Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 15 2 2020 04 30 43 49 Simin Almasi Rheumatology Research Center, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran. Behzad Farahani Department of Cardiology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran. Niloufar Samiei Heart Valve Disease Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran. Yousef Rezaei Heart Valve Disease Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran. Habib Mahmoodi Department of Internal Medicine, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran. Mostafa Qorbani Department of Public Health, Alborz University of Medical Sciences, Karaj, Iran.AND Noncommunicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. 2019 04 15 2020 01 20 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. https://rhythm.tums.ac.ir/index.php/jthc/article/view/1071 https://rhythm.tums.ac.ir/index.php/jthc/article/download/1071/899

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 15 2 2020 04 30 50 56 Maryam Shakiba Cardiovascular Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran. AND Department of Epidemiology and Biostatistics, School of Health, Guilan University of Medical Sciences, Rasht, Iran. Arsalan Salari Cardiovascular Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran. Fardin Mirbolouk Cardiovascular Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran. Nozar Sotoude Department of Epidemiology and Biostatistics, School of Health, Guilan University of Medical Sciences, Rasht, Iran. Salman Nikfarjam Cardiovascular Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran. 2019 07 01 2020 01 16 Background: No-reflow is a major challenging issue in the management of patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). This study aimed to investigate the clinical, laboratory, and procedural predictors of no-reflow. Methods: This study was conducted on 378 patients with STEMI admitted to Dr. Heshmat Educational and Remedial Center (a referral heart hospital in Rasht, Iran) between 2015 and 2017. The study population was divided based on the thrombolysis in myocardial infarction (TIMI) flow grade and the myocardial blush grade into no-reflow and reflow groups. The clinical, laboratory, and procedural characteristics at admission were compared between the 2 groups using the multivariate logistic regression analysis. Results: The mean age of the participants was 58.57±11.49 years, and men comprised 74.1% of the study population. The no-reflow phenomenon was found in 77 patients. The no-reflow group was significantly older and more likely to be female; additionally, it had higher frequencies of hypertension, diabetes mellitus, hyperlipidemia, and a history of cardiovascular diseases. The multivariate logistic regression analysis showed that age >60 years (OR=1.05, 95% CI:1.00–1.09), hypertension (OR=2.91, 95% CI:1.35–6.27), diabetes (OR=4.18, 95% CI:1.89–9.22), a low systolic blood pressure (OR=3.53, 95% CI:1.02–12.2), a history of cardiovascular diseases (OR=4.29, 95% CI:1.88–9.77), chronic heart failure (OR=4.96, 95% CI:1.23–20), a low initial TIMI flow grade (OR=7.58, 95% CI:1.46–39.2 ), anemia (OR=3.42, 95% CI:1.33–8.77), and stenting vs. balloon angioplasty (OR=0.42, 95% CI:0.19–0.91) were the significant independent predictors of no-reflow. Conclusion: This study revealed some clinical, laboratory, and procedural predictors of no-reflow for the prediction of high-risk patients and their appropriate management to reduce the risk of no-reflow. https://rhythm.tums.ac.ir/index.php/jthc/article/view/1099 https://rhythm.tums.ac.ir/index.php/jthc/article/download/1099/900

