Arya Atherosclerosis
Volume:17 Issue: 1, Oct 2021

Perilipin protein located in lipid droplets is involved in formation and storage of lipid in adipocytes; thus, it is considered as one of the obesity biomarkers. This study was performed to examine the effect of educational and encouragement interventions and lifestyle modifications on anthropometric characteristics and perilipin-1 level.

This quasi-experimental study was conducted on subsample of TABASSOM Study. Participants were 42 overweight and obese children and adolescents aged 6-18 years old and 80 overweight and obese adults aged 19-65 years old. Anthropometric characteristics including weight, height, waist circumference (WC), body fat percentage (BFP), and perilipin-1 level were measured at the first and the end of study (after one year).

After intervention, the mean of perilipin-1 decreased significantly in total children and adolescents (before vs. after: 26.79 ± 13.17 vs. 22.57 ± 8.03; P = 0.006) and girls (27.75 ± 10.51 vs. 22.00 ± 8.15; P = 0.001), but decreasing was not significant in boys. In adults, perilipin-1 levels were significantly reduced in total subjects (before vs. after: 16.19 ± 13.42 vs. 15.34 ± 11.25; P = 0.029) and men (18.02 ± 15.78 vs. 15.44 ± 10.61; P = 0.003). There was no significant difference in mean of body mass index (BMI), WC, and BFP in both groups after 12 months.

Educational and encouraging interventions and lifestyle modifications could lead to decreasing perilipin-1 level in adults, children, and adolescents.

The aim of this study was to predict significant coronary artery disease (CAD) in patients undergoing coronary angiography.

In this cross-sectional study, data of 384 patients who underwent angiography during 2015-2017 were reviewed. Electrocardiograms (ECGs) were evaluated in terms of having positive T wave in lead V1 (TV1) described as T wave with amplitude of more than 0.15 mV and angiography records were assessed for presence of significant CAD defined as presence of ≥ 70% internal diameter stenosis in at least one major epicardial coronary artery or more than 50% stenosis in left main artery (LMA).

Out of 384 patients who participated in this study with mean age of 63.6 ± 10.2 years (40-89 years), 71.6% showed positive TV1 and significant CAD simultaneously and left anterior descending artery (LAD) and left circumflex artery (LCX) lesions were more frequently reported in coronary angiography. Based on chi-square test, the prevalence of significant CAD was obviously more in those with positive TV1 as compared to those without this finding [odds ratio (OR) = 2.74, 95% confidence interval (CI): 1.80-4.19, P < 0.001]. Mann-Whitney test showed significant difference in number of coronary arteries involved in CAD between presence of positive and negative T wave in lead V1 (P < 0.001). Great number of patients with significant CAD had remarkably higher T wave amplitude in lead V1 in comparison to lead V6 (OR = 6.22, 95% CI: 3.14-12.30, P < 0.001).

Positive TV1 and TV1 > TV6 pattern can be considered as a predictor for significant CAD in patients with otherwise normal ECG.

Coronary artery disease (CAD) is a major problem in Iran as well as throughout the globe, and coronary artery bypass grafting (CABG) surgery is an appropriate option for many patients with symptomatic and severe CAD. The main purpose of this study was assessment of the short and long-term outcomes of patients undergoing CABG in Yazd Province, Iran.

This historical cohort study examined the mortality rates of patients who had undergone CABG in Afshar Hospital in Yazd from 2011 to 2013. During this period, 2510 patients undergoing CABG were entered into the study and then followed for in-hospital and long-term mortality.

Mean age of the patients was 61.37 ± 10.50 years and 34.1% were women. In-hospital mortality turned out to be 3.7% and age over 70, left ventricular (LV) dysfunction, female gender, and left main (LM) involvement induced significant higher in-hospital mortality. Of all the patients, 84.1% were followed for a period of 41 ± 20 months. The survival rate proved to be 92.4% in one year and 82.9% in five years. The patients with age over 70, diabetes mellitus (DM), and LV systolic dysfunction (LVSD) showed significant lower survival rate, whereas the patients with utilization of left internal mammary artery (LIMA) demonstrated significant higher survival rate.

In-hospital and long-term mortality rate of patients undergoing CABG surgery is acceptable in comparison with other studies and more effort is needed into making this event a success.

The prevalence of hypertension (HTN) varies across countries due to differences in its related risk factors. This study aimed to investigate the prevalence of HTN and related risk factors among adults.

This study was conducted on the data from the recruitment phase of Yazd Health Study. Using multi-stage random cluster sampling, 10000 adults of 20-69 years were selected. Self-reported HTN (diagnosed by a physician) was recorded in a home visit. Blood pressure (BP) was measured using a standard protocol and categorized based on the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and ‎Treatment of High Blood Pressure ‎(JNC-7) classification. T-test was used to examine the gender differences. Qualitative variables were presented as number (frequency). Chi-square test and bivariate logistic regression were carried out to determine the association between risk factors.

The response rate was 95% (n = 9975). The prevalence of positive history of HTN was 18.5%. The mean systolic and diastolic BP was 126.5 ± 18.4 and 80.2 ± 12.5 mmHg, respectively. The prevalence of HTN was 36.0% (95%CI: 35.1–36.9). Its prevalence reduced by high-education, physical activity, lower BMI, and lack of history of diabetes mellitus ‎(DM) (P < 0.0001). HTN is less common in smokers (P < 0.0001). Logistic regression analysis showed that HTN was higher among men (OR: 1.83; 95%CI: 1.64-2.03), the elderly (OR: 5.15; 95%CI: 4.20-6.31), low-educated (OR: 1.40; 95%CI: 1.17-1.67), and diabetics (OR: 1.20; 95%CI: 1.05-1.38). The prevalence of HTN was 2 times higher in obeses. HTN did not have a significant relationship with inactivity, smoking, and hypercholesterolemia.

The prevalence of HTN was high. By identifying modifiable risk factors, health policymakers can prioritize intervention programs. It is necessary to inform younger adult groups how these factors can be managed through a healthy lifestyle and nutritional habits.

Numerous studies have investigated the effect of lavender and damask rose aromatherapy on sleep quality. There is, however, little research to compare the impact of them over each other. The aim of current study was to compare the effect of aromatherapy with lavender and damask rose on sleep quality in patients after coronary artery bypass graft (CABG) surgery in Guilan Province, Iran, in 2017-2018.

In this randomized clinical trial (RCT) study, 97 patients undergoing CABG were randomly assigned to intervention or control groups. In the intervention groups, the patients were asked by the researcher to inhale the lavender or damask rose randomly every night for 5 consecutive nights at 22:00. The control group received routine nursing care in compliance with the hospital procedure. Data were obtained by demographic-clinical and Beck Depression Inventory (BDI) questionnaires. To analyze the data, chi-square test, t-test, Kruskal-Wallis test, and Wilcoxon test were used.

During the 5-night intervention period, despite a relative improvement of sleep quality in intervention groups compared to the control group, none of the two aromatherapies had a statistically significant effect on any of delayed sleep (P = 0.514), sleep duration (P = 0.839), sleep efficiency (P = 0.067), sleep disturbances (P = 0.061), and daily functional disorders (P = 0.114) except for subjective sleep quality (P = 0.016) and use of sleep medications (P = 0.031).

Using both aromatherapies with lavender and damask rose indicated positive effects on sleep quality of the CABG patients, but we could not find a superiority over each other.

Patients affected by myocardial infarction (MI) report prodromal symptoms before heart attack. Deep understanding of these symptoms can increase the likelihood of early recognition and treatment of coronary heart disease (CHD). The purpose of this study was to describe the prodromal symptoms of MI experienced by Iranian adults.

In this qualitative conventional content analysis, data was collected through an in-depth semi-structured interview with 14 men and women (aged 40–82 years). The patients were interviewed at the hospital 2 or 3 days after hospitalization due to MI. MAXQDA software was used for data analysis.

