Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 13 3 2018 07 15 103 107 EN Mozhgan Saeidi Cardiac Rehabilitation Center, Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran. Ali Soroush Heart Research Center, Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran. Saeid Komasi Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran. Agostino Brugnera Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy. Marco Patucelli Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy. Danilo Carrozzino University “G. d'Annunzio” of Chieti and Pescara, Chieti, Italy. Mario Fulcheri University “G. d'Annunzio” of Chieti and Pescara, Chieti, Italy. Angelo Compare Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy. 2017 02 21 2017 07 30 Background: Health-care systems always strive for alternative cardiac rehabilitation (CR) models to ensure that options available to patients better fit their needs, risk factor profiles, and preferences. We assessed the effects of hospital-based cardiac rehabilitation (HBCR) and hybrid cardiac rehabilitation (HCR) on psychological symptoms (i.e., anxiety, depression, and stress) among patients following coronary artery bypass graft surgery (CABG). Methods: This cross-sectional study recruited 115 CABG patients who were referred to the Department of Cardiac Rehabilitation at Imam Ali Hospital in the Iranian city of Kermanshah between January and May 2016. The patients were assigned to 1 of the 2 programs of HBCR (26 sessions) and HCR (10 sessions). The study population’s psychological symptoms were assessed using the Depression, Anxiety, and Stress Scale (DASS) before and after the intervention, and the data were analyzed using paired t-tests and ANCOVA. Results: A total of 105 (91%) patients concluded the CR program. Respectively, 50.8% and 26.2% of the participants in the HBCR and HCR programs were female. The mean age was 59.6±9.2 years in the HBCR group and 58.7±6.1 years in the HCR group. The ANCOVA results indicated that both HBCR and HCR programs were equally effective in reducing anxiety (P=0.001 vs. P=0.015) and stress (P=0.002 vs. P=0.003) among the CABG patients, while only HBCR was effective in alleviating depressive symptoms (P=0.001). Conclusion: Our results demonstrated the efficacy of HBCR and HCR in diminishing stress and anxiety levels among the CABG patients. However, depression was affected only by HBCR. https://jthc.tums.ac.ir/index.php/jthc/article/view/684 https://jthc.tums.ac.ir/index.php/jthc/article/download/684/791

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 13 3 2018 07 15 108 114 EN Mohammad Alidoosti Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Reza Lotfi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Masoumeh Lotfi-Tokaldany Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Ebrahim Nematipour Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Mojtaba Salarifar Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Hamidreza Poorhosseini Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Arash Jalali Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. 2017 06 21 2018 03 15 Background: Despite recent advances in interventional equipment and techniques, the angiographic no-reflow phenomenon occurs in a considerable number of patients undergoing primary percutaneous coronary intervention (PCI). We investigated the clinical, angiographic, preprocedural, and procedural characteristics associated with the no-reflow phenomenon among patients undergoing primary PCI. Methods: Between March 2008 and April 2013, 530 patients (78.5% male, mean age=58.11±12.39 y) with ST-segment-elevation myocardial-infarction who underwent primary PCI were categorized in 2 groups according to their postprocedural thrombolysis-in-myocardial infarction (TIMI) flow grades:  those with a maximum score of 2 (the no-reflow or slow-flow group) and the ones with a score of 3 (the reflow group). A multivariable logistic regression model was used to find the multiple correlates of the no-reflow phenomenon after PCI. Results: There were 166 (31.3%) patients in the no-reflow group and 364 (68.7%) in the reflow group. The no-reflow patients were older and had significantly longer target lesion lengths, higher SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery (SYNTAX) scores, higher infarct-related artery SYNTAX scores, more thrombus burden, and a higher frequency of initial TIMI flow grades of 2 or lower. Our multivariable logistic regression analysis demonstrated that older age, higher numbers of Q waves, not using statin, longer target lesion lengths, higher thrombus grades, and higher infarct-related artery SYNTAX scores remained the independent correlates of increased no-reflow rates after primary PCI (area under the ROC curve=0.784,  95% CI: 0.742–0.826; P<0.001). Conclusion: Clinical, angiographic, and procedural features of patients undergoing primary PCI may be correlated with the occurrence of the no-reflow phenomenon. The thrombus grade and the infarct-related artery SYNTAX score could be among these factors. https://jthc.tums.ac.ir/index.php/jthc/article/view/743 https://jthc.tums.ac.ir/index.php/jthc/article/download/743/792

