Publications by authors named "Mehrdad Sheikhvatan"

69 Publications

The evaluating of pregnancy-associated plasma protein-A with the likelihood of small for gestational age.

Obstet Gynecol Sci 2020 May 16;63(3):225-230. Epub 2020 Apr 16.

Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran.

Objective: Recently, strong evidences were obtained on the association between low pregnancy-associated plasma protein-A (PAPP-A) levels in the first trimester and poor outcomes of pregnancy.

Methods: This cross-sectional study was conducted on all pregnant women who were referred to the Obstetrics and Gynecology Clinic at Imam Hossein Hospital in Tehran, Iran in 2014. Women were asked to attend clinical examinations and screening at 11-14 weeks of gestation.

Results: Based on the definition, 14.5% of neonates found to be small for gestational age (SGA). There was a strong association between PAPP-A levels and birth weight. The mean PAPP-A level in the mothers of neonates who were SGA was significantly lower than those without this poor outcome. Based on the receiver operating characteristic curve analysis, serum PAPP-A level was a main determinant in the prediction of SGA neonates.

Conclusion: The serum PAPP-A level at 11-13 weeks of gestation can effectively predict the increased risk for fetal growth retardation. In patients in this study, the best cutoff value for PAPP-A was 0.75 , which signifies that lower levels of this marker can predict fetal growth restriction with high sensitivity and specificity.
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http://dx.doi.org/10.5468/ogs.2020.63.3.225DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7231942PMC
May 2020

Value of Pregnancy-Associated Plasma Protein-A for Predicting Adverse Pregnancy Outcome.

Arch Iran Med 2019 10 1;22(10):584-587. Epub 2019 Oct 1.

Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran.

Background: It is suggested that pregnancy-associated plasma protein-A (PAPP-A) levels below the fifth percentile or less than 0.4 multiples of the median (MoMs) during the first trimester are closely associated with higher risk for neonatal abnormalities. We assessed the value of PAPP-A within the first trimester for predicting pregnancy outcome.

Methods: In a historical cohort study, we assessed 8460 consecutive pregnant women recruited for chromosomal abnormalities screening within the first trimester at Fertility Infertility and Perinatology Research Center, in Ahvaz Jundishapur University of Medical Sciences between April 2014 and April 2015. The women were categorized into two groups: pregnant women with PAPP-A levels below 0.4 multiples of MOM (n = 237) and those with higher levels of PAPP-A (n = 237).

Results: The median value of MOM PAPP-A was 0.82 ± 0.78, with 237 women having MOM PAPP-A lower than 0.4. Compared to women with MOM PAPP-A higher than 0.4, those with lower MOM PAPP-A had higher mean age, lower gestational age and lower birth weight. The prevalence of small for gestational age (SGA) was higher in women with MOM PAPP-A <0.4 compared to others. According to the ROC curve analysis, MOM PAPP-A <0.4 had a high value for predicting SGA. Best cutoff value for MOM PAPP-A to predict SGA was shown to be 0.25, yielding a sensitivity of 84.7% and a specificity of 68.6.

Conclusion: Measuring the serum level of MOM PAPP-A during the first trimester is a valuable marker for predicting adverse outcomes of pregnancy such as SGA.
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October 2019

A Systematic Review and Bioinformatics Study on Genes and micro-RNAs Involving the Transformation of Endometriosis into Ovarian Cancer.

Microrna 2020 ;9(2):101-111

Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran.

Background: Along with the description of tumorigenesis processes in endometriosisrelated ovarian cancer, identifying dysregulated miRNAs, the target genes of these miRNAs, and the processes abnormally affected by dysregulated miRNAs is essential, which was our goal.

Methods: Two reviewers individually evaluated the articles which collected relevant information including genes and miRNAs involved in the transformation of endometriosis into ovarian cancer. To assess the mature sequence of miRNAs and also their chromosomal positions, miRPathDB software was employed. To determine the main target gene predicted for each considered miRNAs, the TargetScanS Web server was applied. The interaction of each gene with other genes associated with endometrial- related ovarian cancer was determined by GeneMANIA software. Finally, to design integrated model of miRNAs-targeted genes interaction network, the Cytoscape software was used.

Results: The final number of studies available for analysis was 6 manuscripts including 22 miRNAs described as involved in the transformation of endometriosis into different subtypes of ovarian cancers (14 miRNAs up-regulated and 8 miRNAs down-regulated). Three miRNAs of miR-141 (upregulated), miR-205 (down-regulated), and miR-125b (down-regulated) were revealed as the originator for genetic interactions leading to carcinogenesis. We could show some common loops and pathways including uncontrolled cell proliferation and abnormal apoptosis (mediated by PTEN gene induced by miR-21 and miR-214), and disaggregation and epithelialization (mediated by ZEB1 and ZEB2 genes induced by miR-200).

Conclusion: According to our analysis, up-regulation of miR-141 and down-regulation of miR-205 and miR-125b have a central role in transforming endometriosis to ovarian cancer.
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http://dx.doi.org/10.2174/2211536608666190917152104DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7366012PMC
January 2020

Gene Polymorphism and Risk for Myocardial Infarction in Premature Coronary Disease.

Iran J Biotechnol 2019 Apr 20;17(2):e1921. Epub 2019 Apr 20.

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

Background: Contradictory results have been obtained regarding the role of integrin, beta 3 (ITGB3) gene polymorphisms in occurrence of myocardial infarction (MI).

Objectives: We aimed to assess the association between 1565C/T polymorphism of ITGB3 gene and increased risk for acute MI in patients with premature coronary artery disease (CAD).

Material And Methods: Our study included 1000 premature CAD patients that classified into two groups with history of MI (n = 461) and without of MI (n = 539). The polymorphism variants in 10% of samples were determined by PCR-RFLP technique and genotyping of the polymorphism in all subjects was conducted by High Resolution Melting method. Given the two conditions of patients residing in Tehran and also faced with their first episode of MI, 640 out of 1000 study samples that had been previously followed-up were assessed in a retrospective cohort phase regarding long-term major adverse cardiac events (MACE).

Results: There was no significant difference in the frequency of 1565C/T polymorphism between the MI and non-MI groups. The frequency of wild genotype was 69.2% and 72.2%, the frequency of homozygous genotype was 21.3% and 18.4%, and the frequency of mutant genotype was 9.5% and 9.5%, respectively (P = 0.505). No significant difference was also found in total-MACE free survival rate between the patients with different genotypes of 1565C/T polymorphism in both MI and non-MI group.

