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26.  Preventive effect of cinnamon essential oil on lipid oxidation of vegetable oil 
ARYA Atherosclerosis  2013;9(5):280-286.
BACKGROUND
Lipid oxidation is the main deterioration process that occurs in vegetable oils. This process was effectively prevented by natural antioxidants. Cinnamomum zeylanicum (Cinnamon) is rich with antioxidants. The present study was conducted to evaluate the effect of cinnamon on malondialdehyde (MDA) rate production in two high consumption oils in Iranian market.
METHODS
Chemical composition of cinnamon essential oil was analyzed by gas chromatography-mass spectroscopy (GC-MS). 200 µl each oil, 50 µl tween 20, and 2 ml of 40 Mm AAPH solutions were mixed and the prepared solution was divided into four glass vials. Respectively, 50 µl of 500, 1000 and 2000 ppm of cinnamon essential oil were added to three glass vials separately and one of the glass vials was used as the control. All of the glass vials were incubated at 37° C water bath. Rate of MDA production was measured by thiobarbituric acid (TBA) test at the baseline and after the 0.5, 1, 2, 3 and 5 hours.
RESULTS
Compounds of cinnamon essential oil by GC-MS analysis such as cinnamaldehyde (96.8%), alpha-capaene (0.2%), alpha-murolene (0.11%), para-methoxycinnamaldehyde (0.6%) and delta-cadinen (0.4%) were found to be the major compounds. For both oils, maximum rate of MDA production was achieved in 5th hours of heating. Every three concentrations of cinnamon essential oil significantly decreased MDA production (P < 0.05) in comparison with the control.
CONCLUSION
Essential oil of cinnamon considerably inhibited MDA production in studied oils and can be used with fresh and heated oils for reduction of lipid peroxidation and adverse free radicals effects on body.
PMCID: PMC3845693  PMID: 24302936
Cinnamon; Essential Oil; Lipid Peroxidation; Vegetable Oils
27.  Risk of sudden cardiac death 
ARYA Atherosclerosis  2013;9(5):274-279.
BACKGROUND
The aim of this study was to determine characteristics of patients with sudden cardiac arrest (SCA) and/or sudden cardiac death (SCD). We need an effective risk stratification method for SCD in patients without low left ventricular ejection fraction (LVEF).
METHODS
The study population of this cross-sectional study consisted of 241 patients with SCA or SCD who were admitted to an academic hospital, in Tehran, Iran, from 2011 through 2012. SCD was defined as unexpected death from cardiac causes, heralded by abrupt loss of consciousness within one hour of the onset of acute changes in cardiovascular status, or an unobserved death in which the patient was seen and known to be doing well within the previous 24 hours. Survivors of aborted SCD were also included in the study. Clinical and paraclinical characteristics as well as emergency department complications of patients were recorded.
RESULTS
The mean age of population was 66.0 ± 16.5 (17 to 90 years). Among the patients, 166 (68.9 %) were male, 50 (20.7%) were smoker, 77 (32.0%) had hypertension, 47 (19.5%) had diabetes mellitus, 21 (8.7%) had hyperlipidemia, and 32 (13.3%) had renal insufficiency. According to New York Health Association (NYHA) functional class, 31 (12.9%) patients were asymptomatic, 42 (17.4) and 99 (41.1%) subjects were in NYHA I and II, respectively and only 69 (28.6%) patients were in NYHA III or IV. In this study, presenting arrhythmia was pulseless electrical activity or asystole which was observed in 130 (53.9%) subjects. Ventricular tachycardia (VT) or ventricular fibrillation (VF) was seen in 53 (22%) patients. Cardiopulmonary resuscitation in emergency room was successful only in 46 (19.1%) subjects.
CONCLUSION
Low ejection fraction (EF) may be an independent predictor of sudden cardiac death in patients, but it is not enough. While implantable cardioverter defibrillators can save lives, we are lacking effective risk stratification and prevention methods for the majority of patients without low EF who will experience SCD.
PMCID: PMC3845694  PMID: 24302935
Death; Sudden Cardiac Arrest; Sudden Cardiac Death
28.  Evaluating the relative frequency and predicting factors of acute renal failure following coronary artery bypass grafting 
ARYA Atherosclerosis  2013;9(5):287-292.
BACKGROUND
Renal dysfunction or acute renal failure in patients undergoing coronary artery bypass grafting (CABG) is an important cause of morbidity and mortality. The great impact of acute renal failure (ARF) in the outcomes of cardiac surgery demands its study in our population, encouraging to the elaboration of this study, which aimed to identify the incidence and risk factors of ARF after CABG.
METHODS
Since March 2010 to 2011, 589 patients were studied who underwent CABG in Sina Hospital (Isfahan, Iran). In this cross-sectional study, patients were divided into two groups based on the occurrence of ARF after CABG and measured variables were compared between the two groups was also statistically significant. P value less than 0.05 was set as a significant level.
