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Microvascular angina (MVA), historically called cardiac syndrome X, refers to angina with nonobstructive coronary artery disease. This female-predominant cardiovascular disorder adds considerable health-related costs due to repeated diagnostic angiography and frequent hospital admissions. Despite the high prevalence of this diagnosis in patients undergoing coronary angiography, it is still a therapeutic challenge for cardiologists. Unlike obstructive coronary artery disease, with multiple evidence-based therapies and management guidelines, little is known regarding the management of MVA. During the last decade, many therapeutic interventions have been suggested for the treatment of MVA. However, there is a lack of summarization tab and update of current knowledge about pharmacologic management of MVA, mostly due to unclear pathophysiology. In this article, we have reviewed the underlying mechanisms of MVA and the outcomes of various medications in patients with this disease. Contrary to vasospastic angina in which normal angiogram is observed as well, nitrates are not effective in the treatment of MVA. Beta-blockers and calcium channel blockers have the strongest evidence of improving the symptoms. Moreover, the use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, statins, estrogen, and novel antianginal drugs has had promising outcomes. Investigations are still ongoing for vitamin D, omega-3, incretins, and n-acetyl cysteine, which have resulted in beneficial initial outcomes. We believe that the employment of the available results and results of the future large-scale trials into cardiac care guidelines would help reduce the global cost of cardiac care tremendously.

ABO blood groups are considered to be associated with cardiovascular disease. Nonetheless, the definite effect of ABO blood groups on the clinical outcome of coronary artery bypass graft surgery (CABG) is still undetermined. We evaluated whether ABO blood groups can predict long-term major adverse cardiocerebrovascular events (MACCE) in CABG patients.In this retrospective cohort study, we retrieved the clinical files of eligible patients treated with isolated CABG in our hospital between March 2007 and March 2016. We divided the patients into four ABO subgroups. The primary study endpoints were the occurrence of all-cause mortality and MACCE during long-term follow-ups. We used Cox regression survival analysis to define the association of ABO blood groups with the occurrence of MACCE.Of 17,892 patients who underwent isolated CABG, 17,713 (mean age, 61.19±9.47 years, 74.6% male) were successfully followed, and their data used in the final analysis. Our multivariable analysis demonstrated that patients with different blood groups had similar 5-year mortality and 5-year MACCE.Our findings suggest that in patients who underwent CABG, ABO blood groups were not associated with long-term MACCE.

Background Revascularization in diabetic patients with coronary artery disease remains a challenge in cardiology practice. Although clinical trials have reported the mid-term superiority of coronary artery bypass grafting (CABG) surgery over percutaneous coronary intervention in these patients, little is known about the long-term outcomes of CABG in diabetic patients compared to non-diabetics, particularly in developing countries. Methods Between 2007 and 2016, we recruited all patients who underwent isolated CABG in a tertiary care cardiovascular center in a developing country. The patients were followed at 3–6 months and 12 months after surgery, and then annually. The study endpoints were 7-year all-cause mortality and major adverse cardiac and cerebrovascular events (MACCE). Results Of 23,873 patients (17,529 males, mean age 65.67 years) who underwent CABG, 9227 (38.65%) patients were diagnosed with diabetes. After adjustment for potential confounders, patients with diabetes experienced a 31% increase in MACCE seven years after surgery compared to the non-diabetic patients (HR = 1.31, 95% CI: 1.25–1.38, P-value Conclusions Our study showed a higher risk of all-cause mortality and MACCE at seven years in diabetic patients undergoing isolated CABG. The outcomes in the studied center in a developing country were comparable to western centers. The high incidence of adverse outcomes in the long term in diabetic patients implies that not only short-term but long-term measures should be taken to improve the CABG outcomes in this challenging patient population.

Background Mental health disorders (MHD) impose a considerable burden on public health systems. With an increasing worldwide trend in urbanization, urban mental health stressors are affecting a larger population. In this study, we evaluated the epidemiology of mental health disorders in the citizens of Tehran using the Tehran Cohort Study (TeCS) data. Methods We utilized data from the TeCS recruitment phase. A total of 10,247 permanent residents of Tehran metropolitan (aged 15 years and older) were enrolled in the study from March 2016 to 2019 via systematic random sampling from all 22 districts of Tehran. The participant's demographic, socioeconomic, and medical characteristics were evaluated by conducting comprehensive interviews. The standardized Persian version of the General Health Questionnaire version 28 was utilized to assess the mental status of the patients according to four central mental health disorders. Results Almost 37.1% of Tehran residents suffered mental health problems (45.0% of women and 28.0% of men). The greatest incidence of MHDs was seen in the 25–34 and over 75 age groups. The most common mental health disorders were depression (43%) and anxiety (40%), followed by somatization (30%) and social dysfunction (8.1%). Mental health disorders were more frequent in the southeast regions of the city. Conclusions Tehran residents have a significantly higher rate of mental health disorders compared to nationwide studies, with an estimated 2.7 million citizens requiring mental health care services. Awareness of mental health disorders and identifying vulnerable groups are crucial in developing mental health care programs by public health authorities.

Background and aim of the study Several studies have compared early and late outcomes of on-pump coronary artery bypass grafting (CABG) and off-pump CABG. However, there is still an ongoing debate on this matter, especially in patients with triple-vessel coronary artery disease (3VD). Methods We randomly assigned 274 consecutive patients with 3VD to two equal groups to undergo on-pump CABG or off-pump CABG. The primary outcome was major adverse cardiac and cerebrovascular events (MACCE), including all-cause mortality, acute coronary syndrome, stroke or transient ischemic attack, and the need for repeat revascularization. The secondary outcomes were postoperative infection, ventilation time, ICU admission duration, hospital stay length, and renal failure after surgery. Results The median follow-up duration was 31.2 months (range 24.6–35.2 months). The mean age of patients was 61.4 ± 9.3 years (range: 38–86), and 207 (78.7%) were men. There were 15 (11.2%) and 9 (7.0%) MACCE occurrences in on-pump and off-pump groups, respectively (P value = 0.23). MACCE components including all-cause death, non-fatal MI, CVA, and revascularization did not significantly differ between on-pump and off-pump groups. We observed no difference in the occurrence of MACCE between off-pump and on-pump groups in multivariable regression analysis (HR = 0.57; 95% CI 0.24–1.32; P value = 0.192). There were no statistical differences in postoperative outcomes between the off-pump and on-pump CABG groups. Conclusions Off-pump CABG is an equal option to on-pump CABG for 3VD patients with similar rates of MACCE and postoperative complications incidence when surgery is performed in the same setting by an expert surgeon in both methods. (IRCT20190120042428N1).

