Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 16 3 2021 07 15 95 101 EN Amirhossein Abedtash Shahid Beheshti University of Medical Sciences, Tehran, Iran. Maryam Taherkhani Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Soheil Shokrishakib Shahid Beheshti University of Medical Sciences, Tehran, Iran. Shahriar Nikpour Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Adineh Taherkhani Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2021 01 04 2021 10 20 Background: Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are common hypertension medications. We aimed to investigate the association between treatment with ACEIs/ARBs and disease severity and mortality in patients with hypertension hospitalized for coronavirus disease 2019 (COVID-19). Methods: Information from the medical records of 180 hospitalized patients diagnosed with COVID-19 infection admitted in 2020 to Loghman Hakim Hospital, Tehran, Iran, was collected. Clinical histories, drug therapies, radiological findings, hospital courses, and outcomes were analyzed in all the patients. The demographic and clinical characteristics of the patients were also analyzed, and the percentage of patients with hypertension taking ACEIs/ARBs was compared between survivors and nonsurvivors. Results: The study population consisted of 180 patients at mean±SD age of 67.76±18.72 years. Hypertension was reported in 72 patients (40.0%). Patients with hypertension were older than those without it (mean±SD age =72.35±12.09 y). Among those with hypertension, death occurred in 33 patients (45.8%), of whom 60.6% were men. Fifty-three patients (73.6%) with hypertension were on ACEIs/ARBs. The ACEIs/ARBs group had a significantly lower mortality rate than the non-ACEIs/ARBs group (37.7% vs 68.4%; OR: 0.192; 95% CI: 0.05–0.68; P=0.011). Conclusion: This single-center study found no harmful effects associated with ACEIs/ARBs treatment. Patients on ACEIs/ARBs had a lower rate of mortality and disease severity than the non-ACEIs/ARBs group. Our study supports the current guideline to continue ACEIs/ARBs in patients with hypertension. https://jthc.tums.ac.ir/index.php/jthc/article/view/1401 https://jthc.tums.ac.ir/index.php/jthc/article/download/1401/973

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 16 3 2021 07 15 102 108 Esmail Heidaranlu Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran. Naser Sedghi Goyaghaj Shefa Neuroscience Research Center, Khatam Alanbia Hospital, Tehran, Iran. Ali Moradi Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran. Abbas Ebadi Behavioral Sciences Research Center, Lifestyle Institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran. 2021 02 20 2021 10 28 Background: Pain management after sheath removal is one of the most significant points in patient care. The use of a simple, practical, and combined method in this field is essential. The purpose of this study was to evaluate the efficacy of an intervention program for pain intensity reduction in patients undergoing arterial sheath removal after coronary artery angioplasty. Methods: This semi-experimental study was conducted in 2020 on 90 eligible patients selected via the purpose-based method and randomly assigned to experimental and control groups. The intervention program for the experimental group included training to relax the abdominal muscles, deep and slow breathing, and precise pressure on the femoral pulse. Pain intensity was measured before, during, and several times after arterial sheath removal. The independent t, Fisher exact, and χ2 tests were used to analyze the data. Results: Women comprised 66.6% of the study participants, who had a mean age of 58.20±8.70 years. No significant differences were observed concerning pain intensity, bleeding, pseudoaneurysm formation, and hematoma between the 2 groups before the intervention (P=0.531). However, during the intervention and in the fifth and tenth minutes after the intervention, pain intensity was lower in the experimental group (P<0.050), whereas no such differences were observed regarding bleeding, pseudoaneurysm formation, and hematoma. Conclusions: Given the effectiveness of our intervention program in ameliorating pain intensity and vasovagal response after arterial sheath removal, we suggest that this program, along with prescription drugs, be used for the management of patients’ pain. https://jthc.tums.ac.ir/index.php/jthc/article/view/1425 https://jthc.tums.ac.ir/index.php/jthc/article/download/1425/974

