Publications by authors named "Ali Zahedmehr"

35 Publications

The effect of barberry (Berberis vulgaris) consumption on flow-mediated dilation and inflammatory biomarkers in patients with hypertension: A randomized controlled trial.

Phytother Res 2020 Dec 22. Epub 2020 Dec 22.

Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Hypertension is considered as an important cardiovascular risk factor and evidence suggests that hypertension and endothelial dysfunction reinforce each other. Polyphenol-rich foods, such as barberry can reduce the risk of cardiovascular disease. Our aim was to investigate the effects of barberry consumption on vascular function and inflammatory markers in hypertensive subject. In this randomized controlled parallel trial, 84 hypertensive subjects of both genders (aged 54.06 ± 10.19 years; body mass index 28.02 ± 2.18 kg/m ) were randomly allocated to consume barberry (10 g/day dried barberry) or placebo for 8 weeks. Before and after the intervention, changes in brachial flow-mediated dilation (FMD) and plasma macrophage/monocyte chemo-attractant protein-1 (MCP-1), vascular cellular adhesion molecule-1, and intracellular adhesion molecule-1 (ICAM-1) were measured. An intention-to-treat analysis was performed. Compared to placebo (n = 42), barberry consumption (n = 42) improved FMD (B [95% CI] was 6.54% [4.39, 8.70]; p < .001) and decreased plasma ICAM-1 (B [95% CI] was -1.61 ng/ml [-2.74, -0.48]; p = .006). MCP-1 was significantly lower in the barberry group compared with the placebo group (B [95% CI] was -37.62 pg/ml [-72.07, -3.17]; p = .033). Our results indicate that barberry consumption improves FMD and has a beneficial effect on plasma ICAM-1 and MCP-1 in hypertensive patients. This trial was registered at the Iranian Registry of Clinical Trial (IRCT) with number IRCT20160702028742N8.
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http://dx.doi.org/10.1002/ptr.7000DOI Listing
December 2020

Role of stent oversizing in patients undergoing primary percutaneous coronary intervention. An open-labeled randomized controlled trial.

Minerva Cardioangiol 2020 Dec 1. Epub 2020 Dec 1.

Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran -

Background: In patients with ST-segment-elevation myocardial infarction (STEMI), primary percutaneous coronary intervention (PPCI) is the treatment of choice. Stent undersizing might occur due to catecholamine release and coronary spasm. Although routine oversizing has been promising in several investigations, it has never been tested in randomized clinical trials. In this single-center open-label randomized clinical trial, we evaluated the role of stent oversizing in PPCI.

Methods: Candidates for PPCI were randomly divided into oversized and non-oversized groups. In the oversized group, the stent was oversized by 10% according to the mean lumen diameter, retrieved from the quantitative coronary analysis. Primary composite endpoints were defined as the occurrence of complete total ST-segment (STR)resolution and postprocedural thrombolysis in myocardial infarction (TIMI) flow grade III.

Results: The study population was comprised of 122 patients, allocated to the oversized group (n = 61) and the non-oversized group (n = 61). There was no significant difference between the 2 groups regarding the final TIMI flow grade. Complete STR was marginally more favorable in the non-oversized group (56.05 ± 55.12 vs 64.64 ± 23.28; P = 0.056). The troponin ratio, CK-MB ratio, and 6-month follow up outcome-defined as target lesion revascularization, heart failure, and cardiovascular death-were comparable between the 2 groups.

Conclusions: Our study showed that routine oversizing in patients undergoing PPCI had no benefit regarding ST-segment resolution and the final TIMI flow, as well as hard cardiac events, during the follow-up.
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http://dx.doi.org/10.23736/S0026-4725.20.05396-7DOI Listing
December 2020

Effect of barberry (Berberis vulgaris) consumption on blood pressure, plasma lipids, and inflammation in patients with hypertension and other cardiovascular risk factors: study protocol for a randomized clinical trial.

Trials 2020 Nov 27;21(1):986. Epub 2020 Nov 27.

Department of Clinical Nutrition & Dietetics, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, P.O. 19395-4741, Iran.

Background: Cardiovascular diseases (CVDs) remain the leading causes of morbidity and mortality in the world. Hypertension is an important and prevalent cardiovascular risk factor. The present study will be conducted to investigate the effect of barberry as a cardio-protective fruit on the blood pressure in patients with hypertension and other CVD risk factors. Furthermore, plasma concentrations of lipids and inflammatory biomarkers will be evaluated.

Methods/design: This is an 8-week, prospective, single-blinded, parallel assigned, randomized controlled clinical trial (RCT) in which eligible men and women with hypertension and other cardiovascular risk factors will be randomized to either placebo powder (PP; containing 9 g maltodextrin, 1 g citric acid, 1 g milled sucrose and edible red color (n = 37)) or barberry powder (BP; containing 10 g milled dried barberry and 1 g of milled sucrose (n = 37)) groups. At baseline and after 8 weeks of intervention, plasma lipids and inflammatory markers, 24-h urinary nitrite/nitrate and sodium excretion, and 24-h ambulatory blood pressure monitoring (ABPM) will be measured. Anthropometric measures and dietary assessment will be performed as well. Data analysis will be done using SPSS version-21 software.

Discussion: The interest in natural and functional food products has increased globally. This RCT will add to the growing literature for the potential antihypertensive, lipid-lowering, and anti-inflammatory effects of barberry in humans.

Trial Registration: ClinicalTrials.gov (NCT number) NCT04084847 . Registered on 10 December 2019.
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http://dx.doi.org/10.1186/s13063-020-04918-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7694417PMC
November 2020

The significance of coronary artery calcium score as a predictor of coronary artery stenosis in individuals referred for CT angiography.

J Cardiovasc Thorac Res 2020 3;12(3):203-208. Epub 2020 Sep 3.

Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.

