BACKGROUND

The purpose of this study is to evaluate the possible difference of the impact of Women Healthy Heart Project on lifestyle, as well as physical/biochemical parameters of working women and housewives.

METHODS

This was a community-based intervention study conducted over 5 years (2002-2007) in the counties of Isfahan and Najafabad (intervention areas) and Arak (control). Pre-study situation analysis of women was followed by 5 years of wide-ranging interventions (educational/environmental) conducted by various organizations using different methodologies. The interventions were aimed at modifying/improving lifestyle by increasing physical activity, encouraging healthy eating, and tobacco use cessation. The organizations involved in performing the interventions included the local radio and television authority, health/treatment centers, the Red Crescent Society, Municipalities, the Relief Committee, the Center for Retirees’ Welfare, and the Literacy Campaign Organization. After 5 years, final phase same as first phase was planed. The subjects studied in all phases‘ the pre- and post-intervention phases consisted of 10586 women aged above 18 years. Demographic data, obesity index, smoking, physical activity and eating habit were assessed before and after the study. Data were analyzed using SPSS-15 using Student's t-test, chi-square test, the general linear model of ANOVA, and logistic regression.

RESULTS

We studied 10586 women (6105 and 4481 women, pre- and post-intervention, respectively). Mean age of working women was 34.14±10.09 and 34.08±9.35 years before and after the study, respectively. Mean age of housewives before and after the study was 40.05±14.61 and 40.36±15.32 years, respectively. Interventions conducted during 5 years improved eating habits and decreased tobacco use in working women and housewives. In every phase of the study, there was a significant age difference between housewives and working women (P<0.001). Hence data were adjusted according to age in each phase. Overall physical activity of housewives and working women increased, but the percentage of passive smokers among housewives remained unchanged. Waist circumference and waist-to-hip ratio changed significantly in housewives following interventions (P<0.001). The parameter which improved significantly in working women was waist circumference (P<0.05). However, after adjusting for age, no significant difference was seen between working women and housewives following interventions.

CONCLUSION

Community-based interventions, especially those directed at housewives, can lead to significant improvements in lifestyle and cardiovascular risk reduction. It seems that working women require tailored interventions to suit their conditions. Although short-term outcomes may seem insignificant, persistence and continuity of lifestyle changes may lead to reduced prevalence of cardiovascular diseases. Then longer-term studies are warranted.

BACKGROUND

Individuals are faced with numerous stressful life events which can negatively influence mental health. Many individuals use smoking as a means of confronting stress. Given the relatively high prevalence of smoking in central Iran, the present study was conducted to compare stress levels in smokers, non-smokers and those who had quit smoking.

METHODS

This study was conducted as part of Isfahan Cardiovascular Research Program on 9752 individuals in the cities of Isfahan, Arak, and Najafabad in 2008. Sampling was performed using multi-stage cluster randomization method. Data on age, sex, demographic characteristics, and smoking status was collected through interviews. Stress level detected by General Health questionnaire.Logistic regression and chi- squere test was used for data analyzing.

RESULTS

In the present study, 30% of non-smokers, 32.1% ex- smoker and 36.9% of smokers had GHQ of 4 and higher (P=0.01). In regression analysis, the final model which was controlled for age, sex, socioeconomic statues (including place of residence, marital status and education level) showed that the odds ratio of stress in smokers and ex- smoker was significantly higher than in non-smokers (OR=1.66 and OR=1.12, respectively).

CONCLUSION

Since in conducted studies, mental problems and stresses have had an important role in people's smoking, it seems suitable to use the results of this study to present intervention for correct methods of coping with stress towards reducing the prevalence of smoking in the community.

BACKGROUND

Renal artery stenosis is one of the important causes of hypertension and end stage renal failure. Magnetic resonance angiography (MRA) and Doppler ultrasonography are non-invasive and safe diagnostic techniques that have also high sensitivity and specificity. Since the accuracy and reliability of these techniques depend upon technicians and softwares, we decided to evaluate and compare the sensitivity and specificity of these techniques in Isfahan.

METHODS

Our study included all the patients (37 patients) who underwent renal artery angiography during 2 years from May 2003 to May 2005 and up to six months after that had underwent MRA (21 patients) and Doppler sonography (16 patients) in Isfahan. Renal artery angiography was considered as the gold standard.

RESULTS

Sensitivity, specificity, positive and negative predictive values of 100%, 25%, 25%, and 100% were obtained for MRA respectively. Specificity and positive predictive values (PPV) of Doppler sonography were 67%. Its sensitivity and negative predictive values (NPV) were 57%.

CONCLUSION

Although it seems that technician dependency, technical and software problems were the reasons of low specificity of gadolinium-enhanced MRA in our study, further studies with larger sample sizes are recommended.

BACKGROUND

The current study aims to determine the relation between ankle–brachial index (ABI) and angiographic findings and major cardiovascular risk factors in patients with suspected coronary artery diseases (CAD) in Isfahan.

