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INTRODUCTION: In recent years, transradial cardiac catheterization has become the preferred method. However, it can result in a significant complication known as radial artery occlusion (RAO). The medical management of RAO remains controversial, especially with the emergence of novel oral anticoagulants. Nevertheless, there is limited data on the use of these agents for treating RAO, which is the focus of this study using apixaban.METHOD: This pilot double-blinded randomized clinical trial involved 30 patients who developed RAO following transradial coronary angiography. The patients were randomly assigned to receive either apixaban (2.5 mg twice daily) or a conservative approach for 30 days. Doppler ultrasonography was performed at baseline and at the end of the intervention to assess radial artery diameter and the resolution of arterial patency. Demographic, medical, medication, and clinical characteristics were collected.RESULTS: The mean age of the studied population was 59.43±12.14 years, and the majority were males (60%). Radial artery resolution was observed in 21 (70%) patients, independent of medication use. There was no significant association between resolution and age (P-value=0.62), gender (P-value=0.74), body mass index (P-value=0.23), smoking (P-value=0.64), diabetes (P-value=0.999), hypertension (P-value=0.74), statins (P-value=0.999), antiplatelet therapy (P-value=0.999), length of angiography (P-value=0.216), or follow-up arterial diameter (P-value=0.304). Recanalization occurred in 13 (86.7%) cases in the apixaban treatment group, compared to 8 (53.3%) individuals in the control group, indicating a significant difference (P-value=0.046).CONCLUSION: The study findings suggest no demographic, medical, medication, or clinical factors were associated with arterial recanalization. However, a one-month treatment with apixaban at a dose of 2.5 mg twice daily appeared to be effective.

INTRODUCTION: Primary percutaneous coronary intervention (PPCI) is the gold standard approach to restore blood flow in ST-segment elevation myocardial infarction (STEMI); however, the no-reflow phenomenon as a potential complication of PPCI can worsen the outcomes. It has been hypothesized that adjunctive prophylactic intracoronary infusion of low-dose fibrinolytic might improve the PPCI outcomes; however, this theory is a matter of debate. The current study aims to investigate the value of adjunctive prophylactic intracoronary low-dose alteplase to prevent the no-reflow phenomenon in patients with STEMI.METHOD: This case-control study was conducted on 80 STEMI patients who underwent PPCI. The patients were assigned into the case group who were intervened by 10 mg adjunctive intracoronary alteplase immediately at the end of the balloon angioplasty (n=40) and controls (n=40) who underwent conventional PPCI only. The angioplasty-associated outcomes including final TIMI score, need for no-reflow treatment, ST-segment resolution, post-PPCI complications, and death were compared between the groups.RESULTS: Alteplase use was accompanied by significantly improved final TIMI flow scores (P-value0.05).CONCLUSION: Based on the findings of this study, adjunctive infusion of low-dose intracoronary alteplase during PPCI could not efficiently prevent the no-reflow phenomenon. Although the final TIMI flow and need for post-stenting no-reflow treatment improved, ST-segment resolution did not occur dramatically. Given that, this approach requires further investigations and should be considered cautiously.

BACKGROUND: Takotsubo syndrome (TS) is a reversible left ventricular (LV) systolic dysfunction occurred mostly in post-menopausal women after an emotional or physical stress. The exact mechanism has yet to be found. In clinical settings, TS should be differentiated from myocardial infarction (MI) due to totally different management protocols. Several diagnostic criteria are available, but mayo clinic criteria is the most widely used. Prognosis of TS is favorable and the recurrence and mortality rates are low. Treatment is mostly supportive and after a few weeks, most of patients’ electrocardiography (ECG) and echocardiographic findings will be normalized, though to its benign course, TS can cause some complications. Intra-myocardial dissection and LV apical aneurysm, as a complication of TS has never been reported yet and was just announced in rare cases of MI.CASE REPORT: Our patient was a 32-year-old aphasic woman referring with palpitation and chest discomfort. Further examinations after exclusion of MI revealed TS leading to LV apical aneurysm and intra-myocardial dissection.CONCLUSION: Intra-myocardial dissection should be considered as one of the rarest TS complications. Several studies are necessary for defining the exact pathophysiological mechanisms.

