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Background: Aortic dissection is a rare and important emergency condition, which usually involves a high mortality rate. Yet, early diagnosis of the disorder would increase the survival rate significantly. Objectives: The present systematic study and meta-analysis aimed at investigating the efficiency of D-dimer test in diagnosis of aortic dissection. Materials and Methods: The data used in this study were extracted from PubMed, Scopus, Elsevier, Springer, and Willey databases. Specificity, D-dimer, Sensitivity, and Aortic Dissection were the valid keywords used to extract the related articles. Totally, 11 papers published during 1998 - 2007 were selected. I2 index was used to assess heterogeneity across the studies. Results: A total of 596 subjects (averagely 54.5 ones in each study) were examined in the present research and 11 articles were entered into the final meta-analysis. According to the findings, the mean of the specificity test was 0.66 (0.54 - 0.78), with I2 index = 74.9% and p-value = 0.001. Additionally, the mean of the sensitivity test was 0.98 with I2 index = 606% and p-value = 0.381. Moreover, the mean D-dimer plasma level was 18.6 ug/mL in patients suffering from aortic dissection. Conclusion: This study showed the high efficiency of D-dimer test in diagnosis of aortic dissection. Thus, physicians are recommended to apply this quick and inexpensive method when a final diagnosis has not been made yet. Early diagnosis of aortic dissection via D-dimer test would result in implementation of the necessary treatments, eventually leading to a significant decrease in mortality rate. [ABSTRACT FROM AUTHOR]

Peripartum cardiomyopathy is a form of dilated cardiomyopathy that is defined as deterioration in cardiac function presenting typically between the last month of pregnancy and up to five months postpartum. As with other forms of dilated cardiomyopathy, PPCM involves systolic dysfunction of the heart with a decrease of the left ventricular ejection fraction with associated congestive heart failure. In heart failure sinus tachycardia is a poor prognostic factor and the common symptom. In this paper, we presented a case treated with ivabradine which provided additional benefit in patient with acute heart failure. [ABSTRACT FROM AUTHOR]

Background: SYNTAX scores (SS) and clinical SYNTAX scores (CSS) together are widely used in clinical practice as predictors for major adverse cardiac events (MACEs) after an elective primary percutaneous intervention (PCI). Objectives: We sought to investigate prognostic values of the combination of SS and CSS in predicting MACEs in a cohort of patients with acute myocardial infarction treated by primary PCI with a 12-month follow-up. Methods: This prospective, longitudinal study included patients from two referral hospitals who had an acute myocardial infarction and underwent primary PCI. SS and CSS were calculated by researchers blinded to patient details using web-based software and clinical factors. SS and CSS were classified into three categories: low/SS1: < 11.75, moderate/SS2: 11.75 -- 23.25, or high/SS3 > 23.25, and low/CSS1: < 22.95, moderate/ CSS2: 22.95 -- 35.95, or high/CSS3: > 35.95. We followed the patients 12 months after the procedure and recorded clinical examination results and MACEs. Data analysis included the chi-squared test (c2), student's t-test, and Cox regression analysis. Cumulative survival rates were estimated through Kaplan--Meier curve analysis. Results: Among 296 subjects, those with a MACE predominated in the SS3 (16.8%) and CSS3 (14.0%) categories. SS had a significant relationship with all-cause mortality (P = 0.015), re-infarction (P = 0.019), cardiovascular death (P = 0.03), and MACE (P = 0.04). CSS had a significant relationship with all-cause mortality (P < 0.001), re-infarction (P = 0.02), cardiovascular death (P = 0.016), and MACE (P = 0.045). The risk of death by 12-month follow-up of the SS3 patient group was 2.99 times higher than that of the SS1 group (HR = 2.99; 95% CI: 1.11 -- 7.84; P = 0.029). The CSS3 patient group had a 4.23 times higher risk of death than the CSS1 group (HR = 4.23; 95% CI: 1.94 -- 9.36; P < 0.001). According to Kaplan-Meier curve analysis, the difference in survival rates of the three patient groups categorized by SS or CSS was significant. The SS1 group had the highest survival rate of 91.8%, followed by the SS2 (85.0%) and SS3 (77.9%) groups. Regarding CSS, the CSS1 group had the highest survival rate of 93.0%, followed by the CSS2 (85.1%) and CSS3 (73.8%) groups. Conclusions: The classification of SS (low SS1, moderate SS2, high SS3) and CCS (low CSS1, moderate CSS2, high CSS3) has important roles in the risk assessment of patients with ACS treated by primary PCI. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular diseases, with an estimated 18.6 million deaths per year, are the leading cause of death worldwide. One of the major risk factors is elevated blood low-density lipoprotein cholesterol (LDL-C) secondary to multiple environmental and genetic factors. Genes involved in LDL-C metabolism are the targets of the most common treatment options. Advanced molecular techniques could pave the way for identifying novel targets in dyslipidemia therapies. The LIM domain and actin-binding 1 (LIMA1) gene binds to the NPC1L1 protein and facilitates its more efficient recycling to the plasma membrane. Inhibition of LIMA1 could disrupt cellular cholesterol hemostasis with a probable decrease in blood LDL-C levels. Objectives: The present study was designed to knock out exon 2 of the LIMA1 gene using lentiviruses as an in vitro model for reducing cholesterol absorption. Methods: A CRISPR/Cas9 system with dual guide RNAs (gRNAs) was designed to completely excise exon 2 of LIMA1. Two gRNAs (gRNA1 and gRNA2) were cloned in the LentiCRISPR v2 vector. LentiCRISPR viruses were produced in the HEK293T cell line to encode the CRISPR/Cas9 complex structure. HepG2 cell lines were transduced with two different LentiCRISPR viruses simultaneously. Results: Exon 2 deletion was detected by PCR, gel electrophoresis, and subsequent Sanger sequencing of the PCR product. Exon 2 deletion caused a frameshift mutation, and the subsequent production of nonfunctional transcripts led to gene knockout. The dual gRNA CRISPR/Cas9 system could be used in gene editing setups. Conclusions: The in vitro knockout model of LIMA1 could be considered as preliminary work to study the role and mechanism of action of the LIMA1 protein, along with its potential as a target for hypercholesterolemia therapy. [ABSTRACT FROM AUTHOR]