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 15 2 2020 04 30 57 63 EN Yaser Jenab Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Ali-Mohammad Haji-Zeinali Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Javad Alemzadeh-Ansari Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Shapour Shirani 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. Hamed Vahidi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Marzieh Pourjafari Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Arash Jalali Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. 2018 11 16 2020 01 18 Background: In patients with heart failure, elevated levels of blood urea nitrogen (BUN) is a prognostic factor. In this study, we investigated the prognostic value of elevated baseline BUN in short-term mortality among patients with acute pulmonary embolism (PE). Methods: Between 2007 and 2014, cardiac biomarkers and BUN levels were measured in patients with acute PE. The primary endpoint was 30-day mortality, evaluated based on the baseline BUN (≥14 ng/L) level in 4 groups of patients according to the European Society of Cardiology’s risk stratification (low-risk, intermediate low-risk, intermediate high-risk, and high-risk). Results: Our study recruited 492 patients with a diagnosis of acute PE (mean age=60.58±16.81 y). The overall 1-month mortality rate was 6.9% (34 patients). Elevated BUN levels were reported in 316 (64.2%) patients. A high simplified pulmonary embolism severity index (sPESI) score (OR: 5.23, 95% CI: 1.43–19.11; P=0.012), thrombolytic or thrombectomy therapy (OR: 2.42, 95% CI: 1.01–5.13; P=0.021), and elevated baseline BUN levels (OR: 1.04, 95% CI: 1.01–1.03; P=0.029) were the independent predictors of 30-day mortality. According to our receiver-operating characteristics analysis for 30-day mortality, a baseline BUN level of greater than 14.8 mg/dL was considered elevated. In the intermediate-low-risk patients, mortality occurred only in those with elevated baseline BUN levels (7.2% vs. 0; P=0.008). Conclusion: An elevated baseline BUN level in our patients with PE was an independent predictor of short-term mortality, especially among those in the intermediate-risk group. https://rhythm.tums.ac.ir/index.php/jthc/article/view/981 https://rhythm.tums.ac.ir/index.php/jthc/article/download/981/901

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 15 2 2020 04 30 64 68 Yazdan Ghandi Amir Kabir Hospital, Arak University of Medical Sciences, Arak, Iran. Bita Ghahremani Amir Kabir Hospital, Arak University of Medical Sciences, Arak, Iran. Danial Habibi Department of Biostatistics and Epidemiology, Isfahan University of Medical Sciences, Isfahan, Iran. Afsane Pouya Amir Kabir Hospital, Arak University of Medical Sciences, Arak, Iran. Saiid Sadrnia Amir Kabir Hospital, Arak University of Medical Sciences, Arak, Iran. 2019 01 13 2020 03 16 Background: Children with mitral valve prolapse (MVP) may be prone to ventricular arrhythmias due to transmural dispersion of repolarization (TDR). This study aimed to assess alterations in ventricular repolarization in children with MVP and to investigate their relationships with the degree of mitral regurgitation. Methods: Fifty children with MVP and 50 age- and sex-matched healthy children as controls were studied. Twelve-lead electrocardiography and echocardiography were performed in all the subjects. TDR parameters were QT and QTc intervals, QTc dispersion, Tp-e interval, Tp-e interval dispersion, Tp-e/QT, Tp-e/QTc, JTc, JTc dispersion, Tp-e/JT, and Tp-e/JTc. Results: The mean age of the 50 patients with MVP was 12.45±2.50 years (F/M: 15/35). There were no significant differences in QT and QTc intervals between the 2 groups. QTc dispersion (P=0.001), Tp-e dispersion interval (P=0.002), Tp-e/QTc (P=0.001), JTc dispersion (P=0.023), Tp-e/JT (P=0.004), and Tp-e/JTc (P=0.002) were significantly higher in the patients with MVP than in the healthy controls. Positive correlations were found between Tp-e dispersion interval and Tp-e/QTc and an increase in the degree of mitral regurgitation (P=0.012, r=0.42 and P=0.004, r=0.31, respectively). Additionally, positive correlations were detected between JTc dispersion and Tp-e/JTc and an increase in the degree of mitral regurgitation (P=0.032, r=0.20 and P=0.024, r=0.42, correspondingly). Conclusion: In this study, TDR was damaged in children with MVP and was positively correlated with an increase in the degree of mitral regurgitation. It appears that children with MVP are prone to life-threatening ventricular arrhythmias. https://rhythm.tums.ac.ir/index.php/jthc/article/view/1022 https://rhythm.tums.ac.ir/index.php/jthc/article/download/1022/902