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

BACKGROUND: We investigated clinical and procedural factors associated with the no-reflow phenomenon following percutaneous coronary intervention (PCI) of the saphenous-vein grafts (SVG). METHODS: A cross-sectional study was done on patients who had undergone PCI of the SVG. Patients’ medical documents were reviewed for demographic, clinical, laboratory, and procedural data. Slow/no-reflow was defined based on the thrombolysis in myocardial infarction (TIMI) grade (0 to 2). Univariate and multiple logistic regression analyses were performed to investigate factors associated with slow/no-reflow and P < 0.050 was considered as significant. RESULTS: A total of 205 patients were studied (81% man, mean ± standard deviation of age was 66.8 ± 9.6 years). Slow/no-reflow was found in 38 (18.5%) patients. High diastolic blood pressure (P = 0.010), leukocytosis (P = 0.017), diffuse lesions (P = 0.007), degenerated SVG (P < 0.001), proximal lesions (P < 0.001), thrombosis (P = 0.013), and lower number of used stents during procedure (P = 0.032) were associated with slow/no-reflow in unadjusted analyses. Factors independently associated with slow/no-reflow were pre-procedural high diastolic blood pressure with odds ratio (OR) = 3.858 [95% confidence interval (95% CI), 1.157-12.860], degenerated SVG with OR = 5.901 (95% CI: 1.883-18.492), proximal lesions with OR = 5.070 (95% CI: 1.822-14.113), pre-intervention TIMI grade with OR = 0.618 (95% CI: 0.405-0.942), number of used stents for PCI with OR = 0.074 (95% CI: 0.011-0.481) for > 1 stent, and length of stents used for PCI with OR = 0.100 (95% CI: 0.019-0.529) for > 30 mm stents. CONCLUSION: This study on the clinical and procedural factors associated with the slow/no-reflow phenomenon following PCI of the SVG can be used in risk estimation of this serious complication and tailoring preventive strategies to at-risk patients.

BACKGROUND: Haptoglobin (Hp) polymorphisms have been suggested to be associated with many pathological conditions, including cardiovascular diseases, infectious diseases, and type 2 diabetes. For the first time, we aimed to investigate the possible association between Hp genotypes and metabolic syndrome (MES) in a sample of Iranian subjects. METHODS: In this study, 291 patients with MES according to National Cholesterol Education Program-Adult Treatment Panel III criteria, and 284 healthy individuals have been studied. We determined Hp genotype by polymerase chain reaction. RESULTS: The frequency of three genotype (Hp1-1, Hp2-1, and Hp2-2) in healthy individuals and patients were 7.74, 39.7, 52.46, and 7.9, 31.61, 60.48 percent, respectively. There was no significant difference between the groups regarding Hp genotypes. The Hp2 allele was the predominant allele in MES (76.29%) and normal subjects (72.54%). CONCLUSION: Hp polymorphisms are not risk factor for predisposition to MES in a sample of the Iranian population. Further studies with different ethnicities are required to validate our findings.