Data analysis led to the emergence of the 4 categories of ‘Misperception of the symptoms’, ‘Reactions to the symptoms’, ‘Heart disease knowledge deficit’, and ‘Ideas and beliefs about heart disease’. The participants had not recognized the prodromal symptoms of MI and they attributed their symptoms to non-cardiac causes. They did not consider themselves at risk of heart disease, so they did not seek health services.

The participants were unaware of their prodromal symptoms. Clinicians should be attentive that men and women at risk of MI may experience a range of unfamiliar and vague prodromal symptoms, so they must give greater attention to their narratives. A greater understanding of the prodromal symptoms experienced may lead to a more truthful and timely interpretation of their symptoms and earlier detection by physicians.

The relationship between cardiac enzyme release following coronary endarterectomy (CE) and morbidity and mortality is unclear. Therefore, the present study aimed to investigate the association of cardiac enzymes with morbidity and mortality of patients undergoing CE surgery.

This was a single-center retrospective cohort study of 475 patients who had undergone off-pump coronary artery bypass graft (OPCABG). The patients were followed up for a mean of 72.99 ± 14.60 months.

Among 475 patients undergoing OPCABG, 39 (8.2%) were non-survivors. Non-survivors were younger and had a fewer ejection fraction (EF). Comorbidities were similar in survivors and non-survivors. The crude Cox regression analysis showed that creatine kinase-myocardial band (CK-MB) had a protective effect against mortality, but when adjusted with age, sex, diabetes mellitus (DM), hypertension (HTN), hyperlipidemia, smoking, family history, body mass index (BMI), left main disease (LMD), and EF, this effect disappeared. Troponin in crude and adjusted analysis did not have any significant effect.

There is no association between CK-MB and troponin and mortality in patients undergoing coronary artery bypass graft (CABG).

Mitral valve prolapse (MVP) is the most common cause of isolated mitral regurgitation (MR) requiring surgical repair. Therapeutic interventions should be considered before irreversible left ventricular (LV) dysfunction in asymptomatic patients. Measurement of LV volume and function is very important. Because of two-dimensional (2D) echocardiography limitations, three-dimensional (3D) measurement is preferred on the strength of its speed, accuracy, and reproducibility, which are comparable with those of magnetic resonance imaging (MRI).

This study was conducted between April 2018 and February 2019 on 50 patients with different MVP types and severe MR scheduled for valve surgery at Rajaie Cardiovascular Research Center, Tehran, Iran, with the aid of the HeartModelAnatomical intelligence (A.I.) (EPIQ 7: new 3D software) for measurement of LV volume indices and function.

Patients with the Barlow syndrome had a greater drop in LV ejection fraction (LVEF) than those with fibroelastic deficiency (FED) (57.05% ± 6.00% vs. 65.00% ± 4.08%; P = 0.001). LV volume was larger in patients with flail mitral valve (MV) than in those with non-flail MV (165 cc vs. 118 cc; P = 0.001). LVEF declined more in patients with the involvement of both leaflets than in those with the involvement of the anterior leaflet alone (56.00% ± 7.10% vs. 57.70% ± 4.30%; P = 0.021).

The LVEF drop was more remarkable in patients with the Barlow syndrome (both flail and non-flail MV) than in those with FED. It is, therefore, advisable that such patients be monitored more meticulously via the 3D HeartModelA.I. method in terms of LVEF and LV size to prevent irreversible effects on LV function and to reduce mortality.

The oxidative stress is regarded as one of the main contributors to the health problem. Cyclooxygenase-2 (COX-2) and matrix metallopeptidase-9 (MMP-9) are two of the important genes that are reported to be involved in the cardiovascular disease (CVD) development in the molecular and genetic association studies. The aim of this study was to evaluate the level of expression of COX-2 and MMP-9 after selenium supplementation in patients with coronary artery disease (CAD).

In this sub-study of Selenegene study, subjects were randomly divided into groups, 19 subjects who received selenium and 22 patients with CAD who received placebo. Patients received either 200-mg selenium yeast tablets or placebo tablets after a meal, once daily for 60 days. The messenger ribonucleic acid (mRNA) levels of the selenium and prostaglandin-endoperoxide synthase 2 (PTGS2) (COX-2) and MMP-9 genes products were determined before and after the study.

In this sub-study, 41 Iranian patients with CVD were enrolled (placebo group: n = 22, selenium intervention: n = 19). Fasting blood sugar (FBS) was higher among placebo group than selenium group (93.4 ± 12.7 vs. 124.4 ± 40.6 mg/dl, P = 0.03). Triglyceride (TG) level was higher among selenium group versus placebo group (123.3 ± 34.0 vs. 184.8 ± 69.4 mg/dl, P = 0.006). The data analysis demonstrated that the expression of MMP-9 and COX-2 genes did not change significantly in both selenium and placebo groups.

This study showed a positive association between the expression of MMP-9 and COX-2 in the patients with CAD who received selenium but not the placebo groups. Yet, these findings need to be confirmed in further details and expanded sample size.

Cardiac syndrome X (CSX) has been associated with endothelial dysfunction and inflammation. We conducted a case-control study to evaluate the association between platelet‎ and endothelial-derived microparticles (PMPs and EMPs), as specific quantitative plasma markers of endothelial dysfunction, and the presence of CSX.

The present study was conducted on 40 CSX patients and 19 healthy individuals. C-reactive protein (CRP), and hematological and biochemical parameters were evaluated. The MP concentration in platelet-poor plasma (PPP) was quantitatively determined through flow cytometry using specific anti-human CD31, CD41a, CD62E, and CD144antibodies.

The mean platelet volume (MPV) and positive CRP rate (≥ 3.8 mg/l) were higher in patients compared to controls (P = 0.02 and P = 0.01, respectively). The CD62E+, CD144+, and CD31+41− EMPs, as well as CD41+ and CD31+CD41+ PMPs showed significant increase in CSX patients compared to controls (P < 0.05). There were direct correlations between the mean percentage of detected EMPs and PMPs as well as between their expression intensity; however, a reverse correlation was seen between the percentage of MPs and CD144and CD41. Moreover, the MP level was reversely associated with prothrombin time (PT) and partial thromboplastin time (PTT) values. Only CD31+CD41+ PMP was correlated with CRP.

It seems that EMPs and PMPs increase in CSX, which may contribute to various processes involved in the development of this syndrome.

Trimethylamine N-oxide (TMAO) is emerging as a new generation of metabolites related to the activation of inflammatory reactions in the macrophages during atherosclerosis. Stress-activation of cell surface toll-like receptors (TLRs) as well as nicotinamide adenine dinucleotide phosphate (NADPH) oxidases (NOX) is also assumed to be involved in TMAO-induced inflammatory reaction in the macrophages. To elucidate the possible contribution of TLRs and NOX to the mentioned signaling pathway, we aimed to simultaneously evaluate the expression level of TLR2, TLR6, and NOX2 in TMAO-treated macrophages.

2.5 × 106 cells of U937-derived macrophages were treated in triplicates with different concentrations (37.5, 75, 150, and 300 μM) of TMAO for 24 hours. The cells were also treated with tunicamycin (TUN), as a positive control of stress. Normal control group (CTR) cells received no treatment. The viability of treated cells was checked by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide, a tetrazole (MTT) assay. Reverse transcription-quantitative polymerase chain reaction (RT-qPCR) was also used to evaluate the relative expression (fold change) of TLR2, TLR6, and NOX2 at messenger ribonucleic acid (mRNA) levels. One-way analysis of variance (ANOVA) with post-hoc Dunnett’s test was performed to compare every mean with that of the control.

No cell death occurred because of treatments. Dose of 300 μM of TMAO significantly increased the relative expression of both TLR2 and NOX2 compared to the CTR cells (P < 0.001 for both). The elevation of TLR6 was not statistically significant in all groups of TMAO-treated cells (P > 0.050).

Our results provide documentation supporting contribution of TLR2 and NOX2 to previously described inflammatory reactions induced by TMAO in macrophages. In addition, they may clarify the proatherogenic role of TMAO in foam cell formation as well as abnormal activation of macrophages during atherosclerosis.

