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author:("sanes, Hamid")
1.  Short term high dose atorvastatin for the prevention of contrast-induced nephropathy in patients undergoing computed tomography angiography 
ARYA Atherosclerosis  2014;10(5):252-258.
Statins are shown effective by some studies in preventing contrast-induced nephropathy (CIN). We evaluated the effectiveness of atorvastatin in the prevention of CIN in computed tomography angiography (CTA) candidates.
This study was conducted on patients referring for elective CTA with normal renal function. Patients received atorvastatin (80 mg/day) or placebo from 24 h before to 48 h after administration of the contrast material. Serum creatinine was measured before and 48 h after contrast material injection. CIN was defined as an increase in serum creatinine level of ≥ 0.5 mg/dl or ≥ 25% of the baseline creatinine.
A total of 236 patients completed the study; 115 atorvastatin, 121 placebo, mean age = 58.40 ± 9.80 year, 68.6% male. Serum creatinine increased after contrast material injection in both the atorvastatin (1.00 ± 0.16-1.02 ± 0.15 mg/dl, P = 0.017) and placebo groups (1.03 ± 0.17-1.08 ± 0.18 mg/dl, P < 0.001). Controlling for age, gender, comorbidities, drug history, and baseline serum creatinine level, patients who received atorvastatin experienced less increase in serum creatinine after contrast material injection (beta = 0.127, P = 0.034). However, there was no difference between the atorvastatin and placebo groups in the incidence of CIN (4.3 vs. 5.0%, P = 0.535).
In patients undergoing CTA, a short-term treatment with high dose atorvastatin is effective in preventing contrast-induced renal dysfunction, in terms of less increase in serum creatinine level after contrast material injection. Further trials including larger sample of patients and longer follow-ups are warranted.
PMCID: PMC4251479  PMID: 25477982
Kidney Diseases; Multidetector Computed Tomography; Contrast Media; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Atorvastatin
2.  The Effects of Beta-Glucan Rich Oat Bread on Serum Nitric Oxide and Vascular Endothelial Function in Patients with Hypercholesterolemia 
BioMed Research International  2014;2014:481904.
Introduction. Oats are high in soluble fibers and effective in reducing the risk of cardiovascular diseases (CVD). We assessed the effects of beta-glucan from oat bran on serum nitric oxide (NO) endothelial function in patients with hypercholesterolemia. Method. Sixty hypercholesterolemic patients were randomly divided to receive an experimental bread rich in beta-glucan from oat bran (intervention) or bread rich in wheat fiber (control) for four weeks. All subjects had the same diet for two-week baseline period and hypocaloric diet for four weeks of intervention. Serum NO concentration and flow-mediated dilation (FMD) were determined before and after the experiment. Results. Mean age of the participants was 51.1 ± 9.3 years and 65% (n = 39) were female. After intervention, serum NO concentration increased by 50.2 ± 19.8 μmol/lit in the intervention group (P = 0.017), but no change was observed in the control group (17.5 ± 27.5 μmol/lit; P = 0.530). No change of FMD was observed in the intervention (0.48 ± 0.78%; P = 0.546) or in the control group (0.59 ± 0.92%; P = 0.533). Conclusion. Consumption of oat bread for four weeks increases serum NO concentration but has no effect on FMD. Further studies are warranted in this regard.
PMCID: PMC4082950  PMID: 25025057
3.  The relation between occupational exposure to lead and blood pressure among employed normotensive men 
Lead is a pollutant with numerous adverse effects on health. Since it can affect blood pressure, peripheral blood vessels, and the heart, the present study aimed to evaluate the relation between occupational exposure to lead and blood pressure.
