Cardiovascular Research Center Research Articles

Analysis of the survival time of patients with heart failure with reduced ejection fraction: a Bayesian approach via a competing risk parametric model

PurposeHeart failure (HF) is a widespread ailment and is a primary contributor to hospital admissions. The focus of this study was to identify factors affecting the extended-term survival of patients with HF, anticipate patient outcomes through cause-of-death analysis, and identify risk elements for preventive measures.MethodsA total of 435 HF patients were enrolled from the medical records of the Rajaie Cardiovascular Medical and Research Center, covering data collected between March and August 2018. After a five-year follow-up (July 2023), patient outcomes were assessed based on the cause of death. The survival analysis was performed with the AFT method with the Bayesian approach in the presence of competing risks.ResultsBased on the results of the best model for HF-related mortality, age [time ratio = 0.98, confidence interval 95%: 0.96–0.99] and ADHF [TR = 0.11, 95% (CI): 0.01–0.44] were associated with a lower survival time. Chest pain in HF-related mortality [TR = 0.41, 95% (CI): 0.10–0.96] and in non-HF-related mortality [TR = 0.38, 95% (CI): 0.12–0.86] was associated with a lower survival time. The next significant variable in HF-related mortality was hyperlipidemia (yes): [TR = 0.34, 95% (CI): 0.13–0.64], and in non-HF-related mortality hyperlipidemia (yes): [TR = 0.60, 95% (CI): 0.37–0.90]. CAD [TR = 0.65, 95% (CI): 0.38–0.98], CKD [TR = 0.52, 95% (CI): 0.28–0.87], and AF [TR = 0.53, 95% (CI): 0.32–0.81] were other variables that were directly related to the reduction in survival time of patients with non-HF-related mortality.ConclusionThe study identified distinct predictive factors for overall survival among patients with HF-related mortality or non-HF-related mortality. This differentiated approach based on the cause of death contributes to the estimation of patient survival time and provides valuable insights for clinical decision-making.

The Nakata index and McGoon ratio: correlation with the severity of pulmonary regurgitation after the repair of paediatric tetralogy of Fallot.

Pulmonary regurgitation is the most common complication after the complete repair of tetralogy of Fallot, and severe pulmonary regurgitation after surgery requires pulmonary valve replacement. In this retrospective observational, cross-sectional study, we included a total of 56 children aged 6 years or younger who underwent complete repair of TOF at Shahid Rajaei Cardiovascular Medical and Research Center in Tehran, Iran. Preoperative dual-source computed tomography was used to measure the McGoon ratio and Nakata index. The patients were divided into two groups based on the severity of postoperative pulmonary regurgitation, as estimated by trans-thoracic echocardiography: the severe pulmonary regurgitation group and the non-severe pulmonary regurgitation group. The McGoon ratio and Nakata index were then compared between the two groups. When comparing the two groups, we found that the corrected right pulmonary artery diameter, main pulmonary artery diameter, and McGoon ratio in the non-severe pulmonary regurgitation group were higher than in the severe pulmonary regurgitation group. However, none of these differences were statistically significant. Additionally, other variables, including the corrected left pulmonary artery diameter and Nakata index, showed higher measurements in children with severe pulmonary regurgitation, but again, the differences were not statistically significant. This study indicates that pulmonary arteries diameter, Nakata index, and McGoon ratio were not significantly correlated with the severity of pulmonary regurgitation after the complete repair of tetralogy of Fallot.

Short-term outcomes following total correction of tetralogy of fallot in adult patients

ObjectivesTetralogy of Fallot (TOF) is a common congenital heart disease which should be corrected. The recommended time for the Tetralogy of Fallot Total Correction (TFTC) surgery is during the infancy for the possible difficulties during the surgery and the related issues. However, sometimes TOF is diagnosed and managed during the adulthood.MethodsThis study is a descriptive and retrospective one which included all patients who underwent TFTC at the age of 15-year and older in 10 years (between the years 2010 and 2020) to identify short-term (in-hospital mortality, ICU stay, postoperative bleeding, respiratory complications after the surgery such as pulmonary edema, pneumonia, etc.) and one-year (left ventricle ejection fraction (LVEF), right ventricle (RV) ejection fraction, the severity of tricuspid and aortic regurgitation after surgery) outcomes. All data were taken from medical records at Rajaie Cardiovascular Medical and Research Center. Data were analyzed using SPSS 22.Results94 patients with the mean ± SD age of 26.7 ± 9.6 years were enrolled. Most of them were male (59.6%) (P-value: 0.009). In-hospital mortality in our study were 5.3%. Tricuspid regurgitation (TR) was significantly resolved after the surgery (P-value: 0.006). Of 17 (18.1%) patients with small or hypoplastic pulmonary artery (PA) branches, 14 patients had acceptable PA branch size after surgery.ConclusionTFTC at an older age is safe with acceptable results. Age is not a contraindication for TFTC and surgery should be recommended if the patients are diagnosed with TOF in adulthood. Also, the TOF diagnosis should be considered in adult patients with suspicious signs and symptoms.