BACKGROUND: Vitamin D deficiency is associated with vascular endothelial dysfunction. We evaluated endothelial function in ischemic heart disease (IHD) patients with vitamin D deficiency or insufficiency before and after vitamin D therapy. METHODS: An uncontrolled before-after study was conducted in Isfahan, Iran on consecutive sample of female IHD patients who had undergone percutaneous coronary intervention in the preceding 6 months and/or referred with chronic stable angina. Forty patients with vitamin D deficiency or insufficiency (serum 25-hydroxy vitamin D < 20 or 20-30 ng/ml, respectively) were included and received two intramuscular injections of 300,000 IU cholecalciferol with 1 month interval. Endothelial function, assessed by measuring flow-mediated dilatation (FMD), and serum 25-hydroxy vitamin D level were measured at baseline and 1 month after the second dose of cholecalciferol. RESULTS: A total of 30 patients completed the study, age = 59.4 ± 8.7 years; serum 25-hydroxy vitamin D = 19.0 ± 6.5 ng/ml. After treatment, serum 25-hydroxy vitamin D was reached to > 30 ng/ml in all patients. Brachial artery diameter (mm) after ischemia increased significantly, statistically but not clinically (4.55 ± 0.37 to 4.67 ± 0.38, P < 0.001). Furthermore, FMD (%) was increased from 1.96 ± 1.65 to 4.65 ± 1.27 (P < 0.001). The amount of change in FMD was not significantly correlated with serum 25-hydroxy vitamin D (r = 0.038, P = 0.858). CONCLUSION: Endothelial function was improved after vitamin D therapy in IHD patients with low serum vitamin D. Controlled studies with larger sample size are required to confirm if vitamin D therapy has effects on endothelial function.

BACKGROUND: Atherosclerosis and apolipoprotein E4 (APOE4) are known risks for Dementia. We sought to evaluate the relationship between coronary atherosclerosis and APOE4 with mild cognitive impairment (MCI). METHODS: In a case-control study, subjects with age more than 60 years and recent coronary angiography were evaluated by mini-mental state examination and neuropsychiatry Unit Cognitive Assessment Tool (NUCOG) to find the patients with MCI (n = 40) and the controls with normal cognition (n = 40). Coronary angiography records were re-assessed to find the severity of coronary artery disease by the Gensini scores. Plasma levels of APOE4 were measured. RESULTS: There were no-significant difference between the 2 groups regarding the plasma APOE4 levels (P = 0.706) and the Gensini scores (P = 0.236). Associations between the Gensini scores and the NUCOG scores in the MCI group (r = −0.196, P = 0.225) and the control group (r = 0.189, P = 0.243) were not significant. However, the interaction effect between the Gensini and the NUCOG scores based on allocation to the control or the patient groups showed statistically significant difference (F(1,67) = 4.84, P = 0.031). CONCLUSION: Although atherosclerosis has been considered as known risk factor for dementia and MCI, this study could not reveal that coronary atherosclerosis-related to declining in cognitive functioning. There was no significant association between plasma APOE4 levels and MCI. Keywords: Mild Cognitive Impairment, Coronary Artery, Angiography, Apolipoprotein E4

BACKGROUND: Hypertension is a major risk factor for cardiovascular diseases. It affects approximately 18.0% of Iranian adults. This study aimed to estimate age-adjusted prevalence of hypertension and its control among Iranian persons older 19 years of age. It also tried to find and socioeconomic factors associated with hypertension control in Iranian population. METHODS: In Isfahan Healthy Heart Program (IHHP) subjects were selected by multistage random sampling. The participants completed questionnaires containing demographic information, lifestyle habits, medical history, and consumption of relevant medications, especially antihypertensive agents. Income, marital status, and educational level were considered as socioeconomic factors. Hypertension was defined as systolic blood pressure ≥ 140 mmHg, diastolic blood pressure ≥ 90 mmHg, or taking antihypertensive medications. Controlled hypertension was considered as systolic blood pressure < 140 mmHg and diastolic blood pressure < 90 mmHg among hypertensive subjects. RESULTS: The prevalence of hypertension and controlled hypertension was 18.9% and 20.9%, respectively. We found significant relationships between hypertension and marital status, education, and income. At age ≥ 65 years old, odds ratio (OR) was 19.09 [95% confidence interval (CI): 15.01-24.28] for hypertension. Middle family income (OR: 0.71; 95% CI: 0.58-0.87) and education level of 6-12 years (OR: 0.29; 95% CI: 0.25-0.35) were significantly associated with increased risk of hypertension (P = 0.001). Among subjects aging 65 years old or higher, the OR of controlled hypertension was 2.64 (95% CI: 1.61-4.33). Married subjects had a higher OR for controlled hypertension (OR: 2.19; 95% CI: 1.36-3.52). Obesity had no significant relationships with controlled hypertension. CONCLUSION: The IHHP data showed significant relationships between some socioeconomic factors and controlled hypertension. Therefore, as current control rates for hypertension in Iran are clearly unacceptable, we recommend preventive measures to control hypertension in all social strata of the Iranian population. Keywords: Socioeconomic Factor, High Blood Pressure, Control

