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, and AUC). Results: In this study of 1699 patients with confirmed MI, 15.94% experienced fatal complications, and the rest remained alive. The XGBoost model achieved more desirable results based on the accuracy and F1-score metrics and distinguished patients with fatal complications from surviving ones (AUC=78.65%, sensitivity=94.35%, accuracy=91.47%, and F1-score=95.14%). Cardiogenic shock was the most significant feature influencing the prediction of the XGBoost algorithm. Conclusion: XGBoost algorithms can be a promising model for predicting fatal complications following MI. https://rhythm.tums.ac.ir/index.php/jthc/article/view/1852

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 18 4 2023 08 30 288 293 Maryam Moradi Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Abbas Ali Salamatizadeh Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Vahid Talebi Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Mehdi Karami Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Maryam Farghadani Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Mohammad Javad Tarrahi Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran Alireza Khosravi Hypertension research center, Isfahan Cardiovascular research institute, Isfahan University of Medical Sciences, Isfahan, Iran 2023 04 07 2023 12 03 Background: We aimed to assess the agreement between coronary computed tomography angiography (CCTA) and invasive coronary angiography (ICA) to determine whether patients with a high coronary artery calcium score (CS) would benefit from CCTA. Methods: This cross-sectional study was conducted on patients suspected of having coronary artery disease. The patients underwent calcium scoring. The total CS and the number of calcified foci were determined. The calcium score index (CSI) was defined, and coronary arteries were evaluated by CCTA. ICA was performed, and reports of ICA were extracted. All the abovementioned variables were compared. For data analysis, the κ coefficient and the ROC curve were used. Results: The study population consisted of 195 patients: 124 men (63.6%) and 71 women (36.4%). The median (IQR) value of CS was 529 (229-1042), ranging from 17 to 4717. In all 195 patients, the concordance between the final impression of CCTA and ICA was 90.2%, while the number and type of involved territories were similar at 57.9%. The highest agreement was seen in the left main and right coronary arteries, whereas the lowest agreement was detected in the left anterior descending and the left circumflex artery. The patients were categorized into different CS groups, and in those with a high CS (>1000), the agreement between CCTA and ICA concerning final impression and involved territories was similar to the whole group of patients. Conclusion: CCTA in patients with a high CS, even exceeding 1000, remains beneficial as the noninvasive available method. https://rhythm.tums.ac.ir/index.php/jthc/article/view/1832

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 18 4 2023 08 30 294 297 Fateme Mehri Department of Gynecology and Obstetrics, Vali-E-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran. Kianoush Saberi Department of Anesthesiology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mehrdad Salehi Department of Cardiac Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran. Fahimeh Ghotbizadeh Vahdani Maternal, Fetal and Neonatal Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran. Farnoosh Larti Department of Cardiology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran. Alireza Bakhshandeh Department of Cardiac Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran. Shahrzad Sheikhhasani Department of Gynecology and Obstetrics, Vali-E-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2023 01 13 2023 07 26 Pregnancy after a heart transplant is a concern for many female recipients, and it remains a medical challenge that raises many questions. A 24-year-old woman, gravida 3, para 0, contacted us for obstetric care in the first trimester of gestation, about 3 years after an orthotopic cardiac transplant. She was a known case of dextrocardia with congenitally corrected transposition of the great arteries. The transplant had been performed for severe retractable heart failure, manifesting during her previous lost pregnancy. The course of the current gestation was uneventful. The patient’s cardiovascular function was good throughout the pregnancy. She was admitted to the hospital for dyspnea at 35 weeks and 4 days of gestational age. A cardiovascular consult and echocardiography were performed. The results were within the normal range, and labor pains explained the patient’s dyspnea. Because of labor pain, a repeat Cesarean section was performed at 35 weeks and 4 days of gestational age. A male baby weighing 2700 g, with an Apgar score of 7/9, was delivered. The patient was discharged after delivery with enoxaparin (40 mg), prednisolone (5 mg), levothyroxine, and mycophenolate mofetil (500 mg) without any complications. Follow-up was carried out at 1 month, and no abnormality was found. Here, we report a case of a successful pregnancy in a young woman after a heart transplant. https://rhythm.tums.ac.ir/index.php/jthc/article/view/1792