Diet quality partially mediates the association between ultraprocessed food consumption and adiposity indicators.

This study evaluated the potential role of overall diet quality in the associations between ultraprocessed food (UPF) consumption and adiposity indicators among Korean adults. Baseline data of participants (n = 4331) of the Cardiovascular and Metabolic Diseases Etiology Research Center (CMERC) cohort study were obtained. Dietary information was collected by a validated food frequency questionnaire. UPF was defined using the NOVA classification. Overall diet quality was assessed using the Korean Healthy Eating Index. Adiposity indicators included BMI, waist circumference, percentage body fat by bioimpedance, and visceral fat mass by whole-body dual-energy x-ray absorptiometry. Mediation analysis after adjustment for potential confounders was performed. UPF intake was associated with higher adiposity indicators after adjustment for confounders. The mediating effect of the Korean Healthy Eating Index on the relationship between UPF consumption and each adiposity indicator was 35.6% (95% CI: 4.9% to 255.9%) for BMI, 38.3% (17.9% to 132.1%) for waist circumference, 40.2% (8.3% to 259.4%) for percentage body fat, and 60.7% (-396.4% to 662.7%) for visceral fat mass. UPF consumption was positively associated with adiposity indicators, which were partially attributed to the overall diet quality. Further studies are needed to better understand the causal mechanisms of these associations.

Lower atrial fibrillation recurrence after ablation in general anesthesia - a danish nationwide registry study

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Copenhagen Cardiovascular Research Center, Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Denmark Introduction Atrial fibrillation (AF) is the most frequent cardiac arrythmia worldwide with increasing incidence and prevalence. Treatment with catheter ablation (CA) as rhythm control is more frequently used. Studies comparing different ablation methods and strategies, have not found any significant difference in durability and effect on AF recurrence. Whether use of conscious sedation (CS) or general anesthesia (GA) has any impact on AF recurrence, has yet to be determined. There is currently no general recommendation on sedation strategy for CA. Purpose To examine AF recurrence by CS or GA in CA. Method This nationwide retrospective registry study was conducted using large real-life data from Danish mandatory registries. All patients above 18 years of age, that underwent first-time CA for AF from January 1st 2010 to December 31st 2018, were identified and included at the date of ablation. Exposure of interest was type of anesthesia, and patients were stratified into CS or GA. Primary endpoint was recurrent AF after a 3-months blanking period, defined by a composite endpoint of first-reached endpoint of either use of antiarrhythmic drugs (AAD), AF-admission, electrical cardioversions or AF re-ablation. 5-year risk of recurrent AF was examined by the Aalen-Johansen estimator, taking the competing risk of death into account. The relative rates of recurrent AF by anesthesia type were examined by Cox proportional models using GA as refence. The analysis was adjusted for clinically important baseline characteristics including age, sex, diagnosis-to-ablation time, procedural year, body mass index, size of left atrium, parixysmal/persistent AF, heart failure, ischemic heart disease, chronic obstructive pulmonary disease, chronic kidney disease, hypertension and diabetes. Results The study cohort consisted of 7,889 patients, of which 6,402 underwent ablation in CS and 1,487 underwent ablation in GA. A total of 4,167 patients reached the primary endpoint. Admissions for AF was the predominant endpoint (2172, 52,1%) followed by use of AAD (993, 23,8%) and electrical cardioversion (684, 16,4%). 5-year cumulative incidence of recurrent AF was higher in the CS group with 53,9%, compared to 43,2% in the GA group (Figure 1). Multivariate cox proportional-hazard model showed increased hazard ratio of 1.26 (95% CI: 1.15 – 1.39) for the CS group compared to the GA group (Figure 2). Conclusion Small marginals are chased in optimizing outcome after AF ablation. Ablation method and strategy has yet to find significantly improvements in large cohorts and in long-term follow up. In this large nationwide study we found, that the risk of AF recurrence was markedly reduced with CA performed in GA compared to CS. Knowledge from this study suggests, GA could be the most preferable sedation strategy for CA.

