Publications by authors named "Isa Khaheshi"

65 Publications

Retinal Changes in Patients with Angina Pectoris and Anginal Equivalents: A Study of Patients with Normal Coronary Angiography.

Rom J Intern Med 2020 Nov 24. Epub 2020 Nov 24.

Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Approximately 10-30% of the patients with typical symptoms of angina pectoris have normal angiography showing normal macrovasculature. In these patients, however, the microvascular problems should be monitored. Hence, the main aim of this study is to evaluate retinal changes in normal angiographic patients. In this descriptive cross-sectional study, 60 normal angiographic patients with typical chest pain or anginal equivalents visiting Modarres Hospital Cardiology Research Center between 2018 and 2019 were enrolled and retinal changes were determined in Labbafinejad Hospital by Optical Coherence Tomography Angiography using Foveal Avascular Zone (FAZ), Superficial Vascular Density (SVD), and Deep Vascular Density (DVD). The results of this study demonstrated that FAZ was normal in all subjects, but SVD and DVD were abnormal in 45% and 8.3%, respectively. Totally, 18.5% and 66.7% showed abnormal SVD among stable angina (SA) and unstable angina (UA) cases, respectively (P < 0.001). There was no statistically significant difference between abnormal DVD in SA and UA cases (P=0.058). Abnormal SVD was significantly more common among diabetic patients (P < 0.001), while DVD was not related to diabetes presence in the study population (P > 0.05). Moreover, abnormal SVD was more common among patients with chest pain (P=0.036), while there was no significant difference for DVD (P=0.371). Interestingly, abnormal ECG was associated with both abnormal DVD and SVD. The results of this study showed that nearly half of the patients with angina pectoris or anginal equivalents who revealed normal angiographic findings may suffer from retinal changes. Thus, retinal assessment is needed in these patients to evaluate microvascular changes.
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http://dx.doi.org/10.2478/rjim-2020-0039DOI Listing
November 2020

The right ventricle in COVID-19 patients.

Eur Heart J 2021 02;42(6):559-560

Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran.

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http://dx.doi.org/10.1093/eurheartj/ehaa832DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7717190PMC
February 2021

Cardiac arrest after topical application of lidocaine during microneedling procedure: A rare case.

Dermatol Ther 2020 11 20;33(6):e14406. Epub 2020 Oct 20.

Department of General Surgery, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

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http://dx.doi.org/10.1111/dth.14406DOI Listing
November 2020

Peripheral Blood Mononuclear Cells Expression Levels of miR-196a and miR-100 in Coronary Artery Disease Patients.

Immunol Invest 2020 Sep 15:1-11. Epub 2020 Sep 15.

Department of Medical Genetics, Faculty of Medicine, Shahid Beheshti University of Medical Sciences , Tehran, Iran.

As a chronic inflammatory disease, coronary artery disease (CAD) is a common cause of death worldwide. Dysregulation of microRNA expression levels in peripheral blood mononuclear cells (PBMCs) may contribute to CAD and serve as a potential diagnostic biomarker. Here, we evaluated PBMC expression of two CAD-related inflammatory miRNAs, miR-196a and miR-100, in PBMCs of CAD patients with significant stenosis (CAD, n: 72), patients with insignificant coronary stenosis (ICAD, n: 30), and controls (n: 74) and checked whether they can segregate study groups. MiRNA expression was evaluated using the standard stem-loop RT-qPCR method. MiR-196a expression was downregulated in ICAD compared to CADs and healthy groups. MiR100 expression levels were not different between groups. The receiver operating characteristic (ROC) curve analysis acquainted that miR-196a expression levels in PBMC could segregate CAD individuals or any of its clinical manifestations (i.e. unstable angina, stable angina, acute myocardial infarction) from ICADs. In conclusion, this study reported a distinct miR-196a expression pattern in PBMCs of all patient groups and recommended a biomarker potential for miR-196a in discriminating ICADs from CADs or healthy controls.
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http://dx.doi.org/10.1080/08820139.2020.1791177DOI Listing
September 2020

How to overcome cardiovascular challenges in COVID-19 patients: a guide for common practice.

Acta Biomed 2020 09 7;91(3):e2020021. Epub 2020 Sep 7.

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The COVID-19 epidemic initially started in Wuhan, China in December 2019 due to SARS-CoV-2. SARS-CoV-2 is genetically similar to the bat beta-coronavirus genus, but the novel specie of this genus can infect humans. The most common clinical features of COVID-19 are fever, cough, myalgia, fatigue, expectoration, and dyspnea. The primary reported mortality rate was about 2-3% in China; however, it reached up to 10% among patients with underlying cardiovascular diseases. The primary epidemiological investigations showed a high prevalence of underlying cardiovascular diseases in more than 40% of infected patients. A high prevalence of hypertension, ischemic heart disease, and diabetes were reported among deceased patients in Italy. Previous experiments in different pandemic situations showed that the cardiovascular system has been affected in many ways. Previous studies on SARS-CoV and MERS-CoV reported that cardiovascular co-morbidities had a direct correlation with the risk of infection, the severity of disease, and the mortality rate. Therefore, brief and available protocols for controlling the negative effects of this novel respiratory infection on the cardiovascular system, especially in a high-risk populations with underlying cardiovascular conditions, is one of the most serious concerns among healthcare providers. Herein, we aimed to review the available data on the cardiac manifestation of COVID-19. Besides, we described useful maps for the better treatment of COVID-19 infection in patients with underlying cardiovascular conditions, as a high-risk group of patients.
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http://dx.doi.org/10.23750/abm.v91i3.9848DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7716966PMC
September 2020

Air Pollution and Cardiac Arrhythmias: A Comprehensive Review.

Curr Probl Cardiol 2021 Mar 22;46(3):100649. Epub 2020 Jul 22.

