Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 11 2 2016 10 10 49 54 EN Zahra Alborzi Department of Cardiology, Medical School, Yasouj University of Medical Sciences, Yasouj, Iran. Vahid Zangouri Department of General Surgery, Shiraz University of Medical Sciences, Shiraz, Iran. Shahram Paydar Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran. Zahra Ghahramani Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran. Masih Shafa Department of Cardiac Surgery, Shiraz University of Medical Sciences, Shiraz, Iran. Bizhan Ziaeian Department of Thoracic Surgery, Shiraz University of Medical Sciences, Shiraz, Iran. Mohammad Reza Radpey Department of Vascular Surgery, Shiraz University of Medical Sciences, Shiraz, Iran. Armin Amirian Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran. Shahin Khodaei Department of General Surgery, Shiraz University of Medical Sciences, Shiraz, Iran. 2016 07 04 2016 07 04 A myocardial contusion refers to a bruise of the cardiac muscle, the severity of which can vary depending on the severity of the injury and when the injury occurs. It is a major cause of rapid death which happens after blunt chest trauma and should be suspected at triage in the emergency department. We demonstrated that suspected myocardial contusion patients who have normal electrocardiograms (ECGs) and biomarker tests can be safely discharged. However, if the test results are abnormal, the next steps should be echocardiography and more advanced measures. Diagnosing myocardial contusion is very difficult because of its nonspecific symptoms. If a myocardial contusion happens, cardiogenic shock or arrhythmia must be anticipated, and the patient must be carefully monitored. https://jthc.tums.ac.ir/index.php/jthc/article/view/581 https://jthc.tums.ac.ir/index.php/jthc/article/download/581/449

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 11 2 2016 10 10 55 61 EN Homa Kashani Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Hojjat Zeraati Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Kazem Mohammad Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Hamidreza Goodarzynejad Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Mahmood Mahmoudi Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Saeed Sadeghian Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Mohammadali Boroumand Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. 2015 11 02 2016 01 06 Background: Investigators frequently encounter continuous outcomes with plenty of values clumped at zero called semi-continuous outcomes. The Gensini score, one of the most widely used scoring systems for expressing coronary angiographic results, is of this type. The aim of this study was to apply two statistical approaches based on the categorization and original scale of the Gensini score to simultaneously assess the association between covariates and the presence and severity of coronary artery disease (CAD). Methods: We considered the data on 1594 individuals admitted to Tehran Heart Center with CAD symptoms from July 2004 to February 2008. The participants’ baseline demographic and clinical characteristics were collected, and their coronary angiographic results were expressed through the Gensini score. The generalized ordinal threshold and two-part models were applied for the statistical analyses. Results: Totally, 320 (20.1%) individuals had a Gensini score of zero. The results of neither the two-part model nor the generalized ordinal threshold model showed a significant association between Factor V Leiden and the occurrence of CAD. However, based on the two-part model, Factor V Leiden was associated with the severity of CAD, such that the Gensini score increased by moving from a wild genotype to a heterozygote (β = 0.44; 95% CI: 0.20-0.69 in logarithm scale) or a homozygote mutant (β = 0.70; 95% CI: 0.28- 1.12 in logarithm scale). The proportional odds assumption was not met in our data ( = 54.26; p value < 0.001); however, a trend toward severe CAD was also observed at each category of the Gensini score using the generalized ordinal threshold model. Conclusion: We conclude that besides loss of information by sorting a semi-continuous outcome, violation from the proportional odds assumption complicates the final decision, especially for clinicians. Therefore, more straightforward models such as the two-part model should receive more attention while analyzing such outcomes. https://jthc.tums.ac.ir/index.php/jthc/article/view/386 https://jthc.tums.ac.ir/index.php/jthc/article/download/386/450