Atrioventricular block (AVB) is an important complication following valvular surgery. Several factors including inflammation-mediated injury might trigger AVB.Patients with advanced postoperative AVB were randomly assigned to receive either dexamethasone (0.4 mg/kg, maximum 30 mg/day) intravenously for 3 days or conservative care only. Primary endpoint was recovery rate in Day 5 since randomization. Secondary endpoints were recovery rate in Day 7 and Day 10, cumulative AVB time, permanent pacemaker (PPM) implantation rate, length of stay in critical care units, and postoperative major adverse events (MAE).We enrolled 139 subjects (48.9% male) with mean age of 59.9 years randomly allocated to intervention group (n = 69) and control group (n = 70). Dexamethasone led to higher recovery rates at Day 5 (82.6% vs. 62.9%, p = .009) and Day 7 (88.4% vs. 61.4%, p .0001) respectively. This benefit ceased at Day 10 (83.05% vs. 78.6%, p = .547). Median cumulative AVB time was shorter in dexamethasone group compared with control group (41 h vs. 64 h, p = .044). PPM implantation rates were similar between the dexamethasone and control groups (15.9% vs. 17.1%, respectively, p = .849). Median length of stay in intensive care unit (ICU) (10 days vs. 12 days, p = .03) and MAE (17.4% vs. 25.7%, p = .133) tended to be lower with dexamethasone.Dexamethasone may serve as a safe and effective medication to help hasten recovery of advanced AVB after valvular surgery.

Cardiac arrhythmias are a leading cause of mortality, morbidity, and sudden cardiac death (SCD). Current treatment strategies for ventricular tachycardia (VT) are effective for many patients; however, in several cases, this does not result in a cure. Despite significant clinical improvements, conventional catheter ablation remains relatively unsuccessful in achieving the best outcomes in some challenging cases. Stereotactic arrhythmia radioablation (STAR), which delivers precise high-dose radiation to well-defined targets with minimal damage to surrounding tissue, is emerging as a new potential treatment option, having the potential to be used for patients at high risk for catheter ablation or who have refractory VT. Ongoing studies and preliminary experiences on f the efficacy of STAR in patients with refractory VT have shown a reduction in VT recurrence and a promising early safety profile. However, STAR is in its infancy, and clinical evidence on its efficacy and safety is limited; thus, conclusions regarding the efficacy of STAR should be drawn with caution. Further investigation of long-term efficacy and tolerability is ongoing to substantiate this promising therapeutic option better. The present review describes the background and general principles, pretreatment procedures, clinical implications, and toxicity of STAR therapy.

Objective Acute ischemic cardiac events can complicate coronavirus disease 2019 (COVID-19). We report the in-hospital characteristics of patients with acute myocardial infarction and concomitant COVID-19. Methods This was a registry-based retrospective analysis of patients admitted with positive COVID-19 tests who suffered acute myocardial infarction either before or during hospitalization; from 1 March 2020 to 1 April 2020 in a tertiary cardiovascular center-Tehran Heart Center. We performed an exploratory analysis to compare the clinical characteristics of patients who died during hospitalization or were discharged alive. Results In March 2020, 57 patients who had acute myocardial infarction and a confirmed diagnosis of COVID-19 were included in the study. During hospitalization, 13 patients (22.8%) died after a mean hospital stay of 8.4 days. The deceased were older than the survivors. No significant association between mortality and sex or length of hospital stay was observed. Hypertensive individuals were more likely to have a fatal outcome. Previously receiving angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers did not show any association with mortality. Regarding the laboratory data during hospitalization, higher cardiac troponin T, neutrophil count, C-reactive protein, urea, and blood urea nitrogen/creatinine ratio were observed in the mortality group. The deceased had a lower lymphocyte count than the survivors. Conclusions Markers of worsening renal function and immune system disturbance seem to be associated with mortality in concurrent acute myocardial infarction and COVID-19. Optimizing the management of acute coronary syndrome complicating COVID-19 requires addressing such potential contributors to mortality.

BACKGROUND Prediabetes, as a precursor stage, has an important role in development of overt diabetes as well as coronary artery disease (CAD). The aim of this study is to evaluate the association between prediabetes and adverse outcomes (major adverse cardiovascular and cerebrovascular events [MACCE] and all-cause mortality) in patients who underwent coronary artery bypass grafting (CABG). METHODS In this prospective study, we included 3754 patients with CAD who underwent elective isolated CABG between January 2016 to January 2020. Patients were categorized based on their glycemic status at the time of CABG as follows: diabetics (n = 2707), prediabetics (n = 471), and nondiabetics (n = 576). Primary endpoints were occurrence of all-cause mortality and MACCE. RESULTS We studied 3754 patients for a median of 32.25 months after CABG. MACCE occurred in 474 (12.6%) patients. After adjusting for potential confounders, diabetic patients had a higher risk of MACCE (hazard ratio [HR] 1.69; 95% confidence intervals [CI], 1.24-2.29) and death (HR 2.33, 95% CI, 1.45-3.7) compared with nondiabetic and prediabetic ones. However, patients with prediabetes had lower HR of MACCE, but the association was nonsignificant (HR 1.02; 95% CI, 0.67-1.56). CONCLUSIONS Diabetes is significantly associated with higher risk of mortality and MACCE; however, prediabetes did not show a prognostic impact in terms of overall and MACCE-free survival.

Introduction Although several studies are available regarding baseline Electrocardiographic (ECG) parameters, major and minor ECG abnormalities, there is a big controversy regarding their age and gender differences in literature, thus we aimed to investigate any possible age or gender ECG discrepancies in general adult population. Methods Data of 7630 adults aged ≥35 years from Tehran Cohort Study who were registered between March 2016 to March 2019 were collected. ECG basic values, major, and minor ECG abnormalities-defined according to the Minnesota Code-were analyzed and compared between genders, and four distinct age groups. Odds ratio of having any major ECG abnormality between males, and females stratified by age, and number of cardiovascular risk factors was calculated. Results ECG information of 7630 participants was available. The average age was 53.6 (±12.66), and women made up 54.2% (n=4132) of subjects. The average heart rate (HR) was higher among women(pConclusion Basic ECG values is different in male and female general population. In addition, major and minor ECG abnormalities were roughly more prevalent in male subjects. In both genders, odds of having major ECG abnormalities surges with increase in number of conventional CV risk factors and age.

The catheter ablation of idiopathic ventricular arrhythmias is accepted as a first-line treatment as it successfully eliminates about 90.0% of such arrhythmias. One of the most challenging ventricular arrhythmias originates from the left ventricular summit (LVS), a triangular epicardial space with the left main bifurcation as its apex. This area accounts for about 14.0% of LV arrhythmias. The complex anatomy of this region, accompanied by proximity to the major epicardial coronary arteries and the presence of a thick fat pad in this region, renders it a challenging area for catheter ablation. This article presents a review of the anatomy of the LVS and relevant regions and discusses novel mapping and ablation techniques for eliminating LVS ventricular arrhythmias. Additionally, we elaborate on the electrocardiographic (ECG) manifestations of arrhythmias from the LVS and their successful ablation via the direct approach and the adjacent structures.

