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1.  A Case of Noncompaction at All Segments of Both Right and Left Ventricles 
Case Reports in Cardiology  2014;2014:325257.
Background. Noncompaction/hypertrabeculation left ventricle (NCM/HVM) is most commonly reported in one or more segments of left ventricle and sometimes both ventricles. In this case, we present noncompaction of all segments of right and left ventricle, in a young man with mental retardation. Case Presentation. A 19-year-old male was referred to us with sudden dyspnea at rest and chest discomfort. He was a known case of mental retardation. He was born full term with birth weight = 1250 grams. On physical examination. A systolic murmur (II/VI) at left sternal border was heard. ECG showed increased voltage in precordial lead and deep ST segment depression. Chest X-ray (CXR) was within normal limits. Transthoracic echocardiography showed situs solitus, D loop, normal connection of great vessels, noncompaction LV at all segments (noncompaction/compaction = 2.5/0.5) with moderate systolic dysfunction (LVEF = 40%), diastolic dysfunction grade II, normal RV size with mild systolic dysfunction and hypertrabeculation, mild tricuspid regurgitation (TR), and normal pulmonary artery systolic pressure. After injection of agitated saline some bubbles were passed from right to left through patent foramen oval (PFO). Conclusions. Extensive sinusoid formation and trabeculation of RV and nearby all LV segments and its association with mental retardation suggest presence of strong genetic background.
PMCID: PMC4265543  PMID: 25525524
2.  Women health heart project: Methodology and effect of interventional strategies on low education participants 
Cardiovascular diseases (CVD) are the most common cause of mortality and morbidity in women. Intervention programs aimed at improving the lifestyle can reduce the incidence of these diseases and their factors. The purpose of this study was to evaluate the difference of the interventions impact on CVD risk factors and the women's physical and biochemical indicators based on education levels.
Materials and Methods:
As part of Isfahan Healthy Heart Program after identifying the status of women over the age of 18 and over five years, a large educational or environmental intervention was performed in different methodologies and in order to improve the lifestyle. Some organizations such as health care centers and the Literacy Campaign Organization have cooperated for low educated women. Demographic data and risk factors such as obesity, hypertension, diabetes and serum lipids were investigated and compared during the first and last phase. Data were entered in SPSS-15 software and were analyzed by using T-test in two independent samples, Chi-square test and Fisher exact test.
Findings of this study showed that performing the five years interventions could reduce physical and biochemical indexes such as nutrition, lipid profile, waist circumference and waist-to-hip ratio in both groups (P < 0.005). In the pre-intervention phase, 6391 subjects and after the intervention 4786 women participated. After Interventions, women with higher educational levels were showed significant decrease in Body Mass Index (BMI) (P = 0.01) and dyslipidemia (P = 0.02).
The present study showed that the community-based interventions even in low-literate women could cause effective changes on improving lifestyle and CVD risk factors. Due to the greater impact of interventions in literate women, effective interventions should be considered in the society to decrease the prevalence of Non-Communicable Diseases (NCDs).
PMCID: PMC4165102  PMID: 25250369
Education level; lifestyle modification; literacy movement; risk factors; women
3.  Beneficial Effects of Testosterone Therapy on Functional Capacity, Cardiovascular Parameters, and Quality of Life in Patients with Congestive Heart Failure 
BioMed Research International  2014;2014:392432.
Background. According to the present evidences suggesting association between low testosterone level and prediction of reduced exercise capacity as well as poor clinical outcome in patients with heart failure, we sought to determine if testosterone therapy improves clinical and cardiovascular conditions as well as quality of life status in patients with stable chronic heart failure. Methods. A total of 50 male patients who suffered from congestive heart failure were recruited in a double-blind, placebo-controlled trial and randomized to receive an intramuscular (gluteal) long-acting androgen injection (1 mL of testosterone enanthate 250 mg/mL) once every four weeks for 12 weeks or receive intramuscular injections of saline (1 mL of 0.9% wt/vol NaCl) with the same protocol. Results. The changes in body weight, hemodynamic parameters, and left ventricular dimensional echocardiographic indices were all comparable between the two groups. Regarding changes in diastolic functional state and using Tei index, this parameter was significantly improved. Unlike the group received placebo, those who received testosterone had a significant increasing trend in 6-walk mean distance (6MWD) parameter within the study period (P = 0.019). The discrepancy in the trends of changes in 6MWD between study groups remained significant after adjusting baseline variables (mean square = 243.262, F index = 4.402, and P = 0.045). Conclusion. Our study strengthens insights into the beneficial role of testosterone in improvement of functional capacity and quality of life in heart failure patients.
