farshad shakerian

An adult heart has limited regenerative potential, resulting in many problems such as ischemic heart disease and diseases in which heart muscle cells (cardiomyocytes) become defective, leading to heart failure. Since therapies for heart disease and heart transplants are limited due to the small number of heart donors, the ability of pluripotent stem cells to differentiate into heart disease, especially in regenerative medicine, has received considerable attention. Recently, stem cells can be induced to produce functional cardiomyocyte cells using a variety of methods (1-3). As a result, the formation of heart muscle cells from stem cells requires a deep understanding of the molecular processes involved in the evolution of myocardial cells(7). The aim of this study was to investigate genes with differential expression between embryonic stem cells and differentiated cardiomyocyte cells by bioinformatics analysis. Furthermore, we show the importance of these genes in the development of heart disease in order to utilize this model to achieve more appropriate biomarkers for heart diseases which are effective in both cardiac differentiation and heart disease.

RNA-sequencing samples of embryonic stem cells (hESC) and differentiated cardiomyocyte cells were obtained from the dataset number GSE76523 (14). FastQC software was used to check the quality of the raw data reads. Adapter sequences and low quality sequences were removed using Trimmomatic software, version 0.36. Using HISAT2 software, version 2.1.0, the sequences were aligned with the genome, and using the annotation reference obtained from the UCSC database and HTSeq software, version 0.9.1, the reading count of each gene was obtained and using DESeq2 Package in the R program. Genes with differential expression between stem cell samples and differentiated cells were isolated. To evaluate the functional analysis of genes with differences in expression between the two groups, the KEGG and Enrichr databases were used to examine important pathways and biological processes in which genes with differential expression were involved. In the ClinVar and DisGeNET databases, it was determined which genes with differential expression would play a role in heart diseases. In addition, using the database of chromosomal location, important chromosomal positions of genes with differential expression between the two groups were analyzed.

Our results showed that between the two groups, 1463 and 1682 genes had increased and decreased expression, respectively. Functional analysis and examination of disease databases demonstrated genes with differential expression had essential roles in dilated cardiomyopathy (DCM), hypertrophic cardiomyopathy (HCM), arrhythmogenic right ventricular cardiomyopathy (ARVC), adrenergic signaling in myocardial cells, myocardial contraction, and myocardial infarction. Moreover, chr5p11, chr4q, chr11q21 and chr11p1 locations correspondingly were important chromosomal positions among genes with differential expression. Interestingly, it was found that genes involved in the differentiation of cardiomyocyte cells can also be involved in heart diseases as well. Among the genes with differential expression that were examined in different functional analyzes, genes including TTN, MYBPC3, TNNC1, TPM1, ACTC1, MYL2, TNNT2, MYH6, and MYH7 were important genes in both cardiac differentiation and heart diseases, especially different types of cardiomyopathies.

As the prevalence of cardiac disorders such as cardiomyopathies is increasing and due to the limitations of existing experimental models, suitable progress in treatment strategies for these disorders has not been encountered. One of the important factors in the development of cell-based models in heart disease is the existence of reliable methods for the production of heart cells from stem cells (17,18). In the present study, by investigating the signaling pathways and database, it was found that genes with differential expression in the differentiation of stem cells into heart cells can play a role in causing various heart diseases, especially dilated DCM and HCM. Better understanding of the underlying pathological mechanisms of these diseases will help prevent disease progression (24).In addition, we introduced genes which are involved in both cardiac cell differentiation and cardiomyopathy via bioinformatics analysis. Among them, TTN, MYBPC3, TNNC1, TPM1, ACTC1, MYL2, TNNT2, MYH6 and MYH7 genes were found to be involved in patients with dilated cardiomyopathy as well as hypertrophic cardiomyopathy. All of these genes were expressed in cardiac cells resulting from stem cell differentiation. Studies have shown that heterozygous mutations in the sarcomroponin T (TNNT2) protein, which were produced by induced stem cells, impaired calcium control and decreased contraction (27,28). Other stem cell models have examined the effect of LMNA encoding genes (LMNA A / C) and TTN on cardiomyopathy, and have found that TTN mutations are associated with heart disease, especially dilated cardiomyopathy (31). Other studies have shown sarcomere protein mutations, β-myosin heavy chain mutations, and MYH7 genes are associated with hypertrophic cardiomyopathy (32).In this disease stem cell models with mutations in MYH7 and MYBPC3, showed many of the features of the disease, such as cell enlargement, sarcomere disorder and contraction, as well as altered gene expression in calcium administration (33,34). Mutations in the TNNC1 gene also play a central role in the development of hypertrophic cardiomyopathy (38). A study of a large family with familial hypertrophic cardiomyopathy showed that a mutation in the TPM1 gene was associated with the clinical features of cardiac hypertrophy (39). Studies highlight an important role for MYL2 phosphorylation as an important contractile protein in the adult heart. These studies further show that the disappearance of mediated phosphorylation mechanisms in this gene causes dilated cardiomyopathy. Further studies have shown that in the model of hypertrophic cardiomyopathy using human cell-derived stem cells (hiPSC-CMs), the presence of cardiac actin E99K-ACTC1 mutation causes abnormal phenotypes in the produced hiPSC-CMs (40,41). In this study, important chromosomal positions including chr5p11, chr4q, chr11q21 and chr11p1 were introduced, which suggested that these positions may play a role in heart diseases, especially cardiomyopathies. Studies have not yet addressed the role of these chromosomal positions in heart diseases. Therefore, more detailed study and attention to tissue origin genes as well as studies of important chromosomal positions will be needed to achieve more specific biomarkers for the heart diseases and clarify the mechanisms of the heart diseases as well as cardiomyocyte differentiation.

