Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 18 4 2023 08 30 237 243 Sana Ashiq Center for Applied Molecular Biology, University of the Punjab, Lahore, Pakistan. Syed Najam Hyder Department of Pediatric Cardiology, University of Child Health Sciences, The Children’s Hospital, Lahore, Pakistan. Kanwal Ashiq Faculty of Pharmaceutical Sciences, Superior University, Lahore, Pakistan. Muhammad Farooq Sabar Center for Applied Molecular Biology, University of the Punjab, Lahore, Pakistan. 2023 02 25 2023 08 24 Background: Several studies have investigated the role of vascular endothelial growth factor (VEGF) variants, serum levels, and correlations with other extrinsic factors in congenital heart defects (CHDs); however, the findings need confirmation. The present systematic review evaluates the association between CHDs and genetic polymorphisms and serum expressions. Methods: Relevant literature was searched through electronic databases using keywords and MeSH terms. VEGF activity was comparatively assessed between cyanotic and acyanotic CHDs, and the association between different polymorphisms and heart defects was evaluated. Results: We ultimately evaluated 12 studies regarding the association between VEGF serum patterns and found that serum VEGF levels were upregulated or downregulated in correlation with hypoxia and hemoglobin levels and were significantly associated with cyanotic CHDs compared with acyanotic CHDs. Our results also showed a significant role for different single-nucleotide polymorphisms, including rs699947, rs2010963, and rs3025039. Conclusion: The findings of the current study suggested a significant association between CHDs and VEGF genetic polymorphisms or varied serum levels. Nevertheless, more comprehensive studies may provide conclusive results and valuable insights into the pathogenesis of CHDs and relevant treatment strategies. https://jthc.tums.ac.ir/index.php/jthc/article/view/1817

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 18 4 2023 08 30 244 255 Parnian Shobeiri Tehran University of Medical Sciences Amir Hossein Behnoush Tehran University of Medical Sciences Amirmohammad Khalaji Tehran University of Medical Sciences Antonio Teixeira The University of Texas Health Science Center at Houston, Houston, TX Nima Rezaei Tehran University of Medical Sciences 2023 04 09 2023 09 05 Background: Among its functions, brain-derived neurotrophic factor (BDNF) regulates endothelial and macrophage activation, possibly playing a role in atherosclerotic plaque pathophysiology. Given contradicting reports, this study sought to investigate whether blood levels of BDNF differed between patients with coronary heart disease (CHD) and controls. Methods: We explored PubMed, Embase, Web of Science, and Cochrane Library for studies comparing BDNF blood levels in patients with CHD and controls. Random-effect meta-analysis was conducted to calculate the standardized mean differences (SMD) and 95% confidence intervals (CI). The Newcastle-Ottawa scale was used to evaluate the quality of included articles, and statistical analyses were conducted using R version 4.0.4. Results: The final analysis comprised 12 investigations covering 1422 CHD cases and 929 controls with mean ages of 59.66±13.56 and 53.78±13.61 years, respectively. The initial analyses revealed a tendency toward low levels of BDNF in the CHD group compared with the control group (SMD= -0.41; 95% CI, -1.12 to 0.30; P=0.26). After the removal of outliers, the difference achieved statistical difference (SMD= -0.56; 95% CI, -0.93 to -0.19; P<0.01). Subgroup analysis demonstrated no significant difference between serum and plasma BDNF levels (P=0.54); however, subgroup analyses of studies investigating plasma BDNF showed that patients with CHD had significantly lower BDNF levels. Conclusion: Serum and plasma BDNF concentrations were considerably lower in patients with CHD than in healthy controls. Further studies of higher quality are required on the potential role of BDNF as a biomarker of CHD pathophysiology and severity. https://jthc.tums.ac.ir/index.php/jthc/article/view/1835