Right Ventricular Function Indices at Rest and During Exercise in Hyperthyroid Patients: A Cross-sectional Study.

Since hyperthyroidism could be associated with right ventricular dysfunction, this study intended to investigate right ventricular (RV) function using strain echocardiography in hyperthyroid patients both at rest and in maximum-stress conditions. This cross-sectional study was conducted at Rajaie Cardiovascular Medical and Research Center, Tehran, Iran, from January 2019 to January 2020. All study participants completed a maximum treadmill exercise test, as well as a complete two-dimensional echocardiogram at rest and the peak of stress test. The data were analyzed using SPSS statistical software. The independent samples t test and Mann-Whitney U test were used for numerical, and the Chi square test was used for nominal variables. P<0.05 was considered statistically significant. The final analysis included 52 participants (26 subjects in each group). In a maximal stress situation, we found that among the RV function indices, RV global longitudinal strain (P=0.0001), systolic strain rate (P=0.0001), diastolic strain rate (P=0.0002), and tricuspid annular plane systolic excursion (P=0.019) werereduced significantly in the hyperthyroid patients compared to the control group. There was also a linear correlation between RV size and thyroid stimulating hormone (TSH) level (P=0.009, r=0.36). Moreover, we found a negative linear correlation between TSH level with maximum stress RV strain and diastolic strain rate (P<0.001). The findings of the present study revealed a significant change in RV function indices among hyperthyroid patients. Therefore, it highlights the necessity of early diagnosis and treatment of hyperthyroidism, as well as RV function evaluation in these patients.

Comparison of Perceived Self-efficacy, Benefits, and Barriers of Hypertension Control between Male and Female Patients Referred to Rajaie Cardiovascular Medical and Research Center in Tehran.

Hypertension is a health problem. The purpose of the present study was to compare perceived self-efficacy, benefits, and barriers of hypertension control between male and female patients. This cross-sectional study was carried out on 400 patients referred to Rajaie Cardiovascular Medical and Research Center in Tehran from August 2020 through March 2021. The convenience sampling method was used. The data collection tools consisted of a digital sphygmomanometer, a demographic form, and a researcher-made questionnaire of perceived benefits, barriers, and self-efficacy of hypertension control, whose validity and reliability were obtained. The mean age of the male and female patients was 54.02±12.93 years and 56.48±12.10 years, respectively. The mean score of perceived barriers in women was lower than that in men, and the mean perceived self-efficacy in women was higher than that in men (P<0.001). According to the regression test, history of smoking in men and family history of hypertension and age in women were predictors of perceived benefits. Further, occupation and history of smoking in men and education level, family history of hypertension, and history of smoking in women were predictors of perceived barriers. Additionally, marital status, education level, and disease duration in men and education level, family history of hypertension, history of smoking, and age in women were predictors of perceived self-efficacy (P<0.050). In men, the mean score of perceived barriers was higher and the mean score of perceived self-efficacy was lower. Additionally, the predictors of each of these perceptions were determined.

Impact of Bilingualism on the Cognitive Outcomes in Stroke Survivors: A Systematic Review (P4-12.005)