Atrial fibrillation is the most common arrhythmia in adults and its prevalence is growing rapidly. It has been shown that AF is associated with increased risk of heart failure, ischemic and hemorrhagic stroke, and mortality. Hence, there is growing interest among researchers in seeking preventive and therapeutic interventions regarding AF. In recent decades, it has been suggested that statins may decrease the incidence of AF and may also decrease its recurrence after cardioversion and catheter ablation. These effects are thought to be mediated by different mechanisms such as modulating inflammation, altering the properties of transmembrane ion channels, interfering with activation of matrix metalloproteinases, and acting on endothelial function. In this article, we review and update current knowledge about the role of statins in primary and secondary prevention of AF in general and specific populations. Resumo: A fibrilação auricular (FA) é a arritmia mais comum em adultos e a sua prevalência está a crescer rapidamente. Foi demonstrado que a FA está associada a um risco acrescido de insuficiência cardíaca, acidente vascular cerebral isquémico e hemorrágico e mortalidade. Assim, há um interesse crescente entre os investigadores na procura de intervenções preventivas e terapêuticas em relação à FA. Nas últimas décadas, tem sido sugerido que as estatinas podem diminuir a incidência de FA e também diminuir a sua recorrência após a cardioversão e ablação do cateter. Pensa-se que estes efeitos são mediados por diferentes mecanismos, tais como a modulação da inflamação, a alteração das propriedades dos canais de iões transmembrana, a interferência com a ativação das metaloproteinases matriciais e a atuação sobre a função endotelial. Neste artigo, revemos e atualizamos os conhecimentos atuais sobre o papel das estatinas na prevenção primária e secundária da FA em populações gerais e específicas.

Background Stem cell therapy is among the novel approaches for the treatment of post-myocardial infarction cardiomyopathy. This study aims to compare the effect of stromal-derived factor 1 α (SDF1α), mesenchymal stem cells (MSCs) in combination with the lentiviral production of vascular endothelial growth factor (VEGF) on infarct area, vascularization and eventually cardiac function in a rat model of myocardial infarction (MI). Methods The influence of SDf1α on MSCs survival was investigated. MSCs were transduced via a lentiviral vector containing VEGF. After that, the effect of mesenchymal stem cell transfection of VEGF-A165 and SDf1α preconditioning on cardiac function and scar size was investigated in five groups of MI rat models. The MSC survival, cardiac function, scar size, angiogenesis, and lymphocyte count were assessed 72 hours and 6 weeks after cell transplantation. Results SDF1α decreased the lactate dehydrogenase release in MSCs significantly. Also, the number of viable cells in the SDF1α-pretreated group was meaningfully more than the control. The left ventricular systolic function significantly enhanced in groups with p240MSC, SDF1αMSC, and VEGF-A165MSC in comparison to the control group. Conclusions These findings suggest that SDF1α pretreatment and overexpressing VEGF in MSCs could augment the MSCs' survival in the infarcted myocardium, reduce the scar size, and improve the cardiac systolic function.

Sudden cardiac death (SCD) related to ventricular arrhythmias is the most disastrous consequence of hypertrophic cardiomyopathy (HCM). Hence, clinicians seek to identify the highest risk patients that have the greatest potential to benefit from an implantable cardioverter-defibrillator (ICD) for primary prevention; nonetheless, this is where controversies begin as the 2011 American College of Cardiology Foundation/American Heart Association and the 2014 European Society of Cardiology guidelines have significant discrepancies. These guidelines propose clinically and statistically oriented algorithms, respectively, for SCD risk stratification of patients with HCM and recommendation to implantation of primary prevention ICD. The differences between these guidelines have resulted in confusion among care practitioners and patients alike. In this communication, we tried to criticize the statistical viewpoint in terms of clinical outcomes and suggest the more beneficial model.

Although multiple studies have reported the devastating effect of cigarette smoking (CS) on short-term outcomes of patients who underwent coronary artery bypass grafting surgery (CABG), its effect on long-term outcomes is still questionable. We aimed to evaluate the long-term outcomes of CS cessation after CABG surgery.This retrospective cohort study included all patients who underwent isolated CABG at our center between 2007 and 2016 and were cigarette smokers either just before or at the time of surgery. Patients were stratified into those who continued CS and those who were persistently CS abstinent after CABG. The endpoints of the study were 5-year mortality and 5-year major adverse cardiovascular and cerebrovascular events.Of 28,945 patients who underwent isolated CABG, 9173 current cigarette smokers (93.5% men; mean age, 58.6 years) met our selection criteria and were included in the final analysis. Of these 3302 patients (40.0%) continued CS after surgery and 5688 patients were persistently abstinent. Multivariable survival analysis demonstrated that CS cessation after CABG, adjusted for major coronary risk factors, could reduce the 5-year mortality by 35% (hazard ratio, 0.65; 95% confidence interval, 0.54-0.77; P.001) and 5-year major adverse cardiovascular and cerebrovascular events by 18% (hazard ratio, 0.82; 95% confidence interval, 0.74-0.92; P = .001).Our study shows that CS abstinence after CABG significantly reduces long-term mortality and number of major adverse events. As a result, patients who smoke should be encouraged to participate in CS cessation programs after CABG surgery.

Background There are conflicting results regarding the relationship between overweight/obesity and the outcomes of coronary artery bypass graft surgery (CABG), termed “the obesity paradox”. This study aimed to evaluate the effects of body mass index (BMI) on the midterm outcomes of CABG. Methods This historical cohort study included all patients who underwent isolated CABG at our center between 2007 and 2016. The patients were divided into five categories based on their preoperative BMIs (kg/m2): 18.5≤BMI2 were excluded. The endpoints of this study were all-cause mortality and major adverse cardio-cerebrovascular events (MACCEs), comprising acute coronary syndromes, cerebrovascular accidents, and all-cause mortality at five years. For the assessment of the linearity of the relationship between continuous BMI and the outcomes, plots for time varying hazard ratio of BMI with outcomes were provided. Results Of 17 751 patients (BMI = 27.30 ±4.17 kg/m2) who underwent isolated CABG at our center, 17 602 patients (mean age = 61.16±9.47 y, 75.4% male) were included in this study. Multivariable analysis demonstrated that patients with pre-obesity and normal weight had similar outcomes, whereas patients with preoperative BMIs exceeding 30 kg/m2 kg/m2 had a significantly higher risk of 5-year all-cause mortality and 5-year MACCEs than those with pre-obesity. Additionally, a positive association existed between obesity degree and all-cause mortality and MACCEs. Further, BMIs of 40 kg/m2 or higher showed a trend toward higher MACCE risks (adjusted hazard ratio, 1.32; 95% confidence interval, 0.89 to 1.95), possibly due to the small sample size. A nonlinear, albeit negligible, association was also found between continuous BMI and the study endpoints. Conclusions Our findings suggest that preoperative obesity (BMI>30 kg/m2) in patients who survive early after CABG is associated with an increased risk of 5-year all-cause mortality and 5-year MACCEs. These findings indicate that physicians and cardiac surgeons should encourage patients with high BMIs to reduce weight for risk modification.