Air pollution is the mixture of some chemical and environmental agents including dust, fumes, gases, particulate matters, and biological materials which can be harmful for the environment and the human body. The increasing trend of the air pollution, especially in developing countries, may exert its detrimental effects on human health. The potentially harmful effects of air pollution on the human health have been recognized and many epidemiological studies have clearly suggested the strong association between air pollution exposure and increased morbidities and mortalities. Air pollutants are classified into gaseous pollutants including carbon mono oxide, nitrogen oxides, ozone and sulfur dioxide, and particulate matters (PMs). All air pollutants have destructive effects on the health systems including cardiovascular system. Many studies have demonstrated the effect of air pollutant on the occurrence of ST elevation myocardial infarction, sudden cardiac death, cardiac arrythmias, and peripheral arterial disease. Recently, some studies suggested that air pollution may be associated with cardiac arrhythmias. In this study, we aimed to comprehensively review the last evidences related to the association of air pollutant and cardiac arrythmias. We found that particulate matters (PM, PM, and UFP) and gaseous air pollutants can exert undesirable effects on cardiac rhythms. Short-term and long-term exposure to the air pollutants can interact with the cardiac rhythms through oxidative stress, autonomic dysfunction, coagulation dysfunction, and inflammation. It seems that particulate matters, especially PM have stronger association with cardiac arrhythmias among all air pollutants. However, future studies are needed to confirm these results.
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http://dx.doi.org/10.1016/j.cpcardiol.2020.100649DOI Listing
March 2021

Coronary pseudoaneurysm 1 week after complex percutaneous coronary intervention with drug-eluting stent.

Clin Case Rep 2020 Jul 30;8(7):1296-1298. Epub 2020 Apr 30.

Cardiovascular Research Center Shahid Beheshti University of Medical Sciences Tehran Iran.

Pseudoaneurysm formation is a rare complication after complex PCI with drug-eluting stents. Cardiologists and interventionist should be familiar with this rare complication after PCI and its management options.
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http://dx.doi.org/10.1002/ccr3.2910DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7364079PMC
July 2020

Association between Serum Vitamin D Level and Echocardiographic Abnormalities in Patients with Thalassemia Major.

Cardiovasc Hematol Disord Drug Targets 2020 ;20(3):214-220

Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Objectives: Thalassemia major (TM) is one of the most common blood disorders with a high mortality rate due to cardiovascular disease. Vitamin D deficiency has been suggested to implicate in cardiac abnormalities. In this prospective study, we aimed to investigate the relationship between serum levels of vitamin D and tissue Doppler (TD) echocardiographic indices in thalassemia major patients.

Methods: A total of 81 TM patients, including 56 females and 25 males, with a mean age of 27.5± 6.8 years, were enrolled consecutively. Serum levels of vitamin D and other biomedical parameters were measured. Then, all patients were subjected to TD echocardiography. Correlations between the serum parameters and systolic and diastolic indices were examined.

Results: The serum level of vitamin D was correlated with systolic and diastolic indices such as the EF (r= 0.33, P= 0.003) and TD Imaging (TDI)-lateral (r= 0.31, P= 0.005). However, no correlations were observed between vitamin D deficiency and the LV septal and posterior wall thickness, TDIseptal, tricuspid regurgitation peak gradient (TRPG), pulmonary artery systolic pressure (PASP), deceleration time (DT), and propagation velocity (PVcm/s) indices. The results revealed also no linear correlations between serum vitamin D and albumin (r= -0.17, P= 0.06), ALP (r= -0.12, P= 0.14), T4 (r= -0.11, P= 0.16), as well as TSH (r= -0.10, P= 0.19).

Conclusion: It seems that vitamin D deficiency in patients with TM is associated with systolic but not diastolic dysfunctions, possibly as consequences of related biochemical abnormalities.
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http://dx.doi.org/10.2174/1871529X20666200701104931DOI Listing
January 2020

Double orifice mitral valve in a patient with bicuspid aortic valve and coarctation of the aorta: A rare presentation.

Clin Case Rep 2020 Jun 10;8(6):1021-1024. Epub 2020 Mar 10.

Cardiovascular Research Center Shahid Beheshti University of Medical Sciences Tehran Iran.

Double orifice mitral valve is a rare condition and may be accompanied by a bicuspid aortic valve (sometimes normal functioning) and coarctation of the aorta. Echocardiography is valuable in detecting the accompanied anomalies. Management depends on the severity of mitral valve function and the severity of associated anomalies.
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http://dx.doi.org/10.1002/ccr3.2788DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7303849PMC
June 2020

Pulmonary thromboembolism presenting with chest pain in a case of peripartum cardiomyopathy.

Future Cardiol 2020 Jul 17;16(4):263-269. Epub 2020 Mar 17.

Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Peripartum cardiomyopathy (PPCM) is an idiopathic reduction in left ventricular function, presenting at the peripartum period. The diagnosis is based on echocardiographic features and excluding other causes of heart failure. Similar to any other cause of heart failure, the management of PPCM consists of diuretics, prevention of ventricular remodeling, preventing short and long-term complications. Ventricular clots, transient cerebral ischemic attacks, lower extremity thrombosis, kidney and liver infarcts and pulmonary thromboembolism have been previously reported in PPCM cases. Among them, pulmonary thromboembolism is one of the most important complications, as it is also a challenging differential diagnosis of PPCM. We discuss a case of PPCM followed by a diagnosis of pulmonary thromboembolism and briefly review the relevant PPCM literature.
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http://dx.doi.org/10.2217/fca-2019-0029DOI Listing
July 2020

A new approach to cardiac fat volume assessment and the correlation with coronary artery calcification.

Rom J Intern Med 2020 Jun;58(2):81-91

Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Coronary artery disease (CAD) is the foremost cause of death in the most developed societies. Plaque formation in epicardial coronary arteries and ensuing inflammation are a known pathophysiologic factor of CAD.

Objectives: We aimed to separately and simultaneously evaluate the correlation between pericardial fat pad volume and overall peri-coronary epicardial adipose tissue (EAT) thickness with coronary calcium score (CCS) to improve risk stratification of CAD.

