Article: Corrected QT interval and QT dispersion in cirrhotic patients before and after liver transplantation.[show abstract] [hide abstract]
ABSTRACT: Liver cirrhosis is associated with different types of electrophysiological changes, including QT prolongation, which may adversely affect long-term prognosis of these patients. The aim of this study is to evaluate the effect of orthotopic liver transplantation (LT) on corrected QT (QTc) interval and QT dispersion (QTd) in cirrhotic patients of various etiologies. We enrolled 249 patients with end-stage liver disease between 2004 and 2009 at Shiraz Transplant Research Center, Shiraz, Iran. The QTc interval and QTd were measured by 12 lead ECGs for baseline and at 3 months after LT. Mean QTc interval and mean QTd were calculated. A QTc interval above 440 ms was considered abnormal. Within 3 months following surgery, 6 patients died. There were 105 patients (43.2%) with prolonged QTc before transplantation; in 91 (86.6%) patients, the mean QTc normalized after transplantation (baseline: 490.9 ± 45.74 ms; post-transplantation: 385 ± 48.74 ms; P < 0.0001). Fourteen patients (13.3%) had evidence of some shortening of the QTc interval although the QTc remained above the upper limit of normal. Prolongation of the QTc interval in cirrhotic patients was independent of the etiology of cirrhosis. A normal QTc was seen in 138 patients (56.7%) before transplantation, of which 4 (2.9%) developed prolonged QTc after transplantation. The mean QTd decreased significantly after transplantation (baseline: 30 ± 20 ms; post-transplantation: 30 ± 10 ms; P < 0.0001). Many cirrhotic patients have prolonged QTc intervals before LT regardless of disease etiology. In the majority of patients this value returns to normal after LT, suggesting that liver cirrhosis has independent unfavorable, but reversible electrophysiological effects.Archives of Iranian medicine 06/2012; 15(6):375-7. · 0.97 Impact Factor
Kamran Aghasadeghi, Didar Zare[show abstract] [hide abstract]
ABSTRACT: Atorvastatin is a synthetic inhibitor of 3-hydroxy 3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitor. It has a longer half life and longer duration of action than that of all other available HMG-CoA inhibitors. We evaluated the efficacy of alternate-day dosing of atorvastatin in comparison with the standard one-daily dose on total cholesterol, low and High-density lipoprotein (LDL and HDL) and triglycerides. This study is a randomized, blinded, and controlled clinical trial. Sixty-six patients with LDL cholesterol of more than 100 mg/dl were enrolled. Baseline fasting lipid profile (total cholesterol, LDL, HDL and triglyceride), liver function tests and creatine kinase were drawn. Patients were randomized to three atorvastatin dose groups. Group I received 10 mg of atorvastatin every day, group II received 20 mg of atorvastatin every day, and group III received 20 mg every other day. After 6 weeks of treatment with atorvastatin, fasting lipid profiles, liver function tests and creatine kinase concentrations were re-taken. Compliance to treatment was assessed at each visit. Of the sixty-six patients enrolled, sixty completed the study. All three regimens significantly reduced total cholesterol and LDL compared to baseline. No statistically significant difference existed between the three groups in regards to total or a percentage decrease in total cholesterol and LDL cholesterol at 6 weeks compared to baseline. All regimens were well tolerated and none of the patients showed significant elevation of liver enzyme or creatine kinase during the course of the study. In conclusions the alternate-day dosing of atorvastatin is an efficacious and safe alternate to daily dosing and yet inexpensive.Central European Journal of Medicine 04/2012; 3(2):163-166. · 0.31 Impact Factor
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ABSTRACT: In cirrhotic patients, despite presence of significant metabolic abnormalities and enlarged left atria, we have seldom observed atrial fibrillation (AF) rhythm. The aim of this study was to evaluate the prevalence of AF among cirrhotic patients and comparing it with that reported in the general population. Medical documents of 1302 adult cirrhotic patients, booked in the waiting list of liver transplantation, were evaluated retrospectively. Electrocardiograms were reviewed for the presence of AF rhythm, and echocardiographies were reviewed to obtain left atrial (LA) size. Only two patients (0.15%) were detected to have AF rhythm, which was significantly lower than that reported in our general population, even after age and sex adjustment. Six hundred and sixty-eight patients (51%) had enlarged left atria (LA diameter more than 39mm); both AF patients belonged to this group. The result of this study suggests the protective effect of liver cirrhosis on development of atrial fibrillation. Further studies are needed to verify the possible mechanisms.Journal of cardiovascular disease research 04/2012; 3(2):109-12.
Article: The diagnostic efficiency of transesophageal compared to transthoracic echocardiographic findings from 405 patients with ischemic stroke.[show abstract] [hide abstract]
ABSTRACT: This study compared the diagnostic efficacy of transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) for patients with stroke. Examination with TTE was followed by TEE. Stroke causes were classified according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) and Causative Classification of Stroke (CCS) criteria before and after TEE to determined, cryptogenic or unclassified groups. We identified that 55.1% of patients had a determined etiology for stroke with TTE; adding TEE to the examinations increased the proportion of patients with determined stroke etiology to 69.4% (κ = 0.79). TTE alone showed fair agreement with the combined results of TTE and TEE in determining the cause of stroke in young adults (κ = 0.38). TEE improved the detection of cardio-aortic sources, but had no impact on patients who had a determined cause for stroke with other examinations. TEE examination was most useful in young adults with stroke and in patients with an undetermined cause for stroke despite TTE examination and other standard investigations.Journal of Clinical Neuroscience 09/2011; 18(11):1486-9. · 1.25 Impact Factor
Article: Comparison of agitated saline mixed with blood to agitated saline alone in detecting right-to-left shunt during contrast- transcranial Doppler sonography examination.[show abstract] [hide abstract]
ABSTRACT: To evaluate a technique for contrast agent preparation as mixing the patients' blood with agitated saline and to compare it with agitated saline alone in diagnosis of cardiac right-to-left shunt in regard to their sensitivity, time window, and distribution of artificially induced microembolic signals. Fifty-two patients with stroke who had Transesophageal echocardiography proven right-to-left shunt underwent contrast-transcranial Doppler sonography with injection of agitated (i) 9 ml saline with 1 ml air with Valsalva maneuver, (ii) 9 ml saline with 1 ml air without Valsalva maneuver, (iii) 8 ml saline, 1 ml of the patient's fresh blood and 1 ml air with Valsalva maneuver, and (iv) 8 ml saline, 1 ml of the patient's fresh blood and 1 ml air without Valsalva maneuver. The sensitivity of the bilateral middle cerebral artery monitoring in diagnosis of right-to-left shunt was 94.2%, 71.2%, 96.2% and 76.9% for agitated saline with Valsalva maneuver, agitated saline without Valsalva maneuver, agitated saline and blood with Valsalva maneuver, and agitated saline and blood without Valsalva maneuver methods, respectively. Severe right-to-left shunt was detected in 100% of patients when agitated saline and blood with Valsalva maneuver was used. Application of Valsalva maneuver resulted in detection of more right-to-left shunt (P = 0.002). Agitated saline mixed with blood with Valsalva maneuver is a sensitive method to detect right-to- left shunt, especially in the case of severe shunt. Mixing agitated saline with blood may increase the sensitivity of the test.Acta neurologica Taiwanica 09/2011; 20(3):182-7.