<h3>Objective:</h3> To examine existing evidence on the effect of bilingualism on cognitive outcomes in the stroke population. <h3>Background:</h3> Stroke is associated with an increased risk of vascular cognitive impairment. Bilingualism promotes cognitive reserve and resilience through the effect of language switching on the cognitive control systems and is suggested to delay cognitive impairment and dementia in non-stroke populations. However, the impact of bilingualism on cognitive outcomes in stroke patients has not been thoroughly examined. <h3>Design/Methods:</h3> We systematically reviewed published literature in medical databases that compared the cognitive assessment scores between mono-and bilingual stroke patients using cognitive assessment tool(s). We planned (1) a meta-analysis of outcome data using the subdomains of cognitive assessment tool(s); (2) a qualitative comparison if a meta-analysis was impossible. We assessed the study quality using the Joanna Briggs Institute tool. <h3>Results:</h3> Our literature search yielded 348 articles, and six were eligible for our systematic review (N=528 bilinguals; 737 monolinguals). One study was of good quality (Hope, 2015), and five were of moderate quality. We could not perform a meta-analysis because of disparate cohort characteristics and study methods, choice of cognitive tests, outcome measures, and lack of common data elements. Studies used one cognition and three language assessment batteries as cognitive assessment tools. In two studies, bilinguals performed better than monolinguals on cognitive tests (Paplikar, 2019; Alladi, 2016). On language assessment batteries, bilinguals performed better than monolinguals in four studies (Paplikar, 2019; Lahiri, 2020; Ardila, 2021; deLetter, 2021) and poorly in one study (Hope et al., 2015). ACE-R was significantly greater in bilinguals than monolinguals (Paplikar, 2019; Alladi, 2016). <h3>Conclusions:</h3> The current literature on the relationship between bilingualism and cognitive outcomes in stroke patients is sparse and insufficient. Harmonization of study methods (e.g., cognitive assessment tools) and common-data elements are critically needed to advance bilingualism research. <b>Disclosure:</b> Ms. Eldem has nothing to disclose. Mr. Misra has nothing to disclose. Dr. Quinn has nothing to disclose. Dr. Driskell has nothing to disclose. Dr. Perez has nothing to disclose. Dr. Carrión has nothing to disclose. Todd Constable has nothing to disclose. Dr. Schindler has received personal compensation for serving as an employee of Aeromics. Dr. Schindler has received personal compensation in the range of $50,000-$99,999 for serving as an officer or member of the Board of Directors for Aeromics. Dr. Schindler has received stock or an ownership interest from Aeromics. Dr. Schindler has received publishing royalties from a publication relating to health care. Dr. Zhao has nothing to disclose. Dr. Sico has nothing to disclose. Dr. Hinman has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Bertoldo, Baker, Carter &amp; Smith. Dr. Hinman has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Koskoff, Koskoff &amp; Bieder. Dr. Hinman has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Matthew Millea, PC. Dr. Hinman has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Popham Law Firm PC. Dr. Hinman has received stock or an ownership interest from Sage Cerebrovascular Diagnostics, Inc.. Dr. Hinman has received research support from NIH. Dr. Hinman has received research support from American Heart Association. Dr. Hinman has received research support from Reneuron. Dr. Hinman has received intellectual property interests from a discovery or technology relating to health care. Prof. Allore has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American College of Rheumatology. The institution of Prof. Allore has received research support from NIH. Prof. Allore has received personal compensation in the range of $500-$4,999 for serving as a DSMB member with NIH. An immediate family member of Prof. Kiran has received personal compensation for serving as an employee of Constant Therapy. Prof. Kiran has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for Academy of Aphasia. Prof. Kiran has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. Prof. Kiran has stock in Constant Therapy Health. The institution of Prof. Kiran has received research support from NIH. Jubin Abutalebi has nothing to disclose. Dr. Annoni has received personal compensation for serving as an employee of OMPharma, Switzerland . The institution of Dr. Annoni has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for CERC European Cardiovascular Research Centre . Dr. Mishra has nothing to disclose.

Ventricular tachycardia ablation in children

IntroductionThe ablation of ventricular tachycardia, including premature ventricular contractions, is an approved, albeit infrequent procedure in pediatric patients. Data are scarce regarding the outcomes of this procedure. The purpose of this study was to share a high-volume center experience and patient outcomes for catheter ablation of ventricular ectopy and ventricular tachycardia in pediatric population. MethodsData were retrieved from the institutional data bank. Outcomes over time were evaluated, and procedural details were compared. ResultsA total of 116 procedures were performed on 102 pediatric patients between July 2009 and May 2021 at the Rajaie Cardiovascular Medical and Research Center in Tehran, Iran. Ablation was not performed in 4 procedures (3.4%) due to high-risk substrates. Of the remaining 112 ablations performed, 99 (88.4%) were successful. However, one patient died due to a coronary complication. There were no significant differences observed in early ablation results based on patients' age, sex, cardiac anatomy, or ablation substrates (P > 0.05). Follow-up records were available for 80 procedures, and 13 (16.3%) of those experienced recurrence. During long-term follow-up, none of the variables mentioned above were statistically different between patients with or without arrhythmia recurrence. ConclusionThe overall success rate of pediatric ventricular arrhythmia ablation is favorable. We found no significant predictor for the procedural success rate concerning acute and late outcomes. Larger multicenter studies are needed to elucidate the predictors and outcomes of the procedure.