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 13 3 2018 07 15 115 125 EN Arsalan Adam Dow University of Health Sciences (DUHS), Karachi, Pakistan. Muhammad Armughan Ali Dow University of Health Sciences (DUHS), Karachi, Pakistan. Arshad Ali Shah Cardiology Department, Civil Hospital, Karachi, Pakistan. Ather Rizvi Dow University of Health Sciences (DUHS), Karachi, Pakistan. Aiman Rehan Dow University of Health Sciences (DUHS), Karachi, Pakistan. Ansab Godil Dow University of Health Sciences (DUHS), Karachi, Pakistan. Abdul Haseeb Abbas Dow University of Health Sciences (DUHS), Karachi, Pakistan. Najam Ul Ain Durrani Cardiology Department, Civil Hospital, Karachi, Pakistan. Ali Tariq Shaikh Dow University of Health Sciences (DUHS), Karachi, Pakistan. Muhammad Saad Ali Mallick Dow University of Health Sciences (DUHS), Karachi, Pakistan. Muhammad Nawaz Lashari Cardiology Department, Civil Hospital, Karachi, Pakistan. 2017 04 23 2018 05 26 Background: The diagnosis and management of acute coronary syndrome (ACS) have improved significantly over the past few decades; however, the recognition of myocardial ischemia still proves to be a dilemma for cardiologists. The aim of this study was to determine the role of hematological and coagulation parameters in the diagnosis and prognosis of patients with ACS. Methods: This prospective study recruited 250 patients with ACS and 250 healthy controls. The diagnostic role of hematological and coagulation parameters was assessed by comparing the patients with ACS with the control group. The relationships between these parameters and mortality were determined by dividing the patients into 2 groups: Group A (discharged) and Group B (patients who died within 30 days of follow-up). Multivariate Cox regression analysis was performed to calculate the hazard ratio (HR). Results: The mean age of the patients was 55.14±10.71 years, and 65.2% of them were male.  Prothrombin time (P<0.001), activated partial thromboplastin time (P<0.001), mean platelet volume (MPV) (P<0.001), white blood cell (WBC) count (P<0.001), and red blood cell distribution width (RDW) (P<0.001) were significantly higher in the case group than in the control group. WBC count (P<0.001), RDW (P<0.001), and MPV (P<0.001) were significantly higher in the controls than in the case group. The Cox regression model showed that RDW above 16.55% (HR=6.8), MPV greater than 11.25 fL (HR=2.6), and WBC higher than 10.55×103/μL (HR=6.3) were the independent predictors of mortality. Conclusion: In addition to being the independent predictors of short-term mortality, RDW, WBC, and MPV when used together with the coagulation profile may aid in the diagnosis of ACS in patients presenting with chest pain. https://jthc.tums.ac.ir/index.php/jthc/article/view/713 https://jthc.tums.ac.ir/index.php/jthc/article/download/713/793

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 13 3 2018 07 15 126 131 EN Seyed Reza Borzou Chronic Diseases (Home Care) Research Center, Faculty of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran. Sasan Amiri Faculty of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran. Mohsen Salavati Department of Nursing, Nursing & Midwifery Faculty, Hamadan University of Medical Sciences, Hamadan, Iran. Ali Reza Soltanian Modeling of Noncommunicable Diseases Research Center, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran. Gholamreza Safarpoor Department of Cardiac Surgery, Hamadan University of Medical Sciences, Hamadan, Iran. 2017 03 01 2017 09 02 Background: Heart surgery is vital for patients with coronary artery diseases that do not respond to drug treatments. We aimed to determine the effects of the implementation of the first phase of a cardiac rehabilitation program on self-efficacy in patients after coronary artery bypass graft surgery (CABG). Methods: This clinical trial study was conducted on 60 post-CABG patients by convenience sampling method in 2016. Those selected were randomly assigned to intervention (n=30) and control group (n=30). Overall, 72 hours after CABG, the first phase of the cardiac rehabilitation program both in theory and in practice (face-to-face and group methods) was conducted. Data were collected using a self-efficacy questionnaire completed by the patients in 3 stages: before the intervention, at discharge, and at 1 month after discharge. Data was analyzed by using analysis of covariance and repeated measures. Results: The mean of age in the intervention and control groups was 61.60±11.72 and 57.97±13. 4 years, respectively. There were 16 (53.3%) male patients in each group. The mean score of self-efficacy was not significantly different between the 2 groups before the intervention (P=0.076), whereas it had a meaningful statistical difference between the 2 groups at discharge and 1 month afterward (P<0.001). Conclusion:  The implementation of the first phase of the cardiac rehabilitation program not only augmented self-efficacy in regard to independent daily activities but also lessened the need for the second phase of the program among our post-CABG patients. https://jthc.tums.ac.ir/index.php/jthc/article/view/686 https://jthc.tums.ac.ir/index.php/jthc/article/download/686/794