Conclusions: The carriage of the 1565C/T polymorphism of ITGB3 gene seems unlikely to be a significant risk factor for the development of MI in Iranian patients with premature CAD.
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http://dx.doi.org/10.21859/ijb.1921DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6697842PMC
April 2019

Comparison of the efficacy of intravenous tranexamic acid with and without topical administration versus placebo in urgent endoscopy rate for acute gastrointestinal bleeding: A double-blind randomized controlled trial.

United European Gastroenterol J 2018 Feb 20;6(1):46-54. Epub 2017 Jun 20.

Shahid Beheshti University of Medical Science, Tehran, Iran.

Background: Tranexamic acid (TXA), a synthetic antifibrinolytic drug, is effective as a treatment for serious hemorrhage, including bleeding arising from major trauma and post-operative interventions. Significant acute gastrointestinal bleeding may have a poor outcome despite routine medical and endoscopic treatments. The aim of this study was to assess whether early intravenous and/or intravenous plus topical administration of TXA reduces the need for urgent endoscopy for acute gastrointestinal bleeding.

Method: This double-blind randomized clinical trial included 410 patients with proven acute gastrointestinal bleeding. All patients received conventional therapy. The subjects were randomized to three groups: (A) 138 patients received intravenous TXA (1 g q6h); (B) 133 patients received topical TXA (1 g single dose by nasogastric tube) plus systemic TXA; and (C) 139 patients received a placebo (sodium chloride 0.9%) for 24 hours. Subgroup statistical analyses were conducted for urgent endoscopy, mortality, re-bleeding, blood transfusion, endoscopic and/or surgical intervention rates, and health status.

Results: The time to endoscopy was significantly shorter in group C (15.58 ± 7.994,  < 0.001). A need for urgent endoscopy was seen in 14.49%, 10.52%, and 30.21% of patients in groups A, B, and C, respectively ( < 0.001). No significant statistical differences were seen between treatment groups regarding mortality, re-bleeding, blood transfusion, and endoscopic and/or surgical intervention rates. No thromboembolic event was documented during the 1-week follow up.

Conclusions: Our results showed that the antifibrinolytic properties of TXA can aid in changing an urgent endoscopy to an elective procedure, with better outcomes for both physicians and patients.
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http://dx.doi.org/10.1177/2050640617714940DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5802678PMC
February 2018

Reliability and validity of the Persian version of patient assessment of constipation- quality of life (PAC-QOL) questionnaire.

Gastroenterol Hepatol Bed Bench 2017 ;10(4):289-294

Clinical Research Development Center, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.

Aim: The present study aimed to assess the reliability and validity of Persian version of patient assessment of constipation: quality of life (PAC-QOL) questionnaire in Iranian patients.

Background: Chronic constipation has significant effects on daily living, wellbeing and individuals' quality of life (QOL). Validated tools can help us to assessing QOL in affected ones and facilitating clinical management of them.

Methods: The English version of Patient Assessment of Constipation: Quality of Life (PAC-QOL) was translated into the Persian language and was confirmed by back-translation. One hundred and forty patients with functional constipation, according Rome III criteria, completed the questionnaires .The questionnaires were analyzed using Cronbach's Alpha internal consistency score to determine the reliability. Twenty medical experts were then asked to evaluate the PAC-QOL and the results were used to calculate the Content Validity Ratio (CVR) and Content Validity Index (CVI).

Results: Due to obtained value for Cronbach`s α (0.975) and also for the subscale of physical discomfort (0.930), psychosocial discomfort (0.975) and worries and concerns (0.915), the internal consistency is established. According to medical experts' opinions, the value of CVR ranged from 0.5 to 0.8 and the value of CVI was 0.81.

Conclusion: The Persian version of PAC-QOL questionnaire is shown to have acceptable reliability and validity to be used for psychometric evaluation in Iranian patients complaining of functional constipation.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5758737PMC
January 2017

C1019T Polymorphism in the Connexin 37 Gene and Myocardial Infarction Risk in Premature Coronary Artery Disease.

J Tehran Heart Cent 2017 Apr;12(2):72-81

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

The C1019T polymorphism of the connexin-37 (GJA4) gene is a single-nucleotide polymorphisms involved in atherosclerotic plaque rupture and atherosclerosis predisposition. We examined the association between the C1019T polymorphism of the GJA4 gene and the occurrence of myocardial infarction (MI) in patients with premature coronary artery disease (CAD). Our study recruited 1000 patients with the final diagnosis of premature CAD and classified them into 2 groups: with a history of MI (n = 461) and without it (n = 539). The polymorphism variants were determined via the PCR-RFLP, and then genotyping was conducted through the high-resolution melting method. From a total of 1000 patients, 554 patients, who had been previously followed-up with a median follow-up time of 45.74 months vis-à-vis long-term major adverse cardiac events, were enrolled in this retrospective cohort phase. The frequencies of the wild, heterozygous, and mutant genotypes of the C1019T polymorphism were 54.0%, 40.6%, and 5.4% in the MI group and 49.2%, 43.2%, and 7.6% in the non-MI group (p value = 0.187). After adjustment for the baseline covariates, no difference was found between the MI and non-MI groups apropos the frequency of the heterozygous genotype (p value = 0.625) and the mutant genotype (p value = 0.452). Regarding the level of human connexin-37, the serum level of this marker was not different between the MI and non-MI groups. The C1019T polymorphism of the GJA4 gene may not be useful for predicting the occurrence of MI in patients with premature CAD. The presence of this polymorphism in such patients may also have a low value for predicting long-term CAD complications.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5558058PMC
April 2017

Association of R279Q and C1562T polymorphisms of matrix metalloproteinase 9 gene and increased risk for myocardial infarction in patients with premature coronary artery disease.

J Clin Lab Anal 2018 Jan 28;32(1). Epub 2017 Apr 28.

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

Background: A number of matrix metalloproteinase (MMP) gene polymorphisms has been identified which may be probably related to premature myocardial infarction (MI).

Objective: We assessed the relationship between the two polymorphisms of the MMP9 gene including R279Q and C1562T and occurrence of premature MI.

Methods: The study has two phases including a case-control study as the first phase and cohort study as the second phase. Initially, 1000 patients with premature coronary artery disease were classified into MI and non-MI groups. Genotyping of the polymorphism was conducted by PCRRFLP and high-resolution melting techniques. Given the two conditions of patients residing in Tehran and faced with their first episode of MI, 640 of 1000 study samples previously followed up with a median follow-up time of 45.74 months were assessed in a retrospective cohort phase regarding long-term major adverse cardiac events (MACE).

