Background: Insulin resistance (IR), even in its subclinical state, is a significant risk factor for the onset and progression of coronary artery disease (CAD). IR is a multifactorial condition, and dietary composition is a factor associated with its development. Elevated advanced glycation end products (AGEs) in the body, secondary to highly processed food consumption, can impair glucose metabolism. The present study investigated whether a restricted AGE diet could affect insulin sensitivity and anthropometric indices reflecting visceral adipose tissue in nondiabetic CAD patients.
Methods: This trial randomly allocated 42 angioplasty-treated patients to follow either low-AGE or control diets based on the AHA/NCEP guidelines for 12 weeks. Serum levels of total AGEs, insulin, HbA1c, and fasting blood sugar, as well as anthropometric measurements, were evaluated before and after the intervention. The Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) and anthropometric indices were calculated according to the proposed formula. The patients’ health status was assessed using the Seattle Angina Questionnaire (SAQ) at baseline and after the intervention.
Results: Our study showed a significant reduction in anthropometric indices in the low-AGE group after 12 weeks. Insulin levels and IR decreased during the low-AGE diet. No significant changes were observed in the other serum biochemical markers. All SAQ domains significantly decreased in both groups, except for Treatment Satisfaction.
Conclusion: A low-AGE diet for 12 weeks had beneficial effects on HOMA-IR and insulin levels in patients with CAD. Regarding the fundamental role of AGE in IR development and body fat distribution, AGE restriction may positively affect these patients.

Background: Coronary artery disease (CAD) and nonalcoholic fatty liver disease (NAFLD) are 2 common diseases around the globe. This investigation aimed to evaluate NAFLD prevalence in patients with CAD and the potential association between NAFLD and CAD.
Methods: This case-control study was performed between January 2017 and January 2018 at Ziaeian Hospital, Tehran, Iran. All patients aged between 35 and 5 years and referred for myocardial perfusion imaging were selected for the study. Totally, 180 participants were divided into CAD+ and CAD− groups. CAD was defined as stenosis of greater than 50.0% in at least 1 coronary artery. Afterward, all the patients underwent abdominal sonography and laboratory tests for NAFLD evaluation. Patients with a history of liver diseases, alcohol consumption, and drug-induced steatosis were excluded.
Results: The study population consisted of 122 women (67.8%) and 58 men (32.2%) at a mean age of 49.31±5.42 years. NAFLD was detected in 115 patients. NAFLD prevalence in the CAD+ group was 78.9%. NAFLD was determined as an independent risk factor for CAD (OR, 3.9).
Conclusion: NAFLD prevalence was high in the CAD⁺ group. The incidence of steatosis is on the rise in the general population. Hence, considering the high prevalence of abdominal obesity, all patients with NAFLD should be evaluated for CAD. 

Background: COVID-19 has rapidly become a global health emergency. This infection can cause damage to various organs. Injury to myocardial cells is one of the salient manifestations of COVID-19. The clinical course and outcome of acute coronary syndrome (ACS) are influenced by various factors, including comorbidities and concomitant diseases. One of these acute concomitant diseases is COVID-19, which can affect the clinical course and outcome of acute myocardial infarction (MI).
Methods: The present cross-sectional study compared the clinical course and outcome of MI and some of its practical factors between patients with and without COVID-19. The study population consisted of 180 patients (129 males and 51 females) diagnosed with acute MI. Eighty patients had COVID-19 infection concurrently.
Results: The mean age of the patients was 65.62 years. The frequencies of non–ST-elevation MI (vs ST-elevation MI), lower ejection fractions (<30), and arrhythmias were significantly higher in the COVID-19 group than in the non–COVID-19 group (P=0.006, 0.003, and P<0.001, respectively). The single-vessel disease was the most frequent angiographic result in the COVID-19 group, while the double-vessel disease was the most frequent angiographic result in the non–COVID-19 group (P<0.001).
Conclusion: It appears that patients with ACS who are co-infected with COVID-19 infection need essential care.

