Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 18 4 2023 08 30 237 243 Sana Ashiq Center for Applied Molecular Biology, University of the Punjab, Lahore, Pakistan. Syed Najam Hyder Department of Pediatric Cardiology, University of Child Health Sciences, The Children’s Hospital, Lahore, Pakistan. Kanwal Ashiq Faculty of Pharmaceutical Sciences, Superior University, Lahore, Pakistan. Muhammad Farooq Sabar Center for Applied Molecular Biology, University of the Punjab, Lahore, Pakistan. 2023 02 25 2023 08 24 Background: Several studies have investigated the role of vascular endothelial growth factor (VEGF) variants, serum levels, and correlations with other extrinsic factors in congenital heart defects (CHDs); however, the findings need confirmation. The present systematic review evaluates the association between CHDs and genetic polymorphisms and serum expressions. Methods: Relevant literature was searched through electronic databases using keywords and MeSH terms. VEGF activity was comparatively assessed between cyanotic and acyanotic CHDs, and the association between different polymorphisms and heart defects was evaluated. Results: We ultimately evaluated 12 studies regarding the association between VEGF serum patterns and found that serum VEGF levels were upregulated or downregulated in correlation with hypoxia and hemoglobin levels and were significantly associated with cyanotic CHDs compared with acyanotic CHDs. Our results also showed a significant role for different single-nucleotide polymorphisms, including rs699947, rs2010963, and rs3025039. Conclusion: The findings of the current study suggested a significant association between CHDs and VEGF genetic polymorphisms or varied serum levels. Nevertheless, more comprehensive studies may provide conclusive results and valuable insights into the pathogenesis of CHDs and relevant treatment strategies. https://rhythm.tums.ac.ir/index.php/jthc/article/view/1817

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 18 4 2023 08 30 244 255 Parnian Shobeiri Tehran University of Medical Sciences Amir Hossein Behnoush Tehran University of Medical Sciences Amirmohammad Khalaji Tehran University of Medical Sciences Antonio Teixeira The University of Texas Health Science Center at Houston, Houston, TX Nima Rezaei Tehran University of Medical Sciences 2023 04 09 2023 09 05 Background: Among its functions, brain-derived neurotrophic factor (BDNF) regulates endothelial and macrophage activation, possibly playing a role in atherosclerotic plaque pathophysiology. Given contradicting reports, this study sought to investigate whether blood levels of BDNF differed between patients with coronary heart disease (CHD) and controls. Methods: We explored PubMed, Embase, Web of Science, and Cochrane Library for studies comparing BDNF blood levels in patients with CHD and controls. Random-effect meta-analysis was conducted to calculate the standardized mean differences (SMD) and 95% confidence intervals (CI). The Newcastle-Ottawa scale was used to evaluate the quality of included articles, and statistical analyses were conducted using R version 4.0.4. Results: The final analysis comprised 12 investigations covering 1422 CHD cases and 929 controls with mean ages of 59.66±13.56 and 53.78±13.61 years, respectively. The initial analyses revealed a tendency toward low levels of BDNF in the CHD group compared with the control group (SMD= -0.41; 95% CI, -1.12 to 0.30; P=0.26). After the removal of outliers, the difference achieved statistical difference (SMD= -0.56; 95% CI, -0.93 to -0.19; P<0.01). Subgroup analysis demonstrated no significant difference between serum and plasma BDNF levels (P=0.54); however, subgroup analyses of studies investigating plasma BDNF showed that patients with CHD had significantly lower BDNF levels. Conclusion: Serum and plasma BDNF concentrations were considerably lower in patients with CHD than in healthy controls. Further studies of higher quality are required on the potential role of BDNF as a biomarker of CHD pathophysiology and severity. https://rhythm.tums.ac.ir/index.php/jthc/article/view/1835