Results: The prevalence of wild, heterozygous, and mutant genotypes of R279Q polymorphism in MI group was 14.5%, 57.3%, and 28.2% and in non-MI group was 36.9%, 38.4%, and 24.7%, respectively, with a considerable difference (P<.001). There was a significant difference in the prevalence of wild, heterozygous, and mutant genotypes of C1562T polymorphisms in MI group (12.4%, 41.2%, and 46.4%, respectively) and in non-MI group (46.8%, 38.6%, and 14.7%, respectively; P<.001). No difference was found in total MACE-free survival rate between genotypes of R279Q and C1562T polymorphisms.

Conclusion: C1562T and R279Q polymorphisms are associated with the susceptibility to premature MI, but cannot predict long-term cardiac events in these patients.
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http://dx.doi.org/10.1002/jcla.22218DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6817094PMC
January 2018

Endovascular Aortic Aneurysm and Dissection Repair (EVAR) in Iran: Descriptive Midterm Follow-up Results.

Iran J Radiol 2016 Jan 21;13(1):e16021. Epub 2016 Jan 21.

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

Background: Endovascular repair of aorta in comparison to open surgery has a low early operative mortality rate, but its long-term results are uncertain.

Objectives: The current study describes for the first time our initial four-year experience of elective endovascular aortic repair (EVAR) at Tehran heart center, the first and a major referral heart center in Iran, as a pioneer of EVAR in Iran.

Patients And Methods: A total of 51 patients (46 men) who had the diagnosis of either an abdominal aortic aneurysm (AAA) (n = 36), thoracic aortic aneurysm (TAA) (n = 7), or thoracic aortic dissection (TAD) (n = 8) who had undergone EVAR by Medtronic stent grafts by our team between December 2006 and June 2009 were reviewed.

Results: The rate of in-hospital aneurysm-related deaths in the group with AAA stood at 2.8% (one case), while there was no in-hospital mortality in the other groups. All patients were followed up for 13-18 months. The cumulative death rate in follow-up was nine cases from the total 51 cases (18%), out of which six cases were in the AAA group (four patients due to non-cardiac causes and two patients due to aneurysm-related causes), one case in the TAA group (following a severe hemoptysis), and two cases in the TAD group (following an expansion of dissection from re-entrance). The major event-free survival rate was 80.7% for endovascular repair of AAA, 85.7% for endovascular repair of TAA, and 65.6% for endovascular repair of TAD.

Conclusion: The endovascular stent-graft repair of the abdominal and thoracic aortic aneurysm and aortic dissection had high technical success rates in tandem with low-rate early mortality and morbidity, short hospital stay, and acceptable mid-term free symptom survival among Iranian patients.
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http://dx.doi.org/10.5812/iranjradiol.16021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4836048PMC
January 2016

Do preoperative pulmonary function indices predict morbidity after coronary artery bypass surgery?

Ann Card Anaesth 2015 Jul-Sep;18(3):293-8

Department of Anesthesiology; Department of Research, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.

Context: The reported prevalence of chronic obstructive pulmonary disease (COPD) varies among different groups of cardiac surgical patients. Moreover, the prognostic value of preoperative COPD in outcome prediction is controversial.

Aims: The present study assessed the morbidity in the different levels of COPD severity and the role of pulmonary function indices in predicting morbidity in patients undergoing coronary artery bypass graft (CABG).

Settings And Design: Patients who were candidates for isolated CABG with cardiopulmonary bypass who were recruited for Tehran Heart Center-Coronary Outcome Measurement Study.

Methods: Based on spirometry findings, diagnosis of COPD was considered based on Global Initiative for Chronic Obstructive Lung Disease category as forced expiratory volume in 1 s [FEV1]/forced vital capacity <0.7 (absolute value, not the percentage of the predicted). Society of Thoracic Surgeons (STS) definition was used for determining COPD severity and the patients were divided into three groups: Control group (FEV1 >75% predicted), mild (FEV1 60-75% predicted), moderate (FEV1 50-59% predicted), severe (FEV1<50% predicted). The preoperative pulmonary function indices were assessed as predictors, and postoperative morbidity was considered the surgical outcome.

Results: This study included 566 consecutive patients. Patients with and without COPD were similar regarding baseline characteristics and clinical data. Hypertension, recent myocardial infarction, and low ejection fraction were higher in patients with different degrees of COPD than the control group while male gender was more frequent in control patients than the others. Restrictive lung disease and current cigarette smoking did not have any significant impact on postoperative complications. We found a borderline P = 0.057 with respect to respiratory failure among different patients of COPD severity so that 14.1% patients in control group, 23.5% in mild, 23.4% in moderate, and 21.9% in severe COPD categories developed respiratory failure after CABG surgery.

Conclusion: Among post-CABG complications, patients with different levels of COPD based on STS definition, more frequently developed respiratory failure. This finding may imply the prognostic value of preoperative pulmonary function test for determining COPD severity and postoperative morbidities.
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http://dx.doi.org/10.4103/0971-9784.159796DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4881716PMC
April 2016

Discriminative Power of EuroSCORE in Predicting Morbidity and Prolonged Hospital Stay in an Iranian Sample Population.

J Tehran Heart Cent 2014 Jan;9(1):15-9

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

Background: The EuroSCORE is a simple and rigorous risk stratification model and is, thus, commonly used in predicting the early and late outcomes of cardiac surgery across the world. We aimed to assess the discriminative power of the EuroSCORE model to predict postoperative morbidity and total prolonged length of stay in hospital (LOS) and Intensive Care Unit (ICU) stay in an Iranian group of cardiac surgical population.

Methods: In a prospective study, the additive EuroSCORE model was applied to 570 patients undergoing isolated coronary artery bypass grafting (CABG) at Tehran Heart Center. The discrimination power of the EuroSCORE model was tested by the area under the receiver operating characteristic (ROC) curve and the calibration by comparing the observed and predicted outcomes across the risk spectrum assessed using the Hosmer-Lemeshow goodness-of-fit test.

Results: The mean age was 59.03 ± 0.73 years and 429 out of the 570 (75.3%) patients were men. The overall morbidity rate was 47.5%. The observed morbidity in the high-risk patients (EuroSCORE > 6) was significantly greater than that in the low-risk patients (EuroSCORE ≤ 6). Furthermore, 51.2% of the patients had LOS beyond 14 days. Both prolonged LOS (> 14 days) and prolonged ICU stay (> 72 hours) were more prevalent in the high-risk group than in the low-risk group. The discriminative power of the EuroSCORE in predicting morbidity, prolonged LOS, and ICU stay was poor with an area under the ROC curve of 0.617, 0.598, and 0.581, respectively. However, this risk score showed good calibrations for morbidity (p value = 0.119), prolonged LOS (p value = 0.958), and prolonged ICU stay (p value = 0.620).