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 15 2 2020 04 30 69 72 EN Murat Akcay Department of Cardiology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey. 2018 11 30 2019 03 05 Saphenous vein grafts (SVGs) are widely used conduits for the surgical revascularization of coronary arteries, but they are associated with poor long-term patency rates. Acute SVG thromboses often present as acute coronary syndrome and have an extensive atherosclerotic and thrombotic burden. Percutaneous coronary intervention (PCI) is the first treatment option; however, it carries a high risk of distal embolization, no-reflow, and periprocedural myocardial infarction. Reducing the thrombus burden and preventing distal embolization during PCI can be achieved by using some pharmacological strategies (e.g., glycoprotein IIb/IIIa antagonists) and devices (e.g., thrombectomy and filter devices). There are yet no better therapeutic options for patients undergoing PCI of SVG occlusions. Here, we introduce a 52-year-old male patient admitted with a typical acute chest pain of 1 hour’s duration. Electrocardiography showed signs of acute inferoposterior myocardial infarction. A thrombotic SVG occlusion was detected in primary PCI, and a huge thrombus content was aspirated. After the thrombus aspiration with stent therapy, the chest pain was relieved and the ST-segment elevation was improved. The patient has been followed without any symptoms for 10 months. https://rhythm.tums.ac.ir/index.php/jthc/article/view/992 https://rhythm.tums.ac.ir/index.php/jthc/article/download/992/908

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 15 2 2020 04 30 73 76 Ferhat Borulu Department of Cardiovascular Surgery, Medical Faculty, Atatürk University, Erzurum, Turkey. Bilgehan Erkut Department of Cardiovascular Surgery, Medical Faculty, Atatürk University, Erzurum, Turkey. 2019 03 06 2020 03 01 Chylopericardium is a rare complication following cardiac surgery. The incidence of this pathological condition is very low and mainly attributed to lymphatic injuries to the thymus or anterior mediastinum, thoracic duct injuries, or extensive posterior pericardial dissection with the possible interruption of major cardiac lymph channels. A 62-year-old man was admitted to the cardiovascular surgery department for coronary bypass surgery, and the surgical procedure was performed 3 days later. Revision surgery was performed, because of the drainage associated with bleeding. In the post-revision days, the amount of serous drainage increased, and then chylous drainage occurred. After conservative treatment, the drainage of the chylous features decreased and eventually disappeared. The patient was discharged without any problem. At 6 months’ follow-up, the patient was doing well with a normal left ventricular function and without effusion. https://rhythm.tums.ac.ir/index.php/jthc/article/view/1056 https://rhythm.tums.ac.ir/index.php/jthc/article/download/1056/903

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 15 2 2020 04 30 77 80 < and assessments of existing data in the outpatient cardiology clinic. The comparative analysis was conducted using a logistic regression test. Results: The mean follow-up length was 66.26±15.32 months, 105 patients (52.2%) were male, and the mean age of the patients was 53.81±11.91 years. The left anterior descending was the main affected artery (42.8%). At long-term follow-up, 19 patients (9.5%) required repeated angiography. Three patients (1.5%) had a myocardial infarction and 5 (2.5%) died from cardiovascular etiologies. Three patients (1.5%) underwent percutaneous coronary intervention. No patient required coronary artery bypass grafting. The need for a second angiography had no association with sex, symptoms, and echocardiographic findings. Conclusion: The long-term outcome of CSF patients is good, but their follow-up is necessary for the early diagnosis of cardiovascular-related adverse events. https://rhythm.tums.ac.ir/index.php/jthc/article/view/1593 https://rhythm.tums.ac.ir/index.php/jthc/article/download/1593/1030

