Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 20 4 2025 12 06 323 328 Surya Marthias Universitas Batam Carla Octavani Faculty of Medicine Universitas Batam/Hj.Bunda Halimah Hospital, Batam Indonesia Mega Hutapea Faculty of Medicine Universitas Batam/Hj.Bunda Halimah Hospital, Batam Indonesia Ibrahim Ibrahim Faculty of Medicine Universitas Batam/Hj.Bunda Halimah Hospital, Batam Indonesia Nurjanah Nurjanah Faculty of Medicine Universitas Syiah Kuala, Aceh, Indonesia 2025 06 12 2025 08 16 Background: Myxedema crisis, which occurs due to hypothyroidism, is a rare and life-threatening condition that can lead to severe myocardial infarction and lethal arrhythmia, as presented in this case. Case Presentation: A 63-year-old man presented with typical prolonged chest pain, palpitations leading to near syncope, severe fatigue, loss of appetite, dizziness, and somnolence 2 days before admission. The patient exhibited somnolence, hypotension, thin eyebrows, and pretibial pitting edema. Electrocardiography revealed sinus rhythm with a prolonged QT interval, inferolateral-anterior ischemia, and a troponin-T value five times above the upper limit of normal. Therefore, the working diagnosis included non–ST-elevation myocardial infarction Killip IV, severe biventricular heart failure, severe acute kidney injury, and severe acute liver injury. On the third day of treatment, the patient experienced two consecutive episodes of unstable ventricular tachycardia and one episode of return of spontaneous circulation cardiac arrest. Thyroid examination incidentally revealed severe hypothyroidism with severe hyperkalemia. After other causes were excluded, the diagnosis of myxedema crisis was assumed. Oral thyroid therapy, levothyroxine (100 µg once daily), was administered. Within 3 days of initiating all treatments, the patient experienced significant hemodynamic improvement, improved kidney function, and normalization of liver function, accompanied by the disappearance of dyspnea, chest pain, and edema, with a compos mentis status. The patient was discharged with stable hemodynamics without support on the tenth day of treatment and underwent a coronary computed tomography angiography at an outpatient facility, which showed near-normal coronary results. The patient has been on routine follow-up for almost 1 year with levothyroxine (50 µg once daily) and has recently demonstrated good left ventricular function (ejection fraction=50%) and good functional capacity on an exercise test. Conclusion: Clinicians should consider hypothyroidism crisis in the differential diagnosis for myocardial infarction, heart failure, and lethal arrhythmia, and treatment should be initiated immediately. https://jthc.tums.ac.ir/index.php/jthc/article/view/2277 https://jthc.tums.ac.ir/index.php/jthc/article/download/2277/1229

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 20 4 2025 12 06 310 322 Mahin Seifi Alan Alborz University of Medical Sciences Kobra Hosseini Alborz University of Medical Sciences Sanaz Seifi Alan Alborz University of Medical Sciences Zahra Mirzaei Alborz University of Medical Sciences Peyman Saeedi Alborz University of Medical Sciences Soroush Bahrami Alborz University of Medical Sciences Vahid Shahnavaz Alborz University of Medical Sciences Haniyeh Rashidi Alborz University of Medical Sciences Mahnaz Seifi Alan Alborz University of Medical Sciences Hadith Rastad Alborz University of Medical Sciences 2025 10 03 2025 11 04 Background: The coronary slow flow phenomenon (CSFP) involves delayed coronary artery filling without obstruction and is associated with angina and myocardial ischemia. This meta-analysis assessed the link between CSFP and impaired left ventricular global longitudinal strain (LVGLS), a marker of subclinical myocardial dysfunction. Methods: A systematic search (PubMed, Embase, Scopus up to January 2025) identified 18 observational studies comparing LVGLS and layer-specific strain in patients with CSFP vs controls with normal coronary flow. Results: Patients with CSFP showed significantly reduced LVGLS vs controls (SMD, 1.22; 95% CI, 0.69 to 1.75). Layer-specific analysis revealed impairment across all myocardial layers, most pronounced in the endocardium (SMD, 0.79; 95% CI, 0.21 to 1.38). While left ventricular ejection fraction (LVEF) was preserved, LVGLS demonstrated moderate-to-high diagnostic accuracy for CSFP (AUC, 0.80; 95% CI, 0.66 to 0.95). Reduced LVGLS independently predicted CSFP (adjusted OR, 1.43; 95% CI, 1.19 to 1.46). Exercise stress effects on LVGLS were inconsistent. Conclusion: CSFP is associated with impaired LVGLS, particularly in the endocardial layer, despite preserved LVEF. LVGLS may serve as a noninvasive marker for subclinical dysfunction in CSFP. https://jthc.tums.ac.ir/index.php/jthc/article/view/2366 https://jthc.tums.ac.ir/index.php/jthc/article/download/2366/1234