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 16 3 2021 07 15 109 112 Soraya Shadmanfar Health Research Center, Lifestyle Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran. AND Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Maryam Masoumi Clinical Research Development Center, Shahid Beheshti Hospital, Qom University of Medical Sciences, Qom, Iran. AND Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Fereydoun Davatchi 3Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. 4Iran National Elite Foundation, Tehran, Iran. Massoomeh Akhlaghi Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Hoda Kavosi Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Javad Balasi School of Medicine, Iran University of Medical Sciences, Tehran, Iran. Niloofar Deravi School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Seyed Mohammad Hashem Montazeri School of Medicine, Qom University of Medical Sciences, Qom, Iran. Mansoor Namazi 1- Clinical Research Development Center, Shahid Beheshti Hospital, Qom University of Medical Sciences, Qom, Iran. 2- Shahid Beheshti Hospital, Qom University of Medical Sciences, Qom, Iran. 2020 12 06 2021 11 25 Background: Behcet’s disease (BD) is a vasculitis with multisystem and multiorgan involvement. Cardiac involvement in BD is a rare complication with a poor outcome that manifests itself in different forms. In this study, we aimed to investigate cardiac involvement in BD.  Methods: This is a retrospective study based on cardiac manifestations in BD according to the data of the Behçet’s Disease Unit, the Rheumatology Research Center, Tehran University of Medical Sciences, from registered patients from 1975 until June 2017. Cardiac manifestations consisted of pericarditis, myocardiopathy, myocardial infarction, stable ischemic heart disease, endomyocardial fibrosis, thrombosis, and valvular and coronary involvement. All the patients’ baseline and demographic data were recorded in a designed questionnaire. The laboratory workups, imaging, and pathological tests were also performed.      Results: We studied 7650 patients with BD, of whom 51% were male. In the entire study population, 47 patients manifested cardiac involvement: valvular involvement in 6.1%, myocardial infarction in 23.4%, stable ischemic heart disease in 20%, pericarditis in 21.3%, intracardiac thrombosis in 2.1%, coronary aneurysm in 2.1%, heart failure in 12.8%, and dilated cardiomyopathy in 4.3%. Conclusion: The prevalence of cardiac involvement in our patients with BD was 0.6%. A multidisciplinary approach can reduce mortality and morbidity rates. Consequently, we suggest that echocardiography and other cardiac diagnostic tests be routinely considered for early diagnosis and subsequent treatment. https://jthc.tums.ac.ir/index.php/jthc/article/view/1384 https://jthc.tums.ac.ir/index.php/jthc/article/download/1384/975

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 16 3 2021 07 15 113 118 Seyed Kianoosh Hosseini Farshchian Heart Center, Hamadan University of Medical Sciences, Hamadan, Iran. Behshad Naghshtabrizi Farshchian Heart Center, Hamadan University of Medical Sciences, Hamadan, Iran. Farzad Emami Farshchian Heart Center, Hamadan University of Medical Sciences, Hamadan, Iran. Amirhossein Yazdi Farshchian Heart Center, Hamadan University of Medical Sciences, Hamadan, Iran. Nima Naghshtabrizi Farshchian Heart Center, Hamadan University of Medical Sciences, Hamadan, Iran. Sara Zebarjadi Farshchian Heart Center, Hamadan University of Medical Sciences, Hamadan, Iran. 2021 08 18 2021 11 20 Background: The discharge of uncomplicated patients with ST-segment-elevation myocardial infarction (STEMI) within 48 to 72 hours has been proven safe and feasible. The safety and feasibility of the very early discharge (≤48 h) of such patients, especially during the COVID-19 pandemic with limited bed availability and infection risk, have yet to be evaluated. Methods:  In this cohort study on 108 patients with STEMI who presented to Farshchian Heart Center between February and May 2020, 30 patients received fibrinolysis and 78 were scheduled for emergent coronary angiography. One patient had no coronary obstruction, 3 underwent emergent surgery, and 3 had high-risk features mandating a prolonged stay. The remaining patients were assigned to either Group A (≤48 h) or Group B (>48 h) regarding hospital discharge. Demographic, angiographic, procedural, and outcome data were compared between the 2 groups. Results: Group A consisted of 51 patients, including 7 women (13.7%), at a mean age of 62.74±12.35 years, and Group B comprised 20 patients, including 4 women (20.0%), at a mean age of 65.20±12.82 years. The mean hospital length of stay was 38.02±9.15 hours in Group A and 88.20±23.31 hours in Group B (P<0.001). The mean stent diameter was smaller in Group B (3.19±0.34 mm vs 2.96±0.29 mm; P=0.008). Demographic, angiographic, procedural, and outcome data, including the rates of in-hospital, 1-week, and 1-month mortality, were similar between the 2 groups. Conclusion: This study shows that a hospital discharge in less than 48 hours in low-risk patients with STEMI is safe and feasible. The potential advantages of this approach in the COVID-19 pandemic should be balanced against its risks. https://jthc.tums.ac.ir/index.php/jthc/article/view/1508 https://jthc.tums.ac.ir/index.php/jthc/article/download/1508/976

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 16 3 2021 07 15 119 122 EN Muhammet Uyanik Department of Cardiology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey. Omer Gedikli Department of Cardiology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey. Ufuk Yildirim Department of Cardiology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey. 2021 03 12 2021 10 30 The basic components of energy drinks include caffeine, guarana, taurine, ginseng, and sugar. The excessive consumption of energy drinks has been associated with cardiovascular events such as tachycardia and myocardial infarction in the literature. We herein describe a 24-year-old man admitted to the emergency department. The patient’s medical history and family history were unremarkable. It was, however, learned that he had consumed 8 to 10 cans of energy drinks per day (3.5–4 Lit/d) in the 2-week period leading to the hospital admission. Physical examination revealed bilateral diffuse rales and 2+ pretibial edema. Echocardiography showed a left ventricular ejection fraction of 25% with global left ventricular hypokinesia and dilated left ventricular dimensions. Coronary angiography demonstrated normal coronary arteries. On cardiac magnetic resonance imaging, the left ventricle was dilated, and the systolic function was reduced. No pathological enhancement was observed. This case report and many previous studies support a possible link between caffeinated energy drinks and cardiovascular events. https://jthc.tums.ac.ir/index.php/jthc/article/view/1434 https://jthc.tums.ac.ir/index.php/jthc/article/download/1434/977

