Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 12 1 2017 03 05 1 5 EN Nikoo Hamzeh Shariati Hospital, Tehran University of Medical sciences, Tehran, Iran. Fatemeh Ghadimi Shariati Hospital, Tehran University of Medical sciences, Tehran, Iran. Rojin Farzaneh Shariati Hospital, Tehran University of Medical sciences, Tehran, Iran. Seyed Kianoosh Hosseini Shariati Hospital, Tehran University of Medical sciences, Tehran, Iran. 2017 02 11 2017 02 11 The incidence and prevalence of obesity are fast increasing worldwide. Various indices have been used to measure and assess obesity. The body mass index (BMI) is the most common and practical of these indices. Overweight and obesity exert considerable adverse effects on the cardiovascular system. These effects are mediated through various neurohormonal and cytokine pathways, most of which are inflammatory mediators. Systolic and / or diastolic heart failure is more prevalent among obese and overweight individuals than among normal weight people. The concept of the “obesity paradox” has been proposed by some previously published studies, in which the prognosis of obese patients with established cardiovascular diseases, especially heart failure, is better than that of their leaner counterparts. In this review, we discuss the obesity paradox and its possible pathophysiologic mechanisms.  https://rhythm.tums.ac.ir/index.php/jthc/article/view/672 https://rhythm.tums.ac.ir/index.php/jthc/article/download/672/520

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 12 1 2017 03 05 6 10 EN Pınar Türker Duyuler Department of Cardiology, Ankara Numune Training and Research Hospital, Ankara, Turkey. Serkan Duyuler Department of Cardiology, Acıbadem Ankara Hospital, Ankara, Turkey. Mehmet İleri Department of Cardiology, Ankara Numune Training and Research Hospital, Ankara, Turkey. Mevlüt Demir Department of Cardiology, Ankara Numune Training and Research Hospital, Ankara, Turkey. Abdullah Dolu Department of Cardiology, Ankara Numune Training and Research Hospital, Ankara, Turkey. Funda Başyiğit Department of Cardiology, Ankara Numune Training and Research Hospital, Ankara, Turkey. 2016 04 17 2016 12 10 Background: Blood viscosity and aortic sclerosis (AS) are strong predictors of cardiovascular events. The effects of blood viscosity on AS have not been studied adequately. We aimed to investigate the potential connection between whole blood viscosity (WBV) and AS. Methods:  AS was detected by transthoracic echocardiography. The estimation of WBV was carried out at both high shear rate (HSR) (208/s) and low shear rate (LSR) (0.5/s) by previously validated formulae using hematocrit (HcT) and total protein (TP) in g/L. WBV at HSR (208/s) is: (0.12 × HcT) + 0.17 (TP - 2.07) and WBV at LSR (0.5/s) is: (1.89 × HcT) + 3.76 (TP - 78.42). Comparisons of WBV at both HSR and LSR were made between patients with and without AS. Results: We included 94 patients with AS (male = 30.9%, mean age = 67.5 y) and 97 control subjects without AS (male =26.6%, mean age = 69.1 y). Almost all of the clinical, echocardiographic, and biochemical characteristics were similar, but TP values were significantly higher in the AS group than in the control group (72.9 ± 5 g/L vs. 75.8 ± 6.1 g/L; p value < 0.001). Hemoglobin and HcT levels were similar (p value = 0.604 and p value = 0.431, respectively). In the AS group, WBV at LSR and HSR was higher than that in the control group (p value = 0.001 for both LSR and HSR). In multiple stepwise logistic regression analysis, WBV was an independent predictor of AS (p value < 0.001). Conclusion: We found higher WBV in patients with AS than in patients without AS at both LSR (0.5/s) and HSR (208/s). WBV at both LSR and HSR was independently associated with AS. https://rhythm.tums.ac.ir/index.php/jthc/article/view/534 https://rhythm.tums.ac.ir/index.php/jthc/article/download/534/504