Materials and Methods:
This cross-sectional study included male individuals working in battery firms in Isfahan. A questionnaire covering demographic characteristics and the history of different diseases and occupational exposure to lead was completed. Each participant's blood pressure was also measured and recorded. After obtaining blood samples and determining lead levels, mean and frequency analyses were performed. In addition, Pearson's correlation test and linear regression were used to assess the relation between blood lead levels (BLLs) and systolic and diastolic blood pressure. All analyses were performed in SPSS.19
The mean age of the 182 studied workers was 42.85 ± 13.65 years. They had worked in battery firms for a mean period of 23.67 ± 14.72 years. Moreover, the mean value of BLLs among the participants was 7.92 ± 3.44 μg/dL. Correlation between BLL and systolic and diastolic blood pressure was not significant. The effects of lead on systolic and diastolic blood pressure after stepwise regression were B = –0.327 [confidence interval (CI) 95%: –0.877 to 0.223] and B = –0.094 (CI 95%: –0.495 to 0.307), respectively.
This study revealed that BLLs in battery firm workers to be normal. Additionally, BLLs were not significantly related with either systolic or diastolic blood pressure which might have been the result of normal BLLs.
PMCID: PMC4155701  PMID: 25197288
Hypertension; lead; occupational exposure
4.  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
5.  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
6.  Association of apolipoprotein B, apolipoprotein A, and the its ratio with body fat distribution 
To evaluate the association of apolipoprotein B (apoB), apolipoprotein A (apoA), and apoB/apoA ratio with the body fat indicators in patients with stable angina pectoris (SA).
Materials and Methods:
One hundred and twenty two participants aged 40-60 years old, with a mean age of 52.1 ± 7.2 years and SA, were recruited for the present study. Body weight, height, and waist circumference (WC) were measured, and waist to height ratio (WHtR) was calculated. After 12 hours of fasting, a blood sample was obtained and serum levels of apoB and apoA were measured and the apoB/apoA ratio was calculated. These patients underwent an abdominal computerized tomography scan (CTS) to assess visceral and subcutaneous adipose tissue (VAT, SAT). Linear regressions were computed to assess the relation of apoB, apoA, and their ratio with various measurements of adiposity (VAT, SAT, WC, and WHtR), with adjustment for age, sex, and BMI ≥ 25, WC ≥ 80 in women and WC ≥ 90 in men and WHtR ≥ 0.59.
From totally 123 patients with SA with a mean age of 52.1 ± 7.2 years, 44.7% male and 55.3% women were entered. Significant positive associations were found between visceral fat area and the apoB/apoA ratio (P = 0.02, β = 0.2), and significant negative correlations were observed between visceral fat area and apoA concentrations (P = 0.04, β = −0.2).
As abdominal fat accumulation is associated with other risk factors such as apolipoproteins in ischemic patients, then we most focus on control of these factors.
PMCID: PMC3793379  PMID: 24124431
Apolipoprotein A; apolipoprotein B; apolipoprotein B/apolipoprotein A; cardiovascular disease; intra-abdominal fat
7.  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.
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.
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.
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.
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)
8.  Relationship between left ventricular ejection fraction and depression following myocardial infarction: an original article 
ARYA Atherosclerosis  2013;9(1):16-21.
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).
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.
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.
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)
9.  Effects of streptokinase on reflow in rescue percutaneous coronary intervention 
ARYA Atherosclerosis  2013;9(1):22-28.
Primary percutaneous coronary intervention (PPCI) is the preferred treatment method for ST elevation myocardial infarction (STEMI). However, the required equipments are not available in all hospitals. Thus, due to shortage of time, some patients receive thrombolysis therapy first. Patients with chest pain and/or persistent ST segment elevation will then undergo rescue percutaneous coronary intervention (PCI). The present study evaluated and compared the frequency of no-reflow phenomenon and 24-hour complications after PCI among patients who underwent PPCI or rescue PCI.
