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1.  Comparison the Effect of One Session Submaximal Exercise on Plasma Levels of IL6 and TNF- a in Obese and Non-Obese Women 
ARYA Atherosclerosis  2011;6(4):153-156.
BACKGROUND
Cytokines are a group of low-molecular-weight regulatory proteins that produced by cells in response to stimulation. In fact, they increase in response to immune system during exercise. Also, many cytokines such as IL-6 and TNFα are secreted from adipose tissue in obese people. So the aim of this study was to investigate the effect of one session submaximal exercise on plasma levels of IL6 and TNFα in obese and non-obese women.
METHODS
Sixteen healthy women aged 20-30 years old participated in the study. Subjects were classified into obese (n=8) and nonobese (n=8) groups who performed submaximal exercise program (50-65% HRM) for 30minutes. Blood samples were taken for cytokines measurement, before and after exercise. Data were analyzed with SPSS15. The effect of exercise on mentiones variables was evaluated using t-test and covariance test.
RESULTS
Level of IL-6 increased significantly in two studied groups after 30 minutes submaximal exercise (P<0.05). Levels of TNFα increased significantly in obese subjects but not in non-obese subjects. There were no significant changes in the levels of IL-6 and TNFα after 30 minutes submaximal exercise between two studied groups (P>0.05).
CONCLUSION
After submaximal exercise, plasma level of IL6 and TNFα may increase and adipose tissue is the main source of circulating IL6 and TNFα.
PMCID: PMC3347828  PMID: 22577435
Submaximal Exercise; IL6; TNFα; Obese; Women
2.  Anomalous Origin of the Left Coronary Artery from the Right Sinus of Valsalva and Sever Mitral Stenosis 
ARYA Atherosclerosis  2011;6(4):149-152.
Congenital coronary anomalies are presented in approximately1% of patient referred for cardiac catheterization. Among the congenital coronary anomalies, a separated anomalous origin of all the coronary arteries from the right sinus of valsalva is very uncommon. We report a rare occurance of simultaneous occurence of mitral stenosis with ectopic origin of left main stem coronary artery from right sinus of Valsalva.
PMCID: PMC3347829  PMID: 22577434
Anomalous Origin of Coronary Arteries; Mitral Stenosis.
4.  Do Intervention Strategies of Women Healthy Heart Project (WHHP) Impact on Differently on Working and Housewives? 
ARYA Atherosclerosis  2011;6(4):129-135.
BACKGROUND
The purpose of this study is to evaluate the possible difference of the impact of Women Healthy Heart Project on lifestyle, as well as physical/biochemical parameters of working women and housewives.
METHODS
This was a community-based intervention study conducted over 5 years (2002-2007) in the counties of Isfahan and Najafabad (intervention areas) and Arak (control). Pre-study situation analysis of women was followed by 5 years of wide-ranging interventions (educational/environmental) conducted by various organizations using different methodologies. The interventions were aimed at modifying/improving lifestyle by increasing physical activity, encouraging healthy eating, and tobacco use cessation. The organizations involved in performing the interventions included the local radio and television authority, health/treatment centers, the Red Crescent Society, Municipalities, the Relief Committee, the Center for Retirees’ Welfare, and the Literacy Campaign Organization. After 5 years, final phase same as first phase was planed. The subjects studied in all phases‘ the pre- and post-intervention phases consisted of 10586 women aged above 18 years. Demographic data, obesity index, smoking, physical activity and eating habit were assessed before and after the study. Data were analyzed using SPSS-15 using Student's t-test, chi-square test, the general linear model of ANOVA, and logistic regression.
RESULTS
We studied 10586 women (6105 and 4481 women, pre- and post-intervention, respectively). Mean age of working women was 34.14±10.09 and 34.08±9.35 years before and after the study, respectively. Mean age of housewives before and after the study was 40.05±14.61 and 40.36±15.32 years, respectively. Interventions conducted during 5 years improved eating habits and decreased tobacco use in working women and housewives. In every phase of the study, there was a significant age difference between housewives and working women (P<0.001). Hence data were adjusted according to age in each phase. Overall physical activity of housewives and working women increased, but the percentage of passive smokers among housewives remained unchanged. Waist circumference and waist-to-hip ratio changed significantly in housewives following interventions (P<0.001). The parameter which improved significantly in working women was waist circumference (P<0.05). However, after adjusting for age, no significant difference was seen between working women and housewives following interventions.