Several studies have demonstrated the relationship between visfatin and increased risk of diseases caused by inflammation, however, the relationship between visfatin and coronary artery ectasia (CAE) is still unknown. The aim of our study is to investigate the association between serum visfatin with presence of coronary ectasia and its severity. We enrolled 85 individuals including 35 CAE patients (mean age: 58.40 ± 9.82 years) and 50 control persons (mean age: 53.24 ± 8.81 years). These participants underwent some biochemical tests including visfatin, fasting blood glucose and lipid profiles. In univariate analysis, the serum level of visfatin was significantly associated with ectasia in all patients with CAE and CAD coexisting with CAE groups, but a trend toward significance in isolated CAE group. In multivariate analysis, visfatin showed independently significant association with presence of ectasia in all patients with ectasia and in CAD coexisting with ectasia groups, but not significant in isolated CAE group. Visfatin was also independently associated with severity of ectasia according to MARKIS classification. We conclude that visfatin independently can be the useful predictor for the presence and severity of coronary ectasia.

Funding Acknowledgements Type of funding sources: None. Background Limited inconsistent evidence support use of steroids in recovery of atrioventricular block (AVB) after trans-catheter aortic valve implantation. However, there is no study to examine the efficacy of steroids in recovery of high-grade AVB following valvular surgery. Purpose To assess the effect of high-dose dexamethasone on recovery of advanced AVB following valvular heart surgery. Methods In this randomized controlled trial, patients with advanced postoperative AVB (either Mobitz type II or third degree) were randomly assigned to receive either dexamethasone (0.4 mg /kg, maximum 30 mg /day in three divided doses) intravenously for three days or conservative care only. Primary endpoint was recovery rate in day five since randomization. Secondary endpoints were recovery rate in day 7 and day 10, cumulative AVB time, PPM implantation rate, length of stay in critical care units, and post-operative major adverse events (MAE) during one month. We defined MAE as composite of all-cause mortality, all-type infections, major bleeding, prolonged sternal dehiscence, new stroke, postoperative MI, complicated uncontrolled hyperglycemia and readmission for decompensated heart failure. Results We enrolled 139 subjects (48.9% male) with mean age of 59.9 years who were randomly allocated to intervention group (n= 69) and control group (n= 70). Dexamethasone led to higher recovery rates at day 5 (82.6% vs. 62.9%, P= 0.009) and day 7 (88.4% vs. 61.4%, P< 0.0001) respectively. Random 24-hours ECG Holter monitoring of patients at day 5 revealed the same results and confirmed the superiority of dexamethasone for recovery of AVB (80.5% vs 61.2%, respectively, P = 0.024). Although this benefit ceased at day 10 (83.05 vs 78.6 %, P = 0.547), Generalized Estimating Equation analysis for recovery over 10 days favored intervention (odds ratio: 2.56, 95% CI: 1.27- 5.15, P = 0.008). Median cumulative AVB time was shorter in dexamethasone group compared to control group (41 hours vs 64 hours, P = 0.044). PPM implantation rates were similar between the dexamethasone and control groups (15.9% vs 17.1 %, respectively, P = 0.849). Median length of stay in ICU (10 days vs 12 days, P= 0.03) and MAE (17.4 % vs 25.7%, P = 0.133) tended to be lower with dexamethasone. Conclusion Our findings suggest that dexamethasone may serve as a safe and effective medication to improve recovery of advanced AVB after valvular surgery. Further studies are needed to confirm these findings, particularly regarding subsequent PPM implantation rate.

Although atherosclerotic cardiovascular disease (ASCVD) and cancer are seemingly different types of disease, they have multiple shared underlying mechanisms and lifestyle-related risk factors like smoking, unhealthy diet, excessive alcohol consumption, and inadequate physical activity. Opium abuse is prevalent in developing countries, especially the Middle East region and many Asian countries. Besides recreational purposes, many people use opium based on a traditional belief that opium consumption may confer protection against heart attack and improve the control of the risk factors of ASCVD such as diabetes mellitus, hypertension, and dyslipidemia. However, scientific reports indicate an increased risk of ASCVD and poor control of ASCVD risk factors among opium abusers compared with nonusers. Moreover, there is accumulating evidence that opium consumption exerts potential carcinogenic effects and increases the risk of developing various types of cancer. We conducted a review of the literature to review the current evidence on the relationship between opium consumption and ASCVD as well as various kinds of cancer. In addition, we will discuss the potential shared pathophysiologic mechanisms underlying the association between opium abuse and both ASCVD and cancer.

Background: Primary percutaneous coronary intervention (PPCI) as the treatment of choice for ST‑segment elevation myocardial infarction (STEMI) should be rapidly performed. It is necessary to use preventive strategies during the coronavirus disease 2019 (COVID‑19) outbreak, which is an ongoing global concern. However, critical times in STEMI management may be influenced by the implementation of infection control protocols. Aims: We aimed to investigate the impact of our dedicated COVID‑19 PPCI protocol on time components related to STEMI care and catheterization laboratory personnel safety. A subendpoint analysis to compare patient outcomes at a median time of 70 days during the pandemic with those of patients treated in the preceding year was another objective of our study. Methods: Patients with STEMI who underwent PPCI were included in this study. Chest computed tomography (CT) and real‑time reverse transcriptase–polymerase chain reaction (rRT‑PCR) tests were performed in patients suspected of having COVID‑19. A total of 178 patients admitted between February 29 and April 30, 2020 were compared with 146 patients admitted between March 1 and April 30, 2019. Results: Severe acute respiratory syndrome coronavirus 2 infection was confirmed by rRT‑PCR in 7 cases. In 6 out of 7 patients, CT was indicative of COVID‑19. There were no differences between the study groups regarding critical time intervals for reperfusion in STEMI. The 70‑day mortality rate before and during the pandemic was 2.73% and 4.49%, respectively (P = 0.4). Conclusions: The implementation of the dedicated COVID‑19 PPCI protocol in patients with STEMI allowed us to achieve similar target times for reperfusion, short‑term clinical outcomes, and staff safety as in the prepandemic era.