This cross-sectional study assessed no-reflow phenomenon, 24-hour complications, and thrombolysis in myocardial infarction (TIMI) flow in patients admitted to Chamran Hospital (Isfahan, Iran) with a diagnosis of STEMI during March-September, 2011. Subjects underwent PPCI if they had received eptifibatide. Rescue PCI was performed if patients had chest pain and/or persistent ST segment elevation despite receiving streptokinase (SK). Demographic characteristics, history of diseases, medicine, angiography findings, PCI type, and complications during the first 24 hours following PCI were collected. Data was then analyzed by Student’s t-test, chi-square test, and logistic regression analysis.
A total number of 143 individuals, including 67 PPCI cases (46.9%) and 76 cases of rescue PCI (53.1%), were evaluated. The mean age of the participants was 58.92 ± 11.16 years old. Females constituted 18.2% (n = 26) of the whole population. No-reflow phenomenon was observed in 51 subjects (37.1%). Although 9 patients (6.3%) died during the first 24 hours after PCI, neither the crude nor the model adjusted for age and gender revealed significant relations between rescue PCI and death or no-reflow phenomenon. Rescue PCI and no-reflow phenomenon were not significantly correlated even after adjustments for age, gender, history of diabetes, hypertension, hyperlipidemia, coronary artery disease, smoking, platelets number, myocardial infarction level, the extent of stenosis, and the involved artery.
According to the present study, although SK is more effective than eptifibatide in resolution of thrombosis and clots, rescue PCI did not differ from PPCI in terms of the incidence of no-reflow phenomenon or short-term complications.
PMCID: PMC3653257  PMID: 23696756
Primary Percutaneous Coronary Intervention; Rescue Percutaneous Coronary Intervention; No-Reflow Phenomenon
10.  Effects of occupational exposure to lead on left ventricular echocardio graphic variables 
ARYA Atherosclerosis  2012;8(3):130-135.
Lead contamination can affect many body organs including the heart. This study assessed a number of echocardiographic indices to clarify the effects of lead on cardiac function among battery factory workers who are in constant exposure to lead.
In a cross-sectional study, 142 male battery factory workers who had been exposed to lead for at least 1 year were evaluated. The subjects aged 25-55 years old and were excluded if they had hypertension, diabetes, or cardiovascular diseases. Demographic characteristics, professional profile, lead exposure, history of respiratory diseases, drugs intake, and lifestyle information of the participants were collected. Height, weight and blood pressure measurements were then performed. Blood tests were also ordered to determine blood lead levels. The subjects finally underwent M-mode and Doppler echocardiography. Linear regression analysis was used to establish the effects of lead on the target indices. All statistical analyses were conducted in SPSS18.
The mean age and mean duration of lead exposure of the subjects were 41.78 ± 13.58 and 23.54 ± 14.44 years, respectively. The mean blood lead level was 7.59 ± 2.75 µg/dl. Left ventricular hypertrophy was detected in 12% of the participants. Blood lead levels were not significantly related with echocardiographic indices in the crude model or after adjustments for age alone or for age and other risk factors.
Blood lead levels of our participants were below standard values. In addition, no significant relation was found between left ventricular function indices and blood lead levels. The absence of such relations could have been caused by the exclusion of individuals with hypertension or cardiovascular diseases. Structural modifications in battery factories following legislations in Iran might have been responsible for low blood lead levels among the subjects.
PMCID: PMC3557007  PMID: 23358898
Occupational Exposure; Lead; Left Ventricular Echocardiography
11.  Gas transfer and pulmonary function tests in women with disseminated lupus erythematosus 
ARYA Atherosclerosis  2012;8(2):76-78.
Systemic lupus involves different body organs including lungs. However, there is limited information on the systemic lupus without respiratory symptoms. The aim of this study was to investigate the diffusing capacity of the lung for carbon monoxide in women with disseminated lupus erythematosus and to compare it with a control group.
This prospective study was conducted during 2005 in the Rheumatology Clinic of Alzahra Hospital, Isfahan, Iran. The diffusing capacity of the lung for carbon monoxide and pulmonary parameters were measured using the unrelated samples in 76 female patients with systemic lupus.
