Iranian Heart Association Iranian Heart Journal 26 3 2025 07 01 Evaluation of Risk Factors Associated With Mortality in Patients Undergoing Primary PCI: A Retrospective Cohort Study 6 14 223832 EN Abdollah Amirfarhangi Department of Cardiology, School of Medicine, Hazrat-e Rasool General Hospital, Iran University of Medical Sciences, Tehran, IR Iran. Marjan Hajahmadipoor Rafsanjani Department of Cardiology, School of Medicine, Hazrat-e Rasool General Hospital, Iran University of Medical Sciences, Tehran, IR Iran. Mahboobe Pazooki Department of Cardiology, School of Medicine, Hazrat-e Rasool General Hospital, Iran University of Medical Sciences, Tehran, IR Iran. Ali Shamsadini Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran. 0000-0002-0000-1236 Nadia Pourghaz Department of Cardiology, School of Medicine, Hazrat-e Rasool General Hospital, Iran University of Medical Sciences, Tehran, IR Iran. Journal Article 2024 06 30 Background: This study investigates the prognosis and complications in patients who underwent primary percutaneous coronary intervention (PCI) at Rasul Akram Hospital between 2020 and 2021. The primary objective is to improve care quality for myocardial infarction (MI) patients post-PCI by identifying and analyzing prognostic factors. Given MI’s significant impact on mortality in industrialized and developing nations, recognizing and managing risk factors effectively can reduce disease burden. Methods: A retrospective cohort design was employed. Patients were selected based on predefined inclusion and exclusion criteria. Demographic, clinical, and laboratory data and clinical outcomes were extracted from medical records and analyzed using SPSS software. Results: Several factors influenced patient prognosis, including age, sex, prior heart disease, hypertension, diabetes, and hyperlipidemia. Those with a history of cardiac conditions or metabolic risk factors exhibited worse outcomes. The study also highlighted that timely PCI intervention and optimized risk factor management could enhance prognosis. Conclusions: Early identification of high-risk patients and prompt, effective treatment are critical. Public and patient education on MI symptoms and the urgency of seeking immediate medical care may reduce treatment delays and improve outcomes. (Iranian Heart Journal 2025; 26(3): 6-14)

https://journal.iha.org.ir/article_223832_276f2f2d757fb32a8af2c46157e6da4b.pdf

Iranian Heart Association Iranian Heart Journal 26 3 2025 07 01 Neutrophil-to-Lymphocyte Ratio and Major Adverse Cardiac Events in Patients With ST-Elevation Myocardial Infarction Undergoing Primary PCI in Vietnam 15 26 223834 EN Tien Hoang Anh Department of Internal Medicine, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam. 0000-0002-7406-9604 Long Doan Pham Phuoc Department of Internal Medicine, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam. 0000-0002-4446-1402 Nguyen Tran Tu Department of Cardiology, Cardiovascular Center, Hue Central Hospital, Hue, Vietnam. 0009-0002-3229-0105 Journal Article 2024 10 21 Background: ST-elevation myocardial infarction (STEMI) is an acute cardiovascular condition associated with a high mortality rate. Primary percutaneous coronary intervention (pPCI) is the recommended treatment for STEMI. Nonetheless, complications may arise during and after the procedure. The present study evaluated the relationship between the neutrophil-to-lymphocyte ratio (NLR) and major adverse cardiac events occurring within 12 months following pPCI. Methods: The current retrospective cohort study involved 148 STEMI patients who met the inclusion criteria and underwent pPCI at the Cardiovascular Center of Hue University of Medicine and Pharmacy Hospital. The patients were monitored for 12 months post-intervention. Results: The rates of cardiovascular mortality, nonfatal MI, nonfatal cerebrovascular stroke, and in-stent restenosis increased as NLR rose. Logistic regression analysis indicated that NLR was an independent predictive factor (OR, 2.015, 95% CI, 1.718 to 2.984; P = 0.007). Conclusions: NLR is an independent predictor of cardiovascular complications in patients with STEMI following pPCI. This straightforward, cost-effective, and highly accurate tool can be readily implemented in medical centers, enabling physicians to assess risks and develop appropriate preventive strategies for patients with STEMI after pPCI. (Iranian Heart Journal 2025; 26(3): 15-26)