Cardiovascular diseases, including coronary artery disease (CAD), are among the most common causes of death in the elderly population. Recent studies have found that coronary artery calcium score (CACS) is a strong independent predictor of CAD. Here we aimed to investigate the association between CACS and demographic, clinical, laboratory, and CT angiographic findings inpatients with suspected CAD. From June 2008 to August 2018, we retrospectively reviewed 219 consecutive patients suspected with CAD who were referred for CT angiography in Rajaie Cardiovascular, Medical, and Research Center. Medical records were reviewed, and relevant demographic, clinical, laboratory and imaging were collected. A total of 219 patients with an average age of 62.64±12.39 were included. Twelve patients(5.5%) had normal coronary angiography, and 50.2% had mild CAD. An obstructive CAD was found in97 patients (44.3%). The median CACS was 76.4 (IQR, 13.0-289.1). The frequency of obstructive CAD was 28.1% in the CACS <100 group, and 67.0% in CACS >100 group ( < 0.001). On multiple logistic regression analysis, age (OR=1.04 [1.01-1.07], = 0.006), CACS (OR= 4.31 [2.33-7.98], < 0.001), and neutrophil to lymphocyte ratio (NLR) (OR = 0.82 [0.68-0.98], = 0.027) were independent predictors of obstructive CAD. We found a direct association between higher CACS and obstructive patterns in coronary CT angiography. Our findings indicate that the possibility of the presence of obstructive CAD was higher among symptomatic patients with older age, lower NLR, and CACS >100.
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http://dx.doi.org/10.34172/jcvtr.2020.34DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7581835PMC
September 2020

Effect of polyphenol-rich extra-virgin olive oil on lipid profile and inflammatory biomarkers in patients undergoing coronary angiography: a randomised, controlled, clinical trial.

Int J Food Sci Nutr 2021 Jun 29;72(4):548-558. Epub 2020 Oct 29.

Department of Clinical Nutrition & Dietetics, National Nutrition, and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

The present study was conducted to compare the effects of high polyphenol extra-virgin olive oil (EVOO) with low polyphenol refined olive oil (ROO) on some cardiovascular risk factors in patients undergoing coronary angiography. In a randomised, controlled, parallel-arm, clinical trial, 40 patients with at least one classic cardiovascular risk factor who referred to coronary angiography were randomly allocated to two groups and receied 25 mL EVOO or ROO daily for 6 weeks. Plasma LDL-cholesterol significantly reduced in EVOO group (-9.52 ± 20.44 vs 8.68 ± 18.77 mg/dL,  = .007 for EVOO and ROO respectively). EVOO resulted in a significant reduction in plasma CRP (-0.40 ± 0.52 vs 0.007 ± 0.42 mg/L,  = .01 for EVOO and ROO respectively) and increased ex-vivo whole blood LPS-stimulated IL-10 production (12.13 ± 33.64 vs -17.47 ± 49.04 pg/mL,  = .035 for EVOO and ROO respectively). Daily consumption of polyphenol-rich EVOO in subjects who have been under medical treatment with risk-reducing agents could additionally improve LDL-C and selected inflammatory markers. NCT03796780.
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http://dx.doi.org/10.1080/09637486.2020.1841123DOI Listing
June 2021

Effects of canola or olive oil on plasma lipids, lipoprotein-associated phospholipase A and inflammatory cytokines in patients referred for coronary angiography.

Lipids Health Dis 2020 Aug 14;19(1):183. Epub 2020 Aug 14.

Department of Clinical Nutrition & Dietetics, National Nutrition, and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, No. 7, Hafezi St., Farahzadi Blvd., Qods Town, Tehran, Iran.

Background: The potential cardioprotective benefits of olive oil (OO) and canola oil (CO) consumption have been shown in some studies. The present study compared the effects of CO and OO on plasma lipids, some inflammatory cytokines, and lipoprotein-associated phospholipase A (Lp-PLA) mass and activity in patients undergoing coronary angiography.

Methods: The current randomized, controlled, parallel-arm, clinical trial involved 48 patients (44 men and 4 women, aged 57.63 ± 6.34 years) with at least one classic cardiovascular risk factor (hypertension, dyslipidemia, or diabetes) who referred for coronary angiography. Patients were randomly divided into two groups and received 25 mL/day refined olive oil (n = 24) or canola oil (n = 24) for 6 weeks. Plasma lipids, some selected inflammatory markers, and Lp-PLA levels were measured at baseline and after the intervention.

Results: CO consumption produced a significant reduction in plasma Lp-PLA mass (- 0.97 ± 1.84 vs. 0.34 ± 1.57 ng/mL, p = 0.008 for CO and OO, respectively), whereas the mean changes in interleukine-6 concentration were significantly lower after OO consumption compared with CO (- 9.46 ± 9.46 vs. -0.90 ± 6.80 pg/mL, p = 0.008 for OO and CO, respectively). After 6 weeks of intervention, no significant changes were observed in plasma Lp-PLA activity, complement C3, C4, or lipid profiles in the two intervention groups.

Conclusions: Comparing the two vegetable oils in subjects with cardiovascular risk factors showed that the consumption of olive oil is more effective in reducing the level of inflammatory cytokine interleukine-6, whereas canola oil was more effective in lowering Lp-PLA levels; however, this finding should be interpreted with caution, because Lp-PLA activity did not change significantly.

Trial Registration: IRCT20160702028742N5 at www.irct.ir (04/19/2019).
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http://dx.doi.org/10.1186/s12944-020-01362-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7427979PMC
August 2020

Central Nervous System and Cardiac Involvement in the Hypereosinophilic Syndrome: A Case Report.

Immunol Invest 2021 May 27;50(4):356-362. Epub 2020 Jul 27.

Department of internal medicine, Iran University of Medical Sciences, Tehran, Iran.

Hypereosinophilic syndrome is a rare entity and heterogeneous group of disorders characterized by hypereosinophilia and organ involvement. In this study, we presented a 49-year-old woman with cardiac tamponade in the context of Hypereosinophilic syndrome. Identifying hypereosinophilia as the underlying cause can have tremendous clinical implications for rapid initiation of appropriate treatment to minimize further end organ damage.
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http://dx.doi.org/10.1080/08820139.2020.1758131DOI Listing
May 2021

Diagnostic accuracy of two-dimensional coronary angiographic-derived fractional flow reserve-Preliminary results.

Catheter Cardiovasc Interv 2021 Mar 27;97(4):E484-E494. Epub 2020 Jul 27.

Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.

Aim: Noninvasive fractional flow reserve (NiFFR) is an emerging method for evaluating the functional significance of a coronary lesion during diagnostic coronary angiography (CAG). The method relies on the computational flow dynamics and the three-dimensional (3D) reconstruction of the vessel extracted from CAG. In the present study, we sought to evaluate the diagnostic performance and applicability of 2D-based NiFFR.

Methods: In this prospective observational study, we evaluated 2D-based NiFFR in 279 candidates for invasive CAG and invasive fractional flow reserve (FFR). NiFFR was calculated via two methods: variable NiFFR, in which the contrast transport time was extracted from the angiographic view, and fixed NiFFR, in which a prespecified frame count was applied.

