Publications by authors named "Akbar Shafiee"

50 Publications

Clinical implications and indicators of mortality among patients hospitalized with concurrent COVID-19 and myocardial infarction.

Turk Kardiyol Dern Ars 2021 06;49(4):293-302

Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.

Objective: Acute ischemic cardiac events can complicate coronavirus disease 2019 (COVID-19). We report the in-hospital characteristics of patients with acute myocardial infarction and concomitant COVID-19.

Methods: This was a registry-based retrospective analysis of patients admitted with positive COVID-19 tests who suffered acute myocardial infarction either before or during hospitalization; from 1 March 2020 to 1 April 2020 in a tertiary cardiovascular center-Tehran Heart Center. We performed an exploratory analysis to compare the clinical characteristics of patients who died during hospitalization or were discharged alive.

Results: In March 2020, 57 patients who had acute myocardial infarction and a confirmed diagnosis of COVID-19 were included in the study. During hospitalization, 13 patients (22.8%) died after a mean hospital stay of 8.4 days. The deceased were older than the survivors. No significant association between mortality and sex or length of hospital stay was observed. Hypertensive individuals were more likely to have a fatal outcome. Previously receiving angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers did not show any association with mortality. Regarding the laboratory data during hospitalization, higher cardiac troponin T, neutrophil count, C-reactive protein, urea, and blood urea nitrogen/creatinine ratio were observed in the mortality group. The deceased had a lower lymphocyte count than the survivors.

Conclusions: Markers of worsening renal function and immune system disturbance seem to be associated with mortality in concurrent acute myocardial infarction and COVID-19. Optimizing the management of acute coronary syndrome complicating COVID-19 requires addressing such potential contributors to mortality.
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http://dx.doi.org/10.5543/tkda.2021.14331DOI Listing
June 2021

High-Intensity Interval Training in Patients with Pulmonary Embolism: A Randomized Controlled Trial.

Med Sci Sports Exerc 2021 Apr 16. Epub 2021 Apr 16.

Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran Department of Cardiac Rehabilitation, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran Head of Imaging Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran Department of Cardiovascular Research, Tehran Heart Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA Cardiac Exercise Research Group at the Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.

Purpose: High-intensity interval training (HIIT) appears to be safe and effective in cardiovascular diseases. However, there is a paucity of data on the effect of HIIT for patients with acute pulmonary embolism (PE). The present randomized controlled trial (RCT) therefore examined the efficiency and safety of HIIT in patients with acute PE.

Methods: In single-center parallel open-label RCT, 24 patients (5 women) discharged recently with a diagnosis of intermediate-high risk acute PE were randomized (1:1) to supervised HIIT (n = 12) or control (n = 12) group. The primary outcomes were exercise capacity evaluated in terms of the estimated maximal oxygen uptake (eVO2max), lung function (forced expiratory volume in 1 second, FEV1), right ventricular (RV) function, (RV/left ventricle diameter (LV) ratio) and health related quality of life (HRQoL). Safety was the secondary outcome.

Results: 8-weeks of HIIT improved eVO2max (+65%, p < 0.001), FEV1 (%) (+17%, p = 0.031), and RV/LV ratio diameter (-27%, p = 0.005), as well as HRQoL. All patients in the HIIT group tolerated exercise training without serious adverse events. The control group did not improve (p > 0.05) eVO2max, RV/LV ratio diameter, or HRQoL; however, FEV1 (%) was slightly reduced (-6%, p = 0.030).

Conclusion: The present RCT of a tailored center based HIIT intervention provides preliminary evidence that this intervention could improve exercise capacity, lung function, RV function, and HRQoL without serious adverse events, which could provide marked clinical benefits following PE. Further larger multicenter randomized controlled studies are needed to confirm these promising findings.
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http://dx.doi.org/10.1249/MSS.0000000000002680DOI Listing
April 2021

Association of Preoperative Hemoglobin A1c with In-hospital Mortality Following Valvular Heart Surgery.

Braz J Cardiovasc Surg 2020 10 1;35(5):654-659. Epub 2020 Oct 1.

Tehran University of Medical Sciences Cardiovascular Diseases Research Institute Tehran Heart Center Tehran Iran Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.

Objective: To determine the association between the preoperative level of hemoglobin A1c (HbA1c) and in-hospital mortality in patients who underwent valvular heart surgery in our center in a retrospective cohort.

Methods: In this retrospective consecutive cohort study, patients with type 2 diabetes mellitus who were referred to our center for elective valvular surgery were enrolled and followed up. The endpoint of this study was in-hospital mortality. Based on the level of HbA1c, patients were dichotomized around a level of 7% into two groups: exposed patients with HbA1c ≥ 7% and unexposed patients with HbA1c < 7%. Then, the study variables were compared between the two groups.

Results: Two hundred twenty-four diabetic patients who were candidates for valvular surgery were enrolled; 106 patients (47.3%) had HbA1c < 7%, and 118 patients (52.6%) had HbA1c ≥ 7%. The duration of diabetes was higher in patients with HbA1c ≥ 7% (P=0.007). Thirteen (5.8%) patients died during hospital admission, of which nine patients were in the high HbA1c group. There was no significant difference between the groups regarding in-hospital mortality (P=0.899). Both the unadjusted and adjusted logistic regression models showed that HbA1c was not a predictor for in-hospital mortality (P=0.227 and P=0.388, respectively).

Conclusion: This study showed no association between preoperative HbA1c levels and in-hospital mortality in candidates for valvular heart surgery.
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http://dx.doi.org/10.21470/1678-9741-2019-0320DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7598970PMC
October 2020

Safety and efficacy of high intensity interval training in a patient with acute pulmonary embolism.

Prog Cardiovasc Dis 2020 May - Jun;63(3):393-394. Epub 2020 Feb 12.

Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

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http://dx.doi.org/10.1016/j.pcad.2020.02.008DOI Listing
August 2020

Factors Predicting Prostate Specific Antigen Failure Following Radical Prostatectomy: Experience with 961 Patients.