Coronary heart disease (CHD), a major cause of death worldwide, is defined as a narrowing or blockage of the coronary arteries that supply oxygen and blood to the heart. We aimed to find potential biomarkers for coronary artery disease, by comparing the expression profile of blood exosomes of both normal and CHD samples.

Datasets of 6 CHD and 6 normal samples of blood exosomes were downloaded, and differentially expressed RNAs, with adjusted P<0.01 and log2FoldChange≥1 were achieved. Moreover, gene ontology (GO) and pathway analysis were accomplished by PANTHER database for datasets.

Our data analysis found 119 differentially expressed genes between two datasets. By comparing transcriptome profiles, we candidate the highest downregulated gene, ACSBG1, and the highest upregulated one, DEFA4, as specific biomarkers for CHD. Furthermore, GO and pathway analysis depicted that aforementioned differentially expressed genes are mostly involved in different molecular metabolic process, inflammation, immune system process and response to stimulus pathways which all cause cardiovascular diseases.

We have provided new potential biomarkers for CHD, though experimental validation is still needed to confirm the suitability of the candidate genes for early detection of CHD.

We intended to evaluate the effects of stent expansion in percutaneous coronary intervention (PCI) on saphenous vein graft (SVG) lesions and compare over-expansion and under-expansion between SVG stents in the case of major adverse cardiac events (MACE).

Totally, 196 SVG lesions were treated with drug-eluting stents. The ratio of the stent diameter to the diameter of the normal part of the SVG (which was without lesions and considered the reference part of the SVG) was measured by quantitative coronary angiography. Subsequently, the patients were divided into 3 groups: Group I (<0.90 expansion: undersized stents), Group II (0.90–1.0 expansion: normal-sized stents), and Group III (>1.0: oversized stents). MACE rates during PCI, hospitalization length, and follow-up findings were compared between the groups. Additionally, the effects of the embolic protection device (EPD) on MACE were assessed.

Oversized stenting was associated with increased cardiac enzymes (P=0.035) during hospitalization but was not associated with more MACE or restenosis on follow-up. Statistical analysis demonstrated nonsignificant more revascularization in the oversized group mainly due to unknown vessel revascularization and non-target vessel revascularization (P=0.167 and P=0.108, respectively). There were no differences in other MACE outcomes. The EPD was used in 25% of the patients. By comparison with the group without the EPD, there was no decrease in MACE components except a higher incidence of heart failure in the EPD group (P=0.03).

Aggressive stent expansion in SVG lesions resulted in higher myocardial injury; and unlike native arteries, there was no improvement in target vessel revascularization rates at follow-up. (Iranian Heart Journal 2022; 23(1): 85-94)

The size of the coronary stent has an important role in the efficacy of stenting and its complications. The present study focused on the clinical outcomes of undersized, normal-sized, and oversized stenting.

This historical cohort study, conducted from April 2016 to March 2017 at Rajaie Cardiovascular Medical and Research Center, analyzed the results of elective percutaneous coronary intervention (PCI) and angiography on patients who met the inclusion criteria. Based on the ratio between the stent and the reference vessel, the patients were divided into 3 groups: undersized stenting (stent diameter/reference vessel diameter <0.9), normal-sized stenting (ratio=0.9–1), and oversized stenting (ratio>1). Data on demographic characteristics, procedural characteristics, underlying diseases, the hospital length of stay, major adverse cardiac events (MACE), post- PCI restenosis, stent thrombosis, and post-PCI cerebrovascular accident were extracted from the patients’ files and entered into a checklist.

Oversized stenting significantly reduced the incidence of MACE 1 year after PCI compared with undersized and normal-sized stenting. The incidence of rehospitalization for acute coronary syndrome was 7.5 times lower in oversized stenting than in undersized stenting (P=0.002). The incidence of re-PCI on the involved vessel decreased significantly with an increase in the stent size (P=0.017). Additionally, there was no incidence of stent restenosis in oversized stenting (P=0.001). The other outcomes had no significant correlation with the stent size.

Based on the results of our study, oversized stenting could improve clinical outcomes. (Iranian Heart Journal 2021; 22(2): 44-50)

Most fatal presentation of coronary artery disease (CAD) has been related to acute coronary syndrome (ACS), and we as a referral center in the country decide to launch a registry of patients with ACS to monitor the way they are managed and the way they are treated.