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 12 1 2017 03 05 11 14 EN Kasra Moazzami Hackensack University Medical Center, Hackesack, NJ, USA. AND Rutgers New Jersey Medical School, Newark, NJ, USA. Elena Dolmatova Hackensack University Medical Center, Hackesack, NJ, USA. AND Rutgers New Jersey Medical School, Newark, NJ, USA. Thomas Cocke Hackensack University Medical Center, Hackesack, NJ, USA. AND Valley Medical Group and Valley Hospital, Ridgewood, NJ, USA. Elie Elmann Hackensack University Medical Center, Hackesack, NJ, USA. Pranay Vaidya Hackensack University Medical Center, Hackesack, NJ, USA. Arthur Ng Hackensack University Medical Center, Hackesack, NJ, USA. Kumar Satya Hackensack University Medical Center, Hackesack, NJ, USA. Rajeev Narayan Hackensack University Medical Center, Hackesack, NJ, USA. AND Rutgers New Jersey Medical School, Newark, NJ, USA. AND Valley Medical Group and Valley Hospital, Ridgewood, NJ, USA. 2016 06 22 2016 11 22 Background: Venoarterial extracorporeal membrane oxygenation (ECMO) provides systemic arterial support without directly unloading the left heart, which causes an elevated left ventricular (LV) pressure. The aim of the present study was to investigate the adjunctive application of the Impella device for LV unloading in patients during ECMO. Methods: This retrospective cohort study included patients who received Impella support in addition to venoarterial ECMO between April 2012 and December 2015. ECMO cannulation was performed peripherally or centrally, while the Impella device was surgically inserted into the femoral artery or the right axillary artery. Results: Among 62 patients, 10 (16.1%) received an Impella device during ECMO support. Following Impella support, right atrial pressure improved from a median of 18 (IQR, 14–24) mmHg to 13 (IQR, 10–15) mmHg and pulmonary wedge pressure improved from 30 (IQR, 26–35) mmHg to 16 (IQR, 12–19) mmHg in all the patients (p value < 0.001). Follow-up transthoracic echocardiograms (n = 6) showed a median decrease of 0.8 cm in LV end-diastolic volume (p value = 0.021). There were 5 (50%) in-hospital deaths due to sustained brain injury (n = 3) and refractory cardiogenic shock (n = 2). The remaining 5 patients were discharged and successfully bridged to more permanent LV assist device (n = 2) or heart transplantation (n = 3). Conclusion: The findings of the present study indicate that the application of the Impella device during ECMO support is effective in LV unloading and confers optimal hemodynamic support. https://rhythm.tums.ac.ir/index.php/jthc/article/view/573 https://rhythm.tums.ac.ir/index.php/jthc/article/download/573/505

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 12 1 2017 03 05 15 22 EN Noor Mohammand Noori Children and Adolescents’ Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran. Iraj Shahramian Zabol University of Medical Sciences, Zabol, Iran. Alireza Teimouri Children and Adolescents’ Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran. Behrooz Keyvani Children and Adolescents’ Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran. Maziar Mahjoubifard Children and Adolescents’ Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran. 2017 02 11 2017 02 11 Background: Levels of anti-inflammatory cytokines in blood have a positive relationship with congenital heart disease (CHD). We sought to assess the difference in serum cytokines levels between children with and without CHD. Methods: We recruited 60 patients with CHD and 30 healthy children, from 2013 to 2014. Patients with primary pulmonary hypertension; metabolic diseases; renal, endocrine, and chronic inflammatory diseases; fever; infection in the preceding 3 weeks; and malnutrition were excluded. Participants’ demographic data were measured, and their cardiac diseases were diagnosed via echocardiography. Serum levels of tumor necrosis factor (TNF)-α, interleukin (IL)-6, and IL-18 were measured via ELISA. Results: Mean age of the participants was 4.28 ± 3.44, 3.12 ± 3.87, and 3.30 ± 3.61 years in the cyanotic, acyanotic, and control groups, respectively (p value = 0.414). Mean values of TNF-α (p value < 0.001), IL-6 (p value < 0.001), IL-18 (p value = 0.030), right ventricular pressure (p value < 0.001), and pulmonary pressure (p value = 0.015) were higher in the case group, while the BMI was higher in the controls (p value < 0.001). Mean values of TNF-α (p value < 0.001), IL-6 (p value < 0.001), and right ventricular pressure (p value < 0.001) were significantly higher in the cyanotic children, whereas the BMI was higher in the controls (p value < 0.001). Levels of TNF-α and IL-6 had significant correlations with right ventricular pressure.  Conclusion: The present study showed a differed serum cytokines levels between children with and without CHD. https://rhythm.tums.ac.ir/index.php/jthc/article/view/673 https://rhythm.tums.ac.ir/index.php/jthc/article/download/673/521