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 16 3 2021 07 15 123 128 Parminder Otaal Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India. Dinakar Bootla Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India. 2021 05 25 2021 09 09 Longitudinal stent deformation (LSD) is a recently reported problem with newer generation stents. The modification of stent materials and designs to make them more deliverable and conformable, as well as a focused approach in retaining their radial strength, has compromised longitudinal strength in currently available stents. Additionally, enhanced stent radiopacity, improved fluoroscopy, and heightened awareness have led to an increased incidence rate of the potentially under-recognized problem of LSD. Although originally described in deployed stents, LSD is being recognized in undeployed stents too. With available data to suggest an increased rate of adverse cardiac events like stent thrombosis and in-stent restenosis with LSD in deployed stents, an attempt to retrieve an undeployed deformed stent appears justified. We report 3 cases of LSD in undeployed stents and discuss its recognition. We also discuss the retrieval and visual inspection of retrieved stents and the simultaneous completion of coronary interventions via a double guide technique. https://jthc.tums.ac.ir/index.php/jthc/article/view/1472 https://jthc.tums.ac.ir/index.php/jthc/article/download/1472/978

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 16 3 2021 07 15 129 131 EN Ahmadali Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran Elnaz Javanshir Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran 2021 12 27 2023 02 03 Background: Atrial fibrillation (AF) is a supraventricular tachyarrhythmia characterized by disorganized atrial activity and subsequent mechanical atrial failure. Postoperative AF is a frequent complication of coronary artery bypass grafting (CABG). Although there is evidence of decreased AF after CABG with statin usage, information is scarce regarding a direct comparison between atorvastatin and rosuvastatin. The present study was conducted to compare the efficacy of rosuvastatin and atorvastatin in preventing post-CABG AF. Methods: The present double-blind randomized comparative clinical trial selected CABG candidates with stable ischemic heart disease or acute coronary syndromes. Atorvastatin (40 mg per day) or rosuvastatin (20 mg per day) was prescribed 1 week before surgery, and the outcomes were compared. Results: Two-hundred patients, 100 cases in each group, completed the study. Twenty-five patients in each group were female, and the mean age was 59.30±8.42 years in the rosuvastatin group and 60.13±9.40 years in the atorvastatin group (P=0.513). The frequency of AF was 31% in the atorvastatin group and 27% in the rosuvastatin group (P=0.534). No significant differences existed between the groups concerning the length of hospital and ICU stay (P=0.333 and P=0.161) and in-hospital and 3-month mortality (P=0.315 and P=0.648). A subgroup analysis of only patients with stable ischemic heart disease could not detect a significant difference between the study groups in any of the investigated outcomes. Our logistic regression analysis showed an association only between age and the incidence of AF after CABG (OR, 1.12; 95% CI, 1.05 to 1.20; P<0.01). Conclusion: Rosuvastatin and atorvastatin are similar concerning the prevention of post-CABG AF, but there is a need for future well-designed multicenter studies on this topic.  https://jthc.tums.ac.ir/index.php/jthc/article/view/1584 https://jthc.tums.ac.ir/index.php/jthc/article/download/1584/1064

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 18 2 2023 04 30 122 128 Hamid Khederlou Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Seyede Vanoushe Azimi Pirsaraei Student Research Committee, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran. Elaheh Rabbani Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran. Morteza Motedayen Cardiology Department, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran. 2023 01 15 2023 06 28 Background: Ventricular arrhythmias (VAs), which result from acute myocardial infarction and revascularization, are preventable causes of sudden cardiac death. This study aimed to determine the incidence, types, and risk factors of VAs in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention (PCI). Methods: This cross-sectional study was conducted at the cardiology department of a tertiary care cardiac center in Zanjan, Iran. All the patients were monitored during hospitalization, and the incidence of cardiac arrhythmias and the outcomes were recorded. Result: Among 315 patients, the mean age was 62.14±10.11 years, and 76.2% were male. Male gender was significantly associated with VA occurrence (P=0.038). Among the patients, 50.5% had VAs, of which 26.4% were sustained ventricular tachycardia (sustained VT) and ventricular fibrillation (VF). Sustained VT and VF, but not total arrhythmias, were more common in anterior infarctions. Most arrhythmias occurred during the first 12 hours, and frequent premature ventricular contractions (43.3%) and idioventricular rhythm (20.1%) were the most common. A history of PCI and coronary artery bypass grafting (CABG) was associated with substantially reduced arrhythmias (P=0.017 and P=0.013, respectively). However, cardiovascular risk factors exerted no statistically significant effects on the VA type. Conclusion: Approximately half of our patients experienced reperfusion-induced VAs. Overall, gender and a