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 20 4 2025 12 06 2393 2393 Safoura Dorri Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran 2025 11 16 2025 11 18 I read with great interest the recent article by Taskin Yilmaz et al (Vol. 20, No. 2, 2025) examining the association between health literacy and treatment adherence among older patients with hypertension. The authors’ findings-particularly the significant relationship between both functional and communicative health literacy scores and improved blood pressure control-provide valuable evidence for refining patient-centered educational strategies. I wish to highlight two practical points and offer one suggestion for future research. First, the authors reported that media exposure and active search for health information were linked to better blood pressure control. This observation suggests that community-based educational modules—such as short instructional videos tailored for older adults and family-centered counseling sessions-could be implemented and evaluated as adjuncts to routine care. Second, given the cross-sectional design of the study, causal inference remains limited. Potential confounders such as cognitive status and social support may also influence both literacy and adherence. Incorporating brief cognitive screening tools (eg, Mini-Cog) and validated social support scales in future studies would help clarify whether health literacy acts as an independent mediating factor. Finally, I recommend evaluating a structured low-literacy educational package delivered during hospitalization and reinforced through nurse-led telephone follow-up. This model is practical, scalable, and allows measurable outcomes in blood pressure control within 3 months, potentially improving quality of life while reducing the burden on health care systems. https://jthc.tums.ac.ir/index.php/jthc/article/view/2393 https://jthc.tums.ac.ir/index.php/jthc/article/download/2393/1236

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 20 4 2026 01 25 255 258 Hany Demo Swedish Hospital - Endeavour Health, Chicago, United States Mansour Razminia Saint Joseph Hospital, Chicago, United States. 2025 12 23 2025 12 23 Intracardiac echocardiography (ICE) has evolved from an adjunct procedure to a major imaging component of contemporary electrophysiology (EP) and is transforming the assessment of complex ablation and device cases. This growth corresponds to an inflection point for EP practice in response to converging pressures: an interest in improving safety and efficiency in EP procedures, an ever-increasing trend toward minimal or zero fluoroscopy procedures, and a commensurate development of catheter technology and image integration. ICE specifically meets all of these demands by providing high-resolution intracardiac images through conscious sedation techniques and decreasing ionizing radiation exposure. https://jthc.tums.ac.ir/index.php/jthc/article/view/2413 https://jthc.tums.ac.ir/index.php/jthc/article/download/2413/1237

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 20 4 2025 12 06 259 265 Aida Mohamadi Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran. Zahra Tamartash Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran. Sepehr Nayebirad Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran. Farhad Gharibdoost Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran. Zahra Javady Nejad Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran. Maedeh Majidi Shad Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran. Motahare Hatami Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran. Hoda Kavosi Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran. 2025 07 21 2025 09 23 Background: Systemic sclerosis (SSc) is an autoimmune connective tissue disorder that leads to fibrosis of the skin and internal organs. Fragmented QRS (fQRS) is an important electrocardiographic (ECG) finding related to myocardial fibrosis. This study aimed to evaluate the effect of fQRS on ejection fraction (EF) and other echocardiographic parameters in individuals diagnosed with SSc. Methods: This was a retrospective cohort study consisting of 52 patients with fQRS as the case group and 60 patients without fQRS as the control group. The characteristics and echocardiographic parameters of the patients from a minimum of a 3-year interval were recorded. All data were compared between the two groups using SPSS software, version 20.0 (IBM Corp). Results: There were no significant differences in demographics, paraclinical results, and echocardiographic parameters, including average EF, pulmonary hypertension, and tricuspid regurgitation velocity, between cases and controls at the beginning and end of the follow-up. Conclusion: Based on our results, fQRS had no significant effect on EF and other echocardiographic parameters over at least a 3-year interval in SSc patients. However, additional research with longer follow-up periods and larger sample sizes is needed to characterize the association fully. https://jthc.tums.ac.ir/index.php/jthc/article/view/2311 https://jthc.tums.ac.ir/index.php/jthc/article/download/2311/1238