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 18 4 2023 08 30 256 260 Alireza Ahmadi Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran. Mehdi Ghaderian Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran. Hajar Nourmohammadi Department of Pediatrics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. Mohammad Reza Sabri Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran. Bahar Dehghan Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran. Chehreh Mahdavi Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran. 2023 01 09 2023 11 26 Background: Congenital heart disease (CHD), a developmental abnormality of the heart and vessels, is encountered in the pediatric age group frequently. Brachial artery flow-mediated dilation (FMD) and carotid intima-media thickness (CIMT) are indicators of subclinical cardiovascular disease and are used as surrogate measures of subclinical atherosclerosis. The present study aimed to compare CIMT and FMD between children with acyanotic congenital heart disease (ACHD) and healthy controls. Methods: A case-control study on 50 children with ACHD and 43 healthy individuals was done in Isfahan, Iran, between 2021 and 2022. The case group was selected via non-random sampling, and healthy controls were recruited from the relatives of the patients. A checklist, including age, sex, body mass index, and blood pressure, was filled out for all the participants. Then, FMD and CIMT were measured with brachial and carotid artery ultrasonography. Results: Fifty children with ACHD and 43 healthy individuals (controls) under 18 years old participated in this study. Of these, 44 (47.3%) were girls and 49 (52.7%) were boys. The mean FMD was significantly higher in the ACHD group than in the control group (0.084±0.027 vs 0.076±0.042; P=0.021; 95% CI, 007 to 0.122;). CIMT was significantly higher in the ACHD group than in the control group (0.39±0.12 vs 0.34±0.1; P=0.037; 95% CI, 0.009 to 0.102;). However, systolic and diastolic blood pressure did not show differences between the groups. Conclusion: Based on our results, CIMT and FMD assessment may help detect early changes in peripheral vessels associated with atherosclerosis in the future in ACHD. Further studies are needed to confirm our findings. https://jthc.tums.ac.ir/index.php/jthc/article/view/1790

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 18 4 2023 08 30 261 268 EN Mohsen Vahedi Department of Biostatistics and Epidemiology, Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. Niloufar Taherpour Prevention of Cardiovascular Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Mohammad Haji Aghajani 1- Prevention of Cardiovascular Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2- Department of Cardiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Mohamad Amin Pourhoseingholi Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Asma Puorhoseingholi Prevention of Cardiovascular Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2023 08 17 2023 12 14 Background: Knowledge, attitudes, and practices (KAP) studies are widely used in public health. This study aimed to investigate and compare KAP among patients with coronary artery disease (CAD) and premature coronary artery disease (PCAD) regarding cardiovascular disease (CVD). Methods: This cross-sectional study was conducted on 100 PCAD patients and 100 CAD patients in a general hospital in Tehran, Iran, between April and October 2022. A valid questionnaire was utilized to gather information, and descriptive analysis and logistic regression were employed for analysis using SPSS, version 23. Results: This study involved 100 CAD and 100 PCAD patients with average ages of 68.09±7.20 and 50.20±7.65 years, respectively. Men accounted for 58% of the PCAD group and 73% of the CAD group. The PCAD group had a higher level of knowledge and exhibited a more positive attitude toward CVD than the CAD group (P=0.007 and P<0.001, respectively). The PCAD patients and those with a family history of chronic diseases had a higher level of knowledge (P=0.045 and P=0.27, respectively) and showed a more positive attitude (P=0.030 and P<0.001, respectively). However, participants with a self-reported history of chronic diseases and those who were employed exhibited a less positive attitude. Occupation was associated with nutritional and smoking status (P=0.037). Conclusion: Higher levels of knowledge and more positive attitudes regarding CVD were observed; still, the study population’s behaviors were unsatisfactory. Educational interventions are needed to promote positive health behaviors, emphasizing the link between knowledge and risk reduction and decreased CVD and mortality rates. https://jthc.tums.ac.ir/index.php/jthc/article/view/1915