Conclusion: The EuroSCORE provided inappropriate discrimination in predicting early morbidity and prolonged LOS and ICU stay in our study population. Creating a revised model may enable us to accurately predict outcomes in Iranian CABG patients.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4277786PMC
January 2014

Early outcome of off-pump versus on-pump coronary revascularization.

Pan Afr Med J 2014 22;17:309. Epub 2014 Apr 22.

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

Introduction: The use of coronary artery bypass surgery (CABG) with cardiopulmonary bypass (CPB) or without CPB technique (off-pump) can be associated with different mortality and morbidity and their outcomes remain uncertain. The goal of this study was to evaluate the early outcome of on-pump versus off-pump CABG.

Methods: We conducted a retrospective database review of 13866 patients (13560 patients undergoing on-pump CABG and 306 patients undergoing off-pump CABG) at Tehran Heart Center between January 2002 and January 2007. We compared preoperative, operative, and postoperative characteristics between them.

Results: In-hospital mortality in the on-pump group was 0.8% compared to 0.7% in the off-pump group (P=0.999) and in-hospital morbidity was 11.7% and 6.5%, respectively (OR: 1.533, 95%CI: 0.902-2.605, P=0.114). Postoperative atrial fibrillation was more prevalent in on-pump versus off-pump surgery (6.0% vs 3.0%, P=0.028), however there were no statistical significant differences in other postoperative complications with regard to cardiac arrest (P=0.733), prolonged ventilation (P=0.363), brain stroke (P=0.999), renal failure (P=0.525), and postoperative bleeding (P=0.999). The mean length of stay in hospital (P=0.156) and in ICU (P=0.498) was also similar between the two groups.

Conclusion: The results from an Iranian population-based study showed similar early mortality and morbidity of off-pump CABG in comparison to on-pump surgery.
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http://dx.doi.org/10.11604/pamj.2014.17.309.1723DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4198433PMC
August 2015

Gender differences in coronary artery disease: correlational study on dietary pattern and known cardiovascular risk factors.

Int Cardiovasc Res J 2013 Dec 1;7(4):124-9. Epub 2013 Dec 1.

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

Background: The relationship between diet and cardiovascular risk factors in men and women with Coronary Artery Disease (CAD) has been the subject of recent studies. We studied a group of Iranian CAD patients to analyze any relationship between diet and CAD risk factors based on gender.

Methods: In this study, 461 consecutive patients were assessed before their planned isolated coronary artery bypass graft surgery. They were interviewed to obtain the quantity and components of nutrients and micronutrients based on a validated food frequency questionnaire. Diet scores were calculated in each dietary group and the total score was reported as the Mediterranean Diet Quality Index (Med-DQI). Physical activity was assessed using International Physical Activity Questionnaire (IPAQ). Functional class, EuroSCORE and the frequency of the known risk factors in the men and women were recorded as well.

Results: The women were more likely than the men to present with obesity, diabetes mellitus, hypercholesterolemia, and hypertension (all Ps < 0.001). Also, the women had higher functional class and mean of EuroSCORE (P < 0.001 and P = 0.03). Only six women (5.7%) reported to have regular physical activity. In addition, Women's energy intake was more likely to be supplied through fat. Cereals, fruit, and vegetable consumption in both genders was within the safe recommended range, while olive and fish consumption was low in both sexes. MedDQI score was different between men and women with hypertension (P = 0.018) and obesity (P = 0.048).

Conclusions: Modifiable classical risk factors for CAD, except for smoking, were more prevalent in women and were associated with their diet. Therefore, women probably need to maintain low calorie intake while improving physical activity and dietary patterns to decrease the frequency and severity of modifiable cardiac risk factors.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3987447PMC
December 2013

Association between the atrial natriuretic peptide rs5065 gene polymorphism and the presence and severity of coronary artery disease in an Iranian population.

Coron Artery Dis 2014 May;25(3):242-6

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

Objective: The atrial natriuretic peptide (ANP) gene expression and some of its related single-nucleotide polymorphisms have been well established as a characterized biomarker of cardiovascular diseases. In the present study, we aimed to evaluate the potential association between one of the introduced ANP gene polymorphisms of 2238 T/C (rs5065) with coronary artery disease (CAD) in an Iranian population.

Basic Methods: A total of 573 patients with CAD according to angiography reports and 293 controls without any evidence of CAD were enrolled. Allelic discrimination of the single-nucleotide polymorphism rs5065 in both groups was performed using a High Resolution Melt technique in real-time PCR analysis.

Main Results: With respect to the prevalence of different genotypes of rs5065 polymorphism, the frequency of the T allele in the CAD group was significantly lower in CAD than that in the non-CAD group (59.7 vs. 65.1%, P=0.032). A significant inverse association was also found between the frequency of T allele and severity of CAD assessed by the Gensini score; the average of this score in T-allele carriers was 38.6±41.6 and that in C-allele carriers was 57.7±46.3 (P≤0.0001). Using multivariable linear regression modeling with the presence of baseline variables, the presence of the rs5065 ANP T allele could predict decreased severity of CAD assessed by the Gensini score in our population.

Principal Conclusion: The presence of the rs5065 ANP polymorphism is potentially associated with a reduced risk of CAD as well as with reduced severity of CAD independent of the general risk factors of CAD.
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http://dx.doi.org/10.1097/MCA.0000000000000075DOI Listing
May 2014

Association between R353Q polymorphism for coagulative factor VII and severity of coronary artery disease in Iranian population.

Cardiol J 2013 ;20(5):533-8

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

Background: Recent research has supported the central role of coagulative factors in advancing atherosclerosis and causing coronary artery disease (CAD). The present study, for the first time, aimed to clarify the relationship between R353Q polymorphism for factor VII and the occurrence and severity of CAD in a large sample of Iranian population.

Methods: Nine hundred and nineteen consecutive patients with suspected CAD, who candidated for coronary angiography in the Tehran Heart Center between January 2006 and March 2007, were examined. The number of diseased coronary vessels was determined, and the severity of CAD was assessed by the Gensini score. Genotyping was done via the PCR-RFLP method.