CONCLUSION
Community-based interventions, especially those directed at housewives, can lead to significant improvements in lifestyle and cardiovascular risk reduction. It seems that working women require tailored interventions to suit their conditions. Although short-term outcomes may seem insignificant, persistence and continuity of lifestyle changes may lead to reduced prevalence of cardiovascular diseases. Then longer-term studies are warranted.
PMCID: PMC3347831  PMID: 22577430
Women; housewives; working; risk factors; lifestyle modification.
5.  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.
BACKGROUND
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.
METHODS
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.
RESULTS
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.
CONCLUSION
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.
6.  Stress Level and Smoking Status in Central Iran: Isfahan Healthy Heart Program 
ARYA Atherosclerosis  2011;6(4):144-148.
BACKGROUND
Individuals are faced with numerous stressful life events which can negatively influence mental health. Many individuals use smoking as a means of confronting stress. Given the relatively high prevalence of smoking in central Iran, the present study was conducted to compare stress levels in smokers, non-smokers and those who had quit smoking.
METHODS
This study was conducted as part of Isfahan Cardiovascular Research Program on 9752 individuals in the cities of Isfahan, Arak, and Najafabad in 2008. Sampling was performed using multi-stage cluster randomization method. Data on age, sex, demographic characteristics, and smoking status was collected through interviews. Stress level detected by General Health questionnaire.Logistic regression and chi- squere test was used for data analyzing.
RESULTS
In the present study, 30% of non-smokers, 32.1% ex- smoker and 36.9% of smokers had GHQ of 4 and higher (P=0.01). In regression analysis, the final model which was controlled for age, sex, socioeconomic statues (including place of residence, marital status and education level) showed that the odds ratio of stress in smokers and ex- smoker was significantly higher than in non-smokers (OR=1.66 and OR=1.12, respectively).
CONCLUSION
Since in conducted studies, mental problems and stresses have had an important role in people's smoking, it seems suitable to use the results of this study to present intervention for correct methods of coping with stress towards reducing the prevalence of smoking in the community.
PMCID: PMC3347833  PMID: 22577433
Cigarette; Stress; Community-based Program.
7.  Chlamydia Pneumoniae Infection and Cardiac Risk Factors in Patients with Myocardial Infection 
ARYA Atherosclerosis  2011;6(4):125-128.
BACKGROUND
Evidences support the possible involvement of microorganisms such as Chlamydia pneumonia in the pathogenesis of ischemic heart diseases through a chronic inflammatory process. The aim of this study was to determine the relation between Chlamydia pneumoniae seropositivity with acute myocardial infarction and its related risk factors.
METHODS
In this case-control study, 88 patients admitted in CCU with a diagnosis of acute coronary syndrome, without a history of chronic diseases including cancers were selected as cases and 49 surgical patients without an evidence of cardiovascular disease according to clinical examinations and ECG were selected as controls. Demographic characteristics and background risk factors were obtained using a questionnaire by expert nurses. Venous blood sample was obtained from participants for measuring the anti Chlamydia IgG and IgM antibodies using ELISA method. The prevalence of antibodies was compared in both groups and its relation with coronary syndrome was evaluated.
RESULTS
88 and 49 patients were enrolled in case and control groups, respectively. Mean age of patients and the controls was 14±59.7 and 13±56.9 years, respectively (P=0.26). Anti Chlamydia IgG seropositivity rate was 63(71.9%) and 23(46.9%) in case and controlcontrol groups, respectively (P<0.01; OR: 2.85; CI 95%: 1.38-5.9). Anti Chlamydia IgM was positive in 1 patient and 1 control. Anti Chlamydia IgG seropositivity rate was higher in patients older than 50 years old than those younger than 50 years old (OR: 2.83; CI 95%: 1.31 -1.14). There was a significant relation between BMI, smoking and Anti Chlamydia IgG seropositivity.
CONCLUSION
Considering the relation between anti Chlamydia antibody IgG seropositivity with BMI and myocardial infarction, it seems that appropriate diagnosis and treatment of these prone patients can be benefical.
PMCID: PMC3347834  PMID: 22577429
Acute myocardial infarction; Antibody; Chlamydia pneumoniae.