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 17 4 2022 10 31 207 214 Mohammad Javad Zibaeenezhad Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Mehrab Sayadi Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Seyyed Saeed Mohammadi Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Soorena Khorshidi Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Ehsan Hadiyan Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Neda Rasouli University of Colorado, School of Medicine, and VA Eastern Colorado Health Care system, Aurora, Colorado, USA Ali Karimi-Akhormeh Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Iman Razeghian-Jahromi Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran 2022 01 23 2022 10 06 Background: This study aimed to investigate the possible relationship between different stent sizes and clinical outcomes after percutaneous coronary intervention (PCI) in patients with diabetes treated with drug-eluting stents (DESs) and dual antiplatelet therapy (DAPT). Methods: Patients with stable coronary artery disease undergoing elective PCI with the DES were entered into a retrospective cohort between 2003 and 2019. Major adverse cardiac events (MACE), defined as the combined endpoint of revascularization, myocardial infarction, and cardiovascular death, were recorded. The participants were categorized according to the stent size: 27 mm for length and 3 mm for diameter. DAPT (aspirin and clopidogrel) was used for at least 2 years for diabetics and 1 year for nondiabetics. The median duration of follow-up was 74.7 months. Results: Out of 1630 participants, 29.0% had diabetes. The diabetics constituted 37.8% of those with MACE. The mean diameter of the stents in the diabetics and nondiabetics was 2.81±0.29 mm and 2.90±0.35 mm, respectively (P>0.05). The mean stent length was 19.48±7.58 mm and 18.92±6.64 mm in the diabetics and nondiabetics, respectively (P>0.05). After adjustments for confounding variables, MACE was not significantly different between the patients with and without diabetes. Although MACE incidence was not affected by stent dimensions in the patients with diabetes, the nondiabetic patients implanted with a stent length exceeding 27 mm experienced MACE less frequently.  Conclusion: Diabetes did not influence MACE in our population. Additionally, stents of different sizes were not associated with MACE in patients with diabetes. We propose that using the DES supplemented by long-term DAPT and tight control of glycemic status after PCI could decrease the adverse consequences of diabetes. https://rhythm.tums.ac.ir/index.php/jthc/article/view/1600 https://rhythm.tums.ac.ir/index.php/jthc/article/download/1600/1031

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 17 4 2022 10 31 215 222 Fatemeh Rangraz Jeddi Health Information Management Research Centre, Department of Health Information Management & Technology, Kashan University of Medical Sciences, Kashan, Iran Ehsan Nabovati Health Information Management Research Centre, Department of Health Information Management & Technology, Kashan University of Medical Sciences, Kashan, Iran Fateme Peykani Department of Health Information Management & Technology, Kashan University of Medical Sciences, Kashan, Iran Shima Anvari Health Information Management Research Centre, Department of Health Information Management & Technology, Kashan University of Medical Sciences, Kashan, Iran Parissa Bagheri Toolaroud Health Information Management Research Centre, Department of Health Information Management & Technology, Kashan University of Medical Sciences, Kashan, Iran 2022 01 30 2022 07 31 Background: Patients with cardiovascular disorders (CVD) are at higher risk for potential drug-drug interactions (pDDIs) due to complex treatment regimens. This study aimed to evaluate pDDI patterns in physicians’ prescriptions in a specialized heart center using simple software. Methods: This cross-sectional study identified severe and related interactions during a 2-stage survey of experts. The data collected included age, sex, the date of admission and discharge, the length of hospital stay, drug names, inpatient wards, and the final diagnosis. The extracted drug interactions were used as a source of software knowledge. The software was designed using the SQL Server and the C # programming language. Results: Of 24 875 patients included in the study, 14 695 (59.1%) were male. The average age was 62 years. Based on the survey of experts, only 57 pairs of severe pDDIs were identified. The designed software evaluated 185 516 prescriptions. The incidence of pDDIs was 10.5%. The average number of prescriptions per patient was 7.5. The highest frequency of pDDIs was detected in patients with diseases of the lymphatic system (15.0%). Aspirin with heparin (14.3%) and heparin with clopidogrel (11.7%) were the most common documented pDDIs. Conclusion: This study reports the prevalence