PMCID: PMC4109421  PMID: 25110677
4.  Are obese adolescents more depressed? 
Obesity is a growing problem in all countries which leads to various physical, psychological, and social problems. The present study aimed to assess depression in children and adolescents aged 10-18-year old compared with the control group.
Materials and Methods:
In a case-control study, from among the 10- to 18-year-old students of the five education districts of Isfahan, 100 people (50 girls and 50 boys) were selected as obese children with the Body Mass Index (BMI) of greater than 95th percentile for their age and gender and 100 others (50 girls and 50 boys) as the control group with the BMI of 5th to 85th percentile. The case and control groups were matched for age, gender, and socio-economic status. After calculating BMI based on weight (kg)/height2 (meter), subjects were interviewed based on DSM IV criteria to diagnose clinical depression. The severity of children's depression was measured using standardized questionnaire.
The mean age of the case group was 12.2 ± 1.86-years old and that of the control group 13.06 ± 2.25. They were, respectively, diagnosed with depression of 7% and 6%. The mean depression score of the case group was 11.7 ± 5.3 and that of the control group was 10.6 ± 6.03 with no statistical significance.
Given our findings, the Jolly fat hypothesis applies to the case group. It seems that health policy-makers need to make intervention plans to change behavior; attitude, skill, and knowledge (BASK) of the public toward obesity and its long-term side-effects.
PMCID: PMC4113990  PMID: 25077167
Adolescent; depression; obesity
5.  Prediction of short-term clinical outcome of percutaneous coronary intervention in patients with acute coronary syndrome through myeloperoxidase levels 
ARYA Atherosclerosis  2014;10(2):100-106.
The present study assessed the significance of troponin and myeloperoxidase levels in the prediction of major adverse cardiac events (MACE) during the 1st month after percutaneous coronary intervention (PCI).
This prospective, longitudinal study included 100 patients with acute coronary syndrome who underwent PCI. The participants’ characteristics were recorded in a questionnaire. Blood samples were obtained before and 24 h after PCI, and troponin, and myeloperoxidase levels were measured. During the 1st month after PCI, death, myocardial reinfarction, and revascularization during admission were investigated through weekly phone calls. The value of troponin and myeloperoxidase levels before and after PCI in predicting MACE was evaluated using Cox regression.
Considering the obtained methods and the short duration of the study, 99% of the patients completed the study. Moreover, one death and four cases of myocardial infarction and revascularization were reported. Cox regression did not show significant relations between the incidence of MACE and myeloperoxidase levels before (hazard ratio = 1.12; 95% confidence interval 0.9, 1.39) and after PCI (hazard ratio = 0.86; 95% confidence interval = 0.43, 1.71), or troponin levels before (hazard ratio = 0.97; 95% confidence interval = 0.81, 1.17) and after PCI (hazard ratio = 1.03; 95% confidence interval = 0.96, 1.11).
It seems that the few cases of MACE, due to the small sample size and short duration of follow-up, had been insufficient for determining the predictive value of troponin and myeloperoxidase levels before and after PCI. Therefore, further studies with larger sample size and longer follow-up duration are recommended.
PMCID: PMC4144374  PMID: 25161678
Percutaneous Coronary Intervention; Acute Coronary Syndrome; Major Adverse Cardiac Events; Myeloperoxidase
6.  The relation between body iron store and ferritin, and coronary artery disease 
ARYA Atherosclerosis  2014;10(1):32-36.
Iron is essential for many physiological processes; whereas, iron overload has been known as a risk factor in progression of atherosclerosis. The aim of this study was to investigate the importance of serum ferritin levels, which are known as an indicator of body iron stored in the incidence of coronary artery disease (CAD).
In a case-control study, we evaluated 432 eligible men who underwent coronary angiography at Chamran Cardiology Hospital, Isfahan, Iran. They were separated into two groups of case (with CAD) and control (without CAD). All subjects had given written informed consents. Then, the blood samples were taken after 12-14 hours of fast by a biologist for measuring cardiovascular risk factors and body iron stores, including serum ferritin, serum iron, and total iron binding capacity (TIBC). For statistical analyses, chi-square test, Student’s t-test, one-way ANOVA, and the logistic regression were used.