Context: Implementation of health information technologies such as telecardiology has always been associated with many challenges. Identifying these challenges and planning to address them can lead to success in their implementation. The present study aimed to identify the advantages and disadvantages of using telecardiology and to provide solutions for its successful implementation based on the obtained results. Evidence Acquisition: This scoping review was conducted in 2021. A search was done in PubMed, Scopus, and Web of Science databases by combining the related keywords. The data were gathered using an excel sheet data extraction form after applying the article selection steps. Then, data analysis was done through the content analysis method and the results were summarized and reported based on the study objectives. Results: Totally, 30 articles were included in the study based on the inclusion and exclusion criteria. The advantages of telecardiology were divided into eight main categories, namely facilitating healthcare providing processes, medical education, healthcare quality, increasing Health Care Providers' (HCP) performance, reducing costs, availability and accessibility of healthcare services, data management, and patient monitoring. Additionally, the challenges of telecardiology implementation were classified into six categories; i.e., economic and financial difficulties, the nature of heart disease, human resources, difficulties related to Information Technology (IT), wearable devices challenges, and uncertainty of results. Conclusion: Telecardiology systems are recommended to be used more to provide healthcare services to remote and rural areas as well as those with a lack of specialists. Due to the challenges facing the successful implementation of telecardiology, preliminary studies such as feasibility studies and acceptance and initial pre-implementation evaluations are warranted. [ABSTRACT FROM AUTHOR]

Introduction: Aortic Stenosis (AS) and Abdominal Aortic Aneurysm (AAA) typically affect elderly patients, both being associated with adverse outcomes if not adequately managed. Notably, these conditions can be present simultaneously in a significant percentage of cases. Choosing the optimal treatment for these patients is challenging and no clear recommendations are available. Yet, simultaneous treatment by the percutaneous intervention, especially in high surgical risk patients, appears attractive. Case Presentation: Herein, three cases of AAA and severe AS treated via Transcatheter Aortic Valve Implantation (TAVI) and Endovascular Aortic Repair (EVAR) within the same procedure have been reported in details for the first time. Conclusions: The results indicated that one-stage intervention was an effective, safe, and feasible treatment for these two pathologies, especially in frail patients. [ABSTRACT FROM AUTHOR]

Context: Sexual dysfunction is one of the challenges faced by heart patients. In Iran, because of the cultural structure, addressing sexual issues and problems is difficult in these patients and the follow-up of heart problems causes these patients' sexual relations to be marginalized. Considering the fact that there is no general conclusion about the prevalence and types of sexual dysfunction in these patients in the Iranian society, in order to gain comprehensive knowledge about this phenomenon, this study was conducted as a systematic review to investigate the sexual dysfunction status in Iranian heart patients. Evidence Acquisition: In this systematic review, articles published in Persian and English were retrieved from Web of Science, PubMed, Scopus, Medlib, Magiran, SID, Iranmedex, and Google Scholar databases using keywords without time limits. Then, the articles meeting the inclusion criteria were studied and analyzed. Out of the 1011 articles retrieved, 12 were reviewed and analyzed. To extract the data, two experienced researchers reviewed and analyzed the articles simultaneously, and the co-working professors of the research team evaluated the quality of the articles separately to increase the validity and reliability of the study. Results: All reviewed articles were quantitative studies. The results of extracting the findings indicated male sexual dysfunction, including erectile dysfunction, orgasmic function, sexual desire, sexual satisfaction, and marital satisfaction. In female patients, sexual satisfaction and marital satisfaction were impaired. Conclusions: According to the results, heart diseases caused sexual dysfunction in heart patients. Patients with heart diseases had significant problems, such as lack of sexual desire, sexual dissatisfaction, and decreased frequency of sexual activity. Considering the severity of this disorder in the Iranian society, the treatment team is recommended to pay serious attention to sexual relations in these patients and consider the improvement of their sexual function as an integral part of the cardiac rehabilitation function. [ABSTRACT FROM AUTHOR]

Background: Ostium secundum Atrial Septal Defect (ASD) is one of the most common congenital heart diseases. Right Anterior Minithoracotomy (RAMT) is a promising technique for surgical closure of ASD. Objectives: This study aimed to assess the safety of minimally invasive RAMT with peripheral cannulation and compare it to full median sternotomy (Conventional Median Sternotomy, CMS) regarding clinical outcomes and Health-Related Quality of Life (HRQOL) in surgical ostium secundum ASD closure. Methods: In this quantitative, cross-sectional study, all clinical records of 51 patients (30 RAMT and 21 CMS) who underwent ASDII closure between March 2016 and November 2019 were collected. The patients' HRQOL was evaluated using a Short Form-12 (SF- 12) questionnaire. The two groups' clinical outcomes and HRQOL were compared using IBM SPSS Statistics for Windows, version 23.0 (IBM Corp., Armonk, NY, USA). Results: This study was conducted on 30 patients (23 females and 7 males) with RAMT and 21 patients (10 females and 11 males) with CMS ASD closure. The two groups were similar with respect to age, left ventricular ejection fraction, preoperative hemoglobin (Hb), family status, level of education, and employment status. However, operation length, Cardiopulmonary Bypass (CPB) time, and mean aortic cross clamp time were significantly lower in the CMS group (P < 0.001). The mean amount of chest tube drainage in the first 24 hours after surgery was 148.27 ± 122.82 mL in the RAMT group and 217.50 ± 134.04 mL in the CMS group (P = 0.02). The results showed no significant difference between males and females regarding the mean CMS and total score of HRQOL. Yet, the mean score of PCS was significantly better in the female patients in the RAMT group (P = 0.03). Conclusions: Despite the longer operation and cardiopulmonary bypass time, RAMT procedure was associated with similar mortality and lower postoperative bleeding. Moreover, female patients in the RAMT group showed better physical component of HRQOL. [ABSTRACT FROM AUTHOR]

