The Journal of Tehran University Heart Center

A New Chapter for Our Journal: Introducing Research in Heart Yield and Translational Medicine (RHYTHM)

Abbasali Karimi — 2025-07-26

The Article Abstract is not available

A Comprehensive Retrospective Cohort Study on Heart Transplantation: Exploring Complications, Mortality Causes, and Survival Rates

Salma Nozhat — 2025-07-26

Background: Heart transplantation (HTx) has become the preferred treatment for certain individuals with advanced heart failure. However, the outcomes and complications of this procedure have not been thoroughly evaluated in the Iranian population. In this study, we aimed to provide a comprehensive understanding of the epidemiological characteristics of patients who underwent HTx, focusing on the indications for HTx, early and late complications, causes of mortality, and survival rates.

Methods: In this retrospective cohort study, we included all patients aged 18 years and older who underwent HTx between July 2013 and June 2023 at Namazi Academic Hospital, affiliated with Shiraz University of Medical Sciences. We collected baseline and clinical characteristics and 10-year follow-up data from medical records. The 10-year survival data were presented using the Kaplan-Meier curve. Subgroup survival analyses based on Allograft rejection status, sex, and age were also performed.

Results: We identified 75 patients who underwent HTx during the study period, including 48 males and 27 females. The most prevalent underlying cause for HTx was dilated cardiomyopathy, accounting for 85.3% of the surgeries. After the procedure, 15 patients showed signs of allograft rejection. The survival analysis indicated a mean survival of 71.3 ± 6.5 months. The 1-, 5-, and 10-year survival rates were reported at 80%, 51%, and 42%, respectively.

Conclusions: Overall, this study’s findings offer valuable insights into the demographic and clinical characteristics of patients undergoing HTx and their outcomes. Additionally, our results enhance current knowledge regarding pre-HTx risk assessment and patient selection, early post-HTx diagnosis, and the management of significant complications.

Safety of Eptifibatide in Addition to Ticagrelor in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Fatemeh Baharvand — 2025-07-26

Background: Primary percutaneous coronary intervention (PCI) is the gold-standard treatment for patients with ST-segment elevation myocardial infarction (STEMI). In some cases, glycoprotein IIb/IIIa inhibitors, considered part of triple antiplatelet therapy (TAPT), are administered. Most trials investigating the role of glycoprotein IIb/IIIa inhibitors in STEMI were conducted before the era of potent P2Y12 receptor inhibitors. It is, thus, reasonable to reevaluate the safety of eptifibatide, a widely used glycoprotein IIb/IIIa inhibitor, in patients treated with the latest generation of P2Y12 receptor inhibitors such as ticagrelor.

Methods: This cross-sectional study involved STEMI patients who underwent primary PCI and required adjunctive eptifibatide therapy during the procedure at Dr. Heshmat Educational and Remedial Center in Rasht, Iran, between December 22, 2021, and June 22, 2022. Patients were stratified into two groups according to their administered P2Y12 receptor inhibitor. All patients received eptifibatide, and its safety when used concomitantly with ticagrelor was assessed.

Results: The study included 241 patients with a mean age of 57.72 (SD:11.55) years. Procedure-related bleeding showed no significant difference between the groups (P=0.641), and no major bleeding events occurred in either group. Gastrointestinal bleeding and epistaxis rates were significantly higher in the ticagrelor-based TAPT group than in the clopidogrel-based group (P=0.033 and P=0.013, respectively). Among male patients, genitourinary bleeding was significantly more frequent in the ticagrelor-based TAPT subgroup than in the clopidogrel-based subgroup (P=0.035).

Conclusions: In STEMI patients undergoing primary PCI, ticagrelor-based TAPT is associated with a higher risk of minor bleeding than clopidogrel. Nevertheless, given its established clinical advantages over clopidogrel, ticagrelor should not be withheld from eligible STEMI patients. The decision to prescribe ticagrelor should remain at the interventionist’s discretion, with careful consideration of individual benefit-risk profiles

Association Between Hypertension with and Without Left Ventricular Hypertrophy and the Expression of a Panel of microRNAs in an Iranian Population

Shokoufeh Hajsadeghi — 2025-07-26

Introduction: Given the established role of microRNAs (miRNAs) in hypertension (HTN), this study aimed to analyze the expression of a defined miRNA panel in hypertensive individuals, both with and without left ventricular hypertrophy (LVH), compared with normotensive controls within an Iranian population.

Methods: We conducted a cross-sectional study with case-control sampling, comprising three study groups: controls, HTN, and HTN+LVH. Through an extensive literature review, we selected a panel of eight miRNAs (miR-1, miR-21, miR-29a, miR-29b, miR-133, miR-155, miR-221, and miR-222) for analysis using real-time PCR. Gene expression data were analyzed through a general linear model implemented in R programming.