Rajaie Cardiovascular, Medical and Research Center ACS registry (RHC-ACS registry) launched on December 2015 with enrolling all ACS patients referred or presented to the center. All patients’ demographic variables, presenting symptoms, known risk factors, past medical history, past CAD records, serial ischemic electrocardiogram (ECG) changes, presenting echocardiographic data (such as left ventricular ejection fraction [LVEF], valvular abnormality, and mechanical complication of myocardial infarction [MI]), laboratory assessment (biochemistry, complete blood count, cardiac markers, and inflammatory indicators), and their angiographic and angioplasty data were recorded.

Recordings showed in the RHC-ACS registry, most patients were men (73.2%), with mean age of 59.16 ± 11.64 years, hypertension were the most known cardiac risk factor. Most patients were non‑ST elevation MI patients (43.2%), 32.8% were in premature CAD group, and typical retrosternal chest pain were complained in 83.5% of our registry population. Most patients had no new ECG changes (51.7%) and from whom with new ECG changes, anterior territory ECG changes were the most common pattern (28.2%). LVEF was reported 30% or less in 171 (16.6%) of patients. Angiographic findings revealed femoral access was most common access (63.9%), most involved vessel was left anterior descending with 49.3% of the patients, percutaneous coronary intervention was performed in 48% of patients with drug-eluting stent implantation in 99.3% of these patients, dissection was the most angiographic-related complication in our registry (1%), and in-hospital death was reported in six patients (0.5%).

RHC-ACS registry as a real-world middle-east running ACS registry would help cardiologists justify their revascularization strategy in ACS patients and would have a promising impact in future multi-center studies.

Cardiovascular diseases, including coronary artery disease (CAD), are among the most common causes of death in the elderly population. Recent studies have found that coronary artery calcium score (CACS) is a strong independent predictor of CAD. Here we aimed to investigate the association between CACS and demographic, clinical, laboratory, and CT angiographic findings in patients with suspected CAD.

From June 2008 to August 2018, we retrospectively reviewed 219 consecutive patients suspected with CAD who were referred for CT angiography in Rajaie Cardiovascular, Medical, and Research Center. Medical records were reviewed, and relevant demographic, clinical, laboratory and imaging were collected.

A total of 219 patients with an average age of 62.64±12.39 were included. Twelve patients (5.5%) had normal coronary angiography, and 50.2% had mild CAD. An obstructive CAD was found in 97 patients (44.3%). The median CACS was 76.4 (IQR, 13.0-289.1). The frequency of obstructive CAD was 28.1% in the CACS <100 group, and 67.0% in CACS >100 group (P<0.001). On multiple logistic regression analysis, age (OR=1.04 [1.01-1.07], P=0.006), CACS (OR= 4.31 [2.33-7.98], P<0.001), and neutrophil to lymphocyte ratio (NLR) (OR = 0.82 [0.68-0.98], P=0.027) were independent predictors of obstructive CAD.

We found a direct association between higher CACS and obstructive patterns in coronary CT angiography. Our findings indicate that the possibility of the presence of obstructive CAD was higher among symptomatic patients with older age, lower NLR, and CACS >100.

Clinical registries are a targeted way of data collection aimed at finding a solution to a specific clinical inquiry. The present report introduces the Rajaie Cardiovascular, Medical and Research Center percutaneous coronary intervention (RHC-PCI) Registry. The primary objectives of the RHC-PCI Registry consist of monitoring different complex PCI procedures and their mutual impact on interventional cardiology programs.

RHC is a large and well-known cardiovascular tertiary center in Iran. The RHC-PCI Registry was first launched in 2015, since which time it has collected >5000 parameters regarding the baseline, clinical, and procedural characteristics of various PCI procedures. Noncomplex coronary interventions, bifurcation stenting, left main interventions, chronic total occlusion (CTO) PCI, and bypass graft interventions comprise the major categories gathered by the RHC-PCI Registry. The main registry outcomes are comprised in-hospital mortality, major adverse cardiovascular events, vascular access site complications, and 6-month all-cause mortality.

In this primary report, we elaborate on the principal infrastructure of the RHC-PCI Registry and present a synopsis of the registry scope. During the first 40 months of the registry, 11,005 patients underwent PCI. The acute coronary syndrome was reported in 5043 (45.8%) patients. Bifurcation stenting, left main interventions, CTO PCI, and bypass graft interventions were performed in 1679 (15.2%), 236 (2.1%), 946 (8.5%), and 764 (6.9%) patients, respectively. The preferred access site was the femoral artery (n = 6614, 60%), and drug-eluting stents were deployed in 9230 (83.8%) patients. In-hospital mortality in the total registry data was reported in 104 (0.9%) patients.

This report introduces the RHC-PCI Registry, its primary objectives, infrastructure, and preliminary results (the 3-year outcome).

The risk of contrast-induced nephropathy (CIN) as a common and important complication of coronary procedures may be influenced by the vascular access site. We compared the risks of CIN in diagnostic or interventional coronary management between patients treated via the transradial access (TRA) and those treated via the transfemoral access (TFA).