https://journal.iha.org.ir/article_223834_67709fee5c32a80aa00e6ff9ff3badb6.pdf

Iranian Heart Association Iranian Heart Journal 26 3 2025 07 01 Comparison of QT Dispersion Alterations and Left Ventricular Systolic Function in Acute ST-Elevation Myocardial Infarction Following Revascularization by Thrombolytic Therapy versus Primary PCI 27 40 223836 EN Yasser Ahmed Abd El Hady Department of Cardiology, Faculty of Medicine, Beni-Suef University, Egypt. Hesham Boshra Mahmoud Department of Cardiology, Faculty of Medicine, Beni-Suef University, Egypt. Mina Michael Mories Department of Cardiology, Sohag Health Insurance Hospital, Egypt. Osama Ahmed Amin Department of Cardiology, Faculty of Medicine, Beni-Suef University, Egypt. 0000-0001-5461-9720 Journal Article 2024 06 28 Background: Limited information exists regarding alterations in QT dispersion (QTd) in patients with acute ST-elevation myocardial infarction (STEMI) following thrombolytic therapy compared to primary percutaneous coronary intervention (PCI). Speckle-tracking echocardiography (STE) has emerged as a crucial prognostic tool in recent STEMI cases, allowing for the assessment of global and regional remodeling. We sought to analyze the changes in the QTd interval and global longitudinal strain (GLS) in STEMI patients after early reperfusion. Methods: This study is a prospective observational analysis involving 100 STEMI patients. The participants were divided into 2 groups: Group I, consisting of 55 patients treated with primary PCI, and Group II, composed of 45 patients treated with thrombolytic therapy. A 12-lead surface ECG was performed upon admission and 48 hours post-revascularization to assess QTd changes in patients receiving thrombolytic therapy versus those undergoing primary PCI. GLS was evaluated using STE 72 hours after revascularization. Results: No differences were observed between the 2 groups concerning baseline characteristics. A significant reduction in QTd occurred after revascularization in both groups, with a greater mean reduction noted in the primary PCI group. Patients in the primary PCI group exhibited significantly more negative GLS values than those in the thrombolytic group. Admission QTd and the percentage of QTd reduction were significant predictors of ventricular tachycardia. Conclusions: This study underscores the potential of primary PCI to enhance patient outcomes in STEMI. The superior GLS results, reduced incidence of ventricular arrhythmias, and QTd reduction following revascularization in STEMI patients indicate that primary PCI could significantly transform patient care. (Iranian Heart Journal 2025; 26(3): 27-40)

https://journal.iha.org.ir/article_223836_e8ac3ff5c63bb946bc912c16c1b83040.pdf

Iranian Heart Association Iranian Heart Journal 26 3 2025 07 01 Associated Risk Factors of Isolated Coronary Artery Ectasia: MUST University Experience 41 50 223839 EN Ahmed Elbarbary Cardiology Department, Faculty of Medicine, Misr University for Sciences and Technology, 6th of October City, Giza, Egypt. 0000-0001-9384-244X Amr Hossam Abdelmoamen Cardiology Department, Faculty of Medicine, Misr University for Sciences and Technology, 6th of October City, Giza, Egypt. Ahmed Fathy Tamara Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt. Mahmoud Ahmed Tantawy Cardiology Department, Faculty of Medicine, Misr University for Sciences and Technology, 6th of October City, Giza, Egypt. Journal Article 2024 08 03 Background: Coronary artery ectasia (CAE) is an uncommon condition characterized by abnormal dilation of the coronary arteries. Identifying predictors of isolated CAE within specific populations is essential for timely detection and management. This study aimed to assess the risk factors and clinical criteria that serve as predictors of isolated CAE in the Egyptian population referred to our catheterization laboratory for coronary angiography. Methods: This retrospective study was carried out in the catheterization laboratory at Misr University for Science and Technology (MUST) Hospital. Between November 2018 and October 2022, out of 2100 patients undergoing coronary angiography, 40 patients diagnosed with isolated CAE and 252 patients with normal coronary angiography were included as the study and control groups, respectively. The results of the coronary angiography were evaluated by 2 experienced interventional cardiologists. Logistic regression analysis was employed to identify the predictors of CAE. Results: The incidence of isolated CAE was 1.9% among patients undergoing coronary angiography. The majority of patients with isolated CAE were male (80%), with a mean age of 54.62 years. Significant predictors of CAE included smoking status, with 60% of the CAE group being smokers compared to 24.6% in the control group (P < 0.001). The multivariate logistic regression analysis identified smoking as the sole independent determinant of CAE, demonstrated by an odds ratio of 7.769, a 95% confidence interval ranging from 3.311 to 18.229, and a statistically significant P-value (< 0.001). Other factors, such as diabetes mellitus, hypertension, and dyslipidemia, did not exhibit a significant independent association with CAE. Conclusions: In the Egyptian population, smoking is a significant and independent predictor of isolated CAE. (Iranian Heart Journal 2025; 26(3): 41-50)