Mean diffusing capacity of the lung for carbon monoxide in patients with lupus was lower than the control group (P ≤ 0.001). The amount of corrected volumetric capacity of carbon monoxide in lungs of patients was significantly different from the control group (P ≤ 0.001). Residual volume and total capacity of lungs in the female patients with lupus were higher than the control group (P ≤ 0.001).
Decreased diffusing capacity for carbon monoxide in lungs of females with systemic lupus without respiratory symptoms is prevalent. It indicates alveolar capillary membrane involvement in these patients. Increased residual volume and total capacity of lungs in these patients can be caused by bronchiolitis.
PMCID: PMC3463991  PMID: 23056107
Lupus Erythematosus; Transfer Capacity; Carbon Monoxide in Lungs; Total Capacity of Lungs
12.  Evaluation of heart rate reserve and high-sensitivity C-reactive protein in individuals with and without metabolic syndrome in Isfahan, Iran 
ARYA Atherosclerosis  2012;8(2):70-75.
Lack of heart rate increase proportionate to exercise causes poor prognosis. Moreover, inflammatory factors such as C-reactive protein (CRP) are associated with atherosclerosis. The current study compared these two indices in individuals with and without metabolic syndrome in Isfahan, Iran.
This study was performed on 203 people without and 123 patients with metabolic syndrome who were randomly selected from the participants of the Isfahan Cohort Study. The demographic data, waist circumference, blood pressure, height, and weight of the participants were recorded. Moreover, serum tr`viglyceride (TG), fasting blood sugar (FBS), total cholesterol, high density lipoprotein (HDL), low density lipoprotein (LDL), and high-sensitivity CRP (hs-CRP) levels were measured. Exercise test was carried out according to the Bruce standard protocol and heart rate reserve (HRR) was determined and recorded. The age-adjusted data was analyzed using generalized linear regression and student's t-test in SPSS15.
The mean ages of participants without and with metabolic syndrome were 54.16 ± 8.61 and 54.29 ± 7.6 years, respectively. The corresponding values for mean LDL levels were 116.17 ± 24.04 and 120.12 ± 29.55 mg/dl. TG levels were 140.38 ± 61.65 and 259.99 ± 184.49 mg/dl for subjects without and with the metabolic syndrome, respectively. The mean FBS levels were 81.81 ± 9.90 mg/dl in the participants without the syndrome and 107.13 ± 48.46 mg/dl in those with metabolic syndrome. The mean systolic blood pressure was 116.06 ± 13.69 mmHg in persons without metabolic syndrome and 130.73 ± 15.15 mmHg in patients with the syndrome. The values for mean diastolic levels in the two groups were 76.52 ± 6.69 and 82.84 ± 8.7 mmHg, respectively. While the two groups were not significantly different in terms of HRR (P = 0.27), hs-CRP levels in the metabolic syndrome group was significantly higher than the other group (P = 0.02).
We failed to establish a relationship between HRR and the metabolic syndrome. However, the observed relationship between metabolic syndrome and hs-CRP level, which is an inflammatory factor, indicates elevated levels of hs-CRP in patients with metabolic syndrome.
PMCID: PMC3463992  PMID: 23056106
Metabolic Syndrome; Exercise Test; Heart Rate Reserve; High-Sensitivity C-Reactive Protein
13.  Type D personality is associated with hyperlipidemia in patients with myocardial infarction 
There are many studies indicating the role of psychological factors in the pathogenesis of cardiovascular disorders. Type D as a new personality construct has been proposed by Denollet, characterized by the joint global traits including negative affectivity and social inhibition. The purpose of this study was to examine the link between type D personality and hyperlipidemia in patients with myocardial infarction (MI).