Context: The COVID-19 pandemic has involved several millions of people around the world and has dragged thousands of individuals to death. Unfortunately, it seems to be unstoppable for the near future. This review aimed to have a comprehensive appraisal on the latest studies conducted on different aspects of myocardial injury related to COVID-19. Evidence Acquisition: The researchers searched for accredited international investigations, whether original, review, letters, or commentaries or any other published data, in Pubmed/Medline, Google Scholar, Web of Science, Wiley Online Library, and Research Gate databases. Results: Although the dominant manifestation of the disease was related to the respiratory system, a growing body of evidence has suggested that the cardiovascular system was also a target for SARS-CoV-2. In this regard, myocardium suffered injury by possible direct and indirect mechanisms. Two patterns of myocardial injury were seen particularly in critical cases of COVID-19; presentation with acute myocardial injury and development of myocardial injury with escalation of the viral illness. In the case of myocardial damage, a cascade of life-threatening adverse events will deteriorate the functions of the cardiovascular system as well as other vital organs. Cardiac biomarkers are helpful for early diagnosis of myocardial injury. Hypertension, previous cardiovascular diseases, and diabetes have been considered to be the foremost clinical risk factors in the setting of COVID-19. The jeopardy of arrhythmia, thrombotic complications, acute myocardial infarction, and myocarditis are also anticipated in patients with COVID-19. Thrombolytics have been found to contribute substantially to life-saving treatment regimen. Conclusions: Cardiovascular damage in terms of myocardial injury has been assigned a considerable share in patients with COVID-19, which is of paramount importance due to the elevation of the fatality rate. While there is no exclusive medication for this viral uninvited guest, much attention should be paid to maintenance of cardiovascular health, which plays a critical role in the battlefield with COVID-19. [ABSTRACT FROM AUTHOR]

Context: The use of registries to Coronary Artery Disease (CAD) data management plays an important role in the improvement of healthcare processes and reduction of outcomes for patients and healthcare providers. The present study aimed to compare the data management processes of CAD registries in the selected countries. Evidence Acquisition: This review study was conducted comparatively in 2019. After selecting countries based on some criteria, the required data were collected by searching valid databases, more useful search engines, and related websites to CAD registries for the selected countries as well as by sending E-mails containing a data extraction form to the related organizations. Results: Totally, five registries were chosen in the selected countries as follows: CADOSA (Australia), APPROACH (Canada), START (Italy), CLARIFY (Spain), and GWTG-CAD (US). The results showed that 60% of the selected registries made use of the electronic case report form for data gathering. The main data elements included demographic and general information, risk factors, vital sings, medication, laboratory tests results, examination results, ECG results, invasive measures and interventions, patient's status on discharge, results of follow-ups, and post-discharge outcomes. Conclusion: Developing CAD registries based on the data management principles provides the context to conduct cohort studies with very low costs. With regard to the study results, attention should be paid to data management processes, include data gathering, data processing, and information distribution, in development of CAD registries. [ABSTRACT FROM AUTHOR]

Background: Ischemic Heart Disease (IHD) is the leading cause of mortality in both developed and developing countries. It accounts for more than 15% of the total mortality worldwide. At the global scale, the massive occurrence of this disease can have tremendously negative effects on economy, especially among young people. Objective: The present study aimed to investigate the relationship between IHD and several important risk factors involved. It also looked into the prevalence of IHD among patients between 20 and 40 years of age. Methods: The present cross-sectional, retrospective survey was conducted in three referral heart hospitals affiliated to Mashhad University of Medical Sciences, Iran. The required data were extracted from integrated Hospital Information System (HIS) from 2010 to 2012. The data included clinical and demographic information, such as age, gender, marital status, occupation, diabetes, blood pressure, blood cholesterol, cigarette smoking, and family history. In the next phase, clustering technique and k-means algorithm were applied using the WEKA (3-6-9) software. Results: Totally, 88623 patients suffered from heart diseases between 2010 and 2012. When the specific inclusion and exclusion criteria were considered, the number of records was restricted to 776, which included 548 males. The clustering technique was done in two phases. Firstly, there were four clusters extracted and secondly, cluster analysis was done in terms of age and gender. According to the findings, cigarette smoking in males aged between 20 and 40 years was the main risk factor. Conclusion: The present research aimed to investigate the risk factors of heart diseases among patients between 20 and 40 years of age. Those below 40 years old were known as the main human resource in the community. The early prevalence of IHD in this population disabled them for the rest of their lives. This disability could also lead to irreparable physiological effects along with financial costs. It could also impose high costs on the society. Recognition of the risk factors of heart diseases at younger ages could contribute to healthcare policies. [ABSTRACT FROM AUTHOR]

Background: Coronary Artery Disease (CAD) is a major cause of morbidity and mortality world-wild. Thus, its early diagnosis and treatment could be life-saving. Mitral Valve (MV) and mitral annular velocities as well as left atrial and left ventricular wall strain have been claimed to be helpful for prediction of the presence of CAD. Objectives: This case-control study aimed to assess the predictive value of these echocardiographic parameters for detection of CAD. Methods: Eighty consecutive individuals referring with acute angina-like chest pain and requiring diagnostic coronary angiography and had a concomitant echocardiographic Left Ventricular Ejection Fraction (LVEF) ≥ 50% were divided into two groups: those with significant CAD (n = 45) and those with non-significant CAD (n = 35). Tissue Doppler Imaging (TDI) was employed for all participants. Peak early and late MV velocities (E and A, respectively), peak longitudinal systolic myocardial velocity (mitral S'), peak early and late diastolic velocities (e' and a', respectively) from medial mitral annulus, E/e' ratio, peak Left Atrial (LA) strain, and Left Ventricular Global Longitudinal Strain (LV GLS) were measured and compared in the two groups. Chi-square and t-test were used to compare the two groups as appropriated. Multiple logistic regression was also performed to detect the impact of categorical variables on the predictors of the presence of CAD. Receiver operating characteristic curves were constructed as needed. A P value ≤ 0.05 was considered to be statistically significant. Results: Mitral S' and E/e' were significantly different in the two groups. Mitral S' was lower and E/e' was higher in the patients with CAD compared to the control group (P = 0.01 and P = 0.03, respectively). Considering 5.3 cm/sec as the cut-off point for mitral S', sensitivity and specificity for significant CAD were 67.40% and 68.60%, respectively with an odds ratio of 0.275. The cut-off point for mitral E/e' was defined as 12.65, with sensitivity and specificity for significant CAD to be 52.17% and 77.14%, respectively with an odds ratio of 1.249. Conclusion: This study showed that mitral S' and E/e' could predict the presence of significant CAD in patients with chest pain and preserved LVEF. Thus, TDI could be used as a simple, reliable, and non-invasive tool to achieve this goal. [ABSTRACT FROM AUTHOR]