Ideal cardiovascular health metrics and the risk of nonalcoholic fatty liver disease in Korean adults

BackgroundThe association between cardiovascular risk factors and nonalcoholic fatty liver disease (NAFLD) is well established, but whether cardiovascular health (CVH) metrics is associated with NAFLD had not been fully studied. Thus, we examined the association between CVH metrics and NAFLD in the middle-aged Korean population.MethodsWe used data of 2,928 (851 men and 2,077 women) participants aged 30–64 years from the Cardiovascular and Metabolic Disease Etiology Research Center study. CVH metrics were measured using a modified version of Life’s Simple 7 by the American Heart Association. NAFLD diagnosis was based on the fatty liver index or liver-to-spleen ratio on computed tomography. A multiple logistic regression model was used to investigate the cross-sectional and longitudinal associations between CVH metrics and NAFLD.ResultsIn the cross-sectional analysis, the odds ratio for NAFLD was lower in participants with ideal CVH (odds ratio [OR], 0.13; 95% confidence interval [CI], 0.08–0.18), while it was higher in individuals with poor CVH (OR, 2.87; 95% CI, 2.13–3.86). Similarly, the risk of new-onset NAFLD was lower in participants with ideal CVH (OR, 0.28; 95% CI, 0.11–0.74), and higher in individuals with poor CVH (OR, 2.20; 95% CI, 0.50–9.72) in the longitudinal analysis of a subgroup.ConclusionsIdeal CVH was associated with a lower risk of NAFLD while poor CVH was associated with a higher risk of NAFLD. These findings suggest that making efforts to encourage people to manage their CVH to the ideal level may prevent and manage NAFLD.

PS-P09-5: DIET QUALITY PARTIALLY MEDIATES THE ASSOCIATION BETWEEN ULTRA-PROCESSED FOOD CONSUMPTION AND OBESITY

Objective: High consumption of ultra-processed food (UPF) is associated with an increased risk of obesity, which at least partly due to the poor nutritional profile of these foods. However, little is known about the magnitude of the direct and indirect effects of UPF consumption on obesity. Thus we evaluated whether the association between UPF consumption and obesity is mediated by overall diet quality. Design and method: This study is a cross-sectional analysis of the baseline data of adults aged 30–64 years (n = 6,894) which participated in the Cardiovascular and Metabolic Diseases Etiology Research Center (CMERC) cohort study. Dietary intake was assessed by a validated 112-items food frequency questionnaire. Using the NOVA food classification, 23 FFQ items were classified as UPF. Diet quality was assessed using the Korean Healthy Eating Index (KHEI) based on the 2015 Dietary Reference Intake for Koreans. Height, weight, and waist circumference (WC) were measured and body mass index (BMI, kg/m2) was calculated. Obesity was defined as ≧ 25.0 kg/m2. Abdominal obesity was defined as ≧ 90 cm for male and ≧ 85 cm for female. Single mediation models were used to estimate the mediating effect of UPF consumption (% kcal) on obesity, after adjusting for sex, age, research center, income, education, marital status, smoking, drinking, and sitting time. All analyses were performed using SAS version 9.4. Results: UPF accounted for 17.9% of total energy intake and the mean BMI and WC was 24.1 kg/m2 and 82.3 cm. The prevalence of obesity and abdominal obesity was 35.4% and 30.2%, respectively. UPF consumption (per 10% kcal increase) was associated with higher levels of BMI (0.13 kg/m2, P &lt; 0.001) and WC (0.39 cm, P &lt; 0.001), and also with higher odds of obesity (OR = 1.07, 10.1–1.13) and abdominal obesity (OR = 1.10, 1.04–1.17), after adjustment for confounders. The association of UPF consumption with BMI (14.3%, 95% CI: 1.9–26.8), WC (18.1%, 95% CI: 5.3–30.8), and abdominal obesity (20.9%, 95% CI: 6.0–35.8) were partially mediated by KHEI, but the association between UPF and overall obesity was not mediated by KHEI (17.2%, 95% CI: -1.1–35.4). Conclusions: Our findings suggest that the association between UPF consumption and obesity is partially, but not all, mediated by diet quality. Although our findings have a limitation on causal inference between UPF consumption and obesity, it may help understand the mediational structure between them and seek strategies for prevention of obesity.

