Publications by authors named "Farzad Masoudkabir"

33 Publications

Mesenchymal stem cells Pretreatment with stromal-derived factor-1 alpha augments cardiac function and angiogenesis in infarcted myocardium.

Am J Med Sci 2021 Feb 11. Epub 2021 Feb 11.

Department of Genetics, School of Biological Sciences, Tarbiat Modares University, Tehran, Iran. Electronic address:

Background: Stem cell therapy is among the novel approaches for the treatment of post-myocardial infarction cardiomyopathy. This study aims to compare the effect of stromal-derived factor 1 α (SDF1α), mesenchymal stem cells (MSCs) in combination with the lentiviral production of vascular endothelial growth factor (VEGF) on infarct area, vascularization and eventually cardiac function in a rat model of myocardial infarction (MI).

Methods: The influence of SDf1α on MSCs survival was investigated. MSCs were transduced via a lentiviral vector containing VEGF. After that, the effect of mesenchymal stem cell transfection of VEGF-A165 and SDf1α preconditioning on cardiac function and scar size was investigated in five groups of MI rat models. The MSC survival, cardiac function, scar size, angiogenesis, and lymphocyte count were assessed 72 hours and 6 weeks after cell transplantation.

Results: SDF1α decreased the lactate dehydrogenase release in MSCs significantly. Also, the number of viable cells in the SDF1α-pretreated group was meaningfully more than the control. The left ventricular systolic function significantly enhanced in groups with MSC, MSC, and MSC in comparison to the control group.

Conclusions: These findings suggest that SDF1α pretreatment and overexpressing VEGF in MSCs could augment the MSCs' survival in the infarcted myocardium, reduce the scar size, and improve the cardiac systolic function.
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http://dx.doi.org/10.1016/j.amjms.2021.01.025DOI Listing
February 2021

Opium and cardiovascular health: A devil or an angel?

Indian Heart J 2020 Nov-Dec;72(6):482-490. Epub 2020 Oct 20.

Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Opioids have the highest rate of illicit drug consumption after cannabis worldwide. Opium, after tobacco, is still the most commonly abused substance in the Middle East. In addition to the ease of availability, one reason for the high consumption of opium in Asian countries might be a traditional belief among Eastern people and even medical staff that opium may have ameliorating effects on cardiovascular diseases (CVDs) as well as diabetes mellitus, hypertension, and dyslipidemia. Over the last decade, many studies have been performed on humans and animals to evaluate the interplay between opium consumption and stable coronary artery disease, acute coronary syndromes, and atherosclerosis. In this review, we conclude that opium consumption should be considered a risk factor for CVDs. Healthy individuals, as well as cardiac and diabetic patients, should be informed and educated about the hazardous effects of opium consumption on cardiovascular and other chronic diseases.
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http://dx.doi.org/10.1016/j.ihj.2020.10.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7772609PMC
October 2020

Visceral Obesity and Its Shared Role in Cancer and Cardiovascular Disease: A Scoping Review of the Pathophysiology and Pharmacological Treatments.

Int J Mol Sci 2020 Nov 27;21(23). Epub 2020 Nov 27.

Department of Epidemiology & Public Health, Institute of Epidemiology & Health Care, University College London, London WC1E 6BT, UK.

The association between obesity, cancer and cardiovascular disease (CVD) has been demonstrated in animal and epidemiological studies. However, the specific role of visceral obesity on cancer and CVD remains unclear. Visceral adipose tissue (VAT) is a complex and metabolically active tissue, that can produce different adipokines and hormones, responsible for endocrine-metabolic comorbidities. This review explores the potential mechanisms related to VAT that may also be involved in cancer and CVD. In addition, we discuss the shared pharmacological treatments which may reduce the risk of both diseases. This review highlights that chronic inflammation, molecular aspects, metabolic syndrome, secretion of hormones and adiponectin associated to VAT may have synergistic effects and should be further studied in relation to cancer and CVD. Reductions in abdominal and visceral adiposity improve insulin sensitivity, lipid profile and cytokines, which consequently reduce the risk of CVD and some cancers. Several medications have shown to reduce visceral and/or subcutaneous fat. Further research is needed to investigate the pathophysiological mechanisms by which visceral obesity may cause both cancer and CVD. The role of visceral fat in cancer and CVD is an important area to advance. Public health policies to increase public awareness about VAT's role and ways to manage or prevent it are needed.
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http://dx.doi.org/10.3390/ijms21239042DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7730690PMC
November 2020

Time for clinicians to revisit their perspectives on C-statistic.

Eur Heart J 2021 Jan;42(1):132-133

Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, North Kargar Avenue, Tehran 1411713138, Iran.

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http://dx.doi.org/10.1093/eurheartj/ehaa859DOI Listing
January 2021

The impact of a dedicated coronavirus disease 2019 primary angioplasty protocol on time components related to ST‑segment elevation myocardial infarction management in a 24/7 primary percutaneous coronary intervention-capable hospital.

Kardiol Pol 2020 12 21;78(12):1227-1234. Epub 2020 Sep 21.

Background: Primary percutaneous coronary intervention (PPCI) as the treatment of choice for ST‑segment elevation myocardial infarction (STEMI) should be rapidly performed. It is necessary to use preventive strategies during the coronavirus disease 2019 (COVID‑19) outbreak, which is an ongoing global concern. However, critical times in STEMI management may be influenced by the implementation of infection control protocols.

Aims: We aimed to investigate the impact of our dedicated COVID‑19 PPCI protocol on time components related to STEMI care and catheterization laboratory personnel safety. A subendpoint analysis to compare patient outcomes at a median time of 70 days during the pandemic with those of patients treated in the preceding year was another objective of our study.