Results: The frequency of Q and R alleles was 74.1% and 25.9% in the patients with CADand 75.2% and 24.8% in those without CAD, with an insignificant difference (p = 0.625). The frequency of Q allele in the patients with single-vessel, two-vessel, and three-vessel diseases was 72.8%, 71.5%, and 76.4%, respectively; the difference was also insignificant (p = 0.379). No relationship was observed between the distribution of the genotypes and the number of the involved coronary vessels. The average of the Gensini score was 43.39 ± 46.18 in the patients with QQ genotype, 38.87 ± 42.89 in those with QR genotype, and 55.61 ± 53.80 in the ones with RR genotype, with the difference not constituting any statistical significance (p = 0.084).

Conclusions: The results suggest no association between R353Q polymorphism for factor VII and the presence or progression of CAD in the Iranian population.
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http://dx.doi.org/10.5603/CJ.2013.0139DOI Listing
August 2014

Factor Structure of the World Health Organization's Quality of Life Questionnaire-BREF in Patients with Coronary Artery Disease.

Int J Prev Med 2013 Sep;4(9):1052-8

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

Background: The World Health Organization Quality of Life Questionnaire (WHOQOL)-BREF is one of the most known general questionnaires for assessment of quality of life (QOL) in both healthy populations and in various diseases subgroups. The aim of the present study was to examine the construct validity of this questionnaire in patients with coronary artery disease (CAD) using factor analysis.

Methods: Two hundred and seventy-five patients aged 35-80 years old with the diagnosis of CAD admitted to the Tehran Heart Center operating room for coronary artery bypass were consecutively entered into the study. QOL was assessed using the WHOQOL-BREF. To estimate the reliability of the QOL questionnaire, Cronbach's a coefficient was measured. To assess the structure of the questionnaire, we firstly performed confirmatory factor analysis to test the hypothesized factor models. Exploratory factor analysis was then performed using the principal component method with varimax rotation.

Results: Reliability of the questionnaire was low (Cronbach's a for different domains ranged from 0.24 to 0.74). In confirmatory factor analysis, only the 1-factor model indicated a good fit to the data. The exploratory factor analysis indicated a five-factor solution that jointly accounted for 55.7% of the variance observed. Also, the pattern of item loading was very different from the original structure of the questionnaire.

Conclusions: The findings suggest that the WHOQOL-BREF might only be a measure of the overall QOL in patients with CAD, and is not a suitable instrument for measuring the different QOL dimensions as expected in this population.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3793487PMC
September 2013

Incidence and Main Determinants of Contrast-Induced Nephropathy following Coronary Angiography or Subsequent Balloon Angioplasty.

Cardiorenal Med 2013 Jul 25;3(2):128-135. Epub 2013 Jun 25.

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

Background/aims: Patient assessment by imaging studies using contrast media is currently replacing open procedures, especially in high-risk patients. However, the use of such contrast media might result in acute events and injuries after the procedure. In the present study, we first determined the incidence of contrast-induced nephropathy (CIN) in a sample of Iranian patients who candidated for coronary angiography and/or angioplasty, and then assessed major risk factors predicting the appearance of CIN following these procedures.

Methods: Two hundred and fifty consecutive, eligible patients scheduled for coronary angiography and/or angioplasty at the Afshar Hospital in Yazd between January 2009 and August 2010 were considered for enrollment. Renal function was measured at baseline and 48 h after the intervention, and CIN was defined by an increase in creatinine of >0.5 mg/dl or 25% of the initial value. The predictive role of potential risk factors was determined in a multivariate model adjusted for comorbidities, preexisting renal impairment, and angiographic data.

Results: CIN following coronary angiography or angioplasty appeared in 12.8% of the cases. A myocardial infarction before the procedure (OR = 2.121, p = 0.036) and a prior history of hypertension (OR = 2.789, p = 0.025) predicted the appearance of acute renal failure following angiography or subsequent angioplasty. A low estimated glomerular filtration rate at baseline slightly predicted CIN after these interventions.

Conclusion: Transient acute renal dysfunction occurred in 12.8% of the patients within 48 h after angiography or subsequent angioplasty and could be predicted by a myocardial infarction before the procedure or by a prior history of systolic hypertension.
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http://dx.doi.org/10.1159/000351981DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3721129PMC
July 2013

Age and gender differences in the clustering of metabolic syndrome combinations: A prospective cohort research from the Kerman Coronary Artery Disease Risk Study (KERCADRS).

Diabetes Metab Syndr 2015 Oct-Dec;9(4):337-42. Epub 2013 Jul 4.

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

Background: The features of metabolic syndrome (MetS) and its components are now different in Iran compared to western countries.

Aims: The aim of this study was to provide estimates of the prevalence of the different MetS combinations in younger and older men and women in Iran.

Methods: A detailed interview regarding social demographics risk profile, and components of MetS was administered according to the Kerman Coronary Artery Disease Risk Study (KERCADRS) as population-based, epidemiological research among a cohort of 6000 individuals that residence in Kerman city.

Results: The overall prevalence of MetS was 25.2% in men and 42.5% in women considering the International Diabetes Federation (IDF) criteria and 31.0% in men and 38.0% in women when the National Cholesterol Education Program (NCEP) definition was applied. MetS was significantly more prevalent in females, using both definitions. The prevalence of MetS increased with age in both gender when both syndrome criteria were considered. The prevalence of different combinations of the syndrome by both definitions peaked in the age range 51-60 years among both men and women. The appearance of each component was observed earlier in women than men.

Conclusion: The prevalence of the MetS in the State of Kerman, a great province in the south-east of Iran is estimated as 35.0%, higher than in most developed countries and some other Middle-East regions, with generally higher prevalence rates for women. The prevalence of MetS increases with age in both genders with earlier appearance in men.
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http://dx.doi.org/10.1016/j.dsx.2013.02.023DOI Listing
September 2016

Increased carotid artery intima-media thickness in pregnant women with gestational diabetes mellitus.

J Tehran Heart Cent 2012 Nov 30;7(4):156-9. Epub 2012 Nov 30.

Physiology Research Center, Kerman University of Medical Sciences, Kerman, Iran.

Background: Pregnant women with previous gestational diabetes mellitus are at increased risk of progressive carotid artery disorders. The current study evaluated carotid intima-media thickness (IMT) in pregnant women with gestational diabetes at two time points of mid-term and full-term pregnancy to determine whether gestational diabetes mellitus causes increased IMT.

Methods: This cross-sectional study carried out at Afzalipour Hospital (Kerman, Iran) between 2009 and 2010, recruited 50 women who were at high risk of gestational diabetes during pregnancy and had an oral glucose challenge test (OGCT) as screening for gestational diabetes. B-mode ultrasound scans were performed at baseline and at two time points of mid-term pregnancy (20 to 24 weeks) and full-term pregnancy (36 to 38 weeks) on all the participants. The mean IMT of common carotids and internal carotid arteries from two walls (near and far walls) at four different angles was assessed.

