Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 6 3 2011 09 15 109 116 Seyed-Hesameddin Abbasi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Seyed-Ebrahim Kassaian Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 03 Women die of cardiovascular disorders even more than a combination of breast cancer, stroke, chronic obstructive pulmonary disease, and lung cancer. Recent data show that while 1 out of 2.6 women die of coronary artery disease (CAD), only 1 out of 4.6 die from cancer. Whereas some studies show an increase in the age-adjusted mortality of CAD in both women and men, some other studies report an increase in mortality amongst young women. There is a significant decrease in sudden cardiac death in men without significant change in women, and more women die of CAD before their arrival at the emergency room of hospitals than do men. It is, therefore, regrettable that many women and their physicians are not sufficiently aware of the problem and this unawareness is believed to be a major culprit for the existing gender disparities and inaction on the part of women as regards risk modification. What is more, the bulk of our knowledge, preventive measures, diagnostic strategies, and treatment plans are on the basis of studies conducted chiefly in men, when powerful evidence-based gender-specific recommendations call for efforts to enroll more women in order to reach a desirable level of sex representation. Given the significance of CAD assessment in women, it is essential that an acceptable risk score system be devised to estimate the risk of coronary events. The Framingham Risk Score, which has been used for this purpose for a long time, is no longer suitable for women and the Reynolds Risk Score seems to be a more appropriate tool. Finally, from a pathophysiological point of view, endothelial and microvascular dysfunctions are the most salient contributors to the development of CAD in women by comparison with men and they give rise to non-obstructive CAD. Lamentably, most of the relevant studies conducted hitherto have focused predominantly on men; any attempt to redress the balance would be of great value in the endeavors to decrease the risk in women. https://rhythm.tums.ac.ir/index.php/jthc/article/view/210 https://rhythm.tums.ac.ir/index.php/jthc/article/download/210/208

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 6 3 2011 09 15 117 125 Hossein Mehrad Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran. Manijhe Mokhtari-Dizaji Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran. Hossein Ghanaati Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran. Amir-Ali Shahbazfar Faculty of Veterinary, Tabriz University, Tabriz, Iran. Afshin Mohsenifar Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran. 2015 10 03 Background: A precise understanding of the mechanism of human neointimal stenoses and atherosclerotic fibrous plaques, which give rise to thromboses in vital arteries, requires a suitable animal model that would mimic the same characteristics well. We developed a rabbit model of neointimal stenosis and fibrotic plaque rupture in the carotid artery to visualize the lesion progress and to characterize the lesion types according to the American Heart Association classification. Methods: Twenty-eight healthy male New Zealand white rabbits were randomly divided into two groups: The rabbits in group A (n = 14) consumed a standard chow diet, and those in group B (n = 14) were injured via perivascular cold injury using liquid nitrogen at the right common carotid artery before being fed a high cholesterol diet (1.5%) for eight weeks. Plasma lipid evaluation was performed before the sacrificing of the rabbits. At the end of every week, at least 1 rabbit from group B was sacrificed for an analysis of lesion histopathology and calculation of the area ratios of the intima to media. Results: The plasma lipid level in group B was significantly higher than that in group A (p value < 0.05). The histopathological results revealed atherosclerosis characteristics such as endothelial layer destruction, fatty streaks and lipid-containing macrophages (foam cells) formation in the intima and media layers, extracellular lipid collections, smooth muscle cells proliferation and migration, neointima formation, intima thickening and deformation, fibrotic plaque formation, and finally plaque rupture. Statistical analysis revealed a significant increase in the intima-to-media ratio at the end of the eighth week (6.41 ± 0.27, p value < 0.05). Conclusion: We successfully developed a rabbit model of neointimal stenosis and atherosclerotic fibrous connective tissue plaque rupture, which is not only quickly and easily reproducible and inexpensive but also without mortality. The merits of our model render the evaluation of neointimal stenoses and fibrotic plaques and their treatment strategies more feasible in humans. https://rhythm.tums.ac.ir/index.php/jthc/article/view/211 https://rhythm.tums.ac.ir/index.php/jthc/article/download/211/209