Methods: We retrospectively reviewed patients who underwent a non-invasive contrast-enhanced coronary multidetector CT (MDCT) angiography. Peri-coronary EAT thickness, pericardial fat pad volume and CCS were obtained by an expert radiologist from the patients coronary multidetector CT (MDCT) angiography.

Results: We included 141 symptomatic patients (86 men, 55 women) with an average age of 53.53 ± 12.92. An increment of overall peri-coronary EAT thickness (1/3 × (left anterior descending artery (LAD) + left circumflex artery (LCx) + right coronary artery (RCA)) was associated with a 49% increase in the odds for the presence of coronary artery calcification (CAC) (P = 0.004). Significant predictability of peri-coronary EAT-average was seen in diagnosing calcified plaque. Pericardial fat pad volume was positively correlated with overall peri-coronary EAT thickness in age and body mass index (BMI)-adjusted linear regression models, (P < 0.001).

Conclusion: Our results amplify previous idea that peri-coronary EAT and pericardial fat pad volume might act as useful markers and better indicators of CCS based on Agatston score in comparison with BMI or body weight in order to reveal subsequent CADs.
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http://dx.doi.org/10.2478/rjim-2020-0002DOI Listing
June 2020

Stroke Following Successful PTMC in a Patient with Severe Mitral Stenosis: A Case Report and Presenting A Simple Stepwise Approach to PTMC-related Stroke.

Cardiovasc Hematol Disord Drug Targets 2020 ;20(3):232-236

School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.

Stroke following percutaneous trans-septal mitral commissurotomy (PTMC) is an unusual complication that could significantly affect the quality of life of the patients, particularly the young and active ones. We present a middle-aged woman who experienced stroke following PTMC and successfully treated with thrombolytic therapy regarding the potential adverse effects of this type of therapy. Also, we present a simple novel stepwise clinical approach for PTMC-related stroke.
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http://dx.doi.org/10.2174/1871529X20666200220125123DOI Listing
January 2020

Assessment of Admission Time Cell Blood Count (CBC) Parameters in Predicting Post-primary Percutaneous Coronary Intervention TIMI Frame Count in Patients with ST-segment Elevation Myocardial Infarction.

Cardiovasc Hematol Disord Drug Targets 2020 ;20(3):191-197

School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.

Objectives: In this study, we aimed to assess the value of admission time CBC parameters in predicting post-primary PCI corrected TIMI frame count.

Background: Recent years have witnessed a large series of studies evaluating different laboratory variables to predict no-reflow phenomenon following primary PCI (PPCI) in patients with STEMI. However, a general agreement about the most reliable predictor of the no-reflow phenomenon is challenging and also intriguing.

Methods: The current study concluded 208 consecutive patients who underwent primary PCI for ST-Elevation Myocardial Infarction (STEMI) from January 2014 to February 2016. Blood samples were obtained after taking ECG. Complete blood samples were collected and analyzed within 5 minutes from sampling. Post-PCI corrected Thrombolysis in Myocardial Infarction (TIMI) frame count was determined by one interventional cardiologist blinded to patients' clinical data. The correlation between admission time blood parameters and post-primary PCI corrected TIMI frame count in patients with STEMI were assessed.

Results: Corrected TIMI frame count was positively correlated with WBC count (R: 0.18, P-value: <0.01), neutrophil count (R: 0.34, P-value: <0.01), and platelet count (R: 0.23, P-value: <0.01) and negatively correlated with lymphocyte count (R: -0.2, P-value: <0.01). Multiple linear regression results demonstrated that corrected TIMI frame count was positively correlated with neutrophil count (P < 0·001) and platelet count (P < 0·001) and negatively correlated with lymphocyte count (p=0.004).

Conclusion: High counts of WBC, neutrophil, and platelet and low count of lymphocyte may be predictors of no-reflow in STEMI patients undergoing PPCI. The clinical significance of such predictive parameters becomes clear as we consider the treatment approach in STEMI patients. Appropriate risk stratification leads to better treatment planning and allocation of resources.
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http://dx.doi.org/10.2174/1871529X20666200206123118DOI Listing
January 2020

Subclinical involvement of the heart and its associated factors in patients with sarcoidosis with normal systolic function using 2D speckle tracking.

Echocardiography 2020 01 15;37(1):41-46. Epub 2020 Jan 15.

Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Cardiac involvement by sarcoidosis may affect any part of the heart such as the pericardium, atriums, ventricles, and papillary muscles. In this regard, the use of two-dimensional speckle-tracking strain has been reported to be valuable in detecting heart sarcoidosis and its distinction from cardiomyopathy. The aim of this study was to investigate subclinical cardiac involvement using 2D speckle tracking and its associated factors in patients with normal systolic function by 2D transthoracic echocardiography (TTE).

Methods: In this study, 55 patients with extra-cardiac sarcoidosis and 21 normal people were evaluated by 2D speckle tracking. The mean longitudinal global strain for the left ventricle was calculated as an average of 16 segments per patient.

Results: The comparison of the mean 2D speckle-tracking indices including GCS (global circumferential strain) SAXA, GCSSAXM, Average GCS, AP2LS, AP3LS, AP4LS, and also Average GLS (global longitudinal strain) showed a significant difference between the two groups. Also, the evaluation of each of the above indices with a specific cutoff point as well as a high sensitivity and acceptable specificity predicted the presence of sarcoidosis. The occurrence of changes in the above indices was independent of ventricular function by 2D echocardiography in these patients.

Conclusions: The marked changes in the 2D speckle-tracking parameters in patients with extra-cardiac sarcoidosis can be of great value in the prediction of cardiac involvement. The occurrence of the abovementioned cardiac changes can be completely independent of the involvement of left ventricular function and is therefore predictable in patients with normal ventricular function.
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http://dx.doi.org/10.1111/echo.14572DOI Listing
January 2020

Prognostic Value of Cardiac Biomarkers Assessment in Combination with Myocardial 2D Strain Echocardiography for Early Detection of Anthracycline-Related Cardiac Toxicity.

Cardiovasc Hematol Disord Drug Targets 2020 ;20(1):74-83

Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Anthracyclines, a widely used chemotherapy agent with a definite survival improvement, can result in cardiac toxicity presenting with HF (heart failure).

Objective: We aim to assess the predictive value of cardiac biomarkers assessment in combination with myocardial two-dimensional strain echocardiography for early detection of cardiac toxicity in patients who underwent Anthracycline-based chemotherapy.

Methods: Fifty-two consecutive adult patients scheduled to undergo the first course of Anthracycline-based chemotherapy were subjected to the study. All the patients underwent highly sensitive 2D echocardiographic evaluation before the treatment, 4 and 12 weeks after completion of first-course chemotherapy. Longitudinal and segmental strains were measured. Serum levels of High-sensitive cardiac troponin I (hscTn-I) and N-terminal-pro-BNP (NT-proBNP) were also assessed before the initiation and 3 weeks after completion of first-course chemotherapy.

Results: Fifteen patients (28.8%) revealed a decrease in LVEF (Left Ventricular Ejection Fraction) throughout the evaluations, while just 5 patients met the criteria of cardiac toxicity (9.6%). AUC for Global Longitudinal Strain (GLS) ROC curve at 4 weeks of follow-up was calculated to be 0.968. Inferoseptal Systolic Longitudinal Strain (SLS) had the highest AUC value (AUC: 0.934) among different wall SLS. LVESD (Left Ventricular End-Systolic Diameter) at first and second evaluation could predict the risk of cardiac toxicity among LVESD, LVEDD (Left Ventricular End Diastolic Diameter) and LVEDV (Left Ventricular End-Diastolic Volume). Among cardiac biomarkers, hscTnI had higher sensitivity, while NT-proBNP had higher specificity for cardiac toxicity.

Conclusion: This study has shown that hs-cTnI with good sensitivity can predict cardiac toxicity in Anthracycline-based chemotherapy receiver. The use of strain with speckle echocardiography method has a prognostic value; however, both longitudinal and segmental strain should be assessed. Lateral and inferoseptal SLS (Segmental Longitudinal Strain) are specific markers of cardiac toxicity in the course of anthracycline-related cardiac toxicity.
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http://dx.doi.org/10.2174/1871529X19666190912150942DOI Listing
January 2020

Dysregulated expression of STAT1, miR-150, and miR-223 in peripheral blood mononuclear cells of coronary artery disease patients with significant or insignificant stenosis.

J Cell Biochem 2019 12 18;120(12):19810-19824. Epub 2019 Jul 18.

Department of Medical Genetics, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Coronary artery disease (CAD) is a multicellular disease characterized by chronic inflammation. Peripheral blood-mononuclear cells (PBMCs), as a critical component of immune system, actively cross-talk with pathophysiological conditions induced by endothelial cell injury, reflecting in perturbed PBMC expression. STAT1 is believed to be relevant to CAD pathogenesis through regulating key inflammatory processes and modulating STAT1 expression play key roles in fine-tuning CAD-related inflammatory processes. This study evaluated PBMC expressions of STAT1, and its regulators (miR-150 and miR-223) in a cohort including 72 patients with CAD with significant ( ≥ 50%) stenosis, 30 patients with insignificant ( < 50%) coronary stenosis (ICAD), and 74 healthy controls, and assessed potential of PBMC expressions to discriminate between patients and controls. We designed quantitative real-time polymerase chain reaction (RT-qPCR) assays and identified stable reference genes for normalizing PBMC quantities of miR-150, miR-223, and STAT1 applying geNorm algorithm to six small RNAs and five mRNAs. There was no significant difference between CAD and ICAD patients regarding STAT1 expression. However, both groups of patients had higher levels of STAT1 than healthy controls. miR-150 and miR-223 were differently expressed across three groups of subjects and were downregulated in patients compared with healthy controls, with the lowest expression levels being observed in patients with ICAD. ROC curves suggested that PBMC expressions may separate between different groups of study subjects. PBMC expressions also discriminated different clinical manifestations of CAD from ICADs or healthy controls. In conclusion, the present study reported PBMC dysregulations of STAT1, miR-150, and miR-223, in patients with significant or insignificant coronary stenosis and suggested that these changes may have diagnostic implications.
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http://dx.doi.org/10.1002/jcb.29286DOI Listing
December 2019

The Association between the Pulmonary Arterial Obstruction Index and Atrial Size in Patients with Acute Pulmonary Embolism.

Radiol Res Pract 2019 2;2019:6025931. Epub 2019 Jun 2.

Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Purpose: Pulmonary embolism (PE) is a common and potentially fatal form of venous thromboembolism. The aim of this study is to investigate the association between the pulmonary arterial obstruction index and atrial size in patients with acute pulmonary embolism.

Basic Procedure: The study consisted of 86 patients with clinical symptoms of PE. Out of 86 individuals, 50 patients were diagnosed with PE and considered as the patient group. The others were considered as the control group. All patients were scanned by a multidetector CT scanner. Using the radiology workstation, an expert radiologist calculated the left atrium (LA) and right atrium (RA) areas from planimetric measurements obtained from free-hand delineation of the atrial boarders using an electronic pen. Quantitative volumetric measurements of LA and RA were obtained from original axial images.

Main Findings: There were 25 males and 25 females with PE, who had a mean age of 58 years. There was not a significant difference in the positive history of diabetes mellitus, hypertension, asthma, chronic obstructive pulmonary diseases, ischemic heart disease, and smoking between patients and control group. There was a significant negative correlation between almost all LA measurements and the PAOI. RA area and volume had the highest area under the curves for recognizing larger clot burden.

Principal Conclusions: A higher clot load is associated with a smaller LA size and increased RA/LA ratios, measured with CTPA. Atrial measurements are correlated with POAI, and they could be used as sensitive parameters in predicting heart failure in patients with PE.
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http://dx.doi.org/10.1155/2019/6025931DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6582783PMC
June 2019

Expression pattern of miR-21, miR-25 and PTEN in peripheral blood mononuclear cells of patients with significant or insignificant coronary stenosis.

Gene 2019 May 6;698:170-178. Epub 2019 Mar 6.

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

Coronary artery disease (CAD) is primarily caused by atherosclerosis, which is a series of chronic inflammatory processes leading to the initiation and progression of vascular endothelial cell injury enhancing plaque formation. As critical components of the immune system, peripheral blood mononuclear cells (PBMCs) actively cross-talk with pathophysiological conditions induced by endothelial cell injury, reflecting in altered PBMC expression pattern. This study explored PBMC expression levels of miR-21, miR-25 and PTEN in patients with angiographically proven significant coronary stenosis (the CAD group), patients with insignificant coronary stenosis (the ICAD group) and healthy subjects, and assessed potentials of PBMC expressions in discriminating groups of study subjects. In-silico analysis was also performed to obtain insights into CAD-related pathways and biological processes that may be influenced by altered miRNA expressions. A reduced level of PBMC miR-21 was observed in the ICAD group compared to the CAD group (P: 0.004) or healthy controls (P: 0.0001). PBMC miR-21 level was negatively correlated with the PTEN expression (Spearman r: -0.43, P: 3.9e-09). The PTEN expression was increased in the CAD or ICAD group compared to the control group (CAD vs. controls P: 0.0003, ICAD vs. controls P: 0.03). A stepwise increase in PBMC miR-25 levels was observed from healthy controls to ICADs and CAD patients (Kruskal-Wallis P: 7.68e-12). PBMC gene expressions had reasonable power to discriminate between pairs of study groups. PBMC miR-21 levels were able to discriminate ICADs from both CADs and controls and miR-25 levels had potentials to differentiate among all pairs of study groups (i.e. CADs-ICADs, CADs-controls, CADs-all other subjects, ICADs-controls). PBMC PTEN expression was able to discriminate patients with CAD or ICAD from control subjects. Overrepresentation enrichment analysis of experimentally validated targets of miR-21 and miR-25 highlighted key biological processes and pathways, such as "angiogenesis" and "leukocyte cell-cell adhesion", that may be influenced by dysregulation of PBMC miR-21 and miR-25. In conclusion, these findings suggest that patients with insignificant coronary stenosis may have a distinct PBMC miRNA expression profile than those with significant stenosis or healthy controls.
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http://dx.doi.org/10.1016/j.gene.2019.02.074DOI Listing
May 2019

Huge aneurysmal fistula from left main artery to right atrium in a man with atypical chest pain and dyspnea on exertion.

Future Cardiol 2019 03 8;15(2):85-88. Epub 2019 Mar 8.

Non-Communicable Diseases Research Center, Endocrinology & Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.

We present a 33-year-old man with atypical chest pain and with no significant past medical history. The patient was finally diagnosed as a case of huge fistula from the left main coronary artery to the right atrium, a very rare condition with challenging diagnostic and therapeutic approaches. The majority of cases of coronary artery fistula are small, asymptomatic and clinically undetectable; they frequently do not cause any complications and can spontaneously resolve. However, larger fistulas are frequently three times the size of a typical caliber of a coronary artery and may or may not cause symptoms or complications.
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http://dx.doi.org/10.2217/fca-2018-0015DOI Listing
March 2019

Pentraxin Level is the Key to Determine Primary Percutaneous Coronary Intervention (PCI) or Fibrinolysis.

Cardiovasc Hematol Disord Drug Targets 2019 ;19(2):160-168

Golestan Hospital Clinical Research Development Unit, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Aims: To examine if pentraxin can help identify patients benefitting most from primary Percutaneous Coronary Intervention (PCI) vs. fibrinolysis.

Methods: Patients with acute ST-Elevation Myocardial Infarction (STEMI) were consecutively recruited from a community center without PCI and a tertiary center with PCI facilities. Left ventricular ejection fraction (LVEF) was determined echocardiographically at baseline and 5 days after the index admission; the difference between two measurements was considered as the magnitude of improvement. We used regression models to test the hypothesis that the magnitude of the advantage of PCI over fibrinolysis in preserving LVEF 5 days after STEMI is modified by pentraxin 3 (PTX3).

Results: The functional advantage (LVEF) of the PCI over fibrinolysis has been determined by PTX3. LVEF was attenuated and even reversed as PTX3 level increased. The primary PCI of the participants with less than 7 ng.ml-1 PTX3 level, achieved a clinically significant increase in the LVEF as compared to fibrinolysis. At lower levels of PTX3, PCI shows a conspicuous advantage over fibrinolysis in terms of the probability of developing an LVEF <40%.

Conclusion: We demonstrated not only the functional advantage of PCI over fibrinolysis performed within the recommended time frames but also the relative advantage of its relevance to the baseline PTX3 levels. PTX3 can play a role in determining the choice of best therapy. More than 75% of patients with STEMI who have PTX3 levels ≤7 ng.ml-1 imply the need of PCI.
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http://dx.doi.org/10.2174/1871529X19666181120161810DOI Listing
July 2020

Mahaim fibers coexisting with coarctation of aorta and bicuspid aortic valve.

Future Cardiol 2018 11 13;14(6):483-489. Epub 2018 Nov 13.

Department of Medicine, University of Arizona, School of Medicine, Tucson, Arizona, USA.

We found a coexistence of Mahaim fibers, coarctation of aorta and bicuspid valve in a young patient presenting with palpitations and subraventricular tachycardia. This rare combination of these three congenital cardiac abnormalities occurring in the same patient has not been reported previously. Detailed cardiac studies unmasked the patient's cardiac abnormalities. Furthermore, successful percutaneous intervention in treating coarctation and catheter-based ablation of Mahaim fibers were performed with resolution of symptoms. This case is discussed here in detail, alongside a review of the literature.
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http://dx.doi.org/10.2217/fca-2017-0093DOI Listing
November 2018

The role of FFR in clinical decision making in patients with moderate coronary lesions: a pilot study.

Acta Biomed 2018 10 8;89(3):378-381. Epub 2018 Oct 8.

Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran..

Background And Aim: Applying fractional flow reserve (FFR) recently helped to assess borderline coronary defects and also facilitates assessment of these lesions. The present study aimed to assess cost-effectiveness of FFR in detection of these borderline lesions.

Methods: This cross-sectional study was conducted on140 consecutive patients with 219 diseased arteries who underwent coronary angiography and suffered intermediate coronary lesions.

Results: Of 18 patients who candidate for CABG before FFR, only one patient underwent CABG after determining FFR (P-value<0.05), while 15 patients were scheduled for PCI and 2 patients for medical treatment. Of 122 patients who candidate for PCI, 59 were programmed to underwent PCI after FFR determination(P-value<0.05), while the strategy in 63 patients (47 with one-vessel disease, 15 with two vessel diseases, and 1 with three vessel diseases) was modified to medical treatment. Considering strategy modifying from PCI to medical treatment, 101 stents were saved (P-value<0.05). Also, in change of strategy from CABG to PCI, spending has decreased as much as 77.3% (P-value<0.05). Furthermore, the change of treatment approach from PCI on much number of coronary vessels to PCI on less number of coronary lesions led to saving of 52.2% of costs(P-value<0.05).

Conclusions: In patients with an intermediate coronary lesion, measuring FFR to guide the decision to determine treatment strategy may lead to significant cost savings.
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http://dx.doi.org/10.23750/abm.v89i3.5605DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6502121PMC
October 2018

Is it necessary to discontinue metformin in diabetic patients with GFR > 60 ml/min per 1.73 m2 undergoing coronary angiography: A controversy still exists?

Acta Biomed 2018 06 7;89(2):227-232. Epub 2018 Jun 7.

MD Students' Scientific Research center (SSRC) , Tehran University ofMedical Sciences (TUMS) , Tehran , Iran..

Background: Although metformin is not directly nephrotoxic, it has been postulated that it can impair gluconeogenesis from lactate, which may lead lactate to be accumulated under circumstances such as contrast-induced nephropathy. The present study aims to assess the role of metformin in lactate production in a group of diabetic patients with GFR > 60 ml/min per 1.73 m2undergoing coronary angiography.

Methods: In the present randomized clinical trial, 162 metformin-treated diabetic patients were enrolled. The enlisted patients were scheduled to undergo coronary angiography at Modarres Hospital from Feb 2012 to Nov 2012. Patients were randomly allocated to continue metformin during peri-angiography period (M (+) group) or to stop the medication 24 hours prior the procedure (M (-) group). All the patients had glomerular filtration rate of >60 mL/min per 1.73 m2. Iodixanol was the only contrast media which in all patients. Metformin-associated lactic acidosis (MALA) was defined as an arterial pH <7.35 and plasma lactate concentration >5 mmol⁄L.

Results: 162 patients, including79 (48.7%) male and 83 (51.3%) female patients were enrolled in the study. The average of GFR was comparable in both groups (76 ml/min per 1.73 m2 in the M (+) group versus 79 ml/min per 1.73 m2 in the M (-) group, p=0.53). No significant difference was observed in the mean dose of metformin before the study between the 2 groups (2.18 tablets per day in M (+) group vs. 2.21 tablets per day in M(-) group, p=0.62).No lactic acidosis was observed in the studied groups.

Conclusion: In conclusion, the results of the present study indicate that metformin continuation in diabetic patients with a GFR of more than 60 ml/min per 1.73 m2 undergoing coronary angiography does not enhance the risk of MALA development.
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http://dx.doi.org/10.23750/abm.v89i2.5446DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6179027PMC
June 2018

Cystatin C may not be a precious predictor for coronary artery disease and its severity: an area of uncertainty.

Acta Biomed 2018 06 7;89(2):209-213. Epub 2018 Jun 7.

Cardiovascular Research Center, Modarres hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran..

Background And Aim: Cystatin C, an endogenous indicator for kidney function, may be also an original indicator for coron Background and Aim: Cystatin C, an endogenous indicator for kidney function, may be also an original indicator for coronary atherosclerosis. In the current study, we intended to assess its role in establishing the existence of coronary artery disease. We also attempted to present the best cut off point for Cystatin C to discriminate coronary disease from normal coronary condition.

Methods: 147 consecutive patients who were candidate for coronary angiography were included into the study. Cystatin C was measured using Auto-analyzer system and by Gentian kit with enzyme calorimetric method.

Results: The mean level of Cystatin C in the patients with and without coronary artery disease was 0.97±0.51 mg/l and 1.02±0.40 mg/l with no significant difference (p=0.564). In multivariate logistic regression model, the serum level of Cystatin C could not predict coronary artery disease (OR=1.199, 95% CI: 0.531 to 1.706, p=0.662). According to the area under the ROC curve, Cystatin C was not a good indicator to discriminate coronary artery disease from normal coronary condition (AUC=0.465, 95% CI: 0.372 to 0.559, p=0.470). Considering cut of points of 0.85 and 0.94 for Cystatin C, the sensitivity of this test for predicting coronary artery disease in comparison with coronary angiography was 65% and 51%, respectively. In assessing relationship between serum level of Cystatin C and other chemical biomarkers, Cystatin C was only correlated with serum triglyceride level (r=0.207, p=0.012).

Conclusions: Cystatin C measurement may not be a suitable predictor for coronary artery disease and severity of the coronary involvement. Future studies with large sample size are necessitated to demarcate distinct role of Cystatin C in coronary artery disease.    ary atherosclerosis. In the current study, we intended to assess its role in establishing the existence of coronary artery disease. We also attempted to present the best cut off point for Cystatin C to discriminate coronary disease from normal coronary condition.

Methods: 147 consecutive patients who were candidate for coronary angiography were included into the study. Cystatin C was measured using Auto-analyzer system and by Gentian kit with enzyme calorimetric method.  Results: The mean level of Cystatin C in the patients with and without coronary artery disease was 0.97 ± 0.51 mg/l and 1.02 ± 0.40 mg/l with no significant difference (p = 0.564). In multivariate logistic regression model, the serum level of Cystatin C could not predict coronary artery disease (OR = 1.199, 95% CI: 0.531 to 1.706, p = 0.662). According to the area under the ROC curve, Cystatin C was not a good indicator to discriminate coronary artery disease from normal coronary condition (AUC = 0.465, 95%CI: 0.372 to 0.559, p = 0.470). Considering cut of points of 0.85 and 0.94 for Cystatin C, the sensitivity of this test for predicting coronary artery disease in comparison with coronary angiography was 65% and 51%, respectively. In assessing relationship between serum level of Cystatin C and other chemical biomarkers, Cystatin C was only correlated with serum triglyceride level (r = 0.207, p = 0.012).

Conclusions: Cystatin C measurement may not be a suitable predictor for coronary artery disease and severity of the coronary involvement. Future studies with large sample size are necessitated to demarcate distinct role of Cystatin C in coronary artery disease.
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http://dx.doi.org/10.23750/abm.v89i2.5495DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6179010PMC
June 2018

The role of air pollution on ST-elevation myocardial infarction: a narrative mini review.

Future Cardiol 2018 07 22;14(4):301-306. Epub 2018 Jun 22.

Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran.

ST-elevation myocardial infarction (STEMI) is one of the potential causes of death worldwide. In spite of substantial advances in its diagnosis and treatment, STEMI is still considered as a major public health dilemma in developed and particularly developing countries. One of the triggering factors of STEMI is supposed to be air pollutants like gaseous pollutants including, sulfur dioxide, nitric dioxide, carbon monoxide, ozone and particulate matters (PM) including, PM under 2.5 µm (PM) and PM under 10 µm (PM). Air pollution can trigger STEMI with various mechanisms such as increasing inflammatory factors and changing the heart rate or blood viscosity. In this article, we aimed to explore research in the field and discuss the relationship between air pollution and STEMI.
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http://dx.doi.org/10.2217/fca-2017-0078DOI Listing
July 2018

Do Antiplatelet Drugs Increase the Risk of Bleeding After Dental Implant Surgery? A Case-and-Crossover Study.

J Oral Maxillofac Surg 2018 10 10;76(10):2092-2096. Epub 2018 May 10.

Student of Dentistry, Shahid Beheshti Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Purpose: Cessation versus continuation of antiplatelet drugs in patients undergoing dental implant surgery is a controversial issue. The present study evaluated postoperative bleeding during and after dental implant surgery in patients taking aspirin (ASA) or clopidogrel.

Material And Methods: The present study is a case-and-crossover study. Patients who were using antiplatelet drugs and receiving 2 bilateral dental implants in the posterior region of the mandible were studied. During session 1, dental implants were placed without stopping the intake of antiplatelet drugs. During session 2, antiplatelet drugs were stopped for 5 days. In group 1, platelet activity was measured by an assay based on flow cytometry and represented the platelet reactivity index. In group 2, platelet function analysis was used to monitor the antiplatelet effect of ASA. Bleeding severity was assessed using a visual analog scale for 72 hours after dental implant placement during sessions 1 and 2. Use of antiplatelet drugs was the predictive factor of the study and bleeding severity and platelet function were the outcomes of the study.

Results: Twenty-two patients composed group 1 (clopidogrel 75 mg) and 20 composed group 2 (ASA 80 mg). In group 1, bleeding severity was 4.86 ± 0.77 during session 1 and 4.59 ± 0.66 during session 2. Data analysis showed no difference in bleeding severity between sessions 1 and 2 in group 1 (P = .72). In group 2, bleeding severity was 4.05 ± 0.94 during session 1 and 3.9 ± 0.85 during session 2. There was no difference in bleeding severity between sessions 1 and 2 in patients taking ASA (P = .19).

Conclusion: The results suggest that continuing the intake of antiplatelet drugs did not increase bleeding after placement of dental implants.
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http://dx.doi.org/10.1016/j.joms.2018.04.036DOI Listing
October 2018

The severity of coronary artery disease was not associated with non-alcoholic fatty liver disease in a series of 264 non-diabetic patients who underwent coronary angiography.

Rom J Intern Med 2018 Sep;56(3):167-172

Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.

Background: It is now suggested an association between non-alcoholic fatty liver disease (NAFLD) and the occurrence of coronary artery disease even in non-diabetic patients. We will determine the rate of NAFLD and its main determinants in non-diabetic patients undergoing coronary angiography.

Methods: This cross-sectional study was accomplished on 264 patients who were candidates for coronary angiography during the year 2016. Coronary angiography has been done to depict the presence or absence of coronary involvement, and the severity of coronary artery disease by determining the number of vessels involved and also the SYNTAX score. During 48 hours after coronary angiography, the patients underwent abdominal ultrasonography for detection of NAFLD.

Results: The overall prevalence of NAFLD in the patients was 72.3%. The prevalence of NAFLD in those with and without coronary involvement was 71.9% and 73.1% respectively, with no notable difference (p = 0.837). The mean SYNTAX score in the patients with and without NAFLD was 22.32 ± 11.10 and 21.75 ± 10.71 respectively with no difference (p = 0.702). According to the multivariable regression models, the presence of NAFLD could not predict the likelihood of coronary artery disease (OR = 0.879, p = 0.669) or its severity assessed by the SYNTAX score (beta = 0.046, p = 0.456). NAFLD grade was also not a determinant for coronary artery disease (OR = 1.139, p = 0.178) or its severity (beta = 0.058, p = 0.165).