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 11 2 2016 10 10 62 67 EN Mohammad Alidoosti Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Vahideh Sharifnia Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Seyed Ebrahim Kassaian Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Alimohammad Hajizeinali Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Hamidreza Poorhosseini Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Mojtaba Salarifar Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Younes Nozari Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Elham Hakki Kazazi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. 2016 07 04 2016 07 04 Background: The biolimus-eluting stent (BES), with a biodegradable polymer, has not been previously compared with the everolimus-eluting stent (EES), as a second-generation drug-eluting stent (DES).We sought to compare the 1-year outcome between the PROMUS™ stent (EES type) and the BioMatrix™ stent (BES type). Methods: From March 2008 to September 2011, all patients treated with the PROMUS™ stent or the BioMatrix™ stent for coronary artery stenosis at Tehran Heart Center were enrolled. The primary end points were 1-year adverse events, comprising death, myocardial infarction, target vessel revascularization, and target lesion revascularization.  The secondary end point was stent thrombosis. The Cox proportional hazard model was used to assess the adjusted association between the stent type and the follow-up outcome. Results: From 949 patients (66.3% male, mean age =59.48 ± 10.46 y) with 1,018 treated lesions, 591 patients (630 lesions, 65.1% male, mean age = 59.24 ± 10.23 y) received the PROMUS™ stent and 358 patients (388 lesions, 68.2% male, mean age = 59.88 ± 10.83 y) were treated with the BioMatrix™ stent. Before adjustment, the rate of the primary end points was 3.2% and 3.4% in the EES and BES, respectively (p value = 0.925, HR (EES to BES) = 1.035, 95% CI: 0.50 to 2.13). The rate of stent thrombosis was 2% and 1.7% in the EES and BES, respectively (p value = 0.698). After adjustment on confounder variables, there was no statistically significant difference in major adverse cardiac events between the PROMUS™ stent and the BioMatrix™ stent (p value = 0.598, HR (EES to BES) = 0.817, 95% CI: 0.39 to 1.73). Conclusion: At 1 year’s follow-up, the BES and EES showed similar safety and efficacy rates in the patients undergoing percutaneous coronary intervention with a relatively low rate of adverse events in the 2 groups.     https://jthc.tums.ac.ir/index.php/jthc/article/view/580 https://jthc.tums.ac.ir/index.php/jthc/article/download/580/451

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 11 2 2016 10 10 68 72 EN Behzad Alizadeh Emam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. Zahra Badiee Doctor Sheikh Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. Mahmoud Mahmoudi Emam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. Mahsa Mohajery Emam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. AND Doctor Sheikh Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. 2016 07 04 2016 07 04 Background: N-terminal pro-brain natriuretic peptide (NT-proBNP) is a sensitive biomarker for the detection of asymptomatic left ventricular (LV) dysfunction. Since β-thalassemia major patients suffer from early diastolic dysfunction due to iron deposition of chronic blood transfusion, we tried to evaluate the correlation between the serum NT-proBNP level and the severity of LV diastolic dysfunction determined by echocardiography in these patients. Methods: Fifty β-thalassemia major patients with normal LV systolic function were studied by tissue Doppler echocardiography, and blood samples were taken at the same time to measure the serum NT-proBNP level. Using flow velocity through the mitral valve on the tissue velocity of the mitral annulus in early ventricular filling (E/E') as an LV diastolic function indicator, the patients were divided into 3 groups: group 1) no diastolic dysfunction (E/E' < 8), group 2) suspected diastolic dysfunction (E/E' = 8-15), and group 3) documented diastolic dysfunction (E/E' >15). Other variables assessed included sex, age, method of chelator therapy, and mean hemoglobin and ferritin levels for the past 2 years. Results: According to the echocardiographic findings of all the 50 patients (29 male and 21 female) with an age range of 11-35 years (mean = 17.98 y), 46% were classified in group 1, 54% in group 2, and none in group 3. The NT-proBNP level was 1070 ± 566 ng/mL in group 1 and 974 ± 515 ng/mL in group 2. The t-test showed no significant difference between groups 1 and 2 in the NT-proBNP level (p value = 0.536). Conclusions: Due to specific conditions in thalassemia major patients, the correlation between the serum NT-proBNP level and the severity of diastolic dysfunction seems to be not meaningful. https://jthc.tums.ac.ir/index.php/jthc/article/view/582 https://jthc.tums.ac.ir/index.php/jthc/article/download/582/452