Patients undergoing invasive coronary catheterization or percutaneous coronary intervention (PCI) were enrolled. We excluded patients with congenital or structural heart disease and those with end-stage renal disease on dialysis. Based on the vascular access site used for invasive coronary catheterization, the patients were divided into 2 study groups: the TFA and the TRA. CIN was defined as an absolute (≥0.5 mg/dL) or relative (>25%) increase in the baseline serum creatinine level within 48 hours following cardiac catheterization or PCI.

Overall, 410 patients (mean age=61.3±10.8 years) underwent diagnostic or interventional coronary management: 258 were treated via the TFA approach and 152 via the TRA approach. The patients treated via the TFA had a significantly higher incidence of postprocedural CIN (15.1% vs 6.6%; P=0.01). The multivariate analysis showed that the TFA was the independent predictor of CIN (OR: 2.37, 95% CI: 1.11 to 5.10, and P=0.027). Moreover, the BARC (Bleeding Academic Research Consortium) and Mehran scores were the other independent predictors of CIN in our study.

The risk of CIN was lower with the TRA, and the TFA was the independent predictor of CIN after the diagnostic or interventional coronary management.

Although chest pain and normal coronary arteries (known as cardiac syndrome X [CSX]) remained a prevalent clinical condition, underlying pathogenesis has not been fully explained. Microvascular dysfunction has been considered as the most likely cause of CSX. In this research, we attempted to evaluate the coronary sinus filling time (CSFT) at angiographic films, and also introducing it as a new indicator for microvascular function. Patients and

Patients with typical angina or abnormal chest pain with stress-induced ischemia in prior stress tests formed angina group and control group consisted of patients with severe mitral stenosis underwent coronary artery angiography before the balloon mitral valvuloplasty. CSFT was explained as the time necessary for the contrast with pass through myocardial capillaries and reach to the coronary sinus origin at coronary angiography. Furthermore, thrombolysis in myocardial infarction (TIMI), frame count, and myocardial blush score were evaluated for each group. At the end, we compared these parameters and reported the results.

The angina group consisted of 128 patients and there were 71 patients in the control group. The mean of the CSFT in angina group was 47.2 ± 9.9 (in frame count), which was greater than the mean of the control group (mean: 32.2 ± 3, P = 0.0001). Corrected TIMI frame count was 21.1 ± 3.4 in angina group and 20.1 ± 3.1 in the control group, and the differences were not statistically significant (P = 0.75). Myocardial blush score in the angina and the control group had not indicate any meaningful difference (P = 0.52).

CSFT in contrast with TIMI frame count and myocardial blush score, was significantly prolonged in patients with angina and normal coronary arteries.

Inflammatory mechanisms can cause left ventricular (LV) remodeling. These mechanisms include increased matrix metalloproteinases and the tissue inhibitors of metalloproteinases. Doxycycline is an antibiotic (macrolide) and a broad inhibitor of matrix metalloproteinases. This study evaluated the effects of early short-term doxycycline treatment on LV remodeling in patients suffering ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).

In the present double-blinded randomized control trial, 68 post-MI patients who underwent primary PCI for STEMI were assigned to 2 groups, each consisting of 34 volunteers. Over a 7- day period, all these volunteers took 100 mg of Doxycycline twice a day. A placebo with the same order was prescribed for the control group. The cardiac function, the LV diameter, the left atrial diameter, and the LV torsion were measured at baseline and 40 days afterward.

The mean age of the control and experimental groups was 53.7 years and 56.1 years, respectively. The averages of the left atrial volume (P = 0.03), the LV end-diastolic volume (P = 0.03), and the LV end-systolic volume (P = 0.01) in the experimental group rose less significantly than those in the control group. However, the LV torsion such as basal rotation (P = 0.03), apical rotation (P = 0.02), twist (P = 0.02), and torsion (P = 0.002) increased more substantially in the experimental group than in the control group.

Early administration of doxycycline attenuated LV remodeling measured by speckle- tracking echocardiography in our patients with anterior STEMI after primary PCI, vs. our control group subjects, who were on a placebo diet. 

Slow coronary flow (SCF) is a condition defined as the delayed passage of the contrast agent in the absence of angiographic coronary artery stenosis. Left ventricular (LV) systolic and diastolic dysfunction has been reported in patients with SCF, which can influence their functional capacity. This study compared myocardial deformation between cases with normal coronary arteries and patients with SCF. This cross-sectional comparative study included 32 patients with SCF and 32 controls with normal epicardial coronary arteries (NECA). After coronary angiography, echocardiography was done for all the participants and the results were compared between the groups. A total of 64 patients were studied. The mean global longitudinal peak systolic strain (GLPS.Avg) was 16.85. SCF was significantly more frequent in the men than in the women (P < 0.05). Diabetes mellitus, systemic hypertension, a history of past or current smoking, and a family history of coronary artery disease (CAD) in the patients with SCF and dyslipidemia in the NECA group were more frequent, although these differences were not statistically significant. GLPS.Avg and global longitudinal peak systolic stress in the apical 4-chamber view (GLPS.A4C) in the patients with SCF were significantly lower than those in the NECA group. Global strain in the apical 2- and 3-chamber views (GLPS.A2C and GLPS.LAX), septal E, septal A, lateral E, lateral A, and right ventricular Sm (peak myocardial systolic velocity) were also nonsignificantly lower in the patients with SCF. Strain imaging using 2D echocardiography was abnormal in our patients with SCF, in comparison with the NECA group. These abnormalities may represent subtle systolic and/or diastolic dysfunction in patients suffering from SCF.

