Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 10 2 2015 10 13 69 73 EN Payam Safavi-Naeini Department of Cardiology, Texas Heart Institute, Houston, Texas, USA. Mehdi Razavi Department of Cardiology, Texas Heart Institute, Houston, Texas, USA. Mohammad Saeed Department of Cardiology, Texas Heart Institute, Houston, Texas, USA. Abdi Rasekh Department of Cardiology, Texas Heart Institute, Houston, Texas, USA. Ali Massumi Department of Cardiology, Texas Heart Institute, Houston, Texas, USA. 2015 10 13 2015 10 13 The prevalence of atrial fibrillation (AF) is 1-2 % in the general population, and the risk of embolic stroke in AF patients is 4-5 times higher than that in the general population. AF-related strokes are often severe, and the rate of permanent disability is much higher among individuals who have AF-related strokes than in those who have strokes unrelated to AF. In patients with AF, more than 90 % of thrombi originate from the left atrial appendage (LAA). The purpose of this paper is to review the efficacy and safety of performing the LAA closure with the LARIAT Suture Delivery Device to prevent AF-related stroke in patients with contraindications to oral anticoagulant therapy. https://jthc.tums.ac.ir/index.php/rhythm/article/view/369 https://jthc.tums.ac.ir/index.php/rhythm/article/download/369/362

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 10 2 2015 10 13 74 79 EN Farzaneh Dastan School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. Azita Hajhossein Talasaz School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran AND Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Mojtaba Mojtahedzadeh School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. Abbasali Karimi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Abbas Salehiomran Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Payvand Bina Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Arash Jalali Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Zahra Aghaie School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 13 2015 10 13 Background: L-carnitine has been demonstrated to confer cardiac protection against ischemia reperfusion injury in animals. This study evaluates the effects of L-carnitine administration on cardiac biomarkers after coronary artery bypass graft (CABG) surgery. Methods: One hundred thirty-four patients undergoing elective CABG surgery, without a history of myocardial ischemia or previous L-carnitine treatment, were enrolled and randomly assigned to an L-carnitine group ([n = 67], 3000 mg/d, started 2 days preoperatively and continued for 2 days after surgery) or a control group (n = 67). CK-MB (creatine kinase, muscle- brain subunits) and troponin T (TnT) levels were assessed in all the patients before surgery as baseline levels and at 8 and 24 hours postoperatively. Results: Our study included 134 patients (99 [73.8%] males) at a mean ± SD age of 59.94 ± 8.61 years who were candidates for CABG and randomized them into control or L-carnitine groups. The baseline demographic characteristics, including age (60.01 ± 9.23 in the L-carnitine group vs. 59.88 ± 7.98 in the control group) and sex (54 [80.6%] in the L-carnitine group vs. 45 [67.2%] in the control group) did not show any significant differences (p value=0.93 and 0.08, respectively). Patients in the L-carnitine group had lower levels of CK-MB (mean ± SD, 25.06 ± 20.29 in the L-carnitine group vs. 24.26 ± 14.61 in the control group), but the difference was not significant (p value = 0.28). TnT levels also showed no significant differences between the two groups (399.50 ± 378.91 in the L-carnitine group vs. 391.48 ± 222.02 in the control group; p value = 0.34). Conclusion: In this population of intermediate- to high-risk patients undergoing CABG surgery, L-carnitine did not reduce CK-MB and TnT levels. https://jthc.tums.ac.ir/index.php/rhythm/article/view/370 https://jthc.tums.ac.ir/index.php/rhythm/article/download/370/363