RESULTS
A total of 434 men and 155 women were enrolled in the study. The mean age of the study subjects was 57.6 years. ARF was seen in about 22% of patients after CABG. The mean age of ARF group was more than 3 years higher than that in the other group and the difference was significant between the two groups. Serum creatinine level after the surgery was different between the two groups. Moreover, the history of diabetes mellitus was significantly different between the two groups. Pump time comparison also showed was also statistically significant.
CONCLUSION
Our data showed older patients were more prone to affected by ARF. In addition, diabetic patients should be considered as high risk patients and are more likely to deteriorate by ARF. Despite increased prevalence of renal insufficiency in CABG patients, studies show that in most cases, this is not a serious problem and it is easily treatable. A lower proportion of patients (1.0 to 1.7% in different large series) develop ARF severe enough to require dialysis.
PMCID: PMC3845695  PMID: 24302937
Coronary Artery Bypass; Acute Kidney Injury; Creatinine
29.  A retrospective cohort study on factors associated blood pressure using multilevel modeling 
ARYA Atherosclerosis  2013;9(5):293-299.
BACKGROUND
Hypertension is a health problem in Iran. Given the importance of this subject, we reviewed the factors affecting the blood pressure in this survey.
METHODS
This retrospective cohort study was performed on 3961 male workers employed at Isfahan Polyacryl Corporation (Iran) in health and safety executive between 1996 until 2008. In this study, systolic and diastolic blood pressure (SBP and DBP) were considered as dependent variables; body mass index (BMI), age, type of job, marital status, shift work and educational level were considered as independent variables. MLwiN programmer version 2.1 was used to analyze the data.
RESULTS
BMI, age, shift work, marital status and educational level had statistical significant association with DBP. The result for SBP was similar to DBP except shift work and educational level that had no statistically significant association.
CONCLUSION
The results can be considered in the industry to provide practical solutions to reduce blood pressure.
PMCID: PMC3845696  PMID: 24302938
Blood Pressure; Cohort Study; Retrospective Study; Risk Factor; Multilevel Anal
30.  Aortic valve streptococcus group B endocarditis post-extracorporeal shock wave lithotripsy 
ARYA Atherosclerosis  2013;9(5):300-302.
BACKGROUND
Sub-acute left-sided bacterial endocarditis is a serious condition that may present with variable clinical manifestations. Its symptoms include both sterile and infected emboli, and various immunological phenomena.
CASE REPORT
This report presents a 55 year old man with frequency and dysuria after a lithotripsy and several admissions with urosepsis. Due to the suspicion of infective endocarditis echocardiography was done which confirmed streptococcus group B endocarditis.
CONCLUSION
Streptococci group B is one of the rare causes of infective endocarditis, but it was observed after various producers such as lithotripsy.
PMCID: PMC3845697  PMID: 24302939
Group B Streptococci; Infective Endocarditis; Lithotripsy
31.  Comparison of cardiovascular risk factors and biochemical profile in patients with cardiac syndrome X and obstructive coronary artery disease: A propensity score-matched study 
ARYA Atherosclerosis  2013;9(5):269-273.
BACKGROUND
This study was designed to compare the frequency of conventional cardiovascular disease risk factors and clinical biochemistry profile in patients with cardiac syndrome X (CSX) and obstructive coronary artery disease (CAD).
METHODS
A cross-sectional study was conducted on patients with typical angina and positive exercise tolerance test undergoing coronary angiography in our center. 342 consecutive patients with CSX were enrolled into this study and were matched regarding age and sex with 342 patients with acute coronary syndrome (ACS) and also 342 patients with chronic stable angina (SA). Cardiovascular risk factors as well as biochemistry profile of the patients were recorded.
RESULTS
Mean age of the studied patients was 53.0 years and 41.5% were male. There was no significant difference between the CSX patients and CAD patients regarding body mass index (BMI). Frequency of diabetes mellitus, hyperlipidemia, smoking, family history of premature CAD and hypertension was significantly lower in patients with CSX than ACS and SA patients. Patients with CSX had significantly higher levels of high-density lipoprotein cholesterol (HDL-cholesterol) than comparators while the levels of low-density lipoprotein cholesterol (LDL-cholesterol), total cholesterol, triglyceride and fasting blood sugar (FBS) were significantly lower in patients with CSX than CAD patients.
CONCLUSION
The present study demonstrated that CSX patients had substantially lower frequency of all conventional CVD risk factors than patients with obstructive CAD. This might aid in developing novel scoring systems or appropriateness criteria for angiographic evaluation of patients with typical angina and positive exercise test in order to reduce the rate of negative results.