Air pollution and long-term aerobic exercise are diversely associated with cardiovascular disease (CVD) and mortality. However, the simultaneous effect of exercise in polluted air and vitamin C on oxidative stress markers is less clear. In this study, the effect of these variables on oxidative stress markers was investigated in rats.

The study was conducted on 50 male rats. The rats were divided into 5 groups consisting of exercise, exercise with vitamin C, exercise in polluted air, exercise in polluted air with vitamin C, and control group. Animals in the exercise groups exercised on a treadmill for 12 weeks, 5 days/week, 30 minutes/day, at 50-70% of the maximum speed. Animals in the vitamin C groups received 20 mg/kg/day vitamin C orally. After 12 weeks of intervention, 2.5 ml of blood was taken from the rats’ apex. Malondialdehyde (MDA) and oxidized low-density lipoprotein (OxLDL) levels were measured using NavandSalamat’s Nalondi and Eastbiopharm’s ‎OxLDL ELISA kits, respectively. Two-way analysis of variance (ANOVA) was used for data analysis in SPSS software.

There were significant differences in MDA and OxLDL levels between all groups after 12 weeks of intervention (P < 0.050). The levels of MDA and OxLDL were significantly higher in the ExPo group compared to the Ex+VitC groups (P < 0.050). However, no significant difference was observed in MDA and OxLDL levels between the vitamin C groups (P > 0.050).

These findings demonstrate the oxidative stress effects of air pollution, systemically and in the respiratory tract. Moreover, polluted air significantly increased OxLDL levels in both exercise in polluted air groups. Although, vitamin C slightly decreased MDA and OxLDL levels in the ExPo groups, the difference was not significant. Different vitamin C doses could have diverse and maybe significant results.

Heart failure is one of the most common syndromes in the world and Iran. Caring for heart failure patients can cause a burden on their caregivers. Traditional and modern treatment techniques are often used for patients with heart failure. This study was conducted with the aim to "determine the impact of telenursing on short-term caregiver burden of patients with heart failure discharged from hospitals in Iran."

This randomized clinical trial (RCT) was undertaken in Kerman, Iran, in 2018-2019. From among caregivers of patients with minimal grade 2 heart failure, 100 patients were randomly selected to participate in the study. The intervention group, in addition to routine discharge training, received training and care files with videos and related photos via social media every other day for 1 month. The control group received only routine discharge training. The Caregiver Burden Scale (CBS) was completed before and after the intervention in both groups. This scale includes 22 items scored on a Likert scale ranging from 0 (never) to 4 (almost always). The data were analyzed using SPSS software.

The mean age of the participants was 56.44 ± 13.09 years. The mean caregiver burden score in the control and intervention groups at baseline was 37.26 and 35.58, respectively, and after the intervention, it was 34.56 and 24.28, respectively. A significant difference was found in the 2 groups after the study; the mean caregiver burden score in the intervention group was significantly reduced compared to the control group after the study.

Telenursing reduces the caregiver burden in caregivers of patients with heart failure. Telenursing can be considered as an auxiliary method to control the symptoms associated with heart failure.

Electrocardiographic (ECG) study is a principle for the symptoms contributed to the acute myocardial infarction (AMI)/acute coronary syndrome (ACS). The diagnosis of involved coronary artery based on ECG changes is still a challenge. This study is aimed to evaluate the association of mere changes in I and aVL leads with the involved region found through echocardiography and involved coronary artery through angiography.

This cross-sectional study was conducted on 100 patients referred with AMI/ACS symptoms that had mere ECG changes in I and aVL leads (ST elevation + Q wave/ST depression + inverted-T). Transthoracic echocardiography (TTE) and coronary angiography (CAG) were performed for the patients. The correlation of ECG with echocardiography and angiography was assessed.

Among the studied population, 39 patients (39%) were women with the mean ± standard deviation (SD) of age of 64.60 ± 9.39 years. There was no significant association between ECG changes in leads I and aVL with neither the stenosis of first diagonal (D1) coronary artery found through angiography (P = 0.580) nor the mid-anterior wall dyskinesia found through echocardiography (P = 0.380). A remarkable association between the echocardiographic findings representing mid-anterior wall ischemic dyskinesia with the stenosis of D1 coronary artery was detected (P < 0.001). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 100%, 54.54%, 94.68%, and 100% were respectively found as the diagnostic values of mentioned factors.

Our findings showed significant association between D1 involvement and mid-anterior dyskinesia in echocardiography, while the changes in ECG were associated neither with echocardiographic nor angiographic outcomes.

The most dramatic diseases in the aorta are aortic dissection and aneurysm, which both of them are common in pregnant women with Marfan syndrome (MFS). According to recommendations in existing guidelines, pregnancy is not recommended in patients with severe dilation of the aorta and patients with MFS with aortic dilation > 45 mm should have prophylactic aortic repair before pregnancy.

CASE REPORT:

In this rare and unique report, we described a 34-year-old pregnant woman with marfanoid feature who had an approximate aortic root of 60 mm and severe aortic insufficiency. She denied terminating the pregnancy at her first prenatal visit and continued it until 30 weeks of gestation and the pregnancy terminated in the cardiac operating room due to multiple episodes of chest pain. No complication occurred during her close observation before surgery. The aortic repair was performed for her after the cesarean section.

Pregnancy with severe aortic root dilation is high-risk for all patients; however, if it occurs, when the mother denies an abortion, inform the patient about its risk and continue the pregnancy with close observation and tight blood pressure (BP) control until the fetus becomes viable.

Interleukin-18 (IL-18) is a pro-inflammatory and pro-atherogenic factor, and its blood level has shown a direct correlation with atherosclerosis. We aimed to evaluate the serum IL-18 level in patients with systemic lupus erythematosus (SLE) and its relationship with the intima-media thickness (IMT) of the carotid artery in these patients, as an indicator of atherosclerosis.

In this cross-sectional study, 60 patients as the patient group and 30 healthy volunteers as the control group [matched sex, age, and body mass index (BMI)] were selected, and their disease status and general data were gathered using the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) form. A blood sample was also obtained from all participants to determine the serum level of IL-18 and other metrics, including high-sensitivity C-reactive protein (hs-CRP), cholesterol, triglyceride (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL), anti-double stranded deoxyribonucleic acid (anti-dsDNA), complement 3 (C3), and C4. The IMT of the carotid artery was calculated in both groups. We also evaluated the clinical cardiovascular manifestations.

The serum IL-18 levels in patients were significantly higher than in the control group (P ˂ 0.005). It had no significant correlation with disease activity (P = 0.10). The patients with SLE with high IL-18 serum levels (> 280 pg/ml) had higher SLEDAI-2K (P = 0.02) than the patients with a low level (< 280), where 280 was the median of the IL-18 levels. The serum IL18 level had no significant correlation with the carotid artery IMT.

A high level of IL-18 reflects the disease activity, but it was not significantly correlated with subclinical atherosclerosis, denoted by the carotid artery IMT.

Low vitamin D status may contribute to the pathogenesis of heart failure (HF), but therapeutic roles of vitamin D on cardiac performance are not well known. We evaluated vitamin D effects on left ventricular ejection fraction (LVEF) and New York Heart Association (NYHA) functional class in patients with HF for the first time.

This study was a double-blind, randomized, placebo-controlled trial. 110 patients with HF admitted to Shahid Chamran and Khorshid Hospitals, Isfahan, Iran, randomly received 500 mg calcium daily plus either 50000 IU vitamin D3 per week (case group) or placebo (control group) for 6 months. Biochemical variables, LVEF, and NYHA functional class were assessed at baseline and after 6 months.

81 patients completed the study. Vitamin D supplementation increased mean serum 25-hydroxyvitamin D [25(OH)D] concentration in the case group by 33.9 ng/ml (P < 0.001). After 6 months of treatment, both groups showed improvement in LVEF, but the extent of improvement was significant only in the case group (5.48% versus 0.44%, P < 0.001). The NYHA functional class improved in the case group but remained constant in the control group (P < 0.001).