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 20 4 2025 12 06 266 275 Nuril Abshori Medical Doctor Program Faculty of Medicine and Health Sciences, Maulana Malik Ibrahim Islamic State University Malang, Malang, Indonesia Muhammad Iqhrammullah Universitas Muhammadiyah Aceh Syanindita Wardhani Master of Biomedical Science, Faculty of Medicine, Universitas Brawijaya Tio Fauzi Faculty of Medicine and Health Sciences, Maulana Malik Ibrahim Islamic State University, Malang, Indonesia Khoirunnisa Andarwati Faculty of Medicine and Health Sciences, Maulana Malik Ibrahim Islamic State University, Malang, Indonesia Aldivo Pradana Medical Doctor Program, Faculty of Medicine, Brawijaya University, Malang, Indonesia Achmad Arif Department of Internal Medicine, Faculty of Medicine and Health Sciences, Maulana Malik Ibrahim Islamic State University Malang, Indonesia Iwal Reza Ahdi Department of Internal Medicine, Faculty of Medicine and Health Sciences, Maulana Malik Ibrahim Islamic State University Malang, Indonesia Djanggan Sargowo Department of Cardiology, Faculty of Medicine, Brawijaya University, Malang, Indonesia 2025 08 13 2025 10 21 Background: Heart failure (HF) and chronic kidney disease (CKD) frequently coexist and contribute to poor clinical outcomes, particularly in patients with diabetes mellitus. The modifying effect of diabetes on the association between renal markers and left ventricular ejection fraction (LVEF) remains poorly understood. Objective: We sought to investigate whether diabetes modifies the relationship between renal biomarkers and LVEF in hospitalized patients with HF. Methods: We conducted a cross-sectional analysis involving 112 patients diagnosed with HF who were admitted to a tertiary care hospital. Data were extracted from electronic medical records, including demographic characteristics, comorbidities, laboratory values, and echocardiographic assessments. The primary outcome was LVEF, as determined by transthoracic echocardiography. Renal function was evaluated using serum urea, creatinine, hemoglobin, and the estimated glomerular filtration rate (eGFR). To examine whether the association between these renal markers and LVEF differed based on diabetes status, we fitted multivariable linear regression models including interaction terms between diabetes and each renal marker. All models were adjusted for age, sex, and HF subtype (HFpEF, HFmrEF, or HFrEF). Results: In multivariable models, both urea and creatinine remained significantly associated with LVEF (P=0.007 and P=0.005, respectively). Hemoglobin and eGFR did not show significant main effects in both unadjusted and adjusted models. In the moderation analysis, a significant interaction was found between diabetes and urea (P=0.022). Among patients with diabetes, an increase in urea was associated with a significant reduction in LVEF (P=0.022), whereas the association was attenuated in patients without diabetes. Similarly, the interaction between creatinine and diabetes was significant (β=−13.12; P=0.003). In contrast, the interaction between diabetes and eGFR approached significance (β=0.11; P=0.076). No significant interaction was found for hemoglobin and diabetes (β=−0.70; P=0.67). Conclusion: Diabetes modifies the relationship between renal function and systolic performance in patients with HF. The striation locale="en_US">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 history of PCI and CABG were significantly associated with VA occurrence. Therefore, males and patients without a positive history of PCI and CABG should receive antiarrhythmic drugs as a precaution. https://jthc.tums.ac.ir/index.php/jthc/article/view/1795 https://jthc.tums.ac.ir/index.php/jthc/article/download/1795/1071