Background: Little is known regarding the impact of quantity and quality of sleep on the incidence of cardiovascular disease. The aim of this study was to investigate the possible independent association of late bedtime and premature coronary artery disease (PCAD). Methods: Between October 2016 and November 2019, we conducted a cross-sectional population-based study on 30101 participants aged 20–65 years in Khuzestan Comprehensive Health Study (KCHS). Data on major risk factors of cardiovascular disease, habit history, physical activity, and sleep behavior was gathered and participants underwent blood pressure, anthropometric, and serum lipid and glucose profile measurements. PCAD was defined as documented history of developing obstructive coronary artery disease before 45 years in men and before 55 years in women. Results: Of a total of 30101 participants (64.1% female, mean age: 41.7±11.7 years) included in this study, 1602 (5.3%, 95% confidence interval: 5.1%–5.6%) had PCAD. Late bedtime was reported in 7613 participants (25.3%, 95% confidence interval: 24.9%–25.8%). Age-sex standardized prevalence for PCAD and late bedtime were 3.62 (3.43-3.82) and 27.8 (27.2–28.4), respectively. There was no significant difference (P=0.558) regarding prevalence of PCAD between those with late bedtime (5.5%, 95% CI: 4.9%–6.0%) and those with early bedtime (5.3%, 95% CI: 5.0%–5.6%). However, after adjustment for potential confounders, late bedtime was independently associated with PCAD (OR=1.136, 95% CI=1.002–1.288, P=0.046). Conclusion: In this study, late bedtime was significantly associated with presence of PCAD. Future prospective studies should elucidate the exact role of late bedtime in developing coronary atherosclerosis prematurely.

Background A wrong traditional belief persists among people that opium consumption beneficially affects cardiovascular disease and its risk factors. However, no evidence exists regarding the effect of opium consumption or cessation on the long-term risk of major adverse cardio-cerebrovascular events after coronary artery bypass grafting. We therefore aimed to evaluate the effect of persistent opium consumption after surgery on the long-term outcomes of coronary artery bypass grafting. Methods The study population consisted of 28,691 patients (20,924 men, mean age 60.9 years), who underwent coronary artery bypass grafting between 2007 and 2016 at our centre. The patients were stratified into three groups according to the status of opium consumption: never opium consumers (n = 23,619), persistent postoperative opium consumers (n = 3636) and enduring postoperative opium withdrawal (n = 1436). Study endpoints were 5-year mortality and 5-year major adverse cardio-cerebrovascular events, comprising all-cause mortality, acute coronary syndrome, cerebrovascular accident and revascularisation. Results After surgery, 3636 patients continued opium consumption, while 1436 patients persistently avoided opium use. The multivariable survival analysis demonstrated that persistent post-coronary artery bypass grafting opium consumption increased 5-year mortality and 5-year major adverse cardio-cerebrovascular events by 28% (hazard ratio (HR) 1.28, 95% confidence interval (CI) 1.06–1.54; P = 0.009) and 25% (HR 1.25, 95% CI 1.13–1.40; P Conclusions The present data suggest that persistent post-coronary artery bypass grafting opium consumption may significantly increase mortality, major adverse cardio-cerebrovascular events and acute coronary syndrome in the long term. Future studies are needed to confirm our findings.

Several studies have reported an association between elevated liver enzymes and increased risks for developing inflammatory diseases. The aim of our study was to examine how serum liver transaminases, as inexpensive and routinely measured markers, and the De Ritis ratio are associated with the presence of coronary artery ectasia (CAE) and its severity.Participants were recruited from patients admitted to Tehran Heart Center for diagnostic coronary angiography due to suspected myocardial ischaemia. These participants also underwent concurrent laboratory routine biochemical and liver enzyme tests.A total of 104 participants were included; 59 had CAE and 45 were controls without coronary artery disease (CAD). The CAE group was split into a further two subgroups: those with isolated CAE (n=27) and those with CAD and coexisting CAE (n=32). In the adjusted multivariate analysis, a lower ratio of aspartate aminotransferase to ALT (AST/ALT) was, uniquely among the variables, a statistically significant marker for isolated CAE. In the CAD + CAE group, the AST/ALT ratio was not significant after adjustments for the confounding factors. The multivariate linear regression for the Markis score showed that the AST/ALT ratio was inversely associated with the severity of CAE.We conclude that the AST/ALT ratio and, to some extent, ALT independently of other inflammatory factors, can be associated with the presence and severity of isolated CAE.

Cardiovascular disease, mental health, and injury are among the top health issues globally. In Tehran Cohort Study, we aimed to determine the prevalence, incidence, and trend of cardiovascular diseases, psychiatric symptoms, injury, and risk factors in Tehran households. We enrolled 4215 households in the recruitment phase from March 2016 to March 2019. Demographic characteristics, past medical history, medications, and familial history of the participants were collected. Rose angina pectoris, general health Questionnaire-28 (GHQ-28), and injury questionnaires were completed. Fasting blood samples were collected to measure routine biochemistry and store samples in the biobank. Anthropometric and physiological measurements and electrocardiograms were performed. The participants are followed every three years for up to 12 years. In total, 8296 individuals participated in the cardiovascular section, 10247 completed the GHQ-28, and 4167 households completed the injury questionnaire. The mean age of the participants was 48.2 (16.41), and 46.5% were male. 64.3% of recruited individuals had no symptoms of psychiatric disorders, and 3729 (89.5%) households did not have any severe injury requiring treatment. The participants' diversity and their invaluable data will help us provide a general picture of the current prevalence and incidence of the main study objectives.

The association between obesity, cancer and cardiovascular disease (CVD) has been demonstrated in animal and epidemiological studies. However, the specific role of visceral obesity on cancer and CVD remains unclear. Visceral adipose tissue (VAT) is a complex and metabolically active tissue, that can produce different adipokines and hormones, responsible for endocrine-metabolic comorbidities. This review explores the potential mechanisms related to VAT that may also be involved in cancer and CVD. In addition, we discuss the shared pharmacological treatments which may reduce the risk of both diseases. This review highlights that chronic inflammation, molecular aspects, metabolic syndrome, secretion of hormones and adiponectin associated to VAT may have synergistic effects and should be further studied in relation to cancer and CVD. Reductions in abdominal and visceral adiposity improve insulin sensitivity, lipid profile and cytokines, which consequently reduce the risk of CVD and some cancers. Several medications have shown to reduce visceral and/or subcutaneous fat. Further research is needed to investigate the pathophysiological mechanisms by which visceral obesity may cause both cancer and CVD. The role of visceral fat in cancer and CVD is an important area to advance. Public health policies to increase public awareness about VAT’s role and ways to manage or prevent it are needed.

Significant variation is evident among different ethnicities regarding the prevalence, awareness, severity, treatment, and complications of major cardiovascular disease (CVD) risk factors. Relative to white Europeans, stroke mortality is almost doubled in South Asians and Afro-Caribbeans; however, when coronary artery disease mortality is considered, it is high in South Asians and low in Afro-Caribbeans. Hypertension is more common, severe, and is associated with higher rates of morbidity and mortality in black people than white people. Diabetes is more prevalent and less controlled in South Asians which leads to a nearly fourfold higher cardiovascular mortality in South Asians than other ethnic groups. Furthermore, South Asians suffer from a highly atherogenic lipid profile. In contrast, black people are generally known for their higher high-density lipoprotein and lower triglyceride levels than white people which seem to play a major role in protecting them from coronary artery disease. For a given waist circumference, Asian, black, and Caucasian people show different levels of intra-abdominal adiposity and CVD risk. Hence, the joint definition from five major organizations in 2009 of the metabolic syndrome set ethnic-specific values of waist circumference to define central obesity. Black Caribbean men have the highest rates of current smoking among all ethnic groups in the United Kingdom while nearly all South Asian and black African women are never-smokers. Varied genetic and lifestyle-related risk factors and their interactions seem to be responsible for the ethnic differences in CVD risk factors. There is a clear need for ethnic-specific guidelines for diagnosis and treatment of major CVD risk factors to maximize the outcomes of preventive strategies.

