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26.  A case report of truncus arteriosus communis and genetic counseling 
ARYA Atherosclerosis  2013;9(4):254-259.
BACKGROUND
Truncus arteriosus communis (TAC) is a rare heart disorder with the prevalence of approximately 1%, mostly in male newborns. In this disease, aorta and pulmonary artery have not been separated during fetus development and both originate jointly from left ventricle. In addition, various disorders are reported like ventricular septal defect (VSD), mitral and tricuspid valves defects, aortic septal defect (ASD), reduction of lung and lung vessels’ resistance, pulmonary hypertension, increase in heart rate, high perspiration, bad digestion, and tetralogy of Fallot.
CASR REPORT
Parents of deceased patient were referred for genetic counseling after the death of third girl due to severe cardiac disorder. Cardiologist declared the disease in deceased girl as TAC based on findings along with VSD, ASD and hypoplastic aortic arch which resulted to death in the first day of birth.
CONCLUSION
There was no chromosomal disorder in chromosome analysis of patient’ skin. Parents were interested to have another child, so they were referred to university's Genetic Counseling Center to become aware of their next child’s condition. This disorder is genetically heterogeneous and multifactorial and because all external factors are not recognized, the accurate estimation of risk is not possible and the probability of risk for the next child is about 10% to 20%.
PMCID: PMC3746948  PMID: 23970921
Heart Disorder; Truncus Arteriosus Communis; Genetic Counseling
27.  The relationship between inflammatory markers, angiogenesis, and obesity 
ARYA Atherosclerosis  2013;9(4):247-253.
Obesity is recognized as a chronic low grade and systemic inflammatory disease. Angiogenesis is critical for adipose tissue expansion. Several evidences have demonstrated that angiogenesis sustains inflammation by preparing oxygen and nutrients for inflammatory cells and inflammation in turn can cause insulin resistance, type 2 diabetes, and cardiovascular disease. The understanding of mechanisms of obesity especially main roles of inflammation and angiogenesis in fat mass expansion can lead to therapeutic approaches in growing field of obesity and its related disorders. In this review, we studied the relationship between obesity, angiogenesis, and inflammation.
PMCID: PMC3746949  PMID: 23970920
Obesity; Angiogenesis; Inflammation
28.  Five chambered heart or large atrial appendage aneurysm: A report of two cases 
ARYA Atherosclerosis  2013;9(3):213-215.
BACKGROUND
Isolated intrapericardial LAA aneurysm is a rare cardiac anomaly which manifests with angina, dyspnea on exertion (DOE), systemic embolization, arrhythmia, and congestive heart failure.
CASE REPORT
A 30-year-old female and a 46-year-old male were referred for evaluation of abnormal cardiac contour on chest radiograph and echocardiographic findings and non-specific symptoms. Transesophageal echocardiography suggested left atrial appendage (LAA) mass filled with clots. The mass had no compression on cardiac chambers and global ejection fraction was within normal limits. The intraoperative diagnosis was isolated congenital LAA aneurysm. After confirmation of the diagnosis, it was resected. She was discharged with uneventful postoperative course. At follow-up she was asymptomatic.
CONCLUSION
These cases demonstrate the role of on-time surgical approaches in the prevention of fatal complication of this rare cardiac anomaly.
PMCID: PMC3681275  PMID: 23766780
Left Atrial Appendage; Aneurysm; Clot
29.  Lipid profile in antipsychotic drug users: A comparative study 
ARYA Atherosclerosis  2013;9(3):198-202.
BACKGROUND
Schizophrenic patients who receive antipsychotic drugs may be highly prone to metabolic disorders such as weight gain, dyslipidemia, and insulin resistance. The objective of the present study was to compare the effect of atypical and conventional antipsychotics on lipid profile.
METHODS
128 schizophrenic patients were enrolled into the study. Patients were divided into two groups. One group had received one type of atypical antipsychotic drug, and, the other, one type of conventional antipsychotic drug. They were considered as atypical and conventional groups. Moreover, both groups had not used any other antipsychotic drugs during the past year. Demographic data and food frequency questionnaire were completed by the participants. Serum triglyceride, total cholesterol (TC), high-density lipoprotein and low-density lipoprotein (LDL) cholesterols, and apolipoprotein A and B (Apo B) were tested by blood sample drawing after 12 hours of fasting through the antecubital vein. Student’s t-test was used to compare atypical and conventional groups.
RESULTS
There was no significant difference in age, gender, duration of illness, period of drug consumption, and age at onset of illness in the two groups. Patients in the atypical group used clozapine and risperidone (46.9%) more than olanzapine. In the conventional group 81.3% of patients used phenothiazines. Comparison between lipid profile in the conventional and atypical groups showed a significantly higher mean in TC (P = 0.01), LDL (P = 0.03), and Apo B (P = 0.01) in conventional group than the atypical group.
