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Objectives Several popular cardiovascular risk assessment tools have been developed in Western countries; however, the predictive abilities of these tools have not been evaluated in Middle Eastern countries. The present study aimed to determine the abilities of cardiovascular risk assessment tools in a population-based study in Northern Iran. Study design Population-based cohort study in Northern Iran. Methods In total, 2883 individuals (1629 men and 1254 women), aged 40–74 years, were included in the study. We determined the predictive abilities of the American College of Cardiology/American Heart Association (ACC/AHA) risk prediction tool, the Framingham general cardiovascular risk profile in primary care settings, and the Systematic Coronary Risk Evaluation (SCORE) equations for low- and high-risk European countries. Receiver operating characteristic (ROC) analysis was used to determine the predictive abilities of these four risk assessment tools. Results Based on areas under curve (AUC) values and related 95% confidence intervals (95% CIs), the discriminative abilities of the ACC/AHA tool, the Framingham approach, and the SCORE for low- and high-risk European countries to estimate non-fatal cardiovascular disease (CVD) events were 0.6625, 0.6517, 0.6476 and 0.6458, respectively, in men, and 0.7722, 0.7525, 0.7330 and 0.7331, respectively, in women. Moreover, the abilities of these four tools to estimate fatal CVD events were found to be 0.8614, 0.8329, 0.7996 and 0.7988 in men, and 0.8779, 0.8372, 0.8535 and 0.8518 in women, respectively. Conclusions The cardiovascular risk assessment tools investigated in this study showed acceptable predictive abilities in women. The ACC/AHA approach showed slightly better performance compared with the SCORE tool; however, the SCORE tool benefited from the lowest cost compared with all the other tools.

COVID-19 was introduced by the World Health Organization (WHO) as a global pandemic. The disease manifestations ranges from a mild common cold to severe disease and death. It has a higher mortality rate in people with a history of comorbidities, including cardiovascular disease (CVD) and can also contribute to cardiac injury. This study was conducted to evaluate the relationship between troponin levels as a cardiac marker and adverse outcomes in this disease.The study sample included 438 patients hospitalized with COVID-19; however, the troponin data of 6 patients were not available. The need to be admitted to the intensive care unit (ICU), and death were considered the adverse outcome in patients with COVID-19. Troponin levels were checked in all patients on day 1 and day 3 of hospitalization. Multiple logistic regression analysis was performed to determine whether there was an independent association between the adverse outcomes and troponin enzyme in hospitalized patients with COVID-19.The mean age of patients was 61.29 ± 15.84 years. Among the 432 patients tested on day 1 of hospitalization, 24 patients (5.6%) tested positive (Troponin 1), and among the 303 patients tested on day 3, 13 patients (4.3%) tested positive (Troponin 2). Based on our results, Troponin 1 showed an independent association with both death (3.008 [95%CI = 1.091-8.290]; P = 0.033) and need for ICU admission (8.499 [95%CI = 3.316-21.788]; P0.001) in multiple logistic regression analysis. Moreover, the status of Troponin 2 had an independent significant association with both death (4.159 [95%CI = 1.156-14.961]; P = 0.029) and ICU admission (7.796 [95%CI = 1.954-31.097]; P = 0.004).Troponin showed a significant association with adverse outcomes in people who were hospitalized with COVID-19. The periodical assessment of this enzyme from the time of hospitalization may improve the clinical decision making of clinicians.

There are no consistent results between previous studies for an independent association between non-alcoholic fatty liver disease (NAFLD) and cardiovascular disease (CVD) events. To determine if there is an independent association between NAFLD and CVD events. In the present study, valid outcome data of 4808 subjects were available for phase 2 of our cohort study. These subjects had been followed up for seven years from phase 1, beginning in 2009-2010 to phase 2 during 2016-2017. Simple and multiple Cox proportional models were used to determine the association between NAFLD in the primary phase of the cohort and subsequent fatal and non-fatal CVD events during follow-up. The incidence of non-fatal CVD events in males with NAFLD was significantly higher ( = 0.004) than in males without NAFLD. A positive association was demonstrated between NAFLD and non-fatal CVD events in males (Hazard ratio = 1.606; 95%CI: 1.166-2.212; = 0.004) by the simple Cox proportional hazard model, but no independent association was detected between these in the multiple Cox models. No independent association was detected between NAFLD and CVD. It is likely that diabetes mellitus and age may be the principle mediators in this regard. [Abstract copyright: ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.]