Vitamin D3 improved LVEF and NYHA functional class in patients with HF and might serve as a new agent for the future treatment of this disease.

Cardiovascular diseases (CVDs) are one of the main concerns of health care systems. The aim of this study was to investigate the most important prognostic factors of heart failure (HF) and their survival outcomes in patients in Birjand, East of Iran.

A total of 194 systolic HF patients hospitalized in Birjand Valiasr hospital were followed up for 12 months in 2016, and those with reduced left ventricle ejection fraction (LVEF < 50%) were included in this study. Kaplan-Meier and Cox proportional hazard analysis were used to determine the association of each factor with events.

The mean age of patients was 68.23 ± 13.40 (27-95) years, and 57.2% (111 out of 194) were women. Mean survival time was 294.7 ± 9.924 days. Pervious history of myocardial infarction (MI) [2.141 (1.101-4.161)] increased the risk of cardiovascular hospitalization. Elevated blood levels of potassium [2.264 (1.438-3.564)] was found to be a risk factor for all-cause and cardiovascular mortality. Moreover, there was a reverse relationship between body height [0.942 (0.888-0.999)] and cardiovascular death. Patients with opium addiction [4.049 (1.310-12.516)] are at a higher risk of cardiovascular mortality. Lower levels of LDL-C [0.977 (0.960-0.996)] and living in rural areas [3.052 (1.039-8.964)] increased all-cause mortality levels. Lack of pervious history of chronic obstructive pulmonary disease (COPD) decreased cardiovascular hospitalization [0.265 (0.062-1.122)].

In our study, serum potassium, LDL-C, and uric acid levels in patients with HF were identified as prognostic factors. The height of patients, which can be an indicator of the functional state of their respiratory system, and the history of COPD were also recognized as prognostic factors. Opium use and rural living were identified as social factors influencing patients' prognosis.

The compounds in cigarette smoke are believed to cause oxidative stress, leading to endothelial dysfunction. Understanding the mechanism of endothelial dysfunction due to cigarette smoke is useful for the development of early and preventive therapy for cardiovascular diseases (CVDs) with smoking risk factors.

In this experimental study, a posttest-only control group design was used. 20 Wistar rats were divided into two groups: a smoking group (exposed to 40 cigarettes per day for 4 weeks) and a control group. After the exposure, the animals were sacrificed and aortas were removed for measurement of malondialdehyde (MDA), superoxide dismutase (SOD), endothelial nitric oxide synthase (eNOS), intima-media thickness (IMT), and for histological analysis.

Exposure to cigarette smoke caused a significant decrease in SOD activity (24.28 ± 4.90; P = 0.027) and eNOS levels (50.81 ± 4.18; P = 0.014), but no significant effect on the level of MDA (17.08 ± 5.78; P = 0.551). Histological analysis showed an increase in IMT (13.27 ± 2.40; P = 0.000) and disorganization and vacuolation of smooth muscle cells in tunica media after exposure to cigarette smoke. The regression analysis showed a significant negative relationship between the eNOS level and IMT (β = –1.012, P = 0.009).

Subchronic exposure to cigarette smoke caused a decrease in SOD activity and eNOS levels, but no significant change in MDA levels. This study also indicated that smoking causes IMT thickening and pathological structural changes in the aorta. Another finding indicated that a decrease in eNOS levels could cause an increase in the IMT of the aorta.

Reduction of cardiovascular risk (CVR) is based on the correction of risk factors, especially dyslipidemia. Due to the limiting factors of conventional lipid-lowering medications, the investigation of alternative approaches is necessary.

The present open, comparative, randomized, and parallel investigation was conducted on 77 patients. Participants were of both sexes, 40-74 years-of-age, and had dyslipidemia. The participants were divided into 2 groups; the treatment group (n = 41) received a combination of Lactobacillus plantarum and simvastatin 20 mg once a day, and the control group (n = 36) received simvastatin 20 mg once a day. The trial included 5 visits; screening on the first 2, and treatment on the next 3 (on weeks 4, 8, and 12). On visits 1, 3, 4, and 5, the lipid profile was evaluated and CVR was calculated using 5 tools.

The combination treatment led to a more pronounced decrease in total cholesterol (TC) and low-density lipoproteins (LDL) after 8 weeks (P = 0.002 and 0.016, respectively), that persisted after 12 weeks (P < 0.001 and 0.002, respectively). Reduction in TC and LDL by ³ 20% was observed more predominantly in the treatment group. A significant reduction was observed in CVR in the treatment group according to the Prospective Cardiovascular Münster (‎PROCAM) score (P = 0.004). Reduction of CVR by ³ 20% was mostly observed as a result of prescribing combination therapy according to the Framingham Risk Score ‎(70.7%; P = 0.003), 2013 ACC/AHA ASCVD Risk Calculator ‎(51.2%; P = 0.035), PROCAM (65.9%; P < 0.001), and WHO CVD risk chart (56.1%; P = 0.012).

Additional supplementation with Lactobacillus plantarum was more effective in the reduction of TC, LDL, and CVR according to PROCAM and the attainment of treatment goals regarding lipid profile and CVR levels.

Pneumopericardium, presence of air in pericardial cavity, is rare entity with potentially severe complications and mortality. In the neonatal period, it is associated with prematurity, low birth weight, and assisted ventilation, but in full term neonates its occurrence after resuscitation is exceedingly rare.

 Our patient was a 2-day old full term neonate who developed respiratory distress following active resuscitation which was carried out at the time of birth in lieu of perinatal asphyxia. He was immediately put on mechanical ventilatory support. Chest x-ray showed a "halo sign"- rim of air completely surrounding the heart, and echocardiography confirmed pneumopericardium with cardiac tamponade. Pericardiocentesis was performed as a life saving measure.

He was successfully discharged on the tenth day following sheath removal, and is doing fine on follow up.

Atrioventricular node (AVN) is an interatrial septum structure located at the apex of triangle of Koch that modulates the transmission of impulses from atria to the ventricles. Vagally mediated AVN block with high frequency stimulation (HFS) was investigated in a few animal and human studies, but prolonged ventricular asystole that was induced by a low frequency proximal coronary sinus (CS) overdrive pacing has rarely been reported.

A 40-year-old man was admitted in our hospital for evaluation of syncope and palpitation. He presented with prolonged ventricular asystole by proximal CS pacing during electrophysiological study (EPS).

There is no comprehensive clinical study to investigate the association of vasovagal syncope with vagally mediated atrioventricular block (AVB) which is induced by posteroseptal area stimulation. Radiofrequency catheter ablation of ganglionated plexi (GP) located close to sinus node and AVN was reported to eliminate the vagal efferent output during vasovagal syncope as a new treatment strategy.

Pre-hypertension (HTN) and HTN are risk factors for cardiovascular disease (CVD). Despite its importance, HTN is often underestimated and undiagnosed, especially in women. This study was designed to determine the prevalence of pre-HTN and HTN among a large sample of Iranian menopausal women.

This repeated cross-sectional study was conducted on 1013 menopausal women aged 41 to 85 years in Isfahan, Iran, in the years 2001, 2007, and 2016. The participants were selected through multistage cluster random sampling. Awareness, treatment, and control of HTN were assessed using a validated researcher-made questionnaire. Blood pressure was determined via an arm digital blood pressure monitor.

The prevalence of HTN in the years 2001, 2007, and 2016 was 52.6%, 49.0%, and 51.6%, respectively; no significant changes were observed (P > 0.05). The prevalence of pre-HTN in these years was 56.6%, 53.3%, and 42.2%, respectively. In 2001 and 2007, respectively, 28.8% and 50.4% of menopausal women had HTN controlled by medication, and in 2016, 86.6% of women were aware of their disease and 62% of them had controlled HTN (P < 0.001).