8.  Results of Surgical and Non-Surgical Treatment of Aneurysms in Iran 
ARYA Atherosclerosis  2011;6(4):136-139.
BACKGROUND
Direct surgery or endovascular procedures are an accepted way of treating patients with Aneurismal Subarachnoid Haemorrhage (SAH). However the impact of invasive methods of treatment on results in developing countries may differ from that in developed countries.
METHODS
This is a prospective clinical study of consecutive patients with Subarachnoid Haemorrhage (SAH) admitted in Ghaem hospital in Mashhad during 2005-2010. The initial diagnosis and investigations were carried out by neurologists. The patients were divided into two groups. One received surgical treatment whilst the other group was managed medically. The decision as to the choice of method of treatment was made by the neurosurgeons. The initial medical treatment was standardised for all the patients. The rate of complications and mortality was compared in both medical and surgical groups.
RESULTS
20 SAH patients (52% females) with a mean age of 50.6±7 years were evaluated. The angiography revealed the presence of an aneurysm in 62 patients. 63.5% of patients received medical treatment and 37.5% underwent aneurysmal surgery. Difference of rebleeding rate in two therapeutic groups was not significant; χ2=0.014, P=0.91. The effect of rebleeding on mortality was not significant; χ2=2.54, P=0.14. Within 62 SAH patients with cerebral aneurysm, the mortality rate in both therapeutic groups was also not significantly different; χ2=0.16, P=0.77.
CONCLUSION
There is no significant difference in the mortality rate between the “surgical” and non “surgical” groups of patients with SAH. This could be due to delay in performance of surgery in neurovascular centers in Iran.
PMCID: PMC3347835  PMID: 22577431
Mortality; Subarachnoid; Surgery; Haemorrhage.
9.  Hyperhomocysteinemia, Folateo and B12 Vitamin in Iranian Patients with Acute Ischemic Stroke 
ARYA Atherosclerosis  2011;7(3):97-101.
BACKGROUND
The objective of this study was to evaluate the association of some factors such as serum levels of homocysteine, folate and B12 vitamin with stroke in acute ischemic stroke patients.
METHODS
In this case control study, serum levels of homocysteine, folate and B12 vitamin in 93 patients with acute ischemic stroke admitted to Imam Khomeini Hospital between September 2008 and January 2010, and 93 healthy controls were measured. Cerebrovascular risk factors including age, sex, hypertension, hyperlipidemia, smoking, diabetes mellitus, alcohol consumption, coronary artery disease and obesity were recorded. The results were compared between the case and control groups.
RESULTS
The mean ± standard deviation (SD) of fasting total homocysteine (tHcy) level in acute ischemic stroke patients was 20.58 ± 19.6 µmol/l, which was significantly higher than that of control group being 14.11 ± 9.5 µmol/l (P = 0.002). 39 (41.9%) stroke cases and 25 (26.8%) controls had hyperhomocysteinemia. There were no significant relationships between tHcy, folate and B12 vitamin levels with the above mentioned cerebrovascular risk factors except for smoking (p> 0.05). No significant difference in B12 vitamin and folate levels between patients and healthy controls were detected (P> 0.05).
CONCLUSION
Hyperhomocysteinemia is common in Iranian patients with acute ischemic stroke and might play a role as an independent risk factor in stroke.
PMCID: PMC3347852  PMID: 22577454
Stroke; Homocysteine; B12 Vitamin; Folate
10.  Evaluating the Frequency of Postoperative Fever in Patients with Coronary Artery Bypass Surgey 
ARYA Atherosclerosis  2011;7(3):119-123.
BACKGROUND
Nowadays, coronary artery bypass graft (CABG) is a frequent surgery in treatment of coronary artery disease. According to high expense of this surgery and its important role in patients’ quality of life, high survival rate of patients and success of surgery are necessary. The aim of this study was the evaluation of fever incidence (febrile events) due to incidence of pneumonia, wound infection, bacteremia, urinary tract infection and inflammatory response without infection after CABG.
METHODS
In an intergrades descriptive-analytical study, 107 patients who underwent coronary artery bypass graft (CABG) were enrolled in the study. The patients then were examined by the febrile events and also their characteristics including age, sex, duration of surgery, underlying diseases, and frequency distribution of antibiotics consumptions in pre-surgical and postsurgical periods, and incidence of infectious syndromes.