Methods: Patients with STEMI who underwent PPCI were included in this study. Chest computed tomography (CT) and real‑time reverse transcriptase-polymerase chain reaction (rRT‑PCR) tests were performed in patients suspected of having COVID‑19. A total of 178 patients admitted between February 29 and April 30, 2020 were compared with 146 patients admitted between March 1 and April 30, 2019.

Results: Severe acute respiratory syndrome coronavirus 2 infection was confirmed by rRT‑PCR in 7 cases. In 6 out of 7 patients, CT was indicative of COVID‑19. There were no differences between the study groups regarding critical time intervals for reperfusion in STEMI. The 70‑day mortality rate before and during the pandemic was 2.73% and 4.49%, respectively (P = 0.4).

Conclusions: The implementation of the dedicated COVID‑19 PPCI protocol in patients with STEMI allowed us to achieve similar target times for reperfusion, short‑term clinical outcomes, and staff safety as in the prepandemic era.
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http://dx.doi.org/10.33963/KP.15607DOI Listing
December 2020

Recommendations of the current guidelines for implantable cardioverter-defibrillator implantation in patients with hypertrophic cardiomyopathy: Debate still exists.

J Interv Card Electrophysiol 2021 Jan 25;60(1):1-7. Epub 2020 Jul 25.

Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.

Sudden cardiac death (SCD) related to ventricular arrhythmias is the most disastrous consequence of hypertrophic cardiomyopathy (HCM). Hence, clinicians seek to identify the highest risk patients that have the greatest potential to benefit from an implantable cardioverter-defibrillator (ICD) for primary prevention; nonetheless, this is where controversies begin as the 2011 American College of Cardiology Foundation/American Heart Association and the 2014 European Society of Cardiology guidelines have significant discrepancies. These guidelines propose clinically and statistically oriented algorithms, respectively, for SCD risk stratification of patients with HCM and recommendation to implantation of primary prevention ICD. The differences between these guidelines have resulted in confusion among care practitioners and patients alike. In this communication, we tried to criticize the statistical viewpoint in terms of clinical outcomes and suggest the more beneficial model.
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http://dx.doi.org/10.1007/s10840-020-00837-4DOI Listing
January 2021

Effect of persistent opium consumption after surgery on the long-term outcomes of surgical revascularisation.

Eur J Prev Cardiol 2020 Dec 16;27(18):1996-2003. Epub 2020 Jul 16.

Department of Cardiac Surgery, Tehran University of Medical Sciences, Iran.

Background: A wrong traditional belief persists among people that opium consumption beneficially affects cardiovascular disease and its risk factors. However, no evidence exists regarding the effect of opium consumption or cessation on the long-term risk of major adverse cardio-cerebrovascular events after coronary artery bypass grafting. We therefore aimed to evaluate the effect of persistent opium consumption after surgery on the long-term outcomes of coronary artery bypass grafting.

Methods: The study population consisted of 28,691 patients (20,924 men, mean age 60.9 years), who underwent coronary artery bypass grafting between 2007 and 2016 at our centre. The patients were stratified into three groups according to the status of opium consumption: never opium consumers ( = 23,619), persistent postoperative opium consumers ( = 3636) and enduring postoperative opium withdrawal ( = 1436). Study endpoints were 5-year mortality and 5-year major adverse cardio-cerebrovascular events, comprising all-cause mortality, acute coronary syndrome, cerebrovascular accident and revascularisation.

Results: After surgery, 3636 patients continued opium consumption, while 1436 patients persistently avoided opium use. The multivariable survival analysis demonstrated that persistent post-coronary artery bypass grafting opium consumption increased 5-year mortality and 5-year major adverse cardio-cerebrovascular events by 28% (hazard ratio (HR) 1.28, 95% confidence interval (CI) 1.06-1.54;  = 0.009) and 25% (HR 1.25, 95% CI 1.13-1.40;  < 0.0001), respectively. It also increased the 5-year risk of acute coronary syndrome by 34% (sub-distribution HR 1.34, 95% CI 1.16-1.55;  < 0.0001).

Conclusions: The present data suggest that persistent post-coronary artery bypass grafting opium consumption may significantly increase mortality, major adverse cardio-cerebrovascular events and acute coronary syndrome in the long term. Future studies are needed to confirm our findings.
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http://dx.doi.org/10.1177/2047487320932010DOI Listing
December 2020

The interplay of endothelial dysfunction, cardiovascular disease, and cancer: What we should know beyond inflammation and oxidative stress.

Eur J Prev Cardiol 2020 Dec 18;27(19):2075-2076. Epub 2019 Dec 18.

Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

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http://dx.doi.org/10.1177/2047487319895415DOI Listing
December 2020

Smoking Cessation After Surgery and Midterm Outcomes of Surgical Revascularization.

Ann Thorac Surg 2020 06 7;109(6):1874-1879. Epub 2019 Nov 7.

Department of Cardiac Surgery, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.

Background: Although multiple studies have reported the devastating effect of cigarette smoking (CS) on short-term outcomes of patients who underwent coronary artery bypass grafting surgery (CABG), its effect on long-term outcomes is still questionable. We aimed to evaluate the long-term outcomes of CS cessation after CABG surgery.

Methods: This retrospective cohort study included all patients who underwent isolated CABG at our center between 2007 and 2016 and were cigarette smokers either just before or at the time of surgery. Patients were stratified into those who continued CS and those who were persistently CS abstinent after CABG. The endpoints of the study were 5-year mortality and 5-year major adverse cardiovascular and cerebrovascular events.