The results showed that HTN and pre-HTN were highly prevalent among Iranian menopausal women and markedly increased with age. Interventional population-based approaches are needed to improve knowledge and efficient practice that may help to lower the risk of HTN and CVD in this at-risk population.

Among the cardiovascular diseases (CVDs), myocardial infraction (MI) is one of the main causes of mortality around the world. A diagnosis of MI may be followed by psychological problems, such as depression, anxiety, and stress. Therefore, psychological interventions can be beneficial in routine treatment. The purpose of this study was to compare the effect of cognitive-behavioral therapy (CBT) and dialectical behavioral therapy (DBT) on perceived stress and coping skills in patients after MI.

This study was a randomized clinical trial with a pretest-posttest design and control group. The statistical population consisted of 45 patients after MI who referred to Noor Heart Clinic in Rasht, Iran, between 2018 and 2019. They were randomly divided into 3 groups of 15 individuals (2 interventions including CBT and DBT, and 1 control group). In the intervention groups, participants underwent 8 weekly 90-minute sessions. Data were collected using a 3 part self-report questionnaire including a demographic information form, the Ways of Coping Questionnaire (WCQ), and the Perceived Stress Scale‎-14 (PSS-14). The statistical methods used for data analysis included chi-square test, one-way ANOVA, repeated-measures ANOVA, and post hoc Bonferroni test.

We found significant main effects of group (F(2,42)=6.11; P=0.005) and time (F(2,84)=28.48; P<0.001), and a significant group-by-time interaction (F(4,84)=8.97; P<0.001) on perceived stress scores. For problem-focused coping scores, findings indicated significant main effects of group (F(2,42)=7.33; P=0.002) and time (F(2,84)=30.71; P<0.001), and a significant group-by-time interaction (F(4,84)=12.86; P<0.001). For emotion-focused coping scores, the results also indicated significant main effects of group (F(2,42) = 17.41; P < 0.001) and time (F(2,84)=31.74; P<0.001), and a significant group-by-time interaction (F(4,84)=14.90; P<0.001).

The current study revealed that DBT was more effective in improving emotion-focused coping than CBT.

COVID-19 was introduced by the World Health Organization (WHO) as a global pandemic. The spectrum of symptoms of the disease ranges from a mild cold to death. It has a higher mortality rate in people with a history of comorbidities, including cardiovascular disease (CVD) and can also contribute to cardiac injury. This study was conducted to evaluate the relationship between troponin levels as a cardiac marker and adverse outcomes in this disease.

The study sample included 438 patients hospitalized with COVID-19; however, the troponin data of 6 patients were not available. The need to be admitted to the intensive care unit (ICU), and death were considered the adverse outcome in patients with COVID-19. Troponin levels were checked in all patients on day 1 and day 3 of hospitalization. Multiple logistic regression analysis was performed to determine whether there was an independent association between the adverse outcomes and troponin enzyme in hospitalized patients with COVID-19.

The mean age of patients was 61.29 ± 15.84 years. Among the 432 patients tested on day 1 of hospitalization, 24 patients (5.6%) tested positive (Troponin 1), and among the 303 patients tested on day 3, 13 patients (4.3%) tested positive (Troponin 2). Based on our results, Troponin 1 showed an independent association with both death (3.008 [95%CI = 1.091-8.290]; P = 0.033) and need for ICU admission (8.499 [95%CI = 3.316-21.788]; P < 0.001) in multiple logistic regression analysis. Moreover, the status of Troponin 2 had an independent significant association with both death (4.159 [95%CI = 1.156-14.961]; P = 0.029) and ICU admission (7.796 [95%CI = 1.954-31.097]; P = 0.004).

Troponin showed a significant association with adverse outcomes in people who were hospitalized with COVID-19. The serial assessment of this enzyme from the time of hospitalization may improve the clinical decision making of clinicians.

Fragmented QRS (fQRS) is an electrocardiographic parameter, which could be assessed easily and non-invasively using surface electrocardiogram (ECG) and may have significant prognostic value. The present study aimed to evaluate the correlation between left ventricular ejection fraction (LVEF) and fQRS in surface ECG.

This study was conducted on 186 patients with acute ST-elevation myocardial infarction (STEMI). After primary percutaneous coronary intervention (PCI) and transferring the patients to the cardiac care unit (CCU), the patients were examined using echocardiography, and ejection fraction (EF) was assessed using the Simpson's method by a single cardiologist. Data analysis was performed using SPSS software.

Among 186 eligible patients, 113 cases showed fQRS in the surface ECG. In total, 84.9% of these patients were men, and 15.1% were women (P < 0.05). No significant correlation was observed between age and fQRS (P > 0.05), as well as coronary artery disease (CAD) severity and fQRS (P > 0.05). On the other hand, a statistically significant, reverse correlation was denoted between EF and fQRS in the surface ECG (P < 0.05). In addition, significant relations were observed between the rate of ST-segment elevation and depression and fQRS (P < 0.05).

According to the obtained results, EF significantly decreased in the echocardiography of the patients with STEMI and fQRS in the surface ECG. Considering the cost-efficiency and accessibility of fQRS evaluation, it could be used for the assessment of various parameters in cardiology modalities such as cardiac magnetic resonance imaging (CMRI) and computed tomography (CT).

Myocardial ischemia may recur in a significant subset of patients following percutaneous coronary intervention (PCI). Lycopene, a carotenoid with antioxidant activity, has evidence for beneficial effects on cardiovascular system. In the present study, we aimed to evaluate the possible preventive effect of lycopene against post-PCI myocardial damage by detection of cardiac biomarkers of ischemia.

A total of 45 patients who planned to undergo elective PCI were randomly assigned to two groups to receive either lycopene (30 mg 12 hours before PCI as well as 15 mg just before and 8 hours after PCI) along with standard treatment (n = 23) or only standard treatment
(n = 22). Standard treatment included aspirin, a statin, and a beta-blocker. The serum levels of creatine kinase-MB (CK-MB), troponin I, and high sensitivity C-reactive protein (hs-CRP) were measured 12 hours before and 12 hours after the procedure and were compared between the two groups.

The use of lycopene significantly prevented the increase of CK-MB following PCI compared to control (P = 0.048). However, it had not any significant effect on serum levels of troponin I (TnI) (P = 0.176) and hs-CRP (P = 0.186) compared to control.

Lycopene can prevent the increase of CK-MB following PCI. Therefore, it has the potential for prevention of post-PCI cardiovascular events. However, more studies are needed to confirm such an effect.

The high incidence of coronary heart diseases requires early diagnosis to prevent complications. This study aims to assess the mean value of tissue mitral annular displacement (TMAD), using Speckle tracking echocardiography (2D STE) in patients with coronary artery stenosis.

149 patients aged 50 to 76 years were included in this cross-sectional study who were admitted with primary diagnosis of acute coronary syndrome (ACS) to the emergency department. In all patients, the TMAD data were measured using 2D speckle tracking technology.

149 patients with a mean age of 61.83 ± 7.14 years old were studied. Regarding the involved coronary artery as left anterior descending (LAD), right coronary artery (RCA), or left circumflex artery (LCX), the TMAD data was reduced significantly (P < 0.001) in the relevant walls [base of anterior and anteroseptum (4.46 ± 3.53 mm), base of inferior and inferoseptum (4.91 ± 3.81 mm), and base anterolateral and inferolateral walls (5.53 ± 3.827 mm), respectively.] TMAD in anterior, inferior, and lateral ST-elevation myocardial infarction (STEMI) were 2.64 ± 0.870, 4.78 ± 3.8, and 2.80 ± 0.83 mm, respectively which were significantly reduced compared to the non-ST-elevation myocardial infarction (NSTEMI) and unstable angina (P < 0.001). TMAD in different LV function categories was only reduced in those with LAD lesion and with severe LV systolic dysfunction (2.47 ± 0.834 mm, P < 0.001).