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 18 4 2023 08 30 256 260 Alireza Ahmadi Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran. Mehdi Ghaderian Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran. Hajar Nourmohammadi Department of Pediatrics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. Mohammad Reza Sabri Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran. Bahar Dehghan Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran. Chehreh Mahdavi Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran. 2023 01 09 2023 11 26 Background: Congenital heart disease (CHD), a developmental abnormality of the heart and vessels, is encountered in the pediatric age group frequently. Brachial artery flow-mediated dilation (FMD) and carotid intima-media thickness (CIMT) are indicators of subclinical cardiovascular disease and are used as surrogate measures of subclinical atherosclerosis. The present study aimed to compare CIMT and FMD between children with acyanotic congenital heart disease (ACHD) and healthy controls. Methods: A case-control study on 50 children with ACHD and 43 healthy individuals was done in Isfahan, Iran, between 2021 and 2022. The case group was selected via non-random sampling, and healthy controls were recruited from the relatives of the patients. A checklist, including age, sex, body mass index, and blood pressure, was filled out for all the participants. Then, FMD and CIMT were measured with brachial and carotid artery ultrasonography. Results: Fifty children with ACHD and 43 healthy individuals (controls) under 18 years old participated in this study. Of these, 44 (47.3%) were girls and 49 (52.7%) were boys. The mean FMD was significantly higher in the ACHD group than in the control group (0.084±0.027 vs 0.076±0.042; P=0.021; 95% CI, 007 to 0.122;). CIMT was significantly higher in the ACHD group than in the control group (0.39±0.12 vs 0.34±0.1; P=0.037; 95% CI, 0.009 to 0.102;). However, systolic and diastolic blood pressure did not show differences between the groups. Conclusion: Based on our results, CIMT and FMD assessment may help detect early changes in peripheral vessels associated with atherosclerosis in the future in ACHD. Further studies are needed to confirm our findings. https://rhythm.tums.ac.ir/index.php/jthc/article/view/1790

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 18 4 2023 08 30 261 268 EN Mohsen Vahedi Department of Biostatistics and Epidemiology, Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. Niloufar Taherpour Prevention of Cardiovascular Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Mohammad Haji Aghajani 1- Prevention of Cardiovascular Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2- Department of Cardiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Mohamad Amin Pourhoseingholi Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Asma Puorhoseingholi Prevention of Cardiovascular Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2023 08 17 2023 12 14 Background: Knowledge, attitudes, and practices (KAP) studies are widely used in public health. This study aimed to investigate and compare KAP among patients with coronary artery disease (CAD) and premature coronary artery disease (PCAD) regarding cardiovascular disease (CVD). Methods: This cross-sectional study was conducted on 100 PCAD patients and 100 CAD patients in a general hospital in Tehran, Iran, between April and October 2022. A valid questionnaire was utilized to gather information, and descriptive analysis and logistic regression were employed for analysis using SPSS, version 23. Results: This study involved 100 CAD and 100 PCAD patients with average ages of 68.09±7.20 and 50.20±7.65 years, respectively. Men accounted for 58% of the PCAD group and 73% of the CAD group. The PCAD group had a higher level of knowledge and exhibited a more positive attitude toward CVD than the CAD group (P=0.007 and P<0.001, respectively). The PCAD patients and those with a family history of chronic diseases had a higher level of knowledge (P=0.045 and P=0.27, respectively) and showed a more positive attitude (P=0.030 and P<0.001, respectively). However, participants with a self-reported history of chronic diseases and those who were employed exhibited a less positive attitude. Occupation was associated with nutritional and smoking status (P=0.037). Conclusion: Higher levels of knowledge and more positive attitudes regarding CVD were observed; still, the study population’s behaviors were unsatisfactory. Educational interventions are needed to promote positive health behaviors, emphasizing the link between knowledge and risk reduction and decreased CVD and mortality rates. https://rhythm.tums.ac.ir/index.php/jthc/article/view/1915

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 18 4 2023 08 30 269 277 Kobra Noruzi Larki School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran. Tayeb Mohammadi Departments of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran Masoumeh Zakerimoghadam Department of Medical-Surgical Nursing and Basic Sciences, School of Nursing & Midwifery, Tehran University of Medical Sciences, Tehran, Iran. Leila Sayadi Department of Medical-Surgical Nursing and Basic Sciences, School of Nursing & Midwifery, Nursing and Midwifery Care Research Center, Tehran University of Medical, Tehran, Iran. 2023 05 01 2023 10 13 Background: Coronary surgery can have various outcomes, such as fear of death, cardiac anxiety, and pain disability. This study aimed to evaluate the effects of interventions based on patient expectations on different outcomes of coronary surgery, including expectations, cardiac anxiety, and pain-induced disability. Methods: This randomized clinical trial evaluated 60 coronary surgery candidates. Patients meeting the inclusion criteria were randomly assigned to control and intervention groups. The patients were contacted 1 to 2 weeks before coronary surgery to complete the Cardiac Surgery Patient Expectations Questionnaire (C-SPEQ). Based on the analysis of expectations, the intervention group underwent interventions to optimize expectations, whereas the control group received only routine care. The Cardiac Anxiety Questionnaire (CAQ) and the Pain Disability Index (PDI) were completed on the day of hospitalization. Three months later, the participants recompleted all 3 questionnaires. The data were analyzed with descriptive and analytical statistics in SPSS 16.0. Results: There were no significant differences between the control and intervention groups in baseline variables, pain-induced disability (P=0.353), and cardiac anxiety (P=0.479). After the intervention, no significant differences were observed between the groups concerning expectations (P=0.554) and pain-induced disability (P=0.557) when the confounding variables were adjusted. Nevertheless, cardiac anxiety decreased significantly (P=0.027). Conclusion: Our interventions improved expectations and mitigated anxiety among coronary surgery patients. Actualization and optimization of patient expectations should be considered in the care of coronary surgery candidates. https://rhythm.tums.ac.ir/index.php/jthc/article/view/1853

