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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]

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]

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: 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: 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: 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]

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]

Background: Thalassemia is a hereditary hemoglobinopathy whose most common complication is cardiac involvement which ends up in these patients' death. Since troponin is a sensitive and specific marker for the detection of microinfarct, we studied the relationship between troponin and ferritin serum levels for early diagnosis of cardiac involvement in these patients. Materials and Methods: This case-control study was performed on 80 patients, including 40 patients with major thalassemia and normal echocardiography and 40 healthy volunteers ranging from 6 months to 16 years old. All the children were examined and the eligible children who were not infected with known heart disease, iron deficiency anemia, kidney disease, diabetes, fever, and systemic diseases were enrolled into the study after obtaining written informed consents from their parents. At 8:00 A.M. before breakfast, 5cc blood was drawn from these children. After collecting the samples, ferritin and troponin serum levels were evaluated using ELISA and electrokymonolonsense methods, respectively. The gathered data were analyzed through the SPSS statistical software (v. 20) and T-test. Besides, P value<0.05 was considered as statistically significant. Results: The study results revealed a significant difference between the two groups regarding the mean of the serum levels oftroponin (P=0.045) and ferritin (P=0.001). In this study, no significant correlation was observed between serum troponin and ferritin levels and age and BMI in the two groups. Also, no significant relationship was found between serum troponin level and sex (P=0.264). Conclusions: In microinfarct, troponin increases independent of ferritin; therefore, it can be used for early detection of cardiac involvement in thalassemia patients to determine the sub-clinical effects. [ABSTRACT FROM AUTHOR]

Background: Traditional cardiovascular risk factors are strong predictors of an increased likelihood for premature CHD. Considering the benefits of risk factors" management, it is imperative to find and treat them before looking for more unknown and weak risk factors. Objectives: Limited information is available about the demographic and historical characteristics of the patients with premature Coronary Heart Disease (CHD) in IR Iran. The main objective of this study was to determine the prevalence of the traditional risk factors in these patients. Also, the researchers hypothesized that there are insufficient risk assessment and preventive intervention methods for the asymptomatic adult population. Methods: This study was conducted on 125 patients with premature CHD (age<50 years) who were admitted in two academic hospitals with acute coronary syndromes. The patients were accepted since they had a definite CHD on the basis of acute myocardial infarction (elevated cardiac enzymes) or documented CAD in coronary angiography. Results: The mean age of the study population was 42.50+5.65 (26 to 49 years). Among the patients,92 (73.6%) were male, 113 (90.4%) were married, 58 (46.4%) were smokers,19 (15.2%) were opium users, 97 (77.6%) had dyslipidemia, 44 (35.2%) had hypertension, and 33 (26.4%) had diabetes mellitus. In addition, family history was presented in 54 patients (43.2%). Among the study population, 120 patients (96%) had at least one of the traditional risk factors, including dyslipidemia, hypertension, diabetes mellitus, cigarette smoking, and family history of CHD. However, none of the dyslipidemic patients had controlled total cholesterol, LDL, HDL, and triglyceride. Also, none of the diabetic patients had hemoglobin A1C<7%. Among the 44 hypertensive patients, blood pressure of 15 ones (34%) was within the normal range. Besides, only 3 patients (2.4%) had regular physical activity (at least 30 minutes, three times a week). Conclusions: Premature Coronary Heart Disease is a public health problem. However, there is lack of effective and intensive treatments of well-defined traditional risk factors and prevention methods for the majority of the patients experiencing premature CHD. In sum, there is still plenty of room for improvement of risk management in IR Iran. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to evaluate the differences of obesity rate among three ethnic groups in northern adults in IR Iran in 2010. Methods: The present cross-sectional, analytical study was conducted on 2994 cases of the same age and sex in three ethnic proportions (Fars-native=1625, Turkman=977, and Sisstani=392). The subjects aged between 15 and 65 years old and were selected by multistage cluster sampling techniques including 150 clusters each containing 20 subjects in urban and rural areas in 11 districts in Golestan province (northern IR Iran). Obesity was defined after WHO classification by BMI (Body Mass Index) equal or over 30 kg/ m². SPSS 16.0 software was used for statistical analysis and P value<0.05 was considered as statistically significant. Results: Mean±SD of BMI in Fars-native, Turkman, and Sisstanish ethnic groups was 26.72±5.56, 26.18±5.34, and 24.59+6.72 kg/m², respectively. Averagely, obesity was common in 22.8% of the subjects and was significantly higher among the females compared to males (32.3% vs13.3%) (P=0.001). Also, its prevalence was estimated as 25%, 22.6%, and 14% in Fars-native, Turkman, and Sisstanish ethnic groups, respectively. Statistical differences were significant among the three ethnic groups (P=0.001). The risk of obesity was 2.041 [95% CI, 1.502-2.722] in Fars-native and 1.781 [95% CI, 1.298-2.472] in Turkman groups compared to Sisstanish ethnic group. Conclusions: Over one out of five adults in northern IR Iran suffer from obesity and an alarming rate was shown among the women. Among the three ethnic groups, the highest and the lowest rates were seen in Fars-native and Sisstanish ethnic groups, respectively. Variation of obesity among the three ethnic groups should be studied in future studies. [ABSTRACT FROM AUTHOR]