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 6 3 2011 09 15 126 133 Hamidreza Poorhosseini Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Mehdi Mousavi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Ebrahim Nematipour Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Seyed Ebrahim Kassaian Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Mojtaba Salarifar Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Alidoosti Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Alimohammad Hajizeinali Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Younes Nozari Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Alireza Amirzadegan Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Seyed Kianoosh Hosseini Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Mahmood Sheikhfathollahi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 03 Background: Clinical trials of revascularization have routinely under-enrolled elderly subjects. Thus, symptom relief and improved survival might not apply to elderly patients, in whom the risk of mortality and disability from revascularization procedures seems to be high and co-morbidity is more prevalent. The present case control study was performed to draw a comparison in terms of the procedural success, procedural and in-hospital complications, and major adverse cardiac events (MACE) in a one-year follow-up of octogenarians (age ≥ 80 years) with a selected matched younger control group in the Tehran Heart Center Angioplasty Registry. Methods: According to the Tehran Heart Center Interventional Registry of 9, 250 patients with a minimum follow-up period of one year between April 1993 and February 2010, 157 percutaneous coronary intervention (PCI) procedures were performed in 112 octogenarians. Additionally, 336 younger patients (459 PCI procedures) were selected from the database as the propensity-score matched controls. Results: There were 147 (93.6%) and 441 (96.1%) successful PCI procedures in the elderly group and control group, respectively (p value = 0.204). Procedural complications were seen in 5 (3.2%) of the elderly group and 16 (3.5%) of the control group (p value = 0.858). Totally, 7 (6.3%) in-hospital complications occurred in the elderly group and 22 (6.8%) in the control group (p value = 0.866). One-year MACE was seen in 9 (9.1%) of the elderly and 18 (5.8%) of the control group (p value = 0.26). Conclusion: Procedural success and complications, in-hospital complications, and one-year MACE were not significantly different between our two study groups. Therefore, age alone should not be used as the sole criterion when considering revascularization procedures. Furthermore, PCI should not be refused in octogenarians if indicated. https://rhythm.tums.ac.ir/index.php/jthc/article/view/212 https://rhythm.tums.ac.ir/index.php/jthc/article/download/212/210

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 6 3 2011 09 15 134 137 Fariba Alaei Shaheed Rajaei Cardiovascular, Medical and Research Center, Tehran, Iran. Mohammad Yousef Arabi Moghadam Shaheed Rajaei Cardiovascular, Medical and Research Center, Tehran, Iran. Hojat Mortaezaian Shaheed Rajaei Cardiovascular, Medical and Research Center, Tehran, Iran. Mastaneh Alaei Shaheed Rajaei Cardiovascular, Medical and Research Center, Tehran, Iran. Hooman Bakhshandeh Shaheed Rajaei Cardiovascular, Medical and Research Center, Tehran, Iran. 2015 10 03 Background: Coarctation of the aorta is a discrete stenosis of the proximal thoracic aorta. The common clinical pattern is congestive heart failure in infancy. Treatment methods include balloon angioplasty and surgical repair in this age group. Percutaneous balloon angioplasty is a less invasive method for the repair of discrete coarctation but remains controversial as a primary treatment strategy for a native coarctation. This study aimed to compare the effectiveness and outcome of balloon angioplasty and surgical repair in coarctation infants younger than 1 year old. Methods:  This retrospective study evaluated the results of the two methods in 167 patients younger than one year old admitted into a tertiary heart center pediatric ward with the diagnosis of coarctation of the aorta: Balloon angioplasty was done for 55 and surgical repair for 112 infants. Patients with previous interventions were not included in this study. Results: Primary results revealed no significant difference in the effectiveness of the two methods (p value = 0.0601). While the rate of recurrent coarctation was significantly lower in the surgery group [19 (17%) vs. 11 (20%), p value = 0.0470], the mortality rate was lower in the balloon angioplasty method [5 (5.5%) vs. 13 (11.6%), p value = 0.039]. Our multivariate logistic regression model, however, showed no statistically significant difference (p value = 0.120). Conclusion: Because of the incidence of re-coarctation, balloon angioplasty compared with surgical repair did not confer an improved outcome for our infants’ coarctation. https://rhythm.tums.ac.ir/index.php/jthc/article/view/213 https://rhythm.tums.ac.ir/index.php/jthc/article/download/213/211

