Publications by authors named "Armin Attar"

46 Publications

Association of coronary artery dominance and mortality rate and complications in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention.

J Res Med Sci 2020 26;25:107. Epub 2020 Nov 26.

Department of Cardiovascular Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Percutaneous coronary intervention (PCI) is the treatment of choice for patients with ST-segment elevation myocardial infarction (STEMI). Effect of coronary artery dominance on the patients' outcome following primary PCI (PPCI) is not fully investigated. We investigated the association of coronary artery dominance with complications and 1-year mortality rate of PPCI.

Materials And Methods: In this retrospective study, patients with STEMI treated with PPCI from March 2016 to February 2018 were divided into three groups based on their coronary dominancy: left dominance (LD), right dominance (RD), and codominant. Demographic characteristics, medical history, results of physical examination, electrocardiography, angiography, and echocardiography were compared between the groups.

Results: Of 491 patients included in this study, 34 patients (7%) were LD and 22 patients (4.5%) were codominant. Accordingly, 54 propensity-matched RD patients were included in the analysis. The demographics and comorbidities of the three groups were not different ( > 0.05); however, all patients in the RD group had thrombolysis in myocardial infarction (TIMI) 3, while five patients in the LD and five patients in the codominant group had a TIMI ≤2 ( = 0.006). At admission, the median left ventricular ejection fraction (LVEF) was highest in RD patients and lowest in LD and codominant patients (34%, = 0.009). There was no difference in terms of success or complications of PCI, in-hospital, and 1-year mortality rate ( > 0.05).

Conclusion: Patients with left coronary artery dominance had a higher value of indicators of worse outcomes, such as lower LVEF and TIMI ≤ 2, compared with RD patients, but not different rates of success or complications of PCI, in-hospital, and 1-year mortality. This finding may suggest that interventionists should prepare themselves with protective measures for no-reflow and slow-flow phenomenon and also mechanical circulatory support before performing PPCI in LD patients.
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http://dx.doi.org/10.4103/jrms.JRMS_414_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8019104PMC
November 2020

PCSK9 inhibitors: Going forward and beyond.

Authors:
Armin Attar

Eur J Prev Cardiol 2020 Apr 2. Epub 2020 Apr 2.

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http://dx.doi.org/10.1177/2047487320916964DOI Listing
April 2020

Response to statin therapy in the real world.

Authors:
Armin Attar

Eur J Prev Cardiol 2020 Feb 5. Epub 2020 Feb 5.

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http://dx.doi.org/10.1177/2047487320905718DOI Listing
February 2020

J-shaped relationship between cardiovascular risk and efficacy of intensive blood pressure reduction: A post-hoc analysis of the SPRINT trial.

PLoS One 2020 1;15(10):e0240102. Epub 2020 Oct 1.

Cardiovascular Research Center, TAHA Clinical Trial Group, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: In the 2017 ACC/AHA hypertension guidelines, a 10-year risk of more than 10% is considered for initiation of intensive blood pressure reduction. The current study aimed to determine which cut off limit of cardiovascular risk for starting intensive blood pressure reduction is beneficial.

Design: A Secondary Analysis of Systolic Blood Pressure Intervention Trial (SPRINT).

Methods: Data from the SPRINT Trial was obtained from the NHLBI Data Repository Center. In the SPRINT, non-diabetic participants with SBP of ≥ 130 mmHg were randomly assigned to intensive and standard treatment arms with SBP targets of < 120 and < 140 mmHg, respectively. This study analyzed data from non-diabetic participants less than 75 years of age without cardiovascular or chronic kidney disease. The primary composite outcome was myocardial infarction, and other acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes. Cox regression models were used to examine the risk of the occurrence of the SPRINT primary composite outcome. To identify the relationship between BP values and the log hazards, natural cubic spline functions were performed.

Results: In the analysis, 4292 patients were enrolled. The results demonstrated a clear J-shaped relationship between the effect of intensive blood pressure control and the risk of CVD events and 10-year Framingham cardiovascular risk levels at a cut-off limit of approximately <7%.

Conclusions: This post-hoc secondary analyses of the SPRINT trial showed that a cut off value of more than 7% may be useful in selecting patients suitable for initiation of blood pressure reduction.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0240102PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7529282PMC
December 2020

Pharmacological treatment of high-normal blood pressure (prehypertension) in high-risk patients for primary prevention of cardiovascular events.

J Clin Hypertens (Greenwich) 2020 09 20;22(9):1627-1634. Epub 2020 Aug 20.

Department of Cardiovascular Medicine, TAHA Clinical Trial Group, Shiraz University of Medical Sciences, Shiraz, Iran.

Currently, the best treatment strategy for patients with a high-normal blood pressure (prehypertension) is not known. The authors aimed to determine whether pharmacological reduction of systolic blood pressure (SBP) to a normal level (<120 mm Hg) would prevent cardiac morbidity and mortality in prehypertensive patients. In this secondary analysis, the authors obtained the data from SPRINT from the National Heart, Lung, and Blood Institute data repository center. Among 9361 patients enrolled in SPRINT, 289 high-risk (ASCVD risk = 24.8% ± 13.0 [10-65]) prehypertensive patients without previous cardiovascular disease and not receiving any antihypertensive medications were enrolled. One hundred and forty-eight of them were assigned to standard treatment which consisted of clinical follow-up till SBP goes above 140 mm Hg and then staring medications to keep SBP <140 mm Hg. One hundred and forty-one were assigned to the intensive treatment receiving pharmacological SBP reduction to <120 mm Hg upon enrollment. The primary composite outcome was myocardial infarction, and other acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes. Throughout the 3.06 years of follow-up, a primary outcome event was confirmed in three participants (0.74% per year) in the intensive-treatment group and 8 (1.61% per year) in the standard-treatment group (hazard ratio [HR], 0.19; P = .045). Rates of serious adverse events were not increased by intensive-treatment (HR, 0.83; P = .506). Based on this secondary post hoc analysis, intensive SBP reduction may probably be beneficial for primary prevention of cardiovascular morbidity and mortality in high-risk prehypertensive patients. This finding needs to be evaluated in a larger trial designed specifically to answer this question.
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http://dx.doi.org/10.1111/jch.13994DOI Listing
September 2020