Background: Ankylosing spondylitis (AS) is a chronic inflammatory condition associated with more cardiac manifestations than those in the normal population. In this study, we sought to determine the prevalence of cardiac involvement in patients suffering from AS without cardiovascular risk factors. Methods: The present case-control study, conducted in 2 university hospitals in Tehran from January 2016 to December 2017, recruited 67 patients with AS and 40 age- and sex-matched healthy controls. The diagnosis of AS was based on the classification criteria of the Assessment of SpondyloArthritis International Society. All the participants were examined using transthoracic echocardiography and a standard 12-lead ECG. Baseline characteristics, echocardiographic findings, and ECG features were compared between the AS and control groups using univariate analyses. Results: The median age was 33.5 (IQR25-75%: 20.5–59) years in the AS group and 35 (IQR25-75%: 26–59) years in the control group (P=0.301). The number of patients with left ventricular systolic and diastolic dysfunction was significantly higher in the patients with AS than in the controls (7.5% vs. 20.9%; P=0.067, and 22.9% vs. 5.0%; P=0.026, respectively). The number of individuals with a left-axis deviation and a left anterior fascicular block was significantly higher in the patients suffering from AS than in the control group. The number of patients with aortic valve involvement was comparable between the groups (P=0.332). Conclusion: The most common cardiac involvement in our patients with AS was left ventricular dysfunction, followed by rhythm disturbances and aortic valve insufficiency. These findings were independent of age, AS severity, and disease duration. Therefore, the implementation of cardiovascular screening can be recommended for patients with AS.

Background Identification of individuals at risk of cardiovascular diseases (CVDs) results in better clinical outcomes and may help policy makers in conscious decision making for community based and national intervention strategies. The main aim of this study was to compare various CVD risk assessment tools and their related guidelines in estimation of 10-year CVD risk and subsequent therapeutic recommendations, respectively. Methods Data of 3086 subjects aged 40–74years from a cohort study of northern Iran were utilized in this cross-sectional study. The risks were calculated based on American College of Cardiology/American Heart Association (ACC/AHA) tool, two versions of Systematic Coronary Risk Evaluation (SCORE) equations (for low and high risk European countries) and Framingham approach. We also detected participants who ought to be recommended for treatment based on the specific guidelines related to each of the risk assessment tools. Results Mean cardiovascular risks were 12.96%, 8.84%, 1.90% and 3.45% in men and 5.87%, 2.13%, 0.8% and 1.13% in women based on ACC/AHA, Framingham, SCORE equation for low-risk European countries and high-risk European countries, respectively. Based on ACC/AHA, Adult Treatment Panel III (ATPIII) and European Society of Cardiology (ESC) guidelines related to SCORE equations for low and high risk European countries 58.2%, 27.1%, 21.1% and 28.6% of men and 39.7%, 33.0%, 29.5% and 30.7% of women were recommended to statin therapy, respectively. Conclusions In conclusion, more individuals were recommended for treatment by ACC/AHA guideline than the other guidelines.

Contrast-induced Acute Kidney Injury (CI-AKI) is a prevalent complication of chronic kidney disease (CKD) patients. The aim of this study was to evaluate the effects of periprocedural administration of trimetazidine as an anti-oxidant agent on the incidence of CI-AKI in CKD patients based on changes of Neutrophil Gelatinase-Associated Lipocalin (uNGAL) level, which has recently been introduced as an early predictor of CI-AKI.One hundred CKD patients with a mean GFR of 50 ± 7 cc/min who were candidate for coronary angiography assigned randomly to receive (50 patients, intervention group) or not receive (50 patients, control group) trimetazidine (70mg/d) for 72 hours. CI-AKI was defined as 0.5 mg or 25% increase in serum creatinine. We also checked uNGAL before and 12h after angiography.Serum creatinine, showed a trend of less increment in the case group, although could not achieve a significant difference, there was a significant difference in urinary NGAL rise between two groups. CI-AKI was defined as 1.7 times increase in uNGAL level (12h after angiography to pre-procedurally uNGAL level ratio) according to the ROC curves. The incidence of CI-AKI according to urinary NGAL definition was 8% in the Trimetazidine group and 24% in the control group (P.05).We concluded that Trimetazidine treatment before angiography may be effective in CI-AKI prevention. Moreover, it is shown that 1.7 times increase in urine NGAL after angiography is a valuable cut off point for clinicians to discriminate high risk patients for contrast nephropathy.