CONCLUSION
In schizophrenic patients, the level of lipid profile had been increased in both atypical and conventional antipsychotic users, especially conventional users, so the effect of antipsychotic drugs should be investigated periodically.
PMCID: PMC3681276  PMID: 23766777
Atypical Antipsychotic; Conventional Antipsychotic; Lipid Profile
30.  Effect of continuous care model on lifestyle of patients with myocardial infarction 
ARYA Atherosclerosis  2013;9(3):186-191.
BACKGROUND
Myocardial infarction (MI) is a life threatening disease that influences the physical, psychological and social dimensions of the individual. Improper lifestyle is one of the causes of this disease. The use of nursing models could be one of the important and fundamental steps in changing the risk factors associated with MI. This study was carried out to evaluate the effect of continuous care model on the lifestyle of patients with MI.
METHODS
This randomized clinical trial was carried out on 70 patients with MI in coronary care units of hospitals affiliated to Shiraz University of Medical Sciences. Enrolled patients were randomly assigned to intervention or control groups using a randomization list (random permutated blocks with length 4). The continuous care model was used for 35 patients in the intervention group for a period of 3 months and in the control group, the usual cares were applied for 35 patients. Data were collected through lifestyle questionnaire before the intervention and 3 months after. The data were analyzed using chi-square, independent t-test and paired t-test.
RESULTS
Patients in the intervention group showed significant improvements in lifestyle (125.6 ± 15.4 vs. 180.1 ± 19.9). Moreover, the lifestyle score of intervention group was significantly better than that of the control group (117.9 ± 22.0 vs. 180.1 ± 19.9; P < 0.001) after three months.
CONCLUSION
Applying a continuous care model had positive effects on the lifestyle of patients with Myocardial Infarction. In order to reduce the risk factors and improve the lifestyle of patients with MI, nurses could use this model to create an effective change.
PMCID: PMC3681277  PMID: 23766775
Myocardial Infarction; Lifestyle; Continuous Care Model
31.  Preconditioning by isoflurane as a volatile anesthetic in elective coronary artery bypass surgery 
ARYA Atherosclerosis  2013;9(3):192-197.
BACKGROUND
Some pharmacological preconditioning approaches are utilized as an effective adjunct to myocardial protection, particularly following cardiac procedures. The current study addressed the potential clinical implications and protective effects of isoflurane as an anesthetic most applicable on postoperative myocardial function measured by cardiac biomarkers.
METHODS
46 patients were included in the study. In 23 of them, preconditioning was elicited after the onset of cardiopulmonary bypass via a 5-minute exposure to isoflurane (2.5 minimum alveolar concentration), followed by a 10-minute washout before aortic cross clamping and cardioplegic arrest. 23 case-matched control patients underwent an equivalent period (15 minutes) of pre-arrest isoflurane-free bypass. Outcome measurements included creatine phosphokinase (CPK) and creatine kinase-MB (CK-MB) levels until 24 hours after the surgery.
RESULTS
None of the differences in enzyme levels at baseline and 24 hours after surgery between the two groups reached the threshold of statistical significance. The level of CPK was significantly reduced 24 hours after surgery compared with the baseline in the two groups. However, the postoperative release of CPK was consistently smaller in the isoflurane-preconditioned group than in the control group. The release of CK-MB displayed a statistically similar pattern. Multivariate linear regression analysis showed the effect of isoflurane regimen on reducing CPK level within the 24 hours after surgery compared with placebo.
CONCLUSION
Our study supports the cardio protective effect of isoflurane and the role of pharmacological preconditioning of the human heart by this volatile anesthetic during elective coronary artery bypass surgery.
PMCID: PMC3681278  PMID: 23766776
Preconditioning; Isoflurane; Volatile Anesthetic; Coronary Artery Bypass Surgery
32.  Effects of a comprehensive cardiac rehabilitation program on quality of life in patients with coronary artery disease 
ARYA Atherosclerosis  2013;9(3):179-185.
BACKGROUND
Health-related quality of life is an important factor to evaluate effects of different interventions in cardiovascular diseases. Improvement in quality of life (QOL) is an important goal for individuals participating in cardiac rehabilitation (CR) programs. The purpose of this study was to assess the impact of comprehensive CR on QOL in patients with cardiovascular disease (CAD).
METHODS
In this quasi-experimental before-after study, the files of 100 patients with CAD who were referred to rehabilitation department of Isfahan Cardiovascular Research Institute were studied using a consecutive sampling method. Data collection was performed from the patient's files including their demographics, ejection fraction, functional capacity, and resting heart rate. All patients participated in a comprehensive CR program and completed the validated questionnaire Short-Form 36 Health Status Survey (SF-36), before and after CR program. Data was analyzed based on sex and age groups (≥ 65 and < 65 years) using independent t-test and paired t-test (to compare variables between groups and before and after CR, respectively).