Results: The final analysis was performed on 245 patients (250 lesions). Variable NiFFR had an area under the receiver operating characteristic curve of 81.5%, an accuracy of 80.0%, a sensitivity of 82.2%, a specificity of 82.2%, a negative predictive value of 91.4%, and a positive predictive value of 63.6%. The mean difference between FFR and NiFFR was -0.0244 ±.0616 (p ≤.0001). A pressure wire-free hybrid strategy was possible in 68.8% of our population with variable NiFFR.

Conclusions: Our 2D-based NiFFR yielded results comparable to those derived from 3D-based software. Our findings should; however, be confirmed in larger trials.
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http://dx.doi.org/10.1002/ccd.29150DOI Listing
March 2021

Role of polymorphisms of the endothelial nitric oxide synthase gene in predicting slow-flow phenomenon after primary percutaneous coronary intervention.

Turk Kardiyol Dern Ars 2020 07;48(5):472-483

Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran.

Objective: The aim of the present study was to examine the association between 2 polymorphisms of the endothelial nitric oxide (eNOS) gene (-786T>C and +894G>T) and the no-reflow/slow-flow phenomenon in post-primary percutaneous coronary intervention (PPCI) patients.

Methods: A total of 103 post-PPCI patients were enrolled. Coronary no-reflow phenomenon was defined as a Thrombolysis in Myocardial Infarction (TIMI) flow grade 0-1 and coronary slow-flow phenomenon (CSFP) was defined as a TIMI flow grade ≤2.

Results: Due to the small number of post-PPCI patients with the no-reflow phenomenon (n=4), the primary comparison was made between CSFP (n=20) and normal flow (n=83) groups. There was a greater frequency of CSFP among carriers of the -786C allele of the eNOS -786T>C polymorphism (odds ratio [OR]: 3.90; 95% confidence interval [CI]: 0.87-17.45; p=0.07). However, no such association was detected between the +894T allele of the eNOS +894G>T and CSFP (OR: 0.92; 95% CI: 0.21-3.98; p=0.91). In the adjusted analysis, the -786T>C polymorphism did not reach statistical significance.

Conclusion: There was no significant association between CSFP and 2 of the most common polymorphisms of the eNOS gene in post-PPCI patients.
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http://dx.doi.org/10.5543/tkda.2020.53849DOI Listing
July 2020

Effects of the COVID-19 Pandemic on the Management of Patients With ST-elevation Myocardial Infarction in a Tertiary Cardiovascular Center.

Crit Pathw Cardiol 2021 03;20(1):53-55

From the Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran; and.

Background: In the Coronavirus Disease 2019 (COVID-19) pandemic, the appropriate reperfusion strategy in patients with ST-segment elevation myocardial infarction (STEMI) is unclear.

Methods: This retrospective single-center study consecutively enrolled patients who presented with STEMI and scheduled for primary percutaneous coronary intervention (PPCI) during the outbreak of COVID-19. Due to the delay in the reporting of the polymerase chain reaction test results, our postprocedural triage regarding COVID-19, followed by the isolation strategy, was based on lung computerized tomography scan results.

Results: Forty-eight patients with STEMI referred to our center. PPCI was done for 44 (91%) of these patients. The mean symptom-to-device time was 490.93 ± 454.608 minutes, and the mean first medical contact-to-device time was and 154.12 ± 36.27 minutes. Nine (18%) patients with STEMI were diagnosed as having typical/indeterminate features indicating COVID-19 involvement. During hospitalization, 1 (2.0%) patient died of cardiogenic shock. The study population was followed for 35.9 ± 12.7 days. Two patients expired in another centers due to COVID-19. No cardiac catheterization laboratory staff members were infected by COVID-19 during the study period.

Conclusions: Our small report indicates that by taking the recommended safety measures and using appropriate PPE, we can continue PPCI as the main reperfusion strategy safely and effectively.
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http://dx.doi.org/10.1097/HPC.0000000000000228DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7288762PMC
March 2021

Association between the risks of contrast-induced nephropathy after diagnostic or interventional coronary management and the transradial and transfemoral access approaches.

J Cardiovasc Thorac Res 2020 12;12(1):51-55. Epub 2020 Feb 12.

Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.

The risk of contrast-induced nephropathy (CIN) as a common and important complication of coronary procedures may be influenced by the vascular access site. We compared the risks of CIN in diagnostic or interventional coronary management between patients treated via the transradial access (TRA) and those treated via the transfemoral access (TFA). Patients undergoing invasive coronary catheterization or percutaneous coronary intervention (PCI) were enrolled. We excluded patients with congenital or structural heart disease and those with end-stage renal disease on dialysis. Based on the vascular access site used for invasive coronary catheterization, the patients were divided into 2 study groups: the TFA and the TRA. CIN was defined as an absolute (≥0.5 mg/dL) or relative (>25%) increase in the baseline serum creatinine level within 48 hours following cardiac catheterization or PCI. Overall, 410 patients (mean age = 61.3 ± 10.8 years) underwent diagnostic or interventional coronary management: 258 were treated via the TFA approach and 152 via the TRA approach. The patients treated via the TFA had a significantly higher incidence of postprocedural CIN (15.1% vs 6.6%; = 0.01). The multivariate analysis showed that the TFA was the independent predictor of CIN (OR: 2.37, 95% CI: 1.11 to 5.10, and = 0.027). Moreover, the BARC (Bleeding Academic Research Consortium) and Mehran scores were the other independent predictors of CIN in our study. The risk of CIN was lower with the TRA, and the TFA was the independent predictor of CIN after the diagnostic or interventional coronary management.
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http://dx.doi.org/10.34172/jcvtr.2020.08DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7080339PMC
February 2020

Coronary CT Angiography and Dual-Energy Computed Tomography in Ischemic Heart Disease Suspected Patients.

Arch Iran Med 2019 07 1;22(7):376-383. Epub 2019 Jul 1.

Department of Radiology, Amiralalm Hospital, Tehran University of Medical Sciences, Tehran, Iran (C. O).

Background: Advanced computed tomography (CT) scanners enable concurrent assessment of coronary artery anatomy and myocardial perfusion. The purpose of this study was to assess dual-energy CT images in a group of patients suspected for ischemic heart disease and to evaluate agreement of cardiac computed tomography perfusion (CTP) images with CT angiography results in a single dual-energy computed tomography (DECT) acquisition.

