Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 20 3 2025 11 02 170 172 Masih Tajdini Tehran Heart Center, Tehran University Heart Center, Tehran, Iran. 2025 10 28 2025 10 31 Introduction : Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have evolved from glucose-lowering medications for diabetes into foundational cardiometabolic therapies, supported by robust evidence of cardiovascular protection from major clinical trials.1 Their dual capacity to reduce hyperglycemia and promote substantial weight loss is particularly relevant in regions like Iran and the Middle East, where the prevalence of obesity (∼25%), overweight (∼60%), and diabetes (∼10%) is rising rapidly; regional diabetes prevalence is projected to increase by more than 80% by 2050. By enhancing glucose-dependent insulin secretion, suppressing glucagon release and appetite, lowering blood pressure, improving lipid profiles, and exerting anti-inflammatory vascular effects, GLP-1 RAs such as liraglutide, semaglutide, and dulaglutide offer a comprehensive strategy for mitigating the intertwined risks of metabolic and cardiovascular disease. https://jthc.tums.ac.ir/index.php/jthc/article/view/2380 https://jthc.tums.ac.ir/index.php/jthc/article/download/2380/1225

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 20 3 2024 06 12 173 184 Fatemeh-Sadat Alavi Student Research Committee, Faculty of Public Health, Iran University of Medical Sciences, Tehran, Iran Payam Farahbakhsh Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran Tahereh Dehdari Health Promotion Research Center, Iran University of Medical Sciences, Tehran, Iran 2023 12 26 2024 09 12 Background: Adopting healthy nutritional behavior among patients with heart failure (HF) plays a crucial role in controlling disease symptoms. Developing effective interventions requires identifying significant determinants of nutritional behavior using theoretical frameworks from behavioral sciences and validated instruments. This study aimed to develop and validate tools to assess the determinants of nutritional behavior in patients with HF based on the Theory of Planned Behavior (TPB). Methods: A preliminary instrument with four subscales was developed based on the TPB. An instrument for measuring the nutritional behavior of patients with HF was also created. Face and content validity were assessed using qualitative and quantitative methods. The factor structure of the TPB instrument was examined using exploratory factor analysis (EFA) in a sample of 330 patients with HF. Instrument reliability was also evaluated. Results: During face and content validity assessment, 13 items were removed from the TPB instrument, and 14 items were modified across both instruments. The EFA revealed that the 12 items measuring TPB variables loaded onto four distinct subscales: behavioral intention, attitude, perceived behavioral control, and subjective norms. The Kaiser-Meyer-Olkin measure and Bartlett test of sphericity were acceptable. These factors accounted for 87.03% of the total variance. All TPB subscales demonstrated acceptable internal consistency, as measured by Cronbach’s α. Both instruments showed satisfactory intraclass correlation coefficients. Conclusion: The developed instruments are valid and reliable tools for assessing the determinants of nutritional behavior in patients with HF based on the TPB. They can be used for needs assessment and to develop educational interventions for this population. https://jthc.tums.ac.ir/index.php/jthc/article/view/1986 https://jthc.tums.ac.ir/index.php/jthc/article/download/1986/1219

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 20 3 2024 09 07 185 192 EN Shiva Khaleghparast Cardiovascular Nursing Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran Majid Maleki Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran Farnaz Rafiee Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran samaneh karimian Cardiovascular Nursing Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Leila Sari Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran Saeideh Mazloomzadeh Cardiovascular Nursing Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. 2024 02 20 2024 11 07 Background and Objectives: Atrial fibrillation (AF) is the most prevalent persistent arrhythmia and imposes a substantial burden on public health and society. Given prior evidence linking psychological factors with AF, this study was conducted to investigate the association between perceived stress and arrhythmia. Methods: In this case-control study, participants were recruited from the Outpatient Clinic of Rajaie Cardiovascular, Medical, and Research Center in Tehran, Iran, between May 2021 and September 2021 according to eligibility criteria. Data were collected through face-to-face interviews by trained research nurses using standardized checklists. Stress levels were assessed with the Perceived Stress Scale (PSS). Data were analyzed with SPSS, version 22. Results: A total of 155 cases with arrhythmia and 144 controls were enrolled. In the case group, the mean age was 53.99 years (±14.23), with 100 males (64.5%) and 55 females (35.5%). In the control group, the mean age was 48.53 years (±13.59), with 73 males (50.7%) and 71 females (49.3%). The mean perceived stress score was 30.6 in cases and 25.07 in controls (P<0.001). Stress-related symptoms, including palpitation and chest discomfort, were more common in patients with arrhythmia than in healthy controls (P=0.015 and P<0.001, respectively). In multivariate logistic regression analysis, the risk of arrhythmia was independently associated with sex, diabetes mellitus, dyslipidemia, cardiomyopathy, concentration difficulty, chest discomfort, and stress score. Interpretation and Conclusions: The findings demonstrate that AF is significantly associated with psychological stress and higher perceived stress scores. Interventions aimed at reducing stress in individuals at high risk of developing AF may be beneficial. https://jthc.tums.ac.ir/index.php/jthc/article/view/2022 https://jthc.tums.ac.ir/index.php/jthc/article/download/2022/1226