Percutaneous coronary intervention (PCI) with the addition of potent antithrombotic medications is the best therapy recommended for ST-elevation myocardial infarction (STEMI). The prehospital administration of heparin is commonly prescribed in the absence of conclusive data supporting its administration time. We aimed to study the side effects of heparin administration, especially hematoma formation at the arterial access site, between patients who received it before and after femoral arterial access in PCI. This prospectively randomized clinical trial studied 128 patients who were diagnosed with STEMI and candidated for primary PCI at Rajaie Cardiovascular, Medical, and Research Center. Ninety-six patients who fulfilled the inclusion criteria were enrolled and randomly allocated to 2 groups according to a random table. The first group received heparin before the establishment of the femoral arterial access in the catheterization laboratory or in the ambulance (as soon as possible), while the second group received intravenous heparin after arterial access ion for primary PCI. The systemic side effects of heparin and its angiographic appearances were compared between the 2 groups. The administration of unfractionated heparin before femoral arterial access in primary PCI had no more hematoma formation than did heparin injection after femoral arterial access (P=0.03). The study was unable to make any judgments regarding the angiographic thrombus burden before primary PCI according to the time of heparin injection because of the low volume of the patients; nonetheless, there was no significant difference between the 2 groups concerning thrombus burden. Heparin therapy before femoral arterial access in primary PCI had no deleterious effect on hematoma formation.

Preinfarction angina has been recognized as a surrogate for preconditioning episodes. This study was designed to evaluate the cardiovascular effects of preinfarction anginal episodes among acute myocardial infarction (AMI) patients undergoing primary percutaneous coronary intervention (PCI). Of 520 patients who had undergone primary PCI, 393 patients were finally included in a prospective cohort study. Standard primary PCI procedure according to the latest guidelines was performed. The patients were divided into three groups based on previous symptoms as follows: asymptomatic (Group A), chronic stable angina (Group B) and unstable angina (Group C). A total of 393 patients were evaluated. 185 (47.1%) patients were described as asymptomatic, 48 (12.2%) had stable angina and 160 (40.7%) were categorized as unstable angina. There was no significant difference among the study groups regarding pre- and post-PCI thrombolysis in myocardial infarction flow grade (P = 0.81). Median of peak post-PCI creatine-kinase-muscle/brain level of Group A (asymptomatic) was 250.5 (115.5–389), and it was significantly higher than Group C (176 [60.00–313.50]) (P = 0.03). Q wave formation was observed in 142 (88.75%), 31 (64.5%), and 96 (52.0%) patients of Group A, B, and C patients, respectively, which was significantly higher in asymptomatic patients (P = 0.002). There was no significant difference among the three groups regarding in-hospital and 6-month mortality (P = 0.36, 0.06, respectively). The composite endpoint of 6-month mortality, acute coronary events, cerebrovascular accidents, and target vessel revascularization was not significantly different between the three groups (P = 0.11). Preinfarction angina among AMI patients undergoing primary PCI seems to have a limited beneficial effect on infarct size, and this benefit was not translated to any clinical benefit.

There is some controversy over the efficacy of statins for the prevention of contrastinduced nephropathy (CIN). There have also been reports on varying efficacies of different statins. Hence, in this study the efficacy of atorvastatin and rosuvastatin for the prevention of CIN was assessed. This single-blind randomized clinical trial was performed on 495 random patients with myocardial infarction with ST-segment elevation undergoing primary percutaneous coronary intervention (PCI) in a training referral hospital in 2015. Patients were randomly assigned to receive either atorvastatin 80 mg at admission and daily or rosuvastatin 40 mg at admission and daily. CIN was defined based on serum creatinine elevation after 48 hours from the PCI. The incidence of CIN was observed in 63 patients (21.4%) After 48 hours from primary PCI. Of those, 17% (n = 50) were grade 1 CIN, while 4.4% (n = 13) were grade 2 CIN. There was no significant difference between rosuvastatin group compared with atorvastatin group, regarding the CIN grading (P = 0.14). Our results indicate that atorvastatin and rosuvastatin have similar efficacy for the prevention of CIN.