Urol J 2020 01 4;17(5):486-491. Epub 2020 Jan 4.

Department of Urology, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Objective: To determine disease-related predictors for the occurrence of prostate specific antigen (PSA) failure in Iranian prostate cancer patients who underwent radical prostatectomy.

Methods: In this cohort study, we enrolled eligible patients with prostate cancer who underwent radical prostatectomy at our center between 2001 and 2018. The primary endpoint was the incidence of postoperative biochemical failure, defined as two consecutive PSA levels >= 0.2 ng/dl. Patients with TNM stage >= III, Gleason score >=8, or baseline PSA above our calculated cut-off level were considered as high risk. Kaplan-Meier survival method and Cox proportional hazards regression analysis were used for determining the biochemical relapse-free survival and its predictors.

Results: Data of 959 patients (age=61.2 ± 6.4 years) were analyzed with a median follow up of 36 months (range 6 months to 18 years). A total of 97 patients (10.1%) developed biochemical failure at the time of analysis who had a significantly older age and longer follow-up duration (P=0.024 and P<0.001, respectively). Preoperative PSA level of 8.85 mg/dl could predict the occurrence biochemical failure with a sensitivity of 83.2% and specificity of 39.2% (Area under the curve=0.601, 95% CI: 0.541-0.662; P=0.001). In the multivariate analysis, higher preoperative PSA, Gleason score?8, and high-risk TNM stage were independent predictors for biochemical relapse (P=0.029, P=0.001, and P=0.008, respectively).

Conclusion: Preoperative PSA, Gleason score, and TNM stage were independent predictors for biochemical failure following radical prostatectomy in prostate cancer patients. We also determined a lower cut-point for PSA that could predict biochemical failure.
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http://dx.doi.org/10.22037/uj.v0i0.5670DOI Listing
January 2020

The Value of the GRACE Score for Predicting the SYNTAX Score in Patients with Unstable Angina/Non-ST Elevation Myocardial Infarction.

Cardiovasc Revasc Med 2020 04 23;21(4):514-517. Epub 2019 Jul 23.

Department of Cardiovascular Research, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Background: In patients with unstable angina/non-ST-elevation myocardial infarction (UA/NSTEMI), Global Registry for Acute Coronary Events (GRACE) score is a valid tool for risk stratification. The Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) score is an angiographic scoring system to guide the decision-making between coronary artery bypass grafting (CABG) surgery and percutaneous coronary intervention (PCI). The aim of the present study was to assess the accuracy of the GRACE score in predicting the severity and extent of coronary artery stenosis by SYNTAX score.

Methods: A total of 330 patients with acute coronary syndrome (ACS) were enrolled in the study. For every patient, the GRACE score was calculated. All patients underwent coronary angiography within 2 days and the SYNTAX scoring system was used to evaluate the severity and extent of coronary stenotic lesions. Based on ROC curve analysis, the cut-off value of GRACE score that could predict SYNTAX score ≥ 23 was calculated.

Results: GRACE score was 107.12 ± 34.4 in patients with SYNTAX SCORE < 23 and 134.80 ± 48.3 in patients with SYNTAX score ≥ 23 (p value = 0.001). A positive correlation was observed between the GRACE score and angiographic SYNTAX score (r = 0.34 p < 0.001). We found that a GRACE score of 109 is the optimal cut-off to predict SYNTAX score ≥ 23 with a sensitivity of 73.5% and specificity of 60% (p < 0.001). Its negative predictive value was 94.0%.

Conclusion: GRACE score had significant but modest value to predict the severity and extent of coronary artery stenosis in patients with ACS.
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http://dx.doi.org/10.1016/j.carrev.2019.07.023DOI Listing
April 2020

Effect of Various Degrees of Chronic Kidney Disease on Long-term Outcome of Patients with Percutaneous Coronary Intervention.

Arch Iran Med 2019 05 1;22(5):247-251. Epub 2019 May 1.

Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.

Background: We aimed to identify the association of degree of renal failure in chronic kidney disease patients who underwent percutaneous coronary intervention (PCI) at our center with 5-year major adverse cardiac events (MACE).

Methods: In this cohort study, we enrolled all patients who underwent primary or elective PCI and completed their 5-year followup unless they developed events related to study end-points. Demographic, angiographic and clinical data of the participants were retrieved from our databank. Glomerular filtration rate (GFR) was calculated based on the Cockcroft-Gault equation for men and women, separately. Accordingly, our patients were classified into three groups: GFR ≥ 60, GFR < 60 and ≥30 and GFR < 30 mL/ min. Then, the demographic and clinical data, as well as the frequency of MACE and its elements, were compared between the study groups.

Results: We included the data for 5,510 patients. MACE occurred in 891 (16.1%) of the patients. A total of 632 cases (16.7%) occurred in patients with GFR > 60 while 224 cases (18.8%) and 35 events (43.7%) occurred in patients with 30 ≤ GFR < 60 and GFR < 30 mL/min, respectively. So, GFR < 30 mL/min was significant predictor for MACE (hazard ratio [HR] = 3.74, 95% CI: 2.64-5.28; P < 0.001). The prediction effect of GFR < 30 remained significant after adjustment for the confounding variables (HR = 3.43, 95% CI: 2.38-4.94; P < 0.001).

Conclusion: GFR <30 mL/min was a strong predictor for 5-year MACE. Moreover, in patients with GFR > 30 mL/min, PCI is a more applicable approach.
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May 2019

Mean Platelet Volume and Major Adverse Cardiac Events following Percutaneous Coronary Intervention.

Arch Iran Med 2019 04 1;22(4):198-203. Epub 2019 Apr 1.

Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.

Background: Mean platelet volume (MPV) has been introduced as a simple and accurate method for assessing platelet function, which can be used as a prognostic marker for cardiovascular events. We investigated whether pre-procedural MPV could predict major adverse cardiac events (MACE) in candidates for elective percutaneous coronary intervention (PCI).