RESULTS
After CR, scores of all physical domains of the SF-36 including physical function (PF), physical limitation (PL), body pain (BP) and vitality (V) in addition to general health (GH) were significantly improved in all patients (P < 0.05) compared to the baseline. Patients with age < 65 years had greater improvements in mental health (MH) and social function (SF) than patients with age ≥ 65 years (P < 0.05). Women had greater improvement in PF, V and MH compared to men (P < 0.05).
CONCLUSION
These results indicated that CR can improve QOL in cardiac patients especially in women. Elderly patients get benefit the same as other patients in physical domains.
PMCID: PMC3681279  PMID: 23766774
Quality of Life; Cardiac Rehabilitation; Cardiovascular Diseases
33.  Clinical associations between renal dysfunction and vascular events: A literature review 
ARYA Atherosclerosis  2013;9(3):203-209.
Chronic kidney disease affects several other organs of the human body, and causes high levels of morbidity and mortality due to these effects. The cardiovascular system is probably the most vulnerable organ to a decrease in kidney function, and responds very fast to this effect. To the extent that, more kidney disease patients die of cardiovascular events than that of the original renal disease. Moreover, cerebrovascular events have been confirmed to increase, and to have inferior outcomes on the general population. In this review article, we aim to review studies investigating effects of renal disease on vascular events.
PMCID: PMC3681280  PMID: 23766778
Renal Disease; Cardiovascular Disorders; Dialysis; Myocardial Infarction; Risk Factor
34.  Association between markers of systemic inflammation, oxidative stress, lipid profiles, and insulin resistance in pregnant women 
ARYA Atherosclerosis  2013;9(3):172-178.
BACKGROUND
Increased levels of pro-inflammatory factors, markers of oxidative stress and lipid profiles are known to be associated with several complications. The aim of this study was to determine the association of markers of systemic inflammation, oxidative stress and lipid profiles with insulin resistance in pregnant women in Kashan, Iran.
METHODS
In a cross-sectional study, serum high sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-alpha (TNF-α), fasting plasma glucose (FPG), serum insulin, 8-oxo-7, 8-dihydroguanine (8-oxo-G), total cholesterol, triglyceride, High density lipoprotein-cholesterol (HDL-cholesterol), and plasma total antioxidant capacity (TAC) were measured among 89 primigravida singleton pregnant women aged 18-30 years at 24-28 weeks of gestation. Pearson’s correlation and multiple linear regressions were used to assess their relationships with homeostatic model assessment of insulin resistance (HOMA-IR).
RESULTS
We found that among biochemical indicators of pregnant women, serum hs-CRP and total cholesterol levels were positively correlated with HOMA-IR (β = 0.05, P = 0.006 for hs-CRP and β = 0.006, P = 0.006 for total cholesterol). These associations remained significant even after mutual effect of other biochemical indicators were controlled (β = 0.04, P = 0.01 for hs-CRP and β = 0.007, P = 0.02 for total cholesterol). Further adjustment for body mass index made the association of hs-CRP and HOMA-IR disappeared; however, the relationship for total cholesterol remained statistically significant.
CONCLUSION
Our findings showed that serum total cholesterol is independently correlated with HOMA-IR score. Further studies are needed to confirm our findings.
PMCID: PMC3681281  PMID: 23766773
Inflammation; Oxidative Stress; Insulin Resistance; Pregnancy
35.  Heart rate recovery in exercise test in diabetic patients with and without microalbuminuria 
ARYA Atherosclerosis  2013;9(3):167-171.
BACKGROUND
Diabetes mellitus (DM) has a lot of complications such as macrovessel and microvessel disease. Another complication of DM is cardiac autonomic neuropathy (CAN), which have effect on automatic nervous system of heart. Failure in heart rate slowing after exercise is a presentation of this abnormality.
METHODS
We selected diabetic patients and divided them to case and control group based on microalbuminuria. Case group comprised of diabetic patients with microalbuminuria and control group included those without microalbuminuria. Patients in both groups exercised on treadmill using Bruce protocol and heart rate was measured in first and second minutes in the recovery period.
RESULTS
We selected 35 patients with microalbuminuria (case group) and 35 without microalbuminuria (control group) among diabetic patients. No statistically significant difference was seen in sex and age between case and control groups. Heart rate recovery in the first minute of recovery in the case and control groups did not show significant difference; but in the second minute of recovery, it was significantly higher in control group (97 ± 19.4 vs. 101.9 ± 12.4 beat per minute, P = 0.04).