Results: Of 28,945 patients who underwent isolated CABG, 9173 current cigarette smokers (93.5% men; mean age, 58.6 years) met our selection criteria and were included in the final analysis. Of these 3302 patients (40.0%) continued CS after surgery and 5688 patients were persistently abstinent. Multivariable survival analysis demonstrated that CS cessation after CABG, adjusted for major coronary risk factors, could reduce the 5-year mortality by 35% (hazard ratio, 0.65; 95% confidence interval, 0.54-0.77; P < .001) and 5-year major adverse cardiovascular and cerebrovascular events by 18% (hazard ratio, 0.82; 95% confidence interval, 0.74-0.92; P = .001).

Conclusions: Our study shows that CS abstinence after CABG significantly reduces long-term mortality and number of major adverse events. As a result, patients who smoke should be encouraged to participate in CS cessation programs after CABG surgery.
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http://dx.doi.org/10.1016/j.athoracsur.2019.09.045DOI Listing
June 2020

Discrimination between Obstructive Coronary Artery Disease and Cardiac Syndrome X in Women with Typical Angina and Positive Exercise Test; Utility of Cardiovascular Risk Calculators.

Medicina (Kaunas) 2019 Jan 14;55(1). Epub 2019 Jan 14.

Cardiac Primary Prevention Research Center, Tehran Heart Center, Tehran University of Medical Sciences, Tehran 1411713138, Iran.

Nearly 40% of women with typical angina and a positive exercise tolerance test (ETT) have normal or near normal coronary angiography (CAG) labeled as cardiac syndrome X (CSX). We performed this study to evaluate the power of common cardiovascular risk calculators to distinguish patients with CSX from those with coronary artery disease (CAD). 559 women participated in the study. Three risk scores, including (1) newly pooled cohort equation of American College of Cardiology/American Heart Association (ACC/AHA) to predict 10 years risk of first atherosclerotic cardiovascular hard event (ASCVD), (2) Framingham risk score (FRS) for the prediction of 10 years coronary heart disease, and (3) the SCORE tool to estimate 10-year risk of cardiovascular mortality (SCORE), were applied. CAD was diagnosed in 51.5% of the patients. 11.6% of the population had ASCVD < 2.5%, and only 13.8% of these patients had CAD on their CAG. By choosing FRS, 14.4% of patients had FRS < 7.5%, and only 11.3% of these patients had recorded CAD on CAG, while the rest of the patients were diagnosed as CSX. Using the SCORE model, 13.8% of patients had the least value (<0.5%) in whom the prevalence of CAD was 19.9%. The area under receiver operating characteristic curve (AUROC) to discriminate CSX from CAD was calculated for each scoring system, being 0.750 for ASCVD, 0.745 for FRS, and 0.728 for SCORE ( value for all AUROCs < 0.001). The Hosmer⁻Lemeshow chi squares (df, value) for calibration were 8.787 (8, 0.361), 11.125 (8, 0.195), and 10.618 (8, 0.224) for ASCVD, FRS, and SCORE, respectively. Patients who have ASCVD < 2.5% or FRS < 7.5% may be appropriate cases for noninvasive imaging (Such as coronary CT angiography). CAG is indicated for patients with ASCVD ≥ 7.5% and FRS ≥ 15%, whereas the patients with intermediate risk need comprehensive patient⁻physician shared decision-making.
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http://dx.doi.org/10.3390/medicina55010012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6359077PMC
January 2019

Visfatin as marker of isolated coronary artery ectasia and its severity.

Cytokine 2019 01 9;113:216-220. Epub 2018 Jul 9.

Cardiac Primary Prevention Research Center (CPPRC), Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.

Several studies have demonstrated the relationship between visfatin and increased risk of diseases caused by inflammation, however, the relationship between visfatin and coronary artery ectasia (CAE) is still unknown. The aim of our study is to investigate the association between serum visfatin with presence of coronary ectasia and its severity. We enrolled 85 individuals including 35 CAE patients (mean age: 58.40 ± 9.82 years) and 50 control persons (mean age: 53.24 ± 8.81 years). These participants underwent some biochemical tests including visfatin, fasting blood glucose and lipid profiles. In univariate analysis, the serum level of visfatin was significantly associated with ectasia in all patients with CAE and CAD coexisting with CAE groups, but a trend toward significance in isolated CAE group. In multivariate analysis, visfatin showed independently significant association with presence of ectasia in all patients with ectasia and in CAD coexisting with ectasia groups, but not significant in isolated CAE group. Visfatin was also independently associated with severity of ectasia according to MARKIS classification. We conclude that visfatin independently can be the useful predictor for the presence and severity of coronary ectasia.
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http://dx.doi.org/10.1016/j.cyto.2018.07.007DOI Listing
January 2019

Novel Scoring System for Prediction of Cardiac Syndrome X in Women with Typical Angina and a Positive Exercise Tolerance Test.

Tex Heart Inst J 2018 02 1;45(1):5-10. Epub 2018 Feb 1.

