Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 14 1 2019 01 16 1 5 Ali Maleki Madani¬ Heart Center, Lorestan University of Medical Sciences, Khorramabad, Iran. Reza Ghanavati Imam Khomeini Hospital, Lorestan University of Medical Sciences, Khorramabad, Iran. Mahdi Montazeri Imam Khomeini Hospital, Lorestan University of Medical Sciences, Khorramabad, Iran. Saeid Forughi School of Nursing, Lorestan University of Medical Sciences, Khorramabad, Iran. Behjat Nabatchi Imam Khomeini Hospital, Lorestan University of Medical Sciences, Khorramabad, Iran. 2019 01 16 Background: Cardiovascular events are the leading cause of mortality and are highly associated with lifestyle. We aimed to evaluate the prevalence of coronary artery disease (CAD) and its major risk factors in the western Iranian city of Borujerd. Methods: This cross-sectional study was conducted on 801 subjects older than 35 years of age, recruited via cluster sampling in Borujerd. The diagnosis of CAD was based on the positive results of Rose Angina Questionnaire, Minnesota coding, or prior history of CAD. Then, the risk factors were measured by biochemistry and relevant laboratory examinations, or data extraction from the subjects’ history. Results: The study sample consisted of 412 men and 389 women at a mean age of 54.82±12.11 years. The prevalence of risk factors including hypertension, diabetes mellitus, dyslipidemia, smoking, and obesity was 38.2%, 17.4%, 64%, 23.2%, and 22.8%, respectively. Based on the criteria, 19.1% and 31.7% of the CAD cases were definite and probable, respectively. Furthermore, 12.5% had definite signs and symptoms of CAD, and 5.4% had positive Rose Angina Questionnaire outcomes. Conclusion: The current study demonstrated the distribution of CAD in the Iranian city of Borujerd and it was demonstrated that obesity and smoking are the most common risk factors, respectively. https://jthc.tums.ac.ir/index.php/jthc/article/view/1025 https://jthc.tums.ac.ir/index.php/jthc/article/download/1025/810

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 14 1 2019 01 16 6 11 EN Ali Javinani Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran. Zahra Javady Nejad Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran. Farhad Gharibdoost Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran. Ahmad Reza Jamshidi Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran. Reza Atef Yekta Anesthesiology Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Saba Alvand Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran. Vahide Imeni Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran. Seyed Naser Hashemi Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran. Hoda Kavosi Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran. 2017 10 24 2018 11 06 Background: Cardiac involvement, as one of the life-threatening manifestations of systemic sclerosis (SSc), is chiefly caused by collagen fiber deposition in the myocardium, which subsequently leads to conduction abnormalities. In the present study, we aimed to investigate the prevalence and clinical significance of bundle branch blocks (BBBs) and the fragmented QRS complex (fQRS) in Iranian patients with SSc. Methods: Forty-one patients with SSc were enrolled from the outpatient SSc clinic of Shariati Hospital, Tehran University of Medical Sciences, between October 2016 and February 2017. Twelve-lead ECG was obtained and interpreted for BBBs and the fQRS. To adjust for the confounding effects of non–SSc-related cardiovascular risk factors, we calculated the Framingham risk score to estimate the risk of cardiovascular diseases. The associations between the studied conduction abnormalities and SSc cutaneous subtypes; disease duration; and the Medsger SSc severity scale of cutaneous, pulmonary, and vascular involvements were also analyzed. Results: The study population consisted of 41 Iranian patients with SSc at a mean age of 47.48±11.57 years (82.9% female). The prevalence of BBBs and the fQRS was 26.8% and 36.6%, respectively. The fQRS was associated with the limited cutaneous SSc subtype (OR: 0.100, 95%CI: 0.018–0.553, and P=0.028). BBBs and the fQRS were not associated with either the Framingham risk score or the rest of the clinicodemographic variables. Conclusion:  BBBs and the fQRS were more prevalent in our patients with SSc, without any association with the involvement of the other organs. These findings may suggest the independent pathophysiology of cardiac involvement in SSc. https://jthc.tums.ac.ir/index.php/jthc/article/view/797 https://jthc.tums.ac.ir/index.php/jthc/article/download/797/811

