BACKGROUNDResistin and oxidative stress may play a role in the pathogenesis of coronary heart disease (CHD) including acute coronary syndrome (ACS). The aim of this study was to investigate the role of serum resistin and prooxidant-antioxidant balance (PAB) in ACS occurrence in order to differentiate it from stable angina. Moreover, we aimed to determine the correlation between resistin and PAB in patients with ACS and its difference from patients with stable CHD.METHODSThis cross-sectional, descriptive study was conducted on 50 patients with ACS and 50 patients with stable CHD who underwent coronary angiography (CAG). Serum resistin level was measured using enzyme-linked immunosorbent assay (ELISA). PAB and other variables were analyzed using standard methods.RESULTSA significant increase in serum resistin and PAB was observed in patients with ACS (2.55 ± 0.13 ng/ml and 123.5 ± 5.58 HK unit, respectively) compared to patients with stable CHD (1.53 ± 0.12 ng/ml and 95.9 ± 2.7 HK unit, respectively) (P < 0.001). In addition, a significant positive correlation was seen between serum resistin and PAB in patients with ACS (r = 0.39; P = 0.005), but this correlation was not found in patients with stable CHD (r = 0.21; P = 0.140). Resistin (r = 0.52; P < 0.001) and PAB (r = 0.55; P < 0.001) were significantly associated with high-sensitivity C-reactive protein (hs-CRP) in patients with ACS, but this association was not found in patients with stable CHD (resistin: r = 0.24; P = 0.090; PAB: r = -0.02: P = 0.910).CONCLUSIONHigh serum resistin or PAB levels, and their association with the occurrence of ACS, can be used as a robust discriminating factor to differentiate ACS from stable CHD.

BACKGROUNDSome recent studies reported an inverse association between obesity and risk of cardiovascular diseases (CVD), heart failure related mortality rate, outcomes of myocardial infarction (MI), and the consequences of cardiovascular events interventions; this inverse association was named the obesity paradox. The present study was conducted with the aim to determine whether the obesity paradox will be detectable when the 10-year risk of CVD is estimated using CVD risk assessment tools.METHODSThe related data of 2910 subjects aged 40-74 years obtained in our cohort study that was carried out among 6140 subjects in Amol, in northern Iran, was included in this study. CVD risk assessment tools were used to estimate the 10-year risk of CVD. Obesity was evaluated using 4 indices, including waist circumference (WC), waist to height ratio (WHtR), waist to hip ratio (WHR), and body mass index (BMI). The receiver operating characteristic (ROC) curve analysis was utilized to evaluate the discriminatory power of obesity indices for 10-year risk of CVD.RESULTSCategorizing the participants to with and without obesity according to BMI showed that a significantly higher proportion of men with obesity had a 10-year risk of CVD ≥ 7.5% and ≥ 10% according to American College of Cardiology/American Heart Association (ACC/AHA) and the Framingham approaches, respectively. A higher proportion of women without obesity had a 10-year risk of CVD ≥ 7.5% than women with obesity based on the ACC/AHA equation (28.54% vs. 24.15%; P = 0.0707). BMI had a non-significant AUC (< 0.5) according to the the ACC/AHA equation.CONCLUSIONBMI showed a weak and non-significant inverse association with 10-year risk of CVD estimated using pooled cohort equations of ACC/AHA in women. However, this result cannot directly provide enough evidence for the obesity paradox.

BACKGROUNDCardioplegia is one of the main post-operative cardiac protective factors widely used in recent decades in the form of crystalloid (St. Thomas) and bloody solutions [del Nido (DN)]. The purpose of this study was to compare the effect of a crystalloid cardioplegic agent (St. Thomas) with that of a bloody cardioplegic agent (DN) in pediatric cardiac surgery among children with Tetralogy of Fallot (TOF).METHODSThis study was performed on 60 children with TOF, who were candidates for heart repair surgery. The participants were randomly divided into two groups of crystalloid cardioplegic agent and bloody cardioplegic agent. Operative outcomes such as required time for onset of heart arrest, duration of returning to normal heart rhythm, and cardiopulmonary bypass (CPB) time, and operative complications were compared between the two groups.RESULTSThe duration of returning to normal heart rhythm (50.43 ± 10.93 seconds vs. 43.03 ± 16.35 seconds; P = 0.044) and duration of inotropy (80.40 ± 27.14 hours vs. 63.20 ± 26.91 hours; P = 0.017) were significantly higher in the DN group compared to the St. Thomas group. However, there were no significant differences between the two groups in terms of heart arrest time, cross-clamp time, CPB time, supplementary lasix time, duration of intubation, and intensive care unit (ICU) and hospital length of stay (LOS) (P > 0.050).CONCLUSIONThe use of St. Thomas cardioplegic solution was more effective in reducing the duration of returning to normal heart rhythm and inotropy compared with DN cardioplegic agent, and a single dose of these two cardioplegic agents can keep the mean cardiac arrest duration within the range of 50-70 minutes. It seems that the use of St. Thomas cardioplegic solution can be suggested in pediatric heart surgery.