Plasma Levels of High-sensitivity Cardiac Troponin I and Histopathological Findings in Heart Transplant Patients: A Single-center Cross-sectional Study

Abstract Introduction: This study aimed to evaluate the association between plasma levels of high-sensitivity cardiac troponin I (cTnI) in heart transplant patients and the grading of graft rejection. Methods: In a cross-sectional study, 92 biopsy samples from the patients who had undergone heart transplantation during 2022, at Rajaie Cardiovascular Medical and Research Center, the largest referral center in Tehran, Iran, were evaluated for heart transplant rejection. Transplant rejection grades, high-sensitivity troponin I plasma levels, and the relationship between them were assessed statistically. Results: Forty-two patients (mean age 37 ± 9.6 years, 26 (62%) male) were assessed. The mean transplant age was 3 ± 1.8 years. In terms of graft rejection, 30 (33%) biopsies showed Grade 1R and 4 (4%) showed Grade 2R. Quilty effect was observed in 43 (47%). The median (Q1–Q3) of the cTnI was 0.02 (0.02–0.75) and 43 (47%) had high troponin level (&gt;0.03 ng/mL). A positive association was observed between high cTnI and rejection (P = 0.025). Conclusion: The association between the troponin level and rejection grade suggested the considerable myocardial injury during the rejection process.

Presentation, Management and Early Mortality of Patients with Acute Coronary Syndrome in a Large Sample Study of a Middle East Country.

Due to lack of contemporary data on the presentation, management, and mortality of acute coronary syndrome (ACS) admissions in Iran, in this prospective registry study, we aimed to evaluate the presentation, management, and mortality as the outcome of patients with ACS in Isfahan, Iran, 2001-2016 to address treatment and healthcare depletions. Data of 62,276 patients admitted with the diagnosis of ACS from 2001 to 2016 prospectively were obtained by Surveillance Unit of Isfahan Cardiovascular Research Center, Isfahan, Iran, in 13 hospitals of Isfahan province. We evaluated data on presentation, management, and in-hospital and 28-day mortality. Nearly half of the patients ranged in age from 51 to 70 years (32050, 51.5%), which did not differ among ACS types (ST-segment myocardial infarction (STEMI): 53.9%; non-STEMI: 53.4%; unstable angina: 51.9%). In-hospital, anti-platelets use was high (84.9%). Thrombolytic were used in 48.1% of STEMI, 3.8% of non-STEMI, and 1.1% of unstable angina. Discharge medication rates were suboptimal. In-hospital and 28-day mortality were highest for STEMI (6.5 and 12.6%, respectively). These data represent the large ACS registry in Iran. Data revealed the various presentations of ACS and demonstrated opportunities for improving ACS management by focusing on increasing use of recommended drugs especially after discharge due to suboptimal medical treatment in these patients. The high mortality rate needs to be taken into consideration in ACS patients.

Diagnosis of Coronary Artery Disease based on Machine Learning algorithms Support Vector Machine, Artificial Neural Network, and Random Forest.

Coronary artery disease (CAD) is known as the most common cardiovascular disease. The development of CAD is influenced by several risk factors. Diagnostic and therapeutic methods of this disease have many and costly side effects. Therefore, researchers are looking for cost-effective and accurate methods to diagnose this disease. Machine learning algorithms can help specialists diagnose the disease early. The aim of this study is to detect CAD using machine learning algorithms. In this study, three data mining algorithms support vector machine (SVM), artificial neural network (ANN), and random forest were used to predict CAD using the Isfahan Cohort Study dataset of Isfahan Cardiovascular Research Center. 19 features with 11495 records from this dataset were used for this research. All three algorithms achieved relatively close results. However, the SVM had the highest accuracy compared to the other techniques. The accuracy was calculated as 89.73% for SVM. The ANN algorithm also obtained the high area under the curve, sensitivity and accuracy and provided acceptable performance. Age, sex, Sleep satisfaction, history of stroke, history of palpitations, and history of heart disease were most correlated with target class. Eleven rules were also extracted from this dataset with high confidence and support. In this study, it was shown that machine learning algorithms can be used with high accuracy to detect CAD. Thus, it allows physicians to perform timely preventive treatment in patients with CAD.

Cardio-Oncology in Iran: Cardio-toxicity Registry

Advances in cancer treatment have resulted in a growing number of cancer survivors. However, powerful treatments such as chemotherapy, radiation treatments, and some cancer drugs are not without risks, including the potential for serious, long-term damage to the heart. Cardiology and oncology specialists often collaborate to mitigate these risks when treating cancer patients. This joining is known as cardio-oncology. The main goals of cardio-oncology are to screen for and actively manage modifiable cardiovascular risk factors and diseases in cancer patients. Cardio-oncology plays an increasingly active role at every stage of cancer therapy, including baseline risk assessment pretreatment, surveillance and prevention during treatment, response to acute complications, and assessment of survivors’ post-cardiotoxic treatments. Cancer treatment has been optimized through new treatment strategies. The first cardio-oncology clinic in Iran was instituted about 4 years ago (2017) at Shaheed Rajaei Cardiovascular Medical and Research Center in Tehran, which is the first cardio-oncology clinic in the Middle East. It provides care for cancer patients with a history of cardiovascular disease or risk for cardiotoxicity during cancer therapy. Also, all patients are enrolled in the multicenter cardio-oncology Toxicity Registry research database, and 13 other hospitals from different centers in the whole country are involved in the registry. The establishment of the cardio-oncology clinic with a focus on the patient registry is discussed in this article.