CONCLUSION
In this study we evaluated the heart rate recovery or deceleration in diabetic patients with albuminuria and without microalbuminuria in recovery phase after exercise test. We found out that heart rate recovery at the second minute in the case and control groups has statistically significant difference but at the first minute, it did not.
PMCID: PMC3681282  PMID: 23766772
Diabetes Mellitus; Exercise Test; Heart Rate Recovery
36.  Traumatic right pericardial laceration with tension pneumopericardium associated with hemodynamic instability: A case report 
ARYA Atherosclerosis  2013;9(3):210-212.
BACKGROUND
Pneumopericardium is a rare complication following thoracic trauma, and urgent treatment is rendered necessary when it causes tension pneumopericardium due to cardiac tamponade.
CASE REPORT
The case presented here is a right pericardial laceration with tension pneumopericardium due to falling from a height, presenting to the emergency clinic of our hospital with hemodynamic instability.
CONCLUSION
Pneumopericardium that might develop due to blunt thoracic trauma can easily be diagnosed, may result in cardiac tamponade, and is a potentially fatal pathology without treatment.
PMCID: PMC3681283  PMID: 23766779
Pneumopericardium; Trauma; Cardiac Tamponade; Fall
37.  Effects of negative T wave in electrocardiography on prognosis of post-myocardial infarction patients 
ARYA Atherosclerosis  2013;9(2):128-133.
BACKGROUND
Negative T (NT) wave in electrocardiography (ECG) is one of the important factors in determining short- and long-term outcomes in patients with acute myocardial infarction (MI). In this study, we compared clinical and paraclinical findings in post-MI patients according to presence or absence of NT wave.
METHODS
A cross-sectional study was conducted on patients with acute ST elevation MI who presented to Shahid Modares Hospital (Tehran, Iran) during 2009-10. After undergoing streptokinase therapy, demographic characteristics and ECG and exercise test findings of the subjects were compared based on the presence or absence of NT wave.
RESULTS
Overall, 116 patients including 69 cases with NT wave (NT group) and 47 cases without NT wave (PT group) were enrolled (mean age: 53.7 ± 7.1 vs. 54.1 ± 6.8 years old). Mortality rate during the first five days was 13% in the NT group and 29% in the PT group (P < 0.05). Ejection fraction values of the NT group were significantly higher than the PT group (P = 0.005). However, left ventricular end-diastolic diameter of the NT group was significantly less than the PT group (P = 0.005). Moreover, ST segment depression was significantly less frequent in the NT group compared to the PT group.
CONCLUSION
Patients with ST elevation MI accompanying with NT wave in ECG versus have better prognosis and myocardial function than similar patients without NT wave. Therefore, invasive procedures should be recommended for patients without NT wave.
PMCID: PMC3653241  PMID: 23690812
Echocardiography; Exercise Test; Myocardial Infarction; Negative T Wave; Echocardiography
38.  Autonomic function change following a supervised exercise program in patients with congestive heart failure 
ARYA Atherosclerosis  2013;9(2):150-156.
BACKGROUND
Few studies have investigated changes in autonomic function after training in patients with cardiovascular diseases, particularly patients with congestive heart failure (CHF). Heart rate recovery (HRR) is a strong predictor of mortality in coronary artery disease (CAD) patients. The aim of this study was to determine the effect of 8 weeks of supervised exercise training on autonomic function, which were assessed by heart rate, systolic blood pressure (SBP), and rate-pressure product (RPP) in CHF patients.
METHODS
65 patients aged 57-82 years with CHF were assigned to two groups randomly. The first group received a supervised 8-week aerobic training program of 30-45 min sessions, 3 days per week on alternate days, while controls received standard medical care and were followed up. Body weight, body mass index, functional capacity, resting heart rate, HRR, resting systolic blood pressure, peak heart rate, peak systolic blood pressure, and RPP were measured before and after the study period. Medications and diet recommendations remained unchanged in both groups during the study period.
RESULTS
The exercise group consisted of 33 patients with mean age of 61.54 ± 5.89 years and the controls were 32 patients with mean age of 60.94 ± 5.03 years. One-way analysis of variance (ANOVA) with repeated measures revealed a statistically significant difference in the exercise group compared to the control group regarding body mass index, resting heart rate, heart rate recover, functional capacity, peak heart rate, peak systolic blood pressure, peak RPP after 8 weeks (P ≤ 0.05).
CONCLUSION
In conclusion, a multidisciplinary CR program with supervised exercise training support significantly improves functional capacity and autonomic function in CHF patients. Therefore, a supervised and guided exercise training program is safe and beneficial for patients with CHF with different etiologies.