Background: Venous Thromboembolism (VTE) is a global cause of morbidity and mortality with annual incidence rates between 0.75 and 2.69 per 1000 individuals in the population. Despite the large variety of VTE prophylactic solutions and the availability of several guidelines for their use, appropriate prophylaxis practices are not ideal in many healthcare facilities around the world. Objectives: The present study aimed to evaluate the extent of administration of the recommended prophylactic treatment to hospitalized patients at risk of VTE according to local protocols and/or national/international guidelines. Methods: This observational, cross-sectional study was conducted on 1256 medical and surgical patients from 26 sites across the Near East region. The patients' records were screened for the fulfillment of inclusion/exclusion criteria during a single visit. The proportion of medical and surgical patients who were at risk of VTE and the thromboprophylactic measures employed by physicians for these patients were assessed. Results: The results demonstrated that 559 patients (52.2%) did not require thromboprophylaxis. Yet, 17.8% were inappropriately administered a prophylactic treatment. Out of the 512 patients at risk of VTE, 443 were eligible for drug prophylaxis. However, 50% received the recommended treatment. Furthermore, significant variations were observed among centers in different countries regarding prophylactic measures in critically ill, cancer, chronically immobilized, and non-orthopedic surgery patients. Conclusion: Despite the universal acknowledgment of the seriousness of VTE, the employment of thromboprophylaxis remains suboptimal in the Near East region. A considerable number of hospitalized patients are not receiving any VTE prophylaxis or are given inappropriate treatments. Further studies are required to assess and compare compliance rates prior to and following the implementation of such quality improvement projects. [ABSTRACT FROM AUTHOR]

Introduction: Coronary Artery Anomalies (CAAs) are rare, with their prevalence ranging from 0.6% to 1.3%. Case Presentation: A 33-year-old man with no previous medical history was referred to the emergency department with Sudden Cardiac Arrest (SCA) while playing soccer. Systematic assessment revealed that the SCA was caused by a scarce CAA; the Left Anterior Descending (LAD) artery arising from the Right Sinus of Valsalva (RSV). There was also Left Ventricular (LV) systolic dysfunction with an LV ejection fraction of 35%. The patient subsequently underwent single vessel coronary artery bypass grafting of the Left Internal Mammary Artery (LIMA) to LAD as well as cardioverter-defibrillator placement and had no further incidence of SCA. Conclusions: Comprehensive knowledge of CAAs and the related symptoms shortens the time to correct diagnosis and initiation of proper management and is likely to reduce the frequency of complications. [ABSTRACT FROM AUTHOR]

Background: Mechanical PR Interval (MPRI) is an important parameter in the fetus as a surrogate for PR interval. Normal values of MPRI have been reported with controversial effects of Fetal Heart Rate (FHR) and Gestational Age (GA). However, the effect of HR-correction on PR interval is unknown. Objectives: This study aimed to obtain the reference values of fetal MPRI in a large series of normal fetuses by pulsed-Doppler fetal echocardiography. This was done to determine the influence of fetal sex, Heart Rate (HR), GA, and maternal age on MPRI and to calculate the novel HR-Corrected Mechanical PR Interval (CMPRI) to investigate whether HR-correction of PR interval can decrease the influence of HR. Materials and Methods: This cross-sectional study was performed on 516 consecutive normal singleton fetuses. By extrapolation from Bazett's formula, we corrected the MPRI for HR. Impact of fetal sex, HR, and GA on MPRI and CMPRI was studied. Mean ± standard deviation, 5th, 50th, 95th, and 99th percentiles of MPRI and CMPRI were also calculated. Then, the data were entered into Stata, version 12 and analyzed using t-test, ANOVA, and linear regression. Results: Reference values of MPPR and CMPRI were provided in four GA groups; i.e., 14 - 18, 19 - 22, 23 - 26, and 27 - 38 weeks. Fetal sex and maternal age had no influence on either MPRI or CMPRI. After adjustment for fetal sex, GA, and maternal age, there was a 0.14-millisecond (ms) decrease in MPRI and a 8.06-ms increase in CMPRI for every single increase in FHR. Additionally, adjusted linear regression model indicated a 0.43-ms increase in MPRI and a 2.53-ms increase in CMPRI per gestational week. The results of paired t-test showed no significant difference between fetal MPRI and neonatal PR interval. Conclusions: This study provided reference values for MPRI and CMPRI in fetus from 14 to 38 weeks of gestation from the 5th to the 99th percentile. The results also revealed significant correlations between both FHR and GA and MPRI and CMPRI. Furthermore, HR correction of MPRI did not add any advantage in terms of HR-independency of mechanical PR interval. [ABSTRACT FROM AUTHOR]

Background: Acute Heart Failure (AHF) is a common cause of hospitalization in many countries. Rehospitalization due to AHF is also a very important economic issue for health services. Registries for AHF have been made in many countries to characterize such patients, which have provided great information about these patients for better care. To date, there is insufficient information about these patients in Iran and their rehospitalization and short- and long-term follow-up is unclear. Objectives: This study aims to describe the results of a small registry of AHF (HFrEF) patients in Iran and their short-term follow-up. Patients and Methods: This study aimed to describe the earliest results of the AHF registry, which was started from September 2015 in two hospitals (Afshar Heart Center in Yazd and Rajaie Heart Center in Tehran). All patients with diagnosis of AHF and HFrEF were enrolled into this registry. During six months, 352 patients with diagnosis of AHF and HFrEF were entered into this registry. The patients' demographic, clinical, and Para clinical data were collected during hospitalization and they were followed up for all-cause mortality and hospitalization for three months. Patients suffering from heart failure with preserved ejection fraction were excluded because of their small number and incomplete data. Results: The mean age of the patients was 55 ± 16 years and 76% were male. Besides, 77% of the patients had acute decompensation of chronic heart failure and 17% had new-onset AHF. Etiology of heart failure was ischemic heart disease in 52% of the patients. Additionally, the mean left ventricular ejection fraction was 20%. Moreover, length of hospital stay was 10.5±10 days and in-hospital mortality rate was 9.7%. Conclusions: This small and limited registry of patients with AHF (HFrEF) in Iran delineated these patients' characteristics with some discrepancies and similarities with western registries. Thus, a larger nationwide registry is needed for further clarification of the issue. [ABSTRACT FROM AUTHOR]