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 10 2 2015 10 13 80 84 EN Saeed Abrootan Department of Cardiology, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Saeed Yazdankhah Department of Cardiology, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Babak Payami Department of Cardiology, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Mohammad Alasti Department of Cardiology, Bahman General Hospital, Tehran, Iran. 2015 10 13 2015 10 13 Background: Patients with chronic stable angina often have a state of sympathetic hyperactivity. It is considered associated with myocardial ischemia and disappears after ischemia elimination. The aim of this study was to investigate the changes in heart rate variability parameters, a noninvasive technique for the evaluation of the autonomic nervous system activity, after successful revascularization in these patients to evaluate this theory. Methods: The patients were enrolled among those who underwent successful percutaneous coronary intervention. Short- term heart rate variability analyses of all the patients were obtained, and time-domain indices (standard deviation of normal- to-normal intervals [SDNN], standard deviation of differences of successive R-R intervals [SDSD], root-mean square differences of successive R-R intervals [rMSSD], percentage of R-R intervals differing > 10 ms from the preceding one [PNN10 percentage of R-R intervals differing > 20 ms from the preceding one [PNN20],percentage of R-R intervals differing > 30 ms from the preceding one [PNN30]percentage of R-R intervals differing > 40 ms from the preceding one [PNN40],percentage of R-R intervals differing > 50 ms from the preceding one [PNN50percentage of R-R intervals differing > 60 msfrom the preceding one [PNN60 percentage of R-R intervals differing > 70 ms from the preceding one [PNN70])were analyzed. All the measurements were made before and after percutaneous coronary intervention. Results: This study included 64 patients, comprising 27 men and 37 women at a mean age of 56.8 ± 9.1 years. There was a significant difference only between pre- and post-revascularization SDNN (27.5 ± 19.72 vs. 41 ± 41.4; p value = 0.013). The other parameters showed no significant differences after successful coronary intervention. Conclusion: Our data indicate that the increase in SDNN in patients with stable angina pectoris undergoing percutaneous coronary intervention seems to be prominent. https://jthc.tums.ac.ir/index.php/rhythm/article/view/371 https://jthc.tums.ac.ir/index.php/rhythm/article/download/371/364

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 10 2 2015 10 13 85 92 EN Saba Ghaffary Department of Pharmacotherapy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. Azita Hajhossein-Talasaz Department of Pharmacotherapy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran AND Tehran Heart Centre, Tehran University of Medical Sciences, Tehran, Iran. Padideh Ghaeli Department of Pharmacotherapy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. Abbasali Karimi Tehran Heart Centre, Tehran University of Medical Sciences, Tehran, Iran. Abbas Salehiomran Tehran Heart Centre, Tehran University of Medical Sciences, Tehran, Iran. Alireza Hajighasemi Tehran Heart Centre, Tehran University of Medical Sciences, Tehran, Iran. Payvand Bina Tehran Heart Centre, Tehran University of Medical Sciences, Tehran, Iran. Sayeh Darabi Tehran Heart Centre, Tehran University of Medical Sciences, Tehran, Iran. Arash Jalali Tehran Heart Centre, Tehran University of Medical Sciences, Tehran, Iran. Mehrnoush Dianatkhah Department of Pharmacotherapy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. Maryam Noroozian Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran. Nazila Shahmansouri Tehran Heart Centre, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 13 2015 10 13 Background: Postoperative cognitive dysfunction (POCD) has been an important complication of cardiac surgery over the years. Neurocognitive dysfunction can affect quality of life and lead to social, functional, emotional, and financial problems in the patient’s life. To reduce POCD, we sought to identify the association between cognitive dysfunction and perioperative factors in patients undergoing cardiac surgery. Methods: One hundred one patients aged between 45 and 75 years undergoing elective cardiac surgery were enrolled in this study. All the surgeries were performed on-pump by the same medical team. A brief Wechsler Memory Test (WMT) was administered before surgery, 3 to 5 days after the surgery, and 3 months after discharge. All related perioperative parameters were collected in order to study the effect of these parameters on the postoperative WMT scores and WMT score change. Results: The study population consisted of 101 patients, comprising 14 (13.8%) females and 87 (86.2%) males aged between 45 and 75 years. In univariate analysis, the baseline WMT score, serum levels of lactate dehydrogenase and T3, cross-clamp time, and preexistence of chronic obstructive pulmonary disease showed significant effects on the postoperative WMT score (p value < 0.05), whereas only the baseline WMT score and chronic obstructive pulmonary disease showed strong effects on the postoperative WMT score in the multiple regression model. In addition, the multiple regression model demonstrated a significant association between the baseline WMT score, serum creatinine level, and nitrate administration and the WMT score change. Conclusion: Our study showed that preexisting chronic obstructive pulmonary disease and preoperative high serum creatinine levels negatively affected cognitive function after surgery. In addition, there was a strong relationship between the patients’ basic cognition and POCD. Preoperative nitrate administration led to a significant improvement in POCD. It is also concluded that the preoperative administration of specific medicines like nitrates can reduce neurological complications after cardiac surgery. https://jthc.tums.ac.ir/index.php/rhythm/article/view/372 https://jthc.tums.ac.ir/index.php/rhythm/article/download/372/365