PMCID: PMC3653242  PMID: 23690816
Aerobic Exercise; Cardiorespiratory Fitness; Hemodynamics; Autonomic Function; CHF
39.  Risk factors of short-term stroke recurrence in patients with minor ischemic cerebrovascular events 
ARYA Atherosclerosis  2013;9(2):119-127.
BACKGROUND
Assessing the risk of recurrent ischemic events in patients with transient ischemic attack (TIA) and minor ischemic stroke (MIS) is of a great importance in clinical practice.
METHODS
Consecutive patients with TIA or MIS who were visited in Ghaem Hospital, (Mashhad, Iran) were enrolled in a prospective cohort study during 2010 to 2011. Diagnosis of TIA or MIS was accomplished by a stroke neurologist. Only those who presented within 24 hours from the onset of symptoms were recruited. MIS was considered as an ischemic stroke with National Institutes of Health Stroke Scale (NIHSS) < 4. The endpoint of the study was a new ischemic cerebrovascular event or vascular death in 90 days and additionally in 3 days. The decision to admit and type of treatment in each case was left to the discretion of the stroke neurologist. The association between 20 potential factors with recurrent ischemic events in 3 and 90 days was investigated using univariate and multivariate analysis (MVA).
RESULTS
393 TIA patients (238 males and 155 females) and 118 MIS patients (77 males and 41 females) were enrolled in the study. Stroke occurred in 117 (23.2%) patients, TIA in 99 (19.6%), and there was 11 (2.2%) vascular deaths within 3 months in the total 511 patients with minor ischemic events. Crescendo TIAs and multiple TIAs were associated with greater risk of stroke in 3 days in a univariate analysis (OR = 5.12, P < 0.001) and (OR = 3.98, P = 0.003), respectively. Patients with index stroke had 11.5% lower risk of recurrent stroke in 3 days than patients with index TIA in multivariate analysis (OR = 0.115, P = 0.039). Diabetes was independently associated with 3 months stroke recurrence in the patients with minor ischemic events (OR = 2.65, P = 0.039).
CONCLUSION
Multiple and crescendo TIAs are the main predictors of stroke recurrence, derived from the univariate analysis of the patients with minor ischemic events.
PMCID: PMC3653243  PMID: 23690811
Transient Ischemic Attacks; Infarction; Brain; Recurrence; Risk
40.  Percutaneous coronary intervention of an obstructive left anterior descending artery with anomalous origin of right coronary artery 
ARYA Atherosclerosis  2013;9(2):164-166.
Coronary artery anomalies are a rare type of congenital anomalies with an incidence of 1.3% during routine cardiac catheterization. Anomalous origin of the coronary arteries is considered an incidental finding without clinical significance. This case describes a patient in whom evaluation of chest pain revealed an obstructive left anterior descending artery as well as an anomalous right coronary artery arising from the left coronary sinus. The patient underwent successful percutaneous coronary intervention of the left anterior descending artery and was discharged home free of angina 3 days later.
PMCID: PMC3653244  PMID: 23690818
Anomalous Right Coronary Artery; Obstructive Left Anterior Descending Artery; Percutaneous Coronary Intervention
41.  Diagnostic performance of 64-row coronary CT angiography in detecting significant stenosis as compared with conventional invasive coronary angiography 
ARYA Atherosclerosis  2013;9(2):157-163.
BACKGROUND
The aim of the present study is to evaluate the accuracy of 64-multidetector-row computed tomography angiography (CTA) in comparison to conventional invasive angiography (CIA) in the diagnosis of significant stenosis (≥ 50%) of coronary artery tree.
METHODS
Assessment of CTA in the detection of coronary artery disease (CAD) was performed in patients referred because of symptoms or stress studies suggestive of ischemia. For this purpose, among more than 1000 cases of coronary CTA in a 20 months period a study population of 54 patients suspected to have significant stenosis of the coronary artery tree was investigated. The CIA procedure was performed in these patients one month after CTA. The accuracy of CTA in detecting significant stenosis was compared to CIA.
RESULTS
For vessel based analysis of 179 coronary vessels, CTA had a sensitivity of 96%, specificity of 87.5%, positive predictive value of 90.5%, and negative predictive value of 94.6%. For patient-base analysis, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CTA were 97.9%, 28.6%, 66.6%, and 90.2%, respectively.
CONCLUSION
The findings of this study reveal that CT angiography with 64-slice scanner could be considered as a suitable technique for rapid triage of patients presenting to hospitals with chest pain. High values of sensitivity and PPV reveal the good performance of CTA in detecting CAD.
PMCID: PMC3653245  PMID: 23690817
Coronary Artery Disease (CAD); Computed Tomography Angiography (CTA); Conventional Invasive Angiography (CIA)
42.  Postoperative cardiac arrest in children with congenital heart abnormalities 
ARYA Atherosclerosis  2013;9(2):145-149.