Results: An overall comparison between the impaired OGCT test group and the control group revealed significant differences in carotid IMT in the mid-term (0.65 ± 0.07 vs. 0.59 ± 0.06 mm; p value = 0.002) and full-term (0.65 ± 0.05 vs. 0.59 ± 0.04 mm; p value < 0.001) pregnancy; however, the trend of the changes in carotid IMT during mid to full-term pregnancy was insignificant in each group (p value > 0.05).

Conclusion: Carotid IMT was significantly higher in the women with gestational diabetes than that in the normoglycemic group in different trimesters. This finding denotes that atherosclerosis might start years before the diagnosis of gestational diabetes in vulnerable women.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3537204PMC
November 2012

The association of insulin-like growth factor-1 with severity of coronary artery disease.

J Cardiovasc Med (Hagerstown) 2013 Jun;14(6):416-20

Endocrinology Department, Kerman Physiology Research Center, Kerman University of Medical Sciences, Kerman, Iran.

Aim: Insulin-like growth factor-1 (IGF-1) has been identified as a valuable indicator for impaired glucose tolerance, and its relationship with the presence of coronary atherosclerosis has been also suggested. A few studies have assessed the relationship between IGF-1 level and severity of atherosclerosis. In the present study, the relationship between IGF-1 and coronary artery disease (CAD) was examined with particular attention to the association between this parameter and Gensini score as a good angiographic marker for determining extension and severity of CAD.

Methods: One hundred and seven patients with suspected CAD consecutively referred for selective coronary angiography at the Shafa Hospital in Kerman between April and September 2010 were prospectively enrolled. Total IGF-1 was measured using radioimmunoassay methods (Diagnostics Systems Laboratory, Iran). Selective coronary angiography was performed for all study patients and the Gensini score is computed by assigning a severity score to each coronary stenosis according to the degree of luminal narrowing and its importance based on location.

Results: According to the Spearman correlation analysis, total IGF-I was directly correlated with Gensini score (Spearman's rho = 0.362, P = 0.041). Total IGF-I was slightly related to the number of involved coronary vessels (P = 0.058). Relation between age-adjusted and sex-adjusted mean total IGF-I levels with Gensini score remained significant (P = 0.046); however, the association between IGF-1 and the number of diseased vessels lost statistical significance after this adjustment.

Conclusion: IGF-1 appears as a positive indicator for severity of CAD assessed by the Gensini score, and thus its concentration may be an important indicator for assessing the extent of coronary artery involvement.
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http://dx.doi.org/10.2459/JCM.0b013e328358c7c7DOI Listing
June 2013

Effects of cardiac rehabilitation program on right ventricular function after coronary artery bypass graft surgery.

J Tehran Heart Cent 2012 28;7(1):25-9. Epub 2012 Feb 28.

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

Background: Cardiac rehabilitation has been recognized as one of the most effective strategies for managing cardiovascular indices as well as controlling the cardiovascular risk profile, in particular after coronary artery bypass graft surgery (CABG). However, the effect of this program on right ventricular function following CABG is unclear. The aim of this study was to evaluate the impact of cardiac rehabilitation on the right ventricular (RV) function in a cohort of patients who underwent CABG.

Methods: A total of 28 patients who underwent CABG and participated consecutively in an 8-week cardiac rehabilitation program at Tehran Heart Center were studied. The control group consisted of 39 patients who refused to attend cardiac rehabilitation and only received postoperative medical treatment after registration in the Cardiac Rehabilitation Clinic. Two-dimensional and Doppler echocardiography was performed to assess the RV function in both groups at the three time points of before surgery, at the end of surgery, and at the end of the rehabilitation program.

Results: Significant increase of RV function parameters were observed in both rehabilitation group (RG) and control group (CG) at the end of the rehabilitation program compared with post-CABG evaluation in terms of tricuspid annular plane systolic execution (RG: 12.50 mm to 14.18 mm; CG: 13.41 mm to 14.56 mm), tricuspid annular peak systolic velocity (RG: 8.55 cm/s to 9.14 cm/s; CG: 9.03 cm/s to 9.26 cm/s), and tricuspid annular late diastolic velocity (RG: 8.93 cm/s to 9.39 cm/s; CG: 9.26 cm/s to 9.60 cm/s).The parameters of the RV function did improve in both groups, but this improvement was not associated with participation in the complete cardiac rehabilitation program.

Conclusion: The RV function parameters gradually improved after CABG; this progress, however, was independent of the exercise-based cardiac rehabilitation program.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3466878PMC
October 2012

Characterization of suitability of coronary venous anatomy for targeting left ventricular lead placement in patients undergoing cardiac resynchronization therapy.

J Tehran Heart Cent 2012 28;7(1):10-4. Epub 2012 Feb 28.

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

Background: Differences in the quantity and distribution of coronary veins between patients with ischemic and nonischemic cardiomyopathy might affect the potential for the left ventricular (LV) lead targeting in patients undergoing cardiac resynchronization therapy (CRT). In the current study, we assessed and compared the suitability of the coronary venous system for the LV lead placement in ischemic and dilated cardiomyopathy.

Methods: This single-centre study, performed at our hospital, retrospectively studied 173 patients with the New York Heart Association class III or IV who underwent CRT. The study population was comprised of 74 patients with an ischemic underlying etiology and 99 patients with a non-ischemic etiology. The distribution of the veins as well as the final lead positions was recorded.

Results: There was no significant difference between the two groups in terms of the position of the available suitable vein with the exception of the posterior position, where the ischemic group had slightly more suitable veins than did the dilated group (48.4% versus 32.1%, p value = 0.049). There was also no significant difference with respect to the final vein, through which the LV lead was inserted. Comparative analysis showed that the patients with previous coronary artery bypass grafting surgery (CABG) had significantly fewer suitable veins in the posterolateral position than did the non-CABG group (16.3% versus 38.7%, p value = 0.029). There was, however, no significant difference between the two subgroups regarding the final vein position in which the leads were inserted.

Conclusion: The final coronary vein position suitable and selected for the LV lead insertion was not different between the cases with cardiomyopathy with different etiologies, and nor was it different between the ischemic cases with and without a history of CABG. Patients with a history of procedures around the coronary vessel may have an intact or recovered venous system and may, therefore, benefit from transvenous LV lead placement for CRT.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3466881PMC
October 2012

Plausible impact of dietary habits on reduced blood sugar in diabetic opium addicts with coronary artery disease.