https://journal.iha.org.ir/article_223839_42ef954e99f05ba57a2db6c6d8d36eb7.pdf

Iranian Heart Association Iranian Heart Journal 26 3 2025 07 01 Flow-Mediated Arterial Dilatation, Hypertension, and ACE2 in Adolescent Obesity: A Cross-Sectional Study 51 58 223846 EN Meity Ardiana Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. 0000-0002-1706-6247 Nur Aisiyah Widjaja Division of Nutrition and Metabolic Diseases, Childhealth Department, Faculty of Medicine Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. 0000-0002-4253-8760 Achmad Faisal Dwi Raharja Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. Ika Rahmawati Caesarina Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. Journal Article 2024 06 13 Background: Endothelial dysfunction is a significant mechanism underlying various cardiovascular diseases. In the context of COVID-19, soluble angiotensin-converting enzyme 2 (sACE2) and flow-mediated dilation (FMD) are linked to endothelial dysfunction. This study aimed to evaluate sACE2 and FMD levels among obese and non-obese Indonesian adolescents. Methods: This study involved 72 Indonesian adolescents, with a mean age of 195 months (range = 178–217). The majority of participants were male (61%). They were divided into 3 groups: those with obesity and hypertension (n=21), those with obesity without hypertension (n=19), and non-obese individuals (n=32). FMD assessment involved measuring the brachial artery using supra-systolic pressure applied to the forearm for 5 minutes. Further, sACE2 levels were determined using the Sandwich ELISA method. Results: The median level of sACE2 was 25.4 pg/mL, with a range of 0.25 to 181.8 pg/mL. Nonetheless, no statistically significant differences in sACE2 levels were observed between the three groups (P = 0.464). Although descriptive statistics indicated that FMD values were higher in normal adolescents, no significant differences were found in FMD values between the groups: those with obesity and hypertension (9.1 ± 5%), those with obesity without hypertension (8.3 ± 3.1%), and normal adolescents (10.9 ± 6.2%) (P = 0.159). Furthermore, the comparison of sACE2 levels between the groups with and without endothelial dysfunction revealed no differences (P = 0.95). There was also no statistically significant correlation between sACE2 levels and FMD (P = 0.59, r = 0.064). Conclusions: Our results showed no differences in sACE2 and FMD values between obese and non-obese Indonesian adolescents, regardless of hypertension status. Additionally, the correlation between endothelin-1 and FMD is not significant in this population of Indonesian adolescents. (Iranian Heart Journal 2025; 26(3): 51-58)

https://journal.iha.org.ir/article_223846_440657fcc5f9fd895d792e4e0b67f1bf.pdf

Iranian Heart Association Iranian Heart Journal 26 3 2025 07 01 Association Between Spatial QRS-T Angle and Anthropometric/Lipid-Derived Indices 59 68 223853 EN Marwan S.M. Al-Nimer Department of Clinical Pharmacology and Therapeutics, College of Medicine, University of Diyala, 32001 Baqubah, Iraq. 0000-0002-5336-3353 Ismail Ibrahim Hussein Department of Physiology, College of Medicine, Mustansiriyah University. 10011 Baghdad, Iraq. Ahmed Khalid Abdullah Department of Physiology, College of Medicine, University of Diyala, 32001 Baqubah, Iraq. Suad Muslih Al-Deen Abdul Majeed Department of Physiology-Medical Physics, University of Diyala, 32001 Baqubah, Iraq. Journal Article 2025 02 17 Background: Estimating the spatial QRS-T angle (SA) serves as a valuable predictor of abnormal ventricular repolarization sequences, with a wider SA linked to an increased risk of cardiovascular events. SA can be derived from 12-lead ECGs. This study aimed to determine the factors influencing the magnitude of SA, including estimation methods, gender, anthropometric measures, and lipid profile–derived ratios and indices in healthy individuals. Methods: This cross-sectional study involved 138 healthy participants. The primary outcome was the estimation of SA from 12-lead ECGs using 3 different modules: module 1 (aVF, V2, V5, and V6), module 2 (aVF, V2, and V6), and module 3 (I, aVF, and V5). Secondary outcomes involved ratios and indices derived from weight, height, waist circumference, serum triglycerides, and high-density lipoprotein levels. Results: Significant variability in estimating the SA degree and detecting abnormal widening of the SA (> 135°) was found to be related to the measurement modules used. Women exhibited significantly lower SA degrees than men. Estimated total body mass and relative fat mass were important confounding factors contributing to the differences between modules in SA estimation. Among the modules, module 1 demonstrated greater accuracy than the others. Conclusions: An accurate estimation of SA depends on the selected ECG leads, as well as adjustments for anthropometric measurements and gender. (Iranian Heart Journal 2025; 26(3): 59-68)