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 11 2 2016 10 10 73 78 EN Amir Hosein Movahedian Tehran University of Medical Sciences, Tehran, Iran. Ziba Mosayebi Tehran University of Medical Sciences, Tehran, Iran. Setareh Sagheb Tehran University of Medical Sciences, Tehran, Iran. 2016 07 04 2016 07 04 Background: Delayed or missed diagnosis of critical and cyanotic congenital heart disease (CHD) in asymptomatic newborns may result in significant morbidity and mortality. The aim of this study was to determine the accuracy of pulse oximetry screening  performed on the first day of life for the early detection of critical and cyanotic CHD in apparently normal newborns. Methods: This cross-sectional study used postductal pulse oximetry to evaluate term neonates born between 2008 and 2011 with normal physical examinations. Functional oxygen saturation < 95% was considered abnormal, and second measurement was done 2 hours later. If the second measurement remained < 95%, an echocardiogram was performed. On enrolment in the study, the following data for each neonate were recorded: gestational age, gender, birth weight, mode of delivery, and mother’s age. Results: During the study period, totally 3,846 newborns were evaluated. Of the whole study population, 304 (7.9%) babies  had a  postductal functional saturation < 95%. The second measurement was also < 95% in 104 (2.7%) neonates. The mean age of the neonates at the time of pulse oximetry was 18.91 ± 8.61 (min = 4.5 and max = 49) hours. Forty-nine percent of the subjects were female and 51% were male. Echocardiography was performed on 81 out of 104 newborns, and 14 (0.36%) of them had CHD. The types of CHD in our patients were tetralogy of Fallot (3 cases), transposition of the great vessels (2 cases), double-outlet right ventricle (2 cases), truncus arteriosus, total anomalous pulmonary venous return, atrioventricular septal defect, pulmonary atresia, persistent pulmonary hypertension, ventricular septal defect, and atrial septal defect (1 case for each type). The best time for pulse oximetry was within 8-24 hours of the newborns’ life. Conclusion: Pulse oximetry screening along with clinical examination may be able to assist in the early detection of critical and cyanotic CHD in asymptomatic newborns. https://jthc.tums.ac.ir/index.php/jthc/article/view/583 https://jthc.tums.ac.ir/index.php/jthc/article/download/583/453

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 11 2 2016 10 10 79 84 EN Mohammad Reza Zafarghandi Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Morteza Taghavi Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Pezhman Farshidmehr Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Azadeh Sayarifard Center for Academic and Health Policy, Tehran University of Medical Sciences, Tehran, Iran. 2016 07 04 2016 07 04 Background: Chronic wounds are a serious problem for the patient and can increase the socioeconomic burden on the healthcare system and community. This study aimed at investigating the effect of angioplasty on chronic ischemic wound healing. Methods: This study was conducted in Sina Hospital, affiliated to Tehran University of Medical Sciences. Thirty-eight patients with chronic ischemic wounds and a suspicion of the narrowing or blockage of arteries underwent peripheral angiography. Arteries under angioplasty in different patients comprised the aorta and the iliac, superficial femoral, popliteal, and tibial arteries. The patients were evaluated in terms of wound healing in weekly and monthly visits. Wound healing was measured based on the Bates–Jensen criteria. Results: The patients were followed up at a median of 4.5 months. The mean age of the patients was 61.1 ± 7.5 years. Of 38 patients, 12 (31.6%) were female. The involvement of arteries on angiography consisted of 16 (42.2%) cases of total occlusion and 22 (57.8%) cases of stenosis. Following angioplasty, the level of the narrowing of arteries and the wound score showed a significant reduction in all the patients (p value < 0.001). Wound healing was observed in 29 (76.3%) patients. Hematoma, pseudoaneurysm, and thrombosis comprised the complications. No significant differences were observed in terms of age, gender, and history of risk factors between the 2 groups of wound healing and nonhealing. The wound evaluation scores before (p value = 0.044) and after (p value < 0.001) angioplasty were lower in the wound healing group than in the nonhealing group. Conclusion: Angioplasty of the aorta and lower limb arteries improved the healing of chronic ischemic wounds in our patients. https://jthc.tums.ac.ir/index.php/jthc/article/view/584 https://jthc.tums.ac.ir/index.php/jthc/article/download/584/454