Background: While the traditional risk factors of atherosclerotic cardiovascular disease (ASCVD) have been well-established, the evolving role of nontraditional risk factors is not apparent. This study aimed to evaluate the association between nontraditional risk factors and the calculated 10-year ASCVD risk in a general population.
Methods: This cross-sectional study was conducted using the Pars Cohort Study data. All inhabitants of the Valashahr district in southern Iran, aged 40–75 years, were invited (2012-2014). Patients with a history of cardiovascular disease (CVD) were excluded. The demographic and lifestyle data were collected using a validated questionnaire. Multinomial logistic regression analysis was used to evaluate the association between the calculated 10-year ASCVD risk and the nontraditional risk factors of CVD, including marital status, ethnicity, educational level, tobacco and opiate consumption, physical inactivity, and psychiatric disorders.
Results: Of 9264 participants (mean age =52.2±9.0 y; 45.8% male), 7152 patients met the inclusion criteria. In total, 20.2%, 7.6%, 36.3%, 56.4%, and 46.2% of the population were cigarette smokers, opiate consumers, tobacco consumers, ethnically Fars, and illiterate, respectively. The prevalence rates of low, borderline, and intermediate-to-high 10-year ASCVD risks were 74.3%, 9.8%, and 16.2%, respectively. In multinomial regression, anxiety (adjusted odds ratio [aOR], 0.58; P<0.001) was significantly associated with a lower ASCVD risk, whereas opiate consumption (aOR, 2.94; P<0.001) and illiteracy (aOR, 2.48; P<0.001) were significantly associated with a higher ASCVD risk.
Conclusion: Nontraditional risk factors are associated with the 10-year ASCVD risk and, thus, might be considered besides traditional ones for ASCVD in preventive medicine and health policies.

Background: Heart rate variability (HRV) is calculated by electrocardiography (ECG-HRV) or blood pressure (BP-HRV). The purpose of this study was to determine the validity of the above methods in rats with normal and ischemic hearts during the baroreflex maneuver.
Methods: The study was conducted at Shiraz University of Medical Sciences, Shiraz, Iran, in 2021. Sprague-Dawley rats were divided into a sham group and an isoproterenol-mediated cardiac ischemia (ISO) group. Saline and isoproterenol (150 mg/kg) injected subcutaneously for 2 consecutive days in the sham and ISO groups, respectively. Then, the animals were anesthetized with an intraperitoneal injection of sodium thiopental (60 mg/kg), and the femoral artery and vein were cannulated. Baroreflex was activated using an intravenous injection of phenylephrine (10 µg/100 µL saline). ECG, BP, and heart rate (HR) were recorded, and the time domain of HRV and baroreflex gain were calculated.
Results: Baroreflex gain in the ISO group (male, weight=275.8±2.8 g, n=8) was lower than that in the sham group (male, weight=258±2.3 g, n=8) (P<0.05). ECG-HRV indicated an increase in the standard deviation of the RR interval (SDRR), the index of overall HRV, and the parasympathetic index of the root mean square of successive differences (RMSSD) in both groups. However, the rise in SDRR and RMSSD in the ISO group was less than that in the sham group (P<0.05). SDRR and RMSSD obtained from BP did not show a difference between the sham and ISO groups, nor did they correspond with the results seen in baroreflex gain.
Conclusion: BP-HRV was not as valuable as ECG-HRV in assessing cardiac ischemia.

