Iranian Heart Association Iranian Heart Journal 27 2 2026 04 01 The Effect of Trimetazidine Treatment in Diabetic Patients With Intermittent Claudication 6 16 242135 EN Osama Ahmed Amin Department of Cardiology, Beni-Suef University, Egypt. 0000-0001-5461-9720 Marina Awad Department of Cardiology, Beni-Suef University, Egypt. Ahmed Mohamed Hamam Department of Endocrinology and Metabolism, Armed Forces College of Medicine, Egypt. Ahmed Farouk Alaarag Department of Cardiology, Tanta University, Egypt. 0000-0002-9364-6286 Journal Article 2025 02 03 Background: Peripheral arterial disease (PAD) is a vascular condition for which many therapeutic decisions are well established; nonetheless, the potential role of trimetazidine (TMZ) in diabetic patients with PAD remains debatable and warrants further investigation. Objective: This study aimed to determine the effect of TMZ on diabetic patients with intermittent claudication. Methods: In this two-center prospective study, 188 diabetic patients with PAD received guideline-directed medical therapy (GDMT) with (n =93) or without (n =95) TMZ. Baseline and 6-month assessments included the 6-minute walk test (6MWT), ankle-brachial index (ABI), duplex ultrasound, and diabetic foot outcomes (P <0.05). Results: The study included 188 diabetic patients with symptomatic PAD. Patients were divided into Group I, which received all GDMT with TMZ as part of chronic coronary syndrome treatment (93 patients), and Group II, which received all GDMT without TMZ (95 patients). All patients were evaluated at baseline and after a 6-month follow-up period for exercise performance via 6MWT, lower limb hemodynamics via ABI, and the incidence of diabetic foot requiring amputation. At the end of the follow-up period, 6MWT and ABI improved significantly from baseline findings in both groups. The TMZ group demonstrated a substantial improvement in 6MWT, a nonsignificant improvement in ABI, and a nonsignificant reduction in diabetic foot requiring amputation compared with the non-TMZ group. Conclusions: TMZ may improve exercise performance in diabetic patients with PAD, while its role in improving limb hemodynamics or ischemia is nonsignificant and uncertain. (Iranian Heart Journal 2026; 27(2): 6-16)

https://journal.iha.org.ir/article_242135_9b75b5a32dae4f35c74279ed45cd9b43.pdf

Iranian Heart Association Iranian Heart Journal 27 2 2026 04 01 Effect of Ticagrelor Loading Time on the Outcomes of Primary Percutaneous Coronary Intervention 17 26 242136 EN Ali R Tohamy Cardiovascular Medicine Department, Assiut University Heart Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt. Hany Rayek Maher Cardiovascular Medicine Department, Assiut University Heart Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt. Hosam R Hasan-Ali Cardiovascular Medicine Department, Assiut University Heart Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt. Journal Article 2025 03 02 Background: Patients with acute coronary syndrome experience fewer major adverse cardiovascular events when receiving ticagrelor as opposed to clopidogrel. Additionally, patients with ST-segment elevation myocardial infarction (STEMI) receiving primary percutaneous coronary intervention (PPCI) show better coronary reperfusion and prognosis. This study compared the safety and effectiveness of ticagrelor doses administered early and late in patients with STEMI undergoing PPCI. Methods: This prospective observational cohort study was conducted in a hospital with 350 patients diagnosed with recent STEMI and receiving PPCI. Patients were placed into 2 groups: prehospital (n = 179; loading dose > 60 min) and cath. lab (n = 171; loading dose < 60 min) before PPCI. Results: Following a 6-month follow-up period, the Kaplan-Meier analysis revealed that 85.2% of the cath. lab group and 88.8% of the prehospital group were still clinically free and did not have any adverse events. There was no significant difference between the 2 groups (P = 0.357). The prehospital group had reduced thrombus load, greater post-PPCI ST-segment elevation resolution after 90 minutes, and considerably higher initial Thrombolysis in Myocardial Infarction (TIMI) flow grades II and III in the infarct-related artery than the cath. lab group. Both groups had comparable TIMI flow grades following PPCI. Conclusions: Prehospital administration of ticagrelor with a median time of about 2 hours before PPCI was safe and helped improve angiographic pre-PCI coronary reperfusion in STEMI patients undergoing PPCI, without increasing the risk of bleeding events, but it did not significantly affect the final angiographic results. (Iranian Heart Journal 2026; 27(2): 17-26)

