Iranian Heart Association Iranian Heart Journal 27 3 2026 07 01 Short-term Clinical Outcomes of Patients With Chronic Total Occlusion Who Underwent PCI Using the J-CTO Score 6 19 246574 EN Ahmed Ibrahim Bedier Department of Cardiology, Faculty of Medicine, Mansoura University, Dakahlia, Egypt. Ramy Gamal Elsayed Metwali Cardiology Department, Ministry of Health, Eldakahlia, Egypt. Mahmoud Mohamed Abdo Youssof Cardiology Department, Faculty Of Medicine, Mansoura University, Eldakahlia, Egypt. Sally Magdy Teima Cardiology Department, Faculty Of Medicine, Mansoura University, Eldakahlia, Egypt. Journal Article 2025 04 17 Background: Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) remains a significant challenge in interventional cardiology. Advancements in technology and procedures have facilitated high technical and procedural success rates in PCI for CTO while ensuring a minimal risk of procedural complications. The objective of this study was to assess clinical improvement in patients with coronary CTO who underwent PCI based on the Multicenter Chronic Total Occlusion Registry of Japan (J-CTO) score. Methods: A prospective observational study was carried out to evaluate clinical improvement in patients with coronary CTO who underwent percutaneous intervention according to the J-CTO score. This study was carried out in the cardiovascular department of Mansoura University Hospitals, Mansoura, Egypt, and was performed over 1 year, from January 2019 through January 2020. Results: Receiver operating characteristic analysis was carried out to detect the optimal J-CTO score cutoff for the prediction of no improvement (failed cases). The best J-CTO score cutoff value was 2.50. The area under the curve was 0.736 (P = .002). Additionally, logistic regression analysis was carried out to predict major adverse coronary events (MACE) in patients, using laboratory data, demographic data, and J-CTO score as covariates. White blood cell count and J-CTO score were significant risk factors for MACE. Conclusions: The J-CTO score is a valuable tool for predicting procedural success in patients undergoing CTO PCI, with higher scores associated with a greater likelihood of MACE. (Iranian Heart Journal 2026; 27(3): 6-19)

https://journal.iha.org.ir/article_246574_ee4a2b481fd8c7b38587efbeabb209bb.pdf

Iranian Heart Association Iranian Heart Journal 27 3 2026 07 01 New Insights Into the Use of hs-cTnI and NT-proBNP in Chronic Coronary Syndromes 20 26 246576 EN Moayed Basheer Hamid Department of Medicine, College of Medicine, Al-Nahrain University, Baghdad, Iraq. Amal Abbas Hammoodi Department of Biochemistry, College of Medicine, University of Baghdad, Baghdad, Iraq. Basil Oiel Saleh Department of Biochemistry, College of Medicine, University of Baghdad, Baghdad, Iraq. Ameen Abdulhasan Al-Alwany Department of Medicine, University of Baghdad, College of Medicine, Baghdad, Iraq. Journal Article 2025 05 13 Background: A noninvasive method of determining the severity of coronary artery disease (CAD) is the use of cardiac biomarkers. This study aimed to investigate the use of serum levels of high-sensitivity cardiac troponin I (hs-cTnI) and N-terminal pro–B-type natriuretic peptide (NT-proBNP) in determining CAD severity. Methods: This cross-sectional study included 125 participants categorized by coronary angiographic results into 3 groups: group I (no or < 50% stenosis), group II (1 or 2 vessels with ≥ 50% stenosis), and group III (left main stem or ≥ 3 vessels with ≥ 50% obstruction). Serum hs-cTnI and NT-proBNP levels were measured by enzyme-linked immunosorbent assay. Data were analyzed using SPSS version 25.0 and described as percentages, means, medians, and interquartile ranges (Q1–Q3). Receiver operating characteristic curves and relative quality were applied for both biomarkers. Results: Median hs-cTnI and NT-proBNP levels were higher in group III than in groups I and II (P = .001). Both were higher in group II than in group I (P = .001). Receiver operating characteristic analysis showed that hs-cTnI and NT-proBNP effectively discriminated vascular obstruction severity with high sensitivity and specificity. Relative quality testing results showed a slight increase in predictive ability when the 2 biomarkers were combined. Conclusions: Serum hs-cTnI and NT-proBNP levels, combined or separately, can be used to assess CAD severity concerning the number of diseased vessels, which may help improve risk stratification and management strategy selection. (Iranian Heart Journal 2026; 27(3): 20-26)