Evaluation for the Relationship Between Normal Serum Level of Thyroid Hormones and Left Ventricular Systolic and Diastolic Dysfunction

Background: Thyroid hormones play an important role in cardiac tissue function. Therefore, it is important to understand the relationship between thyroid hormone levels and cardiac disorders. Objectives: The present study aimed to assess the relationship between normal serum level of thyroid hormones and left ventricular systolic and diastolic dysfunction. Methods: In this cross sectional descriptive retrospective study, 391 patients were selected. They were referred to the Rajaie Cardiovascular Research Center, Tehran, Iran from 2019 to 2021. After extracting echocardiographic and laboratory data from the clinical records, the parameters affecting the left ventricular systolic and diastolic dysfunction were analyzed using statistical software. Results: The mean age of patients was 41 ± 12.8 years. Among them 58.1% of all patients were female. Tricuspid regurgitation (TR) severity had a significant relationship with thyroid stimulating hormone (TSH) level (P = 0.02). End diastolic interventricular septum thickness (IVSD) was inversely associated with thyroxin4 (T4) level (P = 0.04). Mitral valve inflow deceleration time (MVDT) was inversely correlated with thyroxin3 (T3) (P = 0.04). Left ventricular ejection fraction (LVEF) was inversely related to TSH level and end diastolic right ventricular internal diameter (RVIDd) was directly related to TSH (P = 0.05). Conclusions: Thyroid hormone levels in the normal range can be associated with the tricuspid regurgitation severity, end diastolic right ventricular internal diameter (RVIDd), mitral valve inflow deceleration time (MVDT), and. end diastolic interventricular septum thickness (IVSD). Due to the high prevalence of heart disorders, information on thyroid hormone levels can be helpful in the identification and timely treatment of these disorders.

Application of a joint latent space item response model to clustering stressful life events and the Beck Depression Inventory-II: results from Korean epidemiological survey data.

According to previous findings, stressful life events (SLEs) and their subtypes are associated with depressive symptoms. However, few studies have explored potential models for these events and incidental symptoms of depression. Participants (3,966 men; 5,709 women) were recruited from the Cardiovascular and Metabolic Diseases Etiology Research Center cohort. SLEs were measured using a 47-item Life Experiences Survey (LES) with a standardized protocol. Depressive symptoms were assessed using the Beck Depression Inventory-II (BDI-II). Joint latent space item response models were applied by gender and age group (<50 vs. ≥50 years old). Among the LES items, death or illness of close relatives, legal problems, sexual difficulties, family relationships, and social relationships shared latent positions with major depressive symptoms regardless of gender or age. We also observed a gender-specific domain: occupational and family-related items. By projecting LES and BDI-II data onto the same interaction map for each subgroup, we could specify the associations between specific LES items and depressive symptoms.

New trio for interventional cardiology submissions.

All correspondence relating to this article should be sent to cardiopulse@unicatt.it. From September 2022, a new team of three will be bringing their expertise in interventional cardiology to the process of sifting submissions and shepherding manuscripts for publication in the European Heart Journal (EHJ). Incoming deputy editor Emanuele Barbato, associate editors Tommaso Gori and Margaret McEntegart will take up a two-year tenure from outgoing deputy editor Javier Escaned MD, PhD, from Spain, and associate editors Julinda Mehilli MD, from Germany and Farouc Jaffer, MD, PhD, of the United States (Figure 1). Prof. Barbato graduated in medicine in 1997 and later obtained board certification in Cardiology at the University of Naples Federico II, in Italy. Whilst he was still a medical student, he completed a short-stay research fellowship at Duke University in North Carolina, US. He completed his PhD in Cardiovascular Pathophysiology at the University Tor Vergata in Rome, Italy in 2006. In the early years of the Millennium, he was a clinical research fellow at the Cardiovascular Research Center of Aalst, Belgium, where he eventually became Co-Director of the Cardiovascular Centre. In 2018, he became full Professor of Cardiology at the Department of Advanced Biomedical Sciences of the University of Naples Federico II. In 2022, he was appointed Full Professor of Cardiology at the Department of Clinical and Molecular Medicine of the Sapienza University of Rome.