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 14 1 2019 01 16 12 17 EN Ata Firouzi Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran. Niloufar Samiei Heart valve disease Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran. Somayyeh Ahmadi Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran. Nasim Naderi Rajaie Cardiovascular, Medical, and Research Center, Iran university of Medical Sciences, Tehran, Iran. Parham Sadeghipour Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran. Hamid Reza Sanati Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran. Fahimeh Kashfi Heart valve disease Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran. Roya Sattarzadeh Echocardiography Laboratory, Department of Cardiovascular Diseases, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran. Sedigheh Hantoushzadeh Maternal Fetal Neonatal Research Center, Valiasr Hospital, Tehran University of Medical Sciences, Tehran, Iran. Maryam Bayat Rajaie Cardiovascular, Medical, and Research Center, Iran university of Medical Sciences, Tehran, Iran. Sanaz Pourtaghi Rajaie Cardiovascular, Medical, and Research Center, Iran university of Medical Sciences, Tehran, Iran. Mohsen Nasiri Rajaie Cardiovascular, Medical, and Research Center, Iran university of Medical Sciences, Tehran, Iran. 2018 01 07 2018 11 06 Background: Mitral stenosis tends to worsen during pregnancy because of the increase in the cardiac output and the heart rate. In nonresponders to medical therapy, percutaneous transluminal mitral commissurotomy (PTMC) may be performed when there is a suitable valvular anatomy. In this study, we aimed to investigate the clinical and fetal outcomes of pregnant women with mitral stenosis who underwent PTMC. Methods: Thirty-one patients undergoing PTMC during pregnancy were enrolled in this study. The mitral valve area (MVA), the transmitral valve mean gradient (MVMG), and the severity of mitral regurgitation were assessed pre- and postprocedurally by transthoracic and transesophageal echocardiography. The radiation time was measured during the procedure. The patients were followed up during pregnancy, and the neonates were monitored for weight, height, the head circumference, the birth Apgar score, and the adverse effects of radiation for at least 12 months. Results: PTMC was successfully performed on 29 (93.5%) patients. No maternal death or pulmonary edema was reported. The mean MVA significantly increased (from 0.73±0.17 cm2 to 1.28±0.24 cm2; P<0.001), and the mean MVMG significantly decreased (from 19.62±5.91 mmHg to 8.90±4.73 mmHg; P<0.001) after the procedure. A significant decrease in the systolic pulmonary artery pressure was also detected. Mitral regurgitation did not increase in severity in 16 (51.6%) patients. There was no significant relationship between the Apgar score, weight, height, and the head circumference at birth and at the radiation time. Conclusion:  In our series, PTMC during pregnancy was a safe and effective procedure. Lowering the radiation time with low frame-count techniques confers a significant decrease in radiation-related complications. https://jthc.tums.ac.ir/index.php/jthc/article/view/833 https://jthc.tums.ac.ir/index.php/jthc/article/download/833/812