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 18 4 2023 08 30 278 287 Reza Ghafari Pharmacy faculty, Urmia University of Medical Sciences, Urmia, Iran. Amir Sorayaie Azar Department of Computer Engineering, Urmia University, Urmia, Iran. Ali Ghafari *Medical Physics and Biomedical Engineering Department, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. * Research Center for Evidence-Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. Fatemeh Moradabadi Aghdam Pharmacy faculty, Urmia University of Medical Sciences, Urmia, Iran. Morteza Valizadeh Faculty of Electrical and Computer Engineering, Urmia University, Urmia, Iran. Naser Khalili Department of Cardiology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran. Shima Hatamkhani * Experimental and Applied Pharmaceutical Sciences Research Center, Urmia University of Medical Sciences, Urmia, Iran. * Department of Clinical Pharmacy, Urmia University of Medical Sciences, Urmia, Iran. 2023 04 27 2023 09 05 Background: Myocardial infarction (MI) is a major cause of death, particularly during the first year. The avoidance of potentially fatal outcomes requires expeditious preventative steps. Machine learning (ML) is a subfield of artificial intelligence science that detects the underlying patterns of available big data for modeling them. This study aimed to establish an ML model with numerous features to predict the fatal complications of MI during the first 72 hours of hospital admission. Methods: We applied an MI complications database that contains the demographic and clinical records of patients during the 3 days of admission based on 2 output classes: dead due to the known complications of MI and alive. We utilized the recursive feature elimination (RFE) method to apply feature selection. Thus, after applying this method, we reduced the number of features to 50. The performance of 4 common ML classifier algorithms, namely logistic regression, support vector machine, random forest, and extreme gradient boosting (XGBoost), was evaluated using 8 classification metrics (sensitivity, specificity, precision, false-positive rate, false-negative rate, accuracy, F1-score, aLastName> Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran Elnaz Javanshir Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran 2021 12 27 2023 02 03 Background: Atrial fibrillation (AF) is a supraventricular tachyarrhythmia characterized by disorganized atrial activity and subsequent mechanical atrial failure. Postoperative AF is a frequent complication of coronary artery bypass grafting (CABG). Although there is evidence of decreased AF after CABG with statin usage, information is scarce regarding a direct comparison between atorvastatin and rosuvastatin. The present study was conducted to compare the efficacy of rosuvastatin and atorvastatin in preventing post-CABG AF. Methods: The present double-blind randomized comparative clinical trial selected CABG candidates with stable ischemic heart disease or acute coronary syndromes. Atorvastatin (40 mg per day) or rosuvastatin (20 mg per day) was prescribed 1 week before surgery, and the outcomes were compared. Results: Two-hundred patients, 100 cases in each group, completed the study. Twenty-five patients in each group were female, and the mean age was 59.30±8.42 years in the rosuvastatin group and 60.13±9.40 years in the atorvastatin group (P=0.513). The frequency of AF was 31% in the atorvastatin group and 27% in the rosuvastatin group (P=0.534). No significant differences existed between the groups concerning the length of hospital and ICU stay (P=0.333 and P=0.161) and in-hospital and 3-month mortality (P=0.315 and P=0.648). A subgroup analysis of only patients with stable ischemic heart disease could not detect a significant difference between the study groups in any of the investigated outcomes. Our logistic regression analysis showed an association only between age and the incidence of AF after CABG (OR, 1.12; 95% CI, 1.05 to 1.20; P<0.01). Conclusion: Rosuvastatin and atorvastatin are similar concerning the prevention of post-CABG AF, but there is a need for future well-designed multicenter studies on this topic.  https://rhythm.tums.ac.ir/index.php/jthc/article/view/1584 https://rhythm.tums.ac.ir/index.php/jthc/article/download/1584/1064

