Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 15 3 2020 07 15 88 97 EN Mozhgan Saeidi Cardiac Rehabilitation 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. Angelo Compare Department of Human and Social Sciences, University of Bergamo, Italy. 2018 04 25 2020 06 06 Background: The etiologies and causal beliefs of heart disease are considered one of the 5 dimensions of health self-regulatory model. Thus, the present study aimed to review the literature and screen the appropriate tools for evaluating the causal beliefs and perceived heart risk factors (PHRFs). Methods: The review samples encompassed all published articles from 1992 to March 2017. A systematic search was conducted across 6 databases: the Web of Science, Scopus, Medline, EBSCO, ProQuest, PsycINFO, and Google Scholar. The qualitative evaluation of the articles was examined using the checklists of the Critical Appraisal Skills Programme (CASP) by 2 independent investigators. After the application of the criteria for inclusion in the study, 22 studies were obtained according to the PRISMA guidelines. Results: A total of 10 504 (50.5% male) patients at an average age of 57.85±10.75 years participated in 22 studies under review. The results of the systematic review showed that 22 tools were available to measure PHRFs. The instruments were categorized into 4 groups of valid scales (6 studies), invalid questionnaires (6 studies), checklists (3 studies), and open-ended single items (7 studies). Only 23.2% of the measuring instruments were sufficiently valid. Conclusion: The results of this systematic review showed that a limited number of valid tools were available to measure PHRFs. Considering the importance of studying cardiac patients’ perception of the etiology of disease and the paucity of standards and valid grading scales, it seems necessary to design and provide tools with broader content that can cover all aspects of patients’ beliefs. https://jthc.tums.ac.ir/index.php/jthc/article/view/877 https://jthc.tums.ac.ir/index.php/jthc/article/download/877/911

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 15 3 2020 07 15 98 104 EN Niloufar Samiei Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Nehzat Akiash Atherosclerosis Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Sepideh Djafari Naeini Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Akbar Nikpajouh Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Mahboubeh Pazoki Rasul Akram General Hospital, Iran University of Medical Sciences, Tehran, Iran. 2019 09 26 2020 04 02 Background: The superior type of sinus venosus atrial septal defect (SVASD) is a rare form of the atrial septal defect (ASD) in which the upper part of the atrial septum does not exist. The presence of other cardiac anomalies such as anomalous pulmonary venous connections has been reported in this type of congenital heart disease. This study aimed to assess the presence of the patent foramen ovale (PFO) in patients with the superior type of SVASD. Methods: This retrospective case-control study on 387 patients, consisting of 187 patients with a definite SVASD and 200 patients with problems other than the ASD, was conducted in Rajaie Cardiovascular Medical and Research Center between February 2005 and July 2014. Seven patients with inadequate data were excluded from the analysis. The presence/absence of the PFO was also evaluated in the case and control groups. Results: The analyses were performed on 182 male and 198 female patients at a mean age of 39.07±14.41 and 51.01±15.80 years in the case and control groups, respectively. The PFO was significantly more frequent in the patients with the superior type of SVASD than in those without the condition (P<0.001). The persistence of the left superior vena cava was seen in 34 out of 180 patients with SVASD and in 1 out of 200 patients without the condition (18.9% vs 0.5%; P<0.001). Conclusion: This study was the first to highlight the coexistence of the PFO and the superior type of SVASD. Physiological, genetic, or fetal factors may play an important role in the association between the PFO and the SVASD. https://jthc.tums.ac.ir/index.php/jthc/article/view/1154 https://jthc.tums.ac.ir/index.php/jthc/article/download/1154/912

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 15 3 2020 07 15 128 130 EN Ömer Kertmen Department of Cardiology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey. Gökhan Gök Department of Cardiology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey. Murat Akçay Department of Cardiology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey. 2019 10 02 2020 02 10 Purulent pericarditis is characterized by a purulent pericardial fluid, which usually originates from the extension of a nearby bacterial infection site or by blood dissemination. Candida species is a rare cause of pericarditis; and if not treated, it is extremely fatal. In this report, we describe a 54-year-old man who had esophagojejunostomy due to gastric adenocancer 2 months before his admission into our emergency department with dyspnea, orthopnea, chest pain, and somnolence. Physical and echocardiographic examinations revealed massive fibrinous pericardial effusion, causing pericardial tamponade. We performed urgent pericardiocentesis. The culture of the purulent pericardial fluid illustrated Candida albicans. There was no gastropericardial fistula after endoscopic and computed tomographic evaluations of the gastrointestinal tract. After receiving 1 month of antimicrobial treatment, the patient recovered completely. During his follow-up, he remained asymptomatic and had no pericardial fluid for 6 months. Our case indicates the possibility of the occurrence of purulent pericarditis with tamponade, secondary to the dissemination of Candida albicans from total parenteral nutrition after gastric carcinoma surgery without gastropericardial fistulae or anastomosis leak.   https://jthc.tums.ac.ir/index.php/jthc/article/view/1157 https://jthc.tums.ac.ir/index.php/jthc/article/download/1157/916