Background: The long-term effects of aerobic exercise on the cardiorespiratory system have been studied extensively. This study aimed to evaluate the effects of aerobic exercise with and without external loads on blood glucose, cardiovascular, respiratory, and body temperature indices in patients with type II diabetes.
Methods: The present randomized control trial recruited participants from the Diabetes Center of Hamadan University through advertisement. Thirty individuals were selected and divided into an aerobic exercise group and a weighted vest group via block randomization. The intervention protocol included aerobic exercise on the treadmill (0 slopes) with an intensity of 50% to 70% of the maximum heart rate. The exercise program for the weighted vest group was identical to that of the aerobic group, except that the subjects wore a weighted vest.
Results: The mean age of the study population was 46.77±5.11 years in the aerobic group and 48±5.95 years in the weighted vest group. After the intervention, blood glucose in the aerobic group (167.07±72.48 mg/dL; P<0.001) and the weighted vest group (167.75±61.53 mg/dL; P<0.001) was decreased. Additionally, resting heart rate (aerobic: 96.83±11.86 bpm and vest: 94.92±13.65 bpm) and body temperature (aerobic: 36.20±0.83 ℃ and vest: 35.48±0.46 ℃) were increased (P<0.001). Decreased systolic (aerobic: 117.92±19.27 mmHg and vest: 120.91±12.04 mmHg) and diastolic (aerobic: 77.38±7.54 mmHg and vest: 82.5±11.32 mmHg) blood pressure and increased respiration rate (aerobic: 23.07±5.45 breath/min and vest: 22±3.19 breath/min) were seen in both groups but were not statistically significant.
Conclusion: One aerobic exercise session with and without external loads reduced blood glucose levels and systolic and diastolic blood pressure in our 2 study groups.

Background: Electrocardiography (ECG), as an easily accessible modality, is usually helpful in hypertrophic cardiomyopathy (HCM) diagnosis. The purpose of this study was to evaluate the role of ECG in differentiating between obstructive (OHCM) and non-obstructive (NOHCM) HCM.
Methods: The present study is a cross-sectional analysis of HCM patients referred to our center between 2008 and 2017. The study variables included age, sex, clinical presentation, medications, and ECG characteristics including PR interval, QRS width, QTc duration, Tpeak-Tend interval, QRS axis, QRS transition, ventricular hypertrophies, atrial abnormalities, ST-T abnormalities, and abnormal Q waves.
Results: The HCM sample consisted of 200 patients (55% males; age 45.60±15.50 y) from our HCM database. We compared the clinical and ECG characteristics of 143 NOHCM patients with those of 57 OHCM patients. The OHCM group was significantly younger than the NOHCM group (age =41.7 vs 47.0 y; P=0.016). The initial clinical presentation was similar between the 2 forms (P>0.05), and palpitations were the dominant symptom. Baseline ECG intervals, including PR (155.6 vs 157.9 ms), QRS (82.5 vs 82.0 ms), and QTc (430.5 vs 433.0 ms), were similar (all Ps>0.050). There were no differences regarding baseline rhythm, atrial abnormalities, QRS transition, ventricular hypertrophies, axis changes, ST-T changes, and abnormal Q waves between the HCM groups (all Ps>0.05).
Conclusion: The present study showed that standard 12-lead ECG had no role in distinguishing patients with the obstructive and non-obstructive forms of HCM.

Background: Hypertension is a health problem. The purpose of the present study was to compare perceived self-efficacy, benefits, and barriers of hypertension control between male and female patients.
Methods: This cross-sectional study was carried out on 400 patients referred to Rajaie Cardiovascular Medical and Research Center in Tehran from August 2020 through March 2021. The convenience sampling method was used. The data collection tools consisted of a digital sphygmomanometer, a demographic form, and a researcher-made questionnaire of perceived benefits, barriers, and self-efficacy of hypertension control, whose validity and reliability were obtained.
Results: The mean age of the male and female patients was 54.02±12.93 years and 56.48±12.10 years, respectively. The mean score of perceived barriers in women was lower than that in men, and the mean perceived self-efficacy in women was higher than that in men (P<0.001). According to the regression test, history of smoking in men and family history of hypertension and age in women were predictors of perceived benefits. Further, occupation and history of smoking in men and education level, family history of hypertension, and history of smoking in women were predictors of perceived barriers. Additionally, marital status, education level, and disease duration in men and education level, family history of hypertension, history of smoking, and age in women were predictors of perceived self-efficacy (P<0.050).
Conclusion: In men, the mean score of perceived barriers was higher and the mean score of perceived self-efficacy was lower. Additionally, the predictors of each of these perceptions were determined.