RESULTS
Frequency distribution of febrile events after CABG was 29.9 percent. The most common administered antibiotic before the surgery was cephalothin (Keflin) and then, cefazolin. The most common administered antibiotic after the surgery was cephalothin (Keflin) and cephalexin (47.7%) and then, cephalothin-gentamicin-cephalexin (31.8%). The average age of patients without febrile syndrome was 60.53 years and in those with febrile syndrome was 59.31 years. In terms of gender, 74.8% of the patients were males. So that 32.5% of males and 22.2% of females had fever. The incidence time of fever in most cases was in the postoperative fourth day. In terms of underlying diseases, 13 percent of them had hypertension and hyperlipidemia, 14 percent had only hypertension, 11.2 percent had only hyperlipidemia and 6.5 percent had diabetes.
CONCLUSION
This study showed that the prevalence of fever in patients undergoing CABG was 29.9 percent and the most common cause of fever was sternal infections. There was a significant correlation between administered antibiotics in preoperative and postoperative periods and febrile syndrome.
PMCID: PMC3347853  PMID: 22577458
Antibiotic; Infection; Coronary Artery Bypass Graft; Fever
11.  Nifedipine, Captopril or Sublingual Nitroglycerin, Which can Reduce Blood Pressure the Most? 
ARYA Atherosclerosis  2011;7(3):102-105.
BACKGROUND
Hypertension (HTN) is one of the most important problems in all parts of the world. Although the disease is usually asymptomatic, its diagnosis and treatment are easy. The aim of this study was to compare the effect of Nifedipine (Adalat®), Captopril and sublingual Nitroglycerin on reducing blood pressure (BP).
METHODS
This study was a parallel group randomized controlled trial. From the patients referred to our heart clinic, 120 patients with severe HTN were enrolled in the study. The patients were randomly allocated into 3 groups A, B, and C. The patients were advised to use 5 drops of Adalat in group A, Captopril 25 mg sublingually in group B, and 1 sublingual Nitroglycerin pearl in group C. The BP was measured every 20 minutes during one hour.
RESULTS
Systolic BP was reduced significantly by Adalat and Captopril compared with sublingual Nitroglycerin in the 20th, 40th and 60th minutes (P = 0.001), but there was no significant difference between Adalat and captopril in reducing systolic BP. In addition, the result of reducing diastolic BP was not significantly different among the three groups.
CONCLUSION
We saw the same effect on reducing BP by Captopril, Adalat, and sublingual Nitroglycerin. Among these three drugs, the side effects of Captopril were the least frequent. Adalat caused headache and flushing. Thus, it seems Captopril can be used instead of Adalat in medical centers.
PMCID: PMC3347854  PMID: 22577455
Adalat; Captopril; Nitroglycerin; Severe Hypertension
12.  Acute and Chronic Effects of Morphine on Cardiovascular System and the Baroreflexes Sensitivity During Severe Increase in Blood Pressure in Rats 
ARYA Atherosclerosis  2011;7(3):111-117.
BACKGROUND
This study aimed to determine the role and effects of baroreflexes during acute increase in blood pressure (BP) after severe and long-term infusion of morphine.
METHODS
This experimental study was conducted on male desert rats. They were assigned into 4 groups and the rats of the case group received morphine in the short and long term periods, whereas the control rats received normal saline for the same duration. Then, the rats were anesthetized, and their femoral artery and vein were cannulated for the injection of phenylephrine and naloxone, respectively. The injection of phenylephrine was performed by the device after a period of recording BP, mean arterial pressure (MAP), heart rate (HR) and baroreflex sensitivity (BRS) in order to induce acute hypertension before and after injecting naloxone. The Student t-test and analysis of variance (ANOVA) were used for statistical analysis.
RESULTS
The obtained results suggested that acute and chronic injections of morphine may cause significant reduction in systolic and diastolic arterial BP as well as the mean arterial pressure; moreover, it significantly increased the sensitivity of baroreflexes. Furthermore, the increased baroreflex sensitivity was observed after acute injection of morphine, whereas chronic morphine injection caused reduction in baroreflex sensitivity.