BACKGROUND: Cardiovascular diseases are the major causes of mortality worldwide and acute myocardial infarction (AMI) is the leading cause of mortality among cardiovascular diseases. Thrombolytic therapies, especially during the first few hours after the disease onset, can significantly reduce AMI-related mortality. METHODS: The current study aimed to determine the prevalence and causes of non-administration of thrombolytic therapy for AMI patients admitted to Hajar Hospital, Shahrekord, Iran, from May until November 2000. Non-probability convenient sampling method was used to select 106 subjects with Q-wave AMI. Data was collected by completing a questionnaire, reviewing medical records, and interviewing with patients. SPSS7.5 was for data analysis. RESULTS: A total number of 106 AMI patients were studied among whom 62 (59%) individuals received thrombolytic therapy. Delayed referral to the hospital was the major cause of failure to provide thrombolytic therapy. The cause of non-treatment could not be identified in 15 (19.5%) subjects eligible to receive therapy. CONCLUSION: Training general practitioners and individuals involved in this regard along with accelerating the process of patient referral to hospitals can reduce AMI-related mortality. Keywords: Acute Myocardial Infarction, Thrombolytic, Therapy

BACKGROUND: Atherosclerosis is one of the leading causes of mortality all around the world. Obesity is an independent risk factor for atherosclerosis and cardiovascular diseases (CVD). In this respect, we decided to examine the effect of the subgroups of weight on cardiovascular risk factors. METHODS: This cross-sectional study was done in 2006 using the data obtained by the Iranian Healthy Heart Program (IHHP) and based on classification of obesity by the World Health Organization (WHO). In this study, the samples were tested based on the Framingham risk score, Metabolic Measuring Score (MMS) and classification of obesity. Chi-square and ANOVA were used for statistical analysis. RESULTS: 12514 people with a mean age of 38 participated in this study. 6.8% of women and 14% of men had university degrees (higher than diploma). Obesity was seen in women more than men: 56.4% of women and 40% of men had a Body Mass Index of (BMI) ≥ 25 Kg/m2. 13% of the subjects had FBS > 110 and13.9% of them were using hypertensive drugs. In this study, we found that all risk factors, except HDL cholesterol in men, increased with an increase in weight. This finding is also confirmed by the Framingham flowchart for men and women. CONCLUSION: One of every two Americans, of any age and sex, has a Body Mass Index of (BMI) ≥ 25 Kg/m2. Obesity associated CVD and other serious diseases. Many studies have been done in different countries to find the relationship between obesity and CVD risk factors. For example, in the U.S.A and Canada they found that emteropiotic parameters, blood presser and lipids increased by age(of both sexes). Moreover, another study done in China, which is a country in Asia like Iran, shows that BMI has an indirect effect on HDL cholesterol, LDL cholesterol and triglyceride. This data is consistent with the results of the current study. However, In China they found that this relationship in men is stronger than women, but our study reveals the opposite. Keywords: Body Mass Index (BMI), Overweight, Cardiovascular Risk Factors, Framingham Risk Score, Metabolic Syndrome.