Background: Carotid disease is one of the many forms of cardiovascular disease, which may lead to chronic disability and death. It is a multifactorial inflammatory disease, greatly affected by an individual's habits like smoking, lack of exercise, and a diet high in fats. MicroRNAs (miRs) are known to be involved in vascular inflammation. Objectives: We aimed to analyse in a case-control study the expression profile of selected miRs from patients with symptomatic carotid disease and to examine their involvement in the disease pathogenesis. Patients and Methods: Samples from 38 symptomatic patients who underwent carotid endarterectomy were collected and adjacent healthy regions from 15 patients were used as control samples. Fold change in the expression of miR21, miR122, miR146a and miR196α was measured using reverse transcription-real time PCR. Western blot was used to quantify the levels of MMP2 protein whose gene is a target of miR21. Results: Compared to control samples, all patients showed upregulation of miR21, miR122, miR146a and miR196a. No statistical significance was found to exist from patients with high or low miRs expression and clinical/laboratory parameters. The levels of MMP2 were found to be decreased in patients when compared to control samples. Conclusions: Our results revealed miRs which showed different expression in endarterectomy specimens from patients with symptomatic carotid disease, suggesting that these miRs correlated with vascular inflammation. Furthermore, mir21 seems an appealing pharmaceutical target since by targeting MMP2 can favour a stable plaque since low levels of the protein of its gene MMP2 target prevent the fibrous cap of the atheroma from getting thinner. Thus, miR21 seems to prevent rupture but further research is required. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular disease (CVD) is the most common cause of mortality and morbidity worldwide. Coronary artery disease (CAD) is the leading cause of CVD. In CAD, atherosclerotic plaques lead to coronary artery stenosis, hereby impairing myocardial blood and oxygen supply. The oxidative changes in LDL at the vascular wall play a critical role in the development of atherosclerotic lesions. The paraoxonase 1 (PON1) enzyme present in the HDL surface is capable of destroying oxidized LDL and, therefore has an antiatherogenic activity. Objectives: This study was conducted to investigate the association of two functional polymorphisms in PON1 gene with CAD in northern Iran. Materials and Methods: This study was a case-control study with the case-base sampling method for the control group. Genomic DNA was extracted from the peripheral blood collected from 305 patients with CAD and 302 healthy controls. Two polymorphisms of PON1(L55M)T > A and PON1(Q192R)A > G, for all samples were genotyped by Single-Specific Primer-PCR. GraphPad6 software was used for statistical analysis. Results: Logistic regression analysis showed that age, gender, smoking status, and diabetes mellitus were significantly associated with CAD disease (P < 0.001). There was a significant association between genotype A/A of PON1(L55M)T > A polymorphism and CAD disease (P = 0.011). The results indicated that allele A in this SNP was also significantly associated with the CAD disease (P = 0.005). Analysis of dominant genetic model in PON1 (L55M)T > A showed that one copy of A is sufficient for increased risk (P = 0.016). Conclusions: Our findings, at least in the population of Golestan province, indicated that the PON1(L55M) polymorphism might be associated with atherosclerotic disease. [ABSTRACT FROM AUTHOR]

Background: Implantable Cardioverter Defibrillator (ICD) is an acceptable treatment method in patients suffering from life-threatening ventricular dysrhythmias. In spite of many advantages, ICD can lead to many challenges in living for these patients. Therefore, understanding these experiences can lead to improvement of holistic care and treatment of these patients. Objectives: This study aimed to identify and describe the patients' experiences of living with ICD. Materials and Methods: This qualitative study was conducted using interpretative phenomenological approach. The participants who were selected through purposive sampling included 4 women and 6 men (mean age: 43.1 ± 1.6 years). The data were gathered through semi-structured interviews and field notes from November 2013 to December 2014. The data were also analyzed simultaneously using Van Manen's proposed stages. Results: Analysis of the data resulted in emergence of 4 themes and 11 subthemes representing the dimensions of the patients' lived experiences with ICD. These themes included "compromised self-identity", "crossing the border of the unknown", "fluctuation in the adjustment path", and "surrounded by changes". Compromised self-identity was manifested through "loss of prestige", "changes in body image", and "being hurt by the battery label". "Unpredictable situation", "rise and fall", and "internal turmoil" were the main axes of crossing the border of the unknown. In addition, fluctuation in the adjustment path included "wandering to cope with ICD" and "institutionalization of ICD in life". Considering the patients' descriptions of surrounded by changes, "family changes", "social role changes", and "change in manifestation of routines" were of great importance. Conclusions: This study allowed in-depth identification of aspects of living with ICD. The results also promoted the ability of nurses to understand and interpret the views of patients about living with ICD. In this way, the quality of patient care becomes more favorable, resulting in improvement of the patients' satisfaction. It can also provide a basis to conduct further researches on different aspects of prevention, care, treatment, and rehabilitation of these patients, leading to strengthening of the nursing research body. [ABSTRACT FROM AUTHOR]

Background: The Coronary artery disease (CAD) occurs as a result of atherosclerotic plaque formation. The interferon gamma (IFNγ) as a multifunctional cytokine is involved in inflammatory processes in atherosclerosis. Objectives: We investigated the relationship between IFNγ (+874T/A) SNP with CAD. Moreover, we compared IFNγ mRNA expression in CAD patients and healthy controls. Patients and Methods: This case-control study with randomized sampling included 300 patients with CAD and 301 normal controls. The SSP-PCR method was used for genotyping IFNγ (+874T/A) gene polymorphism. Quantitative Real-Time PCR was performed to measure IFNγ mRNA expression. All data was analyzed by GraphPad software. The chi-square and ordinal logistic regression tests were used to analyze differences in genotype frequencies. Results: In this study, there was a significant association between male genders with CAD (P < 0.001). There was a significant association between genotype T/T and Allele T of IFNγ (+874T/A) polymorphism with CAD (P = 0.021 and P = 0.022, respectively). The inheritance model analysis showed that two copy of allele T is required for increased risk in CAD (P = 0.031). There was a significant association between the genotype T/T of IFNγ (+874T/A) polymorphism with CAD patients with double and triple vessel disease (P = 0.030 and P = 0.013, respectively). The IFNγ mRNA level in CAD group was significantly higher than control group (P = 0.024). Conclusions: Conclusions: IFNγ gene functional polymorphism can be associated with incidence and severity of CAD. IFNγ mRNA level was also increased in CAD patients in comparison with controls. Therefore, IFNγ may play a role in predisposition to CAD. [ABSTRACT FROM AUTHOR]