CONCLUSION
It seems that the details of the opiates' effects on the body including cardiovascular system depend on the type of opioids and consequently, on the type of stimulated receptor.
PMCID: PMC3347855  PMID: 22577457
Morphine; Baroreflex Sensitivity; Blood Pressure
13.  Cytochrome P450 2C19 Polymorphism in Iranian Patients with Coronary Artery Disease 
ARYA Atherosclerosis  2011;7(3):106-110.
BACKGROUND
The polymorphisms of cytochrome P450 2C19 (CYP2C19) gene are major prognostic factors for the response to clopidogrel therapy in patients with coronary artery diseases (CAD). The CYP2C19*2 is the most important allele responsible for resistance to clopidogrel therapy. This study examined CYP2C19 gene polymorphism (CYP2C19*1 and *2) in Iranian patients.
METHODS
This cross-sectional study was performed on 43 Iranian patients with CAD who underwent percutaneous coronary intervention (PCI) and received drug-eluted stents (DES). CYP2C19 polymorphisms were assessed using real time PCR and frequency of CYP2C19*1 and CYP2C19*2 were determined, and then homo- or heterozygous state of genes was detected by Melt Curve Analysis method.
RESULTS
Forty three patients (mean age = 58.8 ± 10.0 years, 79.1% male) participated in this study. CYP2C19*1/CYP2C19*1 genotype was observed in 31 (72.1%) of participates, CYP2C19*1/CYP2C19*2 genotype in 10 (23.3%), and CYP2C19*2/CYP2C19*2 genotype in 2 patients (4.7%). The frequency of CYP2C19*2 allele in the sample was 27.9%.
CONCLUSION
This study demonstrated a high prevalence of CYP2C19*2 gene polymorphism in Iranian patients. Further studies with larger samples or longitudinal are required to determine the effects of this polymorphism on the prognosis of CAD patients in our population.
PMCID: PMC3347856  PMID: 22577456
CYP2C19; Polymorphism; Clopidogrel; Coronary Artery Disease; Iran
14.  The Predictive Factors of Recurrent Deep Vein Thrombosis 
ARYA Atherosclerosis  2011;7(3):123-128.
BACKGROUND
About 2-5% of people experience deep-vein thrombosis (DVT) during their lives. Death, disease recurrence, post-thrombotic syndrome, and excessive bleeding due to coagulant medications are among the most important DVT complications. Recent research found a high incidence of DVT recurrence after the first attack. Disease recurrence has a multifactorial pathogenesis and its probability is related with the number and severity of risk factors. The present study aimed to investigate DVT recurrence and the associated risk factors.
METHODS
This retrospective cross-sectional study evaluated all DVT patients hospitalized in Alzahra Hospital, Isfahan, Iran, during April 2000 to April 2011. The risk factors were obtained from patients' records including smoking, intravenous drug abuse, having a history of surgery in last four weeks, immobility, obesity, history of cardiac disease, and cancer.
RESULTS
A total number of 2550 DVT patients were hospitalized in Alzahra Hospital during the study period. It was only possible to extract the data from 385 patient records. A history of DVT was reported in 48 individuals (12.5%). The comparison between the risk factors in patients with a first time DVT and those experiencing a recurrent DVT revealed significant differences solely in the prevalence of blood disorders and immobility. Applying stepwise regression indicated immobility (OR: 4.57; 95% CI: 1.26-16.57; P < 0.021) and coagulopathy (OR: 0.33; 95% CI: 0.13-0.81; P < 0.016) with DVT recurrence.
CONCLUSION
Based on our findings, DVT patients are suggested to be mobilized as soon as possible. In addition, they should be advised to increase their activity after discharge.
PMCID: PMC3347857  PMID: 22577459
Deep Vein Thrombosis; Immobility; Risk Factor
15.  Comparing Anxiety in Cardiac Patients Candidate for Angiography with Normal Population 
ARYA Atherosclerosis  2011;7(3):93-96.
BACKGROUND
This study aimed to compare the anxiety of cardiac patients candidate for angiography with normal population in Isfahan province.
METHODS
The study population included 109 people, 53 cardiac patients referring to Chamran Cardiology Hospital in Isfahan for angiography and 56 people without cardiac disease. Data were collected by Cattle anxiety scale. In addition, demographic data of the sample population were collected at the same time using another questionnaire.