Introduction: Severe presentation of concomitant carotid, coronary, and peripheral arteriosclerosis is not a common finding. However, some studies have reported surgical and noninvasive interventions for this condition. Case Presentation: Herein, we present a patient with concomitant carotid, coronary, and peripheral arteriosclerosis, who underwent angioplasty in Tehran, Iran in November 2015. Some studies have been carried out on surgical and percutaneous coronary, carotid and peripheral intervention for concomitant lesions; however, reports about percutaneous coronary, carotid and peripheral intervention, similar to the present case, are not available. Conclusions: Due to lack of evidence on the prevalence and management of concomitant multifocal coronary, carotid, and limb arteriosclerosis, it is necessary to perform well-designed studies on such groups of patients to define proper management (surgical versus endovascular interventions), periprocedural complications, as well as short- and long-term outcomes.

Background: The association between liver enzymes and cardiovascular disease (CVD) was previously demonstrated. This study investigated the possible association between liver enzymes and the 10-year risk of cardiovascular events. Methods: The study consisted of 3199 subjects. Two risk-assessment methods, the framingham risk score (FRS) and American college of cardiology and American heart association (ACC/AHA) tools, were used to predict 10-year cardiovascular risks. The association between liver enzymes and ≥ 7.5%, ≥ 10%, and ≥ 20% 10-year CVD risks were evaluated. Results: In the multivariate analysis, alkaline phosphatase (ALP) was significantly associated with 10-year CVD risks in both men and women (P < 0.05). No significant association was detected between 10-year CVD risks and gamma glutamyl transferase (GGT). According to both risk-assessment tools, alanine aminotransferase (ALT) showed a significant inverse association with 10-year CVD risks in men (all P < 0.001). In contrast, this association was significant in women only for ≥ 7.5% and ≥ 10% 10-year risks using the ACC/AHA (P = 0.018) and Framingham tools, respectively (P = 0.028). Conclusions: While ALP exhibited an independent positive association with 10-year CVD risks in both genders, ALT showed an inverse association with10-year CVD risks in men and with some levels of risks in women.

Introduction: Pulmonary hypertension (PHT) is a common complication in β-thalassemia. We aimed to determine the prevalence of PHT and its main indicators in patients with β thalassemia Major (TM) and β-thalassemia Intermedia (TI), considering left ventricular function.Methods: Pulmonary hypertension (PHT) is a common complication in β-thalassemia. We aimed to determine the prevalence of PHT and its main indicators in patients with β thalassemia Major (TM) and β-thalassemia Intermedia (TI), considering left ventricular function.Results: The overall prevalence of PHT in TM and TI group was estimated to be 35.2% and 29.3%, respectively; while reduced LVEF was evident in 22.7% and 10.1% of patients with TM and TI, respectively. No significant correlation was observed between mean PAP and LVEF in the patients with TI (Pearson coefficient = -0.096, P value = 0.345); while, an adverse association was revealed between mean PAP and LVEF in patients with TM (Pearson coefficient = -0.227, P value = 0.033). Upon univariate analysis, the only significant association was observed between LVEF and pulmonary hypertension among TM patients (P value = 0.001).Our results did not indicate that male gender and aging may affect the development of PHT.Conclusions: According to our findings, a considerable proportion of patients with TM and TI may have PHT. We detected an adverse association between mean PAP and LVEF in patients with TM. Left ventricular function was reduced in patients with PHT among TM group.

Objective The aim of this study was to assess validity, reliability, and sensitivity of the Persian version of the short-form McGill Pain Questionnaire 2 (SF-MPQ-2) in patients with neuropathic and non-neuropathic pain. Design Beaton's guideline was used to translate and adapt the SF-MPQ-2 to Persian. Subjects One hundred eighty-four patients with subacute and chronic non-neuropathic pain and 74 patients with painful diabetic peripheral neuropathy (total 258) attending multidisciplinary pain clinic participated in the study. Outcome Measures Internal consistency and intraclass correlation coefficient (ICC) were estimated for participants who had completed the questionnaire in the morning and evening of the first day. The visual analog scale (VAS) and the present pain intensity (PPI) were also recorded to test convergent validity of the questionnaire. Sensitivity to change was examined after a standard treatment and validated by means of the patient global impression of change (PGIC) in addition to VAS and PPI. Exploratory factor analysis (EFA) was used to find possible components. Results Cronbach's alpha was 0.906, which showed high internal consistency. ICC (0.941) revealed test–retest reliability. There was high correlation between the mean VAS and the mean total score ( r = 0.926). Patients in different levels of PPI and PGIC exhibited significant differences among their mean total scores ( P < 0.05). EFA revealed four components similar to the original SF-MPQ-2. Conclusion The Persian translation of the expanded and revised version of the SF-MPQ-2 is a highly reliable, sensitive, and valid instrument to evaluate pain in patients with and without neuropathic etiology.