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 15 3 2020 07 15 147 148 EN Alireza Golbabaei Department of Perinatology and Fetal Cardiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Behdad Gharib Department of Pediatrics, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran. 2020 01 08 2020 06 06 A 21-year-old girl, a known case of hyperimmunoglobulin E syndrome (HIES), was referred for cardiologic evaluation. She was born to consanguineous parents. Her past medical history was significant for several episodes of pneumonia, otitis media, and cutaneous infections. She presented with generalized dermatitis, which was infected in some regions. Staphylococcus aureus was isolated from the infected areas. Cutaneous human papillomavirus (HPV) infections were obvious as epidermodysplasia verruciformis on sun-exposed areas and giant warts on the anogenital regions. The laboratory studies revealed anemia, lymphopenia, and eosinophilia. The patient did not present any cardiac signs or symptoms, and her blood pressure was normal. Preemptive cardiac evaluations using echocardiography and magnetic resonance imaging revealed giant ascending (Figure A and Figure B; blue arrows), descending (Figure 1 and Figure 2; yellow arrows), and abdominal (Figure 3; yellow arrow) aortic tortuosity and dilation. The parasternal long-axis echocardiographic view (Figure 4) showed highly dilated aortic Valsalva sinus (blue line), sinotubular junction (red line), and aortic annulus (yellow line). As the whole length of the aorta was involved and surgical repair could not be performed, we started enalapril and recommended the patient to follow the conservative management. HIES is a very rare type of primary immune deficiency.1 The disease is characterized by high serum immunoglobulin E (IgE) levels; dermatologic, dental, and skeletal abnormalities; recurrent staphylococcal abscesses; and pneumonia. A serum level of IgE is routinely more than 2000 IU/mL.2 Vascular anomalies and their sequelae contribute to significant morbidity and mortality in patients with HIES. It is advisable that all patients with HIES be evaluated thoroughly for vascular involvement. https://jthc.tums.ac.ir/index.php/jthc/article/view/1206 https://jthc.tums.ac.ir/index.php/jthc/article/download/1206/920

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 15 3 2020 07 15 149 150 Ahmad Yaminisharif Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Ali Hosseinsabet Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. 2019 02 07 2019 09 02 - https://jthc.tums.ac.ir/index.php/jthc/article/view/1035 https://jthc.tums.ac.ir/index.php/jthc/article/download/1035/921

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 15 3 2020 07 15 105 112 Pooneh Samaniyan Bavarsada Department of Epidemiology and Biostatistics, School of Public Health, Shahrekord University of Medical Sciences, Shahrekord, Iran. Solieman Kheirib Department of Epidemiology and Biostatistics, School of Public Health, Shahrekord University of Medical Sciences, Shahrekord, Iran. AND Modeling in Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran. Ali Ahmadi Department of Epidemiology and Biostatistics, School of Public Health, Shahrekord University of Medical Sciences, Shahrekord, Iran. AND Modeling in Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran. 2019 02 22 2020 03 30 Background: Predicting the risk of cardiovascular diseases (CVDs) helps the management of high-risk individuals by the health system. We sought to determine the 10-year risk of CVDs in the Shahrekord Cohort Study (SCS). Methods: In this cross-sectional study based on the SCS in the southwest of Iran, the demographic, anthropometric, clinical, and laboratory data of 5152 persons recruited in the SCS by census method from 2016 to 2017 were used. R software was utilized to calculate the 10-year risk of CVDs according to the World Health Organization/International Society of Hypertension (WHO/ISH) chart, the Framingham Risk Score (FRS) model, and the Systematic Coronary Risk Evaluation (SCORE) model. Results: The mean age of the participants was 49.49±9.40 years, and 50.3% of them were female. According to the WHO/ISH chart, 94.1% of the participants were in the low-risk class, 4.1% in the moderate-risk class, and 0.4% in the high-risk class. Based on the FRS model, 72.2% of the participants were in the low-risk class, 18% in the middle-risk class, and 9.8% in the high-risk class. On the basis of the SCORE model for low-risk areas, 55.3% of the participants were in the low-risk class, 39.6% in the moderate-risk class, and 5.1% in the high-risk class. The agreement concerning risk estimation between the models was approximately 70%.  Conclusion: The risk estimated in this study was higher than that in other similar studies. For monitoring risk trends over time, it is essential to nativize a valid risk function, including ethnicity and geographical characteristics, for the Iranian population. https://jthc.tums.ac.ir/index.php/jthc/article/view/1043 https://jthc.tums.ac.ir/index.php/jthc/article/download/1043/913