RESULTS
Independent t-test showed a significant difference between the anxiety of cardiac patients candidate for angiography and non-cardiac people (P < 0.001). Moreover, the differences between the amount of obvious anxiety and hidden anxiety in the two groups were significant (P < 0.001 for both).
CONCLUSION
The results showed that cardiac disease and diagnosis instruments, especially angiography, cause anxiety in patients. Therefore, evaluating this anxiety and applying proper techniques to reduce this anxiety is necessary.
PMCID: PMC3347858  PMID: 22577453
Anxiety; Cardiac Patients; Angiography; Normal Population
16.  Retained Jailed Wire: A Case Report and Literature Review 
ARYA Atherosclerosis  2011;7(3):129-131.
Side branch wiring is not infrequently used to protect side branch flow after main vessel stenting. Rarely, it becomes difficult to retrieve the jailed wire behind the stent and therefore it may even be detached and remained in the circulation. This article presents a report of such a case and reviews treatment options.
PMCID: PMC3347859  PMID: 22577460
Jailed wire; Stent; Retrieval
17.  Evaluation of Patent Foramen Ovale in Young Adults with Cryptogenic Stroke 
ARYA Atherosclerosis  2011;7(2):74-77.
BACKGROUND
Stroke is a leading cause of death and long-term disability worldwide. Although a minority of ischemic strokes in the community affect younger adults, up to 40% of acute ischemic strokes in young adults are cryptogenic in nature, that is, no cause is determined. Underlying pathologies of stroke of unknown cause are multiple, including patent foramen ovale (PFO). The PFO is the most common defect of atrial septum of the heart. This study evaluated the frequency of PFO in brain stroke with unknown etiology in patients younger than 50 years of age in Kerman.
METHODS
This cross-sectional study was done in Shafa Medical Center of Kerman University of Medical Sciences in 2008. For detection of the PFO, we used agitated saline test with transcranial Doppler sonography in brain stroke patients with unknown etiology and also a control group (normal persons).
RESULTS
PFO was found in 53% of patients. No significant difference was observed between sexes. The rate in the control group was 20%. Patients with large PFO had 2 or more attacks of stroke. Subjects in the control group did not have large PFO.
CONCLUSION
One of the most important underlying causes in young adults with cryptogenic stroke is PFO. It is better to prescribe antiplatelet drugs in patients with the first attack of stroke, but as for patients with recurrent stroke, closure of PFO must be considered.
PMCID: PMC3347844  PMID: 22577450
Stroke; Young Adults; Patent Foramen Ovale; Agitated Normal Saline Test.
18.  Comparing Diagnostic Techniques of Magnetic Resonance Angiography (MRA) and Doppler Ultrasonography in Determining Severity of Renal Artery Stenosis 
ARYA Atherosclerosis  2011;7(2):58-62.
BACKGROUND
Renal artery stenosis is one of the important causes of hypertension and end stage renal failure. Magnetic resonance angiography (MRA) and Doppler ultrasonography are non-invasive and safe diagnostic techniques that have also high sensitivity and specificity. Since the accuracy and reliability of these techniques depend upon technicians and softwares, we decided to evaluate and compare the sensitivity and specificity of these techniques in Isfahan.
METHODS
Our study included all the patients (37 patients) who underwent renal artery angiography during 2 years from May 2003 to May 2005 and up to six months after that had underwent MRA (21 patients) and Doppler sonography (16 patients) in Isfahan. Renal artery angiography was considered as the gold standard.
RESULTS
Sensitivity, specificity, positive and negative predictive values of 100%, 25%, 25%, and 100% were obtained for MRA respectively. Specificity and positive predictive values (PPV) of Doppler sonography were 67%. Its sensitivity and negative predictive values (NPV) were 57%.
CONCLUSION
Although it seems that technician dependency, technical and software problems were the reasons of low specificity of gadolinium-enhanced MRA in our study, further studies with larger sample sizes are recommended.
PMCID: PMC3347845  PMID: 22577447
MRA; Doppler Ultrasonography; Renal Artery Stenosis.
19.  Association Between Serum Homocysteine Concentration with Coronary Artery Disease in Iranian Patients 
ARYA Atherosclerosis  2011;7(2):63-67.