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BACKGROUNDHeart failure (HF) resulted from ultimate pathway of many cardiovascular diseases (CVDs) or as a separate entity poses a considerable increasing prevalence and economic burden, but its registry for better management is less frequently done. In this study, we aimed to design and implement HF registry.METHODSPersian Registry Of cardioVascular diseasE (PROVE) was initiated from March 2015 and continuously collected information of patients suffering from HF, ST-elevation myocardial infarction (STEMI), atrial fibrillation (AF), percutaneous coronary intervention (PCI), stroke, familial hypercholesterolemia (FH), congenital heart disease (CHD), chronic ischemic cardiovascular disease (CICD), and acute coronary syndrome (ACS) from 18 different cardiac centers. Data of patients with HF were collected from their medical forms and recorded in a registry system of PROVE/HF plus telephone follow-up survey of 1, 6, and 12 months after the date of HF attack.RESULTSAssessment of all related questions led to definition of a final questionnaire including 27 items regarding demographic information, underlying disorders and their complications, patients’ symptoms and signs, and laboratory and relevant para-clinic data at admission time, during hospitalization, and post discharge. Follow-up information was mostly based on patients’ general status and medication usage.CONCLUSIONPROVE execution was a successful and hopeful project providing data of major CVDs in order to design appropriate preventive actions and better management and treatment strategies plus a valuable data center being utilized in multiple future comprehensive projects.

BACKGROUNDAcute coronary syndrome (ACS) is a common condition that needs appropriate treatment like percutaneous coronary intervention (PCI). Glycoprotein IIb/IIIa inhibitors (GPI) like eptifibatide prevent procedural ischemic complications after PCI. Eptifibatide has increased the risk of bleeding complications, although it is effective in reducing mortality and morbidity. Eptifibatide is routinely used in bolus and infusion forms and the aim of this study is to evaluate the efficacy of bolus-only dose and bolus + infusion strategy for administrating eptifibatide in bleeding complications and consequences after PCI.METHODSThis randomized clinical trial was conducted on subjects who experienced PCI after incidence of myocardial infarction (MI). Patients were randomly divided into two groups who received bolus-only dose (n = 51) or bolus + infusion form of eptifibatide (n = 50). Then, PCI blood pressure, mean time duration of hemostasis after arterial sheath removal, laboratory data, need for blood transfusion, and presence of bleeding complications were evaluated. After 6 months, patients were followed for needs for additional coronary interventions.RESULTSThe mean age of participants was 61.68 ± 1.50 years. The prevalence of men was 70.29%. There was no significant difference in mean of systolic blood pressure (SBP) and diastolic blood pressure (DBP) during hospitalization (P > 0.050). The mean time duration of hemostasis was 8.13 ± 0.45 minutes in the bolus-only group and 16.46 ± 0.71 minutes in the bolus + infusion group (P < 0.001). There was no significant difference in the hemoglobin (Hb) level, platelet count, white blood cell (WBC), blood urea nitrogen (BUN), and creatinine level (P > 0.050).CONCLUSIONThe results of this study suggested that bolus-only dose of eptifibatide before PCI could be able to decrease significantly bleeding complication and other clinical and cardiovascular outcomes.

BACKGROUNDLow health literacy can act as a barrier to effective disease self-management. The study aimed to promote heart health literacy in Iranian society.METHODSThis study was conducted as a participatory action research (PAR) based on Zuber-Skerritt Model to design and implement a program for promoting heart health literacy in Iranian society. Participants were selected among adults with heart diseases and their family members, as well as their health care providers in Chamran Hospital, Isfahan Heart Friends association and researchers, and Isfahan Cardiovascular Research Institute, Isfahan, Iran. Data collection was conducted using interviews. Content analysis was used to analyze the data to promote heart health literacy. Promoting of heart health literacy was implemented in different levels in Isfahan from March 2017 to October 2017. The effect of the program was evaluated based on interviews, feedback, and focus groups at the individual level.RESULTSFinally, at the World Heart Week, a healthy heart campaign was formed with the slogan "Share the power". At the end of this program, participants experienced significant empowerment during the project to promote heart health literacy. The three main themes indicating this feeling of empowerment were “Being worried about the hearts of others”, “Sensitization to the care of the heart”, and “General understanding of heart health”.CONCLUSIONPAR can be an effective way to promote heart health literacy in Iranian society. It integrates the voices of the marginalized group promoting heart health literacy in Iranian society.