Background: Long-term outcomes in patients with idiopathic pulmonary arterial hypertension (IPAH) treated with calcium channel blockers (CCBs) are not well documented. Therefore, this study aimed to determine the long-term response to treatment with CCBs in patients with IPAH.
Methods: This retrospective cohort study was performed on 81 patients with IPAH admitted to our center. Vasoreactivity testing with adenosine was performed. Twenty-five patients showed a positive response and were included in the analysis.
Results: Of 24 patients, 20 (83.3%) were female, and the mean age of the patients was 45.90±10.42 years. Fifteen patients improved after 1 year on CCB therapy (the long-term CCB responders group), and 9 showed no improvement (the CCB failure group). The CCB responders group had a greater proportion of patients in the New York Heart Association (NYHA) functional class I or II (93.3%), a longer distance walked, and less severe hemodynamic parameters. At the 1-year evaluation, the long-term CCB responders showed more improvements in the mean 6-minute walk test result (437.43±125.32 vs 268.17±130.06; P=0.040), the mixed venous oxygen saturation level (71.84±9.87 vs 59.03±9.95; P=0.041), and the cardiac index (4.76±1.12 vs 3.15±0.90; P=0.012). Additionally, mPAP was lower in the long-term CCB responders group (47.35±12.70 vs 67.23±14.08; P=0.034).  Finally, all the CCB responders were in the NYHA functional class I or II (P=0.001).
Conclusion: Our study illustrated that long-term treatment with oral CCBs was effective in 60% of acute responders and 18.5% of the entire study population.

Background: Coronary artery disease (CAD) is the leading cause of cardiovascular death globally, and the most severe form of CAD, ST-elevation myocardial infarction (STEMI), needs immediate treatment. This study aimed to report patient characteristics and the causes of door–to–balloon time (D2BT) delays in STEMI patients admitted to Tehran Heart Center with a D2BT exceeding 90 minutes.
Methods: This cross-sectional study was conducted at Tehran Heart Center, Iran, from March 20th, 2020, through March 20th, 2022. Variables consisted of age, sex, diabetes mellitus, hypertension, dyslipidemia, smoking, opium, family history of CAD, in-hospital mortality, primary percutaneous coronary intervention results, culprit vessels, causes of delays, the ejection fraction, triglycerides, and low and high-density lipoprotein levels.
Results: The study population was composed of 363 patients (272 males [74.9]) at a mean (SD) age of 60±11.47 years. The leading causes of D2BT delays were the catheterization lab used in 95 patients (26.2) and misdiagnosis in 90 (24.8). Other causes were ST-elevation less than 2 mm in electrocardiograms in 50 patients (13.8) and referral from other hospitals in 40 (110.).
Conclusion: The catheterization lab in use and misdiagnosis were the leading causes of D2BT delays. We recommend that high-volume centers allocate an additional catheterization lab with an on-call cardiologist. Improved resident training and supervision in hospitals with many residents are also necessary.

Cardiac valvular Ehlers–Danlos syndrome (EDS) (type IV) is a rare subtype of the syndrome. The progressive and severe involvement of the heart valves is the principal characteristic of cardiovascular EDS, hence the necessity of the screening of patients with EDS for possible cardiovascular complications.
We herein describe a 17-year-old male patient, with a known case of Ehlers–Danlos syndrome, who was referred to our center due to symptomatic severe mitral regurgitation. Echocardiography showed the flailing of the A3 scallop of the mitral valve (MV) and severe enlargement of the left ventricle and the left atrium with mild systolic dysfunction. A physical examination revealed joint hyperlaxity, skin hyperelasticity, and abdominal hernias. He was, therefore, scheduled for surgery. MV repair was performed via commissuroplasty and ring annuloplasty, with an acceptable saline test. After being weaned from cardiopulmonary bypass, the patient had mild mitral regurgitation, which escalated to moderate-to-severe mitral within minutes. Consequently, the MV was replaced with a bioprosthetic valve. The postoperative course was uneventful.
Due to the high fragility of the MV, any resection and sewing of its fragile leaflets may produce residual regurgitation and necessitate valve replacement. MV replacement may be more logical in such patients. Our patient’s postoperative course was uneventful, and he was discharged without symptoms. Over 1 and 3 months of follow-up, he remained asymptomatic, and transthoracic echocardiography showed a normal bioprosthetic MV without paravalvular leakage.  

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