METHODS

In this cross-sectional descriptive-analytic research, patients with suspected CAD were studied. Characteristics of studied subjects including demographics, familial history, past medical history and atherosclerotic risk factors such as diabetes mellitus, hypertension, hyperlipidemia and smoking were obtained using a standard questionnaire. ABI was measured in all studied patients. ABI≤0.9 (ABI+) was considered as peripheral vessel disease and ABI>0.9 (ABI-) was considered as normal. Then, all studied patients underwent coronary artery angiography. The results of the questionnaire and angiographic findings were compared in ABI+ and ABI- groups. Data were analyzed by SPSS 15 using ANOVA, t-test, Spearman's rank correlation coefficient, and discriminant analysis.

RESULTS

In this study, 125 patients were investigated. ABI≤0.9 was seen in 25 patients (20%). The prevalence of ABI+ among men and women was 25.9% and 7.5%, respectively (P=0.01). The prevalence of atherosclerotic risk factors was significantly higher in ABI+ patients than in ABI- ones (P<0.05). ABI+ patients had more significant stenosis than ABI- ones. The mean of occlusion was significantly higher in ABI+ patients with left main artery (LMA), right coronary artery (RCA), left anterior descending artery (LAD), diagonal artery 1 (D1) and left circumflex artery (LCX) involvements (P<0.05).

CONCLUSION

The findings of this research indicated that ABI could be a useful method in assessing both the atherosclerotic risk factors and the degree of coronary involvements in suspected patients. However, in order to make more accurate decisions for using this method in diagnosing and preventing CAD, we should plan further studies in large sample sizes of general population.

BACKGROUND

Doppler echocardiography has been proposed as an appropriate non-invasive assay to estimate left ventricular end diastolic pressure (LVEDP). The aim of present research was to estimate the LVEDP in patients with ischemic heart disease by echocardiography and compare it with the results of cardiac catheterisation and to determine the effect of different echocardiographic variables on its measurement.

METHODS

In this descriptive-analytic study, patients with diagnosed ischemic heart disease were selected by nonrandomized sampling method. Selected population underwent M-mode and pulse doppler echocardiographic evaluation and parameters such as Q-Mitral valve E (Q-MVE), Q-Aortic valve closure (Q-AVC), Aortic valve closure-E (AVC-E), Q-Mitral valve closure/Aortic valve closure-E (Q-MVC/AVC-E), left ventricle-deceleration time (LV-DT), peak velocity-deceleration time (PV-DT) and A/E velocity time integral (A/E VTI) were evaluated. Immediately after echocardiography all patients underwent left heart catheterization for LVEDP measurement. The relation between different echocardiographic measurements and LVEDP, obtained by cardiac catheterization, was evaluated.

RESULTS

In this study, 47 patients with ischemic heart disease with mean age (±SD) of 53±13 were studied. There was a significant correlation between LVDEP and A/E VTI (r=0.44, P=0.001, and also between LVEDP and PV-DT in patients with A/E VTI ≥1.1(r=−0.58, P=0.02). There was a significant correlation between LVEDP and Q-MVC/AVC-E in patients with LVEDP >18mmHg (r=0.76, P=0.03) and those with LVEDP ≤18 mmHg and A/E VTI <1.1 (r=0.37, P=0.03). The correlation between LVEDP and A/E VTI was more significant in men, in patients aged >50 years with EF >55%, without LVH, without MR and those with coronary artery disease (P<0.05).

CONCLUSION

Some echocardiographic indices such as A/E VTI, Q-MVC/AVC-E and PV-DT are able to measure LVEDP especially in male patients aged >50 years, without LVH, without MR and those with coronary artery disease but it is necessary to determine specific conditions and factors affecting these indices, by further studies.

BACKGROUND

Dextrocardia situs inversus refers to the heart being a mirror image situated on the right side of the body. Distorted cardiac anatomy provides technical difficulties during fluoroscopy-guided transcatheter procedures. This is even more difficult in the case with percutaneous transvenous mitral commissurotomy (PTMC). Mitral valvuloplasty is a minimally invasive therapeutic procedure to correct an uncomplicated mitral stenosis by dilating the valve using a balloon. Here, we describe a case of a 25 years-old male with situs inversus and dextrocardia.

CASE REPORT

A 25 years-old man, having situs inversus and suffering from mitral stenosis was referred to hospital for PTMC. His initial examination findings were unremarkable and an electrocardiographic (ECG), trans-esophageal and transthoracic echocardiographic evaluation were performed. Mitral valve (MV) was dome shape and severely stenotic with mild mitral regurgitation (MR). Left ventricularejection Fraction (LVEF) was about 40%, Femoral arterial and venous punctures were made on the left side; the left femoral artery and vein were cannulated with a 5F arterial and 6F venous sheaths, respectively. Then special maneuvers were done to solve the mitral valve stenosis. At the end of the procedure, no MR was documented by checking LV angiogram and there were no signs of mitral stenosis (MS).

CONCLUSION

Mirror-image dextrocardia, as in our case, has been estimated to occur with a prevalence of 1:10,000. However, there are only a few case reports in the literature on PTMC in similar settings. This might be due to the fact that many of these patients undergo surgical commissurotomy due to the technical difficulties involved in a percutaneous procedure in general. Trans-septal catheterization is considered a technical challenge in anatomically malpositioned hearts, as it is fraught with a higher risk of cardiac perforation. Despite the challenging anatomy, PTMC has been demonstrated to be a safe and feasible option for MS in patients with unusual cardiac anatomy.