Expression Pattern of Telomerase Reverse Transcriptase (hTERT) Variants and Bcl-2 in Peripheral Lymphocytes of Systemic Lupus Erythematosus Patients.

Iran J Pathol 2020 21;15(3):225-231. Epub 2020 Apr 21.

Department of Immunology, Shiraz University of Medical Sciences, Shiraz, Iran.

Background & Objective: It is not clear whether activated lymphocytes of patients with systemic lupus erythematosus (SLE) are more proliferative or less apoptotic. We aimed to delineate potential differences between B and T cells of SLE patients compared to healthy controls regarding the telomerase activity and apoptosis status.

Methods: In this cross-sectional case control study, Blood samples were taken from 10 SLE patients and 10 healthy controls. B and T cells were separated using magnetic cell sorting system. Telomeric repeat amplification protocol (TRAP) assay and real-time PCR were used to determine the telomerase activity and the expression of alternatively spliced variants.

Results: Four patients under treatment showed significant telomerase activity in their T cells. Four of the newly diagnosed patients showed telomerase activity in their B cells (20% of all patients and 40% of new onset patients). There was no specific pattern of human telomerase reverse transcriptase variant expression within the patients' lymphocytes. A significantly reduced expression of was detected in B cells (=0.018) and a trend toward lower expression in T cells was seen in SLE patients compared to healthy controls.

Conclusion: Although not definitive, our results may suggest that B cells may have more active roles during the earlier phases of the disease attack, while T cells take over when the disease reaches its chronic stages.
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http://dx.doi.org/10.30699/ijp.2020.110994.2187DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7354072PMC
April 2020

Global longitudinal strain for prediction of ventricular arrhythmia in patients with heart failure.

ESC Heart Fail 2020 10 25;7(5):2956-2961. Epub 2020 Jul 25.

Department of Cardiovascular Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.

Aims: Currently, the ejection fraction [left ventricular ejection fraction (LVEF)] is the main criterion used for implanting implantable cardioverter defibrillators (ICDs) for primary prevention. However, many of ICD receivers would not have an event and do not have any gains from the device. Consequently, improving the discrimination strategies is needed. Here, we aimed at assessing the role of global longitudinal strain (GLS) for such purpose.

Methods And Results: Seventy ischaemic or dilated cardiomyopathy cases characterized by LVEF ≤ 40% with a previously implanted ICD were enrolled. LVEF and GLS amounts were evaluated using 3D echocardiography. The occurrence of ventricular arrhythmias was checked by analysing the ICD history. Mean follow-up period of patients was 1.8 ± 0.6 years. There was a significant difference in the amount of GLS in arrhythmic cases compared with non-arrhythmic ones (-6.97 ± 3.06 vs -11.82 ± 4.25; P < 0.001). This difference was found in both ischaemic and dilated cardiomyopathy groups. A GLS below -10 cm/s could predict the occurrence of a ventricular event by 90% specificity and 72.2% sensitivity (area under the curve = 0.84, P < 0.001). While 27.39 (69.2%) patients with GLS below -10 cm/s had a ventricular event, only 3.31 (9.6%) of the patients with GLS above -10 had an event) P < 0.001). Those patients with a GLS ≥ 17 cm/s never experienced a ventricular arrhythmia.

Conclusions: Global longitudinal strain is a more accurate predictor of ventricular arrhythmias in patients with reduced LVEF. Whether it may help in selecting more appropriate patients for ICD implantation or not should be evaluated within a randomized trial in the future.
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http://dx.doi.org/10.1002/ehf2.12910DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7524120PMC
October 2020

Management of COVID-19 in people with epilepsy: drug considerations.

Neurol Sci 2020 Aug 27;41(8):2005-2011. Epub 2020 Jun 27.

Department of Clinical Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran.

People with epilepsy (PWE) are neither more likely to be infected by the coronavirus nor are they more likely to have severe COVID-19 manifestations because they suffer from epilepsy. However, management of COVID-19 in PWE may be more complicated than that in other individuals. Drug-drug interactions could pose significant challenges and cardiac, hepatic, or renal problems, which may happen in patients with severe COVID-19, may require adjustment to antiepileptic drugs (AEDs). In this review, we first summarize the potential drug-drug interactions between AEDs and drugs currently used in the management of COVID-19. We then summarize other challenging issues that may happen in PWE, who have COVID-19 and are receiving treatment.
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http://dx.doi.org/10.1007/s10072-020-04549-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7320844PMC
August 2020

Improved Landmark Dynamic Prediction Model to Assess Cardiovascular Disease Risk in On-Treatment Blood Pressure Patients: A Simulation Study and Post Hoc Analysis on SPRINT Data.

Biomed Res Int 2020 22;2020:2905167. Epub 2020 Apr 22.

Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.