https://journal.iha.org.ir/article_223853_f5408e575c091f2adc4d35a441f8d0ae.pdf

Iranian Heart Association Iranian Heart Journal 26 3 2025 07 01 Atrial High-Rate Episodes and Their Association With Interatrial Block in Dual-Chamber Pacemaker Recipients 69 78 223859 EN Mostafa Abdelmonaem Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt. Ayman Mortada Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt. Aly Medhat Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt. John Kamel Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt. Journal Article 2025 02 04 Background: In the era of cardiac pacing, atrial lead placement has enabled continuous monitoring of atrial electrical activity, including atrial high-rate episodes (AHRE). Once considered an incidental finding, AHRE has now emerged as a significant risk factor for thromboembolic events. Methods: This study involved 250 patients who visited the pacemaker interrogation clinic for routine follow-up after dual-chamber pacemaker implantation. ECG analysis assessed P-wave morphology and duration as predictors of interatrial block (IAB). Further, atrial lead interrogation was performed to detect AHRE. Results: Among the 250 patients studied, 65 exhibited IAB: 54 had partial IAB, while 11 presented with complete IAB. The mean P-wave duration was 104.04 ± 15.92 milliseconds (range: 80–140 ms). P-wave morphology in lead II was upright in 239 patients (95.6%) and bimodal in 11 patients. Per ESC guidelines, AHRE was defined as lasting > 5 minutes. Forty-five patients developed AHRE, with a median duration of 7 minutes (range: 5–30 min) and a mean rate of 187.53 ± 23.59 beats per minute (range:110–231 bpm). A strong association was observed between P-wave duration and AHRE incidence. Of the 45 patients with AHRE, 33 (73.3%) had partial IAB, 6 (13.3%) had complete IAB, and 6 (13.3%) displayed normal P-wave morphology and duration. Conclusions: The detection of AHRE via dual-chamber pacemakers showed a significant association with IAB. Both IAB and AHRE were strongly linked to older age and comorbidities, including diabetes, hypertension, and ischemic heart disease. (Iranian Heart Journal 2025; 26(3): 69-78)

https://journal.iha.org.ir/article_223859_443ae97a965b3780f22de4874173da7d.pdf

Iranian Heart Association Iranian Heart Journal 26 3 2025 07 01 Conjunctival Chemosis After Coronary Artery Bypass Surgery 79 82 223862 EN Masoud Tarbiat Department of Anesthesiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, IR Iran. 0000-0002-0025-9771 Mahmoud Rezaei Department of Anesthesiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, IR Iran. 0000-0003-2123-1839 Rohollah Abbasi Department of Otolaryngology Head and Neck Surgery, School of Medicine, Hamadan University of Medical Sciences, Hamadan, IR Iran. 0000-0001-7253-8086 Hamid Reza Khorshidi Department of Surgery, Hamadan University of Medical Sciences, School of Medicine, Hamadan, IR Iran. Journal Article 2024 04 25 Postoperative conjunctival chemosis is an uncommon yet uncomfortable complication following non-ophthalmic surgery. Characterized by a blister-like or billowing swelling of the conjunctiva, typically in the lower eyelid, it arises primarily due to irritation and represents a form of ocular inflammation. We herein describe a 59-year-old woman with a medical history of hypertension, hyperlipidemia, rheumatoid arthritis, allergies, and prior left-eye cataract surgery. She underwent coronary artery bypass graft (CABG) surgery using cardiopulmonary bypass (CPB), with a total CPB duration of 167 minutes. The procedure was completed without complications. On the first postoperative day in the ICU, bilateral conjunctival chemosis was observed in the inferolateral region of the conjunctiva. After ophthalmologic consultation and treatment with medications in a head-up position, the chemosis resolved completely within 5 days. This case highlights that postoperative conjunctival chemosis, albeit rare, particularly after non-ophthalmic procedures, has favorable early and long-term outcomes when promptly recognized and appropriately managed. (Iranian Heart Journal 2025; 26(3): 79-82)