Short-term Blood Pressure Variability and Incident CKD in Patients With Hypertension: Findings From the Cardiovascular and Metabolic Disease Etiology Research Center–High Risk (CMERC-HI) Study

The association between short-term blood pressure variability (BPV) and kidney outcomes is poorly understood. This study evaluated the association between short-term BPV and kidney disease outcomes in people with hypertension. Prospective observational cohort study. 1,173 hypertensive participants in the Cardiovascular and Metabolic Disease Etiology Research Center-High Risk (2013-2018) Study with estimated glomerular filtration rate (eGFR)≥60mL/min/1.73m2. Short-term BPV assessed by average real variability (ARV). Composite kidney disease outcome (30% decline in eGFR from baseline, new occurrence of eGFR<60mL/min/1.73m2, or onset of UACR >300mg/g). Multivariable Cox regression analyses to evaluate the association between systolic and diastolic BP ARV (SBP-ARV and DBP-ARV) and outcomes. During a median follow-up of 5.4 [4.1-6.5] years, 271 events of the composite kidney disease outcome occurred (46.5 per 1,000 person-years). Multivariable Cox analysis revealed that the highest SBP-ARV and DBP-ARV tertiles were associated with a higher risk of the composite kidney disease outcome than the lowest tertiles, independent of the 24-hour SBP or DBP levels (HR, 1.64 [95% CI, 1.16-2.33], and 1.60 [95% CI, 1.15-2.24] for SBP-ARV and DBP-ARV, respectively). These associations were consistent when SBP-ARV and DBP-ARV were treated as continuous variables (HR per 1.0-unit greater SBP-ARV, 1.03 [95% CI, 1.01-1.06]; HR per 1.0-unit greater DBP-ARV, 1.04 [95% CI, 1.01-1.08]). These associations were consistent, irrespective of subgroups (age, sex, 24-hour SBP or DBP, and moderate albuminuria). However, other measures of short-term BPV including SD, coefficient of variation, and dipping patterns were not associated with the composite kidney disease outcome. Observational study design, the use of single measurement of 24-hour BP, lack of information on changes in antihypertensive medication during the follow-up. Short-term BPV is associated with the development of a composite kidney disease outcome in hypertensive patients.

Correlations between the Circulating Level of Cell-Derived Microparticles and Surgical Variables in Heart Valve Surgery with Cardiopulmonary Bypass.

Cell-derived microparticles (MPs) as membrane vesicles are procoagulant. They play a role in surgical hemostasis. In this study, the correlations between the circulating level of cell-derived MPs and surgical variables in heart valve surgery were investigated. The present prospective case-series study was conducted in Rajaie Cardiovascular Medical and Research Center from January through March 2021. Forty patients undergoing heart valve surgery with cardiopulmonary bypass (CPB) were enrolled. Before the induction of anesthesia and 30 minutes after the administration of protamine sulfate, venous blood samples were collected. After MP isolation, the concentration of MPs was determined via the Bradford method. Flow cytometry analysis was performed to determine the MP count and phenotype. Intraoperative variables and postoperative routine coagulation tests were defined as surgical variables. Postoperative coagulopathy was defined as an activated partial thromboplastin time (aPTT) ≥48 seconds or an international normalized ratio (INR) >1.5. The total concentration of MPs and the MP count increased significantly after surgery compared with before surgery. The postoperative concentration of MPs was positively correlated with the CPB time (P=0.030, ρ=0.40). The preoperative concentration of MPs was significantly lower in patients with higher postoperative aPTT and INR (P=0.003, P= -0.50 and P=0.020, P= -0.40, respectively). In multivariate logistic regression analysis, the preoperative MP concentration (OR, 1.00; 95% CI, 1.00 to 1.01; P=0.017) was considered a risk factor for postoperative coagulopathy. The levels of MPs, especially platelet-derived MPs, rose after surgery, in correlation with the CPB time. Given the role of MPs in the induction of coagulation and inflammation, they can be considered therapeutic goals for preventing postoperative complications. In addition, the preoperative levels of MPs are a risk factor for predicting the occurrence of postoperative coagulopathy in heart valve surgery.