The current study describes a significant relationship between TMAD and left ventricular function, ACS type, and the culprit coronary artery. In different types of ACS, the TMAD value was worse in the subgroups of STEMI and in the walls affected by the stenosed coronary artery. This method might be helpful in defining the culprit coronary artery.

Understanding the close interaction between the specialties of cardiology and oncology is necessary for early detection of cardiovascular disease (CVD) events in cancer patients. For the risk assessment of CVD in Breast and Colorectal Cancers (CIBC) study, in the current study we aimed to validate a questionnaire for the assessment of clinical history in patients with breast cancer and colorectal cancer (CRC).

We determined the content validity of the questionnaire using the 2 indexes of content validity ratio (CVR) and content validity index (CVI) to examine the specificity, simplicity, clarity, and transparency of the items. Content validity assessment was performed through a panel of experts including 2 oncologists, 5 cardiologists, 2 general practitioners, and 1 epidemiologist. The reliability of the questionnaire was estimated using Cronbach's alpha coefficient in 50 patients. Intraclass correlation coefficient (ICC) was used to examine the reproducibility of the questionnaire during 1 week.

The CRC and breast cancer questionnaire were designed with 16 and 32 questions, respectively. To obtain acceptable CVR, 5 and 11 questions were removed from the CRC and breast cancer questionnaires, respectively. Cronbach's alpha was 0.70 in the breast cancer questionnaire and 0.94 in the CRC questionnaire. All questions had a CVI of higher than 80%. The ICC in the breast cancer questionnaire ranged between 0.71 and 0.96 and in CRC questionnaire ranged between 0.78 and 0.98.

The validity and reliability of our newly developed questionnaire was desirable. The reliability of the breast cancer questions was acceptable and that of the CRC questions was excellent. Thus, thus questionnaire can be used in this group of patients regardless of whether the goal is cardiac care or not.

Coronavirus disease 2019 (COVID-19) has led to considerable morbidity and mortality worldwide and myocardial injury has been one of the most common findings in the affected patients. However, published evidence of cardiac evaluation by imaging techniques including echocardiography is rare. We aimed to evaluate myocardial involvement by echocardiography in patients with severe COVID-19.

We studied 64 patients with severe COVID-19 who were admitted in the intensive care unit (ICU) in Khorshid Hospital, Isfahan, Iran, from February 20, 2020 until May 20, 2020. Demographic characteristics, laboratory tests, and electrocardiography (ECG) data were collected and transthoracic echocardiography (TTE) using a focused time-efficient echocardiography protocol was performed.

Mean age of the participating patients was 66.40 ± 14.14 years (range: 34.0-92.0 years), and 35 patients (54.7%) were men. Reduced left ventricular (LV) systolic function was seen in 20 (32%) patients. Only 4 patients had LV ejection fraction (LVEF) less than 40%. Cardiac troponin I (cTn-I) was elevated (over 15 pg/ml) in 39 (60.9%) patients and was significantly associated with higher mortality in these patients (P = 0.05). In addition, dynamic ST and T wave changes and new bundle branch blocks had a significant association with adverse clinical outcome (P = 0.05 and P = 0.02, respectively).

New LV systolic dysfunction (LVSD) in patients with severe COVID-19 was mild to moderate and not uncommon and had no significant adverse effect on the prognosis of these patients, although elevation of cardiac biomarkers could predict mortality and had an adverse effect on clinical outcome.

This study simultaneously reports bilateral atrial tumor masses including the concurrent occurrence of metastatic carcinoma, consistent with metastatic breast carcinoma, on the main cardiac myxoma mass in the left atrium (LA) and metastatic carcinoma consistent with metastatic breast carcinoma for the right atrial (RA) mass.

These masses were observed in a 79-year-old female patient who had received her pacemaker 6 months ago due to electrical conduction disease. However, no tumor/mass was found in her echocardiogram at the time of the pacemaker reception and mild chest pain and dyspnea were the only signs of her huge masses. Bilateral interseptal atrial cardiac masses protruded to the LA and RA were observed in both atrial chambers in echocardiography, and she underwent the surgical resection of masses.

The findings of the current study represented a novel condition for a patient. More precisely, the patient had two different huge cardiac masses, and at the same time, the metastasis of breast cancer was reported on the other cardiac tumor/myxoma as well. In addition, metastatic carcinoma should be suspected in patients with cardiac myxoma mass consistent with heart block. The simultaneous presence of multiple masses inside the heart is not always evidence of myxoma, rather can be a metastatic lesion.

Wider QRS duration and presence of left bundle branch block (LBBB) predict better cardiac resynchronization therapy (CRT) response. Despite strict patient selection, one-third of patients have a sub-optimal response. We aim to evaluate the impact of lead one ratio (LOR) on CRT response.

We enrolled 93 patients receiving CRT from August 2016 to August 2019. Pre-implant 12-lead electrocardiogram (ECG) was recorded, and LOR was derived by dividing the maximum positive deflection of QRS complex in ECG lead I by the maximum negative deflection in lead I; cutoff value of 12 was used to divide the cohort into two groups. Patients were followed for 6 months, and outcomes were compared for CRT response, New York Heart Association (NYHA) class improvement, all-cause mortality, and heart failure (HF) hospitalization events.

At the end of 6-month follow-up, LOR ≥ 12 was associated with significantly better CRT response (75.76% vs. 51.85% in LOR < 12, P = 0.02), lower mortality per 100 patient-years (9.09 vs. 14.81 in LOR < 12, P = 0.012), and more improvement in HF symptoms (NYHA improvement) (78.79% vs. 55.56% in LOR < 12, P = 0.02). Patients with LOR < 12 had more HF hospitalization events (2.04 vs. 1.81 episodes in LOR ≥ 12, P = 0.029) and less QRS narrowing (∆5.74 ± 2.09 vs. ∆7.10 ± 3.97 ms in LOR ≥ 12, P = 0.01). QRS duration and LBBB morphology were predictors of response in both groups of patients.

LOR ≥ 12 was associated with better response to CRT, less HF hospitalization, and more relief in HF symptoms. This ratio helps to identify possible sub-optimal response among patients with an indication for CRT.

It has been proposed that left ventricular diastolic dysfunction (LVDD) is a possible physiological link between high body mass index (BMI) and future occurrence of heart failure (HF). The present cross-sectional study was aimed to analyze the association between BMI and LVDD by transthoracic echocardiography (TTE).

This study was conducted from May 2017 to September 2019 in Khorshid Hospital of Isfahan University of Medical Sciences, Isfahan, Iran. Based on the calculated BMI (kg/m²), patients were divided into three groups: group 1: subjects with BMI < 25, as a normal group (n = 75), group 2: volunteer cases with 40 > BMI ≥ 30, as an obese group (n = 98), and group 3: patients with BMI ≥ 40, as a morbidly obese group (n = 100). TTE was performed by a trained cardiologist and associated variables including left atrium (LA) volume, E, septal e’, lateral e’ , and E/e’ were assessed and also subjects were characterized as normal diastolic function, abnormal diastolic function, and inconclusive diagnosis of diastolic dysfunction (DD).

Apart from the ejection fraction (EF) and the tricuspid regurgitation velocity (TRV), there was a significant difference between the other echocardiographic variables including LA volume, E, septal e’, lateral e’, and E/e’ (P < 0.05). One patient with morbid obesity in our study revealed LVDD. There was no significant difference between three groups (P = 0.42).

There is no considerable relationship between obesity and LVDD. It seems that the absence of associated comorbidities such as diabetes, coronary disorders, etc. plays a crucial role in preventing LVDD, but for realistic and definitive decision, more cellular and molecular investigations and studies with larger sample size are necessary.