Background: Surgical Aortic Valve Replacement (SAVR) is the gold standard method for treatment of symptomatic severe senile Aortic Valve Stenosis (AS). For inoperable patients, due to severe co-morbidities, Transcatheter Aortic Valve Implantation (TAVI) has been suggested as a new and safe alternative with significant follow up superiority to medical treatment; recently, it was suggested for patients at intermediate risk, as well. Since its introduction in 2002, TAVI has well developed in more than 40 countries. Objectives: We made an attempt to transfer this technology to Tehran University for the first time and then evaluated the feasibility and safety of this new technique with midterm closed clinical and echocardiographic follow up. Patients and Methods: Eight patients (5 males), with a mean age of 77 ± 6.7 years old underwent transfemoral TAVI from 2010, as the first sequential patients in Tehran University, by Balloon expandable bioprosthetic Edwards SAPIEN transcatheter heart valve, under general anesthesia in hybrid operation room. Results: There were 7 tricuspid valves and one bicuspid aortic valve (AV). All the patients had symptomatic severe senile valvular AS with severe co-morbidities so that the surgeons did not agree with open SAVR. Closed preprocedural, procedural, in hospital, one and 6 months clinical and echocardiographic assessments and follow up were done. Results: Procedural success rate was 100% with good implantation of the valve. A decrease in the AV mean gradient (MG) from preprocedural mean AVMG 52.2 ± 19.7 mm Hg to 9.8 ± 3.7 mm Hg was observed in the 6 month follow up. One patient had procedural papillary muscle damage and moderate mitral regurgitation (MR), which needed hemodynamic support. No in hospital mortality or major complications were seen. In the follow up period, one patient had unexplained sudden death in sleep 3 weeks after the discharge. The other 7 patients had good 6 months of follow up with improvement of Functional Class (FC) and Left Ventricle Ejection Fraction (LVEF) from mean 43 ± 13.5 % preprocedural to 50.7 ± 7.8% within 6 months. Conclusions: Inoperable symptomatic senile valvular AS could be treated safely with TAVI. In- hospital results of the first sequential experience of TAVI in Tehran University of Medical Sciences were successful. TAVI in bicuspid AS and concomitant MR patients needs more caution in the procedure and follow up. [ABSTRACT FROM AUTHOR]

Idiopathic right atrial dilation is known as a congenital anomaly in the absence of obvious causes that produce right ventricular pressure or volume overload. Congenital giant right atrium can cause functional tricuspid regurgitation, arrhythmia, and right-sided heart failure. A massive Idiopathic Dilation of Right Atrium (IDRA) was reported in a 30-year-old man presented with intermittent palpitation and dyspnea on effort. Transthoracic echocardiography revealed huge right atrium leading to severe tricuspid regurgitation, moderate right ventricular enlargement with moderate dysfunction, and no evidence of other valvular heart diseases increasing the right ventricular pressure or volume, left to right shunt, and Ebstein anomaly. Cardiac Magnetic Resonance Imaging (MRI) confirmed the right atrial enlargement. The estimated right atrium volume by MRI was about 700 mL. With regard to the patient's symptoms, he was scheduled for surgical treatment. The patient underwent partial surgical resection of the dilated right atrium wall and mechanical tricuspid valve replacement because the tricuspid valve was unrepairable on the operation table. Idiopathic right atrial enlargement is a very rare disease and may be easily confused with other anomalies that lead to right atrial enlargement, such as Ebstein anomaly. Hence, the probability of this pathology should be kept in mind when the usual etiologies of right atrial enlargement are excluded. Partial surgical resection of the dilated right atrium is an effective therapeutic option in symptomatic patients. [ABSTRACT FROM AUTHOR]

Background: Resveratrol has beneficial effects on experimental and clinical hypertension and diabetes. Objectives: This study aimed at examining antidiuretic and antihyperlipidemic effects of resveratrol in rats with simultaneous type II diabetes and endovascular hypertension. Materials and Methods: This study was performed on eight groups of male Spargue-Dawley rats each containing 8 - 10 animals as follows: control, diabetic (induced by streptozotocin and nicotinamide), renovascular hypertensive (induced by placing Plexiglas clips on the left renal arteries), sham, simultaneously hypertensive-diabetic receiving vehicle (distilled water), and 3 simultaneously hypertensive-diabetic groups receiving 5, 10, and 20 mg/kg/day resveratrol. Blood pressure and heart rate were measured weekly and fasting blood glucose, serum cholesterol, triglyceride, and markers of oxidative stress were measured after 4 weeks of treatment with resveratrol vehicle. The data were analyzed using one-way Analysis of Variance (ANOVA) and Duncan's multiple range tests. Data analysis was done using SigmaStat software and P < 0.05 was considered to be statistically significant. Results: Serum malondialdehyde, systolic blood pressure, heart rate, fasting blood glucose, blood glycated hemoglobin, and serum triglyceride, total cholesterol, and low-density lipoprotein cholesterol levels were significantly higher in the hypertensivediabetic group receiving vehicle compared to the control group (P < 0.05) and treatment with resveratrol significantly reduced these variables (P < 0.05). On the other hand, serum superoxide dismutase, glutathione reductase, and high-density lipoprotein cholesterol levels were significantly lower in the hypertensive-diabetic group receiving vehicle compared to the control group (P < 0.05) and treatment with resveratrol significantly increased these variables (P < 0.05). Conclusions: The findings indicated that resveratrol had antidiabetic, antihypertensive, and antihyperlipidemic effects, which might be partly due to an antioxidant mechanism. [ABSTRACT FROM AUTHOR]