Landmark model (LM) is a dynamic prediction model that uses a longitudinal biomarker in time-to-event data to make prognosis prediction. This study was designed to improve this model and to apply it to assess the cardiovascular risk in on-treatment blood pressure patients. A frailty parameter was used in LM, landmark frailty model (LFM), to account the frailty of the patients and measure the correlation between different landmarks. The proposed model was compared with LM in different scenarios respecting data missing status, sample size (100, 200, and 400), landmarks (6, 12, 24, and 48), and failure percentage (30, 50, and 100%). Bias of parameter estimation and mean square error as well as deviance statistic between models were compared. Additionally, discrimination and calibration capability as the goodness of fit of the model were evaluated using dynamic concordance index (DCI), dynamic prediction error (DPE), and dynamic relative prediction error (DRPE). The proposed model was performed on blood pressure data, obtained from systolic blood pressure intervention trial (SPRINT), in order to calculate the cardiovascular risk. Dynpred, coxme, and coxphw packages in the R.3.4.3 software were used. It was proved that our proposed model, LFM, had a better performance than LM. Parameter estimation in LFM was closer to true values in comparison to that in LM. Deviance statistic showed that there was a statistically significant difference between the two models. In the landmark numbers 6, 12, and 24, the LFM had a higher DCI over time and the three landmarks showed better performance in discrimination. Both DPE and DRPE in LFM were lower in comparison to those in LM over time. It was indicated that LFM had better calibration in comparison to its peer. Moreover, real data showed that the structure of prognostic process was predicted better in LFM than in LM. Accordingly, it is recommended to use the LFM model for assessing cardiovascular risk due to its better performance.
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http://dx.doi.org/10.1155/2020/2905167DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7195630PMC
February 2021

Differential expression of drug resistance genes in CD146 positive dental pulp derived stem cells and CD146 negative fibroblasts.

Clin Exp Dent Res 2020 08 7;6(4):448-456. Epub 2020 May 7.

Oral and Dental Disease Research Center, Department of Operative Dentistry, School of Dentistry, Shiraz Universityof Medical Sciences, Shiraz, Iran.

Introduction: The stem cell portion of the dental pulp derived cultures (DPSCs) showed a higher resistance to cytotoxic effect of restorative dental materials compared to pulpal fibroblasts (DPFs). Here, we aimed to compare the expression of some drug resistant genes between these cells.

Methods And Materials: To separate DPSCs from DPFs, we used magnetic cell sorting technique based on CD146 expression. To assess the stem cell properties, the positive and negative portions underwent colony forming assays and were induced to be differentiated into the adipocytes, osteoblasts, hepatocytes, and neural cells. Cell surface antigen panels were checked using immune fluorescence and flow-cytometry techniques. The mRNA expression of 14 ABC transporters including ABCA2, ABCB1, ABCB11, ABCC1, ABCC2, ABCC3, ABCC4, ABCC5-2, ABCC5-4,ABCC5-13, ABCC6, ABCC10, ABCC11, and ABCG2 genes was assessed, using quantitative RT-PCR technique.

Results: Only the CD146 positive portion could be differentiated into the desired fates, and they formed higher colonies (16.7 ± 3.32 vs. 1.7 ± 1.67, p < .001). The cell surface antigen panels were the same, except for CD146 and STRO-1 markers which were expressed only in the positive portion. Among the ABC transporter genes studied, the positive portion showed a higher expression (approximately two-fold) of ABCA2, ABCC5-13, and ABCC5-2 genes.

Conclusion: Dental pulp stem cells which can be separated from dental pulp fibroblasts based on CD146 expression, express higher levels of some drug resistance genes which probably accounts for their features of more resistance to cytotoxic effects of some dental materials. This needs to be more validated in future.
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http://dx.doi.org/10.1002/cre2.297DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7453779PMC
August 2020

PCSK9 inhibitors: Going forward and beyond.

Authors:
Armin Attar

Eur J Prev Cardiol 2020 Apr 1:2047487320916964. Epub 2020 Apr 1.

Department of Cardiovascular Medicine, TAHA clinical Trial Group, Shiraz University of Medical Sciences, Iran.

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http://dx.doi.org/10.1177/2047487320916964DOI Listing
April 2020

Response to statin therapy in the real world.

Authors:
Armin Attar

Eur J Prev Cardiol 2020 Feb 4:2047487320905718. Epub 2020 Feb 4.

Department of Cardiovascular Medicine, TAHA Clinical Trial Group, Shiraz University of Medical Sciences, Iran.

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http://dx.doi.org/10.1177/2047487320905718DOI Listing
February 2020

AICAR and nicotinamide treatment synergistically augment the proliferation and attenuate senescence-associated changes in mesenchymal stromal cells.

Stem Cell Res Ther 2020 02 3;11(1):45. Epub 2020 Feb 3.

Department of Cardiovascular Medicine, Shiraz University of Medical Sciences, PO Box 71344-1864, Shiraz, Iran.

Background: Mesenchymal stromal cell (MSC) stemness capacity diminishes over prolonged in vitro culture, which negatively affects their application in regenerative medicine. To slow down the senescence of MSCs, here, we have evaluated the in vitro effects of 5-aminoimidazole-4-carboxamide ribonucleotide (AICAR), an AMPK activator, and nicotinamide (NAM), an activator of sirtuin1 (SIRT1).

Methods: Human adipose-derived MSCs were cultured to passage (P) 5. Subsequently, the cells were grown in either normal medium alone (control group), the medium supplemented with AICAR (1 mM) and NAM (5 mM), or in the presence of both for 5 weeks to P10. Cell proliferation, differentiation capacity, level of apoptosis and autophagy, morphological changes, total cellular reactive oxygen species (ROS), and activity of mTORC1 and AMPK were compared among different treatment groups.