Int Cardiovasc Res J 2012 Sep 15;6(3):75-8. Epub 2012 Sep 15.

Research Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, IR Iran.

Background: The effect of opium on glycemic control in diabetics is a controversial issue, as some studies have shown glucose lowering effect of opium in diabetes while the results of other studies do not support this idea. The possible role of opioid peptides in the regulation of food intake has been previously investigated. However, there is no data available about relationship between opium using and dietary pattern.

Objectives: The aim of the present study was to determine the daily intake of different nutrients in opium addict with diabetes diagnosed with coronary artery disease (CAD).

Methods: This study comprised 232 consecutive diabetic patients with CAD, and candidates for isolated coronary artery bypass surgery in Tehran Heart Center. Of these, 26 patients were opium addicts. Nutritional assessment was obtained by a validated semi-quantitative food frequency questionnaire (FFQ).

Results: In opium addicts compared to non-addicts, consumption of carbohydrates (360.0±120.9 versus 447.8±249.8 Gr/day, P=0.016) and vitamin A (1170.4±570.2 versus 1496.3±889.6 μg/d as Retinol Activity Equivalent (RAE), P=0.040) was lower than non-addicts and intake of other nutrients were similar across two group of patients.

Conclusions: Opium addiction in diabetic patients may lead to decrease of vitamin A and carbohydrate intake. This study showed that carbohydrate intake in addicted diabetic patients is lower than their non-addict counterpart. Thus, the so called lowering effect of opium on blood sugar may be due to nutritional habit of addicted patients.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3987411PMC
September 2012

Does analgesic effect of opium hamper the adverse effects of severe coronary artery disease on quality of life in addicted patients?

Anesth Pain Med 2012 10;2(1):22-7. Epub 2012 Jul 10.

Anesthesiology Department, Tehran Heart Center, Tehran University of Medical Sciences (TUMS), Tehran, Iran.

Background: Opium is a unique substance, regarding its analgesic effects. This may change the deteriorating effects of coronary artery disease (CAD) on quality of life (QOL) in addicted patients.

Objectives: We studied the QOL in opium-addicted and non-addicted CAD patients so as to determine the relationship between CAD risk factors and the subscales of their QOL.

Patients And Methods: Demographic and laboratory data as well as coronary artery risk factors were obtained and SF-36 questionnaire was completed through interviews with 268 (38 opium-addicted and 230 non-addicted) patients with CAD who were candidates for isolated coronary artery bypass at Tehran Heart Center.

Results: Mean Euro SCORE in addicted and non-addicted patients were 3.7 ± 7.6 and 2.4 ± 2.2 respectively (P = 0.036). In addicted group, higher preoperative HbA1c was associated with low physical function score (β = -0.395, P = 0.021). Low ejection fraction could negatively affect the general health (β = 0.394, P = 0.014) and mental health (β = 0.292, P = 0.015) subscales in the addicted group.

Conclusions: Despite higher rate of morbidities in opium-addicted patients compared to non-addicted ones, subscales of QOL were similar between the two groups. High preoperative HbA1c and low ejection fraction appeared to be determinants of poor QOL in the opium-addicted patients.
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http://dx.doi.org/10.5812/aapm.5139DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3821107PMC
November 2013

Discriminative and diagnostic value of anti-cyclic citrullinated peptide antibodies in Iranian patients with rheumatoid arthritis.

Rheumatol Int 2013 Mar 3;33(3):601-5. Epub 2012 Apr 3.

Medical College, Semnan University of Medical Sciences, Semnan, Iran.

Most studies on the diagnostic utility of the anti-cyclic citrullinated peptide antibody (anti-CCP) test in rheumatoid arthritis (RA) have been performed in developed countries, with only a few done in the developing world. We undertook a cross-sectional study to determine the diagnostic utility of the rheumatoid factor (RF) and anti-CCP tests in urbanized Iranians with early RA. One hundred and ninety-three serum samples were obtained from consecutive patients who were diagnosed with RA. Serum samples of 254 ones without RA, consisting of other inflammatory polyarthritis disorders, were also collected as controls. RF was measured for IgM by latex agglutination test, and titers higher than 1/80 were considered positive. Anti-CCP was also assayed using an ELISA with 6.25 RU/ml as the threshold for a positive result. The anti-CCP had sensitivity, specificity, positive predictive value, and negative predictive value for a diagnosis of RA of 47.2, 92.9, 83.5, and 69.8 %, respectively. Those for RF were 57.0, 83.9, 72.8, and 72.0 %, respectively. For anti-CCP antibodies in combination with RF, they were 38.9, 96.5, 89.3, and 67.5 %, respectively. Anti-CCP has higher specificity and predictive values compared with the RF parameter in diagnosing RA in Iranian patients, but their discriminative values were similar. Anti-CCP and RF in combination further increases the diagnostic value for RA.
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http://dx.doi.org/10.1007/s00296-012-2414-4DOI Listing
March 2013

Thrombolytic effect of streptokinase infusion assessed by ST-segment resolution between diabetic and non-diabetic myocardial infarction patients.

Cardiol J 2012 ;19(2):168-73

Kerman Physiology Research Center, Kerman University of Medical Sciences, Kerman, Iran.

Background: Recently, it has been hypothesized that type 2 diabetes might interfere with acute intravenous thrombolysis effectiveness as estimated by angiographic or electrocardiographic criteria. In our study, we compared the thrombolytic effect of streptokinase infusion between diabetic and non-diabetic myocardial infarction (MI) patients.

Methods: In a prospective interventional study, 240 consecutive patients who were admitted to the emergency ward and diagnosed with ST-elevation MI (STEMI) were enroled and classified into diabetics (n = 85) and non-diabetics (n = 155). Streptokinase was given to each patient at a dose of 1.5 million units in 1 h. Twelve-lead ECG was recorded immediately before the start of thrombolytic therapy and at 180 min afterwards for the patients with STEMI. The ST-segment elevation resolution was calculated and stratified as complete resolution ( > 70% ST-resolution), partial resolution (30-70% ST-resolution), or failed resolution ( < 30% ST-resolution).

Results: Complete ST-resolution occurred in 31.6% of diabetic and 51.0% of non-diabetic patients, respectively (p < 0.001). The incidence of partial ST-resolution in diabetic and non-diabetic patients was 40.5% and 40.0%, whereas 27.8% of patients in the diabetic group and 9.0% of patients in the non-diabetic group showed failed ST resolution. ST-resolution was independent of the location of MI. Multivariate analysis showed that diabetes mellitus, as well as higher Killip class and lower ejection fraction, could effectively predict ST-resolution failure.