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 18 2 2023 04 30 129 135 Hamid Khederlou Tehran University of Medical Sciences Amirali Mohammadi Zanjan university of Medical sciences Maryam Tajik Tehran University of Medical Sciences Mohamad Kazemshiroodi Iran University of Medical Sciences 2023 05 06 2023 06 28 Background: Myocardial perfusion imaging (MPI) is a noninvasive method with acceptable sensitivity and specificity in diagnosing coronary artery disease (CAD) in moderate-risk patients, including those with CAD risk factors. Methods: The present cross-sectional, prospective study was conducted on 4886 patients from April 2020 through March 2023 at Chamran and Tehran Heart Center hospitals. A questionnaire regarding anthropometric variables, demographic characteristics, CAD risk factors, and MPI findings was designed. Results: Totally, 2179 patients (44.6%) had abnormal MPI. Patients with abnormal MPI were significantly older than those with normal MPI. Older age (OR, 1.64; 95% CI, 1.2 to 1.72; P<0.001), diabetes mellitus (DM) (OR, 1.36; 95% CI, 1.1 to 1.48; P=0.012), hypertension (OR, 1.24; 95% CI, 1.04 to 1.37; P=0.032), and dyslipidemia (OR, 1.54; 95% CI, 1.25 to 1.8; P<0.001) were associated with abnormal MPI independently. Patients with more CAD risk factors were more likely to have abnormal MPI. Thus, in patients without or at most with 1 risk factor and those with 8 CAD risk factors, the likelihood of abnormal MPI was 3.7% and 76.2%, respectively. The frequency of left ventricular dilation and right ventricular prominence was significantly higher in patients with older age (P<0.001 and P=0.043, respectively), dyslipidemia (P<0.001 and P=0.007, respectively), DM (P<0.001 and P<0.001, respectively), and hypertension (P=0.048 and P=0.057, respectively). Conclusion: Individuals with CAD risk factors, especially those with older age, DM, hypertension, or dyslipidemia, require meticulous attention during CAD evaluation, particularly via MPI. https://jthc.tums.ac.ir/index.php/jthc/article/view/1854 https://jthc.tums.ac.ir/index.php/jthc/article/download/1854/1066

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 18 2 2023 04 30 136 141 Mana Jameie Tehran Heart Center, Cardiovascular Disease Research Institute Mohammad Safarian Nematabad Ali IbnAbitaleb Educational and Treatment Hospital, Rafsanjan University of Medical Sciences, Rafsanjan, Iran Pejman Mansouri Tehran Heart Center, Cardiovascular Disease Research Institute Arash Jalali “The Journal of Tehran University Heart Center” Faezeh Aghajai Research development Center, Arash women's Hospital, Tehran University of Medical Sciences, Tehran, Iran. Masoumeh Lotfi-Tokaldany Tehran Heart Center, Cardiovascular Disease Research Institute Hassan Aghajani Tehran Heart Center, Cardiovascular Disease Research Institute 2022 12 06 2023 04 18 Backgrounds: Studies have shown a decline in the admission rates of various diseases during the COVID-19 pandemic. Prosthetic valve thrombosis (PVT) is a rare condition followed by surgical or transcatheter valvular interventions. Considering the lack of data on hospitalization rates due to PVT during the pandemic, this study evaluated the implications of the COVID-19 pandemic on PVT admissions and characteristics in a tertiary referral center. Methods: Data from all the consecutive patients hospitalized due to PVT between February 2020 and February 2021 (the first year of the pandemic) were collected from medical records and compared clinically with the corresponding time before the pandemic (February 2019 through February 2020). Variables of interest included the number of hospitalization, patient and valve characteristics, diagnostic and management strategies, and in-hospital events. Results: Forty patients (32.5% male, age: 54.0 [46.5-62.0 y] comprised the study population. We observed a considerable decline in hospitalization rates during the pandemic, from 31 to 9 patients. Admitted patients were 8 years younger, had a higher proportion of the New York Heart Association functional class III or IV symptoms (44.4% vs 22.6%), were more often treated with fibrinolysis (33.3% vs 22.6%) or surgical approaches (33.3% vs 22.6%), and were discharged 6 days sooner. Conclusion: We described a reduction in PVT hospitalization. Patients presented with a higher proportion of severe dyspnea and had increased treatment with fibrinolysis/surgical approaches. These observations highlight the necessity of the active surveillance of patients with prosthetic valves by caregivers for timely diagnosis and appropriate management during the pandemic. https://jthc.tums.ac.ir/index.php/jthc/article/view/1768 https://jthc.tums.ac.ir/index.php/jthc/article/download/1768/1067

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 18 2 2023 04 30 142 145 Usha Kumari Dow University of Health Sciences, Karachi, Pakistan. Mansoor Rahman Postgraduate Trainee Cardiology, Lady Reading Hospital, Peshawar. Muneeb Ullah Jan Department of Cardiology, Lady Reading Hospital, Peshawar Pakistan Salecah Rahmat  Ullah 1. Central Michigan University Hospital Saginaw, USA. 2. Khawaja Safdar Medical College Sialkot, Pakistan Fakhar Abbas King Edward Medical University, Lahore, Pakistan. Zara Mirza Senior Resident, Cardiac Surgery, National Institute of Cardiovascular Disorders, Pakistan. Salim Surani