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 14 1 2019 01 16 18 27 EN Mojtaba Salarifar Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Javad Askari Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Saadat Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Babak Geraiely Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Negar Omidi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Hamidreza Poorhosseini Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Alireza Amirzadegan Tehran Heart Center, Tehran University of Medical Science, Tehran, Iran Alimohammad Hajzeinali Tehran Heart Center, Tehran University of Medical Science, Tehran, Iran Mohammad Alidoosti Tehran Heart Center, Tehran University of Medical Science, Tehran, Iran Hassan Aghajani Tehran Heart Center, Tehran University of Medical Science, Tehran, Iran Younes Nozari Tehran Heart Center, Tehran University of Medical Science, Tehran, Iran Ebrahim Nematipoor Tehran Heart Center, Tehran University of Medical Science, Tehran, Iran 2018 03 14 2018 11 24 Background: Performing primary percutaneous coronary intervention (PPCI) in a timely fashion is a crucial part of the management of ST-elevation myocardial infarction (STEMI). We aimed to evaluate the contributing factors to and the etiologies of a prolonged door-to-device (D2D) time. Methods:  In 2016, the D2D time was measured in all patients who were treated with PPCI at Tehran Hear Center. The major causes of a prolonged D2D time (>90 min) were determined. The second phase was then started in 2017 by focusing on the determined causes, and direct feedback was given to anyone having contributed to the delayed D2D time. The D2D time was compared between these 2 years. Results: The mean age of the patients was 59.54±11.82 years, and 82.2% of them were men. The median D2D time decreased from 55 minutes (IQR25-75%: 40–82) in 2016 to 46 minutes (IQR25-75%: 34–70) in 2017 (P<0.001). In the first year, 79.8% of the patients had a D2D time of below 90 minutes; the figure rose to 84.1% of the patients in the second year (P=0.017). The first cause of a prolonged D2D time was missed ST-elevation in the first electrocardiogram by physician or nurse (8.4% of the cases). Along with a declining rate of missed STE to 6.7%, the median D2D time in the missed patients also decreased from 205 minutes to 177 minutes (P=0.011). The rate of ambulance arrival increased from 10.2% to 20.7% of the cases, and the median D2D time also declined from 45 (IQR25-75%: 34–55) to 34 (IQR25-75%: 25–55) in these patients (P<0.001). Conclusion: Even in the setting of a 24/7 on-site interventionist in the hospital, the dispatch system and prehospital electrocardiograms, along with regular assessment and feedback, may improve the D2D time. https://jthc.tums.ac.ir/index.php/jthc/article/view/863 https://jthc.tums.ac.ir/index.php/jthc/article/download/863/813

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 14 1 2019 01 16 28 32 EN Reza Rahmani Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Amirfarhangh Zand Parsa Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Alborz Sherafati Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Roozbeh Kowsari Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Vahid Mohammadi Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Rizan Mohammadi Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. 2017 06 16 2018 05 23 Prinzmetal’s angina occurs following spasms in a single or multiple vascular beds, resulting in a typical chest pain and an ST-segment elevation in electrocardiography (ECG). It can lead to life-threatening arrhythmias and sudden cardiac death. We describe a 37-year-old woman who was admitted with a typical chest pain and hypotension. Her initial ECG showed an ST-segment elevation in the inferior and precordial leads. She was transferred to the catheterization unit, where coronary angiography illustrated multivessel spasms. The spasms were relieved with a nitroglycerin injection. She was discharged with stable hemodynamics 7 days later, and at 1 month’s follow-up, no recurrent attack was detected. https://jthc.tums.ac.ir/index.php/jthc/article/view/732 https://jthc.tums.ac.ir/index.php/jthc/article/download/732/814

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 14 1 Salehiomran Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Seyed Hesameddin Abbasi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Atefeh Ghiasi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 13 2015 10 13 Central venous catheter (CVC) insertion is a practical way to assess patients hemodynamic specially in cardiovascular surgery but this relatively simple junior level procedure is not risk free and its common reported complications include; pneumothorax, hydrothorax, hemothorax, local hematoma, cardiac tamponade, vascular injury, thrombosis, embolism, and catheter disruption. Here in this article we are going to present 6 patients with very unusual presentation of CVC complication which was neurological deficit presented by agitation , unconsciousness, disorientation to time and place and  hemiparesis. All patients undergone neurologic consult and brain computed tomography. Final diagnosis was brain ischemic damage and finally we kept them on conservative management; fortunately we did not have any permanent damage. https://jthc.tums.ac.ir/index.php/jthc/article/view/355 https://jthc.tums.ac.ir/index.php/jthc/article/download/355/348