BACKGROUND
The exact survival rates and markers of survival after postoperative cardiac arrest in children with congenital heart abnormalities are unknown.
METHODS
In this one-year study, we identified children younger than seven years of age with postoperative cardiac arrest in our pediatric cardiac intensive care unit database. Parameters from perioperative, pre-arrest, and resuscitation periods were analyzed for these patients. Comparisons were made between survivors and non-survivors after cardiopulmonary resuscitation (CPR). Fisher's exact, Student's t, and chi-square tests were used to analyze data.
RESULTS
Of 529 evaluated children who underwent corrective heart surgery, 59 (11%) sustained a documented cardiac arrest. Of these, 22 (37%) survived and regained their vital signs. Perioperative parameters (age, weight, and duration of cardiopulmonary bypass pumping), ventricular physiology, oxygen saturation, and bicarbonate concentration did not influence the outcome of CPR. Greater use of inotropic agents was not associated with higher mortality. A significant relationship was seen between having history of cardiac arrest and CPR success (P < 0.001).
CONCLUSION
CPR had undesirable outcomes in patients with hemodynamic dysfunction (i.e. low mean arterial blood pressure). Patients with univentricular physiology or history of cardiac arrest are not prone to a higher risk of mortality following arrest.
PMCID: PMC3653246  PMID: 23690815
Cardiac arrest; Congenital; Cardiopulmonary resuscitation; Pediatrics; Operation
43.  The association between dietary intake of white rice and central obesity in obese adults 
ARYA Atherosclerosis  2013;9(2):140-144.
BACKGROUND
Obesity has become one of the most important and the fastest growing health and nutritional problem, not only in developed but also in developing countries. White rice consumption causes an increase in postprandial blood glucose and could be a probable reason for obesity. This study was conducted to investigate the association between intake of white rice and central obesity in an Iranian population.
METHODS
In the present cross-sectional study, a total of 212 subjects were selected based on convenience non-random sampling procedure. Expert interviewers collected socio-demographic and dietary intake data by a face to face method.
RESULTS
We failed to find any significant association between frequency of white rice consumption and body mass index or waist circumference, neither in crude model nor in adjusted models.
CONCLUSION
Although there was no significant association between white rice intake and obesity factors in our study, more studies are necessary with larger population and better design.
PMCID: PMC3653247  PMID: 23690814
White Rice; Body Mass Index; Central Obesity; Diet
44.  Corrected thrombolysis in myocardial infarction frame count and ejection fraction in patients undergoing primary percutaneous coronary intervention for myocardial infarction 
ARYA Atherosclerosis  2013;9(2):134-139.
BACKGROUND
This study aimed to assess the associations between corrected thrombolysis in myocardial infarction frame count (CTFC) of the infarct-related artery (IRA) and ejection fraction (EF) after three-six months in patients who underwent primary percutaneous coronary intervention (PPCI) for ST segment elevation myocardial infarction (STEMI).
METHODS
CTFC was determined by a digital system for 78 patients. EF was measured through Simpson’s method upon discharge and three-six months later. The subjects were divided into two groups of CTFC ≤ 20 (n = 54) and CTFC > 20 (n = 24). Association between CTFC and EF were then specified.
RESULTS
CTFC ≤ 20 and CTFC > 20 were present in 69.2% and 30.8% of the patients, respectively. There was no significant difference between the two groups regarding baseline characteristics. EF at the time of discharge was 42.1% ± 10.2% and 43.5% ± 11.4% in groups with CTFC ≤ 20 and > 20, respectively. There was no significant association between EF at discharge and CTFC (P = 0.611). After three months, EF changed to 49.6% ± 8.7% and 41.6 ± 12.4% in the groups with CTFC ≤ 20 and CTFC > 20, respectively. Three months after PPCI, EF and CTFC had a significant relation (P = 0.007). Cumulative number and percentage of shock and death were 3 (3.8%) and 2 (2.6%), respectively.
CONCLUSION
Lower CTFC of the infarct-related artery in patients undergoing PPCI for STEMI was associated with higher left ventricular ejection fraction after three months.
PMCID: PMC3653248  PMID: 23690813
Corrected Thrombolysis in Myocardial Infarction Frame Count; Ejection Fraction; Percutaneous Coronary Intervention; Myocardial Infarction
45.  Differences in the prevalence of metabolic syndrome in boys and girls based on various definitions 
ARYA Atherosclerosis  2013;9(1):70-76.