BACKGROUND: Atrial fibrillation (AF) is the most common complication of cardiac surgery. Although it is managed easily, it can cause critical hemodynamic instabilities for intensive care patients. This observational study investigated the predictive power of P-wave dispersion (PWD) for the incidence of post cardiac surgery AF. METHODS: Among patients undergoing isolated coronary artery bypass grafting surgery (CABG), 52 patients were selected randomly. Before the operation, ejection fraction, regional wall motion abnormality, and mitral regurgitation were determined by echocardiography. Angiographic data provided information about stenosed vessels. PWD was measured before and after CABG. The incidence of post-CABG AF was determined by rhythm monitoring. RESULTS: There were no significant differences in age, sex, stenosed vessels, maximum P-wave duration, the prevalence of hypertension, smoking, mitral regurgitation, and regional wall motion abnormality between post-CABG AF and non-AF groups (P > 0.05). The mean prevalence of diabetes mellitus in post-CABG AF group was more than non-AF group (P = 0.036). The mean ejection fraction in post-CABG AF group was lower than non-AF group (P < 0.005). The mean PWD in AF group vs. non-AF group before CABG was 47.5 vs. 23.7 ms. The mean values of post-surgical PWD in AF and non-AF groups were 48.10 and 24.4 ms, respectively. Before CABG, the mean ejection fraction value and minimum P-wave duration in AF group were lower than non-AF group (P < 0.005). A reverse relation was present between minimum P wave duration and PWD (P < 0.001). There was a negative association between high ejection fraction values and decreased PWD (P = 0.002). CONCLUSION: Our data suggested minimum P wave duration, PWD, and low ejection fraction are as good predictors of AF in patients undergoing isolated CABG. The absence of differences in age, sex, smoking, hypertension, mitral regurgitation, and regional wall motion abnormality in our study was in contrast with other reports. On the other hand, increased rate of post-CABG AF in our diabetic patients with lower ejection fraction supports other studies. Overall, minimum P wave duration, PWD, and low ejection fraction can be used for patient risk stratification of AF after CABG. Keywords: Atrial Fibrillation, Coronary Artery Bypass Grafting, P-Wave Dispersion, Predictor

BACKGROUND: Lack of heart rate increase proportionate to exercise causes poor prognosis. Moreover, inflammatory factors such as C-reactive protein (CRP) are associated with atherosclerosis. The current study compared these two indices in individuals with and without metabolic syndrome in Isfahan, Iran. METHODS: This study was performed on 203 people without and 123 patients with metabolic syndrome who were randomly selected from the participants of the Isfahan Cohort Study. The demographic data, waist circumference, blood pressure, height, and weight of the participants were recorded. Moreover, serum triglyceride (TG), fasting blood sugar (FBS), total cholesterol, high density lipoprotein (HDL), low density lipoprotein (LDL), and high-sensitivity CRP (hs-CRP) levels were measured. Exercise test was carried out according to the Bruce standard protocol and heart rate reserve (HRR) was determined and recorded. The age-adjusted data was analyzed using generalized linear regression and student's t-test in SPSS15. RESULTS: The mean ages of participants without and with metabolic syndrome were 54.16 ± 8.61 and 54.29 ± 7.6 years, respectively. The corresponding values for mean LDL levels were 116.17 ± 24.04 and 120.12 ± 29.55 mg/dl. TG levels were 140.38 ± 61.65 and 259.99 ± 184.49 mg/dl for subjects without and with the metabolic syndrome, respectively. The mean FBS levels were 81.81 ± 9.90 mg/dl in the participants without the syndrome and 107.13 ± 48.46 mg/dl in those with metabolic syndrome. The mean systolic blood pressure was 116.06 ± 13.69 mmHg in persons without metabolic syndrome and 130.73 ± 15.15 mmHg in patients with the syndrome. The values for mean diastolic levels in the two groups were 76.52 ± 6.69 and 82.84 ± 8.7 mmHg, respectively. While the two groups were not significantly different in terms of HRR (P = 0.27), hs-CRP levels in the metabolic syndrome group was significantly higher than the other group (P = 0.02). CONCLUSION: We failed to establish a relationship between HRR and the metabolic syndrome. However, the observed relationship between metabolic syndrome and hs-CRP level, which is an inflammatory factor, indicates elevated levels of hs-CRP in patients with metabolic syndrome. Keywords: Metabolic Syndrome; Exercise Test; Heart Rate Reserve; High-Sensitivity C-Reactive Protein.