Aims The present study was carried out to determine the optimal cutoff points for homeostatic model assessment (HOMA-IR) and quantitative insulin sensitivity check index (QUICKI) in the diagnosis of metabolic syndrome (MetS) and non-alcoholic fatty liver disease (NAFLD). Methods The baseline data of 5511 subjects aged ≥ 18 years of a cohort study in northern Iran were utilized to analyze. Receiver operating characteristic (ROC) analysis was conducted to determine the discriminatory capability of HOMA-IR and QUICKI in the diagnosis of MetS and NAFLD. Youden index was utilized to determine the optimal cutoff points of HOMA-IR and QUICKI in the diagnosis of MetS and NAFLD. Results The optimal cutoff points for HOMA-IR in the diagnosis of MetS and NAFLD were 2.0 [sensitivity = 64.4%, specificity = 66.8%] and 1.79 [sensitivity = 66.2%, specificity = 62.2%] in men and were 2.5 [sensitivity = 57.6%, specificity = 67.9%] and 1.95 [sensitivity = 65.1%, specificity = 54.7%] in women respectively. Furthermore, the optimal cutoff points for QUICKI in the diagnosis of MetS and NAFLD were 0.343 [sensitivity = 63.7%, specificity = 67.8%] and 0.347 [sensitivity = 62.9%, specificity = 65.0%] in men and were 0.331 [sensitivity = 55.7%, specificity = 70.7%] and 0.333 [sensitivity = 53.2%, specificity = 67.7%] in women respectively. Conclusion Not only the optimal cutoff points of HOMA-IR and QUICKI were different for MetS and NAFLD, but also different cutoff points were obtained for men and women for each of these two conditions.

Myocardial infarction (MI) is one of the most important health burdens worldwide. Aspirin as an non- Steroid Anti—inflammatory drug, has been proven to be a protective factor to decrease the incidence, however its effect of MI size is still unknown. We designed this study to compare the biomarkers after MI in patients with and without aspirin intake. 378 patients were enrolled and the results showed lower cardiac troponin T and Creatine Kinases in patients with protective dose of aspirin intake. In addition, Creatine Kinases were significantly higher in patients with no history of MI. We conclude that aspirin can reduce the size of the infraction. Also, higher enzymes can be due to higher muscle content in patient without MI history.[GMJ. 2012;1(1):35-37]

Background: Chronic obstructive pulmonary disease (COPD) and heart failure are prevalent comorbidities affecting a vast proportion of the world population, responsible for significant morbidity and mortality, their coexistence is more frequent than previously recognized that poses important diagnostic and therapeutic challenges. We intend to determine the prevalence of concomitant left ventricular dysfunction in COPD patients. Methods: We performed a cross-sectional study in patients who had referred to Firuzgar University Hospital in Tehran from March 2011 to March 2013 in period of 2 years. All participants were compatible for including and excluding criteria’s. In all cases of COPD, pulmonary function test was done; also Echocardiography was performed as the diagnostic assessment of heart failure. Results: Out of 74 participants there was 56(75.7%) male and 18(24.3%) female with the mean age of 67.712.9 (SD), the prevalence of left ventricular systolic dysfunction (LVSD) was 25.70%, also the prevalence of left ventricular diastolic dysfunction (LVDD) was 74.60% among 71 patients. The prevalence of LVSD in patients with and without history of coronary artery disease (CAD) was 33.30% and 15.60% respectively. The prevalence of LVDD was 85.40% in patient with history of CAD and 60% in patients without it. The presence of ventricular dysfunction (neither systolic nor diastolic) in COPD patients was not statistically associated with presence of CAD or the intensity of underlying COPD disease. Conclusion: Knowledge about the prevalence of concomitant left side heart failure in COPD patients is limited, but it seems the presence is rather common, so more attention should be paid to coexistence of ventricular dysfunction in COPD patients disregarding presence of CAD or COPD intensity in clinical practice.