Methods: In this large retrospective cohort, we reviewed the clinical and follow-up data of 4199 candidates (mean age = 59.9 ± 10.3 years; female patients = 1440 [34.3%]) for elective PCI due to unstable angina (UA) or non-ST segment elevation myocardial infarction (NSTEMI). The primary endpoint of the study was the incidence of MACE defined as in-hospital mortality, cardiac death, nonfatal MI, target lesion revascularization (TLR) or target vessel revascularization (TVR). Based on the MPV level tertiles, patients were categorized into three groups for further comparison.

Results: Higher MPV was significantly associated with older age (P<0.001), hypertension (P<0.001), diabetes mellitus (P=0.003), history of previous CABG (P<0.001) and lower levels of serum triglyceride (P<0.001). The frequency of 1-year MACE was 176 (4.1%) with no significant difference between the MPV tertile groups. The highest MPV tertile could significantly predict MACE in the univariable model (hazard ratio = 1.51, 95% confidence interval: 1.05-2.17; P=0.026). In the adjusted model, the highest MPV tertile was a borderline predictor for MACE (hazard ratio = 1.62, 95% CI: 0.98-2.68; P=0.057).

Conclusion: High MPV was associated with cardiovascular risk factors and older age while high MPV was a borderline independent predictor for 1-year MACE in the candidates for elective PCI.
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April 2019

Predictive value of N-terminal-Pro brain natriuretic peptide in the detection of coronary artery disease in patients with positive myocardial perfusion imaging.

Med J Islam Repub Iran 2019 6;33:14. Epub 2019 Mar 6.

Department of Cardiology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.

N-terminal pro-brain natriuretic peptide (NT-ProBNP) increases during myocardial ischemia and has a potential for the diagnosis of patients with coronary artery disease (CAD). We aimed to determine the incremental diagnostic value of NT-ProBNP in the selection of patients with positive myocardial perfusion imaging (MPI) for coronary angiography. We also tested the association between the level of NT-ProBNP and severity of CAD based on the vessel score and Gensini score. In this cross-sectional study, stable angina patients with positive MPI who were assessed by coronary angiography in Imam Khomeini Hospitalwere enrolled. After the collection of demographic and clinical data, NT-ProBNP was measured in all patients on the day of coronary angiography, and its association with the presence of CAD, vessel score and Gensini score was tested. We enrolled 170 patients (mean age61.2±10.1 years, 86 males (50.6%)). Seventy-two (42.3%) patients had at least one stenotic vessel. NT-Pro BNP was significantly higher in the CAD-positive group (OR=1.01, 95% CI: 1.00-1.02; p=0.008) and could independently predict the presence of CAD at a cut-off point of 69.5, with a sensitivity of 55.6%, specificity of 82.5% and diagnostic accuracy of 61.7%. The Gensini score had a modest correlation with NT-Pro BNP (r=0.60, p<0.001). The combination of MPI result and NT-Pro BNP could predict the presence of CAD (OR=14.57, 95% CI: 4.28, 49.56; p<0.001). Serum level of NT-Pro BNP alone and its combination with the results of MPI can significantly predict the presence of CAD and therefore, highlights the need for performing coronary angiography.
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http://dx.doi.org/10.34171/mjiri.33.14DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6504941PMC
March 2019

Effect of cardiac rehabilitation programme following elective percutaneous coronary angiography on depressive symptoms: A cohort study.

Indian Heart J 2018 Nov - Dec;70(6):783-787. Epub 2017 Dec 16.

Department of Cardiovascular Research, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Community Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Electronic address:

Background: Depression is a common condition in cardiac patients. We investigated the effect of cardiac rehabilitation on depressive symptoms as detected by Beck depression inventory II score (BDI) in patients who underwent percutaneous coronary intervention (PCI).

Methods: In this cohort, 95 patients met our criteria. Patients were then studied in two groups based on their participation in the rehabilitation program to rehabilitation (exposure) and the control (non-exposure) groups. The control group consisted of those who only participated in the introductory session and decided not to continue the program. Finally, demographic and clinical parameters as well as the BDI scores were compared between the study groups.

Results: Data of 35 patients who completed rehabilitation program was compared with 60 patients who did not. There was no significant difference between the study groups regarding the demographic and clinical variables, except for a higher frequency of family history for CAD in the control group (p<0.001). The frequency of the patients with no or mild depression was significantly higher in the rehabilitation group than the controls (p=0.02). There was also a significant increase in the BDI score of the control group and a significant decrease in the rehabilitation group (p<0.001). After adjustment for confounders (family history and severity of CAD), not attending the rehabilitation program was a strong risk factor for depression (OR=10.8, 95% CI: 1.3, 88.5; P=0.027).

Conclusion: Overall, this study showed that not attending cardiac rehabilitation program following elective PCI was a risk factor for depression.
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http://dx.doi.org/10.1016/j.ihj.2017.12.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6306398PMC
January 2019

Risk Factors for Acute Kidney Injury in Coronary Artery Bypass Graft Surgery Patients Based on the Acute Kidney Injury Network Criteria.

J Tehran Heart Cent 2018 Apr;13(2):52-57

Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.