In the present study, 212 participants with CAD in the case group and 220 participants free of CAD in the control group were included in the analysis. At baseline, there were significant differences in serum ferritin (P < 0.001) and other cardiovascular risk factors between the two groups. Moreover, when other risk factors of CVD were included in the model, serum ferritin [Odd Ratio (OR) = 1.006, 95% confidence interval of 95% (95% CI) 1.00-1.01, P = 0.045] and serum ferritin ≥ 200 (OR = 4.49, 95% CI 1.72-11.70, P < 0.001) were associated with CAD.
High iron store, as assessed by serum ferritin, was associated with the increased risk of CAD. Furthermore, it was a strong and independent risk factor in the incident of atherosclerosis in the Iranian male population.
PMCID: PMC4063519  PMID: 24963311
Iron; Ferritin; Coronary Artery Disease; Coronary Angiography
7.  Heart rate recovery in exercise test in diabetic patients with and without microalbuminuria 
ARYA Atherosclerosis  2013;9(3):167-171.
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.
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.
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).
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
8.  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.
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.
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.
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.
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
9.  The incidence of in-hospital atrial fibrillation after coronary artery bypass grafting using ventricular and atrial pacing 
ARYA Atherosclerosis  2013;9(1):11-15.
Atrial fibrillation (AF) after coronary artery bypass graft (CABG) surgery is a common problem. In this study, we sought to evaluate the safety and tolerance of continuous atrial pacing after CABG. We hypothesized that a strategy of temporary atrial pacing after CABG would reduce the incidence of postoperative AF.
During 2012, CABG candidates over 18 years of age at Sina Hospital (Isfahan, Iran) were recruited. Before surgery, the participants were randomly assigned to two groups of ventricular pacing and left atrial ventricular pacing (atrial pacing). The primary end point of the study was the initial occurrence of AF or atrial flutter with a ventricular rate greater than 100 beats per minute for 10 consecutive minutes or completion of the 48-hour monitoring period.
We evaluated 64 consecutive CABG candidates with sinus rhythm. They were allocated to two groups of ventricular pacing and atrial ventricular pacing (n = 32 in each group). Three patients in the ventricular pacing group (10%) and six in the atrial ventricular pacing group (22%) had sustained AF during the first 48 hours after CABG (P = 0.18 according to Fisher’s exact test).
Continuous atrial pacing in the postoperative setting is safe and well-tolerated. In this study, we found that temporary atrial pacing increased the frequency of postoperative AF. Since the difference between the two groups was not significant, larger studies are required to determine the exact relation between pacing method and AF.
PMCID: PMC3653269  PMID: 23696754
Atrial Fibrillation; Coronary Artery Bypass Graft; Atrial Pacing
10.  Association of serum potassium level with ventricular tachycardia after acute myocardial infarction 
ARYA Atherosclerosis  2012;8(2):79-81.
One of the causes of mortality in acute myocardial infarction (AMI) is ventricular tachycardia. Abnormal serum Potassium (K) level is one of the probable causes of ventricular tachycardia in patients with AMI. This study carried out to determine the relationship between serum potassium level and frequency of ventricular tachycardia in early stages of AMI.
Ina cross-sectional study on 162 patients with AMI in the coronary care unit (CCU) of Nour Hospital (Isfahan, Iran), the patients' serum potassium level was classified into three groups: 1) K<3.8 mEq/l, 2) 3.8≤K<4.5 mEq/l and 3) K≥4.5 mEq/l. The incidence of ventricular tachycardia in the first 24 hours after AMI was determined in each group by chi-square statistical method.
The frequency of ventricular tachycardia in the first 24 hours after AMI in K< 3.8 mEq/l, 3.8≤K<4.5 mEq/l and K≥4.5 mEq/l groups were 19.0%, 9.6% and 9.9% respectively. The high frequency of this arrhythmia in the first group as compared with the second and the third group was statistically significant.
Hypokalemia increased the probability of ventricular tachycardia in patients with AMI. Thus, the follow up and treatment of hypokalemia in these patients is of special importance.
PMCID: PMC3463994  PMID: 23056108
Acute Myocardial Infarction; Ventricular Tachycardia; Hypokalemia; SerumPotassium Level

Results 1-10 (10)