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 20 3 2025 09 30 193 202 Firoozeh Abtahi Department of Cardiology, Shiraz University of Medical Sciences, Shiraz, Iran Haleh Esfandiari Department of Cardiology, Shiraz University of Medical Sciences, Shiraz, Iran Alireza Arzhangzadeh Department of Cardiology, Shiraz University of Medical Sciences, Shiraz, Iran Salma Nozhat Department of Cardiology, Shiraz University of Medical Sciences, Shiraz, Iran Roozbeh Narimani-Javid Research Center for Advanced Technologies in Cardiovascular Medicine, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran. 2025 09 03 2025 09 26 Introduction: Echocardiographic planimetry is the primary and most available modality for diagnosing rheumatic mitral stenosis (MS). Nonetheless, this approach is highly reliant on the examiner’s technique. Echocardiographic evaluation of MS should also include assessment of right ventricular (RV) function because of its prognostic role. We hypothesized that the assessment of RV function via speckle-tracking echocardiography could also have a diagnostic role in determining MS severity. Methods: This cross-sectional study included 47 patients with a typical diagnosis of rheumatic MS. Echocardiographic data were recorded and evaluated offline by an expert cardiologist. We measured right ventricular global longitudinal strain (RVGLS), right ventricular free-wall longitudinal strain (RVFWLS), mitral valve area (MVA) using 2D planimetry, and other conventional parameters of MS severity. Data were analyzed and visualized utilizing SPSS version 26 (IBM Corp) and Python 3.10.6 (Python Software Foundation). Results: Our analysis showed that both RVGLS (R=–0.598; P<0.05) and RVFWLS (R=–0.620; P<0.05) were significantly correlated with MVA. The mean RVGLS values in patients with severe and progressive MS were –14.44±4.36 and –18.12±3.25, respectively (P=0.017). The mean RVFWLS values also demonstrated a significant difference between these two groups (–6.3±4.7 vs–20.8±3.2; P=0.005). The area under the curve (AUC) for RVGLS and RVFWLS in detecting severe MS was 0.75 (95% CI, 0.64 to 0.86) and 0.78 (95% CI, 0.66 to 0.90), respectively. Conclusion: RVGLS and RVFWLS significantly correlate with MVA and may serve as tools to assess the severity of rheumatic MS in daily clinical practice. These strain parameters have high sensitivity for ruling out severe MS during routine echocardiographic evaluation. https://jthc.tums.ac.ir/index.php/jthc/article/view/2344 https://jthc.tums.ac.ir/index.php/jthc/article/download/2344/1221

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 20 3 2025 11 02 203 212 Noor Mohammad Noori prof in Pediatric Cardiologist, Children and Adolescents Health Research Center, Research Institute of Cellular and Molecular Science in Infectious Diseases, Zahedan University of Medical Sciences, Zahedan, Iran. Alireza Teimouri M.Phil, PhD in Demography, Children and Adolescents Health research center, Research Institute of cellular and Molecular Science in Infectious Diseases , Zahedan University of Medical Science's, Zahedan, Iran Shima Groohisardou Assistant Professor, Emergency Medicine Department, School of Medicine, Jiroft University of Medical Sciences, Jiroft, Iran. 2025 10 05 2025 10 17 Background: Nephrotic syndrome (NS) in children is a chronic glomerular disorder that, beyond its renal implications, poses a significant risk for cardiovascular complications. Early vascular alterations, such as increased aortic stiffness, may signal subclinical cardiovascular dysfunction with long-term consequences. Objective: This study aimed to evaluate aortic stiffness in children with idiopathic NS compared with age and sex-matched healthy controls using noninvasive echocardiographic indices. Methods: A case-control study was conducted at Ali Asghar Pediatric Hospital from 2023 through 2024. Eighty-seven children with idiopathic NS and 87 healthy controls underwent M-mode echocardiographic assessment of the ascending aorta. Aortic systolic and diastolic diameters, along with systolic and diastolic blood pressure (SBP and DBP, respectively), were used to calculate stiffness indices: aortic strain, distensibility, stiffness index β, and pressure-strain elastic modulus (PSEM). Data were analyzed using SPSS version 23 (IBM), and a P value below 0.05 was considered statistically significant for all analyses. Results: Children with NS had significantly higher SBP and DBP, reduced aortic strain (9.62% vs 14.77%), decreased aortic distensibility (0.0050 vs 0.0085), and elevated stiffness index β and PSEM values (P<0.001 for all). No significant sex distribution differences were noted. Responders to treatment showed better renal function and lower BP but did not differ significantly in vascular stiffness measures. Positive correlations were found between stiffness parameters and proteinuria, serum creatinine, and anthropometric indices. Conclusion: Children with NS exhibited early signs of aortic stiffening, even during clinical remission. These findings support the incorporation of cardiovascular surveillance into the long-term management of NS to identify at-risk children and initiate early interventions. https://jthc.tums.ac.ir/index.php/jthc/article/view/2367 https://jthc.tums.ac.ir/index.php/jthc/article/download/2367/1224