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 18 2 2023 04 30 122 128 Hamid Khederlou Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Seyede Vanoushe Azimi Pirsaraei Student Research Committee, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran. Elaheh Rabbani Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran. Morteza Motedayen Cardiology Department, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran. 2023 01 15 2023 06 28 Background: Ventricular arrhythmias (VAs), which result from acute myocardial infarction and revascularization, are preventable causes of sudden cardiac death. This study aimed to determine the incidence, types, and risk factors of VAs in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention (PCI). Methods: This cross-sectional study was conducted at the cardiology department of a tertiary care cardiac center in Zanjan, Iran. All the patients were monitored during hospitalization, and the incidence of cardiac arrhythmias and the outcomes were recorded. Result: Among 315 patients, the mean age was 62.14±10.11 years, and 76.2% were male. Male gender was significantly associated with VA occurrence (P=0.038). Among the patients, 50.5% had VAs, of which 26.4% were sustained ventricular tachycardia (sustained VT) and ventricular fibrillation (VF). Sustained VT and VF, but not total arrhythmias, were more common in anterior infarctions. Most arrhythmias occurred during the first 12 hours, and frequent premature ventricular contractions (43.3%) and idioventricular rhythm (20.1%) were the most common. A history of PCI and coronary artery bypass grafting (CABG) was associated with substantially reduced arrhythmias (P=0.017 and P=0.013, respectively). However, cardiovascular risk factors exerted no statistically significant effects on the VA type. Conclusion: Approximately half of our patients experienced reperfusion-induced VAs. Overall, gender and a history of PCI and CABG were significantly associated with VA occurrence. Therefore, males and patients without a positive history of PCI and CABG should receive antiarrhythmic drugs as a precaution. https://rhythm.tums.ac.ir/index.php/jthc/article/view/1795 https://rhythm.tums.ac.ir/index.php/jthc/article/download/1795/1071

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 18 2 2023 04 30 129 135 Hamid Khederlou Tehran University of Medical Sciences Amirali Mohammadi Zanjan university of Medical sciences Maryam Tajik Tehran University of Medical Sciences Mohamad Kazemshiroodi Iran University of Medical Sciences 2023 05 06 2023 06 28 Background: Myocardial perfusion imaging (MPI) is a noninvasive method with acceptable sensitivity and specificity in diagnosing coronary artery disease (CAD) in moderate-risk patients, including those with CAD risk factors. Methods: The present cross-sectional, prospective study was conducted on 4886 patients from April 2020 through March 2023 at Chamran and Tehran Heart Center hospitals. A questionnaire regarding anthropometric variables, demographic characteristics, CAD risk factors, and MPI findings was designed. Results: Totally, 2179 patients (44.6%) had abnormal MPI. Patients with abnormal MPI were significantly older than those with normal MPI. Older age (OR, 1.64; 95% CI, 1.2 to 1.72; P<0.001), diabetes mellitus (DM) (OR, 1.36; 95% CI, 1.1 to 1.48; P=0.012), hypertension (OR, 1.24; 95% CI, 1.04 to 1.37; P=0.032), and dyslipidemia (OR, 1.54; 95% CI, 1.25 to 1.8; P<0.001) were associated with abnormal MPI independently. Patients with more CAD risk factors were more likely to have abnormal MPI. Thus, in patients without or at most with 1 risk factor and those with 8 CAD risk factors, the likelihood of abnormal MPI was 3.7% and 76.2%, respectively. The frequency of left ventricular dilation and right ventricular prominence was significantly higher in patients with older age (P<0.001 and P=0.043, respectively), dyslipidemia (P<0.001 and P=0.007, respectively), DM (P<0.001 and P<0.001, respectively), and hypertension (P=0.048 and P=0.057, respectively). Conclusion: Individuals with CAD risk factors, especially those with older age, DM, hypertension, or dyslipidemia, require meticulous attention during CAD evaluation, particularly via MPI. https://rhythm.tums.ac.ir/index.php/jthc/article/view/1854 https://rhythm.tums.ac.ir/index.php/jthc/article/download/1854/1066