Methods: Thirty patients (mean age: 53.8 ± 12.9 years, 60% male) with angina pectoris or atypical chest pain, suspected for ischemic heart disease, were investigated using a 384-row detector CT scanner in dual-energy mode (DECT). Firstly, resting CTP images were acquired, and then from the same raw data, computed tomography angiography (CTA) studies were reconstructed for stenosis detection. CT-based dipyridamole-stress myocardial perfusion imaging was then performed in patients who exhibited coronary stenosis >50% or had myocardial bridge (MB). A color-coded iodine map was used for evaluation of myocardial perfusion defects using the 17-segment model. Two independent blinded readers analyzed all images for stenosis and myocardial perfusion defects. Different myocardial iodine content (mg/mL) was calculated by parametric tests. The kappa agreement was calculated between results of two methods in cardiac scans.

Results: All 30 CT angiograms were evaluated and assessment ability was 100% for combined CTA/CTP. According to the combined CT examination, 17 patients (56.7%) exhibited significant coronary stenosis and/or deep MB (DMB). A total of 510 myocardial segments and 90 vascular territories were analyzed. Coronary CTA demonstrated significant stenosis in 22 vessels (24.4% of all main coronary arteries) among 12 patients (40%), DMB in 6 vessels (6.7% of all main coronary arteries) in 17 out of 30 patients (56.7%). Twenty-eight out of 90 vascular territories (31.1%) and 41 out of 510 segments (8%) showed reversible perfusion defects on stress DECT. Kappa agreement between CTA and CTP results in whole heart was 0.79 (95% confidence interval=0.57-1). There were significant differences in mean iodine concentration between ischemic (0.59 ± 0.07 mg/mL) and normal segments (2.2 ± 0.15) with P < 0.001.

Conclusion: Agreement of CTA and CTP in whole heart and in LAD considering DMB and significant CAD together were good to excellent; however, considering sole pathologies, most of the agreements were weak (<0.5). DECT with iodine quantification may provide a valuable method in comparison with previous methods for identifying both coronary stenosis and myocardial ischemia.
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July 2019

Left ventricular end-diastolic pressure-guided hydration for the prevention of contrast-induced acute kidney injury in patients with stable ischemic heart disease: the LAKESIDE trial.

Int Urol Nephrol 2019 Oct 22;51(10):1815-1822. Epub 2019 Jul 22.

Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Vali-Asr Ave, Tehran, Iran.

Objectives: Contrast-induced acute kidney injury (CI-AKI) is a serious complication in patients undergoing diagnostic cardiac angiography or percutaneous coronary intervention. We aimed to evaluate the preventive effects of left ventricular end-diastolic pressure (LVEDP)-guided hydration for the prevention of CI-AKI in patients with chronic kidney disease undergoing cardiac catheterization.

Methods: This prospective randomized single-blind clinical trial enrolled 114 eligible patients with an estimated glomerular filtration rate (eGFR) of 15 < eGFR ≤ 60 mL/min/1.73 m [according to the level-modified Modification of Diet in Renal Disease formula (MDRD)] and stable ischemic heart disease undergoing coronary procedures. The patients were randomly allocated 1:1 into the LVEDP-guided hydration group (n = 57) or the standard hydration group (n = 57). CI-AKI was defined as a greater than 25% or greater than 0.5 mg/dL (44.2 mmol/L) increase in the serum creatinine concentration compared with the baseline value. Hydration with 0.9% sodium chloride at a rate of 1 mL/kg/h (0.5 mL/kg/h if left ventricular ejection fraction < 40%) within 12 h was given to all the patients in both groups before the procedure. In the LVEDP-guided group, the hydration infusion rate was adjusted according to the LVEDP level during and after the procedure.

Results: The incidence of CI-AKI was 7.01% (4/57) in the LVEDP-guided group vs 3.84% (2/52) in the standard hydration group (summary odds ratio 0.53, 95% CI 0.093-3.022; P = 0.463). Major adverse cardiac events, hemodialysis, or related deaths occurred in neither of the groups during hospitalization or the 30-day follow-up.

Conclusions: In the present study, LVEDP-guided fluid administration, by comparison with standard hydration, failed to offer protection against the risk of CI-AKI in patients with renal insufficiency undergoing coronary angiography with or without percutaneous coronary intervention.
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http://dx.doi.org/10.1007/s11255-019-02235-wDOI Listing
October 2019

The association between increased carotid intima-media thickness and SYNTAX Score in coronary artery disease: A single center study.

Indian Heart J 2018 Sep - Oct;70(5):627-629. Epub 2018 Jan 8.

Rajaei Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.

Background: Carotid artery lesions frequently coexist with coronary arterial disease (CAD). The aim of this study was to investigate the relation between carotid intima-media thickness (CIMT) and the extent of CAD and whether CIMT could be predictive of severity of coronary atherosclerosis.

Methods: Coronary angiography and carotid ultrasound evaluations of 100 consecutive patients with CAD who had undergone elective coronary angiography were reviewed. IMT was measured at both carotid arteries. CIMT and severity of CAD relationship based on SYNTAX score was assessed. The relation between CIMT and cardiovascular risk factors was determined.

Results: Mean overall SYNTAX score was 15.76+4.82. Mean right CIMT was 0.86±0.29 and mean left CIMT was 0.83±0.24. There were no significant correlation between the SYNTAX score and CIMT (r: 10, P: 30). There was significant relationship between hypertension,diabetes and CIMT (P: 0.01).

Conclusion: we found no relationship between CIMT and SYNTAX score in patients who underwent coronary angiography. Diabetes mellitus and hypertension are related to increased carotid intima-media thickness.
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http://dx.doi.org/10.1016/j.ihj.2018.01.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6205025PMC
January 2019

Comparison between rosuvastatin and atorvastatin for the prevention of contrast-induced nephropathy in patients with STEMI undergoing primary percutaneous coronary intervention.

J Cardiovasc Thorac Res 2018 24;10(3):149-152. Epub 2018 Sep 24.

Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.

There is some controversy over the efficacy of statins for the prevention of contrastinduced nephropathy (CIN). There have also been reports on varying efficacies of different statins. Hence, in this study the efficacy of atorvastatin and rosuvastatin for the prevention of CIN was assessed. This single-blind randomized clinical trial was performed on 495 random patients with myocardial infarction with ST-segment elevation undergoing primary percutaneous coronary intervention (PCI) in a training referral hospital in 2015. Patients were randomly assigned to receive either atorvastatin 80 mg at admission and daily or rosuvastatin 40 mg at admission and daily. CIN was defined based on serum creatinine elevation after 48 hours from the PCI. The incidence of CIN was observed in 63 patients (21.4%) After 48 hours from primary PCI. Of those, 17% (n = 50) were grade 1 CIN, while 4.4% (n = 13) were grade 2 CIN. There was no significant difference between rosuvastatin group compared with atorvastatin group, regarding the CIN grading ( = 0.14). Our results indicate that atorvastatin and rosuvastatin have similar efficacy for the prevention of CIN.
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http://dx.doi.org/10.15171/jcvtr.2018.24DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6203872PMC
September 2018

Effect of flaxseed consumption on flow-mediated dilation and inflammatory biomarkers in patients with coronary artery disease: a randomized controlled trial.