Results: The study analyzed 100 total samples. We used miR-29a and miR-133 as endogenous controls for calculations. Analysis revealed no significant association between miR-29b or miR-221 expression and the study groups (P>0.2 for both). Additionally, miR-1 demonstrated downregulation in both hypertensive groups (P<0.05), although this effect lost significance after adjusting for potential confounders (P=0.05–0.2). The HTN+LVH group showed significant downregulation of miR-21 (P<0.05). The duration of HTN diagnosis correlated with the upregulated expression of both miR-155 and miR-222. The strongest association emerged for miR-222, with the study groups explaining 25.7% of its variation (the highest R² value among all models).

Conclusions: HTN without LVH might be associated with the downregulation of miR-1 and miR-155 and the upregulation of miR-222. HTN, along with LVH, might be associated with the downregulation of miR-1 and miR-21 and the upregulation of miR-222. Increasing years of experiencing HTN were correlated with the upregulation of miR-155 and miR-222. The largest effect size was for miR-222.

Frontal T-P Angle: A Novel ECG Parameter for Predicting SYNTAX-1 and SYNTAX-2 Scores in Acute Non–ST-Segment Elevation Myocardial Infarction

Erdoğan Sökmen — 2025-07-26

Background: Few studies have investigated P-wave and T-wave axes, most of which focus on mortality. The frontal T-P angle (fT-Pa) is a novel ECG-derived parameter of ventricular repolarization. We aimed to evaluate the association between fT-Pa and SYNTAX-1 (SS-1) and SYNTAX-2 (SS-2) scores in patients with acute non-ST-segment elevation myocardial infarction (ANSTEMI).

Methods: This retrospective study included 158 ANSTEMI patients undergoing coronary angiography. The study population was stratified based on SS-1 (≤22 vs. >22) and SS-2 (≤26.2 vs. >26.2). The fT-Pa was calculated by subtracting the P-wave axis from the T-wave axis, both obtained from the ECG device's built-in software, and compared between groups.

Results: fT-Pa showed significant correlations with age (r=0.242, P=0.003), SS-2 (r=0.229, P=0.005), and T-wave axis (r=–0.626, P<0.001). Both age and fT-Pa were significantly correlated with and predictive of SS-2 (β=0.679; OR, 0.700 [95% CI, 0.584 to 0.816]; P<0.001 for age) and (β=0.147; OR, 0.048 [95% CI, 0.012 to 0.085; P=0.010 for fT-Pa). ROC curve analysis identified an fT-Pa cutoff of 36.5 (64% sensitivity, 68% specificity; AUC, 0.674; P<0.001) for predicting SS-2 > 26.2, and a cutoff of 39.5 (70% sensitivity, 62% specificity; AUC, 0.692; P=0.010) for predicting SS-1>22.

Conclusions: fT-Pa showed a stronger correlation and association with SS-2 than with SS-1. This parameter may serve as a simple, reproducible tool for predicting coronary artery disease complexity, even in patients with normal T-wave and P-wave axis ranges.

Evaluation of Heart Rate Variability by Smartphone App Using Pulse Photoplethysmography in Acute Myocardial Infarction

Tien Anh Hoang — 2025-07-26

Background: Heart rate variability (HRV) correlates with localized myocardial ischemia and predicts adverse cardiovascular outcomes after acute myocardial infarction (AMI), including sudden cardiac death, non-sudden cardiac death, and noncardiac death. Photoplethysmography (PPG) measurements demonstrate good agreement with ECG for time-domain HRV indices. In this study, HRV was measured via smartphone PPG, focusing on standard deviation of all normal RR (NN) intervals (SDNN) and root mean square of successive differences (rMSSD)—parameters recognized for their low error and recommended for clinical use.

Methods: This cross-sectional case-control study was conducted at a tertiary hospital in Vietnam. HRV indices (SDNN and rMSSD) were measured for 2 minutes using a camera-based PPG smartphone application. Clinical data were collected at admission. Linear and logistic regression analyses assessed associations between HRV, AMI status, and clinical severity. Receiver operating characteristic (ROC) curve analysis evaluated diagnostic performance.

Results: A total of 101 patients with AMI and 121 age- and sex-matched healthy controls were included. The AMI group exhibited significantly lower HRV indices, with a mean SDNN of 20.63 ±10.16 ms and rMSSD of 23.67±12.38 ms, compared with 33.99±11.72 ms (SDNN) and 35.9 ±16.21 ms (rMSSD) in the control group (P <0.001 for both). An SDNN cutoff of ≤21.35 ms yielded an area under the curve of 0.832, with a sensitivity of 87.6% and specificity of 62.4% for identifying AMI. Lower HRV was also significantly associated with higher clinical severity indicators, including reduced left ventricular ejection fraction, Killip class II-IV, regional wall motion abnormalities, and multivessel coronary artery disease.