Conclusion: It seems that the presence and grade of NAFLD may not be correlated with atherosclerotic involvement of coronary arteries and its severity in non-diabetic patients. Future large studies and trials could elucidate the independent role of fatty liver in nondiabetic non-alcoholic patients.
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http://dx.doi.org/10.2478/rjim-2018-0009DOI Listing
September 2018

Rest 2D speckle tracking echocardiography may be a sensitive but nonspecific test for detection of significant coronary artery disease.

Acta Biomed 2018 01 16;88(4):457-461. Epub 2018 Jan 16.

Cardiovascular Research Center, Modarres hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Aims: To detect the significance of coronary artery disease in the patients, who are suspected, was assumed to be one of the advantages of 2D STE, as a novel non-invasive imaging modality with acceptable accuracy.

Methods: In this study, 216 patients who were suspected to have coronary artery disease and candidate for coronary angiography, underwent rest two-dimensional speckle tracking echocardiography (2D STE) and negative global systolic longitudinal strain was evaluated.

Results: Negative global systolic left ventricular longitudinal strain under 18% in rest 2D-STE was significantly prevalent in patients with significant CAD in coronary angiography (P value<0.0001).Our results revealed sensitivity of 91.1%, specificity of 63.0%, positive predictive value of 80.4%, negative predictive value of 81.0% and accuracy of 80.5% for rest 2D-STE in detection of significant CAD.

Conclusion: Here in we showed that rest Two-dimensional speckle tracking echocardiography could be a sensitive but nonspecific imaging modality to determine significant coronary artery disease. Future studies with large size will reveal more detailed findings.
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http://dx.doi.org/10.23750/abm.v88i4.5445DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6166178PMC
January 2018

Comparison of coronary risk factors and angiographic findings in younger and older patients with significant coronary artery disease.

Rom J Intern Med 2018 Jun;56(2):90-95

Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Coronary artery disease (CAD) is uncommon among young adults and may have certain characteristics that are different from those in older patients. The aim of the current study was to determine the risk factors of CAD, important laboratory data and angiographic findings in young patients with CAD and to compare them with the old patients.

Methods: Patients with typical chest pain whose CAD was confirmed by coronary angiography were included in the study. These patients were divided into 2 groups: ≥ 45 and < 45 years old; the risk factors of CAD and angiographic findings were determined in each group and further compared.

Results: Finally, 231 patients with CAD were included in the study. Thirty-five (30.4%) of patients younger than 45 years and 58 (50.0%) aged ≥ 45 had diabetes mellitus (P = 0.002). Statistically remarkable differences were observed between the two groups regarding hypertension (P < 0.001), myocardial infarction (P < 0.001), Gensini score Median (P < 0.001), ejection fraction in echocardiography (P < 0.001) and fasting blood sugar in laboratory data (P = 0.006). The older group, compared with the younger one, had higher left anterior descending (LAD) artery (P < 0.001), right coronary artery (RCA) (P < 0.001), 3 vessel disease (P < 0.001) and 2-vessel disease (P = 0.044); on the other hand, 1-vessel disease was higher in patients aged < 45(P < 0.001).

Conclusion: The risk profile and angiographic findings are different in young patients with CAD compared to older patients. Young patients with CAD tend to be male with a positive familial history, but with less diabetes or hypertension. The older patients had higher 3 vessel disease, 2-vessel disease and left anterior descending (LAD) artery and right coronary artery (RCA) involvements. In contrast, 1-vessel disease was higher in young patients aged <45.
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http://dx.doi.org/10.1515/rjim-2017-0048DOI Listing
June 2018

The association between exposure to air pollutants including PM, PM, ozone, carbon monoxide, sulfur dioxide, and nitrogen dioxide concentration and the relative risk of developing STEMI: A case-crossover design.

Environ Res 2018 02 24;161:299-303. Epub 2017 Nov 24.

Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Modarres Hospital, Kaj square, Sa'adat Abad Ave, Tehran 1998734383, Iran.

Background: Unfavorable associations between air pollution and myocardial infarction are broadly investigated in recent studies and some of them revealed considerable associations; however, controversies exists between these investigations with regard to culprit components of air pollution and significance of correlation between myocardial infarction risk and air pollution.

Methods: The association between exposure to PM, PM, ozone, carbon monoxide, sulfur dioxide, and nitrogen dioxide concentration of background air that residents of Tehran, the capital city of Iran, which is ranked as the most air polluted city of Iran and the relative risk of developing ST-elevation myocardial infarction (STEMI) were investigated by a case-crossover design. Our study included 208 patients admitted with a diagnosis of STEMI and undergone primary percutaneous intervention. Air pollutant concentration was averaged in 24-h windows preceding the time of onset of myocardial infarction for the case period. Besides, the mean level of each element of air pollution of the corresponding time in one week, two weeks and three weeks before onset of myocardial infarction, was averaged separately for each day as one control periods. Thus, 624 control periods were included in our investigation such that. Each patient is matched and compared with him/herself.

Results: The mean level of PM in case periods (61.47µg/m) was significantly higher than its level in control periods (57.86µg/m) (P-value = 0.019, 95% CI: 1.002-1.018, RR = 1.010). Also, the mean level of PM in case periods (95.40µg/m) was significantly higher than that in control days (90.88µg/m) (P-value = 0.044, 95% CI: 1.001-1.011, RR = 1.006). The level of other components including NO, SO, CO and O showed no significant differences between case and control periods. A 10µg/m increase in PM and PM would result in 10.10% and 10.06% increase in STEMI event, respectively. Furthermore, the results of sub-group analysis showed that older patients (equal or more than 60 year-old), diabetic patients, non-hypertensive ones and patients with more than one diseased vessel may be more vulnerable to the harmful effect of particular matters including PM and PM on development of STEMI.

Conclusion: Air pollution is a worldwide pandemic with great potential to cause terrible events especially cardiovascular ones. PM and PM are amongst ambient air pollutant with a high risk of developing STEMI. Thus, more restrictive legislations should be applied to define a safe level of indoor and outdoor air pollutant production.
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http://dx.doi.org/10.1016/j.envres.2017.11.020DOI Listing
February 2018