Eur J Clin Nutr 2019 02 20;73(2):258-265. Epub 2018 Aug 20.

Department of Clinical Nutrition & Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background/objective: Available data indicate a possible beneficial effect of flaxseed on cardiovascular disease, but limited studies have evaluated the effects of flaxseed on endothelial dysfunction and biomarkers of inflammation in patients with coronary artery disease (CAD). The purpose of the present study was to examine the effect of flaxseed consumption on flow-mediated dilation (FMD) and inflammatory markers in CAD patients.

Subjects/method: In this randomized controlled parallel trial, 50 patients with CAD of both genders were randomly allocated to 12 weeks consumption of flaxseed (30 g/day) or usual care control. Before and after the intervention, changes in brachial FMD and plasma high-sensitivity C-reactive protein (hs-CRP), interleukine-6 (IL-6), and tumor necrosis factor-α (TNF-α) were measured.

Results: Forty-four participants (aged 56.43 ± 8.21 years; BMI 26.65 ± 2.44 kg/m) completed the study. No significant weight change was observed in either group. Compared to control (n = 23), flaxseed consumption (n = 21) was associated with improved FMD (mean of change from baseline was 5.1 vs -0.55%; p = 0.001 for the flaxseed and control, respectively). When compared to control, flaxseed consumption was associated with reduced inflammatory markers (mean of change from baseline for hs-CRP was -1.18 and -0.3 mg/L, p = 0.003; for IL-6 was -7.65 and -0.77 pg/mL, p = 0.017; for TNF-α was -34.73 and -2.18 pg/mL p = 0.001 in flaxseed and control, respectively).

Conclusions: The results of this study indicate that by adding flaxseed to diet of CAD patients, it is possible to improve FMD and plasma levels of inflammatory markers.
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http://dx.doi.org/10.1038/s41430-018-0268-xDOI Listing
February 2019

Correction to: Clopidogrel Pharmacogenetics in Iranian Patients Undergoing Percutaneous Coronary Intervention.

Cardiovasc Toxicol 2018 10;18(5):492

Medical Genetics Laboratory, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Valiasr Street, Niyaesh Intersection, Tehran, 1995614331, Iran.

The original version of this article unfortunately contained a typo in the co-author name.
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http://dx.doi.org/10.1007/s12012-018-9475-xDOI Listing
October 2018

Clopidogrel Pharmacogenetics in Iranian Patients Undergoing Percutaneous Coronary Intervention.

Cardiovasc Toxicol 2018 10;18(5):482-491

Medical Genetics Laboratory, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Valiasr Street, Niyaesh Intersection, Tehran, 1995614331, Iran.

Clopidogrel is used in patients with coronary syndromes and at risk of thrombotic events or receiving percutaneous coronary intervention (PCI) for reducing heart attack and stroke. Here we present genotype and phenotype study of Iranian patients undergoing PCI treated with clopidogrel during a 6-month period of follow-up; common variants of CYP2C19, CYP3A5, CYP3A4, and ABCB1 genes were determined as well as the patients' cardiovascular outcomes to find out the effect of these variants individually and in combination. 388 individuals receiving PCI were enrolled in this study. Different pretreatment doses of clopidogrel were prescribed under the interventional cardiologists' guidance. The patients were followed for a duration of 1 month, and 6 months. Six SNPs were selected for genotyping including CYP2C19*2 (c.681G > A), CYP2C19*3 (c.636G > A), CYP2C19*17 allele (c.-806C > T), ABCB1 (c.3435C > T), CYP3A5 (c.6986A > G), and CYP3A4 (c.1026 + 12G > A). The mean loading dose was 600 mg/day in 267 (68.8%) individuals, 300 mg/day in 121 (31.2%). 8 patients had cardiovascular events such as thrombosis, unstable angina, and non-STEMI. The studied alleles and genotypes were in Hardy-Weinberg equilibrium. None of the SNPs individually were significantly associated with outcome events. Our results indicate that combinations of different alleles of genes are involved in pharmacokinetic variability and joint factors are important; this means that genotyping and analysis of an individual variant may not be as straightforward in risk assessment and pharmacogenetics. This highlights the importance of personalized medicine in risk assessment and treatment.
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http://dx.doi.org/10.1007/s12012-018-9459-xDOI Listing
October 2018

Does Garlic Supplementation Control Blood Pressure in Patients with Severe Coronary Artery Disease? A Clinical Trial Study.

Iran Red Crescent Med J 2016 Nov 24;18(11):e23871. Epub 2016 Aug 24.

Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

Background: Hypertension is one of the major risk factors for cardiovascular morbidities, including coronary artery disease (CAD).

Objectives: With interest on the important role of hypertension in the progression of CAD, this study was designed to estimate the effect of garlic powder tablets on the blood pressure (BP) in patients with severe CAD.

Methods: A randomized, placebo-controlled, clinical trial was conducted on 56 CAD patients, aged 25 - 75 years old. The patients were randomly divided into two groups: Galois groups (n = 27), receiving garlic powder tablet (400 mg garlic) twice daily and the placebo groups (n = 29), receiving placebo for 3 months. The BP was assessed at baseline and at the end of the study.

Results: During the 3 months study, in the placebo group, systolic BP (SBP) increased with 6.3 mmHg and diastolic BP (DBP) increased with 4.6 mmHg, changes which were significant. After the 3 months, the effect of garlic on SBP, after adjusting for baseline value, was significant, and this effect was more significant in hypertensive patients. Plasma lipids and lipoproteins did not change significantly in either the garlic or placebo groups, during the study. Tolerability, compliance and acceptability were high in all patients.

Conclusions: These results demonstrate that treatment with garlic-based drugs can be an effective treatment for controlling BP in CAD patients and has no interaction with other drugs that CAD patients take. Therefore, it may be considered as a safe adjunct treatment for this group of patients.
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http://dx.doi.org/10.5812/ircmj.23871DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5292129PMC
November 2016

Mitral valve resistance determines hemodynamic consequences of severe rheumatic mitral stenosis and immediate outcomes of percutaneous valvuloplasty.

Echocardiography 2017 Feb 10;34(2):162-168. Epub 2017 Jan 10.

Department of Cardiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.