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 6 3 2011 09 15 138 142 Mojtaba Salarifar Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Seyed Ebrahim Kassaian Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Alidoosti Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Ali Mohammad Haji-Zeinali Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Hamid Reza Poorhoseini Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Ebrahim Nematipour Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Alireza Amirzadegan Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Sepideh Saroukhani Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 03 Background: For all the wealth of research comparing the efficacy of the different types of the drug-eluting stent (DES) such as sirolimus- , paclitaxel- , and zotarolimus-eluting stents, there is still a dearth of data on the different brands of each DES type. We aimed to investigate the one-year clinical outcomes, including major adverse cardiac events (MACE), of the use of the ultra long Apollo paclitaxel-eluting stent in patients with long atherosclerotic coronary artery lesions. Methods: According to a retrospective review of the Tehran Heart Center Registry of Interventional Cardiology, a single-center nonrandomized computerized data registry in which all adult patients who undergo single or multi-vessel percutaneous coronary intervention (PCI) are enrolled without any specific exclusion criteria, the mixed use of long Apollo paclitaxel-eluting stents and other types of the DES as well as myocardial infarction within forty-eight hours prior to the procedure was excluded. In total, 122 patients were enrolled in the study, and their baseline clinical, angiographic, and procedural characteristics were obtained. In addition, the patients’ follow-up data and, most importantly, MACE during a one-year period after intervention were recorded. Results: The mean follow-up duration was 14.1 ± 3.8 months. The one-year clinical follow-up data were obtained in 95.9 % of all the patients. The incidence of MACE was 5.7% during the entire study period. There was 1 death, which occurred during the initial days after PCI. The incidence of non-fatal myocardial infarction was 2.5% (3 cases), including one patient who underwent target vessel revascularization seven months later. Also, 3 patients with single-vessel disease and in-stent restenosis underwent coronary artery bypass grafting between five to ten months later. Conclusions: Our results showed that the Apollo paclitaxel-eluting stent might be regarded as a safe and effective treatment for long coronary lesions. https://rhythm.tums.ac.ir/index.php/jthc/article/view/214 https://rhythm.tums.ac.ir/index.php/jthc/article/download/214/212

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 6 3 2011 09 15 143 147 Mohammad Alidoosti Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Seyed Kianoosh Hosseini Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Ahmad Sharafi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Ebrahim Nematipour Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Mojtaba Salarifar Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Hamidreza Poorhoseini Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Seyed Ebrahim Kassaian Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Ali Mohammad Haji Zeinali Tehran Heart Center, Tehran University of MebDate PubStatus="accepted"> 2015 10 11 Isolated bilateral internal iliac artery (IIA) aneurysm is a rare and potentially lethal disease. Endovascular repair of this disorder is a matter of debate. A symptomatic 68-year-old male presented with severe pelvic pains. Computed tomography revealed a leaking 46-mm aneurysm in the right IIA, a 27-mm aneurysm in the left IIA, and ectatic changes at a diameter of 31 mm in the right common iliac artery (CIA). Due to lower rates of morbidity and mortality, an endovascular approach was chosen instead of open surgical repair. However, due to anatomical constraints, an endograft had to be implanted in a healthy aorta in order to support an iliac branch endograft in the left CIA. Subsequently, following coil embolization of the left IIA, an iliac stent graft was extended to the right external iliac artery (EIA). Two-year follow-up CT imaging showed complete exclusion of all the aneurysms and patency of the pelvic visceral arteries. The patient is currently asymptomatic. Endovascular repair of bilateral isolated IIAs can be a feasible treatment option. However, due to limited availability of sizes in iliac branch devices currently on the market, a main body device is sometimes required to be deployed in a healthy aorta for additional endograft support. https://rhythm.tums.ac.ir/index.php/jthc/article/view/293 https://rhythm.tums.ac.ir/index.php/jthc/article/download/293/286