A major diagnostic challenge for cardiologists is to distinguish cardiac syndrome X (CSX) from obstructive coronary artery disease in women with typical angina and a positive exercise tolerance test (ETT). We performed this study to develop a scoring system that more accurately predicts CSX in this patient population. Data on 976 women with typical angina and a positive ETT who underwent coronary angiography at our center were randomly divided into derivation and validation datasets. We developed a backward stepwise logistic regression model that predicted the presence of CSX, and a scoring system was derived from it. The derivation dataset (809 patients) was calibrated by uing a Hosmer-Lemeshow goodness-of-fit test (8 degrees of freedom; χ2=12.9; P=0.115), and the area under the curve was 0.758. The validation dataset (167 patients) was calibrated in the same way (8 degrees of freedom; χ2=9.0; P=0.339), and the area under the curve was 0.782. Independent predictors of CSX were age 9.5 was the optimal cutoff point for differentiating CSX from obstructive coronary artery disease. Our proposed scoring system is a simple, objective, and accurate system for distinguishing CSX from obstructive coronary artery disease in women with typical angina and positive ETTs. It may help determine which of these patients need invasive coronary angiograms or noninvasive tests like computed tomographic coronary angiography.

In this protocol, we aimed to show the step-by.step procedures used to develop, evaluate and validate (CVD) risk charts.

Cardiovascular disease (CVD) and cancer are leading causes of mortality and morbidity worldwide. Strategies to improve their treatment and prevention are global priorities and major focus of World Health Organization's joint prevention programs. Emerging evidence suggests that modifiable risk factors including diet, sedentary lifestyle, obesity and tobacco use are central to the pathogenesis of both diseases and are reflected in common genetic, cellular, and signaling mechanisms. Understanding this important biological overlap is critical and may help identify novel therapeutic and preventative strategies for both disorders. In this review, we will discuss the shared genetic and molecular factors central to CVD and cancer and how the strategies commonly used for the prevention of atherosclerotic vascular disease can be applied to cancer prevention.

We aimed to compare the accuracy of a novel index defined by us, as a ratio of Sagittal abdominal diameter (SAD) and triceps skinfold thickness (TSF) with other indices of adiposity for prediction of presence, severity and extension of premature coronary artery disease (CAD).A cross-sectional study was conducted on 238 younger patients (females55 years; males45 years) who underwent coronary angiography. Anthropometric indices including TSF, SAD, waist circumference, and hip circumference were measured before catheterization and body mass index, waist-to-hip ratio, abdominal diameter index, index of central obesity as well as our proposed index, SAD-to-TSF ratio, were calculated accordingly. Evaluation of severity and extension of coronary stenosis was by Gensini score and extent score, respectively.After adjustment for age and sex in multivariate regression models, the SAD-to-TSF ratio was the best predictor for the presence (OR = 2.49, 95% CI = 1.44-4.30; p = 0.001) and extension (β = 1.10, p = 0.004) of premature CAD. TSF and the SAD-to-TSF ratio were the only indices that significantly predicted the Gensini score and the correlation remained significant even after adjustment for age and sex (β = -7.28, p0.0001 and β = 3.76, p0.0001, respectively).We showed that our proposed index, SAD-to-TSF ratio, has a substantially better accuracy than do the known indices of obesity like body mass index, waist circumference, and waist-to-hip ratio for the prediction of premature CAD. Furthermore, our index was the only index that positively correlated with the severity of premature CAD.

BACKGROUND We performed this study to evaluate the possible synergism between hypertension and other conventional risk factors of coronary artery disease (CAD) on an angiographic severity of coronary atherosclerosis. METHODS A cross-sectional study was conducted on 10502 consecutive patients who underwent coronary angiography in the cardiac catheterization laboratory of Tehran Heart Center Hospital (Tehran University of Medical Sciences, Iran), and their conventional risk factors including male gender, hypertension, diabetes mellitus (DM), dyslipidemia, smoking, and family history of premature CAD were recorded. The severity of coronary atherosclerosis evaluated by calculation of Gensini’s score. RESULTS All aforementioned conventional risk factors of CAD were independently associated with severity of CAD. Multivariate linear regression analysis demonstrated that hypertension had synergistic effect with male gender [Excess Gensini’s score: 5.93, 95% confidence interval (CI): 2.72-9.15, P < 0.001] and also with DM (Excess Gensini’s score: 3.99, 95% CI: 0.30-7.69, P = 0.034) on severity of CAD. No interaction was observed between hypertension and smoking, dyslipidemia and also with a family history of CAD. CONCLUSION Hypertension has a synergistic effect with DM and male gender on the severity of CAD. These findings imply that more effective screening and treatment strategies should be considered for early diagnosis and tight control of hypertension in male and diabetic people for prevention of advanced CAD.

We evaluated the association between socioeconomic status (SES) and incident cardiovascular disease (CVD) in a sample of the Iranian population.We followed 6,504 participants who were initially free from CVD. At baseline, subjects were assessed for CVD risk factors and self-reported data were obtained for education, occupation, and income.After 24,379 person-years of follow-up (median = 4.8 years), 276 incident cases of CVD were detected. There was no significant association between the level of education and the incidence of CVD. In univariate analysis, retired individuals showed a significantly higher incidence of CVD than individuals who were working, and subjects in the highest tertile of income were less likely to suffer CVD than those in the lowest tertile. However, the associations disappeared after adjusting for age and sex.There was no detectable, independent association between the SES and incident CVD. The counterbalance of the higher exposure to CVD risk factors and better access to health-care services and more appropriate risk factor modification in higher socioeconomic classes might diminish the association of SES and CVD in developing countries.

There is conflicting data regarding visfatin in gestational diabetes mellitus (GDM). The aim of the present study was to compare serum visfatin levels between patients with GDM and subjects with normal pregnancy and to evaluate its relationship with dietary intake and components of insulin-resistance syndrome.Thirty-five patients with GDM (aged 31 ± 0.8 years, BMI = 29.6) and 35 age- and body mass index-matched healthy pregnant women (aged 29 ± 0.7 years, BMI = 28.6) between 24 and 28 weeks of gestation were studied. In addition to anthropometric and dietary intake assessments, measurements of fasting plasma levels of visfatin, glucose, insulin, hemoglobin A1c (HbA1c) and lipid profile were performed for all subjects.Plasma visfatin levels were significantly lower in pregnant women with GDM compared to healthy subjects (5.29 ± 0.47 vs. 7.76 ± 0.53, p = 0.001). After adjustment for age, maternal gestational age, body mass index, and macronutrients intake, GDM remained the independent predictor of serum visfatin concentrations (β = -1.2, p = 0.001). Serum visfatin levels were significantly correlated with log HbA1c values (r = -0.24, p = 0.03), even after adjustment for age and body mass index (β = -6.45, p = 0.05). No associations between visfatin and other parameters of the insulin-resistance syndrome as well as macronutrient intake were detectable.Plasma visfatin concentrations are lower in patients with GDM and related to glycemic control reflected by HbA1c. Furthermore, visfatin does not seem to be correlated with dietary intake in pregnant women.