Introduction: The mitral valve area (MVA) poorly reflects the hemodynamic status of (MS). In this study, we compared the MVA with mitral valve resistance (MVR) with regard to the determination of hemodynamic consequences of MS and the immediate outcomes of percutaneous balloon mitral valvuloplasty (PBMV).

Methods: In a prospective study, 36 patients with severe rheumatic MS with left ventricular ejection fraction (LVEF) >50% were evaluated. They underwent transthoracic echocardiography (TTE) and catheterization. The MVA was measured by two-dimensional planimetry and pressure half-time (PHT), and the MVR was calculated using the equation: 1333 × transmitral pressure gradient mean transmitral diastolic flow rate.

Results: The patients' mean age was 47.8±10.5 years. MVR ≥140.6 dynes·s/cm detected systolic pulmonary arterial pressure (sPAP) >55 mm Hg with a sensitivity of 100% and a specificity of 74%. The sensitivity and specificity of MVA<0.75 cm to discriminate elevated sPAP were 81% and 89%, respectively. PHT ≥323.5 mseconds had a sensitivity of 78% and a specificity of 96% to detect an elevated sPAP. To predict a successful PBMV, preprocedural MVR ≥106.1 dynes·s/cm had a sensitivity of 100% and a specificity of 67% (area under the curve [AUC]=0.763; 95% confidence interval [CI]=0.520-1.006; P=.034); preprocedural MVA <0.95 cm had a sensitivity of 78% and a specificity of 73% (AUC=0.730; 95% CI=0.503-0.956; P=.065); and preprocedural PHT ≥210.5 mseconds had a sensitivity of 73% and a specificity of 78% (AUC=0.707; 95% CI=0.474-0.941; P=.095).

Conclusions: MVR seems to be more accurate than MVA in determining the hemodynamic consequences of severe MS as determined by sPAP. In addition, preprocedural MVR detected successful PBMVs.
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http://dx.doi.org/10.1111/echo.13448DOI Listing
February 2017

Intracoronary versus Intravenous eptifibatide during percutaneous coronary intervention for acute ST-segment elevation myocardial infarction; a randomized controlled trial.

Cardiovasc Interv Ther 2017 Oct 17;32(4):351-357. Epub 2016 Aug 17.

Cardiovascular Intervention Research Center, Rajaei Cardiovascular Medical and Research Center; Iran University of Medical Sciences, Vali-Asr Ave., Niyayesh Blvd., Tehran, 1996911101, Iran.

Although aspirin and clopidogrel seem to be quite enough during low risk percutaneous coronary intervention (PCI), the combination may need some reinforcement in complex situations such as primary PCI. By modifying the route and also the duration of administration, glycoprotein IIb/IIIa inhibitors might be a viable option. The aim of this study is to compare the benefits and disadvantages of three different methods of administration of eptifibatide in primary PCI population. Primary PCI candidates were randomized in three groups on which three different methods of administration of eptifibitide were tested: intravenous bolus injection followed by 12-h infusion (IV-IV), intracoronary bolus injection followed by intravenous infusion (IC-IV) and, only intracoronary bolus injection (IC). 99 patients were included in the present study. There was no significant difference among the three groups regarding all cause in hospital and one month mortality (p value = 0.99), re-myocardial infarction (p value = 0.89), post-PCI TIMI flow grade 3 (p value = 0.97), ST segment resolution (p value = 0.77) and peak troponin levels (p value = 0.82). The comparison of vascular access and major bleeding complications were not possible due to low events rate. By modifying the route of administration of eptifibitide, the clinical effect might be preserved without increasing the short-term mortality and procedural failure.
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http://dx.doi.org/10.1007/s12928-016-0418-9DOI Listing
October 2017

In-hospital and six-month outcomes of elderly patients undergoing primary percutaneous coronary intervention for acute ST-elevation myocardial infarction.

ARYA Atheroscler 2016 Jan;12(1):28-34

Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.

Background: Elderly patients constitute a rapidly growing proportion of the population, and hence the increasing rises in the number of patients with ST-segment-elevation myocardial infarction (STEMI). Primary percutaneous coronary intervention (PCI), which is now established as the preferred reperfusion strategy in STEMI patients, has been inadequately investigated in this high-risk group. The aim of the present study was to investigate the in-hospital and 6-month outcomes of primary PCI in elderly patients (≥ 75 years) with STEMI.

Methods: A total of 100 elderly patients with STEMI including those with cardiogenic shock were included. Primary PCI procedures were performed in a tertiary referral center between 2009 and 2014. In-hospital and 6-month outcomes of patients were recorded and analyzed.

Results: The average age of the patients was 79.6 ± 3.8 years (range = 75-90 years) and 27.0% were women. Cardiovascular risk factors and prior events were common. Nearly, half of the patients had three-vessel disease and the left anterior descending artery (LAD) was the most common infarct-related artery. The presence of cardiogenic shock but not the other variables was associated with less anatomic and procedural success (P < 0.001). It was also the major independent predictors of 6-month mortality in the patients aged ≥ 75 years, [hazard ratio (HR) = 8.02; 95% confidence interval (CI): 1.75-25.97, P < 0.001]. In-hospital mortality was 2.4% in the patients without and 83.0% in those with cardiogenic shock.

Conclusion: Primary PCI in aged patients could be associated with low complication rates and improved survival if performed in high-volume centers with experienced operators. Considering the very high rate of mortality in patients with cardiogenic shock, there should be measures to treat these patients before the onset of hemodynamic instability.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4834178PMC
January 2016

The Effects of Side Branch Predilation During Provisional Stenting of Coronary Bifurcation Lesions: A Double-Blind Randomized Controlled Trial.

Res Cardiovasc Med 2016 May 5;5(2):e31378. Epub 2016 Mar 5.

Centers of Excellence Secretariat, Ministry of Health and Education of Iran, Tehran, IR Iran.

Background: There is a paucity of data regarding the role of side branch (SB) predilation during the provisional stenting of bifurcation lesions.

Objectives: The present study aimed to assess the effects of SB predilation on the outcomes of true bifurcation interventions.

Patients And Methods: Sixty patients with true bifurcation lesions according to the Medina classification were included in the study and randomly assigned to receive SB predilation before stenting the main branch (n = 30) or no predilation as the control group (n = 30).

Results: There was a trend toward the higher occurrence of dissection in the predilated ostial lesions of the SB compared to the non-predilated group (16.7% vs. 0, P = 0.07). Performance of the SB predilation was not associated with improved flow of the SB or fewer degrees of ostial stenosis after stenting the main branch, the need to rewire, rewiring time, or the rate of use of the final kissing balloon dilation and double stents procedures.