https://journal.iha.org.ir/article_246576_53acc240773dbfaffe4a0fbbfc73c0e0.pdf

Iranian Heart Association Iranian Heart Journal 27 3 2026 07 01 Impact of Vitamin E Supplementation on Inflammatory and Nutritional Markers in Patients Undergoing Hemodialysis With Chronic Kidney Disease: A Randomized Controlled Trial 27 36 246577 EN Farzaneh Banazadehtaheri Department of Pharmacology, Faculty of Pharmacy, Islamic Azad University, Tehran Medical Branch, Tehran, IR Iran. Hananeh Baradaran Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, IR Iran. Farahnaz Pasha Department of Nephrology, Faculty of Medicine, Islamic Azad University, Tehran Medical Branch, Tehran, IR Iran. Maryam Shiehmorteza Department of Clinical Pharmacy, Faculty of pharmacy, Islamic Azad University, Tehran Medical Branch, Tehran, IR Iran. Alireza Banazadehtaheri Department of Nursing and Midwifery, Islamic Azad University, Semnan, IR Iran. Sajjad Sadeqi Department of Nursing and Midwifery, Islamic Azad University, Semnan, IR Iran. Journal Article 2025 06 11 Background: Chronic kidney disease (CKD) is a worldwide concern, and individuals undergoing hemodialysis (HD) are at high risk for cardiovascular disease because of malnutrition and chronic inflammation. This study evaluated the efficacy of vitamin E (VitE) supplementation in modulating nutritional and inflammatory markers in participants undergoing HD. Methods: This double-blind, randomized, controlled trial lasted 12 weeks and included 40 participants undergoing HD who received 400 IU of VitE daily or placebo. Inflammatory markers (ferritin, C-reactive protein [CRP], and erythrocyte sedimentation rate [ESR]) and nutritional markers (body mass index [BMI] and serum albumin) were assessed at baseline and after the intervention. Lipid profile and HD adequacy were also evaluated. Results: Participants receiving VitE exhibited significant improvements in nutritional markers (serum albumin and BMI) and inflammatory markers (ferritin, CRP, and ESR) compared with the placebo group. Nonetheless, lipid profile and HD adequacy did not significantly improve in either group. Conclusions: VitE supplementation improved nutritional status and reduced inflammation in participants with CKD undergoing HD. Still, additional studies are required to determine long-term efficacy and generalizability. (Iranian Heart Journal 2026; 27(3): 27-36)

https://journal.iha.org.ir/article_246577_98855af825e5a3ef47136890d260525d.pdf

Iranian Heart Association Iranian Heart Journal 27 3 2026 07 01 Assessment of the EAS Index for Diagnosis of Coronary Artery Disease in Elective Coronary Angiography Candidates 37 48 246578 EN Fereshteh Ghaderi Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran. Sara Afshar Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran. Arash Gholoobi Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran. Vahid Reza Askari Patient Safety Research Center, Clinical Research Institute, Mashhad University of Medical Sciences, Mashhad, IR Iran. Hoorak Poorzand Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran. Navid Rabiee Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran. Vafa Baradaran Rahimi Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran. Journal Article 2025 01 26 Background: Coronary artery disease (CAD) is the leading cause of mortality, and its gold standard diagnostic method is invasive coronary angiography. Nonetheless, efforts are still in progress to find noninvasive methods for diagnosing CAD. The present study aimed to determine the EAS index as a novel diagnostic tool for CAD. Methods: This study was performed on elective coronary angiography candidates. Patients underwent transthoracic echocardiography, and the EAS index was calculated. Coronary angiography films were interpreted, and the SYNTAX score was calculated by an interventional cardiologist blinded to echocardiography results. Results: This study enrolled 60 patients: 32 were in the CAD group, and 28 were in the normal coronary group. The median age was 53 (IQR, 18) years, and 51.7% of participants were female. The SYNTAX score in patients with CAD was calculated as 16.7 (SD, 8.08). The median EAS in the CAD group (0.18 [IQR, 0.16]) was significantly greater than in the normal coronary group (0.15 [IQR, 0.12]; P = .045). A moderate negative correlation was observed between the SYNTAX score and left atrial (LA) volume (r = −.26; P = .041), LA volume index (r = −.265; P = .04), and left ventricular systolic tissue velocity (LV S') (r = −.254; P = .05) in the CAD group. Additionally, a positive association was found between the SYNTAX score and EAS (r = .35; P = .005) in patients with CAD. Conclusions: The EAS index was higher in patients with CAD than in those with normal coronaries, suggesting potential diagnostic utility. Its positive correlation with the SYNTAX score indicates a possible role in severity assessment. Further studies are warranted to confirm these findings. (Iranian Heart Journal 2026; 27(3): 37-48)