Conclusions: The use of camera-based HRV smartphone applications to measure short-term SDNN and rMSSD may serve as a novel digital health tool to improve the detection of coronary artery disease, particularly AMI, given its simplicity and noninvasive nature.

Effects of Familial Hypercholesterolemia on Major Adverse Cardiac and Cerebrovascular Events in Patients with Premature Coronary Artery Disease: A Retrospective Cohort Study

Shayan Shahi — 2025-07-26

Background: Evaluating the impact of familial hypercholesterolemia (FH) on the occurrence of major adverse cardiac and cerebrovascular events (MACCE) in patients with premature coronary artery disease.

Methods: This retrospective cohort study was conducted at Tehran Heart Center, between 2004 and 2011. 3907 patients with acute coronary syndrome (ACS) who underwent coronary angiography were collected from registry systems. The patients were divided into "Unlikely FH" and "Probable FH" using a modified and simplified version of the Dutch Lipid Clinic Network (DLCN) criteria. After a 10-year follow-up, different components of MACCE between the two groups were evaluated.

Results: Data from 3206 premature coronary artery disease patients with baseline LDL values were extracted. 2558 (79.8%) patients were categorized into the Unlikely FH group, and 648 (20.2%) patients were in the probable FH group. In the unlikely FH group, 745 (29.1%) patients experienced at least one of the MACCE events. In the probable FH group, 193 (29.7%) experienced at least one MACCE event. The difference between groups did not reach the level of significance (p>0.05). The mortality rate in the unlikely FH group was 6.9% (n=179), while in the probable FH group, the mortality rate was 7.8% (n=51) (p<0.05).

Conclusions: In the present study, patients with probable FH pose a higher risk regarding mortality than unlikely FH patients.

Coronary Slow-Flow Syndrome: A Review on Natural History of Disease and Best Practices

Muhammad Iqhrammullah — 2025-07-26

Coronary slow flow (CSF) poses significant clinical challenges, marked by delayed coronary blood flow despite angiographically normal epicardial arteries. With a prevalence of 1% to 7%, the underlying pathogenesis and clinical manifestations of this condition remain incompletely understood. This review examines the natural history of CSF, including its pathophysiological mechanisms, ranging from inflammatory cascades to microvascular dysfunction. Diagnostic approaches, such as corrected TIMI frame count, scintigraphy, and ECG analysis, provide valuable insights into its complex presentation. Further, the review outlines management strategies, focusing on pharmacological interventions like calcium channel blockers and anti-inflammatory agents. Understanding CSF’s natural history is crucial for implementing effective preventive measures, spanning primary to tertiary prevention. Still, further research is essential to fully elucidate its pathophysiology and optimize therapeutic strategies for improving patient outcomes in this complex disorder.

Echocardiographic Diagnosis and Treatment of ALCAPA Syndrome in a Pregnant Woman: A Case Report

Seyed Mohammad Hashem Montazeri — 2025-07-26

In this report, we present the case of a 21-year-old woman diagnosed with ALCAPA syndrome during pregnancy, based on echocardiographic findings. We also review the diagnostic process, pregnancy management, and treatment of the patient.

The Mystery of Situational Syncope: A Case Series of Three Patients with Uncommon Histories

Amir Hossein Behnoush — 2025-07-26

Syncope, characterized by a transient loss of consciousness, is among the most common reasons for emergency department visits worldwide and can be categorized into reflex syncope, orthostatic hypotension, and cardiac syncope. Situational syncope, a subtype of reflex syncope, is less frequently investigated than other forms. Herein, we describe three patients who presented to the Syncope Unit of Tehran Heart Center with unusual situational syncope triggers, along with the diagnostic methods and treatments used.

The first case was a 62-year-old woman who experienced five syncopal episodes over the past 2 years, all of which occurred at an airport during airplane takeoff. Following a prescription for midodrine to be taken before flights, no further syncopal episodes occurred. The second patient was an 18-year-old man with two syncopal episodes, both occurring after smoking marijuana. He was advised to discontinue marijuana use, and no further episodes were reported during a 1-year follow-up period. The final case was a 42-year-old man who was a heavy smoker, presenting with several syncopal episodes following bouts of violent coughing. After cough suppressant medications proved ineffective, he was successfully treated with gabapentin.

In conclusion, given the complex nature of diagnosing syncope in some cases, physicians should consider rare triggers when taking the medical history of patients with unexplained syncope.