Results: MSCs treated with AICAR, NAM, or both displayed an increase in proliferation and osteogenic differentiation, which was augmented in the group receiving both. Treatment with AICAR or NAM led to decreased expression of β-galactosidase, reduced accumulation of dysfunctional lysosomes, and characteristic morphologic features of young MSCs. Furthermore, while NAM administration could significantly reduce the total cellular ROS in aged MSCs, AICAR treatment did not. Moreover, AICAR-treated cells possess a high proliferation capacity; however, they also show the highest level of cellular apoptosis. The observed effects of AICAR and NAM were in light of the attenuated mTORC1 activity and increased AMPK activity and autophagy.

Conclusions: Selective inhibition of mTORC1 by AICAR and NAM boosts autophagy, retains MSCs' self-renewal and multi-lineage differentiation capacity, and postpones senescence-associated changes after prolonged in vitro culture. Additionally, co-administration of AICAR and NAM shows an additive or probably a synergistic effect on cellular senescence.
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http://dx.doi.org/10.1186/s13287-020-1565-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6998366PMC
February 2020

A novel ECG criterion to differentiate left from right ventricular outflow tract premature complex.

Scand Cardiovasc J 2020 Jun 21;54(3):139-145. Epub 2019 Nov 21.

Department of Cardiovascular Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.

. Catheter ablation is an effective method in the treatment of idiopathic ventricular arrhythmias. The mapping methods used for predicting the original site of arrhythmias are difficult to use and time-consuming. Consequently, developing methods using surface ECG for guiding the location is important. Here, we have tested a new ECG criterion to differentiate the left from the right ventricular originated complexes (PVCs) or tachycardias (VTs). . Sixty patients with idiopathic PVC or VT who had undergone a successful radiofrequency catheter ablation (RFA) of arrhythmia were enrolled. The surface ECG during sinus rhythm and arrhythmia was analyzed. Initial r wave Surface Area (ISA) index was measured by multiplying the R wave duration in milliseconds by the R wave amplitude in terms of millivolt in V1 or V2 leads. . Thirty-seven patients with right ventricular (RVOT) and 23 with left ventricular outflow tract (LVOT) originated VT or PVC were enrolled. The ISA index was significantly greater in LVOT-VT/PVC compared to RVOTs (63.6 ± 78.9 8.3 ± 7.3,  < .001). With a cut off value of ≥15, the index could differentiate a left from right arrhythmia with 94.6% specificity and 78.2% sensitivity (Area on the curve, 0.81;  < .001). Compared to other previously reported indices, ISA is the most specific one. . ISA index can serve as a very useful ECG criterion for differentiating a LVOT- from RVOT-originated VTs or PVCs.
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http://dx.doi.org/10.1080/14017431.2019.1693616DOI Listing
June 2020

Effect of Chronic Kidney Disease on Cardiovascular Events: An Epidemiological Aspect from SPRINT Trial.

Iran J Kidney Dis 2019 09;13(5):328-336

Cardiovascular Research Center, TAHA Clinical Trial Group, Shiraz University of Medical Sciences, Shiraz, Iran.

Introduction: Currently, conflicting evidence exists among community-based studies as to whether Chronic kidney disease (CKD) is a Cardiovascular (CVD) risk equivalent. We aimed to evaluate the effect of CKD on CVD based on large trial results.

Methods: To perform a secondary analysis, we obtained the data of SPRINT trial from NHLBI Data Repository Center. 2646 subjects with baseline CKD and 6715 without CKD were enrolled. A composite of myocardial infarction, other acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes was considered as primary outcome.

Results: Throughout the 3.21 years of follow-up, presence of CKD, compared to those without CKD, negatively affected the primary outcome (incidence rate, 2.84% per year vs. 1.55% per year in patients with and without CKD, respectively; Hazard ratio, 1.83; 95% CI, 1.49 to 2.11; P<0.001). This finding was consistent across all the secondary outcomes. However, the risk was not as great as those with clinical cardiovascular disease (incidence rate, 4.13% per year). Presence of CKD was the strongest predictor of developing AKI with intensive blood pressure reduction, increasing its chance by 215%.

Conclusions: SPRINT is the first trial revealing that CKD is an independent risk factor for CVD. However, CKD could not be considered as a CVD risk equivalent. In the presence of CKD, with intensive blood pressure reduction the chance of AKI is dramatically increased.
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September 2019

Global longitudinal strain as an Indicator of cardiac Iron overload in thalassemia patients.

Cardiovasc Ultrasound 2019 Nov 4;17(1):24. Epub 2019 Nov 4.

Department of Cardiovascular Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.

Background And Objective: Cardiac involvement due to iron overload is the most common cause of morbidity and mortality in patients with thalassemia, and many patients remain asymptomatic until the late stages. Therefore, early detection of heart problems in such patients at subclinical stages can improve the prognosis of these patients. We investigated the role of speckled tracking (SI) and tissue Doppler echocardiography (TDI) in early detection of iron overload in these patients.

Methods: 52 thalassemic patients who were receiving regular blood transfusion with normal global LV function were examined by two- and three-dimensional echocardiography. Cardiac MRI was done and T2* images were considered as the non-invasive gold standard for evaluating cardiac iron deposition. Serum ferritin level was assessed and the relationships between serum ferritin levels and echo finding with cardiac MRI T was investigated.