A major diagnostic challenge for cardiologists is to distinguish cardiac syndrome X (CSX) from obstructive coronary artery disease in women with typical angina and a positive exercise tolerance test (ETT). We performed this study to develop a scoring system that more accurately predicts CSX in this patient population. Data on 976 women with typical angina and a positive ETT who underwent coronary angiography at our center were randomly divided into derivation and validation datasets. We developed a backward stepwise logistic regression model that predicted the presence of CSX, and a scoring system was derived from it. The derivation dataset (809 patients) was calibrated by uing a Hosmer-Lemeshow goodness-of-fit test (8 degrees of freedom; χ=12.9; =0.115), and the area under the curve was 0.758. The validation dataset (167 patients) was calibrated in the same way (8 degrees of freedom; χ=9.0; =0.339), and the area under the curve was 0.782. Independent predictors of CSX were age <55 years; negative histories of smoking, diabetes mellitus, hyperlipidemia, hypertension, or familial premature coronary artery disease; and highly positive ETTs. A total score >9.5 was the optimal cutoff point for differentiating CSX from obstructive coronary artery disease. Our proposed scoring system is a simple, objective, and accurate system for distinguishing CSX from obstructive coronary artery disease in women with typical angina and positive ETTs. It may help determine which of these patients need invasive coronary angiograms or noninvasive tests like computed tomographic coronary angiography.
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http://dx.doi.org/10.14503/THIJ-16-5906DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5832089PMC
February 2018

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

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

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

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

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

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

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

PARS risk charts: A 10-year study of risk assessment for cardiovascular diseases in Eastern Mediterranean Region.

PLoS One 2017 19;12(12):e0189389. Epub 2017 Dec 19.

Department of Automatic Control, Biomedical Engineering Research Center, Universitat Politècnica de Catalunya, BarcelonaTech (UPC), Barcelona, Spain.

This study was designed to develop a risk assessment chart for the clinical management and prevention of the risk of cardiovascular disease (CVD) in Iranian population, which is vital for developing national prevention programs. The Isfahan Cohort Study (ICS) is a population-based prospective study of 6504 Iranian adults ≥35 years old, followed-up for ten years, from 2001 to 2010. Behavioral and cardiometabolic risk factors were examined every five years, while biennial follow-ups for the occurrence of the events was performed by phone calls or by verbal autopsy. Among these participants, 5432 (2784 women, 51.3%) were CVD free at baseline examination and had at least one follow-up. Cox proportional hazard regression was used to predict the risk of ischemic CVD events, including sudden cardiac death due to unstable angina, myocardial infarction, and stroke. The model fit statistics such as area under the receiver-operating characteristic (AUROC), calibration chi-square and the overall bias were used to assess the model performance. We also tested the Framingham model for comparison. Seven hundred and five CVD events occurred during 49452.8 person-years of follow-up. The event probabilities were calculated and presented color-coded on each gender-specific PARS chart. The AUROC and Harrell's C indices were 0.74 (95% CI, 0.72-0.76) and 0.73, respectively. In the calibration, the Nam-D'Agostino χ2 was 10.82 (p = 0.29). The overall bias of the proposed model was 95.60%. PARS model was also internally validated using cross-validation. The Android app and the Web-based risk assessment tool were also developed as to have an impact on public health. In comparison, the refitted and recalibrated Framingham models, estimated the CVD incidence with the overall bias of 149.60% and 128.23% for men, and 222.70% and 176.07% for women, respectively. In conclusion, the PARS risk assessment chart is a simple, accurate, and well-calibrated tool for predicting a 10-year risk of CVD occurrence in Iranian population and can be used in an attempt to develop national guidelines for the CVD management.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0189389PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5736201PMC
January 2018

Cardiovascular disease and cancer: Evidence for shared disease pathways and pharmacologic prevention.

Atherosclerosis 2017 08 2;263:343-351. Epub 2017 Jun 2.

Yale Cardiovascular Genetics Program, Yale Cardiovascular Research Center, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.

Cardiovascular disease (CVD) and cancer are leading causes of mortality and morbidity worldwide. Strategies to improve their treatment and prevention are global priorities and major focus of World Health Organization's joint prevention programs. Emerging evidence suggests that modifiable risk factors including diet, sedentary lifestyle, obesity and tobacco use are central to the pathogenesis of both diseases and are reflected in common genetic, cellular, and signaling mechanisms. Understanding this important biological overlap is critical and may help identify novel therapeutic and preventative strategies for both disorders. In this review, we will discuss the shared genetic and molecular factors central to CVD and cancer and how the strategies commonly used for the prevention of atherosclerotic vascular disease can be applied to cancer prevention.
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http://dx.doi.org/10.1016/j.atherosclerosis.2017.06.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6207942PMC
August 2017

Takayasu's Arteritis Presenting with Headache and Peripheral Facial Palsy: A Case Report.

J Tehran Heart Cent 2016 Oct;11(4):195-197

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

Takayasu's arteritis (TA) is a rare case of granulomatous arteritis which mainly involves the aorta and its large branches. Although arterial hypertension is the most common feature of the disease in both adults and children, patients with TA may present with numerous clinical manifestations. Our patient was a 45-year-old woman, known to have hypertension from 3 years earlier following assessments made for severe headache. One year after the diagnosis of hypertension, she developed a left-sided lower motor neuron facial palsy, which was treated with oral corticosteroids (Prednisolone). Notably, the patient's headache was relieved after she took corticosteroid therapy. Transthoracic echocardiography revealed severe aortic insufficiency and aneurysmal changes in the ascending aorta, and she was referred to our center for further evaluation. In multi-slice computed-tomography angiography, significant long stenosis of the left subclavian artery was seen and the diameter of the ascending aorta was 50 mm. The patient underwent the Bentall operation. The pathologic examination of the aortic wall specimen was compatible with giant cell aortitis and more in favor of TA with the ascending aortic aneurysm. At 6months' follow-up, the patient was in good condition and had almost recovered from facial palsy.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5424842PMC
October 2016

Synergistic effect of hypertension with diabetes mellitus and gender on severity of coronary atherosclerosis: Findings from Tehran Heart Center registry.

ARYA Atheroscler 2015 Nov;11(6):317-22

Associate Professor, Department of Cardiology, School of Medicine, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.