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 20 3 2025 09 30 213 220 Mohamma Reza Taban Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran Zahra Shamsian Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran Ali Abdollahzadeh Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran Hadi Mardani Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran Mehdi Maleki Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran Rojin Yaghubi Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran 2025 07 07 2025 09 23 Background: Heart failure remains a global health challenge, necessitating a deeper understanding of factors affecting mortality and quality of life. Given the paucity of studies investigating the relationship between serum albumin levels and outcomes in patients with chronic heart failure, particularly their quality of life, we conducted this study. Methods: This prospective study evaluated demographic information, laboratory findings, and ejection fraction (EF) in hospitalized patients with ischemic and non-ischemic heart failure. Patients with an EF of less than 50% were included as having heart failure. Serum albumin levels were measured. Patients completed the Minnesota Living with Heart Failure Questionnaire (MLHFQ) during hospitalization and were followed up for six months after discharge. Results: A total of 102 individuals were included in this study. Among them, 59.8% had a history of chronic heart failure. There was a weak but significant inverse relationship between serum albumin level and the MLHFQ index (r=−0.263; P=0.018). There was no significant difference in serum albumin level or MLHFQ index between deceased and surviving patients (P=0.816 and P=0.12, respectively). Conclusion: This study indicates that serum albumin levels were weakly associated with quality of life in patients with heart failure with reduced EF, as assessed by the MLHFQ. Nonetheless, serum albumin levels did not predict short-term mortality over the 6-month follow-up period. https://jthc.tums.ac.ir/index.php/jthc/article/view/2292 https://jthc.tums.ac.ir/index.php/jthc/article/download/2292/1220

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 20 3 2025 09 30 221 230 Reenal Fairy Department of Medicine, Jinnah Sindh Medical University Laiba Ali Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 19 3 2024 07 31 206 210 Danial Chaleshi Trauma Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Fahimeh samadi Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Amir Ali Ghaemi Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Negin Parsa Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Aysan Zareiye Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Mohammad Reza Motamedzade Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Mohammadtaghi Sarebanhassanabadi Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Hossein Nough Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran 2024 02 19 2024 09 12 Background: Myocardial bridging (MB) has been associated with acute coronary syndrome, ischemia, arrhythmia, and even sudden death. This study investigated the prevalence of MB and its complications and manifestations. Methods: This cross-sectional study was conducted on symptomatic coronary patients who underwent angiography between March 2022 and March 2023 at Afshar or Shahid Sadoughi hospitals in Yazd, Iran. The angiographic reports of all patients were evaluated. Cases with MB were selected, and their angiographic films were assessed by an interventional cardiologist for diagnostic accuracy. Baseline, radiological, and clinical characteristics were also evaluated. Data were collected and analyzed using SPSS, version 20.0. The dependent variable was stratified based on independent variables using the χ2 test. Results: Out of 3750 symptomatic patients, 165 (4.4%) were diagnosed with MB. Among these, 111 (67.3%) were male, and the mean age was 56.87±10.06 years. A total of 152 patients had MB in the left anterior descending artery, representing the highest occurrence proportion at 92.1%. The most common types of coronary artery disease (CAD) diagnosed included mono-vessel disease and slow flow, accounting for 35.1% and 25.8%, respectively. There was no significant frequency distribution of CAD co-occurrence based on baseline and radiological features (P>0.050). Conclusion: This study provides valuable insights into the prevalence of MB in Iran and its co-occurrence with CAD. While some findings align with previous research, certain discrepancies warrant further investigation. https://jthc.tums.ac.ir/index.php/jthc/article/view/2025