Materials and Methods:
One hundred and seventy-six consecutive patients admitted to the cardiac care unit (CCU) wards of nine hospitals in Isfahan, Iran, following MI, were selected based on the inclusive and exclusive criteria. The patients completed demographic questionnaire and Type D Personality Scale (DS14). Their medical data were obtained from medical records. Chi-squared test, Student's t-test, and multivariate logistic regression were used to analyze the data.
Of the 176 subjects, 63 patients (35.8%) were type D. In univariate analysis, hyperlipidemia was the only significant variable (56% vs. 40%, P = 0.041) found to be associated with type D. Also, by multivariable logistic regression analysis, hyperlipidemia [Odds Ratio (OR) 0.374; 95% confidence interval (CI) 0.175–0.796] was the only independently significant variable found to be linked with type D personality. No other statistically significant differences were found between the two groups on demographic and medical factors characteristics.
The type D personality was associated with hyperlipidemia. Thus, personality factors may make people vulnerable to metabolic syndromes.
PMCID: PMC3634292  PMID: 23626631
Hyperlipidemia; negative affectivity; psychological factors; social inhibition; type D personality
14.  The effects of trinitroglycerin injection on early complications of angiography 
ARYA Atherosclerosis  2012;8(1):50-53.
Today, ischemic heart diseases (IHDs) are the most common diseases worldwide. Angiography is the best way to diagnose IHDs. Angiographic complications however can include death, myocardial infarction, nausea, spasm of the coronary arteries, chest pain, bradyarrhythmia, hypotension, or hypertension. This study aimed to determine the effects of a simultaneous injection of trinitroglycerin (TNG) with contrast agent on the early complications of angiography.
This clinical trial was conducted in Chamran Hospital, Isfahan, Iran in 2005. Before the angiography, the study population were randomly assigned into two groups of intervention (n = 111) and placebo (n = 112). TNG was mixed with contrast material in the intervention group and distilled water was mixed with contrast agent in the placebo group to be used for angiography. Nausea, spasm of the coronary arteries, chest pain, bradyarrhythmia and the mean systolic and diastolic blood pressures were compared during and after the angiography in patients of both groups. The obtained data was analyzed by chi-square and t tests.
The mean age in the intervention and placebo groups were 59.93 ± 9.14 and 59.37 ± 10.12 years, respectively (P > 0.05). The two groups were not significantly different in terms of gender distribution. The frequency of nausea was 4.5% and 6.2% in the intervention and placebo groups, respectively. The corresponding values were 0.9% and 5.4% for coronary artery spasm and 1.8% and 6.3% for chest pain. Bradyarrhythmia occurred in 7.1% of patients in both groups. There were no significant differences in the abovementioned complications. Mean values of the highest and lowest systolic and diastolic blood pressures of the intervention group were significantly different from the placebo group (P = 0.001). Simultaneous injection of TNG and the contrast agent in this study resulted in positive findings (except for changes in blood pressure).
More studies are recommended with different doses of TNG, different times of injection and considering at-risk individuals.
PMCID: PMC3448402  PMID: 23056102
Angiography; Early Complications; Trinitroglycerin
15.  Correlation Between Body Fat Distribution, Plasma Lipids and Apolipoproteins with the Severity of Coronary Involvement in Patients with Stable Angina 
ARYA Atherosclerosis  2011;6(4):140-143.
Previous studies reported that the distribution of body fat is an important risk factor for coronary artery diseases (CAD) and abdominal adipose tissue is associated with severe CAD. This study was conducted to evaluate the relationship between body fat distributions, plasma lipids and the severity of CAD in patients with stable angina.
Ninety seven patients who underwent coronary angiography for stable angina were allocated into two groups: patients with mild or sever coronary artery involvement. Lipid profile (total cholesterol, LDL, HDL) and triglyceride (TG) and apolipoprotein A and B, were measured for all of the participants and a demographic data questionnaire was filled by the subjects. Participants underwent abdominal computed tomography (CT-Scan) for measurement of adipose tissues that was classified to visceral and superficial and deep subcutaneous fat tissue compartment.