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 10 2 2015 10 13 93 97 EN Mohammad Sadegh Parsaee Mazandaran University of Medical Sciences, Sari, Iran. Maryam Nabati Department of Cardiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran Naser Saffar Student Research Committee, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran. Morteza Taghavi Student Research Committee, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran. 2015 10 13 2015 10 13 Background: The drug-eluting stent (DES) decreases the rate of coronary restenosis and re-obstruction. The aim of this study was to assess prospectively the effectiveness of the new generation DES on the left ventricular (LV) systolic and diastolic functions in patients with isolated severe proximal left anterior descending (LAD) coronary artery stenosis. Methods: A prospective study was conducted on 50 patients with isolated severe proximal LAD stenosis. Successful percutaneous coronary intervention (PCI) with Everolimus-eluting stents was performed for the whole study population. All the patients underwent transthoracic echocardiography within 24 hours before and one month after PCI, and LV systolic and diastolic parameters were compared before and after PCI using the paired samples t-test. Results: The mean age of the study population was 57.68 ± 8.82 years. Within the study population, 26 (52%) patients were male and 24 (48%) were female. There was a significant 10.6% and 5.2% increase in the early diastolic mitral annular motion (e') and the LV ejection fraction following PCI, respectively (p value = 0.005 and p value = 0.044, respectively). Before PCI, wall motion abnormality was seen in 2.21 ± 2.91 segments, which significantly decreased to 1.49 ± 2.58 segments (p value = 0.04) after the procedure. Also, the wall motion score index was 1.18 ± 0.26 before PCI, which significantly decreased to 1.13 ± 0.23 after PCI (p value < 0.001).Also, there was a trend toward a higher ratio of transmitral peak early diastolic velocity to peak late diastolic velocity after PCI (p value = 0.068). Conclusion: Our study showed that the use of the Everolimus-eluting stents improved the LV systolic and diastolic functions in patients with isolated severe LAD stenosis. https://jthc.tums.ac.ir/index.php/rhythm/article/view/373 https://jthc.tums.ac.ir/index.php/rhythm/article/download/373/366

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 10 2 2015 10 13 98 100 EN Adem Guler Department of Cardiovascular Surgery, Gulhane School of Medicine, Ankara, Turkey. Mehmet Ali-Sahin Department of Cardiovascular Surgery, Gulhane School of Medicine, Ankara, Turkey. Fahri Gurkan-Yesil Department of Cardiovascular Surgery, Gulhane School of Medicine, Ankara, Turkey. Uzeyir Yildizoglu Department of Cardiovascular Surgery, Gulhane School of Medicine, Ankara, Turkey. Sait Demirkol Department of Cardiovascular Surgery, Gulhane School of Medicine, Ankara, Turkey. Mehmet Arslan https://jthc.tums.ac.ir/index.php/rhythm/article/view/360 https://jthc.tums.ac.ir/index.php/rhythm/article/download/360/353

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 10 1 2015 10 13 50 52 EN Burak Acar Turkey Yuksek Ihtisas Hospital, Ankara, Turkey. Muhammed Suleymanoglu Turkey Yuksek Ihtisas Hospital, Ankara, Turkey. Cengiz Burak Turkey Yuksek Ihtisas Hospital, Ankara, Turkey. Burcu Mecit-Demirkan Turkey Yuksek Ihtisas Hospital, Ankara, Turkey. Yesim Guray Turkey Yuksek Ihtisas Hospital, Ankara, Turkey. Omac Tufekcioglu Turkey Yuksek Ihtisas Hospital, Ankara, Turkey. Sinan Aydogdu Turkey Yuksek Ihtisas Hospital, Ankara, Turkey. 2015 10 13 2015 10 13 Blunt chest traumas mostly occur due to car accidents and can cause many cardiac complications such as septal rupture, free-wall rupture, coronary artery dissection or thrombosis, heart failure, arrhythmias, and chordae and papillary muscle rupture. One of the most serious complication is tricuspid regurgitation (TR), which can be simply diagnosed by physical examination and confirmed by echocardiography. We describe a 48-year-old female patient, diagnosed with severe TR 13 years after a blunt chest trauma due to a car accident. TR was diagnosed with transthoracic echocardiography and three dimensional transthoracic echocardiography had defined the exact pathology of the tricuspid valve. The patient underwent successful surgery with bioprosthetic valve implantation and was discharged at 6th postoperative day without any complication. The patient had no problem according to the follow-up one month and six months after operation https://jthc.tums.ac.ir/index.php/rhythm/article/view/365 https://jthc.tums.ac.ir/index.php/rhythm/article/download/365/358