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 19 3 2024 07 31 211 215 Maryam Favaedi Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran Zahra Khajali Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran Mina Mohseni Cardio-Oncology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran Hajar Kamfiroozi Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran Parisa Firoozbakhsh Cardio-Oncology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran 2023 09 05 2024 08 14 Congenital heart disease (CHD), which accounts for about one-third of all congenital birth defects and affects about 1% of all live births worldwide, has had a stable incidence rate and decreased mortality rate since 1990. Despite advances in fetal cardiac ultrasound examinations and routine pulse oximetry screening of newborns, a considerable proportion of patients with CHD may still be missed until adulthood, leading to major morbidity and mortality due to physical limitations and reduced quality of life. We herein describe a 29-year-old woman who was mistaken as an inoperable case of CHD and referred to our center with palpitation and exertional dyspnea. During workups, she was diagnosed with severe pulmonary hypertension associated with patent ductus arteriosus (PDA), pre-ductal aortic coarctation, ventricular septal defect (VSD), and bicuspid aortic valve, all of which had been missed from infancy. After initial medical treatment for pulmonary hypertension, a simultaneous transcatheter approach was selected, whereby the PDA was closed with an occluder device, and the coarctation was repaired simultaneously with a self-expanding stent. Eight months later, her VSD was closed successfully via an interventional technique using a muscular VSD occluder device. This case highlights the significance of adult CHD fellowship training. A cardiologist specialized in this field was able to properly diagnose and treat an adult with complex CHD, which had been overlooked since infancy. As a result, the patient experienced complete relief from her symptoms and was saved from developing Eisenmenger syndrome. https://jthc.tums.ac.ir/index.php/jthc/article/view/1929

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 19 3 2024 07 31 216 219 Yasmin Chaibakhsh Cardiac intensive care unit, Rajaei cardiovascular heart center Ziae Totonchi Cardiac intensive care unit, Rajaei cardiovascular heart center Nader Givtaj Cardiac intensive care unit, Rajaei cardiovascular heart center Nahid Aghdaei Cardiac intensive care unit, Rajaei cardiovascular heart center Maryam Ghadimi Cardiac intensive care unit, Rajaei cardiovascular heart center 2024 01 16 2024 09 03 Tracheostomy is a widely used procedure for airway maintenance and long-term ventilation of critically ill patients in ICUs or operating rooms. Although several complications, such as bleeding, leakage, infection, and stenosis, have been previously reported due to tracheostomy, cuff herniation is a rare complication of this commonly performed procedure. The first sign of herniation is a sudden drop in oxygen saturation. Since cuff herniation is not among the first differential diagnoses for a drop in oxygen saturation, it should be considered in the absence of other common causative agents. In this study, we delineate a case of tracheostomy cuff herniation after cardiac arrest in a 64-year-old woman who underwent coronary artery bypass graft surgery. The patient experienced a cerebrovascular accident and mediastinitis postoperatively, necessitating tracheostomy due to extended tracheal intubation, during which the cuff herniated for the first time. Furthermore, a repeat tracheostomy was performed; however, the patient ultimately expired due to complications from mediastinitis. https://jthc.tums.ac.ir/index.php/jthc/article/view/2003

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 19 3 2024 07 31 220 224 EN Elaheh Malakan Rad TUMS 2023 12 31 2024 08 31 Neonatal atrial flutter (NAF) is a rare type of macroreentrant supraventricular tachycardia. In this report, we describe a case of atrial flutter in an 8-day-old neonate with a total anomalous pulmonary venous connection. Additionally, we introduce a diagnostic triad for ECG identification of this condition. This triad is composed of 3 components: similar shapes of inter-QRS segments (SIS) in leads II, III, and aVF, different shapes of inter-QRS segments (DIS) in lead I, and the occurrence of 1 or multiple stretched M or inverted V shapes in the inter-QRS (IQS) segment in leads II, III, and aVF. We assessed the effectiveness of this triad through a validation cohort, using previously reported cases of NAF from the literature. The sensitivity rates for detecting SIS and DIS patterns and the singular or multiple reversed W or V signs were 100%, 81%, and 100%, respectively. Furthermore, all 3 components of the triad were found in 81% of neonates diagnosed with atrial flutter. The emergence of this triad can be attributed to the elimination of the isoelectric segment in ECG, caused by the extended duration of flutter