https://journal.iha.org.ir/article_223862_27ec3c12ccfd4f97c0e51007721a4e93.pdf

Iranian Heart Association Iranian Heart Journal 26 3 2025 07 01 Six-Year Survival With Pharmacological Management in a Patient With Aneurysmal Aortic Dissection and Severe Heart Failure: A Case Report 83 91 223864 EN Fahimeh Mohseni Department of Addiction Studies, School of Medicine, Shahroud University of Medical Sciences, Shahroud, IR Iran. 0000-0002-9566-7072 Raheleh Rafaiee Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, IR Iran. 0000-0003-2796-5868 Mahdi Yousefi Student Research Committee, School of Medicine, Shahroud University of Medical Sciences, Shahroud, IR Iran. Hossein Shiebani Clinical Research Development Unit, Imam Hossein Hospital, Shahroud University of Medical Science, Shahroud, IR Iran. 0000-0003-1632-0511 Journal Article 2024 06 24 Prolonged survival with pharmacological management alone in patients with Stanford type A aneurysmal aortic dissection remains uncommon. We herein describe an elderly woman with severe heart failure (left ventricular ejection fraction [LVEF]: 15%–20%), a 9-cm aortic root aneurysm, and a restrictive dissection flap extending from the root to the abdominal aorta who has survived 6 years under medical therapy. The patient had a history of mild hypertension previously undertreated with oral antihypertensive agents. Remarkably, she maintained routine daily activities despite medical advice to the contrary. Serial examinations during this period demonstrated a 5% decline in LVEF and a 1 cm expansion of the aneurysm diameter, while the dissection flap remained stable. This case suggests that conservative pharmacological management in Stanford type A aortic dissection with large root aneurysm and severe LV systolic dysfunction (particularly in older, less active patients) may yield favorable outcomes. Nonetheless, we emphasize that this approach should only be considered for patients who are not candidates for other treatment options. (Iranian Heart Journal 2025; 26(3): 83-91)

https://journal.iha.org.ir/article_223864_2c85bc02c771d482db1fe5e62b180c11.pdf

Iranian Heart Association Iranian Heart Journal 26 3 2025 07 01 Midodrine: A Golden Therapeutic Sword for High-Output Chylothorax 92 98 223866 EN ABU TALHA National Heart Foundation Hospital & Research Institute, Dhaka, Bangladesh. 0009-0001-8274-4526 Ibrahim Hossain National Heart Foundation Hospital & Research Institute, Dhaka, Bangladesh. Nurul Akhtar Hasan National Heart Foundation Hospital & Research Institute, Dhaka, Bangladesh. Journal Article 2024 11 19 Chylothorax, a significant complication after congenital heart surgery, adversely impacts children’s health and can lead to various morbidities, including nutritional deficiencies, prolonged ICU stays, extended hospitalizations, and an increased risk of mortality. Initial management of this condition involves nutritional strategies, such as providing gut rest and implementing a diet based on medium-chain triglycerides and low fat. Pharmacological options and surgical interventions are subsequently considered for refractory cases. This report describes a child who developed high-output chylous effusion following open-heart surgery for the correction of congenital heart disease. This effusion was successfully managed using chest drainage, nutritional intervention, and pharmacotherapy with midodrine. We hope the observations from this case report will help interventionists optimize chylothorax management and consider midodrine as a therapeutic option and a potential area of research for managing high-output chylothorax, before resorting to surgical intervention. (Iranian Heart Journal 2025; 26(3): 92-98)

https://journal.iha.org.ir/article_223866_db8b15e697607d875c635c61c8c34d94.pdf