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 10 1 2015 10 13 24 33 EN Shervin Assari Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, MI, USA AND Center for Research on Ethnicity, Culture and Health, School of Public Health, University of Michigan, Ann Arbor, MI, USA. 2015 10 13 2015 10 13 Background: Patients with heart disease experience limited activities of daily living (ADL). This is a cross-country comparison of the additive effects of Socioeconomics, health behaviors, and the number of medical comorbidities on disability among patients with heart disease. Methods: The current study used a cross-sectional design. Data came from the Research on Early Life and Aging Trends and Effects (RELATE). The current analysis utilized data on elderly individuals (age ≥ 60 y) from 13 countries. The outcome was any ADL limitation (i.e. bathing, dressing, using toilet, transferring, lifting heavy things, shopping, and eating meals). Socioeconomics (i.e. age, gender, education, and income), health behaviors (i.e. exercise, smoking, and drinking), and number of chronic medical conditions (i.e. hypertension, respiratory, arthritis, stroke, and diabetes) were entered into country-specific logistic regressions, considering at least one limitation in ADL as the main outcome. Results: Number of comorbid medical conditions and age were positively associated with disability in 85% of the countries. Physical activity and drinking were linked to disability in 54% and 31% of countries, respectively. Higher education and income were associated with lower disability in 31% and 23% of the countries, respectively. Female gender was associated with higher disability only in 15% of the countries. Smoking was not associated with disability, while the effects of socioeconomics, drinking, exercise, and medical comorbidities were controlled. Conclusion: Determinants of disability depend on the country; accordingly, locally designed health promotion interventions may be superior to the universal interventions for patients with heart disease. Medical comorbidities, however, should be universally diagnosed and treated. https://jthc.tums.ac.ir/index.php/rhythm/article/view/361 https://jthc.tums.ac.ir/index.php/rhythm/article/download/361/354

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 10 1 2015 10 13 53 57 EN Feridoun Sabzi Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran. 2015 10 13 2015 10 13 Giant left atria are defined as those measuring larger than 8 cm and are typically found in patients who have rheumatic mitral valve disease with severe regurgitation. Enlargement of the left atrium may create compression of the surrounding structures such as the esophagus, pulmonary veins, respiratory tract, lung, inferior vena cava, recurrent laryngeal nerve, and thoracic vertebrae and lead to dysphagia, respiratory dysfunction, peripheral edema, hoarse voice, or back pain. However, a huge left atrium is usually associated with rheumatic mitral valve disease but is very rare in a normally functioning prosthetic mitral valve, as was the case in our patient. A 46-year-old woman with a past medical history of mitral valve replacement and chronic atrial fibrillation was admitted to our hospital with a chief complaint of cough and shortness of breath, worsened in the last month. Physical examination showed elevated jugular venous pressure, respiratory distress, cardiac cachexia, heart failure, hepatomegaly, and severe edema in the legs. Chest radiography revealed an inconceivably huge cardiac sell-out. Transthoracic echocardiography demonstrated a huge left atrium, associated with thrombosis, and normal function of the prosthetic mitral valve. Cardiac surgery with left atrial exploration for the extraction of the huge thrombosis and De Vega annuloplasty for tricuspid regurgitation were carried out. The postoperative course was eventful due to right ventricular failure and low cardiac output syndrome; and after two days, the patient expired with multiple organ failure. Thorough literature review showed that our case was the largest left atrium (20 × 22 cm) reported thus far in adults with a normal prosthetic mitral valve function. https://jthc.tums.ac.ir/index.php/rhythm/article/view/366 https://jthc.tums.ac.ir/index.php/rhythm/article/download/366/359

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 10 1 2015 10 13 34 42 EN Seyed Hesameddin Abbasi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Seyed Ebrahim Kassaian Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Saeed Sadeghian Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Abbasali Karimi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Soheil Saadat Sina Trauma Research Center, Tehran University of Medical Sciences, Tehran. Iran. Flora Peyvandi Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milano, Angelo Bianchi Bonomi Hemophilia and Thrombosis Centre, Milan, Italy AND Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy. Arash Jalali Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Tahereh Davarpasand Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Nazila Shahmansouri Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Masoumeh Lotfi-Tokaldany Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Maryam Amiri-Abchouyeh Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Farah Ayatollahzade-Isfahani Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Frits Rosendaal Department of Clinical Epidemiology and Department of Thrombosis and Haemostasis, Leiden University Medical Center, Leiden, The Netherlands. 2015 10 13 2015 10 13 Background: Data on premature coronary artery disease (CAD) are scarce. The Tehran Heart Center's Premature Coronary Atherosclerosis Cohort Study (THC-PAC) is the first study of its kind in the Middle East to assess major adverse cardiac events (MACE) in young CAD patients. Methods: The cohort c