BACKGROUND
The prevalence of metabolic syndrome (MetS) is increasing among children and adolescents. However, the prevalence of this disorder varies based on its different definitions. This study aimed to determine the prevalence of MetS in Iranian adolescents in junior high and high schools according to the definitions provided by the International Diabetes Federation (IDF) and De Ferranti.
METHODS
Overall, 1039 junior high school and 953 high school students were selected using multistage random sampling. Demographic data was collected using validated questionnaires. Fasting blood sugar, total cholesterol, triglyceride, high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) levels were determined. Waist circumference and blood pressure were measured by trained individuals. Subjects with MetS were selected according to two definitions provided by the IDF and De Ferranti. Chi-square and Fisher’s exact tests were used to compare the prevalence of MetS and its components based on sex, school level, and the two definitions.
RESULTS
The mean age of junior high and high school students was 13.11 ± 1.21ad 15.93 ± 1.07 years old, respectively. The prevalence of MetS among all participants was 4.8% and 12.7% according to the definitions by the IDF and De Ferranti, respectively. It was significantly higher among boys compared to girls. According to the IDF definition, low HDL-C and hypertension were the most frequent components. Based on the De Ferranti, abdominal obesity and hypertriglyceridemia were the most frequent components.
CONCLUSION
The prevalence of MetS was higher in both groups of students based on De Ferranti definition compared to the IDF definition. The prevalence was not significantly different in boys and girls. Further studies to investigate the most suitable definition of MetS for Iranian adolescents are necessary.
PMCID: PMC3653251  PMID: 23696762
Metabolic Syndrome; Adolescence; International Diabetes Federation and De Ferranti
46.  Socioeconomic characteristics and controlled hypertension: Evidence from Isfahan Healthy Heart Program 
ARYA Atherosclerosis  2013;9(1):77-81.
BACKGROUND
Hypertension is a major risk factor for cardiovascular diseases. It affects approximately 18.0% of Iranian adults. This study aimed to estimate age-adjusted prevalence of hypertension and its control among Iranian persons older 19 years of age. It also tried to find and socioeconomic factors associated with hypertension control in Iranian population.
METHODS
In Isfahan Healthy Heart Program (IHHP) subjects were selected by multistage random sampling. The participants completed questionnaires containing demographic information, lifestyle habits, medical history, and consumption of relevant medications, especially antihypertensive agents. Income, marital status, and educational level were considered as socioeconomic factors. Hypertension was defined as systolic blood pressure ≥ 140 mmHg, diastolic blood pressure ≥ 90 mmHg, or taking antihypertensive medications. Controlled hypertension was considered as systolic blood pressure < 140 mmHg and diastolic blood pressure < 90 mmHg among hypertensive subjects.
RESULTS
The prevalence of hypertension and controlled hypertension was 18.9% and 20.9%, respectively. We found significant relationships between hypertension and marital status, education, and income. At age ≥ 65 years old, odds ratio (OR) was 19.09 [95% confidence interval (CI): 15.01-24.28] for hypertension. Middle family income (OR: 0.71; 95% CI: 0.58-0.87) and education level of 6-12 years (OR: 0.29; 95% CI: 0.25-0.35) were significantly associated with increased risk of hypertension (P = 0.001). Among subjects aging 65 years old or higher, the OR of controlled hypertension was 2.64 (95% CI: 1.61-4.33). Married subjects had a higher OR for controlled hypertension (OR: 2.19; 95% CI: 1.36-3.52). Obesity had no significant relationships with controlled hypertension.
CONCLUSION
The IHHP data showed significant relationships between some socioeconomic factors and controlled hypertension. Therefore, as current control rates for hypertension in Iran are clearly unacceptable, we recommend preventive measures to control hypertension in all social strata of the Iranian population.
PMCID: PMC3653252  PMID: 23696763
Socioeconomic Factor; High Blood Pressure; Control
47.  Relationship between left ventricular ejection fraction and depression following myocardial infarction: an original article 
ARYA Atherosclerosis  2013;9(1):16-21.
BACKGROUND
The aim of this study was to examine the association between left ventricular ejection fraction (LVEF) and incidence of depression following the myocardial infarction (MI).
METHODS
In a prospective study, 176 patients aged 32-84 years with the mean age of 56 years (SD = 10.05) with a definitive diagnosis of myocardial infarction and admitted to one of the coronary care units (CCU) of Isfahan during April to August 2006 were selected through consecutive sampling method. The demographic and medical characteristics were collected by their medical record and also the results of the LVEF assessment of the patients were obtained through echocardiography or angiography following the myocardial infarction. Thereafter, the patients were given Beck Depression Inventory for the primary care (BDI-PC) in three months after myocardial infarction. The collected data were analyzed during the hospitalization and follow-up periods using logistic regression method.