Results: No significant relationship was seen between serum ferritin levels and cardiac MRI T. Among the echocardiographic findings, septal systolic myocardial velocity (P = 0.002 and r = 0.43) and global strain (GLS) (P = 0.000 and r = 0.60) were significantly associated with T. A GLS < 19.5 could predict a T level below 20 by 82.14% sensitivity and 86.36% specificity (area under the curve = 0.87; p < 0.0001).

Conclusion: While serum ferritin level and ejection fraction are not useful candidates, GLS may be used as a valuable marker to screen thalassemia patients for myocardial iron deposition, using a cut off value below - 19.5. This approach may facilitate the cardiac follow up, reduce the costs, and contribute to preventing deterioration of cardiac function in countries with limited availability of cardiac MRI.
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http://dx.doi.org/10.1186/s12947-019-0174-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6829819PMC
November 2019

Analgesia and sedation post-coronary artery bypass graft surgery: a review of the literature.

Ther Clin Risk Manag 2019 20;15:773-781. Epub 2019 Jun 20.

Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

This review aimed to study the role of analgesia and sedation after coronary artery bypass graft (CABG) surgery, regarding pain management, assisted respiration, overall postoperative health care, and hospitalization. Data were collected from Pubmed, Scopus, and Cochrane databases. The following terms were used for the search: "analgesia", "sedation", "coronary artery bypass grafting", CABG", and "opioids". Articles between the years 1988 and 2018 were evaluated. Several opioid and non-opioid analgesics used to relieve surgical pain are regarded as critical risk factors for developing pulmonary and cardiovascular complications in all kinds of thoracic surgery, especially CABG procedures. Effective pain management in post-CABG patients is largely dependent on effective pain assessment, type of sedatives and analgesics administered, and evaluation of their effects on pain relief. A significant challenge is to determine adequate amounts of administered analgesics and sedatives for postoperative CABG patients, because patients often order more sedatives and analgesics than needed. The pain management process is deemed successful when patients feel comfortable after surgery, with no negative side effects. However, postoperative pain management patterns have not included many modern methods such as patient-controlled analgesia, and postoperative pain management drugs are still limited to a restricted range of opioid and non-opioid analgesics.
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http://dx.doi.org/10.2147/TCRM.S195267DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6592068PMC
June 2019

Reduced myocardial reserve in cirrhotic patients: an evaluation by dobutamine stress speckle tracking and tissue Doppler imaging (TDI) echocardiography.

J Cardiovasc Thorac Res 2019 22;11(2):127-131. Epub 2019 Jun 22.

Department of Cardiovascular Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.

Despite the normal systolic function at rest, cirrhotic patients often suffer from volume overload and symptoms of heart failure as they face stressful situations. This study investigated the myocardial reserve in cirrhotic patients at resting condition and peak stress by dobutamine speckle tracking echocardiography (STE) and tissue Doppler imaging (TDI). Twenty cirrhotic patients and 10 normal individuals aged 30-50 were selected randomly. For all of the participants, complete echocardiographic study of 2D, STE and TDI was done at rest and peak stress status with dobutamine. The following parameters were assessed: ejection fraction (EF), global longitudinal LV strain (GLS), strain rate in the septal basal segment and lateral wall and E' in the septal basal segment by color-coded method. At baseline, EF was higher than 55% in both groups. GLS was higher (-22.6±2.4%) in the case group than the control group (-19.2±1.9%) at resting condition. After stress, it showed a greater increase (-22.5±1.7%) in the controls compared to cirrhotic patients (-22.6±3.3%; mean difference = 2.6 ± 2.03, = 0.02). In cirrhotic patients, the average strain rate in the basal septal segment decreased after stress (-1.2 ± 0.3/s to-1.1 ± 0.3/s), but it increased in the control group (-1.1 ± 0.2/s to -1.8 ± 0.2/s). Despite the presence of normal resting systolic function in cirrhotic patients, there was insufficient increase or even a decrease in myocardial function with stress; this may indicate the absence of sufficient myocardial reserve in cirrhotic patients. These findings would help to explain the reason for occurrence of heart failure or hemodynamic changes in cirrhotic patients.
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http://dx.doi.org/10.15171/jcvtr.2019.22DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6669429PMC
June 2019

Intra-aortic balloon pump postcardiac surgery: A literature review.

J Res Med Sci 2019 31;24. Epub 2019 Jan 31.

Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Intra-aortic balloon pump (IABP) has been the most commonly used mechanical assist circulatory device in many postcardiotomy low output disorders for decades. Mechanism of IABP is based on its inflation in time of the diastolic pressure in the aortic root resulting increase in the blood and oxygen amount of the coronary artery and its deflation in left ventricular afterload during the systolic period. Prophylactic and postoperative application of IABP has been suggested by researchers, which has been commonly used in high-risk patients undertaking coronary artery bypass grafting surgery or percutaneous coronary intervention. Other researchers put forward the idea of the percutaneous IABP insertion throughout the left axillary artery as a reliable and relatively well-tolerated approach and also as a recovery tool to bridge patients with end-stage heart failure to heart transplantation. The current review was aimed to give further insight into routine IABP application by presenting the basic principles and trends in the incidence, management, role of IABP recovery, and long-lasting mortality outcomes in patients with cardiovascular disorders and discussing previous and current evidence.
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http://dx.doi.org/10.4103/jrms.JRMS_199_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6383337PMC
January 2019

Almond oil for patients with hyperlipidemia: A randomized open-label controlled clinical trial.

Complement Ther Med 2019 Feb 19;42:33-36. Epub 2018 Oct 19.