Conclusions: Routine predilation of the SB in provisional stenting of true bifurcation lesions seems to be ineffective and might be associated with some undesirable consequences. Still, there are some complex ostial lesions of the SB which could benefit from predilation.
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http://dx.doi.org/10.5812/cardiovascmed.31378DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4756256PMC
May 2016

Coronary Slow Flow Phenomenon Clinical Findings and Predictors.

Res Cardiovasc Med 2016 Feb 2;5(1):e30296. Epub 2016 Jan 2.

Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

Background: In some patients with chest pain, selective coronary angiography reveals slow contrast agent passage through the epicardial coronary arteries in the absence of stenosis. This phenomenon has been designated the slow coronary flow (SCF) phenomenon.

Objectives: In this study, we aimed to describe the demographic and clinical findings and presence of common atherosclerosis risk factors in patients with the SCF phenomenon.

Patients And Methods: Between October 2014 and March 2015, demographic data, clinical histories, atherosclerosis risk factors, and laboratory and angiographic findings were recorded for all consecutive patients scheduled for coronary angiography and diagnosed with the SCF phenomenon, as well as a control group (patients with normal epicardial coronary arteries; NECA). SCF was diagnosed based on the thrombolysis in myocardial infarction frame count (TFC). A TFC > 27 indicated a diagnosis of SCF phenomenon.

Results: Among the 3600 patients scheduled for selective coronary angiography, 75 (2%) met the SCF criteria. SCF and NECA patients did not exhibit statistically significant differences in traditional risk factors except for hypertension, which was more prevalent in SCF than NECA patients (52% versus 31%, P = 0.008). A multivariable analysis indicated a low body mass index, presence of hypertension, low high-density lipoprotein cholesterol (HDL-c) level, and high hemoglobin level as independent predictors of the SCF phenomenon; of these, hypertension was the strongest predictor (odds ratio = 6.3, 95% confidence interval: 2.2 - 17.9, P = 0.001).

Conclusions: The SCF phenomenon is relatively frequent, particularly among patients with acute coronary syndrome who are scheduled for coronary angiography. Hypertension, a low HDL-c level, and high hemoglobin level can be considered independent predictors of this phenomenon.
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http://dx.doi.org/10.5812/cardiovascmed.30296DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4752610PMC
February 2016

Comparison of outcomes of diseased coronary arteries ectasia, stenosis and combined.

Res Cardiovasc Med 2015 Feb 20;4(1):e25206. Epub 2015 Jan 20.

Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

Background: Coronary artery ectasia (CAE) is a localized or diffuse abnormal dilatation of coronary arteries. Controversy still remains about its cardiovascular events rate, prognosis, and etiology. Adverse effects of CAE coinciding with coronary artery stenosis (CAS) (and in isolated form) are unclear.

Objectives: We aimed to investigate the cardiovascular event rate of CAE in comparison to 'CAS only', and comparing their etiology.

Patients And Methods: This cross-sectional study was conducted on 200 patients between May 2011 and June 2012. Of them, 40 had CAE (case group) and 160 had only CAS (control group). Patients with CAE were divided into 2 subgroups according to the absence (E1) or presence (E2) of CAS. They were followed up for at least 6 month for cardiovascular events, including death, unstable angina and myocardial infarction (MI). Finally, we compared findings in CAE, CAS, and E1 and E2 subgroups and evaluated the relationship between severity of ectasia (1-1.5 times, 1.5-2 times, and > 2 times) and CAS.

Results: Hypertension (HTN), dyslipidemia (DLP), and male sex were matched in both groups without significant difference. Cigarette smoking (C/S) was significantly higher and diabetes mellitus (DM) was significantly lower in CAE compared to CAS patients. A subgroup of CAE patients with CAS (E2 subgroup) had significantly higher mortality rate than isolated CAS (P = 0.043). MI was seen in several isolated CAE patients (E1) subgroup. Severity of ectasia showed no significant relationship with CAS.

Conclusions: Presence of CAE in patients with CAS increases its cardiovascular event rate. Isolated CAE is not a benign finding and MI can occur. Risk factors of CAE are similar to CAS, but C/S is more associated with CAE than CAS. DM is seen in CAE patients less than CAS.
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http://dx.doi.org/10.5812/cardiovascmed.25206DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4350184PMC
February 2015

Effect of garlic powder tablet on carotid intima-media thickness in patients with coronary artery disease: a preliminary randomized controlled trial.

Nutr Health 2013 Apr 8;22(2):143-55. Epub 2015 Jan 8.

Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Background/objectives: This study was designed to investigate whether garlic powder tablets in adjunct to conventional medical treatment could have an effect on carotid intima-media thickness (CIMT) and plasma lipoproteins and lipids in patients with coronary artery disease (CAD).

Subjects/methods: A randomized, placebo-controlled, clinical trial was conducted on 56 patients with CAD between the ages of 25 and 75 years. The patients were randomly divided into two groups: garlic group (n = 27), receiving garlic powder tablet (1200 µg allicin/tab) twice daily and the placebo group (n = 29), receiving placebo for 3 months. The rate of atherosclerosis progression was measured by B-mode ultrasonography as the increase in CIMT.

Results: After 3 months of taking garlic tablets, CIMT values had minor variations (0.009 ± 0.007 mm reduction from baseline), while in the placebo group, an increase in CIMT values was observed (0.04 ± 0.01 mm increase from baseline). After 3 months of treatment, mean CIMT difference from baseline was significantly differ between the two groups (p < 0.001). Plasma lipids and lipoproteins (total cholesterol, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, Apolipoprotein A1 and Apolipoprotein B) did not differ between the two groups.

Conclusions: The results suggest that dry garlic powder tablet is superior to placebo in prevention of CIMT progression in patients with CAD and may be considered as an adjunct treatment for atherosclerosis.
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http://dx.doi.org/10.1177/0260106014563446DOI Listing
April 2013

Intravenous magnesium sulfate: new method in prevention of contrast-induced nephropathy in primary percutaneous coronary intervention.

Int Urol Nephrol 2015 Mar 5;47(3):521-5. Epub 2014 Dec 5.

Department of Interventional Cardiology, Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.

Background: Contrast-induced acute kidney injury (CI-AKI) is an adverse consequence of percutaneous coronary interventions which results in significant morbidity and mortality and adds to the costs of diagnostic and interventional cardiology procedures. Various pathophysiological mechanisms have been proposed for CI-AKI and various agents tested for its prevention. There is currently a general agreement that adequate pre-procedural hydration constitutes the cornerstone of prevention, yet there are reports of the use of some other agents with various efficacies. We prospectively tested IV magnesium sulfate (Mg) for CI-AKI prevention.