BACKGROUND
The role of novel biomarkers like homocystein as a risk factor of coronary artery disease (CAD) is being increasingly recognized. Since there is a marked geographical variation in plasma homocystein concentration and because of importance of hyperhomocysteinemia as a CAD risk factor and due to the paucity of studies in Iran evaluating this risk factor in our population, we evaluated the association between plasma total homocysteine (tHcy) concentration and CAD risk in Iranian population.
METHODS
In a case-control study, we compared the level of tHcy of forty five patients of angiographically proven CAD with forty five subjects without CAD as control group matched for age and gender. The patients with diabetes, hypertension, thyroid dysfunction, chronic renal failure, hyperlipidemia and obesity and other conventional CAD risk factors were excluded from the study. Plasma tHcy was measured using immunoturbidimetry. The results were compared between groups using student t test.
RESULTS
CAD patients had significantly higher mean plasma tHcy than control group (17.1±5.3 versus 14.2±3.8, P= 0.004).
CONCLUSION
This study denoted that high plasma homocysteine concentration was associated to CAD risk in Iranian people.
PMCID: PMC3347846  PMID: 22577448
Coronary Artery Disease; Homocysteine.
20.  The Relation Between Ankle-Brachial Index (ABI) and Coronary Artery Disease Severity and Risk Factors: An Angiographic Study 
ARYA Atherosclerosis  2011;7(2):68-73.
BACKGROUND
The current study aims to determine the relation between ankle–brachial index (ABI) and angiographic findings and major cardiovascular risk factors in patients with suspected coronary artery diseases (CAD) in Isfahan.
METHODS
In this cross-sectional descriptive-analytic research, patients with suspected CAD were studied. Characteristics of studied subjects including demographics, familial history, past medical history and atherosclerotic risk factors such as diabetes mellitus, hypertension, hyperlipidemia and smoking were obtained using a standard questionnaire. ABI was measured in all studied patients. ABI≤0.9 (ABI+) was considered as peripheral vessel disease and ABI>0.9 (ABI-) was considered as normal. Then, all studied patients underwent coronary artery angiography. The results of the questionnaire and angiographic findings were compared in ABI+ and ABI- groups. Data were analyzed by SPSS 15 using ANOVA, t-test, Spearman's rank correlation coefficient, and discriminant analysis.
RESULTS
In this study, 125 patients were investigated. ABI≤0.9 was seen in 25 patients (20%). The prevalence of ABI+ among men and women was 25.9% and 7.5%, respectively (P=0.01). The prevalence of atherosclerotic risk factors was significantly higher in ABI+ patients than in ABI- ones (P<0.05). ABI+ patients had more significant stenosis than ABI- ones. The mean of occlusion was significantly higher in ABI+ patients with left main artery (LMA), right coronary artery (RCA), left anterior descending artery (LAD), diagonal artery 1 (D1) and left circumflex artery (LCX) involvements (P<0.05).
CONCLUSION
The findings of this research indicated that ABI could be a useful method in assessing both the atherosclerotic risk factors and the degree of coronary involvements in suspected patients. However, in order to make more accurate decisions for using this method in diagnosing and preventing CAD, we should plan further studies in large sample sizes of general population.
PMCID: PMC3347847  PMID: 22577449
Ankle–Brachial Index; Angiography; Atherosclerotic Risk Factors.
21.  Dietary Choline and Betaine Intakes and Risk of Cardiovascular Diseases: Review of Epidemiological Evidence 
ARYA Atherosclerosis  2011;7(2):78-86.
BACKGROUND
Cardiovascular diseases (CVD) are the most important causes of human mortality in the world. Higher intakes of choline and betaine have been shown to be associated with lower plasma homocysteine levels (the putative CVD risk factor). This study aimed to review the evidence on the association between dietary intakes of choline and betaine and traditional/novel CVD risk factors.
METHODS
We searched in PubMed website from 1990 to 2009, with the use of following keywords: "dietary choline and betaine, cardiovascular diseases, metabolic syndrome, inflammation". The cross-sectional and prospective studies as well as the clinical trials were recruited in this investigation.