Cardiovascular Research Center, TAHA clinical trial group, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. Electronic address:

Background: Cardiovascular diseases currently account for nearly half of non-communicable diseases. It was shown that enjoying a handful of nuts every day can significantly reduce the risk of developing heart diseases as they contain a variety of nutrients and other bioactive substances contributing to lowering the risk of heart diseases and controlling the cholesterol. The aim of this study was to determine the effect of almond oil on the lipid profile of patients with hyperlipidemia.

Methods: Ninety-seven patients were divided into the intervention (n = 49) and control (n = 48) groups. The intervention group received 10 ml of almond oil two times daily for 30 days. There was no intervention for the control group. The serum lipoproteins were measured before and after the study.

Results: The total cholesterol and LDL levels decreased significantly in the intervention group (treatment difference = -16.12 ± 26.16, P = 0.009; treatment difference = -20.88 ± 18.4, p < 0.001 respectively). But regular almond oil consumption did not significantly affect the triglyceride and HDL in this sample of hyperlipidemic patients.

Conclusion: Consumption of almond could reduce the total cholesterol and LDL in dyslipidemic patients.
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http://dx.doi.org/10.1016/j.ctim.2018.10.013DOI Listing
February 2019

Effect of intensive blood pressure lowering on cardiovascular outcomes based on cardiovascular risk: A secondary analysis of the SPRINT trial.

Eur J Prev Cardiol 2019 02 26;26(3):238-245. Epub 2018 Sep 26.

3 Department of Cardiovascular Surgery, Shiraz University of Medical Sciences, Iran.

Background: It is not clear whether risk stratification can help choose the most favourable systolic blood pressure target for primary prevention of cardiovascular events.

Design: A secondary analysis of Systolic Blood Pressure Intervention Trial (SPRINT).

Methods: To perform a secondary analysis, we obtained the data from SPRINT from the National Heart, Lung, and Blood Institute data repository centre. In SPRINT, an open-label trial, participants without diabetes with systolic blood pressure of ≥130 mmHg were randomly assigned to intensive and standard treatment groups with systolic blood pressure targets of <120 and <140 mmHg, respectively. The primary composite outcome was myocardial infarction and other acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes. Here, we have analysed data from participants without cardiovascular disease and chronic kidney disease aged under 75 years categorised based on the baseline 10-year Framingham risk score (<10% (low risk); ≥10% and <15% (intermediate risk); ≥15% (high risk)).

Results: A total of 4298 patients were included in the analysis. With intensive treatment, there was a significant reduction in the primary outcome events in patients at high risk (0.86% per year vs. 1.81% per year; hazard ratio (HR) 0.51; 95% confidence interval (CI) 0.31 to 0.85; P = 0.010), and at intermediate risk (0.60% per year vs. 1.46% per year; HR 0.37; 95% CI 0.17 to 0.82; P = 0.014) but not for those at low risk (0.75% per year vs. 0.57% per year; HR 1.14; 95% CI 0.55 to 2.38; P = 0.714).

Conclusions: Intensive systolic blood pressure reduction is beneficial for primary prevention of cardiovascular morbidity and mortality in patients without diabetes with more than low cardiac risk (above 10%).
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http://dx.doi.org/10.1177/2047487318800741DOI Listing
February 2019

Purification of Stem Cells from Oral Pyogenic Granuloma Tissue.

Open Dent J 2018 29;12:560-566. Epub 2018 Aug 29.

Department of Operative Dentistry, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran.

Introduction: The isolation of stem cells from pathologically damaged dental tissues has been examined only by a few studies. The purpose of this study was to evaluate the possibility of isolation of stem cells from pyogenic granuloma.

Methods: Pyogenic granuloma tissues were enzymatically digested and the resulting single cells were cultured. Then, the cultured cells differentiated into adipocytes and osteoblasts cells. Flow cytometry analyses were performed on markers such as CD 90, CD 73, CD105, CD 45 and CD14. Other features were also analyzed including the effect of colony formation and potentials of differentiation into adipocytes and osteoblasts.

Results: The cells derived from pyogenic granuloma tissue formed higher colonies similar to typical spindle-shaped fibroblasts. The cells were positive for mesenchymal markers such as CD 44, CD 271, CD 90, and CD 73, and negative for surface molecules such as CD 14, CD 34 and CD 45. Moreover, they successfully differentiated into adipocytes and osteoblasts.

Conclusion: The cells isolated from pyogenic granuloma could form CFU fibroblastic units expressing an appropriate marker panel of the cell surface antigen and adequate differentiation potential, all of which met the Cell Therapy International Association criteria for the definition of mesenchymal stromal cells. Pyogenic granuloma contains cells with stem cell properties.
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http://dx.doi.org/10.2174/1874210601812010560DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6118039PMC
August 2018

The effect of kidney transplantation on speckled tracking echocardiography findings in patients on hemodialysis.

J Cardiovasc Thorac Res 2018 29;10(2):90-94. Epub 2018 Jun 29.

Cardiovascular Research Center, Department of Cardiovascular Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.

Cardiac dysfunction is a major cause of morbidity and mortality in patients with end-stage renal disease (ESRD). Previous studies have shown that kidney transplantation can reverse some of the gross changes in the myocardial structure such as left ventricular ejection fraction (LVEF) and volumes. Whether kidney transplantation can reverse the subtle and early myocardial changes in ESRD patients who do not suffer from gross alternations in myocardial function is not yet studied. The aim of this study was to answer this question. We followed 25 patients with ESRD at baseline that all of them had a kidney transplant and were reassessed 1 month after the transplantation. Conventional and speckle tracking echocardiography (STE)was done at baseline and 1 month after kidney transplantation in patients. LV hypertrophy was the most prevalent finding at baseline (58%), followed by diastolic dysfunction (53%). Kidney transplantation significantly improved the ejection fraction (EF) (treatment effect = 4.23 ± 2.06%; = 0.046) and apical 4-chamber strain (treatment effect = -0.89 ± 0.37%; = 0.021) in the patients. It also reduced the LV mass index (treatment effect = -73.82 ± 11.6; < 0.001) and relative wall thickness (treatment effect = -0.056±0.023; = 0.021). Other variables including global longitudinal strain and diastolic dysfunction were not improved significantly. STE may show early improvements in myocardial function 1 month after renal transplantation.
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http://dx.doi.org/10.15171/jcvtr.2018.14DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6088767PMC
June 2018

Spironolactone Monotherapy in Special Population of Patients with Hypertension.