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 12 1 2017 03 05 23 26 EN Atefe Esmaili Research Institute for Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Saeed Farzanefar Department of Nuclear Medicine, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran. Alireza Emami-Ardakani Research Institute for Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mehrshad Abbasi Department of Nuclear Medicine, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2017 02 11 2017 02 11 Background: The implications of cardiac risk stratification before orthotopic liver transplantation (OLT) are not well established. We studied the usefulness of myocardial perfusion imaging (MPI) in this scenario. Methods: MPI data of 24 patients (9 females), candidates of OLT, were collected. They underwent MPI as part of their preoperative risk assessment. MPIs were interpreted by 2 nuclear physicians, who had access to clinical data, scan, and semi-quantification results (i.e., quantitative perfusion single-photon emission tomography (SPECT) [QPS] and quantitative gated SPECT [QGS]). A 3rd nuclear physician, blinded to the clinical history of the subjects, re-reviewed the scans. The visual interpretations of MPI (i.e., normal vs. abnormal), ejection fraction, and transient ischemic dilation index derived from QPS and clinical and follow-up data were collected and analyzed. Results: The follow-up period was 231.0 ± 86.0 days.  The MPIs were normal in 16 (66.7%) patients and abnormal in 8 (i.e., 5 mild [20.8%], 1 [4.2%] moderate, and 2 [8.3%] severe). Out of 4 patients who died during the follow-up, 1 had mild ischemia and 2 had severe ischemia. A patient who had a normal MPI died due to noncardiac reasons. A patient with abnormal MPI had 3-vessel disease on angiography. Out of the 5 patients who died or had significant coronary angiographic abnormalities, 4 had abnormal MPIs (negative predictive value = 93.8%; sensitivity = 80.0%)  The MPIs of 4 patients without perioperative mortality or cardiac morbidity were abnormal (specificity = 78.9%). Conclusion: MPI seems to be remarkable in discriminating high-risk OLT patients preoperatively.  https://rhythm.tums.ac.ir/index.php/jthc/article/view/674 https://rhythm.tums.ac.ir/index.php/jthc/article/download/674/522

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 12 1 2017 03 05 27 31 EN Seyed Mohsen Mirhosseini Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Ali Sanjari Moghaddam Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Paritash Tahmaseb Pour Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Ali Dabbagh Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2017 02 11 2017 02 11 Postoperative vasoplegic syndrome (VS) is characterized by low systemic vascular resistance, normal or elevated cardiac output, and poor response to volume expansion. The incidence of VS after cardiac surgery requiring cardiopulmonary bypass is about 20%. Sometimes, VS becomes refractory and initial treatments do not work, rendering treatment a great challenge. In this study, we describe a young male patient with endocarditis undergoing tricuspid valve replacement. When being weaned off cardiopulmonary bypass, the patient experienced VS. The patient’s blood pressure did not increase after the administration of a high dose of epinephrine and norepinephrine. Therefore, he was commenced on a low dose of vasopressin and gradually his blood pressure reached the normal range. Although the standard management of VS is a high dose of vasopressors, this patient was refractory to a combination of epinephrine and norepinephrine; only a vasopressin infusion was able to treat the patient. Eventually, he was weaned from bypass and the operation was terminated satisfactorily. Thereafter, the patient passed the recovery period in the cardiac intensive care unit and was discharged. It seems that vasopressin is an excellent option in refractory vasoplegia with minimal response to other vasopressors. https://rhythm.tums.ac.ir/index.php/jthc/article/view/675 https://rhythm.tums.ac.ir/index.php/jthc/article/download/675/523

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 12 1 2017 03 05 32 34 EN Mahmood Hosseinzadeh Maleki Atherosclerosis and Coronary Artery Research Center, Birjand University of Medical Scieion and left ventricular ejection fraction (LVEF) of 35-40%, which was 45-50% two years before. Selective coronary angiography performed 8 years previously was normal but a new one revealed the cut-off of the left anterior descending artery at the proximal portion, for which percutaneous coronary intervention was performed and showed no significant lesion in the other vessels. One should consider coronary artery disease in uncontrolled heart failure with LVEF reduction, even in the absence of typical chest pain. It may not be the natural course of the underlying disease. https://rhythm.tums.ac.ir/index.php/jthc/article/view/649 https://rhythm.tums.ac.ir/index.php/jthc/article/download/649/515

