Publications by authors named "Maryam Shahrzad"

16 Publications

  • Page 1 of 1

Application of short message service to control blood cholesterol: a field trial.

BMC Med Inform Decis Mak 2017 03 28;17(1):32. Epub 2017 Mar 28.

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

Background: Despite recommendations, many middle-age adults neglect to check their blood cholesterol levels. Short message service (SMS, also known as texting) has been seldom studied for preventive education. We estimated how SMS can be a cost-effective method in encouraging people to check their blood cholesterol levels.

Methods: In a field trial, 3600 cell phone users (age > 30) were randomly assigned to the intervention (N: 1200) and the control groups (N: 2400). An SMS was sent to the intervention group for five rounds every two weeks, which targeted the cognitive and affective learning and finally advised the blood cholesterol level to be checked, if not checked during the past twelve months. Two weeks after the last round, both groups were asked for the time/level of their latest blood cholesterol, family history of early cardiac death and having a family member with coronary heart disease (CHD), and to report their attitude about whether annual blood sampling is worth the cost and time to prevent CHD. Moreover, the intervention group was asked if they remembered the SMS content. The cost-effectiveness was evaluated by estimating the "number needed to treat" (NNT) and calculating the cost of sending SMS to that number of people.

Results: In the intervention group, 629 individuals (72.0%) recalled the SMS content. The factors associated with cholesterol screening during the past two years were older age, diabetes, family history of coronary disease, higher education, female gender and being non-smoker. In both groups, women were significantly more aware of their blood cholesterol level (68.7% vs. 53.6%). The relative frequency of respondents who believed it was not worth checking their cholesterol annually was significantly lower in the intervention group (P < 0.001). The intervention group was significantly more likely to check its blood cholesterol levels (OR:1.22) after adjustment for age, diabetes, family history of CHD and smoking. The NNT was estimated ≈ 25 for the general population and ≈ 11 for those who received SMS and had a family member with CHD.

Conclusions: We would postulate that SMS could affect people's adherence to preventive programs. Relatives of patients admitted with a diagnosis of CHD should be prioritized for superior cost-effectiveness and logistical feasibility.
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http://dx.doi.org/10.1186/s12911-017-0427-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5371268PMC
March 2017

Visibility of Different Intraorbital Foreign Bodies Using Plain Radiography, Computed Tomography, Magnetic Resonance Imaging, and Cone-Beam Computed Tomography: An In Vitro Study.

Can Assoc Radiol J 2017 May 19;68(2):194-201. Epub 2016 Feb 19.

Department of Radiology, Imam Reza Teaching Center, Tabriz University of Medical Sciences, Tabriz, Iran.

Purpose: The study sought to compare the usefulness of 4 imaging modalities in visualizing various intraorbital foreign bodies (IOFBs) in different sizes.

Methods: Six different materials including metal, wood, plastic, stone, glass. and graphite were cut in cylindrical shapes in 4 sizes (dimensions: 0.5, 1, 2, and 3 mm) and placed intraorbitally in the extraocular space of fresh sheep's head. Four skilled radiologists rated the visibility of the objects individually using plain radiography, spiral computed tomography (CT), magnetic resonance imaging (MRI), and cone-beam computed tomography (CBCT) in accordance with a previously described grading system.

Results: Excluding wood, all embedded foreign bodies were best visualized in CT and CBCT images with almost equal accuracies. Wood could only be detected using MRI, and then only when fragments were more than 2 mm in size. There were 3 false-positive MRI reports, suggesting air bubbles as wood IOFBs.

Conclusions: Because of lower cost and using less radiation in comparison with conventional CT, CBCT can be used as the initial imaging technique in cases with suspected IOFBs. Optimal imaging technique for wood IOFBs is yet to be defined.
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http://dx.doi.org/10.1016/j.carj.2015.09.011DOI Listing
May 2017

Novel model of direct and indirect cost-benefit analysis of mechanical embolectomy over IV tPA for large vessel occlusions: a real-world dollar analysis based on improvements in mRS.

J Neurointerv Surg 2016 Dec 20;8(12):1312-1316. Epub 2016 Jan 20.

Departments of Internal Medicine and Critical Care, Lincoln Medical Center, Bronx, New York, USA.