The purpose of our study was to prove the hypothesis that balloon pulmonary valvuloplasty could effectively reduce valvular gradient ranged 30 to 50 mmHg to less than 30 mmHg in long-term follow-up.
This cross-sectional study was performed on 271 consecutive patients aged 12 to 67 years who suffered from severe pulmonary stenosis who were scheduled for balloon pulmonary valvuloplasty at Shahid Rajaie Heart Center in Tehran between 2003 and 2013. Two years after the procedure, the patients were examined by transthoracic echocardiography and parameters related to pulmonary valve and right ventricular condition were reassessed. Among all 271 patients who were initially included into the survey, 37 patients (13.7%) had pulmonary valve gradient 30 to 50 mmHg that included our final targeted population for assessment.
Valvular gradient significantly dropped down from 93.19 ± 39.77 mmHg to 38.78 ± 26.26 (P Majority of patients with moderate pulmonic stenosis with gradient of 30 to 50 mmHg benefit from this procedure to achieve gradient less than 30 mmHg in long-term follow-up.

Radial artery occlusion (RAO) is one of the few postprocedural complications of transradial approach (TRA) which may be symptomatic in some cases. The aim of this study was to investigate the safety and efficacy of enoxaparin compared with unfractionated heparin (UFH) for preventing RAO among patients who underwent elective diagnostic coronary artery angiography (CAG) via TRA.
Patients and This randomized clinical trial study was conducted on patients who underwent TRA for elective diagnostic CAG. Then, the patients included were randomly divided into 2 groups. A group received 0.75 mg enoxaparin intravenously and the second group received 70–100 IU/Kg UFH single-bolus dose intravenously. During 24 h after the procedure and 3 months later, all the participants were monitored for the occurrence of RAO, access hematoma, periprocedural myocardial infarction, stroke, and death.
From 189 patients with mean age of 52.52 ± 6.23 years old, 95 patients received UFH (70–100 IU/kg), and the other group (n = 94) received enoxaparin after radial sheath insertion. After 24 h, decrease in radial pulse was observed in 17.6% patient (14.9% in UFH group and 20.2% in enoxaparin group) and only one patient had absent radial pulse in UFH group. There were no significant differences between UFH group compared with enoxaparin group in the reduction of the radial pulse that examined with reverse Allen test (P = 0.359). Furthermore, other complications did not differ significantly between the two groups.
This study demonstrates that intravenous enoxaparin administration compared with intravenous UFH during diagnostic CAG via TRA is a safe and effective strategy for preventing RAO at 24 h after the procedure.

Facilitating radial artery cannulation is important among patients undergoing cardiac catheterization. The aim of this study was to evaluate the efficacy of periarterial injections of nitroglycerin by inexperienced operators in facilitating radial artery cannulation.
This randomized clinical trial study was conducted on patients who underwent transradial cardiac catheterization for coronary artery disease evaluation. The patients were randomly divided into 2 groups: Group I was the control and Group II received an additional 500 μG of nitroglycerin subcutaneously. The procedure was done by cardiologists trained for the fellowship of interventional cardiology (inexperienced operators). All the participants were monitored for the occurrence of radial artery spasm, number of punctures before successful cannulation, and the radial artery access time.
After the exclusion of 16 patients, 144 patients (118 men and 26 women) at an average age of 55.7 ± 10.2 years were randomly divided into 2 groups: Group I (control, n = 73) and Group II (n = 71). The number of punctures before cannulation was markedly lower in Group II than in the control group (1.9 ± 0.64 vs 2.2 ± 1.04; P = 0.045). The radial artery access time was shorter and radial artery spasm was less prevalent in Group II, but these parameters were not statistically significantly different between the 2 groups.
Periarterial injections of nitroglycerin (500 μG subcutaneously) by inexperienced operators significantly reduced the number of punctures during transradial cardiac catheterization. (Iranian Heart Journal 2017; 18(4):6-11)

Large numbers of patients are faced with mechanical complications after myocardial infarction (MI). Such complications occur when the patient does not receive immediate treatment, leading to adverse consequences and even death. The present study was conducted to determine the short- and long-term prognoses of this group of mechanical complications.
The present case-series study recruited all patients (N = 88) who had a diagnosis of cardiac mechanical complications following acute MI at Rajaie Cardiovascular, Medical, and Research Center between 2005 and 2011. The short-term prognosis of the study population was recorded before discharge (hospital mortality rate), and the patients were followed up 6 months later through phone calls. The results and 6 months’ prognosis—including mortality, survival rate, and hospitalization—were recorded again.
The mean age of the study population was 70.50 ± 10.23 years (31–95 y) and 46.6% were male. The most common complications were apical ventricular septal rupture (VSR) (67.1%), ventricular free-wall rupture (14.8%), basal VSR (7.9%), pseudoaneurysm (4.5%), VSR with pseudoaneurysm (3.4%), and papillary muscle rupture (2.3%)–respectively. The rate of death caused by mechanical complications was 4.61%. The rate of re-hospitalization was 6.8%. In this study, 36.3% of the patients died after reconstructive surgery and 34.1% of them died after medical treatment in the hospital. The 6-month survival rate of the patients was 34.1%.
The mechanical complications of the heart occur mainly in women and older patients. In this regard, apical VSR and ventricular free-wall rupture are the most common complications. However, in the case of timely medical interventions such as reconstructive surgery, the survival rate improves significantly. (Iranian Heart Journal 2017; 18(4):21-28)