Conclusions: Failure of ST-segment resolution 180 min after streptokinase infusion is notably higher in diabetic vs non-diabetic patients. This failure rate is correlated with higher Killip class and lower ejection fraction.
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http://dx.doi.org/10.5603/cj.2012.0029DOI Listing
July 2013

Outcomes and long-term quality of life of patients with severe left ventricular dysfunction who underwent coronary artery bypass surgery.

Gen Thorac Cardiovasc Surg 2012 Apr 28;60(4):202-12. Epub 2012 Mar 28.

Department of Cardiac Surgery, Tehran Heart Center, Tehran University of Medical Sciences, Tehran 1411713138, Iran.

Purpose: The aim of this study was to identify determinants of long-term results after coronary artery bypass surgery (CABG) in group of Iranian patients with systolic left ventricular (LV) dysfunction.

Methods: Reduced LV function was defined as an LV ejection fraction of <30%. Using our surgery database, we randomly selected 110 patients with EF < 30% and the same number of patients with EF ≥ 30% for whom demographic and clinical characteristics as well as in-hospital postoperative outcomes were available. Followup data were completed for 94 patients with EF < 30% (85.5%) and 101 patients with EF ≥ 30% (91.8%). Longterm results of the operation and the patients' quality of life were assessed for a mean follow-up period of 29.4 ± 11.0 months.

Results: In-hospital mortality and follow-up survival rates had no statistically differences in the low and normal EF groups (2.2% vs. 1.1% and 86.0% vs. 93.6%, respectively). Long-term surgical morbidity occurred in 43.6% of patients with severe LV dysfunction and in 38.6% of normal EF patients; it was considered similar for the two groups. Family history of coronary artery disease, New York Heart Association class IV, and moderate mitral insufficiency were the main predictors of long-term morbidity. Regarding the quality-of-life assessment, patients with severe LV dysfunction attained significantly lower levels of social activities.

Conclusion: Patients with severe LV dysfunction in comparison with those with normal LV function had similar 3-year survival rates and long-term complications. To improve survival following CABG in patients with severe LV dysfunction, mitral valve repair/replacement at the time of the initial operation should be considered.
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http://dx.doi.org/10.1007/s11748-010-0918-yDOI Listing
April 2012

Premature menopause and severity of coronary artery disease.

J Res Med Sci 2011 Aug;16(8):1026-31

Associate Professor, Physiology Research Center, Department of Cardiology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran.

Background: Relationship between premature menopause and presence, severity and life-threatening events of coronary artery disease (CAD) has been suggested in recent observations. The present study tried to assess relationship between age of menopause and severity of CAD in a sample of women with suspected CAD.

Methods: In a cross-sectional study, we included 189 consecutive women with suspected CAD that were candidate for coronary angiography and admitted to the Shafa hospital in Kerman city. Our final population for analysis included women who underwent natural menopause (n = 148) or premature menopause (n = 41). CAD severity was classified according to the number of coronary artery stenosis ≥ 50% in coronary angiography.

Results: Among 189 study patients with suspected CAD, 22.0% of those with early menopause and 23.6% of those with normal menopause suffered three coronary vessels involvement, while normal angiography features was shown in 39.0%o and 40.5%>, respectively. Regarding severity of CAD and left main lesions, no significant differences were found between the patients with and without premature menopause. According to the multivariable logistic regression model and with the presence of other patients' variables as cofounders, age of menopause could not predict the presence and severity of CAD in patients with suspected CAD. However, patients' age (OR: 1.11, p < 0.001) and family history of CAD (OR: 2.05, p = 0.04) were main predictors of the severity of CAD in these patients.

Conclusions: Premature menopause does not predict occurrence or severity of CAD in women with suspected CAD, but women age and their family history of CAD are main predictors of the severity of CAD.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3263079PMC
August 2011

Inappropriate use of urinary catheters and its common complications in different hospital wards.

Saudi J Kidney Dis Transpl 2012 Jan;23(1):63-7

Department of Infectious Disease, Hormozgan University of Medical Sciences, Hormozgan, Iran.

Inappropriate use of indwelling urinary catheters (IUCs) and their related complications is one of the most important problems in hospital wards. The aim of this study was to evaluate inappropriate use of IUCs and their complications among patients in Tehran, Iran. Two hundred and six consecutive patients hospitalized in the intensive care unit (ICU) as well as medical and surgical wards at the Shahid Mohammadi Hospital in Bandarabbas from September 1 to 30, 2005 and in whom IUCs were used, were studied. Data collected included age of the patients, diagnoses, reason for use of IUC and the complications related to it. Overall, 164 patients (79.6%) had IUCs used appropriately while 42 of them (20.6%) were catheterized unjustifiably. Inappropriate use of IUCs in the ICU, medical and surgical wards was reported in 12 (18.5%), 16 (19.0%) and 14 patients (24.6%), respectively. The most common complication of IUCs was urinary tract infection, which occurred in 91 patients (44.2%) and hematuria, which was seen in 3.9% of the patients. Our study suggests that inappropriate use of IUCs is prevalent, particularly in the surgical wards, and the most common complication observed was catheter-associated urinary tract infection.
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January 2012

Diagnostic performance of electrocardiography in the assessment of significant coronary artery disease and its anatomical size in comparison with coronary angiography.

J Res Med Sci 2011 Jun;16(6):750-5

Resident of Cardiology, Kerman University of Medical Sciences, Kerman, Iran.

Background: Current study addressed the predictive value of 12-lead electrocardiogram (ECG) in patients with suspected coronary artery disease (CAD).

Methods: Four hundred consecutive patients with new onset of chest pain were studied. A resting standard 12-lead ECG was recorded and all patients underwent coronary angiography.

Results: ECG correctly detected significant stenosis in 176 out of 400 patients with an overall sensitivity per patient of 51.5% and specificity per patient of 66.1%. Based on artery analysis, ECG had the highest and lowest sensitivity for the detection of involvement in LAD (37.3%) and RCA (25.8%), respectively. ROC curve analysis showed that ECG changes were not good indicators of coronary arteries involvement with areas under the ROC curves 0.586 (for LAD artery), 0.524 (for RCA artery) and 0.530 (for LCX artery).

Conclusions: ECG has low partial sensitivity and specificity for predicting coronary artery stenosis with accuracy ranged 58.5 to 62.0 percent based on coronary artery analysis.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3214392PMC
June 2011