RESULTS
The findings indicated that left ventricular dysfunction identified by the Left ventricular ejection fraction index was significantly correlated with depression three months after the myocardial infarction (P < 0.01). In addition, the exploratory model (which only includes LVEF variable) had the predictive validity of 64.8% with 55.7% sensitivity and 72.1% specificity.
CONCLUSION
Left ventricular dysfunction is associated with increased risk of depression following the myocardial infarction.
PMCID: PMC3653253  PMID: 23696755
Depression; Myocardial Infarction (MI); Left Ventricular Ejection Fraction (LVEF)
48.  Correlation between seizure in children and prolonged QT interval 
ARYA Atherosclerosis  2013;9(1):7-10.
BACKGROUND
Long QT is a cardiac electrical disorder. One of the symptoms of long QT caused by fatal ventricular arrhythmia is seizure. In some studies it was indicated that up to 35% of seizures induced by long QT may be misdiagnosed as other causes of seizure.
METHODS
In a case-control study, patients experiencing primary seizure with unknown etiology and referring for clinical diagnosis were selected as the case group. The control group consisted of patients hospitalized for other reasons except seizure. Corrected QT Interval (QTc) was measured for each patient on an electrocardiogram, and the two groups were compared. Long QT was defined as a QT more than 0.46 seconds.
RESULTS
Among 508 subjects who were recruited in this study 254 children were in the case group and 254 were in the control group. There were 66 children experiencing seizure and long QT in the case group. In the control group, 48 children with long QT were observed; the difference was statistically significant (P = 0.02). Syncope and sudden death were not significantly different between the two groups.
CONCLUSION
The present study showed that children with unknown causes of seizure have more frequently long QTc, which implies the possibility of an arrhythmic origin of some seizures. Therefore, it is advised to get an electrocardiography for patients with unknown causes of seizure.
PMCID: PMC3653254  PMID: 23696753
Seizure; Children; Long QTc
49.  Social norms of cigarette and hookah smokers in Iranian universities 
ARYA Atherosclerosis  2013;9(1):45-50.
BACKGROUND
First experiences of tobacco use usually occur in adolescence. The recognition of social norms leading to youth smoking is hence necessary. We tried to assess the social norms among Iranian young cigarette and hookah smokers.
METHODS
This cross-sectional study was conducted on 451 girls and 361 boys aging 20-25 years old who entered Isfahan and Kashan Universities (Iran) in 2007. Demographic factors (age, gender, and age at smoking onset) cigarette and hookah smoking status, having a smoking father or smoking friends and four related social norms were recorded. Binary logistic regression analysis was used to separately determine associations between hookah and cigarette smoking and the four social norm variables.
RESULTS
Cigarette and hookah smokers had significant differences with nonsmokers in two social norms: “Perceived smoking by important characters” [odds ratio (OR) = 1.35 in cigarette smokers and 1.58 in hookah smokers; P < 0.001] and “smoking makes gatherings friendly” (OR = 3.62 in cigarette smokers and 6.16 in hookah smokers; P < 0.001). Furthermore, cigarette and hookah smoking were significantly associated with having smoking friends.
CONCLUSION
Highlighting the social norms leading to cigarette and hookah smoking may help policy makers develop comprehensive interventions to prevent smoking among adolescents.
PMCID: PMC3653255  PMID: 23696759
Cigarette; Hookah; Smoking; Social Norm
50.  Non-administration of thrombolytic agents in acute myocardial infarction patients in Hajar hospital, Shahrekord, Iran: prevalence rate and causes 
ARYA Atherosclerosis  2013;9(1):115-118.
BACKGROUND
Cardiovascular diseases are the major causes of mortality worldwide and acute myocardial infarction (AMI) is the leading cause of mortality among cardiovascular diseases. Thrombolytic therapies, especially during the first few hours after the disease onset, can significantly reduce AMI-related mortality.
METHODS
The current study aimed to determine the prevalence and causes of non-administration of thrombolytic therapy for AMI patients admitted to Hajar Hospital, Shahrekord, Iran, from May until November 2000. Non-probability convenient sampling method was used to select 106 subjects with Q-wave AMI. Data was collected by completing a questionnaire, reviewing medical records, and interviewing with patients. SPSS7.5 was for data analysis.
RESULTS
A total number of 106 AMI patients were studied among whom 62 (59%) individuals received thrombolytic therapy. Delayed referral to the hospital was the major cause of failure to provide thrombolytic therapy. The cause of non-treatment could not be identified in 15 (19.5%) subjects eligible to receive therapy.
CONCLUSION
Training general practitioners and individuals involved in this regard along with accelerating the process of patient referral to hospitals can reduce AMI-related mortality.
PMCID: PMC3653256  PMID: 23696767
Acute Myocardial Infarction; Thrombolytic; Therapy

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