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 11 2 2016 10 10 85 87 EN Ibrahim Duvan Guven Hospital, Department of Cardiovascular Surgery, Ankara, Turkey. Umit Pinar Sungur Guven Hospital, Department of Cardiovascular Surgery, Ankara, Turkey. Burak Emre Onuk Guven Hospital, Department of Cardiovascular Surgery, Ankara, Turkey. Mehmet Şanser Ateş Guven Hospital, Department of Cardiovascular Surgery, Ankara, Turkey. Ibrahim Sami Karacan Guven Hospital, Department of Cardiovascular Surgery, Ankara, Turkey. Murat Kurtoglu Guven Hospital, Department of Cardiovascular Surgery, Ankara, Turkey. 2015 10 07 2016 06 12 Surgery for heart diseases during pregnancy, especially necessitating cardiopulmonary bypass, is believed to trigger maternal and fetal risks and should be performed only when medical therapy has been unsuccessful to alleviate the cardiac decompensation. A 33-year-old pregnant woman in her 33rd week of gestation was admitted to our hospital. She had rheumatic mitral valvular stenosis and had undergone mitral valve replacement (MVR) with a mechanical prosthesis 11 years earlier in another center. Echocardiography revealed a thrombotic mass obstructing the leaflets of the mechanical mitral valve. Emergency redo bioprosthetic MVR concomitant with caesarean section was performed uneventfully. Both mother and baby were discharged in good condition. https://jthc.tums.ac.ir/index.php/jthc/article/view/252 https://jthc.tums.ac.ir/index.php/jthc/article/download/252/455

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 11 2 2016 10 10 88 91 EN Feridoun Sabzi Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran. 2016 07 04 2016 07 04 Atrial septal defect (ASD) is a common congenital anomaly that has low surgical mortality and morbidity. We report a very rare case of a low-lying ASD, combined with the drainage of the inferior vena cava and the left superior vena cava into the left atrium. This combination was associated with an unroofed coronary sinus. We also describe an iatrogenic surgical diversion of the inferior vena cava into the left atrium with its complication. The patient presented with moderate cyanosis and was referred for elective ASD repair. He underwent surgical repair of the ASD after transthoracic echocardiography. Early postoperative right-to-left shunting with cyanosis and hypoxia was associated with abdominal complications. Surgical re-exploration revealed the diversion of the inferior vena cava into the left atrium, which was repaired with a pericardial patch. Peptic ulcer perforation was repaired after abdominal laparotomy. The patient had an uneventful recovery and was discharged home on the 17th postoperative day. One-year follow-up revealed no recurrence of cyanosis or residual ASD on echocardiography. https://jthc.tums.ac.ir/index.php/jthc/article/view/585 https://jthc.tums.ac.ir/index.php/jthc/article/download/585/456