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 11 4 2017 02 11 195 197 EN Maryam Sotoudeh Anvari Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Farzad Masoudkabir Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Kyomars Abbasi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Ali Boroumand Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Manijeh Zarghampour Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Hamidreza Goodarzynejad Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. 2017 01 07 2017 01 07 Takayasu’s arteritis (TA) is a rare case of granulomatous arteritis which mainly involves the aorta and its large branches. Although arterial hypertension is the most common feature of the disease in both adults and children, patients with TA may present with numerous clinical manifestations. Our patient was a 45-year-old woman, known to have hypertension from 3 years earlier following assessments made for severe headache. One year after the diagnosis of hypertension, she developed a left-sided lower motor neuron facial palsy, which was treated with oral corticosteroids (Prednisolone). Notably, the patient's headache was relieved after she took corticosteroid therapy. Transthoracic echocardiography revealed severe aortic insufficiency and aneurysmal changes in the ascending aorta, and she was referred to our center for further evaluation. In multi-slice computed-tomography angiography, significant long stenosis of the left subclavian artery was seen and the diameter of the ascending aorta was 50 mm. The patient underwent the Bentall operation. The pathologic examination of the aortic wall specimen was compatible with giant cell aortitis and more in favor of TA with the ascending aortic aneurysm. At 6months' follow-up, the patient was in good condition and had almost recovered from facial palsy.  https://rhythm.tums.ac.ir/index.php/jthc/article/view/650 https://rhythm.tums.ac.ir/index.php/jthc/article/download/650/516

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 11 4 2017 02 11 198 202 EN Hassan Aghajani Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Shahrooz Yazdani Shahid Rajaei Hospital Medical Center, Alborz University of Medical Sciences, Karaj, Iran. Seyed Khalil Forouzan Nia Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Hamed Vahidi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Faezeh Aghajani Tehran University of Medical Sciences, Tehran, Iran. 2016 02 10 2016 08 24 Cardiac manifestations of the hydatid cyst are relatively uncommon. Cardiac involvement may lead to the compression of vital organs, pulmonary hypertension, pericardial effusion, and even anaphylaxis. A 45-year-old woman presented to the Emergency Department of Tehran Heart Center with chest pain. Cardiac examination revealed relatively muffled heart sounds. Echocardiography demonstrated a round echolucent well-defined mass (47 × 25 mm) on the base and the mid lateral wall of the left ventricle (LV) without septation. Computed tomography angiography and cardiac magnetic resonance imaging revealed a large (52 mm) exophytic mass originating from the lateral wall of the LV with upward growth between the left anterior descending artery (LAD) and the left circumflex artery with no LV cavity obliteration. Coronary angiography showed upward displacement in the LAD with significant compressive narrowing. The patient underwent mass resection and grafting of the LAD. During surgery after the incision of the pericardium, the hydatid cyst entity of the mass was revealed. Hydatid cysts covered the anterolateral surface of the LV with adhesion to the pericardium. The patient recovered from the surgery uneventfully. Pathology report and immunological assays confirmed the diagnosis. During a 6-month postoperative follow-up period, she remained asymptomatic with complete recovery and no recurrence. https://rhythm.tums.ac.ir/index.php/jthc/article/view/487 https://rhythm.tums.ac.ir/index.php/jthc/article/download/487/517

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 11 4 2017 02 11 203 205 EN Arash Gholoobi Atherosclerosis Prevention Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. Mohammad Vojdanparast Cardiovascular Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. 2017 01 07 2017 01 07 Large intercoronary communications in the absence of obstructive coronary artery disease constitute a very rare coronary artery anomaly in which there is a readily visible connection between the 2 coronary arteries with a unidirectional or bidirectional blood flow; consequently, this anomaly may be misinterpreted as a functioning collateral vessel, indicative of an unrecognized proximal coronary artery occlusion. In contrast to collateral vessels that are seen in the presence of critical coronary artery stenosis and total occlusions, these arterial communications are vessels that are single, extramural, straight, and large in diameter. Myocardial ischemia could result from the coronary steal phenomenon by a unidirectional intercoronary communication. Herein, we describe a 57-year-old female with chest pain who was found in coronary angiography to have a single large intercoronary channel between the posterolateral branch of the right coronary artery and the distal left circumflex artery with a unidirectional flow. https://rhythm.tums.ac.ir/index.php/jthc/article/view/651 https://rhythm.tums.ac.ir/index.php/jthc/article/download/651/518

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 11 4 2017 02 11 598 598 EN Carlos Mestres Cardiothoracic and Vascular Surgery Heart and Vascular Institute C