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 18 4 2023 08 30 269 277 Kobra Noruzi Larki School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran. Tayeb Mohammadi Departments of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran Masoumeh Zakerimoghadam Department of Medical-Surgical Nursing and Basic Sciences, School of Nursing & Midwifery, Tehran University of Medical Sciences, Tehran, Iran. Leila Sayadi Department of Medical-Surgical Nursing and Basic Sciences, School of Nursing & Midwifery, Nursing and Midwifery Care Research Center, Tehran University of Medical, Tehran, Iran. 2023 05 01 2023 10 13 Background: Coronary surgery can have various outcomes, such as fear of death, cardiac anxiety, and pain disability. This study aimed to evaluate the effects of interventions based on patient expectations on different outcomes of coronary surgery, including expectations, cardiac anxiety, and pain-induced disability. Methods: This randomized clinical trial evaluated 60 coronary surgery candidates. Patients meeting the inclusion criteria were randomly assigned to control and intervention groups. The patients were contacted 1 to 2 weeks before coronary surgery to complete the Cardiac Surgery Patient Expectations Questionnaire (C-SPEQ). Based on the analysis of expectations, the intervention group underwent interventions to optimize expectations, whereas the control group received only routine care. The Cardiac Anxiety Questionnaire (CAQ) and the Pain Disability Index (PDI) were completed on the day of hospitalization. Three months later, the participants recompleted all 3 questionnaires. The data were analyzed with descriptive and analytical statistics in SPSS 16.0. Results: There were no significant differences between the control and intervention groups in baseline variables, pain-induced disability (P=0.353), and cardiac anxiety (P=0.479). After the intervention, no significant differences were observed between the groups concerning expectations (P=0.554) and pain-induced disability (P=0.557) when the confounding variables were adjusted. Nevertheless, cardiac anxiety decreased significantly (P=0.027). Conclusion: Our interventions improved expectations and mitigated anxiety among coronary surgery patients. Actualization and optimization of patient expectations should be considered in the care of coronary surgery candidates. https://jthc.tums.ac.ir/index.php/jthc/article/view/1853

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 18 4 2023 08 30 278 287 Reza Ghafari Pharmacy faculty, Urmia University of Medical Sciences, Urmia, Iran. Amir Sorayaie Azar Department of Computer Engineering, Urmia University, Urmia, Iran. Ali Ghafari *Medical Physics and Biomedical Engineering Department, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. * Research Center for Evidence-Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. Fatemeh Moradabadi Aghdam Pharmacy faculty, Urmia University of Medical Sciences, Urmia, Iran. Morteza Valizadeh Faculty of Electrical and Computer Engineering, Urmia University, Urmia, Iran. Naser Khalili Department of Cardiology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran. Shima Hatamkhani * Experimental and Applied Pharmaceutical Sciences Research Center, Urmia University of Medical Sciences, Urmia, Iran. * Department of Clinical Pharmacy, Urmia University of Medical Sciences, Urmia, Iran. 2023 04 27 2023 09 05 Background: Myocardial infarction (MI) is a major cause of death, particularly during the first year. The avoidance of potentially fatal outcomes requires expeditious preventative steps. Machine learning (ML) is a subfield of artificial intelligence science that detects the underlying patterns of available big data for modeling them. This study aimed to establish an ML model with numerous features to predict the fatal complications of MI during the first 72 hours of hospital admission. Methods: We applied an MI complications database that contains the demographic and clinical records of patients during the 3 days of admission based on 2 output classes: dead due to the known complications of MI and alive. We utilized the recursive feature elimination (RFE) method to apply feature selection. Thus, after applying this method, we reduced the number of features to 50. The performance of 4 common ML classifier algorithms, namely logistic regression, support vector machine, random forest, and extreme gradient boosting (XGBoost), was evaluated using 8 classification metrics (sensitivity, specificity, precision, false-positive rate, false-negative rate, accuracy, F1-score, and AUC). Rini 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. Somayeh Sadat Jalali Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran Alireza Hosseinpour Department of Cardiovascular Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. Hamidreza Pouraliakbar Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Sepideh Taghavi Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Razieh Omidvar Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Hooman Bakhshandeh Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Armin Attar Department of Cardiovascular Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. Tahereh Sadeghi Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Fatemeh Ghorbani Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. 2024 03 30 2024 07 08 Background: Sarcopenia is a predictor of mortality in multiple conditions, but the potential prognostic value of sarcopenia indices in pulmonary hypertension (PH) has not been clarified. This study aimed to determine whether there is an association between computed tomography (CT) scan-measured pectoralis muscle area (PMA) and density (PMD) and adverse clinical outcomes in PH patients. Methods: In this cross-sectional study, the medical records of PH patients (clinical classes I and IV) referred to Rajaie Cardiovascular Institute from March 2016 through March 2021 were retrospectively reviewed. CT scan-measured PMA and PMD were compared between survivors and non-survivors, along with blood biomarkers and right heart catheterization variables. Binary logistic regression analysis was performed to identify potential predictors of mortality. Results: A total of 45 patients with PH (34 survivors and 11 non-survivors) were included in the analysis. PMA was not significantly different between the two groups (P=0.12), whereas PMD differed weakly between survivors and non-survivors (survivors: 45 HU [25.8–51.3] vs. non-survivors: 31 HU [23–36]; P=0.062). In logistic regression analysis, none of the sarcopenia indices predicted mortality (P >0.05). Nonetheless, phosphodiesterase-5 (PDE-5) inhibitor use, right atrial pressure, and systemic arterial oxygen saturation were identified as potential predictors (P<0.05). Conclusions: Although CT scan-measured PMA and PMD showed only a weak correlation with the prognosis of PH, these factors may serve as potential markers of mortality in patients with idiopathic and chronic thromboembolic PH. Further confirmation is needed through future studies with larger sample sizes. https://jthc.tums.ac.ir/index.php/jthc/article/view/2055 https://jthc.tums.ac.ir/index.php/jthc/article/download/2055/1205