Background: Ischemic strokes result in significant healthcare expenditures (direct costs) and loss of quality-adjusted life years (QALYs) (indirect costs). Interventional therapy has demonstrated improved functional outcomes in patients with large vessel occlusions (LVOs), which are likely to reduce the economic burden of strokes.

Objective: To develop a novel real-world dollar model to assess the direct and indirect cost-benefit of mechanical embolectomy compared with medical treatment with intravenous tissue plasminogen activator (IV tPA) based on shifts in modified Rankin scores (mRS).

Method: A cost model was developed including multiple parameters to account for both direct and indirect stroke costs. These were adjusted based upon functional outcome (mRS). The model compared IV tPA with mechanical embolectomy to assess the costs and benefits of both therapies. Direct stroke-related costs included hospitalization, inpatient and outpatient rehabilitation, home care, skilled nursing facilities, and long-term care facility costs. Indirect costs included years of life expectancy lost and lost QALYs. Values for the model cost parameters were derived from numerous resources and functional outcomes were derived from the MR CLEAN study as a reflective sample of LVOs. Direct and indirect costs and benefits for the two treatments were assessed using Microsoft Excel 2013.

Results: This cost-benefit model found a cost-benefit of mechanical embolectomy over IV tPA of $163 624.27 per patient and the cost benefit for 50 000 patients on an annual basis is $8 181 213 653.77.

Conclusions: If applied widely within the USA, mechanical embolectomy will significantly reduce the direct and indirect financial burden of stroke ($8 billion/50 000 patients).
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http://dx.doi.org/10.1136/neurintsurg-2015-012152DOI Listing
December 2016

Rhombencephalosynapsis: a rare congenital anomaly presenting with seizure and developmental delay.

Acta Neurol Belg 2015 Dec 27;115(4):685-6. Epub 2015 May 27.

Lincoln Medical and Mental Health Center, Weill Cornell Medical College, Bronx, NY, USA.

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http://dx.doi.org/10.1007/s13760-015-0492-2DOI Listing
December 2015

Gigantic coronary aneurysms: a late complication of Kawasaki disease.

Kardiol Pol 2014 ;72(10):989

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December 2016

Dose reduction in cardiothoracic CT: review of currently available methods.

Radiographics 2014 Oct;34(6):1469-89

From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Shapiro 4, Boston, MA 02215 (D.E.L., M.S., A.A.B.); and Department of Radiology, Epicura Hospital, Baudour, Belgium (D.M.T.).

Radiation exposure from computed tomography (CT) has received much attention lately in the medical literature and the media, given the relatively high radiation dose that characterizes a CT examination. Although there are a variety of possible strategies for reducing radiation exposure from CT in an individual patient, optimal CT image acquisition requires that the radiologist understand new scanner technology and how to implement the most effective means of dose reduction while maintaining image quality. The authors describe a practical approach to dose reduction in cardiothoracic radiology, discussing CT radiation dose metrics (eg, CT dose index, dose-length product, effective diameter, and size-specific dose estimate) as well as CT scanner parameters that directly or indirectly influence radiation dose (eg, scan length, x-ray tube output, tube current modulation, pitch, image reconstruction techniques [including iterative reconstruction], and noise reduction). These variables are discussed in terms of their relative importance to image quality and the implications of parametric changes for image quality and diagnostic content, and practical recommendations are made for their immediate implementation in the clinical setting. Taken together, the principles of physics and key parameters involved in reducing radiation dose while maintaining image quality can serve as a "survival guide" for a diagnostic radiology practice.
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http://dx.doi.org/10.1148/rg.346140084DOI Listing
October 2014

Organ-based tube current modulation: are women's breasts positioned in the reduced-dose zone?

Radiology 2015 Jan 22;274(1):260-6. Epub 2014 Aug 22.

From the Department of Radiology, Hôpital André Vésale, Montignies-le-Tilleul, Belgium (S.T.); Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass (D.E.L., M.S., A.A.B.); Department of Radiology, Hôpital Erasme, Brussels, Belgium (P.A.G.); and Department of Radiology, Epicura-Clinique Louis Caty, Rue Louis Caty 136, B-7331 Baudour, Belgium (D.T.).

Purpose: To retrospectively determine the potential of organ-based tube current modulation ( OBTCM organ-based tube current modulation ) to reduce the radiation dose delivered to breast tissue by computed tomography (CT) by determining breast angular position in relation to the zones of decreased versus increased radiation.

Materials And Methods: The authors obtained institutional review board approval for this study and patients' written informed consent. In two academic centers (center A: Beth Israel Deaconess Medical Center, Boston, Mass; and center B: Hôpital André Vésale, Montignies-le-Tilleul, Belgium), data were collected from clinical thoracic CT examinations performed in 498 women (mean age, 60 years; age range, 18-95 years) in the supine position and 34 women (mean age, 53 years; age range, 18-84 years) in the prone position. One radiologist in each center determined breast tissue location and measured its inner and outer boundaries with respect to the isocenter of the CT examination. The percentages of women with breast tissue within and those with breast tissue outside the zone of decreased radiation delivered by OBTCM organ-based tube current modulation were determined. The location of breast tissue was correlated with patient age and with sagittal and coronal diameters of the thorax by using the Student t test, Fisher exact test, and Pearson correlation.

Results: None of the women lying in the supine position had the entirety of the breast tissue located within the reduced-dose zone. Breast tissue was located in the increased-dose zone in 99% of women lying supine and in 82% of women lying prone.

Conclusion: The breast angular position of almost all women was higher than the angular limit of the reduced versus the increased dose in OBTCM organ-based tube current modulation . No woman, regardless of supine or prone position, had all breast tissue within the reduced-dose zone.
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http://dx.doi.org/10.1148/radiol.14140694DOI Listing
January 2015

Anterior mediastinal masses.

AJR Am J Roentgenol 2014 Aug;203(2):W128-38

1 All authors: Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215.

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http://dx.doi.org/10.2214/AJR.13.11998DOI Listing
August 2014

Percutaneous treatment of left main coronary stenosis following bentall surgery.

J Card Surg 2014 Sep 16;29(5):628-9. Epub 2014 Jun 16.

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

A 65-year-old male underwent percutaneous coronary stenting of the left main trunk seven months after the Bentall procedure as a probable consequence of surgical glue.
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http://dx.doi.org/10.1111/jocs.12385DOI Listing
September 2014

Imaging in Transcatheter Aortic Valve Replacement (TAVR): role of the radiologist.

Insights Imaging 2014 Feb 21;5(1):123-45. Epub 2014 Jan 21.

Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave-Shapiro 4, Boston, MA, 02215, USA,

Background: Transcatheter aortic valve replacement (TAVR) is a novel technique developed in the last decade to treat severe aortic stenosis in patients who are non-surgical candidates because of multiple comorbidities.

Methods: Since the technique is performed using a transvascular approach, pre-procedural assessment of the aortic valve apparatus, ascending aorta and vascular access is of paramount importance for both appropriate patient selection and correct device selection. This assessment is performed by a multi-disciplinary team with radiology being an integral and important part.

Results: Among imaging modalities, there is growing scientific evidence supporting the crucial role of MDCT in the assessment of the aortic valve apparatus, suitability of the iliofemoral or alternative pathway, and determination of appropriate coaxial angles. MDCT also plays an important role in post-procedure imaging in the assessment of valve integrity and position.

Conclusion: This review outlines the principal aspects of TAVR, the multidisciplinary approach and utilisation of different imaging modalities, as well as a step-by-step approach to MDCT acquisition protocols, reconstruction techniques, pre-procedure measurements and post-procedure assessment.

Teaching Points: • TAVR is a new technique to treat severe aortic stenosis in high-risk and nonsurgical candidates. • MDCT assessment of the aortic annulus is important for appropriate patient and device selection. • Multidisciplinary approach is required for patient selection, procedure planning and performance. • MDCT is required for assessment of the aortic root, iliofemoral or alternative vascular pathway.
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http://dx.doi.org/10.1007/s13244-013-0301-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3948900PMC
February 2014

Endovascular Repair of Supra-Celiac and Abdominal Aortic Pseudo Aneurysms Concomitant with a Right Atrial Mass in a Patient with Behçet's Disease: A Case Report.

J Tehran Heart Cent 2014 6;9(4):179-82. Epub 2014 Jul 6.