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 9 4 2015 10 13 166 173 EN Hamid Reza Bonakdar Heshmat Cardiovascular Medical Center, Guilan University of Medical Sciences, Rasht, Iran. Masoumeh Aslanpour Heshmat Cardiovascular Medical Center, Guilan University of Medical Sciences, Rasht, Iran. Hassan Moladoust Cardiovascular Research Center, Guilan University of Medical Sciences, Rasht, Iran. Parham Sadeghipour Heshmat Cardiovascular Medical Center, Guilan University of Medical Sciences, Rasht, Iran. Fereshteh Mohamadi Razi General Hospital, Guilan University of Medical Sciences, Rasht, Iran. Mohammad Assadian Rad Heshmat Cardiovascular Medical Center, Guilan University of Medical Sciences, Rasht, Iran. Jalal Kheirkhah Heshmat Cardiovascular Medical Center, Guilan University of Medical Sciences, Rasht, Iran. 2015 10 13 2015 10 13 Background: QT interval parameters have been suggested as a predictor of lethal arrhythmia and mortality in patients with myocardial infarction. The aim of the present study was to compare the value of QT interval indices in patients presenting with non-ST-segment elevation myocardial infarction (NSTEMI) between a group of patients with type 2 diabetes mellitus and a nondiabetic group of patients. Methods: This case-control study evaluated QT interval parameters in 115 patients (47 diabetic and 68 nondiabetic patients) diagnosed with NSTEMI between September 2011 and July 2012. The following QT interval indices were analyzed: maximum (max) and minimum (min) QT interval; max and min corrected QT interval (QTc); QT dispersion (QTd); and corrected QT dispersion (QTcd). All the patients were observed for ventricular arrhythmia during their hospital course and underwent coronary angiography. They were selected to undergo coronary artery bypass surgery (CABG) or percutaneous coronary angioplasty (PCI) based on their coronary anatomy. Results: The mean age of the patients was 60.8 ± 11.4 years. The patients were 40.0% female and 60.0% male. There were no significant differences in clinical characters between type 2 diabetic and nondiabetic patients with NSTEMI. Compared with post-myocardial infarction patients without diabetes, those with type 2 diabetes had higher QTc max , QTd and QTcd (p value < 0.05). There was a significant difference in QTd and QTcd in the patients needing coronary revascularization with diabetes as opposed to the nondiabetics (p value = 0.035 and p value = 0.025, respectively) as well as those who had ventricular arrhythmia with diabetes (p value = 0.018 and p value = 0.003, respectively). QTcd was higher in the patients who had higher in-hospital mortality (p value = 0.047). The QTc max, QTd and QTcd were significantly (all p values < 0.05) associated with ventricular arrhythmia, QTcd with need for revascularization and QTc max with in-hospital mortality in the diabetic patients. Conclusion: Based on the findings of this study, it seems that type 2 diabetics with NSTEMI have greater QTc max, QTd, and QTcd and these QT parameters may have a relationship with worse cardiac outcomes and poorer prognoses. https://jthc.tums.ac.ir/index.php/jthc/article/view/351 https://jthc.tums.ac.ir/index.php/jthc/article/download/351/344

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 9 4 2015 10 13 191 193 EN Sinan Sabit-Kocabeyoğlu Yüksek İhtisas Cardiovascular Education and Research Hospital, Ankara, Turkey. Arda Özyüksel Department of Cardiovascular Surgery, Medipol University, Istanbul, Turkey. Erdem Çetin Department of Cardiovascular Surgery, Memorial Hospital, Diyarbakır, Turkey. 2015 10 13 2015 10 13 Carney Syndrome (CS) is an autosomal dominant multiple neoplasia syndrome that includes cardiac, endocrine, cutaneous, and neural tumors. Cardiac myxomas can be seen in the course of CS. A 46-year-old female patient was admitted to our clinic with palpitation, cough, and exertional dyspnea. Physical examination revealed pigmented lesions, especially scattered in the neck, chest, and extremities. Echocardiography revealed a left atrial mass, 6 × 4 cm in size, originating from the interatrial septum that was protruding into the left ventricle through the mitral valve during diastole. The tumor was excised from the interatrial septum with its pedicle. The patient was discharged at the fifth postoperative day without any complication. Cardiac myxomas are a cornerstone of this disease since cardiac manifestations and related complications account for the majority of mortality seen in the course of CS. https://jthc.tums.ac.ir/index.php/jthc/article/view/356 https://jthc.tums.ac.ir/index.php/jthc/article/download/356/349

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 9 4 2015 10 13 174 178 EN Zinat Nadia-Hatmi Nourafshar Hospital, Tehran University of Medical Sciences, Tehran, Iran. Soheila Dabiran Cur