https://journal.iha.org.ir/article_242136_688d4a55e7aa92fcfb2a426c47ba7bf9.pdf

Iranian Heart Association Iranian Heart Journal 27 2 2026 04 01 Evaluation of Atherogenic Indices Among Women With Breast Cancer in Ile-Ife, Nigeria 27 37 242137 EN Abiodun K Ajeigbe Department of Chemical Pathology, Obafemi Awolowo University/ Obafemi Awolowo University Teaching Hospitals, Ile-Ife, Nigeria. Adeleye Dorcas Omisore Department of Radiology, Obafemi Awolowo University/ Obafemi Awolowo University Teaching Hospitals, Nigeria. Ronke Adunni Makinde Department of Chemical Pathology, Obafemi Awolowo University/ Obafemi Awolowo University Teaching Hospitals, Ile-Ife, Nigeria. Tewogbade Adeoye Adedeji Department of Chemical Pathology, Obafemi Awolowo University/ Obafemi Awolowo University Teaching Hospitals, Ile-Ife, Nigeria. Journal Article 2025 03 20 Introduction: Cardiovascular disease is the most common cause of death globally, and its risk among women with breast cancer (BC) is not fully assessed. This study aimed to evaluate the cardiovascular risk among women with BC using atherogenic indices. Methods: Ninety women were recruited for this cross-sectional study and stratified into BC and controls. Anthropometric measurements were taken, followed by blood collection (5 mL) for lipid profile (TC, TG, LDL-c, and HDL-c) assay. Castelli risk index I and II (CRI-I and CRI-II), atherogenic index of plasma (AIP), atherogenic coefficient (AC), Cholindex (CI), and non–HDL-c (NHC) were calculated to estimate cardiovascular risks. Data were analyzed by SPSS 22 using the Student t test and the Pearson correlation and presented as mean ± SD. A P value of less than 0.05 was considered significant. Results: Women with BC were significantly younger than controls (51.6 ± 10.3 vs 59.0 ± 12.7 y; P = 0.003) and had significantly lower mean waist circumference (90.5 ± 11.3 vs 96.3 ± 14.9 cm; P = 0.036). The mean serum TG and HDL-c (1.11 ± 0.4 vs 1.36 ± 0.5 mmol/L; P = 0.015 and 1.09 ± 0.4 vs 1.48 ± 0.3 mmol/L; P = 0.000) were significantly lower in the BC group. CRI-I, CRI-II, and AC were significantly higher in the BC group than in the controls (4.83 ± 2.0 vs 3.69 ± 0.9; P = 0.001 and 3.29 ± 1.8 vs 2.24 ± 0.8; P = 0.001 and 3.83 ± 2.0 vs 2.68 ± 0.9; P = 0.000), respectively. A higher proportion (80.4%, 38.3%, and 59.6%) of women with BC had a high risk of cardiovascular disease than controls (69.8%, 9.3%, and 27.9%), respectively, except for NHC. Conclusions: In this study, women with BC had a high risk of cardiovascular disease. Estimating the atherogenic indices of women with BC may be beneficial. (Iranian Heart Journal 2026; 27(2): 27-37)