BACKGROUND: Myocardial infarction (MI) is an irreversible cardiomyocytes injury which begins after 15-20 minutes of coronary artery occlusion. The extent of infarction is modulated by a number of factors including collateral blood supplies, medications, and ischemic preconditioning. Although angioplasty and thrombolytic agents can relieve the cause of the infarction, the time from the occlusion onset to reperfusion determines the degree of irreversible myocardial injury. Experimental studies suggested that stem cells and progenitor cells derived from bone marrow can be used in the repair of cardiac tissue after acute MI. This study was designed to investigate the feasibility, safety and initial clinical outcome of intracoronary infusion of autologous progenitor cells in patients with acute MI.METHODS: Patients with a history of anterior MI and a left ventricular ejection fraction (LVEF) less than 35 % who were candidates for coronary angioplasty were randomly allocated in a 1:1 ratio to either control or bone marrow cell groups (each including 16 patients). Thallium scan and 17-segment echocardiography analysis for regional wall motion abnormality were performed before and 1 and 6 months after intracoronary infusion of bone marrow cells. The same tests were also conducted for the control group at identical time intervals. Categorical variables were compared by one way analysis of variance (ANOVA). Statistical significance was assumed at a value of P < 0.05.RESULTS: LVEF in the case and control groups increased to 39.37 ± 24.7% and 31.00 ± 1.87%, respectively (P = 0.069 and 0.1, respectively). Wall motion abnormality index (WMAI) decreased insignificantly in both groups. Perfusion defect scores (PDSs) decreased significantly in the case group.CONCLUSION: In this study, autologous mesenchymal stem cell transplantation by intracoronary catheter during angioplasty in patients with a history of severe LV dysfunction caused mild increases in LVEF.Keywords: Myocardial Infarction Left Ventricular Failure, Stem Cell.

BACKGROUND: Renal artery stenosis is one of the important causes of hypertension and endstage renal failure. Magnetic resonance angiography (MRA) and Doppler ultrasonography arenon-invasive and safe diagnostic techniques that have also high sensitivity and specificity. Sincethe accuracy and reliability of these techniques depend upon technicians and softwares, wedecided to evaluate and compare the sensitivity and specificity of these techniques in Isfahan.METHODS: Our study included all the patients (37 patients) who underwent renal arteryangiography during 2 years from May 2003 to May 2005 and up to six months after that hadunderwent MRA (21 patients) and Doppler sonography (16 patients) in Isfahan. Renal arteryangiography was considered as the gold standard.RESULTS: Sensitivity, specificity, positive and negative predictive values of 100%, 25%, 25%,and 100% were obtained for MRA respectively. Specificity and positive predictive values (PPV)of Doppler sonography were 67%. Its sensitivity and negative predictive values (NPV) were 57%.CONCLUSION: Although it seems that technician dependency, technical and softwareproblems were the reasons of low specificity of gadolinium-enhanced MRA in our study, furtherstudies with larger sample sizes are recommended.Keywords: MRA, Doppler Ultrasonography, Renal Artery Stenosis.

BACKGROUND: The barriers to participation in cardiac rehabilitation programs are individualand economic problemsas well aslimited availability of rehabilitation services. Because of theimportant role of rehabilitation, home-basedexercise rehabilitation is a new approach toparticipate in such programs. The purpose of this study was to evaluate theeffect of home-basedrehabilitation on quality of life (QoL) in patients with coronary artery disease aftercoronaryartery bypass graft (CABG) and percutaneous coronary intervention (PCI).METHODS: Participants included 18 CABG (3 women, 15 men) and 40 PCI (12 women, 28men) low tomoderate risk patients. Finally, 17 patients in the exercise group and 16 patients inthe control group remained. The SF-36 was used to evaluate changes in QoL before and after theprogram.RESULTS: forty-three percent was dropped out from the program. Before and after program,the exercise group was betterin all domains of QoL (P rehabilitation, significant improvements were observed inquality of life in both groups (Pbut the exercise group showed more improvements in three domains.CONCLUSION: Home-based exercise rehabilitation after CABG and PCI may improve QoL andprovide an efficient low-costapproach to cardiac rehabilitation. It may be helpful due to limitedavailability and resources in Iran. Nevertheless,there is a need for more trainingto increaseparticipation and decrease drop outKeywords: Quality of life,Coronary artery bypass grafts, Angioplasty.