Acute kidney injury (AKI) after coronary artery bypass graft surgery (CABG) is a common complication. The present study sought to determine AKI risk factors based on the Acute Kidney Injury Network (AKIN) classification. In a cross-sectional study, performed from March 2010 to April 2012 at Tehran Heart Center, affiliated with Tehran University of Medical Sciences, 29 independent risk factors for AKI based on the AKIN criteria were examined in isolated post-CABG patients. The patients' demographic data and risk factors were extracted from the Electronic Database of Tehran Heart Center. According to restricted inclusion and exclusion criteria as well as a creatinine rise to AKI Stage 1, the patients were divided into 2 groups of AKI-negative and AKI-positive and the risk factors were compared between these groups. Out of 3473 included patients at a mean age of 60.78 (±9.46) years, the majority (2474 [71.23%]) were male. Totally, 958 (27.7%) patients had AKI, according to a creatinine rise to AKI Stage 1. Logistic regression analysis demonstrated that higher age (OR=1.021; P<0.001), higher body mass index (OR=1.035; P<0.001), lower preoperative creatinine level (OR=0.417; P<0.001), longer cardiopulmonary bypass time (OR=1.004; P=0.007), blood transfusion in the ICU (OR=1.408; P=0.001), and lack of intraoperative blood transfusion (OR=0.823; P=0.044) were the independent risk factors for AKI after CABG. Based on the findings of the current study, older age, higher body mass index, lower preoperative creatinine level, more blood transfusion in the intensive care unit (ICU), lack of intraoperative blood transfusion, and high cardiopulmonary bypass time may serve as risk factors for the development of AKI in CABG patients.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6246432PMC
April 2018

Comparing Serum Level of Vitamin D3 in Patients With Isolated Coronary Artery Ectasia and Normal Coronary Artery Individuals.

Arch Iran Med 2018 09 1;21(9):393-398. Epub 2018 Sep 1.

Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.

Background: Coronary artery ectasia (CAE) is identified as dilation of one or more segments of coronary arteries that reaches 1.5 times or more, compared with near segments that are normal. Several etiologies like atherosclerosis, autoimmune diseases and congenital anomalies have been proposed for this condition. Vitamin D deficiency activates the renin-angiotensin-aldosterone system, which affects the cardiovascular system. For these reasons, we investigated the serum level of vitamin D in patients with CAE compared with individuals with normal coronary arteries.

Methods: The study group included 30 patients (20 males and 10 females, mean age: 57 ± 9 years) with isolated CAE without any stenotic lesions, and the control group consisted of 60 age/gender matched subjects who had normal coronary angiograms (CAG) (40 males and 20 females, mean age: 57 ± 8 years). All participants underwent CAG at Tehran Heart Center between December 2015 and March 2016. Along with routine lab tests, vitamin D, serum albumin, calcium, phosphorus and alkaline phosphatase levels were analyzed and the unadjusted and adjusted effects of vitamin D on CAE were evaluated using logistic regression model.

Results: The median vitamin D level of the patients with CAE was lower than that of the control group (6.5 [3.0, 18.8] ng/mL vs. 17.7 [8.9, 27.1] ng/mL; P = 0.002). The logistic regression model showed that vitamin D deficiency was a predictor for the presence of CEA (P = 0.013). After adjustment for confounding variables, this association remained significant (P = 0.025).

Conclusion: An association between CAE and vitamin D deficiency was found in our study.
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September 2018

Predictors of Long-term Major Adverse Cardiac Events Following Percutaneous Coronary Intervention in the Elderly.

Arch Iran Med 2018 08 1;21(8):344-348. Epub 2018 Aug 1.

Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.

Background: We aimed to recognize the predictors of long-term major adverse cardiac events (MACE) in the elderly candidates for elective percutaneous coronary intervention (PCI) at our center.

Methods: In this retrospective cohort study, we reviewed the data of the elderly (age ≥65 years) candidates for elective PCI who met our study criteria, at Tehran heart center between 2004 and 2013. Demographic, anthropometric, clinical, angiographic, procedural and follow-up data of the enrolled patients were retrieved from the angiography/PCI databank of our center. The study characteristics of the patients with or without MACE were compared in a univariable Cox-regression analysis. A multivariable Cox-regression model was applied using variables selected from the univariable model to determine the predictors of MACE.

Results: We reviewed the data of 2772 patients (mean age=70.8±4.7 years, male sex=1726 patients [62.3%]) from which 393 patients (14.4%) developed MACE. In the multivariable regression model, female sex was a protective factor for MACE (hazard ratio [HR]=0.701; P=0.001), while presence of diabetes mellitus (HR=1.333; P=0.007), family history of coronary artery disease (CAD) (HR=1.489; P=0.003) and plain balloon angioplasty (HR=1.810; P=0.010) were independent risk factors for MACE.

Conclusion: PCI is a safe and effective method of revascularization in the elderly patients, and some clinical and procedural factors can predict MACE in this group of patients.
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August 2018

The Incidence of Myocardial Injury after Loading Doses of Clopidogrel versus Prasugrel in the Candidates for Percutaneous Coronary Intervention: A Randomized Controlled Trial.

Crit Pathw Cardiol 2018 06;17(2):69-72

Department of Cardiology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Introduction: Prevention of myocardial injury is an essential issue in percutaneous coronary intervention (PCI). We compared the incidence of myocardial injury after loading doses of clopidogrel versus prasugrel in the candidates for PCI.

Methods: In this randomized-controlled clinical trial, we enrolled 88 stable angina patients, candidate for PCI. Patients received either prasugrel (60 mg orally) (n = 42) or clopidogrel (600 mg orally) (n = 46). Serum levels of creatine phosphokinase muscle-brain type, cardiac troponin I, and high sensitive C-reactive protein were measured at baseline and 6 and 12 hours postprocedural. Primary endpoint was periprocedural myocardial infarction (MI), defined as elevation of cTn values (>5 times) in patients with normal baseline values or a rise of cTn values >20% if the baseline values are elevated.

Results: Based on the levels of cTnI 6 hours after PCI, 1 patient (2.4%) had MI in the prasugrel group, whereas 4 patients (8.7%) had MI in the clopidogrel group. After 12 hours, 4 patients (9.5%) had MI in the prasugrel group versus 5 patients (10.9%) in the clopidogrel arm. There was no significant difference between the groups regarding the changes in cardiac specific enzyme levels. However, serum levels of cTnI were significantly lower in patients with myocardial injury in the prasugrel arm (P < 0.001).

Conclusions: Prasugrel is an effective antiplatelet drug in preventing periprocedural MI.
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http://dx.doi.org/10.1097/HPC.0000000000000114DOI Listing
June 2018

Predictors of major adverse cardiac events following elective stenting of large coronary arteries.

Indian Heart J 2018 Jan - Feb;70(1):20-23. Epub 2017 Jun 19.

Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.

Objective: Diameter of the affected coronary artery is an important predictor of restenosis and need for revascularization. In the present study, we investigated the frequency and potential risk factors for major adverse cardiac events following elective percutaneous coronary intervention (PCI) and stenting of large coronary arteries.

Methods: We reviewed the data of elective candidates of PCI on a large coronary artery who presented to our center. Demographic, clinical, angiographic and follow-up data of the eligible patients were retrieved from our databank. The study characteristics were then compared between the patients with and without MACE in order to find out the probable risk factors for MACE in patients with large stent diameter.

Results: Data of 3043 patients who underwent single vessel elective PCI with a stent diameter of ≥3.5mm was reviewed. During a median follow up period of 14 months, 64 (2.1%) patients had MACE. TVR was the most common type of MACE that was observed in 29 patients, while 5 patients had cardiac death. Higher serum levels of creatinine, history of cerebrovascular accident (CVA), and use of a drug eluting stent (DES) were significantly associated with MACE. In the multivariate model, history of CVA (odds ratio=5.23, P=0.030) and use of DES (odds ratio=0.048, P=0.011) were the independent predictors of MACE in patients underwent large coronary artery stenting.

Conclusion: This study showed that prior CVA and the use of BMS were the potential risk factors for MACE in patients who were stented on their large coronary arteries.
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http://dx.doi.org/10.1016/j.ihj.2017.06.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5902817PMC
July 2018

Complementary Diagnostic Value of Heart Type Fatty Acid-binding Protein in Early Detection of Acute Myocardial Infarction.

Crit Pathw Cardiol 2018 03;17(1):43-46

Background: Heart-type fatty acid-binding protein (H-FABP) is a novel biomarker for myocardial injury. We compared the use of H-FABP with serum levels of cardiac troponin-T (cTnT) and creatine kinase-MB (CK-MB) in the diagnosis of patients suspicious to acute myocardial infarction (AMI).

Methods: From October 2013 to December 2014, 182 consecutive patients suspicious to acute coronary syndrome were enrolled in this study, who presented within the past 6 hours from the onset of symptoms. Venous blood samples were drawn at baseline to measure serum biochemistry, high-sensitive cardiac troponin T (hs-cTNT), creatine kinase-MB, and H-FABP, and the measurements were repeated after 8 hours. The patients were categorized into 3 groups based on the baseline and second measurements of cTnT and general characteristics, and changes of H-FABP levels were then compared between the groups. Sensitivity and specificity of H-FABP in predicting the presence of AMI was calculated.

Results: A total of 91 patients had AMI. Changes of H-FABP through time were also significantly different between the AMI and non-AMI patients (P < 0.001). A cutoff point of 7.15 for H-FABP could predict AMI with a sensitivity of 51.5%, specificity of 96.3%, and diagnostic accuracy of 68.3%. The area under the receiver operating characteristic curve for H-FABP at 8 hours was 79.4% (95% confidence interval: 73.0-85.9; P < 0.001). Positive predictive value and negative predictive value for H-FABP were 85% and 60%, respectively.

Conclusions: H-FABP can be used as an additional cardiac biomarker in the diagnosis of AMI.
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http://dx.doi.org/10.1097/HPC.0000000000000107DOI Listing
March 2018

Predictors of High-Sensitivity Cardiac Troponin T Elevation in Patients with Acute Paroxysmal Supraventricular Tachycardia and Ischemic Heart Disease.

Tex Heart Inst J 2017 Oct 1;44(5):306-311. Epub 2017 Oct 1.

We studied the predictors and patterns of high-sensitivity cardiac troponin T (hs-cTnT) elevation in patients with paroxysmal supraventricular tachycardia (PSVT) in the presence and absence of ischemic heart disease. During calendar year 2013, we enrolled 70 of 72 consecutive adult patients with PSVT who presented at our center within 4 hours after the onset of tachycardia. On the basis of increased hs-cTnT at either of 2 initial measurements, we divided patients into groups (hs-cTnT-positive and hs-cTnT-negative), to study the predictors of enzyme elevation. We then divided the hs-cTnT-positive patients into 2 groups-those with and those without ischemic heart disease-and compared hs-cTnT changes. We observed hs-cTnT elevation in 52 of the 70 patients (74.3%). The hs-cTnT-positive patients were significantly older (=0.008) and had a significantly higher duration of tachycardia (=0.01). Older age, the presence of chest pain, lower diastolic blood pressure, and longer duration of tachycardia increased the odds of enzyme elevation. Among patients with elevated hs-cTnT levels, the baseline and maximal hs-cTnT levels were significantly higher in ischemic patients (=0.01 and =0.003, respectively). The increase in hs-cTnT seemed to be higher and longer in ischemic patients, although this was not statistically significant (=0.908). Finally, hs-cTnT did not decrease to baseline levels within 48 hours in either group. We found that hs-cTnT levels increased in all our patients with PSVT, more so in those with ischemic heart disease.
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http://dx.doi.org/10.14503/THIJ-15-5338DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5731582PMC
October 2017

A Rare Case of Pulmonary Artery Sling with the VACTERL Association in a 20-Month-Old Infant.

J Tehran Heart Cent 2017 Jul;12(3):131-133

Mafi Military Hospital, Shush, Khuzestan, Iran.

The VACTERL association, co-occurrence of vertebral, anorectal, cardiac, tracheoesophageal, genitourinary, and limb malformations, is a rare congenital anomaly. Several cardiac anomalies have been reported as a part of the VACTERL association, particularly ventricular and atrial septal defects. Pulmonary artery sling is a rare congenital abnormality in which the left pulmonary artery arises from the right pulmonary artery. This anomaly is not frequently observed in the VACTERL association and has been rarely reported. A 20-month-old girl was admitted to our hospital due to pneumonia in the right lung, which had pulmonary artery sling as a part of the VACTERL association. Barium meal X-ray showed pressure effects on the esophagus, and computed tomography angiography revealed pulmonary artery sling. Pneumonia management was done. However, the parents of our patient refused to give consent for the surgical correction of this vascular anomaly. Three months after discharge from the hospital, the patient was visited, at which time the parents again refused surgery and treatment for their daughter despite our recommendations.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5643871PMC
July 2017

Preoperative Hemoglobin A1c and the Occurrence of Atrial Fibrillation Following On-pump Coronary Artery Bypass Surgery in Type-2 Diabetic Patients.