BACKGROUNDManagement of atrial fibrillation (AF), besides prevention of stroke, mainly stresses symptom control and improvement of quality of life (QOL). In patients with permanent AF, exercising may improve QOL, rhythm, and symptoms. The purpose of this study was to determine the impact of aerobic physical rehabilitation on the QOL of patients suffering from AF and admitted to a coronary care unit (CCU).METHODSThis randomized controlled clinical trial study was conducted on 50 patients who were hospitalized with chronic AF in the CCU of Montazeri Hospital, Najafabad, Iran, and had the inclusion criteria. The participants were selected using convenience sampling method, and were randomly divided into experimental (n = 25) and control (n = 25) groups. The experimental group received a rehabilitation program in the form of an educational package and scheduled physical activity of aerobics for 8 weeks, and the control group received CCU routine care. The researcher measured the patients’ QOL before and after the intervention using the 36-Item Short Form Health Survey (SF-36).RESULTSThere was no significant difference in the mean score of total QOL between the control and experimental groups before the intervention (P > 0.050). However, the comparison of the mean score of total QOL after the intervention showed a significant increase in the experimental group (P < 0.050).CONCLUSIONAerobic rehabilitation activities are effective on the QOL of patients with chronic AF.

BACKGROUNDHeart rate variability (HRV) declines after coronary artery bypass grafting (CABG). The purpose of this study was to evaluate the effect of low-volume high-intensity interval training (LV-HIIT) and moderate-intensity continuous training (MICT) on HRV as well as, hemodynamic and echocardiography indices.METHODSForty-two men after CABG (55.12 ± 3.97 years) were randomly assigned into LV-HIIT, MICT, and control (CTL) groups. The exercise training in LV-HIIT consisted of 2-minute interval at 85-95 percent of maximal heart rate (HRmax), 2-minute interval at 50% of HRmax and 40-minute interval at 70% of HRmax in MICT for three sessions in a week, for 6-weeks. HRV parameters were evaluated by 24-hour Holter electrocardiography (ECG) recording, and echocardiography parameters at baseline and end of intervention were measured in all 3 groups.RESULTSAt the end of the intervention, left ventricular ejection fraction (LVEF) significantly increased in LV-HIIT group (58.53 ± 7.26 percent) compared with MICT (52.26 ± 7.91 percent) and CTL (49.68 ± 7.27 percent) groups (P < 0.001). Furthermore, mean R-R interval, root mean square successive difference (RMSSD) of R-R interval, and standard deviation of R-R interval (SDRR) in LV-HIIT group considerably increased compared with MICT group (P < 0.001). High-frequency power (HF) significantly increased in LV-HIIT and MICT groups compared with CTL group (P < 0.001). On the other hand, low frequency (LF) and LF/HF ratio significantly decreased in LV-HIIT group in comparison with MICT group (P < 0.010).CONCLUSIONThese results suggest that LV-HIIT has a greater effect on improvement of cardiac autonomic activities by increasing R-R interval, SDRR, RMSSD, and HF, and decreasing LF and LF/HF ratio in patients after CABG.

BACKGROUNDHypofibrinogenemia is an independent factor of excessive bleeding after congenital cardiac surgeries. Fresh frozen plasma (FFP) and fibrinogen concentrate are examples of recommended products for management of hypofibrinogenemic bleedings. Unfortunately, there is no study to compare these treatments in pediatric cardiac surgeries. Therefore, this study aimed to compare the effect of fibrinogen concentrate with FFP on postoperative bleeding and clinical outcome after congenital cardiac surgeries in pediatric population.METHODSPhis prospective clinical trial study was carried out on 90 consecutive pediatric patients who underwent congenital cardiac surgeries. The eligible pediatrics who met our study criteria, randomly received FFP (10 ml/kg) or fibrinogen concentrate (70 mg/kg) to assess postoperative bleeding and blood-products requirements.RESULTSEach of FFP and fibrinogen concentrate significantly reduced total chest tube drainage (CTD) at 3, 6, 12, and 24 postoperative hours (P = 0.04). The analysis of time*intervention revealed that our intervention (fibrinogen group) significantly reduced CTD more (P = 0.01). Moreover, fibrinogen group had a significantly higher plasma fibrinogen level in first 24 hours (P = 0.02).CONCLUSIONNowadays, both of fibrinogen concentrate and FFP product are widely used for management of hypofibrinogenic bleedings after cardiac surgeries. According to our results, we concluded that although the both product had a comparable effect on management of hypofibrinogenemic bleeding in pediatrics undergoing congenital cardiac surgeries, choosing better product depended on general condition of patients such as their body fluid status.