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 20 2 2025 09 27 137 153 Jana Jaber 1.Medical Learning Skills Academy, Beirut, Lebanon 2.Lebanese University, Faculty of Medical Sciences, Beirut, Lebanon Tania Al Hakim 1. Medical Learning Skills Academy, Beirut, Lebanon 2.Lebanese University, Faculty of Medical Sciences, Beirut, Lebanon Hussein Alfakeer 1.Medical Learning Skills Academy, Beirut, Lebanon 3.University of Health Sciences, Faculty of International Medicine, Istanbul, Turkey Rafay Ansari 1. Medical Learning Skills Academy, Beirut, Lebanon 4. Ziauddin University ,Pakistan Nour Alameh 1.Medical Learning Skills Academy, Beirut, Lebanon 2. Lebanese University, Faculty of Medical Sciences, Beirut, Lebanon Kantach Kumar 1. Medical Learning Skills Academy, Beirut, Lebanon 5. Internal medicine, Dow University of Health Sciences, Pakistan Hiba Hamdar Medical Learning Skills Academy, Beirut, Lebanon 2025 03 20 2025 05 26 Introduction: β-thalassemia, particularly the major form, is associated with significant morbidity, as it requires lifelong maintenance transfusion therapy to manage the condition. This transforms thalassemia from a fatal childhood disease into a chronic disorder. Nonetheless, this therapeutic approach presents challenges due to its pathological adverse effects on cardiac health, including heart failure and arrhythmias. Discussion: Multiple lifelong transfusions, combined with the pathological effects of thalassemia—such as hemolysis and ineffective erythropoiesis—exacerbate excessive iron deposition, primarily in the liver but most critically in the heart. This creates a vicious cycle between iron overload and cardiac dysfunction. Due to their high dependence on blood transfusions, thalassemia major patients are predisposed to left-sided heart failure, resulting from both dilated and restrictive cardiomyopathy, as well as life-threatening arrhythmias and electrical disturbances. These complications arise from the heart’s overwhelmed capacity to clear free radicals. Cardiac dysfunction represents a critical complication requiring early detection and prompt intervention, underscoring the limitations of conventional echocardiography in diagnosing subclinical and systolic dysfunction—the latter often appearing only in advanced disease. Earlier risk stratification is essential, with recent studies highlighting the role of genetic predisposition, biomarkers, and advanced noninvasive imaging (MRI) in facilitating timely treatment initiation, such as iron-chelating therapy, to improve survival outcomes. Conclusions: Iron overload is an inevitable consequence for thalassemia major patients requiring transfusions, as the human body lacks mechanisms to eliminate excess iron. These patients require careful observation, monitoring, and timely diagnosis according to standard guidelines to facilitate chelation therapy and prevent its harmful effects. This review examines the complex interplay between symptomatic management of thalassemia, subsequent iron overload, and cardiac dysfunction in treated patients, with the goal of promoting early detection of therapeutic complications and timely intervention. https://jthc.tums.ac.ir/index.php/jthc/article/view/2255 https://jthc.tums.ac.ir/index.php/jthc/article/download/2255/1206