Crit Pathw Cardiol 2017 03;16(1):37-41

From the *Tehran Heart Center, Tehran University of Medical Sciences, Iran; †Department of Cardiology, Hormozgan University of Medical Sciences, Bandar Abbas, Iran; and ‡Department of Community Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: We investigated the association of the preoperative hemoglobin A1c (HbA1c) with occurrence of postoperative atrial fibrillation (POAF) in type-2 diabetic patients who underwent isolated coronary artery bypass grafting.

Methods: We prospectively studied 708 type-2 diabetes patients [433 men ([61.2%)], candidate for isolated coronary artery bypass grafting. Biochemistry profile was measured on the day of operation. All patients were telemonitored for 72 hours after operation for the occurrence of atrial fibrillation. The role of HbA1c as a predictor for the occurrence of atrial fibrillation was then evaluated.

Results: A total of 109 (15.3%) patients developed POAF. Patients in the atrial fibrillation group tended to be older, with prolonged longer diabetes, and have renal failure, chronic obstructive pulmonary disease, and hypertension. In the univariable and multivariable regression model, HbA1c was not a predictor for POAF.

Conclusions: Serum level of HbA1c could not be used as a predictor for the development of POAF.
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http://dx.doi.org/10.1097/HPC.0000000000000103DOI Listing
March 2017

Ram's Horn Nail in Lower-Limb Ischemia.

J Tehran Heart Cent 2015 Jul;10(3):163-4

Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4685375PMC
July 2015

Age and the Head-Up Tilt Test Outcome in Syncope Patients.

Res Cardiovasc Med 2015 Nov 15;4(4):e27871. Epub 2015 Sep 15.

Tehran Heart Center, Tehran University of Medical Sciences, Tehran, IR Iran.

Background: The head-up tilt test (HUTT) is a useful diagnostic tool for syncope.

Objectives: We sought to investigate the outcome of the HUTT in syncope patients and identify the relationship between age and different hemodynamic outcomes.

Patients And Methods: In this cross-sectional study, we prospectively enrolled consecutive patients who presented with syncope and underwent the HUTT with a clinical suspicion of neurocardiogenic syncope after the exclusion of orthostatic hypotension cases. The HUTT consisted of consecutive passive and active phases. In the passive phase, the patients were tilted at 70 degrees for 20 minutes; and if negative, the test was repeated with 400 micrograms of sublingual nitroglycerin for another 20 minutes. Positive responses were classified according to the classification of the vasovagal syncope international study (VASIS) and compared for age and gender.

Results: A total of 498 patients were enrolled (age = 44.93 ± 18.77 years; male = 271 [54.4%]). Overall, 291 (58.4%) patients had a positive HUTT, while 256 (88.5%) patients had a positive result during the active phase. The test results were as follows: 107 (36.7%) mixed type (VASIS I), 103 (35.3%) cardioinhibitory (VASIS IIA = 44 [15.1%]; VASIS IIB = 59 [20.2%]), and 80 (27.4%) vasodepressive (VASIS III). There was no relationship between gender and syncope type. The trend of the HUTT result significantly changed with age, and the rate of cardioinhibitory syncope decreased after middle ages (P value for trend = 0.02).

Conclusions: Hemodynamic response to the HUTT was associated with age. Cardioinhibitory response became less frequent with age due to exaggerated vagal activity in the younger patients as compared with the older subjects.
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http://dx.doi.org/10.5812/cardiovascmed.27871DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4623382PMC
November 2015

Tessier number 30 clefts with congenital heart defects.

Iran Red Crescent Med J 2015 Mar 31;17(3):e19078. Epub 2015 Mar 31.

Tehran Heart Center, Tehran University of Medical Sciences, Tehran, IR Iran.

Introduction: Midline cleft of mandible, classified as Tessier 30 clefts is extremely rare, with less than 100 reported cases in the latest studies. Variations in severity and associated malformations have been reported before.

Case Presentation: In this report, we present the first documented Iranian case of Tessier 30 with median cleft of lower lip and bifid tongue concomitant with congenital heart defects.

Conclusions: We explain embryologic origin, differential diagnosis, other associated anomalies and its treatment by reviewing literature.
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http://dx.doi.org/10.5812/ircmj.19078DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4441777PMC
March 2015

Do pregnant women have a higher risk for venous thromboembolism following air travel?

Adv Biomed Res 2015 23;4:60. Epub 2015 Feb 23.

Department of Cardiology, Shahid Rajaee Heart Center, Iran University of Medical Sciences, Tehran, Iran.

International travel has become increasingly common and accessible, and it is part of everyday life in pregnant women. Venous thromboembolism (VTE) is a serious public health disorder that occurs following long-haul travel, especially after air travel. The normal pregnancy is accompanied by a state of hypercoagulability and hypofibrinolysis. Thus, it seems that pregnant women are at a higher risk of VTE following air travel, and, if they have preexisting risk factors, this risk would increase. There is limited data about travel-related VTE in pregnant women; therefore, in the present study, we tried to evaluate the pathogenesis of thrombosis, association of thrombosis and air travel, risk factors and prevention of VTE in pregnant women based on available evidences. Pregnancy is associated with a five- to 10-fold increased risk of VTE compared with nonpregnant women; however, during the postpartum period, this risk would increase to 20-80-fold. Furthermore, the risk of thrombosis is higher in individuals with preexisting risk factors, and the most common risk factor for VTE during pregnancy is a previous history of VTE. Pregnant women are at a higher risk for thrombosis compared with other women. Thus, the prevention of VTE and additional risk factors should be considered for all pregnant women who travel by plane.
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http://dx.doi.org/10.4103/2277-9175.151879DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4361953PMC
March 2015

The SYNTAX Score Can Predict Major Adverse Cardiac Events Following Percutaneous Coronary Intervention.

Heart Views 2014 Oct-Dec;15(4):99-105

Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.

Objectives: The SYNTAX score is a grading system that evaluates the complexity and prognosis of patients undergoing percutaneous coronary intervention (PCI). We investigated the association between the incidence of major adverse cardiac events (MACE) following PCI and the SYNTAX score in patients with three-vessel disease.

Methods: We consecutively enrolled 381 patients with three-vessel disease undergoing PCI and stenting. The SYNTAX score was divided into tertiles as low (≤16), intermediate (16-22) and high (>22). The endpoint was the incidence of MACE defined as cardiac death, in-hospital mortality, nonfatal myocardial infarction (MI), or target vessel revascularization. Then, the incidence of MACE was compared among the SYNTAX score tertile groups.

Results: The median follow-up was 14 months, and the rate of MACE was 12.6%. The rates of MACE were 7.5%, 9.9%, and 21.6% in patients with low, intermediate, and high SYNTAX score tertiles, respectively. Higher SYNTAX scores significantly predicted a higher risk of MACE (hazard ratio = 2.36; P = 0.02) even after adjustment for potential confounders. The main predictors of MACE were SYNTAX score, advanced age, hyperlipidemia, presentation as recent ST-elevation MI, number of total lesions, and history of renal failure.

Conclusion: The SYNTAX score could predict major cardiac outcomes following PCI in patients with three-vessel disease.
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http://dx.doi.org/10.4103/1995-705X.151081DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4348991PMC
March 2015

The effect of continuous low dose methylprednisolone infusion on inflammatory parameters in patients undergoing coronary artery bypass graft surgery: a randomized-controlled clinical trial.

Acta Med Iran 2015 ;53(2):104-11

Department of Cardiovascular Research, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.

This trial was performed to determine if a continuous low-dose infusion of methylprednisolone is as effective as its bolus of high-dose in reducing inflammatory response. The study was single-center, double-blinded randomized clinical trial and performed in a surgical intensive care unit of an academic hospital. In this study, 72 consecutive patients undergoing elective coronary artery bypass grafting (CABG) were assigned to receive either a methylprednisolone loading dose (1mg/kg) followed by continuous infusion (2mg/Kg/24 hours for 1 day) (low-dose regime) or a single dose of methylprednisolone (15 mg/kg) before cardiopulmonary bypass (high dose regime). Serum concentrations of IL-6 and C- reactive protein (CRP) were measured preoperatively and 6, 24 and 48 hours after surgery, and serum creatinine was measured before the operation and 24, 48 and 72 hours postoperatively. The measurements were then compared between the groups to evaluate the efficacy of each regimen. The basic characteristics and measurements were not different between the study groups. There was no significant difference in IL-6 and CRP elevation (P=0.52 and P=0.46, respectively). Early outcomes such as the length of stay in the intensive care unit, intubation time, changes in serum creatinine and blood glucose levels, inotropic support, insulin requirements, and rate of infection were also similar in both groups. A continuous low dose infusion of methylprednisolone was as effective as a single high dose methylprednisolone in reducing the inflammatory response after CABG with extracorporeal circulation with no significant difference in the postoperative measurements and outcomes.
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September 2015

Assessment of adherence to ACC/AHA guidelines in primary management of patients with NSTEMI in a referral cardiology hospital.

Crit Pathw Cardiol 2015 Mar;14(1):36-8

From the Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.

Acute coronary syndromes are considered as a global major health-care problem, and Iran as a developing country is of no exception. We aimed to investigate the degree of adherence to American College of Cardiology and American Heart Association (ACC/AHA) guideline for the management of non-ST-segment elevation myocardial infarction (NSTEMI) in patients who presented to the emergency department at Tehran Heart Center. Data of the patients who presented with acute chest pain to the emergency department of Tehran Heart Center within 1 year and were diagnosed as NSTEMI by the cardiologist in charge were included. The details of the initial managements based on the ACC/AHA guideline for NSTEMI of the patients were recorded from the patients' files in the emergency department for this study. Then, the frequency of guideline-related management in the study population was calculated and reported. A total of 684 patients [mean age = 62.95 ± 12.19 years; male gender = 460 (67.3%)] were diagnosed as NSTEMI at the emergency department of our center. Initial management based on the current guideline including administration of aspirin and clopidogrel was performed in 98.4% and 95.0%, respectively. Intravenous heparin was administered in 67.0% of the patients, whereas 30.8% of patients received enoxaparin. Following the initial management, coronary angiography was performed in 563 (82.3%) patients within 48 hours from the admission. Adherence to ACC/AHA guideline for the management of NSTEMI in patients who presented to a tertiary health-care center was in a high degree.
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http://dx.doi.org/10.1097/HPC.0000000000000040DOI Listing
March 2015

The effect of elective percutaneous coronary intervention of the right coronary artery on right ventricular function.

Int Cardiovasc Res J 2014 Dec 1;8(4):148-51. Epub 2014 Dec 1.

Shariati Hospital, Tehran University of Medical Sciences, Tehran, IR Iran.

Background: Right Ventricular (RV) dysfunction has been introduced as a predictor of mortality in acute myocardial infarction.

Objectives: This study aimed to investigate the effect of right coronary revascularization on systolic and diastolic RV dysfunction.

Patients And Methods: This study was conducted on unstable angina patients who were candidate for elective Percutaneous Revascularization Intervention (PCI) on the right coronary artery. The participants were initially evaluated by transthoracic echocardiography and tissue Doppler imaging prior to PCI and the RV function parameters were assessed. Echocardiography was repeated two months after PCI and the results were compared with baseline. Paired t-test was used to compare the pre- and post-procedural measurements. Besides, Pearson's correlation was used to find out the linear association between the RV function parameters and Left Ventricular Ejection Fraction (LVEF). P value < 0.05 was considered as statistically significant.

