Publications by authors named "Ahmadreza Assareh"

8 Publications

  • Page 1 of 1

Rationale and Design of the Persian CardioVascular Disease Registry (PCVDR): Scale-Up of Persian Registry Of CardioVascular DiseasE (PROVE).

Curr Probl Cardiol 2021 Mar 12;46(3):100577. Epub 2020 Mar 12.

We aimed to present the methodology of a national registry entitled "Persian CardioVascular Disease Registry (PCVDR)." Persian Registry Of cardioVascular diseasE (PROVE) was a demonstration registry conducted in Isfahan since 2014 to test the feasibility and practicality of PCVDR in Iran. Built on that experience, the first phase of PCVDR that consist of angiography and percutaneous coronary intervention (PCI) registry at national level started in March 2017. Currently, PCVDR is in place in 19 hospitals, located in 7 provinces. Five questionnaires including basic information, angiography, and PCI techniques, discharge and follow-up were completed for registered patients. Since beginning until October 7th, 2019, the number of angiography and PCI cases registered in all provinces were 37,120 and 16,277, respectively. Of all PCI cases registered, 11,846 patients (72.8%) were followed up until 12 months. We expect that this registry be expanded to cover most hospitals and centers with cardiology departments in the country.
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http://dx.doi.org/10.1016/j.cpcardiol.2020.100577DOI Listing
March 2021

Interesting Correlation Between the Circulating Pentraxin 3 and Cardiac Rehabilitation Program Outcomes in Coronary Artery Bypass Grafting Patients.

Cardiol Res 2016 Apr 4;7(2):59-65. Epub 2016 May 4.

Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Background: Pentraxin 3 (PTX3) is an inflammatory mediator, reaches to the high levels after ischemic heart diseases (IHD) and could be a helpful tool to predict cardiac rehabilitation (CR) outcomes. The aim of this study was to investigate the possibility of the circulating levels of PTX3 in prediction of CR outcomes in patients with IHD who had undergone coronary artery bypass grafting (CABG).

Methods: One hundred patients who had undergone CABG were included in this study. The CR plan was started 6 weeks after CABG and then PTX3 level, high-sensitivity C-reactive protein (hs-CRP), ejection fraction (EF) and metabolic equivalent (MET) were assessed before and after the CR program. Finally, all gathered data were analyzed using SPSS version 22.

Results: After a 3-month course of CR program, EF, MET, PTX3 and hs-CRP values changed. Statistically significant changes were observed in EF, MET and PTX3 values (P < 0.05) after the CR program and no statistically significant changes were seen in hs-CRP value (P = 0.546) at the end of CR program. Correlations between EF levels and MET with pre-PTX3 levels were also assessed and most changes were observed in the group with pre-PTX3 level more than 0.40 ng/dL.

Conclusion: Our study showed that a regular sufficient CR program based on exercises in IHD patients after CABG increases EF and MET levels, particularly in those patients with pre-PTX3 levels more than 0.40 ng/dL.
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http://dx.doi.org/10.14740/cr462wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5295543PMC
April 2016

Intermediate-Risk Chronic Stable Angina: Neutrophil-Lymphocyte Ratio and Fibrinogen Levels Improved Predicting Angiographically-Detected Coronary Artery Disease.

Iran Red Crescent Med J 2016 Sep 21;18(9):e18570. Epub 2016 Feb 21.

Department of Nutrition, Para Medicine School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran; Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran.

Background: Coronary heart disease (CHD) is the leading cause of death worldwide. Research indicates that coronary atherosclerosis is the most frequent cause of CHD. Evidence is scarce concerning the clinical efficacy of fibrinogen or neutrophil-lymphocyte ratio (NLR) measurement in risk-stratifying patients with chronic stable angina.

Objectives: To examine the independent and incremental prognostic value of fibrinogen and neutrophil-lymphocyte ratio (NLR) for angiographically-detected coronary artery disease (CAD).