There is growing clinical interest in liver transaminases as novel biomarkers of cardiovascular risk. We investigated the possible association of serum liver transaminase activity with the presence and angiographic severity of premature coronary artery disease (CAD). A cross-sectional study was conducted on 187 younger patients (females

Opium is the second-most-commonly abused substance (after tobacco) in developing countries of the Middle East region, and in many Asian nations. One of the reasons for the high prevalence of opium abuse in these countries is a traditional belief among Eastern people, even including some medical staff, that opium might have beneficial effects on cardiovascular health and in the control of diabetes mellitus, hypertension, and dyslipidaemia. In this Perspectives article, we summarize the current understanding of the pharmacotoxicology of opium and its specific effects on glycaemic control, blood pressure, lipid profile, and atherosclerosis. On the basis of the available evidence, we believe not only that opium has no ameliorating effect on cardiovascular diseases, but also that the use of this drug might have adverse effects on these conditions. Therefore, people should be educated about the hazardous effects of opium consumption on cardiometabolic diseases.

Compared to the normal population, patients with congestive heart failure are at higher risk for contrast-induced nephropathy. A variety of interventions are suggested to reduce the risk for contrast-induced nephropathy. Unfortunately results of none of current protective treatments are satisfactory. Apelin a vasodilator adipocytokine, positively inotropic agent, and free radical scavenger has been recently introduced. It has been shown that endogenous apelin levels are decreased in patients with congestive heart failure. Two major mechanisms have been suggested for pathophysiology of contrast induced nephropathy including reactive oxygen species production and impaired renal perfusion due to vasoconstriction. Pretreatment with recombinant apelin (exogenous apelin-13), could compensate decreased endogenous apelin serum levels of congestive heart failure patients. Its antioxidant and cell-protective properties, decrease nephrotoxicity of contrast agent; additionally impaired renal perfusion due to malfunction of cardiac pump will refurbish, because of positively inotropic property of apelin plus its vasodilatation effect in renal arteries. We believe that the triangle of increased contractility, decreased vascular resistance and decreased contrast agent nephrotoxicity could significantly reduce risk of contrast-induced nephropathy in patients with congestive heart failure.

The aim of the present study was to compare the levels of visfatin in portal and systemic circulations and to assess the possible relationship of visfatin with systemic inflammation and insulin resistance in morbidly obese patients undergoing bariatric surgery. A total of 46 morbidly obese patients (BMI = 45.3 ± 5.3 kg/m(2)) undergoing bariatric surgery were included in this study. Blood samplings were performed simultaneously from portal and systemic veins during surgery. Visfatin was measured in both portal and systemic venous samples. Besides, fasting serum levels of insulin, glucose, lipid profile, visfatin, and hs-CRP were determined in systemic venous blood samples. Insulin sensitivity was estimated using the homeostasis model assessment of insulin resistance (HOMA-IR). Visfatin concentrations were significantly higher in portal vein than systemic veins (11.9 ± 12.1 vs. 5.1 ± 3.3 ng/ml, p < 0.0001). While systemic levels of visfatin were significantly correlated with circulating levels of hs-CRP (r = 0.527, p < 0.0001), there were no significant correlations between portal levels of visfatin with systemic levels of hs-CRP concentrations. Substantially higher levels of visfatin in portal vein than systemic veins provide evidence that visceral adipose tissue is the major secretory source of visfatin in humans. Our findings underscore that visceral adipose tissue is an active endocrine organ that is involved in the complex interrelationship between obesity and pathologic conditions.

The aims of this study were to evaluate the short-term effects of laparoscopic restrictive bariatric surgery (LRBS) on plasma levels of vaspin and the potential associations of changes in vaspin levels with changes in anthropometric indices, insulin-resistance and dietary intake. Thirty, severely obese subjects (21 female; mean age, 32.5 years) with a mean body mass index (BMI) of 44.1 ± 4.9 kg/m(2) underwent LRBS. Measurements of anthropometric indices, dietary intakes, physical activity and plasma vaspin concentrations were performed prior to, and six weeks after LRBS. Insulin-sensitivity was estimated using the homeostasis model assessment of insulin-resistance (HOMA-IR). Six weeks after LRBS, BMI decreased to a mean of 38.4 ± 4.9 kg/m(2). Significant reductions were also observed in waist circumference (WC), daily intakes of calorie, fat and protein, and plasma concentrations of triglyceride. No significant change was observed in fasting levels of insulin, blood sugar or HOMA-IR. Vaspin decreased significantly (0.26 ± 0.17 vs 0.36 ± 0.20, p=0.048) following surgery. While the percentage change of vaspin was not correlated with percent changes in anthropometric indices and HOMA-IR, it correlated positively with the percentage change in intake of calories, fat and protein: this correlation remained significant even after adjustment for sex and changes in WC and HOMA-IR. Our study suggests that LRBS decreases the serum vaspin concentrations in parallel with the restriction of dietary intake. Furthermore, decreased levels of vaspin early after LRBS seem more likely to result from decreased dietary intake rather than weight-loss-induced insulin sensitivity improvement.

Objectives To assess contemporary data on characteristics, management and 1-year postdischarge outcomes in Iranian patients hospitalised with acute coronary syndrome (ACS). Setting 11 tertiary care hospitals in 5 major cities in the Islamic Republic of Iran. Participants Patients aged ≥20 and ≤80 years discharged alive with confirmed diagnosis of ACS including ST-segment elevation myocardial infarction (STEMI), non-STEMI (NSTEMI) and high-risk unstable angina (HR-UA). Primary and secondary outcome measures Patients were followed up regarding the use of medications and the end points of the study at 1 month and 1 year after discharge. The primary end point of the study was 1-year postdischarge major adverse cardiac and cerebrovascular events (MACCEs), defined as mortality (cardiac and non-cardiac), ACS and cerebrovascular attack (stroke and/or transient ischaemic attack). The secondary end points were hospital admission because of congestive heart failure, revascularisation by coronary artery bypass grafting surgery or percutaneous coronary intervention (PCI), and major and minor bleeds. Results A total of 1799 patients (25.7% STEMI and 74.3% HR-UA/NSTEMI) discharged alive with confirmed diagnosis of ACS were included in the final analysis. During hospitalisation, the majority of the patients received aspirin (98.6%), clopidogrel (91.8%), anticoagulants (93.4%), statins (94.3%) and β-blockers (89.3%). Reperfusion therapy was performed in 62.6% of patients with STEMI (46.3% thrombolytic therapy and 17.3% primary PCI). The mean door-to-balloon and door-to-needle times were 82.9 and 45.6 min, respectively. In our study, 64.7% and 79.5% of the patients in HR-UA/NSTEMI and STEMI groups, respectively, underwent coronary angiography. During the 12 months after discharge, MACCEs occurred in 15.0% of all patients. Conclusions Our study showed that the composition of Iranian patients with ACS regarding the type of ACS is similar to that in developed European countries and is unlike that in developing countries of the Middle East and Africa. We found that our patients with ACS are treated with high levels of adherence to guideline-recommended in-hospital medications.