PMCID: PMC3845698  PMID: 24302934
Cardiac Syndrome X; Microvascular Dysfunction; Coronary Artery Disease; Risk Factors
32.  Global coronary arteries spasm in a young patient 
ARYA Atherosclerosis  2013;9(4):260-262.
BACKGROUND
Coronary artery spasm is a transient narrowing of coronary arteries that slows or stops blood flow through the artery.
CASE REPORT
We present a 42-year-smoker man without any medical problem who developed syncope. Coronary angiography revealed diffuse significant narrowing of proximal left anterior descending artery (LAD), 90% osteal stenosis of large obtuse marginal (OM), 90% diffuse narrowing of proximal right coronary artery (RCA), which was relieved by intracoronary administration of nitrate. He was discharged on calcium channel blockers and nitrates but one month later developed syncope again and died.
CONCLUSION
Multivessel coronary artery spasm should be considered in young smoker patients without any other coronary risk factors who present with syncope.
PMCID: PMC3746942  PMID: 23970922
Syncope; Implantable Cardiac Defibrillators; Variant Angina
33.  Developing an appropriate model for self-care of hypertensive patients: first experience from EMRO 
ARYA Atherosclerosis  2013;9(4):232-240.
BACKGROUND
Cardiovascular diseases (CVDs) constitute 53% of deaths above the age of 30; 54% of these deaths are attributed to high blood pressure. Coronary artery disease (CAD) is the main cause of mortality in the world. Hypertension accounts for 13% of mortalities and 6% of morbidities and is one of the main risk factors that cause loss of healthy life years. Blood pressure is not optimally controlled even among those who are aware of their disease. Previous studies showed that apart from pharmacological treatment, lifestyle improvement can also play a significant role in the prevention of high blood pressure CVDs. Self-care among them has been addressed in several previous studies. There are few self-care programs in Iran, but no study has been conducted on blood pressure.
METHODS
In this study the primary model is designed and then revised, and in the pilot study the feasibility of the project was approved and the final model presented.
RESULTS
The current project proposes a model for self-care of hypertensive patients and their families, and is based on education of health care providers and patients in such a way that patients can control their illness.
CONCLUSION
The model can be implemented at a national scale.
PMCID: PMC3746943  PMID: 23970918
Self-Care; Hypertension; Model
34.  The correlation between educational levels and central obesity in the north of Iran: An epidemiologic study 
ARYA Atherosclerosis  2013;9(4):217-222.
BACKGROUND
The main aim of this study was to evaluate the association between educational levels and central obesity in northern Iran in 2010.
METHODS
This was a cross-sectional study carried out on 2428 subjects (1227 men and 1201 women) of 15-65 years of age who were chosen by cluster and stratified sampling methods. Subjects were randomly selected from 125 clusters and each cluster included 20 cases. Interviewers recorded the data using a multidimensional questionnaire comprising socio-demographic indexes.
RESULTS
Central obesity was seen in 34.8% of all subjects (15.9% male and 56.7% female) and in 15% of uneducated people. In the uneducated group, it was 20.0% and 31.1% higher than in the 1-9 years of schooling and high school or college educated groups, respectively (P = 0.001). The risk of central obesity increased in uneducated people (OR = 4.214, P = 0.001) and in people with 1-9 years of schooling (OR = 2.283, P = 0.001) compared with high school or college educated people. The risk of central obesity was higher in urban areas than in rural area (OR = 1.481, P = 0.001), in women than men (OR = 7.039, P = 0.001), in 40-65 year olds than 15-40 year olds (OR = 3.090, P = 0.001), and in the wealthy economic group than poor economic group (OR = 1.360, P = 0.013). The risk of central obesity increased in urban areas (OR = 2.266, P = 0.001) and the wealthy economic group (OR = 1.732, P = 0.001) after it was adjusted for education.
CONCLUSION
Central obesity as a health problem in northern Iran has been supported in this study, and it had an inverse correlation with educational levels. Public health programs that aim to reduce central obesity should mainly focus on the illiterate and low educated people.
PMCID: PMC3746944  PMID: 23970916
Education; Northern Iran; Adults; Central Obesity
35.  The correlation between early complications of percutaneous coronary intervention and high sensitive C-reactive protein 
ARYA Atherosclerosis  2013;9(4):263-267.
BACKGROUND
Increased incidence of cardiovascular diseases, especially coronary artery disease (CAD), during recent decades shows this disease entity to be the leading cause of death in the world. On the other hand many successes were achieved in the treatment of these diseases with new technology, which has its own side effects and threats for the patient. Among these new strategies is percutaneous coronary intervention (PCI), especially with stent implantation. Although coronary stents are effective in the treatment of dissection and prevention of restenosis, many side effects and even death have been observed, from 5-10% per year. Some studies showed that there is a relation between high sensitivity C-reactive protein (hs-CRP), as a laboratory marker for early detection of thrombosis and/or restenosis, and early complications of percutaneous coronary intervention. The aim of this study is to evaluate hs-CRP level in patients after PCI and to investigate if this can be a prognostic value for detection of early complication.