Patients And Methods: In this cross-sectional study, angiography was performed for 183 Iranian patients with chronic stable angina with exercise ECG-determined intermediate risk. Generalized estimated equations were used to obtain the odd ratio (OR) of CAD for a 1-unit increase in log-NLR and a 1-SD increase in plasma fibrinogen. Models were adjusted for established CAD risk factors. Integrated discriminatory improvement index (IDI) and net reclassification improvement index (NRI) were used as measures of predictive ability for CAD, combined with traditional risk factors by NLR and fibrinogen.

Results: The mean age of the participants was 57.5, with 51.9% being male. Only 12% of participants had angiographically-determined patent coronary arteries. The number of participants with one, two, and three-vessel stenosis were 76, 31, 31, respectively, while 45 did not have stenosed vessels. NLR and fibrinogen levels were significantly higher in patients with stenosis in two (2.4 and 512 mg.dL) or three (2.6 and 517 mg.dL) coronary arteries, as compared to the group of patients with no significant involvement (2 and 430 mg.dL) (all P < 0.01). Patients with a higher NLR and a higher fibrinogen levels were more likely to have higher grades of CAD. OR log-NLR = 1.36 (95% CI: 1.05 - 1.94) and OR Z-Fibrinogen = 1.61 (95% CI: 1.18 - 2.22). When NLR and fibrinogen were added to the traditional risk factors separately, the NRIs were 0.170 (0.023 - 0.324) and 0.380 (0.214 - 0.543), respectively. The NRI was 0.460 (0.303 - 0.620) when both NLR and fibrinogen added to traditional risk factors simultaneously.

Conclusions: NLR and fibrinogen predicted CAD, independent of traditional CAD risk factors. Both measures (whether separately or together) substantially enhanced the predictive performance of traditional risk factors for identifying patients with CAD.
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http://dx.doi.org/10.5812/ircmj.18570DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5253433PMC
September 2016

Contrast induced nephropathy among patients with normal renal function undergoing coronary angiography.

J Renal Inj Prev 2016 26;5(1):21-4. Epub 2016 Feb 26.

Chronic Renal Failure Research Center, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Introduction: Although contrast induced nephropathy (CIN) is a well-known complication of radiocontrast media administration among patients with underlying renal insufficiency, however the data about CIN among patients with normal renal function are few and it seems that CIN often remained under-diagnosed among these patients.

Objectives: The aim of present study was evaluation of CIN in diabetic and nondiabetic patients with normal renal function undergoing coronary angiography.

Patients And Methods: This cross-sectional and prospective study has conducted on patients with normal renal function candidate for diagnostic coronary angiography at Imam hospital, Ahvaz, Iran from October 2010 to February 2011. CIN defined as an increase in serum creatinine (sCr) >0.5 mg/dL after two days of contrast administration. A standardized questionnaire was used to collect demographics, clinical and laboratory data.

Results: A total of 254 patients (140 males and 114 Females with mean age of 56.6 ± 11.9 years) were included in the study. Of them, 60 patients (23.6%) had congestive heart failure (CHF) and 57 patients (22.4%) had diabetes mellitus (DM). The mean sCr levels before contrast administration in men and women were 1.05 ± 0.22 and 0.93 ± 0.17 mg/dL respectively. In overall CIN occurred in 27 patients (10.6%) with no difference between males and females (P = 0.386) and in patients with or without CHF (P = 0.766). There was a significant association between CIN and DM (P = 0.001) and mean volume of contrast administration (P = 0.001).

Conclusion: Although CIN is a common problem in patients with diabetic nephropathy undergoing coronary angiography, diabetic patients without diabetic nephropathy and also patients without DM who had normal renal function are also at risk of contrast nephropathy.
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http://dx.doi.org/10.15171/jrip.2016.05DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4827381PMC
April 2016

No Relationship between Serum and Salivary β2- Microglobulin Levels in A Sample of Adult Diabetic Men with Chronic Kidney Disease without Renal Replacement Therapy.