There is a traditional belief among Eastern people that opium may have ameliorating effects on cardiovascular risk factors, especially diabetes; thus, it is widely used among diabetic patients. We attempted to investigate the association of opium consumption with coronary artery disease (CAD) in diabetic patients. A cross-sectional study was conducted on diabetic patients undergoing coronary angiography in our center. Out of 1925 diabetic patients included in the study, 228 were opium users, and the remaining 1697 non-opium users were used as a pool of potential comparators. Propensity scores were used to match the 228 opium consumers with 228 matched comparators for age, sex, and smoking status. The Gensini score and extent score were respectively used to assess the angiographic severity and extent of CAD. The mean Gensini score (86.9 ± 62.7 vs. 59.6 ± 43.4, p < 0.0001) and extent score (7.1 ± 2.9 vs. 5.9 ± 2.9, p < 0.0001) were significantly higher in opium user diabetic patients than in non-opium users. After adjustment for potential confounders, a dose-response relationship was observed between dose of opium and the Gensini score ( β = 0.27, p = 0.04). There were no significant differences between the routes of opium administration (inhalation vs. oral) regarding the severity and extent of CAD. In conclusion, exposure to opium in diabetic patients may be positively associated with the risk of CAD, and with the angiographically determined severity and extent of the disease. Furthermore, dosage of opium consumption may correlate with severity of CAD.

Indices of ventricular repolarization heterogeneity are associated with future arrhythmias and sudden cardiac death. We investigated the effect of exercise-based cardiac rehabilitation (CR) on these indices in a sample of Iranian patients.Patients (N 122), who had undergone coronary artery bypass surgery (CABGS), were enrolled in this cohort study. Sixty patients attended 15 or more sessions of CR (CR group) and the remaining 62 patients attended 5 or fewer sessions of CR (control group). A standard 12-lead electrocardiogram was recorded for each patient. QT interval dispersion (QTd), RR interval variability (RRV), and heart rate-corrected QTd (QTc-d) were measured 3 times as follow: just before surgery, at the beginning of the first session of the CR program, and at the end of the 15th session for the CR group or the last session for the control group.Following completion of the exercise-training program, the CR group showed a significant decrease in QTd (Δ = -49.4%, P.0001) and QTc-d (Δ = 52.8%, P .0001), but not in the control group (Δ = 13.4% and 17.9%, respectively, P.05 for both). In both groups, no statistically significant change in RRV was observed. After adjustment for variables such as age, gender, digoxin use, β-blocker use, and prerehabilitation ejection fraction, CR remained the independent predictor of QTd and QTc-d.Results suggest that cardiac rehabilitation and exercise training programs significantly improve the indices of ventricular repolarization heterogeneity in patients with coronary artery disease who received CABGS.

Assessment of the hemodialysis adequacy is one of the key factors in evaluating health service system. This would provide a good background for effective future planning by healthcare authorities. In this study, we aimed to evaluate the hemodialysis adequacy in Iran.One hundred and twenty-seven hemodialysis centers affiliated to 30 medical universities in Iran participated in this cross-sectional multicenter national study. All demographic data as well as hemodialysis prescription data, including blood flow rate, length of the hemodialysis session, hemodialysis membrane type, and composition of the dialysis solution were recorded for each patient. In addition, urea reduction ratio and Kt/V were calculated to determine the hemodialysis adequacy.A total of 4004 patients were included in this study, 2345 men (58.6%) and 1659 women (41.4%). Bicarbonate-based solutions and low-flux membranes were prescribed for 77.0% and 97.6% of the patients, respectively. The mean blood flow rate was 242.9 ± 39.2 mL/min. The mean length of hemodialysis session was 229.2 ± 22.2 minutes. The mean urea reduction ratio and Kt/V were calculated to be 61.0 ± 11.8% and 1.2 ± 0.4, respectively. A Kt/V less than 1.2 and a urea reduction ratio less than 65% were found in 56.7%, and 65.2% of the hemodialysis patients, respectively.This study showed a substantial inadequate hemodialysis in Iran as compared with the Kidney Disease Outcomes Quality Initiative guidelines. Considering the impact of dialysis adequacy on quality of life and survival rates, as well as healthcare costs, rigorous attempts to achieve the desired goals are necessary.

Background Patients with diabetes mellitus (DM) and chronic kidney disease (CKD) constitute to be a high-risk population for the development of contrast-induced nephropathy (CIN), in which the incidence of CIN is estimated to be as high as 50%. We performed this trial to assess the efficacy of N-acetylcysteine (NAC) in the prevention of this complication. Methods In a prospective, double-blind, placebo controlled, randomized clinical trial, we studied 90 patients undergoing elective diagnostic coronary angiography with DM and CKD (serum creatinine ≥ 1.5 mg/dL for men and ≥ 1.4 mg/dL for women). The patients were randomly assigned to receive either oral NAC (600 mg BID, starting 24 h before the procedure) or placebo, in adjunct to hydration. Serum creatinine was measured prior to and 48 h after coronary angiography. The primary end-point was the occurrence of CIN, defined as an increase in serum creatinine ≥ 0.5 mg/dL (44.2 μmol/L) or ≥ 25% above baseline at 48 h after exposure to contrast medium. Results Complete data on the outcomes were available on 87 patients, 45 of whom had received NAC. There were no significant differences between the NAC and placebo groups in baseline characteristics, amount of hydration, or type and volume of contrast used, except in gender (male/female, 20/25 and 34/11, respectively; P = 0.005) and the use of statins (62.2% and 37.8%, respectively; P = 0.034). CIN occurred in 5 out of 45 (11.1%) patients in the NAC group and 6 out of 42 (14.3%) patients in the placebo group (P = 0.656). Conclusion There was no detectable benefit for the prophylactic administration of oral NAC over an aggressive hydration protocol in patients with DM and CKD. Trial registration NCT00808795

About 40% of women with typical angina and positive exercise tolerance test (ETT) have normal coronary angiographies. We performed this study to construct a scoring system for better distinguishing patients with cardiac syndrome × (CSX) than those with obstructive coronary artery disease (CAD)