METHODS
This is a descriptive, analytical study done in Shahid Chamran Hospital (Isfahan, Iran) in 2011-2012. 87 patients who had undergone PCI were studied. Their hs-CRP level was measured before and after the study. Moreover, early stent complications were detected during the first 24 hours after insertion. The data was recorded in a researcher-constructed checklist and analyzed by SPSS for Windows 20.
RESULTS
The mean ± SD of hs-CRP level in patients with and without complication were 1.36 ± 0.97 and 3.09 ± 1.8, respectively. According to Student’s t-test, the hs-CRP level in patients with early complications was higher than patients without early complications of stent implantation; the difference was statistically significant (P < 0.001).
CONCLUSION
The hs-CRP serum concentrations of patients with, and without early stent complications were significantly different. According to the control diseases center (CDC) guideline, patients with a high level of hs-CRP need special care and attention.
PMCID: PMC3746945  PMID: 23970923
High Sensitivity C-reactive Protein (hs-CRP); Percutaneous Coronary Intervention (PCI) Complication
36.  Effects of quince leaf extract on biochemical markers and coronary histopathological changes in rabbits 
ARYA Atherosclerosis  2013;9(4):223-231.
BACKGROUND
Atherosclerosis is the main cause of cardiovascular disease which is caused by a high-fat diet. Many of these patients use boiled quince leaves for their treatment. However, the supporting scientific information is limit. The aim of this study was to evaluate the effect of quince leaf on the progression of atherosclerosis and whether it can be an appropriate alternative to statins.
METHODS
24 male rabbits were randomly divided into two groups: normal diet (6 n) and high-cholesterol diet (2% cholesterol, 18 n) for 8 weeks. At the end of the 8 weeks, both groups underwent blood sampling and their biochemical markers were measured. Then, all animals in the normal-diet group and three of the high-cholesterol diet group were killed to investigate atheromic plaque in their coronary artery. The 15 remaining rabbits of the high-cholesterol diet group were randomly divided into 3 groups (5 n) after discontinuation of the fatty diet. The first group was not given any treatment, the second received atorvastatin (0.5 mg/kg) orally, and the third received quince leaf extract (50 mg/kg) orally for 12 weeks. At the end of this period, after blood sampling, biopsy of coronary artery was performed for histological study.
RESULTS
The results showed that atorvastatin and quince leaf significantly decreased total cholesterol, triglyceride, LDL, AST, ALT, AP, BUN, and Cr levels compared with the first group of the high-cholesterol diet group (P < 0.05). No significant difference was found between atorvastatin and quince leaf extract groups in biochemical markers and atherosclerotic plaque in coronary artery.
CONCLUSION
Atorvastatin and quince leaf extract can effectively prevent the progression of atherosclerosis in coronary arteries. According to the results of this study and also lower toxic effects of herbal medication compared to synthetic medication, leaf extract can be a substitute for statins in treatment and prevention of cardiovascular disease. The anti-atherosclerotic effect of quince leaf is most likely related to its antioxidant components.
PMCID: PMC3746946  PMID: 23970917
Hyperlipidemia; Atherosclerosis; Coronary Arteries; Biochemical Markers; Atheromic Plaque; Atorvastatin; Quince Leaf Extract
37.  Factors affecting outcome of primary percutaneous coronary intervention for acute myocardial infarction 
ARYA Atherosclerosis  2013;9(4):241-246.
BACKGROUND
Primary percutaneous coronary intervention (PCI) is the main treatment for patients with ST-segment elevation myocardial infarction (STEMI). We investigated factors affecting the major complications of this procedure.
METHODS
This case-control study assessed 200 patients receiving primary PCI for STEMI. Effects of some factors including age, sex, coronary artery risk factors, left ventricular function, thrombolysis in myocardial infarction (TIMI) flow, and number of involved vessels on major adverse cardiac events (MACE) were studied.
RESULTS
Two thirds of patients were male but sex had no significant effect on MACE. Similarly, age, hypertension, and hyperlipidemia did not significantly affect the incidence of MACE. However, Killip class, left ventricular ejection fraction, diabetes, TIMI flow, and type of involved vessels had significant relations with the incidence of MACE.
CONCLUSION
According to our findings, factors such as diabetes, left ventricular function, left anterior descending artery involvement, and low TIMI flow are risk factors of MACE.
PMCID: PMC3746947  PMID: 23970919
Primary Percutaneous Coronary Intervention; ST-Segment Elevation Myocardial Infarction; Major Adverse Cardiac Events
38.  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
39.  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
40.  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
41.  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
42.  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
43.  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
44.  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
45.  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
46.  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
47.  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
48.  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
49.  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
50.  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

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