RESULTS
Dietary intakes of “choline”/“choline and betaine” were not significantly associated with CVD risk; however, the higher intakes of choline and betaine were associated with higher serum concentrations of CRP, IL-6 and TNF-α. Individuals with high plasma choline levels were obese and had elevated plasma triglycerides, HDL and non-HDL cholesterol levels; whereas high plasma betaine levels were inversely associated with these biochemical markers. Both choline and betaine supplementation resulted in increased blood lipid profiles.
CONCLUSION
Although dietary intakes of choline and betaine were not significantly associated with CVD incidence, the long-term consumption of these nutrients have been shown to prevent CVD mortality by decreasing inflammation and other risk factors.
PMCID: PMC3347848  PMID: 22577451
Choline; Betaine; Cardiovascular Diseases; Metabolic Syndrome; Inflammation.
22.  A case report on holt-oram syndrome (heart-hand) 
ARYA Atherosclerosis  2011;7(2):87-92.
BACKGROUND
The Holt-Oram Syndrome (HOS) or the Heart-Hand syndrome is considered as an overt autosomal hereditary disease with a complete influential effect and variable expression that emerges due to a genetic mutation. It can be vividly characterized by heart disorders and deficiencies in hand structure. Despite the existing genetic heterogeneity, the variable integration between HOS and the T-BX5 gene from the T-BOX Gene Complex has been observed during which various mutations have been reported in the affected patients. The T-BOX Gene Complex is located on chromosome 12 (12 q 24.1), and is able to encode a copying factor. That has a conservative motive with 180 amino acids. The deficiencies in only 1/3 of patients have been observed caused by the mutation of this gene.
CASE REPORT
This case was a 10-year-old child with hand disorders, incomplete growth of clavicle, moving problems in elbow joint and shoulder, disorder in ventricle and auricle walls. The disease was diagnosed as HOS, based on clinical examination and drawing the family tree diagram. It was impossible to investigate molecular mutation due to inaccessibility to the patient.
CONCLUSION
By investigating the family members and their deficiencies and imaging disorder variables according to different reports as well as parents’ state of health, the HOS can be defined as an overt heredity resulting from a new mutation in the germinating layer of sexual cells in one of the parents. There is a weak possibility that the disease results from a mosaic mutation in the male parent's testicle or the female parent's ovum. In this case, the probability for the disease to be repeated in parents’ next children will be guessed between 1 and 50%.
PMCID: PMC3347849  PMID: 22577452
Holt-Oram Syndrome; Hand- Heart Syndrome; T-BOX.
24.  Ejection Fraction and Mortality Rate of Patients with Isolated Acute Inferior Myocardial Infarction Reperfused by Streptokinase 
ARYA Atherosclerosis  2011;7(2):54-57.
BACKGROUND
This study aimed to evaluate the effects of streptokinase on left ventricular ejection fraction and mortality rate of patients with inferior acute myocardial infarction (AMI) without right ventricular myocardial infarction (RVMI).
METHODS
Fifty five consecutive patients with the diagnosis of inferior AMI without RVMI in the coronary care unit (CCU) of Shariati Hospital in Isfahan were selected for this study. Patients who had a history and/or electrocardiogram (ECG) evidence of previous myocardial infarction, evidence of bundle branch block, historical or clinical findings of valvular or other non-coronary heart diseases or heart failure were excluded. Participants were divided into two groups. Group one (n=28) had no contraindication for taking thrombolytic therapy and group two (n=27) had at least one contraindication for this treatment. Patients in group one took 1,000,000 units streptokinase for one hour. Three days later, LVEF of all participants was measured by an experienced cardiologist using 2-dimentiona1 echocardiography. Patients were followed up until four weeks to assess the mortality rate.
RESULTS
One death in the first 24 hours was reported in group one. However, no death was reported in any group until four weeks after discharge. There was no significant difference in mortality rate during the first 24 hours and four weeks after discharge between the two groups. Mean LVEF in the two groups did not show any significant difference (P=0.21).
CONCLUSION
Probably streptokinase has no effects on one-month mortality rate and LVEF in patients with inferior AMI without RVMI. Therefore, streptokinase side effects must be taken into consideration when being administered for this group of patients.
PMCID: PMC3347851  PMID: 22577446
Inferior Acute Myocardial Infarction; Left Ventricular Ejection Fraction; Streptokinase; Mortality Rate
25.  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.
BACKGROUND
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.
METHODS
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.
RESULTS
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).
CONCLUSION
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

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