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 18 4 2023 08 30 298 302 Gajendra Dubey Department of Cardiology, U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC), Civil Hospital Campus, Gujarat, India Rujuta Parikh Department of Cardiology, U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC), Civil Hospital Campus, Gujarat, India Karthik Natrajan Department of Cardiology, U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC), Civil Hospital Campus, Gujarat, India Kewal Kanabar Department of Cardiology, U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC), Civil Hospital Campus, Gujarat, India 2022 12 08 2023 05 07 Tachyarrhythmias have been well-defined in patients with Takotsubo cardiomyopathy (TTCM) and are estimated to occur in almost 13.5% of patients. However, limited data are available on bradyarrhythmias in patients with TTCM. The pathophysiology, clinical implications, and management are not well defined in this subgroup. We describe a 53-year-old woman presenting with complete heart block with TTCM and a 73-year-old woman presenting with syncope with complete heart block with TTCM. Both had persistent conduction delays despite recovery of ventricular function and eventually required permanent pacemaker implantation. The dependency on pacing was up to 90% in both patients at a 6-month follow-up. https://rhythm.tums.ac.ir/index.php/jthc/article/view/1769

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 18 4 2023 08 30 303 307 EN Maryam Favaedi Rajaie Cardiovascular Medical and Research Center, Medical School, Iran University of Medical Sciences, Tehran, Iran. Yeganeh Pasebani Rajaie Cardiovascular, Medical, and Research Center Ali Kabiri School of Medicine, Iran University of Medical Sciences, Tehran, Iran. Ali Rafati Rajaie Cardiovascular, Medical, and Research Center Somayeh Jalali Rajaie Cardiovascular Medical and Research Center, Medical School, Iran University of Medical Sciences, Tehran, Iran. Azam Kiani Rajaie Cardiovascular Medical and Research Center, Medical School, Iran University of Medical Sciences, Tehran, Iran. Ronak Ahmadi Rajaie Cardiovascular Medical and Research Center, Medical School, Iran University of Medical Sciences, Tehran, Iran. Aghdas Shadmehr Rajaie Cardiovascular Medical and Research Center, Medical School, Iran University of Medical Sciences, Tehran, Iran. Zahra Khajali Rajaie Cardiovascular Medical and Research Center, Medical School, Iran University of Medical Sciences, Tehran, Iran. 2023 03 03 2023 09 09 Adjusting the exact warfarin dose has always been challenging since it has a narrow therapeutic window. Numerous factors, including poor drug compliance, drug-drug interactions, and malabsorption syndromes, affect the warfarin plasma concentration, leading to oversensitivity or resistance to warfarin. Patients who need more than 15 mg/d of warfarin for maintained anticoagulant effects are considered warfarin resistant. We describe a 62-year-old man referred to our center with bruising on his feet in June 2021. The patient had a history of valve replacement (mechanical prosthetic valves in 2013), hypothyroidism, and atrial fibrillation. He presented with warfarin resistance (first noticed in 2013) and did not reach the desired warfarin therapeutic effect despite receiving 60 mg of warfarin daily. Upon admission, the patient was on warfarin (100 mg/d) with an international normalized ratio (INR) of 1.5. He underwent laboratory and molecular genetic tests, which showed no mutation in the CYP2C9 and VKORC1, the genes associated with warfarin resistance. A stepwise diagnosis is required to identify the underlying cause. Assessing the patient’s compliance, drug history, dietary habits, malabsorption diseases, and genetics may be necessary. We evaluated these possible reasons for resistance and found no correlation. The patient’s warfarin intake was monitored closely to reach the INR therapeutic target of 3-3.5. He decided to leave the hospital with personal consent. He was discharged with a cardiologist referral and 24 warfarin tablets daily (120 mg/d) with an INR of 1.8. The patient was followed up 6 months and 2 years after discharge and was on the same daily dose of warfarin as at discharge, with no complications. https://rhythm.tums.ac.ir/index.php/jthc/article/view/1818

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 18 4 2023 08 30 308 309 Arezoo Zoroufian Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Solmaz Borjian Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. 2022 09 28 2023 12 05 No Abstract No Abstract No Abstract https://rhythm.tums.ac.ir/index.php/jthc/article/view/1724