Objectives: The objectives of this study were to compare and analyze the results of right anterolateral thoracotomy and median sternotomy approach for primary mitral valve replacement with reference to the exposure during Valve Replacement, length of surgical incision, mean cross clamp time, mean bypass time, intensive care unit (ICU) stay, hospitalization, overall comorbidity with sternotomy; sepsis, dehiscence, healing cosmetic issues and cost effectiveness. Methods: The present study comprised 68 patients with rheumatic mitral valve disease who underwent mitral valve replacement in the Department of Cardiovascular and Thoracic Surgery at Sher-i-Kashmir Institute of Medical Sciences from September 2009 to August 2011. Results: This study comprised 64 patients with 23 (35.9%) males and 41 (64.1%) females. Sternotomy group had 10 males (31.3%) and 22 females (68.7%). Thoracotomy group had 13 males (40.6%) and 19(59.4%) females. The length of incision between the two groups was statistically significant (P<0.0001). Mean incision length were 24.6±2.1 cm and 14.8±2.3 cm in sternotomy and thoracotomy respectively. Statistically significant difference regarding duration of ICU stay was found between the two groups (P<0.0001). Scar visibility was 100% in sternotomy and around 25% in thoracotomy( P<0.0001). Conclusions: Thoracotomy through a right anterolateral aspect was easy to perform while maintaining maximum security for the patients. Besides its satisfactory cosmetic result especially in female patients, this approach proved to have several advantages. It offers a better exposure to the mitral apparatus even in patients with small left, allowing easy mitral valve replacement which is apparent from the lower cross-clamp time in the test group. The invaluable advantage of the above- mentioned thoracotomy is total eradication of the risk of deep sternal infection. The shorter hospital stay and cost effectiveness of thoracotomy approach are additional relief to the family. [ABSTRACT FROM AUTHOR]

Objectives: Dilated cardiomyopathy is the most prevalent type of cardiomyopathy in children, which results in congestive heart failure and causes significant morbidity and mortality. This study, aims to investigate the effect of supplementation with omega-3 polyunsaturated fatty acids (n-3 PUFA) on heart function and oxidative stress biomarkers in these patients. Methods: The present research was a case-control study on pediatric patients with dilated cardiomyopathy, who received n-3 PUFA and anti-failure therapy for 6 months (group 1, n = 6), or anti-failure therapy alone for 6 months (group 2, n = 6), as well as age matched normal individuals (group 3, n = 6), and evaluated the cardiac function and biomarkers of oxidative stress. Results: Echocardiographic parameters, such as left ventricular ejection fraction, shortening fraction, tissue Doppler Ea and Aa waves of lateral annulus of tricuspid valve, and Ea and S wave of septum, were significantly improved in group 1 after n-3 PUFA compared to pre- treatment status, while they were not changed after treatment in group 2. Antioxidant enzymes, including catalase and glutathione peroxidase activities in erythrocytes were slightly decreased, while plasma 8-iso-prostaglandin F2ct concentrations were somewhat increased in group 1 compared to groups 2 and 3, however these changes were not statistically significant. Total antioxidant capacity of plasma was similar in all 3 groups. Conclusions: The results indicate that some echocardiographic parameters were significantly improved in patients receiving omega-3 fish oil. However, omega-3 had no significant effect on oxidative stress biomarkers. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to evaluate the short- term effects of percutaneous mitral valvuloplasty (PMV) on coexisting AR. Methods: Clinical, echocardiographic and catheterization data from hospital records of a total of 327 patients with rheumatic mitral stenosis who underwent PMV at a tertiary centre were retrospectively reviewed and aortic regurgitation changes 48 hours post PMV was recorded. Results: The study population consisted of 282 females and 45 males. Mean age at the time of intervention was 47.13±11 years. Before PMV, 142 (43.3%) patients had no AR, 124 (37.9%) had mild AR and 61 (18.7%) had moderate AR. There was no change in AR severity in post- PMV follow-up. AR progression after PMV and during the follow-up was not significant and there was no increase in the need for aortic valve replacement (AVR) procedures. Conclusions: Our findings indicated that a considerable number of patients with rheumatic mitral stenosis had concurrent AR. At the time of PMV concomitant AR does affect procedural success and is not associated with inferior outcomes. Patients with moderate degrees of AR remain good candidates for PMV. [ABSTRACT FROM AUTHOR]