Coronary angiography and intervention through transradial approach is becoming default approach because of infrequent local site complications. Although pseudoaneurysm is a well described complication for femoral access, it is extremely rare in transradial access.
CASE REPORT: Our patient was 68-year old female who had presented with pulsatile, painful, and gradually increasing swelling over lower part of right forearm near wrist joint for past 8-weeks following coronary angiography through right radial route. Swelling did not resolve following manual compression. It was diagnosed as pseudoaneurysm arising from right radial artery by duplex ultrasound. It was successfully excluded by deploying 3.5x18mm Graftmaster covered stent (Abott Vascular, USA) through right transbrachial route. Ultrasonography next day revealed partially thrombosed and completely excluded pseudoaneurysm with swelling completely disappearing at 6 weeks with patency maintained at one year.

With increasing use of transradial access, more cases of radial pseudoaneurysm are likely to surface which can be prevented following a proper haemostatic protocol. To best of our knowledge, it is first ever report of percutaneous endovascular exclusion using covered stent of radial pseudoaneurysm through transbrachial approach.

J wave syndrome is an electrical disease of the heart due to pathologic early repolarization. It encompasses a clinical spectrum from aborted sudden cardiac death due to ventricular arrhythmia (VA) usually in young affected patients to self-terminating ventricular ectopies, and finally, asymptomatic relatives of probands detected during electrocardiography acquisition (early repolarization pattern). This syndrome consists of 2 phenotypes, early repolarization and Brugada syndrome. Herein, we first describe 2 patients with early repolarization and Brugada syndrome, then, discuss their definition, epidemiology, genetics, cellular mechanism, diagnosis, risk stratification, and finally, therapeutic challenges and options one by one in detail.

Hypertension (HTN) is one of the most common non-communicable diseases (NCDs), which in 2017 accounted for 1.65% of all deaths, and 0.66% of disability-adjusted life years (DALYs). About 25% of the adult population are hypertensive in Iran. Prevalence of HTN is significantly higher in those with a family history of HTN. This study compares the impact of paternal and maternal history of HTN on the risk of HTN development.

This cross-sectional study was conducted among 2107 adults of 18-84 years old residing in Isfahan, Iran, from August 2015 to March 2016. Blood pressure (BP) measurement standards were taken from World Health Organization (WHO) guidelines. We measured BP in the right arm for three times at 1-minute intervals and considered the mean of second and third measurements. Other data were collected by questionnaire.

Prevalence of HTN was higher in participants whose mother or both parents were hypertensive (P < 0.001). Diastolic BP (DBP) was affected by every side of parental history (P < 0.001), while systolic BP(SBP) was affected when both parents were hypertensive (P < 0.001). As a result, maternal family history increased the odds of HTN by 1.9 times [95% confidence interval (CI): 1.35-2.65] and both maternal and paternal history increased it by 3.1 times (95% CI: 2.01-4.78) compared to those with no family history. However, paternal history was not significantly related to the odds of HTN.

Our study results demonstrate that maternal history of HTN doubles the odds of HTN. Besides, if both parents are hypertensive, it will be tripled.

Ebstein’s anomaly is one of the challenging congenital heart diseases (CHDs) that is presented with different anatomical and clinical symptoms. For this reason, patients with this complication require exact diagnostic methods and appropriate treatment approaches. In addition, multiple cardiac defects accompany this anomaly.

 In this study, we describe a rare associated defect in an adult patient with Ebstein’s anomaly and proper surgical methods performed for her.

The most important issue in adult patients with Ebstein’s anomaly is to pay close attention to the presence of associated anomalies, in which careful examination and use of para-clinical methods is very helpful. Furthermore, accurate diagnosis of the associated defects determines the treatment and surgery of patients.

Fractional excretion of sodium (FENa), the reflection of sodium (Na) handling by the kidney during natriuresis, is influenced by exo- and endogenous factors that have a powerful impact on renal function. We performed this study to define the correlation between FENa and worsening renal function (WRF) and assess the value of FENa in the length of hospital stay and in-hospital mortality in the patients with acute decompensated heart failure (ADHF).

This prospective observational study was performed in two tertiary governmental heart centers located in Ahvaz, Iran, from March 2019 to March 2020. Any individual suffering from ADHF who had no renal failure, received only loop diuretics, and was on a low Na diet was eligible for recruitment in this study. The urine sample used to calculate FENa was a 24-hour sample.

Over the one year, 56 patients met the inclusion criteria. The total study population had a mean age of 61.46 ± 14.22 years with the dominance of women (51.8%). The mean age of men and women was 58.59 ± 14.35 and 64.13 ± 13.80 years, respectively. During hospitalization, 13 (23.2%) patients experienced WRF. In patients who experienced WRF during hospitalization, FENa of < 1% was mostly observed compared to FENa of 1%-2% (42.9% vs. 0%, P < 0.05). Post-hoc test of data on mean hospitalization days indicated that those with lower FENa had longer admission periods than those with other FENa groups (< 1%: 3.04 ± 1.02 days vs. 1%-2%: 1.58 ± 0.66 days, P < 0.001 and < 1%: 3.04 ± 1.02 days vs. > 2%: 2.30 ± 0.92 days, P = 0.02). There was no significant relation in terms of in-hospital death across different categories of FENa (P = 0.69).

Our data suggested that FENa less than 1% was associated with WRF and could be associated with a longer hospitalization period. We did not find any association between FENa and in-hospital mortality. Further studies with a larger number of patients are required to determine the cut-off value.

With the onset of the coronavirus disease-2019 (COVID-19) pandemic, hospitalization and treatment of non-covid patients decreased worldwide. The aim of this study is to evaluate the admission and treatment of patients with coronary artery diseases (CADs) by examining coronary Cath labs activities in some centers of Iran during the COVID-19 period.

A retrospective, multi-center survey was conducted in four cites in Iran which participated in National Persian Registry Of CardioVascular diseasE (N-PROVE). Two periods of COVID-19 occurrence peak in Iran were compared with the same date in 2019. Information was collected on the number of diagnostic and therapeutic coronary catheterizations in both stable ischemic heart diseases (SIHDs) and acute coronary syndrome (ACS) settings.

In the first peak of COVID-19 pandemic, coronary angiographies and angioplasties decreased by 37 and 38% compared to the same period in 2019, respectively. The most common indication for coronary angiography during this period was ACS [especially ST-Segment Elevation Myocardial Infarction (STEMI)]; however, at the time of peak decrease, the SIHDs were the most. In the second peak of COVID-19 pandemic in Iran, 34% and 27% decrease in diagnostic and therapeutic coronary procedures were seen, respectively. During this period, the number of elective admissions increased, although it was still lower than that in 2019. The tendency to rescue percutaneous coronary intervention increased in most centers during the COVID-19 era, especially in the second peak.

A significant reduction in the coronary Cath lab activity has been observed during the COVID-19 pandemic that can indicate an increased risk of cardiovascular mortality and morbidity.

Some types of antidepressants and antipsychotic medications have cardiovascular side effects that can be life-threatening. Electroconvulsive therapy (ECT) is capable of generating physiological stress and may lead to increased QT interval followed by arrhythmias. Risperidone can also increase the risk of arrhythmia by increasing the corrected QT (QTc) interval. Since many patients require co-administration of risperidone and ECT, this study aimed to investigate the concurrent effect of ECT and risperidone administration on the QTc interval.

For this cross-sectional study, 60 patients (18-65 years) admitted in 22 Bahman Psychiatric Hospital (Qazvin, Iran) that were candidate for treatment with risperidone, ECT, or both methods were concurrently divided into three groups. The groups included patients treated with ECT, risperidone, and combination treatment (risperidone and ECT). At the beginning of the study, electrocardiogram (ECG) was obtained for all patients and QT was performed manually, and finally, QTc interval was measured two times for each group. Required information was collected through medical records. Then, inferential statistics, analysis of variance (ANOVA), was used to determine differences between different variables.

A significant increase in heart rate (HR) in the third group compared to first and second groups was observed. None of the treatments had a significant effect on QTc interval, but the QTc interval increased slightly in groups treated with the ECT alone and particularly, the ECT plus risperidone in comparison to the baseline values.

Our study showed that risperidone, ECT, and their concomitant combination did not affect the QTc interval. Therefore, risperidone and ECT are safe and their combination can also be a good option for refractory patients undergoing ECG monitoring and cardiopulmonary devices.