Background: Although several studies have been conducted on the association between lipid profile and sexual function among men with coronary artery disease, there is a paucity of knowledge about this association among women with coronary artery disease. Objectives: Our study aimed to evaluate the link between lipid profile and sexual function in men and women with coronary artery disease. Methods: One hundred and twenty patients with documented coronary artery disease were consecutively sampled from an outpatient cardiovascular clinic. he patients were assessed for lipid profile and sexual relationship using the Relation and Sexuality Scale (RSS). In addition, the Hospital Anxiety and Depression Scale (HADS) was used to measure the symptoms of anxiety and depression. he characteristics of chest pain were also measured using the Rose Angina Questionnaire. he data were analyzed through linear regression analysis. Results: his study was conducted on 91 males (75.8%) and 29 females (24.2%). Multivariate analysis showed that low-density lipoprotein cholesterol was correlated with sexual function (B = 0.01, P = 0.010) and total sexual relationship (B = 0.01, P = 0.050). A correlation was also observed between the level of high-density lipoprotein and sexual frequency score (B = -0.02, P = 0.040). Gender moderated these correlations. Among males, serum cholesterol (r = 0.193, P = 0.047) and low-density lipoprotein (r = 0.224, P = 0.037) were correlated to sexual function. In females, however, low-density lipoprotein was correlated to the total sexual relationship (r = 0.426, P = 0.021) and high- density lipoprotein was correlated to sexual frequency (r = -0.334, P = 0.046). Conclusions: he findings of this study showed a relationship between lipid profile and sexual relationship among both male and female patients with coronary artery disease. he link between lipid profile and sexual function of the patients with coronary artery disease is thus beyond just the effect of lipid profile on erectile dysfunction. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate the interaction between gender and other socio-economic characteristics on sleep quality of the patients with Coronary Artery Disease (CAD). Methods: This cross sectional study was conducted on 717 patients with CAD. The socio-economic status (education level, income, marital status, and place of residence) was considered as the independent variable. Besides, the study outcome was the quality of sleep which was measured using Pittsburgh Sleep Quality Index (PSQI). Gender was considered as a possible effect modifier. Two-way ANOVA was used to evaluate the interaction between gender and socio-economic factors on sleep quality. As defined by Baron and Kenny, moderator was defined as a variable that affected the direction or magnitude of the association of interest. Results: Female gender, low education level, and low income were predictive of poor sleep quality. Among female (10.0 ± 4.3 vs. 7.6 ± 5.0, P < 0.05), but not male patients (6.7 ± 4.2 vs. 7.0 ± 4.2, P > 0.05), low education was associated with poor sleep quality. Also, among female (10.0 ± 4.3 vs. 5.7 ± 2.5, P < 0.05), but not male patients (7.0 ± 4.2 vs. 6.0 ± 3.8, P > 0.05), low income was predictive of poor sleep quality. Gender did not modify the effect of other socio-economic factors on sleep quality. Conclusions: Among female but not male patients with CAD, low education and income were associated with poor sleep quality. This information helps us better understand the mechanisms behind the poor sleep quality of the female patients with CAD. This is important because poor sleep is a prognostic factor among the CAD patients. [ABSTRACT FROM AUTHOR]

Background: This study was performed to determine the changes in corrected QT (QTc) and QT dispersion and their relationship with end-stage liver disease score in the children undergoing orthotopic liver transplantation. Methods: This case-control study was performed in a 2-year period from February 2009 to March 2011 in Department of Organ Transplantation of Nemazee Hospital. We consecutively included all the 22 pediatric patients undergoing orthotopic liver transplantation and 22 healthy age- and sex-matched controls. Electrocardiogram (ECG) was performed for all the patients and controls before and 6 months after the transplantation and the QTc was calculated according to Bazett's formula in lead I, aVF, and V1. Besides, QT dispersion was calculated by the difference between maximum and minimum QTc in the three leads. The data were statistically analyzed using independent sample t-test, chi-square test, paired t-test, and Pearson correlation analysis. In addition, P value < 0.05 was considered as statistically significant. Results: The patients with end-stage liver disease had significantly longer QTc dispersion (P = 0.002) compared to the controls. The post-transplantation QTc dispersion (P = 0.003) was also significantly longer compared to the healthy controls. Moreover, pretransplant QTc dispersion was negatively correlated with weight (r = -0.589, P = 0.004) and Child-Pugh score (r = -0.549, P = 0.008). Conclusions: The patients with ESLD awaiting liver transplantation suffer from prolonged QTc interval predisposing them to ventricular tachycardia. The QTc prolongation in these patients does not response to liver transplantation. This study revealed a fine negative correlation between the Child-Pugh score and QTc. [ABSTRACT FROM AUTHOR]

Background: The main complication of Kawasaki disease is the Coronary Artery (CA) involvement and long term follow up of patients depends on the severity of coronary arterial aneurysms, ischemia, and thrombosis. Early diagnosis of these complications can lead to a more desirable outcome for patients. Myocardial ischemia can prolong QT dispersion and increase the risk of cardiac arrhythmias as well as sudden cardiac arrests. Also, T wave peak-to-end (Tp-Te) interval dispersion, which provides a valuable index of transmural dispersion of repolarization, can trigger the arrhythmia. Methods: We evaluated the non-corrected QT interval dispersion (QTD) and the corrected QT (QTc) dispersion and measured Tp-Te interval dispersion in 49 Iranian children (28 males and 21 females) with the diagnosis of Kawasaki disease (KD) in the acute phase and 49 age-matched controls in a prospective study from 2009 to 2012. Student's t-test and Pearson correlation were used to analyze the data. All the statistical analyses were performed through the SPSS 16. Besides, P<0.05 was considered as statistically significant. Results: Patients with KD had significantly longer QTc dispersion (0.099±0.055 s versus. 0.040±0.018 s; P<0.001), non-corrected QT dispersion (0.075±0.046 versus 0.042±0.019; P<0.001), and Tp-Te dispersion (0.047±0.054 versus 0.022±0.011; P=0.015). The patients with elevation in white blood cell count (above 15000) had a statistically significant increased in QTD (P=0.011). No significant correlation was found between coronary involvement and repolarization indexes. Conclusions: In conclusion, the QT interval (corrected or non-corrected) and the Tp-Te dispersion significantly increased in t he patients with KD which shows repolarization changes during the acute phase of KD. However, there is no correlation between the QT interval and the coronary involvement. [ABSTRACT FROM AUTHOR]

