in the two groups was similar (about 50-60 years). The distribution of sex, diabetes, weight, height and blood pressure was homogeneous in both groups. There was a statistically significant difference in the incidence of thrombosis and pain between the two groups. The results of this study showed that in the snuffbox angiography group, the number of uncomplicated cases was significantly more than the radial angiography group and in the snuffbox angiography group, the number of postoperative pain and thrombosis cases was significantly lower. The length of hospital stay in the Snuffbox group was shorter than the radial group, but there was no statistically significant difference.
Conclusion: Snuffbox angiography has fewer complications compared to the usual transradial method, so it can be used as a safe method for angiography. |
Volume 81, Issue 5 (8-2023)
Methods: This was a prospective cohort study from March 2022 to March 2023 in Mazandaran heart center. The study population was patients who underwent angioplasty through the femoral artery. If the ACT is less than 150-180, sheet removal was done by applying pressure with the hand on the proximal puncture site for 15-20 minutes and ensuring sufficient hemostasis. Then, the ultrasound of the puncture site was performed before pulling the sheet/one hour and six hours after pulling the sheet, and after collecting the data, the data were analyzed to study the effect of BMI, BP, sex, hematocrit, hemoglobin, age, time of sheet removal, anticoagulant agent, etc. on prevalence of hematoma and it size.
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Results: 200 patients were examined, of which 44(22%) had hematoma. Women had hematoma more than men (P<0.05). BMI and blood pressure in patients with hematoma decreased and increased, respectively (P<0.05). Older age, female gender, lower hematocrit, and longer duration of sheet retention were effective factors in increasing hematoma size (P<0.05). In the logistic regression model, with increasing BMI, the chance of hematoma occurrence decreased (P=0.029, OR=0.831).
Conclusion: Controlling blood pressure and preventing of decreasing the hematocrit, reduces the incidence of hematoma in patients after angiography. Also, preventing hematocrit drop and removal of sheet at the appropriate time, can prevent of increasing in size of hematoma. There is some difference between nursing report and sonography finding. Nursing report overestimated the hematoma size. |
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