https://journal.iha.org.ir/article_242137_a1564134223ec2a0b8faaa577009021f.pdf

Iranian Heart Association Iranian Heart Journal 27 2 2026 04 01 Immediate vs Standard Percutaneous Coronary Intervention Timing in Patients Presenting With Non–ST-Segment Elevation Myocardial Infarction 38 46 242138 EN Ahmed Nabih Awad Abdelrazik Hawass Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt. Ahmed Abdelrahman Sharaf Eldin Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt. Ahmed Fathy Tamara Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt. Abd El Rahman Elsayed Attia Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt. Journal Article 2025 03 30 Background: The optimal timing for percutaneous coronary intervention (PCI) in patients with non–ST-segment elevation myocardial infarction (NSTEMI) remains a matter of clinical debate, particularly in high-risk but stable patients. This study aimed to evaluate whether immediate PCI (within the timeframe of primary PCI) improves clinical outcomes compared with standard early PCI (within 24 hours) in high-risk NSTEMI patients. Methods: This prospective, single-center, randomized study included 300 high-risk NSTEMI patients at Ain Shams University hospitals. Patients were randomized to either immediate PCI (n = 150) or standard PCI (n = 150). Baseline characteristics, electrocardiographic (ECG) findings, echocardiographic findings, coronary angiography results, length of hospital stay, and 1- and 6-month major adverse cardiovascular events (MACE) were assessed. Results: Time to angiography was significantly shorter in the immediate PCI group (1.493 ± 0.288 h vs 13.200 ± 4.780 h; P < 0.001). Hospital stay was significantly reduced in the immediate PCI group (1.447 ± 0.651 vs 2.293 ± 0.765 d; P < 0.001). No significant differences were observed in ECG findings, ejection fraction, infarct-related artery occlusion rates, or vessel distribution (P > 0.05). At 1 month, MACE occurred in 5.33% vs 7.33% (P = 0.477); at 6 months, in 11.33% vs 18.67% (P = 0.075) in immediate vs standard PCI groups, respectively. Conclusions: Immediate PCI does not reduce short- or mid-term MACE compared with standard PCI, but it is associated with a significantly shorter hospital stay, supporting its role in optimizing healthcare efficiency. (Iranian Heart Journal 2026; 27(2): 38-46)

https://journal.iha.org.ir/article_242138_5b33891bf1a8599bea0e14961e5ed666.pdf

Iranian Heart Association Iranian Heart Journal 27 2 2026 04 01 Correlation of hs-CRP and the Duke Treadmill Score in the Cardiac Training Test 47 53 242139 EN Muhamad Robiul Fuadi Department of Clinical Pathology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia. 0000-0002-8416-6862 Rinta Prasetiyanti Department of Clinical Pathology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia. 0009-0008-8763-2858 Journal Article 2025 04 19 Background: Risk stratification is the first step to prevent cardiovascular disease. Cardiac training tests perform it with the Duke Treadmill Score (DTS). The limitations and complications that may occur during cardiac training tests require alternative laboratory examinations. High-sensitivity C-reactive protein (hs-CRP) is an independent predictor of cardiovascular events. This study analyzed the relationship between hs-CRP and the Duke Treadmill Score. Methods: This study has a cross-sectional, observational analytical design. Blood samples were taken from 40 patients who underwent cardiac training at Airlangga University Hospital and Telkom Laboratory in Surabaya, Indonesia. Patients’ hs-CRP levels were measured by TMS 24i Premium Tokyo Boeki in the clinical pathology laboratory of Airlangga University Hospital. Results: The average age of subjects was 43 years. Most subjects were male (60%) and had an increase in low-density lipoprotein cholesterol (92.5%). Hypertension was found in 22.5% of subjects. Most subjects were nonsmokers (70%), had a normal body mass index (82.5%), and did not have diabetic mellitus (82.5%). The mean hs-CRP level was 6.04±9.79 mg/L. DTS results showed -5.13±9.3. There was a correlation between serum hs-CRP and DTS by Spearman analysis (P = -0.85 and P < 0.05). Conclusions: Hs-CRP can be an alternative laboratory examination for stratifying cardiovascular event risks to cover DTS by cardiac training tests. (Iranian Heart Journal 2026; 27(2): 47-53)