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 15 3 2020 07 15 131 135 EN Seyed Ebrahim Kassaian Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Behnam Molavi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Kyomars Abbasi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Sadeghian Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Shahrooz Yazdani Shahid Rajaei Hospital, Alborz University of Medical Sciences, Karaj, Iran. 2017 06 16 2020 05 05 Behçet’s disease (BD) is a multisystem inflammatory disorder. Physicians should be alerted to the possibility of BD in a patient with a carotid artery pseudoaneurysm and no clear predisposing factor such as neck trauma or surgery. Endovascular repair of carotid pseudoaneurysms is technically feasible with excellent midterm follow-up results. Administration of immunosuppressive therapy before endovascular intervention is mandatory to reduce the chance of vascular complications accompanied by BD. A 40-year-old man presented with a painful and pulsatile neck mass with 2 episodes of transient ischemic attacks. The patient also complained of recurrent urogenital ulcers and aphthous lesions together with painful rashes. Ultrasonography and computed tomography angiography revealed 2 aneurysmal dilations in the left common carotid artery at the bifurcation level. He was referred to a rheumatologist, who made the diagnosis of BD. High-dose corticosteroids and cyclophosphamide were commenced. One week later, 2 overlapping self-expanding stent grafts were deployed. The final angiogram showed no residual endoleak, and the flow of the carotid and cerebral arteries was satisfactory. The patient was discharged with no neurological complications. Follow-up ultrasonography and computed tomography angiography 6 months later showed no endoleak, as well as significant shrinkage of the aneurysm sac. https://jthc.tums.ac.ir/index.php/jthc/article/view/731 https://jthc.tums.ac.ir/index.php/jthc/article/download/731/917

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 15 3 2020 07 15 207 214 Mohammad Javad Zibaeenezhad Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Mehrab Sayadi Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Seyyed Saeed Mohammadi Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Soorena Khorshidi Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Ehsan Hadiyan Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Neda Rasouli University of Colorado, School of Medicine, and VA Eastern Colorado Health Care system, Aurora, Colorado, USA Ali Karimi-Akhormeh Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Iman Razeghian-Jahromi Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran 2022 01 23 2022 10 06 Background: This study aimed to investigate the possible relationship between different stent sizes and clinical outcomes after percutaneous coronary intervention (PCI) in patients with diabetes treated with drug-eluting stents (DESs) and dual antiplatelet therapy (DAPT). Methods: Patients with stable coronary artery disease undergoing elective PCI with the DES were entered into a retrospective cohort between 2003 and 2019. Major adverse cardiac events (MACE), defined as the combined endpoint of revascularization, myocardial infarction, and cardiovascular death, were recorded. The participants were categorized according to the stent size: 27 mm for length and 3 mm for diameter. DAPT (aspirin and clopidogrel) was used for at least 2 years for diabetics and 1 year for nondiabetics. The median duration of follow-up was 74.7 months. Results: Out of 1630 participants, 29.0% had diabetes. The diabetics constituted 37.8% of those with MACE. The mean diameter of the stents in the diabetics and nondiabetics was 2.81±0.29 mm and 2.90±0.35 mm, respectively (P>0.05). The mean stent length was 19.48±7.58 mm and 18.92±6.64 mm in the diabetics and nondiabetics, respectively (P>0.05). After adjustments for confounding variables, MACE was not significantly different between the patients with and without diabetes. Although MACE incidence was not affected by stent dimensions in the patients with diabetes, the nondiabetic patients implanted with a stent length exceeding 27 mm experienced MACE less frequently.  Conclusion: Diabetes did not influence MACE in our population. Additionally, stents of different sizes were not associated with MACE in patients with diabetes. We propose that using the DES supplemented by long-term DAPT and tight control of glycemic status after PCI could decrease the adverse consequences of diabetes. https://jthc.tums.ac.ir/index.php/jthc/article/view/1600 https://jthc.tums.ac.ir/index.php/jthc/article/download/1600/1031