Background: We performed this study to evaluate the possible synergism between hypertension and other conventional risk factors of coronary artery disease (CAD) on an angiographic severity of coronary atherosclerosis.

Methods: A cross-sectional study was conducted on 10502 consecutive patients who underwent coronary angiography in the cardiac catheterization laboratory of Tehran Heart Center Hospital (Tehran University of Medical Sciences, Iran), and their conventional risk factors including male gender, hypertension, diabetes mellitus (DM), dyslipidemia, smoking, and family history of premature CAD were recorded. The severity of coronary atherosclerosis evaluated by calculation of Gensini's score.

Results: All aforementioned conventional risk factors of CAD were independently associated with severity of CAD. Multivariate linear regression analysis demonstrated that hypertension had synergistic effect with male gender [Excess Gensini's score: 5.93, 95% confidence interval (CI): 2.72-9.15, P < 0.001] and also with DM (Excess Gensini's score: 3.99, 95% CI: 0.30-7.69, P = 0.034) on severity of CAD. No interaction was observed between hypertension and smoking, dyslipidemia and also with a family history of CAD.

Conclusion: Hypertension has a synergistic effect with DM and male gender on the severity of CAD. These findings imply that more effective screening and treatment strategies should be considered for early diagnosis and tight control of hypertension in male and diabetic people for prevention of advanced CAD.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4738041PMC
November 2015

Clinical characteristics, management and 1-year outcomes of patients with acute coronary syndrome in Iran: the Iranian Project for Assessment of Coronary Events 2 (IPACE2).

BMJ Open 2015 12 15;5(12):e007786. Epub 2015 Dec 15.

Sanofi Iran Medical Department, Tehran, Iran.

Objectives: To assess contemporary data on characteristics, management and 1-year postdischarge outcomes in Iranian patients hospitalised with acute coronary syndrome (ACS).

Setting: 11 tertiary care hospitals in 5 major cities in the Islamic Republic of Iran.

Participants: Patients aged ≥ 20 and ≤ 80 years discharged alive with confirmed diagnosis of ACS including ST-segment elevation myocardial infarction (STEMI), non-STEMI (NSTEMI) and high-risk unstable angina (HR-UA).

Primary And Secondary Outcome Measures: Patients were followed up regarding the use of medications and the end points of the study at 1 month and 1 year after discharge. The primary end point of the study was 1-year postdischarge major adverse cardiac and cerebrovascular events (MACCEs), defined as mortality (cardiac and non-cardiac), ACS and cerebrovascular attack (stroke and/or transient ischaemic attack). The secondary end points were hospital admission because of congestive heart failure, revascularisation by coronary artery bypass grafting surgery or percutaneous coronary intervention (PCI), and major and minor bleeds.

Results: A total of 1799 patients (25.7% STEMI and 74.3% HR-UA/NSTEMI) discharged alive with confirmed diagnosis of ACS were included in the final analysis. During hospitalisation, the majority of the patients received aspirin (98.6%), clopidogrel (91.8%), anticoagulants (93.4%), statins (94.3%) and β-blockers (89.3%). Reperfusion therapy was performed in 62.6% of patients with STEMI (46.3% thrombolytic therapy and 17.3% primary PCI). The mean door-to-balloon and door-to-needle times were 82.9 and 45.6 min, respectively. In our study, 64.7% and 79.5% of the patients in HR-UA/NSTEMI and STEMI groups, respectively, underwent coronary angiography. During the 12 months after discharge, MACCEs occurred in 15.0% of all patients.

Conclusions: Our study showed that the composition of Iranian patients with ACS regarding the type of ACS is similar to that in developed European countries and is unlike that in developing countries of the Middle East and Africa. We found that our patients with ACS are treated with high levels of adherence to guideline-recommended in-hospital medications.
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http://dx.doi.org/10.1136/bmjopen-2015-007786DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4679985PMC
December 2015

Comparison of cardiovascular risk factors and biochemical profile in patients with cardiac syndrome X and obstructive coronary artery disease: A propensity score-matched study.

ARYA Atheroscler 2013 Sep;9(5):269-73

Associate Professor, Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.

Background: This study was designed to compare the frequency of conventional cardiovascular disease risk factors and clinical biochemistry profile in patients with cardiac syndrome X (CSX) and obstructive coronary artery disease (CAD).

Methods: A cross-sectional study was conducted on patients with typical angina and positive exercise tolerance test undergoing coronary angiography in our center. 342 consecutive patients with CSX were enrolled into this study and were matched regarding age and sex with 342 patients with acute coronary syndrome (ACS) and also 342 patients with chronic stable angina (SA). Cardiovascular risk factors as well as biochemistry profile of the patients were recorded.

Results: Mean age of the studied patients was 53.0 years and 41.5% were male. There was no significant difference between the CSX patients and CAD patients regarding body mass index (BMI). Frequency of diabetes mellitus, hyperlipidemia, smoking, family history of premature CAD and hypertension was significantly lower in patients with CSX than ACS and SA patients. Patients with CSX had significantly higher levels of high-density lipoprotein cholesterol (HDL-cholesterol) than comparators while the levels of low-density lipoprotein cholesterol (LDL-cholesterol), total cholesterol, triglyceride and fasting blood sugar (FBS) were significantly lower in patients with CSX than CAD patients.

Conclusion: The present study demonstrated that CSX patients had substantially lower frequency of all conventional CVD risk factors than patients with obstructive CAD. This might aid in developing novel scoring systems or appropriateness criteria for angiographic evaluation of patients with typical angina and positive exercise test in order to reduce the rate of negative results.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3845698PMC
September 2013

Effects of opium consumption on cardiometabolic diseases.

Nat Rev Cardiol 2013 Dec 22;10(12):733-40. Epub 2013 Oct 22.

Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Karegar Shomali Street, Jalal al-Ahmad Cross, 14117-13138, Tehran, Iran.

Opium is the second-most-commonly abused substance (after tobacco) in developing countries of the Middle East region, and in many Asian nations. One of the reasons for the high prevalence of opium abuse in these countries is a traditional belief among Eastern people, even including some medical staff, that opium might have beneficial effects on cardiovascular health and in the control of diabetes mellitus, hypertension, and dyslipidaemia. In this Perspectives article, we summarize the current understanding of the pharmacotoxicology of opium and its specific effects on glycaemic control, blood pressure, lipid profile, and atherosclerosis. On the basis of the available evidence, we believe not only that opium has no ameliorating effect on cardiovascular diseases, but also that the use of this drug might have adverse effects on these conditions. Therefore, people should be educated about the hazardous effects of opium consumption on cardiometabolic diseases.
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http://dx.doi.org/10.1038/nrcardio.2013.159DOI Listing
December 2013

Apelin could reduce risk of contrast-induced nephropathy in patients with congestive heart failure.

Med Hypotheses 2013 Nov 11;81(5):898-900. Epub 2013 Aug 11.

Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Compared to the normal population, patients with congestive heart failure are at higher risk for contrast-induced nephropathy. A variety of interventions are suggested to reduce the risk for contrast-induced nephropathy. Unfortunately results of none of current protective treatments are satisfactory. Apelin a vasodilator adipocytokine, positively inotropic agent, and free radical scavenger has been recently introduced. It has been shown that endogenous apelin levels are decreased in patients with congestive heart failure. Two major mechanisms have been suggested for pathophysiology of contrast induced nephropathy including reactive oxygen species production and impaired renal perfusion due to vasoconstriction. Pretreatment with recombinant apelin (exogenous apelin-13), could compensate decreased endogenous apelin serum levels of congestive heart failure patients. Its antioxidant and cell-protective properties, decrease nephrotoxicity of contrast agent; additionally impaired renal perfusion due to malfunction of cardiac pump will refurbish, because of positively inotropic property of apelin plus its vasodilatation effect in renal arteries. We believe that the triangle of increased contractility, decreased vascular resistance and decreased contrast agent nephrotoxicity could significantly reduce risk of contrast-induced nephropathy in patients with congestive heart failure.
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http://dx.doi.org/10.1016/j.mehy.2013.08.001DOI Listing
November 2013

Sagittal abdominal diameter to triceps skinfold thickness ratio: a novel anthropometric index to predict premature coronary atherosclerosis.

Atherosclerosis 2013 Apr 8;227(2):329-33. Epub 2013 Feb 8.

Endocrine and Metabolism Research Center (EMRC), Obesity and Food Group Set, Tehran University of Medical Sciences, Tehran, Iran.

Objective: We aimed to compare the accuracy of a novel index defined by us, as a ratio of Sagittal abdominal diameter (SAD) and triceps skinfold thickness (TSF) with other indices of adiposity for prediction of presence, severity and extension of premature coronary artery disease (CAD).

Methods: A cross-sectional study was conducted on 238 younger patients (females <55 years; males <45 years) who underwent coronary angiography. Anthropometric indices including TSF, SAD, waist circumference, and hip circumference were measured before catheterization and body mass index, waist-to-hip ratio, abdominal diameter index, index of central obesity as well as our proposed index, SAD-to-TSF ratio, were calculated accordingly. Evaluation of severity and extension of coronary stenosis was by Gensini score and extent score, respectively.

Results: After adjustment for age and sex in multivariate regression models, the SAD-to-TSF ratio was the best predictor for the presence (OR = 2.49, 95% CI = 1.44-4.30; p = 0.001) and extension (β = 1.10, p = 0.004) of premature CAD. TSF and the SAD-to-TSF ratio were the only indices that significantly predicted the Gensini score and the correlation remained significant even after adjustment for age and sex (β = -7.28, p < 0.0001 and β = 3.76, p < 0.0001, respectively).

Conclusion: We showed that our proposed index, SAD-to-TSF ratio, has a substantially better accuracy than do the known indices of obesity like body mass index, waist circumference, and waist-to-hip ratio for the prediction of premature CAD. Furthermore, our index was the only index that positively correlated with the severity of premature CAD.
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http://dx.doi.org/10.1016/j.atherosclerosis.2013.01.033DOI Listing
April 2013

Portal and systemic levels of visfatin in morbidly obese subjects undergoing bariatric surgery.

Endocrine 2013 Aug 28;44(1):114-8. Epub 2012 Oct 28.

Tehran University of Medical Sciences, International Campus, (TUMS, IC), Tehran, Iran.

The aim of the present study was to compare the levels of visfatin in portal and systemic circulations and to assess the possible relationship of visfatin with systemic inflammation and insulin resistance in morbidly obese patients undergoing bariatric surgery. A total of 46 morbidly obese patients (BMI = 45.3 ± 5.3 kg/m(2)) undergoing bariatric surgery were included in this study. Blood samplings were performed simultaneously from portal and systemic veins during surgery. Visfatin was measured in both portal and systemic venous samples. Besides, fasting serum levels of insulin, glucose, lipid profile, visfatin, and hs-CRP were determined in systemic venous blood samples. Insulin sensitivity was estimated using the homeostasis model assessment of insulin resistance (HOMA-IR). Visfatin concentrations were significantly higher in portal vein than systemic veins (11.9 ± 12.1 vs. 5.1 ± 3.3 ng/ml, p < 0.0001). While systemic levels of visfatin were significantly correlated with circulating levels of hs-CRP (r = 0.527, p < 0.0001), there were no significant correlations between portal levels of visfatin with systemic levels of hs-CRP concentrations. Substantially higher levels of visfatin in portal vein than systemic veins provide evidence that visceral adipose tissue is the major secretory source of visfatin in humans. Our findings underscore that visceral adipose tissue is an active endocrine organ that is involved in the complex interrelationship between obesity and pathologic conditions.
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http://dx.doi.org/10.1007/s12020-012-9821-xDOI Listing
August 2013

Glycosylated hemoglobin (HbA1c) levels and clinical outcomes in diabetic patients following coronary artery stenting.

Cardiovasc Diabetol 2012 Jul 17;11:82. Epub 2012 Jul 17.

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

Background: Diabetes has been shown to be independent predictor of restenosis after percutaneous coronary intervention (PCI). The aim of the present study was to investigate whether a pre- and post-procedural glycaemic control in diabetic patients was related to major advance cardiovascular events (MACE) during follow up.

Methods: We evaluated 2884 consecutive patients including 2181 non-diabetic patients and 703 diabetics who underwent coronary stenting. Diabetes mellitus was defined as the fasting blood sugar concentration ≥ 126  mg/dL, or the use of an oral hypoglycemic agent or insulin at the time of admission. Diabetic patients were categorized into two groups based on their mean HbA1c levels for three measurements (at 0, 1, and 6  months following procedure): 291 (41.4%) diabetics with good glycaemic control (HbA1c ≤ 7%) and 412 (58.6%) diabetics with poor glycaemic control (HbA1c > 7%).

Results: The adjusted risk of MACE in diabetic patients with poor glycaemic control (HbA1c > 7%) was 2.1 times of the risk in non-diabetics (adjusted HR = 2.1, 95% CI: 1.10 to 3.95, p = 0.02). However, the risk of MACE in diabetics with good glycaemic control (HbA1c ≤ 7%) was not significantly different from that of non-diabetics (adjusted HR = 1.33, 95% CI: 0.38 to 4.68, p = 0.66).

Conclusions: Our data suggest that there is an association between good glycaemic control to obtain HbA1c levels ≤7% (both pre-procedural glycaemic control and post-procedural) with a better clinical outcome after PCI.
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http://dx.doi.org/10.1186/1475-2840-11-82DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3444922PMC
July 2012

Socioeconomic status and incident cardiovascular disease in a developing country: findings from the Isfahan cohort study (ICS).

Int J Public Health 2012 Jun;57(3):561-8

Students’ Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran.

Objectives: We evaluated the association between socioeconomic status (SES) and incident cardiovascular disease (CVD) in a sample of the Iranian population.

Methods: We followed 6,504 participants who were initially free from CVD. At baseline, subjects were assessed for CVD risk factors and self-reported data were obtained for education, occupation, and income.

Results: After 24,379 person-years of follow-up (median = 4.8 years), 276 incident cases of CVD were detected. There was no significant association between the level of education and the incidence of CVD. In univariate analysis, retired individuals showed a significantly higher incidence of CVD than individuals who were working, and subjects in the highest tertile of income were less likely to suffer CVD than those in the lowest tertile. However, the associations disappeared after adjusting for age and sex.

Discussion: There was no detectable, independent association between the SES and incident CVD. The counterbalance of the higher exposure to CVD risk factors and better access to health-care services and more appropriate risk factor modification in higher socioeconomic classes might diminish the association of SES and CVD in developing countries.
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http://dx.doi.org/10.1007/s00038-012-0344-2DOI Listing
June 2012

Short-term effect of weight loss through restrictive bariatric surgery on serum levels of vaspin in morbidly obese subjects.

Eur Cytokine Netw 2011 Dec;22(4):181-6

Department of Nutrition and Biochemistry, School of Public Health and Institute of Public Health Research, Tehran University of Medical Sciences, Tehran, Iran; Endocrine and Metabolism Research Center (EMRC), Obesity and Food group set, Tehran University of Medical Sciences, Tehran, Iran.

The aims of this study were to evaluate the short-term effects of laparoscopic restrictive bariatric surgery (LRBS) on plasma levels of vaspin and the potential associations of changes in vaspin levels with changes in anthropometric indices, insulin-resistance and dietary intake. Thirty, severely obese subjects (21 female; mean age, 32.5 years) with a mean body mass index (BMI) of 44.1 ± 4.9 kg/m(2) underwent LRBS. Measurements of anthropometric indices, dietary intakes, physical activity and plasma vaspin concentrations were performed prior to, and six weeks after LRBS. Insulin-sensitivity was estimated using the homeostasis model assessment of insulin-resistance (HOMA-IR). Six weeks after LRBS, BMI decreased to a mean of 38.4 ± 4.9 kg/m(2). Significant reductions were also observed in waist circumference (WC), daily intakes of calorie, fat and protein, and plasma concentrations of triglyceride. No significant change was observed in fasting levels of insulin, blood sugar or HOMA-IR. Vaspin decreased significantly (0.26 ± 0.17 vs 0.36 ± 0.20, p=0.048) following surgery. While the percentage change of vaspin was not correlated with percent changes in anthropometric indices and HOMA-IR, it correlated positively with the percentage change in intake of calories, fat and protein: this correlation remained significant even after adjustment for sex and changes in WC and HOMA-IR. Our study suggests that LRBS decreases the serum vaspin concentrations in parallel with the restriction of dietary intake. Furthermore, decreased levels of vaspin early after LRBS seem more likely to result from decreased dietary intake rather than weight-loss-induced insulin sensitivity improvement.
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http://dx.doi.org/10.1684/ecn.2011.0295DOI Listing
December 2011

Serum visfatin concentrations in gestational diabetes mellitus and normal pregnancy.

Arch Gynecol Obstet 2012 May 14;285(5):1257-62. Epub 2011 Dec 14.

Department of Nutrition and Biochemistry, School of Public Health and Institute of Public Health Research, Tehran University of Medical Sciences, Poursina Ave., Qods St, 141556446 Tehran, Iran.

Purpose: There is conflicting data regarding visfatin in gestational diabetes mellitus (GDM). The aim of the present study was to compare serum visfatin levels between patients with GDM and subjects with normal pregnancy and to evaluate its relationship with dietary intake and components of insulin-resistance syndrome.

Methods: Thirty-five patients with GDM (aged 31 ± 0.8 years, BMI = 29.6) and 35 age- and body mass index-matched healthy pregnant women (aged 29 ± 0.7 years, BMI = 28.6) between 24 and 28 weeks of gestation were studied. In addition to anthropometric and dietary intake assessments, measurements of fasting plasma levels of visfatin, glucose, insulin, hemoglobin A1c (HbA1c) and lipid profile were performed for all subjects.

Results: Plasma visfatin levels were significantly lower in pregnant women with GDM compared to healthy subjects (5.29 ± 0.47 vs. 7.76 ± 0.53, p = 0.001). After adjustment for age, maternal gestational age, body mass index, and macronutrients intake, GDM remained the independent predictor of serum visfatin concentrations (β = -1.2, p = 0.001). Serum visfatin levels were significantly correlated with log HbA1c values (r = -0.24, p = 0.03), even after adjustment for age and body mass index (β = -6.45, p = 0.05). No associations between visfatin and other parameters of the insulin-resistance syndrome as well as macronutrient intake were detectable.

Conclusions: Plasma visfatin concentrations are lower in patients with GDM and related to glycemic control reflected by HbA1c. Furthermore, visfatin does not seem to be correlated with dietary intake in pregnant women.
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http://dx.doi.org/10.1007/s00404-011-2156-7DOI Listing
May 2012

Opium consumption and coronary atherosclerosis in diabetic patients: a propensity score-matched study.

Planta Med 2011 Nov 28;77(17):1870-5. Epub 2011 Jul 28.

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

There is a traditional belief among Eastern people that opium may have ameliorating effects on cardiovascular risk factors, especially diabetes; thus, it is widely used among diabetic patients. We attempted to investigate the association of opium consumption with coronary artery disease (CAD) in diabetic patients. A cross-sectional study was conducted on diabetic patients undergoing coronary angiography in our center. Out of 1925 diabetic patients included in the study, 228 were opium users, and the remaining 1697 non-opium users were used as a pool of potential comparators. Propensity scores were used to match the 228 opium consumers with 228 matched comparators for age, sex, and smoking status. The Gensini score and extent score were respectively used to assess the angiographic severity and extent of CAD. The mean Gensini score (86.9 ± 62.7 vs. 59.6 ± 43.4, p < 0.0001) and extent score (7.1 ± 2.9 vs. 5.9 ± 2.9, p < 0.0001) were significantly higher in opium user diabetic patients than in non-opium users. After adjustment for potential confounders, a dose-response relationship was observed between dose of opium and the Gensini score ( β = 0.27, p = 0.04). There were no significant differences between the routes of opium administration (inhalation vs. oral) regarding the severity and extent of CAD. In conclusion, exposure to opium in diabetic patients may be positively associated with the risk of CAD, and with the angiographically determined severity and extent of the disease. Furthermore, dosage of opium consumption may correlate with severity of CAD.
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http://dx.doi.org/10.1055/s-0031-1280017DOI Listing
November 2011

Effect of exercise-based cardiac rehabilitation following coronary artery bypass surgery on ventricular repolarization indices.

J Cardiopulm Rehabil Prev 2011 Jul-Aug;31(4):239-44

Department of Cardiology, Tehran Heart Center, Jalal al-Ahmad CrossTehran, Iran.

Purpose: Indices of ventricular repolarization heterogeneity are associated with future arrhythmias and sudden cardiac death. We investigated the effect of exercise-based cardiac rehabilitation (CR) on these indices in a sample of Iranian patients.

Methods: Patients (N 122), who had undergone coronary artery bypass surgery (CABGS), were enrolled in this cohort study. Sixty patients attended 15 or more sessions of CR (CR group) and the remaining 62 patients attended 5 or fewer sessions of CR (control group). A standard 12-lead electrocardiogram was recorded for each patient. QT interval dispersion (QTd), RR interval variability (RRV), and heart rate-corrected QTd (QTc-d) were measured 3 times as follow: just before surgery, at the beginning of the first session of the CR program, and at the end of the 15th session for the CR group or the last session for the control group.

Results: Following completion of the exercise-training program, the CR group showed a significant decrease in QTd (Δ = -49.4%, P < .0001) and QTc-d (Δ = 52.8%, P .0001), but not in the control group (Δ = 13.4% and 17.9%, respectively, P > .05 for both). In both groups, no statistically significant change in RRV was observed. After adjustment for variables such as age, gender, digoxin use, β-blocker use, and prerehabilitation ejection fraction, CR remained the independent predictor of QTd and QTc-d.

Conclusion: Results suggest that cardiac rehabilitation and exercise training programs significantly improve the indices of ventricular repolarization heterogeneity in patients with coronary artery disease who received CABGS.
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http://dx.doi.org/10.1097/HCR.0b013e318211e3c0DOI Listing
December 2011