https://journal.iha.org.ir/article_242139_e5a8c98907ee345116f28a211245ce80.pdf

Iranian Heart Association Iranian Heart Journal 27 2 2026 04 01 A Longitudinal Study of Catheter-Related Infections: Challenges in Diagnosis and Management 54 64 242140 EN Shokoufeh Hajsadeghi Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, IR Iran. 0000-0002-5805-5173 Seyed Masoud Musavian Department of Cardiology, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, IR Iran. Shima Loni Department of Internal Medicine, Tehran University of Medical Sciences, Tehran, IR Iran. 0009-0003-5747-4709 Ali Mehrakizadeh Department of Cardiology, Tehran University of Medical Sciences, Tehran, IR Iran. Shayan Mirshafiee Department of Cardiology, Tehran University of Medical Sciences, Tehran, IR Iran. 0000-0003-2139-5956 Journal Article 2025 05 13 Background: Central venous catheters (CVCs) are essential for vascular access but are associated with catheter-related bloodstream infections (CRBSIs), which can cause significant morbidity and mortality, particularly among hemodialysis patients. This study aimed to investigate risk factors for CVC infections, evaluate the role of echocardiography in diagnosis and prognosis, and assess outcomes of different catheter management strategies. Methods: A longitudinal study of 166 patients with confirmed CVC infections was conducted at Rasoul Akram Hospital, Tehran, Iran, from 2014 through 2022. Data included demographics, comorbidities, catheter site/duration, microbiological cultures, echocardiographic findings, and treatment outcomes. Statistical analyses included the χ2 test, the t test, ANOVA, and regression methods using SPSS, version 26. Results: Participants had a median age of 58 years (IQR, 45–67), and 54.8% were women. Fever was the most common presenting symptom (52.4%). Vegetations were detected in 52 patients (46.4%), most commonly at the catheter site. No significant difference in mortality was found between percutaneous and surgical catheter removal methods (P = 0.26). Vegetation size was not associated with mortality (P = 0.516). Patients with diabetes and transfusion history had longer hospital stays. Recurrence of infection was highest (37.9%) in those managed without catheter removal. Conclusions: Echocardiography plays a critical role in the diagnosis and prognosis of CVC infections. Catheter removal, whether percutaneous or surgical, did not influence in-hospital mortality, even in cases with large vegetations. However, failure to remove infected catheters increased the recurrence risk. (Iranian Heart Journal 2026; 27(2): 54-64)

https://journal.iha.org.ir/article_242140_fb73dd4f377ad8213682750641abe790.pdf

Iranian Heart Association Iranian Heart Journal 27 2 2026 04 01 Evaluation of the Effects of p-Coumaric Acid on Oxidative Stress, Electrocardiographic Parameters, and Cardiac Arrhythmias in a CaCl2-Induced Arrhythmia Model in Rats 65 80 242141 EN Mohammadreza Naderi Department of Physiology, Faculty of Medicine, Persian Gulf Physiology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran Mahin Dianat Department of Physiology, Faculty of Medicine, Persian Gulf Physiology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran. Mohammad Badavi Department of Physiology, Faculty of Medicine, Persian Gulf Physiology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran. Zahra Mansouri Department of Physiology, Faculty of Medicine, Persian Gulf Physiology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran. Journal Article 2025 05 28 Background: Cardiovascular diseases remain a leading global cause of mortality, with sudden cardiac death-primarily resulting from arrhythmias-accounting for nearly half of these fatalities. Limited research has explored the impact of p-coumaric acid (P-co) on chemically induced arrhythmias. Given the cardioprotective role of antioxidants, this study aimed to investigate the effects of P-co on oxidative stress, electrocardiographic (ECG) parameters, and cardiac arrhythmias in Wistar rats using a calcium chloride (CaCl2)-induced arrhythmia model. Methods: Forty-eight Wistar rats were divided into 6 groups: (1) Control (normal saline); (2) CaCl2 (normal saline + CaCl2 140 mg/kg); (3–5) CaCl2 + P-co 25, 50, and 100 mg/kg, respectively; and (6) P-co 100 mg/kg. P-co was administered orally for 10 consecutive days, followed by an intravenous injection of CaCl2 via the femoral vein on the final day. Electrophysiological assessment and arrhythmia evaluation were conducted using lead II ECG. Furthermore, biochemical analyses measured oxidative stress and cardiac injury markers, including MDA, CK-MB, LDH, SOD, CAT, and GPx, across all groups. Results: Intravenous injection of CaCl2 led to significant changes in ECG parameters and the development of arrhythmias. Pretreatment with P-co significantly improved the observed changes. Compared with the CaCl2 group, P-co pretreatment reduced cardiac damage markers and lipid peroxidation and enhanced antioxidant enzymes. Conclusions: The results of this study suggest that the intravenous administration of CaCl2 induces cardiac arrhythmias and oxidative stress in heart tissue. As a natural polyphenol and antioxidant, P-co exhibited a protective effect against CaCl2-induced cardiac damage. (Iranian Heart Journal 2026; 27(2): 65-80)