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 8 2 2015 10 13 89 94 EN Leila Poorgholi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Hana Saffar Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Mahmood Sheikh-Fathollahi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Gholamreza Davoodi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Maryam Sotoudeh-Anvari Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Hamidreza Goodarzynejad Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Shayan Ziaee Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Ali Boroumand Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 11 2015 10 11  Background: The study of the association between genotype and phenotype is of great importance for the prediction of many diseases and pathophysiological conditions. The relationship between angiotensin-converting enzyme (ACE) gene insertion/ deletion (I/D) polymorphism and pathological processes such as coronary artery disease (CAD) has been investigated previously with discordant results. This study was designed to determine the association between ACE gene I/D polymorphism and CAD in an Iranian population. Methods: A total of 1050 individuals who were referred to Tehran Heart Center for coronary angiography were recruited. Six hundred seventy-six CAD-positive patients (documented by coronary angiography and Gensini scores higher than 6) and 374 CAD-negative patients were evaluated for ACE gene I/D polymorphism via the Polymerase Chain Reaction Amplification method. The patients’ age, sex, smoking status and its duration as well as familial history of CAD, hypertension, and diabetes mellitus were recorded. Results: Five hundred four (74.6%) of the CAD-positive patients were male, and the mean age of this group was 60 (60 ±10). In the CAD-negative individuals, the mean age was 56 (56 ± 10) and 196 of them were male (52.4%). After the analysis of all the groups and gender subgroups, neither genotype nor allele frequency was significantly different between the CAD- positive and CAD-negative groups (p values for genotypes and allele frequencies were 0.494 and 0.397, respectively). Conclusion: ACE gene I/D polymorphism was not associated with an increased risk of CAD in an Iranian population. https://rhythm.tums.ac.ir/index.php/jthc/article/view/288 https://rhythm.tums.ac.ir/index.php/jthc/article/download/288/281

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 8 2 2015 10 13 95 100 EN Masoumeh Lotfi-Tokaldany Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Zahra Savand-Roomi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Ali Kasemisaeid Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Hakimeh Sadeghian Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 11 2015 10 11 Background: Several echocardiographic markers have been introduced to assess the left ventricular (LV) mechanical dyssynchrony. We studied dyssynchrony markers and the latest LV activation site in heart failure patients with and without left bundle branch block (LBBB). Methods: Conventional echocardiography and tissue velocity imaging were performed for 78 patients (LV ejection fraction ≤ 35%), who were divided into two groups: LBBB (n = 37) and non-LBBB (n = 41). Time-to-peak systolic velocity (Ts) was measured in 12 LV segments in the mid and basal levels. Seven dyssynchrony markers were defined: delay and standard deviation (SD) of Ts in all and basal segments, septal-lateral and anteroseptal-posterior wall delay (at the basal level), and interventricular mechanical delay (IVMD). Results: The LBBB patients had significantly higher QRS duration and IVMD. The posterior wall was the latest activated site in the LBBB and the inferior wall was the latest in the non-LBBB patients. The most common dyssynchrony marker in the LBBB group was the SD of Ts in all segments (73%), whereas it was Ts delay in the basal segments in the non-LBBB group (48.8%). Ts delay and SD of all LV segments, septal lateral delay, septal-to-posterior wall delay by M-mode, pre-ejection period of the aortic valve, and IVMD were significantly higher in the LBBB group than in the non-LBBB group. Also, 29.3% of the non-LBBB and 10.8% of the LBBB patients did not show dyssynchrony by any marker. The number of patients showing dyssynchrony by ≥ 3 markers was remarkably higher in the LBBB patients (73% vs. 43.9%, respectively; p value = 0.044). Conclusion: The LBBB patients presented with a higher prevalence of dyssynchrony according to the frequently used echocardiographic markers. The latest activation site was different between the groups. https://rhythm.tums.ac.ir/index.php/jthc/article/view/289 https://rhythm.tums.ac.ir/index.php/jthc/article/download/289/282

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 8 2 2015 10 13 101 105 EN Alireza Yaghoubi Cardiovascular Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran. Naser Safaie Cardiovascular Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran. Rasoul Azarfarin Cardiovascular Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran. Azin Alizadehasl Cardiovascular Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran. Samad EJ-Golzari Physical Medicine and ehabilitationResearch Centre, Tabriz University of Medical Sciences, Tabriz, Iran AND Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran. 2015 10 11