Acta Cardiol Sin 2018 Jul;34(4):364

Cardiovascular Research Center, TAHA Clinical Trial Group; Shiraz University of Medical Sciences, Shiraz, Iran.

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http://dx.doi.org/10.6515/ACS.201807_34(4).20180531ADOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6066943PMC
July 2018

The association of plasma high-sensitivity C-reactive protein level with rheumatic heart disease: The possible role of inflammation.

Indian Heart J 2018 May - Jun;70(3):346-349. Epub 2017 Aug 26.

Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. Electronic address:

Background: Currently, it is not clear whether recurrent traumatic events lead to progression of rheumatic heart disease (RHD) after the incident of acute rheumatic fever or a persistent inflammatory state at the site of the valves. The aim of this study was to assess the possible association between plasma high sensitive C Reactive Protein (hs-CRP) level as an indicator of inflammation and RHD.

Materials & Methods: Ninety patients with RHD and 90 healthy controls who had undergone complete echocardiographic examination were enrolled in this cross-sectional study. A score was given to each patient according to the severity of valvular involvement. Plasma hs-CRP level was checked for each patient by ELISA method twice with two-week interval, and the mean hs-CRP was calculated.

Results: The mean plasma hs-CRP level in the case group was significantly higher compared to its level in the control group (2.59±4.82 and 0.55±0.43 in the case and control groups respectively, p<0.001). There was also a strong association between the level of plasma hs-CRP and the severity of rheumatic valvular involvement (p<0.001).

Conclusion: The mean plasma hs-CRP level seems to have a significant association with RHD and its severity. Further studies are needed to determine the cause and effect relationship.
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http://dx.doi.org/10.1016/j.ihj.2017.08.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6034027PMC
September 2018

Low Dose Spironolactone Monotherapy in the Management of Stage I Essential Hypertension: A Pilot Randomized, Double-Blind, Placebo-Controlled Trial.

Acta Cardiol Sin 2018 Jan;34(1):59-65

Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: High blood pressure (BP) is a common chronic disease needs long life drug consumption to control. Spironolactone could be used as the fourth-line therapy in patients with resistant hypertension. However, there is no study to determine the effects of low dose spironolactone as a first line therapy in treatment of essential hypertension. The aim of this study is to investigate the effect of low dose spironolactone monotherapy in management of essential hypertension.

Methods: In this double blind randomized clinical trial, 40 patients who had stage I essential hypertension were randomly divided into two groups: intervention group received spironolactone 25 milligram once daily for one month and control group received placebo once daily. At the baseline and after one month, 24-hour BP holter-monitoring and serum potassium assay were done.

Results: Systolic BP was reduced from 143.5 ± 8.2 mmHg to 137.10 ± 7.57 mmHg in the intervention group, while it did not change significantly in control (between group treatment difference = -4.5 mmHg, p = 0.004). There was no significant reduction of diastolic BP in the intervention group in comparison to placebo group (between group treatment difference = -1.3 mmHg, p = 0.099).

Conclusions: Short course monotherapy with low dose spironolactone is effective in reducing systolic BP in patients with stage I essential hypertension.
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http://dx.doi.org/10.6515/ACS.201801_34(1).20170903BDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5777944PMC
January 2018

Comparison of the effect of omega-3 supplements and fresh fish on lipid profile: a randomized, open-labeled trial.

Nutr Diabetes 2017 Dec 19;7(12). Epub 2017 Dec 19.

Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Dietary fish is a rich source of Omega-3 poly-unsaturated fatty acids (PUFAs). These compounds may have protective effect against cardiovascular events possibly by modifying lipid profiles. Consequently, fish oil supplements are produced commercially to complement low fish intake. It is not clear if both interventions have similar effects. The aim of this trial was to compare the anti-hyperlipidemic effect of omega3 fatty acid supplements with fresh fish.

Method: A total of 106 patients with hyperlipidemia were randomized. One group received 2 g/day of omega-3 capsules for a period of 8 weeks and the other group received a mean of 250 g trout fish twice weekly (for dinner and lunch) for the same time period. The effects of these diets on the lipid profile after the intervention were compared between the two groups.

Results: Data from 48 patients in fish oil group and 47 patients from fish group was used for final analysis. In both groups, total cholesterol, non-HDL cholesterol, triglyceride (TG) levels, and Castelli I index (total cholesterol/HDL ratio) were reduced significantly following the treatment; however, dietary-fish intake had a more pronounced effect (-85.08 ± 74.82 vs. -30.75 ± 89.00, P < 0.001; 75.06 ± 35.43 vs. -16.93 ± 40.21, P < 0.001; -66.55 ± 30.79 vs. -12.7 ± 35.48, P = 0.003; and -0.77 ± 1.39 vs. -3.02 ± 1.85, P < 0.001; respectively). HDL level was increased in both groups with a higher effect in dietary fish group (4.47 ± 7.83 vs. 8.51 ± 8.79, P = 0.022). Atherogenic (Log [TG/HDL ratio]) and Castelli II (LDL/HDL ratio) indices did not change in fish oil group while were reduced significantly by fresh fish consumption (-0.04 ± 0.27 vs. -0.26 ± 0.17, P < 0.001; and 0.15 ± 0.7 vs. -1.32 ± 1.15, P < 0.001, respectively). LDL level was increased in the supplementation group, while it was significantly reduced in the dietary-fish group (+18.7 ± 24.97 vs. -22.75 ± 27.28, P < 0.001).