https://journal.iha.org.ir/article_246578_2cf76b22fa0c3e9ae4c5f798c63ca9e8.pdf

Iranian Heart Association Iranian Heart Journal 27 3 2026 07 01 Prognostic Implications of Subclinical Hypothyroidism in ST-Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention 49 59 246579 EN Osama Ahmed Amin Department of Cardiology, Beni-Suef University, Egypt. 0000-0001-5461-9720 Hazem Shalaby Department of Cardiology, Tanta University, Egypt. 0000-0001-7859-170X Haidy Khattab Department of Medical Physiology, Tanta University, Egypt. Ahmed Hamam Department of Endocrinology and Metabolism, Armed Forces College of Medicine, Egypt. 0000-0002-6190-0323 Ahmed Farouk Alaarag Department of Cardiology, Tanta University, Egypt. 0000-0002-6596-4834 Journal Article 2025 09 28 Background: Subclinical hypothyroidism (SCH), characterized by elevated thyroid-stimulating hormone with normal free thyroxine (FT4), is a potential cardiovascular risk factor. The effect of SCH on outcomes in patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) has received limited investigation. We aimed to evaluate the association between SCH and anti–thyroid peroxidase antibody (anti-TPO) positivity with no-reflow and acute heart failure (HF) in patients with STEMI after PCI. Methods: This prospective cohort study enrolled 303 patients with STEMI undergoing primary PCI at 2 tertiary centers. SCH was defined as thyroid-stimulating hormone levels greater than 4.5 mIU/L with normal FT4 (0.8–1.8 ng/dL). Outcomes included no-reflow (Thrombolysis in Myocardial Infarction [TIMI] flow ≤ 2 or corrected TIMI frame count > 27) and acute HF (Killip class > II). Multivariate logistic regression was used to assess SCH and anti-TPO positivity as predictors of no-reflow and acute HF, adjusting for age, sex, diabetes, hypertension, smoking, Gensini score, thrombus burden, preprocedural TIMI flow, ischemic time, and anti-TPO status. Results: Patients with SCH (n = 37, 12.2%) were more likely to be female (51.4% vs 32.0% in euthyroid patients; P = .02) and anti-TPO positive (83.8% vs 6.4%; P < .001). SCH was associated with higher Gensini scores (P = .02), increased no-reflow, and acute HF with Killip class greater than II. SCH and left ventricular ejection fraction could predict the occurrence of acute HF (P = .04 and P < .001, respectively). SCH and anti-TPO positivity (P = .03 and P = .01, respectively) could be associated with increased no-reflow. Conclusions: SCH and anti-TPO positivity could be associated with adverse outcomes in patients with STEMI post-PCI, suggesting a role for thyroid function screening in risk stratification. (Iranian Heart Journal 2026; 27(3): 49-59)

https://journal.iha.org.ir/article_246579_2674d653cf98c74fbd163baac13b13c6.pdf

Iranian Heart Association Iranian Heart Journal 27 3 2026 07 01 Concordance Between Exercise Stress Testing and Electrophysiologic Study for Supraventricular Tachyarrhythmia Induction 60 70 246580 EN Fatememasume Manuchehr Department of Cardiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, IR Iran. Sajjad Ghane Ezabadi School of Medicine, Tehran University of Medical Sciences, Tehran, IR Iran. 0000-0001-9665-6554 AmirHossein RahimBakhsh Department of Comparative Biosciences, Faculty of Veterinary Medicine, University of Tehran, Tehran, IR Iran. 0009-0003-8524-2518 Arash Zourouni Department of Cardiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, IR Iran. Soraya Shahrzad Department of Cardiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, IR Iran. Journal Article 2026 02 19 Background: Supraventricular tachyarrhythmias (SVTs) are common arrhythmias with paroxysmal presentations that often hinder electrocardiographic documentation during symptomatic episodes. Exercise stress testing may provoke SVT through sympathetic stimulation and increased myocardial demand. This study evaluated the concordance between exercise testing and electrophysiologic study (EPS) in patients with EPS-inducible SVT. Methods: This cross-sectional study included 71 patients with confirmed or suspected SVT referred to a tertiary center (April 2020–March 2021). Exclusion criteria were pregnancy, age below 15 years, inability to exercise, refusal, and absence of inducible arrhythmia during EPS. Participants underwent maximal Bruce protocol exercise testing with continuous monitoring, followed by EPS. Nonparametric tests were used for analysis. Results: Participants were 17 to 67 years of age, and exercise duration ranged from 2 to 16 minutes. Exercise stress testing induced SVT in 6 patients (8.5%) among patients with EPS‑inducible SVT. Exercise-induced SVT was not associated with demographic characteristics, medical history, symptom profile, or exercise capacity. Atrioventricular nodal reentrant tachycardia (AVNRT) was the most frequent SVT subtype overall and the most common subtype among exercise-induced cases. The distribution of SVT subtypes differed significantly according to exercise-induced SVT status. Metabolic equivalents were inversely correlated with age and body mass index. Conclusions: Concordance between exercise stress testing and EPS vis-à-vis SVT induction was low among patients with EPS-inducible SVT. Exercise-induced SVT was not associated with clinical or demographic parameters. Although AVNRT was the most common induced subtype, the limited concordance supports a restricted role for exercise testing in provoking SVT before EPS. (Iranian Heart Journal 2026; 27(3): 60-70)