Cell J 2014 25;16(2):179-86. Epub 2014 May 25.

Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences (RIES), Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Objective: Β2-microglobulin (β2M) associated amyloidosis is an inevitable complication of chronic kidney disease (CKD). Testing β2M in the blood is invasive and expensive. On the other hand, oral fluid is a perfect medium to be explored for public health and disease surveillance. However, it has never been studied if salivary concentration of β2M reflects its concentration in the serum. The current study; therefore, aimed to examine the relationship between salivary and serum β2M in a sample of adult diabetic men with CKD.

Materials And Methods: Among diabetic patients referred to the Nephrology Department of The Golestan Hospital of Ahvaz due to CKD, 40 men not requiring renal replacement therapy were consecutively recruited for this cross-sectional study. Patients were excluded if they had any disease or were using any drugs that might affect the oral mucosa or saliva. The concentration of β2M was measured in both serum and saliva. The correlation between serum and salivary β2M was measured by calculating spearman's ρ.

Results: The Spearman's ρ for correlation between serum and salivary β2M was -0.017 (p=0.917), indicating lack of correlation. Serum and salivary creatinine (Spearman's ρ=0.54; p value<0.001) as well as serum and salivary urea nitrogen levels (Spearman's ρ=0.39; p value=0.014) were correlated.

Conclusion: Salivary β2M levels poorly agreed with serum β2M levels, and thus may not be used as a surrogate for serum β2M in CKD patients who did not require replacement therapy.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4072078PMC
July 2014

Defining the at risk patients for contrast induced nephropathy after coronary angiography; 24-h urine creatinine versus Cockcroft-Gault equation or serum creatinine level.

J Res Med Sci 2012 Sep;17(9):859-64

Department of Cardiology, Ahvaz Jundishapur University of Medical science, Golestan Hospital, Ahvaz, Iran.

Background: Definitions of chronic kidney disease (CKD) in many catheterization laboratories have relied on the serum creatinine (Scr) rather than glomerular filtration rate (GFR). Regarding that CKD is the primary predisposing factor for contrast induced nephropathy (CIN), we compared the sensitivity of calculated GFR by 24-h Urine creatinine with Cockcroft-Gault (CG) equation and Scr level to define at risk patients for CIN who were undergone coronary angiography (CAG).

Materials And Methods: Two hundred fifty four subjects who were candidate for CAG and had normal creatinine level were enrolled. Before CAG, GFR was calculated from a 24-h urine collection, CG equation and a single Scr sample regarding to previously described protocol. Contrast volume used for each case <100 ml. CIN was defined as a 0.5 mg/dL or 25% elevation in the Scr.

Results: CIN occurred in 10.6%. Baseline GFR, the volume of contrast agent, and diabetes were the independent risk factors for CIN. GFR was less than 60 ml/min/1.73 m2 in 28% and 23.2% of patients regarding to 24-h urine creatinine and CG equation, respectively. In CIN prediction, 24-h urine creatinine estimated GFR had 85.2%, 59.3% and CG equation GFR had 78.9%, 81.1% sensitivity and specificity, respectively.

Conclusion: Although, GFR estimated by CG equation has less sensitivity than GFR calculated from 24-h creatinine in CIN probability, but it is better than Scr alone and because of cost-effectiveness and convenience using of this method, we suggest at least using CG equation for GFR calculation before CIN, especially in diabetic and/or older than 60 years cases.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3697212PMC
September 2012

Bedside-Friendly Prediction for Presence of Post-Myocardial lnfarction Systolic Dysfunction Using Multimarker Panel: Integrating Salivary Diagnostics into Clinical Practice.

Korean Circ J 2013 Apr 30;43(4):246-54. Epub 2013 Apr 30.

Cardiovascular Research Center, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran.

Background And Objectives: We investigated if a combination of plasma or salivary interleukin-2 (IL-2), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), transforming growth factor-beta (TGF-β), and troponin can improve estimation of the pretest probability of the left ventricular systolic dysfunction (LVSD).