An elevation in the levels of troponin I and T is more frequent than a rise in CK-MB levels after percutaneous coronary intervention (PCI). Nevertheless, the prognostic value of elevated troponin I and T levels has yet to be compared with that of elevated CK-MB levels. Given the more specific role of troponin in cardiac incidents, we sought both to investigate the factors and elevated levels of cardiac troponin in patients having undergone PCI and to examine the predictive value of elevated cardiac troponin levels in comparison with that of elevated levels of CK-MB.
This case-series study was conducted in Rajaie Cardiovascular, Medical, and Research Center in 2011. The inclusion criteria comprised patients with coronary artery disease and stable hemodynamic who were ively candidated for nonemergency coronary angiography in the hospital. Five hundred patients were included via convenient sampling within a year. Troponin and CK-MB levels were checked after PCI. In data analysis, the t- test, χ2 test, and Fisher exact test were used. The results were analyzed using SPSS, version 17.
The troponin level was elevated in 26.8% of the patients following PCI. The troponin assay was negative and positive in 73.2% and 26.8% of the patients, respectively. The mean age of the patients was 56.6 ± 9.9 years (71.8% male and 28.2% female). Totally, 68.2% of the patients’ lesions were non-C patent type. There was a significant relationship between increased levels of troponin I and re-PCI (1 year after PCI) and also between gender and troponin elevation. Serum troponin was higher in the male patients after PCI.
A significant relationship was observed between elevated troponin I levels and redo- PCI a year after PCI. Increased levels of troponin I following PCI were not correlated with major cardiac events. (Iranian Heart Journal 2017; 18(3):13-20)

Atrial fibrillation (AF) is one of the most common complications occurring after cardiac surgeries. The incidence of post-operative AF is increasing continuously over the past decades and it is associated with lengthened hospital stay and risk of stroke.
This study was designed to examine the relationship between coronary artery involvement and the occurrence of AF after coronary artery bypass graft (CABG).
This prospective observational study was to assess the relationship between the coronary artery involvement and the occurrence of post CABG surgery AF. Patients with chronic and paroxysmal AF before surgery were excluded. All patients had a complete evaluation by echocardiography, electrocardiography, and laboratory testing. The patients were monitored for 3 days after surgery and any tachycardia monitored as AF was noted. Patients were also divided into two groups of having post-operative AF and not having AF. Coronary artery involvement was defined using the Rentrop system. The coronary arteries were divided into 14 segments for better understanding of the lesions.
In this study 232 patients were selected, from which 106 patients had AF and 126 patients had sinus rhythm. The results of the present study confirmed that the older patients had a more frequent occurrence of AF after CABG (P Although age has been the most important predictor for occurrence of AF after CABG in the past and present studies, there are many other variables affecting its occurrence. Out of the variables evaluated in this study, higher PAP, proximal LAD lesion, higher levels of BNP, and D dimer as well as single vessel and two vessel coronary artery diseases were noted to significantly predict a higher occurrence of AF after CABG.

Diabetes is the cause of 25% of all the cases of coronary artery disease and myocardial infarction (MI). One of the best interventions for coronary artery occlusion treatment is percutaneous coronary intervention (PCI). In PCI, myocardial area size, lesion morphology, cardiac function, renal failure, and other comorbidities are very important. Evaluation of the periprocedural MI prevalence is significant for comparing diabetic and nondiabetic patients.
This cross-sectional study was done in Rajaie Cardiovascular, Medical, and Research Center by convenience sampling in 2009. PCI was performed on 605 patients, comprising 171 diabetic and 434 nondiabetic patients. Our information form included the type of contrast, arterial access, diabetic type, blood glucose control, lab tests, and number of coronary artery lesions. The incidence of postprocedural MI was evaluated by the measurement of CK-MB. The data were then entered into SPSS before they were described and analyzed. The χ2 test and the t-test were employed for data evaluation.
The incidence of post procedural MI was 2.9% in the diabetics and 2.5% in the nondiabetics. Moreover, 71.7 % of the patients were diabetic and 28.3% were nondiabetic. The blood glucose level was controlled in 12.6% of the study population, while it was not controlled in 87.4%. The P value for the comparison of periprocedural MI between the diabetic and nondiabetic patients was 0.788. All of the 5 diabetic patients with periprocedural MI belonged to the uncontrolled blood glucose group. The highest frequency of MI was in the patients with 3-vessel PCI (P=0.027).
No significant statistical difference was observed regarding postprocedural MI between the diabetic and nondiabetic patients. Preprocedural MI was more frequent in the patients with 3-vessel PCI. PCI is a safe procedure with a low incidence rate of postprocedural MI.