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 17 4 2022 10 31 215 222 Fatemeh Rangraz Jeddi Health Information Management Research Centre, Department of Health Information Management & Technology, Kashan University of Medical Sciences, Kashan, Iran Ehsan Nabovati Health Information Management Research Centre, Department of Health Information Management & Technology, Kashan University of Medical Sciences, Kashan, Iran Fateme Peykani Department of Health Information Management & Technology, Kashan University of Medical Sciences, Kashan, Iran Shima Anvari Health Information Management Research Centre, Department of Health Information Management & Technology, Kashan University of Medical Sciences, Kashan, Iran Parissa Bagheri Toolaroud Health Information Management Research Centre, Department of Health Information Management & Technology, Kashan University of Medical Sciences, Kashan, Iran 2022 01 30 2022 07 31 Background: Patients with cardiovascular disorders (CVD) are at higher risk for potential drug-drug interactions (pDDIs) due to complex treatment regimens. This study aimed to evaluate pDDI patterns in physicians’ prescriptions in a specialized heart center using simple software. Methods: This cross-sectional study identified severe and related interactions during a 2-stage survey of experts. The data collected included age, sex, the date of admission and discharge, the length of hospital stay, drug names, inpatient wards, and the final diagnosis. The extracted drug interactions were used as a source of software knowledge. The software was designed using the SQL Server and the C # programming language. Results: Of 24 875 patients included in the study, 14 695 (59.1%) were male. The average age was 62 years. Based on the survey of experts, only 57 pairs of severe pDDIs were identified. The designed software evaluated 185 516 prescriptions. The incidence of pDDIs was 10.5%. The average number of prescriptions per patient was 7.5. The highest frequency of pDDIs was detected in patients with diseases of the lymphatic system (15.0%). Aspirin with heparin (14.3%) and heparin with clopidogrel (11.7%) were the most common documented pDDIs. Conclusion: This study reports the prevalence of pDDIs in a cardiac center. Patients with lymphatic system disorders, male patients, and older patients were at higher risk of pDDIs. This study shows that pDDIs are common among CVD patients and highlights the need to use computer software to screen patients’ prescriptions to assist in detection and prevention. https://jthc.tums.ac.ir/index.php/jthc/article/view/1611 https://jthc.tums.ac.ir/index.php/jthc/article/download/1611/1032

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 17 4 2022 10 31 223 229 Alireza Rostamzadeh Department of Cardiology, Urmia University of Medical Sciences, Urmia, Iran Kamal Khademvatani Department of Cardiology, Urmia University of Medical Sciences, Urmia, Iran Shahyad Salehi Department of Cardiology, Urmia University of Medical Sciences, Urmia, Iran Mirhossein Seyyed-mohammadzad Department of Cardiology, Urmia University of Medical Sciences, Urmia, Iran Mehdi Khani Tabriz University of Medical Sciences, Tabriz, Iran Mojgan Hajahmadipour Rafsanjani Department of Cardiology, Urmia University of Medical Sciences, Urmia, Iran Behnam Askari Department of Cardiology, Urmia University of Medical Sciences, Urmia, Iran Behzad Rahimi Department of Cardiology, Urmia University of Medical Sciences, Urmia, Iran Zahra Mostafavi Department of Cardiology, Urmia University of Medical Sciences, Urmia, Iran Reza Hajizadeh Urmia University of Medical Sciences 2022 06 08 2022 10 29 Target: Bendopnea, defined as dyspnea while bending, can be observed in patients with heart failure (HF). In this study, we investigated the frequency of this symptom in patients with systolic HF and its association with echocardiographic parameters. Material and Methods: In this study, patients with left ventricular ejection fraction (LVEF) ≤45% and decompensated HF referred to our clinics were prospectively recruited. All patients were examined by cardiologists for collecting data on the presence of bendopnea and baseline characteristics. They also underwent electrocardiographic and echocardiographic examinations. All findings compared between patients with or without bendopnea. Results: A total of 120 patients with a mean age of 65.19 ± 12.62 years were evaluated, and 74.8% were men. Bendopnea was observed in 44.2% of the patients. The etiology of HF was ischemic in most patients (81.9%), and the functional class of most patients (85.9%) was III or IV. The mortality rate at 6 months follow-up was comparable between patients with or without bendopnea (6% vs. 9.5%, p=0.507). The waist circumference (odds ratio [OR] 1.037, 95% confidence interval [CI] 1.005 – 1.070, p = 0.023), paroxysmal nocturnal dyspnea (OR 0.338, 95% CI 0.132 – 0.866, p = 0.024), and right atrium size (OR 1.084, 95% CI 1.002 – 1.172, p = 0.044) were associated with bendopnea. Conclusions: Bendopnea can be frequently found among patients with systolic HF. This phenomenon is associated with obesity and baseline symptoms of patients and right atrium size upon echocardiographic examinations. It can help clinicians with the risk stratification of HF patients. https://jthc.tums.ac.ir/index.php/jthc/article/view/1660 https://jthc.tums.ac.ir/index.php/jthc/article/download/1660/1033

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 17 4 2022 10 31 230 235 Parsa Tavassoli Naini School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran </