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1.  Role of electrophysiological study in patients with syncope and bundle branch block 
The finding of bundle branch block (BBB) in patients with syncope suggests that paroxysmal atrioventricular block (AVB) or ventricular tachyarrhythmia (VT) may be the cause of syncope. Guidelines for cardiac pacing and cardiac resynchronization therapy have been recommended to perform electrophysiological study (EPS) for confirming main cause of syncope. Therefore, the aim of our study was to evaluate the role of EPS in patients with syncope and BBB.
Materials and Methods:
We evaluated 133 patients (mean age 63 ± 13.8 years) with past history of syncope and BBB from April 2002 to December 2010 who referred to Arrhythmia clinic in two tertiary care centers. All patients underwent EPS on admission time. The frequency distributions of AVB and VT in patients were determined.
Left bundle branch block was diagnosed in 184 (82.1%) patients. 133 of them had preserved left ventricular ejection fraction (LVEF ≥45%) that in 91 (68.4%) of those, EPS finding was normal. In 41 (30.8%) patients AVB was reported. In 2 (1.5%) patients VT and atrioventricular nodal reentrant tachycardia were seen. Coronary artery disease was more common in patients with AVB and abnormal EPS finding (P = 0.02).
Ventricular tachyarrhythmia was a rare electrophysiological finding in those with syncope, bifascicular block, and preserved LVEF. Considering cost-effect benefit, pacemaker or implantable loop recorder implantation is suggested; however, EPS may not be necessary to perform before permanent pacemaker implantation.
PMCID: PMC4274573  PMID: 25538780
Atrioventricular block; electrophysiological study; left bundle branch block; permanent pacemaker implantation; syncope; ventricular tachyarrhythmia
2.  Undiagnosed interrupted aortic arch in a 59-year-old male patient with severe aortic valve stenosis: A case report and literature review 
ARYA Atherosclerosis  2014;10(4):230-232.
Interrupted aortic arch (IAA) is defined by a lack of the luminal continuity between the ascending and descending thoracic aorta. It is a rare, severe congenital heart defect which without surgery is associated with high mortality in the neonatal period. The aims of this study were to present a case with IAA who was alive until the age of 59 years without any surgical intervention and to review the literatures that have presented IAA cases.
The patient was admitted with respiratory distress and pulmonary edema. Echocardiography showed the sever stenosis in aortic valve and sever left ventricular dysfunction. Cardiac catheterization and angiography confirmed interrupted aorta (type A). The descending thoracic aorta was supplied by extensive collateral vessels from the vertebrobasilar system down to the posterior chest wall and the spine. Surgical correction including coronary artery bypass graft and aortic valve replacement and repair of interruption of the aorta was performed. Three weeks later the patient was died due to uncontrollable gastrointestinal bleeding and hospital acquired pneumonia. We described diagnosis and management of our case.
This case was very interesting for us, because the patient had not been diagnosed until the recent presentation. Similar cases with this diagnosis do not reach adulthood, but our patient was alive up to 59 years of age.
PMCID: PMC4173315  PMID: 25258640
Interrupted; Aorta; Aortic Valve Stenosis; Thoracic Aorta; Aortic Arch
3.  Acute effects of smoking on QT dispersion in healthy males 
ARYA Atherosclerosis  2014;10(2):89-93.
Cigarette smoking increases the risk of ventricular fibrillation and sudden cardiac death (SCD). QT dispersion (QTD) is an important predictor of cardiac arrhythmia. The aim of this study was to assess the acute effect of smoking a single standard cigarette containing 1.7 mg nicotine on QT interval and QTD in healthy smokers and nonsmokers.
The study sample population consisted of 40 healthy male hospital staff, including 20 smokers and 20 nonsmokers. They were asked to refrain from smoking at least 6 h before attending the study. A 12-lead surface electrocardiogram (ECG), recorded at paper speed of 50 mm/s, was obtained from all participants before and 10 min after smoking of a single complete cigarette. QT interval, corrected QT interval, QTD, and corrected QT dispersion (QTcD) were measured before and after smoking.
Smokers and nonsmokers did not have any significant differences in heart rate (HR) (before smoking = 67.35 ± 5.14 vs. 67.70 ± 5.07, after smoking = 76.70 ± 6.50 vs. 76.85 ± 6.50, respectively), QTD (before smoking = 37.75 ± 7.16 vs. 39.15 ± 6.55, after smoking = 44.75 ± 11.97 vs. 45.50 ± 9.58, respectively), and QTcD (before smoking = 39.85 ± 7.40 vs. 41.55 ± 6.57, after smoking = 50.70 ± 14.31 vs. 51.50 ± 11.71, respectively). However, after smoking a single cigarette, HR, mean QTD, and QTcD significantly increased (all had P value <0.001) in comparison to the measures before smoking.
Smoking of a single complete cigarette in both smokers and nonsmokers results in significant QTD increase, which can cause arrhythmia and SCD.
PMCID: PMC4144371  PMID: 25161676
Cardiac; Death; Electrocardiography; Smoking; Sudden
4.  Does significant weight reduction in men with coronary artery disease manage risk factors after cardiac rehabilitation program? 
Vast majority of cardiac patients who refer to cardiac rehabilitation program (CRP) are obese and obesity is associated with coronary heart disease (CHD). So, the aim of this study is to investigate the effects of CRP on obesity indexes, lipid profiles, and functional capacity (FC) in obese men with CHD and to explore whether significant weight reduction affected these risk factors and FC or not.
Materials and Methods:
In an observational study, we evaluated 536 patients, including 464 non-obese men and 72 obese men. All participants completed CRP for 2 months; then, obese patients were divided into two groups: patients with weight reduction ≥ 5% and patients who didn’t have significant weight reduction. Data were analyzed with SPSS software version 15. For comparing the mean of outcomes independent t-tests and paired t-tests were used.
Results showed following CRP, non-obese men had significant improvement in obesity indexes (P = 0.00), lipid profiles (P < 0.05), and FC (P = 0.00) and in obese men, favorable improvement were seen in obesity indexes (P = 0.00), FC (P = 0.00), and total cholesterol (P = 0.02). Comparing two groups revealed that there were significant differences in obesity indexes, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio. In addition, comparing subgroup of obese patients revealed that there were significant differences in FC (P = 0.00) and low-density lipoprotein cholesterol/ high-density lipoprotein cholesterol ratio (P = 0.04).
CRP has more advantage in management of obesity, FC, and lipid profiles in both obese and non-obese patients. Also, weight reduction may cause greater improvement in FC and fitness levels in obese men with CHD.
PMCID: PMC3906786  PMID: 24523781
Coronary artery disease; obesity; risk factor cardiac rehabilitation program; weight reduction
5.  Effects of Pioglitazone on Asymmetric Dimethylarginine and Components of the Metabolic Syndrome in Nondiabetic Patients (EPICAMP Study): A Double-Blind, Randomized Clinical Trial 
PPAR Research  2013;2013:358074.
The present trial aimed to investigate the effects of pioglitazone on the serum level of asymmetric dimethylarginine (ADMA), a marker of endothelial function, and some indices of inflammation and glucose and lipid metabolism in nondiabetic metabolic syndrome patients. 104 eligible participants (57% female; age between 20 and 70) were enrolled in a double-blind placebo-controlled trial and were randomized to receive either pioglitazone (uptitrated to 30 mg/day) or matching placebo for 24 weeks. Participants were clinically examined and a blood sample was obtained at baseline and at the end of the trial. Pioglitazone significantly improved C-reactive protein level irrespective of changes in insulin sensitivity. Compared with the placebo group, alanine and aspartate transaminases were decreased and high-density lipoprotein cholesterol was increased after treatment with pioglitazone. A considerably greater weight gain was also recorded in the intervention group. We failed to observe any significant changes in serum ADMA in either group and between groups with and without adjustment for age, sex, and components of the metabolic syndrome. In a nutshell, pioglitazone seems to have positive effects on lipid profile, liver transaminases, and systemic inflammation. However, its previously demonstrated endothelial function-improving properties do not seem to be mediated by ADMA.
PMCID: PMC3654334  PMID: 23710164
6.  Promoting sexual abstinence intention among female university students: A quasi-experimental study 
The effectiveness of a theory-based educational intervention on intension for sexual abstinence among female university students was evaluated.
Materials and Methods:
Female students were recruited from humanity sciences department through cluster sampling. Educational intervention was applied for four 90-min sessions and by application of cognitive theories during 4 weeks.
One hundred and nine female students with mean age of 20.74 ± 1.57 years took part in the study. Despite the similarity of two groups of intervention (n = 53) and control (n = 59) at baseline, there were significant differences between the two groups in mean scores of the variables, knowledge (4.62 ± 1.38 vs. 3.53 ± 1.61), perceived susceptibility (14.05 ± 1.51 vs. 12.37 ± 2.11), and perceived benefits (28.41 ± 2.14 vs. 27.51 ± 3.05), at follow-up time after 3 months (P < 0.05). Additionally, these variables were observed with improvement over 3 months in the intervention group (P < 0.05). However, this study showed no significant effect on the behavior intention and self-efficacy.
This study showed that educational intervention could improve knowledge, perceived benefits, and self-efficacy of the female students regarding HIV/AIDS.
PMCID: PMC3719224  PMID: 23900294
Attitude; health education; human immunodeficiency virus; knowledge; sexual abstinence
7.  Diagnostic dilemma: Saccular aneurysm or pseudoaneurysm of the ascending aorta with dissection above level of leaflets 
ARYA Atherosclerosis  2012;8(3):167-169.
In true aneurysm, the wall of aneurysm is composed of the normal histological components of aorta. A false aneurysm (pseudoaneurysm) represents a rupture which does not contain the normal histological components of aorta. It is a fibrous peel that has formed from a small perforation of aorta. We describe an unusual presentation that has signs which some of them are only manifested in true aneurysm and some others only in pseudoaneurysm.
An 85-year-old man underwent elective coronary angiography for chest pain work-up. Our evaluation by invasive angiography and CT angiography showed aortic dissection. In surgery we found that dissection flap was composed of some parts of intima and media layers. These signs leaded to confusing symptoms. Localized bulging of ascending aorta had continued to brachiocephalic artery (transverse arch involvement). Dissection flap was composed of some part of intima and media layers. It was a strange case, it was not solely a perivascular hematoma and it did not have all three layers of aorta wall. Partial aorta replacement was performed. The operation and recovery was uneventful.
This unusual presentation of disease has not been mentioned in literatures. Our experience can help to manage similar cases. This case was the first unusual presentation of its type.
PMCID: PMC3557002  PMID: 23358558
Saccular Aneurysm; Aortic Dissection; Pseudoaneurysm; Aneurysm
8.  Can cardiac rehabilitation programs improve functional capacity and left ventricular diastolic function in patients with mechanical reperfusion after ST elevation myocardial infarction?: A double-blind clinical trial 
ARYA Atherosclerosis  2012;8(3):125-129.
Current guidelines recommend cardiac rehabilitation programs (CRP) as a means to improve functional status of patients after coronary revascularization. However, research supporting this recommendation has been limited and positive effects of CRP on diastolic function are controversial. The aim of this study was to examine the effects of an 8-week CRP on left ventricular diastolic function.
This randomized, clinical trial included 29 men with ST elevation myocardial infarction (MI) who had received reperfusion therapy, i.e. coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). They were randomized to a training group (n = 15; mean age: 54.2 ± 9.04 years old) and a control group (n = 14; mean age: 51.71 ± 6.98 years old). Patients in the training group performed an 8-week CRP with an intensity of 60-85% of maximum heart rate. Exercise sessions lasted 60-90 minutes and were held three times a week. At the start and end of the study, all patients performed symptom-limited exercise test based on Naughton treadmill protocol. Pulsed-wave Doppler echocardiography was also used to determine peak velocity of early (E) and late (A) waves, E/A ratios, and the deceleration time of E (DT).
Left ventricular diastolic indices (E, A, E/A ratio, DT) did not change significantly after the CRP. Compared to baseline, patients in the training group had significant improvements in functional capacity (8.30 ± 1.30 vs. 9.7 ± 1.7) and maximum heart rate (118.50 ± 24.48 vs. 126.85 ± 22.75). Moreover, resting heart rate of the training group was significantly better than the control group at the end of the study (75.36 ± 7.94 vs. 79.80 ± 7.67; P < 0.001).
An 8-week CRP in post-MI patients revascularized with PCI or CABG led to improved exercise capacity. However, the CRP failed to enhance diastolic function.
PMCID: PMC3557005  PMID: 23358827
Cardiac Rehabilitation; Diastolic Function; Functional Capacity; Post-Myocardial Patients
9.  Aspirin resistance and ischemic heart disease on Iranian experience 
Coronary artery disease (CAD) and myocardial infarction are the most common causes of mortality and morbidity all over the world. Aspirin resistance is an important part of therapeutic failure in patients who experience several atherosclerotic events despite aspirin therapy. Different studies have reported aspirin resistance between 5% and 45% all over the world.
According to different responses to aspirin therapy in countries and lack of adequate studies on aspirin resistance in Iran, this study was designed for evaluation of aspirin resistance in ischemic patients.
Materials and Methods:
Total 170 patients with documented coronary artery stenosis with were enrolled in this cross-sectional prospective study. Two cc urine samples were obtained from all the subjects. Then a questionnaire including questions about major risk factors (hypertension, diabetes, hyperlipidemia, obesity and smoking) was completed for each patient. Thromboxane B2 level in urine was measured two times for each patient by one kit of via ELISA method. Gensini modified was usedfor assessment of severity of coronary arteries involvement. Data were analyzed via SPSS 16. with general linear model (univariate).
75.3% of studied patients were aspirin resistant. There was significant relationship between angiography score and aspirin resistance (P<0.001).Our results also showed that aspirin resistance is more common in studied women than men (P=0.003).Significant correlation was observed between diabetes and aspirin resistance in studied subjects (P=0.023).
Our study showed aspirin resistance in a sample of Iranian ischemic patients is so prevalent which is higher than other studies in another communities and also aspirin resistance is more common in patients with severe CAD.
PMCID: PMC3507033  PMID: 23210092
Aspirin resistance; coronary artery disease; thromboxane B2 level
11.  Takotsubo cardiomyopathy or broken heart syndrome: A review article 
Stress-induced cardiomyopathy or Takotsubo cardiomyopathy is a recently increasing diagnosed disease showed by transient apical or mid left ventricular dilation and dysfunction. This sign is similar to acute myocardial infarction but without significant coronary artery stenosis and intra coronary clots. On the other hand there are important and essential differences in their management. Consequently, our physicians should know about its pathophysiology, diagnosis and treatment.
PMCID: PMC3214344  PMID: 22091255
Stress induced cardiomyopathy; Takotsubo cardiomyopathy; Broken heart syndrome; Apical ballooning syndrome; Ampulla cardiomyopathy
12.  Can doubling the maintenance dose of clopidogrel prevent from early stent thrombosis after the primary percutaneous coronary intervention? 
ARYA Atherosclerosis  2011;7(1):18-23.
Treatment of significant coronary artery disease with primary percutaneous coronary intervention (PCI) seems better than angioplasty balloon; because the incidence of restenosis is lower in this method, however, a serious complication of PCI is stent thrombosis which would lead to repeated myocardial infarction (MI) and increase the mortality and morbidity. One of the frequent medications which is used to prevent from stent thrombosis is clopidogrel, but, stent thrombosis was seen in many of the patients despite given the conventional dosage of this drug. This study aimed to evaluate the effect of doubling the maintenance dose of clopidogrel to prevent from early stent thrombosis, MI and mortality rate.
This was a clinical trial study which was done in Shahid Chamran Hospital in winter 2010 in Isfahan, Iran. A total of 400 patients with PCI were prospectively followed-up for 30 days. All the patients were randomly allocated into two groups. The control group received a maintenance dose of 75 mg clopidogrel while the case group received 150 mg clopidogrel after the initial dosage of 600 mg for 30 days after the PCI. The incidence of primary outcome such as total mortality was recorded during the study.
Early stent thrombosis was observed in 4 patients (1%) (One subject in the control group and 3 in the case group) during the first 30 days after PCI, but the difference was not significant between the two groups (P=0.62). Mortality due to stent thrombosis occurred in 2 patients in the case group which showed no significant difference in this group (P=0.5). In addition, MI occurred in 2 patients (1 in each group) which also showed no significant difference between the two groups (P=1). Drug complication such as major bleeding had no significant difference between the two groups (P=0.9).
The present study showed that doubling dose of clopidogrel could not reduce the incidence of early stent thrombosis, mortality and myocardial infarction in comparison with conventional dosage; therefore it is recommended that more studies be done in Iranian and Asian race for clinical decision-making to prevent form stent thrombosis using high dose of clopidogrel.
PMCID: PMC3347836  PMID: 22577440
Primary Coronary Intervention; Early Stent Thrombosis; Clopidogrel; Coronary Stenting
13.  Assessment of Clopidogrel on the Left Ventricular Ejection Fraction in Acute Myocardial Infarction 
Left ventricular (LV) dysfunction heart failure is one of the causes of morbidity and mortality following ST elevation myocardial infarction (STEMI). This study was done to determine the clopidogrel effect in preventing reduced LV function in patients with STEMI.
In this study, 144 patients with STEMI admitted to the Isfahan University of Medical Sciences hospitals were followed in two groups for one month. The case group received Clopidogrel, 300 mg, on admission and then, 75 mg daily, while the control group received routine therapy for STEMI without Clopidogrel. Left ventricular ejection fraction (LVEF) on the 4th day and one month after STEMI was measured by echocardiography. The results of LVEF were compared within and between groups.
The mean LVEF in the case group on the 4th day and one month after STEMI were 45.92 and 52.15%, respectively (P<0.001). The mean LVEF in the control group on 4th day and one month after STEMI were 44.72 and 42.71%, respectively.
We suggest that Clopidogrel is effective in prevention of LVEF reduction in patients with STEMI.
PMCID: PMC3075522  PMID: 21566782
Heart failure; Myocardial infarction; Prevention
14.  What Every Cardiologist Should Know about H1N1? 
ARYA Atherosclerosis  2010;6(3):118-121.
The world is witnessing ever fastest growing pandemic with high morbidity and mortality that excessive volume of airline travels spread influenza infection; so physicians with various specialties should know and consider the impact of current pandemic on their daily practice. Among influenza A viruses that infect humans, an influenza A virus emerged that had shifted to H1N1. Primarily, the results of pandemic of H1N1 were in younger humans without preexisting immunity. Attack rates of swine influenza are relatively high, but mortality is relatively low and mortality rate is highest in the very young, the very old, and the immunosuppressed. In this new pandemic, there is not more evidence of the interface of H1N1 with chronic diseases; however, we expect that the Swine flu such as the previous influenza pandemics can change the course of many chronic diseases.
In this review, we want to show the impacts of swine flu on cardiovascular system and disease. We will also discuss the importance of vaccination in chronic cardiovascular disease.
PMCID: PMC3347827  PMID: 22577427
H1N1 virus; Vaccination; Cardiovascular disease; Myocarditis
15.  Efficacy of Glucose-Insulin-Potassium Infusion on Left Ventricular Performance in Type II Diabetic Patients Undergoing Elective Coronary Artery Bypass Graft.Dy 
ARYA Atherosclerosis  2010;6(2):62-68.
Glucose-insulin-potassium (GIK) may improve cardiovascular performance after coronary artery bypass graft surgery (CABG). Our study investigated whether an infusion of GIK during elective CABG surgery in type II diabetic patient improved left ventricular performance.
We measured left ventricular ejection fraction and troponin (Tn), a myofibrillar structural protein. In this research, after ethics committee approval, 50 patients with type 2 diabetes mellitus (DM) were enrolled into a randomized simple sampling, prospective, double-blind clinical trial study. In the case group, 500 cc dextrose water 5% plus 80 IU regular insulin and 40 mEq KCL were infused at the rate of 30 cc/hr. Patients in control group received 5% dextrose solution at the rate of 30cc/hr. Venous blood samples were taken before induction of anesthesia, after removal of the aortic clamp and before discharging from hospital. The Mann-Whitney-test was used to test for differences in troponin concentration between the groups. Fisher's exact test was used to determine whether there was a difference in the proportion of patients with a low ejection fraction (<45%) in the case group compared with that in the control group. Changes in potassium and glucose concentrations over time within the groups were examined by ANOVA and paired t-tests. P < 0.05 was regarded as significant level for all tests.
In this study, 50 patients with type 2 DM were evaluated in case and control groups. The mean age ± SD in the case group was 57.7 ± 9.9 years and in the other group was 61.2 ± 8.4 years. The groups were well-matched for age, sex and number of bypass grafts. Randomization did not give an equal distribution of male and female patients. There wasn't any significant difference in ejection fraction between the case and control groups before and after CABG (P > 0.05). Troponin concentration in the case group was 3.3 ± 5.0 and in the control group was 3.9 ± 5.1. There was no significant difference in Tn between the two groups before and after CABG (P > 0.05). There was not any significant difference in hospitalization time between the two groups.
The results suggested that GIK can't improve left ventricular performance in routine CABG surgery.
PMCID: PMC3347817  PMID: 22577416
Cardiovascular surgery; Glucose-Insulin-Potassium; Cardiac troponin
16.  Evaluation of Leptin and Adiponectin Levels in Patients with Stable Angina Pectoris 
ARYA Atherosclerosis  2010;6(2):50-55.
Leptin and adiponectin are two adipose tissue hormones and their association with the incidence of cardiovascular diseases is under evaluation. The aim of this study was to determine the relationship of leptin and adiponectin with coronary artery diseases.
One hundred and seventy patients with angina pectoris and indications of coronary angiography underwent angiography. Serum levels of blood lipids, leptin, and adiponectin were measured. The gathered data was evaluated using SPSS15 software, by multivariate variance analysis.
Analysis of the data demonstrated that 45.1% of the patients had positive angiographic findings. The serum levels of leptin and adiponectin were significantly lower than the minimum levels specified by the kit. However, the two groups, i.e., patients with positive angiographic findings and those with negative findings were not significantly different according to the serum levels of the hormones. Moreover, no significant correlation between the serum levels of the hormones and serum lipids was observed.
Various studies have demonstrated that high serum level of leptin and the incidence of coronary artery diseases are correlated. On the other hand, they have reported that adiponectin has cardioprotective role. Confirmation of these findings requires more detailed studies.
PMCID: PMC3347818  PMID: 22577414
Leptin; Adiponectin; Coronary artery disease
17.  Can Timi Risk Score Predict Angiographic Involvement in Patients with St-Elevation Myocardial Infarction? 
ARYA Atherosclerosis  2010;6(2):69-73.
In most studies, the agreeable risk scores for ST-elevation myocardial infarction (STEMI) consist of thrombolytic in myocardial infarction (TIMI) risk score and modified Gensini risk score. Researchers showed significant relations between TIMI with angiography scores in patients with UA/NSTEMI. We studied this relation in patients with STEMI.
We studied CCU patients with STEMI hospitalized in several hospitals of Isfahan, Iran from September 2007 to June 2008. Sampling method of 240 patients was random and simple. Exclusion criteria were incomplete history, nonspecific electrocardiogram changes, left bundle branch block and not accomplished angiography or accomplished angiography after 2 months of STEMI. Questionnaire indices collected on the basis of TIMI (0–14 points). Echocardiography and angiography were done and then, we used Gensini (0–400 points) to review films of angiography. Spearman‘s rank test and Pearson correlation coefficient were used to study the relation between these scores.
One hundred and sixty one patients were male and their average age was 60.02 years. Averages of TIMI and Gensini scores were 6.30±2.5 and 120.77±50.4, respectively. Study showed significant relation between TIMI, age and LVEF (P<0.001, r=−0.46). Also, between Gensini and age, gender and LVEF significant relation was found (P<0.001). But, a meaningful correlation didn't exist between TIMI and the gender (P=0.08). Our study proved direct relation between TIMI risk scores and modified Gensini scores (P<0.001, r=0.55).
We may decide quickly and correctly in emergency room to distinguish which patients with STEMI could derive a benefit from invasive strategies using TIMI score. Also, TIMI risk score can be a good predictor to determine the extension of coronary artery disease in patients with STEMI. As a result, we suggest determination of TIMI score for any patient entered emergency room. Also, this score should be recorded at the time patient's discharge.
PMCID: PMC3347819  PMID: 22577417
TIMI Risk Score; Modified Gensini Risk Score; LVEF; STEMI

Results 1-17 (17)