An increase in the plasma levels of catecholamines and other neurohormones after acute myocardial infarction (AMI) leads to coronary vasoconstriction and may cause the undersizing of stents during primary percutaneous coronary intervention (PCI) in ST- segment elevation myocardial infarction (STEMI). We aimed to compare the reference vessel diameter of the infarct-related artery during and after primary PCI in patients with AMI.
This prospective interventional study was performed on 43 consecutive patients with STEMI (TIMI flow grade III), who were candidated for primary PCI. The main proximal diameter of the coronary artery (reference vessel diameter) was assessed at baseline and also 3 days to 3 months after 2nd angiography. The study end point was to compare the reference vessel diameter within and after primary PCI.
Comparison between the mean diameter of the involved coronaries after PCI and the mean diameter during the procedure showed a significant increase in the real size of the right coronary artery (RCA) and a slight decrease in the size of the left circumflex artery (LCx). However, the mean sizes of the left anterior descending coronary artery remained insignificant. The decrease in the LCx diameter and inversely the increase in the RCA diameter remained significant in the study population even after adjusting cardiovascular risk factors as potential confounders.
The changes in the diameter of the reference coronary arteries, namely an increase in the RCA diameter and a decrease in the LCx diameter, are expected following primary PCI in patients with STEMI. (Iranian Heart Journal 2017; 18(1):25-29)

Pulmonary hypertension (PH) is a common consequence of mitral stenosis (MS). After treatment, PH reverses depending on the chronicity and severity of MS. The characteristic changes in the pulmonary artery (PA) secondary to an elevated pulmonary artery pressure (PAP) can be evaluated via cardiovascular magnetic resonance imaging (CMR). In this study, we aimed to evaluate if there was any correlation between PAP and hemodynamic findings measured by CMR and whether these findings could be useful in predicting the PAP response after MS relief.
Thirty-three patients with a diagnosis of severe MS, who were candidated for percutaneously transvenous mitral commissurotomy (PTMC) or mitral valve replacement (MVR), were included. CMR was performed in all of them before the procedure and PA distensibility, PA peak velocity, PA forward volume, and PA forward flow were measured. Transthoracic echocardiography was performed at baseline, immediately after the procedure, and 3 months after MS relief for the assessment systolic PAP.
Thirty-three patients with a diagnosis of MS PH (15 PTMC and 18 MVR) were enrolled in this study. The mean PAP at baseline catheterization ranged 25 to 70 mm Hg. There was a significant drop in systolic PAP immediately after the procedure and 3 months after MS relief. There was no relationship between the PA distensibility index and systolic PAP changes after MS relief. PA peak velocity was significantly higher in the patients with > 50% drops in their systolic PAP 3 months after the treatment. The multivariable analysis showed that none of the CMR findings was an independent predictor of a more systolic PAP decline.
Although we found no significant relationship between CMR findings and systolic PAP changes after MS treatment, the result of this study can be used for further investigations in this regard. (Iranian Heart Journal 2017; 18(1):30-36)

Atrial fibrillation (AF) is one of the most common complications after cardiac surgeries. The incidence of postoperative AF has risen continuously over the past decades. AF is associated with lengthened hospital stays and risk of stroke. We sought to study the relationship between the pulmonary artery pressure (PAP) and the occurrence of AF after coronary artery bypass graft surgery (CABG).
This prospective observational study was designed to assess the relationship between the PAP and the occurrence of post-CABG AF. Patients with chronic and paroxysmal AF before surgery were excluded. All the patients had complete evaluation via echocardiography, ECG, and laboratory testing. The patients were monitored for 3 days after surgery, and any tachycardia monitored as AF was noted. The study population was divided into 2 groups: with postoperative AF and without AF.
We ed 232 patients, 106 with AF and 126 with sinus rhythm. The results confirmed that the occurrence rate of AF after CABG was higher in the older patients (P ≤ 0.001). Both univariate and multivariate analyses showed a significant relationship between a higher occurrence rate of post-CABG AF and a higher PAP (mean value = 26.5 vs 20 mm Hg) in the patients (P ≤0.001 and P = 0.01, respectively).
Although age has been the most important predictor for the occurrence of AF after CABG in the past and present studies, there are many other variables affecting its occurrence. Among the variables evaluated in this study, a higher PAP was a significant predictor for a higher occurrence rate of AF following CABG. (Iranian Heart Journal 2017; 17(4): 17-20)

The preferred treatment for isolated pulmonary valve stenosis is percutaneous balloon pulmonary valvuloplasty. The aim of our study was to evaluate the efficacy and short-term results of this procedure in pediatric and adult patients with pulmonary valve stenosis.
In this retrospective case series, we reviewed the hospital records of pediatric and adult patients with a diagnosis of pulmonary valve stenosis subjected to balloon pulmonary valvuloplasty over a period of 10 years. Data regarding the immediate postprocedural findings as well as echocardiographic transvalvular pressure gradients after 6 months were recorded and analyzed.
Between 2003 and 2013, a total of 248 patients underwent balloon pulmonary valvuloplasty in our institution. Seventy-nine (31.8%) patients were In our case series, we demonstrated that balloon pulmonary valvuloplasty was an effective and safe method for the treatment of pulmonary valve stenosis in both pediatric and adult populations. However, there was a tendency toward a higher postprocedural pressure gradient in the older patients, which made the obstruction more difficult to regress.