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 13 3 2018 07 15 132 135 EN Mahshid Talebi-Taher Rasool-e-Akram General Teaching Hospital, Iran University of Medical Sciences, Tehran, Iran. Batool Naghavi Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran. Shokoufeh Hajsadeghi Rasool-e-Akram General Teaching Hospital, Iran University of Medical Sciences, Tehran, Iran. Aida Iranpour Department of Internal medicine, Firoozabadi General Hospital, Iran University of Medical Sciences, Tehran, Iran. Seyed Mahdai Pahlavani Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. 2017 10 22 2018 03 10 Inferior vena cava (IVC) thrombosis is a rare medical condition. Suppurative thrombophlebitis of the IVC is even a more uncommon subtype of IVC thrombosis and is mostly associated with IVC filters or venous catheters. We describe a 66-year-old man with persistent fever and history of pyonephrosis secondary to transurethral lithotripsy 1 month before recent admission. Computed tomography scan of the chest and abdomen revealed a filling defect in the IVC protruding into the right atrium. Transesophageal echocardiogram (TEE) revealed a large mass at the origin of the IVC entering into the right atrium, suggestive of a clot. Diagnosis of suppurative thrombophlebitis of the IVC secondary to a retroperitoneal abscess was made, and intravenous antibiotic therapy for 6 weeks without anticoagulation conferred ample thrombus resolution. Follow-up TEE in week 16 showed no residual thrombus in the IVC. https://jthc.tums.ac.ir/index.php/jthc/article/view/796 https://jthc.tums.ac.ir/index.php/jthc/article/download/796/795

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 13 3 2018 07 15 140 143 EN Hossein Doustkami Department of Cardiology, Ardabil University of Medical Sciences, Ardabil, Iran. Afshin Habibzadeh Department of Internal Medicine, Ardabil University of Medical Sciences, Ardabil, Iran. 2017 11 14 2018 06 09 Single coronary arteries (SCAs) constitute a rare coronary anomaly which is usually asymptomatic. However, SCAs may become symptomatic and even cause myocardial ischemia and infarction and as such necessitate proper interveaffiliation> Mahmood Sheikh-Fathollahi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 10 2015 10 10 Background: Extubation is associated with the risk of complications such as accumulated secretion above the endotracheal tube cuff, eventual atelectasia following a reduction in pulmonary volumes because of a lack of physiological positive end expiratory pressure, and intra-tracheal suction. In order to reduce these complications, and, based on basic physiological principles, a new practical extubation method is presented in this article. Methods: The study was designed as a six-month prospective cross-sectional clinical trial. Two hundred fifty-seven patients undergoing coronary artery bypass grafting (CABG) were divided into two groups based on their scheduled surgery time. The first group underwent the conventional extubation method, while the other group was extubated according to a new described method. Arterial blood gas (ABG) analysis results before and after extubation were compared between the two groups to find the effect of the extubation method on the ABG parameters and the oxygenation profile. Results: In all time intervals, the  partial pressure of oxygen in arterial blood / fraction of inspired oxygen(PaO/ FiO ) ratio in the new method group patients was improved compared to that in the conventional method; some differences, like PaO\FiO four hours after extubation, were statistically significant, however (p value = 0.0063). Conclusion:  The  new  extubation  method  improved somerespiratory  parameters  and  thus  attenuated  oxygenationcomplications and amplified oxygenation after extubation.   https://jthc.tums.ac.ir/index.php/jthc/article/view/259 https://jthc.tums.ac.ir/index.php/jthc/article/download/259/253