Method And Design: This study is a prospective, randomized, open-labeled, single-center clinical trial. We randomly assigned 122 consecutive patients to two groups. The first group was the control group with routine treatment (n = 64), and second group was the study group with routine treatment plus IV magnesium sulfate 1 g just before the procedure (n = 62). Serum creatinine was measured before the procedure and 2 days after the procedure. The primary end point was the occurrence of CI-AKI within 48 h. CI-AKI was defined as 0.5 mg/dl or more increase in serum creatinine or 25% or more increase above baseline serum creatinine. There was no difference in definition if both of these parameters were present.

Results: The control and study groups were comparable in the overall predicted risk of CI-AKI. Also, the type and volume of the contrast were not significantly different between the two groups. Following angioplasty, CI-AKI occurred in 17 (26.6%) patients in the control group and nine (14.5%) patients in the study group; there was a significant reduction in CI-AKI in the study group (P = 0.01). Additionally, there was no mortality or a need for hemodialysis in either group.

Conclusion: In primary PCI patients, the prophylactic use of intravenous Mg can be recommended to be added to traditional hydration for CI-AKI prevention.
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http://dx.doi.org/10.1007/s11255-014-0890-zDOI Listing
March 2015

Risk Factors of Reperfusion Failure following Primary Angioplasty for ST-Segment Elevation Myocardial Infarction (STEMI).

J Tehran Heart Cent 2013 Jul 30;8(3):146-51. Epub 2013 Jul 30.

Cardiovascular Intervention Research Center, Shaheed Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.

Background: Although percutaneous coronary intervention (PCI) improves outcomes compared to thrombolysis, a substantial number of ST-elevation myocardial infarction (STEMI) patients do not achieve optimal myocardial reperfusion. This study was designed to evaluate factors related to suboptimal myocardial reperfusion after primary PCI in patients with STEMI.

Methods: Totally, 155 patients (124 men; mean age = 56.6 ± 11.03 years, range = 31- 85 years) with STEMI undergoing primary PCI were retrospectively studied. Additionally, the relationships between the occurrence of reperfusion failure and variables such as age, sex, cardiac risk factors, family history, Body Mass Index, time of symptom onset, ejection fraction, previous PCI, coronary artery bypass graft surgery or previous myocardial infarction, and angiographic data were analyzed.

Results: Procedural success was 97.1% and complete ST resolution occurred in 43.2%. Age; cardiac risk factors; family history; body mass index; previous MI, coronary artery bypass graft surgery, or PCI; and use of thrombectomy device and GPIIb/IIIa inhibitor were not the determining factors (p value > 0.05). According to our multivariate analysis, time of symptom onset (OR [95% CI]: 045 [0.2 to 0.98]; p value = 0.044) and ejection fraction (OR [95% CI]:0.37 [0.26 to .091]; p value = 0.050) had reverse and male gender had direct significant associations with failed reperfusion (OR [95% CI]: 0.34 [0.11 to 1.08]; p value = 0.068). More degrees of ST resolution occurred when the right coronary artery was the culprit vessel (p value = 0.001). The presence of more than three cardiac risk factors was associated with failed reperfusion (p value = 0.050).

Conclusion: Considering the initial risk profile of patients with acute STEMI, including time of symptom onset and ejection fraction, as well as the accumulation of cardiac risk factors in a given patient, we could predict failed myocardial reperfusion to design a more aggressive therapeutic strategy.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874374PMC
July 2013

Difficult management of coronary artery disease in a patient with thrombotic thrombocytopenic purpura.

J Tehran Heart Cent 2014 3;9(3):140-2. Epub 2014 Jul 3.

Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.

Thrombotic thrombocytopenic purpura (TTP) is a rare syndrome affecting multiple organs. There is no sufficient evidence regarding the clinical cardiac manifestations of TTP. Nonetheless, pathologic cardiac involvement is quite frequent in acute TTP, which is predominantly manifested as myocardial necrosis due to coronary arteriolar microthrombosis. The present case report describes a 43-year-old man with long-standing remitted TTP, who suffered from a sequence of refractory thrombotic epicardial coronary events. Aggressive medical and interventional therapies, including long-term dual antiplatelets and coronary angioplasty, were finally successful in remitting the thrombotic events. During his two-year follow up, he has been asymptomatic.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4393839PMC
April 2015

Intracoronary adenosine to prevent myonecrosis in patients with stable angina undergoing percutaneous interventions: a double-blinded randomized controlled trial.

J Tehran Heart Cent 2013 Jan 8;8(1):28-34. Epub 2013 Jan 8.

Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical and Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Background: Significant elevation of cardiac biomarkers after percutaneous coronary intervention (PCI) is associated with increased mortality. However, clinical importance of lesser degrees of cardiac enzyme elevation has not been well understood. Multiple factors might have an etiologic role, and the incidence of myonecrosis has not changed dramatically despite pharmacological and technological advances in PCI. The aim of this study was to evaluate the role of intracoronary (IC) Adenosine in preventing the elevation of cardiac enzymes as a marker of myonecrosis after PCI in patients with chronic stable angina.

Methods: Two hundred sixty patients with chronic stable angina who were candidates for PCI were randomly assigned to double-blinded pretreatment with IC Adenosine or placebo before crossing of the guide wire. The patients were observed during the hospital course, and blood samples were obtained in standard intervals after the intervention for cardiac biomarkers. The primary end point of this study was post-PCI myonecrosis, and secondary end point was safety of IC Adenosine administration in the setting of PCI in patients with chronic stable angina.

Results: Of the 260 patients, who were initially randomized, finally 83 patients were analyzed in the placebo and 96 in the Adenosine arms. The study patients were comparable in clinical and angiographic characteristics. The mean of the patients' age was 57.3 years (range = 35 to 79 years), and 71.5% were male. There were no differences in the mean serum cardiac biomarkers between the study groups (mean creatine kinase-MB [CK.MB] level of 29.5 ± 14.5 IU/L in the placebo group and 31.5 ± 18.5 IU/L in the control group; p value = 0.41; mean cardiac troponin I (cTnI) level of 0.097 ± 0.178 μg/L in the placebo group and 0.167 ± 0.5 μg/L in the control group; p value = 0.24).

Conclusion: Despite promising results in primary PCI, our study showed that a strategy of IC Adenosine pretreatment is not beneficial in reducing post-PCI myonecrosis in patients with chronic stable angina and should not be routinely used.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3587671PMC
January 2013