Patients with severe coronary artery involvement had higher level of apo B (P=0.02). Significant correlation was seen between visceral fat index and TG (P=0.01), HDL-C (P<0.01) in patients with mild coronary involvement and with total cholesterol (P=0.02), LDL-C (P=0.01) and apoB (P<0.01) in patients with severe coronary involvement.No significant relationship was seen among deep cutaneous fat index and lipid profile in both groups.
Our findings showed that visceral adipose tissue is significantly associated with severe CAD and has a significant correlation with lipid profile as well as Apo B.
PMCID: PMC3347832  PMID: 22577432
Visceral Abdominal Adipose Tissue; Superficial Subcutaneous Adipose Tissue; Deep Subcutaneous Adipose Tissue; Coronary Involvement; Lipid Profile.
16.  The relationship between type D personality and perceived social support in myocardial infarction patients 
Type D personality is based on two global and stable personality traits, including negative affectivity (NA) and social inhibition (SI). The aim of this study was to examine the relationship between type D personality and perceived social support in post myocardial infarction (MI) patients.
One hundred seventy six consecutive patients following MI admitted to the cardiac care unit (CCU) of nine hospitals in Isfahan, Iran from April to September 2006 were selected based on the inclusive and exclusive criteria. The patients completed the Persian version of type D personality scale and the Persian version of multidimensional scale of perceived social support (MSPSS). Also, demographic and medical questionnaire was completed for each patient. Chi-squared test, t-test and MANOVA were used to analyze the data.
The findings indicated that 35.8% patients (35.8 %) were classified as type D. The results of MANOVA showed that type D patients were significantly different from non-type D patients (F = 8.72, p = 0.0001) on MSPSS scores and on all dimensions including family subscale (F = 11.52, p = 0.001), friends subscale (F= 16.16, p = 0.0001) and significant others subscale (F = 5.04, p = 0.026).
Type D personality substantially affects the way MI patients perceive availability of social support from different sources including family, friends, and significant others. One implication of this finding may be to develop tailor-made interventions for MI patients with type D.
PMCID: PMC3214374  PMID: 22091285
Myocardial Infraction; Negative Affectivity; Social Inhibition; Type D Personality; Perceived Social Support
17.  Arrhythmia Detection based on Morphological and Time-frequency Features of T-wave in Electrocardiogram 
As the T-wave section in electrocardiogram (ECG) illustrates the repolarization phase of heart activity, the information which is accumulated in this section is so significant that it can explain the proper operation of electrical activities in heart. Long QT syndrome (LQT) and T-Wave Alternans (TWA) have imperceptible effects on time and amplitude of T-wave interval. Therefore, T-wave shapes of these diseases are similar to normal beats. Consequently, several T-wave features can be used to classify LQT and TWA diseases from normal ECGs. Totally, 22 features including 17 morphological and 5 wavelet features have been extracted from T-wave to show the ability of this section to recognize the normal and abnormal records. This recognition can be implemented by pre-processing, T-wave feature extraction and artificial neural network (ANN) classifier using Multi Layer Perceptron (MLP). The ECG signals obtained from 142 patients (40 normal, 47 LQT and 55 TWA) are processed and classified from MIT-BIH database. The specificity factor for normal, LQT, and TWA classifications are 99.89%, 99.90%, and 99.43%, respectively. T-wave features are one of the most important descriptors for LQT syndrome, Normal and TWA of ECG classification. The morphological features of T-wave have also more effect on the classification performance in LQT, TWA and normal samples compared with the wavelet features.
PMCID: PMC3342620  PMID: 22606664
ECG; feature extraction; morphology; neural network; T-wave; wavelet
18.  The effect of contrast dye injection and balloon inflation on QTC and QTC dispersion in 12 leads surface EKG during PTCA 
ARYA Atherosclerosis  2011;7(1):7-10.