https://journal.iha.org.ir/article_242141_f9202914d827852fdf4ce97b7efdea47.pdf

Iranian Heart Association Iranian Heart Journal 27 2 2026 04 01 Kounis Syndrome: Acute Myocardial Infarction Following Multiple Bee Stings 81 86 242142 EN Barun Kumar Department of Cardiology, All India Institute of Medical Sciences, Rishikesh, India. 0000-0002-2562-1714 Kishan Mavani Department of Cardiology, All India Institute of Medical Sciences, Rishikesh, India. 0000-0001-5963-7653 Kanika Kukreja Department of Cardiology, All India Institute of Medical Sciences, Rishikesh, India. 0009-0009-6841-7279 Journal Article 2025 11 12 Introduction: Kounis syndrome is an acute coronary syndrome triggered by allergic or hypersensitivity reactions. It is an underdiagnosed clinical entity where mast cell activation leads to coronary vasospasm, plaque erosion, or thrombosis. Hymenoptera stings, such as those from bees, are a rare but well-documented cause. Case Presentation: A 64-year-old man presented to the emergency department with multiple bee stings, manifesting only mild cutaneous urticaria. He was discharged after observation with stable vitals. Approximately 12 hours post-sting, he experienced sudden-onset chest pain, diaphoresis, and syncope. Upon arrival, he was in a gasping state, requiring immediate intubation and mechanical ventilation. He suffered a cardiac arrest, and after 30 minutes of cardiopulmonary resuscitation, return of spontaneous circulation was achieved. Electrocardiography revealed ST-segment elevation in the inferior leads (II, III, and aVF) with reciprocal ST-depression in the anterolateral leads. Emergency coronary angiography demonstrated a complete thrombotic occlusion of the mid-right coronary artery. Successful primary percutaneous coronary intervention with a drug-eluting stent was performed, restoring TIMI grade 3 flow. Conclusions: This case highlights the critical importance of considering Kounis syndrome in patients presenting with acute coronary symptoms following an allergic insult, even with a delayed presentation. A high index of suspicion is necessary for timely diagnosis and management, which must address both the allergic reaction and the acute coronary syndrome concurrently. (Iranian Heart Journal 2026; 27(2): 81-86)

https://journal.iha.org.ir/article_242142_93f2def80547324857495d4956849bd7.pdf

Iranian Heart Association Iranian Heart Journal 27 2 2026 04 01 Wellens Syndrome Following Transient ST-Elevation Myocardial Infarction: A Clinical Dilemma of “Treat Now or Later?” 87 93 242143 EN Pandit Bagus Tri Saputra Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia. 0000-0002-5815-0592 Budi Baktijasa Dharmadjati Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia. Yosua Hendriko Manurung Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia. Kevin Luke Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia. 0000-0003-2160-2927 Journal Article 2025 10 04 Introduction: Transient ST-segment elevation myocardial infarction (TSTEMI) is often associated with better prognosis due to spontaneous reperfusion, yet its progression to Wellens syndrome indicates severe left anterior descending (LAD) occlusion and raises the risk of anterior infarction. Case Presentation: We describe a 61-year-old woman with the initial presentation of typical chest pain (numeric rating scale [NRS]: 6/10) and ST-segment elevation at the extensive anterior leads at the referring hospital. The patient was given dual antiplatelet treatment and referred to our hospital. Upon arrival, her symptoms resolved (NRS: 0/10), and her ST-segment elevation was evolved to biphasic T waves in leads V2-V6 along with ST elevation-T-wave inversion in leads I and aVL, similar to Wellens syndrome. Cardiac biomarkers were markedly elevated, and echocardiography revealed hypokinetic wall motion abnormalities. Coronary angiography revealed proximal LAD occlusion, a feature of Wellens syndrome. Despite the potential for extensive myocardial damage, the patient was managed under a delayed invasive strategy. She remained stable after the intervention and at 3 months’ follow-up at the outpatient clinic. Conclusions: Conversion of TSTEMI to Wellens syndrome raises clinical dilemma regarding invasive strategy decision-making. TSTEMI occurs due to spontaneous resolution, which can be partial or total, yet the risk of spontaneous reocclusion is also inevitable. TSTEMI requires an early invasive strategy (< 24 h) with close monitoring of new or worsening ischemic signs; however, the urgency may be individualized on a case-by-case basis. (Iranian Heart Journal 2026; 27(2): 87-93)

https://journal.iha.org.ir/article_242143_afd5e47fb62006edfff3e6fd7b719db4.pdf