During ongoing coronavirus disease 2019 (COVID-19) pandemic, social isolation and lockdown measures were implemented to prevent spread of virus which created enormous challenges to patient healthcare. In order to overcome these challenges, teleconsultation (telecardiology) was initiated. Objective of this study was to assess outcome of telecardiology using audio/visual/audio-visual consultation among patients with implantable cardiac devices.

Telecardiology was performed (either physician-initiated or patient-initiated) among 1200 patients over a five-month period (July 13 to December 13, 2020) to review health status of patients to decide further course of treatment and to access their satisfaction level with telecardiology.

Teleconsultation was cardiologist- and patient-initiated in 1042 (86.8%) and 158 (13.2%) cases, respectively. 1117 (93.2%) patients were stable, while scheduled admission, urgent hospitalization, and death were noted in 20 (1.8%), 45 (3.9%), and 18 (1.5%) patients, respectively. Next visit was rescheduled in 986 (82.2%), while 127 (10.6%) were called earlier because of battery depletion. Majority (n = 1077, 89.8%) were satisfied.

Telecardiolgy is an effective option during COVID-19 to minimize interpersonal contact, spread of disease, psychological stress, and burden on already stretched healthcare.

Evaluation of socioeconomic status (SES) is an important aspect in community-based health studies and it is a major predictor of health and nutritional status as well as mortality and morbidity from many diseases. This study aimed to construct and validate socioeconomic status short-from questionnaire (SES-SQ) in Iranian population.

This cross-sectional methodological study was conducted among 1437 Iranian general population. Face and content validity of the developed questionnaire was evaluated qualitatively. Internal consistency, construct validity using exploratory factor analysis (EFA) and latent class analysis (LCA), and convergent and known-group validity were also evaluated.

The SES-SQ consisted of 6 items. The overall Cronbach’s alpha was 0.64, showing acceptable internal consistency. EFA resulted in two factors explaining 47.78% of total variance. Three SES classes (low/middle/high) were extracted by LCA. The score of SES-SQ ranged from 0 to 17; two cutoff scores of 4.5 and 8.5 were determined by receiver operating characteristic (ROC) analysis for differentiating low from middle and middle from high SES classes, respectively.

An efficient, reliable, and valid short-form questionnaire was developed for evaluating SES in Iranian general population. The relevancy of questionnaire items is not lost over time.

Cardiovascular diseases (CVDs) are in charge of many deaths worldwide including myocardial infarction (MI), hypertension (HTN), coronary atherosclerosis (CAS), infective endocarditis (IE), heart failure (HF), arterial fibrillation (AF), and peripheral artery disease (PAD). Besides, periodontitis is the sixth prevalent disease among humans and it seems that there are common risk factors between these diseases which are creating communication between prevalence and treatment. The purpose of this study is to assess the articles that reviewed the relationship between heart diseases and periodontitis.

Three databases, including PubMed, Scopus, and Web of Science were searched until November 2020. The search terms “periodontal disease, periodontitis, oral health, cardiovascular disease, atherosclerosis, myocardial infarction, hypertension, coronary heart disease, angina pectoris, arterial fibrillation, arrhythmia, and peripheral artery disease” were used in combination to identify the publications providing data.

MI, HTN, atherosclerosis diseases for coronary artery, IE, HF, AF, and PAD were associated with periodontitis. It seems that the treatment of periodontitis may help to improve the state of mentioned heart-related diseases. However, more studies are needed to prove this relationship.

The prevalence of heart diseases is more common in individuals with periodontitis.

Myocardial infarction (MI) is one of the leading causes of mortality globally. Although it is most prevalent in the elderly, it may occur in young adults (men ≤ 55 years or women ≤ 65 years) as premature MI (PMI). As awareness of genetic risks may lead to effective prevention of PMI, we aim to investigate the association of two susceptible single nucleotide polymorphisms (SNPs) in the LPA gene with PMI in the Iranian population, rs1801693 and rs7765781, identified in previous genome-wide association studies (GWAS).

A total number of 85 patients with PMI and 85 healthy controls were recruited from December 2015 to March 2016 from Isfahan, Iran. Peripheral blood samples were collected from all individuals. Deoxyribonucleic acid (DNA) was extracted and genotyped at rs1181693 and rs7765781 polymorphisms, using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Results were statistically analyzed to find any possible association of the two polymorphisms with PMI by SPSS software and P-values less than 0.05 were considered to be statistically significant.

Statistical analysis displayed no significant difference between rs1801693 (P = 0.815)/rs7765781 (P = 0.746) alleles in patients with PMI and healthy control subjects.

There is no meaningful association between rs1801693/rs7765781 and PMI incidence in the Iranian population.

Pulmonary complications following cardiopulmonary bypass (CPB) pump during coronary artery bypass grafting (CABG) are relatively common and the incidence of cognitive dysfunction is reported as ranging in rate from 30% to 80% in the early postoperative period. The purpose of this study was to assess the effect of modafinil administration on the prevention of pulmonary and cerebral complications and shortening the hospital stay after CABG surgery.

This randomized double-blind intervention-controlled clinical trial was performed on 74 patients (37 in the intervention group and 37 in the control group) undertaking CABG surgery. The intervention group was orally treated with doses of 200 mg of modafinil on the day of surgery, and on the morning of the day after surgery, the second dose of modafinil 200 mg was given to patients. The control group underwent a placebo with the same intervals.

Administration of modafinil in intervention group significantly decreased the time to reach consciousness (P = 0.001), ventilator time in intensive care unit (ICU) (P < 0.001), length of stay in ICU (P = 0.009), duration of hospitalization (P = 0.008), and arterial blood carbon dioxide pressure (PaCO2) (P = 0.047). In the intervention group, no patients with delirium, agitation, respiratory depression, non-invasive respiratory ventilation, and endotracheal re-intubation were observed.

Modafinil tablet as a respiratory and brain stimulant through the central nervous system (CNS) can improve the quality of breathing and arterial blood gases (ABGs) and also can increase the level of consciousness and shorten the recovery time.

Cardiovascular disease (CVD) is one of the most important causes of mortality and morbidity in Iran. Secondary prevention of acute myocardial infarction (AMI) is necessary. The main aim of this cohort is evaluating clinical, paraclinical, management, and 5-year major events of the participants in Isfahan, Iran.

All consecutive patients with AMI hospitalized in Chamran Hospital, Isfahan, during 1 year from march 2015 were recruited and followed for 5 years. ST-Elevation Myocardial Infarction Cohort Study (SEMI-CI) has been initiated as a longitudinal study to evaluate course of patients with AMI in Iran, adherence to evidence-based secondary prevention drug, and five-year events such as death, re-myocardial infarction (REMI), re-hospitalization, congestive heart failure (CHF), and referring to another procedure [percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG), and resynchronization therapy].

A total of 867 patients with ST-elevation myocardial infarction (STEMI) with mean age of 60.91 ± 12.76 years were recruited. 705 (81.3%) subjects were men with mean age of 59.63 ± 12.59 years. 470 (54.2%) patients had anterior AMI (ant-AMI) and the rest had other types of AMI. The ejection fraction (EF) mean was 37.80 ± 11.74 percent. A total of 30 (3.5%) cases of AMI had not received reperfusion. 445 (51.4%) had primary PCI and 392 (45.2%) had thrombolysis at first revascularization strategy. In-hospital death occurred in 72 participants (8.3%). Drug during hospital included: at discharge, 767 (88.5%) received aspirin, 787 (90.7%) statin, 697 (80.4%) beta-blocker, and 480 (55.4%) angiotensin-converting enzyme (ACE) inhibitor.

According to the best of our knowledge, it is among few cohorts in Eastern Mediterranean Region (EMR) in patients with AMI. This paper showed methodology of this study in patients with STEMI and its follow-up protocol. We can use this result in policy-making for improving secondary prevention strategies.