Conclusion: Consumption of fresh fish seems to be superior in positively modifying the lipid profiles which may have important translations in the occurrence of cardiovascular events.
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http://dx.doi.org/10.1038/s41387-017-0007-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5865539PMC
December 2017

Effect of kernel oil consumption on lipid profile of the patients with dyslipidemia: a randomized, open-label controlled clinical trial.

Oncotarget 2017 Oct 4;8(45):79636-79641. Epub 2017 Jul 4.

Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran.

Background: Amygdalus scoparia kernel (ASK) oil is traditionally used for Hyperlipidemia. Compared to olive oil, it has higher proportion of unsaturated to saturated fatty acid besides exhibiting higher index of oxidative stability. The lipid-lowering effects of ASK oil however, has not been investigated yet. This study is the first one to evaluate such effects in patients with dyslipidemia.

Results: Serum triglyceride levels significantly decreased in the intervention compared to control group (24.80 ± 51.70 vs 3.13 ± 44.80, -value = 0.03). Serum total cholesterol, LDL and HDL cholesterol levels did not change significantly ( = 0.28 and = 0.68 and = 0.10 respectively).

Materials And Methods: In a double arm, open-label, randomized controlled trial,101 hyperlipidemic patients were recruited. The designation of hyperlipidemia was upon meeting either of the three criteria: having serum low-density lipoprotein (LDL) cholesterol level 130-190 (mg/dl), serum triglyceride level 150-400 (mg/dl), and serum high-density lipoprotein (HDL) cholesterol level less than 50 (mg/dl) for women and 40 (mg/dl) for men. Patients who have ever been prescribed with an antihyperlipidemic medication were excluded. They were randomly assigned to intervention group, receiving the ASK oil, for 60 days and control group. Serum lipid measurements were repeated at the end of the intervention period.

Conclusions: ASK oil supplementation may have a positive effect in reducing serum triglyceride level in patients with dyslipidemia without significant effect on serum cholesterol levels.
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http://dx.doi.org/10.18632/oncotarget.18956DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5668076PMC
October 2017

Accuracy of exercise tolerance test in the diagnosis of coronary artery disease in patients with left dominant coronary circulation.

Indian Heart J 2017 Sep - Oct;69(5):624-627. Epub 2017 Feb 24.

Department of Cardiovascular Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. Electronic address:

Background: Exercise is a physiologic stress that helps the physicians to clarify the presence or absence of cardiovascular disease which may be obscure at rest. Although it is sensitive, its specificity is affected by several parameters, such as some metabolic conditions, some structural heart diseases, and some baseline electrocardiogram abnormalities. Currently, the relationship between coronary dominance and accuracy of EET is not examined. Therefore, this study was conducted to determine the potential impact of coronary dominance on the accuracy of EET.

Methods: In this retrospective study, data were gathered from 720 patients from four medical centers. The pattern of dominancy was determined, and the coronary dominance pattern of the patients who had normal angiograms despite abnormal EETs was compared to that from all the patients.

Results: Among the patients who had a normal angiogram despite an abnormal EET, 27% were left dominant while the frequency of left dominancy in the whole population of the study was only 10.9% (P=0.013). There were no significant differences in baseline characteristics, such as age and sex, between the two studied groups.

Conclusion: The results indicated that the presence of left dominance in patients who had normal angiograms despite an abnormal EET was significantly higher than general population. Therefore, left dominance may be considered a confounding factor for EET, producing false positive results.
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http://dx.doi.org/10.1016/j.ihj.2017.02.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5650573PMC
June 2018

Endothelial progenitor cell subsets and preeclampsia: Findings and controversies.

J Chin Med Assoc 2017 Oct 14;80(10):615-622. Epub 2017 Jul 14.

Infertility and Reproductive Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Vascular remodeling is an essential component of gestation. Endothelial progenitor cells (EPCs) play an important role in the regulation of vascular homeostasis. The results of studies measuring the number of EPCs in normal pregnancies and in preeclampsia have been highly controversial or even contradictory because of some variations in technical issues and different methodologies enumerating three distinct subsets of EPCs: circulating angiogenic cells (CAC), colony forming unit endothelial cells (CFU-ECs), and endothelial colony-forming cells (ECFCs). In general, most studies have shown an increase in the number of CACs in the maternal circulation with a progression in the gestational age in normal pregnancies, while functional capacities measured by CFU-ECs and ECFCs remain intact. In the case of preeclampsia, mobilization of CACs and ECFCs occurs in the peripheral blood of pregnant women, but the functional capacities shown by culture of the derived colony-forming assays (CFU-EC and ECFC assays) are altered. Furthermore, the number of all EPC subsets will be reduced in umbilical cord blood in the case of preeclampsia. As EPCs play an important role in the homeostasis of vascular networks, the difference in their frequency and functionality in normal pregnancies and those with preeclampsia can be expected. In this review, there was an attempt to provide a justification for these controversies.
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http://dx.doi.org/10.1016/j.jcma.2017.06.013DOI Listing
October 2017