Considering that determining the effect of both contrast dye injection and balloon inflation on electrophysiological parameters would help us to predict the ischemic event during PTCA, the aim of this study was to determine the effects of these factors on QTc and QTc dispersion during PTCA in Isfahan.
In this cross-sectional study, consecutive patients undergoing elective PTCA in Chamran hospital in Isfahan enrolled. All patients were in sinus rhythm. A 12-lead electrocardiogram was continuously recorded before (baseline) and during PTCA after dye injection and balloon inflation. QTc and QT dispersion was calculated in all 12 leads of electrocardiogram during the mentioned times and compared with each other.
33 patients with mean age of 49.1±16.2 years were studied. Anatomic distribution of the coronary artery stenosis was as follows: left anterior descending artery (LAD) in 76.7% patients, left circumflex (Cx) in 16.6% and right coronary (RCA) in 6.66%. Mean of QTc at baseline, after contrast dye injection and after balloon inflation was 423.9±28.5, 437±29 and 437±22 msec, respectively (P<0.05). Mean of QTc dispersion at baseline, after contrast dye injection and after balloon inflation was 92.3±7.2, 95.4±8.3 and 93.75±7.5, respectively (P>0.05).
The findings of this research supports the fact that during PTCA a transient myocardial ischemia occurs but further studies is recommended to accurately determine the stages at which ischemia occurred and the extent of its effect of it on cardiac depolarization and repolarization periods.
PMCID: PMC3347837  PMID: 22577438
PTCA; QTc; QTc Dispersion; Balloon Inflation; Contrast Dye Injection
19.  Estimation of left ventricular end diastolic pressure (lvedp) in patients with ischemic heart disease by echocardiography and compare it with the results of cardiac catheterization 
ARYA Atherosclerosis  2011;7(1):1-6.
Doppler echocardiography has been proposed as an appropriate non-invasive assay to estimate left ventricular end diastolic pressure (LVEDP). The aim of present research was to estimate the LVEDP in patients with ischemic heart disease by echocardiography and compare it with the results of cardiac catheterisation and to determine the effect of different echocardiographic variables on its measurement.
In this descriptive-analytic study, patients with diagnosed ischemic heart disease were selected by nonrandomized sampling method. Selected population underwent M-mode and pulse doppler echocardiographic evaluation and parameters such as Q-Mitral valve E (Q-MVE), Q-Aortic valve closure (Q-AVC), Aortic valve closure-E (AVC-E), Q-Mitral valve closure/Aortic valve closure-E (Q-MVC/AVC-E), left ventricle-deceleration time (LV-DT), peak velocity-deceleration time (PV-DT) and A/E velocity time integral (A/E VTI) were evaluated. Immediately after echocardiography all patients underwent left heart catheterization for LVEDP measurement. The relation between different echocardiographic measurements and LVEDP, obtained by cardiac catheterization, was evaluated.
In this study, 47 patients with ischemic heart disease with mean age (±SD) of 53±13 were studied. There was a significant correlation between LVDEP and A/E VTI (r=0.44, P=0.001, and also between LVEDP and PV-DT in patients with A/E VTI ≥1.1(r=−0.58, P=0.02). There was a significant correlation between LVEDP and Q-MVC/AVC-E in patients with LVEDP >18mmHg (r=0.76, P=0.03) and those with LVEDP ≤18 mmHg and A/E VTI <1.1 (r=0.37, P=0.03). The correlation between LVEDP and A/E VTI was more significant in men, in patients aged >50 years with EF >55%, without LVH, without MR and those with coronary artery disease (P<0.05).
Some echocardiographic indices such as A/E VTI, Q-MVC/AVC-E and PV-DT are able to measure LVEDP especially in male patients aged >50 years, without LVH, without MR and those with coronary artery disease but it is necessary to determine specific conditions and factors affecting these indices, by further studies.
PMCID: PMC3347838  PMID: 22577437
LVEDP; Coronary Artery Disease; Echocardiography
20.  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
21.  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

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