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 20 2 2025 09 28 154 158 EN Sahar Asl Fallah Cardiologist, cardiovascular imaging fellowship, Cardiovascular Disease Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Sahebjam MD, Professor of cardiology, Department of Echocardiogrpahy, Cardiovascular Disease Research Center , Tehran Heart Center , Tehran University of Medical Science kyomars abbasi MD,Cardiac Surgeon, Cardiovascular Disease Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Narges Shahbazi MD, Assistant professor of pathology and laboratory medicine, Cardiovascular Disease Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. shayan shahi MD, Cardiovascular Disease Research Center , Tehran Heart Center , Tehran University of Medical Science Samira Shirzad Cardiologist, Cardiovascular Disease Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. 2024 06 03 2024 11 25 Cardiac fibroma is a sporadic primary cardiac tumor that is more prevalent in children but accounts for approximately 1% of cardiac tumors in the adult population. It is a benign tumor consisting of fibroblasts and connective tissues, typically associated with a favorable prognosis. Nonetheless, large fibromas may have a poorer prognosis due to the increased risk of arrhythmias and sudden cardiac death. In this case report, we describe a 38-year-old woman who experienced chest discomfort and shortness of breath roughly 3 months following the total resection of a left ventricular fibroma. The initial suspicion was the recurrence of fibroma, but upon further investigation, an intriguing scenario unfolded: the formation of a hematoma and abscess at the previous surgical site. Ultimately, the patient underwent redo-cardiac surgery. https://jthc.tums.ac.ir/index.php/jthc/article/view/2107 https://jthc.tums.ac.ir/index.php/jthc/article/download/2107/1207

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 20 2 2025 09 28 159 164 Aditya Pradana Department of Cardiology and Vascular Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta Real Marsam Department of Cardiology and Vascular Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada – Dr. Sardjito General Hospital, Yogyakarta, Indonesia Hendry Bagaswoto Department of Cardiology and Vascular Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta Habibie Arifianto Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Sebelas Maret – Dr. Moewardi General Hospital, Surakarta, Indonesia Putrika Gharini Department of Cardiology and Vascular Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta 2025 04 14 2025 06 29 Background: Cardiac tamponade is a life-threatening emergency caused by substantial pericardial accumulation of fluid, blood, or pus. This buildup compresses the cardiac chambers, resulting in hemodynamic compromise, shock, and possible death. Postoperative cardiac tamponade incidence ranges from 0.1% to 6%. We describe a case of late-onset type I left ventricular (LV) rupture after double-valve replacement (DVR), presenting as cardiac tamponade. Case Presentation:  A 58-year-old woman was referred to our hospital with a 1-month history of progressive breathlessness and orthopnea. She had undergone DVR surgery, specifically an aortic and mitral valve replacement, 3 months prior to admission. Echocardiography performed at the referring hospital revealed a large, loculated pericardial mass, suspected to be a hemopericardium, that was compressing the LV structure and causing cardiac tamponade. Further imaging with cardiac computed tomography (CT) demonstrated contrast extravasation at the atrioventricular groove adjacent to the prosthetic mitral valve, which confirmed a type I LV rupture. The patient was diagnosed with a late-onset type I LV wall rupture following DVR. Urgent pericardiocentesis was performed, followed by an open thoracotomy, the creation of a pericardial window, and the surgical repair of the rupture site. Conclusions: Multimodal cardiac imaging, such as echocardiography and cardiac computed tomography, is essential for comprehensive assessment and characterization of the underlying etiology of postoperative cardiac tamponade. https://jthc.tums.ac.ir/index.php/jthc/article/view/2261 https://jthc.tums.ac.ir/index.php/jthc/article/download/2261/1208

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 20 2 2025 09 28 165 166 EN Rohan