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

Behcet's disease is a rare immune mediated systemic vasculitis which besides it's more frequent involvement of eyes and skin, sometimes present with aortic pseudo aneurysm and more rarely cardiac inflammatory masses.A 51-year-old patient with Behçet's Disease presented with two symptomatic aortic pseudoaneurysms concomitant with a right atrial mass. Computed tomography (CT) revealed one supra-celiac and another infrarenal aortic pseudoaneurysms. Echocardiography showed a large mobile mass in the right atrium. Both pseudoaneurysms were successfully excluded simultaneously via endovascular approach with Zenith stent-grafts, and the atrial mass was surgically removed 10 days later. Post-implant CT showed successful exclusion of both pseudo-aneurysms, patency of all relevant arteries, and patient is now asymptomatic and has returned to normal lifestyle. Multiple pseudoaneurysms concomitant with a right atrial mass can be an initial manifestation of Behçet's disease. Endovascular repair can be a good treatment option for the pseudoaneurysms.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4394057PMC
April 2015

Cardiothoracic imaging in the pregnant patient.

J Thorac Imaging 2014 Jan;29(1):38-49

*Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA †Department of Radiology, Epicura Hospital, Baudour, Belgium.

Cardiovascular imaging during pregnancy poses a unique challenge to clinicians in differentiating between physiological changes mimicking pathology and true pathologic conditions, as well as for radiologists in terms of image quality. This review article will focus on 3 goals: first, to familiarize radiologists with safety issues related to imaging pregnant women using computed tomography and magnetic resonance imaging; second, to review the current, evidence-based recommendations for radiology topics unique and common to pregnant and lactating patients; and third, to provide practical algorithms to minimize risk and increase safety for both the pregnant woman and the fetus.
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http://dx.doi.org/10.1097/RTI.0000000000000064DOI Listing
January 2014

Echocardiographic determinants of ischemic mitral regurgitation.

J Card Surg 2013 Jul;28(4):359-65

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

Objectives: It is not clear whether the presence and degree of chronic ischemic mitral regurgitation (IMR) in patients with left ventricular (LV) dysfunction are related to LV dysfunction, local LV remodeling or mitral valve deformation. We sought to establish the strongest determinants of IMR severity in patients with LV dysfunction and IMR.

Methods: We prospectively performed transthoracic echocardiography for 135 patients (mean age = 60.76 ± 9.69 years, 71.9% male) with LV dysfunction (ejection fraction ≤ 50%) and coronary artery disease (70% stenosis in ≥ 1 coronary artery and no myocardial infarction during the previous 16 days). Global and local LV remodeling and mitral deformity indices were measured. Using the vena contracta, MR severity was graded as no regurgitation; mild; moderate; and severe.

Results: Mild regurgitation was found in 45 (33.3%) patients, moderate in 71 (52.6%), severe in 6 (4.4%), and no regurgitation in 13 (9.6%). By linear logistic multivariable analysis, the major echocardiographic determinants of MR severity were tenting area (TA), sphericity index (LV systolic length/width), and C-septal (distance between the leaflet coaptation and the septum). TA was best related to coaptation depth and annulus diameter. Mitral annular diameter was best correlated with left atrial surface area (r = 0.630, p < 0.001).

Conclusion: TA was significantly correlated with annulus diameter and, along with sphericity index and C-septal, were the independent echocardiographic determinants of MR severity. These findings warrant consideration when performing mitral valve repairs for patients with IMR.
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http://dx.doi.org/10.1111/jocs.12145DOI Listing
July 2013

Posteroseptal accessory pathway in association with coronary sinus diverticulum: electrocardiographic description and result of catheter ablation.

J Interv Card Electrophysiol 2013 Oct 8;38(1):43-9. Epub 2013 Feb 8.

Department of Cardiac Electrophysiology, Tehran Heart Center, Tehran University of Medical Sciences, North Kargar Ave., 1411713138, Tehran, Iran.

Aims: A precise knowledge of the coronary sinus (CS) anatomy and its potential anomalies seems essential to increase the rate of success in patients with a prior history of multiple ablation failures of the posteroseptal accessory pathway or in whom this procedure cannot be performed easily. We aimed to describe the anatomic and electrocardiographic characteristics of the CS diverticulum in association with the posteroseptal accessory pathway and subsequent catheter ablation results.