Background: Coronary Artery Disease (CAD) is the most important cause of mortality in the world. About half of cardiovascular risk factors have not been completely understood. Oxidation of LDL by oxidants such as iron plays a central role in atherogenesis. As a result, evaluation of the iron stores is important in the risk evaluation of the atherosclerotic disease. Methods: This cross sectional study was performed on 337 patients with chronic stable angina hospitalized in Sari heart center, Mazandaran University of Medical Sciences from February 2010 to July 2012. Coronary angiography was performed and the angiograms were evaluated by two cardiologists. Moreover, blood samples were collected after a 14-hour fast immediately before the coronary angiography in order to measure the total cholesterol, HDL- cholesterol, and glucose. The patients were divided into four groups to evaluate the severity of Coronary Artery Disease (CAD) according to Syntax scoring system. Results: The study results revealed a significant difference among the four study groups regarding the iron serum level. It was significantly higher in the sever atherosclerosis group compared to the normal (P=0.0122), mild (P=0.023), and moderate CAD groups (P<0.001). Conclusions: The findings indicated that the serum level of iron was higher in the atherosclerotic patients and increased with the severity of CAD. Therefore, a basic relationship probably exists between the serum iron level and CAD. Further prospective and experimental studies are needed to confirm the association between the iron status and atherosclerosis. [ABSTRACT FROM AUTHOR]

Background: Aortic Valve Replacement (AVR) is usually done through median sternotomy. The present study aimed to compare the right anterolateral thoracotomy and median sternotomy approaches for AVR. Methods: The present prospective study was conducted on 60 patients who had aortic valve disease and were subjected to AVR. Thirty patients underwent aortic valve replacement via right anterolateral thoracotomy (study group) and thirty patients via median sternotomy (control group). Statistical analysis was done using Mann Whitney U test and Fischer's Exact test. Statistical Package SPSS 17 was used for data analysis. Results: The mean length of the incision was 18.7±1.8 cm in the patients who had undergone AVR through median sternotomy, while 7.8±0.9 cm in the study group patients. Besides, the mean bypass time was 121.8±18.6 minutes for the patients who had undergone AVR through median sternotomy, while 122.1±20.8 minutes for the study group. In addition, the mean aortic cross clamp time was 67.7±13.4 minutes for the patients who had undergone AVR through median sternotomy, while 68.0±8.9 minutes for the study group. The mean operating time was 181.6±31.5 minutes for the patients who had undergone AVR through median sternotomy, while 190.8±29.8 minutes for the study group. Patient satisfaction with respect to cosmesis was higher in the study group. Only 50% of the patients who had undergone AVR through median sternotomy in comparison to 73.3% of those in the study group were satisfied with the cosmesis. Conclusions: The right anterolateral thoracotomy approach for aortic valve replacement proved to be easy to perform whilst maintaining the maximum security for the patients. Besides its better cosmetic result especially in female patients, this approach proved to have several advantages. [ABSTRACT FROM AUTHOR]

Objectives: Transposition of Great Arteries (TGA) is a serious congenital heart disease and anatomic correction in the first few weeks of life has revealed good outcomes nowadays. In this study, we aimed to evaluate the myocardial and valvular function at midterm postoperative follow-up. Patients and Methods: In this study, thirty-three patients with TGA and Arterial Switch Operation (ASO) were evaluated by 2-dimensional, M-mode, Doppler, and pulsed Tissue Doppler. These patients were compared with 33 healthy children of the same age and gender as the normal control group. Student's t-test and Pearson correlation were used to analyze the data. Besides, P<0.05 was considered as statistically significant. Results: The mean follow up time was 40.9±5.6 months. Among the 33 patients with ASO, 6% had mild pulmonary stenosis, while 3% had mild pulmonary insufficiency. Aortic stenosis and aortic insufficiency of trivial to mild degree was seen in 12% and 12% of the patients, respectively. The patients' systolic velocity of tricuspid (S), early diastolic velocity of tricuspid (Ea), and late velocity of tricuspid valve (Aa) were significantly different from those of the controls (P<0.001). Also, pulmonary annulus diameter was significantly dilated in the patients compared to the controls (1.67±0.41 vs. 1.29±0.28, P⩽0.001). Besides, aortic annulus diameter (1.56±0.42 vs. 1.24±0.21, P=0.001) and also aortic sinus diameter (2.06±0.41 vs. 1.44±0.34, P=0.002) were significantly dilated, while sinutuboar junction diameter (1.65±0.5 vs. 1.28±0.29, P=0.094) was not dilated. Left ventricular function was in the normal range. Conclusions: This study showed good left ventricular function, but some abnormalities in lateral tricuspid tissue Doppler velocities. Neoaortic and pulmonary diameters were significantly dilated, while aortic and pulmonary insufficiencies were clinically insignificant in most of the patients. Long-term follow-up is necessary in these patients. [ABSTRACT FROM AUTHOR]

Background: Prevalence of obesity is rapidly rising. To reverse the obesity epidemic, efforts should be made to incorporate intensive weight loss programs into medical practice. The primary aim of this study was to change the behavior for achieving a mean weight loss of 5-10% of initial body weight over 6 months in overweight and obese adults. Methods: In this quasi-experimental study, 266 out of 533 subjects screened for coronary heart disease risk factors in Shiraz Healthy Heart House were overweight or obese. 140 individuals with BMI⩾25 completed this study's 6 month program. The subjects were visited on day 1 and at 2 week intervals and taught intensive lifestyle modification. The subjects who did not lose 5% of their initial body weight after 3 months were assigned to receive 120 mg orlistat three times daily for 3 months in addition to counseling sessions. The main outcome measures were body weight and BMI. Results: The mean weight and BMI of participants were 78.6±10.7 kg and 30±0.2 kg/m2, respectively. Women included 58% of the sample. 110 subjects (78.5%) lost ⩾5% of their initial body weight during 3 months. The Mean weight and BMI loss in these subjects were 7.6±0.8 kg and 2.4±0.3 kg/m2, respectively. Conclusions: Teaching of how to modify lifestyle and to gain more self-control with eating have the major role in reducing weight and BMI. So, training accompanied by continual follow up for performing the instructions could lead to favourable results. [ABSTRACT FROM AUTHOR]