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of mortality worldwide. Various studies showed relationship between electrocardiographic (ECG) changes at rest and CVD mortality. Present study was performed to find the relation between ECG and CVD risk factors in an Iranian population. METHODS: This cross-sectional study was performed on 3343 subjects aged ≥ 35 years from three provincial cities of Isfahan, Arak, and Najafabad. Demographic and lifestyle information, as well as weight, height, blood pressure, hip and waist circumference measurement was recorded. Laboratory tests including total cholesterol (TC), LDL-C, HDL-C, triglycerides (TG) and fasting serum glucose were measured too. Ischemic criteria of ECG included minor and major changes in ST segment, T wave, conductive disorders, blocks and arrhythmias. RESULTS: Ischemic changes in women were 1.5 times more than men (P < 0.05). Mean age of the group with ischemic findings was 5 years more than non-Ischemic group. Comparison of lifestyle variables indicated that physical activity in reverse to nutrient index was significantly more in non-ischemic individuals compared to the ischemic individuals. Smoking showed a significant difference between the two groups, too (P < 0.05). Anthropometric variables including body mass index (BMI), hip and waist circumference and diabetic and systolic blood pressure as well as biochemical factors including TC, HDL-C, and LDL-C were significantly higher in Ischemic group (P < 0.05). CONCLUSION: Considering the ischemic change in individuals with unhealthy life style or with CVD risk factors, these should be considered in evaluation of these patients. Keywords: Ischemic Changes, Electrocardiography, Cardiovascular Risk Factors.

Abstract INTRODUCTION: Introducing a foreign body into the heart, a part of the human anatomy that symbolically represents emotions, is a major life event which may result in a change in the body image, changes in physical and emotional wellbeing and quality of life. methods: In a descriptive study in Fall 2006, 78 out of 267 patients with implanted cardiac pacemakers (PPM) were randomly evaluated by using a quality of life questionnaire for patients published by Salud Co. Data entry and analysis were done by SPSS 11.5. results: Thirty-two men and 46 women with mean ages of 67.4 and 66.7 years, respectively, were included in the study. Thirty-six patients had single chamber VVIR, 15 had dual chamber VDD and 27 had dual chamber DDDR PPM implanted. Scores of physical and emotional wellbeing were grater than 75, but those of social/family and functional wellbeing were lower than 50 in the majority of patients. Except for a few questions, there was no significant difference between patients with single or dual chamber PPM in terms of quality of life (P=0.34). CONCLUSIONS: Quality of life of patients with PPM is good in respect of physical and emotional wellbeing. However, the results were not desirable in terms of family/social and functional wellbeing. Thus, family and social educational programs are recommended. Keywords: Quality of life, pacemaker, physical/emotional wellbeing, family/functional wellbeing.

Abstract INTRODUCTION: Cerebrovascular accident (CVA) or stroke remains a devastating complication of cardiac surgical procedures, especially coronary artery bypass graft (CABG) despite advances in perioperative monitoring and management. An individual's risk of stroke is based in part on preoperative characteristics, but also on intra- and postoperative factors. The purpose of this study was to determine the prevalence and predictors of stroke in a large group of patients undergoing cardiac surgery. methods: Data were collected on 1467 patients who underwent CABG at Chamran Heart Center from 1995 to 2003. Stroke was defined as "a new focal neurological deficit which appears and is still at least partially evident more than 24 hours after its onset". Logistic regression identified significant predictors of stroke. results: Among the preoperative and postoperative factors, significant correlates of stroke included chronic renal insufficiency (P=0.0001), hypertension (P=0.0001), diabetes (P=0.0001), and atrial fibrillation (P=0.0001). However, stroke had no significant correlation with sex (P=0.054), age (P=0.28), severe LV failure (P=0.062), history of CVA (P=0.723) or shock state (P=0.802). Discussion: Neurologic complications after cardiac surgical procedures remain a relatively common problem despite improvements in anesthetic and surgical techniques, as well as in perioperative monitoring and management. Increased stroke risk can be predicted by preoperative and postoperative clinical factors.Keywords • Stroke • Cerebrovascular accident • Coronary artery bypass graft (CABG)