Methods: We retrospectively recruited 12 patients with posteroseptal accessory pathways associated with CS diverticula from patients referred to Tehran Heart Center for electrophysiological study and ablation between January 2004 and December 2011.

Results: The study population consisted of eight males and four females at a mean age of 48.2 ± 17.5 years with posteroseptal accessory pathways. The most frequent initial presentation was orthodromic atrioventricular re-entrant tachycardia and atrial fibrillation. The rate of acute success for radiofrequency ablation and the recurrence rate were 75 and 16.6 %, respectively. Larger diverticula tended to have more failure and recurrence rate, albeit not significant. None of the patient's characteristics could significantly predict the success of the ablation.

Conclusion: Our total initial failure rate and subsequent recurrence was around 41 %. Better results might have been achieved had we applied irrigated tip catheters or NavX(TM)-guided cryoablation or subxiphoid epicardial mapping and ablation.
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http://dx.doi.org/10.1007/s10840-012-9775-1DOI Listing
October 2013

Clinical characteristics and mid-term outcome of patients with slow coronary flow.

Acta Cardiol 2012 Oct;67(5):583-7

Dept. Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.

Objective: Due to uncertainty in the clinical implications of slow coronary flow (SCF), we aimed to investigate the clinical features and mid-term outcome of the Iranian patients with the slow coronary flow phenomenon.

Methods: During a four-year period from January 2005 to December 2009, out of 3523 consecutive patients who underwent coronary angiography in the Tehran Heart Center, 325 patients with no stenosis, ectasia, or aneurysm were enrolled in the study. Among them 81 (2.2%) patients were diagnosed with SCF. Baseline characteristics, lab parameters, coronary risk factors and mid-term outcome were described, consequently. RESUITS: Typical chest pain was the most frequent complaint in both groups (normal flow; 118 (48.4%) vs slow flow; 45 (55.6%)). RCA was the most frequently involved vessel for coronary slow flow followed by LCX and LAD and the combination of LCX and LAD involvement for coronary slow flow accounts for 27.2% of cases and three vessel involvement counts for 23.5%. Most patients experienced no symptoms during the follow-up period (NI; 66.4% vs slow flow; 59.3%). However, three patients (3.7%) in the SCF group who underwent a second angiography 2-4 years later, were redefined as slow coronary flow.

Conclusions: We could not show any significant difference with respect to initial presentation, coronary risk factors and even mid-term outcome of these patients in comparison to the normal group. However, due to the persistence of the SCF phenomenon even after 2-4 years in the second angiography of our three patients, it seems that slow flow might be a permanent rather than a transient manifestation.
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http://dx.doi.org/10.1080/ac.67.5.2174134DOI Listing
October 2012

Role of fine-needle aspiration in the management of thyroid nodules.

Saudi Med J 2009 Apr;30(4):515-8

Department of Internal Medicine, Tehran University of Medical Sciences, Sina Hospital, Imam Khomeini Ave., Tehran 11364, Iran.

Objective: To show the benefits of fine-needle aspiration biopsy (FNAB) in managing thyroid nodules.

Methods: As a retrospective study, reports of 888 FNABs of the thyroid performed during a period of 11 years (1996-2007) at Tehran University of Medical Sciences, Sina Hospital and Endocrine Clinic, Tehran, Iran were reviewed. Histological diagnoses were available for 182 cases, and we compared cytological diagnoses of FNAB with pathologic reports.

Results: The cytology diagnoses by FNAB were: papillary 6 (3.2%); follicular neoplasm 51 (28%); follicular adenoma 10 (5.4%); Hurthle cell neoplasm 8 (4.3%); suspicious 20 (10.9%); inconclusive 2 (1%); and benign 85 (46.4%). Due to surgery pathologic reports, malignant cytologies were: 6 (100%) for papillary, 1 (1.96%) for follicular neoplasm, 4 (50%) for Hurthle cell neoplasm. In suspicious reports, 11 (55%) reports of pathology were malignant; and in inconclusive reports, one report (50%) was malignant.

Conclusion: Fine needle aspiration is a useful technique for selecting patients with nodular thyroid disease for surgery.
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April 2009