Results: This study was conducted on 30 patients (mean age = 60.00 ± 8.44 years; 24 [80%] males). In the pre-procedural echocardiography, 15 patients (50%) had normal RV function, 14 patients (46.7%) had grade-1 RV dysfunction, and only 1 patient (3.3%) had grade-2 RV dysfunction. Following PCI, however, all the patients had normal systolic and diastolic RV functions. Comparison of echocardiographic RV function parameters showed an improvement in both systolic and diastolic functional parameters of the RV. Nonetheless, no significant correlation was observed between these parameters and Left Ventricular (LV) function.

Conclusions: A significant improvement was found in RV function, but not LV function, after right coronary PCI. Revascularization of the right coronary artery may be beneficial for the patients who suffer from RV failure due to ischemia.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4302501PMC
December 2014

Multiple multisite low-temperature and low-power radiofrequency currents for the induction of atrioventricular nodal reentry tachycardia in non-inducible patients.

J Interv Card Electrophysiol 2015 Jan 8;42(1):5-9. Epub 2014 Nov 8.

Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran,

Aims: Some patients with documented episodes of paroxysmal supraventricular tachycardia (PSVT) do not have inducible tachycardia during the electrophysiological study. In this study, we describe how multiple low-temperature, low-power radiofrequency (RF) currents in the atrioventricular (AV) junction region can increase the rate of the induction of atrioventricular nodal reentrant tachycardia (AVNRT) in non-inducible cases.

Method: We enrolled 31 consecutive patients (mean age = 50.9 ± 11.9 years; 5 [16.1 %] male) who presented with documented clinical PSVT in superficial electrocardiography but had non-inducible arrhythmia in the electrophysiology laboratory despite applying different stimulation protocols. We delivered low-power (25 W), low-temperature (45 °C) RF currents into the AV junction region to induce AVNRT.

Results: Arrhythmia was induced in 20 (64.5 %) patients, and it was non-sustained in 3 (9.6 %) patients. RF current was delivered into the posterior region near the coronary sinus ostium and midseptal region. RF ablation target in inducible patients was the non-inducibility of the AVNRT at the end of the procedure, while the target in the non-inducible patients was slow pathway ablation with no antegrade conduction over the slow pathway. During the follow-up period, none of the patients (either with inducible or non-inducible arrhythmia) had recurrence of AVNRT.

Conclusion: Multiple low-power, low-temperature RF current application into the AV junction region is a more effective method for the induction of AVNRT in comparison with a single current use into the slow pathway.
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http://dx.doi.org/10.1007/s10840-014-9955-2DOI Listing
January 2015

The association between premature coronary artery disease and level of testosterone in young adult males.

Arch Iran Med 2014 Aug;17(8):545-50

Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.

Objective: Low testosterone levels in men have been associated with an increased risk of cardiovascular disease. We aimed to identify the association between serum testosterone level and premature coronary artery disease (CAD) and its predictors in young adult males.

Methods: In this cross sectional study, consecutive male candidates for coronary angiography with unstable angina, no previous CAD and age ≤ 45 years were included. Serum levels of free (FT) and total testosterone (TT) as well as demographic and cardiovascular characteristics were compared between the CAD-positive and normal coronary subjects. The cutoff point for low TT was 2.5 ng/L. Additionally, the relationships between all the variables and the number of affected vessels and FT and TT and predictors of CAD were assessed.

Results: In this study, 191 patients with premature CAD were compared with 94 normal coronary subjects. Patients in the CAD group were significantly older (41.59 ± 3.79 versus 39.27 ± 4.97 years; P-value < 0.01), and had higher rates of diabetes mellitus (P-value = 0.04) and dyslipidemia (P-value = 0.01). Serum levels of FT and TT were significantly lower in the CAD group than the normal coronary subjects (P-value < 0.01 for both). The rate of subjects with low TT increased by the number of the affected vessels (p-value for trend <0.01) and there was a significant correlation between the Gensini score and FT and TT (r = -0.37, P-value < 0.01 and r = -0.34, P-value < 0.01, respectively). After adjustment for confounders, the association between low TT and CAD remained significant (Odds ratio = 4.30, 95% confidence interval: 1.99-9.32; P-value ≤ 0.001) CONCLUSION: Low levels of testosterone were associated with premature CAD and its severity in young adults.
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http://dx.doi.org/014178/AIM.005DOI Listing
August 2014

Prevalence of depression in patients with β-thalassemia as assessed by the Beck's Depression Inventory.

Hemoglobin 2014 2;38(4):289-91. Epub 2014 Jul 2.

Tehran Heart Centre, Tehran University of Medical Sciences , Tehran , Iran.

β-Thalassemia (β-thal) is a frequent, chronic hereditary disease, and a plausible cause for psychological disorders. In this cross-sectional study, we aimed to identify the rate and severity of depression among Iranian patients with β-thal using the Beck's Depression Inventory (BDI). β-Thalassemic patients aged 13-20 years [median age 17.2 years; 27 males (48.2%), 29 females (51.8%)], who presented to the Mofid Children Hospital, Tehran, Iran, for blood transfusions within a 1-year period, were asked to complete the BDI questionnaire. Based on the BDI score, patients were classified as normal or mild-to-severe depression groups, and the collected data were then analyzed according to age and sex. A total of 56 subjects completed the BDI form. Mean score for BDI was 14.27 ± 12.79. Based on the BDI results, 35 (62.5%) had a BDI score below 16 and were therefore not classified as being depressed, while seven (12.5%) patients suffered from severe depression (BDI > 47). Age and gender did not have any significant association with the BDI results (p = 0.52 and p = 0.67, respectively). The total prevalence of various degrees of depression was 30.8% in this study. We concluded that the noticeable rate of depression in thalassemic patients signifies the necessity for improving psychosocial care in this specific group of patients.
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http://dx.doi.org/10.3109/03630269.2014.929008DOI Listing
March 2015