Abstract BACKGROUND: Treatment of hypertension (HTN) as an important risk factor of coronary artery disease (CAD) is for prevention of its mortality. The aim of the present study was to investigate risk factor distribution, prevalence and severity of CAD among hypertensive and normotensive patients undergoing elective coronary angiography in Tabriz Madani Heart Center. METHODS: In a descriptive cross-sectional study, 976 out of 3000 patients who underwent coronary angiography (CAG) between February 1, 2005 and February 1, 2006 were randomly selected to enter the study. Demographic and angiographic data were collected. Data entry and analysis was done by SPSS software version 11.5 and EPI software version 6.4. RESULTS: Prevalence of hypertension in patients who underwent coronary angiography was 60.5%. Prevalence of CAD was 84% and 87% in hypertensive and normotensive patients, respectively (P = 0.2). Prevalence of diabetes mellitus and hyperlipidemia were more frequent in hypertensive patients (P = 0.001). Although the prevalence of 3-vessel disease was higher in hypertensive patients (32% vs. 28%) the difference was not significant statistically. The difference in prevalence of CAD among hypertensive and normotensive men was not statistically significant (91% and 92%, respectively); but this difference among women was statistically meaningful (78% vs. 63%, p = 0.01). 3-vessel disease in hypertensive women was more frequent than normotensive women (37% vs. 18%, P = 0.02). CONCLUSION: With regard to high prevalence of cardiac risk factors and severe CAD in hypertensive patients, prompt health measures are needed for control of hypertension in general population especially in the hypertensive women. Keywords: Hypertension, Coronary Artery Disease, Risk Factors.

BACKGROUND: Recent studies have confirmed inflammatory factors and metabolic syndrome (MetS) as important cardiovascular disease (CVD) risk factors. Recently measurement of carotid intima-media thickness (IMT) has been used for evaluation of early atherosclerosis. This study was designed to assess the correlation between IMT with some inflammatory biomarkers, ghrelin and adiponectin in people with and without MetS in a cohort sample in Isfahan province. METHODS: Among participants of Isfahan Cohort Study (ICS) by random sampling, 88 participants were selected and divided into case (with MetS) and control (without MetS) groups. A questionnaire including demographic data and CVD risk factors was completed for all of the participants. Physical examination and blood pressure, height, weight and waist circumference measurements were done for all subjects. Vascular echocardiography was done for evaluation of IMT of each carotid artery of both sides. Interlukin-6 (IL-6), interlukin-10 (IL-10), highly sensitive C-reactive protein (hs-CRP), ghrelin and adiponectin levels were measured using ELIZA method. Data were entered in SPSS version 15 and analyzed by t test, chi square, Pearson correlation and linear regression analyze. RESULTS: The mean waist circumference, BMI, systolic blood pressure, diastolic blood pressure, hs –CRP and IMT of left carotid artery were significantly higher in participants with Mets. There was significant correlation between left carotid IMT and IL-6 level in all patients (P=0.03). After adjustment for age and sex, significant relationship in groups with MetS was only reported between the left IMT and IL-6 (P=0.02). There was no relation between IMT and other inflammatory markers in subjects with and without MetS. CONCLUSION: Significant correlation between IL-6 and IMT was reported in patients with MetS. While no significant correlation between IL-10, adiponectin and ghrelin with IMT was observed in metabolic syndrome group. Keywords: Intima-media thickness (IMT), carotid artery, hs-CRP, Ghrelin, Adiponectin IL-6, IL-10.