Subjects And Methods: Eighty patients with newly-diagnosed myocardial infarction (MI) were echocardiographically examined for LVSD (ejection fraction ≤40%). Measurements included traditional MI risk factors, plasma and salivary concentrations of troponin, IL-2, IL-6, TNF-α, and TGF-β. With the LVSD as the outcome variable, we developed logistic regression models, starting with a basic model incorporating traditional risk factors and consecutively adding salivary and plasma biomarkers. Models were compared using several criteria, including (but not limited to) C statistic (discrimination) and net reclassification improvement index (NRI).

Results: APART FROM TROPONIN, PLASMA, AND SALIVARY VALUES OF THE BIOMARKERS WERE CORRELATED: spearman's ρ was 0.19 (p=0.088) for troponin, 0.36 (p=0.001) for IL-2, 0.74 (p<0.001) for IL-6, 0.61 (p<0.001) for TNF-α, and 0.65 (p<0.001) for TGF-β. The predictive performances of the basic model for estimating the pretest probability of the presence of LVSD considerably improved when cytokines were added (salivary added: C-statistic from 0.77 to 0.82 and NRI 77%; plasma added: C-statistic to 0.80 and NRI 134%).

Conclusion: Multiple biomarkers added diagnostic value to the standard risk factors for predicting the presence of post-MI LVSD.
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http://dx.doi.org/10.4070/kcj.2013.43.4.246DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3654112PMC
April 2013

Incremental diagnostic value of circulating pentraxin in patients with intermediate risk of coronary artery disease.

Heart 2013 May 6;99(9):640-8. Epub 2013 Mar 6.

Cardiovascular Research Center, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran.

Objectives: Pentraxins are a superfamily of multifunctional conserved proteins, some of which are components of the humoral arm of innate immunity and behave as functional ancestors of antibodies. They are divided into short (C reactive protein) and long pentraxins (pentraxin 3; PTX3). We investigated the diagnostic values of systematic arterial and coronary sinus (PTX3) in developing prediction models for estimating pretest probability of coronary artery disease (CAD) among an intermediate-risk population of patients with chronic stable angina.

Design: Cross-sectional analysis.

Setting: Referral cardiology hospital.

Participants: Patients with chronic stable angina, without evidence of previous CAD if they were referred for angiography.

Main Outcome Measures: All participants underwent diagnostic angiography. Prevalence rate ratio (PRR) of angiographically-determined coronary artery stenosis was separately examined in association with coronary sinus and femoral artery PTX3 concentrations using a general linear model. Duke treadmill score (DTS) was derived from the results of treadmill exercise cardiac stress testing. PTX3 data were collected in 100 patients with DTS-determined intermediate-risk chronic stable angina (aged 56.1 (1.1) years, 51 female).

Results: Both coronary sinus (PRR: 2.33, 95% CIs 1.64 to 3.31) and femoral artery PTX3 (PRR: 2.09, 95% CIs 1.46 to 2.97) independently predicted the prevalence rate of coronary artery involved with stenosis independent of the established CAD risk factors. Femoral artery PTX3 was highly correlated with coronary sinus PTX3 (β=0.8, 95% CIs 0.66 to 0.94; p value<0.001). When we added femoral artery PTX3 to the predictive models incorporating traditional CAD risk factors, net reclassification improvement indices were 40% (cutpoint-free) and 15% (cutpoint-based). In the presence of PTX3, high-density lipoprotein cholesterol (HDL-C) was no longer protective against CAD.

Conclusions: Gathering information on systemic arterial PTX3 may help more accurately reclassify DTS-determined patients with intermediate-risk chronic stable angina into more appropriate risk categories. PTX3 possibly, at least in part, mediates the protective effect on CAD of HDL-C.
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http://dx.doi.org/10.1136/heartjnl-2012-303560DOI Listing
May 2013