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 11 2 2016 10 10 92 97 EN Maryam Nabati Department of Cardiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran. Keyvan Yosofnezhad Department of Cardiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran. Morteza Taghavi Student Research Committee, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran. Ali Abbasi Department of Pathology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran. Ali Ghaemian Department of Cardiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran. 2016 07 04 2016 07 04 Constrictive pericarditis (CP) is an uncommon post inflammatory disorder. It is described as pericardial thickening, myocardial constriction, and impaired diastolic filling. The most common etiologies are idiopathy, mediastinal radiotherapy, and prior cardiac surgery. Less common etiologies include viral infections, collagen vascular disorders, renal failure, sarcoidosis, tuberculosis, and blunt chest trauma. CP can less commonly be caused by malignancy. We report a very rare case of non-Hodgkin’s lymphoma (NHL) presenting twice with attacks of decompensated heart failure. Echocardiography revealed that CP was responsible for the patient's symptoms as the first manifestation of NHL. Chest computed tomography scan and biopsy findings were compatible with the diagnosis of NHL. The patient received R-CHOP (cyclophosphamide, hydroxydaunorubicin, Oncovin®, and prednisone or prednisolone, combined with the monoclonal antibody rituximab) chemotherapy. Three months later, there was significant improvement in the patient’s symptoms and considerable decrease in pericardial thickness. https://jthc.tums.ac.ir/index.php/jthc/article/view/586 https://jthc.tums.ac.ir/index.php/jthc/article/download/586/457

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 11 2 2016 10 10 98 101 EN Arsalan Salari Guilan Interventional Cardiovascular Research Center, Guilan University of Medical Sciences, Rasht, Iran. Mahboobe Gholipur Guilan Interventional Cardiovascular Research Center, Guilan University of Medical Sciences, Rasht, Iran. Maedeh Rezaeidanesh Guilan Interventional Cardiovascular Research Center, Guilan University of Medical Sciences, Rasht, Iran. Anoosh Barzigar Guilan Interventional Cardiovascular Research Center, Guilan University of Medical Sciences, Rasht, Iran. Shahram Rahmani Guilan Interventional Cardiovascular Research Center, Guilan University of Medical Sciences, Rasht, Iran. Mohadeseh Pursadeghi Guilan Interventional Cardiovascular Research Center, Guilan University of Medical Sciences, Rasht, Iran. Hannan Ebrahimi Guilan Interventional Cardiovascular Research Center, Guilan University of Medical Sciences, Rasht, Iran. 2016 07 04 2016 07 04 Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome and sudden cardiac death. We report coronary artery dissection in a 36-year-old woman with retrosternal chest pain 2 weeks after abortion. Electrocardiography showed ST elevation in leads V2-V4 and ST depression in the inferior leads. Lab data were normal. Cardiac catheterization showed a suspicious thrombotic lesion at the proximal portion of the left anterior descending artery with a smooth contour consistent with distal haziness and dissection site. Final diagnosis was coronary artery dissection. At 1 week's follow-up, the patient was in good physical condition. At 1 month's follow-up, she had no complaints of discomfort. And finally, 8 months after having suffered a heart attack, she presented no evidence of angina, dyspnea, or congestive heart failure Spontaneous coronary artery dissection is a rare disease that mainly affects younger women. Compared with earlier reports, the prognosis seems to be improved by early diagnosis and interventional treatment. https://jthc.tums.ac.ir/index.php/jthc/article/view/587 https://jthc.tums.ac.ir/index.php/jthc/article/download/587/458

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 11 2 2016 10 10 102 103 EN Ali Hosseinsabet Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Sohyl Mansorian Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Maryam Sotoudeh Anvary Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. 2016 07 04 2016 07 04 - https://jthc.tums.ac.ir/index.php/jthc/article/view/588 https://jthc.tums.ac.ir/index.php/jthc/article/download/588/444

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 11 2 2016 10 10 589 589 EN Hilman Zulkifli Amin Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia. Lukman Zulkifli Amin Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia. Jakarta, Indonesia. Firman Zulkifli Amin Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia. 2016 07 04 2016 07 04 - https://jthc.tums.ac.ir/index.php/jthc/article/view/589 https://jthc.tums.ac.ir/index.php/jthc/article/download/589/442