https://journal.iha.org.ir/article_246580_d7622d7f8f5b88ca7cd9250189a4d925.pdf

Iranian Heart Association Iranian Heart Journal 27 3 2026 07 01 Transseptal Triumph: Overcoming the Challenges of Balloon Mitral Valvotomy in a Rigid Interatrial Septum: A Case Report 71 75 246581 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 13 Background: Balloon mitral valvotomy (BMV) is a well-established, commonly performed interventional procedure for the treatment of rheumatic mitral stenosis, offering symptomatic relief and improved hemodynamics. Despite its routine nature, certain anatomical variations and pathological changes can present significant procedural challenges, occasionally escalating to life-threatening complications if not managed appropriately. One such challenge is the presence of a thickened and fibrotic interatrial septum (IAS), which can complicate the critical step of transseptal puncture required to access the left atrium for balloon crossing. Case Presentation: We report the case of a 67-year-old man with severe rheumatic mitral stenosis who underwent BMV complicated by dense fibrotic thickening of the IAS. This abnormality posed considerable difficulty during the transseptal puncture and subsequent passage of the valvotomy balloon catheter. To overcome this obstacle, a novel approach utilizing a percutaneous transluminal angioplasty (PTA) balloon to dilate the fibrotic septum was employed, facilitating successful transseptal access and completion of the valvotomy. Conclusion: This case highlights the importance of assessing patient-specific anatomy when performing BMV. When the atrial septum is fibrotic, adjunctive techniques such as PTA balloon dilatation can facilitate transseptal access. Identifying these challenges early and adjusting the approach accordingly may improve procedural efficiency and clinical outcomes. (Iranian Heart Journal 2026; 27(3): 71-75)

https://journal.iha.org.ir/article_246581_8a1e8f3d213d701a867f52cb70fb69a2.pdf

Iranian Heart Association Iranian Heart Journal 27 3 2026 07 01 Wellens Syndrome in a Female Patient: When NSTEMI Is Actually a STEMI Equivalent 81 89 246583 EN Stevanus Chrisputra Pribadi Supit Department of Cardiology and Vascular Medicine, Dr Soetomo General Academic Hospital, Surabaya, East Java, Indonesia. Meity Ardiana Department of Cardiology and Vascular Medicine, Dr Soetomo General Academic Hospital, Surabaya, East Java, Indonesia. 0000-0002-1706-6247 Kevin Luke Department of Cardiology and Vascular Medicine, Dr Soetomo General Academic Hospital, Surabaya, East Java, Indonesia. 0000-0003-2160-2927 Wynne Widiarti Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia. 0000-0003-2045-5689 Journal Article 2026 01 30 Background: Specific patterns in the precordial leads of an ECG are hallmarks of Wellens syndrome. Despite its association with imminent anterior myocardial infarction, the syndrome often presents with transient ECG changes, leading to under-recognition and delayed treatment. Female patients are underrepresented in reported cases, reflecting persistent sex-based variations in acute coronary syndrome diagnosis and management. Case Presentation: A 52-year-old woman was admitted with escalating left-sided chest pain lasting over 20 minutes, following a week of intermittent exertional symptoms. Pretreatment ECG demonstrated biphasic T waves in leads V1–V4, consistent with Wellens Type A pattern. Five hours later, a repeat ECG revealed progression to deep, symmetric T-wave inversions in leads V1–V6, I, and aVL, consistent with Wellens Type B pattern and demonstrating dynamic ischemic evolution. Transthoracic echocardiography showed anterior wall hypokinesis with preserved left ventricular ejection fraction (51%). Coronary computed tomography angiography identified critical proximal left anterior descending artery (LAD) stenosis (99%), which was confirmed on invasive coronary angiography. Following the identification of Wellens syndrome, the patient received definitive treatment through successful percutaneous revascularization with overlapping drug-eluting stents, achieving TIMI grade III flow and complete revascularization. Conclusions: This case highlights Wellens syndrome as a dynamic and unstable manifestation of critical LAD disease that should be recognized as a true STEMI equivalent. Serial ECG monitoring is essential for detecting rapid pattern evolution, and early invasive management is crucial to prevent extensive anterior myocardial infarction. Heightened clinical vigilance is particularly warranted in female patients to mitigate persistent sex-based disparities and improve outcomes. (Iranian Heart Journal 2026; 27(3): 81-89)

https://journal.iha.org.ir/article_246583_7f11626daf946c844882e47d27e2a3ca.pdf