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 7 3 2015 10 11 128 135 EN Tavoos Rahmani-Cherati Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran. Manijhe Mokhtari-Dizaji Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran. Alireza Vajhi Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran. Abdorrazzagh Rostami Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran. Hossein Mehrad Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran Afshin Mohsenifar Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran 2015 10 10 2015 10 10 Background: In this study, we used a new computerized analytical method for the measurement of the endothelial function in sequential ultrasound images and compared it with histological studies, using the abdominal aorta in normal and atherosclerotic rabbits. Methods: Six rabbits received a standard rabbit chow as the normal group and the other 6 rabbits were fed a high cholesterol diet for four weeks as the atherosclerotic group. B-mode images of the abdominal aorta with 46 frames per second were saved over three cardiac cycles at baseline and during acetylcholine or nitroglycerin drug infusion in the normal and atherosclerotic rabbits. In order to evaluate endothelial-dependent relaxation, acetylcholine-mediated dilation (AMD) was measured during the infusion of acetylcholine at a rate of 0.5 µg/kg/min and endothelial-independent relaxation was evaluated by measuring nitroglycerine-mediated dilation (NMD) during the infusion of nitroglycerin at a rate of 5 µg/kg/min. In addition, the ultrasonic evaluation was confirmed by histopathological evaluation of the abdominal aorta. Results: Significant differences in AMD were detected between the normal and the four-week cholesterol-fed rabbits (p value < 0.05), whereas there were no significant differences in NMD between the two groups (p value > 0.05). No microscopic intimal lesions were seen in the normal rabbits, but intimal thickening was observed in the histological studies in the four- week cholesterol-fed rabbits. Additionally, the total cholesterol, triglycerides, low-density lipoprotein cholesterol, and high- density lipoprotein cholesterol levels were remarkably increased in the sera of the four-week cholesterol-fed rabbits (p value< 0.05). Conclusion: A new automatic method can help accurately evaluate the endothelial function in normal and hypercholesterolemic rabbits. https://jthc.tums.ac.ir/index.php/jthc/article/view/260 https://jthc.tums.ac.ir/index.php/jthc/article/download/260/254

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 7 3 2015 10 11 136 139 EN Yaser Jenab Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Mohamad Taher Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran. Samira Shirzad Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 10 2015 10 10 Stress-induced cardiomyopathy or Takotsubo cardiomyopathy is a recently increasing diagnosed disease manifested by transient apical or mid left ventricular dilation and dysfunction. This sign is similar to acute myocardial infarction but without significant coronary artery stenosis. There are important and essential differences between Takotsubo cardiomyopathy and acute myocardial infarction in terms of management, necessitating a good understanding of the pathophysiology, diagnosis, and treatment of the former. We report a case of Takotsubo cardiomyopathy which presented with dizziness and near syncope after an intense emotional stress. Electrocardiogram showed ST-T changes in V1-V3 and echocardiography revealed severe left ventricular systolic dysfunction with marked regional wall motion abnormalities. Coronary angiography demonstrated minimal coronary artery disease. The patient was treated with beta -blockers, angiotensin-converting enzyme inhibitors, Aspirin, Clopidogrel, and diuretics. At the follow-up visit, all the symptoms had disappeared and control echocardiography showed significant improvement in the left ventricular systolic function with a normal ejection fraction and normal wall motion. https://jthc.tums.ac.ir/index.php/jthc/article/view/261 https://jthc.tums.ac.ir/index.php/jthc/article/download/261/255

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 7 3 2015 10 11 140 142 EN Maryam Taherkhani Cardiovascular Research Center, Modarres Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran. Seyyed Reza Hashemi Cardiovascular Research Center, Modarres Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran. Shahryar Nikpoor Cardiovascular Research Center, Modarres Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran. 2015 10 10 2015 10 10 Isolated dissection of the superior mesenteric artery is a rare occurrence with a hitherto unknown exact etiology. Patients m