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 18 2 2023 04 30 136 141 Mana Jameie Tehran Heart Center, Cardiovascular Disease Research Institute Mohammad Safarian Nematabad Ali IbnAbitaleb Educational and Treatment Hospital, Rafsanjan University of Medical Sciences, Rafsanjan, Iran Pejman Mansouri Tehran Heart Center, Cardiovascular Disease Research Institute Arash Jalali “The Journal of Tehran University Heart Center” Faezeh Aghajai Research development Center, Arash women's Hospital, Tehran University of Medical Sciences, Tehran, Iran. Masoumeh Lotfi-Tokaldany Tehran Heart Center, Cardiovascular Disease Research Institute Hassan Aghajani Tehran Heart Center, Cardiovascular Disease Research Institute 2022 12 06 2023 04 18 Backgrounds: Studies have shown a decline in the admission rates of various diseases during the COVID-19 pandemic. Prosthetic valve thrombosis (PVT) is a rare condition followed by surgical or transcatheter valvular interventions. Considering the lack of data on hospitalization rates due to PVT during the pandemic, this study evaluated the implications of the COVID-19 pandemic on PVT admissions and characteristics in a tertiary referral center. Methods: Data from all the consecutive patients hospitalized due to PVT between February 2020 and February 2021 (the first year of the pandemic) were collected from medical records and compared clinically with the corresponding time before the pandemic (February 2019 through February 2020). Variables of interest included the number of hospitalization, patient and valve characteristics, diagnostic and management strategies, and in-hospital events. Results: Forty patients (32.5% male, age: 54.0 [46.5-62.0 y] comprised the study population. We observed a considerable decline in hospitalization rates during the pandemic, from 31 to 9 patients. Admitted patients were 8 years younger, had a higher proportion of the New York Heart Association functional class III or IV symptoms (44.4% vs 22.6%), were more often treated with fibrinolysis (33.3% vs 22.6%) or surgical approaches (33.3% vs 22.6%), and were discharged 6 days sooner. Conclusion: We described a reduction in PVT hospitalization. Patients presented with a higher proportion of severe dyspnea and had increased treatment with fibrinolysis/surgical approaches. These observations highlight the necessity of the active surveillance of patients with prosthetic valves by caregivers for timely diagnosis and appropriate management during the pandemic. https://rhythm.tums.ac.ir/index.php/jthc/article/view/1768 https://rhythm.tums.ac.ir/index.php/jthc/article/download/1768/1067

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 18 2 2023 04 30 142 145 Usha Kumari Dow University of Health Sciences, Karachi, Pakistan. Mansoor Rahman Postgraduate Trainee Cardiology, Lady Reading Hospital, Peshawar. Muneeb Ullah Jan Department of Cardiology, Lady Reading Hospital, Peshawar Pakistan Salecah Rahmat  Ullah 1. Central Michigan University Hospital Saginaw, USA. 2. Khawaja Safdar Medical College Sialkot, Pakistan Fakhar Abbas King Edward Medical University, Lahore, Pakistan. Zara Mirza Senior Resident, Cardiac Surgery, National Institute of Cardiovascular Disorders, Pakistan. Salim Surani Adj. Clinical Professor of Medicine and Pharmacology, Texas A&M University 2023 01 08 2023 04 30 Coronary artery aneurysms (CAAs) occur when an artery dilates 1.5 times the reference vessel. They occur most commonly because of atherosclerosis. CAAs are a rare phenomenon, and it is even rarer to find a giant CAA, which is roughly defined as a size 400% above the reference vessel. Giant CAAs are commonly found in the right coronary artery. The sinoatrial nodal artery (SNA) is among the least common sites for CAA involvement. Sometimes, communication exists between the aneurysm and a chamber of the heart or a great vessel. The consequences of the fistula depend on its size. Because of the rarity of the condition, guidelines are not well developed. However, small CAAs can be managed conservatively, whereas giant CAAs require resection, ligation, and bypass grafting. CAAs have a predilection for males and the elderly. We describe a 40-year-old South Asian woman presenting with mild dyspnea on exertion of 1 year’s duration. Echocardiography showed a 60×60 mm cystic sac, subsequently confirmed by computerized tomography, which showed 3 large aneurysms (70×61 mm) and 3 small aneurysms in the SNA. Coronary angiography illustrated that the SNA branched off the left main coronary artery, and the aneurysm communicated with the right coronary artery. The aneurysm was partially resected and plicated. https://rhythm.tums.ac.ir/index.php/jthc/article/view/1788 https://rhythm.tums.ac.ir/index.php/jthc/article/download/1